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

<b>&nbsp;Abstractb><br /><b>Objective b>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.<br /><br /><b>Methods b>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.<br /><br /><b>Results b>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%).<br /><br /><b>Conclusion b>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.<br /><br /><b>What is known about the topic? b>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.<br /><br /><b>What does this paper add? b>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.<br /><br /><b>What are the implications for health professionals? b>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.

Comparing mortality outcomes of major burns and toxic epidermal necrolysis in a tertiary burns centre

<b>&nbsp;Introductionb><br />Our aim was to provide descriptive information to burn clinicians, who have extensive experience treating major burns and determining prognosis, as to whether significant differences in mortality exist between major burns injuries and the comparatively less common toxic epidermal necrolysis for a given age and total body surface area percentage.<br /><br /><b>Methodsb><br />Retrospective data was analyzed of all deceased patients admitted to the Victorian Adult Burns Service in Melbourne, Australia over a period of 10 years with greater than 30% total body surface area burned or greater than 30% total body surface area epidermal detachment in the case of toxic epidermal necrolysis. Retrospective data was also collected on all patients, survivors and deceased, with toxic epidermal necrolysis and these patients were matched with burns patients by age and % total body surface area burned. Comparisons in outcomes were performed with mortality being the primary variable of interest.<br /><br /><b>Resultsb><br />Toxic epidermal necrolysis patients that died were older (median: 68.5 vs 57 yrs; P = 0.04), had a longer length of hospital stay (36.5 vs 0.8 days; P = 0.001) and significantly longer periods of mechanical ventilation (1404 vs 14.5 h; P = 0.011) than major burns patients that died. When toxic epidermal necrolysis patients were matched to major burns patients by age and total body surface area burned, there were no significant differences between the two groups with respect to mortality.<br /><br /><b>Conclusionb><br />Palliative care approaches are more frequently administered at the time of presentation for major burns patients in comparison to toxic epidermal necrolysis patients. This may be due to a perception that if toxic epidermal necrolysis patients can survive their initial systemic injury, they are likely to survive, as opposed to major burns patients who often undergo extensive surgery and for whom other factors should be taken into account in the context of end-of-life decision making.

Indices for cashmere fleece competition and across farm comparisons: The role of staple length in identifying goats of higher cashmere production

A single focus on mean fibre diameter (MFD, μm) as the definition of cashmere quality overlooks the effects of fibre length, softness and fibre curvature on cashmere processing, textile quality and consumer acceptance. Many farmers overlook the importance of cashmere staple length (SL, cm) in their fleece assessments. We aimed to determine the importance of SL in comparison with MFD when evaluating cashmere production and to identify how across farm comparisons of cashmere fleeces can be objectively undertaken. A sample of 1244 commercial cashmere fleeces from goats originating from many Australian farms was used. Least squares models, relating the logarithm of clean cashmere production (CCMwt, g) to MFD and SL, were fitted. Six years of data from the Australian cashmere industry between farm fleece competitions were analysed to determine the relation between CCMwt and MFD. In the research flocks, adjusting CCMwt of individual goats across farms for MFD only accounted for 2% of the variance, whereas SL accounted for 39% of the variance. The least squares additive model involving only SL was: log10(CCMwt)=1.570+0.06010×SL. Thus CCMwt was proportional to: 100.06010×SL=1.1484SL. It was appropriate to adjust CCMwt for SL by a factor 1/1.1484(SL-SL0) where SL0 is a standard SL of 7.5cm. The between farm index for cashmere weight equals: cleancashmerestaplelengthindex=2.823×CCMwt/1.1484SL. For industry fleece competitions, regression analysis indicated that there was no association between cashmere production and MFD (P=0.81), similar to the research data. Adjusting CCMwt for MFD in across farm comparison and fleece competitions appears to be ineffective. For farm comparisons and in fleece competitions it is important to assess cashmere SL. The use of the Clean Cashmere Staple Length Index will provide a more robust comparison of cashmere productivity between farms as it is an indirect indicator of desirable skin secondary follicle development. The results have application in development projects where obtaining a cashmere MFD test is costly or unavailable. © 2013 Elsevier B.V.

Facilitated communication and authorship: a systematic review

Facilitated Communication (FC) is a technique whereby individuals with disabilities and communication impairments allegedly select letters by typing on a keyboard while receiving physical support, emotional encouragement, and other communication supports from facilitators. The validity of FC stands or falls on the question of who is authoring the typed messages--the individual with a disability or the facilitator. The International Society for Augmentative and Alternative Communication (ISAAC) formed an Ad Hoc Committee on FC and charged this committee to synthesize the evidence base related to this question in order to develop a position statement. The purpose of this paper is to report this synthesis of the extant peer-reviewed literature on the question of authorship in FC. A multi-faceted search was conducted including electronic database searches, ancestry searches, and contacting selected authors. The authors considered synopses of systematic reviews, and systematic reviews, which were supplemented with individual studies not included in any prior reviews. Additionally, documents submitted by the membership were screened for inclusion. The evidence was classified into articles that provided (a) quantitative experimental data related to the authorship of messages, (b) quantitative descriptive data on the output generated through FC without testing of authorship, (c) qualitative descriptive data on the output generated via FC without testing of authorship, and (d) anecdotal reports in which writers shared their perspectives on FC. Only documents with quantitative experimental data were analyzed for authorship. Results indicated unequivocal evidence for facilitator control: messages generated through FC are authored by the facilitators rather than the individuals with disabilities. Hence, FC is a technique that has no validity.

Effects of multivitamin, mineral and herbal supplement on cognition in younger adults and the contribution of B group vitamins

Cognitive benefits of multivitamins have been observed in the elderly, but fewer trials have investigated younger, healthy cohorts. This randomised, double-blind, placebo-controlled study investigated the cognitive effects of 16-week multivitamin supplementation in adults aged 20-49 years.

Neighbourhood socioeconomic disadvantage and fruit and vegetable consumption: a seven countries comparison

BACKGROUND: Low fruit and vegetable consumption is a risk factor for poor health. Studies have shown consumption varies across neighbourhoods, with lower intakes in disadvantaged neighbourhoods. However, findings are inconsistent, suggesting that socio-spatial inequities in diet could be context-specific, highlighting a need for international comparisons across contexts. This study examined variations in fruit and vegetable consumption among adults from neighbourhoods of varying socioeconomic status (SES) across seven countries (Australia, Canada, Netherlands, New Zealand, Portugal, Scotland, US). METHODS: Data from seven existing studies, identified through literature searches and knowledge of co-authors, which collected measures of both neighbourhood-level SES and fruit and vegetable consumption were used. Logistic regression was used to examine associations between neighbourhood-level SES and binary fruit and vegetable consumption separately, adjusting for neighbourhood clustering and age, gender and education. As much as possible, variables were treated in a consistent manner in the analysis for each study to allow the identification of patterns of association within study and to examine differences in the associations across studies. RESULTS: Adjusted analyses showed evidence of an association between neighbourhood-level SES and fruit consumption in Canada, New Zealand and Scotland, with increased odds of greater fruit intake in higher SES neighbourhoods. In Australia, Canada, New Zealand and Portugal, those residing in higher SES neighbourhoods had increased odds of greater vegetable intake. The other studies showed no evidence of a difference by neighbourhood-level SES. CONCLUSIONS: Acknowledging discrepancies across studies in terms of sampling, measures, and definitions of neighbourhoods, this opportunistic study, which treated data in a consistent manner, suggests that associations between diet and neighbourhood-level socioeconomic status vary across countries. Neighbourhood socioeconomic disadvantage may differentially impact on access to resources in which produce is available in different countries. Neighbourhood environments have the potential to influence behaviour and further research is required to examine the context in which these associations arise.

Characterization of antibody V segment diversity in the Tasmanian devil (Sarcophilus harrisii)

The Tasmanian devil (Sarcophilus harrisii) immune system has recently been under scrutiny because of the emergence of a contagious cancer, which has decimated devil numbers. Here we provide a comprehensive description of the Tasmanian devil immunoglobulin variable regions. We show that heavy chain variable (VH) and light chain variable (VL) repertoires are similar to those described in other marsupial taxa: VL diversity is high, but VH diversity is restricted and belongs only to clan III. As in other mammals, one VH and one V&lambda; germline family and multiple incomplete V&kappa; germline sequences were identified in the genome. High V&kappa; variation was observed in transcripts and we predict that it may have arisen by gene conversion and/or somatic mutations, as it does not appear to have originated from germline variation. Phylogenetic analyses revealed that devil VL gene segments are highly complex and ancient, with some lineages predating the separation of marsupials and eutherians. These results indicate that although the evolutionary history of immune genes lead to the expansions and contractions of immune gene families between different mammalian lineages, some of the ancestral immune gene variants are still maintained in extant species. A high degree of similarity was found between devil and other marsupial VH segments, demonstrating that they originated from a common clade of closely related sequences. The VL families had a higher variation than VH both between and within species. We suggest that, similar to other studied marsupial species, the complex VL segment repertoire compensates for the limited VH diversity in Tasmanian devils.

Depressive symptomatology, weight status and obesogenic risk among Australian adolescents: a prospective cohort study

OBJECTIVES: Adolescence is a period of increased risk for mental health problems and development of associated lifestyle risk behaviours. This study examined cross-sectional and longitudinal associations between obesogenic risk factors, weight status, and depressive symptomatology in a cohort of Australian adolescents. <br /><br />DESIGN: Prospective cohort study. <br /><br />SETTING: The study used repeated measures data from the Australian Capital Territory (ACT) It's Your Move project, an Australian community-based obesity prevention intervention. Intervention effect was non-significant therefore intervention and comparison groups were combined in this study. <br /><br />PARTICIPANTS: Total sample was 634 secondary school students (female n=338, male n=296) with mean age 13 years (SD=0.6) at baseline (2012) and 15 years (SD=0.6) at follow-up (2014) recruited from 6 government secondary schools in the ACT. <br /><br />PRIMARY AND SECONDARY OUTCOMES MEASURES: Primary outcome was depressive symptomatology measured by Short Mood and Feelings Questionnaire. Secondary outcomes were weight status, physical activity, screen time and diet related measures. <br /><br />RESULTS: Increased physical activity was associated to lower depressive symptomatology among males (OR=0.35, p<0.05). Sweet drink (OR=1.15, p<0.05) and takeaway consumption (OR=1.84, p<0.05) were associated with higher levels of depressive symptomatology among females at follow-up. Males who were classified as overweight or obese at baseline, and remained so over the study period, were at increased risk of depressive symptomatology at follow-up (b=1.63, 95% CI 0.33 to 2.92). Inactivity among males over the 2-year study period was predictive of higher depressive symptomatology scores at follow-up (b=2.55, 95% CI 0.78 to 4.32). For females, those who increased their consumption of takeaway foods during the study period were at increased risk for developing depressive symptomatology (b=1.82, 95% CI -0.05 to 3.71). <br /><br />CONCLUSIONS: There are multiple, probably complex, relationships between diet, physical activity and outcomes of obesity and mental health as well as between the outcomes themselves. Healthier diets and increased physical activity should be foundations for healthier body weight and mental health.<br />

Gênero e políticas públicas: iniciativas de governos subnacionais no Brasil

Este relatório apresenta os resultados de pesquisa sobre a incorporação da perspectiva de gênero por políticas públicas e programas governamentais desenvolvidos por governos municipais e estaduais no período recente no Brasil. O trabalho dá continuidade a pesquisa anterior sobre este mesmo tema (FARAH, 1998a), considerando um novo conjunto de programas e políticas. Analisam-se tanto iniciativas que têm como foco a mulher, como iniciativas de diversas áreas e setores, em que a questão de gênero é integrada a políticas e programas governamentais. Utilizou-se como base empírica banco de dados do Programa Gestão Pública e Cidadania, programa de premiação e disseminação de inovações em governos subnacionais, desenvolvido pela Fundação Getulio Vargas de São Paulo e pela Fundação Ford, com apoio do BNDES, considerando iniciativas governamentais inscritas no Ciclo de 1997. O trabalho analisa 41 programas, dos quais sete têm foco na mulher e 34 consistem em programas de diversos setores que incorporam a questão de gênero. A principal referência para a análise consiste em agenda formulada por movimentos e entidades ligadas à questão de gênero, agenda esta reconstituída no âmbito da presente pesquisa e da que a antecedeu. A análise sugere que, tanto nos programas com foco na mulher, como nas demais iniciativas governamentais, ao lado de uma abordagem que tende a reforçar os papéis tradicionais da mulher ou que apenas a considera como um grupo de risco sobretudo nos programas de saúde materno-infantil emerge uma nova perspectiva que incorpora reivindicações de movimentos e entidades ligadas à questão de gênero, as quais destacam a existência na sociedade brasileira de desigualdades de gênero. Neste segundo caso, os programas governamentais desenvolvem mecanismos e estratégias orientados para a redução das desigualdades de gênero, nos campos específicos de sua atuação.

Genetic differentiation between sympatric populations of Bacillus cereus and Bacillus thuringiensis

Little is known about genetic exchanges in natural populations of bacteria of the spore-forming Bacillus cereus group, because no population genetics studies have been performed with local sympatric populations. We isolated strains of Bacillus thuringiensis and B. cereus from small samples of soil collected at the same time from two separate geographical sites, one within the forest and the other at the edge of the forest. A total of 100 B. cercus and 98 B. thuringiensis strains were isolated and characterized by electrophoresis to determine allelic composition at nine enzymatic loci. We observed genetic differentiation between populations of B. cereus and B. thuringiensis. Populations of a given Bacillus species-B. thuringiensis or B. cereus-were genetically more similar to each other than to populations of the other Bacillus species. Hemolytic activity provided further evidence of this genetic divergence, which remained evident even if putative clones were removed from the data set. Our results suggest that the rate of gene flow was higher between strains of the same species, but that exchanges between B. cereus and B. thuringiensis were nonetheless possible. Linkage disequilibrium analysis revealed sufficient recombination for B. cereus populations to be considered panmictic units. In B. thuringiensis, the balance between clonal proliferation and recombination seemed to depend on location. Overall, our data indicate that it is not important for risk assessment purposes to determine whether B. cereus and B. thuringiensis belong to a single or two species. Assessment of the biosafety of pest control based on B. thuringiensis requires evaluation of the extent of genetic exchange between strains in realistic natural conditions.

Characterization and selection of Bacillus thuringiensis isolates effective against Sitophilus oryzae

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Preferência para oviposição de Bemisia tabaci (Genn.) biótipo B (Hemiptera: Aleyrodidae) em genótipos de soja, sob condições de campo

Dez genótipos de soja: IAC 100, IAC 74-2832, IAC 90-2971, IAC 78-2318, PI 227687, PI 229358, PI 274454, BR-82 12547, MG/BRS-68 (Vencedora) e FT-5 (Formosa), foram avaliados quanto a resistência, do tipo não-preferência para oviposição, à mosca-branca, Bemisia tabaci (Genn.) biótipo B. O ensaio foi realizado no campo experimental da FCAV/UNESP, Jaboticabal-SP, de outubro de 1999 a janeiro de 2000. Pretendeu-se, ainda, verificar a preferência de oviposição da referida espécie em relação às folhas unifolioladas e trifolioladas, e quanto à posição do folíolo na folha trifoliolada, e estabelecer o número mínimo de folíolos necessários para amostrar adequadamente a oviposição da mosca branca. Constatou-se que a oviposição foi menor nos genótipos BR-82 12547 e IAC 74-2832 em todas as avaliações (15, 30, 45, 65 e 85 dias após a emergência das plantas). As maiores taxas de oviposição ocorreram em IAC 90-2971, IAC 100, PI 227687 e PI 274454. O número médio de ovos depositados por seção de folha pelas fêmeas de B. tabaci biótipo B nas folhas trifolioladas não diferiu significativamente dos obtidos nas unifolioladas, 15 dias após a emergência das plantas (estádios de desenvolvimento entre V3 e V5), em 70% dos genótipos. Quanto à posição dos folíolos, a mosca-branca ovipositou indistintamente sobre os folíolos mediano e laterais. Também o número médio de ovos depositados por área foliar, pela mosca-branca, nos três folíolos da folha trifoliolada não diferiu significativamente da média obtida para dois ou um folíolo desta, o que sugere ser, um folíolo, uma unidade amostral representativa da oviposição de B. tabaci biótipo B em soja.

Old beagle dogs have lower faecal concentrations of some fermentation products and lower peripheral lymphocyte counts than young adult beagles

The effects of age on microbiota composition, gut fermentation end-product formation and peripheral lymphocyte numbers were compared between old and young adult Beagle dogs fed four kibble diets differing in yeast cell wall contents. The experiment had a double 4 x 4 Latin square design, one with four mature dogs (4 years old) and the other with four old dogs (10 years old), with four replicates (diets) per dog. In each period a 15d adaptation period preceded a 5d total collection of faeces for the digestibility trial. on day 21, fresh faecal samples were collected for the determination of bacterial enumeration, pH, biogenic amine and short-chain fatty acid. Flow cytometry was used for immunophenotypic evaluation. Dogs were fed four kibble diets with similar composition with 0, 0.15, 0.30 and 0.45% of yeast cell wall (as-fed), respectively. Data were evaluated using general linear models of Statistical Analysis Systems statistical software (P<0.05). No evidence of a difference in faecal bacteria counts between ages was found (total aerobes, total anaerobes, Bifidobacterium, Lactobacillus, Clostridium and Escherichia coli: P. 0.15). Faecal concentrations of butyrate, histamine, agmatine and spermine were lower (P <= 0.05) and faecal pH was higher (P=0.03) in older dogs than in mature adult dogs, suggesting an alteration in bacterial metabolic activity, or in the rate of intestinal absorption of these compounds. Concentrations of T-lymphocytes, T-cytotoxic lymphocytes and B-lymphocytes were also lower (P <= 0.01) in older dogs than in mature adult dogs. The study confirmed alterations in peripheral lymphocytes and revealed a reduced concentration of some fermentation end products in the colon of old dogs.

O concreto e o simbólico no cotidiano da educação em saúde: práticas, representações e processo identitário dos agentes comunitários de saúde de João Pessoa PB

The present study is about an etnographic research based on the Theory of Social Representation and its complementary approach, the Theory of Central Core based on the bourdiesianos concepts of field and habitus , concerning that these concepts, articulated to the constructed social representation, may contribute to the study of social identities. Its aim is to acknowledge which identity references community health agents (CHA), agents from Community Health Agent Program (CHAP) and Family Health Program (FHP) from João Pessoa PB and which social representation is constructed by them towards health education. The study had the participation of 119 CHAs, from which 90,3 % were female and 9,7% were male. Since the identity is also built by the representation of others towards the group, 63 professionals of the FHP group (16 nurses, 16 nursing assistents, 12 doctors, 9 dentists, 6 dentistry office assistents, 4 coordinators, 1 psicologist and 1 receptionist) and 1 nurse from CHAP took part of the study, oficial documents from the Health Ministry were analyzed, verbal information from its representatives were also taken into consideration, as well as reports from the many benefitiaries of the CHA, CHAP and FHP. For data collecting, we used the combination of (a) Direct Observation and Participant Observation of the functioning micro-areas of the CHA at the Family Health Units, and the Union of the Agents; (b) Free-Association of words and expressions to stimulate the CHA , Health Education and Health ; (c) Questionnaire; (d) Interviews. The interviews were submitted to a thematic analysis of its topic. The free-association was analyzed taking in consideration the vèrgesiana proposal (a combination of the frequency and average order of evocation) which treatment enabled the identification of the central and peripheral systems of social representation towards health education and the community health agent. A test of central refutation, associated to the analysis of the indicated evocations as the most important, provided empirical evidence of social representation towards health education as orientation , prevention and hygiene , as well as the identity of CHA as supervisor , friend , help , important , and the link between the community and the Family Health Staff. Other professionals from CHAP, FHP and the Health Ministry share all of these representational contents, especially the concepts of friend and link , also shared by the community. A habitus towards the community health agents was identified, as a representation based on trust and friendship, which gives the professional a great importance towards the daily inconsistencies faced by the community

Efeito do silício na preferência para oviposição de Bemisia tabaci biótipo B (Genn.) (Hemiptera: Aleyrodidae) em plantas de feijão (Phaseolus vulgaris L.)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)