Reactivation of herpes zoster (shingles) infection associated with an increased risk of death in immunocompetent older persons.

OBJECTIVES: To determine whether cutaneous herpes zoster infection in immunocompetent older people is correlated with an increased risk for death. SETTING: Primary care clinics associated with West Virginia University, Morgantown West Virginia. DESIGN: Case-control study PARTICIPANTS: Immunocompetent outpatients born from 1903 through 1931, seen from 1994 through 2001; 102 patients diagnosed with herpes zoster (HZV) infection and 201 controls. The median age of both groups was 75 and the sample size was approximately 5,000. MEASUREMENTS: Three-year mortality, risk, and age of death after first clinic visit for herpes zoster. RESULTS: Fourteen deaths occurred in the control group with a mean age of death of 83.4 and 26 deaths among the subjects with HZV with a mean age of death of 79.6. This age difference was not statistically significant, however the age adjusted risk of dying in three years after reactivation of HZV was 4.9 times the adjusted odds of dying without HZV, controlling for age. (95% confidence intervals for the ratio of adjusted odds: 2.4-10.44) CONCLUSION: In this study reactivation of herpes zoster infection was associated with an increased risk for death in the three years following an infection; deaths were not directly correlated with such an infection, but occurred for various other reasons. This suggests that herpes zoster infections may be a marker for early mortality.

Assessment of commercial NLP engines for medication information extraction from dictated clinical notes.

PURPOSE: We assessed the current state of commercial natural language processing (NLP) engines for their ability to extract medication information from textual clinical documents. METHODS: Two thousand de-identified discharge summaries and family practice notes were submitted to four commercial NLP engines with the request to extract all medication information. The four sets of returned results were combined to create a comparison standard which was validated against a manual, physician-derived gold standard created from a subset of 100 reports. Once validated, the individual vendor results for medication names, strengths, route, and frequency were compared against this automated standard with precision, recall, and F measures calculated. RESULTS: Compared with the manual, physician-derived gold standard, the automated standard was successful at accurately capturing medication names (F measure=93.2%), but performed less well with strength (85.3%) and route (80.3%), and relatively poorly with dosing frequency (48.3%). Moderate variability was seen in the strengths of the four vendors. The vendors performed better with the structured discharge summaries than with the clinic notes in an analysis comparing the two document types. CONCLUSION: Although automated extraction may serve as the foundation for a manual review process, it is not ready to automate medication lists without human intervention.