Methods for Ensuring High Quality of Coding of Cause of Death. The Mortality Register to Follow Southern Urals Populations Exposed to Radiation

BACKGROUND

To follow up populations exposed to several radiation accidents in the Southern Urals, a cause-of-death registry was established at the Urals Center capturing deaths in the Chelyabinsk, Kurgan and Sverdlovsk region since 1950.

OBJECTIVES

When registering deaths over such a long time period, quality measures need to be in place to maintain quality and reduce the impact of individual coders as well as quality changes in death certificates.

METHODS

To ensure the uniformity of coding, a method for semi-automatic coding was developed, which is described here. Briefly, the method is based on a dynamic thesaurus, database-supported coding and parallel coding by two different individuals.

RESULTS

A comparison of the proposed method for organizing the coding process with the common procedure of coding showed good agreement, with, at the end of the coding process, 70  - 90% agreement for the three-digit ICD -9 rubrics.

CONCLUSIONS

The semi-automatic method ensures a sufficiently high quality of coding by at the same time providing an opportunity to reduce the labor intensity inherent in the creation of large-volume cause-of-death registries.

Aggressive surgery in the multimodality treatment of liver metastases from colorectal cancer

PURPOSE

The purpose of this study was to analyze the impact of aggressive surgery concerning resection of liver metastases (LMs) from colorectal cancer (CRC) on morbidity, mortality and survival rates and to establish the benefits of multimodal strategies in increasing the resectability rates of LMs.

PATIENTS AND METHODS

From January 2004 - April 2006 184 patients with CRC underwent surgical interventions at our clinic. Thirty-four (18.4%) of them had LMs at the time of initial diagnosis, and 26 patients developed LMs in a certain period of time after resection of the primary CRC. Multimodal therapeutic approach included thermoablation, neoadjuvant chemotherapy and surgery.

RESULTS

44 resections were performed in 29 patients: one-stage resection of the primary CRC and the LMs in 15 (40%) cases, resection and thermoablation after adjuvant chemotherapy in 2 (4.3%), resection after neoadjuvant chemotherapy in 8 (17.2%), two-stage liver resection in 1 (2.15%), resection after recurrence or because of a newfound LM in 3 (6.45%). Five resections of metastases larger than 5 cm, and 4 resections of 4 or more liver metastases were performed. Morbidity rate was 15.9% (bile leakage in 4 patients, liver abscess in 1 and wound disruption in 2). Mortality rate was 2.2% (1 patient).

CONCLUSION

Multimodal approach in the treatment of LMs of CRC increases resectability and patient survival and has no influence on morbidity and mortality.

Universal newborn hearing screening program in Bulgaria

The design of a Universal Newborn Hearing Screening Program (UNHSP) depends on many factors unique to each hospital. The goal of any UNHSP is to perform a valid hearing screening on all newborn infants prior to hospital discharge. Ultimately hearing screening of all infants should decrease the age at which intervention is initiated in these who require it. It is clear that there is no "one" model for UNHSPs. Each program must carefully consider what type and severity of hearing loss it wishes to identify. Then, based on available screening tools, program philosophy, prior experience, personnel, typical maternity length of stay, etc., an appropriate protocol must be developed. We present our protocol for detection and confirmation of hearing loss, and for habilitation of deaf children. For detection the hearing loss we used the automated auditory brainstem response (ABR) delivery system (A-ABR), and we confirm this with conventional non-automated ABR delivery system (BERA). The healthy babies we screen after 6h of age using a simultaneous 35-dB nHL screening option available on the Newborn Hearing Screener ALGO-2. The neonatal intensive care unit (NICU) babies we screen prior to discharge using all options of the ALGO-2. The "refer" ALGO-2 results are immediately retested. Infants in need of an outpatient screen are recalled at age 3-4 weeks. The diagnosis "hearing loss" is determinate only by BERA and the neonatal hearing screening is the first part of program of habilitation of hearing-impaired children. The cost for UNHSP in Bulgaria is 1407 euro per case identified.

A case of nasal glioma in a new-born infant

We report a 1 day old girl with a nasal mass that was diagnosed as an intranasal glioma. The tumor mass was noted to be localized laterally from, and based along, the inferior turbinate. Nasal glioma is a developmental abnormality of neurogenic origin with no malignant potential. An intranasal mass requires careful rhinological, neurological and radiological examinations. With adequate initial removal, excisional biopsy usually allows complete recovery. A frontal craniotomy approach is preferred for those patients who have nasal glioma with an intracranial connection. With no evidence of an intracranial connection, a conservative extracranial approach is recommended.