Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “APACHE”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 271 records · Page 15Linked to original sources
PubMed1996

Post-high school employment: a follow-up of Apache Native American youth.

The purpose of this study was to assess the post-high school employment status of Apache Native American youth. In 1992, face-to-face interviews were conducted with 106 former high school students who exited from Alchesay High School between 1988 and 1992. Fourteen students who received special education services and 19 who received general education were employed. The remaining 38 special education students and 35 general education students expressed various reasons for their unemployment. The unemployed Apache youth stated that their lives would be better off if they had suitable employment. Results are discussed in light of their cultural implications for employment and the transition mandates of the Individuals with Disabilities Education Act.

Adolescent↗
PubMed1992

Time-dependent error in the APACHE II scoring system.

Using the APACHE II scoring system, the risk of death was calculated for 189 patients in the Wanganui Intensive Care Unit and 194 patients in the Harare Intensive Care Unit. Using tables of actual and predicted outcome, the predictive power of the system was compared in patients grouped according to the length of time that they spent in the ICU. The predictive error increased from 15% in those patients staying less than six days, to 38% in those staying six days or more (P less than 0.01). The predictive accuracy of the APACHE II system appeared to decrease with the length of time the patient stayed in the Intensive Care Unit.

Adult↗
PubMed1982

Decreasing incidence of disseminated coccidioidomycosis among Piman and San Carlos Apache Indians. A probable environmental basis.

Among Piman and San Carlos Apache Indians, the rates of disseminated disease and death from coccidioidomycosis have declined 67 percent (p less than 0.001) and 71 percent (p less than 0.01), respectively, between the first and second half of a 22-year observation period (1959-1980), despite a lack of significant change in the rate of primary infection (as determined by the coccidioidin skin test) between the two 11-year periods. The two tribal groups studied comprised 76 percent of the Indian population in the endemic area. More than 90 percent of Pimans and San Carlos Apaches have full Indian heritage, and almost all of them have been lifelong inhabitants of the endemic region. There is no evidence that genetic factors are responsible for the Indians' decrease in mortality and mortality from disseminated coccidioidomycosis. Improvements in housing and working conditions appear to have lessened the exposure to dust laden with C immitis, decreased the size of infecting inoculum, and, thereby, contributed to a decline in disseminated coccidiodomycosis among these native Americans, who have often been considered to have increased susceptibility to this fungal infection. Thus, the outcome of coccidioidal infection in American Indians seems to be largely determined by environmental influences. The possibility of decreasing disseminated disease rates by reducing the inhalation of arthroconidia also has important implications for other ethnic groups.

Adolescent↗
PubMed1990

APACHE II in surgical lung carcinoma patients.

Recent extensive development of thoracic surgery meets the need to treat elderly patients with a wide variety of pathophysiologic alterations, even if they require continuous medical assistance and high technologic support. Methods in providing such care are still limited by imprecision in evaluation of results; in this setting, a severity of disease classification system is essential to estimate the pretreatment risk of death of elder or chronically ill patients, the appropriate indication to surgical treatments, and the prediction of outcome. We tested hospital admission characteristics and hospital mortality on 59 consecutive high-risk patients from our Surgical Department using the APACHE II severity of disease classification system. Predicted mortality rate for the high-risk patients was 12.44 percent and total mortality ratio (actual deaths/predicted deaths) was 0.94. The APACHE II scoring system showed good correct classification rate, sensitivity, and specificity.

Carcinoma, Non-Small-Cell Lung↗
PubMed1991

APACHE III study: a summary.

This paper summarizes the APACHE III Study now being performed by the ICU Research Unit at the George Washington University Medical Center. It presents a review of the material included in a recent detailed description of the APACHE III Study and introduces new work being developed with data from Brazilian hospitals.

Brazil↗
PubMed1991

APACHE II: preliminary report on 100 intensive care unit cases in University Hospital, Kuala Lumpur.

A good overall assessment of the severity of illnesses of patients admitted to a general intensive care unit (ICU) is not without problems. The APACHE (acute physiology and chronic health evaluation) prognostic scoring system enables us to stratify acutely ill patients and compare efficiency of ICU therapy in different hospitals. This preliminary study carried out on 100 consecutive admissions to the ICU in University Hospital, Kuala Lumpur showed the spectrum of ICU admissions and the direct relationship between APACHE II score and mortality.

Acute Disease↗
PubMed1990

Audit in intensive care. The APACHE II classification of severity of disease.

The Acute Physiology and Chronic Health Evaluation System (APACHE II) was used in 451 patients admitted to the intensive care unit, Belfast City Hospital, in 1988 and 1989. Mortality in the patients studied was 15.5% which is slightly less than that predicted for patients with equal severity of disease (18.8%). Within the limitations discussed the APACHE II system has valuable potential both in terms of predictive power and as a means of audit.

Adolescent↗
PubMedDate not supplied

[Prognostic accuracy and efficacy of treatment at intensive care units evaluated by the APACHE II system].

The APACHE II system can stratify acutely ill patients on hand of simple physiological measurements. In a retrospective study, 121 patients were stratifyed in regard to the mortality rates in three groups: first one with the mortality rate of 10% second one with 47%, and the third one with 100%. Mortality rates predicted and observed were similar (40.5% and 39.7%, respectively, p greater than 0.8; 95% confidence interval 31.8% to 49.7%). The APACHE II system is useful for accurate stratification of patients and the evaluation of treatment efficacy.

Brazil↗
PubMed1994

Changes in skeletal muscle pO2 after administration of anti-TNF alpha-antibody in patients with severe sepsis: comparison to interleukin-6 serum levels, APACHE II, and Elebute scores.

In 20 patients with severe sepsis, skeletal muscle pO2 was continuously measured in order to assess whether a decrease of skeletal muscle pO2 was accompanied by an improvement of sepsis after repeated administration of F(ab')2 fragments of a murine anti-TNF alpha-antibody. Abnormally high skeletal muscle pO2 decreased from 43.5 +/- 10.9 mmHg (day 0) to 36.4 +/- 10.1 mmHg within 24 h after the first administration of anti-TNF alpha-antibody (day 1, p = .006, n = 20) and remained at 34.6 +/- 7.7 mmHg thereafter (mean day 2-7, p = .004). The decrease of skeletal muscle pO2 within 24 h exceeded 5 mmHg (-7 to -19 mmHg) in 11 patients in contrast to nine patients (-4 to +4 mmHg). Only in the patients showing a decrease of skeletal muscle pO2 did sepsis improve as determined by Elebute score, APACHE II score, and interleukin-6 serum levels. The change of skeletal muscle pO2 within 24 h was associated with a change of interleukin-6 serum levels within 24 h (r = .5, n = 20), with a change of Elebute score (r = .7, n = 20) and of APACHE II score (r = .62). These data suggest that a decrease of skeletal muscle pO2 might be an early indicator of improvement of sepsis after administration of anti-TNF alpha-antibodies.

Adult↗
PubMed1994

[Failure of prediction of results with APACHE II. Analysis of prediction errors of mortality in critical patients].

BACKGROUND: The evaluation of the prognosis of critically ill patients by the APACHE II method is common in intensive care units (ICU). The aim of the present was to analyze the possible factors associated to errors in prediction. METHODS: A prospective study of 564 consecutive admissions in a department of intensive medical care was carried out. Prediction errors were studied by the calculation of the probability of death established after the first 24 hours of admission by means of APACHE II. The factors analyzed in relation to the prediction errors were: the diagnosis or cause of admission to the ICU, the length of the stay in the ICU, the time until possible death, the possible relation of the death with the cause of admission and the treatment given to the patients during the first 24 hours. Statistical analysis was performed with the SPSS software package with significance being determined at p < 0.05. RESULTS: Mortality was of 20.6% (116 cases) with three cut off points being chosen for probability of death (50, 70, and 90%). Accuracy of precision was 83.5%, 82.8% and 80.1%. There were 64 false survivors (mortality lower than 50%, 13.25%-64/483) and 29 false deaths (survival greater than 50%, 35.8%-29/81). Upon analysis of the cause of admission of these patients in whom there were prediction errors it was found that there were no differences among the false survivors and the false deaths. Significant differences were only detected upon comparison of the false survivors with the verified survivors, however these disappeared when the 136 cases admitted due to myocardial infarction were excluded. Neither did the length of stay in the ICU demonstrate any significant difference except among the verified and false deaths in that the stay was longer in the latter. CONCLUSIONS: The factors analyzed did not demonstrate that they may influence or be associated with errors in prediction of the prognosis of patients admitted to an intensive care unit, with these errors probably being due to errors in the system used.

Adolescent↗
PubMed1997

Ketoacidosis in Apache Indians with non-insulin-dependent diabetes mellitus.

BACKGROUND: Although more classically associated with insulin-dependent diabetes mellitus, diabetic ketoacidosis (DKA) can occur in some patients with non-insulin-dependent diabetes mellitus (NIDDM). To better define the clinical features that may be associated with ketoacidosis in patients with NIDDM, we reviewed the medical histories of Apache Indians with NIDDM who had been treated for an episode of DKA. METHODS: Cases of ketoacidosis among patients with NIDDM were identified at 2 separate Apache Indian reservations. Chart data were used to confirm and characterize the diagnosis of NIDDM, the metabolic disturbances associated with DKA, and the historical features of the patients. RESULTS: Among 724 patients with NIDDM, 17 patients experiencing at least 1 episode of DKA were identified. The mean (+/-SD) age at the time of the episode was 40.8 +/- 13.9 years. The patients were predominantly male (15[88%]), with a mean (+/-SD) body mass index (calculated as the weight in kilograms divided by the square of the height in meters) of 24.9 +/- 4.4 kg/m2. Causes of DKA included infections (8[47%]) and omission of treatment (3/15[20%]). Concurrent abuse of alcohol was noted in 4 (27%) of the patients. In addition, a lifetime history of alcohol abuse was noted in 15 (94%) of 16 patients. CONCLUSIONS: This report confirms the growing recognition that DKA occurs in some patients with NIDDM. The present study also adds male sex, alcohol abuse, and relatively low body mass index as clinical factors that may play a role in the development of DKA in this setting.

Adult↗
PubMed2005

The influence of missing components of the Acute Physiology Score of APACHE III on the measurement of ICU performance.

OBJECTIVE: To determine the impact of missing Acute Physiology Score (APS) values on risk-adjusted mortality. DESIGN: Retrospective review of prospectively collected Acute Physiology and Chronic Health Evaluation (APACHE) III database. SETTING: The intensive care units (ICUs) of an academic medical center. PATIENTS: 38,411 patients admitted to ICU between October 1994 and December 2003. MEASUREMENTS AND RESULTS: Data were collected on ICU type, missing first ICU day APS values, predicted and observed hospital mortality, standardized mortality ratio (SMR), 95% confidence interval (CI), odds ratio (OR). The overall observed and predicted hospital mortality rates were 8.7% and 10.8%, respectively, with SMR of 0.806 (95% CI 0.779-0.834). Complete data were available in 829 (2.2%). Vital signs were missing in almost none and serum albumin and bilirubin in over 80% of the patients. The number of missing variables was higher in less sick and surgical ICU patients. Logistic regression analysis showed that the risk of dying in the hospital was significantly associated with the number of missing APS variables (OR 1.058, 95% CI 1.027-1.090) when adjusted for the severity of illness. The risk of death was also associated with the type of missing variables. CONCLUSIONS: Since missing APS values may lead to underestimation of the predicted mortality rates, the number and type of missing variables should be taken into consideration when assessing the performance of an ICU. Unless data collection is standardized, future prognostic models should use variables that are routinely measured in most critically ill patients without sacrificing statistical precision.

APACHE↗
PubMed2001

Risk factors for prolonged ventilation after cardiac surgery using APACHE II, SAPS II, and TISS: comparison of three different models.

OBJECTIVE: To identify the risk for prolonged mechanical ventilation in cardiac surgical patients. DESIGN: Prospective study with retrospective combination of a second database. PATIENTS: Six hundred and eighty-seven patients after cardiac surgery over a period of 12 months. MEASUREMENTS: Demographic data were recorded preoperatively, and surgical procedures intraoperatively using a surgical database designed for quality control. Length of ICU and hospital stay, and hospital outcome were recorded. Severity of illness was assessed daily using APACHE II, SAPS II, and Organ Failure Score. Intensity of treatment and nursing care was monitored by means of the Therapeutic Intervention Scoring System (TISS). Univariate and multivariate analyses were performed using logistic regression. The predictive value of the identified variables was tested by the Wilcoxon test using the receiver operating characteristic curve. MAIN RESULTS: Sixty-two patients (9.0%) were ventilated for > 48 h and accounted for 42.8% of the total costs in the ICU. The pre- and intraoperatively collected data produced a model with weak predictive capacity for prolonged ventilation [area under curve (AUC) 73.22 and 71.08, respectively]. The use of TISS and SAPS postoperatively resulted in an effective model of prediction (AUC 93.76). Adding the occurrence of reoperation, reintubation, emergency transfusion, intraaortic balloon pumping, and need for total parenteral nutrition to the model further improved its predictive capacity (AUC 94.74). CONCLUSIONS: The present results strongly suggest that data collected postoperatively using established scoring systems as well as documented events of high clinical impact for risk assessment and quality control are reliable predictors of prolonged ventilation.

APACHE↗
PubMed1985

Otitis media at Canyon Day, Ariz. A 16-year follow-up in Apache Indians.

A 16-year follow-up survey of native Americans living in Canyon Day, Ariz, did not show improvement in the 9.3% rate of clinically significant otitis media. However, the manifestations were more benign, especially in children, and included the spectrum of otitis media. A genetically determined eustachian tube difference may explain the high rate of occurrence of otitis media in these Apache Indians. Improvements in living conditions and health care may explain the change to less severe manifestations.

Adolescent↗
PubMed1985

Otitis media and language performance in a cohort of Apache Indian children.

Language performance was evaluated in 167 healthy Apache Indian children aged 6 to 8 years, who had contrasting histories of otitis media and who had been followed since birth. All children received pneumatic otoscopy, tympanometry, pure tone audiometry, and a battery of language measures. Groups were similar with respect to age, sex, school experience, family income, housing, primary language spoken, and nonverbal intelligence. No statistically or clinically significant differences in language performance were observed between groups of children with frequent episodes of otitis media and those from the same cohort with infrequent otitis. While frequent otitis media was associated with abnormalities on tympanometry and otoscopy, bilateral hearing loss (greater than 25 dB) was observed in only 1% of the children.

Acoustic Impedance Tests↗
PubMed1987

Lack of association of cleft uvula with otitis media in Apache Indian children.

Cleft uvula occurs in approximately 20% of Athabaskan Indians. The association of cleft uvula with otitis media was examined in a cohort of 175 Apache Indian children followed up prospectively from birth. No association was found between the occurrence of cleft uvula and the rate, frequency, or timing of otitis media attacks.

Arizona↗
PubMed1992

Trends in anthropometric measurements among Mescalero Apache Indian preschool children. 1968 through 1988.

OBJECTIVE: To determine if there were trends in underweight, short stature, and obesity among 1- through 5-year-old Mescalero (NM) Apache Indian children from 1968 through 1988. DESIGN: Cross-sectional review of hospital clinic charts for five cohorts. SETTING: General pediatric outpatient clinic at the Mescalero Indian Health Service Hospital. PARTICIPANTS: Sixty-nine patients aged 1 through 5 years in 1968, 1973, 1978, 1983, or 1988 for whom weight and height were recorded during a well-child visit that occurred in the respective year. SELECTION PROCEDURES: Approximately half the charts were screened for eligibility through systematic sampling for all years except 1988; for 1988 all available charts were screened for eligibility for the study. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: We found trends of decreasing prevalence of both underweight (defined as weight-for-height below the fifth percentile) and short stature (defined as height-for-age below the fifth percentile) based on the Centers for Disease Control/World Health Organization growth reference. We found no secular trends in obesity (weight-for-height above the 95th percentile), although the prevalences throughout the 21-year period were as much as two to four times higher than expected when compared with the Centers for Disease Control/World Health Organization reference. There has been an upward shift in both weight-for-height and height-for-age distributions since 1968, indicating that Mescalero children today are, on average, heavier and taller. CONCLUSIONS: Underweight and short stature decreased among Mescalero preschool children from 1968 through 1988, suggesting nutritional improvements. However, given the current high prevalence of obesity, it is recommended that surveillance of nutritional status be continued and appropriate interventions be developed to treat and prevent obesity in this population.

Anthropometry↗
PubMed1987

Familial predisposition for otitis media in Apache Indians at Canyon Day, Arizona.

The familial occurrence of otitis media was studied in White Mountain Apache Indians at Canyon Day, Arizona. Of the 760 residents, 366 persons were seen during a village survey for otitis media. There were 133 first-degree relatives involving 113 first-degree relative pairs. Of these, there were 38 children involving 19 separate sibling pairs, for whom age- and sex-matched controls could be assigned. Tympanic membrane scarring was assumed to be a marker of prior otitis media. The findings suggested (P less than .01 for the nonindependent first-degree relative pairs, and P less than .05 for the independent sibling pairs) a familial predisposition. With the additional assumption that the severity of tympanic membrane scarring can be ranked, no association of severity of otitis media was apparent in the first-degree relatives.

Arizona↗