Assessing the impact of health conditions using the ICF

Purpose.?People may suffer from diseases and a variety of health conditions, but a full understanding of the experience of their health condition also requires comprehensive information about the impact of the disease or the health condition on the person. This article operationalises the impacts of health conditions as classified in the International Classification of Diseases (ICD) in terms of the concept of functioning as found in the International Classification of Functioning, Disability and Health (ICF). It identifies a set of ICF categories as the functioning properties – to describe the impact of health conditions generically across health conditions to be jointly used with the ICD.

Method.?The ICF categories to characterise the functioning properties of any health condition have been selected from three main generic health profile instruments: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), the World Health Survey (WHS) Questionnaire and a list of candidate categories of the generic ICF core set.

Results.?A set of ICF categories to describe the impact of a health condition is presented according to specific functioning domains.

Conclusions.?The joint use of the ICD and the ICF through the list of functioning properties and in the context of ICD-11 development captures the valuable synergy of the two classifications. It enhances patient management, intervention design and the reporting of health. It also enables us to distinguish severity of disease from its impacts. The ICD–ICF joint use creates a shared formal representation across the continuum of care for health information system implementation.     

Posttraumatic Stress Disorder in DSM‐5: New Criteria and Controversies

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; American Psychiatric Association, 2013) featured extensive changes to the posttraumatic stress disorder (PTSD) diagnosis. PTSD was moved out of the anxiety disorders into a new class of “trauma‐ and stressor‐related disorders,” and the definition of what constitutes a traumatic experience was revised. Three new symptoms were added, existing ones were modified, and a new four‐cluster organization and diagnostic algorithm were introduced. Finally, a new dissociative subtype was added to the diagnosis. We review these changes, discuss some of the controversies surrounding them, and then introduce a new debate involving a radically different conceptualization of PTSD proposed for International Classification of Diseases, 11th edition.     

Prevention of sudden cardiac death beyond the ICD: Have we reached the boundary or are we just burning the surface?

Preventing sudden cardiac death (SCD) remains a major unsolved problem in contemporary medical practice. As the most common cause of SCD, treatment for ventricular arrhythmias is the target area of interest in research field. While implantable cardioverter-defibrillator (ICD) effectively decreases death from ventricular arrhythmias in highly selected patients, risk of inappropriate shocks, mortality from frequent therapy, chance of failing in abortion of arrhythmias despite having a defibrillator, and our inability to recognize which of several hundreds of thousands of patients at risk for sudden death but do not meet current criteria for defibrillator, limit ICD effectiveness. In this article, a brief review of mechanism leading to SCD, the existing evidence for a defibrillator and the lacunae in present guidelines for patients clearly at risk for sudden death but without proven benefit from a defibrillator are presented in Section I. Following this, interventional approaches, both catheter-based and general measures that may serve as adjuncts to a defibrillator in preventing this all too common catastrophic end event, are summarized in Section II.     

Use of external defibrillator jacket to facilitate safe delivery of radiotherapy for lung cancer – A report of two cases

The increasing rate of implantable cardioverter defibrillator (ICD) implantation coupled with shared risk factors between lung cancer and ischemic cardiac disease means that the need for radiotherapy in cardiac device patients is set to become commonplace. We describe two cases referred to our electrophysiology service over a 6-month period. Both had been diagnosed with lung cancer in tissue directly posterior to a previously implanted ICD device. The cases highlight the risks to device function caused by ionizing radiation, the practical difficulties and ethical dilemmas of delivering radiotherapy to cardiac device patients safely and a novel setting for the use of a wearable defibrillator system.     

The localization of HER4 intracellular domain and expression of its alternately-spliced isoforms have prognostic significance in ER+ HER2- breast cancer

Human epidermal growth factor receptors (HERs) are known to play a pivotal role in breast cancer, both as prognostic markers and as therapeutic targets. The importance of Her4 expression is, however, still controversially discussed; there are few reports on the clinical significance of HER4, its splice variants, and cleaved HER4 intracellular domains (4ICD) which function differently depending on their localization in breast cancer. In 238 primary invasive breast cancer patients, we analyzed the expression levels of HER4 extracellular (JM-a and JM-b) and intracellular (CYT-1 and CYT-2) domains as well as 4ICD localization, and tested the relationship with clinicopathological characteristics and prognosis. The predominantly-expressed extracellular domain was JM-a, and lower CYT-2 dominance was a factor related to better relapse-free survival. CYT-2-dominance with higher nuclear 4ICD expression was a favorable prognostic marker especially in patients with the ER+ HER2- subtype treated with endocrine therapy. The absence of cytoplasmic 4ICD staining was related to better prognosis in CYT-1-dominant patients. In conclusion, analysis of splicing variants and 4ICD localization should be considered when targeting HER4 as a novel ER+/HER2- breast cancer treatment.     

Orbital Measurement in Black and White Populations

Objective: Obtain measurements of globe projection, intercanthal distance (ICD), interpupillary distance (IPD), palpebral fissure width (PFW), and palpebral fissure height (PFH) in a population of presumably normal white and black adults to determine if any significant differences exist between these groups. Study Design: Prospective direct measurement of cohorts regarding orbital and globe measurements in a tertiary medical center. Methods: Measurements of globe projection, ICD, IPD, PFW, and PFH were taken in 61 black adults and directly compared with measures taken from 65 white adults in an outpatient setting. Mean values and ranges were calculated and compared between races and sexes using an unpaired t test. Results: A significant difference was found between races for globe projection, with black males demonstrating a mean projection of 18.23 ± 2.26 mm as compared with 17 ± 2.65 mm for white males (P > .025). Black females demonstrated a mean projection of 17.27 ± 1.44 mm as compared with 15.98 ± 2.22 mm for white females (P > .01). Similar differences were seen for measures of IPD and PFW, with greater mean values for black as compared with white adults. No racial differences existed for ICD or PFH. Conclusions: These findings suggest that racial differences exist for certain measures of globe and orbital position, i.e., projection, IPD, and PFW. Racial background should be considered when evaluating orbital anatomy.     

2009年浙江省中医医院住院优势病种分析

目的:了解各级中医医院优势病种的差别。方法:对2009年浙江省省级、地市级和县区级中医医院进行抽样调查。按照ICD-10疾病分类法对住院病人的病种相关信息进行分析,比较疾病构成比和中医药参与治疗率之间的差别。结果:不同级别中医医院的优势病种构成差别很大,地市级中医医院的中医药参与治疗率最低。结论:中医优势病种在不同级别中医医院之间是不均衡的,地市级中医医院的中医特色优势还有待加强。     

Subcutaneous implantable cardioverter-defibrillator electrode fracture: Follow-up,troubleshooting, and evaluation

The subcutaneous-implantable cardioverter-defibrillator (S-ICD) and its electrode were developed to avoid long-term complications of transvenous leads in the vasculature. We report a case of unexpected, inappropriate S-ICD shocks due to oversensing of high-amplitude, nonphysiologic, electrical noise artifacts that were not preceded by high-impedance alerts or sensing electrogram noise detections. Following explant, high-magnification X-ray imaging of the S-ICD electrode demonstrated partial fracture of the distal sensing conductor located near a short radius bend in the electrode at the electrode-header interface. Clinicians should be aware of a potential for fatigue failure fracture of the S-ICD electrode. Recommendations for systematic S-ICD follow-up and troubleshooting are discussed.     

Implantable cardioverter defibrillator shocks from ventricular tachyarrhythmias in patients with ischemic heart disease: Preventative measures,shortcomings, cost-effectiveness,and global practice perspectives

Implantable cardioverter defibrillators (ICDs) have proven to be life-saving devices in patients with ischemic cardiomyopathy (ICM) who are prone to develop ventricular tachycardia (VT) and fibrillation (VF). Antiarrhythmic drugs (AADs) are commonly prescribed in many such patients with ICDs to treat and prevent different forms of arrhythmias in clinical practice. When these patients experience recurrent monomorphic VT despite chronic AADs therapy, or when AAD therapy is contraindicated or not tolerated, and VT storm is refractory to AAD therapy, catheter ablation constitute guideline-based class I indication of treatment. However, what should be the most appropriate strategy to prevent first ICD shock or subsequent multiple shocks from VT/VF in patients with ICM who undergo ICD implantation without prior incidence of cardiac arrest, remains debatable. The purpose of this review is to discuss preventative aspects of ICD shocks for VT and the shortcomings of these measures along with the cost-effectiveness and global perspectives based on the current knowledge of the topic.