Biomedical subjects

C Waternaux

Publications and source records attributed to C Waternaux.

47 records · Page 3Linked to original sources

PubMed1984

Objective, quantitative measurement of severity of illness in critically ill patients.

Severity of illness must be quantitated in critically ill patients if studies of outcome and therapeutic efficacy are to be meaningful. Objective physiologic indicators of critical illness, such as pertinent laboratory values, can be quantitated using the Therapeutic Intervention Scoring System--TISS. TISS data were obtained for 199 consecutive Class IV critically ill surgical ICU patients and compared to the same data obtained in less critically ill Class II and III ICU patients who served as the control group. For the physiologic indicators of critical illness, a wide range of normal values was established prospectively. The actual values generated by Class IV patients were compared to values of the same indicators as measured in Class II and III ICU patients. Of all objective indicators of critical illness, 55% were either outside the normal range or more than 2 SD away from the mean value of objective indicators for Class II and III ICU patients; 49% were beyond the normal range or more than 3 SD away. Of all TISS indicators, 73% were abnormal, and 36% of all physiologic indicators were still abnormal despite massive therapeutic support when compared to Class II or III ICU patients. Those patients who had more than 40% of their physiologic indicators abnormal were more likely to die. However, the percentage of abnormal TISS indicators did not discriminate between patients who died and those who lived, because almost all patients received massive support.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗

PubMed1984

Open trial of S-adenosylmethionine for treatment of depression.

Nine depressed inpatients completed trials with S-adenosylmethionine. Seven showed improvement or remission of their symptoms. As in European studies, no side effects were seen except the apparent induction of mania in two patients with bipolar disorder.

Adult↗

PubMed1983

Graphical displays of growth data.

An informative and visually pleasing way of displaying growth information on groups of children is presented. The technique allows for simultaneous comparisons of subgroups of children from a particular survey or study with international growth standards and with other subgroups within the study or the survey. The technique consists of showing, in the form of a boxplot, the median, 5th, 25th, 75th, and 95th percentiles of the distribution of growth parameters. These are characteristics little affected by extreme or deviant values. The plots also show the upper and lower extremes and the mean value of the distribution. Boxplots representing age-specific distributions may be shown on a single graph using the abscissa labeled as the "age" axis. Anthropometric indices for different groups of children may then be compared with one another for specific age intervals and over time. This graphical method also enables establishing local anthropometric norms without the considerable expense and difficulty of generating local growth standards.

Child, Preschool↗

PubMed1982

Thrombogenicity of heparin- and non-heparin-coated catheters: clinical trail.

Catheters used in clinical cerebral angiography were examined by scanning electron microscopy for buildup of thrombus. In 21 (67%) of 31 individuals studied with non-heparin-coated catheters, either cell aggregations or thrombi developed compared with seven (28%) of 25 individuals studied with heparin-coated catheters. The median size of the cell aggregations and thrombi on non-heparin- and heparin-coated catheters was significantly different (p less than 0.01). The slopes that estimated the probable rate of thrombus formation were also significantly different (p less than 0.01). This suggests the desirability of replacement of non-heparin-coated catheters if the angiographic procedure is extended.

Adult↗

PubMed1981

Prognostic importance of anginal symptoms in angiographically defined coronary artery disease.

To evaluate the prognostic importance of anginal symptoms, 44 patients with angiographically defined coronary artery disease and no anginal symptoms at time of cardiac catheterization were selected from the Duke Harvard Collaborative Data Bank. They were "matched" with 127 symptomatic patients in the Data Bank who had similar coronary anatomy and ventricular function. Follow-up data indicated that the patients without anginal symptoms had a significantly better prognosis over a 7 year period than did those with symptoms: Annual mortality in the asymptomatic group was 2.7 percent compared with 5.4 percent in the group with angina (P 0.05). Although the patient population was a highly selective one and the matching categories were relatively broad, these results suggest that the presence of anginal symptoms may be an important independent correlate of prognosis in patients with coronary artery disease. The absence of angina did not preclude the presence of multivessel disease and did not necessarily imply a benign prognosis, because the yearly mortality rate was nearly 5 percent in the subgroup of asymptomatic patients with three vessel disease.

Angina Pectoris↗

PubMed1981

Impact of a cardiology data bank on physicians' prognostic estimates. Evidence that cardiology fellows change their estimates to become as accurate as the faculty.

To determine whether physicians would be influenced by the prognostic information in a large coronary artery disease data bank, cardiology faculty and fellows made initial estimates of the prognoses of their patients and then made revised final estimates after seeing the outcome of matched patients (OMP) from the data bank. The faculty cardiologists' original estimates proved to be as accurate as those of the data bank's OMP, and the faculty revised their estimates minimally in response to the data bank's OMP. Conversely, the cardiology fellows' original estimates were less accurate than the data bank's OMP, and under all observed circumstances the fellows responded more to the data bank's OMP than did the faculty. As a result, the accuracy of the fellows' final estimates was similar to the accuracies of both the faculty cardiologists and the data bank's OMP. Computerized data banks seem more likely to have impact when their information is provided to physicians who are relatively inexperienced with the disease in question.

Cardiology↗

PubMedDate not supplied

Modelling the decline pattern in functional measures from a prevalent cohort study.

In studying decline among cognitively impaired people, a prevalent cohort study design is commonly used to account for entry into the study at different levels of impairment. The data set typically consists of many short series of repeated measurements collected over time. However, the time origin, such as time of disease/impairment onset, is often uncertain. In order to model non-linear decline patterns in functional test scores and associated risk factors with such data, we propose two approaches as alternatives to Liu et al. One approach models change over adjacent visits with varying time intervals. The second models the change since baseline using a random effect for heterogeneity of change. We used these two approaches to examine the decline in cognitive test scores among special care unit (SCU) and non-SCU residents at the New York sites of the National Institute on Aging (NIA) collaborative studies of special dementia care. The analyses suggest that, controlling for several covariates, SCU residents experienced more rapid cognitive decline than did non-SCU residents. The relative advantages and disadvantages of the two models are discussed.

Aged↗

PubMedDate not supplied

Low-level lead exposure, social class, and infant development.

A prospective cohort study was conducted to assess the association between early development and low-level prenatal and postnatal lead exposure. Infants' performance between 6 and 24 months on the Mental Development Index of the Bayley Scales of Infant Development declined with increasing concentration of lead in blood, but the decline varied with children's age at exposure, level of exposure, and socioeconomic status. Within the second year of life, the performance of children in lower socioeconomic strata was adversely affected at lower levels of prenatal exposure (blood lead levels of 6 to 7 micrograms/dl) than was the performance of children in higher socioeconomic strata. However, even the performance of these advantaged infants was lower when cord blood lead level exceeded 10 micrograms/dl, well below the figure currently regarded as the maximum permissable level for young children. Exploratory analyses suggested that early postnatal blood lead levels between 10 and 25 micrograms/dl were also associated with lower Mental Development Index scores, but only among children in lower socioeconomic strata.

Aging↗

PubMedDate not supplied

The Yugoslavia Prospective Lead Study: contributions of prenatal and postnatal lead exposure to early intelligence.

To investigate associations between the timing of lead (Pb) exposure on early intelligence, we examined the results of psychometric evaluations at ages 3, 4, 5, and 7 years, from 442 children whose mothers were recruited during pregnancy from a smelter town and a non-lead-exposed town in Yugoslavia. We compared the relative contribution of prenatal blood lead (BPb) with that of relative increases in BPb in either the early (0-2 years) or the later (from 2 years on) postnatal period to child intelligence measured longitudinally at ages 3 and 4 (McCarthy GCI), 5 (Wechsler Preschool and Primary Scale of Intelligence-Revised, WPPSI-R IQ), and 7 (Wechsler Intelligence Scale for Children-version III, WISC-III IQ), controlling for: Home Observation for Measurement of the Environment (HOME) quality; maternal age, intelligence, education, and ethnicity; and birthweight and gender. Elevations in both prenatal and postnatal BPb were associated with small decrements in young children's intelligence.

Analysis of Variance↗

PubMedDate not supplied

Low-level lead exposure and infant development in the first year.

The developmental impact of prenatal and early postnatal low-level lead exposure was assessed in a prospective study of 249 middle and upper-middle class infants with umbilical cord blood lead levels in the range currently considered "normal." Infants were classified into three exposure groups: "low" (less than 3 micrograms/dl), "mid" (6 to 7 micrograms/dl), and "high" (greater than or equal to 10 micrograms/dl). At 6 and 12 months, the lead concentration of capillary blood was measured, and the Bayley Scales of Infant Development administered. At both ages, Mental Development Index scores, adjusted for confounding, were inversely related to infants' umbilical cord blood lead levels. The difference between the mean adjusted scores of the infants in the low and high cord blood lead groups was 5.8 points at 6 months and 7.3 points at 12 months. At neither age were scores significantly related to postnatal blood lead levels. Prenatal exposure to lead levels relatively common among urban populations appear to be associated with less favorable development through the first year of life.

Age Factors↗

PubMedDate not supplied

Early sensory-motor development and prenatal exposure to lead.

As part of a longitudinal study of the early developmental effects of exposure to lead, we administered the Bayley Scales of Infant Development at age 6 months to infants classified into three groups based on their umbilical cord blood lead levels ("low": mean = 1.8 micrograms/dl; "mid": mean = 6.5 micrograms/dl; "high": mean = 14.6 micrograms/dl). No infant had a cord blood lead level greater than 30 micrograms/dl, the level currently regarded as the upper limit of "normal" for young children. Multiple regression analyses indicated that high cord blood levels were associated with lower covariance-adjusted scores on the Mental Development Index. Scores on the Psychomotor Development Index were not significantly related to cord blood lead level. The level of lead in blood at 6 months of age was not associated with scores on either the Mental or Psychomotor Development Index. These data are compatible with the hypothesis that low levels of lead delivered transplacentally are toxic to infants.

Child Development↗