Reliability, usability and applicability of the ICD-11 beta draft focusing on hand injuries and diseases: results from German field testing

Objective To test the interrater reliability when using the codes of the 11th revision of the International Classification of Diseases (ICD)-11 beta draft as well as ICD-10 and to explore the usability of the ICD-11 beta draft and the applicability of ICD-11’s Supplementary section for functioning assessment in hand injuries and diseases. Design We conducted a validation study of the ICD-11 beta draft complemented by a single-centre study to collect clinical routine data on functioning. Setting German hand surgery clinics. Participants Twenty-three physicians coded real-life cases containing diagnostic information on hand injuries and diseases. Additionally, clinical information of 100 patients was coded by 6 physicians and a nurse using ICD-11’s Supplementary section for functioning assessment. Main Outcome Measures Physicians coded 210 cases using the ICD-11 beta draft and ICD-10. Krippendorff’s alpha was calculated. Clinical routine data was coded using 38 functioning categories. Results Interrater reliability (Krippendorff’s alpha) of 0.67 for ICD-11 coding and 0.71 for ICD-10 coding was obtained, indicating substantial agreement. However, physicians reported a high proportion of problems with ICD-11 coding and slightly fewer problems with ICD-10 coding. The collected data on functioning could be mapped to ICD-11’s Supplementary section for functioning assessment. For some data, however, only unspecific codes were available. Conclusions Interrater reliability of ICD-10 and ICD-11 was satisfactory. Training material for ICD-11 is needed to further improve reliability and usability. Future users of ICD-11 should be encouraged to use the Supplementary section for functioning assessment to shed light on the problems patients experience in everyday life.

Indoril: An I-PV Add-On for Visualization of Point Mutations on 3D Cartesian Coordinates

ABSTRACTSummaryOne of the main goals of proteomics is to understand how point mutations impact on the protein structure. Visualization and clustering of point mutations on user-defined 3 dimensional space can allow researchers to have new insights and hypothesis about the mutation’s mechanism of action.Availability and ImplementationWe have developed an interactive I-PV add-on called INDORIL to visualize point mutations. Indoril can be downloaded fromhttp://[email protected]║[email protected] InformationPlease refer to the supplementary section andhttp://www.i-pv.org.

The Black Death in Hebrew Literature: Ha-Maamar Be-Qaddaat Ha-Dever (Treatise on Pestilential Fever)

Ha-Maamar be-Qaddaat ha-dever (Treatise on Pestilential Fever), composed by an anonymous author, is one of several treatises devoted to the subject of plague that exist in Hebrew literature. The treatise is basically a concise regimen of health as it was common throughout the Middle Ages that has been adapted to the special case of the plague and that has been supplemented with a final section of remedies for the time of the plague. Although we do not know the name of the author nor where and when he lived and composed the treatise, we can draw some conclusions from the foreign, non-Hebrew terminology used in the treatise. As several of the foreign terms used for the different plants and remedies are in old Spanish, it seems reasonable to suppose that the author hailed from the Iberian Peninsula and possibly composed the treatise there as well. The frequent quotations in the supplementary section 21 from Spanish Islamic physicians like Ibn Rushd, al-Zahrāwī, al-Ghāfiqī and above all Ibn Zuhr also confirm such a supposition.

Are improvements needed in the management of severe acute skin reactions following completion of breast radiotherapy? A discussion of some possible service options

Radiotherapy is a critical component for many patients undergoing treatment for breast cancer. Most patients develop some degree of acute radiation skin reaction as a result of the treatment. Acute skin reactions range from faint erythema to moist desquamation and often peak within 1 month after completion of treatment.The emphasis of radiotherapy skincare advice is often during treatment with less attention paid to post-radiotherapy skincare. This article highlights this gap in service provision at one radiotherapy centre and demonstrates the difficulties encountered when there is an inadequate support system. Possible options are discussed for the management of skin reactions after radiotherapy and the potential implications of adopting these strategies. The pragmatic solution introduced to Addenbrookes’ Hospital was to amend patient information providing a supplementary section for health-care professionals overseeing patient care after completion of treatment. This has gone some way to addressing this issue but still has limitations.Provision of timely and consistent skincare advice and support is vital to provide high-quality patient care. This article emphasises the importance of standardisation of radiotherapy skincare and providing an effective support network for patients after completion of radiotherapy.

ELIMINATION OF THE FERGUSON REFLEX BY SECTION OF THE PELVIC NERVES IN THE LACTATING GOAT

SUMMARY Distension of the vagina by an inflated balloon induces milk ejection in goats. This reflex (the Ferguson reflex) is based on a neurohormonal mechanism. In three goats the reflex was abolished after bilateral section of the complex pelvic nerves plus caudal rectal nerves. Bilateral section of the pelvic nerves only, caused a complete elimination of the reflex in 11 out of 13 goats; in the two remaining animals, the reflex was abolished after a supplementary section of the pudendal nerve plus caudal rectal nerves. The reflex remained intact in one goat in which first the caudal rectal nerves and subsequently the pudendal nerve were cut. Elimination of the Ferguson reflex was accompanied by a marked reduction of the intensity of straining movements which are normally induced by distension of the vagina. Bilateral section of the pelvic nerves provoked a severe but temporary paralysis of the large intestine with blocking of the defaecation reflex. It is suggested that in ruminants the afferent pelvic nerves are involved in the release of oxytocin and in the intense straining occurring during the phase of expulsion at parturition.