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THE PREDICTIVE ABILITY OF THE ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION (APACHE II) SCORE FOR MORTALITY IN THE INTENSIVE CARE UNIT IN KIMBERLEY HOSPITALKrog, Colleen 11 March 2010 (has links)
Introduction:
The aim of this study was to assess the Acute Physiology and Chronic Health
Evaluation (APACHE II) prognostic index in the Intensive Care Unit of Kimberley
Hospital Complex (KHC) on admission. The study was more specifically aimed at
patients meeting criteria for the Systemic Inflammatory Response Syndrome (SIRS),
as patients admitted to KHC ICU frequently meet the criteria and often progress to
sepsis, severe sepsis and septic shock.
Design:
A cohort study on South African patients meeting SIRS criteria, including all races
and gender.
Setting:
Intensive Care Unit of Kimberley Hospital Complex, provincial hospital in the
Northern Cape province, South Africa.
Patients and measurements:
Consecutive patients meeting the criteria for SIRS on admission to ICU between
August 2006 and May 2007 were included. For each patient the diagnosis,
physiological and chronic health data necessary for the APACHE score was gathered
and recorded by the doctor on duty on time of admission.
Predicted and actual mortality rates were calculated. Data was provided to the
department of Biostatistics of the UFS for processing. Results were summarised by
means, standard variations and percentiles (numerical variables) and frequencies and
percentages (categorical variables).
Results
Of the 160 patients included in the study, 59 died (36.9%). Patients discharged from
the unit before 14 days were followed up in the ward until 14 days or discharge from
hospital (whichever came first). 77 patients were discharged from ICU within 14
days of which 3 (1.9%) died in the ward within the 14-day period. 74 of the
discharged patients (46.3%) were alive after 14 days. 24 patients (14%) participating
in the trial were still in ICU after 14 days and mortality not recorded.
The counting of patients who survived and those who died, for each level of death
risk predicted, allowed the calculation of sensitivity, specificity and the percentage of correct predictions for each level of predicted death risk.
The sensitivity of the calculated death risk was higher at scores below 8, gradually
decreasing as scores increased, reaching 50.9% at score >21. Conversely the
specificity increased from 1% for scores <5, reaching 79.2% for death risk at scores
>21. The most accurate combination of sensitivity and specificity was found at
scores of 16-18, with the positive prediction value ranging from 51.3-54.4% and the
negative prediction value ranging from 76.1-77.5%.
There was a meaningful connection between APACHE II scores and the mortality
rate, for all patients and each diagnostic group. In each successive APACHE II score
interval the mortality rate was higher than that of the preceding interval. Thus, the
result has confirmed the capability of this index to stratify such patients according to
the degree of severity of their health condition.
Conclusion
The APACHE II scoring system may be usefully applied in Intensive Care Units for
predicting mortality, classifying and assessing severity of disease and evaluating
performance. It must however be used with caution for planning department resource
allocation and decision making regarding admission of patients to Intensive Care.
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Gender differences in health service utilization among Hong Kong adults /Cheng, P. Y., Rachel. January 2007 (has links)
Thesis (M. P. H.)--University of Hong Kong, 2007.
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Gender differences in health service utilization among Hong Kong adultsCheng, P. Y., Rachel. January 2007 (has links)
Thesis (M. P. H.)--University of Hong Kong, 2007. / Also available in print.
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Care by districts nurses : management of patients with chronic-pain conditions, patient satisfaction and effects of pain advisers /Törnkvist, Lena, January 1900 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 5 uppsatser.
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Reconciling decisions near the end of life a grouded theory study /Norton, Sally Ann. January 1999 (has links) (PDF)
Thesis (Ph.D.)--University of Wisconsin-Madison, 1999. / Includes bibliographical references (leaves 226-234).
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The perceived role of physician office health coaches in delivering chronic care to patients in a primary care clinic group in the midwest a phenomenological qualitative study /Roberts-Andersen, Janet Patricia. Hawkins, Peggy L. Morin, Patricia J. Erhlich, Donna. January 2009 (has links)
Thesis (Ed. D)--College of Saint Mary -- Omaha, 2009. / A dissertation submitted by Janet Patricia Roberts-Andersen to College of Saint Mary in partial fulfillment of the requirement for the degree of Doctor of Education with an emphasis on Health Professions Education. This dissertation has been accepted by the faculty of Saint Mary by: Peggy L. Hawkins, PhD, RN, BC, CNE, Professor, Health Professions ; Pat Morin, PhD, RN ; Donna Erhlich, PhD. Includes bibliographical references.
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Interaction between normals and the terminally ill the stigma of death /Glotzer, Richard S., January 1976 (has links)
Thesis (M.S.)--University of Wisconsin--Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 40-41).
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A study of the quality improvement of Hong Kong's health care system /Chu, Yim-kwong. January 2000 (has links)
Thesis (M.P.A.)--University of Hong Kong, 2000. / Includes bibliographical references (leaves 221-226).
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Maine hospice volunteers : a study of motivations, death awareness and religious beliefs /Donovan, Anne F. Baranowski, Marc D. Schilmoeller, Gary L. Bicknell, Elizabeth. January 2001 (has links)
Thesis (M.S.) in Human Development--University of Maine, 2001. / Includes vita. Advisory Committee: Marc D. Baranowski, Assoc. Prof. of Human Development, Advisor; Gary L. Schilmoeller, Assoc. Prof. of Child Development & Family Relations; Elizabeth H. Bicknell, Assoc. Prof. of Nursing. Includes bibliographical references (leaves 47-50).
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Trends in geographic disparities in health workforce and hospital-beds in Guangdong ProvinceWang, Chunxiao. January 2008 (has links)
Thesis (M.P.H.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 21-24).
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