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PubMed1994

American College of Surgeons trauma quality indicators: an analysis of outcome in a statewide trauma registry.

Quality assurance/quality improvement (QA-QI) is a priority for maintaining the highest standards of care in trauma systems. To be an effective tool for system review, the QA-QI indicators should identify patients with higher rates of morbidity and mortality from injury. While the American College of Surgeons (ACS) and the Joint Commission on Accreditation of Health Care Operations have identified certain audit filters within the trauma system, there are few data to substantiate the value of these audit filters for trauma care. The purpose of this study was to analyze the ability of the ACS trauma indicators to predict adverse patient outcome following injury requiring review. The study population consisted of 44,019 patients from the North Carolina State Trauma Registry from 1987 to 1992. Of the 22 audit filters nine were available for analysis. Mortality rate, length of stay, and total charges were used as measures of outcome. The hypotheses tested were that patients who met the indicator criteria would have higher mortality rates and worse outcomes than the non-indicator group. Student's t test and Chi-square analysis were used to test the differences between the group which met the criteria for the indicator and those without. Of the nine audit filters tested, only three were found to have significantly worse outcomes than their non-indicator comparison group: gunshot wound to the abdomen with non-surgical management, femur fracture without fixation, and complications from pulmonary embolism-deep vein thrombosis-decubitus ulcer (p < 0.05). Contrary to expectations, four of the audit filters, coma without intubation, laparotomy > 2 hours, transfer > 6 hours, and admission to non-surgical service, actually had significantly better outcomes than their non-indicator counterpart. Scene time > 20 minutes, laparotomy > 2 hours after arrival, and craniotomy > 4 hours after arrival may be indicators of patients at risk for morbidity. This study demonstrates that several ACS clinical indicators, as currently written, are not useful in identifying patients at higher risk for poor outcome. The indicators need further definition to be of value in the quality review process. Specifically, the study suggests that audit filters should be data driven and based upon analyses of large populations of injured patients and their outcomes to be valid QA-QI tools.

General Surgery↗
PubMed1989

Validation of hysterectomy indications and the quality assurance process.

Hysterectomy is one of the most commonly performed major operations in the United States. Despite efforts to explain its high incidence, the perception remains that a significant number of hysterectomies are unjustified. More indications are listed for hysterectomy than for any other major operation. A quality assurance process is presented that requires the surgeon to select preoperatively one designated indication for each hysterectomy performed. The pathology report is expected to verify the surgical indication in 66% of the cases. The other 34% of hysterectomy specimens are not expected to show tissue pathology based on the listed indication. For these cases, predetermined validation criteria must be satisfied in the surgeon's preoperative note. Applying the process in this series of 584 consecutive hysterectomies, 93% (N = 396) of the "pathology expected" indications were verified by the pathology report and 98% (N = 188) of the "no pathology expected" indications were validated by the surgeon's preoperative note. The process of using a single designated indication and reviewing only two documents (the pathology report and the surgeon's preoperative note) has greatly simplified the quality assurance process. This system enables a quality assurance committee to monitor easily the appropriateness of hysterectomy indications for their institution. Information obtained from this process can influence changes regarding the acceptability of certain indications. As a result of this study, adenomyosis, because of its low (38%) verification rate, is no longer considered a reliable preoperative indication for hysterectomy at San Diego Naval Hospital.

California↗
PubMed2005

Gait analysis of people walking on tactile ground surface indicators.

Tactile ground surface indicators installed on sidewalks help visually impaired people walk safely. The visually impaired distinguish the indicators by stepping into its convexities and following them. However, these indicators sometimes cause the nonvisually impaired to stumble. This study examines the effects of these indicators by comparing the kinematic and kinetic variables of walking on paths with and without indicators. The results suggest that walking on the indicators causes extra movements of the lower extremities such as increased minimum toe heights during the midswing phase, increased peak hip flex moments, and increased peak hip heights. This study also suggests that a functional leg length discrepancy while walking on the indicators is one of the reasons for the extra movements of the lower extremities. Therefore, we designed a new recessed tactile surface to offset the differences of surface depth while walking on the path containing indicators, and found that the newly designed recessed tactile surface was effective in reducing the extra movements while walking on the path in which indicators were installed. These indicators may help both the visually impaired and elderly people with normal vision to walk safely.

Adult↗
PubMed2005

Development of performance indicators for the bovine clinical salmonellosis surveillance network in France.

Performance indicators are variables used to calculate on a continuous basis the operational level of a surveillance network's priority activities. A 10-step process was developed to enable network coordinators to identify specific performance indicators to help them monitor their networks. The methodology was based on a listing of surveillance activities, the definition and choice of network's global priority objectives, the construction of performance indicators and monitoring tables and the implementation of the system within the network. This process was implemented for the bovine clinical digestive salmonellosis surveillance network in France (RESSAB). The process produced a list of 26 activities synthesized into 15 global objectives, from which 12 were retained as priority objectives. This made it possible to develop 12 performance indicators. Indicators retrospectively calculated for the year 2003 indicated that RESSAB was operating according to the objectives set by the network's stakeholders and its financial supporter. The methodology was implemented successfully and was not very time consuming (12 person-days) or expensive. The decision makers and actors in the network quickly appropriated the system. The methodology can thus be considered validated through this example. Nevertheless, the risks inherent in the use of performance indicators must be addressed by ensuring the relevance of the selected indicators through external assessment and by prioritizing an internal and participatory approach to avoid a misuse of the performance indicators. In addition, considering that performance indicators address only the operation of the network, relevance of surveillance procedure should be addressed by external evaluation.

Animals↗
PubMed2000

Preterm delivery for maternal or fetal indications: maternal morbidity, neonatal outcome and late sequelae in infants.

OBJECTIVE: To assess maternal morbidity, and neonatal outcome and especially long term sequelae in infants born preterm due to maternal or fetal indications. DESIGN: Analysis of retrospective cohort. SETTING: Oulu University Central Hospital, Finland. POPULATION: One hundred and three women, who were between the 24th and the 33rd week of pregnancy, delivered by caesarean delivery because of maternal or fetal indications. They were matched with 103 women who had spontaneous preterm delivery at corresponding gestational weeks between 1990-1997. MAIN OUTCOME MEASURES: Maternal morbidity, reasons for caesarean delivery, neonatal mortality and morbidity rates, and later development of the infants. RESULTS: Pre-eclampsia was diagnosed in 57% of the women in the indicated group and only in one woman in the control group. All infants in the indicated group and almost a third in the control group were born by caesarean birth; the main indication was threatening fetal asphyxia. There was a significant difference in neonatal mortality rates between the groups (175 vs 78 per thousand live births in the indicated vs control infants; RR 2.3, 95% CI 1.02, 4.9) and the main cause of death was respiratory insufficiency: 64% in the indicated group and 22% in the controls; RR 2.9, 95% CI 0.8, 10. Respiratory distress syndrome occurred more often (73% vs 53%, RR 1.4, 95% CI 1.1, 1.7) and it was more severe and more complicated in infants in the indicated group, compared with those in the control group. Symptomatic chronic lung disease at one year of age was more common in infants in the indicated group than in the control group (15% vs 3%; RR 4.6, 95% CI 1.4, 15.9). CONCLUSIONS: Not only the risks of neonatal mortality and morbidity but also long term pulmonary consequences, appear to be greater in infants born preterm by indicated delivery than in preterm infants born spontaneously at corresponding weeks.

Asphyxia Neonatorum↗
PubMed1995

Identifying deprived areas using indices from the 1991 census and information about the recipients of community charge and council tax benefit.

STUDY OBJECTIVE: To assess the level of agreement between those small areas selected as materially deprived by indicators derived from the 1991 census and those indicators derived from local authority benefit data. DESIGN: Census indices of deprivation and local authority benefits data were collected, compiled, and correlated for three districts in Yorkshire at enumeration district (ED) level. The composition of the "most deprived" quintiles of pairs of indicators was compared. PARTICIPANTS: Data were obtained from the 1991 census for the Bradford, Kirklees, and Rotherham districts. Community charge benefit and council tax benefit data were also obtained for all claimants in the three districts. MAIN RESULTS: Correlation coefficients between indicators of deprivation from the census and from the benefits data were shown to be quite high. However, the composition of EDs in the highest quintiles of pairs of indicators showed marked differences. CONCLUSIONS: Census indicators of deprivation and local authority benefits data select broadly similar groups of "deprived" EDs. Where deprivation indicators disagree is in the composition of specific quintiles which is due partly to methodological differences in the construction of the indicators, partly to deficiencies of the benefit data, and partly to the different aspects of deprivation which the various indicators measure.

Data Collection↗
PubMed2004

A critique of international indicators of sexual risk behaviour.

OBJECTIVES: To investigate whether the indicators of sexual risk behaviour, defined by UNAIDS for use among members of general populations, have been found as risk factors, to examine how information on sexual behaviour is collected and summarised in order to calculate the indicators, and to look for possible sources of error in the data and in interpretation of those indicators. METHODS: The literature on risk factors for HIV infection was reviewed. Indicators were calculated for countries where data were available for two or more points in time. RESULTS: Indicators of sexual behaviour describe behaviours that are relevant to HIV risk and that are amenable to change. These behaviours do not correspond closely to the individual risk factors for HIV infection that have been identified in observational studies. CONCLUSIONS: Although potential errors of both measurement and interpretation exist, most of the indicators currently defined can fulfil their purpose, providing they are used with caution. Many of the indicators should not be interpreted in isolation but need supporting information to make sense of trends or differences between groups. Much of this information is provided by other indicators. The source of the data used to calculate the indicator is potentially important and should always be provided with indicator estimates. Some estimate of the accuracy of the estimate, either by means of confidence intervals or the number of respondents, should be given.

Age Factors↗
PubMed2002

[Change in indications for cesarean section].

The drastic decrease in the maternal lethality risk has influenced the indication for caesarean section. As the overall difference in mortality and morbidity between elective caesarean section and attempted vaginal delivery decreases, the consequence is a more liberal indication for caesarean section in order to avoid pain, damage to the pelvic structures and to protect the fetus. Maternal autonomy has to be respected by the obstetrician. He must know on what premises the mother has to be informed and given sufficient time to make a decision in favour of or against a caesarean section. To enable the patient to take the best decision, it is essential that she has ready access to reliable evidence-based information of the maternal and fetal risks. The motives of a woman asking for an elective caesarean section must be included into the medical indication. But even without a medical indication, respecting the right of self-determination of the woman, caesarean section on demand is in principle permitted by German law, since it is generally accepted that patients are entitled to request operations, which are not medically necessary, such as sterilisation, abortion and cosmetic surgery. When there is no contra-indication, the obstetrician can comply with the serious request of the woman, but without being obliged to do so.The drastic decrease in the maternal lethality risk has influenced the indication for caesarean section. As the overall difference in mortality and morbidity between elective caesarean section and attempted vaginal delivery decreases, the consequence is a more liberal indication for caesarean section in order to avoid pain, damage to the pelvic structures and to protect the fetus. Maternal autonomy has to be respected by the obstetrician. He must know on what premises the mother has to be informed and given sufficient time to make a decision in favour of or against a caesarean section. To enable the patient to take the best decision, it is essential that she has ready access to reliable evidence-based information of the maternal and fetal risks. The motives of a woman asking for an elective caesarean section must be included into the medical indication. But even without a medical indication, respecting the right of self-determination of the woman, caesarean section on demand is in principle permitted by German law, since it is generally accepted that patients are entitled to request operations, which are not medically necessary, such as sterilisation, abortion and cosmetic surgery. When there is no contra-indication, the obstetrician can comply with the serious request of the woman, but without being obliged to do so.

Cesarean Section↗
PubMed2006

Evaluating indices of traditional ecological knowledge: a methodological contribution.

BACKGROUND: New quantitative methods to collect and analyze data have produced novel findings in ethnobiology. A common application of quantitative methods in ethnobiology is to assess the traditional ecological knowledge of individuals. Few studies have addressed reliability of indices of traditional ecological knowledge constructed with different quantitative methods. METHODS: We assessed the associations among eight indices of traditional ecological knowledge from data collected from 650 native Amazonians. We computed Spearman correlations, Chronbach's alpha, and principal components factor analysis for the eight indices. RESULTS: We found that indices derived from different raw data were weakly correlated (rho<0.5), whereas indices derived from the same raw data were highly correlated (rho>0.5; p < 0.001). We also found a relatively high internal consistency across data from the eight indices (Chronbach's alpha = 0.78). Last, results from a principal components factor analysis of the eight indices suggest that the eight indices were positively related, although the association was low when considering only the first factor. CONCLUSION: A possible explanation for the relatively low correlation between indices derived from different raw data, but relatively high internal consistency of the eight indices is that the methods capture different aspects of an individual's traditional ecological knowledge. To develop a reliable measure of traditional ecological knowledge, researchers should collect raw data using a variety of methods and then generate an aggregated measure that contains data from the various components of traditional ecological knowledge. Failure to do this will hinder cross-cultural comparisons.

Adolescent↗
PubMed2001

Comparison of measured and estimated indices of insulin sensitivity and beta cell function: impact of ethnicity on insulin sensitivity and beta cell function in glucose-tolerant and normotensive subjects.

Type 2 diabetes mellitus is the result of an imbalance between insulin sensitivity and beta cell function. Although the assessment of these 2 parameters is critical for various studies, the current methods are time consuming and labor intensive. Recently, new estimated indices have been proposed. We examined the impact of ethnicity on the indices of insulin sensitivity and beta cell function measured from the hyperglycemic clamp and compared the results to the estimated indices, proposed by Matsuda and DeFronzo and Stumvoll et al., from a standard oral glucose tolerance test in 105 healthy, glucose-tolerant, and normotensive subjects from 4 ethnic groups. Among the ethnic groups, differences were noted in the measured insulin sensitivity (P = 0.0006) and beta cell function (P = 0.006 for the first phase insulin response, P = 0.0002 for the second phase insulin response). Although the estimated indices correlated with the measured indices (r(2) = 0.5184--0.3014), the estimated indices barely detected the differences among the ethnic groups. Multivariate analysis confirmed that ethnicity had an independent impact for the measured indices, but had only a modest impact on the estimated insulin sensitivity indices and had no impact on the estimated indices of beta cell function. We conclude that although the estimated indices of insulin sensitivity and beta cell function from the oral glucose tolerance test correlated with the measured ones in a wide spectrum of healthy, glucose-tolerant, and normotensive subjects, they were much less likely to detect the differences than measured ones among the ethnic groups.

Adolescent↗
PubMed2002

Indicator-based assessment of environmental hazards and health effects in the industrial cities of upper Silesia, Poland.

Using an indicator-based approach, we assessed environmental hazards and related health effects in populations of industrial cities with more than 100,000 inhabitants in Upper Silesia, Poland, and analyzed the relationship between environment and health. We adopted the method developed by Dutkiewicz et al. for assessing large geographic areas. Based on routinely collected environmental and health data, two groups of indicators, environmental indicators (EIs) and health status indicators (HSIs), related to environmental contamination were selected. The EI and HSI values were normalized and aggregated into synthetic measures using Strahl's taxonometric method. The synthetic measures indicated the intensity of environmental hazards and health outcomes. We used a three-level index scale to compare and rank the cities under the study and, consequently, to facilitate decision making. Findings of the assessment identified cities where actions aimed at reducing environmental hazards and improving population health status should be established as priorities. These cities included Chorzów, Katowice, Sosnowiec, Bytom, and Zabrze. We found a high correlation between the synthetic measures of environmental indicators and the synthetic measure of health status indicators (r = 0.77), as well as a high level of consistency between environmental hazard indices and environmental-related health status indices (73%). This may indicate the existence of a causal relationship between the environmental contamination within industrial cities and the health status of their inhabitants.

Adolescent↗
PubMedDate not supplied

Prescribing indicators for evaluating drug use in nursing homes.

OBJECTIVE: To evaluate drug use in 2 Dutch nursing homes (254 residents) by developing and evaluating prescribing indicators based on pharmacy prescription data. METHODS: We evaluated the prescribing of benzodiazepines, nonsteroidal antiinflammatory drugs (NSAIDs), ulcer-healing drugs, and diuretics. Prescribing indicators were used to identify prescribing that was potentially not in line with recommendations in national and regional prescribing guidelines. We used both descriptive indicators, such as the number and percentage of users, and indicators reflecting potentially suboptimal prescribing, such as use of drugs outside the regional drug formulary, use of >1 drug from the same drug class, and prescription of drug dosages above recommended values. When potentially suboptimal prescribing was found, we verified the findings by means of an interview with 1 of the prescribers. RESULTS: The prescribing indicators we assessed were generally in agreement with national and regional guidelines. However, prescribing of NSAIDs without concomitant prescribing of gastroprotective drugs was found in a relatively high number of patients. After prescriber interview and patient chart review, it was found that some prescribing indicators, such as dosages above recommended values, were not always indicative for suboptimal prescribing. CONCLUSIONS: This pilot study showed that prescribing indicators based solely on pharmacy prescription data can be a useful tool to evaluate drug prescribing. With some of these prescribing indicators, we identified cases of potentially suboptimal prescribing. However, with other indicators such as those based on drug dosages, we could not identify suboptimal prescribing, and clinical information from the prescriber was necessary to get insight into the appropriateness of prescribing.

Aged↗
PubMed2001

An evaluation of occlusal contact marking indicators. A descriptive quantitative method.

BACKGROUND: Dentistry needs an accurate means of recording occlusal contacts. The authors undertook a study to evaluate the accuracy of occlusal contact marking indicators and the reproducibility of their results. METHODS: The authors recorded occlusal contact areas using occlusal indicators made of paper, film and silk. They studied 10 indicators by testing them on articulator-mounted, impact-resistant casts and measuring the surface area of the resultant contact marks made on impact using a video camera, a frame grabber and a computer-linked image analyzer. RESULTS: All indicators differed in surface area markings between and within groups. The indicator's thickness and color and the material from which it was made separately and interactively had an effect on the size of the markings. Measurements were evaluated at a P = .05 significance level. The authors used Bonferroni-adjusted cutoffs when computing post hoc pairwise comparisons. The data were grouped into four categories: descriptive statistics, comparison of indicators by surface area marked, indicator thickness and repeatability. CONCLUSIONS: Indicators vary, and their markings may not be repeatable even when they are used alike. Further study is required, as is the development of an indicator measuring standard. CLINICAL IMPLICATIONS: Indicators are used to determine occlusal disharmony and to establish occlusal harmony. Since the accuracy of the markings can be questioned, the interpretation of the markings may be correct but the accuracy of the markings themselves may be misleading.

Analysis of Variance↗
PubMedDate not supplied

Preventable drug-related morbidity in older adults 1. Indicator development.

OBJECTIVE: To develop viable clinical indicators of preventable drug-related morbidity (PDRM) in older adults. METHODS: A survey was constructed, listing the clinical outcome and pattern of care related to a number of possible PDRMs in older adults. Using the Delphi technique, a geriatric medicine expert panel of 6 physicians and one clinical pharmacist from a hospital-based health care system was asked to judge whether the outcome in each situation was foreseeable and recognizable, and whether causality was identifiable and controllable. The panel could also suggest additional PDRMs. RESULTS: Fifty-two consensus-approved clinical indicators of PDRM in older adults were developed after 2 rounds of the Delphi technique. There was a high degree of consensus among the expert panel: all 7 members agreed on 35 indicators; 6 of 7 members agreed on 15 indicators; and 5 members agreed on 2 indicators. Only 6 outcomes and patterns of care were rejected as indicators. CONCLUSIONS: This phase of the study showed that consensus on clinical indicators of PDRM can be reached among experts. These indicators could be used by a managed care organization to proactively identify patients at risk for a PDRM and to improve the quality, safety, and appropriateness of medication use. Additionally, the indicators form an important bridge between processes and outcomes of care and could be used in conjunction with HEDIS and other performance indicators.

Journal Article↗
PubMed1988

Testing reliability of plaque and gingival indices. Two methods.

This investigation was undertaken to compare two methods of interexaminer and intraexaminer reliability in the evaluation of Plaque and Gingival Indices prior to a study of toothbrushing. Inter-/intraexaminer reliabilities were compared using a projected slide series consisting of 40 slides of clinical examples of gingival inflammation and plaque accumulation. Time between assessments was three weeks. Using the slide technique, intraexaminer reliability was established for: (1) Gingival Indices and (2) Plaque Indices. Interexaminer reliability was also established for Gingival Indices. Interexaminer reliability could not be established for Plaque Indices on the first assessment but was established on the post-assessment. Intraexaminer reliability was also determined through clinical examinations of patients. A third clinician was used to manipulate the tissue while investigators evaluated bleeding on provocation and plaque accumulation. Significant results were established for the Gingival Indices and Plaque Indices. Results of this investigation suggest that significant inter-/intraexaminer reliabilities may be obtained for gingival indices using the slide technique. In addition, the clinic technique appeared useful for assessing interexaminer reliability for Gingival Indices. Plaque Indices using the slide technique required more practice than those using the clinic technique.

Dental Health Surveys↗
PubMed2004

Indications for magnetic resonance imaging in presumed adolescent idiopathic scoliosis.

BACKGROUND: The use of magnetic resonance imaging has led to the diagnosis of abnormalities of the central nervous system associated with apparent idiopathic scoliosis. The indications for magnetic resonance imaging for presumed adolescent idiopathic scoliosis have not been established. METHODS: One thousand, two hundred and eighty children with presumed adolescent idiopathic scoliosis were evaluated over a ten-year period. Magnetic resonance imaging of the central nervous system (brainstem and spinal cord) was performed for specific patients, on the basis of the presence of selected indicators determined from the clinical history, physical examination, and plain radiographic examination of the spine. The medical records were reviewed to determine the specific indicators, the results of the imaging studies, and the subsequent treatment. RESULTS: Magnetic resonance imaging was ordered for 274 (21%) of the 1280 children who were evaluated. Abnormal findings were seen in twenty-seven (10%) of the 274 patients who underwent imaging, or 2% of the entire cohort. The most valuable single indicator of an abnormal finding on magnetic resonance imaging was absence of thoracic apical segment lordosis: eight of thirty-nine patients with that indicator had an abnormal finding on magnetic resonance imaging. The optimal diagnostic yield for a single category of indicators occurred when an atypical curve pattern was the only indicator: six of fifty-eight patients in whom this was the case had an abnormal finding on magnetic resonance imaging. None of the twenty children in whom pain was the only indicator category had an abnormal imaging study. The optimal diagnostic yield occurred when both an atypical curve pattern and neurological indicators were present: thirteen (25%) of fifty-three patients in whom this was the case had an abnormal finding on magnetic resonance imaging. Thirteen of the twenty-seven patients received surgical treatment for the abnormality of the central nervous system revealed by the imaging. CONCLUSIONS: The correct use of diagnostic tests is an important component of effective medical practice. An abnormality of the central nervous system is present in approximately 10% of patients with presumed adolescent idiopathic scoliosis in whom only subtle abnormalities are identified on the basis of the clinical history, physical examination, or radiographic examination. Knowledge of the diagnostic value of the specific clinical indicators, considered individually and in combination, can help the clinician to determine more effectively when advanced imaging of the central nervous system should be performed.

Adolescent↗
PubMed1998

A panel of indices in newborns with birthweight more than 2500 grams treated with conventional ventilation during the neonatal period.

Intelligent application of the monitoring methods forms the mainstay of the diagnostic and treatment strategy in intensive care and is in harmony with the basic principle of minimal handling in neonatal intensive care. Thus, based on the monitoring data it is possible to derive a number of equipment, oxygen-derivative, respiratory, hemodynamic, metabolic and other indices. The information provided by these indices is significantly greater and more important than that gained from the initial data (ventilatory parameters) and biologic variables). It is of foremost importance for the successful performance of both conventional and nonconventional ventilation techniques and the evaluation of the newborn status as well as for prognostic discussions and conclusions. In the present study we used the Neonatal Intensive Computer File developed by the author with graphic trends for visualization of the dynamics of indices over time in each and every one of the neonates in our groups of patients which are statistically analyzed using standard methods and computer models. A total of 30 neonates (14 survived and 16 non-survived) who had been treated with conventional ventilation during the neonatal period were enrolled in the study. Our results show that: 1. The dynamics of indices between the survived and the non-survived shows significant differences in terms of values, dynamics and general tendency. 2. Major relationships between the different indices are observed and their correct interpretation improves the information yield of each and every one of the above-mentioned indices. There are identical tendencies in the dynamics of MAP, OI and VI values in the survived whereas in the non-survived these indices are discordant. The improvement in a/A values coincides in time with that of AaDO2 reduction, or the improvement in oxygenation is accompanied by a reduction of the degree of shunting in the survived which is a favorable prognostic indication, whereas decrease in a/A values in the presence of practically unchanged AaDO2 values suggests an unfavorable outcome. The improvement in compliance is accompanied by improvement in the rate of oxygenation in the survivor group whereas in the non-survivors the deterioration in oxygenation is accompanied by a decrease in compliance and reflects the major underlying pathologic mechanism of gas exchange. 3. The panel of indices used by us specifies exactly the onset of the changes in gas exchange. 4. The application of the panel of indices contributes to more profound diagnostic reasoning and conclusions as well as the therapy and prognosis ad vitam.

Birth Weight↗
PubMed2000

Socio-demographic factors and indications in second trimester voluntary abortion.

BACKGROUND: According to Italian Law, second trimester termination of pregnancy is allowed for life threatening conditions or for severe psychological distress, linked or not to prenatal diagnosis of foetal abnormalities. Socio-demographic factors related to this condition have been analysed. METHODS: Clinical records of 330 patients admitted during the years 1988-1997 to the Obstetrics and Gynaecology Department, University of Bari, Italy, for voluntary second trimester abortion, were examined. Maternal psychiatric indications have been given in nearly all of the cases. In 123 cases the indications were secondary to the women suffering a psychiatric disorder due to foetal pathologies. In 205 cases--where poor social conditions were more frequent--the indication was given on the ground of a psychiatric disorder linked to the pregnancy itself. RESULTS: Significantly higher incidence of teenagers (23.3%) and singles (50%) in women who underwent a late abortion. Students were 16.4% in this group. In primary psychiatric indication singles prevail (74.4%) and students represent 23.6% while in secondary psychiatric indication the married were 84.7%, students only 4.8%. In primary psychiatric indication 32.5% of women aged nineteen or less, while in secondary psychiatric indication this percentage was 8%. CONCLUSIONS: Among patients who have a late abortion, teenagers students and singles are prevalent, these patients have significantly more primary psychiatric indications, not linked to foetal abnormalities. The high percentage of teenagers with primary psychiatric indication could depend on inadequate information and social service. Reduction of mid-trimester terminations of pregnancy can be significantly achieved intervening in this group of young women. On the other hand, in secondary indications earlier diagnosis of foetal abnormalities must be encouraged (villocentesis instead of amniocentesis) and abortion discouraged when the foetal pathology is minor, treatable or unlikely to significantly impair the future quality of life.

Abortion, Induced↗