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[Visual processing of 12,000 electrocardiograms according to the USPHS code and comparison of visual and automatic processing of about 6,000 electrocardiograms in accordance with the USPHS code].

Multistage screening in Hesse (W. Germany) and the visual processing of about 12,000 ECG's in accordance with the USPHS (Riedel programme) are reported. A good fit was found with data obtained from a similar study in another part of the country. Comparison is then made with the visual and computerised processing of about 6,000 ECG's in accordance with the same code, using four classes: "normal", "conditionally within the limits of normal", "suspect" and "definitely pathological". The encouraging result on comparison between "normal" and "pathological" in the 6.3% consisting of false negatives (only 2.1% definitely pathological) suggests that "normal" and "conditionally normal" ratings by the computer can be accepted, whereas considerable possibilities for cardiological diagnosis would remain in the case of pathological traces, which would always be accepted, where as considerable possibilities recognised standards set down by the USPHS code are considered reliable. They can be used under hospital or screening conditions. On the other hand, the "scale of values" programme offered as a model requires further checking. Notes on future development are also offered.

Coronary Disease

Correlation of M-L, Leinfelder, and USPHS clinical evaluation techniques for wear.

Most recent clinical research studies on wear of posterior composite restorations have used the USPHS and Leinfelder measuring techniques. New studies are adopting the Moffa-Lugassy (M-L) technique. However, to date there has been no means of comparing results of the different techniques. The objective of this study was to correlate the M-L scale wear values to Leinfelder scale wear values and to USPHS scale alfa-bravo transitions, so that data can be pooled across studies for comparisons. M-L evaluations were made for 221 restorations previously evaluated by the USPHS and Leinfelder methods. The M-L wear values were determined as the mean of three independent evaluators' values. At the USPHS alfa-bravo transition, the mean Leinfelder wear value was 192 microns, and the mean M-L value was 97 microns. The correlation coefficient for the linear regression of M-L values vs. Leinfelder values was 0.87. The scales were linearly related, with a slope of 0.52. The average values for M-L readings of wear were statistically different and approximately half the Leinfelder values.

Clinical Trials as Topic

Comparison of a novel photogrammetric technique and modified USPHS criteria to monitor the wear of restorations.

This paper describes monitoring the wear of restorations borne by partial dentures over a 12 months period using a novel photogrammetric technique and modified United States Public Health Service (USPHS) criteria. The performance of Class II restorations of Dispersalloy was compared with that of similar restorations of either KetacFil or Occlusin. The photogrammetric technique highlighted differences in performance not detected by the modified USPHS criteria. It is concluded that the photogrammetric technique should prove valuable in the in vivo assessment of the performance of restorative materials but that further refinement of the method is required particularly with regard to the orientation of replicas for sequential measurements.

Composite Resins

[The Caceres-USPHS (version HP-3) computer program. Evaluation of automatic analysis of 40,000 ECG (author's transl)].

The main features of Caceres-USPHS (version HP-3) program for automatic analysis of the ECG are reviewed. Our experience at the Ospedale Regionale di Udine has now reached a total of 40,000 tracings analyzed by such a program and with an HP 1530-A computer system. In a detailed study of 1,000 consecutive computer-analyzed tracings reviewed by three experienced cardiologists, 534 were normal and 466 abnormal. A high degree of specificity was detected in the normal group (only 1.5% of false negatives) while the sensivity was rather low. In the abnormal group there were 18.1% of false positives and while the agreement was 100% in complete bundle branch block and some types of infarction, it was 56% in atrial fibrillation and 47% in incomplete right bundle branch block. Program errors were more common in measurements and pattern recognition; they were unusual in the program logic (0.3%). A significant improvement over comparable data obtained one year previously was attributed to a better quality control in data recording and to increase physician acceptance of the program diagnostic criteria. On the current and past figures of accuracy, it is concluded that the version HP-3 of Caceres-USPHS program represents a step forward in computer-derived ECG interpretation. However more progress is still needed for a larger and more profitable clinical application of this ECG computer program.

Computers

[ECG evaluation by the computer using the USPHS program (author's transl)].

The efficiency of ECG evaluation by the computer has definitely increased owing to the current improvement of the program. Applying the USPHS program in our material, a wrong diagnosis was made in 14% of the pathological tracings and in 25% of the normal tracings under investigation. These results are certainly encouraging, considering that dissimilar diagnoses are established by different cardiologists in about 20% of the cases. However, we deem the number of wrong diagnoses both in pathological and in normal cases still too high and, therefore, further improvement should be made before applying ECG diagnosis by the computer in practice.

Arrhythmias, Cardiac

USPHS Tuberculosis Short-Course Chemotherapy Trial 21: effectiveness, toxicity, and acceptability. The report of final results.

STUDY OBJECTIVE: To determine the effectiveness, toxicity, and acceptability of a 6-month antituberculous regimen compared with a 9-month regimen. DESIGN: A nonblinded, unbalanced, randomized, multicenter clinical trial. SETTING: Twenty-two tuberculosis clinics in public health departments and hospitals in the United States. PATIENTS: Patients were eligible if Mycobacterium tuberculosis, isolated from sputum cultures, was susceptible to study drugs. Of 1451 patients enrolled, 75% (617 of 823) assigned to the 6-month regimen and 71% (445 of 628) assigned to the 9-month regimen were eligible. INTERVENTIONS: Patients took self-administered isoniazid and rifampin daily for 24 weeks (6-month regimen) or 36 weeks (9-month regimen). In addition, patients assigned to the 6-month regimen took self-administered pyrazinamide daily during the first 8 weeks. RESULTS: Patients on the 6-month regimen converted more rapidly than patients on the 9-month regimen (94.6% compared with 89.9% after 16 weeks of therapy, with a difference of 4.7% [95% CI, 0.7% to 8.7%]); had similar rates of adverse drug reactions (7.7% compared with 6.4%, with a difference of 1.3% [95% CI, 0.0% to 4.6%]); had lower noncompliance rates (16.8% compared with 29.2%, with a difference of 12.4% [95% CI, 6.8% to 18.0%]); and had similar relapse rates 96 weeks after completing therapy (3.5% compared with 2.8%, with a difference of 0.7% [95% CI, 0.0% to 3.9%]). A significantly greater proportion of patients assigned to the 6-month regimen successfully completed therapy (61.4% compared with 50.6%; chi 2 = 11.976). CONCLUSIONS: Our results suggest that this 6-month regimen is similar in effectiveness, toxicity, and acceptability to the 9-month regimen for treating pulmonary tuberculosis.

Adult

Direct and indirect evaluation of posterior composite restorations at three years.

The purpose of this study was to compare the use of direct (USPHS) and indirect (M-L) systems of evaluating the occlusal wear of posterior composite restorations. Additionally, this study has utilized the USPHS method to compare the in vivo performance of posterior resin composite restorations made from four different visible-light-cured materials. Of the 202 restorations placed for this randomized clinical trial, only those restorations that were scored by both direct and indirect evaluation systems were included in these comparisons. Restorations were evaluated by two calibrated examiners from baseline to 36 months. While there were some differences noted among the four materials, the majority (99%) of the restorations evaluated in this study received "alpha" or "bravo" scores for all USPHS parameters, indicating acceptable in vivo performance. The results of this study also indicate that there was a consistent relationship between the direct (USPHS) and indirect (M-L scale) scoring systems. For those restorations that changed anatomic form scores, the mean wear at the alfa/bravo transition was 100 +/- 80 microns. By the 24-month recall examination, the use of the USPHS evaluation system category of anatomic form enabled examiners to differentiate restorations and materials that had experienced little occlusal wear from those that had experienced greater amounts of wear.

Analysis of Variance

Assessing composite resin wear in primary molars: four-year findings.

Many investigators have reported minimal wear of resin restorations in primary molars. Until recently, quantitative wear assessments have not been reported. The purpose of this investigation was (1) to present and contrast data from two 48-month clinical trials wherein quantitative wear assessments were used to evaluate wear of resin restorations in primary molars, and (2) to compare these results with those using the USPHS method of wear assessment. The data were collected from two different clinical trials. One was conducted at the University of California in San Francisco by Tonn and Ryge (TR Trial). The other was conducted at the University of North Carolina at Chapel Hill by Oldenburg, Vann, and Dilley (OVD Trial). The OVD Trial had a sample size of 45 patients with 106 restorations; the TR Trial had 44 patients with 96 restorations. The restorations in both trials were Class I and II restorations in occlusion. They were placed with the experimental light-cured posterior composite resin F-70, later marketed as Ful-Fill. At baseline, six, 12, 24, 36, and 48 months, restorations were evaluated by two evaluators trained in USPHS criteria as well as by a quantitative method of wear assessment, the standard cast technique as described by Leinfelder. Interstudy comparisons were made by Chi-square tests (USPHS evaluations) and ANOVA (quantitative assessments). The results showed that resin restorations in primary molars exhibited progressive wear with time in service. The rate and quantity of wear were very similar to those seen in permanent posterior teeth over 36 months. Findings agree with previous reports that the USPHS evaluation criteria are insensitive in detecting early wear in primary molars.

Bisphenol A-Glycidyl Methacrylate

Comparison of direct and indirect methods for analyzing wear of posterior composite restorations.

The vast majority of recent clinical research involving wear analyses of posterior composite resin restorations have used either the direct evaluation method (USPHS) or the indirect cast comparison (Leinfelder) method. However, there has never been any established correlation of the two wear scales. The objective of this study was to determine the amount of wear for the USPHS alfa-bravo transition on the basis of cast comparison data. Clinical wear data were collected over five years by both the direct method and the indirect method. Three materials were used involving a total of 221 restorations in 61 patients. Each restoration was evaluated at baseline, six months, one, two, three, and five years by each method. Then, for those restorations which underwent a transition from an alfa to a bravo clinical rating, the absolute wear at the transition was determined by averaging the indirect ratings just before and just after the transition. The mean wear corresponding to the alfa-bravo transition was 192 +/- 60 microns. Because of the large width of the alfa category up to the alfa-bravo transition, extensive early changes and high initial wear rates cannot be detected by the USPHS system.

Bicuspid

Assessment of appearance match by visual observation and clinical colorimetry.

Judgments of appearance matching by means of the visual criteria established by the United States Public Health Service (USPHS) and by means of an extended visual rating scale were determined for composite resin veneer restorations and their comparison teeth. Using a colorimeter of 45 degrees/0 degrees geometry and the CIELAB color order system we used the color of the restorations and comparison teeth to calculate a color difference for every visual rating. Statistically significant relationships were found between each of the two visual rating systems and the color differences. The average CIELAB color difference of those ratings judged a match by the USPHS criteria was found to be 3.7. However, the overlap in ranges of the color differences for those comparisons rated matches and mismatches indicates the importance of other factors in appearance matching, such as translucency and the effects of other surrounding visual stimuli. The extended visual rating scale offers no advantages to the more broadly defined criteria established by the USPHS.

Color

Five-year clinical study of u.v.-polymerized posterior composites.

Four u.v.-polymerized composites (Estilux, Nuva-Fil, Nuva-Fil P.A. and Uvio-Fil) were clinically evaluated in Class I and II cavity preparations in permanent teeth. The restorations were evaluated at baseline, 1, 2, 3, 4 and 5 years using USPHS criteria for direct evaluation and at 3, 4 and 5 years using the Leinfelder method for indirect evaluation of wear. The wear measured by the USPHS method showed increasing wear rates in earlier reports, apparently due to the limited sensitivity of the scale to early wear. The wear by the Leinfelder method showed gradually decreasing wear rates. There were no statistically significant differences among the wear values for the four u.v.-cured materials or between these materials and the self-cured and visible light-cured controls.

Analysis of Variance

Prevalence and course of diabetes modified by fasting blood glucose levels: implications for diagnostic criteria.

Data from the epidemiologic survey in Sudbury, Massachusetts, demonstrate that the prevalence of new cases of diabetes, based on the USPHS criteria for the standard 3-h oral glucose tolerance test as originally published, was 0.7%. If a fasting blood sugar greater than or equal to 110 mg/dl had been required for those USPH diagnoses, the prevalence would have fallen to 0.28%. Further, if a peak serum insulin level of less than or greater than 60 microM/ml had been required, the original prevalence rate would have dropped to 0.02%. Data from a prospeh criteria for diabetes indicate by life table analyses that 41% show further deterioration of carbohydrate control over the first 13 yr of the study when the fasting blood sugar was less than 110 mg/dl in the initial diagnostic test and 82% when the fasting blood sugar was greater than or equal to 110 mg/dl. The relationship of fasting blood glucose to later decompensation proved to be a continuous one without evidence of a threshold effect. The implications of both of these studies for diagnostic criteria, particularly recent proposals, is discussed.

Adolescent

National gonorrhea therapy monitoring study: adverse drug reactions.

The Center for Disease Control and cooperating clinics monitored adverse drug reactions in 6,969 patients who were treated for suspected uncomplicated gonorrhea with one of the four 1972 United States Public Health Service (USPHS) recommended regimens and returned for reexamination. Of those patients receiving the aqueous procaine penicillin G (APPG)-probenecid regimen, 2.0% had at least one adverse reaction and 0.18% experienced procaine reactions. No life-threatening reactions occurred. The overall reaction rates for the ampicillin-probenecid, tetracycline and spectinomycin regimens were 0.62%, 5.9%, and 0.61%, respectively. Our findings document the relative safety of the USPHS recommended regimens.

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