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According to this study: Compared with other fetal surveillance methods, intermittent auscultation seems to reduce the risk of emergency cesarean delivery without increasing that of adverse neonatal and maternal outcomes.Newer methods of fetal surveillance didn't improve neonatal outcomes or reduce the risk of unnecessary maternal interventions.

Background: Accurate community surveillance of cardiovascular disease requires hospital record abstraction, which is typically a manual process. The costly and time-intensive nature of manual abstraction precludes its use on a regional or national scale in the US. Whether an efficient system can accurately reproduce traditional community surveillance methods by processing electronic health records (EHRs) has not been established. Objective: We sought to develop and test an EHR-based system to reproduce abstraction and classification procedures for acute myocardial infarction (MI) as defined by the Atherosclerosis Risk in Communities (ARIC) Study. Methods: Records from hospitalizations in 2014 within ARIC community surveillance areas were sampled using a broad set of ICD discharge codes likely to harbor MI. These records were manually abstracted by ARIC study personnel and used to classify MI according to ARIC protocols. We requested EHRs in a unified data structure for the same hospitalizations at 6 hospitals and built programs to convert free text and structured data into the ARIC criteria elements necessary for MI classification. Per ARIC protocol, MI was classified based on cardiac biomarkers, cardiac pain, and Minnesota-coded electrocardiogram abnormalities. We compared MI classified from manually abstracted data to (1) EHR-based classification and (2) final ICD-9 coded discharge diagnoses (410-414). Results: These preliminary results are based on hospitalizations from 1 hospital. Of 684 hospitalizations, 355 qualified for full manual abstraction; 83 (23%) of these were classified as definite MI and 78 (22%) as probable MI. Our EHR-based abstraction is sensitive (>75%) and highly specific (>83%) in classifying ARIC-defined definite MI and definite or probable MI (Table). Conclusions: Our results support the potential of a process to extract comprehensive sets of data elements from EHR from different hospitals, with completeness and accuracy sufficient for a standardized definition of hospitalized MI.

Purpose of review Central venous catheter (CVC)-associated bloodstream infections (CLABSIs) result in poorer patient outcomes and increased healthcare costs. Reduced reimbursement for CLABSI events is now provided for hospitalized patients in the United States. Although a zero target is proposed, the feasibility has not been evaluated. The objective of this review is to identify factors contributing to CLABSI and determine whether current evidence supports attainment of a zero infection rate. Recent findings Limitations of current surveillance methods and reporting of aggregate data impact on achieving target CLABSI rates. Standard prevention practices, including physician and patient preparation (e.g. hand hygiene), are frequently incorporated into bundles of care. CVC dwell time has been identified as means of risk stratification. Additional strategies (e.g. chlorhexidine-impregnated dressings, antimicrobial-coated devices) may be better used in patients with expected long dwell times. Non-ICU populations are increasingly targeted with prevention strategies, but expected rates of infection have not been proposed. Summary A zero CLABSI rate should be the target only for ICU populations having CVCs with a dwell time of 1-9 days following aseptic insertion. Additional measures should be reserved for patients with expected longer dwell time. Refinement and validation of surveillance methodology is required before target CLABSI rates can be proposed for non-ICU populations.

OBJECTIVE To better understand the severity of 2009 H1N1 influenza disease, enhanced surveillance of patients hospitalized with influenza was conducted during the 2009-2010 influenza season in New York State through existing Emerging Infections Program surveillance and a newly established sentinel hospital surveillance program. The 2 surveillance systems were compared to determine consistency across surveillance modalities and reveal the strengths and weaknesses of each to accomplish comprehensive influenza surveillance. DESIGN Similar variables from the aggregate data collected from each system were compared and differences were analyzed in detail. SETTING New York State. PARTICIPANTS Hospitalized adult and pediatric patients detected through 2 influenza surveillance programs. MAIN OUTCOME MEASURES Significant differences in age distribution, timing of illness onset, illness complications, underlying medical conditions, critical care admissions, use of mechanical ventilation, and illness outcomes. RESULTS Both surveillance systems saw the highest numbers of confirmed influenza infection among patients hospitalized in early fall 2009, with sharp declines thereafter. Sentinel hospital surveillance continued to detect hospitalizations for influenza-like illness that were not due to 2009 H1N1 influenza well into March 2010. Compared to influenza surveillance conducted through the Emerging Infections Program, the sentinel hospital influenza surveillance program tended to detect a sicker population of children and adults, including a higher rate of critical illness and mechanical ventilation, and among adults, higher rates of some underlying medical conditions. There were no differences in disease outcomes detected between the 2 systems. CONCLUSIONS Although the 2 surveillance systems were complementary, inherent methodologic variations revealed important differences at season conclusion. The lessons learned should be used to determine the best way to allocate resources to meet the needs of future state and national influenza surveillance efforts.

PURPOSE OF REVIEW: To present recent advances in HIV/AIDS surveillance methods in low- and middle-income countries. RECENT FINDINGS: From 2001 to 2008 30 low- and middle-income countries implemented national population-based surveys with HIV testing. Antenatal clinic HIV sentinel surveillance sites in sub-Saharan Africa increased from just over 1000 in 2003-2004 to almost 2500 in 2005-2006 becoming more representative of rural areas. Between 2003 and 2007 at least 122 behavioral surveys in low- and middle-income countries used respondent-driven sampling for surveillance among high-risk populations although many countries with concentrated epidemics continue to have major sentinel surveillance gaps. Improvements have been made in modeling estimates of number of persons HIV infected and systems are now in place to measure HIV drug resistance. However the reliable monitoring of trends and the measuring of HIV incidence morbidity and mortality is still a challenge. SUMMARY: In the past 5 years there have been substantial improvements in the quantity and quality of HIV surveillance studies especially in the countries with high prevalence. Further efforts should be made in countries that lack fully implemented surveillance systems to improve HIV incidence morbidity and mortality surveillance and to use data more effectively.

To monitor the collective national impact of initiatives to expand the availability of HIV therapy including antiretroviral treatment (ART) countries need to monitor the proportion of HIV-infected individuals who are receiving HIV therapy, whether morbidity is decreasing, and HIV-infected individuals are experiencing increased survival, and if there is an overall decrease in the number of individuals dying of HIV. However, in many resource-constrained countries these data are limited or unavailable. Morbidity surveillance relies primarily on AIDS case reporting, but severe under-reporting limits the usefulness of these data. A variety of AIDS case definitions are in use and case definitions do not concur with clinical staging definitions. Harmonizing AIDS case definitions with clinical staging, providing resources and training to improve reporting, and using other surveillance systems, such as tuberculosis programme data to monitor morbidity are urgently needed. A cohort analysis of individuals in ART programmes to follow the progress and outcomes of these patients longitudinally is important to monitor quality of care and impact. Because the rapid scale-up of ART programmes may result in HIV drug resistance, surveillance for drug resistant viruses is also required. Very few resource-constrained countries have well-functioning vital registration systems to assess mortality trends and cause-specific mortality. Alternative approaches to measuring mortality trends, such as sample vital registration with verbal autopsy should be considered. Strong commitments from governments, international organizations and other partners are needed to establish and strengthen the HIV morbidity and mortality monitoring surveillance systems.

Many studies have shown a positive association between both migration and temporary expatriation and HIV risk. This association is likely to be similar or even more pronounced for forced migrants. In general, HIV transmission in host-migrant or host-forced-migrant interactions depends on the maturity of the HIV epidemic in both the host and the migrant population, the relative seroprevalence of HIV in the host and the migrant population, the prevalence of other sexually transmitted infections (STIs) that may facilitate transmission, and the level of sexual interaction between the two communities. Complex emergencies are the major cause of mass population movement today. In complex emergencies, additional factors such as sexual interaction between forced-migrant populations and the military; sexual violence; increasing commercial sex work; psychological trauma; and disruption of preventive and curative health services may increase the risk for HIV transmission. Despite recent success in preventing HIV infection in stable populations in selected developing countries, internally displaced persons and refugees (or forced migrants) have not been systematically included in HIV surveillance systems, nor consequently in prevention activities. Standard surveillance systems that rely on functioning health services may not provide useful data in many complex emergency settings. Secondary sources can provide some information in these settings. Little attempt has been made, however, to develop innovative HIV surveillance systems in countries affected by complex emergencies. Consequently, data on the HIV epidemic in these countries are scarce and HIV prevention programs are either not implemented or interventions are not effectively targeted. Second generation surveillance methods such as cross-sectional, population-based surveys can provide rapid information on HIV, STIs, and sexual behavior. The risks for stigmatization and breaches of confidentiality must be recognized. Surveillance, however, is a key component of HIV and STI prevention services for forced migrants. It is required to define the high risk groups, target interventions, and ultimately decrease HIV and STI transmission within countries facing complex emergencies. It is also required to facilitate regional control of HIV epidemics.

STUDY DESIGN A 1-year prospective study of the influence of surveillance methods on the surgical wound infection rates in a tertiary care spinal surgery unit. OBJECTIVES To assess the effect of postdischarge surveillance, the diagnostic indications for surgery, and the type of procedure on the surgical wound infection rates. SUMMARY OF BACKGROUND DATA Use of the National Nosocomial Infection Surveillance system for surgical wound infection resulted in infection rates above the published values for procedures performed by the Spinal Surgical Service. A preliminary review failed to find causes for these higher rates, and a study was undertaken to assess the influence of the surveillance methods used. METHODS Patient information collected by the Spinal Surgical Service and surveillance data obtained by infection control were combined in a relational database. Surveillance after discharge was performed by regularly sending questionnaires to surgeons' offices. The diagnostic indications were assessed by dividing all patients into three groups: Class D (disc disease or spinal stenosis). Class T (spinal trauma within 60 days), and Class M (mostly complex spinal procedures for deformity and instability). Infection rates for the three diagnostic indication classes and for procedures with and without instrumentation were calculated. RESULTS Postdischarge surveillance significantly increased the infection rates, mostly by detecting superficial infections that did not require readmission. Significant differences were noted between Class T and Class M patients undergoing lumbar posterior segmental instrumentation, despite the fact that they had a similar incidence of risk factors according to the National Nosocomial Infection Surveillance system. The surgical wound infection rates of the National Nosocomial Infection Surveillance system may not be appropriate standards for specialized units with a high incidence of complex clinical problems and complicated surgical procedures. CONCLUSIONS Postdischarge surveillance, surgical procedure classification methods, and the indications for surgery (e.g., trauma, congenital deformity) influence the surgical wound infection rate. Current adjustments for some of these factors in the National Nosocomial Infection Surveillance system appear to be inadequate when used in a tertiary care facility.

OBJECTIVE: To evaluate laboratory-initiated CD4 reporting (LICR) for AIDS surveillance and for differences in cases found by LICR and traditional surveillance methods (i.e., health care provider or death certificate reports and medical record searches). METHODS: We compared the characteristics of persons reported with AIDS between May 1993 and April 1994 by traditional methods or by LICR reports

ContextAlthough adverse drug events have been extensively evaluated by computer-based surveillance, medical device errors have no comparable surveillance techniques.ObjectivesTo determine whether computer-based surveillance can reliably identify medical device–related hazards (no known harm to patient) and adverse medical device events (AMDEs; patient experienced harm) and to compare alternative methods of detection of device-related problems.Design, Setting, and ParticipantsThis descriptive study was conducted from January through September 2000 at a 520-bed tertiary teaching institution in the United States with experience in using computer tools to detect and prevent adverse drug events. All 20 441 regular and short-stay patients (excluding obstetric and newborn patients) were included.Main Outcome MeasuresMedical device events as detected by computer-based flags, telemetry problem checklists, International Classification of Diseases, Ninth Revision (ICD-9) discharge code (which could include AMDEs present at admission), clinical engineering work logs, and patient survey results were compared with each other and with routine voluntary incident reports to determine frequencies, proportions, positive predictive values, and incidence rates by each technique.ResultsOf the 7059 flags triggered, 552 (7.8%) indicate a device-related hazard or AMDE. The estimated 9-month incidence rates (number per 1000 admissions [95% confidence intervals]) for AMDEs were 1.6 (0.9-2.5) for incident reports, 27.7 (24.9-30.7) for computer flags, and 64.6 (60.4-69.1) for ICD-9 discharge codes. Few of these events were detected by more than 1 surveillance method, giving an overall incidence of AMDE detected by at least 1 of these methods of 83.7 per 1000 (95% confidence interval, 78.8-88.6) admissions. The positive predictive value of computer flags for detecting device-related hazards and AMDEs ranged from 0% to 38%.ConclusionsMore intensive surveillance methods yielded higher rates of medical device problems than found with traditional voluntary reporting, with little overlap between methods. Several detection methods had low efficiency in detecting AMDEs. The high rate of AMDEs suggests that AMDEs are an important patient safety issue, but additional research is necessary to identify optimal AMDE detection strategies.

Injury is a major health problem in the United States that has been viewed primarily as a disease of the young. As a result, the devastating consequences of injury on the elderly population have not been sufficiently explored. Proximal femur fractures (hip fractures), common injuries in persons over the age of 65, carry a mild Injury Severity Score but are associated with high morbidity and mortality in the older population. The author provides a rationale based on clinical and research literature for increasing injury surveillance for hip fractures in the elderly in order that injury care and control can be improved. Language: en

INTRODUCTION: Community-based surveillance methods to monitor epidemiological progress in surgery have not yet been employed for surgical capacity building. The goals of this study are twofold: to create a validated survey tool to easily measure surgical disease; and to accurately define the surgical epidemiology of a catchment population for a Partners In Health-supported district hospital in northern Rwanda.

Coronary heart disease surveillance studies require monitoring of hospitalized events. Retrospective record reviews and patient interviews during hospitalization are common surveillance methods. This study reports the agreement between these two methods in assessing medical history among 4,230 patients enrolled in the Minnesota Heart Survey Registry. Agreements between methods in determining a patient's history of stroke, myocardial infarction, and hypertension were substantial (kappa coefficients > 0.69). Agreements on acute chest pain (kappa coefficient = 0.39) and ever-smoking status (kappa coefficient = 0.43) were only moderate. In determining medical history, retrospective medical record surveillance appears to be comparable to more direct, yet more expensive, contemporaneous methods.

INTRODUCTION: Community-based surveillance methods to monitor epidemiological progress in surgery have not yet been employed for surgical capacity building. The goals of this study are twofold: to create a validated survey tool to easily measure surgical disease; and to accurately define the surgical epidemiology of a catchment population for a Partners In Health-supported district hospital in northern Rwanda.

INTRODUCTION: Community-based surveillance methods to monitor epidemiological progress in surgery have not yet been employed for surgical capacity building. The goals of this study are twofold: to create a validated survey tool to easily measure surgical disease; and to accurately define the surgical epidemiology of a catchment population for a Partners In Health-supported district hospital in northern Rwanda.