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Selected AbstractsDefibrillation Efficacy and Pain Perception of Two Biphasic Waveforms for Internal Cardioversion of Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2003Jens Jung M.D. Introduction: We evaluated the influence of the peak voltage of waveforms used for internal cardioversion of atrial fibrillation on defibrillation efficacy and pain perception. A low peak voltage biphasic waveform generated by a 500-,F capacitor with 40% tilt was compared to a standard biphasic waveform generated by a 60-,F capacitor with 80% tilt. Methods and Results: In 19 patients with paroxysmal atrial fibrillation (79% male, age 55 ± 11 years, 21% with heart disease), the atrial defibrillation threshold (ADFT) was determined during deep sedation with midazolam for both waveforms in a randomized fashion using a step-up protocol. Internal cardioversion with a single lead (shock vector: coronary sinus to right atrium) was successful in 18 (95%) of 19 patients. ADFT energy and peak voltage were significantly lower for the low-voltage waveform (2.1 ± 2.4 J vs 3.5 ± 3.9 J, P < 0.01; 100 ± 53 V vs 290 ± 149 V, P < 0.01). Sedation then was reversed with flumazenil after ADFT testing. Two shocks at the ADFT (or a 3-J shock if ADFT >3 J) were administered to the patient using each waveform in random order. Pain perception was assessed using both a visual scale and a numerical score. ADFTs were above the pain threshold in 17 (94%) of 18 patients, even though the ADFT with the 500-,F waveform was <100 V in 63% of the patients. Pain perception was comparable for both waveforms (numerical score: 6.5 ± 2.4 vs 6.3 ± 2.6; visual scale: 5.4 ± 2.6 vs 5.2 ± 3.1; P = NS, 500-,F vs 60-,F). The second shock was perceived as more painful in 88% of the patients, independent of the waveform used. Conclusion: Despite a 66% lower peak voltage and a 40% lower energy, the 40% tilt, 500-,F capacitor biphasic waveform did not change the pain perceived by the patient during delivery of internal cardioversion shocks. Pain perception for internal cardioversion probably is not influenced by peak voltage alone and increases with the number of applied shocks. (J Cardiovasc Electrophysiol, Vol. 14, pp. 837-840, August 2003) [source] The School Health Portfolio System: A New Tool for Planning and Evaluating Coordinated School Health ProgramsJOURNAL OF SCHOOL HEALTH, Issue 9 2004Robert M. Weiler ABSTRACT: The School Health Portfolio System (SHPS), developed originally to evaluate the Florida Coordinated School Health Program Pilot Schools Project, offers a new and innovative system for planning and evaluating a coordinated school health program at the individual school level. The SHPS provides practitioners a detailed but easy-to-use system that enables schools to create new programs or modify existing programs across all eight components of the CSHP model, as well as administrative support critical to sustainability. The System comes packaged as a self-contained, notebook-style manual divided into 15 sections. It includes electronic templates of key documents to guide school teams in creating a customized portfolio, and a list of sample goals and artifacts that confirm achievement of a goal related to the school's coordinated school health program. An evaluation rubric provides a structured method to assess a program portfolio's contents, and the extent to which the contents document achievement of program goals. The rubric produces both a qualitative assessment, such as a narrative summary of program strengths and areas for improvement, and a quantitative assessment, such as a numerical score (0,100), letter grade (A-F), or 5-star system (* - *****). The physical structure, function, and scoring of the rubric depend on the method of assessment. The SHPS enables schools to set goals based on individual school needs, and incorporate CSHP goals into school improvement plans - a critical factor in sustainability and accountability. The System also offers teams the option of coordinating their efforts with CDC's School Health Index as a companion assessment measure. This article outlines the process a team would follow in developing a portfolio, and includes a sample assessment for the area of School Health Education. (J Sch Health. 2004;74(9):359,364) [source] Evaluation of a severity score to predict the prognosis of Fournier's gangreneBJU INTERNATIONAL, Issue 3 2010Saturnino Luján Marco Study Type , Prognosis (case series) Level of Evidence 4 OBJECTIVE To determine the validity of a Fournier's gangrene severity index (FGSI), developed to assign a numerical score describing the severity of FG, and evaluate factors in the survival of patients with FG. PATIENTS AND METHODS We retrospectively reviewed 51 patients diagnosed with FG between 1994 and 2006. Data were collected on their medical history, which included vital signs (temperature, heart and respiratory rates) and metabolic variables (sodium, potassium, creatinine, bicarbonate levels, haematocrit, and white blood cell count). We computed a score relating to the severity of the disease at the time, and compared it to other features according to whether the patient survived or died. The different prognostic factors were assessed by univariate analysis with the Mann,Whitney U and Kendall A-B tests. RESULTS Of the evaluated 51 inpatients, eight died (16%) and 43 survived (84%). The median (range) age was 63 (17,85) years and the median time from the onset of the symptoms until the admission to the emergency room was 7.8 (1,60) days. The mean hospital stay was 33 (2,90) days and 17 patients were admitted to the intensive-care unit for a mean of 4.5 days. There was no statistically significant difference between the groups. Body surfaces involved were the scrotum in five patients (10%), the penis and scrotum in 11 (22%), the scrotum and perineum in 30 (59%) and the abdominal wall in five (10%). There was no statistically significant difference in the distribution in those who survived or died (P = 0.131). The median age of 60 (17,81) years in the survivors was significantly lower than that of 73.5 (50,85) years in those who died (P = 0.02). There was no significant difference (P = 0.06) between the number of repeated debridements in the survivors (3.23) and those who died (5.25). The mean (range) FGSI score for survivors was 6.7 (0,14), vs 8.7 (6,13) for those who died (P = 0.12). The only laboratory variables associated with death were serum bicarbonate (P = 0.04) and serum sodium (P = 0.02) levels. CONCLUSIONS FG is an unpredictable disease process with wide variability in its presentation. In our experience, the FGSI gives no indication of the likelihood of survival, but the risk factors for predicting the severity of FG seem to be greater in older patients and those with high sodium and low bicarbonate levels. [source] Does stimulation of nasal mucosa cause referred pain to the face?CLINICAL OTOLARYNGOLOGY, Issue 5 2001M. Abu-Bakra Ten healthy volunteers (five men and five women, mean age 30 years 3 months), with no nasal contact points, had pressure, adrenaline (1 : 1000), substance P (10 and 80 nmol/mL) and placebo topically applied to their nasal mucosa. Areas stimulated were the nasal floor, septum and lateral wall as well as the inferior and middle turbinates in both nasal cavities. The application of stimuli was randomized and single-blinded. A numerical score of the subjective severity of pain was used to assess outcome. Pressure caused variable local nasal discomfort limited by the duration of application and the site of pressure. Substance P caused variable nasal itching and sneezing. None of the stimuli caused referred pain to the face. The results question the role of mucosal contact points in facial pain. [source] Multiple criteria and fuzzy based evaluation of logistics performance for intermodal transportationJOURNAL OF ADVANCED TRANSPORTATION, Issue 2 2009Shinya Hanaoka Abstract This paper presents a framework to evaluate the logistics performance of intermodal freight transportation. Fuzzy set techniques are applied to assess the logistics performance within the decision process of freight operators. Using a fuzzy-based approach, fuzzy-AHP is applied to assess the criteria by different judgment procedures. Consequently, fuzzy-MCDM is used to assess operators' perception of the logistics performance via proper assignment of numerical scores. The subjective judgments for hierarchical criteria are transformed into fuzzy degrees of score. The methodology provides an alternative approach to facilitate the importance of a set of performance criteria. It can also entail use of improved corresponding parameters to develop a better freight transport system. [source] Comparing data mining methods on the VAERS database,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 9 2005David Banks PhD Abstract Purpose Data mining may enhance traditional surveillance of vaccine adverse events by identifying events that are reported more commonly after administering one vaccine than other vaccines. Data mining methods find signals as the proportion of times a condition or group of conditions is reported soon after the administration of a vaccine; thus it is a relative proportion compared across vaccines, and not an absolute rate for the condition. The Vaccine Adverse Event Reporting System (VAERS) contains approximately 150,000 reports of adverse events that are possibly associated with vaccine administration. Methods We studied four data mining techniques: empirical Bayes geometric mean (EBGM), lower-bound of the EBGM's 90% confidence interval (EB05), proportional reporting ratio (PRR), and screened PRR (SPRR). We applied these to the VAERS database and compared the agreement among methods and other performance properties, particularly focusing on the vaccine,event combinations with the highest numerical scores in the various methods. Results The vaccine,event combinations with the highest numerical scores varied substantially among the methods. Not all combinations representing known associations appeared in the top 100 vaccine,event pairs for all methods. Conclusions The four methods differ in their ranking of vaccine,COSTART pairs. A given method may be superior in certain situations but inferior in others. This paper examines the statistical relationships among the four estimators. Determining which method is best for public health will require additional analysis that focuses on the true alarm and false alarm rates using known vaccine,event associations. Evaluating the properties of these data mining methods will help determine the value of such methods in vaccine safety surveillance. Copyright © 2005 John Wiley & Sons, Ltd. [source] | ||||||||||