The inaccuracy of ICD-9-CM Code 530.2 for identifying patients with Barrett's esophagus

SUMMARY.  Barrett's esophagus (BE) is a chronic complication associated with gastroesophageal reflux disease. The ICD-9-CM code used for BE, 530.2, is also used for patients with 'ulcer of the esophagus.' We aimed to determine if the ICD-9-CM code of 530.2 is reliable for identifying cases of Barrett's esophagus within databases for research purposes. We reviewed the records of all patients assigned code 530.2 at two university medical center hospitals and a veterans' administration hospital over a cumulative 16-year period. Billing records provided information about where the code was assigned, whether it was a major or minor diagnosis, and if the code was assigned on multiple occasions for each patient. Histology and endoscopy records were reviewed to confirm the diagnosis of Barrett's esophagus. Among 435 patients with code 530.2 in their records, 354 (82%) had an esophageal biopsy reported and 393 (90%) had an endoscopy report available for review. Only 182 (42%) had specialized intestinal metaplasia documented in a biopsy from an area of salmon-colored mucosa arising above the esophagogastric junction (51% of those with histology available). There were 288 patients (66%) with an endoscopic diagnosis of Barrett's esophagus (73% of those with an endoscopy reported). Variables associated with documented specialized intestinal metaplasia were age ≥ 60 (OR 2.3; 95% CI 1.4–3.7), multiple assignments of 530.2 (OR 3.2; 95% CI 2.0–5.0), and assignment of 530.2 in a gastrointestinal (GI) clinic or an endoscopy unit (OR 3.5; 95% CI 2.0–6.3). The positive predictive value of the code being assigned in a GI location was 48% (95% CI 43–54%). Therefore, ICD-9-CM code of 530.2 is not specific for the diagnosis of Barrett's esophagus. The usage of code 530.2 in a GI setting was not sufficiently predictive of BE to be reliable for rigorous epidemiological studies.     

世界卫生资源配置模式探讨

采用主成分回归方法对138个国家的代表经济，文化、人口、健康和卫生资源配置等方面的指标进行研究，探讨卫生资源配置与社会，经济、文化和人口等因素的关系，为建立适宜于卫生资源配置的区域分类方法和分类制定卫生资源配置标准提供依据。     

医院药品的分类编码探讨

本文就医院药品的管理,设计了药剂学-药理学分类、四层五位全数字编码体系,并就编码的六统一,即医院基本用药目录、药库存放与入出库登记、药房存放与进耗存帐册、盘存记录等六个环节的编码实行统一进行了探讨。     

Chiari畸形的研究进展

Chiari畸形是以小脑扁桃体下疝畸形为特，止的先天性疾患，目前较为公认的理论是起源于胚胎中胚叶轴旁的枕骨原节发育不良所敏，其诊断主要依赖于MRI。根据解剖上的异常，通常分为4型。临床分型有利于术式的选择，有Pillay、Bindal等分型，但尚无公认的分型。手术是治疗Chiari畸形的唯一有效方法，针对不同病情相位采取后颅窝减压、分流术或减压加分流手术，大部分患者的症状和体征可以得到改善。     

Usefulness of the Newly Proposed International Classification of Epilepsies, Epileptic Syndromes, and Related Seizure Disorders (1989): A Trial on Adult Patients in a Neuropsychiatric Clinic

Abstract: The utility of the "International Classification of Epilepsies, Epileptic Syndromes, and Related Seizure Disorders," proposed by ILAE in 1989, was investigated in a neuropsychiatric clinic with a patient population numbering 300. Two hundred and three patients (67.7%) had localization-related epilepsies (LRE), including one idiopathic case. Sixty-six patients (22%) had generalized epilepsies, 50 idiopathic, 2 Lennox-Gastaut syndrome, and 14 symptomatic. Thirty-one patients (10.3%) with generalized tonic-clonic seizures occurring only during sleep had the epilepsies undetermined whether they are focal or generalized. In the symptomatic LRE cases, 34 cases could not be classified, and 7 of the cases with frontal lobe epilepsies were difficult to subtype. Eleven of the symptomatic LRE cases had some independent seizures, multiple foci in surface EEGs and were intractable. These cases may be defined as "multifocal epilepsies."     

Ultrasonic investigation of the hip in newborns in the diagnosis of congenital hip dislocation: classification and results of a screening program

Summary The method of ultrasonic examination of the hip is described, the latest updated Graf classification is explained, and the results of a prospective screening program are described. One thousand four hundred and sixty newborn infants were examined by ultrasound and clinically by independent observers. The distribution of the ultrasound types was determined. Recommendations are given for the use of ultrasonic investigation of the hip for groups at risk in the neonatal period.     

Classification of primary headaches

In 1988, the International Headache Society (IHS) classification committee published operational diagnostic criteria for the primary headaches and a broard range of other headache disorders. These criteria have been translated into more than ten languages, providing uniform terminology for clinical practice, multinational clinical trials, and biologic and epidemiologic research. The criteria have also been evaluated in a number of field studies intended to address their generalizability, exhaustiveness, reliability, and validity. In the present publication the IHS criteria for migraine and tension-type headache are presented.     

The relationship of pathologic classification and prognosis in diabetic nephropathy

Objective To explore the relationship between clinical manifestations and pathological changes in diabetic nephropathy (DN) and to assess the predictive power of the pathologic classification for DN established by the Renal Pathology Society in 2010. Methods Patients with type 1 or type 2 diabetes and biopsy-proven DN in the Third Affiliated Hospital of Sun Yat-sen University between January 2004 to June 2014 were enrolled in the present study and were followed-up until 31 December 2014. The outcome was defined as renal end-points including renal replacement therapy and doubling of serum creatinine as well as all-cause mortality. The laboratory and histologic data were analyzed and outcomes were assessed using survival analysis. Results Fifty-seven people enrolled in this study were categorized into Class IIa (n=9), Class IIb (n=9), Class III (n=25) and Class IV (n=14) while no participants belonged to Class I. The changes of Class IIa were slight and those of Class IV were severe both in the clinical data (diabetic duration, blood pressure, estimated glomerular filtration rate, urine protein excretion rate, albumin and hemoglobin) and the pathological data (percentage of global glomerulosclerosis, percentage and scoring of interstitial fibrosis and tubular atrophy, scoring of interstitial inflammation and incidence of large vessel lesions). There were no significant differences between Class IIb and III in the above variables except for the scoring of arteriosclerosis. The mean follow-up duration was 25.9 months. Twenty-five patients (43.9%) reached the renal outcomes and six people (10.5%) reached all-cause mortality. The survival analysis showed that there were significant differences among the renal survival curves of different glomerular classes and of different interstitial and vascular scorings, but not in the survival curves related to all-cause mortality. Conclusions The glomerular classes are not completely associated with renal prognosis. The clinical manifestations and renal outcomes are benign in Class IIa, moderate but similar in Class IIb and III and severe in Class IV. The glomerular classification and interstitial and vascular scorings are associated to renal prognosis while their associations with mortality remain to be verified.