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PubMed1991

A basic program for calculation of APACHE II and Elebute scores and sepsis evaluation in intensive care medicine.

This paper describes a program for bedside-practicable calculation of APACHE II score, providing an additional option for both a rapid and sensitive screening as well as for a more specific sepsis assessment by the Elebute score in case of a putative diagnosis of sepsis. Thus, diagnostic and prognostic evaluation of septic patients and the assessment of disease progression and classification of "responders" to therapy can be promptly available in the ICU setting. The program is written in BASIC and therefore can easily be adapted to most microcomputers available on the market.

Bacterial Infections↗
PubMed1975

Enterotoxigenic Escherichia-coli-associated diarrheal disease in Apache children.

A search for intestinal enterotoxigenic Escherichia coli was made in 59 Apache children hospitalized with 64 episodes of acute diarrhea. Esch. coli isolates from acute-phase and convalescent-phase specimens of small-bowel fluid and stool were tested in three currently recognized models: the adult-rabbit ileal loop; infant rabbit; and the adrenal-cell assay. Enterotoxigenic strains were isolated from 10 children during acute diarrheal episodes (16 per cent); none were isolated from convalescent-phase specimens. None of 64 "enteropathogenic" serotypes of Esch. coli from 43 children with diarrhea, however, caused fluid production in the ileal-loop model. These results suggest that enterotoxigenic Esch. coli may be the cause of considerable diarrhea in this population and that the term "enteropathogenic" as applied to serotypes of Esch. coli needs to be redefined.

Acute Disease↗
PubMed2000

Immunogenicity of a heptavalent pneumococcal conjugate vaccine in Apache and Navajo Indian, Alaska native, and non-native American children aged <2 years.

High rates of invasive pneumococcal disease have been described among infants living in various Native American communities. In this study, we evaluated the immunogenicity of a 7-valent pneumococcal vaccine consisting of serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F covalently linked to the outer membrane protein complex of Neisseria meningitidis in Apache and Navajo Indian, Alaska Native, and non-Native American children. The vaccine was administered at ages 2, 4, and 6 months; a booster dose was given at age 15 months. Levels of serotype-specific immunoglobulin G (IgG) were measured by a standardized enzyme-linked immunosorbent assay. The responses after 3 primary doses of vaccine were similar in all 3 groups of children, except for those to serotypes 14 and 23F. One month after the booster dose, geometric mean concentrations (GMCs) of serotype-specific IgG antibodies increased significantly in all 3 groups of children, compared with GMCs of IgG antibodies to pneumococcal serotypes before the booster dose.

Antibodies, Bacterial↗
PubMed2005

Epidemiology of invasive Haemophilus influenzae type A disease among Navajo and White Mountain Apache children, 1988-2003.

BACKGROUND: Before the introduction of Haemophilus influenzae type b (Hib) conjugate vaccines, rates of H. influenzae disease among Navajo and White Mountain Apache (WMA) children were among the highest reported worldwide. Routine Hib vaccination has significantly reduced rates of Hib disease in these populations. As Hib disease rates decrease to very low levels, there are concerns that non-type b strains of H. influenzae may emerge as more prevalent causes of invasive disease in children. METHODS: We reviewed population-based, active laboratory surveillance data from the period of 1988-2003 for invasive H. influenzae type a (Hia) disease among Navajo and WMA children aged <5 years. Clinical information on cases was collected by chart review. A sample of Hia isolates from Navajo children was typed by pulsed-field gel electrophoresis (PFGE). RESULTS: During 1988-2003, a total of 76 reported cases of invasive Hia disease occurred among Navajo and WMA children. The overall annual incidence was 20.2 cases per 100,000 population aged <5 years. There was no increase in Hia disease rates after Hib vaccination was introduced. The median age of patients was 12 months. Meningitis (50% of cases) was the most common presentation, followed by pneumonia (27.6%). Two children with Hia disease died. PFGE analysis revealed a limited genetic diversity of Hia strains in this population. CONCLUSIONS: Active surveillance data showed high rates of invasive Hia disease among Navajo and WMA children but no increase in the incidence after Hib vaccination was introduced. The presentation of Hia disease is similar to that of Hib disease in the prevaccine era.

Arizona↗
PubMed1989

Open management of the septic abdomen: therapeutic and prognostic considerations based on APACHE II.

We analyzed the results of open treatment in 30 patients with abdominal sepsis (11 patients after trauma [group 1], five patients with pancreatic abscess [group 2], and 14 patients with acute GI pathology [group 3]) uncontrolled by conventional methods as evidenced by continuing fever with leukocytosis and worsening organ functions. APACHE scores at the time of initial laparotomy and at the time of open management, respectively, were: group 1, 19.8 and 16.6; group 2, 8.4 and 12.4; and group 3, 14.2 and 15.0. Twenty-seven patients had multiple system failure. Sixteen (53%) of the 30 patients survived, 73% in group 1, 60% in group 2, and 36% in group 3. Survival correlated well with age less than 50 yr and the absence of multiple organ failure. The technique was easily performed and many of the pitfalls previously reported were not observed. In patients requiring fascial prosthesis, the absorbable polyglycol acid (Dexon) mesh was found to be superior to the nonabsorbable polypropylene. We conclude that the open technique is feasible, effective, and worthy of consideration in patients with extensive wound necrosis and uncontrolled abdominal sepsis.

Abdomen↗
PubMed1993

The use of indirect calorimetry in critically ill patients--the relationship of measured energy expenditure to Injury Severity Score, Septic Severity Score, and APACHE II Score.

The nutritional needs of critically ill septic patients or patients with multiple injuries are often difficult to estimate. Indirect calorimetry can simply and accurately determine individual caloric and nutritional needs, especially in cases of critically ill patients with complicated injuries. This prospective study compared the measured energy expenditures of 30 patients using indirect calorimetry with their predicted basal energy expenditure according to the Harris-Benedict equation, or their calculated energy expenditure derived from basal energy expenditure times, an activity factor, and a stress factor. These numbers were then used to evaluate the relationship between measured energy expenditure, measured energy expenditure per kilogram, and four specific scoring systems--the Septic Severity Score (SSS), the Injury Severity Score (ISS), the Trauma Score (TS), and APACHE II. The results showed the severity of sepsis or trauma correlated with the measured energy expenditure per kilogram of body weight. Among the 15 septic patients, in whom the measured energy expenditure per kilogram was 42.2 +/- 2.6 kcal/kg, the SSS provided a better predictor of energy needs and closer correlation with measured energy expenditure per kilogram (r = 0.69, Y = 1.41 + 0.72 X). Their stress factors could be modified as "0.97 + 0.0125 x SSS" to get a more accurate Harris-Benedict calculation. For the 15 patients with multiple injuries in whom the measured energy expenditure per kilogram was 34.9 +/- 1.6 kcal/kg, the ISS offered the best correlation with measured energy expenditure per kilogram (r = 0.84, Y = -31.47 +/- 1.73 X). Their stress factors could be modified as "1.04 + 0.0077 x ISS" to get a more accurate Harris-Benedict calculation.

Adult↗
PubMedDate not supplied

Haemophilus influenzae disease in the White Mountain Apaches: molecular epidemiology of a high risk population.

Based on a 10-year retrospective and a 15-month prospective analysis, White Mountain Apache Indian children younger than 5 years were found to have an annual incidence of Haemophilus influenzae meningitis of 254 cases/100,000--an 8-fold higher incidence than that seen in the general United States population. In our prospective surveillance, H. influenzae isolates from cases of systemic disease were further characterized by capsular type, biotype and by outer membrane protein (OMP) and lipopolysaccharide (LPS) patterns on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Unexpectedly, H. influenzae type a strains were isolated in 3/18 cases of systemic disease. All other disease-producing strains were type b. H. influenzae b strains possessing common OMP, LPS, capsular and biotype characteristics were isolated from individuals in geographically distinct communities within the reservation. These apparently identical strains were isolated from different individuals who had systemic infections that occurred months apart (longest interval, 14 months). Both OMP and LPS subtyping were necessary to discriminate among invasive H. influenzae isolates.

Age Factors↗
PubMedDate not supplied

Southwestern Athabaskan (Navajo and Apache) genetic diseases.

PURPOSE: Four apparently unique disorders are known among the Southwestern Athabasan Amerindians, i.e., the Navajo and Apache; they are Athabaskan severe combined immunodeficiency, Navajo neuropathy, Navajo poikiloderma, and Athabaskan brainstem dysgenesis. This study reviews background information on Athabaskan groups and clinical descriptions of these recessive disorders. METHODS: The major clinical findings of these four disorders are reviewed. In addition, the findings of epidemiological surveys are included where available. RESULTS: Although the importance of genetic bottlenecks in increasing the frequency of rare, sometimes unique, autosomal recessive disorders is known for a number of populations, similar phenomena among Native Americans seem to be less well known. CONCLUSION: As many more Native Americans move off the Reservation, the awareness of susceptibility to particular genetic diseases needs to be more widely disseminated.

Brain Stem↗
PubMed1982

Seroepidemiology of heat-labile enterotoxigenic Escherichia coli and Norwalk virus infections in Panamanians, Canal Zone residents, Apache Indians, and United States Peace Corps volunteers.

Serum antibody titrations against the heat-labile enterotoxin (LT) of Escherichia coli were carried out on Panamanians, U.S. citizens resident in the Panama Canal Zone, Apache Indians living on the reservation in Whiteriver, Arizona, and Peace Corps volunteers before they traveled overseas. Antibody titers to Norwalk virus were also carried out on serum from Panamanian and Canal Zone residents. A high prevalence of low-titer LT antibodies was found in infants and adults from Panama, the Canal Zone, and Whiteriver. Panamanian children aged 1 to 5 years had the highest LT antibody titers. Peace Corps volunteers had a low prevalence and titer of LT antibodies. Prevalence and titer of antibodies to Norwalk virus were generally higher in Panamanians compared with Canal Zone residents of the same age. In the populations we studied, various modes of transmission and mechanisms of immunity likely explain the differences which we observed in antibody prevalence and titer to these two enteric pathogens.

Adolescent↗
PubMed1993

Intensive Care Society's APACHE II study in Britain and Ireland--I: Variations in case mix of adult admissions to general intensive care units and impact on outcome.

OBJECTIVES: To describe the extent of variation in the case mix of adult admissions to general intensive care units in Britain and Ireland and investigate the impact of such variation on outcome. DESIGN: Prospective, cohort study of consecutive admissions to intensive care units. SETTING: 26 general intensive care units in Britain and Ireland. SUBJECTS: 9099 admissions to the intensive care units studied. MAIN OUTCOME MEASURE: Death or survival at discharge before and after adjustment of case mix (age, history of chronic conditions, surgical status, diagnosis, and severity of illness) according to the APACHE II method. RESULTS: Important differences in case mix were found, with large variations between the units. Hospital mortality was significantly associated with most of the case mix factors investigated. CONCLUSIONS: Comparing crude death rates in hospital between intensive care units may be misleading indicators of performance. The collection of data on case mix needs to be standardised and differences in case mix adjusted for when comparing outcome between different intensive care units.

Age Factors↗
PubMed1984

Initial international use of APACHE. An acute severity of disease measure.

We need objective and reliable ways of measuring the severity of disease of hospitalized patients. This paper demonstrates the international predictive accuracy of a severity of disease measure on 1504 consecutive, unscheduled intensive care admissions to 14 hospitals in the United States, France, Spain, and Finland. Using laboratory data gathered within 24 hours of ICU admission, the Acute Physiology Score of APACHE (Acute Physiology and Chronic Health Evaluation) was a strong and stable predictor of hospital survival and concurrent therapeutic effort. In ordinary least squares and logistic multiple regression analysis, the impact of the Acute Physiology Score (APS) was highly significant (p less than 0.001) and of virtually identical magnitude in the United States and European hospitals. The use of this severity of disease measure should help researchers gain insights concerning the efficacy of medical services and the characteristics of physician decision making by permitting more precise prognostic stratification of severely ill patients.

Costs and Cost Analysis↗
PubMed1975

Attempted prevention of diarrheal disease in Apache children with a non-absorbable broad-spectrum antimicrobial.

A double-blind study was conducted to test the prophylactic effect of a non-absorbable broad-spectrum antimicrobial (oral colistin sulfate) against acute diarrhea in Apache children. Children 1 to 6 months old had over twice the morbidity from diarrhea if assigned to the antimicrobial group as compared to placebo, while the toddler group (7-30 months) taking the antimicrobial had somewhat less diarrhea. Enteropathogenic E. coli were significantly more often isolated from the antimicrobial group (but only in well children). No special effect on the children's growth by the antimicrobial was discerned.

Age Factors↗
PubMed1984

Acute physiology and chronic health evaluation (APACHE II) and Medicare reimbursement.

This article describes the potential for the acute physiology score (APS) of acute physiology and chronic health evaluation (APACHE) II, to be used as a severity adjustment to diagnosis-related groups (DRG's) or other diagnostic classifications. The APS is defined by a relative value scale applied to 12 objective physiologic variables routinely measured on most hospitalized patients shortly after hospital admission. For intensive care patients, APS at admission is strongly related to subsequent resource costs of intensive care for 5,790 consecutive admissions to 13 large hospitals, across and within diagnoses. The APS could also be used to evaluate quality of care, medical technology, and the response to changing financial incentives.

Costs and Cost Analysis↗
PubMed2005

Developing Online Communities with LAMP (Linux, Apache, MySQL, PHP) - the IMIA OSNI and CHIRAD Experiences.

Many health informatics organisations do not seem to use, on a practical basis, for the benefit of their activities and interaction with their members, the very technologies that they often promote for use within healthcare environments. In particular, many organisations seem to be slow to take up the benefits of interactive web technologies. This paper presents an introduction to some of the many free/libre and open source (FLOSS) applications currently available and using the LAMP - Linux, Apache, MySQL, PHP architecture - as a way of cheaply deploying reliable, scalable, and secure web applications. The experience of moving to applications using LAMP architecture, in particular that of the Open Source Nursing Informatics (OSNI) Working Group of the Special Interest Group in Nursing Informatics of the International Medical Informatics Association (IMIA-NI), in using PostNuke, a FLOSS Content Management System (CMS) illustrates many of the benefits of such applications. The experiences of the authors in installing and maintaining a large number of websites using FLOSS CMS to develop dynamic, interactive websites that facilitate real engagement with the members of IMIA-NI OSNI, the IMIA Open Source Working Group, and the Centre for Health Informatics Research and Development (CHIRAD), as well as other organisations, is used as the basis for discussing the potential benefits that could be realised by others within the health informatics community.

Humans↗
PubMed1990

[The value of 2 distinct prognosis scores in patients with peritonitis. The Mannheim Peritonitis Index versus the Apache II score].

Seventy patients suffering from purulent peritonitis entered this study, 31 of them were taken in prospectively, to contrast two different prognostic scores, the Mannheim Peritonitis Index (MPI) vs. the Apache II (APS II). The MPI is shown as a prognostic index for peritonitis with high accuracy in individual prognosis. The simultaneous use of both scores, the MPI as well as the APS II, leads to a negligible improvement of prognostic accuracy. Moreover, sensitivity and specificity with the MPI are of higher accuracy than calculated with the APS II.

Adolescent↗
PubMed1988

Use of APACHE II classification to evaluate outcome of patients receiving hemodialysis in an intensive care unit.

We retrospectively reviewed the medical records of all patients who were admitted to the medical and surgical intensive care units of a university center (N = 100) and its affiliated veterans' hospital (N = 46) between 1982 and 1986 to receive dialysis. The APACHE II severity-of-disease classification was used to identify the cases in which the prognosis was so poor that no long-term benefit would accrue from hemodialysis treatment. A "risk of death" was calculated for each patient. At a risk of death of 70% or greater, the system correctly predicted the demise of patients with 100% specificity regardless of what interventions were carried out. Sensitivity and predicted negative value were low in all cases, however, indicating a poor predictability of those who will survive. Withholding the average of 6 dialysis treatments that this group of patients received would probably have reduced patient suffering during a lingering terminal illness and led to a savings of about $4,500 per patient.

Adult↗
PubMed1986

Bifid uvula and otitis media in Apache Indians.

The association of bifid uvula with otitis media and scarred tympanic membrane was studied in White Mountain Apache Indians at Canyon Day, Arizona. Of 349 persons seen during a survey for otitis media, 13.5 percent had clinical otitis media, and 64.2 percent had scarring of the tympanic membrane of the otoscopically worse ear; 20.3 percent had bifid uvula. Bifid uvula was not associated with clinical otitis media or scarred tympanic membrane.

Arizona↗