Biomedical subjects

A E Kramer

Publications and source records attributed to A E Kramer.

17 recordsLinked to original sources

PubMed2000

The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development.

In the past two decades, noteworthy advances have been made in measuring the physiologic outcomes of dysphagia, including measurement of duration of structure and bolus movements, stasis, and penetration-aspiration. However, there is a paucity of data on health outcomes from the patients' perspective, such as quality of life and patient satisfaction. A patient-based, dysphagia-specific outcomes tool is needed to enhance information on treatment variations and treatment effectiveness. We present the conceptual foundation and item generation process for the SWAL-QOL, a quality of life and quality of care outcomes tool under development for dysphagia researchers and clinicians.

Aged↗

PubMed2000

The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II. Item reduction and preliminary scaling.

The SWAL-QOL outcomes tool was constructed for use in clinical research for patients with oropharyngeal dysphagia. The SWAL-QOL was constructed a priori to enable preliminary psychometric analyses of items and scales before its final validation. This article describes data analysis from a pretest of the SWAL-QOL. We evaluated the different domains of the SWAL-QOL for respondent burden, data quality, item variability, item convergent validity, internal consistency reliability as measured by Cronbach's alpha, and range and skewness of scale scores upon aggregation and floor and ceiling effects. The item reduction techniques outlined reduced the SWAL-QOL from 185 to 93 items. The pretest of the SWAL-QOL afforded us the opportunity to select items for the ongoing validation study which optimally met our a priori psychometric criteria of high data quality, normal item distributions, and robust evidence of item convergent validity.

Aged↗

PubMed1995

CHESS classification of bladder-outflow obstruction. A consequence in the discussion of current concepts.

The present discussion on the natural history, growth rate pathophysiology, morbidity, and possible treatment of benign prostatic hyperplasia (BPH) reinforces the need to objectify mechanical BPH-induced obstruction with pressure-flow study. Different methods for the quantification of BPH-induced obstruction exist and the grade of simplification depends on their working mechanism. To review the limitations of the current concepts, 118 BPH patients were selected for computerized pressure-flow data analysis according to quadratic passive urethral resistance relation (PURR) function. The CHESS classification differs from all other concepts due to its two-dimensional character and was developed as a result of the following way of thinking: (1) the whole individual pressure-flow plot is the most accurate basis for further analysis; (2) PURR as the true low-pressure flank of the individual plot is the most favorable definition for mechanical obstruction; (3) PURR quantification requires at least two parameters, footpoint and curvature/slope, with regard to the documented missing significant correlation of both; and (4) a two-parameter-based classification is two-dimensional (CHESS classification).

Aged↗

PubMed1991

Trends in future urodynamics: computer support-data base-digitized imaging.

The use of computers in urodynamics must be based preferably on the structure of the urodynamic investigation itself. This enables implementation of computerized systems in the urodynamic laboratory in the most natural way and provides transparency of urodynamic software for the investigators. Additionally, the algorithms of the urodynamic software then can provide for a urodynamic investigation following a logical path based on the patient's history and clinical data and (automatically interpreted) results from earlier steps in the urodynamics. As an extension of this structured logical reasoning, the computer use in urodynamics can be extended to include validation and decision rules, comprising measurement data and rules for interpretation and combination of history, clinical and measurement data. Conclusions will be presented then in the form of a preliminary differential diagnosis, including the odds for each of the possible diagnoses. These kinds of computerized interpretation systems will be validated by comparison with the classical clinical diagnoses and are generally known as expert systems. These systems rely on logical branching-as opposed to systems that are statistical in nature and use large data bases to classify individual data into known groups. Data bases will remain for the purpose of documentation, based on individual patients and comprising all patient data-comparable to the existing patient files in the hospital's archives. The computer files have to include also the original data from functional studies like urodynamics-and not just the abstracted conclusions-and from imaging techniques. Intelligent compression of data prevents the data bases from exploding. Digital imaging techniques combined with computerized urodynamic investigations open possibilities for dynamic analysis of morphologic data and combination thereof with urodynamic measurement data.

Databases, Factual↗

PubMed1991

Entering data into expert system for lower urinary tract pressure-flow studies.

This paper describes methods of entering data into an expert system used to study lower urinary tract pressure and flow. Data is usually entered into an expert system directly from the keyboard or on an online basis. We have developed a new method of offline data entry using a photoscanner. For this method, we developed versatile software to convert the graphic data read by a photoscanner to online data format. This software allows us to handle graphic data printed on paper in the same way as online data. The software is also designed to solve the problems caused by blurred lines or ink spots on printed charts. In other words, the software compensates for data reading errors caused by blurred or stained lines on printed charts. Because data can be entered through the photoscanner, the enormous volume of data already recorded in graphic forms can be used by the expert system. As a result, the diagnostic capability of the expert system is significantly improved.

Diagnosis, Computer-Assisted↗

PubMed1989

Recurrence of superficial bladder carcinoma after intravesical instillation of mitomycin-C. Comparison of exposure times.

A total of 70 patients were treated with intravesical instillations of Mitomycin-C (MMC) following transurethral resection for superficial bladder carcinoma. In this randomised prospective study the influence of 2 exposure times (0.5 and 1 h) was studied in relation to tumour recurrence, recurrence interval, tumour progression and toxicity. The number of patients with recurrent tumours was significantly lower in the 1-h group. Tumour progression was seen in only 2 patients in each group and all had primary or secondary carcinoma in situ of the bladder or prostatic urethra. Fourteen patients were excluded from further evaluation because of side effects. A longer instillation time over a longer period and a lower dose of MMC are recommended.

Administration, Intravesical↗

PubMed1988