Conceptual-driven classification for coding advise in health insurance reimbursement.

OBJECTIVE: With the non-stop increases in medical treatment fees, the economic survival of a hospital in Taiwan relies on the reimbursements received from the Bureau of National Health Insurance, which in turn depend on the accuracy and completeness of the content of the discharge summaries as well as the correctness of their International Classification of Diseases (ICD) codes. The purpose of this research is to enforce the entire disease classification framework by supporting disease classification specialists in the coding process. METHODOLOGY: This study developed an ICD code advisory system (ICD-AS) that performed knowledge discovery from discharge summaries and suggested ICD codes. Natural language processing and information retrieval techniques based on Zipf's Law were applied to process the content of discharge summaries, and fuzzy formal concept analysis was used to analyze and represent the relationships between the medical terms identified by MeSH. In addition, a certainty factor used as reference during the coding process was calculated to account for uncertainty and strengthen the credibility of the outcome. RESULTS: Two sets of 360 and 2579 textual discharge summaries of patients suffering from cerebrovascular disease was processed to build up ICD-AS and to evaluate the prediction performance. A number of experiments were conducted to investigate the impact of system parameters on accuracy and compare the proposed model to traditional classification techniques including linear-kernel support vector machines. The comparison results showed that the proposed system achieves the better overall performance in terms of several measures. In addition, some useful implication rules were obtained, which improve comprehension of the field of cerebrovascular disease and give insights to the relationships between relevant medical terms. CONCLUSION: Our system contributes valuable guidance to disease classification specialists in the process of coding discharge summaries, which consequently brings benefits in aspects of patient, hospital, and healthcare system.

Differentiating vascular pathophysiological states by objective analysis of flow dynamics.

BACKGROUND AND PURPOSE: There is an unmet need to classify cerebrovascular conditions physiologically and to assess cerebrovascular system performance. The authors hypothesized that by simultaneously considering the dynamic parameters of flow velocity, acceleration, and pulsatility index (PI) (impedance) in individual Doppler spectrum waveforms, they could develop an objective method to elucidate the pathophysiology of vascular conditions and classify cerebrovascular disorders. This method, dynamic vascular analysis (DVA), is described. METHODS: First, a theoretical model was developed to determine how any vascular segment and the ensemble of intracranial vascular segments could be defined according to its dynamic physiological characteristics. Next, the DVA method was applied to 847 anonymous serial complete clinical transcranial Doppler (TCD) studies of patients without regard for their diagnosis to ascertain actual reference ranges and the normality of the distribution curves for each dimension of the 3-parameter nomogram. The authors applied DVA to 2 clinical cases to see if they could track the changes in vascular performance of 2 known progressive diseases. RESULTS: The theoretical analysis identified 295,245 possible vascular states for the ensemble of vascular segments in the cerebral circulation. When applied to clinical TCD data, DVA revealed continuous, normally distributed data for the velocity, PI, and logarithm of the acceleration. CONCLUSIONS: DVA is proposed as a method for monitoring the physiological state of each cerebral artery segment individually and in ensemble. DVA evaluates the relationship among acceleration (force or pressure), velocity, and PI and provides an objective means to evaluate intracranial vascular segments using the paradigm of the well-described pressure-perfusion autoregulation relationship. DVA may be used to study cerebrovascular pathophysiology and to classify, evaluate, and monitor cerebrovascular disorders or systemic disorders with cerebrovascular effects.

Hallazgos angiotomográficos en pacientes con diagnóstico clínico de enfermedad vascular cerebral / Angiotomography in patients with cerebral vascular disease

Se describe, retrospectivamente los hallazgos angiotomográficos en 58 pacientes con diagnóstico de enfermedad vascular cerebral consistentes en isquemia cerebral transitoria, insuficiencia vértebrobasilar, ictus completo, alteraciones visuales y cefalea. Las ventajas de este procedimiento son su rapidez, alta sensibilidad para detectar placas de ateroma calcificadas y excelente demostración de la anatomía vascular intra y extracraneal. La aterosclerosis (31 por ciento) y los infartos lacunares (21 por ciento) fueron los hallazgos más comunes sobrre todo en pacientes mayores a los 50 años de edad. El 20 por ciento de los estudios no presentaron anormalidades, 8 por ciento correspondieron a aneurismas y el restante 20 por ciento correspondió a infartos crónicos, trombosis arterial, vasculitis, angiomas venosos, lesión selar y hemorragia subaracnoidea. Por último, considerando únicamente los estudios de cráneo (50 pacientes) los aneurismas saculares a nivel del polígono de Willis fueron el 12 por ciento

Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study.

Compensation by the unaffected upper extremity (UE) was studied in stroke patients who were unable to use the affected UE. The main aim was to evaluate the need of teaching compensatory techniques to stroke patients during rehabilitation of UE function. The study was prospective and community based and included 636 consecutive acute stroke patients. UE function and UE paresis were assessed weekly using the Barthel Index subscores for feeding and grooming and the Scandinavian Stroke Scale (SSS) subscores for arm and hand. Rehabilitation was performed according to the Bobath technique. Initially, 214 had severe UE paresis according to SSS; the arm could not move against gravity and the fingertips could not reach palm. In 64 of the 115 patients discharged alive, the affected UE definitely remained useless despite intensive and longstanding rehabilitation. Improvement of UE function was seen in 25 of these patients (39%) and was possible only through compensation by the unaffected UE. Patients who gained UE function by compensation were younger (p < 0.01), had less severe stroke (p < 0.01), smaller (p < 0.01), and subcortically located (p = 0.02) lesions and less affection of higher cortical function (p = 0.01). Recovery of UE function in more than half of the stroke patients with initial severe UE paresis can be achieved only by compensation by the unaffected UE.