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Scoring System (scoring + system)
Kinds of Scoring System Selected AbstractsEvaluation of 6 Prognostic Models Used to Calculate Mortality Rates in Elderly Heart Failure Patients With a Fatal Heart Failure AdmissionCONGESTIVE HEART FAILURE, Issue 5 2010Andria L. Nutter The objective was to evaluate 6 commonly used heart failure (HF) prognostic models in an elderly, fatal HF population. Predictive models have been established to quantify risk among HF patients. The validation of these models has not been adequately studied, especially in an elderly cohort. Applying a single-center, retrospective study of serially admitted HF patients who died while in the hospital or within 30 days of discharge, the authors evaluated 6 prognostic models: the Seattle Heart Failure Model (SHFM), Heywood's model, Classification and Regression Tree (CART) Analysis, the Heart Failure Survival Score (HFSS), Heart Failure Risk Scoring System, and Pocock's score. Eighty patients were included (mean age, 82.7 ± 8.2 years). Twenty-three patients (28.75%) died in the hospital. The remainder died within 30 days of discharge. The models' predictions varied considerably from one another and underestimated the patients' actual mortality. This study demonstrates that these models underestimate the mortality risk in an elderly cohort at or approaching the end of life. Moreover, the predictions made by each model vary greatly from one another. Many of the models used were not intended for calculation during hospitalization. Development of improved models for the range of patients with HF syndromes is needed. Congest Heart Fail. 2010;16:196,201. © 2010 Wiley Periodicals, Inc. [source] Increased immature hematopoietic progenitor cells CD34+/CD38dim in myelodysplasiaCYTOMETRY, Issue 2 2006Mariela B. Monreal Abstract Background Myelodysplastic syndromes (MDS) are clonal disorders affecting hematopoietic progenitor cells (HPC). Despite the relevance of clonal CD34+ cells in developing MDS, only few studies analyze the phenotype of this cell population. The aim of this study was to evaluate phenotypic changes on HPC in MDS that could reflect abnormalities in the differentiation process of stem cells. Methods We analyzed the expression of CD38 and HLA-DR on CD34+ cells by flow cytometry in 36 patients with MDS, as well as in healthy donors (n = 12) and patients with other hematological disorders: non-Hodgkin lymphomas and multiple myeloma, both in complete remission (CR) (n = 32); acute lymphoblastic leukemia in CR (n = 17); de novo acute myeloblastic leukemia (AML) at diagnosis (n = 22) and in CR (n = 37); and AML secondary to MDS at diagnosis (n = 19). Cases with available karyotype were grouped according to the International Prognostic Scoring System (IPSS). Results Compared to normal BM, the fraction of immature HPC, characterized as CD34+bright, intermediate FSC/SSC, and CD38dim, was significantly increased in high risk MDS and secondary AML, but not in low risk MDS, (P , 0.001, P = 0.03, and P = 0.7). De novo AML showed decreased immature HPC. High numbers of immature HPC correlated with higher IPSS risk groups (P = 0.05) and showed significant impact on disease progression (P = 0.03). Conclusion Our study confirms that evaluation of CD38 expression pattern on HPC is an easy and reproducible test that allows evaluating the immature subset of progenitor cells. Increased immature HPC in high risk MDS and secondary AML may reflect blocked differentiation of CD34+ cells in these diseases. © 2006 International Society for Analytical Cytology [source] Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulationINTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2002Y. Boucher Abstract Aim This study was undertaken to examine the prevalence and technical quality of root fillings and the periapical status of endodontically treated teeth in a French subpopulation. Methodology Full-mouth periapical radiographs were obtained from 208 consecutive adult patients seeking care within the dental service provided by the Hôtel-Dieu in Paris. The occurrence and technical quality of root fillings were assessed for each root according to the position and the density of the obturation. The periapical status was evaluated using the Periapical Index Scoring System. The type of coronal restoration and the presence of posts were also noted. Results Of the 8743 roots included in the survey, 23% were root-filled. An acceptable standard of treatment was found in 21% of roots with 16% of these cases associated with signs of periapical disease. In roots with unacceptable root-fillings, 27% had periapical pathology. A post was seen in 26% of the root-filled canals, with 29% of these cases associated with periapical pathology. An intracoronal restoration existed in 30% of the filled roots, of which 22% exhibited a periapical lesion. An extra-coronal restoration was present in 60% of the filled roots, of which 24% had radiographic signs of periapical pathology. The remaining 10% of filled roots that had no coronal restoration were associated with periapical pathology in 33% of cases. At least one periapical lesion was seen in 63% of the patients. Conclusion The results demonstrate a high prevalence of root-filled teeth and poor technical quality of treatment. Roots presenting with acceptable root fillings were associated with a lower prevalence of periapical pathology (P < 0.001). Posts in roots were associated with periapical pathology significantly more than in roots without posts (P < 0.001). [source] Prospective Evaluation of a Pediatric Inpatient Early Warning Scoring SystemJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2009Karen M. Tucker PURPOSE. The present study evaluated the use of the Pediatric Early Warning Score (PEWS) for detecting clinical deterioration among hospitalized children. DESIGN/METHODS. A prospective, descriptive study design was used. The tool was used to score 2,979 patients admitted to a single medical unit of a pediatric hospital over a 12-month period. RESULTS. PEWS discriminated between children who required transfer to the pediatric intensive care unit and those who did not require transfer (area under the curve = 0.89, 95% CI = 0.84,0.94, p < .001). IMPLICATIONS. The PEWS tool was found to be a reliable and valid scoring system to identify children at risk for clinical deterioration. [source] Assessing the ecological integrity of a grassland ecosystem: the applicability and rapidity of the SAGraSS methodAFRICAN JOURNAL OF ECOLOGY, Issue 3 2009W. Kaiser Abstract The Grassland Biome is currently one of the most threatened biomes in South Africa and is in dire need of a biomonitoring protocol. The components of ecological integrity in these ecosystems are, however, too diverse and time-consuming to measure scrupulously. It is therefore necessary to develop a set of grassland indicators that are efficient and rapid in their assessment of grassland ecosystem integrity. The South African Grassland Scoring System (SAGraSS), based on the grassland insect community, is such a suggested indicator. The present study is the first to investigate the applicability and rapidity of this proposed method. Although SAGraSS scores correlated significantly with Ecological Index values (the most commonly used index by which veld condition is evaluated in central South Africa), the method proved to be tedious and the identification of insects taxing. We offer a number of changes to make the SAGraSS method a more rapid method of assessment. Résumé Le Biome « Prairies » est aujourd'hui un des plus menacés d'Afrique du Sud et a sérieusement besoin d'un protocole de biomonitoring. Les composantes de l'intégritéécologique de ces écosystèmes sont cependant trop diverses, et il faudrait trop de temps pour les mesurer scrupuleusement. Il est donc nécessaire de mettre au point un ensemble d'indicateurs pour les prairies qui soient efficaces et permettent d'évaluer rapidement l'intégrité de ces écosystèmes. Le système sud-africain South African Grassland Scoring System (SAGraSS), basé sur la communauté des insectes des prairies, est un des indicateurs qui fut proposé. Cette étude est la première qui analyse l'applicabilité et la rapidité de cette méthode. Bien que les résultats du SAGraSS soient significativement reliés aux valeurs de l'Indice Ecologique (EI , l'indice le plus utilisé pour évaluer les conditions écologiques du Veld au centre de l'Afrique du Sud), la méthode s'est avérée fastidieuse, et l'identification des insectes assez longue. Nous proposons un certain nombre de changements à apporter pour faire de la méthode SAGraSS une méthode d'évaluation plus rapide. [source] The Generalizability of Scores for a Performance Assessment Scored with a Computer-Automated Scoring SystemJOURNAL OF EDUCATIONAL MEASUREMENT, Issue 3 2000Brian E. Clauser When performance assessments are delivered and scored by computer, the costs of scoring may be substantially lower than those of scoring the same assessment based on expert review of the individual performances. Computerized scoring algorithms also ensure that the scoring rules are implemented precisely and uniformly. Such computerized algorithms represent an effort to encode the scoring policies of experts. This raises the question, would a different group of experts have produced a meaningfully different algorithm? The research reported in this paper uses generalizability theory to assess the impact of using independent, randomly equivalent groups of experts to develop the scoring algorithms for a set of computer-simulation tasks designed to measure physicians' patient management skills. The results suggest that the impact of this "expert group" effect may be significant but that it can be controlled with appropriate test development strategies. The appendix presents multivariate generalizability analysis to examine the stability of the assessed proficiency across scores representing the scoring policies of different groups of experts. [source] Nursing staff resources in direct patient care: comparison of TISS and ICNSSACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2004A. K. Pyykkö Background:, The aim was to study the variation in the nursing workload and nursing staff resources in direct patient care. Methods:, Nursing staff resources and the patient-nurse ratio (P/N) were compared between postoperative and mixed-type intensive care units (ICUs) using the Therapeutic Intervention Scoring System (TISS) and the Intensive Care Nursing Scoring System (ICNSS) during a 4-month period. Results:, A total of 832 patients were treated. In the postoperative ICU, the mean daily TISS score per nurse was 41.1, corresponding to a P/N of 1 : 1, and the mean ICNSS score was 33.8, corresponding to a P/N of 1 : 1.5. In the mixed-type ICU, the mean TISS score per nurse was 34.7, corresponding to a P/N of 2 : 1, and the mean ICNSS score was 27.7, corresponding to a P/N of 1 : 1. In the postoperative unit, 50.4% of the patients would have required a 1 : 1 P/N ratio based on their TISS scores and 47.5% would have required 1.5 or two nurses as estimated by the ICNSS score. In the mixed ICU 57.1% of the patients would have required a P/N ratio of 1 : 1 based on TISS scores and 61.3% a ratio of 1 : 1.5 or 1 : 2 according to the ICNSS score. Conclusion:, Intensive Care Nursing Scoring System gives additional information about the nursing staff resources and yields a higher number of nurses needed in direct patient care even when TISS scores show the number of nurses to be adequate. [source] Classroom processes and positive youth development: Conceptualizing, measuring, and improving the capacity of interactions between teachers and studentsNEW DIRECTIONS FOR YOUTH DEVELOPMENT, Issue 121 2009Robert C. Pianta The National Research Council's (NRC) statement and description of features of settings that have value for positive youth development have been of great importance in shifting discourse toward creating programs that capitalize on youth motivations toward competence and connections with others. This assets-based approach to promote development is consistent with the Classroom Assessment Scoring System (CLASS) framework for measuring and improving the quality of teacher-student interactions in classroom settings. This chapter highlights the similarities between the CLASS and NRC systems and describes the CLASS as a tool for standardized measurement and improvement of classrooms and their effects on children. It argues that the next important steps to be taken in extending the CLASS and NRC frameworks involve reengineering assessments of teacher and classroom quality and professional development around observations of teachers' performance. This might include using observations in policies regarding teacher quality or a "highly effective teacher" that may emanate from the reauthorization of No Child Left Behind and moving away from a course or workshop mode of professional development to one that ties supports directly to teachers' practices in classroom settings. [source] Host immunity affects survival in myelodysplastic syndromes: Independent prognostic value of the absolute lymphocyte count,AMERICAN JOURNAL OF HEMATOLOGY, Issue 3 2010Nisha L. Jacobs The prognostic significance of the peripheral blood absolute lymphocyte count (ALC) has been carefully examined in lymphoid malignancies, but the importance of the baseline ALC in chronic myeloid neoplasms is less clear. In a recent analysis of myelodysplastic syndromes (MDS) associated with deletion of chromosome 5q, we observed that an ALC < 1.2× 109 cells/L at diagnosis is independently associated with poorer survival. Clinicopathological data from 503 patients with non-del(5q) MDS evaluated at Mayo Clinic between 1996 and 2007 were reviewed to determine the prognostic impact of ALC at diagnosis in non-del(5q) MDS. Patients with MDS and an ALC at diagnosis ,1.2× 109 (N = 248) experienced a superior overall survival (OS) compared with patients with an ALC < 1.2× 109/L (N = 255, median OS of 26.6 months versus 18.5 months, P < 0.001, respectively). ALC at diagnosis was an independent predictor for OS when compared with the International Prognostic Scoring System and the WHO-based Prognostic Scoring System. This study suggests that ALC at diagnosis is a prognostic factor for OS in MDS, and argues in favor of further studies to assess the role of host immunity in MDS clinical outcomes. Am. J. Hematol. 2010. © 2009 Wiley-Liss, Inc. [source] Red blood cell transfusion need at diagnosis adversely affects survival in primary myelofibrosis,increased serum ferritin or transfusion load does not,AMERICAN JOURNAL OF HEMATOLOGY, Issue 5 2009Ayalew Tefferi Serum ferritin level at diagnosis was available in 185 patients with primary myelofibrosis (PMF); twenty-two (12%) patients had serum ferritin >1,000 ng/mL and 32 (17%) were red blood cell (RBC) transfusion-dependent. As expected, RBC transfusion need and increased serum ferritin displayed strong correlation (P < 0.0001); in addition, the latter but not the former correlated with advanced age (P < 0.0001). During median follow-up of 28 months (range 0.5,231), peak serum ferritin levels exceeded 1,000 ng/mL in 41 (22%) patients. On multivariable analysis that included age as a covariate, RBC transfusion need at diagnosis (P < 0.0001), but not increased serum ferritin or transfusion load, predicted shortened survival. The prognostic relevance of RBC transfusion need was independent of the International Prognostic Scoring System and was also illustrated for leukemia-free survival (P = 0.003). In PMF, the presence of a more severe erythropoietic defect, and not iron overload, has additional adverse prognostic value. Am. J. Hematol., 2009. © 2009 Wiley-Liss, Inc. [source] Myelodysplastic syndromes associated with interstitial deletion of chromosome 5q: Clinicopathologic correlations and new insights from the prelenalidomide era,,AMERICAN JOURNAL OF HEMATOLOGY, Issue 9 2008Shernan G. Holtan To better estimate prognosis for patients with myelodysplastic syndromes (MDS) associated with clonal interstitial deletions of the long arm of chromosome 5 (del(5q)), we reviewed the medical records of 130 adults with del(5q) MDS seen at our institution over a 15-year period. Overall median survival of this cohort was 9.5 months, shorter than reported in earlier series. The least favorable outcomes are associated with complex cytogenetics, lack of any normal metaphases, normocytic rather than macrocytic erythrocyte indices, and low baseline lymphocyte counts. Lymphopenia but not neutropenia at the time of diagnosis appears to be a new adverse prognostic indicator. Cytogenetic breakpoints defined by G-banded karyotyping correlate poorly with particular disease features. Surprisingly, survival of patients with treatment-related MDS was equivalent to that of de novo MDS with del(5q) in this series. Morphologic features associated with del(5q) are diverse. Most patients with del(5q) MDS do not meet criteria for WHO-defined 5q-syndrome, and the presence of del(5q) does not appear to modify the clinical phenotype otherwise risk-stratified by the International Prognostic Scoring System (IPSS). Additional important prognostic factors not taken into account by the IPSS include the baseline erythrocyte indices, lymphocyte count, and clonal burden. Am. J. Hematol., 2008. © 2008 Wiley-Liss, Inc. [source] Impact of Perioperative Systemic Steroids on Surgical Outcomes in Patients With Chronic Rhinosinusitis With Polyposis: Evaluation With the Novel Perioperative Sinus Endoscopy (POSE) Scoring System,THE LARYNGOSCOPE, Issue S115 2007Erin D. Wright MDCM Abstract Objectives/Hypothesis: The objective of this randomized, double-blind, placebo-controlled study was to assess the effect of perioperative systemic steroids on subjective and objective surgical outcomes for patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis with polyposis (CRSwP). The secondary objective was to begin validation of the newly developed Perioperative Sinus Endoscopy (POSE) scoring system. Methods: Patients who had failed maximal medical therapy and were scheduled to undergo ESS were eligible for the study. Participants were randomized to receive either 30 mg of prednisone or placebo for 5 days preoperatively and 9 days postoperatively. Operative and baseline clinical data were collected using the Lund-McKay staging system including its Sinus Symptom Questionnaire as well as additional data regarding mucosal health, the technical difficulty of surgery, and endoscopic data using the Lund-Kennedy Endoscopic Score (LKES) and POSE scale. Data were also collected at 2 weeks, 1 month, 3 months, and 6 months postoperatively. A sample size of 24 was calculated to detect a clinically relevant difference between groups of 40%. Routine statistical comparisons were performed as were repeated measures analysis of variance with Bonferroni adjustment because of the multiple comparisons performed. To address the secondary objective, data were also collected at all postoperative time points using the POSE instrument, which was designed with the intention of enhancing face validity and responsiveness to change. Comparisons were performed between the POSE and LKES, including assessment of sensitivity to change, correlation between the two scales, and correlation with symptom scores. Results: Twenty-six patients participated in the study. Operative data demonstrated a significantly higher percentage of severely inflamed sinonasal mucosa in patients not pretreated with systemic steroids, which was associated with technically more difficult surgery in the estimation of the operating surgeon. In terms of postoperative symptoms, there was no difference between treatment groups, with both placebo and prednisone significantly improved over baseline up to 4 weeks postoperatively. Endoscopic assessment of patients postoperatively demonstrated a treatment effect (P < .05), with clinically healthier cavities seen in patients treated with prednisone up to 6 months postoperatively as compared with baseline (P < .001), although the strongest effect was seen at the 2-week time point. In comparing the two endoscopic scales, the POSE and LKES correlated highly (R > 0.70; P < .001) both in terms of absolute score and change in score. There is some evidence that the POSE score may be more sensitive to change than the LKES, and the POSE scores did correlate more strongly with symptom scores than the LKES, although both endoscopic scores correlated only weakly with symptom scores. Conclusions: The data presented in this study support the practice of administering preoperative systemic steroids to patients undergoing ESS for CRSwP. Furthermore, in the practice of surgeons who provide intensive postoperative care post-ESS, including debridement and medical therapy based on the endoscopic findings, there is evidence to support administering systemic steroids in the postoperative period. The POSE scoring system compares favorably with the LKES and may confer advantages in terms of face/content validity and responsiveness to change and is worthy of further validation. [source] Comparison between Contrast-Enhanced Magnetic Resonance Imaging and Selvester QRS Scoring System in Estimating Changes in Infarct Size between the Acute and Chronic Phases of Myocardial InfarctionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2009Daniël A. Geerse M.D. Background: The Selvester QRS score was developed as a method to estimate infarct size (IS) using the ECG and has been validated during the prereperfusion era. Few comparisons exist with contrast-enhanced magnetic resonance imaging (ceMRI) in reperfused patients. This study evaluates the ability of the Selvester QRS score to estimate serial changes in IS during the acute and chronic phases of the infarct evolution in patients who have received reperfusion therapy. Methods: Thirteen patients with acute myocardial infarction underwent serial ceMRI studies in the acute (<1 week) and chronic phase (>2 months) after their initial myocardial infarction. QRS scoring was performed on the corresponding ECGs. The correlation between ceMRI measurement and QRS score estimation of IS was determined at both time points and for the difference between the two phases. Results: The mean IS was 20.1 ± 11.0% of total left ventricular mass (% LV) in the acute phase and 13.3 ± 6.4% LV in the chronic phase ceMRI. The mean IS estimated by Selvester QRS score in the acute and chronic phases were 18.7 ± 8.2% and 16.4 ± 8.5% LV, respectively. A modest correlation was found for the acute (r = 0.57) and chronic phase IS (r = 0.54). However, there was no correlation for the difference in IS between the acute and chronic phases. Conclusions: In this pilot study, the Selvester QRS score correlates modestly to IS by ceMRI during both the acute and chronic phases of the infarction process. The serial changes over time in the Selvester QRS score and IS by ceMRI show no correlation. [source] Evaluation of the prognostic significance of Eosinophilia and Basophilia in a larger cohort of patients with myelodysplastic syndromesCANCER, Issue 10 2010Friedrich Wimazal MD Abstract BACKGROUND: Lineage involvement and maturation arrest are considered to have prognostic significance in patients with myelodysplastic syndromes (MDS). However, although the prognostic value of neutropenia, thrombocytopenia, and monocytosis have been documented, little is known about the impact of eosinophils and basophils. METHODS: The authors examined the prognostic significance of eosinophils and basophils in 1008 patients with de novo MDS. Patients were enrolled from 3 centers of the Austrian-German MDS Working Group and were analyzed retrospectively. Blood eosinophils and basophils were quantified by light microscopy, and their impact on survival and leukemia-free survival was calculated by using Cox regression. RESULTS: Eosinophilia (eosinophils >350/,L) and basophilia (basophils >250/,L) predicted a significantly reduced survival (P < .05) without having a significant impact on leukemia-free survival. In multivariate analysis, eosinophilia and basophilia were identified as lactate dehydrogenase (LDH)-independent prognostic variables with International Prognostic Scoring System (IPSS)-specific impact. Although elevated LDH was identified as a major prognostic determinant in IPSS low-risk, intermediate-1 risk, and high-risk subgroups, the condition "eosinophilia and/or basophilia" was identified as a superior prognostic indicator in the IPSS intermediate-2 risk subgroup. CONCLUSIONS: The evaluation of eosinophils and basophils in patients with MDS was helpful and may complement the spectrum of variables to optimize prognostication in MDS. Cancer 2010. © 2010 American Cancer Society. [source] Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring SystemCANCER, Issue 6 2008Hagop Kantarjian MD Abstract BACKGROUND. Recent studies have highlighted issues with the International Prognostic Scoring System (IPSS) model in relation to the exclusion of many subgroups that now represent a large proportion of patients with myelodysplastic syndrome (MDS) (eg, secondary MDS, chronic myelomonocytic leukemia [CMML] with leukocytosis, prior therapy) and its lack of applicability to most patients on investigational programs, because many would have received prior therapies and would have had MDS for a significant length of time. METHODS. The authors analyzed 1915 patients with MDS who were referred from 1993 to 2005 (including those with CMML, secondary MDS, and MDS with prior therapy). Only 507 patients (26%) had primary MDS without prior therapy (ie, classifiable by the IPSS). Patients were divided randomly into a study group (n = 958) and a test group (n = 957). RESULTS. A multivariate analysis of prognostic factors in the study group identified the following adverse, independent factors as continuous and categoric values (P<.001): poor performance, older age, thrombocytopenia, anemia, increased bone marrow blasts, leukocytosis, chromosome 7 or complex (,3) abnormalities, and prior transfusions. Cutoffs for anemia, thrombocytopenia and blasts, and cytogenetic subsets were different according to the IPSS. The new MDS prognostic model divided patients into 4 prognostic groups with significantly different outcomes. The model was validated in the test group. Applying the prognostic score of the new model within the 4 IPSS risk groups, overall, and in patients who had primary MDS without prior therapy was found to be highly prognostic in each subset. Applying the IPSS within each of the 4 risk groups of the new MDS model was not found to be prognostic. CONCLUSIONS. The new model accounts for duration of MDS and prior therapy. It is applicable to any patient with MDS at any time during the course of MDS. Cancer 2008. © 2008 American Cancer Society. [source] Thalidomide therapy in adult patients with myelodysplastic syndromeCANCER, Issue 4 2006A North Central Cancer Treatment Group phase II trial Abstract BACKGROUND. Thalidomide has shown promise for the treatment of patients with myelodysplastic syndrome. The current prospective multicenter study examined the efficacy and toxicity of thalidomide in adult patients with myelodysplastic syndrome. METHODS. Using the International Prognostic Scoring System (IPSS), patients were stratified into 2 groups: favorable (IPSS score, 0,1.0) or unfavorable (IPSS score, 1.5,3.5). Seventy-two patients (42 of whom were favorable and 30 of whom were unfavorable) received a starting dose of oral thalidomide of 200 mg daily. The dose was increased by 50 mg per week to a targeted maximum daily dose of 1000 mg. RESULTS. According to the International Working Group response criteria for myelodysplastic syndrome, 1 patient in the unfavorable group achieved a partial remission with a complete cytogenetic response. Overall, 2 patients (5%) in the favorable group and 4 patients (14%) in the unfavorable group experienced either a hematologic improvement or a partial response. The most frequent Grade 3 or 4 (grading was based on the National Cancer Institute's Common Toxicity Criteria [version 2.0]) nonhematologic adverse events were fatigue (24%), infection (19%), neuropathy (13%), dyspnea (8%), and constipation (7%). CONCLUSIONS. Thalidomide alone, at the schedule and dose levels used in the current study, is not a safe and viable therapeutic option for patients with myelodysplastic syndrome. Limited efficacy and increased toxicity were observed in the current Phase II trial. Cancer 2006. © 2006 American Cancer Society. [source] Corporate Governance Scoring Systems: What Do They Tell Us?AUSTRALIAN ACCOUNTING REVIEW, Issue 32 2004Pernilla Linden The failure of companies such as Enron in the United States, and One. Tel and HIH in Australia, and the collapse of Arthur Andersen have created a worldwide debate on the importance of good corporate governance practices. A number of accounting and consulting firms and rating agencies have responded to the debate by developing corporate governance scoring systems (CGSS). In this paper we seek evidence of whether CGSS convey any information about the financial characteristics and performance of companies. We find no evidence of any significant relationship between the corporate governance score and financial performance. However, we find a direct relationship between a firm's size and its corporate governance score. [source] Performance of Severity of Illness Scoring Systems in Emergency Department Patients with InfectionACADEMIC EMERGENCY MEDICINE, Issue 8 2007Michael D. Howell MD ObjectivesTo validate the Mortality in Emergency Department Sepsis (MEDS) score, the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65) score, and a modified Rapid Emergency Medicine Score (mREMS) in patients with suspected infection. MethodsThis was a prospective cohort study. Adult patients with clinically suspected infection admitted from December 10, 2003, to September 30, 2004, in an urban emergency department with approximately 50,000 annual visits were eligible. The MEDS and CURB-65 scores were calculated as originally described, but REMS was modified in neurologic scoring because a full Glasgow Coma Scale score was not uniformly available. Discrimination of each score was assessed with the area under the receiver operating characteristics curve (AUC). ResultsOf 2,132 patients, 3.9% (95% confidence interval [CI] = 3.1% to 4.7%) died. Mortality stratified by the MEDS score was as follows: 0,4 points, 0.4% (95% CI = 0.0 to 0.7%); 5,7 points, 3.3% (95% CI = 1.7% to 4.9%); 8,12 points, 6.6% (95% CI = 4.4% to 8.8%); and ,13 points, 31.6% (95% CI = 22.4% to 40.8%). Mortality stratified by CURB-65 was as follows: 0 points, 0% (0 of 457 patients); 1 point, 1.6% (95% CI = 0.6% to 2.6%); 2 points, 4.1% (95% CI = 2.3% to 6.0%); 3 points, 4.9% (95% CI = 2.8% to 6.9%); 4 points, 18.1% (95% CI = 11.9% to 24.3%); and 5 points, 28.0% (95% CI = 10.4% to 45.6%). Mortality stratified by the mREMS was as follows: 0,2 points, 0.6% (95% CI = 0 to 1.2%); 3,5 points, 2.0% (95% CI = 0.8% to 3.1%); 6,8 points, 2.3% (95% CI = 1.1% to 3.5%); 9,11 points, 7.1% (95% CI = 4.2% to 10.1%); 12,14 points, 20.0% (95% CI = 12.5% to 27.5%); and ,15 points, 40.0% (95% CI = 22.5% to 57.5%). The AUCs were 0.85, 0.80, and 0.79 for MEDS, mREMS, and CURB-65, respectively. ConclusionsIn this large cohort of patients with clinically suspected infection, MEDS, mREMS, and CURB-65 all correlated well with 28-day in-hospital mortality. [source] Peroxisome proliferator-activated receptor-gamma agonist rosiglitazone reduces the size of experimental endometriosis in the rat modelAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2007Hakan AYTAN Abstract Background:, The effect of rosiglitazone, an activator of peroxisome proliferator-activated receptor-gamma, on the growth of ectopic uterine tissue was assessed. Methods:, Endometriosis was surgically induced in 28 rats by transplanting an autologous fragment of endometrial tissue onto the inner surface of the abdominal wall. Four weeks later, rats were randomly grouped and a second laparatomy was performed. The length, width, height and volume of the explants were measured. Rosiglitazone at 0.2 mg/kg/day was orally administered to one group, while vehicle treatment was given to the control group. Four weeks later, rats were sacrificed and ectopic uterine tissues were re-evaluated morphologically and histologically. Scoring system was used to evaluate the preservation of epithelia. Results:, One rat in the study group and two rats in the control group died as a result of complications related to surgery. There was a significant difference in post-treatment length, width, height, and spherical volumes between control and rosiglitazone-treated groups. The epithelia were found to be preserved significantly better in the control group when compared with the rosiglitazone-treated group. Conclusion:, Rosiglitazone was found to cause regression of experimental endometriosis in rats. [source] The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal haemorrhageINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2010R. Srirajaskanthan Summary Background:, Upper gastrointestinal (UGI) haemorrhage is a frequent cause of hospital admission. Scoring systems have been devised to identify those at risk of adverse outcomes. We evaluated the Glasgow Blatchford score's (GBS) ability to identify the need for clinical and endoscopic intervention in patients with UGI haemorrhage. Methods:, A retrospective observational study was performed in all patients who attended the A&E department with UGI haemorrhage during a 12-month period. Patients were separated into low and high risk categories. High risk encompassed patients who required blood transfusions, operative or endoscopic interventions, management on high dependency or intensive care units, and those who re-bled, represented with further bleeding, or who died. Results:, A total of 174 patients were seen with UGI bleeding. Eight of them self-discharged and were excluded. Of the remaining 166, 94 had a ,low risk' bleed, and 72 ,high risk'. The GBS was significantly higher in the high risk (median = 10) than in the low risk group (median 1, p < 0.001). To assess the validity of the GBS at separating low and high risk groups, receiver-operator characteristic (ROC) curves were plotted. The GBS had an area under ROC curve of 0.96 (95% CI 0.95,1.00). When a cut-off value of , 3 was used, sensitivity and specificity of GBS for identifying high risk bleeds was 100% and 68%. Thus at a cut-off value of , 2 the GBS is useful for distinguishing those patients with a low risk UGI bleed. Conclusions:, The GBS accurately identifies low risk patients who could be managed safely as outpatients. [source] Peripheral blood MDS score: A new flow cytometric tool for the diagnosis of myelodysplastic syndromes,CYTOMETRY, Issue 1 2005Sindhu Cherian Abstract Background Myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic disorders diagnosed using morphologic and clinical findings supported by cytogenetics. Because abnormalities may be subtle, diagnosis using these approaches can be challenging. Flow cytometric (FCM) approaches have been described; however the value of bone marrow immunophenotyping in MDS remains unclear due to the variability in detected abnormalities. We sought to refine the FCM approach by using peripheral blood (PB) to create a clinically useful tool for the diagnosis of MDS. Methods PB from 15 patients with MDS was analyzed by multiparametric flow cytometry using an extensive panel of monoclonal antibodies. Patterns of neutrophil antigen expression were compared with those of normal controls (n = 16) to establish light scatter and/or immunophenotypic abnormalities that correlated with MDS. A scoring algorithm was developed and validated prospectively on a blinded patient set. Results PB neutrophils from patients with MDS had lower side scatter and higher expression of CD66 and CD11a than did controls. Some MDS PB neutrophils demonstrated abnormal CD116 and CD10 expression. Because none of these abnormalities proved consistently diagnostic, we sought to increase the power of the assay by devising a scoring system to allow the association of multiple abnormalities and account for phenotypic variations. The PB MDS score differentiated patients with MDS from controls (P < 0.0001) in the test set. In a prospective validation, the PB MDS score successfully identified patients with MDS (sensitivity 73%, specificity 90%). Conclusions FCM analysis of side scatter and only four additional immunophenotypic parameters of PB neutrophils using the PB MDS score proved more sensitive than standard laboratory approaches and may provide an additional, more reliable diagnostic tool in the identification of MDS. © 2005 Wiley-Liss, Inc. [source] Low-Fluence Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser for Melasma with Pre- or Post-Treatment Triple Combination CreamDERMATOLOGIC SURGERY, Issue 6 2010SE-YEONG JEONG MD BACKGROUND Topical triple combination (TC) treatment is considered the primary approach to melasma. Recently, collimated low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment has attracted attention as an alternative approach. OBJECTIVES To compare the clinical efficacy and adverse effects of low-fluence Q-switched Nd:YAG laser when performed before and after treatment with topical TC using a split-face crossover design. METHODS Thirteen patients with melasma received topical treatment with TC cream or 1,064-nm Q-switched Nd:YAG laser treatment on opposite sides of the face for 8 weeks, and then treatments were reversed for 8 weeks. Responses were evaluated using the Melasma Area and Severity Index scoring system, spectrophotometry measurements, and a subjective self-assessment method. RESULTS After 16 weeks, better results were seen in subjective assessments when laser treatment was used after 8 weeks of topical TC treatment than before usage of TC. There were no significant adverse effects with the laser treatments. CONCLUSIONS Laser treatment after topical TC cream was found to be safer and more effective than the post-treatment use of topical agents. The authors have indicated no significant interest with commercial supporters. [source] The Amiel-Tison neurological assessment at term: Conceptual and methodological continuity in the course of follow-upDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 1 2005Julie Gosselin Abstract The Amiel-Tison Neurological Assessment at Term (ATNAT) is part of a set of three different instruments based on a neuro-maturative framework. By sharing a same methodology and a similar scoring system, the use of these three assessments prevents any rupture in the course of high risk children follow-up from 32 weeks post-conception to 6 years of age. The ATNAT which takes 5 minutes to administer may be used in clinical setting as well as in research. Clustering of severe to mild neuro-cranial signs in the neonatal period permits identification of children who could benefit from early intervention. © 2005 Wiley-Liss, Inc. MRDD Research Reviews 2005;11:34,51. [source] Measuring aggression with the staff observation aggression scale , revisedACTA PSYCHIATRICA SCANDINAVICA, Issue 2002H. Nijman Objective:, The staff observation aggression scale (SOAS; Palmstierna & Wistedt, 1987) was developed to measure nature, number, as well as severity of aggressive incidents. In 1999, a revised version of the SOAS (i.e. the SOAS-R), with a more fine-grained severity scoring system, was presented. In the current paper, the development and testing of the revised severity scores of the SOAS-R are addressed. Method: In two consecutive studies, staff members recorded inpatient aggression on SOAS-R forms, but also expressed their opinion about the severity of incidents on 100 mm visual analogue scales (VASs). Correlations were calculated between SOAS and SOAS-R severity scores, on the one hand, and clinical judgements of severity, on the other. Results:, In both studies, revised SOAS severity scores were more closely related to clinical judgements of aggression severity than the original ones. Conclusion: The SOAS-R is a promising tool for research on the prevalence, severity and determinants of inpatient aggression. [source] Intraoperative evaluation of sentinel lymph nodes in breast carcinoma by imprint cytology, frozen section and rapid immunohistochemistryDIAGNOSTIC CYTOPATHOLOGY, Issue 12 2009Sharma Upender M.D. Abstract Sentinel lymph nodes (SLN) isolated in 40 patients of breast carcinoma (stage T1/T2) were evaluated intraoperatively by imprint cytology and frozen section. Rapid immunohistochemistry (IHC) was done in cases where both imprint smears and frozen sections were negative for any metastatic tumor deposits. The results of these different techniques were compared with postoperative paraffin sections taken as "Gold Standard." Nottingham modification of Bloom Richardson scoring system was used for grading the tumors. Further, the correlation of the SLN status with tumor size, grade, and lymphovascular invasion was studied. The sensitivity, specificity, and overall accuracy of imprint cytology were 91.7, 100, and 95% respectively, and those of the frozen section were 95.8, 100, and 97.5% respectively. Examination of multiple serial sections improved the sensitivity and overall accuracy of frozen section. Results of intraoperative rapid IHC were equivalent to final paraffin sections. Histological grade and lymphovascular invasion were in direct correlation with SLN metastasis (P < 0.05). The risk of lymphovascular invasion increased from 22.2% in grade I tumors to 85.7% in grade III tumors. SLN biopsy is a reliable method to evaluate the status of the axillary lymph nodes. Imprint cytology can be used reliably where the facility of frozen section is not available. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Virtual microscopy: An educator's tool for the enhancement of cytotechnology students' locator skillsDIAGNOSTIC CYTOPATHOLOGY, Issue 6 2008Jimmie Stewart III M.D. Abstract Virtual microscopy (VM) is being utilized as an educational tool in many areas of pathology. The aim of this study is to analyze the locator and diagnostic skills of cytotechnology students by using the Aperio T3 ScanScope®, and examine VM's viability as an educational tool in cytotechnology. Ten validated cytology slides were digitized and reviewed by three senior cytotechnologist instructors. Each technologist made annotations indicating diagnostic areas on the virtual slide. A subset of the slides was used for locator skill evaluation. Cytotechnology students examined a pristine copy of the virtual slide and made annotations for comparison to those made by experienced instructors. Annotations of the subset were then scored based on the degree of correlation between students and cytotechnologists. A cytopathologist performed a final review of the students' marks; points were then added or subtracted based on this interpretation. Students were graded based on their correlation to senior cytotechnologists. A statistical analysis using modified interrater calculations ranked the students as to locator ability, producing illuminating results. This study shows that VM has promise as a cytotechnology educational tool by allowing the instructor to evaluate students' locator and diagnostic abilities. We have attempted to implement a simple scoring system for evaluation of locator skills where students are compared versus expert cytotechnologists. We anticipate further technological improvements as the products mature. Diagn. Cytopathol. 2008;36:363,368. © 2008 Wiley-Liss, Inc. [source] Fine-needle aspiration cytology of Hürthle cell carcinoma of the thyroidDIAGNOSTIC CYTOPATHOLOGY, Issue 3 2008Howard Her-Juing Wu M.D. Abstract Specific criteria for the diagnosis of fine-needle aspiration (FNA) of Hürthle Cell Carcinoma (HCC) have rarely been discussed in the literature. A retrospective review of 35 FNA cases with the diagnosis of Hürthle cell lesion or Hürthle cell neoplasm was performed. In each case, there was a subsequent surgical excision. The FNA specimens were divided according to histologic diagnoses as HCC (12 cases), Hürthle cell adenoma (HCA) (14 cases), and benign nonneoplastic Hürthle cell lesions (BNHCL) (9 cases). Each case was examined using a semiquantitative scoring system for the following 11 features: presence or absence of colloid, lymphocytes, and transgressed blood vessels (each scored 0 or 1); the percentage of nuclear enlargement, small cell dysplasia, large cell dysplasia, nuclear crowding, and cellular dyshesion (each scored 0,3); and age, gender, and size of lesion. When diagnosed by FNA as either Hürthle cell neoplasm or Hürthle cell lesion, males were much more likely to have malignant tumors than females. Statistically significant cytologic features that favored malignant (HCC) over benign lesions (HCA and BNHCL) included small cell dysplasia, large cell dysplasia, nuclear crowding, and cellular dyshesion. The presence of colloid and lymphocytes favored a benign lesion. Nuclear enlargement and large tumor size are significantly more common in neoplasms than BNHCL. Diagn. Cytopathol. 2008;36:149,154. © 2008 Wiley-Liss, Inc. [source] The effects of antibody clone and pretreatment method on the results of HER2 immunostaining in cytologic samples of metastatic breast cancer: A query and a review of the literature,,§DIAGNOSTIC CYTOPATHOLOGY, Issue 6 2007Patricia A. Fetsch M.T. (ASCP) Abstract The standardization and use of heat-induced epitope retrieval (HIER) is particularly important with immunohistochemical markers that direct the course of cancer treatment, such as Herceptin therapy. Increasingly, many laboratories are performing immunohistochemical analysis using various antibodies and methodologies for HER2/neu. We attempted to determine the effects of antibody clone and pretreatment methods on the interpretation of HER-2/neu staining in cytologic samples. Cell block sections from 54 cases of metastatic breast cancer (24 FNAs, 30 effusions) were analyzed for HER2 expression using antibodies to CB-11, TAB250, and A0485. Antibodies were analyzed with and without HIER. One pathologist using the FDA-approved scoring system for the HercepTest reviewed all slides in a blinded fashion. Five of fifty-four cases (9%) using CB-11 showed a significant increase in HER2 immunoreactivity using HIER (i.e. from 0/1+ to 2,3+). However, in twenty-nine of fifty-four cases (54%), the cytoplasmic background was significantly higher after HIER. With the A0485 antibody, two of fifty four cases (4%) showed a significant increase in immunoreactivity using HIER, while seventeen of fifty-four cases (31%) exhibited only more pronounced cytoplasmic staining. HIER pretreatment did not increase HER2 staining in any TAB250 stained sample, rather four of fifty-four cases (7%) showed a significant decrease in staining with HIER. We conclude that HIER may enhance membrane staining with the CB-11 and A0485 antibodies, but also increases cytoplasmic background. Loss of antigenicity is seen when HIER is used with TAB250. Diagn. Cytopathol. 2007;35:319,328. © 2007 Wiley-Liss, Inc. [source] Finnegan neonatal abstinence scoring system: normal values for first 3 days and weeks 5,6 in non-addicted infantsADDICTION, Issue 3 2010Urs Zimmermann-Baer ABSTRACT Objective The neonatal abstinence scoring system proposed by Finnegan is used widely in neonatal units to initiate and to guide therapy in babies of opiate-dependent mothers. The purpose of this study was to assess the variability of the scores in newborns and infants not exposed to opiates during the first 3 days of life and during 3 consecutive days in weeks 5 or 6. Patients and methods Healthy neonates born after 34 completed weeks of gestation, whose parents denied opiate consumption and gave informed consent, were included in this observational study. Infants with signs or symptoms of disease or with feeding problems were excluded. A modified scoring system was used every 8 hours during 72 hours by trained nurses; 102 neonates were observed for the first 3 days of life and 26 neonates in weeks 5,6. A meconium sample and a urine sample at weeks 5,6 were stored from all infants to be analysed for drugs when the baby scored high. Given a non-Gaussian distribution the scores were represented as percentiles. Results During the first 3 days of life median scores remained stable at 2 but the variability increased, with the 95th percentile rising from 5.5 on day 1 to 7 on day 2. At weeks 5,6 median values were higher during daytime (50th percentile = 5, 95th percentile = 8) than night-time (50th percentile = 2, 95th percentile = 6, P = 0.02). Conclusion Scores increase from days 1,3 to weeks 5,6 and show day,night cycles with 5,6 weeks. Values above 8 can be considered pathological. This data may help to raise suspicion of narcotic withdrawal and to guide therapy. [source] Preventive Care in the Emergency Department: Should Emergency Departments Conduct Routine HIV Screening?ACADEMIC EMERGENCY MEDICINE, Issue 3 2003A Systematic Review Abstract Objective: To perform a systematic review of the emergency medicine literature to assess the appropriateness of offering routine HIV screening to patients in the emergency department (ED). Methods: The systematic review was conducted with the aid of a structured template, a companion explanatory guide, and a grading and methodological scoring system based on published criteria for critical appraisal. Two reviewers conducted independent searches using OvidR, PubMed, MD Consult, and Grateful Med. Relevant abstracts were reviewed; those most pertinent to the stated objective were selected for complete evaluation using the structured template. Results: Fifty-two relevant abstracts were reviewed; of these, nine were selected for detailed evaluation. Seven ED-based prospective cross-sectional seroprevalence studies found HIV rates of 2,17%. Highest rates of infection were seen among patients with behavioral risks such as male homosexual activity and intravenous drug use. Two studies demonstrated feasibility of both standard and rapid HIV testing in the ED, with more than half of the patients approached consenting to testing by either method, consistent with voluntary testing acceptance rates described in other settings. Several cost,benefit analyses lend indirect support for HIV screening in the ED. Conclusions: Multiple ED-based studies meeting the Centers for Disease Control and Prevention Guideline threshold to recommend routine screening, in conjunction with limited feasibility trials and extrapolation from cost,benefit studies, provide evidence to recommend that EDs offer HIV screening to high-risk patients (i.e., those with identifiable risk factors) or high-risk populations (i.e., those where HIV seroprevelance is at least 1%). [source] | |||||||||||||||||||