Accuracy of administrative coding in identifying hip and knee primary replacements and revisions

Rationale, aims and objectives Hospital discharge notes can be used to identify rates of revisions in hip and knee arthroplasty surgeries if such administrative codes are accurate. In order to trust the data taken from the hospital discharge abstracts it is important to assess their reliability. The purpose of this study is to evaluate the accuracy of the administrative coding used in measuring revision rates for total hip and knee arthroplasty. Methods Validation coding was determined by two orthopaedic surgery residents who reviewed the operative, radiological and discharge summaries in order to identify the revision rates for total hip and knee arthroplasty. A random sample of 637 patients from two tertiary care hospitals was studied. These patients had total hip or knee arthroplasty between 1996 and 2006. All of these patients had an International Classification of Disease (ICD)‐9CM or ICD‐10CM code indicating what procedure they had done. The validation reviewers were blinded to the administrative codes used. The sensitivity, specificity and positive and negative predictive values of the administrative codes for revision rates were measured. Results Based on 1201 procedures performed on 637 patients, when comparing validation review versus hospital administrative chart coding for primary and revision surgeries of total hip and knee arthroplasty, the following data were obtained: for total hip arthroplasty sensitivity is 99%, specificity is 91%, positive predictive value is 91% and negative predictive value is 99%; for total knee arthroplasty sensitivity is 89%, specificity is 98%, positive predictive value is 97% and negative predictive value is 93%. The accuracy of ICD‐9CM and ICD‐10CM were 96% and 95%, respectively. Conclusion This study demonstrates that ICD‐9CM and ICD‐10CM codes can be used accurately when analysing hip and knee arthroplasty. This study was conducted in a large tertiary academic centre where a significant number of records analysts are employed; therefore, there should be little inter‐hospital error. These results should help researchers understand the potential accuracy of classification for these procedures as part of an audit or quality assurance project.     

Stigma,Social Comparison and Self‐Esteem in Adults with an Intellectual Disability

Background The paper examines the perception of stigma in 43 adults with an intellectual disability, the relationship this has with their psychological well‐being and whether the process of social comparison has a moderating effect on this relationship. Materials and Methods A questionnaire‐based, within‐participant design was used. Participants completed three self‐report measures of perception of stigma, self‐esteem and social comparison. Results Perception of stigma was found to be significantly related to negative social comparisons, which in turn was significantly related to low self‐esteem. No difference was found between social comparisons made with other service users and those made with people in the community. Social comparison was not found to have a moderating effect on the relationship between stigma and self‐esteem. Conclusion This study provides support for the influence of the perception of stigma and social comparison on the self‐concept of individuals with an intellectual disability.     

Harmonization and external quality assessment of antithrombin activity assays

In the framework of a Dutch project named “Calibration 2000” harmonization of antithrombin activity assays was studied. The commutability of potential calibrators for antithrombin was assessed by means of a twin-study design, which is a multicentre, split-patient sample, between-field-methods protocol. The twin-study consisted of simultaneous analysis of fresh-frozen patient plasmas and three potential calibrators for antithrombin by 30 Dutch laboratories forming 15 couples. The state-of-the-art intralaboratory standard deviation (SD_SA) was used to assess the commutability of the potential calibrators. The regression line residuals for the potential calibrators were normalized by expressing them as multiples of SD_SA. All residuals of the potential calibrators were within the 3 × SD_SA limit. One potential calibrator was used in an attempt to harmonize antithrombin assay results in a Dutch field study. The interlaboratory coefficient of variation (CV) of the antithrombin results for three test samples could be reduced from 6.9 - 13.2% (before harmonization) to 5.6 - 9.8% using the common calibrator.

Conclusion

The potential calibrators were commutable. Limited harmonization was achieved by using a common calibrator for all participants.     

留学生药理学教材与国内教材对比浅析——以肾上腺皮质激素章为例

随着留学生药理学课程教学的日益成熟,教师对使用的中外教材的优缺点有了较清晰的认识。文章对美国著名医学院校教材Pharmacology lippincott与我国国家级规划药理学教材进行了对比,国内教材显示出系统化、条理化优势,机制方面阐述详尽而lippincott以图示和一些细节见长,建议讲授时取长补短,才能相得益彰。     

不同检测系统21项常规生化结果的比对与临床可接受性评价

目的探讨不同检测系统间常规生化结果的可比性,为本实验室不同检测系统检验结果的互认和实验室认可提供依据。方法参考美国临床实验室标准化委员会（NCCLS）的EP9-A2文件,以Modular P-800检测系统为目标,用患者新鲜血清对不同实验（自建）检测系统的21项常规生化结果与目标检测系统进行比对,计算实验检测系统（Y）和目标检测系统（X）之间的相对偏差,以美国临床医学检验部门修正法规（CLIA′88）允许总误差的1/2为标准,判断检验结果的可比性。结果实验检测系统1的总蛋白（TP）、谷丙转氨酶（ALT）、碱性磷酸酶（ALP）、直接胆红素（DBil）、尿素（Urea）、无机磷（P）与目标系统不具可比性,实验检测系统2的r-谷氨酰基转移酶（GGT）、DBIL、尿酸（UA）、三酰甘油（TG）、P与目标检测系统不具可比性,实验检测系统3的所有21个项目与目标检测系统均具可比性。结论实验检测系统与目标检测系统的常规生化结果依项目不同存在不同程度的偏差;当用2个以上的检测系统检测同一检验项目时,应进行方法比对和临床可接受性评价,以实现检验结果的可比性。     

不同血气分析仪检测结果的一致性评价

目的实验室内部以及实验室间不同检测方法的一致性研究已是临床实验室质量管理内容之一,血气分析由于其标本的不稳定性,使其一致性研究比其他生化分析项目更困难,我们对血气分析检测结果一致性研究方法进行了探讨,以寻找一种合理的比对方法。方法建立我室两种检测仪器对质控品、病人全血标本检测结果以及美国病理学家学会室间质评PT回报数据,三类标本参照CLSI EP9-A2文件,进行回归相关分析和配对t检验,以1/2 CLI-A’88允许误差作为临床可接受判断标准,并对三类标本检测数据之间的差异进行单因素方差分析。结果三类标本分析得到相同的趋势结果,两检测系统pH、PCO2和PO2具有良好的相关性（P〈0.01）;配对t检验都显示两系统除PO2外,pH和PCO2检测结果无统计学差异（P〉0.05）,平均SE〈1/2 CLIA’88允许误差,可被临床接受;方差分析表明三类标本间差异没有统计学差异（P〉0.05）。结论两种检测系统具有相同差异趋势,都可用于血气分析仪的比对,可根据实验室具体情况进行适当选择。     

Attitudes of Dutch, German and Swiss nursing staff towards physical restraint use in nursing home residents, a cross-sectional study

Objective

To investigate the attitudes of nursing staff towards restraint measures and restraint use in nursing home residents, and to investigate if these attitudes are influenced by country of residence and individual characteristics of nursing staff.

Methods

A questionnaire on attitudes regarding restraints (subscales: reasons, consequences, and appropriateness of restraint use) and opinions regarding the restrictiveness of restraint measures and discomfort in using them was distributed to a convenience sample of nursing staff in The Netherlands (n = 166), Germany (n = 258), and Switzerland (n = 184).

Results

In general, nursing staff held rather neutral opinions regarding the use of physical restraints, but assessed the use of restraints as an appropriate measure in their clinical practice. Gender and age were not related to attitudes of nursing staff, but we did find some differences in attitudes between nursing staff from the different countries. Dutch nursing staff were most positive regarding the reasons of restraint use (p < 0.01), but were less positive than German and Swiss nursing staff regarding the appropriateness of restraint use (p < 0.01). Swiss nursing staff were less positive than German nursing staff regarding the appropriateness of restraint use (p < 0.01). Nursing staff with longer clinical experience showed a more negative attitude towards restraint use than nursing staff with less experience (p < 0.05) and charge nurses had the least positive attitude towards restraint use (p < 0.05).Opinions regarding restraint measures differed between the three countries. The use of bilateral bedrails was considered as a moderate restrictive measure; the use of belts was rated as the most restrictive measure and nursing staff expressed pronounced discomfort on the use of these measures.

Conclusions

Nursing staff from three European countries have different attitudes and opinions regarding the use of physical restraints. The results underline the importance of more tailored, culturally sensitive interventions to reduce physical restraints in nursing homes.     

Nurses’ attitudes to mental illness: A comparison of a sample of nurses from five European countries

Background

Mental health problems are of serious concern across Europe. A major barrier to the realisation of good mental health and well-being is stigma and discrimination. To date there is limited knowledge or understanding of mental health nurses’ attitudes towards mental illness and individuals experiencing mental health problems.

Objectives

To describe and compare attitudes towards mental illness and those experiencing mental health problems across a sample of registered nurses working in mental health settings from five European countries and the factors associated with these attitudes.

Design

A questionnaire survey.

Settings

A total of 72 inpatient wards and units and five community facilities in Finland, Lithuania, Ireland, Italy and Portugal.

Participants

810 registered nurses working in mental health settings.

Methods

The data were collected using The Community Attitudes towards the Mentally Ill (CAMI) scale, which is a 40-item self-report questionnaire. The data were analysed using quantitative methods.

Results

Nurses’ attitudes were mainly positive. Attitudes differed across countries, with Portuguese nurses’ attitudes being significantly more positive and Lithuanian nurses’ attitudes being significantly more negative than others’. Positive attitudes were associated with being female and having a senior position.

Conclusions

Though European mental health nurses’ attitudes to mental illness and people with mental health problems differ significantly across some countries, they are largely similar. The differences observed could be related to wider social, cultural and organisational circumstances of nursing practice.     

A Qualification Course in an International Emergency Medicine Intervention

Background: The Tuscan Emergency Medicine Initiative is a comprehensive training program for physicians designed to create a lasting infrastructure for training in emergency medicine (EM) in a region of Italy. A “Train-the-Trainers” model was utilized to prepare physicians who were working in the emergency department (ED) to become the teachers of EM, and a master's program was created to train the next generation of emergency physicians as well as to put in place a structure into which residency training in EM will be placed. This model has been used in other projects as well; however, the dilemma of what to do with physicians who are already in practice remained an unsolved problem. Objectives: We wished to create a qualification course in EM for this important group of physicians. Methods: Didactic lectures, workshops, simulations, and clinical rotations were utilized to standardize current emergency care delivery in the region's EDs. Results: Between 2005 and 2008, 488 physicians completed the program. Conclusions: We propose this model as a way of training and including the physicians caught in the transition to specialty training in any area developing the specialty of EM.     

The impact of social comparison on the neural substrates of reward processing: An event-related potential study

Event-related potentials (ERPs) were recorded to explore the electrophysiological correlates of reward processing in the social comparison context when subjects performed a simple number estimation task that entailed monetary rewards for correct answers. Three social comparison stimulus categories (three relative reward levels/self reward related to the other subject's) were mainly prepared: Self:Other = 1:2 (Disadvantageous inequity condition); Self:Other = 1:1 (Equity condition); and Self:Other = 2:1 (Advantageous inequity condition). Results showed that: both Disadvantageous and Advantageous inequity elicited a more negative ERP deflection (N350–550) than did Equity between 350 and 550 ms, and the generators of N350–550 were localized near the parahippocampal gyrus and the medial frontal/anterior cingulate cortex, which might be related to monitor and control reward prediction error during reward processing. Then, Disadvantageous and Advantageous inequity both elicited a more late negative complex (LNC1 and LNC2) than did Equity between 550 and 750 ms. The generators of LNC1 and LNC2 were both localized near the caudate nucleus, which might be related to reward processing under social comparison.