Medical Terminology Coding Systems and Medicolegal Death Investigation Data: Searching for a Standardized Method of Electronic Coding at a Statewide Medical Examiner’s Office*

Abstract: Medical examiner and coroner reports are a rich source of data for epidemiologic research. To maximize the utility of this information, medicolegal death investigation data need to be electronically coded. In order to determine the best option for coding, we evaluated four different options (Current Procedural Terminology [CPT], International Classification of Disease [ICD] coding, Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT], and an in‐house system), then conducted internal and external needs assessments to determine which system best met the needs of a centralized, statewide medical examiner’s office. Although all four systems offer distinct advantages and disadvantages, SNOMED CT is the most accurate for coding pathologic diagnoses, with ICD‐10 the best option for classifying the cause of death. For New Mexico’s Office of the Medical Investigator, the most feasible coding option is an upgrade of an in‐house coding system, followed by linkage to ICD codes for cause of death from the New Mexico Bureau of Vital Records and Health Statistics, and ideally, SNOMED classification of pathologic diagnoses.     

Women leadership in Oxford House: examining their strengths and challenges

This study examined the perspectives and definition of leadership by women and mothers with children (n = 40) affiliated with Oxford Houses, a communal mutual-help recovery setting. Participants were asked questions relating to their experiences living in an Oxford House including the strengths and challenges encountered and how leadership impacted the stability in their house. Results illustrated the value of female leadership and highlighted the characteristics deemed important for women leaders in Oxford House, as well as some differences between these women's perception of leadership and the standard definition of leadership. The implications of the findings and how they may be useful to women's and mothers' with children houses are discussed.     

Do too many cooks always spoil the stew? An experimental analysis of rent-seeking and the role of a strategic buyer

Laboratory methods are used to evaluate the effects of institutional arrangements and rent-defending activity on rent-seeking auction outcomes. In part, Nash equilibrium predictions are a useful behavioral guide: As predicted, more rents are dissipated in perfectly-discriminating auctions, where the high-bidder wins, than in lotteries, where relative bids determine the chance of winning. Also as predicted, the introduction of a rent-defending buyer reduces social costs. Nevertheless, the social costs of rent-seeking consistently exceed predicted levels. Moreover, individual bidding, especially by buyers, deviates markedly from Nash predictions.     

Diagnosis of sudden unexplained death in epilepsy by immunohistochemical staining for prolactin in cerebral vessels

Sudden unexplained death in epilepsy occurs when epilepsy patients die suddenly and unexpectedly in the absence of recent tonic-clonic seizure activity. There is currently no known reliable indicator of acutely lethal seizure activity. Clinical studies record a relationship between recent (within 10-40 minutes) seizure activity and elevated serum prolactin levels, and postictal elevation of prolactin within peripheral vessels has proved clinically useful in determining recent seizure activity. The authors hypothesized that elevated prolactin could be detected in cerebral vessels by immunohistochemical stains, serving as a marker for sudden unexplained death in epilepsy. They conducted a retrospective study of individuals who died in their jurisdiction during the 14 years from 1986 through 1999. The study contained one group of individuals who died of sudden unexplained death in epilepsy, a group with epilepsy who died of some other cause, and a control group whose members died rapidly of a gunshot wound of the torso. Sections of hippocampus and neocortex were obtained and stained with a polyclonal prolactin antibody. No significant difference in the level of immunostaining for prolactin in cerebral vessels was found between the experimental and control groups. A review of the protocols used indicates that revision of certain aspects may provide better immunostaining and more conclusive results.     

Modeling eligibility under national systems of compensation for treatment injury

How can different schemes of compensation for treatment injury be evaluated? This article offers an empirical approach to assessment based on the simulation of alternative models of eligibility using real-world data. It draws on information about adverse events generated from a representative survey of public hospital admissions in New Zealand and classifies these under a range of eligibility criteria for different possible compensation systems. These are then evaluated according to a number of policy design considerations, using variables available from the New Zealand study.