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Predicting severity of cognitive impairment after severe head injury.

It is often assumed that age is an important variable in determining cognitive outcome following severe head injury. The present study was carried out to determine whether age at time of injury predicted severity of cognitive impairment. Our hypothesis was that the older the patient at time of head injury the worse should be the cognitive impairment. Cognitive impairment was assessed by scores on nine standardized tests. Scores were obtained from 144 consecutive referrals to a clinical psychologist; all subjects had sustained a severe head injury. Of these, 115 had suffered a closed head injury. Ages ranged from 13 to 65 years. Apart from Unusual Views and Verbal Fluency no significant correlations were found between age and test performance. Thus there was little evidence that age predicted performance on cognitive tests. A number of significant correlations were found between length of coma and cognitive performance. The findings would seem to confirm that cognitive outcome after severe head injury is predicted by length of coma (which reflects severity of brain damage) whilst age at time of injury does not appear to be a good predictor of outcome.

Activities of Daily Living↗

PubMed1987

Severe rheumatoid arthritis of the temporomandibular joints and its coincidence with severe rheumatoid arthritis of the cervical spine.

The degree of arthritis of the cervical spine was retrospectively studied in cervical spine radiographs from 400 patients with rheumatoid arthritis. In the same cervical radiographs the arthritic destruction of the temporomandibular joints was measured as diminished ramal height from the mandibular angle to the palato-occipital line. Reduced ramal height was found in 76 patients, 69 women and 7 men, and in 33 patients the reduction in height was severe enough to be compatible with a total destruction of the mandibular head. An arthritic destruction of the temporomandibular joints occurred significantly more often in patients with a severe cervical arthritis than in those without cervical affection, and vice versa. Of the 76 patients with a reduced ramal height, 66% had a severe arthritis of the cervical spine and of the 100 patients with severe arthritic changes of the cervical spine, 50% had severe destructive arthritis of the temporomandibular joints.

Age Factors↗

PubMed2001

Clinical application of tentorium cerebelli hiatus incision in treatment of severe and most severe brain injuries.

OBJECTIVE: To explore the role of tentorium cerebelli hiatus incision in treating severe and most severe brain injuries complicated by tentorial herniation. METHODS: From July 1994 to July 1999 tentorium cerebelli hiatus incision was done based on intracranial hematoma evacuation and bone flap craniectomy decompression in 70 cases of severe and most severe brain injuries complicated by tentorial herniation. RESULTS: Of the 70 cases, GCS 3-5 was in 23 and GCS 6-8 in 47; satisfactory recovery in 39 cases (55.7%), moderate disability in 12 (17.1%), severe deficit in 6 (8.6%), vegetative survival in 4 (5.7%) and 8 (11.4%) died. CONCLUSIONS: Tentoriun cerebelli incision is helpful in alleviating secondary brain stem injury from tentorial herniation and in reducing the disability and death rate of the patients.

Adolescent↗

PubMed1987

[An experiment of acute fulminant severe ulcerative colitis in a 75- year-old male--a case report and a consideration of the surgical treatment of elderly patients with severe ulcerative colitis].

This is a case report of 75 year-old male patient with acute fulminant severe ulcerative colitis who underwent proctocolectomy after emergency ileostomy and decompression colostomy, and consideration of surgical treatment for elderly patients with severe ulcerative colitis are also discussed. A 75 year-old male was hospitalized as emergency case with complaints of high fever, severe abdominal pain and diarrhea. He was diagnosed as acute fulminant ulcerative total colitis by colonoscopy and barium enema examination. He had urgent operation of ileostomy and decompression cecostomy in the presence of severe disease after intensive medical treatment had failed. After a few days toxic signs gradually disappeared and general status was slightly improved. And then, radical operation of proctocolectomy and permanent ileostomy was successfully performed 3 weeks after the previous operation. We wish to emphasize in the elderly patients, namely 60 years and over with severe ulcerative colitis, that radical surgical treatment such as proctocolectomy or total colectomy should be performed after minimal laparotomy with decompression colostomy and ileostomy, because they do not survive so readily as the younger patients.

Acute Disease↗

PubMed1995

[Assessment of coronary stenosis severity using a Doppler guide wire in vivo: is the continuity equation applicable to moderate to severe coronary artery stenosis?].

The usefulness of a Doppler guide wire was evaluated in the estimation of coronary stenosis severity in patients with moderate to severe coronary stenosis using the continuity equation. The maximal coronary flow velocities (V) proximal to the stenosis (p), at the stenosis (s), and distal to the stenosis (d) were measured using a Doppler guide wire (12-MHz, 0.018-in) in 12 patients with mild coronary stenosis (less than 50% diameter stenosis: group A) and 12 patients with moderate to severe coronary stenosis (more than 50% diameter stenosis: group B). Percent diameter stenosis (%DS) was calculated from Vp/Vs by: %DS = (1 - square root of Vp/Vs) x 100 (%) (Vp = the maximal velocity proximal to the stenosis; Vs = the peak velocity at the stenotic site) Percent DS was calculated from Vd/Vs by: %DS = (1 - square root of Vd/Vs) x 100 (%) (Vd = the peak velocity distal to the stenosis) Regression of Doppler-derived %DS from Vp/Vs compared to quantitative coronary angiographic % DS were: Group A: y = 0.83x + 3.0 (r = 0.79), Group B: y = 0.63x + 9.4 (r = 0.81), Overall: y = 0.63x + 9.6 (r = 0.91) Regression of Doppler-derived %DS from Vd/Vs compared to quantitative coronary angiographic %DS were: Group A: y = 0.98x - 1.0 (r = 0.81), Group B: y = 0.67x + 14.6 (r = 0.84), Overall: y = 0.79x + 7.6 (r = 0.91) The continuity equation method using a Doppler guide wire underestimates coronary stenosis severity in patients with moderate to severe coronary stenosis, although Doppler-derived %DS is correlated with angiographic %DS.

Blood Flow Velocity↗

PubMed1998

Employment of trauma and injury severity score and a severity characterization of trauma in the outcome evaluation of trauma care and their research advances.

OBJECTIVE: To review the application of trauma and injury severity score (TRISS) and a severity characterization of trauma (ASCOT) in the outcome evaluation of trauma care and their research advances. DATA SOURCES: Both Chinese- and English-language literature searched by using MEDLINE/CD-ROM (1985-1996) and Index of Chinese-Language Literature (1985-1996). STUDY SELECTION: Over fifty papers and reviews published over the past ten years were selected. RESULTS AND CONCLUSION: TRISS can be employed for different purposes, that is, preliminary outcome-based evaluation (PRE) and definitive outcome-based evaluation (DEF). TRISS is a method which is now the most extensively used for the outcome evaluation of trauma. Even so, it still has some shortcomings, e.g., trauma can not be given the weights that should be given, and the section of age is too simple. ASCOT is also a physiologic and anatomic combined method for the evaluation of injury severity and outcome. To some extent, this method obviates the shortcomings of TRISS in the calculation of probability of survival (Ps) with injury severity score (ISS). Therefore, ASCOT is considered to be superior to TRISS in the evaluation of Ps. However, TRISS is still now more extensively used than ASCOT just because ASCOT was recently developed.

Humans↗

PubMed2002

Detection of early ischemia in severe head injury by means of arteriovenous lactate differences and jugular bulb oxygen saturation. Relationship with CPP, severity indexes and outcome. Preliminary analysis.

UNLABELLED: Early ischemia may be highly relevant in patients with severe head injuries. The aims of the study were: 1) to define if abnormal arteriovenous lactate difference (AVDL) and jugular bulb oxygen saturation (SjO2) are found in the early 24 hrs post injury; 2) to compare if abnormalities of SjO2 and of AVDL were associated with a specific typology of severity indexes and outcome; 3) to detect any association between abnormal AVDL and SjO2 with levels of cerebral perfusion pressure (CPP). The study involved 29 patients, with CPP, AVDL and SjO2 measured within 24 hours post-injury. RESULTS: 1) Abnormal AVDL was found in 21% while abnormal SjO2 was detected in 38% of the patients; 2) abnormal AVDL was associated with cases of most severe injury; 3) CPP level below 60 mmHg was associated with abnormal AVDL and SjO2. Low CPP appeared to be the most likely measurable cause of early ischemia. Abnormalities of AVDL appeared to be more sensitive, than SjO2, with regard to detection of the most severe cases.

Adult↗

PubMed2000

A comparison of severity of illness scoring systems for elderly patients with severe pneumonia.

OBJECTIVE: To evaluate the predictive ability of three severity of illness scoring systems in elderly patients with severe pneumonia requiring mechanical ventilation compared to a younger age group. DESIGN: Prospective cohort study. SETTING: Two university-affiliated tertiary care hospitals. PATIENTS AND PARTICIPANTS: One hundred four patients 75 years of age and older and 253 patients younger than 75 years of age enrolled from medical intensive care units. MEASUREMENTS AND RESULTS: Probabilities of hospital death for patients were estimated by the Acute Physiology and Chronic Health Evaluation (APACHE) II, the Mortality Probability Model (MPM) II and the Simplified Acute Physiology Score (SAPS) II. Predicted risks of hospital death were compared with observed outcomes using three methods of assessing the overall goodness of fit. The actual mortality of the elderly group was 54.87 % (95 % confidence interval [CI]: 45.2-64.4 %) compared to 28.9 % (95 % CI, 23.3-34.4 %) in the younger age group. There was a significant difference in the predictive accuracy of the scoring systems as assessed by the c-index, which is equivalent to the area under the receiver operator characteristics (ROC) curve, between the two groups, but not within individual groups. Calibration was insufficient for APACHE II and SAPS II in the elderly cohort as in-hospital mortality was lower than the predicted mortality for both models. CONCLUSIONS: Although the three severity of illness scoring systems (APACHE II, MPM II and SAPS II) demonstrated average discrimination when applied to estimate hospital mortality in the elderly patients with severe pneumonia, MPM II had the closest fit to our database. Alternative modeling approaches might be needed to customize the model coefficients to the elderly population for more accurate probabilities or to develop specialized models targeted to the designed population.

APACHE↗

PubMed1996

Is hypertension more severe among U.S. blacks, or is severe hypertension more common?

It is frequently stated that the risk of sequelae from hypertension at a given level of severity is higher among blacks than whites, although little empirical evidence supports that supposition. In this work we examined the basis for accepting the existence of a black: white differential in hypertension outcomes in a representative biracial sample of the U.S. population followed in the First National Health and Nutrition Examination Survey (NHANES-1) Epidemiologic Follow-up Study. As well recognized, the risk associated with increasing blood pressure is not dichotomous but varies across the entire distribution in a curvilinear fashion. The rightward skew of the blood pressure distribution with increasing mean levels affects comparisons between populations, since the change in shape results in a change in the mix of case severity. These considerations can influence estimates of the relative population-attributable risk from hypertension, considered as a dichotomous classification in blacks and whites. Although the relative risk of death associated with a systolic blood pressure of > or = 140 mmHg in this study was higher for blacks than for whites (1.7 and 1.5, respectively), with all-cause mortality as the outcome, the logistic coefficient for systolic blood pressure was not significantly different among white as compared with black men (beta = 0.016 vs. 0.010; p = 0.320 for race interaction term) and was slightly greater among white vs. black women (beta = 0.013 vs. 0.010; P = 0.05). After strata-specific blood pressure adjustment, the principal determinant of increased population risk for both black men and women was the higher prevalence of hypertension, not differential severity. The population-attributable risk for hypertension was at least two times higher among blacks because of the higher prevalence among them; moreover, the increased prevalence accounted for 10% of the interethnic difference in mortality. Data from this study indicate that hypertension was not more severe among individual blacks, simply more common in the population.

Adult↗

PubMed2005

The Injury Severity Score or the New Injury Severity Score for predicting intensive care unit admission and hospital length of stay?

OBJECTIVES: To compare the New Injury Severity Score (NISS) and the Injury Severity Score (ISS) as predictors of intensive care unit (ICU) admission and hospital length of stay (LOS) in an urban North American trauma population and in a subset of patients with head injuries. METHODS: The study population consisted of 23,909 patients from three urban level I trauma centres in the province of Quebec, Canada. The predictive accuracies of the NISS and the ISS were compared using Receiver Operator Characteristic (ROC) curves and Hosmer-Lemeshow (H-L) statistics for the logistic regression model of ICU admission and using r2 for the linear regression model of LOS. RESULTS: A total of 7660 (32%) patients were admitted to the ICU. Mean LOS was 8.2+/-2.5 days. In the whole sample, the NISS presented equivalent discrimination (area under ROC curve: NISS = 0.839 versus ISS = 0.843, p = 0.08) but better calibration (H-L statistic: 309 versus 611) for predicting ICU admission. In the subgroup patients with moderate to serious head injuries, the NISS was a better predictor of ICU admission in terms of both discrimination (area under ROC curve: NISS = 0.771 versus ISS = 0.747, p < 0.00001) and calibration (H-L statistic: 12 versus 21). The NISS explained more variation in LOS than the ISS for the whole sample (r2 = 0.254 versus 0.249, p = 0.0008) and in the sub-population with moderate to severe head injuries (r2 = 0.281 versus 0.263, p = 0.0002). CONCLUSIONS: The NISS is a better choice for case mix control in trauma research than the ISS for predicting ICU admission and LOS, particularly among patients with moderate to severe head injuries.

Adolescent↗

PubMed2005

Aspirin sensitivity and severity of asthma: evidence for irreversible airway obstruction in patients with severe or difficult-to-treat asthma.

BACKGROUND: Patients with aspirin sensitivity experience hyperplastic sinusitis and nasal polyposis. We speculated that similar mechanisms could be acting in the lower airway and that these individuals would demonstrate more severe asthma and irreversible loss of lung function. OBJECTIVE: We sought to investigate the role of aspirin-exacerbated respiratory disease (AERD) as a risk factor for the development of irreversible airway obstruction. METHODS: The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study is a multicenter observational study of subjects with severe or difficult-to-treat asthma. Data were compared between subjects who reported asthma exacerbation after aspirin ingestion and those who did not. The primary measure of bronchodilator-resistant obstruction (possible remodeling) was the maximally achieved postbronchodilator spirometry averaged over the 3-year duration of the study. RESULTS: Adult subjects (>/=18 years) with AERD (n = 459) were compared with subjects with non-aspirin-sensitive asthma (n = 2848). Subjects with AERD had significantly lower mean postbronchodilator percent predicted FEV(1) compared with subjects with non-aspirin-sensitive asthma (75.3% vs 79.9%, P < .001). Differences in spirometry between the 2 cohorts persisted after controlling for potential confounding variables. In addition, subjects with AERD were more likely to have severe asthma by means of physician assessment (66% vs 49%, P < .001), to have been intubated (20% vs 11%, P < .001), to have a steroid burst in the previous 3 months (56% vs 46%, P < .001), and to have required high-dose inhaled corticosteroids (34% vs 26%, P < .001). CONCLUSIONS: These data suggest that aspirin sensitivity is associated with increased asthma severity and possible remodeling of both the upper and lower airways.

Adolescent↗

PubMed2006

A pilot study to assess the effects of combining fluticasone propionate/salmeterol and tiotropium on the airflow obstruction of patients with severe-to-very severe COPD.

The aim of this pilot study was to explore the relative efficacy in terms of improvement in symptoms and lung function of combining fluticasone propionate/salmeterol combination (FSC) and tiotropium in patients with severe-to-very severe stable COPD. Ninety patients were randomized to receive 3 months of treatment in one of three treatment groups: (1) FSC 500/50 microg Diskus, 1 inhalation twice daily+placebo Handihaler 1 inhalation once-daily daily; (2) tiotropium 18 microg Handihaler, 1 inhalation once daily+placebo Diskus, 1 inhalation twice daily; (3) FSC 500/50 microg Diskus, 1 inhalation twice daily+tiotropium 18 microg Handihaler, 1 inhalation once-daily daily. Patients attended the clinic before and after 1 month, 2 months, and 3 months of treatment for evaluations of pulmonary function, and dyspnea, which was assessed using a visual analog scale (VAS). Also the supplemental salbutamol use was measured. Eighty-one patients completed the 3-month treatment period: 26 patients receiving FSC, 26 patients receiving tiotropium, and 29 patients receiving FSC+tiotropium. Patients were withdrawn for COPD exacerbation. Improvements in trough FEV(1) with all treatments medications were observed by the first month when trough FEV(1) had improved significantly above baseline by 74 mL (p<0.05) in the tiotropium group, by 117 mL (p<0.05) in the FSC group and by 115 mL (p<0.05) in FSC+tiotropium group. At the end of the study, trough FEV(1) had improved significantly above baseline by 141 mL (p<0.05) in the tiotropium group, by 140 mL (p<0.05) in the FSC group and by 186 mL (p<0.05) in FSC+tiotropium group. The difference between FSC and tiotropium appeared to decrease, that between FSC and FSC+tiotropium appeared to increase and that between tiotropium and FSC+tiotropium remained almost similar with study duration. Our results suggest that adding FSC and tiotropium may provide benefits in symptomatic patients with severe-to-very severe stable COPD.

Administration, Inhalation↗

PubMed2002

Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH.

BACKGROUND/AIMS: Controversy surrounding the efficacy of corticosteroids in severe alcoholic hepatitis (AH) persists. THE AIMS OF OUR STUDY WERE: (a) to analyze individual data of patients with severe AH discriminant function (DF)> or =32 from the last three randomized controlled trials; and (b) to identify the independent prognostic factors associated with short-term survival. METHODS: Individual data were collected from the three principal investigators. Survival analysis was performed at 28 days using the Kaplan-Meier method and log-rank test. The independent prognostic values were assessed by the proportional hazards regression model. RESULTS: About 102 placebo and 113 corticosteroid patients with DF > or =32 were analyzed. At 28 days, corticosteroid patients had significantly higher survival: 84.6+/-3.4% vs. 65.1+/-4.8%, P=0.001. In univariate analysis, corticosteroid treatment, age, DF, albumin, creatinine and encephalopathy were prognostic factors. In multivariate analysis, age (P=0.0001), serum creatinine (P<0.002) and corticosteroid treatment (P=0.002) were independent prognostic variables. A more dramatic decrease of median serum bilirubin values (micromol/l) was observed at 7 and 14 days in corticosteroid patients (P<0.05) : -76.5 vs. -35 and -105 vs. -45. CONCLUSIONS: Corticosteroids improved short-term survival of patients with severe AH. Age and serum creatinine are independent prognostic factors. Corticosteroids are recommended for patients with severe AH.

Adrenal Cortex Hormones↗

PubMed1997

Is the Addiction Severity Index a reliable and valid assessment instrument among clients with severe and persistent mental illness and substance abuse disorders?

OBJECTIVE: This study examined aspects of reliability, validity and utility of Addiction Severity Index (ASI) data as administered to clients with severe and persistent mental illness (SMI) and concurrent substance abuse disorders enrolled in a publicly-funded community mental health center. METHODS: A total of 62 clients with SMI volunteered to participate in an interobserver and test-retest reliability study of the ASI. Spearman-Brown and Pearson correlation coefficients were calculated to examine the extent of agreement among client responses. RESULTS: Overall 16% of the composite scores could not be calculated due to missing data and 31% of the clients misunderstood or confused items in at least one of the seven ASI domains. As a whole, the interobserver reliability of the ASI composite scores for those subjects where sufficient data were available was satisfactory. However, there was more variance in the stability of client responses, with four composite scores producing test-retest reliability coefficients below .65. CONCLUSION: Evidence from this study suggests that the ASI has a number of limitations in assessing the problems of clients with severe and persistent mental illness, and it is likely that other similar instruments based on the self-reports of persons with severe and persistent mental illness would also encounter these limitations.

Adolescent↗

PubMed1998

Service support to people in Wales with severe intellectual disability and the most severe challenging behaviours: processes, outcomes and costs.

A survey of people with severe intellectual disability and the most severe challenging behaviour in Wales identified five adults living in family homes, 17 in new specialist community housing and 19 in traditional services. With the omission of two people from the latter group and with a restricted collection of data for people living in the family home, the present study explored service input, outcome and costs across the three setting types. Process and outcome indicators for the family home group, who received little service input, were better than those for the traditional service group, although less good than those for the community house group. The specialist community home model produced significant gains over the traditional services in virtually all areas. Across the residential data set as a whole, there was no association between staff:resident ratios and severity of disability or between costs and severity of disability. This was largely true of the service types separately. There was a relationship between costs and service quality. However, this association was underpinned by gross differences between community houses and traditional settings. Costs, processes and outcomes ceased to be related when the two residential types were considered separately. Although higher costs of new community services compared to traditional services may be set against improved outcomes, high costs within the former could not be related to benefit. Outcome indicators were generally related to each other, suggesting that high quality in one sense was matched by high quality in other senses. Outcome was significantly associated with the ability of residents. Outcome indicators also tended to be related to observed staff performance, which was independent of resident ability. Therefore, outcome may be considered as dually determined by differences in resident ability and in what staff did.

Adult↗

PubMed2003

Case report of the first Severe Acute Respiratory Syndrome patient in China: successful application of extracorporeal liver support MARS therapy in multiorgan failure possibly induced by Severe Acute Respiratory Syndrome.

A previously healthy patient was transferred to our infectious department with a 9-day-history of continued fever. The patient was placed on assisted respiration support in addition to anti-viral medication. The diagnosis of SARS (Severe Acute Respiratory Syndrome) was made in view of the severe hypoxemia and the characteristic symptoms exhibited by the patient. Despite the best intensive therapy, he clinically deteriorated into multiorgan dysfunction syndrome (MODS) including additional dysfunction of kidney, liver, and heart. We initiated MARS therapy (extracorporeal liver support utilizing albumin dialysis) with intention to positively influence the organ functions in his MODS on the basis of recently published studies which suggested a positive impact of MARS in multiorgan failure secondary to respiratory illnesses and the possible influence on inflammatory mediators and cytokines. The application of 4 intermittent MARS treatments (8 h each, mean blood flow rate 180 ml/min) on 4 consecutive days resulted in an immediate improvement of clinical conditions within the treatment days. The further improvement of organ functions allowed withdrawing the patient from ventilatory support 13 days after start of MARS, and 44 days after admission he was discharged home with completely resolved organ functions and laboratory abnormalities. SARS is a severe form of the epidemic outbreak of atypical pneumonia which remains poorly defined regarding etiology and special therapy recommendations. However, the development and aggravation of this ARDS-like severe acute respiratory syndrome is pathologically associated with the systemic inflammatory response syndrome (SIRS) which may then mediate or cause MODS. To our knowledge, this is the first report of an application of MARS therapy in MODS which was probably induced by SARS in a patient in China which improved the clinical condition of the patient in multi-organ failure secondary to respiratory failure indicating that MARS might be an additional therapeutic option in multiorgan failure induced by SARS.

China↗

PubMed2000

Two randomised and placebo-controlled studies of an oral prostacyclin analogue (Iloprost) in severe leg ischaemia. The Oral Iloprost in severe Leg Ischaemia Study Group.

UNLABELLED: Two separate studies are described using the same prostacyclin analogue in a similar group of patients. OBJECTIVES: to assess the tolerability and efficacy of two dose regimens of oral Iloprost compared with placebo in the treatment of patients with ischaemic ulcers, gangrene or rest pain due to severe arterial disease over a period of 4 weeks (Study A) and one year (Study B). DESIGN: multicentre, placebo controlled, double-blind, randomized prospective studies. SUBJECTS & METHODS: 178 (study A) and 624 (study B) patients with trophic skin lesions (ulcers or gangrene) or ischaemic rest pain due to severe arterial disease. To confirm severe arterial disease patients were required to have a systolic ankle Doppler pressure of 70 mmHg or less or a toe systolic Doppler pressure of 50 mmHg or less in one leg. In both studies patients were randomly allocated to three treatment groups: placebo, low dose Iloprost (50-100 microgram twice a day) or high dose (150-200 microgram twice a day) In Study A the main outcome measures were tolerability of different doses of Iloprost and death, major amputation, healing of trophic lesions and relief of rest pain at the end of the follow up, which was 5 months after the end of the treatment. In Study B the primary end point was time to major amputation and stroke or death up to 12 months. Secondary pre-defined end points included the combined end point of patients alive without amputation, no trophic skin changes, no rest pain and not on regular analgesics. RESULTS: the proportion of patients who completed the 4-week treatment period in Study A at the intended dose was 58%, 43%, 45% respectively in the placebo, low dose and high dose Iloprost groups. In an intention to treat analysis the proportion of patients who survived without major amputation, ulcers or gangrene and had no rest pain was 11% in the placebo group, 19% in the low dose iloprost group and 28% in the high dose Iloprost group. The pooled Iloprost groups showed a statistically significantly better result than the placebo group (p=0.04), as did the high dose Iloprost group compared to the placebo (p=0.014). In Study B there was no treatment benefit in terms of a primary end point of amputation and death. However the secondary combined end point of patients who survived without a major amputation, ulcers or gangrene and had no rest pain, nor a need for regular analgesia was favourable for Iloprost, with 18% of patients in the placebo group reaching this optimal secondary end point, compared to 23% in the low dose Iloprost group and 26% in the higher dose Iloprost group (p<0.05). CONCLUSIONS: oral Iloprost administered for a year showed no clear benefit in patients with advanced severe leg ischaemia (PAOD III and IV). The results obtained with 4 weeks' treatment in Study A and in previous trials of intravenous Iloprost could not be reproduced

Administration, Oral↗

PubMed1997

The Bedford Alzheimer Nursing Severity scale for the severely demented: validation study.

We evaluated the floor effect and convergent, discriminant, and known-group validity of the Bedford Alzheimer Nursing Severity scale (BANS-s), a rating scale comprising cognitive and functional items recently developed for grading severe dementia. Ninety-nine demented patients (81 females and 18 males aged 55-100 years) in two nursing homes were assessed with the BANS-s, established cognitive and functional scales [Mini Mental State Examination, the extended version of the Clinical Dementia Rating (CDR), Katz's basic activities of daily living, Tinetti balance and gait, and Crichton scales], a behavioral scale (UCLA Neuropsychiatric Inventory), and indicators of malnutrition (Prognostic Nutritional Index). A relevant proportion (40%) of patients scored close to the floor of all scales except BANS-s and CDR, which showed a more uniform distribution of scores throughout the possible range. Convergent validity of BANS-s with the other cognitive and functional scales was good, with Pearson's r ranging from 0.62 to 0.79. Discriminant validity analysis of BANS-s versus the UCLA Neuropsychiatric Inventory showed that the two scales measure different domains (Pearson's r = 0.36). To test known-group validity, all patients were divided into two groups of different severity as defined by the Prognostic Nutritional Index. BANS-s and CDR were the scales with the best ability to discriminate malnourished from nonmalnourished patients. As a further validity test, the 37 patients reaching the floor on other cognitive and functional scales were divided into two subgroups of different dementia severity as defined by the Tinetti scale. BANS-s but not CDR was able to differentiate the two groups.

Aged↗