scholarly journals Civilian-military Collaboration: Department of Defense data in the BioSense Platform

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Jessica Deerin ◽  
Jean-Paul Chretien ◽  
Paul E. Lewis
Keyword(s):  
Department Of Defense ◽  
Family Members ◽  
Active Duty ◽  
Surveillance Program ◽  
Age Group ◽  
Diagnosis Codes ◽  
Time Period ◽  
Control And Prevention ◽  
Military Treatment Facility ◽  
Clinic Visits

ObjectiveThe Department of Defense data is available to NationalSyndromic Surveillance Program (NSSP) users to conduct syndromicsurveillance. This report summarizes the demographic characteristicsof DoD health encounter visits.IntroductionThe DoD provides daily outpatient and emergency room data feedsto the BioSense Platform within NSSP, maintained by the Centersfor Disease Control and Prevention. This data includes demographiccharacteristics and diagnosis codes for health encounter visits ofMilitary Health System beneficiaries, including active duty, activeduty family members, retirees, and retiree family members. NSSPfunctions through collaboration with local, state, and federal publichealth partners utilizing the BioSense Platform, an electronic healthinformation system.MethodsDoD data was pulled from the BioSense Platform through aRStudio server on October 11, 2016, querying data from November1, 2015 to September 30, 2016. Appointment type and beneficiarycategory data was not available in BioSense until November 1, 2015.Appointment type was categorized into clinic visits and telephoneconsults. Demographic characteristics (age group, gender, beneficiarycategory) are stratified by appointment type.ResultsDuring the time period of November 1, 2015 to September 30, 2016,data were received from 452 clinics. There is a military treatmentfacility located in 45 states and a military treatment facility mayhave one to 12 clinics. There were a total of 86,840,632 healthcareencounter records. The age group, 25-44 years, accounted for 39.4%of the medical encounters; the mean age was 33.9 (SD=19.1). Malesaccounted for 55.6% of the medical encounters. For the time periodfrom November 1, 2015 to September 30, 2016, 78.9% of medicalencounters were clinic visits. The remaining medical encounterswere telephone consults. Of the clinic visits, 53.7% of the medicalencounters were for active duty personnel.ConclusionsThis report highlights the DoD data available to NSSP users forcollaborative syndromic surveillance efforts, promoting a communityof practice. It is important to understand the population demographicsand limitations to the DoD data when conducting syndromicsurveillance.

scholarly journals Evaluation of DoD Syndrome Mapping and Baseline for ICD-9-CM to ICD-10-CM Transition

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Jessica Deerin ◽  
Jean-Paul Chretien ◽  
Paul Lewis
Keyword(s):  
Department Of Defense ◽  
Human Services ◽  
Military Health ◽  
Health And Human Services ◽  
Diagnostic Codes ◽  
Diagnosis Codes ◽  
Time Period ◽  
Icd 10 ◽  
Icd Codes ◽  
Number Of Visits

ObjectiveThe transition from ICD-9-CM to ICD-10-CM requires evaluationof syndrome mappings to obtain a baseline for syndromic surveillancepurposes. Two syndrome mappings are evaluated in this report.IntroductionThe Department of Defense conducts syndromic surveillanceof health encounter visits of Military Health System (MHS)beneficiaries. Providers within the MHS assign up to 10 diagnosiscodes to each health encounter visit. The diagnosis codes are groupedinto syndrome and sub-syndrome categories. On October 1, 2015,the Health and Human Services-mandated transition from ICD-9-CM to ICD-10-CM required evaluation of the syndrome mappingsto establish a baseline of syndrome rates within the DoD. The DoDdata within the BioSense system currently utilizes DoD ESSENCEsyndrome mappings. The Master Mapping Reference Table (MMRT)was developed by the CDC to translate diagnostic codes across theICD-9-CM and ICD-10-CM encoding systems to prepare for thetransition. The DoD ESSENCE and MMRT syndrome definitions arepresented in this analysis for comparison.MethodsDoD data was pulled from the BioSense Platform through aRStudio server on October 11, 2016, querying data from October1, 2014 to September 30, 2016. This time period provides twelvemonths of ICD-9-CM data and twelve months of ICD-10-CM data.The ICD codes were binned to both DoD ESSENCE syndromes andMMRT macro syndromes for comparison. Although a patient visitmay contain up to 10 ICD codes, only the first four were includedfor this analysis. Providers are trained to prioritize diagnosis codesby position. Only 2.2% of visits had greater than 4 diagnostic codes.Each ICD code in a visit is binned to an applicable syndrome. Thetotal number of visits includes visits that binned and did not bin toa syndrome. Multiple syndromes may be assigned to one patient’shealth encounter visit if multiple ICD codes are binned. Additionally,more than one code per visit may bin to the same syndrome; however,only unique syndromes are counted in the total syndrome rate. Thetotal syndrome rate was calculated by total unique syndrome visitsas the numerator and total number of visits during the ICD-9-CM orICD-10-CM time period as the denominator. The rates per 1000 totalvisits were calculated.ResultsAmong the DoD ESSENCE syndromes, the ICD-9-CM ratefor ILI was 36.3 per 1,000 compared to the ICD-10-CM rate of38.6 per 1,000. The ICD-9-CM rate for neurological was 18.1 per1,000 compared to the ICD-10-CM rate of 0.2 per 1,000.Among the MMRT syndromes, the ICD-9-CM rate for ILI was16.7 per 1,000 compared to the ICD-10-CM rate of 38.4 per 1,000.The ICD-9-CM rate for mental disorders was 73.8 per 1,000 comparedto the ICD-10-CM rate of 73.2 per 1,000.ConclusionsThis analysis provides baseline rates of MMRT syndromes andsub-syndromes for syndromic surveillance during the ICD-9-CM toICD-10-CM transition. These data will serve for future comparisonand tracking of syndrome-specific trends for military-relevant healththreats.

Errors in Administrative-Reported Ventilator-Associated Pneumonia Rates: Are Never Events Really So?

2011 ◽  
Vol 77 (8) ◽  
pp. 998-1002 ◽  
Author(s):  
Bradley W. Thomas ◽  
Robert A. Maxwell ◽  
Benjamin W. Dart ◽  
Elizabeth H. Hartmann ◽  
Dustin L. Bates ◽  
...  
Keyword(s):  
Care Service ◽  
Surveillance Program ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Time Period ◽  
Surgical Critical Care ◽  
Hospital Infection Control ◽  
Control And Prevention ◽  
Hospital Administrative ◽  
Never Event

Ventilator-associated pneumonia (VAP) is a common problem in an intensive care unit (ICU), although the incidence is not well established. This study aims to compare the VAP incidence as determined by the treating surgical intensivist with that detected by the hospital Infection Control Service (ICS). Trauma and surgical patients admitted to the surgical critical care service were prospectively evaluated for VAP during a 5-month time period. Collected data included the surgical intensivist's clinical VAP (SIS-VAP) assessment using Centers for Disease Control and Prevention (CDC) VAP criteria. As part of the hospital's VAP surveillance program, these patients’ medical records were also reviewed by the ICS for VAP (ICS-VAP) using the same CDC VAP criteria. All patients suspected of having VAP underwent bronchioalveolar lavage (BAL). The SIS-VAP and ICS-VAP were then compared with BAL-VAP. Three hundred twenty-nine patients were admitted to the ICU during the study period. One hundred thirty-three were intubated longer than 48 hours and comprised our study population. Sixty-two patients underwent BAL evaluation for the presence of VAP on 89 occasions. SIS-VAP was diagnosed in 38 (28.5%) patients. ICS-VAP was identified in 11 (8.3%) patients ( P < 0.001). The incidence of VAP by BAL criteria was 23.3 per cent. When compared with BAL, SIS-VAP had 61.3 per cent sensitivity and ICS-VAP had 29 per cent sensitivity. VAP rates reported by hospital administrative sources are significantly less accurate than physician-reported rates and dramatically underestimate the incidence of VAP. Proclaiming VAP as a never event for critically ill for surgical and trauma patients appears to be a fallacy.

scholarly journals A comparative evaluation of two chromogenic media for surveillance of carbapenem-resistant Enterobacterales with non-carbapenemase-producing or carbapenemase-producing strains other than blaKPC: blaGES-5, blaNDM-1 or blaVIM-2

2019 ◽  
Vol 43 (3) ◽  
pp. 173-176
Author(s):  
Chang-Hun Park
Keyword(s):  
Rapid Detection ◽  
Comparative Evaluation ◽  
Susceptibility Testing ◽  
Rapid Identification ◽  
Surveillance Program ◽  
Contact Precaution ◽  
Chain Reaction ◽  
Carbapenem Resistant ◽  
Control And Prevention ◽  
Polymerase Chain

Abstract Background Infections caused by carbapenem-resistant Enterobacterales (CREs) are an emerging problem associated with high rates of morbidity and mortality. CREs are divided into two categories (carbapenemase-producing [CP] CRE and non-CP CRE). The most prevalent carbapenemase produced by Enterobacterales is Klebsiella pneumoniae carbapenemase (KPC) in Korea. Rapid identification of CREs is clinically important in infection control precaution. We compared the performance of two chromogenic media (chromID CARBA agar and CHROMagar KPC agar) for non-CP CREs or CP CREs with blaGES-5, blaNDM-1 or blaVIM-2 in a Korean hospital. Methods The study was carried out during a 3-month period from April to June 2017 during the surveillance program for CRE colonization. Antimicrobial susceptibility testing (AST) and polymerase chain reaction (PCR) were performed at the Korean Centers for Disease Control and Prevention. Results A total of 45 rectal swabs from 42 hospitalized patients were examined. Sensitivity of both chromID CARBA and CHROMagar KPC were 100% for CP CREs; and 50% and 100% for non-CP CREs, respectively. Specificity of chromID CARBA and CHROMagar KPC were 89.2% and 70.3% for CP CRE, respectively; and 76.9% and 66.7% for non-CP CRE, respectively. Conclusions The CHROMagar KPC is useful to monitor non-CP and CP CREs. The chromID CARBA is efficient for rapid detection of CP CREs requiring high contact precaution.

scholarly journals 143. Initial Impact of COVID-19 on Ambulatory Antibiotic Prescribing for Respiratory Viral Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Zahra Kassamali Escobar ◽  
Todd Bouchard ◽  
Jose Mari Lansang ◽  
Scott Thomassen ◽  
Joanne Huang ◽  
...  
Keyword(s):  
Primary Care ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Specific Rate ◽  
Inclusion Criteria ◽  
Diagnosis Codes ◽  
Control And Prevention ◽  
Viral Respiratory Infections

Abstract Background Between 15–50% of patients seen in ambulatory settings are prescribed an antibiotic. At least one third of this usage is considered unnecessary. In 2019, our institution implemented the MITIGATE Toolkit, endorsed by the Centers for Disease Control and Prevention to reduce inappropriate antibiotic prescribing for viral respiratory infections in emergency and urgent care settings. In February 2020 we identified our first hospitalized patient with SARS-CoV(2). In March, efforts to limit person-to-person contact led to shelter in place orders and substantial reorganization of our healthcare system. During this time we continued to track rates of unnecessary antibiotic prescribing. Methods This was a single center observational study. Electronic medical record data were accessed to determine antibiotic prescribing and diagnosis codes. We provided monthly individual feedback to urgent care prescribers, (Sep 2019-Mar 2020), primary care, and ED providers (Jan 2020 – Mar 2020) notifying them of their specific rate of unnecessary antibiotic prescribing and labeling them as a top performer or not a top performer compared to their peers. The primary outcome was rate of inappropriate antibiotic prescribing. Results Pre toolkit intervention, 14,398 patient visits met MITIGATE inclusion criteria and 12% received an antibiotic unnecessarily in Jan-April 2019. Post-toolkit intervention, 12,328 patient visits met inclusion criteria and 7% received an antibiotic unnecessarily in Jan-April 2020. In April 2020, patient visits dropped to 10–50% of what they were in March 2020 and April 2019. During this time the unnecessary antibiotic prescribing rate doubled in urgent care to 7.8% from 3.6% the previous month and stayed stable in primary care and the ED at 3.2% and 11.8% respectively in April compared to 4.6% and 10.4% in the previous month. Conclusion Rates of inappropriate antibiotic prescribing were reduced nearly in half from 2019 to 2020 across 3 ambulatory care settings. The increase in prescribing in April seen in urgent care and after providers stopped receiving their monthly feedback is concerning. Many factors may have contributed to this increase, but it raises concerns for increased inappropriate antibacterial usage as a side effect of the SARS-CoV(2) pandemic. Disclosures All Authors: No reported disclosures

scholarly journals Over view of clinical presentation, management and outcome of cervical cancer: A tertiary cancer centre experience

2016 ◽  
Author(s):  
H. Shukla ◽  
K. Batra ◽  
R. Sekhon ◽  
S. Giri ◽  
S. Rawal
Keyword(s):  
Cervical Cancer ◽  
Local Recurrence ◽  
Radical Hysterectomy ◽  
Gynecological Cancer ◽  
Age Group ◽  
Recurrence Rates ◽  
Oncological Safety ◽  
Robotic Radical Hysterectomy ◽  
Time Period ◽  
Hospital Registry

Objectives: (a) To understand the profile of cervical cancer patients attending our hospital from January 2011 till January 2015. (b) To audit the type of care given to the patients with respect to their stage at presentation. (c) To compare the outcomes of open v/s robotic radical hysterectomy done for cervical cancer. Methods: We prospectively analyzed all cases of cervical cancer from January 2011 to January 2015 presenting at our institute. Data was retrieved from patient’s records and institute’s tumor registry. We compared all patients undergoing open v/s robotic RH. All the data were analysed using SPSS version 21. Results: A total of 562 patients were treated for cervical cancer during the time period between 2011-2015. Of these there were 316 (56%) cases taken up for surgery-212 robotic RH, 104 open radical hysterectomy and rest 246 (44%) patients received definitive CCRT. Most common age group was 40-54 yrs. IB1 stage was most common presenting stage. SCC was most common histology (75%). Immediate post op complication and oncological safety in terms of local recurrence was same in both groups. However length of stay and post operative blood requirement was significantly lower in robotic RH group. 45% of all patients who underwent surgery did not require adjuvant therapy in post op period while 35% patient required post op RT and 20% CCRT. 2.2% patient had local recurrence and most of the patients were in stage IIA1 at presentation. Conclusion: Cervical cancer is the most common gynecological cancer in our hospital registry. Mostly women were in the age group of 40-54 years. Most common stage at presentation was 1B and the histology being SCC. Not many differences seen in open v/s robotic techniques of radical hysterectomy except for shorter hospital stay and less need of blood transfusion in the robotic group. Local recurrence rates are comparable in both open and robotic groups.

scholarly journals One Year of the COVID-19 Pandemic in Galicia: A Global View of Age-Group Statistics during Three Waves

2021 ◽  
Vol 18 (10) ◽  
pp. 5104
Author(s):  
Iván Area ◽  
Henrique Lorenzo ◽  
Pedro J. Marcos ◽  
Juan J. Nieto
Keyword(s):  
Intensive Care Unit ◽  
Hospital Admissions ◽  
Age Groups ◽  
Age Group ◽  
Nw Spain ◽  
The Past ◽  
Global View ◽  
Time Period ◽  
Key Variables ◽  
One Year

In this work we look at the past in order to analyze four key variables after one year of the COVID-19 pandemic in Galicia (NW Spain): new infected, hospital admissions, intensive care unit admissions and deceased. The analysis is presented by age group, comparing at each stage the percentage of the corresponding group with its representation in the society. The time period analyzed covers 1 March 2020 to 1 April 2021, and includes the influence of the B.1.1.7 lineage of COVID-19 which in April 2021 was behind 90% of new cases in Galicia. It is numerically shown how the pandemic affects the age groups 80+, 70+ and 60+, and therefore we give information about how the vaccination process could be scheduled and hints at why the pandemic had different effects in different territories.

scholarly journals Characteristics, Treatment, and Outcomes of Patients With Severe or Life-threatening COVID-19 at a Military Treatment Facility—A Descriptive Cohort Study

2021 ◽  
Author(s):  
Brian P Elliott ◽  
Gregory M Buchek ◽  
Matthew T Koroscil
Keyword(s):  
Severe Disease ◽  
Ambient Air ◽  
Active Duty ◽  
Urban Setting ◽  
Arterial Oxygen ◽  
Treatment Facility ◽  
Blood Oxygen Saturation ◽  
Life Threatening ◽  
Military Treatment Facility ◽  
Active Duty Personnel

ABSTRACT Introduction The treatment of severe and life-threatening COVID-19 is a rapidly evolving practice. The purpose of our study was to describe the characteristics and outcomes of patients with severe or life-threatening COVID-19 who present to a Military Treatment Facility (MTF) with an emphasis on addressing institutional adaptations to rapidly changing medical evidence. Materials and Methods A single-center retrospective study conducted on a prospectively maintained cohort. The MTF is a 52-bed hospital within an urban setting. Patients were included in the cohort if they had laboratory-confirmed severe or life-threatening COVID-19 with positive SARS-CoV-2 reverse transcription polymerase chain reaction. Severe disease was defined as dyspnea, respiratory frequency ≥30/min, blood oxygen saturation ≤93% on ambient air, partial pressure of arterial oxygen to fraction of inspired oxygen ratio &lt;300, or lung infiltrates involving &gt;50% of lung fields within 24-48 hours. Life-threatening COVID-19 was defined as respiratory failure, septic shock, or multiple organ dysfunction. The cohort included patients admitted from June 1 through November 13. Data were collected retrospectively via chart review by a resident physician. Results In total, our MTF saw 14 cases of severe or life-threatening COVID-19 from June 1 to November 13. Patients had a median age of 70.5 years, with 7% being active duty personnel, 21% dependents, and 71% retired military members. The median time to dexamethasone, remdesivir, and convalescent plasma administration was 4.7, 6.3, and 11.2 hours, respectively. The 28-day in-hospital mortality was 0%. Conclusions Patients who present to an MTF with severe or life-threatening COVID-19 are largely retirees, with only a small fraction comprising active duty personnel. The institution of order sets and early consultation can help facilitate prompt patient care for COVID-19.

scholarly journals Gambaran Kasus Difteri Tahun 2009-Agustus 2019 di Kabupaten Bojonegoro

2020 ◽  
Vol 8 (2) ◽  
pp. 67
Author(s):  
Kiki Famalasari
Keyword(s):  
Secondary Data ◽  
Distribution Patterns ◽  
Surveillance Program ◽  
Age Group ◽  
District Health Office ◽  
District Health ◽  
Work Area ◽  
Serious Infections ◽  
Life Threatening ◽  
History Of

Pendahuluan : Difteri adalah suatu infeksi yang disebabkan oleh bakteri Corybacterium diphteriae, yang menyerang selaput lendir pada hidung dan tenggorokan, serta dapat mempengaruhi kulit. Penyakit ini sangat menular dan termasuk infeksi serius yang berpotensi mengancam jiwa.Tujuan : Penelitian ini bertujuan untuk menganalisis pola distribusi kasus difteri di Kabupaten Bojonegoro pada tahun 2009– 2019 (Agustus 2019).Metode : Penelitian ini dilakukan pada tanggal l5 Agustus-18 September 2019 di Kabupaten Bojonegoro. Penelitian ini adalah penelitian deskriptif dengan menggunakan data sekunder berupa laporan bulanan kasus difteri yang dilaporkan oleh Puskesmas atau Rumah Sakit di Wilayah kerja Dinas Kesehatan Kabupaten Bojonegoro dan hasil wawancara dengan Kepala Seksi Surveilans dan Imunisasi, serta Penanggungjawab Program Surveilans Difteri di Dinas Kesehatan Kabupaten Bojonegoro.Hasil : Hasil penelitian menunjukkan bahwa berdasarkan usia kasus difteri di Kabupaten Bojonegoro tertinggi terjadi pada kelompok usia 5-9 tahun (29,16%). Berdasarkan jenis kelamin sebagian besar terjadi pada jenis kelamin laki-laki (61,84%). Berdasarkan status imunisasi, kejadian difteri terjadi pada kelompok usia < 1tahun. Berdasarkan tempat, kejadian difteri di Kabupaten Bojonegoro sering terjadi di Kecamatan Bojonegoro. Berdasarkan waktu, kejadian difteri terjadi pada periode Januari-Maret dan Agustus-Desember.Kesimpulan : Kasus penyakit difteri di Kabupaten Bojonegoro dari tahun 2009 sampai dengan Agustus 2019 cenderung fluktuatif. Pada tahun 2009 hingga tahun 2012 kasus difteri di Kabupaten Bojonegoro mengalami peningkatan yang signifikan dan mengalami penurunan di tahun 2013 dan 2014. Kemudian pada tahun 2015, kasus difteri mengalami peningkatan kembali dan penemuan kasus terbanyak ada di tahun 2018 yaitu sebanyak 15 kasus.Penderita difteri paling banyak adalah anak usia 5-9 tahun yaitu sebanyak 21 anak. Beberapa penderita difteri memiliki riwayat imunisasi yang tidak lengkat maupun yang tidak pernah imunisasi sama sekali. Sedangkan penemuan kasus difteri terbanyak sering terjadi pada laki-laki.ABSTRACTBackground: Diphtheria is an infection caused by the Bacterium Corybacterium diphteriae, which attacks the mucous membranes of the nose and throat,then can affect the skin. This disease is very contagious and includes serious infections that are potentially life-threatening. Objectives: This study to analyze the distribution patterns of diphtheria cases in Bojonegoro Regency in 2009 - 2019 (August 2019). Methods This research was conducted on August 5-September 18, 2019 in Bojonegoro Regency. This research is a descriptive study using secondary data in the form of monthly reports of diphtheria cases reported by Puskesmas or Hospitals in the Work Area of the Bojonegoro District Health Office and the results of interviews with the Head of the Surveillance and Immunization Section, and the Person in Charge of the Diphtheria Surveillance Program at the Bojonegoro District Health Office. Result: The results showed that the highest age of diphtheria cases in Bojonegoro District occurred in the 5-9 years age group (29.16%). Based on sex, the majority occurred in male sex (61.84%). Based on immunization status, the incidence of diphtheria occurs in the age group <1 year. Based on location, diphtheria events in Bojonegoro Regency often occur in Bojonegoro District. By time, diphtheria events occurred in the January-March and August-December periods. Conclusions: Cases of diphtheria in Bojonegoro Regency from 2009 to August 2019 tended to be volatile. In 2009 until 2012 diphtheria cases in Bojonegoro Regency experienced a significant increase and decreased in 2013 and 2014. Then in 2015, diphtheria cases increased again and the most cases found were in 2018 which were 15 cases. The most diphtheria sufferers many are children aged 5-9 years, as many as 21 children. Some diphtheria sufferers have a history of immunizations that are not complete or have never been immunized at all. Whereas most cases of diphtheria are often found in men.

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