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  • 1
    ISSN: 1432-1238
    Keywords: Critical care medicine ; Intensive care units ; Scoring systems ; Severity of illness index ; SAPS II ; Hospital mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To assess the validity of SAPS II (new Simplified Acute Physiology Score) in a cohort of patients admitted to a large sample of Italian intensive care units (ICU). Design and setting The ability of the SAPS II scoring system to predict the probability of hospital mortality was assessed with calibration and discrimination measures obtained using published coefficients. A new logistic regression equation was then developed and further formal calibration and discrimination measures were estimated for the customized model. Patients From the 2202 consecutive patients recruited during a 1-month period in 99 ICUs, a total of 1393 patients were included in this validation study. Results When the parameters based on the standard model were applied, the expected probability of mortality did not fit those actually observed in the cohort (p〈0.001), although it showed satisfactory discrimination (area under the receiver operating characteristic curve=0.80). Such lack of fit yields an overall under prediction of mortality (observed/expected ratio=1.14) that reflects a uniform pattern across a preselected set of subgroups. Customization allowed new mortality estimates to be calculated, with satisfactory calibration (p=0.82) and a more uniform pattern across subgroups. Conclusions SAPS II maintained its validity in an independent sample of patients recruited in a large network of Italian ICUs only after appropriate adaptation (first-level customization). Whether the determinants of this relatively poor performance are related to differences in unmeasured case-mix, methods of application, or quality of care delivered is a matter for discussion that cannot be solved with the data presently available. However, these findings suggest that caution is warranted before implementing the standard SAPS II scoring system parameters outside formal research projects.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1238
    Keywords: Key words Critical care medicine ; Intensive care units ; Scoring systems ; Severity of illness index ; SAPS II ; Hospital mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract   Objective: To assess the validity of SAPS II (new Simplified Acute Physiology Score) in a cohort of patients admitted to a large sample of Italian intensive care units (ICU). Design and Setting: The ability of the SAPS II scoring system to predict the probability of hospital mortality was assessed with calibration and discrimination measures obtained using published coefficients. A new logistic regression equation was then developed and further formal calibration and discrimination measures were estimated for the customized model. Patients: From the 2202 consecutive patients recruited during a 1-month period in 99 ICUs, a total of 1393 patients were included in this validation study. Results: When the parameters based on the standard model were applied, the expected probability of mortality did not fit those actually observed in the cohort (p〈0.001), although it showed satisfactory discrimination (area under the receiver operating characteristic curve=0.80). Such lack of fit yields an overall under prediction of mor-28.8ntality (observed/expected ratio=1.14) that reflects a uniform pattern across a preselected set of subgroups. Customization allowed new mortality estimates to be calculated, with satisfactory calibration (p=0.82) and a more uniform pattern across subgroups. Conclusions: SAPS II maintained its validity in an independent sample of patients recruited in a large network of Italian ICUs only after appropriate adaptation (first-level customization). Whether the determinants of this relatively poor performance are related to differences in unmeasured case-mix, methods of application, or quality of care delivered is a matter for discussion that cannot be solved with the data presently available. However, these findings suggest that caution is warranted before implementing the standard SAPS II scoring system parameters outside formal research projects.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1248-9204
    Keywords: Inguinal hernia ; Hernioplasty ; Preperitoneal approach ; Mesh ; Tension-free technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The study describes the advantages of using the positioning of the prosthesis in the pre-peritoneal space by a posterior approach in the repair of inguinal hernia. The research was carried out on 388 patients (372 (96%) men and 16 (4%) women), who had undergone hernioplasties with the insertion of a polypropylene prosthesis by a preperitoneal approach, between January 1994 and December 1996. 216 of these patients (56%) had an indirect inguinal hernia, 94 (24%) a direct inguinal hernia and 78 (20%) a double inguinal hernia (direct and indirect). In 21 cases (6%) it was a recurrent hernia. The following clinical parameters were considered: pain, sensitivity of the inguinal region, testicular pathology, wound pathology and recurrence. 384 patients out of 388 (99%) were discharged at latest one day after the operation. On average the patients went back to work 6 days after the operation. All the patients were checked at least three times out of four, with follow-ups at 30 days, 6 months, 1 year and 2 years after the operation. In 13 patients (1.8%) there was a minor complication, in 3 patients (0.8%) we found an early recurrence due to technical error. We consider that positioning the prosthesis in the preperitoneal space using this minimally invasive procedure can be carried out easily and with very good clinical results in terms of typical early and/or late complications, which range from 2% to 20% by the anterior approach.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Clinica Chimica Acta 122 (1982), S. 293-300 
    ISSN: 0009-8981
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1749-6632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Natural Sciences in General
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1476-4687
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Chemistry and Pharmacology , Medicine , Natural Sciences in General , Physics
    Notes: [Auszug] In human embryos, ontogenic development of the erythron entails parallel switches of erythropoietic site, erythroblast morphology and haemoglobin (Hb) content3-7. The primitive yolk sac-derived lineage consists of nucleated 'megaloblasts', which appear 2-3 weeks after conception7-9 and are present ...
    Type of Medium: Electronic Resource
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