Ferrete-Araujo, A M; Egea-Guerrero, J J; Vilches-Arenas, Á; Godoy, D A; Murillo-Cabezas, F
To analyze mortality and functional outcome in patients with severe spontaneous intracerebral hemorrhage (ICH), and identify the clinical characteristics, radiological findings and therapeutic procedures predictive of mortality in the Intensive Care Unit (ICU) and during hospitalization, as well as of poor functional results at 6 months. A prospective, observational study was carried out. Neurocritical Care Unit of a university hospital. Patients diagnosed with ICH were included over a period of 23 months. Demographic characteristics, cardiovascular risk factors, regular medication, laboratory test parameters, cranial CT findings, therapeutic procedures and outcome data. None. A total of 186 patients with ICH met the inclusion criteria. Surgery to evacuate ICH was performed in 25.8% of the patients. The mortality rate was 46.7%. The modified Rankin score at 6 months was 5 (RI: 4.6). Multivariate Cox regression analysis showed the presence of diabetes, prior anticoagulation, as well as APACHE II severity and the type of bleeding on the cranial CT scan to be predictors of mortality and poor functional outcomes. On the other hand, neurosurgical procedures and intracranial pressure (ICP) monitoring were associated with better outcomes. The presence of comorbidities such as diabetes, or previous anticoagulation, as well as the CT findings were associated to poorer outcomes. In contrast, ICP monitoring and early neurosurgery were predictive of longer survival and better functional outcomes. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.
Pierluissi, Edgar; Mehta, Kala M.; Kirby, Katharine A.; Boscardin, W. John; Fortinsky, Richard H.; Palmer, Robert M.; Landefeld, C. Seth
Objectives To determine the relationship between depressive symptoms after hospitalization and survival and functional outcomes. Design Secondary analysis of a prospective cohort study Setting General medical service of two urban, teaching hospitals in Ohio Participants Hospitalized patients, age 70 years or older. Measurements We measured 10 depressive symptoms, instrumental activities of daily living (IADL), and basic activities of daily living (ADL) at hospital discharge and 1, 3, 6, and 12 months later. Using all data points, we determined subject-specific changes in depressive symptoms (slopes). We also defined four groups according to the number of depressive symptoms (≤3 symptoms, Low; 4–10 symptoms, High) at discharge and follow-up: Low-Low, Low-High, High-Low, and High-High. We measured mortality at 3, 6, and 12 months after hospital discharge. Results Both subject-specific discharge depressive symptoms and change in depressive symptoms over time (slopes) were associated (Pdepressive symptom group were alive and independent in instrumental activities of daily living (IADL) and basic activities of daily living (ADL), compared to the Low-High group (49% vs 37%, P=0.02).and more patients in the High-Low group were alive and independent in IADL and ADL, compared to the High-High group (39% vs 19%, Pdepressive symptoms and the change in the number of depressive symptoms during the year after discharge were associated with functional and mortality outcomes in hospitalized older adults. Fewer patients with persistently high or increasing depressive symptoms after hospitalization were alive and functionally independent 1 year later than patients with decreasing or persistently low symptoms, respectively. PMID:23176725
Francisco José Tarazona-Santabalbina
Full Text Available OBJECTIVES: Hip fractures are associated with high levels of co-morbidity and mortality. Orthogeriatric units have been shown to be effective with respect to functional recovery and mortality reduction. The aim of this study is to document the natural history of early multidisciplinary intervention in elderly patients with hip fractures and to establish the prognostic factors of mortality and walking ability after discharge. METHODS: This observational, retrospective study was performed in an orthogeriatric care unit on patients aged >70 years with a diagnosis of hip fracture between 2004 and 2008. This study included 1363 patients with a mean age of 82.7 + 6.4 years. RESULTS: On admission to the unit, the average Barthel score of these patients was 77.2 + 27.8 points, and the average Charlson index score was 2.14 + 2.05. The mean length of stay was 8.9 + 4.26 days, and the readmission rate was 2.3%. The in-hospital mortality rate was 4.7%, and the mortality rates at one, six, and 12 months after discharge were 8.7%, 16.9%, and 25.9%, respectively. The Cox proportional hazards model estimated that male sex, Barthel scale, heart failure, and cognitive impairment were associated with an increased risk of death. With regard to functionality, 63.7% of the patients were able to walk at the time of discharge, whereas 77.4% and 80.1% were able to walk at one month and six months post-discharge, respectively. The factors associated with a worse functional recovery included cognitive impairment, performance status, age, stroke, Charlson score, and delirium during the hospital stay. CONCLUSIONS: Early multidisciplinary intervention appears to be effective for the management of hip fracture. Age, male sex, baseline function, cognitive impairment and previous comorbidities are associated with a higher mortality rate and worse functional recovery.
Jin, P. H. Ping Fung Kon; Penning, Niels; Joosse, Pieter; Hijdra, Albert H. J.; Bouma, Gert Joan; Ponsen, Kees Jan; Goslings, J. Carel
The purpose of this study was to analyze the effect of the introduction of an all-in workflow concept that included direct computed tomography (CT) scanning in the trauma room on mortality and functional outcome of trauma patients with severe traumatic brain injury (TBI) admitted to a level-1 trauma
Tripathy, Swagata; Mishra, J C; Dash, S C
To study the mortality and outcome of critically ill elderly patients in a developing country with focus on nutritional and socioeconomic status. A prospective study of 109 patients (215 screened) admitted consecutively to the intensive care unit from 2011 to 2012. Demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, mechanical ventilation, Malnutrition Universal Screening Tool score, socioeconomic category, functional status, delirium, and length of stay were recorded. Telephonic assessment of outcome was done at 1 year. Appropriate statistical tests compared differences between subgroups. Multivariate analysis was performed on significant variables (P<.1) affecting mortality. At 12 months after discharge, 46.8% of patients (mean age, 76.5±9.6 years; APACHEII, 22.7±6.4; and intensive care unit stay, 7.8±3.4 days) had died. Risk factors for mortality at 12 months were APACHE II score (P<.001; odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3), severe malnutrition (P=.006; OR, 0.08; 95% CI, 0.01-0.48), and delirium (P=.03; OR, 0.32; 95% CI, 0.11-0.9). Risk factors for short-term mortality (at 28 days) were APACHE II score (P=.02; OR, 1.1 [1.0-1.2]) and premorbid functional status (P=.03; OR, 0.2 [0.1-0.8]). Kaplan-Meier survival analysis showed a significant association with malnutrition (log-rank test, P=.012) but not with socioeconomic category. Most (72%) of the survivors had a favorable functional status. Malnutrition, delirium, and APACHEII were risk factors for long-term mortality. Survivors had a good functional outcome. Appropriate quality of life tools for this population need to be developed. Copyright © 2014 Elsevier Inc. All rights reserved.
Full Text Available The number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee, cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed, and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy.We used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS ranging from 0 (worst to 48 (best in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both p<0.001. Patients with hybrid prostheses had the best functional outcome (mean OHS 39.4, 95%CI 39.1 to 39.7 and those with cemented prostheses the worst (37.7, 37.3 to 38.1. Patients with cemented prostheses had the lowest reported 5-year revision rates (1.3%, 1.2% to 1.4% and those with cementless prostheses the highest (2.2%, 2.1% to 2.4%. Differences in mortality according to prosthesis type were small and not significant (p = 0.06. Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best and cementless prostheses (p = 0.01, with Corail Pinnacle having the best. Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest.Functional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a benchmark in randomised trials.
Pennington, Mark; Grieve, Richard; Black, Nick; van der Meulen, Jan H
The number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed), and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy). We used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS) ranging from 0 (worst) to 48 (best)) in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both pprosthesis type were small and not significant (p = 0.06). Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best) and cementless prostheses (p = 0.01, with Corail Pinnacle having the best). Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest). Functional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a benchmark in randomised trials.
Dawes, Piers; Cruickshanks, Karen J.; Fischer, Mary E.; Klein, Barbara E.K.; Klein, Ronald; Nondahl, David M.
Objective To clarify the impact of hearing aids on mental health, social engagement, cognitive function, and physical health outcomes in older adults with hearing impairment. Design We assessed hearing handicap (Hearing Handicap Inventory for the Elderly; HHIE-S), cognition (Mini Mental State Exam, Trail Making, Auditory Verbal Learning, Digit-Symbol Substitution, Verbal Fluency, incidence of cognitive impairment), physical health (SF-12 physical component, basic and instrumental activities of daily living, mortality), social engagement (hours per week spent in solitary activities) and mental health (SF-12 mental component) at baseline, 5 years prior to baseline, and 5 and 11 years after baseline. Study sample Community-dwelling older adults with hearing impairment (N=666) from the Epidemiology of Hearing Loss Study cohort. Results There were no significant differences between hearing aid users and non-users in cognitive, social engagement or mental health outcomes at any time point. Aided HHIE-S was significantly better than unaided HHIE-S. At 11 years hearing aid users had significantly better SF-12 physical health scores (46.2 versus 41.2; p=0.03). There was no difference in incidence of cognitive impairment or mortality. Conclusion There was no evidence that hearing aids promote cognitive function, mental health, or social engagement. Hearing aids may reduce hearing handicap and promote better physical health. PMID:26140300
Dawes, Piers; Cruickshanks, Karen J; Fischer, Mary E; Klein, Barbara E K; Klein, Ronald; Nondahl, David M
To clarify the impact of hearing aids on mental health, social engagement, cognitive function, and physical health outcomes in older adults with hearing impairment. We assessed hearing handicap (hearing handicap inventory for the elderly; HHIE-S), cognition (mini mental state exam, trail making, auditory verbal learning, digit-symbol substitution, verbal fluency, incidence of cognitive impairment), physical health (SF-12 physical component, basic and instrumental activities of daily living, mortality), social engagement (hours per week spent in solitary activities), and mental health (SF-12 mental component) at baseline, five years prior to baseline, and five and 11 years after baseline. Community-dwelling older adults with hearing impairment (N = 666) from the epidemiology of hearing loss study cohort. There were no significant differences between hearing-aid users and non-users in cognitive, social engagement, or mental health outcomes at any time point. Aided HHIE-S was significantly better than unaided HHIE-S. At 11 years hearing-aid users had significantly better SF-12 physical health scores (46.2 versus 41.2; p = 0.03). There was no difference in incidence of cognitive impairment or mortality. There was no evidence that hearing aids promote cognitive function, mental health, or social engagement. Hearing aids may reduce hearing handicap and promote better physical health.
Peng, Li-Ning; Lu, Wan-Hsuan; Liang, Chih-Kuang; Chou, Ming-Yueh; Chung, Chih-Ping; Tsai, Shu-Ling; Chen, Zhi-Jun; Hsiao, Fei-Yuan; Chen, Liang-Kung
To evaluate the benefits of the national stroke postacute care (PAC) program on clinical outcomes and subsequent healthcare utilization. Propensity score-matched case-control study using the National Health Insurance data. A total of 1480 stroke cases receiving PAC services and 3159 matched controls with similar stroke severity but without PAC services. Demographic characteristics, functional outcomes (modified Rankin Scale, Barthel Index, Lawton-Brody Instrumental Activities of Daily Living, Functional Oral Intake Scale, Mini-Nutritional Assessment, Berg Balance Test, Usual Gait Speed Test, 6-Minute Walk Test, Fugl-Meyer Assessment (modified sensation and motor), Mini-Mental State Examination, Motor Activity Log, and the Concise Chinese Aphasia Test), subsequent healthcare utilization (90-day stroke re-admission and emergency department visits), and 90-day mortality. After propensity score matching, baseline characteristics, stroke severity, and status of healthcare utilization before index stroke admission were similar between cases and controls. After PAC services, the case group obtained significant improvement in all functional domains and may have reduced subsequent disability. Among all functional assessments, balance was the most significantly improved domain and was suggestive for the reduction of subsequent falls risk and related injuries. Compared with controls, patients receiving PAC services had significantly lower 90-day hospital re-admissions [11.1% vs 21.0%, adjusted odds ratio (aOR) 0.47 with 95% confidence interval (CI) 0.34-0.64], stroke-related re-admissions (2.1% vs 8.8%, aOR 0.22, 95% CI 0.12-0.41), and emergency department visits (13.5% vs 24.0%, aOR 0.49, 95% CI 0.37-0.65), but the 90-day mortality rate remained similar between groups (1.4% case group vs 2.0% control group, aOR 0.68, 95% CI 0.29-1.62). PAC significantly improved the recovery of stroke patients in all functional domains through the program, with universal interorganizational
Full Text Available OBJECTIVE: To evaluate the various causes of perinatal deaths and adopt strategies to improve perinatal outcome at a referral teaching hospital in North Kerala. METHODS: A prospective observational study conducted at Institute of Maternal and Child Health, Government Medical College, Kozhikode. All perinatal deaths during the period January 2013 to December 2014 were analysed and from this factors responsible for perinatal deaths were identified. RESULTS: Out of total 30,042 deliveries , there were 966 perinatal deaths during the study period. 566 were still births and 400 early neonatal deaths. The perinatal mortality rate was 31.1 per 1000 live births. Perinatal asphyxia was the major cause of perinatal mortality. The important factors contributing to perinatal asphyxia were prematurity (39%, abruptio placenta (19% and MSAF ( 12%. Among the antenatal factors, hypertensive disorders of pregnancy leading to iatrogenic elective preterm delivery were the most important. CONCLUSION: Perinatal asphyxia due to prematurity and low birth weight emerged as the most important cause of perinatal mortality in this study and hypertensive disorders of pregnancy were the most important antenatal complication leading to prematurity
Tomaschitz, A.; Meinitzer, A.; Pilz, S.; Rus-Machan, J.; Genser, B.; Drechsler, C.; Grammer, T.; Krane, V.; Ritz, E.; Kleber, M.E.; Pieske, B.; Kraigher-Krainer, E.; Fahrleitner-Pammer, A.; Wanner, C.; Boehm, B.O.; Marz, W.
BackgroundHomoarginine is a novel biomarker for cardiovascular diseases. In the present large cohort study, we evaluate how homoarginine is linked to kidney function and examine the potential interaction of homoarginine and kidney function as predictors of cardiovascular outcomes.MethodsSerum
Marcela da Cunha Sales
Full Text Available Objective: To compare in-hospital outcomes in aortic surgery in our cardiac surgery unit, before and after foundation of our Center for Aortic Surgery (CTA. Methods: Prospective cohort with non-concurrent control. Foundation of CTA required specialized training of surgical, anesthetic and intensive care unit teams, routine neurological monitoring, endovascular and hybrid facilities, training of the support personnel, improvement of the registry and adoption of specific protocols. We included 332 patients operated on between: January/2003 to December/2007 (before-CTA, n=157, 47.3%; and January/2008 to December/2010 (CTA, n=175, 52.7%. Baseline clinical and demographic data, operative variables, complications and in-hospital mortality were compared between both groups. Results: Mean age was 58±14 years, with 65% male. Group CTA was older, had higher rate of diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular procedures, and aneurysms. In the univariate analysis, CTA had lower mortality (9.7 vs. 23.0%, P=0.008, which occurred consistently across different diseases and procedures. Other outcomes which were reduced in CTA included lower rates of reinterventions (5.7 vs 11%, P=0.046, major complications (20.6 vs. 33.1%, P=0.007, stroke (4.6 vs. 10.9%, P=0.045 and sepsis (1.7 vs. 9.6%, P=0.001, as compared to before-CTA. Multivariable analysis adjusted for potential counfounders revealed that CTA was independently associated with mortality reduction (OR=0.23, IC 95% 0.08 – 0.67, P=0.007. CTA independent mortality reduction was consistent in the multivariable analysis stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 – 0.98, P=0.048; dissection, OR=0.31, CI 95% 0.09 – 0.99, P=0.049 and by procedure (hybrid, OR=0.07, CI 95% 0.007 – 0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 – 0.904, P=0.037. Additional multivariable predictors of in-hospital mortality included creatinine (OR=1.7 [1.1-2.6], P=0.008, urgent
Sujatha; Ramalingam; Vinodkumar; Vasumathi; Valarmathi; Anu
BACKGROUND Ischemic strokes account for >80% of total stroke events. Biochemical modalities like serum uric acid, ESR, CRP, Serum Fibrinogen will be a low cost and useful way to predict functional outcome after ischemic stroke. The Barthel ADL index it is an ordinal scale helping us to measure performances in ADL-activities in daily living. The present study aims to study the Biochemical parameters Uric Acid, CRP, ESR and Fibrinogen in Ischemic Stroke patients and to assess fu...
Witcher, Patricia M; Sisson, Melissa C
A better understanding of why women die during pregnancy, childbirth, or postpartum offers valuable insight into strategies aimed at preventing maternal deaths and arresting the progression in the severity of a complication. The rate of severe maternal morbidity and maternal mortality in the United States has been trending upward in recent years and has garnered national attention with concentration on bolstering reviews of maternal deaths and implementing patient safety initiatives. The obstetric nurse is in a unique position to improve maternal outcomes through the anticipation, recognition, and communication of the early warning signs of impending deterioration in maternal condition. Presented in the context of the conceptual model of Stephen Covey's Circle of Influence, the professional nurse can proactively influence maternal outcomes directly, with actions defined by the scope of professional nursing practice or indirectly through professional interactions with others. Advancing one's education, knowledge, and technical skills broadens the influential capacity.
Zinman, Bernard; Wanner, Christoph; Lachin, John M; Fitchett, David; Bluhmki, Erich; Hantel, Stefan; Mattheus, Michaela; Devins, Theresa; Johansen, Odd Erik; Woerle, Hans J; Broedl, Uli C; Inzucchi, Silvio E
The effects of empagliflozin, an inhibitor of sodium-glucose cotransporter 2, in addition to standard care, on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk are not known. We randomly assigned patients to receive 10 mg or 25 mg of empagliflozin or placebo once daily. The primary composite outcome was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, as analyzed in the pooled empagliflozin group versus the placebo group. The key secondary composite outcome was the primary outcome plus hospitalization for unstable angina. A total of 7020 patients were treated (median observation time, 3.1 years). The primary outcome occurred in 490 of 4687 patients (10.5%) in the pooled empagliflozin group and in 282 of 2333 patients (12.1%) in the placebo group (hazard ratio in the empagliflozin group, 0.86; 95.02% confidence interval, 0.74 to 0.99; P=0.04 for superiority). There were no significant between-group differences in the rates of myocardial infarction or stroke, but in the empagliflozin group there were significantly lower rates of death from cardiovascular causes (3.7%, vs. 5.9% in the placebo group; 38% relative risk reduction), hospitalization for heart failure (2.7% and 4.1%, respectively; 35% relative risk reduction), and death from any cause (5.7% and 8.3%, respectively; 32% relative risk reduction). There was no significant between-group difference in the key secondary outcome (P=0.08 for superiority). Among patients receiving empagliflozin, there was an increased rate of genital infection but no increase in other adverse events. Patients with type 2 diabetes at high risk for cardiovascular events who received empagliflozin, as compared with placebo, had a lower rate of the primary composite cardiovascular outcome and of death from any cause when the study drug was added to standard care. (Funded by Boehringer Ingelheim and Eli Lilly; EMPA-REG OUTCOME ClinicalTrials.gov number
Honeybrook, Adam; Patki, Aniruddha; Chapurin, Nikita; Woodard, Charles
The aim of this article is to determine hearing and mortality outcomes following temporal bone fractures. Retrospective chart review was performed of 152 patients diagnosed with a temporal bone fracture presenting to the emergency room at a tertiary care referral center over a 10-year period. Utilizing Patients' previously obtained temporal bone computed tomographic scans and audiograms, fractures were classified based on several classification schemes. Correlations between fracture patterns, mortality, and hearing outcomes were analyzed using χ 2 tests. Ossicular chain disruption was seen in 11.8% of patients, and otic capsule violation was seen in 5.9%; 22.7% of patients presented for audiologic follow-up. Seventeen patients with conductive hearing loss had air-bone gaps of 26 ± 7.5 dB (500 Hz), 27 ± 6.8 dB (1,000 Hz), 18 ± 6.2 dB (2,000 Hz), and 32 ± 7.7 dB (4,000 Hz). Two cases of profound sensorineural hearing loss were associated with otic capsule violation. No fracture classification scheme was predictive of hearing loss, although longitudinal fractures were statistically associated with ossicular chain disruption ( p fractures in patients older than 60 years carried a relative risk of death of 3.15 compared with those younger than 60 years. The average magnitude of conductive hearing loss resulting from temporal bone fracture ranged from 18 to 32 dB in this cohort. Classification of fracture type was not predictive of hearing loss, despite the statistical association between ossicular chain disruption and longitudinal fractures. This finding may be due to the low follow-up rates of this patient population. Physicians should make a concerted effort to ensure that audiological monitoring is executed to prevent and manage long-term hearing impairment.
Mateu, L; Peri, L; Franco, A; Roldán, F; Musquera, M; Ribal, M J
To assess the functional effects of prostatic cryosurgery on micturition. Prospective study of men who underwent cryosurgery (CS) for prostate cancer between 2013 - 2015. Low urinary tract symptoms (LUTS) and quality of life (QoL) were assessed 1 month before surgery using IPSS questionnaire, a three-day voiding diary (3DVD) and uroflowmetry with ultrasound-measured postvoid residual volume. Need of medical treatment for LUTS was also recorded. The same assessment was performed at 3, 6 and 12 months after CS. Outcomes after surgery were compared to those prior to surgery. Forty-five patients underwent a CS during the study period, of whom 25 patients could be recruited in the study. Mean age was 73.5 years (range 66-84). Nineteen CS (76%) were performed as a primary procedure, while 6 CS (24%) as a salvage procedure. No statistical differences were found comparing results of IPSS, QoL, D3vd or uroflowmetry and PVR at 3, 6 or 12 months after CS compared to before surgery. Before CS, 8 (32%) patients were on medical treatment for LUTS, while at 6 and 12 months after surgery, 3 (13.6%) and 2 (9.5%) patients required some medication, respectively. According to the punctuation of IPSS, QoL questionnaire, and a 3-day voiding diary, LUTS does not worsen after CS. Prostatic cryosurgery does not seem to impact uroflowmetry results. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
Faurschou, Mikkel; Dreyer, Lene; Kamper, Anne-Lise
To evaluate the long-term mortality and renal outcome in a cohort of Danish patients with lupus nephritis (LN) and to identify outcome predictors among findings registered at the time of the first renal biopsy.......To evaluate the long-term mortality and renal outcome in a cohort of Danish patients with lupus nephritis (LN) and to identify outcome predictors among findings registered at the time of the first renal biopsy....
Gianise Toboliski Bongiorni
Full Text Available ABSTRACT Objective To assess, by Rankin scale, the functional disability of patients who had a malignant middle cerebral artery (MCA ischemic stroke, who underwent decompressive craniotomy (DC within the first 30 days. Methods A cross-sectional study in a University hospital. Between June 2007 and December 2014, we retrospectively analyzed the records of all patients submitted to DC due to a malignant MCA infarction. The mortality rate was defined during the hospitalization period. The modified outcome Rankin score (mRS was measured 30 days after the procedure, for stratification of the quality of life. Results The DC mortality rate was 30% (95% CI 14.5 to 51.9 for the 20 patients reported. The mRS 30 days postoperatively was ≥ 4 [3.3 to 6] for all patients thereafter. Conclusion DC is to be considered a real alternative for the treatment of patients with a malignant ischemic MCA infarction.
Givertz, Michael M; Postmus, Douwe; Hillege, Hans L; Mansoor, George A; Massie, Barry M; Davison, Beth A; Ponikowski, Piotr; Metra, Marco; Teerlink, John R; Cleland, John G F; Dittrich, Howard C; O'Connor, Christopher M; Cotter, Gad; Voors, Adriaan A
Prior studies have demonstrated adverse risk associated with baseline and worsening renal function in acute heart failure, but none has modeled the trajectories of change in renal function and their impact on outcomes. We used linear mixed models of serial measurements of blood urea nitrogen and creatinine to describe trajectories of renal function in 1962 patients with acute heart failure and renal dysfunction enrolled in the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function study. We assessed risk of 180-day mortality and 60-day cardiovascular or renal readmission and used Cox regression to determine association between renal trajectories and outcomes. Compared with patients alive at 180 days, patients who died were older, had lower blood pressure and ejection fraction, and higher creatinine levels at baseline. On average for the entire cohort, creatinine rose from days 1 to 3 and increased further after discharge, with the trajectory dependent on the day of discharge. Blood urea nitrogen, creatinine, and the rate of change in creatinine from baseline were the strongest independent predictors of 180-day mortality and 60-day readmission, whereas the rate of change of blood urea nitrogen from baseline was not predictive of outcomes. Baseline blood urea nitrogen>35 mg/dL and increase in creatinine>0.1 mg/dL per day increased the risk of mortality, whereas stable or decreasing creatinine was associated with reduced risk. Patients with acute heart failure and renal dysfunction demonstrate variable rise and fall in renal indices during and immediately after hospitalization. Risk of morbidity and mortality can be predicted based on baseline renal function and creatinine trajectory during the first 7 days. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00328692 and NCT
de Ven, A.C.V.; Netea-Maier, R.T.; de Vegt, F.; Ross, H.A.; Sweep, F.C.G.J.; Kiemeney, L.A.; Smit, JW; Hermus, A.R.; den Heijer, M.
Objective: The aim of this study was to investigate the influence of age on the association between thyroid function and mortality. Design: The Nijmegen Biomedical Study is a population-based study, comprising 5816 randomly selected adults of all age groups without previously known thyroid disease.
Stuart E. Samuels, MD, PhD
Conclusion: Neoadjuvant twice-daily chemoradiation for esophageal cancer is a safe and effective alternative to daily fractionation with low treatment-related mortality and long-term outcomes similar to standard fractionation courses.
Varekojis, Sarah M.; Miller, Larry; Schiller, M. Rosita; Stein, David
Purpose: This paper aims to describe the relationship between functional health literacy level and smoking cessation outcomes. Design/methodology/approach: Participants in an inpatient smoking cessation program in a mid-western city in the USA were enrolled and the Short Test of Functional Health Literacy in Adults was administered while the…
Cheng, Jocelyn Y
Status epilepticus (SE) is a life-threatening neurologic emergency. Despite advances in management, in-hospital mortality remains unchanged. This is partly due to the pharmacoresistance which develops the longer that seizures persist. Therefore, rapid antiseizure medication (ASM) administration may represent a beneficial treatment option. The purpose of this study was to determine: 1) whether in-hospital mortality is reduced with shorter latencies to initial treatment of SE with an ASM (LTSE); and 2) the critical time frame during which LTSE is associated with reduced in-hospital mortality. This was a retrospective, single-center study of adults diagnosed with SE between 1/1/2005 and 10/31/2012. Demographic characteristics included seizure history, etiology, semiology, and duration. Subjects were assigned to LTSE groups at the time frames of 5, 10, 30 and 60min. The primary outcome was in-hospital mortality, with poor functional status (mRS 3-6) as a secondary measure. Pearson's chi-square, Mann-Whitney-U, two-sample-t-tests, and binary logistic regression analysis were used as appropriate, with p30min demonstrated increased risk of mortality (OR 2.06, CI 1.01-4.17, p=0.046) and poor functional status (OR 2.48, CI 1.05-5.85, p=0.038) compared to LTSE≤30min. Increased mortality risk remained after adjusting for SE duration (OR 2.07, CI 1.01-4.26, p=0.047) and nonconvulsive seizures (OR 2.28, CI 1.08-4.80, p=0.03). Compared to subjects treated within 60min, those treated after 60min were at increased risk of poor functional status, regardless of the presence of nonconvulsive seizures (OR 2.96, CI 1.14-7.73, p=0.026). In addition, when acute symptomatic SE was stratified by cardiac versus non-cardiac etiologies, subjects with non-cardiac acute symptomatic SE demonstrated worse functional outcome when treated after 60min (OR 7.20, CI 1.13-46.07, p=0.037). Treatment of SE within 30min of onset is associated with reduced risk of in-hospital mortality and poor
Chua, Choon-Bing; Sun, Cheuk-Kwan; Tsui, Huan-Wen; Yang, Po-Jen; Lee, Kuo-Hsin; Hsu, Chih-Wei; Tsai, I-Ting
Star fruit (SF) is a commonly available fruit produced and eaten in tropical and subtropical countries. Since 1993, various reports have described neurotoxicity after eating SF, but this clinical condition remains unfamiliar. We aimed to describe this clinical entity, the role of renal dysfunction in this disorder, treatment strategies, and prognosis of patients with SF intoxication. We conducted a search of PubMed and Google Scholar databases from 1993 to 2016. We included reports describing patients with a clear history of SF ingestion with acute symptoms. We described the demographic characteristics, reported SF intake, treatments used, and outcomes. We reviewed totally 126 patients (male:female = 1.5:1) from 33 articles with mean age 54.4 ± 11 (range: 30-84). The most common symptom was hiccups (65%), whereas confusion and seizure were the most common symptoms associated with mortality (42% and 61%, respectively). Pre-intoxication renal function also affected mortality. While there was no mortality in patients with normal renal function (NRF), the mortality of patients among reported cases with chronic renal insufficiency and end-stage renal disease undergoing dialysis were 36% and 27%, respectively. With the inclusion of patients reported to have NRF, the overall mortality was 24%. Consistently, the number of SF consumed was substantially higher in the patients with NRF than those with renal functional impairment. The most common treatment strategy was hemodialysis (59%). Patients with impaired renal function were at higher risks of SF intoxication. Severe neurologic symptoms mandate immediate medical intervention because of the association between their occurrence and high mortalities. Toxin removal through dialysis, rather than symptomatic relief, seems to be beneficial to patient survival. Early and continuous dialysis appears to alleviate severe symptoms and prevent symptom rebounds.
Xu, Hong; Huang, Xiaoyan; Risérus, Ulf; Krishnamurthy, Vidya M; Cederholm, Tommy; Arnlöv, Johan; Lindholm, Bengt; Sjögren, Per; Carrero, Juan Jesús
In the United States population, high dietary fiber intake has been associated with a lower risk of inflammation and mortality in individuals with kidney dysfunction. This study aimed to expand such findings to a Northern European population. Dietary fiber intake was calculated from 7-day dietary records in 1110 participants aged 70-71 years from the Uppsala Longitudinal Study of Adult Men (examinations performed during 1991-1995). Dietary fiber was adjusted for total energy intake by the residual method. Renal function was estimated from the concentration of serum cystatin C, and deaths were registered prospectively during a median follow-up of 10.0 years. Dietary fiber independently and directly associated with eGFR (adjusted difference, 2.6 ml/min per 1.73 m(2) per 10 g/d higher; 95% confidence interval [95% CI], 0.3 to 4.9). The odds of C-reactive protein >3 mg/L were lower (linear trend, P=0.002) with higher fiber quartiles. During follow-up, 300 participants died (incidence rate of 2.87 per 100 person-years at risk). Multiplicative interactions were observed between dietary fiber intake and kidney dysfunction in the prediction of mortality. Higher dietary fiber was associated with lower mortality in unadjusted analysis. These associations were stronger in participants with kidney dysfunction (eGFRdietary fiber was associated with better kidney function and lower inflammation in community-dwelling elderly men from Sweden. High dietary fiber was also associated with lower (cancer) mortality risk, especially in individuals with kidney dysfunction. Copyright © 2014 by the American Society of Nephrology.
Richard D Hayes
Full Text Available Serious mental illness can affect many aspects of an individual's ability to function in daily life. The aim of this investigation was to determine if the environmental and functional status of people with serious mental illness contribute to the high mortality risk observed in this patient group.We identified cases of schizophrenia, schizoaffective and bipolar disorder aged ≥ 15 years in a large secondary mental healthcare case register linked to national mortality tracing. We modelled the effect of activities of daily living (ADLs, living conditions, occupational and recreational activities and relationship factors (Health of the Nation Outcome Scale [HoNOS] subscales on all-cause mortality over a 4-year observation period (2007-10 using Cox regression.We identified 6,880 SMI cases (242 deaths in the observation period. ADL impairment was associated with an increased risk of all-cause mortality (adjusted HR 1.9; 95% CI 1.3-2.8; p = 0.001, p for trend across ADL categories = 0.001 after controlling for a broad range of covariates (including demographic factors, physical health, mental health symptoms and behaviours, socio-economic status and mental health service contact. No associations were found for the other three exposures. Stratification by age indicated that ADLs were most strongly associated with mortality in the youngest (15 to <35 years and oldest (≥ 55 years groups.Functional impairment in people with serious mental illness diagnoses is a marker of increased mortality risk, possibly in younger age groups as a marker of negative symptomatology.
Post, Richard Bernardus
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
Puhan, Milo A; Siebeling, Lara; Zoller, Marco; Muggensturm, Patrick; ter Riet, Gerben
Exercise tests are important to characterise chronic obstructive pulmonary disease patients and predict their prognosis, but are often not available outside of rehabilitation or research settings. Our aim was to assess the predictive performance of the sit-to-stand and handgrip strength tests. The prospective cohort study in Dutch and Swiss primary care settings included a broad spectrum of patients (n=409) with Global Initiative for Chronic Obstructive Lung Disease stages II to IV. To assess the association of the tests with outcomes, we used Cox proportional hazards (mortality), negative binomial (centrally adjudicated exacerbations) and mixed linear regression models (longitudinal health-related quality of life) while adjusting for age, sex and severity of disease. The sit-to-stand test was strongly (adjusted hazard ratio per five more repetitions of 0.58, 95% CI 0.40-0.85; p=0.004) and the handgrip strength test moderately strongly (0.84, 95% CI 0.72-1.00; p=0.04) associated with mortality. Both tests were also significantly associated with health-related quality of life but not with exacerbations. The sit-to-stand test alone was a stronger predictor of 2-year mortality (area under curve 0.78) than body mass index (0.52), forced expiratory volume in 1 s (0.61), dyspnoea (0.63) and handgrip strength (0.62). The sit-to-stand test may close an important gap in the evaluation of exercise capacity and prognosis of chronic obstructive pulmonary disease patients across practice settings.
Murphy, M.; Connolly, P.; O’Byrne, J.
We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years. This study was a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine injuries between 1994 and 2002. The data was acquired by analysis of the national spinal unit database, hospital inpatient enquiry system, chart and radiographic review. Mean age was 74 years (range 66–93 years). The male to female ratio was 2.1:1 (M = 72, F = 35). The mean follow-up was 4.4 years (1–9 years) and mean in-hospital stay was 10 days (2–90 days). The mechanism of injury was a fall in 75 and road traffic accident in the remaining 32 patients. The level involved was atlanto-axial in 44 cases, sub-axial in 52 cases and the remaining 11 had no bony injury. Multilevel involvement occurred in 48 patients. C2 dominated the single level injury and most of them were type II odontoid fractures. Four patients had complete neurology, 27 had incomplete neurology, and the remaining 76 had no neurological deficit. Treatment included cervical orthosis in 67 cases, halo immobilization in 25, posterior stabilization in 12 patients and anterior cervical fusion in three patients. The overall complication rate was 18.6% with an associated in-hospital mortality of 11.2%. The complications included loss of reduction due to halo and Minerva loosening, non-union and delayed union among conservatively treated patients, pin site and wound infection, gastrointestinal bleeding and complication due to associated injuries. Among the 28.9% patients with neurological involvement, 37.7% had significant neurological recovery. Outcome was assessed using a cervical spine outcome questionnaire from Johns Hopkins School of Medicine. Sixty-seven patients (70%) completed the form, 20 patients (19%) were deceased at review and 8 patients (7%) were uncontactable. Functional disability was more marked in the patients with
Meier, Robert H; Melton, Danielle
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. Copyright © 2014 Elsevier Inc. All rights reserved.
Wu, Frances M; Rubenstein, Lisa V; Yoon, Jean
New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality. Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia). In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p team functioning within PCMH models for achieving improved patient outcomes. A focus on team functioning is important especially in the early implementation of team-based primary care models.
Pollack, Murray M; Holubkov, Richard; Funai, Tomohiko; Berger, John T; Clark, Amy E; Meert, Kathleen; Berg, Robert A; Carcillo, Joseph; Wessel, David L; Moler, Frank; Dalton, Heidi; Newth, Christopher J L; Shanley, Thomas; Harrison, Rick E; Doctor, Allan; Jenkins, Tammara L; Tamburro, Robert; Dean, J Michael
Assessments of care including quality assessments adjusted for physiological status should include the development of new morbidities as well as mortalities. We hypothesized that morbidity, like mortality, is associated with physiological dysfunction and could be predicted simultaneously with mortality. Prospective cohort study from December 4, 2011, to April 7, 2013. General and cardiac/cardiovascular PICUs at seven sites. Randomly selected PICU patients from their first PICU admission. None. Among 10,078 admissions, the unadjusted morbidity rates (measured with the Functional Status Scale and defined as an increase of ≥ 3 from preillness to hospital discharge) were 4.6% (site range, 2.6-7.7%) and unadjusted mortality rates were 2.7% (site range, 1.3-5.0%). Morbidity and mortality were significantly (p 0.20). Predictive ability assessed with the volume under the surface was 0.50 ± 0.019 (derivation) and 0.50 ± 0.034 (validation) (vs chance performance = 0.17). Site-level standardized morbidity ratios were more variable than standardized mortality ratios. New morbidities were associated with physiological status and can be modeled simultaneously with mortality. Trichotomous outcome models including both morbidity and mortality based on physiological status are suitable for research studies and quality and other outcome assessments. This approach may be applicable to other assessments presently based only on mortality.
.73 models. Conclusions Both pre- and post-bronchodilator lung function predicted mortality in this analysis with a similar degree of accuracy. Post-bronchodilator lung function may not be needed in population studies that predict long-term outcomes.
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
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.
Islam, M Mazharul
The long tradition of high prevalence of consanguineous marriages in Omani society may have ramifications for reproductive behaviour and health of offspring. To examine the relevance of consanguinity to reproductive behaviour, adverse pregnancy outcome and offspring mortality in Oman. The data analysed came from the 2000 Oman National Health Survey. Selected indicators that are related to reproductive behaviour, adverse pregnancy outcome and offspring mortality were considered as explanatory variables. Various statistical methods and tests were used for data analysis. Consanguineous marriage was found to be associated with lower age at first birth, higher preference for larger family size, lower level of husband-wife communication about use of family planning methods and lower rate of contraceptive use. Although bivariate analysis showed elevated fertility and childhood mortality among the women with consanguineous marriage, after controlling for relevant socio-demographic factors in multivariate analysis, fertility, childhood mortality and foetal loss showed no significant association with consanguinity in Oman. Consanguinity plays an important role in determining some of the aspects of reproduction and health of newborns, but did not show any detrimental effects on fertility and offspring mortality. The high level of consanguinity and its relevance to reproduction in Oman need to be considered in its public health strategy in a culturally acceptable manner.
Ramanathan, Kollengode; Tan, Chuen Seng; Rycus, Peter; MacLaren, Graeme
Extracorporeal membrane oxygenation is a rescue therapy used to support severe cardiorespiratory failure. Data on outcomes from severe community-acquired pneumonia in adults receiving rescue extracorporeal membrane oxygenation are mainly confined to single-center experiences or specific pathogens. We examined data from the Extracorporeal Life Support Organisation registry to identify risk factors for poor outcomes in adult patients with community-acquired pneumonia. Retrospective data analysis. Extracorporeal Life Support Organization Registry database. We collected deidentified data on adult patients (> 18 yr) receiving extracorporeal membrane oxygenation for community-acquired pneumonia between 2002 and 2012. Patients with incomplete data or brain death were excluded. The primary outcome measure was in-hospital mortality. Other measurements included demographic information, pre-extracorporeal membrane oxygenation mechanical ventilation and biochemical variables, inotrope requirements, extracorporeal membrane oxygenation mode, duration, and complications. Initial univariate analysis assessed potential associations between survival and various pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation factors. Variables with p values of less than 0.1 were considered for logistic regression analysis to identify predictors of mortality. None. One thousand fifty-five patients, who satisfied inclusion criteria, were included in the final analysis. There was an increase in the number of patients cannulated per annum over the 10-year period studied. Univariate analysis identified pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation variables associated with high mortality. Further multiple regression analysis identified certain pre-extracorporeal membrane oxygenation factors as predictors of mortality, including duration of mechanical ventilation prior to extracorporeal membrane oxygenation, lower arterial pressure, fungal
Beiles, C Barry; Retegan, Claudia; Maddern, Guy J
Improved outcomes are desirable results of clinical audit. The aim of this study was to use data from the Victorian Audit of Surgical Mortality (VASM) and the Victorian Admitted Episodes Dataset (VAED) to highlight specific areas of clinical improvement and reduction in mortality over the duration of the audit process. This study used retrospective, observational data from VASM and VAED. VASM data were reported by participating public and private health services, the Coroner and self-reporting surgeons across Victoria. Aggregated VAED data were supplied by the Victorian Department of Health. Assessment of outcomes was performed using chi-squared trend analysis over successive annual audit periods. Because initial collection of data was incomplete in the recruitment phase, statistical analysis was confined to the last 3-year period, 2010-2013. A 20% reduction in surgical mortality over the past 5 years has been identified from the VAED data. Progressive increase in both surgeon and hospital participation, significant reduction in both errors in management as perceived by assessors and increased direct consultant involvement in cases returned to theatre have been documented. The benefits of VASM are reflected in the association with a reduction of mortality and adverse clinical outcomes, which have clinical and financial benefits. It is a purely educational exercise and continued participation in this audit will ensure the highest standards of surgical care in Australia. This also highlights the valuable collaboration between the Victorian Department of Health and the RACS. © 2014 Royal Australasian College of Surgeons.
Foster, M C; Weiner, D E; Bostom, A G; Carpenter, M A; Inker, L A; Jarolim, P; Joseph, A A; Kusek, J W; Pesavento, T; Pfeffer, M A; Rao, M; Solomon, S D; Levey, A S
Cystatin C and beta-2-microglobulin (B2M) are filtration markers associated with adverse outcomes in nontransplant populations, sometimes with stronger associations than for creatinine. We evaluated associations of estimated glomerular filtration rate from cystatin C (eGFR cys ), B2M (eGFR B 2M ), and creatinine (eGFR cr ) with cardiovascular outcomes, mortality, and kidney failure in stable kidney transplant recipients using a case-cohort study nested within the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial. A random subcohort was selected (N = 508; mean age 51.6 years, median transplant vintage 4 years, 38% women, 23.6% nonwhite race) with enrichment for cardiovascular events (N = 306; 54 within the subcohort), mortality (N = 208; 68 within the subcohort), and kidney failure (N = 208; 52 within the subcohort). Mean eGFR cr , eGFR cys , and eGFR B 2M were 46.0, 43.8, and 48.8 mL/min/1.73m 2 , respectively. After multivariable adjustment, hazard ratios for eGFR cys and eGFR B 2M mortality; and 9.49 (4.28-21.00) and 15.53 (6.99-34.51; both p mortality, and kidney failure in stable kidney transplant recipients. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.
Tipping, Claire J; Harrold, Meg; Holland, Anne; Romero, Lorena; Nisbet, Travis; Hodgson, Carol L
Early active mobilisation and rehabilitation in the intensive care unit (ICU) is being used to prevent the long-term functional consequences of critical illness. This review aimed to determine the effect of active mobilisation and rehabilitation in the ICU on mortality, function, mobility, muscle strength, quality of life, days alive and out of hospital to 180 days, ICU and hospital lengths of stay, duration of mechanical ventilation and discharge destination, linking outcomes with the World Health Organization International Classification of Function Framework. A PRISMA checklist-guided systematic review and meta-analysis of randomised and controlled clinical trials. Fourteen studies of varying quality including a total of 1753 patients were reviewed. Active mobilisation and rehabilitation had no impact on short- or long-term mortality (p > 0.05). Meta-analysis showed that active mobilisation and rehabilitation led to greater muscle strength (body function) at ICU discharge as measured using the Medical Research Council Sum Score (mean difference 8.62 points, 95% confidence interval (CI) 1.39-15.86), greater probability of walking without assistance (activity limitation) at hospital discharge (odds ratio 2.13, 95% CI 1.19-3.83), and more days alive and out of hospital to day 180 (participation restriction) (mean difference 9.69, 95% CI 1.7-17.66). There were no consistent effects on function, quality of life, ICU or hospital length of stay, duration of mechanical ventilation or discharge destination. Active mobilisation and rehabilitation in the ICU has no impact on short- and long-term mortality, but may improve mobility status, muscle strength and days alive and out of hospital to 180 days. CRD42015029836.
Otto-Knapp, Ralf; Cortes, Claudia P; Saavedra, Felipe; Wolff, Marcelo; Weitzel, Thomas
To analyze the prevalence of hepatitis B virus (HBV) co-infection and its influence on mortality and treatment outcome within a large AIDS cohort in Chile. Clinical and epidemiological data from the Chilean AIDS Cohort were retrospectively analyzed. Adult patients tested for hepatitis B surface antigen (HBsAg) during the time period of October 2001 to October 2007 were included. Of 5115 cohort patients, 1907 met the inclusion criteria. The prevalence of HBV co-infection was 8.4%. Overall mortality rates were 2.15 and 1.77 per 100 person-years for HBsAg-positive and HBsAg-negative HIV patients, respectively, with a mortality rate ratio of 1.22 (95% confidence interval 0.58-2.54). Kaplan-Meier survival and Cox regression analysis did not show significant differences between the groups. Virological and immunological responses to antiretroviral therapy (ART) were not influenced by HBsAg status, but in co-infected patients, initial ART was more frequently changed. The prevalence of hepatitis B co-infection was 8.4%, indicating a markedly elevated hepatitis B risk compared to the general population in Chile. Neither treatment outcome nor overall mortality was influenced by hepatitis B co-infection. Still, patients with hepatitis B co-infection had less stable ART regimens, which might be related to a higher risk of hepatotoxic drug effects. Copyright © 2013. Published by Elsevier Ltd.
disability accounted for 18.2% and 5.3% while mortality accounted for 10%. Increasing age. (p=0.006), a lower GCS score at admission, pupillary abnormalities, a history of loss of consciousness and admission into our Intensive Care Unit were all associated with poorer outcomes (p<0.000). Conclusion: Outcome depended ...
Study Setting: Hindu Mandal Hospital in Dar es Salaam ,Tanzania Main OutCome Measures: Echocardiographic features useful in assessing patients with peripartum cardiomyopathy; clinical outcome as well as mortality after treatment with the current therapy of heart failure Subjects: Sixty four consecutive patients with ...
Shih, Yu-Hsuan; Islam, Tariqul; Hore, Samar Kumar; Sarwar, Golam; Shahriar, Mohammad Hasan; Yunus, Mohammad; Graziano, Joseph H; Harjes, Judith; Baron, John A; Parvez, Faruque; Ahsan, Habibul; Argos, Maria
Chronic arsenic exposure is a public health concern in many parts of the world, with elevated concentrations in groundwater posing a threat to millions of people. Arsenic is associated with various cancers and an array of chronic diseases; however, the relationship with adverse pregnancy outcomes and child mortality is less established. We evaluated associations between individual-level prenatal arsenic exposure with adverse pregnancy outcomes and child mortality in a pregnancy study among 498 women nested in a larger population-based cohort in rural Bangladesh. Creatinine-adjusted urinary total arsenic concentration, a comprehensive measure of exposure from water, food, and air sources, reflective of the prenatal period was available for participants. Self-reported pregnancy outcomes (livebirth, stillbirth, spontaneous/elective abortion) were ascertained. Generalized estimating equations, accounting for multiple pregnancies of participants, were used to estimate odds ratios and 95% confidence intervals in relation to adverse pregnancy outcomes. Vital status of livebirths was subsequently ascertained through November 2015. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals in relation to child mortality. We observed a significant association between prenatal arsenic exposure and the risk of stillbirth (greater than median; adjusted OR = 2.50; 95% CI = 1.04, 6.01). We also observed elevated risk of child mortality (greater than median; adjusted HR = 1.92; 95% CI = 0.78, 4.68) in relation to prenatal arsenic exposure. Prospective studies should continue to evaluate prenatal and early life health effects of arsenic exposure and arsenic remediation strategies for women of child-bearing age. Copyright © 2017 Elsevier Inc. All rights reserved.
De Vera, Mary A; Bhole, Vidula; Burns, Lindsay C; Lacaille, Diane
Aims While suboptimal adherence to statin medication has been quantified in real-world patient settings, a better understanding of its impact is needed, particularly with respect to distinct problems of medication taking. Our aim was to synthesize current evidence on the impacts of statin adherence, discontinuation and persistence on cardiovascular disease and mortality outcomes. Methods We conducted a systematic review of peer-reviewed studies using a mapped search of Medline, Embase and International Pharmaceutical Abstracts databases. Observational studies that met the following criteria were included: defined patient population; statin adherence exposure; defined study outcome [i.e. cardiovascular disease (CVD), mortality]; and reporting of statin-specific results. Results Overall, 28 studies were included, with 19 studies evaluating outcomes associated with statin adherence, six with statin discontinuation and three with statin persistence. Among adherence studies, the proportion of days covered was the most widely used measure, with the majority of studies reporting increased risk of CVD (statistically significant risk estimates ranging from 1.22 to 5.26) and mortality (statistically significant risk estimates ranging from 1.25 to 2.54) among non-adherent individuals. There was greater methodological variability in discontinuation and persistence studies. However, findings of increased CVD (statistically significant risk estimates ranging from 1.22 to 1.67) and mortality (statistically significant risk estimates ranging from 1.79 to 5.00) among nonpersistent individuals were also consistently reported. Conclusions Observational studies consistently report an increased risk of adverse outcomes associated with poor statin adherence. These findings have important implications for patients and physicians and emphasize the importance of monitoring and encouraging adherence to statin therapy. PMID:25364801
Full Text Available Naeem A Ali1, David Gutteridge2, Sajid Shahul3, William Checkley4, Jonathan Sevransky4, Greg S Martin2 1The Ohio State University Medical Center, Columbus, OH; 2Emory University, Atlanta, GA; 3Beth Israel Deaconess Medical Center, Boston, MA; 4Johns Hopkins University, Baltimore, MD, USA Abstract: Individual intensive care unit (ICU characteristics including staffing, expertise, continuity, and team structure, have been associated with patient outcomes. Separately, some aspects of care in ICUs have been implemented through treatment protocols. The United States Critical Illness and Injury Trials Group-Critical Illness Outcomes Study (USCIITG-CIOS was designed to determine whether the extent of protocol use in ICUs is associated with hospital survival in a large number of US ICUs. Here, we describe the study protocol and analysis plan approved by the USCIITG-CIOS steering committee. USCIITG-CIOS is a prospective, observational, ecological, multicentered study of mixed ICUs in the US. The data to be collected include organizational information for the ICU (eg, protocol availability and utilization, multidisciplinary staffing assessment, and patient level information (eg, demographics, acute and chronic medical conditions. The primary outcome is all-cause hospital mortality, with the objective being to determine whether there is an association between protocol number and hospital mortality for ICU patients. USCIITG-CIOS is powered to detect a 3% difference in crude hospital mortality between high-protocol and low-protocol use ICUs, dichotomized according to protocol number at the median. The analysis will utilize multivariable regression approaches to adjust for outcome clustering by ICU, with secondary linear analysis of protocol number and mortality and a variety of a priori planned ancillary studies. We anticipate at least 60 ICUs participating in USCIITG-CIOS to enroll approximately 6000 study subjects. USCIITG-CIOS is a multicenter study
Naughton, B J; Mylotte, J M; Tayara, A
To derive a prediction model of 30 day mortality for nursing home-acquired pneumonia (NHAP) based on factors that can be readily identified by nursing home staff at the time of diagnosis and to apply the model to management issues related to NHAP including clarifying the importance of prepneumonia functional status as a predictor of outcome of NHAP. This was a retrospective chart review of 378 episodes of NHAP treated in the nursing home or hospital during two periods: November 1997 to April 1998 and November 1998 to April 1999. Eleven nursing homes in the greater Buffalo, NY region. Nursing home residents with radiographically proven pneumonia who had at least one of the following signs/symptoms: cough, fever, purulent sputum, respiratory rate > or =25 breaths/minute, localized auscultatory findings, or pleuritic pain. Status (alive or dead) of each resident at 30 days (30 day mortality) after diagnosis of NHAP was the dependent variable. Factors predicting 30 day mortality were identified by logistic regression analysis. A scoring system was developed based on the results of the logistic model. Each episode of NHAP in the derivation cohort was scored using the model and the cohort was stratified by the model score into six categories or risk for mortality (0-5). The predictability of the model in the derivation cohort was measured using receiver operator characteristics curve analysis. Of 378 episodes of NHAP, 74% were treated initially in the nursing home and 26% were hospitalized initially for treatment. The overall 30 day mortality was 21.4%; however, the mortality rate was significantly higher for those treated initially in the hospital (29.6% vs 16.6%; P = .012). Logistic regression analysis identified four predictors of 30 day mortality: (1) respiratory rate >30 breaths/minute (2 points), (2) pulse > 125 beats/minute (1 point), (3) altered mental status (1 point), and (4) a history of dementia (1 point). Applying the scoring system to each episode in the
Veiga, Dalila; Luís, Clara; Parente, Daniela; Abelha, Fernando
Most studies that follow up hepatectomy cases are limited in scope to an investigation of mortality and morbidity rates or the costs and length of hospital stay. In this study the authors aimed to characterize the quality of life and to evaluate mortality and its determinants after hepatectomy. This prospective study was carried in a Post-Anaesthesia Care Unit (PACU) over 15 months, and 70 patients submitted to hepatectomy were enrolled. Demographic and peri-operative characteristics were evaluated for associations with mortality. At admission and 6 months after discharge, patients completed a Short Form-36 questionnaire (SF-36) and have their independence in Activities of Daily Living (ADL) was evaluated. Binary and multiple logistic regression analyses were used to evaluate of associations with mortality, and the Wilcoxon signed rank test was used to compare SF-36 scores before and after 6 months after hepatectomy. The mortality rate was 19% at 6 months. Multivariate analysis identified postoperative delirium as an independent determinant for mortality. Six months after discharge, 46% patients stated that their health in general was better or much better than that 1 year previously. Six months after hepatectomy, patients had worse scores in the physical function domain of SF-36; however, scores for all the other domains did not differ. At this time point, patients were more dependent in instrumental ADL than before surgery (32% versus 7%, p = 0.027). This study identified postoperative delirium as an independent risk factor for mortality 6 months after hepatectomy. After 6 months, survivors were more dependent in instrumental ADL tasks and had worse scores in the physical function domain of SF-36.
Intramedullary Nail. 65 %. 24 %. 11 %. Forty one (89%) patients had good to excellent early functional outcome, 3 (6.5%) had fair, and 2 (4.3%) had a poor early functional outcome (Figure 5). Figure 5. Proportion of the study population with various early functional outcomes (HSS scores) at 3 months post treatment. 41 %.
Full Text Available The effect of dyslipidemia on peritoneal dialysis (PD patients based on the presence of residual renal function (RRF; renal creatinine clearance >2 mL/min/1.73 m2 is unknown. Data from the Taiwan Renal Registry Data System between 2005 and 2012 were analyzed to estimate the association between dyslipidemia and mortality in PD patients. Long-term PD patients (n = 8032 were divided into groups with (RRF; n = 2691, 33.5% and without RRF (non-RRF; n = 5341, 66.5%. The primary outcome was three-year mortality, and multivariate Cox regression was used for survival analysis. After stratifying the total cholesterol (TC level between the first and third years, the hazard ratio for mortality was estimated. In the non-RRF group, TC < 120 mg/dL was associated with independently increased risk of mortality. In the RRF group, low TC was not independently correlated with increased mortality, but TC > 285 mg/dL was associated with increased risk. PD patients with higher level of TC (>200 mg/dL in both first and third years of dialysis had significantly lower risk of mortality. In this nationwide cohort study, PD patients without RRF who had low TC level had the highest mortality, in contrast to those with RRF. Malnutrition in long-term PD patients without RRF is an important issue to be monitored.
Full Text Available Background/Aim. Acute heart failure (AHF is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and longterm mortality. The aim of this study was to investigate characteristics, outcomes and one year mortality of patients with AHF in the local population. Methods. This prospective study consisted of 64 consecutive unselected patients treated in the Coronary Care Unit of the Emergency Centre (Clinical Center of Serbia, Belgrade and were followed for one year after the discharge. Results. Mean age of the patients was 63.6 ± 12.6 years and 59.4% were males. Acute congestion (43.8% and pulmonary edema (39.1% were the most common presentations of AHF. Mean left ventricular ejection fraction (LVEF was 39.7% ± 9.25%, while 44.4% of the patients had LVEF ≥ 50%. At discharge, 55.9% of the patients received therapy with β-blockers, 94.9% diuretics, out of which 47.7% spironolactone, 94.9% patients were given ACE-inhibitors or angiotensin receptor blokcers (ARB. The 12-month all-cause mortality was 26.5%. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF, reduced fraction of shortening (FS and a higher tricuspid velocity. Conclusion. One year mortality of our patients with AHF was high, similar to the known European studies. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF and LVFS and a higher tricuspid velocity.
Bassetti, Matteo; Righi, Elda; Ansaldi, Filippo; Merelli, Maria; Trucchi, Cecilia; Cecilia, Trucchi; De Pascale, Gennaro; Diaz-Martin, Ana; Luzzati, Roberto; Rosin, Chiara; Lagunes, Leonel; Trecarichi, Enrico Maria; Sanguinetti, Maurizio; Posteraro, Brunella; Garnacho-Montero, Jose; Sartor, Assunta; Rello, Jordi; Rocca, Giorgio Della; Antonelli, Massimo; Tumbarello, Mario
Candida is the most common cause of severe yeast infections worldwide, especially in critically ill patients. In this setting, septic shock attributable to Candida is characterized by high mortality rates. The aim of this multicenter study was to investigate the determinants of outcome in critically ill patients with septic shock due to candidemia. This was a retrospective study in which patients with septic shock attributable to Candida who were treated during the 3-year study period at one or more of the five participating teaching hospitals in Italy and Spain were eligible for enrolment. Patient characteristics, infection-related variables, and therapy-related features were reviewed. Multiple logistic regression analysis was performed to identify the risk factors significantly associated with 30-day mortality. A total of 216 patients (mean age 63.4 ± 18.5 years; 58.3 % males) were included in the study. Of these, 163 (75 %) were admitted to the intensive care unit. Overall 30-day mortality was 54 %. Significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, dysfunctional organs, and inadequate antifungal therapy were compared in nonsurvivors and survivors. No differences in survivors versus nonsurvivors were found in terms of the time from positive blood culture to initiation of adequate antifungal therapy. Multivariate logistic regression identified inadequate source control, inadequate antifungal therapy, and 1-point increments in the APACHE II score as independent variables associated with a higher 30-day mortality rate.
Vasilevskis, Eduard E; Kuzniewicz, Michael W; Cason, Brian A; Lane, Rondall K; Dean, Mitzi L; Clay, Ted; Rennie, Deborah J; Dudley, R Adams
Existing intensive care unit (ICU) mortality measurement systems address in-hospital mortality only. However, early postdischarge mortality contributes significantly to overall 30-day mortality. Factors associated with early postdischarge mortality are unknown. We performed a retrospective study of 8484 ICU patients. Our primary outcome was early postdischarge mortality: death after hospital discharge and 30 days or less from ICU admission. Cox regression models assessed the association between patient, hospital, and utilization factors and the primary outcome. In multivariate analyses, the hazard for early postdischarge mortality increased with rising severity of illness and decreased with full-code status (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.21-0.49). Compared with discharges home, early postdischarge mortality was highest for acute care transfers (HR, 3.18; 95% CI, 2.45-4.12). Finally, patients with very short ICU length of stay (<1 day) had greater early postdischarge mortality (HR, 1.86; 95% CI; 1.32-2.61) than those with longest stays (≥7 days). Early postdischarge mortality is associated with patient preferences (full-code status) and decisions regarding timing and location of discharge. These findings have important implications for anyone attempting to measure or improve ICU performance and who rely on in-hospital mortality measures to do so. Published by Elsevier Inc.
Lu, Jun Ling; Molnar, Miklos Z; Naseer, Adnan; Mikkelsen, Margit K; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P
Compared with normal weight, obesity might be associated with worse clinical outcomes, including chronic kidney disease. Whether this association is modified by age is not known. We investigated the association of BMI with progressive loss of kidney function and all-cause mortality in US veterans. In a national cohort of 3,376,187 US veterans with an estimated glomerular filtration rate (eGFR) of more than 60 mL/min per 1·73 m(2), we assessed the association of BMI in patients of different ages (5 mL/min per 1·73 m(2)). The lowest risk for loss of kidney function was noted in patients with BMI of at least 25 kg/m(2) but less than 30 kg/m(2). A generally consistent U-shaped association was noted between BMI and rapid loss of kidney function that was more prominent with increasing age, except in the patients younger than 40 years, in whom BMI did not seem to be predictive of renal function impairment. 672,341 veterans died (28·7 per 1000 patient-years, 95% CI 28·6-28·7) over a median follow-up of 6·8 years (IQR 6·5-7·7). BMI also showed a U-shaped association with mortality, which was similar in all age groups. A BMI of 30 kg/m(2) or more is associated with rapid loss of kidney function in patients with eGFR of at least 60 mL/min per 1·73 m(2), and this association is accentuated in older patients. A BMI of 35 kg/m(2) or more is also associated with high mortality. A BMI of at least 25 kg/m(2) but less than 30 kg/m(2) is associated with the best clinical outcomes. National Institute of Health, Memphis VA Medical Center, Long Beach VA Healthcare System, Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, and VA Information Resource Center. Copyright © 2015 Elsevier Ltd. All rights reserved.
Saratzis, Athanasios; Sarafidis, Pantelis; Melas, Nikolaos; Saratzis, Nikolaos; Kitas, George
Renal function may be associated with poor outcome following endovascular abdominal aortic aneurysm repair (EVAR), but this relationship has not been adequately investigated. The aim of this study is to evaluate the association of estimated glomerular filtration rate (eGFR) with cardiovascular events and all-cause mortality after EVAR. Prospective cohort study of patients undergoing elective EVAR; eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula, and patients were divided in four groups (eGFR ≥ 90 mL/min/1.73 m(2), group 1; 60-89, group 2; 30-59, group 3; stroke, and vascular complications. Kaplan-Meier curves were constructed, and between-group comparisons were performed adjusted for variables that differed at baseline. A total of 383 patients (mean age, 69 ± 8 years; mean abdominal aortic aneurysm diameter, 6.2 ± 1.4 cm) were included. Over a mean follow-up of 34 ± 12 months, the following events occurred: 20 deaths (5.2%), 15 nonfatal myocardial infarctions (3.9%), 9 nonfatal strokes (2.3%), and 7 peripheral vascular complications (1.8%). Patients with an eGFR function is associated with an increase in cardiovascular events and mortality following elective EVAR. Copyright © 2013 Society for Vascular Surgery. All rights reserved.
Alfred C Banda
Full Text Available BACKGROUND: HIV/AIDS affects all sectors of the population and the defence forces are not exempt. A national survey was conducted in all public and private sectors in Malawi that provide antiretroviral therapy (ART to determine the uptake of ART by army personnel, their outcomes while on treatment, and the impact of ART on mortality in the Malawi Defence Force. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cohort analysis was carried out, collecting data on access and retention on treatment from all 103 public and 38 private sector ART clinics in Malawi, using standardised patient master cards and clinic registers. Observations were censored on December 31(st 2006. Independent data on mortality trends in army personnel from all causes between 2002 and 2006 were available from army records. By December 31(st 2006, there were 85,168 patients ever started on ART in both public and private sectors, of whom 547 (0.7% were army personnel. Of these, 22% started ART in WHO clinical stage 1 or 2 with a CD4-lymphocyte count of
Behlau, Mara; Madazio, Glaucya; Oliveira, Gisele
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
Savva, Athina; Brouwer, Matthijs C.; Valls Serón, Mercedes; Le Roy, Didier; Ferwerda, Bart; van der Ende, Arie; Bochud, Pierre-Yves; van de Beek, Diederik; Calandra, Thierry
Pneumococcal meningitis is the most frequent and critical type of bacterial meningitis. Because cytokines play an important role in the pathogenesis of bacterial meningitis, we examined whether functional polymorphisms of the proinflammatory cytokine macrophage migration inhibitory factor (MIF) were associated with morbidity and mortality of pneumococcal meningitis. Two functional MIF promoter polymorphisms, a microsatellite (−794 CATT5–8; rs5844572) and a single-nucleotide polymorphism (−173 G/C; rs755622) were genotyped in a prospective, nationwide cohort of 405 patients with pneumococcal meningitis and in 329 controls matched for age, gender, and ethnicity. Carriages of the CATT7 and −173 C high-expression MIF alleles were associated with unfavorable outcome (P = 0.005 and 0.003) and death (P = 0.03 and 0.01). In a multivariate logistic regression model, shock [odds ratio (OR) 26.0, P = 0.02] and carriage of the CATT7 allele (OR 5.12, P = 0.04) were the main predictors of mortality. MIF levels in the cerebrospinal fluid were associated with systemic complications and death (P = 0.0002). Streptococcus pneumoniae strongly up-regulated MIF production in whole blood and transcription activity of high-expression MIF promoter Luciferase reporter constructs in THP-1 monocytes. Consistent with these findings, treatment with anti-MIF immunoglogulin G (IgG) antibodies reduced bacterial loads and improved survival in a mouse model of pneumococcal pneumonia and sepsis. The present study provides strong evidence that carriage of high-expression MIF alleles is a genetic marker of morbidity and mortality of pneumococcal meningitis and also suggests a potential role for MIF as a target of immune-modulating adjunctive therapy. PMID:26976591
Winther-Jensen, Matilde; Pellis, Tommaso; Kuiper, Michael
AIM: To assess older age as a prognostic factor in patients resuscitated from out-of-hospital-cardiac arrest (OHCA) and the interaction between age and level of target temperature management. METHODS AND RESULTS: 950 patients included in the target temperature management (TTM) trial were randomly...... allocation was not statistically significant for either mortality or neurological outcome. CONCLUSION: Increasing age is associated with significantly increased mortality after OHCA, but mortality rate is not influenced by level of target temperature. Risk of poor neurological outcome also increases with age...
Lund, Stine; Rasch, Vibeke; Hemed, Maryam; Boas, Ida Marie; Said, Azzah; Said, Khadija; Makundu, Mkoko Hassan; Nielsen, Birgitte Bruun
Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse. We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality. Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74). Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings. Clinical
Theocharis, George J; Arvaniti, Vassiliki; Assimakopoulos, Stelios F; Thomopoulos, Konstantinos C; Xourgias, Vassilis; Mylonakou, Irini; Nikolopoulou, Vassiliki N
AIM: To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians. METHODS: We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups: Group A (65-80 years old) and Group B (> 80 years old). RESULTS: Four hundred and sixteen patients over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B 147 patients. Co-morbidity was more common in octogenarians (P = 0.04). The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians (P = 0.05) and more patients died in the group of octogenarians compared to the younger age group (P = 0.02). Inability to perform endoscopic examination (P = 0.002), presence of high risk for rebleeding stigmata (P = 0.004), urea on admission (P = 0.036), rebleeding (P = 0.004) and presence of severe co-morbidity (P < 0.0001) were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality (P = 0.032). CONCLUSION: While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome. PMID:18609689
Walther, Sebastian; Eisenhardt, Sarah; Bohlhalter, Stephan; Vanbellingen, Tim; Müri, René; Strik, Werner; Stegmayer, Katharina
The functional outcome of schizophrenia is heterogeneous and markers of the course are missing. Functional outcome is associated with social cognition and negative symptoms. Gesture performance and nonverbal social perception are critically impaired in schizophrenia. Here, we tested whether gesture performance or nonverbal social perception could predict functional outcome and the ability to adequately perform relevant skills of everyday function (functional capacity) after 6 months. In a naturalistic longitudinal study, 28 patients with schizophrenia completed tests of nonverbal communication at baseline and follow-up. In addition, functional outcome, social and occupational functioning, as well as functional capacity at follow-up were assessed. Gesture performance and nonverbal social perception at baseline predicted negative symptoms, functional outcome, and functional capacity at 6-month follow-up. Gesture performance predicted functional outcome beyond the baseline measure of functioning. Patients with gesture deficits at baseline had stable negative symptoms and experienced a decline in social functioning. While in patients without gesture deficits, negative symptom severity decreased and social functioning remained stable. Thus, a simple test of hand gesture performance at baseline may indicate favorable outcomes in short-term follow-up. The results further support the importance of nonverbal communication skills in subjects with schizophrenia. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
Background Women in Nigeria face some of the highest maternal mortality risks in the world. We explore the benefits and cost-effectiveness of individual and integrated packages of interventions to prevent pregnancy-related deaths. Methods We adapt a previously validated maternal mortality model to Nigeria. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to Southwest and Northeast zones using survey-based data. Strategies consisted of improving coverage of effective interventions, and could include improved logistics. Results Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality, was cost saving in the Southwest zone and cost-effective elsewhere, and prevented nearly 1 in 5 abortion-related deaths. However, with a singular focus on family planning and safe abortion, mortality reduction would plateau below MDG 5. Strategies that could prevent 4 out of 5 maternal deaths included an integrated and stepwise approach that includes increased skilled deliveries, facility births, access to antenatal/postpartum care, improved recognition of referral need, transport, and availability quality of EmOC in addition to family planning and safe abortion. The economic benefits of these strategies ranged from being cost-saving to having incremental cost-effectiveness ratios less than $500 per YLS, well below Nigeria’s per capita GDP. Conclusions Early intensive efforts to improve family planning and control of fertility choices, accompanied by a stepwise effort to scale-up capacity for integrated maternal health services over several years, will save lives and provide equal or greater value than many public health interventions we consider among the most cost-effective (e.g., childhood immunization). PMID:22978519
Erim Daniel O
Full Text Available Abstract Background Women in Nigeria face some of the highest maternal mortality risks in the world. We explore the benefits and cost-effectiveness of individual and integrated packages of interventions to prevent pregnancy-related deaths. Methods We adapt a previously validated maternal mortality model to Nigeria. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to Southwest and Northeast zones using survey-based data. Strategies consisted of improving coverage of effective interventions, and could include improved logistics. Results Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality, was cost saving in the Southwest zone and cost-effective elsewhere, and prevented nearly 1 in 5 abortion-related deaths. However, with a singular focus on family planning and safe abortion, mortality reduction would plateau below MDG 5. Strategies that could prevent 4 out of 5 maternal deaths included an integrated and stepwise approach that includes increased skilled deliveries, facility births, access to antenatal/postpartum care, improved recognition of referral need, transport, and availability quality of EmOC in addition to family planning and safe abortion. The economic benefits of these strategies ranged from being cost-saving to having incremental cost-effectiveness ratios less than $500 per YLS, well below Nigeria’s per capita GDP. Conclusions Early intensive efforts to improve family planning and control of fertility choices, accompanied by a stepwise effort to scale-up capacity for integrated maternal health services over several years, will save lives and provide equal or greater value than many public health interventions we consider among the most cost-effective (e.g., childhood immunization.
Saha, Michael V; Davis, Robert E; Hondula, David M
Mortality rates increase immediately after periods of high air temperature. In the days and weeks after heat events, time series may exhibit mortality displacement-periods of lower than expected mortality. We examined all-cause mortality and meteorological data from 1980 to 2009 in the cities of Atlanta, Georgia; Boston, Massachusetts; Minneapolis-St. Paul, Minnesota; Philadelphia, Pennsylvania; Phoenix, Arizona; Seattle, Washington; and St. Louis, Missouri. We modeled baseline mortality using a generalized additive model. Heat waves were defined as periods of 3 or more consecutive days in which the apparent temperature exceeded a variable percentile. For each heat wave, we calculated the sum of excess and deficit mortality. Mortality displacement, which is the ratio of grand sum deficit to grand sum excess mortality, decreased as a function of event strength in all cities. Displacement was close to 1.00 for the weakest events. At the highest temperatures, displacement varied from 0.35 (95% confidence interval: 0.21, 0.55) to 0.75 (95% confidence interval: 0.54, 0.97). We found strong evidence of acclimatization across cities. Without consideration of displacement effects, the net impacts of heat-wave mortality are likely to be significant overestimations. A statistically significant positive relationship between the onset temperature of nondisplaced heat mortality and mean warm-season temperature (R(2) = 0.78, P < 0.01) suggests that heat mortality thresholds may be predictable across cities.
Christopher J Miller
Full Text Available Non-AIDS conditions such as cardiovascular disease and non-AIDS defining cancers dominate causes of morbidity and mortality among persons with HIV on suppressive combination antiretroviral therapy. Accurate estimates of disease incidence and of risk factors for these conditions are important in planning preventative efforts.With use of medical records, serious non-AIDS events, AIDS events, and causes of death were adjudicated using pre-specified criteria by an Endpoint Review Committee in two large international trials. Rates of serious non-AIDS which include cardiovascular disease, end-stage renal disease, decompensated liver disease, and non-AIDS cancer, and other serious (grade 4 adverse events were determined, overall and by age, over a median follow-up of 4.3 years for 3,570 participants with CD4+ cell count ≥300 cells/mm³ who were taking antiretroviral therapy and had an HIV RNA level ≤500 copies/mL. Cox models were used to examine the effect of age and other baseline factors on risk of a composite outcome of all-cause mortality, AIDS, or serious non-AIDS.Five-year Kaplan-Meier estimates of the composite outcome, overall and by age were 8.3% (overall, 3.6% (<40, 8.7% (40-49 and 16.1% (≥50, respectively (p<0.001. In addition to age, smoking and higher levels of interleukin-6 and D-dimer were significant predictors of the composite outcome. The composite outcome was dominated by serious non-AIDS events (overall 65% of 277 participants with a composite event. Most serious non-AIDS events were due to cardiovascular disease and non-AIDS cancers.To date, few large studies have carefully collected data on serious non-AIDS outcomes. Thus, reliable estimates of event rates are scarce. Data cited here, from a geographically diverse cohort, will be useful for planning studies of interventions aimed at reducing rates of serious non-AIDS events among people with HIV.
Wang, Tsai-Yu; Hung, Chia-Yen; Shie, Shian-Sen; Chou, Pai-Chien; Kuo, Chih-Hsi; Chung, Fu-Tsai; Lo, Yu-Lun; Lin, Shu-Min
Recent epidemiologic studies have showed that candidemia is an important nosocomial infection in hospitalized patients. The majority of candidemia patients were non-neutropenic rather than neutropenic status. The aim of this study was to determine the clinical outcome of non-neutropenic patients with candidemia and to measure the contributing factors for mortality. A total of 163 non-neutropenic patients with candidemia during January 2010 to December 2013 were retrospectively enrolled. The patients' risk factors for mortality, clinical outcomes, treatment regimens, and Candida species were analyzed. The overall mortality was 54.6%. Candida albicans was the most frequent Candida species (n = 83; 50.9% of patients). Under multivariate analyses, hemodialysis (OR, 4.554; 95% CI, 1.464-14.164) and the use of amphotericin B deoxycholate (OR, 8.709; 95% CI, 1.587-47.805) were independent factors associated with mortality. In contrast, abdominal surgery (OR, 0.360; 95% CI, 0.158-0.816) was associated with a better outcome. The overall mortality is still high in non-neutropenic patients with candidemia. Hemodialysis and use of amphotericin B deoxycholate were independent factors associated with mortality, whereas prior abdominal surgery was associated with a better outcome.
van Eijk RPA
Full Text Available Ruben PA van Eijk,1 Marinus JC Eijkemans,2 Dimitris Rizopoulos,3 Leonard H van den Berg,4,* Stavros Nikolakopoulos5,* 1Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands; 2Department of Biostatistics, University Medical Center Utrecht, Utrecht, the Netherlands; 3Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands; 4Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands; 5Department of Biostatistics, University Medical Center Utrecht, Utrecht, the Netherlands *These authors contributed equally to this work Objective: Amyotrophic lateral sclerosis (ALS clinical trials based on single end points only partially capture the full treatment effect when both function and mortality are affected, and may falsely dismiss efficacious drugs as futile. We aimed to investigate the statistical properties of several strategies for the simultaneous analysis of function and mortality in ALS clinical trials. Methods: Based on the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT database, we simulated longitudinal patterns of functional decline, defined by the revised amyotrophic lateral sclerosis functional rating scale (ALSFRS-R and conditional survival time. Different treatment scenarios with varying effect sizes were simulated with follow-up ranging from 12 to 18 months. We considered the following analytical strategies: 1 Cox model; 2 linear mixed effects (LME model; 3 omnibus test based on Cox and LME models; 4 composite time-to-6-point decrease or death; 5 combined assessment of function and survival (CAFS; and 6 test based on joint modeling framework. For each analytical strategy, we calculated the empirical power and sample size. Results: Both Cox and LME models have increased false-negative rates when treatment exclusively affects either function or survival. The joint model has superior power compared to other strategies. The composite end point
Full Text Available Medical comorbidities affect outcome in elderly patients with hip fracture. This study was designed to preliminarily evaluate the usefulness of a hip-fracture unit led by an internal medicine specialist.In-hospital and 3-month outcomes in patients with hip fracture were prospectively evaluated in 121 consecutive patients assessed before and followed after surgery by a multidisciplinary team led by internal medicine specialist; 337 consecutive patients were recalled from ICD-9 discharge records and considered for comparison regarding in-hospital mortality.In the intervention period, patients treated within 48 hours were 54% vs. 26% in the historical cohort (P<0.0001. In-hospital mortality remained stable at about 2.3 per 1000 person-days. At 3 months, 10.3% of discharged patients had died, though less than 8% of patients developed postoperative complications (mainly pneumonia and respiratory failure. The presence of more than 2 major comorbidities and the loss of 3 or more BADL were independent predictors of death. 50/105 patients recovered previous functional capacity, but no independent predictor of functional recovery could be identified. Mean length of hospital stay significantly decreased in comparison to the historical cohort (13.6± 4.7 vs 17 ± 5 days, p = 0.0001. Combined end-point of mortality and length of hospitalization < 12 days was significantly lower in study period (27 vs 34%, p <0.0132.Identification and stabilization of concomitant clinical problems by internal medicine specialists may safely decrease time to surgery in frail subjects with hip fracture. Moreover, integrated perioperative clinical management may shorten hospital stay with no apparent increase in in-hospital mortality and ultimately improve the outcome. These results are to be confirmed by a larger study presently ongoing at our institution.
Balhara, Kamna S; Silvestri, David M; Tyler Winders, W; Selvam, Anand; Kivlehan, Sean M; Becker, Torben K; Levine, Adam C
Malnutrition contributes to paediatric morbidity and mortality in disasters and complex emergencies, but summary data describing specific nutritional interventions in these settings are lacking. This systematic review aimed to characterise such interventions and their effects on paediatric mortality, anthropometric measures and serum markers of nutrition. A systematic search of OVID MEDLINE, Cochrane Library and relevant grey literature was conducted. We included all randomised controlled trials and observational controlled studies evaluating effectiveness of nutritional intervention(s) on defined health outcomes in children and adolescents (0-18 years) within a disaster or complex emergency. We extracted study characteristics, interventions and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. A total of 31 studies met inclusion criteria. Most were conducted in Africa (17), during periods of conflict or hunger gaps (14), and evaluated micronutrient supplementation (14) or selective feeding (10). Overall study quality was low, with only two high and four moderate quality studies. High- and medium-quality studies demonstrated positive impact of fortified spreads, ready-to-use therapeutic foods, micronutrient supplementation, and food and cash transfers. In disasters and complex emergencies, high variability and low quality of controlled studies on paediatric malnutrition limit meaningful data aggregation. If existing research gaps are to be addressed, the inherent unpredictability of humanitarian emergencies and ethical considerations regarding controls may warrant a paradigm shift in what constitutes adequate methods. Periodic hunger gaps may offer a generalisable opportunity for robust trials, but consensus on meaningful nutritional endpoints is needed. © 2017 John Wiley & Sons Ltd.
Inaba, Colette S; Koh, Christina Y; Sujatha-Bhaskar, Sarath; Silva, Jack P; Chen, Yanjun; Nguyen, Danh V; Nguyen, Ninh T
Contemporary mortality after bariatric surgery is low and has been decreasing over the past 2 decades. Most studies have reported inpatient or 30-day mortality, which may not represent the true risk of bariatric surgery. The objective of this study was to examine 1-year mortality and factors predictive of 1-year mortality after contemporary laparoscopic bariatric surgery. Using the 2008 to 2012 Bariatric Outcomes Longitudinal Database (BOLD), data from 158,606 operations were analyzed, including 128,349 (80.9%) laparoscopic Roux-en-Y gastric bypass (LRYGB) and 30,257 (19.1%) laparoscopic sleeve gastrectomy (LSG) operations. Multivariate logistic regression was used to determine independent risk factors associated with 1-year mortality for each type of procedure. The 30-day and 1-year mortality rates for LRYGB were 0.13% and 0.23%, respectively, and for LSG were 0.06% and 0.11%, respectively. Risk factors for 1-year mortality included older age (LRYGB: adjusted odds ratio [AOR] 1.05 per year, p Contemporary 1-year mortality after laparoscopic bariatric surgery is much lower than previously reported, at <0.25%. It is important to continually refine techniques and perioperative management in order to minimize leaks, hemorrhage, and pulmonary embolus after bariatric surgery because these complications contribute to a higher risk of mortality. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Yuan-Ming Tsai; Kuan-Hsun Lin; Tsai-Wang Huang; Chun-Ying Chen; Zhi-Jie Hong; Sheng-Der Hsu
Background: Blunt chest trauma is associated with a high risk of mortality. Respiratory complications may necessitate prolonged ventilation and result in death. The present study aimed to investigate possible signs of trauma and the prognosis of trauma patients with thoracic injuries and identify risk factors for mortality. Patients and Methods: A retrospective study was performed to investigate the clinical characteristics and treatment outcomes of trauma patients with blunt chest injuries ...
Good functional recovery was achieved by 139(66.5%) of the patients in our series, whereas moderate and severe disability accounted for 18.2% and 5.3% while mortality accounted for 10%. Increasing age (p=0.006), a lower GCS score at admission, pupillary abnormalities, a history of loss of consciousness and admission ...
Keeling, W Brent; Binongo, Jose; Sarin, Eric L; Leshnower, Bradley G; Chen, Edward P; Lattouf, Omar M; Thourani, Vinod H; Guyton, Robert A; Halkos, Michael E
Transfusion has been linked with increased postoperative morbidity and death after cardiac operations. The purpose of this study was to determine the associations among The Society of Thoracic Surgeons Predicted Risk of Mortality (PROM), transfusion, and postoperative outcomes in patients who underwent isolated primary valve operations. A retrospective review of the local Society of Thoracic Surgeons database of 1,575 adults undergoing isolated primary valve operations from 2003 to 2013 at a United States academic center was performed. Patients were compared by their postoperative transfusion status (NONE vs TRANS) and by PROM. Taking into account procedure type and preoperative hemoglobin, three-step multiple linear or logistic regression analyses were performed to assess (1) the influence of PROM on postoperative outcomes, (2) influence of PROM on transfusion, and (3) influence of PROM and transfusion on postoperative outcomes. Of 1,575 patients studied, 1,245 (79%) received transfusions. The mean PROM was 1.2% (95% confidence interval [CI], 1.1 to 1.3) for patients in the NONE group, and was 2.7% (95% CI, 2.6 to 2.9) for the TRANS group. The correlation between PROM and total red blood cell units transfused was r = 0.31 (p < 0.0001). Patients with a PROM of 4% to 8% (odds ratio [OR], 2.10; 95% CI, 1.28 to 3.45) and exceeding 8% (OR 3.80, 95% CI, 1.35 to 10.68) were more likely to receive transfusions than the low-risk (<4%) PROM stratum. For each percentage increase in PROM, the odds of transfusion increased by 27% (95% CI, 16% to 39%), controlling for procedure type and preoperative hemoglobin. There were no 30-day deaths in the NONE group, and rates of stroke, renal failure, and mediastinitis were lower. Composite event rates increased with increasing PROM (OR, 1.39; 95% CI, 1.19 to 1.63), with TRANS patients consistently showing a higher risk of major adverse cardiac events than NONE patients (OR, 7.47; 95% CI, 2.08 to 26.80). Increased PROM yielded higher
Scheen, André J
Empagliflozin, a sodium-glucose cotransporter type 2 (SGLT2) inhibitor, has shown a remarkable reduction in cardiovascular and all-cause mortality in patients with type 2 diabetes (T2D) and antecedents of cardiovascular disease in the EMPA-REG OUTCOME trial. This effect has been attributed to a hemodynamic rather than a metabolic effect, partly due to the osmotic/diuretic effect of empagliflozin and to the reduction in arterial blood pressure. The present review will: (1) summarize the results of specific studies having tested the blood pressure lowering effects of SGLT2 inhibitors; (2) describe the results of meta-analyses of trials having evaluated the effects on mortality and cardiovascular outcomes of lowering blood pressure in patients with T2D, with a special focus on baseline and target blood pressures; (3) compare the cardiovascular outcome results in EMPA-REG OUTCOME versus other major trials with antihypertensive agents in patients with T2D; and (4) evaluate post-hoc analyses from EMPA-REG OUTCOME, especially subgroups of patients of special interest regarding the blood pressure lowering hypothesis. Although BP reduction associated to empagliflozin therapy may partly contribute to the benefits reported in EMPA-REG OUTCOME, other mechanisms most probably play a greater role in the overall CV protection and reduction in mortality observed in this trial. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Park, Meyeon; Maristany, Daniela; Huang, Debbie; Shlipak, Michael G; Whooley, Mary
Tumor necrosis factor receptor type 1 (TNFR1) is associated with kidney disease and mortality risk in various populations , . We evaluated associations of TNFR1 with mortality and mediators of this relationship in doi: 10.1016/j.atherosclerosis.2017.05.021. Whether or not these associations are influenced by age, gender, or baseline kidney function are not known. We evaluated associations of TNFR1 levels with measures of kidney function stratifying by these variables. Our outcomes included estimated glomerular filtration rate (eGFR) 30 mg/g, and rapid kidney function loss, defined as a change in eGFR of greater than 3% per year.
Feigin, V L; Barker-Collo, S; Parag, V; Senior, H; Lawes, C M M; Ratnasabapathy, Y; Glen, E
Studying long-term stroke outcomes including body functioning (neurologic and neuropsychological impairments) and activity limitations and participation is essential for long-term evidence-based rehabilitation and service planning, resource allocation, and improving health outcomes in stroke. However, reliable data to address these issues is lacking. This study (February 2007-December 2008) sourced its participants from the population-based incidence study conducted in Auckland in 2002-2003. Participants completed structured self-administered questionnaires, and a face-to-face interview including a battery of neuropsychological tests. Logistic regression analysis was used to analyze associations between and within functional outcomes and their potential predictors. Of 418 5-year stroke survivors, two-thirds had good functional outcome in terms of neurologic impairment and disability (defined as modified Rankin Score <3), 22.5% had cognitive impairment indicative of dementia, 20% had experienced a recurrent stroke, almost 15% were institutionalized, and 29.6% had symptoms suggesting depression. Highly significant correlations were found between and within various measurements of body functioning (especially neuropsychological impairments), activity, and participation. Age, dependency, and depression were independently associated with most outcomes analyzed. The strong associations between neuropsychological impairment and other functional outcomes and across various measurements of body functioning, activity, and participation justify utilizing a multidisciplinary approach to studying and managing long-term stroke outcomes. Observed gender and ethnic differences in some important stroke outcomes warrant further investigations.
Gupta, Ankur; Allen, Larry A; Bhatt, Deepak L; Cox, Margueritte; DeVore, Adam D; Heidenreich, Paul A; Hernandez, Adrian F; Peterson, Eric D; Matsouaka, Roland A; Yancy, Clyde W; Fonarow, Gregg C
Public reporting of hospitals' 30-day risk-standardized readmission rates following heart failure hospitalization and the financial penalization of hospitals with higher rates have been associated with a reduction in 30-day readmissions but have raised concerns regarding the potential for unintended consequences. To examine the association of the Hospital Readmissions Reduction Program (HRRP) with readmission and mortality outcomes among patients hospitalized with heart failure within a prospective clinical registry that allows for detailed risk adjustment. Interrupted time-series and survival analyses of index heart failure hospitalizations were conducted from January 1, 2006, to December 31, 2014. This study included 115 245 fee-for-service Medicare beneficiaries across 416 US hospital sites participating in the American Heart Association Get With The Guidelines-Heart Failure registry. Data analysis took place from January 1, 2017, to June 8, 2017. Time intervals related to the HRRP were before the HRRP implementation (January 1, 2006, to March 31, 2010), during the HRRP implementation (April 1, 2010, to September 30, 2012), and after the HRRP penalties went into effect (October 1, 2012, to December 31, 2014). Risk-adjusted 30-day and 1-year all-cause readmission and mortality rates. The mean (SD) age of the study population (n = 115 245) was 80.5 (8.4) years, 62 927 (54.6%) were women, and 91 996 (81.3%) were white and 11 037 (9.7%) were black. The 30-day risk-adjusted readmission rate declined from 20.0% before the HRRP implementation to 18.4% in the HRRP penalties phase (hazard ratio (HR) after vs before the HRRP implementation, 0.91; 95% CI, 0.87-0.95; P service Medicare beneficiaries discharged after heart failure hospitalizations, implementation of the HRRP was temporally associated with a reduction in 30-day and 1-year readmissions but an increase in 30-day and 1-year mortality. If confirmed, this finding may require reconsideration of the HRRP in
Snarska, Katarzyna; Kapica-Topczewska, Katarzyna; Bachórzewska-Gajewska, Hanna; Małyszko, Jolanta
We evaluated renal function and the impact of renal function on in-hospital outcomes in patients with ischaemic and haemorrhagic stroke. We collected data from 766 patients with stroke; 637 (83.2 %) with ischaemic and 129 with haemorrhagic one. The mean serum creatinine on admission in patients with both types of stroke, who died, was significantly higher than in those who survived. Multivariate analysis showed that independent predictors of mortality in patients with ischaemic stroke were: ischemic heart disease or prior myocardial infarction, diabetes, admission glucose and eGFR on admission. Also, multivariate analysis showed that independent predictors of mortality in patients with haemorrhagic stroke were: age and admission glucose. Patients with haemorrhagic stroke, in particular with acute kidney injury during hospitalisation had significantly worse outcomes than patients with ischaemic stroke. Assessment of kidney function is prerequisite to employ the necessary measures to decrease the risk of in-hospital mortality among patients with acute stroke. Appropriate approach to patients with renal dysfunction (adequate hydration, avoidance of nephrotoxic drugs, drug dose adjustment etc) should be considered as preventive and therapeutic strategies in the management of acute stroke. © 2016 The Author(s) Published by S. Karger AG, Basel.
Hurd, Kelle; Barnabe, Cheryl
Indigenous populations of Canada, America, Australia, and New Zealand have increased rates and severity of rheumatic disease. Our objective was to summarize mortality outcomes and explore disease and social factors related to mortality. A systematic search was performed in medical (Medline, EMBASE, and CINAHL), Indigenous and conference abstract databases (to June 2015) combining search terms for Indigenous populations and rheumatic diseases. Studies were included if they reported measures of mortality (crude frequency, mortality rate, survival, and potential years of life lost (PYLL)) in Indigenous populations from the four countries. Of 5269 titles and abstracts identified, 504 underwent full-text review and 12 were included. No studies from New Zealand were found. In five Canadian studies of systemic lupus erythematosus (SLE) patients, First Nations ethnicity was associated with lower survival after adjusting for disease and social factors, and an increased frequency of death from lupus and its complications compared to Caucasians was found. All-cause mortality was higher in Native Americans (n = 2 studies) relative to Whites with SLE after adjusting for disease and social factors, but not in those with lupus nephritis alone. Australian Aborigines with SLE frequently developed infection and lupus complications leading to death (n = 3 studies). Mortality rates were increased in Pima Indians in the United States with rheumatoid arthritis (RA) compared to those without RA. One study in Native Americans with scleroderma found nearly all deaths were related to progressive disease. Canadian and American Indigenous populations with SLE have increased mortality rates compared to Caucasian populations. Mortality in Canadian and Australian Indigenous populations with SLE, and in Native American populations with RA and scleroderma, is frequently attributed to disease progression or complications. The proportional attribution of rheumatic disease severity and social factors
Bootsma, A M Jikke; Buurman, Bianca M; Geerlings, Suzanne E; de Rooij, Sophia E
To study differences in functional status at admission in acutely hospitalized elderly patients with urinary incontinence, a catheter, or without a catheter or incontinence (controls) and to determine whether incontinence or a catheter are independent risk factors for death, institutionalization, or functional decline. Prospective cohort study conducted between 2006 and 2008 with a 12-month follow-up. Eleven medical wards of 2 university teaching hospitals and 1 teaching hospital in The Netherlands. Participants included 639 patients who were 65 years and older, acutely hospitalized for more than 48 hours. Baseline characteristics, functional status, presence of urinary incontinence or catheter, length of hospital stay, mortality, institutionalization, and functional decline during admission and 3 and 12 months after admission were collected. Regression analyses were done to study a possible relationship between incontinence, catheter use, and adverse outcomes at 3 and 12 months. Of all patients, 20.7% presented with incontinence, 23.3% presented with a catheter, and 56.0% were controls. Patients with a catheter scored worst on all baseline characteristics. A catheter was an independent risk factor for mortality at 3 months (odds ratio [OR] = 1.73, 95% confidence interval [CI] 1.10-2.70), for institutionalization at 12 months (OR = 4.03, 95% CI 1.67-9.75), and for functional decline at 3 (OR = 2.17, 95% CI 1.32-3.54) and 12 months (OR = 3.37, 95% CI 1.81-6.25). Incontinence was an independent risk factor for functional decline at 3 months (OR = 1.84, 95% CI 1.11-3.04). There is an association between presence of a catheter, urinary incontinence, and development of adverse outcomes in hospitalized older patients. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Mburu, Gitau; Paing, Aung Zayar; Myint, Nwe Ni; Di, Win; Thu, Kaung Htet; Ram, Mala; Hoffmann, Christopher J; Wang, Bangyuan; Naing, Soe
Introduction There is a growing interest in the potential contribution the private sector can make towards increasing access to antiretroviral therapy (ART) in low- and middle-income settings. This article describes a public–private partnership that was developed to expand HIV care capacity in Yangon, Myanmar. The partnership was between private sector general practitioners (GPs) and a community-based non-governmental organization (International HIV/AIDS Alliance). Methods Retrospective analysis of 2119 patient records dating from March 2009 to April 2015 was conducted. Outcomes assessed were immunological response, loss to follow-up, all-cause mortality, and alive and retained in care. Follow-up time was calculated from the date of registration to the date of death, loss to follow-up, transfer out, or if still alive and known to be in care, until April 2015. Cox proportional hazards model was used to identify predictors of loss to follow-up and mortality. Kaplan–Meier survival analysis was used to estimate survival function of being alive and retained in care. Results The median number of patients for each of the 16 GPs was 42 (interquartile range (IQR): 25–227), and the median follow-up period was 13 months. The median patient age was 35 years (IQR: 30–41); 56.6% were men, 62 and 11.8% were in WHO Stage III and Stage IV at registration, respectively; median CD4 count at registration was 177 cells/mm3; and 90.7% were on ART in April 2015. The median CD4 count at registration increased from 122 cells/mm3 in 2009 to 194 cells/mm3 in 2014. Among patients on ART, CD4 counts increased from a median of 187 cells/mm3 at registration to 436 cells/mm3 at 36 months. The median time to initiation of ART among eligible patients was 29 days, with 93.8% of eligible patients being initiated on ART within 90 days. Overall, 3.3% patients were lost to follow-up, 4.2% transferred out to other health facilities, and 8.3% died during the follow-up period. Crude mortality rate
Jarvis, Joseph N; Bicanic, Tihana; Loyse, Angela; Namarika, Daniel; Jackson, Arthur; Nussbaum, Jesse C; Longley, Nicky; Muzoora, Conrad; Phulusa, Jacob; Taseera, Kabanda; Kanyembe, Creto; Wilson, Douglas; Hosseinipour, Mina C; Brouwer, Annemarie E; Limmathurotsakul, Direk; White, Nicholas; van der Horst, Charles; Wood, Robin; Meintjes, Graeme; Bradley, John; Jaffar, Shabbar; Harrison, Thomas
Cryptococcal meningitis (CM) is a leading cause of death in individuals infected with human immunodeficiency virus (HIV). Identifying factors associated with mortality informs strategies to improve outcomes. Five hundred one patients with HIV-associated CM were followed prospectively for 10 weeks during trials in Thailand, Uganda, Malawi, and South Africa. South African patients (n = 266) were followed for 1 year. Similar inclusion/exclusion criteria were applied at all sites. Logistic regression identified baseline variables independently associated with mortality. Mortality was 17% at 2 weeks and 34% at 10 weeks. Altered mental status (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.7-5.9), high cerebrospinal fluid (CSF) fungal burden (OR, 1.4 per log10 colony-forming units/mL increase; 95% CI, 1.0-1.8), older age (>50 years; OR, 3.9; 95% CI, 1.4-11.1), high peripheral white blood cell count (>10 × 10(9) cells/L; OR, 8.7; 95% CI, 2.5-30.2), fluconazole-based induction treatment, and slow clearance of CSF infection were independently associated with 2-week mortality. Low body weight, anemia (hemoglobin <7.5 g/dL), and low CSF opening pressure were independently associated with mortality at 10 weeks in addition to altered mental status, high fungal burden, high peripheral white cell count, and older age. In those followed for 1 year, overall mortality was 41%. Immune reconstitution inflammatory syndrome occurred in 13% of patients and was associated with 2-week CSF fungal burden (P = .007), but not with time to initiation of antiretroviral therapy (ART). CSF fungal burden, altered mental status, and rate of clearance of infection predict acute mortality in HIV-associated CM. The results suggest that earlier diagnosis, more rapidly fungicidal amphotericin-based regimens, and prompt immune reconstitution with ART are priorities for improving outcomes.
Fortrie, Gijs; Manintveld, Olivier C; Caliskan, Kadir; Bekkers, Jos A; Betjes, Michiel G H
Although chronic deterioration in renal function is frequently seen after cardiac transplantation, which is partly explained by the use of calcineurin inhibitors, data on the consequences of acute kidney injury (AKI) after cardiac transplantation are scarce. In the current study, the incidence of AKI and its impact on mortality and renal function was evaluated. Five hundred thirty-one cardiac transplant recipients (age ≥18 years) were evaluated for the postoperative incidence of AKI defined by the Kidney Disease Improving Global Outcome criteria. Secondary outcomes were renal function and mortality during the first postoperative year. Overall, 405 (76%) recipients met the AKI criteria of which 211 (40%) had AKI stage I, 119 (22%) stage II, 75 (14%) stage III, and 25 patients (5%) required renal replacement therapy (RRT). One-year mortality rates in patients without AKI, stages I, II, and III were 4.8%, 7.6%, 11.8%, and 14.7%, respectively (log-rank test for trend, P = 0.008). In patients that required RRT 1-year mortality was 28.2% (log-rank test P = 0.001). In multivariable analysis only AKI requiring RRT was an independent predictor of 1-year mortality (hazard ratio, 2.75; P = 0.03). Improvement in renal function, compared with baseline values, occurred in 27% of recipients 1 month after transplantation. This was less likely to occur after previous AKI (P ≤ 0.04). The AKI stages I to III were independently proportionally associated with a worse renal function 1 year after transplantation (P ≤ 0.01). Acute kidney injury is highly frequent after cardiac transplantation, and the stage of AKI is associated with increased mortality and impaired renal function in the first postoperative year.
Relationship between Kidney Dysfunction and Ischemic Stroke Outcomes: Albuminuria, but Not Estimated Glomerular Filtration Rate, Is Associated with the Risk of Further Vascular Events and Mortality after Stroke.
Lee, Seung-Jae; Lee, Dong-Geun
Estimated glomerular filtration rate (eGFR) and albuminuria are known to be associated with ischemic stroke outcomes. In this study, we investigated the longitudinal relationships of the two markers with mortality, vascular events and functional outcomes in a stroke cohort. A total of 295 patients with acute ischemic stroke were prospectively recruited in a single center between May 2012 and February 2015. Renal dysfunction was defined as a decreased eGFR (albuminuria (urine albumin-to-creatinine ratio ≥ 30 mg/g). Good functional outcome at 6 months was defined as a modified Rankin scale score ≤ 2, and the occurrence of major vascular events (stroke, acute coronary syndrome or peripheral artery occlusion) or death was monitored. The associations between renal dysfunction and mortality, major vascular events, and 6-month functional outcome were evaluated by the Cox proportional hazards model and logistic regression analysis. Unadjusted and adjusted hazards ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were obtained. A Kaplan-Meier survival curve for composite adverse events (major vascular events or death) was also computed according to the presence or absence of albuminuria. Albuminuria, not eGFR, was significantly associated with mortality (P = 0.028; HR 2.15; 95% CI 1.09-4.25) and major vascular events (P = 0.044; HR 2.24; 95% CI 1.02-4.94) in the multivariate Cox proportional hazards models adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history, initial National Institutes of Health Stroke Scale (NIHSS) score and eGFR. In addition, albuminuria was negatively associated with 6-month functional outcome in the multivariate logistic regression analysis adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history and eGFR (P = 0.001; OR 0.36; 95% CI 0.20-0.65), but the association disappeared when NIHSS score was
Shuvy, Mony; Chen, Shmuel; Vorobeichik, Dina; Krashin, Eilon; Shlomo, Nir; Goldenberg, Ilan; Pereg, David
Recent new therapeutic options have improved outcomes of acute coronary syndrome (ACS) patients. However, data regarding the incremental effect of the improved treatment on patients with renal dysfunction are limited. We sought to evaluate temporal trends in management and outcome of ACS patients according to renal function. The study population consisted of all ACS patients enrolled in the Acute Coronary Syndromes Israeli Survey (ACSIS) during 2002-2013. Patients were categorized as normal renal function, mild to moderate and severe renal insufficiency. Patient's characteristics, clinical data and outcomes were compared in each group between 2 time frames - early (2002-2006) vs. late (2008-2013). The study population included 11,234 patients. Regardless of renal function, patients enrolled in the recent surveys were more frequently selected for an invasive approach and were more commonly treated with guideline-based therapy. Among patients with normal renal function or mild to moderate renal dysfunction the improvement in treatment was associated with a significant reduction in 5-year mortality (10.1% vs. 12.6%, p=0.004, and 36% vs. 41.9%, p=0.01, respectively). On the other hand, outcomes of patients with severe renal insufficiency were unchanged. Multivariate analysis showed that reperfusion was associated with 41% mortality reduction in patients with mild to moderate renal insufficiency (HR=0.59 CI 95 0.48-0.72, prenal function and mild to moderate renal dysfunction but not in patients with severe renal dysfunction. Copyright Â© 2017 Elsevier B.V. All rights reserved.
Powell, T.; Kueppers, L. M.; Koven, C.; Johnson, D. J.; Faybishenko, B.; McDowell, N. G.; Chambers, J. Q.
Land surface models that include demographic and plant hydrodynamic processes are promising tools for characterizing how different drought scenarios may affect carbon cycling of tropical forests. The Ecosystem Demography (ED2) model, now formulated with such features, was used to evaluate how different drought scenarios affect mortality patterns, functional diversity and coexistence of four plant functional types (PFTs) of tropical trees at Barro Colorado Island (BCI), Panama. The four PFTs simulated were early- versus late-successional groups subdivided into drought-tolerant versus -intolerant groups. The hydrodynamic formulation enables the four PFTs to compete mechanistically along two largely orthogonal resource gradients of water and light. The model simulations produced considerable differences in the aboveground biomass response to contrasting drying scenarios that included longer dry seasons, El Nino related droughts, and drier dry seasons. The emergent mortality dynamics reflect the physiological trade-off between water-use and carbon fixation formulated by the hydrodynamic regulation over stomatal conductance. During dry periods, the model predicts increased mortality rates of pioneer trees compared to generalists and drought-intolerant trees compared to -tolerant trees. The model also predicts that surviving cohorts in the smallest size classes of drought-intolerant trees are occasionally primed for release from competition following acute droughts. Observations at BCI showed increased mortality rates for large trees (i.e. >30 cm dbh) during the 1982 El Nino drought, but not subsequent El Nino related droughts. The causes of the elevated mortality rates are explored with the model. Coexistence of four plant functional types in the model is highly sensitive to the parameterization of stem hydraulic conductivity; but, surprisingly not very sensitive to shifts in rainfall patterns. These results demonstrate (a) that plant hydrodynamics are critical for
Foebel, Andrea D; Heckman, George A; Ji, Kexin; Dubin, Joel A; Turpie, Irene D; Hussack, Patricia; McKelvie, Robert S
Heart failure (HF) is common in long-term care facilities (LTCs). This study compared mortality and hospitalization rates and examined predictors of these outcomes among new LTC residents with and without HF. This prospective cohort study followed 546 newly admitted residents from 42 LTCs for up to 1 year. Health information was collected from participant and caregiver interviews, physicians' records, diagnostic procedures, and hospitalization records. Multivariate logistic regression modeling determined predictors of hospitalization among residents, and Cox proportional hazards regression determined predictors for time to mortality. HF prevalence was 21.4%. The sample was predominantly (>70%) female, and individuals with HF were significantly older with higher prevalence of reduced left ventricular ejection fraction. Overall annual mortality and hospitalization rates were 24% and 27%, respectively. Among residents with HF, 42% died and 31% were hospitalized within 1 year. Among residents with HF, use of major tranquilizers was the strongest predictor of sooner mortality; use of anticoagulants and major tranquilizers also increased mortality risk, whereas higher baseline function was associated with longer time to mortality. History of peripheral vascular disease was the strongest predictor of hospitalizations among residents with HF, and use of antiplatelet agents and history of any smoking exposure increased this risk. Among LTC residents, HF is associated with high mortality and hospitalization rates. Many factors contribute to mortality and hospitalizations among residents with HF, and comprehensive HF management programs are needed to improve outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.
Geerlings, M I; Deeg, D J; Penninx, B W; Schmand, B; Jonker, C; Bouter, L M; van Tilburg, W
OBJECTIVE: This study examined whether dementia patients with greater cognitive reserve had increased mortality rates, and whether this association was different across strata of cognition, functional ability and depression. METHODS: In the community-based Amsterdam Study of the Elderly, 261
Geerlings, M. I.; Deeg, D. J.; Penninx, B. W.; Schmand, B.; Jonker, C.; Bouter, L. M.; van Tilburg, W.
This study examined whether dementia patients with greater cognitive reserve had increased mortality rates, and whether this association was different across strata of cognition, functional ability and depression. In the community-based Amsterdam Study of the Elderly, 261 non-institutionalized
Geerlings, M.I.; Deeg, D.J.H.; Penninx, B.W.J.H.; Schmand, B.A.; Jonker, C.; Bouter, L.M.; van Tilburg, W.
Objective. This study examined whether dementia patients with greater cognitive reserve had increased mortality rates, and whether this association was different across strata of cognition, functional ability and depression. Methods. In the community-based Amsterdam Study of the Elderly, 261
de Jongh, R.T.; Lips, P.T.A.M.; van Schoor, N.M.; Rijs, K.J.; Deeg, D.J.H.; Comijs, H.C.; Kramer, M.H.H.; Vandenbroucke, J.P.; Dekkers, O.M.
Objective: To what extent endogenous subclinical thyroid disorders contribute to impaired physical and cognitive function, depression, and mortality in older individuals remains a matter of debate. Design: A population-based, prospective cohort of the Longitudinal Aging Study Amsterdam. Methods: TSH
O'Connor, P A
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.
Finkton, Darryl W; El-Sayed, Abdulrahman M; Galea, Sandro
Arab-Americans (AAs) have lower risk of preterm birth relative to Non-Arab Whites. This has been attributed to lower likelihood of birth out of wedlock, maternal tobacco use during pregnancy, and foreign maternal birthplace among AAs. We were interested in understanding the roles of these and other demographic factors in the etiology of infant mortality among this group. Using data about all live, singleton births between 1989 and 2005 in the state with the highest proportion of AAs in the US, we calculated infant mortality (death prior to 1 year of life) for AAs and Non-Arab Whites. To clarify the etiology of potential differences in infant mortality, we also assessed infant mortality sub-categories, including neonatal mortality (death prior to 28 days of life) and post-neonatal mortality (death between 28 and 365 days of life). We fit trivariable and multivariable logistic regression models adjusted for explanatory covariates to assess each covariate's contributions to the relation between ethnicity and infant mortality. AAs had a lower infant mortality rate (4.7 per 1,000 live births) than non-Arab Whites (5.6 per 1,000 live births), overall (odds ratio = 0.84, 95% confidence interval: 0.74-0.96). In trivariable models, adjusting for marital status, maternal tobacco consumption during pregnancy, and maternal birthplace each separately attenuated the bivariate ethnicity-mortality relation to non-significance. Our findings suggest that lower risk of infant mortality among AAs relative to non-Arab Whites may be explained by differences in demographic characteristics and parental behavioral practices between them.
Curzio, Olivia; Bernacca, Emilia; Bianchi, Bruno; Rossi, Giuseppe
Sense of self-worth influences the health status of the elderly and may be associated with mortality. The aim of the study was to investigate whether the association between subjective feelings of uselessness and mortality was confounded or modified by functional limitation in non-institutionalized older people. Participants were community-dwelling older people, aged 70 years and older, who lived in neighbourhoods of Massa and Carrara municipalities in northern Tuscany, Italy. At baseline, 2335 non-institutionalized older people were assessed with a short self-administered questionnaire; the analysis included 2132 older persons for whom vital statistical data were available after a 3-year follow-up. The feeling of uselessness was associated with an increased mortality at the 3-year follow-up, but only in older people who reported disability problems (adjusted hazard ratio = 1.97, 95% confidence interval = 1.48-2.63, P People who reported disability problems and a feeling of uselessness may be vulnerable to an increased risk for poor health outcomes in later life. This study outlined the importance of enquiring about feelings of uselessness, which is a relational variable that is linked to both psychological and physical health status, especially in older people who need help in daily activities. © 2017 Japanese Psychogeriatric Society.
Richard F. Gillum
Full Text Available Previous studies report that low levels cognitive function and history of smoking are associated with increased mortality risk. Elderly smokers may have increased risk of dementia, but risk in former smokers is unclear. We tested the hypotheses that the harmful effect of impaired cognitive function as related to mortality is greater in persons smoking at baseline than in others. Further, we used serum cotinine levels to assess recall bias of smoking history by cognitive function level. Data were analyzed from a longitudinal mortality follow-up study of 4,916 American men and women aged 60 years and over, examined in 1988–1994 with complete data followed an average 8.5 years. Measurements at baseline included smoking history, a short index of cognitive function (SICF, serum cotinine and socio-demographics. Death during follow-up occurred in 1,919 persons. In proportional hazards regression analysis, a significant interaction of current smoking with cognitive function was not found; but there was a significant age-smoking interaction. After adjusting for confounding by age or multiple variables, current smoking associated with over 2-fold increased mortality (hazards ratio and 95% confidence limits current versus never smoking 2.13, 1.75–2.59 and SICF with 32% reduction in mortality; top versus bottom SICF stratum 0.68, 0.53–0.88. Serum cotinine data revealed substantial recall bias of smoking history in persons with cognitive impairment. However analyses correcting for this bias did not alter the main conclusions: In a nationwide cohort of older Americans, analyses demonstrated a lower risk of death independent of confounders among those with high SICF scores and never smokers, without a significant interaction of the two.
Wagener, Jeffrey S; Elkin, Eric P; Pasta, David J; Schechter, Michael S; Konstan, Michael W; Morgan, Wayne J
Assessing cystic fibrosis (CF) patient quality of care requires the choice of an appropriate outcome measure. We looked systematically and in detail at pulmonary function outcomes that potentially reflect clinical practice patterns. Epidemiologic Study of Cystic Fibrosis data were used to evaluate six potential outcome variables (2002 best FVC, FEV(1), and FEF(25-75) and rate of decline for each from 2000 to 2002). We ranked CF care sites by outcome measure and then assessed any association with practice patterns and follow-up pulmonary function. Sites ranked in the top quartile had more frequent monitoring, treatment of exacerbations, and use of chronic therapies and oral corticosteroids. The follow-up rate of pulmonary function decline was not predicted by site ranking. Different pulmonary function outcomes associate slightly differently with practice patterns, although annual FEV(1) is at least as good as any other measure. Current site ranking only moderately predicts future ranking. Copyright © 2014 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
Lee, Yeong-Bae; Park, Joo-Hwan; Kim, Eunja; Kang, Chang-Ki; Park, Hyeon-Mi
Arterial stiffness is a common change associated with aging and can be evaluated by measuring pulse wave velocity (PWV) between sites in the arterial tree, with the stiffer artery having the higher PWV. Arterial stiffness is associated with the risk of stroke in the general population and of fatal stroke in hypertensive patients. This study is to clarify whether PWV value predicts functional outcome of acute ischemic stroke. ONE HUNDRED PATIENTS WERE ENROLLED WITH A DIAGNOSIS OF ACUTE ISCHEMIC STROKE AND CATEGORIZED INTO TWO GROUPS: large-artery atherosclerosis (LAAS) or small vessel disease (SVD) subtype of Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Each group was divided into two sub-groups based on the functional outcome of acute ischemic stroke, indicated by modified Rankin Scale (mRS) at discharge. Poor functional outcome group was defined as a mRS ≥ 3 at discharge. Student's t-test or Mann-Whitney U-test were used to compare maximal brachial-ankle PWV (baPWV) values. Twenty-four patients whose state was inadequate to assess baPWV or mRS were excluded. There were 38 patients with good functional outcome (mRS vs. 1,789.80 ± 421.91, p = 0.022), while there was no significant difference of baPWV among patients with LAAS subtype (2,071.76 ± 618.42 vs. 1,878.00 ± 365.35, p = 0.579). Arterial stiffness indicated by baPWV is associated with the functional outcome of acute ischemic stroke. This finding suggests that measurement of baPWV predicts functional outcome in patients with stroke especially those whose TOAST classification was confirmed as SVD subtype.
Shimbo, Daichi; Abdalla, Marwah; Falzon, Louise; Townsend, Raymond R.; Muntner, Paul
Ambulatory blood pressure monitoring (ABPM) is more commonly recommended for assessing out-of-clinic blood pressure than home blood pressure monitoring (HBPM). We conducted a systematic review to examine whether ABPM or HBPM is more strongly associated with cardiovascular disease events and/or mortality. Of 1,007 abstracts published through July 20, 2015, nine articles, reporting results from seven cohorts, were identified. After adjustment for blood pressure on HBPM, blood pressure on ABPM was associated with an increased risk of outcomes in two of four cohorts for systolic blood pressure and two of three cohorts for diastolic blood pressure. After adjustment for blood pressure on ABPM, systolic blood pressure on HBPM was associated with outcomes in zero of three cohorts; an association was present in one of two cohorts for diastolic blood pressure on HBPM. There is a lack of strong empiric evidence supporting ABPM or HBPM over the other approach for predicting cardiovascular events or mortality. PMID:26822864
Noman, Awsan; Balasubramaniam, Karthik; Alhous, M Hafez A; Lee, Kelvin; Jesudason, Peter; Rashid, Muhammad; Mamas, Mamas A; Zaman, Azfar G
To assess the mortality in patients with diabetes mellitus (DM) following percutaneous coronary intervention (PCI) according to their insulin requirement and PCI setting (elective, urgent, and emergency). DM is a major risk factor to develop coronary artery disease (CAD). It is unclear if meticulous glycemic control and aggressive risk factor management in patients with DM has improved outcomes following PCI. Retrospective analysis of prospectively collected data on 9,224 patients treated with PCI at a regional tertiary center between 2008 and 2011. About 7,652 patients were nondiabetics (non-DM), 1,116 had non-insulin treated diabetes mellitus (NITDM) and 456 had ITDM. Multi-vessel coronary artery disease, renal impairment and non-coronary vascular disease were more prevalent in DM patients. Overall 30-day mortality rate was 2.4%. In a logistic regression model, the adjusted odds ratios (95% confidence intervals [CI]) for 30-day mortality were 1.28 (0.81-2.03, P = 0.34) in NITDM and 2.82 (1.61-4.94, P diabetes, this study reveals higher mortality only in insulin-treated diabetic patients following PCI for stable coronary artery disease and acute coronary syndrome. Importantly, diabetic patients with good risk factor control and managed on diet or oral hypoglycemics have similar outcomes to the non-diabetic population. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.
Losito, Attilio; Pittavini, Loretta; Ferri, Carla; De Angelis, Luigi
Stroke is a dangerous long-term complication of kidney failure, yet its occurrence early in disease is poorly characterized. Our aim was to investigate the association of reduced kidney function, hypertension and diabetes with acute ischaemic stroke and the outcome thereof. In this prospective cohort study, the association of reduced kidney function, hypertension and diabetes with stroke and 2-year all-cause mortality was investigated. Glomerular filtration rate (eGFR) was estimated by the simplified Modification of Diet in Renal Disease formula in 13 365 consecutive patients (671 with acute ischaemic stroke) admitted to our clinical facility over a 12-month period. Ischaemic stroke, after adjustment for age and gender, was significantly associated with eGFR stroke. Age and gender-adjusted survival analysis by Cox regression showed an association of mortality with reduced eGFR alone (HR = 4.29, 95% CI 1.02-19.60). In patients acutely admitted to hospital, reduced kidney function, hypertension and diabetes are independently associated with ischaemic stroke, but do not exert a synergic effect. After hospital discharge, mortality is strongly associated with reduced eGFR but with neither hypertension nor diabetes.
Jarvis, JN; Bicanic, T; Loyse, A; Namarika, D; Jackson, A; Nussbaum, JC; Longley, N; Muzoora, C; Phulusa, J; Taseera, K; Kanyembe, C; Wilson, D; Hosseinipour, MC; Brouwer, AE; Limmathurotsakul, D
BACKGROUND: Cryptococcal meningitis (CM) is a leading cause of death in individuals infected with human immunodeficiency virus (HIV). Identifying factors associated with mortality informs strategies to improve outcomes. METHODS: Five hundred one patients with HIV-associated CM were followed prospectively for 10 weeks during trials in Thailand, Uganda, Malawi, and South Africa. South African patients (n = 266) were followed for 1 year. Similar inclusion/exclusion criteria were applied at all...
Huang, Gregory S; Dunham, C Michael
The value of prehospital red blood cell (RBC) transfusion for trauma patients is controversial. The purposes of this literature review were to determine the mortality rate of trauma patients with hemodynamic instability and the benefit of prehospital RBC transfusion. A 30-year systematic literature review was performed in 2016. Eligible studies were combined for meta-analysis when tests for heterogeneity were insignificant. The synthesized mortality was 35.6% for systolic blood pressure ≤ 90 mmHg; 51.1% for ≤ 80 mmHg; and 63.9% for ≤ 70 mmHg. For patients with either hypotension or emergency trauma center transfused RBCs, the synthesized Injury Severity Score (ISS) was 27.0 and mortality was 36.2%; the ISS and mortality correlation was r = 0.766 ( P = 0.0096). For civilian patients receiving prehospital RBC transfusions, the synthesized ISS was 27.5 and mortality was 39.5%. One civilian study suggested a decrement in mortality with prehospital RBC transfusion; however, patient recruitment was only one per center per year and mortality was undergoing prehospital RBC transfusion and a matched control subset showed that the synthesized mortality was similar for those transfused (37.5%) and not transfused (38.7%; P = 0.8933). A study of civilian helicopter patients demonstrated a similar 30-day mortality for those with and without prehospital blood product availability (22% versus 21%; P = 0.626). Mortality in a study of matched military patients was better for those receiving prehospital blood or plasma (8%) than the controls (20%; P = 0.013). However, transfused patients had a shorter prehospital time, more advanced airway procedures, and higher hospital RBC transfusion ( P 16 showed similar mortality with and without prehospital RBC availability (27.6% versus 32.0%; P = 0.343). Trauma patient mortality increases with the magnitude of hemodynamic instability and anatomic injury. Some literature evidence indicates no survival advantage with prehospital RBC
Tan, Tze-Woei; Joglar, Fernando L; Hamburg, Naomi M; Eberhardt, Robert T; Shaw, Palma M; Rybin, Denis; Doros, Gheorghe; Farber, Alik
To examine the outcomes of lower extremity (LE) and upper extremity (UE) arterial trauma. Retrospective review of 2008 version of National Trauma Databank. Adult patient with LE and UE arterial trauma was identified and outcomes were compared. There were 8311 cases of extremity arterial trauma and 37% involved the LE. The LE cohort had higher blunt injury (56.2% vs 37.4%; P extremity, blunt trauma was associated with higher mortality (4.8% vs 3.8%; P = .03) and amputation (6.7% vs 1.3%; P upper extremity arterial injuries have different modes of presentation and outcomes. Lower extremity arterial trauma is more commonly caused by blunt injury and associated with worse outcomes despite more intensive intervention.
Yuen, W C; Wong, K; Cheung, Y S; Lai, P Bs
Since 2008, the Hong Kong Hospital Authority has implemented a Surgical Outcomes Monitoring and Improvement Programme (SOMIP) at 17 public hospitals with surgical departments. This study aimed to assess the change in operative mortality rate after implementation of SOMIP. The SOMIP included all Hospital Authority patients undergoing major/ultra-major procedures in general surgery, urology, plastic surgery, and paediatric surgery. Patients undergoing liver or renal transplantation or who had multiple trauma or massive bowel ischaemia were excluded. In SOMIP, data retrieval from the Hospital Authority patient database was performed by six full-time nurse reviewers following a set of precise data definitions. A total of 230 variables were collected for each patient, on demographics, preoperative and operative variables, laboratory test results, and postoperative complications up to 30 days after surgery. In this study, we used SOMIP cumulative 5-year data to generate risk-adjusted 30-day mortality models by hierarchical logistic regression for both emergency and elective operations. The models expressed overall performance as an annual observed-to-expected mortality ratio. From 2009/2010 to 2015/2016, the overall crude mortality rate decreased from 10.8% to 5.6% for emergency procedures and from 0.9% to 0.4% for elective procedures. From 2011/2012 to 2015/2016, the risk-adjusted observed-to-expected mortality ratios showed a significant downward trend for both emergency and elective operations: from 1.126 to 0.796 and from 1.150 to 0.859, respectively (Mann- Kendall statistic = -0.8; PAuthority's overall crude mortality rates and risk-adjusted observed-to-expected mortality ratios for emergency and elective operations significantly declined after SOMIP was implemented.
Imasaka, Ken-ichi; Tayama, Eiki; Tomita, Yukihiro
There are few data concerning the impact of preoperative renal function, assessed using estimated glomerular filtration rate, on surgical outcomes following acute type A aortic dissection. We investigated the accuracy of estimated glomerular filtration rate (in ml/min/1.73 m(2)) in predicting in-hospital mortality and postoperative renal replacement therapy in such cases. We reviewed 114 consecutive patients with non-dialysis-dependent renal dysfunction who underwent thoracic aortic surgery for acute type A aortic dissection between 1997 and 2012. Preoperative renal function was categorized as normal (estimated glomerular filtration rate >90; n = 15) or as mild (60-89; n = 39), moderate I (45-59; n = 39), moderate II (30-44; n = 14) or severe (15-29; n = 7) renal dysfunction. In-hospital mortality was 14.9%. Eighteen (15.8%) of 114 patients required renal replacement therapy. A more severe stage stratified by preoperative estimated glomerular filtration rate levels could effectively predict postoperative renal replacement therapy (area under the receiver operating characteristic curve 0.786). The best cut-off value of estimated glomerular filtration rate for predicting postoperative renal replacement therapy was 60 (sensitivity 95%, specificity 59%). On multiple regression analysis, the independent preoperative and intraoperative risk factors for postoperative renal replacement therapy were estimated glomerular filtration rate (P replacement (P replacement therapy (OR, 5.47; P regression analysis. Preoperative estimated glomerular filtration rate can effectively predict the need for renal replacement therapy after surgery for acute type A aortic dissection. However, it is not an effective diagnostic tool to predict in-hospital mortality. The complexity of the characteristics of patients who undergo surgical procedures may make prediction of surgical outcomes difficult. Risk models to predict hospital mortality and morbidities are needed to assist clinicians in
Weidmann, Zoraida Moreno; Breidthardt, Tobias; Twerenbold, Raphael; Züsli, Christina; Nowak, Albina; von Eckardstein, Arnold; Erne, Paul; Rentsch, Katharina; de Oliveira, Mucio T; Gualandro, Danielle; Maeder, Micha T; Rubini Gimenez, Maria; Pershyna, Kateryna; Stallone, Fabio; Haas, Laurent; Jaeger, Cedric; Wildi, Karin; Puelacher, Christian; Honegger, Ursina; Wagener, Max; Wittmer, Severin; Schumacher, Carmela; Krivoshei, Lian; Hillinger, Petra; Osswald, Stefan; Mueller, Christian
Renal function, as quantified by the estimated glomerular filtration rate (eGFR), is a predictor of death in acute heart failure (AHF). It is unknown whether one of the clinically-available serum creatinine-based formulas to calculate eGFR is superior to the others for predicting mortality. We quantified renal function using five different formulas (Cockroft-Gault, MDRD-4, MDRD-6, CKD-EPI in patientsrenal function and in three vulnerable subgroups: women, patients with severe left ventricular dysfunction, and the elderly. The prognostic accuracy for readmission was poor for all equations, with an AUC around 0.5. Calculating eGFR using the Cockcroft-Gault formula assesses the risk of mortality in patients with AHF more accurately than other commonly used formulas. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Full Text Available OBJECTIVE: If the present data defining the prognostic predictors is examined carefully, a serious contradiction is noticed. In this study, we tried to determine which factors affect the sixth month mortality, recurrence and functional recovery measured quantitatively after ischemic stroke, among our own patients followed in a tertiary health care center. METHODS: Age, sex, the presence of hypertension, coronary heart disease, atrial fibrillation, diabetes mellitus, hyperlipidemia, previous stroke, stroke subtype, admittance mean blood pressure, admittance blood sugar, hemotocrit, the presence of left ventricle hypertrophy and ejection fraction was recorded for 223 patients with ischemic stroke. The scores for National Institute of Health Stroke Scale (NIHSS, modified Rankin Scale (mRS and Barthel Index (BI were recorded at the beginning and at the end of six months. The correlation of these 14 clinical and laboratory parameters with mortality, recurrence and recovery was examined statistically. RESULTS: Mortality rate was 33%, recurrence rate was 3.8%. Factors related with mortality were age, female gender, coronary artery disease, atrial fibrillation, low ejection fraction, low hematocrit and high admittance blood glucose (p 0.05. In the multivariate analyses, only, the effect of age, gender and hyperlipidemia on mortality was persisting (p< 0.05. Considering NIHSS, patients with high mean admittance blood pressure, considering mRS and BI younger patients and patients with lacunar infarcts had better recovery levels, while patients with previous strokes had poorer recovery (p< 0.05. CONCLUSION: Higher age and high admittance blood sugar were the most important determinants of mortality after ischemic stroke. Hyperlipidemia reduces the risk of death after stroke probably because of the neuroprotective effects of lipid lowering drugs. None of these parameters clearly affect functional recovery at the end of six month
Full Text Available OBJECTIVE: If the present data defining the prognostic predictors is examined carefully, a serious contradiction is noticed. In this study, we tried to determine which factors affect the sixth month mortality, recurrence and functional recovery measured quantitatively after ischemic stroke, among our own patients followed in a tertiary health care center. METHODS: Age, sex, the presence of hypertension, coronary heart disease, atrial fibrillation, diabetes mellitus, hyperlipidemia, previous stroke, stroke subtype, admittance mean blood pressure, admittance blood sugar, hemotocrit, the presence of left ventricle hypertrophy and ejection fraction was recorded for 223 patients with ischemic stroke. The scores for National Institute of Health Stroke Scale (NIHSS, modified Rankin Scale (mRS and Barthel Index (BI were recorded at the beginning and at the end of six months. The correlation of these 14 clinical and laboratory parameters with mortality, recurrence and recovery was examined statistically. RESULTS: Mortality rate was 33%, recurrence rate was 3.8%. Factors related with mortality were age, female gender, coronary artery disease, atrial fibrillation, low ejection fraction, low hematocrit and high admittance blood glucose (p 0.05. In the multivariate analyses, only, the effect of age, gender and hyperlipidemia on mortality was persisting (p< 0.05. Considering NIHSS, patients with high mean admittance blood pressure, considering mRS and BI younger patients and patients with lacunar infarcts had better recovery levels, while patients with previous strokes had poorer recovery (p< 0.05. CONCLUSION: Higher age and high admittance blood sugar were the most important determinants of mortality after ischemic stroke. Hyperlipidemia reduces the risk of death after stroke probably because of the neuroprotective effects of lipid lowering drugs. None of these parameters clearly affect functional recovery at the end of six month.
Hurvitz, Edward; Warschausky, Seth; Berg, Michelle; Tsai, Shane
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 life satisfaction. Patients who scored below adequate on 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.
Sung, Eun Jung; Kim, Dae Yul; Chang, Min Cheol; Ko, Eun Jae
To identify the factors that could predict the functional outcome in patients with the axonal type of Guillain-Barre syndrome (GBS). 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. 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. 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.
Objective: The aim of this study was to determine the surgical outcomes and renal function following salvage surgery for bilateral Wilms tumor (BWT). Summary background data The challenge for the surgeon treating BWT lies in striking a fine balance between renal preservation and oncological clearance. Methods: This is ...
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
Background: Functional outcome scores are often used to measure results of Total Hip Replacement (THR). Most current scoring systems were designed for use in Europe or North America and seem not optimally suited for a general West African setting. We introduce a cross-cultural adaptation of the Lequesne index as a ...
Objective: To evaluate the functional and cosmetic outcome of single stage partial penile disassembly repair in isolated male epispadias. Patients and methods: A retrospective analysis of 43 cases of primary epispadias repair, performed during July 1998 to March 2013. Patients were classified on the basis of type of ...
Objective The aim of this study was to determine the surgical outcomes and renal function following salvage surgery for bilateral Wilms tumor (BWT). Summary background data The challenge for the surgeon treating BWT lies in striking a fine balance between renal preservation and oncological clearance. Methods This is a ...
Objective: To determine the functional outcome and quality of life of acetabular fracture patients treated operatively with open reduction and internal fixation. Design: Retrospective case series. Subjects: Patients aged 18 to 65 years old undergoing operative treatment for acetabular fractures from October 2010 to September ...
Carr, Edward G.; Yarborough, Scott C.; Langdon, Nancy A.
A study involving three individuals (ages 13-20) with developmental disabilities and problem behaviors examined the influential role that unanticipated idiosyncratic stimulus variables play in affecting the outcome of a functional analysis. Guidelines are discussed concerning when to suspect that idiosyncratic stimuli might be acting to influence…
currently considered the gold standard for treatment of femur shaft fractures although retrograde technique is gaining acceptance. Although introducing the nail through the knee has potential to damage the intra articular structures, several reports have indicated acceptable functional outcome. The results are not known in ...
Tiago C. Antonini
Full Text Available ABSTRACT Objective To ascertain whether modifiable physical performance–based measurements predicted 5.5-year mortality in a riparian elderly cohort in the Amazon rainforest region. Methods A longitudinal study evaluating the impact of functional determinants on 5.5-year mortality in a riparian elderly cohort from Maués City in the state of Amazonas, Brazil, was performed. The study was a follow-up of a previous observational investigation that evaluated various fitness tests in 630 Amazonian riparian elderly (291 males and 339 females aged 72.3 ± 8.0 (60–99 years old. The cohort was selected for its adverse environmental conditions, which increased the risk of falls yet required maintenance of good physical condition for carrying out relatively rigorous daily activities, and restricted access to specialized health services. Official death records were obtained from the Maués Municipal Health Department. Results A total of 80 study participants (12.7% died over the 5.5-year study period. Kaplan-Meier regression analysis showed significant association between Timed Up and Go (TUG test scores ≥ 14 seconds and mortality risk, independent of sex, age, and other health variables. Conclusions The study results suggest that the TUG test can be used as an indicator for initiating therapeutic and preventive actions, including conducting exercises or physical activities adapted to the health and functional conditions of the elderly, by identifying elderly people with a higher relative risk of mortality.
Tarazona-Santabalbina, Francisco José; Belenguer-Varea, Ángel; Rovira Daudi, Eduardo; Salcedo Mahiques, Enmanuel; Cuesta Peredó, David; Doménech-Pascual, Juan Ramón; Gac Espínola, Homero; Avellana Zaragoza, Juan Antonio
To identify how the severity of dementia influences functional recovery and mortality in elderly patients hospitalized for hip fracture. An observational retrospective study of 1258 patients aged older than 69 years and diagnosed with hip fracture who received care within an orthogeriatrics unit from 2004 to 2008 was carried out. During a 12-month follow-up period, functional recovery and mortality outcomes were measured. Dementia was present in 383 (28.1%) patients: it was mild in 183 (48%), moderate in 102 (26.5%) and severe in 98 (25.5%). Compared with patients with preserved cognitive status, patients with dementia had the following statistically significant differences (means [standard deviation] or percentage): older age (preserved, 82.29 years [6.5 years]; mild, 83.63 years [6.1 years]; moderate, 83.47 years [5.9 years]; severe, 84.46 years [6.1 years]; P recovery at discharge (OR 0.272, 95% CI 0.140-0.526, P recovery with increasing severity of dementia. © 2014 Japan Geriatrics Society.
Kulik, Ulf; Lehner, Frank; Klempnauer, Jürgen; Borlak, Jürgen
The shortage of liver donations demands the use of suboptimal grafts with steatosis being a frequent finding. Although ≤30% macrovesicular steatosis is considered to be safe the risk for primary non-function (PNF) and outcome after re-transplantation (re-OLT) is unknown. Among 1205 orthotopic liver transplantations performed at our institution the frequency, survival and reason of re-OLT were evaluated. PNF (group A) cases and those with initial transplant function but subsequent need for re-OLT (group B) were analysed. Histopathology and clinical judgement determined the cause of PNF and included an assessment of hepatic steatosis. Additionally, survival of fatty liver allografts (group C) not requiring re-OLT was considered in Kaplan-Meier and multivariate regression analysis. A total of 77 high urgency re-OLTs were identified and included 39 PNF cases. Nearly 70% of PNF cases were due to primary fatty liver allografts. The 3-month in-hospital mortality for PNF cases after re-OLT was 46% and the mean survival after re-OLT was 0.5 years as compared to 5.2 and 5.1 years for group B, C, respectively, (Pfatty liver allografts to be a major cause for PNF with excessive mortality after re-transplantation. The findings demand the development of new methods to predict risk for PNF of fatty liver allografts. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Anabitarte, Pablo; Kurz, David J; Stettler, Irene; Naegeli, Barbara; Bertel, Osmund; Frielingsdorf, Juergen; Maurer, Dominik; Straumann, Edwin
Percutaneous coronary intervention (PCI) is the most effective reperfusion modality in patients with acute myocardial infarction (MI). Data concerning long-term survival and functional outcome are sparse. One thousand consecutive patients treated by emergency PCI were systematically ana-lysed in a single-centre registry. Multivariate predictors of in-hospital mortality, post-discharge mortality and late functional capacity were identified. Follow-up was completed for 978 patients. The median clinical follow-up length was 3.2 years. In-hospital and post-discharge mortality were 7.6% and 7.3%, respectively. Annualised post-discharge mortality remained stable over time at 2% per year. Independent predictors of in-hospital death were cardiogenic shock, TIMI flow 6 h. Independent predictors of post-discharge mortality were TIMI flow after PCI <3, prior MI, elevated glucose levels at admission, and increasing age. In contrast, cardiogenic shock, time to patent artery and left ventricular ejection fraction <40% were not independently associated with post-hospital death. At late follow-up, 47% of patients had normal functional capacity and 49.1% were in New York Heart Association functional class II. Predictors of impaired functional capacity at follow-up were age, gender, smoking habits and multivessel coronary disease. Post-discharge mortality after PCI for acute MI was 2% per year. Significant differences exist between predictors of in-hospital and post-discharge mortality. The functional capacity of surviving patients was remarkably good, even when presented in cardiogenic shock.
Mentz, Robert J; Greiner, Melissa A; DeVore, Adam D; Dunlay, Shannon M; Choudhary, Gaurav; Ahmad, Tariq; Khazanie, Prateeti; Randolph, Tiffany C; Griswold, Michael E; Eapen, Zubin J; O'Brien, Emily C; Thomas, Kevin L; Curtis, Lesley H; Hernandez, Adrian F
QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans. We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead ECG. We defined QRS prolongation as QRS≥100 ms. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models and reported the cumulative incidence of heart failure hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n=1528) of participants had QRS prolongation. The cumulative incidences of mortality and heart failure hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% confidence interval [CI], 11.0-14.4) versus 7.1% (95% CI, 6.3-8.0) and 8.2% (95% CI, 6.9-9.7) versus 4.4% (95% CI, 3.7-5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (hazard ratio, 1.27; 95% CI, 1.03-1.56; P=0.02). There was a linear relationship between QRS duration and mortality (hazard ratio per 10 ms increase, 1.06; 95% CI, 1.01-1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation. QRS prolongation in African Americans was associated with increased mortality and heart failure hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities. © 2015 American Heart Association, Inc.
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.
Jarvis, Joseph N.; Bicanic, Tihana; Loyse, Angela; Namarika, Daniel; Jackson, Arthur; Nussbaum, Jesse C.; Longley, Nicky; Muzoora, Conrad; Phulusa, Jacob; Taseera, Kabanda; Kanyembe, Creto; Wilson, Douglas; Hosseinipour, Mina C.; Brouwer, Annemarie E.; Limmathurotsakul, Direk; White, Nicholas; van der Horst, Charles; Wood, Robin; Meintjes, Graeme; Bradley, John; Jaffar, Shabbar; Harrison, Thomas
Background. Cryptococcal meningitis (CM) is a leading cause of death in individuals infected with human immunodeficiency virus (HIV). Identifying factors associated with mortality informs strategies to improve outcomes. Methods. Five hundred one patients with HIV-associated CM were followed prospectively for 10 weeks during trials in Thailand, Uganda, Malawi, and South Africa. South African patients (n = 266) were followed for 1 year. Similar inclusion/exclusion criteria were applied at all sites. Logistic regression identified baseline variables independently associated with mortality. Results. Mortality was 17% at 2 weeks and 34% at 10 weeks. Altered mental status (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.7–5.9), high cerebrospinal fluid (CSF) fungal burden (OR, 1.4 per log10 colony-forming units/mL increase; 95% CI, 1.0–1.8), older age (>50 years; OR, 3.9; 95% CI, 1.4–11.1), high peripheral white blood cell count (>10 × 109 cells/L; OR, 8.7; 95% CI, 2.5–30.2), fluconazole-based induction treatment, and slow clearance of CSF infection were independently associated with 2-week mortality. Low body weight, anemia (hemoglobin <7.5 g/dL), and low CSF opening pressure were independently associated with mortality at 10 weeks in addition to altered mental status, high fungal burden, high peripheral white cell count, and older age. In those followed for 1 year, overall mortality was 41%. Immune reconstitution inflammatory syndrome occurred in 13% of patients and was associated with 2-week CSF fungal burden (P = .007), but not with time to initiation of antiretroviral therapy (ART). Conclusions. CSF fungal burden, altered mental status, and rate of clearance of infection predict acute mortality in HIV-associated CM. The results suggest that earlier diagnosis, more rapidly fungicidal amphotericin-based regimens, and prompt immune reconstitution with ART are priorities for improving outcomes. PMID:24319084
Carbajosa, Sofía; Rodríguez-Angulo, Héctor O; Gea, Susana; Chillón-Marinas, Carlos; Poveda, Cristina; Maza, María C; Colombet, Diana; Fresno, Manuel; Gironès, Núria
Chagas disease caused by Trypanosoma cruzi is a neglected disease that affects about 7 million people in Latin America, recently emerging on other continents due to migration. As infection in mice is characterized by depletion of plasma L-arginine, the effect on infection outcome was tested in mice with or without L-arginine supplementation and treatment with 1400W, a specific inhibitor of inducible nitric oxide synthase (iNOS). We found that levels of L-arginine and citrulline were reduced in the heart and plasma of infected mice, whereas levels of asymmetric dimethylarginine, an endogenous iNOS inhibitor, were higher. Moreover, L-arginine supplementation decreased parasitemia and heart parasite burden, improving clinical score and survival. Nitric oxide production in heart tissue and plasma was increased by L-arginine supplementation, while pharmacological inhibition of iNOS yielded an increase in parasitemia and worse clinical score. Interestingly, electrocardiograms improved in mice supplemented with L-arginine, suggesting that it modulates infection and heart function and is thus a potential biomarker of pathology. More importantly, L-arginine may be useful for treating T. cruzi infection, either alone or in combination with other antiparasitic drugs.
Full Text Available Chagas disease caused by Trypanosoma cruzi is a neglected disease that affects about 7 million people in Latin America, recently emerging on other continents due to migration. As infection in mice is characterized by depletion of plasma L-arginine, the effect on infection outcome was tested in mice with or without L-arginine supplementation and treatment with 1400W, a specific inhibitor of inducible nitric oxide synthase (iNOS. We found that levels of L-arginine and citrulline were reduced in the heart and plasma of infected mice, whereas levels of asymmetric dimethylarginine, an endogenous iNOS inhibitor, were higher. Moreover, L-arginine supplementation decreased parasitemia and heart parasite burden, improving clinical score and survival. Nitric oxide production in heart tissue and plasma was increased by L-arginine supplementation, while pharmacological inhibition of iNOS yielded an increase in parasitemia and worse clinical score. Interestingly, electrocardiograms improved in mice supplemented with L-arginine, suggesting that it modulates infection and heart function and is thus a potential biomarker of pathology. More importantly, L-arginine may be useful for treating T. cruzi infection, either alone or in combination with other antiparasitic drugs.
Gea, Susana; Chillón-Marinas, Carlos; Poveda, Cristina; Maza, María C.; Colombet, Diana; Fresno, Manuel
Chagas disease caused by Trypanosoma cruzi is a neglected disease that affects about 7 million people in Latin America, recently emerging on other continents due to migration. As infection in mice is characterized by depletion of plasma L-arginine, the effect on infection outcome was tested in mice with or without L-arginine supplementation and treatment with 1400W, a specific inhibitor of inducible nitric oxide synthase (iNOS). We found that levels of L-arginine and citrulline were reduced in the heart and plasma of infected mice, whereas levels of asymmetric dimethylarginine, an endogenous iNOS inhibitor, were higher. Moreover, L-arginine supplementation decreased parasitemia and heart parasite burden, improving clinical score and survival. Nitric oxide production in heart tissue and plasma was increased by L-arginine supplementation, while pharmacological inhibition of iNOS yielded an increase in parasitemia and worse clinical score. Interestingly, electrocardiograms improved in mice supplemented with L-arginine, suggesting that it modulates infection and heart function and is thus a potential biomarker of pathology. More importantly, L-arginine may be useful for treating T. cruzi infection, either alone or in combination with other antiparasitic drugs. PMID:29337988
Reardon, David C; Coleman, Priscilla K
There is a growing interest in examining death rates associated with different pregnancy outcomes for time periods beyond one year. Previous population studies, however, have failed to control for complete reproductive histories. In this study we seek to eliminate the potential confounding effect of unknown prior pregnancy history by examining mortality rates associated specifically with first pregnancy outcome alone. We also examine differences in mortality rates associated with early abortion and late abortions (after 12 weeks). Medical records for the entire population of women born in Denmark between 1962 and 1991 and were alive in 1980, were linked to death certificates. Mortality rates associated with first pregnancy outcomes (delivery, miscarriage, abortion, and late abortion) were calculated. Odds ratios examining death rates based on reproductive outcomes, adjusted for age at first pregnancy and year of women's births, were also calculated. A total of 463,473 women had their first pregnancy between 1980 and 2004, of whom 2,238 died. In nearly all time periods examined, mortality rates associated with miscarriage or abortion of a first pregnancy were higher than those associated with birth. Compared to women who delivered, the age and birth year adjusted cumulative risk of death for women who had a first trimester abortion was significantly higher in all periods examined, from 180 days (OR=1.84; 1.11 <95% CI <3.71) through 10 years (1.39; 1.22 <95% CI <1.61), as was the risk for women who had abortions after 12 weeks from one year (OR=4.31; 2.18 <95% CI <8.54) through 10 years (OR=2.41; 1.56 <95% CI <2.41). For women who miscarried, the risk was significantly higher for cumulative deaths through 4 years (OR=1.75; 1.34 <95% CI <2.27) and at 10 years (OR=1.48; 1.18 <95% CI <1.85). Compared to women who delivered, women who had an early or late abortion had significantly higher mortality rates within 1 through 10 years. A lesser effect may also be present
Angurana, Suresh Kumar; Jayashree, Muralidharan; Bansal, Arun; Singhi, Sunit; Nallasamy, Karthi
To evaluate pediatric intensive care unit (PICU) needs, outcome and predictors of mortality in post-neonatal tetanus. Review of 30 consecutive post-neonatal tetanus cases aged 1 months to 12 years admitted to a PICU in north India over a period of 10 years (January 2006 to December 2015). Chronic suppurative otitis media was the commonest portal of entry. All received tetanus toxoid, human tetanus immunoglobulin (HTIG) and appropriate antibiotics; 7 (23.3%) received intrathecal HTIG. Common complications were respiratory failure, rhabdomyolysis, autonomic dysfunction, acute kidney injury and healthcare-associated infections. PICU needs were as follows: ventilation; benzodiazepine, morphine and magnesium sulfate infusion; neuromuscular blockers, inotropes, tracheostomy and renal replacement therapy. Mortality rate was 40%; severity Grade IIIb, autonomic dysfunction, use of vasoactive drugs and those who did not receive intrathecal HTIG were significantly associated with mortality. Post-neonatal tetanus is associated with high mortality, and PICU needs include management of spasms, autonomic dysfunction and complications and cardiorespiratory support. © The Author . Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org
Zhang, Yiqiang; Fischer, Kathleen E; Soto, Vanessa; Liu, Yuhong; Sosnowska, Danuta; Richardson, Arlan; Salmon, Adam B
Obesity is a serious chronic disease that increases the risk of numerous co-morbidities including metabolic syndrome, cardiovascular disease and cancer as well as increases risk of mortality, leading some to suggest this condition represents accelerated aging. Obesity is associated with significant increases in oxidative stress in vivo and, despite the well-explored relationship between oxidative stress and aging, the role this plays in the increased mortality of obese subjects remains an unanswered question. Here, we addressed this by undertaking a comprehensive, longitudinal study of a group of high fat-fed obese mice and assessed both their changes in oxidative stress and in their performance in physiological assays known to decline with aging. In female C57BL/6J mice fed a high-fat diet starting in adulthood, mortality was significantly increased as was oxidative damage in vivo. High fat-feeding significantly accelerated the decline in performance in several assays, including activity, gait, and rotarod. However, we also found that obesity had little effect on other markers of function and actually improved performance in grip strength, a marker of muscular function. Together, this first comprehensive assessment of longitudinal, functional changes in high fat-fed mice suggests that obesity may induce segmental acceleration of some of the aging process. Published by Elsevier Inc.
Bazoukis, G; Letsas, K P; Korantzopoulos, P; Thomopoulos, C; Vlachos, K; Georgopoulos, S; Karamichalakis, N; Saplaouras, A; Efremidis, M; Sideris, A
Cardiac resynchronization therapy (CRT) improves both morbidity and mortality in selected patients with heart failure and increased QRS duration. However, chronic kidney disease (CKD) may have an adverse effect on patient outcome. The aim of this systematic review was to analyze the existing data regarding the impact of baseline renal function on all-cause mortality in patients who underwent CRT. Medline database was searched systematically, and studies evaluating the effect of baseline renal function on all-cause mortality in patients who underwent CRT were retrieved. We performed three separate analyses according to the comparison groups included in each study. Data were analyzed using Review Manager software (RevMan version 5.3; Oxford, UK). We included 16 relevant studies in our analysis. Specifically, 13 studies showed a statistically significant higher risk of all-cause mortality in patients with impaired baseline renal function who underwent CRT. The remaining three studies did not show a statistically significant result. The quantitative synthesis of five studies showed a 19% decrease in all-cause mortality per 10-unit increment in estimated glomerular filtration rate (eGFR) [HR: 0.81, 95% CI (0.73-0.90), p <0.01, 86% I 2 ]. Additionally, we demonstrated that patients with an eGFR<60 mL/min/1.73 m 2 had an all-cause mortality rate of 66% [HR: 1.66, 95% CI (1.37-2.02), p <0.01, 0% I 2 ], which was higher than in those with an eGFR≥60 mL/min/1.73 m 2 . Baseline renal dysfunction has an adverse effect on-all cause mortality in patients who underwent CRT.
Nørskov, Marianne S.; Dahl, Morten; Tybjærg-Hansen, Anne
66,069 individuals from the white general population for two common functional variants in the glutathione S-transferase pi 1 gene (GSTP1)—amino acid isoleucine 105 changed to a valine (Ile105Val) and amino acid alanine 114 changed to a valine (Ala114Val)—and recorded lung function, lung cancer......, tobacco-related cancer, and death as outcomes. Results Lung function was increased stepwise with the Ile105Val genotype overall (p smokers separately (p
Madarasz, Wendy; Manzardo, Ann; Mortensen, Erik Lykke
Central Psychiatric Research Registry for 8109 birth cohort members aged 45 years. Lifetime psychiatric diagnoses (International Classification of Diseases, Revision 10, group F codes, Mental and Behavioural Disorders, and one Z code) for identified subjects were organized into 14 mutually exclusive......Objective: Psychiatric comorbidities are common among psychiatric patients and typically associated with poorer clinical prognoses. Subjects of a large Danish birth cohort were used to study the relation between mortality and co-occurring psychiatric diagnoses. Method: We searched the Danish...... diagnostic categories. Mortality rates were examined as a function of number and type of co-occurring diagnoses. Results: Psychiatric outcomes for 1247 subjects were associated with 157 deaths. Early mortality risk in psychiatric patients correlated with the number of diagnostic categories (Wald ¿² = 25...
Cox, Cathy R; Cooper, Douglas P; Vess, Matthew; Arndt, Jamie; Goldenberg, Jamie L; Routledge, Clay
Using the terror management health model (J. L. Goldenberg & J. Arndt, 2008), the authors examined tanning outcomes as a function of priming tanning-relevant standards for attractiveness after reminders of death. Study 1 consisted of 101 female college students recruited from a midwestern university; Study 2 consisted of 53 female participants recruited from a beach in south Florida. In both experiments, participants answered questions about their mortality or a control topic, and were presented with a fashion article that highlighted either the attractiveness of tanned (just in Study 1), pale, or natural-looking skin. Self-reported suntan intentions (Study 1) and sunscreen intentions (Study 2). Study 2 also assessed participants' interest in various sun protection products. Study 1 demonstrated that mortality salience led to higher tanning intentions when the association between tanned skin and physical attractiveness was made salient and reduced intentions when the attractiveness of paler skin was highlighted. In Study 2, beachgoers, after reminders of death, reported greater preference for high sun protection sunscreen after reading an article about the attractiveness of paler skin tones. These findings contribute to an emerging understanding of how mortality concerns can influence health-related judgment and behavior. PsycINFO Database Record (c) 2009 APA, all rights reserved.
Bassetti, Matteo; Righi, Elda; Ansaldi, Filippo; Merelli, Maria; Scarparo, Claudio; Antonelli, Massimo; Garnacho-Montero, Jose; Diaz-Martin, Ana; Palacios-Garcia, Inmaculada; Luzzati, Roberto; Rosin, Chiara; Lagunes, Leonel; Rello, Jordi; Almirante, Benito; Scotton, Pier Giorgio; Baldin, Gianmaria; Dimopoulos, George; Nucci, Marcio; Munoz, Patricia; Vena, Antonio; Bouza, Emilio; de Egea, Viviana; Colombo, Arnaldo Lopes; Tascini, Carlo; Menichetti, Francesco; Tagliaferri, Enrico; Brugnaro, Pierluigi; Sanguinetti, Maurizio; Mesini, Alessio; Sganga, Gabriele; Viscoli, Claudio; Tumbarello, Mario
Clinical data on patients with intra-abdominal candidiasis (IAC) is still scarce. We collected data from 13 hospitals in Italy, Spain, Brazil, and Greece over a 3-year period (2011-2013) including patients from ICU, medical, and surgical wards. A total of 481 patients were included in the study. Of these, 27% were hospitalized in ICU. Mean age was 63 years and 57% of patients were male. IAC mainly consisted of secondary peritonitis (41%) and abdominal abscesses (30%); 68 (14%) cases were also candidemic and 331 (69%) had concomitant bacterial infections. The most commonly isolated Candida species were C. albicans (n = 308 isolates, 64%) and C. glabrata (n = 76, 16%). Antifungal treatment included echinocandins (64%), azoles (32%), and amphotericin B (4%). Septic shock was documented in 40.5% of patients. Overall 30-day hospital mortality was 27% with 38.9% mortality in ICU. Multivariate logistic regression showed that age (OR 1.05, 95% CI 1.03-1.07, P < 0.001), increments in 1-point APACHE II scores (OR 1.05, 95% CI 1.01-1.08, P = 0.028), secondary peritonitis (OR 1.72, 95% CI 1.02-2.89, P = 0.019), septic shock (OR 3.29, 95% CI 1.88-5.86, P < 0.001), and absence of adequate abdominal source control (OR 3.35, 95% CI 2.01-5.63, P < 0.001) were associated with mortality. In patients with septic shock, absence of source control correlated with mortality rates above 60% irrespective of administration of an adequate antifungal therapy. Low percentages of concomitant candidemia and high mortality rates are documented in IAC. In patients presenting with septic shock, source control is fundamental.
Abdollah, F.; Schmitges, J.; Sun, M.
The objectives of this study were to compare the mortality outcomes of radical prostatectomy and radiotherapy as treatment modalities for patients with localized prostate cancer. Our cohort consisted of 68 665 patients with localized prostate cancer, treated with radical prostatectomy or radiotherapy, between 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type on cancer-specific mortality, after accounting for other-cause mortality. All analyses were stratified according to prostate cancer risk groups, baseline Charlson Comorbidity Index and age. For patients treated with radical prostatectomy versus radiotherapy, the 10-year cancer-specific mortality rates were 1.4 versus 3.9% in low-intermediate risk prostate cancer and 6.8 versus 11.5% in high-risk prostate cancer, respectively. Rates were 2.4 versus 5.9% in patients with Charlson Comorbidity Index of 0, 2.4 versus 5.1% in patients with Charlson Comorbidity Index of 1, and 2.9 versus 5.2% in patients with Charlson Comorbidity Index of ≥2. Rates were 2.1 versus 5.0% in patients aged 65-69 years, 2.8 versus 5.5% in patients aged 70-74 years, and 2.9 versus 7.6% in patients aged 75-80 years (all P<0.001). At multivariable analyses, radiotherapy was associated with less favorable cancer-specific mortality in all categories (all P<0.001). Patients treated with radical prostatectomy fare substantially better than those treated with radiotherapy. Patients with high-risk prostate cancer benefit the most from radical prostatectomy. Conversely, the lowest benefit was observed in patients with low-intermediate risk prostate cancer and/or multiple comorbidities. An intermediate benefit was observed in the other examined categories. (author)
Lassi, Zohra S; Bhutta, Zulfiqar A
While maternal, infant and under-five child mortality rates in developing countries have declined significantly in the past two to three decades, newborn mortality rates have reduced much more slowly. While it is recognised that almost half of the newborn deaths can be prevented by scaling up evidence-based available interventions (such as tetanus toxoid immunisation to mothers, clean and skilled care at delivery, newborn resuscitation, exclusive breastfeeding, clean umbilical cord care, and/or management of infections in newborns), many require facility-based and outreach services. It has also been stated that a significant proportion of these mortalities and morbidities could also be potentially addressed by developing community-based packaged interventions which should also be supplemented by developing and strengthening linkages with the local health systems. Some of the recent community-based studies of interventions targeting women of reproductive age have shown variable impacts on maternal outcomes and hence it is uncertain if these strategies have consistent benefit across the continuum of maternal and newborn care. To assess the effectiveness of community-based intervention packages in reducing maternal and neonatal morbidity and mortality; and improving neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2014), World Bank's JOLIS (25 May 2014), BLDS at IDS and IDEAS database of unpublished working papers (25 May 2014), Google and Google Scholar (25 May 2014). All prospective randomised, cluster-randomised and quasi-randomised trials evaluating the effectiveness of community-based intervention packages in reducing maternal and neonatal mortality and morbidities, and improving neonatal outcomes. Two review authors independently assessed trials for inclusion, assessed trial quality and extracted the data. Data were checked for accuracy. The review included 26 cluster-randomised/quasi-randomised trials
Lee, Yeong-Bae; Park, Joo-Hwan; Kim, Eunja; Kang, Chang-Ki; Park, Hyeon-Mi
Objective Arterial stiffness is a common change associated with aging and can be evaluated by measuring pulse wave velocity (PWV) between sites in the arterial tree, with the stiffer artery having the higher PWV. Arterial stiffness is associated with the risk of stroke in the general population and of fatal stroke in hypertensive patients. This study is to clarify whether PWV value predicts functional outcome of acute ischemic stroke. Methods One hundred patients were enrolled with a diagnosi...
Gronda, Edoardo; Genovese, Stefano; Padeletti, Luigi; Cacciatore, Francesco; Vitale, Dino Franco; Bragato, Renato; Innocenti, Lisa; Schiano, Concetta; Sommese, Linda; De Pascale, Maria Rosaria; Genovese, Luca; Abete, Pasquale; Donatelli, Francesco; Napoli, Claudio
The use of cardiac resynchronization therapy (CRT) and implantable cardioverter- defibrillator (ICD) for advanced heart failure (HF) is increasing. Renal dysfunction is a common condition in HF which is associated with a worse survival. The study aims at identifying in patients with advanced HF treated with CRT the effect of baseline glomerular filtration rate (GFR), GFR improvement and left ventricular ejection fraction (LVEF) change, after 6-months of CRT implant, on survival. The study population consisted of 375 advanced HF patients who received a CRT between 1999 and 2009, of these 277 received also an ICD implant. Clinical characteristics (New York Heart Association [NYHA] functional class, ischemic vs. non-ischemic etiology, atrial fibrillation, diabetes, hypertension, LVEF, QRS duration and GFR were recorded. The use of common used drugs was evaluated. Cox proportional hazards analysis was calculated in order to evaluate variables associated to mortality. During a median follow-up of 43.0 months, 93 (24.8%) patients died. Patients deceased during the study had at baseline higher NYHA class and lower LVEF and GFR. In Cox regression analysis, GFR predicts long-term mortality (hazard ratio [HR] 0.983; 95% confidence interval [CI] 0.969-0.998; p = 0.023) independently from the effect of others covariates. In addition, a positive GFR improvement 6 months after CRT implant is significantly associated with a lower hazard of mortality (for each 10 mL/min of GFR improvement HR 0.86; 95% CI 0.75-0.99; p = 0.038). GFR is a significant predictor of mortality in advanced HF patients who received CRT. A GFR improvement 6 months after CRT implant is significantly associated with a lower hazard of mortality.
Mendenhall, Stephen K; Sivaganesan, Ahilan; Mistry, Akshitkumar; Sivasubramaniam, Priya; McGirt, Matthew J; Devin, Clinton J
Only Level 3 evidence exists for the diagnosis and treatment of atlantooccipital dislocation (AOD) with few studies examining mortality, neurologic improvement, and patient-reported outcomes (PROs). First, the aim was to determine: the incidence of AOD, 90-day surgical morbidity and mortality after AOD, patient factors that may be associated with delayed or missed diagnosis, and factors that were associated with mortality and neurologic improvement after AOD. Secondly, the aim was to quantify the pain, disability, and quality of life experienced by patients surviving AOD. This was a retrospective cohort study. A total of 5,337 consecutive spine computed tomography traumagrams from 1997 to 2012 were included. Mortality, neurologic improvement, complications, EuroQol five dimensions (EQ-5D), Neck Disability Index (NDI), Numeric Rating Scale (NRS)-neck, NRS-arm, and return-to-work were the outcome measures. Patients were considered to have AOD if they met one of the following radiographic criteria: basion-dens interval greater than 10 mm; basion-axial interval: anterior displacement greater than 12 mm or posterior displacement greater than 4 mm between the basion and posterior C2 line; and condyle to C1 interval greater than 1.4 mm. Linear regression analysis was performed to identify factors associated with 90-day mortality, neurologic improvement, and missed diagnosis. Patient-reported outcomes were assessed via phone interview. Thirty-one patients met radiographic criteria for AOD; an incidence of 0.6% over 15 years. Twenty-one (68%) patients were treated with occipital cervical fusion. At 90 days postoperatively, there were no new neurologic deficits or reoperations. Eight (26%) patients died within 90 days. All patients who died had no documented AOD diagnosis and were not treated surgically. Missed AOD diagnosis was the strongest predictor of mortality. Younger age, lower Glasgow Coma Score, lower Injury Severity Score (ISS) score, and worse initial American
Jørgensen, Terese S. H.; Wium-Andersen, Ida K.; Wium-Andersen, Marie K.
Importance: More than 30 million people live with a stroke diagnosis worldwide. Depression after stroke is frequent, and greater knowledge of associated risk factors and outcomes is needed to understand the etiology and implications of this disabling complication. Objectives: To examine whether......, history of depression, and stroke severity (in patients with stroke). The associations were strongest for the reference population. In both populations, depressed individuals, especially those with new onset, had increased all-cause mortality (hazard ratio for new-onset depression, 1.89 [95% CI, 1...
Panico, Flávia F; Troster, Eduardo J; Oliveira, Cindy S; Faria, Aline; Lucena, Michelle; João, Paulo R D; Saad, Everardo D; Foronda, Flávia A K; Delgado, Artur F; de Carvalho, Werther Brunow
Children admitted to PICUs often present with or develop respiratory failure that requires mechanical ventilation. We prospectively identified children admitted to three general PICUs, with the goal of identifying risk factors for mortality. Prospective multicenter observational study. Three general PICUs, two in São Paulo and one in Curitiba, Brazil. Children aged between 1 month and 15 years, consecutively admitted between August 2008 and July 2010, with acute lung injury or acute respiratory distress syndrome that developed at least 12 hours after invasive or noninvasive mechanical ventilation. None. We used logistic regression models to explore the relationship between death and independent variables. Of 3,046 patients admitted to the three PICUs, 1,658 patients underwent mechanical ventilation, and 84 fulfilled the acute lung injury/acute respiratory distress syndrome inclusion criteria and were analyzed. Nearly 60% were boys, and the median age was 31 months. Pressure control/assist control was the initial mode of mechanical ventilation in 86% of cases, and the median durations of mechanical ventilation and PICU stay were 12 and 15 days, respectively. None of the eight patients with acute lung injury died, whereas 33 of 76 of the remaining patients with acute respiratory distress syndrome died, for an overall mortality rate of 39.3% (95% CI, 28.8-50.6%). In different multivariate logistic regression model, the number of organ dysfunctions at admission, peak inspiratory pressure, airway pressure gradient on day 1, and the mean airway pressure gradient over the first 7 days of mechanical ventilation were significantly associated with mortality. Mortality is high in pediatric acute lung injury/acute respiratory distress syndrome. Mechanical ventilation-associated risk factors for death among such patients are potential targets for intervention.
Background From a mechanistic or physical perspective there is no basis to suspect that electric charges on clusters of air molecules (air ions) would have beneficial or deleterious effects on respiratory function. Yet, there is a large lay and scientific literature spanning 80 years that asserts exposure to air ions affects the respiratory system and has other biological effects. Aims This review evaluates the scientific evidence in published human experimental studies regarding the effects of exposure to air ions on respiratory performance and symptoms. Methods We identified 23 studies (published 1933–1993) that met our inclusion criteria. Relevant data pertaining to study population characteristics, study design, experimental methods, statistical techniques, and study results were assessed. Where relevant, random effects meta-analysis models were utilized to quantify similar exposure and outcome groupings. Results The included studies examined the therapeutic benefits of exposure to negative air ions on respiratory outcomes, such as ventilatory function and asthmatic symptoms. Study specific sample sizes ranged between 7 and 23, and studies varied considerably by subject characteristics (e.g., infants with asthma, adults with emphysema), experimental method, outcomes measured (e.g., subjective symptoms, sensitivity, clinical pulmonary function), analytical design, and statistical reporting. Conclusions Despite numerous experimental and analytical differences across studies, the literature does not clearly support a beneficial role in exposure to negative air ions and respiratory function or asthmatic symptom alleviation. Further, collectively, the human experimental studies do not indicate a significant detrimental effect of exposure to positive air ions on respiratory measures. Exposure to negative or positive air ions does not appear to play an appreciable role in respiratory function. PMID:24016271
Volume-Outcome Relationships in Pediatric Acute Lymphoblastic Leukemia: Association Between Hospital Pediatric and Pediatric Oncology Volume With Mortality and Intensive Care Resources During Initial Therapy.
Wilkes, Jennifer J; Hennessy, Sean; Xiao, Rui; Rheingold, Susan; Seif, Alix E; Huang, Yuan-Shung; Vendetti, Neika; Li, Yimei; Bagatell, Rochelle; Aplenc, Richard; Fisher, Brian T
There are few contemporary studies of volume-outcome relationships in pediatric oncology. Children with acute lymphoblastic leukemia (ALL) are treated at a wide variety of hospitals. We investigated if inpatient hospital volume influences outcomes. The objective of this study was to evaluate the relationship between inpatient pediatric and pediatric oncology volume and mortality and intensive care resources (ICU care). We hypothesized an inverse relationship between volume and these outcomes. This was a retrospective cohort study. Patients 0 to 18 years of age in the Pediatric Health Information System or Perspective Premier Database from 2009 to 2011 with ALL were included. Exposures were considered as the average inpatient pediatric and pediatric oncology volume. The primary outcome was inpatient mortality; secondary outcome was need for ICU care. The included population comprised 3350 patients from 75 hospitals. The inpatient mortality rate was 0.86% (95% confidence interval, 0.58%-1.2%). In the unadjusted analysis, mortality increased as pediatric oncology volume increased from low (0%) to high volume (1.3%) (P = .009). The small number of deaths precluded multivariable analysis of this outcome. Pediatric and pediatric oncology volume was not associated with ICU care when we controlled for potential confounders. Induction mortality was low. We did not observe an inverse relationship between volume and mortality or ICU care. This suggests that in a modern treatment era, treatment at a low-volume center might not be associated with increased mortality or ICU care in the first portion of therapy. This relationship should be evaluated in other oncology populations with higher mortality rates and with longer-term outcomes. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.
Bjerrum, Søren Solborg; la Cour, Morten
To study the epidemiology of patients with endogenous endophthalmitis in Denmark. Retrospective and prospective case series of 59 eyes in patients with endogenous endophthalmitis in Denmark between 2000 and 2016. The age of the patients ranged from 28 to 90 years with a median of 66 years. Sixty-two percent of the eyes had a final VA (visual acuity) ≤ 0.1 while 8% had a final VA ≥ 1.0. Positive cultures were obtained in 51% of the cases from the blood and in 43% from the vitreous. Streptococcus species and Staphylococcus aureus were the most commonly identified microorganisms. The sources of endogenous endophthalmitis were diverse and were not identified in 36% of the patients. Diabetes (36%) was the most predisposing medical illness. A total of 15% of the patients died within the first year after surgery for endophthalmitis and half of the patients died during follow up. The mortality of patients was 22.6 times higher compared to a Danish background population. Culture positive patients had a higher mortality compared to culture negative patients. Endogenous endophthalmitis is a heterogeneous condition which is reflected in the age, the visual outcome and the mortality of the patients. The epidemiology of the disease is very different in Scandinavia compared to Asia. The visual prognosis remains grave and the majority of the eyes lose useful vision.
Miller, Joseph B; Lewandowski, Christopher; Wira, Charles R; Taylor, Andrew; Burmeister, Charlotte; Welch, Robert
Plasma expansion in acute ischemic stroke has potential to improve cerebral perfusion, but the long-term effects on functional outcome are mixed in prior trials. The goal of this study was to evaluate how the magnitude of plasma expansion affects neurological recovery in acute stroke. This was a secondary analysis of data from the Albumin in Acute Stroke Part 2 trial investigating the relationship between the magnitude of overall intravenous volume infusion (crystalloid and colloid) to clinical outcome. The data were inclusive of 841 patients with a mean age of 64 years and a median National Institutes of Health Stroke Scale (NIHSS) of 11. In a multivariable-adjusted logistic regression model, this analysis tested the volume of plasma expansion over the first 48 h of hospitalization as a predictor of favorable outcome, defined as either a modified Rankin Scale score of 0 or 1 or a NIHSS score of 0 or 1 at 90 days. This model included all study patients, irrespective of albumin or isotonic saline treatment. Patients that received higher volumes of plasma expansion more frequently had large vessel ischemic stroke and higher NIHSS scores. The multivariable-adjusted model revealed that there was decreased odds of a favorable outcome for every 250 ml additional volume plasma expansion over the first 48 h (OR 0.91, 95 % CI, 0.88-0.94). The present study demonstrates an association between greater volume of plasma expansion and worse neurological recovery.
Chittithavorn, Voravit; Duangpakdee, Pongsanae; Rergkliang, Chareonkiat; Pruekprasert, Napat
To determine the association between several perioperative variables and in-hospital shunt thrombosis and mortality in patients weighing less than 3 kg with functional univentricular heart (UVH) who underwent modified Blalock-Taussig shunt. Between January 2006 and February 2016, 85 patients who weighed less than 3 kg with functional UVH and underwent modified Blalock-Taussig shunt were reviewed. In-hospital shunt thrombosis and mortality were the primary outcomes. The associations between perioperative variables and outcomes were assessed with univariate and multivariate analyses. In-hospital shunt thrombosis was 14% (12 of 85). Hospital mortality was 18% (15 of 85), which resulted in an 82% discharge survival rate. Shunt thrombosis was significantly associated with in-hospital mortality (odds ratio 18.9, 95% confidence interval 4.5-78.9). There were no statistically significant associations between weight, specific diagnosis of functional UVH and shunt thrombosis or mortality. Multivariate analysis identified delayed initiation of anticoagulant (P thrombosis, while intraoperative bradycardia (P thrombosis (P thrombosis. Our study highlighted the perioperative variables of delayed postoperative initiation of anticoagulant, cardiac arrest and the occurrence of intraoperative bradycardia that were significant risk factors for shunt thrombosis and mortality. Achieving better quality of perioperative care potentially improves outcomes.
Michael J Proctor
Full Text Available Markers of the systemic inflammatory response, including C-reactive protein and albumin (combined to form the modified Glasgow Prognostic Score, as well as neutrophil, lymphocyte and platelet counts have been shown to be prognostic of survival in patients with cancer. The aim of the present study was to examine the prognostic relationship between these markers of the systemic inflammatory response and all-cause, cancer, cardiovascular and cerebrovascular mortality in a large incidentally sampled cohort.Patients (n = 160 481 who had an incidental blood sample taken between 2000 and 2008 were studied for the prognostic value of C-reactive protein (>10mg/l, albumin (>35mg/l, neutrophil (>7.5×109/l lymphocyte and platelet counts. Also, patients (n = 52 091 sampled following the introduction of high sensitivity C-reactive protein (>3mg/l measurements were studied. A combination of these markers, to make cumulative inflammation-based scores, were investigated.In all patients (n = 160 481 C-reactive protein (>10mg/l (HR 2.71, p35mg/l (HR 3.68, p3mg/l (n = 52 091. A combination of high sensitivity C-reactive protein (>3mg/l, albumin and neutrophil count predicted all-cause (HR 7.37, p<0.001, AUC 0.723, cancer (HR 9.32, p<0.001, AUC 0.731, cardiovascular (HR 4.03, p<0.001, AUC 0.650 and cerebrovascular (HR 3.10, p<0.001, AUC 0.623 mortality.The results of the present study showed that an inflammation-based prognostic score, combining high sensitivity C-reactive protein, albumin and neutrophil count is prognostic of all-cause mortality.
Wertaschnigg, Dagmar; Manlhiot, Cedric; Jaeggi, Michelle; Seed, Mike; Dragulescu, Andreea; Schwartz, Steven M; van Arsdell, Glen; Jaeggi, Edgar T
Ebstein anomaly (EA) and tricuspid valve dysplasia (TVD) are rare anomalies and data on outcomes after a fetal or neonatal EA/TVD diagnosis are conflicting. To examine the outcome and identify markers predictive of mortality, we reviewed our single-centre experience from 2000-2014. Variables were analyzed separately for cases diagnosed in utero without pregnancy termination and for all live-born patients. Of 47 fetal cases, 8 (17%) died in utero and 10 (21%) as neonates. Independent predictors associated with fetal demise included severe tricuspid regurgitation with a Doppler gradient tricuspid annulus diameter (HR per z-score increase, 1.76; P = 0.004), and no pulmonary forward flow (HR, 4.63; P = 0.03). Our experience with fetal and neonatal EA/TVD shows better survival rates than previously reported. Mortality after a fetal diagnosis was significantly associated with hemodynamic changes indicative of a circular shunt, including pulmonary and tricuspid regurgitation severe enough to cause diastolic umbilical arterial flow reversal. Copyright Â© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
Tissue, D.; Maier, C.; Creek, D.; Choat, B.
Drought induced tree mortality and decline are key issues facing forest ecology and management. Here, we primarily investigated the hydraulic limitations underpinning drought-induced mortality in three Australian tree species. Using field-based large rainout shelters, three angiosperm species (Casuarina cunninghamiana, Eucalyptus sideroxylon, Eucalyptus tereticornis) were subjected to two successive drought and recovery cycles, prior to a subsequent long and extreme drought to mortality; total duration of experiment was 2.5 years. Leaf gas exchange, leaf and stem hydraulics, and carbon reserves were monitored during the experiment. Trees died as a result of failure in the hydraulic transport system, primarily related to water stress induced embolism. Stomatal closure occurred prior to the induction of significant embolism in the stem xylem of all species. Nonetheless, trees suffered a rapid decline in xylem water potential and increase in embolism during the severe drought treatment. Trees died at water potentials causing greater than 90% loss of hydraulic conductivity in the stem, providing support for the theory that lethal water potential is correlated with complete loss of hydraulic function in the stem xylem of angiosperms.
Sim, John J.; Bhandari, Simran K.; Shi, Jiaxiao; Reynolds, Kristi; Calhoun, David A.; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.
We sought to compare the risk of end stage renal disease (ESRD), ischemic heart event (IHE), congestive heart failure (CHF), cerebrovascular accident (CVA), and all-cause mortality among 470,386 individuals with resistant and nonresistant hypertension (non-RH). Resistant hypertension (60,327 individuals) was sub-categorized into 2 groups; 23,104 patients with cRH (controlled on 4 or more medicines) and 37,223 patients with uRH (uncontrolled on 3 or more medicines) in a 5 year retrospective cohort study. Cox proportional hazard modeling was used to estimate hazard ratios adjusting for age, gender, race, body mass index, chronic kidney disease (CKD), and co-morbidities. Resistant hypertension (cRH and uRH) compared to non-RH, had multivariable adjusted hazard ratios (95% confidence intervals) of 1.32 (1.27–1.37), 1.24 (1.20–1.28), 1.46 (1.40–1.52), 1.14 (1.10–1.19), and 1.06 (1.03–1.08) for ESRD, IHE, CHF, CVA, and mortality, respectively. Comparison of uRH to cRH had hazard ratios of 1.25 (1.18–1.33), 1.04 (0.99–1.10), 0.94 (0.89–1.01), 1.23 (1.14–1.31), and 1.01 (0.97–1.05) for ESRD, IHE, CHF, CVA, and mortality, respectively. Males and Hispanics had greater risk for ESRD within all 3 cohorts. Resistant hypertension had greater risk for ESRD, IHE, CHF, CVA, and mortality. The risk of ESRD and CVA and were 25% and 23% greater, respectively, in uRH compared to cRH supporting the linkage between blood pressure and both outcomes. PMID:25945406
Nazrun, Ahmad Shuid; Tzar, Mohd Nizam; Mokhtar, Sabarul Afian; Mohamed, Isa Naina
Purpose Osteoporotic fracture is the main complication of osteoporosis. The current management is to discharge patients as early as possible so they can get back to their daily activities. Once discharged, there are three main issues relating to morbidity, mortality, and risk of a subsequent fracture that need to be addressed and discussed. Therefore, the aim of this systematic review was to summarize and evaluate the evidence from published literature, to determine the outcome of osteoporotic fracture patients after their hospital discharge. Methods The MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched, using the terms “osteoporosis”, “fracture”, “osteoporotic fracture”, “hip fracture”, and “vertebral fracture”. We included only human studies published in English between 2004 and 2014. The reference lists of included studies were thoroughly reviewed in search for other relevant studies. Results A total of 18 studies met the selection criteria. Most were observational and cohort studies. Out of all the studies, five studies looked into the morbidity, six studies looked into the risk of subsequent fractures, and seven studies looked into mortality. Vertebral fracture caused the greatest health burden, but hip fracture patients were the main users of informal care after hospital discharge. There was an increased risk of a subsequent fracture after a primary fracture compared with the control group, a cohort comparison, or the general population. Osteoporotic fractures, especially hip fractures, are associated with higher mortality rate despite the advances in the management of osteoporotic fracture cases. Conclusion There is strong evidence to show that after hospital discharge, osteoporotic fracture patients are faced with higher morbidity, subsequent fractures, and mortality. PMID:25429224
Wang, Justin; Alotaibi, Naif M; Akbar, Muhammad Ali; Ayling, Oliver G S; Ibrahim, George M; Macdonald, R Loch
Transient loss of consciousness (LOC) is one of the most common presentations of aneurysmal subarachnoid hemorrhage (SAH) and may be an indicator of early brain injury. In this study, we examined the association of LOC and functional outcomes in patients with good-grade SAH. We searched the Subarachnoid Hemorrhage International Trialists Repository for patients who presented with LOC at ictus of SAH. A propensity score analysis was performed on good-grade patients (defined as World Federation of Neurosurgical Societies grade 1-3) to balance selected covariates between those with and without LOC. The primary outcome was Glasgow Outcome Score (GOS) at 3 months (with poor outcome defined as a GOS of 1-3). Secondary outcomes were delayed cerebral ischemia (DCI), rebleed, length of hospital stay, and time to death. A propensity score-matching algorithm identified 336 patients (168 with and 168 without LOC at ictus). The proportion of patients with poor functional outcome at 3 months was significantly higher in the cohort with LOC at ictus compared with the matched cohort without LOC at ictus (30% vs. 19%; P = 0.02). There was a nonsignificant trend toward greater mortality in the patients with LOC at ictus (19% vs. 13%; P = 0.14). There were no significant differences in the secondary outcomes between the 2 cohorts. LOC at ictus of SAH is associated with a higher rate of unfavorable functional outcomes but not of mortality, DCI, or rebleed in patients with good-grade SAH. Future studies should further investigate the putative mechanisms through which LOC mediates early brain injury in SAH. Copyright © 2016 Elsevier Inc. All rights reserved.
Marshall, Gary T; James, Robert F; Landman, Matthew P; O'Neill, Patrick J; Cotton, Bryan A; Hansen, Erik N; Morris, John A; May, Addison K
To identify predictors of mortality and long-term outcomes in survivors after pentobarbital coma (PBC) in patients failing current treatment standards for severe traumatic brain injuries (TBI). This is a retrospective cohort study of severe TBI patients receiving PBC at Level I Trauma Center and tertiary university hospital. Four thousand nine hundred thirty-four patients were admitted to the trauma intensive care unit with severe TBI (head Abbreviated Injury Scale >or= 3) between April 1998 and December 2004. Six hundred eleven received intracranial pressure (ICP) monitoring and 58 received PBC. Three patients underwent craniotomy for intracranial mass lesion and were excluded. The study group received standardized medical management for severe TBI including opiates, benzodiazepines, elevation of the head of bed, avoidance of hypotension and hypercapnia and hyperosmolar therapy (HOsmRx). In addition, 31 of 55 patients (56%) underwent placement of intraventricular catheters for cerebrospinal fluid drainage. If routine medical management and cerebrospinal fluid diversion failed to control ICP, then the patient was determined to have refractory intracranial hypertension (RICH) and PBC treatment was initiated. PBC was performed with pentobarbital infusion with continuous electroencephalogram monitoring to ensure adequate burst suppression. The measurements include serum sodium (Na) and osmolality (Osm) were assessed as indicators for initiation of PBC and to estimate the 50% mortality cut-points when controlling for ICP. Follow-up functional outcomes were assessed using the Glasgow Outcome Scale and stratified according to admission Glasgow Coma Scale score and Marshall computed tomography classification. Of the 55 PBC patients, 22 (40%) survived at discharge. 19 of 22 had long-term follow-up (1 year or more) available. Of these, 13 (68%) were normal or functionally independent (Glasgow Outcome Scale score 4 or 5). Serum Na and Osm were associated with death (p < 0
Osler, M; Andersen, A-M N; Due, P
OBJECTIVE: To examine the relation between socioeconomic position in early life and mortality in young adulthood, taking birth weight and childhood cognitive function into account. DESIGN: A longitudinal study with record linkage to the Civil Registration System and Cause of Death Registry....... The data were analysed using Cox regression. SETTING: The metropolitan area of Copenhagen, Denmark. SUBJECTS: 7493 male singletons born in 1953, who completed a questionnaire with various cognitive measures, in school at age 12 years, and for whom birth certificates with data on birth and parental...
Koren-Hakim, Tamar; Weiss, Avraham; Hershkovitz, Avital; Otzrateni, Irena; Grosman, Boris; Frishman, Sigal; Salai, Moshe; Beloosesky, Yichayaou
Malnutrition is common in hip fracture elderly patients. The purpose of this study was to examine the relationship between the Mini Nutrition Assessment Short Form (MNA-SF) and cognitive, functional status, comorbidity and outcome of operated patients. Clinical data, MNA, functioning, cognition were prospectively determined. Retrospectively, the Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale for Geriatrics (CIRS-G) were applied. The study consisted of 95 well-nourished (WN), 95 at risk of malnutrition (ARM) and 25 malnourished (MN) patients. More WN patients were independent vs. partially or fully dependent; more WN patients were cognitively normal vs. cognitively impaired (p nutritional condition. Poor nutritional status was associated with higher comorbidity indices, mortality and readmissions. However, we found that only comorbidity and low functioning can predict long-term mortality. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Jørgensen, Terese Sara Høj; Lund, Rikke; Siersma, Volkert Dirk
It is well established that socioeconomic position (SEP) and social relations impact physical function and mortality in old age. Due to differential vulnerability, few social relations may lead to greater decline in physical function and mortality among older people with low compared to high SEP....... The aim was to investigate whether older people with few social relations experience greater decline in physical function and mortality when also subject to low financial assets? The study population included 4060 older people aged 75 or 80 years at baseline in 1998–1999. Social relations at baseline...... and physical function at baseline and after 1.5, 3.0 and 4.5 years were obtained from questionnaires. Financial assets at baseline and mortality during 10 years of follow-up were obtained from registers. Analyses of the associations between financial assets combined with social relations and decline...
Lap, Chiara C M M; Bolhuis, Sandra W; Van Braeckel, Koenraad N J A; Reijneveld, Sijmen A; Manten, Gwendolyn T R; Bos, Arend F; Hulscher, Jan B F
We aimed to determine motor, cognitive and behavioural outcomes of school aged children born with gastroschisis compared to matched controls. We compared outcomes of 16 children born with gastroschisis treated at the University Medical Center Groningen, the Netherlands, between 1999 and 2006 with 32 controls matched for gender, gestational age, birth weight, and corrected for small for gestational age (SGA) and parental socioeconomic status (SES). Intelligence, auditory-verbal memory, attention, response inhibition, visual perception, motor skills, visuomotor integration, problem behaviour and executive functioning were evaluated. Median verbal intelligence quotient and global executive functioning scores of children born with gastroschisis were poorer than of controls (95 (inter quartile range (IQR) 88-100) vs. 104 (IQR 98-113), P=0.001, and 29 (IQR 6.8-63.8) vs. 5.0 (IQR 2.8-19.8), P=0.03, respectively). Children with gastroschisis were more often classified as borderline or abnormal than controls regarding response inhibition (odds ratio (OR) 20.4; 95%-confidence interval (95%-CI); 2.4-171.5), selective visual attention (OR 40.4; 95%-CI 5.9-275.4), sustained auditory attention (OR 88.1; 95%-CI 5.8-1342.8), and fine motor skills (50% vs. 0%). Grade retention was more prevalent in gastroschisis children (OR 6.07; 95%-CI 1.42-25.9). These associations persisted after adjustment for SGA and SES. The auditory-verbal memory, visuomotor integration and behavioural problems did not significantly differ from the controls. Gastroschisis is associated with poorer verbal intelligence, and with an increased risk for poor performance on several aspects of attention, response inhibition and fine motor skills at school age. The follow-up of children born with gastroschisis deserves attention regarding these specific domains, to improve their functional outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.
George, Lekha K; Koshy, Santhosh K G; Molnar, Miklos Z; Thomas, Fridtjof; Lu, Jun L; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P
Heart failure (HF) is associated with poor cardiac outcomes and mortality. It is not known whether HF leads to poor renal outcomes in patients with normal kidney function. We hypothesized that HF is associated with worse long-term renal outcomes. Among 3 570 865 US veterans with estimated glomerular filtration rate (eGFR) ≥60 mL min -1 1.73 m -2 during October 1, 2004 to September 30, 2006, we identified 156 743 with an International Classification of Diseases , Ninth Revision , diagnosis of HF. We examined the association of HF with incident chronic kidney disease (CKD), the composite of incident CKD or mortality, and rapid rate of eGFR decline (slopes steeper than -5 mL min -1 1.73 m -2 y -1 ) using Cox proportional hazard analyses and logistic regression. Adjustments were made for various confounders. The mean±standard deviation baseline age and eGFR of HF patients were 68±11 years and 78±14 mL min -1 1.73 m -2 and in patients without HF were 59±14 years and 84±16 mL min -1 1.73 m -2 , respectively. HF patients had higher prevalence of hypertension, diabetes mellitus, cardiac, peripheral vascular and chronic lung diseases, stroke, and dementia. Incidence of CKD was 69.0/1000 patient-years in HF patients versus 14.5/1000 patient-years in patients without HF, and 22% of patients with HF had rapid decline in eGFR compared with 8.5% in patients without HF. HF patients had a 2.12-, 2.06-, and 2.13-fold higher multivariable-adjusted risk of incident CKD, composite of CKD or mortality, and rapid eGFR decline, respectively. HF is associated with significantly higher risk of incident CKD, incident CKD or mortality, and rapid eGFR decline. Early diagnosis and management of HF could help reduce the risk of long-term renal complications. © 2017 American Heart Association, Inc.
Smith, Emily R; Shankar, Anuraj H; Wu, Lee S-F
BACKGROUND: Micronutrient deficiencies are common among women in low-income and middle-income countries. Data from randomised trials suggest that maternal multiple micronutrient supplementation decreases the risk of low birthweight and potentially improves other infant health outcomes. However, h...
Full Text Available Background: Bowel function has been reported to be adversely affected following surgery in cases of Hirschsprung. We retrospectively studied both the clinical outcome and bowel function status following surgery in patients diagnosed with Hirschprung′s disease (HD. 161 cases, who underwent pull-through operations for HD in Sheikh Pediatric Tertiary Centre, Mashhad, Iran. The specified time bracket spanned between 2006 and 2011. Materials and Methods: Data was extracted from Health Information System with the aim of investigating patients for both short and long-term gastrointestinal (GI complications after surgery bases in addition to the concurrence of any associated anomalies. Three main procedures were analysed in this respect (Swenson, Duhamel and Soave. Results: In a study of 96 (59% boys and 65 (40.3% girls, mortality rate was reported to be 15.5% (15 males and 10 females. A considerable majority of almost three fourths were detected with both early and late GI complications after surgery. The latter mainly included constipation (30.8%, incontinence (19.8%, enterocolitis (8%, diarrhea (11% in a declining order of incidence. Down syndrome and others HD-associated anomalies were detected in 3.7% and 24.3% of cases respectively. Conclusions: Constipation and foecal incontinence were the most prevalent postoperative complications, which were reported almost as frequent in other studies. Yet, Enterocolitis, was reported slightly less in prevalence. Also mortality rates were considerably higher, compared to developed nations.
Lindley, Kathryn J; Conner, Shayna N; Cahill, Alison G; Novak, Eric; Mann, Douglas L
Preeclampsia is a risk factor for the development of peripartum cardiomyopathy (PPCM), but it is unknown whether preeclampsia impacts clinical or left ventricular (LV) functional outcomes. This study sought to assess clinical and functional outcomes in women with PPCM complicated by preeclampsia. This retrospective cohort study included women diagnosed with PPCM delivering at Barnes-Jewish Hospital between 2004 to 2014. The primary outcome was one-year event-free survival rate for the combined end point of death and hospital readmission. The secondary outcome was recovery of LV ejection fraction. Seventeen of 39 women (44%) with PPCM had preeclampsia. The groups had similar mean LV ejection fraction at diagnosis (29.6 with versus 27.3 without preeclampsia; P =0.5). Women with preeclampsia had smaller mean LV end-diastolic diameters (5.2 versus 6.0 cm; P =0.001), greater relative wall thickness (0.41 versus 0.35 mm Hg; P =0.009), and lower incidence of eccentric remodeling (12% versus 48%; P =0.03). Clinical follow-up was available for 32 women; 5 died of cardiovascular complications within 1 year of diagnosis (4/15 with versus 1/17 without preeclampsia; P =0.16). In time to event analysis, patients with preeclampsia had worse event-free survival during 1-year follow-up ( P =0.047). Echocardiographic follow-up was available in 10 survivors with and 16 without preeclampsia. LV ejection fraction recovered in 80% of survivors with versus 25% without preeclampsia ( P =0.014). PPCM with concomitant preeclampsia is associated with increased morbidity and mortality and different patterns of LV remodeling and recovery of LV function when compared with patients with PPCM that is not complicated by preeclampsia. © 2017 American Heart Association, Inc.
Putaala, J; Strbian, D; Mustanoja, S; Haapaniemi, E; Kaste, M; Tatlisumak, T
To determine the functional outcome in a cohort of young adults with ischemic stroke patients, focusing on components of lipid profile. In our registry including consecutive patients with first-ever ischemic stroke aged 15-49 from 1994 to 2007, we analyzed predictors of 3-month functional outcome (modified Rankin Scale, mRS). Infarct size fell into small, medium, large posterior, or large anterior. Stroke severity was assessed with NIH Stroke Scale (NIHSS). Serum lipids were measured within 72 h after admission. Binary, multinomial ordinal, and Poisson regressions allowed revealing factors associated with size of infarct, stroke severity, and unfavorable outcome or death (mRS, 2-6) or mRS as an ordinal measure. In the 968 patients included (mean age, 41.3 ± 7.6; 62.6% men; 49.5% with mRS 0-1), factors associated with unfavorable outcome after multivariable analysis were increasing age (odds ratio, 1.03 per year; 95% confidence interval, 1.01-1.05), higher NIHSS score (1.23 per point, 1.17-1.29), large anterior (4.37, 2.26-8.42) or posterior (1.73, 1.05-2.85) infarcts, bilateral lesions (2.28, 1.30-3.98), internal carotid artery dissection (ICAD) (3.65, 1.41-9.47), and inversely high-density lipoprotein (HDL) levels (0.58 per unit increase, 0.38-0.86). Increasing HDL associated with smaller infarct size (0.71, 0.51-0.98). Both higher total and HDL cholesterol associated with lower NIHSS score (0.96, 0.93-0.98 for total cholesterol and 0.82, 0.75-0.88 for HDL) and lower 3-month mRS (0.87, 0.78-0.97 for total cholesterol and 0.65, 0.47-0.90 for HDL). In addition to known prognosticators, ICAD and lower HDL levels were independently associated with adverse clinical outcomes in our young adult stroke cohort. © 2012 John Wiley & Sons A/S.
Hall, Peter A; Dubin, Joel A; Crossley, Margaret; Holmqvist, Maxine E; D'Arcy, Carl
To assess the robustness of the association between intelligence quotient (IQ) and mortality in older adults and to examine whether or not the association can be explained by more specific cognitive processes, including individual differences in executive functioning. We examined the associations among Full Scale IQ, individual IQ subtest scores, and 10-year mortality among older community-dwelling, adult participants in the Canadian Study of Health and Aging, who were verified as disease and cognitive-impairment free at baseline via comprehensive medical and neurological evaluation (n = 516). Survival analysis including Cox proportional hazards regression models were used to examine mortality risk as a function of Full Scale IQ and its specific subcomponents. An inverse association was found between IQ and mortality, but this did not survive adjustment for demographics and education. The association between IQ and mortality seemed to be predominantly accounted for by performance on one specific IQ subtest that taps executive processes (i.e., Digit Symbol (DS)). Performance on this subtest uniquely and robustly predicted mortality in both unadjusted and adjusted models, such that a 1-standard deviation difference in performance was associated with a 28% change in risk of mortality over the 10-year follow-up interval in adjusted models. The association between IQ and mortality in older adults may be predominantly attributable to individual differences in DS performance.
Full Text Available OBJECTIVES: The aim of this study was to explore the left ventricular (LV deformation changes and the potential impact of deformation on outcome in patients with proven light-chain (AL amyloidosis and LV hypertrophy. BACKGROUND: Cardiac involvement in AL amyloidosis patients is associated with poor outcome. Detecting regional cardiac function by advanced non-invasive techniques might be favorable for predicting outcome. METHODS: LV longitudinal, circumferential and radial peak systolic strains (Ssys were assessed by speckle tracking imaging (STI in 44 biopsy-proven systemic AL amyloidosis patients with LV hypertrophy (CA and in 30 normal controls. Patients were divided into compensated (n = 18 and decompensated (n = 26 group based on clinical assessment and followed-up for a median period of 345 days. RESULTS: Ejection fraction (EF was preserved while longitudinal Ssys (LSsys was significantly reduced in both compensated and decompensated groups. Survival was significantly reduced in decompensated group (35% vs. compensated 78%, P = 0.001. LSsys were similar in apical segments and significantly reduced in basal segments between two patient groups. LSsys at mid-segments were significantly reduced in all LV walls of decompensated group. Patients were further divided into 4 subgroups according to the presence or absence of reduced LSsys in no (normal, only basal (mild, basal and mid (intermediate and all segments of the septum (severe. This staging revealed continuously worse prognosis in proportion to increasing number of segments with reduced LSsys (mortality: normal 14%, mild 27%, intermediate 67%, and severe 64%. Mid-septum LSsys<11% suggested a 4.8-fold mortality risk than mid-septum LSsys≥11%. Multivariate regression analysis showed NYHA class and mid-septum LSsys were independent predictors for survival. CONCLUSIONS: Reduced deformation at mid-septum is associated with worse prognosis in systemic amyloidosis patients with LV
Miranda-Chan, Thomas; Fruiht, Veronica; Dubon, Valeska; Wray-Lake, Laura
Adolescence is a time during which positive adults outside the familial context may be most influential to development. A growing body of research on naturally occurring mentors has found favorable outcomes for youth who have these types of positive adult figures in their lives. Less is known, however, about how these naturally occurring mentors influence youths' development in the long-term. This study examines the long-term outcomes related to having a naturally occurring community mentor in adolescence. Results from longitudinal analyses of a nationally representative sample of adolescents revealed that having a mentor in adolescence was related to higher educational attainment, lower criminal activity, higher psychological well-being (i.e., optimism, self-efficacy, and lack of depressive symptoms), and greater romantic relationship satisfaction in adulthood. Additionally, a taxonomy of mentoring functions was created from qualitative responses and drawing upon the youth, work, and academic mentoring literature. This taxonomy aims to serve as a framework for understanding the functions of youth mentors to provide a foundation for future research. Implications of findings and future directions are considered. © Society for Community Research and Action 2016.
Li, Yanting; Zhang, Yimin; Fang, Shuai; Liu, Shanshan; Liu, Xinyu; Li, Ming; Liang, Hong; Fu, Hua
Inequality in maternal and child health seriously hinders the overall improvement of health, which is a concern in both the United Nations Sustainable Development Goals (SDGs) and Healthy China 2030. However, research on the equality of maternal and child health is scarce. This study longitudinally assessed the equality trends in China's maternal and child health outcomes from 2000 to 2013 based on place of residence and gender to improve the fairness of domestic maternal and child health. Data on China's maternal and child health monitoring reports were collected from 2000 to 2013. Horizontal and vertical monitoring were performed on the following maternal and child health outcome indicators: incidence of birth defects (IBD), maternal mortality rate (MMR), under 5 mortality rate (U5MR) and neonatal mortality rate (NMR). The newly developed HD*Calc software by the World Health Organization (WHO) was employed as a tool for the health inequality assessment. The between group variance (BGV) and the Theil index (T) were used to measure disparity between different population groups, and the Slope index was used to analyse the BGV and T trends. The disparity in the MMR, U5MR and NMR for the different places of residence (urban and rural) improved over time. The BGV (Slope BGV = -32.24) and T (Slope T = -7.87) of MMR declined the fastest. The gender differences in the U5MR (Slope BGV = -0.06, Slope T = -0.21) and the NMR (Slope BGV = -0.01, Slope T = 0.23) were relatively stable, but the IBD disparity still showed an upward trend in both the place of residence and gender strata. A decline in urban-rural differences in the cause of maternal death was found for obstetric bleeding (Slope BGV = -14.61, Slope T = -20.84). Improvements were seen in the urban-rural disparity in premature birth and being underweight (PBU) in children under 5 years of age. Although diarrhoea and pneumonia decreased in the U5MR, no obvious gender-based trend in the causes of death was observed. We
Charlton, K; Nichols, C; Bowden, S; Milosavljevic, M; Lambert, K; Barone, L; Mason, M; Batterham, M
Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up. A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n = 476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates. At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; Pnutritional intervention following hospital discharge.
Lucas López Millán
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.
Tibblin, G; Svärdsudd, K; Welin, L; Erikson, H; Larsson, B
To construct a simple assessment of the quality of life that can be used to evaluate medical treatment in light of the need to conserve resources and limit costs. The Göteborg Quality of Life Assessment was constructed in 1973 from the responses of men who were 50 years old at the time of the initial survey (1963) and were re-evaluated 10 years later. The assessment covers 15 factors in the World Health Organization definition of health or well-being, and includes a symptom questionnaire of 30 items relating to the most common elements of physical, mental and social well-being. The assessment was validated by determining the variation in these three principle components of well-being as a function of age. The use of this assessment as an outcome variable for subjects with cardiovascular disease indicated significantly lower quality of life scores, especially with regard to the general well-being, fitness and energy of subjects with hypertension and congestive heart failure compared to subjects without these diseases. When the assessment was evaluated as a risk factor for cardiovascular disease and mortality, the results of univariate analysis showed that health, fitness and appetite were significantly correlated with total mortality, while multivariate analysis indicated that only health was a significant factor.
Full Text Available Aim of this research has been directed to the functional abilities relation testing (as predictors and athletic results (as criterion of students, who are VII and VIII grade of primary school (Χ= 13, 9 years; SD = 1, 17. The research has been conducted in Valjevo during November 2010. on the sample of 108 examinees. Variables’ sample has been assembled from 3 tests for functional abilities (maximal oxygen consumption, pulse frequency and vital lungs capacity evaluation and 4 athletic disciplines (high jump, long jump, shot put and 60 meters low start sprint from current physical education curriculum. Crombah-alfa coefficient values indicate to satisfactory reliability of applied instruments. In data processing canonical correlation analysis and multiple regression analysis have been used. Achieved canonical correlation analysis results showed that functional abilities set is statistically and significantly related to criterion variables set (R=.67, manifesting one canonical factor on the level p<.03. Achieved determination coefficient (R² = .43 indicates to functional abilities prognostic significance of explained variance 46% criterion. Using hierarchy regression model following statistically significant beta coefficient of functional abilities as partial predictors of athletics outcome have been determined: I for vital lungs capacity- high jump (β = .67, p < .01, II for vital lungs capacity- long jump (β = .55, p < .01, III for vital lungs capacity and pulse frequency- shot put (β =.-.34, p < .01; β =.42, p < .02 and IV for vital lungs capacity- 60 meters sprint (β = .-.39. Regression equation calculation of other applied functional abilities preadolescents’ predictor variables has not statistically and significantly contributed to univariance prediction of criterion variable variance
Cerón Navarro, José; de Aguiar Quevedo, Karol; Ansótegui Barrera, Emilio; Jordá Aragón, Carlos; Peñalver Cuesta, Juan Carlos; Mancheño Franch, Nuria; Vera Sempere, Francisco José; Padilla Alarcón, Jose
Lung transplantation (LT) is a therapeutic option with controversial results in chronic obstructive pulmonary disease (COPD). We aimed to analyze the outcomes of transplantation in terms of lung function and to identify prognostic factors. A retrospective analysis of 107 patients with COPD receiving lung transplants in the La Fe Hospital between 1991 and 2008 was performed. Preoperative variables, pulmonary function tests before and after LT, surgical procedure variables and long-term monitoring, expressed as mean or percentage, as applicable, were analyzed. Spirometric results before and after LT were analyzed. Linear or logistic regression were used for multivariate analysis depending on the variable. Ninety-four men (87.9%) and 13 women (12.1%) were transplanted, with a mean age±standard deviation of 52.58±8.05 years; 71% of LTs were double-lung transplantations. Spirometric values improved after LT: FVC: +1.22L (+34.9%), FEV1: +1.66L (+56.7%) and FEF25-75: +1.85L (+50.8%); P=.001. This functional improvement was maintained after 5 years only in the group with BODE score >7 (P=.001). Recipient height, type of LT, use of extracorporeal circulation during the surgical procedure, presence of bronchiolitis obliterans syndrome and the age and cause of death of the donor significantly influenced lung function over time. LT improves lung function in COPD patients. This improvement was maintained at 5years only in patients with BODE>7. Double lung transplantation provides better functional results than single-lung transplantation. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.
Carbajosa, Sofía; Rodríguez-Angulo, Héctor O.; Gea, Susana; Chillón-Marinas, Carlos; Poveda, Cristina; Maza, María C.; Colombet, Diana; Fresno, Manuel; Gironès, Núria
Chagas disease caused by Trypanosoma cruzi is a neglected disease that affects about 7 million people in Latin America, recently emerging on other continents due to migration. As infection in mice is characterized by depletion of plasma L-arginine, the effect on infection outcome was tested in mice with or without L-arginine supplementation and treatment with 1400W, a specific inhibitor of inducible nitric oxide synthase (iNOS). We found that levels of L-arginine and citrulline were reduced i...
Jasmine L Hamilton
Full Text Available Iron chelation therapy using iron (III specific chelators such as desferrioxamine (DFO, Desferal, deferasirox (Exjade or ICL-670, and deferiprone (Ferriprox or L1 are the current standard of care for the treatment of iron overload. Although each chelator is capable of promoting some degree of iron excretion, these chelators are also associated with a wide range of well documented toxicities. However, there is currently very limited data available on their effects in developing embryos. In this study, we took advantage of the rapid development and transparency of the zebrafish embryo, Danio rerio to assess and compare the toxicity of iron chelators. All three iron chelators described above were delivered to zebrafish embryos by direct soaking and their effects on mortality, hatching and developmental morphology were monitored for 96 hpf. To determine whether toxicity was specific to embryos, we examined the effects of chelator exposure via intra peritoneal injection on the cardiac function and gene expression in adult zebrafish. Chelators varied significantly in their effects on embryo mortality, hatching and morphology. While none of the embryos or adults exposed to DFO were negatively affected, ICL -treated embryos and adults differed significantly from controls, and L1 exerted toxic effects in embryos alone. ICL-670 significantly increased the mortality of embryos treated with doses of 0.25 mM or higher and also affected embryo morphology, causing curvature of larvae treated with concentrations above 0.5 mM. ICL-670 exposure (10 µL of 0.1 mM injection also significantly increased the heart rate and cardiac output of adult zebrafish. While L1 exposure did not cause toxicity in adults, it did cause morphological defects in embryos at 0.5 mM. This study provides first evidence on iron chelator toxicity in early development and will help to guide our approach on better understanding the mechanism of iron chelator toxicity.
Torrico, Faustino; Alonso-Vega, Cristina; Suarez, Eduardo; Rodriguez, Patricia; Torrico, Mary-Cruz; Dramaix, Michèle; Truyens, Carine; Carlier, Yves
This work compares the results of two epidemiologic and clinical surveys on the consequences of maternal chronic Trypanosoma cruzi infection. They were conducted in 1992-1994 and 1999-2001 in the same maternity clinic in Bolivia, a country highly endemic for infection with this parasite. In both surveys, the materno-fetal transmission of parasites occurred in 5-6% of the infected mothers. Maternal chronic T. cruzi infection had no effect on pregnancy outcome and health of newborns when there was no materno-fetal transmission of parasites. Comparisons between the older and the more recent surveys highlighted significant reductions in frequencies of symptomatic cases (from 54% to 45%), Apgar scores infected babies. Neonatal mortality related to congenital Chagas disease also decreased from 13% to 2% in the interval between both studies. These results suggest that the decrease in poverty that has occurred in Bolivia between both surveys might have contributed to reduce the morbidity and mortality, but not the transmission rate of T. cruzi congenital infection, which remains a serious public health problem in this country.
Goh, Nicole S; Hoyles, Rachel K; Denton, Christopher P; Hansell, David M; Renzoni, Elisabetta A; Maher, Toby M; Nicholson, Andrew G; Wells, Athol U
To determine the prognostic value of pulmonary function test (PFT) trends at 1 and 2 years in interstitial lung disease (ILD) associated with systemic sclerosis (SSc). The prognostic significance of PFT trends at 1 year (n = 162) and 2 years (n = 140) was examined against 15-year survival in patients with SSc-associated ILD. PFT trends, expressed as continuous change and as categorical change in separate analyses, were examined against mortality in univariate and multivariate models. SSc-associated ILD was defined at presentation as either limited lung fibrosis or extensive lung fibrosis, using the United Kingdom Raynaud's and Scleroderma Association severity staging system. One-year PFT trends were predictive of mortality only in patients with extensive lung fibrosis: categorical change in the forced vital capacity (FVC), alone or in combination with categorical change in the diffusing capacity for carbon monoxide (DLco), had greater prognostic significance than continuous change in the FVC or trends in other PFT variables. Taking into account both prognostic value and sensitivity to change, the optimal definition of progression for trial purposes was an FVC and DLco composite end point, consisting of either an FVC decline from baseline of ≥10% or an FVC decline of 5-9% in association with a DLco decline of ≥15%. At 2 years, gas transfer trends had the greatest prognostic significance, in the whole cohort and in those with limited lung fibrosis. However, in patients with extensive lung fibrosis, the above-defined FVC and DLco composite end point was the strongest prognostic determinant. Larger changes in the FVC:DLco ratio than in the carbon monoxide transfer coefficient were required to achieve prognostic significance. Based on linkages to long-term outcomes, these findings provide support for use of routine spirometry and gas transfer monitoring in patients with SSc-associated ILD, with further evaluation of a composite FVC and DLco end point
Sabino Neto, Miguel; Demattê, Maria Fernanda; Freire, Marcia; Garcia, Elvio Bueno; Quaresma, Marina; Ferreira, Lydia M
Both physical health and psychosocial outcomes are important issues in the evaluation of medical treatment. Women with breast hypertrophy may suffer from low self-esteem and reduced functional capacity because of the size of their breasts. The aim of this study was to evaluate the impact of reduction mammaplasty on self-esteem and functional capacity in patients with breast hypertrophy. One hundred patients with breast hypertrophy who ranged in age from 18 to 55 years and who had undergone no previous mammary surgery were selected from the Plastic Surgery Outpatient Clinic of the Federal University of São Paulo (UNIFESP-EPM). They were randomly allocated into two groups (A and B) of 50 patients each. Patients from group A were submitted for reduction mammaplasty while those from group B were placed on the waiting list and used as a control group. At the beginning of the study, all patients were interviewed to collect clinical and demographic data and to have their self-esteem and functional capacity measured. Two Brazilian-validated versions of quality of life measurement instruments were chosen: the Rosenberg Self-Esteem Scale and Rolland-Morris (to assess functional capacity). A visual analog scale (VAS) was used to evaluate pain intensity. Six months after the beginning of the study, these instruments were again administered to both groups. Forty-six out of 50 patients from each group (A and B) completed the study. The mean age of group A was 31.6 years (SD, 11 yrs), and that of group B was 32.3 years (SD, 10 yrs). The mean weight of removed breast tissue from group A patients was 1052 g (SD, 188 g). A decrease on the score of Rosenberg Self-Esteem Scale of patients from group A indicated an improvement of self-esteem (P self-esteem and functional capacity and relieved pain in the lower back region in patients with breast hypertrophy.
Mutambudzi, Miriam; Chen, Nai-Wei; Markides, Kyriakos S; Al Snih, Soham
To examine the effect of co-occurring depressive symptoms and functional disability on mortality in older Mexican-American adults with diabetes mellitus. Longitudinal cohort study. Hispanic Established Populations for the Epidemiological Study of the Elderly (HEPESE) survey conducted in the southwestern United States (Texas, Colorado, Arizona, New Mexico, California). Community-dwelling Mexican Americans with self-reported diabetes mellitus participating in the HEPESE survey (N = 624). Functional disability was assessed using a modified version of the Katz activity of daily living scale. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Mortality was determined by examining death certificates and reports from relatives. Cox proportional hazards regression analyses were used to examine the hazard of mortality as a function of co-occurring depressive symptoms and functional disability. Over a 9.2-year follow-up, 391 participants died. Co-occurring high depressive symptoms and functional disability increased the risk of mortality (hazard ratio (HR) = 3.02, 95% confidence interval (CI) = 2.11-4.34). Risk was greater in men (HR = 8.11, 95% CI = 4.34-16.31) than women (HR = 2.21, 95% CI = 1.42-3.43). Co-occurring depressive symptoms and functional disability in older Mexican-American adults with diabetes mellitus increases mortality risk, especially in men. These findings have important implications for research, practice, and public health interventions. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Full Text Available Abstract Background Although HIV program evaluations focusing on mortality on ART provide important evidence on treatment effectiveness, they do not asses overall HIV program performance because they exclude patients who are eligible but not started on ART for whatever reason. The objective of this study was to measure mortality that occurs both pre-ART and during ART among HIV-positive children enrolled in two HIV-programs in Cambodia. Methods Retrospective cohort study on 1168 HIV-positive children Results Over half (53% of children were 5 years or above and only 69(6% were Conclusion HIV-positive children experienced a high mortality and loss-to-follow-up rates before starting ART. These program outcomes may be improved by a more timely ART initiation. Measuring overall in-program mortality as opposed to only mortality on ART is recommended in order to more accurately evaluate pediatric HIV-programs performance.
Bowie, Christopher R; Harvey, Philip D
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.
Rydell, Robert J; Van Loo, Katie J; Boucher, Kathryn L
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.
Chamuene, António; Araújo, Tamíris Alves; Silva, Gerson; Costa, Thiago Leandro; Berger, Paulo Geraldo; Picanço, Marcelo Coutinho
Natural mortality factors are responsible for regulating pest populations in the field. However, plant attributes such as the variety and phenological stage can influence the performance of these factors. Therefore, we investigated the performance of the natural mortality factors of Aphis gossypii (Glover; Hemiptera: Aphididae) as a function of the plant variety and phenology. To investigate the performance of these factors, we evaluated the mortality of A. gossypii caused by natural mortality factors for 2 yr in field conditions in transgenic (Bacillus thuringiensis/Roundup Ready) and non-transgenic cotton crops during vegetative, flowering, and fruiting stages. The natural mortality factors were affected similarly between the transgenic and non-transgenic plants; however, differences were observed in their performance, depending on the phenological stage of the cotton plant. Compared with other stages, predation was higher in the flowering stage, whereas the mortality caused by rainfall was higher in the vegetative stage. Coccinellid beetles were primarily responsible for the predation on A. gossypii. These findings highlight that the performance of the natural mortality factors of A. gossypii varied more as a function of the phenological stage of cotton than of the variety. © The Author(s) 2018. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: email@example.com.
Gustafsson, Finn; Kragelund, Charlotte B; Torp-Pedersen, Christian
AIMS: Previous studies have suggested that a high body mass index (BMI) is associated with an improved outcome in congestive heart failure (CHF). However, the studies addressing this problem have not included enough patients with non-systolic heart failure to evaluate how left ventricular systolic...... function interacts with obesity on prognosis in CHF. The aim of this study was to evaluate how BMI influences mortality in patients hospitalized with CHF, and to address in particular whether the effect of BMI is influenced by left ventricular (LV) systolic function. METHODS AND RESULTS: Retrospective...... with normal systolic function [RR 1.66 (1.29-2.14), compared with normal weight] than in patients with reduced systolic function [RR 1.11 (0.87-1.42), P for interaction 0.03]. In patients with systolic dysfunction, obesity was associated with increased risk compared with normal weight [RR 1.21 (1...
Redmond, Christine L; Morris, Tim; Otto, Charissa; Zerella, Tanisha; Semmler, John G; Human, Taaibos; Phadnis, Joideep; Bain, Gregory I
To investigate outcomes after surgical repair of distal biceps tendon rupture and the influence of arm dominance on isokinetic flexion and supination results. 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. 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. 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. 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. Retrospective case series. Level 4.
Adler, Matthew D; Hammitt, James K; Treich, Nicolas
We examine how different welfarist frameworks evaluate the social value of mortality risk reduction. These frameworks include classical, distributively unweighted cost-benefit analysis--i.e., the "value per statistical life" (VSL) approach-and various social welfare functions (SWFs). The SWFs are either utilitarian or prioritarian, applied to policy choice under risk in either an "ex post" or "ex ante" manner. We examine the conditions on individual utility and on the SWF under which these frameworks display sensitivity to wealth and to baseline risk. Moreover, we discuss whether these frameworks satisfy related properties that have received some attention in the literature, namely equal value of risk reduction, preference for risk equity, and catastrophe aversion. We show that the particular manner in which VSL ranks risk-reduction measures is not necessarily shared by other welfarist frameworks. Copyright © 2014 Elsevier B.V. All rights reserved.
Eaton, Jessica; Hanif, Asma Bilal; Grudziak, Joanna; Charles, Anthony
Trauma accounts for 4.7 million deaths each year, with an estimated 90% of these occurring in low- and middle-income countries (LMICs). Approximately half of trauma-related deaths are caused by central nervous system injury. Because a thorough understanding of traumatic brain injury (TBI) in LMICs is essential to mitigate TBI-related mortality, we established a clinical and radiographic database to characterize TBI in our low-income setting. This is a review of prospectively collected data from Kamuzu Central Hospital, a tertiary care center in the capital of Malawi. All patients admitted from October 2016 through May 2017 with a history of head trauma, altered consciousness, and/or radiographic evidence TBI were included. We performed descriptive statistics, a Cox regression analysis, and a survival analysis. There were 280 patients who met inclusion criteria; of these, 80.5% were men. The mean age was 28.8 ± 16.3 years. Median Glasgow Coma Scale (GCS) score was 12 (interquartile range, 8-15). Road traffic crashes constituted the most common injury mechanism (60.7%). There were 148 (52.3%) patients who received a computed tomography scan, with the most common findings being contusions (26.1%). Of the patients, 88 (33.0%) had severe TBI, defined as a GCS score ≤8, of whom 27.6% were intubated and 10.3% received tracheostomies. Overall mortality was 30.9%. Of patients who survived, 80.1% made a good recovery. Female sex was protective, and the only significant predictor of poor functional outcome was presence of severe TBI (hazard ratio, 2.98; 95% confidence interval, 1.79-4.95). TBI represents a significant part of the global neurosurgical burden of disease. Implementation of proven in-hospital interventions for these patients is critical to attenuate TBI-related morbidity and mortality. Copyright © 2017 Elsevier Inc. All rights reserved.
Kadoglou, Nikolaos Pe; Mandila, Christina; Karavidas, Apostolos; Farmakis, Dimitrios; Matzaraki, Vasiliki; Varounis, Christos; Arapi, Sofia; Perpinia, Anastasia; Parissis, John
Background/design Functional electrical stimulation of lower limb muscles is an alternative method of training in patients with chronic heart failure (CHF). Although it improves exercise capacity in CHF, we performed a randomised, placebo-controlled study to investigate its effects on long-term clinical outcomes. Methods We randomly assigned 120 patients, aged 71 ± 8 years, with stable CHF (New York Heart Association (NYHA) class II/III (63%/37%), mean left ventricular ejection fraction 28 ± 5%), to either a 6-week functional electrical stimulation training programme or placebo. Patients were followed for up to 19 months for death and/or hospitalisation due to CHF decompensation. Results At baseline, there were no significant differences in demographic parameters, CHF severity and medications between groups. During a median follow-up of 383 days, 14 patients died (11 cardiac, three non-cardiac deaths), while 40 patients were hospitalised for CHF decompensation. Mortality did not differ between groups (log rank test P = 0.680), while the heart failure-related hospitalisation rate was significantly lower in the functional electrical stimulation group (hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.21-0.78, P = 0.007). The latter difference remained significant after adjustment for prognostic factors: age, gender, baseline NYHA class and left ventricular ejection fraction (HR 0.22, 95% CI 0.10-0.46, P electrical stimulation training was associated with a lower occurrence of the composite endpoint (death or heart failure-related hospitalisation) after adjustment for the above-mentioned prognostic factors (HR 0.21, 95% CI 0.103-0.435, P electrical stimulation training reduced the risk of heart failure-related hospitalisations, without affecting the mortality rate. The beneficial long-term effects of this alternative method of training require further investigation.
Full Text Available Jacqueline B Palmer,1 Howard S Friedman,2 Katherine Waltman Johnson,1 Prakash Navaratnam,2 Stephen S Gottlieb3 1Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 2DataMed Solutions, LLC, New York, NY, USA; 3Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA Background: Data comparing effects of transient worsening renal function (WRFt and persistent WRF (WRFp on outcomes in patients hospitalized with acute heart failure (AHF are lacking. We determined the characteristics of hospitalized AHF patients who experienced no worsening renal function (non-WRF, WRFt, or WRFp, and the relationship between cohorts and AHF-related outcomes. Methods and results: A patient’s first AHF hospitalization (index was identified in the Cerner Health Facts® database (January 2008-March 2011. Patients had WRF if serum creatinine (SCr was ≥0.3 mg/dL and increased ≥25% from baseline, and they were designated as WRFp if present at discharge or WRFt if not present at discharge. A total of 55,436 patients were selected (non-WRF =77%, WRFp =10%, WRFt =13%. WRFp had greater comorbidity burden than WRFt. At index hospitalization, WRFp patients had the highest mortality, whereas WRFt patients had the longest length of stay (LOS and highest costs. These trends were observed at 30, 180, and 365 days postdischarge and confirmed by multivariable analyses. WRF patients had more AHF-related readmissions than non-WRF patients. In sensitivity analyses of the patient subset with live index hospitalization discharges, postdischarge LOS and costs were highest in WRFt patients, whereas mortality associated with a HF hospitalization was significantly higher for WRF patients vs non-WRF patients, with no difference between WRFp and WRFt. Conclusion: In patients hospitalized for AHF, WRFp was associated with the highest mortality, whereas WRFt was associated with the highest LOS and costs. WRF patients had higher readmissions than non
Harris, Patricia R E; Stein, Phyllis K; Fung, Gordon L; Drew, Barbara J
Objective This study sought to examine the prognostic value of heart rate variability (HRV) measurement initiated immediately after emergency department presentation for patients with acute coronary syndrome (ACS). Background Altered HRV has been associated with adverse outcomes in heart disease, but the value of HRV measured during the earliest phases of ACS related to risk of 1-year rehospitalization and death has not been established. Methods Twenty-four-hour Holter recordings of 279 patients with ACS were initiated within 45 minutes of emergency department arrival; recordings with ≥18 hours of sinus rhythm were selected for HRV analysis (number [N] =193). Time domain, frequency domain, and nonlinear HRV were examined. Survival analysis was performed. Results During the 1-year follow-up, 94 patients were event-free, 82 were readmitted, and 17 died. HRV was altered in relation to outcomes. Predictors of rehospitalization included increased normalized high frequency power, decreased normalized low frequency power, and decreased low/high frequency ratio. Normalized high frequency >42 ms2 predicted rehospitalization while controlling for clinical variables (hazard ratio [HR] =2.3; 95% confidence interval [CI] =1.4–3.8, P=0.001). Variables significantly associated with death included natural logs of total power and ultra low frequency power. A model with ultra low frequency power 0.3 ng/mL (HR =4.0; 95% CI =1.3–12.1; P=0.016) revealed that each contributed independently in predicting mortality. Nonlinear HRV variables were significant predictors of both outcomes. Conclusion HRV measured close to the ACS onset may assist in risk stratification. HRV cut-points may provide additional, incremental prognostic information to established assessment guidelines, and may be worthy of additional study. PMID:25143740
Anne Marie W. Efsen
Full Text Available Objectives. The study aimed at describing characteristics and outcome of tuberculous meningitis (TBM in HIV-positive patients and comparing these parameters with those of extrapulmonary TB (TBEP and pulmonary TB (TBP. Methods. Kaplan-Meier estimation and Poisson regression models were used to assess the mortality following TB diagnosis and to evaluate potential prognostic factors for the 3 groups of TB patients separately. Results. A total of 100 patients with TBM, 601 with TBEP, and 371 TBP were included. Patients with TBM had lower CD4 cell counts and only 17.0% received antiretroviral therapy (ART at TB diagnosis. The cumulative probability of death at 12 months following TB was 51.2% for TBM (95% CI 41.4–61.6%, 12.3% for TBP (8.9–15.7%, and 19.4% for TBEP (16.1–22.6 (P<0.0001; log-rank test. For TBM, factors associated with a poorer prognosis were not being on ART (adjusted incidence rate ratio (aIRR 4.00 (1.72–9.09, a prior AIDS diagnosis (aIRR=4.82 (2.61–8.92, and receiving care in Eastern Europe (aIRR=5.41 (2.58–11.34. Conclusions. TBM among HIV-positive patients was associated with a high mortality rate, especially for patients from Eastern Europe and patients with advanced HIV-infection, which urgently calls for public health interventions to improve both TB and HIV aspects of patient management.
Mehta, Saurabh; Hunter, David J; Mugusi, Ferdinand M; Spiegelman, Donna; Manji, Karim P; Giovannucci, Edward L; Hertzmark, Ellen; Msamanga, Gernard I; Fawzi, Wafaie W
Vitamin D is a strong immunomodulator and may protect against adverse pregnancy outcomes, mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV), and child mortality. A total of 884 HIV-infected pregnant women who were participating in a vitamin supplementation trial in Tanzania were monitored to assess pregnancy outcomes and child mortality. The association of these outcomes with maternal vitamin D status at enrollment was examined in an observational analysis. No association was observed between maternal vitamin D status and adverse pregnancy outcomes, including low birth weight and preterm birth. In multivariate models, a low maternal vitamin D level (vitamin D level had a 61% higher risk of dying during follow-up (95% CI, 25%-107%). If found to be efficacious in randomized trials, vitamin D supplementation could prove to be an inexpensive method of reducing the burden of HIV infection and death among children, particularly in resource-limited settings.
Abdelmalik, Peter A; Boorman, David W; Tracy, Joseph; Jallo, Jack; Rincon, Fred
Approximately one-third of patients with isolated traumatic brain injury (iTBI) present with acute traumatic coagulopathy (ATC). ATC is associated with increased morbidity and mortality. Its effects on long-term functional and cognitive outcomes are not as well characterized. Data from the Citicoline Brain Injury Treatment Trial (COBRIT) were analyzed retrospectively. Exclusion criteria were renal failure or malignancy, and any extracranial injury severity score >3. ATC was defined as INR > 1.3, PTT > 38 s, or platelets 6), and the DRS (i.e., score < 2) at 180 days, for which ATC was found to be an independent predictor with binary logistic regression. ATC patients also performed significantly worse on several components of the CVLT-II at 180 days. ATC accompanying iTBI is associated with worse functional and cognitive outcomes at 180 days.
Berra, Gregory; Garin, Nicolas; Stirnemann, Jérôme; Jannot, Anne-Sophie; Martin, Pierre-Yves; Perrier, Arnaud; Carballo, Sebastian
The prognostic value of worsening renal function (WRF) in acute heart failure is debated. Moreover, it is not clear if the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in this context is detrimental. In a retrospective cohort study of 646 patients hospitalized for acute heart failure, the risk of death or readmission associated with acute kidney injury (AKI) present at admission, WRF during the 1st 7 days, and up-titration of ACEI/ARB were analyzed in a Cox proportional hazards model. AKI, WRF, hemoglobin concentration, ACEI/ARB up-titration, and use of loop diuretics before admission were significantly associated with the primary outcome in univariate analysis. In a multivariate model, the association remained significant for AKI (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.13-1.47; P = .0002), WRF (HR 1.24, 95% CI 1.06-1.45; P = .0059), and ACEI/ARB up-titration (HR 0.79, 95% CI 0.64-0.97; P = .026). There was no excess mortality in patients with ACEI/ARB up-titration despite WRF. Both AKI and WRF are strongly associated with poor outcome in patients hospitalized for acute heart failure. ACEI/ARB up-titration seems to be protective. Copyright © 2015 Elsevier Inc. All rights reserved.
Freud, Lindsay R; Escobar-Diaz, Maria C; Kalish, Brian T; Komarlu, Rukmini; Puchalski, Michael D; Jaeggi, Edgar T; Szwast, Anita L; Freire, Grace; Levasseur, Stéphanie M; Kavanaugh-McHugh, Ann; Michelfelder, Erik C; Moon-Grady, Anita J; Donofrio, Mary T; Howley, Lisa W; Tierney, Elif Seda Selamet; Cuneo, Bettina F; Morris, Shaine A; Pruetz, Jay D; van der Velde, Mary E; Kovalchin, John P; Ikemba, Catherine M; Vernon, Margaret M; Samai, Cyrus; Satou, Gary M; Gotteiner, Nina L; Phoon, Colin K; Silverman, Norman H; McElhinney, Doff B; Tworetzky, Wayne
Ebstein anomaly and tricuspid valve dysplasia are rare congenital tricuspid valve malformations associated with high perinatal mortality. The literature consists of small, single-center case series spanning several decades. We performed a multicenter study to assess the outcomes and factors associated with mortality after fetal diagnosis in the current era. Fetuses diagnosed with Ebstein anomaly and tricuspid valve dysplasia from 2005 to 2011 were included from 23 centers. The primary outcome was perinatal mortality, defined as fetal demise or death before neonatal discharge. Of 243 fetuses diagnosed at a mean gestational age of 27±6 weeks, there were 11 lost to follow-up (5%), 15 terminations (6%), and 41 demises (17%). In the live-born cohort of 176 live-born patients, 56 (32%) died before discharge, yielding an overall perinatal mortality of 45%. Independent predictors of mortality at the time of diagnosis were gestational age tricuspid valve annulus diameter z-score (odds ratio, 1.3; 95% confidence interval, 1.1-1.5; Ptricuspid valve dysplasia, perinatal mortality remained high. Fetuses with pulmonary regurgitation, indicating circular shunt physiology, are a high-risk cohort and may benefit from more innovative therapeutic approaches to improve survival. © 2015 American Heart Association, Inc.
Lopes, Antonio Alberto; Bragg-Gresham, Jennifer L; Elder, Stacey J; Ginsberg, Nancy; Goodkin, David A; Pifer, Trinh; Lameire, Norbert; Marshall, Mark R; Asano, Yasushi; Akizawa, Tadao; Pisoni, Ronald L; Young, Eric W; Port, Friedrich K
To consider the Kidney Disease Outcomes Quality Initiative recommendation of using multiple nutritional measurements for patients on maintenance dialysis, we explored data for independent and joint associations of nutritional indicators with mortality risk among maintenance hemodialysis patients treated in 12 countries. Dialysis units in seven European countries, the United States, Canada, Australia, New Zealand, and Japan. Mortality risk. We conducted a prospective cohort study of 40,950 patients from phases I to III of the Dialysis Outcomes and Practice Patterns Study (1996-2008). Independent and joint effects (interactions) of nutritional indicators (serum creatinine, serum albumin, normalized protein catabolic rate, body mass index [BMI]) on mortality risk were assessed by Cox regression with adjustments for demographics, years on dialysis, and comorbidities. Important variations in nutritional indicators were seen by country and patient characteristics. Poorer nutritional status assessed by each indicator was independently associated with higher mortality risk across regions. Significant multiplicative interactions (each p 10.5 mg/dL (relative risk = 0.68) but with higher mortality risk among those with creatinine nutritional indicators on mortality indicate the need to use multiple measurements when assessing the nutritional status of hemodialysis patients. Copyright 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Full Text Available Introduction: To date, many prognostic models have been proposed to predict the outcome of patients withtraumatic brain injuries. External validation of these models in different populations is of great importancefor their generalization. The present study was designed, aiming to determine the value of CRASH prognosticmodel in prediction of 14-day mortality (14-DM and 6-month unfavorable outcome (6-MUO of patients withtraumatic brain injury. Methods: In the present prospective diagnostic test study, calibration and discriminationof CRASH model were evaluated in head trauma patients referred to the emergency department. Variablesrequired for calculating CRASH expected risks (ER, and observed 14-DM and 6-MUO were gathered. Then ERof 14-DM and 6-MUO were calculated. The patients were followed for 6 months and their 14-DM and 6-MUOwere recorded. Finally, the correlation of CRASH ER and the observed outcome of the patients was evaluated.The data were analyzed using STATA version 11.0. Results: In this study, 323 patients with the mean age of 34.0Â´s 19.4 years were evaluated (87.3% male. Calibration of the basic and CT models in prediction of 14-day and6-month outcome were in the desirable range (P Ç 0.05. Area under the curve in the basic model for predictionof 14-DM and 6-MUO were 0.92 (95% CI: 0.89–0.96 and 0.92 (95% CI: 0.90–0.95, respectively. In addition,area under the curve in the CT model for prediction of 14-DM and 6-MUO were 0.93 (95% CI: 0.91–0.97 and0.93 (95% CI: 0.91–0.96, respectively. There was no significant difference between the discriminations of thetwo models in prediction of 14-DM (p Æ 0.11 and 6-MUO (p Æ 0.1. Conclusion: The results of the presentstudy showed that CRASH prediction model has proper discrimination and calibration in predicting 14-DMand6-MUO of head trauma patients. Since there was no difference between the values of the basic and CT models,using the basic model is recommended to simplify the risk
Stingl, Katarina; Bartz-Schmidt, Karl-Ulrich; Gekeler, Florian; Kusnyerik, Akos; Sachs, Helmut; Zrenner, Eberhart
An active microelectronic subretinal implant, developed to replace the photoreceptive function in hereditary degenerations of the outer retina, has been applied in a pilot and clinical study in patients with end-stage retinal degeneration. The study population comprised 20 blind patients, all of whom lost vision as result of a hereditary retinal disease. An active visual implant was placed surgically within the subretinal space of each patient: subfoveal placement in eight patients (group 1) and parafoveal placement in 12 (group 2). Standardized low-vision tests, including light perception, light localization, movement detection, grating acuity, and visual acuity by Landolt C-rings, were used under masked, randomized implant-OFF and implant-ON conditions. For the chip-mediated vision functional results of both subject groups were compared. Three of 20 patients were excluded from analysis because of surgical or technical implant issues. Among patients with nonfoveal placement of the implant, 80% could perceive light, 10% recognized location, and 10% correctly distinguished stripe patterns up to a resolution of 0.33 cycles/degree. No nonfoveal placement patient passed the motion or Landolt C-ring tests. When the implant was placed subfoveally, 100% of patients could perceive light and determine light localization, 75% could resolve motion up to 35°/s, 88% correctly distinguished stripe patterns up to a resolution of 3.3 cycles/degree, and 38% passed a Landolt C-ring test with a decimal visual acuity of up to 20/546 (logMAR 1.43). Subfoveal placement of active subretinal visual implants allows superior measurable outcomes compared to para- or nonfoveal placement locations. (ClinicalTrials.gov numbers, NCT01024803, NCT00515814.).
Mummareddy, Nishit; Dewan, Michael C; Mercier, Michael R; Naftel, Robert P; Wellons, John C; Bonfield, Christopher M
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.
Ngo-Huang, An; Yadav, Rajesh; Fu, Jack B; Liu, Diane; Williams, Janet L; Bruera, Eduardo; Guo, Ying
The aim of the study was to describe the mobility outcomes of neurofibromatosis (NF) patients who received acute inpatient rehabilitation. This is a retrospective study of 62 consecutive neurofibromatosis patients of any age who received physical medicine and rehabilitation consultations at a comprehensive cancer center. Postoperative, inpatient rehabilitation admission and discharge functional independence measures (FIM scores) of transfers and gait and length of hospital stay were obtained from 37 patients who were transferred to inpatient rehabilitation (acute rehabilitation) and 25 who had an alternative disposition (consultation only). Mean age was 34 yrs. Both groups had similar postoperative FIM transfer and gait scores; however, at approximately postoperative day 10, the consultation only group was discharged with median FIM of 5 (supervision level) as compared with the acute rehabilitation group FIM of 4 (P = 0.000). The acute rehabilitation group had improved mobility FIM scores from postoperative to rehabilitation admission and again from rehabilitation admission to discharge (P neurofibromatosis patients minimizing caregiver needs at home.
Lowry, Estelle; Woodman, Richard J; Soiza, Roy L; Mangoni, Arduino A
The anticholinergic risk scale (ARS) score is associated with the number of anticholinergic side effects in older outpatients. We tested the hypothesis that high ARS scores are negatively associated with "global" parameters of physical function (Barthel Index, primary outcome) and predict length of stay and in-hospital mortality (secondary outcomes) in older hospitalized patients. Prospective study in 2 acute geriatric units. Three hundred sixty-two consecutive patients (age 83.6 ± 6.6 years) admitted between February 1, 2010, and June 30, 2010. Clinical and demographic characteristics, Barthel Index, full medication exposure, and ARS score were recorded on admission. Data on length of stay and in-hospital mortality were obtained from electronic records. After adjustment for age, gender, dementia, institutionalization, Charlson Comorbidity Index, admission site, and number of nonanticholinergic drugs, a unit increase in ARS score was associated with a 29% reduction in the odds of being in a higher Barthel quartile than a lower quartile (odds ratio 0.71, 95% confidence interval [CI] 0.59-0.86, P = .001). The Barthel components mostly affected were bathing (P Barthel Index and predict in-hospital mortality in the presence of hyponatremia among older patients. The ARS score may be useful in the acute setting to improve risk stratification. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
Leach, J P; Smith, P E; Craig, J; Bagary, M; Cavanagh, D; Duncan, S; Kelso, A R C; Marson, A G; McCorry, D; Nashef, L; Nelson-Piercy, C; Northridge, R; Sieradzan, K; Thangaratinam, S; Walker, M; Winterbottom, J; Reuber, M
Between 2009 and 2012 there were 26 epilepsy-related deaths in the UK of women who were pregnant or in the first post-partum year. The number of pregnancy-related deaths in women with epilepsy (WWE) has been increasing. Expert assessment suggests that most epilepsy-related deaths in pregnancy were preventable and attributable to poor seizure control. While prevention of seizures during pregnancy is important, a balance must be struck between seizure control and the teratogenic potential of antiepileptic drugs (AEDs). A range of professional guidance on the management of epilepsy in pregnancy has previously been issued, but little attention has been paid to how optimal care can be delivered to WWE by a range of healthcare professionals. We summarise the findings of a multidisciplinary meeting with representation from a wide group of professional bodies. This focussed on the implementation of optimal pregnancy epilepsy care aiming to reduce mortality of epilepsy in mothers and reduce morbidity in babies exposed to AEDs in utero. We identify in particular -What stage to intervene - Golden Moments of opportunities for improving outcomes -Which Key Groups have a role in making change -When - 2020 vision of what these improvements aim to achieve. -How to monitor the success in this field We believe that the service improvement ideas developed for the UK may provide a template for similar initiatives in other countries. Copyright © 2017 British Epilepsy Association. All rights reserved.
Villa, Jordan C.; van der List, Jelle P.; Gausden, Elizabeth B.; Lorich, Dean G.; Helfet, David L.; Kloen, Peter; Wellman, David S.
The optimal treatment for distal clavicle nonunions remains unknown. Small series have reported outcomes following distal fragment excision and various fixation techniques. We present the clinical, radiographic and functional outcomes after superior plating or double (superior and anteroinferior)
Ravera, Maura; Cannavò, Rossella; Noberasco, Giuseppe; Guasconi, Alessandro; Cabib, Ursula; Pieracci, Laura; Pegoraro, Valeria; Brignoli, Ovidio; Cricelli, Claudio; Deferrari, Giacomo; Paoletti, Ernesto
The aim of this study was to assess the accuracy of a risk calculator that includes renal function as compared with that of the traditional Framingham Risk Score (FRS) in predicting the risk of mortality of hypertensive individuals managed in primary care. From the databases of British and Italian General Practitioners, we retrieved demographic and clinical data for 35 101 UK and 27 818 Italian individuals aged 35-74 years with a diagnosis of hypertension. Then, the 5-year incidence of cardiovascular events as well as all-cause and cardiovascular mortality were recorded for both samples. A comparison analysis of the performance of the Individual Data Analysis of Antihypertensive Intervention Trials (INDANA) calculator with that of FRS in predicting 5-year all-cause and cardiovascular mortality risk was made. The INDANA calculator was more accurate than the FRS in predicting all-cause [Δc 0.038, 95% confidence interval (CI) 0.026-0.051 for United Kingdom, and 0.018, 95% CI 0.010-0.027 for Italy, both P calculator, 20% of the UK and 10% of the Italian patients were reclassified to higher risk classes for all-cause mortality, and 25 and 28%, respectively were reclassified when cardiovascular mortality was assessed (P calculator proved to be more accurate than the FRS in predicting the risk of mortality in hypertensive patients and should be considered for systematic adoption for risk stratification of hypertensive individuals managed in primary care.
Full Text Available Ferdinand Vogt,1 Susanne Wicklein,2 Markus Gosch,2 Jürgen Jessl,3 Wolfgang Hitzl,4 Theodor Fischlein,1 Matthias Pauschinger,3 Steffen Pfeiffer,1 Dennis Eckner3 1Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany; 2Department of Geriatric Medicine, Paracelsus Medical University, Nuremberg, Germany; 3Department of Cardiology, Paracelsus Medical University, Nuremberg, Germany; 4Research Office – Biostatistics, Paracelsus Medical University, Salzburg, Austria Background: Frailty is a geriatric syndrome that can influence mortality and functional recovery after treatment of severe aortic stenosis (AS. The integration of standardized geriatric assessment (GA in clinical practice is limited by a lack of consensus on how to measure it. Objectives: This study aims to compare the incremental predictive value of different frailty scales to predict the outcomes following surgical aortic valve replacement, transcatheter aortic valve implantation, and conservative treatment of severe AS. Methods: A prospective cohort of 300 older adults with severe AS will be assembled after standard clinical examinations and a comprehensive GA, including 18 different tests and values. Primary outcome parameters are overall mortality, cardiovascular mortality, quality of life, and functionality. Secondary parameters are overall complications, cardiovascular complications, and costs. Results: Expected results will contribute to the growing body of evidence on frailty based on parameters that influence clinical and functional outcome in elderly patients independent of the method of treatment. The pre-procedural assessment is expected to be valuable in discriminating new post-procedural complications from simple exacerbations of pre-existing conditions. Therefore, a new frailty test which is simple and feasible for application in a clinical routine by most medical professionals, may help in identifying patients for whom further GA should be
Full Text Available INTRODUCTION For more displaced fractures and osteopenic bone, techniques of internal fixation, which emphasise less disruptive soft tissue dissection, and minimal fixation with wire and non-absorbable sutures have been successful with a low complication rate. Even AO type buttress plates are being used, but they require more soft tissue dissection and may lead to infection. Management of these fractures is associated with some morbidity and undesirable sequelae. They include complications like avascular necrosis, malunion, non-union, infection, neurovascular injury, loss of motion of shoulder from adhesive capsulitis, chronic oedema, elbow stiffness and atrophy of the soft tissues of the immobilised limb causing significant disability during healing and afterwards. The purpose of this study is to evaluate the functional outcome of the surgical management of fresh displaced three- and four-part proximal humerus fractures with locking plate system. MATERIAL AND METHODS The present study was carried out from August 2012 to December 2014 at Orthopaedic Department in Bangalore Medical College and Hospital. During this period, 25 patients of proximal humerus fractures were treated with locking plates. All patients were followed up for every 4 weeks. Local examination of the affected shoulder for tenderness, instability, deformity and shoulder movements were assessed. X-rays were taken at each visit to know about progressive fracture union and implant position. Rehabilitation of the affected extremity was done according to the stage of fracture union and time duration from surgery. Patients were followed up till radiological union. RESULTS The present study consists of 25 patients of fresh three- and four-part fractures of proximal humerus which were treated surgically with locking plates from August 2012 to December 2014. All the patients were available for follow-up and they were followed every month for first 3 months then once in 3 months. In this
Full Text Available Background : Cervical spondylotic myelopathy (CSM is serious consequence of cervical intervertebral disk degeneration. Morbidity ranges from chronic neck pain, radicular pain, headache, myelopathy leading to weakness, and impaired fine motor coordination to quadriparesis and/or sphincter dysfunction. Surgical treatment remains the mainstay of treatment once myelopathy develops. Compared to more conventional surgical techniques for spinal cord decompression, such as anterior cervical discectomy and fusion, laminectomy, and laminoplasty, patients treated with corpectomy have better neurological recovery, less axial neck pain, and lower incidences of postoperative loss of sagittal plane alignment. The objective of this study was to analyze the outcome of corpectomy in cervical spondylotic myelopathy, to assess their improvement of symptoms, and to highlight complications of the procedure. Materials and Methods: Twenty-four patients underwent cervical corpectomy for cervical spondylotic myelopathy during June 1999 to July 2005.The anterior approach was used. Each patient was graded according to the Nuricks Grade (1972 and the modified Japanese Orthopaedic Association (mJOA Scale (1991, and the recovery rate was calculated. Results: Preoperative patients had a mean Nurick′s grade of 3.83, which was 1.67 postoperatively. Preoperative patients had a mean mJOA score of 9.67, whereas postoperatively it was 14.50. The mean recovery rate of patients postoperatively was 62.35% at a mean follow-up of 1 year (range, 8 months to 5 years.The complications included one case (4.17% of radiculopathy, two cases (8.33% of graft displacement, and two cases (8.33% of screw back out/failure. Conclusions: Cervical corpectomy is a reliable and rewarding procedure for CSM, with functional improvement in most patients.
Neubauer, Thomas; Krawany, Manfred; Leitner, Lukas; Karlbauer, Alois; Wagner, Michael; Plecko, Michael
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. Copyright 2012, SLACK Incorporated.
Schuurman, Arnold H; Teunis, Teun
To present the evolution of design and the short-term functional outcome of our distal radioulnar joint (DRUJ) prosthesis. This total DRUJ prosthesis differs from others in that it consists of 2 parts and attains bony fixation by its hydroxyapatite coating. Nineteen patients received a DRUJ prosthesis after a failed Darrach procedure (n = 10), Sauvé-Kapandji procedure (n = 7), trauma (n = 1), or DRUJ synovitis (n = 1). Indications for the placement were decreased grip, decreased forearm motion, and pain due to ulnar impingement syndrome and instability of the distal ulna. Seven prostheses were removed, 5 due to loosening, 1 due to continuing pain, and 1 at the request of the patient. The 5 prostheses that loosened were an intermediate prototype no longer in use. In 12 remaining cases, range of motion, grip strength, and pinch strength were measured, and patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Pain was assessed with the visual analog scale (range, 0-10). A paired t-test was performed to assess the significance of the difference between preoperative and postoperative measurements. Statistically significant improvements were seen in forearm pronation, from an average of 79° to 88°; grip strength, from an average of 10 kg to an average of 16 kg; and visual analog scale score, decreased from a mean of 5.3 to a mean of 3.5. The distal ulna was clinically stable in all 12 patients who retained the prosthesis. The intermediate prototype had a high failure rate, 5 out of 5. The early results for the current prosthesis prototype show clinical improvement. Based on these results, we conclude that this prosthesis offers a new treatment option for ulnar instability after distal ulnar resection. Therapeutic IV. Copyright © 2010. Published by Elsevier Inc.
Park, Eun-Young; Kim, Won-Ho
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…
Lap, Chiara C M M; Bolhuis, Sandra W; Van Braeckel, Koenraad J. A.; Reijneveld, Sijmen A.; Manten, Gwendolyn T. R.; Bos, Arend F.; Hulscher, Jan
Objective: We aimed to determine motor, cognitive and behavioural outcomes of school aged children born with gastroschisis compared to matched controls. Study design: We compared outcomes of 16 children born with gastroschisis treated at the University Medical Center Groningen, the Netherlands,
Osté, Maryse C J; Gomes-Neto, António W; Corpeleijn, Eva; Gans, Rijk O B; de Borst, Martin H; van den Berg, Else; Soedamah-Muthu, Sabita S; Kromhout, Daan; Navis, Gerjan J; Bakker, Stephan J L
Renal transplant recipients (RTR) are at risk of decline of graft function and premature mortality, with high blood pressure as an important risk factor for both. To study the association of the Dietary Approach to Stop Hypertension (DASH) diet with these adverse events, we conducted a prospective cohort study of adult RTR. Dietary data were collected using a validated 177-item food frequency questionnaire and an overall DASH-score was obtained. We included 632 stable RTR (mean ± standard deviation age 53.0 ± 12.7 years, 57% men). Mean DASH score was 23.8 ± 4.7. During median follow-up of 5.3 (interquartile range, 4.1-6.0) years, 119 (18.8%) RTR had renal function decline, defined as a combined endpoint of doubling of serum creatinine and death-censored graft failure, and 128 (20.3%) died. In Cox-regression analyses, RTR in the highest tertile of the DASH score had lower risk of both renal function decline (hazard ratio [HR] = 0.57; 95% confidence interval [CI], 0.33-0.96, P = .03) and all-cause mortality (HR = 0.52; 95%CI, 0.32-0.83, P = .006) compared to the lowest tertile, independent of potential confounders. Adherence to a DASH-style diet is associated with lower risk of both renal function decline and all-cause mortality. These results suggest that a healthful diet might benefit long-term outcome in RTR. © 2018 The Authors. American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.
Mace Firebaugh, Casey; Moyes, Simon; Jatrana, Santosh; Rolleston, Anna; Kerse, Ngaire
The relationship between physical activity, function, and mortality is not established in advanced age. Physical activity, function, and mortality were followed in a cohort of Māori and non-Māori adults living in advanced age for a period of six years. Generalised Linear regression models were used to analyse the association between physical activity and NEADL while Kaplan-Meier survival analysis, and Cox-proportional hazard models were used to assess the association between the physical activity and mortality. The Hazard Ratio for mortality for those in the least active physical activity quartile was 4.1 for Māori and 1.8 for non- Māori compared to the most active physical activity quartile. There was an inverse relationship between physical activity and mortality, with lower hazard ratios for mortality at all levels of physical activity. Higher levels of physical activity were associated with lower mortality and higher functional status in advanced aged adults.
Huber, Erika O; de Bie, Rob A; Roos, Ewa M.
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 outcome after the intervention. Thus, improving functional status prior to surgery through exercise may improve after surgery outcome. However, results from several previous trials testing the concept have been inconclusive after surgery....
Full Text Available We describe a three-year experience with patients with dementia. Method: clinical, cognitive and functional evaluation was performed by a multidisciplinary team for persons above 60 years. Mortality was assessed after three years. Results: Mini-Mental State Examination (MMSE (n=2,074 was 15.7 (8.4. Male patients MMSE (n=758 was 15.6 (8.3 and female's (n=1315 was 15.8 (8.3. Instrumental Activities of Daily Living Scale (n=2023 was 16.5 (7.6; females (n=1277 was 16.9 (7.2 and males (n=745 was 15.7(8.2. From these patients, 12.6% (n=209 died within three years. Baseline cognition of patients still alive was higher (p<0.001 than MMSE of those who died [MMSE=16.3 (8.1 vs. 10.6 (7.6]. Mortality rate decreased 6% (IR=0.94 for each additional point on MMSE. Higher functional status decreases the mortality rate approximately 11% (IR=0.89 independently of age, gender, and education. Conclusion: Three-year mortality rates are dependent on baseline functional and cognitive status
Teoh, Hooi-Ling; Mohammad, Shekeeb S; Britton, Philip N; Kandula, Tejaswi; Lorentzos, Michelle S; Booy, Robert; Jones, Cheryl A; Rawlinson, William; Ramachandran, Vidiya; Rodriguez, Michael L; Andrews, P Ian; Dale, Russell C; Farrar, Michelle A; Sampaio, Hugo
Enterovirus 71 (EV71) causes a spectrum of neurological complications with significant morbidity and mortality. Further understanding of the characteristics of EV71-related neurological disease, factors related to outcome, and potential responsiveness to treatments is important in developing therapeutic guidelines. To further characterize EV71-related neurological disease and neurological outcome in children. Prospective 2-hospital (The Sydney Children's Hospitals Network) inpatient study of 61 children with enterovirus-related neurological disease during a 2013 outbreak of EV71 in Sydney, Australia. The dates of our analysis were January 1, to June 30, 2013. Clinical, neuroimaging, laboratory, and pathological characteristics, together with treatment administered and functional motor outcomes, were assessed. Among 61 patients, there were 4 precipitous deaths (7%), despite resuscitation at presentation. Among 57 surviving patients, the age range was 0.3 to 5.2 years (median age, 1.5 years), and 36 (63%) were male. Fever (100% [57 of 57]), myoclonic jerks (86% [49 of 57]), ataxia (54% [29 of 54]), and vomiting (54% [29 of 54]) were common initial clinical manifestations. In 57 surviving patients, EV71 neurological disease included encephalomyelitis in 23 (40%), brainstem encephalitis in 20 (35%), encephalitis in 6 (11%), acute flaccid paralysis in 4 (7%), and autonomic dysregulation with pulmonary edema in 4 (7%). Enterovirus RNA was more commonly identified in feces (42 of 44 [95%]), rectal swabs (35 of 37 [95%]), and throat swabs (33 of 39 [85%]) rather than in cerebrospinal fluid (10 of 41 [24%]). Magnetic resonance imaging revealed characteristic increased T2-weighted signal in the dorsal pons and spinal cord. All 4 patients with pulmonary edema (severe disease) demonstrated dorsal brainstem restricted diffusion (odds ratio, 2; 95% CI, 1-4; P = .001). Brainstem or motor dysfunction had resolved in 44 of 57 (77%) at 2 months and in 51 of 57 (90%) at 12 months
Winkler, Laura Al-Dakhiel
Eating disorders (EDs) comprise a wide range of symptoms, with severe psychological and physical implications for the patient. EDs include anorexia nervosa (AN), bulimia nervosa (BN) and until 2013 eating disorder not otherwise specified (EDNOS), if criteria for AN or BN were not met. Patients suffering from an ED have poor prognosis, with more than half of AN patients not obtaining complete remission. One-fifth develops a chronic disease. EDs have an increased risk of premature death and patients with EDs report poorer quality of life (QoL) compared to both the general population and other psychiatric/somatic diseases. Patients who, apparently, obtain complete remission will still be affected in QoL when compared to a healthy reference group. Treatment is complicated by high drop-out rates, hence making large retrospective follow-up studies difficult to conduct. The multiple endocrine disturbances as a result of the severe malnourishment in AN often result in amenorrhea and a weight goal for remenorrhea has been ambiguous. This thesis encompasses results from four studies examining the abovementioned challenges and is based on a large retrospective cohort of ED patients referred to a highly specialized ED treatment unit. Study 1: QoL in EDs was reported for a large retrospective Danish cohort. Furthermore, meta-analysis on existing published literature was performed to determine potential differences between the diagnostic groups. QoL in EDs was significantly decreased compared to the general population and no difference between the diagnostic groups was established. Study 2: ED pathology (measured by the Eating Disorder Inventory - 2 (EDI-2)) and outcome (measured by the Morgan Russell Outcome Schedule (MROS)) was reported for a large retrospective Danish cohort. The correlation between the patient-reported measurements (SF-36 & EDI-2) and clinician-assessed characteristics (BMI and remission status) was investigated in a group of ED patients (n=383). A high
Full Text Available Research has shown that reminders of mortality lead people to engage in defenses to minimize the anxiety such thoughts could arouse. In accord with this notion, younger adults reminded of mortality engage in behaviors aimed at denying vulnerability to death. However, little is known about the effects of mortality reminders on older adults. The present study examined the effect of reminders of death on older adults' subjective life expectancy. Mortality reminders did not significantly impact the life expectancy estimates of old-old adults. Reminders of death did however lead to shorter life expectancy estimates among young-old participants low in neuroticism but longer life expectancy estimates among young-old participants high in neuroticism, suggesting that this group was most defensive in response to reminders of death.
Kim, Won Ho; Park, Eun Young
This study examined the causal relation between spasticity, weakness, gross motor function, and functional outcome (expressed as activity limitation) in children with cerebral palsy (CP) and tested models of functional outcome mediated by gross motor function. Eighty-one children (50 males, 31 females) with CP were recruited for this cross-sectional study. Their mean age was 10 years 4 months (SD 1y 9mo). Strength was assessed using the Manual Muscle Test. Spasticity was assessed by the Modified Ashworth Scale. The Gross Motor Function Measure assessed gross motor function. The Functional Skills domain of the Pediatric Evaluation of Disability Inventory assessed functional outcome. Twenty-eight children (34.6%) had quadriplegia, 44 children (54.3%) had diplegia, and nine children (11.1%) had hemiplegia. Children were classified using the Gross Motor Function Classification System with 14 (17.3%) in level I, 9 (11.1%) in level II, 13 (16.0%) in level III, 5 (6.2%) in level IV, and 40 (49.4%) in level V. The proposed path model showed good fit indices. The direct effects were significant between spasticity and gross motor function (β=-0.339), between strength and gross motor function (β=0.447), and between gross motor function and functional outcome (β=0.708). Spasticity had a significant negative indirect effect (β=-0.240) and strength had a significant positive indirect effect (β=0.317) on functional outcome through effects on gross motor function. Activity-based rather than impairment-based intervention is more important for reducing activity limitation in children with CP. The study established a base from which researchers can further develop a causal model between motor impairments and functional outcome. © The Authors. Journal compilation © Mac Keith Press 2010.
Laxe, Sara; León, Daniel; Salgado, Dalila; Zabaleta, Mikel
Traumatic brain injury is the leading cause of mortality and disability in children in the developed countries. Despite the plasticity of an infant's brain, injury at this early stage can lead to important sequelae that will affect functioning later in life. The understanding of the functional profile after a traumatic brain injury is important for planning interventions and treatment resources once the preventive phase has failed. This was a retrospective study of the patients admitted in a neurorehabilitation unit with the aim of describing their functioning after an intensive rehabilitation programme. A total of 65 records of children with a mean age of 10.38 years that had been admitted to a rehabilitation programme were reviewed. Of the traumatic brain injuries, 89.2% were severe and 78.4% were secondary to traffic accidents. The mean length of stay was 79.35 days. At discharge, 72% were able to walk, but 76.9% showed some cognitive impairment. Despite good physical recovery, only 29.2% of the children were able to return to school. Permanence of deficits made 21.5% of the children unable to return to any type of education. The population under study was characterised by a good clinical outcome as well as good physical improvement. Nevertheless, cognitive problems were notable and were the main factor responsible for the changes in school attendance and return to normal life. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.
Checkley, William; Martin, Greg S; Brown, Samuel M; Chang, Steven Y; Dabbagh, Ousama; Fremont, Richard D; Girard, Timothy D; Rice, Todd W; Howell, Michael D; Johnson, Steven B; O'Brien, James; Park, Pauline K; Pastores, Stephen M; Patil, Namrata T; Pietropaoli, Anthony P; Putman, Maryann; Rotello, Leo; Siner, Jonathan; Sajid, Sahul; Murphy, David J; Sevransky, Jonathan E
Hospital-level variations in structure and process may affect clinical outcomes in ICUs. We sought to characterize the organizational structure, processes of care, use of protocols, and standardized outcomes in a large sample of U.S. ICUs. We surveyed 69 ICUs about organization, size, volume, staffing, processes of care, use of protocols, and annual ICU mortality. ICUs participating in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. Sixty-nine intensivists completed the survey. We characterized structure and process variables across ICUs, investigated relationships between these variables and annual ICU mortality, and adjusted for illness severity using Acute Physiology and Chronic Health Evaluation II. Ninety-four ICU directors were invited to participate in the study and 69 ICUs (73%) were enrolled, of which 25 (36%) were medical, 24 (35%) were surgical, and 20 (29%) were of mixed type, and 64 (93%) were located in teaching hospitals with a median number of five trainees per ICU. Average annual ICU mortality was 10.8%, average Acute Physiology and Chronic Health Evaluation II score was 19.3, 58% were closed units, and 41% had a 24-hour in-house intensivist. In multivariable linear regression adjusted for Acute Physiology and Chronic Health Evaluation II and multiple ICU structure and process factors, annual ICU mortality was lower in surgical ICUs than in medical ICUs (5.6% lower [95% CI, 2.4-8.8%]) or mixed ICUs (4.5% lower [95% CI, 0.4-8.7%]). We also found a lower annual ICU mortality among ICUs that had a daily plan of care review (5.8% lower [95% CI, 1.6-10.0%]) and a lower bed-to-nurse ratio (1.8% lower when the ratio decreased from 2:1 to 1.5:1 [95% CI, 0.25-3.4%]). In contrast, 24-hour intensivist coverage (p = 0.89) and closed ICU status (p = 0.16) were not associated with a lower annual ICU mortality. In a sample of 69 ICUs, a daily plan of care review and a lower bed-to-nurse ratio were both associated with a
Ko, Darae; Thigpen, Jonathan L; Otis, James A; Forster, Kristen; Henault, Lori; Quinn, Emily; Tripodis, Yorghos; Berger, Peter B; Limdi, Nita; Hylek, Elaine M
Statin pretreatment has been associated with reduced infarct volume in nonlacunar strokes. The effect of statins on functional outcomes of strokes related to atrial fibrillation (AF) is unknown. We aimed to define the influence of prestroke statin use on functional outcome in AF. We assembled a cohort of consecutive ischemic stroke patients from 2006 to 2010. All patients underwent CT or MRI and were adjudicated by site investigators. AF was confirmed by electrocardiogram in 100% of patients. Site neurologists blinded to the study hypothesis affirmed the type of stroke and assessed the severity of disability at the time of hospital discharge. The frequency of death at 30-days was calculated. Ischemic stroke (n=1030) resulted in a severe neurological deficit or death (modified Rankin scale ≥4) at 30days in 711 patients (69%). Using multivariable logistic regression models adjusting for factors associated with statin treatment and factors associated with functional outcome, prestroke statin use was associated with a 32% reduction in frequency of severe stroke (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50-0.92; P=0.011). Other independent factors associated with severe stroke included older age, female sex, non-White race, diabetes mellitus, prior ischemic stroke, prior venous thromboembolism, and dementia. Ischemic strokes in AF are associated with high mortality and morbidity. Statin use at time of stroke onset among patients with AF was associated in this study with less severe stroke and warrant validation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Oct 9, 2015 ... on the presumption by most urologists that RN provided the excel- lent cancer control with little effect on the overall renal function. Most of the functional studies in the past used either serum creati- nine or calculated or estimated glomerular filtration rate (eGFR) for measurement of the kidney function.
Naseer, M; Forssell, H; Fagerström, C
This study aimed to assess the association between risk of malnutrition and 7-year mortality, controlling for functional ability, socio-demographics, lifestyle behavior and diseases, and investigate the interaction between risk of malnutrition and functional ability on the risk of mortality. A longitudinal study on home-living and special-housing residents aged ⩾ 60 years was conducted. Of 2312 randomly invited participants, 1402 responded and 1203 provided information on both nutritional status and functional ability. The risk of malnutrition was estimated by the occurrence of at least one anthropometric measure (BMI, MAC and CC) below cut-off in addition to the presence of at least one subjective measure (decreased food intake, weight loss and eating difficulty). At baseline, 8.6% of subjects were at risk of malnutrition and during the 7-year follow-up 34.6% subjects died. The risk of malnutrition was independently associated with 7-year mortality (hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.28-2.65). Additional independent predictors were dementia (HR 2.76, 95% CI 1.85-4.10), activity of daily living (ADL) dependence (HR 2.08, 95% CI 1.62-2.67), heart disease (HR 1.44, 95% CI 1.16-1.78), diabetes (HR 1.41, 95% CI 1.03-1.93) and older age (HR 1.09, 95% CI 1.07-1.10). Moreover, the risk of malnutrition and ADL dependence in combination predicted the poorest survival rate (18.7%, P<0.001). The risk of malnutrition significantly increases the risk of mortality in older people. Moreover, risk of malnutrition and ADL dependence together explain a significantly poorer survival rate; however, the importance of this interaction decreased in the multivariable model and risk of malnutrition and ADL dependence independently explained a significant risk of mortality.
Schomaker, Michael; Davies, Mary-Ann; Malateste, Karen; Renner, Lorna; Sawry, Shobna; N'Gbeche, Sylvie; Technau, Karl-Günter; Eboua, François; Tanser, Frank; Sygnaté-Sy, Haby; Phiri, Sam; Amorissani-Folquet, Madeleine; Cox, Vivian; Koueta, Fla; Chimbete, Cleophas; Lawson-Evi, Annette; Giddy, Janet; Amani-Bosse, Clarisse; Wood, Robin; Egger, Matthias; Leroy, Valeriane
There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modeling analysis in children ages 1-5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups, and regions. ART-naïve children of ages 12-59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation. About one quarter of the 5,826 included children was from West Africa (24.6%).The median (first; third quartile) CD4% at the first visit was 16% (11%; 23%), the median weight-for-age z-scores and height-for-age z-scores were -1.5 (-2.7; -0.6) and -2.5 (-3.5; -1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count <750 cells/mm³ or CD4% <25% was 0.2% (95% CI = -0.2%; 0.3%), and the difference in the mean height-for-age z-scores of those who survived was -0.02 (95% CI = -0.04; 0.01). Younger children ages 1-2 and children in West Africa had worse outcomes. Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, although we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below 750/25%.
Selim, Ahmed M; Mazurek, Jeremy A; Iqbal, Muhammad; Wang, Dan; Negassa, Abdissa; Zolty, Ronald
With recent legislation imposing penalties on hospitals for above-average 30-day all-cause readmissions for patients with acute decompensated heart failure (ADHF), there is concern these penalties will more heavily impact hospitals serving socioeconomically vulnerable and underserved populations. Patients with ADHF and low socioeconomic status have better postdischarge mortality and readmission outcomes when cardiologists are involved in their in-hospital care. We retrospectively searched the electronic medical record for patients hospitalized for ADHF from 2001 to 2010 in 3 urban hospitals within a large university-based health system. These patients were divided into 2 groups based on whether a cardiologist was involved in their care or not. Measured outcomes were 30- and 60-day postdischarge mortality and readmission rates. Out of the 7516 ADHF patients, 1434 patients were seen by a cardiologist (19%). These patients had lower 60-day mortality (5.4% vs 7.0%; hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.52-0.96, P = 0.034) and lower 30- and 60-day readmission rates (16.7% vs 20.6%; HR: 0.76, 95% CI: 0.66-0.89, P = 0.002, and 26.1% vs 30.2%; HR: 0.81, 95% CI: 0.72-0.92, P = 0.003, respectively). There was no significant difference in the in-hospital mortality between the 2 groups. Compared with other races, whites with systolic HF have marginally lower HF-related readmission rates when treated by cardiologists. In this cohort of ADHF patients from the Bronx, New York, involvement of a cardiologist resulted in improved short-term mortality and readmission outcomes compared with treatment by general internal medicine. © 2015 Wiley Periodicals, Inc.
Imanishi, Yasuo; Fukuma, Shingo; Karaboyas, Angelo; Robinson, Bruce M; Pisoni, Ronald L; Nomura, Takanobu; Akiba, Takashi; Akizawa, Tadao; Kurokawa, Kiyoshi; Saito, Akira; Fukuhara, Shunichi; Inaba, Masaaki
Socioeconomic status (SES) factors such as employment, educational attainment, income, and marital status can affect the health and well-being of the general population and have been associated with the prevalence of chronic kidney disease (CKD). However, no studies to date in Japan have reported on the prognosis of patients with CKD with respect to SES. This study aimed to investigate the influences of employment and education level on mortality and hospitalization among maintenance hemodialysis (HD) patients in Japan. Data on 7974 HD patients enrolled in Dialysis Outcomes and Practice Patterns Study phases 1-4 (1999-2011) in Japan were analysed. Employment status, education level, demographic data, and comorbidities were abstracted at entry into DOPPS from patient records. Mortality and hospitalization events were collected during follow-up. Patients on dialysis employment and both mortality and hospitalization among patients education and outcomes was also assessed. The association between patient characteristics and employment among patients education and patients who graduated HS with some college tended to have elevated mortality (HR = 1.41; 95% CI, 1.04-1.92 and HR = 1.36; 95% CI: 1.02-1.82, respectively) but were not at risk for increased hospitalizations. Factors associated with unemployment included lower level of education, older age, female gender, longer vintage, and several comorbidities. Employment and education status were inversely associated with mortality in patients on maintenance HD in Japan. Employment but not education was also inversely associated with hospitalizations. After adjustment for comorbidities, the associations with clinical outcomes tended to be stronger for employment than education status.
Montezuma-Rusca, Jairo Mauricio; Powers, John H.
Opinion statement Cryptococcal meningitis (CM) is a common disease in resource-challenged settings, with a high mortality within weeks of disease onset. Mortality remains high with current treatments, so more effective interventions are needed to decrease mortality. There has been interest in using the outcome assessment of quantification of fungus from cerebrospinal fluid as a replacement (surrogate) endpoint for all-cause mortality (ACM) as a means of decreasing sample size in randomized clinical trials in CM. To evaluate a biomarker as a potential surrogate endpoint to replace ACM requires several steps. This paper discusses the issues of determining whether the context of a disease is one where a potential surrogate endpoint is rational, the types of outcome assessments that might qualify as potential surrogates, and the process for evaluation of the evidence that a chosen biomarker is a valid replacement for ACM in the given context of use. We then apply those principles to the context of randomized clinical trials of CM. PMID:26306077
Azria, Elie; Kayem, Gilles; Langer, Bruno; Marchand-Martin, Laetitia; Marret, Stephane; Fresson, Jeanne; Pierrat, Véronique; Arnaud, Catherine; Goffinet, François; Kaminski, Monique; Ancel, Pierre-Yves
To determine whether breech presentation is an independent risk factor for neonatal morbidity, mortality, or long-term neurologic morbidity in very preterm infants. Prospective population-based cohort. Singletons infants without congenital malformations born from 27 to 32 completed weeks of gestation enrolled in France in 1997 in the EPIPAGE cohort. The neonatal and long-term follow-up outcomes of preterm infants were compared between those in breech presentation and those in vertex presentation. The relation of fetal presentation with neonatal mortality and neurodevelopmental outcomes was assessed using multiple logistic regression models. Among the 1518 infants alive at onset of labor included in this analysis (351 in breech presentation), 1392 were alive at discharge. Among those eligible to follow up and alive at 8 years, follow-up data were available for 1188 children. Neonatal mortality was significantly higher among breech than vertex infants (10.8% vs. 7.5%, P = 0.05). However the differences were not significant after controlling for potential confounders. Neonatal morbidity did not differ significantly according to fetal presentation. Severe cerebral palsy was less frequent in the group born in breech compared to vertex presentation but there was no difference after adjustment. There was no difference according to fetal presentation in cognitive deficiencies/learning disabilities or overall deficiencies. Our data suggest that breech presentation is not an independent risk factor for neonatal mortality or long-term neurologic deficiencies among very preterm infants.
the quality of life for many cataract-blind patients. Key words: cataract, blindness, outcome, Plateau State. INTRODUCTION. Up to 75% of blindness worldwide is a result of five preventable and treatable conditions. Cataract, an avoidable. 1 cause of blindness, is the leading cause of blindness and low vision worldwide.
Buchvald, Frederik; Petersen, Bodil Laub; Pedersen, Karen Damgaard
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 f...
Two patients reported infection and five reported avascular necrosis, four of which required hip replacements. Conclusions: Operative treatment of acetabular fractures, particularly posterior approaches for elemental posterior wall approaches, can lead to good outcomes with acceptable complication rates at a busy trauma.
Stern, Marc J; Predmore, S Andrew
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.
Full Text Available Few data are available to assess whether a low-moderate reduction in estimated glomerular filtration rates (eGFR has a role per se on cardiovascular (CV mortality or other biomarkers such as NT-proBNP allow to explain such association.In a prospective study including 1,645 type 2 diabetic subjects of the population-based Casale Monferrato Study, who had no clinical evidence of heart failure and eGFR >45 ml/min/1.73 m2, we examined 6 years CV mortality. Multivariate Cox proportional hazards modeling were used to estimate the effect of NT-proBNP on the association between eGFR and mortality, independently of baseline CV risk factors, albumin excretion rate (AER and C-reactive protein (CRP. During follow-up, 327 people died (149 of CV diseases out of 8334.5 person-years. Compared to eGFR≥90 ml/min/1.73 m2, values of 60-89 and 45-59 ml/min/1.73 m2 conferred a fully adjusted hazard ratios (HRs of CV mortality of 1.74 (1.08-2.82 and 1.95 (1.03-3.68, respectively. After further adjustment for NT-proBNP, however, HRs were no longer significant (HRs 1.42, 0.83-2.42 and 1.22, 0.59-2.51. In this model, HR for logNT-proBNP was 1.84 (1.52-2.22. Adding NT-proBNP to the model improved the C-statistic of CV mortality from 0.79 (0.76-0.83 to 0.84 (0.81-0.87, yielded an IDI of 0.03 (p = 0.02, and a NRI of 0.44 (p = 0.016.In diabetic people a modest reduction in renal function increased 6-year CV mortality independently of albuminuria. This association, however, was mainly explained by the effect of NT-proBNP, that remained the strongest prognostic marker for a worse CV outcome, even after adjustment for other CV risk factors and pre-existing CVD.
Pedersen, P M; Jørgensen, H S; Kammersgaard, L P
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....
Cantarutti, Anna; Galeone, Carlotta; Leuzzi, Giovanni; Bertocchi, Elena; Pomponi, Giovanna; Langer, Martin; Mazzaferro, Vincenzo; Galmozzi, Gustavo; Apolone, Giovanni; Corrao, Giovanni; Pastorino, Ugo
Accurate measurement of outcomes is essential to monitor the effectiveness of public health policies. In Italy, the Ministry of Health has chosen 30-day mortality after major surgical or medical procedures as the main outcome measure, pooling all pulmonary resections for malignancy in a single category. The present audit evaluated all pulmonary resections performed over a 13-year period in a single institution to assess the immediate (30-day mortality) and long-term (5-year survival) outcomes according to type and stage of disease and extent of surgery. We analyzed the results of 4,234 first pulmonary resections performed from 2003 to 2015 for lung cancer (2,636), lung metastases (1,080), other primary cancers (259) and benign diseases (259). The median follow-up of cancer patients was 4.1 years. Overall 30-day mortality was 1.1%, being 1.2% for lung cancer, 0.3% for lung metastases, 3.5% for pneumonectomies, 1% for lobectomies, and 0.5% for sublobar resections. Among lung cancer patients, 30-day mortality was 0.7% for simple anatomical resections, 2.8% for complex resections, 0.7% for stage I, and 1.6% for higher stages. Overall 5-year survival was 56% for lung cancer, 49% for lung metastases, and 53% for other primary cancers (p = 0.03). According to the surgical procedure for lung cancer, 5-year survival was 60%, 55% and 36% for lobectomies, segmentectomies and pneumonectomies, respectively (p<0.0001). For better monitoring of thoracic surgery outcomes in a real-world setting, we suggest evaluating lung cancer separately from other thoracic malignancies, and including 5-year survival rates stratified by resection volume and surgical procedure complexity.
Reduction in cardiac mortality with bivalirudin in patients with and without major bleeding: The HORIZONS-AMI trial (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction).
Stone, Gregg W; Clayton, Tim; Deliargyris, Efthymios N; Prats, Jayne; Mehran, Roxana; Pocock, Stuart J
The purpose of this study was to determine whether, in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), the reduction in cardiac mortality in those taking bivalirudin compared with unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (UFH+GPI) can be fully attributed to reduced bleeding. The association between hemorrhagic complications and mortality may explain the survival benefit with bivalirudin. A total of 3,602 STEMI patients undergoing primary PCI were randomized to bivalirudin versus UFH+GPI. Three-year cardiac mortality was analyzed in patients with and without major bleeding. When compared with UFH+GPI, bivalirudin resulted in lower 3-year rates of major bleeding (6.9% vs. 10.5%, hazard ratio [HR]: 0.64 [95% confidence interval (CI): 0.51 to 0.80], p accounting for major bleeding and other adverse events, bivalirudin was still associated with a 43% reduction in 3-year cardiac mortality (adjusted HR: 0.57 [95% CI: 0.39 to 0.83], p = 0.003). Bivalirudin reduces cardiac mortality in patients with STEMI undergoing primary PCI, an effect that can only partly be attributed to prevention of bleeding. Further studies are required to identify the nonhematologic benefits of bivalirudin. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction; NCT00433966). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Viña Soria, L; Martín Iglesias, L; López Amor, L; Astola Hidalgo, I; Rodríguez García, R; Forcelledo Espina, L; Gonzalo Guerra, J A; de Cima Iglesias, S; Murias Quintana, E; Vega Valdés, P; Calleja Puerta, S; Escudero Augusto, D
To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. Observational prospective study. Mixed ICU. Third level hospital. Sixty adult patients. Consecutive sample. None. Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Hile, Sarah; Erickson, Sarah J; Agee, Brittany; Annett, Robert D
Childhood cancer survivors are at risk for long-term neurocognitive and psychosocial morbidities. Research has seldom examined the relationship between these morbidities; thus, little empirical evidence exists concerning overall salience and how morbidities converge to impair day-to-day functioning. An increased understanding of functional impairment resulting from the pediatric cancer experience can inform early risk identification as well as sources for intervention. The purpose of this study was to characterize the frequency/severity of functional impairment and identify significant neurocognitive and psychosocial determinants of functional impairment. Fifty child-parent dyads were enrolled. Children were aged 7-19 years who were at least 2 years postdiagnosis with leukemia/lymphoma and were recruited through a pediatric oncology late effects clinic. Parents completed questionnaires, rating their own adjustment to their child's illness as well as their child's level of functional impairment, while a brief neuropsychological exam was administered to children. Twenty-six percent of the sample evidenced clinically significant functional impairment. Regression analyses indicated that neurocognitive deficits did not predict functional impairment, whereas parental stress was a significant predictor. Although children demonstrated both neurocognitive deficits and functional impairments, results favor psychosocial factors, such as parental stress, as a predictor of overall functional impairment. The implications of this study suggest that late effects aggregate to impact day-to-day functioning in pediatric cancer survivor populations and parental stress may serve as a marker for heightened risk. The results suggest that broader functional domains, especially school and self-care domains, should be evaluated and considered when identifying potential targets for psychosocial interventions. Copyright © 2014 John Wiley & Sons, Ltd.
Background: During normal pregnancy, changes in thyroid function are well documented; however, information regarding thyroid function in preeclampsia is scanty. Aim: The present study was planned to study thyroid hormones in mild and severe preeclamptic women and normotensive women and correlate them with ...
Sep 3, 2013 ... It further underscores the administration of a functional rating scale on admission in order to aggressively manage activity limitations. .... rating scale (presented with intervals of 5 points) of this tool allows for the measurement of the ..... function and life satisfaction after stroke. Journal of the American Heart ...
J.T.M. van Baalen (Bianca)
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
Wada, Takuro; Moriya, Tamami; Iba, Kosuke; Ozasa, Yasuhiro; Sonoda, Tomoko; Aoki, Mitsuhiro; Yamashita, Toshihiko
The purpose of this study was to evaluate surgical outcomes of arthroscopic debridement for lateral epicondylitis using a validated, patient-assessed scoring system as well as conventional outcome measures. We also wanted to identify potential predictive factors that may be associated with the outcomes. A total of 20 elbows in 18 patients with chronic lateral epicondylitis who underwent arthroscopic surgery were included. There were nine men and nine women with a mean age of 54 years (range 42-71 years). Operative treatment consisted of debridement of the extensor carpi radialis brevis (ECRB) origin and resection of the radiocapitellar synovial plica interposed in the joint. Outcomes were assessed using a patient rating, visual analogue scale (VAS) pain score, the Japanese Orthopaedic Association (JOA) elbow score, and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. The average length of follow-up was 28 months (range 24-40 months). After surgery, according to the patients' reports, 14 of 20 elbows were much better, and 6 elbows were better. A mean preoperative VAS pain score at rest of 3.9 points improved to 0.3 points (P<0.0001), and that during activity improved from 7.8 points to 0.9 points (P<0.0001). The mean preoperative JOA elbow score of 29 points was improved to 90 points (P<0.0001). The mean postoperative DASH score was 10.6 (range 0-50). Absent of T2-weighted high signal focus of the ECRB origin on preoperative magnetic resonance imaging (MRI) (P=0.02) and receiving public assistance (P=0.01) were significantly associated with worse DASH scores. Arthroscopic release was a satisfactory procedure for chronic lateral epicondylitis. Preoperative MRI of the ECRB origin and socioeconomic factors were significantly associated with postoperative residual symptoms evaluated with the DASH score. (author)
León-Jiménez, C; Ruiz-Sandoval, J L; Chiquete, E; Vega-Arroyo, M; Arauz, A; Murillo-Bonilla, L M; Ochoa-Guzmán, A; Carrillo-Loza, K; Ramos-Moreno, A; Barinagarrementeria, F; Cantú-Brito, C
Information regarding hospital arrival times after acute ischaemic stroke (AIS) has mainly been gathered from countries with specialised stroke units. Little data from emerging nations is available. We aim to identify factors associated with achieving hospital arrival times of less than 1, 3, and 6 hours, and analyse how arrival times are related to functional outcomes after AIS. We analysed data from patients with AIS included in the PREMIER study (Primer Registro Mexicano de Isquemia Cerebral) which defined time from symptom onset to hospital arrival. The functional prognosis at 30 days and at 3, 6, and 12 months was evaluated using the modified Rankin Scale. Among 1096 patients with AIS, 61 (6%) arrived in <1 hour, 250 (23%) in <3 hours, and 464 (42%) in <6 hours. The factors associated with very early (<1 hour) arrival were family history of ischemic heart disease and personal history of migraines; in <3 hours: age 40-69 years, family history of hypertension, personal history of dyslipidaemia and ischaemic heart disease, and care in a private hospital; in <6 hours: migraine, previous stroke, ischaemic heart disease, care in a private hospital, and family history of hypertension. Delayed hospital arrival was associated with lacunar stroke and alcoholism. Only 2.4% of patients underwent thrombolysis. Regardless of whether or not thrombolysis was performed, arrival time in <3 hours was associated with lower mortality at 3 and 6 months, and with fewer in-hospital complications. A high percentage of patients had short hospital arrival times; however, less than 3% underwent thrombolysis. Although many factors were associated with early hospital arrival, it is a priority to identify in-hospital barriers to performing thrombolysis. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.
Din, Natasha; Allen, Isabel Elaine; Satariano, William A; Demb, Joshua; Braithwaite, Dejana
To determine the association of prediagnostic alcohol consumption with long-term mortality from breast cancer and other causes in a cohort of women with breast cancer. We studied a Michigan-based cohort of 939 women aged 40-84 years, who provided complete information about the type, amount and intensity of prediagnostic alcohol consumption. Associations of alcohol consumption, based on weekly volume of alcohol consumption during the year prior to breast cancer diagnosis, with mortality were evaluated in Cox proportional hazards models, with adjustment for sociodemographic factors, body mass index, smoking, comorbidity, tumor characteristics, and treatment. Differences among covariates were assessed with Pearson χ2 , Student t -tests and Wilcoxon Rank Sum tests. All statistical tests were two-sided. During a median follow-up of 11 years, 724 deaths occurred overall, with 303 from breast cancer. Fifty-five percent of the women were categorized as drinkers with volume of alcohol consumption ranging from 0.75 to 36.00 drinks/week. In multivariable models, a decreased risk of other-cause mortality was associated with low alcohol drinking (0.75-3.75 drinks/week; HR = 0.61, 95% CI = 0.47-0.78), moderate volume alcohol drinking (4.00-9.75 drinks/week; HR = 0.57, 95% CI = 0.39-0.85) and low frequency (0.75-3.75 drinks/week) beer and wine intake (HR = 0.69, 95% CI = 0.50-0.96 and HR = 0.68, 95% CI = 0.52-0.88 respectively). Although the risk of breast cancer-specific mortality was not statistically significantly associated with moderate (4.00-9.75 drinks/week) and high volume (10.00-36.00 drinks/week) alcohol drinking in the overall cohort (HR = 1.43, 95% CI = 95% 0.97-2.12 and HR = 1.53, 95% CI = 0.87-2.70 respectively), there was a positive association of alcohol consumption with breast cancer-specific mortality among current smokers (HR = 1.92, 95% CI = 1.03-3.57; Pinteraction = 0.04). In this prospective cohort study, regular consumption of 0.75-36.00 alcoholic drinks
L.A. 't Hoen (Lisette)
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
Fulks, Michael; Stout, Robert L; Dolan, Vera F
Determine the relative mortality in apparently healthy adults with various levels of urinary protein measured by urine protein/creatinine (p/c) ratio. By use of the Social Security Death Master File, mortality in 2010 was determined for 7.5 million life insurance applicants age 20 to 89 providing urine samples between 1992 and 2006. Relative mortality by Cox regression for bands of p/c ratios was determined using age and sex as covariates and with an age split at 60 after excluding those with hematuria (> 3 red cells/hpf), diabetes, evidence of blood sugar elevation, or eGFR urine samples with elevated p/c ratios as not containing albumin; those cases appeared to be associated with much lower risk as long as the p/c ratio was urine protein/creatinine ratios of 0.11 mg/mg or higher (much lower than the usual lower cut-off value of 0.21) are associated with substantial excess mortality risk, even after excluding diabetics and those with reduced kidney function or hematuria.
Zhang, Qiang; Ma, Chang-Sheng; Nie, Shao-Ping
This study determined the profile of renal insufficiency in patients without chronic kidney disease (CKD) undergoing coronary revascularization and elucidated the effect of renal insufficiency of different degrees on clinical outcomes after revascularization and examined whether the reasonable choice of the mode of revascularization could favourably influence prognosis. Patients undergoing coronary revascularization were grouped by estimated creatinine clearance (CrCl) (Group I, CrCl > or = 90 ml/min; Group II, 60 relationship between the CrCl and the clinical outcomes of all of the patients. The mean Scr level of 2896 patients was (80.0 +/- 35.4) micromol/L. There were 1035 patients (35.7%) in Group I, 1337 patients (46.2%) in Group II, 524 patients (18.1%) in Group III and no patient in Group IV. During hospitalization, significant difference was found among Group I-III on mortality (1.0%, 2.5% and 2.9%, P = 0.009) and major adverse cardiac cerebra events (MACCE) (1.4%, 3.5% and 4.6%, P = 0.001). Compared with the normal renal function group, there were significantly higher rate of mortality (2.5% vs. 1.0%, P = 0.007), new-onset myocardial infarction (1.0% vs. 0.2%, P = 0.018) and MACCE (3.5% vs. 1.4%, P = 0.002) in mild renal insufficiency (Grou II). During follow-up, there were significant difference among Group I-III on mortality (2.0%, 3.0% and 5.7%, P = 0.002), stroke (1.0%, 1.8% and 3.1%, P = 0.023) and MACCE (9.9%, 10.3% and 16.6%, P = 0.001). The independent risk factors for all-cause death in patients after revascularization were the mode of revascularization (OR 8.332, 95%CI 2.386 - 22.869, P = 0.001), age (OR 1.184, 95%CI 1.020 - 1.246, P = 0.001), and the level of CrCl (OR 0.503, 95%CI 0.186 - 0.988, P = 0.045). In patients with normal renal function and mild renal insufficiency, the all-cause mortality after PCI was significantly lower that than after CABG (both P function or mild renal insufficiency, the mode of revascularization might lead to a
Pillai, Shibu; Metrie, Mary; Dunham, Christopher; Sargent, Michael; Hukin, Juliette; Steinbok, Paul
Intracranial tumors are rare in the first year of life. This study evaluates survival rates and functional outcomes of survivors at least 5 years after diagnosis and the predictors of this outcome. A retrospective chart review of all infants with a primary intracranial tumor was carried out. Radiology and pathology were re-reviewed. Outcome was assessed at 5 years or more after diagnosis using Bloom's categories (Bloom 1-2 = good outcome, the rest = poor outcome) and late effects severity scoring. Age, tumor location, size, extent of tumor resection, type of adjuvant therapy given, and WHO grade of tumor histology were evaluated as predictors of outcome. Among 35 infants, 20 (57%) survived, with 12 (34%) having a good outcome. Deficits among the survivors included neurological dysfunction in 14 (70%), visual impairment in 9 (45%), endocrine dysfunction in 5 (25%), and auditory disability in 3 (15%). Ten of the 20 survivors were either attending regular school or were engaged in a skilled job. At presentation, older age and an infratentorial location of the tumor are predictors of poor outcome. After histopathological diagnosis, the WHO grading of tumor is the only independent predictor of survival (p = 0.002) and functional outcome (p brain tumors (34%) had a good functional outcome and approximately a quarter of them (28%) were able to attend regular school or take up a skilled job. After tissue diagnosis, histological grade of tumor is the only independent predictor associated with outcome.
M.S. Biagioni Santos
Full Text Available The objective of the present study was to determine the prevalence of electrolyte disturbances in AIDS patients developing acute kidney injury in the hospital setting, as well as to determine whether such disturbances constitute a risk factor for nephrotoxic and ischemic injury. A prospective, observational cohort study was carried out. Hospitalized AIDS patients were evaluated for age; gender; coinfection with hepatitis; diabetes mellitus; hypertension; time since HIV seroconversion; CD4 count; HIV viral load; proteinuria; serum levels of creatinine, urea, sodium, potassium and magnesium; antiretroviral use; nephrotoxic drug use; sepsis; intensive care unit (ICU admission, and the need for dialysis. Each of these characteristics was correlated with the development of acute kidney injury, with recovery of renal function and with survival. Fifty-four patients developed acute kidney injury: 72% were males, 59% had been HIV-infected for >5 years, 72% had CD4 counts <200 cells/mm³, 87% developed electrolyte disturbances, 33% recovered renal function, and 56% survived. ICU admission, dialysis, sepsis and hypomagnesemia were all significantly associated with nonrecovery of renal function and with mortality. Nonrecovery of renal function was significantly associated with hypomagnesemia, as was mortality in the multivariate analysis. The risks for nonrecovery of renal function and for death were 6.94 and 6.92 times greater, respectively, for patients with hypomagnesemia. In hospitalized AIDS patients, hypomagnesemia is a risk factor for nonrecovery of renal function and for in-hospital mortality. To determine whether hypomagnesemia is a determinant or simply a marker of critical illness, further studies involving magnesium supplementation in AIDS patients are warranted.
Hecking, Manfred; Bieber, Brian A; Ethier, Jean; Kautzky-Willer, Alexandra; Sunder-Plassmann, Gere; Säemann, Marcus D; Ramirez, Sylvia P B; Gillespie, Brenda W; Pisoni, Ronald L; Robinson, Bruce M; Port, Friedrich K
A comprehensive analysis of sex-specific differences in the characteristics, treatment, and outcomes of individuals with end-stage renal disease undergoing dialysis might reveal treatment inequalities and targets to improve sex-specific patient care. Here we describe hemodialysis prevalence and patient characteristics by sex, compare the adult male-to-female mortality rate with data from the general population, and evaluate sex interactions with mortality. We assessed the Human Mortality Database and 206,374 patients receiving hemodialysis from 12 countries (Australia, Belgium, Canada, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, the UK, and the US) participating in the international, prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) between June 1996 and March 2012. Among 35,964 sampled DOPPS patients with full data collection, we studied patient characteristics (descriptively) and mortality (via Cox regression) by sex. In all age groups, more men than women were on hemodialysis (59% versus 41% overall), with large differences observed between countries. The average estimated glomerular filtration rate at hemodialysis initiation was higher in men than women. The male-to-female mortality rate ratio in the general population varied from 1.5 to 2.6 for age groups sex-specific differences and does not provide information about patients not treated with dialysis or dying prior to a planned start of dialysis. Women's survival advantage was markedly diminished in hemodialysis patients. The finding that fewer women than men were being treated with dialysis for end-stage renal disease merits detailed further study, as the large discrepancies in sex-specific hemodialysis prevalence by country and age group are likely explained by factors beyond biology. Modifiable variables, such as catheter use, showing significant sex interactions suggest interventional targeting. Please see later in the article for the Editors' Summary.
Spaccavento, Simona; Cafforio, Elisabetta; Cellamare, Fara; Colucci, Antonia; Di Palma, Angela; Falcone, Rosanna; Craca, Angela; Loverre, Anna; Nardulli, Roberto; Glueckauf, Robert L
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
Scali, Salvatore; Bertges, Daniel; Neal, Daniel; Patel, Virendra; Eldrup-Jorgensen, Jens; Cronenwett, Jack; Beck, Adam
Heart rate (HR) parameters are known indicators of cardiovascular complications after cardiac surgery, but there is little evidence of their role in predicting outcome after major vascular surgery. The purpose of this study was to determine whether arrival HR (AHR) and highest intraoperative HR are associated with mortality or major adverse cardiac events (MACEs) after elective vascular surgery in the Vascular Quality Initiative (VQI). Patients undergoing elective lower extremity bypass (LEB), aortofemoral bypass (AFB), and open abdominal aortic aneurysm (AAA) repair in the VQI were analyzed. MACE was defined as any postoperative myocardial infarction, dysrhythmia, or congestive heart failure. Controlled HR was defined as AHR HR (DHR) was defined as highest intraoperative HR - AHR. Procedure-specific MACE models were derived for risk stratification, and generalized estimating equations were used to account for clustering of center effects. HR, beta-blocker exposure, cardiac risk, and their interactions were explored to determine association with MACE or 30-day mortality. A Bonferroni correction with P HR associations disappeared in controlling for beta-blocker status. For AFB and open AAA repair patients, there was no significant association between AHR and MACE or 30-day mortality, irrespective or cardiac risk or beta-blocker status. DHR and extremes of highest intraoperative HR (>90 or 100 beats/min) were analyzed among all three operations, and no consistent associations with MACE or 30-day mortality were detected. The VQI AHR and highest intraoperative HR variables are highly confounded by patient presentation, operative variables, and beta-blocker therapy. The discordance between cardiac risk and HR as well as the lack of consistent correlation to outcome makes them unreliable predictors. The VQI has elected to discontinue collecting AHR and highest intraoperative HR data, given insufficient evidence to suggest their importance as an outcome measure. Copyright
Kobylecki, Camilla J; Afzal, Shoaib; Nordestgaard, Børge G
(COPD) and an increased risk of ischemic heart disease (IHD). We questioned whether SOD3 R213G homozygosity (213GG) influences morbidity, mortality, and lung function. We found 14 R213G homozygotes (213GG) among 95,871 individuals (1/7000) from the Copenhagen General Population Study and the Copenhagen...... in cardiovascular disease and in impairing and maintaining lung function in never-smokers. However, our findings should be retested in larger studies and in nonsmoking COPD patient cohorts. Antioxid. Redox Signal. 24, 884-891....
Barrington, Wendy E; White, Emily
To evaluate associations of fast-food items (FFI) and sugar-sweetened drinks (SSD) with mortality outcomes including deaths due to any cause, CVD and total cancers among a large sample of adults. Using a prospective design, risk of death was compared across baseline dietary exposures. Intakes of FFI and SSD were quantified using a semi-quantitative FFQ (baseline data collected 2000-2002). Deaths (n 4187) were obtained via the Washington State death file through 2008, excluding deaths in the first year of follow-up. Causes of death were categorized as due to CVD (I00-I99) or cancer (C00-D48). Cox models were used to estimated hazard ratios (HR) and 95 % CI. The Vitamins and Lifestyle (VITAL) study among adults living in Western Washington State. Men and women (n 69 582) between 50 and 76 years of age at baseline. Intakes of FFI and SSD were higher among individuals who were younger, female, African-American, American Indian or Alaska Native, Asian-American or Pacific Islander, of lower educational attainment, and of lower income (Pintake of FFI (HR=1·16; 95 % CI 1·04, 1·29; P=0·004; comparing highest v. lowest quartile) and SSD (HR=1·19; 95 % CI 1·08, 1·30; Pintake of FFI was associated with greater cancer-specific mortality while an association with CVD-specific mortality was suggested. Associations between intake of SSD and cause-specific mortality were less clear. Intake of FFI and SSD has a detrimental effect on future mortality risk. These findings may be salient to socially patterned disparities in mortality.
Gasch, O; Camoez, M; Dominguez, M A; Padilla, B; Pintado, V; Almirante, B; Molina, J; Lopez-Medrano, F; Ruiz, E; Martinez, J A; Bereciartua, E; Rodriguez-Lopez, F; Fernandez-Mazarrasa, C; Goenaga, M A; Benito, N; Rodriguez-Baño, J; Espejo, E; Pujol, M
Mortality related to methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) remains high, despite changes in the epidemiology. To analyze the current predictive factors for mortality we conducted a prospective study in a large cohort of patients with MRSA-BSI from 21 Spanish hospitals. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed, including susceptibility to antibiotics and molecular characterization. Vancomycin MICs (V-MIC) were tested by the E-test and microdilution methods. Time until death was the dependent variable in a Cox regression analysis. Overall, 579 episodes were included. Acquisition was nosocomial in 59% and vascular catheter was the most frequent source (38%). A dominant PFGE genotype was found in 368 (67%) isolates, which belonged to Clonal Complex (CC)5 and carried SCCmecIV and agr2. Microdilution V-MIC50 and V-MIC90 were 0.7 and 1.0 mg/L, respectively. Initial therapy was appropriate in 66% of episodes. Overall mortality was observed in 179 (32%) episodes. The Cox-regression analysis identified age >70 years (HR 1.88), previous fatal disease (HR 2.16), Pitt score >1 (HR 3.45), high-risk source (HR 1.85) and inappropriate initial treatment (HR 1.39) as independent predictive factors for mortality. CC5 and CC22 (HR 0.52 and 0.45) were associated with significantly lower mortality rates than CC8. V-MIC ≥1.5 did not have a significant impact on mortality, regardless of the method used to assess it. © 2012 The Authors Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.
Donati, D; D'Apote, G; Boschi, M; Cevolani, L; Benedetti, M G
The implantation of a saddle prosthesis after resection of a pelvic tumor has been proposed as a simple method of reconstruction that provides good stability and reduces the surgical time, thus limits the onset of intraoperative complications. There are no studies in the literature of patients evaluated using gait analysis after being implanted with a saddle prosthesis. The present study is a retrospective case review aimed at illustrating long-term clinical and functional findings in tumor patients reconstructed with a saddle prosthesis. A series of 15 patients who received pelvic reconstruction with a saddle prosthesis were retrospectively reviewed in terms of clinical, radiographic, and functional evaluations. Two patients were additionally assessed by gait analysis. Long-term functional follow-up was achieved in only 6 patients, and ranged from 97 to 167 months. Function was found to be rather impaired, as a mean of only 57 % of normal activity was restored. Gait analysis demonstrated that the implant had poor biomechanics, as characterized by very limited hip motion. Though the saddle prosthesis was proposed as advance in tumor-related pelvic surgery, the present study indicates that it yields unsatisfactory clinical and functional results due to both clinical complications and the poor biomechanics of the device. The use of a saddle prosthesis in tumor surgery did not provide satisfactory results in long-term follow-up. It is no longer implanted at our institute, and is currently considered a "salvage technique."
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.
Landi, F; Calvani, R; Ortolani, E; Salini, S; Martone, A M; Santoro, L; Santoliquido, A; Sisto, A; Picca, A; Marzetti, E
This study evaluates the prevalence of sarcopenia among older people admitted to a rehabilitation unit after hip fracture and the association between sarcopenia and functional outcomes. The results show that sarcopenia had a negative impact on functional recovery. The assessment of sarcopenia among older adults receiving rehabilitation programs is crucial. Sarcopenia is a highly prevalent geriatric syndrome associated with adverse outcomes, including falls, disability, institutionalization, and mortality. Few studies assessed sarcopenia among older adults receiving rehabilitation programs. Patients aged 70 years or more consecutively admitted to in-hospital rehabilitation programs that had suffered from hip fracture entered the study. Sarcopenia was defined according to the Foundation for National Institutes of Health (FNIH) criteria. Multivariable linear regression models were used to analyze the association between the sarcopenia and functional recovery. The recruited population was composed of 127 patients, with a mean age of 81.3 ± 4.8 years, predominantly females (64.6%). Using the criteria proposed by the FNIH, patients with a diagnosis of sarcopenia were 43 (33.9%). After adjustment for potential confounders, participants with sarcopenia had a significant increased risk of incomplete functional recovery compared with non-sarcopenic patients (OR 3.07, 95% CI 1.07-8.75). Compared with participants without sarcopenia, those with sarcopenia showed lower Barthel index scores at the time of discharge from the rehabilitation unit (69.2 versus 58.9, respectively; p sarcopenia among older adults receiving rehabilitation programs to assist in the development of personalized treatment plans aimed at improving functional outcomes.
Ruiz-Benito, Paloma; Ratcliffe, Sophia; Zavala, Miguel A; Martínez-Vilalta, Jordi; Vilà-Cabrera, Albert; Lloret, Francisco; Madrigal-González, Jaime; Wirth, Christian; Greenwood, Sarah; Kändler, Gerald; Lehtonen, Aleksi; Kattge, Jens; Dahlgren, Jonas; Jump, Alistair S
Intense droughts combined with increased temperatures are one of the major threats to forest persistence in the 21st century. Despite the direct impact of climate change on forest growth and shifts in species abundance, the effect of altered demography on changes in the composition of functional traits is not well known. We sought to (1) quantify the recent changes in functional composition of European forests; (2) identify the relative importance of climate change, mean climate and forest development for changes in functional composition; and (3) analyse the roles of tree mortality and growth underlying any functional changes in different forest types. We quantified changes in functional composition from the 1980s to the 2000s across Europe by two dimensions of functional trait variation: the first dimension was mainly related to changes in leaf mass per area and wood density (partially related to the trait differences between angiosperms and gymnosperms), and the second dimension was related to changes in maximum tree height. Our results indicate that climate change and mean climatic effects strongly interacted with forest development and it was not possible to completely disentangle their effects. Where recent climate change was not too extreme, the patterns of functional change generally followed the expected patterns under secondary succession (e.g. towards late-successional short-statured hardwoods in Mediterranean forests and taller gymnosperms in boreal forests) and latitudinal gradients (e.g. larger proportion of gymnosperm-like strategies at low water availability in forests formerly dominated by broad-leaved deciduous species). Recent climate change generally favoured the dominance of angiosperm-like related traits under increased temperature and intense droughts. Our results show functional composition changes over relatively short time scales in European forests. These changes are largely determined by tree mortality, which should be further
Full Text Available Socioeconomic status (SES factors such as employment, educational attainment, income, and marital status can affect the health and well-being of the general population and have been associated with the prevalence of chronic kidney disease (CKD. However, no studies to date in Japan have reported on the prognosis of patients with CKD with respect to SES. This study aimed to investigate the influences of employment and education level on mortality and hospitalization among maintenance hemodialysis (HD patients in Japan.Data on 7974 HD patients enrolled in Dialysis Outcomes and Practice Patterns Study phases 1-4 (1999-2011 in Japan were analysed. Employment status, education level, demographic data, and comorbidities were abstracted at entry into DOPPS from patient records. Mortality and hospitalization events were collected during follow-up. Patients on dialysis < 120 days at study entry were excluded from the analyses. Cox regression modelled the association between employment and both mortality and hospitalization among patients < 60 years old. The association between education and outcomes was also assessed. The association between patient characteristics and employment among patients < 60 years old was assessed using logistic regression.During a median follow-up of 24.9 months (interquartile range, 18.4-32.0, 10% of patients died and 43% of patients had an inpatient hospitalization. Unemployment was associated with mortality (hazard ratio [HR] = 1.57; 95% confidence interval [CI]: 1.05-2.36 and hospitalization (HR = 1.25; 95% CI: 1.08-1.44. Compared to patients who graduated from university, patients with less than a high school (HS education and patients who graduated HS with some college tended to have elevated mortality (HR = 1.41; 95% CI, 1.04-1.92 and HR = 1.36; 95% CI: 1.02-1.82, respectively but were not at risk for increased hospitalizations. Factors associated with unemployment included lower level of education, older age, female
Menezes Paulo R.
Full Text Available High mortality rates among those suffering from schizophrenia and related psychoses have been consistently described in developed societies. However, to date there is a lack of data on this matter in Brazil. In order to examine this issue, a prospective 2-year follow-up study was carried out in S. Paulo. The sample consisted of 120 consecutive admissions to psychiatric hospitals in a defined catchment area, aged 18 to 44 years old, with clinical diagnoses of non-affective functional psychoses according to the ICD-9. After 2 years, 116 (96.7% subjects were traced. During the study period there were 7 deaths (6.0% of those traced, 5 (4.3% due to suicide. All but one of the suicides occurred in the first year after discharge from hospital. Age and sex Standardised Mortality Ratios (relative to rates for the population of the city of Sao Paulo were 8.4 for overall mortality (95% confidence interval: 4.0-15.9 and 317.9 for deaths due to suicide (95% confidence interval: 125.2-668.3. These results are in agreement with previous studies, and show that in Brazil non-affective functional psychoses are life-threatening illnesses, which need adequate care, particularly when patients go back to live in the community after hospital discharge.
Cambiano, Valentina; Bertagnolio, Silvia; Jordan, Michael R
the prevalence of resistance in ART-naive people is reaching alerting levels. Whereas adherence counseling has to be an integral component of any treatment program, it is still unclear which threshold of transmitted drug resistance (TDR) should trigger additional targeted public health actions and which action...... is the most cost-effective. Mathematical models can contribute to answer these questions. In order to estimate the potential long-term impact of TDR on mortality in people on ART we used the Synthesis transmission model. TDR is predicted to have potentially significant impact on future HIV mortality....... It is critical to remain vigilant over transmission of drug-resistant HIV....
Harpin, V; Mazzone, L; Raynaud, J P; Kahle, J; Hodgkins, P
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.
Jitendra Nath Pal
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.
Huete, John M.; Kurtz, Patricia F.
Analog functional analyses (FAs) are commonly used to assess factors that maintain problem behavior of individuals with intellectual disabilities. These analyses are usually conducted by trained staff in clinic settings. However, recent research suggests that FAs conducted by unfamiliar individuals, such as hospital or clinic staff, may result in…
Preceding the yearly operating program, a preoperative grouped outpatient clinic is run. At this time patients selected for THR filled out the questionnaire, possibly a second time. Patients who had completed the questionnaire twice were asked whether their pain or functional impairment had changed since the previous.
Results: The mean Barthel Index scores on admission and at discharge were 58.85 and 81.59 respectively. A significant improvement was noted in the ... It further underscores the administration of a functional rating scale on admission in order to aggressively manage activity limitations. Key words: stroke, activity limitations, ...
18.2%) and Dandy Walker cyst (18.2%). 162 (81%) of the patients had surgical intervention which included shunts (92.6%), drains (0.6%), therapeutic aspiration (0.6%) and endoscopic third ventriculostomy (6.2%). Good functional recovery ...
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.
Freire, Marcia; Neto, Miguel Sabino; Garcia, Elvio Bueno; Quaresma, Marina Rodrigues; Ferreira, Lydia Masako
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
Wojtalik, Jessica A; Smith, Matthew J; Keshavan, Matcheri S; Eack, Shaun M
Individuals with schizophrenia are burdened with impairments in functional outcome, despite existing interventions. The lack of understanding of the neurobiological correlates supporting adaptive function in the disorder is a significant barrier to developing more effective treatments. This research conducted a systematic and meta-analytic review of all peer-reviewed studies examining brain-functional outcome relationships in schizophrenia. A total of 53 (37 structural and 16 functional) brain imaging studies examining the neural correlates of functional outcome across 1631 individuals with schizophrenia were identified from literature searches in relevant databases occurring between January, 1968 and December, 2016. Study characteristics and results representing brain-functional outcome relationships were systematically extracted, reviewed, and meta-analyzed. Results indicated that better functional outcome was associated with greater fronto-limbic and whole brain volumes, smaller ventricles, and greater activation, especially during social cognitive processing. Thematic observations revealed that the dorsolateral prefrontal cortex, anterior cingulate, posterior cingulate, parahippocampal gyrus, superior temporal sulcus, and cerebellum may have role in functioning. The neural basis of functional outcome and disability is infrequently studied in schizophrenia. While existing evidence is limited and heterogeneous, these findings suggest that the structural and functional integrity of fronto-limbic brain regions is consistently related to functional outcome in individuals with schizophrenia. Further research is needed to understand the mechanisms and directionality of these relationships, and the potential for identifying neural targets to support functional improvement. © The Author 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Full Text Available Background. Many studies have reported on the surgical outcomes of soft tissue sarcoma. However, there was no longitudinal cohort study. Because time is the most valuable factor for functional recovery, adjusting time value was the key for finding the causal relationship between other risk factors and postoperative function. Therefore, existing cross-sectional studies can neither fully explain the causal relationship between the risk factors and the functional score nor predict functional recovery. The aim of this study was to determine important predictive factors that affect postoperative functional outcomes and longitudinal changes in functional outcomes in patients who had undergone limb-sparing surgery (LSS for soft tissue sarcoma (STS. Methods. Between January 2008 and December 2014, we retrospectively enrolled 150 patients who had undergone LSS for STS and had been assessed for postoperative functional outcomes with questionnaires. To evaluate functional outcomes, we used the Musculoskeletal Tumor Society (MSTS score and Toronto Extremity Salvage Score (TESS. Multivariate generalized estimating equation (GEE analysis was used to identify the predictive factors, including size, stage, and anatomic location of tumor, bone resection, flap reconstruction, age, and time after surgery. Each continuous variable such as age and time after surgery was explored for statistically significant cutoff points using the Wilcoxon rank sum test. Results. Functional scores significantly improved until the second year after surgery and plateaued for the rest of the 5-year period. Age p<0.0001, bone resection p=0.0004, and time after surgery p<0.0001 were identified as significant predictive factors. The functional score was significantly higher in patients younger than 47 years old. Conclusions. Functional outcomes can improve until the second year after surgery. Patients who were older than 47 and underwent bone resection may have poor final functional
Ramage, Lisa; Yen, Clarence; Qiu, Shengyang; Simillis, Constantinos; Kontovounisios, Christos; Tekkis, Paris; Tan, Emile
The aim of this study was to compare functional and quality of life data in patients with increasing grades of obstetric anal sphincter injury (OASI) presenting to a tertiary colorectal pelvic floor clinic within 24 months of delivery. Prospective data were collected from the patients for the period 2009-2016 and included data on functional outcomes and motor anorectal manometry parameters. The instruments used for the evaluation of functional outcomes were the Birmingham Bowel and Urinary Symptoms Questionnaire, the Wexner Incontinence Score, Short Form 36, and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. OASI grade of injury was based on the postdelivery endoanal ultrasound scan. Data from patients with a grade 3a, 3b, 3c or 4 OASI were compared using one-way ANOVA for parametric data and the Kruskal-Wallis test for nonparametric data overall and for separate time periods (3-6 months, 6-12 months, 12-24 months). Functional patient data were available in 177 patients: 29 with grade 3a, 55 with grade 3b, 77 with grade 3c and 16 with grade 4 OASI. There was no discernible trend in worsening function with increasing severity of OASI overall, nor for the specified time periods of 3-6 months 58 patients), 6-12 months (85 patients) or 12-24 months (18 patients). Our series demonstrated no significant differences in functional outcomes or quality of life in patients with different OASI grades. Longer-term follow-up is required to ascertain any later functional differences which may become apparent with time.
Mocroft, Amanda; Ryom, Lene; Begovac, Josip
OBJECTIVES: To determine the relationship between measures of renal function [current estimated glomerular filtration rate (eGFR) and proportion of follow-up with a low eGFR (%FU ≤60 ml/min)] and fatal/ nonfatal AIDS, non-AIDS events and all-cause mortality. DESIGN: An observational, longitudinal...... incidence of AIDS events (95% CI 1.06-1.24). CONCLUSION: Both current eGFR and %FU of 60 ml/min or less were associated with death and non-AIDS events in HIV-positive persons. Our findings highlight the association between underlying renal dysfunction and morbidity and mortality in HIV infection, although...
Donati, D.; D’Apote, G.; Boschi, M.; Cevolani, L.; Benedetti, M. G.
Background The implantation of a saddle prosthesis after resection of a pelvic tumor has been proposed as a simple method of reconstruction that provides good stability and reduces the surgical time, thus limits the onset of intraoperative complications. There are no studies in the literature of patients evaluated using gait analysis after being implanted with a saddle prosthesis. The present study is a retrospective case review aimed at illustrating long-term clinical and functional findings...
Nawoczenski, Deborah A; Barske, Heather; Tome, Joshua; Dawson, Laura K; Zlotnicki, Jason P; DiGiovanni, Benedict F
Gastrocnemius recession has emerged as a viable intervention for patients with recalcitrant foot and ankle disorders associated with isolated gastrocnemius contracture. The purpose of this case-control study was to investigate the effects of an isolated gastrocnemius recession on pain, patient-reported function, and strength in patients with chronic Achilles tendinopathy and an isolated gastrocnemius contracture. Thirteen patients with unilateral Achilles tendinopathy (mean age [and standard deviation], fifty-two ± 7.7 years) who received a gastrocnemius recession and ten matched-control subjects participated. A visual analog scale was used to assess pain, and the Foot and Ankle Ability Measure was used to evaluate patient-reported function in activities of daily living and sports. Patients were asked about their satisfaction with the results of the gastrocnemius recession. Ankle plantar flexion peak torque was assessed at 60°/sec and 120°/sec. Appropriate t tests were used to assess limb symmetry and strength differences between the groups. The mean duration of follow-up was eighteen months (range, twelve to twenty-eight months). Gastrocnemius recession provided significant pain relief (mean preoperative visual analog scale score [and standard deviation], 6.8 ± 1.8; mean follow-up visual analog scale score, 1.4 ± 2.7; p recession provides significant and sustained pain relief for chronic Achilles tendinopathy. Good function can be expected for activities of daily living, but power and endurance activities were more problematic for the Achilles tendinopathy group. Isokinetic strength assessment may not effectively capture patient-reported functional deficits. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.
Chao, Shin Margaret; Donatoni, Giannina; Bemis, Cathleen; Donovan, Kevin; Harding, Cynthia; Davenport, Deborah; Gilbert, Carol; Kasehagen, Laurin; Peck, Magda G
This article provides an example of how Perinatal Periods of Risk (PPOR) can provide a framework and offer analytic methods that move communities to productive action to address infant mortality. Between 1999 and 2002, the infant mortality rate in the Antelope Valley region of Los Angeles County increased from 5.0 to 10.6 per 1,000 live births. Of particular concern, infant mortality among African Americans in the Antelope Valley rose from 11.0 per 1,000 live births (7 cases) in 1999 to 32.7 per 1,000 live births (27 cases) in 2002. In response, the Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs partnered with a community task force to develop an action plan to address the issue. Three stages of the PPOR approach were used: (1) Assuring Readiness; (2) Data and Assessment, which included: (a) Using 2002 vital records to identify areas with the highest excess rates of feto-infant mortality (Phase 1 PPOR), and (b) Implementing Infant Mortality Review (IMR) and the Los Angeles Mommy and Baby (LAMB) Project, a population-based study to identify potential factors associated with adverse birth outcomes. (Phase 2 PPOR); and (3) Strategy and Planning, to develop strategic actions for targeted prevention. A description of stakeholders' commitments to improve birth outcomes and monitor infant mortality is also given. The Antelope Valley community was engaged and ready to investigate the local rise in infant mortality. Phase 1 PPOR analysis identified Maternal Health/Prematurity and Infant Health as the most important periods of risk for further investigation and potential intervention. During the Phase 2 PPOR analyses, IMR found a significant proportion of mothers with previous fetal loss (45%) or low birth weight/preterm (LBW/PT) birth, late prenatal care (39%), maternal infections (47%), and infant safety issues (21%). After adjusting for potential confounders (maternal age, race, education level, and marital status), the
Ye, Ying; Desai, Ravi; Vargas Abello, Lina M; Rajeswaran, Jeevanantham; Klein, Allan L; Blackstone, Eugene H; Pettersson, Gösta B
The study objective was to investigate whether, in patients undergoing surgery for degenerative mitral valve disease, associated right ventricular remodeling and dysfunction are stronger determinants of preoperative organ dysfunction and prognosis than functional tricuspid regurgitation. From January 2001 to January 2011, 4197 patients underwent primary mitral valve surgery for degenerative valve disease at Cleveland Clinic. Using a quasi-experimental enriched study design, 781 patients were randomly selected within each grade of functional tricuspid regurgitation. Renal function was assessed by glomerular filtration rate and blood urea nitrogen, and hepatic function was assessed by Model for End-stage Liver Disease (MELD) score. Preoperative and postoperative right ventricular morphology and function were measured de novo on stored echocardiographic images. To assess survival, 3471 patient-years of follow-up data were available for analysis. Several preoperative right ventricular variables, but not functional tricuspid regurgitation grade (P>.05), were associated with preoperative renal and hepatic dysfunction, but neither was associated with early mortality (.2), was among the risk factors for later mortality. Postoperative unadjusted right ventricular function, but not functional tricuspid regurgitation grade (P≥.2), was associated with both early (P=.04) and later (P=.01) mortality, but in multivariable analysis appeared to be a surrogate for worse preoperative condition. Together with patient comorbidities and operative factors, right ventricular morphology and function are associated more strongly with preoperative organ dysfunction and prognosis than is functional tricuspid regurgitation severity in patients undergoing surgery for degenerative mitral valve disease. Our previous study showed that tricuspid valve repair remains the most effective treatment to improve right ventricular function. Copyright © 2014 The American Association for Thoracic Surgery
Full Text Available Xin Wang,1,* Shikui Li2,* 1Intensive Care Unit, 2Cardiothoracic Surgery, Daqing Oilfield General Hospital, Daqing, Heilongjiang, People’s Republic of China *These authors contributed equally to this work Aim: As a primary cause of death not only in Western countries but also in the People’s Republic of China, sepsis is diagnosed as abnormal organ functions as a result of a disordered response to a severe infection. This study was designed to assess the effect of small-dose levosimendan without a loading dose on mortality rates and organ functions in Chinese elderly patients with sepsis.Methods: Following a prospective, randomized, and double-blinded design, 240 Chinese elderly patients with sepsis shock were admitted to the intensive care unit (ICU. All patients were randomly and evenly assigned into a levosimendan group (number of patients =120 and a control group (number of patients =120. The control group underwent standard care, and the levosimendan group was administered levosimendan in addition to standard care.Results: All participants, comprising 134 males (55.8% and 106 females (44.2%, were 70 (67–73 years old. Baseline characteristics, preexisting illnesses, initial infections, organ failures, and additional agents and therapies showed no significant difference between the two groups (P>0.05 for all. There were no significant differences in mortality rates at 28 days, at ICU discharge, and at hospital discharge between the two groups (P>0.05 for all. The number of days of ICU and hospital stay in the levosimendan group was significantly less than for those in the control group (P<0.05 for all. Mean daily total sequential organ failure assessment score and all organ scores except the cardiovascular scores showed no significant difference between the two groups (P>0.05 for all. Cardiovascular scores in the levosimendan group were significantly higher than those in the control group (P<0.05 for all.Conclusion: Small
Birmingham, Patrick; Muller, Mark; Wickiewicz, Thomas; Cavanaugh, John; Rodeo, Scott; Warren, Russell
Rupture of the proximal origin of the hamstrings leads to pain, weakness, and a debilitating decrease in physical activity. Repair of these injuries should be based on the expectation that these deficits can be addressed. The goal of this study was to objectively evaluate the efficacy of repair of proximal hamstring avulsions. Thirty-four patients were identified retrospectively to have a complete rupture of the proximal origin of the hamstrings based on the presence of a bowstring sign and the results of magnetic resonance imaging (MRI).Patients were contacted for follow-up evaluation to fill out a subjective questionnaire, to undergo functional testing, and to undergo isokinetic testing on a Cybex dynamometer. Twenty-three patients were evaluated. There were nine acute and fourteen chronic repairs, and the average period of follow-up was 43.3 months. Twenty-one of twenty-three patients reported returning to activity at an average of 95% of their pre-injury activity level at an average of 9.8 months. Eighteen patients reported excellent results; four, good results; and one, fair results. Hamstring strength was an average of 93% and 90% of that in the uninvolved limb at 240° per second and 180° per second, respectively. The hamstrings-to-quadriceps ratio was 56% for 240° per second and 48% at 180° per second. Hamstring endurance was an average of 81% and 91% of the nonoperative limb at 240° per second and 180° per second, respectively. Postoperative quadriceps strength and endurance were positively correlated with return to pre-injury level of activity (r = 0.6, p hamstring tendon yields good subjective and objective functional results with minimal complications. Overall, patients are satisfied with surgical repair and experience return of functional activity with minimal postoperative weakness.
Baughman, Penelope; Marott, Jacob L; Lange, Peter
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...
Bertolin, Andy; Lionello, Marco; Russo, Simone; Rizzotto, Giuseppe; Lucioni, Marco
To evaluate the effect of preepiglottic space (PES) dissection in the endoscopic supraglottic laryngectomy (ESL). A retrospective cohort study. We retrospectively compared 15 patients who underwent ESL with 15 patients matched for clinical stage who underwent open partial horizontal laryngectomy (OPHL). The functional outcomes were assessed in terms of hospital stay; need for nasal feeding tube (NFT) and tracheostomy, as well as duration of their use; postoperative complications; aspiration pneumonia rates; voice quality; and dysphagia. Among the ESL cases, combined dissection of the epiglottis and PES (type III) had a negative impact on functional outcomes. ESL patients experienced shorter hospital stays, as well as shorter use of NFT and tracheostomy, than patients who had OPHL. Combined dissection of the epiglottis and PES (ESL type III) negatively affected functional outcome in patients undergoing ESL, a procedure generally related to significantly better functional outcomes than OPHL type I. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Roussel, Jean C; Baron, Olivier; Périgaud, Christian; Bizouarn, Philippe; Pattier, Sabine; Habash, Oussama; Mugniot, Antoine; Petit, Thierry; Michaud, Jean L; Heymann, Marie Françoise; Treilhaud, Michèle; Trochu, Jean N; Gueffet, Jean P; Lamirault, Guillaume; Duveau, Daniel; Despins, Philippe
The study was conducted to determine the long-term outcome of patients who underwent heart transplantation 15 to 20 years ago, in the cyclosporine era, and identify risk factors for death. A retrospective analysis was done of 148 patients who had undergone heart transplantation between 1985 and 1991 at a single center. Operative technique and immunosuppressive treatment were comparable in all patients. Actuarial survival rates were 75% (n = 111), 58% (n = 86), and 42% (n = 62) at 5, 10, and 15 years, respectively. The mean follow-up period was 12.1 +/- 5.6 years for patients who survived more than 3 months after transplantation (n = 131). The major causes of death were malignancy (35.8%) and cardiac allograft vasculopathy (24.7%). No death related to acute rejection was reported after the first month of transplantation. Graft coronary artery disease was detected on angiography in 66 (50.3%), and 7 (5.3%) had retransplantation. Malignancies developed in 131 patients (48.1%), including skin cancers in 31 (23.6%), solid tumors in 26 (19.8%), and hematologic malignancies in 14 (10.6%). Severe renal function requiring dialysis or renal transplantation developed in 27 patients (20.6%). By multivariable analysis, the only pre-transplant risk factor found to affect long-term survival was a history of cigarette use (p transplantation remains excellent in the cyclosporine era. Controlling acute allograft rejection can be achieved but seems to carry a high rate of cancers and renal dysfunction. History of cigarette use affects significantly long-term survival in our study.
Pella, Jeffrey E; Drake, Kelly L; Tein, Jenn-Yun; Ginsburg, Golda S
This study examined the impact of a selective anxiety prevention program for offspring of clinically anxious parents on three domains of child functioning: (1) social, (2) familial, and (3) emotional/behavioral. Dyads were randomized into either the Coping and Promoting Strength program (CAPS; n = 70) or Information Monitoring (IM; n = 66) comparison group. Multi-informant assessments were conducted at baseline, post intervention, and 6 and 12 months follow-ups. Random effects mixed models under the linear growth modeling (LGM) framework was used to assess the impact of CAPS on growth trajectories. Over time, children in the CAPS group had significantly lower anxiety, anxious/depressed symptoms, and lower total behavior problems (parent report), compared to children in IM group. The intervention did not impact other domains assessed (e.g., social functioning), which may be due to "floor effects" on these measures. Longitudinal follow-up data is needed to provide valuable information about this high risk population.
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: email@example.com [Division of Radiation Oncology, St Jude Children' s Research Hospital, Memphis, Tennessee (United States)
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.
Landau, Efrat; Boop, Frederick A.; Conklin, Heather M.; Wu, Shengjie; Xiong, Xiaoping; Merchant, Thomas E.
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
Full Text Available BACKGROUND: A comprehensive analysis of sex-specific differences in the characteristics, treatment, and outcomes of individuals with end-stage renal disease undergoing dialysis might reveal treatment inequalities and targets to improve sex-specific patient care. Here we describe hemodialysis prevalence and patient characteristics by sex, compare the adult male-to-female mortality rate with data from the general population, and evaluate sex interactions with mortality. METHODS AND FINDINGS: We assessed the Human Mortality Database and 206,374 patients receiving hemodialysis from 12 countries (Australia, Belgium, Canada, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, the UK, and the US participating in the international, prospective Dialysis Outcomes and Practice Patterns Study (DOPPS between June 1996 and March 2012. Among 35,964 sampled DOPPS patients with full data collection, we studied patient characteristics (descriptively and mortality (via Cox regression by sex. In all age groups, more men than women were on hemodialysis (59% versus 41% overall, with large differences observed between countries. The average estimated glomerular filtration rate at hemodialysis initiation was higher in men than women. The male-to-female mortality rate ratio in the general population varied from 1.5 to 2.6 for age groups <75 y, but in hemodialysis patients was close to one. Compared to women, men were younger (mean = 61.9 ± standard deviation 14.6 versus 63.1 ± 14.5 y, were less frequently obese, were more frequently married and recipients of a kidney transplant, more frequently had coronary artery disease, and were less frequently depressed. Interaction analyses showed that the mortality risk associated with several comorbidities and hemodialysis catheter use was lower for men (hazard ratio [HR] = 1.11 than women (HR = 1.33, interaction p<0.001. This study is limited by its inability to establish causality for the observed sex
Schomaker, Michael; Davies, Mary-Ann; Malateste, Karen; Renner, Lorna; Sawry, Shobna; N’Gbeche, Sylvie; Technau, Karl-Günter; Eboua, François; Tanser, Frank; Sygnaté-Sy, Haby; Phiri, Sam; Amorissani-Folquet, Madeleine; Cox, Vivian; Koueta, Fla; Chimbete, Cleophas; Lawson-Evi, Annette; Giddy, Janet; Amani-Bosse, Clarisse; Wood, Robin; Egger, Matthias; Leroy, Valeriane
Background There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modelling analysis in children aged 1–5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups and regions. Methods ART-naïve children of age 12–59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation. Results About one quarter of the 5826 included children was from West Africa (24.6%). The median (first; third quartile) CD4% at the first visit was 16% (11%;23%), the median weight-for-age z-scores and height-for-age z-scores were −1.5 (−2.7; −0.6) and −2.5 (−3.5; −1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count<750 cells/mm3 or CD4%<25% was 0.2% (95%CI: −0.2%;0.3%), and the difference in the mean height-for-age z-scores of those who survived was −0.02 (95%CI: −0.04;0.01). Younger children aged 1–2 and children in West Africa had worse outcomes. Conclusions Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, though we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below750/25%. PMID:26479876
Bommer, Jürgen; Locatelli, Francesco; Satayathum, Sudtida; Keen, Marcia L; Goodkin, David A; Saito, Akira; Akiba, Takashi; Port, Friedrich K; Young, Eric W
Experimental and some clinical data suggest that metabolic acidosis contributes to poor nutritional status, a strong predictor for mortality in hemodialysis patients. However, recent cross-sectional studies indicate that severe predialysis metabolic acidosis is associated with a greater normalized protein catabolic rate (nPCR) and greater serum albumin levels. Given this controversy, we analyzed data from the Dialysis Outcomes and Practice Pattern Study (DOPPS) for associations between predialysis serum bicarbonate and albumin concentrations, nPCR, and patient risk for mortality and hospitalization. Data from more than 7,000 representative and randomly selected hemodialysis DOPPS patients from France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States were analyzed. Serum bicarbonate (total CO2 ) levels predialysis were corrected to the midweek interdialytic interval. The midweek predialysis serum bicarbonate level averaged 21.9 mEq/L (mmol/L) and correlated inversely with nPCR, serum albumin, and serum phosphorus values. Before and after adjusting for 15 comorbidities, nutrition, and equilibrated Kt/V, a U-curve best represented the association between predialysis serum bicarbonate level and risk for mortality or hospitalization. Patients with midweek predialysis serum bicarbonate levels of 20.1 to 21.0 mEq/L (mmol/L) faced the lowest risk for mortality, whereas those with bicarbonate levels of 21.1 to 22.0 mEq/L faced the lowest risk for hospitalization. Both high (>27 mEq/L) and low (nutritional status and lower relative risk for mortality or hospitalization than is observed in patients with normal ranges of midweek predialysis serum bicarbonate concentration (approximately 24 mEq/L) or severe acidosis (<16 mEq/L).
Grupper, Avishay; Zhao, Yanjun M; Sajgalik, Pavol; Joyce, Lyle D; Park, Soon J; Pereira, Naveen L; Stulak, John M; Burnett, John C; Edwards, Brooks S; Daly, Richard C; Kushwaha, Sudhir S; Schirger, John A
Neurohormonal blockade drug therapy (NHBDT) is the cornerstone therapy in heart failure (HF) management for promoting reverse cardiac remodeling and improving outcomes. It's utility in left ventricular assist device (LVAD) supported patients remains undefined. Sixty-four patients who received continuous flow LVAD at our institution were retrospectively reviewed and divided into 2 groups: no-NHBDT group (n = 33) received LVAD support only and NHBDT group (n = 31) received concurrent NHBDT based on the clinical judgment of the attending physicians. Cardiac remodeling (echocardiographic parameters and biomarkers) and clinical outcome (functional status, HF-related hospital readmissions, and mortality) data were collected. A statistically significant increase in ejection fraction, decrease in LV end-diastolic diameter index and LV mass index, and a sustained reduction in N-terminal pro B-type natriuretic peptide (NTproBNP) were observed in the NHBDT group at 6 months after LVAD implant (p <0.05). NHBDT-treated patients experienced significantly greater improvement in New York Heart Association functional classification and 6-minute-walk distance throughout the study. The combined end point of cardiovascular death or HF hospitalization was significantly reduced in patients receiving NHBDT (p = 0.013) associated primarily with a 12.1% absolute reduction in HF-related hospitalizations (p = 0.046). In conclusion, NHBDT in LVAD-supported patients is associated with a significant reversal in adverse cardiac remodeling and a reduction in morbidity and mortality compared with LVAD support alone. Copyright © 2016 Elsevier Inc. All rights reserved.
Little, Dianne; Johnson, Stephen; Hash, Jonathan; Olson, Steven A.; Estes, Bradley T.; Moutos, Franklin T.; Lascelles, B. Duncan X.; Guilak, Farshid
Background The hip is one of the most common sites of osteoarthritis in the body, second only to the knee in prevalence. However, current animal models of hip osteoarthritis have not been assessed using many of the functional outcome measures used in orthopaedics, a characteristic that could increase their utility in the evaluation of therapeutic interventions. The canine hip shares similarities with the human hip, and functional outcome measures are well documented in veterinary medicine, pr...
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.
Chen, Yung-Tai; Shih, Chia-Jen; Ou, Shuo-Ming; Hung, Szu-Chun; Lin, Chi-Hung; Tarng, Der-Cherng
The association between periodontal disease and chronic kidney disease in older people is controversial, and evidence for a causal link between kidney function decline and subsequent mortality risk is limited. Longitudinal, observational, community-based cohort study. Participants were citizens 65 years or older who received the Taipei City Government-sponsored Annual Elderly Health Examination Program during 2005 to 2010, including dental status assessment and biochemical examinations. Participants with periodontal disease defined by the World Health Organization Community Periodontal Index of Treatment Need criteria. All-cause and cardiovascular mortality and estimated glomerular filtration rate (eGFR) decline ≥ 30% over 2 years. Of 100,263 study participants, 13,749 (13.7%) had periodontal disease. In a mean follow-up of 3.8 years, all-cause and cardiovascular mortality rates in those with periodontal disease (11.5% and 2.6%, respectively) were higher compared with those without periodontal disease (6.7% and 1.6%, respectively). After adjustment for demographic characteristics, comorbid conditions, and biochemistry data, adjusted HRs for all-cause and cardiovascular mortality were 1.34 (95% CI, 1.26-1.42) and 1.25 (95% CI, 1.13-1.41), respectively. The frequency of eGFR decline ≥ 30% over 1-, 2-, and 3-years' follow-up in those with periodontal disease was 1.8%, 3.7%, and 4.0%, respectively. In a logistic regression model, adjusted ORs of the detrimental effect of periodontal disease on 30% eGFR decline in participants over 1-, 2-, or 3-years' follow-up were 1.03 (95% CI, 0.85-1.25), 1.62 (95% CI, 1.41-1.87), and 1.59 (95% CI, 1.37-1.86), respectively. In subgroup analyses according to age, sex, and comorbid conditions, risks for eGFR decline and mortality remained consistent. Results may not be generalizable to other non-Asian ethnic populations. The results indicate that periodontal disease is a risk factor for all-cause and cardiovascular mortality and e
Longitudinal associations between body composition, sarcopenic obesity and outcomes of frailty, disability, institutionalisation and mortality in community-dwelling older men: The Concord Health and Ageing in Men Project.
Hirani, Vasant; Naganathan, Vasi; Blyth, Fiona; Le Couteur, David G; Seibel, Markus J; Waite, Louise M; Handelsman, David J; Cumming, Robert G
to explore the longitudinal associations between body composition measures, sarcopenic obesity and outcomes of frailty, activities of daily living (ADL) and instrumental ADL (IADL) disability, institutionalisation and mortality. men aged ≥ 70 years (2005-07) from the Concord Health and Ageing in Men Project were assessed at baseline (n = 1,705), 2 (n = 1,366) and 5 years (n = 954). The main outcome measures were frailty (adapted Fried criteria), ADL, including personal care and mobility and IADL disability (ability to perform tasks for independent living), institutionalisation and mortality. The Foundation for the National Institutes of Health cut-points were used for low muscle mass: appendicular lean mass (ALM):Body Mass Index (BMI) ratio (ALMBMI) obesity was defined as >30% fat. Generalised estimating equations were used to examine the longitudinal associations between the independent variables (obesity alone, low muscle mass and sarcopenic obesity) and frailty, ADL and IADL disability. in unadjusted, age adjusted and fully adjusted analysis, men with low muscle mass showed increased risk of frailty and IADL disability. In fully adjusted analysis, men with sarcopenic obesity had an increased risk of frailty (odds ratio (OR): 2.00 (95% confidence of interval (CI): 1.42, 2.82)) ADL disability (OR: 1.58 (95% CI: 1.12, 2.24)) and IADL disability (OR: 1.36 (95% CI: 1.05, 1.76)). Obesity alone was protective for institutionalisation (OR: 0.51 (95% CI: 0.31, 0.84)) but was not associated with any other outcomes. low muscle mass and sarcopenic obesity were associated with poor functional outcomes, independent of confounders. This would suggest that future trials on frailty and disability prevention should be designed to intervene on both muscle mass and fat mass. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: firstname.lastname@example.org
Verbeke, F.; Biesen, W. Van; Honkanen, E.; Wikstrom, B.; Jensen, P.B.; Krzesinski, J.M.; Rasmussen, M.; Vanholder, R.; Rensma, P.L.; Hamersvelt, H.W. van; et al.,
BACKGROUND AND OBJECTIVES: Radiographic calcification and arterial stiffness each individually are predictive of outcome in dialysis patients. However, it is unknown whether combined assessment of these intermediate endpoints also provides additional predictive value. DESIGN, SETTING, PARTICIPANTS,
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.
Sun, Hui-Yan; Li, Qiang; Chen, Xi-Ping; Tao, Lu-Yang
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.
Hayder Kadhim Zghair
Full Text Available The Main advantage of this work is to concentrate on the outcome of the function as a function of , ( . This type of work has been studied deeply by [HIL , 12] . Here , we see that the outcomes of the function are depending on the of the function . More deeply , ' s value will appear as a matrix of zero triangle values depending 0n the positive of on the real line .
Full Text Available Aastha Sethi1, Michelle M Estrella1, Richard Ugarte2, Mohamed G Atta1 1Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA; 2University of Maryland Medical Center, Department of Medicine, Baltimore, MD, USA Abstract: The Model for End-Stage Liver Disease (MELD score incorporates serum creatinine and was introduced to facilitate allocation of orthotopic liver transplantation (LT. The objective is to determine the impact of MELD and kidney function on all-cause mortality. Among LTs performed in a tertiary referral hospital between 1995 and 2009, 419 cases were studied. Cox proportional hazards models were constructed to estimate the hazard ratios (HR and 95% confidence intervals (CI for death. Over mean follow-ups of 8.4 and 3.1 years during the pre-MELD and MELD era, 57 and 63 deaths were observed, respectively. Those transplanted during the MELD era had a higher likelihood of hepatorenal syndrome (8% vs 2%, P < 0.01, lower kidney function (median estimated glomerular filtration rate [eGFR] 77.8 vs 92.6 mL/min/1.73 m2, P < 0.01, and more pretransplantation renal replacement therapy (RRT (5% vs 1%; P < 0.01. All-cause mortality risk was similar in the MELD vs the pre-MELD era (HR: 0.98, 95% CI: 0.58–1.65. The risk of death, however, was nearly 3-fold greater (95% CI: 1.14–6.60 among those requiring pre-transplant RRT. Similarly, eGFR < 60 mL/min/1.73 m2 post-transplant was associated with a 2.5-fold higher mortality (95% CI: 1.48–4.11. The study suggests that MELD implementation had no impact on all-cause mortality post-LT. However, the need for pre-transplant RRT and post-transplant kidney dysfunction was associated with a more than 2-fold greater risk of subsequent death. Keywords: eGFR, mortality, MELD, liver transplant
David J McLernon
Full Text Available BACKGROUND: Although liver function tests (LFTs are routinely measured in primary care, raised levels in patients with no obvious liver disease may trigger a range of subsequent expensive and unnecessary management plans. The aim of this study was to develop and validate a prediction model to guide decision-making by general practitioners, which estimates risk of one year all-cause mortality in patients with no obvious liver disease. METHODS: In this population-based historical cohort study, biochemistry data from patients in Tayside, Scotland, with LFTs performed in primary care were record-linked to secondary care and prescription databases to ascertain baseline characteristics, and to mortality data. Using this derivation cohort a survival model was developed to predict mortality. The model was assessed for calibration, discrimination (using the C-statistic and performance, and validated using a separate cohort of Scottish primary care practices. RESULTS: From the derivation cohort (n = 95 977, 2.7% died within one year. Predictors of mortality included: age; male gender; social deprivation; history of cancer, renal disease, stroke, ischaemic heart disease or respiratory disease; statin use; and LFTs (albumin, transaminase, alkaline phosphatase, bilirubin, and gamma-glutamyltransferase. The C-statistic for the final model was 0.82 (95% CI 0.80-0.84, and was similar in the validation cohort (n = 11 653 0.86 (0.79-0.90. As an example of performance, for a 10% predicted probability cut-off, sensitivity = 52.8%, specificity = 94.0%, PPV = 21.0%, NPV = 98.5%. For the model without LFTs the respective values were 43.8%, 92.8%, 15.6%, 98.1%. CONCLUSIONS: The Algorithm for Liver Function Investigations (ALFI is the first model to successfully estimate the probability of all-cause mortality in patients with no apparent liver disease having LFTs in primary care. While LFTs added to the model's discrimination and sensitivity, the
Mortini, Pietro; Gagliardi, Filippo; Bailo, Michele; Spina, Alfio; Parlangeli, Andrea; Falini, Andrea; Losa, Marco
Quality of life of craniopharyngioma patients can be severely impaired by derangement of hypothalamic function. A classification, taking into account preoperative hypothalamic damage, evaluated by magnetic resonance imaging (MRI), and correlating it with postoperative weight change is still missing in the literature. The aim of our study is to identify objective radiological criteria as preoperative prognostic factors for hypothalamic damage. Pre- and post-operative MRI and clinical data of 47 patients, treated at our Institution for craniopharyngioma, were retrospectively analyzed, based on radiological variables, identified as prognostic factor for hypothalamic involvement. Main factors associated with postoperative obesity were hypothalamic hyperintensity in T2-weighted/FLAIR imaging (p < 0.033), mammillary body involvement according to Müller classification (p < 0.020), unidentifiable pituitary stalk (p < 0.001), dislocated chiasm (p < 0.038), either not visible infundibular recess (p < 0.019) or unrecognizable supra-optic recess (p < 0.004), and retrochiasmatic tumor extension (p < 0.019). Accordingly, postoperative hypothalamic syndrome was associated with peritumoral edema in T2-weighted/FLAIR images (p < 0.003), unidentifiable hypothalamus (p < 0.024), hypothalamic compression (p < 0.006), fornix displacement (p < 0.032), and unrecognizable supra-optic recess (p < 0.031). Ultimately, variables identified as predictive factors of postoperative hypothalamic syndrome were the degree of hypothalamic involvement according to the classification described by Sainte-Rose and Puget (p < 0.002; grade 0 vs 2 p < 0.001), Van Gompel (p < 0.002; grade 0 vs 1, p < 0.027; and grade 0 vs 2, p < 0.002), and Muller (p < 0.006; grade 0 vs 1, p < 0.05; and grade 0 vs 2, p < 0.004). The identification of these predictive factors will help to define and score the preoperative hypothalamic involvement in craniopharyngioma patients.
Brandenburg, Jacob B; Kapron, Ashley L; Wylie, James D; Wilkinson, Brandon G; Maak, Travis G; Gonzalez, Cristian D; Aoki, Stephen K
Arthroscopic release of the iliopsoas tendon may alleviate pain associated with internal snapping hip, but previous reports of physical function, hip strength, and muscle atrophy after surgery are mixed. The hips of patients who underwent arthroscopic iliopsoas release would demonstrate significantly reduced hip flexion strength and iliopsoas muscle volume when compared with their contralateral hips and the hips of patients who underwent hip arthroscopy without psoas release. Cohort study; Level of evidence, 3. Eighteen patients who underwent hip arthroscopy with iliopsoas release for symptomatic internal snapping hip and concomitant femoroacetabular impingement (FAI) and/or chondrolabral damage (release group) and 18 patients who underwent arthroscopy for FAI and/or chondrolabral damage without iliopsoas release (control group) were evaluated at a mean of 21 months (range, 16-30 months) postoperatively. Magnetic resonance images were performed and segmented to calculate iliopsoas volume. Isometric hip flexion strength was evaluated in the supine and seated positions with a custom testing apparatus. Differences between groups and differences between the operative and nonoperative limbs within groups were compared with unpaired and paired t tests, respectively. In the release group, the iliopsoas muscle of the surgical limb was significantly smaller (288 ± 98 vs 384 ± 113 cm(3), P strength (-19% ± 16% vs -3.9% ± 20%, P = .018) between the operative and contralateral limbs. There were no significant differences in supine strength between limbs or groups (all P > .168). Arthroscopic iliopsoas release results in iliopsoas atrophy with a 25% volume loss and a 19% reduction in seated hip flexion strength. © 2016 The Author(s).
Takahashi, Haruo; Sato, Hiroaki; Nakamura, Hajime; Naito, Yasushi; Umeki, Hiroshi
To examine the correlation between the middle-ear pressure-regulation functions including active eustachian tube (ET) functions and transmucosal gas exchange function, and outcome of tympanoplasty. Seventy five patients (78 ears) with non-cholesteatomatous chronic otitis media with eardrum perforation but without ossicular damage or middle-ear anomaly participated in this study. Before surgery, patency of the ET was examined by applying positive pressure to the middle ear through the eardrum perforation, and then the ET pressure-regulation functions were examined using the inflation-deflation test. Also their transmucosal gas exchange function was evaluated by examining the presence or absence of aeration in the mastoid on the CT before surgery or through the microscope during the surgery. All of them underwent type-I tympanoplasty, and their postoperative conditions including the hearing were followed for more than 6 months. The outcome of the surgery was judged as poor outcome when they had any of the following conditions; more than 20 dB of mean air-bone gap, spontaneous perforation within 6 months, or persistent wet condition including recurrent otorrhea. First, the outcome of all the four ears of which ETs were considered mechanically obstructed was poor. Next, among the remaining 74 ears, none of the three individual parameters, including positive and negative middle-ear pressure-equalizing functions and mastoid aeration, showed significantly positive correlation with the outcome of the surgery, but significantly higher incidence of poor outcome was seen only when all the three parameters were poor. These results indicated that impairment of all the middle-ear pressure-regulation functions was likely to cause poor outcome of tympanoplasty, and also allowed us reconfirm that ears with mechanically obstructed ETs were contraindicated for tympanoplasty. Therefore, assessment of mastoid condition is important as well as the ET function before tympanoplasty.
Oz, Ibrahim Ilker; Altınsoy, Bülent; Serifoglu, Ismail; Sayın, Rasit; Buyukuysal, Mustafa Cagatay; Erboy, Fatma; Akduman, Ece Isin
The aim of this study was to examine the association between right atrium (RA) and right ventricle (RV) diameters on computed tomography (CT) pulmonary angiography in response to acute pulmonary embolism (APE), in addition to 30-day mortality and adverse outcomes in patients with APE. This retrospective study was accepted by the institutional ethics committee. From January 2013 to March 2014, 79 hospitalized adult patients with symptomatic APE were included. Inclusion criteria were a CT pulmonary angiography positive for pulmonary embolism, availability of patient records, and a follow-up of at least 30 days. A review of patient records and images was performed. The maximum diameters of the heart chambers were measured on a reconstructed four-chamber heart view, and the vascular obstruction index was calculated on CT pulmonary angiography. There were statistically significant relationships in both the RA/RV diameter ratio and the RV/left ventricle (LV) diameter ratio between patients with and without adverse outcomes (prights reserved.
Gialanella, Bernardo; Santoro, Raffaele
To address the relationships among motor patterns evaluated according to the limb synergies and functional outcomes in stroke patients and clarify which motor pattern was the most important predictor of functional outcomes. The study was conducted on 208 patients with primary diagnosis of stroke admitted for in-hospital rehabilitation. At entry, the Fugl-Meyer Scale was administered to assess motor function according to limb synergies. Pearson's correlation was used to assess the relationship between variables, and backward stepwise regression analysis was used to identify the outcome determinants. Final functional independence measure (FIM) scores and length of in-hospital stay were the outcome measures. At the end of rehabilitation, motor-FIM scores of patients with extensor and flexor synergies, mixing synergies, and no dependence from the synergies were higher than those of no movements and flexor synergy. Multivariate regression analysis showed that extensor synergy of upper limb was an independent predictor of final motor-FIM, personal care and mobility, extensor synergy of lower limb of locomotion, while mixing synergies of upper limb was an independent predictor of length of in-hospital stay. In stroke rehabilitation, the patients' motor patterns according to the synergies strongly relate with functional outcomes and are important outcome predictors.
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: email@example.com [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)
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
Studer, Patrick; Suhm, Norbert; Wang, Qing; Rosenthal, Rachel; Saleh, Hatem Al-Fadel; Jakob, Marcel
The importance of the greater trochanter and its attached abductor muscles for physiological gait is well accepted. However the influence of a displaced greater trochanter fracture after a pertrochanteric fracture is unknown. The aim of this study is to determine if there is an association between the greater trochanter position and the level of patient mobility following internal fixation of pertrochanteric fractures. One hundred and thirty-three consecutive elderly patients with a median age of 85 (interquartile range [IQR] 79-91) years, who were treated for pertrochanteric fractures at a level I trauma centre, were recruited. AO 31 A3.1 and A3.2 fracture types were excluded from the statistical analysis. Patient mobility was prospectively assessed before the fracture and one year following fracture treatment using the Parker mobility score. In a multivariable analysis, the influence of a displaced greater trochanter on patient mobility at one-year follow-up was assessed. The analysis was adjusted for age, gender, body mass index, Charlson comorbidity index, AO fracture classification, varus-/valgus malposition of the neck-shaft fragments, and Parker mobility score before fracture. Post-operative X-rays were available in 125 patients, out of which 66 (53%) patients were identified with a displaced or migrated greater trochanter. One year mortality rate was 22% (n=27). In the 82 patients who had functional assessment one year post-operatively, the median Parker mobility score before fracture and at one-year follow-up was 7 (IQR 4-9) and 7 (IQR 3-9) in patients without, and 7 (IQR 4-9) and 3 (IQR 2-5) in patients with a displaced greater trochanter. In multivariable analysis, a displaced greater trochanter was significantly associated with a lower Parker mobility score (-1.74, 95% confidence interval -2.37, -1.12, pfractures with a cephalomedullary nail is associated with a poor functional outcome. Greater attention to achieve adequate reduction and stabilisation
Kuhn, Louise; Semrau, Katherine; Ramachandran, Shobana; Sinkala, Moses; Scott, Nancy; Kasonde, Prisca; Mwiya, Mwiya; Kankasa, Chipepo; Decker, Don; Thea, Donald M; Aldrovandi, Grace M
Single-dose nevirapine (SDNVP) for prevention of mother-to-child HIV transmission selects mutations conferring resistance to nonnucleoside reverse transcriptase inhibitor (NNRTI)-based therapy. We investigated mortality and virologic and clinical outcomes after introduction of antiretroviral treatment (ART) among a cohort of women given SDNVP. When ART programs were introduced in 2004 in Lusaka, Zambia, we were completing a trial of infant feeding, which involved following HIV-infected women who received SDNVP between 2001 and 2005. Women still in follow-up or who could be contacted were evaluated for eligibility for ART (CD4 count or=3) and started on NNRTI-based therapy if eligible. We compared mortality in the cohort of women before and after ART access, and examined, among women initiating ART, whether virologic response was better allowing a longer time to elapse between SDNVP and treatment initiation. In the cohort of 872 women, mortality more than halved after ART became available (relative hazard = 0.46, 95% confidence interval: 0.23 to 0.91, P = 0.03). Of 161 SDNVP-exposed women followed on NNRTI-based ART, 70.8% suppressed (viral load 24 months after exposure (chi2 trend P = 0.01). Most SDNVP-exposed women respond well to NNRTI-based therapy, but there was an attenuation of therapy efficacy that persisted to 12 months after exposure. Women should be screened for ART eligibility during pregnancy and started on effective regimens before delivery.
Zhang, Chi; Qin, Ying-Yi; Wei, Xin; Yu, Fei-Fei; Zhou, Yu-Hao; He, Jia
Studies that investigated the association between tea consumption and the risk of major cardiovascular events have reported inconsistent results. We conducted a meta-analysis of prospective observational studies in order to summarize the evidence regarding the association between tea consumption and major cardiovascular outcomes or total mortality. In July 2014, we performed electronic searches in PubMed, EmBase, and the Cochrane Library, followed by manual searches of reference lists from the resulting articles to identify other relevant studies. Prospective observational studies that reported effect estimates, with 95 % confidence intervals (CIs), for coronary heart disease (CHD), stroke, cardiac death, stroke death, or total mortality for more than two dosages of tea consumption were included. A random-effects meta-analysis was performed to determine the risk of major cardiovascular outcomes associated with an increase in tea consumption by 3 cups per day. Of the 736 citations identified from database searches, we included 22 prospective studies from 24 articles reporting data on 856,206 individuals, and including 8,459 cases of CHD, 10,572 of stroke, 5,798 cardiac deaths, 2,350 stroke deaths, and 13,722 total deaths. Overall, an increase in tea consumption by 3 cups per day was associated with a reduced risk of CHD (relative risk [RR], 0.73; 95 % CI: 0.53–0.99; P = 0.045), cardiac death (RR, 0.74; 95 % CI: 0.63–0.86; P < 0.001), stroke (RR, 0.82; 95 % CI: 0.73–0.92; P = 0.001), total mortality (RR, 0.76; 95 % CI: 0.63–0.91; P = 0.003), cerebral infarction (RR, 0.84; 95 % CI: 0.72–0.98; P = 0.023), and intracerebral hemorrhage (RR, 0.79; 95 % CI: 0.72–0.87; P < 0.001), but had little or no effect on stroke mortality (RR, 0.93; 95 % CI: 0.83–1.05; P = 0.260). The findings from this meta-analysis indicate that increased tea consumption is associated with a reduced risk of CHD, cardiac death, stroke, cerebral infarction, and
Reniers, Renate L E P; Lin, Ashleigh; Yung, Alison R; Koutsouleris, Nikolaos; Nelson, Barnaby; Cropley, Vanessa L; Velakoulis, Dennis; McGorry, Patrick D; Pantelis, Christos; Wood, Stephen J
Most individuals at ultra-high risk (UHR) for psychosis do not transition to frank illness. Nevertheless, many have poor clinical outcomes and impaired psychosocial functioning. This study used voxel-based morphometry to investigate if baseline grey and white matter brain densities at identification as UHR were associated with functional outcome at medium- to long-term follow-up. Participants were help-seeking UHR individuals (n = 109, 54M:55F) who underwent magnetic resonance imaging at baseline; functional outcome was assessed an average of 9.2 years later. Primary analysis showed that lower baseline grey matter density, but not white matter density, in bilateral frontal and limbic areas, and left cerebellar declive were associated with poorer functional outcome (Social and Occupational Functioning Assessment Scale [SOFAS]). These findings were independent of transition to psychosis or persistence of the at-risk mental state. Similar regions were significantly associated with lower self-reported levels of social functioning and increased negative symptoms at follow-up. Exploratory analyses showed that lower baseline grey matter densities in middle and inferior frontal gyri were significantly associated with decline in Global Assessment of Functioning (GAF) score over follow-up. There was no association between baseline grey matter density and IQ or positive symptoms at follow-up. The current findings provide novel evidence that those with the poorest functional outcomes have the lowest grey matter densities at identification as UHR, regardless of transition status or persistence of the at-risk mental state. Replication and validation of these findings may allow for early identification of poor functional outcome and targeted interventions. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Lin, Chieh-Hsin; Huang, Chieh-Liang; Chang, Yue-Cune; Chen, Po-Wei; Lin, Chun-Yuan; Tsai, Guochuan E; Lane, Hsien-Yuan
The functional outcome of schizophrenia is affected by multiple factors such as cognitive function and clinical symptoms. The complex relationship among cognitive function (both neuro- and social-cognitions), clinical symptoms, and functional outcome remains unclear. The current study employed structural equation modeling (SEM) to examine whether clinical symptoms mediate the relationship between cognitive function and functional outcome in a large cohort of patients with schizophrenia. Three hundred and two Han-Chinese patients with chronically stable schizophrenia received evaluation of cognitive function (using the Measurement and Treatment Research to Improve Cognition in Schizophrenia [MATRICS] Consensus Cognitive Battery, including 7 domains covering neurocognition and social cognition), clinical symptoms (including positive, negative and depressive symptoms), and functional outcome as assessed by Global Assessment of Functioning Scale and Quality of Life Scale. SEM identified clinical symptoms as a mediator between cognitive function (including all 7 domains of MATRICS) and functional outcome in schizophrenia. The relationship between cognitive function and functional outcome was significant in the basic model. In the mediation model, the link between cognitive function and functional outcome was mediated by clinical symptoms, mainly negative symptoms. This study suggests that clinical symptoms, mainly negative symptoms, mediate the influence of neurocognition and social cognition on functional outcome of schizophrenia. Future studies should explore the impact on other functional outcomes in different ethnicities and various illness phases. Copyright © 2013 Elsevier B.V. All rights reserved.
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
Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco
INTRODUCTION: Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence,
Hatisaru, Vesife; Erbas, Ayhan Kursat
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…
Ong, Chengsi; Lee, Jan Hau; Leow, Melvin K S; Puthucheary, Zudin A
Although more children are surviving critical illness, little is known about long-term physical impairment. This scoping review aims to critically appraise existing literature on functional outcome measurement tools, prevalence, and risk factors for physical impairments in pediatric critical care survivors. PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature, using a combination of MeSH terms and keywords (critical illness, intensive care, and functional outcomes/status). All human studies reporting functional outcomes in children 0-18 years old admitted to the PICU. Non-English language, adult and preterm infant studies were excluded. Three global assessment tools and eight multidimensional measures were used to measure functional outcome in pediatric survivors of critical illness. Rates of acquired functional impairment in a general pediatric intensive care cohort ranged from 10% to 36% at discharge and 10% to 13% after more than 2 years. Risk factors for acquired functional impairment include illness severity, the presence of organ dysfunction, length of ICU stay, and younger age. There is some evidence that physical impairment may be more severe and persistent than psychosocial components. Functional impairment may be persistent in pediatric survivors of critical care. Unfortunately, studies varied largely in measurement timing and tools used. The lack of differentiation between impairment in different functional domains limited the generalizability of data. Further studies using a combination of standardized measures at various time points of the disease process can help establish more comprehensive rates of physical impairment.
Viberg, Bjarke; Kleven, Silje; Hamborg-Petersen, Ellen
as minor and major complications, was retrieved from electronic health records and patient interviews. Long-term functional outcome assessed by EuroQol EQ-5D-5L questionnaire, AOFAS Ankle-Hindfoot scale, and return to pre-injury job function through patient interview and examination. RESULTS: There were 32...
Ojala, K; Meretoja, T J; Leidenius, M H K
Recent studies implicate that oncoplastic breast cancer surgery provides better aesthetic outcome than conventional resection. Several factors have been associated with poor aesthetic outcome. This study aims to compare patient-reported aesthetic and functional outcome after conventional and oncoplastic resection and to evaluate prognostic factors for poor aesthetic outcome in a population-based setting. 637 patients having breast conserving treatment (BCT) due to unilateral primary breast cancer at a single hospital district during 2010 were included. Aesthetic and functional outcome were evaluated using two questionnaires three years after surgery. Questionnaires were returned by 379 (59%) patients; 293 (77%) of these had conventional and 86 (23%) oncoplastic resection. Patients in oncoplastic resection group had larger tumour diameter (p oncoplastic group and 230 patients (81%) in the conventional resection group, p oncoplastic surgery (p oncoplastic resection group. Patient satisfaction to aesthetic outcome after BCT is high. Conventional resection provides good aesthetic outcome in appropriately selected patients. Oncoplastic resection enables BCT in patients with larger and multifocal tumours with favourable aesthetic outcome. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Guyonnet, Clément; Martins, Antoine; Marengo, Lorenza; Mansour, Mounira; Rousset, Marie; Samba, Antoine; Dimeglio, Alain; Canavese, Federico
The objectives of this study were to retrospectively investigate the clinical and radiological outcomes of displaced radial head fractures in children treated by elastic stable intramedullary nailing (ESIN) and evaluate the functional outcome of these injuries using the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). A total of 24 patients (nine males and 15 females) fulfilled the inclusion criteria. The mean age at the time of injury was 10.7±2.8 years (range: 9.5-16.33 years). Before surgery, the mean angulation was 53.8°±18.4° (range: 28°-82°) differentiating fractures on the basis of Judet's classification. The mean Quick DASH score was a good 4 (range: 0-15.9). Functional outcomes were similar irrespective of the severity of fracture displacement (P>0.05), presence or absence of associated fracture (P>0.05), and time immobilized (P>0.05). The Quick DASH score was better in children younger than 9 years of age (1.62) than children older than 9 years of age (4.95), but without a statistically significant difference (P=0.058). Children with displaced radial head fractures treated with ESIN showed good functional outcomes. Associated fracture injuries were not a predictive factor of functional outcome. Open reduction must be avoided as it carries an increased risk of complications.
Fractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. TRACE Investigators. TRAndolapril Cardiac Evaluation
Mäkikallio, T H; Høiber, S; Køber, L
variability predict mortality in patients with depressed left ventricular (LV) function after acute myocardial infarction (AMI). Traditional time- and frequency-domain HR variability indexes along with short-term fractal-like correlation properties of RR intervals (exponent alpha) and power-law scaling...... (exponent beta) were studied in 159 patients with depressed LV function (ejection fraction ... variables and LV function. A short-term fractal-like scaling exponent was the most powerful HR variability index in predicting mortality in patients with depressed LV function. Reduction in fractal correlation properties implies more random short-term HR dynamics in patients with increased risk of death...
Lau, Simon; Guest, Catherine; Hall, Marcus; Tacey, Mark; Joseph, Samuel; Oppy, Andrew
To identify whether transarticular screws, dorsal bridging plates or a combination of the 2 result in the best functional outcome after Lisfranc injury. Case series. Level one trauma center. Fifty patients who underwent surgical fixation of Lisfranc injuries over a 6-year period were retrospectively reviewed. One of 3 treatment arms: transarticular screw fixation alone, dorsal bridge plating alone or a combination of dorsal bridge and transarticular screw fixation. The primary outcome measures were 1 of 2 midfoot scores-the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score and the Foot Function Index (FFI) Score. Secondary results included postoperative complications. Quality anatomical reduction is the best predictor of functional outcomes (FFI-P = 0.008, AOFAS-P = 0.02). Functional outcomes with both FFI and AOFAS scores were not significantly associated with any of the fixation groups (FFI-P = 0.495, AOFAS-P = 0.654) on univariate analysis. Injury type by Myerson classification systems or open versus closed status was also not significantly associated with any fixation group. Open exposures were more likely to result in soft-tissue complications, but there was no significant difference in metalware failure or need for removal. Functional outcomes after Lisfranc fractures are most dependant on the quality of anatomical reduction and not the choice of fixation implant used. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
González Sánchez, S; Martín Conejero, A; Moñux Ducajú, G; Martínez López, I; Hernando Rydings, M; Serrano Hernando, F J
Traumatic aortic injury is usually lethal, most often because of serious associated wounds. The short- and midterm outcome of endovascular exclusion was assessed as the current treatment of choice due to a lower mortality and morbidity than open surgical treatment. We reviewed the cases of 8 patients (5 male, mean age 33 years) undergoing endovascular repair of a traumatic thoracic aortic lesion, confirmed by computed tomographic angiography, at our centre. Most patients showed a contained lesion limited to the aortic isthmus and severe associated injuries. Intrahospital mortality was 37.5% (N.=3) and mostly due to posttraumatic brain injury (N.=2). Most patients were hemodynamically stable at the time of endovascular repair (N.=6). The median time to surgery was 12 hours (3-48 hours). The endografts used were TAG® (W.L. Gore and Associates, Flagstaff) in three patients, and Valiant® (Medtronic, Santa Rosa, CA) in four. The technical success rate was 100%. In one case, the left subclavian artery was occluded without signs of arm ischemia. There were no cases of paraplegia or stroke related to treatment. No revision procedures were needed during follow-up. Endovascular repair shortly after injury seems to be effective and safe with a low associated morbidity and mortality.
Background: The prevalence of obesity-related adverse health outcomes is increasing among older adults. Because it is thought that nutrition plays an important role in successful aging, there has been considerable interest in the association between dietary patterns of older adults and obesity-relat...
Sweeting, M. J.; Ulug, P.; Powell, J. T.; Desgranges, P.; Balm, R.; Koelemay, M. J. W.; Idu, M. M.; Kox, C.; Legemate, D. A.; Huisman, L. C.; Willems, M. C. M.; Reekers, J. A.; van Delden, O. M.; van Lienden, K. P.; Hoornweg, L. L.; Reimerink, J. J.; van Beek, S. C.; Vahl, A. C.; Leijdekkers, V. J.; Bosma, J.; Montauban van Swijndregt, A. D.; de Vries, C.; van der Hulst, V. P. M.; Peringa, J.; Blomjous, J. G. A. M.; Visser, M. J. T.; van der Heijden, F. H. W. M.; Wisselink, W.; Hoksbergen, A. W. J.; Blankensteijn, J. D.; Visser, M. T. J.; Coveliers, H. M. E.; Nederhoed, J. H.; van den Berg, F. G.; van der Meijs, B. B.; van den Oever, M. L. P.; Lely, R. J.; Meijerink, M. R.; Voorwinde, A.; Ultee, J. M.; van Nieuwenhuizen, R. C.; Dwars, B. J.; Nagy, T. O. M.; Tolenaar, P.; Wiersema, A. M.; Lawson, J. A.; van Aken, P. J.; Stigter, A. A.; van den Broek, T. A. A.; VosZaans, G. A.; Mulder, W.; Strating, R. P.; Nio, D.; Akkersdijk, G. J. M.; van der Elst, A.; van Exter, P.; Mondor, Henri; Desgranges, Pascal; Becquemin, Jean- Pierre; Allaire, Eric; Castier, Yves; Leseche, Guy; Francis, Fady; Steinmetz, Eric; Berne, Jean-Pierre; Favier, Claire; Haulon, Stephan; Koussa, Mohammed; Azzaoui, Richard; Piervito, D.'elia; Alimi, Yves; Boufi, Mourad; Hartung, Olivier; Cerquetta, Pierre; Amabile, Philippe; Piquet, Philippe; Penard, Julien; Demasi, Mariangela; Alric, Pierre; Cannaud, Ludovic; Berthet, Jean-Pierre; Julia, Pierre; Fabiani, Jean-Nöel; Alsac, Jean Marc; Gouny, Pierre; Badra, Ali; Braesco, Jacques; Favre, Jean-Pierre; Albertini, Jean-Noel; Martinez, Robert; Batt, Michel; Jean, Elixène; Sosa, Miguel; Declemy, Serge; Destrieux-Garnier, Laurence; Lermusiaux, Patrick; Feugier, Patrick; Powell, Janet T.; Ashleigh, Ray; Gomes, Manuel; Greenhalgh, Roger M.; Grieve, Richard; Hinchliffe, Robert; Sweeting, Michael; Thompson, Matt M.; Thompson, Simon G.; Ulug, Pinar; Cheshire, Nicholas J.; Boyle, Jonathan R.; Serracino-Inglott, Ferdinand; Smyth, J. Vince; Hinchliffe, Robert J.; Bell, Rachel; Wilson, Noel; Bown, Matt; Dennis, Martin; Davis, Meryl; Howell, Simon; Wyatt, Michael G.; Valenti, Domenico; Bachoo, Paul; Walker, Paul; MacSweeney, Shane; Davies, Jonathan N.; Rittoo, Dynesh; Parvin, Simon D.; Yusuf, Waquar; Nice, Colin; Chetter, Ian; Howard, Adam; Chong, Patrick; Bhat, Raj; McLain, David; Gordon, Andrew; Lane, Ian; Hobbs, Simon; Pillay, Woolagasen; Rowlands, Timothy; El-Tahir, Amin; Asquith, John; Cavanagh, Steve; Dubois, Luc; Forbes, Thomas L.
To assess current knowledge for the management of ruptured abdominal aortic aneurysm (AAA), based on the 1-year outcomes of 3 recent randomised trials. An individual patient data meta-analysis of three recent randomised trials of endovascular versus open repair, including 817 patients, was conducted
Steinman, Michael A; Zullo, Andrew R; Lee, Yoojin; Daiello, Lori A; Boscardin, W John; Dore, David D; Gan, Siqi; Fung, Kathy; Lee, Sei J; Komaiko, Kiya D R; Mor, Vincent
Although β-blockers are a mainstay of treatment after acute myocardial infarction (AMI), these medications are commonly not prescribed for older nursing home residents after AMI, in part owing to concerns about potential functional harms and uncertainty of benefit. To study the association of β-blockers after AMI with functional decline, mortality, and rehospitalization among long-stay nursing home residents 65 years or older. This cohort study of nursing home residents with AMI from May 1, 2007, to March 31, 2010, used national data from the Minimum Data Set, version 2.0, and Medicare Parts A and D. Individuals with β-blocker use before AMI were excluded. Propensity score-based methods were used to compare outcomes in people who did vs did not initiate β-blocker therapy after AMI hospitalization. Functional decline, death, and rehospitalization in the first 90 days after AMI. Functional status was measured using the Morris scale of independence in activities of daily living. The initial cohort of 15 720 patients (11 140 women [70.9%] and 4580 men [29.1%]; mean [SD] age, 83  years) included 8953 new β-blocker users and 6767 nonusers. The propensity-matched cohort included 5496 new users of β-blockers and an equal number of nonusers for a total cohort of 10 992 participants (7788 women [70.9%]; 3204 men [29.1%]; mean [SD] age, 84  years). Users of β-blockers were more likely than nonusers to experience functional decline (odds ratio [OR], 1.14; 95% CI, 1.02-1.28), with a number needed to harm of 52 (95% CI, 32-141). Conversely, β-blocker users were less likely than nonusers to die (hazard ratio [HR], 0.74; 95% CI, 0.67-0.83) and had similar rates of rehospitalization (HR, 1.06; 95% CI, 0.98-1.14). Nursing home residents with moderate or severe cognitive impairment or severe functional dependency were particularly likely to experience functional decline from β-blockers (OR, 1.34; 95% CI, 1.11-1.61 and OR, 1.32; 95% CI, 1.10-1.59, respectively
Matthew B. Russell; Christopher W. Woodall; Anthony W. D' Amato; Grant M. Domke; Sassan S. Saatchi
Plant functional traits (PFTs) have increased in popularity in recent years to describe various ecosystems and biological phenomena while advancing general ecological principles. To date, few have investigated distributional attributes of individual PFTs and their relationship with key attributes and processes of forest ecosystems. The objective of this study was to...
McBride, Devin W; Donovan, Virginia; Hsu, Mike S; Obenaus, Andre; Rodgers, V G J; Binder, Devin K
Traumatic brain injury (TBI), the foremost cause of morbidity and mortality in persons under 45 years of age worldwide, leads to about 200,000 victims requiring hospitalization and approximately 52,000 deaths per year in the United States. TBI is characterized by cerebral edema leading to raised intracranial pressure, brain herniation, and subsequent death. Current therapies for TBI treatment are often ineffective, thus novel therapies are needed. Recent studies have shown that an osmotic transport device (OTD) is capable of reducing brain water content and improving survival in mice with severe cerebral edema. Here we compare the effects of a craniectomy and an OTD plus craniectomy on neurological function in mice after TBI. Animals treated with a craniectomy plus an OTD had significantly better neurological function 2 days after TBI compared with those treated with craniectomy only. This study suggests that an OTD for severe brain swelling may improve patient functional outcome. Future studies include a more comprehensive neurological examination, including long-term memory tests.
Brown, Allen W; Therneau, Terry M; Schultz, Billie A; Niewczyk, Paulette M; Granger, Carl V
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.
Nguyen, Michelle C; Strosberg, David S; Jones, Teresa S; Bhakta, Ankur; Jones, Edward L; Lyaker, Michael R; Byrd, Cindy A; Sobol, Carly; Eiferman, Daniel S
Patients with prolonged hospitalizations in the surgical intensive care unit often have ongoing medical needs that require further care at long-term, acute-care hospitals upon discharge. Setting expectations for patients and families after protracted operative intensive care unit hospitalization is challenging, and there are limited data to guide these conversations. The purpose of this study was to determine patient survival and readmission rates after discharge from the surgical intensive care unit directly to a long-term, acute-care hospital. All patients who were admitted to the surgical intensive care unit at an academic, tertiary care medical center from 2009-2014 and discharged directly to long-term, acute-care hospitals were retrospectively reviewed. Patients represented all surgical subspecialties excluding cardiac and vascular surgery patients. Primary outcomes included 30-day readmission, and 1- and 3-year mortality rates following discharge. In total, 296 patients were discharged directly from the surgical intensive care unit to a long-term, acute-care hospital during the study period. There were 190 men (64%) and mean age was 61 ± 16 years. Mean duration of stay in the surgical intensive care unit was 27 ± 17 days. The most frequent complication was prolonged mechanical ventilation (277, 94%) followed by pneumonia (139, 47%), sepsis (78, 26%), and acute renal failure (32, 11%); 93% of patients required tracheostomy and enteral feeding access prior to discharge, and 19 patients (6%) were newly dependent on hemodialysis. The readmission rate was 20%. There were 86 deaths within 1 year from discharge (29%) with an overall 3-year mortality of 32%. In a multiple logistic regression analysis, a history of end-stage renal disease had a greater odds of readmission (odds ratio 6.07, P = .028). Patients with history of cancer had greater odds of 1- and 3-year mortality (odds ratio = 2.99, P = .028 and odds ratio 2.56, P = .053, respectively
Kaminski, Ludovic; Cordemans, Virginie; Cernat, Eduard; M'Bra, Kouamé Innocent; Mac-Thiong, Jean-Marc
Spinal cord injury (SCI) is a devastating condition that affects patients on both a personal and societal level. The objective of the study is to improve the prediction of long-term functional outcome following SCI based on the acute clinical findings. A total of 76 patients with acute traumatic SCI were prospectively enrolled in a cohort study in a single Level I trauma center. Spinal Cord Independence Measure (SCIM) at 1 year after the trauma was the primary outcome. Potential predictors of...
Welsh, Marilyn C.; Peterson, Eric; Jameson, Molly M.
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 o...
Saif, S.; Fazal, N.
To evaluate the association between baseline national institutes of health stroke scale score and functional outcome after acute ischemic stroke. Study Design: Descriptive study. Place and Duration of Study: Medical unit-IV, Jinnah Hospital, Lahore, from May 2009 to October 2009. Patients and Methods: Patients who presented with stroke within 24 hours of onset of symptom and had a developing infarct on the CT- scan were further evaluated for neurological impairment using NIH stroke scale. The baseline NIHSS score was calculated using a proforma. Age of the patient, gender and time of presentation to the hospital was recorded. Follow-up was done on the 7th day of admission using Glasgow outcome scale (GOS). Results: Total number of subjects was 150. Good outcome (GOS=1-2) was noticed in those subjects who had a low baseline NIHSS score (0-6) while poor outcome (GOS=3-5) was noticed in those subjects who had a higher baseline NIHSS score (>16)( p value< 0.05). In cases who had a moderate score (7-15); the ratio of good outcome to bad outcome was almost 70:30. Likewise good outcome (GOS=1-2) was noticed in those subjects who were younger (less than 45 years) while poor outcome (GOS=3-5) was noticed in the elderly (more than 45 years)( p value< 0.05). Similarly patients who presented within 12 hrs of symptom onset had a good outcome compared to those who presented after 12 hrs( p value< 0.05). Conclusion: Baseline NIH Stroke Scale score is strongly associated with functional outcome after 1 week of acute ischemic stroke. (author)
Kondo, Naoki; Suzuki, Kohta; Minai, Junko; Yamagata, Zentaro
Rotating savings and credit associations (ROSCAs) involve group financial self-help activities. These voluntary financial cooperative associations-mujin in Japanese-are found in some rural areas of Japan. Cross-sectional evidence suggests that active participation in mujin correlates with rich social capital and better functional capacities among older adults. However, the effect of mujin on subsequent health outcomes is unknown. In 2003, we conducted a baseline interview survey of 583 functionally independent adults randomly selected from Yamanashi Prefecture residents aged 65 years or older. They were followed up until 2011. We used proportional hazards models, and factor analysis of 8 mujin-related questions identified 2 components: the "intensity and attitude" and "financing" aspects of mujin. The hazard ratios (HRs) for incident functional disability-identified by using the public long-term care insurance database-per 1-SD increase in factor scores were 0.82 (95% CI: 0.68-0.99) for the intensity and attitude score and 1.21 (1.07-1.38) for financing score. Adjustments for age, sex, marital status, household composition, physical health, education, income, and other factor scores only slightly attenuated these HRs. The results for mortality models were very similar to those for incident functional disability. ROSCA-type activities in Japan could have beneficial effects on the health of older adults if used primarily for the purpose of friendship. Mujin for aggressively financial purposes might be somewhat harmful, as such activities might reflect the "dark side" of social capital, ie, overly demanding expectations of group conformity.
Kaminski, Ludovic; Cordemans, Virginie; Cernat, Eduard; M'Bra, Kouamé Innocent; Mac-Thiong, Jean-Marc
Spinal cord injury (SCI) is a devastating condition that affects patients on both a personal and societal level. The objective of the study is to improve the prediction of long-term functional outcome following SCI based on the acute clinical findings. A total of 76 patients with acute traumatic SCI were prospectively enrolled in a cohort study in a single Level I trauma center. Spinal Cord Independence Measure (SCIM) at 1 year after the trauma was the primary outcome. Potential predictors of functional outcome were recorded during the acute hospitalization: age, sex, level and type of injury, comorbidities, American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA Motor Score (AMS), ASIA Light Touch score (LT), ASIA Pin Prick score (PP), Injury Severity Score (ISS), traumatic brain injury, and delay from trauma to surgery. A linear regression model was created with the primary outcome modeled relative to the acute clinical findings. Only four variables were selected in the model, with performance averaging an R-square value of 0.57. In descending order, the best predictors for SCIM at 1 year were: LT, AIS grade, ISS, and AMS. One-year functional outcome (SCIM) can be estimated by a simple equation that takes into account four parameters of the initial physical examination. Estimating the patient long-term outcome early after traumatic SCI is important in order to define the management strategies that might diminish the costs and to give the patient and family a better view of the long-term expectations.
Tchetgen Tchetgen, Eric J
Unobserved confounding is a well known threat to causal inference in non-experimental studies. The instrumental variable design can under certain conditions be used to recover an unbiased estimator of a treatment effect even if unobserved confounding cannot be ruled out with certainty. For continuous outcomes, two stage least squares is the most common instrumental variable estimator used in epidemiologic applications. For a rare binary outcome, an analogous linear-logistic two-stage procedure can be used. Alternatively, a control function approach is sometimes used which entails entering the residual from the first stage linear model as a covariate in a second stage logistic regression of the outcome on the treatment. Both strategies for binary response have previously formally been justified only for continuous exposure, which has impeded widespread use of the approach outside of this setting. In this note, we consider the important setting of binary exposure in the context of a binary outcome. We provide an alternative motivation for the control function approach which is appropriate for binary exposure, thus establishing simple conditions under which the approach may be used for instrumental variable estimation when the outcome is rare. In the proposed approach, the first stage regression involves a logistic model of the exposure conditional on the instrumental variable, and the second stage regression is a logistic regression of the outcome on the exposure adjusting for the first stage residual. In the event of a non-rare outcome, we recommend replacing the second stage logistic model with a risk ratio regression.
Little, Dianne; Johnson, Stephen; Hash, Jonathan; Olson, Steven A; Estes, Bradley T; Moutos, Franklin T; Lascelles, B Duncan X; Guilak, Farshid
The hip is one of the most common sites of osteoarthritis in the body, second only to the knee in prevalence. However, current animal models of hip osteoarthritis have not been assessed using many of the functional outcome measures used in orthopaedics, a characteristic that could increase their utility in the evaluation of therapeutic interventions. The canine hip shares similarities with the human hip, and functional outcome measures are well documented in veterinary medicine, providing a baseline for pre-clinical evaluation of therapeutic strategies for the treatment of hip osteoarthritis. The purpose of this study was to evaluate a surgical model of hip osteoarthritis in a large laboratory animal model and to evaluate functional and end-point outcome measures. Seven dogs were subjected to partial surgical debridement of cartilage from one femoral head. Pre- and postoperative pain and functional scores, gait analysis, radiographs, accelerometry, goniometry and limb circumference were evaluated through a 20-week recovery period, followed by histological evaluation of cartilage and synovium. Animals developed histological and radiographic evidence of osteoarthritis, which was correlated with measurable functional impairment. For example, Mankin scores in operated limbs were positively correlated to radiographic scores but negatively correlated to range of motion, limb circumference and 20-week peak vertical force. This study demonstrates that multiple relevant functional outcome measures can be used successfully in a large laboratory animal model of hip osteoarthritis. These measures could be used to evaluate relative efficacy of therapeutic interventions relevant to human clinical care.
Kamstra, Jolanda I; Jager-Wittenaar, Harriet; Dijkstra, Pieter U; Huisman, Paulien M; van Oort, Rob P; van der Laan, Bernard F A M; Roodenburg, Jan L N
This study aimed to assess: (1) oral symptoms of patients treated for oral or oropharyngeal cancer; (2) how patients rank the burden of oral symptoms; (3) the impact of the tumor, the treatment, and oral symptoms on functional outcome. Eighty-nine patients treated for oral or oropharyngeal cancer were asked about their oral symptoms related to mouth opening, dental status, oral sensory function, tongue mobility, salivary function, and pain. They were asked to rank these oral symptoms according to the degree of burden experienced. The Mandibular Function Impairment Questionnaire (MFIQ) was used to assess functional outcome. In a multivariate linear regression analyses, variables related to MFIQ scores (p≤0.10) were entered as predictors with MFIQ score as the outcome. Lack of saliva (52%), restricted mouth opening (48%), and restricted tongue mobility (46%) were the most frequently reported oral symptoms. Lack of saliva was most frequently (32%) ranked as the most burdensome oral symptom. For radiated patients, an inability to wear a dental prosthesis, a T3 or T4 stage, and a higher age were predictive of MFIQ scores. For non-radiated patients, a restricted mouth opening, an inability to wear a dental prosthesis, restricted tongue mobility, and surgery of the mandible were predictive of MFIQ scores. Lack of saliva was not only the most frequently reported oral symptom after treatment for oral or oropharyngeal cancer, but also the most burdensome. Functional outcome is strongly influenced by an inability to wear a dental prosthesis in both radiated and non-radiated patients.
Full Text Available Background: Subdural hematoma (SDH is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005, yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44% were discharged home, 16 (36% discharged to nursing home or rehab, 6 (13% to hospice and 3 (7% died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.
Pareja Sierra, T; Bartolomé Martín, I; Rodríguez Solís, J; Bárcena Goitiandia, L; Torralba González de Suso, M; Morales Sanz, M D; Hornillos Calvo, M
Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture CONCLUSIONS: Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.
Huber, Erika O; Roos, Ewa M.; Meichtry, André
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 from...... sessions of KS or 3 sessions of KS alone. Function was assessed with the Chair Stand Test (CST, primary endpoint) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales focusing on daily living function (ADL) and pain (secondary endpoints). Assessments were performed immediately before...... pain the treatment effect was -4.9 points (-16.3, 6.5) and -3.3 points (-13.5, 6.8) respectively. CONCLUSIONS: A median (IQR) of 10 (8, 14) exercise sessions before surgery showed an additional small but non-significant improvement in all functional assessments compared to patient education alone...
Davies, Geoff; Fowler, David; Greenwood, Kathryn
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: email@example.com
Rasmussen, Laust Dupont; Winther, Simon; Jørgensen, Hanne Skou
and mortality data were extracted from the Western Denmark Heart Registry, a review of patient records and patient interviews. RESULTS: Baseline patient characteristics did not differ between LAEDV tertiles. LAEDV was positively associated with measures of LV function - both LVEDV (β = 0.36, p ... mass (β = 0.30, p positively and LAEF negatively associated with NT-PRO-BNP (LAEDV: β = 10.28, p patients died and 19 (16.2%) patients suffered......BACKGROUND: Patients with chronic kidney disease (CKD) have an increased risk of cardiovascular events. Previous studies using 2-dimensional echocardiography show that left atrial end-diastolic volume (LAEDV) predicts cardiovascular outcomes and mortality in patients with CKD. However, contrast...
Laxy, Michael; Mielck, Andreas; Hunger, Matthias; Schunk, Michaela; Meisinger, Christa; Rückert, Ina-Maria; Rathmann, Wolfgang; Holle, Rolf
Little is known about the impact of diabetes self-management behavior (SMB) on long-term outcomes. We aimed to examine the association among patient-reported SMB, intermediate clinical outcomes, and mortality in patients with type 2 diabetes. Data were collected from 340 patients with type 2 diabetes of the KORA-A study (1997/1998) who were recruited from two previous population-based surveys (n = 161) and a myocardial infarction registry (n = 179) in southern Germany. Based on previous methodological work, a high level of SMB was defined as being compliant with at least four of six different self-care dimensions, comprising physical exercise, foot care, blood glucose self-monitoring, weight monitoring, having a diet plan, and keeping a diabetes diary. The vital status of the participants was observed until 2009. Multivariable linear, logistic, and Cox regression models were applied to assess the association with intermediate clinical outcomes at baseline and to predict mortality over the follow-up period, adjusted for sociodemographic, behavioral, and disease-related factors. In the cross-sectional perspective, a high level of SMB was weakly associated with a lower glycated hemoglobin A1c level (-0.44% [-4.8 mmol/mol] [95% CI -0.88 to 0.00]), but not with low-density lipoprotein cholesterol, systolic blood pressure, or the presence of microalbuminuria, peripheral arterial disease, or polyneuropathy. During a mean follow-up time of 11.6 years, 189 patients died. SMB was a preventive factor for all-cause (hazard ratio 0.61 [95% CI 0.40-0.91]) and cardiovascular mortality (0.65 [95% CI 0.41-1.03]). Although measuring SMB is difficult and the used operationalization might be limited, our results give some indication that a high level of SMB is associated with prolonged life expectancy in patients with type 2 diabetes and highlight the potential impact of the patients' active contribution on the long-term trajectory of the disease. We assume that the used proxy for SMB
Fischer, John P; Elliott, River M; Kozin, Scott H; Levin, L Scott
Free functional muscle transfer (FFMT) replaces destroyed, denervated, or resected skeletal muscle units in the upper extremity with functioning skeletal muscle from other locations in the body. Common indications for FFMT include brachial plexus injuries, ischemic contracture, tumor resection, and extensive direct muscle trauma. Recent studies have focused on improving patient outcomes through refinements in muscle flap harvest and inset, donor nerve selection, and postoperative management. In this review, we assess and summarize the current literature on FFMT, with emphasis on etiopathogenesis, diagnosis, treatment, postoperative management, and clinical outcomes. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Madarasz, Wendy; Manzardo, Ann; Mortensen, Erik Lykke
Central Psychiatric Research Registry for 8109 birth cohort members aged 45 years. Lifetime psychiatric diagnoses (International Classification of Diseases, Revision 10, group F codes, Mental and Behavioural Disorders, and one Z code) for identified subjects were organized into 14 mutually exclusive.......0, df = 1, P high mortality rates with no comorbidities. Conclusions: Risk of early mortality among psychiatric patients appears to be a function of both...
Full Text Available Alpha-lipoic acid (aLA is a strong antioxidant commonly used for treating diabetic polyneuropathy. Previously, we demonstrated the neurorestorative effects of aLA after cerebral ischemia in rats. However, its effects on patients with stroke remain unknown. We investigated whether patients treated with aLA have better functional outcomes after acute ischemic stroke (AIS and reperfusion therapy than patients not receiving aLA.In this retrospective study of 172 prospectively registered patients with diabetes and AIS treated with tissue plasminogen activator (tPA, we investigated the relationship between aLA use and functional outcome both after 3 months and after 1 year. The functional outcomes included occurrence of hemorrhagic transformation (HT, early neurological deterioration (END, and early clinical improvement (ECI. Favorable outcomes were defined as modified Rankin Scale (mRS scores of 0-2.Of the 172 patients with AIS and diabetes, 47 (27.3% used aLA. In the entire cohort, favorable outcomes occurred at significantly higher rates both at 3 months and at 1 year in those treated with aLA. The risks for END and HT were lower and the occurrence of ECI was higher in patients treated with aLA. In multivariable analysis, aLA use was associated with favorable outcomes both at 3 months and at 1 year. Age, HT, and increased National Institutes of Health Stroke Scale scores were negative predictors of a favorable outcome.The use of aLA in patients with AIS and diabetes who are treated with tPA is associated with favorable outcomes. These results indicate that aLA could be a useful intervention for the treatment of AIS after reperfusion therapy.
Montgomery, Alexander Sheriff; Cunningham, John Edward; Robertson, Peter Alexander
Prospective cohort study and systematic literature review. To compare the functional outcomes for lumbar spinal fusion in both compensation and noncompensation patients in an environment of universal no fault compensation and then to compare these outcomes with those in worker's compensation and nonworkers compensation cohorts from other countries. Compensation has an adverse effect on outcomes in spine fusion possibly based on adversarial environment, delayed resolution of claims and care, and increased compensation associated with prolonged disability. It is unclear whether a universal no fault compensation system would provide different outcomes for these patients. New Zealand's Accident Compensation Corporation (ACC) provides universal no fault compensation for personal injury secondary to accident and offers an opportunity to compare results with differing provision of compensation. A total of 169 patients undergoing lumbar spinal fusion were assessed preoperatively, at 1 year, and at long-term follow-up out to 14 years, using functional outcome measures and health-related quality-of-life measures. Comparison was made between those covered and not covered by ACC for 3 distinct diagnostic categories. A systematic literature review comparing outcomes in Worker's Compensation and non-Compensation cohorts was also performed. The functional outcomes for both ACC and non-ACC cohorts were similar, with significant and comparable improvements over the first year that were then sustained out to long-term follow-up for both cohorts. At long-term follow-up, the health-related quality-of-life measures were the same between the 2 cohorts.The literature review revealed a marked difference in outcomes between worker's compensation and non-worker's compensation cohorts with a near universal inferior outcome for the compensation group. The similarities in outcomes of patients undergoing lumbar spine fusion under New Zealand's universal no fault compensation system, when
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.
Chien, Kuo-Liong; Hsu, Hsiu-Ching; Lee, Yuan-Teh; Chen, Ming-Fong
Impaired renal function and metabolic syndrome have been associated with risk of cardiovascular disease (CVD). We investigated their roles in CVD and all-cause death among ethnic Chinese population. We followed up a cohort of 11429 men and 7472 women aged 20 years and older for an average 4.9 years (median: 3.5, inter-quartile range: 2.7-7.9) from the tertiary hospital health check-up population. CVD death rates increased when the quintiles of each variable progressed. Metabolic syndrome was a significant predictor for CVD death, with relative risk of up to 4.68. In the multivariate adjusted model that included metabolic syndrome, quintiles of serum creatinine concentrations, estimated glomerular filtration rate (GFR), and uric acids were significantly associated CVD death, with the highest relative risk of creatinine concentration (11.22, 95% confidence interval [CI]: 2.43-51.7, P for trend: creatinine concentrations and estimated GFR had the higher areas under ROC curves of CVD death (0.76, 95% CI: 0.71-0.80 for creatinine and 0.76, 95% CI: 0.72-0.81 for estimated GFR). The two marker models showed that metabolic syndrome and impaired renal function had the most significant roles in predicting CVD deaths; the multivariate relative risk was 30.6 (95% CI: 3.7-254, P: 0.002) in participants with the highest creatinine and presence of metabolic syndrome compared with those with the lowest and absence of metabolic syndrome. Impaired renal function and metabolic syndrome are important risk factors for CVD and all-cause deaths among ethnic Chinese.
van den Berg, Juriaan; Reul, Maike; Nunes Cardozo, Menno; Starovoyt, Anastasiya; Geusens, Eric; Nijs, Stefaan; Hoekstra, Harm
INTRODUCTION: Although regularly ignored, there is growing evidence that posterior tibial plateau fractures affect the functional outcome. The goal of this study was to assess the incidence of posterior column fractures and its impact on functional outcome and general health status. We aimed to identify all clinical variables that influence the outcome and improve insights in the treatment strategies. A retrospective cohort study including 218 intra-articular tibial plateau fractures was conducted. All fractures were reclassified and applied treatment was assessed according to the updated three-column concept. Relevant demographic and clinical variables were studied. The patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Median follow-up was 45.5 (IQR 24.9-66.2) months. Significant outcome differences between operatively and non-operatively treated patients were found for all KOOS subscales. The incidence of posterior column fractures was 61.9%. Posterior column fractures, sagittal malalignment and an increased complication rate were associated with poor outcome. Patients treated according to the updated three-column concept, showed significantly better outcome scores than those patients who were not. We could not demonstrate the advantage of posterior column fracture fixation, due to a limited patient size. Our data indicates that implementation of the updated three-column classification concept may improve the surgical outcome of tibial plateau fractures. Failure to recognize posterior column fractures may lead to inappropriate utilization of treatment techniques. The current concept allows us to further substantiate the importance of reduction and fixation of posterior column fractures with restoration of the sagittal alignment. 3.
Chen, Yan; Liu, Xinyu; Li, Shan; Wan, Hong
Recent studies indicate that the local field potential (LFP) carries information about an animal's behavior, but issues regarding whether there are any relationships between the LFP functional networks and behavior tasks as well as whether it is possible to employ LFP network features to decode the behavioral outcome in a single trial remain unresolved. In this study, we developed a network-based method to decode the behavioral outcomes in pigeons by using the functional connectivity strength values among LFPs recorded from the nidopallium caudolaterale (NCL). In our method, the functional connectivity strengths were first computed based on the synchronization likelihood. Second, the strength values were unwrapped into row vectors and their dimensions were then reduced by principal component analysis. Finally, the behavioral outcomes in single trials were decoded using leave-one-out combined with the k -nearest neighbor method. The results showed that the LFP functional network based on the gamma-band was related to the goal-directed behavior of pigeons. Moreover, the accuracy of the network features (74 ± 8%) was significantly higher than that of the power features (61 ± 12%). The proposed method provides a powerful tool for decoding animal behavior outcomes using a neural functional network.
Burke, Jeffrey D; Rowe, Richard; Boylan, Khrista
Oppositional defiant disorder(ODD) is considered to be a disorder of childhood, yet evidence suggests that prevalence rates of the disorder are stable into late adolescence and trajectories of symptoms persist into young adulthood. Functional outcomes associated with ODD through childhood and adolescence include conflict within families, poor peer relationships, peer rejection, and academic difficulties. Little examination of functional outcomes in adulthood associated with ODD has been undertaken. Data for the present analyses come from a clinic referred sample of 177 boys aged 7-12 followed up annually to age 18 and again at age 24. Annual parental report of psychopathology through adolescence was used to predict self-reported functional outcomes at 24. Controlling for parent reported symptoms of attention deficit hyperactivity disorder (ADHD), Conduct disorder (CD), depression and anxiety, ODD symptoms from childhood through adolescence predicted poorer age 24 functioning with peers, poorer romantic relationships, a poorer paternal relationship, and having nobody who would provide a recommendation for a job. CD symptoms predicted workplace problems, poor maternal relationship, lower academic attainment, and violent injuries. Only parent reported ODD symptoms and child reported CD symptoms predicted a composite of poor adult outcomes. Oppositional defiant disorder is a disorder that significantly interferes with functioning, particularly in social or interpersonal relationships. The persistence of impairment associated with ODD into young adulthood calls for a reconsideration of ODD as a disorder limited to childhood. © 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.
Inzucchi, Silvio E; Zinman, Bernard; Fitchett, David; Wanner, Christoph; Ferrannini, Ele; Schumacher, Martin; Schmoor, Claudia; Ohneberg, Kristin; Johansen, Odd Erik; George, Jyothis T; Hantel, Stefan; Bluhmki, Erich; Lachin, John M
In the BI 10773 (Empagliflozin) Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) trial involving 7,020 patients with type 2 diabetes and established cardiovascular (CV) disease, empagliflozin given in addition to standard of care reduced the risk of CV death by 38% versus placebo (hazard ratio [HR] 0.62 [95% CI 0.49, 0.77]). This exploratory mediation analysis assesses the extent to which treatment group differences in covariates during the trial contributed to CV death risk reduction with empagliflozin. Effects of potential mediators, identified post hoc, on the HR for CV death with empagliflozin versus placebo were analyzed by Cox regression models, with treatment group adjusted for the baseline value of the variable and its change from baseline or updated mean (i.e., considering all prior values), each as a time-dependent covariate. HRs were compared with a model without adjustment for covariates. Multivariable analyses also were performed. Changes in hematocrit and hemoglobin mediated 51.8% and 48.9%, respectively, of the effect of empagliflozin versus placebo on the risk of CV death on the basis of changes from baseline, with similar results in analyses on the basis of updated means. Smaller mediation effects (maximum 29.3%) were observed for uric acid, fasting plasma glucose, and HbA 1c . In multivariable models, which incorporated effects of empagliflozin on hematocrit, fasting glucose, uric acid, and urine albumin:creatinine ratio, the combined changes from baseline provided 85.2% mediation, whereas updated mean analyses provided 94.6% mediation of the effect of empagliflozin on CV death. In this exploratory analysis from the EMPA-REG OUTCOME trial, changes in markers of plasma volume were the most important mediators of the reduction in risk of CV death with empagliflozin versus placebo. © 2017 by the American Diabetes Association.
Bushnell, Cheryl; Bettger, Janet Prvu; Cockroft, Kevin M; Cramer, Steven C; Edelen, Maria Orlando; Hanley, Daniel; Katzan, Irene L; Mattke, Soeren; Nilsen, Dawn M; Piquado, Tepring; Skidmore, Elizabeth R; Wing, Kay; Yenokyan, Gayane
About half of survivors with stroke experience severe and significant long-term disability. The purpose of this article is to review the state of the science and to make recommendations for measuring patient-centric outcomes in interventions for motor improvement in the chronic stroke phase. A 9-member expert panel reviewed evidence to identify measures of upper and lower extremity function used to date as outcomes in trials with patients who experienced a stroke ≥6 months before assessment. Outcome measures were screened using StrokEDGE consensus panel recommendations, and evaluated for availability of a published minimal clinically important difference. Measures meeting these criteria were further evaluated with regard to their level of measurement, psychometric properties, and ability of minimal clinically important difference to capture gains associated with improved function and clinical relevance to patients, to arrive at recommendations. A systematic literature review yielded 115 clinical trials of upper and lower extremity function in chronic stroke that used a total of 34 outcome measures. Seven of these had published minimal clinically important differences and were recommended or highly recommended by StrokEDGE. Those are the Fugl-Meyer Upper Extremity and Lower Extremity scales, Wolf Motor Function Test, Action Research Arm Test, Ten-Meter and Six-Minute Walk Tests, and the Stroke Impact Scale. All had evidence for their psychometric performance, although the strength of evidence for validity varied, especially in populations with chronic stroke Fugl-Meyer Upper and Lower Extremity scales showing the strongest evidence for validity. The panel recommends that the Fugl-Meyer Upper and Lower Extremity scales be used as primary outcomes in intervention trials targeting motor function in populations with chronic stroke. The other 6 measures are recommended as secondary outcomes. © 2015 American Heart Association, Inc.
Anderson, Vicki A; Catroppa, Cathy; Dudgeon, Paul; Morse, Sue A; Haritou, Flora; Rosenfeld, Jeffrey V
Much is known about outcome following traumatic brain injury (TBI) in school-age children; however, recovery in early childhood is less well understood. Some argue that such injuries should lead to good outcome, because of the plasticity of the developing brain. Other purport that the young brain is vulnerable, with injury likely to result in a substantial impairment (H. G. Taylor & J. Alden, 1997). The aim of this study was to examine outcomes following TBI during early childhood, to plot recovery over the 30 months postinjury, and to identify predictors of outcome. The study compared 3 groups of children sustaining mild, moderate, and severe TBI, ages 2.0 to 6.11 years at injury, with healthy controls. Groups were comparable for preinjury adaptive and behavioral function, psychosocial characteristics, age, and gender. Results suggested a strong association between injury severity and outcomes across all domains. Further, 30-month outcome was predicted by injury severity, family factors, and preinjury levels of child function. In conclusion, children with more severe injuries and lower preinjury adaptive abilities, and whose families are coping poorly, are at greatest risk of long-term impairment in day-to-day skills, even several years postinjury.
Winther, Signe Abitz; Øllgaard, Jens Christian; Parving, Hans-Henrik Dyring
pressure, cholesterol, HbA1c and u-AER (p ≤ 0.014). After further adjustment for baseline eGFR significance was lost for all endpoints, except for CVD events (HR per doubling: 1.22, [1.05-1.41]; p=0.010). Conclusion In type 1 diabetes patients with diabetic nephropathy, higher fasting plasma TMAO level......Background Trimethylamine-N-Oxide (TMAO) is a metabolite of phosphatidylcholine, choline and carnitine produced by the gut microbiota from ingested animal foods. It has been suggested as an independent gut microbiota derived risk factor for renal and cardiovascular disease (CVD). Patients with type...... 1 diabetes are at increased risk of renal and cardiovascular disease and early mortality. We investigated associations between plasma TMAO and outcomes in a prospective study. Methods TMAO was measured at baseline in 384 patients with type 1 diabetes with diabetic nephropathy (u-AER > 300 mg/g), 61...
Rebecca I. Clark
Full Text Available Alterations in the composition of the intestinal microbiota have been correlated with aging and measures of frailty in the elderly. However, the relationships between microbial dynamics, age-related changes in intestinal physiology, and organismal health remain poorly understood. Here, we show that dysbiosis of the intestinal microbiota, characterized by an expansion of the Gammaproteobacteria, is tightly linked to age-onset intestinal barrier dysfunction in Drosophila. Indeed, alterations in the microbiota precede and predict the onset of intestinal barrier dysfunction in aged flies. Changes in microbial composition occurring prior to intestinal barrier dysfunction contribute to changes in excretory function and immune gene activation in the aging intestine. In addition, we show that a distinct shift in microbiota composition follows intestinal barrier dysfunction, leading to systemic immune activation and organismal death. Our results indicate that alterations in microbiota dynamics could contribute to and also predict varying rates of health decline during aging in mammals.
Kobza, Joanna; Geremek, Mariusz
Life expectancy at birth is considered the best mortality-based summary indicator of the health status of the population and is useful for measuring long-term health changes. The objective of this article was to present the concept of the bottom-up policy risk assessment approach, developed to identify challenges involved in analyzing risk factor reduction policies and in assessing how the related health indicators have changed over time. This article focuses on the reasons of the significant life expectancy prolongation in Poland over the past 2 decades, thus includes policy context. The methodology details a bottom-up risk assessment approach, a chain of relations between the health outcome, risk factors, and health policy, based on Risk Assessment From Policy to Impact Dimension project guidance. A decline in cardiovascular disease mortality was a key factor that followed life expectancy prolongation. Among basic factors, tobacco and alcohol consumption, diet, physical activity, and new treatment technologies were identified. Poor health outcomes of the Polish population at the beginning of 1990s highlighted the need of the implementation of various health promotion programs, legal acts, and more effective public health policies. Evidence-based public health policy needs translating scientific research into policy and practice. The bottom-up case study template can be one of the focal tools in this process. Accountability for the health impact of policies and programs and legitimization of the decisions of policy makers has become one of the key questions nowadays in European countries' decision-making process and in EU public health strategy. © The Author(s) 2015.
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.
Kliethermes, Stephanie; Oleson, Jacob
Longitudinal growth patterns are routinely seen in medical studies where individual and population growth is followed over a period of time. Many current methods for modeling growth presuppose a parametric relationship between the outcome and time (e.g., linear, quadratic); however, these relationships may not accurately capture growth over time. Functional mixed effects (FME) models provide flexibility in handling longitudinal data with nonparametric temporal trends. Although FME methods are well-developed for continuous, normally distributed outcome measures, nonparametric methods for handling categorical outcomes are limited. We consider the situation with binomially distributed longitudinal outcomes. Although percent correct data can be modeled assuming normality, estimates outside the parameter space are possible and thus estimated curves can be unrealistic. We propose a binomial FME model using Bayesian methodology to account for growth curves with binomial (percentage) outcomes. The usefulness of our methods is demonstrated using a longitudinal study of speech perception outcomes from cochlear implant users where we successfully model both the population and individual growth trajectories. Simulation studies also advocate the usefulness of the binomial model particularly when outcomes occur near the boundary of the probability parameter space and in situations with a small number of trials. PMID:24723495
Kliethermes, Stephanie; Oleson, Jacob
Longitudinal growth patterns are routinely seen in medical studies where individual growth and population growth are followed up over a period of time. Many current methods for modeling growth presuppose a parametric relationship between the outcome and time (e.g., linear and quadratic); however, these relationships may not accurately capture growth over time. Functional mixed-effects (FME) models provide flexibility in handling longitudinal data with nonparametric temporal trends. Although FME methods are well developed for continuous, normally distributed outcome measures, nonparametric methods for handling categorical outcomes are limited. We consider the situation with binomially distributed longitudinal outcomes. Although percent correct data can be modeled assuming normality, estimates outside the parameter space are possible, and thus, estimated curves can be unrealistic. We propose a binomial FME model using Bayesian methodology to account for growth curves with binomial (percentage) outcomes. The usefulness of our methods is demonstrated using a longitudinal study of speech perception outcomes from cochlear implant users where we successfully model both the population and individual growth trajectories. Simulation studies also advocate the usefulness of the binomial model particularly when outcomes occur near the boundary of the probability parameter space and in situations with a small number of trials. Copyright © 2014 John Wiley & Sons, Ltd.
Stephan, Patrick; Röling, Maarten A; Mathijssen, Nina M C; Hannink, Gerjon; Bloem, Rolf M
Hip arthroscopic treatment is not equally beneficial for every patient undergoing this procedure. Therefore, the purpose of this study was to develop a clinical prediction model for functional outcome after surgery based on preoperative factors. Prospective data was collected on a cohort of 205 patients having undergone hip arthroscopy between 2011 and 2015. Demographic and clinical variables and patient reported outcome (PRO) scores were collected, and considered as potential predictors. Successful outcome was defined as either a Hip Outcome Score (HOS)-ADL score of over 80% or improvement of 23%, defined by the minimal clinical important difference, 1 year after surgery. The prediction model was developed using backward logistic regression. Regression coefficients were converted into an easy to use prediction rule. The analysis included 203 patients, of which 74% had a successful outcome. Female gender (OR: 0.37 (95% CI 0.17-0.83); p = 0.02), pincer impingement (OR: 0.47 (95% CI 0.21-1.09); p = 0.08), labral tear (OR: 0.46 (95% CI 0.20-1.06); p = 0.07), HOS-ADL score (IQR OR: 2.01 (95% CI 0.99-4.08); p = 0.05), WHOQOL physical (IQR OR: 0.43 (95% CI 0.22-0.87); p = 0.02) and WHOQOL psychological (IQR OR: 2.40 (95% CI 1.38-4.18); p = prediction model of successful functional outcome 1 year after hip arthroscopy. The model's discriminating accuracy turned out to be fair, as 71% (95% CI: 64-80%) of the patients were classified correctly. The developed prediction model can predict the functional outcome of patients that are considered for a hip arthroscopic intervention, containing six easy accessible preoperative risk factors. The model can be further improved trough external validation and/or adding additional potential predictors.
Iwata, D; Broun, H C; Black, A P; Preston, C A; Anderson, G I
A retrospective multi-centre study was carried out in order to compare outcomes between cemented and uncemented total hip arthoplasties (THA). A quantitative orthopaedic outcome assessment scoring system was devised in order to relate functional outcome to a numerical score, to allow comparison between treatments and amongst centres. The system combined a radiographic score and a clinical score. Lower scores reflect better outcomes than higher scores. Consecutive cases of THA were included from two specialist practices between July 2002 and December 2005. The study included 46 THA patients (22 uncemented THA followed for 8.3 +/- 4.7M and 24 cemented THA for 26.0 +/- 15.7M) with a mean age of 4.4 +/- 3.3 years at surgery. Multi-variable linear and logistical regression analyses were performed with adjustments for age at surgery, surgeon, follow-up time, uni- versus bilateral disease, gender and body weight. The differences between treatment groups in terms of functional scores or total scores were not significant (p > 0.05). Radiographic scores were different between treatment groups. However, these scores were usually assessed within two months of surgery and proved unreliable predictors of functional outcome (p > 0.05). The findings reflect relatively short-term follow-up, especially for the uncemented group, and do not include clinician-derived measures, such as goniometry and thigh circumference. Longer-term follow-up for the radiographic assessments is essential. A prospective study including the clinician-derived outcomes needs to be performed in order to validate the outcome instrument in its modified form.
Radauceanu, Anca; Ducki, Camille; Virion, Jean-Marc; Rossignol, Patrick; Mallat, Ziad; McMurray, John; Van Veldhuisen, Dirk J.; Tavazzi, Luigi; Mann, Douglas L.; Capiaumont-Vin, Josette; Li, Minjiang; Hanriot, Didier; Zannad, Faiez
Background: Inflammatory pathways may promote extracellular matrix (ECM) remodeling and chronic heart failure (CHF) progression. The relationship between markers of inflammation and of ECM remodeling, and their influence oil functional status and outcomes has not been examined in a large cohort of
Burke, Jeffrey D.; Rowe, Richard; Boylan, Khrista
Background: Oppositional defiant disorder (ODD) is considered to be a disorder of childhood, yet evidence suggests that prevalence rates of the disorder are stable into late adolescence and trajectories of symptoms persist into young adulthood. Functional outcomes associated with ODD through childhood and adolescence include conflict within…
Luna, I E; Kehlet, H; Peterson, B
AIMS: The purpose of this study was to assess early physical function after total hip or knee arthroplasty (THA/TKA), and the correlation between patient-reported outcome measures, physical performance and actual physical activity (measured by actigraphy). PATIENTS AND METHODS: A total of 80 pati...
Ruiz Santiago, Fernando, E-mail: firstname.lastname@example.org [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)
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.
Dnyanesh G Lad
Conclusions: A significantly improved placement of the component was found in the coronal and sagittal planes of the tibial component by CAS. The placement of the components in the other planes was comparable with the values recorded in the jig-based surgery group. Functional outcome was not significantly different.
Full Text Available The surgical, oncologic, and functional outcomes were retrospectively compared of laparoscopic partial nephrectomy (LPN and open partial nephrectomy (OPN for the treatment of renal masses. Between January 2006 and November 2011, 115 LPNs and 97 OPNs were performed. The patients’ demographics were matched. Their intraoperative and postoperative data, oncologic and renal function outcomes were compared. Surgical time, renal arterial occlusion time, estimated blood loss, and postoperative hospitalization days were shorter in the LPN group (p < 0.01. The total complications were comparable; however, LPN had a higher intraoperative complication due to 12 subcutaneous emphysemas. The LPN group was followed up with a mean time of 29.3 ± 14.4 months and the OPN group with a mean time of 31.2 ± 12.6 months. All patients survived and no distant relapse or metastasis were observed. Kaplan–Meier estimates of 60-month local recurrence-free survival were comparable with 92.4% after LPN and 93.8% after OPN, respectively (p = 0.57. The reduction of glomerular filtration rate was more obvious after LPN at the 3-month follow-up (p < 0.01, but similar between the two groups at the 30.2-month follow-up. LPN provides similar results in oncologic and functional outcomes when compared to OPN. Long-term observations are still required to the oncologic and function outcomes.
Dahl, Jordi S; Videbæk, Lars; Poulsen, Mikael K
ventricular (LV) function and remodeling and to evaluate the significance of preoperative OPG on long-term outcome in terms of survival and symptomatic improvement in 124 patients with severe AS scheduled for aortic valve replacement (AVR). Patients were divided according to tertiles of preoperative OPG...
Damman, Kevin; Kjekshus, John; Wikstrand, John; Cleland, John G. F.; Komajda, Michel; Wedel, Hans; Waagstein, Finn; McMurray, John J. V.
AimWe aimed to study the relationships of loop diuretic dose with renal function and clinical outcomes in patients with chronic heart failure (HF). Methods and resultsLoop diuretic dose at baseline was recorded in patients included in the Controlled Rosuvastatin Multinational Trial in Heart Failure
Kamstra, Jolanda I.; Jager-Wittenaar, Harriet; Dijkstra, Pieter U.; Huisman, Paulien M.; van Oort, Rob P.; van der Laan, Bernard F. A. M.; Roodenburg, Jan L. N.
Purpose This study aimed to assess: (1) oral symptoms of patients treated for oral or oropharyngeal cancer; (2) how patients rank the burden of oral symptoms; (3) the impact of the tumor, the treatment, and oral symptoms on functional outcome. Methods Eighty-nine patients treated for oral or
Qazi, S. H.; Faruque, A. V.; Khan, M. A. M.
Objective: To describe the management and functional outcome of anorectal malformations and associated anomalies according to Krickenbeck classification. Study Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2002 to December 2012. Methodology: Anorectal anomalies were classified according to Krickenbeck classification. Data was collected and proforma used regarding the primary disease associated anomalies, its management and functional outcome, according to Krickenbeck classification. Cases included were: all those children with imperforate anus managed during the study period. Qualitative variables like gender and functional outcome were reported as frequencies and percentages. Quantitative variables like age were reported as medians with interquartile ranges. Results: There were 84 children in study group. Most common associated anomaly was cardiac (38 percent), followed by urological anomaly (33 percent). All children were treated by Posterior Sagittal Anorectoplasty (PSARP). Fistula was present in 64 out of 84 (76 percent) cases. The most common fistula was rectourethral (33 percent), followed by recto vestibular (31 percent). According to Krickenbeck classification, continence was achieved in 62 percent children; however 27 percent children were constipated, followed by 12 percent children having fecal soiling. Conclusion: Functional outcome of anorectal malformation depends upon severity of disease. A thorough evaluation of all infants with ARM should be done with particular focus on cardiovascular (38 percent) and genitourinary abnormalities (33 percent). (author)
Lane, Kathleen Lynne; Oakes, Wendy Peia; Powers, Lisa; Diebold, Tricia; Germer, Kathryn; Common, Eric A.; Brunsting, Nelson
This paper provides outcomes of a study examining the effectiveness of a year-long professional development training series designed to support in-service educators in learning a systematic approach to functional assessment-based interventions developed by Umbreit and colleagues (2007) that has met with demonstrated success when implemented with…
Kuizenga-Wessel, Sophie; Benninga, Marc A.; Tabbers, Merit M.
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
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 that...
The duration of untreated psychosis is well recognised as an independent predictor of symptomatic and functional outcome in the short term and has facilitated the development of worldwide early intervention programmes. However, the extent and mechanisms by which it might influence prognosis beyond a decade remain poorly understood.
Wahal, Naman; Gaba, Sahil; Malhotra, Rajesh; Kumar, Vijay; Pegg, Elise C; Pandit, Hemant
A small proportion of patients with mobile unicompartmental knee arthroplasty (UKA) report poor functional outcomes in spite of optimal component alignment on postoperative radiographs. The purpose of this study is to assess whether there is a correlation between functional outcome and knee kinematics. From a cohort of consecutive cases of 150 Oxford medial UKA, patients with fair/poor functional outcome at 1-year postsurgery (Oxford Knee Score [OKS] bearing position with knee flexion angle. Mean OKS in the fair/poor group was 29.9 and the mean OKS in the good/excellent group was 41.1. The tibial slope, time taken to complete the exercises, and patellar tendon angle trend over the flexion range were similar in both the groups; however, bearing position and the extent of bearing excursion differed significantly. The total bearing excursion in the OKS bearing was positioned 1.7 mm more posterior on the tibia in the OKS bearing excursion and positioning, are associated with worse functional outcomes after mobile UKA. Copyright © 2017 Elsevier Inc. All rights reserved.
French, Helen P; Fitzpatrick, Martina; FitzGerald, Oliver
To compare the responsiveness of two self-report measures and three physical performance measures of function following physiotherapy for osteoarthritis of the knee. Single centre study in acute hospital setting. Patients referred for physiotherapy with osteoarthritis of the knee were recruited. The Western Ontario and McMaster Universities (WOMAC), Lequesne Algofunctional Index (LAI), timed-up-and-go test (TUGT), timed-stand test (TST) and six-minute walk test (6MWT) were administered at first and final physiotherapy visits. Wilcoxon Signed Rank tests were used to determine the effect of physiotherapy on each outcome. Responsiveness was calculated using effect size, standardised response mean and a median-based measure of responsiveness due to some outlying data. Thirty-nine patients with a mean age of 65.3 (standard deviation 6.9) years were investigated before and after a course of exercise-based physiotherapy. There was a significant improvement in all outcomes except the WOMAC scores. All measures demonstrated small effect sizes for all statistics (Physiotherapy. Published by Elsevier Ltd. All rights reserved.
Lopes, Antonio Alberto; Tong, Lin; Thumma, Jyothi; Li, Yun; Fuller, Douglas S; Morgenstern, Hal; Bommer, Jürgen; Kerr, Peter G; Tentori, Francesca; Akiba, Takashi; Gillespie, Brenda W; Robinson, Bruce M; Port, Friedrich K; Pisoni, Ronald L
Poor nutritional status and both hyper- and hypophosphatemia are associated with increased mortality in maintenance hemodialysis (HD) patients. We assessed associations of phosphate binder prescription with survival and indicators of nutritional status in maintenance HD patients. Prospective cohort study (DOPPS [Dialysis Outcomes and Practice Patterns Study]), 1996-2008. 23,898 maintenance HD patients at 923 facilities in 12 countries. Patient-level phosphate binder prescription and case-mix-adjusted facility percentage of phosphate binder prescription using an instrumental-variable analysis. All-cause mortality. Overall, 88% of patients were prescribed phosphate binders. Distributions of age, comorbid conditions, and other characteristics showed small differences between facilities with higher and lower percentages of phosphate binder prescription. Patient-level phosphate binder prescription was associated strongly at baseline with indicators of better nutrition, ie, higher values for serum creatinine, albumin, normalized protein catabolic rate, and body mass index and absence of cachectic appearance. Overall, patients prescribed phosphate binders had 25% lower mortality (HR, 0.75; 95% CI, 0.68-0.83) when adjusted for serum phosphorus level and other covariates; further adjustment for nutritional indicators attenuated this association (HR, 0.88; 95% CI, 0.80-0.97). However, this inverse association was observed for only patients with serum phosphorus levels ≥3.5 mg/dL. In the instrumental-variable analysis, case-mix-adjusted facility percentage of phosphate binder prescription (range, 23%-100%) was associated positively with better nutritional status and inversely with mortality (HR for 10% more phosphate binders, 0.93; 95% CI, 0.89-0.96). Further adjustment for nutritional indicators reduced this association to an HR of 0.95 (95% CI, 0.92-0.99). Results were based on phosphate binder prescription; phosphate binder and nutritional data were cross
Full Text Available Ahmad Shuid Nazrun,1 Mohd Nizam Tzar,2 Sabarul Afian Mokhtar,3 Isa Naina Mohamed1 1Department of Pharmacology, 2Department of Medical Microbiology and Immunology, 3Department of Orthopedic, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia Purpose: Osteoporotic fracture is the main complication of osteoporosis. The current management is to discharge patients as early as possible so they can get back to their daily activities. Once discharged, there are three main issues relating to morbidity, mortality, and risk of a subsequent fracture that need to be addressed and discussed. Therefore, the aim of this systematic review was to summarize and evaluate the evidence from published literature, to determine the outcome of osteoporotic fracture patients after their hospital discharge.Methods: The MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL databases were searched, using the terms “osteoporosis”, “fracture”, “osteoporotic fracture”, “hip fracture”, and “vertebral fracture”. We included only human studies published in English between 2004 and 2014. The reference lists of included studies were thoroughly reviewed in search for other relevant studies.Results: A total of 18 studies met the selection criteria. Most were observational and cohort studies. Out of all the studies, five studies looked into the morbidity, six studies looked into the risk of subsequent fractures, and seven studies looked into mortality. Vertebral fracture caused the greatest health burden, but hip fracture patients were the main users of informal care after hospital discharge. There was an increased risk of a subsequent fracture after a primary fracture compared with the control group, a cohort comparison, or the general population. Osteoporotic fractures, especially hip fractures, are associated with higher mortality rate despite the advances in the management of osteoporotic fracture cases
Wallace, Sarah J; Worrall, Linda; Rose, Tanya; Le Dorze, Guylaine
This study synthesised the findings of three separate consensus processes exploring the perspectives of key stakeholder groups about important aphasia treatment outcomes. This process was conducted to generate recommendations for outcome domains to be included in a core outcome set for aphasia treatment trials. International Classification of Functioning, Disability, and Health codes were examined to identify where the groups of: (1) people with aphasia, (2) family members, (3) aphasia researchers, and (4) aphasia clinicians/managers, demonstrated congruence in their perspectives regarding important treatment outcomes. Codes were contextualized using qualitative data. Congruence across three or more stakeholder groups was evident for ICF chapters: Mental functions; Communication; and Services, systems, and policies. Quality of life was explicitly identified by clinicians/managers and researchers, while people with aphasia and their families identified outcomes known to be determinants of quality of life. Core aphasia outcomes include: language, emotional wellbeing, communication, patient-reported satisfaction with treatment and impact of treatment, and quality of life. International Classification of Functioning, Disability, and Health coding can be used to compare stakeholder perspectives and identify domains for core outcome sets. Pairing coding with qualitative data may ensure important nuances of meaning are retained. Implications for rehabilitation The outcomes measured in treatment research should be relevant to stakeholders and support health care decision making. Core outcome sets (agreed, minimum set of outcomes, and outcome measures) are increasingly being used to ensure the relevancy and consistency of the outcomes measured in treatment studies. Important aphasia treatment outcomes span all components of the International Classification of Functioning, Disability, and Health. Stakeholders demonstrated congruence in the identification of important
Fox, Ida K; Davidge, Kristen M; Novak, Christine B; Hoben, Gwendolyn; Kahn, Lorna C; Juknis, Neringa; Ruvinskaya, Rimma; Mackinnon, Susan E
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.
van Koperen, Paul J; de Jong, Vincent M; Luitse, Jan S K; Schepers, Tim
The standard operative treatment of Lisfranc fracture dislocations currently consists of open reduction and transarticular fixation. Recently, bridge plating has been used more often. Using joint spanning, the reduced fracture dislocation is temporary stabilized to minimize articular damage. The present study describes the outcomes of patients treated with bridge plating after tarsometatarsal fracture dislocations compared with transarticular screw fixation. A retrospective cohort study was performed. Patients with an isolated tarsometatarsal injury who had been treated operatively from June 2000 to October 2013 were included. The primary functional outcome was measured using the American Orthopaedic Foot and Ankle Society midfoot score and the Foot Function Index. The secondary outcome was patient satisfaction, which was measured using the EuroQol 5 dimensions questionnaire and a visual analog scale. A total of 34 patients were included. Bridge plating was used in 21 patients. In 13 patients, Kirschner wires or transarticular screws or a combination were used. The median follow-up period was 49 (interquartile range 18 to 89) months. The implants were removed in 10 of 13 patients in the transarticular group and 17 of 21 patients in the bridge plating group. The incidence of wound complications was comparable in both groups. The median American Orthopaedic Foot and Ankle Society score was lower in the transarticular group (77 versus 66). The Foot Function Index score was 18 in both groups. Patient satisfaction was 90% in the bridge plating group and 80% in the transarticular group. Bridge plating for Lisfranc injuries led to at least similar results compared with transarticular fixation in terms of functional outcomes and patient satisfaction. Longer follow-up is necessary to determine whether the prevention of secondary damage to the articular surface leads to less post-traumatic arthritis and better functional outcomes. Copyright © 2016 American College of Foot
Brown, Anthony; Gibson, Richard; Tavener, Meredith; Guest, Maya; D'Este, Catherine; Byles, Julie; Attia, John; Horsley, Keith; Harrex, Warren; Ross, James
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.
Witherow, Marta Parkanyi; Chandraiah, Shambhavi; Seals, Samantha R; Sarver, Dustin E; Parisi, Kathryn E; Bugan, Antal
Relational intimacy is hypothesized to underlie the association between female sexual functioning and various sexual outcomes, and married women and women with sexual dysfunction have been generally absent from prior studies investigating these associations, thus restricting generalizability. To investigate whether relational intimacy mediates sexual outcomes (sexual satisfaction, coital frequency, and sexual distress) in a sample of married women with and without impaired sexual functioning presenting in clinical settings. Using a cross-sectional design, 64 heterosexual married women with (n = 44) and without (n = 20) impaired sexual functioning completed a battery of validated measurements assessing relational intimacy, sexual dysfunction, sexual frequency, satisfaction, and distress. Intimacy measurements were combined using latent factor scores before analysis. Bias-corrected mediation models of the indirect effect were used to test mediation effects. Moderated mediation models examined whether indirect effects were influenced by age and marital duration. Patients completed the Female Sexual Function Index, the Couple's Satisfaction Index, the Sexual Satisfaction Scale for Women, the Inclusion of the Other in the Self Scale, and the Miller Social Intimacy Test. Mediation models showed that impaired sexual functioning is associated with all sexual outcomes directly and indirectly through relational intimacy. Results were predominantly independent of age and marital duration. Findings have important treatment implications for modifying interventions to focus on enhancing relational intimacy to improve the sexual functioning of women with impaired sexual functioning. The importance of the role relational intimacy plays in broad sexual outcomes of women with impaired sexual functioning is supported in clinically referred and married women. Latent factor scores to improve estimation of study constructs and the use of contemporary mediation analysis also are
Stankovic, Ivan; Janicijevic, Aleksandra; Dimic, Aleksandra; Stefanovic, Milica; Vidakovic, Radosav; Putnikovic, Biljana; Neskovic, Aleksandar N
Bundle branch blocks (BBB)-related mechanical dyssynchrony and dispersion may improve patient selection for device therapy, but their effect on the natural history of this patient population is unknown. A total of 155 patients with LVEF ≤ 35% and BBB, not treated with device therapy, were included. Mechanical dyssynchrony was defined as the presence of either septal flash or apical rocking. Contraction duration was assessed as time interval from the electrocardiographic R-(Q-)wave to peak longitudinal strain in each of 17 left ventricular segments. Mechanical dispersion was defined as either the standard deviation of all time intervals (dispersion SD ) or as the difference between the longest and shortest time intervals (dispersion delta ). Patients were followed for cardiac mortality during a median period of 33 months. Mechanical dyssynchrony was not associated with survival. More pronounced mechanical dispersion delta was found in patients with dyssynchrony than in those without. In the multivariate regression analysis, patients' functional class, diabetes mellitus and dispersion delta were independently associated with mortality. Mechanical dispersion, but not dyssynchrony, was independently associated with mortality and it may be useful for risk stratification of patients with heart failure (HF) and BBB. Key Messages Mechanical dispersion, measured by strain echocardiography, is associated with poor outcome in heart failure with a severely depressed left ventricular function and bundle branch blocks. Mechanical dispersion may be useful for risk stratification of patients with heart failure and bundle branch blocks.
Guney, Hande; Yuksel, Inci; Kaya, Defne; Doral, Mahmut Nedim
The aim of this study was to investigate the correlation between quadriceps to hamstring (Q:H) ratio and the functional outcomes in Patellofemoral Pain (PFP) patients. The study included forty-four women diagnosed with unilateral PFP. Eccentric and concentric quadriceps and hamstring strength were recorded. Conventional Q:H ratio was calculated as the concentric quadriceps to concentric hamstring peak torque (Ratio 1). Functional ratios were calculated as the eccentric quadriceps to concentric hamstring peak torque (Ratio 2) and as the concentric quadriceps to eccentric hamstring torque (Ratio 3). Functional levels of the patients were determined by using Kujala scores, hop test and step test. Pain levels during activities were recorded. The relationship among Ratio 1, Ratio 2 and Ratio 3 with functional outcomes and pain levels were evaluated using Spearman's correlation coefficient test. Eccentric and concentric quadriceps and hamstring strength were lower on involved side than uninvolved side. Ratio 2 correlated stronger with Kujala score (r=0.69) than Ratio 1 (r=0.49) and Ratio 3 (r=0.30). Step test (r=0.35) and hop test (r=0.38) only correlated with Ratio 2. Pain levels correlated more with Ratio 2 (r values ranged between 0.38 and 0.48). Eccentric quadriceps to concentric hamstring ratio was observed more related to the functional outcomes and painful activities in patients with PFP. Cross-sectional study. Copyright © 2016 Elsevier B.V. All rights reserved.
Savitz, D.A.; Whelan, E.A.; Kleckner, R.C.
Although fetal development is known to be sensitive to environmental agents, relatively little epidemiologic research has addressed this concern. Effects on pregnancy outcome of self-reported parental exposure to pesticides and to radiation were examined using data from the National Natality and Fetal Mortality Surveys, large national probability samples of live births and stillbirths occurring in 1980. In case-control analyses, maternal exposure to pesticides at home or work was associated with increased risk of stillbirth (odds ratios (ORs) = 1.5-1.6). Paternal pesticide exposure was associated with stillbirth (ORs = 1.2-1.4) and delivery of small-for-gestational-age infants (ORs = 1.4-2.0). A small increased risk of stillbirth (OR = 1.3) was found in relation to either parent's reported exposure to radiation. In spite of limitations in the quality of exposure data and the possibility of biased recall related to pregnancy outcome, associations of reported pesticide exposure to either parent with risk of stillbirth and small-for-gestational-age infants warrant further evaluation
Full Text Available Of the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable.Retrospective analysis of births records from 2008 to 2015 at Shoklo Malaria Research Unit (SMRU on the Thailand-Myanmar border.From 21,225 newbonrs delivered, 15,073 (71% met the inclusion criteria (liveborn, singleton, ≥28 weeks' gestation, delivered in SMRU. Neonatal resuscitation was performed in 460 (3%; 422 basic, 38 advanced cases. Overall early neonatal mortality was 6.6 deaths per 1000 live births (95% CI 5.40-8.06. Newborns receiving basic and advanced resuscitation presented an adjusted rate for death of 1.30 (95%CI 0.66-2.55; p = 0.442, and 6.32 (95%CI 3.01-13.26; p<0.001 respectively, compared to newborns given routine care. Main factors related to increased need for resuscitation were breech delivery, meconium, and fetal distress (p<0.001. Neurodevelopmental follow-up to one year was performed in 1,608 (10.5% of the 15,073 newborns; median neurodevelopmental scores of non-resuscitated newborns and those receiving basic resuscitation were similar (64 (n = 1565 versus 63 (n = 41; p = 0.732, while advanced resuscitation scores were significantly lower (56 (n = 5; p = 0.017.Newborns requiring basic resuscitation at birth have normal neuro-developmental outcomes at one year of age compared to low-risk newborns. Identification of risk factors (e.g., breech delivery associated with increased need for neonatal resuscitation may facilitate allocation of staff to high-risk deliveries. This work endorses the use of basic resuscitation in low-resource settings, and supports on-going staff training to maintain bag-and-mask ventilation skills.
Full Text Available Background. Cervical spondylosis can cause three different categories of symptoms and signs with possible overlap in the affected patients. Aim. We aim to compare functional outcome of surgery in the patients with cervical spondylotic radiculopathy and myelopathy, regardless of their surgical type and approach. Materials and Methods. We retrospectively reviewed 140 patients with cervical spondylotic radiculopathy and myelopathy who had been operated from August 2006 to January 2011, as Group A (68 cases and Group B (72 cases, respectively. The mean age was 48.2 and 55.7 years, while the mean followup was 38.9 and 37.3 months, respectively. Functional outcome of the patients was assessed by neck disability index (NDI and patient satisfaction with surgery. Results. Only in Group A, the longer delay caused a worse surgical outcome (NDI. In addition, in Group B, there was no significant relationship between imaging signal change of the spinal cord and our surgical outcomes. Improvement in NDI and final satisfaction rate in both groups are comparable. Conclusions. Surgery was associated with an improvement in NDI in both groups (P<0.001. The functional results in both groups were similar and comparable, regarding this index and patient's satisfaction score.
Menga, Emmanuel N; Kebaish, Khaled M; Jain, Amit; Carrino, John A; Sponseller, Paul D
Prospective analysis. Our objective was to analyze clinical and functional results of patients with spondylolysis treated via direct intralaminar screw fixation and autograft, a minimally invasive and motion-preserving surgery. Spondylolysis is usually treated nonoperatively; multiple surgical techniques are available when nonoperative measures fail. No studies evaluate the clinical and functional outcomes and their correlation with pars defect size and disc morphology on magnetic resonance imaging. We reviewed patients with spondylolysis treated with intralaminar screw fixation and bone grafting from 2000 through 2010. Of the 31 patients (mean age, 16 yr; range, 10-37 yr), 25 (81%) were competitive athletes. Preoperative computed tomographic scans were used to measure the pars defect size, and preoperative magnetic resonance images were graded using Pfirrmann classification for correlation with postoperative outcomes. Student t test was used for analysis (significance, P spondylolysis repair for persistent pain starting 18 months after intralaminar screw fixation, 2 patients sustained unilateral intralaminar screw fractures at L5, and 1 patient required irrigation and debridement for a superficial postoperative infection. There was no correlation among preoperative magnetic resonance imaging disc morphology, defect size on computed tomography, patient age, and clinical outcomes. Direct repair of spondylolysis with intralaminar screws offers a low profile, reliable treatment with good functional outcome and a low complication rate in active patients. 4.
Hung, Man; Baumhauer, Judith F; Latt, L Daniel; Saltzman, Charles L; SooHoo, Nelson F; Hunt, Kenneth J
In 2012, the American Orthopaedic Foot & Ankle Society(®) established a national network for collecting and sharing data on treatment outcomes and improving patient care. One of the network's initiatives is to explore the use of computerized adaptive tests (CATs) for patient-level outcome reporting. We determined whether the CAT from the NIH Patient Reported Outcome Measurement Information System(®) (PROMIS(®)) Physical Function (PF) item bank provides efficient, reliable, valid, precise, and adequately covered point estimates of patients' physical function. After informed consent, 288 patients with a mean age of 51 years (range, 18-81 years) undergoing surgery for common foot and ankle problems completed a web-based questionnaire. Efficiency was determined by time for test administration. Reliability was assessed with person and item reliability estimates. Validity evaluation included content validity from expert review and construct validity measured against the PROMIS(®) Pain CAT and patient responses based on tradeoff perceptions. Precision was assessed by standard error of measurement (SEM) across patients' physical function levels. Instrument coverage was based on a person-item map. Average time of test administration was 47 seconds. Reliability was 0.96 for person and 0.99 for item. Construct validity against the Pain CAT had an r value of -0.657 (p foot and ankle surgery. Further validation of the PROMIS(®) item banks may ultimately provide a valid and reliable tool for measuring patient-reported outcomes after injuries and treatment.
De Carlo, Francesco; Celestino, Francesco; Verri, Cristian; Masedu, Francesco; Liberati, Emanuele; Di Stasi, Savino Mauro
Despite the wide diffusion of minimally invasive approaches, such as laparoscopic (LRP) and robot-assisted radical prostatectomy (RALP), few studies compare the results of these techniques with the retropubic radical prostatectomy (RRP) approach. The aim of this study is to compare the surgical, functional, and oncological outcomes and cost-effectiveness of RRP, LRP, and RALP. A systematic review of the literature was performed in the PubMed and Embase databases in December 2013. A 'free-text' protocol using the term 'radical prostatectomy' was applied. A total of 16,085 records were found. The authors reviewed the records to identify comparative studies to include in the review. 44 comparative studies were identified. With regard to the perioperative outcome, LRP and RALP were more time-consuming than RRP, but blood loss, transfusion rates, catheterisation time, hospitalisation duration, and complication rates were the most optimal in the laparoscopic approaches. With regard to the functional and oncological results, RALP was found to have the best outcomes. Our study confirmed the well-known perioperative advantage of minimally invasive techniques; however, available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. On the contrary, cost comparison clearly supports RRP.
Kovarik, Miroslav; Hronek, Miloslav; Zadak, Zdenek
Lung cancer belongs to the type of tumors with a relatively high frequency of malnutrition, sarcopenia and cachexia, severe metabolic syndromes related to impairment of physical function and quality of life, resistance to therapy and short survival. Inexpensive and accessible methods of evaluating changes in body composition, physical function and nutrition status are for this reason of great importance for clinical practice to enable the early identification, monitoring, preventing and treatment of these nutritional deficiencies. This could lead to improved outcomes in the quality of life, physical performance and survival of patients with lung cancer. The aim of this article is to summarize the recent knowledge for the use of such methods, their predictability for patient outcomes and an association with other clinically relevant parameters, specifically with lung cancer patients, because such an article collectively describing their practical application in clinical practice is lacking. The interest of this article is in the use of anthropometry, handgrip dynamometry, bioelectrical impedance analysis derived phase angle and nutritional screening questionnaires in lung cancer patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Wu, Xuehai; Zou, Qihong; Hu, Jin; Tang, Weijun; Mao, Ying; Gao, Liang; Zhu, Jianhong; Jin, Yi; Wu, Xin; Lu, Lu; Zhang, Yaojun; Zhang, Yao; Dai, Zhengjia; Gao, Jia-Hong; Weng, Xuchu; Zhou, Liangfu; Northoff, Georg; Giacino, Joseph T; He, Yong; Yang, Yihong
For accurate diagnosis and prognostic prediction of acquired brain injury (ABI), it is crucial to understand the neurobiological mechanisms underlying loss of consciousness. However, there is no consensus on which regions and networks act as biomarkers for consciousness level and recovery outcome in ABI. Using resting-state fMRI, we assessed intrinsic functional connectivity strength (FCS) of whole-brain networks in a large sample of 99 ABI patients with varying degrees of consciousness loss (including fully preserved consciousness state, minimally conscious state, unresponsive wakefulness syndrome/vegetative state, and coma) and 34 healthy control subjects. Consciousness level was evaluated using the Glasgow Coma Scale and Coma Recovery Scale-Revised on the day of fMRI scanning; recovery outcome was assessed using the Glasgow Outcome Scale 3 months after the fMRI scanning. One-way ANOVA of FCS, Spearman correlation analyses between FCS and the consciousness level and recovery outcome, and FCS-based multivariate pattern analysis were performed. We found decreased FCS with loss of consciousness primarily distributed in the posterior cingulate cortex/precuneus (PCC/PCU), medial prefrontal cortex, and lateral parietal cortex. The FCS values of these regions were significantly correlated with consciousness level and recovery outcome. Multivariate support vector machine discrimination analysis revealed that the FCS patterns predicted whether patients with unresponsive wakefulness syndrome/vegetative state and coma would regain consciousness with an accuracy of 81.25%, and the most discriminative region was the PCC/PCU. These findings suggest that intrinsic functional connectivity patterns of the human posteromedial cortex could serve as a potential indicator for consciousness level and recovery outcome in individuals with ABI. Varying degrees of consciousness loss and recovery are commonly observed in acquired brain injury patients, yet the underlying neurobiological
Tei, Hideaki; Uchiyama, Sinichiro; Usui, Toru; Ohara, Kuniko
Whether lesion volume on diffusion-weighted MRI imaging (DWI) can reliably predict functional outcome in acute ischemic stroke is controversial. The aim of our study was to assess whether the Alberta Stroke Program Early CT Score (ASPECTS) on DWI is useful for predicting functional outcome in patients with anterior circulation infarction with a broad range of severities. Three-hundred and fifty patients with first-ever ischemic stroke in the anterior circulation within 24 h of onset were enrolled. We compared background characteristics, vital signs, laboratory data, and MRI findings between favorable (F) and unfavorable (U) outcome groups at 3 months, according to the modified Rankin Scale (mRS). The F and U groups were defined as having a mRS of 0-2 and 3-6, respectively. DWI ASPECTS was scored by DWI obtained 3-24 h after onset. Two-hundred and eighteen patients (62.3%) were classified into the F group and 132 patients (37.7%) into the U group. On univariate analysis, the F group patients were younger, had lower score of the National Institutes of Health Stroke Scale (NIHSS) at entry (5.7 ± 3.3 vs. 14.2 ± 6.0), male predominance, longer time after onset, lower rate of prior antithrombotic therapy, higher hematocrit and lower fibrinogen than the U group patients. Stroke subtype was different between the two groups, and F group patients had higher DWI ASPECTS score, lower leukoaraiosis and medial temporal atrophy score, and lower rate of early neurological deterioration (END) than the U group patients. Multiple logistic regression analysis revealed that NIHSS (p < 0.001), prior antithrombotic therapy (p = 0.013), ASPECTS (p = 0.002), and END (p < 0.001) were independent predictors of functional outcome. DWI ASPECTS can be an independent predictor for functional outcome, along with other clinical variables.
Full Text Available Background: We aimed to compare the surgical, oncological, and functional outcomes of robot-assisted partial nephrectomy (RAPN with open partial nephrectomy (OPN in the management of small renal masses. Materials and Methods: Between 2009 and 2013, a total of 46 RAPN patients and 20 OPN patients was included in this study. Patients′ demographics, mean operative time, estimated blood loss (EBL, warm ischemia time (WIT, length of hospital stay, pre- and post-operative renal functions, complications and oncological outcomes were recorded, prospectively. Results: Mean tumor size was 4.04 cm in OPN group and 3.56 cm in RAPN group (P = 0.27. Mean R.E.N.A.L nephrometry score was 6.35 in OPN group and 5.35 in RAPN group (P = 0.02. The mean operative time was 152 min in OPN group and 225 min in RAPN group (P = 0.006. The mean EBL in OPN and RAPN groups were 417 ml and 268 ml, respectively (P = 0.001. WIT in OPN group was significantly shorter than RAPN group (18.02 min vs. 23.33 min, P = 0.003. The mean drain removal time and the length of hospital stay were longer in OPN group. There were no significant differences in terms of renal functional outcomes and postoperative complications between groups. Conclusion: Minimally invasive surgical management of renal masses with RAPN offers better outcomes in terms of EBL and length of stay. However, the mean operative time and WIT were significantly shorter in OPN group. RAPN is a safe and effective minimally invasive alternative to OPN in terms of oncological and functional outcomes.
Katja, Pynnönen; Timo, Törmäkangas; Taina, Rantanen; Tiina-Mari, Lyyra
Social activity and health correlate in old age, but less is known about what explains this association. The aim of this study was to investigate whether mobility, cognitive functioning, and depressive symptoms mediate the association between social activity and mortality risk, or whether they alternatively should be considered as prerequisites for social activity in older Finnish men and women. In 1988, 406 men and 775 women aged 65-84 years took part in face-to-face interviews about their health, socioeconomic status, and social activities. Confirmatory factor analyses were used to form latent variables describing collective and productive social activity. Latent variable models were used to investigate the possible pathways among social activity, mobility, cognitive functioning, depressive symptoms, and mortality risk. In the 21-year follow-up, 89 % of men and 81 % of women had died. Collective and productive social activity correlated with a lower risk for mortality among men and women. Part of the association between social activity and mortality was mediated by mobility. Cognitive functioning and depressive symptoms were not mediators in the association. Instead, good cognitive functioning and having less depressive symptoms were prerequisites for participating in collective social activity among men and women. Among men, good cognitive functioning, and among women, good cognitive functioning and having less depressive symptoms were prerequisites for productive social activity. The health-enhancing influences of social activity may be partly explained by better mobility among persons who are socially active. Moreover, social activity may maintain mobility and thus decreases mortality risk, as many social activities also include physical activity. Better cognitive functioning and having less depressive symptoms should be considered as prerequisites for participating in social activities.
Naumann, Markus G; Sigurdsen, Ulf; Utvåg, Stein Erik; Stavem, Knut
To compare the functional outcomes between patients with and without postoperative surgical-site infection (SSI) after surgical treatment in closed ankle fractures. Retrospective cohort study with prospective follow-up. Of 1011 treated patients, 959 were eligible for inclusion in a postal survey. Functional outcomes were assessed using three self-reported questionnaires. In total 567 patients responded a median of 4.3 years (range 3.1-6.2 years) after surgery. In total 29/567 had an SSI. The mean Olerud and Molander Ankle Score was 19.8 points lower for patients with a deep SSI (p=0.02), the Lower Extremity Functional Scale score was 10.2 points lower (p<0.01) and the Self-Reported Foot & Ankle Questionnaire score was 5.0 points higher (p=0.10) than for those without an SSI, after adjusting for age, sex, smoking status, diabetes, physical status, fracture classification and duration of surgery. Patients with a deep SSI had worse long-term functional outcomes than those without an SSI. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
Hamilton, Holly K; Sun, Jane C; Green, Michael F; Kee, Kimmy S; Lee, Junghee; Sergi, Mark; Sholty, Gretchen L; Mathis, Kristopher I; Jetton, Christopher; Williams, Terrance J; Kern, Robert; Horan, William; Fiske, Alan; Subotnik, Kenneth L; Ventura, Joseph; Hellemann, Gerhard; Nuechterlein, Keith H; Yee, Cindy M
Individuals with schizophrenia face significant challenges in daily functioning, and although social cognition predicts how well patients respond to these challenges, associated physiological mechanisms remain unspecified. The present study draws from polyvagal theory and tested the hypothesis that respiratory sinus arrhythmia (RSA), an established indicator of the capacity to self-regulate and adapt to environmental demands, combines with social cognition to predict functional outcome. Using data from 41 schizophrenia patients and 36 healthy comparison subjects, we replicated group differences in RSA and social cognition and also demonstrated that RSA and social cognition interact to predict how effectively patients manage work and independent living activities. Specifically, RSA did not enhance functional outcomes when social cognition was already strong, but higher levels of RSA enabled effective role functioning when social-cognitive performance was impaired. Jointly, RSA and social cognition accounted for 40% of the variance in outcome success, compared with 21% when evaluating social cognition alone. As polyvagal theory suggests, physiological flexibility and self-regulatory capacity may compensate for poorer social-cognitive skills among schizophrenia patients.
Buchholtz, Kristine; Larsen, Carsten T; Hassager, Christian
function at the time of admittance. METHODS: In a prospective observational cohort study data from 235 consecutive IE patients were collected at 2 tertiary heart centres in Copenhagen. Kidney function was evaluated as Estimated Endogenous Creatinine Clearance (EECC) calculated at the time of admission...... was demonstrated, PCalculated EECC at the time of admission is easily obtained in all IE patients.......9%) and Staphylococcus aureus (21.8%). Mean follow-up time was 453 days (SD 350). A total number of 76 patients died (32%), with an in-hospital mortality of 14%, and a post discharge mortality of 18%. In 64.9% EECC was decreased at time of admission, and a highly significant relationship between EECC and mortality...
Steens, W; Rosenbaum, D; Goetze, C; Gosheger, G; van den Daele, R; Steinbeck, J
The purpose of this study was to objectively assess the functional outcome after implantation of a Thrust Plate Prosthesis. This retrospective study compared the gait patterns of 33 patients to a control group. Few studies have been published about this type of prosthesis describing clinical and radiographic outcome. Even though the evaluation of the functional outcome is a commonly accepted way to measure the success of an implant it has not been reported in previous studies. Beside clinical (SF-36, and Harris Hip Score) and radiographic evaluation subjects were examined by three dimensional gait analysis and surface electromyography from seven leg and trunk muscles bilaterally. The average Harris Hip Score was 85.7 points, and the SF-36 only differed significantly from controls regarding physical functioning. The radiography showed considerable radiolucencies under the Thrust Plate. Kinematic parameters indicated a slight impairment of the operated limb. The analysis revealed a decreased hip (28.2%) and knee (51.2%) range of motion during gait. The joint moments on the operated side were reduced in hip (72%) and knee abduction (59%) in comparison to controls. The average electromyographic parameters indicated a significantly higher mean and peak amplitude of the tensor fasciae latae (mean 56%, peak 54%), and gluteus medius (mean 33%, peak 21%) and a lower peak activity of the gluteus maximus (19%). The results indicate a generally good functional outcome even though a slightly asymmetrical loading was observed. No major limitations in physical functioning and health-related quality of life was seen. The radiographic signs of loosening might indicate difficulties in achieving the proximal load transfer of this implant. The data provided in this study may serve to establish the Thrust Plate Prosthesis as an alternative procedure in total hip replacement in younger patients.
Lim, Jun Wei; Ridley, David; Johnston, Linda R; Clift, Benedict A
The coexistence of a stable femoral and a loose acetabular component may pose a clinical dilemma for the surgeon. Our study aims at comparing the intermediate functional outcomes and survivorship of acetabulum-only revision total hip arthroplasty (ArTHA) with an age-matched and gender-matched total revision THA (TrTHA) group. We retrospectively reviewed prospectively collected data on the pain, function, and total Harris Hip Scores (HHS) and complication profile for ArTHA and TrTHA cohorts from our regional arthroplasty database. Kaplan-Meier survivorship, with the need for repeat revision surgery as the end point, was used for survival analysis. Among 538 cases, there were fewer acute medical complications in ArTHA and a similar dislocation rate for both cohorts. Preoperative HHS for pain, function, and total were better in the ArTHA cohort, but only the function score reached statistical significance. No significant differences in subsequent years for all aspects of HHS, except the function score was significantly better in the ArTHA cohort at year 1. And 10.0% of ArTHAs and 7.8% of TrTHAs had required rerevision. The 5-year survivorship was 90.3% (95% confidence interval ± 2.1%) for the ArTHA cohort and 92.7% (95% confidence interval ± 1.8%) for the TrTHA cohort (P = .394). The ArTHA with posterior approach (n = 118) group had the lowest dislocation rate and the best trend of functional outcomes. ArTHA can provide similar functional outcomes and dislocation rate to TrTHA, with an acceptable rerevision rate. The posterior approach in this study was not associated with a significant dislocation rate. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.
Full Text Available Background/Aim. Spinal cord injuries (SCI could be associated with a significant functional impairment in the areas of mobility, self-care, bowel and bladder emptying and sexuality. The aim of this study was to compare demographic characteristics and functional outcomes of nontraumatic and traumatic spinal cord injury patients. Methods. This study was designed as retrospective case series study. A detailed medical history including sex, age, mode of trauma, and clinical and radiological examination was taken for all patients. Hospital records were used to classify the patients according to the following: mechanism of injury, neurological level of injury, functional outcomes, associated injuries, method of treatment, secondary complications and length of stay. The following clinical scores were measured in the patients: American Spinal Injury Association standards (CASTA, Functional Independence Measure (FIM, and Modified Aschworth score (MAS. Results. Out of totally 441 patients with spinal cord injury, 279 were traumatic patients (TSCI and 162 nontraumatic patients (NTSCI; 322 men and 119 women. The mean age of the patients was 46.1 ± 19.9 years. Traumatic and nontraumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower FIM score at admission and significantly better improvement in the FIM score at discharge. The two populations were discharged with similar functional outcome. Conclusions. The NTSCI patients in our study were younger, more frequently female, with less complications before rehabilitation and less frequently treated operatively than the TSCI patients. Hospital rehabilitation of the TSCI patients was longer than that of the NTSCI patients, but their functional gain from admission was also higher, so at discharge. Traumatic and nontraumatic spinal cord lesion patients achieved similar
Gulin, Tonko; Kruljac, Ivan; Kirigin, Lora; Merc, Marcela; Pavić, Marina; Trcin, Mirna Tominac; Bokulić, Adrijana; Megla, Željka Bukovec; Kaštelan, Darko
Risk factors for increased mortality in hip fracture patients include older age, male sex, fracture type, bone mineral density, and pre-existing co-morbidities. The role of biochemical and other anthropometric parameters on hip fracture mortality remains unclear. The aim of this study was to identify the risk factors for one-year mortality in patients with hip fractures. A total of 236 consecutive patients (59 males) with hip fractures were followed over a one-year period. Patient age, gender, type of fracture, type of treatment, time from admission to surgery, type of anesthesia, body mass index, and electrocardiograms were recorded. Complete blood counts, serum electrolytes, urea, creatinine, d-dimers, calcium, phosphate, osteocalcin, and beta-isomerised C-terminal telopeptide of collagen type I (β-CTX) were measured at admission and estimated glomerular filtration rate (eGFR) was calculated. Multivariate Cox regression models were used to analyze the association of these parameters with survival. One-year mortality rate was 28.4%. Age was independently associated with mortality (HR 1.117, 95% CI 1.062-1.174, P 0.276 g/L (3.5 vs. 25.7%, HR 9.5, 95% CI 2.11-42.76). Advanced age, high β-CTX levels, and impaired renal function are independent risk factors of mortality in patients with hip fractures.
Sposato, Luciano A; Cohen, Geoffrey; Wardlaw, Joanna M; Sandercock, Peter; Lindley, Richard I; Hachinski, Vladimir
In patients with acute ischemic stroke, whether involvement of the insular cortex influences outcome is controversial. Much of the apparent adverse outcome may relate to such strokes usually being severe. We examined the influence of right and left insular involvement on stroke outcomes among patients from the IST-3 study (Third International Stroke Trial) who had visible ischemic stroke on neuroimaging. We used multiple logistic regression to compare outcomes of left versus right insular and noninsular strokes across strata of stroke severity, on death, proportion dead or dependent, and level of disability (ordinalized Oxford Handicap Score) at 6 months, with adjustment for the effects of age, lesion size, and presence of atrial fibrillation. Of 3035 patients recruited, 2099 had visible ischemic strokes limited to a single hemisphere on computed tomography/magnetic resonance scans. Of these, 566 and 714 had infarction of right and left insula. Six months after randomization, right insular involvement was associated with increased odds of death when compared with noninsular strokes on the left side (adjusted odds ratio, 1.83; 95% confidence interval, 1.33-2.52), whereas the adjusted odds ratio comparing mortality after insular versus noninsular strokes on the left side was not significant. Among mild/moderate strokes, outcomes for right insular involvement were worse than for left insular, but among more severe strokes, the difference in outcomes was less substantial. We found an association between right insular involvement and higher odds of death and worse functional outcome. The difference between right- and left-sided insular lesions on outcomes seemed to be most evident for mild/moderate strokes. URL: http://www.isrctn.com. Unique identifier: ISRCTN25765518. © 2016 American Heart Association, Inc.
Mahon, Caitlin E; Pruziner, Alison L; Hendershot, Brad D; Wolf, Erik J; Darter, Benjamin J; Foreman, K Bo; Webster, Joseph B
Altered body structures that occur with the loss of a lower limb can impact mobility and quality of life. Specifically, biomechanical changes that result from wearing a prosthesis have been associated with an increased risk of falls or joint degeneration, as well as increased energy demands. While previous studies describing these outcomes are typically limited by number of outcome measures and/or small, diverse patient groups, recent military conflicts present a unique opportunity to collect outcomes from a relatively homogenous, active patient population with limb loss. Thus, the objective of this study is to provide reference outcome measures on the basis of a large, relatively homogenous cohort of military personnel with transfemoral limb loss. A retrospective review of biomechanical, physiological, functional, and subjective measures was completed for 67 male servicemembers who sustained an injury resulting in traumatic, transfemoral limb loss during recent conflicts. These individuals represent a defined cohort, capable of exhibiting improved clinical outcomes resulting from demographic characteristics and extensive rehabilitation. Biomechanical and physiological outcome measures for 76 uninjured male servicemembers are also provided to serve as normative reference for full return to function. Select biomechanical and physiological outcomes related to stability, overuse, and efficiency are discussed in the text, on the basis of relevance to clinical gait assessment, in addition to functional and subjective measures. In general, individuals with transfemoral limb loss exhibit decreased stability relative to uninjured individuals, noted by larger peak trunk velocity and step width variability; increased risk of low back and knee joint pain and/or degeneration, noted by larger trunk lateral flexion and bending moments, as well as larger vertical ground reaction force (vGRF) loading rates and impulses, respectively; and decreased efficiency during gait, noted by
Goss, Christopher H; Sykes, Jenna; Stanojevic, Sanja; Marshall, Bruce; Petren, Kristofer; Ostrenga, Josh; Fink, Aliza; Elbert, Alexander; Quon, Bradley S; Stephenson, Anne L
A 10-year gap in the median age of survival for patients with cystic fibrosis (CF) was reported between patients living in Canada compared with patients living in the United States. Because both malnutrition and poor lung function are associated with an increased risk of mortality in CF, we investigated the temporal and longitudinal trends in lung function and nutrition between Canada and the United States. This cohort study used Canadian CF Registry and U.S. CF Foundation Patient Registry data from 1990 to 2013. A unified dataset was created to harmonize the variables collected within the two registries for the purpose of comparing outcomes between the two countries. We conducted three analyses: survival differences by birth cohort; population trends for FEV 1 and body mass index (BMI) over time; and individual patient FEV 1 and BMI trajectories. The study included a total of 37,772 patients in the United States and 5,149 patients in Canada. Patients with CF experienced significant improvements in nutritional status and lung function in both Canada and the United States during the study. In addition, the survival gap between the two countries is narrowing within younger birth cohorts. The improvements for the patients within the United States were most prominent in the BMI trajectories, where patients born after 1990 in the United States have higher BMI that has persisted over time. The reasons for the observed improvements, and catch-up in the United States, are likely multifactorial and include the introduction of high-fat, high-calorie diets; introduction of newborn screening; and/or improved access to care for CF children in the United States.
Astradsson, Arnar; Munck Af Rosenschöld, Per; Feldt-Rasmussen, Ulla
BACKGROUND: The purpose of this study was to examine visual outcome, endocrine function and tumor control in a prospective cohort of craniopharyngioma patients, treated with fractionated stereotactic radiation therapy (FSRT). MATERIAL AND METHODS: Sixteen adult patients with craniopharyngiomas were.......7-13.1) for visual outcome, endocrine function, and tumor control, respectively. RESULTS: Visual acuity impairment was present in 10 patients (62.5%) and visual field defects were present in 12 patients (75%) before FSRT. One patient developed radiation-induced optic neuropathy at seven years after FSRT. Thirteen...... of 16 patients (81.3%) had pituitary deficiency before FSRT, and did not develop further pituitary deficiency after FSRT. Mean tumor volume pre-FSRT was 2.72 cm3(range 0.20-9.90) and post-FSRT 1.2 cm3(range 0.00-13.10). Tumor control rate was 81.3% at two, five, and 10 years after FSRT. CONCLUSIONS...
Parlevliet, Juliette L.; MacNeil-Vroomen, Janet; Buurman, Bianca M.; de Rooij, Sophia E.; Bosmans, Judith E.
ObjectivesTo assess the independent association between health-related quality of life (HRQOL) at admission and mortality, functional decline, and institutionalization 3 and 12months after admission in acutely hospitalized older adults. DesignPost hoc analysis of data from prospective cohort study,
Osté, M.C.J.; Gomes-neto, A.W.; Corpeleijn, E.; Gans, R.O.B.; De Borst, M.H.; Van Den Berg, E.; Soedamah-Muthu, S.S.; Kromhout, D.; Navis, G.J.; Bakker, S.J.L.
Renal transplant recipients (RTR) are at risk of decline of graft function and premature mortality, with high blood pressure as important risk factor for both. To study the association of the Dietary Approach to Stop Hypertension (DASH) diet with these adverse events, we conducted a prospective
Phillips, David E; AbouZahr, Carla; Lopez, Alan D; Mikkelsen, Lene; de Savigny, Don; Lozano, Rafael; Wilmoth, John; Setel, Philip W
In this Series paper, we examine whether well functioning civil registration and vital statistics (CRVS) systems are associated with improved population health outcomes. We present a conceptual model connecting CRVS to wellbeing, and describe an ecological association between CRVS and health outcomes. The conceptual model posits that the legal identity that civil registration provides to individuals is key to access entitlements and services. Vital statistics produced by CRVS systems provide essential information for public health policy and prevention. These outcomes benefit individuals and societies, including improved health. We use marginal linear models and lag-lead analysis to measure ecological associations between a composite metric of CRVS performance and three health outcomes. Results are consistent with the conceptual model: improved CRVS performance coincides with improved health outcomes worldwide in a temporally consistent manner. Investment to strengthen CRVS systems is not only an important goal for individuals and societies, but also a development imperative that is good for health. Copyright © 2015 Elsevier Ltd. All rights reserved.
Lad, Dnyanesh G; Thilak, Jai; Thadi, Mohan
Incorrect positioning of the implant and improper alignment of the limb following total knee arthroplasty (TKA) can lead to rapid implant wear, loosening, and suboptimal function. Studies suggest that alignment errors of > 3° are associated with rapid failure and less satisfactory function. Computer navigated systems have been developed to enhance precision in instrumentation during surgery. The aim of the study was to compare component alignment following computer assisted surgery (CAS) and jig based TKA as well as functional outcome. This is a prospective study of 100 knees to compare computer-assisted TKA and jig-based surgery in relation to femoral and tibial component alignment and functional outcome. The postoperative x-rays (anteroposterior and lateral) of the knee and CT scanogram from hip to foot were obtained. The coronal alignment of the femoral and tibial components and rotational alignment of femoral component was calculated. Knee society score at 24 months was used to assess the function. Results of our study show that mean placement of the tibial component in coronal plane (91.3037°) and sagittal planes (3.6058°) was significantly better with CAS. The difference was statistically insignificant in case of mean coronal alignment of the femoral components (90.34210° in navigation group and 90.5444° in jig group) and in case of the mean femoral condylar twist angle (external rotation 2.3406° in navigation group versus 2.3593° in jig group). A significantly improved placement of the component was found in the coronal and sagittal planes of the tibial component by CAS. The placement of the components in the other planes was comparable with the values recorded in the jig-based surgery group. Functional outcome was not significantly different.
Ball, Jill E; Ball, Chad G; Mulloy, Robert H; Datta, Indraneel; Kirkpatrick, Andrew W
Abstract Background Horseback riding is considered more dangerous than motorcycle riding, skiing, automobile racing, football and rugby. The integral role of rehabilitation therapy in the recovery of patients who have sustained a major horse-related injury is previously not described. The goals of this paper were to (1) define the incidence and pattern of severe equestrian trauma, (2) identify the current level of in-patient rehabilitation services, (3) describe functional outcomes for patien...
Holtkamp, M; Buchheim, K; Unterberg, A; Hoffmann, O; Schielke, E; Weber, J; Masuhr, F
OBJECTIVE—To assess the survival rate and functional outcome in elderly patients with space occupying supratentorial infarction who underwent hemicraniectomy compared with those who received medical treatment alone. METHODS—All patients older than 55 years with space occupying middle cerebral artery (MCA) infarction treated in our clinic between January 1998 and July 1999 were included in this retrospective analysis. Patients were eligible for decompressive surgery if they w...
Zaheer, Sana; Beg, Mujahid; Rizvi, Imran; Islam, Najmul; Ullah, Ekram; Akhtar, Nishat
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 < 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). 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.
Flosadottir, Vala; Roos, Ewa M; Ageberg, Eva
extremity muscle function and PROs after ACL injury. METHODS: Fifty-four participants (15 women, mean 30 years) with ACL injury or reconstruction, from the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial (ISRCTN84752559), were assessed with hop performance, muscle power...... and postural orientation 3 years (SD 0.85) after ACL injury. PROs at 3 and 5 years after injury included Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Function in sport and recreation (KOOS Sport/rec) and Knee-related Quality of life (KOOS QoL), KOOS item Q3 (KOOS Q3), Tegner Activity Scale...
Schröder, Andreas; Ørnbøl, Eva; Fink, Per
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...... mental health subscales showed no significant differences. Conclusion The negative weights of the orthogonal factor solution distorted the results in both study samples. As outcome measures, PCS and MCS should be interpreted with caution in patients with functional disorders and in other patient groups...
Schneider, Hauke; Hertel, Franziska; Kuhn, Matthias; Ragaller, Maximilian; Gottschlich, Birgit; Trabitzsch, Anne; Dengl, Markus; Neudert, Marcus; Reichmann, Heinz; Wöpking, Sigrid
Tracheostomy is performed in ventilated stroke patients affected by persisting severe dysphagia, reduced level of consciousness, or prolonged mechanical ventilation. The study aim was to determine the frequency and predictors of successful decannulation and long-term functional outcome in tracheotomized stroke patients. A prospective single-center observational study recruited ventilated patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Follow-up visits were performed at hospital discharge, 3, and 12 months. Competing risk analyses were performed to identify predictors of decannulation. We included 53 ventilated stroke patients who had tracheostomy. One year after tracheostomy, 19 patients were decannulated (median [IQR] time to decannulation 74 [58-117] days), 13 patients were permanently cannulated, and 21 patients died without prior removal of the cannula. Independent predictors for decannulation in our cohort were patient age (HR 0.95 [95% CI: 0.92-0.99] per one year increase, p = 0.003) and absence of sepsis (HR 4.44 [95% CI: 1.33-14.80], p = 0.008). Compared to surviving patients without cannula removal, decannulated patients had an improved functional outcome after one year (median modified Rankin Scale score 4 vs. 5 [p tracheostomy and was associated with better functional outcome compared to patients without decannulation. Further prospective studies with larger sample sizes are needed to confirm our results.
Fabiano, Gregory A.; Waschbusch, Daniel A.; Belin, Peter J.; Gnagy, Elizabeth M.; Pelham, William E.; Greiner, Andrew R.; Roemmich, James N.
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 many aspects of children’s sports functioning, including knowledge of game rules, in vivo game performance, and fundamental skill tasks (motor proficiency, ability to trap a soccer ball appropriately, reduced handball penalties in soccer, and improved ability to catch a baseball). Parents also reported improved sports skills and good sportsmanship in the treatment group. No differences between groups were evident on additional skill tasks evaluating accurately kicking a soccer ball, throwing a baseball, or hitting a baseball off a tee. These results suggest intensive behavioral intervention that includes sports training can significantly improve functional sports outcomes for young children with ADHD. PMID:24362766
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
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 many aspects of children's sports functioning, including knowledge of game rules, in vivo game performance, and fundamental skill tasks (motor proficiency, ability to trap a soccer ball appropriately, reduced handball penalties in soccer, and improved ability to catch a baseball). Parents also reported improved sports skills and good sportsmanship in the treatment group. No differences between groups were evident on additional skill tasks evaluating accurately kicking a soccer ball, throwing a baseball, or hitting a baseball off a tee. These results suggest intensive behavioral intervention that includes sports training can significantly improve functional sports outcomes for young children with ADHD.
Chen, Chih-Yu; Hu, Chia-Chian; Weng, Pei-Wei; Huang, Yu-Ming; Chiang, Chang-Jung; Chen, Chia-Hsien; Tsuang, Yang-Hwei; Yang, Rong-Sen; Sun, Jui-Sheng; Cheng, Cheng-Kung
The treatment of adhesive capsulitis is a dilemma for orthopaedic rehabilitation specialists. In this study, we assessed whether extracorporeal shockwave therapy (ESWT) improves the functional outcome of primary shoulder adhesive capsulitis. In this prospective, randomized, controlled, single-blind clinical trial, we enrolled 40 patients with primary adhesive capsulitis to assess whether ESWT can improve the functional outcome of primary adhesive capsulitis better than oral steroid therapy. Patients were allocated to the oral steroid group or ESWT group with randomization. Functional outcome evaluations were performed using the Constant Shoulder Score (CSS) and Oxford Shoulder Score. Both groups showed significant improvement in the Oxford Shoulder Score evaluation throughout the study period. In the ESWT group, the total CSS and range of motion (ROM) parameter of the CSS in the ESWT group showed significant improvement from the fourth week that was better than that in the steroid group; the activities–of–daily living (ADL) parameter of the CSS achieved significance and was better than that in the steroid group at the sixth week. For the steroid group, pain was significantly reduced from baseline to the fourth week of the study; ADL and ROM improved at the fourth to 12th week. For the ESWT group, ADL and ROM improvements were significant from baseline to the sixth week. Our results showed that ESWT can be an alternative treatment, at least in the short-term, for primary adhesive capsulitis of the shoulder. In addition, all of the side effects of ESWT were transient and tolerable.
Full Text Available ABSTRACT Objective: To explore the influence of infarct location on long-term functional outcome following a first-ever arterial ischemic stroke (AIS in non-neonate children. Method: The MRIs of 39 children with AIS (median age 5.38 years; 36% girls; mean follow-up time 5.87 years were prospectively evaluated. Infarct location was classified as the absence or presence of subcortical involvement. Functional outcome was measured using the modified Rankin scale (mRS for children after the follow-up assessment. We utilized multivariate logistic regression models to estimate the odds ratios (ORs for the outcome while adjusting for age, sex, infarct size and middle cerebral artery territory involvement (significance < 0.05. Results: Both infarcts ≥ 4% of total brain volume (OR 9.92; CI 1.76 – 55.9; p 0.009 and the presence of subcortical involvement (OR 8.36; CI 1.76 – 53.6; p 0.025 independently increased the risk of marked functional impairment (mRS 3 to 5. Conclusion: Infarct extension and location can help predict the extent of disability after childhood AIS.
Mohammad Idrees Adhi
Full Text Available Purpose: To study anatomical and functional outcomes of retinectomies in rhegmatogenous retinal detachments complicated by proliferative vitreoretinopathy. Methods: This is a retrospective interventional consecutive case series of eyes with rhegmatogenous retinal detachments complicated by advanced proliferative vitreoretinopathy and managed by relaxing retinectomy over a period of seventeen years. Three-port pars plana vitrectomy included core vitrectomy and removal of all epi-retinal membranes. On failure to flatten, retina was cut and excised. Basal vitrectomy and removal of anterior flap of retina then followed. Silicone oil was used as temponade in majority of cases. The dependent variables were anatomical and functional outcomes. The statistical analysis was performed on SPSS 21. Results: Series included 370 eyes of 337 patients. Mean follow up was 39Â months. Scleral explant was used in 90(24.39% cases. Two hundred and nine (56.49% eyes were operated with trans conjunctival sutureless vitrectomy technique. Procedure was bilateral in 33 patients (09.79%. Retina attached in 311(84.05% eyes after initial surgery. Final re-attachment after one or more surgeries was achieved in 344(92.97% eyes. Two hundred and eleven (57.02% cases achieved visual acuity of 6/60 or better. Conclusion: Relaxing retinectomies have good and encouraging anatomical and functional outcomes. This surgery can be effectively carried out with trans conjunctival sutureless vitrectomy technique. Keywords: Retinotomy and retinectomy, Proliferative vitreoretinopathy, Trans conjunctival sutureless vitrectomy, Silicone oil
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.
Lin, Xue; Xu, Rui-Yi; Liu, Jian-Zhou; Chen, Wei; Chen, Lian-Feng; Yang, Peng-Hua; Fang, Li-Gang
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. PMID:26830985
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
Vestgaard, Marianne; Nielsen, Lene Ringholm; Rasmussen, Åse Krogh
In pregnant women with type 1 diabetes, we evaluated whether the presence of thyroid peroxidase autoantibodies (anti-TPO) was associated with changes in thyroid function, metabolic control and pregnancy outcome.......In pregnant women with type 1 diabetes, we evaluated whether the presence of thyroid peroxidase autoantibodies (anti-TPO) was associated with changes in thyroid function, metabolic control and pregnancy outcome....
Wang, Chi-Te; Huang, Tsung-Wei; Kuo, Shih-Wei; Cheng, Po-Wen
This study investigated whether audiovestibular function tests, namely auditory brain stem response (ABR) and vestibular-evoked myogenic potential (VEMP) tests were correlated to hearing outcomes after controlling the effects of other potential confounding factors in severe to profound sudden sensorineural hearing loss (SSHL). Eighty-eight patients with severe to profound SSHL were enrolled in this study. Pretreatment hearing levels, results of audiovestibular function tests, and final hearing outcomes were recorded from retrospective chart reviews. Other factors, including age, gender, delay of treatment, vertigo, diabetes mellitus, and hypertension, were collected as well. Comparative analysis between multiple variables and hearing outcomes was conducted using the cumulative logits model in overall subjects. Further, multivariate analysis of prognostic factors was conducted in the stratified groups of severe (70 dB HL 90 dB HL) SSHL. Multivariate analysis showed that pretreatment hearing levels, presence of vertigo, and results of ABR and VEMP testing were significant outcome predictors in the overall subjects. Stratification analysis demonstrated that both the presence of ABR and VEMP waveforms were significantly correlated with better hearing outcomes in the group of severe SSHL [ABR: adjusted odds ratio (aOR) = 14.7, 95% confidence interval (CI) = 1.78 to 122, p = 0.01; VEMP: aOR = 5.91, 95% CI = 1.18 to 29.5, p = 0.03], whereas the presence of vertigo was the only significant negative prognostic factor in the group of profound SSHL (aOR = 0.24, 95% CI = 0.06 to 0.95, p = 0.04). Other variables, including age, gender, diabetes mellitus, hypertension, and delay of treatment, were not significantly related to hearing outcomes in both groups (p > 0.05). A predictive hearing recovery table with the combined ABR and VEMP results was proposed for the group of severe SSHL. ABR and VEMP tests should be included in the battery of neurootological examinations in
Tenenbaum, Shay; Bariteau, Jason; Coleman, Scott; Brodsky, James
Total ankle arthroplasty (TAA) is becoming an increasingly utilized procedure for the management of end-stage ankle arthritis. Elderly patients are the fastest growing segment of the population in the western world, creating a unique challenge to the health economics of our era. Determining if elderly patients with end-stage ankle arthritis demonstrate the same improvements in clinical outcomes and functional measures of gait following TAA would be valuable. This can aid to evaluate the utilization of TAA in this enlarging cohort of our population. Consecutive series of twenty-one patients over the age of 70, who underwent TAA for end-stage ankle arthritis, was prospectively compared to a series of twenty-one patients aged 50-60, who underwent the same procedure by single surgeon during same time period. Clinical outcomes were measured with outcome scores including VAS pain score, AOFAS Ankle and Hindfoot Score, and the SF-36. Three-dimensional gait analysis was performed preoperatively and at a minimum of one year postoperatively, to measure temporal-spatial, kinematic, and kinetic parameters of gait. Mixed model multivariate statistical analysis was used to evaluate and compare the independent contributions to outcomes of the surgical intervention over time; of patient age; and of time-plus-age interaction, as these influenced both the clinical outcomes and the functional gait outcomes. Statistically significant improvements in VAS pain scores, AOFAS ankle/hindfoot scores, and SF-36 scores were demonstrated in both age groups. Following surgery, there were improvements in all parameters of gait, including temporal-spatial parameters as step length and walking velocity; kinematic parameters, including, increase in total range of motion to a total of 17-19°; and kinetic parameters, including increase in ankle power and moment. The improvements both in clinical and gait outcomes were equivalent in the two age groups. In this comparative study, it is shown that both
Spaccavento, Simona; Cellamare, Fara; Falcone, Rosanna; Loverre, Anna; Nardulli, Roberto
Because of the loss of autonomy in daily-life activities, spatial neglect after stroke is one of the main causes of disability. According to the spatial domains, neglect can be divided into personal (body), peripersonal (reaching) and extrapersonal (far) space. We evaluated the effect of these subtypes of neglect on functional outcome of rehabilitation in stroke patients. A total of 1350 stroke patients were consecutively admitted into our neurorehabilitation unit from 2002 to 2016. We analyzed data for patients with a first ischemic or hemorrhagic right-hemispheric stroke in this observational retrospective study. The presence of neglect was evaluated by using structured tests for specific spatial domains. Patients underwent individual physical and occupational therapy, and those with neglect received specific therapy for 8 consecutive weeks consisting of visual scanning, reading and copying, copying line drawings on a dot matrix and describing scenes. The Functional Independence Measure (FIM) instrument was administered at both admission and discharge to assess functional autonomy. Rehabilitation effectiveness for FIM (percentage of potential improvement achieved) was calculated. Multiple regression analyses were performed. Among 359 patients with right-brain damage, 130 showed left neglect, or unilateral spatial neglect (USN), and 229 only left hemiparesis, without neglect. Overall, 90 patients (69%) with USN showed peripersonal neglect, 89 (68%) extrapersonal neglect and 60 (46%) personal neglect. Functional motor and cognitive impairment was greater with than without USN as measured by FIM at admission and discharge and the rehabilitation hospital stay was longer. USN affected functional status at admission and rehabilitation effectiveness for FIM. Extrapersonal and peripersonal neglect significantly affected both function at admission and effectiveness. Our data confirm the negative prognostic effect of neglect on functional outcome in a large sample. We also
Chu, Wei-Min; Liao, Wen-Chun; Li, Chi-Rong; Lee, Shu-Hsin; Tang, Yih-Jing; Ho, Hsin-En; Lee, Meng-Chih
To evaluate whether late-career unemployment is associated with increased all-cause mortality, functional disability, and depression among older adults in Taiwan. In this long-term prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging. This study was conducted from 1996 to 2007. The complete data from 716 men and 327 women aged 50-64 years were retrieved. Participants were categorized as normally employed or unemployed depending on their employment status in 1996. The cumulative number of unemployment after age 50 was also calculated. Logistic regression analysis was used to examine the effect of the association between late-career unemployment and cumulative number of late-career unemployment on all-cause mortality, functional disability, and depression in 2007. The average age of the participants in 1996 was 56.3 years [interquartile range (IQR)=7.0]. A total of 871 participants were in the normally employed group, and 172 participants were in the unemployed group. After adjustment of gender, age, level of education, income, self-rated health and major comorbidities, late-career unemployment was associated with increased all-cause mortality [Odds ratio (OR)=2.79; 95% confidence interval (CI)=1.74-4.47] and functional disability [OR=2.33; 95% CI=1.54-3.55]. The cumulative number of late-career unemployment was also associated with increased all-cause mortality [OR=1.91; 95% CI=1.35-2.70] and functional disability [OR=2.35; 95% CI=1.55-3.55]. Late-career unemployment and cumulative number of late-career unemployment are associated with increased all-cause mortality and functional disability. Older adults should be encouraged to maintain normal employment during the later stage of their career before retirement. Employers should routinely examine the fitness for work of older employees to prevent future unemployment. Copyright © 2016. Published by Elsevier Ireland Ltd.
Full Text Available The purpose of this present study was to examine the effect of Taichi softball (TCSB on physical function in Chinese older adults. Eighty Chinese older adults were randomly assigned into either an experimental group experiencing four 90-minute TCSB sessions weekly for seven consecutive weeks or a control group. At baseline and 7 weeks later, all participants were asked to perform physical functional tests for both lower and upper limbs. Multiple separate Analyses of Variance (ANOVA with repeated measures were applied to evaluate the effects of TCSB on function-related outcomes between baseline and postintervention in the two groups. The findings indicate that a short-term and intensive TCSB training program does not only improve low limb-related physical function such as dynamic balance and leg strength, but also strengthen upper limb-related physical function (e.g., arm and forearm strength, shoulder mobility, fine motor control, handgrip strength, and fine motor function. Health professionals could take into account TCSB exercise as an alternative method to help maintain or alleviate the inevitable age-related physical function degeneration in healthy older adults. In addition, researchers could investigate the effect of TCSB exercise on physical function in special populations such as patients with different chronic diseases or neurological disorder (e.g., Parkinson’s disease.
Full Text Available Background: Uni-knee arthroplasty (UKA has shown better knee kinematics and motion that may better suit the activities of daily living in Eastern countries. The purpose of this study was to evaluate the functional outcomes of UKA for medial compartment knee arthropathy in Asian patients. Methods: The study cohort consisted of 48 patients with 51 UK A knees. Only one type of prosthesis was used and all components were cemented. Postoperative management included ambulation with weight bearing, range of motion, and muscle strengthening exercises as tolerated until full recovery. The average follow-up was 52.0 ± 24.0 (range 12-92 months. The evaluation included functional assessment, the Knee Society knee and functional scores, the International Knee Document Committee (IKDC subjective and objective scores, and radiographs of the knee. Results: The overall clinical outcomes of the knee showed the functional outcome of the knee to be normal in 51%, nearly normal in 37%, abnormal in 8%, and severely abnormal in 4%. The functional activities included stair climbing in 96%, squatting in 76%, jogging in 71% and kneeling in 47%. Three-quarters of the patients were able to kneel for daily activities. Approximately 98% of the patients were satisfied with the operation. The survivorship of the prosthesis was 98% with one revision pending. Radiographic evaluations revealed the components were centered in 82% and off-centered in 18%. Osteoarthritis was 22% preoperative and 27% postoperative for the patellofemoral compartment, and 0% before and 4% after surgery for the lateral compartment. The functional outcomes showed no difference between patients with and without patellofemoral arthritis. The complications included one component malposition and one knee pain of undetermined origin. Conclusions: UKA provides excellent pain relief and restoration of knee function including kneeling, squatting, and sit-to-stand activities that perfectly fit the oriental
Background The effects of multiple injuries on the neurological and functional outcomes of patients with traumatic spinal cord injury (SCI) are debated—some groups have shown that subjects with multiple injuries have the same neurological and functional outcomes of those without them, whereas others have found that SCI patients with associated traumatic brain injury have worse functional status at admission and discharge and longer rehabilitation stays than patients without brain injury. Thus, the aim of this study was to compare the outcomes of SCI subjects with or without multiple injuries. Methods A total of 245 patients with a traumatic SCI during the first rehabilitation stay after the development of the lesion (202 males and 43 females; age 39.8 ± 17 years; lesion to admission time 51.1 ± 58 days) were examined on a referral basis. Patients were assessed using the following measures: American Spinal Injury Association standards, Barthel Index, Rivermead Mobility Index, and Walking Index for Spinal Cord Injury. The statistical analysis comprised Poisson regression models with relative risks and 95% confidence intervals, adjusted for the following confounders: age, sex, lesion level, and ASIA impairment scale (AIS) grade. Student’s T test was used to compare the outcomes of patients divided by AIS impairment and lesion level. Results SCI patients with and without multiple injuries differed significantly with regard to the level and completeness of the lesion. Overall, patients with multiple injuries had worse functional status at admission and discharge than monotraumatic subjects. However, when adjusted for neurological features, the populations had comparable functional and neurological status at admission and discharge and similar rates of complications and discharge destinati