[On results of operative conference of pulmonologists and occupational therapists in St. Petersburg and Leningrad region, concerning the topic "Justifying changes in "Occupational Diseases list" according to respiratory disease classification and global strategies of diagnosis, treatment and prevention of chronic obstructive pulmonary diseases (COLD) and bronchial asthma (GINA)"]

Results of operative conference of North-West Russia pulmonologists and occupational therapists were summarized and covered improvement of current list of occupational diseases. Resolution of the operative conference on the problem is presented.

[New international classification of epilepsy and new antiepileptic drugs for medically intractable epilepsy]

The task force of the international league against epilepsy (ILAE) proposed the "Diagnostic scheme for people with epileptic seizures and epilepsy" in 2001. The 2001 diagnostic scheme was updated in 2006. The ILAE Core Group recommended the new classification to replace the previous one (ILAE, 1981, 1989). However, the new classification is too complex to use for clinicians except expert epileptologists. About 10 new antiepileptic drugs are launched recently. Among them, gabapentine, topiramate, and lamotrigine have been approved in Japan as adjunctive therapy for medically intractable seizures. The advantage of the new antiepileptic drugs includes newer mechanism of action, broad spectrum of anti-seizure effects, fewer side effects, and lesser drug interactions. The rational polytherapy is necessary for refractory epilepsy. The majority of elderly patients with new onset epilepsy become seizure free on antiepileptic monotherapy, often with modest dose. We are now in the new era of epilepsy treatment.

[Psychiatric epidemiology--recent advances]

The aim of this article is to review recent advances and the latest research trends in psychiatric epidemiology. Examination of mental disorders prevalence delivers important information about the mental state of society and need for professional psychiatric care. The 12 months prevalence estimates are 30% for any mental disorders. Knowledge about historical methods of data collecting helps to understand psychiatric epidemiology better. We overview few generations of research that differ in methodology. The most common difficulties observed during that kind of research will be described. Available methods of examination of mental disorders prevalence will be presented in this article. The most significant results of international WHO epidemiologic project will be discussed. We also point out future challenges for psychiatric epidemiology and predict the systemic solutions that make intercultural comparisons possible.

Terminologien oder Klassifikationen

Classifications like ICD-10 are always purpose-dependent reconstructions of a domain. The strong hierarchical, mutually exclusive divisions of classes are necessarily the result of a compromise, i.e. by using residual classes. Below the aggregation level of classes a machine manipulable level of concepts is needed to enable knowledge-based decision support or semantic integration of patient data. A set of concepts with their meanings and descriptions is provided by terminologies like LOINC. For large specialty areas, terminologies can be no longer realized by enumeration. Similar to human beings using language according to the "LEGO principle", i.e. decomposing in primitive building blocks (vocabulary) and rule-compliant composing to meaningful sentences (grammar), in almost the same manner complex concepts are dealt with in compositional terminologies like SNOMED CT by using logical approaches. Those terminologies enable a sophisticated machine-supported interpretation of exchanged patient data, e.g. for decision support modules in drug therapy.

The effectiveness of ICD-10-CM in capturing public health diseases

This research study examined the usefulness of the ICD-10-CM system in capturing public health diseases (reportable diseases or the nationally notifiable infectious diseases, leading causes of death, and morbidity/mortality related to terrorism), when compared to ICD-9-CM.1-3 It also examined agreement levels of coders when coding public health diseases in both ICD-10-CM and ICD-9-CM. Overall results demonstrate that ICD-10-CM is more specific and fully captures more of the public health diseases examined than ICD-9-CM. In the analysis of all the public health diseases, such as reportable diseases (p<0.001), top 10 causes of death (p<0.001), and those related to terrorism (p<0.001), it was found that the overall rankings for disease capture for ICD-10-CM were significantly higher than the rankings for ICD-9-CM. When examining whether diseases were captured more straightforwardly and clearly (regarding agreement levels) between coding systems, statistically significant differences were found for external causes of injury (p<0.001), diabetes (average rank only, p<0.05), lower respiratory disease (p<0.001), heart disease (p<0.001), and malignant neoplasms (p<0.05). Although this result may be due to the coder's higher level of experience with ICD-9-CM, it also points to the potential need for more specific coding education and practice with the ICD-10-CM system.

[ENT and head and neck surgery in the German DRG system 2007]

BACKGROUND

The German DRG system has been further developed into version 2007. For ENT and head and neck surgery, significant changes in the coding of diagnoses and medical operations as well as in the the DRG structure have been made.

RESULTS

New ICD codes for sleep apnoea and acquired tracheal stenosis have been implemented. Surgery on the acoustic meatus, removal of auricle hyaline cartilage for transplantation (e. g. rhinosurgery) and tonsillotomy have been coded in the 2007 version. In addition, the DRG structure has been improved. Case allocation of more than one significant operation has been established.

CONCLUSION

The G-DRG system has gained in complexity. High demands are made on the coding of complex cases, whereas standard cases require mostly only one specific diagnosis and one specific OPS code. The quality of case allocation for ENT patients within the G-DRG system has been improved. Nevertheless, further adjustments of the G-DRG system are necessary.

Coding issues for the interventionalist: a consensus statement by the ASDIN

The field of Interventional Nephrology has matured and expanded over the last decade. The American Society of Diagnostic and Interventional Nephrology (ASDIN) has recognized the need for standardization and uniformity in coding of interventional procedures on dialysis access. After extensive study, an ASDIN committee developed a coding manual in 2004 with revisions in 2005 and 2006, which is available to ASDIN members through the ASDIN web site. This article comprises a brief overview of appropriate coding for access related procedures and contrasts the ASDIN recommendations with a recent interventional radiology generated approach.

Das Klassifikationssystem der ICF

With the International Classification of Functioning, Disability and Health, ICF and its adoption by the World Health Organization in May 2001, the concept of "functional health" reached a new dimension. Prepared and developed further over many years, the concept of a comprehensive and internationally consented classification system completed the shifting of paradigm in our notion of disease and disablement, bringing along far-reaching consequences for theory and practice in particular in rehabilitation. Symbolizing this paradigmatic shift, destigmatization, resource orientation, context factors, and participation are among the central notions of the concept. The ICF is a foundation for seeking international agreement across the bounds of disciplines and is amidst an intensive transfer and implementation process, also in Germany. Due to the multitude of actors and activities involved, it has become almost impossible even for those taking a strong interest in the matter to keep up with developments and fields of applications, let alone to achieve consensus in these respects. The German Society of Rehabilitation Sciences therefore initiated a problem-oriented stocktaking of the present situation. This article seeks to point out a number of important developments and trends in order to provide initial orientation and overview. The stocktaking is intended to contribute to further disseminating the ICF, at the same time however to outline several crucial fields of application and development. To be continued and deepened, this preliminary stocktaking underlines several core developments along with a number of conceptual issues still unresolved for the time being. Notwithstanding a high degree of acceptance of the concepts underlying the ICF, continued and, as far as possible, coordinated efforts toward implementation will be required at all levels.

Lifting The Burden: the global campaign to reduce the burden of headache worldwide

Lifting The Burden envisions a future world in which headache disorders are recognized everywhere as real, disabling and deserving of medical care to which all who need it have access without artificial barriers.

Trends in the sensitivity, positive predictive value, false-positive rate, and comparability ratio of hospital discharge diagnosis codes for acute myocardial infarction in four US communities, 1987-2000

Variations in the validity of hospital discharge diagnoses can complicate the assessment of trends in incidence of acute myocardial infarction (AMI). To clarify trends in the validity of discharge codes, the authors compared event classification based on published Atherosclerosis Risk in Communities (ARIC) Study criteria with the presence or absence of an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) hospital discharge code for AMI (code 410). Between 1987 and 2000, 154,836 coronary heart disease events involving hospitalization in the four ARIC communities had ICD-9-CM codes screened for AMI. The sensitivity of ICD-9-CM code 410 for classifying AMI in men (sensitivity = 0.65, 95% confidence interval (CI): 0.63, 0.66) was statistically significantly greater than that found for women (sensitivity = 0.60, 95% CI: 0.58, 0.62) and was greater in Whites (sensitivity = 0.67, 95% CI: 0.65, 0.68) than in Blacks (sensitivity = 0.50, 95% CI: 0.47, 0.53). The ethnic difference was related to a greater frequency of hypertensive heart disease and congestive heart failure codes encompassing AMI among Blacks as compared with Whites. The authors found that although the validity of ICD-9-CM code 410 to identify AMI was generally stable from 1987 through 2000, differences between Blacks and Whites and across geographic locations support investment in validation efforts in ongoing surveillance studies.

The bone and joint decade. strategies to reduce the burden of disease: the Bone and Joint Monitor Project

Musculoskeletal conditions are the major cause of morbidity and substantially influence health and quality of life, with enormous costs to health systems. This article describes the Bone and Joint Monitor Project, whose objective is to provide evidence to enable development of policies and strategies to improve the prevention and treatment of musculoskeletal conditions, relevant to their geographic and socioeconomic settings. By identifying the burden of disease and establishing strategies that can be implemented in routine clinical practice, musculoskeletal conditions can be managed more effectively and progress can be demonstrated through the establishment of routine health monitoring. With the interventions currently available, it is feasible that all people will be afforded the right to pain control, mobility, and independence.

An overview of lung cancer

Small cell lung cancer remains a devastating disease. A reduction in its impact will most likely come in the immediate future from smoking cessation programs. Because it is a rapidly growing disease, it seems unlikely that screening programs will have a significant impact on its curability. New chemotherapeutic agents with greater activity in this disease are desperately needed. Biologic agents such as the anti-idiotypic antibody BEC2 when combined with BCG may offer some hope to those with minimal residual disease after standard chemotherapy and radiation. Finally, an improved understanding of the biology of small cell cancer may ultimately provide the necessary clues to more effective treatment.