scholarly journals Validation of a Semiautomated Surveillance Algorithm for Deep Surgical Site Infections After Primary Hip or Knee Arthroplasty

2020 ◽  
Vol 41 (S1) ◽  
pp. s83-s83
Author(s):  
Janneke Verberk ◽  
Stephanie van Rooden ◽  
Mayke Koek ◽  
Titia Hopmans ◽  
Marc Bonten ◽  
...  
Keyword(s):  
Data Extraction ◽  
Surgical Site Infections ◽  
Routine Care ◽  
Algorithm Performance ◽  
Primary Surgery ◽  
Automated Surveillance ◽  
Total Knee ◽  
Workload Reduction ◽  
The University ◽  
Near Future

Background: Surgical site infections (SSIs) complicate ~2% of primary total hip (THAs) or total knee arthroplasties (TKAs). Accurate and timely identification through surveillance is essential for targeted implementation and monitoring of preventive interventions. Electronic health records (EHR) facilitate (semi)-automated surveillance and enable upscaling. A validated algorithm is a prerequisite for broader implementation of semiautomated surveillance. Objectives: To validate a previously published algorithm for semiautomated surveillance of deep SSI after THA or TKA in 4 independent regional Dutch hospitals. The algorithm was developed and implemented in the University Medical Centre Utrecht and relies on retrospective routine care data. Methods: For this multicenter retrospective cohort study, the following data required for the algorithm were extracted from the EHR from all patients under THA and TKA surveillance: microbiology results, antibiotics, (re)admissions, and surgical procedures within the 120 days following the primary surgery. Patients were retrospectively classified with a low or high probability of having developed a deep SSI after THA or TKA, according to the algorithm. Sensitivity, positive predictive value (PPV), and workload reduction (defined as the proportion of manuals requiring review) were calculated compared to the traditional (manual) surveillance results, as reported to the national surveillance PREZIES. Discrepancy analyses were performed to understand algorithm results. Results: Data from 8,378 total THA and TKA surgeries (deep SSI n = 95, 1.1%) performed between 2012 and 2018 were extracted by 4 hospitals (Table 1). Sensitivity ranged across centers from 93.6% to 100%, with a PPV from 55.8% to 72.2%. In all hospitals, the algorithm resulted in >98% workload reduction. Cases missed by the algorithm could be explained by incomplete data extraction. Conclusions: This study shows that the surveillance algorithm performance is good in general Dutch hospitals. Broader implementation of this semiautomated surveillance for SSIs after THA or TKA may be possible in the near future and will result in a substantial workload reduction.Funding: This work was supported by the Regional Healthcare Network Antibiotic Resistance Utrecht with a subsidy of the Dutch Ministry of Health, Welfare and Sport (grant number 326835).Disclosures: None

A computerized indicator for surgical site infection (SSI) assessment after total hip or total knee replacement: The French ISO-ORTHO indicator

2021 ◽  
pp. 1-8
Author(s):  
Leslie Grammatico-Guillon ◽  
Katiuska Miliani ◽  
Linda Banaei-Bouchareb ◽  
Agnès Solomiac ◽  
Jessica Sambour ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Target Population ◽  
Total Hip ◽  
Classification Of Diseases ◽  
Multidisciplinary Working ◽  
Icd 10 ◽  
International Statistical Classification ◽  
Automated Surveillance ◽  
Total Knee ◽  
Procedure Codes

Abstract Objective: The French National Authority for Health (HAS), with a multidisciplinary working group, developed an indicator ‘ISO-ORTHO’ to assess surgical site infections (SSIs) after total hip arthroplasty or total knee arthroplasty (THA/TKA) based on the hospital discharge database. We present the ISO-ORTHO indicator designed for SSI automated detection and its relevance for quality improvement and hospital benchmarks. Methods: The algorithm is based on a combination of International Statistical Classification of Diseases, Tenth Revision (ICD-10) and procedure codes of the hospital stay. The target population was selected among adult patients who had a THA or TKA between January 1, 2017, and September 30, 2017. Patients at very high risk of SSI and/or with SSI not related to hospital care were excluded. We searched databases for SSIs up to 3 months after THA/TKA. The standardized infection ratio (SIR) of observed versus expected SSIs was calculated (logistic regression) and displayed as funnel plot with 2 and 3 standard deviations (SD) after adjustment for 13 factors known to increase SSI risk. Results: In total, 790 hospitals and 139,926 THA/TKA stays were assessed; 1,253 SSI were detected in the 473 included hospitals (incidence, 0.9%: 1.0% for THA, 0.80% for TKA). The SSI rate was significantly higher in males (1.2%), in patients with previous osteo-articular infection (4.4%), and those with cancer (2.3%), obesity, or diabetes. Most hospitals (89.9%) were within 2 SD; however, 12 hospitals were classified as outliers at more than +3 SD (1.6% of facilities), and 59 hospitals (7.9%) were outliers between +2 SD and +3 SD. Conclusion: ISO-ORTHO is a relevant indicator for automated surveillance; it can provide hospitals a metric for SSI assessment that may contribute to improving patient outcomes.

Spectrophotometric reductions with an IBM 1620

1966 ◽  
Vol 24 ◽  
pp. 116-117
Author(s):  
P.-I. Eriksson
Keyword(s):  
Astronomical Data ◽  
Spectrophotometric Data ◽  
Electronic Computers ◽  
The University ◽  
Near Future

Nowadays more and more of the reductions of astronomical data are made with electronic computers. As we in Uppsala have an IBM 1620 at the University, we have taken it to our help with reductions of spectrophotometric data. Here I will briefly explain how we use it now and how we want to use it in the near future.

MANAGEMENT OF THE SUCCESS OF STUDENT’S LEARNING BASED ON THE MARKOV MODEL

2018 ◽  
pp. 4-11
Author(s):  
M. V. Noskov ◽  
M. V. Somova ◽  
I. M. Fedotova
Keyword(s):  
Information System ◽  
Markov Process ◽  
Continuous Time ◽  
Information Technologies ◽  
Educational Process ◽  
Automated Information System ◽  
The Subject ◽  
The University ◽  
Independent Work ◽  
Near Future

The article proposes a model for forecasting the success of student’s learning. The model is a Markov process with continuous time, such as the process of “death and reproduction”. As the parameters of the process, the intensities of the processes of obtaining and assimilating information are offered, and the intensity of the process of assimilating information takes into account the attitude of the student to the subject being studied. As a result of applying the model, it is possible for each student to determine the probability of a given formation of ownership of the material being studied in the near future. Thus, in the presence of an automated information system of the university, the implementation of the model is an element of the decision support system by all participants in the educational process. The examples given in the article are the results of an experiment conducted at the Institute of Space and Information Technologies of Siberian Federal University under conditions of blended learning, that is, under conditions when classroom work is accompanied by independent work with electronic resources.

scholarly journals Validation of an algorithm for semiautomated surveillance to detect deep surgical site infections after primary total hip or knee arthroplasty—A multicenter study

2020 ◽  
Vol 42 (1) ◽  
pp. 69-74
Author(s):  
Janneke D. M. Verberk ◽  
Stephanie M. van Rooden ◽  
Mayke B. G. Koek ◽  
David J. Hetem ◽  
Annelies E. Smilde ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
High Probability ◽  
Surgical Site Infections ◽  
Data Interpretation ◽  
Routine Care ◽  
Successful Implementation ◽  
Subjective Data ◽  
Essential Information ◽  
Total Hip ◽  
Healthcare Associated

AbstractObjective:Surveillance of healthcare-associated infections is often performed by manual chart review. Semiautomated surveillance may substantially reduce workload and subjective data interpretation. We assessed the validity of a previously published algorithm for semiautomated surveillance of deep surgical site infections (SSIs) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) in Dutch hospitals. In addition, we explored the ability of a hospital to automatically select the patients under surveillance.Design:Multicenter retrospective cohort study.Methods:Hospitals identified patients who underwent THA or TKA either by procedure codes or by conventional surveillance. For these patients, routine care data regarding microbiology results, antibiotics, (re)admissions, and surgeries within 120 days following THA or TKA were extracted from electronic health records. Patient selection was compared with conventional surveillance and patients were retrospectively classified as low or high probability of having developed deep SSI by the algorithm. Sensitivity, positive predictive value (PPV), and workload reduction were calculated and compared to conventional surveillance.Results:Of 9,554 extracted THA and TKA surgeries, 1,175 (12.3%) were revisions, and 8,378 primary surgeries remained for algorithm validation (95 deep SSIs, 1.1%). Sensitivity ranged from 93.6% to 100% and PPV ranged from 55.8% to 72.2%. Workload was reduced by ≥98%. Also, 2 SSIs (2.1%) missed by the algorithm were explained by flaws in data selection.Conclusions:This algorithm reliably detects patients with a high probability of having developed deep SSI after THA or TKA in Dutch hospitals. Our results provide essential information for successful implementation of semiautomated surveillance for deep SSIs after THA or TKA.

scholarly journals Impact of the COVID-19 pandemic and its related psychological effect on orthopedic surgeries conducted in different types of hospitals in Taiwan

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199607 ◽  
Author(s):  
Chia-Lung Shih ◽  
Peng-Ju Huang ◽  
Hsuan-Ti Huang ◽  
Chung-Hwan Chen ◽  
Tien-Ching Lee ◽  
...  
Keyword(s):  
Community Hospital ◽  
University Hospital ◽  
Total Knee Arthroplasties ◽  
Peak Period ◽  
Number Of Patients ◽  
Total Knee ◽  
Investigation Period ◽  
Orthopedic Diseases ◽  
The University ◽  
The Impact

Aim: Taiwan’s response to the coronavirus disease 2019 (COVID-19) differed in that it successfully prevented the spread without having to shutdown or overburden medical services. Patients’ fear regarding the pandemic would be the only reason to reduce surgeries, so Taiwan could be the most suitable place for research on the influence of psychological factors. This study aimed to assess the impact of patients’ fear on orthopedic surgeries in Taiwan amid the peak period of the COVID-19 pandemic. Patients and Methods: The investigation period included the COVID-19 pandemic (March 2020 to April 2020) and the corresponding period in the previous year. The following data on patients with orthopedic diseases were collected: outpatient visits, hospital admission, and surgical modalities. Results: The COVID-19 pandemic led to a 22%–29% and 20%–26% reduction in outpatients, 22%–27% and 25%–37% reduction in admissions, and 26%–35% and 18%–34% reduction in surgeries, respectively, at both hospitals. The weekly mean number of patients was significantly smaller during the COVID-19 pandemic for all types of surgery and elective surgeries at the university hospital, and for all types of surgery, elective surgeries, and total knee arthroplasties at the community hospital. Further, patients visiting the community hospital during the pandemic were significantly younger, for all types of surgery, elective surgeries, and total knee arthroplasties. Conclusions: The reduction in orthopedic surgeries in Taiwan’s hospitals during COVID-19 could be attributed to patients’ fear. Even without restriction, the pandemic inevitably led to a reduction of about 20%–30% of the operation volume.

scholarly journals 911Development of an Automated Surveillance System for Identifying Surgical Site Infections and Triaging Clinical Review

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S263-S263
Author(s):  
Westyn Branch-Elliman ◽  
Judith Strymish ◽  
Kamal Itani ◽  
Kalpana Gupta
Keyword(s):  
Clinical Review ◽  
Surveillance System ◽  
Surgical Site Infections ◽  
Automated Surveillance

scholarly journals “Our” Bodies: Property Rights in Human Tissue

1993 ◽  
Vol 8 (2) ◽  
pp. 113-138 ◽  
Author(s):  
Joan M. Gilmour
Keyword(s):  
Property Rights ◽  
Medical Research ◽  
Human Tissue ◽  
Effective Control ◽  
Technological Advances ◽  
The Supreme Court ◽  
The Many ◽  
Economic Goods ◽  
The University ◽  
Near Future

AbstractIn Moore v. Regents of the University of California, the Supreme Court of California held that the human source of blood and tissue used by his physician and other defendants in potentially lucrative medical research without his permission could not assert a legal claim that, in doing so, the defendants had deprived him of any property right in these materials or the cell line developed from them. He was, however, permitted to proceed with his claim that there had been a failure to obtain his informed consent to the excision or removal of these materials, given that their end uses were not disclosed. The decision in Moore is but one example of the range of new legal problems created by the many and rapid advances in biotechnology, and of the attempts courts are making to respond. The judgment raises questions about whether these types of issues as between the patient and medical, research, and pharmaceutical concerns can or ought to be analyzed in terms of property rights. Are the general justifications for recognizing proprietary rights that have traditionally been influential in judicial decisions useful or helpful in this context? And what of the identity of the decision-maker? In Moore, the majority was content to effectively delegate much of the decision-making authority to the U.S. Patent Office and the Office of Technology Assessment. While there are no Canadian decisions directly on point as yet, the pace of technological advances, the potential for economic gain, and the international nature of biotechnology enterprises all set the scene for these issues' coming before our courts in the near future. This paper begins to explore the implications of adopting an analytical model based on property rights and to address the fact that the biotechnology industry already operates on the premise that such material can be owned. It concludes that the current legal regime needs to be modified to allow effective control of these new realities and suggests principles that might be adopted to address important concerns that are raised by the transformation of human tissue and cells into economic goods.

Forestry education in Canada

1997 ◽  
Vol 73 (3) ◽  
pp. 341-347
Author(s):  
Claude Godbout
Keyword(s):  
Education System ◽  
Forest Sector ◽  
General Picture ◽  
Forestry Education ◽  
University Level ◽  
The University ◽  
Near Future

This paper aims at providing the reader with information about the forestry education system in Canada and its trends. As a basis for undertanding the framework of forestry education, a general picture of the Canadian forest sector is drawn and the main issues and concerns that will shape its evolution in the near future are presented.In a second part, after having described the current forestry education system with some emphasis on the university level, a summary of the challenges facing forestry education is presented. In the last part, a practical example of program revision influenced by these trends and challenges is presented in order to convey to the reader how a revised university forestry program can be designed to meet society's needs.

The Masks of Greek Tragedy as Point of Departure for Modern Performance

2001 ◽  
Vol 17 (3) ◽  
pp. 254-272 ◽  
Author(s):  
Chris Vervain ◽  
David Wiles
Keyword(s):  
Greek Tragedy ◽  
Research Programme ◽  
Cambridge University ◽  
Performance Space ◽  
And Performance ◽  
The University ◽  
Near Future ◽  
Point Of Departure ◽  
Valuable Point ◽  
New Comedy

In this article, David Wiles and Chris Vervain stake out the ground for a substantial programme of continuing research. Chris Vervain, coming from a background in visual and performance art, is in the first instance a maker of masks. She is also now writing a thesis on the masks of classical tragedy and their possibilities in modern performance, and, in association with the University of Glasgow, working on an AHRB research programme that involves testing the effect of Greek New Comedy masks in performance. David Wiles, Professor of Theatre at Royal Holloway, University of London, has published books on the masks of Greek New Comedy and on Greek performance space, and lectured on Greek masks. Most recently, his Greek Theatre Performance: an Introduction (Cambridge University Press, 2000) included an investigation of the classical mask and insights provided by the work of Lecoq. He is now planning a book on the classical Greek mask. Wiles and Vervain are both committed to the idea that the mask was the determining convention which gave Greek tragedy its identity in the ancient world, and is a valuable point of departure for modern practitioners engaging with the form. They anticipate that their research will in the near future incorporate a symposium and a further report on work-in-progress.

scholarly journals Dynamic risk stratification in the follow-up of thyroid cancer: what is still to be discovered in 2017?

2017 ◽  
Vol 24 (11) ◽  
pp. R387-R402 ◽  
Author(s):  
Jolanta Krajewska ◽  
Ewa Chmielik ◽  
Barbara Jarząb
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Risk Stratification ◽  
Prospective Studies ◽  
Response To Treatment ◽  
Dynamic Risk ◽  
Primary Surgery ◽  
Risk Patients ◽  
Near Future

The adequate risk stratification in thyroid carcinoma is crucial to avoid on one hand the overtreatment of low-risk and on the other hand the undertreatment of high-risk patients. The question how to properly assess the risk of relapse has been discussed during recent years and resulted in a substantial change in our approach to risk stratification in differentiated thyroid cancer, proposed by the newest ATA guidelines. First initial risk stratification, based on histopathological data is carried out just after primary surgery. It should be emphasized, that a high quality of histopathological report is crucial for proper risk stratification. Next, during the follow-up, patients are restratified considering their response to treatment applied and classified to one of the following categories: excellent response, biochemical incomplete response, structural incomplete or indeterminate response. This new approach is called dynamic risk stratification as, in contrary to the previous rigid evaluation performed at diagnosis, reflects a real-time prognosis and thereby substantially influences and personalizes disease management. In this review, we raise some unresolved questions, among them the lack of prospective studies, fulfilling evidence-based criteria, necessary to validate this model of risk stratification. We also provided some data concerning the use of dynamic risk stratification in medullary thyroid cancer, not yet reflected in ATA guidelines. In conclusion, dynamic risk stratification allows for better prediction of the risk of recurrence in thyroid carcinoma, what has been demonstrated in numerous retrospective analyses. However, the validation of this approach in prospective studies seems to be our task for near future.

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