List Of Classification Research Articles

Respiratory-related workers’ compensation claims from private employers — Ohio, 2001–2018

Background: Diseases and conditions related to the respiratory system contribute to work-related morbidity, mortality, and disability. Details on the causes and nature of work-related respiratory disease and the specific industries in which they occur are limited. This study identifies respiratory-related claims in the Ohio Bureau of Workers’ Compensation (OHBWC) system and describes claim and worker characteristics to inform public health surveillance. Methods: We developed a list of respiratory-related International Classification of Diseases Clinical Modification (ICD-CM) diagnosis codes and searched over 2 million claims filed between 2001 and 2018 in the OHBWC system for at least one of these codes. The claim characteristics, rates of claims by employer industry classification, and causes of claims from narrative text were determined for these respiratory-related claims. Results: Among the 23,015 respiratory-related claims (5.8 per 10,000 full-time equivalents [FTE]), 54.6% had at least one ICD-CM code for Allergic Reactions and 30.6% had at least one code for Toxic Effects of Substances Chiefly Non-medicinal as to Source. Claim causes from narrative text included Chemical Exposure (30.3%), Activity Suggesting Exposure (24.4%), and Vapors, Gases, Dusts, or Fumes (VGDF) Exposure (19.3%). The highest overall rates of respiratory-related claims among private employers were for the agriculture, forestry & fishing (11.4 per 10,000), public safety (ambulance services) (11.3), and manufacturing (10.7) industry sectors. Conclusions: Respiratory-related claims in the OHBWC system were often acute in nature and included allergic reactions. Narratives from these claims provide insight into the work-related exposures and events causing claims or the disease and symptom factors surrounding claims.

Comment on the Article by N.N. Zadneprovskiy et al. “Suggestions for the Introduction of Some New Terms in Surgery of Pelvic and Acetabulum Fractures”

Medical terminology is the subject of constant systematic regulation. The author›s team of the scientific article has determined the actual purpose of the study — to develop names for some parts of the pelvic bones and its areas that still do not have their own designations, and to propose the developed terms for professional discussion. Introduction of new anatomical terms for the designation of parts and structures of pelvic bones and their injuries in a systematic list of clinical classification will contribute to the formation of uniformity of therapeutic and diagnostic approaches, promote generalization and exchange of experience between practitioners in the field of surgery of pelvic ring injuries and acetabulum fractures, and have a significant scientific and educational character among the medical community.

Abstract 845: Population attributable fraction of cancer incidence due to infectious agents in 2020 in the Republic of Korea

Abstract Purpose: Earlier in 2009, National Cancer Center Korea estimated population attributable fraction (PAF) of cancer incidence due to infectious agents as 24.5% in men and 15.4% in women. This study aimed to investigate the proportion of cancer incidence attributable to infectious agents in the Korean population as of 2020. Materials and Methods: We organized the Consensus Committee to establish strategy and methodology of PAF estimation. Based on the consensus, infectious agents and cancer sites for PAF estimation were selected according to the IARC List of classification with sufficient evidence in human. As a result, infectious agents included hepatitis B and C virus (HBV and HCV), Helicobacter pylori (H. pylori), human papilloma virus (HPV), Clonorchis sinensis (C.sinensis), Epstein Barr virus, and human immunodeficiency virus, and cancer sites included hepatocellular carcinoma (HCC), cholangiocarcinoma (CCC), gastric cancer, pancreatic cancer, cervical cancer, and non-Hodgkin lymphoma. The PAF was calculated by using Levin’s formula including exposure prevalence and relative risks (RRs). Exposure prevalence data were collected from literature review of studies in Korean population in 2005 or earlier, assuming at least 15 years of latent period from risk exposure to cancer development. We performed systematic review for cohort studies and case-control studies which investigated RRs or ORs of cancer due to infectious agents in Korean population. Pooled RRs were estimated by meta-analysis of RRs or ORs by using random-effects model. Results: The fractions of all cancer incidence attributable to infectious agents were estimated to be 13.5% and 7.1% in men and women, respectively. The reduction in PAFs of cancer incidence due to infection in 2020 compared to 2009 is considered due to decrease in exposure prevalence. The major findings regarding infectious agents with large PAFs are as the following. We found that the fractions of HCC cases attributable to HBV infection were 47.7% and 38.4% for cancer incidence in men and women, respectively. The estimated PAFs of gastric cancer due to H. pylori were 40.4% in men and 38.2% in women. C. sinensis was related to 9.8% of CCC cases in men and 5.2% in women. A total of 77.7% of cervical cancer incidence was attributed to HPV infection. Conclusion: Although the total PAF due to infection has decreased over the last decade, infection still contributes a substantial fraction to cancer incidence in Korea. These recent estimates of cancer burden due to infection are important for planning and evaluating the national cancer prevention programs. Citation Format: Kyung-Shin Lee, Hwa Jin Lee, Yoon-Jung Choi, Moran Ki, Aesun Shin, Jong-Hun Kim, Sue-Kyung Park, So-Seul Sung, Sung Ji Moon, Hong Gwan Seo, Jin-Kyoung Oh, Jeong-Soo Im. Population attributable fraction of cancer incidence due to infectious agents in 2020 in the Republic of Korea [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 845.

Abstract 2216: Population attributable fraction of tobacco smoking on cancer incidence in 2020 in the Republic of Korea

Abstract Backgrounds: Cancer is the most common cause of mortality in Korea. According to International Agency for Research on Cancer (IARC), tobacco smoking is the Group I carcinogen, and the National Cancer Center Korea reported in 2009 that 20.9% and 2.3% of total cancer incidence were attributable to tobacco smoking in men and women, respectively. As of 2020, we estimated population attributable fraction (PAF) of cancer incidence due to tobacco smoking. Methods: We organized the Consensus Committee to develop strategy and methodology for PAF estimation. From the consensus, cancer sites for PAF estimation were selected based on the IARC list of classification with sufficient evidence in human. PAF was calculated by using Levin’s formula which includes exposure prevalence and relative risk (RR). Exposure prevalence was collected from the Korea National Health and Nutrition Examination Survey (KNHANES) in 2005, assuming that latent period from risk exposure to cancer development was 15 years. Tobacco smoking was defined as a categorical variable including non-smokers, past smokers, and current smokers. Pooled RRs were estimated from meta-analysis of RRs obtained from Korean Genome and Epidemiology Study, National Health Examination data provided by National Health Insurance Services, Korean Cancer Prevention Study-II, and KNHANES, each of which was linked with Korea Cancer Registry. Cox proportional hazards model were used to estimate RRs, while adjusted by age groups and alcohol consumption. Results: For men, 17.4% of all cancer cases were attributed to smoking, compared to 1.7% for women. Specifically, in men, 57.9% of lung cancer, 36.4% of bladder cancer, 31.9% of esophageal cancer, 39.1% of laryngeal cancer, 25.4% of oral cavity/pharyngeal cancer, 19.7% of liver cancer, and 19.5% of stomach cancer were attributed to tobacco smoking. In women, 51.7% of laryngeal cancer, 15.0% of esophageal cancer, 11.6% of lung cancer, 6.0% of bladder cancer, 5.1% of oral cavity/pharyngeal cancer, 5.0% of cervix cancer, and 4.6% of liver cancer were due to smoking. Conclusion: Tobacco smoking is an important cause of esophageal, laryngeal, and lung cancer in men, and esophageal and laryngeal cancer in women, and comprises a substantial proportion of PAF in cancer incidence. Thus, intervention measures are needed to reduce smoking prevalence for cancer prevention in Korea. Citation Format: Su Jung Byoun, Yoon-Jung Choi, Ye Lin Min, Sue-Kyung Park, Kwang Pil Ko, So_Seul Sung, NaYoung Kim, Keum Ji Jung, Sun Ha Jee, Sung-II Cho, Min Kyung Lim, Sohee Park, Eun Young Park, Hae Dong Woo, Kyu-Won Jung, E Hwa Yun, Byungmi Kim, Jin-Kyoung Oh, Yoonjoo Choi, Bohyun Park, Hong Gwan Seo, Jeong-Soo Im. Population attributable fraction of tobacco smoking on cancer incidence in 2020 in the Republic of Korea [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2216.

Abstract 2201: Population attributable fraction of alcohol consumption on cancer incidence in 2020 in the Republic of Korea

Abstract Backgrounds: Alcohol consumption is the Group I carcinogen according to International Agency for Research on Cancer (IARC). In 2009, National Cancer Center Korea reported that 3.0% and 0.5% of total cancer incidence were attributable to alcohol consumption in men and women, respectively. Herein, we estimated population attributable fraction (PAF) of cancer incidence due to alcohol consumption as of 2020. Methods: We organized the Consensus Committee to establish strategy and methodology of PAF estimation. Based on the consensus, cancer sites for PAF estimation were selected according to the IARC List of classification with sufficient evidence in human. PAF was calculated by using Levin’s formula which incorporates exposure prevalence and relative risk (RR). Exposure prevalence was obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) in 2005, assuming that latent period between exposure to alcohol consumption and diagnosis of cancer would be 15 years. Alcohol consumption was defined as non-drinking (<0.1g/day), light (0.1~30g/day), moderate (30~60g/day), and heavy (60~588g/day) drinking according to the definition by World Health Organization. We estimated RRs from the cohort data established by Korean Genome and Epidemiology Study, National Health Examination data provided by National Health Insurance Services, Korean Cancer Prevention Study-II, and KNHANES, while each cohort was linked with Korea Cancer Registry. RRs were estimated by using Cox proportional hazards model adjusted by age group and smoking status. RRs were then meta-analyzed to yield pooled RR by using random-effects model. Results: A total of 4.1% and 1.2% of all cancer incidence were attributable to alcohol consumption in men and women. By cancer sites, 67.1% of esophageal cancer, 23.8% of oral cavity/pharyngeal cancer, 15.1% of laryngeal cancer, 12.0% of colorectal cancer, and 7.9% of liver cancer were attributable to alcohol consumption in men. In women, 54.1% of liver cancer, 10.3% of colorectal cancer, 7.8% of oral cavity/pharyngeal cancer, and 3.6% of breast cancer were due to alcohol consumption. Conclusion: PAF of cancer incidence due to alcohol consumption has increased in 2020 compared to PAF in 2009. As alcohol consumption is an important cause of oral cavity/pharyngeal, esophageal, and laryngeal cancer in men, and liver and breast cancer in women, prevention measures are required to reduce alcohol consumption for cancer prevention in Korea. Citation Format: Ye Lin Min, YounJu Park, Su Jung Byoun, Sue_Kyung Park, Kwang Pil Ko, So-Seul Sung, Na Young Kim, Keum Ji Jung, Sun Ha Jee, Sung-Il Cho, Min Kyung Lim, Sohee Park, Eun Young Park, Hae Dong Woo, Kyu-Won Jung, E Hwa Yun, Byungmi Kim, Jin-Kyoung Oh, Yoonjoo Choi, Bohyun Park, Hong Gwan Seo, Yoon-Jung Choi, Jeong-Soo Im. Population attributable fraction of alcohol consumption on cancer incidence in 2020 in the Republic of Korea [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2201.

Economic approaches to assessing the environmental consequences of the war in Ukraine

The article examines the environmental consequences of the war in Ukraine, the types of effects of military actions on the environment and their potential danger to humanity now and in the future.
 The problems related to ecology and climate change as a result of military actions concern not only one country, nation or community, but can also affect the daily life of many future generations of Ukrainians, Europeans and the whole world. The issue of assessing the environmental consequences of military actions, classifying the damage caused, and choosing methods for assessing environmental damage are extremely popular in modern conditions for the Ukrainian and world community, which confirms the relevance and timeliness of this study.
 According to the materials of open sources, it was determined that the main risks for the ecology of Ukraine and the world ecological and economic system were the threat of a nuclear disaster, the impact of active offensive actions on forests, steppes and the natural landscape, the impact of war on plants and animals, the threat to red book species, water pollution and soil as a result of multifactor intervention, hitting industrial facilities and critical infrastructure facilities.
 A comprehensive algorithm for assessing the environmental consequences of military actions has been developed, which includes the following stages: establishment of a list of possible consequences, data collection, data analysis and classification of consequences according to the degree of security, assessment of environmental damage, information exchange and monitoring. Such a sequence allows you to identify the most influential risks and urgently take measures to overcome them. The created algorithm has a consolidated nature and should be refined and supplemented in further work.
 It is proposed to carry out zoning of the territories of Ukraine depending on the possibility of obtaining information about the environmental impacts and consequences of the war and the availability of data collection.
 In the future, it is advisable to develop methods for express assessment of environmental consequences for quick response to violations of environmental requirements, as well as in-depth methods that take into account detailed assessment of consequences and will allow to determine the most accurate economic component of consequences for ecology.

Validating ICD-10 codes for adverse drug events in hospitalised older adults: protocol for a cross-sectional study

IntroductionAdverse drug events (ADEs) among hospitalised older adults are common yet often preventable. Efforts to recognise ADEs using pharmacist review and electronic health record adaptations have had mixed results. Our...

Antibiotic Use and Bacterial Infection in COVID-19 Patients in the Second Phase of the SARS-CoV-2 Pandemic: A Scoping Review.

This scoping review aimed to explore the prevalence and patterns of global antibiotic use and bacterial infection in COVID-19 patients from studies published between June 2020 and March 2021. This review was reported in line with the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews, and the protocol is registered with the Open Science Framework. Compared with our previously-published review of the period (December 2019–June 2020), the antibiotic prescribing rate for COVID-19 patients (June 2020–March 2021) was found to have declined overall (82.3% vs. 39.7%), for mild and moderate patients (75.1% vs. 15.5%), and for severe and critical patients (75.3% vs. 48.3%). The seven most frequently prescribed antibiotics in COVID-19 patients were all on the “Watch” list of the WHO AWaRe antibiotics classification. The overall reported bacterial infection rate in COVID-19 patients was 10.5%, and the most frequently reported resistant pathogen in COVID-19 patients was Staphylococcus aureus, followed by Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. There is an urgent need to establish comprehensive and consistent guidelines to assist clinicians in selecting appropriate antibiotics for COVID-19 patients when needed. The resistance data on the most frequently used antibiotics for COVID-19 patients for certain resistant pathogens should be closely monitored.

A Study on Likeness of Services and Service Suppliers under the GATS

WTO의 서비스무역 분쟁에서 피제소국과 제소국 간의 분쟁대상이 되는 서비스 및 서비스 공급자에 대한 동종성 판단 여부는 가장 핵심이 되는 이슈이다. 특히 그 분쟁이 GATS의 제2조(최혜국대우) 혹은 제17조(내국민대우)에 관한 사안일 경우 동종성 판단이 선행되지 않고서는 해당 분쟁을 자체를 논하거나 판결할 수가 없기 때문에 그 중요성은 매우 크다고 할 수 있다. 동종성 판단이 단순하지 않은 이유는 우선 GATS 협정문에 ‘동종’에 대한 명확한 정의가 내려져 있지 않기 때문이다. 나아가 상품과는 달리 서비스의 무형성 때문에 GATS의 서비스 및 서비스 공급자의 동종성에 관한 판단은 GATT의 동종 상품 판단에 비해 모호해질 수밖에 없고 이는 더욱 면밀하고 복잡한 분석 절차를 요구하게 된다. 한편 CPC는 각 회원국의 양허표상 서비스 분류에 대한 기준을 제시해주는 반면에 단순히 CPC 분류만으로는 해당 서비스의 동종성에 대한 직접적 판단이나 비약적인 결론을 내릴 수는 없다. 동종성 판단에 대한 법적인 기준은 그동안 다양한 GATS 분쟁을 통해 논의되어 왔으나 지금까지도 명확한 기준이 되는 리스트가 제시되지는 않은 상태이다. 따라서 본 연구를 통해 지금까지 GATS의 동종성이 이슈가 되었던 7개의 WTO 분쟁사례에 대한 패널 및 상소기구 보고서를 분석함으로써 동종성 판단에 대한 분쟁 당사국들의 주장과 논거를 살펴보고 각 분쟁에서 동종성 판결의 근거가 된 법리를 종합하여 향후 적용 가능한 기준을 도출해보도록 한다.A determination on “likeness” between domestic and foreign services and service suppliers is one of the most critical issues in disputes under the General Agreement on Trade in Services (GATS). Likeness under the GATS requires a complex analysis because the term “like” is not defined in the GATS text itself. In the meantime, the intangible nature of services and its four different modes of supply make it inappropriate to transpose the traditional like standards used under the GATT. While the “CPC” provides a list of services classification for the schedule of specific commitments for Members, the categories alone do not fully solve the question of likeness. Therefore, this article seeks to discuss seven GATS dispute cases where the likeness of services and service suppliers was analyzed and determined and provide some level of a general rule for likeness determination extrapolated based on the reasoning of the panel and Appellate Body in these disputes.

Aproximación al mapa de actores de la AER INTA General Pinedo y sus aportes al trabajo de extensión

<p>El objetivo del trabajo fue identificar y relevar aquellos actores presentes en el territorio. Propiciar la creación de un mapa y visualizar las redes de acciones conjuntas entre ellos y la AER INTA. Para ello, fue necesario recurrir al aporte de bibliografía y antecedentes metodológicos de autores referentes en mapeo de actores. A partir de pautas concretas y armado de planillas, se consultaron a referentes locales. Con el listado se procedió a categorizar y clasificar en función de tres variables (aproximación, importancia y vínculos de trabajo). Con esta valoración se realizó la representación gráfica y posterior análisis. De la obtención del mapa, se destaca la identificación de una diversidad significativa de actores. Las interacciones observadas aportan a la planificación del trabajo que se realiza en el territorio. A su vez, se establecen pautas para visualizar y evaluar el rol del extensionista en este contexto. Da cuenta del dinamismo y cambios en el escenario territorial. Por último, el desarrollo y resultado del trabajo facilita una metodología para aquellos extensionistas que deseen incorporar esta herramienta a su trabajo.</p>

Пріоритетні напрями логістичної діяльності підприємства для передачі на аутсорсинг

Annotation. Introduction. The article examines the services of logistic outsourcing from the point of view of Ukrainian manufacturing companies, analyzes the results of the survey, compares them with global trends. It was determined that Ukrainian companies use logistic outsourcing less often than companies in other regions of the world. Also, the most often outsourced fields were identified. Purpose. Analysis of logistics outsourcing services from the viewpoint of Ukrainian manufacturing companies and comparison of survey results based on the survey with global trends. Results. It was found that from the list of enterprise groups classification (micro, small, medium, large) all categories use the services of freight forwarding companies. The following types of logistic processes are most often outsourced: transportation, lease and maintenance of equipment, warehousing, logistic chain optimization. It was found that among other countries in the study of third-party logistics, Ukraine occupies the lowest position in the usage of outsourcing services in logistics. The reasons for outsourcing logistic processes in logistics are significant: lack of own resources and capacity, cost reduction. The relationship between causes and logistic processes has shown that in order to reduce logistic costs in the enterprise it is necessary to outsource transportation. Conclusions. Statistical research has shown a small relationship between the areas of logistic outsourcing and the main causes of outsourcing of logistic activities. Therefore, it is not appropriate to say that some logistical measures should be outsourced and others should not. The mixed system, which combines the usage of own and third-party production facilities, is the most suitable for most Ukrainian manufacturing companies Keywords: logistics, outsourcing, third-party logistics, transport, warehousing, supply chain management, optimization, respondent, survey.

United States emergency department visits for children with cerebrospinal fluid shunts.

CSF shunt placement is the primary therapy for hydrocephalus; however, shunt malfunctions remain common and lead to neurological deficits if missed. There is a lack of literature characterizing the epidemiology of children with possible shunt malfunctions presenting to United States emergency departments (EDs). A retrospective study was conducted of the 2006-2017 National Emergency Department Sample. The data were queried using an exhaustive list of Current Procedural Terminology and International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes representing children with hydrocephalus diagnoses, diagnostic imaging for shunt malfunctions, and shunt-related surgical revision procedures. In 2017, there were an estimated 16,376 ED visits for suspected shunt malfunction. Children were more commonly male (57.9%), ages 0-4 years (42.2%), and publicly insured (55.8%). Many did not undergo diagnostic imaging (37.2%), and of those who did, most underwent head CT scans (43.7%). Between 2006 and 2017, pediatric ED visits for suspected shunt malfunction increased 18% (95% CI 12.1-23.8). The use of MRI increased substantially (178.0%, 95% CI 176.9-179.2). Visits resulting in discharge home from the ED increased by 76.3% (95% CI 73.1-79.4), and those involving no surgical intervention increased by 32.9% (95% CI 29.2-36.6). Between 2006 and 2017, ED visits for children to rule out shunt malfunction increased, yet there was a decline in surgical intervention and an increase in discharges home from the ED. Possible contributing factors include improved clinical criteria for shunt evaluation, alternative CSF diversion techniques, changing indications for shunt placement, and increased use of advanced imaging in the ED. CPT = Current Procedural Terminology; ED = emergency department; ETV = endoscopic third ventriculostomy; ICD-9 = International Classification of Diseases, Ninth Revision; ICD-10 = International Classification of Diseases, Tenth Revision; NEDS = National Emergency Department Sample.

Uncomplicated Wide Oblique Clivus Fracture, the First Case to be Included in the List of Classification; Report of the Case and Review of Literature

Sheno-occipital diastasis happens more frequently in children and is accompanied with neural and vascular injuries leading to a high rate of mortality. We present a rare type of clival fracture in a 21 years old man who could survive without any deficit even though the fracture extended widely from left Asterion to the right orbit accompanied by widespread damage of the skull base air sinuses in 3D CT scan. To the best knowledge of the authors, neither this type of fracture, nor the clinical presentation, has been reported in relevant literature.

Treatment of cartography in official classification of fields of sciences and its misuse by the State Educational Inspectorate and the University of Tetova

Treatment of cartography in official classification of fields of sciences and its misuse by the State Educational Inspectorate and the University of Tetova

Odonata of Wadi Bouarroug (northeastern Algeria), and environmental determinants of their distribution

The present paper describes odonates recorded over an extended period at wadi Bouarroug, south of lake Mellah, in the national reserve of Brabtia (North-east Algeria). In all, 42 weekly visits were made to four stations at wadi Bouarroug between March 2015 and February 2016. A total of 19 species of odonates comprising seven families (Calopterygidae, Lestidae, Plactycnemidae, Coenagrionidae, Gomphidae, Aeshnidae, Libellulidae) was recorded. Among the 19 species, autochthonous status was confirmed for 12 species. Two Maghrebian endemics species, Platycnemis subdilatata, Gomphus lucasii (“Data Deficient” species in the Mediterranean Red-List) were recorded. In the latest check-list of the odonates fauna of wadi Bouarroug, 11 species were reported,during 1993 and 1994. Eight species have been recently added ( Lestes virens, Erythromma lindinii, Erythromma viridulu, Paragomphus geneii, Onychogomphus uncatus, Crocothemis erythraea, Trithemis arteriosa, Trithemis annulata ) of which Paragomphus genei was recorded for the first time in the reserve of Brabtia in 2014 and its autochthonous status is confirmed at wadi Bouarroug from June 2015. Species richness along the wadi Bouarroug is positively correlated with density of riverine vegetation and with weak to moderate water flow during all the year. By contrast, species richness varies negatively with habitat fragmentation and the destruction caused by urbanization and pollution. As a result of this study, we do not propose any change of the Red List of the IUCN classification of the recorded species recorded at wadi Bouarroug. However, the presence of some taxa like Calopteryx haemorrhoidalis and Para gomphus geneii at wadi Bouarroug, testifies to the persistence of high-quality natural environments which are able to still support an important diversity of aquatic species.

Priority target conditions for algorithms for monitoring children's growth: Interdisciplinary consensus

BackgroundGrowth monitoring of apparently healthy children aims at early detection of serious conditions through the use of both clinical expertise and algorithms that define abnormal growth. Optimization of growth monitoring requires standardization of the definition of abnormal growth, and the selection of the priority target conditions is a prerequisite of such standardization.ObjectiveTo obtain a consensus about the priority target conditions for algorithms monitoring children's growth.MethodsWe applied a formal consensus method with a modified version of the RAND/UCLA method, based on three phases (preparatory, literature review, and rating), with the participation of expert advisory groups from the relevant professional medical societies (ranging from primary care providers to hospital subspecialists) as well as parent associations. We asked experts in the pilot (n = 11), reading (n = 8) and rating (n = 60) groups to complete the list of diagnostic classification of the European Society for Paediatric Endocrinology and then to select the conditions meeting the four predefined criteria of an ideal type of priority target condition.ResultsStrong agreement was obtained for the 8 conditions selected by the experts among the 133 possible: celiac disease, Crohn disease, craniopharyngioma, juvenile nephronophthisis, Turner syndrome, growth hormone deficiency with pituitary stalk interruption syndrome, infantile cystinosis, and hypothalamic-optochiasmatic astrocytoma (in decreasing order of agreement).ConclusionThis national consensus can be used to evaluate the algorithms currently suggested for growth monitoring. The method used for this national consensus could be re-used to obtain an international consensus.

Hemodialysis Facility Variation in Hospitalization and Transfusions Using Medicare Claims: The DOPPS Practice Monitor for US Dialysis Care

Hemodialysis Facility Variation in Hospitalization and Transfusions Using Medicare Claims: The DOPPS Practice Monitor for US Dialysis Care

Who needs an orthopedic trauma surgeon? An analysis of US national injury patterns

Many hospitals in the United States are seeking to obtain and maintain trauma credentialing. Assessment of trauma center success has traditionally focused on mortality without directed measure of surgical subspecialization. However, survival alone may not be a sufficient marker of success with modern health care. The purpose of this study was to determine the number of trauma patients nationally who would benefit from subspecialized care by an orthopedic traumatologist. A list of musculoskeletal DRG International Classification of Diseases-9th Rev. codes representing injuries warranting care by subspecialized orthopedic traumatologists was generated by survey to each of two cohorts: one consisting of 10 subspecialized orthopedic traumatologists and one consisting of 10 nontraumatologists. The 2006 National Inpatient Sample data set was used to estimate the national volume of patients sustaining an orthopedic injury and the number requiring subspecialty orthopedic trauma care, as defined by the DRG International Classification of Diseases-9th Rev. lists generated by our survey. Survey response rate was 100%. In 2006, 2,068,349 patients sustained a traumatic injury; 46.7% of these had an orthopedic injury. Our cohort of subspecialized orthopedic traumatologists identified 25.7% of all trauma patients as requiring an orthopedic traumatologist. Our cohort of general orthopedists identified 13.5% of all trauma patients as requiring an orthopedic traumatologist. Rates of polytrauma, injury severity, and treatment at trauma centers were similar between the two groups. Between 13.5% and 25.7% of all injured patients should, if resources permit, receive subspecialty orthopedic trauma care. The magnitude of this figure highlights the importance, from a public health perspective, of policy interventions aimed at better coordinating the field of orthopedic traumatology. Detailed outcome measures beyond mortality and triage guidelines suggesting which patients should receive subspecialty orthopedic trauma care should be developed. In addition, resources, including fellowship training, should be allocated in a methodical manner that matches supply to the national demand for this type of care. Economic/decision analysis, level IV.

Inequalities in outcomes of acute kidney injury in England

Renal replacement is managed by renal specialists and is well documented in national registries. In contrast, nation-wide data on acute kidney injury (AKI) are difficult to capture as it presents in many different ways to all acute hospitals. This paucity impacts on the coordination of appropriate services. We have set out to use all the information submitted by all hospitals in England to identify emergency patients in whom AKI was a major contributor to their hospital stay. We then examined workload in relation to specialist provision and outcomes of care. All English hospitals submit a sequential list of International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD 10) codes to describe the diagnosis of each admission. An algorithm was applied to all emergency admissions over a 2-year period to identify AKI. The level of renal specialist care available within each hospital trust was compared with patient outcomes, including 30-day mortality. The incidence of AKI was 1.34% of all emergency admissions. The numbers and types of AKI cases were similar in all trusts, regardless of the service available. Thirty-day mortality was 30.0%. More than half the acute hospitals did not have on-site renal specialists and their AKI mortality rates were significantly higher (P < 0.001). These differences persisted despite adjusting for multiple variables. The country has created specialist renal units in 45% of hospital trusts, but AKI presents as emergencies to all hospitals and there is an increased risk of mortality in the 55% of trusts without renal specialists.

Comments on the WHO histological classification of pituitary tumors

I would like to agree, in general, with the view of Drs. Al-Shraim and Asa on the new WHO classification, especially on the necessity of introducing cell lineage. The basic tone of the argument for the new WHO histological classification of pituitary tumors was to try to build a new framework by shifting from the classical classification, which has been mainly based on electron microscopy, to a classification based on light microscopic immunohistochemistry. This was addressed on the background of recently accumulating knowledge on cell lineage of adenohypophysial cells. Nobody doubts that electron microscopic observations can provide essential information about cell nature, although it has been argued that electron microscopy has not been well performed even in sophisticated institutes. That is why each tumor type is primarily described on the basis of immunohistochemical information, such as growth hormone (GH)-producing adenoma, adrenocorticotropic hormone (ACTH)-producing adenoma, and so on. In my view, it seems to be indispensable to show a list of the WHO histological classification of pituitary tumors at the beginning of the chapter. Although a simple list of the WHO classification including typical adenoma, atypical adenoma and carcinoma is shown, it is not sufficient. In other chapters such as those on tumors of thyroid gland, adrenal gland and endocrine pancreas, the comprehensive list is appropriately documented with international classification of diseases (ICD) codes. Remarkably, glucagonoma and VIPoma of the endocrine pancreas, which are much rarer than GH-producing adenoma and ACTH-producing adenoma, are shown in a list with ICD codes. Table 1 may represent such a list of the new classification of pituitary tumors. I am afraid that people may misunderstand that Table 1.01, which shows the incidence of pituitary adenoma types classified by Horvath and Kovacs, indicates the new WHO classification, since this is the only list of pituitary adenoma types shown in the chapter.