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Severity Ratings (severity + rating)

Distribution by Scientific Domains

Medical Sciences	86%
Life Sciences	13%

Selected Abstracts

Establishment of new severity ratings based on analysis of hospital-acquired pneumonia

RESPIROLOGY, Issue 2009
Article first published online: 19 OCT 200
SUMMARY ,,The Japanese Respiratory Society issued its first guidelines for the management of hospital-acquired pneumonia in adults in 2002. Pathological and severity ratings were investigated based on the results of a national multicenter survey of hospital-acquired pneumonia, and the new severity ratings shown below were established (Fig. II-1). Figure II-1. Severity ratings. MRSA, Methicillin-resistant Staphylococcus aureus. ,,Severity ratings in the 2002 guidelines were based mainly on markers that predicted the effectiveness of antimicrobial treatment. In the current revision, severity is rated using markers that predict the prognosis of patients. ,,Five criteria were established as factors that predict prognosis: malignant tumour or immunocompromised status; decreased level of consciousness; FiO2 >35% required to maintain SpO2 >90%; age ,70 years in men or ,75 years in women; and oliguria or dehydration. ,,Two criteria were established as factors specifying the severity of the pneumonia itself: CRP ,200 mg/L and shadows infiltrating more than two-thirds the area of one lung on chest radiography. ,,Patients who satisfy up to two of the five criteria above to predict prognosis are classified in the mild group (Group A) if they do not satisfy either of the two criteria specifying severity of pneumonia, or in the moderate group (Group B) if they satisfy one or both of those two criteria. Patients who satisfy three or fewer of the five criteria to predict prognosis are classified in the severe group (Group C). ,,When the new severity ratings were applied to the results of the national multicenter survey of hospital-acquired pneumonia, the mortality rate was found to be 12.1% (101/834) in the mild group (Group A), 24.9% (69/277) in the moderate group (Group B) and 40.8% (98/240) in the severe group (Group C). Statistically-significant differences were seen between groups, and patient classification may be useful as an indicator of prognosis (Fig. II-2). Figure II-2. Number of cases and outcomes for each group. VAP, ventilator-assisted pneumonia. [source]

Update of the Pompe disease mutation database with 107 sequence variants and a format for severity rating,

HUMAN MUTATION, Issue 6 2008
Marian Kroos
Abstract Pompe disease was named after the Dutch pathologist Dr JC Pompe who reported about a deceased infant with idiopathic hypertrophy of the heart. The clinical findings were failure to thrive, generalized muscle weakness and cardio-respiratory failure. The key pathologic finding was massive storage of glycogen in heart, skeletal muscle and many other tissues. The disease was classified as glycogen storage disease type II and decades later shown to be a lysosomal disorder caused by acid ,-glucosidase deficiency. The clinical spectrum of Pompe disease appeared much broader than originally recognized. Adults with the same enzyme deficiency, alternatively named acid maltase deficiency, were reported to have slowly progressive skeletal muscle weakness and respiratory problems, but no cardiac involvement. The clinical heterogeneity is largely explained by the kind and severity of mutations in the acid ,-glucosidase gene (GAA), but secondary factors, as yet unknown, have a substantial impact. The Pompe disease mutation database aims to list all GAA sequence variations and describe their effect. This update with 107 sequence variations (95 being novel) brings the number of published variations to 289, the number of non-pathogenic mutations to 67 and the number of proven pathogenic mutations to 197. Further, this article introduces a tool to rate the various mutations by severity, which will improve understanding of the genotype-phenotype correlation and facilitate the diagnosis and prognosis in Pompe disease. © 2008 Wiley-Liss, Inc. [source]

Long-term fine caliber hair removal with an electro-optic Q-switched Nd:YAG Laser,

LASERS IN SURGERY AND MEDICINE, Issue 8 2010
Abnoeal D. Bakus PhD
Abstract Background In spite of major advances in hair removal therapy, fine caliber hair remains a significant challenge for laser- and light-based devices. Objective Evaluate a novel Electro-Optic (EO) Q-switched Nd:YAG laser for pigmented fine caliber hair removal in the Standard Single and a double pulse (DP) mode. Methods Eleven patients underwent four laser treatments at monthly intervals. Bilateral anatomical regions received to one side the standard single pulse (SSP) while the other side the DP option. Blinded investigators conducted hair counts at 6 months post-treatment and after 24 months. Patients assessed hair loss and discomfort. Six patients rated their satisfaction at 6 months. Results At 6 months, investigators found a reduction of 50% in hair counts with the DP and 46% with standard pulse. Ninety percent in DP and 50% in SSP reported none to mild discomfort. Transient erythema and edema was observed with a lower severity rating with the DP. There were no other untoward effects. 83.3% of patients who completed the study at 6 months expressed satisfaction with the results. At 24 months hair loss was maintained at the same rate. Conclusion The EO Q-switched Nd:YAG laser is an effective option for the permanent treatment of unwanted fine hair and has a high-patient satisfaction rate. There is less therapeutic discomfort in the DP mode. Lasers Surg. Med. 42:706,711, 2010 © 2010 Wiley-Liss, Inc. [source]

Fatigue rating scales critique and recommendations by the Movement Disorders Society task force on rating scales for Parkinson's disease,

MOVEMENT DISORDERS, Issue 7 2010
Joseph H. Friedman MD
Abstract Fatigue has been shown to be a consistent and common problem in Parkinson's disease (PD) in multiple countries and cultures. It is one of the most disabling of all symptoms, including motor dysfunction, and appears early, often predating the onset of motor symptoms. Several studies of the epidemiology of fatigue have been published, often using different scales, but few on treatment. The Movement Disorder Society (MDS) commissioned a task force to assess available clinical rating scales, critique their psychometric properties, summarize their clinical properties, and evaluate the evidence in support of their use in clinical studies in PD. Six clinical researchers reviewed all studies published in peer reviewed journals of fatigue in PD, evaluated the scales' previous use, performance parameters, and quality of validation data, if available. Scales were rated according to criteria provided by the MDS. A scale was "recommended" if it has been used in clinical studies beyond the group that developed it, has been used in PD and psychometric studies have established that it is a valid, reliable and sensitive to change in people with PD. Requiring a scale to have demonstrated sensitivity to change in PD specifically rather than in other areas in order to attain a rating of "recommended" differs from the use of this term in previous MDS task force scale reviews. "Suggested" scales failed to meet all the criteria of a "recommended" scale, usually the criterion of sensitivity to change in a study of PD. Scales were "listed" if they had been used in PD studies but had little or no psychometric data to assess. Some scales could be used both to screen for fatigue as well as to assess fatigue severity, but some were only used to assess severity. The Fatigue Severity Scale was "recommended" for both screening and severity rating. The Fatigue Assessment Inventory, an expanded version of the Fatigue severity Scale, is "suggested" for both screening and severity. The Functional Assessment of Chronic Illness Therapy-Fatigue was "recommended" for screening and "suggested" for severity. The Multidimensional Fatigue Inventory was "suggested" for screening and "recommended" for severity. The Parkinson Fatigue Scale was "recommended" for screening and "suggested" for severity rating. The Fatigue Severity Inventory was "listed" for both screening and severity. The Fatigue Impact Scale for Daily Use, an adaptation of the Fatigue Impact Scale was "listed" for screening and "suggested" for severity. Visual Analogue and Global Impression Scales are both "listed" for screening and severity. The committee concluded that current scales are adequate for fatigue studies in PD but that studies on sensitivity and specificity of the scales are still needed. © 2010 Movement Disorder Society [source]

Revision of the severity rating and classification of hospital-acquired pneumonia in the Japanese Respiratory Society guidelines

RESPIROLOGY, Issue 6 2008
Masafumi SEKI
Background and objective: Based on the results of a multicentre collaborative survey of hospital-acquired pneumonia (HAP) conducted in Japan, the severity rating and classification of pneumonia in the Japanese Respiratory Society guidelines for management of HAP were examined. Methods: Parameters for the severity classification were selected from the factors associated with prognosis in the HAP survey and in other previous reports. Depending on the presence of the parameters listed below, patients with HAP were stratified into those with high, moderate or low-risk. The high-risk group was defined as patients with three or more of the following risk factors: ,malignant tumour or immunocompromised status', ,impaired consciousness', ,requiring fraction of inspired oxygen (FiO2) >35% to maintain SaO2 >90%', ,man aged 70 years or older, or woman aged 75 years or older' and ,oliguria or dehydration.' The moderate-risk group was defined as patients with any of the secondary risk factors as follows: ,CRP , 200 mg/L' and ,extent of infiltration on CXR covers at least 2/3 of one lung'. The low-risk group was defined as all other patients. Results: Application of this classification scheme to the patients enrolled in the HAP survey revealed a mortality rate of 40.8% (98/240) in the high-risk group, which was significantly higher than the mortality rates in the moderate and low-risk groups: 24.9% (69/277) and 12.1% (101/834), respectively. Conclusion: These results indicate that it is possible to classify patients using these parameters as prognostic indicators. [source]

3445: Evaluation, diagnosis and grading of severity of MGD

ACTA OPHTHALMOLOGICA, Issue 2010
AJ BRON
Purpose To evaluate current diagnostic tests and make future recommendations. Methods An evidence-based review of procedures. Results MGD is a common symptomatic disorder leading to associated ocular surface disease including evaporative dry eye. A two stage diagnostic approach is recommended including an assessment of meibomian function based on lid morphology, gland mass, expressibility, lipid layer appearance and tear evaporation. A diagnosis of dry eye is based on measures of tear production and clearance, tear osmolarity, tear film stability and the presence of ocular surface changes revealed by tissue staining and inflammatory biomarkers. Quantification of MGD depends on grading meibum quality and expressibility. Newer, quantitative methods will make grading more accurate in the future and include quantitative meibomian expression, non-invasive meibography, confocal microscopy, video-interferometry and the use of inflammatory biomarkers. Meibomian gland dropout can be to monitor and stratify MGD in clinical trials. Conclusion A provisional severity rating of MGD and MGD-related disease has been proposed as a guide to the selection of treatment and the monitoring of disease progression. [source]

Reliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale (SIGH-A)

DEPRESSION AND ANXIETY, Issue 4 2001
M. Katherine Shear M.D.
Abstract The Hamilton Anxiety Rating Scale, a widely used clinical interview assessment tool, lacks instructions for administration and clear anchor points for the assignment of severity ratings. We developed a Structured Interview Guide for the Hamilton Anxiety Scale (SIGH-A) and report on a study comparing this version to the traditional form of this scale. Experienced interviewers from three Anxiety Disorders research sites conducted videotaped interviews using both traditional and structured instruments in 89 participants. A subset of the tapes was co-rated by all raters. Participants completed self-report symptom questionnaires. We observed high inter-rater and test-retest reliability using both formats. The structured format produced similar but consistently higher (+ 4.2) scores. Correlation with a self-report measure of overall anxiety was also high and virtually identical for the two versions. We conclude that in settings where extensive training is not practical, the structured scale is an acceptable alternative to the traditional Hamilton Anxiety instrument. Depression and Anxiety 13:166,178, 2001. © 2001 Wiley-Liss, Inc. [source]

Menopausal symptom perception and severity: results from a screening questionnaire

JOURNAL OF CLINICAL NURSING, Issue 7 2008
FAANP, Judith A Berg PhD
Background., Although it is widely acknowledged women experience symptoms during their transition from reproductive to postreproductive stage, there is inconsistency as to the prevalence of symptoms as well as their severity ratings. Aim and objectives., The purpose of this study was to describe symptom perception and severity in mid-life women volunteering for an intervention study for menopause symptom management. Design., A cross-sectional descriptive design was used to provide data on presenting symptoms in a sample of women negotiating the menopausal transition. Methods., A community-based sample of Caucasian women aged 43,55 years was recruited from national nursing media, local media and a variety of local community sources. A screening questionnaire was administered to determine qualification for study entry based upon symptom severity scores from the questionnaire. This report includes results from the screening questionnaire. Results., One hundred and sixty-five women were screened to obtain 110 qualified participants with mean age of 49·3 SD 3·04 years who were 4·7 SD 7 months past their last menstrual period. Sleep difficulties, forgetfulness and irritability were perceived by the highest number of women while sleep difficulties, night sweats, irritability and forgetfulness were rated the most severe. Conclusions., Findings from this study expand understanding of the menopause symptom experience, because few reports include symptom severity reports. All aspects of the symptom experience are necessary to develop appropriate interventions and to evaluate them. Relevance to clinical practice., Providing education about menopause symptoms is central to nursing practice of mid-life women. Therefore, nurses must keep abreast of current knowledge to prepare women for their transition to postreproductive phase or to reassure women who are surprised to find hot flashes are not the only symptoms encountered. [source]

Validation of the Wong-Baker FACES Pain Rating Scale in Pediatric Emergency Department Patients

ACADEMIC EMERGENCY MEDICINE, Issue 1 2010
Gregory Garra DO
Abstract Objectives:, The Wong-Baker FACES Pain Rating Scale (WBS), used in children to rate pain severity, has been validated outside the emergency department (ED), mostly for chronic pain. The authors validated the WBS in children presenting to the ED with pain by identifying a corresponding mean value of the visual analog scale (VAS) for each face of the WBS and determined the relationship between the WBS and VAS. The hypothesis was that the pain severity ratings on the WBS would be highly correlated (Spearman's rho > 0.80) with those on a VAS. Methods:, This was a prospective, observational study of children ages 8,17 years with pain presenting to a suburban, academic pediatric ED. Children rated their pain severity on a six-item ordinal faces scale (WBS) from none to worst and a 100-mm VAS from least to most. Analysis of variance (ANOVA) was used to compare mean VAS scores across the six ordinal categories. Spearman's correlation (,) was used to measure agreement between the continuous and ordinal scales. Results:, A total of 120 patients were assessed: the median age was 13 years (interquartile range [IQR] = 10,15 years), 50% were female, 78% were white, and six patients (5%) used a language other than English at home. The most commonly specified locations of pain were extremity (37%), abdomen (19%), and back/neck (11%). The mean VAS increased uniformly across WBS categories in increments of about 17 mm. ANOVA demonstrated significant differences in mean VAS across face groups. Post hoc testing demonstrated that each mean VAS was significantly different from every other mean VAS. Agreement between the WBS and VAS was excellent (, = 0.90; 95% confidence interval [CI] = 0.86 to 0.93). There was no association between age, sex, or pain location with either pain score. Conclusions:, The VAS was found to have an excellent correlation in older children with acute pain in the ED and had a uniformly increasing relationship with WBS. This finding has implications for research on pain management using the WBS as an assessment tool. ACADEMIC EMERGENCY MEDICINE 2010; 17:50,54 © 2009 by the Society for Academic Emergency Medicine [source]

Identification of resistance to Ascochyta fabae in Vicia faba germplasm

PLANT BREEDING, Issue 6 2001
J. C. Sillero
Abstract A total of 752 faba bean accessions were screened under field conditions for resistance to Ascochyta fabae. Several methods of assessing disease development were compared for evaluating the resistance of these accessions. Thirty-four accessions displayed low disease severity ratings. In 15 of them, lesions were restricted in size and number, whereas in the remaining 19, lesions were well developed but scarce. These lines could have been discarded if screening had depended only on scales based on lesion type, which shows the need to complement such scores with disease severity or to use a simplified scale that integrates both lesion type and the amount of damage. [source]

Establishment of new severity ratings based on analysis of hospital-acquired pneumonia

Voice, Speech, and Swallowing Outcomes in Laser-Treated Laryngeal Cancer,

THE LARYNGOSCOPE, Issue 6 2003
Matthew C. Jepsen MD
Abstract Objective To describe preliminary voice, speech, and swallowing outcomes in patients treated by endoscopic laser excision of laryngeal cancer with or without adjuvant radiation therapy. Study Design Retrospective review. Methods Seventeen surgically treated patients (five T2 glottic and 12 clinically staged T2 supraglottic squamous cell carcinomas) participated in the study. Self-ratings of voice (Voice Handicap Index) and swallowing (M. D. Anderson Dysphagia Inventory) were completed, as well as independent auditory-perceptual ratings of voice and speech recordings. Results Although no significant difference between Voice Handicap Index, M. D. Anderson Dysphagia Inventory, and listener ratings was identified based on tumor site and irradiation status, there was a trend toward poorer outcomes in patients who received adjuvant radiation therapy. Whereas the patients having supraglottic cancer tended to report better voice but poorer swallowing outcomes, the glottic cancer group displayed the opposite pattern. Severity on Voice Handicap Index correlated significantly with listener severity ratings of speech, suggesting that the patients' perception of their voice handicap was similar to the listeners' judgments of their speech severity. Conclusions The results suggest the following trends: 1) Adjuvant radiation therapy was associated with poorer outcomes for voice, speech, and swallowing and may be associated with more impairment than surgery alone and 2) poorer outcomes on voice and swallowing were observed for the glottic and supraglottic cancer groups, respectively. To bolster these preliminary findings, additional outcomes studies in patients treated with conservation therapy are needed. [source]