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At least 19 recordsLinked to original sources

PubMed1989

Physician ratings of appropriate indications for three procedures: theoretical indications vs indications used in practice.

We previously reported substantial disagreement among expert physician panelists about the appropriateness of performing six medical and surgical procedures for a large number of theoretical indications. A recently completed community-based medical records study of about 4,500 patients who had one of three procedures--coronary angiography, upper gastrointestinal endoscopy, and carotid endarterectomy--shows that many of the theoretical indications are seldom or never used in practice. However, we find that there is also substantial disagreement (5, 25, or 32 per cent for angiography, endoscopy, or endarterectomy, respectively) about the appropriateness of indications used in actual cases if disagreement is defined by first discarding the two extreme of nine ratings, then looking for at least one rating near the bottom (1 to 3) and one near the top (7 to 9) of the 9-point scale. Patients should know that a substantial percentage of procedures are performed for indications about which expert physicians disagree.

Attitude of Health Personnel↗

PubMed1978

[Application of a new method for the calculation and description of the resistance of microbiological indicators. I. Testing of several common microbiological sterilization indicators (author's transl)].

The method described by SPICHER and PETERS (1975) for the calculation and description of the resistance of microbiological indicators was tested. As test objects served spore-containing earth according to DIN 58946, Attest indicators (3 M Company, Minnesota) and Oxoid Spore Strips (Oxoid Ltd., London). The tests were performed not only for different batches of indicators but also for preparations of different age. After application of steam (120 degrees C), the indicators were examined for the presence of surviving germs capable of multiplication. When plotting the frequency of indicators with surviving germs (q) against the duration of steam action, S-shaped curves were obtained as expected. By altering the scale of the ordinate (y = lg (-ln(1 - q))), the S-shaped curves could be transformed into straight lines. Thus, the experimentally established paired values could be used for a calculation of regression. This method of calculation proved to be suitable in all cases studied. By indicating the position and the slope of these straight regression lines, the resistance of microbiological indicators can be exactly described (cf. Table 2). This method is applicable not only to indicators containing culture spores but also for native spore-containing earth. The indicators examined differed in their resistance and stability. Seven out of eight batches of Attest indicators (cf Figs. 1 and 2 and Table 1) fulfilled the requirements of DIN 58946, Part 4, for the resistance of bio-indicators for steam sterilization. One of the batches had a slightly higher resistance. The Attest indicators tested were of good stability (see Fig. 1 and Table 1). Where surviving germs were present on the indicators after treatment by steam, their growth was recognizable, in 99% of cases, already after incubation of the cultures for 24 hours. Only two batches of Oxoid Spore Strips were available for testing. One batch was of a higher resistance than required by DIN 58946. The second batch was slightly above the lower limit of the permissible range (see Fig. 3). During storage for 12 months, the resistance of both batches was reduced by 3--4 min. Where the indicators exhibited surviving germs after treatment by steam, growth was recognizable in 87% of the cases after incubation for 24 hours, while for the other indicators, incubation for 48 hours was necessary. The experiments confirmed the good stability of native spore-containing earth (see Fig. 5). Within 4--5 years, the steam resistance of the preparations decreased only by 3--4 min.

Bacteriological Techniques↗

PubMed1991

Current status of biological indicators to detect and quantify previous exposures to radiation. Biological Indicators Working Group.

Hematologic changes following whole-body exposure to gamma or x-ray radiation have been used to estimate dose. The usefulness of this biological indicator is limited because of the recovery of these cells with time, thus making it unsuitable for estimation of dose years after exposure. The same is true for spermatogenic indicators; recovery and restoration of sperm numbers and fertility makes this biological indicator impractical for assessing radiation dose decades after radiation exposure. As noted in the text of the report, immunological concepts are in a state of rapid development, and it is possible that improved methods for applying immunologic procedures as biological indicators of radiation may be developed in the future. However, at the time, immunological indicators are not useful, even in an early time period, for quantitating radiation dose after total-body irradiation. A semiquantitative effect is observable in the early phase after total-body irradiation over a period of days to weeks, but there is little data available to indicate whether any of the immunological parameters can be indicative of a dose when the test is applied several years after radiation exposure. More detailed information regarding immunological indicators for estimating irradiation dose has been summarized elsewhere (Wasserman 1986). There is good agreement that ionizing radiation causes biochemical changes in the body; however, attempts to apply these changes to provide a reliable biological dosimetry system have not been particularly successful. The status of this research has been summarized by Gerber (1986). One of the difficulties has been the problem of establishing clear dose-effect relationships in humans. The lack of specificity in the response for radiation is another problem. Additional problems are due to the strict time dependency of biochemical changes and the limited duration of the changes during the postexposure period. Information on biochemical indicators is based on animal experiments; human experience is limited to a relatively few accidental human exposures and investigations involving patients undergoing radiation therapy. It appears that none of the biochemical indicators studied are currently useful for radiation dosimetry. Even if further developed, it is questionable whether or not biochemical indicators could be of use in estimating radiation dose received years and decades prior to the assay.

Blood↗

PubMed1986

A comparison of Doppler ultrasound waveform indices in the umbilical artery--I. Indices derived from the maximum velocity waveform.

Various Doppler waveform indices have been used for assessment of the fetal circulation. Comparisons were made to show what relations exist between the indices, and to identify any differences or difficulties which might arise from using one as opposed to another in clinical practice. Both normal pregnancy and cases of fetal growth failure were studied. Indices were obtained from the maximum velocity envelope of the umbilical artery waveform using a curve fitting technique. The values were very reproducible for all indices. The FHR, which varied over the entire normal range, did not significantly affect the values of any index. The downstream impedance indices calculated included the AB ratio, pulsatility index (PI) and Pourcelot ratio. These all gave very closely correlated results for normals but discrepancies occurred in the at risk group, where values were elevated. This could be attributed to differences in the underlying distributions. The indices suggested for cardiac contractility were not as closely related to each other, and moreover the differences between them showed no clear pattern. None of the indices varied independently of the others. The rising slope, which is by definition related to the PI, was more highly correlated with the downstream indices than the relative flow rate index.

Blood Flow Velocity↗

PubMed1986

A comparison of Doppler ultrasound waveform indices in the umbilical artery--II. Indices derived from the mean velocity and first moment waveforms.

Umbilical artery Doppler recordings in both normal pregnancy and cases of fetal growth failure were processed by computer. Representative waveforms for the maximum velocity, mean velocity and first moment were obtained after ensemble averaging and correction for thump filtering. The same set of indices, which included the AB ratio, pulsatility index, rising slope and relative flow rate index, were calculated for each of the waveforms. The results were compared to identify differences which might arise in clinical practice if a waveform other than the usual (maximum velocity) was used. The ratio of the mean to the maximum velocity, which gives an indication of the velocity profile, was shown to be very error prone. The reproducibility of the mean velocity and first moment indices was inferior to that of the maximum velocity indices. The results from the different waveforms were highly correlated for normals for most indices. However, in the growth retarded group there was a tendency for the mean velocity and first moment indices to classify as normal studies classified as abnormal by the maximum velocity index. The values of indices derived from the first moment waveform were generally larger than the maximum and mean velocity values. For the relative flow rate index, where results were often different to the general trend, the values were more nearly equal.

Blood Flow Velocity↗

PubMed1990

Regional indices of relative hepatic arterial perfusion from dynamic liver scintigraphy: the variability of indices and the use of parametric imaging.

Regional indices of relative arterial hepatic perfusion have been studied in 21 control subjects following dynamic radiocolloid scintigraphy of the liver (DLS). Three different indices have been calculated: the hepatic perfusion index (HPI); the hepatic arterial ratio (HAR) and the mesenteric fraction (MF). Three regions were defined in the upper, mid and lower right hepatic lobes and the three indices were calculated for each region. There was reasonable agreement between regional values of the same index with inter-regional correlation coefficients above 0.7 and standard errors in straight line fits of less than 0.093. There were significant regional differences for (1-MF) and HPI indices, but not for HAR. The index (1-MF) was calculated for each pixel and presented as a parametric image in 16 control subjects. The parametric images indicated the raised regional arterial indices due to overlying lung, right kidney and aorta. Parametric images may be of value to show the hepatic area free of significant overlying tissue and therefore available for analysis by DLS. However, the results suggest that the observed variability of single pixel indices limit the potential of parametric imaging for the localization of small focal lesions.

Humans↗

PubMed1975

Decision-making in clinical practice: application of predictors, indicators and indices to the medical history obtained by a self-administered questionnaire.

A theoretical description of predictors, indicators, and health indices was presented in an earlier paper (Hall and Sebag, 1974). The application of predictors, indicators and health indices--including dynamic health indices--to anamnestic data obtained by a self-administered questionnaire is presented herein. Predictors and indicators showed a varying degree of 'decision-making significance' in the 122 questions examined. The health index distinguished between diagnosed individuals and those receiving no diagnosis(es). The dynamic health index was found to reflect changes in the health status of an individual over a period of time.

Decision Making↗

PubMed1975

Relationship between work environment and anamnestic health status. Use of predictors, indicators and indices for the evaluation of medical and environmental factors.

Experience with computerized medical record systems in handling medical data in hospital and health screening environments has led to the development of a new approach to the evaluation of medical data. Predictors and indicators quantify the "information value" of medical data and can, theoretically, do so for all types of data. This paper describes the methodology and presents the results obtained when the technique was applied to the anamnestic data of the medical history and environmental data about the conditions in the work environment. Over 4,000 individuals who underwent multiphasic health screening were used as a data base for this study. From these 4,000 persons 3,164 were used for the calculation of anamnestic predictors and indicators and 1,013 for the environmental predictors and indicators. Anamnestic environmental indices were calculated upon 77 test individuals so as to correlate the association and dependence of the two indices.

Environmental Exposure↗

PubMedDate not supplied

[Differential indications in the clinical field. Empirical study of management of indications for analytic individual and group psychotherapy respectively in a psychotherayp clinic ].

This study aims at a systematic description of factors which influence the practice of differential indication between psycho-analytic individual and group-therapy in apsychotherapeutic clinic. The self-description of inclinic patients for who individual therapy was indicated, was compared to the self-description of those who were expected to join a therapeutic group. Two personality-tests (Giessentest "GT" and Freiburger Persönlichkeitsinventar "FPI") and a symptom-questionnaire (Beschwerdenliste"BSB") were applicated. If the self-description fo patients is an important factor influencing differential indication, then a difference should be found in comparison of the self-description of both samples. The result is , that important differences are not to be found, and that, moreover the little differences are variable by the time. In conclusion, patient-centered explorations give no sufficient explanation, why group therapy was indicated in some cases and individual therapy in others. Basing on these results, differential indication in clinical psychotherapy is defined as an interactional process which is influenced by specific cognitive factors of the therapist and his clinical socialisation on the background of variable institution-bound experience.

Humans↗

PubMed1992

[Indications and counter-indications for non-mutilating treatment of breast cancer].

Progress achieved in understanding the biology of breast cancer, as well as the desire of patients to avoid major mutilation, have resulted in ever increasing indications for breast-conserving surgery. Such indications depend on two considerations: the medical consideration which seeks to achieve the same rate of control of loco-regional disease as mutilating surgery and the aesthetic consideration, permitting a satisfactory result on a functional plane. Nevertheless, a case of breast cancer appearing unifocal under clinical examination and radiology is frequently accompanied by tumoral intramammal dissemination, the evaluation of which after histological examination varies according to the author. Should the coexistence of cancer in situ and invasive cancer radically modify the choice of therapy? It seems absurd to accept non-mutilating surgery for invasive cancer and to choose mutilating treatment for certain cases of cancer in situ. Although there appears to be only relative counter-indication for conservatory treatment in cases of advanced cancer (T3N1b and above), it is not recommended in the presence of several types of histology and in certain specific circumstances when associated with cancer in situ. A review of the literature will enable us to cover in detail other risk factors and to enumerate indications and counter-indications for non-mutilating treatment of breast cancer.

Biomarkers, Tumor↗

PubMed1990

Height-normalized indices of the body's fat-free mass and fat mass: potentially useful indicators of nutritional status.

Expressing fat-free mass (FFM) and body fat mass (BFM) as percentages of body weight or by weight is unsatisfactory. For example, tall patients with protein-energy malnutrition (PEM) can exhibit values for FFM and BFM similar to those of shorter well-nourished individuals. To obviate such difficulties, we propose use of height-normalized indices, namely, a FFM index [FFM (kg)/height (m)2, or FFMI] and a BFM index [BFM (kg)/height (m)2, or BFMI]. We calculated these indices in a reference population of 124 healthy young men and in 32 nonobese young men (from the Minnesota Study) before, during, and after experimental semistarvation. When values for FFMI and BFMI falling below the reference cohort's 5th percentile cutoff point were used as a criterion for PEM, these indices, together with basal oxygen-consumption rate, diagnosed PEM in 27 of the 32 Minnesota Study subjects after 12 wk of semi-starvation. These findings indicate that FFMI and BFMI may be useful in nutritional assessment.

Adipose Tissue↗

PubMed1990

[14C]urea and 58Co-EDTA as reference indicators in hepatic multiple indicator dilution studies.

The space distribution and the processes underlying uptake of tracer substrate may be appraised by the multiple indicator dilution technique, after the simultaneous injection of noneliminated vascular (51Cr-labeled red blood cells), extracellular (125I-labeled albumin and [14C]sucrose for high and low molecular weight interstitial space, respectively), and cellular (3H2O) indicators and tracer substrate. When tracer substrates and/or their metabolites containing 14C or 3H labels are being studied, it becomes necessary to find substitutions for the similarly labeled noneliminated indicators. In red blood cell-perfused rat livers, 58Co-EDTA is found to be a good replacement for the low molecular weight interstitial reference; it has a space distribution indistinguishable from that for [14C]sucrose. [14C]urea and 3H2O, which distribute similarly in red blood cells, have similar outflow dilution profiles. With corrections for minor deviations in recovery [a ratio of 0.936 +/- 0.024 (SD)] and transit time [a ratio of 0.962 +/- 0.008 (SD)], the cellular water space can be closely approximated from the [14C]-urea curve. 58Co-EDTA and [14C]urea are reasonable substitutes for [14C]sucrose and 3H2O, respectively, in multiple indicator dilution liver perfusion studies for investigating transfer and removal characteristics of tracer substrates.

Animals↗

PubMed1991

D2O as a substitute for 3H2O, as a reference indicator in liver multiple-indicator dilution studies.

The hepatic space of distribution and the processes underlying uptake of tracer substrate may be appraised by the multiple-indicator dilution technique after simultaneous injection of noneliminated vascular (51Cr-labeled red blood cells), extracellular 125I-labeled albumin and [14C]sucrose (or [58Co]EDTA) as high- and low-molecular-weight interstitial references, respectively], and cellular (3H2O or [14C]urea) indicators, together with the tracer-labeled substrate. The use of 3H2O or [14C]urea, with [14C]- or [3H]sucrose, however, precludes the simultaneous introduction and analysis of the behavior of 3H- and 14C-labeled substrate and metabolite. An assay for the quantitation of D2O in plasma by Fourier transform infrared spectrometry was therefore developed such that D2O could be used in lieu of 3H2O in multiple-indicator dilution studies in the blood-perfused rat liver. In experiments performed with an injection dose containing 51Cr-labeled red blood cells, 125I-labeled albumin, [14C]sucrose, 3H2O, and D2O, D2O was found to behave virtually identical to 3H2O in blood and liver; the accessible cellular water spaces were 0.625 and 0.621 ml/g liver for 3H2O and D2O, respectively, and the corresponding ratios of the sum of the cellular water plus the interstitial water space to the sinusoidal water space were 3.87 and 3.89. D2O was found to be an ideal substitute and is much superior to [14C]urea, which exhibits a small red blood cell carriage effect and which is slightly less dispersed than 3H2O.

Animals↗

PubMed1977

Indications and contra-indications for perforation keratoplasty.

Thirty years' experience with perforating keratoplasty has shown us new indications for this technique, but certainly also new contra-indications. At first the prognosis of perforating keratoplasty improved because of better surgical techniques, so that the number of indications increased. Recently a better prognosis for heavily vascularized eyes has become possible thanks to HLA-matched donor material.

Age Factors↗

PubMed1992

Short- and long-term variability of selected indices related to nutritional status. II. Vitamins, lipids, and protein indices.

Five free-living women (ages 23-38 years) who consumed a self-selected diet and five women (ages 23-44 years) residing in a metabolic unit who were fed constant diet were assessed for variation in vitamin and general chemistry indices. Blood was drawn from these women once a month for five months, once a week for five weeks, and once a day for five days to assess analytical and biological variability of the indices. Analytical variability was determined by concurrently analyzing control samples prepared from plasma and serum pools. All samples were analyzed in duplicate. Of the measured indices, vitamins and lipids seemed to be the most variable. Diet had a significant effect only on ascorbic acid. We were unable to show any seasonal change for these analytes. Estimations of analytical variability, along with estimates of biological variability, and knowledge of dietary practices are essential when interpreting differences in analytes.

Adult↗

PubMedDate not supplied

[Is a radial nerve paralysis in a humeral shaft fracture an indication for surgery? Indications].

Surgery for humeral shaft fractures. A series of 78 operative treated humeral shaft fractures was studied retrospectively. Sixteen times we found a radial nerve palsy, preoperatively. In this group we evaluated the type of fracture, the operation indication, the time of treatment and the postoperative recovery of the radial nerve palsy. Fourteen times we did an early exploration. The indication to operate was 9 times the conducting polytrauma, 5 times the radial nerve palsy itself and 2 times a pseudarthrosis. In 13 of the 16 patients nerve function recovered either clinically and/or electromyographically. This study confirms that radial nerve palsy is found especially in fractures located at the junction of the middle and the lower third of the humeral shaft. Because we found nearly always a macroscopically lesion of the nerve in this type of fracture, we recommend an early exploration in spiroid fractures at that junction. For the same reason we advise an early exploration in cases of secondary radial nerve palsy. If no other indication to operate occurs, we accept a conservative treatment of the humeral fracture with radial palsy.

Adult↗

PubMed1990

[The effect of pesticides on health indices and the test indicators for their determination].

It is suggested that causal-sequel relationships of the levels of morbidity and functional changes in the health condition of the population reflect the intensity in the use of pesticides and are locally manifested in conditions of extreme loads of pesticides. The authors distinguish priority unspecific tests-indicators according to nosological entities of pathology and indices of the functional state of the body that may be recommended for systemic evaluation of links with territorial loads of pesticides and for providing information in the monitoring of the health of the population in regions of intensive use of agrochemical agents.

Adolescent↗

PubMed1990

[Typical combinations of personal satisfaction and their relation to symptoms, diagnosis and indications for therapy. II: Relation of personal satisfaction, symptoms and indications for psychotherapy].

In our sample of psychotherapy outpatients (n = 562) age, gender and education do not influence satisfaction measured by questionnaire. Patients with low satisfaction showed more depressive symptoms, conflict reactions, psychotic/borderline symptoms and come into therapy more often. Patients with higher satisfaction showed to be more hysteric and had more psychosomatic symptoms. Indication for therapy depends more on (dis)satisfaction than on diagnosis. Dissatisfaction with a certain area affects indication for therapy less than statistically evaluated types of answers. Those types (satisfaction or dissatisfaction with all areas) are interpreted as a sign of psychological dedifferentiation. Satisfaction is a subjective phenomenon and does not depend on objective facts.

Adolescent↗