Universal Score Research Articles

Mechanical Complications in Adult Spinal Deformity Surgery: Can Spinal Alignment Explain Everything?

Cohort study. Our goal was to verify the validity of the global alignment and proportion (GAP) score, SRS-Schwab, and Roussouly theoretical apex of lordosis in predicting mechanical complications in adult spinal deformity (ASD). Achieving adequate sagittal alignment is critical to obtain favorable outcomes in ASD surgery. It has been proposed that mechanical complications are largely secondary to postoperative spinal alignment. Retrospective review of consecutive primary ASD cases that underwent deformity correction in the same institution over a 5-year period. Association between the 6-week postoperative spinal alignment classification and occurrence of mechanical complications on the last follow-up was assessed using logistic regressions. The discriminant capacity was assessed using the receiver operating characteristic (ROC) curve analysis. 58.3% (N = 49/84) of patients presented with mechanical complications and 32.1% (N = 27/84) underwent revision surgery. GAP score did not show discriminant ability to predict complications (AUC = 0.53, 95% confidence interval [CI] = 0.40-0.66, P = 0.58). Conversely, the SRS-Schwab sagittal modifier score demonstrated a statistically significant (although modest) predictive value for mechanical complications (AUC = 0.67, 95% CI = 0.54-0.79, P = 0.008). There was a significant association between pelvic tilt (PT) (P = 0.03) and sagittal vertical axis (SVA) (P = 0.01) at 6 weeks postoperatively and the occurrence of later mechanical complications. There was no significant association between matched Roussouly theoretical apex of lordosis and final outcome (P = 0.47). The results point to the complexity of mechanical failure and the high likelihood that causative factors are multifactorial and not limited to alignment measures. GAP score should be used with caution as it may not explain or predict mechanical failure based on alignment in all populations as originally expected. Future studies should focus on etiology, surgical technique, and patient factors in order to generate a more universal score that can be applied to all populations.Level of Evidence: 4.

A universal molecular prognostic score for gastrointestinal tumors

Colorectal and gastric cancers are a leading cause of cancer deaths in developed countries. Precise estimation of prognosis is important with regard to clinical decision making for individuals with such cancers. We here comprehensively compiled a complete atlas of prognostic genes based on an integrated meta-analysis of one of the largest assembled colorectal cancer cohorts. A simple yet robust machine learning approach was then applied to establish a universal molecular prognostic score (mPS_colon) that relies on the expression status of only 16 genes and which was validated with independent data sets. This score was found to be an independent prognostic indicator in multivariate models including cancer stage, to be valid independent of tumor characteristics or patient ethnicity, and to be also applicable to gastric cancer. We conclude that mPS_colon is a universal prognostic classifier for patients with gastrointestinal cancers and that it should prove informative for optimization of personalized therapy for such patients.

Safety and quality of perioperative anesthesia care–Ensuring safe care for older people living with frailty

The clinical concept of frailty as a detectable and improvable clinical condition has emerged in the field of geriatric medicine over the past two decades. Albeit frailty can be described as the rapid deterioration of organ function during the physiological aging process, this syndrome is not exclusively limited to the elderly. Recently, this concept has been introduced in the field of anesthesia and critical care as a means to better appraise perioperative risks and offer patient-centered individual treatment pathways. Extensive efforts have been invested into the research on tools for the detection and quantification of frailty. However, while multiple tools have been validated for the detection of frailty in different populations, no universal score or test has been validated to be universally applicable. Furthermore, it is unclear whether interventions capable of improving the detected degree of frailty may result in better outcomes. Ongoing and future research is aimed at developing automated systems that help in harnessing standard medical records for reliable frailty screening without additional user input. Further efforts are pointed at understanding the potential reversibility of frailty through interventions such as exercise or nutritional supplements. While the role of frailty detection, quantification, and treatment in anesthesia and critical care is limited today, it is likely that it may become a key element of perioperative care of older patients in the near future.

A Universal Score for Deconvolution of Intact Protein and Native Electrospray Mass Spectra.

The growing use of intact protein mass analysis, top-down proteomics, and native mass spectrometry have created a need for improved data analysis pipelines for deconvolution of electrospray (ESI) mass spectra containing multiple charge states and potentially without isotopic resolution. Although there are multiple deconvolution algorithms, there is no consensus for how to judge the quality of the deconvolution, and many scoring schemes are not published. Here, an intuitive universal score (UniScore) for ESI deconvolution is presented. The UniScore is the weighted average of deconvolution scores (DScores) for each peak multiplied by the R2 of the fit to the data. Each DScore is composed of separate components to score (1) the uniqueness and fit of the deconvolution to the data, (2) the consistency of the peak shape across different charge states, (3) the smoothness of the charge state distribution, and (4) symmetry and separation of the peak. Example scores are provided for a range of experimental and simulated data. By providing a means of judging the quality of the overall deconvolution as well as individual mass peaks, the UniScore scheme provides a foundation for standardizing ESI data analysis of larger molecules and enabling the use of ESI deconvolution in automated data analysis pipelines.

(144) The Xm2 Pain Management Profile for Systematically Assessing Use of Pain Management Strategies from Multiple Domains: Example Profiles for Individuals with Chronic Pain

Management of chronic pain can require the use of many strategies from multiple domains. When so many strategies from multiple domains are being used, conducting a systematic assessment is difficult. This study describes the development of a pain management profile and illustrates its use with example profiles representing patients using a variety of strategies. The pain management profile was developed by modifying the framework used by Widerstrom-Noga and Turk1 and the universal scoring procedure (i.e. scores are on a single numeric scale regardless of original scale) developed by Robinson-Papp et al.2 Example profiles were developed using data collected from an online survey of the types of multi-domain strategies used by pharmacists who had chronic pain. Xm2 profiles organize management strategies into five domains: medications, medical, physical, psychological, and self-initiated strategies. Specific strategies (e.g. naproxen, rest) used are listed for each domain with a score indicating their associated level of use. The number of strategies reported ranged from two to 24 and the level of use score ranged from two to 72. Example profiles were developed for an individual with average scores who used opioids and an individual who did not use opioids, and for individuals in the lowest and highest 25% level of use. The use of a framework and universal score for level of use resulted in a profile that clearly identified the types of pain management strategies being used from all five domains with level of use. Such a profile could be developed for any individual with pain and may be helpful clinically to identify the most appropriate types and level of use of pain management strategies. (1. Widerstrom-Noga, Spinal Cord, 2003; 2. Robinson-Papp, J Pain Sym Man, 2005).

The Munich Ankle Questionnaire (MAQ): a self-assessment tool for a comprehensive evaluation of ankle disorders

BackgroundThere are many approved patient-related outcome measurement tools regarding ankle pathologies. However, there is none incorporating the range of motion (ROM) as an objective parameter. Most instruments focus on subjective parameters such as pain and impairment at work or daily living. Furthermore, the majority is only applicable to a specific pathology. Therefore, the objective of our study was to develop and validate the Munich Ankle Questionnaire (MAQ) as a universal self-assessment score including subjective and objective items.MethodsThe established McGuire Score, Bray Score, Ankle Hindfoot Score (AOFAS) and Olerud and Molander Score were analyzed for relevant items and subscales. Items of interest were then condensed and allocated to the respective subscales of the MAQ. The final MAQ consists of 6 items addressing general and demographic data and 12 items addressing three domains: pain (3 items), work and daily living (5 items), movement and ROM (4 items). The evaluation of validity, reliability and responsiveness of the MAQ was performed in a prospective clinical study including traumatic as well as degenerative ankle pathologies.ResultsIn total, 148 patients (79 female, 69 male, median age 45 years) were included in the validation study. With intra-class correlation coefficients of at least 0.77, test–retest reliability was proven. Construct validity with a correlation coefficient of 0.82 and responsiveness with a correlation coefficient ranging from 0.42 to 0.47 were confirmed.ConclusionThe MAQ is a reliable and valid self-assessment measurement tool for the follow-up examination regarding subjective and objective parameters of traumatic and degenerative ankle pathologies. The MAQ has no limitation to specific disorders and allows a broad application.

What Is in a Name? A Historical Review of Intelligence Test Score Labels

Labels for scores stemming from intelligence tests have been employed since their inception in the United States. The purpose of this study was to systematically identify and document score labels for IQs used during the past 102 years. Using pairs of reviewers, score labels from 40 tests were reviewed, and 61 unique labels were identified. Comparative analyses by score range and decade were completed. Results indicate a paradigm shift beginning in the 1980s that has slowly resulted in more common, but not universal, use of terminology that focuses on the statistical aspect of scores, rather than employing value-laden and potentially stigmatizing terms. A universal score label system would help to avoid confusion, miscommunication, and biased decision making.

The impact of donor liver graft quality on postoperative outcome in liver transplant recipients. A single centre experience.

The Donor Risk Index (DRI) has become a universal score for organ allocation in liver transplantation (LT) worldwide. The aim of this study was to evaluate the impact of liver graft quality measured by DRI, CIT, WIT and donor age on intraoperative hemodynamics (reperfusion syndrome) and early postoperative outcome, defined as initial graft poor function (within 3 days of LT), of deceased donor liver transplant (DDLT) recipients. Secondary end-points were the assessment of the impact of graft quality on the intraoperative and postoperative day 1 hemostasis (evaluated using ROTEM assay). We retrospectively analyzed 135 patients who underwent deceased-donor LT between January 2013 and December 2014. Patient demographic data (age, sex, cause of End-Stage Liver Disease), preoperative paraclinical data (total bilirubin, creatinine, serum sodium), severity of liver disease scores (Model for End-Stage Liver Disease - MELD and MELD-sodium), intraoperative blood loss and blood products transfusion, incidence of post reperfusion syndrome, postoperative biochemical data (including total bilirubin, hepatic transaminases, lactate levels) and outcome (initial graft poor function diagnosis) were noted. Donor characteristics including DRI, CIT, WIT and donor age were noted. Coagulation was assessed by rotational thromboelastometry (ROTEM) after reperfusion of the graft and on postoperative day 1 in order to determine the effects of liver graft quality on hemostasis. Donor age has significantly correlated with decreased derived ROTEM parameters time to the maximum velocity of clot formation - MaxVt (p = 0.000), area under the curve (AUC) (p = 0.008) and maximum clot elasticity (MCE) (p = 0.018) although no difference in transfusion requirements has been observed. A longer CIT was associated with an increase in AST and ALT observed during the early postoperative period: day 1 ALT (p = 0.032) and AST (p = 0.008), day 2 ALT (p = 0.001) and AST (p = 0.001) and day 3 AST (p = 0.010) and ALT (p = 0.001). Higher DRI correlated with higher bilirubin levels measured on postoperative day 1 (p = 0.027) and 2 (p = 0.001). Patients who developed initial graft poor function received liver grafts from older donors (p = 0.05) with a higher DRI (p = 0.002). Our results suggest a significant impact of donor age and DRI on perioperative coagulation kinetics that may be a result of initial graft poor function. Although CIT and DRI correlated with a more severe cholestasis and hepatocitolysis during the early postoperative period these seems to be short-lived.

Encouraging Assessment of the Educational Climate in Medical Schools under the MEPI-MESAU Consortium

The educational environment is one of the most important factors that determine the effectiveness of an undergraduate medical curriculum. There are many evaluations (both qualitative and quantitative) that have been conducted globally to measure the academic environment of health sciences programmes (undergraduate and postgraduate) by utilising different methodologies. These evaluations include assessment of medicine, nursing, physiotherapy, dental science, chiropractic and other related programmes [1]. The World Federation for Medical Education notes the learning environment to be one of the targets for the evaluation of medical education programs [2]. Student’s perception of the educational environment has been designated as the educational climate (EC) and consequently, it has been defined as “the soul and the spirit of the medical school environment and curriculum” [3,4]. Because of its role in influencing teacher behavior, behavioral development of students, and its implication in the achievement of corporate goals and the level of satisfaction obtained, the educational climate must be taken into serious consideration [5-9]. It can serve as a stimulus for change since it has been considered as an expression, manifestation and measure of a curriculum [10]. The Dundee Ready Educational Environment Measure (DREEM), developed by Roff et al. in 1997 has been widely used as principal tool in measuring the educational climate. The DREEM is a general, multidimensional, multicultural instrument. It gives a universal score of a maximum of 200 and is capable of measuring five separate elements of the education environment: Students’ Perceptions of Learning (SPoL), Students Perceptions of Teachers (SPoT), Students Perceptions of Atmosphere (SPoA), Students’ Academic Self-Perception (SASP), and Student’s Social SelfPerceptions (SSSP) [11]. The instrument can be used to highlight the weaknesses and strengths of any educational institution, compare the performance and success of medical schools, and make comparisons among students in different levels of study and of different sex [9,12].

A trust-score-based access control in assured information sharing systems: An application of financial credit risk score models

Ensuring appropriate user access to information is a key objective of information security on a computer network. We propose a solution in which an individual user is assigned a universal trust score determined by applying the same model financial institutions use to determine an individual's credit risk score. This universal trust score is combined with the Bell-La Padula model to control the individual's access to information across multiple assured information sharing systems.

Statistical Scoring Algorithm for Learning and Study Skills

This study examines the study skills and the learning styles of university students by using scoring method. The study investigates whether the study skills can be summarized in a single universal score that measures how hard a student works. The sample consists of 418 undergraduate students of an international university. The presented scoring was method adapted from the domain of risk management. The proposed method computes an overall score that represents the study skills, using a linear weighted summation scheme. From among 50 questions regarding to learning and study skills, the 30 highest weighted questions are suggested to be used in the future studies as a learning and study skills inventor. The proposed scoring method and study yield results and insights that can guide educators regarding how they can improve their students’ study skills. The main point drawn from this study is that the students greatly value opportunities for interaction with instructors and peers, cooperative learning and active engagement in lectures.

Statistical Scoring Algorithm for Learning and Study Skills

This study examines the study skills and the learning styles of university students by using scoring method. The study investigates whether the study skills can be summarized in a single universal score that measures how hard a student works. The sample consists of 418 undergraduate students of an international university. The presented scoring was method adapted from the domain of risk management. The proposed method computes an overall score that represents the study skills, using a linear weighted summation scheme. From among 50 questions regarding to learning and study skills, the 30 highest weighted questions are suggested to be used in the future studies as a learning and study skills inventor. The proposed scoring method and study yield results and insights that can guide educators regarding how they can improve their students’ study skills. The main point drawn from this study is that the students greatly value opportunities for interaction with instructors and peers, cooperative learning and active engagement in lectures.