Consistency and accuracy of diagnostic cancer codes generated by automated registration: comparison with manual registration

BACKGROUND: Automated procedures are increasingly used in cancer registration, and it is important that the data produced are systematically checked for consistency and accuracy. We evaluated an automated procedure for cancer registration adopted by the Lombardy Cancer Registry in 1997, comparing automatically-generated diagnostic codes with those produced manually over one year (1997). METHODS: The automatically generated cancer cases were produced by Open Registry algorithms. For manual registration, trained staff consulted clinical records, pathology reports and death certificates. The social security code, present and checked in both databases in all cases, was used to match the files in the automatic and manual databases. The cancer cases generated by the two methods were compared by manual revision. RESULTS: The automated procedure generated 5027 cases: 2959 (59%) were accepted automatically and 2068 (41%) were flagged for manual checking. Among the cases accepted automatically, discrepancies in data items (surname, first name, sex and date of birth) constituted 8.5% of cases, and discrepancies in the first three digits of the ICD-9 code constituted 1.6%. Among flagged cases, cancers of female genital tract, hematopoietic system, metastatic and ill-defined sites, and oropharynx predominated. The usual reasons were use of specific vs. generic codes, presence of multiple primaries, and use of extranodal vs. nodal codes for lymphomas. The percentage of automatically accepted cases ranged from 83% for breast and thyroid cancers to 13% for metastatic and ill-defined cancer sites. CONCLUSION: Since 59% of cases were accepted automatically and contained relatively few, mostly trivial discrepancies, the automatic procedure is efficient for routine case generation effectively cutting the workload required for routine case checking by this amount. Among cases not accepted automatically, discrepancies were mainly due to variations in coding practice

Descriptive epidemiology of selected birth defects, areas of Lombardy, Italy, 1999

<p>Abstract</p> <p>Background</p> <p>Birth defects are a leading cause of neonatal and infant mortality in Italy, however little is known of the etiology of most defects. Improvements in diagnosis have revealed increasing numbers of clinically insignificant defects, while improvements in treatment have increased the survival of those with more serious and complex defects. For etiological studies, prevention, and management, it is important to have population-based monitoring which provides reliable data on the prevalence at birth of such defects.</p> <p>Methods</p> <p>We recently initiated population-based birth defect monitoring in the Provinces of Mantova, Sondrio and Varese of the Region of Lombardy, northern Italy, and report data for the first year of operation (1999). The registry uses all-electronic source files (hospital discharge files, death certificates, regional health files, and pathology reports) and a proven case-generation methodology, which is described.</p> <p>The data were checked manually by consulting clinical records in hospitals. Completeness was checked against birth certificates by capture-recapture. Data on cases were coded according to the four-digit malformation codes of the International Classification of Diseases, Ninth Revision (ICD-9). We present data only on selected defects.</p> <p>Results</p> <p>We found 246 selected birth defects in 12,008 live births in 1999, 148 among boys and 98 among girls. Congenital heart defects (particularly septal defects) were the most common (90.8/10,000), followed by defects of the genitourinary tract (34.1/10, 000) (particularly hypospadias in boys), digestive system (23.3/10,000) and central nervous system (14.9/10,000), orofacial clefts (10.8/10,000) and Down syndrome (8.3/10,000). Completeness was satisfactory: analysis of birth certificates resulted in the addition of two birth defect cases to the registry.</p> <p>Conclusion</p> <p>This is the first population-based analysis on selected major birth defects in the Region. The high birth prevalences for septal heart defect and hypospadias are probably due to the inclusion of minor defects and lack of coding standardization; the latter problem also seems important for other defects. However the data produced are useful for estimating the demands made on the health system by babies with birth defects.</p

An immersive virtual reality platform to enhance walking ability of children with acquired brain injuries

Background: Acquired brain injury (ABI) may result in lifelong impairment of physical, cognitive, and psychosocial functions. Several rehabilitative treatments are often needed to support walking recovery, thus participantsâ\u80\u99 engagement becomes a crucial aspect, especially when patients are children. In the last few years, traditional physiotherapy (PT) has been flanked by innovative technologies for rehabilitation in the fields of robotics and Virtual Reality (VR). Preliminary results have shown interesting perspectives in the use of a VR system, the GRAIL (Gait Real-time Analysis Interactive Lab), in improving walk- ing abilities in a small group of children with ABI, although further insights are needed about its use as rehabilitative tool in the pediatric population. Objectives: To evaluate the efficacy of a rehabilitation treatment on a GRAIL system for the improvement of walking abilities, in a group of children suffering from ABI. Methods: 12 children with ABI (study group â\u80\u93 SG; mean age = 12.1 ± 3.8 years old) underwent a 10-session treatment with the GRAIL, an instrumented multi-sensor platform based on immersive VR for gait training and rehabilitation in engaging VR environments. Before (T0) and at the end of the treatment (T1), the participants were assessed by means of functional scales (Gross Motor Function Measure (GMFM), Functional Assessment Questionnaire (FAQ), 6-Minute Walk Test (6minWT) and the 3D-Gait Analysis, over ground (OGA) and on GRAIL (GGA). Results: All the participants completed the rehabilitative treatment. The functional evaluations showed an improvement in Gross Motor abilities (GMFM-88, p = 0.008), especially in standing (GMFM-D, p = 0.007) and walking (GMFM-E, p = 0.005), an increase of the endurance (6minWT, p = 0.002), and enhanced autonomy in daily life activities (FAQ, p = 0.025). OGA identified a significant decrease of the Gillette Gait Index for the impaired side and a general increase of symmetry. GGA showed improvements in spatiotemporal parameters and joints range of motion that moved towards normality and symmetry recovery. Conclusions: A 10-session treatment with GRAIL on children with ABI led to improvements in their walking abilities and enhanced their engagement during the training. This is desirable when long life impairments are faced and childrenâ\u80\u99s motor functions have to be regained and it supports the leading role that VR might have in the rehabilitation field

Could an Immersive Virtual Reality Training Improve Navigation Skills in Children with Cerebral Palsy? A Pilot Controlled Study

Children with cerebral palsy (CP) suffer deficits in their motor, sensory, and cognitive abilities, as well as in their visuospatial competences. In the last years, several authors have tried to correlate the visuospatial abilities with the navigational ones. Given their importance in everyday functions, navigation skills have been deeply studied using increasingly cutting-edge techniques such as virtual reality (VR). However, to our knowledge, there are no studies focused on training using immersive VR (IVR) in children with movement disorders. For this reason, we proposed an IVR training to 35 young participants with CP and conceived to improve their navigation skills in a &ldquo;simil-real&rdquo; environment while playing on a dynamic platform. A subgroup performed a part of the training which was specifically dedicated to the use of the allocentric strategy (i.e., looking for landmarks) to navigate the virtual environment. We then compared the children&rsquo;s navigation and spatial skills pre- and post-intervention. All the children improved their visual&ndash;spatial abilities; particularly, if the IVR activities specifically trained their ability to look for landmarks and use them to navigate. The results of this work highlight the potential of an IVR training program to increase the navigation abilities of patients with CPs

A pilot study on sports activities in pediatric palliative care: just do it

Abstract Background There has been a growing interest in studying the value of physical exercise in children with disabilities or chronic health conditions because of evidence of improvement in quality of life, social acceptance, and physical functioning. However, only scant evidence exists for routine sports activities in children requiring pediatric palliative care (PPC), and in most cases, such evidence has been collected in oncological patients. The Pediatric Hospice of Padua is the referral center for PPC in the Veneto region (northern Italy). Starting from the experience of this PPC center, this pilot study aims to describe the personal experience of children and young people who practice physical activity and their caregivers’ perspectives, focusing particularly on the emotional and social impact of exercise and sports practice. Methods Patients involved in at least one regular and structured sports activity were included in the pilot analysis. Two different ICF-CY (International Classification of Functioning, Disability and Health-Children and Youth Version) scales (“Body Function” and “Activity and Participation”) were filled out to assess the children’s global functional competence. Two online ad hoc questionnaires were created and administered to children, when able to respond, and caregivers. Results A total of 9% of patients reported being involved in a sports activity. All children who played sports did not have indications of cognitive retardation. The most practiced sport was swimming. The use of standardized methods such as ICF-CY shown that severe motor impairments do not limit sports accessibility. Questionnaires result suggest that sports are a positive experience for both children needing PPC and their parents. Children encourage other children to do sports and can find the positive side even in difficulties. Conclusion Since PPC is encouraged as early as the diagnosis of incurable pathologies, the inclusion of sports activities in the context of a PPC plan should be considered from the perspective of improving quality of life

Efficacy of Robotic-Assisted Gait Training Compared with Intensive Task-Oriented Physiotherapy for Children with Cerebral Palsy

Abstract -The purpose of this study was to evaluate if adding paediatric robotic-assisted gait training (RAGT) to taskoriented physiotherapy (TOP) in children with Cerebral Palsy (CP) could improve gross motor abilities and gait compared to intensive TOP. Nineteen ambulatory children with Bilateral Spastic CP were assigned to two 10-week training groups. 9 children had 20 sessions of RAGT and 20 sessions of TOP, the other 10 children had 40 sessions only of TOP. The Gross Motor Function Measure, 6-Minute Walk Test and 3D Gait Analysis were assessed prior to, at the end of, and 3 months after the end of the treatment. After the training and during the follow up, both groups improved their Gross Motor Function Measure scores, maintained their gait pattern and had unchanged 6-Minute Walk Test results. No between group differences were found in any outcome measures. In conclusion, compared to intensive TOP alone, the addition of RAGT to TOP was demonstrated to be equally effective at improving gross motor abilities and maintaining gait pattern over time. The robotic rehabilitation allows care-providers to administer a standardized, controlled, dosed therapy, and DSSHDUV WR LQFUHDVH SDWLHQW ¶V PRWLYDWLR

Immersive Virtual Reality to Improve Walking Abilities in Cerebral Palsy: A Pilot Study

Immersive virtual reality (IVR) offers new possibilities to perform treatments in an ecological and interactive environment with multimodal online feedbacks. Sixteen school-aged children (mean age 11 ± 2.4 years) with Bilateral CP—diplegia, attending mainstream schools were recruited for a pilot study in a pre–post treatment experimental design. The intervention was focused on walking competences and endurance and performed by the Gait Real-time Analysis Interactive Lab (GRAIL), an innovative treadmill platform based on IVR. The participants underwent eighteen therapy sessions in 4 weeks. Functional evaluations, instrumental measures including GAIT analysis and parental questionnaire were utilized to assess the treatment effects. Walking pattern (stride length left and right side, respectively p = 0.001 and 0.003; walking speed p = 0.001), endurance (6MWT, p = 0.026), gross motor abilities (GMFM-88, p = 0.041) and most kinematic and kinetic parameters significantly improved after the intervention. The changes were mainly predicted by age and cognitive abilities. The effect could have been due to the possibility of IVR to foster integration of motor/perceptual competences beyond the training of the walking ability, giving a chance of improvement also to older and already treated children

Improving walking ability of children with acquired brain injuries by means of an immersive virtual reality platform

Improving walking ability is one of the main goals of a rehabilitation procedure. New technologies based on Virtual Reality (VR) has been recently flanked standard therapies. In this study, 4 children suffering from acquired brain injury (ABI) underwent a 5 session treatment with the Gait Real-time Analysis Interactive Lab (GRAIL), to improve walking and balance ability. The GRAIL is an instrumented multi-sensor platform based on immersive virtual reality for gait training and rehabilitation in engaging VR environments, which has been included in few studies to evaluate gait patterns in normal and disabled people and to improve gait in adults. Results are promising: improvements were recorded at the ankle level, selectively at the affected side, and at the pelvic level, thus improving the walking pattern symmetry. Small changes were measured at the hip and knee joints, which were already comparable to healthy subjects. These results suggest that a longer intervention may be even more effective. In the next future more children will be enrolled to strongly prove the effectiveness of GRAIL in the rehabilitation of children with ABI

Immersive virtual reality platform for cerebral palsy rehabilitation

The Gait Real-time Analysis Interactive Lab (GRAIL) is an innovative platform based on immersive Virtual Reality (VR), providing amazing scenarios where the subjects are asked to walk or change their load and posture to get points and conclude exergames. The system captures in real-time the kinematic and kinetic of the motion and gives multi sensorial feedbacks (audio, video, or proprioceptive) to the subject. The GRAIL system has been recently used for the rehabilitation of walking abilities in the developmental age. In this study, 11 children suffering from bilateral cerebral palsy (CP) underwent a 20-session treatment with the GRAIL plus 20 sessions of physical therapy; gross motor abilities and the 3D gait analysis were selected as outcome measures. Significant improvements in the kinematic and kinetics of the walking were observed: the walking speed, the maximum power at the ankle during flexo-extension, the knee flexion at the initial contact are only some of the parameters that improved after the training