Standardized Coding Research Articles

Analysis of Publications on Health Information Management Using the Science Mapping Method: A Holistic Perspective

Objective: In the age of digital transformation, there is a need for a sustainable information management vision in health. Understanding the accumulation of health information management (HIM) knowledge from the past to the present and building a new vision to meet this need reveals the importance of understanding the available scientific knowledge. With this research, it is aimed to examine the scientific documents of the last 40 years of HIM literature with a holistic approach using science mapping techniques and to guide future research. Methods: This study used a bibliometric analysis method for science mapping. Co-citation and co-occurrence document analyses were performed on 630 academic publications selected from the Web of Science core collection (WoSCC) database using the keyword “Health Information Management” and inclusion criteria. The analyses were performed using the R-based software Bibliometrix (Version 4.0; K-Synth Srl), Python (Version 3.12.1; The Python Software Foundation), and Microsoft® Excel® 2016. Results: Co-occurrence analyses revealed the themes of personal health records, clinical coding and data quality, and health information management. The HIM theme consisted of five subthemes: “electronic records”, “medical informatics”, “e-health and telemedicine”, “health education and awareness”, and “health information systems (HISs)”. As a result of the co-citation analysis, the prominent themes were technology acceptance, standardized clinical coding, the success of HISs, types of electronic records, people with HIM, health informatics used by consumers, e-health, e-mobile health technologies, and countries’ frameworks and standards for HISs. Conclusions: This comprehensive bibliometric study shows that structured information can be helpful in understanding research trends in HIM. This study identified critical issues in HIM, identified meaningful themes, and explained the topic from a holistic perspective for all health system actors and stakeholders who want to work in the field of HIM.

Variability in Occult Injury Screening Among Siblings/Household Contacts of Physical Abuse Victims.

The objective of this study is to examine radiologic occult injury screening performance/yield among contacts presenting for precautionary medical assessments and assess factors associated with deferred screening. Data were collected retrospectively from charts of contacts younger than 8 years presenting for precautionary evaluation to a level 1 pediatric emergency department January 1, 2018 to March 31, 2023. Demographics, radiologic performance/yield, physical examination, social work-based psychosocial assessment, reasons for deferred imaging, and diagnostic codes were abstracted. Descriptive statistics and χ 2 analysis are reported. Three hundred ninety contacts were identified; 364 (93.3%) were biological siblings. Most (276, 70.8%) were 2 to 8 years old. Statistically significant relationships were identified with age, insurance, and hospital social work assessment and screening. Thirty-four infants (54%) underwent neuroimaging; no studies were abnormal. Of 114 contacts, <2 years old, 97 (85%) underwent skeletal survey (SS); 9 (9%) SS were abnormal. Twenty-seven (24%) returned for follow-up SS; 4 (14.8%) were abnormal. For 2 contacts, an abnormal initial SS was refuted by follow-up imaging. Physical examinations were abnormal for 11% of contacts. Reasons for deferred imaging included contact well appearance, caregiver concerns, and clinician disagreement with indications. Encounter International Classification of Diseases codes varied, commonly reflecting nonspecific screening assessments. Despite national clinical practice guidelines, studies of abusive injury prevalence and radiologic yield among at-risk contacts exposed to unsafe environments are few. Screening evaluations inclusive of physical examination and radiologic studies identify abuse concerns among at-risk contacts. Further study of factors impacting radiologic screening decisions is needed. Considerations to advance epidemiologic research include standardized diagnostic coding and prospective assessment of radiologic yield.

Analysis of The Effectiveness of Web Portals used in Academic Institutions of Tribhuvan University

For many academic institutions, the website has been used as a tool for inter- and intra-organizational information exchange. Since universities and colleges have started to use their websites as information centers, effective website design and functionality are very important for higher education institutions to attract students and share information regarding academic activities. The researcher observed various web portals based on the technology used, user perspective, and compatibility of some academic institutions observing that many students spent a lot of time on the Internet than in libraries. A checklist is formed to collect data from the websites and explains it in different tables and figures. Thus, the study is designed to provide insights into ICT colleges' websites' effectiveness. All the websites are based on PHP, mostly WordPress, The use of Bootstrap is quite good, comparatively websites have slow page loading speeds due to the lack of code and image optimization though valid and standardized codes were used. The use of media queries was very impressive but the lack of proper placing of CSS codes made it visually poor on some of the devices. This research explores the effectiveness of portals and websites in academic institutions and some recommendations are made based on the findings.

Censorship and the Nationalization of Dance in India: An Overview from 1947 to the Present

In this essay, I present a broad overview of the intersections between dance and censorship in independent India. I try to explore the consequent exclusions within the mainstream dance discourse and practices as they were shaped by hegemonic forces of nationalism. I also look at how the changes in instruments and objectives of censorship reflect changing visions of nationalism. Thisessay broadly examines two major forms of censorship, both of which have been crucial in the appropriation and reconstruction of dance as an integral part of the nationalist cultural identity of India. First, there are the overt forms of censorship, which have been enforced by instruments of state power like legislation and statutory bodies. The post-independence government enacted the Madras Devadasis (Prevention of Dedication) Act 1947 and Cinematograph Act 1952 ostensibly for socialreformandprotectionofpublicmorality,butineffectthey carried forward socio-political biases of Orientalism and colonialism into the postcolonial project of constructing the Indian imaginary. The process necessitated the elimination of hereditary artist communities and professional women performers (and many of their movement idioms) from mainstream practices of dance, even as their art was decontextualized and reconstructedtosuittheofficiallysanctifiedhighculture. This mode of erasure also influenced popular forms ofdance, especially those appearing in Indian cinema, by inscribing them with nationalist notions of womanhood, sexuality, and, more recently, religious majoritarianism. Second, I trace the covert operation of censorship, in which state institutions play a key role in the support and promotion of art. Through selective funding and promotion, conferring privileging labels like “classical,” and presiding over the formalization and classicization of dance, these institutions helped fit dance practices within the nationalist framework of a normative Indian cultural identity that is predominantly Hindu and rahminical. This process resulted in hierarchization, stigmatization, and even omission of certain dance practices, some of which I have highlighted in this essay. The sustained influence of direct and indirect modes of censorship created standardized codes of aesthetics and performance practices, contributing to a chilling effect and leading practitioners to censor themselves. Finally, I argue that the centrality of dance in the national cultural discourse enabled its use as propaganda to censor negative actions of or perceptions about the government. The phenomenon, which may be described as artwashing, has become increasingly prominent in the contemporary context of Hindu majoritarian nationalism seeking to launder itsexclusionary tendencies in the process of redefining Indian cultural identity on its terms. Thus, I argue that censorship in the domain of dance has played not just a repressive role but also a productive role by enabling discourses of nationalism. It has acted as a tool of governmentality, by which nationalist ideologies have been established and reinforced to public, such that they are no longer confined to the sphere of the state but have percolated down to the conduct of individuals.

Association between job control and time to pregnancy in a preconception cohort

ObjectiveTo evaluate associations between low job control (operationalized as job independence and freedom to make decisions) and time-to-pregnancy. Low job control, a form of workplace stress, is associated with adverse health outcomes ranging from cardiovascular disease to premature mortality; few studies have specifically examined its association with reproductive outcomes. DesignWe used data from Pregnancy Study Online (PRESTO), an internet-based preconception cohort study of couples trying to conceive in the U.S. and Canada. We estimated fecundability ratios (FRs) and 95% confidence intervals via proportional probabilities regression models, adjusting for sociodemographic and behavioral characteristics. SubjectsParticipants self-identified as female, were aged 21-45 years, and reported ≤6 cycles of pregnancy attempt time at enrollment (2018-2022). ExposureWe assessed job control by matching participants’ baseline self-reported occupation and industry with standardized occupation codes from the NIOSH Industry and Occupation Computerized Coding System, then linked codes to O*NET job exposure scores for job independence and freedom to make decisions. Main outcome measureOur main outcome measure was fecundability. Participants completed self-administered questionnaires at baseline and every 8 weeks for up to 12 months or until reported pregnancy, whichever occurred first. ResultsAmong 3,110 participants, lower job independence was associated with reduced fecundability. Compared with the fourth (highest) quartile, corresponding to the most job independence, FRs (95% CI) for first (lowest), second, and third quartiles were 0.92 (0.82-1.04), 0.84 (0.74-0.95), and 0.99 (0.88, 1.11), respectively. Lower freedom to make decisions was associated with slightly reduced fecundability (first versus fourth quartile: FR=0.92; 95% CI: 0.80-1.05). ConclusionLower job control, a work-related stressor, may adversely influence time-to-pregnancy. As job control is a condition of work (i.e., not modifiable by individuals), findings may strengthen arguments for improving working conditions as a means of improving worker health, including fertility.

Clinical utility of the standardized observation tool Autism Behavior Coding System for early intervention research in autism spectrum disorder.

The Autism Behavior Coding System (ABCS) was developed to help evaluating the effectiveness of early intensive interventions in children with autism spectrum disorder (ASD). The video-based ABCS assesses eight core autistic behavioral variables during therapist-child interaction using standardized quantitative criteria, four behaviors according to their frequency of occurrence, four according to their duration. The present study focuses (1) on the correspondence of ABCS scores with scores on two standard clinical instruments (the ADOS-2 and an ASD-adaptation of the Children's Global Assessment Scale, DD-CGAS), (2) on the sensitivity to change of ABCS scores by the end of an intensive 18 days intervention period (EIP) and (c) on the predictability of short- and longer-term changes in social and repetitive behaviors from ABCS scores at baseline and EIP. Data from 51 children (42 M, 9 F; median age 45 months) followed over 1 year were available. There were significant correlations at baseline between several ABCS scores and ADOS-2 as well as DD-CGAS scores. Correlations at EIP between some ABCS and DD-CGAS scores were highly significant. Four ABCS scores reflected significant changes from baseline to EIP. Several baseline ABCS scores were predictive of DD-CGAS and ADOS-2 scores at EIP and Year 1. However, associations between ABCS score changes from baseline to EIP and the clinical scale changes by Year 1 were not significant. It is concluded that several ABCS scores have adequate clinical validity and sensitivity to change. The short-term changes in ABCS scores and their relationship to longer-term clinical changes need further study.

Lack of Standardized Coding Limits Accuracy of Electronic Clinical Quality Measure for Pulmonary Embolism Diagnosis

Introduction: ASH Guidelines for diagnosis of pulmonary embolism (PE) start with risk assessment using a pretest probability tool (PTP) followed by D-dimer testing or CT pulmonary angiography (CTPA) depending on risk. We aimed to develop an electronic clinical quality measure (eCQM) to encourage broader use of a validated PTP scoring tool in emergency departments (EDs). The Centers for Medicare &amp; Medicaid Services require reporting of eCQMs which consist of value sets or lists of standardized codes linked to patient data within the electronic health record. We sought to identify a standardized way to identify CTPA and abnormal D-dimer tests using administrative codes (i.e. CPT, LOINC, SNOMEDCT codes) across three institutions. Methods: Value sets identifying CTPA and D-dimers were reviewed from existing eCQMs. Three institutions representing 38 EDs from across the country submitted data from all ED encounters between September 12, 2022 and January 11, 2023. Imaging types were reviewed from each of the CPT codes and LOINC (Logical Observation Identifiers Names and Codes). We determined the number of ED encounters, pre-test probability tool use, and diagnosis of PE using different codes. We calculated sensitivity, specificity, positive and negative predictive value (PPV and NPV, respectively). Results: Over the 4-month study period, 270,214 encounters were identified across 38 EDs. Each institution identified CTPA with site-specific codes (Table 1). The Full CTPA Value Set identified 55% more encounters than the site-specific codes (Full set 15,054/9679 site-specific codes). LOINC code 88322-3 was only used at one site. CPT code 71275 had the best sensitivity and specificity, but still had false positives (PPV 82%) (Table 2). D-dimer values were identified as LOINC code 48065-7 and 91556-1 at Site 1 and 48067-3 at Site 2. SNOMEDCT codes were not used at any site despite being the way other eCQMs identify elevated D-dimer results. Different D-dimer tests with different normal ranges were used at each site. All sites did not have an electronically extractable positive indicator for D-dimer. Conclusion: Due to persistent false positives using CPT Code 71275 for identification of CTPA, using this code would lead to inclusion of patients for whom PTP was not required or recommended. Additionally, coding for an abnormal D-dimer test result are not standardized across institutions. Therefore, administrative codes cannot be used to develop eCQMs whose aim is to evaluate whether CTPA is ordered appropriately based on the PTP risk level and laboratory testing.

Designing NLP applications to support ICD coding: an impact analysis and guidelines to enhance baseline performance when processing patient discharge notes

Financial costs are a major concern in the healthcare system, with medical billing and coding playing a key role in facilitating transactions and financing procedures. Billing involves filing claims with insurance companies and requires scrutiny of clinical summaries and electronic health records to correctly match diagnoses, prescriptions, and procedures to standardized codes. Accuracy in assigning International Classification of Diseases (ICD) codes is critical to proper reimbursement of care. Incorrect codes waste time and resources, and cause administrative and financial problems for hospitals, insurance companies and patients. Manual medical coding is a labor-intensive and error-prone process that creates additional administrative burden and inconvenience for hospitals, insurance companies, and patients. To simplify the process, clinical records are often processed to automatically identify and extract clinical concepts and corresponding ICD codes. Deep learning and natural language processing techniques have shown promise in a variety of tasks but applying them to medical coding has been challenging. Accurate coding requires a deep understanding of medical terminology, context, and guidelines that may be difficult to capture with traditional deep learning methods. Although deep learning shows promise in healthcare, its specific impact on ICD coding is not fully understood, and translating scalable deep learning methods into practical improvements in ICD coding remains a challenge. Evaluating deep learning models under the scenarios of real-world coding and comparing them to established practice is critical to determining their true effectiveness. In this work, we address the automation of ICD coding by highlighting pitfalls and contrasting different perspectives. We investigated automatic ICD coding using baseline machine learning models, with a focus on identifying ICD-9 codes in discharge notes from Medical Information Mart for Intensive Care (MIMIC) database. A thorough evaluation of different models and approaches is crucial to avoid over-reliance on any method. Our findings show that simpler methods can achieve comparable results to deep learning models while still requiring fewer computational resources.

A community-endorsed open-source lexicon for contrast agent-based perfusion MRI: A consensus guidelines report from the ISMRM Open Science Initiative for Perfusion Imaging (OSIPI).

This manuscript describes the ISMRM OSIPI (Open Science Initiative for Perfusion Imaging) lexicon for dynamic contrast-enhanced and dynamic susceptibility-contrast MRI. The lexicon was developed by Taskforce 4.2 of OSIPI to provide standardized definitions of commonly used quantities, models, and analysis processes with the aim of reducing reporting variability. The taskforce was established in February 2020 and consists of medical physicists, engineers, clinicians, data and computer scientists, and DICOM (Digital Imaging and Communications in Medicine) standard experts. Members of the taskforce collaborated via a slack channel and quarterly virtual meetings. Members participated by defining lexicon items and reporting formats that were reviewed by at least two other members of the taskforce. Version 1.0.0 of the lexicon was subject to open review from the wider perfusion imaging community between January and March 2022, and endorsed by the Perfusion Study Group of the ISMRM in the summer of 2022. The initial scope of the lexicon was set by the taskforce and defined such that it contained a basic set of quantities, processes, and models to enable users to report an end-to-end analysis pipeline including kinetic model fitting. We also provide guidance on how to easily incorporate lexicon items and definitions into free-text descriptions (e.g., in manuscripts and other documentation) and introduce an XML-based pipeline encoding format to encode analyses using lexicon definitions in standardized and extensible machine-readable code. The lexicon is designed to be open-source and extendable, enabling ongoing expansion of its content. We hope that widespread adoption of lexicon terminology and reporting formats described herein will increase reproducibility within the field.

The Digitalization Impact of The Payment System Through Qris on East Java Regional Financial Transactions

Payment system transaction efficiency can be optimized by utilizing technology in the digital era. Bank Indonesia with the Indonesian Payment System Association (ASPI) launched QRIS as a payment transaction instrument employing a standardized QR code. This study aims to evaluate the impact of the QRIS implementation policy and the QRIS transaction limit change policy on financial transactions in East Java Province. Financial transactions are represented using outflows, which is the cash flow of currency going out from Bank Indonesia. The research was performed using the intervention analysis. The results show that the implementation of QRIS in January 2020 had a significant impact on reducing outflow 5 periods after the policy was implemented. The decline in outflows even exceeds 90% in 2021 and exceeds 80% in 2022. The QRIS transaction limit change policy does not affect the increase/decrease in outflow transactions. This can be caused by QRIS users who are dominated by the MSME sector so the transactions made are retail. Further research on the impact of the QRIS policy using the amount of money in circulation, the net flow of currency, and digital banking transactions as the indicator of financial transactions also need to be carried out.

Application of specialized word embeddings and named entity and attribute recognition to the problem of unsupervised automated clinical coding

Notes documented by clinicians, such as patient histories, hospital courses, lab reports and others are often annotated with standardized clinical codes by medical coders to facilitate a variety of secondary processing applications such as billing and statistical analyses. Clinical coding, traditionally manual and labor-intensive, has seen a surge in research interest by deep learning researchers pursuing to automate it. However, deep learning methods require large volumes of annotated clinical data for training and offer little to explain why codes were assigned to pieces of text. In this paper, we propose an unsupervised method which does not need annotated clinical text and is fully interpretable, by using Named Entity and Attribute Recognition and word embeddings specialized for the clinical domain. These methods successfully glean important information from large volumes of clinical notes and encode them effectively in order to perform automatic clinical coding.

Unique Characteristics of Women and Infants Moderate the Association between Depression and Mother-Infant Interaction.

Research has shown mixed results regarding the association between women's postpartum depression and mother-infant interactions, suggesting that a woman's unique experience and context may moderate how depression shapes these interactions. We examined the extent to which a woman's comorbid anxiety, her exposure to adversity, and infant characteristics moderate the relationship between depressive symptoms of women and interactions with their infants at 6 (n = 647) and 12 months (n = 346) postpartum. The methods included standardized coding of mother-infant interactions and structural regression modeling. The results at 6 months of infant age indicated that infant male sex and infant negative affectivity were risk factors for mothers' depression being associated with less optimal interactions. At 12 months of infant age, two moderators appeared to buffer the influence of depression: a woman's history of trauma and infant preterm birth (≤37 weeks gestation). The results reinforce the salience of infant characteristics in the relationship between maternal depression and mother-infant interactions. The findings also suggest that experiences of trauma may offer opportunities for psychological growth that foster constructive management of depression's potential effect on mother-infant interactions. Further research is needed to clarify the underlying processes and mechanisms that explain the influence of these moderators. The ultimate goals are to reduce the risk of suboptimal interactions and reinforce healthy dyadic relations.

Six Years of Complaints Issued by Patients at a Laser Treatment Center in a Plastic Surgery Hospital.

Patient complaints can provide valuable feedback regarding the objective deficiencies of medical services. There are few studies on the complaints of patients receiving photoelectric therapy, so this study aims to understand the expectations and requirements of patients by analyzing the complaints of patients receiving photoelectric therapy. The complaints of patients who underwent photoelectric therapy were retrospectively examined. Authors plan to analyze treatment items, complaint contents, appeals, time trend regarding the number of complaints, and economic compensation. Fifty-four patients were involved in the study in total, and all of them were included. According to the standardized coding classification of complaints by Reader et al., the number of clinical, management and relationship complaints were 36 (59.02%), 14 (22.95%), and 11 (18.03%), respectively. These were divided among the categories of quality (31.15%), safety (27.87%), institutional issues (22.95%), communication (8.20%), and humaneness/caring (9.84%); with the most common subcategories involving treatment (31.15%) and safety incidents (24.59%). The patients' demands involved 20 cases (32.26%) requesting a refund of their medical expenses, 16 (25.81%) issuing a warning, 15 (24.19%) requesting compensation for loss, 10 (16.13%) requiring free repair or consultation, and 1 (1.61%) demanding an apology. Eventually, financial compensation was provided to the patients in eight of the cases. At a significance level of P = 0.05, even if the number of annual complaints increased over time, the increasing trend was not significant. Patient complaints in photoelectric therapy were most commonly clinical in nature. Specifically, quality and safety concerns are the main complaints.

What Is Written on a Dog's Face? Evaluating the Impact of Facial Phenotypes on Communication between Humans and Canines.

Facial phenotypes are significant in communication with conspecifics among social primates. Less is understood about the impact of such markers in heterospecific encounters. Through behavioral and physical phenotype analyses of domesticated dogs living in human households, this study aims to evaluate the potential impact of superficial facial markings on dogs' production of human-directed facial expressions. That is, this study explores how facial markings, such as eyebrows, patches, and widow's peaks, are related to expressivity toward humans. We used the Dog Facial Action Coding System (DogFACS) as an objective measure of expressivity, and we developed an original schematic for a standardized coding of facial patterns and coloration on a sample of more than 100 male and female dogs (N = 103), aged from 6 months to 12 years, representing eight breed groups. The present study found a statistically significant, though weak, correlation between expression rate and facial complexity, with dogs with plainer faces tending to be more expressive (r = -0.326, p ≤ 0.001). Interestingly, for adult dogs, human companions characterized dogs' rates of facial expressivity with more accuracy for dogs with plainer faces. Especially relevant to interspecies communication and cooperation, within-subject analyses revealed that dogs' muscle movements were distributed more evenly across their facial regions in a highly social test condition compared to conditions in which they received ambiguous cues from their owners. On the whole, this study provides an original evaluation of how facial features may impact communication in human-dog interactions.

Digitization of building systems using IFC to support performance analysis and code checking: standard limits and technological barriers. A case study on fire safety

The study presented in this paper is part of a digitization project developed for the University of Padua. It aims at demonstrating how IFC (Internet Foundation Classes) ISO Standard can be used as a reliable data model to support Performance Analysis (PA) and code checking for construction disciplines. Fire Safety Engineering (FSE) is analyzed as a challenging test field because it highly affects different building aspects and highlights interoperability issues. The methodology proposed in the study consists in checking a digital approach to PA based on information classes that can express both users’ requirements and performance specification of technical elements to develop computational code checking. This method is developed by creating virtual classes representing built systems and using relation classes and performance attributes to check if technical elements fulfil users’ requirements. By forcing the model to be based on standardized information classes, the study verifies if IFC, as an ISO standard, can be used as a universal and scalable reference model for performance analysis and code checking. More specifically, the study focuses on the availability of IFC’s information classes and attributes that define a PA model. This research verifies the achievement of the proposed goals for FSE (Section 2) and then highlights the interoperability limits that affect an IFC-based approach to computational FSE code checking (Section 3). Finally, the technical feasibility of the methodology’s market implementation is presented (Section 4). The study’s innovative approach is related to the fact that IFC is often analyzed as an information exchange format, not as a data model, where standardized relations between building ontologies can be simulated. Digital ontologies of relational aspects are experimented with by following this approach. These reports support code conformance analyses of the technical element performance specification. The study then indicates how the information modelling discipline could be shaped to encourage standardized code checking better.

Automated Optimum Design of Light Steel Frame Structures in Chinese Rural Areas Using Building Information Modeling and Simulated Annealing Algorithm

Many manual calculations and repeated modeling are required during the traditional structural design process. However, due to the high cost, rural buildings in China cannot be professionally designed and verified by designers as urban buildings, and their safety and economy cannot easily meet the requirements. Building Information Modeling (BIM) technology and intelligent optimization algorithms can effectively improve the structural design process and reduce design costs, but their applications in the field of rural residential buildings in China are limited. Therefore, this paper presents an innovative framework that realizes the structural design of rural light steel frame structures on the BIMBase platform (widely used BIM software in China, BIMBase 2023R1.3). Based on the parametric library of structural components built on standardized component coding, the framework completes the rapid modeling of rural light steel frame structures and the interaction between the BIMBase platform and structural analysis software, SATWE. The improved two-stage simulated annealing (SA) algorithm is applied to the structural design of rural buildings to obtain a design scheme that meets the design requirements and reduces the material consumption as much as possible. Two prefabricated rural light steel frame structures were analyzed to evaluate the efficiency of the proposed framework. The results show the feasibility of the proposed framework. Compared with traditional manual design methods, the design period can be reduced by six times while maintaining comparable levels of material consumption and structural design indicators.

Clinicopathological Features and ICD-10 Categorization of Oro-maxillofacial Surgical Biopsies from Sulaimani

Background: Few updated retrospective histopathological-based studies in Iraq evaluate a comprehensive spectrum of oro-maxillofacial lesions. Also, there was a need for a systematic way of categorizing the diseases and reporting results in codes according to the WHO classification that helps occupational health professionals in the clinical-epidemiological approach. Objectives: to establish an electronic archiving database according to the ICD-10 that encompasses oro-maxillofacial lesions in Sulaimani city for the last 12 years, then to study the prevalence trend and correlation with clinicopathological parameters. Subjects and Methods: A descriptive-analytical study included the archived records from three major histopathological centers in Sulaimani (College of Dentistry, Shahid Saifaldeen, and Shorsh Hospitals), related to surgical biopsies of oro-maxillofacial lesions performed between 2008 and 2019 in Sulaimani. Data were tabulated in an excel sheet and analyzed. Results: This study involved 2100 oro-maxillofacial lesions, male: female ratio was 1:1.2, and a mean age of 41.03±19.51 years old. The most frequently involved sites were; the lip (14.5%), followed by the gum and alveolar ridge (14.2%). 69.4% of cases were non-neoplastic lesions. The neoplastic lesions were significantly (P=.000) observed in old patients with a mean age of 46.1±21.09, mostly epithelial tumors (39.1%), followed by connective tissue tumors (19.5%). Malignant connective tissue tumors were more frequently seen than benign ones (52.5% versus 47.5%). The non-neoplastic lesions revealed predominate soft tissue lesions (45.2%), followed by salivary gland diseases (13.8%), with a mean age of 38.26±18.8. Squamous cell carcinoma was the most common epithelial tumor, while haemangioma was predominant among connective tissue tumors Conclusions: ICD-10 classification of oro-maxillofacial lesions in Sulaimani city helps establish a standardized coding database system for clinicopathological distribution. However, the majority of recorded lesions were non-neoplastic especially diagnosed as soft tissue lesions. Still, neoplastic lesions with their minor distribution deserve great attention as they threaten patients’ lives.

Evaluation of the updated SOCcer v2 algorithm for coding free-text job descriptions in three epidemiologic studies.

Computer-assisted coding of job descriptions to standardized occupational classification codes facilitates evaluating occupational risk factors in epidemiologic studies by reducing the number of jobs needing expert coding. We evaluated the performance of the 2nd version of SOCcer, a computerized algorithm designed to code free-text job descriptions to US SOC-2010 system based on free-text job titles and work tasks, to evaluate its accuracy. SOCcer v2 was updated by expanding the training data to include jobs from several epidemiologic studies and revising the algorithm to account for nonlinearity and incorporate interactions. We evaluated the agreement between codes assigned by experts and the highest scoring code (a measure of confidence in the algorithm-predicted assignment) from SOCcer v1 and v2 in 14,714 jobs from three epidemiology studies. We also linked exposure estimates for 258 agents in the job-exposure matrix CANJEM to the expert and SOCcer v2-assigned codes and compared those estimates using kappa and intraclass correlation coefficients. Analyses were stratified by SOCcer score, score distance between the top two scoring codes from SOCcer, and features from CANJEM. SOCcer's v2 agreement at the 6-digit level was 50%, compared to 44% in v1, and was similar for the three studies (38%-45%). Overall agreement for v2 at the 2-, 3-, and 5-digit was 73%, 63%, and 56%, respectively. For v2, median ICCs for the probability and intensity metrics were 0.67 (IQR 0.59-0.74) and 0.56 (IQR 0.50-0.60), respectively. The agreement between the expert and SOCcer assigned codes linearly increased with SOCcer score. The agreement also improved when the top two scoring codes had larger differences in score. Overall agreement with SOCcer v2 applied to job descriptions from North American epidemiologic studies was similar to the agreement usually observed between two experts. SOCcer's score predicted agreement with experts and can be used to prioritize jobs for expert review.

Pediatric intraoperative cardiopulmonary arrests: A survey to evaluate if Medical Emergency Teams are utilized in pediatric operating rooms.

Studies have shown that standardized code teams may improve outcomes following cardiac arrests. Pediatric intra-operative cardiac arrests are rare events and are associated with a mortality rate of 18%. There is limited data available regarding use Medical Emergency Team (MET) response to pediatric intra-operative cardiac arrest. The purpose of this study was to identify the use of MET in response to pediatric intraoperative cardiac arrest as an exploratory step in establishing evidence-based standardized practice across the hospital for training and management of this rare event. An anonymous electronic survey was created and sent to two populations: The Pediatric Anesthesia Leadership Council, a section of the Society for Pediatric Anesthesia, and the Pediatric Resuscitation Quality Collaborative, a multinational collaborative group, which works to improve resuscitation care in children. Standard summary and descriptive statistics were used for survey responses. The overall response rate was 41%. The majority of respondents worked in a university affiliated, free-standing children's hospital. Ninety-five percent of respondents had a dedicated pediatric MET at their hospital. In 60% of responses from Pediatric Resuscitation Quality Collaborative and 18% of Pediatric Anesthesia Leadership Council hospitals, the MET responds to pediatric intra-operative cardiac arrest; however, the majority of times MET involvement is requested rather than automatic. The MET was found to be activated intraoperatively for situations other than cardiac arrest such as, massive transfusion events, need for extra staff, and for specialty expertise. In 65% of institutions, simulation-based training for cardiac arrest is supported but lacking pediatric intra-operative focus. This survey revealed heterogeneity in the composition and response of the medical response teams responding to pediatric intra-operative cardiac arrests. Improved collaboration and cross training among MET, anesthesia, and operating room nursing may improve outcomes of pediatric intra-operative code events.

Multicenter Study of High-Flow Nasal Cannula Initiation and Duration of Use in Bronchiolitis.

There is a paucity of multicenter data on rates of high flow nasal cannula (HFNC) usage in bronchiolitis in the United States, largely because of the absence of standardized coding, with HFNC often subsumed into the larger category of noninvasive mechanical ventilation. We examined HFNC utilization in patients with bronchiolitis from a sample of hospitals participating in a national bronchiolitis quality improvement collaborative. Medical records of patients aged <2 years admitted November 2019 to March 2020 were reviewed and hospital-specific bronchiolitis policies were collected. Exclusion criteria were prematurity <32 weeks, any use of mechanical ventilation, and presence of comorbidities. HFNC utilization (including initiation, initiation location, and treatment duration), and hospital length of stay (LOS) were calculated. HFNC utilization was analyzed by individual hospital HFNC policy characteristics. Sixty-one hospitals contributed data on 8296 patients; HFNC was used in 52% (n = 4286) of admissions, with the most common initiation site being the emergency department (ED) (75%, n = 3226). Hospitals that limited HFNC use to PICUs had reduced odds of initiating HFNC (odds ratio, 0.3; 95% confidence interval [CI], 0.3 to 0.4). Hospitals with an ED protocol to delay HFNC initiation had shorter HFNC treatment duration (-12 hours; 95% CI, -15.6 to -8.8) and shorter LOS (-14.9 hours; 95% CI, -18.2 to -11.6). HFNC was initiated in >50% of patients admitted with bronchiolitis in this hospital cohort, most commonly in the ED. In general, hospitals with policies to limit HFNC use demonstrated decreased odds of HFNC initiation, shorter HFNC duration, and reduced LOS compared with the study population.