Diagnosing delirium in very elderly intensive care patients.

OBJECTIVE: To determine the incidence of delirium in elderly intensive care patients and to compare incidence using two retrospective chart-based diagnostic methods and a hospital reporting measure (ICD-10). DESIGN: Retrospective study. SETTING: An ICU in a large metropolitan private hospital in Melbourne, Australia. PATIENTS: English-speaking participants (n=348) 80+ years, admitted to ICU for >24 hours. MEASUREMENTS AND MAIN RESULTS: Medical files of ICU patients admitted October 2009-October 2012 were retrospectively assessed for delirium using the Inouye chart review method, DSM-IV diagnostic criteria and ICD-10 coding data. General patient characteristics, first onset of delirium symptoms, source of delirium information, administration of delirium medication, hospital and ICU length of stay, 90 day mortality were documented. Delirium was found in 11-29% of patients, the highest incidence identified by chart review. Patients diagnosed with delirium had higher 90 day mortality, and those meeting criteria for all three methods had longer hospital and ICU length of stay. CONCLUSIONS: ICU delirium in the elderly is often under-reported and strategies are needed to improve staff education and diagnosis.

The reporting and diagnosis of uterine fibroids in the UK: an observational study.

BACKGROUND: Uterine fibroids (UFs) are the most common benign tumour in women, and many undergo hysterectomy or uterus-preserving procedures (UPPs) to manage their symptoms. We aimed to validate the recording of UFs in a primary care database, The Health Improvement Network (THIN), and to determine the incidence of UFs in the UK. METHODS: In this observational study, women in THIN aged 15-54 years between January 2000 and December 2009 with no previous record of UFs, hysterectomy or UPPs were identified. Individuals were followed up until there was a Read code indicating UFs, they reached 55 years of age or died, or the study ended. Among those without a UF code, women were identified with a code for hysterectomy, UPPs or heavy menstrual bleeding (HMB). Anonymized patient profiles from each category were randomly selected and reviewed. Subsequently, primary care physicians were asked to complete questionnaires to verify the diagnosis for a randomly selected subgroup. RESULTS: In total, 737,638 women were identified who met the initial inclusion criteria. The numbers of women with a code for UFs, hysterectomy, UPPs and HMB were 9380, 11,002, 3220 and 60,915, respectively; the proportions of confirmed cases of UFs were 88.8, 29.7, 57.7 and 15.9 %. The estimated number of women with UFs was 23,140 (64.0 % without a recorded UF diagnosis). The overall incidence of UFs was 5.8 per 1000 woman-years. CONCLUSIONS: UFs were confirmed in a high proportion of women with UF Read codes. However, almost two-thirds of cases were identified among women with a code for hysterectomy, UPPs or HMB. These results show that UFs are under-recorded in UK primary care, and suggest that primary care physicians tend to code the symptoms of UFs more often than the diagnosis.

Helicobacter pylori: Helicobacter pylori gastritis--a novel distinct disease entity.

A global consensus report on Helicobacter pylori gastritis has been developed. Topics discussed include whether dyspepsia caused by H. pylori infection is separate from functional dyspepsia or not, the evaluation method for H. pylori-induced gastritis, eradication therapy for H. pylori gastritis to prevent gastric carcinogenesis and management after H. pylori eradication.

Kyoto global consensus report on Helicobacter pylori gastritis.

OBJECTIVE: To present results of the Kyoto Global Consensus Meeting, which was convened to develop global consensus on (1) classification of chronic gastritis and duodenitis, (2) clinical distinction of dyspepsia caused by Helicobacter pylori from functional dyspepsia, (3) appropriate diagnostic assessment of gastritis and (4) when, whom and how to treat H. pylori gastritis. DESIGN: Twenty-three clinical questions addressing the above-mentioned four domains were drafted for which expert panels were asked to formulate relevant statements. A Delphi method using an anonymous electronic system was adopted to develop the consensus, the level of which was predefined as ≥80%. Final modifications of clinical questions and consensus were achieved at the face-to-face meeting in Kyoto. RESULTS: All 24 statements for 22 clinical questions after extensive modifications and omission of one clinical question were achieved with a consensus level of >80%. To better organise classification of gastritis and duodenitis based on aetiology, a new classification of gastritis and duodenitis is recommended for the 11th international classification. A new category of H. pylori-associated dyspepsia together with a diagnostic algorithm was proposed. The adoption of grading systems for gastric cancer risk stratification, and modern image-enhancing endoscopy for the diagnosis of gastritis, were recommended. Treatment to eradicate H. pylori infection before preneoplastic changes develop, if feasible, was recommended to minimise the risk of more serious complications of the infection. CONCLUSIONS: A global consensus for gastritis was developed for the first time, which will be the basis for an international classification system and for further research on the subject.

Discovering beaten paths in collaborative ontology-engineering projects using Markov chains.

Biomedical taxonomies, thesauri and ontologies in the form of the International Classification of Diseases as a taxonomy or the National Cancer Institute Thesaurus as an OWL-based ontology, play a critical role in acquiring, representing and processing information about human health. With increasing adoption and relevance, biomedical ontologies have also significantly increased in size. For example, the 11th revision of the International Classification of Diseases, which is currently under active development by the World Health Organization contains nearly 50,000 classes representing a vast variety of different diseases and causes of death. This evolution in terms of size was accompanied by an evolution in the way ontologies are engineered. Because no single individual has the expertise to develop such large-scale ontologies, ontology-engineering projects have evolved from small-scale efforts involving just a few domain experts to large-scale projects that require effective collaboration between dozens or even hundreds of experts, practitioners and other stakeholders. Understanding the way these different stakeholders collaborate will enable us to improve editing environments that support such collaborations. In this paper, we uncover how large ontology-engineering projects, such as the International Classification of Diseases in its 11th revision, unfold by analyzing usage logs of five different biomedical ontology-engineering projects of varying sizes and scopes using Markov chains. We discover intriguing interaction patterns (e.g., which properties users frequently change after specific given ones) that suggest that large collaborative ontology-engineering projects are governed by a few general principles that determine and drive development. From our analysis, we identify commonalities and differences between different projects that have implications for project managers, ontology editors, developers and contributors working on collaborative ontology-engineering projects and tools in the biomedical domain.

Internationally comparable diagnosis-specific survival probabilities for calculation of the ICD-10-based Injury Severity Score.

BACKGROUND: The International Statistical Classification of Diseases, 10th Revision (ICD-10)-based Injury Severity Score (ICISS) performs well but requires diagnosis-specific survival probabilities (DSPs), which are empirically derived, for its calculation. The objective was to examine if DSPs based on data pooled from several countries could increase accuracy, precision, utility, and international comparability of DSPs and ICISS. METHODS: Australia, Argentina, Austria, Canada, Denmark, New Zealand, and Sweden provided ICD-10-coded injury hospital discharge data, including in-hospital mortality status. Data from the seven countries were pooled using four different methods to create an international collaborative effort ICISS (ICE-ICISS). The ability of the ICISS to predict mortality using the country-specific DSPs and the pooled DSPs was estimated and compared. RESULTS: The pooled DSPs were based on a total of 3,966,550 observations of injury diagnoses from the seven countries. The proportion of injury diagnoses having at least 100 discharges to calculate the DSP varied from 12% to 48% in the country-specific data set and was 66% in the pooled data set. When compared with using a country's own DSPs for ICISS calculation, the pooled DSPs resulted in somewhat reduced discrimination in predicting mortality (difference in c statistic varied from 0.006 to 0.04). Calibration was generally good when the predicted mortality risk was less than 20%. When Danish and Swedish data were used, ICISS was combined with age and sex in a logistic regression model to predict in-hospital mortality. Including age and sex improved both discrimination and calibration substantially, and the differences from using country-specific or pooled DSPs were minor. CONCLUSION: Pooling data from seven countries generated empirically derived DSPs. These pooled DSPs facilitate international comparisons and enables the use of ICISS in all settings where ICD-10 hospital discharge diagnoses are available. The modest reduction in performance of the ICE-ICISS compared with the country-specific scores is unlikely to outweigh the benefit of internationally comparable Injury Severity Scores possible with pooled data. LEVEL OF EVIDENCE: Prognostic and epidemiological study, level III.

Saúde mental / Mental health / Salud mental

Este material foi escrito por profissionais que já desenvolveram trabalhos ligados àsaúde mental e à abordagem do álcool e outras drogas no campo da Atenção Básica. Escrevemoseste caderno com a expectativa de estimular e compartilhar o conhecimento acumulado nocuidado em saúde mental na Atenção Básica. Além de apresentar ferramentas e estratégiasde intervenções terapêuticas, também almejamos que este caderno possa dialogar com a suarealidade de profissional de Saúde, trazendo cenas e questionamentos que acreditamos seremfundamentais ao exercício do trabalho com a saúde mental.Para começar, entendemos que a saúde mental não está dissociada da saúde geral. E por issofaz-se necessário reconhecer que as demandas de saúde mental estão presentes em diversasqueixas relatadas pelos pacientes que chegam aos serviços de Saúde, em especial da AtençãoBásica. Cabe aos profissionais o desafio de perceber e intervir sobre estas questões. É por issoque neste caderno privilegiamos as práticas de saúde mental que possam ser realizadas portodos os trabalhadores na Atenção Básica, independentemente de suas formações específicas.Ao atentar para ações de saúde mental que possam ser realizadas no próprio contexto doterritório das equipes, pretendemos chamar a atenção para o fato de que a saúde mental nãoexige necessariamente um trabalho para além daquele já demandado aos profissionais deSaúde. Trata-se, sobretudo, de que estes profissionais incorporem ou aprimorem competênciasde cuidado em saúde mental na sua prática diária, de tal modo que suas intervenções sejamcapazes de considerar a subjetividade, a singularidade e a visão de mundo do usuário noprocesso de cuidado integral à saúde...

Deaths: leading causes for 2009.

OBJECTIVES: This report presents final 2009 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the Division of Vital Statistics' annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2009. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. RESULTS: In 2009, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). These causes accounted for approximately 75% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2009 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.

Deaths: leading causes for 2007.

OBJECTIVES: This report presents final 2007 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the Division of Vital Statistics' annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2007. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. RESULTS: In 2007, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Septicemia. They accounted for approximately 76 percent of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2007 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.

Aportaciones de dos clasificaciones psiquiátricas latinoamericanas para el desarrollo de la CIE-11 / Contributions from two Latin American psychiatric classifications to the development of ICD-11

Dentro del marco del análisis de la décima revisión de la Clasificación Internacional de Enfermedades y Problemas de Salud Asociados (CIE-10), se realizó una comparación código a código entre las categorías diagnósticas de dos clasificaciones latinoamericanas -el Tercer Glosario Cubano de Psiquiatría (GC-3) y la Guía Latinoamericana para el Diagnóstico Psiquiátrico (GLADP)- y el capítulo de "Trastornos mentales y del comportamiento" de la CIE-10. El objetivo fue ayudar a definir qué categorías de la clasificación actual deberían ampliarse y qué nuevas categorías podrían añadirse a la futura CIE-11 para lograr una mayor aplicabilidad local en contextos socioculturales y clínicos distintos del estadounidense y del europeo, cuyas perspectivas han dominado la CIE históricamente. Se espera que el resultado contribuya a los esfuerzos que se están llevando a cabo para desarrollar un sistema clasificatorio que sea genuinamente internacional.

In the context of the updating of the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), this study conducted a code-by-code comparison between the ICD-10 chapter "Mental and Behavioural Disorders" and the diagnostic categories of two Latin American classification schemes: the Third Cuban Psychiatric Glossary (GC-3) and the Latin American Guide to Psychiatric Diagnosis (GLADP). The objective was to help define what categories in the current classification should be broadened and what new categories might be added to the future ICD-11 to make it more applicable in local sociocultural and clinical contexts that differ from those found in regions whose perspectives have historically dominated the ICD, namely, the United States and Europe. It is hoped that the results will contribute to the efforts under way to develop a genuinely international classification system.

Health risk profile for older adults with blindness: an application of the International Classification of Functioning, Disability, and Health framework.

PURPOSE: To develop a health risk profile for adults age 65 years or older with blindness, using the International Classification of Functioning, Disability and Health (ICF) as our conceptual framework. METHODS: We combined and analyzed data from the 2000-2006 National Health Interview Survey after backcoding questions to the ICF. We compared older adults with blindness (n = 477) and older adults with vision loss but not blindness (n = 6,721) with older adults who reported no vision loss (n = 33,497) for the following outcome measures: demographics, functional limitations (self-care, social participation, and mobility limitations), level of psychological distress, physical health status, selected chronic conditions and health risk behaviors (smoking, alcohol use, obesity, and physical inactivity). RESULTS: Older adults with blindness were more likely to be poorer, older, and less educated than older adults without vision loss. They were also more likely to have fair to poor health; to have difficulty walking; to experience diabetes, heart problems, and breathing problems; and to be physically inactive, compared with older adults reporting vision loss but not blindness and older adults without vision loss. CONCLUSION: Older adults with blindness face significant health disparities that can diminish their quality of life without timely, disability-sensitive interventions to address serious psychological distress and physical inactivity.

Effect of psoriatic arthritis according to the affected categories of the international classification of functioning, disability and health.

OBJECTIVE: To determine the categories of the International Classification of Functioning, Disability and Health (ICF) checklist and core sets of rheumatoid arthritis and ankylosing spondylitis frequently occurring in people with psoriatic arthritis (PsA) and to compare the number of such categories with scores on self-report measures of participation restrictions and activity limitations. METHODS: Data were collected from 94 patients with PsA attending rheumatology clinics in 6 centers. For each ICF category affected by PsA in at least 30% of patients, the percentage of such patients was determined for Body Structures, Body Functions, Activities and Participation, and Environmental Factors. A count of all affected categories by ICF chapter was compared to patient self-report scores on a number of functional and health status instruments using Spearman's correlation. RESULTS: There were 25 categories in the Body Functions section, 6 categories in the Body Structures section, and 51 categories in the Activities and Participation section that were relevant in at least 30% of participants. Thirteen Environmental Factors were facilitating and 1 Environmental Factor (climate) was a barrier in at least 30% of participants. The number of involved Activities and Participation categories by chapter did not correlate in predictable ways with self-report measures of participation restrictions and activity limitations. CONCLUSION: PsA is associated with a wide range of impairments, limitations, and restrictions across the ICF categories. People with PsA find environmental factors to be helpful more often than to be barriers. The unexpected pattern of correlation between ICF chapters and self-report measures suggests the need for a better way of quantitatively representing the ICF concepts.

A classification of hospital-acquired diagnoses for use with routine hospital data.

OBJECTIVE: To develop a tool to allow Australian hospitals to monitor the range of hospital-acquired diagnoses coded in routine data in support of quality improvement efforts. DESIGN AND SETTING: Secondary analysis of abstracted inpatient records for all episodes in acute care hospitals in Victoria for the financial year 2005-06 (n=2.032 million) to develop a classification system for hospital-acquired diagnoses; each record contains up to 40 diagnosis fields coded with the ICD-10-AM (International Classification of Diseases, 10th revision, Australian modification). MAIN OUTCOME MEASURE: The Classification of Hospital Acquired Diagnoses (CHADx) was developed by: analysing codes with a "complications" flag to identify high-volume code groups; assessing their salience through an iterative review by health information managers, patient safety researchers and clinicians; and developing principles to reduce double counting arising from coding standards. RESULTS: The dataset included 126,940 inpatient episodes with any hospital-acquired diagnosis (complication rate, 6.25%). Records had a mean of three flagged diagnoses; including unflagged obstetric and neonatal codes, 514,371 diagnoses were available for analysis. Of these, 2.9% (14,898) were removed as comorbidities rather than complications, and another 118,640 were removed as redundant codes, leaving 380,833 diagnoses for grouping into CHADx classes. We used 4345 unique codes to characterise hospital-acquired conditions; in the final CHADx these were grouped into 144 detailed subclasses and 17 "roll-up" groups. CONCLUSIONS: Monitoring quality improvement requires timely hospital-onset data, regardless of causation or "preventability" of each complication. The CHADx uses routinely abstracted hospital diagnosis and condition-onset information about in-hospital complications. Use of this classification will allow hospitals to track monthly performance for any of the CHADx indicators, or to evaluate specific quality improvement projects.

Using ICD-10-AM codes to characterise hospital-acquired complications.

This paper describes the limitations of using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) to characterise patient harm in hospitals. Limitations were identified during a project to use diagnoses flagged by Victorian coders as hospital-acquired to devise a classification of 144 categories of hospital acquired diagnoses (the Classification of Hospital Acquired Diagnoses or CHADx). CHADx is a comprehensive data monitoring system designed to allow hospitals to monitor their complication rates month-to-month using a standard method. Difficulties in identifying a single event from linear sequences of codes due to the absence of code linkage were the major obstacles to developing the classification. Obstetric and perinatal episodes also presented challenges in distinguishing condition onset, that is, whether conditions were present on admission or arose after formal admission to hospital. Used in the appropriate way, the CHADx allows hospitals to identify areas for future patient safety and quality initiatives. The value of timing information and code linkage should be recognised in the planning stages of any future electronic systems.