Hospital Data Collection Research Articles

Risk factors and recurrence of hyperemesis gravidarum: A population-based record linkage cohort study.

There are limited contemporary population-based studies on the risk factors for hyperemesis gravidarum (HG), a severe type of nausea and vomiting in pregnancy. This study aimed to determine the prevalence and trend of HG over time, identify risk factors for any and multiple HG health service visits during pregnancy, and investigate HG recurrence across pregnancies. This population-based record linkage cohort study featured births in New South Wales, Australia from 2010 to 2019. Hospital and emergency data collections were used to identify health service visits for HG using relevant diagnosis codes and were linked to the corresponding pregnancy on the birth data set. Outcomes included any HG and multiple HG visits during pregnancy, and HG recurrence across pregnancies. Annual HG prevalence was calculated, and negative binomial regression was used to examine standardized prevalence trends. Risk factors for any HG and multiple HG visits within a pregnancy were examined using Robust Poisson models with generalized estimating equations and Prentice-Williams-Peterson Gap Time models, respectively. Rates and risk of recurrence were calculated for women with a second and third pregnancy. Of the 955 107 pregnancies, 21 702 (2.3%) were classified as HG. There was an average annual increase of 6.8% (95% CI 5.3-8.3) in HG prevalence. Younger maternal age, multiple pregnancies, and selected preexisting conditions were associated with an increased risk of HG, with the strongest factor being HG in any previous pregnancy (risk ratio 8.92, 99% CI 8.43-9.44). Hyperemesis gravidarum recurrence at the second (28.9%) and third (54.7%) pregnancies was high. Hyperemesis gravidarum history is the strongest risk factor for HG, which has implications for counseling and care that women receive around pregnancy.

Lessons learned: avoiding bias via multi-state analysis of patients' trajectories in real-time.

Many studies have attempted to determine the disease severity and patterns of COVID-19. However, at the beginning of the pandemic, the complex patients' trajectories were only descriptively reported, and many analyses were worryingly prone to time-dependent-, selection-, and competing risk biases. Multi-state models avoid these biases by jointly analysing multiple clinical outcomes while taking into account their time dependency, including current cases, and modelling competing events. This paper uses a publicly available data set from the first wave in Israel as an example to demonstrate the benefits of analysing hospital data via multi-state methodology. We compared the outcome of the data analysis using multi-state models with the outcome obtained when various forms of bias are ignored. Furthermore, we used Cox regression to model the transitions among the states in a multi-state model. This allowed for the comparison of the covariates' influence on transition rates between the two states. Lastly, we calculated expected lengths of stay and state probabilities based on the multi-state model and visualised it using stacked probability plots. Compared to standard methods, multi-state models avoid many biases in the analysis of real-time disease developments. The utility of multi-state models is further highlighted through the use of stacked probability plots, which visualise the results. In addition, by stratification of disease patterns by subgroups and visualisation of the distribution of possible outcomes, these models bring the data into an interpretable form. To accurately guide the provision of medical resources, this paper recommends the real-time collection of hospital data and its analysis using multi-state models, as this method eliminates many potential biases. By applying multi-state models to real-time data, the gained knowledge allows rapid detection of altered disease courses when new variants arise, which is essential when informing medical and political decision-makers as well as the general population.

PRECISION-TBI: a study protocol for a vanguard prospective cohort study to enhance understanding and management of moderate to severe traumatic brain injury in Australia

IntroductionTraumatic brain injury (TBI) is a heterogeneous condition in terms of pathophysiology and clinical course. Outcomes from moderate to severe TBI (msTBI) remain poor despite concerted research efforts. The heterogeneity...

Average Length of Stay, Average Preventable Readmission Rates, and Average Total Cost of Care: Is there a Relationship?

Average Length of Stay (ALOS), Average Preventable Readmission Rates (APRRs), and Average Total Cost of Care (ATCc) were examined to see if any relationship exists among the variables. Secondary data from the Texas Hospital data collection database was used for the study. Out of 379 acute care hospitals in Texas, 65 hospitals were selected for analysis using a G*Power analysis. Demographic analysis, Spearman’s Rank correlation, and Regression Analyses were conducted to explore the relationship. The results of the Spearman’s Rho correlation showed a significant negative relationship between ALOS and ATCc [ALOS – ATCc (rs = - .271, p = .016)], and for APRRs and ATCc, there was no statistically significant relationship [APRRs – ATCc (rs = .065, p = .564)]. The multiple regression analysis showed there was no statistically significant relationship between the variables [ALOS – ARRs – ATCc (F (2,62) = 1.584, p = .211)]. The results showed that ALOS and APRRs do not necessarily predict ATCc. Consequently, based on the study results ATCc is not solely determined by ALOS and APRRs. The absence of a significant relationship between ALOS, APRRs, and ATCc does not necessarily indicate inefficiency in practice or lack of effectiveness. The results showed that there are other mediating factors impacting care that were not assessed in the study that need to be examined carefully which may have implications for practice, research, and methodology. Future research should be considered to determine these moderating factors to better understand the complex relationship between ALOS, APRRs, and ATCc. An understanding of these complex dynamics may inform managerial strategies and help with critical clinical and fiscal decisions in a healthcare setting.
 Keywords: Average Length of Stay, Average Preventable Readmission Rates, Average Total Cost of care

Status of Quality and Compliance to Inpatient Quality Indicators and Patient Safety Indicators in a Selected Private Corporate Hospital at Dhaka City Bangladesh

Background: The stutus of quality and compliance to inpatient quality indicators (IQIs) and patient safety indicators (PSIs) in corporate hospitals at dhaka city Bangladesh are not known as they are not adequately studied. Objective: The present descriptive cross-sectional study was therefor undertaken to know the status of quality and compliance to selected IQIs and PSIs in a selected private (corporate) hospital at Dhaka City Bangladesh. The period of study and hospital data collection period were May to August 2019 and January to March 2019 respectively. Methods: Selected IQIs and PSIs developed by Agency for Healthcare Research and Quality (AHRQ), USA and hospital facilities utilization parameters were investigated. Data were collected using questionnaires and checklists for the period of January to March 2019 from the purposively selected private (corporate) hospital. Sociodemographic information of randomly selected junior doctors and nurses were taken. Randomly selected senior clinicians, nurses and executives were interviewed regarding knowledge about selective IQIs, PSIs, JCIS, ISO relevant to quality healthcare. Data were analysed by SPSS programme version 20. Results: The hospital has all relevant admistrative and clinical departments, bed patterns and has efficient admission and discharge processes for inpatients. Bed utilization was 87.5% of total 159 available beds. Patients visited OPD: 2434 per day, admitted: 28 per day and discharged with successful outcome: 27 per day. Average length of stay (ALS), hospital acquired infection (HAI) and hospital deaths were 3.6 days, 1.76% (18/1000 cases), and 124 (01 per day) respectively during data collection period. Tests done in Laboratory Medicine were 267637 with Clinical Biochemistry tests highest (51.21%) and investigations in Radiology-Imaging departments were 74997 with X-rays being highest (40.22%). Of the five selected IQIs, total CABG cases done were 191 with 04 hospital deaths i.e. 2.1% (21 per 1000 cases) and total AMI cases done were 140 with 12 hospital deaths i.e. 8.5% (85 per 1000 cases). No casualties were reported for caesarean deliveries or primary/normal deliveries. None of the five selected PSIs were traced over the data collection period. Conclusion: These findings suggested that the selected hospital’s services were demanding and it was concerned about quality healthcare services. However, comparative studies with other private corporate hospotals at Dhaka City including larger number of respodents are warrented. Bangladesh Medical Res Counc Bull 2023; 49(2): 98-112

Gambaran Intervensi Family Centered Care pada Pasien Balita di RS Perkebunan Wilayah Karesidenan Besuki Raya

The implementation of family-centered care in pediatric hospitals in developed countries has been well-standardized. But, in Indonesia, it can be implemented with the possibility to be realized ideally is not easy because of many health workers do not understand family-centered care properly. The purpose of this study is to describe the application of Family Centered Care in toddler patients in inpatient rooms conducted by nurses. This research is a descriptive study with a cross-sectional approach using a purposive sampling technique. The study was conducted at Kaliwates General Hospital, Jember Klinik Hospital and Elizabeth Situbondo Hospital Data collection was performed using a Family Centered Care questionnaire. Data Collection was carried out from September 2019 to December 2019. The study Participants were 98 families selected by purposive sampling technique. Data were collected techniques using in-depth interviews and documentation. The results showed that the majority of families (83.7%) were good. Nurses can be good counselors and educators in meeting the needs of families and children in the hospital to have a good cooperative relationship between family and nurses. Nurses can improve the quality of their services by understanding more deeply about family needs and strengths.

Emergence and evolution of the Omicron SARS-CoV-2 variant in the island of Martinique

IntroductionWe aimed to describe the epidemiological situation during the Omicron variant circulation in light of genomic surveillance data in Martinique, a territory with low vaccination rates. Patients and methodsWe exploited COVID-19 national databases of virological tests, for the collection of hospital data and for the sequencing data from December 13, 2021 to July 11, 2022. ResultsThree prevailing sub-lineages of Omicron have been identified in Martinique (BA.1, BA.2, BA.5) during this period causing three distinct waves characterized by an increase in virological indicators compared to previous waves, with moderate severity in the first and last waves, caused by BA.1 and BA.5, respectively. ConclusionThe SARS-CoV-2 outbreak is still progressing in Martinique. Genomic surveillance system in this overseas territory must be continued for rapid detection of emerging variants/sub-lineages.

Death by suicide among aged care recipients in Australia 2008-2017.

To characterize the features of aged care users who died by suicide and examine the use of mental health services and psychopharmacotherapy in the year before death. Population-based, retrospective exploratory study. Individuals who died while accessing or waiting for permanent residential aged care (PRAC) or home care packages in Australia between 2008 and 2017. Linked datasets describing aged care use, date and cause of death, health care use, medication use, and state-based hospital data collections. Of 532,507 people who died, 354 (0.07%) died by suicide, including 81 receiving a home care package (0.17% of all home care package deaths), 129 in PRAC (0.03% of all deaths in PRAC), and 144 approved for but awaiting care (0.23% of all deaths while awaiting care). Factors associated with death by suicide compared to death by another cause were male sex, having a mental health condition, not having dementia, less frailty, and a hospitalization for self-injury in the year before death. Among those who were awaiting care, being born outside Australia, living alone, and not having a carer were associated with death by suicide. Those who died by suicide more often accessed Government-subsidized mental health services in the year before their death than those who died by another cause. Older men, those with diagnosed mental health conditions, those living alone and without an informal carer, and those hospitalized for self-injury are key targets for suicide prevention efforts.

RADIOGRAPHIC EXAMINATION TECHNIQUES OF LUMBAL VERTEBRA IN CASE OF LOW BACK PAIN IN ISLAMIC HOSPITAL PURWOKERTO

Low Back Pain (LBP) is a pain condition that attacks the lower part of the spine, caused by injury to muscles or ligaments, common causes include lifting the wrong weight, poor posture, not exercising regularly and so on. One of the radiological examinations to establish the diagnosis of LBP is a radiographic examination of the lumbar spine. In the examination procedure, the radiological examination of the lumbar spine, the patient's position during the examination was arranged to sleep supine on the examination table, while at RSI Purwokerto the examination of the lumbar vertebrae with the case of LBP the patient position setting was arranged to stand in front of the bucky stand. The research used in the preparation of this scientific article is a qualitative research with approach case study, the method of data collection is carried out by direct observation of the technique of radiographic examination of the lumbar spine with LBP cases at the Radiology Installation of Islamic Hospital Purwokerto and data collection methods by taking data from documents, including radiographs, medical records and radiographic readings. On radiographic examination of the lumbar spine with LBP cases with the patient standing, the results were: low back pain with normal lumbar curvature and no disc narrowing. Conclusions that can be drawn from the technique of examining the lumbar vertebrae at the Radiology Installation of the Islamic Hospital of Purwokerto were carried out with the AP and Lateral erect projections. the use of this projection can be more informative and can clarify the intervertebral space or narrowed intervertebral disc.
 Keywords : Low Back Pain, Radiography, Erect

Registry-based pilot epidemiological study of traumatic brain injury in a tertiary trauma care center in Kerala, India - Difficulties encountered during data collection warranting the need for standardized electronic database.

Background: Head injury is referred to as a “silent epidemic” globally. Studies regarding epidemiology of head injury are very few especially in Kerala and most have conflicting reports. Unlike developed countries, there is no well-established system for collecting and managing information on traumatic brain injury (TBI) in India, especially in Kerala. The present study shares the difficulties encountered and the insights acquired by conducting a registry-based epidemiological pilot study for collecting a baseline data of traumatic head injury patients in a tertiary care center in Kerala.Methods: The pilot study was conducted to know the efficiency of present reporting system of a tertiary hospital in Kerala. We tried to collect retrospective data from December 2018 to December 2019 in the department of neurosurgery. As there was no standardized protocol or electronic database for data collection in hospital, we made a sample proforma for data collection. The patient details were obtained from medical records (case sheets), resident doctor’s, and staff nurse’s notes which included demography, clinical details, and radiological findings which were analyzed.Results: We were not able to fill the full details regarding demography, prehospital data, and clinicoetiological details which are important as far as head injury management is considered. The hospital records were grossly inadequate for full retrieval of information. Inadequate case definition and lack of centralized electronic reporting mechanisms were some of the major difficulties we faced obviating the need for collecting, managing, and utilizing epidemiological data using an electronic database.Conclusion: We believe that the present pilot study will give an insight regarding the difficulties encountered in collecting data regarding TBI. This study will be the first of its kind in Kerala highlighting the importance of maintaining a proper head injury electronic registry. The data from this study would definitely guide future experimental operational research on these unexplored areas which will be relevant in head injury policy-making in Kerala as well as in India.

'Hot gall bladder service' by emergency general surgeons: Is this safe and feasible?

Background:Despite NICE/AUGIS recommendations, the practice of early laparoscopic cholecystectomy (ELC) has been particularly poor in the UK offered only by 11%–20% surgeons as compared to 33%–67% internationally, possibly due to financial constraints, logistical difficulties and shortage of expertise, thus, reflecting the varied provision of emergency general surgical care. To assess whether emergency general surgeons (EGS) could provide a 'Hot Gall Bladder Service' (HGS) with an acceptable outcome.Patients and Methods:This was a prospective HGS observational study that was protocol driven with strict inclusion/exclusion criteria and secure online data collection in a district general hospital between July 2018 and June 2019. A weekly dedicated theatre slot was allocated for this list.Results:Of the 143 referred for HGS, 86 (60%) underwent ELC which included 60 (70%) women. Age, ASA and body mass index was 54* (18–85) years, II* (I-III) and 27* (20–54), respectively. 86 included 46 (53%), 19 (22%), 19 (22%) and 2 (3%) patients presenting with acute calculus cholecystitis, gallstone pancreatitis, biliary colic, and acalculus cholecystitis, respectively. 85 (99%) underwent LC with a single conversion. Grade of surgical difficulty, duration of surgery and post-operative stay was 2* (1–4) 68* (30–240) min and 0* (0–13) day, respectively. Eight (9%) required senior surgical input with no intra-operative complications and 2 (2%) 30-day readmissions. One was post-operative subhepatic collection that recovered uneventfully and the second was pancreatitis, imaging was clear requiring no further intervention.Conclusion:In the current climate of NHS financial crunch, COVID pandemic and significant pressure on inpatient beds: Safe and cost-effective HGS can be provided by the EGS with input from upper GI/HPB surgeons (when required) with acceptable morbidity and a satisfactory outcome.

Exploring the differences in ICD and hospital morbidity data collection features across countries: an international survey

BackgroundThe International Classification of Diseases (ICD) is the reference standard for reporting diseases and health conditions globally. Variations in ICD use and data collection across countries can hinder meaningful comparisons of morbidity data. Thus, we aimed to characterize ICD and hospital morbidity data collection features worldwide.MethodsAn online questionnaire was created to poll the World Health Organization (WHO) member countries that were using ICD. The survey included questions focused on ICD meta-features and hospital data collection systems, and was distributed via SurveyMonkey using purposive and snowball sampling. Accordingly, senior representatives from organizations specialized in the topic, such as WHO Collaborating Centers, and other experts in ICD coding were invited to fill out the survey and forward the questionnaire to their peers. Answers were collated by country, analyzed, and presented in a narrative form with descriptive analysis.ResultsResponses from 47 participants were collected, representing 26 different countries using ICD. Results indicated worldwide disparities in the ICD meta-features regarding the maximum allowable coding fields for diagnosis, the definition of main condition, and the mandatory type of data fields in the hospital morbidity database. Accordingly, the most frequently reported answers were “reason for admission” as main condition definition (n = 14), having 31 or more diagnostic fields available (n = 12), and “Diagnoses” (n = 26) and “Patient demographics” (n = 25) for mandatory data fields. Discrepancies in data collection systems occurred between but also within countries, thereby revealing a lack of standardization both at the international and national level. Additionally, some countries reported specific data collection features, including the use or misuse of ICD coding, the national standards for coding or lack thereof, and the electronic abstracting systems utilized in hospitals.ConclusionsHarmonizing ICD coding standards/guidelines should be a common goal to enhance international comparisons of health data. The current international status of ICD data collection highlights the need for the promotion of ICD and the adoption of the newest version, ICD-11. Furthermore, it will encourage further research on how to improve and standardize ICD coding.

Prevalence of Caesarean Sections in Mosul City Hospitals :A Cross – Sectional Study

Background: Caesarean section rates had been increasing markedly in the world and the procedure as it become more safe than before (although it still a major surgical operation) and the objective of this study is to estimate the prevalence of caesarean section in Mosul city hospitals. Methods: A cross-sectional study was conducted at eight hospitals in Mosul city from both river sides including five governmental hospitals and three private hospitals, (671) women who delivered by caesarean section in Mosul city hospitals during a period of data collection were included from beginning 15th of November 2019 and ending at 15th of April 2020. Results: Women delivered by caesarean section aged between 20-35 years in (70.6%), (74.8%) of low educational level and (91.8%) were unemployed. The rate of caesarean section during the period of data collection in Mosul city hospitals was (28.8%) while the rate of caesarean section during the period of data collection showed that the highest rate of caesarean section were in private hospital and especially at Al-Zahrawi and Al-Rabee Private Hospitals (100%) while Al-Batool Hospital include (37.6%) from governmental hospitals in spite that the highest numbers of deliveries and caesarean section was in Al-Khansa Teaching Hospital. Conclusions: Caesarean section rate was higher than WHO recommendation among Mosul hospitals. Further improvement and attention to primary health care should be applied.

Sharing Cancer Survivorship Care between Oncology and Primary Care Providers: A Qualitative Study of Health Care Professionals’ Experiences

Survivorship care that is shared between oncology and primary care providers may be a suitable model to effectively and efficiently care for the growing survivor population, however recommendations supporting implementation are lacking. This qualitative study aimed to explore health care professionals’ (HCPs) perceived facilitators and barriers to the implementation, delivery and sustainability of shared survivorship care. Data were collected via semi-structured focus groups and analysed by inductive thematic analysis. Results identified four overarching themes: (1) considerations for HCPs; (2) considerations regarding patients; (3) considerations for planning and process; and (4) policy implications. For HCPs, subthemes included general practitioner (GP, primary care physician) knowledge and need for further training, having clear protocols for follow-up, and direct communication channels between providers. Patient considerations included identifying patients suitable for shared care, discussing shared care with patients early in their cancer journey, and patients’ relationships with their GPs. Regarding process, subthemes included rapid referral pathways back to hospital, care coordination, and ongoing data collection to inform refinement of a dynamic model. Finally, policy implications included development of policy to support a consistent shared care model, and reliable and sustainable funding mechanisms. Based on study findings, a set of recommendations for practice and policy were developed.

Following COVID-19 clinicians now overwhelmingly accept virtual clinics in Oral and Maxillofacial Surgery.

Virtual consultations and telemedicine have been an emerging trend in modern medicine, which has seen acceleration in uptake across a wide range of specialties as a result of the COVID-19 pandemic. Following on from previous work by the authors in 2019 examining clinician and patient appetite for virtual consultations in maxillofacial surgery, we sought to evaluate whether there had been a change in attitudes as a result of the pandemic. A clinician survey of the consultants at a large teaching hospital and prospective data collection of virtual consultation outcomes was carried out from the inception of UK government lockdown measures to tackle the pandemic. From 151 consultations, 149 (98.7%) successfully established a working diagnosis and treatment plan and/or concluded an episode of patient care, without the need to convert to a face-to-face encounter between clinician and patient. The total number of consultations (virtual or otherwise) was significantly lower than the same time period the preceding year however (1,223 compared with 465 consultations). All consultants surveyed felt the pandemic had altered their opinion of virtual clinics and their place in maxillofacial surgery but cited a number of issues. Further work is required to understand the driving forces behind staff attitudes and the long-term adoption of telemedicine within the specialty as services return to some sense of normalcy.

Developing a national minimum data set for hospital information systems in the Islamic Republic of Iran.

Standardized data collection supports disease information management and leads to better quality of care. The Islamic Republic of Iran lacks a standard data set for data collection in hospitals. The aim of this study was to design a minimum data set for hospital information systems in the Islamic Republic of Iran. This study was conducted in 2015. Data sets of other countries, hospital records, hospital information systems and electronic health record systems in the Islamic Republic of Iran were reviewed for data elements for the minimum data set. Data elements were collected using a data extraction form and were categorized into similar classes, which were divided into administrative and clinical sections. The list of data elements was reviewed by experts in technical offices of the Iranian Ministry of Health and Medical Education, and a minimum data set was drawn up. There were nine and 18 data classes in the administrative and clinical sections with a total of 166 and 684 data elements respectively. After review by the expert panel, 159 administrative and 621 clinical data elements were retained as the minimum data set for the Iranian hospital information system. Our dataset can be used by the Iranian health ministry, hospital information system companies and health surveillance centres for more efficient management of health data.

Nurses’ Performance Regarding Patient with Permanent Pacemaker in Intensive Care Unit

Background: The pacemaker is a device that placed under the skin of the chest or abdominal to help control abnormal heart rhythms. This device sends electrical impulses to the heart muscle to maintain a suitable heart rate and rhythm. Aim of the study: This study aims to: Assess the Nurses’ Performance Regarding Patient with Permanent Pacemaker In Intensive Care Unit through the following: Assess nurses’ level of knowledge regarding Patient with Permanent Pacemaker. Assess nurses’ practice regarding Patient with Permanent Pacemaker. Design: A descriptive design was used to conduct this study. Study subject: All available nurses working in intensive care unit at Benha University Hospital. Setting: This study was conducted at the intensive care unit at Benha University Hospital Data collection tool: Self-administered questionnaire tool. It was developed by the researcher based on related literature, it was written in simple Arabic language 1- assess demographic characteristics 2- assess nurses’ information regarding Permanent Pacemaker and Observational check list It will be developed by the researcher based on the related literature It will be used to assess Nurses’ practice for Patient with Permanent Pacemaker. Result: it was found that about eighty percent of studied nurses had unsatisfactory level of knowledge regarding pacemaker and about seventy seven percent of studied nurses had unsatisfactory level of practice regarding patient with permanent pacemaker. Conclusion: most of the studied nurses at cardiac care unit had unsatisfactory level of performance (knowledge & practice) regarding management of patients with permanent pacemaker in cardiac care unit. Recommendations: the study recommended Orientation and periodic training program for nurses in critical areas. Further studies is recommended to evaluate the reflection of training program regarding patient with permanent pacemaker in cardiac care units on nurses’ performance on the patients’ outcome. Developing a simplified and comprehensive booklet including guidelines about nursing care of patients with permanent pacemaker in cardiac care units. The study should be replicated on large sample and different hospitals setting in order to generalize the results.

Bleeding After Cardiac Surgery Is Associated With an Increase in the Total Cost of the Hospital Stay

Cardiac surgery results in complications for some patients that lead to a longer hospital stay and higher costs. This study identified the presurgery characteristics of patients that were associated with the cost of their hospital stay and estimated how much of that cost could be attributed to a bleeding event, defined as requiring 3 units or more of packed red blood cells or returning to the operating room for bleeding. We also identified the presurgery characteristics that were associated with the bleeding event. This prospective cohort of patients (n= 1459) underwent cardiac surgery at 3 tertiary referral hospitals in Australia during 2014 and 2015. Clinical data included the variables held by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons registry. Cost data were collected as part of a state-level hospital data collection. Many of the baseline patient characteristics were associated with the total cost of cardiac surgery. After adjusting for these characteristics, the cost of cardiac surgery was 1.76 (confidence interval, 1.64-1.90) times higher for patients who had a bleeding event (P < .001), thus resulting in a median increase in costs (in Australian dollars) of $33,338 (confidence interval, $21,943-$38,415). Several baseline characteristics were strongly associated with a bleeding event. The impact of a bleeding event on the cost of cardiac surgery is substantial. This study identified a set of risk factors for bleeding that could be used to identify patients for discussion at the heart team level, where measures to minimize the risk of transfusion may be initiated.

Better survival for patients with colon cancer operated on by specialized colorectal surgeons, Bergvall et al.

Several studies suggest that surgeon subspecialisation and nature of surgery (emergency or elective) both impact outcomes of colon cancer surgery. It is not possible to realize a prospective randomized study on this issue, and therefore large well documented population-based registers can be a possible source of information to shed light on this issue. This month’s Editor’s Choice by Bergvall et al. 1 studied 12 365 patients operated on for colon cancer in Sweden between 2007 and 2010. They used the Swedish Colorectal Cancer Registry to perform a retrospective analysis of the prospectively collected data on early and late outcomes of colon cancer operations done by colorectal specialists or general surgeons in the emergency or elective setting. Postoperative complications occurred in 1 in 3 patients after acute operations (N = 2931) versus 1 in 4 patients after elective surgery (N = 10 434). Among acute patients with postoperative complications 3 in 4 died within 5 years. Adjusting for 31 other well-known risk-factors (e.g. curative resection, TNM stage, ASA classification, postoperative complications, etc.), Bergvall et al. found that patients who undergo surgery for colon cancer by colorectal surgeons have an improved 5-years survival (60%) compared to patients who underwent surgery by general surgeons (48%). The significance of colorectal subspecialisation on short-term and 5-years survival was demonstrated after both elective and acute surgery. This article is yet another well-constructed analysis proving the importance of specialized surgical training. The remaining question is to construct a definition of the colorectal surgeon. In most of the European countries there is not a well-defined colorectal surgery subspecialty. The accreditation and certification are based on self-reporting or subjective credentials. Recently, the European Board of Surgery with its European Board of Surgical Qualification (EBSQ) has started offering the possibility to apply for a Fellowship of the European Board of Surgery – Coloproctology. There is no doubt that the ESBQ-coloproctology examination will become the norm for colorectal surgeons in Europe. However, to display an ESBQ-coloproctology certificate on the wall is not enough. An ongoing effort to read the professional literature and to attend the colorectal society meetings is necessary. Furthermore, it is important to be involved in the colorectal cancer/ IBD/ pelvic floor multidisciplinary meetings, and the development and maintenance of hospital protocols, data collection and complication registration. Yo-Yo Ma said: “I think one of the great things about being a musician is that you never stop learning.” Hopefully, colorectal surgeons feel the same about their job. Professor Mortensen, is an example of this attitude par excellence. Since his appointment in Oxford in 1987 he campaigned for the recognition of colorectal surgery as a specialty and created the now world-renowned colorectal department. Even in the winter of his surgical career he continues developing his surgical skills and as an early adopter he lowers the threshold for others to hold up to develop their skills. His recent involvement in the introduction of robotic surgery and transanal total mesorectal excision in the department shows this extraordinary ability to learn. Furthermore, his highly influential research subjects varied from basic to functional science, from pelvic floor to oncology. This issue of Colorectal Disease will unfortunately be his last as Editor-in-Chief. It is the merit of Professor Mortensen’s leadership that Colorectal Disease achieved its highest impact factor. We thank him for his great contribution to the success of Colorectal Disease and we are excited about Neil Smart taking on the Editor-in-Chief position. We can rest assured that the journal will stay in the hands of one of the best colorectal surgeons of his generation.

ICD-data collection features: an international survey

Background: The International Classification of Diseases (ICD) is globally used for coding morbidity and mortality statistics, however, its use, as well as the data collection features vary greatly across countries.&#x0D; Objective: To characterize hospital ICD-coded data collection worldwide.&#x0D; Methods: After an in-depth grey and academic literature review, an online survey was created to poll the 194 World Health Organization (WHO) member countries. Questions focused on hospital data collection systems and ICD-coded data features. The survey was distributed, using different methods, to potential participants that met the specific criteria, as well as organizations specialized in the topic, such as WHO Collaborating Centers (WHO-CC) or International Federation of Health Information Management Association (IFHIMA), to be forwarded to their representatives. Answers were analyzed using descriptive statistics.&#x0D; Results: Data from 48 respondents from 26 different countries has been collected. Results reveal worldwide use of ICD, with variations in the maximum allowable coding fields for diagnoses and interventions. For instance, in some countries there is an unlimited number of coding fields (Netherlands, Thailand and Iran), as opposed to others with only 1-6 available (Guatemala or Mauritius). Disparities also exist in the definition of a main condition, as 60% of the countries use “reason for admission” and 40% utilize “resource use”. Additionally, the mandatory type of data fields in the hospital morbidity database (e.g. patient demographics, admission type, discharge disposition, diagnoses, …) differ among countries, with diagnosis timing and physician information being the least frequently required.&#x0D; Conclusion: These survey data will establish the current state of ICD use internationally, which will ultimately be valuable to the WHO for the promotion of ICD and the rollout of ICD-11. Additionally, it will improve international comparisons of health data, and encourage further research on how to improve ICD coding.