Effect of perioperative complications on excess mortality among women after coronary artery bypass: The israeli coronary artery bypass graft study (ISCAB)

AbstractBackground: Widely observed excess mortality among women after coronary artery bypass grafting is still largely unexplained, although case-mix factors have been identified. We evaluated the contribution of perioperative complications to the risk of 180-day mortality among women while adjusting for case-mix factors. Methods: This is part of a prospective, 1-year nationwide Israeli coronary artery bypass graft study of 1029 female and 3806 male patients. Deaths within 180 days were independently ascertained. Case-mix risk strata were obtained from a pooled Cox survival model (including all subjects and study variables) by using the adjusted coefficients corresponding to the case-mix factors within the model. Sex-specific mortality associated with perioperative complications was evaluated within the strata. In addition, sex-specific Cox models were constructed. Results: Higher mortality among women compared with that among men was significant within the pooled model (hazard ratio, 1.4; P =.038) and was evident early in the postoperative period. Women tended to cluster in the highest risk quartile compared with men (39.8% vs 20.9%, P <.001). However, although the incidence of perioperative complications was similar for the 2 sexes, the associated mortality for a given perioperative complication was higher among women. Sex-specific Cox models confirmed the above findings. For example, the hazard ratio for women with low postoperative hemoglobin was 6.9, whereas for men, the hazard ratio was 3.9. Conclusions: The role of perioperative factors in the excess mortality among women after coronary artery bypass grafting shifts the focus of attention from the selection of women for the operation to the in-hospital experience. Improving the outcome for women will entail efforts to prevent complications in the perioperative period.J Thorac Cardiovasc Surg 2002;123:517-2

Use of linked data to assess the impact of out-of-hospital deaths on 30-day mortality indicators

Introduction Publicly reported 30-day mortality indicators in Canada usually only take into account in-hospital deaths recorded in clinical administrative databases. Studies show that the percentage out-of-hospital deaths may account for 24% to 53% of all 30-day mortality, depending on the indicator, however, such assessments have not been done in Canada. Objectives and Approach The objective of this study was to compare 30-day mortality rates calculated using clinical administrative data only (in-hospital deaths) with rates calculated combining administrative data and Canadian Vital Statistics Death Database (CVSD) that captures both in- and out-of-hospital deaths. We considered mortality following acute myocardial infarction (AMI), stroke and major surgery. Episodes of care were created through linkage of Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS). Mortality information on deaths outside of acute care hospitals was obtained from DAD/NACRS-CVSD linked files created by Statistics Canada. Data from Quebec and Yukon were not included in the analysis. Results The overall 30-day AMI mortality rate calculated using both DAD and DAD-CSVD linked file was 7.4% compared to 6.7% 30-day in-hospital mortality rate calculated using DAD only. Mortality rates after stroke were 15.8% and 14.0% and after major surgery 1.8% and 1.6%, respectively. The impact of adding out-of-hospitals deaths to rate calculations varied by province and rurality. Adding death data from the DAD-CVSD linked file accounted for 10% of 30-day AMI mortality, 11% of 30-day stroke mortality and 12% of 30-day mortality after major surgery, based on 2011 data. However, depending on the indicator, 7% to 9% of the deaths within 30 days recorded in DAD were not found in DAD-CVSD linked file due to limitations of the linkage methodology. Conclusion/Implications An impact of including out-of-hospital deaths in the 30-day mortality rates appears to be less in Canada (~10%) than shown in other studies. However, while the DAD/NACRS-CVSD linked files provide valuable supplemental information, linkage methodology limitations suggest that they should be used in conjunction with mortality information available in DAD

Magnetic Field Penetration Technique to Study Field Shielding of Multilayered Superconductors

The SIS structure which consists of alternative thin layers of superconductors and insulators on a bulk niobium has been proposed to shield niobium cavity surface from high magnetic field and hence increase the accelerating gradient. The study of the behavior of multilayer superconductors in an external magnetic field is essential to optimize their SRF performance. In this work we report the development of a simple and efficient technique to measure penetration of magnetic field into bulk, thin film and multilayer superconductors. Experimental setup contains a small superconducting solenoid which can produce a parallel surface magnetic field up to 0.5 T and Hall probes to detect penetrated magnetic field across the superconduct- ing sample. This system was calibrated and used to study the effect of niobium sample thickness on the field of full magnetic flux penetration. We determined the optimum thickness of the niobium substrate to fabricate the multi-layer structure for the measurements in our setup. This technique was used to measure penetration fields of Nb3Sn thin films and Nb3Sn/Al2O3 multilayers deposited on Al2O3 wafers. The system was optimized to mitigate thermo- magnetic flux jumps at low temperatures

ICD-11 for quality and safety: overview of the who quality and safety topic advisory group

This paper outlines the approach that the WHO's Family of International Classifications (WHO-FIC) network is undertaking to create ICD-11. We also outline the more focused work of the Quality and Safety Topic Advisory Group, whose activities include the following: (i) cataloguing existing ICD-9 and ICD-10 quality and safety indicators; (ii) reviewing ICD morbidity coding rules for main condition, diagnosis timing, numbers of diagnosis fields and diagnosis clustering; (iii) substantial restructuring of the health-care related injury concepts coded in the ICD-10 chapters 19/20, (iv) mapping of ICD-11 quality and safety concepts to the information model of the WHO's International Classification for Patient Safety and the AHRQ Common Formats; (v) the review of vertical chapter content in all chapters of the ICD-11 beta version and (vi) downstream field testing of ICD-11 prior to its official 2015 release. The transition from ICD-10 to ICD-11 promises to produce an enhanced classification that will have better potential to capture important concepts relevant to measuring health system safety and quality—an important use case for the classificatio

Effect of infections on 30-day mortality among critically ill patients hospitalized in and out of the intensive care unit

Background: This analysis is part of a multicenter study conducted in Israel to evaluate survival of critically ill patients treated in and out of intensive care units (ICUs). Objective: To assess the role of infection on 30-day survival among critically ill patients hospitalized in ICUs and regular wards. Design: All adult inpatients were screened on four rounds for patients meeting ICU admission criteria. Retrospective chart review was used to detect presence and type of infection. Mortality was ascertained from day of meeting study criteria to 30 days thereafter. Analysis: The effect of infection on mortality among patients, treated in and out of the ICU, was compared using Kaplan Meier survival curves. Multivariate Cox models were constructed to adjust interdepartmental comparisons for case-mix differences. Results: Of 641 critically ill patients identified, 36.8% already had an infection on day 0. An additional 40.2% subsequently developed a new infection during the follow-up period, ranging from 64.6% in the ICU to 31.5% in regular wards (p < .001). Resistant infections were more prevalent in ICUs. Infection was independently associated with an increase in mortality, regardless of whether the patient was admitted to the ICU. There was no difference in the adjusted risk of mortality associated with an infection diagnosed on day 0 vs. an infection diagnosed later. Risk of dying was similar in resistant and nonresistant infections. Adjusting for infections, survival of ICU patients was better relative to patients in regular wards (adjusted hazard ratio = 0.7). Among the different types of infection, risk of mortality from pneumonia was significantly lower in ICUs relative to regular wards. There was a protective effect in ICUs among noninfected patients. Conclusion: The risk of acquiring a new infection is greater in the ICU. However, risk of mortality among ICU patients was lower for the most serious infections and for those without any infection

ablab/spades: rnacloudSPAdes: paper version

&lt;p&gt;cloudrnaSPAdes is a SPAdes-based tool for assembling full-length isoforms from barcoded RNA-seq linked-read data in a reference-free fashion. cloudrnaSPAdes accurately assembles isoforms, even for genes with high isoform diversity.&lt;/p&gt; &lt;p&gt;Usage example is available at &lt;a href="https://cab.spbu.ru/software/cloudrnaspades/"&gt;&lt;/a&gt;&lt;/p&gt; &lt;p&gt;This is a version of cloudrnaSPAdes used during paper preparation.&lt;/p&gt

Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International Classification of Diseases (ICD-11)

The World Health Organization (WHO) plans to submit the 11th revision of the International Classification of Diseases (ICD) to the World Health Assembly in 2018. The WHO is working toward a revised classification system that has an enhanced ability to capture health concepts in a manner that reflects current scientific evidence and that is compatible with contemporary information systems. In this paper, we present recommendations made to the WHO by the ICD revision's Quality and Safety Topic Advisory Group (Q&amp;S TAG) for a new conceptual approach to capturing healthcare-related harms and injuries in ICD-coded data. The Q&amp;S TAG has grouped causes of healthcare-related harm and injuries into four categories that relate to the source of the event: (a) medications and substances, (b) procedures, (c) devices and (d) other aspects of care. Under the proposed multiple coding approach, one of these sources of harm must be coded as part of a cluster of three codes to depict, respectively, a healthcare activity as a 'source' of harm, a 'mode or mechanism' of harm and a consequence of the event summarized by these codes (i.e. injury or harm). Use of this framework depends on the implementation of a new and potentially powerful code-clustering mechanism in ICD-11. This new framework for coding healthcare-related harm has great potential to improve the clinical detail of adverse event descriptions, and the overall quality of coded health data