Accuracy of surgical complication rate estimation using ICD-10 codes.

BACKGROUND: The ICD-10 codes are used globally for comparison of diagnoses and complications, and are an important tool for the development of patient safety, healthcare policies and the health economy. The aim of this study was to investigate the accuracy of verified complication rates in surgical admissions identified by ICD-10 codes and to validate these estimates against complications identified using the established Global Trigger Tool (GTT) methodology. METHODS: This was a prospective observational study of a sample of surgical admissions in two Norwegian hospitals. Complications were identified and classified by two expert GTT teams who reviewed patients' medical records. Three trained reviewers verified ICD-10 codes indicating a complication present on admission or emerging in hospital. RESULTS: A total of 700 admissions were drawn randomly from 12 966 procedures. Some 519 possible complications were identified in 332 of 700 admissions (47·4 per cent) from ICD-10 codes. Verification of the ICD-10 codes against information from patients' medical records confirmed 298 as in-hospital complications in 141 of 700 admissions (20·1 per cent). Using GTT methodology, 331 complications were found in 212 of 700 admissions (30·3 per cent). Agreement between the two methods reached 83·3 per cent after verification of ICD-10 codes. The odds ratio for identifying complications using the GTT increased from 5·85 (95 per cent c.i. 4·06 to 8·44) to 25·38 (15·41 to 41·79) when ICD-10 complication codes were verified against patients' medical records. CONCLUSION: Verified ICD-10 codes strengthen the accuracy of complication rates. Use of non-verified complication codes from administrative systems significantly overestimates in-hospital surgical complication rates.

The effects of safety checklists in medicine: a systematic review.

BACKGROUND: Safety checklists have become an established safety tool in medicine. Despite studies showing decreased mortality and complications, the effects and feasibility of checklists have been questioned. This systematic review summarises the medical literature aiming to show the effects of safety checklists with a number of outcomes. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement was used. All studies in which safety checklists were used as an additional tool designed to assure that an operation or task was performed as planned were included. RESULTS: The initial search extracted 7408 hits. Twenty-nine articles met the inclusion criteria. Five additional studies were identified by a cross-referencing search. Four groups were made according to outcome measures. One group (n = 7) had 'hard' outcome measures, such as mortality and morbidity. The remaining studies, reporting 'softer' process-related measures, were divided into three categories: adherence to guidelines (n = 6), human factors (n = 16), and reduction of adverse events (n = 5). The main findings were improved communication, reduced adverse events, better adherence to standard operating procedures, and reduced morbidity and mortality. None of the included studies reported decreased patient safety or quality after introducing safety checklists. CONCLUSION: Safety checklists appear to be effective tools for improving patient safety in various clinical settings by strengthening compliance with guidelines, improving human factors, reducing the incidence of adverse events, and decreasing mortality and morbidity. None of the included studies reported negative effects on safety.

The COMT rs4680 Met allele contributes to long-lasting low back pain, sciatica and disability after lumbar disc herniation.

BACKGROUND: The COMT enzyme metabolizes catecholamines and thus modulates adrenergic, noradrenergic and dopaminergic signaling. A functional polymorphism in the gene encoding this enzyme, i.e. the COMT Val158Met SNP that reduces enzyme activity, has previously been linked to pain sensitivity. METHODS: We examined if the COMT Val158Met SNP could contribute to discogenic subacute low back pain and sciatica by comparing the frequency of the Val158Met genotypes of degenerative disc disease patients with healthy controls. Moreover, we examined if this SNP could predict the clinical outcome, i.e. the progression of pain and disability. RESULTS: The present data demonstrated that there were no differences in COMT genotype frequencies between the newly diagnosed patients and controls. Analysis of pain and disability in the patients over time revealed, however, a significant or border-line significant increase in McGill sensory score and Oswestry Disability Index (ODI) score for individuals with COMT Met/Met genotype. Furthermore, significant associations between the COMT Met-allele and VAS activity score, McGill sensory score and ODI score were observed in the patients 6 months after inclusion. DISCUSSION: Although the Val158Met SNP was not a risk factor for disc herniation, patients with Met/Met had more pain and slower recovery than those with Val/Met, which in turn also had more pain and slower recovery than those with Val/Val suggesting the SNP contributes to the progression of the symptoms of disc herniation. CONCLUSION: We conclude that the functional COMT Val158Met SNP contributes to long lasting low back pain, sciatica and disability after lumbar disc herniation.

[Environmental health and industrial pollution in the 1890s]. / Miljørettet helsevern og industriforurensning i 1890-årene.

BACKGROUND: Pollution from industry assumed new dimensions when large-scale industry and mining were established in Norway towards the end of the nineteenth century. The present article discusses how the local health administration responded to the first extensive industrial pollution of air and water. MATERIAL AND METHODS: Two chemical factories producing wood pulp and one abandoned nickel mine are studied by means of information from court records and municipal archives. RESULTS: New forms of large quantity pollutants and their great spreading capacity were not anticipated in the Health Act of 1860. The legislation at the time had ambiguous points which made it difficult to apply in cases of industrial pollution. One major problem was reliable documentation of adverse health effects. INTERPRETATION: Neither central nor local medical authorities had adequate competence to exert the professional influence required. In spite of this, local health commissions acted with considerable authority in the early 1890s. Within a few years, however, the health aspects were down-played because of the strong economic and political interests behind the new industries. The principal difficulties emerging in the 1890s with industrial pollution eventually lasted for nearly one hundred years.

[Smallpox in Telemark in the last part of the 19th century]. / Kopper i Telemark i siste del av 1800-tallet.

Was vaccination the only cause of the decline of smallpox in Norway during the 19th century? This regional study focuses on the history of the disease in Telemark county with special emphasis on the last, extensive epidemic in 1868. In addition to vaccination, other possible causal relations are discussed. In Telemark, smallpox seems to have been relatively mild in the 19th century with the exception of the epidemics at the end of the 1830s and in 1868. In 1868 the disease spread along the main transportation routes northward through the western part and eastward through the more densely populated districts along the coast. The importance of vaccination is apparent from the fact that the municipalities with the lowest annual percentage of newborns vaccinated were most heavily struck by the epidemic. Despite vaccination procedures, both adults and unvaccinated children were groups at risk. Local initiatives--especially isolation and revaccination--largely prevented or restricted outbreaks of smallpox. It seems that the efforts of the district medical officers and local health administrators after 1860 were of decisive importance for the decline in smallpox cases in the period in question.

[Health Commission's activity and public health work in Skien and Langesund 1861-1900]. / Sunnhetskommisjonenes virksomhet og offentlig helsearbeid i Skien og i Langesund 1861-1900.

The role played by the health commissions in preventive health work in a major and a minor urban community in Telemark, Skien and Langesund respectively, is analysed by means of a classification method applicable to cases and decisions referred to in the proceedings of the health commissions. Increasingly, health commissions had to rely on their own initiative under the leadership of the district medical officer. After 1890, the decisions reached by the health commissions were increasingly recommendations to local authorities. Sanitation and waste processing were the principal problems. Regular house-to-house inspections in Langesund appear to have become effective, while the problems in Skien presumably were too great to permit similar improvements there. Even though practical work of preventing the spread of epidemic diseases had to remain the doctors' responsibility, the health commissions were active in providing the necessary resources. However, the commissions did not play a leading role in developing improved drinking water supplies or other major issues essential to health. Neither did they engage to any considerable extent in the distribution of public health information. On the other hand, the commissions acted as a controlling authority in cases brought before them, thus fulfilling the intentions of the Health Act of 1860.

[Health commissions' activities in five rural municipalities in Telemark between 1861-1900]. / Sunnhetskommisjonenes virksomhet i fem herreder i Telemark 1861-1900.

It has been assumed that local health administrations in rural areas in the second half of the nineteenth century functioned in a rather passive and ineffective way. The present study focuses on the activity of the health commissions in the municipalities of Vinje, Seljord, Hitterdal, Gjerpen and Bamble. In the 1860s og 1870s, few meetings were held. Lack of interest and communication problems between doctors (who chaired the commissions) and the municipal councils were pointed out as causes. In commission meetings, the doctors used most of the time to give information on the present health situation in the area and on general medical issues. After 1885 the activity in the commissions gradually increased. New legislation and health regulations gave the health commissions a more important role in public health administration. In Hitterdal and Seljord the health commissions contributed actively to fighting the diphteria epidemics in the late 1880s. With urbanization and industrialisation in lower Telemark, environmental health issues took on added importance for the health commissions of Gjerpen and Bamble. The problems were much more effectively dealt with in Bamble than in Gjerpen, possible because of differences in the organisation of the commissions and in the workload for the doctors who chaired them.

Ultrastructural evidence for a direct connection between the myocardial granules and the sarcoplasmic reticulum in the cardiac ventricle of Myxine glutinosa (L.).

The occurrence of structural connections between myocardial granules and tubular elements of the sarcoplasmic reticulum in the cardiac ventricle of the Atlantic hagfish is described. The core substance of the myocardial granules is shown to be uranophilic and in this respect similar to the granular cores within the lumen of the sarcoplasmic reticulum. After application of CaCl2-containing fixatives, the ultrastructure of the core substance of these organelles resembles that described for calcium-containing structures in vertebrate glial cells. Incidences of uranophilic core substance in the extracellular space suggest a secretory function of the myocardial granules. Possible implications of the sarcoplasmic reticulum and the myocardial granules in storage, intracellular transport, and secretion of bound calcium are discussed.