In an attempt to assess the universal applicability of the International Classification of Disease (ICD-10), two psychiatrists from different socio-cultural backgrounds and training independently performed a chart review of 238 Chinese patients. Inter-rater reliability figures were comparable to those found in the WHO-coordinated ICD-10 field trials. The results suggest that ICD-10 has good 'universality' in routine clinical practice.
To review the categorisation of patients who were transferred out from outlying islands to urban hospitals utilising casualty evacuation (CASEVAC), and to search for possible patient characteristics which might have contributed to mis-categorisation during the 'non-flying' hours. Methods: The medical records of 459 patients, who were transferred out in the year 2009 were reviewed. Correctness of categorisation was determined by 2 independent assessors according to the CASEVAC guidelines. The rates of mis-categorisation between 'clinic hours' and 'AED hours', and that between the 'flying' and 'non-flying' hours, were compared. The patients' demographic data and their presenting symptoms were collected and analysed using logistic regression models to identify factors contributing to mis-categorisation. Results: The mis-categorisation rate was 60.1%. Among them, all were over-categorised. The over-categorisation rates between 'clinic hours' and 'AED hours', and between 'flying' and 'non-flying' hours, were not significantly different (p=0.07 and 0.09, respectively). Abnormal pulse rate was significantly associated with over-categorisation (p<0.01). Patients at extremes of age and psychiatric/ drunk patients were significantly less likely to be over-categorised (p<0.05 and p<0.01, respectively). There was 20% disagreement between the two assessors when applying the existing CASEVACs guidelines (kappa score 0.58 or 'moderate agreement'). Conclusions: Over-triage in CASEVAC categorisation is common irrespective of the time of day. Revision of the current CASEVAC guidelines is recommended. (Hong Kong j.emerg.med. 2013; 20:327-336) 目的:檢討用緊急撤離(CASEVAC)將病人從離島轉送到巿區醫院的分類並尋找那些在「無飛行時 間」中可能會導致誤分類的病人特徵。方法:我們檢討了在 2009 年期間的 459 個轉院病人的醫療報告。 由 2 個獨立的評估人員根據緊急撤離的指引去決定分類正確與否。誤分類率在「門診時間」和「急症 時間」及「飛行時間」和「無飛行時間」之間都作了比較。我們搜集了病人的人口統計學數據和他 們的主訴症狀並運用邏輯回歸法去分析以達致找出引至誤分類的因素。結果:誤分類率是 60.1% 。所有誤 分類個案都分類過高。過高分類率在「門診時間」和「急症時間」及「飛行時間」和「無飛行時 間」之間沒有明顯的區別(分別是 p=0.07 和 0.09)。不正常的脈搏率與分類過高明顯有關(p<0.01)。 病人兩極化年齡和精神病/醉酒的病人與過高分類明顯有較少的關係(分別是 p<0.05 和 p<0.01)。當 使用現時的緊急撤離指引時兩個評估人員之間持不同意見有 20% (kappa 評分 0.58 或中度同意)。結論: 在緊急撤離分類中,過高的分流是常見的並且不受時間影響。我們建議再審視現時的緊急撤離指引。
The human nuclear pregnane X receptor (PXR;NR1I2) which regulates the expression of ABCB1 gene which encodes phosphoglycoprotein, an efflux pump for carbamazepine (CBZ). The aim of this study was to investigate whether ABCB1 C3435T and NR1I2 A7635G variants significantly impact the response of epilepsy patients to CBZ monotherapy. ABCB1 C3435T and NR1I2 A7635G genotyping were performed on 168 Malaysian epilepsy subjects (76 drug‐responsive and 92 drug‐resistant) receiving CBZ monotherapy by PCR‐RFLP. The results for C3435T revealed a genotype distribution of CC, CT, TT: 39.5%, 43.4%, 17.1% for drug‐resistant patients compared to CC, CT, TT: 29.3%, 58.7%, 12.0% for drug‐responsive patients. The genotypes distribution of A7635G in the drug‐resistant patients for AA, AG, and GG were 13.0%, 39.1%, 47.8% and in drug‐responsive patients 10.5%, 57.9%, 31.6%, respectively. Furthermore, among drug‐resistants and drug‐responsive patients, the frequency of carriers of T allele and was 41.3.1% and 38.8% and for G allele 67.4% and 60.5%, respectively. The association of genotype and allele frequencies in C3435T and A7635G with response to CBZ was nonsignificant. In conclusion, the allelic and genotype analysis in Malaysian epilepsy patients suggests that the NR1I2 A7635G and ABCB1 C3435T polymorphisms are not associated with resistance to CBZ.
ResumenEn un intento de evaluar la aplicabilidad universal de la Clasificación Internacional de Enfermedades (CIE-10), dos psiquiatras de origen sociocultural y formación diferentes realizaron independientemente una revisión de los historiales de 238 pacientes chinos. Las cifras de fiabilidad interevaluador fueron comparables a las encontradas en los ensayos de campo de la CIE-10 coordinados por la OMS. Los resultados indican que la «universalidad» de la CIE-10 en la práctica clínica de rutina es buena.
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