Estimation of the severity of breathlessness in the emergency department: a dyspnea score

BACKGROUND: Dyspnea is a frequent complaint in emergency departments (ED). It has a significant amount of subjective and affective components, therefore the dyspnea scores, based on the patients' rating, can be ambiguous. Our purpose was to develop and validate a simple scoring system to evaluate the severity of dyspnea in emergency care, based on objectively measured parameters. METHODS: We performed a double center, prospective, observational study including 350 patients who were admitted in EDs with dyspnea. We evaluated the patients' subjective feeling about dyspnea and applied our Dyspnea Severity Score (DSS), rating the dyspnea in 7 Dimensions from 0 to 3 points. The DSS was validated using the deterioration of pH, base-excess and lactate levels in the blood gas samples (Objective Classification Scale (OCS) 9 points and 13 points groups). RESULTS: All of the Dimensions correlated closely with the OCS values and with the subjective feeling of the dyspnea. Using multiple linear regression analysis we were able to decrease the numbers of Dimensions from seven to four without causing a significant change in the determination coefficient in any OCS groups. This reduced DSS values (exercise tolerance, cooperation, cyanosis, SpO2 value) showed high sensitivity and specificity to predict the values of OCS groups (the ranges: AUC 0.77-0.99, sensitivity 65-100%, specificity 64-99%). There was a close correlation between the subjective dyspnea scores and the OCS point values (p /=7 points without correction factors) can be useful at the triage or in pre-hospital care

Reassessing the Evidence Hierarchy in Asthma: Evaluating Comparative Effectiveness

Classical randomized controlled trials are the gold standard in medical evidence because of their high internal validity. However, their necessarily strict design can limit their external validity and the ability to extrapolate these data to real world patients. Therefore, alternatively designed studies may play a complementary role in evaluating the comparative effectiveness of therapies in nonidealized patients in more naturalistic, real world settings. Observational studies have high external validity and can evaluate real world outcomes. Their strength lies in hypothesis generation and testing and in identifying areas in which further clinical trials may be required. Pragmatic trials are designed to maximize applicability of trial results to usual care settings by relying on clinically important outcomes and enrolling a wide range of participants. A combination of these approaches is preferable and necessary

Multistrange baryon elliptic flow in Au plus Au collisions at root(NN)-N-S=200 GeV

We report on the first measurement of elliptic flow nu(2)(p(T)) of multistrange baryons Xi(-)+Xi(+) and Omega(-)+Omega(+) in heavy-ion collisions. In minimum-bias Au+Au collisions at root s(NN)=200 GeV, a significant amount of elliptic flow, comparable to other nonstrange baryons, is observed for multistrange baryons which are expected to be particularly sensitive to the dynamics of the partonic stage of heavy-ion collisions. The p(T) dependence of nu(2) of the multistrange baryons confirms the number of constituent quark scaling previously observed for lighter hadrons. These results support the idea that a substantial fraction of the observed collective motion is developed at the early partonic stage in ultrarelativistic nuclear collisions at the Relativistic Heavy Ion Collider

Ontwikkelingen in de blootstelling van zuigelingen aan dioxinen, furanen en PCBs en potentiele gezondheidsrisico's, in Nederland

This report describes the evaluation of the time trend by means of PBPK modelling, and the associated health effects of pre- and postnatal exposure of infants to dioxins, furans and PCBs. Using PBPK modelling there was an expected decrease of ca. 20% in dioxin levels in human milk shown for 1998 compared to 1993. Evaluation of the epidemiological literature resulted in critical remarks on the exposure characterisation and the data analyses of the studies. Lack of convincing exposure-response relationships meant that no quantitative assessment of the associated health risk in infants could be performed. Pooled and/or re-analysis of the existing data could shed some light on the apparant inconsistencies reported so far.De tijdtrends (m.b.v. PBPK modellering) en geassocieerde gezondheidseffecten, van pre- en postnatale blootstelling van zuigelingen aan dioxinen, furanen en PCBs werden ge-evalueerd. Op basis van de PBPK modellering wordt in 1998 een daling van ca. 20% in de dioxine gehalten in moedermelk verwacht, ten opzichte van 1993. In de evaluatie van de epidemiologische onderzoeken worden een aantal kritische kant-tekeningen geplaatst bij de blootstellingskarakterisering en de data-analyse van de studies. Door het ontbreken van duidelijke blootstellings-respons relaties kan geen kwantitatieve schatting van het gezondheidsrisico voor zuigelingen worden uitgevoerd. Gepoolde en/of her-analyse van de bestaande data zouden meer inzicht kunnen geven in de inconsistenties in de tot nu toe gerapporteerde data

Ontwikkelingen in de blootstelling van zuigelingen aan dioxinen, furanen en PCBs en potentiele gezondheidsrisico's, in Nederland

De tijdtrends (m.b.v. PBPK modellering) en geassocieerde gezondheidseffecten, van pre- en postnatale blootstelling van zuigelingen aan dioxinen, furanen en PCBs werden ge-evalueerd. Op basis van de PBPK modellering wordt in 1998 een daling van ca. 20% in de dioxine gehalten in moedermelk verwacht, ten opzichte van 1993. In de evaluatie van de epidemiologische onderzoeken worden een aantal kritische kant-tekeningen geplaatst bij de blootstellingskarakterisering en de data-analyse van de studies. Door het ontbreken van duidelijke blootstellings-respons relaties kan geen kwantitatieve schatting van het gezondheidsrisico voor zuigelingen worden uitgevoerd. Gepoolde en/of her-analyse van de bestaande data zouden meer inzicht kunnen geven in de inconsistenties in de tot nu toe gerapporteerde data.This report describes the evaluation of the time trend by means of PBPK modelling, and the associated health effects of pre- and postnatal exposure of infants to dioxins, furans and PCBs. Using PBPK modelling there was an expected decrease of ca. 20% in dioxin levels in human milk shown for 1998 compared to 1993. Evaluation of the epidemiological literature resulted in critical remarks on the exposure characterisation and the data analyses of the studies. Lack of convincing exposure-response relationships meant that no quantitative assessment of the associated health risk in infants could be performed. Pooled and/or re-analysis of the existing data could shed some light on the apparant inconsistencies reported so far.IG

Modelling the fate of chemicals in humans using a lifetime physiologically based pharmacokinetic (PBPK) model in MERLIN-expo

This chapter presents the human model implemented in MERLIN-Expo. This model is a physiologically based pharmacokinetic (PBPK) model that describes the relationship between an external dose and an internal dosimetry using parameters related to the anatomy and physiology of individuals and the physico-chemical properties of the contaminants. The goal of the PBPK model is to simulate the toxicokinetics of contaminants in humans, e.g. the amounts or concentrations of contaminants in different organs/tissues, under various exposure conditions. The generic PBPK model is based on a detailed compartmentalisation of the human body and parameterised with relationships describing the time evolution of the physiology and anatomy of the individuals. In this chapter, we present the detailed description of the human model and the conditions to apply it in MERLIN-Expo. Finally, the model predictability is evaluated by a direct comparison between computational predictions and experimental data on small case studies