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CLINIC is a computerized medical record system currently being used in two primary care clinics in Israel. Clinic features direct coded data-entry by the medical personnel via a system based on categories of problems and complaints with common signs and symptoms.
The data of the authors' work based on the experience gained with 36,500 telecardiological consultations provided within the framework of the counselling center point to the importance of taking into consideration, in addition to the ECG readings, of the clinical data on the patient to formulate the final diagnosis. In order to obtain formalized clinical information, a coding chart including 19 signs with regard to the gradation in the monotonously increasing extent of derangements has been elaborated. The mathematic maintenance of the work using algorithms of image recognition made it possible to derive a linear formula for computing the magnitude of the total diagnostic index. According to its magnitude the patient's pathology can be attributed to one of the three classes: 0--no coronary heart disease. I--steady angina pectoris, II--acute coronary heart disease. Judging from the examination sequence the percentage of errors does not exceed 8.3% with a tendency towards overdiagnosis of coronary heart disease.
The association between factors that place patients at risk for adverse drug reactions (ADRs) and the occurrence of ADRs was examined, and a therapeutic risk-assessment model was developed. Theoretical risk factors for ADRs to digoxin and theophylline were identified through the literature by researchers at a private tertiary-care hospital. Data were then collected from two groups of 67 patient charts each during a 15-month period. One group of charts represented patients who had experienced an ADR to digoxin or theophylline. The other group represented matched control patients who had not experienced an ADR to either drug. ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modifications) ADR codes were assigned by medical records department personnel, and the ADRs were verified by using the Naranjo algorithm. Seven risk factors for each drug were found to be significantly associated with ADRs. A serum digoxin concentration greater than 2.5 ng/mL and elevated blood urea nitrogen were the two best predictors of an ADR to digoxin. The probability of experiencing an ADR to digoxin was 94.1% for a patient with both of these risk factors. A serum theophylline concentration greater than 25 micrograms/mL was the greatest predictor of an ADR to theophylline; the probability of experiencing an ADR to theophylline was 85.2% if a patient had that risk factor. The sensitivity and specificity of the therapeutic risk-assessment model were 92.9% and 61.8%, respectively, for digoxin and 95.8% and 84.0%, respectively, for theophylline. Several laboratory-based screening criteria demonstrated an ability to predict ADRs to digoxin and theophylline.
Incidence rates for pleural and peritoneal mesotheliomas in about 10% of the U.S. population were examined by various demographic characteristics based on 1973-84 data from the Surveillance, Epidemiology, and End Results Program. Although pleural mesothelioma was more common than peritoneal mesothelioma, both are rare diseases in this country. Pleural mesothelioma incidence rates among white males increased over time and were highest in seaboard areas where shipyards have been located (Seattle, San Francisco-Oakland, Hawaii). The significant secular change was attributed to both period (date of diagnosis) and cohort (date of birth) effects. Pleural mesothelioma incidence rates among white males were nearly 50% higher in the 1980-84 period compared to those in 1975-79; the cohort effect rose to a peak for the 1905-9 birth cohort and then declined. These effects probably reflect changes in asbestos exposure patterns in the past and more recent changes in clinical awareness and coding rules for mesothelioma. Geographic analysis of U.S. death certificates for pleural cancer among white males and females dying during 1968-78 indicated that mortality rates were significantly elevated in several areas that have had asbestos-manufacturing plants or shipyards. Analyses of mortality rates must be viewed with caution, since mesothelioma is considerably underreported on death certificates.
The advent of cochlear implants has increased the clinical interest in the cochlear code for pitch. It is widely believed that pitch is determined by the location of the excitation maximum in the cochlea. However, direct recordings from cochlear hair cells indicate that, for a given sound frequency, the location changes appreciably with sound intensity, whereas the corresponding pitch remains approximately constant. Correlated with this constancy is a surprising constancy of the location of the high-frequency cutoff of cochlear excitation.
Healthcare bar code applications have developed more slowly than industrial or supermarket bar codes, but they are beginning to gain acceptance. Clinical laboratories that use bar code systems have already improved productivity and, more importantly, patient care through reduction of human clerical errors in identifying laboratory samples. Soon, integration of proven technology should expand the benefits of automatic ID to a broader range of healthcare applications.
Old and modern codes of ethics exist, which can be used as guidelines in human experimentation. Medical researchers should be familiar with the contents of these codes. A four-point proposal, to be used in determining the ethical acceptability of clinical therapeutic trials, is presented.
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A stand-alone PC expert system for evaluating the appropriateness of inpatient admissions has been integrated with an existing hospital information system. The expert system supports preadmission screening for appropriateness of inpatient admissions. The HIS provides extensive clinical data in a coded electronic form, permitting high-level decision support. The integrated system was developed for a 20 week randomized clinical trial to evaluate the effects of preadmission screening on inappropriate inpatient admissions. Three factors of the integration are considered: programmatic integration of the expert system, seamless presentation of mixed platform applications, and integration of coded data from the stand-alone application into the HIS data structure.
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Clinical research involving prospective data collection in randomized controlled trials is not always feasible. Increasingly, hospitals are developing large clinical databases that are waiting to be mined. We have developed a computer program, ClinQuery, that facilitates such exploration and analysis. We have also shown in a series of studies that the use of clinical data is a powerful tool in health services research. In some cases, we have shown that coded data are inaccurate and that alternative clinical data are preferable. In other cases, a combination of clinical data and coded discharge diagnoses is preferable.
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.
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.
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.
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.
PURPOSE: Type 1 hereditary hemochromatosis (HH) can result in iron overload and liver disease if not detected and treated early. Most cases are found among people homozygous for HFE p.Cys282Tyr variants. Compound heterozygosity with the HFE p.His63Asp variant is associated with disease to a lesser degree. We sought to examine the association of HFE variation with HH-related phenotypes and assess the prevalence of testing and diagnosis of HH using All of Us data. METHODS: We used data from 133,978 participants with genetic information linked to medical records. For different HFE genotypes, we examined the prevalence of HH diagnosis codes and related biochemical and clinical phenotypes. RESULTS: Among participants who were p.Cys282Tyr homozygotes, the prevalence of HH diagnosis codes was 22.6% among males and 15.6% among females. Serum transferrin-iron saturation measures were available only for 31.4% of males and 21.1% of females who were p.Cys282Tyr homozygotes. Liver disease, including cirrhosis or hepatocellular carcinoma, was present more among males who were p.Cys282Tyr homozygotes compared with males with no p.Cys282Tyr or p.His63Asp variants (15.5% vs 8.5%, P = .0001). Of the 71 participants who were p.Cys282Tyr homozygotes with indication of liver disease, 32 (45.1%) did not have a serum transferrin-iron saturation measure, and 37 (52.1%) did not have diagnosis codes for HH. CONCLUSION: Limited serum transferrin-iron saturation measures or HH diagnosis codes among p.Cys282Tyr homozygotes, even those with liver disease, suggests potential undertesting and underdiagnosis of type 1 HH in clinical practice and a need for improved awareness, education, and testing around HH.
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