Applying the international classification of diseases to perinatal mortality data, South Africa

Objective:To examine the feasibility of applying the International Classification of Diseases-perinatal mortality (ICD-PM) coding to an existing data set in the classification of perinatal deaths.Methods One author, a researcher with a non-clinical public health background, applied the ICD-PM coding system to South Africa's national perinatal mortality audit system, the Perinatal Problem Identification Program. The database for this study included all perinatal deaths (n=26 810), defined as either stillbirths (of birth weight >1000 g and after 28 weeks of gestation) or early neonatal deaths (age 0­7 days), that occurred between 1 October 2013 and 31 December 2016. A clinical obstetrician verified the coding. Findings The South African classification system does not include the timing of death; however, under the ICD-PM system, deaths could be classified as antepartum (n=15 619; 58.2%), intrapartum (n=3725; 14.0%) or neonatal (n=7466; 27.8%). Further, the South African classification system linked a maternal condition to only 40.3% (10 802/26 810) of all perinatal deaths; this proportion increased to 68.9% (18 467/26 810) under the ICD-PM system. Conclusion The main benefit of using the clinically relevant and user-friendly ICD-PM system was an enhanced understanding of the data, in terms of both timing of death and maternal conditions. We have also demonstrated that it is feasible to convert an existing perinatal mortality classification system to one which is globally comparable and can inform policy-makers internationally

The Design of a Practice-based Study of Attendees at Chiropractic Offices in Western Australia.

Introduction: This paper presents the protocols for a pilot study that will provide a design critique and collect information to describe the patients who attend chiropractors in Western Australia. Aims and Objectives: 1. Provide a critique of the research design and methodology, including enrolment and recruitment, data collection, and sample size calculations. 2. Describe the patient demographics, reason for consultation and baseline health status of patients that present to chiropractic practices in Western Australia. Methods/Research Design: This will be a prospective, cross-sectional, practice-based pilot study of patients seeking chiropractic services in Western Australia. A minimum of seven (7) independent private chiropractic practices across urban, regional, rural and remote settings will be recruited. Consecutive adult patients that self-present to these practices for the first time will be invited to participate. Data for analysis will be collected in participating clinics using a computer-based online questionnaire. Data collected will include; patient demographics; age, gender, primary language, occupation, payment source, presenting complaint, prior treatment, pre-existing health conditions, medications, attendance at other health practitioners, lifestyle choices, previous use of chiropractic and human quality of life measures (HQoL’s; SF-12 and PIQ-R). Priori sample size estimation indicates a total sample of 320 would be sufficient to achieve a study power of >80% (assumed effect size 0.2, α=0.05, assumed df=5). Conclusion: Innovative electronic and internet portals for gathering practice-based data are to be assessed. Information describing patients who attend allied and complementary practitioners is critical to facilitate appropriate and effective health system planning and administration in Western Australia.