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PubMed2017

Route of infection alters virulence of neonatal septicemia Escherichia coli clinical isolates.

Escherichia coli is the leading cause of Gram-negative neonatal septicemia in the United States. Invasion and passage across the neonatal gut after ingestion of maternal E. coli strains produce bacteremia. In this study, we compared the virulence properties of the neonatal E. coli bacteremia clinical isolate SCB34 with the archetypal neonatal E. coli meningitis strain RS218. Whole-genome sequencing data was used to compare the protein coding sequences among these clinical isolates and 33 other representative E. coli strains. Oral inoculation of newborn animals with either strain produced septicemia, whereas intraperitoneal injection caused septicemia only in pups infected with RS218 but not in those injected with SCB34. In addition to being virulent only through the oral route, SCB34 demonstrated significantly greater invasion and transcytosis of polarized intestinal epithelial cells in vitro as compared to RS218. Protein coding sequences comparisons highlighted the presence of known virulence factors that are shared among several of these isolates, and revealed the existence of proteins exclusively encoded in SCB34, many of which remain uncharacterized. Our study demonstrates that oral acquisition is crucial for the virulence properties of the neonatal bacteremia clinical isolate SCB34. This characteristic, along with its enhanced ability to invade and transcytose intestinal epithelium are likely determined by the specific virulence factors that predominate in this strain.

Bacteremia↗

PubMed2005

The therapy process observational coding system-alliance scale: measure characteristics and prediction of outcome in usual clinical practice.

The authors describe psychometric characteristics of the new Therapy Process Observational Coding System-Alliance scale (TPOCS-A; B. D. McLeod, 2001) and illustrate its use in the study of treatment as usual. The TPOCS-A uses session observation to assess child-therapist and parent-therapist alliance. Both child and parent forms showed acceptable interrater reliability and internal consistency; when applied to cases treated for internalizing disorders, both forms were associated with youth outcomes. Child-therapist alliance during treatment predicted reduced anxiety symptoms at the end of treatment. Parent-therapist alliance during treatment predicted reduced internalizing, anxiety, and depression symptoms at the end of treatment. The findings held up well after confounding variables were controlled, which suggests that both child-therapist and parent-therapist alliance play key (and potentially different) roles in the outcome of treatment as usual.

Adolescent↗

PubMed2003

Accuracy and reliability of the clinical indicators related to hip fractures.

In order to assess the accuracy of the clinical indicators for hip fracture outcomes, we compared the hip fracture outcomes of in-hospital mortality and length of hospital stay as determined by the hospital coded records with that of a prospectively recorded separate hip fracture database over a 5-year period. There was excellent correlation between the two databases with in-hospital mortality figures of 78/1264 versus 79/1299 patients, a difference of 0.1%. For discharge within 28 days the figures for the two databases were 930/1264 versus 987/1299, a difference of 2.4%. The main reason for differences between the databases was caused by ambiguous clinical codes in 66 cases and errors in coding for 57 cases. The next step is to find ways of using these indicators to promote real improvement in the care of these patients.

Aged↗

PubMed2003

Automated coded ambulatory problem lists: evaluation of a vocabulary and a data entry tool.

BACKGROUND: Problem lists are fundamental to electronic medical records (EMRs). However, obtaining an appropriate problem list dictionary is difficult, and getting users to code their problems at the time of data entry can be challenging. OBJECTIVE: To develop a problem list dictionary and search algorithm for an EMR system and evaluate its use. METHODS: We developed a problem list dictionary and lookup tool and implemented it in several EMR systems. A sample of 10,000 problem entries was reviewed from each system to assess overall coding rates. We also performed a manual review of a subset of entries to determine the appropriateness of coded entries, and to assess the reasons other entries were left uncoded. RESULTS: The overall coding rate varied significantly between different EMR implementations (63-79%). Coded entries were virtually always appropriate (99%). The most frequent reasons for uncoded entries were due to user interface failures (44-45%), insufficient dictionary coverage (20-32%), and non-problem entries (10-12%). CONCLUSION: The problem list dictionary and search algorithm has achieved a good coding rate, but the rate is dependent on the specific user interface implementation. Problem coding is essential for providing clinical decision support, and improving usability should result in better coding rates.

Algorithms↗

PubMed2005

Detecting possible vaccination reactions in clinical notes.

The Vaccine Safety Datalink is a collaboration between the CDC and eight large HMO's to investigate adverse events following immunization through analysis of medical care databases and patients' medical charts. We modified an existing system called MediClass that uses natural language processing (NLP) and knowledge-based methods to classify clinical encounters recorded in electronic medical records (EMRs). We developed the knowledge necessary for MediClass to detect possible vaccine reactions in the outpatient, ED, and telephone encounters recorded in the EMR of a large HMO. We first trained the system using a manually coded gold standard training set, and achieved high sensitivity and specificity. We then ran a large set of post-immunization encounter records through MediClass to see if our method would generalize. Compared to methods that use administrative and clinical codes assigned to the EMR by clinicians, the system significantly improves the positive predictive value for detecting possible vaccine reactions.

Adverse Drug Reaction Reporting Systems↗

PubMed1998

Limits of ICD-9-CM code usefulness in epidemiological studies of contact and other types of dermatitis.

BACKGROUND: International Classification of Diseases, Version 9, Clinical Modification (ICD-9-CM) coding information used for billing is readily available in computerized form. OBJECTIVES: The purpose of this article is to determine the usefulness of ICD-9-CM codes in a descriptive dermatoepidemiological study of contact and other dermatitis. METHODS: Prospective recording of specific dermatologic diagnoses and the ICD-9-CM code assigned for each diagnosis was performed for all patient visits to the author's dermatology clinics for 6 months. RESULTS: There were 2,524 patient visits with 4,451 diagnoses, of which 789 diagnoses were dermatitis. The 10 different diagnostic categories of dermatitis had eight associated ICD-9-CM codes. Allergic contact dermatitis with 247 visits, irritant contact dermatitis with 30 visits, and nummular dermatitis with 61 visits shared one diagnostic code. Thus, 43% of visits for dermatitis were intermixed by having the same ICD-9-CM code. CONCLUSION: Lack of one-to-one correspondence of ICD-9-CM codes with dermatitis diagnostic categories creates a situation in which ICD-9-CM codes are not useful for dermatoepidemiological studies of contact and other types of dermatitis. This could be corrected by assigning additional five-digit ICD-9-CM codes to cover each type of dermatitis. Coding for specific allergens or irritants is not feasible with the current five-digit ICD-9-CM codes.

Adult↗

PubMed2006

Matching waveform audio files with toxicall data: Record linkage in a poison control center.

Analysis of coded communications and electronic patient record data present a unique opportunity for nursing knowledge discovery, the integration of communication content with clinical data. However, joint analysis of coded communications and clinical data depends on the ability to link waveform audio files with patient records. A procedure has been developed to link waveform audio files with Toxicall patient records, using date/time stamps and station identification numbers.

Communication↗

PubMed2005

[Take-over of the risk-benefit by the clinical study subject and its regulation].

There should be two levels of the risk-benefit consideration related to all the clinical trials. At the individual trial subject's level, whose rights should be protected against the interest of the society. At the level of the community, the main interest is to improve the therapeutical procedures, to provide more efficacious health care for the present and future patients. The summary intends to shed light, whether the guidelines has been shifted from the absolute defend of the individual subject's interest towards the considerations of the interest of the society since the Nürnberg-Code or not.

Clinical Trials as Topic↗

PubMed2026

Respiratory syncytial virus (RSV) in older adults: from infection to outcomes - who gets sick, who gets hospitalized, who survives?

Respiratory syncytial virus (RSV) is a virus responsible for acute respiratory infections and is widely recognized as a major pathogen in the paediatric population. Thus, the burden of RSV in the adult population remains poorly understood, as epidemiological studies mainly rely on PMSI (Medicalization of Information Systems Program) data, which are coded for economic purposes, and because many adults RSV infections remain underdiagnosed. The aim of this study was to describe epidemiological and clinical characteristics of RSV infections in elderly population across four university hospitals in north-western France during the 2022-2023 epidemic season. This retrospective cohort included all patients aged 60 years and older who tested positive for RSV between September 1st, 2022, and January 31st, 2023, in four university hospitals. Viral detection was performed using molecular assays on respiratory samples. Clinical, demographic, biological, and coding data were collected from medical records and hospital information systems. Outcomes included need for oxygen therapy, intensive care admission, in-hospital mortality, length of stay, readmission within 90 days for a respiratory or cardiac reason, and changes in living arrangements. Statistical analyses used descriptive methods and standard tests for comparisons. A total of 647 patients were included. The mean age was 77.8 years, and most patients had at least one chronic medical condition, primarily respiratory or cardiac. 508 (78.5%) patients were hospitalized. The mean hospital stay was 16.2 days, and oxygen therapy was required in 68.3% of cases. In-hospital mortality reached 11.0%. Among survivors, 38.0% were readmitted within 90 days for a respiratory or cardiac reason. A notable proportion of patients experienced a loss of autonomy leading to institutional placement at discharge. RSV was coded in the PMSI database as a diagnosis in approximately two-thirds of hospitalizations, with substantial variations between centers. RSV infection in older adults was associated with significant morbidity, prolonged hospitalization, and a frequent decline in functional status. The study also identified heterogeneity in coding practices and emphasized limitations of PMSI data for capturing respiratory syncytial virus burden. These findings support the need for expanded screening, along with targeted preventive strategies and structured post-discharge follow-up to reduce the long-term burden of RSV in older populations.

Humans↗

PubMed1997

Student and staff opinion of electronic capture of data related to clinical activity.

OBJECTIVE: To seek the opinion of staff and students of a new electronic method for collection of data related to student clinical activity. DESIGN: Questionnaire survey. SETTING: Staff and students in the Department of Child Dental Health, Dental School, Cardiff, and staff in the Community Dental Service who undertake clinical supervision. METHOD: A questionnaire was circulated to all 2nd and 3rd clinical year dental undergraduate students seeking their opinion on a range of issues associated with the recently introduced bar code system of data gathering of their clinical activity and achievement. A similar questionnaire was circulated to staff who have responsibility for clinical supervision of these students. RESULTS: A total of 102 replies were received. With the exception of 2 aspects, there was no disagreement between staff and students. An overall majority preferred the use of bar codes to other methods of data collection; bar codes were perceived to be more accurate and reliable than other methods; students were satisfied with the method of quality assessment; staff were dissatisfied (P < 0.05). Staff were strongly in favour of extension of the use of bar codes to other clinics, whereas students were less strongly in favour (P < 0.001); there was little enthusiasm to extend bar codes for recording attendance at lectures, seminars and other such activity. CONCLUSION: The new system has been accepted by staff and students alike. It has proven to be satisfactory for its intended purpose. As a result of this survey, minor adjustments to procedures will take place, and the method of assessment of clinical work will be reconsidered.

Attitude of Health Personnel↗

PubMed2003

MMPI-2 short form proposal: CAUTION.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is widely used in neuropsychology, though its length (567 items) is sometimes prohibitive. This study investigated some psychometric characteristics of the 180-item version of the MMPI-2 () in order to delineate its strengths, limitations, and appropriate scope of clinical application. Limited reliability and poor predictive accuracy were recently reported for many of the MMPI-2 short-form scales in a study that used 205 brain-injured patients. In the present investigation, we used a psychiatric sample (N=186) with normal neurological findings to examine short-form accuracy in predicting basic scale scores, profile code types, identifying high-point scales, and classifying scores as pathological (T>/=65) or normal-range. The results suggest that, even as applied to neurologically normal individuals, the proposed short form of the MMPI-2 is unreliable for predicting clinical code types, identifying the high-point scale, or predicting the scores on most of the basic scales. In contrast, this short form can be used to predict whether the full-scale scores fall within the pathological range (T>/=65). These findings suggest that clinicians might be able to salvage a small amount of information from the shortened (180-item) version of the MMPI-2 when MMPI-2 protocols are incomplete. However, clinicians should not use a standard interpretive approach with this test, and routine clinical application is unwarranted. Future evaluations of short-form validity should provide a more detailed examination of individual protocols, including an analysis of the frequency of accurate prediction of full-form scores.

Adult↗

PubMedDate not supplied

Intravenous nursing code of ethics.

Preamble: A code of ethics acknowledges the acceptance by a profession of the responsibility and trust that society has conferred, and it recognizes the obligations inherent in that trust. The specialty practice of intravenous nursing involves ethical decision making. The Intravenous Nursing Code of Ethics is based on the premise that intravenous nurses, both individually and collectively, must be aware of ethical issues, and pursue the highest possible ethical standards. The principles in this Code of Ethics define the nursing profession's expectations and responsibilities for each member of the Intravenous Nurses Society. This code is a guide to ethical decision making to which all intravenous nurses should adhere.

Clinical Competence↗

PubMedDate not supplied

The ITACARE Study.

ITACARE is a collaborative study on the survival of Italian cancer patients diagnosed in the period 1978-1989. The study involves 11 Italian population-based cancer registries (CRs) (Firenze, Forli-Ravenna, Genova, Latina, Modena, Parma, Ragusa, Torino, Varese, the childhood CR of Piedmont and the colorectal CR of Modena), and its principal aim is to identify and analyze possible differences between the areas covered by the CRs. This article describes the ITACARE database. Ten percent of the Italian population is covered by the participating CRs, most of which are located in the northern part of the country. All malignant cancer sites (classified by ICD-9) except skin cancers were included. For bladder cancers, papillomas and transitional cell tumours grade 1 and 2 were also included. Survival data on over 100,000 cases were collected. The principal information variables were sex, date of birth, diagnosis and end of follow-up, life status, ICD-9 code for tumour site, diagnosis modality (clinical, cytologic confirmation, histologic confirmation), ICD-0 morphology code, and tumour stage (grouped into broad categories). Follow-up is active in all registries. All cases were checked systematically for errors and inconsistencies, following which about 0.2% of cases were excluded from the analyses. The percentage of cases microscopically verified, which is an indicator of diagnostic accuracy and data reliability, was higher among patients under 65 years of age (90%), breast cancer patients (92%) and cases covered by the Varese, Torino and Forli-Ravenna CRs (more than 82%). The percentage of cases known by death certificate only (an indicator of the completeness and quality of registration) was about 3% of total cases and was higher among older patients (4%). Province-specific mortality, used to compute relative survival from cancer (i.e., survival adjusted for competing causes of death), varied according to period of diagnosis, sex and area: the highest mortality was among women of the Ragusa CR (Sicily) and men in northern CRs. Overall mortality decreased during the period, more markedly in the north and among women.

Adolescent↗

PubMed2006

The challenge of mapping between two medical coding systems.

OBJECTIVE: Deployable medical systems patient conditions (PCs) designate groups of patients with similar medical conditions and, therefore, similar treatment requirements. PCs are used by the U.S. military to estimate field medical resources needed in combat operations. Information associated with each of the 389 PCs is based on subject matter expert opinion, instead of direct derivation from standard medical codes. Currently, no mechanisms exist to tie current or historical medical data to PCs. Our study objective was to determine whether reliable conversion between PC codes and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes is possible. METHODS: Data were analyzed for three professional coders assigning all applicable ICD-9-CM diagnosis codes to each PC code. Inter-rater reliability was measured by using Cohen's K statistic and percent agreement. Methods were developed to calculate kappa statistics when multiple responses could be selected from many possible categories. RESULTS: Overall, we found moderate support for the possibility of reliable conversion between PCs and ICD-9-CM diagnoses (mean kappa = 0.61). CONCLUSION: Current PCs should be modified into a system that is verifiable with real data.

Diagnosis-Related Groups↗

PubMed1999

Polymerase chain reaction techniques for differentiating cytotoxic and noncytotoxic Pasteurella trehalosi from Rocky Mountain bighorn sheep.

OBJECTIVE: To evaluate 2 polymerase chain reaction (PCR)-based methods for differentiating cytotoxic and noncytotoxic Pasteurella trehalosi from Rocky Mountain bighorn sheep (Ovis canadensis canadensis). SAMPLE POPULATION: 23 isolates of P. trehalosi from bighorn sheep in Colorado, including 18 from free-ranging herds and 5 from a captive herd. PROCEDURE: Using a sequence of the leukotoxin gene region of P. haemolytica serotype 1, 7 PCR primers were designed. A PCR amplification was performed on a sample of bacterial cell suspensions from pure cultures of P. trehalosi with known in vitro cytotoxic effects. The 2 most promising primer pairs were used in a study of 23 P. trehalosi isolates. Results were analyzed for association with cytotoxicity and 3 distinct ribotypes (Eco, Aco, and Bco). RESULTS: Significant associations were observed between in vitro cytotoxicity and PCR results for coding region, between ribotype Eco classification and PCR results for coding region, and between ribotype Eco classification and PCR results for promoter region. There was a negative association between ribotype Aco classification and PCR results for coding and promoter regions. CONCLUSIONS AND CLINICAL RELEVANCE: The PCR for the leukotoxin A coding region may be useful in differentiating cytotoxic from noncytotoxic P. trehalosi isolates recovered from bighorn sheep. It may be useful for studying epidemiologic features of pasteurellosis in bighorn sheep and for designing vaccines to protect wild sheep against pneumonia caused by P. trehalosi and P. haemolytica.

Animals↗

PubMed1986

Classifying and coding morbidity in general practice: validity and reliability in an international trial.

An international field trial of the draft defined version of the International Classification of Health Problems in Primary Care (ICHPPC) was undertaken in nine countries. Fifty-two physicians coded morbidity in 76 standard written clinical vignettes. The validity and reliability of morbidity coding using the defined classification and the extent to which these might be improved by using definitions have been estimated. There was an average of 1.7 problems per encounter, for a total of 807 different problems recorded. Sixty-two percent of the problems were coded correctly. The majority of incorrectly recorded problems were due to varied minority views of the contents of the encounters and to mistakes in recording code numbers. The results of morbidity surveys are useful only if the methods of gathering, recording, coding, collating, and analyzing the data are explicit and well documented. This study illustrates the difficulties of recording morbidity in general practice encounters. Better use of definitions and the addition of an index could improve coding accuracy.

Australia↗

PubMed2005

Antibiotic use in children who have asthma: results of retrospective database analysis.

OBJECTIVE: Inappropriate antibiotic use is a well-recognized public health problem because of its association with the emergence of resistant bacteria. It also is a source of unnecessary health care costs and of potentially severe adverse drug reactions. Although there are no evidence-based indications for the use of antibiotics in the treatment of asthma in the absence of comorbid bacterial conditions, physicians might feel more pressure to prescribe them to children with this common chronic disease. The objectives of this study were to (a) determine if antimicrobial prescription utilization rates are higher for pediatric patients with asthma than a matched comparison group and (b) identify common variables (gender and age) that might explain higher antibiotic utilization rates in children. METHODS: Using administrative claims data, we conducted a retrospective cohort study of children with asthma (age range 5 to 18 years) who were members of a large health plan from January 1, 2000, to December 31, 2002, in the southeastern United States. A comparison group was created that was matched according to age, sex, regional codes, and insurance product line. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify asthmatic patients (493.xx), as well as to link antibiotic prescriptions to diagnosis codes from claims for medical office visits. RESULTS: Asthmatics consistently received significantly more services, including a mean of 1.74 (SD 1.82) antibiotics per patient per year (PPPY) compared with a mean of 0.96 (SD 1.32) antibiotics PPPY for nonasthmatics (t=25.71, P <0.001). Asthmatics received antibiotics more often for all diagnoses. The more frequent receipt of antibiotics was true for conditions related to the respiratory tract (e.g., upper respiratory infection and bronchitis) as well as for conditions unrelated to the respiratory tract (e.g., urinary tract infection and acne). A diagnosis of asthma significantly increased the likelihood of a prescribed antibiotic by 26% to 86%. CONCLUSION: This study demonstrated that pediatric asthmatic patients received significantly more antibiotic prescriptions than nonasthmatics for conditions caused by bacteria as well as for conditions more likely to be viral in origin. In this era of concern about the widespread use of antibiotics and consequent antimicrobial resistance, further research needs to be conducted concerning the appropriateness of antibiotics in the treatment of asthma. Studies on the appropriate use of antibiotics in asthma could help reduce the overall use of antibiotics in children.

Adolescent↗

PubMed2000

Sigmoid volvulus in Department of Veterans Affairs Medical Centers.

PURPOSE: Sigmoid volvulus is the third leading cause of large-bowel obstruction. The optimal management strategy remains controversial. This study was undertaken to evaluate the care of patients with sigmoid volvulus recently treated at Department of Veterans Affairs hospitals. METHODS: All patients with the International Classification of Diseases, Ninth Revision, Clinical Modification, Third Edition code for colonic volvulus during the period 1991 to 1995 were identified in the computerized national Department of Veterans Affairs database. Data on patient demographics, clinical course, and outcomes were analyzed. RESULTS: Two hundred twenty-eight patients had volvulus of the sigmoid colon and sufficient clinical data for evaluation. The mean age was 70; all were males. Endoscopic decompression was attempted in 189 of 228 (83 percent) patients and was successful in 154 of 189 (81 percent). Management included celiotomy in 178 of 228 (78 percent) patients. There were no intraoperative deaths. Twenty-five of 178 (14 percent) patients died within 30 days of surgery. The mortality rate was 24 percent for emergency operations (19/79), and 6 percent for elective procedures (6/99). Mortality was correlated with emergent surgery (P < 0.01) and necrotic colon (P < 0.05). Among those 50 patients managed by decompression alone, six (12 percent) died during the index admission. Ten of the remaining 44 (23 percent) patients eventually developed recurrent volvulus requiring further treatment, and 2 of 10 (20 percent) patients died. CONCLUSIONS: In this cohort sigmoid volvulus often presents as a surgical emergency. Initial endoscopic decompression resolves the acute obstruction in the majority of cases. Surgical intervention carries a substantial risk of mortality, particularly in the setting of emergent surgery or in the presence of necrotic colon.

Aged↗