Exploring in-hospital adverse drug events using ICD-10 codes

 Abstract
Objective Adverse drug events (ADEs) during hospital admissions are a widespread problem associated with adverse patient outcomes. The ‘external cause’ codes in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) provide opportunities for identifying the incidence of ADEs acquired during hospital stays that may assist in targeting interventions to decrease their occurrence. The aim of the present study was to use routine administrative data to identify ADEs acquired during hospital admissions in a suburban healthcare network in Melbourne, Australia.

Methods Thirty-nine secondary diagnosis fields of hospital discharge data for a 1-year period were reviewed for ‘diagnoses not present on admission’ and assigned to the Classification of Hospital Acquired Diagnoses (CHADx) subclasses. Discharges with one or more ADE subclass were extracted for retrospective analysis.

Results From 57 205 hospital discharges, 7891 discharges (13.8%) had at least one CHADx, and 402 discharges (0.7%) had an ADE recorded. The highest proportion of ADEs was due to administration of analgesics (27%) and systemic antibiotics (23%). Other major contributors were anticoagulation (13%), anaesthesia (9%) and medications with cardiovascular side-effects (9%).

Conclusion Hospital data coded in ICD-10 can be used to identify ADEs that occur during hospital stays and also clinical conditions, therapeutic drug classes and treating units where these occur. Using the CHADx algorithm on administrative datasets provides a consistent and economical method for such ADE monitoring.

What is known about the topic? Adverse drug events (ADEs) can result in several different physical consequences, ranging from allergic reactions to death, thereby posing a significant burden on patients and the health system. Numerous studies have compared manual, written incident reporting systems used by hospital staff with computerised automated systems to identify ADEs acquired during hospital admissions. Despite various approaches aimed at improving the detection of ADEs, they remain under-reported, as a result of which interventions to mitigate the effect of ADEs cannot be initiated effectively.

What does this paper add? This research article demonstrates major methodological advances over comparable published studies looking at the effectiveness of using routine administrative data to monitor rates of ADEs that occur during a hospital stay and reviews the type of ADEs and their frequency patterns during patient admission. It also provides an insight into the effect of ADEs that occur within different hospital treating units. The method implemented in this study is unique because it uses a grouping algorithm developed for the Australian Commission on Safety and Quality in Health Care (ACSQHC) to identify ADEs not present on admission from patient data coded in ICD-10. This algorithm links the coded external causes of ADEs with their consequences or manifestations. ADEs identified through the use of programmed code based on this algorithm have not been studied in the past and therefore this paper adds to previous knowledge in this subject area.

What are the implications for health professionals? Although not all ADEs can be prevented with current medical knowledge, this study can assist health professionals in targeting interventions that can efficiently reduce the rate of ADEs that occur during a hospital stay, and improve information available for future medication management decisions.

Performances of rainfall-runoff models calibrated over single and continuous storm flow events

Accurate parameter estimation is important for reliable rainfall-runoff modeling. Previous studies emphasize that a sufficient length of continuous events is required for model calibration to overcome the effect of initial conditions. This paper investigates the feasibility of calibrating rainfall-runoff models over a number of limited storm flow events. For a subcatchment having a moderate influence from initial soil moisture conditions, this study shows that rainfall-runoff models could still be calibrated reliably over a set of representative events provided that the events cover a wide range of peak flow, total runoff volume, and initial soil moisture conditions. This approach could provide an alternative calibration strategy for a small watershed that has a limited data length but consists of runoff events with a wide range of magnitudes. Compared to continuous-event calibration, event-based calibration appears to perform better in simulating the overall shape of hydrograph, peak flow and time to peak. However, continuous-event calibration was found to be more reliable in providing runoff volume, suggesting that continuous-event calibration should still be used when runoff volume is the main concern of a study.

The Victorian bushfires and extreme weather events : media coverage, crisis and communication

The 2009 'Black Saturday' Victorian bushfires claimed the lives of 173 people and have become known as the worst fire event in Australian history. Victoria has been at the centre of two other significant Australian fire disasters - 'Black Friday' in 1939 and the 1983 'Ash Wednesday' fires in south-eastern Australia that claimed the lives of 47 people in Victoria. As media scholar and commentator Michael Gawenda has noted, the media not only report an 'event' - like the Victorian bushfires or the tsunami in the South Pacific - but in a sense create and define it. Print and electronic media coverage of extreme weather events therefore raises a multitude of issues about the media's role in serving the community before, during and after a crisis, while also trying to produce the best possible reportage in a competitive industry undergoing dramatic change. This issue of MIA provides a venue for critical, empirical engagement with media coverage and representation, and the role of journalism and journalists in reporting national and international bushfires, tsunamis, hurricanes and other extreme weather events, with a special focus on the 2009 Victorian bushfires. Its goal is to address the ramifications of an industry in flux - indeed, some may say crisis - driven by technological advances, staff reductions and media organisations under financial pressure, and to explore the ways in which such extreme weather events have impacted media practices and policy

Deleuze's neo-leibnizianism, events and the logic of sense's 'static ontological genesis'

In The Logic of Sense, Deleuze effectively argues that two types of relation between events govern their ‘evental’ or ‘ideal play’, and ultimately underlie determined substances, that is, worldly individuals and persons. Leibniz calls these relations ‘compossibility’ and ‘incompossibility’. Deleuze calls them ‘convergence’ and ‘divergence’. This paper explores how Deleuze appropriates and extends a number of Leibnizian concepts in order to ground the idea that events have ontological priority over substances ‘all the way down’.

Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review

A hypoglycemia-induced fall is common in older persons with diabetes. The etiology of falls in this population is usually multifactorial, and includes microvascular and macrovascular complications and age-related comorbidities, with hypoglycemia being one of the major precipitating causes. In this review, we systematically searched the literature that was available up to March 31, 2014 from MEDLINE/PubMed, Embase, and Google Scholar using the following terms: hypoglycemia; insulin; diabetic complications; and falls in elderly. Hypoglycemia, defined as blood glucose <4.0 mmol/L (70 mg/dL) requiring external assistance, occurs in one-third of elderly diabetics on glucose-lowering therapies. It represents a major barrier to the treatment of diabetes, particularly in the elderly population. Patients who experience hypoglycemia are at a high risk for adverse outcomes, including falls leading to bone fracture, seizures, cognitive dysfunction, and prolonged hospital stays. An increase in mortality has been observed in patients who experience any one of these events. Paradoxically, rational insulin therapy, dosed according to a patient's clinical status and the results of home blood glucose monitoring, so as to achieve and maintain recommended glycemic goals, can be an effective method for the prevention of hypoglycemia and falls in the elderly. Contingencies, such as clinician-directed hypoglycemia treatment protocols that guide the immediate treatment of hypoglycemia, help to limit both the duration and severity of the event. Older diabetic patients with or without underlying renal insufficiency or other severe illnesses represent groups that are at high risk for hypoglycemia-induced falls and, therefore, require lower insulin dosages. In this review, the risk factors of falls associated with hypoglycemia in elderly diabetics were highlighted and management plans were suggested. A target hemoglobin A1c level between 7% and 8% seems to be more appropriate for this population. In addition, the first-choice drugs should have good safety profiles and have the lowest probability of causing hypoglycemia - such as metformin (in the absence of significant renal impairment) and incretin enhancers - while other therapies that may cause more frequent hypoglycemia should be avoided.

Psychosocial moderators of associations between life events and changes in physical activity after leaving high school

To examine 1) associations between life events and changes in leisure-time physical activity (LTPA) in school leavers and 2) whether these associations are moderated by psychosocial factors.

Using patients' experiences of adverse events to improve health service delivery and practice: protocol of a data linkage study of Australian adults age 45 and above

Evidence of patients' experiences is fundamental to creating effective health policy and service responses, yet is missing from our knowledge of adverse events. This protocol describes explorative research redressing this significant deficit; investigating the experiences of a large cohort of recently hospitalised patients aged 45 years and above in hospitals in New South Wales (NSW), Australia.

The impact of past direct-personal traumatic events on 12-month outcome in first episode psychotic mania: trauma and early psychotic mania

Past traumatic events have been associated with poorer clinical outcomes in people with bipolar disorder. However, the impact of these events in the early stages of the illness remains unclear. The aim of this study was to investigate whether prior traumatic events were related to poorer outcomes 12 months following a first episode of psychotic mania.

Analysis of serious non-AIDS events among HIV-infected adults at Latin American sites

Acquired immune deficiency appears to be associated with serious non-AIDS (SNA)-defining conditions such as cardiovascular disease, liver and renal insufficiency and non-AIDS-related malignancies. We analysed the incidence of, and factors associated with, several SNA events in the LATINA retrospective cohort.

Mega-events and mega-profits: Unravelling the Vancouver 2010 security–development nexus

Academic and political commentators have commonly sought to understand the Olympics as a cultural dynamic, a "spectacle" that motivates certain actors to project their relative interests in localized spaces and as well on a global scale (Hiller 2006; Boyle and Haggerty 2009b ). Mega-events, as this argument goes, are monumental cultural events (Roche 2000) that rely on the audacity of spectacle to dramatize and condition the cultural, political, legal and economic landscape. Extending these insights into surveillance studies, Boyle and Haggerty (2009b: 259-260) position spectacle and the disciplinary mechanisms of anxieties associated with mega-events to explain the risk management practices of security planners. The dynamic social implications of the spectacle condition dramatic regimes of securitization and surveillance such that sovereign power emanates from the production and consumption of spectacle. In similar fashion Vida Bajc (2007: 1648) writes that security meta-rituals "demonstrate[s] that the process of transformation of [the] public space [of mega-events] from one of routine of daily life into a sterile area [that] has a ritual form [that] .... separates insiders from outsiders and brings about a new socio-political reality." Put another way, the "security-meta ritual" legitimates security and surveillance practices by normalizing the social hierarchies it imposes. Bajc focuses on the over-determination of dividing practices in mega-event security, but the signifying practices associated with capital are absent (perhaps due to her empirical focus on presidential addresses). Klauser (2008: 181) links commercialization and mechanisms of surveillance, but only by foregrounding the significance of "neutralized space" created by granting absolute commercial rights to event sponsors. Neoliberalprivatization and its articulation with security and surveillance, however, cannot be reduced to control over sponsorship rights and consumptive practices in particular urban "zones," nor can it be limited by the methodological temporality of the event itself.

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Adverse events associated with lithium and anticonvulsant use in patients with bipolar disorder have been determined to decrease rates of treatment adherence; however, research that explores how adverse events influence treatment adherence, and which events have the greatest impact, is sparse and limited. This paper reviews the existing literature regarding common side effects encountered with lithium and anticonvulsant use in patients with bipolar disorder and presents data regarding their impact on treatment adherence. Guidelines for reducing and limiting adverse events are highlighted, as are recommendations for improving compliance associated with the experience of adverse events in the bipolar disorder population.

Amiodarone, anticoagulation, and clinical events in patients with atrial fibrillation: insights from the ARISTOTLE trial

Amiodarone is an effective medication in preventing atrial fibrillation (AF), but it interferes with the metabolism of warfarin.