Heart Failure Care Dyadic Typology: Initial Conceptualization, Advances in Thinking, and Future Directions of a Clinically Relevant Classification System.

BACKGROUND: Heart failure (HF) dyadic self-care science is advancing rapidly, as evidenced by recent theoretical work, literature reviews, and multiple empiric studies. Typologies, once considered archaic, are now viewed as person-oriented classification systems that allow a whole-system view of information patterns. This whole-system view is particularly needed to understand complex tasks like dyadic HF self-care. PURPOSE: The purpose of this article is to review the initial conceptualization of an HF care dyadic typology and the present advances in our thinking and suggest future directions for this clinically relevant classification system. CONCLUSIONS: Development and testing of the typology across 5 studies resulted in a well-characterized, pragmatic and parsimonious, person-oriented classification system for understanding how patients and informal caregivers conduct patients' HF self-care at home. The 4 types are characterized as 2 individually oriented types-type I, patient oriented; type II, caregiver oriented; and 2 relationally oriented types-type III, collaboratively oriented; and type IV, incongruently oriented. We have devised a single-item measure of typology group that can be assessed in the clinical setting. Once this information is ascertained, the clinician can personalize the plan of care to the realities of the dyad. IMPLICATIONS: Dyads that disagree on who is responsible for self-care may forego or delay action, resulting in self-care failures with subsequent HF advancement, hospitalization, and mortality. As the HF dyadic self-care science has advanced, we have come to appreciate the complexity that arises when 2 individuals work together on 1 complex task-HF self-care.

Dyadic heart failure care types: qualitative evidence for a novel typology.

BACKGROUND: Compared with other chronic illness populations, relatively little is known about heart failure (HF) patient and caregiver spousal/partner dyads and what effect dyadic interactions have on self-care. OBJECTIVE: The aim of this study was to present a new typology of patient and caregiver dyadic interdependence in HF care, presenting exemplar cases of each type: patient oriented, caregiver oriented, collaboratively oriented, complementarily oriented. METHODS: Stake's instrumental case study methodology was used. Interviews were unstructured, consisting of open-ended questions exploring dyad's experiences with HF, audiorecorded, and transcribed. Cases were selected because they exhibited the necessary characteristics and also highlighted a unique, little understood variation in self-care practice. Each case represents a dyad's discussion of caring for HF in their normal environment. RESULTS: From 19 dyads, 5 exemplar case studies illustrate the 4 dyadic types. A fifth, incongruent case, defined as a case where the patient and caregiver indicated incongruent dyadic types, was included to highlight that not all dyads agree on their type. A major theme of Sharing Life infused all of the dyad's narratives. This typology advances the science of dyadic interdependence in HF self-care, explains possible impact on outcomes, and is an early theoretical conceptualization of these complex and dynamic phenomena. CONCLUSION: The cases illustrate how long-term dyads attempt to share the patient's HF care according to established patterns developed over the trajectory of their relationship. In keeping with the interdependence theory, these couples react to the patient's declining ability to contribute to his/her own care by maintaining their habitual pattern until forced to shift. This original pattern may or may not have involved the dyad working together. As the patient's dependence on the caregiver increases, the caregiver must decide whether to react out of self-interest or the patient's interest. Continued study of the typology is needed in nonspousal/partner dyads.

A new classification approach for comparing two active treatments when there is no prior projection on which one is better.

We developed a new classification approach in this paper to compare two active treatments. This approach is especially useful when there is no prior judgment on which treatment is better and the traditional hypothesis testing approach is thus not applicable. Our method classifies all the possible outcomes into categories and draws conclusions on the difference in the outcome measurement between two treatment arms according to the location of the confidence interval for the treatment difference in the response variable. This method controls the misclassification rate regardless of the true difference in the response between the two treatment arms. The method was applied to a diabetes clinical trial.

[Confusions and ambiguities in the classification of adverse events in the clinical research]. / Confusões e ambigüidades na classificação de eventos adversos em pesquisa clínica.

It is quite common to consider the terms ambiguous and confusing as synonyms. Confusing information brings together various data with similar meanings. In ambiguous information, on the other hand, several meanings are assigned to a single word. Excessive information also generates ambiguity; therefore, a concise, clear language is demanded. The term adverse event (AE) is defined as any inconvenient medical occurrence suffered by a subject during a clinical investigation research. Confusion and ambiguity in the use of words may generate relevant consequences in the appraisal of AEs. The objective of this present theoretical study is to harmonize the vocabulary applied in the characterization of risks and in the communication of AEs in clinical research processes. AEs may be classified according to their predictability, frequency, gravity, causality, and severity. Regulatory documents usually address AEs in their severity and causality aspects. Vocabulary conformity in the communication of AEs is an essential step towards avoiding inaccurate use of words with confused or ambiguous meanings.

Extraction of semantic biomedical relations from text using conditional random fields.

BACKGROUND: The increasing amount of published literature in biomedicine represents an immense source of knowledge, which can only efficiently be accessed by a new generation of automated information extraction tools. Named entity recognition of well-defined objects, such as genes or proteins, has achieved a sufficient level of maturity such that it can form the basis for the next step: the extraction of relations that exist between the recognized entities. Whereas most early work focused on the mere detection of relations, the classification of the type of relation is also of great importance and this is the focus of this work. In this paper we describe an approach that extracts both the existence of a relation and its type. Our work is based on Conditional Random Fields, which have been applied with much success to the task of named entity recognition. RESULTS: We benchmark our approach on two different tasks. The first task is the identification of semantic relations between diseases and treatments. The available data set consists of manually annotated PubMed abstracts. The second task is the identification of relations between genes and diseases from a set of concise phrases, so-called GeneRIF (Gene Reference Into Function) phrases. In our experimental setting, we do not assume that the entities are given, as is often the case in previous relation extraction work. Rather the extraction of the entities is solved as a subproblem. Compared with other state-of-the-art approaches, we achieve very competitive results on both data sets. To demonstrate the scalability of our solution, we apply our approach to the complete human GeneRIF database. The resulting gene-disease network contains 34758 semantic associations between 4939 genes and 1745 diseases. The gene-disease network is publicly available as a machine-readable RDF graph. CONCLUSION: We extend the framework of Conditional Random Fields towards the annotation of semantic relations from text and apply it to the biomedical domain. Our approach is based on a rich set of textual features and achieves a performance that is competitive to leading approaches. The model is quite general and can be extended to handle arbitrary biological entities and relation types. The resulting gene-disease network shows that the GeneRIF database provides a rich knowledge source for text mining. Current work is focused on improving the accuracy of detection of entities as well as entity boundaries, which will also greatly improve the relation extraction performance.

HIPAA administrative simplification: modification to medical data code set standards to adopt ICD-10-CM and ICD-10-PCS. Proposed rule.

This proposed rule would modify two of the medical data code set standards adopted in the Transactions and Code Sets final rule published in the Federal Register. It would also implement certain provisions of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Specifically, the proposed rule would modify the standard code sets for coding diagnoses and inpatient hospital procedures by concurrently adopting the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding. These new codes would replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9- CM) Volumes 1 and 2, and the International Classification of Diseases, Ninth Revision, Clinical Modification (CM) Volume 3 for diagnosis and procedure codes, respectively.

Evaluation of the simplified therapeutic intervention scoring system: Chinese version.

OBJECTIVE: To prepare the Simplified Therapeutic Intervention Scoring System (TISS-28) to measure nursing workload in Intensive Care Units in Guangdong Province of China. METHODS: A non-experimental descriptive study was conducted in the intensive care units in the Province. TISS-28, TISS-76, Acute Physiology and Chronic Health Evaluation (APACHE II) were all measured. RESULTS: There were significant positive correlations between TISS-28 and APACHE II (n=91, r=0.432, p<0.001), TISS-76 scores (n=83, r=0.764, p<0.001). A significant difference was found between the mean TISS-28 score in the first day of the intensive care stay and the last day (30.76±6.86 vs 24.67±5.48, p<0.001). A significant intra-class correlation was found between TISS-28 scores collected by the researcher and research associates (ICC=0.959, p<0.001). CONCLUSION: The reliability and validity of TISS-28 were shown in Chinese intensive care units. It is a practical tool for estimating the nursing workload and providing opportunities to compare the data between intensive care units in different facilities. The TISS-28 Chinese version is recommended to guide the allocation of nursing manpower in Chinese intensive care units.

Desarrollo de una plataforma virtual para el entrenamiento de razonamiento clínico en estudiantes de fonoaudiología / Development of a Virtual Platform for Clinical Reasoning Training of Speech-Therapy Students

Objetivo. Desarrollar una plataforma virtual de aprendizaje (PVA) para el entrena-miento de razonamiento clínico en estudiantes de fonoaudiología. Método. Investigación aplicada en base al desarrollo de software; se utilizó lenguaje de programación PHP en su versión 7.3.26, gráficas y transiciones en framework Laravel 8 y Vue 2 con Vuetify. El manejo de base de datos se ejecutó en MySql 5.5. Resultados. Se creó una PVA para el almacenamiento y uso de guiones clínicos basados en la teoría de concordancia de guiones (scripts). La operatividad de la plataforma contempló tres perfiles diferenciados para docentes, estudiantes y gestores. Los estudiantes accedieron a un corpus aleatorio de guiones clínicos previamente validados. El profesor contó con acceso a las estadísticas de usabilidad y notas de los estudiantes y el gestor pudo cargar nuevos guiones, revisar estadísticas, resolver dificultades de soporte y asignar roles. Conclusiones. La PVA desarrollada ofrece un soporte informático para la metodología de entrenamiento del RC scripts en fonoaudiología. Los procesos de innovación educativa diversifican las estrategias de aprendizaje y promueven el desarrollo de competencias relevantes para la toma de decisiones clínicas en los ámbitos de diagnóstico, estudio e intervención

Objective. To develop a virtual learning platform (VLP) for CR training in speech therapy students. Method. Applied research based on software development. PHP programming language version 7.3.26, graphics and transitions in framework Laravel 8 and Vue 2 with Vuetify were used. The database management of the project was executed in MySql 5.5. Results. A VLP was created for storage and use of clinical scripts based on script concordance test. The operative functions of platform included three profiles: teachers, students, and managers. Students accessed a random corpus of previously validated scripts. Teachers had access to usability statistics and student grades, and the manager could upload new scripts, review statistics, resolve support issues, and assign roles. Conclusions. The VLP developed offers support for scripts training methodology in speech therapy. Educational innovation processes diversify learning strategies and promote the development of relevant skills for decision-making in the fields of diagnosis, study, and intervention.

Spending Estimates for Gastric Cancer in Central Brazil

Abstract Stomach cancer is the second leading cause of death by cancer worldwide and is even more pronounced in South America. In Brazil, it is estimated that an increase in the number of cases due to this cancer occurred in the biennium 2018-2019. In this study, we investigated the expenditures of the State Health Department of Goiás on hospitalizations and treatment of gastric cancer for the Unified Health System (SUS) from 2008-2016. This is a cross-sectional, descriptive, and analytical study based on secondary data from the Unified Health System computing department (DATASUS) and the System of Management of the Table of Procedures, Medications, Orthosis, Prosthesis, and Special Materials of SUS through CONECTA-SUS related to International Classification of Diseases-10/C16 (ICD-10/C16) procedures for gastric neoplasms. A total of I$ 5,697,958.20 was spent on gastric tumor in the last nine years in Goiás, I$ 4,492,916.67 (0.3%) on hospitalizations, and I$ 1,997,120.91 on treatment. This study presents a current and relevant estimate of the costs of gastric cancer patients in Goiás. Moreover, we provide information on the extent of the cancer issue to public health. Our analysis offers components for service management and studies that reduce resource allocation in more rational ways

Detailed diagnoses and procedures, National Hospital Discharge Survey, 1997.

OBJECTIVES: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1997. Estimates of first-listed diagnoses, all-listed diagnoses, days of care for first-listed diagnoses, and all-listed procedures are shown by sex and age of patient and geographic region of hospital. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey for 1997. The survey has been conducted annually by the National Center for Health Statistics since 1965. In 1997 data were collected for approximately 300,000 discharges from 474 non-Federal short-stay hospitals. Diagnoses and procedures are presented according to their code number in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).

Detailed diagnoses and procedures, national hospital discharge survey, 1990.

This report presents statistics on conditions diagnosed and surgical and nonsurgical procedures performed in non-federal short-stay hospitals. The statistics are based on data collected through the National Hospital Discharge Survey from a national sample of the hospital records of discharged inpatients. Estimates of first-listed diagnoses, all-listed diagnoses, days of care for first-listed diagnoses, and all-listed procedures are shown by sex and age of patient and geographic region of hospital.

Expert agreement in Current Procedural Terminology evaluation and management coding.

BACKGROUND: Available data suggest that physicians are accurate in approximately 55% of Current Procedural Terminology (CPT) evaluation and management (E/M) coding for their services. This accuracy is relative to observers' or auditors' assigned codes for these services, a group that has not been studied for their consistency in application of the CPT E/M coding guidelines. The purpose of this study was to determine the level of agreement of certified coding specialists in their application of CPT E/M coding guidelines. METHODS: Three hundred certified professional coding specialists randomly selected from the active membership of the American Health Information Management Association were sent 6 hypothetical progress notes of office visits along with a demographic survey. The study group assigned CPT E/M codes to each of the progress notes and completed the demographic survey. RESULTS: Coding specialists agreed on the CPT E/M codes for 57% of these 6 cases. The level of agreement for the individual cases ranged from 50% to 71%. Relative to the most common or consensus code, undercoding of established patients occurred more commonly than overcoding. In contrast, for new patient progress notes, overcoding relative to the consensus code was more common than undercoding. CONCLUSIONS: There is substantial disagreement among coding specialists in application of the CPT E/M coding guidelines. The results of this study are similar to results of prior studies assessing physician coding accuracy, suggesting that the CPT coding guidelines are too complex and subjective to be applied consistently by coding specialists or physicians.

1996 summary: National Hospital Discharge Survey.

OBJECTIVES: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1996. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Discharges are also shown by geographic region of hospital. Average lengths of stay are presented for discharges and selected diagnostic categories. METHODS: The estimates are based on medical abstract data collected through the National Hospital Discharge Survey for 1996. The survey has been conducted annually by the National Center for Health Statistics since 1965. Diagnoses and procedures presented are coded according to the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM. RESULTS: In 1996, there were an estimated 30.5 million discharges of inpatients, excluding newborn infants, from non-Federal, short-stay hospitals in the United States. The discharge rate was 116 per 1,000 population and the average length of stay was 5.2 days. Five diagnostic categories accounted for more than a million discharges. These were heart disease, delivery, malignant neoplasms, pneumonia, and psychoses. There were 40.4 million procedures performed on hospital inpatients during the same year. About three-fourths of all procedures were in four ICD-9-CM chapters: miscellaneous diagnostic and therapeutic procedures, obstetrical procedures, operations on the cardiovascular system, and operations on the digestive system.

1997 summary: National Hospital Discharge Survey.

OBJECTIVES: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1997. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Discharges are also shown by geographic region of the hospital. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and by sex. METHODS: The estimates are based on medical abstract data collected through the National Hospital Discharge Survey for 1997. The survey has been conducted annually by the National Center for Health Statistics since 1965. Diagnoses and procedures presented are coded according to the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM.

National Hospital Ambulatory Medical Care Survey: 1997 outpatient department summary.

OBJECTIVE: This report describes ambulatory care visits to hospital outpatient departments in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics. METHODS: The data presented in this report were collected from the 1997 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to hospital outpatient and emergency departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual estimates. RESULTS: During 1997, an estimated 77.0 million visits were made to hospital outpatient departments in the United States, an overall rate of 28.9 per 100 persons. Visit rates did not vary by age. Black persons had higher rates of visits than white persons. Of all visits made to hospital outpatient departments in 1997, 34.1 percent and 27.8 percent, respectively, listed private insurance and Medicaid as the primary expected source of payment, and 20.1 percent were made by patients belonging to a health maintenance organization. There were an estimated 7.1 million injury-related outpatient department visits during 1997.

A therapeutic taxonomy of treatments for erectile dysfunction: an evolutionary imperative.

AIM OF THE STUDY: A functional classification of treatments for erectile dysfunction is important but none exists at present. Advances in the understanding of the mechanisms of drug action and of the mechanisms of penile erection suggest that there is now a rational basis for a therapeutic classification, with the expectation that a logical diagnostic classification will follow. METHODS: The currently available treatments for erectile function and the known relevant basic science were reviewed and assessed. From this, and analysis of classification systems in other fields, a classification was proposed and evaluated with respect to existing treatments. RESULTS: The treatments for erectile dysfunction were classified into five major classes by their mode of action: (I) Central Initiators, (II) Peripheral Initiators, (III) Central Conditioners, (IV) Peripheral Conditioners and (V) Other. Drugs in these classes are further subdivided by the routes of administration and the mechanisms of specificity. CONCLUSIONS: It is possible to analyze all known treatments using this classification. The principles of this scheme should be sufficiently clear as to enable knowledgeable specialists to arrive at similar conclusions about a drug. The classification proposed is general enough such that most new drugs should fall within a class. However, it should be modified if necessary, if new therapeutic agents can not be appropriately classified. It is our conclusion that with such endeavours the specialty itself and national regulatory bodies will find it easier to define and control how to apply new drugs, how to evaluate new drugs, and how to establish reasonable equivalences among agents and in whom these drugs and devices should be used.