Suchergebnisse

In this article Eritrea is discussed as a developmental state based on biopolitics. Taking the example of higher education, it is shown how the biopolitical project as applied to education policies and human resource development at first succeeded in terms of reinforcing personal nationalism, while at the same time opening up spaces for the fulfilment of personal aspirations. Of late, however, the biopolitical project has turned pernicious and has become a tool of oppression. These developments, if they are to continue, will not only jeopardise the state's developmental agenda but may lead to the Eritrean polity in its present form becoming unviable. Adapted from the source document.

ABSTRACT
ObjectivesPatients with atrial fibrillation (AF) have an increased risk of developing stroke, and oral anticoagulants (OACs) are commonly used in stroke prevention. The CHA2DS2-VASc score has been proved to be a simple and effective tool for stroke risk assessment which guides the selection of treatment with OACs. This score is calculated using disease diagnoses; however, a range of different versions exist, making comparability questionable.
The aim of this study was to compare CHA2DS2-VASc scores in OAC treated patients with a hospital-confirmed diagnosis of AF in Scotland using different subsets of ICD-10 codes.
Approach This is a retrospective study, covering AF patients in Scotland who received at least one prescription for any OAC between January 2009 and June 2014. The Prescribing Information System (PIS) was used to identify patients with OAC prescriptions, while the Scottish Morbidity Records (SMR) provided patients' diagnoses. Different sets of ICD-10 codes, using varying definitions, were used to classify the stroke risk in AF patients in order to account for heterogenous definitions applied in previously published studies. The main differences in codes used were the inclusion or exclusion of unclassified stroke (ICD-10 code I64), and the inclusion of pulmonary embolism (PE) (I26) as either "prior thromboembolic event" or "vascular disease".
ResultsIn our study, a cohort of 71012 AF patients with OAC prescription were analysed. Using narrow disease definitions, 18.15% of patients were categorised as being at low risk of stroke (score 0-1), 74.80% at medium risk (score 2-5), and 7.04% at high risk (score 6-9). With an extended disease definition, including PE in "prior thromboembolic event", 14.81% of patients were at low risk (score 0-1), 72.60% at medium risk (score 2-5), and 12.59% at high risk (score 6-9); while including PE in "vascular disease", 14.99% of the patients had a score 0-1, 73.54% a score 2-5, and 11.48% a score 6-9.
Conclusion The change in score definitions makes a difference mainly in the number of patients categorised as very low risk or high risk. Standardisation in ICD-10 code definition of risk diseases could be useful in order to make the results comparable from different studies and further evaluate OAC choice according to risk group.

IntroductionTo support both electronic prescribing and documentation of medicines administration in secondary care, hospitals in Scotland are currently implementing the Hospital Electronic Prescribing and Medicines Administration (HEPMA) software. Driven by the COVID-19 pandemic, agreements have been put in place to centrally collate data stemming from the operational HEPMA system. The aim was to develop a national data resource based on records created in secondary care, in line with pre-existing collections of data from primary care.
MethodsHEPMA is a live clinical system and updated on a continuous basis. Data is automatically extracted from local systems at least weekly and, in most cases, on a nightly basis, and integrated into the national HEPMA dataset. Subsequently, the data are subject to quality checks including data consistency and completeness. Records contain a unique patient identified (Community Health Index number), enabling linkage to other routinely collected data including primary care prescriptions, hospital admission episodes, and death records.
ResultsThe HEPMA data resource captures and compiles information on all medicines prescribed within the ward/hospital covered by the system; this includes medicine name, formulation, strength, dose, route, and frequency of administration, and dates and times of prescribing. In addition, the HEPMA dataset also captures information on medicines administration, including dates and time of administration. Data is available from January 2019 onwards and held by Public Health Scotland.
ConclusionThe national HEPMA data resource supports cross-sectional/point-prevalence studies including drug utilisation studies, and also offers scope to conduct longitudinal studies, e.g., cohort and case-control studies. With the possibility to link to other relevant datasets, additional areas of interest may include health policy evaluations and health economics studies. Access to data is subject to approval; researchers need to contact the electronic Data Research and Innovation Service (eDRIS) in the first instance.