Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring.

OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. METHODS: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. FINDINGS: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. CONCLUSIONS: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians

The Ninth Visual Object Tracking VOT2021 Challenge Results

acceptedVersionPeer reviewe

Prediction of morbidity after lung resection in patients with lung cancer using fuzzy logic

Background: Preoperative evaluation of patients with potentially resectable non-small cell lung cancer aims to estimate the risk of planned surgery. Evidence of several factors that identify patients at risk for complications from thoracotomy is controversial. The aim of this study was to introduce and implement in medical practice a fuzzy system used in risk assessment of pulmonary resection for lung cancer. Methods: Ninety-one consecutive patients who underwent pulmonary resection for lung cancer were investigated. The overall complication rate was 39.6% (a total of 63 complications were seen in 36 patients). A fuzzy logic model was created with 9 input (presence of chest pain, weight loss, clinical T stage of the tumor, FEV1, serum protein, preoperative arterial partial oxygen pressure and cigarette smoking, erythrocyte sedimentation rate and peripheral blood leukocyte count) and two output classes (high-risk and low-risk groups). The fuzzy classifier's performance was tested. Results: The model was able to predict correctly the occurrence of complications in 22 out of 29 patients in the high-risk group with a sensitivity of 76%, while 9 out of the 52 patients from the low-risk group developed complications (17%). Conclusion: The fuzzy classification system provides an accurate tool to predict complications of resections in patients with non-small cell lung cancer

Aprotinin reduces postoperative bleeding and the need for blood products in thoracic surgery: results of a randomized double-blind study

Objective: Bleeding complications have been a major concern in certain thoracic surgery operations, especially decortication and pulmonary resection for inflammatory pulmonary infection. Prevention of plasminogen activation and fibrinolysis by aprotinin administration has been shown to reduce perioperative bleeding during operations associated with high blood consumption. Methods: Use of blood products (packed red cells, whole blood), chest tube drainage, analgesic requirement, chest tube duration for the patients undergoing major thoracic operations were recorded. In a double blind randomized fashion, patients were assigned to two groups receiving aprotinin (n = 51), at a loading dose of 10(6) kallikrein inhibitory units (KIU) followed by an infusion of the same dose during chest closure or receiving placebo (n = 52). On a daily basis, red-cell percentages of total fluid from drainage bottles were recorded and using the blood hematocrit level of the patient of the day before, the corrected value for the patient's blood volume equivalent of daily drainage was calculated. Results: There was a significant reduction in perioperative use of donor blood (0.98 +/- 0.92 vs. 0.45 +/- 0.32 unite P = 0.0026), and total chest tube drainage (corrected value for the corresponding blood volume) (28.2 +/- 36.9 vs. 76.9 +/- 53.3 ml, P = 0.0004) (mean standard deviation) in the aprotinin group. However, aprotinin did not reduce postoperative transfusion or decrease in hematocrit level due to thoracic operations. In high transfusion-risk thoracic surgery patients (patients who underwent decortication, pulmonary resection for inflammatory lung disease and chest wall resection), the perioperative transfusion was only 0.50 +/- 1.08 units in aprotinin group, compared with 1.94 +/- 0.52 units in control group (P = 0.003). Postoperative transfusion was also reduced in aprotinin administrated group (0.53 +/- 0.56 vs. 1.38 +/- 0.97 units, P = 0.02). The mean total blood loss was decreased to nearly one third of the blood loss of the control group (41 +/- 28 ml vs. 121 +/- 68 ml P = 0.001). Conclusion: Aprotinin significantly reduced perioperative transfusion requirement and postoperative bleeding during major thoracic operations. Aprotinin decreased perioperative transfusion needs. Moreover, patients who were at risk of greater blood loss during and after certain thoracic operations had a greater potential to benefit from prophylactic perioperative aprotinin treatment. (C) 2001 Elsevier Science B.V, All rights reserved