Vijaya Chevendra

DISTRIBUTION OF SPLENIC, MESENTERIC AND RENAL NEURONS IN SYMPATHETIC GANGLIA IN RATS

The distribution of postganglionic neurons innervating the spleen, intestine and kidney in paravertebral and prevertebral sympathetic ganglia was studied in rats using retrograde transport of fluorescent dyes. Labelled cells were counted in the thoracolumbar chain ganglia T6-L4, splanchnic ganglia and the solar plexus (fusion of left and right coeliac ganglia and superior mesenteric ganglion). Most splenic neurons were located in the splanchnic ganglion (64%), mesenteric neurons in the solar plexus (96%) and renal neurons in the sympathetic chain ganglia (80%). These three groups of neurons were distributed in overlapping ganglia within the paravertebral chain. Innervation of the spleen and intestine from the chain ganglia was bilateral, whereas innervation of the kidney was almost entirely ipsilateral. In conclusion, the sympathetic postganglionic neurons controlling the spleen, intestine and kidney have their cell bodies in different ganglia. These three groups of neurons are candidates for innervation by different subgroups of preganglionic neurons.

Investigating concordance in diabetes diagnosis between primary care charts (electronic medical records) and health administrative data: a retrospective cohort study

BackgroundElectronic medical records contain valuable clinical information not readily available elsewhere. Accordingly, they hold important potential for contributing to and enhancing chronic disease registries with the goal of improving chronic disease management; however a standard for diagnoses of conditions such as diabetes remains to be developed. The purpose of this study was to establish a validated electronic medical record definition for diabetes.MethodsWe constructed a retrospective cohort using health administrative data from the Institute for Clinical Evaluative Sciences Ontario Diabetes Database linked with electronic medical records from the Deliver Primary Healthcare Information Project using data from 1 April 2006 - 31 March 2008 (N = 19,443). We systematically examined eight definitions for diabetes diagnosis, both established and proposed.ResultsThe definition that identified the highest number of patients with diabetes (N = 2,180) while limiting to those with the highest probability of having diabetes was: individuals with ≥2 abnormal plasma glucose tests, or diabetes on the problem list, or insulin prescription, or ≥2 oral anti-diabetic agents, or HbA1c ≥6.5%. Compared to the Ontario Diabetes Database, this definition identified 13% more patients while maintaining good sensitivity (75%) and specificity (98%).ConclusionsThis study establishes the feasibility of developing an electronic medical record standard definition of diabetes and validates an algorithm for use in this context. While the algorithm may need to be tailored to fit available data in different electronic medical records, it contributes to the establishment of validated disease registries with the goal of enhancing research, and enabling quality improvement in clinical care and patient self-management.

Number of HbA1c tests unrelated to quality of diabetes control: An electronic medical record data linkage study

Process measures are heavily relied on to assess physician performance/quality of diabetes control. A unique primary care electronic medical record-health administrative database linkage found no clinically meaningful relationship between control (HbA1c value) and number of tests performed, casting doubt on the usefulness in diabetes performance and quality of care assessment.

Pre- and postganglionic sympathetic activity in white rami of rats

Multifiber sympathetic activity was recorded from the central end of severed 13th thoracic communicating rami in urethane-anesthetized rats before and after ganglionic blockade by chlorisondamine. Ganglionic blockade decreased nerve discharge by 49 +/- 10% (n = 7) indicating that these rami are composed of postganglionic axons (other than gray rami fibers) as well as preganglionic axons. Histological examination of excised T13 rami showed that postganglionic cell bodies are located along the course of these nerves.