Lubrication and Lubricants

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Evaluation of simplified acute physiology score 3 performance: a systematic review of external validation studies

Introduction: Simplified Acute Physiology Score 3 (SAPS 3) was the first critical care prognostic model developed from worldwide data. We aimed to systematically review studies that assessed the prognostic performance of SAPS 3 general and customized models for predicting hospital mortality in adult patients admitted to the ICU. Methods: Medline, Lilacs, Scielo and Google Scholar were searched to identify studies which assessed calibration and discrimination of general and customized SAPS 3 equations. Additionally, we decided to evaluate the correlation between trial size (number of included patients) and the Hosmer-Lemeshow (H-L) statistics value of the SAPS 3 models. Results: A total of 28 studies were included. Of these, 11 studies (42.8\%) did not find statistically significant mis-calibration for the SAPS 3 general equation. There was a positive correlation between number of included patients and higher H-L statistics, that is, a statistically significant mis-calibration of the model (r = 0.747, P < 0.001). Customized equations for major geographic regions did not have statistically significant departures from perfect calibration in 9 of 19 studies. Five studies (17.9\%) developed a regional customization and in all of them this new model was not statistically different from a perfect calibration for their populations. Discrimination was at least very good in 24 studies (85.7\%). Conclusions: Statistically significant departure from perfect calibration for the SAPS 3 general equation was common in validation studies and was correlated with larger studies, as should be expected, since H-L statistics (both C and H) are strongly dependent on sample size This finding was also present when major geographic customized equations were evaluated. Local customizations, on the other hand, improved SAPS 3 calibration. Discrimination was almost always very good or excellent, which gives excellent perspectives for local customization when a precise local estimate is needed.publishersversionpublishe

Comparison Between Combined Sensory Index Test and Diagnostic Ultrasonography (Inlet Outlet Ratio) in Suspected or Early Cases of Carpal Tunnel Syndrome

Background: The combined sensory index (CSI) test is more precise in diagnosing carpal tunnel syndrome (CTS) early cases. Another useful tool for early detection of CTS is the diagnostic ultrasonography. Objective: The present study was conducted to compare between the CSI test and its sensitivity with diagnostic ultrasonography IOR (inlet outlet ratio) in suspected or early cases of carpal tunnel syndrome (CTS).Patients and methods: The present case-control study involved 20 subjects with signs and symptoms suggestive of early cases of CTS with duration less than 6 months, in addition to 20 apparently healthy subjects who were clinically examined and underwent EDX and US evaluation. We excluded patients with severe CTS, proximal cervical lesion, or other neurological diseases.Results: By comparison, CSI shows a higher sensitivity than IOR. Combining both tests induced elevated substantial differences between patients as well as controls (P &lt;0.01), besides elevating the sensitivity to 100%.Conclusion: It could be concluded that the sensitivity and accuracy of CSI is higher than diagnostic ultrasonography IOR on the median nerve. On the contrary, diagnostic ultrasonography can detect the anatomical abnormalities of the median nerve while the physiological abnormalities of the median nerve and their level can be examined by nerve conduction studies (NCS). They are complementary tests for CTS diagnosi