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At least 1,423 records · Page 79Linked to original sources
PubMed2004

The value of uterine artery Doppler ultrasound in the prediction of severe complications in a risk population.

AIM: The aim of this prospective study was to assess the role of uterine artery color Doppler waveform analysis in the prediction of adverse pregnancy outcome such as preeclampsia, intrauterine growth retardation, placental abruption or a combination of outcome parameters in risk pregnancies (n=52). METHODS: Various uterine artery Doppler ultrasound parameters (resistance index (RI)>0.58, RI>0.7 and uni/bilateral or bilateral notching) were tested. The mean time of delivery was 37+1 weeks' gestation. Six newborns (12%) were delivered before 34 weeks of gestation. The mean birth weight was 2,910 g. Dystrophic fetuses (<10% percentile) were registered in 7 cases (13%). In 11 of the 52 women (21%) a cesarean section was performed because of abnormal fetal heart recording. RESULTS: Preeclampsia was diagnosed in 4 cases (8%). In 4 cases (8%) an intrauterine fetal death was diagnosed. Placental abruption did not occur. The sensitivity of notching for the prediction of preeclampsia and for the prediction of a severe pregnancy complication was 75 and 69% with relative risks of 2.7 and 2.0. The sensitivity of notching in the uterine arteries for developing an intrauterine growth retardation (IUGR) was 71% with a relative risk of 2.2. The sensitivity of RI>0.58 in the uterine arteries for developing an IUGR was 67% with a relative risk of 5.4. The sensitivity of RI>0.58 for the prediction of preeclampsia, of intrauterine death and for the prediction of a severe pregnancy complication was 50, 75 and 80% with relative risks of 2.7, 8.1 and 10.9 respectively. CONCLUSION: The results of this study suggest that Doppler ultrasound of the uterine artery in the second trimester of gestation is a useful method to predict abnormal outcomes in risk pregnancies, with high negative predictive values.

Adult↗
PubMed2005

The validity of predicting maximal oxygen uptake from a perceptually-regulated graded exercise test.

The purpose of this study was to assess the validity of predicting maximal oxygen uptake(VO(2max)) from sub-maximal VO(2) values elicited during a perceptually-regulated exercise test. We hypothesised that the strong relationship between the ratings of perceived exertion (RPE) and VO(2) would enable VO(2max) to be predicted and that this would improve with practice. Ten male volunteers performed a graded exercise test (GXT) to establish VO(2max) followed by three sub-maximal RPE production protocols on a cycle ergometer, each separated by a period of 48 h. The perceptually-regulated trials were conducted at intensities of 9, 11, 13, 15 and 17 on the RPE scale, in that order. VO(2) and HR were measured continuously and recorded at the end of each 4 min stage. Individual's RPE values yielded correlations in the range 0.92-0.99 across the three production trials. There were no significant differences between measured VO(2max) (48.8 ml.kg(-1).min(-1)) and predicted VO(2) max values (47.3, 48.6 and 49.9 ml.kg(-1).min(-1), for trials 1, 2 and 3, respectively) when VO(2) max was predicted from RPE values of 9-17. The same was observed when VO(2max) was predicted using RPE 9-15. Limits of agreement (LoA) analysis on actual and predicted VO(2max) values (from RPE 9-17) were (bias+/-1.96xSDdiff) 1.5+/-7.3, 0.2+/-4.9 and -1.2+/-5.8 ml.kg(-1).min(-1), for trials 1, 2 and 3, respectively. Corresponding LoA values for actual and predicted VO(2max) (from RPE 9-15) were 5.4+/-11.3, 4.4+/-8.7 and 2.3+/-8.4 ml.kg(-1).min(-1), respectively. The data suggest that a sub-maximal, perceptually-guided, graded exercise protocol can provide acceptable estimates of maximal aerobic power, which are further improved with practice in fit young males.

Adult↗
PubMed2004

Bone densitometry: which skeletal sites are best predicted by bone mass determinants?

Evaluation of bone mineral content/bone mass density (BMC/BMD) is important to determine bone mass development among adolescents in health and disease. It is uncertain at which skeletal site BMC/BMD is best predicted by bone mass determinants. On the other hand, intrapersonal BMC/BMD data can be clustered into a composite index score to facilitate correlation and outcome prediction analysis. This study aimed to identify the skeletal site that was best predicted by bone mass determinants and to develop a composite index score based on multisite BMC/BMD values in healthy adolescent girls. Eleven BMD/BMC variables per subject were evaluated by using dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) in 236 healthy girls aged 12-15 years. Bone mass determinants, namely, weight, height, puberty, dietary calcium, physical activity, and bone turnover markers, were determined. Factor analysis was used to develop composite index scores that summarized characteristics of multisite BMC/BMD. Results showed that lumbar spinal BMD and BMC (by DXA) and tibial integral BMD (by pQCT) were the BMC/BMD sites better predicted by bone mass determinants (R2, 0.57-0.77) in multiple regression analysis. On the other hand, three composite index scores representing areal BMD, areal BMC, and vBMD were derived to summarize the original BMC/BMD values. The composite index scores had similar predicting power (R2, 0.419-0.749) compared to those of original BMC/BMD, indicating that the composite index scores were representative of the original variables. To conclude, lumbar spinal BMD and BMC and tibial integral BMD were the three BMC/BMD variables better predicted by bone mass determinants. This evaluation would help select appropriate skeletal sites as outcome measures for bone mass evaluation in future studies. Also, the development of composite index scores could help reduce the number of variables for correlation and outcome prediction analyses.

Absorptiometry, Photon↗
PubMed2004

Reliability of electrophysiologic anal tests in predicting the outcome of sacral nerve modulation for fecal incontinence.

INTRODUCTION: Sacral nerve modulation has been demonstrated to be a new efficacious treatment for fecal incontinence. The effectiveness of the procedure is preliminarily tested by means of a peripheral nerve evaluation. Integrity of the sacral neural pathway is generally believed to be a necessary condition for a good response, but no data are available to confirm whether electrophysiologic anal tests are predictive of the clinical outcome of the peripheral nerve evaluation. METHODS: Eighty-two incontinent patients underwent the peripheral nerve evaluation after full evaluation of the anorectal physiology. Univariate analysis was performed, and the positive predictive value, sensitivity, and specificity were calculated for each of the tests. RESULTS: Forty-six patients had successful results to the peripheral nerve evaluation and were subjected to permanent implant of a sacral electrostimulator. Anal sphincter electromyography had been performed in 60 patients, whereas pudendal nerve terminal motor latency had been assessed in 68 and evoked sacral potentials in 29 patients. Anal electromyography was statistically related to the outcome of the peripheral nerve evaluation ( P = 0.0004) with a positive predictive value of 81 percent, a sensitivity of 44 percent, and a specificity of 81 percent. Pudendal nerve terminal motor latency on the right side did not correlate with the outcome, but left pudendal nerve terminal motor latency was weakly correlated ( P = 0.02), although both tests had a low positive predicting value and sensitivity vs. good specificity. Evoked sacral potentials did not correlate with the outcome and had a low positive predictive value, sensitivity, and specificity. CONCLUSIONS: Simple anal sphincter electromyography can predict the outcome of the peripheral nerve evaluation with good positive predictive value and specificity in patients with fecal incontinence. Other, more expensive, electrophysiologic anal tests do not add further prognostic information.

Aged↗
PubMed2006

Predictions of the in vivo clearance of drugs from rate of loss using human liver microsomes for phase I and phase II biotransformations.

PURPOSE: The utility of in vitro metabolism to accurately predict the clearance of hepatically metabolized drugs was evaluated. Three major goals were: (1) to optimize substrate concentration for the accurate prediction of clearance by comparing to Km value, (2) to prove that clearance of drugs by both oxidation and glucuronidation may be predicted by this method, and (3) to determine the effects of nonspecific microsomal binding and plasma protein binding. METHODS: The apparent Km values for five compounds along with scaled intrinsic clearances and predicted hepatic clearances for eight compounds were determined using a substrate loss method. Nonspecific binding to both plasma and microsomal matrices were also examined in the clearance calculations. RESULTS: The Km values were well within the 2-fold variability expected for between laboratory comparisons. Using both phase I and/or phase II glucuronidation incubation conditions, the predictions of in vivo clearance using the substrate loss method were shown to correlate with published human clearance values. Of particular interest, for highly bound drugs (>95% plasma protein bound), the addition of a plasma protein binding term increased the accuracy of the prediction of in vivo clearance. CONCLUSIONS: The substrate loss method may be used to accurately predict hepatic clearance of drugs.

Algorithms↗
PubMed1993

The presence of cervical and vaginal fetal fibronectin predicts preterm delivery in an inner-city obstetric population.

OBJECTIVE: It has previously been shown that fibronectin bearing a specific oncofetal domain is present at the chorionic-decidual interface and that its release into cervical and vaginal secretions accurately predicts preterm delivery in patients with uterine contractions. This study examines whether serial assessment of cervical and vaginal fetal fibronectin allows for the prediction of preterm delivery in symptom-free patients derived from an inner-city, general obstetric population. STUDY DESIGN: Cervical and vaginal samples were obtained from 429 consenting patients who received routine prenatal care between 24 and 37 weeks' gestation. A sensitive immunoassay was used to quantitate cervical and vaginal fetal fibronectin levels, and clinicians were blinded to fetal fibronectin results. Post hoc receiver operating characteristic curve analysis was used to determine which sample site (cervical or vaginal), fetal fibronectin concentration, and number of consecutive positive samples optimized screening efficacy. Logistic regression was employed to determine whether fetal fibronectin was an independent predictor of preterm delivery. RESULTS: The spontaneous preterm delivery rate was 11% (49/429). Among the 326 patients sampled within 28 days of delivery, receiver operating characteristic curve analysis indicated that the presence of a single cervical fetal fibronectin value > 60 ng/ml between 24 and 36 weeks' gestation predicted preterm delivery with a sensitivity of 73%, a specificity of 72%, and positive and negative predictive values of 25% and 95%, respectively. A vaginal fetal fibronectin value > 50 ng/ml predicted preterm delivery with a sensitivity of 68%, a specificity of 80%, and positive and negative predictive values of 30% and 95%, respectively. Cervical and vaginal fetal fibronectin predicted preterm deliveries resulting from both membrane rupture and preterm labor with intact membranes. A positive fetal fibronectin result preceded preterm delivery by 3.4 (+/- 3.2) weeks. Stepwise logistic regression demonstrated that cervical and vaginal fetal fibronectin levels were independent predictors of preterm delivery with adjusted odds ratios of 8.9 (95% confidence interval 3.6 to 22.1) and 6.0 (95% confidence interval 2.6 to 13.7), respectively. CONCLUSIONS: Among patients undergoing monthly cervical and vaginal sampling between 24 and 36 weeks' gestation, the presence of fetal fibronectin is a sensitive and specific predictor of preterm delivery.

Cervix Uteri↗
PubMed1995

Neural network prediction of nonstress test results: how often should we perform nonstress tests?

OBJECTIVE: Our purpose was to predict outcomes and optimal intervals for nonstress tests of term gravid women with neural networks. STUDY DESIGN: We studied 100 normal term patients whose 30-minute nonstress tests, performed on 5 consecutive days, were computer analyzed for the following elements: fetal heart rate baseline, variability, signal loss, accelerations (> 15 beats/min), and decelerations. The training set used 65 patients; the testing, 35 patients. Nonstress test data (days 1 to 4) were inputs; day 5 data were training patterns. Networks for each nonstress test element used Brainmaker Macintosh 1.0 (California Scientific Software, Nevada City, Calif.) trained to 0.12 tolerance. Actual fetal heart rate elements and their daily differences were compared with predictions by the networks and multiple regressions. RESULTS: There was little difference between networks using daily or alternate-day inputs for predicting test performance on day 5; networks using test intervals > 2 days could not be trained to tolerance. Long-term fetal heart rate variation was the nonstress test element best predicted. Daily differences networks provided better prediction of all day 5 data than did actual daily values networks or multiple regression formulas. CONCLUSIONS: Baseline long-term fetal heart rate variability seems to be the most predictable fetal heart rate element over time and should merit more consideration in overall fetal testing. Fetal heart rate elements are not easily predicted by any method for intervals longer than 2 days. Using longer test intervals might run a greater risk for unanticipated changes in nonstress test outcomes, even when fetal condition is normal.

Female↗
PubMed1993

A comparison of the nonstress test, oxytocin challenge test, Doppler velocimetry and biophysical profile in predicting umbilical vein pH in growth-retarded fetuses.

OBJECTIVE: To examine and compare the value of the nonstress test (NST), oxytocin challenge test (OCT), Doppler velocimetry (S/D ratio), and biophysical profile (BPP) in predicting fetal acidosis. METHOD: NST, OCT, S/D ratio and BPP were performed in 23 pregnancies with growth-retarded fetuses. The value of each parameter in predicting fetal acidosis (umbilical vein pH obtained by cordocentesis) was examined. RESULT: The NST, OCT and BPP were found to have the same positive predictive value of 57.1% in predicting fetal acidosis. The S/D ratio was found to have a very low positive predictive value (14.3%). The only combination of two parameters that showed improved positive predictive value, was that of OCT and NST (66.7%). CONCLUSION: (1) The best indirect method in assessing fetal well-being is the combination of NST and OCT. (2) Since the positive predictive value of the indirect methods is still low, direct assessment of the fetal metabolic status is recommended in premature growth-retarded fetuses with an abnormal test.

Acidosis↗
PubMed1993

A practical equation to predict resting metabolic rate in older men.

The accuracy of previous equations for predicting resting metabolic rate (RMR) in healthy older men is questionable because they are based on limited sample sizes and the absence of cross-validation procedures. The purposes of this study were to (1) examine biological predictors of RMR in healthy older men; (2) develop a practical equation to predict RMR from easily measured variables and examine its accuracy using cross-validation procedures; and (3) test the validity of existing equations in the literature to predict RMR in older men by comparison with measured RMR values. RMR, body composition, anthropometric measurements, leisure time activity (LTA), maximal aerobic power (VO2max), energy intake, and plasma thyroid hormone levels were determined in 89 healthy older men aged 50 to 78 years. Stepwise regression analysis showed that RMR was best predicted by fat-free weight ([FFW] R2 = 85%), free 3,5,3'-triiodothyronine (T3) level (R2 = 1%), and VO2max (R2 = 1%); these variables predicted RMR with a residual error of +/- 30 kcal/d. A practical equation was developed in a randomly selected subsample (N = 61) using easily measured variables as potential predictors, and was successfully cross-validated in a random subsample of older men (N = 28). The pooled equation to predict RMR is as follows: RMR (in kilocalories per day) = 9.7 (weight in kilograms) - 6.1 (chest skinfold thickness in millimeters) - 1.8 (age in years) + 0.1 (leisure time activity [LTA] in kilocalories per day) + 1,060. These variables accounted for 76% (R2) of the variation, and predicted RMR with a residual error of +/- 42 kcal/d.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

Prediction of spontaneous preterm birth by fetal fibronectin and uterine activity.

OBJECTIVE: To evaluate the usefulness of fetal fibronectin and home uterine contraction assessment in predicting preterm birth (before 34 weeks) in at-risk asymptomatic women. METHODS: One hundred fifty women were enrolled prospectively; five were lost to follow-up, leaving 145 women available for analysis. Because patients with preterm labor before 34 weeks' gestation most commonly develop this problem after 28 weeks, the period of 26-28 weeks' gestation was selected prospectively as the first window for prediction and study analysis. Eighty-five of 145 asymptomatic women at high risk for preterm birth had both home uterine contraction assessment of 2 hours per day and one or more cervical sampling(s) for fetal fibronectin measurement at 26-28 weeks. A positive home uterine contraction assessment was defined as contractions exceeding two per hour averaged over the 2-week study interval. Positive fetal fibronectin was defined as greater than 50 ng/mL. RESULTS: Fourteen of the 85 women (16.5%) delivered before 34 weeks. Home uterine contraction assessment alone had a sensitivity, specificity, positive predictive value, and negative predictive value for preterm birth of 64, 85, 45, and 92%, respectively; fetal fibronectin alone was associated with values of 43, 89, 43, and 89%, respectively. A positive home uterine contraction assessment was associated with a relative risk (RR) for preterm birth of 5.9% (95% confidence interval [CI] 2.4-14.2), whereas a positive fetal fibronectin demonstrated an RR of 3.8 (95% CI 1.5-9.4). When both assessments were positive, all patients delivered before 34 weeks and there was an RR of 27.0 (95% CI 8.7-84.1) compared with those with both tests being negative. Only two patients with both tests negative delivered before 34 weeks (negative predictive value 96%). CONCLUSION: Both the home uterine contraction assessment and fetal fibronectin accurately predicted preterm birth before 34 weeks. When both tests were combined, the predictive ability improved substantially.

Adult↗
PubMed1996

The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery.

OBJECTIVE: To determine the accuracy of late antenatal anogenital cultures in predicting group B streptococcal colonization at delivery. METHODS: Swabs of the vagina and rectum were obtained from 826 women during routine prenatal visits at approximately 35-36 weeks' estimated gestation. The same women were recultured at admission for delivery. Swabs were cultured in broth media. Test performance indices were calculated using culture status at the time of delivery as the reference. Based on the sensitivity and specificity of antenatal cultures derived from analysis of this study population, we estimated predictive values of late antenatal cultures for a range of group B streptococcal carriage rates. RESULTS: Group B streptococci were identified in specimens from 219 of 826 women (26.5%). The sensitivity of late antenatal cultures for identifying colonization status at delivery was 87% (95% confidence interval [95% CI] 83-92). Specificity was 96% (95% CI 95-98). Positive predictive value was 87% (95% CI 83-92), and negative predictive value was 96% (95% CI 95-98). Test performance was similar from 1-5 weeks before delivery, but declined when 6 or more weeks had elapsed between the antenatal culture and delivery. Among patients cultured 6 or more weeks before delivery, sensitivity was only 43%, specificity 85%, and positive and negative predictive values were 50 and 81%, respectively. We estimated positive and negative predictive values of 85 and 97% for a colonization rate of 20%, and 79 and 98% for a colonization rate of 15%. CONCLUSION: Anogenital cultures in broth media obtained during the late antenatal period are accurate in predicting group B streptococcal colonization status at delivery in term parturients, and they perform significantly (P < .01) better than cultures collected 6 or more weeks before delivery.

Adult↗
PubMed1988

Prospective prediction of post-radiation therapy lung function using quantitative lung scans and pulmonary function testing.

Surgeons have made use of quantitative perfusion lung scanning (QS) and forced expiratory volume in one second (FEV1) to predict a patient's ability to tolerate lung resection. In this study QS and FEV1 were used to predict prospectively pulmonary function following lung irradiation (XRT). Twenty-two patients have had QS and FEV1 determined before XRT and at planned intervals post-XRT. Serial determination of lung function post-XRT allows comment on the temporal nature of the XRT effect on lung function. Seventeen patients had QS and FEV1 determined at an interval of 2-6 months post-irradiation with a drop in the groups mean FEV1 from 1.91 to 1.87L. or 2% during that interval. In the interval from 6-12 months post-XRT, 13 patients had studies with the groups mean FEV1 dropping from 1.79 to 1.58L or 12% of the original. In the interval from 12-18 months, 6 patients had a decline in mean FEV1 from 1.73 to 1.56L. or 10% of the original. In 22 patients a predicted final FEV1 was compared with a measured value at an interval from XRT. Fourteen of these determinations were at intervals greater than 6 months from the start of XRT and 6 at intervals of greater than 1 year. FEV1 was seen to drop during the follow-up intervals toward the predicted value. In only 2 patients did the final FEV1 drop below the predicted FEV1 and never by more than 0.12L. (6%). In summary, a method for predicting post-XRT pulmonary function using QS and FEV1 is described. Serial follow-up revealed a latent period followed by a late phase where FEV1 fell toward, but not significantly below, the predicted value. Such a determination can be of value in formulating a treatment plan for patients with significantly diminished pulmonary function.

Forced Expiratory Volume↗
PubMed1996

Predictive power of increased heart rate versus depressed left ventricular ejection fraction and heart rate variability for risk stratification after myocardial infarction. Results of a two-year follow-up study.

OBJECTIVES: The aim of this study was to compare the predictive value of mean RR interval assessed from predischarge Holter recordings with that of heart rate variability and left ventricular ejection fraction for risk stratification after myocardial infarction. BACKGROUND: Heart rate variability is a powerful tool for risk stratification after myocardial infarction. Although heart rate variability is related to heart rate, little is known of the prognostic value of 24-h mean heart rate. METHODS: A total of 579 patients surviving the acute phase of myocardial infarction were followed up for at least 2 years. Predischarge heart rate variability, 24-h mean RR interval and left ventricular ejection fraction were analyzed. RESULTS: During the first 2 years of follow-up, there were 54 deaths, 42 of which were cardiac (26 sudden). Shorter mean RR interval was a better predictor of all-cause mortality as well as cardiac and sudden death than depressed left ventricular ejection fraction. Depressed heart rate variability predicted the risk of death better than mean RR interval for sensitivities < 40%. For sensitivities > or = 40%, mean RR interval was as powerful as heart rate variability. All three variables performed equally well in predicting nonsudden cardiac death. For cardiac death prediction, a left ventricular ejection fraction < 35% had a 40% sensitivity, 78% specificity and 14% positive predictive accuracy; a mean RR interval < 700 ms had a 45% sensitivity, 85% specificity and 20% positive predictive accuracy; and a heart rate variability < 17 U had a 40% sensitivity, 86% specificity and 20% positive predictive accuracy. CONCLUSIONS: Predischarge 24-h mean heart rate is a strong predictor of mortality after myocardial infarction that can compete with left ventricular ejection fraction and heart rate variability.

Cohort Studies↗
PubMed2005

Candidate gene susceptibility variants predict intermediate end points but not angiographic coronary artery disease.

BACKGROUND: Moderate-sized studies have suggested that variants of candidate genes can influence laboratory markers of coronary artery disease (CAD), but whether they predict parallel changes in clinical CAD risk is unknown. METHODS: We studied a single nucleotide polymorphism (SNP) from each of the 5 candidate genes for intermediate (laboratory) and clinical (angiographic CAD) end points in a large cohort of patients. The 5 gene SNPs were cholesteryl ester transfer protein (CETP) TaqIB (N = 3219), ATP-binding cassette (ABCA1) G596A (N = 3302), lipoprotein lipase (LPL) HindIII (N = 909), plasminogen activator inhibitor, type 1 (PAI1), 4G/5G (N = 1142), and hepatic lipase (HL) C-541T (N = 4704). Intermediate outcomes were high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs). Cases had 1- to 3-vessel CAD (> or = 70% stenosis); controls had angiographically normal coronaries. RESULTS: Cholesteryl ester transfer protein predicted HDL (mean, B1B1 35.0 mg/dL, B2B2 38.6 mg/dL; P < .001) but not CAD (B1B1 74%, B2B2 70%; adjusted P = .35, odds ratio [OR] = 0.89). ABCA1 predicted HDL (mean, GG = 36.4 mg/dL, AA = 39.2 mg/dL; P = .02) but not CAD (GG 74%, AA 75%; adjusted P = .96, OR = 0.99). HL predicted HDL (CC 37.1 mg/dL, TT 40.9 mg/dL; P = .002) but not CAD (CC 71%, TT 68%, adjusted P = .66, OR = 0.94). LPL predicted TG (median: [++] 134, [--] 98 mg/dL; P < .001) but not CAD ([++] 79%, [--] 79%; adjusted P = .99, OR = 1.00). PAI1 predicted TG (median, 4G4G 130 mg/dL, 5G5G 148 mg/dL; P = .16), but not CAD (4G4G 77%, 5G5G 76%; adjusted P = .62, OR = 1.11). CONCLUSIONS: Five SNPs predicted differences in risk-related lipids but not angiographic CAD. These discrepancies suggest that genetic determinants of CAD are complex and intermediate phenotypes are poor surrogates. These findings have important implications for future directions in genetic research.

ATP Binding Cassette Transporter 1↗
PubMed2006

Assessment of basic human performance resources predicts performance of ureteroscopy.

BACKGROUND: Our objective was to predict endoscopic performance in a cadaver model using basic performance resources (BPRs) measurements. METHODS: Medical students (n = 16) underwent intense ureteroscopic training on a virtual reality ureteroscopy trainer and were rated on performing ureteroscopy on a cadaver. The medical students also underwent 13 validated BPR measurements. Urology residents also performed cadaveric ureteroscopy and BPRs. A predictive model built from urology residents' (n = 16) BPRs and performance assessment was used to predict medical student cadaveric ureteroscopy performance based on their BPRs alone. RESULTS: The predictive model built with urology residents predicted the ureteroscopic performance of 10 of 16 medical students within 15% of their rated ureteroscopic performance on the cadaver. CONCLUSIONS: A predictive model built with urology residents can moderately predict the ureteroscopic performance of medical students from BPRs. Additional in vivo evaluation is required.

Adult↗
PubMed2005

Predicting pressure ulcer risk with the modified Braden, Braden, and Norton scales in acute care hospitals in Mainland China.

The aim of this study was to develop a modified Braden scale, to evaluate its predictive validity, and to identify a more valid pressure ulcer risk calculator for application in acute care hospitals in Mainland China among the modified Braden, Braden, and Norton scales. The initial modified Braden scale, with the addition of skin type and body build for height, was proposed in this study. Four hundred twenty-nine subjects who were admitted to two acute care hospitals in Mainland China within 24 hr and free of pressure ulcers upon admission were assessed with the initial modified Braden, Braden, and Norton scales by three nurse assessors. This was followed by a daily skin assessment to note any pressure ulcer by a nurse assessor. Nine subjects had pressure ulcers detected at Stages I (89%) and II (11%) after an average stay of 11 days. The descriptive analysis of each subscale scoring item in the initial modified Braden scale indicated that skin type and body build for height were the most distinct predictive factors whereas nutrition was the least distinct factor for predicting pressure ulcer development. Based on these findings, the modified Braden scale was further developed with the addition of skin type and body build for height and by exclusion of nutrition. The predictive validity test reported that the modified Braden scale demonstrated a better balance of sensitivity (89%) and specificity (75%) at a cutoff score of 16, with a higher positive predictive value (7%), than the Braden and Norton scales. This finding revealed that for this sample, the modified Braden scale is more effective in pressure ulcer risk prediction than the other two scales. Because the modified Braden scale is not 100% sensitive and specific, to increase clinical efficacy in the prevention of pressure ulcer, it is recommended that it be adopted combined with nursing judgment to predict pressure ulcer development in acute care settings in Mainland China.

Activities of Daily Living↗
PubMed2006

Resting energy expenditure in severely burned children: analysis of agreement between indirect calorimetry and prediction equations using the Bland-Altman method.

INTRODUCTION: Knowledge of a child's resting energy expenditure (REE) is essential in optimizing nutritional support for severely burned children. The provision of adequate nutritional support is vital in order to avoid the consequences of malnutrition or overfeeding. Nutritional requirements for severely burned children are often based on equations for estimates of REE. The accuracy of the predictive equations of REE has been questioned and many authors have advocated the measurement of REE. This study tests the hypothesis that estimates of REE vary significantly from measured REE (MREE) in a population of severely burned children, and are not accurate for determining nutritional requirements. METHODS: In 91 severely burned children aged between 3 and 18 years, REE was measured by indirect calorimetry (MREE) at the height of the hypermetabolic response and compared with predicted equations (PREE) from the Food and Agriculture/World Health Organization/United Nations University (FAO/WHO/UNU), Schofield-HW and Harris-Benedict. Agreement between indirect calorimetry and predicted equations was assessed following the Bland-Altman method. RESULTS: In the entire cohort group, predicted REE from all three equations were significantly lower compared to MREE (p<0.05). There was poor agreement between the MREE and predicted using all three equations. The Schofield-HW equation showed the lowest mean MREE-PREE difference: 635+/-526 kcal/day (limits of agreement -608 and 1878 kcal/day; 95% confidence interval for the bias 525-745 kcal/day). Additionally, all three equations under predicted REE and were not significantly different from one another (p=0.98). CONCLUSIONS: Until more accurate predicted equations are developed, we recommend indirect calorimetry measurements for determining resting energy expenditure in severely burned children.

Adolescent↗
PubMed2006

Predictive value of in vitro safety studies.

The predictive value of in vitro safety studies is discussed for three important areas of pharmaceutical safety evaluations. In genetic toxicology, currently assays are sensitive for the prediction of cancer, but their overall predictive value is strongly diminished because of their low specificity. In the area of safety pharmacology blockage of hERG channel in vitro has recently been introduced to predict cardiac repolarization delay (QT interval prolongation) in patients. There is a plethora of in vitro methods to predict and characterize liver toxicity. However, little data is available that demonstrate a reliable prediction for hepatotoxicity in vivo over a wide range of chemical structures. In all three areas, further improvements are needed. 'Omics' technologies and new cell lines derived from stem cells are expected to strongly contribute to establish new and more predictive in vitro assays.

Animals↗