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Demographic patterns for mesothelioma in the United States.

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.

Adolescent

[Prediction of new outbreaks of myocardial infarction, based on a multivariate meteorological analysis].

In a previous paper, meteorological circumstances of myocardial infarctions, cerebrovascular attacks, and suicidal attempts were studied by a univariate method. The present work used the same clinical reports, collected by the Medical Emergency Assistance System (SAMU) in the Paris area from 1975 to 1977, but with multivariate calculations. 150 potential predictive indicators were submitted to "progressive ascending selection". Selected indicators were then combined into a composite index by "linear canonic discrimination". This index was tested in terms of successful prediction. The 150 indicators were: 1) meteorological variables, recorded at ground level, such as wind and temperature (expressed respectively in 28 and 24 ways), airpressure, moisture; 2) variables computed from data recorded in altitude; 3) pollutants; 4) non-meteorological indicators, such as day of the week, season, solar activity; 5) the "past of the predictand", i.e. the frequency of infarctions during the previous days; 6) types of weather, defined after confronting meteorological maps with clinical data. The coding of qualitative data required a new procedure. The event to be predicted, which occurred only one day a week, was an incidence of infarctions of at least twice the average. The percentage of successful prediction was 78.7%. The type of weather was by far the best indicator. Detrimental circumstances were changing weathers, with in the order of decreasing correlations, atmosphere fluxes coming from S-SE, E, SW, and NW. These results complete those of univariate analysis. They validate a simple and efficient predictive method, similar in its principle to that used in Germany.

Epidemiologic Methods

What is the cochlear place code for pitch?

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.

Acoustics

Putting bar codes to work for improved patient care.

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.

Blood Banking

High-energy versus low-energy defibrillation: experience in patients (excluding those in the intensive care unit) at Mayo Clinic-affiliated hospitals.

/he purpose of this study was to determine whether electric shocks of low (200 to 240 J), intermediate (300 to 320 J), or high (400 to 440 J) delivered energy were most successful in defibrillating hospitalized patients (excluding those in intensive care units) in whom resuscitation was attempted by a code emergency team. From January 1980 through December 1982, 101 cases of ventricular fibrillation in 100 patients were treated by Mayo Clinic code emergency teams. Many of the patients in this trial had secondary or agonal ventricular Defibrillation. Most patients (64%) were defibrillated by one to eight shocks. For the first shock, intermediate and high energy seemed to be more effective than low energy. Patient weight, time of delivery of shock 1 after onset of the code emergency, blood pH, acute and chronic medical diagnoses, and pharmacotherapy before the onset of ventricular fibrillation were not clearly related to the response to shock 1. Nine of 16 patients who did not initially respond to shocks of low or intermediate energy were defibrillated when higher energy was subsequently used. Only 14 patients ultimately survived and were dismissed from the hospital. These results suggest that in this patient population, high levels of delivered energy are preferable to low energy for the first shocks administered; we recommend that 400 J of delivered energy be used initially. The 360-J maximal energy dose available in most currently manufactured defibrillators should be sufficiently close to this recommendation to justify use of that dose with the initial shock.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Medical ethics and clinical therapeutic trials.

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.

Codes of Ethics

Integration of a stand-alone expert system with a hospital information system.

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.

Evaluation Studies as Topic

Using routinely collected data for clinical research.

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.

Boston

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

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

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

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

Association of HFE genotypes with hemochromatosis-related phenotypes in the All of Us research program.

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.

C282Y homozygosity

The Howie Code.

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Clinical Laboratory Techniques