Exploring in-hospital adverse drug events using ICD-10 codes.

OBJECTIVE: Adverse drug events (ADEs) during hospital admissions are a widespread problem associated with adverse patient outcomes. The 'external cause' codes in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) provide opportunities for identifying the incidence of ADEs acquired during hospital stays that may assist in targeting interventions to decrease their occurrence. The aim of the present study was to use routine administrative data to identify ADEs acquired during hospital admissions in a suburban healthcare network in Melbourne, Australia. METHODS: Thirty-nine secondary diagnosis fields of hospital discharge data for a 1-year period were reviewed for 'diagnoses not present on admission' and assigned to the Classification of Hospital Acquired Diagnoses (CHADx) subclasses. Discharges with one or more ADE subclass were extracted for retrospective analysis. RESULTS: From 57205 hospital discharges, 7891 discharges (13.8%) had at least one CHADx, and 402 discharges (0.7%) had an ADE recorded. The highest proportion of ADEs was due to administration of analgesics (27%) and systemic antibiotics (23%). Other major contributors were anticoagulation (13%), anaesthesia (9%) and medications with cardiovascular side-effects (9%). CONCLUSION: Hospital data coded in ICD-10 can be used to identify ADEs that occur during hospital stays and also clinical conditions, therapeutic drug classes and treating units where these occur. Using the CHADx algorithm on administrative datasets provides a consistent and economical method for such ADE monitoring.

Comprehensive sequencing of PALB2 in patients with breast cancer suggests PALB2 mutations explain a subset of hereditary breast cancer.

BACKGROUND: This study sought to determine the prevalence of PALB2 mutations in a cohort referred for diagnostic testing for hereditary breast cancer. METHODS: Sanger sequencing was used to analyze the entire coding region and flanking introns of PALB2 in anonymized DNA samples from 1479 patients. Samples were stratified into a "high-risk" group, 955 samples from individuals predicted to have a high probability of carrying a mutation in BRCA1 or BRCA2 based on their personal and family history, and a "lower-risk" group consisting of 524 samples from patients with breast cancer, but fewer risk factors for being a BRCA1 or BRCA2 mutation carrier. All patients were known to be negative for deleterious sequence mutations and large rearrangements in BRCA1 and BRCA2. RESULTS: We identified 12 disease-associated PALB2 mutations among the 1479 patients (0.8%). The PALB2 mutations included 8 nonsense, 3 frameshift mutations and a splice-site mutation. The mutation prevalence for the high-risk population was 1.05% (95% CI = 0.5-1.92), whereas that for the lower-risk population was 0.38% (95% CI = 0.05-1.37). We identified 59 PALB2 variants of uncertain significance (VUS) among 57 of the 1479 patients (3.9%). CONCLUSIONS: These results suggest that PALB2 mutations occur at a frequency of ~1% in patients with hereditary breast cancer.

'Rule of Law' initiatives and the liberal peace: the impact of politicised reform in post-conflict states.

Strengthening the 'Rule of Law' (RoL) has emerged as a key requirement in the reconstruction of conflict-affected states. No longer simply a philosophical ideal, RoL now exists as a tangible set of policies created and implemented by international actors, to which conflict-affected states are expected to conform. Masked in the neutral, apolitical rhetoric of blind and objective justice, RoL programming is in fact a political tool within the larger liberal peacebuilding project. Its employment as such mutes its potential contribution to constructing a positive peace as it often creates new socio-political tensions and distorts accountability structures. An analysis of reforms in Kosovo under the United Nations administration illustrates the potential for liberal RoL reforms to increase insecurity in the short term and threaten the sustainability of peacebuilding reforms in the long term. Instrumental use of RoL programming thus provides further evidence of weaknesses and contradictions within the politicised liberal peacebuilding project, necessitating reconsideration of its role in post-conflict transformations.