Browsing by Subject "Skin"
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Item Assessing Disease Severity in Cutaneous Lupus Patients Using Natural Language Processing(2024-01-30) Wang, Laura; Nezafati, Kuroush; Rong, Ruichen; Park, Andrew; Zhu, Jane; Xiao, Guanghua; Xie, Yang; Yang, Donghan M.; Chong, Benjamin F.BACKGROUND: Cutaneous lupus erythematous (CLE) is an autoimmune skin disorder that manifests as inflammatory cutaneous lesions commonly in photosensitive areas. It is often chronic in nature, with exacerbations that can lead to hyperpigmentation and scarring. One tool used to measure disease activity and damage in CLE patients is the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) score. There has been little work done previously using natural language processing (NLP) in dermatology to assess disease severity, though there is promising potential for its use given the role of narrative data in dermatology. OBJECTIVE: We aim to develop a NLP model that interprets physical examination (PE) documentation in CLE patients and computes disease severity scores in the form of CLASI activity and damage scores. METHODS: Dataset was derived from 50 patients enrolled in the UTSW CLE registry. 89 clinical exams of 24 patients were used in a training set, used to train the NLP model. 35 clinical exams of 26 patients were selected for a validation set, used to test the model's accuracy in prediction. An entity dictionary was defined that provided rules for labeling vocabulary pertinent to CLASI scores within the PE note. This was used to label the relationships between entities in the training and validation sets. The BERT (Bidirectional Encoder Representations from Transformers) model was trained to predict all entities and relationships in the notes, based on which the CLASI scores were calculated. After training, the model was applied to the validation set. In evaluation, scores generated from the model were compared to the ground-truth CLASI scores based on human annotation. RESULTS: The model-predicted scores had a correlation of 0.79 and 0.86 with the ground truth on the activity and damage scores, respectively, in the training set, and a 0.61 and 0.79 correlation in the validation set. The model had 0.84 and above for accuracy, recall, precision and F1 within the sub-goal of determining the category of score severity (high or low), for both training and validation sets. CONCLUSIONS: Using PE notes as the input, a BERT-based NLP model can be trained to predict CLASI scores in CLE patients. If successfully implemented, this algorithm can significantly increase the volume of real-world data available for CLE research by efficiently processing PE notes in the EHR. Future steps are to increase the size and representation of the training set to improve accuracy and external validity of BERT's predictions.Item Characterizing Morphea Subsets Using a Multi-Center, Prospective, Cross-Sectional Analysis of Morphea in Adults and Children(2020-05-01T05:00:00.000Z) Prasad, Smriti; Jacobe, Heidi; Haley, Robert; Chong, Benjamin F.BACKGROUND: There are few prospective studies in morphea. Most that exist focus exclusively on adults or children, or are insufficiently powered. Others are retrospective, which have limitations in understanding subsets. As a result, there is limited understanding of the demographic and clinical features of morphea, particularly of the less frequent subtypes. There is also little known about the differences between adults and children. OBJECTIVE: To determine the clinical and demographic features of the inception cohort of two prospectively-collected datasets and to determine novel latent disease phenotypes among this cohort. METHODS: This is a cross sectional analysis of initial visits of the Morphea in Adults and Children (MAC) and the National Registry of Childhood-Onset Scleroderma (NRCOS) cohorts, two prospectively collected databases that collect demographic, physical exam and clinical data. We performed traditional univariate analyses as well as multivariate analyses, include a principal component analysis (PCA) of certain variables. RESULTS: Of the total 944 participants, 500 (53%) had pediatric onset morphea, and 444 (47%) had adult onset morphea. Whites (76%) and females (78%) comprised the majority of participants. The median age at onset was 16 years overall. Five factors were extracted from the PCA based on the inflection point in the scree plot (CF1-5). CF2 described a clustering of patients with depression and high comorbidities of headaches, joint pain, muscle pain, and fatigue. Based on this, we did a post-hoc analysis on the quality of life measures collected in adults, which was derived from the SKINDEX 29+3. CONCLUSION: We've described the clinical and demographic features in the largest cohort of morphea patients to date. Here we describe subsets of patients that have been previously described, such as a group of patients with depression and somatic symptoms.Item Disorders of the stratum corneum(1978-02-02) Bergstresser, Paul R.Item Evaluation of the Sterility of a Vapocoolant Spray for Use in Minor Surgery(2015-01-26) Hwang, Lyahn; Mlynek, Karolina; Kreft, Michael; Zins, JamesVapocoolant sprays (skin refrigerants) are topical agents frequently utilized in a clinical office setting to reduce pain caused by needle injections or minor surgical procedures by rapid cooling of the skin. However, possible flammability and bacterial contamination have limited their use in clinics. The recent introduction of a non-flammable vapocoolant spray, "Pain Ease®" (Gebauer Co., Cleveland, OH), composed of 1,1,1,3.3-Pentafluoropropane and 1,1,1,2-Tetrafluoroethane, has been suggested as a possible alternative product. The purpose of this study is to evaluate the sterility of Pain Ease® and to determine whether this product is suitable for use prior to small skin incisions or injections such as botulinum toxin. A prospective, blinded, and controlled study was performed on 50 healthy adult volunteers. From each subject, three swab cultures were obtained from the same cheek area: (1) at time 0 prior to any skin preparation (control), (2) after antiseptic preparation with 70% isopropyl alcohol swabs, and (3) after spraying with Pain Ease®. All microbiology specimens were quantitatively and qualitatively analyzed for five days in a blinded fashion regarding the nature and sequence of the culture swabs, and gram stains were obtained when cultures were positive. Three samples of Pain Ease® alone were also cultured to further investigate the microbiologic activity of the product. No injections or surgical procedures were carried out in this study. Bacterial growth was found in 98% of cultures taken before antiseptic was applied (group I), in 54% of cultures after alcohol was applied, and in 46% of cultures after spraying with vapocoolant. There was statistically significant difference found between group I (no antiseptic) and both group II (after antiseptic but before vapocoolant) and group III (after vapocoolant) (p < 0.001), but not between groups 2 and 3 (p = 0.74). The pathogens most commonly cultured were gram positive cocci and gram positive bacilli. No positive cultures were observed in samples containing only Pain Ease®. The widely used and cost-effective topical antiseptic 70% isopropyl alcohol significantly reduces skin colonization when compared to unprepared skin (p < 0.001). When Pain Ease® is sprayed on skin prepared with alcohol, there is no statistically significant increase in bacterial colonization than when alcohol is used alone. We present prospective, blinded data using a mock injection clinical model suggesting the use of Pain Ease® as an inexpensive and safe product in clinics from a microbiologic standpoint.Item The Impact of Morphea on Quality of Life Over Time(2014-02-04) Grewal, Simer; Grabell, Daniel; Jacobe, HeidiBACKGROUND: Morphea is an inflammatory disorder that has subsequent clinical manifestations of sclerosis and atrophy of the dermis and underlying tissue. Resulting cosmetic disfigurement or functional impairments are likely to persist even after the transition to inactive disease. The impact of Morphea on a patient's self-reported health-related quality of life (HRQOL) is not well described in medical literature. OBJECTIVE: To determine the impact of specific clinical, treatment, and demographic variables on self-reported QoL over time of the Morphea in adults and children (MAC) cohort. As a secondary objective, to correlate physician measures to patient reported QoL measures in order to determine which aspects of morphea are important to patients that might not be addressed in physician based outcomes. METHODS: Adult patients of the MAC cohort with ≥ 2 visits with a recorded HRQOL measure were studied. Self-reported HRQOL was examined via three previously validated questionnaires. Each included patient had at least 2 Dermatology Life Quality Indexes (DLQI). In addition, the Skindex-29+3 with an added morphea specific subscale and the Short Form 36 were included when available. In order to capture physician assessment of disease, Physician Global Assessment of disease (PGA), Modified Rodnan Skin Score (MRSS) and Localized Scleroderma Skin Severity Index (LOSSI) with its damage correlate LOSDI were employed. RESULTS: A total of 110 adult patients with 307 visits were included in these analyses. The QoL for patients with morphea is shown to be worse than the general population, with mean scores below 50 for SF-36 PCS and MCS scores. Though there was a marked decrease in activity, as measured by a 68 percent change in both PGA-A and LOSSI, QoL measures only had slight improvement with an 11.34 percent change over the same course of time. The damage measures (PGA-D, LOSDI) had an average 6.66 percent improvement. Limitations: All patients were seen at one referral center, which resulted in a skew towards more severe forms of morphea. The sample size, though larger than anything to date, limits complexity of statistical analysis. CONCLUSION: A decrease in disease severity does not mean an improvement in QoL. Lesions often don't disappear even as they transition to inactivity but rather leave frequent permanent sequalae. This indicates a need for further studies examining treatment of residual cosmetic and functional sequalae.Item Melanoma: what a difference a decade makes(2019-07-19) Homsi, JadeItem [News](1982-10-22) Rutherford, SusanItem Scar wars: a new hope for scars(2021-09-17) Levi, Benjamin; Culver, AbbyItem The silk road: Behcet's disease and its fellow travelers(2022-09-23) Kazi, SalahuddinItem [Southwestern News](2003-04-16) Shields, AmyItem [Southwestern News](2001-12-28) Echeverria, Ione