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Sample records for functional outcome measures

  1. Outcome Measures in Functional Urology : Towards evaluation through patient reported outcome measures?

    NARCIS (Netherlands)

    L.A. 't Hoen (Lisette)

    2015-01-01

    markdownabstractAbstract Pelvic floor disorders are characterized by four domains: urinary symptoms, anorectal symptoms, pelvic organ prolapse and sexual dysfunction. The symptoms of the different domains have a significant impact on patient’s quality of life. Traditional outcome measures, such a

  2. The gross motor function measure is a valid and sensitive outcome measure for spinal muscular atrophy.

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    Nelson, Leslie; Owens, Hollis; Hynan, Linda S; Iannaccone, Susan T

    2006-06-01

    Spinal muscular atrophy is a genetic disease of the anterior horn cell with high morbidity rate in childhood. Certain drugs may be of benefit and are in or under consideration for Phase II trials. Outcome measures that are age appropriate and representative of disease activity remain under study. Several have not yet been validated for spinal muscular atrophy. The Gross Motor Function Measure is a measure of motor function. We showed previously that the Gross Motor Function Measure is a reliable outcome measure to assess motor function in children with spinal muscular atrophy. By collating our data from 40 spinal muscular atrophy patients, ages 5 through 17 years, we now show the validity of the Gross Motor Function Measure when compared to Quantitative Muscle Testing and ambulatory status in children with spinal muscular atrophy. The median for Gross Motor Function Measure total scores for walkers was 237 (range: 197-261) and for non-walkers, 64 (range: 4-177; PGross Motor Function Measure is valid and sensitive as an outcome measure for clinical trials in pediatric spinal muscular atrophy.

  3. The tools of disability outcomes research functional status measures.

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    Cohen, M E; Marino, R J

    2000-12-01

    To review the major functional status measures currently used in rehabilitation research, including the domains and scope of functional status measures, as well as the psychometric properties of selected functional status measures and their use in adult rehabilitation populations. Measures of physical functioning widely used in rehabilitation research. Major generic measures included the following activities of daily living and instrumental activities of daily living: the FIM instrument, the Katz Activities of Daily Living Scale, the Level of Rehabilitation Scale, the Barthel index, and the Patient Evaluation and Conference System. Measures were evaluated based on published evidence of validity, reliability, and sensitivity. Measures were chosen on the basis of the amount and quality of published research on the functional measures widely used in rehabilitation medicine. Independent research of computer databases and reviews of functional measures were conducted to determine suitability for inclusion. The quality and validity of the measures were assessed using standard psychometric guidelines. Measures were evaluated based on published evidence of validity, reliability, sensitivity response and administrative burdens and instrument bias. Each criterion was graded on a 3-point scale reflecting the level of evidence. Researchers in the field of disabilities research need to consider carefully study objectives when measuring physical functioning in people with disabilities.

  4. Ability of Functional Independence Measure to accurately predict functional outcome of stroke-specific population: Systematic review

    OpenAIRE

    Madeleine Spencer, DPT, PT; Karen Skop, DPT, PT; Kristina Shesko, DPT, PT; Kristen Nollinger, DPT, PT; Douglas Chumney, DPT, PT; Roberta A. Newton, PT, PhD

    2010-01-01

    Stroke is a leading cause of functional impairments. The ability to quantify the functional ability of poststroke patients engaged in a rehabilitation program may assist in prediction of their functional outcome. The Functional Independence Measure (FIM) is widely used and accepted as a functional-level assessment tool that evaluates the functional status of patients throughout the rehabilitation process. From February to March 2009, we searched MEDLINE, Ovid, CINAHL, and EBSCO for full-text ...

  5. Measure of functional independence dominates discharge outcome prediction after inpatient rehabilitation for stroke.

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    Brown, Allen W; Therneau, Terry M; Schultz, Billie A; Niewczyk, Paulette M; Granger, Carl V

    2015-04-01

    Identifying clinical data acquired at inpatient rehabilitation admission for stroke that accurately predict key outcomes at discharge could inform the development of customized plans of care to achieve favorable outcomes. The purpose of this analysis was to use a large comprehensive national data set to consider a wide range of clinical elements known at admission to identify those that predict key outcomes at rehabilitation discharge. Sample data were obtained from the Uniform Data System for Medical Rehabilitation data set with the diagnosis of stroke for the years 2005 through 2007. This data set includes demographic, administrative, and medical variables collected at admission and discharge and uses the FIM (functional independence measure) instrument to assess functional independence. Primary outcomes of interest were functional independence measure gain, length of stay, and discharge to home. The sample included 148,367 people (75% white; mean age, 70.6±13.1 years; 97% with ischemic stroke) admitted to inpatient rehabilitation a mean of 8.2±12 days after symptom onset. The total functional independence measure score, the functional independence measure motor subscore, and the case-mix group were equally the strongest predictors for any of the primary outcomes. The most clinically relevant 3-variable model used the functional independence measure motor subscore, age, and walking distance at admission (r(2)=0.107). No important additional effect for any other variable was detected when added to this model. This analysis shows that a measure of functional independence in motor performance and age at rehabilitation hospital admission for stroke are predominant predictors of outcome at discharge in a uniquely large US national data set. © 2015 American Heart Association, Inc.

  6. How measurement artifacts affect cerebral autoregulation outcomes: A technical note on transfer function analysis.

    Science.gov (United States)

    Meel-van den Abeelen, Aisha S S; de Jong, Daan L K; Lagro, Joep; Panerai, Ronney B; Claassen, Jurgen A H R

    2016-05-01

    Cerebral autoregulation (CA) is the mechanism that aims to maintain adequate cerebral perfusion during changes in blood pressure (BP). Transfer function analysis (TFA), the most reported method in literature to quantify CA, shows large between-study variability in outcomes. The aim of this study is to investigate the role of measurement artifacts in this variation. Specifically, the role of distortion in the BP and/or CBFV measurementon TFA outcomes was investigated. The influence of three types of artifacts on TFA outcomes was studied: loss of signal, motion artifacts, and baseline drifts. TFA metrics of signals without the simulated artifacts were compared with those of signals with artifacts. TFA outcomes scattered highly when more than 10% of BP signal or over 8% of the CBFV signal was lost, or when measurements contained one or more artifacts resulting from head movement. Furthermore, baseline drift affected interpretation of TFA outcomes when the power in the BP signal was 5 times the power in the LF band. In conclusion, loss of signal in BP and loss in CBFV, affects interpretation of TFA outcomes. Therefore, it is vital to validate signal quality to the defined standards before interpreting TFA outcomes.

  7. Manual function outcome measures in children with developmental coordination disorder (DCD): Systematic review.

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    Bieber, Eleonora; Smits-Engelsman, Bouwien C M; Sgandurra, Giuseppina; Cioni, Giovanni; Feys, Hilde; Guzzetta, Andrea; Klingels, Katrijn

    2016-08-01

    This study systematically reviewed the clinical and psychometric properties of manual function outcome measures for children with developmental coordination disorder (DCD) aged 3-18 years. Three electronic databases were searched to identify manual function tools at the ICF-CY body function, activity and participation level used in children with DCD. Study selection and data extraction was conducted by two blind assessors according to the CanChild Outcome Measures Rating Form. Nineteen clinical tests (seven fine hand use tools and 12 handwriting measures), three naturalistic observations and six questionnaires were identified. The fine-motor subdomain of the Movement Assessment Battery for Children, the Bruininks-Oseretsky Test of Motor Proficiency-2 and the Functional Strength Measurement, with adequate reliability and validity properties, might be useful for manual function capacity assessment. The Systematic Detection of Writing Problems (SOS) and the Detailed Assessment of Speed of Handwriting (DASH) could be adopted for handwriting assessment, respectively from 6 and 9 years old. Naturalistic observations and questionnaires, whose psychometric properties have been investigated into limited extent, offer an assessment of the daily performances. This review shows that a combination of different tools is needed for a comprehensive assessment of manual function in children with DCD including the three levels of the ICF-CY. Further investigation of psychometric properties of those tools in children with DCD is warranted. Tests validated in other populations should be explored for their applicability for assessing manual function in children with DCD.

  8. Validation of GAITRite and PROMIS as high-throughput physical function outcome measures following ACL reconstruction.

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    Papuga, M Owen; Beck, Christopher A; Kates, Stephen L; Schwarz, Edward M; Maloney, Michael D

    2014-06-01

    New healthcare demands for quality measures of elective procedures, such as anterior cruciate ligament (ACL) reconstructive surgery, warrant the establishment of high throughput outcomes for high volume clinics. To this end, we evaluated the PROMIS and GAITRite as physical function outcome measures to quantify early healing and post-operative complications in 106 patients at pre-operative and 3, 10, 20 and 52 weeks post-ACL reconstruction with bone-tendon-bone autograft, and compared the results to the current IKDC validated outcome measure. The results showed that both PROMIS and GAITRite were significantly quicker to administer versus IKDC (pPROMIS and GAITRite detected a significant decrease in physical function at 3 weeks post-operative, and a significant improvement at 10 weeks post-operative versus pre-operative (pPROMIS and IKDC detected significant improvement out to 52 weeks post-operative (pPROMIS, with a combined correlation value of 0.8954 (pPROMIS is a diagnostic test for poor outcomes.

  9. DTI measures track and predict motor function outcomes in stroke rehabilitation utilizing BCI technology.

    Science.gov (United States)

    Song, Jie; Nair, Veena A; Young, Brittany M; Walton, Leo M; Nigogosyan, Zack; Remsik, Alexander; Tyler, Mitchell E; Farrar-Edwards, Dorothy; Caldera, Kristin E; Sattin, Justin A; Williams, Justin C; Prabhakaran, Vivek

    2015-01-01

    Tracking and predicting motor outcomes is important in determining effective stroke rehabilitation strategies. Diffusion tensor imaging (DTI) allows for evaluation of the underlying structural integrity of brain white matter tracts and may serve as a potential biomarker for tracking and predicting motor recovery. In this study, we examined the longitudinal relationship between DTI measures of the posterior limb of the internal capsule (PLIC) and upper-limb motor outcomes in 13 stroke patients (median 20-month post-stroke) who completed up to 15 sessions of intervention using brain-computer interface (BCI) technology. Patients' upper-limb motor outcomes and PLIC DTI measures including fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) were assessed longitudinally at four time points: pre-, mid-, immediately post- and 1-month-post intervention. DTI measures and ratios of each DTI measure comparing the ipsilesional and contralesional PLIC were correlated with patients' motor outcomes to examine the relationship between structural integrity of the PLIC and patients' motor recovery. We found that lower diffusivity and higher FA values of the ipsilesional PLIC were significantly correlated with better upper-limb motor function. Baseline DTI ratios were significantly correlated with motor outcomes measured immediately post and 1-month-post BCI interventions. A few patients achieved improvements in motor recovery meeting the minimum clinically important difference (MCID). These findings suggest that upper-limb motor recovery in stroke patients receiving BCI interventions relates to the microstructural status of the PLIC. Lower diffusivity and higher FA measures of the ipsilesional PLIC contribute toward better motor recovery in the stroke-affected upper-limb. DTI-derived measures may be a clinically useful biomarker in tracking and predicting motor recovery in stroke patients receiving BCI interventions.

  10. Influence of stroke infarct location on functional outcome measured by the modified rankin scale.

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    Cheng, Bastian; Forkert, Nils Daniel; Zavaglia, Melissa; Hilgetag, Claus C; Golsari, Amir; Siemonsen, Susanne; Fiehler, Jens; Pedraza, Salvador; Puig, Josep; Cho, Tae-Hee; Alawneh, Josef; Baron, Jean-Claude; Ostergaard, Leif; Gerloff, Christian; Thomalla, Götz

    2014-06-01

    In the early days after ischemic stroke, information on structural brain damage from MRI supports prognosis of functional outcome. It is rated widely by the modified Rankin Scale that correlates only moderately with lesion volume. We therefore aimed to elucidate the influence of lesion location from early MRI (days 2-3) on functional outcome after 1 month using voxel-based lesion symptom mapping. We analyzed clinical and MRI data of patients from a prospective European multicenter stroke imaging study (I-KNOW). Lesions were delineated on fluid-attenuated inversion recovery images on days 2 to 3 after stroke onset. We generated statistic maps of lesion contribution related to clinical outcome (modified Rankin Scale) after 1 month using voxel-based lesion symptom mapping. Lesion maps of 101 patients with middle cerebral artery infarctions were included for analysis (right-sided stroke, 47%). Mean age was 67 years, median admission National Institutes of Health Stroke Scale was 11. Mean infarct volumes were comparable between both sides (left, 37.5 mL; right, 43.7 mL). Voxel-based lesion symptom mapping revealed areas with high influence on higher modified Rankin Scale in regions involving the corona radiata, internal capsule, and insula. In addition, asymmetrically distributed impact patterns were found involving the right inferior temporal gyrus and left superior temporal gyrus. In this group of patients with stroke, characteristic lesion patterns in areas of motor control and areas involved in lateralized brain functions on early MRI were found to influence functional outcome. Our data provide a novel map of the impact of lesion localization on functional stroke outcome as measured by the modified Rankin Scale. © 2014 American Heart Association, Inc.

  11. Reporting outcome measures of functional constipation in children from 0 to 4 years of age.

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    Kuizenga-Wessel, Sophie; Benninga, Marc A; Tabbers, Merit M

    2015-04-01

    Functional constipation (FC) often begins in the first year of life. Although standard definitions and criteria have been formulated to describe FC, these are rarely used in research and clinical practice. The aim of the study is to systematically assess how definitions and outcome measures are defined in therapeutic randomized controlled trials (RCTs) of infants with FC. PubMed, EMBASE, and Cochrane databases were searched. Studies were included if it was a (systematic review of) therapeutic RCT, children ≤4 years old, they had FC, a clear definition of constipation was provided, and were written in English. Quality was assessed using the Delphi list. A total of 1115 articles were found; only 5 studies fulfilled the inclusion criteria. Four different definitions were used, of which only 2 used the internationally accepted Rome III criteria. Defecation frequency was used as primary outcome in all included trials and stool consistency in 3 trials. Two trials involving infants investigated new infant formulas, whereas the third RCT evaluated the efficacy of a probiotic strain. The 2 trials including infants up to 4 years of age compared polyethylene glycol without electrolytes (PEG4000) with lactulose and milk of magnesia. All of the trials used nonvalidated parental diaries. Different definitions and outcome measures for FC in infants are used in RCTs. Disappointingly, there is a lack of well-designed therapeutic trials in infants with constipation. To make comparison between future trials possible, standard definitions, core outcomes, and validated instruments are needed.

  12. Validation of the Italian version of the SBMA Functional Rating Scale as outcome measure.

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    Querin, Giorgia; DaRe, Elisa; Martinelli, Ilaria; Bello, Luca; Bertolin, Cinzia; Pareyson, Davide; Mariotti, Caterina; Pegoraro, Elena; Sorarù, Gianni

    2016-11-01

    The Spinal and Bulbar Muscular Atrophy Functional Rating Scale (SBMAFRS) is an established rating instrument used to assess the functional status of patients with Spinal and Bulbar Muscular Atrophy (SBMA). Our aim was to validate an Italian version of the scale. We administered the SBMAFRS to sixty SBMA patients during routine follow-up of clinical evaluations. To estimate the test stability, the scale was re-administered to a subset of 39 randomly selected patients after 8 weeks. The patients underwent clinical evaluation including 6-min walk. Psychometric analysis included reliability assessment and factorial analysis. To evaluate convergent validity, correlations between SBMAFRS items and muscular force assessed by manual testing, ALSFRS total score and subscales scores, and forced vital capacity, were performed. Internal consistency as measured by Cronbach's alpha (total scale 0.85) was high. Test-retest reliability assessed by Spearman's rho was also high. Principal component analysis with varimax rotation yielded a four-factor solution accounting for approximately 79 % of the variance. The scale total score and subscales score were strongly correlated with respective items and subscores of the ALSFRS, with respiratory function and with the 6-min walk test. In conclusion, we performed an Italian validation of the only existing disease-specific Functional Rating Scale for SBMA patients. This scale will be a useful tool not only in the clinical practice but also as an outcome measure in upcoming clinical trials.

  13. Does progressive resistance strength training as additional training have any measured effect on functional outcomes in older hospitalized patients?

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Andersen, Christina W.; Pedersen, Sigrid F

    2014-01-01

    OBJECTIVE: To evaluate the effect of progressive resistance strength training as additional training measured on functional outcomes in older hospitalized patients. DESIGN: A single-blinded randomized controlled trial. SETTING: Department of Geriatric Rehabilitation in university hospital...

  14. Behavioral, Brain Imaging and Genomic Measures to Predict Functional Outcomes Post - Bed Rest and Spaceflight

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    Mulavara, A. P.; DeDios, Y. E.; Gadd, N. E.; Caldwell, E. E.; Batson, C. D.; Goel, R.; Seidler, R. D.; Oddsson, L.; Zanello, S.; Clarke, T.; Peters, B.; Cohen, H. S.; Reschke, M.; Wood, S.; Bloomberg, J. J.

    2016-01-01

    retrospective study, leveraging data already collected from relevant ongoing or completed bed rest and spaceflight studies. These data will be combined with predictor metrics that will be collected prospectively (as described for behavioral, brain imaging and genomic measures) from these returning subjects to build models for predicting post-mission (bed rest - non-astronauts or space flight - astronauts) adaptive capability as manifested in their outcome measures. To date we have completed a study on 15 normal subjects with all of the above measures. In this presentation we will discuss the optimized set of tests for predictive metrics to be used for evaluating post mission adaptive capability as manifested in their outcome measures. Comparisons of model performance will allow us to better design and implement sensorimotor adaptability training countermeasures against decrements in post-mission adaptive capability that are customized for each crewmember's sensory biases, adaptive capacity, brain structure and functional capacities, and genetic predispositions. The ability to customize adaptability training will allow more efficient use of crew time during training and will optimize training prescriptions for astronauts to ensure expected outcomes.

  15. Macular SD-OCT Outcome Measures: Comparison of Local Structure-Function Relationships and Dynamic Range

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    Miraftabi, Arezoo; Amini, Navid; Morales, Esteban; Henry, Sharon; Yu, Fei; Afifi, Abdolmonem; Coleman, Anne L.; Caprioli, Joseph; Nouri-Mahdavi, Kouros

    2016-01-01

    Purpose We tested the hypothesis that the macular ganglion cell layer (GCL) thickness demonstrates a stronger structure-function (SF) relationship and extends the useful range of macular measurements compared with combined macular inner layer or full thickness. Methods Ninety-eight glaucomatous eyes and eight normal eyes with macular spectral domain optical coherence tomography (SD-OCT) volume scans and 10-2 visual fields were enrolled. Inner plexiform layer (IPL), GCL, macular retinal nerve fiber layer (mRNFL), ganglion cell-inner plexiform layer (GCIPL), ganglion cell complex (GCC), and full thickness (FT) measurements were calculated for 8 × 8 arrays of 3° superpixels. Main outcome measures were local structure-function relationships between macular superpixels and corresponding sensitivities on 10-2 fields after adjusting for ganglion cell displacement, dynamic range of measurements, and the change point (total deviation value where macular parameters reached measurement floor). Results Median (interquartile range [IQR]) mean deviation was −7.2 (−11.6 to −3.2) dB in glaucoma eyes. Strength of SF relationships was highest for GCIPL, GCL, GCC, and IPL (ρ = 0.635, 0.627, 0.621, and 0.577, respectively; P ≤ 0.046 for comparisons against GCIPL). Highest SF correlations coincided with the peak of GCL thickness, where the dynamic range was widest for FT (81.1 μm), followed by GCC (65.7 μm), GCIPL (54.9 μm), GCL (35.2 μm), mRNFL (27.5 μm), and IPL (20.9 μm). Change points were similar for all macular parameters (−7.8 to −8.9 dB). Conclusions GCIPL, GCL, and GCC demonstrated comparable SF relationships while FT, GCC, and GCIPL had the widest dynamic range. Measurement of GCL did not extend the range of useful structural measurements. Measuring GCL does not provide any advantage for detection of progression with current SD-OCT technology. PMID:27623336

  16. ADAPTATION OF DASH OUTCOME MEASURES TO SLOVENIAN POPULATION - FUNCTIONALITY OF ARM, SHOULDER AND HAND

    Directory of Open Access Journals (Sweden)

    Katja Semprimožnik

    2015-04-01

    Full Text Available  ABSTRACT BackgroundIn Slovenia, there is no test for upper limb function, which would be uniform for all institutions and would allow comparison of results of the therapy and upper limb rehabilitation with medical centers. MethodsAfter reviewing the existing hand function tests and current literature we decided to translate the DASH test - Disabilities of arm, shoulder and hand. Adaptation was tested on patient population in outpatient hand clinic, General hospital Celje and showed good validity, reliability and responsiveness. Results and discussionAdaptation of DASH test to Slovene population is a procedure, where language and cultural differences must be considered. Testing the adapted DASH in the general population shows good validity, reliability and responsiveness of adapted test. ConclusionTranslations DASH test, QuickDASH test and instructions for scoring the DASH outcome measures are approved by the Institute for Work and Health. Translations are published on their site and available for use.

  17. Symptomatic Remission in Schizophrenia and its Relationship with Functional Outcome Measures in Indian Population

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    Jayaraman, Komal; Daniel, Sharon Joe; Ramasamy, Jeyaprakash

    2017-01-01

    Introduction Schizophrenia is a chronic mental disorder with disabling symptoms and variable outcome. Outcome is a multidimensional construct that depends on description of clinical and social domains. Symptomatic remission is one such clinical domain which can determine the outcome of illness. Aim The study aimed to assess functional outcome in symptomatic remitted schizophrenia patients compared to unremitted patients in Indian population. Materials and Methods This cross-sectional observational study was conducted at the Institute of Mental Health, Chennai, India. Remitted (symptom free in preceding six months) and unremitted patients were assessed by Positive and Negative Symptom Scale (PANSS), Personal and Social Performance (PSP) scale, World Health Organization-Quality of Life BREF (WHOQOL-BREF) and Global Assessment of Functioning (GAF). There were 30 patients in each group. All statistical analysis was done using SPSS version 20.0 statistical software. Results Patients in symptomatic remission were found to have better quality of life in personal, environmental and social domains (p<0.01). Their personal and social performance is significantly better in remission group. The overall functioning was assessed by GAF, was better in patients with symptomatic remission (p<0.001). Conclusion Symptomatic remission may be a good indicator of better clinical status, personal and social functioning and quality of life. PMID:28274026

  18. Quantitative measures of damage to subchondral bone are associated with functional outcome following treatment of displaced acetabular fractures.

    Science.gov (United States)

    Lubovsky, Omri; Kreder, Michael; Wright, David A; Kiss, Alex; Gallant, Aimee; Kreder, Hans J; Whyne, Cari M

    2013-12-01

    Current analysis of displaced acetabular fractures is limited in its ability to predict functional outcome. This study aimed to (1) quantify initial acetabular damage following acetabular fracture through measurement of subchondral bone density and fracture lines, and (2) evaluate associations between acetabular damage and functional outcomes following fracture. Subchondral bone intensity maps were created for 24 patients with unilateral acetabular fractures. Measures of crack length and density differences between corresponding regions in the fractured acetabuli, normalized by the unfractured side, were generated from preoperative CT images. Damage measures were compared to quality of life survey data collected for each patient at least 2 years post-injury (Musculoskeletal Functional Assessment [MFA] and Short Form-36 [SF-36], with specific focus on parameters that best describe patients' physical health). CT image quantification of initial damage to acetabular subchondral bone was associated with functional outcome post-injury. In general, damage as quantified through differences in density in the superior dome region (zones 8 and 12) and the central anterior region of the acetabulum (zone 3) were found to be the strongest significant predictors of functional outcome (adjusted R(2) = 0.3-0.45, p fractures toward improving clinical prognoses.

  19. Comparing contents of outcome measures in cerebral palsy using the International Classification of Functioning (ICF-CY): a systematic review.

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    Schiariti, Veronica; Klassen, Anne F; Cieza, Alarcos; Sauve, Karen; O'Donnell, Maureen; Armstrong, Robert; Mâsse, Louise C

    2014-01-01

    The International Classification of Functioning children and youth version (ICF-CY) provides a universal framework for defining and classifying functioning and disability in children worldwide. To facilitate the application of the ICF in practice, ICF based-tools like the "ICF Core Sets" are being developed. In the context of the development of the ICF-CY Core Sets for children with Cerebral Palsy (CP), the aims of this study were as follows: to identify and compare the content of outcome measures used in studies of children with CP using the ICF-CY coding system; and to describe the most frequently addressed areas of functioning in those studies. We searched multiple databases likely to capture studies involving children with CP from January 1998 to March 2012. We included all English language articles that studied children aged 2-18 years and described an interventional or observational study. Constructs of the outcome measures identified in studies were linked to the ICF-CY by two trained professionals. We found 231 articles that described 238 outcome measures. The outcome measures contained 2193 concepts that were linked to the ICF-CY and covered 161 independent ICF-CY categories. Out of the 161 categories, 53 (33.5%) were related to body functions, 75 (46%) were related to activities/participation, 26 (16.1%) were related to environmental factors, and 7 (4.3%) were related to body structures. This systematic review provides information about content of measures that may guide researchers and clinicians in their selection of an outcome measure for use in a study and/or clinical practice with children with CP. Copyright © 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  20. Outcome measures of antidepressive therapy.

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    Rosenberg, R

    2000-01-01

    A variety of outcome measures assessing antidepressive therapy are available. However, in randomized clinical trials, the Hamilton Rating Scale for Depression (HAM-D) is often the primary outcome measure. Results from factor analysis and Rasch item analysis indicate that the HAM-D is heterogeneous and that the sum of items scores may not be an adequate measure of the severity of depression. A Melancholia Scale of 11 items has been suggested as a more valid measure of the core symptoms of affective syndrome. Other global outcome measures, focusing on health-related quality of life issues and on social functioning as well as macro-economic analyses are also used in depression. Applying stringent and well-documented outcome measures in randomized clinical trials of antidepressants may give the clinician a better indication of the most appropriate drug for treatment of the individual patient.

  1. Physical function metric over measure: An illustration with the Patient-Reported Outcomes Measurement Information System (PROMIS) and the Functional Assessment of Cancer Therapy (FACT).

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    Kaat, Aaron J; Schalet, Benjamin D; Rutsohn, Joshua; Jensen, Roxanne E; Cella, David

    2017-09-08

    Measuring patient-reported outcomes (PROs) is becoming an integral component of quality improvement initiatives, clinical care, and research studies in cancer, including comparative effectiveness research. However, the number of PROs limits comparability across studies. Herein, the authors attempted to link the Functional Assessment of Cancer Therapy-General Physical Well-Being (FACT-G PWB) subscale with the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) calibrated item bank. The also sought to augment a subset of the conceptually most similar FACT-G PWB items with PROMIS PF items to improve the linking. Baseline data from 5506 participants in the Measuring Your Health (MY-Health) study were used to identify the optimal items for linking FACT-G PWB with PROMIS PF. A mixed methods approach identified the optimal items for creating the 5-item FACT/PROMIS-PF5 scale. Both the linked and augmented relationships were cross-validated using the follow-up MY-Health data. A 5-item FACT-G PWB item subset was found to be optimal for linking with PROMIS PF. In addition, a 2-item subset, including only items that were conceptually very similar to the PROMIS item bank content, were augmented with 3 PROMIS PF items. This new FACT/PROMIS-PF5 provided superior score recovery. The PROMIS PF metric allows for the evaluation of the extent to which similar questionnaires can be linked and therefore expressed on the same metric. These results allow for the aggregation of existing data and provide an optimal measure for future studies wishing to use the FACT yet also report on the PROMIS PF metric. Cancer 2017. © 2017 American Cancer Society. © 2017 American Cancer Society.

  2. Outcome measures for hand function naturally reveal three distinct domains in older adults: strength, coordinated upper extremity function, and sensorimotor processing

    Directory of Open Access Journals (Sweden)

    Emily L Lawrence

    2015-06-01

    Full Text Available Understanding the mapping between individual outcome measures and the latent functional domains of interest is critical to a quantitative evaluation and rehabilitation of hand function. We examined whether and how the associations among six hand-specific outcome measures reveal latent functional domains in elderly individuals. We asked 66 healthy older adult participants (38F, 28M, 66.1±11.6yrs, range: 45-88yrs and 33 older adults (65.8±9.7yrs, 44-81yrs, 51 hands diagnosed with osteoarthritis (OA of the carpometacarpal (CMC joint, to complete six functional assessments: hand strength (Grip, Key and Precision Pinch, Box and Block, Nine Hole Pegboard, and Strength-Dexterity tests. The first three principal components suffice to explain 86% of variance among the six outcome measures in healthy older adults, and 84% of variance in older adults with CMC OA. The composition of these dominant associations revealed three distinct latent functional domains: strength, coordinated upper extremity function, and sensorimotor processing. Furthermore, in participants with thumb CMC OA we found a blurring of the associations between the latent functional domains of strength and coordinated upper extremity function. This motivates future work to understand how the physiological effects of thumb CMC OA lead upper extremity coordination to become strongly associated with strength, while dynamic sensorimotor ability remains an independent functional domain.Thus, when assessing the level of hand function in our growing older adult populations, it is particularly important to acknowledge its multidimensional nature—and explicitly consider how each outcome measure maps to these three latent and fundamental domains of function. Moreover, this ability to distinguish among latent functional domains may facilitate the design of treatment modalities to target the rehabilitation of each of them.

  3. Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients' views

    Directory of Open Access Journals (Sweden)

    Rasch Coen RN

    2009-11-01

    Full Text Available Abstract Background Aim of this study is to thoroughly assess pretreatment organ function in advanced head and neck cancer through various clinical outcome measures and patients' views. Methods A comprehensive, multidimensional assessment was used, that included quality of life, swallowing, mouth opening, and weight changes. Fifty-five patients with stage III-IV disease were entered in this study prior to organ preserving (chemoradiation treatment. Results All patients showed pretreatment abnormalities or problems, identified by one or more of the outcome measures. Most frequent problems concerned swallowing, pain, and weight loss. Interestingly, clinical outcome measures and patients' perception did no always concur. E.g. videofluoroscopy identified aspiration and laryngeal penetration in 18% of the patients, whereas only 7 patients (13% perceived this as problematic; only 2 out of 7 patients with objective trismus actually perceived trismus. Conclusion The assessment identified several problems already pre-treatment, in this patient population. A thorough assessment of both clinical measures and patients' views appears to be necessary to gain insight in all (perceived pre-existing functional and quality of life problems.

  4. Functional recovery measures for spinal cord injury : An evidence-based review for clinical practice and research - Functional recovery outcome measures work group

    NARCIS (Netherlands)

    Anderson, Kim; Aito, Sergio; Atkins, Michal; Biering-Sorensen, Fin; Charlifue, Susan; Curt, Armin; Ditunno, John; Glass, Clive; Marino, Ralph; Marshall, Ruth; Mulcahey, Mary Jane; Post, Marcel; Savic, Gordana; Scivoletto, Giorgio; Catz, Amiram

    2008-01-01

    Background/Objective: The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome meas

  5. Relationship between knee kinetic outcome measures in vertical counter movement jumps and self-reported function in ACL reconstructed subjects

    DEFF Research Database (Denmark)

    Brekke, Anders Falk

    2014-01-01

    and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark Introduction: Altered loading pattern of the medial aspect of the knee has been associated with the development of knee osteoarthritis (OA). Anterior cruciate ligament (ACL) injuries are associated......Relationship between knee kinetic outcome measures in counter movement jumps and self-reported function in ACL reconstructed subjects Brekke AF1,2, Nielsen DB2, Holsgaard-Larsen A2 1School of physiotherapy, University College Zealand, Denmark 2Orthopaedic Research Unit, Department of Orthopaedics...

  6. Equating activities of daily living outcome measures: the Functional Independence Measure and the Korean version of Modified Barthel Index.

    Science.gov (United States)

    Hong, Ickpyo; Woo, Hee-Soon; Shim, Sunhwa; Li, Chih-Ying; Yoonjeong, Lim; Velozo, Craig A

    2016-12-08

    To create a crosswalk between the Functional Independence Measure (FIM) motor items and the Korean version of the Modified Barthel Index (K-MBI). Korean community-dwelling adult patients (n = 276) completed the FIM and K-MBI on the same day in outpatient rehabilitation hospitals. We used a single group design with the Rasch common person equating and conducted a factor analysis of the co-calibrated item pool using the two measures. Rasch analysis was used to investigate the psychometrics of the equated test items in the identified factor structure(s). The correlation between FIM raw scores and converted K-MBI scores was examined. Three measurement constructs were identified: self-care, mobility, involuntary movement. The equated test items in the three constructs demonstrated good person separation reliability (r = 0.94-0.96) and good internal consistency (Cronbach's alpha =0.93-0.97). The three crosswalks between the FIM raw scores and converted K-MBI scores demonstrated good correlations (r = 0.91-0.93, all p test items demonstrating good psychometrics. The crosswalks would address the incomparable scoring systems between the FIM motor items and K-MBI. Implications for Rehabilitation The three crosswalk tables (scoring tables) would allow clinicians to compare or translate a patient's motor scores between the FIM and K-MBI. The crosswalk tables would allow health-care administrators to track patients' functional status across various rehabilitation facilities that exclusively use the FIM or K-MBI.

  7. Functional outcome after thrombolytic therapy.

    Science.gov (United States)

    Miljković, Sinisa; Prtina, Drasko; Rabi Zikić, Tamara; Vujković, Zoran; Racić, Dusko; Dajić, Vlado; Jesić, Aleksandar; Arbutina, Milan; Zikić, Milorad

    2010-06-01

    In this paper, we report our experience from a prospective study in 40 ischemic stroke patients admitted during the last two years at University Department of Neurology Stroke Unit, Banja Luka Clinical Center, in order to assess the safety and efficacy of thrombolytic therapy, the impact of age, sex and risk factors, and functional outcome at 6 months of intravenous tissue plasminogen activator treatment. According to the National Institutes of Health Stroke Scale, there were 5 mild, 22 moderate and 13 severe stroke cases in the study group. The outcome measures at 6 months of thrombolytic treatment were taken in 38 (100%) patients, yielding a Functional Independent Measure score > or=90 (good clinical outcome) in 21 (52.50%) and modified Rankin Score < or =2 (good clinical outcome) in 22 (55%) patients. The rate of symptomatic intracerebral hemorrhage in tissue plasminogen activator treated patients was 5%, with a mortality rate of 17.50%. The outcomes were comparable with those found in the NINDS t-PA trial. Current guidelines recommend a 'door-to-needle' time of less than 60 minutes and emphasize that 'time is brain'.

  8. Toward a Specific Outcome Instrument for Spinal Trauma : How to Measure Function and Health

    NARCIS (Netherlands)

    Sadiqi, Said; Lehr, A. Mechteld; Post, Marcel W.; Vaccaro, Alexander R.; Dvorak, Marcel F.; Oner, F. Cumhur

    2015-01-01

    Study Design. Validation study. Objective. To investigate the most valid, reliable, and comprehensible response scale for spinal trauma patients to compare their current level of function and health with their preinjury state. Summary of Background Data. In the context of a main project of the AOSpi

  9. Towards a specific outcome instrument for spinal trauma : How to measure function and health

    NARCIS (Netherlands)

    Sadiqi, S; Lehr, A.M.; Post, MWM; Vaccaro, A.R.; Dvorak, Marcel F; Oner, FC

    2015-01-01

    Study Design. Validation study. Objective. To investigate the most valid, reliable, and comprehensible response scale for spinal trauma patients to compare their current level of function and health with their preinjury state. Summary of Background Data. In the context of a main project of the AOSpi

  10. Measuring functional outcome after total hip replacement with subject-specific hip joint loading

    NARCIS (Netherlands)

    Weber, Tim; Dendorfer, Sebastian; Dullien, Silvia; Grifka, Joachim; Verkerke, Gijsbertus Jacob; Renkawitz, Tobias

    2012-01-01

    Total hip replacement is an often-performed orthopedic surgical procedure; the amount of procedures undertaken will increase since our life expectancy is growing. In order to optimize function, hip biomechanics should be restored to as near normal as possible. The goal of this pilot study was to

  11. Do SF-36 summary scores work as outcome measures in chronic functional disorders?

    DEFF Research Database (Denmark)

    Schröder, Andreas; Ørnbøl, Eva; Fink, Per

    based on an oblique factor solution and the summary components from the RAND-36 HSI. Results Pilot study: Improvement on subscales of physical health was not reflected by the original PCS. The three methods showed different results with regard to individual changes over time. Baseline data: Surprisingly...... controlled trial on cognitive behavioural therapy in patients with severe and chronic functional disorders. Based on a pilot study and baseline data, we have assessed the performance of the summary scores. Aim To demonstrate problems in the orthogonal factor solution for PCS and MCS and to assess other...... methods of summarising the SF-36 subscales. Method Subjects were 102 patients included in our trial and 10 patients from the pilot study. We examined three methods of summarising physical and mental health subscales of the SF-36: the original summary scores PCS and MCS, an alternative summary scoring...

  12. Functional Outcomes Following Burn Injury.

    Science.gov (United States)

    Ryan, Colleen M; Parry, Ingrid; Richard, Reginald

    Major advances in functional recovery following burn injury over the last ten years include the development of conceptual framework for disability assessment and its application burn recovery, the description of the long-term outcomes in the burn population, and progress in basic science research leading to new treatments that improve long-term functional outcomes. Future tasks and challenges include the development of common data elements and standards for burn recovery in order to measure and optimize the path toward functional recovery. The development of patient-reported outcome measures with benchmarks for recovery over time has the potential to improve patient-provider communication and quality of patient-centered care. The study of burn recovery should include an examination of resiliency along with the study of disabilities following burn injury. Better understanding of the mechanisms, impact and modulation of hypermetabolism and inflammation following burn injury is essential to improve functional recovery. Continued basic science and clinical research must focus on scar modulation and skin replacements and address recalcitriant problems such as heterotopic ossification. Health tracking technologies should be leveraged to understand and optimize physical therapy interventions.

  13. Behavioral, Brain Imaging and Genomic Measures to Predict Functional Outcomes Post-Bed Rest and Space Flight

    Science.gov (United States)

    Mulavara, A. P.; Peters, B.; De Dios, Y. E.; Gadd, N. E.; Caldwell, E. E.; Batson, C. D.; Goel, R.; Oddsson, L.; Kreutzberg, G.; Zanello, S.; Clark, T. K.; Oman, C. M.; Cohen, H. S.; Wood, S.; Seidler, R. D.; Reschke, M. F.; Bloomberg, J. J.

    2017-01-01

    data already collected from relevant ongoing or completed bed rest and spaceflight studies. This data will be combined with predictor metrics that will be collected prospectively (as described for behavioral, brain imaging and genomic measures) from these returning subjects to build models for predicting post spaceflight and bed rest adaptive capability. In this presentation we will discuss the optimized set of tests for predictive metrics to be used for evaluating post mission adaptive capability as manifested in their outcome measures. Comparisons of model performance will allow us to better design and implement sensorimotor adaptability training countermeasures against decrements in post-mission adaptive capability that are customized for each crewmember's sensory biases, adaptive ability, brain structure, brain function, and genetic predispositions. The ability to customize adaptability training will allow more efficient use of crew time during training and will optimize training prescriptions for astronauts to mitigate the deleterious effects of spaceflight.

  14. Validation of a Chinese version of the Medical Outcomes Study Family and Marital Functioning Measures in patients with SLE.

    Science.gov (United States)

    Thumboo, J; Feng, P H; Soh, C H; Boey, M L; Thio, S; Fong, K Y

    2000-01-01

    The objective was to validate a Chinese translation of the Medical Outcomes Study Family and Marital Functioning Measures (FFM and MFM) in patients with systemic lupus erythematosus (SLE). Chinese-speaking SLE patients (n = 69) completed a self-administered questionnaire containing the FFM and MFM and assessing demographic and socio-economic status twice within a 2 week period. SLE activity, disease-related damage and quality of life were assessed using the BILAG, SLICC/ACR Damage Index and SF-36 Health Survey, respectively. Scale psychometric properties were assessed through factor analysis, Cronbach's alpha, quantifying test-retest differences and known-groups construct validity. Factor analysis identified 1 factor corresponding to the FFM and 2 factors corresponding to the MFM. Internal consistency for the FFM was excellent (alpha = 0.92) while that for the MFM was acceptable (alpha = 0.62). Mean (s.d.) test-retest differences were 0.06 (1.54) points for the FFM and 0.03 (2.08) points for the MFM. 11 and 10 of 13 a priori hypotheses relating the FFM and MFM, respectively, to demographic, disease and quality of life variables were confirmed, supporting the construct validity of these scales. The Chinese FFM and MFM are valid and reliable measures of family and marital functioning in Chinese-speaking SLE patients, with psychometric properties very similar to the source English version.

  15. [Defense mechanisms as outcome measure in short-term psychotherapy related to symptoms, severity and overall functioning: a preliminary study].

    Science.gov (United States)

    Coccanari de' Fornari, Maria Antonietta; Piccione, Michele; Maiello, Luca; Giampà, Alessio

    2011-01-01

    The assessment of defense mechanisms in psychotherapy is currently one of the most used ways to evaluate the effectiveness of psychotherapy. In literature there are few reports on defense mechanisms changes by short-term treatments. To determine whether the defense mechanisms are changed after twelve sessions of short-term psychotherapy related to psychopathological symptoms, severity and overall functioning. Twenty patients (12 F and 8 M; age 38.4) affected by anxiety and mood disorders were recruited to the study between November 2008 and July 2009 and were assessed with the Defense Style Questionnaire-88 (DSQ-88), scale Symptom Checklist-90-Revised (SCL-90-R), scale Clinical Global Impression (CGI) and scale Valutazione Globale del Funzionamento (VGF) at the beginning and after short-term psychotherapy. Half the sample also assumed drugs. The treatment was supportive-expressive psychotherapy of Luborsky, a short focal dynamic therapy, characterized by the integration of supportive and expressive techniques. Both patients showed a significant decrease in immature defenses and a significant-increase in mature defenses (p < 0.01). Mature defenses were significantly correlated with severity (r = -0632; p = 0.003) and overall functioning (r = 0529; p = 0.01). Immature and mature defenses seem to be a useful outcome measure in short-term psychotherapy as well as severity and overall functioning and the combined treatment may be most effective in reducing immature defenses.

  16. Social Function and Communication in Optimal Outcome Children and Adolescents with an Autism History on Structured Test Measures

    Science.gov (United States)

    Orinstein, Alyssa J.; Suh, Joyce; Porter, Kaitlyn; De Yoe, Kaitlin A.; Tyson, Katherine E.; Troyb, Eva; Barton, Marianne L.; Eigsti, Inge-Marie; Stevens, Michael C.; Fein, Deborah A.

    2015-01-01

    Youth who lose their ASD diagnosis may have subtle social and communication difficulties. We examined social and communication functioning in 44 high-functioning autism (HFA), 34 optimal outcome (OO) and 34 typically developing (TD) youth. Results indicated that OO participants had no autism communication symptoms, no pragmatic language deficits,…

  17. Social Function and Communication in Optimal Outcome Children and Adolescents with an Autism History on Structured Test Measures

    Science.gov (United States)

    Orinstein, Alyssa J.; Suh, Joyce; Porter, Kaitlyn; De Yoe, Kaitlin A.; Tyson, Katherine E.; Troyb, Eva; Barton, Marianne L.; Eigsti, Inge-Marie; Stevens, Michael C.; Fein, Deborah A.

    2015-01-01

    Youth who lose their ASD diagnosis may have subtle social and communication difficulties. We examined social and communication functioning in 44 high-functioning autism (HFA), 34 optimal outcome (OO) and 34 typically developing (TD) youth. Results indicated that OO participants had no autism communication symptoms, no pragmatic language deficits,…

  18. Identifying the concepts contained in outcome measures of clinical trials on four internal disorders using the international classification of functioning, disability and health as a reference

    OpenAIRE

    2004-01-01

    Objectives: To systematically identify and compare the concepts contained in outcome measures of clinical trials on chronic ischemic heart disease, diabetes mellitus, obesity and obstructive pulmonary disease, including asthma using the International Classification of Functioning, Disability and Health (ICF) as a reference. Methods: Randomized controlled trials between 1993 and 2003 were located in MEDLINE and selected according predefined criteria. The outcome measures were extracted and...

  19. Measurement properties of performance-based outcome measures to assess physical function in young and middle-aged people known to be at high risk of hip and/or knee osteoarthritis

    DEFF Research Database (Denmark)

    Kroman, S L; Roos, Ewa M.; Bennell, K L;

    2014-01-01

    To systematically appraise the evidence on measurement properties of performance-based outcome measures to assess physical function in young and middle-aged people known to be at high risk of hip and/or knee osteoarthritis (OA).......To systematically appraise the evidence on measurement properties of performance-based outcome measures to assess physical function in young and middle-aged people known to be at high risk of hip and/or knee osteoarthritis (OA)....

  20. The Takei Handheld Dynamometer: An Effective Clinical Outcome Measure Tool for Hand and Wrist Function in Boxing.

    Science.gov (United States)

    Gatt, Ian; Smith-Moore, Sophie; Steggles, Charlie; Loosemore, Mike

    2017-05-01

    The aim of this article was to explore retrospectively the Takei dynamometer as a valid and reliable outcome measure tool for hand and wrist pathology in the Great Britain amateur boxing squad between 2010 and 2014. Longitudinal retrospective injury surveillance of the Great Britain boxing squad was performed from 2010 to 2014. The location, region affected, description, and duration of each injury were recorded by the team doctor and team physiotherapists. For each significant injury, we recorded hand grip scores using the Takei handheld dynamometer and compared the scores with baseline measures. At the hand, fractures and dislocations were highly detected with an average difference of 40.2% ( P 20% should be highly considered for significant pathology. The Takei dynamometer is a valid and reliable outcome measure tool for hand and wrist pathologies in boxing. Our study highlights the importance of appropriate clinical tools to guide injury management in this sport.

  1. [Measuring outcome in spasticity rehabilitation].

    Science.gov (United States)

    Fheodoroff, K; Wissel, J; Entner, T; Freimüller, M

    2001-01-01

    Spasticity is a frequent consequence of upper motor neuron lesion and is associated with a variety of symptoms such as pain, muscle stiffness and reflex patterns that interfere with activities of daily living, dexterity and gait. As therapy strategies in managing spasticity-associated problems have been evolving there is an increasing need for a practicable documentation system which describes spasticity and related symptoms on different levels in order to evaluate especially the level of functioning. In daily routine the single-case-design reflects a useful technique to evaluate the status in terms of technical, functional and individual goals for treatment. However, there is no single tool to measure the different types of changes due to treatment, therefore a variety of selecting tests, based on the functional changes expected from the selected treatment, is recommended. The sensitivity of the selected tests should match the range of expected improvements related to the specific treatment. Technical goals should be evaluated by validated spasticity rating scales. As changes in technical measures of spasticity such as muscle tone, muscle length, range of motion or repetitive voluntary movements may not correlate with clinical improvements, individual functional goals should be defined. Those functional goals should reflect the patients' and care-givers' individual perception of the actual problem. A treatment diary is a useful tool to document subjective perception of changes over time. Some practical issues are adressed below. Reliable outcome measures enable patients and doctors to select further treatment strategies and gives health care providers information on treatment expectations in return for their investments.

  2. [Patient evaluation and outcome measures].

    Science.gov (United States)

    Nieto Pol, Enrique

    2014-01-01

    Both the initial evaluation and follow-up of patients with osteoarthritis require systematic evaluation of the indicators that provide information on the degree of involvement of the disease and allow its quantification. Reliable measures of disease progression help decision-making by clinicians and provide valid information on treatment response and the effectiveness of the distinct therapeutic interventions. The instruments recommended in research, as outcome measures in osteoarthritis, are pain evaluation, assessment of physical function, and self-reported global evaluation. In studies lasting more than 1 year, structural changes are evaluated through simple X-ray. Self-reported quality of life assessment and physician global assessment are also recommended as options. These indicators should be incorporated into routine clinical practice for adequate evaluation and correct follow-up of patients with osteoarthritis. The recommended pain evaluation method for use in clinical practice is the visual analog scale (VAS). The best instrument to evaluate physical function in patients with hip or knee osteoarthritis is the WOMAC scale (Western Ontario and McMaster Universities Osteoarthritis Index). For patient-reported global assessment in routine practice, the recommended scales are VAS or the SF-12 (12-item short-form health survey). Copyright © 2014 Elsevier España, S.L. All rights reserved.

  3. Development of the osteoporosis assessment questionnaire—physical function (OPAQ-PF): an osteoporosis-targeted, patient-reported outcomes (PRO) measure of physical function

    OpenAIRE

    Naegeli, A. N.; Nixon, A; Burge, R.; Gold, D. T.; Silverman, S

    2013-01-01

    Summary We have developed a short, patient-reported outcome questionnaire—the Osteoporosis Assessment Questionnaire—Physical Function (OPAQ-PF)—that assesses the impact of osteoporosis on physical function. OPAQ-PF contains 15 items in three domains (mobility, physical positions, and transfers) and has content validity in osteoporosis patients with and without a history of fracture. Introduction This paper describes the development of the Osteoporosis Assessment Questionnaire—Physical Functio...

  4. Responsiveness of Clinical Outcome Measures

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein

    to condition alterations in PrS patients and should be added as an outcome measure to standard questionnaires used serially. The prospective acceptable outcome method offers a benchmark by which clinicians can balance any mismatch between what are acceptable outcomes to the patient with what is realistically......, the most commonly used retrospective method to establish the MCID has inherent methodological flaws. Perhaps it would be more prudent to ask LBP patients what is an acceptable result of the treatment before it begins? Objectives The overall objective was to establish the responsiveness and MCID in specific...... subgroups of patients with LBP. In addition, we explored whether low back pain patients were able to determine an acceptable treatment outcome before it began. Methods The responsiveness in subgroups study. An extensive cross-cultural adaptation and validation of the ODI was carried out on patients seen...

  5. The ICF Core Sets for hearing loss: researcher perspective, Part II: Linking outcome measures to the International Classification of Functioning, Disability and Health (ICF).

    Science.gov (United States)

    Granberg, Sarah; Möller, Kerstin; Skagerstrand, Asa; Möller, Claes; Danermark, Berth

    2014-02-01

    To link outcome measures used in audiological research to the ICF classification and thereby describe audiological research from the ICF perspective. Through a peer-reviewed or a joint linking procedure, link outcome measures to the ICF classification system using standardized ICF linking rules. Additional linking rules were developed in combination with the established rules to overcome difficulties when connecting audiological data to ICF. Absolute and relative frequencies of ICF categories were reported. The identified outcome measures from the previous study (Part I) constituted the empirical material. In total, 285 ICF categories were identified. The most prevalent categories were related to listening, hearing functions, auditory perceptions, emotions and the physical environment, such as noise and hearing aids. Categories related to communication showed lower relative frequencies, as did categories related to the social and attitudinal environment. Based on the linked outcome measures, communication as a research topic is subordinated to other research topics. The same conclusion can be drawn for research targeting the social and attitudinal environment of adults with HL. Difficulties in the linking procedure were highlighted and discussed, and suggestions for future revisions of the ICF from the audiological perspective were described.

  6. Validation of the German version of the extended ALS functional rating scale as a patient-reported outcome measure.

    Science.gov (United States)

    Abdulla, Susanne; Vielhaber, Stefan; Körner, Sonja; Machts, Judith; Heinze, Hans-Jochen; Dengler, Reinhard; Petri, Susanne

    2013-09-01

    The revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) is a well-established rating instrument to assess the functional status of ALS patients. A recent innovation was the addition of three further items designed to improve its sensitivity at lower levels of physical function (ALSFRS-Extension, ALSFRS-EX). Neither the ALSFRS-R nor the ALSFRS-EX has been validated in German yet. The aim of the present study was the validation of the German version of a self-administered form of the ALSFRS-EX. Seventy-six patients participated in the study. Psychometric analysis included reliability assessment and factorial analysis. To evaluate convergent validity, correlations between ALSFRS-EX items and the MRC score, spasticity, tongue movement, pulmonary function, ALSAQ-40 and Borg dyspnoea scales (upright and supine) were performed. Internal consistency as measured by Cronbach's alpha (total scale 0.868, subscales 0.690-0.938) and corrected item to total correlations (all above 0.50) was high. Test-retest reliability assessed by Spearman's rho (0.882-0.972) and Cohen's Kappa (0.63-0.92) was also high. Principal component analysis with varimax rotation yielded a four-factor solution accounting for approximately 79% of the variance. Clinical parameters were strongly correlated with respective items and subscores of the ALSFRS-EX (muscle strength 0.568-0.833 p scale including high internal consistency and test-retest reliability as well as excellent convergent validity.

  7. Concept analysis of the patient reported outcomes measurement information system (PROMIS(®)) and the international classification of functioning, disability and health (ICF).

    Science.gov (United States)

    Tucker, Carole A; Cieza, Alarcos; Riley, Anne W; Stucki, Gerold; Lai, Jin Shei; Bedirhan Ustun, T; Kostanjsek, Nenad; Riley, William; Cella, David; Forrest, Christopher B

    2014-08-01

    The Patient Reported Outcomes Measurement Information System (PROMIS (®) ) is a US National Institutes of Health initiative that has produced self-report outcome measures, using a framework of physical, mental, and social health defined by the World Health Organization in 1948 (WHO, in Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 1948). The World Health Organization's International Classification of Functioning, Disability and Health (ICF) is a comprehensive classification system of health and health-related domains that was put forward in 2001. The purpose of this report is to compare and contrast PROMIS and ICF conceptual frameworks to support mapping of PROMIS instruments to the ICF classification system . We assessed the objectives and the classification schema of the PROMIS and ICF frameworks, followed by content analysis to determine whether PROMIS domain and sub-domain level health concepts can be linked to the ICF classification. Both PROMIS and ICF are relevant to all individuals, irrespective of the presence of health conditions, person characteristics, or environmental factors in which persons live. PROMIS measures are intended to assess a person's experiences of his or her health, functional status, and well-being in multiple domains across physical, mental, and social dimensions. The ICF comprehensively describes human functioning from a biological, individual, and social perspective. The ICF supports classification of health and health-related states such as functioning, but is not a specific measure or assessment of health, per se. PROMIS domains and sub-domain concepts can be meaningfully mapped to ICF concepts. Theoretical and conceptual similarities support the use of PROMIS instruments to operationalize self-reported measurement for many body function, activity and participation ICF concepts, as well as several environmental factor concepts. Differences observed in

  8. Comparison of self-reported and performance-based measures of functional ability in elderly patients in an emergency department: implications for selection of clinical outcome measures

    DEFF Research Database (Denmark)

    Nielsen, Louise Møldrup

    2016-01-01

    moderate (r = 0.53). The correlation between the Barthel-20 and the 30s-CST was fair (r = 0.45). The correlation between Barthel-20 and the AMPS process was non-significant. The results were affected by high ceiling effect (Barthel-20). Conclusion Self-reported and performance-based measures seem to assess......Background Assessment of functional ability in elderly patients is often based on self-reported rather than performance-based measures. This study aims to compare self-reported and performance-based measures of functional ability in a population of elderly patients at an emergency department (ED......). Methods Participants were 61 patients aged 65 years and above admitted to an ED. The self-reported measure used was the Barthel-20; the performance-based measures were Timed Up and Go (TUG); 30s-Chair Stand Test (30s-CST) and Assessment of Motor and Process Skills (AMPS) with the two scales; motor...

  9. Differential item functioning in Patient Reported Outcomes Measurement Information System® (PROMIS® Physical Functioning short forms: Analyses across ethnically diverse groups

    Directory of Open Access Journals (Sweden)

    Richard N. Jones

    2016-06-01

    Full Text Available We analyzed physical functioning short form items derived from the PROMIS® item bank (PF16 using data from more than 5,000 recently diagnosed, ethnically diverse cancer patients. Our goal was to determine if the short form items demonstrated evidence of differential item functioning (DIF according to sociodemographic characteristics in this clinical sample. We evaluated respons-es for evidence of unidimensionality, local independence (given a single common factor, differen-tial item functioning, and DIF impact. DIF was evaluated attributable to sex, age (middle aged vs. younger and older, race/ethnicity (White vs. Black or African-American, Asian/Pacific Islander, Hispanic and level of education. We used a multiple group confirmatory factor analysis with covariates approach, a multiple indicators multiple causes (MIMIC model. We confirmed essential unidimensionality but some evidence for multidimensionality is present, particularly for basic activities of daily living items, and many instances of local dependence. The presence of local dependence calls for further review of the meaning and measurement of the physical functioning domain among cancer patients. Nearly every item demonstrated statistically significant DIF. In all group comparisons the impact of DIF was negligible. However, the Hispanic subgroup comparison revealed an impact estimate just below an arbitrary threshold for small impact. Within the limitations of local dependency violations, we conclude that items from a static short form derived from the PROMIS physical functioning item bank displayed trivial and ignorable DIF attributable to sex, race, ethnicity, age, and education among cancer patients.

  10. Application of self-report and performance-based outcome measures to determine functional differences between four categories of prosthetic feet

    Directory of Open Access Journals (Sweden)

    Robert S. Gailey, PhD, PT

    2012-06-01

    Full Text Available We examined the application of outcome measures to determine changes in function caused by standardized functional prosthetic gait training and the use of four different prosthetic feet in people with unilateral transtibial limb loss. Two self-report measures (Prosthetic Evaluation Questionnaire-Mobility Scale [PEQ-13] and Locomotor Capabilities Index [LCI], and three performance-based measures (Amputee Mobility Predictor with a prosthesis [AMPPRO], 6-minute walk test [6MWT] and step activity monitor [SAM] were used. Ten people with unilateral transtibial limb loss, five with peripheral vascular disease (PVD and five without PVD, completed testing. Subjects were tested at baseline and after receiving training with their existing prosthesis and with the study socket and four prosthetic feet, i.e., SACH (solid ankle cushion heel, SAFE (stationary attachment flexible endoskeletal, Talux, and Proprio feet, over 8 to 10 weeks. Training was administered between testing sessions. No differences were detected by the PEQ-13, LCI, 6MWT, or SAM following training and after fitting with test feet. The AMPPRO demonstrated differences following training with the existing prosthesis in the PVD group and between selected feet from baseline testing (p measures were unable to detect differences between prosthetic feet.

  11. Danish translation of a physical function item bank from the Patient-Reported Outcome Measurement Information System (PROMIS)

    DEFF Research Database (Denmark)

    Schnohr, Christina W.; Rasmussen, Charlotte L.; Langberg, Henning

    2017-01-01

    of the Physical Function item bank into Danish. METHODS: We followed the PROMIS standard procedure, including: 1) two independent translations, 2) back translation, 3) independent reviews of translation quality, and 4) cognitive interviews with a representative sample of the adult population from the municipality....... Cognitive testing revealed problem of a general issue: annoyance in case of mismatch between respondents' functional level and question difficulty, problems imagining performance on activities that the respondents did not usually do, and uncertainty whether mobility aids (e.g., canes and walkers) should...... be considered when performing an activity. Solutions to the more general issues would require revisions to the original items. CONCLUSIONS: The standard translation methodology was successful in eliminating problems in translation, and pointed to problems of a general issue in some of the original questions...

  12. Self versus family ratings of the frontal systems behaviour scale and measured executive functions: adult outcomes following childhood traumatic brain injury.

    Science.gov (United States)

    Barrett, Robert D; McLellan, Tracey L; McKinlay, Audrey

    2013-01-01

    Traumatic brain injury (TBI) frequently occurs during childhood and adolescence with long-term neuropsychological and behavioral effects. Greater personal awareness of injury is associated with better outcomes. However, personal awareness is often assessed using ratings obtained from family members or significant others. Surprisingly, the accuracy of family-ratings compared with self-ratings has not been well studied in the TBI population. Thus, the purpose of this study was to examine self versus family-ratings of frontal dysfunction and secondly, the association between self/family reported frontal dysfunction and measured executive function outcomes. A total of 60 participants, approximately 10 years post-TBI, comprised 3 groups including; moderate/severe TBI (N=26; mean age 22.9, SD=3.0), mild TBI (N=20; mean age, 21.7, SD=2.7), and control (N=14: mean age, 21.6, SD=3.7). Neuropsychological testing was used to obtain domain scores for executive function and working memory/attention for each participant, and nominated family members and participants with TBI were asked to complete the Frontal Systems Behaviour Scale (FrSBe), consisting of three sub-scales; apathy, disinhibition, and executive dysfunction. Using the FrSBe there was no significant difference between the groups in executive function score, but the moderate/severe and mild groups had significantly lower working memory/attention scores compared with the control group (p<0.05). Repeated measures analysis of variance showed higher self-ratings on all sub-scales compared with family in each group (p<0.05). Scores on executive function and working memory/attention domains correlated with self, but not family reported executive dysfunction. Self-rated executive dysfunction explained 36% of the variance in executive function (p<0.001). While agreement between self-rated and family-rated total FrSBe scores was significant in all groups (p<0.001), our results showed that self-ratings were of higher

  13. Self versus family ratings of the frontal systems behaviour scale and measured executive functions: adult outcomes following childhood traumatic brain injury.

    Directory of Open Access Journals (Sweden)

    Robert D Barrett

    Full Text Available Traumatic brain injury (TBI frequently occurs during childhood and adolescence with long-term neuropsychological and behavioral effects. Greater personal awareness of injury is associated with better outcomes. However, personal awareness is often assessed using ratings obtained from family members or significant others. Surprisingly, the accuracy of family-ratings compared with self-ratings has not been well studied in the TBI population. Thus, the purpose of this study was to examine self versus family-ratings of frontal dysfunction and secondly, the association between self/family reported frontal dysfunction and measured executive function outcomes. A total of 60 participants, approximately 10 years post-TBI, comprised 3 groups including; moderate/severe TBI (N=26; mean age 22.9, SD=3.0, mild TBI (N=20; mean age, 21.7, SD=2.7, and control (N=14: mean age, 21.6, SD=3.7. Neuropsychological testing was used to obtain domain scores for executive function and working memory/attention for each participant, and nominated family members and participants with TBI were asked to complete the Frontal Systems Behaviour Scale (FrSBe, consisting of three sub-scales; apathy, disinhibition, and executive dysfunction. Using the FrSBe there was no significant difference between the groups in executive function score, but the moderate/severe and mild groups had significantly lower working memory/attention scores compared with the control group (p<0.05. Repeated measures analysis of variance showed higher self-ratings on all sub-scales compared with family in each group (p<0.05. Scores on executive function and working memory/attention domains correlated with self, but not family reported executive dysfunction. Self-rated executive dysfunction explained 36% of the variance in executive function (p<0.001. While agreement between self-rated and family-rated total FrSBe scores was significant in all groups (p<0.001, our results showed that self-ratings were of

  14. Clinical Outcome Measures in Chiari I Malformation.

    Science.gov (United States)

    Yarbrough, Chester K; Greenberg, Jacob K; Park, Tae Sung

    2015-10-01

    Chiari malformation type 1 (CM-I) is a common and often debilitating neurologic disease. Reliable evaluation of treatments has been hampered by inconsistent use of clinical outcome measures. A variety of outcome measurement tools are available, although few have been validated in CM-I. The recent development of the Chicago Chiari Outcome Scale and the Chiari Symptom Profile provides CM-I-specific instruments to measure outcomes in adults and children, although validation and refinement may be necessary.

  15. Content comparison of haemophilia specific patient-rated outcome measures with the international classification of functioning, disability and health (ICF, ICF-CY)

    Science.gov (United States)

    2010-01-01

    Background Patient-Reported Outcomes (PROs) are considered important outcomes because they reflect the patient's experience in clinical trials. PROs have been included in the field of haemophilia only recently. Purpose Comparing the contents of PROs measures used in haemophilia, based on the ICF/ICF-CY as frame of reference. Methods Haemophilia-specific PROs for adults and children were selected on the grounds of international accessibility. The content of the selected instruments were examined by linking the concepts within the items of these instruments to the ICF/ICF-CY. Results Within the 5 selected instruments 365 concepts were identified, of which 283 concepts were linked to the ICF/ICF CY and mapped into 70 different categories. The most frequently used categories were "b152: Emotional functions" and "e1101: Drugs". Conclusions The present paper provides an overview on current PROs in haemophilia and facilitates the selection of appropriate instruments for specific purposes in clinical and research settings. This work was made possible by the grant of the European Murinet Project (Multidisciplinary Research Network on Health and Disability in Europe). PMID:21108796

  16. Understanding and measuring child welfare outcomes.

    Science.gov (United States)

    D'Andrade, Amy; Osterling, Kathy Lemon; Austin, Michael J

    2008-01-01

    The new "Children's and Family Services Reviews" (CFSR) process focuses on the effectiveness of services to children and families by measuring client outcomes. This article reviews the research literature related to child welfare outcomes in order to provide a context for federal accountability efforts. It also summarizes the 2001 federal mandate to hold states accountable for child welfare outcomes and describes California's response to this mandate. Implications of the outcomes literature review and measurement problems in the CFSR process suggest CSFR measures do not always capture meaningful outcomes. Recommendations for change are made.

  17. Effect size for dichotomous outcome measures

    Institute of Scientific and Technical Information of China (English)

    Yuanjia WANG; Naihua DUAN

    2011-01-01

    @@ Effect size for continuous outcome measures was discussed in our previous column[1].In this column we discuss several widely used effect size measures for dichotomous (Yes/No) outcome measures such as mortality,relapse,cure,discontinuation of treatment,and so forth.

  18. Responsiveness and Minimally Important Differences for 4 Patient-Reported Outcomes Measurement Information System Short Forms: Physical Function, Pain Interference, Depression, and Anxiety in Knee Osteoarthritis.

    Science.gov (United States)

    Lee, Augustine C; Driban, Jeffrey B; Price, Lori Lyn; Harvey, William F; Rodday, Angie Mae; Wang, Chenchen

    2017-09-01

    Patient-Reported Outcomes Measurement Information System (PROMIS) instruments can provide valid, interpretable measures of health status among adults with osteoarthritis (OA). However, their ability to detect meaningful change over time is unknown. We evaluated the responsiveness and minimally important differences (MIDs) for 4 PROMIS Short Forms: Physical Function, Pain Interference, Depression, and Anxiety. We analyzed adults with symptomatic knee OA from our randomized trial comparing Tai Chi and physical therapy. Using baseline and 12-week scores, responsiveness was evaluated according to consensus standards by testing 6 a priori hypotheses of the correlations between PROMIS and legacy change scores. Responsiveness was considered high if ≥5 hypotheses were confirmed, and moderate if 3 or 4 were confirmed. MIDs were evaluated according to prospective change for people achieving previously-established MID on legacy comparators. The lowest and highest MIDs meeting a priori quality criteria formed a MID range for each PROMIS Short Form. Among 165 predominantly female (70%) and white (57%) participants, mean age was 61 years and body mass index was 33. PROMIS Physical Function had 5 confirmed hypotheses and Pain Interference, Depression, and Anxiety had 3 or 4. MID ranges were: Depression = 3.0 to 3.1; Anxiety = 2.3 to 3.4; Physical Function = 1.9 to 2.2; and Pain Interference = 2.35 to 2.4. PROMIS Physical Function has high responsiveness, and Depression, Anxiety, and Pain Interference have moderate responsiveness among adults with knee OA. We established the first MIDs for PROMIS in this population, and provided an important standard of reference to better apply or interpret PROMIS in future trials or clinical practice. This study examined whether PROMIS Short Form instruments (Physical Function, Pain Interference, Depression, and Anxiety) were able to detect change over time among adults with knee OA, and provided minimally important change estimates

  19. Longitudinal Outcomes of Functional Behavioral Assessment--Based Intervention

    Science.gov (United States)

    Kern, Lee; Gallagher, Patricia; Starosta, Kristin; Hickman, Wesley; George, Michael

    2006-01-01

    A critical measure of intervention effectiveness is durability over time. Still, few studies have examined the long-term outcomes of support derived from a functional behavioral assessment as well as enablers and barriers that contribute to or impede successful outcomes. In the current study, a functional behavioral assessment was conducted with a…

  20. Health outcome after major trauma: what are we measuring?

    Directory of Open Access Journals (Sweden)

    Karen Hoffman

    Full Text Available Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients.To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma.MEDLINE, EMBASE, and CINAHL (from 2006-2012 were searched for studies evaluating health outcome after traumatic injuries.Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF were used to evaluate to what extent outcome measures captured health impacts.34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%, functional activities (11% and environmental factors (2%.Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.

  1. [Patient-reported outcomes: definition and measurement].

    Science.gov (United States)

    Botturi, Davide; Rodella, Stefania

    2014-06-01

    The concept of "patient-reported outcomes" have been proposed by the Food and Drug Administration in the year 2000, in order to describe one of the different and potential sources of information on the drug's safety and effectiveness. It represents an "umbrella" term, which covers a multiplicity of meanings and primarily identifies a conceptual approach and a methodology specifically oriented to the patients' point of view on outcomes, instead of the traditional clinical and professional perspective. The patient-reported outcomes measures are frequently self-completed questionnaires. The measures can be classified in general and specific. The first one, general, relates to the assessment of the quality of life or the health status, in the general population or in subgroups with particular health problems (eg. SF-36 Health Survey, EQ-5D). The second one, specific, mainly relates to the assessment of particular types of symptoms (eg. pain, anxiety, fear, depression) and functions (eg. daily living activities), in population's subgroups with definite health problems, undergoing or not to a healthcare procedure (eg. Adult Asthma Quality of Life Questionnaire, Kidney Disease Quality of Life Instrument, Oxford Hip Score, Oxford Knee Score). For the selection of an instrument a series of criteria needs to be taken into account, among which the psychometric properties, the expert judgement, the interpretability, the acceptability, and the feasibility of the entire process.

  2. Evaluation of functional outcomes in congenital hydrocephalus

    Directory of Open Access Journals (Sweden)

    N K Venkataramana

    2011-01-01

    Full Text Available Aim: The long term outcomes of congenital hydrocephalus are still not clearly known despite it being a common clinical condition. Several clinical, radiological factors were correlated to predict the functional outcomes. This study aimed to correlate the clinical, radiological parameters with the regional functional outcomes of the brain. Materials and Methods: Children with congenital hydrocephalus were divided into Group A with hydrocephalus alone and Group B hydrocephalus with spina bifida. Ventriculoperitoneal shunt surgery was performed by the same surgeon. CT scans and neuropsychological assessments were performed before and serially after the shunt. The clinical and the radiological findings were correlated with the developmental levels during the follow-up. Results: There were 25 children in Group A and 15 children in Group B; 72% in Group A and 93% in Group B were less than 6 months of age at the time of treatment. Forty percent in Group A and 92% in Group B had the signs of hydrocephalus at admission. Cerebrospinal fluid (CSF diversion results in the reduction in ventricular dilatation and corresponding increase in the cortical mantle thickness. The ventricular size and the cortical mantle thickness were measured serially and correlated with the development in the neuropsychological function. In this study, 80% in Group B reached near normal development in comparison to 33% in Group A. We have noticed a significant correlation in the increase in the regional cortical mantle thickness with corresponding improvement in the functional development. This clearly ratifies the improvement in the frontal and parietal areas having their distinctive effect on the functional development of the child. Conclusion: Early CSF diversion and timely intervention seems to benefit functional recovery. It is interesting to note that reconstitution of cortical mantle in different areas of the brain showing corresponding improvement in their respective areas

  3. Analysis of differential item functioning in the depression item bank from the Patient Reported Outcome Measurement Information System (PROMIS: An item response theory approach

    Directory of Open Access Journals (Sweden)

    JOSEPH P. EIMICKE

    2009-06-01

    Full Text Available The aims of this paper are to present findings related to differential item functioning (DIF in the Patient Reported Outcome Measurement Information System (PROMIS depression item bank, and to discuss potential threats to the validity of results from studies of DIF. The 32 depression items studied were modified from several widely used instruments. DIF analyses of gender, age and education were performed using a sample of 735 individuals recruited by a survey polling firm. DIF hypotheses were generated by asking content experts to indicate whether or not they expected DIF to be present, and the direction of the DIF with respect to the studied comparison groups. Primary analyses were conducted using the graded item response model (for polytomous, ordered response category data with likelihood ratio tests of DIF, accompanied by magnitude measures. Sensitivity analyses were performed using other item response models and approaches to DIF detection. Despite some caveats, the items that are recommended for exclusion or for separate calibration were "I felt like crying" and "I had trouble enjoying things that I used to enjoy." The item, "I felt I had no energy," was also flagged as evidencing DIF, and recommended for additional review. On the one hand, false DIF detection (Type 1 error was controlled to the extent possible by ensuring model fit and purification. On the other hand, power for DIF detection might have been compromised by several factors, including sparse data and small sample sizes. Nonetheless, practical and not just statistical significance should be considered. In this case the overall magnitude and impact of DIF was small for the groups studied, although impact was relatively large for some individuals.

  4. Analysis of differential item functioning in the depression item bank from the Patient Reported Outcome Measurement Information System (PROMIS): An item response theory approach

    Science.gov (United States)

    Teresi, Jeanne A.; Ocepek-Welikson, Katja; Kleinman, Marjorie; Eimicke, Joseph P.; Crane, Paul K.; Jones, Richard N.; Lai, Jin-shei; Choi, Seung W.; Hays, Ron D.; Reeve, Bryce B.; Reise, Steven P.; Pilkonis, Paul A.; Cella, David

    2009-01-01

    The aims of this paper are to present findings related to differential item functioning (DIF) in the Patient Reported Outcome Measurement Information System (PROMIS) depression item bank, and to discuss potential threats to the validity of results from studies of DIF. The 32 depression items studied were modified from several widely used instruments. DIF analyses of gender, age and education were performed using a sample of 735 individuals recruited by a survey polling firm. DIF hypotheses were generated by asking content experts to indicate whether or not they expected DIF to be present, and the direction of the DIF with respect to the studied comparison groups. Primary analyses were conducted using the graded item response model (for polytomous, ordered response category data) with likelihood ratio tests of DIF, accompanied by magnitude measures. Sensitivity analyses were performed using other item response models and approaches to DIF detection. Despite some caveats, the items that are recommended for exclusion or for separate calibration were “I felt like crying” and “I had trouble enjoying things that I used to enjoy.” The item, “I felt I had no energy,” was also flagged as evidencing DIF, and recommended for additional review. On the one hand, false DIF detection (Type 1 error) was controlled to the extent possible by ensuring model fit and purification. On the other hand, power for DIF detection might have been compromised by several factors, including sparse data and small sample sizes. Nonetheless, practical and not just statistical significance should be considered. In this case the overall magnitude and impact of DIF was small for the groups studied, although impact was relatively large for some individuals. PMID:20336180

  5. Responsiveness of Clinical Outcome Measures

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein

    Rating Scale is recommended. The MCID was more or less stable across subgroups for most instruments and increased monotonously with baseline condition severity in PrS and LBP patients only. The clinical question: “how are you now compared to when you started the treatment” seems to be most sensitive...... obtainable by a certain treatment. Chronic LBP patients seem to have a reasonable idea of an acceptable change in pain but overestimate change in functional and psychological /affective domains....

  6. Measuring Inclusive Education Outcomes in Alberta, Canada

    Science.gov (United States)

    Loreman, Tim

    2014-01-01

    This study details the results of a review of the academic and public sector literature on measuring inclusive education in large systems. It highlights some outcomes drawn from the international literature on inclusion that might be indicative of the presence and quality of inclusive education in an effort to develop a set of outcomes for…

  7. Functional outcome 5 years after non-operative treatment of type A spinal fractures

    NARCIS (Netherlands)

    Post, RB; Keizer, HJE; Leferink, VJM; van der Sluis, CK

    2006-01-01

    This study was conducted to study the functional outcome after non-operative treatment of type A thoracolumbar spinal fractures without neurological deficit. Functional outcome was determined following the International Classification of Functioning, Disability and Health, measuring restrictions in

  8. Outcome Measures in Clinical Trials for Multiple Sclerosis.

    Science.gov (United States)

    van Munster, Caspar E P; Uitdehaag, Bernard M J

    2017-02-09

    Due to the heterogeneous nature of the disease, it is a challenge to capture disease activity of multiple sclerosis (MS) in a reliable and valid way. Therefore, it can be difficult to assess the true efficacy of interventions in clinical trials. In phase III trials in MS, the traditionally used primary clinical outcome measures are the Expanded Disability Status Scale and the relapse rate. Secondary outcome measures in these trials are the number or volume of T2 hyperintense lesions and gadolinium-enhancing T1 lesions on magnetic resonance imaging (MRI) of the brain. These secondary outcome measures are often primary outcome measures in phase II trials in MS. Despite several limitations, the traditional clinical measures are still the mainstay for assessing treatment efficacy. Newer and potentially valuable outcome measures increasingly used or explored in MS trials are, clinically, the MS Functional Composite and patient-reported outcome measures, and on MRI, brain atrophy and the formation of persisting black holes. Several limitations of these measures have been addressed and further improvements will probably be proposed. Major improvements are the coverage of additional functional domains such as cognitive functioning and assessment of the ability to carry out activities of daily living. The development of multidimensional measures is promising because these measures have the potential to cover the full extent of MS activity and progression. In this review, we provide an overview of the historical background and recent developments of outcome measures in MS trials. We discuss the advantages and limitations of various measures, including newer assessments such as optical coherence tomography, biomarkers in body fluids and the concept of 'no evidence of disease activity'.

  9. Do Patient-Reported Outcome Measures describe functioning in patients with low back pain, using the Brief International Classification of Functioning, Disability and Health Core Set as a reference?

    DEFF Research Database (Denmark)

    Ibsen, Charlotte; Schiøttz-Christensen, Berit; Melchiorsen, Hanne

    2016-01-01

    OBJECTIVE: To link the items in the Patient-Reported Outcome Measures (PROMs): Roland Morris Disability Questionnaire, Short Form 36 (SF-36) and pain scores, to the Brief International Classification of Functioning, Disability and Health (ICF) Core Set for low back pain, and to examine the extent...... to which a clinician's assessment of patients' problems according to the Brief ICF Core Set correlates with the scores of matching items from the PROMs. METHODS: The PROMs were linked to the Brief ICF Core Set for low back pain. Secondly, a cross-sectional study was conducted including 70 patients with low...... back pain. The patients completed the PROMs, and the Brief ICF Core Set for low back pain was assessed by a clinician using qualifiers. RESULTS: The items in the PROMs were successfully linked to the ICF. Twelve of the 38 unique ICF categories derived from the PROMs were covered by the Brief ICF Core...

  10. Current status of outcome measure development in vasculitis.

    Science.gov (United States)

    Merkel, Peter A; Aydin, Sibel Z; Boers, Maarten; Cornell, Christina; Direskeneli, Haner; Gebhart, Don; Hatemi, Gulen; Luqmani, Raashid; Matteson, Eric L; Milman, Nataliya; Robson, Joanna; Seo, Philip; Tomasson, Gunnar

    2014-03-01

    The conduct of randomized controlled trials for vasculitis, especially for the antineutrophil cytoplasmic antibody-associated vasculitides [AAV, granulomatosis with polyangiitis (Wegener's) and microscopic polyangiitis], has been greatly advanced by the development, use, and acceptance of validated outcome measures. Trials have subsequently provided the opportunity to validate and refine reliable, valid outcome measures for these multisystemic and relapsing rare diseases. The Outcome Measures in Rheumatology (OMERACT) Vasculitis Working Group was formed in 2004 to foster development of validated and widely accepted outcomes in vasculitis using data-driven analyses, a dedication to building consensus, and adherence to, and guidance by, the principles of the OMERACT approach. This work led to the endorsement by OMERACT of the core set of domains and associated outcome measures for AAV. Next steps for the study of existing outcome tools in AAV include better definition of response criteria through development of more data-driven weighting of the elements of activity and damage assessment. The Working Group is now also embarking on a series of linked projects to develop validated patient-reported outcomes for use in clinical research in vasculitis. Additionally, the Working Group is studying how current methods of disease assessment and plans for new outcomes can be informed by the conceptual framework of the International Classification of Function of the World Health Organization. The success of the Group's work in AAV has also led to a formal process for developing outcomes for the large vessel vasculitides (Takayasu arteritis and giant cell arteritis) and Behçet disease.

  11. Measuring Learning Outcomes in Auditing Education

    DEFF Research Database (Denmark)

    Holm, Claus; Steenholdt, Niels

    2003-01-01

    The ability to provide sensible measures for learning outcomes in accounting education is under increased scrutiny. In this paper we use a learner perspective in auditing education, which reflects that some students taking accounting classes also are provided with on-the-job training in accounting...... firms. Hence knowledge about learning outcomes for different groups of students is essential information for educators as well as the accounting profession. This paper extends prior research on the role of declarative and procedural knowledge in performing auditing tasks. Measuring learning outcomes...... is a complex matter requiring sensible measures for both declarative knowledge (ability to verbalize pertinent facts or processes) and procedural knowledge (intellectual skills). The study uses a multitude of measures based on a hierarchical separation of intellectual skills originally suggested by Gagné (1984...

  12. Measuring participation outcomes in rehabilitation medicine

    NARCIS (Netherlands)

    van der Zee, C.H.

    2013-01-01

    We developed the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) to fulfill the need for a generic measurement instrument to assess outcomes of outpatient rehabilitation programmes. The USER-Participation assesses three aspects of participation, thereby measuring bo

  13. Measuring social function in diverse cancer populations: Evaluation of measurement equivalence of the Patient Reported Outcomes Measurement Information System® (PROMIS® Ability to Participate in Social Roles and Activities Short Form

    Directory of Open Access Journals (Sweden)

    Elizabeth A. Hahn

    2016-06-01

    Full Text Available Conceptual and psychometric measurement equivalence of self-report questionnaires are basic requirements for valid cross-cultural and demographic subgroup comparisons. The purpose of this study was to evaluate the psychometric measurement equivalence of a 10-item PROMIS® Social Function short form in a diverse population-based sample of cancer patients obtained through the Measuring Your Health (MY-Health study (n = 5,301. Participants were cancer survivors within six to 13 months of a diagnosis of one of seven cancer types, and spoke English, Spanish, or Mandarin Chinese. They completed a survey on sociodemographic and clinical characteristics, and health status. Psychometric measurement equivalence was evaluated with an item response theory approach to differential item functioning (DIF detection and impact. Although an expert panel proposed that many of the 10 items might exhibit measurement bias, or DIF, based on gender, age, race/ethnicity, and/or education, no DIF was detected using the study’s standard DIF criterion, and only one item in one sample comparison was flagged for DIF using a sensitivity DIF criterion. This item’s flagged DIF had only a trivial impact on estimation of scores. Social function measures are especially important in cancer because the disease and its treatment can affect the quality of marital relationships, parental responsibilities, work abilities, and social activities. Having culturally relevant, linguistically equivalent and psychometrically sound patient-reported measures in multiple languages helps to overcome some common barriers to including underrepresented groups in research and to conducting cross-cultural research.

  14. The International Dermatology Outcome Measures Group

    DEFF Research Database (Denmark)

    Gottlieb, Alice B; Levin, Adriane A; Armstrong, April W;

    2015-01-01

    As quality standards are increasingly in demand throughout medicine, dermatology needs to establish outcome measures to quantify the effectiveness of treatments and providers. The International Dermatology Outcome Measures Group was established to address this need. Beginning with psoriasis......, the group aims to create a tool considerate of patients and providers using the input of all relevant stakeholders in assessment of disease severity and response to treatment. Herein, we delineate the procedures through which consensus is being reached and the future directions of the project....

  15. Responsiveness of outcome measures for upper limb prosthetic rehabilitation.

    Science.gov (United States)

    Resnik, Linda; Borgia, Matthew

    2016-02-01

    There is limited research on responsiveness of prosthetic rehabilitation outcome measures. To examine responsiveness of the Box and Block test, Jebsen-Taylor Hand Function tests, Upper Extremity Functional Scale, University of New Brunswick skill and spontaneity tests, Activity Measure for Upper Limb Amputation, and the Patient-Specific Functional Scale. This was a quasi-experimental study with repeated measurements in a convenience sample of upper limb amputees. Measures were collected before, during, and after training with the DEKA Arm. Largest effect sizes were observed for Patient-Specific Functional Scale (effect size: 1.59, confidence interval: 1.00, 2.14), Activity Measure for Upper Limb Amputation (effect size: 1.33, confidence interval: 0.73, 1.90), and University of New Brunswick skill test (effect size: 1.18, confidence interval: 0.61, 1.73). Other measures that were responsive to change were Box and Block test, Jebsen-Taylor Hand Function light and heavy can tests, and University of New Brunswick spontaneity test. Responsiveness and pattern of responsiveness varied by prosthetic level. The Box and Block test, Jebsen-Taylor Hand Function light and heavy can tests, University of New Brunswick skill and spontaneity tests, Activities Measure for Upper Limb Amputation, and the Patient-Specific Functional Scale were responsive to change during prosthetic training. These findings have implications for choice of measures for research and practice and inform clinicians about the amount of training necessary to maximize outcomes with the DEKA Arm. Findings on responsiveness of outcome measures have implications for the choice of measures for clinical trials and practice. Findings regarding the responsiveness to change over the course of training can inform clinicians about the amount of training that may be necessary to maximize specific outcomes with the DEKA Arm. © The International Society for Prosthetics and Orthotics 2014.

  16. The effect of posterior and lateral approach on patient-reported outcome measures and physical function in patients with osteoarthritis, undergoing total hip replacement

    DEFF Research Database (Denmark)

    Rosenlund, Signe; Broeng, Leif; Jensen, Carsten

    2014-01-01

    BACKGROUND: Total hip replacement provides pain relief and improves physical function and quality of life in patients with end-stage hip osteoarthritis. The incidence of hip replacement operations is expected to increase due to the growing elderly population. Overall, the posterior approach...... and lateral approach are the two most commonly used approaches for hip replacement operations. The posterior approach is associated with an increased risk of revision due to dislocations, and some studies have shown that the lateral approach is associated with reduced patient-reported outcomes, including...... is a prospective, double blinded, parallel-group controlled trial with balanced randomisation [1: 1]. Patients with hip osteoarthritis scheduled for hip replacement surgery, aged 45-70 years, will be consecutively recruited and randomised into two groups. Group A will receive hip replacement using the posterior...

  17. Functional outcome after a spinal fracture

    NARCIS (Netherlands)

    Post, Richard Bernardus

    2008-01-01

    This thesis takes a closer look at the functional outcome after a spinal fracture. An introduction to different aspects regarding spinal fractures is presented in Chapter 1. The incidence of traumatic thoracolumbar spinal fractures without neurological deficit in the Netherlands is approximately 1.2

  18. Functional outcome after a spinal fracture

    NARCIS (Netherlands)

    Post, Richard Bernardus

    2008-01-01

    This thesis takes a closer look at the functional outcome after a spinal fracture. An introduction to different aspects regarding spinal fractures is presented in Chapter 1. The incidence of traumatic thoracolumbar spinal fractures without neurological deficit in the Netherlands is approximately 1.2

  19. Disability outcome measures in multiple sclerosis clinical trials

    DEFF Research Database (Denmark)

    Cohen, Jeffrey A; Reingold, Stephen C; Polman, Chris H;

    2012-01-01

    recommend practical refinements. Conversely, although substantial data support the multiple sclerosis functional composite as an alternative measure, changes to its component tests and scoring method are needed. Novel approaches, including the use of composite endpoints, patient-reported outcomes......, and measurement of biomarkers, show promise as adjuncts to the current disability measures, but are insufficiently validated to serve as substitutes. A collaborative approach that involves academic experts, regulators, industry representitives, and funding agencies is needed to most effectively develop disability...

  20. Functional dysphonia: strategies to improve patient outcomes

    Science.gov (United States)

    Behlau, Mara; Madazio, Glaucya; Oliveira, Gisele

    2015-01-01

    Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient’s perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient’s recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for

  1. Ideal functional outcomes for amputation levels.

    Science.gov (United States)

    Meier, Robert H; Melton, Danielle

    2014-02-01

    This article provides a generalized overview of amputation classifications and the idealized outcomes for upper and lower amputations at their respective levels. The following levels are discussed: above knee/transfemoral, below knee/transtibial, above elbow/transhumeral, below elbow/transradial, and bilateral for upper and lower extremities. This classification defines a framework for clinicians to share with patients so that they understand the potential for their expected functional outcomes regarding mobility and activities of daily living, both with and without a prosthesis. Moreover, it addresses some of the vocational and avocational needs of the individual regarding amputation.

  2. Biobehavioral Measures as Outcomes: A Cautionary Tale

    Science.gov (United States)

    Kovach, Christine R.; Woods, Diana Lynn; Devine, Elizabeth C.; Logan, Brent R.; Raff, Hershel

    2013-01-01

    This article discusses the use of biobehavioral measures as outcomes for healthcare intervention studies. Effect size (ES) values for salivary cortisol, and observation-based measures of pain and agitation are examined. Effects pre to post treatment were assessed separately for nursing home (NH) residents with and without acute psychotic symptoms. This study revealed large positive effects on both pain and agitation measures in the group with acute psychotic symptoms and small-to-medium positive effects on these same measures in the group without acute psychotic symptoms. In both of these groups the ES values were not consistently positive on the cortisol measures. Prior to determining if a measure can be used to estimate minimum clinically important differences, it is essential to consider if the biomarker will be responsive to therapy in the populations and contexts being studied. PMID:24158972

  3. Clinical outcome measures in juvenile idiopathic arthritis.

    Science.gov (United States)

    Consolaro, Alessandro; Giancane, Gabriella; Schiappapietra, Benedetta; Davì, Sergio; Calandra, Serena; Lanni, Stefano; Ravelli, Angelo

    2016-04-18

    Juvenile idiopathic arthritis (JIA), as a chronic condition, is associated with significant disease- and treatment-related morbidity, thus impacting children's quality of life. In order to optimize JIA management, the paediatric rheumatologist has begun to regularly use measurements of disease activity developed, validated and endorsed by international paediatric rheumatology professional societies in an effort to monitor the disease course over time and assess the efficacy of therapeutic interventions in JIA patients.A literature review was performed to describe the main outcome measures currently used in JIA patients to determine disease activity status.The Juvenile Disease Activity Score (JADAS), in its different versions (classic JADAS, JADAS-CRP and cJADAS) and the validated definitions of disease activity and response to treatment represent an important tool for the assessment of clinically relevant changes in disease activity, leading more and more to a treat-to-target strategy, based on a tight and thorough control of the patient condition. Moreover, in recent years, increasing attention on the incorporation of patient-reported or parent-reported outcomes (PRCOs), when measuring the health state of patients with paediatric rheumatic diseases has emerged.We think that the care of JIA patients cannot be possible without taking into account clinical outcome measures and, in this regard, further work is required.

  4. Outcome measures in amyotrophic lateral sclerosis clinical trials

    Science.gov (United States)

    Paganoni, Sabrina; Cudkowicz, Merit; Berry, James D

    2017-01-01

    Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with an average survival of 3–5 years. While therapies for ALS remain limited, basic and translational ALS research has been host to numerous influential discoveries in recent years. These discoveries have led to a large pipeline of potential therapies that await testing in clinical trials. Until recently, ALS clinical trials have relied on a limited cadre of ‘traditional’ outcome measures, including survival and measures of function. These measures have proven useful, although imperfect, in Phase III ALS trials. However, their utility in early-phase ALS trials is limited. For these early trials, outcome measures focused on target engagement or biological pathway analysis might improve trial outcomes and better support the drug development process.

  5. Measuring Learning Outcomes in Auditing Education

    DEFF Research Database (Denmark)

    Holm, Claus; Steenholdt, Niels

    The ability to provide sensible measures for learning outcomes in accounting education is under increased scrutiny. In this paper we use a learner perspective in auditing education, which reflects that some students taking accounting classes also are provided with on-the-job training in accounting...... firms. Hence knowledge about learning outcomes for different groups of students is essential information for educators as well as the accounting profession. Sensible measures are needed by educators in order to (1) chose teaching methods matching prerequisite skills among a heterogeneous student body......-order-rules. This paper presents data collected in 1999-2000 including 75 graduate students representing both types of schema. The study provides evidence, which confirms an interrelationship between declarative and procedural knowledge in auditing. The hypotheses are tested by traditional ANOVAs, and have been confirmed...

  6. Routine outcome measures in Norway: Only partly implemented.

    Science.gov (United States)

    Ruud, Torleif

    2015-01-01

    Norway has not had any strategy exclusively for the implementation of routine outcome measurement in the mental health services, but some efforts have been made as part of strategies for a national patient register and quality indicators. Fifteen years after the decision to make the rating of the Global Assessment of Functioning scale (GAF) mandatory at admission and discharge of each treatment episode in adult mental health services, this is still not fully implemented. An unknown and probably very low proportion of mental health services use GAF as a routine outcome measure in everyday clinical practice. Well-established electronic patient records in the mental health services and established procedures for reporting routine data to the National Patient Register should make it possible to collect and use routine outcome data. Implementation of routine outcome measurement in mental health services must be done with due emphasis on the critical steps in the various phases of the implementation process. The regional health authorities have a key role in establishing electronic systems that make relevant outcome measurements available in a seamless way for clinicians as well as for patients, and by contributing to a culture where quality and outcome are valued and given priority.

  7. A clinically meaningful theory of outcome measures in rehabilitation medicine.

    Science.gov (United States)

    Massof, Robert W

    2010-01-01

    Comparative effectiveness research in rehabilitation medicine requires the development and validation of clinically meaningful and scientifically rigorous measurements of patient states and theories that explain and predict outcomes of intervention. Patient traits are latent (unobservable) variables that can be measured only by inference from observations of surrogate manifest (observable) variables. In the behavioral sciences, latent variables are analogous to intensive physical variables such as temperature and manifest variables are analogous to extensive physical variables such as distance. Although only one variable at a time can be measured, the variable can have a multidimensional structure that must be understood in order to explain disagreements among different measures of the same variable. The use of Rasch theory to measure latent trait variables can be illustrated with a balance scale metaphor that has randomly added variability in the weights of the objects being measured. Knowledge of the distribution of the randomly added variability provides the theoretical structure for estimating measures from ordinal observation scores (e.g., performance measures or rating scales) using statistical inference. In rehabilitation medicine, the latent variable of primary interest is the patient's functional ability. Functional ability can be estimated from observations of surrogate performance measures (e.g., speed and accuracy) or self-report of the difficulty the patient experiences performing specific activities. A theoretical framework borrowed from project management, called the Activity Breakdown Structure (ABS), guides the choice of activities for assessment, based on the patient's value judgments, to make the observations clinically meaningful. In the case of low vision, the functional ability measure estimated from Rasch analysis of activity difficulty ratings was discovered to be a two-dimensional variable. The two visual function dimensions are independent

  8. Korean Clinic Based Outcome Measure Studies

    Directory of Open Access Journals (Sweden)

    Jongbae Park

    2003-02-01

    Full Text Available Background: Evidence based medicine has become main tools for medical practice. However, conducting a highly ranked in the evidence hierarchy pyramid is not easy or feasible at all times and places. There remains a room for descriptive clinical outcome measure studies with admitting the limit of the intepretation. Aims: Presents three Korean clinic based outcome measure studies with a view to encouraging Korean clinicians to conduct similar studies. Methods: Three studies are presented briefly here including 1 Quality of Life of liver cancer patients after 8 Constitutional acupuncture; 2 Developing a Korean version of Measuring yourself Medical Outcome profile (MYMOP; and 3 Survey on 5 Shu points: a pilot In the first study, we have included 4 primary or secondary liver cancer patients collecting their diagnostic X-ray film and clinical data f개m their hospital, and asked them to fill in the European Organization Research and Treatment of Cancer, Quality of Life Questionnaire before the commencement of the treatment. The acupuncture treatment is set up format but not disclosed yet. The translation and developing a Korean version of outcome measures that is Korean clinician friendly has been sought for MYMOP is one of the most appropriate one. The permission was granted, the translation into Korean was done, then back translated into English only based on the Korean translation by the researcher who is bilingual in both languages. The back translation was compared by the original developer of MYMOP and confirmed usable. In order to test the existence of acupoints and meridians through popular forms of Korean acupuncture regimes, we aim at collecting opinions from 101 Korean clinicians that have used those forms. The questions asked include most effective symptoms, 5 Shu points, points those are least likely to use due to either adverse events or the lack of effectiveness, theoretical reasons for the above proposals, proposing outcome measures

  9. Gross motor function in children with spastic cerebral palsy and cerebral visual impairment: A comparison between outcomes of the original and the Cerebral Visual Impairment adapted Gross Motor Function Measure-88 (GMFM-88-CVI)

    NARCIS (Netherlands)

    Salavati, M.; Rameckers, E.A.A.; Waninge, A.; Krijnen, W.P.; Steenbergen, B.; Schans, C.P. van der

    2017-01-01

    Purpose: To investigate whether the adapted version of the Gross Motor Function Measure-88 (GMFM-88) for children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) results in higher scores. This is most likely to be a reflection of their gross motor function, however it may be the result

  10. Gross motor function in children with spastic Cerebral Palsy and Cerebral Visual Impairment : A comparison between outcomes of the original and the Cerebral Visual Impairment adapted Gross Motor Function Measure-88 (GMFM-88-CVI)

    NARCIS (Netherlands)

    Salavati, M.; Rameckers, E. A. A.; Waninge, A.; Krijnen, W. P.; Steenbergen, B.; van der Schans, C. P.

    2017-01-01

    Purpose: To investigate whether the adapted version of the Gross Motor Function Measure 88 (GMFM-88) for children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) results in higher scores. This is most likely to be a reflection of their gross motor function, however it may be the result

  11. Gross motor function in children with spastic cerebral palsy and cerebral visual impairment: A comparison between outcomes of the original and the Cerebral Visual Impairment adapted Gross Motor Function Measure-88 (GMFM-88-CVI)

    NARCIS (Netherlands)

    Salavati, M.; Rameckers, E.A.A.; Waninge, A.; Krijnen, W.P.; Steenbergen, B.; Schans, C.P. van der

    2017-01-01

    Purpose: To investigate whether the adapted version of the Gross Motor Function Measure-88 (GMFM-88) for children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) results in higher scores. This is most likely to be a reflection of their gross motor function, however it may be the result

  12. Patient reported outcome measures in neurogenic bladder

    Science.gov (United States)

    Clark, Roderick

    2016-01-01

    Many interventions for neurogenic bladder patients are directed towards improving quality of life (QOL). Patient reported outcome measures (PROMs) are the primary method of evaluating QOL, and they provide an important quantification of symptoms which can’t be measured objectively. Our goal was to review general measurement principles, and identify and discuss PROMs relevant to neurogenic bladder patients. We identify two recent reviews of the state of the literature and updated the results with an additional Medline search up to September 1, 2015. Using the previous identified reviews, and our updated literature review, we identified 16 PROMs which are used for the assessment of QOL and symptoms in neurogenic bladder patients. Several are specifically designed for neurogenic bladder patients, such as the Qualiveen (for neurogenic bladder related QOL), and the Neurogenic Bladder Symptom Score (NBSS) (for neurogenic bladder symptoms). We also highlight general QOL measures for patients with multiple sclerosis (MS) and spinal cord injury (SCI) which include questions about bladder symptoms, and incontinence PROMs which are commonly used, but not specifically designed for neurogenic bladder patients. It is essential for clinicians and researchers with an interest in neurogenic bladder to be aware of the current PROMs, and to have a basic understanding of the principals of measurement in order to select the most appropriate one for their purpose. PMID:26904409

  13. Patient reported outcome measures in neurogenic bladder.

    Science.gov (United States)

    Clark, Roderick; Welk, Blayne

    2016-02-01

    Many interventions for neurogenic bladder patients are directed towards improving quality of life (QOL). Patient reported outcome measures (PROMs) are the primary method of evaluating QOL, and they provide an important quantification of symptoms which can't be measured objectively. Our goal was to review general measurement principles, and identify and discuss PROMs relevant to neurogenic bladder patients. We identify two recent reviews of the state of the literature and updated the results with an additional Medline search up to September 1, 2015. Using the previous identified reviews, and our updated literature review, we identified 16 PROMs which are used for the assessment of QOL and symptoms in neurogenic bladder patients. Several are specifically designed for neurogenic bladder patients, such as the Qualiveen (for neurogenic bladder related QOL), and the Neurogenic Bladder Symptom Score (NBSS) (for neurogenic bladder symptoms). We also highlight general QOL measures for patients with multiple sclerosis (MS) and spinal cord injury (SCI) which include questions about bladder symptoms, and incontinence PROMs which are commonly used, but not specifically designed for neurogenic bladder patients. It is essential for clinicians and researchers with an interest in neurogenic bladder to be aware of the current PROMs, and to have a basic understanding of the principals of measurement in order to select the most appropriate one for their purpose.

  14. Chronic hyperglycemia is related to poor functional outcome after acute ischemic stroke

    NARCIS (Netherlands)

    Luitse, Merel Ja; Velthuis, Birgitta K; Kappelle, L Jaap; van der Graaf, Yolanda; Biessels, Geert Jan

    2017-01-01

    BACKGROUND: Acute hyperglycemia is associated with poor functional outcome after ischemic stroke, but the association between chronic antecedent hyperglycemia and outcome is unclear. AIM: We assessed the association between chronic hyperglycemia, measured by hemoglobin A1c, and functional outcome in

  15. Long-term functional outcome of pediatric stroke survivors.

    Science.gov (United States)

    Hurvitz, Edward; Warschausky, Seth; Berg, Michelle; Tsai, Shane

    2004-01-01

    To examine the long-term functional, psychosocial, and medical outcome of pediatric stroke survivors. This was a descriptive survey performed on patients with childhood stroke who participated in an earlier study. Measures included the Vineland Adaptive Behavior Scales (VABS) and the Diener Satisfaction with Life Scale. Current information on living situation, school placement, employment, and medical outcome were obtained. Twenty-nine (58%) patients participated. The mean age was 19.3 years (SD = 6.6), mean age of onset of stroke was 7.0 years (SD = 5.4), and mean follow-up time was 11.9 years (SD = 3.9). Diagnoses included hemorrhagic (31%) and ischemic (69%) stroke. All but one adult had finished high school, and the majority of participants had gone to college. 60% of patients over age 16 were employed. The average VABS levels for communication, daily living skills, socialization, and adaptive behavior fell into the moderately low range. Use of seizure medications and ADL dependence were the predictors for lower VABS levels (p VABS tended toward lower life satisfaction. Pediatric stroke survivors had good educational and mobility outcomes, but communication, ADL, and socialization fell into the low-moderate range. The different predictors of functional and subjective quality of life outcomes suggest that functional outcomes may mediate the relations between medical factors and satisfaction with life.

  16. Tuberculous Dactylitis : Case Presentation and Functional outcome

    Science.gov (United States)

    Fairag, Rayan; Hamdi, Amre

    2016-01-01

    Introduction: Skeletal tuberculosis involving the small bones is less common than pulmonary tuberculosis. Tuberculous dactylitis involves the short tubular bones of the hands and feet more commonly in children. The bones of the hands are the one’s more frequently affected than bones of the feet, with the proximal phalanx of the index and middle fingers as the commonest sites for infection. Spread to the skeletal system occurs during the initial infection via the lympho-haematogenous route. The radiographic features of cystic expansion have led to the name “Spina Ventosa” for tuberculous dactylitis of the short bones. We report a case of tuberculous dactylitis in the right little finger. Case Presentation: We describe a 36-year-old woman, who presented with a 12-month history of painless swelling of her right little finger associated with fever and night sweats. Her history was remarkable for persistent productive cough. On examination, her investigation reports and radiographs correlated with the symptoms of tuberculosis, suggestive of tuberculous arthritis. Magnetic resonance imaging of the hand was suggestive of osteomyelitis. Histopathological examination revealed chronic granulomatous inflammation that was consistent with osteomyelitis of the bone due to tuberculosis. However, acid-fast bacilli were not identified. Full course of anti-tuberculosis regimen was commenced. Monthly follow-up and radiographic examinations revealed improvement of the patient under this treatment. She also achieved a good functional outcome. Conclusion: Tuberculosis should be considered in patients with unusual soft tissue or skeletal lesions in order to make an early diagnosis and to achieve a good functional outcome. Although tuberculosis of the hand has a varied presentation, the majority of lesions respond to conservative treatment, as anti-tuberculosis chemotherapy is the cornerstone in the management of skeletal tuberculosis. PMID:28116260

  17. Executive function processes predict mobility outcomes in older adults.

    Science.gov (United States)

    Gothe, Neha P; Fanning, Jason; Awick, Elizabeth; Chung, David; Wójcicki, Thomas R; Olson, Erin A; Mullen, Sean P; Voss, Michelle; Erickson, Kirk I; Kramer, Arthur F; McAuley, Edward

    2014-02-01

    To examine the relationship between performance on executive function measures and subsequent mobility outcomes in community-dwelling older adults. Randomized controlled clinical trial. Champaign-Urbana, Illinois. Community-dwelling older adults (N = 179; mean age 66.4). A 12-month exercise trial with two arms: an aerobic exercise group and a stretching and strengthening group. Established cognitive tests of executive function (flanker task, task switching, and a dual-task paradigm) and the Wisconsin card sort test. Mobility was assessed using the timed 8-foot up and go test and times to climb up and down a flight of stairs. Participants completed the cognitive tests at baseline and the mobility measures at baseline and after 12 months of the intervention. Multiple regression analyses were conducted to determine whether baseline executive function predicted postintervention functional performance after controlling for age, sex, education, cardiorespiratory fitness, and baseline mobility levels. Selective baseline executive function measurements, particularly performance on the flanker task (β = 0.15-0.17) and the Wisconsin card sort test (β = 0.11-0.16) consistently predicted mobility outcomes at 12 months. The estimates were in the expected direction, such that better baseline performance on the executive function measures predicted better performance on the timed mobility tests independent of intervention. Executive functions of inhibitory control, mental set shifting, and attentional flexibility were predictive of functional mobility. Given the literature associating mobility limitations with disability, morbidity, and mortality, these results are important for understanding the antecedents to poor mobility function that well-designed interventions to improve cognitive performance can attenuate. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  18. Improving Outcome Measures Other Than Achievement

    Directory of Open Access Journals (Sweden)

    Kristin Anderson Moore

    2015-05-01

    Full Text Available Research indicates that educational, economic, and life success reflect children’s nonacademic as well as academic competencies. Therefore, longitudinal surveys that assess educational progress and success need to incorporate nonacademic measures to avoid omitted variable bias, inform development of new intervention strategies, and support mediating and moderating analyses. Based on a life course model and a whole child perspective, this article suggests constructs in the domains of child health, emotional/psychological development, educational achievement/attainment, social behavior, and social relationships. Four critical constructs are highlighted: self-regulation, agency/motivation, persistence/diligence, and executive functioning. Other constructs that are currently measured need to be retained, including social skills, positive relationships, activities, positive behaviors, academic self-efficacy, educational engagement, and internalizing/emotional well-being. Examples of measures that are substantively and psychometrically robust are provided.

  19. Social cognition, empathy and functional outcome in schizophrenia.

    Science.gov (United States)

    Sparks, Amy; McDonald, Skye; Lino, Bianca; O'Donnell, Maryanne; Green, Melissa J

    2010-09-01

    Social and occupational functioning difficulties are a characteristic feature of schizophrenia, and a growing body of evidence suggests that deficits in social cognition contribute significantly to these functional impairments. The present study sought to investigate whether the association between social cognition and social functioning in schizophrenia would be mediated by self-reported levels of empathy. Thirty outpatients with a diagnosis of schizophrenia or schizoaffective disorder, and twenty-five healthy controls completed a well-validated facial affect processing task (Ekman 60-faces facial task from the Facial Expressions of Emotion - Stimuli and Tests; FEEST), The Awareness of Social Inference Test (TASIT; to assess emotion perception and complex social cognitive skills such as the detection of sarcasm and deceit, from realistic social exchanges), and measures of self-reported empathy and social functioning. Participants with schizophrenia performed more poorly than controls in identifying emotional states from both FEEST and TASIT stimuli, and were impaired in their ability to comprehend counterfactual information in social exchanges, including sarcasm and lies, on the TASIT. Impairment in the comprehension of sarcasm was associated with higher empathic personal distress, and lower recreational functioning. Impairment in the identification of the emotions of others was found to be associated with lower satisfaction and lower empathic fantasy. However, empathy could not be explored as a mediator of associations between social cognition and functional outcome, due to lack of common associations with functional outcome measures. These findings have implications for the remediation of specific social cognitive deficits with respect to improving functional outcomes in schizophrenia.

  20. Measurement properties of patient-reported outcome measures (PROMS) in Patellofemoral Pain Syndrome: a systematic review.

    Science.gov (United States)

    Green, Andrew; Liles, Clive; Rushton, Alison; Kyte, Derek G

    2014-12-01

    This systematic review investigated the measurement properties of disease-specific patient-reported outcome measures used in Patellofemoral Pain Syndrome. Two independent reviewers conducted a systematic search of key databases (MEDLINE, EMBASE, AMED, CINHAL+ and the Cochrane Library from inception to August 2013) to identify relevant studies. A third reviewer mediated in the event of disagreement. Methodological quality was evaluated using the validated COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) tool. Data synthesis across studies determined the level of evidence for each patient-reported outcome measure. The search strategy returned 2177 citations. Following the eligibility review phase, seven studies, evaluating twelve different patient-reported outcome measures, met inclusion criteria. A 'moderate' level of evidence supported the structural validity of several measures: the Flandry Questionnaire, Anterior Knee Pain Scale, Functional Index Questionnaire, Eng and Pierrynowski Questionnaire and Visual Analogue Scales for 'usual' and 'worst' pain. In addition, there was a 'Limited' level of evidence supporting the test-retest reliability and validity (cross-cultural, hypothesis testing) of the Persian version of the Anterior Knee Pain Scale. Other measurement properties were evaluated with poor methodological quality, and many properties were not evaluated in any of the included papers. Current disease-specific outcome measures for Patellofemoral Pain Syndrome require further investigation. Future studies should evaluate all important measurement properties, utilising an appropriate framework such as COSMIN to guide study design, to facilitate optimal methodological quality.

  1. Guest Editorial: Implementing outcome measures- The military physical therapists perspective

    Directory of Open Access Journals (Sweden)

    COL (Ret Paul D. Stoneman, PhD, MPT, DPT, OCS, SCS

    2013-10-01

    Full Text Available Outcome measures are a necessary part of rehabilitation. Various methods and measures have been used to assess patient progress and as criteria for discharge from inpatient care, routine outpatient care, and long-term rehabilitation in a variety of patient populations for many years. In the sports medicine setting, outcome measures become especially important in determining when injured athletes are able to return to the playing field. In a military setting, similar to sports medicine, the use of outcome measures is necessary to help determine when the patient is able to return to duty or deploy. In the case of servicemembers with traumatic limb loss, the ultimate goal for many is to return to Active Duty as a "tactical athlete" and member of today's Army, Navy, Air Force, Marine Corps, or Coast Guard. Determining the functional level and ability to meet the demands they may face is a challenge for the military healthcare system (MHCS and more specifically for the providers rehabilitating servicemembers with major limb loss.

  2. Functional outcome of diaphyseal fractures of femur managed by ...

    African Journals Online (AJOL)

    the clinical and radiological outcome to evaluate the effectiveness, functional outcome and morbidity associated ... nail offers the added advantages of early joint mobilization, early weight .... by applying standard Chi-square and Gaussian test.

  3. Gross motor function in children with spastic Cerebral Palsy and Cerebral Visual Impairment: A comparison between outcomes of the original and the Cerebral Visual Impairment adapted Gross Motor Function Measure-88 (GMFM-88-CVI).

    Science.gov (United States)

    Salavati, M; Rameckers, E A A; Waninge, A; Krijnen, W P; Steenbergen, B; van der Schans, C P

    2017-01-01

    To investigate whether the adapted version of the Gross Motor Function Measure-88 (GMFM-88) for children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) results in higher scores. This is most likely to be a reflection of their gross motor function, however it may be the result of a better comprehension of the instruction of the adapted version. The scores of the original and adapted GMFM-88 were compared in the same group of children (n=21 boys and n=16 girls), mean (SD) age 113 (30) months with CP and CVI, within a time span of two weeks. A paediatric physical therapist familiar with the child assessed both tests in random order. The GMFCS level, mental development and age at testing were also collected. The Wilcoxon signed-rank test was used to compare two different measurements (the original and adapted GMFM-88) on a single sample, (the same child with CP and CVI; pvisual problems. On the basis of these findings, we recommend using the adapted GMFM-88 to measure gross motor functioning in children with CP and CVI. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Does obesity predict functional outcome in the dysvascular amputee?

    Science.gov (United States)

    Kalbaugh, Corey A; Taylor, Spence M; Kalbaugh, Brooke A; Halliday, Matthew; Daniel, Grace; Cass, Anna L; Blackhurst, Dawn W; Cull, David L; Langan, Eugene M; Carsten, Christopher G; York, John W; Snyder, Bruce A; Youkey, Jerry R

    2006-08-01

    Limited information is available concerning the effects of obesity on the functional outcomes of patients requiring major lower limb amputation because of peripheral arterial disease (PAD). The purpose of this study was to examine the predictive ability of body mass index (BMI) to determine functional outcome in the dysvascular amputee. To do this, 434 consecutive patients (mean age, 65.8 +/- 13.3, 59% male, 71.4% diabetic) undergoing major limb amputation (225 below-knee amputation, 27 through-knee amputation, 132 above-knee amputation, and 50 bilateral) as a complication of PAD from January 1998 through May 2004 were analyzed according to preoperative BMI. BMI was classified according to the four-group Center for Disease Control system: underweight, 0 to 18.4 kg/m2; normal, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; and obese, > or = 30 kg/m2. Outcome parameters measured included prosthetic usage, maintenance of ambulation, survival, and maintenance of independent living status. The chi2 test for association was used to examine prosthesis wear. Kaplan-Meier curves were constructed to assess maintenance of ambulation, survival, and maintenance of independent living status. Multivariate analysis using the multiple logistic regression model and a Cox proportional hazards model were used to predict variables independently associated with prosthetic use and ambulation, survival, and independence, respectively. Overall prosthetic usage and 36-month ambulation, survival, and independent living status for the entire cohort was 48.6 per cent, 42.8 per cent, 48.1 per cent, 72.3 per cent, and for patients with normal BMI was 41.5 per cent, 37.4 per cent, 45.6 per cent, and 69.5 per cent, respectively. There was no statistically significant difference in outcomes for overweight patients (59.2%, 50.7%, 52.5%, and 75%) or obese patients (51.8%, 46.2%, 49.7%, and 75%) when compared with normal patients. Although there were significantly poorer outcomes for underweight

  5. Thurstone scaling as a measurement method to quantify subjective health outcomes

    NARCIS (Netherlands)

    Krabbe, Paul F M

    BACKGROUND: Many objective health outcome measures are used to monitor patients or evaluate health interventions, but there are also subjective measures. For the latter, it is difficult to derive metric data, which are needed to quantify health outcomes such as functional disability, severity of

  6. Thurstone scaling as a measurement method to quantify subjective health outcomes.

    NARCIS (Netherlands)

    Krabbe, P.F.M.

    2008-01-01

    BACKGROUND: Many objective health outcome measures are used to monitor patients or evaluate health interventions, but there are also subjective measures. For the latter, it is difficult to derive metric data, which are needed to quantify health outcomes such as functional disability, severity of

  7. Personal Outcomes as Measures of Quality.

    Science.gov (United States)

    Gardner, James F.; Nudler, Sylvia; Chapman, Michael S.

    1997-01-01

    The Council on Quality and Leadership in Supports for People with Disabilities conducted interviews with 447 people with disabilities to identify priority outcomes they expect from service and supports. An analysis resulted in 24 variables loading onto 7 major factors: identity, autonomy, affiliation, attainment, rights, health, and safeguards.…

  8. Impact/outcome measures for libraries

    Directory of Open Access Journals (Sweden)

    Roswitha Poll

    2003-12-01

    Full Text Available Libraries today document their performance for the most part only in data of input and output (e.g. size of the collection, number of issues, of reference answers etc.. If they do more, they evaluate the quality and user-orientation of their services by applying performance indicators or user satisfaction surveys. Data of high use or high user satisfaction seem to indicate that users benefit from the library's services. But in demonstrating the library's value to the financing authorities or the public it would be much more effective if libraries could show a direct impact/outcome of their services on their users. Such outcome might be either a monetary value attributed to one case of use, or the impact on the users' skills and knowledge, their information literacy. Quite a number of projects in different countries have tested methods to catch this 'outcome'. They have tried to assess the value assigned by the population to certain library services, to find a connection between success in studies or research and library use, to assess the library's impact on students' information literacy, to explore the information behaviour of groups in order to specify the library's role in information research and information delivery. The paper describes the different starting points for assessing outcome of library services.

  9. Stakeholders' views on measuring outcomes for people with learning disabilities.

    Science.gov (United States)

    Young, Anita F; Chesson, Rosemary A

    2006-01-01

    What works and how do we know? These are recurring questions for health and social care professionals, although mediated through differing philosophies and historical perspectives. The aims of the study reported here were to discover views of managers and commissioners of services for people with learning disabilities in Scotland regarding (a) current approaches to service evaluation (as an indication of what is to be measured) and (b) healthcare outcome measurement (as an indication of preferences regarding how this should be measured). A postal questionnaire was used to survey 94 stakeholders from the NHS, Local Authorities, and non-statutory organisations across Scotland. Respondents' views were sought on current approaches to service evaluation within learning disabilities; outcome measurement; appropriateness of specified methods of measuring health outcomes; desired future methods of outcome measurement within learning disabilities; and service user involvement in care. A 77% (73/94) response rate to the questionnaire was achieved. Different methods of service evaluation were used by different stakeholders. Staff appraisal was the most frequently identified method (used by 85% of respondents). Specific outcome measures were used by 32% of respondents although there were differences of opinion as to what constitutes specific outcome measures. Overall there was strong support for goal-setting and reviewing (83%) and individualised outcome measures (75%) as appropriate methods for use with people with learning disabilities. The hypothetical question asking what outcome measures should be introduced for this client group had by far the lowest response rate (51/73). The overwhelming majority of all respondents, 68 (92%), reported user involvement in their service. Staff ambivalence to outcome measurement was evident in the research and respondents highlighted the complexity and multidimensional nature of outcomes for this service user group. Managers recognised

  10. Functional Impairment and Occupational Outcome in Adults with ADHD

    Science.gov (United States)

    Gjervan, Bjorn; Torgersen, Terje; Nordahl, Hans M.; Rasmussen, Kirsten

    2012-01-01

    Objective: ADHD is associated with poor functional outcomes. The objectives were to investigate the prevalence of functional impairment and occupational status in a clinically referred sample of adults with ADHD and explore factors predicting occupational outcome. Method: A sample of 149 adults with a confirmed diagnosis of ADHD participated in…

  11. Long term functional outcome of idiopathic inflammatory myopathies

    Directory of Open Access Journals (Sweden)

    G. Pasero

    2011-09-01

    Full Text Available The idiopathic inflammatory myopathies (IIM comprise a group of diseases characterized by chronic inflammation of the skeletal muscles. The definition of the long-term outcome of IIM, has been limited by the difficulty in objectively evaluating the rate of muscle function impairment. Aim of our study, was to define the long term outcome in a group of 37 IIM patients, followed at our centres between 1979 and 1999. A protocol, evaluating CK levels, muscle function, and disability in daily life activity was prospectively designed. The disease outcome was defined on the basis the patient’s functional evaluation. Disease activity was defined as the presence of an increase in serum CK levels associated with an increase of therapy. At the end of follow up, 27% of the patients had an active disease and 35% had a poor functional outcome. On the basis of our results we could distinguish three different outcomes of IIM: (i good functional outcome (65%; (ii poor functional outcome with inactive disease (13.5%; (iii poor functional outcome and active disease (21,5%. In conclusion, although IIM seem to have a good evolution in terms of disease activity, in about 46% of patients they are associated with an elevated incidence of functional impairement, probably attributable both to the disease’s damage and to the side effects of therapy.

  12. Vitamin d and rehabilitation: improving functional outcomes.

    Science.gov (United States)

    Shinchuk, Leonid M; Shinchuk, Leonid; Holick, Michael F

    2007-06-01

    Vitamin D inadequacy is pandemic among rehabilitation patients in both inpatient and outpatient settings. Male and female patients of all ages and ethnic backgrounds are affected. Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and worsens proximal muscle strength and postural sway. Vitamin D inadequacy can be prevented by sensible sun exposure and adequate dietary intake with supplementation. Vitamin D status is determined by measurement of serum 25-hydroxyvitamin D. The recommended healthful serum level is between 30 and 60 ng/mL. 25-Hydroxyvitamin D levels of >30 ng/mL are sufficient to suppress parathyroid hormone production and to maximize the efficiency of dietary calcium absorption from the small intestine. This can be accomplished by ingesting 1000 IU of vitamin D(3) per day, or by taking 50,000 IU of vitamin D(2) every 2 weeks. Vitamin D toxicity is observed when 25-hydroxyvitamin D levels exceed 150 ng/mL. Identification and treatment of vitamin D deficiency reduces the risk of vertebral and nonvertebral fractures by improving bone health and musculoskeletal function. Vitamin D deficiency and osteomalacia should be considered in the differential diagnosis of patients with musculoskeletal pain, fibromyalgia, chronic fatigue syndrome, or myositis. There is a need for better education of health professionals and the general public regarding the optimization of vitamin D status in the care of rehabilitation patients.

  13. Practical considerations for the implementation of health outcome measures.

    Science.gov (United States)

    Carriere, Robin S

    2009-01-01

    The collection of health outcomes information is important for effective management of the health care system. The Health Outcomes for Better Information and Care (HOBIC) program is implementing a set of nurse-sensitive health outcome measures across the province of Ontario. This paper examines some of the opportunities and challenges of implementing measures across multiple organizations and multiple sectors of the health care system.

  14. Patient-Reported Outcome Measures in Systemic Sclerosis (Scleroderma).

    Science.gov (United States)

    Pellar, Russell E; Tingey, Theresa M; Pope, Janet Elizabeth

    2016-05-01

    Scleroderma (systemic sclerosis) is a rare autoimmune connective tissue disease that can damage multiple organs and reduce quality of life. Patient-reported outcome measures capture the patient's perspective. Some measures are specific to systemic sclerosis and others are general. Patient-reported outcomes in systemic sclerosis are important to aid in understanding the impact of systemic sclerosis on patients.

  15. Patient-reported outcome measures for asthma : a systematic review

    NARCIS (Netherlands)

    Worth, Allison; Hammersley, Victoria; Knibb, Rebecca; Flokstra-de-Blok, Bertine; DunnGalvin, Audrey; Walker, Samantha; Dubois, Anthony EJ; Sheikh, Aziz

    2014-01-01

    BACKGROUND: Patient-reported outcome measures (PROMs) are measures of the outcome of treatment(s) reported directly by the patient or carer. There is increasing international policy interest in using these to assess the impact of clinical care. AIMS: To identify suitably validated PROMs for asthma a

  16. [Outcomes count: the importance of measuring the outcomes of hospital care].

    Science.gov (United States)

    Sangha, Oliver; Schneeweiss, Sebastian

    2002-01-01

    A century ago the Boston surgeon Earnest A. Codman described in detail the requirements for monitoring quality of care and emphasized the importance of outcomes in evaluating care. At the time the medical societies were disconcerted by his ideas, which were perceived as revolutionary. After several decade of focusing on the structures and processes of care we are now witnessing a renaissance of measuring outcomes. This paper emphasizes the need for outcomes measurement monitor quality of care. The introduction of diagnosis-related groups in Germany is the most recent development that underlines the importance of outcomes measurement and benchmarking.

  17. Correlations between outcomes of random measurements

    Science.gov (United States)

    Tran, Minh Cong; Dakić, Borivoje; Laskowski, Wiesław; Paterek, Tomasz

    2016-10-01

    We recently showed that multipartite correlations between outcomes of random observables detect quantum entanglement in all pure and some mixed states. In this followup article we further develop this approach, derive a maximal amount of such correlations, and show that they are not monotonous under local operations and classical communication. Nevertheless, we demonstrate their usefulness in entanglement detection with a single random observable per party. Finally we study convex-roof extension of the correlations and provide a closed-form necessary and sufficient condition for entanglement in rank-2 mixed states and a witness in general.

  18. Observer bias in randomized clinical trials with measurement scale outcomes

    DEFF Research Database (Denmark)

    Hróbjartsson, Asbjørn; Thomsen, Ann Sofia Skou; Emanuelsson, Frida;

    2013-01-01

    BACKGROUND:Clinical trials are commonly done without blinded outcome assessors despite the risk of bias. We wanted to evaluate the effect of nonblinded outcome assessment on estimated effects in randomized clinical trials with outcomes that involved subjective measurement scales. METHODS......:We conducted a systematic review of randomized clinical trials with both blinded and nonblinded assessment of the same measurement scale outcome. We searched PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, HighWire Press and Google Scholar for relevant studies. Two......%). Heterogeneity was moderate (I(2) = 46%, p = 0.02) and unexplained by metaregression. INTERPRETATION:We provide empirical evidence for observer bias in randomized clinical trials with subjective measurement scale outcomes. A failure to blind assessors of outcomes in such trials results in a high risk...

  19. Factors Associated With Rehabilitation Outcomes After Traumatic Brain Injury: Comparing Functional Outcomes Between TBIMS Centers Using Hierarchical Linear Modeling.

    Science.gov (United States)

    Dahdah, Marie N; Hofmann, Melissa; Pretz, Christopher; An, Viktoriya; Barnes, Sunni A; Bennett, Monica; Dreer, Laura E; Bergquist, Thomas; Shafi, Shahid

    To examine differences in patient outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers and factors that influence these differences using hierarchical linear modeling (HLM). Sixteen TBIMS centers. A total of 2056 individuals 16 years or older with moderate to severe traumatic brain injury (TBI) who received inpatient rehabilitation. Multicenter observational cohort study using HLM to analyze prospectively collected data. Functional Independence Measure and Disability Rating Scale total scores at discharge and 1 year post-TBI. Duration of posttraumatic amnesia (PTA) demonstrated a significant inverse relationship with functional outcomes. However, the magnitude of this relationship (change in functional status for each additional day in PTA) varied among centers. Functional status at discharge from rehabilitation and at 1 year post-TBI could be predicted using the slope and intercept of each TBIMS center for the duration of PTA, by comparing it against the average slope and intercept. HLM demonstrated center effect due to variability in the relationship between PTA and functional outcomes of patients. This variability is not accounted for in traditional linear regression modeling. Future studies examining variations in patient outcomes between centers should utilize HLM to measure the impact of additional factors that influence patient rehabilitation functional outcomes.

  20. Responsiveness of the OARSI-OMERACT osteoarthritis pain and function measures

    DEFF Research Database (Denmark)

    Bond, M; Davis, A; Lohmander, Stefan

    2012-01-01

    To assess the responsiveness of the Intermittent and Constant Osteoarthritis Pain (ICOAP) measure, Hip Disability and Osteoarthritis Outcome Score Physical Function Short Form (HOOS-PS), and the Knee Disability and Osteoarthritis Outcome Score Physical Function Short Form (KOOS...

  1. Vision and vision-related outcome measures in multiple sclerosis.

    Science.gov (United States)

    Balcer, Laura J; Miller, David H; Reingold, Stephen C; Cohen, Jeffrey A

    2015-01-01

    Visual impairment is a key manifestation of multiple sclerosis. Acute optic neuritis is a common, often presenting manifestation, but visual deficits and structural loss of retinal axonal and neuronal integrity can occur even without a history of optic neuritis. Interest in vision in multiple sclerosis is growing, partially in response to the development of sensitive visual function tests, structural markers such as optical coherence tomography and magnetic resonance imaging, and quality of life measures that give clinical meaning to the structure-function correlations that are unique to the afferent visual pathway. Abnormal eye movements also are common in multiple sclerosis, but quantitative assessment methods that can be applied in practice and clinical trials are not readily available. We summarize here a comprehensive literature search and the discussion at a recent international meeting of investigators involved in the development and study of visual outcomes in multiple sclerosis, which had, as its overriding goals, to review the state of the field and identify areas for future research. We review data and principles to help us understand the importance of vision as a model for outcomes assessment in clinical practice and therapeutic trials in multiple sclerosis.

  2. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure

    DEFF Research Database (Denmark)

    1998-01-01

    There is broad consensus that good outcome measures are needed to distinguish interventions that are effective from those that are not. This task requires standardized, patient-centered measures that can be administered at a low cost. We developed a questionnaire to assess short- and long......-term patient-relevant outcomes following knee injury, based on the WOMAC Osteoarthritis Index, a literature review, an expert panel, and a pilot study. The Knee injury and Osteoarthritis Outcome Score (KOOS) is self-administered and assesses five outcomes: pain, symptoms, activities of daily living, sport...

  3. The National Outcomes Measurement System for Pediatric Speech-Language Pathology

    Science.gov (United States)

    Mullen, Robert; Schooling, Tracy

    2010-01-01

    Purpose: The American Speech-Language-Hearing Association's (ASHA's) National Outcomes Measurement System (NOMS) was developed in the late 1990s. The primary purpose was to serve as a source of data for speech-language pathologists (SLPs) who found themselves called on to provide empirical evidence of the functional outcomes associated with their…

  4. Italian adaptation of the functional outcome questionnaire - aphasia: initial psychometric evaluation.

    Science.gov (United States)

    Spaccavento, Simona; Cafforio, Elisabetta; Cellamare, Fara; Colucci, Antonia; Di Palma, Angela; Falcone, Rosanna; Craca, Angela; Loverre, Anna; Nardulli, Roberto; Glueckauf, Robert L

    2017-08-04

    To evaluate the psychometric properties of the Italian version of Functional Outcome Questionnaire - Aphasia. Two hundred and five persons with stroke-related aphasia and right hemiparesis who received ongoing assistance from a family caregiver were assessed using the Functional Outcome Questionnaire - Aphasia, Aachener Aphasie Test, Token Test, Raven's Coloured Progressive Matrices, Functional Independence Measure (FIM), Functional Assessment Measure (FAM), and Quality of Life Questionnaire for Aphasics (QLQA). The Functional Outcome Questionnaire - Aphasia was translated into the Italian language using a translation and back-translation method. Reliability and construct validity of the Functional Outcome Questionnaire - Aphasia were evaluated. The Italian version of the Functional Outcome Questionnaire - Aphasia showed good internal consistency and test-retest reliability for the overall scale (α = 0.98; ICC = 0.95) and subscales (α = 0.89 for the communicating basic needs (CBN), α = 0.92 for the making routine requests (MRR), α = 0.96 for the communicating new information (CNI), α = 0.93 for the attention/other communication skills (AO); ICC = 0.95 for CBN, ICC = 0.96 for MRR, ICC = 0.97 for CNI and ICC = 0.92 for AO). Significant correlations were found between the Functional Outcome Questionnaire - Aphasia and Token Test, QLQA, Aachener Aphasie Test scores, and FAM linguistic scores, indicating good convergent validity. Low correlations were found between Functional Outcome Questionnaire - Aphasia and Raven's Coloured Progressive Matrices and FIM motor scores, showing good discriminant validity. The overall findings of this study supported the reliability and construct validity of the Italian version of the Functional Outcome Questionnaire - Aphasia. This measure holds considerable promise in assessing the functional outcomes of aphasia rehabilitation in Italian-speaking persons with aphasia. Implications for

  5. Frequency, treatment, and functional outcome in children with hypersensitivity pneumonitis

    DEFF Research Database (Denmark)

    Buchvald, Frederik; Petersen, Bodil Laub; Damgaard, Karen;

    2011-01-01

    Hypersensitivity pneumonitis is a rare interstitial lung disease and very few data regarding frequency, treatment and outcome exist for children. Children identified with hypersensitivity pneumonia from a Danish national cohort with diffuse interstitial lung disease form the basis of this study...... focused on disease frequency, treatment, and functional outcome....

  6. The Development of NOAA Education Common Outcome Performance Measures (Invited)

    Science.gov (United States)

    Baek, J.

    2013-12-01

    The National Oceanic and Atmospheric Administration (NOAA) Education Council has embarked on an ambitious Monitoring and Evaluation (M&E) project that will allow it to assess education program outcomes and impacts across the agency, line offices, and programs. The purpose of this internal effort is to link outcome measures to program efforts and to evaluate the success of the agency's education programs in meeting the strategic goals. Using an outcome-based evaluation approach, the NOAA Education Council is developing two sets of common outcome performance measures, environmental stewardship and professional development. This presentation will examine the benefits and tradeoffs of common outcome performance measures that collect program results across a portfolio of education programs focused on common outcomes. Common outcome performance measures have a few benefits to our agency and to the climate education field at large. The primary benefit is shared understanding, which comes from our process for writing common outcome performance measures. Without a shared and agreed upon set of definitions for the measure of an outcome, the reported results may not be measuring the same things and would incorrectly indicate levels of performance. Therefore, our writing process relies on a commitment to developing a shared set of definitions based on consensus. We hope that by taking the time to debate and coming to agreement across a diverse set of programs, the strength of our common measures can indicate real progress towards outcomes we care about. An additional benefit is that these common measures can be adopted and adapted by other agencies and organizations that share similar theories of change. The measures are not without their drawbacks, and we do make tradeoffs as part of our process in order to continue making progress. We know that any measure is necessarily a narrow slice of performance. A slice that may not best represent the unique and remarkable contribution

  7. Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review.

    Directory of Open Access Journals (Sweden)

    Leire Santisteban

    Full Text Available Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians.In this study we aimed to identify the most commonly used upper limb outcome measures in intervention studies after stroke and to describe domains covered according to ICF, how measures are combined, and how their use varies geographically and over time.Pubmed, CinHAL, and PeDRO databases were searched for upper limb intervention studies in stroke according to PRISMA guidelines and477 studies were included.In studies 48different outcome measures were found. Only 15 of these outcome measures were used in more than 5% of the studies. The Fugl-Meyer Test (FMTwas the most commonly used measure (in 36% of studies. Commonly used measures covered ICF domains of body function and activity to varying extents. Most studies (72% combined multiple outcome measures: the FMT was often combined with the Motor Activity Log (MAL, the Wolf Motor Function Test and the Action Research Arm Test, but infrequently combined with the Motor Assessment Scale or the Nine Hole Peg Test. Key components of manual dexterity such as selective finger movements were rarely measured. Frequency of use increased over a twelve-year period for the FMT and for assessments of kinematics, whereas other measures, such as the MAL and the Jebsen Taylor Hand Test showed decreased use over time. Use varied largely between countries showing low international consensus.The results showed a large diversity of outcome measures used across studies. However, a growing number of studies used the FMT, a neurological test with good psychometric properties. For thorough assessment the FMT needs to be combined with functional measures. These findings illustrate the need for strategies to build international consensus on appropriate outcome measures for upper limb function after stroke.

  8. Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review

    Science.gov (United States)

    Santisteban, Leire; Térémetz, Maxime; Bleton, Jean-Pierre; Baron, Jean-Claude; Maier, Marc A.; Lindberg, Påvel G.

    2016-01-01

    Background Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians. Objective In this study we aimed to identify the most commonly used upper limb outcome measures in intervention studies after stroke and to describe domains covered according to ICF, how measures are combined, and how their use varies geographically and over time. Methods Pubmed, CinHAL, and PeDRO databases were searched for upper limb intervention studies in stroke according to PRISMA guidelines and477 studies were included. Results In studies 48different outcome measures were found. Only 15 of these outcome measures were used in more than 5% of the studies. The Fugl-Meyer Test (FMT)was the most commonly used measure (in 36% of studies). Commonly used measures covered ICF domains of body function and activity to varying extents. Most studies (72%) combined multiple outcome measures: the FMT was often combined with the Motor Activity Log (MAL), the Wolf Motor Function Test and the Action Research Arm Test, but infrequently combined with the Motor Assessment Scale or the Nine Hole Peg Test. Key components of manual dexterity such as selective finger movements were rarely measured. Frequency of use increased over a twelve-year period for the FMT and for assessments of kinematics, whereas other measures, such as the MAL and the Jebsen Taylor Hand Test showed decreased use over time. Use varied largely between countries showing low international consensus. Conclusions The results showed a large diversity of outcome measures used across studies. However, a growing number of studies used the FMT, a neurological test with good psychometric properties. For thorough assessment the FMT needs to be combined with functional measures. These findings illustrate the need for strategies to build international consensus on appropriate outcome measures for upper limb function after stroke. PMID:27152853

  9. Correlation of Thyroid Functions with Severity and Outcome of ...

    African Journals Online (AJOL)

    Correlation of Thyroid Functions with Severity and Outcome of Pregnancy. ... Journal Home > Vol 3, No 1 (2013) > ... Aim: The present study was planned to study thyroid hormones in mild and severe preeclamptic women and normotensive ...

  10. Pilot Cognitive Functioning and Training Outcomes

    Science.gov (United States)

    2012-07-01

    reducing physical stress and damage to the airframe. In summary, there has been extensive research in the USAF on the use of cognitive ability tests...has amassed a body of knowledge about many topics Comprehension Measures “social acculturation ,” “social intelligence,” and the conventional

  11. Identifying meaningful outcome measures for the intensive care unit.

    Science.gov (United States)

    Martinez, Elizabeth A; Donelan, Karen; Henneman, Justin P; Berenholtz, Sean M; Miralles, Paola D; Krug, Allison E; Iezzoni, Lisa I; Charnin, Jonathan E; Pronovost, Peter J

    2014-01-01

    Despite important progress in measuring the safety of health care delivery in a variety of health care settings, a comprehensive set of metrics for benchmarking is still lacking, especially for patient outcomes. Even in high-risk settings where similar procedures are performed daily, such as hospital intensive care units (ICUs), these measures largely do not exist. Yet we cannot compare safety or quality across institutions or regions, nor can we track whether safety is improving over time. To a large extent, ICU outcome measures deemed valid, important, and preventable by clinicians are unavailable, and abstracting clinical data from the medical record is excessively burdensome. Even if a set of outcomes garnered consensus, ensuring adequate risk adjustment to facilitate fair comparisons across institutions presents another challenge. This study reports on a consensus process to build 5 outcome measures for broad use to evaluate the quality of ICU care and inform quality improvement efforts.

  12. Culturally Sensitive and Environment-Friendly Outcome Measures in ...

    African Journals Online (AJOL)

    Dr Olaleye

    2Department of Medical Rehabilitation, Nnamdi Azikwe University, Nigeria. 3 School of Research ..... Gibbon B (1991): Measuring stroke recovery. Nursing Times .... Yoemans S. G. (2000): The Clinical Application of Outcomes. Assessment ...

  13. Functional outcome in adult patients following Bernese periacetabular osteotomy.

    Science.gov (United States)

    Badra, Mohammad I; Anand, Ashish; Straight, Joseph J; Sala, Debra A; Ruchelsman, David E; Feldman, David S

    2008-01-01

    This study evaluated functional outcome following Bernese periacetabular osteotomy. In 24 patients with mean follow-up of 3.5 years, mean dysfunction score was 15.23 on the Short Musculoskeletal Function Assessment. Eighteen patients (75%) scored = or <20, indicating a high functional level. Irrespective of preoperative Shenton line continuity, most patients demonstrated a high functional level. However, a trend toward a poorer outcome was observed in patients with preoperative noncongruent joints and Tonnis osteoarthritis grade 3. These results suggest patients with less than optimal presentation may still benefit from this surgery, delaying or eliminating the need for total hip arthroplasty.

  14. FUNCTIONAL OUTCOMES AFTER DISTAL BICEPS BRACHII REPAIR: A CASE SERIES

    Science.gov (United States)

    Morris, Tim; Otto, Charissa; Zerella, Tanisha; Semmler, John G; Human, Taaibos; Phadnis, Joideep; Bain, Gregory I

    2016-01-01

    Objectives To investigate outcomes after surgical repair of distal biceps tendon rupture and the influence of arm dominance on isokinetic flexion and supination results. Background/Purpose While relatively uncommon, rupture of the distal biceps tendon can result in significant strength deficits, for which surgical repair is recommended. The purpose of this study was to assess patient reported functional outcomes and muscle performance following surgery. Methods A sample of 23 participants (22 males, 1 female), who had previously undergone surgical repair of the distal biceps tendon, were re-examined at a minimum of one year after surgery. Biodex isokinetic elbow flexion and supination testing was performed to assess strength (as measured by peak torque) and endurance (as measured by total work and work fatigue). The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Mayo Elbow Performance Scale (MEPS) were used to assess participants' subjectively reported functional recovery. Results At a mean of 7.6 years after surgical repair, there were no differences between the repaired and uninvolved elbows in peak torque (p = 0.47) or total work (p = 0.60) for flexion or supination. There was also no difference in elbow flexion work fatigue (p = 0.22). However, there was significantly less work fatigue in supination, which was likely influenced by arm dominance, as most repairs were to the dominant arm, F(1,22)=5.67, p = 0.03. Conclusion The long-term strength of the repaired elbow was similar to the uninvolved elbow after surgery to the distal biceps tendon. Endurance of the repaired elbow was similar in flexion but greater in supination, probably influenced by arm dominance. Study design Retrospective case series Level of Evidence Level 4 PMID:27904798

  15. The relationship of the Brief Assessment of Cognition in Schizophrenia (BACS) to functional capacity and real-world functional outcome.

    Science.gov (United States)

    Keefe, Richard S E; Poe, Margaret; Walker, Trina M; Harvey, Philip D

    2006-02-01

    The Brief Assessment of Cognition in Schizophrenia (BACS) assesses five different domains of cognitive function with six tests, and takes about 30-35 minutes to complete in patients with schizophrenia. Previous work has demonstrated the reliability of this measure, and its sensitivity to the deficits of schizophrenia. However, the relationship of this brief cognitive measure to functional outcome has not been determined. Further, future registration trials for potentially cognitive enhancing compounds may not only assess efficacy with cognitive performance measures, but with assessments of real-world functional outcome and functional capacity. The purpose of this study was to determine the relationship between the BACS and a potential co-primary measure for treatment studies of cognition in schizophrenia, and to determine if such a measure accounts for significant variance in functioning beyond that provided by cognitive function. The current study assessed 60 patients with schizophrenia over the course of six months. Cognitive functions were measured with the BACS. Functional capacity was measured with the UCSD Performance-based Skills Assessment (UPSA). Real-world functional outcome was measured with the Independent Living Skills Inventory (ILSI). BACS composite scores were significantly correlated with functional capacity as measured by the UPSA (r = .65, df = 55, p BACS. These data suggest that brief cognitive assessments such as the BACS are able to assess aspects of cognition that are related to important functional measures in clinical trials of cognitive enhancement. They also suggest that the measures being considered as potential co-primary indicators of cognitive function for registration trials are significantly correlated with cognition as assessed by brief cognitive assessments.

  16. Measuring behavioral outcomes in cardiopulmonary rehabilitation: AN AACVPR STATEMENT.

    Science.gov (United States)

    Verrill, David; Graham, Helen; Vitcenda, Mark; Peno-Green, Laura; Kramer, Valerie; Corbisiero, Teresa

    2009-01-01

    Outcome measurement in cardiopulmonary rehabilitation is required for optimal assessment of program quality, effectiveness of treatments, and evaluation of patient progress. Recent position statements from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), American College of Cardiology, American Heart Association, American Thoracic Society, and American College of Chest Physicians have provided state-of-the-art information on the importance of assessing performance and outcome measures for optimal program effectiveness. Such measures are also required for AACVPR program certification. To meet current standards of practice, the AACVPR developed an Outcomes Matrix that includes 4 domains: Health, Clinical, Behavioral, and Service. Although the Clinical and Health domains have been most commonly used in outcome reporting (eg, 6-minute walk test, quality-of-life survey scores), behavioral measures have received less attention, primarily because they have been perceived as being more difficult to measure and quantify over time. This statement describes 5 common behavioral outcome measures: smoking cessation, medication use, supplemental oxygen use, exercise habits, and nutritional behaviors. Sample questions and calculations for each of these behavioral measures are also provided. By using these measures at program entry and completion, cardiac and pulmonary rehabilitation practitioners can effectively track and document behavioral changes over time for physicians, third-party insurance providers, or hospital administrators and thus demonstrate the effectiveness of exercise and educational interventions on patient overall health and well-being.

  17. The International Dermatology Outcome Measures initiative as applied to psoriatic disease outcomes

    DEFF Research Database (Denmark)

    Gottlieb, Alice B; Armstrong, April W; Christensen, Robin

    2014-01-01

    In the United States, access to care is the number one issue facing our patients with dermatological conditions. In part, this is because we do not have outcome measures that are useful in clinical practice and available in databases where payers and governmental agencies can compare the performa......, payers, and pharmaceutical scientists. As reported herein, the group's goal is to develop outcome measures in dermatology that address the needs of all involved....

  18. Neuropsychologic and functional outcome after complicated mild traumatic brain injury.

    Science.gov (United States)

    Kashluba, Shauna; Hanks, Robin A; Casey, Joseph E; Millis, Scott R

    2008-05-01

    To investigate the extent to which neuropsychologic and functional outcome after complicated mild traumatic brain injury (TBI) parallels that of moderate TBI recovery. A longitudinal study comparing neuropsychologic and functional status of persons with complicated mild TBI and moderate TBI at discharge from inpatient rehabilitation and at 1 year postinjury. Rehabilitation hospital with a Traumatic Brain Injury Model System. Persons with complicated mild TBI (n=102), each with an intracranial brain lesion documented through neuroimaging and a highest Glasgow Coma Scale (GCS) score in the emergency department between 13 and 15, and 127 persons with moderate TBI. Not applicable. FIM instrument, Disability Rating Scale, Community Integration Questionnaire, Wechsler Memory Scale logical memory I and II, Rey Auditory Verbal Learning Test, Trail-Making Test, Controlled Oral Word Association Test, Symbol Digit Modalities Test, Wisconsin Card Sorting Test, and block design. Few differences in neuropsychologic performance existed between the TBI groups. Less severely impaired information processing speed and verbal learning were seen in the complicated mild TBI group at rehabilitation discharge and 1 year postinjury. Despite overall improvement across cognitive domains within the complicated mild TBI group, some degree of impairment remained at 1 year postinjury on those measures that had identified participants as impaired soon after injury. No differences on functional ability measures were found between the TBI groups at either time period postinjury, with both groups exhibiting incomplete recovery of functional status at the 1-year follow-up. When classifying severity of TBI based on GCS scores, consideration of a moderate injury designation should be given to persons with an intracranial bleed and a GCS score between 13 and 15.

  19. Functional Outcomes in the Treatment of Adults with ADHD

    Science.gov (United States)

    Adler, Lenard A.; Spencer, Thomas J.; Levine, Louise R.; Ramsey, Janet L.; Tamura, Roy; Kelsey, Douglas; Ball, Susan G.; Allen, Albert J.; Biederman, Joseph

    2008-01-01

    Objective: ADHD is associated with significant functional impairment in adults. The present study examined functional outcomes following 6-month double-blind treatment with either atomoxetine or placebo. Method: Patients were 410 adults (58.5% male) with "DSM-IV"--defined ADHD. They were randomly assigned to receive either atomoxetine 40 mg/day to…

  20. Lisfranc injuries: patient- and physician-based functional outcomes.

    LENUS (Irish Health Repository)

    O'Connor, P A

    2012-02-03

    The purpose of this study was to assess functional outcome of patients with a Lisfranc fracture dislocation of the foot by applying validated patient- and physician-based scoring systems and to compare these outcome tools. Of 25 injuries sustained by 24 patients treated in our institution between January 1995 and June 2001, 16 were available for review with a mean follow-up period of 36 (10-74) months. Injuries were classified according to Myerson. Outcome instruments used were: (a) Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), (b) Baltimore Painful Foot score (PFS) and (c) American Orthopedic Foot and Ankle Society (AOFAS) mid-foot scoring scale. Four patients had an excellent outcome on the PFS scale, seven were classified as good, three fair and two poor. There was a statistically significant correlation between the PFS and Role Physical (RP) element of the SF-36.

  1. Entanglement-assisted guessing of complementary measurement outcomes

    NARCIS (Netherlands)

    Berta, M.; Coles, P.J.; Wehner, S.D.C.

    2014-01-01

    Heisenberg's uncertainty principle implies that if one party (Alice) prepares a system and randomly measures one of two incompatible observables, then another party (Bob) cannot perfectly predict the measurement outcomes. This implication assumes that Bob does not possess an additional system that i

  2. Relationship outcomes as measurement criteria to assist communication strategists to manage organisational relationships

    Directory of Open Access Journals (Sweden)

    E. Botha

    2011-06-01

    Full Text Available Nonfinancial assets like relationships are increasingly important to managers. Communication managers in particular are focusing on measuring and managing organisational relationships as a means to quantify the return on investment (ROI of public relations and communication strategies. Measuring relationships offers communication managers a way to evaluate its contribution to the organisation. A commonly agreed upon definition of these relationships, however, does not exist. If we consider communication management is a managerial function, it must first refine its instruments of measurement. This study looks at the three-stage model of organisational relationships (relationship antecedents, maintenance strategies and relationship outcomes proposed by Grunig & Huang (2000 to firstly review the development of the model. Secondly, the study takes an in-depth look at each relationship outcomes of trust, commitment, satisfaction and control mutuality. Lastly, we assess the reliability and validity of the use of current relationship outcome measures through a survey of 154 organisational relationships. Previous studies that have utilized these outcomes in the measurement of organisational relationships do not discuss the possible interaction (or relationship among these outcomes. This study contributes to current literature by both providing an improved framework for the measurement of relationship outcomes and hypothesizing about how these outcomes interact with one another. It also discusses the managerial implications of managing relationships through the constant measurement of trust, commitment, satisfaction and control mutuality

  3. Proof in the Pudding: Implications of Measure Selection in Academic Outcomes Assessment

    Science.gov (United States)

    Priniski, Stacy J.; Winterrowd, Erin

    2017-01-01

    Academic outcomes assessment in student affairs is integral for both service improvement and demonstrating the unit's value to the university's academic mission. However, identifying the right measures is challenging. We implemented three common measures (pre-post self-reported academic functioning, retrospective perceptions of service impact, and…

  4. Patient Reported Outcomes Measurement Information System (PROMIS) in the upper extremity: the future of outcomes reporting?

    Science.gov (United States)

    Makhni, Eric C; Meadows, Molly; Hamamoto, Jason T; Higgins, John D; Romeo, Anthony A; Verma, Nikhil N

    2017-02-01

    Patient reported outcomes (PROs) serve an integral role in clinical research by helping to determine the impact of clinical care as experienced by the patient. With recent initiatives in health care policy and pay for performance, outcome reporting is now recognized as a policy-driven requirement in addition to a clinical research tool. For outcome measures to satisfy these regulatory requirements and provide value in understanding disease outcomes, they must be responsive and efficient. Recent research has uncovered certain concerns regarding traditional PROs in patients with upper extremity disability and injury. These include lack of consensus regarding selection of PROs for a given diagnoses, inconsistent techniques of administration of the same PROs, and the administrative burden to patients and providers of completing these forms. To address these limitations, emphasis has been placed on streamlining the outcomes reporting process, and, as a result, the National Institutes of Health (NIH) created the Patient Reported Outcomes Measurement Information System (PROMIS). PROMIS forms were created to comprehensively and efficiently measure outcomes across multiple disease states, including orthopedics. These tools exist in computer adaptive testing and short forms with the intention of more efficiently measuring outcomes compared with legacy PROs. The goals of this review are to highlight the main components of PROMIS reporting tools and identify recent use of the scores in the upper extremity literature. The review will also highlight the research and health policy potentials and limitations of implementing PROMIS into everyday orthopedic practice. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  5. Measuring outcomes of communication partner training of health care professionals:

    DEFF Research Database (Denmark)

    Isaksen, Jytte; Jensen, Lise Randrup

    are best measured in research and in clinical practice in a valid, reliable and feasible manner. Rationale: Research studies have used a variety of outcome measures, including blind ratings of videotaped interactions or self-rating questionnaires for staff [8]. Video rating does not seem feasible...... different needs? Implications for clinical practice: There is a need to develop different types of outcome measures for communication partner training in the health care context, including questionnaires for health care staff, which address generally agreed-upon problem areas in patient...... of the available questionnaires. However, it is important in order to lay the groundwork for future studies, which compare the efficacy and outcome of different methods of implementing conversation partner training in clinical practice. Aims: The overall purpose of this round table is to: 1. provide an overview...

  6. Outcome Measures for Clinical Drug Trials in Autism

    OpenAIRE

    Aman, Michael G; Novotny, Sherie; Samango-Sprouse, Carole; Lecavalier, Luc; Leonard, Elizabeth; Gadow, Kenneth D.; King, Bryan H; Pearson, Deborah A.; Gernsbacher, Morton Ann; Chez, Michael

    2004-01-01

    This paper identifies instruments and measures that may be appropriate for randomized clinical trials in participants with autism spectrum disorders (ASDs). The Clinical Global Impressions scale was recommended for all randomized clinical trials. At this point, however, there is no “perfect” choice of outcome measure for core features of autism, although we will discuss five measures of potential utility. Several communication instruments are recommended, based in part on suitability across t...

  7. Mismatch negativity, social cognition, and functional outcomes in patients after traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Hui-yan Sun

    2015-01-01

    Full Text Available Mismatch negativity is generated automatically, and is an early monitoring indicator of neuronal integrity impairment and functional abnormality in patients with brain injury, leading to decline of cognitive function. Antipsychotic medication cannot affect mismatch negativity. The present study aimed to explore the relationships of mismatch negativity with neurocognition, daily life and social functional outcomes in patients after brain injury. Twelve patients with traumatic brain injury and 12 healthy controls were recruited in this study. We examined neurocognition with the Wechsler Adult Intelligence Scale-Revised China, and daily and social functional outcomes with the Activity of Daily Living Scale and Social Disability Screening Schedule, respectively. Mismatch negativity was analyzed from electroencephalogram recording. The results showed that mismatch negativity amplitudes decreased in patients with traumatic brain injury compared with healthy controls. Mismatch negativity amplitude was negatively correlated with measurements of neurocognition and positively correlated with functional outcomes in patients after traumatic brain injury. Further, the most significant positive correlations were found between mismatch negativity in the fronto-central region and measures of functional outcomes. The most significant positive correlations were also found between mismatch negativity at the FCz electrode and daily living function. Mismatch negativity amplitudes were extremely positively associated with Social Disability Screening Schedule scores at the Fz electrode in brain injury patients. These experimental findings suggest that mismatch negativity might efficiently reflect functional outcomes in patients after traumatic brain injury.

  8. Mismatch negativity, social cognition, and functional outcomes in patients after traumatic brain injury

    Institute of Scientific and Technical Information of China (English)

    Hui-yan Sun; Qiang Li; Xi-ping Chen; Lu-yang Tao

    2015-01-01

    Mismatch negativity is generated automatically, and is an early monitoring indicator of neuronal integrity impairment and functional abnormality in patients with brain injury, leading to decline of cognitive function. Antipsychotic medication cannot affect mismatch negativity. The present study aimed to explore the relationships of mismatch negativity with neurocognition, daily life and social functional outcomes in patients after brain injury. Twelve patients with traumatic brain injury and 12 healthy controls were recruited in this study. We examined neurocogni-tion with the Wechsler Adult Intelligence Scale-Revised China, and daily and social functional outcomes with the Activity of Daily Living Scale and Social Disability Screening Schedule, re-spectively. Mismatch negativity was analyzed from electroencephalogram recording. The results showed that mismatch negativity amplitudes decreased in patients with traumatic brain injury compared with healthy controls. Mismatch negativity amplitude was negatively correlated with measurements of neurocognition and positively correlated with functional outcomes in patients after traumatic brain injury. Further, the most signiifcant positive correlations were found be-tween mismatch negativity in the fronto-central region and measures of functional outcomes. The most signiifcant positive correlations were also found between mismatch negativity at the FCz electrode and daily living function. Mismatch negativity amplitudes were extremely positive-ly associated with Social Disability Screening Schedule scores at the Fz electrode in brain injury patients. These experimental ifndings suggest that mismatch negativity might efifciently relfect functional outcomes in patients after traumatic brain injury.

  9. Recommendations for Self-Report Outcome Measures in Vulvodynia Clinical Trials.

    Science.gov (United States)

    Pukall, Caroline F; Bergeron, Sophie; Brown, Candace; Bachmann, Gloria; Wesselmann, Ursula

    2017-08-01

    Vulvodynia (idiopathic chronic vulvar pain) is a prevalent condition associated with significant and negative impacts in many areas of function. Despite the increased research interest in vulvodynia in recent years, recommendations for outcome measures for use in clinical trials are missing. The purpose of this paper, therefore, was to provide recommendations for outcome measures for vulvodynia clinical trials so that consistent measures are used across trials to facilitate between-study comparisons and the conduct of large multicenter trials, and to improve measurement of the multiple dimensions of vulvodynia. Given that provoked vestibulodynia (PVD)-characterized by provoked pain localized to the vaginal opening-is the most common subtype of vulvodynia and the current main focus of clinical trials, this paper focused on recommended outcome measures in PVD clinical trials. The framework used to guide the selection of outcome measures was based on the one proposed by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). The IMMPACT framework provided a well-suited guideline for outcome measure recommendations in PVD clinical trials. However, given the provoked presentation of PVD and the significant impact it has on sexuality, modifications to some of the IMMPACT recommendations were made and specific additional measures were suggested. Measures that are specific to vulvovaginal pain are ideal for adoption in PVD clinical trials, and many such measures currently exist that allow the relevant IMMPACT domains to be captured.

  10. Measuring outcomes and efficiency in medicare value-based purchasing.

    Science.gov (United States)

    Tompkins, Christopher P; Higgins, Aparna R; Ritter, Grant A

    2009-01-01

    The Medicare program may soon adopt value-based purchasing (VBP), in which hospitals could receive incentives that are conditional on meeting specified performance objectives. The authors advocate for a market-oriented framework and direct measures of system-level value that are focused on better outcomes and lower total cost of care. They present a multidimensional framework for measuring outcomes of care and a method to adjust incentive payments based on efficiency. Incremental reforms based on VBP could provoke transformational changes in total patient care by linking payments to value related to the whole patient experience, recognizing shared accountability among providers.

  11. Measures of language outcomes using the Aboriginal Children's Survey.

    Science.gov (United States)

    Findlay, Leanne C; Kohen, Dafna E

    2013-01-01

    Speech and language skills are an important developmental milestone for all children, and one of the most prevalent forms of developmental delay among Aboriginal children. However, population-based indicators of Aboriginal children's language outcomes are limited. Data from the Aboriginal Children's Survey (ACS) were used to examine measures of language for Aboriginal children who were 2 to 5 years of age. Responses to ACS questions on ability in any language were examined in exploratory factor analyses to determine possible language indicators. Construct validity was examined by regressing language outcomes onto socio-demographic characteristics known to be associated with children's language. Four language outcomes were identified and labelled: expressive language, mutual understanding, story-telling, and speech and language difficulties. The conceptualization of items from the ACS into separate language indicators can be used by researchers examining young Aboriginal children's language outcomes.

  12. Prediction of Functional Outcome in Axonal Guillain-Barre Syndrome

    Science.gov (United States)

    2016-01-01

    Objective To identify the factors that could predict the functional outcome in patients with the axonal type of Guillain-Barre syndrome (GBS). Methods Two hundred and two GBS patients admitted to our university hospital between 2003 and 2014 were reviewed retrospectively. We defined a good outcome as being "able to walk independently at 1 month after onset" and a poor outcome as being "unable to walk independently at 1 month after onset". We evaluated the factors that differed between the good and poor outcome groups. Results Twenty-four patients were classified into the acute motor axonal neuropathy type. There was a statistically significant difference between the good and poor outcome groups in terms of the GBS disability score at admission, and GBS disability score and Medical Research Council sum score at 1 month after admission. In an electrophysiologic analysis, the good outcome group showed greater amplitude of median, ulnar, deep peroneal, and posterior tibial nerve compound muscle action potentials (CMAP) and greater amplitude of median, ulnar, and superficial peroneal sensory nerve action potentials (SNAP) than the poor outcome group. Conclusion A lower GBS disability score at admission, high amplitude of median, ulnar, deep peroneal, and posterior tibial CMAPs, and high amplitude of median, ulnar, and superficial peroneal SNAPs were associated with being able to walk at 1 month in patients with axonal GBS. PMID:27446785

  13. In Search of an Integrative Measure of Functioning

    Directory of Open Access Journals (Sweden)

    Rosamond H. Madden

    2015-05-01

    Full Text Available International trends towards people-centred, integrative care and support require any measurement of functioning and disability to meet multiple aims. The information requirements of two major Australian programs for disability and rehabilitation are outlined, and the findings of two searches for suitable measures of functioning and disability are analysed. Over 30 current measures of functioning were evaluated in each search. Neither search found a generic measure of functioning suitable for these multibillion dollar programs, relevant to a wide range of people with a variety of health conditions and functioning experiences, and capable of indicating support needs, associated costs, progress and outcomes. This unsuccessful outcome has implications internationally for policy-relevant information for disability, rehabilitation and related programs. The paper outlines the features of an Integrative Measure of Functioning (IMF based on the concepts of functioning and environmental factors in the International Classification of Functioning, Disability and Health (ICF. An IMF would be applicable across a variety of health conditions, settings and purposes, ranging from individual assessment to public health. An IMF could deliver person-centred, policy-relevant information for a range of programs, promoting harmonised language and measurement and supporting international trends in human services and public health.

  14. FUNCTIONAL OUTCOME OF REHABILITATED BILATERAL LOWER-LIMB AMPUTEES

    NARCIS (Netherlands)

    DEFRETES, A; BOONSTRA, AM; VOS, LDW

    The functional outcome of rehabilitated bilateral lower limb amputees was studied. The study included 31 amputees who were admitted during 1980-1990 to a rehabilitation centre in the north of the Netherlands. The clinical notes made during the patients' admission were studied to obtain information

  15. Functional outcome after laparoscopic and open incisional hernia repair

    NARCIS (Netherlands)

    H.H. Eker (Hasan); D. den Hartog (Dennis); W.E. Tuinebreijer (Wim); G.J. Kleinrensink (Gert Jan); H.J. Stam (Henk); J.F. Lange (Johan)

    2010-01-01

    textabstractAbstract: Background: The debate about the advantages of laparoscopic versus open incisional hernia repair is still ongoing. The primary outcomes of already published studies are mainly recurrence, pain and quality of life. Data on postoperative abdominal wall function after these corre

  16. Outcome Measures for Clinical Trials in Down Syndrome.

    Science.gov (United States)

    Esbensen, Anna J; Hooper, Stephen R; Fidler, Deborah; Hartley, Sigan L; Edgin, Jamie; d'Ardhuy, Xavier Liogier; Capone, George; Conners, Frances A; Mervis, Carolyn B; Abbeduto, Leonard; Rafii, Michael; Krinsky-McHale, Sharon J; Urv, Tiina; Group, Outcome Measures Working

    2017-05-01

    Increasingly individuals with intellectual and developmental disabilities, including Down syndrome, are being targeted for clinical trials. However, a challenge exists in effectively evaluating the outcomes of these new pharmacological interventions. Few empirically evaluated, psychometrically sound outcome measures appropriate for use in clinical trials with individuals with Down syndrome have been identified. To address this challenge, the National Institutes of Health (NIH) assembled leading clinicians and scientists to review existing measures and identify those that currently are appropriate for trials; those that may be appropriate after expansion of age range addition of easier items, and/or downward extension of psychometric norms; and areas where new measures need to be developed. This article focuses on measures in the areas of cognition and behavior.

  17. Use of Outcome Measurement by Paediatric AHPs in Northern Ireland

    Science.gov (United States)

    Harron, Anita; Titterington, Jill

    2016-01-01

    Background: Professional standards advocate routine use of outcome measurement (OM) in the practice of allied health professionals (AHPs). Historically, OM has focused on impairment and its immediate constraints on activity, while current policy encourages the development and addition of impact-based OM. There appears to be an assumption at this…

  18. Patient-reported outcome measures in arthroplasty registries

    DEFF Research Database (Denmark)

    Rolfson, Ola; Eresian Chenok, Kate; Bohm, Eric

    2016-01-01

    The International Society of Arthroplasty Registries (ISAR) Steering Committee established the Patient-Reported Outcome Measures (PROMs) Working Group to convene, evaluate, and advise on best practices in the selection, administration, and interpretation of PROMs and to support the adoption and u...

  19. OMERACT: An international initiative to improve outcome measurement in rheumatology

    Directory of Open Access Journals (Sweden)

    Simon Lee

    2007-11-01

    Full Text Available Abstract OMERACT is the acronym for an international, informally organized network initiated in 1992 aimed at improving outcome measurement in rheumatology. Chaired by an executive committee, it organizes consensus conferences in a 2-yearly cycle that circles the globe. Data driven recommendations are prepared and updated by expert working groups. Recommendations include core sets of measures for most of the major rheumatologic conditions. Since 2002 patients have been actively engaged in the process.

  20. Measuring patient satisfaction for the Quality and Outcomes Framework

    OpenAIRE

    Hankins, Matthew; Fraser, Alice; Hodson, Andrew; Hooley, Claire; Smith, Helen

    2007-01-01

    The general medical services (GMS) contract Quality and Outcomes Framework (QOF) awards up to 70 points for measuring patient satisfaction with either the Improving Practices Questionnaire (IPQ) or the General Practice Assessment Questionnaire (GPAQ). The usefulness of data collected depends crucially on the validity and reliability of the measurement instrument. The literature was reviewed to assess the validity and reliability of these questionnaires. The literature was searched for peer-re...

  1. Analysis of repeated outcome measures from longitudinal studies

    Institute of Scientific and Technical Information of China (English)

    Yuanjia WANG; Naihua DUAN

    2011-01-01

    @@ In many clinical studies repeated measurements of an outcome are collected over time.For example,in an 8-week study of treatment for obsessive compulsive disorder,the severity of the disorder may be measured weekly using the Yale-Brown-Obsessive-Compulsive-Disorder-Scale (YBOCS).For each study participant who completes the study,there will be nine repeated measures of YBOCS (a baseline assessment plus eight assessments during the course of treatment).Such a study in which participants are followed and measured repeatedly over time is called a longitudinal study and the resulting data are called longitudinal data.

  2. Functional outcome of patients with spinal cord injury : rehabilitation outcome study

    NARCIS (Netherlands)

    Schönherr, M.C.; Groothoff, J.W.; Mulder, G.A.; Eisma, W.H.

    1999-01-01

    Objective: To increase our knowledge of neurological recovery and functional outcome of patients with spinal cord injuries in order to make more successful rehabilitation programmes based on realistic goals. Design: Descriptive analysis of data gathered in an information system. Setting: Rehabilitat

  3. Functional outcome of patients with spinal cord injury : rehabilitation outcome study

    NARCIS (Netherlands)

    Schönherr, M.C.; Groothoff, J.W.; Mulder, G.A.; Eisma, W.H.

    1999-01-01

    Objective: To increase our knowledge of neurological recovery and functional outcome of patients with spinal cord injuries in order to make more successful rehabilitation programmes based on realistic goals. Design: Descriptive analysis of data gathered in an information system. Setting: Rehabilitat

  4. Lung function measurements in children

    DEFF Research Database (Denmark)

    Poorisrisak, Porntiva

    2010-01-01

    , there was no effect of the child's history of atopy, parental atopy or smoking. We subsequently pooled these normative data (105 children) with previous data from 121 healthy young children; mean sRaw (SD) 1.27 kPa*s (0.25). Conclusion: Control using biological standards revealed errors in factory setting......The Ph.D. thesis is based on studies conducted at 6 pediatric departments in following hospitals: Naestved, Gentofte, Kolding, Skejby, Hvidovre and Rigshospitalet. Study I: Specific airway resistance (sRaw) measured by wholebody plethysmography in preschool children is increasingly used in research...... and clinical practise. However, there is no available method for calibration of the resistance measure, which raises concern of accuracy. The primary aim was to determine the agreement of sRaw measurements in 6 centers. Seven healthy young children were brought to each of the 6 centers for sRaw measurements...

  5. Defeatist Performance Beliefs, Negative Symptoms, and Functional Outcome in Schizophrenia: A Meta-analytic Review.

    Science.gov (United States)

    Campellone, Timothy R; Sanchez, Amy H; Kring, Ann M

    2016-11-01

    Negative symptoms are a strong predictor of poor functional outcome in people with schizophrenia. Unfortunately there are few effective interventions for either negative symptoms or functional outcome, despite the identification of potential mechanisms. Recent research, however, has elucidated a new potential mechanism for negative symptoms and poor functional outcome: defeatist performance beliefs (DPB), or negative thoughts about one's ability to successfully perform goal-directed behavior that can prevent behavior initiation and engagement. We conducted 2 meta-analyses examining the relationship between DPB and both negative symptoms (n = 10 studies) and functional outcome (n = 8 studies) in people with schizophrenia. We found a small effect size for the relationship between DPB and negative symptoms, regardless of how negative symptoms were measured. We also found a small effect size for the relationship between DPB and functional outcome, which was significantly moderated by the method of assessing DPB and moderated by the sex composition of the study at a trend level. These findings highlight the potential of targeting DPB in psychosocial interventions for both negative symptoms and functional outcome.

  6. Social cognition and its relationship to functional outcomes in patients with sustained acquired brain injury

    Directory of Open Access Journals (Sweden)

    Ubukata S

    2014-11-01

    Full Text Available Shiho Ubukata,1,2 Rumi Tanemura,2 Miho Yoshizumi,1 Genichi Sugihara,1 Toshiya Murai,1 Keita Ueda1 1Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, 2Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan Abstract: Deficits in social cognition are common after traumatic brain injury (TBI. However, little is known about how such deficits affect functional outcomes. The purpose of this study was to investigate the relationship between social cognition and functional outcomes in patients with TBI. We studied this relationship in 20 patients with TBI over the course of 1 year post-injury. Patients completed neurocognitive assessments and social cognition tasks. The social cognition tasks included an emotion-perception task and three theory of mind tasks: the Faux Pas test, Reading the Mind in the Eyes (Eyes test, and the Moving-Shapes paradigm. The Craig Handicap Assessment and Reporting Technique was used to assess functional outcomes. Compared with our database of normal subjects, patients showed impairments in all social cognition tasks. Multiple regression analysis revealed that theory of mind ability as measured by the Eyes test was the best predictor of the cognitive aspects of functional outcomes. The findings of this pilot study suggest that the degree to which a patient can predict what others are thinking is an important measure that can estimate functional outcomes over 1 year following TBI. Keywords: Eyes test, social emotion perception, social function, social participation, theory of mind

  7. The importance of quality of survival as an outcome measure for an integrated trauma system.

    Science.gov (United States)

    Cameron, Peter A; Gabbe, Belinda J; McNeil, John J

    2006-12-01

    Risk-adjusted survival rates have been the principle mode of comparison between trauma systems. In mature trauma systems, it is possible that there will be further improvements in survival but these are likely to be small. In the future, the largest gains will come from quality of life and improved function of the survivors. The issues related to measuring quality of survival for trauma systems are reviewed, including feasibility, ethical considerations, risk adjustment of outcomes of survivors, and challenges for selection of instruments and administration. In addition, the preliminary experiences of measuring outcomes in survivors through the Victorian State Trauma Registry are discussed. Although function and quality of life have been identified as important factors to measure in trauma populations, a standardised protocol has not been established. The experience in Victoria suggests that monitoring of population-based outcomes in survivors is feasible and may create the basis for benchmarking the level of morbidity in survivors.

  8. Physical functional outcome assessment of patients with major burns admitted to a UK Burn Intensive Care Unit.

    Science.gov (United States)

    Smailes, Sarah T; Engelsman, Kayleen; Dziewulski, Peter

    2013-02-01

    Determining the discharge outcome of burn patients can be challenging and therefore a validated objective measure of functional independence would assist with this process. We developed the Functional Assessment for Burns (FAB) score to measure burn patients' functional independence. FAB scores were taken on discharge from ICU (FAB 1) and on discharge from inpatient burn care (FAB 2) in 56 patients meeting the American Burn Association criteria for major burn. We retrospectively analysed prospectively collected data to measure the progress of patients' physical functional outcomes and to evaluate the predictive validity of the FAB score for discharge outcome. Mean age was 38.6 years and median burn size 35%. Significant improvements were made in the physical functional outcomes between FAB 1 and FAB 2 scores (ppatients were discharged home, 8 of these with social care. 8 patients were transferred to another hospital for further inpatient rehabilitation. FAB 1 score (≤ 9) is strongly associated with discharge outcome (pburn patients.

  9. Unconditionally secure bit commitment by transmitting measurement outcomes.

    Science.gov (United States)

    Kent, Adrian

    2012-09-28

    We propose a new unconditionally secure bit commitment scheme based on Minkowski causality and the properties of quantum information. The receiving party sends a number of randomly chosen Bennett-Brassard 1984 (BB84) qubits to the committer at a given point in space-time. The committer carries out measurements in one of the two BB84 bases, depending on the committed bit value, and transmits the outcomes securely at (or near) light speed in opposite directions to remote agents. These agents unveil the bit by returning the outcomes to adjacent agents of the receiver. The protocol's security relies only on simple properties of quantum information and the impossibility of superluminal signalling.

  10. Unconditionally Secure Bit Commitment by Transmitting Measurement Outcomes

    CERN Document Server

    ,

    2011-01-01

    We propose a new unconditionally secure bit commitment scheme based on Minkowski causality and the properties of quantum information. The receiving party sends a number of randomly chosen BB84 qubits to the committer at a given point in space-time. The committer carries out measurements in one of the two BB84 bases, depending on the committed bit value, and transmits the outcomes securely at light speed in opposite directions to remote agents. These agents unveil the bit by returning the outcomes to adjacent agents of the receiver. The security proofs rely only on simple properties of quantum information and the impossibility of superluminal signalling.

  11. Longitudinal evaluation of patient-reported outcomes measurement information systems measures in pediatric chronic pain.

    Science.gov (United States)

    Kashikar-Zuck, Susmita; Carle, Adam; Barnett, Kimberly; Goldschneider, Kenneth R; Sherry, David D; Mara, Constance A; Cunningham, Natoshia; Farrell, Jennifer; Tress, Jenna; DeWitt, Esi Morgan

    2016-02-01

    The Patient-Reported Outcomes Measurement Information System (PROMIS) initiative is a comprehensive strategy by the National Institutes of Health to support the development and validation of precise instruments to assess self-reported health domains across healthy and disease-specific populations. Much progress has been made in instrument development, but there remains a gap in the validation of PROMIS measures for pediatric chronic pain. The purpose of this study was to investigate the construct validity and responsiveness to change of 7 PROMIS domains for the assessment of children (ages: 8-18) with chronic pain--Pain Interference, Fatigue, Anxiety, Depression, Mobility, Upper Extremity Function, and Peer Relationships. The PROMIS measures were administered at the initial visit and 2 follow-up visits at an outpatient chronic pain clinic (CPC; N = 82) and at an intensive amplified musculoskeletal pain day-treatment program (N = 63). Aim 1 examined construct validity of PROMIS measures by comparing them with corresponding "legacy" measures administered as part of usual care in the CPC sample. Aim 2 examined sensitivity to change in both CPC and amplified musculoskeletal pain samples. Longitudinal growth models showed that PROMIS' Pain Interference, Anxiety, Depression, Mobility, Upper Extremity, and Peer Relationship measures and legacy instruments generally performed similarly with slightly steeper slopes of improvement in legacy measures. All 7 PROMIS domains showed responsiveness to change. Results offered initial support for the validity of PROMIS measures in pediatric chronic pain. Further validation with larger and more diverse pediatric pain samples and additional legacy measures would broaden the scope of use of PROMIS in clinical research.

  12. Evaluating psychological debriefing: are we measuring the right outcomes?

    Science.gov (United States)

    Deahl, M P; Srinivasan, M; Jones, N; Neblett, C; Jolly, A

    2001-07-01

    The efficacy of critical incident stress debriefing (CISD) and psychological debriefing (PD) following potentially traumatising events has recently been challenged after a number of recent randomised controlled trials (RCTs) failed to demonstrate that CISD or PD prevents or reduces the incidence of posttraumatic stress disorder (PTSD). These studies have used measures of PTSD as the principal outcome and have generally not measured comorbid psychopathology, behavioral or social dysfunction. In a recent RCT of group debriefing amongst British soldiers returning from peacekeeping operations in Bosnia, PD had a significant effect in reducing a worrying level of alcohol misuse in the sample. The findings of this study suggest that that it is premature to conclude that debriefing is ineffective and that a broader range of outcome measures should be employed in future trials of debriefing.

  13. Divisors, Measures and Critical Functions

    Indian Academy of Sciences (India)

    B Petracovici; L Petracovici; A Zaharescu

    2009-06-01

    In [4] we have introduced a new distance between Galois orbits over $\\mathbb{Q}$. Using generalized divisors, we have extended the notion of trace of an algebraic number to other transcendental quantities. In this article we continue the work started in [4]. We define the critical function for a class of transcendental numbers, that generalizes the notion of minimal polynomial of an algebraic number. Our results extend the results obtained by Popescu et al [5].

  14. Functional Outcome in Bipolar Disorder: The Big Picture

    Directory of Open Access Journals (Sweden)

    Boaz Levy

    2012-01-01

    Full Text Available Previous research on functional outcome in bipolar disorder (BD has uncovered various factors that exacerbate psychosocial disability over the course of illness, including genetics, illness severity, stress, anxiety, and cognitive impairment. This paper presents an integrated view of these findings that accounts for the precipitous decline in psychosocial functioning after illness onset. The proposed model highlights a number of reciprocal pathways among previously studied factors that trap people in a powerful cycle of ailing forces. The paper discusses implications to patient care as well as the larger social changes required for shifting the functional trajectory of people with BD from psychosocial decline to growth.

  15. Do sex and atopy influence cough outcome measurements in children?

    Science.gov (United States)

    Chang, Anne B; Gibson, Peter G; Willis, Carol; Petsky, Helen L; Widdicombe, John G; Masters, I Brent; Robertson, Colin F

    2011-08-01

    Despite the commonality of cough and its burden, there are no published data on the relationship between atopy or sex on objectively measured cough frequency or subjective cough scores in children. In 202 children with and without cough, we determined the effect of sex and atopy on validated cough outcome measurements (cough receptor sensitivity [CRS], objective cough counts, and cough scores). We hypothesized that in contrast to adult data, sex does not influence cough outcome measures, and atopy is not a determinant of these cough measurements. We combined data from four previous studies. Atopy (skin prick test), the concentration of capsaicin causing two and five or more coughs (C2 and C5, respectively), objectively measured cough frequency, and cough scores were determined and their relationship explored. The children's (93 girls, 109 boys) mean age was 10.6 years (SD 2.9), and 56% had atopy. In multivariate analysis, CRS was influenced by age (C2 coefficient, 5.9; P = .034; C5 coefficient, 29.1; P = .0001). Atopy and sex did not significantly influence any of the cough outcomes (cough counts, C2, C5, cough score) in control subjects and children with cough. Atopy does not influence important cough outcome measures in children with and without chronic cough. However, age, but not sex, influences CRS in children. Unlike adult data, sex does not affect objective counts or cough score in children with and without chronic cough. Studies on cough in children should be age matched, but matching for atopic status and sex is less important.

  16. Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome.

    Science.gov (United States)

    Maiti, Tanmoy K; Bir, Shyamal C; Patra, Devi Prasad; Kalakoti, Piyush; Guthikonda, Bharat; Nanda, Anil

    2016-08-01

    OBJECTIVE Spinal meningiomas are benign tumors with a wide spectrum of clinical and radiological features at presentation. The authors analyzed multiple clinicoradiological factors to predict recurrence and functional outcome in a cohort with a mean follow-up of more than 4 years. The authors also discuss the results of clinical studies regarding spinal meningiomas in the last 15 years. METHODS The authors retrospectively reviewed the clinical and radiological details of patients who underwent surgery for spinal tumors between 2001 and 2015 that were histopathologically confirmed as meningiomas. Demographic parameters, such as age, sex, race, and association with neurofibromatosis Type 2, were considered. Radiological parameters, such as tumor size, signal changes of spinal cord, spinal level, number of levels, location of tumor attachment, shape of tumor, and presence of dural tail/calcification, were noted. These factors were analyzed to predict recurrence and functional outcome. Furthermore, a pooled analysis was performed from 13 reports of spinal meningiomas in the last 15 years. RESULTS A total of 38 patients were included in this study. Male sex and tumors with radiological evidence of a dural tail were associated with an increased risk of recurrence at a mean follow-up of 51.2 months. Ventral or ventrolateral location, large tumors, T2 cord signal changes, and poor preoperative functional status were associated with poor functional outcome at 1-year follow-up. CONCLUSIONS Spine surgeons must be aware of the natural history and risk factors of spinal meningiomas to establish a prognosis for their patients.

  17. Adaptive behavior, functional outcomes, and quality of life outcomes of children requiring urgent ICU admission.

    Science.gov (United States)

    Ebrahim, Shanil; Singh, Simran; Hutchison, Jamie S; Kulkarni, Abhaya V; Sananes, Renee; Bowman, Kerry W; Parshuram, Christopher S

    2013-01-01

    To describe the adaptive behavior and functional outcomes, and health-related quality of life of children who were urgently admitted to the ICU. Prospective observational study. Critical Care Medicine program at a University-affiliated pediatric institution. Urgently admitted patients, aged 1 month to 18 yrs. None. We evaluated children's adaptive behavior functioning with the Vineland Adaptive Behavior Scale-2, functional outcomes with the pediatric cerebral performance category and pediatric overall performance category, and health-related quality of life with the Pediatric Quality of Life Inventory 4 and Visual Analogue Scale. We enrolled 91 children and 65 (71%) completed the 1-month assessment. Patients had a mean (SD) Vineland Adaptive Behavior Scale-2 rating of 83.2 (± 24.8), considered to be moderate-low adaptive behavior functioning. From baseline to 1 month, pediatric cerebral performance category ratings did not significantly change (p = 0.59) and pediatric overall performance category ratings significantly improved (p = 0.03). Visual Analogue Scale ratings significantly worsened from baseline to 1 wk (p adaptive behavior functioning. Neurological admissions, worse pediatric cerebral performance category score at baseline, longer ICU stay, and longer duration of extracorporeal membrane oxygenation were independently associated with worse functional outcome. Worse pediatric cerebral performance category score at baseline, longer ICU stay, and longer duration of extracorporeal membrane oxygenation were independently associated with worse health-related quality of life. Children surviving PICU have significant adaptive behavior functioning and functional morbidity and reduced health-related quality of life. Although neurologic morbidity following ICU was associated with baseline state, we found that resuscitation intensity and illness severity factors were independently associated with the development of acquired brain injury and reduced quality of life.

  18. Antipsychotic medication, functional outcome and quality of life in schizophrenia: focus on amisulpride.

    Science.gov (United States)

    Nuss, Philippe; Tessier, Cedric

    2010-04-01

    Restoration of quality of life is considered as the ultimate treatment goal in the management of schizophrenia and is important for destigmatising the disease. However, few studies, including the most recent, have collected quality of life data prospectively or evaluated the relationship of treatment with quality of life. Amisulpride is an atypical antipsychotic drug which has been described to have potency in improving negative symptoms of chronic schizophrenia and whose use is associated with a relatively low rate of emergence of extrapyramidal side-effects. These properties may contribute to a beneficial effect on quality of life. A systematic literature review of functional outcome in clinical trials with amisulpride was performed in order to assess the effect of this drug on quality of life and social functioning in patients. The Medline database was searched for all studies of amisulpride in schizophrenia which reported functional and quality of life outcomes up until 30 September 2009. Only one dedicated study assessing functional outcome or quality of life as a primary outcome criterion was identified. This demonstrated significant improvement in subjective well-being in patients with schizophrenia initiating treatment with amisulpride, and a correlation between this improvement and amelioration of psychopathology. In addition, functional outcome rating scales were used as secondary outcome measures in eight randomised clinical trials, and two naturalistic observational studies. Amisulpride treatment was associated with improvement in functional outcome, with effect sizes that were comparable between studies. Improvements in functional outcome are consistently greater than those observed in patients treated with haloperidol and similar in magnitude to those seen with three other atypical antipsychotics, namely olanzapine, ziprasidone and risperidone. A patient-reported outcome measure was used in only one comparative study, and demonstrated perception of a

  19. Measuring Learning Outcomes. A Learner Perspective in Auditing Education

    DEFF Research Database (Denmark)

    Holm, Claus; Steenholdt, Niels

    2000-01-01

    The ability to provide sensible measures for learning outcomes in accounting education is under increased scrutiny. In this paper we use a learner perspective in auditing education which reflects that some students taking accounting classes also are provided with on-the-job training in accounting...... firms. Hence knowledge about learning outcomes for different groups of students is essential information for educators as well as the accounting profession. Sensible measures are needed by educators in order to (1) chose teaching methods matching prerequisite skills among a heterogenous student body, (2......-order-rules. This paper presents data collected in September 1999 including 34 graduate students representing both types of schema. The study provides evidence, which confirms an interrelationship between declarative and procedural knowledge in auditing. The findings suggest that the student-mass, to some extent, is able...

  20. Measuring Learning Outcomes. A Learner Perspective in Auditing Education

    DEFF Research Database (Denmark)

    Holm, Claus; Steenholdt, Niels

    The ability to provide sensible measures for learning outcomes in accounting education is under increased scrutiny. In this paper we use a learner perspective in auditing education which reflects that some students taking accounting classes also are provided with on-the-job training in accounting...... firms. Hence knowledge about learning outcomes for different groups of students is essential information for educators as well as the accounting profession. Sensible measures are needed by educators in order to (1) chose teaching methods matching prerequisite skills among a heterogenous student body, (2......-order-rules. This paper presents data collected in September 1999 including 34 graduate students representing both types of schema. The study provides evidence, which confirms an interrelationship between declarative and procedural knowledge in auditing. The findings suggest that the student-mass, to some extent, is able...

  1. Measuring the Outcome of Biomedical Research: A Systematic Literature Review

    OpenAIRE

    Frédérique Thonon; Rym Boulkedid; Tristan Delory; Sophie Rousseau; Mahasti Saghatchian; Wim van Harten; Claire O'Neill; Corinne Alberti

    2015-01-01

    Background There is an increasing need to evaluate the production and impact of medical research produced by institutions. Many indicators exist, yet we do not have enough information about their relevance. The objective of this systematic review was (1) to identify all the indicators that could be used to measure the output and outcome of medical research carried out in institutions and (2) enlist their methodology, use, positive and negative points. Methodology We have searched 3 databases ...

  2. Scoping review of outcome measures used in telerehabilitation and virtual reality for post-stroke rehabilitation.

    Science.gov (United States)

    Veras, Mirella; Kairy, Dahlia; Rogante, Marco; Giacomozzi, Claudia; Saraiva, Silvia

    2017-07-01

    Introduction Despite the increased interest in telerehabilitation (TR), virtual reality (VR) and outcome measures for stroke rehabilitation, surprisingly little research has been done to map and identify the most common outcome measures used in TR. For this review, we conducted a systematic search of the literature that reports outcome measures used in TR or VR for stroke rehabilitation. Our specific objectives included: 1) to identify the outcome measures used in TR and VR studies; and 2) to describe which parts of the International Classification of Functioning are measured in the studies. Methods We conducted a comprehensive search of relevant electronic databases (e.g. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PSYCOINFO, The Cochrane Central Register of Controlled Trial and the Physiotherapy Evidence Database). The scoping review included all study designs. Two reviewers conducted pilot testing of the data extraction forms and independently screened all the studies and extracted the data. Disagreements about inclusion or exclusion were resolved by consensus or by consulting a third reviewer. Results In total, 28 studies were included in this scoping review. The results were synthesized and reported considering the implications of the findings within the clinical practice and policy context. Discussion This scoping review identified a wide range of outcome measures used in VR and TR studies and helped identify gaps in current use of outcome measures in the literature. The review also informs researchers and end users (i.e. clinicians, policymakers and researchers) regarding the most appropriate outcome measures for TR or VR.

  3. Mismatch negativity is a stronger indicator of functional outcomes than neurocognition or theory of mind in patients with schizophrenia.

    Science.gov (United States)

    Lee, Seung-Hwan; Sung, Kyongae; Lee, Kyong-Sang; Moon, Eunok; Kim, Chang-Gyu

    2014-01-03

    Mismatch negativity (MMN) is known to be associated with neurocognition, social cognition, and functional outcomes. The present study explored the relationships of MMN with neurocognition, theory of mind, and functional outcomes in patients with schizophrenia, first-degree relatives of patients with schizophrenia, and healthy controls. Twenty-five patients with schizophrenia, 21 first-degree relatives of patients with schizophrenia, and 29 healthy controls were recruited. We examined symptom severity, neurocognition, theory of mind, functional outcomes, and MMN. MMN amplitudes decreased in order of patients with schizophrenia, then first-degree relatives, then healthy controls. MMN amplitude was significantly correlated with measures of neurocognition, theory of mind, and functional outcome measurements in patients with schizophrenia. However, the most powerful correlations were those between MMN in the frontal region and measures of functional outcomes. The power and frequency of the correlations were weaker in first-degree relatives and healthy controls than in patients with schizophrenia. Hierarchical regression analysis revealed that functional outcomes (relative to measures of neurocognition and theory of mind) constituted the most powerful predictor of MMN. Our results suggest that MMN reflects functional outcomes more efficiently than do measures of neurocognition and theory of mind in patients with schizophrenia. © 2013.

  4. Comparisons of clinically based outcome measures and laboratory-based outcome measure for balance in patients following total hip and knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Jogi P

    2017-04-01

    Full Text Available Pankaj Jogi, Tom Overend, John Kramer School of Physical Therapy, University of Western Ontario, London, ON, Canada Background: Information available in the literature on clinically based and laboratory-based outcome measures of balance is limited. How much information is provided by clinically based outcome measures compared to laboratory-based measure in patients with total hip (THA and knee arthroplasty (TKA is not known. Aim: The purpose of this study was to determine the relationship between selected clinically based outcome measures and laboratory-based force platform measure in patients following THA and TKA. Methods: Patients who underwent THA (n = 26 and TKA (n = 28 were evaluated at about 5–7 weeks following surgery. Participants were assessed using four clinically based outcome measures – 1 the Berg Balance Scale (BBS, 2 the Timed Up and Go test (TUG, 3 the Activities-specific Balance Confidence Scale (ABC, and 4 the Western Ontario McMaster Universities Osteoarthritis Index-function subscale (WOMAC-function – and one laboratory-based force plate measure (95% ellipse area. Results: Moderate correlations were observed between the BBS and the 95% ellipse area of force plate (r = 0.46–0.51 for the two-legged stance, the anterior lean stance, and the posterior lean stance. Fair correlations were observed between TUG and the 95% ellipse area of force plate (r = 0.31–0.37 for all the three test conditions. Low correlations were observed for the ABC and the WOMAC-function with the 95% ellipse area of force plate (r = 0.11–0.25 for all the three test conditions. Conclusion: The BBS demonstrated the greatest correlations with the 95% ellipse area of the force plate measure and should be preferred by physical therapists over the TUG, the ABC, and the WOMAC-function to assess balance in patients with THA and TKA. Keywords: total knee arthroplasty, total hip arthroplasty, force plate, clinical measures, balance

  5. Chronic hyperglycemia is related to poor functional outcome after acute ischemic stroke.

    Science.gov (United States)

    Luitse, Merel Ja; Velthuis, Birgitta K; Kappelle, L Jaap; van der Graaf, Yolanda; Biessels, Geert Jan

    2017-02-01

    Background Acute hyperglycemia is associated with poor functional outcome after ischemic stroke, but the association between chronic antecedent hyperglycemia and outcome is unclear. Aim We assessed the association between chronic hyperglycemia, measured by hemoglobin A1c, and functional outcome in patients with acute ischemic stroke. Methods We included 812 patients with acute ischemic stroke (mean age 66 ± 14 years; 61.5% male). Patients were categorized per hemoglobin A1c level: no (chronic hyperglycemia (>42 mmol/mol). Poor functional outcome was defined as modified Rankin Scale score > 2 after 3 months. The relation between chronic hyperglycemia and functional outcome was assessed with a Poisson regression analysis and expressed as risk ratios with 95% confidence intervals with no chronic hyperglycemia as the reference. Results Moderate chronic hyperglycemia was present in 234 (28.8%) patients and severe chronic hyperglycemia in 183 (22.5%) patients. Acute hyperglycemia on admission was present in 338 (41.6%) patients. Severe chronic hyperglycemia was associated with poor outcome (risk ratios 1.40; 95% confidence interval 1.09-1.79). After adjustment for age, sex, stroke severity, vascular risk factors, and acute hyperglycemia on admission the risk ratios was 1.35 (95% confidence interval 1.04-1.76). Moderate chronic hyperglycemia was not associated with poor outcome (risk ratios 1.12; 95% confidence interval 0.87-1.44). Conclusion Severe chronic hyperglycemia is associated with poor functional outcome in patients with acute ischemic stroke. This association is independent of hyperglycemia in the acute stage of stroke and of an unfavorable vascular risk factor profile.

  6. Nonclassical characteristic functions for highly sensitive measurements

    CERN Document Server

    Richter, T; Richter, Th.

    2007-01-01

    Characteristic functions are shown to be useful for highly sensitive measurements. Redistributions of motional Fock states of a trapped atom can be directly monitored via the most fragile nonclassical part of the characteristic function. The method can also be used for decoherence measurements in optical quantum-information systems.

  7. Relationship of patient-reported outcomes with MRI measures in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Baker, Joshua F; Conaghan, Philip G; Emery, Paul;

    2017-01-01

    PURPOSE: We assessed whether MRI measures of synovitis, osteitis and bone erosion were associated with patient-reported outcomes (PROs) in a longitudinal clinical trial setting among patients with rheumatoid arthritis (RA). METHODS: This longitudinal cohort of 291 patients with RA was derived from...... across treatment groups. CONCLUSIONS: MRI measures of inflammation and structural damage correlate independently with physical function, pain and patient global assessments. These observations support the validity of MRI biomarkers. TRIAL REGISTRATION NUMBER: NCT00264537; Post-results....

  8. Ablation of advanced tongue or base of tongue cancer and reconstruction with free flap: functional outcomes.

    Science.gov (United States)

    Chien, C Y; Su, C Y; Hwang, C F; Chuang, H C; Jeng, S F; Chen, Y C

    2006-04-01

    To evaluate the functional outcomes of patients who underwent total or nearly total glossectomy for advanced tongue or base of tongue cancer. We used the radial forearm free flap (RFFF), anterior lateral thigh flap (ALTF) or fibular osteocutaneous flap (FOCF) to reconstruct the oral defect after radical resection in 39 patients undergoing total or nearly total glossectomy with laryngeal preservation. Good functional outcomes, measured by independent feeding, speech and swallowing were achieved in 35, 36 and 35 patients, respectively. The cumulative 4-year survival rates were 63.8% for tongue cancer and 42.9% for base of tongue cancer. Reconstruction with free flaps is a feasible method to restore the functional outcomes in speech and deglutition among patients who undergo total or nearly total glossectomy with laryngeal preservation.

  9. On Various Nonlinearity Measures for Boolean Functions.

    Science.gov (United States)

    Boyar, Joan; Find, Magnus Gausdal; Peralta, René

    2016-07-01

    A necessary condition for the security of cryptographic functions is to be "sufficiently distant" from linear, and cryptographers have proposed several measures for this distance. In this paper, we show that six common measures, nonlinearity, algebraic degree, annihilator immunity, algebraic thickness, normality, and multiplicative complexity, are incomparable in the sense that for each pair of measures, μ1, μ2, there exist functions f1, f2 with f1 being more nonlinear than f2 according to μ1, but less nonlinear according to μ2. We also present new connections between two of these measures. Additionally, we give a lower bound on the multiplicative complexity of collision-free functions.

  10. Measuring the instrument function of radiometers

    Energy Technology Data Exchange (ETDEWEB)

    Winston, R. [Univ. of Chicago, IL (United States); Littlejohn, R.G. [Univ. of California, Berkeley, CA (United States)

    1997-12-31

    The instrument function is a function of position and angle, the knowledge of which allows one to compute the response of a radiometer to an incident wave field in any state of coherence. The instrument function of a given radiometer need not be calculated; instead, it may be measured by calibration with incident plane waves.

  11. Pelvic Floor Disorders Registry: Study Design and Outcome Measures.

    Science.gov (United States)

    Weber LeBrun, Emily; Adam, Rony A; Barber, Matthew D; Boyles, Sarah Hamilton; Iglesia, Cheryl B; Lukacz, Emily S; Moalli, Pamela; Moen, Michael D; Richter, Holly E; Subak, Leslee L; Sung, Vivian W; Visco, Anthony G; Bradley, Catherine S

    2016-01-01

    Pelvic floor disorders affect up to 24% of adult women in the United States, and many patients with pelvic organ prolapse (POP) choose to undergo surgical repair to improve their quality of life. While a variety of surgical repair approaches and techniques are utilized, including mesh augmentation, there is limited comparative effectiveness and safety outcome data guiding best practice. In conjunction with device manufacturers, federal regulatory organizations, and professional societies, the American Urogynecologic Society developed the Pelvic Floor Disorders Registry (PFDR) designed to improve the quality of POP surgery by facilitating quality improvement and research on POP treatments. The PFDR will serve as a resource for surgeons interested in benchmarking and outcomes data and as a data repository for Food and Drug Administration-mandated POP surgical device studies. Provider-reported clinical data and patient-reported outcomes will be collected prospectively at baseline and for up to 3 years after treatment. All data elements including measures of success, adverse events, and surgeon characteristics were identified and defined within the context of the anticipated multifunctionality of the registry, and with collaboration from multiple stakeholders. The PFDR will provide a platform to collect high-quality, standardized patient-level data from a variety of nonsurgical (pessary) and surgical treatments of POP and other pelvic floor disorders. Data from this registry may be used to evaluate short- and longer-term treatment outcomes, patient-reported outcomes, and complications, as well as to identify factors associated with treatment success and failure with the overall goal of improving the quality of care for women with these conditions.

  12. Goal setting as an outcome measure: A systematic review.

    Science.gov (United States)

    Hurn, Jane; Kneebone, Ian; Cropley, Mark

    2006-09-01

    Goal achievement has been considered to be an important measure of outcome by clinicians working with patients in physical and neurological rehabilitation settings. This systematic review was undertaken to examine the reliability, validity and sensitivity of goal setting and goal attainment scaling approaches when used with working age and older people. To review the reliability, validity and sensitivity of both goal setting and goal attainment scaling when employed as an outcome measure within a physical and neurological working age and older person rehabilitation environment, by examining the research literature covering the 36 years since goal-setting theory was proposed. Data sources included a computer-aided literature search of published studies examining the reliability, validity and sensitivity of goal setting/goal attainment scaling, with further references sourced from articles obtained through this process. There is strong evidence for the reliability, validity and sensitivity of goal attainment scaling. Empirical support was found for the validity of goal setting but research demonstrating its reliability and sensitivity is limited. Goal attainment scaling appears to be a sound measure for use in physical rehabilitation settings with working age and older people. Further work needs to be carried out with goal setting to establish its reliability and sensitivity as a measurement tool.

  13. Impact of yoga on functional outcomes in breast cancer survivors with aromatase inhibitor-associated arthralgias.

    Science.gov (United States)

    Galantino, Mary Lou; Desai, Krupali; Greene, Laurie; Demichele, Angela; Stricker, Carrie Tompkins; Mao, Jun James

    2012-12-01

    Arthralgia affects postmenopausal breast cancer survivors (BCSs) receiving aromatase inhibitors (AIs). This study aims to establish the feasibility of studying the impact of yoga on objective functional outcomes, pain, and health-related quality of life (HR-QOL) for AI-associated arthralgia (AIAA). Postmenopausal women with stage I to III breast cancer who reported AIAA were enrolled in a single-arm pilot trial. A yoga program was provided twice a week for 8 weeks. The Functional Reach (FR) and Sit and Reach (SR) were evaluated as primary outcomes. Pain, as measured by the Brief Pain Inventory (BPI), self-reported Patient Specific Functional Scale (PSFS), and Functional Assessment of Cancer Therapy-Breast (FACT-B) were secondary outcomes. Paired t tests were used for analysis, and 90% provided data for assessment at the end of the intervention. Participants experienced significant improvement in balance, as measured by FR, and flexibility, as measured by SR. The PSFS improved from 4.55 to 7.21, and HR-QOL measured by FACT-B also improved; both P AIAA. A randomized controlled trial is needed to establish the definitive efficacy of yoga for objective functional improvement in BCSs related to AIAA.

  14. Interaction between anesthesia, gender, and functional outcome task following diffuse traumatic brain injury in rats.

    Science.gov (United States)

    O'Connor, Christine A; Cernak, Ibolja; Vink, Robert

    2003-06-01

    A number of experimental and clinical studies have demonstrated that functional outcome following traumatic brain injury differs between males and females. Some studies report that females have a better outcome than males following trauma while others report the opposite. In experimental studies, some of the contradictory results may be due to the different experimental conditions, including type of anesthesia and the outcome measures employed. In the present study we have used three different anesthetic protocols and four different outcome measures to determine how these parameters interact and affect functional outcome following traumatic brain injury in male and female rats. Diffuse traumatic brain injury was induced in adult male and female animals using the impact-acceleration brain injury model. Mortality in female animals was no different than males when using halothane anesthesia, slightly better than males when using isoflurane anesthesia, but significantly worse than males under pentobarbital anesthesia. Female animals always performed better than males on rotarod tests of motor outcome, with this effect being unrelated to anesthetic effects. Conversely, in cognitive tests using the Barnes Maze, only isoflurane-anesthetized females performed better than their male counterparts. Similarly, in an open field activity task, females always performed better than males after trauma, with isoflurane-anesthetized females also performing significantly better than the halothane-anesthetized female group after injury. Our results suggest that female animals do better than males after diffuse traumatic brain injury, although this observation is dependent upon the type of anesthesia and the functional task employed. Isoflurane is particularly protective in females, pentobarbital is deleterious to female outcome, while halothane anesthesia has the least influence on gender-related outcome.

  15. Psychometric properties of outcome measures for children and adolescents with brachial plexus birth palsy: a systematic review.

    Science.gov (United States)

    Bialocerkowski, Andrea; O'shea, Kate; Pin, Tamis W

    2013-12-01

    The aim of this review was to evaluate the psychometric properties of outcome measures used to quantify upper limb function in children and adolescents with brachial plexus birth palsy (BPBP). Eleven electronic databases were searched to identify studies on the effects of conservative management to improve upper limb function in young people with BPBP. Outcome measures used in these studies were extracted and used in a subsequent search to identify studies that evaluated the psychometric properties of these measures. The methodological quality of these studies was rated using a standardized critical appraisal tool. Thirty-three outcome measures and 12 psychometric studies were identified. Nine outcome measures had some psychometric evidence, which was variable in quality. The outcome measures which seem to have the most robust psychometric properties include the Active Movement Scale, Assisting Hand Assessment, Pediatric Evaluation of Disability Index, and the Pediatric Outcomes Data Collection Instrument. Further research is required to determine the psychometric properties of outcome measures used for children and adolescents with BPBP. Caution is required when interpreting the results of commonly used outcome measures in this population owing to their relatively unknown psychometric properties. © 2013 Mac Keith Press.

  16. Outcomes 'out of africa': the selection and implementation of outcome measures for palliative care in Africa

    Directory of Open Access Journals (Sweden)

    Downing Julia

    2012-01-01

    Full Text Available Abstract Background End-of-life care research across Africa is under-resourced and under-developed. A central issue in research in end-of-life care is the measurement of effects and outcomes of care on patients and families. Little is known about the experiences of health professionals' selection and implementation of outcome measures (OM in clinical care, research, audit, or teaching in Africa. Methods An online survey was undertaken of those using outcome measures across the region, as part of the PRISMA project. A questionnaire addressing the use of OMs was developed for a similar survey in Europe and adapted for Africa. Participants were sampled through the contacts database of APCA. Invitation emails were sent out in January 2010 and reminders in February 2010. Results 168/301 invited contacts (56% from 24 countries responded, with 78 respondents having previously used OM (65% in clinical practice, 12% in research and 23% for both. Main reasons for not using OM were a lack of guidance/training on using and analysing OM, with 49% saying that they would use the tools if this was provided. 40% of those using OM in clinical practice used POS, and 80% used them to assess, evaluate and monitor change. The POS was also the main tool used in research, with the principle criteria for use being validation in Africa, access to the tool and time needed to complete it. Challenges to the use of tools were shortage of time and resources, lack of guidance and training for the professionals, poor health status of patients and complexity of OM. Researchers also have problems analysing OM data. The APCA African POS was the most common version of the POS used, and was reported as a valuable tool for measuring outcomes. Respondents indicated the ideal outcome tool should be short, multi-dimensional and easy to use. Conclusion This was the first survey on professionals' views on OM in Africa. It showed that the APCA African POS was the most frequently OM used

  17. Imatinib enhances functional outcome after spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Mathew B Abrams

    Full Text Available We investigated whether imatinib (Gleevec®, Novartis, a tyrosine kinase inhibitor, could improve functional outcome in experimental spinal cord injury. Rats subjected to contusion spinal cord injury were treated orally with imatinib for 5 days beginning 30 minutes after injury. We found that imatinib significantly enhanced blood-spinal cord-barrier integrity, hindlimb locomotor function, sensorimotor integration, and bladder function, as well as attenuated astrogliosis and deposition of chondroitin sulfate proteoglycans, and increased tissue preservation. These improvements were associated with enhanced vascular integrity and reduced inflammation. Our results show that imatinib improves recovery in spinal cord injury by preserving axons and other spinal cord tissue components. The rapid time course of these beneficial effects suggests that the effects of imatinib are neuroprotective rather than neurorestorative. The positive effects on experimental spinal cord injury, obtained by oral delivery of a clinically used drug, makes imatinib an interesting candidate drug for clinical trials in spinal cord injury.

  18. The selection of core International Classification of Functioning, Disability, and Health (ICF) categories for patient-reported outcome measurement in spine trauma patients-results of an international consensus process

    NARCIS (Netherlands)

    Sadiqi, Said; Lehr, A. Mechteld; Post, Marcel W.; Jacobs, Wilco C. H.; Aarabi, Bizhan; Chapman, Jens R.; Dunn, Robert N.; Dvorak, Marcel F.; Fehlings, Michael G.; Rajasekaran, S.; Vialle, Luiz R.; Vaccaro, Alexander R.; Oner, F. Cumhur

    2016-01-01

    BACKGROUND CONTEXT: There is no outcome instrument specifically designed and validated for spine trauma patients without complete paralysis, which makes it difficult to compare outcomes of different treatments of the spinal column injury within and between studies. PURPOSE: The paper aimed to report

  19. Predicting stroke outcome using DCE-CT measured blood velocity

    Science.gov (United States)

    Oosterbroek, Jaap; Bennink, Edwin; Dankbaar, Jan Willem; Horsch, Alexander D.; Viergever, Max A.; Velthuis, Birgitta K.; de Jong, Hugo W. A. M.

    2015-03-01

    CT plays an important role in the diagnosis of acute stroke patients. Dynamic contrast enhanced CT (DCE-CT) can estimate local tissue perfusion and extent of ischemia. However, hemodynamic information of the large intracranial vessels may also be obtained from DCE-CT data and may contain valuable diagnostic information. We describe a novel method to estimate intravascular blood velocity (IBV) in large cerebral vessels using DCE-CT data, which may be useful to help predict stroke outcome. DCE-CT scans from 34 patients with isolated M1 occlusions were included from a large prospective multi-center cohort study of patients with acute ischemic stroke. Gaussians fitted to the intravascular data yielded the time-to-peak (TTP) and cerebral-blood-volume (CBV). IBV was computed by taking the inverse of the TTP gradient magnitude. Voxels with a CBV of at least 10% of the CBV found in the arterial input function were considered part of a vessel. Mid-sagittal planes were drawn manually and averages of the IBV over all vessel-voxels (arterial and venous) were computed for each hemisphere. Mean-hemisphere IBV differences, mean-hemisphere TTP differences, and hemisphere vessel volume differences were used to differentiate between patients with good and bad outcome (modified Rankin Scale score <3 versus ≥3 at 90 days) using ROC analysis. AUCs from the ROC for IBV, TTP, and vessel volume were 0.80, 0.67 and 0.62 respectively. In conclusion, IBV was found to be a better predictor of patient outcome than the parameters used to compute it and may be a promising new parameter for stroke outcome prediction.

  20. Simple measures of progress and outcome in the evaluation of mental health services.

    Science.gov (United States)

    Newman, F L; Hunter, R H; Irving, D

    1987-01-01

    There is a tautology regarding the use of progress and outcome measures. Such measures are easy to use in a reliable and valid fashion if the language of the measures is used as an integral part of (a) treatment planning and progress review, (b) clinical supervision, and (c) program management. The paper describes example guidelines and uses of measures in each of these functions. Also included are listings of scales with documented reliability and validity (by target population) and some sources for finding computer software for scoring some of the scales.

  1. Patient population management: taking the leap from variance analysis to outcomes measurement.

    Science.gov (United States)

    Allen, K M

    1998-01-01

    Case managers today at BCHS have a somewhat different role than at the onset of the Collaborative Practice Model. They are seen throughout the organization as: Leaders/participants on cross-functional teams. Systems change agents. Integrating/merging with quality services and utilization management. Outcomes managers. One of the major cross-functional teams is in the process of designing a Care Coordinator role. These individuals will, as one of their functions, assume responsibility for daily patient care management activities. A variance tracking program has come into the Utilization Management (UM) department as part of a software package purchased to automate UM work activities. This variance program could potentially be used by the new care coordinators as the role develops. The case managers are beginning to use a Decision Support software, (Transition Systems Inc.) in the collection of data that is based on a cost accounting system and linked to clinical events. Other clinical outcomes data bases are now being used by the case manager to help with the collection and measurement of outcomes information. Hoshin planning will continue to be a framework for defining and setting the targets for clinical and financial improvements throughout the organization. Case managers will continue to be involved in many of these system-wide initiatives. In the words of Galileo, 1579, "You need to count what's countable, measure what's measurable, and what's not measurable, make measurable."

  2. A scoping review of outcomes related to orthodontic treatment measured in cleft lip and palate.

    Science.gov (United States)

    Tsichlaki, A; O'Brien, K; Johal, A; Fleming, P S

    2017-05-01

    The aim of this study was to identify and summarize the outcomes measured in orthodontic studies of children with cleft lip and/or palate. The objectives were to categorize the outcomes into pre-determined domains and to explore whether any domains were under-represented. Electronic databases and grey literature were searched until December 2016 to identify all studies of orthodontic treatment interventions in children and adolescents with cleft lip and palate. Abstracts and subsequently eligible full-text articles were screened independently and in duplicate by two reviewers. All reported outcome measures were identified and categorized into six predetermined outcome domains. The search identified 833 abstracts. The majority of studies did not assess orthodontic interventions and were therefore not eligible for inclusion. Consequently, following screening 71 eligible articles were retrieved in full, of which 40 met the inclusion criteria. Morphological features of malocclusion were measured in 27 studies (68%) and adverse effects of orthodontic treatment in 10 (25%). Functional status (n=4; 10%), physical consequences of malocclusion (n=3; 7.5%), quality of life (n=3; 7.5%) and health resource utilization (n=2; 5%) were rarely considered. Relatively few studies concerning patients with cleft lip and palate focused on orthodontic interventions. Most of the identified outcomes were concerned with measuring morphological treatment-related changes and do not reflect patient perspectives. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Functional outcomes after bilateral arthroscopic rotator cuff repair.

    Science.gov (United States)

    Aleem, Alexander W; Syed, Usman Ali M; Wascher, Jocelyn; Zoga, Adam C; Close, Koby; Abboud, Joseph A; Cohen, Steven B

    2016-10-01

    Arthroscopic repair of rotator cuff tears is a common procedure performed by orthopedic surgeons. There is a well-known incidence of up to 35% of bilateral rotator cuff tear disease in patients who have a known unilateral tear. The majority of the literature focuses on outcomes after unilateral surgery. The purpose of this study was to determine if there are clinical differences in shoulders of patients who underwent staged bilateral rotator cuff repairs during their lifetime. A retrospective review of all patients who underwent staged bilateral arthroscopic rotator cuff surgery at our institution was performed. All patients had at least 2 years of follow-up. Clinical outcome scores including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Rowe measures were obtained. A subset of patients returned for clinical and ultrasound evaluation performed by an independent fellowship-trained musculoskeletal radiologist. Overall, 110 shoulders in 55 patients, representing 68% of all eligible patients, participated. No clinical or statistical difference was found in any outcome measure. ASES scores averaged 86.5 (36.7-100) in the dominant shoulder compared with 89.6 (23.3-100) in the nondominant shoulder (P = .42). Ultrasound was available on 34 shoulders and showed complete healing rate of 88%. The shoulders with retearing of the rotator cuff (12%) demonstrated clinically relevant lower ASES scores (72.5) compared with shoulders with confirmed healed repairs (86.2; P = .2). Patients who undergo staged bilateral rotator cuff repair can expect to have similarly good clinical outcomes regardless of hand dominance or chronologic incidence with excellent healing rates in both shoulders. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  4. Directly measured secondhand smoke exposure and COPD health outcomes

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    Balmes John

    2006-06-01

    Full Text Available Abstract Background Although personal cigarette smoking is the most important cause and modulator of chronic obstructive pulmonary disease (COPD, secondhand smoke (SHS exposure could influence the course of the disease. Despite the importance of this question, the impact of SHS exposure on COPD health outcomes remains unknown. Methods We used data from two waves of a population-based multiwave U.S. cohort study of adults with COPD. 77 non-smoking respondents with a diagnosis of COPD completed direct SHS monitoring based on urine cotinine and a personal badge that measures nicotine. We evaluated the longitudinal impact of SHS exposure on validated measures of COPD severity, physical health status, quality of life (QOL, and dyspnea measured at one year follow-up. Results The highest level of SHS exposure, as measured by urine cotinine, was cross-sectionally associated with poorer COPD severity (mean score increment 4.7 pts; 95% CI 0.6 to 8.9 and dyspnea (1.0 pts; 95% CI 0.4 to 1.7 after controlling for covariates. In longitudinal analysis, the highest level of baseline cotinine was associated with worse COPD severity (4.7 points; 95% CI -0.1 to 9.4; p = 0.054, disease-specific QOL (2.9 pts; -0.16 to 5.9; p = 0.063, and dyspnea (0.9 pts; 95% CI 0.2 to 1.6 pts; p Conclusion Directly measured SHS exposure appears to adversely influence health outcomes in COPD, independent of personal smoking. Because SHS is a modifiable risk factor, clinicians should assess SHS exposure in their patients and counsel its avoidance. In public health terms, the effects of SHS exposure on this vulnerable subpopulation provide a further rationale for laws prohibiting public smoking.

  5. Pain and functional outcome after vertebroplasty and kyphoplasty. A comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz Santiago, Fernando, E-mail: ferusan@ono.co [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Perez Abela, Antonio [Department of Traumatology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Guzman Alvarez, Luis [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada Spain (Spain); Alvarez Osuna, Rosa Maria [Department of Traumatology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Mar Castellano Garcia, Maria del [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain)

    2010-08-15

    Purpose: The aim of this study was to compare the effectiveness of percutaneous vertebroplasty and kyphoplasty to treat pain from non-neoplastic vertebral fractures and improve functional outcomes. Materials and methods: We compared 30 patients treated by vertebroplasty for non-neoplastic vertebral fractures with 30 patients treated by kyphoplasty for the same condition. Pain was measured with a visual analogue scale (VAS) and functional outcome with the Oswestry disability index (ODI). Baseline data were compared with measurements on the day after the procedure (for pain alone) and at 1 month, 6 months, and 1 year. Results: The VAS pain score was reduced by 4-5 points on the day after either type of treatment, a statistically significant improvement. The global ODI was significantly improved (by 13-18 points) at 1 month after either procedure. These improvements persisted at 6 months and 1 year. No significant differences in functional outcome were observed between the techniques. Conclusion: Vertebroplasty and kyphoplasty obtain similar improvements in pain and functional outcomes in these patients. The choice of technique must therefore depend on other factors. An initial improvement with either technique is a good predictor of long-term improvement.

  6. On the measurability of quantum correlation functions

    Energy Technology Data Exchange (ETDEWEB)

    Lima Bernardo, Bertúlio de, E-mail: bertulio.fisica@gmail.com; Azevedo, Sérgio; Rosas, Alexandre

    2015-05-15

    The concept of correlation function is widely used in classical statistical mechanics to characterize how two or more variables depend on each other. In quantum mechanics, on the other hand, there are observables that cannot be measured at the same time; the so-called incompatible observables. This prospect imposes a limitation on the definition of a quantum analog for the correlation function in terms of a sequence of measurements. Here, based on the notion of sequential weak measurements, we circumvent this limitation by introducing a framework to measure general quantum correlation functions, in principle, independently of the state of the system and the operators involved. To illustrate, we propose an experimental configuration to obtain explicitly the quantum correlation function between two Pauli operators, in which the input state is an arbitrary mixed qubit state encoded on the polarization of photons.

  7. FUNCTIONAL OUTCOME OF ARTHROSCOPIC RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT TEARS

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    Ashok Kumar

    2016-02-01

    Full Text Available BACKGROUND Anterior Cruciate Ligament (ACL tear is the most common serious ligamentous injury to the knee joint. Anterior Cruciate Ligament (ACL injury is quite common among young active population, athletes and contact sports. The exact incidence of anterior cruciate ligament tears is not known as the cases are being under reported. The ACL is the primary stabilizer against anterior translation of the tibia on the femur and is important in counteracting rotation and valgus stress. MATERIALS AND METHODS Between November 2012 to October 2014, 34 consecutive patients who underwent arthroscopic assisted ACL reconstructions in the Department of Orthopedics and Traumatology, King George Hospital, Visakhapatnam were the material in our study. Age groups between 18 to 45 years considered. We utilised both BPTB and Quadrupled hamstring graft depending on the patient’s age, outcome testing in all cases was performed at the latest follow-up (at least 6 months. Post-operative physiotherapy rehabilitation protocol followed for 06 months. RESULTS Standard protocol of Lysholm and IKDC knee scoring system were used for evaluation of the results of the surgery during followup. Patients were evaluated periodically at preop, 3 months, 6 months, 12 months, 18 months and 24 months. CONCLUSION Patients with isolated ACL injury had better outcome compared to patients who underwent associated meniscectomy. Most common mechanism of injury was activity of sports in 20 patients. Postoperatively at 3 months, anterior drawer’s was 1+ in 6, 29 (85.2% patients had normal range of motion; 29 (85.29% patients had 5/5 quadriceps power (MRC grading 94% of them had 5/5 power at latest followup. No significant difference between outcomes of BPTB and Hamstrings graft. Functional outcome of our study were similar to the previously published studies.

  8. Measuring the outcome of biomedical research: a systematic literature review.

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    Frédérique Thonon

    Full Text Available There is an increasing need to evaluate the production and impact of medical research produced by institutions. Many indicators exist, yet we do not have enough information about their relevance. The objective of this systematic review was (1 to identify all the indicators that could be used to measure the output and outcome of medical research carried out in institutions and (2 enlist their methodology, use, positive and negative points.We have searched 3 databases (Pubmed, Scopus, Web of Science using the following keywords: [Research outcome* OR research output* OR bibliometric* OR scientometric* OR scientific production] AND [indicator* OR index* OR evaluation OR metrics]. We included articles presenting, discussing or evaluating indicators measuring the scientific production of an institution. The search was conducted by two independent authors using a standardised data extraction form. For each indicator we extracted its definition, calculation, its rationale and its positive and negative points. In order to reduce bias, data extraction and analysis was performed by two independent authors.We included 76 articles. A total of 57 indicators were identified. We have classified those indicators into 6 categories: 9 indicators of research activity, 24 indicators of scientific production and impact, 5 indicators of collaboration, 7 indicators of industrial production, 4 indicators of dissemination, 8 indicators of health service impact. The most widely discussed and described is the h-index with 31 articles discussing it.The majority of indicators found are bibliometric indicators of scientific production and impact. Several indicators have been developed to improve the h-index. This indicator has also inspired the creation of two indicators to measure industrial production and collaboration. Several articles propose indicators measuring research impact without detailing a methodology for calculating them. Many bibliometric indicators identified

  9. FUNCTIONAL OUTCOME OF PHILOS PLATE FIXATION FOR PROXIMAL HUMERUS FRACTURES

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    Ch. Venkateswarlu

    2016-01-01

    Full Text Available INTRODUCTION Treating a proximal humerus fracture remained a challenging problem until proximal humeral internal locking system has been developed. Our study aims at evaluating the functional outcome of 30 consecutive patients with proximal humeral fracture treated by Philos plate fixation; 30 patients with proximal humeral fractures who attended our hospital between December 2013 and December 2015 were included in the study; 18 women and 12 men with a mean age of 47.5years (30-60 years are included. Data was collected prospectively and outcomes were assessed using constant shoulder score. The mean follow-up period was 12 months (6-18 months. Mean union time of all the fractures was 11.4 weeks (8-20 weeks. The mean constant shoulder score at final review was 70.5 (52-92. Philos plate provides stable fracture fixation for proximal humerus fracture in both young and elderly patients, which enables for early mobilisation and achieves acceptable functional results.

  10. Normal weight obesity and functional outcomes in older adults.

    Science.gov (United States)

    Batsis, John A; Sahakyan, Karine R; Rodriguez-Escudero, Juan P; Bartels, Stephen J; Lopez-Jimenez, Francisco

    2014-07-01

    Obesity defined by body mass index (BMI) is associated with higher levels of functional impairment. However, BMI strata misrepresent true adiposity, particularly in those with a normal BMI but elevated body fat (BF%) (normal weight obesity [NWO]) whom are at higher metabolic and mortality risk. Whether this subset of patients is associated with worsening functional outcomes is unclear. Subjects aged ≥60 years with a BMI ≥18.5 kg/m(2) from NHANES III (1988-1994) were included. We created sex-specific tertiles of BF%. Data on physical limitations (PL), instrumental (IADL) and basic activities of daily living (BADL) were obtained. The analysis focused on the association between NWO and these outcomes. Comparative rates among each tertile using logistic regression (referent=lowest tertile) were assessed, incrementally adding co-variates. Of the 4484 subjects aged ≥60 years, 1528 had a normal BMI, and the range of the mean age of tertiles was 69.9-71.2 years. Lean mass was lowest in the elevated BF% group than in the middle or low tertiles (42.6 vs 44.9 vs 45.8; polder adults in females only, highlighting the importance of recognizing the association of obesity with disability in elders. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  11. Minimal Clinically Important Difference of Patient Reported Outcome Measures of Lower Extremity Injuries in Orthopedics

    Science.gov (United States)

    Çelik, Derya; Çoban, Özge; Kılıçoğlu, Önder

    2017-01-01

    Purpose: MCID scores for outcome measures are frequently used evidence-based guides to gage meaningful changes. To conduct a systematic review of the quality and content of the the minimal clinically important difference (MCID) relating to 16 patient-rated outcome measures (PROM) used in lower extremity. Methods: We conducted a systematic literature review on articles reporting MCID in lower extremity outcome measures and orthopedics from January 1, 1980, to May 10, 2016. We evaluated MCID of the 16 patient reported outcome measures (PROM) which were Harris Hip Score (HHS), Oxford Hip Score (OHS), Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score (HOOS), The International Knee Documentation Committee Subjective Knee Form (IKDC), The Lysholm Scale, The Western Ontario Meniscal Evaluation Tool (WOMET), The Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QOL), The Lower Extremity Functional Scale (LEFS), The Western Ontario and Mcmaster Universities Index (WOMAC), Knee İnjury And Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Kujala Anterior Knee Pain Scale, The Victorian Institute of Sports Assessment Patellar Tendinosis (Jumper’s Knee) (VİSA-P), Tegner Activity Rating Scale, Marx Activity Rating Scale, Foot And Ankle Outcome Score (FAOS), The Foot Function Index (FFI), Foot And Ankle Ability Measure (FAAM), The Foot And Ankle Disability Index Score and Sports Module, Achill Tendon Total Rupture Score(ATRS), The Victorian İnstitute Of Sports Assesment Achilles Questionnaire(VİSA-A), American Orthopaedic Foot and Ankle Society (AOFAS). A search of the PubMed/MEDLINE, PEDro and Cochrane Cen¬tral Register of Controlled Trials and Web of Science databases from the date of inception to May 1, 2016 was conducted. The terms “minimal clinically important difference,” “minimal clinically important change”, “minimal clinically important improvement” “were combined with one of the PROM as mentioned above

  12. A comparison of functional outcome in patients sustaining major trauma: a multicentre, prospective, international study.

    Directory of Open Access Journals (Sweden)

    Timothy H Rainer

    Full Text Available OBJECTIVES: To compare 6 month and 12 month health status and functional outcomes between regional major trauma registries in Hong Kong and Victoria, Australia. SUMMARY BACKGROUND DATA: Multicentres from trauma registries in Hong Kong and the Victorian State Trauma Registry (VSTR. METHODS: Multicentre, prospective cohort study. Major trauma patients and aged ≥18 years were included. The main outcome measures were Extended Glasgow Outcome Scale (GOSE functional outcome and risk-adjusted Short-Form 12 (SF-12 health status at 6 and 12 months after injury. RESULTS: 261 cases from Hong Kong and 1955 cases from VSTR were included. Adjusting for age, sex, ISS, comorbid status, injury mechanism and GCS group, the odds of a better functional outcome for Hong Kong patients relative to Victorian patients at six months was 0.88 (95% CI: 0.66, 1.17, and at 12 months was 0.83 (95% CI: 0.60, 1.12. Adjusting for age, gender, ISS, GCS, injury mechanism and comorbid status, Hong Kong patients demonstrated comparable mean PCS-12 scores at 6-months (adjusted mean difference: 1.2, 95% CI: -1.2, 3.6 and 12-months (adjusted mean difference: -0.4, 95% CI: -3.2, 2.4 compared to Victorian patients. Keeping age, gender, ISS, GCS, injury mechanism and comorbid status, there was no difference in the MCS-12 scores of Hong Kong patients compared to Victorian patients at 6-months (adjusted mean difference: 0.4, 95% CI: -2.1, 2.8 or 12-months (adjusted mean difference: 1.8, 95% CI: -0.8, 4.5. CONCLUSION: The unadjusted analyses showed better outcomes for Victorian cases compared to Hong Kong but after adjusting for key confounders, there was no difference in 6-month or 12-month functional outcomes between the jurisdictions.

  13. Recanalization Modulates Association Between Blood Pressure and Functional Outcome in Acute Ischemic Stroke.

    Science.gov (United States)

    Martins, Ana Inês; Sargento-Freitas, João; Silva, Fernando; Jesus-Ribeiro, Joana; Correia, Inês; Gomes, João Pedro; Aguiar-Gonçalves, Mariana; Cardoso, Leila; Machado, Cristina; Rodrigues, Bruno; Santo, Gustavo C; Cunha, Luís

    2016-06-01

    Historical stroke cohorts reported a U- or J-shaped relationship between blood pressure (BP) and clinical outcome. However, these studies predated current revascularization strategies, disregarding the recanalization state of the affected arterial territory. We aimed to investigate the relationship between BP in the first 24 hours after ischemic stroke and clinical outcome in patients submitted to intravenous or intra-arterial recanalization treatments. Consecutive patients with acute stroke treated with intravenous thrombolysis or intra-arterial therapies were enrolled in a retrospective cohort study. BP was measured on regular intervals throughout day and night during the first 24 hours after stroke onset. The mean systolic BP and diastolic BP during the first 24 hours post stroke were calculated. Recanalization was assessed at 6 hours by transcranial color-coded Doppler, angiography, or angio-computed tomography. Functional outcome was assessed at 3 months by modified Rankin Scale. Linear and quadratic multivariate regression models were performed to determine associations between BP and functional outcome for the whole population and recanalyzed and nonrecanalyzed patients. We included 674 patients; mean age was 73.28 (SD, 11.50) years. Arterial recanalization was documented in 355 (52.70%) patients. In multivariate analyses, systolic BP and diastolic BP in the first 24 hours post stroke show a J-shaped relationship with functional outcome in the total population and in the nonrecanalyzed patients. Recanalyzed patients show a linear association with functional outcome (systolic BP: odds ratio, 1.015; 95% confidence interval, 1.007-1.024; P=0.001; R(2) change=0.001; P=0.412 and diastolic BP: odds ratio, 1.019; 95% confidence interval, 1.004-1.033; P=0.012; R(2) changeischemic stroke influences 3-month clinical outcome. This association is dependent on the revascularization status. © 2016 American Heart Association, Inc.

  14. Methods for Developing Patient-Reported Outcome-Based Performance Measures (PRO-PMs).

    Science.gov (United States)

    Basch, Ethan; Spertus, John; Dudley, R Adams; Wu, Albert; Chuahan, Cynthia; Cohen, Perry; Smith, Mary Lou; Black, Nick; Crawford, Amaris; Christensen, Keri; Blake, Kathleen; Goertz, Christine

    2015-06-01

    To recommend methods for assessing quality of care via patient-reported outcome-based performance measures (PRO-PMs) of symptoms, functional status, and quality of life. A Technical Expert Panel was assembled by the American Medical Association-convened Physician Consortium for Performance Improvement. An environmental scan and structured literature review were conducted to identify quality programs that integrate PRO-PMs. Key methodological considerations in the design, implementation, and analysis of these PRO-PM data were systematically identified. Recommended methods for addressing each identified consideration were developed on the basis of published patient-reported outcome (PRO) standards and refined through public comment. Literature review focused on programs using PROs to assess performance and on PRO guidance documents. Thirteen PRO programs and 10 guidance documents were identified. Nine best practices were developed, including the following: provide a rationale for measuring the outcome and for using a PRO-PM; describe the context of use; select a measure that is meaningful to patients with adequate psychometric properties; provide evidence of the measure's sensitivity to differences in care; address missing data and risk adjustment; and provide a framework for implementation, interpretation, dissemination, and continuous refinement. Methods for integrating PROs into performance measurement are available. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  15. Psychometric properties of the Spanish version of the Clinical Outcomes in Routine Evaluation – Outcome Measure

    Directory of Open Access Journals (Sweden)

    Trujillo A

    2016-06-01

    Full Text Available Adriana Trujillo,1,2 Guillem Feixas,1,2 Arturo Bados,1 Eugeni García-Grau,1 Marta Salla,1 Joan Carles Medina,1 Adrián Montesano,1,2 José Soriano,3 Leticia Medeiros-Ferreira,4 Josep Cañete,5 Sergi Corbella,6 Antoni Grau,7 Fernando Lana,8 Chris Evans9 1Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, 2Institute for Brain, Cognition and Behaviour, University of Barcelona, 3Hospital of the Holy Cross and Saint Paul, 4Nou Barris Mental Health Center, Barcelona, 5Hospital of Mataró, Sanitary Consortium of Maresme, Mataró, 6FPCEE, Blanquerna, Universitat Ramon Llull, 7Institute of Eating Disorders, Barcelona, 8MAR Health Park, CAEMIL, Santa Coloma de Gramenet, Spain; 9East London NHS Foundation Trust, NPDDNet, London, UK Objective: The objective of this paper is to assess the reliability and validity of the Spanish translation of the Clinical Outcomes in Routine Evaluation – Outcome Measure, a 34-item self-report questionnaire that measures the client’s status in the domains of Subjective well-being, Problems/Symptoms, Life functioning, and Risk.Method: Six hundred and forty-four adult participants were included in two samples: the clinical sample (n=192 from different mental health and primary care centers; and the nonclinical sample (n=452, which included a student and a community sample.Results: The questionnaire showed good acceptability and internal consistency, appropriate test–retest reliability, and acceptable convergent validity. Strong differentiation between clinical and nonclinical samples was found. As expected, the Risk domain had different characteristics than other domains, but all findings were comparable with the UK referential data. Cutoff scores were calculated for clinical significant change assessment.Conclusion: The Spanish version of the Clinical Outcomes in Routine Evaluation – Outcome Measure showed acceptable psychometric properties, providing support for using the

  16. Vector Spaces of Non-measurable Functions

    Institute of Scientific and Technical Information of China (English)

    Francisco J. GARC(I)A-PACHECO; Juan B. SEOANE-SEP(U)LVEDA

    2006-01-01

    We show that there exists an infinite dimensional vector space every non-zero element of which is a non-measurable function. Moreover, this vector space can be chosen to be closed and to have dimensionβ for any cardinalityβ. Some techniques involving measure theory and density characters of Banach spaces are used.

  17. Metacognition as a Mediating Variable Between Neurocognition and Functional Outcome in First Episode Psychosis.

    Science.gov (United States)

    Davies, Geoff; Fowler, David; Greenwood, Kathryn

    2016-09-02

    Neurocognitive and functional outcome deficits have long been acknowledged in schizophrenia and neurocognition has been found to account for functional disability to a greater extent than psychopathology. Much of the variance in functional outcome however still remains unexplained and metacognition may mediate the relationship between neurocognition, functional capacity, and self-reported social and occupational function. Eighty first episode psychosis participants were recruited and completed measures of neurocognition (memory, executive function, and intelligence quotient), metacognition (Beck Cognitive Insight Scale, Metacognitive Awareness Interview), psychopathology (PANSS), and both functional capacity (UPSA) and real-life social and occupational function (The Time Use Survey). Path analyses investigated the relationships between variables through structural equation modeling. A series of path models demonstrated that metacognition partially mediates the relationship between neurocognition and functional capacity, and fully mediates the relationship between functional capacity and social and occupational function. The present study findings identify that metacognition may be critical to translating cognitive and functional skills into real-world contexts, and this relationship is found at early stages of illness. Understanding how individuals translate cognitive and functional skills into the real-world (the competence-performance gap) may offer valuable guidance to intervention programs. This finding is important to models of recovery as it suggests that intervention programs that focus on enhancing metacognition abilities may have a greater impact than traditional rehabilitation programs focusing on cognitive abilities, on social and occupational outcomes. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  18. Functional neuromuscular stimulation: outcomes in young people with tetraplegia.

    Science.gov (United States)

    Mulcahey, M J; Smith, B T; Betz, R R; Triolo, R J; Peckham, P H

    1994-01-01

    Percutaneous intramuscular functional neuromuscular stimulation (FNS) systems were fitted to the forearms of five adolescents with tetraplegia in an effort to provide active grasp and release. Two assessments designed at Case Western Reserve University to evaluate functional outcomes of FNS in adults were employed. The common object test (COT) was used to assess hand function during five activities of daily living (ADLs): eating, drinking, writing, brushing teeth and applying toothpaste. A usage survey provided information on the frequency of FNS use in environments outside of the laboratory. In addition, interviews were employed using open-ended questions to gain a deeper understanding of the perceptions of FNS in the adolescents' own environments. Based on the COT results, each adolescent was able to perform ADLs with and without FNS. However, FNS allowed unilateral function so that the extremity without FNS was freed to assist in balance or participate in bilateral tasks. Also, FNS reduced the need for multiple devices, providing users with the potential to perform activities in a variety of environments without transporting adaptive equipment. Those who reported using FNS most often obtained hard-bound school books, held pens during classroom and homework assignments, engaged in leisure activities and performed hygiene tasks. FNS was also used as a means to communicate and socialize through hand gestures. Well-known factors that influence the independence of people with tetraplegia also appeared to affect FNS use.

  19. Clinical and functional outcomes of tibial intercalary allograft reconstructions

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    Lucas López Millán

    2012-12-01

    Full Text Available Background The purpose of this study was to evaluate the survival, the complications and the functional outcome of intercalary tibial allografts reconstructions following tumor resections. Methods Intercalary tibia segmental allografts were implanted in 26 consecutive patients after segmental resections. Average follow-up was 6 years. Allograft survival was determined with the Kaplan-Meier method. Function was evaluated with the Musculoskeletal Tumor Society scoring system (MSTS. Results The rate of survival was 84% (CI 95%: 90%- 70% at 5 years and 79% at 10 years (CI 95%: 95%-63%. Allografts were removed in 5 patients (3 due to infections and 2 due to local recurrences. Two patients showed diaphyseal nonunion and 3 had an incomplete fracture, but it was not necessary to remove the allografts. Average MSTS functional score was 29 points (range 27 to 30. Conclusions Despite the incidence of complications, this analysis showed an acceptable survival with excellent functional scores. The use of intercalary allograft clearly has a place in the reconstruction of a segmental defect created by the resection of a tumor in the diaphyseal and/or metaphyseal portion of the tibia.

  20. Measuring cognitive outcomes in a pre-clinical bioethics course.

    Science.gov (United States)

    Fernandes, Ashley K; Borges, Nicole; Rodabaugh, Heather

    2012-05-01

    Medical schools universally accept the idea that bioethics courses are essential components of education, but few studies which measure outcomes (i.e., knowledge or retention) have demonstrated their educational value in the literature. The goal of this study was to examine whether core concepts of a pre-clinical bioethics course were learned and retained. Over the course of 2 years, a pre-test comprising 25 multiple-choice questions was administered to two classes (2008-2010) of first-year medical students prior to the start of a 15-week ethics course, and an identical post-test was administered at the end of the course. A total of 189 students participated. Paired t tests showed a significant difference between pre-test scores and post-test scores. The pre-test average score was 69.8 %, and the post-test average was 82.6 %, an increase of 12.9 % after the ethics course. The pre- and post-test results also suggested a shift in difficulty level of the questions, with students finding identical questions easier after the intervention. Given the increase in post-test scores after the 15-week intervention, the study suggests that core concepts in medical ethics were learned and retained. These results demonstrate that an introductory bioethics course can improve short-term outcomes in knowledge and comprehension, and should provide impetus to educators to demonstrate improved educational outcomes in ethics at higher levels of B.S. Bloom's Taxonomy of Learning.

  1. Training working memory and fluid intelligence in older adults: developing measures and exploring outcomes

    OpenAIRE

    Hynes, Sinéad

    2013-01-01

    This thesis investigates computerised cognitive training in older adults, with a focus on training working memory and fluid intelligence. A series of studies is reported, with two broad aims. The first was to develop and validate outcome measures appropriate for use in this population, and the second was to examine whether established gains in cognitive functioning generalised to everyday life. In relation to the first aim, two studies were conducted which concerned the development of a se...

  2. Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury: Update and Preliminary Outcomes.

    Science.gov (United States)

    Fox, Ida K; Davidge, Kristen M; Novak, Christine B; Hoben, Gwendolyn; Kahn, Lorna C; Juknis, Neringa; Ruvinskaya, Rimma; Mackinnon, Susan E

    2015-10-01

    Cervical spinal cord injury can result in profound loss of upper extremity function. Recent interest in the use of nerve transfers to restore volitional control is an exciting development in the care of these complex patients. In this article, the authors review preliminary results of nerve transfers in spinal cord injury. Review of the literature and the authors' cases series of 13 operations in nine spinal cord injury nerve transfer recipients was performed. Representative cases were reviewed to explore critical concepts and preliminary outcomes. The nerve transfers used expendable donors (e.g., teres minor, deltoid, supinator, and brachialis) innervated above the level of the spinal cord injury to restore volitional control of missing function such as elbow extension, wrist extension, and/or hand function (posterior interosseous nerve or anterior interosseous nerve/finger flexors reinnervated). Results from the literature and the authors' patients (after a mean postsurgical follow-up of 12 months) indicate gains in function as assessed by both manual muscle testing and patients' self-reported outcomes measures. Nerve transfers can provide an alternative and consistent means of reestablishing volitional control of upper extremity function in people with cervical level spinal cord injury. Early outcomes provide evidence of substantial improvements in self-reported function despite relatively subtle objective gains in isolated muscle strength. Further work to investigate the optimal timing and combination of nerve transfer operations, the combination of these with traditional treatments (tendon transfer and functional electrical stimulation), and measurement of outcomes is imperative for determining the precise role of these operations. Therapeutic, IV.

  3. Vision and vision-related outcome measures in multiple sclerosis

    DEFF Research Database (Denmark)

    Balcer, Laura J; Miller, David H; Reingold, Stephen C

    2015-01-01

    sclerosis is growing, partially in response to the development of sensitive visual function tests, structural markers such as optical coherence tomography and magnetic resonance imaging, and quality of life measures that give clinical meaning to the structure-function correlations that are unique...... to the afferent visual pathway. Abnormal eye movements also are common in multiple sclerosis, but quantitative assessment methods that can be applied in practice and clinical trials are not readily available. We summarize here a comprehensive literature search and the discussion at a recent international meeting...

  4. Functional Independence Measure Penderita Cedera Servikal

    Directory of Open Access Journals (Sweden)

    Muhammad Zafrullah Arifin

    2013-09-01

    Full Text Available Cervical spine injury is one of the most common spinal cord injuries in trauma patients. From 100,000 spinal cord injury cases reported in the United States of America (2008, 2/3 involved cervical spine injury. American Spinal Cord Injury Association (ASIA Impairment Score is used as an initial assessment but further prognostic outcome of these patients is often not paid enough attention. The objective of this study was to find the value of functional independence measure (FIM cervical spine injury patients with conservative management and correlation with age, sex, type of trauma, onset of trauma, cervical bone abnormalities, type of spinal lesion and ASIA Impairment Score. A prospective cohort study was performed to all patients with cervical spine injury which fullfil the inclusion criteria treated in Neurosurgery Department of Dr. Hasan Sadikin Hospital Bandung. The subjects were classified based on age, sex, single/multiple trauma, acute/chronic, cervical bone abnormalities, complete/incomplete lesion, ASIA impairment score and initial complication. The patients were performed to FIM examination in Outpatient clinic of Neurosurgery. T-test and chi-square test with p<0.05 were done to analyze the data. There were 17 cervical spine injury patients treated in Neurosurgery Department of Dr. Hasan Sadikin Hospital Bandung during April 2009–April 2010. The average FIM value of cervical spine injury in those patients was 4+1.63 by cohort prospective study. There were no correlation between FIM value with age (p=0.064, sex (p=0.144, type of trauma (p=0.959, onset of trauma (p=0.220 and cervical bone abnormalities (p=0.869. We found a significant correlation between FIM value with type of cervical spine lesion (p=0.037 and ASIA Impairment Score (p<0.001 in cervical spine patients. In conclusion, type of cervical spine lesion and ASIA impairment score have significant correlation with FIM value of patients in 3 months after cervical injury.

  5. Functional outcome of the surgical management of acute acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    Naseem Munshi; Asad Abbas; Mohamed Amirali Gulamhussein; Ghulam Mehboob; Rija Aitzaz Qureshi

    2015-01-01

    Objective:To assess the functional outcome of early surgical management of displaced acetabular fractures and the complications associated with the procedure. Methods: This is a case series study and data was collected using specialized performance. The study included 75 patients and the sampling technique was a non-probability purposive type. Patients presenting with close displaced acetabular fractures of more than 2 mm within 10 days of injury were included. However, elderly patients presenting after 10 days of injury, with evidence of local infection, severe osteoporotic bone and co-morbid such as chronic obstructive pulmonary disease were not included in the study. New acetabular scoring system was used for assessing outcome of patients. Results:A total of 75 patients were operated on. Union was achieved in anatomical position in 66 (88%) patients and in malposition in 9 (12%) patients. Excellent results were obtained in 18 (24%) patients, good results in 41 (54.6%), fair results in 12 (16%), and poor results in 4 (5.4%) patients. Postoperative complications included infection [5 (6.7%)], heterotropic ossification [3 (4%)], sciatic nerve injury [10 (13.3%)], avascular necrosis [3 (4%)] patients. Conclusions: Patients with displaced acetabular fractures should be referred to specialised centres. Early surgical intervention and experienced management is a prime factor in achieving good results.

  6. SEIZURE SEVERITY AS AN ALTERNATIVE MEASURE OF OUTCOME IN EPILEPSY

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    Koraliya S. Todorova

    2013-07-01

    Full Text Available Seizure severity emerges as an important aspect of epilepsy. This is most relevant in refractory patients in whom complete remission of seizures is unlikely and reduced seizure severity may be a significant determinant of psychosocial well-being with a consequent improvement in quality of life (QOL. Thus a valid measure of seizure severity can serve both as an indicator of clinical outcome and as an evaluation tool of the interaction between seizures and the psychosocial complications of epilepsy.After a brief review of the most frequently used scales measuring seizure severity in adults with epilepsy we have explored the relationship between seizure severity and QOL in a set of 103 patients. Two self-evaluation questionnaires were applied: the Seizure Severity Questionnaire (SSQ and the Quality of Life in Epilepsy Inventory (QOLIE-31. The severity of the coexisting depression, an important confounder in the relationship between seizure severity and QOL, was assessed by the Hamilton Depression Rating Scale (HAMD-17.All domains of the Quality-of-Life in Epilepsy Inventory (QOLIE-31 correlated highly significantly with seizure severity (p≤0.01. The correlation was strong for the Overall score (r=-0.70; p≤0.001 and the Seizure worry domain (r=-0.71; p≤0.001. When the potentially confounding effect of depression was controlled for, the regression of seizure severity with the QOLIE-31 Overall score (P=0.001; R²=0.56 and the Seizure worry domain (P=0.001; R²=0.50 remained significant. These findings indicate that seizure severity is strongly associated with QOL in epilepsy and could be used as an alternative indicator of outcome in clinical research.

  7. Outcome Measures for Clinical Drug Trials in Autism

    Science.gov (United States)

    Aman, Michael G.; Novotny, Sherie; Samango-Sprouse, Carole; Lecavalier, Luc; Leonard, Elizabeth; Gadow, Kenneth D.; King, Bryan H.; Pearson, Deborah A.; Gernsbacher, Morton Ann; Chez, Michael

    2015-01-01

    This paper identifies instruments and measures that may be appropriate for randomized clinical trials in participants with autism spectrum disorders (ASDs). The Clinical Global Impressions scale was recommended for all randomized clinical trials. At this point, however, there is no “perfect” choice of outcome measure for core features of autism, although we will discuss five measures of potential utility. Several communication instruments are recommended, based in part on suitability across the age range. In trials where the intention is to alter core features of ASDs, adaptive behavior scales are also worthy of consideration. Several “behavior complexes” common to ASDs are identified, and instruments are recommended for assessment of these. Given the prevalence of cognitive impairment in ASDs, it is important to assess any cognitive effects, although cognitive data from ASD randomized clinical trials, thus far, are minimal. Guidance from trials in related pharmacologic areas and behavioral pharmacology may be helpful. We recommend routine elicitation of side effects, height and weight, vital signs, and (in the case of antipsychotics) extrapyramidal side-effects assessment. It is often appropriate to include laboratory tests and assessments for continence and sleep pattern. PMID:14999174

  8. A prospective study of short-term functional outcome after dysvascular major lower limb amputation.

    Science.gov (United States)

    Madsen, Ulla Riis; Bååth, Carina; Berthelsen, Connie Bøttcher; Hommel, Ami

    2017-08-12

    This study investigates functional status on Day 21 after dysvascular major lower limb amputation compared with one month pre-amputation and evaluates factors potentially influencing outcome. A prospective cohort study design was used. Data were collected via in-person interviews using structured instruments and covered functional level (Barthel index 100) one month pre-amputation and on Day 21. Out of a consecutive sample of patients having major lower limb amputation (tibia, knee or femoral) (n = 105), 51 participated on Day 21 follow-up. Clinical, demographic, body function and environmental data were analysed as factors potentially influencing outcome. From pre-amputation to Day 21, participants' functional level decreased significantly in all ten activities of daily living activities as measured by the Barthel Index. Almost 60% of participants were independent in bed-chair transfer on Day 21. Being independent in transfer on Day 21 was positively associated with younger age and attending physiotherapy after discharge. The findings indicate that short-term functional outcome is modifiable by quality of the postoperative care provided and thus highlights the need for increased focus on postoperative care to maintain basic function as well as establish and provide everyday rehabilitation in the general population of patients who have dysvascular lower limb amputations. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. A Meta-Analysis of Emotion Perception and Functional Outcomes in Schizophrenia

    Science.gov (United States)

    Irani, Farzin; Seligman, Sarah; Kamath, Vidyulata; Kohler, Christian; Gur, Ruben C.

    2012-01-01

    Introduction Emotion perception (EP) is impaired in schizophrenia, is stable across clinical state, resistant to antipsychotic treatment and linked to symptom severity. Given its pervasive nature, there is a need to quantitatively examine whether this dysfunction impacts functional outcomes. We used a meta-analytic strategy to combine results from several studies and examine synthesized effect sizes. Methods A Meta-analysis Of Observational Studies in Epidemiology standard was used to extract data following a PubMed and PsychInfo search. Studies reporting correlations between measures of EP and functional outcomes in schizophrenia spectrum disorders were selected. The impact of potential methodological (task type), demographic (sex, age, race, education, marital status) and clinical (age of onset, duration of illness, setting, symptoms, anti-psychotic medication) moderators on effect sizes were examined. Results Twenty-five studies met inclusion criteria and included 1306 patients who were 37 years old, with 12 years of education, 64% male and 63% Caucasian. There was a significant relationship between EP and functional outcomes in individuals with schizophrenia or schizoaffective disorder, with effect sizes in the medium range. Medium to large range positive correlations were observed between emotion identification and functional outcome domains involving social problem solving, social skills and community functioning. Significant moderators included task type (emotion identification tasks), sex (% male in sample), race (% Caucasian in sample) and clinical symptoms (negative and positive). Conclusions Emotion identification deficits are associated with functional impairments in schizophrenia and moderated by sex, race and symptoms. This has implications for treatment efforts to improve outcomes. PMID:22341200

  10. Objective versus subjective outcome measures of biofeedback: what really matters?

    Science.gov (United States)

    Berry, Amanda; Rudick, Kristen; Richter, Meg; Zderic, Stephen

    2014-08-01

    Clinical epidemiologic studies suggest that once established, voiding dysfunction can become a lifelong condition if not treated correctly early on in life. Biofeedback is one component of a voiding retraining program to help children with voiding dysfunction. Our goal was to compare objective non-invasive urodynamic data obtained during office biofeedback sessions with patient reported voiding symptom scores. Charts of 55 children referred in 2010 for pelvic floor muscle biofeedback therapy for urinary incontinence were retrospectively reviewed. Patients with any anatomic diagnoses were excluded. Forty-seven (86%) females and eight males (14%) with a mean age of 8.2 years made up the cohort. Uroflow curves, voided volumes, and post-void residuals were recorded at each visit and served as objective data. Volumes were normalized as a percentage of expected bladder capacity according to age. The patient reported symptom score and patient reported outcome (improved, no change or worse) served as subjective measures of intervention. The primary referral diagnoses were day and night wetting in 37 (67%) and daytime incontinence in 18 (33%) children. A history of urinary tract infection (UTI) was noted in 32 (64%) patients, and 25% were maintained on antibiotic prophylaxis during the study period. Twenty-nine percent were maintained on anticholinergic medication. Patients attended an average of 2.5 biofeedback sessions. Voided volumes and post void residual volumes were unchanged, 50% of the abnormal uroflow curves normalized over the course of treatment (p biofeedback were rated an improved in 26 (47%), no change in 15 (27%), worse in three (5%) patients, and not rated in 11 patients (21%). Pelvic floor muscle biofeedback is associated with patient-reported improvement in symptoms, reduction in voiding symptom score, and normalization of uroflow curves, but these improvements are not correlated with objective parameters of voided volumes and post-void residual urine

  11. Factors predicting work outcome in Japanese patients with schizophrenia: role of multiple functioning levels

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    Chika Sumiyoshi

    2015-09-01

    Full Text Available Functional outcomes in individuals with schizophrenia suggest recovery of cognitive, everyday, and social functioning. Specifically improvement of work status is considered to be most important for their independent living and self-efficacy. The main purposes of the present study were 1 to identify which outcome factors predict occupational functioning, quantified as work hours, and 2 to provide cut-offs on the scales for those factors to attain better work status. Forty-five Japanese patients with schizophrenia and 111 healthy controls entered the study. Cognition, capacity for everyday activities, and social functioning were assessed by the Japanese versions of the MATRICS Cognitive Consensus Battery (MCCB, the UCSD Performance-based Skills Assessment-Brief (UPSA-B, and the Social Functioning Scale Individuals’ version modified for the MATRICS-PASS (Modified SFS for PASS, respectively. Potential factors for work outcome were estimated by multiple linear regression analyses (predicting work hours directly and a multiple logistic regression analyses (predicting dichotomized work status based on work hours. ROC curve analyses were performed to determine cut-off points for differentiating between the better- and poor work status. The results showed that a cognitive component, comprising visual/verbal learning and emotional management, and a social functioning component, comprising independent living and vocational functioning, were potential factors for predicting work hours/status. Cut-off points obtained in ROC analyses indicated that 60–70% achievements on the measures of those factors were expected to maintain the better work status. Our findings suggest that improvement on specific aspects of cognitive and social functioning are important for work outcome in patients with schizophrenia.

  12. Communication abnormalities predict functional outcomes in chronic schizophrenia: differential associations with social and adaptive functions.

    Science.gov (United States)

    Bowie, Christopher R; Harvey, Philip D

    2008-08-01

    Communication abnormalities are hallmark features of schizophrenia. Despite the prevalence and persistence of these symptoms, little is known about their functional implications. In this study, we examined, in a sample of chronically institutionalized schizophrenia patients (N=317), whether two types of communication abnormalities (i.e., verbal underproductivity and disconnected speech) had differential relationships with social and adaptive outcomes. Baseline ratings of verbal underproductivity, disconnected speech, global cognitive performance, and clinical symptoms, were entered into stepwise regression analyses to examine their relationship with 2.5 year social and adaptive outcomes. At baseline, disconnected speech was significantly associated with socially impolite behavior, while verbal underproductivity was associated with social disengagement and impaired friendships. Both types of communication abnormalities were significantly associated with other types of social skills. Verbal underproductivity predicted follow-up social skills, social engagement, and friendships, accounting for more variance than. cognition or symptoms. In contrast to social outcomes, adaptive outcomes were predicted by baseline neurocognition and clinical symptoms, but not communication abnormalities. These findings provide evidence for specific relationships of communication disorder subtypes with diverse impairments in social functions. In this chronically institutionalized sample, communication disorder was a stronger predictor of social, but not adaptive, outcomes than neurocognition or clinical symptoms.

  13. A psychometric analysis of outcome measures in peripheral spondyloarthritis

    Science.gov (United States)

    Turina, Maureen C; Baeten, Dominique L; Mease, Philip; Paramarta, Jacqueline E; Song, In-Ho; Pangan, Aileen L; Landewé, Robert

    2016-01-01

    Objectives To assess the discriminatory capacity of various outcome measures and response criteria in patients with peripheral spondyloarthritis (pSpA). Methods Data originated from two randomised controlled trials, ABILITY-2 and Tnf Inhibition in PEripheral SpondyloArthritis (TIPES). Continuous outcome measures included patient's global assessment (PGA)/physician's global assessment of disease (PhGA), C-reactive protein (CRP), tender joint counts (TJC)/swollen joint counts (SJC), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Ankylosing Spondylitis Disease Activity Score (ASDAS). Dichotomous response criteria included Peripheral SpondyloArthritis Response Criteria (PSpARC), American College of Rheumatology (ACR), ASDAS and BASDAI response criteria. The capacity to discriminate between adalimumab and placebo groups was assessed by standardised mean differences (SMD) for continuous variables, and Pearson's χ2 for dichotomous response criteria. Results Within each trial, the composite indices for axial SpA assessment, ASDAS-CRP (SMD: −0.63 and −0.89 in ABILITY-2 and the TIPES trial, respectively) and BASDAI (SMD: −0.50 and −0.73), and the single-item measures PGA (SMD: −0.47 and −1.12) and PhGA (SMD: −0.64 and −0.87) performed better than other single-item measures, such as CRP (SMD: −0.18 and −0.53), SJC or TJC. In general, the PSpARC and ACR response criteria discriminated better than ASDAS and BASDAI response criteria. Conclusions The axial SpA-specific ASDAS-CRP and BASDAI, but also PGA and PhGA, demonstrated good discriminatory ability in patients with pSpA. The pSpA-specific pSpARC response criteria and the rheumatoid arthritis-specific ACR response criteria also discriminated well. To fully capture typical pSpA manifestations, it may be worth developing new pSpA-specific indices with better performance and face validity. Trial registration numbers ABILITY-2: NCT01064856; TIPES: EUDRACT 2008-006885-27. PMID:26245756

  14. Functional outcomes and quality of life in patients with subtalar arthrodesis for posttraumatic arthritis.

    Science.gov (United States)

    Hollman, Ernest J; van der Vliet, Quirine M J; Alexandridis, Georgios; Hietbrink, Falco; Leenen, Luke P H

    2017-07-01

    Subtalar arthrodesis is a common salvage operation for posttraumatic subtalar arthritis, a condition frequently seen in patients who suffered major trauma. Functional outcomes in trauma patients may be influenced by concomitant injuries and the severity of the initial trauma. The aim of this study was to evaluate quality of life and functional outcomes of subtalar arthrodesis for posttraumatic arthritis in patients with severe or complex foot injuries. This is a retrospective single center study with prospective follow-up. Patients who underwent subtalar arthrodesis for posttraumatic arthritis between 2000 and 2016 were included and invited to complete a Maryland Foot Score (MFS), a EuroQol five-dimensional (EQ-5D™) and Visual Analog Scale (EQ-VAS™) questionnaire, and four additional questions. Forty patients were included in the study, functional outcome scores were available for 30 patients (response rate 75%). Additional surgery of the fused foot was performed in 29 patients and 15 suffered multiple lower extremity injuries. Six patients were polytraumatized. Ninety percent of all patients would recommend the procedure to others, walking abilities improved in 69% and less pain was experienced in 76%. Median MFS score was 61 (IQR 53-72). Quality of life was significantly lower when compared to a reference population (p<0.001). Satisfaction was high, as 90% of all patients would recommend subtalar fusion to others, even though the relatively poor outcome measures would suggest differently. Existing functional outcomes measures were influenced by concomitant injuries and additional procedures. This demands development of instruments suitable for severely injured patients with multiple or complex injuries. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Radiotherapy deteriorates postoperative functional outcome after partial glossectomy with free flap reconstruction.

    Science.gov (United States)

    Shin, Yoo Seob; Koh, Yoon Woo; Kim, Se-Heon; Jeong, Jun Hui; Ahn, Sanghyeon; Hong, Hyun Jun; Choi, Eun Chang

    2012-01-01

    Most patients with tongue cancer require surgical resection of the tongue to varying degrees. As a result, quality of life, which is strongly related to speech, chewing, and swallowing, can deteriorate severely from extensive surgical treatment of tongue cancer. In addition to surgery, adjuvant therapy may affect the severity of functional impairment. Therefore, the influence of postoperative radiotherapy on functional outcome after partial glossectomy with free flap reconstruction was evaluated in patients with early oral tongue cancer. Functional outcome was measured and charts of 31 patients with oral tongue cancer who were surgically treated at Yonsei Head and Neck Cancer Clinic from 2003 through 2008 were reviewed. Only patients who underwent partial glossectomy and reconstruction with radial forearm free flap and did not develop recurrence were included. Speech integrity was evaluated with diadochokinetic testing by a professional speech therapist. Tongue mobility was checked by measurements of upward distance, protrusion distance, and lateral deviation distance. Swallowing capacity was evaluated with the M.D. Anderson Dysphagia Inventory. Diadochokinetic rates of the surgery-only and postoperative radiotherapy groups were 27.8 and 23.9, respectively, which was statistically different. Swallowing capacity was significantly superior in the surgery-only group. Tongue mobility was not statistically different between the 2 groups. Functional outcome of speech and swallowing is negatively influenced by postoperative radiotherapy. Copyright © 2012. Published by Elsevier Inc.

  16. A preliminary longitudinal study on the cognitive and functional outcome of bipolar excellent lithium responders.

    Science.gov (United States)

    Mora, E; Portella, M J; Forcada, I; Vieta, E; Mur, M

    2016-11-01

    Neurocognitive dysfunction in bipolar disorder represents a possible marker of underlying pathophysiology, but to date, most studies are cross-sectional and heterogeneous with regard to pharmacological treatments. In the present study we investigated the 6-year cognitive and functional outcome of a sample of euthymic excellent lithium responders (ELR). A total sample of twenty subjects was assessed at baseline and 6years later: ten diagnosed of bipolar disorder according to DSM-IV criteria and ten healthy matched controls. The sample size was enough to find statistical differences between groups, with a statistical power of 0.8. Bipolar patients were on lithium treatment during all this follow-up period and fulfilled ELR criteria as measured by the Alda scale. A neuropsychological test battery tapping into the main cognitive domains was used at baseline and at after 6-year of follow-up. Functional outcome was evaluated by means of the Functioning Assessment Short Test at study endpoint. Repeated measures multivariate analyses of variance showed that bipolar patients were cognitively impaired in the executive functioning, inhibition, processing speed and verbal memory domains (p<0.03) compared to controls and such deficits were stable over time. Longer duration of illness and lower psychosocial outcome were significantly related to cognitive impairment (p<0.05). Cognitive dysfunction was present even in euthymic ELR. These deficits remain stable over the long term, and are basically associated with greater symptoms and poorer psychosocial adjustment. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. A systematic framework for functional connectivity measures

    Directory of Open Access Journals (Sweden)

    Huifang Elizabeth Wang

    2014-12-01

    Full Text Available Various methods have been proposed to characterize the functional connectivity between nodes in a network measured with different modalities (electrophysiology, functional magnetic resonance imaging etc.. Since different measures of functional connectivity yield different results for the same dataset, it is important to assess when and how they can be used. In this work, we provide a systematic framework for evaluating the performance of a large range of functional connectivity measures – based upon a comprehensive portfolio of models generating measurable responses. Specifically, we benchmarked 42 methods using 10,000 simulated datasets from 5 different types of generative models with different connectivity structures. Since all functional connectivity methods require the setting of some parameters (window size and number, model order etc., we first optimized these parameters using performance criteria based upon (threshold free ROC analysis. We then evaluated the performance of the methods on data simulated with different types of models. Finally, we assessed the performance of the methods against different levels of signal-to-noise ratios and network configurations. A MATLAB toolbox is provided to perform such analyses using other methods and simulated datasets.

  18. Stereotype threat and executive functions: which functions mediate different threat-related outcomes?

    Science.gov (United States)

    Rydell, Robert J; Van Loo, Katie J; Boucher, Kathryn L

    2014-03-01

    Stereotype threat research shows that women's math performance can be reduced by activating gender-based math stereotypes. Models of stereotype threat assert that threat reduces cognitive functioning, thereby accounting for its negative effects. This work provides a more detailed understanding of the cognitive processes through which stereotype threat leads women to underperform at math and to take risks, by examining which basic executive functions (inhibition, shifting, and updating) account for these outcomes. In Experiments 1 and 2, women under threat showed reduced inhibition, reduced updating, and reduced math performance compared with women in a control condition (or men); however, only updating accounted for women's poor math performance under threat. In Experiment 3, only updating accounted for stereotype threat's effect on women's math performance, whereas only inhibition accounted for the effect of threat on risk-taking, suggesting that distinct executive functions can account for different stereotype threat-related outcomes.

  19. Arterial endothelial function measurement method and apparatus

    Energy Technology Data Exchange (ETDEWEB)

    Maltz, Jonathan S; Budinger, Thomas F

    2014-03-04

    A "relaxoscope" (100) detects the degree of arterial endothelial function. Impairment of arterial endothelial function is an early event in atherosclerosis and correlates with the major risk factors for cardiovascular disease. An artery (115), such as the brachial artery (BA) is measured for diameter before and after several minutes of either vasoconstriction or vasorelaxation. The change in arterial diameter is a measure of flow-mediated vasomodification (FMVM). The relaxoscope induces an artificial pulse (128) at a superficial radial artery (115) via a linear actuator (120). An ultrasonic Doppler stethoscope (130) detects this pulse 10-20 cm proximal to the point of pulse induction (125). The delay between pulse application and detection provides the pulse transit time (PTT). By measuring PTT before (160) and after arterial diameter change (170), FMVM may be measured based on the changes in PTT caused by changes in vessel caliber, smooth muscle tone and wall thickness.

  20. Measuring Dynamic Transfer Functions of Cavitating Pumps

    Science.gov (United States)

    Baun, Daniel

    2007-01-01

    A water-flow test facility has been built to enable measurement of dynamic transfer functions (DTFs) of cavitating pumps and of inducers in such pumps. Originally, the facility was intended for use in an investigation of the effects of cavitation in a rocket-engine low-pressure oxygen turbopump. The facility can also be used to measure DTFs of cavitating pumps in general

  1. Functional outcomes of conservatively managed acute ruptures of the Achilles tendon.

    Science.gov (United States)

    Lawrence, J E; Nasr, P; Fountain, D M; Berman, L; Robinson, A H N

    2017-01-01

    This prospective cohort study aims to determine if the size of the tendon gap following acute rupture of the Achilles tendon shows an association with the functional outcome following non-operative treatment. All patients presenting within two weeks of an acute unilateral rupture of the Achilles tendon between July 2012 and July 2015 were considered for the study. In total, 38 patients (nine female, 29 male, mean age 52 years; 29 to 78) completed the study. Dynamic ultrasound examination was performed to confirm the diagnosis and measure the gap between ruptured tendon ends. Outcome was assessed using dynamometric testing of plantarflexion and the Achilles tendon Total Rupture score (ATRS) six months after the completion of a rehabilitation programme. Patients with a gap ≥ 10 mm with the ankle in the neutral position had significantly greater peak torque deficit than those with gaps tendon gap and functional outcome in acute rupture of the Achilles tendon. We have identified 10 mm as a gap size at which deficits in plantarflexion strength become significantly greater, however, the precise relationship between gap size and plantarflexion strength remains unclear. Large, multicentre studies will be needed to clarify this relationship and identify population subgroups in whom deficits in peak torque are reflected in patient-reported outcome measures. Cite this article: Bone Joint J 2017;99-B:87-93. ©2017 The British Editorial Society of Bone & Joint Surgery.

  2. Novel mechanisms, treatments and outcome measures in childhood sleep

    Directory of Open Access Journals (Sweden)

    Annalisa eColonna

    2015-05-01

    Full Text Available Sleep disorders and sleep of insufficient duration and quality are on the increase due to changes in our lifestyle, particularly in children and adolescents. Sleep disruption is also more common in children with medical conditions, compounding their difficulties. Recent studies have focused on new mechanisms that explain how learning and cognitive performance depend on a good night’s sleep. Growing alongside this latest understanding is an innovative new field of non-drug interventions that improve sleep architecture, with resulting cognitive improvements. However, we need to rigorously evaluate such potentially popular and self-administered sleep interventions with equally state-of-the-art outcome measurement tools. Animated hand-held games, that incorporate embedded sleep-dependent learning tasks, promise to offer new robust methods of measuring changes in overnight learning. Portable computing technology has the potential to offer practical, inexpensive and reliable tools to indirectly assess the quality of sleep. They may be adopted in both clinical and educational settings, providing a unique way of monitoring the effect of sleep disruption on learning, leading also to a radical rethink of how we manage chronic diseases.

  3. Quantifying prosthetic gait deviation using simple outcome measures

    Science.gov (United States)

    Kark, Lauren; Odell, Ross; McIntosh, Andrew S; Simmons, Anne

    2016-01-01

    AIM: To develop a subset of simple outcome measures to quantify prosthetic gait deviation without needing three-dimensional gait analysis (3DGA). METHODS: Eight unilateral, transfemoral amputees and 12 unilateral, transtibial amputees were recruited. Twenty-eight able-bodied controls were recruited. All participants underwent 3DGA, the timed-up-and-go test and the six-minute walk test (6MWT). The lower-limb amputees also completed the Prosthesis Evaluation Questionnaire. Results from 3DGA were summarised using the gait deviation index (GDI), which was subsequently regressed, using stepwise regression, against the other measures. RESULTS: Step-length (SL), self-selected walking speed (SSWS) and the distance walked during the 6MWT (6MWD) were significantly correlated with GDI. The 6MWD was the strongest, single predictor of the GDI, followed by SL and SSWS. The predictive ability of the regression equations were improved following inclusion of self-report data related to mobility and prosthetic utility. CONCLUSION: This study offers a practicable alternative to quantifying kinematic deviation without the need to conduct complete 3DGA. PMID:27335814

  4. Sexual function in F-111 maintenance workers: the study of health outcomes in aircraft maintenance personnel.

    Science.gov (United States)

    Brown, Anthony; Gibson, Richard; Tavener, Meredith; Guest, Maya; D'Este, Catherine; Byles, Julie; Attia, John; Horsley, Keith; Harrex, Warren; Ross, James

    2009-06-01

    In Australia, four formal F-111 fuel tank deseal/reseal (DSRS) repair programs were implemented over more than two decades, each involving different processes and using a range of hazardous substances. However, health concerns were raised by a number of workers. The "Study of Health Outcomes in Aircraft Maintenance Personnel" was commissioned by the Australian Department of Defence to investigate potential adverse health outcomes as a result of being involved in the deseal/reseal processes. To compare measures of sexual function in F-111 aircraft fuel tank DSRS maintenance workers, against two appropriate comparison groups. Exposed and comparison participants completed a postal questionnaire which included general questions of health and health behavior, and two specific questions on sexual functioning. They also completed the International Index of Erectile Function (IIEF) questionnaire. Logistic regression was used to explore exposure status and outcome while adjusting for potential confounders. The three outcomes of interest for this study were the proportion of participants with erectile dysfunction (ED) according to the IIEF, the proportion with self-reported loss of interest in sex, and the proportion with self-reported problems with sexual functioning. Compared with each of the comparison groups, a larger proportion of the exposed group reported sexual problems and were classified as having ED according to the IIEF. In logistic regression, the odds of all three outcomes were higher for exposed participants relative to each comparison group and after adjustment for potentially confounding variables including anxiety and depression. There was a consistent problem with sexual functioning in the exposed group that is not explained by anxiety and depression, and it appears related to DSRS activities.

  5. Thurstone scaling as a measurement method to quantify subjective health outcomes.

    Science.gov (United States)

    Krabbe, Paul F M

    2008-04-01

    Many objective health outcome measures are used to monitor patients or evaluate health interventions, but there are also subjective measures. For the latter, it is difficult to derive metric data, which are needed to quantify health outcomes such as functional disability, severity of side effects, and health status. Thurstone's Law of Comparative Judgment is presented as an alternative means to derive metric values for subjective health outcomes. The appeal of Thurstone's scaling model is that it can transform subjective individual rank order data or comparative preference data to a single group composite interval scale. To demonstrate its contribution, an empirical study was conducted, focusing on the valuation of health states. Rank order data were collected for 18 health states and were then used as input for Thurstone scaling. Visual analogue scale (VAS) values were also collected for the same states. An agency for market research recruited 212 Dutch respondents aged 18-75 years. The derived Thurstone values showed a strong relationship with the VAS values. The positions of the 2 worst states were almost identical on the VAS and the Thurstone scale. Intermediate states were scaled somewhat differently by the 2 methods. For many subjective health outcomes, Thurstone scaling and its derivatives may be an attractive methodology to arrive at quantitative measures.

  6. Lung function measurement in awake young children

    DEFF Research Database (Denmark)

    Bisgaard, H; Klug, B

    1995-01-01

    The aim of the study was to evaluate methods applicable in a clinical setting for monitoring of changes in lung function in awake young children. Impedance measurements by the impulse oscillation technique (ZIOS), respiratory resistance measurements by the interrupter technique (Rint) and transcu......The aim of the study was to evaluate methods applicable in a clinical setting for monitoring of changes in lung function in awake young children. Impedance measurements by the impulse oscillation technique (ZIOS), respiratory resistance measurements by the interrupter technique (Rint......, with suspected asthma. Measurements with each technique were repeated after each challenge step. A special face-mask was developed with an integrated mouthpiece which ensured mouth breathing during the measurements. The order of sensitivity of the techniques to assess methacholine-induced changes in lung...... to methacholine in young children aged 4-6 yrs. This implies that ZIOS, Rint and Ptc,O2 provide convenient indices of changes in lung function. Their combined use will be useful for monitoring airway diseases of young children....

  7. Outcome measures for primary Sjögren's syndrome.

    Science.gov (United States)

    Seror, Raphaèle; Bootsma, Hendrika; Bowman, Simon J; Dörner, Thomas; Gottenberg, Jacques-Eric; Mariette, Xavier; Ramos-Casals, Manel; Ravaud, Philippe; Theander, Elke; Tzioufas, Athanasios; Vitali, Claudio

    2012-08-01

    Lymphocytic infiltration of different exocrine and non-exocrine epithelia is the pathological hallmark of primary Sjögren's syndrome, whereas involvement of salivary and lachrymal glands with the clinical counterpart of dry eye and dry mouth are the predominant features of the disease, together with fatigue and musculoskeletal pain. In addition, systemic manifestations, like arthritis, skin vasculitis, peripheral neuropathy, glomerulonephritis, may also be present in a consistent number of patients. As result, clinical features in SS can be divided into two facets: the benign subjective but disabling manifestations such as dryness, pain and fatigue, and the systemic manifestations. In the past decades, a core set of domains, which included sicca symptoms, objective measurements of tear and saliva production, fatigue, quality of life, disease activity and damage was indicated as essential for outcome assessment in this disorder. Afterwards, great efforts have been made to develop valid tools for the assessment of different domains. Specific questionnaires such as the Profile of Fatigue and Discomfort (PROFAD) and Sicca Symptoms Inventory (SSI) have been proposed as dedicated tools for the evaluation of patients symptoms, whereas different composite indexes have been suggested for the assessment of disease activity and damage. Some of these preliminary studies served as bases of an international project supported by EULAR, aimed at developing two consensus disease activity indexes: the EULAR Sjögren's Syndrome Patients Reported Index (ESSPRI), and the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), a systemic activity index to assess systemic manifestations. A detailed and critical review of all these indexes is provided in this article. Both EULAR indexes showed, in recent studies, to be feasible, valid, and reliable instruments. After their final validation, which is currently in process, they could be used as consensus outcome criteria in therapeutic

  8. Outcomes of anatomical versus functional testing for coronary artery disease.

    Science.gov (United States)

    Douglas, Pamela S; Hoffmann, Udo; Patel, Manesh R; Mark, Daniel B; Al-Khalidi, Hussein R; Cavanaugh, Brendan; Cole, Jason; Dolor, Rowena J; Fordyce, Christopher B; Huang, Megan; Khan, Muhammad Akram; Kosinski, Andrzej S; Krucoff, Mitchell W; Malhotra, Vinay; Picard, Michael H; Udelson, James E; Velazquez, Eric J; Yow, Eric; Cooper, Lawton S; Lee, Kerry L

    2015-04-02

    Many patients have symptoms suggestive of coronary artery disease (CAD) and are often evaluated with the use of diagnostic testing, although there are limited data from randomized trials to guide care. We randomly assigned 10,003 symptomatic patients to a strategy of initial anatomical testing with the use of coronary computed tomographic angiography (CTA) or to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure. The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the functional-testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; P=0.75). CTA was associated with fewer catheterizations showing no obstructive CAD than was functional testing (3.4% vs. 4.3%, P=0.02), although more patients in the CTA group underwent catheterization within 90 days after randomization (12.2% vs. 8.1%). The median cumulative radiation exposure per patient was lower in the CTA group than in the functional-testing group (10.0 mSv vs. 11.3 mSv), but 32.6% of the patients in the functional-testing group had no exposure, so the overall exposure was higher in the CTA group (mean, 12.0 mSv vs. 10.1 mSv; P<0.001). In symptomatic patients with suspected CAD who required noninvasive testing, a strategy of initial CTA, as compared with functional testing, did not improve clinical outcomes over a median follow-up of 2 years. (Funded by the National Heart, Lung, and Blood Institute

  9. Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease

    Science.gov (United States)

    Douglas, Pamela S.; Hoffmann, Udo; Patel, Manesh R.; Mark, Daniel B.; Al-Khalidi, Hussein R.; Cavanaugh, Brendan; Cole, Jason; Dolor, Rowena J.; Fordyce, Christopher B.; Huang, Megan; Khan, Muhammad Akram; Kosinski, Andrzej S.; Krucoff, Mitchell W.; Malhotra, Vinay; Picard, Michael H.; Udelson, James E.; Velazquez, Eric J.; Yow, Eric; Cooper, Lawton S.; Lee, Kerry L.

    2015-01-01

    BACKGROUND Many patients have symptoms suggestive of coronary artery disease (CAD) and are often evaluated with the use of diagnostic testing, although there are limited data from randomized trials to guide care. METHODS We randomly assigned 10,003 symptomatic patients to a strategy of initial anatomical testing with the use of coronary computed tomographic angiography (CTA) or to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure. RESULTS The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the functional-testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; P = 0.75). CTA was associated with fewer catheterizations showing no obstructive CAD than was functional testing (3.4% vs. 4.3%, P = 0.02), although more patients in the CTA group underwent catheterization within 90 days after randomization (12.2% vs. 8.1%). The median cumulative radiation exposure per patient was lower in the CTA group than in the functional-testing group (10.0 mSv vs. 11.3 mSv), but 32.6% of the patients in the functional-testing group had no exposure, so the overall exposure was higher in the CTA group (mean, 12.0 mSv vs. 10.1 mSv; P<0.001). CONCLUSIONS In symptomatic patients with suspected CAD who required noninvasive testing, a strategy of initial CTA, as compared with functional testing, did not improve clinical outcomes over a median follow-up of 2 years. (Funded by the

  10. Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease.

    Science.gov (United States)

    Jokinen, Hanna; Melkas, Susanna; Madureira, Sofia; Verdelho, Ana; Ferro, José M; Fazekas, Franz; Schmidt, Reinhold; Scheltens, Philip; Barkhof, Frederik; Wardlaw, Joanna M; Inzitari, Domenico; Pantoni, Leonardo; Erkinjuntti, Timo

    2016-12-01

    Cerebral small vessel disease (SVD) is characterised by progressive white matter hyperintensities (WMH), cognitive decline and loss of functional independence. The correspondence between neuroimaging findings and the severity of clinical symptoms has been modest, however, and thus the outcome may be affected by various host factors. We investigated the predictive value of educational and occupational attainments as proxy measures of cognitive reserve on long-term cognitive and functional outcome in patients with different degrees of WMH. In the Leukoaraiosis and Disability (LADIS) study, 615 older individuals with WMH were evaluated with brain MRI and detailed clinical and neuropsychological assessments at 3-year follow-up. A prolonged follow-up of functional and cognitive status was administered with a structured telephone interview after up to 7 years. Higher levels of educational and occupational attainment were strongly related to baseline cognitive scores and predicted a slower rate of decline at 3-year follow-up in measures of processing speed, executive functions and memory independently of WMH volume and other confounders. The deleterious effect of WMH on processing speed and memory was moderated by education and occupation. Education mitigated the relation of WMH volume on 7-year cognitive status. Moreover, higher education and occupational attainments were related to favourable outcome at 7-year follow-up as defined by sustained functional independence and lower mortality. The results support the presumption that cognitive reserve plays a significant role as a buffer against the clinical manifestations of SVD and may in part explain high individual variability in outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Methodological issues in examining measurement equivalence in patient reported outcomes measures: Methods overview to the two-part series, “Measurement equivalence of the Patient Reported Outcomes Measurement Information System® (PROMIS® short forms”

    Directory of Open Access Journals (Sweden)

    Jeanne A. Teresi

    2016-03-01

    Full Text Available The purpose of this article is to introduce the methods used and challenges confronted by the authors of this two-part series of articles describing the results of analyses of measurement equivalence of the short form scales from the Patient Reported Outcomes Measurement Information System® (PROMIS®. Qualitative and quantitative approaches used to examine differential item functioning (DIF are reviewed briefly. Qualitative methods focused on generation of DIF hypotheses. The basic quantitative approaches used all rely on a latent variable model, and examine parameters either derived directly from item response theory (IRT or from structural equation models (SEM. A key methods focus of these articles is to describe state-of-the art approaches to examination of measurement equivalence in eight domains: physical health, pain, fatigue, sleep, depression, anxiety, cognition, and social function. These articles represent the first time that DIF has been examined systematically in the PROMIS short form measures, particularly among ethnically diverse groups. This is also the first set of analyses to examine the performance of PROMIS short forms in patients with cancer. Latent variable model state-of-the-art methods for examining measurement equivalence are introduced briefly in this paper to orient readers to the approaches adopted in this set of papers. Several methodological challenges underlying (DIF-free anchor item selection and model assumption violations are presented as a backdrop for the articles in this two-part series on measurement equivalence of PROMIS measures.

  12. Quadrupole Transfer Function for Emittance Measurement

    CERN Document Server

    Cameron, Peter; Jansson, Andreas; Tan, Cheng-Yang

    2008-01-01

    Historically the use of the quadrupole moment measurement has been impeded by the requirement for large dynamic range, as well as measurement sensitivity to beam position. We investigate the use of the transfer function technique [1-3] in combination with the sensitivity and 160dB revolution line rejection of the direct diode detection analog front end [4] to open the possibility of an emittance diagnostic that may be implemented without operational complication, quasi- parasitic to the operation of existing tune measurement systems. Such a diagnostic would be particularly useful as an emittance monitor during acceleration ramp development in machines like RHIC and the LHC.

  13. Towards Objective Measures of Functional Hearing Abilities

    DEFF Research Database (Denmark)

    Innes-Brown, Hamish; Tsongas, Renee; Marozeau, Jeremy

    2016-01-01

    sensitivity to temporal fine structure (TFS) cues, brainstem encoding of complex harmonic and amplitude modulated sounds, and the ability to understand speech in noise. Understanding these links will allow the development of an objective measure that could be used to detect changes in functional hearing...

  14. Functional and anatomical outcome in closed globe combat ocular injuries.

    Science.gov (United States)

    Islam, Qamar Ul; Ishaq, Mazhar; Yaqub, Amer; Saeed, Muhammad Kamran

    2016-12-01

    To analyse the pattern, visual and anatomical outcome of closed globe combat-related ocular injuries sustained by troops. This retrospective study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan, and comprised patients with ocular injuries from January 2010 to June 2014. Record of each patient was evaluated and demography, mode and type of injury, initial and final visual acuity, associated globe injuries, concomitant non-ocular injuries, type of surgical procedures and complications were endorsed on a pre-devised proforma. Statistical analysis was done using SPSS 13. Overall, 49 eyes of 44 male participants were analysed. The overall mean age was 27.59±6.89 years. The most common mode of injury was improvised explosive device blast responsible for 22(50%) casualties. Ocular contusion was the most frequent closed-globe injury occurring in 35(71.42%) eyes. Most frequent ocular findings in all injured eyes were vitreous haemorrhage 16(32.65%), cataract 12(24.48%), retinal detachment 8(16.32%) and commotio retinae 8(16.32%). A total of 48(97.96%) intra-ocular/adnexal surgeries were performed with pars plana vitrectomy 17(34.69%), cataract surgery 16(32.65%), intraocular lens implantation 8(16.32%), and adnexal surgery 5(10.20%) being the most frequently performed procedures. Overall visual improvement at the final follow-up was statistically significant in all injured eyes irrespective of mode of treatment (p =0.001). The functional and anatomical outcome was better in closed-globe combat ocular injuries compared to open-globe injuries.

  15. Functional outcome after arthroscopic repair of triple shoulder instability

    Directory of Open Access Journals (Sweden)

    Glaydson Gomes Godinho

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the functional outcomes of patients submitted to arthroscopic repair of triple labral lesion. METHODS: This was an analytical retrospective study of patients who underwent arthroscopic treatment of triple labral lesion from March 2005 to December 2014. Patients with at least one year of postoperative follow-up were included. A total of nine patients were evaluated. The mean age was 32.3 years and the dominant side was affected in five patients. Patients were functionally assessed regarding the range of motion (ROM in elevation, external rotation with the arm close to the body the arm in abduction of 90°, and internal rotation, and by the Carter-Rowe score. The degree of satisfaction was assessed at the end of the follow-up period. RESULTS: Three patients had less than five episodes of instability, four patients had between five and ten episodes, and two patients had more than ten episodes. Seven patients had positive O'Brien test for SLAP lesions and positive apprehension test in abduction and external rotation, and only one patient had apprehension in adduction and internal rotation. Three patients persisted with positive O'Brien test and one with apprehension in abduction and external rotation at the end of follow-up. The range of motion was complete in all cases. The median Carter-Rowe score increased from 40 preoperatively to 90 (p = 0.008. CONCLUSION: The arthroscopic repair of triple labral lesions allows for the restoration of the stability of the glenohumeral joint, achieving excellent functional results.

  16. Functional capacity and postural pain outcomes after reduction mammaplasty.

    Science.gov (United States)

    Freire, Marcia; Neto, Miguel Sabino; Garcia, Elvio Bueno; Quaresma, Marina Rodrigues; Ferreira, Lydia Masako

    2007-04-01

    Neck, shoulder, and lower back pain and reduction of functional capacity can be caused by breast hypertrophy. Reduction mammaplasty appears to improve these aspects. After a systematic review of the literature, no scientific evidence was found to confirm this hypothesis. The authors' objective was to evaluate the impact of reduction mammaplasty on pain and functional capacity of patients with mammary hypertrophy. One hundred patients with mammary hypertrophy, between 18 and 55 years old, with no previous mammary surgery, were consecutively selected from the Plastic Surgery Outpatient Clinic of the Universidade Federal de São Paulo-Escola Paulista de Medicina and randomly allocated into two groups. Group A (n = 50) underwent mammaplasty reduction immediately, whereas group B patients (n = 50) were placed on a waiting list (control group). All patients were interviewed for clinical and demographic data and evaluated to measure pain and functional capacity. To measure shoulder, neck, and lower back pain, a visual analogue scale (0 = no pain, 10 = unbearable pain) was used. The Stanford Health Assessment Questionnaire (HAQ-20), Brazilian validated version (0 = best, 3 = worst), was applied to assess functional capacity. Pain and functional capacity were measured at baseline and 6 months after surgery. Forty-six of 50 patients, from both groups, completed the study. The mean (+/-SD) patient age in groups A and B was 31.6 +/- 11 and 32.3 +/- 10 years, respectively. The mean breast tissue weight was 1052 +/- 188 g. Functional capacity in group A was improved 6 months after reduction mammaplasty, compared with group B (control), in the following aspects: getting dressed, getting up, walking, maintaining personal hygiene, reaching, and grasping objects. The mean pain intensity dropped in the lower back, from 5.7 to 1.3; in the shoulders, from 6.1 to 1.1; and in the neck, from 5.2 to 0.9. Reduction mammaplasty improved functional capacity and relieved pain in the lower back

  17. Evaluation of mobility and functionality outcomes post cerebrovascular accident

    Directory of Open Access Journals (Sweden)

    Jeanne Caldas Carvalho

    2013-12-01

    Introduction: individuals with cerebrovascular accident (CVA have sequels that interfere with its functionality and mobility and undertake activities of daily living (Dlas. Objectives: the aim of this study was to correlate the mobility with functional independence in people with sequelae of CVA. Methods: the 19 volunteers were evaluated through Functional independence measurement and Time Up and Go. The descriptive analysis of data was performed by statistics percentage, average, and standard deviation and the Pearson Correlation was used to analyze the correlation of variables in the study. Results: the statistical analysis on the functional independence pointed out that 52.6% of individuals require 25% more aid in the performance of daily activities. In relation to mobility, 63.1% of participants needed more than 20 seconds to perform the Time Up and Go. There was a negative correlation (r = - 0.6 between the functionality and mobility in individuals affected by CVA (p < 0.05. It is concluded that the performance of the individual affected by a CVA is related to the level of mobility. This study supports new studies which can develop new hypotheses.

  18. Parity Measurements, Decoherence and Spiky Wigner Functions

    CERN Document Server

    D'Almeida, A M O

    2003-01-01

    Notwithstanding radical conceptual differences between classical and quantum mechanics, it is usually assumed that physical measurements concern observables common to both theories . Not so with the eigenvalues ($\\pm 1$) of the parity operator. The effect of such a measurement on a mixture of even and odd states of the harmonic oscillator is akin to separating at a single stroke a pair of shuffled card decks: the result is a set of definite parity, though otherwise mixed. The Wigner function should be a sensitive probe for this phenomenon, for it can be interpreted as the expectation value of the parity operator. We here derive the general form of Wigner functions $W_{\\pm}$, resulting from an ideal parity measurement on $W(\\x)$. Even if $W(\\x)$ resembles a classical distribution, $W_{\\pm}$ displays a quantum spike, which is positive for $W_+$ and negative for $W_-$. However we conjecture that $W_+$ always has negative values.

  19. Age dependence of rat liver function measurements

    DEFF Research Database (Denmark)

    Fischer-Nielsen, A; Poulsen, H E; Hansen, B A

    1989-01-01

    Changes in the galactose elimination capacity, the capacity of urea-N synthesis and antipyrine clearance were studied in male Wistar rats at the age of 8, 20 and 44 weeks. Further, liver tissue concentrations of microsomal cytochrome P-450, microsomal protein and glutathione were measured. All...... liver function measurements increased from the age of 8 to 44 weeks when expressed in absolute values. In relation to body weight, these function measurements were unchanged or reduced from week 8 to week 20. At week 44, galactose elimination capacity and capacity of urea-N synthesis related to body...... weight were increased by 10% and 36%, respectively, and antipyrine plasma clearance was reduced to 50%. Liver tissue concentrations of microsomal cytochrome P-450 and microsomal protein increased with age when expressed in absolute values, but were unchanged per g liver, i.e., closely related to liver...

  20. Patient-reported outcome measures in pediatric epilepsy: a content analysis using World Health Organization definitions.

    Science.gov (United States)

    Sadeghi, Salva; Fayed, Nora; Ronen, Gabriel M

    2014-09-01

    Patient-reported outcome (PRO) measures that assess the effect of epilepsy on children's lives include the concepts of health, health-related quality of life (HRQOL), and quality of life (QOL). They also contain varied health and health-related content. Our objectives were to identify what generic and epilepsy-specific PRO instruments are used in childhood epilepsy research and to make explicit their conceptual approach and biopsychosocial content. MEDLINE, EMBASE, and PsycINFO were searched from 2001 to 2011 for PRO measures used in pediatric epilepsy. Measures were analyzed on an item-by-item basis according to World Health Organization (WHO) definitions of QOL and the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) biopsychosocial health framework to distinguish the conceptual approach within each measure. The health content analysis coded each item according to specific ICF-CY components of body function, activity and participation, environment, or personal factors to determine the health content for each measure. Three generic and 13 epilepsy-specific PRO measures were identified; 10 of 16 measures utilized a biopsychosocial health approach rather than an HRQOL or QOL approach. Content analysis showed that in 11 of 16 measures, >25% of the items represented participation and activity components of the ICF-CY, whereas a high proportion of environment items were found in only one epilepsy-specific measure. This comprehensive review provides information aiding clinicians and researchers in the selection of the appropriate PRO instruments for children with epilepsy on the basis of content. Most epilepsy-specific and generic PROs use a biopsychosocial health approach as opposed to a subjective HRQOL/QOL approach to measurement. Clinicians and researchers must be aware of these concepts and content when intending to measure outcomes validly. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

  1. Predicting functional remission in patients with schizophrenia: a cross-sectional study of symptomatic remission, psychosocial remission, functioning, and clinical outcome

    Directory of Open Access Journals (Sweden)

    Valencia M

    2015-09-01

    Full Text Available Marcelo Valencia,1 Ana Fresán,2 Yoram Barak,3 Francisco Juárez,1 Raul Escamilla,4 Ricardo Saracco41Division of Epidemiological and Psychosocial Research, 2Division of Clinical Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico; 3Psychiatry Department, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 4Schizophrenia Clinic, National Institute of Psychiatry Ramón de la Fuente, Mexico City, MexicoBackground: New approaches to assess outcome in schizophrenia include multidimensional measures such as remission, cognition, psychosocial functioning, and quality of life. Clinical and psychosocial measures have been recently introduced to assess functional outcome.Objective: The study presented here was designed to examine the rates of symptomatic remission, psychosocial remission, global functioning, and clinical global impressions in a sample of schizophrenia outpatients in order to assess functional remission and to identify predictive factors for functional remission.Methods: A total of 168 consecutive Mexican outpatients receiving pharmacological treatment at the National Institute of Psychiatry in Mexico City were enrolled in a cross-sectional study. Symptomatic remission was assessed according to the definition and criteria proposed by the Remission in Schizophrenia Working Group using the Positive and Negative Symptom Scale. Psychosocial remission was assessed according to Barak criteria using the Psychosocial Remission in Schizophrenia scale. Functioning was measured with the Global Assessment of Functioning, and clinical outcome with the Clinical Global Impressions (CGI Scale.Results: Findings showed that 45.2% of patients fulfilled the symptomatic remission criteria, 32.1% achieved psychosocial remission, and 53% reported adequate functioning. However, the combination of these three outcome criteria – symptomatic, psychosocial remission, and functioning – indicated that 14.9% of the

  2. Routine outcome measurement in the Netherlands - A focus on benchmarking.

    Science.gov (United States)

    Delespaul, Philippe A E G

    2015-01-01

    Routine outcome measurement (ROM) is a 'hot' topic in the Netherlands. Over recent years the Netherlands have developed a centralized monitoring system for all reimbursed mental health interventions, in an attempt to improve the quality of care. The Foundation for Benchmarking Mental Health (SBG) is an independent knowledge centre for mental health providers and insurance companies. It was founded to organize and manage the countrywide ROM initiative. A Dutch countrywide ROM initiative is appealing, and the procedures in the Netherlands are described. However, the national ROM system was oversold. Arguments are discussed. It would have been a far better strategy if insurance companies and authorities had not focused on a national system but stimulated local data collection and requested a managerial plan-do-check-act (PDCA) cycle to stimulate service improvements from year to year. Within the same service, chances are higher that the same kind of clientele is served from year to year and therefore it will be easier to interpret the data. The ROM should regain its clinical focus. Mobile ROM systems using smartphones that collect sampled experiences could be an interesting future solution.

  3. Issues for the selection of wheelchair-specific activity and participation outcome measures: a review.

    Science.gov (United States)

    Mortenson, William B; Miller, William C; Auger, Claudine

    2008-06-01

    To use the World Health Organization's International Classification of Functioning, Disability and Health as a framework to identify and to evaluate wheelchair-specific outcome instruments that are useful for measuring activity and participation. CINHAL, PsychInfo, EMBASE, Google Scholar, Dissertation Abstracts Medline databases, and conference proceedings. Activity and participation measures that were specifically intended for adults who use wheelchairs and that were published in English in a peer-reviewed journal were included in this review. Based on electronic database searches using a variety of search terms, articles were identified by title, and appropriate abstracts were retrieved. Articles were obtained for all relevant abstracts. For peer-reviewed measures included in the review, we obtained any instruction manuals and related publications, frequently published in conference proceedings and theses or available electronically, on the development and testing of the measure. Tools included in the review were evaluated based on their conceptual coverage, reliability, validity, responsiveness, usefulness, and wheelchair contribution, which indicated how well the tool isolated the effect of the wheelchair on activity and participation outcomes. A number of conceptual, psychometric, and applicability issues were identified with the 11 wheelchair-specific measures included in the review. A majority of the measures were mobility focused. No single tool received excellent ratings in all areas of the review. Some of the most frequent issues identified included a failure to account for differences attributable to different wheelchairs and wheelchair seating, limited psychometric testing, and high administrative and respondent burden. Good reliability evidence was reported for most of the measures, but validity information was only available for 6 of the 11 measures, and responsiveness information for 3. This review suggests that these measures could be improved with

  4. Sensitivity as outcome measure of androgen replacement: the AMS scale

    Directory of Open Access Journals (Sweden)

    Dinger Juergen C

    2006-03-01

    Full Text Available Abstract Background The capacity of the AMS scale as clinical utility and as outcome measure still needs validation. Methods An open post-marketing study was performed by office-based physicians in Germany in 2004. We analysed data of 1670 androgen-deficient males who were treated with testosterone gel. The AMS scale was applied prior to and after 3 months treatment. Results The improvement of complaints under treatment relative to the baseline score was 30.7% (total score, 27.3% (psychological domain, 30.5% (somatic domain, and 30.7% (sexual domain, respectively. Patients with little or no symptoms before therapy improved by 9%, those with mild complaints at entry by 24%, with moderate by 32%, and with severe symptoms by 39% – compared with the baseline score. We showed that the distribution of complaints of testosterone deficient men before therapy almost returned to norm values after 12 weeks of testosterone treatment. Age, BMI, and total testosterone level at baseline did not modify the positive effect of androgen therapy. We also demonstrated that the AMS results can predict the independent (physician's opinion about the individual treatment effect. Both, sensitivity (correct prediction of a positive assessment by the physician and specificity (correct prediction of a negative assessment by the physician were over 70%, if about 22% improvement of the AMS total score was used as cut-off point. Conclusion The AMS scale showed a convincing ability to measure treatment effects on quality of life across the full range of severity of complaints. Effect modification by other variables at baseline was not observed. In addition, results of the scale can predict the subjective clinical expert opinion on the treatment efficiency.

  5. Functional connectivity estimated from intracranial EEG predicts surgical outcome in intractable temporal lobe epilepsy.

    Directory of Open Access Journals (Sweden)

    Arun R Antony

    Full Text Available This project aimed to determine if a correlation-based measure of functional connectivity can identify epileptogenic zones from intracranial EEG signals, as well as to investigate the prognostic significance of such a measure on seizure outcome following temporal lobe lobectomy. To this end, we retrospectively analyzed 23 adult patients with intractable temporal lobe epilepsy (TLE who underwent an invasive stereo-EEG (SEEG evaluation between January 2009 year and January 2012. A follow-up of at least one year was required. The primary outcome measure was complete seizure-freedom at last follow-up. Functional connectivity between two areas in the temporal lobe that were sampled by two SEEG electrode contacts was defined as Pearson's correlation coefficient of interictal activity between those areas. SEEG signals were filtered between 5 and 50 Hz prior to computing this correlation. The mean and standard deviation of the off diagonal elements in the connectivity matrix were also calculated. Analysis of the mean and standard deviation of the functional connections for each patient reveals that 90% of the patients who had weak and homogenous connections were seizure free one year after temporal lobectomy, whereas 85% of the patients who had stronger and more heterogeneous connections within the temporal lobe had recurrence of seizures. This suggests that temporal lobectomy is ineffective in preventing seizure recurrence for patients in whom the temporal lobe is characterized by weakly connected, homogenous networks. This pilot study shows promising potential of a simple measure of functional brain connectivity to identify epileptogenicity and predict the outcome of epilepsy surgery.

  6. Functional outcome after perineal stapled prolapse resection for external rectal prolapse

    Directory of Open Access Journals (Sweden)

    Borovicka Jan

    2010-03-01

    Full Text Available Abstract Background A new surgical technique, the Perineal Stapled Prolapse resection (PSP for external rectal prolapse was introduced in a feasibility study in 2008. This study now presents the first results of a larger patient group with functional outcome in a mid-term follow-up. Methods From December 2007 to April 2009 PSP was performed by the same surgeon team on patients with external rectal prolapse. The prolapse was completely pulled out and then axially cut open with a linear stapler at three and nine o'clock in lithotomy position. Finally, the prolapse was resected stepwise with the curved Contour® Transtar™ stapler at the prolapse's uptake. Perioperative morbidity and functional outcome were prospectively measured by appropriate scores. Results 32 patients participated in the study; median age was 80 years (range 26-93. No intraoperative complications and 6.3% minor postoperative complications occurred. Median operation time was 30 minutes (15-65, hospital stay 5 days (2-19. Functional outcome data were available in 31 of the patients after a median follow-up of 6 months (4-22. Preoperative severe faecal incontinence disappeared postoperatively in 90% of patients with a reduction of the median Wexner score from 16 (4-20 to 1 (0-14 (P Conclusions The PSP is an elegant, fast and safe procedure, with good functional results. Trial registration ISRCTN68491191

  7. Assessing the impact of unmeasured confounding for binary outcomes using confounding functions.

    Science.gov (United States)

    Kasza, Jessica; Wolfe, Rory; Schuster, Tibor

    2017-03-03

    A critical assumption of causal inference is that of no unmeasured confounding: for estimated exposure effects to have valid causal interpretations, a sufficient set of predictors of exposure and outcome must be adequately measured and correctly included in the respective inference model(s). In an observational study setting, this assumption will often be unsatisfied, and the potential impact of unmeasured confounding on effect estimates should be investigated. The confounding function approach allows the impact of unmeasured confounding on estimates to be assessed, where unmeasured confounding may be due to unmeasured confounders and/or biases such as collider bias or information bias. Although this approach is easy to implement and pertains to the sum of all bias, its use has not been widespread, and discussion has typically been limited to continuous outcomes. In this paper, we consider confounding functions for use with binary outcomes and illustrate the approach with an example. We note that confounding function choice encodes assumptions about effect modification: some choices encode the belief that the true causal effect differs across exposure groups, whereas others imply that any difference between the true causal parameter and the estimate is entirely due to imbalanced risks between exposure groups. The confounding function approach is a useful method for assessing the impact of unmeasured confounding, in particular when alternative approaches, e.g. external adjustment or instrumental variable approaches, cannot be applied. We provide Stata and R code for the implementation of this approach when the causal estimand of interest is an odds or risk ratio.

  8. Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group

    DEFF Research Database (Denmark)

    Terslev, Lene; Gutierrez, Marwin; Schmidt, Wolfgang A

    2015-01-01

    OBJECTIVE: To summarize the work performed by the Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Working Group on the validation of US as a potential outcome measure in gout. METHODS: Based on the lack of definitions, highlighted in a recent literature review on US as an outcome tool...

  9. Using Cross-Cultural Dimensions Exercises to Improve and Measure Learning Outcomes in International Business Courses

    Science.gov (United States)

    Zainuba, Mohamed; Rahal, Ahmad

    2012-01-01

    This article proposes an approach for using cross-cultural dimensions exercises to improve and measure learning outcomes in international business courses. The following key issues are highlighted: (a) what are the targeted learning outcomes to be assessed, (b) how to measure the accomplishment of these learning outcomes, (c) the input measures…

  10. Measuring, comparing and improving clinical outcomes in gastrointestinal cancer surgery

    NARCIS (Netherlands)

    Henneman, D.

    2016-01-01

    In this thesis, hospital variation concerning various surgical outcomes is illustrated, thereby exploring the usability of these outcomes for hospital comparisons, both from a clinical and methodological point of view. Moreover, the studies provide insight in risk factors for adverse events in color

  11. Measuring, comparing and improving clinical outcomes in gastrointestinal cancer surgery

    OpenAIRE

    Henneman, D.

    2016-01-01

    In this thesis, hospital variation concerning various surgical outcomes is illustrated, thereby exploring the usability of these outcomes for hospital comparisons, both from a clinical and methodological point of view. Moreover, the studies provide insight in risk factors for adverse events in colorectal and oesophageal cancer surgery, focusing on the mechanism behind postoperative complications leading to mortality or not.

  12. Scoliosis in myelomeningocele: epidemiology, management, and functional outcome.

    Science.gov (United States)

    Mummareddy, Nishit; Dewan, Michael C; Mercier, Michael R; Naftel, Robert P; Wellons, John C; Bonfield, Christopher M

    2017-07-01

    OBJECTIVE The authors aimed to provide an updated and consolidated report on the epidemiology, management, and functional outcome of cases of myelomeningocele (MMC) in patients with scoliosis. METHODS A comprehensive literature search was performed using MEDLINE, Embase, Google Scholar, and the Cochrane Database of Systematic Reviews on cases of MMC in patients with scoliosis between 1980 and 2016. The initial search yielded 670 reports. After removing duplicates and applying inclusion criteria, we included 32 full-text original articles in this study. RESULTS Pooled statistical analysis of the included articles revealed the prevalence of scoliosis in MMC patients to be 53% (95% CI 0.42-0.64). Slightly more females (56%) are affected with both MMC and scoliosis than males. Motor level appears to be a significant predictor of prevalence, but not severity, of scoliosis in MMC patients. Treatment options for these patients include tethered cord release (TCR) and fusion surgeries. Curvature improvement and stabilization after TCR may be limited to patients with milder (scoliosis correction, albeit with greater complication rates. Quality of life metrics including ambulatory status and sitting stability are influenced by motor level of the lesion as well as the degree of the scoliosis curvature. CONCLUSIONS Scoliosis is among the most common and challenging comorbidities from which patients with MMC suffer. Although important epidemiological and management trends are evident, larger, prospective studies are needed to discover ways to more accurately counsel and more optimally treat these patients.

  13. Functional outcome of tibial fracture with acute compartment syndrome and correlation to deep posterior compartment pressure.

    Science.gov (United States)

    Goyal, Saumitra; Naik, Monappa A; Tripathy, Sujit Kumar; Rao, Sharath K

    2017-05-18

    To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome (ACS) and to correlate it with functional outcome. Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale (LEFS)] and complications were assessed. Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk (10 to 54 wk) and 23.8 ± 9.2 wk (12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness (76%) that caused difficulty in walking, running and squatting. Of 21 patients who had paralysis at diagnosis, 13 (62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients (48.3%) with severe disability, 10 patients (34.5%) with moderate disability and 5 patients (17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmHg respectively (P < 0.001). ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intra-compartmental pressure (ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.

  14. American College of Rheumatology White Paper on Performance Outcome Measures in Rheumatology.

    Science.gov (United States)

    Suter, Lisa G; Barber, Claire E; Herrin, Jeph; Leong, Amye; Losina, Elena; Miller, Amy; Newman, Eric; Robbins, Mark; Tory, Heather; Yazdany, Jinoos

    2016-10-01

    To highlight the opportunities and challenges of developing and implementing performance outcome measures in rheumatology for accountability purposes. We constructed a hypothetical performance outcome measure to demonstrate the benefits and challenges of designing quality measures that assess patient outcomes. We defined the data source, measure cohort, reporting period, period at risk, measure outcome, outcome attribution, risk adjustment, reliability and validity, and reporting approach. We discussed outcome measure challenges specific to rheumatology and to fields where patients have predominantly chronic, complex, ambulatory care-sensitive conditions. Our hypothetical outcome measure was a measure of rheumatoid arthritis disease activity intended for evaluating Accountable Care Organization performance. We summarized the components, benefits, challenges, and tradeoffs between feasibility and usability. We highlighted how different measure applications, such as for rapid cycle quality improvement efforts versus pay for performance programs, require different approaches to measure development and testing. We provided a summary table of key take-home points for clinicians and policymakers. Performance outcome measures are coming to rheumatology, and the most effective and meaningful measures can only be created through the close collaboration of patients, providers, measure developers, and policymakers. This study provides an overview of key issues and is intended to stimulate a productive dialogue between patients, practitioners, insurers, and government agencies regarding optimal performance outcome measure development. © 2016, American College of Rheumatology.

  15. Motor function measure: validation of a short form for young children with neuromuscular diseases.

    Science.gov (United States)

    de Lattre, Capucine; Payan, Christine; Vuillerot, Carole; Rippert, Pascal; de Castro, Denis; Bérard, Carole; Poirot, Isabelle

    2013-11-01

    To validate a useful version of the Motor Function Measure (MFM) in children with neuromuscular diseases aged .90), and discriminant validity was good. The MFM-20 can be used as an outcome measure for assessment of motor function in young children with neuromuscular disease. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Memory and executive function predict mobility rehabilitation outcome after lower-limb amputation.

    Science.gov (United States)

    O'Neill, Brian F; Evans, Jonathan J

    2009-01-01

    Post-amputation rehabilitation is physically and cognitively demanding. Understanding which specific cognitive domains mediate outcome is critical to the development of interventions. A cohort undergoing post-amputation rehabilitation was assessed before limb fitting and followed up at 6 months (n = 34). The average age was 60.69 years (SD = 13.98). 82.4% of the sample was male. 79.4% had amputations because of peripheral arterial disease. Memory, visuospatial function, executive function, praxis, emotion and language were assessed at Time 1 (first prosthetic clinic attendance). Time 1 data were also gathered on aetiology, level of amputation, comorbidities, pain and demographics. Six month outcomes were the locomotor capability index (LCI), the special interest group in amputee medicine (SIGAM) mobility grades and self reported hours of use. The LCI at 6 months was significantly predicted in regression analyses by a measure of visual memory (figure recall) (adjusted R2 = 24.8%, df = 32, zbeta = 0.52, p = 0.002. Hours of use were predicted by the verbal fluency test total (adjusted R2 = 17.1%, df= 26, zbeta = 0.45, p = 0.017). SIGAM mobility grades were predicted by a combination of immediate verbal memory (story recall), age, level of amputation and presence of pain (adjusted R2 = 58.2, df = 30, zbeta = 0.52, p = 0.000). Neuropsychological and clinical variables predict a large amount of 6 month outcome variance. Cognitive difficulties may be considered mediators of poor outcome.

  17. Prediction of responders for outcome measures of Locomotor Experience Applied Post Stroke trial

    Directory of Open Access Journals (Sweden)

    Bruce H. K. Dobkin, MD

    2014-03-01

    Full Text Available The Locomotor Experience Applied Post Stroke rehabilitation trial found equivalent walking outcomes for body weight-supported treadmill plus overground walking practice versus home-based exercise that did not emphasize walking. From this large database, we examined several clinically important questions that provide insights into recovery of walking that may affect future trial designs. Using logistic regression analyses, we examined predictors of response based on a variety of walking speed-related outcomes and measures that captured disability, physical impairment, and quality of life. The most robust predictor was being closer at baseline to the primary outcome measure, which was the functional walking speed thresholds of 0.4 m/s (household walking and 0.8 m/s (community walking. Regardless of baseline walking speed, a younger age and higher Berg Balance Scale score were relative predictors of responding, whether operationally defined by transitioning beyond each speed boundary or by a continuous change or a greater than median increase in walking speed. Of note, the cutoff values of 0.4 and 0.8 m/s had no particular significance compared with other walking speed changes despite their general use as descriptors of functional levels of walking. No evidence was found for any difference in predictors based on treatment group.

  18. Incorporating longitudinal pediatric patient-centered outcome measurement into the clinical workflow using a commercial electronic health record: a step toward increasing value for the patient.

    Science.gov (United States)

    Carberry, Kathleen; Landman, Zachary; Xie, Michelle; Feeley, Thomas; Henderson, John; Fraser, Charles

    2016-01-01

    Patient-centered outcomes measurement provides healthcare organizations with crucial information for increasing value for patients; however, organizations have struggled to obtain outcomes data from electronic health record (EHR) systems. This study describes how Texas Children's Hospital customized a commercial EHR system and assembled a cross-functional team to capture outcomes data using existing functionality. Prior to its installation and customization, no surgical subspecialties besides the congenital heart and transplant surgery groups conducted prospective, patient outcomes measurement, but by 2015, the outcomes of over 1300 unique patients with supracondylar fractures, cleft lip and/or palate, or voiding dysfunction had been tracked. Key factors for integrating outcomes measurement into the clinical workflow include ongoing communication between cross-functional teams composed of clinicians and technical professionals, an iterative design process, organizational commitment, and prioritizing measurement as early as possible during EHR optimization.

  19. Measuring outcomes in orthopaedics: implementation of an outcomes program in an outpatient orthopaedic practice.

    Science.gov (United States)

    Rodts, Mary F; Glanzman, Renée; Gray, Adam; Johnson, Randal; Viellieu, Dennis; Hachem, Fadi

    2014-01-01

    With increased demand to provide quality care for patients, orthopaedic practices will need to develop ways to efficiently collect and manage data to support the care that they provide. An outcomes management program must be efficient and consistent to provide good data. This article describes the implementation of an outcomes program at one large private orthopaedic practice within an academic medical setting.

  20. Functional improvement after Total Knee Arthroplasty Revision: New observations on the dimensional nature of outcome

    Directory of Open Access Journals (Sweden)

    Bershadsky Boris

    2007-12-01

    Full Text Available Abstract Background Despite the numerous outcomes measures described it remains unclear what aspects of patient outcome are important in determining actual improvement following total knee arthroplasty revisions (TKAR. We performed a prospective cohort study of TKAR to determine the components of clinical improvement and how they are related and best measured. Methods An improvement scale was devised utilizing data from 186 consecutive TKAR patients on SF-36 physical (PCS and mental (MCS components, Western Ontario and McMaster Universities Osteoarthritis (WOMAC Index, Knee Society Score (KSS, a novel Activity Scale (AS and a physician derived severity assessment scale performed both preoperatively and at 6 month post-operative follow-up. The change in each of these scores was analyzed using factor analysis, deriving a composite improvement scale. Results All the instruments demonstrated statistically significantly better scores following TKAR (except the SF-36 MCS. Furthermore, all significant correlations between the scores were positive. Statistical factor analysis demonstrated that scores could be arranged into 4 related factor groupings with high internal consistency (Cronbach Alpha = 0.7. Factor 1 reflected patient perceived functional outcomes, Factor 2 activity levels, Factor 3 the MCS and Factor 4 the KSS. Conclusion This study demonstrates that improvement following TKAR has a multidimensional structure. The improvement scales represent a more coordinated method of the previously fragmented analysis of TKAR outcomes. This will improve assessment of the actual effectiveness of TKAR for patients and what aspects of improvement are most critical.

  1. Evaluating complementary and alternative medicine interventions: in search of appropriate patient-centered outcome measures

    Directory of Open Access Journals (Sweden)

    Mallory Devon

    2006-11-01

    Full Text Available Abstract Background Central to the development of a sound evidence base for Complementary and Alternative Medicine (CAM interventions is the need for valid, reliable and relevant outcome measures to assess whether the interventions work. We assessed the specific needs for a database that would cover a wide range of outcomes measures for CAM research and considered a framework for such a database. Methods The study was a survey of CAM researchers, practitioners and students. An online questionnaire was emailed to the members of the Canadian Interdisciplinary Network for CAM Research (IN-CAM and the CAM Education and Research Network of Alberta (CAMera. The majority of survey questions were open-ended and asked about outcome measures currently used, outcome measures' assessment criteria, sources of information, perceived barriers to finding outcome measures and outcome domains of importance. Descriptive quantitative analysis and qualitative content analysis were used. Results One hundred and sixty-four completed surveys were received. Of these, 62 respondents reported using outcome measures in their CAM research and identified 92 different specific outcomes. The most important barriers were the fact that, for many health concepts, outcome measures do not yet exist, as well as issues related to accessibility of instruments. Important outcome domains identified included physical, psychological, social, spiritual, quality of life and holistic measures. Participants also mentioned the importance of individualized measures that assess unique patient-centered outcomes for each research participant, and measures to assess the context of healing and the process of healing. Conclusion We have developed a preliminary framework that includes all components of health-related outcomes. The framework provides a foundation for a larger, comprehensive collection of CAM outcomes. It fits very well in a whole systems perspective, which requires an expanded set of

  2. Clinico-electrophysiological profile and predictors of functional outcome in Guillain-Barre syndrome (GBS).

    Science.gov (United States)

    Verma, Rajesh; Chaudhari, Tejendra Sukdeo; Raut, Tushar Premraj; Garg, Ravindra Kumar

    2013-12-15

    Guillain-Barre syndrome (GBS) is an acute polyradiculoneuropathy with varied severity of presentation. To study the clinical and electrophysiological profile of patients with GBS and to determine the factors associated with poor functional outcome and need for mechanical ventilation. It was a hospital-based prospective observational study. 90 patients with GBS diagnosed as per Asbury and Cornblath criteria were enrolled and followed up for 6 months. Various epidemiological, clinical and electrophysiological parameters were evaluated. Hughes motor scale was used to measure functional outcome. Factors associated with poor functional outcome and need for mechanical ventilation were determined. 90 patients (56 males; 34 females; mean age of 29.3±15.2 years) were enrolled in this study. Amongst these 6 (6.7%) patients died during in-hospital stay. Antecedent infection was present in 29 (32.2%), autonomic dysfunction in 31 (34.4%), bulbar palsy in 21 (23.3%), neck flexor weakness in 52 (57.8%). 60 cases (66.7%) were of axonal variety and 30 (33.3%) of demyelinating variety. On univariate analysis, predictors associated with poor functional outcome at 6 months were autonomic dysfunction (p=0.013), neck flexor weakness (p=0.009), requirement of ventilatory assistance (p=<0.001), MRC sum score<30 on admission (p=<0.001) and axonal pattern on electrophysiological assessment (p=<0.001). On multivariate analysis, MRC sum score<30 on admission (p=0.007) and axonal pattern on electrophysiological assessment (p=<0.001) were independently associated with poor functional outcome at 6 months. Factors associated with need for mechanical ventilation were presence of autonomic dysfunction (p=<0.001), cranial nerve palsy including facial palsy (p=<0.001) and bulbar palsy (p=0.002), neck flexor weakness (p=<0.001), low MRC sum score (<30) (p=0.001), and low proximal CPN CMAP amplitude to distal CPN CMAP amplitude ratio (p=0.042); none of them being significant on multivariate analysis

  3. Greater patient confidence yields greater functional outcomes after primary total shoulder arthroplasty.

    Science.gov (United States)

    Styron, Joseph F; Higuera, Carlos A; Strnad, Greg; Iannotti, Joseph P

    2015-08-01

    Patient satisfaction is increasingly being tied to reimbursement rates, and patient satisfaction is often associated with improving functionality and decreasing disability postoperatively. This study sought to determine if a total shoulder arthroplasty patient's preoperative confidence in his or her ability to attain the level of activity desired would influence postoperative functional scores. Patients undergoing a primary total shoulder arthroplasty at a single institution were asked to complete a preoperative questionnaire with multiple items including baseline symptom severity measures and their confidence in reaching their level of desired functionality postoperatively (scored 0-10). Patients then completed an identical postoperative questionnaire at their follow-up visits. Associations between the patient's confidence in attaining treatment goals and functional outcomes was established by multiple linear regression models that were adjusted for gender, age, body mass index, baseline 12-Item Short Form Health Survey mental component scores, college education, smoking status, baseline functional scores, and length of follow-up. Patients had a high level of confidence that their outcome would match their expectations, with an average score of 7.8 (range, 0-10; 28.4% reported a full 10/10 confidence). For every 1-point increase in confidence, patients experienced an average increase in their function score of 2.7 points (P = .039) and improvement in their pain score of 2.0 (P = .033) according to the Penn Shoulder Score. There was no significant association with the patient's 12-Item Short Form Health Survey score postoperatively. Patients with greater preoperative confidence actually have significantly better postoperative functional outcomes than their less confident peers even with adjustment for other known risk factors. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  4. Parental psychopathology and treatment outcome for anxious youth: Roles of family functioning and caregiver strain

    Science.gov (United States)

    Schleider, Jessica L.; Ginsburg, Golda S.; Keeton, Courtney P.; Weisz, John R.; Birmaher, Boris; Kendall, Phillip C.; Piacentini, John; Sherrill, Joel; Walkup, John T.

    2014-01-01

    Objective Research has examined the effects of parental psychopathology, family functioning, and caregiver strain on treatment response in anxious youths. Although these variables have shown individual links to youth treatment response, theoretical models for their combined effects remain unexplored. This study tested the hypothesis that improvements in family functioning and reductions in caregiver strain explained the effects of parental psychopathology on youth treatment outcome in an anxiety treatment trial. Method A multiple mediation technique was used to test the proposed model across independent evaluator (IE), parent, and youth informants in 488 youths, aged 7–17 years (50% female; mean age 10.7) meeting DSM-IV-TR criteria for social phobia, separation anxiety, and/or generalized anxiety disorder. Youths were randomized to receive 12 weeks of cognitive-behavioral treatment (Coping Cat), medication (sertraline), their combination, or a pill placebo. At pre- and post-treatment, parents completed self-report measures of global psychopathology symptoms, family functioning, and caregiver strain; parents, youths, and IEs rated youths’ anxiety symptom severity. Results Changes in family functioning and caregiver strain jointly explained relations between parental psychopathology and reductions in youth anxiety. Specifically, across IE and parent informants, families with higher pre-treatment parental psychopathology showed more improvement in family functioning and caregiver strain, which in turn predicted greater youth anxiety reductions. Further, higher pre-treatment parental psychopathology predicted greater caregiver strain reductions, and in turn, greater youth anxiety reductions, based on youths’ reports of their own anxiety. Conclusions Findings suggest that improvements in family functioning and reductions in caregiver strain can influence treatment outcomes for anxious youths, especially among youths with more distressed parents. Public health

  5. Measuring Networking as an Outcome Variable in Undergraduate Research Experiences.

    Science.gov (United States)

    Hanauer, David I; Hatfull, Graham

    2015-01-01

    The aim of this paper is to propose, present, and validate a simple survey instrument to measure student conversational networking. The tool consists of five items that cover personal and professional social networks, and its basic principle is the self-reporting of degrees of conversation, with a range of specific discussion partners. The networking instrument was validated in three studies. The basic psychometric characteristics of the scales were established by conducting a factor analysis and evaluating internal consistency using Cronbach's alpha. The second study used a known-groups comparison and involved comparing outcomes for networking scales between two different undergraduate laboratory courses (one involving a specific effort to enhance networking). The final study looked at potential relationships between specific networking items and the established psychosocial variable of project ownership through a series of binary logistic regressions. Overall, the data from the three studies indicate that the networking scales have high internal consistency (α = 0.88), consist of a unitary dimension, can significantly differentiate between research experiences with low and high networking designs, and are related to project ownership scales. The ramifications of the networking instrument for student retention, the enhancement of public scientific literacy, and the differentiation of laboratory courses are discussed. © 2015 D. I. Hanauer and G. Hatfull. CBE—Life Sciences Education © 2015 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

  6. Cognitive and functional outcomes of terror victims who suffered from traumatic brain injury.

    Science.gov (United States)

    Schwartz, Isabella; Tuchner, Maya; Tsenter, Jeanna; Shochina, Mara; Shoshan, Yigal; Katz-Leurer, Michal; Meiner, Zeev

    2008-03-01

    To describe the outcomes of terror victims suffered from traumatic brain injury (TBI). Retrospective chart review of 17 terror and 39 non-terror TBI patients treated in a rehabilitation department during the same period. Variables include demographic data, Injury Severity Scale (ISS), length of stay (LOS) and imaging results. ADL was measured using the Functional Independence Measurement (FIM), cognitive and memory functions were measured using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery and the Rivermead Battery Memory Test (RBMT), respectively. Terror TBI patients were significantly younger, had higher ISS score and higher rates of intracerebral haemorrhage (ICH), brain surgery and penetrating brain injuries than the non-terror TBI group. There was no difference in mean LOS, mean FIM values, mean FIM gain and mean cognitive and memory improvement between groups. Terror victims suffered from a higher percentage of post-traumatic epilepsy (35% vs. 10%, p=0.05), whereas the rate of PTSD and the rate of return to previous occupation were similar between groups. Although TBI terror victims had more severe injury, they gained most of ADL functions and their rehabilitation outcomes were similar to non-terror TBI patients. These favourable results were achieved due to a comprehensive interdisciplinary approach to terror victims and also by national support which allowed an adequate period of treatment and sufficient resources as needed.

  7. Axial force measurement for esophageal function testing

    DEFF Research Database (Denmark)

    Gravesen, Flemming Holbæk; Funch-Jensen, Peter; Gregersen, Hans

    2009-01-01

    force transducers over in-vivo strain gauges of various sizes to electrical impedance based measurements. The amplitude and duration of the axial force has been shown to be as reliable as manometry. Normal, as well as abnormal, manometric recordings occur with normal bolus transit, which have been...... force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external...... documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe...

  8. Hepatology may have problems with putative surrogate outcome measures

    DEFF Research Database (Denmark)

    Gluud, Christian; Brok, Jesper; Gong, Yan;

    2007-01-01

    hepatitis C, serum bilirubin concentration following ursodeoxycholic acid or immunosuppressants for patients with primary biliary cirrhosis, and nutritional outcomes following artificial nutrition for liver patients may not be valid surrogates for morbidity or mortality. The challenge is to develop reliable...

  9. ibadan knee/hip osteoarthritis outcome measure: process of ...

    African Journals Online (AJOL)

    results of care and its effect upon the health of the patient and society.1 ... centeredness to customer centeredness in outcomes assessment. ... only meet accountability but patient satisfaction. ..... Price DD, McGrath PA, Raffi A, Buckingham B.

  10. Correlation between serum neuron specific enolase and functional neurological outcome in patients of acute ischemic stroke.

    Science.gov (United States)

    Zaheer, Sana; Beg, Mujahid; Rizvi, Imran; Islam, Najmul; Ullah, Ekram; Akhtar, Nishat

    2013-10-01

    The use of biomarkers to predict stroke prognosis is gaining particular attention nowadays. Neuron specific enolase (NSE), which is a dimeric isoenzyme of the glycolytic enzyme enolase and is found mainly in the neurons is one such biomarker. This study was carried out on patients of acute ischemic stroke with the aims to determine the correlation between NSE levels on the day of admission with infarct volume, stroke severity, and functional neurological outcome on day 30. Seventy five patients of acute ischemic stroke admitted in the Department of Medicine were included in the study. Levels of NSE were determined on day 1 using the human NSE ELISA kit (Alpha Diagnostic International Texas 78244, USA). Volume of infarct was measured by computed tomography (CT) scan using the preinstalled software Syngo (version A40A) of Siemen's medical solutions (Forchheim, Germany). Stroke severity at admission was assessed using Glasgow coma scale (GCS) and functional neurological outcome was assessed using modified Rankin scale (mRS) on day 30. Statistical analysis was performed using the SPSS software for windows version 15.0 (SPSS). A positive correlation was found between concentration of NSE on day 1 and infarct volume determined by CT scan (r = 0.955, P serve as a useful marker to predict stroke severity and early functional outcome. However, larger studies with serial estimation of NSE are needed to establish these observations more firmly.

  11. MANAGEMENT OF PRIMARY FROZEN SHOULDER PROSPECTIVE EVALUATION OF FUNCTIONAL OUTCOME BETWEEN HYDRODILATATION AND INTRA-ARTICULAR STEROID INJECTION

    Directory of Open Access Journals (Sweden)

    Dinesh Mitra R. P

    2017-01-01

    Full Text Available BACKGROUND The aim of this prospective randomized control study is to compare the functional outcome between hydrodilatation and intraarticular steroid injection in patients with primary frozen shoulder. MATERIALS AND METHODS A total number of 52 patients who attended the orthopaedic outpatient between November 2014 and January 2016 were included in this study. The patients were categorized into two groups. Group I patients were treated with hydrodilatation method and Group II patients were treated with intra-articular steroids. Both the group of patients were advised to perform home exercise programs. The patients were assessed at baseline (before the procedure at two weeks, six weeks, three months and six months. All patients were evaluated for functional improvement by measuring the range of active movements and Constant and Murley shoulder outcome scores. RESULTS Up to three months patients treated with hydrodilatation have significantly better functional outcome as evaluated by active range of movements and Constant and Murley score. But at six months there is no significant difference in functional outcome between two methods of treatment. CONCLUSION There was improvement in functional outcome in both the methods of treatment. But patients treated by hydrodilatation showed more significant increase in functional outcome for the first three months. Home exercise forms an integral part in the management of primary frozen shoulder.

  12. Retrograde femoral nailing in elderly patients: outcome and functional results.

    Science.gov (United States)

    Neubauer, Thomas; Krawany, Manfred; Leitner, Lukas; Karlbauer, Alois; Wagner, Michael; Plecko, Michael

    2012-06-01

    Functional outcome after retrograde femoral intramedullary nailing was investigated in 35 patients older than 60 years (mean, 86 years) with 36 fractures, comprising 15 (41.7%) shaft and 21 (58.3%) distal fractures; overall, 7 (19.4%) periprosthetic fractures occured. Twenty-two (62.9%) of 35 patients were evaluated at a mean 16.5-month follow-up with the Lyshom-Gillquist score and the SF-8 questionaire. Primary union rate was 97.8%, with no significant differences in duration of surgery, bone healing, mobilization, and weight bearing among different fracture types; periprosthetic fractures revealed a significantly delayed mobilization (P=.03). Complications occured significantly more often among distal femoral fractures (P=.009), including all revision surgeries. The most frequently encountered complication was loosening of distal locking bolts (n=3). Lysholm score results were mainly influenced by age-related entities and revealed fair results in all fractures (mean in the femoral shaft fracture group, 78.1 vs mean in the distal femoral fracture group, 74.9; P=.69), except in the periprosthetic subgroup, which had good results (mean, 84.8; P=.23). This group also had increased physical parameters according to SF-8 score (P=.026). No correlation existed between SF-8 physical parameters and patient age or surgery delay, whereas a negative correlation existed between patient age and SF-8 mental parameters (P=.012). Retrograde femoral intramedullary nailing is commonly used in elderly patients due to reliable bone healing, minimal soft tissue damage, and immediate full weight bearing. It also offers a valid alternative to antegrade nailing in femoral shaft fractures.

  13. Correlation between serum neuron specific enolase and functional neurological outcome in patients of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Sana Zaheer

    2013-01-01

    Full Text Available Context: The use of biomarkers to predict stroke prognosis is gaining particular attention nowadays. Neuron specific enolase (NSE, which is a dimeric isoenzyme of the glycolytic enzyme enolase and is found mainly in the neurons is one such biomarker. Aims: This study was carried out on patients of acute ischemic stroke with the aims to determine the correlation between NSE levels on the day of admission with infarct volume, stroke severity, and functional neurological outcome on day 30. Materials and Methods: Seventy five patients of acute ischemic stroke admitted in the Department of Medicine were included in the study. Levels of NSE were determined on day 1 using the human NSE ELISA kit (Alpha Diagnostic International Texas 78244, USA. Volume of infarct was measured by computed tomography (CT scan using the preinstalled software Syngo (version A40A of Siemen′s medical solutions (Forchheim, Germany. Stroke severity at admission was assessed using Glasgow coma scale (GCS and functional neurological outcome was assessed using modified Rankin scale (mRS on day 30. Statistical Analysis Used: Statistical analysis was performed using the SPSS software for windows version 15.0 (SPSS. Results: A positive correlation was found between concentration of NSE on day 1 and infarct volume determined by CT scan (r = 0.955, P < 0.001. A strong negative correlation was found between GCS at presentation and concentration of NSE on day 1 (r = −0.806, P < 0.001. There was a positive correlation between NSE levels at day 1 and functional neurological outcome assessed by mRS at day 30 (r = 0.744, P < 0.001. Conclusions: Serum levels of NSE in first few days of ischemic stroke can serve as a useful marker to predict stroke severity and early functional outcome. However, larger studies with serial estimation of NSE are needed to establish these observations more firmly.

  14. Strategies for assessment and outcome measurement in physical and rehabilitation medicine: an educational review.

    Science.gov (United States)

    Küçükdeveci, Ayşe A; Tennant, Alan; Grimby, Gunnar; Franchignoni, Franco

    2011-07-01

    The aim of this educational review, which is based upon expert opinion, is to describe to clinicians training in Physical and Rehabilitation Medicine and research students training to work in the field, the appropriate attributes and standards required for assessment and outcome measurement. "What to assess" is discussed in the context of the conceptual framework provided by the International Classification of Functioning, Disability and Health, supplemented with quality of life as an additional construct. The reasons for making the assessment, and the context in which the assessment will be used, are then considered. Examples of recommendations of some international organizations regarding what and how to assess are presented. Suggestions are made about the selection of assessment tools, including examples from two diagnostic groups: stroke and rheumatoid arthritis. Finally, the basic psychometric standards required for any assessment tool, and additional requirements for outcome assessment, are explained.

  15. Structural Equation Modeling of Motor Impairment, Gross Motor Function, and the Functional Outcome in Children with Cerebral Palsy

    Science.gov (United States)

    Park, Eun-Young; Kim, Won-Ho

    2013-01-01

    Physical therapy intervention for children with cerebral palsy (CP) is focused on reducing neurological impairments, improving strength, and preventing the development of secondary impairments in order to improve functional outcomes. However, relationship between motor impairments and functional outcome has not been proved definitely. This study…

  16. Effect of Right Heart Systolic Function on Outcomes in Patients with Constrictive Pericarditis Undergoing Pericardiectomy

    Institute of Scientific and Technical Information of China (English)

    Xue Lin; Rui-Yi Xu; Jian-Zhou Liu; Wei Chen; Lian-Feng Chen; Peng-Hua Yang; Li-Gang Fang

    2016-01-01

    Background:To determine the influence of right ventricular function in patients with constrictive pericarditis (CP) undergoing surgery and to compare the outcomes of patients who received surgery with those managed medically.Methods:Patients with the diagnosis of CP and healthy volunteers were recruited from January 2006 to November 2011.Patients with CP chose to either receive pericardiectomy or medical management.Echocardiographic measurements were performed to evaluate heart function,and survival was recorded.Results:A total of 58 patients with CP (36 received pericardiectomy,22 managed medically),and 43 healthy volunteers were included.CP patients who received surgery had a higher survival rate than those managed medically (P =0.003),and higher survival was also seen in the subgroup of CP patients with severely impaired right systolic function.Albumin level,left ventricular end-diastolic dimension,and tricuspid regurgitation velocity were associated with survival in CP patients who received surgery.Conclusions:Preoperative right heart function does not affect surgical outcomes.Patients with severely impaired preoperative right systolic function obtain a greater survival advantage with surgery than with medical treatment.

  17. Effect of Right Heart Systolic Function on Outcomes in Patients with Constrictive Pericarditis Undergoing Pericardiectomy

    Directory of Open Access Journals (Sweden)

    Xue Lin

    2016-01-01

    Full Text Available Background: To determine the influence of right ventricular function in patients with constrictive pericarditis (CP undergoing surgery and to compare the outcomes of patients who received surgery with those managed medically. Methods: Patients with the diagnosis of CP and healthy volunteers were recruited from January 2006 to November 2011. Patients with CP chose to either receive pericardiectomy or medical management. Echocardiographic measurements were performed to evaluate heart function, and survival was recorded. Results: A total of 58 patients with CP (36 received pericardiectomy, 22 managed medically, and 43 healthy volunteers were included. CP patients who received surgery had a higher survival rate than those managed medically (P = 0.003, and higher survival was also seen in the subgroup of CP patients with severely impaired right systolic function. Albumin level, left ventricular end-diastolic dimension, and tricuspid regurgitation velocity were associated with survival in CP patients who received surgery. Conclusions: Preoperative right heart function does not affect surgical outcomes. Patients with severely impaired preoperative right systolic function obtain a greater survival advantage with surgery than with medical treatment.

  18. Axial force measurement for esophageal function testing

    Institute of Scientific and Technical Information of China (English)

    Flemming H Gravesen; Peter Funch-Jensen; Hans Gregersen; Asbjφrn Mohr Drewes

    2009-01-01

    The esophagus serves to transport food and fluid from the pharynx to the stomach. Manometry has been the "golden standard" for the diagnosis of esophageal motility diseases for many decades. Hence, esophageal function is normally evaluated by means of manometry even though it reflects the squeeze force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external force transducers over in-vivo strain gauges of various sizes to electrical impedance based measurements. The amplitude and duration of the axial force has been shown to be as reliable as manometry. Normal, as well as abnormal, manometric recordings occur with normal bolus transit, which have been documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe with combined axial force and manometry recordings showed that axial force amplitude increased by 130% in contrast to an increase of 30% using manometry. Using axial force in combination with manometry provides a more complete picture of esophageal motility, and the current paper outlines the advantages of using this method.

  19. Axial force measurement for esophageal function testing.

    Science.gov (United States)

    Gravesen, Flemming H; Funch-Jensen, Peter; Gregersen, Hans; Drewes, Asbjørn Mohr

    2009-01-14

    The esophagus serves to transport food and fluid from the pharynx to the stomach. Manometry has been the "golden standard" for the diagnosis of esophageal motility diseases for many decades. Hence, esophageal function is normally evaluated by means of manometry even though it reflects the squeeze force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external force transducers over in-vivo strain gauges of various sizes to electrical impedance based measurements. The amplitude and duration of the axial force has been shown to be as reliable as manometry. Normal, as well as abnormal, manometric recordings occur with normal bolus transit, which have been documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe with combined axial force and manometry recordings showed that axial force amplitude increased by 130% in contrast to an increase of 30% using manometry. Using axial force in combination with manometry provides a more complete picture of esophageal motility, and the current paper outlines the advantages of using this method.

  20. functional and psychological outcome of cataract surgeries in platea

    African Journals Online (AJOL)

    Perpetua

    cause of blindness, is the leading cause of blindness and low vision worldwide. .... (includes light/dark adaptation, colour discrimination and glare disability), a ..... are dissatisfied could have the opposite effect, and fear of a poor outcome may ...

  1. In vivo measurement of protein functional changes

    Directory of Open Access Journals (Sweden)

    Aili Wang, Zhicheng Zhang, Qinyi Zhao

    2009-01-01

    Full Text Available Conformational changes in proteins are fundamental to all biological functions. In protein science, the concept of protein flexibility is widely used to describe protein dynamics and thermodynamic properties that control protein conformational changes. In this study, we show that urea, which has strong sedative potency, can be administered to fish at high concentrations, and that protein functional changes related to anesthesia induction can be measured in vivo. Ctenopharyngodon idellus (the grass carp has two different types of N-methyl d-aspartate (NMDA receptors, urea-insensitive and urea-sensitive, which are responsible for the heat endurance of fish. The urea-sensitive NMDA receptor showed high protein flexibility, the gamma aminobutyric acid (GABA receptor showed less flexibility, and the protein that is responsible for ethanol anesthesia showed the lowest flexibility. The results suggest that an increase in protein flexibility underlies the fundamental biophysical mechanisms of volatile general anesthetics.

  2. Connecting Stuttering Management and Measurement: V. Deduction and Induction in the Development of Stuttering Treatment Outcome Measures and Stuttering Treatments

    Science.gov (United States)

    Onslow, Mark

    2006-01-01

    Background: The development of evidence-based practice, which is increasingly popular in stuttering treatment, is closely linked to the development of outcome measures. Aims: Two approaches to the development of stuttering treatment outcome measures are outlined. The first is the deductive, top-down approach, where the development of specific…

  3. Management guidelines and outcome measures in polymyalgia rheumatica (PMR).

    Science.gov (United States)

    Dasgupta, B; Matteson, E L; Maradit-Kremers, H

    2007-01-01

    Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease of the elderly that is subject to wide variations in clinical practice and is managed both in the primary and secondary care settings by general practitioners, rheumatologists and non-rheumatologists. Considerable uncertainty exists relating to diagnosis, management and outcome in patients with PMR. The guidelines presented here seek to improve outcomes for PMR patients by outlining a process to ensure more accurate diagnosis and timely specialist referral. The guidelines are directed to promote more conservative treatment and to ensure early bone protection in order to reduce the common morbidity of osteoporotic fractures. Furthermore, these guidelines specify the goals of treatment, including clinical and patient-based outcomes, and provide advice concerning monitoring for disease activity and complications.

  4. Outcomes measurement in patients with head and neck cancer.

    Science.gov (United States)

    Gourin, Christine G

    2014-03-01

    Outcomes research is defined as clinical and population-based research that investigates the results of healthcare practices or interventions through the filter of the benefit to the patient and other stakeholders. Outcomes research is an increasingly important field or research, because of the pressing need for evidence-based information that can be used to make better informed health and healthcare decisions, and define desired health care practices in the current era of healthcare reform. This article will review the head and neck cancer (HNCA) outcomes literature published in the past year, with a focus on studies evaluating treatment and survival, short-term and long-term complications, and quality of life (QOL).

  5. The Gompertz function does not measure ageing.

    Science.gov (United States)

    Driver, C

    2001-01-01

    The Gompertz transform of the distribution function for the age at death expresses mortality in a form R = R0e(alphat) where R0 is the mortality at time zero and alpha is the rate of increase of mortality, frequently taken as the rate of ageing. The slope of the line alpha is frequently used as a measure of the rate of ageing. It is argued that it is incorrect to use alpha in this way. To support this contention, a paradox is produced whereby selection for longevity increases alpha, which could lead to the absurd conclusion that selection for longevity increases the rate of ageing.

  6. Emotion perception and functional outcome in schizophrenia: the importance of negative valence and fear.

    Science.gov (United States)

    Brittain, Philip J; Ffytche, Dominic H; Surguladze, Simon A

    2012-12-30

    A substantial body of work has demonstrated that persons with schizophrenia have a deficit in the perception of emotional stimuli. More recently this deficit has been linked to poor functional outcomes (FO) in this group. The current research investigated the perception of emotional stimuli in a group of 64 schizophrenia patients and 65 matched healthy controls. In the patient group, across two different emotion perception tasks and a social perception task, small deficits were found in the perception of negative, positive and neutrally valenced stimuli. Only the ability to perceive negative and neutrally valenced stimuli significantly correlated with a set of FO measures in the patients, with one task indicating these associations were strongest for the perception of fear. Subsequent regression modelling, controlling for the effects of symptomatology, demonstrated that for each of the three tasks, the measure of negative valence perception accounted for a similar but small amount (4%) of the variance seen in the functional status of the patients.

  7. Functional outcome at school age of preterm-born children treated with high-dose dexamethasone

    NARCIS (Netherlands)

    Hitzert, Marrit M.; Van Braeckel, Koenraad N. A.; de Bok, Marijn; Maathuis, Carel G. B.; Roze, Elise; Bos, Arend F.

    2014-01-01

    Background: Postnatal dexamethasone (DXM) treatment is associated with adverse motor outcome. It is largely unknown as to what extent functional outcome at school age is affected. Aims: Our first aim was to determine motor, cognitive, and behavioural outcome at school age of preterm-born children tr

  8. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: assessment of functional outcome following lumbar fusion.

    Science.gov (United States)

    Ghogawala, Zoher; Resnick, Daniel K; Watters, William C; Mummaneni, Praveen V; Dailey, Andrew T; Choudhri, Tanvir F; Eck, Jason C; Sharan, Alok; Groff, Michael W; Wang, Jeffrey C; Dhall, Sanjay S; Kaiser, Michael G

    2014-07-01

    Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.

  9. Overview to the two-part series: Measurement equivalence of the Patient Reported Outcomes Measurement Information System® (PROMIS® short forms

    Directory of Open Access Journals (Sweden)

    Bryce B. Reeve

    2016-03-01

    Full Text Available Measurement equivalence across differing socio-demographic groups is essential for valid assessment. This is one of two issues of Psychological Test and Assessment Modeling that contains articles describing methods and substantive findings related to establishing measurement equivalence in self-reported health, mental health and social functioning measures. The articles in this two part series describe analyses of items assessing eight domains: fatigue, depression, anxiety, sleep, pain, physical function, cognitive concerns and social function. Additionally, two overview articles describe the methods and sample characteristics of the data set used in these analyses. An additional article describes the important topic of assessing magnitude and impact of differential item functioning. These articles provide the first strong evidence supporting the measurement equivalence of the Patient Reported Outcomes Measurement Information System® (PROMIS® short form measures in ethnically, socio-demographically diverse groups, and is a beginning step in meeting the international call for further study of their performance in such groups.

  10. A hierarchy of patient-reported outcome measures for meta-analysis of knee osteoarthritis trials

    DEFF Research Database (Denmark)

    Juhl, Carsten Bogh; Lund, Hans; Guyatt, GH

    2010-01-01

    Title A hierarchy of patient-reported outcome measures for meta-analysis of knee osteoarthritis trials: empirical evidence from a survey of high impact journals Objective To develop a prioritized list for extracting patient-reported outcomes (PROs) measuring pain and disability for meta-analyses ......Title A hierarchy of patient-reported outcome measures for meta-analysis of knee osteoarthritis trials: empirical evidence from a survey of high impact journals Objective To develop a prioritized list for extracting patient-reported outcomes (PROs) measuring pain and disability for meta...

  11. Preoperative Patient-Recorded Outcome Measures Predict Patient Discharge Location Following Unicondylar Knee Arthroplasty.

    Science.gov (United States)

    Ayala, Alfonso E; Lawson, Kevin A; Gruessner, Angelika C; Dohm, Michael P

    2017-02-01

    Advantages of unicondylar knee arthroplasty (UKA) over total knee arthroplasty include rapid recovery and shorter lengths of stay following surgery. Patients requiring extended postoperative care fail to recognize these benefits. Patient-reported outcome measures have proved useful in predicting outcomes following joint arthroplasty. The purpose of this study was to identify and report preoperative patient-reported outcome measures and clinical variables that predict discharge to skilled nursing facilities following UKA. A prospective cohort of 174 patients was used to collect 36-Item Short Form scores and objective clinical data. Univariate and multivariate analysis with backward elimination were conducted to find a predictive risk model. The predictive model reported (78.7% concordance, receiver operating characteristic curve c-statistic 0.719, P = .0016) demonstrates that risk factors for discharge to skilled nursing facilities are: older age (odds ratio 4.18; 95% confidence interval [CI] 1.256-13.911, P = .019), bilateral UKA procedures (odds ratio 1.887; 95% CI 1.054-3.378, P = .0326) and lower patient-reported preoperative 36-Item Short Form physical function scores (odds ratio 0.968; CI 0.938-1, P = .0488). The information presented here regarding possible patient disposition following UKA could aid informed decision-making regarding patients' short-term needs following surgery and help streamline preoperative planning. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Recommendations for a first Core Outcome Measurement set for complex regional PAin syndrome Clinical sTudies (COMPACT).

    Science.gov (United States)

    Grieve, Sharon; Perez, Roberto Sgm; Birklein, Frank; Brunner, Florian; Bruehl, Stephen; Harden, R Norman; Packham, Tara; Gobeil, Francois; Haigh, Richard; Holly, Janet; Terkelsen, Astrid; Davies, Lindsay; Lewis, Jennifer; Thomassen, Ilona; Connett, Robyn; Worth, Tina; Vatine, Jean-Jacques; McCabe, Candida S

    2017-02-04

    Complex Regional Pain Syndrome (CRPS) is a persistent pain condition that remains incompletely understood and challenging to treat. Historically, a wide range of different outcome measures have been used to capture the multidimensional nature of CRPS. This has been a significant limiting factor in the advancement of our understanding of the mechanisms and management of CRPS.In 2013, an international consortium of patients, clinicians, researchers and industry representatives was established, to develop and agree on a minimum core set of standardised outcome measures for use in future CRPS clinical research, including but not limited to clinical trials within adult populationsThe development of a core measurement set was informed through workshops and supplementary work, using an iterative consensus process. 'What is the clinical presentation and course of CRPS, and what factors influence it?' was agreed as the most pertinent research question that our standardised set of patient-reported outcome measures should be selected to answer. The domains encompassing the key concepts necessary to answer the research question were agreed as: pain, disease severity, participation and physical function, emotional and psychological function, self efficacy, catastrophizing and patient's global impression of change. The final core measurement set included the optimum generic or condition-specific patient-reported questionnaire outcome measures, which captured the essence of each domain, and one clinician reported outcome measure to capture the degree of severity of CRPS. The next step is to test the feasibility and acceptability of collecting outcome measure data using the core measurement set in the CRPS population internationally.

  13. Quality of life as an outcome measure in surgical oncology

    NARCIS (Netherlands)

    Langenhoff, B S; Krabbe, P F; Wobbes, T; Ruers, T J

    2001-01-01

    BACKGROUND: There is a growing interest in assessing the impact of a disease and the effect of a treatment on a patient's life, expressed as health-related quality of life (HRQoL). HRQoL assessment can provide essential outcome information for cancer surgery. METHODS: The core of this review is deri

  14. Outcome Measures of Triple Board Graduates, 1991-2003

    Science.gov (United States)

    Warren, Marla J.; Dunn, David W.; Rushton, Jerry

    2006-01-01

    Objective: To describe program outcomes for the Combined Training Program in Child and Adolescent Psychiatry, Pediatrics, and Psychiatry (Triple Board Program). Method: All Triple Board Program graduates to date (1991-2003) were asked to participate in a 37-item written survey from February to April 2004. Results: The response rate was 80.7%. Most…

  15. Psychometric validation of patient-reported outcome measures assessing chronic constipation

    Directory of Open Access Journals (Sweden)

    Nelson LM

    2014-09-01

    Full Text Available Lauren M Nelson,1 Valerie SL Williams,1 Sheri E Fehnel,1 Robyn T Carson,2 James MacDougall,3 Mollie J Baird,3 Stavros Tourkodimitris,2 Caroline B Kurtz,3 Jeffrey M Johnston31RTI Health Solutions, Durham, NC, USA; 2Forest Research Institute, Jersey City, NJ, USA; 3Ironwood Pharmaceuticals, Cambridge, MA, USABackground: Measures assessing treatment outcomes in previous CC clinical trials have not met the requirements described in the US Food and Drug Administration's guidance on patient-reported outcomes.Aim: Psychometric analyses using data from one Phase IIb study and two Phase III trials of linaclotide for the treatment of chronic constipation (CC were conducted to document the measurement properties of patient-reported CC Symptom Severity Measures.Study methods: Each study had a multicenter, randomized, double-blind, placebo-controlled, parallel-group design, comparing placebo to four doses of oral linaclotide taken once daily for 4 weeks in the Phase IIb dose-ranging study (n=307 and to two doses of linaclotide taken once daily for 12 weeks in the Phase III trials (n=1,272. The CC Symptom Severity Measures addressing bowel function (Bowel Movement Frequency, Stool Consistency, Straining and abdominal symptoms (Bloating, Abdominal Discomfort, Abdominal Pain were administered daily using interactive voice-response system technology. Intraclass correlations, Pearson correlations, factor analyses, F-tests, and effect sizes were computed.Results: The CC Symptom Severity Measures demonstrated satisfactory test–retest reliability and construct validity. Factor analyses indicated one factor for abdominal symptoms and another for bowel symptoms. Known-groups F-tests substantiated the discriminating ability of the CC Symptom Severity Measures. Responsiveness statistics were moderate to strong, indicating that these measures are capable of detecting change.Conclusion: In large studies of CC patients, linaclotide significantly improved abdominal and

  16. Quality of care in systemic lupus erythematosus: the association between process and outcome measures in the Lupus Outcomes Study.

    Science.gov (United States)

    Yazdany, Jinoos; Trupin, Laura; Schmajuk, Gabriela; Katz, Patricia P; Yelin, Edward H

    2014-08-01

    Although process measures to assess quality of care in systemic lupus erythematosus (SLE) are available, their relationship to long-term outcomes has not been studied. Using a prospective, longitudinal cohort study, we examined the associations between high-quality care and two important SLE outcomes, disease activity and damage. Data were derived from the University of California, San Francisco Lupus Outcomes Study. Participants were followed from 2009 through 2013, responding to yearly surveys. Primary outcomes in this study were clinically meaningful increases in disease activity and damage, assessed by the Systemic Lupus Activity Questionnaire (SLAQ) and the Brief Index of Lupus Damage (BILD), respectively. Using multivariable regression, we examined the relationship between high performance on 13 validated quality measures (receipt of ≥85% of quality measures), and disease outcomes, adjusting for disease status, sociodemographic characteristics, healthcare services and follow-up time. The 737 participants were eligible for a mean of five quality measures (SD 2, range 2-12). There were 155 and 162 participants who had clinically meaningful increases in SLAQ and BILD, respectively. In our models, we found no statistically significant relationship between performance on quality measures and changes in SLAQ. However, receiving higher-quality SLE care was significantly protective against increased disease damage (adjusted OR 0.4, 95% CI 0.4 to 0.7), even after adjusting for covariates. In this community-based cohort, we illustrate for the first time a strong link between processes of care, defined by SLE quality measures, and the subsequent accumulation of disease damage, an important outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Outcome Measurement Using Naturalistic Language Samples: A Feasibility Pilot Study Using Language Transcription Software and Speech and Language Therapy Assistants

    Science.gov (United States)

    Overton, Sarah; Wren, Yvonne

    2014-01-01

    The ultimate aim of intervention for children with language impairment is an improvement in their functional language skills. Baseline and outcome measurement of this is often problematic however and practitioners commonly resort to using formal assessments that may not adequately reflect the child's competence. Language sampling,…

  18. From clinically relevant outcome measures to quality of life in epilepsy : A time trade-off study

    NARCIS (Netherlands)

    de Kinderen, Reina J A; Wijnen, Ben F M; van Breukelen, Gerard; Postulart, Debby; Majoie, Marian H J M; Aldenkamp, Albert P; Evers, Silvia M A A

    2016-01-01

    OBJECTIVES: A proposed method for bridging the gap between clinically relevant epilepsy outcome measures and quality-adjusted life years is to derive utility scores for epilepsy health states. The aim of this study is to develop such a utility-function and to investigate the impact of the epilepsy o

  19. Introduction to measure theory and functional analysis

    CERN Document Server

    Cannarsa, Piermarco

    2015-01-01

    This book introduces readers to theories that play a crucial role in modern mathematics, such as integration and functional analysis, employing a unifying approach that views these two subjects as being deeply intertwined. This feature is particularly evident in the broad range of problems examined, the solutions of which are often supported by generous hints. If the material is split into two courses, it can be supplemented by additional topics from the third part of the book, such as functions of bounded variation, absolutely continuous functions, and signed measures. This textbook addresses the needs of graduate students in mathematics, who will find the basic material they will need in their future careers, as well as those of researchers, who will appreciate the self-contained exposition which requires no other preliminaries than basic calculus and linear algebra.

  20. Effect of preoperative neuromuscular training (NEMEX-TJR) on functional outcome after total knee replacement

    DEFF Research Database (Denmark)

    Huber, Erika O; Roos, Ewa M.; Meichtry, André

    2015-01-01

    BACKGROUND: Improving functional status preoperatively through exercise may improve postoperative outcome. Previous knowledge on preoperative exercise in knee osteoarthritis is insufficient. The aim of the study was to compare the difference in change between groups in lower extremity function fr...

  1. Fatigue, patient reported outcomes, and objective measurement of physical activity in systemic lupus erythematosus.

    Science.gov (United States)

    Mahieu, M A; Ahn, G E; Chmiel, J S; Dunlop, D D; Helenowski, I B; Semanik, P; Song, J; Yount, S; Chang, R W; Ramsey-Goldman, R

    2016-10-01

    Fatigue is a common symptom in systemic lupus erythematosus (SLE), and engaging in physical activity may reduce fatigue. We aimed to characterize relationships between fatigue, other health status measures assessed with the Patient Reported Outcomes Measurement Information System (PROMIS) instruments, and accelerometer-based physical activity measurements in patients with SLE. The internal consistency of each PROMIS measure in our SLE sample was also evaluated. This cross-sectional study analyzed 123 adults with SLE. The primary fatigue outcome was Fatigue Severity Scale score. Secondary outcomes were PROMIS standardized T-scores in seven health status domains. Accelerometers were worn for seven days, and mean daily minutes of light, moderate/vigorous, and bouted (10 minutes) moderate/vigorous physical activity were estimated. Cronbach's alpha was determined for each PROMIS measure to assess internal consistency. Relationships between Fatigue Severity Scale, PROMIS, and physical activity were summarized with Spearman partial correlation coefficients (r), adjusted for average daily accelerometer wear time. Mean Fatigue Severity Scale score (4.3, SD 1.6) was consistent with clinically relevant levels of fatigue. Greater daily and bouted moderate/vigorous physical activity minutes correlated with lower Mean Fatigue Severity Scale score (r = -0.20, p = 0.03 and r = -0.30, p = 0.0007, respectively). For PROMIS, bouted moderate/vigorous physical activity minutes correlated with less fatigue (r = -0.20, p = 0.03). PROMIS internal consistency was excellent, with Cronbach's alpha > 0.90 for each domain. Mean PROMIS T-scores for fatigue, pain interference, anxiety, sleep disturbance, sleep-related impairment, and physical function were worse than reported for the general US population. More moderate/vigorous physical activity minutes were associated with less pain interference (r = -0.22, p = 0.01). Both light physical activity and

  2. Measurement of global functional performance in patients with rheumatoid arthritis using rheumatology function tests

    Science.gov (United States)

    Escalante, Agustín; Haas, Roy W; del Rincón, Inmaculada

    2004-01-01

    Outcome assessment in patients with rheumatoid arthritis (RA) includes measurement of physical function. We derived a scale to quantify global physical function in RA, using three performance-based rheumatology function tests (RFTs). We measured grip strength, walking velocity, and shirt button speed in consecutive RA patients attending scheduled appointments at six rheumatology clinics, repeating these measurements after a median interval of 1 year. We extracted the underlying latent variable using principal component factor analysis. We used the Bayesian information criterion to assess the global physical function scale's cross-sectional fit to criterion standards. The criteria were joint tenderness, swelling, and deformity, pain, physical disability, current work status, and vital status at 6 years after study enrolment. We computed Guyatt's responsiveness statistic for improvement according to the American College of Rheumatology (ACR) definition. Baseline functional performance data were available for 777 patients, and follow-up data were available for 681. Mean ± standard deviation for each RFT at baseline were: grip strength, 14 ± 10 kg; walking velocity, 194 ± 82 ft/min; and shirt button speed, 7.1 ± 3.8 buttons/min. Grip strength and walking velocity departed significantly from normality. The three RFTs loaded strongly on a single factor that explained ≥70% of their combined variance. We rescaled the factor to vary from 0 to 100. Its mean ± standard deviation was 41 ± 20, with a normal distribution. The new global scale had a stronger fit than the primary RFT to most of the criterion standards. It correlated more strongly with physical disability at follow-up and was more responsive to improvement defined according to the ACR20 and ACR50 definitions. We conclude that a performance-based physical function scale extracted from three RFTs has acceptable distributional and measurement properties and is responsive to clinically meaningful change. It

  3. Long-term functional outcome after stroke: the impact of MRI-detected lesion characteristics

    NARCIS (Netherlands)

    Schiemanck, S.K.

    2007-01-01

    The objective of this thesis was to gain a better understanding of the relationship between ischemic lesion characteristics and long-term functional outcome of stroke survivors. The relationship between volume and localization of the ischemic cerebral lesion and the long-term functional outcome of

  4. Manual and oral apraxia in acute stroke, frequency and influence on functional outcome

    DEFF Research Database (Denmark)

    Pedersen, P M; Jørgensen, H S; Kammersgaard, L P;

    2001-01-01

    To determine the frequency of manual and oral apraxia in acute stroke and to examine the influence of these symptoms on functional outcome.......To determine the frequency of manual and oral apraxia in acute stroke and to examine the influence of these symptoms on functional outcome....

  5. Functional outcome at school age of neonatal post-hemorrhagic ventricular dilatation

    NARCIS (Netherlands)

    Holwerda, Janyte C; Van Braeckel, Koenraad N J A; Roze, Elise; Hoving, Eelco W; Maathuis, Carel G B; Brouwer, Oebele F; Martijn, Albert; Bos, Arend F

    2016-01-01

    BACKGROUND: Specific knowledge about the functional outcome of preterm born children with post-hemorrhagic ventricular dilatation (PHVD) is lacking. OBJECTIVES: To determine functional outcome at school age in children with post-hemorrhagic ventricular dilatation and to identify whether PHVD charact

  6. Problem-Solving After Traumatic Brain Injury in Adolescence: Associations With Functional Outcomes.

    Science.gov (United States)

    Wade, Shari L; Cassedy, Amy E; Fulks, Lauren E; Taylor, H Gerry; Stancin, Terry; Kirkwood, Michael W; Yeates, Keith O; Kurowski, Brad G

    2017-08-01

    To examine the association of problem-solving with functioning in youth with traumatic brain injury (TBI). Cross-sectional evaluation of pretreatment data from a randomized controlled trial. Four children's hospitals and 1 general hospital, with level 1 trauma units. Youth, ages 11 to 18 years, who sustained moderate or severe TBI in the last 18 months (N=153). Problem-solving skills were assessed using the Social Problem-Solving Inventory (SPSI) and the Dodge Social Information Processing Short Stories. Everyday functioning was assessed based on a structured clinical interview using the Child and Adolescent Functional Assessment Scale (CAFAS) and via adolescent ratings on the Youth Self Report (YSR). Correlations and multiple regression analyses were used to examine associations among measures. The TBI group endorsed lower levels of maladaptive problem-solving (negative problem orientation, careless/impulsive responding, and avoidant style) and lower levels of rational problem-solving, resulting in higher total problem-solving scores for the TBI group compared with a normative sample (P<.001). Dodge Social Information Processing Short Stories dimensions were correlated (r=.23-.37) with SPSI subscales in the anticipated direction. Although both maladaptive (P<.001) and adaptive (P=.006) problem-solving composites were associated with overall functioning on the CAFAS, only maladaptive problem-solving (P<.001) was related to the YSR total when outcomes were continuous. For the both CAFAS and YSR logistic models, maladaptive style was significantly associated with greater risk of impairment (P=.001). Problem-solving after TBI differs from normative samples and is associated with functional impairments. The relation of problem-solving deficits after TBI with global functioning merits further investigation, with consideration of the potential effects of problem-solving interventions on functional outcomes. Copyright © 2017 American Congress of Rehabilitation Medicine

  7. The importance of team functioning to natural resource planning outcomes.

    Science.gov (United States)

    Stern, Marc J; Predmore, S Andrew

    2012-09-15

    In its recent history, the U.S. Forest Service is among many federal land management agencies struggling with questions concerning why its planning procedures are sometimes inefficient, perform poorly in the eyes of the public, and fail to deliver outputs that advance agency mission. By examining a representative sample of National Environmental Policy Act (NEPA) processes conducted by the agency between 2007 and 2009, we provide new insights into what drives outcomes in these planning processes. We examined team leaders' perceptions of the following outcomes: achievement of agency goals and NEPA mandates, process efficiency, public relations, and team outcomes. The most consistently important predictors of positive outcomes were team harmony and a clearly empowered team leader. Other factors, such as perceptions of the use of best science, a clear and unambiguous purpose and need, team turnover (personnel changes during the process), extra-agency engagement, and intra-agency relations, were also important, but played a less consistent role. The findings suggest the importance of empowering team leaders and team members through enhancing elements of discretion, responsibility, clear role definition, collaborative interdisciplinary deliberation, and perceived self-efficacy. The results also suggest the importance of genuine concern and respect for participating publics and effective inter-agency coordination. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Clinical and Functional Outcomes of the Birmingham Hip Resurfacing System.

    Science.gov (United States)

    Pascual-Garrido, Cecilia; Morris, Brandon L; Dayton, Michael R

    2016-01-01

    This study reported the outcomes of patients treated with the Birmingham Hip Resurfacing System (Smith & Nephew, Memphis, Tennessee) to identify the prevalence of complications and failures. A retrospective review of 202 patients (206 hips) was performed. Outcomes were assessed clinically with Harris Hip Score at 6 and 12 months and then yearly. Subanalysis was performed, with the hips divided according to patient sex and size of the femoral component. Mean patient age was 51±8 years, and mean follow-up was 4±1.6 years. Of the patients, 163 were men (83%) and 35 were women (17%). Postoperative improvement was significant, with preoperative Harris Hip Score of 62.9±10.6 and postoperative Harris Hip Score of 98.6±6.7 (Phips (2.4%) underwent revision. At 3 years, mean survival was better for men than for women (99% vs 92%, respectively). Survival was lowest in patients with femoral component diameter of less than 46 mm. According to the authors' results, the Birmingham Hip Resurfacing System resulted in good clinical outcomes at 4 years. Survival and outcomes in women, particularly those with modest bone size, are inferior.

  9. Measuring management success for protected species: Looking beyond biological outcomes

    Directory of Open Access Journals (Sweden)

    Kathryn D Bisack

    2016-05-01

    Full Text Available The complexity of the ocean ecosystem, including the human component, is such that a single fishery may require multiple policy instruments to support recovery and conservation of protected species, in addition to those for fisheries management. As regulations multiply, the need for retrospective analysis and evaluation grows in order to inform future policy. To accurately evaluate policy instruments, clear objectives and their link to outcomes are necessary, as well as identifying criteria to evaluate outcomes. The Northeast United States sink gillnet groundfish fishery provides a case study of the complexity of regulations and policy instruments implemented under the Marine Mammal Protection Act and the Endangered Species Act to address bycatch of marine mammals. The case study illustrates a range of possible objectives for the policy instruments including biological, economic, social-normative and longevity factors. We highlight links between possible objectives, outcomes and criteria for the four factors, as well as areas for consideration when undertaking ex-post analyses. To support learning from past actions, we call for a coordinated effort involving multiple disciplines and jurisdictions to undertake retrospective analyses and evaluations of key groups of policy instruments used for protected species.

  10. Development of a new patient-reported outcome measure in sarcopenia.

    Science.gov (United States)

    Evans, Christopher J; Chiou, Chiun-Fang; Fitzgerald, Kristina A; Evans, William J; Ferrell, Betty R; Dale, William; Fried, Linda P; Gandra, Shravanthi R; Dennee-Sommers, Brooke; Patrick, Donald L

    2011-03-01

    The objective of this study was to develop a patient-reported outcome (PRO) to assess reduced muscle strength in sarcopenia. Qualitative research study. University of Arkansas for Medical Sciences. Subjects with sarcopenia. Adults aged 55 years and older with sarcopenia (n = 12) attended open-ended, concept elicitation interviews to characterize the functional effects of reduced muscle strength on their lives. The resulting qualitative data were analyzed using a qualitative analysis software program (Atlas.ti [Atlas.ti GmbH, Berlin, Germany]) and a common set of codes was developed to summarize the data. Subsequently, the initial PRO measure was drafted. Cognitive interviews were then conducted with additional sarcopenia subjects (n = 12) to refine the measure. Qualitative interviews identified key concepts (eg, impacts) in the areas of activities of daily living, emotions, social activities, energy, balance, coordination, sleep, and strength. Based on data from the cognitive debriefing interviews (eg, understandability, relevance, suggestions to reword items), the PRO measure development team came to consensus on which items or parts of the instructions to retain, revise, or delete. The final measure included 14 items. The final PRO measure, the Age-Related Muscle Loss Questionnaire, can be used in both clinical practice and clinical trial settings to assess functional impacts of reduced muscle strength in sarcopenia. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

  11. Cardiovascular Magnetic Resonance Relaxometry Predicts Regional Functional Outcome After Experimental Myocardial Infarction.

    Science.gov (United States)

    Haberkorn, Sebastian M; Jacoby, Christoph; Ding, Zhaoping; Keul, Petra; Bönner, Florian; Polzin, Amin; Levkau, Bodo; Schrader, Jürgen; Kelm, Malte; Flögel, Ulrich

    2017-08-01

    Cardiovascular magnetic resonance with gadolinium-based contrast agents has established as gold standard for tissue characterization after myocardial infarction (MI). Beyond accurate diagnosis, the value of cardiovascular magnetic resonance to predict the outcome after MI has yet to be substantiated. Recent cardiovascular magnetic resonance approaches were systematically compared for quantification of tissue injury and functional impairment after MI using murine models with permanent left anterior descending coronary artery ligation (n=14) or 50 minutes ischemia/reperfusion (n=13). Cardiovascular magnetic resonance included native/postcontrast T1 maps, T2 maps, and late gadolinium enhancement at days 1 and 21 post-MI. For regional correlation of parametric and functional measures, the left ventricle was analyzed over 200 sectors. For T1 mapping, we used retrospective triggering with variable flip angle analysis. Sectoral analysis of native T1 maps already revealed in the acute phase after MI substantial discrepancies in myocardial tissue texture between the 2 MI models (native T1 day 1: permanent ligation, 1280.0±162.6 ms; ischemia/reperfusion, 1115.0±140.5 ms; Pfunctional outcome (left ventricular ejection fraction day 21: permanent ligation, 24.5±7.0%; ischemia/reperfusion, 33.7±11.6%; Pfunction in corresponding areas at day 21 demonstrated for early native T1 values the best correlation with the later functional impairment (R(2) =0.94). The present T1 mapping approach permits accurate characterization of local tissue injury and holds the potential for sensitive and graduated prognosis of the functional outcome after MI without gadolinium-based contrast agents. © 2017 American Heart Association, Inc.

  12. Measuring ecological function on California's rangelands

    Science.gov (United States)

    Porzig, E.

    2016-12-01

    There is a need for a better understanding of ecosystem processes on rangelands and how management decisions influence these processes on scales that are both ecologically and socially relevant. Point Blue Conservation Science's Rangeland Monitoring Network is a coordinated effort to collect standardized data on birds, vegetation, and soils on rangelands throughout California. We work with partners, including private landowners, land trusts, state and federal agencies, and others, to measure bird and plant abundance and diversity and three soil dynamic properties (water infiltration, bulk density, and organic carbon). Here, we present data from our first two years of monitoring on over 50 ranches in 17 counties. By collecting data on the scope and scale of variation in ecological function across rangelands and the relationship with management practices, we aim to advance rangeland management, restoration, and conservation.

  13. Functional and Radiographic Outcomes Following Growth-Sparing Management of Early-Onset Scoliosis.

    Science.gov (United States)

    Johnston, Charles E; Tran, Dong-Phuong; McClung, Anna

    2017-06-21

    In this study, we sought to evaluate radiographic, functional, and quality-of-life outcomes of patients who have completed growth-sparing management of early-onset scoliosis. This prospective study involved patients with early-onset scoliosis who underwent growth-sparing treatment and either "final" fusion or observation for ≥2 years since the last lengthening procedure. Demographics, radiographic parameters, pulmonary function test (PFT) values, and scores of patient-reported assessments (Early-Onset Scoliosis Questionnaire [EOSQ] and Scoliosis Research Society [SRS]-30) were obtained. At the most recent follow-up, patients performed 2 additional functional outcome tests: step-activity monitoring and a treadmill exercise-tolerance test. Twelve patients were evaluated as "graduates" of growth-sparing management of early-onset scoliosis (mean of 37 months since the most recent surgery). The major scoliosis curve measurement averaged 88° before treatment and 47° at the most recent follow-up. T1-S1 height increased from a mean of 22.3 cm to 34.7 cm and T1-T12 height, from 13.3 to 22.3 cm. At the most recent follow-up, the mean forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) as a percentage of the predicted volume were 52.1% and 55.3%, respectively, and were essentially unchanged from the earliest PFT that patients could perform (FEV1 = 53.8% of predicted and FVC = 53.5% of predicted). There was no difference between graduates and controls with respect to activity time or total steps in step-activity monitoring, and in the exercise-tolerance test, graduates walked at the same speed but at a higher heart rate and at a significantly higher (p scoliosis appears to be spine elongation and maintenance of pulmonary function at a level that is no less than the percentage of normal at initial presentation. Functional testing and patient-reported outcomes at a mean of 3 years from the last surgery suggest that activity levels were generally equal

  14. Process and outcome measures of quality of care at the diabetes ...

    African Journals Online (AJOL)

    2016-05-16

    May 16, 2016 ... services such as blood pressure and weight measurement, it performed suboptimally for foot examinations. Performance indicators that .... Table 4: Frequency distribution of outcome measures. Parameter n (%). HbA1c (%).

  15. Establishing construct validity for the thyroid-specific patient reported outcome measure (ThyPRO)

    DEFF Research Database (Denmark)

    Watt, Torquil; Bjorner, Jakob Bue; Groenvold, Mogens;

    2009-01-01

    To establish a reliable and valid scale structure of a patient-reported outcome measuring thyroid-specific quality of life.......To establish a reliable and valid scale structure of a patient-reported outcome measuring thyroid-specific quality of life....

  16. Discrepancies between patient-reported outcome measures when assessing urinary incontinence or pelvic-prolapse surgery

    DEFF Research Database (Denmark)

    Larsen, Michael Due; Lose, Gunnar; Guldberg, Rikke

    2016-01-01

    INTRODUCTION AND HYPOTHESIS: In order to assess the outcome following surgery for urinary incontinence (UI) and pelvic organ prolapse (POP) the importance of patient-reported outcome measures, in addition to the clinical objective measures, has been recognised. The International Consultation...

  17. Nonprofit Organizations and Outcome Measurement: From Tracking Program Activities to Focusing on Frontline Work

    Science.gov (United States)

    Benjamin, Lehn M.

    2012-01-01

    Why do we continue to see evidence that nonprofit staff feel like outcome measurement is missing important aspects of their work? Based on an analysis of over 1,000 pages of material in 10 outcome measurement guides and a focused literature review of frontline work in three types of nonprofit organizations, this article shows that existing outcome…

  18. Proposed outcome measures for prospective clinical trials in juvenile idiopathic arthritis-associated uveitis

    DEFF Research Database (Denmark)

    Heiligenhaus, Arnd; Foeldvari, Ivan; Edelsten, Clive

    2012-01-01

    To develop a set of core outcome measures for use in randomized controlled trials (RCTs) and longitudinal observational studies in juvenile idiopathic arthritis (JIA)-associated uveitis.......To develop a set of core outcome measures for use in randomized controlled trials (RCTs) and longitudinal observational studies in juvenile idiopathic arthritis (JIA)-associated uveitis....

  19. Neighbourhood social capital: measurement issues and associations with health outcomes.

    Science.gov (United States)

    Mackenbach, J D; Lakerveld, J; van Lenthe, F J; Kawachi, I; McKee, M; Rutter, H; Glonti, K; Compernolle, S; De Bourdeaudhuij, I; Feuillet, T; Oppert, J-M; Nijpels, G; Brug, J

    2016-01-01

    We compared ecometric neighbourhood scores of social capital (contextual variation) to mean neighbourhood scores (individual and contextual variation), using several health-related outcomes (i.e. self-rated health, weight status and obesity-related behaviours). Data were analysed from 5,900 participants in the European SPOTLIGHT survey. Factor analysis of the 13-item social capital scale revealed two social capital constructs: social networks and social cohesion. The associations of ecometric and mean neighbourhood-level scores of these constructs with self-rated health, weight status and obesity-related behaviours were analysed using multilevel regression analyses, adjusted for key covariates. Analyses using ecometric and mean neighbourhood scores, but not mean neighbourhood scores adjusted for individual scores, yielded similar regression coefficients. Higher levels of social network and social cohesion were not only associated with better self-rated health, lower odds of obesity and higher fruit consumption, but also with prolonged sitting and less transport-related physical activity. Only associations with transport-related physical activity and sedentary behaviours were associated with mean neighbourhood scores adjusted for individual scores. As analyses using ecometric scores generated the same results as using mean neighbourhood scores, but different results when using mean neighbourhood scores adjusted for individual scores, this suggests that the theoretical advantage of the ecometric approach (i.e. teasing out individual and contextual variation) may not be achieved in practice. The different operationalisations of social network and social cohesion were associated with several health outcomes, but the constructs that appeared to represent the contextual variation best were only associated with two of the outcomes.

  20. Predicting clinically significant changes in motor and functional outcomes after robot-assisted stroke rehabilitation.

    Science.gov (United States)

    Hsieh, Yu-wei; Lin, Keh-chung; Wu, Ching-yi; Lien, Hen-yu; Chen, Jean-lon; Chen, Chih-chi; Chang, Wei-han

    2014-02-01

    To investigate the predictors of minimal clinically important changes on outcome measures after robot-assisted therapy (RT). Observational cohort study. Outpatient rehabilitation clinics. A cohort of outpatients with stroke (N=55). Patients with stroke received RT for 90 to 105min/d, 5d/wk, for 4 weeks. Outcome measures, including the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL), were measured before and after the intervention. Potential predictors include age, sex, side of lesion, time since stroke onset, finger extension, Box and Block Test (BBT) score, and FMA distal score. Statistical analysis showed that the BBT score (odds ratio[OR]=1.06; P=.04) was a significant predictor of clinically important changes in the FMA. Being a woman (OR=3.9; P=.05) and BBT score (OR=1.07; P=.02) were the 2 significant predictors of clinically significant changes in the MAL amount of use subscale. The BBT score was the significant predictor of an increased probability of achieving clinically important changes in the MAL quality of movement subscale (OR=1.07; P=.02). The R(2) values for the 3 logistic regression models were low (.114-.272). The results revealed that patients with stroke who had greater manual dexterity measured by the BBT appear to have a higher probability of achieving clinically significant motor and functional outcomes after RT. Further studies are needed to evaluate other potential predictors to improve the models and validate the findings. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Quantum Correlations Are Stronger Than All Nonsignaling Correlations Produced by n-Outcome Measurements.

    Science.gov (United States)

    Kleinmann, Matthias; Cabello, Adán

    2016-10-07

    We show that, for any n, there are m-outcome quantum correlations, with m>n, which are stronger than any nonsignaling correlation produced from selecting among n-outcome measurements. As a consequence, for any n, there are m-outcome quantum measurements that cannot be constructed by selecting locally from the set of n-outcome measurements. This is a property of the set of measurements in quantum theory that is not mandatory for general probabilistic theories. We also show that this prediction can be tested through high-precision Bell-type experiments and identify past experiments providing evidence that some of these strong correlations exist in nature. Finally, we provide a modified version of quantum theory restricted to having at most n-outcome quantum measurements.

  2. Health outcomes in diabetics measured with Minnesota Community Measurement quality metrics

    Directory of Open Access Journals (Sweden)

    Takahashi PY

    2014-12-01

    Full Text Available Paul Y Takahashi,1 Jennifer L St Sauver,2 Lila J Finney Rutten,2 Robert M Jacobson,3 Debra J Jacobson,2 Michaela E McGree,2 Jon O Ebbert1 1Department of Internal Medicine, Division of Primary Care Internal Medicine, 2Department of Health Sciences Research, Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery, 3Department of Pediatric and Adolescent Medicine, Division of Community Pediatrics, Mayo Clinic, Rochester, MN, USA Objective: Our objective was to understand the relationship between optimal diabetes control, as defined by Minnesota Community Measurement (MCM, and adverse health outcomes including emergency department (ED visits, hospitalizations, 30-day rehospitalization, intensive care unit (ICU stay, and mortality. Patients and methods: In 2009, we conducted a retrospective cohort study of empaneled Employee and Community Health patients with diabetes mellitus. We followed patients from 1 September 2009 until 30 June 2011 for hospitalization and until 5 January 2014 for mortality. Optimal control of diabetes mellitus was defined as achieving the following three measures: low-density lipoprotein (LDL cholesterol <100 mg/mL, blood pressure <140/90 mmHg, and hemoglobin A1c <8%. Using the electronic medical record, we assessed hospitalizations, ED visits, ICU stays, 30-day rehospitalizations, and mortality. The chi-square or Wilcoxon rank-sum tests were used to compare those with and without optimal control. We used Cox proportional hazard models to estimate the associations between optimal diabetes mellitus status and each outcome. Results: We identified 5,731 empaneled patients with diabetes mellitus; 2,842 (49.6% were in the optimal control category. After adjustment, we observed that non-optimally controlled patients had higher risks for hospitalization (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.00–1.23, ED visits (HR 1.15; 95% CI 1.06–1.25, and mortality (HR 1.29; 95% CI 1.09–1

  3. Prospective evaluation of outcome measures in free-flap surgery.

    LENUS (Irish Health Repository)

    Kelly, John L

    2004-08-01

    Free-flap failure is usually caused by venous or arterial thrombosis. In many cases, lack of experience and surgical delay also contribute to flap loss. The authors prospectively analyzed the outcome of 57 free flaps over a 28-month period (January, 1999 to April, 2001). The setting was a university hospital tertiary referral center. Anastomotic technique, ischemia time, choice of anticoagulant, and the grade of surgeon were recorded. The type of flap, medications, and co-morbidities, including preoperative radiotherapy, were also documented. Ten flaps were re-explored (17 percent). There were four cases of complete flap failure (6.7 percent) and five cases of partial failure (8.5 percent). In patients who received perioperative systemic heparin or dextran, there was no evidence of flap failure (p = .08). The mean ischemia time was similar in flaps that failed (95 +\\/- 29 min) and in those that survived (92 +\\/- 34 min). Also, the number of anastomoses performed by trainees in flaps that failed (22 percent), was similar to the number in flaps that survived (28 percent). Nine patients received preoperative radiotherapy, and there was complete flap survival in each case. This study reveals that closely supervised anastomoses performed by trainees may have a similar outcome to those performed by more senior surgeons. There was no adverse effect from radiotherapy or increased ischemia time on flap survival.

  4. The importance of rating scales in measuring patient-reported outcomes

    Directory of Open Access Journals (Sweden)

    Khadka Jyoti

    2012-07-01

    Full Text Available Abstract Background A critical component that influences the measurement properties of a patient-reported outcome (PRO instrument is the rating scale. Yet, there is a lack of general consensus regarding optimal rating scale format, including aspects of question structure, the number and the labels of response categories. This study aims to explore the characteristics of rating scales that function well and those that do not, and thereby develop guidelines for formulating rating scales. Methods Seventeen existing PROs designed to measure vision-related quality of life dimensions were mailed for self-administration, in sets of 10, to patients who were on a waiting list for cataract extraction. These PROs included questions with ratings of difficulty, frequency, severity, and global ratings. Using Rasch analysis, performance of rating scales were assessed by examining hierarchical ordering (indicating categories are distinct from each other and follow a logical transition from lower to higher value, evenness (indicating relative utilization of categories, and range (indicating coverage of the attribute by the rating scale. Results The rating scales with complicated question format, a large number of response categories, or unlabelled categories, tended to be dysfunctional. Rating scales with five or fewer response categories tended to be functional. Most of the rating scales measuring difficulty performed well. The rating scales measuring frequency and severity demonstrated hierarchical ordering but the categories lacked even utilization. Conclusion Developers of PRO instruments should use a simple question format, fewer (four to five and labelled response categories.

  5. Objective measures of subjective experience: the use of therapist notes in process-outcome research.

    Science.gov (United States)

    Bucci, Wilma; Maskit, Bernard; Hoffman, Leon

    2012-06-01

    Computerized linguistic measures of emotional engagement, and reflective and affective language, previously applied to session transcripts, were applied to notes of 14 treatments by candidates under supervision at the New York Psychoanalytic Society and Institute, covering the five decades from the 1950s to the 1990s. The findings indicate a strong relationship between candidates' subjective experience as represented unintentionally in the linguistic style of their case notes and the effectiveness of their clinical work. The treatments were evaluated for effectiveness by experienced clinicians using the Global Assessment of Functioning (GAF) and the Psychodynamic Functioning Scales of Høglend and colleagues; a Composite Clinical Effectiveness (CCE) measure was constructed based on level and change in these measures. The Mean High Weighted Referential Activity Dictionary (MHW), a computerized measure of emotional engagement developed in the framework of Bucci's theory of multiple coding and the referential process, showed a positive correlation of .73 with CCE. The Hostility subcategory of the Negative Affect Dictionary (ANH) showed a negative correlation, -.48, with CCE. In a multiple regression analysis, these two variables accounted for over three-quarters of the variance in the CCE. Implications of the findings for process/outcome research and supervision and evaluation of trainees are discussed.

  6. Systematic review: patient-reported outcome measures in coeliac disease for regulatory submissions.

    Science.gov (United States)

    Canestaro, W J; Edwards, T C; Patrick, D L

    2016-08-01

    New therapeutics are moving into phase 3 clinical trials for the treatment of coeliac disease, a condition with no established therapies other than gluten-free diet. These trials will require a meaningful, validated and fit for purpose patient-reported outcome measure (PROM) to quantify the symptomatic improvement of patients. To evaluate existing PROMs for suitability in a Food and Drug Administration (FDA) approval trial for a coeliac disease therapeutic. We performed a systematic search in five online databases (MedLine, EmBase, Web of Science, CENTRAL, CINAHL) for studies that enrolled patients with coeliac disease and used PROMs. Studies included in this review had to measure some PROM concept, be patient administered and based upon a previously validated instrument with published measurement properties. Our literature search identified 2706 unique records of which 199 ultimately qualified for abstraction. The majority of PROMs used in studies of coeliac disease was generic and did not measure numerous symptoms or concerns of interest to patients. Four PROMs were found to contain appropriate content for use in an FDA trial: the coeliac disease-specific modification of the Gastrointestinal Symptoms Rating Scale (CeD-GSRS), Psychological General Well-Being Index (PGWB), the Celiac Disease Symptom Diary (CDSD) and the Celiac Disease Patient Reported Outcome (CeD-PRO). The GSRS and PGWB are most often used together and are two of the most extensively used measures in coeliac disease. The CDSD and CeD-PRO were developed exclusively for trials in coeliac disease but have much less published information on their measurement properties. While we did not find PROMs that currently meet the stated expectations of the FDA for regulatory purposes, four PROMs (CeD-GSRS, PGWB, CDSD and CeD-PRO) appear to contain appropriate content and with modest additional validation work could meet scientific standards for valid and sensitive measures of disease and treatment outcome

  7. Functional outcome of nerve transfer for restoration of shoulder and elbow function in upper brachial plexus injury

    Directory of Open Access Journals (Sweden)

    Faruquee Sajedur

    2008-05-01

    Full Text Available Abstract Background Purpose of this study was to evaluate the functional outcome of spinal accessory to suprascapular nerve transfer (XI-SSN done for restoration of shoulder function and partial transfer of ulnar nerve to the motor branch to the biceps muscle for the recovery of elbow flexion (Oberlin transfer. Methods This is a prospective study involving 15 consecutive cases of upper plexus injury seen between January 2004 and December 2005. The average age of patients was 35.6 yrs (15–52 yrs. The injury-surgery interval was between 2–6 months. All underwent XI-SSN and Oberlin nerve transfer. The coaptation was done close to the biceps muscle to ensure early recovery. The average follow up was 15 months (range 12–36 months. The functional outcome was assessed by measuring range of movements and also on the grading scale proposed by Narakas for shoulder function and Waikakul for elbow function. Results Good/Excellent results were seen in 13/15 patients with respect to elbow function and 8/15 for shoulder function. The time required for the first sign of clinical reinnervation of biceps was 3 months 9 days (range 1 month 25 days to 4 months and for the recovery of antigravity elbow flexion was 5 months (range 3 1/2 months to 8 months. 13 had M4 and two M3 power. On evaluating shoulder function 8/15 regained active abduction, five had M3 and three M4 shoulder abduction. The average range of abduction in these eight patients was 66 degrees (range 45–90. Eight had recovered active external rotation, average 44 degrees (range 15–95. The motor recovery of external rotation was M3 in 5 and M4 in 3. 7/15 had no active abduction/external rotation, but they felt that their shoulder was more stable. Comparable results were observed in both below and above 40 age groups and those with injury to surgery interval less than 3 or 3–6 months. Conclusion Transfer of ulnar nerve fascicle to the motor branch of biceps close to the muscle consistently

  8. Core Outcome Sets and Multidimensional Assessment Tools for Harmonizing Outcome Measure in Chronic Pain and Back Pain

    Directory of Open Access Journals (Sweden)

    Ulrike Kaiser

    2016-08-01

    Full Text Available Core Outcome Sets (COSs are a set of domains and measurement instruments recommended for application in any clinical trial to ensure comparable outcome assessment (both domains and instruments. COSs are not exclusively recommended for clinical trials, but also for daily record keeping in routine care. There are several COS recommendations considering clinical trials as well as multidimensional assessment tools to support daily record keeping in low back pain. In this article, relevant initiatives will be described, and implications for research in COS development in chronic pain and back pain will be discussed.

  9. Core Outcome Sets and Multidimensional Assessment Tools for Harmonizing Outcome Measure in Chronic Pain and Back Pain

    Science.gov (United States)

    Kaiser, Ulrike; Neustadt, Katrin; Kopkow, Christian; Schmitt, Jochen; Sabatowski, Rainer

    2016-01-01

    Core Outcome Sets (COSs) are a set of domains and measurement instruments recommended for application in any clinical trial to ensure comparable outcome assessment (both domains and instruments). COSs are not exclusively recommended for clinical trials, but also for daily record keeping in routine care. There are several COS recommendations considering clinical trials as well as multidimensional assessment tools to support daily record keeping in low back pain. In this article, relevant initiatives will be described, and implications for research in COS development in chronic pain and back pain will be discussed. PMID:27589816

  10. Comparison of Structural and Functional Ocular Outcomes Between 14- and 70 Day Bed Rest

    Science.gov (United States)

    Cromwell, R. L.; Taibbi, G.; Zanello, S. B.; Yarbough, P. O.; Ploutz-Snyder, R. J.; Vizzeri, G.

    2016-01-01

    Purpose: To compare structural and functional ocular outcomes in healthy human subjects undergoing 14- and/or 70-day head-down-tilt bed rest (HDTBR). We hypothesized the amount of HDTBR-induced ocular changes be affected by the HDTBR duration. Methods: The studies were conducted at the NASA Flight Analogs Research Unit, The University of Texas Medical Branch at Galveston, Galveston, TX. Participants were selected using NASA standard screening procedures. Standardized NASA screening procedures and bed rest conditions (e.g., strict sleep-wake cycle, standardized diet, continuous video monitoring) were implemented in both studies. Participants maintained a 6deg HDTBR position for 14 and/or 70 consecutive days and did not engage in exercise. Weekly ophthalmological examinations were conducted in the sitting (pre/post-bed rest only) and HDT positions. Ocular outcomes of interest included: near best-corrected visual acuity (BCVA); spherical equivalent, as determined by cycloplegic autorefraction; Goldmann applanation tonometry and iCare (Icare Finland Oy, Espoo, Finland) intraocular pressure (IOP) measurement; color vision; red dot test; modified Amsler grid test; confrontational visual field; stereoscopic color fundus photography; Spectralis OCT (Heidelberg Engineering, GmbH, Heidelberg, Germany) retinal nerve fiber layer thickness (RNFLT), peripapillary and macular retinal thicknesses. Mixed-effects linear models were used to compare pre- and post-HDTBR observations between 14- and 70-day HDTBR for our continuously scaled outcomes.

  11. Neurocognition, social cognition and functional outcome in schizophrenia

    Directory of Open Access Journals (Sweden)

    Iosune Torio

    2014-12-01

    Full Text Available Background and Objectives: A relationship has been found between cognition and functioning in patients with schizophrenia. Our objective was to study the relationship between the cognitive domains assessed by the MATRICS Consensus Cognitive Battery (MCCB, and functioning as evaluated using the functioning subscale of the Global Assessment of Functioning scale (GAF-f. Methods: A sample of 83 clinically stable outpatients diagnosed with schizophrenia according to DSM-IV criteria were assessed using the MCCB and the GAF-f. Pearson correlations and stepwise linear regression analyses were performed. Results: Correlation analysis between the GAF-f and the cognitive domains of the MCCB showed a significant relationship between functioning and all of the cognitive domains. Regression yielded a statistically significant model (F2,74 = 20.4, p < 0.001 in which functioning was related to Speed of processing (standardized β = 0.369, p = 0.001 and to Social cognition (standardized β = 0.325, p = 0.003. Together, these two variables explained 33.8% of the variance of functioning. Conclusions: Both speed of processing and social cognition have an important association with functioning in patients with schizophrenia.

  12. Clinimetrics and functional outcome one year after traumatic brain injury

    NARCIS (Netherlands)

    J.T.M. van Baalen (Bianca)

    2008-01-01

    textabstractThis thesis is based on the findings of the FuPro-TBI (Functional Prognosis in Traumatic Brain Injury) study, which was part of the national FuPro research programme which investigated the functional prognosis of four neurological disorders: multiple sclerosis (MS), stroke, amyotrofic l

  13. Surgeon Reported Outcome Measure for Spine Trauma an International Expert Survey Identifying Parameters Relevant for The Outcome of Subaxial Cervical Spine Injuries

    NARCIS (Netherlands)

    Sadiqi, Said; Verlaan, Jorrit Jan; Lehr, A. M.; Dvorak, Marcel F.; Kandziora, Frank; Rajasekaran, S.; Schnake, Klaus J.; Vaccaro, Alexander R.; Oner, F. C.

    2016-01-01

    STUDY DESIGN.: International web-based survey OBJECTIVE.: To identify clinical and radiological parameters that spine surgeons consider most relevant when evaluating clinical and functional outcomes of subaxial cervical spine trauma patients. SUMMARY OF BACKGROUND DATA.: While an outcome instrument

  14. Surgeon Reported Outcome Measure for Spine Trauma an International Expert Survey Identifying Parameters Relevant for The Outcome of Subaxial Cervical Spine Injuries

    NARCIS (Netherlands)

    Sadiqi, Said; Verlaan, Jorrit Jan; Lehr, A. M.; Dvorak, Marcel F.; Kandziora, Frank; Rajasekaran, S.; Schnake, Klaus J.; Vaccaro, Alexander R.; Oner, F. C.

    2016-01-01

    STUDY DESIGN.: International web-based survey OBJECTIVE.: To identify clinical and radiological parameters that spine surgeons consider most relevant when evaluating clinical and functional outcomes of subaxial cervical spine trauma patients. SUMMARY OF BACKGROUND DATA.: While an outcome instrument

  15. Outcome Measures in Tele-Rehabilitation and Virtual Reality for Stroke Survivors: Protocol for a Scoping Review.

    Science.gov (United States)

    Veras, Mirella; Kairy, Dahlia; Rogante, Marco; Giacomozzi, Claudia

    2015-05-17

    Despite the increased interest about tele-rehabilitation, virtual reality and outcome measures for stroke rehabilitation, surprisingly little research has been done to map and summarize the most common outcome measures used in tele-rehabilitation. For this review, we propose to conduct a systematic search of the literature that reports outcome measures used in tele-rehabilitation or virtual reality for stroke rehabilitation. Specific objectives include: 1) to identify the outcome measures used in tele-rehabilitation studies; 2) to describe the psychometric properties of the outcome measures in the included studies; 3) to describe which parts of the International Classification of Functioning are measured in the studies. we will conduct a comprehensive search of relevant electronic databases (e.g., PUBMED, CINAHL, EMBASE, PSYCOINFO, Cochrane Central Register of Controlled Trial and PEDRO). The scoping review will include all study designs. Two reviewers will pilot-test the data extraction forms and will independently screen all the studies and extract the data. Disagreements about inclusion or exclusion will be resolved by consensus or by consulting a third reviewer. The results will be synthesized and reported considering the implications of the findings within the clinical practice and policy context. Dissemination: we anticipate that this scoping review will contribute to inform researchers and end-users (ie, clinicians and policy-makers), regarding the most appropriate outcome measures for tele-rehabilitation or virtual reality as well as help to identify gaps in current measures. Results will be disseminated through reports and open access journals, conference presentations, as well as newsletters, podcasts and meetings targeting all the relevant stakeholders.

  16. Cystic fibrosis and the role of gastrointestinal outcome measures in the new era of therapeutic CFTR modulation.

    Science.gov (United States)

    Bodewes, Frank A J A; Verkade, Henkjan J; Taminiau, Jan A J M; Borowitz, Drucy; Wilschanski, Michael

    2015-03-01

    With the development of new drugs that directly affect CFTR protein function, clinical trials are being designed or initiated for a growing number of patients with cystic fibrosis. The currently available and accepted clinical endpoints, FEV1 and BMI, have limitations. The aim of this report is to draw attention to the need and the ample possibilities for the development and validation of relevant gastrointestinal clinical endpoints for scientific evaluation of CFTR modulation treatment, particularly in young children and infants. The gastrointestinal tract offers very good opportunities to measure CFTR protein function and systematically evaluate CF related clinical outcomes based on the principal clinical gastrointestinal manifestations of CF: intestinal pH, intestinal transit time, intestinal bile salt malabsorption, intestinal inflammation, exocrine pancreatic function and intestinal fat malabsorption. We present a descriptive analysis of a variety of gastrointestinal outcome measures for clinical relevance, reliability, validity, responsiveness to interventions, feasibility in particular in young children and the availability of reference values.

  17. Measuring Conflict Functions in Generalized Power Space

    Institute of Scientific and Technical Information of China (English)

    HU Lifang; GUAN Xin; DENG Yong; HAN Deqiang; HE You

    2011-01-01

    One of the most important open issues is that the classical conflict coefficient in D-S evidence theory (DST) cannot correctly determine the conflict degree between two pieces of evidence.This drawback greatly limits the use of DST in real application systems.Early researches mainly focused on the improvement of Dempster's rule of combination (DRC).However, the current research shows it is very important to define new conflict coefficients to determine the conflict degree between two or more pieces of evidence.The evidential sources of information are considered in this work and the definition of a conflict measure function (CMF) is proposed for selecting some useful CMFs in the next fusion work when sources are available at each instant.Firstly, the definition and theorems of CMF are put forward.Secondly, some typical CMFs are extended and then new CMFs are put forward.Finally, experiments illustrate that the CMF based on Jousselme and its similar ones are the best suited ones.

  18. Functional outcome following an ankle or subtalar arthrodesis in adults.

    Science.gov (United States)

    Faraj, Adnan A; Loveday, David T

    2014-06-01

    Arthrodesis surgery aims to give pain relief by abolishing the movement of the joint concerned. Few studies describe the outcome as appreciated by the patient. This was the major concern of the authors, when they set up this retrospective study about the outcome after ankle fusion or subtalar fusion. Inclusion criteria were: pre-existing idiopathic and posttraumatic osteoarthritis, leading to joint pain unresponsive to conservative treatment, clinically and radiologically fused with an open approach between 2007 and 2011. Exclusion criteria were: preexisting joint infection, diabetes, rheumatoid arthritis, nonunion, age below 18 years, decease, and arthroscopic fusion. Fifteen ankle fusions and 18 subtalar fusions fulfilled the criteria. The mean age of the patients was 77 and 69 years, respectively; the average follow-up period was 3 and 4 years. A telephone questionnaire showed that the average patients' satisfaction was 7.86/10 in the ankle group and 7.94/10 in the subtalar group. All patients driving a car prior to surgery were able to do so afterwards. Forty percent walked unaided and without problems (excellent). Fifty-one percent were able to mobilise, but their walking distance was limited and a stick was required (good or fair). Nine percent were unable to mobilise out of their homes (poor), however it was generalized osteoarthritis which limited their mobility. Forty-five percent were involved in sports including judo, swimming, cycling, jogging, gardening, bowling, golf, and boules.

  19. Low back pain: what determines functional outcome at six months? An observational study

    Directory of Open Access Journals (Sweden)

    Peers Charles E

    2010-10-01

    Full Text Available Abstract Background The rise in disability due to back pain has been exponential with escalating medical and societal costs. The relative contribution of individual prognostic indicators to the pattern of recovery remains unclear. The objective of this study was to determine the prognostic value of demographic, psychosocial, employment and clinical factors on outcome in patients with low back pain Methods A prospective cohort study with six-month follow-up was undertaken at a multidisciplinary back pain clinic in central London employing physiotherapists, osteopaths, clinical psychologists and physicians, receiving referrals from 123 general practitioners. Over a twelve-month period, 593 consecutive patients referred from general practice with simple low back pain were recruited. A baseline questionnaire was developed to elicit information on potential prognostic variables. The primary outcome measures were change in 24-item Roland Morris disability questionnaire score at six months as a measure of low back related functional disability and the physical functioning scale of the SF-36, adjusted for baseline scores. Results Roland Morris scores improved by 3.8 index points (95% confidence interval 3.23 to 4.32 at six months and SF-36 physical functioning score by 10.7 points (95% confidence interval 8.36 to 12.95. Ten factors were linked to outcome yet in a multiple regression model only two remained predictive. Those with episodic rather than continuous pain were more likely to have recovered at six months (odds ratio 2.64 confidence interval 1.25 to 5.60, while those that classified themselves as non-white were less likely to have recovered (0.41 confidence interval 0.18 to 0.96. Conclusions Analysis controlling for confounding variables, demonstrated that participants showed greater improvement if their episodes of pain during the previous year were short-lived while those with Middle Eastern, North African and Chinese ethnicity demonstrated

  20. Day-by-Day Blood Pressure Variability and Functional Outcome After Acute Ischemic Stroke: Fukuoka Stroke Registry.

    Science.gov (United States)

    Fukuda, Kenji; Kai, Hisashi; Kamouchi, Masahiro; Hata, Jun; Ago, Tetsuro; Nakane, Hiroshi; Imaizumi, Tsutomu; Kitazono, Takanari

    2015-07-01

    The relationship between blood pressure (BP) variability and functional outcome in patients with acute ischemic stroke remains unclear. This study aimed to elucidate whether in-hospital day-by-day BP variability is associated with functional outcome after acute ischemic stroke. Using the Fukuoka Stroke Registry, we included 2566 patients with a first-ever ischemic stroke who had been functionally independent before the onset and were hospitalized within 24 hours. BP was measured daily, and its variability was assessed by SD, coefficients of variance, and variations independent of mean. Poor functional outcome was assessed by modified Rankin Scale scores ≥3 at 3 months. After adjustment for multiple confounding factors including age, sex, risk factors, stroke features, baseline severity, thrombolytic therapy, antihypertensive agents, and mean BP, day-by-day BP variability during the subacute stage (4-10 days after onset) was independently associated with a poor functional outcome (multivariable-adjusted odds ratios [95% confidence interval] in the top versus bottom quartile of systolic BP variability, 1.51 [1.09-2.08] for SD; 1.63 [1.20-2.22] for coefficients of variance; 1.64 [1.21-2.24] for variations independent of mean). Similar trends were also observed for diastolic BP variability. These trends were unchanged in patients who were not treated with antihypertensive drugs. In contrast, no association was found between indices of BP variability during the acute stage and functional outcome after adjusting for potential confounders. These data suggest that intraindividual day-by-day BP variability during the subacute stage is associated with the 3-month functional outcome after acute ischemic stroke. © 2015 American Heart Association, Inc.

  1. Long-Term Outcomes of ADHD: A Systematic Review of Self-Esteem and Social Function.

    Science.gov (United States)

    Harpin, V; Mazzone, L; Raynaud, J P; Kahle, J; Hodgkins, P

    2016-04-01

    To compare the long-term self-esteem and social function outcomes of individuals with untreated and treated ADHD across childhood, adolescence, and adulthood. A systematic search of 12 databases was performed to identify peer-reviewed, primary research articles, published January 1980 to December 2011, reporting long-term self-esteem and/or social function outcomes (≥2 years; life consequences distinct from symptoms) of individuals with untreated or treated ADHD. Overall, 127 studies reported 150 outcomes. Most outcomes were poorer in individuals with untreated ADHD versus non-ADHD controls (57% [13/23] for self-esteem; 73% [52/71] for social function). A beneficial response to treatment (pharmacological, nonpharmacological, and multimodal treatments) was reported for the majority of self-esteem (89% [8/9]) and social function (77% [17/22]) outcomes. Untreated ADHD was associated with poorer long-term self-esteem and social function outcomes compared with non-ADHD controls. Treatment for ADHD was associated with improvement in outcomes; however, further long-term outcome studies are needed. © The Author(s) 2013.

  2. Patient-reported outcome measures in arthroplasty registries

    DEFF Research Database (Denmark)

    Rolfson, Ola; Bohm, Eric; Franklin, Patricia

    2016-01-01

    should consider the absolute level of pain, function, and general health status as well as improvement, missing data, approaches to analysis and case-mix adjustment, minimal clinically important difference, and minimal detectable change. The Working Group recommends data collection immediately before...

  3. DCD kidney transplantation: results and measures to improve outcome.

    NARCIS (Netherlands)

    Hoogland, E.R.; Snoeijs, M.G.; Heurn, L.W.E. van

    2010-01-01

    PURPOSE OF REVIEW: The purpose of the present review is to describe the current kidney preservation techniques for donors after cardiac death and to give insight in new developments that may reduce warm ischemia times and therefore improve graft function after transplantation. RECENT FINDINGS: There

  4. Which measures of time preference best predict outcomes? Evidence from a large-scale field experiment

    OpenAIRE

    Burks, Stephen V.; Carpenter, Jeffrey P.; Goette, Lorenz; Rustichini, Aldo

    2011-01-01

    Economists and psychologists have devised numerous instruments to measure time preferences and have generated a rich literature examining the extent to which time preferences predict important outcomes; however, we still do not know which measures work best. With the help of a large sample of non-student participants (truck driver trainees) and administrative data on outcomes, we gather four different time preference measures and test the extent to which they predict both on their own and whe...

  5. Thyroid-Stimulating Hormone, White Matter Hyperintensities, and Functional Outcome in Acute Ischemic Stroke Patients

    Directory of Open Access Journals (Sweden)

    Christopher O. Leonards

    2014-03-01

    Full Text Available Background: Thyroid-stimulating hormone (TSH concentrations are frequently altered in acute ischemic stroke patients. It is becoming increasingly apparent that various hormones in the hypothalamus-pituitary-thyroid axis may be associated with functional stroke outcome. We have previously shown that white matter hyperintensities (WMH of presumed vascular origin are strong indicators of functional outcome. It is unclear whether an association exists between WMH and TSH. We therefore sought to determine whether TSH levels, measured in acute ischemic stroke patients, are associated with WMH and functional outcome. Methods: We analyzed all first ischemic stroke patients who participated in the Berlin ‘Cream & Sugar' Study (NCT 01378468 and completed a 1-year follow-up assessment from January 2009 to March 2013. Patients were stratified into 3 groups: (1 low TSH (0.1-0.44 μU/ml; (2 normal TSH (0.44-2.5 μU/ml, and (3 high TSH (2.5-20 μU/ml. WMH were assessed using the Fazekas and Wahlund visual rating scales. Functional outcome was assessed using the modified Rankin Scale and was performed via telephone at 1 year by a certified rater. Results: 183 patients were included [median age 66, interquartile range (IQR 54-75; 33% females; median National Institute of Health Stroke Scale 3, IQR 1-4, range 0-24]. Venous samples were collected a median of 4 days (IQR 3-5 following initial symptom onset between 8 and 9 a.m. following a 10-hour fast. Patients with normal TSH levels (n = 132; 72% had significantly higher rates of prestroke diabetes than patients with high TSH levels (normal TSH 17%; high TSH 1%; p = 0.03. Additionally, patients with normal TSH levels tended to have higher estimated glomerular filtration rates than patients with high and low TSH concentrations (normal TSH median estimated glomerular filtration rates: 83 ml/min/1.73 m2; high TSH median estimated glomerular filtration rates: 76 ml/min/1.73 m2; low TSH median: 78 ml/min/1.73 m2; p

  6. Identifying best practice through benchmarking and outcome measurement.

    Science.gov (United States)

    Lanier, Lynne

    2004-01-01

    Collecting and analyzing various types of data are essential to identifying areas for improvement. Data collection and analysis are routinely performed in hospitals and are even required by some regulatory agencies. Realization of the full benefits, which may be achieved through collection and analysis of data, should be actively pursued to prevent a meaningless exercise in paperwork. Internal historical comparison of data may be helpful but does not achieve the ultimate goal of identifying external benchmarks in order to determine best practice. External benchmarks provide a means of comparison with similar facilities, allowing the identification of processes needing improvement. The specialty of ophthalmology presents unique practice situations that are not comparable with other specialties, making it imperative to benchmark against other facilities where quick surgical case time, efficient surgical turnover times, low infection rates, and cost containment are essential and standard operations. Important data to benchmark include efficiency data, financial data, and quality or patient outcome data. After identifying facilities that excel in certain aspects of performance, it is necessary to analyze how their procedures help them achieve these favorable results. Careful data collection and analysis lead to improved practice and patient care.

  7. Strength, body composition, and functional outcomes in the squat versus leg press exercises.

    Science.gov (United States)

    Rossi, Fabrício E; Schoenfeld, Brad J; Ocetnik, Skyler; Young, Jonathan; Vigotsky, Andrew; Contreras, Bret; Krieger, James W; Miller, Michael G; Cholewa, Jason

    2016-10-13

    The purpose of this study was to compare strength, body composition, and functional outcome measures following performance of the back squat, leg press, or a combination of the two exercises. Subjects were pair-matched based on initial strength levels and then randomly assigned to 1 of 3 groups: A squat-only group (SQ) that solely performed squats for the lower body; a leg press-only group (LP) that solely performed leg presses for the lower body, or; a combined squat and leg press group (SQ-LP) that performed both squats and leg presses for the lower body. All other RT variables were held constant. The study period lasted 10 weeks with subjects performing 2 lower body workouts per week comprising 6 sets per session at loads corresponding to 8-12 RM with 90 to 120 second rest intervals. Results showed that SQ had greater transfer to maximal squat strength compared to the leg press. Effect sizes favored SQ and SQ-LP versus LP with respect to countermovement jump while greater effect sizes for dynamic balance were noted for SQ-LP and LP compared to SQ, although no statistical differences were noted between conditions. These findings suggest that both free weights and machines can improve functional outcomes, and that the extent of transfer may be specific to the given task.

  8. Nonlinear neurobiological probability weighting functions for aversive outcomes.

    Science.gov (United States)

    Berns, Gregory S; Capra, C Monica; Chappelow, Jonathan; Moore, Sara; Noussair, Charles

    2008-02-15

    While mainstream economic models assume that individuals treat probabilities objectively, many people tend to overestimate the likelihood of improbable events and underestimate the likelihood of probable events. However, a biological account for why probabilities would be treated this way does not yet exist. While undergoing fMRI, we presented individuals with a series of lotteries, defined by the voltage of an impending cutaneous electric shock and the probability with which the shock would be received. During the prospect phase, neural activity that tracked the probability of the expected outcome was observed in a circumscribed network of brain regions that included the anterior cingulate, visual, parietal, and temporal cortices. Most of these regions displayed responses to probabilities consistent with nonlinear probability weighting. The neural responses to passive lotteries predicted 79% of subsequent decisions when individuals were offered choices between different lotteries, and exceeded that predicted by behavior alone near the indifference point.

  9. Long-term functional outcome in adult prison inmates with ADHD receiving OROS-methylphenidate.

    Science.gov (United States)

    Ginsberg, Ylva; Hirvikoski, Tatja; Grann, Martin; Lindefors, Nils

    2012-12-01

    In a recent randomized, double-blind, placebo-controlled trial, we established a robust efficacy (Cohen's d = 2.17) of osmotic release oral system-methylphenidate (OROS-methylphenidate) delivered 72 mg daily for 5 weeks versus placebo on attention deficit hyperactivity disorder (ADHD) symptoms, global severity and global functioning in 30 adult male prison inmates with ADHD and coexisting disorders. Outcomes continued to improve during the subsequent 47-week open-label extension with OROS-methylphenidate delivered at a flexible daily dosage of up to 1.3 mg/kg body weight. In the present study, we evaluated long-term effectiveness and maintenance of improvement over the cumulated 52-week trial on cognition, motor activity, institutional behaviour and quality of life. Post hoc, we explored the associations between investigators' and self-ratings of ADHD symptoms and between ratings of symptoms and functioning, respectively. Outcomes, calculated by repeated measures ANOVA, improved from baseline until week 16, with maintenance or further improvement until week 52. Both verbal and visuospatial working memory, and abstract verbal reasoning improved significantly over time, as well as several cognition-related measures and motor activity. No substance abuse was detected and a majority of participants took part in psychosocial treatment programmes. The quality of life domains of Learning, and Goals and values improved over time; the latter domain was at open-label endpoint significantly related to improvements in attention. Investigators' and self-ratings of ADHD symptoms, as well as global symptom severity related most significantly to global functioning at week 52. Finally, investigators' and self-ratings of ADHD symptoms associated significantly at baseline with increasing convergence over time.

  10. Impact of Cognitive Impairment on Functional Outcome in Stroke

    Directory of Open Access Journals (Sweden)

    Nurdan Paker

    2010-01-01

    Full Text Available The aim of this study was to investigate the effect of the cognitive impairment on functional status in patients with subacute stroke. Fifty-two patients with subacute stroke were included in the study. Mini mental state examination (MMSE test was used for the evaluation of cognitive status. Patients were separated into two groups according to their cognitive functions. Functional follow-up parameters were activities of daily living (ADL, global recovery and ambulation status. All patients were evaluated on admission to rehabilitation unit, at discharge and 6 months after discharge. Forty-four patients were completed the study. Mean age was 66 and 57 years; disease duration on admission was 4,8 and 3,5 months in the cognitively impaired and normal groups, respectively. Significant improvement was found in terms of functional follow-up parameters in both groups at discharge (<.05. Functional follow-up parameters did not show statistically significant difference between the groups. But community ambulation rate was higher in cognitively normal group at the sixth month visit. As a result of this study, inpatient rehabilitation was effective both cognitively normal and impaired subacute stroke patients.

  11. Specific characteristics of abnormal general movements are associated with functional outcome at school age.

    Science.gov (United States)

    Hamer, Elisa G; Bos, Arend F; Hadders-Algra, Mijna

    2016-04-01

    Assessing the quality of general movements (GMs) is a non-invasive tool to identify at early age infants at risk for developmental disorders. To investigate whether specific characteristics of definitely abnormal GMs are associated with developmental outcome at school age. Observational cohort study (long-term follow-up). Parents of 40 children (median age 8.3 years, 20 girls) participated in this follow-up study. In infancy (median corrected age 10 weeks), the children (median gestational age 30.3 weeks; birth weight 1243 g) had shown definitely abnormal GMs according to Hadders-Algra (2004). Information on specific GM characteristics such as the presence of fidgety movements, degree of complexity and variation, and stiff movements, was available (see Hamer et al. 2011). A standardised parental interview (presence of CP, attendance of school for special education, Vineland Adaptive Behavior Scale to determine functional performance) and questionnaires (Developmental Coordination Disorder Questionnaire [DCD-Q] to evaluate mobility and Child Behavior Checklist to assess behaviour) were used as outcome measures. Six children had cerebral palsy (CP), ten children attended a school for special education, and eight children had behavioural problems. Both the absence of fidgety movements and the presence of stiff movements were associated with CP (p=0.001; p=0.003, respectively). Stiff movements were also related to the need of special education (p=0.009). A lack of movement complexity and variation was associated with behavioural problems (p=0.007). None of the GM characteristics were related to DCD-Q scores. The evaluation of fidgety movements and movement stiffness may increase the predictive power of definitely abnormal GMs for motor outcome--in particular CP. This study endorses the notion that the quality of GMs reflects the integrity of the infant's brain, assisting prediction of long-term outcome. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Measuring Social Capital as an Outcome of Service Learning

    Science.gov (United States)

    D'Agostino, Maria J.

    2010-01-01

    Service-learning has been put forth as one of the proposed solutions to increasing social capital. However, service-learning research has not significantly addressed the impact of service learning on social capital. Unlike most previous studies, this research used quantitative analysis to measure the effect of university service-learning programs…

  13. Measuring Social Capital as an Outcome of Service Learning

    Science.gov (United States)

    D'Agostino, Maria J.

    2010-01-01

    Service-learning has been put forth as one of the proposed solutions to increasing social capital. However, service-learning research has not significantly addressed the impact of service learning on social capital. Unlike most previous studies, this research used quantitative analysis to measure the effect of university service-learning programs…

  14. Functional recovery measures for spinal cord injury: an evidence-based review for clinical practice and research

    DEFF Research Database (Denmark)

    Anderson, K.; Aito, S.; Atkins, M.

    2008-01-01

    measures designed to assess functional status relevant to SCI are important to develop. METHOD: Evaluation of currently available SCI functional outcome measures by a multinational work group. RESULTS: The 4 measures that fit the prespecified inclusion criteria were the Modified Barthel Index (MBI...

  15. Sociodemographic, clinical, and functional long-term outcomes in adolescents and young adults with mental disorders.

    Science.gov (United States)

    Asselmann, E; Wittchen, H-U; Lieb, R; Beesdo-Baum, K

    2017-08-31

    To examine unfavorable sociodemographic, clinical, and functional long-term outcomes for a range of adolescent mental disorders. A total number of 2210 adolescents and young adults (14-24 years at baseline, T0) from a representative community sample were prospectively followed up (T1-T3) over 10 years. DSM-IV mental disorders, sociodemographic, clinical, and functional outcomes were assessed using the DIA-X/M-CIDI and its embedded assessment modules. In (multinomial) logistic regressions adjusted for sex, age, other baseline disorders and sociodemographics, baseline anxiety, affective, substance use, somatoform and eating disorders (lifetime) predicted various unfavorable sociodemographic, clinical, and functional outcomes at T3. Particularly, strong associations were found between baseline disorders and adverse clinical outcomes at T3 (12-month diagnosis of the same/other disorder(s), drug use, suicide attempts, and help-seeking due to psychological problems). While substance use disorders were primarily associated with unfavorable sociodemographic and educational outcomes, anxiety and eating disorders were associated with unfavorable interpersonal outcomes, affective disorders with pregnancy-/childbirth-related complications and financial issues, and somatoform disorders with unfavorable educational/occupational and interpersonal outcomes. The risk of unfavorable outcomes increased with clinical severity, especially a higher number of baseline diagnoses. Our findings emphasize the importance of effective treatment of mental disorders to prevent unfavorable long-term outcomes in various life domains. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. A hierarchy of patient-reported outcome measures for meta-analysis of knee osteoarthritis trials

    DEFF Research Database (Denmark)

    Juhl, Carsten Bogh; Lund, Hans; Guyatt, GH

    2010-01-01

    Title A hierarchy of patient-reported outcome measures for meta-analysis of knee osteoarthritis trials: empirical evidence from a survey of high impact journals Objective To develop a prioritized list for extracting patient-reported outcomes (PROs) measuring pain and disability for meta-analyses ......Title A hierarchy of patient-reported outcome measures for meta-analysis of knee osteoarthritis trials: empirical evidence from a survey of high impact journals Objective To develop a prioritized list for extracting patient-reported outcomes (PROs) measuring pain and disability for meta......-analyses in knee osteoarthritis (OA). Methods A systematic literature search was conducted in high impact factor journals. Eligible were randomized controlled trials, using two or more PROs measuring pain or disability. A prioritized list was developed based on the capacity to discriminate between intervention...

  17. Automaticity of walking: functional significance, mechanisms, measurement and rehabilitation strategies

    Directory of Open Access Journals (Sweden)

    David J Clark

    2015-05-01

    Full Text Available Automaticity is a hallmark feature of walking in adults who are healthy and well-functioning. In the context of walking, ‘automaticity’ refers to the ability of the nervous system to successfully control typical steady state walking with minimal use of attention-demanding executive control resources. Converging lines of evidence indicate that walking deficits and disorders are characterized in part by a shift in the locomotor control strategy from healthy automaticity to compensatory executive control. This is potentially detrimental to walking performance, as an executive control strategy is not optimized for locomotor control. Furthermore, it places excessive demands on a limited pool of executive reserves. The result is compromised ability to perform basic and complex walking tasks and heightened risk for adverse mobility outcomes including falls. Strategies for rehabilitation of automaticity are not well defined, which is due to both a lack of systematic research into the causes of impaired automaticity and to a lack of robust neurophysiological assessments by which to gauge automaticity. These gaps in knowledge are concerning given the serious functional implications of compromised automaticity. Therefore, the objective of this article is to advance the science of automaticity of walking by consolidating evidence and identifying gaps in knowledge regarding: a functional significance of automaticity; b neurophysiology of automaticity; c measurement of automaticity; d mechanistic factors that compromise automaticity; and e strategies for rehabilitation of automaticity.

  18. Mind your hand during the energy crunch: Functional Outcome of Circular Saw Hand Injuries.

    Science.gov (United States)

    Frank, Matthias; Hecht, Juliane; Napp, Matthias; Lange, Joern; Grossjohann, Rico; Stengel, Dirk; Schmucker, Uli; Ekkernkamp, Axel; Hinz, Peter

    2010-09-06

    Although injuries due to circular saws are very common all over the world, there is surprisingly little information available about their functional outcomes. As the socioeconomic impact of these injuries is immense and determined by the casualties' disability and impairment, it is the objective of this study to present data on the functional outcome, disability, and impairment of hand injuries due to electric circular saws. Patients treated from 1999 through 2007 for circular saw-related hand injuries were contacted and asked for clinical follow-up assessment. The clinical follow-up protocol consisted of a physical examination and an assessment of static muscle power (grip and pinch strength). For assessment of the subjective experience of the patients regarding their injury-related disability and impairment, the DASH follow-up questionnaire was used. The occupational impact of these injuries was measured by number of lost working days. Finally, safety-related behaviour of the patients was investigated. 114 Patients were followed-up on average 52 months after the injury. Average in-house treatment was 8.8 days. Average time lost from work was 14.8 weeks. A significant reduction of static muscle testing parameters compared with the uninjured hand was revealed for grip strength, tip pinch, key pinch, and palmar pinch. Average DASH score was 17.4 (DASH work 15.8, DASH sports/music 17.7). Most patients had more than ten years experience in using these power tools. The everyday occurrence of circular saw-related hand injuries followed by relatively short periods of in-house treatment might distort the real dimension of the patients' remaining disability and impairment. While the trauma surgeon's view is generally confined to the patients' clinical course, the outcome parameters in this follow-up investigation, with loss of working time as the key factor, confirm that the whole socioeconomic burden is much greater than the direct cost of treatment.

  19. Functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair

    Science.gov (United States)

    Abechain, José Jorge Kitagaki; Godinho, Glaydson Gomes; Matsunaga, Fabio Teruo; Netto, Nicola Archetti; Daou, Julia Pozzetti; Tamaoki, Marcel Jun Sugawara

    2017-01-01

    AIM To compare the functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair. METHODS Eighty-seven patients with rotator cuff tears following arthroscopic treatment were divided into traumatic and non-traumatic tear groups. Postoperative muscle strength and outcomes using the modified University of California, Los Angeles score were evaluated. Sex, age, affected limb and dominant limb were correlated between groups. Muscle strength of the repaired and unaffected shoulders was compared. Rotator cuff injury size was measured. RESULTS Of the 87 patients who underwent rotator cuff repairs, 35 had traumatic tears and 52 had non-traumatic tears. In patients with non-traumatic tears, the average age was 59 years, 74.5% were female, 96.1% were right-hand dominant and 92.3% had their dominant shoulder affected. Patients with traumatic tears were 59.5 years old on average, 51.4% were female, 91.4% were right-hand dominant and 88.5% had their dominant shoulder affected. No difference existed in the mean modified University of California, Los Angeles score between patients with traumatic tears (33.7) compared with those with non-traumatic tears (32.8). No strength differences were observed between groups: The strength difference between the non-affected and affected sides was 1.21 kg in the non-traumatic group and 1.39 kg in the traumatic group (P = 0.576), while the strength ratio between the non-affected/affected sides was 0.805 in the non-traumatic group and 0.729 in the traumatic group (P = 0.224). CONCLUSION The functional results of traumatic rotator cuff repairs are similar to non-traumatic tears. Both outcomes are satisfactory. PMID:28875129

  20. Mnk kinase pathway: Cellular functions and biological outcomes

    Institute of Scientific and Technical Information of China (English)

    Sonali; Joshi; Leonidas; C; Platanias

    2014-01-01

    The mitogen-activated protein kinase(MAPK) interacting protein kinases 1 and 2(Mnk1 and Mnk2) play important roles in controlling signals involved in mRNA translation. In addition to the MAPKs(p38 or Erk), multiple studies suggest that the Mnk kinases can be regulated by other known kinases such as Pak2 and/or other unidentified kinases by phosphorylation of residues distinct from the sites phosphorylated by the MAPKs. Several studies have established multiple Mnk protein targets, including PSF, heterogenous nuclear ribonucleoprotein A1, Sprouty 2 and have lead to the identification of distinct biological functions and substrate specificity for the Mnk kinases. In this review we discuss the pathways regulating the Mnk kinases, their known substrates as well as the functional consequences of engagement of pathways controlled by Mnk kinases. These kinases play an important role in mRNA translation via their regulation of eukaryotic initiation factor 4E(eIF4E) and their functions have important implications in tumor biology as well as the regulation of drug resistance to anti-oncogenic therapies. Other studies have identified a role for the Mnk kinases in cap-independent mRNA translation, suggesting that the Mnk kinases can exert important functional effects independently of the phosphorylation of eIF4 E. The role of Mnk kinases in inflammation and inflammationinduced malignancies is also discussed.

  1. Outcome of humeral shaft fractures treated by functional cast brace

    Directory of Open Access Journals (Sweden)

    Jitendra Nath Pal

    2015-01-01

    Conclusion: Modified functional cast brace is one of the options in treatment for humeral shaft fractures as it can be applied on the 1 st day of the presentation in most of the situations. Simple objective scoring system was useful particularly in uneducated patients.

  2. Functional Outcome of Internal Fixation of Radial and Ulna Fracture

    Directory of Open Access Journals (Sweden)

    mehrdad Mansouri

    2006-02-01

    Conclusion: Anatomic reduction and internal fixation is the standard method for treatment of fractures by displacing radios and ulna in adults. According to results, it seems more intension to motions specially pronation and muscle strengthening foream after surgery will have affect on improving patients’ function specially pronation and Grip strength.

  3. Treatment of patients with hand osteoarthritis : outcome measures, patient satisfaction, and economic evaluation

    NARCIS (Netherlands)

    Marks, Miriam

    2014-01-01

    The aim of this thesis was to investigate the limitations in daily life, outcome measures, clinical outcomes with the emphasis on patient satisfaction, and economic aspects of the treatment of hand osteoarthritis (OA). Patients with hand OA report severe restrictions in daily life, in particular in

  4. Consensus for tinnitus patient assessment and treatment outcome measurement : Tinnitus Research Initiative meeting, Regensburg, July 2006

    NARCIS (Netherlands)

    Langguth, B.; Goodey, R.; Azevedo, A.; Bjorne, A.; Cacace, A.; Crocetti, A.; Del Bo, L.; De Ridder, D.; Diges, I.; Elbert, T.; Flor, H.; Herraiz, C.; Ganz Sanchez, T.; Eichhammer, P.; Figueiredo, R.; Hajak, G.; Kleinjung, T.; Landgrebe, M.; Londero, A.; Lainez, M. J. A.; Mazzoli, M.; Meikle, M. B.; Melcher, J.; Rauschecker, J. P.; Sand, P. G.; Struve, M.; Van de Heyning, P.; Van Dijk, P.; Vergara, R.; Langguth, B; Hajak, G; Kleinjung, T; Cacace, A; Moller, AR

    2007-01-01

    There is widespread recognition that consistency between research centres in the ways that patients with tinnitus are assessed and outcomes following interventions are measured would facilitate more effective co-operation and more meaningful evaluations and comparisons of outcomes. At the first Tinn

  5. History of Childhood Maltreatment and College Academic Outcomes: Indirect Effects of Hot Execution Function

    Directory of Open Access Journals (Sweden)

    Marilyn C. Welsh

    2017-07-01

    Full Text Available College students who report a history of childhood maltreatment may be at risk for poor outcomes. In the current study, we conducted an exploratory analysis to examine potential models that statistically mediate associations between aspects of maltreatment and aspects of academic outcome, with a particular focus on executive functions (EF. Consistent with contemporary EF research, we distinguished between relatively “cool” EF tasks (i.e., performed in a context relatively free of emotional or motivational valence and “hot” EF tasks that emphasize performance under more emotionally arousing conditions. Sixty-one male and female college undergraduates self-reported childhood maltreatment history (emotional abuse and neglect, physical abuse and neglect, and sexual abuse on the Childhood Trauma Questionnaire (CTQ, and were given two EF measures: (1 Go-No-Go (GNG test that included a Color Condition (cool; Neutral Face Condition (warm; and Emotion Face condition (hot, and (2 Iowa Gambling Task (IGT, a measure of risky decision making that reflects hot EF. Academic outcomes were: (1 grade point average (GPA: first-semester, cumulative, and semester concurrent with testing, and (2 Student Adaptation to College Questionnaire (SACQ. Correlational patterns suggested two EF scores as potential mediators: GNG reaction time (RT in the Neutral Face condition, and IGT Block 2 adaptive responding. Indirect effects analyses indicated that IGT Block 2 adaptive responding has an indirect effect on the relationship between CTQ Total score and 1st semester GPA, and between CTQ Emotional Abuse and concurrent GPA. Regarding college adaptation, we identified a consistent indirect effect of GNG Neutral Face RT on the relationship between CTQ Emotional Neglect and SACQ total, academic, social, and personal–emotional adaption scores. Our results demonstrate that higher scores on a child maltreatment history self-report negatively predict college academic

  6. Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees

    NARCIS (Netherlands)

    Schoppen, Tanneke; Boonstra, Antje; Groothoff, JW; de Vries, J; Goeken, LN; Eisma, Willem

    2003-01-01

    Objective: To study the value of physical, mental, and social characteristics as predictors of functional outcome of elderly amputees. Design: Prospective, inception cohort study; comparisons with reference populations. Setting: Main hospitals, rehabilitation centers, nursing homes, patients' own re

  7. Health outcomes associated with lung function decline and respiratory symptoms and disease in a community cohort

    DEFF Research Database (Denmark)

    Baughman, Penelope; Marott, Jacob L; Lange, Peter

    2011-01-01

    BACKGROUND: In workplace respiratory disease prevention, a thorough understanding is needed of the relative contributions of lung function loss and respiratory symptoms in predicting adverse health outcomes. METHODS: Copenhagen City Heart Study respiratory data collected at 4 examinations (1976...

  8. FUNCTIONAL PERFORMANCE, PARTICIPATION AND AUTONOMY AFTER DISCHARGE FROM PROSTHETIC REHABILITATION : BARRIERS, FACILITATORS AND OUTCOMES

    NARCIS (Netherlands)

    van Twillert, Sacha; Stuive, Ilse; Geertzen, Jan H. B.; Postema, Klaas; Lettinga, Ant T.

    2014-01-01

    Objective: To examine functional performance, participation and autonomy after discharge from prosthetic rehabilitation and to identify the barriers and facilitators affecting these outcomes. Design: Concurrent mixed-methods design. Quantitative and qualitative data were collected at discharge from

  9. Restoration of hip architecture with bipolar hemiarthroplasty in the elderly : does it affect early functional outcome?

    NARCIS (Netherlands)

    Hartel, Maximilian; Arndt, Marius; Eulenburg, Christine Zu; Petersen, Jan Philipp; Rueger, Johannes M.; Hoffmann, Michael

    2014-01-01

    Reconstruction of the anatomic architecture correlates with functional outcome in patients receiving elective total hip arthroplasty. In theory similar rules should apply for bipolar hemiarthroplasty in femoral neck fractures. The influence of anatomic restoration after bipolar hemiarthroplasty on s

  10. Functional outcomes after laryngopharyngectomy with anterolateral thigh flap reconstruction.

    Science.gov (United States)

    Lewin, Jan S; Barringer, Denise A; May, Annette H; Gillenwater, Ann M; Arnold, Katherine A; Roberts, Dianna B; Yu, Peirong

    2006-02-01

    We examined speech and swallowing outcomes and complications in patients with anterolateral thigh (ALT) flap reconstruction of cervical esophageal defects. We retrospectively reviewed 29 patients treated with laryngopharyngectomy and ALT flap reconstruction at The University of Texas M. D. Anderson Cancer Center from March 2002 to July 2004. We compared complication rates, nutritional intake, number of tracheoesophageal punctures (TEPs), speech fluency and use, operative defects, and radiotherapy effects. Twenty-two patients had circumferential defects, and seven had partial defects. Twenty-four patients had radiotherapy. Eleven patients underwent TEP. Higher complication rates in patients after TEP compared with those without TEP were not statistically significant (p = .268). Ninety percent of patients with TEP spoke fluently. Ninety percent of all patients returned to oral alimentation without significant effect from TEP (p = 1.00), complications (p = 1.00), radiation therapy (p = 1.00), or surgical defect (p = .56). The ALT flap successfully reconstructs laryngopharyngeal defects with excellent speech and swallowing results. Copyright 2005 Wiley Periodicals, Inc.

  11. Functional ability of community dwelling elderly. Criterion-related validity of a new measure of functional ability

    DEFF Research Database (Denmark)

    Schultz-Larsen, K; Avlund, K; Kreiner, S

    1992-01-01

    Criterion-related validity of a new measure of functional ability was conducted according to a causal model based on conceptual models employed in the area of rehabilitative and geriatric medicine. The criteria variables included concurrent diagnosed diseases, global self-rated health, drug...... consumption and general practitioner (GP) consultations. The measure of functional ability was developed with the intention of achieving a high degree of discrimination among a group of community dwelling elderly. Data were derived from a sample survey of 70-year-old men and women conducted in 1984...... different unidimensional index scales of functional ability divided into two types, with reduced speed and tiredness as subdimensions. The two scale types were mobility function and lower limb function. Early losses of ability together with global self-rated health were treated as outcome measures...

  12. Consistency of three measures commonly used in the assessment of balance and functional outcome of patients with post-stroke hemiplegia%三种常用平衡量表评估脑卒中偏瘫患者平衡和功能结局的一致性

    Institute of Scientific and Technical Information of China (English)

    赵承军; 瓮长水; 毕胜

    2005-01-01

    -stoke patients would be conducive to establish rehabilitative goal and to set up therapeutic plan.OBJECTIVE: To investigate the relationship between parameters of three commonly used measures and those of other functional evaluation for patients with post-stroke hemiplegia.DESIGN: Analysis of the relationship between parameters of balance rating scales.SETTING: At otolaryngology department and rehabilitative medicine department of the general military hospital.PARTICIPANTS: From September 2002 to July 2003, totally 57 patients with post-stroke hemiplegia, 45 males and 12 females, aged from 14 to 78years old, with the course of disease ranged from 0. 3 to 11 months, received rehabilitative treatment at rehabilitative department of the general military hospital, were selected to take part in the study. All were confirmed of internal carotid artery system lateral hemispheric disease.METHODS: Three balance measures, namely Berg balance scale, modified Balance subscale of the Fugl-Meyer test and Postural assessment scale for stroke patients were administered on 57 patients for evaluating their lower limb motor function, daily life capability and walking ability after rehabilitative treatments. The relationship between three measures was analyzed with Pearson-correlative analysis, and the relationship between three measures and lower limb motor function, daily life capability and walking ability were also investigated.MAIN OUTCOME MEASURES: ① relationship between three measures;② relationship between three measures and lower limb motor function, daily life capability and walking ability.RESULTS: The data from 57 stroke hemiplegic patients was analyzed without missing. ① Scores for Berg balance assessment, Fugl-Meyer balance rating scale and posture controlling scale for stroke patients was 46.70 ± 5. 15, 10. 26 ± 1.58 and 32.56 ± 2.06, respectively, and the scores of lower limb motor function in Fugl-Meyer assessment was 22. 35 ± 5.82,and moving and marching item in

  13. Beyond FEV1 in COPD: a review of patient-reported outcomes and their measurement

    Directory of Open Access Journals (Sweden)

    Jones P

    2012-10-01

    Full Text Available Paul Jones,1 Marc Miravitlles,2 Thys van der Molen,3 Karoly Kulich41Division of Clinical Science, University of London, London, UK; 2Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Ciber de Enfermedades Respiratorias, Barcelona, Spain; 3Department of Primary Care, University Medical Centre Groningen, Groningen, The Netherlands; 4Novartis Pharma AG, Basel, SwitzerlandAbstract: Patients with chronic obstructive pulmonary disease (COPD present with a variety of symptoms and pathological consequences. Although primarily viewed as a respiratory disease, COPD has both pulmonary and extrapulmonary effects, which have an impact on many aspects of physical, emotional, and mental well-being. Traditional assessment of COPD relies heavily on measuring lung function, specifically forced expiratory volume in 1 second (FEV1. However, the evidence suggests that FEV1 is a relatively poor correlate of symptoms such as breathlessness and the impact of COPD on daily life. Furthermore, many consequences of the disease, including anxiety and depression and the ability to perform daily activities, can only be described and reported reliably by the patient. Thus, in order to provide a comprehensive view of the effects of interventions in clinical trials, it is essential that spirometry is accompanied by assessments using patient-reported outcome (PRO instruments. We provide an overview of patient-reported outcome concepts in COPD, such as breathlessness, physical functioning, and health status, and evaluate the tools used for measuring these concepts. Particular attention is given to the newly developed instruments emerging in response to recent regulatory guidelines for the development and use of PROs in clinical trials. We conclude that although data from the development and validation of these new PRO instruments are emerging, to build the body of evidence that supports the use of a new instrument takes many years. Furthermore, new

  14. Multiple cluster axis II comorbidity and functional outcome in severe patients with borderline personality disorder.

    Science.gov (United States)

    Palomares, Nerea; McMaster, Antonia; Díaz-Marsá, Marina; de la Vega, Irene; Montes, Ana; Carrasco, José Luis

    2016-11-01

    Current literature suggests that personality disorder comorbidity negatively contributes to both the severity and prognosis of other disorders; however, little literature has been devoted to its influence on borderline personality disorder (BPD). The objective of the present work is to study comorbidity with other personality disorders in a severe clinical sample of patients with BPD, and its relationship with global functionality. A sample of 65 patients with severe borderline personality disorder was included in the study. Clinical and functionality measures were applied in order to study comorbidity of BPD with other disorders and its relationship with functionality. Associations with other comorbid PDs were analyzed with t-tests and linear correlations. Most patients (87%) presented comorbidity with other PDs. Almost half of the sample (42%) presented more than two PDs, and cluster A (paranoid) and C (obsessive and avoidant) PD were more frequent than cluster B (histrionic and antisocial). Only the presence of avoidant PD predicted a worse functional outcome in the long term (U Mann Withney ppersonality disorder might negatively predict for prognosis.

  15. The impact of cognitive impairment at admission on short-term functional outcome of elderly hip fracture patients

    Directory of Open Access Journals (Sweden)

    Dubljanin-Raspopović Emilija

    2010-01-01

    Full Text Available Introduction The number of patents with dementia increases among hip fracture patients. Cognitive dysfunction is defined as a premorbid state which is potentionally negatively related to short-term functional outcome. Objective To assess the relationship between cognitive status on admission and functional gain during an early rehabilitation period in elderly hip fracture patients. Methods Forty-five elderly patients with surgically treated hip fracture were examined. Cognitive status was assessed by the Mini Mental State Examination (MMSE at admission; functional status was assessed by the motor subscale of Functional Independence Measure (FIM at admission and before discharge, while absolute functional gain was determined by the motor FIM gain (FIM discharge - FIM admission. Absolute functional gain was analyzed in respect to cognitive status. Results Both cognitively impaired and cognitively intact hip fracture patients exhibited overall FIM motor improvements, as well as functional gains in specific FIM motor areas (p<0.01. Absolute functional gain, however, was higher in 1 cognitively intact compared to cognitively impaired patients (p<0.01, and 2 cognitively moderately impaired patients compared to severely cognitively impaired patients (p<0.01. No difference in functional gain was detected between the patients with moderately cognitively impaired compared to the cognitive intact patients (p>0.05. Conclusion The systematic use of MMSE identifies cognitively impaired hip fracture patients, and effectively predicts their short-term functional outcome. A higher admission cognitive status is related to a more favorable short term rehabilitation outcome. In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes. The systematic identification of cognitively impaired hip fracture patients at admission facilitates optimal treatment and rehabilitation, and thus enables the best

  16. Functional outcome of auditory implants in hearing loss.

    Science.gov (United States)

    Di Girolamo, S; Saccoccio, A; Giacomini, P G; Ottaviani, F

    2007-01-01

    The auditory implant provides a new mechanism for hearing when a hearing aid is not enough. It is the only medical technology able to functionally restore a human sense i.e. hearing. The auditory implant is very different from a hearing aid. Hearing aids amplify sound. Auditory implants compensate for damaged or non-working parts of the inner ear because they can directly stimulate the acoustic nerve. There are two principal types of auditory implant: the cochlear implant and the auditory brainstem implant. They have common basic characteristics, but different applications. A cochlear implant attempts to replace a function lost by the cochlea, usually due to an absence of functioning hair cells; the auditory brainstem implant (ABI) is a modification of the cochlear implant, in which the electrode array is placed directly into the brain when the acoustic nerve is not anymore able to carry the auditory signal. Different types of deaf or severely hearing-impaired patients choose auditory implants. Both children and adults can be candidates for implants. The best age for implantation is still being debated, but most children who receive implants are between 2 and 6 years old. Earlier implantation seems to perform better thanks to neural plasticity. The decision to receive an implant should involve a discussion with many medical specialists and an experienced surgeon.

  17. Good outcome and valve function despite Medtronic-corevalve underexpansion.

    Science.gov (United States)

    Jilaihawi, Hasan; Asgar, Anita; Bonan, Raoul

    2010-12-01

    An 80-year old nun with severe calcific aortic stenosis and a bicuspid aortic valve was referred for transcatheter aortic valve implantation. She was declined for conventional surgery on the basis of poor left ventricular function, frailty, and a logistic EuroSCORE of 29.66. A 29-mm Medtronic-Corevalve bioprosthesis was implanted by transfemoral route. The inflow portion of the stent frame was grossly underexpanded. However, aortic valve area at 1.3 cm(2) was more than satisfactory for a body surface area of 1.29 m(2) (indexed area 1.0 cm(2)/m(2), peak gradient 23, and mean 16 mmHg). There was an early sustained improvement in New York Heart Association (NYHA) status, and there was no change in valvular function at 2 year follow-up. This case highlights that gross underexpansion of the Medtronic-Corevalve stent frame is compatible with good bioprosthetic function and excellent symptomatic recovery. Copyright © 2010 Wiley-Liss, Inc.

  18. Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation

    OpenAIRE

    Karmarkar, Amol M.; Graham, James E.; Reistetter, Timothy A.; Amit Kumar; Jacqueline M. Mix; Paulette Niewczyk; Granger, Carl V.; Ottenbacher, Kenneth J.

    2014-01-01

    The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the ...

  19. Long-term functional outcome of bilateral spontaneous and simultaneous Achilles tendon ruptures.

    LENUS (Irish Health Repository)

    Ellanti, Prasad

    2012-10-01

    Bilateral simultaneous ruptures are rare comprising less than 1% of all Achilles tendon ruptures. Risk factors for bilateral ruptures include chronic diseases and medications such as corticosteroids and fluoroquinolones. There is little in the literature on the long-term functional outcome of bilateral Achilles tendon ruptures. This article present a series of 3 cases of simultaneous and spontaneous bilateral Achilles tendon ruptures with a minimum of 5-year follow up suggesting a good functional outcome.

  20. Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review.

    Science.gov (United States)

    Buurman, Bianca M; van Munster, Barbara C; Korevaar, Johanna C; de Haan, Rob J; de Rooij, Sophia E

    2011-06-01

    To study instruments used and definitions applied in order to measure (instrumental) activities of daily living (I [ADL]) functioning and functional decline in hospitalized older medical patients. We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews from 1990 to January 2010. Articles were included if they (1) focused on acute hospitalization for medical illness in older patients; (2) described the instrument used to measure functioning; and (3) outlined the clinical definition of functional decline. Two reviewers independently extracted data. In total, 28 studies were included in this review. Five different instruments were used to measure functioning: the Katz ADL index, the IADL scale of Lawton and Brody, the Barthel index, Functional Independence Measure, and Care Needs Assessment. Item content and scoring between and within the instruments varied widely. The minimal amount for decline, as defined by the authors, referred to a decrease in functioning between 2.4% and 20.0%. This review shows there is a large variability in measuring (I)ADL functioning of older hospitalized patients and a large range of clinical definitions of functional decline. These conceptual and clinimetric barriers hamper the interpretation and comparison of functional outcome data of epidemiological and clinical studies. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Exploring the comparative responsiveness of a core set of outcome measures in a school-based conductive education programme.

    Science.gov (United States)

    Wright, F V; Boschen, K; Jutai, J

    2005-05-01

    Conductive education (CE) is a holistic educational system that uses an active cognitive approach to teach individuals with motor disorders to become more functional participants in daily activities. While CE's popularity continues to grow in North America and Europe, its effectiveness has not been established. The lack of definition of responsive outcome measures for evaluation of CE programmes has limited the interpretability of conclusions from earlier studies evaluating effectiveness. To determine which measures from a core set were most responsive to physical, functional and psychosocial changes associated with a school-based CE programme. This was a one-group before and after data collection design using an 8-month follow-up period. We enrolled a referral sample of nine children with cerebral palsy in Kindergarten or Grade 1 (Gross Motor Function Classification System levels 3, 4 or 5). The study took place within a school-based CE programme at a Canadian children's rehabilitation centre. Children participated in a CE full-day class for an entire school year. Physical, functional, psychosocial and participation measures included: Gross Motor Function Measure (GMFM), Quality of Upper Extremity Skills Test (QUEST), Peabody Developmental Motor Scales, Paediatric Evaluation of Disability Inventory (PEDI), Pictorial Scale of Perceived Competence and Social Acceptance for Young Children, Individualized Educational Plan, and Goal Attainment Scaling (GAS). Four children from the study's second year were also evaluated on the Impact on Family Scale (IFS), GAS and School Function Assessment. The Gross Motor Function Measure, QUEST, PEDI (Caregiver Assistance) and IFS were most responsive to change. GAS was useful in documenting and quantifying goals. Problems were encountered in evaluating self-esteem and school participation. Several strong measures of outcome were identified. Further work is needed to find valid and sensitive psychosocial and school participation

  2. Supratentorial Ependymoma: Disease Control, Complications, and Functional Outcomes After Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Landau, Efrat [Department of Radiation Oncology, Sheba Medical Center, Ramat Gan (Israel); Boop, Frederick A. [Department of Neurosurgery, St Jude Children' s Research Hospital, Memphis, Tennessee (United States); Conklin, Heather M. [Department of Psychology, St Jude Children' s Research Hospital, Memphis, Tennessee (United States); Wu, Shengjie; Xiong, Xiaoping [Department of Biostatistics, St Jude Children' s Research Hospital, Memphis, Tennessee (United States); Merchant, Thomas E., E-mail: thomas.merchant@stjude.org [Division of Radiation Oncology, St Jude Children' s Research Hospital, Memphis, Tennessee (United States)

    2013-03-15

    Purpose: Ependymoma is less commonly found in the supratentorial brain and has known clinical and molecular features that are unique. Our single-institution series provides valuable information about disease control for supratentorial ependymoma and the complications of supratentorial irradiation in children. Methods and Materials: A total of 50 children with newly diagnosed supratentorial ependymoma were treated with adjuvant radiation therapy (RT); conformal methods were used in 36 after 1996. The median age at RT was 6.5 years (range, 1-18.9 years). The entire group was characterized according to sex (girls 27), race (white 43), extent of resection (gross-total 46), and tumor grade (anaplastic 28). The conformal RT group was prospectively evaluated for neurologic, endocrine, and cognitive effects. Results: With a median follow-up time of 9.1 years from the start of RT for survivors (range, 0.2-23.2 years), the 10-year progression-free and overall survival were 73% + 7% and 76% + 6%, respectively. None of the evaluated factors was prognostic for disease control. Local and distant failures were evenly divided among the 16 patients who experienced progression. Eleven patients died of disease, and 1 of central nervous system necrosis. Seizure disorders were present in 17 patients, and 4 were considered to be clinically disabled. Clinically significant cognitive effects were limited to children with difficult-to-control seizures. The average values for intelligence quotient and academic achievement (reading, spelling, and math) were within the range of normal through 10 years of follow-up. Central hypothyroidism was the most commonly treated endocrinopathy. Conclusion: RT may be administered with acceptable risks for complications in children with supratentorial ependymoma. These results suggest that outcomes for these children are improving and that complications may be limited by use of focal irradiation methods.

  3. Psychosocial and Functional Outcomes in Long-Term Survivors of Osteosarcoma: A Comparison of Limb-Salvage Surgery and Amputation

    Science.gov (United States)

    Robert, Rhonda S.; Ottaviani, Giulia; Huh, Winston W.; Palla, Shana; Jaffe, Norman

    2009-01-01

    Background Traditionally, physicians have believed that limb-salvage surgery has functional and cosmetic advantages over amputation, yet the literature is equivocal. Therefore, we sought to compare the psychosocial and functional outcomes in osteosarcoma survivors after limb-salvage surgery and amputation. We hypothesized there to be neither psychosocial nor functional outcome differences between groups. Procedure Participants received treatment of extremity osteosarcoma, had received their cancer diagnosis at least 2 years prior, and were at least 16 years old. A comprehensive set of validated psychosocial and functional measures was used to assess outcome. Results Fifty-seven patients participated in this study (33 who underwent limb-salvage surgery and 24 who underwent amputation). Participants had gone 12–24 years since diagnosis and were 16–52 years old at study participation. We used multiple linear regression models to examine differences in quality of life, body image, self-esteem, and social support between the two groups and found no differences. Lower limb function was a significant predictor of quality of life (p amputation, amputation after failed limb salvage, than by those who did not. Conclusions Participants with more functional lower limbs had better quality of life than did those with less functional lower limbs regardless of whether they underwent amputation or limb-salvage surgery. PMID:20135700

  4. MRI as outcome measure in facioscapulohumeral muscular dystrophy

    DEFF Research Database (Denmark)

    Andersen, Grete; Dahlqvist, Julia R; Vissing, Christoffer R

    2017-01-01

    muscles. Changes were compared with those in FSHD score, muscle strength (hand-held dynamometry), 6-minute-walk-distance, 14-step-stair-test, and 5-time-sit-to-stand-test. Composite absolute fat fraction of all assessed muscles increased by 0.036 (CI 0.026-0.046, P increases in all measured...... disease progression in patients with FSHD1. Ambulatory patients with confirmed diagnosis of FSHD1 (25/20 men/women, age 20-75 years, FSHD score: 0-12) were tested with 359-560-day interval between tests. Using the MRI Dixon technique, muscle fat replacement was evaluated in paraspinal, thigh, and calf...... muscle groups. The clinical severity FSHD score worsened (10%, P muscle strength decreased over the hip (8%), neck (8%), and back (17%) (P muscle strength...

  5. Abnormal liver function tests as predictors of adverse maternal outcomes in women with preeclampsia.

    Science.gov (United States)

    Kozic, Jennifer R; Benton, Samantha J; Hutcheon, Jennifer A; Payne, Beth A; Magee, Laura A; von Dadelszen, Peter

    2011-10-01

    To evaluate whether (1) the absolute magnitude of liver function test values, (2) the percentage change in liver function test values over time, or (3) the rate of change in liver function test values over time predicts adverse maternal outcomes in women with preeclampsia. We used data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study, a prospective multicentre cohort study assessing predictors of adverse maternal outcomes in women with preeclampsia. Women with at least one liver function test performed at the time of hospital admission were included. Liver functions were tested by serum concentrations of aspartate amino transferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH), albumin, total bilirubin, and the international normalized prothrombin time ratio. Parameters investigated were absolute levels, change within 48 hours of hospital admission, change from admission to delivery or outcome, and rate of change from admission to delivery or outcome of each liver function test. The ability of these parameters to predict adverse outcomes was assessed using logistic regression analyses and by calculating the receiver operating characteristic (ROC) area under the curve (AUC). Of the 2008 women, 1056 (53%) had at least one abnormal liver function test result. The odds of having an adverse maternal outcome were higher in women with any abnormal liver function test than in women with normal results. When test results were stratified into quartiles, women with results in the highest quartile (lowest quartile for albumin) were at higher risk of adverse outcomes than women in the lowest quartile for all parameters (highest for albumin). The absolute magnitude of AST, ALT, and LDH predicted adverse maternal outcomes (AST: ROC AUC 0.73 [95% CI 0.67 to 0.97]; ALT: ROC AUC 0.73 [95% CI 0.67 to 0.79]; LDH: ROC AUC 0.74 [95% CI 0.68 to 0.81]). Neither change of liver function test results, within 48 hours of admission or from admission to

  6. Development and evaluation of an Individualized Outcome Measure (IOM) for randomized controlled trials in mental health.

    Science.gov (United States)

    Pesola, Francesca; Williams, Julie; Bird, Victoria; Freidl, Marion; Le Boutillier, Clair; Leamy, Mary; Macpherson, Rob; Slade, Mike

    2015-12-01

    Pre-defined, researcher-selected outcomes are routinely used as the clinical end-point in randomized controlled trials (RCTs); however, individualized approaches may be an effective way to assess outcome in mental health research. The present study describes the development and evaluation of the Individualized Outcome Measure (IOM), which is a patient-specific outcome measure to be used for RCTs of complex interventions. IOM was developed using a narrative review, expert consultation and piloting with mental health service users (n = 20). The final version of IOM comprises two components: Goal Attainment (GA) and Personalized Primary Outcome (PPO). For GA, patients identify one relevant goal at baseline and rate its attainment at follow-up. For PPO, patients choose an outcome domain related to their goal from a pre-defined list at baseline, and complete a standardized questionnaire assessing the chosen outcome domain at baseline and follow-up. A feasibility study indicated that IOM had adequate completion (89%) and acceptability (96%) rates in a clinical sample (n = 84). IOM was then evaluated in a RCT (ISRCTN02507940). GA and PPO components were associated with each other and with the trial primary outcome. The use of the PPO component of IOM as the primary outcome could be considered in future RCTs. Copyright © 2015 John Wiley & Sons, Ltd.

  7. THE ANALYSIS OF MIXED DISCRETE AND CONTINUOUS OUTCOMES USING DESIRABILITY FUNCTIONS.

    Science.gov (United States)

    Multiple types of outcomes are sometimes measured on each animal in toxicology dose-response experiments, and multiple analyses may increase the overall type I error. One approach to analyzing these outcomes in an integrated way is through the use of a composite score. We int...

  8. THE STATISTICAL ANALYSIS OF DISCRETE AND CONTINUOUS OUTCOMES USING DESIRABILITY FUNCTIONS.

    Science.gov (United States)

    Multiple types of outcomes are sometimes measured on each animal in toxicology dose-response experiments. In this paper we introduce a method of deriving a composite score for a dose-response experiment that combines information from discrete and continuous outcomes through the ...

  9. Measurement of sexual functioning after spinal cord injury: preferred instruments

    DEFF Research Database (Denmark)

    Alexander, Marcalee Sipski; Brackett, Nancy L; Bodner, Donald

    2009-01-01

    into male and female sexual function, male reproductive function, and female reproductive function. The instruments that have been used most frequently to measure these aspects of sexual function over the past 5 years were identified by expert consensus. Finally, these instruments were subjected...... to a critical review. RESULTS: The Female Sexual Function Index (FSFI), measurement of vaginal pulse amplitude (VPA), the International Index of Erectile Function (IIEF), and the measurement of ejaculatory function and semen quality were considered appropriate measures to assess sexual responses...... and reproductive function after SCI. There were no measures identified to assess female reproductive function. CONCLUSIONS: For clinical trials aiming to improve sexual function after SCI, the FSFI or the IIEF is currently preferred. Although VPA is an appropriate means to assess female sexual responses...

  10. Use of outcome measures in stroke rehabilitation in the transition from hospital to home-based rehabilitation

    DEFF Research Database (Denmark)

    Maribo, Thomas; Nielsen, Claus Vinther

    treating stroke patients at home in three regions in Denmark. The three regions have a total population of three million. The survey was targeted at health care professionals that typically take part in municipal health service: nurses, physiotherapists, occupational therapists, speech......-language pathologists, nursing assistants and neuropsychologists. The questionnaire had one open-ended question: “Which instruments, outcome measures or tests are commonly used to describe functioning in persons with stroke?”. The questionnaire underlined that only instruments routinely used to assess functioning were...... half the Danish health care sector shows that the vast majority of services use standardised instruments, but there is absolutely no consensus in the selection of instruments. Impact and Implications: There is a strong need for recommendations on which outcome measures should be used in stroke...

  11. The Myotonic Dystrophy Health Index: Italian validation of a disease-specific outcome measure.

    Science.gov (United States)

    Sansone, Valeria A; Lizio, Andrea; Greco, Lucia; Gragnano, Gaia; Zanolini, Alice; Gualandris, Marco; Iatomasi, Marino; Heatwole, Chad

    2017-07-10

    The Myotonic Dystrophy Health Index (MDHI) is a disease-specific, self-reported outcome measure that assesses total disease burden and 17 areas of Myotonic Dystrophy type 1 (DM1) specific health. This study translated the MDHI into Italian and validated the instrument using a cohort of Italian DM1 patients. Italian DM1 patients were interviewed regarding the form and content of the instrument. Thirty-eight DM1 patients were subsequently recruited to test the reliability and concurrent validity of the instrument by serially completing the MDHI and a battery of clinical tests. Lastly, we determined the internal consistency of the Italian MDHI and each of its subscales. The internal consistency was excellent in the total Italian MDHI score and acceptable in all of its subscales; the test-retest reliability was high (intraclass correlation coefficient = 0.95); Italian MDHI total scores and subscales were associated with neuromuscular function, cognitive and social health, respiratory function, and quality of life. Overall, the Italian MDHI is valid and well suited to measure the multi-dimensional aspects of disease burden in Myotonic Dystrophy clinical trials. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Measurement properties of patient-reported outcome measures (PROMs) in adults with obstructive sleep apnea (OSA): A systematic review

    NARCIS (Netherlands)

    Abma, I.L.; Wees, P.J. van der; Veer, V.; Westert, G.P.; Rovers, M.M.

    2016-01-01

    This systematic review summarizes the evidence regarding the quality of patient-reported outcome measures (PROMs) validated in patients with obstructive sleep apnea (OSA). We performed a systematic literature search of all PROMs validated in patients with OSA, and found 22 measures meeting our

  13. Conservation covenants on private land: issues with measuring and achieving biodiversity outcomes in Australia.

    Science.gov (United States)

    Fitzsimons, James A; Carr, C Ben

    2014-09-01

    Conservation covenants and easements have become essential tools to secure biodiversity outcomes on private land, and to assist in meeting international protection targets. In Australia, the number and spatial area of conservation covenants has grown significantly in the past decade. Yet there has been little research or detailed policy analysis of conservation covenanting in Australia. We sought to determine how conservation covenanting agencies were measuring the biodiversity conservation outcomes achieved on covenanted properties, and factors inhibiting or contributing to measuring these outcomes. In addition, we also investigated the drivers and constraints associated with actually delivering the biodiversity outcomes, drawing on detailed input from covenanting programs. Although all conservation covenanting programs had the broad aim of maintaining or improving biodiversity in their covenants in the long term, the specific stated objectives of conservation covenanting programs varied. Programs undertook monitoring and evaluation in different ways and at different spatial and temporal scales. Thus, it was difficult to determine the extent Australian conservation covenanting agencies were measuring the biodiversity conservation outcomes achieved on covenanted properties on a national scale. Lack of time available to covenantors to undertake management was one of the biggest impediments to achieving biodiversity conservation outcomes. A lack of financial resources and human capital to monitor, knowing what to monitor, inconsistent monitoring methodologies, a lack of benchmark data, and length of time to achieve outcomes were all considered potential barriers to monitoring the biodiversity conservation outcomes of conservation covenants.

  14. Conservation Covenants on Private Land: Issues with Measuring and Achieving Biodiversity Outcomes in Australia

    Science.gov (United States)

    Fitzsimons, James A.; Carr, C. Ben

    2014-09-01

    Conservation covenants and easements have become essential tools to secure biodiversity outcomes on private land, and to assist in meeting international protection targets. In Australia, the number and spatial area of conservation covenants has grown significantly in the past decade. Yet there has been little research or detailed policy analysis of conservation covenanting in Australia. We sought to determine how conservation covenanting agencies were measuring the biodiversity conservation outcomes achieved on covenanted properties, and factors inhibiting or contributing to measuring these outcomes. In addition, we also investigated the drivers and constraints associated with actually delivering the biodiversity outcomes, drawing on detailed input from covenanting programs. Although all conservation covenanting programs had the broad aim of maintaining or improving biodiversity in their covenants in the long term, the specific stated objectives of conservation covenanting programs varied. Programs undertook monitoring and evaluation in different ways and at different spatial and temporal scales. Thus, it was difficult to determine the extent Australian conservation covenanting agencies were measuring the biodiversity conservation outcomes achieved on covenanted properties on a national scale. Lack of time available to covenantors to undertake management was one of the biggest impediments to achieving biodiversity conservation outcomes. A lack of financial resources and human capital to monitor, knowing what to monitor, inconsistent monitoring methodologies, a lack of benchmark data, and length of time to achieve outcomes were all considered potential barriers to monitoring the biodiversity conservation outcomes of conservation covenants.

  15. Functional Outcome Trajectories After Out-of-Hospital Pediatric Cardiac Arrest.

    Science.gov (United States)

    Silverstein, Faye S; Slomine, Beth S; Christensen, James; Holubkov, Richard; Page, Kent; Dean, J Michael; Moler, Frank W

    2016-12-01

    To analyze functional performance measures collected prospectively during the conduct of a clinical trial that enrolled children (up to age 18 yr old), resuscitated after out-of-hospital cardiac arrest, who were at high risk of poor outcomes. Children with Glasgow Motor Scale score less than 5, within 6 hours of resuscitation, were enrolled in a clinical trial that compared two targeted temperature management interventions (THAPCA-OH, NCT00878644). The primary outcome, 12-month survival with Vineland Adaptive Behavior Scale, second edition, score greater or equal to 70, did not differ between groups. Thirty-eight North American PICUs. Two hundred ninety-five children were enrolled; 270 of 295 had baseline Vineland Adaptive Behavior Scale, second edition, scores greater or equal to 70; 87 of 270 survived 1 year. Targeted temperatures were 33.0°C and 36.8°C for hypothermia and normothermia groups. Baseline measures included Vineland Adaptive Behavior Scale, second edition, Pediatric Cerebral Performance Category, and Pediatric Overall Performance Category. Pediatric Cerebral Performance Category and Pediatric Overall Performance Category were rescored at hospital discharges; all three were scored at 3 and 12 months. In survivors with baseline Vineland Adaptive Behavior Scale, second edition scores greater or equal to 70, we evaluated relationships of hospital discharge Pediatric Cerebral Performance Category with 3- and 12-month scores and between 3- and 12-month Vineland Adaptive Behavior Scale, second edition, scores. Hospital discharge Pediatric Cerebral Performance Category scores strongly predicted 3- and 12-month Pediatric Cerebral Performance Category (r = 0.82 and 0.79; p Vineland Adaptive Behavior Scale, second edition, scores (r = -0.81 and -0.77; p Vineland Adaptive Behavior Scale, second edition, scores strongly predicted 12-month performance (r = 0.95; p Scale score less than 5 in the initial hours after out-of-hospital cardiac arrest resuscitation

  16. The Promise of Patient-Reported Outcomes Measurement Information System-Turning Theory into Reality: A Uniform Approach to Patient-Reported Outcomes Across Rheumatic Diseases.

    Science.gov (United States)

    Witter, James P

    2016-05-01

    PROMIS, the Patient-Reported Outcomes Measurement Information System, is opening new possibilities to explore and learn how patient (or proxy) self-report of core symptoms and health-related quality of life can meaningfully advance clinical research and patient care. PROMIS leverages Item Response Theory to agnostically assess, across diseases and conditions or clinical settings, numerous universally applicable core "domains" of health (symptoms and functioning) from the patient perspective. Importantly, PROMIS is enabling the testing and adoption of computerized adaptive testing, which holds great potential to minimize patient burden while maximizing accuracy.

  17. Toward the development of a universal outcome instrument for spine trauma : A systematic review and content comparison of outcome measures used in spine trauma research using the ICF as reference

    NARCIS (Netherlands)

    Oner, F. Cumhur; Jacobs, Wilco C H; Lehr, A. Mechteld; Sadiqi, Said; Post, Marcel W.; Aarabi, Bizhan; Chapman, Jens R.; Dvorak, Marcel F.; Fehlings, Michael G.; Kandziora, Frank; Rajasekaran, S.; Vaccaro, Alexander R.

    2016-01-01

    Study Design. A systematic literature review. Objective. The aim of this study was (1) to identify patient-reported and clinician-based outcome measures most frequently used to evaluate the function and health of spine trauma patients, (2) to identify and quantify the concepts of these measures

  18. Toward the development of a universal outcome instrument for spine trauma : A systematic review and content comparison of outcome measures used in spine trauma research using the ICF as reference

    NARCIS (Netherlands)

    Oner, F. Cumhur|info:eu-repo/dai/nl/188615326; Jacobs, Wilco C H; Lehr, A. Mechteld; Sadiqi, Said; Post, Marcel W.|info:eu-repo/dai/nl/137146426; Aarabi, Bizhan; Chapman, Jens R.; Dvorak, Marcel F.; Fehlings, Michael G.; Kandziora, Frank; Rajasekaran, S.; Vaccaro, Alexander R.

    2016-01-01

    Study Design. A systematic literature review. Objective. The aim of this study was (1) to identify patient-reported and clinician-based outcome measures most frequently used to evaluate the function and health of spine trauma patients, (2) to identify and quantify the concepts of these measures usin

  19. Functional verification coverage measurement and analysis

    CERN Document Server

    Piziali, Andrew

    2007-01-01

    This book addresses a means of quantitatively assessing functional verification progress. Without this process, design and verification engineers, and management, are left guessing whether or not they have completed verifying the device they are designing.

  20. AGS vertical beta function measurements for Run 15

    Energy Technology Data Exchange (ETDEWEB)

    Harper, C. [Brookhaven National Lab. (BNL), Upton, NY (United States); Ahrens, L. [Brookhaven National Lab. (BNL), Upton, NY (United States); Huang, H. [Brookhaven National Lab. (BNL), Upton, NY (United States); Schoefer, V. [Brookhaven National Lab. (BNL), Upton, NY (United States)

    2016-10-07

    One key parameter for running the AGS efficiently is by maintaining a low emittance. To measure emittance, one needs to measure the beta function throughout the cycle. This can be done by measuring the beta function at the ionization profile monitors (IPM) in the AGS. This tech note delves into the motivation, the measurement, and some strides that were made throughout Run15.

  1. Outcomes of bone density measurements in coeliac disease.

    Science.gov (United States)

    Bolland, Mark J; Grey, Andrew; Rowbotham, David S

    2016-01-29

    Some guidelines recommend that patients with newly diagnosed coeliac disease undergo bone density scanning. We assessed the bone density results in a cohort of patients with coeliac disease. We searched bone density reports over two 5-year periods in all patients from Auckland District Health Board (2008-12) and in patients under 65 years from Counties Manukau District Health Board (2009-13) for the term 'coeliac.' Reports for 137 adults listed coeliac disease as an indication for bone densitometry. The average age was 47 years, body mass index (BMI) 25 kg/m(2), and 77% were female. The median time between coeliac disease diagnosis and bone densitometry was 261 days. The average bone density Z-score was slightly lower than expected (Z-score -0.3 to 0.4) at the lumbar spine, total hip and femoral neck, but 88-93% of Z-scores at each site lay within the normal range. Low bone density was strongly related to BMI: the proportions with Z-score 30 kg/m(2) were 28%, 15%, 6% and 0% respectively. Average bone density was normal, suggesting that bone density measurement is not indicated routinely in coeliac disease, but could be considered on a case-by-case basis for individuals with strong risk factors for fracture.

  2. Use of the measure your medical outcome profile (MYMOP2 and W-BQ12 (Well-Being outcomes measures to evaluate chiropractic treatment: an observational study

    Directory of Open Access Journals (Sweden)

    Polus Barbara I

    2011-03-01

    Full Text Available Abstract Background The objective was to assess the use of the Measure Yourself Medical Outcome Profile (MYMOP2 and W-BQ12 well-being questionnaire for measuring clinical change associated with a course of chiropractic treatment. Methods Chiropractic care of the patients involved spinal manipulative therapy (SMT, mechanically assisted techniques, soft tissue therapy, and physiological therapeutic devices. Outcome measures used were MYMOP2 and the Well-Being Questionnaire 12 (W-BQ12. Results Statistical and clinical significant changes were demonstrated with W-BQ12 and MYMOP2. Conclusions The study demonstrated that MYMOP2 was responsive to change and may be a useful instrument for assessing clinical changes among chiropractic patients who present with a variety of symptoms and clinical conditions.

  3. Multidisciplinary Treatment of Severe Osteogenesis Imperfecta: Functional Outcomes at Skeletal Maturity.

    Science.gov (United States)

    Montpetit, Kathleen; Palomo, Telma; Glorieux, Francis H; Fassier, François; Rauch, Frank

    2015-10-01

    To determine the functional outcomes associated with long-term multidisciplinary treatment, intravenous bisphosphonate treatment, orthopedic surgery, and rehabilitation in children with severe osteogenesis imperfecta (OI) (diagnosed clinically as OI types III or IV). Retrospective study where outcomes were measured prospectively. Pediatric orthopedic hospital. Adolescents (N=41; age range, 15-21y) with severe OI (OI type III: n=17; OI type IV: n=24) who had started therapy before the age of 6 years, had received treatment for at least 10 years, and had achieved final height. Intravenous bisphosphonate treatment, orthopedic surgery, and rehabilitation. Pediatric Evaluation of Disability Inventory. At the time of the last available follow-up examination, none of the individuals diagnosed with OI type III (most severely affected group) was able to ambulate without ambulation aids, whereas 20 (83%) patients with OI type IV were able to ambulate without ambulation aids. Regarding self-care, we specifically assessed 8 skills that we deemed essential for living independently (grooming; dressing; toileting; bed, chair, toilet, tub, and car transfers). Only 6 (35%) of the youths with OI type III were able to complete all 8 items, whereas 23 (96%) individuals with OI type IV managed to perform all tasks. Teens with OI type III often needed assistance for the transfer to toilet, tub, and car and for personal hygiene and clothing management associated with toileting, usually because of limitations in upper-extremity function. These observations suggest that further improvements in the functional status of the most severely affected children with OI are contingent on advances in the clinical management of upper-extremity issues. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. The challenges of translating the clinical outcomes in Routine Evaluation-Outcome Measure (CORE-OM) into British Sign Language.

    Science.gov (United States)

    Rogers, Katherine D; Young, Alys; Lovell, Karina; Evans, Chris

    2013-01-01

    This article discusses translation issues arising during the production of a British Sign Language (BSL) version of the psychological outcome measure "Clinical Outcomes in Routine Evaluation-Outcome Measure" (CORE-OM). The process included forward translation, meeting with a team of translators, producing a second draft of the BSL version and back translating into English. Further modifications were made to the BSL version before piloting it with d/Deaf populations. Details of the translation process are addressed, including (a) the implications of translating between modalities (written text to visual language); (b) clarity of frequency anchors: analog versus digital encoding; (c) pronouns and the direction of signing; and (iv) the influence of the on-screen format. The discussion of item-specific issues encountered when producing a BSL version of the CORE-OM includes the expression of precise emotional states in a language that uses visual modifiers, problems associated with iconic signs, and the influence of Deaf world knowledge when interpreting specific statements. Finally, it addresses the extent to which lessons learned through this translation process are generalizable to other signed languages and spoken language translations of standardized instruments. Despite the challenges, a BSL version of the CORE-OM has been produced and found to be reliable.

  5. Feedback from Outcome Measures and Treatment Effectiveness, Treatment Efficiency, and Collaborative Practice: A Systematic Review.

    Science.gov (United States)

    Gondek, Dawid; Edbrooke-Childs, Julian; Fink, Elian; Deighton, Jessica; Wolpert, Miranda

    2016-05-01

    Due to recent increases in the use of feedback from outcome measures in mental health settings, we systematically reviewed evidence regarding the impact of feedback from outcome measures on treatment effectiveness, treatment efficiency, and collaborative practice. In over half of 32 studies reviewed, the feedback condition had significantly higher levels of treatment effectiveness on at least one treatment outcome variable. Feedback was particularly effective for not-on-track patients or when it was provided to both clinicians and patients. The findings for treatment efficiency and collaborative practice were less consistent. Given the heterogeneity of studies, more research is needed to determine when and for whom feedback is most effective.

  6. Use of the extended therapy outcome measure for children with dysarthria.

    Science.gov (United States)

    Enderby, Pam

    2014-08-01

    Increasing demand on healthcare resources has led to a greater emphasis on the examination of the impact of service delivery on outcomes. Clinical assessments frequently do not cover all aspects of change associated with interventions for those with complex conditions. This paper reviews the need for more comprehensive outcome measurement suitable for clinical practice and benchmarking. It describes an extension of the Therapy Outcome Measure for specific use in reflecting the impact of the broad range of interventions commonly required when managing children with dysarthria. Three case histories are used to illustrate the approach, and data from four speech-language pathology services are used to illustrate the value of benchmarking.

  7. Impact of retrograde flexible ureteroscopy and intracorporeal lithotripsy on kidney functional outcomes

    Directory of Open Access Journals (Sweden)

    Nicolas Hoarau

    2015-10-01

    Full Text Available ABSTRACT Objective: The aim of the study was to evaluate renal function and to identify factors associated with renal function deterioration after retrograde intrarenal surgery (RIRS for kidney stones. Materials and Methods: We retrospectively analyzed patients with renal stones treated by RIRS between January 2010 and June 2013 at a single institute. We used the National Kidney Foundation classification of chronic kidney disease (CKD to classify Glomerular Filtration Rate (GFR in 5 groups. The baseline creatinine level was systematically pre-operatively and post-operatively evaluated. All patients had a creatinine blood measurement in June 2013. A change toward a less or a more favorable GFR group following RIRS was considered significant. Results: We included 163 patients. There were 86 males (52.8% and 77 females (47.3% with a mean age of 52.8±17 years. After a mean follow-up of 15.5±11.5 months, median GFR was not significantly changed from 84.3±26.2 to 84.9±24.5 mL/min (p=0.675. Significant renal function deterioration occurred in 8 cases (4.9% and significant renal function amelioration occurred in 23 cases (14.1%. In univariate analysis, multiple procedures (p=0.023; HR: 5.4 and preoperative CKD (p=0.011; HR: 6.8 were associated with decreased renal function. In multivariate analysis these factors did not remain as predictive factors. Conclusion: Stone management with RIRS seems to have favorable outcomes on kidney function; however, special attention should be given to patients with multiple procedures and preoperative chronic kidney disease.

  8. Retrospective comparison of functional and radiological outcome, between two contemporary high flexion knee designs

    Directory of Open Access Journals (Sweden)

    Kapoor Vikash

    2016-01-01

    Full Text Available Introduction: Patient satisfaction after total knee replacement (TKR depends on the amount of pain relief and the functional activities achieved. An important criterion of good functional outcome is the amount of flexion achieved and whether the patient can manage high flexion activities. In order to increase the amount of safe flexion, various implant designs have been developed. This study aims to compare the outcome after TKR using two contemporary high flexion knee designs: Sigma CR150 High Flex Knee prosthesis (Depuy, Warsaw, Indiana and NexGen High Flex Knee prosthesis (Zimmer, Warsaw, Indiana. Material: A retrospective study was conducted with 100 cases of each design and their functional and radiological outcome was assessed after two years of follow-up. Results: The two groups had comparable results in terms of subjective satisfaction, range of motion achieved and radiological outcome. Depuy group fared better than Zimmer in terms of functional outcome (modified Oxford knee score. Conclusion: Depuy group was found to have fared better than Zimmer in terms of functional outcome. However, it is very difficult to rate one design above the other based on our small sample size and short duration of follow-up.

  9. Retrospective comparison of functional and radiological outcome, between two contemporary high flexion knee designs

    Science.gov (United States)

    Kapoor, Vikash; Chatterjee, Daipayan; Hazra, Sutanu; Chatterjee, Anirban; Garg, Parag; Debnath, Kaustav; Mandal, Soham; Sarkar, Sudipto

    2016-01-01

    Introduction: Patient satisfaction after total knee replacement (TKR) depends on the amount of pain relief and the functional activities achieved. An important criterion of good functional outcome is the amount of flexion achieved and whether the patient can manage high flexion activities. In order to increase the amount of safe flexion, various implant designs have been developed. This study aims to compare the outcome after TKR using two contemporary high flexion knee designs: Sigma CR150 High Flex Knee prosthesis (Depuy, Warsaw, Indiana) and NexGen High Flex Knee prosthesis (Zimmer, Warsaw, Indiana). Material: A retrospective study was conducted with 100 cases of each design and their functional and radiological outcome was assessed after two years of follow-up. Results: The two groups had comparable results in terms of subjective satisfaction, range of motion achieved and radiological outcome. Depuy group fared better than Zimmer in terms of functional outcome (modified Oxford knee score). Conclusion: Depuy group was found to have fared better than Zimmer in terms of functional outcome. However, it is very difficult to rate one design above the other based on our small sample size and short duration of follow-up. PMID:27748254

  10. Measuring developmental and functional status in children with disabilities.

    Science.gov (United States)

    Ottenbacher, K J; Msall, M E; Lyon, N; Duffy, L C; Granger, C V; Braun, S

    1999-03-01

    This study compared performance on the Functional Independence Measure for Children (WeeFIM), the Battelle Developmental Inventory Screening Test (BDIST), and the Vineland Adaptive Behavior Scales (VABS) in children with developmental disabilities. The three instruments were administered to 205 children with identified disabilities. All 205 children were tested using the WeeFIM instrument. The BDIST was administered to 101 children and the VABS to the remaining 104 children. Administration was counterbalanced and randomized across all three instruments. A proportional sampling plan was used to select the 205 children, who ranged in age from 11 to 87 months. A variety of medical diagnoses and levels of severity of motor, cognitive, and communication impairments were systematically included in the sample. Correlations (r) among subscales for all three instruments ranged from 0.42 to 0.92. Correlations for total scores ranged from 0.72 to 0.94. Analyses of potential moderator variables found no significant relation between age and severity of disability (r=0.05) or between socioeconomic status (SES) and severity of disability (r=0.21). Correlations with age were strongest for those subscale scores involving gross and fine motor skills. Correlations with SES and subscale scores ranged from 0.03 to 0.18. The three instruments provide important information regarding childhood performance in motor, self-care, communicative, cognitive, and social skills. The WeeFIM instrument requires less administration time and provides information directly relevant to evaluating functional outcomes for children with disabilities and their families.

  11. An outcome measure for patients with cervical myelopathy: Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ): Part 1.

    Science.gov (United States)

    Fukui, Mitsuru; Chiba, Kazuhiro; Kawakami, Mamoru; Kikuchi, Shin-Ichi; Konno, Shin-Ichi; Miyamoto, Masabumi; Seichi, Atsushi; Shimamura, Tadashi; Shirado, Osamu; Taguchi, Toshihiko; Takahashi, Kazuhisa; Takeshita, Katsushi; Tani, Toshikazu; Toyama, Yoshiaki; Wada, Eiji; Yonenobu, Kazuo; Tanaka, Takashi; Hirota, Yoshio

    2007-05-01

    An outcome measure to evaluate the neurological function of cervical myelopathy was proposed by the Japanese Orthopaedic Association in 1975 (JOA score), and has been widely used in Japan. However, the JOA score does not include patients' satisfaction, disability, handicaps, or general health, which can be affected by cervical myelopathy. The purpose of this study was to develop a new outcome measure for patients with cervical myelopathy. This study was conducted in eight university hospitals and their affiliated hospitals from February to May 2002. The questionnaire included 77 items. Forty-one questions, which were originally listed by the authors, were for evaluation of the physical function of the cervical spine and spinal cord. The Medical Outcome Study Short-Form 36-Item Health Survey (SF-36) was used to examine health-related quality of life (QOL). Patients with cervical myelopathy and healthy volunteers were recruited at each institution. After analysis of the answers from patients and volunteers, irrelevant questions using the following criteria were excluded: (1) a question 80% of answers for which were concentrated on one choice, (2) a question whose answer was highly correlated with that of other questions, (3) a question that could be explained by other questions, and (4) a question for which the distribution of the answers obtained from the patients was not different from that obtained from the normal volunteers. The patients comprised 164 men and 86 women, and the healthy volunteers 96 men and 120 women. Thirteen items from the questions about the physical functions of the cervical spine and the spinal cord and 11 items from SF-36 remained as candidates that should be included in the final outcome measure questionnaire. Twenty-four questions remained as candidates for the final questionnaire. This new self-administered questionnaire might be used to evaluate the outcomes in patients with cervical myelopathy more efficiently.

  12. Patient-reported outcome measures in psoriasis: the good, the bad and the missing!

    Science.gov (United States)

    Kitchen, H; Cordingley, L; Young, H; Griffiths, C E M; Bundy, C

    2015-01-01

    As a long-term condition, psoriasis demands significant personal and professional input for optimal self-management. Low levels of well-being and high levels of psychological distress in patients with psoriasis are associated with reduced resources for self-care. Patient-reported outcome (PRO) measures can be used to assess physical, social and psychological functioning in order to guide treatment. In this article, we systematically reviewed the development and validation of existing PRO measures. PubMed (Medline), PsycINFO and CINAHL were searched systematically using predefined search terms. The search was limited to articles in the English language relating to human subjects. Articles were selected for full review through explicit inclusion/exclusion criteria. PRO measures were critically reviewed in accordance with the published guidelines and theory on the development and validation of PROs. The search identified 967 abstracts; 71 of these articles met the criteria for full review. In these 71 articles, 45 PRO measures were found: 16 were specific to psoriasis, 21 assessed other dermatological conditions and eight were developed for generic nondermatological health conditions. The review revealed several limitations of the existing measures, including: (i) a composite structure assessing multiple, poorly-defined concepts; (ii) a lack of evidence for face and content validity; (iii) a failure to include both patient and clinician perspectives and requirements and (iv) a lack of evidence regarding the feasibility and acceptability for patients and physicians. No single PRO measure with adequate evidence of validity, reliability and sensitivity to change captures patient well-being in psoriasis. A valid, sensitive, specific and acceptable PRO that assesses the full impact of psoriasis on well-being is needed for the comprehensive clinical management of psoriasis.

  13. Cerebrolysin enhances neurogenesis in the ischemic brain and improves functional outcome after stroke.

    Science.gov (United States)

    Zhang, Chunling; Chopp, Michael; Cui, Yisheng; Wang, Lei; Zhang, Ruilan; Zhang, Li; Lu, Mei; Szalad, Alexandra; Doppler, Edith; Hitzl, Monika; Zhang, Zheng Gang

    2010-11-15

    Cerebrolysin is a peptide preparation mimicking the action of neurotrophic factors and has beneficial effects on neurodegenerative diseases and stroke. The present study investigated the effect of Cerebrolysin on neurogenesis in a rat model of embolic middle cerebral artery occlusion (MCAo). Treatment with Cerebrolysin at doses of 2.5 and 5 ml/kg significantly increased the number of bromodeoxyuridine-positive (BrdU(+)) subventricular zone (SVZ) neural progenitor cells and doublecortin (DCX) immunoreactivity (migrating neuroblasts) in the ipsilateral SVZ and striatal ischemic boundary 28 days after stroke when the treatment was initiated 24 hr after stroke. The treatment also reduced TUNEL(+) cells by ∼50% in the ischemic boundary. However, treatment with Cerebrolysin at a dose of 2.5 ml/kg initiated at 24 and 48 hr did not significantly reduce infarct volume but substantially improved neurological outcomes measured by an array of behavioral tests 21 and 28 days after stroke. Incubation of SVZ neural progenitor cells from ischemic rats with Cerebrolysin dose dependently augmented BrdU(+) cells and increased the number of Tuj1(+) cells (a marker of immature neurons). Blockage of the PI3K/Akt pathway abolished Cerebrolysin-increased BrdU(+) cells. Moreover, Cerebrolysin treatment promoted neural progenitor cell migration. Collectively, these data indicate that Cerebrolysin treatment when initiated 24 and 48 hr after stroke enhances neurogenesis in the ischemic brain and improves functional outcome and that Cerebrolysin-augmented proliferation, differentiation, and migration of adult SVZ neural progenitor cells contribute to Cerebrolysin-induced neurogenesis, which may be related to improvement of neurological outcome. The PI3K/Akt pathway mediates Cerebrolysin-induced progenitor cell proliferation.

  14. Aesthetic, urological, orthopaedic and functional outcomes in complex bladder exstrophy-epispadias′s management

    Directory of Open Access Journals (Sweden)

    Bertin Dibi Kouame

    2015-01-01

    Full Text Available Background: Postoperative complications are related to the surgical procedures, of failures of initial bladder closure and influence the urological, aesthetical and orthopaedic outcomes. Materials and Methods: We reviewed four patients who underwent complex bladder exstrophy-epispadias repair over a period of 14 years. The outcomes of treatment were assessed using, aesthetic, urological and orthopaedic examination data. Orthopaedic complications were explored by a radiography of the pelvis. Results: Out of four patients who underwent bladder exstrophy surgical management, aesthetic, functional outcomes and complications in the short and long follow-up were achieved in three patients. The first patient is a male and had a good penis aspect. He has a normal erection during micturition with a good jet miction. He has a moderate urinary incontinence, which requires diaper. In the erection, his penis-measures 4 cm long and 3 cm as circumference. The second patient was a female. She had an unsightly appearance of the female external genitalia with bipartite clitoris. Urinary continence could not be assessed; she did not have the age of cleanness yet. The third patient had a significant urinary leakage due to the failure of the epispadias repair. He has a limp, a pelvic obliquity, varus and internal rotation of the femoral head. He has an inequality of limbs length. Pelvis radiograph shows the right osteotomy through the ilium bone, the left osteotomy through the hip joint at the acetabular roof. Conclusion: When, the epispadias repair is performed contemporary to initial bladder closure, its success is decisive for urinary continence. In the female, surgical revision is required after the initial bladder closure for an aesthetic appearance to the external genitalia. Innominate osteotomy must be performed with brilliancy amplifier to avoid osteotomy through to the hip joint to prevent inequality in leg length.

  15. Associations between nine family dinner frequency measures and child weight, dietary and psychosocial outcomes

    Science.gov (United States)

    Fulkerson, Jayne A.; Friend, Sarah E.; Neumark-Sztainer, Dianne

    2015-01-01

    Background Family meal frequency has been consistently and significantly associated with positive youth dietary and psychosocial outcomes but less consistently associated with weight outcomes. Family meal frequency measurement has varied widely and it is unclear how this variation may impact relationships with youth weight, dietary, and psychosocial outcomes. Objective This study assesses how five parent/caregiver-reported and four child-reported family dinner frequency measures correlate with each other and are associated with health-related outcomes. Design/Participants This secondary, cross-sectional analysis uses baseline, parent/caregiver (n=160) and 8–12 year old child (n=160) data from the Healthy Home Offerings via the Mealtime Environment (HOME) Plus trial (collected 2011–2012). Data were obtained from objective measurements, dietary recall interviews, and psychosocial surveys. Outcome measures Outcomes included child body mass index z-scores (BMIz), fruit, vegetable and sugar-sweetened beverage intake, dietary quality (Healthy Eating Index-2010 [HEI-2010]), family connectedness, and meal conversations. Statistical analyses performed Pearson correlations and general linear models were used to assess associations between family dinner frequency measures and outcomes. Results All family dinner frequency measures had comparable means and were correlated within and across parent/caregiver- and child-reporters (r=0.17–0.94, pfamily dinner frequency measures were significantly associated with BMIz scores and 100% were significantly associated with fruit/vegetable intake and HEI-2010. In adjusted models, most significant associations with dietary and psychosocial outcomes remained but associations with child BMIz remained significant only for parent/caregiver- (β±SE= −0.07±0.03; pfamily dinner frequency measures asking about ‘sitting and eating’ dinner. Conclusions In spite of phrasing variations in family dinner frequency measures (e.g., which

  16. Hip Arthroscopy in athletes with Femoroacetabular Impingement: functional outcomes

    Science.gov (United States)

    Magi, Gonzalo; Carucci, Juan Pablo; Berro, Manuel; Bergues, Sebastián

    2017-01-01

    Introduction: Hip pathology is being recognized with more frequency as source of disability and functional limitation in athletes. It has been stated that the overload made with certain positions during some sports activities can develop condral damage. Moreover, the sum of bone deformity and repetitive movements of the hip requiered in sports may increase the risk of causing injuries. These can be treated with hip arthroscopy. Despite of this, there is a lack of evidence about the time taken to return to sports activity and the level reached afterwards by those patients treated with this procedure. Objective: Describe the clinical evolution, the time taken to return to sports activity and the level reached a year after the treatment of femoroacetabular impingement (FAI) with hip arthroscopy in 23 athletes. Method: 23 athletes were included in the study, defined as those patients with a minimum of 6 hours a week of sports practice, who were treated for FAI with hip arthroscopy between 2010 and 2015 by the same surgeon at our institution. The diagnosis was clinical (positive impingement test, hip pain and functional limitation of the hip), radiological (cam and pincer) and with magnetic nuclear resonance (labral tears). Preoperative modified Harris hip score was registered in all cases. Tonnis radiographic score was used. All patients had type 0 or 1 Tonnis hips. After 3 months of ineffective non operative treatment the arthroscopy was performed. Patients were treated in dorsal decubitus with orthopedic table. Labral reconstruction with anchors and femoral and acetabular osteoplasty was made. After surgery, patients were able to walk with support for 4 weeks and began physiotherapy. A year after surgery, all patients were questioned about the time taken to return to sports activity and the level of activity reached at that time compared to the one they had before symptoms appeared. The modified Harris hip score was also registered. Results: Ten patients played

  17. Capturing Psychologists' Work in Integrated Care: Measuring and Documenting Administrative Outcomes.

    Science.gov (United States)

    Kearney, Lisa K; Smith, Clifford A; Pomerantz, Andrew S

    2015-12-01

    With the expansion of integrated primary care and the increased focus on fiscal sustainability, it is critical for clinical managers of these innovative systems to have practical methods for measuring administrative outcomes. Administrative outcomes will assist leadership in the development of efficient, streamlined clinics to provide services to the primary care population. Additionally, administrative measures can be utilized to provide information to assist in guiding resource utilization and management decisions. Several administrative outcomes are suggested for integrated primary care managers to consider for application, including: clinic utilization measures, integrated care administrative measures, wait time and access metrics, and productivity monitors. Effective utilization of these measures can help office managers and clinic leadership not only to maximize patient care, but also to enhance essential business operations, which increase the long-term sustainability of integrated primary care programs.

  18. Associations of Ischemic Lesion Volume With Functional Outcome in Patients With Acute Ischemic Stroke: 24-Hour Versus 1-Week Imaging.

    Science.gov (United States)

    Bucker, Amber; Boers, Anna M; Bot, Joseph C J; Berkhemer, Olvert A; Lingsma, Hester F; Yoo, Albert J; van Zwam, Wim H; van Oostenbrugge, Robert J; van der Lugt, Aad; Dippel, Diederik W J; Roos, Yvo B W E M; Majoie, Charles B L M; Marquering, Henk A

    2017-05-01

    Ischemic lesion volume (ILV) on noncontrast computed tomography at 1 week can be used as a secondary outcome measure in patients with acute ischemic stroke. Twenty-four-hour ILV on noncontrast computed tomography has greater availability and potentially allows earlier estimation of functional outcome. We aimed to assess lesion growth 24 hours after stroke onset and compare the associations of 24-hour and 1-week ILV with functional outcome. We included 228 patients from MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), who received noncontrast computed tomography at 24-hour and 1-week follow-up on which ILV was measured. Relative and absolute lesion growth was determined. Logistic regression models were constructed either including the 24-hour or including the 1-week ILV. Ordinal and dichotomous (0-2 and 3-6) modified Rankin scale scores were, respectively, used as primary and secondary outcome measures. Median ILV was 42 mL (interquartile range, 21-95 mL) and 64 mL (interquartile range: 30-120 mL) at 24 hours and 1 week, respectively. Relative lesion growth exceeding 30% occurred in 121 patients (53%) and absolute lesion growth exceeding 20 mL occurred in 83 patients (36%). Both the 24-hour and 1-week ILVs were similarly significantly associated with functional outcome (both P<0.001). In the logistic analyses, the areas under the curve of the receiver-operator characteristic curves were similar: 0.85 (95% confidence interval, 0.80-0.90) and 0.87 (95% confidence interval, 0.82-0.91) for including the 24-hour and 1-week ILV, respectively. Growth of ILV is common 24-hour poststroke onset. Nevertheless, the 24-hour ILV proved to be a valuable secondary outcome measure as it is equally strongly associated with functional outcome as the 1-week ILV. URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758. © 2017 American Heart Association, Inc.

  19. Core outcome measures for exercise studies in people with multiple sclerosis: recommendations from a multidisciplinary consensus meeting.

    Science.gov (United States)

    Paul, Lorna; Coote, Susan; Crosbie, Jean; Dixon, Diane; Hale, Leigh; Holloway, Ed; McCrone, Paul; Miller, Linda; Saxton, John; Sincock, Caroline; White, Lesley

    2014-10-01

    Evidence shows that exercise is beneficial for people with multiple sclerosis (MS); however, statistical pooling of data is difficult because of the diversity of outcome measures used. The objective of this review is to report the recommendations of an International Consensus Meeting for a core set of outcome measures for use in exercise studies in MS. From the 100 categories of the International Classification of Function Core Sets for MS, 57 categories were considered as likely/potentially likely to be affected by exercise and were clustered into seven core groups. Outcome measures to address each group were evaluated regarding, for example, psychometric properties. The following are recommended: Modified Fatigue Impact Scale (MFIS) or Fatigue Severity Scale (FSS) for energy and drive, 6-Minute Walk Test (6MWT) for exercise tolerance, Timed Up and Go (TUG) for muscle function and moving around, Multiple Sclerosis Impact Scale (MSIS-29) or Multiple Sclerosis Quality of Life-54 Instrument (MSQoL54) for quality of life and body mass index (BMI) or waist-hip ratio (WHR) for the health risks associated with excess body fat. A cost effectiveness analysis and qualitative evaluation should be included where possible. Using these core measures ensures that future meta-analyses of exercise studies in MS are more robust and thus more effectively inform practice.

  20. Outcomes of Proton Therapy for Patients With Functional Pituitary Adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Wattson, Daniel A.; Tanguturi, Shyam K. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Spiegel, Daphna Y. [Tufts University School of Medicine, Boston, Massachusetts (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Biller, Beverly M.K.; Nachtigall, Lisa B. [Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts (United States); Bussière, Marc R. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Swearingen, Brooke; Chapman, Paul H. [Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (United States); Loeffler, Jay S. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Shih, Helen A., E-mail: hshih@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2014-11-01

    Purpose/Objective(s): This study evaluated the efficacy and toxicity of proton therapy for functional pituitary adenomas (FPAs). Methods and Materials: We analyzed 165 patients with FPAs who were treated at a single institution with proton therapy between 1992 and 2012 and had at least 6 months of follow-up. All but 3 patients underwent prior resection, and 14 received prior photon irradiation. Proton stereotactic radiosurgery was used for 92% of patients, with a median dose of 20 Gy(RBE). The remainder received fractionated stereotactic proton therapy. Time to biochemical complete response (CR, defined as ≥3 months of normal laboratory values with no medical treatment), local control, and adverse effects are reported. Results: With a median follow-up time of 4.3 years (range, 0.5-20.6 years) for 144 evaluable patients, the actuarial 3-year CR rate and the median time to CR were 54% and 32 months among 74 patients with Cushing disease (CD), 63% and 27 months among 8 patients with Nelson syndrome (NS), 26% and 62 months among 50 patients with acromegaly, and 22% and 60 months among 9 patients with prolactinomas, respectively. One of 3 patients with thyroid stimulating hormone—secreting tumors achieved CR. Actuarial time to CR was significantly shorter for corticotroph FPAs (CD/NS) compared with other subtypes (P=.001). At a median imaging follow-up time of 43 months, tumor control was 98% among 140 patients. The actuarial 3-year and 5-year rates of development of new hypopituitarism were 45% and 62%, and the median time to deficiency was 40 months. Larger radiosurgery target volume as a continuous variable was a significant predictor of hypopituitarism (adjusted hazard ratio 1.3, P=.004). Four patients had new-onset postradiosurgery seizures suspected to be related to generously defined target volumes. There were no radiation-induced tumors. Conclusions: Proton irradiation is an effective treatment for FPAs, and hypopituitarism remains the primary

  1. Anorectal functional outcome after repeated transanal endoscopic microsurgery

    Institute of Scientific and Technical Information of China (English)

    Hong-Wei Zhang; Xiao-Dong Han; Yu Wang; Pin Zhang; Zhi-Ming Jin

    2012-01-01

    AIM:To evaluate the status of anorectal function after repeated transanal endoscopic microsurgery (TEM).METHODS:Twenty-one patients undergoing subtotal colectomy with ileorectal anastomosis were included.There were more than 5 large (> 1 cm) polyps in the remaining rectum (range:6-20 cm from the anal edge).All patients,19 with villous adenomas and 2 with low-grade adenocarcinomas,underwent TEM with submucosal endoscopic excision at least twice between 2005 and 2011.Anorectal manometry and a questionnaire about incontinence were carried out at week 1 before operation,and at weeks 2 and 3 and 6 mo after the last operation.Anal resting pressure,maximum squeeze pressure,maximum tolerable volume (MTV) and rectoanal inhibitory reflexes (RAIR) were recorded.The integrity and thickness of the internal anal sphincter (IAS) and external anal sphincter (EAS)were also evaluated by endoanal ultrasonography.We determined the physical and mental health status with SF-36 score to assess the effect of multiple TEM on patient quality of life (QoL).RESULTS:All patients answered the questionnaire.Apart from negative RAIR in 4 patients,all of the anorectal manometric values in the 21 patients were normal before operation.Mean anal resting pressure decreased from 38 ± 5 mmHg to 19 ± 3 mmHg (38 ±5 mmHg vs 19 ± 3 mmHg,P =0.000) and MTV from 165±19mLto60±11mL(165±19mL vs 60±11mL,P =0.000) at month 3 after surgery.Anal resting pressure and MTV were 37 ± 5 mmHg (38 ± 5 mmHg vs 37-5 mmHg,P =0.057) and 159 ± 19 mL (165± 19 mL vs 159 ± 19 mL,P =0.071),respectively,at month 6 alter TEM.Maximal squeeze pressure decreased from 171 ± 19 mmHg to 62 ± 12 mmHg (171± 19 mmHg vs 62 ± 12 mmHg,P =0.000) at week 2 after operation,and returned to normal values by postoperative month 3 (171 ± 19 vs 166 ± 18,P =0.051).RAIR were absent in 4 patients preoperatively and in 12 (x2 =4.947,P =0.026) patients at month 3 after surgery.RAIR was absent only in 5 patients at postoperative month 6 (x

  2. Effect of pre-operative neuromuscular training on functional outcome after total knee replacement

    DEFF Research Database (Denmark)

    Huber, Erika O; de Bie, Rob A; Roos, Ewa M.

    2013-01-01

    Total Knee Replacement (TKR) is the standard treatment for patients with severe knee osteoarthritis (OA). Significant improvement in pain and function are seen after TKR and approximately 80% of patients are very satisfied with the outcome. Functional status prior to TKR is a major predictor of o...

  3. Mathematical Knowledge for Teaching the Function Concept and Student Learning Outcomes

    Science.gov (United States)

    Hatisaru, Vesife; Erbas, Ayhan Kursat

    2017-01-01

    The purpose of this study was to examine the potential interrelationships between teachers' mathematical knowledge for teaching (MKT) the function concept and their students' learning outcomes of this concept. Data were collected from two teachers teaching in a vocational high school and their students through a function concept test for teachers…

  4. Outcome after 40 years with rheumatoid arthritis: a prospective study of function, disease activity and mortality

    NARCIS (Netherlands)

    Minaur, Nicola J.; Jacoby, Richard K.; Cosh, John A.; Taylor, Gordon; Rasker, Hans J.

    2004-01-01

    In an inception cohort of 100 patients with rheumatoid arthritis (RA) we studied course and outcome after 40 years, regarding function, disease activity, cause and age of death, and prognostic factors. Function, joint count, erythrocyte sedimentation rate (ESR), hemoglobin (Hb), rheumatoid factor

  5. A Tool for Measuring NASA's Aeronautics Research Progress Toward Planned Strategic Community Outcomes

    Science.gov (United States)

    Tahmasebi, Farhad; Pearce, Robert

    2016-01-01

    Description of a tool for portfolio analysis of NASA's Aeronautics research progress toward planned community strategic Outcomes is presented. For efficiency and speed, the tool takes advantage of a function developed in Excels Visual Basic for Applications. The strategic planning process for determining the community Outcomes is also briefly discussed. Stakeholder buy-in, partnership performance, progress of supporting Technical Challenges, and enablement forecast are used as the criteria for evaluating progress toward Outcomes. A few illustrative examples of using the tool are also presented.

  6. Cnages in activity limitations and predictors of functional outcome of patients with spinal cord injury following in patient rehabilitation

    Directory of Open Access Journals (Sweden)

    C. Joseph

    2013-01-01

    Full Text Available The purpose of this study was to investigate the changes in the activity limitations of patients following in-patient rehabilitation and the factors influencing functional ability as measured by the Spinal Cord independence measure III (SCIM III. A longitudinal study design was utilised to study the change in functional abilities of patients with spinal cord injury between admission and discharge. A convenient sampling strategy was employed, in which every consecutive patient admitted to the rehabilitation centre within a three-month period was eligible for the study. Demographic-, medical, and process of rehabilitation data were collected and collated from the patients’ medical records using a data gathering sheet that was validated and tested for reliability. functional abilities were measured by the SCIM III. Seventy-six patients met the inclusion criteria, consisting of 58 paraplegics and 18 tetraplegics. The mean age of this cohort was 34.14 years. A significant difference (p<0.001 in functional ability was detected for the total sample, with only 12.5% of patients independent in walking ability and 28.12% in stair management. four (4 factors were found to be predictors of functional outcomes on bivariate analysis, but when considered together in a multiple regression model, only functional status on admission remained correlated to functional outcomes. Conclusion and implication for practice: Significant improvement in functional abilities of persons with spinal cord injury following in-patient rehabilitation was observed. however, mobility and stair-management limitations were the most prevalent at discharge. lastly, a lower functional status should be better targeted to optimise functional ability in the future. future research should be directed towards illuminating whether personal factors or rehabilitation inefficiencies are responsible for the limitations observed at discharge.

  7. Disease-specific quality indicators, guidelines, and outcome measures in systemic lupus erythematosus (SLE).

    Science.gov (United States)

    Mosca, M; Bombardieri, S

    2007-01-01

    The assessment of quality of care is becoming increasingly important, but as yet no standard set of measures to assess quality has been developed. The ACR Quality Measures Committee has selected the following areas of study to develop quality indicators: diagnostic/classification criteria, outcome measures/response criteria, treatment guidelines/management recommendations, definition of quality indicators, and definition of data collection systems. The aim of the present review is to evaluate existing guidelines and outcome measures concerning disease/activity monitoring, autoantibody and laboratory assessment, outcomes, and therapy in systemic lupus erythematosus (SLE) that could be used to define disease-specific quality indicators. Much data is available in the literature that could serve to define a starter set of quality indicators for SLE. Monitoring issues are discussed in the ACR and EULAR recommendations. As far as therapy is concerned, the ACR has provided indicators for rheumatoid arthritis that could also be applied to SLE, as well as indications for anti-malarial monitoring. The outcomes measures most frequently used in SLE are damage and death, but organ-specific definitions of outcome and response are being evaluated. The development of quality measures for SLE is just beginning; existing information could serve to construct a starter set of indicators such as the one proposed here. Certainly much progress will be made in the near future. A practical, user-friendly tool for physicians that will help them deliver high quality care to populations is also needed.

  8. Functional outcomes following palatal reconstruction with a folded radial forearm free flap.

    Science.gov (United States)

    Sinha, Uttam K; Young, Philip; Hurvitz, Keith; Crockett, Dennis M

    2004-01-01

    Defects of the soft palate often occur after extirpative procedures are performed to treat oropharyngeal cancers. These defects usually result in velopharyngeal insufficiency and an alteration in speech and deglutition. Palatal prostheses have been used to circumvent this problem in the past. Recently, however, folded radial forearmfreeflaps have been introduced for reconstruction of the soft palate to eliminate velopharyngeal insufficiency and the need for a prosthesis. We conducted a study to evaluate pharyngeal and palatal functions following reconstruction of soft-palate defects with radial forearm free flaps in 16 patients who had undergone resection of the soft palate for squamous cell carcinoma. Nine patients had partial soft-palate defects and 7 had total defects. All patients had lateral pharyngeal-wall defects. In addition, 14 patients had defects of the base of the tongue. Patients were followed for 3 to 40 months. Outcome measures were determined according to several parameters, including postoperative complications, resumption of diet, intelligibility of speech, and decannulation. All patients were evaluated by a speech pathologist and an otolaryngologist with a bedside swallowing evaluation and flexible nasopharyngoscopy. Twelve patients underwent videofluoroscopic studies. There was no incidence of flap failure. One patient developed a transient salivary fistula, which resolved with conservative management. Four patients without dysphagia resumed oral intake 2 weeks after surgery. The 12 patients with dysphagia underwent swallowing therapy. Ten of them responded and were able to resume oral intake, while the other 2 required a palatal prosthesis. Overall, 10 patients resumed a normal diet and 4 tolerated a soft diet within 6 weeks. The 2 patients who required a palatal prosthesis were able to take purees. All patients were decannulated, and all were able to speak intelligibly. Speech was hypernasal in 2 patients and hyponasal in 3. We conclude that

  9. Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

    Directory of Open Access Journals (Sweden)

    Leandro Pretto Flores

    2011-08-01

    Full Text Available OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. CONCLUSION: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand.

  10. Thyroid function and autoimmunity in Danish pregnant women after an iodine fortification program and associations with obstetric outcomes

    DEFF Research Database (Denmark)

    Bliddal, Sofie; Boas, Malene; Hilsted, Linda

    2015-01-01

    OBJECTIVE: Aberrations in maternal thyroid function and autoimmunity during pregnancy have been associated with negative obstetric outcome. In Denmark, a national iodine fortification program was implemented in the year 2000 with the aim to alleviate the mild-moderate iodine deficiency. Following...... the iodine implementation, there has been an increase in thyroid autoimmunity in the background population. This study investigates the thyroid status of pregnant Danish women following the iodine fortification program, and a possible association with preterm delivery. DESIGN: Historical cohort study of 1278...... randomly selected pregnant Danish women attending the national Down's syndrome screening program. METHODS: The main outcome measures were thyroid status according to laboratory- and gestational-age-specific reference intervals, and association with risk of abnormal obstetric outcome. Antibody...

  11. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN and how to select an outcome measurement instrument

    Directory of Open Access Journals (Sweden)

    Lidwine B. Mokkink

    2016-01-01

    Full Text Available Background: COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments is an initiative of an international multidisciplinary team of researchers who aim to improve the selection of outcome measurement instruments both in research and in clinical practice by developing tools for selecting the most appropriate available instrument. Method: In this paper these tools are described, i.e. the COSMIN taxonomy and definition of measurement properties; the COSMIN checklist to evaluate the methodological quality of studies on measurement properties; a search filter for finding studies on measurement properties; a protocol for systematic reviews of outcome measurement instruments; a database of systematic reviews of outcome measurement instruments; and a guideline for selecting outcome measurement instruments for Core Outcome Sets in clinical trials. Currently, we are updating the COSMIN checklist, particularly the standards for content validity studies. Also new standards for studies using Item Response Theory methods will be developed. Additionally, in the future we want to develop standards for studies on the quality of non-patient reported outcome measures, such as clinician-reported outcomes and performance-based outcomes. Conclusions: In summary, we plea for more standardization in the use of outcome measurement instruments, for conducting high quality systematic reviews on measurement instruments in which the best available outcome measurement instrument is recommended, and for stopping the use of poor outcome measurement instruments.

  12. Realization of a Binary-Outcome Projection Measurement of a Three-Level Superconducting Quantum System

    Science.gov (United States)

    Jerger, Markus; Macha, Pascal; Hamann, Andrés Rosario; Reshitnyk, Yarema; Juliusson, Kristinn; Fedorov, Arkady

    2016-07-01

    Binary-outcome measurements allow one to determine whether a multilevel quantum system is in a certain state while preserving quantum coherence between all orthogonal states. In this paper, we explore different regimes of the dispersive readout of a three-level superconducting quantum system coupled to a microwave cavity in order to implement binary-outcome measurements. By designing identical cavity-frequency shifts for the first and second excited states of the system, we realize strong projective binary-outcome measurements onto its ground state with a fidelity of 94.3%. Complemented with standard microwave control and low-noise parametric amplification, this scheme enables the quantum nondemolition detection of leakage errors and can be used to create sets of compatible measurements to reveal the contextual nature of superconducting circuits.

  13. Systematic review of systemic sclerosis-specific instruments for the EULAR Outcome Measures Library: An evolutional database model of validated patient-reported outcomes.

    Science.gov (United States)

    Ingegnoli, Francesca; Carmona, Loreto; Castrejon, Isabel

    2017-04-01

    The EULAR Outcome Measures Library (OML) is a freely available database of validated patient-reported outcomes (PROs). The aim of this study was to provide a comprehensive review of validated PROs specifically developed for systemic sclerosis (SSc) to feed the EULAR OML. A sensitive search was developed in Medline and Embase to identify all validation studies, cohort studies, reviews, or meta-analyses in which the objective were the development or validation of specific PROs evaluating organ involvement, disease activity or damage in SSc. A reviewer screened title and abstracts, selected the studies, and collected data concerning validation using ad hoc forms based on the COSMIN checklist. From 13,140 articles captured, 74 met the predefined criteria. After excluding two instruments as they were unavailable in English the selected 23 studies provided information on seven SSc-specific PROs on different SSc domains: burden of illness (symptom burden index), functional status (Scleroderma Assessment Questionnaire), functional ability (scleroderma Functional Score), Raynaud's phenomenon (Raynaud's condition score), mouth involvement (Mouth Handicap in SSc), gastro-intestinal involvement (University of California Los Angeles-Scleroderma Clinical Trial Consortium Gastro-Intestinal tract 2.0), and skin involvement (skin self-assessment). Each of them is partially validated and has different psychometric requirements. Seven SSc-specific PROs have a minimum validation and were included in the EULAR OML. Further development in the area of disease-specific PROs in SSc is warranted. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Functional outcomes of sensate versus insensate free flap reconstruction in oral and oropharyngeal reconstruction: A systematic review.

    Science.gov (United States)

    Namin, Arya W; Varvares, Mark A

    2016-11-01

    The purposes of this article were to review the literature regarding subjective outcomes, objective functional outcomes, and objective sensation return after sensate and/or insensate free flap reconstruction of the oral cavity and oropharynx. Sensate radial forearm and anterolateral thigh free flaps tend to have better static 2-point discrimination and pressure threshold sensitivity than insensate flaps. There is insufficient evidence to draw conclusions on whether sensate flaps improve functional speech and swallowing outcomes measured by videofluoroscopic swallowing studies and percentage of word intelligibility by a listener blinded to the study. These data highlight the complexity and number of variables affecting functional outcomes in patients who have undergone reconstructive surgery after oral and oropharyngeal cancer ablative operations. A prospective randomized multicenter study that properly and rigidly stratifies patients by defect, flap and recipient nerve choice, adjuvant therapies, and uses widely agreed upon pretreatment and posttreatment evaluation tools could help to answer this important question. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016. © 2016 Wiley Periodicals, Inc.

  15. Measurement of lactate in a prehospital setting is related to outcome

    NARCIS (Netherlands)

    van Beest, Paul A.; Mulder, Peter Jan; Oetomo, Suparto Bambang; van den Broek, Bert; Kuiper, Michael A.; Spronk, Peter E.

    2009-01-01

    Objective We evaluated the relationship of lactate measured in a preclinical setting with outcome. Simultaneously, we evaluated the feasibility of implementing blood lactate measurement in a prehospital setting as part of a quality improvement project Methods Chart review of patients from whom serum

  16. The Benchmarking Capacity of a General Outcome Measure of Academic Language in Science and Social Studies

    Science.gov (United States)

    Mooney, Paul; Lastrapes, Renée E.

    2016-01-01

    The amount of research evaluating the technical merits of general outcome measures of science and social studies achievement is growing. This study targeted criterion validity for critical content monitoring. Questions addressed the concurrent criterion validity of alternate presentation formats of critical content monitoring and the measure's…

  17. Test-Retest Reliability of Dual-Task Outcome Measures in People With Parkinson Disease

    NARCIS (Netherlands)

    Strouwen, C.; Molenaar, E.A.; Keus, S.H.; Munks, L.; Bloem, B.R.; Nieuwboer, A.

    2016-01-01

    BACKGROUND: Dual-task (DT) training is gaining ground as a physical therapy intervention in people with Parkinson disease (PD). Future studies evaluating the effect of such interventions need reliable outcome measures. To date, the test-retest reliability of DT measures in patients with PD remains l

  18. Voice-Related Patient-Reported Outcome Measures: A Systematic Review of Instrument Development and Validation

    Science.gov (United States)

    Francis, David O.; Daniero, James J.; Hovis, Kristen L.; Sathe, Nila; Jacobson, Barbara; Penson, David F.; Feurer, Irene D.; McPheeters, Melissa L.

    2017-01-01

    Purpose: The purpose of this study was to perform a comprehensive systematic review of the literature on voice-related patient-reported outcome (PRO) measures in adults and to evaluate each instrument for the presence of important measurement properties. Method: MEDLINE, the Cumulative Index of Nursing and Allied Health Literature, and the Health…

  19. Fatigue is a reliable, sensitive and unique outcome measure in rheumatoid arthritis.

    LENUS (Irish Health Repository)

    Minnock, Patricia

    2009-12-01

    Fatigue is an important symptom in patients with RA. Measurement of fatigue in clinical trials and in clinical practice requires scales that are reproducible, sensitive to change and practical. This study examined the reliability and sensitivity to change of fatigue and its relative independence as an outcome measure in RA.

  20. Effects of a Summer Treatment Program on Functional Sports Outcomes in Young Children with ADHD

    OpenAIRE

    O’Connor, Briannon C.; Fabiano, Gregory A.; Waschbusch, Daniel A.; Belin, Peter J.; Gnagy, Elizabeth M.; Pelham, William E.; Greiner, Andrew R.; Roemmich, James N

    2014-01-01

    Participation in youth sports can be very beneficial, but children with Attention Deficit Hyperactivity Disorder (ADHD) may participate less often and less successfully. The current study evaluated functional sports outcomes for children with ADHD who attended an intensive behavioral treatment program that included a sports training component, and it compared outcomes to children with ADHD who did not attend the program. Results suggest that treatment resulted in significant improvements in m...

  1. Surgical management of acromegaly: Long term functional outcome analysis and assessment of recurrent/residual disease

    OpenAIRE

    Banerji, Deepu; Das, Nitu K.; Sharma, Siddhiraj; Jindal, Yogesh; Vijendra K Jain; Behari, Sanjay

    2016-01-01

    Context: Functional growth hormone producing adenomas have long-term deleterious effects on the visual apparatus, the cardiovascular and musculoskeletal systems, and often predispose to malignancies. Since persistence of acromegaly affects outcome and quality of life, therapeutic interventions become mandatory. Aim: This study represents an analysis of long-term clinical and endocrinal outcome of 115 patients of acromegaly after surgical management. Setting and Design: Tertiary care retrospec...

  2. Impact of functional and structural social relationships on two year depression outcomes: A multivariate analysis.

    Science.gov (United States)

    Davidson, Sandra K; Dowrick, Christopher F; Gunn, Jane M

    2016-03-15

    High rates of persistent depression highlight the need to identify the risk factors associated with poor depression outcomes and to provide targeted interventions to people at high risk. Although social relationships have been implicated in depression course, interventions targeting social relationships have been disappointing. Possibly, interventions have targeted the wrong elements of relationships. Alternatively, the statistical association between relationships and depression course is not causal, but due to shared variance with other factors. We investigated whether elements of social relationships predict major depressive episode (MDE) when multiple relevant variables are considered. Data is from a longitudinal study of primary care patients with depressive symptoms. 494 participants completed questionnaires at baseline and a depression measure (PHQ-9) two years later. Baseline measures included functional (i.e. quality) and structural (i.e. quantity) social relationships, depression, neuroticism, chronic illness, alcohol abuse, childhood abuse, partner violence and sociodemographic characteristics. Logistic regression with generalised estimating equations was used to estimate the association between social relationships and MDE. Both functional and structural social relationships predicted MDE in univariate analysis. Only functional social relationships remained significant in multivariate analysis (OR: 0.87; 95%CI: 0.79-0.97; p=0.01). Other unique predictors of MDE were baseline depression severity, neuroticism, childhood sexual abuse and intimate partner violence. We did not assess how a person's position in their depression trajectory influenced the association between social relationships and depression. Interventions targeting relationship quality may be part of a personalised treatment plan for people at high risk due of persistent depression due to poor social relationships. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Measuring the value of treatment to patients: patient-reported outcomes in drug development.

    Science.gov (United States)

    Willke, Richard J

    2008-02-01

    Patient-reported outcomes (PROs) can be important measures of the impact and value of new drug treatments to patients. Recently, both multisector stakeholder groups and the U.S. Food and Drug Administration have carefully considered and issued guidance on best practices for the use of PROs in measuring treatment impact. When best practices are followed and PRO data are appropriately included in drug development strategy and clinical trials, these data can be part of the evidence submitted for drug approval and included in drug labeling. One study showed that PRO data were included in 30% of a sample of new drug labels and were more concentrated in certain therapeutic areas, such as anti-inflammatory agents, vaccines, gastrointestinal agents, and respiratory and urologic agents. PRO data included in labeling, or generated in a similar scientific manner, may often then be used in other communication vehicles, such as formulary submission dossiers, journal or direct-to-consumer advertisements, publications, or continuing medical education. Meaningful and reliable PRO results regarding the effects of new treatments on how patients feel and function provide useful information to those who must make decisions about the availability and utilization of such treatments.

  4. Improved Functional Outcomes with Robotic Compared with Manual Total Hip Arthroplasty.

    Science.gov (United States)

    Bukowski, Brandon R; Anderson, Paul; Khlopas, Anton; Chughtai, Morad; Mont, Michael A; Illgen, Richard L

    2016-10-26

    Functional outcome following total hip arthroplasty (THA) is affected by accurate component positioning and restoration of hip biomechanics. Robotic-assisted THA (rTHA) has been shown to improve accuracy of component positioning, but its impact on functional outcomes has not been demonstrated. The purpose of this study was to compare: 1) operative time; 2) estimated blood loss; 3) postoperative complications; and 4) patient-reported outcome measures (PROMs) between patients who either underwent rTHA or manual THA (mTHA). In this retrospective cohort study, a single-center database was used to identify all patients who underwent primary THA since introduction of rTHA at a large academic medical center. Surgical factors including operative time and estimated blood loss as well as postoperative complications were recorded. Validated PROMs following rTHA (n = 100) were compared with consecutive mTHA cases (n = 100) performed by the same fellowship-trained surgeon at a minimum one-year follow-up (24 ± 6 months). PROMs included the Short-Form 12 Health Survey (SF-12), UCLA activity score (UCLA), Western Ontario and McMaster (WOMAC) Osteoarthritis Index, and modified Harris Hip Score (mHHS). A categorical analysis was performed to determine differences in proportions of patients with mHHS scores of 90 to 100, 80 to 89, 70 to 79, and < 70 points between the two groups. Chi-square and two-tailed t-tests were used to compare categorical and continuous data between cohorts. Mean operative time was nine minutes longer for the rTHA group compared with the mTHA group (131 ± 23 min vs. 122 ± 29 min, respectively, p = 0.012). Estimated intraoperative blood loss was significantly reduced for the rTHA group when compared to the mTHA group (374 ± 133 mL vs. 423 ± 186 mL, p = 0.035), and there was no difference in overall complication rates between the two groups (p = 0.101). Robotic-assisted THA demonstrated significantly higher mean postoperative mHHS (92.1 ± 10.5 vs. 86.1

  5. Measuring the Effects of Self-Awareness: Construction of the Self-Awareness Outcomes Questionnaire.

    Science.gov (United States)

    Sutton, Anna

    2016-11-01

    Dispositional self-awareness is conceptualized in several different ways, including insight, reflection, rumination and mindfulness, with the latter in particular attracting extensive attention in recent research. While self-awareness is generally associated with positive psychological well-being, these different conceptualizations are also each associated with a range of unique outcomes. This two part, mixed methods study aimed to advance understanding of dispositional self-awareness by developing a questionnaire to measure its outcomes. In Study 1, expert focus groups categorized and extended an initial pool of potential items from previous research. In Study 2, these items were reduced to a 38 item self-report questionnaire with four factors representing three beneficial outcomes (reflective self-development, acceptance and proactivity) and one negative outcome (costs). Regression of these outcomes against self-awareness measures revealed that self-reflection and insight predicted beneficial outcomes, rumination predicted reduced benefits and increased costs, and mindfulness predicted both increased proactivity and costs. These studies help to refine the self-awareness concept by identifying the unique outcomes associated with the concepts of self-reflection, insight, reflection, rumination and mindfulness. It can be used in future studies to evaluate and develop awareness-raising techniques to maximize self-awareness benefits while minimizing related costs.

  6. Measuring the Effects of Self-Awareness: Construction of the Self-Awareness Outcomes Questionnaire

    Directory of Open Access Journals (Sweden)

    Anna Sutton

    2016-11-01

    Full Text Available Dispositional self-awareness is conceptualized in several different ways, including insight, reflection, rumination and mindfulness, with the latter in particular attracting extensive attention in recent research. While self-awareness is generally associated with positive psychological well-being, these different conceptualizations are also each associated with a range of unique outcomes. This two part, mixed methods study aimed to advance understanding of dispositional self-awareness by developing a questionnaire to measure its outcomes. In Study 1, expert focus groups categorized and extended an initial pool of potential items from previous research. In Study 2, these items were reduced to a 38 item self-report questionnaire with four factors representing three beneficial outcomes (reflective self-development, acceptance and proactivity and one negative outcome (costs. Regression of these outcomes against self-awareness measures revealed that self-reflection and insight predicted beneficial outcomes, rumination predicted reduced benefits and increased costs, and mindfulness predicted both increased proactivity and costs. These studies help to refine the self-awareness concept by identifying the unique outcomes associated with the concepts of self-reflection, insight, reflection, rumination and mindfulness. It can be used in future studies to evaluate and develop awareness-raising techniques to maximize self-awareness benefits while minimizing related costs.

  7. Associations among Nine Family Dinner Frequency Measures and Child Weight, Dietary, and Psychosocial Outcomes.

    Science.gov (United States)

    Horning, Melissa L; Fulkerson, Jayne A; Friend, Sarah E; Neumark-Sztainer, Dianne

    2016-06-01

    Family meal frequency has been consistently and significantly associated with positive youth dietary and psychosocial outcomes, but less consistently associated with weight outcomes. Family meal frequency measurement has varied widely and it is unclear how this variation might impact relationships with youth weight, dietary, and psychosocial outcomes. This study assesses how five parent/caregiver-reported and four child-reported family dinner frequency measures correlate with each other and are associated with health-related outcomes. This secondary, cross-sectional analysis uses baseline, parent/caregiver (n=160) and 8- to 12-year-old child (n=160) data from the Healthy Home Offerings via the Mealtime Environment (HOME) Plus trial (collected 2011 to 2012). Data were obtained from objective measurements, dietary recall interviews, and psychosocial surveys. Outcomes included child body mass index z scores (BMIz); fruit, vegetable, and sugar-sweetened beverage intake; dietary quality (Healthy Eating Index-2010); family connectedness; and meal conversations. Pearson correlations and general linear models were used to assess associations between family dinner frequency measures and outcomes. All family dinner frequency measures had comparable means and were correlated within and across parent/caregiver and child reporters (r=0.17 to 0.94; Pfamily dinner frequency measures were significantly associated with BMIz and 100% were significantly associated with fruit and vegetable intake and Healthy Eating Index-2010. In adjusted models, most significant associations with dietary and psychosocial outcomes remained, but associations with child BMIz remained significant only for parent/caregiver- (β±standard error=-.07±.03; Pfamily dinner frequency measures asking about "sitting and eating" dinner. Despite phrasing variations in family dinner frequency measures (eg, which family members were present and how meals were occurring), few differences were found in associations

  8. Collins fragmentation function measurements at BABAR

    Science.gov (United States)

    Brown, David Norvil

    2016-05-01

    We present the results of the measurement of Collins asymmetries in electron-positron annihilation events with the BABAR detector in the process e+e- → h1h2X, for charged hadrons where h1h2 = KK, Kπ, or ππ. Using 468 fb-1 of data collected by BABAR at the SLAC PEP-II B factory, we observe distinct azimuthal asymmetries for hadrons in opposite thrust hemispheres of events, with the asymmetries increasing in proportion to the hadron energies. We find Kπ asymmetries similar to those for ππ pairs, with the high-energy KK asymmetries generally larger.

  9. Long-term functional and radiological outcome after displaced sacral fractures

    OpenAIRE

    Adelved, Aron

    2015-01-01

    Background and objectives Displaced, unstable sacral fractures are severe injuries resulting in considerable morbidity and functional sequelae. Several authors report neurologic deficits, bladder, bowel, and sexual dysfunction, as well as residual pain and poor self-reported health, in short, and medium-term follow-up studies. However, there is a lack of information on long-term functional outcome following these injures, nor whether any changes occur in functional status many years after ...

  10. Effect of baseline magnetic resonance imaging (MRI) apparent diffusion coefficient lesion volume on functional outcome in ischemic stroke.

    Science.gov (United States)

    Ma, Li; Gao, Pei-yi; Hu, Qing-mao; Lin, Yan; Jing, Li-na; Xue, Jing; Chen, Zhi-jun; Wang, Yong-jun; Liu, Mei-li; Cai, Ye-feng

    2011-06-01

    We explored the relationship between predicted infarct core, predicted ischemic penumbras and predicted final infarct volumes obtained though apparent diffusion coefficient (ADC)-based method, as well as other clinical variables, and functional outcome. Patients with acute cerebral ischemic stroke were retrospectively recruited. The National Institutes of Health Stroke Scale score was evaluated at baseline and the modified Rankin Scale (mRS) at day 90. Favorable outcome was defined as an mRS score of 0 to 2, and unfavorable outcome as 3 to 6. Multimodal stroke magnetic resonance imaging was carried out at presentation. The volumes of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) were measured using the regions of interest (ROI) method. The volumes of predicted infarct core, predicted ischemic penumbra and predicted final infarct were obtained by an automated image analysis system based on baseline ADC maps. The association between baseline magnetic resonance imaging volumes, baseline clinical variables, and functional outcome was statistically analyzed. The study included 30 males and 20 females (mean±SD age, 56±10 years). Baseline DWI, PWI and PWI-DWI mismatch volumes were not correlated with day-90 mRS (P>0.05). Predicted infarct core, predicted ischemic penumbra and predicted final infarct through ADC-based method were all correlated with day-90 mRS (PStroke Scale and recanalization also demonstrated a trend toward a favorable outcome. Receiver operating characteristic analysis showed that the area under the curve of predicted final infarct volume and recanalization were higher with statistical significance (PStroke Scale and recanalization may have effect on functional outcome in acute ischemic stroke.

  11. Functional Outcome Trajectories after Out-of Hospital Pediatric Cardiac Arrest

    Science.gov (United States)

    Silverstein, Faye S; Slomine, Beth; Christensen, James; Holubkov, Richard; Page, Kent; Dean, J. Michael; Moler, Frank

    2016-01-01

    Objective To analyze functional performance measures collected prospectively during the conduct of a clinical trial that enrolled children (up to age 18 years), resuscitated after out-of-hospital cardiac arrest, who were at high risk for poor outcomes. Design Children with Glasgow Motor Scales VABS-II) score ≥70, did not differ between groups. Setting 38 North American pediatric ICU’s. Participants 295 children were enrolled; 270/295 had baseline VABS-II scores ≥70; 87/270 survived one year. Interventions Targeted temperatures were 33.0°C and 36.8°C for hypothermia and normothermia groups. Measurements and Main Results Baseline measures included VABS-II, Pediatric Cerebral Performance Category(PCPC), and Pediatric Overall Performance Category (POPC). PCPC and POPC were rescored at hospital discharges; all three were scored at 3 and 12 months. In survivors with baseline VABS-II scores ≥70, we evaluated relationships of hospital discharge PCPC with 3 and 12 month scores, and between 3 and 12 month VABS-II scores. Hospital discharge PCPC scores strongly predicted 3 and 12 month PCPC (r=0.82,0.79; pVABS-II scores (r=−0.81,−0.77; pVABS-II scores strongly predicted 12 month performance (r=0.95, p<0.0001). Hypothermia treatment did not alter these relationships. Conclusions In comatose children, with Glasgow Motor Scales <5 in the initial hours after out-of-hospital cardiac arrest resuscitation, function scores at hospital discharge and at 3 months predicted 12-month performance well in the majority of survivors. PMID:27509385

  12. Operationalising the capability approach for outcome measurement in mental health research.

    Science.gov (United States)

    Simon, Judit; Anand, Paul; Gray, Alastair; Rugkåsa, Jorun; Yeeles, Ksenija; Burns, Tom

    2013-12-01

    Amartya Sen's multidimensional capability approach focuses on the importance of freedoms to be or do things people have reason to value. It is an alternative to standard utilitarian welfarism, the theoretical approach to quality-adjusted life years (QALYs) and cost-utility analyses. Despite the limitations of the utility approach in capturing non-health benefits and broader welfare inequalities, there have been very limited applications of the capability approach in the mental health context where these issues are imperative. We report the development and application of a multidimensional instrument, the OxCAP-MH, which aims to operationalise the capability approach for outcome measurement in mental health research. The study was carried out as part of an ongoing programme on community coercion experienced by service users with severe and enduring mental illness being treated using Community Treatment Orders. Capabilities data were collected at baseline in the OCTET RCT for 333 'revolving door' mental health service users who were in involuntary hospital treatment at the time of recruitment in England (2008-2011). The research focused on the identification of capabilities domains most affected by mental illness and their association with socio-demographic and clinical factors and other measures of well-being such as the EQ-5D and Global Assessment of Functioning (GAF) scales. The OxCAP-MH item response rate was 90%-68%. There were significant correlations between service users' overall capability scores and the GAF, EQ-5D VAS and EQ-5D-3L utilities (corr = 0.249, 0.514, 0.415, respectively). The most affected capability domains were: 'Daily activities', 'Influencing local decisions', 'Enjoying recreation', 'Planning one's life' and 'Discrimination'. Age had a mixed effect, while female service users and those with a primary diagnosis of schizophrenia or longer illness duration reported significantly lower capability scores. The results support the feasibility and

  13. Translating patient reported outcome measures: methodological issues explored using cognitive interviewing with three rheumatoid arthritis measures in six European languages

    NARCIS (Netherlands)

    Hewlett, Sarah E.; Nicklin, Joanna; Bode, Christina; Carmona, Loretto; Dures, Emma; Engelbrecht, Matthias; Hagel, Sofia; Kirwan, John R.; Molto, Anna; Redondo, Marta; Gossec, Laure

    2016-01-01

    Objective. Cross-cultural translation of patient-reported outcome measures (PROMs) is a lengthy process, often performed professionally. Cognitive interviewing assesses patient comprehension of PROMs. The objective was to evaluate the usefulness of cognitive interviewing to assess translations and c

  14. Long-Term Intellectual Functioning and School-Related Behavioural Outcomes in Children and Adolescents after Invasive Treatment for Congenital Heart Disease

    Science.gov (United States)

    Spijkerboer, A. W.; Utens, E. M. W. J.; Bogers, A. J. J. C.; Verhulst, F. C.; Helbing, W. A.

    2008-01-01

    In this study, long-term intellectual functioning and school-related behavioural outcomes were assessed in a patient sample that underwent invasive treatment for congenital heart disease (ConHD) between 1990 and 1995. The Wechsler Intelligence Scale for Children-Revised was used to measure intellectual functioning and the Teacher's Report Form to…

  15. Long-Term Intellectual Functioning and School-Related Behavioural Outcomes in Children and Adolescents after Invasive Treatment for Congenital Heart Disease

    Science.gov (United States)

    Spijkerboer, A. W.; Utens, E. M. W. J.; Bogers, A. J. J. C.; Verhulst, F. C.; Helbing, W. A.

    2008-01-01

    In this study, long-term intellectual functioning and school-related behavioural outcomes were assessed in a patient sample that underwent invasive treatment for congenital heart disease (ConHD) between 1990 and 1995. The Wechsler Intelligence Scale for Children-Revised was used to measure intellectual functioning and the Teacher's Report Form to…

  16. Agreement between personally generated areas of quality of life concern and standard outcome measures in people with advanced cancer.

    Science.gov (United States)

    Aburub, Ala' S; Gagnon, B; Rodríguez, A M; Mayo, Nancy E

    2016-09-01

    People with advanced cancer experience different sequelae which have unique effects on quality of life (QOL). The patient-generated index (PGI) is a personalized measure that allows patients to nominate, rate, and value areas that have the most impact on QOL. Fatigue, pain, and aspects of physical function are among the top 10 areas with QOL impact. An area of validation that is lacking for the PGI is the extent to which spontaneously nominated areas of QOL that patients are concerned with, agree with ratings obtained from standard patient reported outcomes (PROs). Data from 192 patients were used to compare ratings on fatigue, pain, and physical function obtained from PGI to those from standard outcome measures. Within one severity rating, agreement ranged from 32.1 to 76.9 % within the fatigue domain, 34.2 to 95.24 % for pain, and between 84.2 and 94.7 % for physical function. Of the 10 items where the PGI had the highest agreement, 7 came from the RAND-36. At the domain level, people nominating an area scored in the more impaired range on standard measures than people who did not. PGI gives comparable information as do standard measures. PGI provides important information to guide clinical care of the patient and also produces a legitimate total score suitable for research.

  17. Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children.

    Science.gov (United States)

    Biederman, Joseph; Monuteaux, Michael C; Doyle, Alysa E; Seidman, Larry J; Wilens, Timothy E; Ferrero, Frances; Morgan, Christie L; Faraone, Stephen V

    2004-10-01

    The association between executive function deficits (EFDs) and functional outcomes were examined among children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Participants were children and adolescents with (n = 259) and without (n = 222) ADHD, as ascertained from pediatric and psychiatric clinics. The authors defined EFD as at least 2 executive function measures impaired. Significantly more children and adolescents with ADHD had EFDs than did control participants. ADHD with EFDs was associated with an increased risk for grade retention and a decrease in academic achievement relative to (a) ADHD alone, (b) controlled socioeconomic status, (c) learning disabilities, and (d) IQ. No differences were noted in social functioning or psychiatric comorbidity. Children and adolescents with ADHD and EFDs were found to be at high risk for significant impairments in academic functioning. These results support screening children with ADHD for EFDs to prevent academic failure.

  18. The future of outcomes measurement: item banking, tailored short-forms, and computerized adaptive assessment.

    Science.gov (United States)

    Cella, David; Gershon, Richard; Lai, Jin-Shei; Choi, Seung

    2007-01-01

    The use of item banks and computerized adaptive testing (CAT) begins with clear definitions of important outcomes, and references those definitions to specific questions gathered into large and well-studied pools, or "banks" of items. Items can be selected from the bank to form customized short scales, or can be administered in a sequence and length determined by a computer programmed for precision and clinical relevance. Although far from perfect, such item banks can form a common definition and understanding of human symptoms and functional problems such as fatigue, pain, depression, mobility, social function, sensory function, and many other health concepts that we can only measure by asking people directly. The support of the National Institutes of Health (NIH), as witnessed by its cooperative agreement with measurement experts through the NIH Roadmap Initiative known as PROMIS (www.nihpromis.org), is a big step in that direction. Our approach to item banking and CAT is practical; as focused on application as it is on science or theory. From a practical perspective, we frequently must decide whether to re-write and retest an item, add more items to fill gaps (often at the ceiling of the measure), re-test a bank after some modifications, or split up a bank into units that are more unidimensional, yet less clinically relevant or complete. These decisions are not easy, and yet they are rarely unforgiving. We encourage people to build practical tools that are capable of producing multiple short form measures and CAT administrations from common banks, and to further our understanding of these banks with various clinical populations and ages, so that with time the scores that emerge from these many activities begin to have not only a common metric and range, but a shared meaning and understanding across users. In this paper, we provide an overview of item banking and CAT, discuss our approach to item banking and its byproducts, describe testing options, discuss an

  19. Patient reported outcomes measures in neurogenic bladder and bowel: A systematic review of the current literature.

    Science.gov (United States)

    Patel, Darshan P; Elliott, Sean P; Stoffel, John T; Brant, William O; Hotaling, James M; Myers, Jeremy B

    2016-01-01

    To describe existing bladder and bowel specific quality of life (QoL) measurement tools, QoL in patients with multiple sclerosis (MS), spinal cord injury (SCI), Parkinson's Disease (PD), stroke, or spina bifida (SB) affected by bladder or bowel dysfunction, and the impact of specific bladder and bowel management on QoL. We performed a systematic review in PubMed/Medline databases in accordance with the PRISMA statement for English publications between January 1, 2000 and January 1, 2014. Articles were first screened based on their abstract and select full-text articles were then reviewed for eligibility. Articles with no QoL or PROM assessing urinary or bowel dysfunction were excluded. Risk of bias assessment included randomization, incomplete outcomes data, selective outcomes reporting, and other biases. All articles were graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system as per the Cochrane Handbook for Systematic Reviews of Interventions. The most common QoL measurement tool for urinary and bowel dysfunction was the Medical Outcomes Study SF-36. Twelve (24%) studies used only non-validated QoL questionnaires. Only three urinary or bowel specific QoL measures were found: the Qualiveen questionnaire, the FICQoL, and the QoL-BM. Several studies identified instances were clinical and patient-reported outcomes were inconsistent particularly with indwelling urinary catheter usage and reconstructive surgery. Additionally, certain clinical outcomes surrogates commonly used as primary outcomes measures may not correlate with the patient reported outcomes (PRO). Current PRO measures (PROM) and QoL assessments are heterogeneous and several inconsistencies in clinical and PRO for various management options exist. Standardized PROM will help identify optimal bladder and bowel management for patients with neurologic conditions. © 2014 Wiley Periodicals, Inc.

  20. Mind your hand during the energy crunch: Functional Outcome of Circular Saw Hand Injuries

    Directory of Open Access Journals (Sweden)

    Frank Matthias

    2010-09-01

    Full Text Available Abstract Background Although injuries due to circular saws are very common all over the world, there is surprisingly little information available about their functional outcomes. As the socioeconomic impact of these injuries is immense and determined by the c