Neurologically active drugs in spinal cord injury: a clinical coding system.
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Adult↗
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Results for “Clinical Coding”
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A clinically useful coding system for normal coronary artery anatomy.
Cine coronary arteriograms of 121 patients with normal coronary arteriograms with and without associated valvular or myocardial disease were reviewed to describe normal coronary artery anatomy and the distribution of potentially graftable vessels. Coronary arterio grams were divided into right, mixed, and left interior emphasis systems, depending upon the blood supply to the inferior surface of the left ventricle. Whether a coronary artery at its origin was less than 50%, between 50-70% of the left anterior descending coronary artery (LAD) at its origin was described in a simple lettering and numbering code to allow easy comparison. The diameter of the LAD at its origin averaged 4.2 mm. All vessels greater than 70% of the LAD were clearly graftable. The frequency (in percent) with which that vessel was greater than 70% of the LAD in right, mixed, and left systems, respectively, was as follows: right coronary artery 100. 100. 0. LAD 100. 100. 100. intermediate artery 8.7 12.5 33.3 obtuse marginal artery 53.7 43.7 44.4 atrioventricular groove artery 0. 56.2 100. diagonal branch of the LAD 15. 6.3 11.1. This simple method of classification is recommended to provide more accurate comparison in published series and to assist the coronary arteriographer in his interpretations.
Adult↗
[Experiences with the use of bar codes in clinical medicine].
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Clinical Laboratory Techniques↗
[Use of coding in clinical medicine].
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Abbreviations as Topic↗
Confidentiality in the age of AIDS.
Confidentiality is a fundamental rule of medicine and has been specifically defined in many codes of medical ethics. A changing clinical environment both because of diseases such as AIDS, which were not anticipated when these clinical codes were created, and because of the changing relationship between the physician, the patient, and the payor for the physician's care creates dilemmas concerning the rule of confidentiality.
Acquired Immunodeficiency Syndrome↗
Evaluation of a modified dye pour-plate auxanographic method for the rapid identification of clinically significant yeasts. Comparison with two commercial systems.
A modified dye pour-plate auxanographic (DPPA) method for the presumptive identification of medically important yeasts was evaluated, in a comparative study with a conventional procedure, the API 20C clinical yeast system (Analytab Products Inc.), and the Uni-Yeast-Tek (UYT) system. The 174 coded clinical isolates were members of the genera Candida, Cryptococcus, Rhodotorula, Saccharomyces, Torulopsis, and Trichosporon. The identification accuracies with DPPA, API, and UYT were 95%, 93%, and 99% respectively. DPPA and API required more time to inoculate but gave rapid identification profiles. UYT was simple to inoculate and both UYT and DPPA were easy to read. Cost analysis of the three rapid methods demonstrated DPPA to be the most economical making it a feasible alternative for small clinical laboratories as well as large laboratories possessing the facilities to make their own media.
Carbohydrate Metabolism↗
Mnemonic coding system for clinical data entry into laboratory computers: its effect on quality and efficiency.
A simplified coding method for entering the clinical details found on pathology request cards was developed. The method uses a basic four letter code, derived from the initial character of the first four words in a clinical detail, being expanded to four characters with letters from the final word if the number of words is less than four. Rules were devised to cope with common medical terminology. In excess of 90% of clinical details on request cards are readily input by clerical staff using our coding system, and 8% of clinical details are used intelligently by the computer in scheduling further tests or automatically commenting on results. A carefully designed coding system such as the one outlined above could greatly facilitate input of clinical detail without the penalty of reduced throughput.
Clinical Laboratory Information Systems↗
Genetic Susceptibility to Incisional Hernia Evaluation of Hernia Polygenic Risk Scores.
OBJECTIVES: Incisional hernia (IH) affects 13-30% of people after abdominal surgery, resulting in substantial morbidity and costs. While clinical risk factors have been studied extensively, genomic risk for IH is incompletely understood. We aimed to evaluate the impact of polygenic risk scores (PRS) on IH risk prediction. METHODS: We created and evaluated three PRS for abdominal hernia, ventral hernia and latent hernia susceptibility for prediction of IH in an institutional biobank. The primary outcome was defined as the diagnosis or repair of an IH based on ICD-9/10-CM/PCS and CPT codes. Clinical covariates included age, sex, body mass index (BMI), smoking status, index procedure type, and perioperative surgical site infection. A phenome-wide association study (PheWAS) was performed to assess clinical associations with increased PRS. We then tested the ability of the PRS to improve prediction for IH by modeling clinical covariates with and without PRS in patients who underwent abdominal surgery. Model performance was assessed using 10 iterations of 5-fold cross-validation to estimate Brier scores and area under the receiver operating characteristic curve (AUROC), which were compared using cross-model Bayesian analysis of variance. RESULTS: In 55,809 subjects, assessed PRS was significantly associated with incisional, umbilical, and ventral hernia on PheWAS, with 1.19 greater odds of developing IH per 1-SD increase in PRS (95% CI: 1.13-1.25, P < 0.001). Of 9,909 subjects who underwent qualifying abdominal surgery, 706 developed IH. In this cohort, the latent hernia susceptibility PRS was associated with a 16% increased hazard of developing IH per 1-SD increase (HR 1.16; 95% CI: 1.07-1.26; P < 0.001). Compared to a predictive model using clinical covariates (Brier score = 0.047, 95% CI: 0.046-0.048; AUROC = 0.660, 95% CI: 0.653-0.666), addition of the PRS showed similar Brier score and AUROC estimates (Brier score = 0.047, 95% CI: 0.046-0.048; AUROC: 0.667, 95% CI: 0.661-0.673) at five years. Cross-model Bayesian analysis demonstrated >99% probability of practical equivalence when trying to detect a difference of ≥ 0.02. CONCLUSION: All three PRS for hernia were independently associated with IH, suggesting that genomic factors contribute significantly to IH development. However, none of the three PRS meaningfully improved clinical IH risk prediction in patients who underwent abdominal surgery. This suggests that clinical comorbidities and surgical techniques may be equally as important as genomic architecture.
Bayesian analysis↗
Comparison of immunofluorescence and immunoperoxidase staining for identification of rubella virus isolates.
To explore possible advantages which immunoperoxidase (IP) staining might have over immunofluorescence (IF) staining for identifying rubella virus isolates, direct comparative studies were done on the same coded clinical materials using the same rubella immune rabbit serum as the primary antiserum in both systems. The rubella immune rabbit serum and conjugated anti-rabbit immune globulins could be used more dilute in the IP system than in the IF system. Both IP and IF staining detected rubella antigen in all specimens which were positive by interference. IP staining also detected low levels of rubella antigen in a few additional specimens which had originally been positive for rubella virus, but which on retesting were negative by interference and IF staining. With second-cell-culture-passage material, IP and IF staining showed comparable specificity, and the few specimens which reacted nonspecifically generally did so in both systems. Cell cultures inoculated directly with urine specimens showed greater nonspecificity by IP than by IF, but this activity could be abolished by pretreatment with sodium azide and peroxide; other methods tried for inactivating endogenous peroxidase activity destroyed rubella antigen as well. The intensity of staining for positive specimens was comparable in the two systems. However, more antigen was demonstrable in both systems when BHK-21 cells were inoculated as a cell suspension and then permitted to grow into monolayers than when the same specimens were inoculated into preformed monolayers. IP staining was considered to be a highly satisfactory alternative to IF staining for identification of rubella virus isolates.
Animals↗
Substituted phenylacetylguanidines: a new class of antihypertensive agents.
The synthesis of a new series of phenylacetylguanidines is described. Several of them exhibited high antihypertensive activity in the rat. The most potent member of the series is N-amidino-2-(2,6-dichlorophenyl)acetamide hydrochloride [2,6-dichlorophenylacetylguanidine hydrochloride, compound 19], which is now in clinical study under the clinical code number BS 100-141. The structure-activity relationships in this class of compounds are discussed.
Animals↗
Hepatitis of viral origin in Leporidae: introduction and aetiological hypotheses.
In less than ten years, two very serious viral hepatic diseases have spread through Leporidae populations (rabbits and hares) in numerous countries. In May 1989, the Office International des Epizooties designated this new disease of rabbits "viral haemorrhagic disease" and entered it as a List B disease in the International Animal Health Code. Clinically, the disease is very similar to the European brown hare syndrome. However, numerous uncertainties prevail today on the true nature of the viruses of the two species. Although they are related, the viruses appear to be different and cross infection between species has given contradictory results. Hepatitis of Leporidae have probably existed in Europe for several years, although their viral aetiology has been demonstrated only recently. The acute form has occurred in hares in Northern Europe since approximately 1980, while the inapparent (or ignored) form has been present in rabbits in Czechoslovakia since 1975. These diseases of Leporidae are true viral hepatitis which, in their fulminating forms, bear a remarkable resemblance to human viral hepatitis (B and non-A non-B) with regard to clinical symptoms, pathological lesions and mode of transmission. The dominant faecal-oral transmission observed for types A and E hepatitis would explain the particular susceptibility of family-kept rabbits, as they are fed potentially contaminated fodder. As the clinically similar fulminating hepatitis in human beings is caused by a diversity of viruses (both RNA and DNA), the disease in Leporidae might also be caused by different viruses.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[Bicyclic 3-hydrazinopyridazines with antihypertensive action (author's transl)].
The synthesis of a series of 3-hydrazinopyridazines is described. Several of these compounds exhibited high antihypertensive activity in the rat. The most potent member of the series is l-benzoyl-3-hydrazino-5,6,7,8-tetrahydropyrido-[4,3-c]pyridazine, compound 28 [1], which is now under clinical trial [2] under the clinical code number BQ 22-708 (endrazaline, Miretilan). It was possible to discover certain structure-activity relationships.
Animals↗
Exercise electrocardiograms: Code for their clinical evaluation.
This report suggests the use of a simple clinical method of codification of the most significant electrocardiographic changes as a result of the exercise stress test. It uses common abbreviations in the evaluation of the electrocardiographic findings before, during and after exercise. The five major categories to be codified include: (1) the basic electrocardiographic pattern, (2) the heart rate, (3) the pattern of ventricular conduction, (4) the pattern of rhythm and (5) the ST segment deviation. The initial sequence of five symbols indicates the findings in the preexercise electrocardiogram. This is followed by the word "to" with a subscript number. The number in subscript indicates the peak heart rate achieved during the exercise. The sequence of symbols following "to[]" serves to indicate the electrocardiographic changes observed in the postexercise period. The data codified using this system have been found to be concise and easily comparable. The familiarity of the symbols used facilitates its learning and application.
Diagnosis, Computer-Assisted↗
New bar coding tools for clinical managers.
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Ancillary Services, Hospital↗
Code of practice for clinical proton dosimetry.
The objective of this document is to make recommendations for the determination of absorbed dose to tissue for clinical proton beams and to achieve uniformity in proton dosimetry. A Code of Practice has been chosen, providing specific guidelines for the choice of the detector and the method of determination of absorbed dose for proton beams only. This Code of Practice is confined specifically to the determination of absorbed dose and is not concerned with the biological effects of proton beams. It is recommended that dosimeters be calibrated by comparison with a calorimeter. If this is not available, a Faraday cup, or alternatively, an ionization chamber, with a 60Co calibration factor should be used. Physical parameters for determining the dose from tissue-equivalent ionization chamber measurements are given together with a worksheet. It is recommended that calibrations be carried out in water at the centre of the spread-out-Bragg-peak and that dose distributions be measured in a water phantom. It is estimated that the error in the calibrations will be less than +/- 5% (1 S.D.) in all cases. Adoption and implementation of this Code of Practice will facilitate the exchange of clinical information.
Cobalt Radioisotopes↗
[Comparison between peak expiratory flow rate and daily report of the symptoms in asthmatic children (author's transl)].
In a group of 140 asthmatic children (6-15 years old) followed up for six months, the authors compared : (1) the daily transcription of asthmatic symptoms, of their intensity and of the use of antibiotics or corticosteroids ; (2) the peak expiratory flow rate measured daily at nine a.m. ; (3) the clinical history, coded every fifth day. A clinical score was computed by multiple linear correlation between (1) and (3), with a correlation coefficient of 0.84 (p less than 0.001), showing that the propounded quantification of symptoms and treatments was very good for estimating the clinical history. The coefficient of simple linear correlation between peak expiratory flow rate and score (r = --0.41) and between peak expiratory flow rate and clinical history (r = --0.65) was statistically significant ; however a further computation by stepwise multiple linear correlation showed that the peak expiratory flow rate was essentially correlated to the intensity of the symptoms, and to a lesser degree to the presence of breathlessness and prescription of corticosteroids. The correlation coefficient was -- 0.55 (p less than 0.01). Thus the peak expiratory flow rate does not very well account for the clinical state of asthmatics ; useful for the fast but superficial monitoring of patients, it cannot replace the daily transcription of symptoms and treatments : both methods are complementary.
Adolescent↗
Organizing patient data for use in clinical pharmacy practice and education.
A simple, low-cost manual data retrieval system, which provides selective access to all patient cases monitored by pharmacists, is described. The system uses notched cards which are coded by clinical descriptors. The codes are based on a modification of the International Calssification of Diseases, Adapted, disease-diagnosis coding system. This multiple entry system is flexible and can be easily converted to a computer-based system.
Education, Pharmacy↗
Accuracy of Medicare reimbursement for cardiac arrest.
Diagnosis related group (DRG) 129 consists exclusively of discharges having a principal diagnosis of International Classification of Diseases, Ninth Revision, Clinical Modification code 427.5 (cardiac arrest). It excludes patients with more specific diagnoses (eg, myocardial infarction and arrhythmia) or patients admitted for a different reason and who subsequently experience cardiac arrest. This study used a one-stage sample design to select all DRG 129 discharges from random hospitals, stratified by their annual number of DRG 129 bills. Using blinded techniques, medical records specialists reabstracted the International Classification of Diseases codes for 857 medical records. For the bills that were not coded DRG 129 on reabstraction, physicians classified the incorrect bills by clinical situation and reason for error. Diagnosis related group 129 had significantly higher rates of coding errors and upcoding than other DRGs. Of discharges erroneously billed to DRG 129, 42.1% of the patients entered the hospital for heart disease other than cardiac arrest and 55.2% died after entering the hospital for other diseases. Attending physicians need to distinguish between the "immediate cause" of death for the death certificate and the "principal diagnosis" for reimbursement purposes.
Cause of Death↗