Enriching a primary health care version of ICD-10 using SNOMED CT mapping

<p>Abstract</p> <p>Background</p> <p>In order to satisfy different needs, medical terminology systems must have richer structures. This study examines whether a Swedish primary health care version of the mono-hierarchical ICD-10 (KSH97-P) may obtain a richer structure using category and chapter mappings from KSH97-P to SNOMED CT and SNOMED CT's structure. Manually-built mappings from KSH97-P's categories and chapters to SNOMED CT's concepts are used as a starting point.</p> <p>Results</p> <p>The mappings are manually evaluated using computer-produced information and a small number of mappings are updated. A new and poly-hierarchical chapter division of KSH97-P's categories has been created using the category and chapter mappings and SNOMED CT's generic structure. In the new chapter division, most categories are included in their original chapters. A considerable number of concepts are included in other chapters than their original chapters. Most of these inclusions can be explained by ICD-10's design. KSH97-P's categories are also extended with attributes using the category mappings and SNOMED CT's defining attribute relationships. About three-fourths of all concepts receive an attribute of type <it>Finding site </it>and about half of all concepts receive an attribute of type <it>Associated morphology</it>. Other types of attributes are less common.</p> <p>Conclusions</p> <p>It is possible to use mappings from KSH97-P to SNOMED CT and SNOMED CT's structure to enrich KSH97-P's mono-hierarchical structure with a poly-hierarchical chapter division and attributes of type <it>Finding site </it>and <it>Associated morphology</it>. The final mappings are available as additional files for this paper.</p

Views of diagnosis distribution in primary care in 2.5 million encounters in Stockholm: a comparison between ICD-10 and SNOMED CT

Background Primary care (PC) in Sweden provides ambulatory and home health care outside hospitals. Within the County Council of Stockholm, coding of diagnoses in PC is mandatory and is done by general practitioners (GPs) using a Swedish primary care version of the International Statistical Classification of Diseases, version 10 (ICD-10). ICD-10 has amono-hierarchical structure. SNOMED CT is poly-hierarchical and belongs to a new generation of terminology systems with attributes (characteristics) that connect concepts in SNOMED CT and build relationships. Mapping terminologies and classifications has been pointed out as a way to attain additional advantages in describing and documenting healthcare data. A poly-hierarchical system supports the representation and aggregation of healthcare data on the basis of specific medical aspects and various levels of clinical detail. Objective To describe and compare diagnoses and health problems in KSH97-P/ICD-10 and SNOMED CT using primary care diagnostic data, and to explore and exemplify complementary aggregations of diagnoses and health problems generated from a mapping to SNOMED CT. Methods We used diagnostic data collected throughout 2006 and coded in electronic patient records (EPRs), and a mapping from KSH97-P/ ICD-10 to SNOMED CT, to aggregate the diagnostic data with SNOMED CT defining hierarchical relationship Is a and selected attribute relationships. Results The chapter level comparison between ICD-10 and SNOMED CT showed minor differences except for infectious and digestive system disorders. The relationships chosen aggregated the diagnostic data to 2861 concepts, showing a multidimensional view on different medical and specific levels and also including clinically relevant characteristics through attribute relationships. Conclusions SNOMED CT provides a different view of diagnoses and health problems on a chapter level, and adds significant new views of the clinical data with aggregations generated fromSNOMED CT Is a and attribute relationships. A broader use of SNOMED CT is therefore of importance when describing and developing primary care

Increased prevalence of vulnerable atherosclerotic plaques and low levels of natural IgM antibodies against phosphorylcholine in patients with systemic lupus erythematosus

The role of inflammation in the development of atherosclerosis is now accepted and a focus of many studies because of its complex mechanisms. The risk of cardiovascular disease (CVD) and atherosclerosis is reported to be increased in systemic lupus erythematosus (SLE), especially in the group of young women. The introduction of statins in the 1990’s lowered considerably the morbidity and mortality in CVD. In the last decade, research efforts were concentrated on the immunological mechanisms of atherosclerosis and on the possibility to influence these mechanisms. Our group recently reported a negative association between natural IgM-antibodies against phosphorylcholine (IgM anti-PC) and CVD outcome in the general population. Potential mechanisms considered include anti-inflammatory properties and inhibition of uptake of oxidized low density lipoprotein (oxLDL) in macrophages. The objective herein was to study mechanisms of atherosclerosis in SLE and the relation to traditional and non-traditional risk factors in an SLE cohort, in comparison with an age and sex matched control group. As systemic endothelial dysfunction is one of the earliest signs of atherosclerosis in the general population, we also assessed skin microvascular endothelial function in SLE patients and controls. A total of 114 patients with SLE were compared with 122 age and sex-matched population-based controls. Common carotid intima-media thickness (IMT), calculated intima-media area (cIMa) and plaque occurrence were determined by B-mode ultrasound. Plaques were graded according to echogenicity. Anti-PC was assessed by enzyme-linked immunosorbent assay (ELISA). Endothelial function in skin was tested with local application of acetylcholine (ACh) and any concomitant increase in skin perfusion was measured with Laser Doppler Fluxmetry (LDF) in 84 of the SLE-patients and 81 of the age- and sex-matched controls. Incidence of hypertension, presence of insulin resistance (determined by homeostasis model assessment of insulin resistance, HOMA-IR) and the levels of triglycerides and C-reactive protein (CRP) were increased in the SLE patients, while smoking, cholesterol and high density lipoprotein (HDL) did not differ from controls. Low levels of IgM anti-PC were more common in the SLE patients than in the controls. IMT and cIMa did not differ significantly between groups. However, plaques were more often found in the SLE patients. Age, LDL and IgM anti-PC were independently associated with plaque occurrence in the SLE patients. Furthermore, in the left carotid arteries echolucent plaques were more prevalent in SLE when compared to controls. There were no significant differences in skin microvascular endothelial function between SLE patients and controls. In the SLE group, endothelial function did not vary in relation to presence of skin manifestations, Raynaud’s phenomenon, nephritis or plaque occurrence. In SLE patients with CVD, however, endothelial function was impaired. Conclusion: Plaque occurrence in the carotid arteries was increased in SLE and was independently associated with age, LDL and low anti-PC levels. Vulnerable plaques were more common in SLE than in controls. Anti-PC could be a novel risk marker for atherosclerosis with therapeutic potential in SLE. Skin microvascular endothelial function was associated with CVD but not with early signs of atherosclerosis in SLE-patients. The endothelial function was not different in SLE-patients, as compared to controls

Kestävän kehityksen toimenpidesitoumustyökalu: kokonaisarvio ja kehittämismahdollisuudet

Kestävän kehityksen yhteiskuntasitoumus on Suomen kansallinen linjaus kestävän kehityksen tavoitta-miseksi vuoteen 2050 mennessä. Sen toteuttamisen keskeinen väline ovat toimenpidesitoumukset, jotka ovat eri tahojen antamia julkisia lupauksia konkreettisista ja vapaaehtoisista toimista. Tässä rapor-tissa esitetään kokonaisarvio toimenpidesitoumusprosessin tähänastisesta toteutumisesta ja hahmote-taan suositukset jatkokehitystä varten. Esitetyt arviot perustuvat toimenpidesitoumusten antajien rapor-toimiin tietoihin, toimijoille tehtyyn verkkokyselyyn, kahteen yhteistoiminnalliseen työpajaan, media-analyysiin, toimenpidesitoumuksille asetettujen kriteereiden analyysiin sekä vertailutietoihin muista vastaavista vapaaehtoisuuteen perustuvista aloitteista ja järjestelmistä. Hankkeen tulokset auttavat luomaan edellytyksiä nykyistä huomattavasti laajemman toimijajoukon aktiiviselle ja vaikuttavalle osal-listumiselle kestävän kehityksen tavoitteiden toteutuksee

Coding of procedures documented by general practitioners in Swedish primary care-an explorative study using two procedure coding systems

<p>Abstract</p> <p>Background</p> <p>Procedures documented by general practitioners in primary care have not been studied in relation to procedure coding systems. We aimed to describe procedures documented by Swedish general practitioners in electronic patient records and to compare them to the Swedish Classification of Health Interventions (KVÅ) and SNOMED CT.</p> <p>Methods</p> <p>Procedures in 200 record entries were identified, coded, assessed in relation to two procedure coding systems and analysed.</p> <p>Results</p> <p>417 procedures found in the 200 electronic patient record entries were coded with 36 different Classification of Health Interventions categories and 148 different SNOMED CT concepts. 22.8% of the procedures could not be coded with any Classification of Health Interventions category and 4.3% could not be coded with any SNOMED CT concept. 206 procedure-concept/category pairs were assessed as a complete match in SNOMED CT compared to 10 in the Classification of Health Interventions.</p> <p>Conclusions</p> <p>Procedures documented by general practitioners were present in nearly all electronic patient record entries. Almost all procedures could be coded using SNOMED CT.</p> <p>Classification of Health Interventions covered the procedures to a lesser extent and with a much lower degree of concordance. SNOMED CT is a more flexible terminology system that can be used for different purposes for procedure coding in primary care.</p

Hedging Options with Different Time Units in the Pricing Models

This study examined the effects of the Greeks of the options and the trading results of delta hedging strategies, with three different time units or option-pricing models. These time units were calendar time, trading time and continuous time using discrete approximation (CTDA) time. The CTDA time model is a pricing model, that among others accounts for intraday and weekend, patterns in volatility. For the CTDA time model some additional theta measures, which were believed to be usable in trading, were developed. The study appears to verify that there were differences in the Greeks with different time units. It also revealed that these differences influence the delta hedging of options or portfolios. Although it is difficult to say anything about which is the most usable of the different time models, as this much depends on the traders view of the passing of time, different market conditions and different portfolios, the CTDA time model can be viewed as an attractive alternative