Operational Code Research Articles

Postoperative paralytic ileus remains a problem following surgery for advanced pelvic cancers

BackgroundParalytic postoperative ileus (POI) is associated with increased morbidity and mortality after abdominal surgery. Despite increased awareness and implementation of various measures, POI remains a problem, perhaps moreso for those patients undergoing extensive oncological surgical treatment. The aim of this study was to describe the extent of POI after advanced cancer surgery in the era of contemporary treatment modalities of POI. MethodsA retrospective analysis of all patients who underwent either abdominoperineal excision with transpelvic vertical rectus abdominal musculocutaneous (VRAM)-flap after anal cancer or pelvic exenteration at single institution from January 2012 to November 2013 was carried out. Patients were identified from operative codes, and data were retrieved from patient records. ResultsEighty-nine patients were included in the study, 21 abdominoperineal excision and 68 pelvic exenteration procedures. Median nasogastric tube duration was 4 days (range: 0-44). Median time to first flatus was 1 day (range 0-15). Median time to defecation was 3 days (range 0-16 days). Twenty-three patients (28%) experienced prolonged ileus. There was a significant longer time to first defecation for patients who received a VRAM flap (P = 0.046). There was also a significant association between longer operative times and first flatus (P = 0.007). ConclusionsThis retrospective study reveals that POI remains as a significant clinical problem in patients undergoing advanced pelvic cancer surgery, despite the increased awareness and implementation of enhanced recovery protocols. New regimens for better prophylaxis are needed, and further research on POI treatment is important.

Deliverology and Canadian military commitments in Europe circa 2017

ABSTRACTThe Liberal government elected in October 2015 established an operational code based on the concept of “deliverology,” especially on its campaign promises. Such promises included a change in the Canadian contributions against Daesh (actualized), a renewal of Canadian contributions to United Nations-led “peacekeeping” (not yet actualized), and the maintenance of Canadian commitments to North Atlantic Treaty Organization operations (to be increased). This divergence between promises and decisions presents a puzzle. Why would the government fulfill some promises but not others? The increase in the future military commitments comes at a cost, and the government’s efforts to reconcile its costs and commitments in the future will reveal the depth of its idealism. The challenge for future research will be trying to discern between a preference for being a “reliable ally” and the need to be perceived as the same in order to enable the pursuit of liberal internationalist goals.

64 Older (higher risk) patients with non-st-elevation acute coronary syndrome (nsteacs) have the most to gain from invasive therapy: a population study in south wales 2004–2014

Background and aimCardiovascular disease is the biggest killer in Wales, with non-ST-elevation acute coronary syndrome (NSTEACS) forming the commonest diagnosis. NSTEACS patients are at risk of death, reinfarction and ischaemia,...

The paradox of invasive therapy following non-ST-acute coronary syndrome in older higher risk patients: A population level study in South Wales 2000-2014

ABSTRACT
 ObjectivesFollowing non-ST-elevation acute coronary syndrome (NSTEACS), patients are treated with medication and considered for invasive therapy and revascularization. Mortality for this whole population is high in the first year with multiple studies suggesting anything from 4% to 10%. However, the risk of death after the first year has a wide distribution amongst the whole population with a much higher risk in older patients. We will highlight that decisions to revascularise are predominantly focused on a younger lower risk population with smaller improvements in outcome. Older, higher risk patients frequently do not receive invasive therapy despite the potential to benefit the most. However, the evidence base for using invasive therapy in this group is poor overall. With the use of data linkage from a novel national NSTEACS registry dataset we aim to clarify the influence of invasive therapy on this group in terms of adjusted mortality, reinfarction, re-admission with ischaemia, stroke and major bleeding.
 ApproachAll patients over a 14-year period in south Wales with a first diagnosis of NSTEACS and treated either medically or invasively. Cohorts identified by a combination of ICD-10 codes, operation codes, and linkage to coronary angiography data. Extraction of cohorts validated externally using novel national NSTEACS registry data. Multivariate analysis of baseline-characteristics for understanding how these factors influence treatment decisions. Propensity matching between medical cohorts and invasive cohorts to show the corrected effect of invasive vs. medical therapy.
 ResultsTotal population 83,712 from 2000 until 2015. With 23,670 patients invasive therapy, 57,042 medical therapy. Invasive therapy was common in the 65-69 age groups and below but the proportion was never more than 50%. Above 65-69 exponential decline in invasive therapy, 75-79 (24.4%) 80-84 (14.7%) and 85-89 (6.5%). Unadjusted mortality revealed highly significant improvements in survival for the invasively treated patients in all age groups but with large increases as age increased. Adjusted and matched results to follow.
 ConclusionInitial results suggest increasing age and cardiovascular risk is associated with much higher mortality at one year and beyond. Older higher risk patients have very low rates of invasive revascularization but appear to have more to gain from this approach (than younger, lower risk patients), in terms of mortality and morbidity. In the older higher risk population these results suggest that increased frequency of invasive therapy will lead to reduced short and long term mortality, reduced hospital readmission with less frequent development of heart failure and reinfarction.

The operational code approach to profiling political leaders: understanding Vladimir Putin

Content analytics applied to open source material can assist in understanding, predicting, and influencing the behavior of foreign political leaders. We provide evidence to this effect by profiling Russian President Vladimir Putin, who remains a source of consternation to the academic, intelligence, and policy communities. We apply the operational code scheme to a corpus of over one million words spoken by Putin across his time in office, and use the results to adjudicate between the competing portraits of him in the extant literature. We find Putin to hold broadly mainstream beliefs about international politics, albeit qualified by hyper-aggressiveness toward terrorism and a startling preoccupation with political control. His approach is that of an opportunist rather than a strategist. These data represent a stream of information that must be combined with other sources and integrated, through policy judgment, into a comprehensive approach to a foreign political leader.

Leadership Analysis at a “Great Distance”: Using the Operational Code Construct to Analyse Islamist Leaders

Operational code analysis was originally designed to analyse the Soviet Politburo members’ political strategies and was codified by George and Walker, Schafer and Young. The approach has mostly been used to analyse individual world leaders, rather than specific political groups. In this article, I use the operational code construct to analyse political Islamists’ belief systems. I discuss issues regarding using the operational code construct in a non-Western political and cultural setting. The first difficulty of using the operational code analysis to analyse political Islamists’ strategies is the diversity of the movement, which led to a certain “level of analysis” problem. Second, whether to use computerised analysis or traditional hand coding was an important decision. Third, some procedures of the operational code research agenda, such as coding only transitive verbs, at times seemed to be in conflict with Turkish and Arabic sentence structures and verbs. Lastly, since the “Western” foreign policy analysis (FPA) theories are not frequently applied in the “global south” cases, I did not have a large body of literature to use while conducting my research. This article discusses the “boundedness” of the operational code analysis in analysis of non-Western individual leaders and political movements by discussion of these issues and others.

The importance of communication for the maintenance of health and safety in work operations in ports

IntroductionThe work of transport and handling of goods at the port is collectively executed and so it requires good communication among workers to deal with the usual and unexpected situations of daily work. ObjectiveThe aim of this study was to analyze the form and functions used in the communication between port workers and determine their importance for the preservation of workers' health and safety. MethodologyThis research is the result of a case study conducted in a port located in the north of Portugal. It involved general and systematic observations of work activity on the pier and boats, completed with semi-structured interviews and individual and collective refunds. Individual and collective refunds served to deepen some aspects identified during observations, fundamental to the knowledge of subjective experiences of these workers. Results and discussionDuring the investigation each port worker was observed not as an isolated individual but inserted into working relations with other port workers, who perform other functions, such as boarding, stevedores, inspectors, crane operators, among others. These interactions among workers take place through various forms of communication: gestures, movements, looks, facial expressions, verbal or printed information, operative codes. ConclusionsThe impact of these forms of communication is visible at several levels: the possibility of meeting deadlines; the quality of their work; and also for the safety of all those involved in work situations. There are variations in communication not only according to the type of load to be carried, but also according to the function of each team member.

Fen Osler Hampson and Stephen M. Saideman, eds. Canada Among Nations 2015: Elusive Pursuits: Lessons from Canada’s Interventions Abroad Centre for International Governance Innovation

Reviewed by: Aaron Ettinger, University of WaterlooIt is uncommon for an academic book review to begin with cover art but 29th volume of Canada Among Nations is worthy of mention. Gracing front is image of a special operations soldier with parachute in full bloom, slightly above a treeline, with a snow-capped mountain in distance. Exactly what paratrooper will encounter on ground is not clear. It is a clever visual representation of challenge of and purpose of this volume. Elusive Pursuits serves as a comparative evaluation of Canadian interventions in post-Cold War era, a period that saw Canada in (or above) Afghanistan, Bosnia, East Timor, Haiti, Kosovo, Libya, Somalia, and at present, Iraq-Syria. Elusive Pursuits is intended to provide lessons learned for that paratrooper and policymakers that will send him drifting to ground next time, wherever and whenever that may be.The volume is inspired by formal end of Afghanistan mission in 2014, which looms large in Canadian consciousness. Or, to be more precise, what looms large is deadly 2006-2011 period of counter-insurgency in Kandahar. This informs scope of intervention laid out in editors' introduction, which defines it narrowly as the use of force to affect domestic dynamics of another country, with broad aim of contributing to international peace and (3). It is for best, however, that contributors do not strictly adhere to this definition. After all, Canada's experience with intervention is much broader than introduction lets on. Thus, Elusive Pursuit's principal strength is broad perspective it takes on and insights that flow from diverse scholarship on issue. The individual contributions in this volume cover a wide expanse of issues that serve to remind readers of scope and implications of Canada's interventions over past 25 years. There are chapters on Canada's recent high-profile combat experiences in Iraq/Syria, Kandahar, and Libya, but also on diplomatic responses to Arab Spring, security sector reform initiatives in Haiti, and disastrous peacekeeping and aid mission in Somalia, consequences of which still linger. Furthermore, there are up-to-date analyses of how Canadian government institutions and society have evolved during post-September 11 era.Undoubtedly, though, most ambitious and controversial chapter in Elusive Pursuits tries to articulate Harper Doctrine on military by schematizing operational code that informed Stephen Harper's duty-driven internationalism. Authors Derek Burney, Fen Osler Hampson, and Simon Palamar make important observation that Harper's interventions appeared to mimic humanitarian and multilateral impulses of liberal internationalism, but his pathways to military are entirely different. …

The Psychological Dimension of Russian Foreign Policy: Putin and the Annexation of Crimea

This article contributes to the growing scholarly literature endeavouring to explain Russia’s annexation of the Crimean Peninsula in 2014. While much of the debate relies on the grand theories of International Relations such as realism, liberalism or constructivism, this article approaches the puzzle from a psychological point of view and discusses several middle-range theories within this genre. These theories are examined sympathetically but critically, spelling out the added value they might have in elucidating Russian foreign policy, while also considering the methodological limitations in producing plausible explanations. Moreover, the article strives to overcome the traditional juxtaposition between the idea of rationality as a standard account of agency, and various psychological interpretations. Obvious methodological problems notwithstanding, the article concludes that cognitive and psychological features—such as the possibility of groupthink, assessment of prospects, operational codes and belief systems, personality characteristics and emotions—can be applied to the Russian case and they can all explain Russia’s higher willingness to take risks in the context of the Ukrainian crisis. In that way, they can provide us with partial explanations, and indeed are important elements of our understanding of Russian foreign policy in general and the Crimean case in particular.

Can an operative coding sticker improve coding accuracy and remuneration for upper tract stone-related procedures?

Objective: Rigid ureteroscopy, flexible uretero-renoscopy and ureteric stenting are commonly performed procedures. Operative clinical coding and remuneration varies depending on the procedure. We determined if loss of remuneration, through poor operative coding, could be improved with an operative coding sticker. Patients and methods: We performed a retrospective review of 133 random stone-related procedures (rigid ureteroscopy/flexible uretero-renoscopy and ureteric stenting). Using the Office of Population Censuses and Surveys codes, we compared actual operative coding and urological surgeon coding. We introduced an operative coding sticker and prospectively re-audited to determine if coding accuracy improved. Results: Flexible uretero-renoscopy was initially miscoded in 29 of 53 cases (55%), with a loss of remuneration of £1014 per case. Rigid ureteroscopies were correctly coded in 99% of cases, but ureteric stenting was only correctly coded in 82%. The introduction of the coding sticker resulted in improved coding accuracy rates of 100% for rigid ureteroscopy, 95% for flexible uretero-renoscopy and 100% for ureteric stenting. Overall, coding accuracy improved from 54% to 99%. We estimate this coding sticker will improve our departmental remuneration by £67,938 per year. Conclusion: Rigid ureteroscopy, flexible uretero-renoscopy and ureteric stenting were initially poorly coded. The introduction of a simple operative coding sticker improved coding compliance to 99% and increased operative remuneration.

A real-time surgical site infections surveillance mode to monitor surgery classification-specific, hospital-wide surgical site infections in a Chinese tertiary hospital.

We introduced a real-time surgical site infections surveillance mode (SSISM) to monitor hospital-wide surgical site infections (SSIs) based on the ICD-9-CM Volume 3 operational codes and the ICD-10 disease codes. Compared with the gold standard, the SSISM confirmed 71.9% (82/114) of SSIs from 3,048 operations with a 60-fold time-savings. The SSISM could obtain the SSI rates for each type of surgery or disease among hospital-wide inpatients in a tertiary hospital with 3,800 beds.

Complications of Bilateral Neck Dissection in Thyroid Cancer From a Single High-Volume Center

The morbidity of bilateral lateral neck dissection (BLND) for thyroid cancers has not been described in detail. This study delineates the specific complications arising from BLND for thyroid cancers at a single high-volume center. To determine the morbidity associated with BLNDs for differentiated thyroid cancers at our institution. This was a retrospective review of medical records performed to identify patients having undergone BLNDs for thyroid cancers by a single surgeon at an academic, tertiary medical center in Toronto, Ontario, Canada, from 1988 to 2015. Patients who underwent BLND for papillary, follicular, or medullary thyroid cancers were identified through operative procedure codes and review of operative and pathology reports. The indication for this procedure was suspicious bilateral lateral compartment on imaging and clinical examination. Sixty-two patients who underwent BLND for thyroid cancers, with or without total thyroidectomy and central compartment dissection, were identified. The main outcome measures for this study were unanticipated medical or surgical complications during the operation or in the postoperative period. Secondary measures were oncologic outcomes, including regional structural or biochemical recurrence. Of the 62 patients, 24 were male (39%), and 38 (61%) were female. Their mean age was 46 years (range, 17-80 years). The overall risk of permanent hypoparathyroidism was 37%. There was 1 case of unanticipated permanent recurrent nerve paralysis and 1 case of temporary nerve paresis. Postoperative chyle fistula occurred in 6 cases (10%). There were 3 readmissions within 30 days of surgery, 1 pulmonary embolism, and 1 perioperative mortality. Fifty percent of patients had pN0 contralateral necks despite preoperative clinical suspicion. Four patients were found to have anaplastic thyroid cancers intraoperatively. Five patients (8%) developed nodal recurrence in the neck. Four patients died of their disease within available follow-up (mean, 3.2 years). Bilateral lateral neck dissection for thyroid cancers confers a significant amount of morbidity, including a significant rate of hypoparathyroidism. Knowledge of the complications of this procedure, especially in the setting of questionable survival benefit, may assist in preoperative decision-making and patient counseling.

Trauma surgery without proper compensation under the current Korean National Health Insurance System.

PurposeThis study aimed to evaluate the situations and problems of the current health insurance fees for trauma surgeries.MethodsWe reviewed the medical records and billing data from trauma surgeries performed in the hospital from August 2012 to July 2014. The name and number of surgeries were investigated and the code and number of operations prescribed by surgeons were compared with the number of cases actually billed to insurance. In addition, the results returned by the Health Insurance Review & Assessment Services (HIRA) after deduction were investigated and compared to verify the insurance review findings.ResultsDuring the study period, total 1,534 trauma surgical procedures were performed for a total of 253 trauma patients. Based on names, 1,092 procedures were performed; however, 442 cases (28.8%) could not be prescribed because of lack of proper insurance codes for the procedures. A total of 1,046.5 surgical procedures were prescribed by surgeons, adjusted by the insurance team, and finally billed to the HIRA; 162 bills were returned from the HIRA after rate reductions, corresponding to a reduction rate of 15.5%. The major reason for reduction was “fee criteria and limited number”. The compensation rate for billed surgical procedures was 84.5%.ConclusionThe high reduction and low compensation rate for trauma surgery under the current Korean National Health Insurance System need to be reviewed and improved. Furthermore, it is necessary to establish new criteria for surgical procedures fees for latest ones such as damage control surgery performed on severe trauma patients.

РОЛЬ НАЦИОНАЛЬНЫХ АРХЕТИПОВ ДЛЯ ФОРМИРОВАНИЯ ОБРАЗА БУДУЩЕГО РОССИИ

The article discusses the conceptualization and formation of the image of the future of Russia in domestic and foreign policy. The author emphasizes the high heuristic potential of the civiliza-tional approach and the theory of archetypes of C.G. Jung. The author shows that the important role in shap-ing the image of future Russia should play psycho-political analysis of socio-cultural and operational code of Russia that should be carried out by the Russian political expert community.

Validation of the Onsite Used Operational Code Against Burnup Measurement

A spectrometric system was developed for spent fuel burnup evaluations at the LVR-15 research reactor, which employed highly enriched (36%) IRT-2M-type fuel. Such a system allows the measurement of fission product axial distribution by measuring certain nuclides, such as Cs137, Cs134, and their ratios, respectively. Within the paper, a comparison between experimental data provided by the spectrometric system and calculations in operational code called NODER is provided.

Postoperative Venous Thromboembolism in Children Is Increased in Setting of Cancer or Infection

Background: Venous thromboembolism (VTE) is an uncommon but clinically significant postoperative complication in children. Incidence of VTE in pediatric patients ranges from 34-58 per 10,000 hospitalized children1. Due to rarity of these events, there is limited information about the factors predisposing children to VTE after surgery. We queried a national surgical database to identify risks and outcomes associated with VTE in pediatric surgical patients.Methods: The National Surgical Quality Improvement Program-Pediatric (NSQIP) is a prospectively collected database that records pediatric surgical information, surgical approaches, and 30 day patient outcomes. The database was queried for the years 2012-2013 to identify pediatric patients (age < 18) who had received surgical intervention and were diagnosed with postoperative VTE. Because of their separate coding in NSQIP, we defined VTE as including venous thromboembolism, or pulmonary embolism (PE) diagnosed radiographically within 30 days of operation. To reduce non-random differences between patients we used propensity scores based on age, sex, race, BMI, and ASA classification to match patients in a 1:2 ratio using the nearest neighbor method. Using univariate and multivariate analysis, we identified preoperative risk factors associated with VTE.Results: In total, 130 patients were identified who developed VTE postoperatively (VTE n=122, PE n=7, BOTH PE + VTE n= 1) from this database of 114,395 patients. There were 104 patients with VTE that also had complete entries and were subsequently analyzed in this study. Surgical specialties treating patients in this analysis included cardiothoracic surgery, general surgery, neurosurgery, orthopedic surgery, otolaryngology, plastic surgery, and urology. Eighty-one unique operative CPT codes were identified for patients with VTE. Patients who developed VTE had increased operative time, anesthesia time, and total length of stay (all p < 0.001). Multivariate analysis demonstrated that pneumonia (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.3 - 2.29), Central Line Associated Bloodstream Infection (CLABSI) (OR 1.69, 95% CI 1.18 - 2.42), sepsis (OR 1.47, 95% CI 1.18 - 1.82), septic shock (OR 1.36, 95% CI 1.06 - 1.75), and current solid or hematologic malignancy or active treatment of malignancy (OR 1.30, 95% CI 1.08 - 1.58) were all statistically significant risk factors associated with development of VTE (all p < 0.05).Conclusions: Postoperative VTE risk is significantly increased in children with malignancy or severe infections. Further research is needed to understand the mechanism between malignancy, systemic inflammation, and VTE risk in children. These findings may help to identify patients in need of prophylactic treatment in order to reduce postoperative thrombotic risk in pediatric patients.

Use of Display File Structure and Operation Code for DNA Sequence to Visualise and Presentation for Dot Matrix Graph for DNA Sequence Alignment

The management and analysis of bio information using computer application is study that related with the use of computing facility for collection, visualization, analysis and presentation of bio information. The DNA sequence achieving in lab is stored in the computer files like as ordinary text files. This file includes information about the sequences. This sequence alignment is comparison and finding relatedness of two sequences using dot matrix graphical method. Display file structure and operation code assigned to nucleic acid used for generating this graph and this will make computing faster. So goal of this concept is used to made visualisation and presentation faster as compared to traditional method. The similarities in graph of two sequences represent that the two sequences must have derived from a common ancestor and evolutionary origin.

S4: An O2R/R2O Infrastructure for Optimizing Satellite Data Utilization in NOAA Numerical Modeling Systems: A Step Toward Bridging the Gap between Research and Operations

Abstract In 2011, the National Oceanic and Atmospheric Administration (NOAA) began a cooperative initiative with the academic community to help address a vexing issue that has long been known as a disconnection between the operational and research realms for weather forecasting and data assimilation. The issue is the gap, more exotically referred to as the “valley of death,” between efforts within the broader research community and NOAA’s activities, which are heavily driven by operational constraints. With the stated goals of leveraging research community efforts to benefit NOAA’s mission and offering a path to operations for the latest research activities that support the NOAA mission, satellite data assimilation in particular, this initiative aims to enhance the linkage between NOAA’s operational systems and the research efforts. A critical component is the establishment of an efficient operations-to-research (O2R) environment on the Supercomputer for Satellite Simulations and Data Assimilation Studies (S4). This O2R environment is critical for successful research-to-operations (R2O) transitions because it allows rigorous tracking, implementation, and merging of any changes necessary (to operational software codes, scripts, libraries, etc.) to achieve the scientific enhancement. So far, the S4 O2R environment, with close to 4,700 computing cores (60 TFLOPs) and 1,700-TB disk storage capacity, has been a great success and consequently was recently expanded to significantly increase its computing capacity. The objective of this article is to highlight some of the major achievements and benefits of this O2R approach and some lessons learned, with the ultimate goal of inspiring other O2R/R2O initiatives in other areas and for other applications.

Economic evaluation of chronic lymphocytic leukemia from a hospital management perspective.

Treatment of chronic lymphocytic leukemia (CLL) is currently undergoing dramatic changes. We analyzed economic risks in hospitalized patients with CLL from a management perspective. One hundred and twelve patients with CLL hospitalized in 2013 and 2014 at the University Hospital of Cologne were analyzed. To assess profit margins (PMs) per case, diagnosis-related group (DRG) reimbursement data were merged with an internal cost accounting scheme depending on age, prognostic factors, and DRG key performance indicators. In 112 patients, 284 cases coded by 19 different DRG with strongly fluctuating cost revenue ratios were found with an overall negative PM of €137 147. The DRG R61H was identified as the one most commonly coded (174 cases, 61.3%) with a deficit per case of €814. Subanalysis demonstrated that the payments were not cost covering due to excessive length of stay and staff costs. Significant differences in PM per case concerning age, length of stay and number of operation and procedure key (OPS) codes (P < 0.05) were found. In our research-driven tertiary care hospital, inpatient treatment of patients with CLL is not cost covering. This analysis demonstrates the need for novel care/reimbursement structures in CLL. From a hospital management perspective, cost revenue controlling is crucial to avoid major economic risks.

Data errors in the National Hip Fracture Database: a local validation study.

We present an audit comparing our level I major trauma centre's data for a cohort of patients with hip fractures in the National Hip Fracture Database (NHFD) with locally held data on these patients. A total of 2036 records for episodes between July 2009 and June 2014 were reviewed. The demographics of nine patients were recorded incorrectly. The rate of incorrect data in operation codes was most significant with overall accuracy of 0.637 (95% CI 0.615 to 0.658). The sensitivity of NHFD coding ranged from 0.250 to 1.000 and the specificity 0.879 to 0.999. The recording of cementation had a sensitivity of 0.932 and specificity of 0.713. The recording of total hip arthroplasty had a sensitivity of 0.739 and specificity of 0.983. The overall accuracy of mortality data was 0.942 (95% CI 0.931 to 0.952), with sensitivity of 0.967 and specificity of 0.419. This paper highlights the need for local audit of the integrity of data uploaded to the NHFD. Cite this article: Bone Joint J 2016;98-B:1406-9.