How many diagnosis fields are needed to capture safety events in administrative data? Findings and recommendations from the WHO ICD-11 Topic Advisory Group on Quality and Safety

OBJECTIVE: As part of the WHO ICD-11 development initiative, the Topic Advisory Group on Quality and Safety explores meta-features of morbidity data sets, such as the optimal number of secondary diagnosis fields. DESIGN: The Health Care Quality Indicators Project of the Organization for Economic Co-Operation and Development collected Patient Safety Indicator (PSI) information from administrative hospital data of 19-20 countries in 2009 and 2011. We investigated whether three countries that expanded their data systems to include more secondary diagnosis fields showed increased PSI rates compared with six countries that did not. Furthermore, administrative hospital data from six of these countries and two American states, California (2011) and Florida (2010), were analysed for distributions of coded patient safety events across diagnosis fields. RESULTS: Among the participating countries, increasing the number of diagnosis fields was not associated with any overall increase in PSI rates. However, high proportions of PSI-related diagnoses appeared beyond the sixth secondary diagnosis field. The distribution of three PSI-related ICD codes was similar in California and Florida: 89-90% of central venous catheter infections and 97-99% of retained foreign bodies and accidental punctures or lacerations were captured within 15 secondary diagnosis fields. CONCLUSIONS: Six to nine secondary diagnosis fields are inadequate for comparing complication rates using hospital administrative data; at least 15 (and perhaps more with ICD-11) are recommended to fully characterize clinical outcomes. Increasing the number of fields should improve the international and intra-national comparability of data for epidemiologic and health services research, utilization analyses and quality of care assessment.

Estudio de la estensión urbana de la ciudad de Port-Saint-Louis-du-Rhône, Marsella

Projecte presentat en el concurs d'estudis per a l'extensió urabana de la ciutat de Port-Saint-Louis-du-Rhône

« Histoire sommaire du commerce et de la navigation des anciens, » par P.-D. HUET. (1669).

Ms. autographe, dédié à Colbert.

El carrer del Port

Projecte presentat al concurs "La transformació urbana de la Ronda Barceló"

Iowa Highway Safety Program, Iowa Department of Public Safety, 2008

Annual Highway Safety Report for Iowa Department of Public Safety.

Mémoire instructif concernant la ville de St. Jean-Pied-de-Port, et sa citadelle

Ancien possesseur : Argenson, Antoine-René de Voyer (1722-1787 ; marquis de Paulmy d')

Treatment of acute uncomplicated falciparum malaria with artemether-lumefantrine in nonimmune populations: a safety, efficacy, and pharmacokinetic study.

The efficacy and safety of artemether-lumefantrine for the treatment of malaria in nonimmune populations are not well defined. In this study, 165 nonimmune patients from Europe and non-malarious areas of Colombia with acute, uncomplicated falciparum malaria or mixed infection including P. falciparum were treated with the six-dose regimen of artemether-lumefantrine. The parasitologic cure rate at 28 days was 96.0% for the per protocol population (119/124 patients). Median times to parasite clearance and fever clearance were 41.5 and 36.8 hours, respectively. No patient had gametocytes after Day 7. Treatment was well tolerated; most adverse events were mild to moderate and seemed to be related to malaria. There were few serious adverse events, none of which were considered to be drug-related. No significant effects on ECG or laboratory parameters were observed. In conclusion, the six-dose regimen of artemether-lumefantrine was effective and well tolerated in the treatment of acute uncomplicated falciparum malaria in nonimmune patients.

Long-term safety and effectiveness of ritonavir, nelfinavir, and lopinavir/ritonavir in antiretroviral-experienced HIV-infected children.

AIM: To evaluate the long-term safety and effectiveness of ritonavir, nelfinavir, and lopinavir/ritonavir in antiretroviral-experienced, initially protease inhibitor (PI)-naive, human immunodeficiency virus (HIV)-1-infected children. METHODS: HIV-1-infected children enrolled in the Swiss Mother and Child HIV Cohort Study were eligible for this observational cohort study if they received at least 1 PI of interest between March 1996 and October 2003: ritonavir, nelfinavir, or lopinavir/ritonavir. Data regarding demographics, clinical disease and antiretroviral treatment history, HIV-1 RNA copies/mL, CD4 T-cell counts [absolute (cells/microL) and percentages (%)], adverse events, clinical laboratory values, reasons for discontinuation of PIs, and concomitant medications were extracted from the database for PI-naive (first-line) and PI-experienced (second- or higher-line) PI use. RESULTS: The total duration of ritonavir, nelfinavir, and lopinavir/ritonavir use for 133 HIV-1-infected children was 163.8, 235.0, and 46.1 patient-years, respectively. In an on-treatment analysis, first-line therapy with any of the PIs significantly reduced HIV-1 concentrations and increased CD4 T-cell counts and percentages from baseline throughout the 288-week study (P <or= 0.05) for ritonavir and nelfinavir and throughout 84 weeks of use for lopinavir/ritonavir, which was introduced into treatment more recently. All PIs investigated were most effective in PI-naive children. Thirteen PI-associated toxicities occurred requiring treatment changes or interruptions (neurologic symptoms, n = 2; pancreatitis, n = 1; allergic reactions, n = 4; visual symptoms, n = 3; and hyperlipidemia, n = 3). CONCLUSIONS: Long-term PI-based therapy seems to be safe and to result in durable virologic and immunologic effectiveness in HIV-1-infected antiretroviral-experienced children.

Department of Public Safety, FY 2007

These Facts sheets have been developed to provide a multitude of information about executive branch agencies/departments on a single sheet of paper. The Facts provides general information, contact information, workforce data, leave & benefits information, and affirmative action data. This is the most recent update of information for the fiscal year 2007.

Department of Public Safety, FY 2008

These Facts sheets have been developed to provide a multitude of information about executive branch agencies/departments on a single sheet of paper. The Facts provides general information, contact information, workforce data, leave & benefits information, and affirmative action data. This is the most recent update of information for the fiscal year 2007.

A phase 2 randomized trial of radiotherapy (RT) plus panitumumab compared to chemoradiotherapy in patients with unresected, locally advanced squamous cell carcinoma of the head and neck (SCCHN): interim pooled safety analysis

Background: Panitumumab (pmab), a fully human monoclonal antibody against the epidermal growth factor receptor (EGFR), is indicated as monotherapy for treatment of metastatic colorectal cancer. This ongoing study is designed to assess the efficacy and safety of pmab in combination with radiotherapy (PRT) compared to chemoradiotherapy (CRT) as initial treatment of unresected, locally advanced SCCHN (ClinicalTrials.gov Identifier: NCT00547157). Methods: This is a phase 2, open-label, randomized, multicenter study. Eligible patients (pts) were randomized 2:3 to receive cisplatin 100 mg/m2 on days 1 and 22 of RT or pmab 9.0 mg/kg on days 1, 22, and 43. Accelerated RT (70 to 72 Gy − delivered over 6 to 6.5 weeks) was planned for all pts and was delivered either by intensity-modulated radiation therapy (IMRT) modality or by three-dimensional conformal (3D-CRT) modality. The primary endpoint is local-regional control (LRC) rate at 2 years. Key secondary endpoints include PFS, OS, and safety. An external, independent data monitoring committee conducts planned safety and efficacy reviews during the course of the trial. Results: Pooled data from this planned interim safety analysis includes the first 52 of the 150 planned pts; 44 (84.6%) are male; median (range) age is 57 (33−77) years; ECOG PS 0: 65%, PS 1: 35%; 20 (39%) pts received IMRT, and 32 (61%) pts received 3D-CRT. Fifty (96%) pts completed RT, and 50 pts received RT per protocol without a major deviation. The median (range) total RT dose administered was 72 (64−74) Gy. The most common grade _ 3 adverse events graded using the CTCAE version 3.0 are shown (Table). Conclusions: After the interim safety analysis, CONCERT-2 continues per protocol. Study enrollment is estimated to be completed by October 2009.

El Comportament humà en situacions de crisi: resultats del projecte de recerca europeo BESECU

Les aportacions que es presenten en aquest llibre mostren els resultats de la investigació sobre el comportament humà en situacions d’emergència que s’ha dut a terme en el marc del projecte de recerca europeu BeSeCu. El projecte Be- SeCu —acrònim de Behaviour, Security and Culture (Comportament, Seguretat i Cultura)— forma part de la línia d’investigació i coneixement en matèria de seguretat del Setè Programa Marc de la Unió Europea. Concretament, el projecte es centra en una de les necessitats bàsiques establertes per la política europea en matèria de seguretat, com és la de conèixer en profunditat la realitat de les emergències a través de les persones que les han patit o dels professionals que hi treballen diàriament. Per assolir aquest objectiu, el projecte ha investigat les diferències i similituds del comportament humà en diferents situacions d’emergència i en diversos països europeus per tal de millorar els processos d’evacuació i protecció en aspectes com ara la comunicació, les indicacions i els procediments d’intervenció dels agents actuants. Les situacions d’emergències s’han investigat mitjançant dos actors clau, és a dir des de l’òptica de persones que han estat víctimes d’una situació d’emergència i des de l’òptica dels professionals dels serveis d’emergència. El grup principal d’estudi dels serveis d’emergència ha estat els cossos de bombers. La investigació del comportament humà, tant de víctimes com dels serveis d’emergència (cossos de bombers), s’ha centrat en cinc tipus diferents d’emergències: incendis d’habitatge, incendis en edificis públics, atemptats terroristes, terratrèmols i inundacions. El projecte estava format per un consorci d’institucions en què participaven un grup multidisciplinari de psicòlegs, sociòlegs, criminòlegs, enginyers i professionals de les emergències que treballen en escoles de bombers i policies, serveis d’emergència, centres de recerca i investigació i universitats de set països europeus: • Alemanya: Ernst-Moritz-Arndt Universität Greifswald, Department of Health and Prevention, Institute of Psychology (coordinació del projecte); • Alemanya: Hamburg Fire and Emergency Service Academy; • Espanya: Institut de Seguretat Pública de Catalunya, Unitat de Recerca de l’Escola de Policia i de l’Escola de Bombers; • Anglaterra: University of Greenwich, Fire Safety Engineering Group; • Itàlia: Università di Bologna, Gruppo di Ricerca in Psicologia dell’Emergenza; • República Txeca: Prague Psychiatric Centre; • Suècia: Man-Technology-Organisation; • Turquia: Association of Emergency Ambulance Physicians.