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Exam Code: AHIMA-CCS Practice exam 2022 by Killexams.com team
AHIMA-CCS Certified Coding Specialist (ICD-10-CM)

Number of Questions on exam:
 97 multiple-choice questions (79 scored/18 pretest)
 8 medical scenarios (6 scored/2 pretest)
Exam Time: 4 hours – no breaks
Domain 1 – Health Information Documentation (8-10%)
Tasks:
1. Interpret health record documentation using knowledge of anatomy, physiology, clinical indicators and disease processes, pharmacology and medical terminology to identify codeable diagnoses and/or procedures
2. Determine when additional clinical documentation is needed to assign the diagnosis and/or procedure code(s)
3. Consult with physicians and other healthcare providersto obtain further clinical documentation to assist with code assignment
4. Compose a compliant physician query
5. Consult reference materialsto facilitate code assignment
6. Identify patient encounter type
7. Identify and post chargesfor healthcare services based on documentation

Domain 2 – Diagnosis & Procedure Coding (64-68%)
Tasks:
Diagnosis:
1. Select the diagnosesthat require coding according to current coding and reporting requirementsfor acute care (inpatient) services
2. Select the diagnosesthat require coding according to current coding and reporting requirementsfor outpatient services
3. Interpret conventions, formats, instructional notations, tables, and definitions of the classification system to select diagnoses, conditions, problems, or other reasonsfor the encounter that require coding
4. Sequence diagnoses and other reasons for encounter according to notations and conventions of the classification system and standard data set definitions(such as Uniform Hospital Discharge Data Set [UHDDS])
5. Apply the official ICD-10-CM coding guidelines
Procedure:
1. Select the proceduresthat require coding according to current coding and reporting requirementsfor acute care (inpatient) services
2. Select the proceduresthat require coding according to current coding and reporting requirementsfor outpatient services
3. Interpret conventions, formats, instructional notations, and definitions of the classification system and/ornomenclature to select procedures/servicesthat require coding
4. Sequence procedures according to notations and conventions of the classification system/nomenclature and standard data set definitions(such as UHDDS)
5. Apply the official ICD-10-PCS procedure coding guidelines
6. Apply the official CPT/HCPCS Level II coding guidelines

Domain 3 – Regulatory Guidelines and Reporting Requirements for Acute Care (Inpatient) Service (6-8%)
Tasks:
1. Select the principal diagnosis, principal procedure, complications, comorbid conditions, other diagnoses and proceduresthat require coding according to UHDDS definitions and Coding Clinic
2. Assign the present on admission (POA) indicators
3. Evaluate the impact of code selection on Diagnosis Related Group (DRG) assignment
4. Verify DRG assignment based on Inpatient Prospective Payment System (IPPS) definitions
5. Assign and/or validate the discharge disposition

DOMAIN 4. Regulatory Guidelines and Reporting Requirements for Outpatient Services (6-8%)
Tasks:
1. Select the reason for encounter, pertinentsecondary conditions, primary procedure, and other proceduresthat require coding according to UHDDS definitions, CPT Assistant, Coding Clinic, and HCPCS
2. Apply Outpatient Prospective Payment System (OPPS) reporting requirements:
a. Modifiers
b. CPT/ HCPCS Level II
c. Medical necessity
d. Evaluation and Management code assignment (facility reporting)
3. Apply clinical laboratory service requirements

DOMAIN 5. Data Quality and Management (2-4%)
Tasks:
1. Assess the quality of coded data
2. Communicate with healthcare providersregarding reimbursementmethodologies, documentation rules, and regulationsrelated to coding
3. Analyze health record documentation for quality and completeness of coding
4. Review the accuracy of abstracted data elementsfor database integrity and claims processing
5. Review and resolve coding edits such as Correct Coding Initiative (CCI), Medicare Code
Editor (MCE) and Outpatient Code Editor (OCE)

DOMAIN 6. Information and Communication Technologies (1-3%)
Tasks:
1. Use computer to ensure data collection,storage, analysis, and reporting of information.
2. Use common software applications(for example, word processing,spreadsheets, and email) in the execution of work processes
3. Use specialized software in the completion of HIM processes

DOMAIN 7. Privacy, Confidentiality, Legal, and Ethical Issues (2-4%)
Tasks:
1. Apply policies and proceduresfor access and disclosure of personal health information
2. Apply AHIMA Code of Ethics/Standards of Ethical Coding
3. Recognize and report privacy and/or security concerns
4. Protect data integrity and validity using software or hardware technology

DOMAIN 8. Compliance (2-4%)
Tasks:
1. Evaluate the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards
2. Monitor compliance with organization-wide health record documentation and coding guidelines
3. Recognize and report compliance concerns

Certified Coding Specialist (ICD-10-CM)
Medical (ICD-10-CM) test
Killexams : Medical (ICD-10-CM) test - BingNews https://killexams.com/pass4sure/exam-detail/AHIMA-CCS Search results Killexams : Medical (ICD-10-CM) test - BingNews https://killexams.com/pass4sure/exam-detail/AHIMA-CCS https://killexams.com/exam_list/Medical Killexams : Pharming Announces New ICD-10-CM Code for APDS, a Rare Primary Immunodeficiency

Implemented by the Centers for Disease Control and Prevention, the diagnosis code will accurately identify US patients with APDS, supporting care and research efforts

LEIDEN, Netherlands, Aug. 2, 2022 /CNW/ -- Pharming Group N.V. ("Pharming" or "the Company") (EURONEXT Amsterdam: PHARM/Nasdaq: PHAR) announces that a new diagnosis code for reporting cases of activated phosphoinositide 3-kinase delta syndrome (APDS), a rare primary immunodeficiency, will be added to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) by the US Centers for Disease Control and Prevention (CDC). The diagnosis code, D81.82 ‒ Activated Phosphoinositide 3-kinase Delta Syndrome (APDS), will be effective starting October 1, 2022.

Pharming Group N.V. logo (PRNewsfoto/Pharming Group N.V.)

Anurag Relan, Chief Medical Officer of Pharming, commented:

"By assigning this ICD-10-CM code, the CDC is formally recognizing APDS as a discrete immunological disease, and that will make a life-altering difference for people affected by the condition. By using the unique diagnostic code to identify both established and new patients with APDS, physicians will increase care options for affected individuals while helping to boost the world's understanding of the prevalence, mechanisms, and outcomes of this progressively debilitating disease. For healthcare practitioners, this milestone marks an opportunity to make a big difference by taking a simple action."

The assignment of the ICD-10-CM code will, for the first time, enable physicians and payors in the US to add a diagnosis of APDS to patients' health records, which will help connect these individuals with researchers studying the prevalence and course of the disease. In addition, by allocating a specific diagnosis, the new ICD-10-CM code may help confirm medical necessity in individual patients, thus improving their access to relevant care options through US health insurance plans.

Caused by genetic variants affecting approximately one to two people per million, APDS causes significant lymphoproliferation and immune dysfunction, as well as an increased risk of lymphoma. There is no approved therapy for the disease and treatment is generally limited to supportive care, such as antibiotics and immunoglobulin replacement therapy. Physician and patient advocacy groups specializing in immunodeficiency disorders, along with Pharming, expect the decision to raise awareness about this rare disease.

Vicki and Fred Modell, co-founders of the Jeffrey Modell Foundation, commented:

"We are excited that US regulatory authorities have assigned APDS an ICD-10-CM code. As a foundation dedicated to early diagnosis, meaningful treatments, and cures for primary immunodeficiency, we are aware of the physical and emotional challenges people with APDS face due to misdiagnosis of their disease. By increasing recognition of the condition, we expect the new diagnostic code to help ensure that every patient is included when it comes to the delivery of appropriate and meaningful treatments for APDS."

About Activated Phosphoinositide 3-Kinase δ Syndrome (APDS)

APDS is a rare primary immunodeficiency that affects approximately one to two people per million. Also known as PASLI, it is caused by variants in either of two genes, PIK3CD or PIK3R1, that regulate maturation of white blood cells. Variants of these genes lead to hyperactivity of the PI3Kδ (phosphoinositide 3-kinase delta) pathway.1,2 Balanced signaling in the PI3Kδ pathway is essential for physiological immune function. When this pathway is hyperactive, immune cells fail to mature and function properly, leading to immunodeficiency and dysregulation.1,3 APDS is characterized by severe, recurrent sinopulmonary infections, lymphoproliferation, autoimmunity, and enteropathy.4,5 Because these symptoms can be associated with a variety of conditions, including other primary immunodeficiencies, people with APDS are frequently misdiagnosed and suffer a median 7-year diagnostic delay.6 As APDS is a progressive disease, this delay may lead to an accumulation of damage over time, including permanent lung damage and lymphoma.4-7 The only way to definitively diagnose this condition is through genetic testing.

About Pharming Group N.V.

Pharming Group N.V. (EURONEXT Amsterdam: PHARM/Nasdaq: PHAR) is a global biopharmaceutical company dedicated to transforming the lives of patients with rare, debilitating, and life-threatening diseases. Pharming is commercializing and developing an innovative portfolio of protein replacement therapies and precision medicines, including small molecules, biologics, and gene therapies that are in early to late-stage development. Pharming is headquartered in Leiden, Netherlands, and has employees around the globe who serve patients in over 30 markets in North America, Europe, the Middle East, Africa, and Asia-Pacific.

For more information, visit www.pharming.com.

About the Jeffrey Modell Foundation

Vicki and Fred Modell established the Jeffrey Modell Foundation (JMF) in 1987, in memory of their son Jeffrey, who died at the age of 15, from complications of Primary Immunodeficiency (PI) — a genetic condition that is chronic, serious, and often fatal. JMF is a global nonprofit organization dedicated to early diagnosis, meaningful treatments and, ultimately, cures through research, physician education, public awareness, advocacy, patient support, newborn screening, and genetic sequencing. For more information, visit https://www.info4pi.org/.

Forward-Looking Statements

This press release contains forward-looking statements, including with respect to timing and progress of Pharming's preclinical studies and clinical trials of its product candidates, Pharming's clinical and commercial prospects, Pharming's ability to overcome the challenges posed by the COVID-19 pandemic to the conduct of its business, and Pharming's expectations regarding its projected working capital requirements and cash resources, which statements are subject to a number of risks, uncertainties and assumptions, including, but not limited to the scope, progress and expansion of Pharming's clinical trials and ramifications for the cost thereof; and clinical, scientific, regulatory and technical developments. In light of these risks and uncertainties, and other risks and uncertainties that are described in Pharming's 2021 Annual Report and the Annual Report on Form 20-F for the year ended December 31, 2021 filed with the US Securities and Exchange Commission, the events and circumstances discussed in such forward-looking statements may not occur, and Pharming's actual results could differ materially and adversely from those anticipated or implied thereby. Any forward-looking statements speak only as of the date of this press release and are based on information available to Pharming as of the date of this release.

Inside Information

This press release relates to the disclosure of information that qualifies, or may have qualified, as inside information within the meaning of Article 7(1) of the EU Market Abuse Regulation.

References

1. Lucas CL, et al. Nat Immunol. 2014;15:88-97.
2. Elkaim E, et al. J Allergy Clin Immunol. 2016;138(1):210-218.
3. Nunes-Santos C, Uzel G, Rosenzweig SD. J Allergy Clin Immunol. 2019;143(5):1676-1687.
4. Coulter TI, et al. J Allergy Clin Immunol. 2017;139(2):597-606.
5. Maccari ME, et al. Front Immunol. 2018;9:543.
6. Jamee M, et al. Clin Rev Allergy Immunol. 2019;May 21.
7. Condliffe AM, Chandra A. Front Immunol. 2018;9:338.

Logo - https://mma.prnewswire.com/media/1454235/Pharming_Group_NV_Logo.jpg

Cision

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SOURCE Pharming Group N.V.

Cision

View original content to get multimedia: http://www.newswire.ca/en/releases/archive/August2022/02/c2721.html

Mon, 01 Aug 2022 17:03:00 -0500 en-US text/html https://finance.yahoo.com/news/pharming-announces-icd-10-cm-050000217.html
Killexams : What to know about chronic hepatitis C without hepatic coma

Hepatitis C is a bloodborne virus that affects the liver. Following infection, a small number of people can spontaneously clear the virus. However, others develop chronic hepatitis C. Without treatment, the infection might lead to advanced liver disease and even hepatic coma.

Many people with chronic hepatitis C do not know that they have an infection until it shows on a routine blood test. It may not cause any symptoms, and people may live with an infection for decades before they receive a diagnosis.

Although chronic hepatitis C can cause serious liver complications, doctors can successfully treat it with antiviral medication. This prevents further damage to the liver, cures the infection, and prevents its spread.

However, if people do not seek treatment, they may develop complications that lead to a disorder called hepatic encephalopathy. They may even fall into a hepatic coma.

Keep practicing to learn more about chronic hepatitis C, including the complications that might lead to hepatic coma and how doctors treat hepatitis C when hepatic coma is not present.

Hepatitis C is a virus that damages the liver. Doctors classify it as acute or chronic according to how long it inflames and damages the liver.

Acute hepatitis C lasts for less than 6 months and goes away on its own. About 10–15% of people with an HCV infection experience this type.

Conversely, chronic hepatitis C is a long-term infection that can last for years and cause serious liver damage. Approximately 20% of people with chronic hepatitis C infections develop cirrhosis within 20 years, and 1–5% develop liver cancer within 30 years.

People with hepatitis C may have no symptoms initially. However, they may develop chronic liver disease after years of infection. If symptoms do occur, they may include the following:

  • abdominal and joint pain
  • dark urine
  • decreased appetite
  • fever
  • nausea and vomiting
  • yellowing of the skin and the whites of the eyes

Diagnosis

People may not know that they have hepatitis C until they have a routine blood test or develop liver problems. When diagnosing hepatitis C, doctors use a blood test that looks for antibodies to the hepatitis C virus. However, following infection, it can take some time for the immune system to make antibodies. This means that a person might not have a positive reaction initially.

A positive test shows that a person has had a hepatitis C infection at some point, but it does not necessarily mean that they have an infection currently. Therefore, doctors may also use a PCR blood test to see whether the virus is still present in the body.

Learn more about antibody tests and other diagnostic tests for hepatitis C.

Hepatic encephalopathy is a brain and nervous system disorder that can develop in some individuals with hepatitis C. It happens because the liver is not functioning properly, so toxins build up in the blood and affect brain function.

About 70% of individuals with liver cirrhosis may develop symptoms of hepatic encephalopathy.

A person with hepatic encephalopathy may appear confused and have difficulty thinking. The symptoms can vary a lot from person to person, and they can even be life threatening.

Learn more about the symptoms of hepatic encephalopathy.

There are five stages of hepatic encephalopathy, and each stage is more progressive than the one preceding it.

Some people with advanced hepatic encephalopathy may lose consciousness and fall into a hepatic coma. This is characteristic of the last stage of hepatic encephalopathy.

However, hepatic encephalopathy may not always lead to hepatic coma, especially if doctors treat the condition and the underlying cause of it early enough.

Learn more about the stages of hepatic encephalopathy.

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) system is a classification system that healthcare professionals use for medical diagnoses. It assigns alphanumeric codes to health conditions.

The assigned code can help track public health conditions, billing, and processing claims. Some codes for chronic viral hepatitis and hepatic coma are as follows:

  • B18.2 — chronic viral hepatitis C
  • B19.21 — unspecified viral hepatitis C without hepatic coma
  • K72.10 — chronic hepatic failure without coma
  • K72.11 — chronic hepatic failure with coma

Healthcare professionals may use multiple codes in certain instances. For example, they may provide someone with chronic hepatitis C and hepatic encephalopathy the following codes: B18.2 and K72.10. Hepatitis C can lead to liver failure and hepatic encephalopathy, a condition that can occur with or without coma. As coma does not occur in all cases of hepatic encephalopathy, other codes may not be appropriate.

Doctors may prescribe a single drug or a combination of antiviral medicines to treat the chronic hepatitis C infection:

  • daclatasvir (Daklinza)
  • elbasvir/grazoprevir (Zepatier)
  • ledipasvir/sofosbuvir (Harvoni)
  • ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekira Pak, Viekira XR)
  • ribavirin (Virazole)
  • peginterferon alfa-2a or alfa-2b

The course of treatment may last 2–6 months, although this depends on the extent of a person’s liver damage and the specific genetics of the hepatitis C virus.

Throughout treatment, doctors monitor the individual by using blood tests to ensure that the treatment is working. These antiviral medications usually cure the hepatitis C infection, as long as the individual completes the treatment.

Without treatment, chronic hepatitis C infection can cause liver complications, such as hepatic encephalopathy and even hepatic coma. People should note that the treatment course for people with chronic hepatitis C with hepatic coma may be different.

Besides hepatic coma, the possible complications of chronic hepatitis C infection include:

  • Cirrhosis of the liver: Scarring of the liver is the most common complication of hepatitis C. After many years of hepatitis C infection, the liver breaks down and does not function as it should. Scar tissue replaces healthy tissue and blocks normal blood flow through the liver. As cirrhosis worsens, the liver begins to fail.
  • Liver failure: As cirrhosis advances, the liver may be unable to replace damaged cells, and it can fail entirely. Doctors may also refer to liver failure as end stage liver disease.
  • Liver cancer: Living with hepatitis C increases the risk of liver cancer. If an individual has severe liver damage before receiving treatment, the increased risk of liver cancer remains.

Additionally, some individuals with chronic HCV infection develop complications unrelated to the liver, including:

Receiving a diagnosis of hepatitis C may feel overwhelming, but with proper treatment, most people fully recover.

In the meantime, people should take steps to prevent the spread of the infection. These include:

  • avoiding sharing needles, medical equipment, toothbrushes, razors, or anything else that might have contacted infected blood
  • covering wounds with bandages
  • cleaning up blood spills with a bleach solution
  • washing the hands after touching wounds or blood
  • informing doctors, dentists, and other healthcare professionals of their hepatitis C status
  • avoiding sexual activities where blood is present

Chronic hepatitis C is a serious infection that can lead to cirrhosis, liver damage, and liver cancer. In some cases, it can also cause other complications, including hepatic coma, diabetes, and non-Hodgkin lymphoma.

Typically, treatment with antiviral medication for 2–6 months successfully cures the infection and prevents further liver damage. While they are receiving treatment, people with chronic hepatitis C should take measures to prevent the spread of the virus.

Wed, 27 Jul 2022 12:00:00 -0500 en text/html https://www.medicalnewstoday.com/articles/chronic-hepatitis-c-symptoms-disease-progression-and-more
Killexams : with Medical Billing and Coding

Obtaining a CPC, CCA, or CBCS certification implies that an individual has met competencies in the field of medical billing and coding. Certification is invaluable to the student's career goals. Students have an opportunity to make confident, informed decisions about the national certification they prefer.

The Certified Professional Coder (CPC) exam is offered by the American Academy of Professional Coders (AAPC). It is the gold standard entry-level coding certification for physician, or professional fee, coders.

The Certified Coding Associate (CCA) is offered by the American Health Information Management Association (AHIMA). It is an entry-level medical coding certification across all settings--physician practices and inpatient hospital.

The Certified Billing and Coding Specialist (CBCS) is offered by the National Healthcareer Association (NHA) and is currently an entry-level medical billing certification for physician practices. In the summer of 2021, the exam will transition to an entry-level billing and coding certification, with the inclusion of ICD-10-CM, CPT, and HCPCS Level II testing.

Mon, 31 Jan 2022 02:17:00 -0600 en text/html https://www.utsa.edu/pace/online/certified-medical-administrative-assistant-medical-billing-coding.html
Killexams : Value of Peripheral Blood Eosinophil Markers to Predict Severity of Asthma

Julian Casciano1, Jerry A. Krishnan2, Mary Buatti Small3, Philip O. Buck3, Gokul Gopalan3, Chenghui Li4, Robert Kemp1 and Zenobia Dotiwala1*

1eMAX Health Systems, LLC, 445 Hamilton Avenue, 11th floor, White Plains, NY, USA. 2Medicine and Public Health, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA. 3Teva, Frazer, PA, USA. 4University of Arkansas for Medical Sciences, Little Rock, AR, USA.

*Correspondence
zenobiadotiwala@emaxhealth.net

JC and ZD received consulting fees from Teva. JK and CL received consulting fees from eMAX Health. Mary Small (MS), Phil Buck (PB), Gokul Gopal (GG) were employees at Teva at the time of drafting this manuscript. Julian Casciano (JC), Zenobia Dotiwala (ZD), Robert Kemp (RK) were hired by Teva to conduct the study. Jerry Krishnan (JK), Chenghui Li (CL) received fees as consultants to eMAX Health.

Authors' contributions
All authors were involved in conceptualization, development and finalization of study design. JK and JC contributed significantly to core study design. ZD and CL were involved in conducting the analysis and interpreting results. MS, RK, PB, GG contributed to manuscript text, content, and flow development. All authors were involved in developing the results into manuscript. All authors were involved in reviewing interim drafts to prepare a final version. All authors read and approved the final manuscript.

Competing interests
This study was funded by Teva Pharmaceuticals.

Tue, 26 Jul 2022 12:00:00 -0500 en text/html https://www.medscape.com/viewarticle/866967_3
Killexams : Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy

The following investigators and centers participated in the study: F. Abi-Samra, E. Faranceware, Alton Ochsner Medical Foundation, New Orleans; C. Albert, B. Kelly, Massachusetts General Hospital, Boston; A. Bhandari, B. Firth, Heart Institute, Good Samaritan Hospital, Los Angeles; B. Belhassen, Ichilov Hospital, Tel Aviv, Israel; H. Calkins, J. Bolt, Johns Hopkins Hospital, Baltimore; T. Chow, J. Everett, Linder Clinical Trial Center, Cincinnati; J. Conti, D. Leach, University of Florida, Gainesville; J. Cook, J. Provencher, Baystate Medical Center, Springfield, Mass.; S. Cossu, K. Mullinax, Charlotte Heart Group, Port Charlotte, Fla.; R. Damle, L. Stoune, South Denver Cardiology, Littleton, Colo.; J.P. Daubert, G. Head, University of Rochester Medical Center, Rochester, N.Y.; M. Eldar, Sheba Medical Center, Tel Hashomer, Israel; N.A.M. Estes III, S. Galvin, New England Medical Center, Boston; N. Freedberg, Haemek Medical Center, Afula, Israel; J. Goldberger, K. Acker, Northwestern University, Chicago; C. Gottlieb, F. Hoffman, Abington Medical Specialists, Abington, Pa.; M. Hazday, L. Jopperi, Orlando Regional Medical Center, Orlando, Fla.; B. Hook, L. Pimenta, New England Heart Institute, Manchester, N.H.; G. Horvath, E. Healy, Berkeley Cardiovascular Medical Group, Berkeley, Calif.; L.L. Horvitz, M. Cole-Ferry, Cardiovascular Associates of the Delaware Valley, Cherry Hill, N.J.; L. Kanter, P. Farrar, Virginia Beach General Hospital, Virginia Beach; A. Katz, Soroka Medical Center, Beer Sheva, Israel; S. Klein, D. Ricks, LeBauer Cardiovascular Research Foundation, Greensboro, N.C.; H.A. Kopelman, C. Griffith, American Cardiovascular Research Institute, Atlanta; C.S. Kuo, L. Withrow, University of Kentucky Divison of Cardiovascular Medicine, Lexington; J.H. Levine, M. Ferrara, Cardiac Arrhythmia and Pacemaker Center of St. Francis Hospital, Roslyn, N.Y.; D. Man, B. Gardner, S. Gable, Associated Cardiologists/Pinnacle Health Hospitals, Harrisburg, Pa.; F. Marchlinski, G. Schott, Hospital of the University of Pennsylvania, Philadelphia; D. Martin, N. Todd, Lahey Hitchcock Medical Center, Burlington, Mass.; T. Mattioni, S. Welch, Arizona Arrhythmia Consultants, Phoenix; R. McCowan, C. Tignor, Charleston Cardiology Group, Charleston, W.V.; J.P. McKenzie, III, N. Magno, California Cardiac Institute, Glendale; J. Merrill, T. Dicken, The Heart Center, Cardiovascular Associates, Kingsport, Tenn.; W. Miles, M. Barr, Southwest Florida Heart Group, Fort Myers; A. Natale, D. Holmes, Cleveland Clinic Foundation, Cleveland; B. Pavri, K. Henry, Thomas Jefferson University Hospital, Philadelphia; J. Pennington III, L. Bittner, Christiana Health Care Systems, Newark, Del.; E. Rashba, M. Mclane, University of Maryland School of Medicine, Baltimore; S. Rothbart, J. McCarthy, Newark Beth Israel Medical Center, Newark, N.J.; D. Rubenstein, C. Bell, Arrhythmia Consultants, Greenville, S.C.; S. Saba, D. Parkinson, University of Pittsburgh Medical Center, Pittsburgh; W.E. Sanders, C.A. Sueta, M.C. Herbst, University of North Carolina at Chapel Hill, Chapel Hill; A. Shalaby, K. Hickey, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh; J. Szwed, J. Jackson, The Care Group, Indianapolis; T. Talbert, L. Wright, Diagnostic Center, Chattanooga, Tenn.; R.K. Thakur, L. Blaske, Thoracic and Cardiovascular Healthcare Foundation, Lansing, Mich.; S.L. Winters, K. Wain, Morristown Memorial Hospital, Morristown, N.J.; J. Zebede, S. Tong, Mt. Sinai Hospital, Miami Beach, Fla.; Events Committee — J.P. Daubert, University of Rochester Medical Center, Rochester, N.Y.; S. Murali, University of Pittsburgh Medical Center, Pittsburgh; B. Pavri, Hospital of the University of Pennsylvania, Philadelphia; S.L. Winters, Morristown Memorial Hospital, Morristown, N.J.

Thu, 13 Aug 2020 21:39:00 -0500 en text/html https://www.nejm.org/doi/full/10.1056/NEJMoa033088
Killexams : Using Antidepressants and the Risk of Stroke Recurrence: Report From a National Representative Cohort Study

Methods

Data Source and Study Subjects

This cohort study used the Longitudinal Health Insurance Database (LHID), a sub-dataset of National Health Insurance (NHI) Research Database containing healthcare claims between 1996 and 2010 for a cohort of one million people randomly sampled from beneficiaries of NHI. The NHI provides coverage to 99 % or more of Taiwanese population. LHID consists of many data files, including inpatient records, ambulatory care records, contracted pharmacies records, and registries for beneficiaries and contracted medical facilities.

Included in this study were patients had a first hospitalization with diagnosis of stroke during 2000 and 2009. The date of the first hospitalization for stroke was identified as the index date. Stroke was identified by principal diagnosis with ICD-9-CM code (International Classification of Diseases, 9th revision, Clinical Modification codes) 430 to 432 for hemorrhagic stroke and 433 to 437 for ischemic stroke. Those who had any diagnosis of stroke from 1996 to 1999 were excluded to reduce the possibility of including prevalent stroke cases. We further excluded patients who were aged <20 years (N = 91), who had inappropriate data with index date after the date of withdrawing from insurance (N = 293), and patients with recurrent stroke or died within 30 days after index date (N = 2232). Patients who had use of combinations of antidepressants and psycholeptics (amitriptyline-psycholeptics or melitracen-psycholeptics) (N = 1553) or too high dose (>3 DDDs, defined daily doses) (N = 69) during the follow-up period were also excluded. Therefore, the study included 16770 patients with stroke (Fig. 1). This study was approved by the institutional ethics review board at the National Taiwan University Hospital.

Figure 1.

Patients Inclusion Chart

Exposure to Antidepressants and Covariates

For each patient, the records (detail information of drug code by Bureau of National Health Insurance, total dosage and days of use for each prescription) of prescriptions of antidepressants were obtained during the follow-up. The types of antidepressants were categorized by Anatomical Therapeutic Chemical (ATC) classification system:[15] non-selective monoamine reuptake inhibitors (tricyclic antidepressants, TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and other antidepressants. The average dosage for the each prescription of antidepressants per day was calculated. We classified average dose by defined daily doses (DDDs),[15] as defined by the World Health Organization, into <0.5, 0.5–1, and > =1 DDDs.

Other covariates included sex, age, related-disease and prescriptions of other drugs within one year before the index date such as antipsychotics (ATC code: N05A), antithrombotic agents included anticoagulant (ATC code: B01AA03) and antiplatelet (ATC code: B01AC06, B01AC04, B01AC05, B01AC23, B01AC07), anti-inflammatory (ATC code: M01A), antidepressants use before stroke (ATC code: N06A), depression (ICD-9-CM code: 296.2, 296.3, 300.4, 311), other mood disorders or (ICD-9-CM code: 296.0, 296.1, 296.4–296.9) anxiety (ICD-9-CM code: 300.0), atrial fibrillation (ICD-9-CM code: 427.3), coronary heart disease (ICD-9-CM code: 410–414), congestive heart failure (ICD-9-CM code: 428), chronic obstructive pulmonary disease (ICD-9-CM code: 490,491,492,493,494,495,496), cancer (ICD-9-CM code: 140–208), diabetes mellitus or medicine treatment (ICD-9-CM code: 250; ATC code: A10), hypertension or medicine treatment (ICD-9-CM code: 401–405; ATC code: C02, C03, C07, C08, C09), and hyperlipidemia or medicine treatment (ICD-9-CM code: 272; ATC code: C10). These variables were all possible confounders between antidepressants and stroke recurrence. The presence of depression during the follow-up was also obtained.

Main Outcome

The main outcome was a re-hospitalization with hemorrhagic stroke or ischemic stroke during the follow-up period. The follow-up started from the index date, which was between 2000 and 2009, and ended on the date of stroke recurrence, the date of withdrawing from insurance, or date of termination of this study, December 31, 2010; whichever came first.

Statistical Analyses

Demographic and clinical characteristics between use of antidepressants group (at least one prescription of antidepressants during follow-up) and non-use were compared by the chi-square test. We also divided the type of antidepressants into TCAs, SSRIs, MAOIs, others, or multiple types, as well as dose groups into >0.5, 0.5–1, and > =1 DDDs to perform the descriptive analyses. Because of the time-varying nature of drug use, we defined the duration of antidepressants exposure as days of use for each prescription from database at ambulatory care, and contracted pharmacies, but not at inpatient records because data on days supplied for each prescription were not obtained. We classified the exposure status into "use" during the duration of antidepressants and "non-use" during the days of no prescriptions. We computed their incidence rate (per 1000 person-year) by dividing number of events of recurrent stroke with person-years of exposure to each antidepressant. We used the Simon and Makuchmethod[16] to graphically represent survival curves for time to use of antidepressants by Stata to compute 'Kaplan-Meier' estimates for time-dependent covariates.[17]

We used univariable and multivariable models to estimate the hazard ratios (HR) and 95 % confidence interval (C.I.) by the Cox proportional hazards model with time-varying antidepressants use to assess the association between each antidepressants use category and recurrent stroke with "non-use" as the reference group and adjusted the models for demographic and clinical characteristics. Moreover, subgroup analyses were performed including antidepressants use before stroke or not (prevalent users, or new users), depression status (no-diagnosed depression, prevalent depression, or post-stroke depression with newly-diagnosed depression), other drugs use, and other disease. Finally, we performed two sensitivity analyses. First, the duration of antidepressants exposure was redefined by adding seven days to the end of days supply for each prescription in order to take into account for the potential carry over effect and gaps in therapies.[10] Second, we added the prescriptions of antidepressants in the inpatient settings. Because the inpatients claims do not contain information on the days supply for medications, we defined the duration of antidepressants exposure using the length of hospital stay. All analyses were carried out with SAS 9.2 and Stata 10. A two-sided p value < 0.05 was considered statistically significant.

Fri, 22 Jul 2022 12:00:00 -0500 en text/html https://www.medscape.com/viewarticle/847739_3
Killexams : Pharming Announces New ICD-10-CM Code for APDS, a Rare Primary Immunodeficiency

Implemented by the Centers for Disease Control and Prevention, the diagnosis code will accurately identify US patients with APDS, supporting care and research efforts

LEIDEN, Netherlands, Aug. 2, 2022 /PRNewswire/ -- Pharming Group N.V. (“Pharming” or “the Company”) (EURONEXT Amsterdam: PHARM/Nasdaq: PHAR) announces that a new diagnosis code for reporting cases of activated phosphoinositide 3-kinase delta syndrome (APDS), a rare primary immunodeficiency, will be added to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) by the US Centers for Disease Control and Prevention (CDC). The diagnosis code, D81.82 ‒ Activated Phosphoinositide 3-kinase Delta Syndrome (APDS), will be effective starting October 1, 2022.

Anurag Relan, Chief Medical Officer of Pharming, commented:

“By assigning this ICD-10-CM code, the CDC is formally recognizing APDS as a discrete immunological disease, and that will make a life-altering difference for people affected by the condition. By using the unique diagnostic code to identify both established and new patients with APDS, physicians will increase care options for affected individuals while helping to boost the world’s understanding of the prevalence, mechanisms, and outcomes of this progressively debilitating disease. For healthcare practitioners, this milestone marks an opportunity to make a big difference by taking a simple action.”

The assignment of the ICD-10-CM code will, for the first time, enable physicians and payors in the US to add a diagnosis of APDS to patients’ health records, which will help connect these individuals with researchers studying the prevalence and course of the disease. In addition, by allocating a specific diagnosis, the new ICD-10-CM code may help confirm medical necessity in individual patients, thus improving their access to relevant care options through US health insurance plans.

Caused by genetic variants affecting approximately one to two people per million, APDS causes significant lymphoproliferation and immune dysfunction, as well as an increased risk of lymphoma. There is no approved therapy for the disease and treatment is generally limited to supportive care, such as antibiotics and immunoglobulin replacement therapy. Physician and patient advocacy groups specializing in immunodeficiency disorders, along with Pharming, expect the decision to raise awareness about this rare disease.

Vicki and Fred Modell, co-founders of the Jeffrey Modell Foundation, commented:

“We are excited that US regulatory authorities have assigned APDS an ICD-10-CM code. As a foundation dedicated to early diagnosis, meaningful treatments, and cures for primary immunodeficiency, we are aware of the physical and emotional challenges people with APDS face due to misdiagnosis of their disease. By increasing recognition of the condition, we expect the new diagnostic code to help ensure that every patient is included when it comes to the delivery of appropriate and meaningful treatments for APDS.”

About Activated Phosphoinositide 3-Kinase δ Syndrome (APDS)

APDS is a rare primary immunodeficiency that affects approximately one to two people per million. Also known as PASLI, it is caused by variants in either of two genes, PIK3CD or PIK3R1, that regulate maturation of white blood cells. Variants of these genes lead to hyperactivity of the PI3Kδ (phosphoinositide 3-kinase delta) pathway.1,2 Balanced signaling in the PI3Kδ pathway is essential for physiological immune function. When this pathway is hyperactive, immune cells fail to mature and function properly, leading to immunodeficiency and dysregulation.1,3 APDS is characterized by severe, recurrent sinopulmonary infections, lymphoproliferation, autoimmunity, and enteropathy.4,5 Because these symptoms can be associated with a variety of conditions, including other primary immunodeficiencies, people with APDS are frequently misdiagnosed and suffer a median 7-year diagnostic delay.6 As APDS is a progressive disease, this delay may lead to an accumulation of damage over time, including permanent lung damage and lymphoma.4-7 The only way to definitively diagnose this condition is through genetic testing.

About Pharming Group N.V.

Pharming Group N.V. (EURONEXT Amsterdam: PHARM/Nasdaq: PHAR) is a global biopharmaceutical company dedicated to transforming the lives of patients with rare, debilitating, and life-threatening diseases. Pharming is commercializing and developing an innovative portfolio of protein replacement therapies and precision medicines, including small molecules, biologics, and gene therapies that are in early to late-stage development. Pharming is headquartered in Leiden, Netherlands, and has employees around the globe who serve patients in over 30 markets in North America, Europe, the Middle East, Africa, and Asia-Pacific.

For more information, visit www.pharming.com.

About the Jeffrey Modell Foundation

Vicki and Fred Modell established the Jeffrey Modell Foundation (JMF) in 1987, in memory of their son Jeffrey, who died at the age of 15, from complications of Primary Immunodeficiency (PI) — a genetic condition that is chronic, serious, and often fatal. JMF is a global nonprofit organization dedicated to early diagnosis, meaningful treatments and, ultimately, cures through research, physician education, public awareness, advocacy, patient support, newborn screening, and genetic sequencing. For more information, visit https://www.info4pi.org/.

Forward-Looking Statements

This press release contains forward-looking statements, including with respect to timing and progress of Pharming’s preclinical studies and clinical trials of its product candidates, Pharming’s clinical and commercial prospects, Pharming’s ability to overcome the challenges posed by the COVID-19 pandemic to the conduct of its business, and Pharming’s expectations regarding its projected working capital requirements and cash resources, which statements are subject to a number of risks, uncertainties and assumptions, including, but not limited to the scope, progress and expansion of Pharming’s clinical trials and ramifications for the cost thereof; and clinical, scientific, regulatory and technical developments. In light of these risks and uncertainties, and other risks and uncertainties that are described in Pharming’s 2021 Annual Report and the Annual Report on Form 20-F for the year ended December 31, 2021 filed with the US Securities and Exchange Commission, the events and circumstances discussed in such forward-looking statements may not occur, and Pharming’s actual results could differ materially and adversely from those anticipated or implied thereby. Any forward-looking statements speak only as of the date of this press release and are based on information available to Pharming as of the date of this release.

Inside Information

This press release relates to the disclosure of information that qualifies, or may have qualified, as inside information within the meaning of Article 7(1) of the EU Market Abuse Regulation.

References

1. Lucas CL, et al. Nat Immunol. 2014;15:88-97.
2. Elkaim E, et al. J Allergy Clin Immunol. 2016;138(1):210-218.
3. Nunes-Santos C, Uzel G, Rosenzweig SD. J Allergy Clin Immunol. 2019;143(5):1676-1687.
4. Coulter TI, et al. J Allergy Clin Immunol. 2017;139(2):597-606.
5. Maccari ME, et al. Front Immunol. 2018;9:543.
6. Jamee M, et al. Clin Rev Allergy Immunol. 2019;May 21.
7. Condliffe AM, Chandra A. Front Immunol. 2018;9:338.

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SOURCE Pharming Group N.V.

Mon, 01 Aug 2022 17:00:00 -0500 en text/html https://apnews.com/press-release/pr-newswire/covid-health-netherlands-9ccaf5ecf121c1e3aa5b9a25fe142267
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