Thesis (M.Eng.). / Written for the Dept. of Biomedical Engienering and Montreal Neurological Institute. Title from title page of PDF (viewed 2009/06/17). Includes bibliographical references.

Thesis--University of Oklahoma. / Includes bibliographical references (leaves 49-50).

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb. 16, 2009). Includes bibliographical references.

Thesis (M.S.)--University of Missouri-Columbia, 2009. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. "May 2009" Includes bibliographical references.

Thesis (M.S.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2719. Adviser: Asha Kapadia. Includes bibliographical references.

The development, use, and understanding of severity of illness scoring systems has advanced rapidly in the last decade; their weaknesses and limitations have also become apparent. This work follows some of this development and explores some of these aspects. It was undertaken in three stages and in two countries. The first study investigated three severity of illness scoring systems in a general Intensive Care Unit (ICU) in Cape Town, namely the Acute Physiology and Chronic Health Evaluation (APACHE II) score, the Therapeutic Intervention Scoring System (TISS), and a locally developed organ failure score. All of these showed a good relationship with mortality, with the organ failure score the best predictor of outcome. The TISS score was felt to be more likely to be representative of intensiveness of medical and nursing management than severity of illness. The APACHE II score was already becoming widely used world-wide and although it performed less well in some diagnostic categories (for example Adult Respiratory Distress Syndrome) than had been hoped, it clearly warranted further investigation. Some of the diagnosis-specific problems were eliminated in the next study which concentrated on the application of the APACHE II score in a cardiothoracic surgical ICU in London. Although group predictive ability was statistically impressive, the predictive ability of APACHE II in the individual patient was limited as only very high APACHE II scores confidently predicted death and then only in a small number of patients. However, there were no deaths associated with an APACHE II score of less than 5 and the mortality was less than 1 % when the APACHE II score was less than 10. Finally, having recognised the inadequacies in mortality prediction of the APACHE II score in this scenario, a study was undertaken to evaluate a novel concept: a combination of preoperative, intraoperative, and postoperative (including APACHE II and III) variables in cardiac surgery patients admitted to the same ICU. The aim was to develop a more precise method of predicting length of stay, incidence of complications, and ICU and hospital outcome for these patients. There were 1008 patients entered into the study. There was a statistically significant relationship between increasing Parsonnet (a cardiac surgery risk prediction score), APACHE II, and APACHE III scores and mortality. By forward stepwise logistic regression a model was developed for the probability of hospital death. This model included bypass time, need for inotropes, mean arterial pressure, urea, and Glasgow Coma Scale. Predictive performance was evaluated by calculating the area under the receiver operating characteristic (ROC) curve. The derived model had an area under the ROC curve 0.87, while the Parsonnet score had an area of 0.82 and the APACHE II risk of dying 0.84. It was concluded that a combination of intraoperative and postoperative variables can improve predictive ability.

Objetivo: Avaliar a acurácia da colposcopia utilizando a Classificação Colposcópica Internacional de 2002. Métodos: 3040 pacientes de população geral foram rastreadas para patologia cervical através de exame citopatológico, captura híbrida para HPV de alto risco e inspeção cervical. As colposcopias que resultaram em biópsia (n=468) executadas no rastreamento e acompanhamento destas pacientes foram gravadas, revistas por dois colposcopistas cegados e incluídas para análise. Resultados: Os observadores apresentaram excelente concordância (Kappa=0.843) no relato dos achados pela nova nomenclatura. A colposcopia apresentou sensibilidade de 86% e especificidade de 30.3% em diferenciar colo normal de colo anormal (LSIL, HSIL ou carcinoma); quando a colposcopia objetivava diferenciar colo normal ou LSIL de HSIL ou carcinoma, apresentou sensibilidade de 61.1% e especificidade de 94.4%. Os achados colposcópicos classificados como “maiores” pela nova classificação apresentaram valores preditivos positivos elevados para HSIL. Presença do achado colposcópico na zona de transformação e tamanho da lesão estavam associados a HSIL. Bordas externas definidas, associação de múltiplos achados distintos e presença de zona iodo negativa não estavam relacionados à gravidade das lesões. Conclusão: A colposcopia utilizando a Classificação Internacional de 2002 mostra-se um bom método de rastreamento, mas como método diagnóstico apresenta falhas, não podendo substituir a avaliação histológica. A categorização em achados colposcópicos “maiores” e “menores” apresentada pela nova classificação é adequada. Na realização da colposcopia, é importante também que a lesão seja situada em relação à zona de transformação e que seu tamanho seja indicado, já que estes foram fatores associados a lesões de alto grau. / Objectives: To evaluate the colposcopic accuracy according to 2002 International Colposcopic Classification. Methods: 3,040 women from the general population were screened for cervical pathology by Pap smear, high risk HPV Hybrid Capture and naked eye visual inspection. All colposcopic exams that needed biopsy (n=468) performed during screening or follow-up were recorded, reviewed by two blinded colposcopists and included for analysis. Results: The two observers showed excellent agreement (Kappa=0.843) on reporting colposcopic findings according to the new classification. Colposcopy had sensitivity of 86% and specificity of 30.3% when the objective was to distinguish normal cervix from abnormal (LSIL, HSIL or carcinoma); for distinguishing normal cervix or LSIL from HSIL or carcinoma, colposcopy had sensitivity of 61.1% and specificity of 94.4%. Colposcopic findings graded as “major changes” had the highest predictive positive values for detecting HSIL or carcinoma. Colposcopic findings at transformation zone and size of lesion were related to HSIL. Sharp outer border, multiple colposcopic findings and iodine negativity were not statically related to severe lesions. Conclusion: Colposcopy using the new International Classification is a considerable screening method, but its value for diagnoses is restricted and it is not possible to substitute histological sampling. Categorization in “major changes” and “minor changes” according to the new classification is appropriate. When performing colposcopy, it is important to describe where is the colposcopic finding, in or outside the transformation zone, and its size, whereas these characteristics were related to high grade lesions.

Objetivo: Avaliar a acurácia da colposcopia utilizando a Classificação Colposcópica Internacional de 2002. Métodos: 3040 pacientes de população geral foram rastreadas para patologia cervical através de exame citopatológico, captura híbrida para HPV de alto risco e inspeção cervical. As colposcopias que resultaram em biópsia (n=468) executadas no rastreamento e acompanhamento destas pacientes foram gravadas, revistas por dois colposcopistas cegados e incluídas para análise. Resultados: Os observadores apresentaram excelente concordância (Kappa=0.843) no relato dos achados pela nova nomenclatura. A colposcopia apresentou sensibilidade de 86% e especificidade de 30.3% em diferenciar colo normal de colo anormal (LSIL, HSIL ou carcinoma); quando a colposcopia objetivava diferenciar colo normal ou LSIL de HSIL ou carcinoma, apresentou sensibilidade de 61.1% e especificidade de 94.4%. Os achados colposcópicos classificados como “maiores” pela nova classificação apresentaram valores preditivos positivos elevados para HSIL. Presença do achado colposcópico na zona de transformação e tamanho da lesão estavam associados a HSIL. Bordas externas definidas, associação de múltiplos achados distintos e presença de zona iodo negativa não estavam relacionados à gravidade das lesões. Conclusão: A colposcopia utilizando a Classificação Internacional de 2002 mostra-se um bom método de rastreamento, mas como método diagnóstico apresenta falhas, não podendo substituir a avaliação histológica. A categorização em achados colposcópicos “maiores” e “menores” apresentada pela nova classificação é adequada. Na realização da colposcopia, é importante também que a lesão seja situada em relação à zona de transformação e que seu tamanho seja indicado, já que estes foram fatores associados a lesões de alto grau. / Objectives: To evaluate the colposcopic accuracy according to 2002 International Colposcopic Classification. Methods: 3,040 women from the general population were screened for cervical pathology by Pap smear, high risk HPV Hybrid Capture and naked eye visual inspection. All colposcopic exams that needed biopsy (n=468) performed during screening or follow-up were recorded, reviewed by two blinded colposcopists and included for analysis. Results: The two observers showed excellent agreement (Kappa=0.843) on reporting colposcopic findings according to the new classification. Colposcopy had sensitivity of 86% and specificity of 30.3% when the objective was to distinguish normal cervix from abnormal (LSIL, HSIL or carcinoma); for distinguishing normal cervix or LSIL from HSIL or carcinoma, colposcopy had sensitivity of 61.1% and specificity of 94.4%. Colposcopic findings graded as “major changes” had the highest predictive positive values for detecting HSIL or carcinoma. Colposcopic findings at transformation zone and size of lesion were related to HSIL. Sharp outer border, multiple colposcopic findings and iodine negativity were not statically related to severe lesions. Conclusion: Colposcopy using the new International Classification is a considerable screening method, but its value for diagnoses is restricted and it is not possible to substitute histological sampling. Categorization in “major changes” and “minor changes” according to the new classification is appropriate. When performing colposcopy, it is important to describe where is the colposcopic finding, in or outside the transformation zone, and its size, whereas these characteristics were related to high grade lesions.

Objetivo: Avaliar a acurácia da colposcopia utilizando a Classificação Colposcópica Internacional de 2002. Métodos: 3040 pacientes de população geral foram rastreadas para patologia cervical através de exame citopatológico, captura híbrida para HPV de alto risco e inspeção cervical. As colposcopias que resultaram em biópsia (n=468) executadas no rastreamento e acompanhamento destas pacientes foram gravadas, revistas por dois colposcopistas cegados e incluídas para análise. Resultados: Os observadores apresentaram excelente concordância (Kappa=0.843) no relato dos achados pela nova nomenclatura. A colposcopia apresentou sensibilidade de 86% e especificidade de 30.3% em diferenciar colo normal de colo anormal (LSIL, HSIL ou carcinoma); quando a colposcopia objetivava diferenciar colo normal ou LSIL de HSIL ou carcinoma, apresentou sensibilidade de 61.1% e especificidade de 94.4%. Os achados colposcópicos classificados como “maiores” pela nova classificação apresentaram valores preditivos positivos elevados para HSIL. Presença do achado colposcópico na zona de transformação e tamanho da lesão estavam associados a HSIL. Bordas externas definidas, associação de múltiplos achados distintos e presença de zona iodo negativa não estavam relacionados à gravidade das lesões. Conclusão: A colposcopia utilizando a Classificação Internacional de 2002 mostra-se um bom método de rastreamento, mas como método diagnóstico apresenta falhas, não podendo substituir a avaliação histológica. A categorização em achados colposcópicos “maiores” e “menores” apresentada pela nova classificação é adequada. Na realização da colposcopia, é importante também que a lesão seja situada em relação à zona de transformação e que seu tamanho seja indicado, já que estes foram fatores associados a lesões de alto grau. / Objectives: To evaluate the colposcopic accuracy according to 2002 International Colposcopic Classification. Methods: 3,040 women from the general population were screened for cervical pathology by Pap smear, high risk HPV Hybrid Capture and naked eye visual inspection. All colposcopic exams that needed biopsy (n=468) performed during screening or follow-up were recorded, reviewed by two blinded colposcopists and included for analysis. Results: The two observers showed excellent agreement (Kappa=0.843) on reporting colposcopic findings according to the new classification. Colposcopy had sensitivity of 86% and specificity of 30.3% when the objective was to distinguish normal cervix from abnormal (LSIL, HSIL or carcinoma); for distinguishing normal cervix or LSIL from HSIL or carcinoma, colposcopy had sensitivity of 61.1% and specificity of 94.4%. Colposcopic findings graded as “major changes” had the highest predictive positive values for detecting HSIL or carcinoma. Colposcopic findings at transformation zone and size of lesion were related to HSIL. Sharp outer border, multiple colposcopic findings and iodine negativity were not statically related to severe lesions. Conclusion: Colposcopy using the new International Classification is a considerable screening method, but its value for diagnoses is restricted and it is not possible to substitute histological sampling. Categorization in “major changes” and “minor changes” according to the new classification is appropriate. When performing colposcopy, it is important to describe where is the colposcopic finding, in or outside the transformation zone, and its size, whereas these characteristics were related to high grade lesions.