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PubMedDate not supplied

Methods for semi-automated indexing for high precision information retrieval.

OBJECTIVE: To evaluate a new system, ISAID (Internet-based Semi-automated Indexing of Documents), and to generate textbook indexes that are more detailed and more useful to readers. DESIGN: Pilot evaluation: simple, nonrandomized trial comparing ISAID with manual indexing methods. Methods evaluation: randomized, cross-over trial comparing three versions of ISAID and usability survey. PARTICIPANTS: Pilot evaluation: two physicians. Methods evaluation: twelve physicians, each of whom used three different versions of the system for a total of 36 indexing sessions. MEASUREMENTS: Total index term tuples generated per document per minute (TPM), with and without adjustment for concordance with other subjects; inter-indexer consistency; ratings of the usability of the ISAID indexing system. RESULTS: Compared with manual methods, ISAID decreased indexing times greatly. Using three versions of ISAID, inter-indexer consistency ranged from 15% to 65% with a mean of 41%, 31%, and 40% for each of three documents. Subjects using the full version of ISAID were faster (average TPM: 5.6) and had higher rates of concordant index generation. There were substantial learning effects, despite our use of a training/run-in phase. Subjects using the full version of ISAID were much faster by the third indexing session (average TPM: 9.1). There was a statistically significant increase in three-subject concordant indexing rate using the full version of ISAID during the second indexing session (p < 0.05). SUMMARY: Users of the ISAID indexing system create complex, precise, and accurate indexing for full-text documents much faster than users of manual methods. Furthermore, the natural language processing methods that ISAID uses to suggest indexes contributes substantially to increased indexing speed and accuracy.

Abstracting and Indexing↗
PubMed2003

HLA-A and -B alleles and haplotypes in 240 index patients with common variable immunodeficiency and selective IgG subclass deficiency in central Alabama.

BACKGROUND: We wanted to quantify HLA-A and -B phenotype and haplotype frequencies in Alabama index patients with common variable immunodeficiency (CVID) and selective IgG subclass deficiency (IgGSD), and in control subjects. METHODS: Phenotypes were detected using DNA-based typing (index cases) and microlymphocytotoxicity typing (controls). RESULTS: A and B phenotypes were determined in 240 index cases (114 CVID, 126 IgGSD) and 1,321 controls and haplotypes in 195 index cases and 751 controls. Phenotyping revealed that the "uncorrected" frequencies of A*24, B*14, B*15, B*35, B*40, B*49, and B*50 were significantly greater in index cases, and frequencies of B*35, B*58, B*62 were significantly lower in index cases. After Bonferroni corrections, the frequencies of phenotypes A*24, B*14, and B*40 were significantly greater in index cases, and the frequency of B*62 was significantly lower in index cases. The most common haplotypes in index cases were A*02-B*44 (frequency 0.1385), A*01-B*08 (frequency 0.1308), and A*03-B*07 (frequency 0.1000), and the frequency of each was significantly greater in index cases than in control subjects ("uncorrected" values of p < 0.0001, 0.0252, and 0.0011, respectively). After performing Bonferroni corrections, however, the frequency of A*02-B*44 alone was significantly increased in probands (p < 0.0085). Three other haplotypes were also significantly more frequent in index cases (A*03-B*14, A*31-B*40, and A*32-B*14). The combined frequencies of three latter haplotypes in index patients and control subjects were 0.0411 and 0.0126, respectively ("uncorrected" value of p < 0.0002; "corrected" value of p = 0.0166). Most phenotype and haplotype frequencies in CVID and IgGSD were similar. 26.7% of index patients were HLA-haploidentical with one or more other index patients. We diagnosed CVID or IgGSD in first-degree or other relatives of 26 of 195 index patients for whom HLA-A and -B haplotypes had been ascertained; A*01-B*08, A*02-B*44, and A*29-B*44 were most frequently associated with CVID or IgGSD in these families. We conservatively estimated the combined population frequency of CVID and IgGSD to be 0.0092 in adults, based on the occurrence of CVID and IgGSD in spouses of the index cases. CONCLUSIONS: CVID and IgGSD in adults are significantly associated with several HLA haplotypes, many of which are also common in the Alabama Caucasian population. Immunoglobulin phenotype variability demonstrated in index cases and family studies herein suggests that there are multiple gene(s) on Ch6p or other chromosomes that modify immunoglobulin phenotypes of CVID and IgGSD. The estimated prevalence of CVID and IgGSD in central Alabama could be reasonably attributed to the fact that many HLA haplotypes significantly associated with these disorders are also common in the general population.

Adult↗
PubMed1994

Adolescent body mass index and infertility caused by ovulatory disorder.

OBJECTIVE: Our aim was to examine the association between body mass index at age 18 and subsequent primary ovulatory infertility. STUDY DESIGN: A nested case-control study was conducted within a cohort of 116,678 female registered nurses residing in 14 U.S. states. Cases comprised 2527 married nulliparous nurses unable to become pregnant for at least 1 year because of ovulatory disorder; controls comprised 46,718 married parous nurses with no history of infertility. The risk of ovulatory infertility for women at different levels of body mass index at age 18 was compared with that for women whose body mass index at age 18 was 20 to 21.9 (median for the cohort). Logistic regression was used to adjust for age at infertility or first birth, year of birth, age at menarche, physical activity during ages 18 to 22, smoking at ages 15 to 19, ethnicity, alcohol use at ages 18 to 22, use of oral contraceptives before age 22, and diagnosis of diabetes mellitus. RESULTS: Multivariate relative risks for infertility were: 1.2 (body mass index < 16), 1.1 (body mass index 16 to 17.9), 1.0 (body mass index 18 to 19.9), 1.0 (referent body mass index 20 to 21.9), 1.1 (body mass index 22 to 23.9), 1.3 (body mass index 24 to 25.9), 1.7 (body mass index 26 to 27.9), 2.4 (body mass index 28 to 29.9), 2.7 (body mass index 30 to 31.9), and 2.7 (body mass index > or = 32). The relative risks for all categories of body mass index above 23.9 were statistically significantly elevated. Greater body mass index at age 18 was a predictor of ovulatory infertility in women with and without a diagnosis of polycystic ovary syndrome. CONCLUSION: These findings suggest that elevated body mass index at age 18, even at levels lower than those considered to be obese, is a risk factor for subsequent ovulatory infertility.

Adolescent↗
PubMed2001

A useful insight into 2 occlusal indexes: HLD(Md) and HLD(CalMod).

Maryland and California are among the states that have adopted the Handicapping Labiolingual Deviation (HLD) Index to determine eligibility for public funding of orthodontic treatment. As a result of several lawsuits against the state, California has developed and employed a modification of that index, called the HLD(CalMod) index. This study compared and contrasted the effects of analyzing prospective patients with the HLD(Md)-the HLD index as used in Maryland-and the HLD(CalMod) indexes. The specific aims of this study were to observe (1) the correlation between the 2 occlusal indexes in determining patients' eligibility for treatment with public funding, (2) the characteristics of patients eligible according to each index, and (3) the major contributing factors in assigning patients as eligible under each index. Initial study models of 313 patients from the orthodontic clinic at the University of Maryland were scored by both HLD(Md) and HLD(CalMod) indexes. According to the scores, the patients were divided into 2 groups-those with handicapping malocclusions and those without handicapping malocclusions. Scores from each index were analyzed by the Pearson product moment correlation. The Angle classification for each patient was also recorded with the HLD variables. The mean and the percentage of the total score for each variable were calculated. The following conclusions were obtained: (1) Of the 313 patients, 127 (41%) were approved for treatment by the HLD(Md) index, and 110 (35%) were approved for treatment by the HLD (CalMod) index.(2) The correlation between the 2 indexes (R = 0.78) was not very strong, indicating the power of the additional variables introduced in the HLD(CalMod) index. (3) The use of the HLD(CalMod) index directs more public funding toward patients with severe Class II malocclusions than does the HLD(Md) index.

Adolescent↗
PubMed1996

Comparison of histological and biochemical hepatic iron indexes in the diagnosis of genetic haemochromatosis.

AIMS: To compare a histological hepatic iron index with a biochemical hepatic iron index, derived from atomic absorption spectroscopy measurements of hepatic iron content, for the diagnosis of genetic haemochromatosis (GH). METHODS: Histological sections of liver biopsy specimens from 70 subjects, who had previously had their biochemical hepatic iron index measured, were examined. The iron stores were scored to derive a histological hepatic iron index and were also graded from 0 to 4 by a standard grading system. The case history of each patient was then reviewed to establish a definitive clinical diagnosis and patients were classified as GH, non-GH or indeterminate. RESULTS: There were 26 cases of GH, 40 cases of non-GH and four indeterminate cases in whom a definite clinical diagnosis was not established. Using a biochemical hepatic iron index cut off level of 2.0, two cases were misclassified, with one case of GH having a biochemical hepatic iron index of 1.8 and one non-GH case having a biochemical hepatic iron index of 3.1. This could not have been improved by altering the cut off level. Using the recommended cut off level of 0.15, the histological hepatic iron index was raised in all cases of GH, but was also increased in 11 of the 40 non-GH patients. The specificity of this histological index can be improved by increasing the cut off level to 0.30. A histological iron grade of > or = 3 is more specific than the histological index but has a lower sensitivity, which particularly affects the diagnosis of younger patients with GH. CONCLUSIONS: The biochemical hepatic iron index is a reliable method for establishing a diagnosis of homozygous GH. In contrast, the histological hepatic iron index as originally described is non-specific and does not reliably distinguish patients with GH from others with a raised hepatic iron index due to other causes. The specificity of this index can be improved by increasing the cut off level used, but the discrimination provided by the histological index is still inferior to that provided by the biochemical hepatic iron index.

Adult↗
PubMed1992

The validity of the MIMIC (Multiple Indicators/MultIple Causes) health index--some empirical evidence.

This study evaluates the potential of econometric models with latent (unobservable) variables for measuring health or health impairment due to a specific disease. A MIMIC disability index is estimated for a sample of 145 adults with chronic bronchitis, expressing their self-reported disability caused by the disease on a one-dimensional scale. The index is determined up to a linear transformation. Disability is thus measured on an interval scale. The data were collected by interviews. The questionnaire used for this purpose is based on a number of in-depth interviews with selected bronchitis patients conducted beforehand. The study therefore focuses directly on the patients' perceptions of their disease. The validity of the index is evaluated in three different ways. First, construct validity is assessed performing groupwise analysis and testing for differences in the index values by subgroup. To a large extent, the index is consistent with a priori expectations. Therefore, we conclude that it has high construct validity. Second, validity of the index is assessed by comparing its results to a direct rating scale produced by 21 physicians with various medical backgrounds. The MIMIC index turns out to be related in a systematic, but nonlinear way to this direct rating scale. This can be interpreted in two different ways. If one accepts the preferences of health providers as the ultimate yardstick when it comes to ranking health or chronic states the result suggests that the MIMIC index estimated in this way is not a valid measure of treatment success. By contrast, if patients' preferences are considered to be decisive, it suggests that physician-based ratings should be substituted for or at least complemented with patient-based indices (such as the MIMIC disability index estimated here) when evaluating medical services in terms of cost-effectiveness. Third we explore the extent to which the MIMIC index reflects utility associated with different states of disability, using a modified Torrance Standard Gamble approach. The above-mentioned physicians are used as experts in this procedure. The results indicate that the MIMIC index as estimated here is related in a systematic, but nonlinear way to the Standard Gamble risk index as well. The fact that this relationship is nonlinear indicates that the MIMIC index does not measure utility as derived from the experts' preferences directly. How this index would fare compared to a Standard Gamble risk index provided by patients (bronchitis subjects) is a question which remains open.(ABSTRACT TRUNCATED AT 400 WORDS)

Attitude to Health↗
PubMed1996

Amniotic fluid index predicts the relief of variable decelerations after amnioinfusion bolus.

OBJECTIVE: Our purpose was to determine whether intrapartum amniotic fluid index before amnioinfusion can be used to predict response to therapeutic amnioinfusion. STUDY DESIGN: Intrapartum patients (n = 85) with repetitive variable decelerations in fetal heart rate that necessitated amnioinfusion (10 ml/min for 60 minutes) underwent determination of amniotic fluid index before and after bolus amnioinfusion. The fetal heart tracing was scored (scorer blinded to amniotic fluid index values) for number and characteristics of variable decelerations before and 1 hour after initiation of amnioinfusion. The amnioinfusion was considered successful if it resulted in a decrease of > or = 50% in total number of variable decelerations or a decrease of > or = 50% in the rate of atypical or severe variable decelerations after administration of the bolus. Spontaneous vaginal births before completion of administration of the bolus (n = 18) were excluded from analysis. The probability of success of amnioinfusion in relation to amniotic fluid index was analyzed with the chi(2) test for progressive sequence. RESULTS: The mean amniotic fluid index before amnioinfusion was 6.2 +/- 3.3 cm. An amniotic fluid index of < or = 5 cm was present in 40% of patients (27/67), and an amniotic fluid index of < or = 8 cm was present in 72% of patients (48/67). The probability of success of amnioinfusion decreased with increasing amniotic fluid index before amnioinfusion (76% [16/21] when initial amniotic fluid index was 0 to 4 cm, 63% [17/27] when initial amniotic fluid index was 4 to 8 cm, 44% [7/16] when initial amniotic fluid index was 8 to 12 cm, and 33% [1/3] when initial amniotic fluid index was > 12 cm, p = 0.03). The incidence of nuchal cords or true umbilical cord knots increased in relation to amniotic fluid index before amnioinfusion. CONCLUSIONS: Amniotic fluid index before amnioinfusion can be used to predict the success of amnioinfusion for relief of variable decelerations in fetal heart rate. Failure of amnioinfusion at a high amniotic fluid index before amnioinfusion may be explained by the increased prevalence of nuchal cords or true knots in the umbilical cord.

Adult↗
PubMedDate not supplied

Refractive index of the crystalline lens in young and aged eyes.

BACKGROUND: When the ageing crystalline lens is modelled on the basis of a constant equivalent lens, the changes in ocular dimensions would lead to an increase in power of the order of two dioptres. A comparable increase in myopia is usually not evident with increasing age and this inconsistency has been referred to as the lens paradox. It has been proposed that this paradox can be resolved if the refractive index is modelled as a gradient refractive index. The purpose of this paper was to study differences in the equivalent, gradient and surface refractive index of the crystalline lens between a young and old age group. METHODS: Biometric data was collected for 96 subjects: 48 young adults with an age range 19 to 31 years (mean 22.10 +/- 2.93 years) and 48 old adults with an age range 49 to 61 years (mean 53.88 +/- 3.88 years). The equivalent refractive index was determined for each subject by paraxial ray tracing and a merit function based on refractive error and Purkinje image height. The refractive index gradient was determined by modelling the crystalline lens as a bi-elliptical iso-indicial structure in a three-surface Gullstrand-Emsley schematic eye and a merit function based on the surface power, the gradient refractive index power and the equivalent power of the lens. The central refractive index of the lens was assumed to be 1.406. RESULTS: The differences between the groups included a decrease in the mean equivalent refractive index from 1.427 +/- 0.007 to 1.418 +/- 0.006, an increase in surface refractive index from 1.386 +/- 0.007 to 1.394 +/- 0.006 with a concurrent change in the gradient refractive index profile. The refractive index changes maintained a constant mean lens power in each group. CONCLUSIONS: The so-called 'lens paradox' whereby an increase in the power of the crystalline lens does not lead to an increase in myopia is resolved by a decrease in the equivalent refractive index of the lens or when modelled as a gradient refractive index structure, by an increase in the surface refractive index and an associated change in gradient for an assumed central refractive index of 1.406.

Journal Article↗
PubMed1997

Relative changes of MIB1 and PC10 labeling indexes in cell kinetics during radiotherapy for cervical squamous cell carcinoma.

To assess the changes in cell kinetics during radiotherapy (RT) in terms of the MIB1 and PC10 labeling indexes of cancer cells, a total of 230 biopsy specimens taken from 76 consecutive patients with cervical squamous cell carcinoma treated with RT was investigated. The MIB1 and PC10 indexes represent the growth fraction and proliferative activity, respectively. The MIB1 index ranged from 11 to 67% (mean value: 38%) before RT, from 21 to 86% (50%) at 5.4 Gy, from 15 to 85% (53%) at 9 Gy, and from 0 to 69% (26%) at 27 Gy. The PC10 index ranged from 4 to 46% (23%) before RT, from 5 to 62%, (26%) at 5.4 Gy, from 6 to 63% (23%) at 9 Gy, and from 0 to 35% (11%) at 27 Gy. The correlational relationships between the increment of both indexes during RT (delta index) and the index before RT were analyzed on an individual basis. The delta index was calculated by the index at various doses during RT minus the index before RT. Negative linear relationships were observed between the delta MIB1 index at 9 Gy or delta MIB1 index at 27 Gy and the MIB1 before RT, and also between the delta PC10 index at 9 Gy or delta PC10 index at 27 Gy and the PC10 index before RT. The linear regression coefficient values showed more than 0.5 (0.511 to 0.682) with statistical significance. According to these results, it was suggested that the cervical cancers of lower proliferative activity showed greater increases in growth fraction and proliferative activity by irradiation than those of higher proliferative tumors. These findings suggest that reversal patterns of changes in cell kinetics including growth fraction and proliferative activity took place in the early period of RT for cervical squamous cell carcinomas. The study of changes in cell cycle kinetics in human tumors during RT may have potential impact on the further development of RT.

Adult↗
PubMed2000

A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests.

In epidemiological surveys of female urinary incontinence, it is not feasible to demonstrate urine loss objectively. The aim of this study was to develop a valid epidemiological instrument (a severity index) for assessing the severity of incontinence. The severity index is based on information about frequency (four levels) and amount of leakage (two or three levels). By multiplication, an index value (1-8 or 1-12) is reached. This index value is further categorized into a severity index of three or four levels. The index was compared with the results of 315 pad-weighing tests performed by 265 women in hospital and general practice. Data from an epidemiological survey were also re-analyzed by applying the four-level severity index. Mean pad-weighing results (grams per 24 hours, 95% confidence interval) for the three-level severity index was slight (6; 2-9), moderate (17; 13-22), and severe (56; 44-67). For the four-level severity index, the results were slight (6; 2-9), moderate (23; 15-30), severe (52; 38-65), and very severe (122; 84-159). Spearman's correlation coefficient for pad-weighing results and the three-level severity index was 0.47 (P < 0.01) and for the four-level severity index 0.54 (P< 0.01). The four-level severity index gave a more balanced distribution among the women in the clinical materials, and data from the epidemiological survey showed that the four-level severity index identifies a sub-group of older women with very severe incontinence. The four-level severity index seems to be a valid representation of incontinence severity as measured by pad-weighing tests in women presenting for clinical care. It should be considered a potentially valid measure of incontinence severity in epidemiological studies. Neurourol. Urodynam. 19:137-145, 2000.

Adolescent↗
PubMed2005

Body mass index and body fatness in childhood.

PURPOSE OF REVIEW: The prevalence of overweight, as assessed by a high body mass index (kg/m), has greatly increased among children and adolescents over the last three decades. Because body mass index is a measure of excess weight rather than excess body fatness, it is important to understand the ability of a high level to identify children who truly have excess adiposity. This review covers the measurement and classification of overweight and obesity, the expression of body composition data, and the relation of body mass index to adiposity. RECENT FINDINGS: Although adiposity has typically been expressed as percentage body fat, the use of the fat mass index (fat mass/height) and the fat-free mass index (fat-free mass/height) may provide more information. For example, body mass index differences among relatively thin children have been found to largely reflect differences in fat-free mass index, whereas differences among relatively heavy children are primarily due to differences in fat mass index. In addition, the ability of overweight to identify obese children is greatly influenced by the cutpoints selected for body mass index and adiposity. The use of inappropriate cutpoints, rather than the limitations of body mass index, may account for the frequently reported finding that many obese children are not overweight. SUMMARY: The use of fat mass index and fat-free mass index in expressing body composition data allows one to easily assess the contribution of each to body mass index. If appropriate cutpoints are used, a high body mass index level is a moderately sensitive and a very specific indicator of excess adiposity among children.

Adipose Tissue↗
PubMed2004

KP index at the initiation of dialysis for patients with end-stage renal disease.

BACKGROUND: The time at which renal replacement therapy (RRT) is initiated in patients with end-stage renal disease (ESRD) has a great influence on the prognosis of the patient; however, there are currently no accurate guidelines for the initiation of RRT. Traditionally, nephrologists usually initiate RRT on the basis of the observation of the uremic symptoms and changes in the laboratory parameters, such as the serum creatinine concentration and/or glomerular filtration rate (GFR). DOQI guidelines suggest a weekly Kt/Vurea < 2.0 or an nPNA < 0.8 g/kg/day as objective indices for the initiation of dialysis. Thus, a KP index was formulated (weekly Kt/Vurea+2.5 x nPNA) x 1/2 using the above two clinically useful and objective indices to determine the adequate time to initiate RRT in patients with ESRD. METHODS: Of 186 patients admitted to the renal unit of Soonchunhyang Bucheon hospital, those with ESRD and a weekly Kt/Vurea below 3.0 were selected. The patients with a weekly Kt/Vurea index between 1.0 and 2.0 were classified into one of two groups; KP index > 2.0 and KP index < 2.0. The groups were compared and analyzed in relation to their renal function, biochemical indices and the numbers of patients per group starting RRT. Further, the correlations between the KP and other indices were analyzed in all the patients. The patients were then further divided into another two groups according to their weekly Kt/Vurea and KP index: group one; between 1.5 and 2.0 and group 2; between 2.0 and 2.5. The numbers of patients per group starting RRT were compared. RESULTS: The KP index < 2.0 group showed significantly lower indices for weekly Kt/Vurea, nPNA and %LBM (%) than those of the KP index > 2.0 group, while there were no significant differences between the groups in the serum albumin concentration, serum creatinine concentration, FFEFBM and RRF. Also, there was a statistically significant higher rate of incidence of patients starting RRT in the KP index < 2.0 group than in the KP index > 2.0 group. There was a significant correlation between the KP and other indices in all patients. When comparing the number of patients starting RRT, the weekly Kt/Vurea index demonstrated no significant differences between the 1.5 < weekly Kt/Vurea < 2.0 and 2.0 < weekly Kt/Vurea < 2.5 groups, but the number of patients starting RRT in the 1.5 < KP index < 2.0 group was significantly higher than that in the 2.0 < KP index < 2.5 group. CONCLUSION: The KP index is considered a clinically useful index in ESRD patients for determining an appropriate time for the initiation of RRT. Also, the timing of the initiation of RRT should be fixed with regard to the various other indices and clinical features for a desirable prognosis of the patients. In addition, further studies will be required to determine accurate guidelines for an appropriate time for RRT initiation.

Adult↗
PubMedDate not supplied

Distance-related indexes in the quantitative structure-property relationship modeling.

A comparative study of structure-boiling point modeling for a set of 180 acyclic and cyclic hydrocarbons (DS-180) and two of its subsets (one containing a selection of 76 acyclic and cyclic alkanes (DS-76), and the other containing 104 (DS-104) mono- and polycyclic butanes through octanes) using several known and novel distance-related indices is reported. The distance-related indices used were as follows: Wiener index, hyper-Wiener index, detour index, hyper-detour index, Harary index, Pasaréti index, Vérhalom index, Wiener-sum index, inverse Wiener-sum index and the product-form version of the Wiener index. Additional indices used were the total number of paths, the Hosoya Z index, the total walk count index, the number of carbon atoms, and the number of rings in the hydrocarbon. The best models for predicting the boiling points of 76, 104, and 180 acyclic and cyclic alkanes contain the natural logarithm of the cross-products of the Hosoya and detour index and of the Pasaréti index and the number of rings. This result extends earlier work by us and Rücker and Rücker on the use of the Wiener, detour, and Hosoya indices in modeling boiling points of alkanes and cycloalkanes. It also supports later work by Rücker and Rücker on the use of the descriptor combination for the same purpose.

Journal Article↗
PubMed2002

Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion.

OBJECTIVE: Peripheral perfusion in critically ill patients frequently is assessed by use of clinical signs. Recently, the pulse oximetry signal has been suggested to reflect changes in peripheral perfusion. A peripheral perfusion index based on analysis of the pulse oximetry signal has been implemented in monitoring systems as an index of peripheral perfusion. No data on the variation of this index in the normal population are available, and clinical application of this variable in critically ill patients has not been reported. We therefore studied the variation of the peripheral perfusion index in healthy adults and related it to the central-to-toe temperature difference and capillary refill time in critically ill patients after changes in clinical signs of peripheral perfusion. DESIGN: Prospective study. SETTING: University-affiliated teaching hospital. PATIENTS: One hundred eight healthy adult volunteers and 37 adult critically ill patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Capillary refill time, peripheral perfusion index, and arterial oxygen saturation were measured in healthy adults (group 1). Capillary refill time, peripheral perfusion index, arterial oxygen saturation, central-to-toe temperature difference, and hemodynamic variables were measured in critically ill patients (group 2) during different peripheral perfusion profiles. Poor peripheral perfusion was defined as a capillary refill time >2 secs and central-to-toe temperature difference > or = 7 degrees C. Peripheral perfusion index and arterial oxygen saturation were measured by using the Philips Medical Systems Viridia/56S monitor. In group 1, measurements were made before and after a meal. In group 2, two measurements were made, with the second measurement taken when the peripheral perfusion profile had changed. A total of 216 measurements were carried out in group 1. The distribution of the peripheral perfusion index was skewed and values ranged from 0.3 to 10.0, median 1.4 (inner quartile range, 0.7-3.0). Seventy-four measurements were carried out in group 2. A significant correlation between the peripheral perfusion index and the core-to-toe temperature difference was found (R2=.52; p <.001). A cutoff peripheral perfusion index value of 1.4 (calculated by constructing a receiver operating characteristic curve) best reflected the presence of poor peripheral perfusion in critically ill patients. Changes in peripheral perfusion index and changes in core-to-toe temperature difference correlated significantly (R =.52, p <.001). CONCLUSIONS: The peripheral perfusion index distribution in the normal population is highly skewed. Changes in the peripheral perfusion index reflect changes in the core-to-toe temperature difference. Therefore, peripheral perfusion index measurements can be used to monitor peripheral perfusion in critically ill patients.

Adult↗
PubMed1994

Doppler sonography of adnexal masses: the predictive value of the pulsatility index in benign and malignant disease.

OBJECTIVE: The purpose of this study was to determine whether pulsed Doppler sonography can be used to distinguish between benign and malignant adnexal masses on the basis of pulsatility index. SUBJECTS AND METHODS: In an 18-month period, all patients in whom an adnexal mass was detected at sonography had further evaluation of the mass by color and pulsed Doppler sonography. Ninety-nine patients with 102 masses that were surgically removed were included in the study. The pulsatility indexes were calculated from the reproducible spectral waveforms generated from flow centrally or peripherally within or immediately adjacent to the mass. Each lesion was categorized on the basis of its gray scale morphologic features as typically benign or indeterminate/malignant in appearance. RESULTS: Of the 102 adnexal masses, 89 were benign and 13 were malignant. In seven of the 89 benign lesions, no flow could be detected, and these were excluded from analysis. Of the remaining 82 benign lesions, 65 showed pulsatility indexes consistently equal to or greater than 1.0, and 17 showed pulsatility indexes of less than 1.0. Ten of the 13 malignant lesions had pulsatility indexes consistently less than 1.0, and three primary malignant tumors had their lowest pulsatility indexes ranging between 1.1 and 1.8. Sixty-five of the 68 masses with pulsatility indexes equal to or greater than 1.0 were benign, for a positive predictive value of 96% for benign disease. Ten of the 27 masses with pulsatility indexes of less than 1.0 were malignant, for a positive predictive value of 37% for malignant disease. Forty-five masses were detected in perimenopausal and postmenopausal patients. In this group, the pulsatility index had a positive predictive value of 88% for benign disease and 47% for malignant disease. In this study, 45 of 49 masses that had a typically benign sonographic appearance had pulsatility indexes equal to or greater than 1.0. All 49 masses had benign histology. In the remaining 46 masses with an indeterminate/malignant sonographic appearance, 20 of 23 with pulsatility indexes equal to or greater than 1.0 were benign, and 10 of 23 with pulsatility indexes of less than 1.0 were malignant. CONCLUSION: Our results show a high positive predictive value of high-impedance flow in benign adnexal disease and a predominance of low-impedance flow in malignant adnexal disease. However, the pulsatility indexes showed considerable overlap between benign and malignant lesions, indicating that Doppler sonography has severe limitations in the differentiation of benign from malignant adnexal disease on the basis of low-impedance flow (pulsatility index < 1.0).

Adenofibroma↗
PubMed1989

Pharmacologic alterations of the isovolumic index: a study of the effects of isoproterenol, propranolol and verapamil.

The isovolumic index has been proposed as a noninvasive index of left ventricular function which, unlike the traditional systolic time index, incorporates the period of isovolumic relaxation. The responses of the isovolumic index and the systolic time index to three cardioactive drugs (isoproterenol, propranolol and verapamil) were assessed by measurements of ejection time (ET), isovolumic contraction time (IVC) and isovolumic relaxation time (IVR) in 23 dogs instrumented with high fidelity micromanometers and ultrasonic crystals. Isoproterenol infusions resulted in improvements in both the isovolumic and systolic time indices as a result of significant shortening of ET, IVC and IVR. Propranolol infusions caused significant and parallel increases of IVC (P less than 0.01) and ET (P less than 0.05) but failed to cause prolongation of either the systolic time index, defined as (IVC/ET) or deterioration of regional function. A higher propranolol dose caused significant increases in ET, IVC (P less than 0.001) and IVR (P less than 0.05), yet neither the systolic time index or the isovolumic index (IVC + IVR/ET) were prolonged, and regional function remained normal. Verapamil infusion caused an upward, nonsignificant trend in the isovolumic index and no change in the systolic time index. Stepwise multiple linear regression analysis demonstrated a similar load dependency of both indices and a higher inverse correlation of the isovolumic index with fractional shortening. The systolic time index showed a higher dependency on peak positive dP/dt whereas only the isovolumic index showed dependency on the isovolumic relaxation time constant. When altered loading conditions are accounted for, the isovolumic index shows directional changes that reflect changes in peak positive dP/dt, the isovolumic relaxation time constant and regional shortening.

Animals↗
PubMed1979

Bronchial carcinoma. IV. A methodological evaluation of the vitagram index for measurement of quality of survival.

The validity of the Carlens Vitagram Index was tested by using the result of therapy in 48 patients with bronchial carcinoma in advanced disease, 54 patients with localized disease and 34 deceased treated surgically. The Carlens Vitagram Index, which is additional and composed of six items, was correlated to a set of additive indexes including the same items but other item weights, which were chosen with non-controversial pre-specified restrictions. The lowest correlation achieved was an indicator of the lowest degree of consistency that could be attributed to the Carlens Index given. The definition of the index was operationalized so far that each item in the set of six items included in the index was regarded as valid, and it was also considered reasonable that only these six items should be included; that each item had a weight; that the index was obtained as a product (weight x item value) sum and that the pre-specified conditions were accepted. By using restrictive conditions the lowest correlation between the index giving the lowest correlation and the Carlens Index for the 48 patients with localized disease was 0.98, for the 54 patients with localized disease 0.91 and for the surgically treated ones 0.83. In addition to the total index, the average index per month was also studied and the corresponding correlations were 0.96, 0.86 and 0.81 respectively. The Carlens Index and its application per month was found to have good validity for inoperable patients and acceptable validity for surgically treated patients. The Carlens Index was shown to be robust and there is reason to believe that it lies close to the optimal index.

Adult↗
PubMed2002

Fecal incontinence severity index after fistulotomy: a predictor of quality of life.

PURPOSE: The purpose of this study was to use the Fecal Incontinence Severity Index to assess fecal incontinence after fistulotomy and to correlate the Fecal Incontinence Severity Index score with quality-of-life measures. METHODS: A retrospective chart review was performed on consecutive patients undergoing fistulotomy by a single colon and rectal surgeon at a university hospital from 1991 to 1999. Demographics, fistula anatomy, surgical technique, and length of follow-up were recorded. Mailed questionnaires and telephone interviews were conducted to determine the Fecal Incontinence Severity Index score, pad usage, lifestyle restriction, and psychosocial factors. A linear regression model was used to determine the relationship of clinical factors with Fecal Incontinence Severity Index. One-way ANOVA was used to correlate Fecal Incontinence Severity Index with quality-of-life measures. RESULTS: Of 110 patients who underwent fistulotomy, 96 (88 percent) had complete follow-up. Mean age was 48 (range, 17-84) years, and 68 percent were male. Follow-up was less than two years in 26 percent, two to five years in 39 percent, and more than five years in 35 percent. Of these patients, 41 percent had intersphincteric fistulas, whereas 59 percent had transsphincteric fistulas. Median Fecal Incontinence Severity Index score was 6, with a mean of 13 (maximum Fecal Incontinence Severity Index = 61); 36 percent had a Fecal Incontinence Severity Index score of zero. Linear regression revealed that only the amount of external sphincter divided correlated with Fecal Incontinence Severity Index score (P = 0.05). Quality-of-life measures strongly correlated with Fecal Incontinence Severity Index by analysis of variance (P < 0.01 for pad usage, lifestyle restriction, depression, and embarrassment), with substantial quality-of-life drop-off documented with Fecal Incontinence Severity Index >30. CONCLUSION: The Fecal Incontinence Severity Index is an excellent tool to gauge quality of life after fistulotomy. Fecal Incontinence Severity Index scores >30 predict a detrimental effect on quality of life.

Adolescent↗