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D F Signorini

Publications and source records attributed to D F Signorini.

26 records · Page 2Linked to original sources
PubMed1997

Transcranial cytokine gradients in patients requiring intensive care after acute brain injury.

After acute brain injury there may be increased intracranial production of cytokines, with activation of inflammatory cascades. We have sought to determine if a transcranial cytokine gradient was demonstrable in paired sera of 32 patients requiring intensive care after acute brain injury. The difference between concentrations of IL-1 beta, IL-6, IL-8 and TNF alpha in jugular venous and arterial serum was measured on admission, and at 24, 48 and 96 h after the primary injury. There were no differences in IL-1 beta, IL-8 or TNF alpha, but median gradients of 6.7 and 11.5 pg ml-1 for IL-6 were demonstrated in the traumatic brain injury (n = 22) and subarachnoid haemorrhage (n = 10) groups, respectively (normal values in serum < 4.7 pg ml-1; P < 0.001 both groups). This suggests that there is significant production of IL-6 by intracranial cells after acute brain injury. Therapy directed towards combatting the negative effects of IL-6 may potentially benefit patients who have sustained an acute brain injury.

Acute Disease↗
PubMed1997

Importance of textual data in multimodality monitoring.

OBJECTIVES: The use of multimodality monitoring of patients in the intensive care unit (ICU) and the subsequent collection and analysis of such data are increasing. The aim of this work was to assess the importance of recording complementary textual data referring to patient care maneuvers, calibrations, and other incidents, in addition to the raw numerical values. DESIGN: A retrospective analysis of multimodality monitoring data, which included comments entered concurrently at the bedside, collected from head-injured patients admitted to an ICU. PATIENTS: One hundred forty-seven patients with a postresuscitation Glasgow Coma Scale score of < or = 12 were monitored for a total of nearly 1 million minutes on up to eight commonly used channels. MEASUREMENTS AND MAIN RESULTS: Approximately 13,000 comments were added to the raw data at the time of collection. The data were subsequently validated using these comments as indicators of artifactual values. The comments were classified into a surprisingly small number of important categories, with the most frequent referring to monitor calibrations and regular ICU care maneuvers. The difference between validated and unvalidated data on the quantity of secondary insult observed was in some cases nearly 50%. CONCLUSIONS: This work demonstrates that such textual information should be recorded concurrently with the raw monitoring values to ensure proper interpretation of the data in any retrospective analysis. Furthermore, it also suggests that a small number of prespecified categories could be used in the on-line validation of such data.

Craniocerebral Trauma↗
PubMed1997

The Edinburgh Extended Glasgow Outcome Scale (EEGOS): rationale and pilot studies.

The Glasgow Outcome Scale (GOS) is the most widely used outcome measure in head injury research. However, it is a global and relatively insensitive measure, precluding any description of the types of impairments that lead to the disability. The Edinburgh Extended Glasgow Outcome Scale (EEGOS) was devised as a new outcome measure that retains the advantages of the existing GOS but allows comparison of patterns of recovery in different areas of function; behavioural, cognitive and physical. This report describes pilot studies of the EEGOS used retrospectively, and in 'live' face-to-face interviews. The results show raw percentage agreements of 45%, 60% and 70% in the retrospective study, and 83%, 78% and 83% in the 'live' study. These results demonstrate that the inter-rater reliability of the EEGOS is comparable to that of the GOS applied in similar situations.

Craniocerebral Trauma↗
PubMed1997

A comparison of the Invos 3100 and the Critikon 2020 near-infrared spectrophotometers as monitors of cerebral oxygenation.

Assessment of cerebral oxygenation using near-infrared spectroscopy in intensive care is increasing. We compared the ability of the Invos 3100 and the Critikon 2020 monitors to produce stable and consistent readings of regional cerebral oxygen saturation in resting volunteers. Failure to obtain any stable reading with the Critikon occurred in eight out of 18 subjects (44.4%) and with the Invos in three out of 15 subjects (20%). The Critikon showed a significantly higher failure rate in male subjects (p = 0.0011). Differences in recorded values of cerebral oxygen saturation (Critikon-Invos) ranged from -4.7% to 12.6% and were significantly related to the average saturation level (p < 0.0001). The within-monitor variability was significantly higher for the Invos (p = 0.0124). Neither monitor is able to give stable and consistent readings over time, particularly in male subjects. The unacceptably high failure rate of the recently introduced Critikon 2020 will limit or prevent its clinical use.

Adult↗
PubMed1995

Neural networks.

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Mathematical Computing↗
PubMed1993

Dynamic balanced randomization for clinical trials.

Common methods of treatment allocation for multi-centre and/or stratified randomized clinical trials can result in substantial differences between the number of patients allocated to each treatment arm. This can occur in the overall trial for a permuted block design or within individual institutions/strata when using a minimization scheme. This may lead to a bias in the result. Also, these procedures can be predictable, with the possibility of an investigator-introduced selection bias. An easily implemented method of randomization is proposed which attempts to overcome these problems by balancing treatment allocations both within strata and across the trial as a whole. The method keeps a running tally on total treatment allocation numbers at all stratification levels. When a patient accrues a hierarchical decision rule is applied, and the allocation is deterministic if certain pre-defined limits are exceeded, and random otherwise. The method is an extension of the big stick design of Soares and Wu, and is related to both Zelen's key number randomization methods and the schemes of Nordle and Brantmark. Simulation studies are used to demonstrate that major imbalances possible with other schemes do not occur using this method, and that the potential for selection bias is much reduced.

Algorithms↗