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PubMed2001

Increased adenosine in cerebrospinal fluid after severe traumatic brain injury in infants and children: association with severity of injury and excitotoxicity.

OBJECTIVES: To measure adenosine concentration in the cerebrospinal fluid of infants and children after severe traumatic brain injury and to evaluate the contribution of patient age, Glasgow Coma Scale score, mechanism of injury, Glasgow Outcome Score, and time after injury to cerebrospinal fluid adenosine concentrations. To evaluate the relationship between cerebrospinal fluid adenosine and glutamate concentrations in this population. DESIGN: Prospective survey. SETTING: Pediatric intensive care unit in a university-based children's hospital. PATIENTS: Twenty-seven critically ill infants and children who had severe traumatic brain injury (Glasgow Coma Scale < 8), who required placement of an intraventricular catheter and drainage of cerebrospinal fluid as part of their neurointensive care. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients ranged in age from 2 months to 14 yrs. Cerebrospinal fluid samples (n = 304) were collected from 27 patients during the first 7 days after traumatic brain injury. Control cerebrospinal fluid samples were obtained from lumbar puncture on 21 infants and children without traumatic brain injury or meningitis. Adenosine concentration was measured by using high-pressure liquid chromatography. Adenosine concentration was increased markedly in cerebrospinal fluid of children after traumatic brain injury vs. controls (p < .001). The increase in cerebrospinal fluid adenosine was independently associated with Glasgow Coma Scale < or = 4 vs. > 4 and time after injury (both p < .005). Cerebrospinal fluid adenosine concentration was not independently associated with either age (< or = 4 vs. > 4 yrs), mechanism of injury (abuse vs. other), or Glasgow Outcome Score (good/moderately disabled vs. severely disabled, vegetative, or dead). Of the 27 patients studied, 18 had cerebrospinal fluid glutamate concentration previously quantified by high-pressure liquid chromatography. There was a strong association between increases in cerebrospinal fluid adenosine and glutamate concentrations (p < .005) after injury. CONCLUSIONS: Cerebrospinal fluid adenosine concentration is increased in a time- and severity-dependent manner in infants and children after severe head injury. The association between cerebrospinal fluid adenosine and glutamate concentrations may reflect an endogenous attempt at neuroprotection against excitotoxicity after severe traumatic brain injury.

Adenosine↗
PubMed2004

C-reactive protein and alpha2-macroglobulin plasma activity in medium-severe and severe psoriasis.

BACKGROUND: An acute phase of psoriasis can be induced by cytokines involved in psoriatic pathogenic phenomena. Activation of the acute phase reaction by proinflammatory cytokines (including interleukins 1 and 6, tumour necrosis factor alpha) may account for systemic symptoms in severe psoriasis, especially in pustular and arthropathic forms of this disease. OBJECTIVE: To study the activity of selected acute phase proteins in psoriatics before and after effective treatment. METHOD: Plasma concentrations of C-reactive protein (CRP) and alpha2-macroglobulin (alpha2-MG) were examined in 175 males with medium-severe and severe psoriasis in the active stage, before treatment and in remission achieved with various treatments (local, acitretin, psoralen + ultraviolet A, retinoid + psoralen + UVA [Re-PUVA] methotrexate, cyclosporin A). Clinical activity of psoriasis was evaluated using the Psoriasis Area and Severity Index score, ranging from 18 to 70.8 (mean 29.2). Measurements were done using the immunoenzymatic method. The control group consisted of 30 healthy male volunteers. RESULTS: In the active stage of disease highly increased plasma levels of both CRP and alpha2-MG were found (P < 0.001). It appeared that efficacious treatment was correlated with a considerable decrease of the proteins examined towards the control values. Mean levels of alpha2-MG after treatment did not differ significantly from those of controls (P > 0.15). However, despite their strong decrease following all methods of treatment, mean plasma levels of CRP remained significantly elevated during remission compared with those of the healthy controls (P < 0.001). CONCLUSIONS: The results of this study indicate that in medium-severe and severe psoriasis the acute phase response can be initiated and is not completely extinguished in phases of clinical remission.

Adolescent↗
PubMed2006

A systematic review of the clinical and cost-effectiveness of memantine in patients with moderately severe to severe Alzheimer's disease.

Alzheimer's disease (AD) is the most common form of dementia and is characterised by a worsening of cognition, functional ability, and behaviour and mood. The objective of this study was to review the clinical and cost-effectiveness of memantine for the treatment of patients with moderately severe to severe AD. To achieve this, a systematic search and review of the clinical and cost effectiveness literature for memantine was undertaken. The literature search covered the period from the inception of MEDLINE, Cochrane Library, EMBASE and other electronic databases until July 2004. The search included randomised controlled trials (RCTs) and full economic evaluations that assessed the use of memantine in patients with moderately severe to severe AD. Two published RCTs were included in this review; in one of these trials the participants were already being treated with donepezil. The two RCTs showed benefit for patients receiving memantine compared with placebo on the outcome measures of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory modified for severe dementia, the Clinician's Interview-Based Impression of Change Plus Caregiver Input, and the Severe Impairment Battery, and that memantine appeared to be slightly more effective in patients already receiving a stable dose of donepezil. Five cost-effectiveness studies were included in the review. Although these studies reported cost reductions and improved outcomes with memantine, the evaluations were based on a number of assumptions. In conclusion, memantine appears to be beneficial when assessed using functional and global measurements. However, the effect of memantine on cognitive scores and behaviour and mood outcomes is less clear. Cost-effectiveness is dependent upon assumptions surrounding clinical effect and context-specific cost data.

Aged↗
PubMed1984

The Severity of Illness Index as a severity adjustment to diagnosis-related groups.

This article discusses the Severity of Illness case-mix groups, and suggests a refinement to diagnosis-related groups (DRG's) designed to accommodate the important element of patient severity. An application of the suggested refinement is presented in a discussion of the efficient production of hospital services. The following areas are addressed. A brief summary of the goals and development of the Severity of Illness Index, and the methodology used to collect severity of illness data on hospital inpatients. Comparative analyses of the resulting case-mix groups within hospitals, and an application of severity-adjusted diagnosis-related groups case-mix definitions. The contribution of the variation in physician practice patterns to the variation in resource use per patient within a hospital. Cross-hospital comparisons. Some of the consequences of incorporating a patient severity refinement into the prospective payment system.

Costs and Cost Analysis↗
PubMed1998

Systemic endothelial activation occurs in both mild and severe malaria. Correlating dermal microvascular endothelial cell phenotype and soluble cell adhesion molecules with disease severity.

Fatal Plasmodium falciparum malaria is accompanied by systemic endothelial activation. To study endothelial activation directly during malaria and sepsis in vivo, the expression of cell adhesion molecules on dermal microvascular endothelium was examined in skin biopsies and correlated with plasma levels of soluble (circulating) ICAM-1, E-selectin, and VCAM-1 and the cytokine tumor necrosis factor (TNF)-alpha. Skin biopsies were obtained from 61 cases of severe malaria, 42 cases of uncomplicated malaria, 10 cases of severe systemic sepsis, and 17 uninfected controls. Systemic endothelial activation, represented by the up-regulation of inducible cell adhesion molecules (CAMs) on endothelium and increased levels of soluble CAMs (sCAMs), were seen in both severe and uncomplicated malaria and sepsis when compared with uninfected controls. Plasma levels of sICAM-1, sVCAM-1, and sE-selectin correlated positively with the severity of malaria whereas TNF-alpha was raised nonspecifically in malaria and sepsis. Immunohistochemical evidence of endothelial activation in skin biopsies did not correlate with sCAM levels or disease severity. This indicates a background of systemic endothelial activation, which occurs in both mild and severe malaria and sepsis. The levels of sCAMs in malaria are thus not an accurate reflection of endothelial cell expression of CAMs in a particular vascular bed, and other factors must influence their levels during disease.

Adolescent↗
PubMed1992

Correlation between injury severity scores and subjective ratings of injury severity: a basis for trauma audit.

A retrospective review of 1900 road accident victims attending the emergency departments of two Melbourne hospitals was undertaken to identify Injury Severity Score levels which could distinguish between minor, moderate, severe and critical injury. Injuries scoring ISS 6 or below were designated 'minor' because they were associated with a low risk of requiring admission to hospital. Case notes of patients scoring above ISS 6 were then reviewed by a panel of clinicians, who independently rated each patient's overall injury severity as moderate, severe or critical according to what was recorded in the notes and their 'clinical' judgement. ISS values were compared with clinicians' ratings. Measures of each clinician's individual rating consistency, and correlation between pairs of clinicians with respect to inter-rater consistency, were made. By combining data from both hospitals it emerged that 'moderate' injury corresponded to ISS 8-13, 'severe' to ISS 14-20 and 'critical' to ISS 21 and above. These ISS breakpoints will be useful in selecting groups of injured patients for future trauma audit studies.

Accidents, Traffic↗
PubMed2005

The effects of disease severity, use of corticosteroids and social factors on neuropsychiatric complaints in severe acute respiratory syndrome (SARS) patients at acute and convalescent phases.

OBJECTIVE: To evaluate the effects of disease severity, corticosteroids and social factors on neuropsychiatric complaints in severe acute respiratory syndrome (SARS) patients, both during acute and convalescent phases. SUBJECTS AND METHODS: Self-administered mail questionnaires survey to 308 SARS patients after discharging from hospital. Both patients and their families were asked about symptoms related to various neuropsychiatric domains, and the questions covered both acute and convalescent phases. RESULTS: Among the 102 (33%) valid replies, 65% had strong symptoms in convalescent phase as indicated by GHQ28 score >/= 5. In multiple linear regression analysis, use of pulse steroid and total dosages of pulse steroid during hospitalisation were predictive for anxiety-depression, psychosis and behavioural symptoms in acute phase, the effects persisted in convalescent phase. Disease severity had direct correlation with symptoms in all neuropsychiatric domains at acute phase and anxiety-depression and cognition at convalescent phase. Health care workers had more neuropsychiatric complaints in both phases. Severity of symptoms, corticosteroids and social factors explained about half of the variances (R(2) = 52) in anxiety-depression at acute phase and 33% at convalescent phase. CONCLUSION: Severe disease, high dose corticosteroids and being health care workers were independent predictors of neuropsychiatric complaints in both acute and convalescent phases.

Adult↗
PubMed2007

Severe asthma: lessons from the Severe Asthma Research Program.

Severe asthma affects only a small percentage of the asthma population. However, these patients remain poorly understood and difficult to treat. Because the numbers are relatively small (10% or less of the asthma population), a network approach with shared protocols, samples, and data provides a unique opportunity to recruit the numbers of subjects necessary to perform adequately powered studies. The Severe Asthma Network (Severe Asthma Research Program) was established by the National Heart, Lung, and Blood Institute in 2001 to advance collectively the study of severe asthma to determine factors that differentiated these patients or subjects from those with milder asthma. Nearly 800 subjects have been recruited in less than 4 years to begin to address these differences. Future studies will specifically evaluate the role of inflammatory/oxidative processes, infection, genetics, and the distal lung in the pathogenesis of severe asthma.

Asthma↗
PubMed1996

The National Hospital Seizure Severity Scale: a further development of the Chalfont Seizure Severity Scale.

Seizure severity scales have recently been identified as an important additional outcome measure in trials of new antiepileptic drugs (AEDs). The National Hospital Seizure Severity Scale (NHS3) is presented as a refined version of the Chalfont Seizure Severity Scale. The principal advantages of the new version are that it is quicker and simpler to apply, the limits of reliability are now clearly defined, and construct validity for the scale is available. The scale is administered by a health professional during an interview with a patient and a witness to the seizures. It contains seven seizure-related factors and generates a score from 1 to 27. An intraclass correlation coefficient of 0.90 was obtained during interobserver and test-retest reliability assessment, suggesting that the scale is sufficiently reliable for group studies. Scores for an individual patient should be interpreted with caution in light of the limits of agreement obtained. Validation experiments indicate that NHS3 measures seizure severity in a manner compatible with the subjective impression of people with epilepsy. We suggest that the NHS3 is a valid, easily applicable measure of seizure severity that is acceptably reliable for use in trials of novel AEDs.

Adult↗
PubMed1994

Severe impairment battery. A neuropsychological test for severely demented patients.

OBJECTIVE: Patients with progressive dementia invariably evolve to a stage where they can no longer be tested by standard neuropsychological tests. We studied the use of the Severe Impairment Battery (SIB) in such patients. DESIGN: Case series. SETTING: Geriatric long-term facility. PATIENTS: Sixty-nine patients who met the criteria of the Diagnostic and Statistical Manual for Mental Disorders, Revised Third Edition, for dementia were selected. The diagnosis of probable Alzheimer's disease was established according to the guidelines suggested by the National Institute of Neurologic and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association. There were 18 men and 51 women. The mean age of the population was 82.99 +/- 5.66 years. The mean Mini-Mental State Examination (MMSE) score was 10.71 +/- 6.14. MAIN OUTCOME MEASURE: To characterize the cognitive profile and evolution of severely demented patients by means of the SIB. RESULTS: The mean score on the SIB was 92.52 +/- 31.92, with a possible maximum of 133 points. Subgroups of patients with the most severe degree of dementia (MMSE scores of 0 to 5 and 6 to 11) showed significant differences in their scores on the SIB. In contrast, no differences were found between subgroups with MMSE scores of 6 to 11, 12 to 17, and greater than 17. Fifteen patients who had MMSE scores of less than 6 had SIB scores ranging from 7 to 81. All cognitive domains showed a deterioration across the four severity groups as determined by the MMSE scores and also during a longitudinal study performed on 26 patients. CONCLUSION: Our study indicates that the SIB is useful for the neuropsychological evaluation of severely demented patients and for their follow-up.

Aged↗
PubMed2003

Outcome of adult severe or very severe aplastic anemia treated with immunosuppressive therapy compared with bone marrow transplantation: multicenter trial.

To compare survival rates and long-term complications after bone marrow transplantation (BMT) or treatment with immunosuppressive agents (ISA) in the management of adult aplastic anemia (AA) and to identify prognostic factors associated with improved survival, we evaluated 229 adult AA patients treated with ISA from 1990 to 2001 and compared the results with those for 64 BMT recipients. Of 156 patients with severe aplastic anemia (SAA) or very severe AA treated with ISA (antithymocyte globulin [ATG] or ATG plus cyclosporine), 46.8% showed complete or partial response and 7.1% had relapses. After long-term follow-up, 1 case each of acute leukemia, myelodysplastic syndrome, and paroxysmal nocturnal hemoglobinuria developed. The 6-year survival rate was 69%. Response to ISA, disease severity, and low absolute neutrophil count (ANC) (< or = 200/mm3) were associated with poor survival. Patient age, sex, initial platelet count, etiology, or treatment regimen did not significantly affect survival. Cox regression analysis showed low ANC to be the only pretreatment variable significantly associated with poor survival (P = .000). Of 64 BMT recipients, 82.8% had sustained engraftment, and 12.5% experienced graft failure. Twenty (31.3%) of the patients developed grade II to IV acute graft-versus-host disease (GVHD), and 12 (18.8%) of the patients developed chronic GVHD. The 6-year survival rate was 79%. Patient age and sex, disease severity, etiology, ANC, initial platelet count, and treatment regimen did not affect survival. Survival of 83 AA patients, aged 14 to 40 years, treated with ISA was not statistically significant from that of 61 adult AA patients who underwent BMT (6-year survival rate, 65% and 79%, respectively). However, BMT in adult AA achieved long-term engraftment and a lower relapse rate than ISA. These results suggest that ISA can achieve a high response rate and long-term survival among patients with adult AA, regardless of disease severity. Further studies with larger numbers of patients and long-term follow-up are needed.

Adolescent↗
PubMed2005

Independent predictors of the severity of angiographic coronary atherosclerosis: the lack of association between impaired glucose tolerance and stenosis severity.

Independent predictors of the severity of coronary atherosclerosis are ill defined. We sought to determine the predictors and examine the association of impaired glucose tolerance with stenosis severity. Four hundred thirty-seven patients were studied who underwent coronary angiography for suspected coronary artery disease. Serum concentrations of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDLc), lipoprotein(a) [Lp(a)] and apolipoproteins (Apo A-I and Apo B) were measured and low-density lipoprotein cholesterol (LDLc) concentration was calculated. Except the patients treated for diabetes mellitus (DM), patients were classified into three groups such as normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and DM by glucose tolerance test. Coronary atherosclerosis index (CAI) representing the severity of coronary atherosclerosis was determined by summation of the stenosis score of all lesions on coronary angiograms. Results indicated that age, total amount of cigarettes smoked, Apo B/Apo A-I, and LDLc/HDLc correlated with CAI, whereas HDLc and Apo A-I concentrations inversely correlated with CAI. TC, TG, Lp(a), LDLc, Apo B concentrations and body mass index did not correlate with CAI. One- and two-hour plasma glucose concentrations and the area of plasma glucose concentration under the curve at the glucose tolerance test did not correlate with CAI, revealing that post-challenge glycemia is not associated with stenosis severity. CAI in IGT patients was significantly lower than that in DM patients but did not differ from that in NGT patients, indicating that IGT does not affect the stenosis severity. Multivariate analysis showed that age, male gender, Apo B/Apo A-I, DM, systemic hypertension, and total amount of cigarettes smoked were independent predictors of CAI.

Adolescent↗
PubMed2006

Central nervous system infection is an important cause of death in underfives hospitalised with World Health Organization (WHO) defined severe and very severe pneumonia.

Over 6 years, 1667 children aged 2-59 months admitted for pneumonia [1287 severe and 380 very severe] were studied. The case fatality rate (CFR) in children with severe pneumonia was 2.1% and 14.3% with CNS infection, with very severe pneumonia the CFR was 18.9%, 10.4% in those with hypoxemia and 43.6% with CNS infection. High CFRs were associated with CNS infection and inability to drink/cyanosis. The appropriate management of children with very severe pneumonia should include cerebrospinal fluid examination, oxygen monitoring and possibly ventilated support, suggesting that these are minimal standards of care at the district hospital.

Age Factors↗
PubMed2003

Cognitive remediation of working memory deficits: durability of training effects in severely impaired and less severely impaired schizophrenia.

OBJECTIVE: To determine whether augmenting work therapy (WT) with neurocognitive enhancement therapy (NET) yields greater improvement in working memory performance than WT alone and whether there is an interaction with severity of impairment. METHOD: A total of 102 participants with schizophrenia or schizoaffective disorder were categorized as severely or less severely cognitively impaired and randomly assigned to receive NET + WT or WT alone. NET consisted of cognitive training exercises in attention, memory, executive function, and social information processing, and WT was a 6-month work program. RESULTS: Comparison on Digits Backwards from intake to follow-up revealed significantly greater improvement for participants receiving NET + WT, but there was no interaction with severity group. Follow-up 6 months after training showed that training effects endured. CONCLUSION: NET + WT improved working memory for most participants regardless of impairment severity. Intensity and duration of training may have contributed to duration of effects. Findings support continued exploration of cognitive remediation.

Adult↗
PubMed1998

The characteristics and residential situations of people with severe intellectual disability and the most severe challenging behaviour in Wales.

A total population study of people in Wales with severe intellectual disability and the most severe challenging behaviour was undertaken to identify their characteristics, and the nature of their residential arrangements and service support. Forty-one participants were identified: five living in family homes, 17 in community housing, 17 in hospitals and two in hostels. The family home group had slightly higher adaptive behaviour scores than residents in community housing. Both groups had significantly higher scores than the hospital and hostel residents combined. Assessments of challenging behaviour showed the groups to be similar and to have a considerable range and extent of severely problematic behaviour. Co-occurrence of several forms of frequent severe problem behaviour was the norm and there was a marked association with social impairment. The five people living in their family homes had nominated service keyworkers, but reported professional input was low. The residential situations comprised two main service types: (1) traditional services, which were characterized by large living unit and facility size, atypical architectural design, relative isolation from the community, a greater level of buildings adaptations, low staff:resident ratios, a relatively high percentage of qualified staff, and a relative absence of systematic approaches to goal planning and structured activity; and (2) new community houses, which were characterized by small size, domestic design, location within the community, a lower level of buildings adaptations, much higher staff:resident ratios, and less emphasis on qualified staff but a greater emphasis on systematic working methods. Community settings were similar in having 'specialist' resident groupings based on challenging behaviour or conditions like autism in which challenging behaviours are common. A policy to provide for people with these characteristics being resettled from traditional settings in this way seems to have been established.

Adult↗
PubMed2005

Serum lipids and disease severity in children with severe meningococcal sepsis.

OBJECTIVE: To evaluate the role of cholesterol and lipoproteins in children with severe meningococcal sepsis. DESIGN: Retrospective observational study. SETTING: A university-affiliated pediatric intensive care unit. PATIENTS: Fifty-seven patients admitted to the pediatric intensive care unit with meningococcal sepsis or septic shock. INTERVENTIONS: Total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) concentrations were measured in serum samples drawn within 6 hrs after admission to the pediatric intensive care unit and 12, 24, 48, 72 hrs, 7 days, and 1-3 months afterward. Standard deviation scores of these variables (sd scores) were calculated to correct for age-related differences. To assess disease severity, the Pediatric Risk of Mortality (PRISM) score, the Sepsis-related Organ Failure Assessment (SOFA) score, and the Disseminated Intravascular Coagulation (DIC) score were determined as well as selected laboratory variables. MEASUREMENTS AND MAIN RESULTS: Ten patients died. Total serum cholesterol on admission was very low in all patients. This hypocholesterolemia was caused by low HDL concentrations but in particular by low LDL cholesterol levels. Eight patients had undetectable LDL levels on admission. Total cholesterol levels were significantly lower in nonsurvivors than in survivors (0.97 vs. 1.60, p = .013), whereas levels of LDL and HDL did not significantly differ between both groups. Total cholesterol sd scores were similar between survivors and nonsurvivors. Within survivors, cholesterol sd score was significantly lower in patients with shock compared with those with sepsis. The total cholesterol, HDL, and LDL levels correlated with clinical variables of disease severity and with levels of cytokines. Total cholesterol, HDL, and LDL levels normalized rapidly in survivors and were completely normal 1-3 months after admission. CONCLUSIONS: Extremely low levels of total serum cholesterol, HDL, and LDL are found in the initial phase of children with severe meningococcal disease. Total cholesterol levels are significantly lower in nonsurvivors than in survivors, but not the sd score. Total cholesterol, HDL, and LDL levels on admission are inversely associated with disease severity. Hypocholesterolism is associated with hypocortisolism. The concentrations of total cholesterol and lipoproteins steadily increase after 24 hrs in survivors and are normalized 1-3 months after pediatric intensive care unit admission.

Adolescent↗
PubMed1993

Insulin-like growth factor-I blood levels in severely burned patients: effects of time post injury, age of patient and severity of burn.

OBJECTIVES: Insulin-like growth factor-I (IGF-I) is a polypeptide growth factor that stimulates protein synthesis. The aims of this study were to determine (1) the effect of a severe burn on blood IGF-I levels and (2) the variables controlling IGF-I level variations during recovery of these hypermetabolic patients. PATIENTS: Eleven patients, nine men and two women (age range 22-55 years) were studied for 25 days following a severe burn (18-75% of total body surface area, mean 36%). Nitrogen balances were recorded daily and total IGF-I levels were measured every 3 days. MEASUREMENTS: IGF-I was extracted from serum using a validated formic acid-acetone methodology, then measured by a double antibody radioimmunoassay. IGF-I levels were compared to those of a reference healthy population. RESULTS: Within 24 hours following injury, IGF-I levels were low in all patients when compared to normal values for the same age range (mean +/- SEM of all patients, 131 +/- 26 micrograms/l). They remained low for the first week (days 4 and 7, 109 +/- 16 micrograms/l), then increased to reach normal values at the end of the study period (days 10-16, 144 +/- 19 micrograms/l, P = 0.005 when compared to days 4-7; days 19-25, 206 +/- 30 micrograms/l, P = 0.008 when compared to days 10-16). IGF-I levels were negatively correlated with age in the second phase of recovery only (days 10-16, r = -0.70, P < 0.05; days 19-25, r = -0.75, P < 0.01) and with severity of burn between days 19 and 25 (r = -0.62, P < 0.05). The presence of bronchial burn injury tended to lower IGF-I blood concentration (P = 0.08). Whereas IGF-I concentrations increased in the later phase of recovery, nitrogen balances did not. As a result, there was no significant correlation between these parameters. CONCLUSIONS: IGF-I levels followed a biphasic pattern in severely burned patients. They dropped dramatically in response to the traumatic shock, then increased during recovery. The degree of increase was dependent on the age of the patient and on the severity of the burn, but was not associated with an improvement in the nitrogen balance.

Acute Disease↗
PubMed1994

Evaluating therapeutic change in symptom severity at the level of the individual woman experiencing severe PMS.

Treatment effectiveness of an intervention designed for women experiencing severe Premenstrual Syndrome (PMS) was assessed at the level of the individual woman since patterns of individual response are of most relevance to practitioners. Symptom severity was evaluated daily in five women across seven menstrual cycles using a time-series methodology. Three symptom severity patterns emerged from the baseline data analysis: a "classic" PMS pattern, a premenstrual magnification pattern and a social week pattern. Patterns of therapeutic response emerged from the time-series analysis of post-treatment data compared with baseline symptom severity patterns: a "normalized" response pattern where symptom severity declined to a mild, cyclic process and an "unstable" response pattern that remained reactive. Treatment effects for menstrual cycle phenomena may be evaluated using the "normalizing" or "unstable" patterns as clinical indicators.

Adult↗