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for the shortlisted countries, asthma ervs were calculated by combining asthma ervs with the number of total ervs, and asthma ervs per 100,000 persons with asthma were calculated by dividing the combination of asthma ervs and the total number of ervs by the population with asthma in the year. asthma hospital admissions were calculated similarly, combining asthma hospital admissions with the number of total hospital admissions, and asthma hospital admissions per 100,000 persons with asthma were calculated by dividing the combination of asthma hospital admissions and the total number of hospital admissions by the population with asthma in the year.
the years for which asthma-related data were available varied by country.

introduction: the berlin definition of ards is a consensus document detailing a standardized nomenclature and a set of consensus criteria for the diagnosis of ards, in addition to protective mechanical ventilation and prone positioning for ards. developed in 2014 in berlin, it can be considered as a milestone in the history of ards, because it represents an important step forward in disease recognition and classification. after a long period of more than 3 decades of basic and clinical investigation and after several previous definitions, the berlin criteria have represented the first worldwide accepted definition of ards. however, despite that it is the reference definition of ards, the berlin definition has two important weaknesses: the lack of an international classification of ards severity and the absence of severity assessment. furthermore, the berlin definition does not incorporate specific parameters for diagnosis of ards, such as risk of exposure to a certain pollutant, comorbidities, ventilator management, or prone position.




the berlin definition has been critically revised in 2019, with improvements in the methods of recognition, classification, and severity of ards, as well as the current proposal of a better tool to characterize these diseases. this new revised berlin definition of ards has been written with new tools in the clinical tools field (i.e. the acute lung injury network registry, the acute respiratory distress syndrome mortality probability calculator, and the acute respiratory distress syndrome network flowchart), improving the way physicians recognize the disease, as well as focusing on identifying individualized risk factors and a systematic intervention of patients. a new icd-10-segment includes ards with a related pulmonary edema, with a revised icd-10 code, without any revision of the original icd-10-code. the definition of severe ards is re-evaluated, and is characterized by the need of ventilator settings higher than a peep of 8 cmh2o, resulting in a more accurate identification of severe ards. in this chapter, we present the previous berlin definition and the recent revision, its limitations and advantages, together with the new icd-10-segment and classification tools that should be taken into consideration by the clinicians, researchers and data collectors. introduction: having a clear and agreed upon definition is a prerequisite for advancing knowledge in a specific field, such as epidemiology. for nearly 30 years the international literature has discussed the definition of ards; however, a clear definition has not been reached. in 2014, in the landmark concept paper, the berlin definition of ards was published. the major weakness of this definition is that the severity of ards (the overall disease burden) is not directly included, thus it fails to account for severity that is necessary to predict the ultimate outcome. another issue is that the berlin definition does not provide a unique tool to classify ards, instead it includes a lung-specific marker and a global disease-specific marker. furthermore, the berlin definition was agreed upon by an expert group, which included important clinicians and epidemiologists, and its validation against real medical records showed excellent specificity and sensitivity. this led to the so-called berlin criteria, which were then adapted to a revised version published in 2019. although this updated definition is much more robust and scientifically correct than the previous one, it still presents some limitations and challenges in epidemiological studies for which the berlin definition was intended. a more useful diagnostic test to define ards should be such as incidence, sensitivity, specificity, and positive and negative predictive values. 5ec8ef588b


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