Improving the sensitivity and specificity of the abbreviated injury scale coding system

The Abbreviated Injury Scale with Epidemiologic Modifications (AIS 85-EM) was developed to make it possible to code information about anatomic injury types and locations that, although generally available from medical records, is not codable under the standard Abbreviated Injury Scale, published by the American Association for Automotive Medicine in 1985 (AIS 85). In a population-based sample of 3,223 motor vehicle trauma cases, 68 percent of the patients had one or more injuries that were coded to the AIS 85 body region nonspecific category external. When the same patients' injuries were coded using the AIS 85-EM coding procedure, only 15 percent of the patients had injuries that could not be coded to a specific body region. With AIS 85-EM, the proportion of codable head injury cases increased from 16 percent to 37 percent, thereby improving the potential for identifying cases with head and threshold brain injury. The data suggest that body region coding of all injuries is necessary to draw valid and reliable conclusions about changes in injury patterns and their sequelae. The increased specificity of body region coding improves assessments of the efficacy of injury intervention strategies and countermeasure programs using epidemiologic methodology.     

Costing out nursing: combining PCSs (patient classification systems), DRGs, and standards of care

Perhaps the greatest challenge hospitals face today is simultaneously providing high-quality care and containing costs. To meet this challenge, nursing services must master the ability to accurately project staffing that guarantees high-quality care within justifiable cost limits. Nursing is an important cost center in hospitals; therefore, it is necessary to extract nursing care costs from room and board costs. By establishing a PCS and a set of standards of care for each DRG category, nurse administrators can control nursing staff ratios while ensuring quality care, therefore, effectively and efficiently using their nursing resources. This study suggests that direct nursing care can be delivered to meet the patient care needs within the DRG trim points and that by delivering care according to a set of standards, nursing care costs can be determined for a specific group of patients. These findings assist the nurse administrator in establishing control measures and setting resource allocation priorities.     

Content comparison of health-related quality of life (HRQOL) instruments based on the international classification of functioning,disability and health (ICF)

The increasing recognition of the patient perspective and, more specifically, functioning and health, has led to an impressive effort in research to develop concepts and instruments to measure them. Health-Related Quality of Life (HRQOL) and the International Classification of Functioning Disability and Health (ICF) represent two different perspectives from which to look at functioning and health. Therefore, it is expected that both will often be used concurrently in clinical practice, research and health reporting. The objective of our study was to examine the relationship between six HRQOL instruments (the SF-36, the NHP, the QL-I, the WHOQOL-BREF, the WHODASII and the EQ-5D) and the ICF. All six HRQOL instruments were linked to the ICF separately by two trained health professionals according to ten linking rules developed specifically for this purpose. The degree of agreement between health professionals was calculated by means of the kappa statistic. Bootstrapped confidence intervals were calculated. In the 148 items of the 6 instruments a total of 226 concepts were identified and linked to the ICF. The estimated kappa coefficients range between 0.82 and 0.98. The concepts contained in the items of the HRQOL instruments were linked to 91 different ICF categories, 17 categories of the component body functions, 60 categories of the component activities and participation, and 14 categories of the component environmental factors. Twelve concepts could not be linked to the ICF at all. In the component body functions, only emotional functions are covered by all examined instruments. In the component activities and participation, all instruments cover aspects of work, but the half of them scarcely cover aspects of mobility. Only four of the six instruments address environmental factors. The ICF proved highly useful for the comparison of HRQOL instruments. The comparison of selected HRQOL instruments may provide clinicians and researchers with new insights when selecting health-status measures for clinical studies.     

Cross-cultural validation of an international questionnaire,the General Measure of the Functional Assessment of Cancer Therapy scale (FACT-G), for Japanese

The General Measure of the Functional Assessment of Cancer Therapy scale (FACT-) was developed in an English-speaking culture (USA). To determine if FACT-G could be used in Japan, a cross-cultural validation was performed. The Japanese version was created through an iterative forward-backward translation sequence used throughout the FACT multi-lingual translation project. In evaluating psychometric testing, its construct validated was investigated by factor analysis and multi-trait scaling analysis clinical validity was estimated by known-groups comparison using stage, performance score (PS) and patient location, and validated longitudinally by PS. The FACT-G (version 3) was given to 180 patients with lung cancer. Analyses showed that the scales of Physical, Functional, Emotional Well-Being, and Relationship with Doctors were constructively valid in Japan. Japanese patients felt that familial relationships were different than those with friends and neighbors, indicating that the Social/Family Well-Being scale needed cultural adaptation. Two items concerning coping with illness and acceptance of illness did not load predictably onto their respective scales and were considered to be cross-culturally problematic. However, clinical validity demonstrated its sensitivity. Japanese version 4 has been improved to address the weakness in an attempt to become an instrument that is applicable across cultures. This revised version was published online in June 2006 with corrections to the Cover Date.     

Content comparisons of stroke-specific quality of life based upon the international classification of functioning, disability, and health

Purpose  To link the concepts underlying the Stroke-Specific Quality of Life (SS-QOL) scale with those of the International Classification of Functioning, Disability, and Health (ICF), which are two different perspectives to consider functioning and health. This will facilitate the understanding of the relationships between the SS-QOL and the ICF. One of the purposes of the ICF is to be used as a common terminology and a clinical problem-solving tool in clinical and research settings. The ICF concept of functioning can also serve as the basis for the operationalization of the health-related quality of life. Thus, efforts should be made to allow the concurrent use of the ICF and health measurements in both clinical and research settings. Methods  Linking of the SS-QOL concepts with the ICF categories was carried out by two independently trained health care professionals who applied the standardized eight linking rules that were specifically developed and updated for this purpose. The degree of agreement between the health care professionals was determined by kappa coefficients. Results  Of the 49 items of the SS-QOL, 54 concepts were identified. The level of agreement between the health care professionals showed that the kappa coefficients ranged from 0.75 to 1.00. Three concepts (5.5%) could not be linked to the ICF and were coded as not covered. Fifty-one were linked to the ICF categories for the following components: 22 (41%)—body functions; 26 (48%)—activities and participation; and three (5.5%)—environmental factors. Eleven ICF chapters were identified. Conclusions  Several categories of the ICF were linked to the items of the SS-QOL, with acceptable levels of agreement. These categories were specific and meaningful for stroke subjects, since the majority of the identified concepts were included in the comprehensive ICF core set for stroke. The findings indicated that the ICF provided a useful framework for the conceptual understanding of the SS-QOL, which demonstrated multiple representations of the ICF categories and covered a broad range of the ICF components that were meaningful for the stroke subjects.     

三硝基甲苯、邻甲苯胺、苯及其同系物致肝损害的调查分析

长期低浓度接触三硝基甲苯、邻甲苯胺、苯及其同系物等亲肝毒物．可以导致肝损害．这些损害的早期表现主要为生化方面的变化．且以肝功能异常为主．其敏感性和特异性均较差。该调查在现场职业卫生学调查和临床体检的基础上，检测ALT、AST、A／G、TBIL、DBIL、IBIL、铜蓝蛋白（CP）、乳酸脱氢酶同功酶（LDH同功酶）等生化指标．同时采用病原学诊断方法剔除甲肝和乙肝病毒感染者，为评价亲肝毒物肝损害提供依据。     

Evaluation and modeling of HIV based on communication theory in biological systems

Some forms of communication are used in biological systems such as HIV transmission in human beings. In this paper, we plan to get a unique insight into biological communication systems generally through the analogy between HIV infection and electrical communication system. The model established in this paper can be used to test and simulate various communication systems since it provides researchers with an opportunity. We interpret biological communication systems by using telecommunications exemplification from a layered communication protocol developed before and use the model to indicate HIV spreading. We also implement a simulation of HIV infection based on the layered communication protocol to predict the development of this disease and the results prove the validity of the model.     

Content comparison of health-related quality of life measures used in stroke based on the international classification of functioning,disability and health (ICF): a systematic review

OBJECTIVE: To examine and compare the contents of health-related quality of life (HRQoL) measures used in stroke, based on the ICF as the frame of reference. DESIGN: We conducted a systematic literature review to select current generic and condition-specific HRQoL measures applied in stroke. We examined the contents of the selected measures by linking the concepts within the instruments' items to the ICF. RESULTS: The systematic literature review resulted in the selection of six generic and seven stroke-specific HRQoL measures. Within the selected instruments we identified 979 concepts. To map these concepts, we used 200 different ICF categories. None of the ICF categories is contained in all of the instruments. The most frequently used category is 'b152 Emotional functions' contained in 53 items from 10 instruments. Stroke-specific measures more often address 'Mental functions', while the selected generic instruments more often include Environmental Factors. DISCUSSION: The present study provides an overview on current HRQoL measures in stroke with respect to their covered contents and provides valuable information to facilitate the selection of appropriate instruments for specific purposes in clinical as well as research settings.     

基于黄曲霉毒素国际比对结果的评价及检测关键点

目的分析黄曲霉毒素国际比对考核结果,明确食品中黄曲霉毒素检测的质量控制要求。方法采用Z评分法,分析黄曲霉毒素的考核结果,研究分析实验操作过程中的质量控制关键点。结果经过4轮黄曲霉毒素的比对考核,其结果∣Z∣<2,考核结果均满意。检测样品的取样及检测方法的选择是影响结果的重要因素。结论由黄曲霉毒素的国际比对考核结果提示,加强实验操作关键点的控制可有效提高测定结果的可靠性。     

Content comparison of haemophilia specific patient-rated outcome measures with the international classification of functioning, disability and health (ICF, ICF-CY)

Background  

Patient-Reported Outcomes (PROs) are considered important outcomes because they reflect the patient's experience in clinical trials. PROs have been included in the field of haemophilia only recently.     

Effect of tocopherol-monoglucoside (TMG), a water-soluble glycosylated derivate of vitamin E, on hematopoietic recovery in irradiated mice

A preparation of alpha-tocopherol monoglucoside (TMG) administered i.p. at a dose of 600 mg/kg immediately after whole body gamma irradiation was examined for its radioprotective efficacy towards bone marrow and peripheral blood nucleated cells. When mice received X-rays at a dose of 5,6 Gy, a marked decrease in bone marrow karyocytes and a reduction of peripheral leukocytes within the early post-irradiated period were observed. However these changes were attenuated in TMG-treated mice. Significant protection of blood lymphocytes was found for the TMG group of mice. The return to normal value of the reduced blood leukocyte count starting from the 8th day was more rapid in TMG-treated mice than in untreated irradiated mice. TMG administration was found to enhance hematopoietic recovery, as measured by the exceeded nucleated bone marrow cell count due to elevated amount of both lymphoid and granulocytic elements in the TMG-group, in comparison with that of both control irradiated and non-irradiated animals. These findings indicate that the radioprotective effect of TMG is apparently realized through its influence on hematopoietic system.     

Evaluation of immunotoxicity induced by single or concurrent exposure to N,N-diethyl-m-toluamide (DEET), pyridostigmine bromide (PYR), and JP-8 jet fuel

Approximately 5,000 to 80,000 of the US service personnel involved in the Persian Gulf War have complained of a variety of nonspecific symptoms since their return in 1991. These symptoms have been collectively labeled Gulf War Illness and include muscle fatigue, general malaise, myalgia, impaired cognition, ataxia, headaches, fever, joint pain, skin rash, gastrointestinal disturbances, sleep disturbances, and respiratory difficulties. Exposures of military and service personnel were diverse and included the prescribed anti-nerve gas agent pyridostigmine bromide (PYR), N.N-diethyl-m-toluamide (DEET) insect repellent, and environmental exposures to jet fuel. Thus, studies in our laboratory were undertaken to determine if concurrent exposure to these agents, singly or in combination, would contribute to significant alterations in immunological function and disease susceptibility. To assess immune status, eight-week old B6C3F1 female mice were exposed for 14 days to single compounds or tertiary mixtures of 15.5 mg/kg DEET, 2 mg/kg PYR, and 500 mg/kg JP-8 (termed low dose), or 31 mg/kg DEET, 5 mg/kg PYR, and 1,000 mg/kg JP-8 (termed high dose). Immunosuppression was assessed 24 h after the last exposure. No remarkable alterations were evident in hematological parameters, spleen and thymus organ weight and total cellularity, natural killer (NK) cell activity, cytotoxic T-cell activity, or mitogen-induced lymphocyte proliferation after exposure to either single or tertiary mixtures at low or high doses. A few changes in CD4/CD8 flow cytometric lymphocyte subpopulations were detected after exposure to the tertiary mixture at the high dose. Delayed type hypersensitivity (DTH) was decreased by 88% after exposure to the high-dose mixture, and suppression of antibody-specific IgM immune responses (plaque-forming cell, PFC) occurred after exposure to all single and tertiary mixtures at both dose levels. In the PFC response, antagonism was apparent in the mixture, while coexposure to these agents resulted in a synergistic effect in the DTH response. Susceptibility to B16F10 tumor or Listeria monocytogenes challenge was not affected after single or tertiary exposures. These data suggest that combined exposure to DEET, PYR, and JP-8 does not profoundly alter many immunological endpoints, but does selectively target functional endpoints such as the PFC and DTH response. This should be considered when assessing human health risks in the military environment.     

Coenzyme Q(10), vitamin E, selenium, and methionine in the treatment of chronic recurrent viral mucocutaneous infections

ObjectiveHost defense and latency determinants in viral recurrent dermatologic infections are not entirely understood, as conventional protocols are inadequate to achieve fast healing and relapse prevention. Endogenously produced oxygen/nitrogen reactive species (ROS/RNS) are essential for antiviral immune defense, while their excess may aggravate skin inflammation. Here, we sought a nutritional approach capable of controlling ROS/RNS balance to accelerate recovery and inhibit recurrences of two mucocutaneous chronic DNA-virus infections.MethodsTwo controlled clinical trials evaluated the feasibility of ROS/RNS-modulating nutriceutical dosages of coenzyme Q₁₀, RRR-α-tocopherol, selenium aspartate, and L-methionine associated with established therapies. Clinical trial 1 evaluated 68 patients with relapsing human papillomavirus skin warts treated with cryotherapy followed by 180 d of nutriceutical/placebo administration. Clinical trial 2 compared the combination of acyclovir followed by 90 d of nutriceutical administration versus acyclovir alone in patients with recurrences of herpes simplex genitalis (n = 60) or herpes zoster (n = 29). Viral DNA levels were assessed by polymer chain reaction, biomarkers of antiviral defense (peroxynitrite and IFNα/γ) and antioxidant capacity (lipophilic antioxidants and glutathione) were assayed by biochemical/enzyme-linked immunosorbent assay techniques in blood fractions.ResultsIn both trials, the nutriceutical induced significantly faster healing (P < 0.01-0.05) with reduced incidence of relapses (P < 0.05) as compared to control groups, which was confirmed by decreased viral load and increased antiviral cytokine and peroxynitrite plasma levels. Plasma antioxidant capacity was higher (P < 0.01) in the experimental versus control groups.ConclusionsResults document positive clinical outcomes of the selected nutriceutical associated with conventional protocols in the management of relapsing mucocutaneous human papillomavirus and herpes infections.     

AHIMA provides testimony on coding/classification issues pertaining to HIPAA (Health Insurance Portability and Accountability Act of 1996) implementation

In summary, AHIMA has identified the following key issues: Uniformity and consistency must be required of all health-care organization, payers, and other data users. A central authority, comprised of representatives from the public and private sector, should be created to ensure compliance with and enforcement of coding system rules and official coding guidelines. A realistic implementation plan for the introduction of any new coding system, including migration to a single procedural classification system, must be established. Since data quality is based on the data source, clinical vocabulary, and classification system, it is important not to focus on only one component. A standard data set must be established. It is important to maintain data comparability with other nations in order to conduct global research studies. AHIMA has had a long-standing relationship working with the department on coding and classification issues and is committed to providing assistance to carry out out the requirements of the law.     

The effect of inaccuracies in death certification and coding practices in the European Economic Community (EEC) on international cancer mortality statistics

An investigation into the effect of national death certification and coding practices on published mortality statistics in eight EEC countries is reported. Doctors in each country were asked to complete specimen death certificates for a bank of written case histories. Certificates from each country were coded by their own offices and then by a WHO reference centre. Within and between countries, discrepancies occurred both in the doctors' diagnoses and in the codes assigned to certificates. At an international level these differences had serious implications for the comparability of mortality data for cancers of the cervix and uterus, and for mesotheliomas.