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Sample records for range clinical outcomes

  1. A systematic review of electric-acoustic stimulation: device fitting ranges, outcomes, and clinical fitting practices.

    Science.gov (United States)

    Incerti, Paola V; Ching, Teresa Y C; Cowan, Robert

    2013-03-01

    Cochlear implant systems that combine electric and acoustic stimulation in the same ear are now commercially available and the number of patients using these devices is steadily increasing. In particular, electric-acoustic stimulation is an option for patients with severe, high frequency sensorineural hearing impairment. There have been a range of approaches to combining electric stimulation and acoustic hearing in the same ear. To develop a better understanding of fitting practices for devices that combine electric and acoustic stimulation, we conducted a systematic review addressing three clinical questions: what is the range of acoustic hearing in the implanted ear that can be effectively preserved for an electric-acoustic fitting?; what benefits are provided by combining acoustic stimulation with electric stimulation?; and what clinical fitting practices have been developed for devices that combine electric and acoustic stimulation? A search of the literature was conducted and 27 articles that met the strict evaluation criteria adopted for the review were identified for detailed analysis. The range of auditory thresholds in the implanted ear that can be successfully used for an electric-acoustic application is quite broad. The effectiveness of combined electric and acoustic stimulation as compared with electric stimulation alone was consistently demonstrated, highlighting the potential value of preservation and utilization of low frequency hearing in the implanted ear. However, clinical procedures for best fitting of electric-acoustic devices were varied. This clearly identified a need for further investigation of fitting procedures aimed at maximizing outcomes for recipients of electric-acoustic devices.

  2. A Systematic Review of Electric-Acoustic Stimulation: Device Fitting Ranges, Outcomes, and Clinical Fitting Practices

    OpenAIRE

    Incerti, Paola V.; Ching, Teresa Y. C.; Cowan, Robert

    2013-01-01

    Cochlear implant systems that combine electric and acoustic stimulation in the same ear are now commercially available and the number of patients using these devices is steadily increasing. In particular, electric-acoustic stimulation is an option for patients with severe, high frequency sensorineural hearing impairment. There have been a range of approaches to combining electric stimulation and acoustic hearing in the same ear. To develop a better understanding of fitting practices for devic...

  3. Validity of clinical outcome measures to evaluate ankle range of motion during the weight-bearing lunge test.

    Science.gov (United States)

    Hall, Emily A; Docherty, Carrie L

    2017-07-01

    To determine the concurrent validity of standard clinical outcome measures compared to laboratory outcome measure while performing the weight-bearing lunge test (WBLT). Cross-sectional study. Fifty participants performed the WBLT to determine dorsiflexion ROM using four different measurement techniques: dorsiflexion angle with digital inclinometer at 15cm distal to the tibial tuberosity (°), dorsiflexion angle with inclinometer at tibial tuberosity (°), maximum lunge distance (cm), and dorsiflexion angle using a 2D motion capture system (°). Outcome measures were recorded concurrently during each trial. To establish concurrent validity, Pearson product-moment correlation coefficients (r) were conducted, comparing each dependent variable to the 2D motion capture analysis (identified as the reference standard). A higher correlation indicates strong concurrent validity. There was a high correlation between each measurement technique and the reference standard. Specifically the correlation between the inclinometer placement at 15cm below the tibial tuberosity (44.9°±5.5°) and the motion capture angle (27.0°±6.0°) was r=0.76 (p=0.001), between the inclinometer placement at the tibial tuberosity angle (39.0°±4.6°) and the motion capture angle was r=0.71 (p=0.001), and between the distance from the wall clinical measure (10.3±3.0cm) to the motion capture angle was r=0.74 (p=0.001). This study determined that the clinical measures used during the WBLT have a high correlation with the reference standard for assessing dorsiflexion range of motion. Therefore, obtaining maximum lunge distance and inclinometer angles are both valid assessments during the weight-bearing lunge test. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  4. Greenness and Birth Outcomes in a Range of Pennsylvania Communities

    Directory of Open Access Journals (Sweden)

    Joan A. Casey

    2016-03-01

    Full Text Available Living in communities with more vegetation during pregnancy has been associated with higher birth weights, but fewer studies have evaluated other birth outcomes, and only one has been conducted in the Eastern United States, in regions with a broad range, including high levels, of greenness. We evaluated associations between prenatal residential greenness and birth outcomes (term birth weight, small for gestational age, preterm birth, and low 5 min Apgar score across a range of community types using electronic health record data from 2006–2013 from the Geisinger Health System in Pennsylvania. We assigned greenness based on mother’s geocoded address using the normalized difference vegetation index from satellite imagery. We used propensity scores to restrict the study population to comparable groups among those living in green vs. less-green areas. Analyses were adjusted for demographic, clinical, and environmental covariates, and stratified by community type (city, borough, and township. In cities, higher greenness (tertiles 2–3 vs. 1 was protective for both preterm (OR = 0.78, 95% CI: 0.61–0.99 and small for gestational age birth (OR = 0.73, 95% CI: 0.58–0.97, but not birth weight or Apgar score. We did not observe associations between greenness and birth outcomes in adjusted models in boroughs or townships. These results add to the evidence that greener cities might be healthier cities.

  5. PLA2R Antibody Levels and Clinical Outcome in Patients with Membranous Nephropathy and Non-Nephrotic Range Proteinuria under Treatment with Inhibitors of the Renin-Angiotensin System

    Science.gov (United States)

    Hoxha, Elion; Harendza, Sigrid; Pinnschmidt, Hans; Panzer, Ulf; Stahl, Rolf A. K.

    2014-01-01

    Patients with primary membranous nephropathy (MN) who experience spontaneous remission of proteinuria generally have an excellent outcome without need of immunosuppressive therapy. It is, however, unclear whether non-nephrotic proteinuria at the time of diagnosis is also associated with good prognosis since a reasonable number of these patients develop nephrotic syndrome despite blockade of the renin-angiotensin system. No clinical or laboratory parameters are available, which allow the assessment of risk for development of nephrotic proteinuria. Phospholipase A2 Receptor antibodies (PLA2R-Ab) play a prominent role in the pathogenesis of primary MN and are associated with persistence of nephrotic proteinuria. In this study we analysed whether PLA2R-Ab levels might predict development of nephrotic syndrome and the clinical outcome in 33 patients with biopsy-proven primary MN and non-nephrotic proteinuria under treatment with blockers of the renin-angiotensin system. PLA2R-Ab levels, proteinuria and serum creatinine were measured every three months. Nephrotic-range proteinuria developed in 18 (55%) patients. At study start (1.2±1.5 months after renal biopsy and time of diagnosis), 16 (48%) patients were positive for PLA2R-Ab. A multivariate analysis showed that PLA2R-Ab levels were associated with an increased risk for development of nephrotic proteinuria (HR = 3.66; 95%CI: 1.39–9.64; p = 0.009). Immunosuppressive therapy was initiated more frequently in PLA2R-Ab positive patients (13 of 16 patients, 81%) compared to PLA2R-Ab negative patients (2 of 17 patients, 12%). PLA2R-Ab levels are associated with higher risk for development of nephrotic-range proteinuria in this cohort of non-nephrotic patients at the time of diagnosis and should be closely monitored in the clinical management. PMID:25313791

  6. Cardiorenal Syndrome: Clinical Outcome Study.

    Science.gov (United States)

    Shah, H R; Singh, N P; Aggarwal, N P; Singhania, D; Kumar, A

    2016-12-01

    Over recent years, the field of medicine has been challenged by the twin epidemic of heart failure and renal insufficiency. The coexistence of the two problems in the same patient, referred to as cardiorenal syndrome (CRS), is defined as 'disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The mechanisms underlying this interaction are complex and multifactorial in nature. Identify and classify patients admitted with cardiorenal syndrome into various subtypes and assess clinical outcome at discharge and at three months. Ours was a longitudinal study of 50 patients admitted in ICU with CRS. They were classified as per RONCO classification (2008) into various subtypes. Outcomes was addressed as favourable for patients stable at discharge and at 3 months follow up, whereas outcome was termed non-favourable for patients who expired or initiated on hemodialysis. Of 50 patients, two-third patients were males (66%), with mean age of males and females being 64.18 years and 64.64 years respectively. Majority of the patients had Type-1 CRS (46%) followed by twenty two percent Type-2, twenty six percent type-4 and six percent Type-5. There were no patients with type-3 CRS. At the end of the study, 24 (48%) patients were stable, 12 (24%) required dialysis and 14 (28%) patients had expired. The total non-favourable outcomes (dialysis / death) were higher with subtypes CRS-4 (n-11, 22%) and CRS-1 (n-8, 16%). Anemia, raised serum creatinine, low eGFR values, low ejection fraction were significant predictors of non-favourable outcome in our study. CRS occurs in all age groups, more commonly in elderlies with a male preponderance. Prevalence of CRS-1 was higher followed by CRS-4. Prognosis was unfavourable in CRS-1, CRS-4 and CRS-5. Sepsis was predominant cause of death in patients with CRS-5 with hundred percent mortality during hospital stay. Risk factors like pre-existing renal impairment

  7. Clinical Outcomes Following Revision Anterior Shoulder Stabilization

    Science.gov (United States)

    Frank, Rachel M.; Mellano, Chris; Shin, Jason J.; Feldheim, Terrence F.; Mascarenhas, Randhir; Yanke, Adam Blair; Cole, Brian J.; Nicholson, Gregory P.; Romeo, Anthony A.; Verma, Nikhil N.

    2015-01-01

    Objectives: The purpose of this study was to determine the clinical outcomes following revision anterior shoulder stabilization performed either via all-arthroscopic soft tissue repair or via Latarjet coracoid transfer. Methods: A retrospective review of prospectively collected data on 91 shoulders undergoing revision anterior shoulder stabilization was performed. All patients underwent prior soft tissue stabilization; those with prior open bone grafting procedures were excluded. For patients with 25% glenoid bone loss, Latarjet was performed (n=28). Patients were queried regarding recurrent instability (subluxation or dislocation). Clinical outcomes were evaluated using validated patient reported outcome questionnaires including the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), visual analog scale (VAS) for pain, and Western Ontario Shoulder Instability Index (WOSI). Results: A total of 63 shoulders in 62 patients (46 males, 16 females) with an average age of 23.2 ± 6.9 years were included in the revision arthroscopy group. At an average follow-up of 46.9 ± 16.8 months (range, 15 to 78), the mean WOSI score was 80.1 (range, 15.0 to 100), and there were significant improvements (pLatarjet group. Thirteen (46%) had more than one previous stabilization attempt. ), the average WOSI score was 71.9, and there were significant improvements (pLatarjet. Conclusion: Both arthroscopic revision stabilization and Latarjet coracoid transfer result in satisfactory outcomes in patients who have failed previous arthroscopic capsulolabral repair. Recurrent instability rates were higher in the all-arthroscopic group (19% versus 7%). Longer-term studies are required to determine whether similar results are maintained over time, and to provide guidance on focused clinical indications for this challenging patient population.

  8. Responsiveness of Clinical Outcome Measures

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein

    subgroups of patients with LBP. In addition, we explored whether low back pain patients were able to determine an acceptable treatment outcome before it began. Methods The responsiveness in subgroups study. An extensive cross-cultural adaptation and validation of the ODI was carried out on patients seen...... in SeS and leg pain patients. Moreover, patients' retrospective evaluation of treatment effect was more responsive in PrS patients compared to serial measurements. The prospective acceptable outcome study. The prospective acceptable outcome method was reproducible. The MCIDpre was outside instrument...... measurement error and 1.5-4.5 times larger compared to the MCIDpost. Furthermore, the MCIDpre was almost comparable to patients' post-treatment acceptable change, but only for the pain scale. Conclusion The Danish version of the ODI is a reliable, valid and responsive HMS which is psychometrically more...

  9. Clinical outcome measures of specific immunotherapy.

    Science.gov (United States)

    Pfaar, Oliver; Anders, Clemens; Klimek, Ludger

    2009-06-01

    To provide an overview of clinical parameters generally used for monitoring the clinical efficacy of specific immunotherapy (SIT) in clinical trials. In particular, it focuses on primary and secondary outcome measurements and reviews the advantages and disadvantages of each method. In 2007, the World Allergy Organization defined the severity of symptoms and the need for concomitant medication as primary endpoint parameters in clinical outcome measures of SIT. Furthermore, it was stated that the symptom score should always be combined with the rescue medication score. The 'quality of life' is usually used as a secondary outcome measure in clinical trials on SIT. In clinical trials on SIT, several clinical parameters are commonly used to provide evidence of the clinical efficacy of the therapy. These parameters should include a measurement of symptoms and of the use of concomitant medications, which represent the 'primary outcome' parameters. Both physician-rated and patient self-rate scores have been implemented in clinical studies. Furthermore, disease-unspecific (generic) and disease-specific questionnaires for evaluating the quality of life are widely used and partially validated as 'secondary outcome' parameters. This review provides an overview on the different methods to measure the clinical outcome of SIT and points out the advantages and disadvantages of each method.

  10. Optimizing Outcomes with Clinical Data Registries.

    Science.gov (United States)

    Ishii, Lisa

    2016-12-01

    Clinical data registries are platforms to extract, store, analyze, and disseminate large amounts of clinical data. The type of data contained in clinical data registries varies by the registry, and may include patient demographics, clinical examination findings, imaging and laboratory results, procedures performed, and patient-reported outcomes. When large numbers of participants submit data to a clinical data registry the data can then be analyzed in aggregate to answer new clinical questions. Analyses on the data may be performed to show outcomes over time, compare procedures, evaluate care patterns, among others. With the launch of an otolaryngology-specific clinical data registry, Regent, facial plastic and reconstructive surgeons have the opportunity to participate in a clinical data registry for the first time. Through broad participation in the registry, the specialty has a chance to optimize patient outcomes in a manner never before possible. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  11. Clinical Features and Outcome of Mucormycosis

    Directory of Open Access Journals (Sweden)

    Carlos Rodrigo Camara-Lemarroy

    2014-01-01

    Full Text Available Mucormycosis (MCM is a life-threatening infection that carries high mortality rates despite recent advances in its diagnosis and treatment. The objective was to report 14 cases of mucormycosis infection and review the relevant literature. We retrospectively analyzed the demographic and clinical data of 14 consecutive patients that presented with MCM in a tertiary-care teaching hospital in northern Mexico. The mean age of the patients was 39.9 (range 5–65. Nine of the patients were male. Ten patients had diabetes mellitus as the underlying disease, and 6 patients had a hematological malignancy (acute leukemia. Of the diabetic patients, 3 had chronic renal failure and 4 presented with diabetic ketoacidosis. All patients had rhinocerebral involvement. In-hospital mortality was 50%. All patients received medical therapy with polyene antifungals and 11 patients underwent surgical therapy. Survivors were significantly younger and less likely to have diabetes than nonsurvivors, and had higher levels of serum albumin on admission. The clinical outcome of patients with MCM is poor. Uncontrolled diabetes and age are negative prognostic factors.

  12. Clinical and radiological outcomes following radioscapholunate fusion.

    Science.gov (United States)

    Montoya-Faivre, D; Pomares, G; Calafat, V; Dap, F; Dautel, G

    2017-11-01

    Radioscapholunate (RSL) fusion is typically performed following wrist trauma. It addresses the pain caused by radiocarpal osteoarthritis but reduces the wrist's mobility. The objective of this study was to determine the long-term clinical and radiological outcomes of this procedure. This was a retrospective study of all wrists operated for RSL fusion in our surgery unit over a 12-year period. The clinical analysis consisted of joint amplitudes, grip strength, pain (VAS) and functional scores (PRWE, QuickDash, Mayo Wrist Score). The radiological analysis focused on bone fusion and the presence of midcarpal osteoarthritis. This surgery procedure was performed on 48 wrists. Of these, 34 patients were available for review, including 6 who had subsequently undergone total wrist fusion after the RSL procedure. The average follow-up was 53 months. Flexion/extension and radioulnar deviation were 56° and 30°, respectively. Grip strength in the operated wrist was 71% of the contralateral wrist. The mean pain level was 3 out of 10. The PRWE, QuickDash and Mayo Wrist Score were 35.7, 44.5 and 57.2, respectively. Seventy-nine percent of patients were satisfied with the outcome. The fusion rate was 71%, the midcarpal osteoarthritis rate was 64% and the STT osteoarthritis rate was 46%. Reduced wrist range of motion in patients who have undergone RSL fusion helps to preserve satisfactory function in the majority of patients; however, the functional outcome scores point to some hindrance in day-to-day activities. Nonunion occurred in nearly one-quarter of patients and appears to be preventable by excision of the distal pole of the scaphoid (DPS). Midcarpal osteoarthritis develops in most wrists over the long-term and appears to be inevitable. RSL fusion is a palliative procedure that preserves some of the wrist's mobility. However, it is a difficult procedure that has a significant nonunion rate. Excision of the DPS may contribute to lowering the nonunion rate. Copyright © 2017

  13. CONGENITAL TOXOPLASMOSIS: CLINICAL COURSE AND RESIDUAL OUTCOMES

    Directory of Open Access Journals (Sweden)

    L. Yu. Barycheva

    2014-01-01

    Full Text Available We examined 69 infants with clinically manifested forms of congenital toxoplasmosis diagnosed in theStavropolregion in the period from 1992 to 2012. The clinical course was characterized by a predominance of severe forms of congenial toxoplasmosis, high mortality rate (39,1%, predominant damage the central nervous system (100% and adverse neurological outcome. Surviving children developed disabilities at the outcome of congenital toxoplasmosis such as hydrocephaly (71,4%, microcephaly (9,5%, cerebral palsy (52,4%, episindroma (16,7%, mental retardation (19,0 % complete or partial blindness (28,6%. 

  14. Clinical and radiological outcome after periacetabular osteotomy

    DEFF Research Database (Denmark)

    Dahl, Line B; Dengsø, Kristine; Bang-Christiansen, Karl

    2014-01-01

    PURPOSE: Few papers have described results after periacetabular osteotomy (PAO) and risk factors for conversion to total hip arthroplasty (THA). The aim of the present paper was to analyse clinical and radiographic outcome, survival of the hip joint and risk factors of early conversion to THA in ...

  15. Biosimilars : linking quality data to clinical outcomes

    NARCIS (Netherlands)

    Halim, L.A.

    2016-01-01

    The aim of this study was to establish a link between quality attributes of biosimilars and potential clinical outcomes with regards to safety and immunogenicity. As we have access to multiple biosimilar and copy biologic products as well to patient data, the research involved linking comparative

  16. Clinical outcomes in clinical trials of anti-HIV treatment

    DEFF Research Database (Denmark)

    Reekie, J; Mocroft, A; J, Neaton

    2007-01-01

    and knowledge of HIV led to short-term trials using surrogate outcomes such as viral load and CD4 count. This established a faster drug approval process that complimented the rapid need to evaluate and provide access to drugs based on short-term trials. However, no treatment has yet been found that eradicates......Since the introduction of combination antiretroviral therapy, there has been a decrease in both AIDS-defining illnesses and deaths. This decrease meant that performing clinical trials with clinical outcomes in HIV infection became more time consuming and hence costly. Improved understanding...... the infection, so when treatment is started it is currently a lifelong commitment. Is it reasonable then that guidelines are based almost completely on short-term randomized trials and observational studies of surrogate markers, or is there still a need for trials with clinical outcomes?...

  17. Clinical outcomes in clinical trials of anti-HIV treatment

    DEFF Research Database (Denmark)

    Reekie, J; Mocroft, A; J, Neaton

    2007-01-01

    Since the introduction of combination antiretroviral therapy, there has been a decrease in both AIDS-defining illnesses and deaths. This decrease meant that performing clinical trials with clinical outcomes in HIV infection became more time consuming and hence costly. Improved understanding...... the infection, so when treatment is started it is currently a lifelong commitment. Is it reasonable then that guidelines are based almost completely on short-term randomized trials and observational studies of surrogate markers, or is there still a need for trials with clinical outcomes?...... and knowledge of HIV led to short-term trials using surrogate outcomes such as viral load and CD4 count. This established a faster drug approval process that complimented the rapid need to evaluate and provide access to drugs based on short-term trials. However, no treatment has yet been found that eradicates...

  18. Clinical nurse leader impact on clinical microsystems outcomes.

    Science.gov (United States)

    Hix, Carolyn; McKeon, Leslie; Walters, Sandra

    2009-02-01

    The clinical nurse leader (CNL) role is being rapidly implemented in healthcare settings. A major component of the CNL role is to provide a leader at the center of the microsystem to promote quality outcomes. To examine the impact of CNLs at the Department of Veterans Affairs Tennessee Valley Healthcare System, outcomes from 5 diverse microsystems were evaluated before and after CNL implementation using electronic scheduling system reports, patient medical records, and quality improvement reports. Statistically significant improvements were found in all 5 of the indicators evaluated. The authors discuss the implications of improvement for clinical, satisfaction, and financial performance.

  19. Clinical outcomes following revision anterior shoulder arthroscopic capsulolabral stabilization.

    Science.gov (United States)

    Shin, Jason J; Mascarenhas, Randy; Patel, Anish V; Yanke, Adam B; Nicholson, Gregory P; Cole, Brian J; Romeo, Anthony A; Verma, Nikhil N

    2015-11-01

    Traditionally surgeons have treated failed shoulder instability with open capsulolabral repair. Despite improved instrumentation, technique and familiarity in shoulder arthroscopy, few studies have reported the outcomes of arthroscopic revision shoulder instability repair. The purpose of this study was to assess clinical outcomes in patients following revision shoulder arthroscopic anterior capsulolabral stabilization. Sixty-two patients (63 shoulders) with failure of primary instability repairs were treated with revision arthroscopic anterior shoulder stabilization at a mean follow-up of 46.9 ± 16.8 months (range 18-78). Clinical outcomes were evaluated using validated patient-reported outcome questionnaires including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, visual analog pain scale and Western Ontario Shoulder Instability Index. In addition, patients were queried for recurrent instability events (subluxation or dislocation) or revision surgery. At final follow-up, the mean postoperative Western Ontario Shoulder Instability normalized score was 80.1 ± 18.7 (range 15.0-100). There were clinically significant improvements in American Shoulder and Elbow Surgeons scores, Simple Shoulder Test scores and ten-point visual analog scale for pain (P instability occurred in 12 shoulders (19.0 %), with number of prior surgeries and hyperlaxity found to be significant risk factor for failure (P shoulder can result in satisfactory outcomes in appropriately selected patients who have failed previous capsulolabral repair. An increased number of prior surgeries and hyperlaxity are predictive of poor outcome. Case series, LOE IV.

  20. Clinical outcomes of ED patients with bandemia.

    Science.gov (United States)

    Shi, Eileen; Vilke, Gary M; Coyne, Christopher J; Oyama, Leslie C; Castillo, Edward M

    2015-07-01

    Although an elevated white blood cell count is a widely utilized measure for evidence of infection and an important criterion for evaluation of systemic inflammatory response syndrome, its component band count occupies a more contested position within clinical emergency medicine. Recent studies indicate that bandemia is highly predictive of a serious infection, suggesting that clinicians who do not appreciate the value of band counts may delay diagnosis or overlook severe infections. Whereas previous studies focused on determining the quantitative value of the band count (ie, determining sensitivity, threshold for bandemia, etc.), this study directs attention to patient-centered outcomes, hypothesizing that the degree of bandemia predisposes patients to subsequent negative clinical outcomes associated with underappreciated severe infections. This retrospective study of electronic medical records includes patients who initially presented to the emergency department (ED) with bandemia and were subsequently discharged from the ED. These patients were screened for repeat ED visits within 7 days and death within 30 days. In patients with severe bandemia who were discharged from the ED, there was a 20.9% revisit rate at 7 days and a 4.9% mortality rate at 30 days, placing severely bandemic patients at 5 times significantly greater mortality compared to nonbandemic patients (P = .032). Our review of patient outcomes suggests that the degree of bandemia, especially in the setting of concurrent tachycardia or fever, is associated with greater likelihood of negative clinical outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Combining clinical variables to optimize prediction of antidepressant treatment outcomes.

    Science.gov (United States)

    Iniesta, Raquel; Malki, Karim; Maier, Wolfgang; Rietschel, Marcella; Mors, Ole; Hauser, Joanna; Henigsberg, Neven; Dernovsek, Mojca Zvezdana; Souery, Daniel; Stahl, Daniel; Dobson, Richard; Aitchison, Katherine J; Farmer, Anne; Lewis, Cathryn M; McGuffin, Peter; Uher, Rudolf

    2016-07-01

    The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Clinical characteristics and outcomes of septic bursitis.

    Science.gov (United States)

    Lieber, Sarah B; Fowler, Mary Louise; Zhu, Clara; Moore, Andrew; Shmerling, Robert H; Paz, Ziv

    2017-12-01

    Limited data guide practice in evaluation and treatment of septic bursitis. We aimed to characterize clinical characteristics, microbiology, and outcomes of patients with septic bursitis stratified by bursal involvement, presence of trauma, and management type. We conducted a retrospective cohort study of adult patients admitted to a single center from 1998 to 2015 with culture-proven olecranon and patellar septic bursitis. Baseline characteristics, clinical features, microbial profiles, operative interventions, hospitalization lengths, and 60-day readmission rates were determined. Patients were stratified by bursitis site, presence or absence of trauma, and operative or non-operative management. Of 44 cases of septic bursitis, patients with olecranon and patellar bursitis were similar with respect to age, male predominance, and frequency of bursal trauma; patients managed operatively were younger (p = 0.05). Clinical features at presentation and comorbidities were similar despite bursitis site, history of trauma, or management. The most common organism isolated from bursal fluid was Staphylococcus aureus. Patients managed operatively were discharged to rehabilitation less frequently (p = 0.04). This study of septic bursitis is among the largest reported. We were unable to identify presenting clinical features that differentiated patients treated surgically from those treated conservatively. There was no clear relationship between preceding trauma or bursitis site and clinical course, management, or outcomes. Patients with bursitis treated surgically were younger. Additional study is needed to identify patients who would benefit from early surgical intervention for septic bursitis.

  3. Nutrition-Related Cardiovascular Disease Risk Factors In Chronic Kidney Disease: Relationship With Clinical Outcome

    Directory of Open Access Journals (Sweden)

    Emma McMahon

    2012-06-01

    Traditional CV-risk factors in this CKD population were not associated with clinical outcome. Despite being within clinical reference range, serum phosphate and albumin were independently associated with clinical outcome. This may highlight a potential therapeutic target for risk management to delay or prevent renal end-points in CKD.

  4. Korean Clinic Based Outcome Measure Studies

    Directory of Open Access Journals (Sweden)

    Jongbae Park

    2003-02-01

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

  5. Pyogenic sacroiliitis: diagnosis, management and clinical outcome

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    Kucera, Tomas; Sponer, Pavel [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Orthopaedic Surgery, Hradec Kralove (Czech Republic); Brtkova, Jindra [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Diagnostic Radiology, Hradec Kralove (Czech Republic); Ryskova, Lenka [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Microbiology, Hradec Kralove (Czech Republic); Popper, Eduard [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Rehabilitation, Hradec Kralove (Czech Republic); Frank, Martin [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Surgery, Hradec Kralove (Czech Republic); Kucerova, Marie [Regional Hospital in Pardubice, Department of Neurosurgery, Hradec Kralove (Czech Republic)

    2015-01-15

    The purpose of the present study was to evaluate the role of diagnostic tools and management options for patients with pyogenic sacroiliitis, including potential complications. This retrospective study included 16 patients with pyogenic sacroiliitis who were admitted to a single orthopaedic centre between 2007 and 2012. The following data were collected: demographics, history, radiography, magnetic resonance images (MRI), biological data, type of pathogenic agent, abscess formation, type of management, and clinical outcome. Our study demonstrated that only one-fifth of the patients with lumbogluteal or hip pain had established diagnoses of suspected pyogenic sacroiliitis upon admission. MRIs confirmed this diagnosis in all cases. MRI examinations revealed joint fluid in the sacroiliac joint and significant oedema of the adjacent bone and soft tissues. In 12 of the 16 cases, erosions of the subchondral bone were encountered. Contrast-enhanced MRI revealed that 9 patients had abscesses. All patients received antibiotic therapy. Antibiotic treatment was only successful in 9 cases. The other 7 patients underwent computed tomography (CT)-guided abscess drainage. Drainage was sufficient for 4 patients, but 3 patients required open surgery. One patient required sacroiliac arthrodesis. The clinical outcomes included minimal disability (n = 10), moderate disability (n = 5), and full disability (n = 1) of the spine. Contrast-enhanced MRI is mandatory for a reliable diagnosis. Abscess formation was observed in approximately half of the MRI-diagnosed sacroiliitis cases and required minimally invasive drainage under CT guidance or frequently open surgery. (orig.)

  6. The Clinical Outcomes after Total Pancreatectomy.

    Science.gov (United States)

    Suzuki, Shuji; Kajiyama, Hideki; Takemura, Akira; Shimazaki, Jiro; Nishida, Kiyotaka; Shimoda, Mitsugi

    2017-01-01

    Total pancreatectomy (TP) is not more beneficial than less aggressive resection techniques for the treatment of pancreatic neoplasms and is associated with high morbidity and mortality. However, with advances in surgical techniques and glycemic monitoring, and the development of synthetic insulin and pancreatic enzymes for postoperative treatment, TP has been increasingly indicated. This is a review of the recent literature reporting the clinical outcomes after TP. We reviewed the publications reporting the use of TP starting 2007. The clinicophysiological and survival data were analyzed. Few studies evaluated the differences in clinical outcomes between TP and pancreaticoduodenectomy (PD) with inconsistent results. It was reported that while the perioperative morbidity did not decrease, the mortality decreased compared to previous literature. All patients who underwent TP required insulin and high dose of pancreatic enzyme supplements. The 5-year survival rates after TP and PD for pancreatic cancer were similar. The perioperative mortality decreased in patients who underwent TP with advances in the operative procedures and perioperative care. The long-term survival rates were similar for TP and PD. Therefore, treating pancreatic neoplasms using TP is feasible. Patients undergoing TP should receive adequate treatment with synthetic insulin and pancreatic enzyme supplements. © 2016 S. Karger AG, Basel.

  7. Observer bias in randomised clinical trials with binary outcomes

    DEFF Research Database (Denmark)

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

    2012-01-01

    To evaluate the impact of non-blinded outcome assessment on estimated treatment effects in randomised clinical trials with binary outcomes.......To evaluate the impact of non-blinded outcome assessment on estimated treatment effects in randomised clinical trials with binary outcomes....

  8. Outcome of managing impotence in clinical practice.

    Science.gov (United States)

    Braatvedt, G D

    1999-07-23

    Outside of controlled clinical trials, the outcome of treatment for unselected men with impotence is uncertain. This study aims to describe the clinical course of consecutive, unselected men referred to a specialist endocrinology private practice with a primary diagnosis of impotence. Consecutive men referred with a primary diagnosis of impotence between June 1995 and December 1997 were studied. After initial evaluation and appropriate investigation, treatment with testosterone in hypogonadal men and instruction in the use of a vacuum device and intracavernosal alprostadil (Caverject) in all men was offered. All men were followed up by telephone and/or questionnaire about erection outcome three to twelve months later. Nineteen diabetic men, aged 53.1+/-8.2 years and forty non-diabetic men, aged 54.8+/-11.6 years were seen. Follow-up information beyond three months was complete in fifty-three (90%). Eighteen eugonadal men chose no further therapy and four of these men had spontaneous return of erections. Eight men were hypogonadal and potency returned in two of six men treated with replacement testosterone. Nine men used the vacuum device, which was effective in three of them. Forty-one men had a trial of Caverject injection, which was effective in twenty-eight. Only twelve of these men used Caverject for longer than six months. Return of erections with therapy beyond three months in unselected men with impotence is successful in only about one-third. Unexpected hypogonadism is relatively common in impotent men, but testosterone replacement therapy has a low rate of improving erections. New therapies for impotence need careful follow-up studies to assess their effectiveness in clinical practice.

  9. Outcome Measures for Clinical Trials in Down Syndrome.

    Science.gov (United States)

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

    2017-05-01

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

  10. The clinical outcome of childhood masturbation.

    Science.gov (United States)

    Unal, F

    2000-01-01

    This study was performed to investigate the clinical outcome of childhood masturbation. For this purpose 50 children (mean age = 48.7 +/- 24.5 months, 34 girls females and 16 boys males) with masturbation symptoms were examined at first visit to the Department of Child Psychiatry and two years thereafter with psychiatric interviews. The mean masturbation frequency at the initial interview was significantly decreased after two years. It was noted that 39 children (78%) were completely recovered and 11 children (22%) continued to masturbate after two years. Children who did not recover were significantly younger, began to masturbate earlier and masturbated more frequently than others at the time of initial evaluation. It was concluded that the findings about the beneficial effect of sedative drugs in combination with parental guidance, education and means for behavior modification were promising.

  11. Stress, oral health behaviour and clinical outcome.

    Science.gov (United States)

    Deinzer, Renate; Granrath, Nicole; Spahl, Manuela; Linz, Sandra; Waschul, Bernd; Herforth, Armin

    2005-05-01

    Several studies indicate that stress adversely affects various health behaviours. Oral hygiene behaviour, however, has been rarely studied in this context. The present study thus aims to assess the effects of stress on oral hygiene behaviour and clinical outcome. In a prospective matched controlled design 12 pairs of medical students, each consisting of 1 student participating in a major academic exam and 1 student not participating in any exams (control) were studied. A professional tooth cleaning was performed 4 weeks prior to exams to obtain plaque levels of 0 at all sites. Immediately prior to professional tooth cleaning and 4 weeks after exams plaque levels (as indicator of oral hygiene behaviour) and bleeding on probing (an indicator of gingivitis) were assessed. No group differences were observed at the beginning of the exam period; after exams significant higher rates of plaque (p=.0005, d=1.74) and gingivitis (p=.016, d=1.01) were observed in exam students as compared with controls. The study illustrates the clinical significance of stress effects on health behaviour. Stress should be included as a factor in models of patient compliance and health behaviour.

  12. Controlled outcome studies of child clinical hypnosis.

    Science.gov (United States)

    Adinolfi, Barbara; Gava, Nicoletta

    2013-09-01

    Background Hypnosis is defined as "as an interaction in which the hypnotist uses suggested scenarios ("suggestions") to encourage a person's focus of attention to shift towards inner experiences". Aim of the work The focus of this review is to summarize the findings of controlled outcome studies investigating the potential of clinical hypnosis in pediatric populations. We will examine the following themes: anesthesia, acute and chronic pain, chemotherapy-related distress, along with other specific medical issues. Results Hypnosis is an effective method to reduce pain and anxiety before, during and after the administration of anesthetics, during local dental treatments, invasive medical procedures and in burn children. Hypnosis can be successfully used to manage recurrent headaches, abdominal pain, irritable bowel syndrome and chemotherapy-related distress. Hypnosis has an important role in managing symptoms and improving the quality of life of children suffering from asthma and cystic fibrosis and in facilitating the treatment of insomnia in school-age children. Finally, hypnosis can be effectively used for the treatment of some habitual disorders such as nocturnal enuresis and dermatologic conditions, including atopic dermatitis and chronic eczema Conclusions Clinical hypnosis seems to be a useful, cheap and side-effects free tool to manage fear, pain and several kinds of stressful experiences in pediatric populations. Children who receive self-hypnosis trainings achieve significantly greater improvements in their physical health, quality of life, and self-esteem.

  13. Relationship Between Patient-Reported Outcomes and Clinical Outcomes in Patients With Morquio A Syndrome

    Directory of Open Access Journals (Sweden)

    Christina Lampe MD

    2015-04-01

    Full Text Available This cross-sectional analysis assessed the correlation between patient-reported outcomes (PROs and clinical outcomes in 24 German patients with Morquio A. Clinical outcomes included 6-minute walk test (6MWT, 3-minute stair climb (3MSC test, and joint range of motion as measures for endurance/mobility, forced vital capacity (FVC and maximum voluntary ventilation (MVV as measures for respiratory function, and height as an important manifestation. The PROs included the EuroQoL (EQ 5D-5L (EQ5D-5L, to measure health-related QoL (HRQoL, and patients’ rating of their ability to walk, climb, or breathe. In adults, endurance and pulmonary function measures and height showed strong and statistically significant correlation with the patients’ EQ5D-5L (6MWT: R = .884, 3MSC test: R = .852, FVC: R = .815, MVV: R = .825, height: R = .842. The adult patients’ rating of their ability to walk and climb also correlated strongly with 6MWT (R = .839 and 3MSC test (R = .700 results. Improvements in these clinical outcomes may be robust surrogate parameters of a better EQ5D-5L/HRQoL in patients with Morquio A.

  14. Hepatitis C treatment outcomes in Australian clinics.

    Science.gov (United States)

    Gidding, Heather F; Law, Matthew G; Amin, Janaki; Ostapowicz, George; Weltman, Martin; Macdonald, Graeme A; Sasadeusz, Joe J; Haber, Paul A W; George, Jacob; Dore, Gregory J

    2012-06-04

    To determine hepatitis C (HCV) treatment effectiveness and predictors of response in the "real-world" Australian clinic setting. Patients with chronic HCV, who were HCV-treatment-naive at enrolment, and were then treated with standard therapy (pegylated interferon-α plus ribavirin), were recruited prospectively through a national network of 24 HCV clinics between April 2008 and December 2009. Patients were interviewed and a medical record review was conducted at enrolment and at routine follow-up clinic visits. Proportion of patients achieving a sustained virological response (SVR), predictors of SVR, and impact of treatment on biochemical markers of liver disease (alanine aminotransferase levels and aspartate aminotransferase-to-platelet ratio index scores). The SVR by intention to treat was 60% (327/550). Infection with HCV genotype 2 or 3 (compared with genotype 1) was an independent predictor of SVR (odds ratio [OR], 2.45; 95% CI, 1.70-3.52), while HIV coinfection (OR, 0.28; 95% CI, 0.10-0.82), cirrhosis (OR, 0.38; 95% CI, 0.18-0.81), and increased body mass index for ≥ 30 kg/m(2) v ≤ 25 kg/m(2) (OR, 0.58; 95% CI, 0.35-0.96) were independently associated with lower SVR. There was a significant improvement in biochemical markers of liver disease following SVR (P< 0.001). Our findings are similar to those seen in clinical trials, despite the inclusion of patients with a broad range of comorbid conditions such as injecting drug and alcohol use and psychiatric illness. They suggest that, with appropriate patient and infrastructure support, expansion of treatment services to the broader HCV-infected community is warranted.

  15. Subjective and objective outcomes in randomized clinical trials

    DEFF Research Database (Denmark)

    Moustgaard, Helene; Bello, Segun; Miller, Franklin G

    2014-01-01

    OBJECTIVES: The degree of bias in randomized clinical trials varies depending on whether the outcome is subjective or objective. Assessment of the risk of bias in a clinical trial will therefore often involve categorization of the type of outcome. Our primary aim was to examine how the concepts...... "subjective outcome" and "objective outcome" are defined in methodological publications and clinical trial reports. To put this examination into perspective, we also provide an overview of how outcomes are classified more broadly. STUDY DESIGN AND SETTING: A systematic review of methodological publications...... provided for subjective outcome: (1) dependent on assessor judgment, (2) patient-reported outcome, or (3) private phenomena (ie, phenomena only assessable by the patient). Of the 200 clinical trial reports, 12 used the term "subjective" and/or "objective" about outcomes, but no clinical trial reports...

  16. Renal Oncocytosis: Management and Clinical Outcomes

    Science.gov (United States)

    Adamy, Ari; Lowrance, William T.; Yee, David S.; Chong, Kian Tai; Bernstein, Melanie; Tickoo, Satish K.; Coleman, Jonathan A.; Russo, Paul

    2014-01-01

    Purpose Renal oncocytosis is an extremely rare pathological condition in which renal parenchyma is diffusely involved by numerous oncocytic nodules, in addition to showing a spectrum of other oncocytic changes. Our aim was to describe our experience with renal oncocytosis, focusing on management and outcomes. Materials and Methods Twenty patients with a final pathologic diagnosis of renal oncocytosis from July 1995 through June 2009 were included in the analysis. Patient demographics, intraoperative variables and postoperative outcomes are reported. Results The median age at nephrectomy was 71 years. Fifteen patients (75%) had bilateral disease. There were 23 operations performed on 20 patients. Thirteen (57%) were partial nephrectomies and 10 (43%) were radical nephrectomies. The median diameter of the dominant tumor mass was 4.1 cm (range 1–14.6). The most common dominant tumor histology was hybrid tumor between oncocytoma and chromophobe renal cell carcinoma in 13 of 23 specimens (57%), followed by chromophobe RCC in 6 (26%), oncocytoma in 3 (13%) and conventional RCC in 1 (4%). Ten patients (50%) had pre-existing chronic kidney disease before nephrectomy and 5 more developed CKD after surgery. After a median follow-up of 35 months, no patient developed metastatic disease. Conclusions Patients with renal oncocytosis usually present with multiple and bilateral renal nodules. Half of the patients had CKD at diagnosis and 25% developed new-onset of CKD. No patient developed distant metastatic disease during follow-up. Our management approach is to perform a partial nephrectomy when possible and then employ careful surveillance of the remaining renal masses. PMID:21239013

  17. Clinical characteristics and outcomes of familial and idiopathic ...

    African Journals Online (AJOL)

    Background. It is not known whether there are differences in clinical characteristics and outcomes of patients with familial and idiopathic dilated cardiomyopathy (DCM) in an African setting. Purpose. To compare the clinical characteristics and outcomes of familial and idiopathic DCM. Methods. We performed a retrospective ...

  18. Analysis of clinical features and visual outcomes of pars planitis.

    Science.gov (United States)

    Berker, Nilufer; Sen, Emine; Elgin, Ufuk; Atilgan, Cemile Ucgul; Dursun, Erdem; Yilmazbas, Pelin

    2017-04-07

    To evaluate the demographic characteristics, clinical features, treatment and outcomes of patients with pars planitis in a tertiary referral center in Turkey. Medical records of patients with pars planitis were retrospectively reviewed. The data including demographic and ocular features and treatment outcomes were recorded. The distribution of clinical findings and complications were evaluated according to age and gender groups. The changes in final BCVA compared to the initial BCVA were noted. Statistical analysis was performed using SPSS software (Version 18.0, SPSS Inc., Chicago, USA). Twenty-seven patients (54 eyes) were included in this study. 16 patients were male (59.3%), and 11 were female (40.7%). Mean age at diagnosis was 12.84 ± 8.26 (range 4-36) years. Mean follow-up period was 61.3 ± 52.15 (range 9-172) months. Mean BCVA was 0.58 ± 0.36 (range 0.03-1.00) (0.40 ± 0.45 logMAR) at presentation, and 0.81 ± 0.28 (range 0.10-1.00) (0.14 ± 0.27 logMAR) at final visit (P = 0.001). Vitreous inflammation (100%), vitreous haze (92.6%), snowballs (74.1%), snowbanks (66.7%), anterior chamber cells (66.7%) and peripheral retinal vascular sheathing (48.1%) were the most common presentations. Ocular complications included vitreous condensation (51.9%), cystoid macular edema (22.2%), cataract (18.5%), inferior peripheral retinal detachment (11.1%), glaucoma (5.6%) and vitreous hemorrhage (3.7%). Treatments included topical, periocular, intravitreal and systemic corticosteroids, immunosuppressives, peripheral laser photocoagulation and pars plana vitrectomy when needed. Pars planitis is an idiopathic chronic intermediate uveitis mostly affecting children and adolescents. In spite of its chronic nature with high potential of causing ocular complications, adequate treatment and close follow-up lead to favorable visual outcomes.

  19. Immediate Implants: Clinical Guidelines for Esthetic Outcomes

    Directory of Open Access Journals (Sweden)

    Mohammad A. Javaid

    2016-06-01

    Full Text Available Research has shown that tooth loss results in morphological changes in alveolar ridge that may influence the subsequent implant placement. Immediate implant placement was introduced as a possible means to limit bone resorption and reduce the number of surgical procedures following tooth extraction. Histological and clinical evidence from human clinical studies showing efficacy of immediate implants has come to light over the last decade or so. However, immediate implant placement is a challenging surgical procedure and requires proper case selection and surgical technique. Furthermore, there appears to be a lack of clinical guidelines for immediate implant placement case selection. Therefore, the aim of this mini-review is to analyze critical evidence from human studies in order to establish clinical guidelines which may help clinicians in case selection when considering immediate implant placement protocol.

  20. QT Prolongation and Clinical Outcomes in Patients with Takotsubo Cardiomyopathy.

    Science.gov (United States)

    Imran, Tasnim F; Rahman, Ifad; Dikdan, Sean; Shah, Rashesh; Niazi, Osama T; Thirunahari, Nandan; Alhaj, Eyad; Klapholz, Marc; Gaziano, J Michael; Djousse, Luc

    2016-06-01

    Takotsubo cardiomyopathy (TCM) has been associated with repolarization abnormalities including QT prolongation and acquired long QT syndrome. However, the association between QT prolongation and clinical outcomes in patients with TCM remains unclear. The aim of this study is to examine the association between QT prolongation and ventricular arrhythmias, cardiogenic shock, and death in patients with TCM. Forty-six patients with TCM met our inclusion criteria in an ongoing prospective cohort database from 2010 to May 2015. We assigned the patients to a long QT group or a normal QT group, and created a composite outcome consisting of ventricular arrhythmias, cardiogenic shock, or death. The mean age of the participants was 59.7 ± 16 years, 67% were women, and 63% had hypertension. Median follow-up time was 3.1 years (interquartile range: 2.0-3.8), with a total of 133.8 person-years. The mean left ventricular ejection fraction at diagnosis was 27.2% ± 1.4%. The mean QTc on diagnosis was 484 ms ± 10.2 ms for men, and 488 ms ± 8.6 ms for women. The long QT group had a 4.1-times higher odds of having the composite clinical outcome as compared to the normal QT group (95% confidence interval: 1.1, 16.1, P = 0.04) after adjusting for age and race in logistic regression. Patients with TCM who have a long QT interval or develop acquired long QT syndrome due to TCM may be more likely to be intubated; require vasopressors; and develop shock, ventricular arrhythmias, and death than those with a normal QT interval. ©2016 Wiley Periodicals, Inc.

  1. Clinical outcomes of symptomatic arterioportal fistulas after transcatheter arterial embolization.

    Science.gov (United States)

    Hirakawa, Masakazu; Nishie, Akihiro; Asayama, Yoshiki; Ishigami, Kousei; Ushijima, Yasuhiro; Fujita, Nobuhiro; Honda, Hiroshi

    2013-02-28

    To evaluate the complications and clinical outcomes of transcatheter arterial embolization (TAE) for symptoms related to severe arterioportal fistulas (APFs). Six patients (3 males, 3 females; mean age, 63.8 years; age range, 60-71 years) with chronic liver disease and severe APFs due to percutaneous intrahepatic treatment (n = 5) and portal vein (PV) tumor thrombosis of hepatocellular carcinoma (n = 1) underwent TAE for symptoms related to severe APFs [refractory ascites (n = 4), hemorrhoidal hemorrhage (n = 1), and hepatic encephalopathy (n = 1)]. Control of symptoms related to APFs and complications were evaluated during the follow-up period (range, 4-57 mo). In all patients, celiac angiography revealed immediate retrograde visualization of the main PV before TAE, indicating severe APF. Selective TAE for the hepatic arteries was performed using metallic coils (MC, n = 4) and both MCs and n-butyl cyanoacrylate (n = 2). Three patients underwent repeated TAEs for residual APFs and ascites. Four patients developed PV thrombosis after TAE. During the follow-up period after TAE, APF obliteration and symptomatic improvement were obtained in all patients. Although TAE for severe APFs may sometimes be complicated by PV thrombosis, TAE can be an effective treatment to improve clinical symptoms related to severe APFs.

  2. How can we assess outcomes of clinical trials: the MCID approach.

    Science.gov (United States)

    Make, Barry

    2007-09-01

    Interpreting changes in outcomes of clinical trials in chronic obstructive pulmonary disease should be viewed from a broader perspective than only the statistical significance of the findings. The minimal clinical difference in outcome measures provides a conceptual framework to assist in clinical trial interpretation and a methodology to assess the clinical relevance of study results. Use of distribution-based techniques, comparison with other external measures, and opinions from experts, clinicians and patients can assist in minimal clinically important difference development. Although the minimal clinically important difference has been suggested for a wide range of outcomes of importance in chronic obstructive pulmonary disease, many have not been subjected to rigorous analysis. For newer tools such as activity monitors and questionnaires and measures not widely employed such as laboratory-based exercise tests, minimal clinically important differences remain to be determined.

  3. CLINICAL PRESENTATION AND OUTCOME OF MANAGEMENT

    African Journals Online (AJOL)

    carcinoma of the prostate. Patients and Methods: Thirty-two patients. (mean age: 68 x ... MANAGEMENT OF SYMPTOMATIC SPINAL METASTASIS FROM PROSTATIC CARCINOMA. Table 1: Clinical and Radiological Features of ... chronic urinary retention from atonic bladder and constipation with a lax anal sphincter and.

  4. Clinical auditing to improve patient outcomes

    Directory of Open Access Journals (Sweden)

    David Yorston

    2010-12-01

    Full Text Available Clinical audit is about measuring the quality of care we provide against relevant standards. If we are failing to meet these standards, the audit should help us understand the factors that are causing us to fail, so that we can set priorities and make improvements.

  5. Congenital clinical malaria: Incidence, management and outcome ...

    African Journals Online (AJOL)

    However, 6 babies that had both neonatal malaria and septicaemia died while, 5 babies that were negative for both malaria parasite and blood culture but with worsening clinical signs and persistent fever also died despite adequate treatment for possible septicaemia and malaria. Conclusion: Although no mortality occurred ...

  6. A study of the correlation between patient-reported outcomes and clinical outcomes after cataract surgery in ophthalmic clinics.

    Science.gov (United States)

    Mollazadegan, Kaziwe; Lundström, Mats

    2015-05-01

    To analyse the relationship between patient-reported outcome measures and clinical outcome measures in 42 individual Swedish cataract surgery settings. The study material consisted of follow-up data on cataract extractions collected by the Swedish National Cataract Register in 2008-2011. Patient-reported outcome was measured using the Catquest-9SF questionnaire. A total of 9707 pairs of questionnaires completed before and after a cataract extraction were analysed together with clinical data. The analyses were performed for each clinic. For almost all clinics, a factor related to a poor patient-reported outcome after surgery was a good preoperative self-assessed visual function. For some clinics, up to 50% of the patients stated that they were very satisfied with their vision before surgery. For single clinics, different factors such as large anisometropia (≥3D), capsule complications, biometry prediction error (≥3D) and ocular comorbidity were related to a poor patient-reported outcome. In situations where the clinical outcome was good and the patient-reported outcome was poor, problems with near-vision activities after surgery was the main factor noted. Analysing factors related to a poor patient-reported outcome for each clinic showed large variation. Weak indication for surgery, refractive problems after surgery, surgical complications and a poor chance of visual recovery due to ocular comorbidity were among the reasons for a poor patient-reported outcome. Post-operative care in terms of establishing a good near vision seemed to be another problem for some clinics. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  7. Clinical Characteristics and Outcomes of Takotsubo Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Jen-Li Looi

    2016-01-01

    Full Text Available Takotsubo cardiomyopathy (TC is a transient, reversible form of cardiomyopathy which predominantly affects post-menopausal women and is an important differential diagnosis of acute coronary syndrome. It is characterised by normal (or near-normal coronary arteries, regional wall motion abnormalities that extend beyond a single coronary vascular bed, and often proceeded by a stressful event. The pathophysiologic mechanism is complex and remains to be elucidated. There is increasing awareness among physicians about TC and hence, more cases are being reported. The diagnosis of TC has important clinical implications in the management at presentation and afterward. In this review, we discuss the demographics, clinical features, prognosis and management of this cardiomyopathy.

  8. Admission Hyperglycemia and Clinical Outcome in Cerebral Venous Thrombosis

    NARCIS (Netherlands)

    Zuurbier, Susanna M.; Hiltunen, Sini; Tatlisumak, Turgut; Peters, Guusje M.; Silvis, Suzanne M.; Haapaniemi, Elena; Kruyt, Nyika D.; Putaala, Jukka; Coutinho, Jonathan M.

    2016-01-01

    Background and Purpose-Admission hyperglycemia is associated with poor clinical outcome in ischemic and hemorrhagic stroke. Admission hyperglycemia has not been investigated in patients with cerebral venous thrombosis. Methods-Consecutive adult patients with cerebral venous thrombosis were included

  9. Clinical characteristics and outcomes of patients with stroke ...

    African Journals Online (AJOL)

    Clinical characteristics and outcomes of patients with stroke admitted to three tertiary hospitals in Zimbabwe: A retrospective one-year study. Farayi Kaseke, Aimee Stewart, Lovemore Gwanzura, James Hakim, Vasco Chikwasha ...

  10. Prediction of outcome after subarachnoid hemorrhage : Timing of clinical assessment

    NARCIS (Netherlands)

    van Donkelaar, Carlina E.; Bakker, Nicolaas A.; Veeger, Nic J. G. M.; Uyttenboogaart, Maarten; Metzemaekers, Jan D. M.; Eshghi, Omid S.; Mazuri, Aryan; Foumani, Mahrouz; Luijckx, Gert-Jan; Groen, Rob J. M.; van Dijk, J. Marc C.

    OBJECTIVE Currently, early prediction of outcome after spontaneous subarachnoid hemorrhage (SAH) lacks accuracy despite multiple studies addressing this issue. The clinical condition of the patient on admission as assessed using the World Federation of Neurosurgical Societies (WFNS) grading scale is

  11. Sociodemographic, clinical, and functional long-term outcomes in adolescents and young adults with mental disorders.

    Science.gov (United States)

    Asselmann, E; Wittchen, H-U; Lieb, R; Beesdo-Baum, K

    2018-01-01

    To examine unfavorable sociodemographic, clinical, and functional long-term outcomes for a range of adolescent mental disorders. A total number of 2210 adolescents and young adults (14-24 years at baseline, T0) from a representative community sample were prospectively followed up (T1-T3) over 10 years. DSM-IV mental disorders, sociodemographic, clinical, and functional outcomes were assessed using the DIA-X/M-CIDI and its embedded assessment modules. In (multinomial) logistic regressions adjusted for sex, age, other baseline disorders and sociodemographics, baseline anxiety, affective, substance use, somatoform and eating disorders (lifetime) predicted various unfavorable sociodemographic, clinical, and functional outcomes at T3. Particularly, strong associations were found between baseline disorders and adverse clinical outcomes at T3 (12-month diagnosis of the same/other disorder(s), drug use, suicide attempts, and help-seeking due to psychological problems). While substance use disorders were primarily associated with unfavorable sociodemographic and educational outcomes, anxiety and eating disorders were associated with unfavorable interpersonal outcomes, affective disorders with pregnancy-/childbirth-related complications and financial issues, and somatoform disorders with unfavorable educational/occupational and interpersonal outcomes. The risk of unfavorable outcomes increased with clinical severity, especially a higher number of baseline diagnoses. Our findings emphasize the importance of effective treatment of mental disorders to prevent unfavorable long-term outcomes in various life domains. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Clinical Outcomes of Colorectal Cancer in Kenya | Saidi | Annals of ...

    African Journals Online (AJOL)

    Background The incidence of colorectal cancer in Africa is increasing. True data on clinical outcomes of the disease is hampered by follow up challenges. Method Follow up data of 233 patients treated for colorectal cancer between 2005 and 2010 at various Nairobi hospitals were evaluated. The primary outcome was ...

  13. Varying the item format improved the range of measurement in patient-reported outcome measures assessing physical function

    DEFF Research Database (Denmark)

    Liegl, Gregor; Gandek, Barbara; Fischer, H. Felix

    2017-01-01

    Background: Physical function (PF) is a core patient-reported outcome domain in clinical trials in rheumatic diseases. Frequently used PF measures have ceiling effects, leading to large sample size requirements and low sensitivity to change. In most of these instruments, the response category...... easy, increases the range of precise measurement of self-reported PF. Methods: Three five-item PF short forms were constructed from the Patient-Reported Outcomes Measurement Information System (PROMIS®) wave 1 data. All forms included the same physical activities but varied in item stem and response...... precision between the short forms using different item formats. Results: Sufficient unidimensionality of all short-form items and the original PF item bank was supported. Compared to formats A and B, format C increased the range of reliable measurement by about 0.5 standard deviations on the positive side...

  14. Clinical Outcomes of Zirconia Dental Implants: A Systematic Review

    Science.gov (United States)

    Pieralli, S; Kohal, R J; Jung, R E; Vach, K; Spies, B C

    2017-01-01

    To determine the survival rate and marginal bone loss (MBL) of zirconia dental implants restored with single crowns or fixed dental prostheses. An electronic search was conducted up to November 2015 (without any restriction regarding the publication time) through the databases MEDLINE (PubMed), Cochrane Library, and EMBASE to identify randomized controlled clinical trials and prospective clinical trials including >15 patients. Primary outcomes were survival rate and MBL. Furthermore, the influence of several covariates on MBL was evaluated. Qualitative assessment and statistical analyses were performed. This review was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic reviews. With the applied search strategy, 4,196 titles could be identified. After a screening procedure, 2 randomized controlled clinical trials and 7 prospective clinical trials remained for analyses. In these trials, a total of 326 patients received 398 implants. The follow-up ranged from 12 to 60 mo. Implant loss was mostly reported within the first year, especially within the healing period. Thereafter, nearly constant survival curves could be observed. Therefore, separate meta-analyses were performed for the first and subsequent years, resulting in an implant survival rate of 95.6% (95% confidence interval: 93.3% to 97.9%) after 12 mo and, thereafter, an expected decrease of 0.05% per year (0.25% after 5 y). Additionally, a meta-analysis was conducted for the mean MBL after 12 mo, resulting in 0.79 mm (95% confidence interval: 0.73 to 0.86 mm). Implant bulk material and design, restoration type, and the application of minor augmentation procedures during surgery, as well as the modes of temporization and loading, had no statistically significant influence on MBL. The short-term cumulative survival rates and the MBL of zirconia implants in the presented systematic review are promising. However, additional data are still

  15. Clinical spectrum, management and outcome of neonatal candidiasis.

    Science.gov (United States)

    Khan, Ejaz Ahmed; Choudhry, Shehla; Fatima, Masooma; Batool, Zahra

    2015-11-01

    To identify clinical spectrum, management and outcome of neonatal candidiasis. The retrospective study was conducted at the Shifa International Hospital, Islamabad, Pakistan, and comprised microbiological records of all the babies admitted to the Neonatal Intensive Care Unit from January 2009 to January 2014 that were reviewed to identify those with positive candida cultures. Medical records were analysed for demographic and clinical spectrum features, management and outcome. SPSS 16 was used statistical analysis. Of the total 1550 neonatal admissions, 560 (36%) had positive cultures, and, of them, candida was isolated in 49(8.8%) neonates. Among them, 13(26%) had candida albicans and the rest had candida species. Majority were males 34(70%), and preterm with 30(61%) being <37 weeks. The mean birth weight was 2000±873 grams. Mean age at admission was 6±7.6 days. Overall, 39(80%) had ≥2 risk factors. The commonest site of isolation was blood in 41(84%). Besides, 32 (65%) received fluconazole alone for treatment. Mean duration of anti-fungal therapy was 10±5 days (range: 1-21 days). Twelve (24%) neonates expired and the cause of death was candida sepsis in 10(20%) cases. Mortality was not significantly associated with gender, place of birth, gestation, risk factors, length of stay, prior antibiotic exposure or receipt of antifungal prophylaxis except those who were ≤1500 grams (p<0.05). Approximately one in ten at-risk neonates may develop candida sepsis with high mortality. Early institution of anti-fungal therapy may prove to be life-saving.

  16. Intracranial Hypertension in Children: Etiologies, Clinical Features, and Outcome.

    Science.gov (United States)

    Masri, Amira; Jaafar, Amani; Noman, Rasha; Gharaibeh, Almutez; Ababneh, Osama H

    2015-10-01

    This retrospective study aimed to describe the clinical presentations, possible causes, and outcomes of children with idiopathic intracranial hypertension who presented to the authors' clinic. The mean age at onset of symptoms in the authors' cohort of 19 children was 6 years (range: 7 months to 12 years). Most patients (90%) were under 11 years old and (84.2%) symptomatic. The probable cause was identified in 7/19 (37.0%) patients. The most common cause was vitamin D deficiency (26.3%). Other associated probably coincidental comorbidities included sinusitis (5/19, 26.3%), hypophosphatasia (1/19), Pyle disease (1/19), and measles vaccine (1/19). Apart from 2 patients who required lumboperitoneal shunt, the cerebrospinal fluid pressure returned to normal in all patients within a period of 6 weeks to 1 year (average, 5 months). Of those who followed up with the authors' ophthalmologist, 30.7% developed optic atrophy or pallor; 75% of these patients had previous ocular comorbidities. © The Author(s) 2015.

  17. Villitis of unknown aetiology: correlation of recurrence with clinical outcome.

    LENUS (Irish Health Repository)

    Feeley, L

    2010-01-01

    Villitis of unknown aetiology (VUA) is associated with adverse pregnancy outcome. Consequently, an ability to predict recurrence could be clinically relevant. We examined placentas where villitis was diagnosed in a previous pregnancy to establish the risk of recurrence and outcome. A total of 304 cases of VUA were diagnosed in our laboratory over a 4-year period. Subsequently, 19 of this cohort had a second placenta examined histologically. Recurrence and clinical outcome were recorded. Villitis recurred in 7 of 19 cases (37%). There was a high level of adverse pregnancy outcome in this cohort overall, characterised by small for gestational age infants and stillbirth, particularly in cases with high-grade villitis. We identified recurrent villitis more frequently than previously reported. Our findings confirm an association between high-grade villitis and poor outcome. Adequately powered prospective studies are required to determine if enhanced surveillance of subsequent pregnancies is indicated following a diagnosis of villitis.

  18. Predictors of clinical outcome following lumbar disc surgery

    DEFF Research Database (Denmark)

    Hebert, Jeffrey J; Fritz, Julie; Koppenhaver, S.L.

    2016-01-01

    , and leg and low back pain (LBP) intensity at 10 weeks. Linear regression models were used to identify univariate and multivariate predictors of outcome. RESULTS: Univariate predictors of better outcome varied depending on the outcome measure. Clinical history predictors included a greater proportion...... of leg pain to LBP, pain medication use, greater time to surgery, and no history of previous physical or injection therapy. Physical examination predictors were a positive straight or cross straight leg raise test, diminished lower extremity strength, sensation or reflexes, and the presence of postural...... abnormality or pain peripheralization. Preoperative pain peripheralization remained a significant predictor of improved disability (p = 0.04) and LBP (p = 0.02) after accounting for information from the clinical history. Preoperative lumbar multifidus function was not associated with clinical outcome...

  19. Clinical outcomes in hypertensive or diabetes patients who ...

    African Journals Online (AJOL)

    Background: The use of complementary medicines in addition to medical prescription by patients with hypertension, diabetes and other chronic diseases presents a challenge for healthcare providers in Nigeria and globally. There is very little data on the clinical outcomes in these patients. Objectives: To evaluate clinical ...

  20. Antenatal clinical pelvimetry in primigravidae and outcome of labour ...

    African Journals Online (AJOL)

    Method: A retrospective study of clinical pelvimetry and outcome of labour in primigravidae. Results: The total number of primigravidae included in the study was 268 and of these, 74 were adjudged to have adequate pelvis at antenatal clinical pelvimetry. The APGAR scores at one and five minutes were significantly higher ...

  1. Comparison of clinical profiles and treatment outcomes between ...

    African Journals Online (AJOL)

    a dearth of information on the clinical status of this group in low-income countries. ... Key words: Vagrant; mental illness; clinical profile; outcome; Nigeria ... It is a World Health. Organization (WHO) collaborating centre for training and research in mental health. The hospital plays a vital role in mental health care for patients ...

  2. A clinically weighted approach to outcome assessment in radial polydactyly.

    Science.gov (United States)

    Dijkman, R; Selles, R; van Rosmalen, J; Hülsemann, W; Mann, M; Habenicht, R; Hovius, S; van Nieuwenhoven, C

    2016-03-01

    Currently available outcome assessment systems for radial polydactyly are mainly based on expert opinion. The aim of this study was to develop an outcome assessment system based on clinical data. We performed linear regression analysis on data from a multicentre study of 121 patients with radial polydactyly types II, IV and VII to develop a clinically weighted outcome assessment system. Items were weighted according to their influence on overall functional and aesthetic outcome in the regression analysis. Active flexion, scar appearance and prominence at amputation site were the main items influencing overall functional and aesthetic outcome (β = 0.393, β = 0.326 and β = 0.288, respectively). Palmar abduction, metacarpophalangeal joint deviation and nail appearance influenced overall functional and aesthetic outcome the least (β = -0.002, β = -0.104 and β = 0.070, respectively). Our proposed assessment system for radial polydactyly reflects the way clinicians value individual aspects of outcome as determinants of overall outcome and helps guide future treatment and evaluation of outcome. III. © The Author(s) 2015.

  3. Proteinuria and clinical outcome in CHD patients.

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-08-01

    CHD patients, especially those with associated hypoxaemia, usually have some level of renal function impairment, even though they are relatively young. The aim of the study was to evaluate those clinical and analytical factors that may contribute to microalbuminuria and determine the association of 24-hour proteinuria with thrombotic events and mortality. A total of 251 CHD patients were studied and demographic characteristics, blood test, and 24-hour urinalysis were analysed. Of the patients, 221 were non-hypoxaemic, and 30 were hypoxaemic (oxygen saturation of 84.3±5.9%). Of the non-hypoxaemic patients, 30 (13.6%), and of the hypoxaemic patients 9 (30%), showed proteinuria (>0.15 g/24 hours) (p=0.028). Hypoxaemic CHD patients also showed higher haematocrit (%) (50.7 (34.6; 72.1) versus 42.8 (34.6; 48.9), pproteinuria (gr/24 hours) (1.0 (0.4; 3.1) versus 0.08 (0.04; 0.52), p=0.043), and N-terminal pro-B-type natriuretic peptide (pg/ml) (417.8 (35.7; 8534.0) versus 44.9 (0.0; 670.5), pproteinuria and four patients did not (p=0.581) - and three patients had some type of thrombosis - two patients had 24-hour proteinuria and one patient did not (p=0.014). Kaplan-Meier survival analysis showed no significant difference between CHD patients with and without 24-hour proteinuria (p=0.631). CHD patients with proteinuria have significantly more thrombosis and more hypoxaemia than those patients without proteinuria.

  4. Nephrotic Range Proteinuria in Renal Transplantation: Clinical and Histologic Correlates in a 10-year Retrospective Study.

    Science.gov (United States)

    Leal, R; Pinto, H; Galvão, A; Santos, L; Romãozinho, C; Macário, F; Alves, R; Pratas, J; Sousa, V; Marinho, C; Prado E Castro, L; Campos, M; Mota, A; Figueiredo, A

    2017-05-01

    There is a high incidence of nephrotic proteinuria in renal transplant recipients, which is an accurate predictor of graft loss. Despite this, its histologic correlates and prognostic implications are still not well characterized. We assessed the clinical and histological correlates of kidney transplantation patients with nephrotic range proteinuria. We have retrospectively analyzed clinical and histological data from 50 kidney transplantation biopsy specimens from 44 renal transplant recipients with nephrotic range proteinuria between 2006 and 2015. The median follow-up time was 93 months (range, 14 months to 190 months). The mean age of the patients was 45.2 ± 13.7 years and our cohort included 86% recipients of deceased-donor grafts. The maintenance immunosuppressive regimen included calcineurin inhibitors in 68% and mammalian target of rapamycin inhibitors in 32% of patients. The average proteinuria was 6.9 ± 3.8 g/d and 52% of patients presented with nephrotic syndrome. The main histological findings were transplant glomerulopathy (22%), de novo glomerular disease (22%), and recurrence of primary disease (22%). Tubular atrophy and interstitial fibrosis was present in 78% of the biopsy specimens. Thirty-one patients (62%) lost the graft at follow-up. There was no statistically significant difference between the histologic diagnosis nor the proteinuria levels and the outcome of the graft. The main causes of nephrotic range proteinuria in patients undergoing biopsy were transplant glomerulopathy, recurrence of the underlying disease, and de novo glomerulonephritis. Nephrotic range proteinuria was related to a high rate of graft loss. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Clinical presentations and outcomes of Filipino juvenile systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Dans Leonila F

    2011-02-01

    Full Text Available Abstract Objective Juvenile Systemic Lupus Erythematosus (SLE varies by location and ethnicity. This study describes the clinical, laboratory profile and outcome of juvenile SLE seen at Philippine General Hospital (PGH from 2004-2008. Method Medical charts of all Filipino Juvenile SLE cases admitted at PGH during the 5-year period were reviewed collecting demographic profile, clinical and laboratory manifestations and treatment during disease course. Results Seventy-eight cases of juvenile SLE were reviewed. There were 7 boys and 71 girls. The mean age at diagnosis was 14 years (SD 2.7 with a range of 8-18 years. Fever (52.5% and malar rash (41.0% were the most common features at disease onset. At the time of diagnosis, the most common features were malar rash (65.3%, renal involvement (62.8% and photosensitivity (55.1%. Mucocutaneous (92.3%, renal (71.7% and hematologic (69.2% involvement were the most common features during the entire course of illness. Infection (34.5% and neurologic (19.0% complications were observed most frequently. Corticocosteroid treatment was given in most of the patients in the form of prednisone (97.4% and concomitant methylprednisolone intravenous pulses (29.4%. Nine patients died during the study period. The overall 5-year mortality rate was 11.5%. Infection (77.0% was the most frequent cause of death. Conclusion Malar rash was a common feature at disease onset and at diagnosis among Filipinos with juvenile SLE. Throughout the disease course, renal involvement occurs in 71.7% of patients. Infection was the leading cause of complication and death. The clinical presentations of Filipinos with juvenile SLE were similar to juvenile SLE in other countries.

  6. Clinical Outcome Prediction Using Single-Cell Data.

    Science.gov (United States)

    Pouyan, Maziyar Baran; Jindal, Vasu; Nourani, Mehrdad

    2016-10-01

    Single-cell technologies like flow cytometry (FCM) provide valuable biological data for knowledge discovery in complex cellular systems like tissues and organs. FCM data contains multi-dimensional information about the cellular heterogeneity of intricate cellular systems. It is possible to correlate single-cell markers with phenotypic properties of those systems. Cell population identification and clinical outcome prediction from single-cell measurements are challenging problems in the field of single cell analysis. In this paper, we propose a hybrid learning approach to predict clinical outcome using samples' single-cell FCM data. The proposed method is efficient in both i) identification of cellular clusters in each sample's FCM data and ii) predict clinical outcome (healthy versus unhealthy) for each subject. Our method is robust and the experimental results indicate promising performance.

  7. Clinical outcome of urachal cancer in Japanese patients.

    Science.gov (United States)

    Hayashi, Tatsuro; Yuasa, Takeshi; Uehara, Sho; Inoue, Yasushi; Yamamoto, Shinya; Masuda, Hitoshi; Fujii, Yasuhisa; Fukui, Iwao; Yonese, Junji

    2016-02-01

    The outcome of treatment of Japanese patients with urachal cancer is not well known. The purpose of this study is to clarify the characteristics and outcomes of Japanese patients with urachal cancer. The medical records of patients with urachal cancer who were treated in our hospital between 1994 and 2014 were retrospectively reviewed and statistically analyzed. We found 28 patients who had been diagnosed with urachal cancer and treated in our hospital during the study period. The median age of these patients was 52.3 years [interquartile range (IQR), 46.0-56.8 years]. Seventeen patients underwent surgery in our department. The median observation period of these patients was 42.6 months (IQR, 21.1-49.7 months). Among patients who had undergone surgery, cancer recurred in 7 (41 %). The estimated median time from surgery to recurrence and overall survival (OS) period were 35.8 months [95 % confidence interval (CI), 7.7 months-not determined] and not reached, respectively. Seventeen patients received chemotherapy for metastatic disease. The estimated median OS time from initial metastasis was 23.5 months (95 % CI, 11.8-33.3 months). Urachal cancer is usually locally advanced at presentation and it has a high risk of distant metastases. However, long-term survival following surgical treatment occurs in a significant fraction of patients. This study indicates the current treatment results for patients with urachal cancer in Japanese clinical practice. To establish a standard operation method and chemotherapy, a multicenter, prospective study is needed in a larger population in the future.

  8. Clinical characteristics and perinatal outcome of fetal hydrops.

    Science.gov (United States)

    Yeom, Wonkyung; Paik, E Sun; An, Jung-Joo; Oh, Soo-Young; Choi, Suk-Joo; Roh, Cheong-Rae; Kim, Jong-Hwa

    2015-03-01

    To investigate the clinical characteristics of fetal hydrops and to find the antenatal ultrasound findings predictive of adverse perinatal outcome. This is a retrospective study of 42 women with fetal hydrops who delivered in a tertiary-referral center from 2005 to 2013. Fetal hydrops was defined as the presence of fluid collection in ≥2 body cavities: ascites, pleural effusion, pericardial effusion, and skin edema. Predictor variables recorded included: maternal characteristics, gestational age at diagnosis, ultrasound findings, and identifiable causes. Primary outcome variables analyzed were fetal death and neonatal death. The mean gestational age at diagnosis was 29.3±5.4 weeks (range, 18 to 39 weeks). The most common identifiable causes were cardiac abnormality (10), followed by syndrome (4), aneuploidy (3), congenital infection (3), twin-to-twin transfusion syndrome (3), non-cardiac anormaly (2), chorioangioma (2), inborn errors of metabolism (1), and immune hydrops by anti-E antibody isoimmunization (1). Thirteen cases had no definite identifiable causes. Three women elected termination of pregnancy. Fetal death occurred in 4 cases. Among the 35 live-born babies, only 16 survived (54.0% neonatal mortality rate). Fetal death and neonatal mortality rate was not significantly associated with Doppler velocimetry indices or location of fluid collection, but increasing numbers of fluid collection site was significantly associated with a higher risk of neonatal death. The incidence of fetal hydrops in our retrospective study was 24.4 per 10,000 deliveries and the perinatal mortality rate was 61.9% (26/42). The number of fluid collection sites was the significant antenatal risk factor to predict neonatal death.

  9. Clinical Outcome Metrics for Optimization of Robust Training

    Science.gov (United States)

    Ebert, D.; Byrne, V. E.; McGuire, K. M.; Hurst, V. W., IV; Kerstman, E. L.; Cole, R. W.; Sargsyan, A. E.; Garcia, K. M.; Reyes, D.; Young, M.

    2016-01-01

    Introduction: The emphasis of this research is on the Human Research Program (HRP) Exploration Medical Capability's (ExMC) "Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-Flight Medical Capabilities." Specifically, this project aims to contribute to the closure of gap ExMC 2.02: We do not know how the inclusion of a physician crew medical officer quantitatively impacts clinical outcomes during exploration missions. The experiments are specifically designed to address clinical outcome differences between physician and non-physician cohorts in both near-term and longer-term (mission impacting) outcomes. Methods: Medical simulations will systematically compare success of individual diagnostic and therapeutic procedure simulations performed by physician and non-physician crew medical officer (CMO) analogs using clearly defined short-term (individual procedure) outcome metrics. In the subsequent step of the project, the procedure simulation outcomes will be used as input to a modified version of the NASA Integrated Medical Model (IMM) to analyze the effect of the outcome (degree of success) of individual procedures (including successful, imperfectly performed, and failed procedures) on overall long-term clinical outcomes and the consequent mission impacts. The procedures to be simulated are endotracheal intubation, fundoscopic examination, kidney/urinary ultrasound, ultrasound-guided intravenous catheter insertion, and a differential diagnosis exercise. Multiple assessment techniques will be used, centered on medical procedure simulation studies occurring at 3, 6, and 12 months after initial training (as depicted in the following flow diagram of the experiment design). Discussion: Analysis of procedure outcomes in the physician and non-physician groups and their subsets (tested at different elapsed times post training) will allow the team to 1) define differences between physician and non-physician CMOs in terms of both procedure performance

  10. Implementation of a clinical pathway may improve alcohol treatment outcome

    DEFF Research Database (Denmark)

    Nielsen, Anette Søgaard; Nielsen, Bent

    2015-01-01

    a structured intake, a referral and independent follow-up system, checklists, audit, and feedback, there was no change in length of stay, but significantly more patients had a good clinical outcome (stopped or moderated their consumption) at the end of treatment (OR = 1.9; 1.2–3.1). The study documents......This article describes the design, implementation, and evaluation of a clinical pathway system in a two-cohort quasi-experimental study before and after implementation, controlling for confounders. The main outcome measures were retention in care and sensible alcohol use (defined as abstinent...... or drinking no more than 21 standard drinks per week). Patients with harmful alcohol use or dependence as their primary problem who were seeking psychosocial treatment at one of four alcohol clinics in Denmark participated in the study. After implementation of the clinical pathway system, which incorporated...

  11. Proton Radiotherapy for Parameningeal Rhabdomyosarcoma: Clinical Outcomes and Late Effects

    Energy Technology Data Exchange (ETDEWEB)

    Childs, Stephanie K. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Kozak, Kevin R. [Department of Radiation Oncology, University of Wisconsin Cancer Center Johnson Creek, Madison, WI (United States); Friedmann, Alison M. [Department of Pediatric Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Yeap, Beow Y. [Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Adams, Judith; MacDonald, Shannon M.; Liebsch, Norbert J.; Tarbell, Nancy J. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Yock, Torunn I., E-mail: tyock@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)

    2012-02-01

    Purpose: To report the clinical outcome and late side effect profile of proton radiotherapy in the treatment of children with parameningeal rhabdomyosarcoma (PM-RMS). Methods and Materials: Seventeen consecutive children with PM-RMS were treated with proton radiotherapy at Massachusetts General Hospital between 1996 and 2005. We reviewed the medical records of all patients and asked referring physicians to report specific side effects of interest. Results: Median patient age at diagnosis was 3.4 years (range, 0.4-17.6). Embryonal (n = 11), alveolar (n = 4), and undifferentiated (n = 2) histologies were represented. Ten patients (59%) had intracranial extension. Median prescribed dose was 50.4 cobalt gray equivalents (GyRBE) (range, 50.4-56.0 GyRBE) delivered in 1.8-2.0-GyRBE daily fractions. Median follow-up was 5.0 years for survivors. The 5-year failure-free survival estimate was 59% (95% confidence interval, 33-79%), and overall survival estimate was 64% (95% confidence interval, 37-82%). Among the 7 patients who failed, sites of first recurrence were local only (n = 2), regional only (n = 2), distant only (n = 2), and local and distant (n = 1). Late effects related to proton radiotherapy in the 10 recurrence-free patients (median follow-up, 5 years) include failure to maintain height velocity (n = 3), endocrinopathies (n = 2), mild facial hypoplasia (n = 7), failure of permanent tooth eruption (n = 3), dental caries (n = 5), and chronic nasal/sinus congestion (n = 2). Conclusions: Proton radiotherapy for patients with PM-RMS yields tumor control and survival comparable to that in historical controls with similar poor prognostic factors. Furthermore, rates of late effects from proton radiotherapy compare favorably to published reports of photon-treated cohorts.

  12. Clinical spectrum and outcome of pulmonary nocardiosis: 5-year experience

    Directory of Open Access Journals (Sweden)

    Akashdeep Singh

    2016-01-01

    Full Text Available Background: Pulmonary nocardiosis is a rare but a life-threatening infection caused by Nocardia spp. The diagnosis is often missed and delayed resulting in delay in appropriate treatment and thus higher mortality. Aim: In this study, we aim to evaluate the clinical spectrum and outcome of patients with pulmonary nocardiosis. Methods: A retrospective, 5-year (2009-2014 review of demographic profile, risk factors, clinical manifestations, imaging findings, treatment, and outcome of patients with pulmonary nocardiosis admitted to a tertiary care hospital. Results: The median age of the study subjects was 54 years (range, 16-76 and majority of them (75% were males. The risk factors for pulmonary nocardiosis identified in our study were long-term steroid use (55.6%, chronic lung disease (52.8%, diabetes (27.8%, and solid-organ transplantation (22.2%. All the patients were symptomatic, and the most common symptoms were cough (91.7%, fever (78%, and expectoration (72%. Almost two-third of the patients were initially misdiagnosed and the alternative diagnosis included pulmonary tuberculosis (n = 7, community-acquired pneumonia (n = 5, lung abscess (n = 4, invasive fungal infection (n = 3, lung cancer (n = 2, and Wegener′s granulomatosis (n = 2. The most common radiographic features were consolidation (77.8% and nodules (56%. The mortality rate for indoor patients was 33% despite treatment. Higher mortality rate was observed among those who had brain abscess (100.0%, HIV positivity (100%, need for mechanical ventilation (87.5%, solid-organ transplantation (50%, and elderly (age > 60 years patients (43%. Conclusion: The diagnosis of pulmonary nocardiosis is often missed and delayed resulting in delay in appropriate treatment and thus high mortality. A lower threshold for diagnosing pulmonary nocardiosis needs to be exercised, in chest symptomatic patients with underlying chronic lung diseases or systemic immunosuppression, for the early diagnosis, and

  13. Review of nutritional assessment and clinical outcomes in pediatric surgical patients: does preoperative nutritional assessment impact clinical outcomes?

    Science.gov (United States)

    Wessner, Scott; Burjonrappa, Sathyaprasad

    2014-05-01

    Malnourished adult patients who undergo surgical procedures tend to have worse clinical outcomes compared to well-nourished patients. In the pediatric surgical patient, nutritional assessment is considered a critical aspect of the initial evaluation, but a correlation between preoperative malnutrition and poor surgical outcomes is not clear. We hypothesized that an evidence-based review would reveal that measures of nutritional assessment in children would not correlate pre-operative malnutrition with poor surgical outcomes. A search of major English language medical databases (Medline, Cochrane, SCOPUS) was conducted for the key words nutritional assessment, pediatric, children, surgery, and outcomes. All methods of nutritional assessment in pediatric surgery were evaluated for their relevance and relation to outcomes after surgery. The Oxford Center for Evidence Based Medicine (CEBM) classification for levels of evidence was used to develop grades of clinical recommendation for each variable studied. 35 articles were evaluated after an exhaustive literature search, of which six met inclusion criteria for this review. There is a paucity of high quality evidence correlating preoperative malnutrition in pediatric surgical patients with clinical outcomes. Factors contributing to the low level of evidence include a lack of high quality randomized controlled trials, a lack of consensus in study design and methods, and utilization of incongruous methods of nutritional assessment, including methods that may be unproven in the study population. Larger multi center randomized studies are needed to offer higher level of evidence to support nutritional intervention prior to major elective pediatric surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Clinical profile and outcome of pediatrics tetanus: the experience of ...

    African Journals Online (AJOL)

    Background: Tetanus is an acute vaccine preventable illness manifested by neuromuscular dysfunction due to a potent exotoxin, tetanospasmin produced by Clostridium tetani. It is a common health problem in developing countries like Ethiopia. The aim of this study was to assess clinical profile and outcome of Pediatrics ...

  15. Original Research Clinical outcomes among febrile children aged 2 ...

    African Journals Online (AJOL)

    Original Research. Clinical outcomes among febrile children aged 2 to. 59 months with negative malaria rapid diagnostic test results in Mchinji District, Malawi five children ... Research and Ethics Committee (COMREC) reviewed and approved the .... There were some limitations for this study; first, although the findings of ...

  16. Comparison of clinical profiles and treatment outcomes between ...

    African Journals Online (AJOL)

    Other factors found to prolong the time to improvement among all patients were old age, education, being single, unemployment, the diagnoses of schizophrenia, and substance abuse. Conclusion: The clinical profiles and treatment outcomes were poorer among the vagrant mentally ill patients, underscoring a need for ...

  17. Clinical Features, Complications and Treatment Outcome of Brucella ...

    African Journals Online (AJOL)

    Erah

    Purpose: Brucellosis is a multi-systemic infection that is endemic in some parts of the world. The purpose of this study was to examine the epidemiology as well as the clinical and haematological characteristics, complications, and treatment outcome of patients with brucellosis at the King Fahd. Hospital of the University ...

  18. Clinical Features, Complications and Treatment Outcome of Brucella ...

    African Journals Online (AJOL)

    Purpose: Brucellosis is a multi-systemic infection that is endemic in some parts of the world. The purpose of this study was to examine the epidemiology as well as the clinical and haematological characteristics, complications, and treatment outcome of patients with brucellosis at the King Fahd Hospital of the University ...

  19. Quality management systems and clinical outcomes in Dutch nursing homes.

    NARCIS (Netherlands)

    Wagner, C.; Klein Ikkink, K.; Wal, G. van der; Spreeuwenberg, P.; Bakker, D.H. de; Groenewegen, P.P.

    2006-01-01

    The objective of the article is to explore the impact quality management systems and quality assurance activities in nursing homes have on clinical outcomes. The results are based on a cross-sectional study in 65 Dutch nursing homes. The management of the nursing homes as well as the residents (N =

  20. Quality management systems and clinical outcomes in Dutch nursing homes

    NARCIS (Netherlands)

    Wagner, Cordula; Klein Ikkink, Karen; Wal, Gerrit van der; Spreeuwenberg, Peter; Bakker, Dinny Herman de; Groenewegen, Peter Paulus

    2006-01-01

    The objective of the article is to explore the impact quality management systems and quality assurance activities in nursing homes have on clinical outcomes. The results are based on a cross-sectional study in 65 Dutch nursing homes. The management of the nursing homes as well as the residents (N=

  1. Implementation of a clinical pathway may improve alcohol treatment outcome

    DEFF Research Database (Denmark)

    Nielsen, Anette Søgaard; Nielsen, Bent

    2015-01-01

    This article describes the design, implementation, and evaluation of a clinical pathway system in a two-cohort quasi-experimental study before and after implementation, controlling for confounders. The main outcome measures were retention in care and sensible alcohol use (defined as abstinent...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    conducted a systematic review of randomized clinical trials with both blinded and nonblinded assessment of the same measurement scale outcome. We searched PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, HighWire Press and Google Scholar for relevant studies. Two...

  3. Observer bias in randomised clinical trials with binary outcomes

    DEFF Research Database (Denmark)

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

    2012-01-01

    : PubMed, Embase, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, HighWire Press, and Google Scholar. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised clinical trials with blinded and non-blinded assessment of the same binary outcome. RESULTS: We included 21 trials in the main...

  4. the prevalence, clinical features, risk factors and outcome ...

    African Journals Online (AJOL)

    East African Medical Journal Vol. 87 No. 12 December 2010. THE PREVALENCE, CLINICAL FEATURES, RISK FACTORS AND OUTCOME ASSOCIATED WITH CRYPTOCOCCAL. MENINGITIS IN HIV POSITIVE PATIENTS IN KENYA. R. Mdodo, MS, DrPH, University of Alabama at Birmingham (UAB) School of Public ...

  5. Clinical outcomes of surgical management of anterior bilateral mandibular fractures

    NARCIS (Netherlands)

    Boffano, P.; Gallesio, C.; Roccia, F.; van den Bergh, B.; Forouzanfar, T.

    2013-01-01

    Purpose: The aims of this study were to assess the clinical outcomes of patients with anterior bifocal mandibular fractures and to discuss the management of this peculiar type of trauma. Methods: From the systematic computer-assisted database that has continuously recorded patients hospitalized with

  6. Clinical Outcomes after Regenerative Periodontal Therapy with Emdogain

    Directory of Open Access Journals (Sweden)

    Beresescu Gabriela Felicia

    2017-09-01

    Full Text Available Objective: Regeneration is defined as a reconstruction of a lost part of the body in such a way that the structure and function of the lost tissue are completely restored. The aim of this study is to compare the clinical outcomes of intrabony defects treatment using regenerative periodontal therapy with enamel matrix proteins (Emdogain, EMD with a control group.

  7. Multisystemic Therapy(®) : Clinical Overview, Outcomes, and Implementation Research.

    Science.gov (United States)

    Henggeler, Scott W; Schaeffer, Cindy M

    2016-09-01

    Multisystemic therapy (MST) is an evidence-based treatment originally developed for youth with serious antisocial behavior who are at high risk for out-of-home placement and their families; and subsequently adapted to address other challenging clinical problems experience by youths and their families. The social-ecological theoretical framework of MST is presented as well as its home-based model of treatment delivery, defining clinical intervention strategies, and ongoing quality assurance/quality improvement system. With more than 100 peer-reviewed outcome and implementation journal articles published as of January 2016, the majority by independent investigators, MST is one of the most extensively evaluated family based treatments. Outcome research has yielded almost uniformly favorable results for youths and families, and implementation research has demonstrated the importance of treatment and program fidelity in achieving such outcomes. © 2016 Family Process Institute.

  8. Arginine as an adjuvant to chemotherapy improves clinical outcome in active tuberculosis

    DEFF Research Database (Denmark)

    Schön, T; Elias, D; Moges, F

    2003-01-01

    NO production, would improve the clinical outcome of TB by increasing NO production. In a randomised double-blind study, patients with smear-positive TB (n = 120) were given arginine or placebo for 4 weeks in addition to conventional chemotherapy. Primary outcomes were sputum conversion, weight gain......, defined as increased weight gain, higher sputum conversion rate and faster reduction of symptoms, such as cough. The arginine level increased after week 2 in the HIV-/TB+ arginine group (100.2 microM (range 90.5-109.9) versus 142.1 microM (range 114.1-170.1)) compared with the HIV-/TB+ placebo group (105...

  9. Predictors of Clinical Outcomes in Sexually Abused Adolescents.

    Science.gov (United States)

    Tocker, Lotem; Ben-Amitay, Galit; Horesh-Reinman, Netta; Lask, Michal; Toren, Paz

    2017-01-01

    This cross-sectional, case control study examines the association between child sexual abuse and interpersonal and intrapersonal outcomes among 54 adolescents, examining specific clinical measures (depression, anxiety, dissociation, and posttraumatic stress disorder, attachment patterns, self-esteem, self-disclosure, and family environment characteristics). The research results point to a correlation between sexual abuse and higher levels of the clinical measures. In addition, a correlation was found between sexual abuse and level of avoidant attachment, self-esteem, and family environment characteristics. Stepwise hierarchical regressions were conducted to examine how adolescent attributes predicted depression, anxiety, and dissociation beyond the prediction based on sexual abuse. A combination of self-esteem, anxiety attachment, and family cohesiveness made sexual abuse insignificant when predicting levels of depression, anxiety, and dissociation. This study contributes to characterizing the emotional, personal, and family attributes of adolescents who experienced sexual abuse. It also raises questions about the clinical outcomes usually associated with sexual abuse.

  10. Coronary Stents: The Impact of Technological Advances on Clinical Outcomes.

    Science.gov (United States)

    Mennuni, Marco G; Pagnotta, Paolo A; Stefanini, Giulio G

    2016-02-01

    Percutaneous coronary interventions (PCI) were proposed in the late 1970s as an alternative to surgical coronary artery bypass grafting for the treatment of coronary artery disease. Important technological progress has been made since. Balloon angioplasty was replaced by bare metal stents, which allowed to permanently scaffold the coronary vessel avoiding acute recoil and abrupt occlusion. Thereafter, the introduction of early generation drug-eluting stents (DES) has significantly improved clinical outcomes, primarily by markedly reducing the risk of restenosis. New generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new limus antiproliferative agents, have further improved upon the safety and efficacy profile of early generation DES. The present article aims to review the impact of technological advances on clinical outcomes in the field of PCI with coronary stents, and to provide a brief overview on clinical margins of improvement and unmet needs of available DES.

  11. Clinical outcomes assessment in clinical trials to assess treatment of femoroacetabular impingement

    DEFF Research Database (Denmark)

    Harris-Hayes, Marcie; McDonough, Christine M; Leunig, Michael

    2013-01-01

    Patient-reported outcome measures are an important component of outcomes assessment in clinical trials to assess the treatment of femoroacetabular impingement (FAI). This review of disease-specific measures and instruments used to assess the generic quality of life and physical activity levels...

  12. Outcome models in clinical studies: implications for designing and evaluating trials in clinical nutrition.

    Science.gov (United States)

    Koller, Michael; Schütz, Tatjana; Valentini, Luzia; Kopp, Ina; Pichard, Claude; Lochs, Herbert

    2013-08-01

    The selection of appropriate outcome variables in clinical nutrition is particularly challenging, since nutrition is an adjunct therapy in most cases. Therefore, its effect may be confounded with the primary therapy, and classic biomedical outcomes may not reflect the effect of the nutritional intervention. This paper scrutinizes different alternatives to the biomedical perspective. Five different outcome models are proposed and analyzed for their suitability in clinical nutrition studies: biomedical, patient-centered/-reported, health economic, decision-making, and integration of classical and patient-reported endpoints. Most published studies in the field of clinical nutrition make use of biomedical endpoints, but the growing importance of patient-centered/-reported and health economic outcomes is recognized. We recommend avoiding to focus solely on biomedical endpoints in clinical nutrition studies. The availability and value of a broader set of outcome-models should be acknowledged. Patient-centered/-reported, health economic or combined endpoints are particularly useful to assess the effect of nutritional therapies, especially when applied in conjunction with a primary therapy. The proposed outcome models can also contribute to refine clinical nutrition guidelines in assessing the clinical relevance of the study results. Copyright © 2012. Published by Elsevier Ltd.

  13. Clinical outcome of autologous cultivated limbal epithelium transplantation

    Directory of Open Access Journals (Sweden)

    Sangwan Virender

    2006-01-01

    Full Text Available Purpose: To report the clinical outcome of autologous cultivated limbal epithelial transplantation. Methods: Eighty-six patients′ records and their clinical photographs were reviewed for demographics, primary etiology, type of limbal transplantation, ocular surface stability, visual acuity, final outcome, and possible factors affecting outcome and complications. Results: Eighty-eight eyes of 86 patients with limbal stem cell deficiency (LSCD underwent autologous cultivated limbal epithelium transplantation between March 2001 and May 2003, with a mean follow-up of 18.3 months. The etiology of LSCD was alkali burns in 64% patients. Sixty-one eyes had total LSCD. Thirty-two of the 88 eyes had undergone amniotic membrane transplantation and 10 eyes had previously undergone limbal transplantation with unfavorable outcome. Nineteen eyes underwent penetrating keratoplasty, of which 11 grafts survived at the final follow-up. Finally, 57 eyes (73.1%, 95% CI: 63.3-82.9 had a successful outcome with a stable ocular surface without conjunctivalization, 21 eyes (26.9%, 95%CI: 17.1-36.7 were considered failures, and 10 patients were lost to follow-up. Conclusion: LSCD can be successfully treated by autologous cultivated limbal epithelium transplantation in majority of the cases.

  14. Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment.

    Science.gov (United States)

    Marcus, Dawn A; Bernstein, Cheryl D; Haq, Adeel; Breuer, Paula

    2014-06-01

    Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact. The aim of the present study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment. This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme. Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities. Numerical rating scores for pain decreased by 10-13% (p Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p exercise repetitions doubled. Despite modest albeit statistically significant improvements in standard measures of pain severity and the FIQ, more substantial pain improvement was noted when utilizing alternative measures of pain and functional improvement. Alternative symptom assessment measures might be important outcome measures to include in drug and non-drug studies to better understand fibromyalgia treatment effectiveness. © 2013 John Wiley & Sons, Ltd.

  15. Clinical Presentation and Outcome of Patients With Optic Pathway Glioma.

    Science.gov (United States)

    Robert-Boire, Viviane; Rosca, Lorena; Samson, Yvan; Ospina, Luis H; Perreault, Sébastien

    2017-10-01

    Optic pathway gliomas (OPGs) occur sporadically or in patients with neurofibromatosis type 1 (NF1). The purpose of this study was to evaluate the clinical presentation at diagnosis and at progression of patients with OPGs. We conducted a chart review of patients with OPGs diagnosed in a single center over a period of 15 years. Demographic data including age, sex, NF1 status, clinical presentation, and outcome were collected. Of the 40 patients who were identified, 23 had sporadic tumors (57.5%) and 17 had NF1-related tumors (42.5%). Among the children with NF1, there was a significant overrepresentation of girls (82.3%) (P = 0.02), while among the children without NF1, there were slightly more boys (56.5%) than girls (43.5%). The presence of nystagmus was strongly associated with sporadic optic pathway gliomas. Poor visual outcome was related to tumor affecting both optic pathways, hydrocephalus at diagnosis, and optic nerve atrophy. Of the 40 patients, five died of OPG complications (12.5%) and all had sporadic tumors. Our cohort is one of the largest with OPGs and a detailed description of the clinical presentation both at diagnosis and at progression. We observed a significant difference between sporadic and NF1 optic pathway gliomas in terms of demographics, clinical presentation, and outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Molecular Subtypes of Uterine Leiomyosarcoma and Correlation with Clinical Outcome

    Directory of Open Access Journals (Sweden)

    Joyce N. Barlin

    2015-02-01

    Full Text Available The molecular etiology of uterine leiomyosarcoma (ULMS is poorly understood, which accounts for the wide disparity in outcomes among women with this disease. We examined and compared the molecular profiles of ULMS and normal myometrium (NL to identify clinically relevant molecular subtypes. Discovery cases included 29 NL and 23 ULMS specimens. RNA was hybridized to Affymetrix U133A 2.0 transcription microarrays. Differentially expressed genes and pathways were identified using standard methods. Fourteen NL and 44 ULMS independent archival samples were used for external validation. Molecular subgroups were correlated with clinical outcome. Pathway analyses of differentially expressed genes between ULMS and NL samples identified overrepresentation of cell cycle regulation, DNA repair, and genomic integrity. External validation confirmed differential expression in 31 genes (P < 4.4 × 10−4, Bonferroni corrected, with 84% of the overexpressed genes, including CDC7, CDC20, GTSE1, CCNA2, CCNB1, and CCNB2, participating in cell cycle regulation. Unsupervised clustering of ULMS identified two clades that were reproducibly associated with progression-free (median, 4.0 vs 26.0 months; P = .02; HR, 0.33 and overall (median, 18.2 vs 77.2 months; P = .04; HR, 0.33 survival. Cell cycle genes play a key role in ULMS sarcomagenesis, providing opportunities for therapeutic targeting. Reproducible molecular subtypes associated with clinical outcome may permit individualized adjuvant treatment after clinical trial validation.

  17. THORACOLUMBAR BURST FRACTURE: STRUCTURAL CHANGES AND CLINICAL OUTCOME OF TREATMENT

    Directory of Open Access Journals (Sweden)

    Rodrigo Arnold Tisot

    2016-03-01

    Full Text Available ABSTRACT Objective: To evaluate the correlation between structural changes in burst fractures of thoracic and lumbar spine with clinical outcome of the treatment. Methods: A retrospective study in 25 patients with fractures of thoracic and lumbar spine burst fractures without neurological deficit. Eleven patients underwent conservative treatment and for the remaining the treatment was surgical. All patients were followed up for at least 24 months. The cases were evaluated by a protocol that included: posttraumatic measurement of kyphosis, vertebral body collapse and narrowing of the spinal canal, the visual analog scale of pain, and the quality of life questionnaire SF-36 at the follow-up. For statistical analysis, the significance level was 5% and the software SPSS 18.0 was used. Results: No statistically significant difference was observed when comparing the clinical outcomes of one treatment over another. Similarly, there was no statistically significant correlation between kyphosis and post-traumatic narrowing of the spinal canal with clinical worsening in the follow-up, regardless of the treatment used. We found a positive correlation (p<0.05 between initial collapse and SF-36 domains in both groups (operated and non-operated. Conclusion: There was no significant superiority of one treatment over the other, and no correlation was found between kyphosis and spinal canal narrowing in burst fractures of the thoracic and lumbar spine without neurological deficit. However, there was correlation between initial collapse and clinical outcome in some domains of the SF-36 questionnaire.

  18. Aspergillus Osteomyelitis: Epidemiology, Clinical Manifestations, Management, and Outcome

    Science.gov (United States)

    Gamaletsou, Maria N.; Rammaert, Blandine; Bueno, Marimelle A.; Moriyama, Brad; Sipsas, Nikolaos V.; Kontoyiannis, Dimitrios P.; Roilides, Emmanuel; Zeller, Valerie; Prinapori, Roberta; Tajaldeen, Saad Jaber; Brause, Barry; Lortholary, Olivier; Walsh, Thomas J.

    2014-01-01

    Background The epidemiology, pathogenesis, diagnosis, and management of Aspergillus osteomyelitis are not well understood. Methods Protocol-defined cases of Aspergillus osteomyelitis published in the English literature were reviewed for comorbidities, microbiology, mechanisms of infection, clinical manifestations, radiological findings, inflammatory biomarkers, antifungal therapy, and outcome. Results Among 180 evaluable patients, 127 (71%) were males. Possible predisposing medical conditions in 103 (57%) included pharmacological immunosuppression, primary immunodeficiency, and neutropenia. Seventy-three others (41%) had prior open fracture, trauma or surgery. Eighty (44%) followed a hematogenous mechanism, 58 (32%) contiguous infections, and 42 (23%) direct inoculation. Aspergillus osteomyelitis was the first manifestation of aspergillosis in 77%. Pain and tenderness were present in 80%. The most frequently infected sites were vertebrae (46%), cranium (23%), ribs (16%), and long bones (13%). Patients with vertebral Aspergillus osteomyelitis had more previous orthopedic surgery (19% vs 0%; P=0.02), while those with cranial osteomyelitis had more diabetes mellitus (32% vs 8%; P=0.002) and prior head/neck surgery (12% vs 0%; P=0.02). Radiologic findings included osteolysis, soft-tissue extension, and uptake on T2-weighted images. Vertebral body Aspergillus osteomyelitis was complicated by spinal-cord compression in 47% and neurological deficits in 41%. Forty-four patients (24%) received only antifungal therapy, while 121(67%) were managed with surgery and antifungal therapy. Overall mortality was 25%. Median duration of therapy was 90 days (range, 10–772 days). There were fewer relapses in patients managed with surgery plus antifungal therapy in comparison to those managed with antifungal therapy alone (8% vs 30%; P=0.006). Conclusions Aspergillus osteomyelitis is a debilitating infection affecting both immunocompromised and immunocompetent patients. The most

  19. Community to clinic navigation to improve diabetes outcomes

    Directory of Open Access Journals (Sweden)

    Nancy E. Schoenberg

    2017-03-01

    Full Text Available Rural residents experience rates of Type 2 Diabetes Mellitus (T2DM that are considerably higher than their urban or suburban counterparts. Two primary modifiable factors, self-management and formal clinical management, have potential to greatly improve diabetes outcomes. “Community to Clinic Navigation to Improve Diabetes Outcomes,” is the first known randomized clinical trial pilot study to test a hybrid model of diabetes self-management education plus clinical navigation among rural residents with T2DM. Forty-one adults with T2DM were recruited from two federally qualified health centers in rural Appalachia from November 2014–January 2015. Community health workers provided navigation, including helping participants understand and implement a diabetes self-management program through six group sessions and, if needed, providing assistance in obtaining clinic visits (contacting providers' offices for appointments, making reminder calls, and facilitating transportation and dependent care. Pre and post-test data were collected on T2DM self-management, physical measures, demographics, psychosocial factors, and feasibility (cost, retention, and satisfaction. Although lacking statistical significance, some outcomes indicate trends in positive directions, including diet, foot care, glucose monitoring, and physical health, including decreased HbA1c and triglyceride levels. Process evaluations revealed high levels of satisfaction and feasibility. Due to the limited intervention dose, modest program expenditures (~$29,950, and a severely affected population most of whom had never received diabetes education, outcomes were not as robust as anticipated. Given high rates of satisfaction and retention, this culturally appropriate small group intervention holds promise for hard to reach rural populations. Modifications should include expanded recruitment venues, sample size, intervention dosage and longer term assessment.

  20. Clinical capabilities of graduates of an outcomes-based integrated medical program

    Directory of Open Access Journals (Sweden)

    Scicluna Helen A

    2012-06-01

    Full Text Available Abstract Background The University of New South Wales (UNSW Faculty of Medicine replaced its old content-based curriculum with an innovative new 6-year undergraduate entry outcomes-based integrated program in 2004. This paper is an initial evaluation of the perceived and assessed clinical capabilities of recent graduates of the new outcomes-based integrated medical program compared to benchmarks from traditional content-based or process-based programs. Method Self-perceived capability in a range of clinical tasks and assessment of medical education as preparation for hospital practice were evaluated in recent graduates after 3 months working as junior doctors. Responses of the 2009 graduates of the UNSW’s new outcomes-based integrated medical education program were compared to those of the 2007 graduates of UNSW’s previous content-based program, to published data from other Australian medical schools, and to hospital-based supervisor evaluations of their clinical competence. Results Three months into internship, graduates from UNSW’s new outcomes-based integrated program rated themselves to have good clinical and procedural skills, with ratings that indicated significantly greater capability than graduates of the previous UNSW content-based program. New program graduates rated themselves significantly more prepared for hospital practice in the confidence (reflective practice, prevention (social aspects of health, interpersonal skills (communication, and collaboration (teamwork subscales than old program students, and significantly better or equivalent to published benchmarks of graduates from other Australian medical schools. Clinical supervisors rated new program graduates highly capable for teamwork, reflective practice and communication. Conclusions Medical students from an outcomes-based integrated program graduate with excellent self-rated and supervisor-evaluated capabilities in a range of clinically-relevant outcomes. The program

  1. Reference ranges for the clinical laboratory derived from a rural population in Kericho, Kenya.

    Directory of Open Access Journals (Sweden)

    Rukia S Kibaya

    Full Text Available The conduct of Phase I/II HIV vaccine trials internationally necessitates the development of region-specific clinical reference ranges for trial enrollment and participant monitoring. A population based cohort of adults in Kericho, Kenya, a potential vaccine trial site, allowed development of clinical laboratory reference ranges. Lymphocyte immunophenotyping was performed on 1293 HIV seronegative study participants. Hematology and clinical chemistry were performed on up to 1541 cohort enrollees. The ratio of males to females was 1.9:1. Means, medians and 95% reference ranges were calculated and compared with those from other nations. The median CD4+ T cell count for the group was 810 cells/microl. There were significant gender differences for both red and white blood cell parameters. Kenyan subjects had lower median hemoglobin concentrations (9.5 g/dL; range 6.7-11.1 and neutrophil counts (1850 cells/microl; range 914-4715 compared to North Americans. Kenyan clinical chemistry reference ranges were comparable to those from the USA, with the exception of the upper limits for bilirubin and blood urea nitrogen, which were 2.3-fold higher and 1.5-fold lower, respectively. This study is the first to assess clinical reference ranges for a highland community in Kenya and highlights the need to define clinical laboratory ranges from the national community not only for clinical research but also care and treatment.

  2. Clinical outcomes after selective dorsal rhizotomy in an adult population.

    Science.gov (United States)

    Reynolds, Matthew R; Ray, Wilson Z; Strom, Russell G; Blackburn, Spiros L; Lee, Amy; Park, Tae Sung

    2011-01-01

    Selective dorsal rhizotomy (SDR) is a highly effective and well-established surgical tool for correction of lower-extremity spasticity in children with spastic diplegia caused by cerebral palsy (CP). Although the literature demonstrates considerable immediate and long-term functional benefits in children treated with SDR, the effects of SDR on adults with spastic diplegia have not been thoroughly investigated. The purpose of this retrospective study was to examine the objective and subjective clinical outcomes of SDR on an adult population. We reviewed the charts of 21 consecutive adult patients who underwent SDR for treatment of CP-related spastic diplegia between the years of 1989 and 2007. All patients were treated by a single surgeon (T.S.P.) and underwent formal pre- and postoperative physical therapy assessments to examine joint range of motion (ROM), gross motor function measure (GMFM), and muscle tone. The majority of patients (15/21) exhibited preoperative ambulatory independence without an assistive device. Postoperative assessments were performed at 4 months, but most patients (11/21) had longer follow-up periods (mean, 17.6 ± 30.2 months). All patients were assessed with a telephone survey to estimate pre- and postoperative function with the Katz and Lawton Activities of Daily Living (ADL) Scale. After SDR surgery, patients experienced significant improvements in lower-extremity passive joint ROM (namely, decreases in hamstring and gastrocnemius tightness) as well as in GMFM crawling and kneeling scores. In addition, spasticity in all measured lower-extremity muscle groups was decreased as compared with preoperative levels. On the basis of our patient self-assessments conducted via telephone, each patient demonstrated subjective improvements in ambulatory ability, spasticity, coordination, joint ROM, pain, overall quality of life, and independence. Also, the Lawton total instrumental ADL scale scores were subjectively improved from preoperative levels

  3. Disability outcome measures in multiple sclerosis clinical trials

    DEFF Research Database (Denmark)

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

    2012-01-01

    Many of the available disability outcome measures used in clinical trials of multiple sclerosis are insensitive to change over time, inadequately validated, or insensitive to patient-perceived health status or quality of life. Increasing focus on therapies that slow or reverse disability...... progression makes it essential to refine existing measures or to develop new tools. Major changes to the expanded disability status scale should be avoided to prevent the loss of acceptance by regulators as a measure for primary outcomes in trials that provide substantial evidence of effectiveness. Rather, we...... recommend practical refinements. Conversely, although substantial data support the multiple sclerosis functional composite as an alternative measure, changes to its component tests and scoring method are needed. Novel approaches, including the use of composite endpoints, patient-reported outcomes...

  4. Phonetogram voice range profile : assessment of voice capacities and its clinical value

    NARCIS (Netherlands)

    Schutte, HK; Clements, MP

    1996-01-01

    Voice range profile measurement is being used more and more as a practical clinical tool in the process of voice evaluation. In principle it means a graphical representation of a patient's or person's vocal capabilities concerning the fundamental frequency range and dynamic range on several

  5. Missing Data in Alcohol Clinical Trials with Binary Outcomes.

    Science.gov (United States)

    Hallgren, Kevin A; Witkiewitz, Katie; Kranzler, Henry R; Falk, Daniel E; Litten, Raye Z; O'Malley, Stephanie S; Anton, Raymond F

    2016-07-01

    Missing data are common in alcohol clinical trials for both continuous and binary end points. Approaches to handle missing data have been explored for continuous outcomes, yet no studies have compared missing data approaches for binary outcomes (e.g., abstinence, no heavy drinking days). This study compares approaches to modeling binary outcomes with missing data in the COMBINE study. We included participants in the COMBINE study who had complete drinking data during treatment and who were assigned to active medication or placebo conditions (N = 1,146). Using simulation methods, missing data were introduced under common scenarios with varying sample sizes and amounts of missing data. Logistic regression was used to estimate the effect of naltrexone (vs. placebo) in predicting any drinking and any heavy drinking outcomes at the end of treatment using 4 analytic approaches: complete case analysis (CCA), last observation carried forward (LOCF), the worst case scenario (WCS) of missing equals any drinking or heavy drinking, and multiple imputation (MI). In separate analyses, these approaches were compared when drinking data were manually deleted for those participants who discontinued treatment but continued to provide drinking data. WCS produced the greatest amount of bias in treatment effect estimates. MI usually yielded less biased estimates than WCS and CCA in the simulated data and performed considerably better than LOCF when estimating treatment effects among individuals who discontinued treatment. Missing data can introduce bias in treatment effect estimates in alcohol clinical trials. Researchers should utilize modern missing data methods, including MI, and avoid WCS and CCA when analyzing binary alcohol clinical trial outcomes. Copyright © 2016 by the Research Society on Alcoholism.

  6. Survival and clinical outcome of dogs with ischaemic stroke

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Toft, Nils; Westrup, Ulrik

    2013-01-01

    The objectives of the present study were to investigate survival time, possible predictors of survival and clinical outcome in dogs with ischaemic stroke. A retrospective study of dogs with a previous diagnosis of ischaemic stroke diagnosed by magnetic resonance imaging (MRI) was performed....... The association between survival and the hypothesised risk factors was examined using univariable exact logistic regression. Survival was examined using Kaplan-Meier and Cox regression. Twenty-two dogs were identified. Five dogs (23%) died within the first 30days of the stroke event. Median survival in 30-day...... survivors was 505days. Four dogs (18%) were still alive by the end of the study. Right-sided lesions posed a significantly increased risk of mortality with a median survival time in dogs with right-sided lesions of 24days vs. 602days in dogs with left sided lesions (P=0.006). Clinical outcome was considered...

  7. Clinical Manifestations and Outcomes of West Nile Virus Infection

    Science.gov (United States)

    Sejvar, James J.

    2014-01-01

    Since the emergence of West Nile virus (WNV) in North America in 1999, understanding of the clinical features, spectrum of illness and eventual functional outcomes of human illness has increased tremendously. Most human infections with WNV remain clinically silent. Among those persons developing symptomatic illness, most develop a self-limited febrile illness. More severe illness with WNV (West Nile neuroinvasive disease, WNND) is manifested as meningitis, encephalitis or an acute anterior (polio) myelitis. These manifestations are generally more prevalent in older persons or those with immunosuppression. In the future, a more thorough understanding of the long-term physical, cognitive and functional outcomes of persons recovering from WNV illness will be important in understanding the overall illness burden. PMID:24509812

  8. Clinical Manifestations and Outcomes of West Nile Virus Infection

    Directory of Open Access Journals (Sweden)

    James J. Sejvar

    2014-02-01

    Full Text Available Since the emergence of West Nile virus (WNV in North America in 1999, understanding of the clinical features, spectrum of illness and eventual functional outcomes of human illness has increased tremendously. Most human infections with WNV remain clinically silent. Among those persons developing symptomatic illness, most develop a self-limited febrile illness. More severe illness with WNV (West Nile neuroinvasive disease, WNND is manifested as meningitis, encephalitis or an acute anterior (polio myelitis. These manifestations are generally more prevalent in older persons or those with immunosuppression. In the future, a more thorough understanding of the long-term physical, cognitive and functional outcomes of persons recovering from WNV illness will be important in understanding the overall illness burden.

  9. Validity and reliability of patient reported outcomes used in Psoriasis: results from two randomized clinical trials

    Directory of Open Access Journals (Sweden)

    Koo John

    2003-10-01

    Full Text Available Abstract Background Two Phase III randomized controlled clinical trials were conducted to assess the efficacy, safety, and tolerability of weekly subcutaneous administration of efalizumab for the treatment of psoriasis. Patient reported measures of psoriasis-related functionality and health-related quality of life and of psoriasis-related symptom assessments were included as part of the trials. Objective To assess the reliability, validity, and responsiveness of the patient reported outcome measures that were used in the trials – the Dermatology Life Quality Index (DLQI, the Psoriasis Symptom Assessment (PSA Scale, and two itch measures, a Visual Analog Scale (VAS and the National Psoriasis Foundation (NPF itch measure. Methods Subjects aged 18 to 70 years with moderate to severe psoriasis for at least 6 months were recruited into the two clinical trials (n = 1095. Internal consistency reliability was evaluated for all patient reported outcomes at baseline and at 12 weeks. Construct validity was evaluated by relations among the different patient reported outcomes and between the patient reported outcomes and the clinical assessments (Psoriasis Area and Severity Index; Overall Lesion Severity Scale; Physician's Global Assessment of Change assessed at baseline and at 12 weeks, as was the change over the course of the 12 week portion of the trial. Results Internal consistency reliability ranged from 0.86 to 0.95 for the patient reported outcome measures. The patient reported outcome measures were all shown to have significant construct validity with respect to each other and with respect to the clinical assessments. The four measures also demonstrated significant responsiveness to change in underlying clinical status of the patients over the course of the trial, as measured by the independently assessed clinical outcomes. Conclusions The DLQI, the PSA, VAS, and the NPF are considered useful tools for the measurement of dermatology

  10. Clinical outcomes and medical care costs among medicare beneficiaries receiving therapy for peripheral arterial disease.

    Science.gov (United States)

    Jaff, Michael R; Cahill, Kevin E; Yu, Andrew P; Birnbaum, Howard G; Engelhart, Luella M

    2010-07-01

    Peripheral arterial disease (PAD) is a common disorder with multiple options for treatment, ranging from medical interventions, surgical revascularization, and endovascular therapy. Despite the explosive advances in endovascular therapy, cost-effective methods of care have not been well defined. We analyze therapeutic strategies, outcomes, and medical cost of treatment among Medicare patients with PAD. Patients who underwent therapy for PAD were identified from a 5% random sample of Medicare beneficiaries from Medicare Standard Analytic Files for the period 1999-2005. Clinical outcomes (death, amputation, new clinical symptoms related to PAD) and direct medical costs were examined by chosen revascularization options (endovascular, surgical, and combinations). One-year PAD prevalence increased steadily from 8.2% in 1999 to 9.5% in 2005. The risk-adjusted time to first post-treatment clinical outcome was lowest in those treated with "percutaneous transluminal angioplasty (PTA) or atherectomy and stents" (HR, 0.829; 95% CI, 0.793-0.865; p PAD population and was associated with higher risks of clinical events and higher medical costs compared with PAD patients without diabetes. The clinical and economic burden of PAD in the Medicare population is substantial, and the interventions used to treat PAD are associated with differences in clinical and economic outcomes. Prospective cost-effectiveness analyses should be included in future PAD therapy trials to inform payers and providers of the relative value of available treatment options. Copyright (c) 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  11. Myasthenia gravis and pregnancy: clinical implications and neonatal outcome

    Directory of Open Access Journals (Sweden)

    Estanol Bruno

    2004-11-01

    Full Text Available Abstract Background The myasthenia gravis is twice as common in women as in men and frequently affects young women in the second and third decades of life, overlapping with the childbearing years. Generally, during pregnancy in one third of patients the disease exacerbates, whereas in two thirds it remains clinically unchanged. Complete remission can occur in some patients. Methods To describe the clinical course, delivery and neonatal outcome of 18 pregnant women with the diagnosis of myasthenia gravis. Retrospective chart review of pregnant patients with myasthenia gravis, followed at the National Institute of Perinatology in Mexico City over an 8-year period. Data was abstracted from the medical records on the clinical course during pregnancy, delivery and neonatal outcome. Results From January 1, 1996 to December 31, 2003 18 patients with myasthenia gravis were identified and included in the study. The mean ± SD maternal age was 27.4 ± 4.0 years. During pregnancy 2 women (11% had an improvement in the clinical symptoms of myasthenia gravis, 7 women (39% had clinical worsening of the condition of 9 other patients (50% remained clinically unchanged. Nine patients delivered vaginally, 8 delivered by cesarean section and 1 pregnancy ended in fetal loss. Seventeen infants were born at mean ± SD gestational age of 37.5 ± 3.0 weeks and a mean birth weight of 2710 ± 73 g. Only one infant presented with transient neonatal myasthenia gravis. No congenital anomalies were identified in any of the newborns. Conclusions The clinical course of myasthenia gravis during pregnancy is variable, with a significant proportion of patients experiencing worsening of the clinical symptoms. However, neonatal transient myasthenia was uncommon in our patient population.

  12. Clinical manifestations and outcomes of severe malaria among ...

    African Journals Online (AJOL)

    clinical manifestations and outcomes of severe malaria in children admitted to district hospital in. Rungwe and Kyela in south-western Tanzania. A total of 1371 children were selected as screening group of which 409 (29.8%) were tested positive for malaria. Mean age of the children was 2.7. (95%CI= 2.5, 2.8) years and the ...

  13. Clinical characteristics and perinatal outcome of fetal hydrops

    OpenAIRE

    Yeom, Wonkyung; Paik, E Sun; An, Jung-Joo; Oh, Soo-young; Choi, Suk-Joo; Roh, Cheong-Rae; Kim, Jong-Hwa

    2015-01-01

    Objective To investigate the clinical characteristics of fetal hydrops and to find the antenatal ultrasound findings predictive of adverse perinatal outcome. Methods This is a retrospective study of 42 women with fetal hydrops who delivered in a tertiary-referral center from 2005 to 2013. Fetal hydrops was defined as the presence of fluid collection in ?2 body cavities: ascites, pleural effusion, pericardial effusion, and skin edema. Predictor variables recorded included: maternal characteris...

  14. Radiological and clinical outcomes following extreme lateral interbody fusion.

    Science.gov (United States)

    Alimi, Marjan; Hofstetter, Christoph P; Cong, Guang-Ting; Tsiouris, Apostolos John; James, Andrew R; Paulo, Danika; Elowitz, Eric; Härtl, Roger

    2014-06-01

    Extreme lateral interbody fusion (ELIF) is a popular technique for anterior fixation of the thoracolumbar spine. Clinical and radiological outcome studies are required to assess safety and efficacy. The aim of this study was to describe the functional and radiological impact of ELIF in a degenerative disc disease population with a longer follow-up and to assess the durability of this procedure. Demographic and perioperative data for all patients who had undergone ELIF for degenerative lumbar disorders between 2007 and 2011 were collected. Trauma and tumor cases were excluded. For radiological outcome, the preoperative, immediate postoperative, and latest follow-up coronal Cobb angle, lumbar sagittal lordosis, bilateral foraminal heights, and disc heights were measured. Pelvic incidence (PI) and PI-lumbar lordosis (PI-LL) mismatch were assessed in scoliotic patients. Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS), as well as the Macnab criteria. One hundred forty-five vertebral levels were surgically treated in 90 patients. Pedicle screw and rod constructs and lateral plates were used to stabilize fixation in 77% and 13% of cases, respectively. Ten percent of cases involved stand-alone cages. At an average radiological follow-up of 12.6 months, the coronal Cobb angle was 10.6° compared with 23.8° preoperatively (p postoperatively (p postoperatively or at the latest follow-up. Clinical evaluation at an average follow-up of 17.6 months revealed an improvement in the ODI and the VAS scores for back, buttock, and leg pain by 21.1% and 3.7, 3.6, and 3.7 points, respectively (p postoperative thigh numbness and weakness was detected in 4.4% and 2.2% of the patients, respectively, which resolved within the first 3 months after surgery in all but 1 case. This study provides what is to the authors' knowledge the most comprehensive set of radiological and clinical outcomes of ELIF in a fairly large population at a

  15. Renal Involvement in AA Amyloidosis: Clinical Outcomes and Survival

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    Murvet Yilmaz

    2013-03-01

    Full Text Available Background: The natural history of AA amyloidosis is typically progressive, leading to multiple organ failure and death. We analyzed the etiology as well as clinical and laboratory features of patients with biopsy-proven AA amyloidosis and evaluated the ultimate outcome. Methods: Seventy-three patients (24 female; mean age 41.85±15.89 years were analyzed retrospectively. Demographic, clinical and laboratory features were studied and the outcome was assessed. Results: Familial Mediterranean Fever and tuberculosis were the most frequent causes of amyloidosis. Mean serum creatinine and proteinuria at diagnosis were 4.65±4.89 mg/dl and 8.04±6.09 g/day, respectively; and stage I, II, III, IV and V renal disease were present in 19.2%, 13.7%, 16.4%, 11%, and 39.7% of the patients, respectively. ESRD developed in 16 patients during the follow-up period. All of the ESRD patients started a dialysis programme. Thirty patients (41% died during the follow-up period; median patient survival was 35.9±6.12 months. Old age, tuberculosis etiology, advanced renal disease and low serum albumin levels were associated with a worse prognosis. Serum albumin was a predictor of mortality in logistic regression analysis. Conclusion: The ultimate outcome of the patients with AA amyloidosis is poor, possibly due to the late referral to the nephrology clinics. Early referral may be helpful to improve prognosis.

  16. Beyond the Basics of Clinical Outcomes Assessment: Selecting Appropriate Patient-Rated Outcomes Instruments for Patient Care

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    Valier, Alison R.; Lam, Kenneth C.

    2015-01-01

    The fifth edition of the "Athletic Training Education Competencies" emphasizes the concepts of clinical outcomes assessment. In athletic training, clinical outcomes assessment, especially as it relates to patient-rated outcomes (PRO) instruments, is new, which produces uncertainty with regard to how to integrate PROs into athletic…

  17. Infectious scleritis: Clinical spectrum and management outcomes in India

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    Zia Sultan Pradhan

    2013-01-01

    Full Text Available In this retrospective case series, we studied the predisposing factors, causative organisms, clinical spectrum, and outcomes of 12 cases of culture-proven infectious scleritis. Nine of 12 patients had a history of preceding trauma (surgical or accidental. Past surgical history included small-incision cataract surgery (4, pterygium surgery (1, and trabeculectomy (1. Six patients had multifocal scleral abscesses due to Pseudomonas, Klebsiella, or Nocardia. Only 2 patients retained useful vision (>6/18. A poor visual acuity at presentation usually resulted in a worse visual outcome (P = 0.005. Four eyes developed phthisis. The addition of surgical intervention did not result in a significantly better visual outcome than medical management alone (P = 0.209, but resulted in a higher globe preservation rate (P = 0.045. Therefore, we concluded that infection must be ruled out in cases of scleritis with preceding history of trauma, and aggressive surgical intervention improves the anatomical outcome but does not change the visual outcome.

  18. Clinical, socio-demographic and radiological predictors of short-term outcome in rotator cuff disease

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    Engebretsen Kaia

    2010-10-01

    Full Text Available Abstract Background Shoulder pain is common with rotator cuff disease as the most frequently used clinical diagnosis. There is a wide range of treatment options for this condition, but limited evidence to guide patients and clinicians in the choice of treatment strategy. The purpose of this study was to investigate possible prognostic factors of short-term outcome after corticosteroid injection for rotator cuff disease. Methods We performed analyses of data from 104 patients who had participated in a randomized controlled study. Socio-demographic, clinical and radiographic baseline factors were assessed for association with outcome at six-weeks follow-up evaluated by Shoulder Pain and Disability Index (SPADI and patient perceived outcome. Factors with significant univariate association were entered into multivariate linear and logistic regression analyses. Results In the multivariate analyses; a high SPADI score indicating pain and disability at follow-up was associated with decreasing age, male gender, high baseline pain and disability, being on sick-leave, and using regular pain medication. A successful patient perceived outcome was associated with not being on sick-leave, high active abduction, local corticosteroid injection and previous cortisone injections. Structural findings of rotator cuff tendon pathology on MRI and bursal exudation or thickening on ultrasonography did not contribute to the predictive model. Conclusions Baseline characteristics were associated with outcome after corticosteroid injection in rotator cuff disease. Sick-leave was the best predictor of poor short-term outcome. Trial registration: Clinical trials NCT00640575

  19. Clinical and economic outcomes assessment in nuclear cardiology

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    Shaw, L.J. [Atlanta Emory Univ., Atlanta, GA (United States); Miller, D.D. [St. Louis Univ. Health Sciences Center, St. Louis MO (United States); Berman, D.S. [Cedars-Sinai Medical Center, Los Angeles, CA (United States); Hachamovitch, R. [St. Francis Medical Center, New York (United States)

    2000-06-01

    The future of nuclear medicine procedures, as understood within our current economic climate, depends upon its ability to provide relevant clinical information at similar or lower comparative costs. With an ever-increasing emphasis on cost containment, outcome assessment forms the basis of preserving the quality of patient care. Today, outcomes assessment encompasses a wide array of subjects including clinical, economic, and humanistic (i.e., quality of life) outcomes. For nuclear cardiology, evidence-based medicine would require a threshold level of evidence in order to justify the added cost of any test in a patient's work-up. This evidence would include large multicenter, observational series as well as randomized trial data in sufficiently large and diverse patient populations. The new movement in evidence-based medicine is also being applied to the introduction of new technologies, in particular when comparative modalities exist. In the past 5 years, it has seen a dramatic shift in the quality of outcomes data published in nuclear cardiology. This includes the use of statistically rigorous risk-adjusted techniques as well as large populations (i.e., >500 patients) representing multiple diverse medical care settings. This has been the direct result of the development of multiple outcomes databases that have now amassed thousands of patients worth of data. One of the benefits of examining outcomes in large patient datasets is the ability to assess individual endpoints (e.g., cardiac death) as compared with smaller datasets that often assess combined endpoints (e.g., death, myocardial infarction, or unstable angina). New technologies for the diagnosis of coronary artery disease have contributed to the rising costs of care. In the United States and in Europe, costs of care have risen dramatically, consuming an ever-increasing amount of available resources. The overuse of diagnostic angiography often leads to unnecessary revascularization that does not lead to

  20. A systematic review of team formulation in clinical psychology practice: Definition, implementation, and outcomes.

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    Geach, Nicole; Moghaddam, Nima G; De Boos, Danielle

    2017-10-03

    Team formulation is promoted by professional practice guidelines for clinical psychologists. However, it is unclear whether team formulation is understood/implemented in consistent ways - or whether there is outcome evidence to support the promotion of this practice. This systematic review aimed to (1) synthesize how team formulation practice is defined and implemented by practitioner psychologists and (2) analyse the range of team formulation outcomes in the peer-reviewed literature. Seven electronic bibliographic databases were searched in June 2016. Eleven articles met inclusion criteria and were quality assessed. Extracted data were synthesized using content analysis. Descriptions of team formulation revealed three main forms of instantiation: (1) a structured, consultation approach; (2) semi-structured, reflective practice meetings; and (3) unstructured/informal sharing of ideas through routine interactions. Outcome evidence linked team formulation to a range of outcomes for staff teams and service users, including some negative outcomes. Quality appraisal identified significant issues with evaluation methods; such that, overall, outcomes were not well-supported. There is weak evidence to support the claimed beneficial outcomes of team formulation in practice. There is a need for greater specification and standardization of 'team formulation' practices, to enable a clearer understanding of any relationships with outcomes and implications for best-practice implementations. Under the umbrella term of 'team formulation', three types of practice are reported: (1) highly structured consultation; (2) reflective practice meetings; and (3) informal sharing of ideas. Outcomes linked to team formulation, including some negative outcomes, were not well evidenced. Research using robust study designs is required to investigate the process and outcomes of team formulation practice. © 2017 The British Psychological Society.

  1. Does cruciate retention primary total knee arthroplasty affect proprioception, strength and clinical outcome?

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    Vandekerckhove, Pieter-Jan T K; Parys, Roel; Tampere, Thomas; Linden, Patrick; Van den Daelen, Luc; Verdonk, Peter C

    2015-06-01

    It remains unclear what the contribution of the PCL is in total knee arthroplasty (TKA). The goal of this study was to investigate the influence of the PCL in TKA in relationship to clinical outcome, strength and proprioception. Two arthroplasty designs were compared: a posterior cruciate-substituting (PS) and a posterior cruciate-retaining (CR) TKA. A retrospective analysis was performed of 27 CR and 18 PS implants with a minimum of 1 year in vivo. Both groups were compared in terms of clinical outcome (range of motion, visual analogue scale for pain, Hospital for Special Surgery Knee Scoring system, Lysholm score and Knee Injury and Osteoarthritis Outcome Score), strength (Biodex System 3 Dynamometer(®)) and proprioception (balance and postural control using the Balance Master system(®)). Each design was also compared to the non-operated contralateral side in terms of strength and proprioception. There were no significant differences between both designs in terms of clinical outcome and strength. In terms of proprioception, only the rhythmic weight test at slow and moderate speed shifting from left to right was significant in favour of the CR design. None of the unilateral stance tests showed any significant difference between both designs. There was no difference in terms of strength and proprioception between the operated side and the non-operated side. Retaining the PCL in TKA does not result in an improved performance in terms of clinical outcome and proprioception and does not show any difference in muscle strength. III.

  2. Comparison of visual outcomes after bilateral implantation of extended range of vision and trifocal intraocular lenses.

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    Ruiz-Mesa, Ramón; Abengózar-Vela, Antonio; Aramburu, Ana; Ruiz-Santos, María

    2017-06-26

    To compare visual outcomes after cataract surgery with bilateral implantation of 2 intraocular lenses (IOLs): extended range of vision and trifocal. Each group of this prospective study comprised 40 eyes (20 patients). Phacoemulsification followed by bilateral implantation of a FineVision IOL (group 1) or a Symfony IOL (group 2) was performed. The following outcomes were assessed up to 1 year postoperatively: binocular uncorrected distance visual acuity (UDVA), binocular uncorrected intermediate visual acuity (UIVA) at 60 cm, binocular uncorrected near visual acuity (UNVA) at 40 cm, spherical equivalent (SE) refraction, defocus curves, mesopic and photopic contrast sensitivity, halometry, posterior capsule opacification (PCO), and responses to a patient questionnaire. The mean binocular values in group 1 and group 2, respectively, were SE -0.15 ± 0.25 D and -0.19 ± 0.18 D; UDVA 0.01 ± 0.03 logMAR and 0.01 ± 0.02 logMAR; UIVA 0.11 ± 0.08 logMAR and 0.09 ± 0.08 logMAR; UNVA 0.06 ± 0.07 logMAR and 0.17 ± 0.06 logMAR. Difference in UNVA between IOLs (p<0.05) was statistically significant. There were no significant differences in contrast sensitivity, halometry, or PCO between groups. Defocus curves were similar between groups from 0 D to -2 D, but showed significant differences from -2.50 D to -4.00 D (p<0.05). Both IOLs provided excellent distance and intermediate visual outcomes. The FineVision IOL showed better near visual acuity. Predictability of the refractive results and optical performance were excellent; all patients achieved spectacle independence. The 2 IOLs gave similar and good contrast sensitivity in photopic and mesopic conditions and low perception of halos by patients.

  3. Fusarium keratitis: genotyping, in vitro susceptibility and clinical outcomes

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    Oechsler, Rafael A; Feilmeier, Michael R; Miller, Darlene; Shi, Wei; Hofling-Lima, Ana Luisa; Alfonso, Eduardo C

    2012-01-01

    Purpose To determine differences in the clinical characteristics and antifungal susceptibility patterns among molecularly characterized ocular Fusarium sp isolates. Methods 58 Fusarium isolates obtained from 52 eyes of 52 patients were retrieved from the Bascom Palmer Eye Institute’s (BPEI) ocular microbiology laboratory and grown in pure culture. These isolates were characterized based on DNA sequence analysis of the ITS1/2 and rDNA regions. Antifungal susceptibilities were determined for each isolate using broth microdilution methods and the corresponding medical records were reviewed to determine clinical outcomes. Results Fusarium (F.) solani isolates had significantly higher voriconazole MIC90 values than F. non-solani organisms (16 and 4ug/ml, respectively). F. solani isolates also exhibited a significantly longer time to cure (65 vs 40.5 days), a worse follow up BCVA (20/118 vs 20/36), and increased need for urgent surgical management (7 vs 0 penetrating keratoplasties) when compared to F. non-solani isolates. Conclusions This is the first report to examine the correlation between ocular genotyped Fusarium species and clinical outcomes. It supports the overall worse prognosis for F. solani versus F. non-solani isolates, including higher voriconazole resistance by the former. The clinical implementation of molecular-based diagnostics and antifungal efficacy testing, may yield important prognostic and therapeutic information that could improve the management of fungal ocular infections. PMID:23343947

  4. Clinical outcome of narrow diameter implants inserted into allografts

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    Maurizio Franco

    2009-08-01

    Full Text Available OBJECTIVE: Narrow diameter implants (NDI (i.e. diameter <3.75 mm are a potential solution for specific clinical situations, such as reduced interradicular bone, thin alveolar crest and replacement of teeth with small cervical diameter. NDI have been available in clinical practice since the 1990s, but only few studies have analyzed their clinical outcome and no study have investigated NDI inserted in fresh-frozen bone (FFB grafts. Thus, a retrospective study on a series of NDI placed in homologue FFB was designed to evaluate their clinical outcome. MATERIAL AND METHODS: In the period between December 2003 and December 2006, 36 patients (22 females and 14 males, mean age 53 years with FFB grafts were selected and 94 different NDI were inserted. The mean follow-up was 25 months. To evaluate the effect of several host-, surgery-, and implant-related factors, marginal bone loss (MBL was considered an indicator of success rate (SCR. The Kaplan Meier algorithm and Cox regression were used. RESULTS: Only 5 out of 94 implants were lost (i.e. survival rate - SVR 95.7% and no differences were detected among the studied variables. On the contrary, the Cox regression showed that the graft site (i.e. maxilla reduced MBL. CONCLUSIONS: NDI inserted in FFB have a high SVR and SCR similar to those reported in previous studies on regular and NDI inserted in non-grafted jaws. Homologue FFB is a valuable material in the insertion of NDI.

  5. Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

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    Barbara Campos Abreu Marino

    2015-05-01

    Full Text Available Background: Clinical in-stent restenosis (CISR is the main limitation of coronary angioplasty with stent implantation. Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods: We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI] and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization during a minimal follow-up of one year. Results: Mean age was 61 ± 11 years (68.2% males. Clinical presentations included acute coronary syndrome (ACS in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES in 36.4%, Bare Metal Stent (BMS in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5% deaths and 13 (11.8% AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009 and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001. Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001 and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019 emerged as predictors of a secondary outcome. Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

  6. Clinical outcomes resulting from telemedicine interventions: a systematic review

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    Kraemer Dale

    2001-11-01

    Full Text Available Abstract Background The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based. Methods Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis. All included articles were abstracted and graded for quality and direction of the evidence. Results A total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery. Conclusions Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective.

  7. Effects of PaCO2 derangements on clinical outcomes after cerebral injury: A systematic review.

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    Roberts, Brian W; Karagiannis, Paul; Coletta, Michael; Kilgannon, J Hope; Chansky, Michael E; Trzeciak, Stephen

    2015-06-01

    Partial pressure of arterial carbon dioxide (PaCO2) is a major regulator of cerebral blood flow (CBF). Derangements in PaCO2 have been thought to worsen clinical outcomes after many forms of cerebral injury by altering CBF. Our aim was to systematically analyze the biomedical literature to determine the effects of PaCO2 derangements on clinical outcomes after cerebral injury. We performed a search of Cochrane Library, PUBMED, CINHAL, conference proceedings, and other sources using a comprehensive strategy. Study inclusion criteria were (1) human subjects; (2) cerebral injury; (3) mechanical ventilation post-injury; (4) measurement of PaCO2; and (5) comparison of a clinical outcome measure (e.g. mortality) between different PaCO2 exposures. We performed a qualitative analysis to collate and summarize effects of PaCO2 derangements according to the recommended methodology from the Cochrane Handbook. Seventeen studies involving different etiologies of cerebral injury (six traumatic brain injury, six post-cardiac arrest syndrome, two cerebral vascular accident, three neonatal ischemic encephalopathy) met all inclusion and no exclusion criteria. Three randomized control trials were identified and only one was considered a high quality study as per the Cochrane criteria for assessing risk of bias. In 13/17 (76%) studies examining hypocapnia, and 7/10 (70%) studies examining hypercapnia, the exposed group (hypercapnia or hypocapnia) was associated with poor clinical outcome. The majority of studies in this report found exposure to hypocapnia and hypercapnia after cerebral injury to be associated with poor clinical outcome. However, the optimal PaCO2 range associated with good clinical outcome remains unclear. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. The Clinical Outcome Study for dysferlinopathy: An international multicenter study.

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    Harris, Elizabeth; Bladen, Catherine L; Mayhew, Anna; James, Meredith; Bettinson, Karen; Moore, Ursula; Smith, Fiona E; Rufibach, Laura; Cnaan, Avital; Bharucha-Goebel, Diana X; Blamire, Andrew M; Bravver, Elena; Carlier, Pierre G; Day, John W; Díaz-Manera, Jordi; Eagle, Michelle; Grieben, Ulrike; Harms, Matthew; Jones, Kristi J; Lochmüller, Hanns; Mendell, Jerry R; Mori-Yoshimura, Madoka; Paradas, Carmen; Pegoraro, Elena; Pestronk, Alan; Salort-Campana, Emmanuelle; Schreiber-Katz, Olivia; Semplicini, Claudio; Spuler, Simone; Stojkovic, Tanya; Straub, Volker; Takeda, Shin'ich; Rocha, Carolina Tesi; Walter, M C; Bushby, Kate

    2016-08-01

    To describe the baseline clinical and functional characteristics of an international cohort of 193 patients with dysferlinopathy. The Clinical Outcome Study for dysferlinopathy (COS) is an international multicenter study of this disease, evaluating patients with genetically confirmed dysferlinopathy over 3 years. We present a cross-sectional analysis of 193 patients derived from their baseline clinical and functional assessments. There is a high degree of variability in disease onset, pattern of weakness, and rate of progression. No factor, such as mutation class, protein expression, or age at onset, accounted for this variability. Among patients with clinical diagnoses of Miyoshi myopathy or limb-girdle muscular dystrophy, clinical presentation and examination was not strikingly different. Respiratory impairment and cardiac dysfunction were observed in a minority of patients. A substantial delay in diagnosis was previously common but has been steadily reducing, suggesting increasing awareness of dysferlinopathies. These findings highlight crucial issues to be addressed for both optimizing clinical care and planning therapeutic trials in dysferlinopathy. This ongoing longitudinal study will provide an opportunity to further understand patterns and variability in disease progression and form the basis for trial design.

  9. The clinical outcomes of 234 spiral family implants.

    Science.gov (United States)

    Danza, Matteo; Fromovich, Ophir; Guidi, Riccardo; Carinci, Francesco

    2009-09-01

    Spiral family implants (SFIs) are a new type of implant fixture with a conical internal helix and a variable thread design. The aim of this retrospective study was to evaluate the clinical outcomes of a series of SFIs. A total of 234 SFIs were placed in 86 patients (55 females and 31 males, median age 53 years) during the period between May 2004 and November 2007. The mean follow-up was 13 months. Several host, surgery, and implant-related factors were investigated, and the Kaplan Meier algorithm and the Cox regression were used to detect variables associated with the clinical outcome. Only nine out of 234 implants were lost (i.e., survival rate (SVR) of 96.2%) and no differences were detected among the studied variables. SFIs have a high SVR similar to those reported in previous studies on different implant types. SFIs demonstrated a very high primary stability which offers the potential for use of a specific implant device for immediate loading. However, additional studies are necessary to verify their outcome on the medium/long period.

  10. Comparison of statistical and clinical predictions of functional outcome after ischemic stroke.

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    Douglas D Thompson

    Full Text Available To determine whether the predictions of functional outcome after ischemic stroke made at the bedside using a doctor's clinical experience were more or less accurate than the predictions made by clinical prediction models (CPMs.A prospective cohort study of nine hundred and thirty one ischemic stroke patients recruited consecutively at the outpatient, inpatient and emergency departments of the Western General Hospital, Edinburgh between 2002 and 2005. Doctors made informal predictions of six month functional outcome on the Oxford Handicap Scale (OHS. Patients were followed up at six months with a validated postal questionnaire. For each patient we calculated the absolute predicted risk of death or dependence (OHS≥3 using five previously described CPMs. The specificity of a doctor's informal predictions of OHS≥3 at six months was good 0.96 (95% CI: 0.94 to 0.97 and similar to CPMs (range 0.94 to 0.96; however the sensitivity of both informal clinical predictions 0.44 (95% CI: 0.39 to 0.49 and clinical prediction models (range 0.38 to 0.45 was poor. The prediction of the level of disability after stroke was similar for informal clinical predictions (ordinal c-statistic 0.74 with 95% CI 0.72 to 0.76 and CPMs (range 0.69 to 0.75. No patient or clinician characteristic affected the accuracy of informal predictions, though predictions were more accurate in outpatients.CPMs are at least as good as informal clinical predictions in discriminating between good and bad functional outcome after ischemic stroke. The place of these models in clinical practice has yet to be determined.

  11. [Clinical features and outcomes of patients with Hashimoto's encephalopathy].

    Science.gov (United States)

    Tang, Yi; Xing, Yi; Zhang, Jin; Jia, Jianping

    2014-03-11

    As an ill-defined syndrome consisting of heterogeneous neurological symptoms and high serum antithyroid antibody titers, Hashimoto's encephalopathy typically responds to steroids. More serial clinical studies are required to characterize the clinical, laboratory and imaging features and outcomes. We analyzed retrospectively the clinical, laboratory, and imaging features and outcomes of 15 consecutive patients with Hashimoto's encephalopathy diagnosed at our hospital from 2005 to 2011. Cognitive impairment (11/15) and psychiatric symptoms (5/15) were the most frequent manifestations. Seizure (4/15) and myoclonus (1/15) were less common than previously described. Three (3/15) patients showed abnormal signals in hippocampus or temporal lobe related to memory disorders. Among 10 patients on steroid therapy, there were recovery (n = 5), improvement with residual deficits (n = 2) and relapse or no effect (n = 3). Among 5 patients on non-steroid, there were stable remission with antiepileptic drugs or general neurotrophic therapy (n = 3) and continuous deterioration (n = 2). Most patients respond well to steroids while someone improves without steroid therapy. In light of its reversible course, we recommend that Hashimoto's encephalopathy should always be considered in the differential diagnosis while evaluating disorders of central nervous system, even disorders those without manifestations of encephalopathy.

  12. Tuberculous spondylodiscitis: epidemiology, clinical features, treatment, and outcome.

    Science.gov (United States)

    Trecarichi, E M; Di Meco, E; Mazzotta, V; Fantoni, M

    2012-04-01

    Tuberculous spondylodiscitis (TS) is a rare but serious clinical condition which may lead to severe deformity and early or late neurological complications. To discuss certain aspects of the approach to TSs, focusing upon epidemiology, diagnosis, and treatment outcome. For the purpose of this review, a literature search was performed using the Pubmed database through to 19th October 2011 to identify studies published in the last 20 years, concerned in epidemiological, clinical, diagnostic, and therapeutical aspects of TS in adults. Only studies drafted in English language and reporting case series of more than 20 patients have been included. TS has been reported to accounts for 1-5% of all TB cases, and for about 50% of the cases of articulo-skeletal TB infections. Despite the actual availability of more effective diagnostic tools, early recognition of TS remains difficult and a high index of suspicion is needed due to the chronic nature of the disease and its insidious and variable clinical presentation. A prompt diagnosis is required to improve long term outcome, and a microbiological confirmation is recommended to enable appropriate choice of anti-mycobacterial agents. Surgery has an important role in alleviating pain, correcting deformities and neurological impairment, and restoring function. Further studies are required to assess the appropriate duration of anti-microbial treatment, also in regarding of a combined surgical approach.

  13. Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes.

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    Amir Sariaslan

    2016-08-01

    psychiatric inpatient hospitalisation (adjusted relative risk [aRR] = 2.0; 95% CI: 1.9-2.0; 6,632 versus 37,095 events, disability pension (aRR = 1.8; 95% CI: 1.7-1.8; 4,691 versus 29,778 events, and premature mortality (aRR = 1.7; 95% CI: 1.6-1.9; 799 versus 4,695 events. These risks were only marginally attenuated when the comparisons were made with their unaffected siblings, which implies that the effects of TBI were consistent with a causal inference. A dose-response relationship was observed with injury severity. Injury recurrence was also associated with higher risks-in particular, for disability pension we found that recurrent TBI was associated with a 3-fold risk increase (aRR = 2.6; 95% CI: 2.4-2.8 compared to a single-episode TBI. Higher risks for all outcomes were observed for those who had sustained their first injury at an older age (ages 20-24 y with more than 25% increase in relative risk across all outcomes compared to the youngest age group (ages 0-4 y. On the population level, TBI explained between 2%-6% of the variance in the examined outcomes. Using hospital data underestimates milder forms of TBI, but such misclassification bias suggests that the reported estimates are likely conservative. The sibling-comparison design accounts for unmeasured familial confounders shared by siblings, including half of their genes. Thus, residual genetic confounding remains a possibility but will unlikely alter our main findings, as associations were only marginally attenuated within families.Given our findings, which indicate potentially causal effects between TBI exposure in childhood and later impairments across a range of health and social outcomes, age-sensitive clinical guidelines should be considered and preventive strategies should be targeted at children and adolescents.

  14. Individual-level outcomes from a national clinical leadership development programme.

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    Patton, Declan; Fealy, Gerard; McNamara, Martin; Casey, Mary; Connor, Tom O; Doyle, Louise; Quinlan, Christina

    2013-08-01

    A national clinical leadership development programme was instituted for Irish nurses and midwives in 2010. Incorporating a development framework and leadership pathway and a range of bespoke interventions for leadership development, including workshops, action-learning sets, mentoring and coaching, the programme was introduced at seven pilot sites in the second half of 2011. The programme pilot was evaluated with reference to structure, process and outcomes elements, including individual-level programme outcomes. Evaluation data were generated through focus groups and group interviews, individual interviews and written submissions. The data provided evidence of nurses' and midwives' clinical leadership development through self and observer-reported behaviours and dispositions including accounts of how the programme participants developed and displayed particular clinical leadership competencies. A key strength of the new programme was that it involved interventions that focussed on specific leadership competencies to be developed within the practice context.

  15. Clinical and neurocognitive outcome in symptomatic isovaleric acidemia

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    Grünert Sarah C

    2012-01-01

    Full Text Available Abstract Background Despite its first description over 40 years ago, knowledge of the clinical course of isovaleric acidemia (IVA, a disorder predisposing to severe acidotic episodes during catabolic stress, is still anecdotal. We aimed to investigate the phenotypic presentation and factors determining the neurological and neurocognitive outcomes of patients diagnosed with IVA following clinical manifestation. Methods Retrospective data on 21 children and adults with symptomatic IVA diagnosed from 1976 to 1999 were analyzed for outcome determinants including age at diagnosis and number of catabolic episodes. Sixteen of 21 patients were evaluated cross-sectionally focusing on the neurological and neurocognitive status. Additionally, 155 cases of patients with IVA published in the international literature were reviewed and analyzed for outcome parameters including mortality. Results 57% of study patients (12/21 were diagnosed within the first weeks of life and 43% (9/21 in childhood. An acute metabolic attack was the main cause of diagnostic work-up. 44% of investigated study patients (7/16 showed mild motor dysfunction and only 19% (3/16 had cognitive deficits. No other organ complications were found. The patients' intelligence quotient was not related to the number of catabolic episodes but was inversely related to age at diagnosis. In published cases, mortality was high (33% if associated with neonatal diagnosis, following manifestation at an average age of 7 days. Conclusions Within the group of "classical" organic acidurias, IVA appears to be exceptional considering its milder neuropathologic implications. The potential to avoid neonatal mortality and to improve neurologic and cognitive outcome under early treatment reinforces IVA to be qualified for newborn screening.

  16. Mechanical Ventilation-induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes.

    Science.gov (United States)

    Goligher, Ewan C; Dres, Martin; Fan, Eddy; Rubenfeld, Gordon D; Scales, Damon C; Herridge, Margaret S; Vorona, Stefannie; Sklar, Michael C; Rittayamai, Nuttapol; Lanys, Ashley; Murray, Alistair; Brace, Deborah; Urrea, Cristian; Reid, W Darlene; Tomlinson, George; Slutsky, Arthur S; Kavanagh, Brian P; Brochard, Laurent J; Ferguson, Niall D

    2017-09-20

    Rationale Diaphragm dysfunction worsens outcomes in mechanically ventilated patients but the clinical impact of potentially preventable changes in diaphragm structure and function due to mechanical ventilation is unknown. Objectives To determine whether diaphragm atrophy developing during mechanical ventilation leads to prolonged ventilation. Methods Diaphragm thickness was measured daily by ultrasound in adults requiring invasive mechanical ventilation; inspiratory effort was assessed by thickening fraction. The primary outcome was time to liberation from ventilation. Secondary outcomes included complications (reintubation, tracheostomy, prolonged ventilation, or death). Associations were adjusted for age, severity of illness, sepsis, sedation, neuromuscular blockade, and comorbidity. Measurements and Main Results Of 211 patients enrolled, 191 had two or more diaphragm thickness measurements. Thickness decreased more than 10% in 78 patients (41%) by median day 4 (IQR 3-5). Development of decreased thickness was associated with a lower daily probability of liberation from ventilation (adjusted HR 0.69, 95%CI 0.54-0.87, per 10% decrease), prolonged ICU admission (duration ratio 1.71, 95%CI 1.29-2.27), and a higher risk of complications (OR 3.00, 95%CI 1.34-6.72). Development of increased thickness (n=47, 24%) also predicted prolonged ventilation (duration ratio 1.38, 95%CI 1.00-1.90). Decreasing thickness was related to abnormally low inspiratory effort; increasing thickness was related to excessive effort. Patients with thickening fraction between 15-30% (similar to breathing at rest) during the first 3 days had the shortest duration of ventilation. Conclusions Diaphragm atrophy developing during mechanical ventilation strongly impacts clinical outcomes. Targeting an inspiratory effort level similar to that of healthy subjects at rest might accelerate liberation from ventilation.

  17. Anesthesia clinical performance outcomes: does teaching method make a difference?

    Science.gov (United States)

    McLain, Nina E; Biddle, Chuck; Cotter, J James

    2012-08-01

    The purpose of this study was to compare traditional methods of instruction to the use of audiovisual patient safety vignettes in terms of their impact on student registered nurse anesthetists' recall and subsequent clinical performance. These vignettes used simulated, crisis-oriented anesthetic events known to be associated with catastrophic patient outcomes. Using a randomized controlled crossover trial, 24 student registered nurse anesthetists encountered either a malfunctioning suction device vignette or a stuck expiratory unidirectional valve vignette. Recall and clinical performances were measured after exposure to a lecture and written case studies or to lecture and patient safety vignettes. Of the 24 students, 23 were able to recognize the malfunctioning components and take corrective action. In this research study, memory and clinical performance were significantly affected when the anesthesia provider incorporated the correct anesthesia apparatus checkout process and crisis management skills into practice. This research demonstrated that under the conditions of this study, teaching methods had an impact on some areas of clinical performance. In this study, crisis-oriented, anesthesia patient safety vignettes had the potential to affect recall and clinical performance in a simulated environment.

  18. Sex differences in clinical characteristics and outcomes after myocardial infarction

    DEFF Research Database (Denmark)

    Lam, Carolyn S P; McEntegart, Margaret; Claggett, Brian

    2015-01-01

    BACKGROUND: We examined the association of sex with clinical characteristics and outcomes in patients following myocardial infarction (MI) in the Valsartan in Acute Myocardial Infarction Trial (VALIANT). METHODS AND RESULTS: A total of 4570 women and 10 133 men with heart failure (HF), left...... ventricular systolic dysfunction or both were enrolled 0.5-10 days after myocardial infarction (MI) and followed for a median of 24.7 months. Compared with men, women were older, had more comorbidities, and were more likely to present in Killip Class III/IV and experience post-infarction angina or HF. After...

  19. Malnutrition Predicts Clinical Outcome in Patients with Neuroendocrine Neoplasia.

    Science.gov (United States)

    Maasberg, Sebastian; Knappe-Drzikova, Barbora; Vonderbeck, Dorothée; Jann, Henning; Weylandt, Karsten H; Grieser, Christian; Pascher, Andreas; Schefold, Jörg C; Pavel, Marianne; Wiedenmann, Bertram; Sturm, Andreas; Pape, Ulrich-Frank

    2017-01-01

    Malnutrition is a common problem in oncological diseases, influencing treatment outcomes, treatment complications, quality of life and survival. The potential role of malnutrition has not yet been studied systematically in neuroendocrine neoplasms (NEN), which, due to their growing prevalence and additional therapeutic options, provide an increasing clinical challenge to diagnosis and management. The aim of this cross-sectional observational study, which included a long-term follow-up, was therefore to define the prevalence of malnutrition in 203 patients with NEN using various methodological approaches, and to analyse the short- and long-term outcome of malnourished patients. A detailed subgroup analysis was also performed to define risk factors for poorer outcome. When applying malnutrition screening scores, 21-25% of the NEN patients were at risk of or demonstrated manifest malnutrition. This was confirmed by anthropometric measurements, by determination of serum surrogate parameters such as albumin as well as by bioelectrical impedance analysis (BIA), particularly phase angle α. The length of hospital stay was significantly longer in malnourished NEN patients, while long-term overall survival was highly significantly reduced. Patients with high-grade (G3) neuroendocrine carcinomas, progressive disease and undergoing chemotherapy were at particular risk of malnutrition associated with a poorer outcome. Multivariate analysis confirmed the important and highly significant role of malnutrition as an independent prognostic factor for NEN besides proliferative capacity (G3 NEC). Malnutrition is therefore an underrecognized problem in NEN patients which should systematically be diagnosed by widely available standard methods such as Nutritional Risk Screening (NRS), serum albumin assessment and BIA, and treated to improve both short- and long-term outcomes. © 2015 S. Karger AG, Basel.

  20. Clinical outcomes of endovascularly managed iatrogenic renal hemorrhages

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    George Koshy Chiramel

    2015-01-01

    Full Text Available Objective: To evaluate the effectiveness of endovascular management in iatrogenic renal injuries with regard to clinical status on follow-up and requirements for repeat angiography and embolization. Materials and Methods: This retrospective study included patients who were referred for endovascular management of significant hemorrhage following an iatrogenic injury. Data was recorded from the Picture Archiving and Communication system (PACS and electronic medical records. The site and type of iatrogenic injury, imaging findings, treatment, angiography findings, embolization performed, clinical status on follow-up, and requirement for repeat embolization were recorded. The outcomes were clinical resolution, nephrectomy, or death. Clinical findings were recorded on follow-up visits to the clinic. Statistical analysis was performed using descriptive statistics. Results: Seventy patients were included in this study between January 2000 and June 2012. A bleeding lesion (a pseudoaneurysm or arteriovenous fistula was detected during the first angiogram in 55 patients (78.6% and was selectively embolized. Fifteen required a second angiography as there was no clinical improvement and five required a third angiography. Overall, 66 patients (94.3% showed complete resolution and 4 patients (5.7% died. Three patients (4.3% underwent nephrectomy for clinical stabilization even after embolization. There were no major complications. The two minor complications resolved spontaneously. Conclusions: Angiography and embolization is the treatment of choice in iatrogenic renal hemorrhage. Upto 20% of initial angiograms may not reveal the bleed and repeat angiography is required to identify a recurrent or unidentified bleed. The presence of multiple punctate bleeders on angiography suggests an enlarging subcapsular hematoma and requires preoperative embolization and nephrectomy.

  1. Clinical outcomes and satisfaction of patients of clinical nurse specialists in psychiatric-mental health nursing.

    Science.gov (United States)

    Baradell, J G

    1995-10-01

    Survey research was conducted to examine clinical outcomes and satisfaction of patients of psychiatric mental health clinical nurse specialists (CNSs). Patients who had terminated from outpatient psychotherapy with 6 CNSs in 1993 were mailed a questionnaire (N = 223). Follow-ups by mail yielded a response rate of 45% (n = 100). The questionnaires included the Profile of Mood States-Short Form ([POMS-SF]; McNair, Lorr, & Droppleman, 1992). Quality of Life Function ([QOL]; Lehman, 1991), and Patient Satisfaction Scale (Baradell, 1994). Paired difference t-tests were used to evaluate clinical outcomes. Percentages were used to report satisfaction, and Pearson correlations were used to examine the relationship between clinical outcomes and patient satisfaction. The mean age for respondents was 37 years; 82% were female. Diagnoses included depression (46%), adjustment disorders (34%), anxiety (10%), and other (10%). Patients reported significant improvement in all clinical symptoms: anxiety, depression, anger, confusion, fatigue and vigor. Patients reported significant improvement in all domains of QOL: family, social, and job. Patients reported a very high level of satisfaction with the care provided. The more clinical improvement the patients reported, the more satisfied they were with the care provided. If nurses are to be included in a reformed health care delivery system in the future, additional research is essential.

  2. [Radiological analysis of acute distal radius fractures and clinical outcomes].

    Science.gov (United States)

    Herzberg, G; Burnier, M

    2016-12-01

    Radiological analysis of acute distal radius fractures (DRF) begins with the initial AP and lateral X-ray views. A CT scan is very often indicated. In addition to the three standard planes, 3D reconstructions are mandatory. We recommend not only AP views of the distal facets of the radius but also a complete 3D view in the surgical position. The distal ulna and carpus should also be analyzed. We describe the radiological sequence and the criteria used. These criteria are recorded in the one-page PAF chart, since they all impact the treatment choice. Clinical outcomes of DRF treatment are rarely addressed in the literature. We review the most commonly used clinical scores and describe the one that we use currently. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  3. Posttraumatic Hydrocephalus as a Confounding Influence on Brain Injury Rehabilitation: Incidence, Clinical Characteristics, and Outcomes.

    Science.gov (United States)

    Weintraub, Alan H; Gerber, Donald J; Kowalski, Robert G

    2017-02-01

    To describe incidence, clinical characteristics, complications, and outcomes in posttraumatic hydrocephalus (PTH) after traumatic brain injury (TBI) for patients treated in an inpatient rehabilitation program. Cohort study with retrospective comparative analysis. Inpatient rehabilitation hospital. All patients admitted for TBI from 2009 to 2013 diagnosed with PTH (N=59), defined as ventriculomegaly, delayed clinical recovery discordant with injury severity, hydrocephalus symptoms, or positive lumbar puncture results. None. Primary measures were incidence of PTH and patient and injury characteristics. Secondary measures included frequency and timing of ventriculoperitoneal (VP) shunt, related complications, emergence from and duration of posttraumatic amnesia (PTA), Rancho Los Amigos Scale (RLAS) score, and FIM score at rehabilitation admission and discharge. Of 701 patients with TBI admitted, 59 (8%) were diagnosed with PTH. Of these, the median age was 25 years, with 73% being men. At initial presentation, 52 (88%) did not follow commands. Fifty-two (90%) patients with PTH had a VP shunt placed. Median time from injury to shunt placement was 69 (range, 9-366) days. Seven (12%) patients with PTH experienced postsurgical seizure, 3 (6%) had shunt infection, and 7 (12%) had shunt malfunction. Thirty-six (61%) patients with PTH emerged from PTA during rehabilitation. Median total FIM score at rehabilitation admission was 20 (range, 18-76), and at discharge it was 43 (range, 18-118). Injury severity predicted outcome at rehabilitation admission, whereas shunt timing predicted outcome at rehabilitation discharge. Incidence of PTH was observed in 8% of patients with TBI in inpatient rehabilitation. Earlier shunting predicted improved outcome during rehabilitation. Future studies should prospectively examine clinical decision rules, type, and timing of intervention and the coeffectiveness of rehabilitation treatment on outcomes. Copyright © 2016 American Congress of

  4. Clinical outcome measurement: Models, theory, psychometrics and practice.

    Science.gov (United States)

    McClimans, Leah; Browne, John; Cano, Stefan

    In the last decade much has been made of the role that models play in the epistemology of measurement. Specifically, philosophers have been interested in the role of models in producing measurement outcomes. This discussion has proceeded largely within the context of the physical sciences, with notable exceptions considering measurement in economics. However, models also play a central role in the methods used to develop instruments that purport to quantify psychological phenomena. These methods fall under the umbrella term 'psychometrics'. In this paper, we focus on Clinical Outcome Assessments (COAs) and discuss two measurement theories and their associated models: Classical Test Theory (CTT) and Rasch Measurement Theory. We argue that models have an important role to play in coordinating theoretical terms with empirical content, but to do so they must serve: 1) as a representation of the measurement interaction; and 2) in conjunction with a theory of the attribute in which we are interested. We conclude that Rasch Measurement Theory is a more promising approach than CTT in these regards despite the latter's popularity with health outcomes researchers. Copyright © 2017. Published by Elsevier Ltd.

  5. A long term clinical outcome of the Medial Pivot Knee Arthroplasty System.

    Science.gov (United States)

    Macheras, George A; Galanakos, Spyridon P; Lepetsos, Panagiotis; Anastasopoulos, Panagiotis P; Papadakis, Stamatios A

    2017-03-01

    The ideal total knee arthroplasty (TKA) should provide maximum range of motion and functional stability for all desired daily activities and, if possible, to replicate normal knee kinematics and function. The ADVANCE® Medial Pivot (AMP) Knee System was designed with a highly congruent medial compartment and a less conforming lateral compartment to more closely mimic the kinematics of the normal knee and to offer more stability through out of range of motion (ROM). The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of this TKA system. Three hundred and twenty-five (325) patients (347 knees) with knee osteoarthritis underwent a TKA using the AMP prosthesis in our Department. For evaluation, objective and subjective clinical rating systems along with radiograph series were used. The average follow-up was 15.2years. All patients showed a statistically significant improvement (p<0.0005) in the Knee Society clinical rating system, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, SF-12® questionnaire, and Oxford knee score. The majority of patients (94%) were able to perform age-appropriate activities with a mean knee flexion of 120° (range, 105°-135°) at final follow-up. Survival analysis showed a cumulative success rate of 98.8% at 17years. The obtained results demonstrate excellent long-term clinical outcome for this knee design. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

    Massof, Robert W

    2010-01-01

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

  7. Clinical Profile and Visual Outcome of Ocular Bartonellosis in Malaysia

    Directory of Open Access Journals (Sweden)

    Chai Lee Tan

    2017-01-01

    Full Text Available Background. Ocular bartonellosis can present in various ways, with variable visual outcome. There is limited data on ocular bartonellosis in Malaysia. Objective. We aim to describe the clinical presentation and visual outcome of ocular bartonellosis in Malaysia. Materials and Methods. This was a retrospective review of patients treated for ocular bartonellosis in two ophthalmology centers in Malaysia between January 2013 and December 2015. The diagnosis was based on clinical features, supported by a positive Bartonella spp. serology. Results. Of the 19 patients in our series, females were predominant (63.2%. The mean age was 29.3 years. The majority (63.2% had unilateral involvement. Five patients (26.3% had a history of contact with cats. Neuroretinitis was the most common presentation (62.5%. Azithromycin was the antibiotic of choice (42.1%. Concurrent systemic corticosteroids were used in approximately 60% of cases. The presenting visual acuity was worse than 6/18 in approximately 60% of eyes; on final review, 76.9% of eyes had a visual acuity better than 6/18. Conclusion. Ocular bartonellosis tends to present with neuroretinitis. Azithromycin is a viable option for treatment. Systemic corticosteroids may be considered in those with poor visual acuity on presentation.

  8. Intraocular lens iris fixation. Clinical and macular OCT outcomes

    Directory of Open Access Journals (Sweden)

    Garcia-Rojas Leonardo

    2012-10-01

    Full Text Available Abstract Background To assess the efficacy, clinical outcomes, visual acuity (VA, incidence of adverse effects, and complications of peripheral iris fixation of 3-piece acrylic IOLs in eyes lacking capsular support. Thirteen patients who underwent implantation and peripheral iris fixation of a 3-piece foldable acrylic PC IOL for aphakia in the absence of capsular support were followed after surgery. Clinical outcomes and macular SD-OCT (Cirrus OCT; Carl Zeiss Meditec, Germany were analyzed. Findings The final CDVA was 20/40 or better in 8 eyes (62%, 20/60 or better in 12 eyes (92%, and one case of 20/80 due to corneal astigmatism and mild persistent edema. No intraoperative complications were reported. There were seven cases of medically controlled ocular hypertension after surgery due to the presence of viscoelastic in the AC. There were no cases of cystoid macular edema, chronic iridocyclitis, IOL subluxation, pigment dispersion, or glaucoma. Macular edema did not develop in any case by means of SD-OCT. Conclusions We think that this technique for iris suture fixation provides safe and effective results. Patients had substantial improvements in UDVA and CDVA. This surgical strategy may be individualized however; age, cornea status, angle structures, iris anatomy, and glaucoma are important considerations in selecting candidates for an appropriate IOL fixation method.

  9. Cauda equina syndrome: evaluation of the clinical outcome.

    Science.gov (United States)

    Tamburrelli, F C; Genitiempo, M; Bochicchio, M; Donisi, L; Ratto, C

    2014-01-01

    Cauda equina syndrome is a rare but highly impairing syndrome involving lower limbs as well as urinary, defecatory and sexual function. In the literature the most investigated sphincter dysfunction is the urinary. Bowel and sexual function are often overlooked since they become more relevant after the acute phase. Eight consecutive male patients affected by cauda equina syndrome with sphincter dysfunction due to herniated disc disease of lumbar spine were treated between 2007 and 2009. Five patients were followed-up for at least two years. Sexual function was evaluated by IIEF-5 questionnaire; bowel function was investigated by means of clinical and instrumental investigation and manometry. Although little clinical improved, patients still complained severe symptoms at first year follow-up while all but one improved significantly in the following year. At two years follow-up only the patient whose cauda equina syndrome was misdiagnosed and surgically treated late respect to the onset of the syndrome, complained a persistent severe sexual and bowel dysfunction. Our results show that a long-term follow-up is mandatory to evaluate the real outcome of surgical managed cauda equine syndrome because short-term evaluation could be misleading about the residual capacity of late neurologic improving. Despite the relatively low number of cases evaluated, our results confirm that early diagnosing and treating the syndrome are relevant for the final outcome.

  10. Hardware Location and Clinical Outcome in Ulna Shortening Osteotomy.

    Science.gov (United States)

    Megerle, Kai; Hellmich, Susanne; Germann, Günter; Sauerbier, Michael

    2015-10-01

    The purpose of this study was to investigate the influence of plate location during ulna shortening osteotomy on the incidence of hardware irritation and clinical outcome. Forty patients (17 women, 23 men; mean age, 47 years) who underwent a shortening osteotomy of the ulna due to idiopathic ulna impaction syndrome were examined after a mean of 36 months. All complications and secondary procedures were extracted from the patients' records. The rate of hardware removal was higher in patients who had a dorsal placement of the plate in comparison with ulnar or palmar placements, although this difference was not statistically significant. Apart from hardware irritation, there were 4 nonunions, 1 secondary osteoarthritis of the distal radioulnar joint, and 1 case of chronic irritation of the dorsal branch of the ulnar nerve, which required secondary surgery. The incidence of secondary surgery other than hardware removal was not significantly related to the original location of the plate. Secondary surgery after ulnar shortening osteotomy is common. However, we found no difference in clinical outcomes based on plate location.

  11. Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients.

    NARCIS (Netherlands)

    Westerveld, L.A.; van Bemmel, J.C.; Dhert, W.J.A.|info:eu-repo/dai/nl/10261847X; Öner, F.C.; Verlaan, J.J.

    2014-01-01

    Background context The clinical outcome of patients with ankylosing spinal disorders (ASDs) sustaining a spinal fracture has been described to be worse compared with the general trauma population. Purpose To investigate clinical outcome (neurologic deficits, complications, and mortality) after

  12. Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas.

    Science.gov (United States)

    Nasr, Deena M; Brinjikji, Waleed; Clarke, Michelle J; Lanzino, Giuseppe

    2017-05-01

    OBJECTIVE Spinal epidural arteriovenous fistulas (SEDAVFs) constitute a rare but treatable cause of vascular myelopathy and are a different subtype from the more common Type I spinal dural AVFs. The purpose of this study was to review a consecutive series of SEDAVFs from a single institution and report on the clinical presentations, functional status, and treatment outcomes. METHODS The authors identified all SEDAVFs treated at their institution from 2005 to 2015. SEDAVFs were defined as spinal AVFs in which the fistulous connection occurred in the epidural venous plexus. The clinical presentation, functional status, immediate treatment outcomes, and long-term neurological outcomes were analyzed. RESULTS Twenty-four patients with SEDAVFs were included in this study. The patients' mean age at presentation was 66.9 years. The most common presenting symptoms were pain and numbness (22 patients, 91.7%), followed by lower-extremity weakness (21 patients, 87.5%). The mean duration of symptoms prior to diagnosis was 11.8 months. Eighteen patients (75.0%) were treated with endovascular therapy alone, 4 (16.7) with surgery, and 2 (8.3%) with a combination of techniques. There was 1 major treatment-related complication (4.2%). Fifteen patients (62.5%) had improvement in disability, and 12 patients (54.5%) had improvement in sensory symptoms. CONCLUSIONS SEDAVFs often present with lower-extremity motor dysfunction and sensory symptoms. With the availability of newer liquid embolic agents, these lesions can be effectively treated with endovascular techniques. Surgery is also effective at treating these lesions, especially in situations where endovascular embolization fails or is not safe and in patients presenting with mass effect from compressive varices.

  13. Nursing outcomes content validation according to Nursing Outcomes Classification (NOC) for clinical, surgical and critical patients.

    Science.gov (United States)

    Seganfredo, Deborah Hein; Almeida, Miriam de Abreu

    2011-01-01

    The objective of this study was to validate the Nursing Outcomes (NO) from the Nursing Outcomes Classification (NOC) for the two Nursing Diagnoses (ND) most frequent in hospitalized surgical, clinical and critical patients. The content validation of the REs was performed adapting the Fehring Model. The sample consisted of 12 expert nurses. The instrument for data collection consisted of the NOs proposed by NOC for the two NDs in the study, its definition and a five-point Likert scale. The data were analyzed using descriptive statistics. The NOs that obtained averages of 0.80 or higher were validated. The ND Risk for Infection was the most frequent, being validated eight (38.1%) of 21 NOs proposed by the NOC. The ND Self-Care Deficit: Bathing/Hygiene was the second most frequent and five (14.28%) out of 35 NOs were validated.

  14. Effects of maternal prenatal smoking and birth outcomes extending into the normal range on academic performance in fourth grade in North Carolina, USA.

    Science.gov (United States)

    Anthopolos, Rebecca; Edwards, Sharon E; Miranda, Marie Lynn

    2013-11-01

    Research has documented the adverse relationship of child cognitive development with maternal prenatal smoking and poor birth outcomes. The potential, however, for maternal prenatal smoking to modify the association between birth outcomes and cognitive development is unclear. We linked statewide North Carolina birth data for non-Hispanic white and non-Hispanic black children to end-of-grade test scores in reading and mathematics at fourth grade (n = 65 677). We fit race-stratified multilevel models of test scores regressed on maternal smoking, birth outcomes (as measured by continuous and categorical gestational age and birthweight percentile for gestational age), and their interaction, controlling for maternal- and child-level socio-economic factors. Smoking was consistently associated with decrements in test scores, and better birth outcomes were associated with improvements in test scores, even in clinically normal ranges. Test scores increased quadratically with improving birth outcomes among smoking and non-smoking mothers. Among non-Hispanic white children, the magnitude of the association between gestational age and test scores was larger for children whose mothers smoked during pregnancy compared with the non-smoking group. However, among non-Hispanic black children, birth outcomes did not appear to interact with maternal smoking on test scores. Maternal prenatal smoking may interact with birth outcomes on reading and mathematics test scores, particularly among non-Hispanic white children. Improvements in birth outcomes, even within the clinically normal range, may be associated with improved academic performance. Pregnancy-related exposures and events exert a significant and long-term impact on cognitive development. © 2013 John Wiley & Sons Ltd.

  15. Acquire uterine vascular malformation: Clinical outcome of transarterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Chae Hoon [Dept. of Radiology, Gangneung Asan Hospital, Gangneung (Korea, Republic of); Yang, Seung Boo; Goo, Dong Erk; Kim, Yong Jae; Lee, Jae Myung; Lee, Woong Hee [Dept. of Radiology, Soonchunhyang University Gumi Hospital, Gumi (Korea, Republic of)

    2017-02-15

    To evaluate clinical outcomes of transarterial embolization of bilateral uterine arteries (UAE) in patients with acquired uterine vascular malformation (UVM). This retrospective study was performed on the medical records of all 19 patients who underwent transarterial embolization of bilateral UAE for the treatment of symptomatic UVMs from January 2003 to June 2011. Embolization was performed via the unilateral femoral artery approach with a catheter and angiographic techniques. Clinical success was defined as definitive resolution of abnormal vaginal bleeding. Post-procedural complications included all adverse events related to the embolization procedure. A total of 20 procedures were performed in 19 patients. One patient required repeat embolization because of incomplete embolization related to prominent high flow malformation. Clinically, in all patients, bleeding was controlled immediately after embolization. No complications occurred in all patients during the follow up period. In all patients who underwent successful UAE, menstrual cycles were normally restored within 1-2 months. Normal pregnancy with term delivery was observed in two of the 19 cases. Transarterial bilateral UAE is a safe and effective treatment in patients with vaginal bleeding caused by acquired UVM, and it allows the possibility of future pregnancy.

  16. Optimizing Medication Outcomes in Neurocritical Care: Focus on Clinical Pharmacology.

    Science.gov (United States)

    Rhoney, Denise H; Morbitzer, Kathryn; Hatton-Kolpek, Jimmi

    2016-12-01

    Drug dosing in neurocritically ill patients presents enormous challenges for clinicians due to the complex pathophysiological alterations. These alterations are dynamic both between and within patients. Unpredictable exposure from standard dosing regimens, which were extrapolated to intensive care unit patients from healthy volunteer studies, may influence medication outcomes. Knowledge of potential alterations in pharmacokinetics/pharmacodynamics in these patients could be applied to maximize the clinical response and minimize adverse effects. Recognizing potential confounding clinical and treatment factors affecting drug response is an important step, but it is not enough. Overcoming absorption and distribution challenges by using specialized formulations and delivery systems is an area of active research. Improved methods for measuring drug concentrations in clinical settings across different matrices are also needed. Even with these advances, defining endogenous mediators signaling drug-target activation is necessary. Identifying biomarkers in disease and changes when a drug has reached its target will be pivotal. This information will improve our understanding of the pharmacogenomic and pharmacokinetic variables affecting pharmacodynamic endpoints across a spectrum of neurologic diseases. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Hair mercury concentrations and in vitro fertilization (IVF) outcomes among women from a fertility clinic

    Science.gov (United States)

    Ehrlich, Shelley; Smith, Kristen; Williams, Paige L.; Chavarro, Jorge E.; Batsis, Maria; Toth, Thomas L.; Hauser, Russ

    2015-01-01

    Total hair mercury (Hg) was measured among 205 women undergoing in vitro fertilization (IVF) treatment and the association with prospectively collected IVF outcomes (229 IVF cycles) was evaluated. Hair Hg levels (median=0.62 ppm, range: 0.03-5.66 ppm) correlated with fish intake (r=0.59), and exceeded the recommended EPA reference of 1ppm in 33% of women. Generalized linear mixed models with random intercepts accounting for within-woman correlations across treatment cycles were used to evaluate the association of hair Hg with IVF outcomes adjusted for age, body mass index, race, smoking status, infertility diagnosis, and protocol type. Hair Hg levels were not related to ovarian stimulation outcomes (peak estradiol levels, total and mature oocyte yields) or to fertilization rate, embryo quality, clinical pregnancy rate or live birth rate. PMID:25601638

  18. Childhood Acute Bacterial Meningitis: Clinical Spectrum, Bacteriological Profile and Outcome.

    Science.gov (United States)

    Bari, Attia; Zeeshan, Fatima; Zafar, Aiza; Ejaz, Hassan; Iftikhar, Aisha; Rathore, Ahsan Waheed

    2016-10-01

    To determine the disease pattern, etiological agents and outcome of childhood acute bacterial meningitis. Adescriptive study. Department of Paediatric Medicine, The Children's Hospital, Lahore, from January to December 2012. Atotal of 199 children between the ages of 1 month and 5 years, admitted with the diagnosis of meningitis on the basis of clinical findings and positive cerebrospinal fluid (CSF), were included. In all patients, complete blood count (CBC), CSF culture sensitivity, and blood culture sensitivity were performed. Data was analysed using SPSS version 20. Out of 199 children, 127 (63.8%) were males with M:F ratio of 1.7:1. Mean age was 11.33 ±12 months. Maximum numbers of children were bacterial meningitis mostly affected children under the age of 1 year. CSF culture revealed both Grampositive and Gram-negative bacteria. The most common pathogen in children who died was streptococcus pneumoniae.

  19. Clinical outcomes of enjoying sexualization among lesbian women.

    Science.gov (United States)

    Erchull, Mindy J; Liss, Miriam

    2015-01-01

    The Enjoyment of Sexualization Scale (ESS) was given to 150 lesbians in addition to measures of self-objectification, negative eating attitudes, and depression. The ESS was found to have acceptable levels of internal consistency reliability with a lesbian sample. Scores on the ESS were lower in this sample than in previously reported research with heterosexual women. Enjoying sexualization was found to moderate the relationship between body shame and both depressive symptomatology and negative eating attitudes. In contrast to findings from a heterosexual sample, lesbians who enjoyed sexualization had smaller relationships between these negative clinical outcomes and body shame than lesbians who did not. For lesbians, enjoying sexualization may serve a protective function against the negative effects of self-objectification. Findings are discussed in terms of body image and perceptions of ideal beauty among lesbians.

  20. Functional Outcomes for Clinical Evaluation of Implant Restorations

    NARCIS (Netherlands)

    Bassi, Francesco; Carr, Alan B.; Chang, Ting-Ling; Estafanous, Emad W.; Garrett, Neal R.; Happonen, Risto-Pekka; Koka, Sreenivas; Laine, Juhani; Osswald, Martin; Reintsema, Harry; Rieger, Jana; Roumanas, Eleni; Salinas, Thomas J.; Stanford, Clark M.; Wolfaardt, Johan

    2013-01-01

    The functional outcomes related to treating patients afflicted with tooth loss are an important hallmark in substantiating prosthodontic intervention. The Oral Rehabilitation Outcomes Network (ORONet) conducted two international workshops to develop a core set of outcome measures, including a

  1. Poor clinical outcomes among pneumonia patients with depressive disorder.

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    Li-Ting Kao

    Full Text Available Some studies suggested that psychological stress may be associated with the severity and duration of infectious diseases. In this population-based study, we investigated associations between depressive disorder (DD and pneumonia outcomes in Taiwan with a large-scale database from the National Health Insurance.Our study defined 112,198 patients who were hospitalized with a principal diagnosis of pneumonia. We defined their admission date for treatment of pneumonia as the index date. Subsequently, we selected 2,394 patients with DD within 3 years prior to their index date and 11,970 matched patients without DD. We carried out separate conditional logistic regressions to explore the association of clinical pneumonia treatment outcome (ICU admission, use of mechanical ventilation, acute respiratory failure and in-hospital death with previously diagnosed DD.Patients with DD had a significantly higher probability of an intensive care unit admission (18.1% vs. 12.9%; p<0.001, need for mechanical ventilation (21.9% vs. 18.1%; p<0.001 and in-hospital death (10.4% vs. 9.0%; p = 0.025 than patients without DD. The study showed that pneumonia patients with DD were respectively 1.41- (95% CI: 1.25∼1.59, p<0.001, 1.28- (95% CI: 1.14∼1.43, p<0.001, and 1.17- times (95% CI: 1.01∼1.36, p = 0.039 greater odds of being admitted to the ICU, need for mechanical ventilation, and in-hospital death than patients without DD after adjusting for monthly income, urbanization level, geographic region and Charlson Comorbidity Index score.In conclusion, we found that pneumonia patients with DD were associated with poor treatment outcomes compared to patients without DD.

  2. Patient-reported outcomes in cancer cachexia clinical trials.

    Science.gov (United States)

    Wheelwright, Sally J; Johnson, Colin D

    2015-12-01

    Patient-reported outcome (PRO) measures should be used when measuring concepts best known to the patient. To maximize the translation of findings into clinical practice, PRO measures that are most relevant for the patient group, should be used and careful reporting of the PRO results is required. The study reviews the use of PRO assessments in cancer cachexia randomized controlled trials. Most, but not all, recent cancer cachexia randomized controlled trials include PRO measures, and significant informative results have been found. PRO measures are rarely the primary endpoint. Most frequently, health -related quality of life and/or symptoms are assessed. However, instruments which are not cancer cachexia-specific are often used. Reporting of PRO data is generally poor. Patient-centred care cannot be delivered without patient-centred outcome information and the assessment of the efficacy of interventions is partly determined by whether there is a measurable perceived patient benefit. To improve the chance of finding significant and useful results, investigators should use cancer cachexia-specific instruments and report their studies carefully.

  3. Clinical Features and Outcomes Differ between Skeletal and Extraskeletal Osteosarcoma

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    Sheila Thampi

    2014-01-01

    Full Text Available Background. Extraskeletal osteosarcoma (ESOS is a rare subtype of osteosarcoma. We investigated patient characteristics, overall survival, and prognostic factors in ESOS. Methods. We identified cases of high-grade osteosarcoma with known tissue of origin in the Surveillance, Epidemiology, and End Results database from 1973 to 2009. Demographics were compared using univariate tests. Overall survival was compared with log-rank tests and multivariate analysis using Cox proportional hazards methods. Results. 256/4,173 (6% patients with high-grade osteosarcoma had ESOS. Patients with ESOS were older, were more likely to have an axial tumor and regional lymph node involvement, and were female. Multivariate analysis showed ESOS to be favorable after controlling for stage, age, tumor site, gender, and year of diagnosis [hazard ratio 0.75 (95% CI 0.62 to 0.90; p=0.002]. There was an interaction between age and tissue of origin such that older patients with ESOS had superior outcomes compared to older patients with skeletal osteosarcoma. Adverse prognostic factors in ESOS included metastatic disease, larger tumor size, older age, and axial tumor site. Conclusion. Patients with ESOS have distinct clinical features but similar prognostic factors compared to skeletal osteosarcoma. Older patients with ESOS have superior outcomes compared to older patients with skeletal osteosarcoma.

  4. Amiodarone-induced thyrotoxicosis: clinical course and predictors of outcome.

    Science.gov (United States)

    Conen, David; Melly, Ludovic; Kaufmann, Christoph; Bilz, Stefan; Ammann, Peter; Schaer, Beat; Sticherling, Christian; Muller, Beat; Osswald, Stefan

    2007-06-19

    This study sought to determine the clinical course and predictors of long-term outcome in patients with documented amiodarone-induced thyrotoxicosis (AIT). Amiodarone-induced thyrotoxicosis is a condition that is difficult to manage, in particular because of the long half-life of amiodarone. Data on optimal treatment for AIT are scarce. We performed a retrospective review among patients with documented AIT at a tertiary care center. Baseline characteristics, treatment received, laboratory parameters, and events during follow-up were evaluated. The predefined composite end point consisted of the following AIT-associated complications: death, heart transplantation, hospitalization for heart failure, myocardial infarction, stroke, hospitalization for arrhythmia management, or hospitalization for treatment complications. Eighty-four patients were included in the present analysis; 27 patients received prednisone for AIT. There was no difference in time to normalization of free thyroxine between those receiving and those not receiving prednisone. Long-term follow-up showed high morbidity and mortality; 47 patients (56%) reached the primary end point. Patients receiving prednisone had a worse outcome than those not receiving prednisone (p = 0.003). Although patients received prednisone for 84 +/- 65 days, curves started to separate only 12 months after the initial diagnosis. Patients with AIT have a high event rate during follow-up. Prednisone had no effect on time to normalization of thyroxine levels and was associated with an increased event rate. Importantly, AIT-related problems must be expected late, at a time when thyroid function is under control.

  5. Different Placebos, Different Mechanisms, Different Outcomes: Lessons for Clinical Trials.

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    Fabrizio Benedetti

    Full Text Available Clinical trials use placebos with the assumption that they are inert, thus all placebos are considered to be equal. Here we show that this assumption is wrong and that different placebo procedures are associated to different therapeutic rituals which, in turn, trigger different mechanisms and produce different therapeutic outcomes. We studied high altitude, or hypobaric hypoxia, headache, in which two different placebos were administered. The first was placebo oxygen inhaled through a mask, whereas the second was placebo aspirin swallowed with a pill. Both placebos were given after a conditioning procedure, whereby either real oxygen or real aspirin was administered for three consecutive sessions to reduce headache pain. We found that after real oxygen conditioning, placebo oxygen induced pain relief along with a reduction in ventilation, blood alkalosis and salivary prostaglandin (PGE2, yet without any increase in blood oxygen saturation (SO2. By contrast, after real aspirin conditioning, placebo aspirin induced pain relief through the inhibition of all the products of cyclooxygenase, that is, PGD2, PGE2, PGF2, PGI2, thromboxane (TXA2, without affecting ventilation and blood alkalosis. Therefore, two different placebos, associated to two different therapeutic rituals, used two different pathways to reduce headache pain. The analgesic effect following placebo oxygen was superior to placebo aspirin. These findings show that different placebos may use different mechanisms to reduce high altitude headache, depending on the therapeutic ritual and the route of administration. In clinical trials, placebos and outcome measures should be selected very carefully in order not to incur in wrong interpretations.

  6. Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes

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    Tasso Julio Lobo

    2015-01-01

    Full Text Available Background: Heart failure and atrial fibrillation (AF often coexist in a deleterious cycle. Objective: To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF ablation. Methods: Patients with ventricular systolic dysfunction [ejection fraction (EF <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class and echocardiographic (EF, left atrial diameter data were compared (McNemar test and t test before and after ablation. Results: 31 patients (6 women, 25 men, aged 37 to 77 years (mean, 59.8±10.6, underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%. During a mean follow-up of 20.3±17 months, 24 patients (77% were in sinus rhythm, 11 (35% being on amiodarone. Eight patients (26% underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures. Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001. The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005 and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026. No major complications occurred. Conclusion: Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement.

  7. Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes

    Science.gov (United States)

    Lobo, Tasso Julio; Pachon, Carlos Thiene; Pachon, Jose Carlos; Pachon, Enrique Indalecio; Pachon, Maria Zelia; Pachon, Juan Carlos; Santillana, Tomas Guillermo; Zerpa, Juan Carlos; Albornoz, Remy Nelson; Jatene, Adib Domingos

    2015-01-01

    Background Heart failure and atrial fibrillation (AF) often coexist in a deleterious cycle. Objective To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF) ablation. Methods Patients with ventricular systolic dysfunction [ejection fraction (EF) <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class) and echocardiographic (EF, left atrial diameter) data were compared (McNemar test and t test) before and after ablation. Results 31 patients (6 women, 25 men), aged 37 to 77 years (mean, 59.8±10.6), underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%). During a mean follow-up of 20.3±17 months, 24 patients (77%) were in sinus rhythm, 11 (35%) being on amiodarone. Eight patients (26%) underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures). Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001). The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005) and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026). No major complications occurred. Conclusion Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement. PMID:25387404

  8. Financial and clinical outcomes of extracorporeal mechanical support.

    Science.gov (United States)

    Chiu, Ryan; Pillado, Eric; Sareh, Sohail; De La Cruz, Kim; Shemin, Richard J; Benharash, Peyman

    2017-03-01

    Over the past decade, extracorporeal mechanical support (ECMO) has been increasingly utilized in respiratory failure and cardiogenic shock. There is a need for assessing clinical and financial outcomes of ECMO use. This study presents our institution's experience with veno-arterial ECMO (VA-ECMO) over a 9-year period. A retrospective review of our institution's ECMO database identified patients undergoing VA-ECMO between 2005 and 2013 (N = 150). Patients were assigned to four groups by indication: post-cardiotomy syndrome, cardiogenic shock requiring cardiopulmonary resuscitation (CPR), cardiogenic shock not requiring CPR, and respiratory failure. Hospital charges from administrative records were analyzed. Trend and correlation analyses were used to evaluate clinical and financial outcomes. Of the 150 patients meeting inclusion criteria, 28% required VA-ECMO for post-cardiotomy syndrome, 31.3% for cardiogenic shock with CPR, 35.3% for cadiogenic shock with no CPR, and 5.4% for respiratory failure. Mean duration on ECMO was 5.0 ± 3.4 days with a survival rate of 64% and no difference between the four groups (p = 0.40). ECMO-associated charges averaged $74,500 ± 61,400 per patient, 6% of total hospital charges. Subgroup analysis of cardiogenic shock patients revealed a nearly twofold increase in ECMO-related charges among patients who did not receive CPR (p = 0.04), as well as a trend toward improved survival (69.8% vs 51.1%, p = 0.06). In view of the variations in survival and costs in ECMO patients, further studies should aim to delineate patient populations that benefit from early initiation of ECMO. © 2017 Wiley Periodicals, Inc.

  9. Clinical Features and Outcomes of Pasteurella multocida Infection.

    Science.gov (United States)

    Giordano, Antonio; Dincman, Toros; Clyburn, Benjamin E; Steed, Lisa L; Rockey, Don C

    2015-09-01

    Pasteurella multocida, a zoonotic infectious organism, has most often been described in patients after an animal bite. Here, we characterize the clinical features and outcomes of P multocida infection in a large cohort of patients according to the presence or absence of an animal bite.We retrospectively searched MUSC's laboratory information system for all patients with positive P multocida cultures from 2000 to 2014. Extensive data were abstracted, including clinical and outcome data. The Charlson comorbidity index (CCI) was used to assess comorbidities among patients.We identified 44 patients with P multocida infections, including 25 with an animal bite. The average age was 64 years and the majority of patients were women (N = 30). There was no difference in age and sex distribution among those with and without a bite (P = 0.38 and 0.75, respectively). A CCI ≥1 was significantly associated with the absence of a bite (P = 0.006). Patients presenting without a bite were more frequently bacteremic (37% vs 4%, respectively, P = 0.001), and were hospitalized more often (84% vs 44%, respectively, P = 0.012). Of the 8 patients who required intensive care unit (ICU)-based care, 7 were non-bite-related. There were 4 deaths, all occurring in patients not bitten.P multocida infections not associated with an animal bite were often associated with bacteremia, severe comorbidity(ies), immune-incompetent states, the need for ICU management, and were associated with substantial mortality.

  10. Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome

    Energy Technology Data Exchange (ETDEWEB)

    Plett, Sara K.; Hackney, Lauren A.; Heilmeier, Ursula; Nardo, Lorenzo; Zhang, Chiyuan A.; Link, Thomas M. [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); Yu, Aihong [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); 4th Medical College of Peking University, Department of Radiology, Beijing Jishuitan Hospital, Beijing (China)

    2015-12-15

    To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures, bone marrow infarct, osteochondritis dissecans, or underlying tumor. Two board-certified musculoskeletal radiologists classified morphologic findings including lesion diameter, associated bone marrow edema pattern, and associated cartilage/meniscus damage. Electronic medical charts were evaluated for symptoms, risk factors, and longitudinal outcomes, including total knee arthroplasty (TKA). Imaging characteristics were correlated with clinical findings, and comparison of outcome groups was performed using a regression model adjusted for age. The majority of patients with FCIF were women (64.4 %, 47/73), on average 10 years older than men (66.28 ± 15.86 years vs. 56.54 ± 10.39 years, p = 0.005). The most common location for FCIF was the central weight-bearing surface of the medial femoral condyle; overlying full thickness cartilage loss (75.7 %, 53/70) and ipsilateral meniscal injury (94.1 %, 64/68) were frequently associated. Clinical outcomes were variable, with 23.9 % (11/46) requiring TKA. Cartilage WORMS score, adjacent cartilage loss, and contralateral meniscal injury, in addition to decreased knee range of motion at presentation, were significantly associated with progression to TKA (p < 0.05). FCIF are frequently associated with overlying cartilage loss and ipsilateral meniscal injury. The extent of cartilage loss and meniscal damage, in addition to loss of knee range of motion at the time of presentation, are significantly associated with clinical progression. (orig.)

  11. A roadmap to defining the clinical reportable ranges of chemistry analytes: Increasing automation efficiency and decreasing manual dilutions.

    Science.gov (United States)

    Lo, Sheng-Ying; Baird, Geoffrey S; Greene, Dina N

    2015-12-07

    Proper utilization of resources is an important operational objective for clinical laboratories. To reduce unnecessary manual interventions on automated instruments, we conducted a workflow analysis that optimized dilution parameters and reporting of abnormally high chemistry results for the Beckman AU series of chemistry analyzers while maintaining clinically acceptable reportable ranges. Workflow analysis for the Beckman AU680/5812 and DxC800 chemistry analyzers was performed using historical data. Clinical reportable ranges for 53 chemistry analytes were evaluated. Optimized dilution parameters and upper limit of reportable ranges for the AU680/5812 instruments were derived and validated to meet these reportable ranges. The number of specimens that required manual dilutions before and after optimization was determined for both the AU680/5812 and DxC800, with the DxC800 serving as the reference instrument. Retrospective data analysis revealed that 7700 specimens required manual dilutions on the DxC over a 2-y period. Using our optimized AU-specific dilution and reporting parameters, the data-driven simulation analysis showed a 61% reduction in manual dilutions. For the specimens that required manual dilutions on the AU680/5812, we developed standardized dilution procedures to further streamline workflow. We provide a data-driven, practical outline for clinical laboratories to efficiently optimize their use of automated chemistry analyzers. The outcomes can be used to assist laboratories wishing to improve their existing procedures or to facilitate transitioning into a new line of instrumentation, regardless of the instrument model or manufacturer. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Outcomes of laparoscopic adrenalectomy. Clinical experience with 68 patients.

    Science.gov (United States)

    Pugliese, Raffaele; Boniardi, Marco; Sansonna, Fabio; Maggioni, Dario; De Carli, Stefano; Costanzi, Andrea; Scandroglio, Ildo; Ferrari, Giovanni Carlo; Di Lernia, Stefano; Magistro, Carmelo; Loli, Paola; Grossrubatscher, Erika

    2008-07-01

    The aim of this study was to analyze feasibility and outcomes of laparoscopic adrenalectomy (LA). Pathology, size and bilateral site of lesions were considered. Between December 1998 and May 2007 in our institution a total of 68 patients of mean age of 53 years underwent unilateral (n=57) or bilateral (n=11) LA. Adrenal masses averaged 5.4cm in size (range 1.2-13cm) and 56.7g in weight (range 10-265) including 71 benign and 8 malignant lesions. A total of 79 adrenal glands were resected, 44 right sided and 35 left sided. Removal was complete in 77 cases and partial (sparing adrenalectomy) in 1 patient affected by bilateral pheochomocytoma. Three left adrenalectomies for pheochromocytoma were robot-assisted. The transperitoneal lateral approach was preferred and the posterior retroperitoneal approach was adopted in 5 patients. The mean duration of surgery for each LA was 138+/-90min and 3.8 trocar were used on average (range 3-6). Conversion was needed in 3 cases owing to difficult dissection of large masses. Estimated mean blood loss for each LA was 95+/-30ml and it was greater for bilateral LA. Mortality was nil and morbidity was 5.8%. The average length of hospital stay (LOS) in surgical unit was 4+/-2.4 days (range 2-8). Patients affected by hormone secreting or bilateral lesions, by unilateral or bilateral pheochromocytoma and by bilateral Cushing's disease were transferred to the endocrinological ward so that their overall hospital stay was prolonged to 9+/-2.8 days on average (range 7-17). Mean duration of follow-up of patients was 38 months (range 2-100) and demonstrated acceptable endocrine results. Three primary cortical carcinomas were discovered as chance findings on histologic examination. While long-term results after LA for cortical carcinomas were poor and LA is not recommended in such cases, long-term results after LA for adrenal metastases were encouraging.

  13. Pancreatitis before pancreatic cancer: clinical features and influence on outcome.

    Science.gov (United States)

    Dzeletovic, Ivana; Harrison, M Edwyn; Crowell, Michael D; Pannala, Rahul; Nguyen, Cuong C; Wu, Qing; Faigel, Douglas O

    2014-10-01

    Pancreatitis is considered a possible risk factor for and a presentation of pancreatic adenocarcinoma (PA). We aimed to evaluate a large PA patient registry to determine whether prior history of pancreatitis influenced survival. We retrospectively analyzed the Mayo Clinic Biospecimen Resource for Pancreas Research database from January 1992 to September 2011. Data collected included demographic characteristics, history of tobacco or alcohol use, diabetes mellitus (DM), cholelithiasis, pseudocyst, and details regarding PA. Clinical characteristics and outcomes of PA patients with pancreatitis were compared with PA patients without pancreatitis history. We analyzed 2573 patients with PA diagnosis. Among these patients, 195 (8%) were identified who had pancreatitis diagnosis ≥ 10 days before PA diagnosis. The cohort with pancreatitis history included more patients with DM (30% vs. 18%; Ppancreatitis history, these patients received diagnoses of PA at a younger age (63 vs. 65 y; P=0.005) and earlier stage (stages I and II; 52% vs. 37%; Ppancreatitis had more weight loss and DM, but had PA diagnosis at an earlier stage, were more likely to have pancreatic surgery, and therefore better survival than PA patients without pancreatitis, likely due to the earlier diagnosis. Further studies are needed to evaluate whether screening for PA in patients with pancreatitis history would provide survival benefit.

  14. Kikuchi-Fujimoto disease: Clinical and laboratory characteristics and outcome

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    P S Rakesh

    2014-01-01

    Full Text Available Introduction: Kikuchi-Fujimoto disease is an uncommon disorder with worldwide distribution, characterized by fever and benign enlargement of the lymph nodes, primarily affecting young adults. Awareness about this disorder may help prevent misdiagnosis and inappropriate investigations and treatment. The objective of the study was to evaluate the clinical and laboratory characteristics of histopathologically confirmed cases of Kikuchi′s disease from a tertiary care center in southern India. Materials and Methods: Retrospective analysis of all adult patients with histopathologically confirmed Kikuchi′s disease from January 2007 to December 2011 in a 2700-bed teaching hospital in South India was done. The clinical and laboratory characteristics and outcome were analyzed. Results: There were 22 histopathologically confirmed cases of Kikuchi′s disease over the 5-year period of this study. The mean age of the subjects′ was 29.7 years (SD 8.11 and majority were women (Male: female- 1:3.4. Apart from enlarged cervical lymph nodes, prolonged fever was the most common presenting complaint (77.3%. The major laboratory features included anemia (54.5%, increased erythrocyte sedimentation rate (31.8%, elevated alanine aminotransferase (27.2% and elevated lactate dehydrogenase (LDH (31.8%. Conclusion: Even though rare, Kikuchi′s disease should be considered in the differential diagnosis of young individuals, especially women, presenting with lymphadenopathy and prolonged fever. Establishing the diagnosis histopathologically is essential to avoid inappropriate investigations and therapy.

  15. Stenotrophomonas maltophilia endogenous endophthalmitis: clinical presentation, antibiotic susceptibility, and outcomes

    Directory of Open Access Journals (Sweden)

    Chhablani J

    2014-08-01

    Full Text Available Jay Chhablani,1 Aditya Sudhalkar,1 Animesh Jindal,2 Taraprasad Das,1 Swapna R Motukupally,3 Savitri Sharma,3 Avinash Pathengay,2 Harry W Flynn Jr4 1Srimati Kannuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; 2L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India; 3Jhaveri Microbiology Centre, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; 4Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miller School of Medicine, Miami, FL, USA Objective: To describe clinical presentation, antibiotic susceptibility, and outcomes in patients with Stenotrophomonas maltophilia endogenous endophthalmitis.Design: Retrospective case series.Participants: Four eyes of four patients with S. maltophilia endogenous endophthalmitis.Methods: Retrospective chart review of culture-positive S. maltophilia endogenous endophthalmitis treated at L V Prasad Eye Institute, Hyderabad, India, between January 2007 and December 2012, was done. Collected information included demographic, clinical, and microbiology data.Results: These four patients with S. maltophilia endogenous endophthalmitis cases accounted for 0.47% (4/836 of total bacterial endophthalmitis cases treated in this period. All patients were from a rural setting and younger than 40 years. Two of the four patients had a history of immune compromise or hospitalization. The visual acuity at presentation was less than 20/320 in all patients. Common presenting features were severe anterior and posterior segment inflammation and hypopyon. All patients underwent vitrectomy with injection of intravitreal antibiotics and dexamethasone. Direct microscopy of the vitreous sample was positive in all cases. All isolates were sensitive to fluoroquinolones and chloramphenicol; sensitivity to aminoglycosides and third-generation cephalosporins was highly variable. The final visual acuity was 20

  16. Neonatal Transcutaneous Carbon Dioxide Monitoring--Effect on Clinical Management and Outcomes.

    Science.gov (United States)

    Mukhopadhyay, Sagori; Maurer, Rie; Puopolo, Karen M

    2016-01-01

    This work aimed to compare frequency of blood gas measurements per day of mechanical ventilation, occurrence of extreme blood gas CO2 values, and clinical outcomes among ventilated neonates managed with and without transcutaneous carbon dioxide (PtcCO2) monitors. This work also measures agreement between simultaneous PtcCO2 and blood gas CO2 measurements and ascertains factors that affect agreement. This is a cohort study with retrospective analysis comparing 5,726 blood gas measurements and clinical outcomes for 123 neonates intubated for >48 h before and after the introduction of transcutaneous carbon-di-oxide monitoring devices in a single tertiary care unit. Median (interquartile range) blood gas frequency per mechanical ventilation day was 3.9 (2.6-5.3) and 2.9 (2.1-4.0) before and after PtcCO2 monitoring (P = .002) without differences in clinical outcomes at discharge. After adjusting for confounders using Poisson regression, this difference remained significant. The mean ± 2 SD blood gas-PtcCO2 difference was -5.2 ± 17.3 mm Hg. 64% of simultaneous blood gas-PtcCO2 measurements per subject were within ± 7 mm Hg. Greater bias was noted with arterial sample and during the use of high-frequency ventilation. Despite only moderate agreement between simultaneous PtcCO2 and blood gas measurements, PtcCO2 monitoring statistically decreased blood gas frequency among ventilated neonates without affecting the duration of mechanical ventilation or clinical outcomes at discharge. The clinical impact of this technology appears to be minimal. Copyright © 2016 by Daedalus Enterprises.

  17. Evaluation of Clinical Outcome after Laparoscopic Antireflux Surgery in Clinical Practice: Still a Controversial Issue

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    Sandro Contini

    2011-01-01

    Full Text Available Background. Laparoscopic antireflux surgery has shown to be effective in controlling gastroesophageal reflux (GERD. Yet, a universally accepted definition and evaluation for treatment success/failure in GERD is still controversial. The purpose of this paper is to assess if and how the outcome variables used in the different studies could possibly lead to an homogeneous appraisal of the limits and indications of LARS. Methods. We analyzed papers focusing on the efficacy and outcome of LARS and published in English literature over the last 10 years. Results. Symptoms scores and outcome variables reported are dissimilar and not uniform. The most consistent parameter was patient's satisfaction (mean satisfaction rate: 88.9%. Antireflux medications are not a trustworthy outcome index. Endoscopy and esophageal manometry do not appear very helpful. Twenty-four hours pH metry is recommended in patients difficult to manage for recurrent typical symptoms. Conclusions. More uniform symptoms scales and quality of life tools are needed for assessing the clinical outcome after laparoscopic antireflux surgery. In an era of cost containment, objective evaluation tests should be more specifically addressed. Relying on patient's satisfaction may be ambiguous, yet from this study it can be considered a practical and simple tool.

  18. Adult Hematology and Clinical Chemistry Laboratory Reference Ranges in a Zimbabwean Population.

    Directory of Open Access Journals (Sweden)

    Wadzanai P Samaneka

    Full Text Available Laboratory reference ranges used for clinical care and clinical trials in various laboratories in Zimbabwe were derived from textbooks and research studies conducted more than ten years ago. Periodic verification of these ranges is essential to track changes over time. The purpose of this study was to establish hematology and chemistry laboratory reference ranges using more rigorous methods.A community-based cross-sectional study was carried out in Harare, Chitungwiza, and Mutoko. A multistage sampling technique was used. Samples were transported from the field for analysis at the ISO15189 certified University of Zimbabwe-University of California San Francisco Central Research Laboratory. Hematology and clinical chemistry reference ranges lower and upper reference limits were estimated at the 2.5th and 97.5th percentiles respectively.A total of 769 adults (54% males aged 18 to 55 years were included in the analysis. Median age was 28 [IQR: 23-35] years. Males had significantly higher red cell counts, hemoglobin, hematocrit, and mean corpuscular hemoglobin compared to females. Females had higher white cell counts, platelets, absolute neutrophil counts, and absolute lymphocyte counts compared to males. There were no gender differences in eosinophils, monocytes, and absolute basophil count. Males had significantly higher levels of urea, sodium, potassium, calcium, creatinine, amylase, total protein, albumin and liver enzymes levels compared to females. Females had higher cholesterol and lipase compared with males. There are notable differences in the white cell counts, neutrophils, cholesterol, and creatinine kinase when compared with the currently used reference ranges.Data from this study provides new country specific reference ranges which should be immediately adopted for routine clinical care and accurate monitoring of adverse events in research studies.

  19. Adult Hematology and Clinical Chemistry Laboratory Reference Ranges in a Zimbabwean Population.

    Science.gov (United States)

    Samaneka, Wadzanai P; Mandozana, Gibson; Tinago, Willard; Nhando, Nehemiah; Mgodi, Nyaradzo M; Bwakura-Dangarembizi, Mutsawashe F; Munjoma, Marshall W; Gomo, Zvenyika A R; Chirenje, Zvavahera M; Hakim, James G

    2016-01-01

    Laboratory reference ranges used for clinical care and clinical trials in various laboratories in Zimbabwe were derived from textbooks and research studies conducted more than ten years ago. Periodic verification of these ranges is essential to track changes over time. The purpose of this study was to establish hematology and chemistry laboratory reference ranges using more rigorous methods. A community-based cross-sectional study was carried out in Harare, Chitungwiza, and Mutoko. A multistage sampling technique was used. Samples were transported from the field for analysis at the ISO15189 certified University of Zimbabwe-University of California San Francisco Central Research Laboratory. Hematology and clinical chemistry reference ranges lower and upper reference limits were estimated at the 2.5th and 97.5th percentiles respectively. A total of 769 adults (54% males) aged 18 to 55 years were included in the analysis. Median age was 28 [IQR: 23-35] years. Males had significantly higher red cell counts, hemoglobin, hematocrit, and mean corpuscular hemoglobin compared to females. Females had higher white cell counts, platelets, absolute neutrophil counts, and absolute lymphocyte counts compared to males. There were no gender differences in eosinophils, monocytes, and absolute basophil count. Males had significantly higher levels of urea, sodium, potassium, calcium, creatinine, amylase, total protein, albumin and liver enzymes levels compared to females. Females had higher cholesterol and lipase compared with males. There are notable differences in the white cell counts, neutrophils, cholesterol, and creatinine kinase when compared with the currently used reference ranges. Data from this study provides new country specific reference ranges which should be immediately adopted for routine clinical care and accurate monitoring of adverse events in research studies.

  20. Review of nutritional screening and assessment tools and clinical outcomes in heart failure.

    Science.gov (United States)

    Lin, Hong; Zhang, Haifeng; Lin, Zheng; Li, Xinli; Kong, Xiangqin; Sun, Gouzhen

    2016-09-01

    Recent studies have suggested that undernutrition as defined using multidimensional nutritional evaluation tools may affect clinical outcomes in heart failure (HF). The evidence supporting this correlation is unclear. Therefore, we conducted this systematic review to critically appraise the use of multidimensional evaluation tools in the prediction of clinical outcomes in HF. We performed descriptive analyses of all identified articles involving qualitative analyses. We used STATA to conduct meta-analyses when at least three studies that tested the same type of nutritional assessment or screening tools and used the same outcome were identified. Sensitivity analyses were conducted to validate our positive results. We identified 17 articles with qualitative analyses and 11 with quantitative analysis after comprehensive literature searching and screening. We determined that the prevalence of malnutrition is high in HF (range 16-90 %), particularly in advanced and acute decompensated HF (approximate range 75-90 %). Undernutrition as identified by multidimensional evaluation tools may be significantly associated with hospitalization, length of stay and complications and is particularly strongly associated with high mortality. The meta-analysis revealed that compared with other tools, Mini Nutritional Assessment (MNA) scores were the strongest predictors of mortality in HF [HR (4.32, 95 % CI 2.30-8.11)]. Our results remained reliable after conducting sensitivity analyses. The prevalence of malnutrition is high in HF, particularly in advanced and acute decompensated HF. Moreover, undernutrition as identified by multidimensional evaluation tools is significantly associated with unfavourable prognoses and high mortality in HF.

  1. Multisession stereotactic radiosurgery for large benign brain tumors of >3cm- early clinical outcomes

    Science.gov (United States)

    Memon, Muhammad Ali; Ahmed, Usman; Saleem, Muhammad Abid; Bhatti, Amer Iqtidar; Ahmed, Naveed; Hashim, Abdul Sattar M.

    2012-01-01

    Objective To evaluate the clinical outcome of linear accelerator based multisession stereotactic radiosurgery (SRS) for large benign brain tumors of >3cm. Methods Between June 2009 and May 2011, 35 patients having large benign brain tumors of >3cm (≥15 cm3) were treated by multisession stereotactic radiosurgery. This retrospective study was carried out at Neurospinal & Medical Institute Karachi. There were 17 (48.6 %) males and 18(51.4 %) females. Median age was 36 years (range: 13-65 years). Median target volume was 49.4 cm3 (range: 15-184 cm3). The median marginal dose was 25 Gy (range: 20–27.5Gy) prescribed to a median 75% isodose line (range: 65-100 %). Median number of 5 fractions were used ranging 3-5 fractions. Results All the patients tolerated treatment very well. 21 (58.3%) patients had remarkable clinical improvement of neurological symptoms, 14 (38.9%) patients had stable symptoms, and only one patient had transient worsening of symptoms. No permanent neurological damage or radiation injury was seen. Radiologically, 9 (25.7%) patients achieved reduction in size of the tumor, 26(74.3 %) patients were having stable disease, and overall control rate was found to be 100 %. Median follow-up time from the end of SRS was 6.4 months (range: 1-22.5months). Conclusion Linear accelerator based multisession stereotactic radiosurgery for large benign brain tumors of >3cm is effective and well tolerated. PMID:29296340

  2. Sexual obsessions in pediatric obsessive-compulsive disorder: clinical characteristics and treatment outcomes.

    Science.gov (United States)

    Fernández de la Cruz, Lorena; Barrow, Faye; Bolhuis, Koen; Krebs, Georgina; Volz, Chloe; Nakatani, Eriko; Heyman, Isobel; Mataix-Cols, David

    2013-08-01

    Sexual obsessions are common in adults with obsessive-compulsive disorder (OCD), cause great distress, and are sometimes misinterpreted as indicating risk to others. Little is known about the prevalence, clinical correlates, and prognosis of such symptoms in young people. Three hundred and eighty-three patients referred to a specialist pediatric OCD clinic were administered a series of measures at intake and, for those treated at the clinic, again after treatment. Patients with and without sexual obsessions were compared on socio-demographic and clinical characteristics. Mixed model analyses of variance compared treatment outcomes in both groups. A quarter of patients had sexual obsessions at baseline (age range 8-17); they had slightly more severe OCD symptoms and were more depressed than those without sexual obsessions. Aggressive and religious obsessions, magical thinking, fear of saying certain things, repeating rituals, superstitious games, mental rituals, and the need to tell, ask, or confess were more frequent in participants with sexual obsessions. Crucially, no differences in treatment outcome were found between the groups. Sexual obsessions are common in pediatric OCD, even in very young children. Although they may be associated with particular clinical features, they do not interfere with treatment response. The occurrence of sexual obsessions in children should be recognized and these symptoms understood as ordinary, nonthreatening OCD symptoms, which pose no risk to others. They respond to the standard treatment strategies, so children and families should receive the usual message of optimism regarding the chances of recovery. © 2013 Wiley Periodicals, Inc.

  3. Foot Drop Caused by Lumbar Degenerative Disease: Clinical Features, Prognostic Factors of Surgical Outcome and Clinical Stage: e80375

    National Research Council Canada - National Science Library

    Kun Liu; Wei Zhu; Jiangang Shi; Lianshun Jia; Guodong Shi; Yuan Wang; Ning Liu

    2013-01-01

      Objective The purpose of this study was to analyze the clinical features and prognostic factors of surgical outcome of foot drop caused by lumbar degenerative disease and put forward the clinical stage...

  4. Impact of clinical registries on quality of patient care and clinical outcomes: A systematic review.

    Directory of Open Access Journals (Sweden)

    Dewan Md Emdadul Hoque

    Full Text Available Clinical quality registries (CQRs are playing an increasingly important role in improving health outcomes and reducing health care costs. CQRs are established with the purpose of monitoring quality of care, providing feedback, benchmarking performance, describing pattern of treatment, reducing variation and as a tool for conducting research.To synthesise the impact of clinical quality registries (CQRs as an 'intervention' on (I mortality/survival; (II measures of outcome that reflect a process or outcome of health care; (III health care utilisation; and (IV healthcare-related costs.The following electronic databases were searched: MEDLINE, EMBASE, CENTRAL, CINAHL and Google Scholar. In addition, a review of the grey literature and a reference check of citations and reference lists within articles was undertaken to identify relevant studies in English covering the period January 1980 to December 2016. The PRISMA-P methodology, checklist and standard search strategy using pre-defined inclusion and exclusion criteria and structured data extraction tools were used. Data on study design and methods, participant characteristics attributes of included registries and impact of the registry on outcome measures and/or processes of care were extracted.We identified 30102 abstracts from which 75 full text articles were assessed and finally 17 articles were selected for synthesis. Out of 17 studies, six focused on diabetes care, two on cardiac diseases, two on lung diseases and others on organ transplantations, rheumatoid arthritis, ulcer healing, surgical complications and kidney disease. The majority of studies were "before after" design (#11 followed by cohort design (#2, randomised controlled trial (#2, experimental non randomised study and one cross sectional comparison. The measures of impact of registries were multifarious and included change in processes of care, quality of care, treatment outcomes, adherence to guidelines and survival. Sixteen of 17

  5. Nutritional Risk, Micronutrient Status and Clinical Outcomes: A Prospective Observational Study in an Infectious Disease Clinic

    Directory of Open Access Journals (Sweden)

    Oguzhan Sıtkı Dizdar

    2016-02-01

    Full Text Available Malnutrition has been associated with increased morbidity and mortality. The objective of this study was to determine the nutritional status and micronutrient levels of hospitalized patients in an infectious disease clinic and investigate their association with adverse clinical outcomes. The nutritional status of the study participants was assessed using the Nutritional Risk Screening 2002 (NRS 2002 and micronutrient levels and routine biochemical parameters were tested within the first 24 h of the patient’s admission. The incidence of zinc, selenium, thiamine, vitamin B6, vitamin B12 deficiency were 66.7% (n = 40, 46.6% (n = 29, 39.7% (n = 27, 35.3% (n = 24, 14.1% (n = 9, respectively. Selenium levels were significantly higher in patients with urinary tract infections, but lower in soft tissue infections. Copper levels were significantly higher in patients with soft tissue infections. In the Cox regression models, lower albumin, higher serum lactate dehydrogenase levels and higher NRS-2002 scores were associated with increased death. Thiamine, selenium, zinc and vitamin B6 deficiencies but not chromium deficiencies are common in infectious disease clinics. New associations were found between micronutrient levels and infection type and their adverse clinical outcomes. Hypoalbuminemia and a high NRS-2002 score had the greatest accuracy in predicting death, systemic inflammatory response syndrome and sepsis on admission.

  6. Clinical Heterogeneity of Guillain-Barré Syndrome in the Emergency Department: Impact on Clinical Outcome

    Directory of Open Access Journals (Sweden)

    Athanasios Papathanasiou

    2016-01-01

    Full Text Available Guillain-Barré syndrome (GBS is mainly classified into acute inflammatory demyelinating polyneuropathy (AIDP and acute motor axonal neuropathy (AMAN. Although diagnosis of GBS requires progressive weakness and universal areflexia or hyporeflexia, cases of GBS with preserved or increased deep tendon reflexes (DTRs have been increasingly recognized. We report three cases of GBS, presenting at a single unit in six months. Our first case presented with pure sensory symptoms. The second case had nonspecific generalized weakness, while the third presented with typical ascending weakness. One of our patients had preserved DTRs, while the other two had increased DTRs. Our two cases with hyperreflexia were found to have a preceding Campylobacter jejuni infection and anti-ganglioside antibodies, and their electrophysiological studies revealed AMAN. The other case had an AIDP. Only one case was offered a diagnosis and treatment from the first emergency department (ED visit and had a better clinical outcome. Clinical diagnosis of GBS in the ED can be challenging. Delay in diagnosis of GBS in the ED is common due to cases with intact or increased DTRs, atypical pattern of weakness, or pure sensory symptoms. Emergency physicians should be aware of GBS clinical heterogeneity, because early diagnosis and treatment improve clinical outcome.

  7. Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting.

    Science.gov (United States)

    Goldberg, Simon B; Rousmaniere, Tony; Miller, Scott D; Whipple, Jason; Nielsen, Stevan Lars; Hoyt, William T; Wampold, Bruce E

    2016-01-01

    Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time. The present study examined changes in psychotherapists' outcomes over time using a large, longitudinal, naturalistic psychotherapy data set. The sample included 6,591 patients seen in individual psychotherapy by 170 therapists who had on average 4.73 years of data in the data set (range = 0.44 to 17.93 years). Patient-level outcomes were examined using the Outcome Questionnaire-45 and a standardized metric of change (prepost d). Two-level multilevel models (patients nested within therapist) were used to examine the relationship between therapist experience and patient prepost d and early termination. Experience was examined both as chronological time and cumulative patients seen. Therapists achieved outcomes comparable with benchmarks from clinical trials. However, a very small but statistically significant change in outcome was detected indicating that on the whole, therapists' patient prepost d tended to diminish as experience (time or cases) increases. This small reduction remained when controlling for several patient-level, caseload-level, and therapist-level characteristics, as well as when excluding several types of outliers. Further, therapists were shown to vary significantly across time, with some therapists showing improvement despite the overall tendency for outcomes to decline. In contrast, therapists showed lower rates of early termination as experience increased. Implications of these findings for the development of expertise in psychotherapy are explored. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  8. Clinical outcomes of kinesio taping applied in patients with knee osteoarthritis: A randomized controlled trial.

    Science.gov (United States)

    Aydoğdu, Onur; Sari, Zübeyir; Yurdalan, S Ufuk; Polat, M Gülden

    2017-09-22

    The aim of this study was to compare kinesio taping along with conventional treatment to conventional treatment alone and to report the results of both a single and repetitive kinesio taping application applied on quadriceps femoris and hamstring muscles on pain, range of motion, muscle strength, and functional status in patients with knee osteoarthritis. Fifty-four patients with knee osteoarthritis were randomly allocated to two groups. A total of 28 patients were included in kinesio taping group, others were included in the control group. Before and after intervention, pain was measured with visual analog scale, range of motion was measured with universal goniometer, muscle strength was measured with dynamometer, and functional status was measured with Knee Injury Osteoarthritis Outcome Score. There were statistically significant improvements in measures of pain, range of motion, quadriceps muscle strength and functional status between pre- and post-treatment in both groups (p 0.05). It was also found that significant difference was observed in terms of range of motion, pain, functional status between pre-treatment and post-taping in intervention group (ptaping has significant immediate effects after a single kinesio taping application on range of motion, pain and functional status in patients with knee osteoarthritis. We could also report that KT in addition to conventional treatment is not superior to conventional treatment alone in terms of clinical outcomes over 3 weeks later.

  9. Snoezelen Room and Childbirth Outcome: A Randomized Clinical Trial.

    Science.gov (United States)

    Jamshidi Manesh, Mansoureh; Kalati, Mahnaz; Hosseini, Fatemeh

    2015-05-01

    One of the strategies for a good outcome and pain free childbearing is to design the delivery room. The aim of this study was to evaluate the effects of snoezelen room on childbearing outcome such as pain intensity, duration of labor, and perinea status in nulliparous women. This study was a randomized controlled clinical trial consists of 100 childbearing women. They were randomly divided into 2 groups. The experimental group went to snoezelen room when their cervix dilation was 4 cm, while the control group went to physiologic delivery room with the same cervix dilation. The mean ± SD of VAS (Visual Analogue Scale) pain intensity of the experimental and control groups before the intervention were 5.1 ± 1.95 and 5.58 ± 1.62, respectively (P = 0.13). The mean ± SD of VAS pain intensity scores of the experimental and control groups after 3 hours spending in their assigned rooms were 5.26 ± 0.86 and 9.56 ± 1.48, respectively (P = 0.01). The mean ± SD of the first stage scores of the experimental and control groups were 6.95 ± 0.97 and 8.41 ± 0.67, respectively (P = 0.042). About 92% of participants' intervention vs. 66% of control participants had perinea laceration (P = 0.041). According to the findings of the present study, distracting senses in snoezelen room decreases mother's pain intensity, the length of labor, and incidence of episiotomy.

  10. Effect of sports modification on clinical outcome in children and adolescent athletes with symptomatic lumbar spondylolysis.

    Science.gov (United States)

    El Rassi, Georges; Takemitsu, Masakazu; Glutting, Joseph; Shah, Suken A

    2013-12-01

    This cohort study aimed to report the compliance of young athletes with nonoperative treatment and to clarify the role of sports modification on clinical outcome of symptomatic spondylolysis. This study included patients with a chief complaint of low back pain participating in regular sports activity, having spondylolysis, and being treated and followed up between 1990 and 2002 in the authors' hospital. One hundred thirty-two athletes were included in this study: 78 males and 54 females. The mean age of the patients was 13 yrs (range, 7-18 yrs). Only 56 patients (42.4%) were compliant to nonoperative treatment. Eighty-six patients (65%) stopped all sports activities for at least 3 mos, and 46 patients (35%) stopped exercising for a variable period of less than 3 mos. The grading of clinical outcome after nonoperative treatment was as follows: excellent in 48 patients (36.4%), good in 74 patients (56.1), fair in 6 patients (4.5%), and poor in 4 patients (3%). The patients who stopped sports for at least 3 mos were 16.39 times more likely to have an excellent result than those who did not stop sports. Bony healing on radiographs did not correlate with clinical outcome. Timely cessation of sports activity for 3 mos is considered an effective method of nonoperative treatment for young athletes with symptomatic lumbar spondylolysis.

  11. Below knee angioplasty in elderly patients: predictors of major adverse clinical outcomes.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2012-02-01

    AIM: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). MATERIALS AND METHODS: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. RESULTS: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). CONCLUSION: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  12. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Keeling, Aoife N.; Khalidi, Karim; Leong, Sum [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland); Wang, Tim T. [Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary' s Hospital, London W2 1NY (United Kingdom); Ayyoub, Alaa S.; McGrath, Frank P. [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland); Athanasiou, Thanos [Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary' s Hospital, London W2 1NY (United Kingdom); Lee, Michael J., E-mail: mlee@rcsi.ie [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland)

    2011-03-15

    Aim: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). Materials and methods: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. Results: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). Conclusion: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  13. The clinical outcomes of deep gray matter injury in children with cerebral palsy in relation with brain magnetic resonance imaging.

    Science.gov (United States)

    Choi, Ja Young; Choi, Yoon Seong; Rha, Dong-Wook; Park, Eun Sook

    2016-08-01

    In the present study we investigated the nature and extent of clinical outcomes using various classifications and analyzed the relationship between brain magnetic resonance imaging (MRI) findings and the extent of clinical outcomes in children with cerebral palsy (CP) with deep gray matter injury. The deep gray matter injuries of 69 children were classified into hypoxic ischemic encephalopathy (HIE) and kernicterus patterns. HIE patterns were divided into four groups (I-IV) based on severity. Functional classification was investigated using the gross motor function classification system-expanded and revised, manual ability classification system, communication function classification system, and tests of cognitive function, and other associated problems. The severity of HIE pattern on brain MRI was strongly correlated with the severity of clinical outcomes in these various domains. Children with a kernicterus pattern showed a wide range of clinical outcomes in these areas. Children with severe HIE are at high risk of intellectual disability (ID) or epilepsy and children with a kernicterus pattern are at risk of hearing impairment and/or ID. Grading severity of HIE pattern on brain MRI is useful for predicting overall outcomes. The clinical outcomes of children with a kernicterus pattern range widely from mild to severe. Delineation of the clinical outcomes of children with deep gray matter injury, which are a common abnormal brain MRI finding in children with CP, is necessary. The present study provides clinical outcomes for various domains in children with deep gray matter injury on brain MRI. The deep gray matter injuries were divided into two major groups; HIE and kernicterus patterns. Our study showed that severity of HIE pattern on brain MRI was strongly associated with the severity of impairments in gross motor function, manual ability, communication function, and cognition. These findings suggest that severity of HIE pattern can be useful for predicting the

  14. Submillimeter ionoacoustic range determination for protons in water at a clinical synchrocyclotron

    Science.gov (United States)

    Lehrack, Sebastian; Assmann, Walter; Bertrand, Damien; Henrotin, Sebastien; Herault, Joel; Heymans, Vincent; Vander Stappen, Francois; Thirolf, Peter G.; Vidal, Marie; Van de Walle, Jarno; Parodi, Katia

    2017-09-01

    Proton ranges in water between 145 MeV to 227 MeV initial energy have been measured at a clinical superconducting synchrocyclotron using the acoustic signal induced by the ion dose deposition (ionoacoustic effect). Detection of ultrasound waves was performed by a very sensitive hydrophone and signals were stored in a digital oscilloscope triggered by secondary prompt gammas. The ionoacoustic range measurements were compared to existing range data from a calibrated range detector setup on-site and agreement of better than 1 mm was found at a Bragg peak dose of about 10 Gy for 220 MeV initial proton energy, compatible with the experimental errors. Ionoacoustics has thus the potential to measure the Bragg peak position with submillimeter accuracy during proton therapy, possibly correlated with ultrasound tissue imaging.

  15. AN ANALYTICAL STUDY OF GALLSTONES AND ITS CLINICAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Vimal Venkatachalam

    2017-08-01

    Full Text Available BACKGROUND Gallstones occur when there is an imbalance in the chemical constituents of bile that result in precipitation of one or more of the components. This disease is, however, a worldwide medical problem, even though there are geographical variations in gallstone prevalence. In most cases, they do not cause symptoms and only 10% and 20% will eventually become symptomatic within 5 years and 20 years of diagnosis. Thus, the average risk of developing symptomatic disease is low and approaches 2.0- 2.6% year in all populations of the world regardless of overall gallstone prevalence. Women during their fertile years are almost twice as likely as men to experience cholelithiasis. Treatment of gallstones depends partly on whether they are causing symptoms or not. This study was conducted at government KAPV Medical College Hospital in patients who had undergone cholecystectomy to delineate their age and sex distribution, symptomatology and to find out the fraction of patients with incidental malignancy in the gallbladder. The aim of the study is to- 1. Study the clinical presentation of gallstone diseases - symptomatology and acuteness of presentation. 2. Study the gender and age, distribution of patients presenting with gallstone diseases and compare with given standards. 3. Study the prevalence of concomitant CBD stones in patients with gallstone diseases. 4. Study the prevalence of gallbladder carcinoma in patients with gallstone diseases. 5. Study the surgical management of patients with gallstone diseases/CBD stone and outcome. MATERIALS AND METHODS An analysis of patients presenting with gallstone diseases at Government KAPV Medical College Hospital between 2014-2016 was made with regard to the prevalence, age distribution, clinical presentation and the surgical management and outcome. RESULTS In our study, the male-to-female ratio is 1:1.61. The prevalence of symptomatic gallstone diseases in our study is highest in the 40-49 years age group

  16. Clinical and radiological profiles and outcomes in pediatric patients with intracranial aneurysms.

    Science.gov (United States)

    Mehrotra, Anant; Nair, Anup P; Das, Kuntal Kanti; Srivastava, Arun; Sahu, Rabi Narayan; Kumar, Raj

    2012-10-01

    Intracranial aneurysms are extremely uncommon in the pediatric population, their characteristics are not well studied, and certain features make them unique. The authors analyzed pediatric patients with aneurysms to try to understand their clinical, radiological, and outcome profile. Sixty-three pediatric patients (≤ 18 years of age) with ages ranging from 4 to 18 years and features (clinical and radiological) suggestive of aneurysm presented to, and were treated at, the authors' center in the past 20 years (1991-2011). Included in the present study were only those patients who underwent surgical intervention, and thus data for 57 patients were analyzed. Seventy-three aneurysms in 57 patients were surgically treated. There was a slight female predominance (M/F 1:1.2), and the mean age among all patients was 12.69 ± 3.75 years. Fifty patients (87.72%) presented with subarachnoid hemorrhage, 4 (7.02%) with mass effect, and 3 (5.26%) with seizure. On presentation the majority of patients (45 [78.95%]) had a good clinical grade. Eleven patients had multiple aneurysms. The internal carotid artery (ICA) bifurcation was the most common aneurysm site (18 cases [24.66%]), followed by the middle cerebral artery (MCA) bifurcation (11 cases [15.07%]). At a mean follow-up of 18.58 ± 10.71 months (range 1.5-44 months), 44 patients (77.19%) had a favorable outcome, and 5 patients had died. Pediatric patients with intracranial aneurysms most commonly presented with subarachnoid hemorrhage, and there was a slight female predominance. The ICA bifurcation followed by the MCA bifurcation was the most common aneurysm site. The incidence of posterior circulation and giant aneurysms is higher in pediatric patients than in the adult population. Children tend to present with better clinical grades and have better overall survival results and good functional outcomes.

  17. Clinical epidemiology of premenstrual disorder: informing optimized patient outcomes

    Directory of Open Access Journals (Sweden)

    Robinson LLL

    2015-09-01

    Full Text Available Lynne LL Robinson,1 Khaled MK Ismail1,21Department of Obstetrics and Gynaecology, Birmingham Women’s Hospital, Birmingham, UK; 2Birmingham Centre for Women’s and Children’s Health, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UKAbstract: Premenstrual disorders encompass a spectrum that ranges from mild cyclical psychological and somatic symptoms to the rarer but much-more-severe premenstrual dysphoric disorder. This condition is serious and the etiology is unclear, but possible causes include genetic factors, hormonal fluctuations, and neurotransmitter dysfunctions. Differentiation from other affective disorders can be difficult but is key to providing appropriate management. This comprehensive review will discuss the most-recent classification of premenstrual disorders, etiology, diagnosis, and potential current management strategies.Keywords: premenstrual dysphoric disorder, progesterone, oestrogen, oophrectomy, GNRH analogues

  18. Clinical Outcomes of Correcting Cervical Deformity in Cerebral Palsy Patients.

    Science.gov (United States)

    Lee, Chang Kyu; Jeon, Ha Ra; Yoon, Do Heum; Kim, Keung Nyun; Yi, Seong; Shin, Dong Ah; Hosogane, Naobumi; Cao, Kai; Cho, Sung-Rae; Ha, Yoon

    2016-12-01

    To assess several different cervical alignment parameters to determine the clinical relationship between cerebral palsy (CP) with cervical spondylotic myelopathy (CSM) and cervical deformity. This study included consecutive patients (N = 31) with CP CSM who underwent cervical operation between January 2006 and January 2014 and who had cervical deformities, such as angular and translational deformities. Cervical spine alignment was assessed with the following parameters: C2-7 Cobb angle, C2-7 sagittal vertical axis (SVA), and T1 slope minus C2-7 Cobb angle. Other clinical values were the manual muscle test, spasticity, grip and pinch test, Box and Block test, and Jebsen-Taylor Hand Function Test. Outcome assessments (Oswestry Neck Disability Index [NDI] and modified Barthel Index) were obtained for all patients pre- and postoperatively. Mean follow-up duration was 3.5 years. There were 13 patients in the corrected group and 18 in the not corrected group. Angular and translational correction were 19.0° (C2-7 Cobb angle), 19.8° (T1 slope minus C2-7 Cobb angle), and 16 mm (C2-7 SVA). Postoperative NDI scores showed greater improvement in the corrected group than the uncorrected group (P = 0.049). In the corrected group, grip power increased postoperatively (8.9 ± 8.9 vs 15.5 ± 8.3; P = 0.021). Surgical treatment for patients with CP CSM deformity helped alleviate symptoms. Postoperative NDI scores and hand function improved in patients with CP CSM deformity, especially those in the corrected group. Clinicians should consider correcting the deformity in patients with CP CSM. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Age-related distance esotropia: Clinical features and therapeutic outcomes.

    Science.gov (United States)

    Gómez de Liaño Sánchez, P; Olavarri González, G; Merino Sanz, P; Escribano Villafruela, J C

    2016-12-01

    To describe the clinical characteristics and surgical outcomes of a group of patients with age-related distance esotropia (ARDE). A retrospective study was conducted on a consecutive case series of 16 adult patients diagnosed with ARDE between 2008 and 2015. The clinical features evaluated included mean age and gender, primary position deviations at distance and near, measured in prism dioptres (pd), treatment offered in each case, and post-surgical deviations. Ductions and versions were full, with no evidence of lateral rectus paresis. None of these patients had any obvious underlying neurological disorder, such as, high myopia or thyroid disease. A good result is considered to be the disappearance of diplopia in all positions of gaze. A total of 16 patients (11 females [68.8%]) were identified. The mean age at diagnosis was 78.19±6.77 years. The mean initial esodeviation was 2.25±3.08 pd at near (-4 to +8 pd) and 9.5±4.18 pd at distance (2 to 18 pd). Treatment was not necessary in 5 cases because the symptoms were intermittent or well-tolerated. Of the 11 patients with symptoms, one was corrected with an external base therapeutic prism. Botulinum toxin was administered in another patient, without satisfactory results. Unilateral medial rectus muscle recession was performed on one patient, and unilateral lateral rectus plication on 7 patients, indicating prisms before surgery. One patient refused surgery despite continuous diplopia in far vision. After a mean follow-up of 16.5 months, all operated patients were asymptomatic. Not all patients with ARDE require treatment, as the tolerance to diplopia varies from one subject to another. Both medial rectus weakening and lateral rectus strengthening provides excellent results. Crown Copyright © 2016. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Neurofeedback and biofeedback with 37 migraineurs: a clinical outcome study

    Directory of Open Access Journals (Sweden)

    Lappin Martha S

    2010-02-01

    Full Text Available Abstract Background Traditional peripheral biofeedback has grade A evidence for effectively treating migraines. Two newer forms of neurobiofeedback, EEG biofeedback and hemoencephalography biofeedback were combined with thermal handwarming biofeedback to treat 37 migraineurs in a clinical outpatient setting. Methods 37 migraine patients underwent an average of 40 neurofeedback sessions combined with thermal biofeedback in an outpatient biofeedback clinic. All patients were on at least one type of medication for migraine; preventive, abortive or rescue. Patients kept daily headache diaries a minimum of two weeks prior to treatment and throughout treatment showing symptom frequency, severity, duration and medications used. Treatments were conducted an average of three times weekly over an average span of 6 months. Headache diaries were examined after treatment and a formal interview was conducted. After an average of 14.5 months following treatment, a formal interview was conducted in order to ascertain duration of treatment effects. Results Of the 37 migraine patients treated, 26 patients or 70% experienced at least a 50% reduction in the frequency of their headaches which was sustained on average 14.5 months after treatments were discontinued. Conclusions All combined neuro and biofeedback interventions were effective in reducing the frequency of migraines with clients using medication resulting in a more favorable outcome (70% experiencing at least a 50% reduction in headaches than just medications alone (50% experience a 50% reduction and that the effect size of our study involving three different types of biofeedback for migraine (1.09 was more robust than effect size of combined studies on thermal biofeedback alone for migraine (.5. These non-invasive interventions may show promise for treating treatment-refractory migraine and for preventing the progression from episodic to chronic migraine.

  1. Evans syndrome and systemic lupus erythematosus: clinical presentation and outcome.

    Science.gov (United States)

    Costallat, Guilherme Lavras; Appenzeller, Simone; Costallat, Lilian Tereza Lavras

    2012-07-01

    To review the clinical, laboratory and outcome features of Evans syndrome (ES) in systemic lupus erythematosus (SLE) patients. We reviewed the charts of 953 SLE patients followed up regularly at our service. ES was defined as the presence of hemolytic anemia and thrombocytopenia concomitantly or sequentially. Clinical and laboratory manifestations occurring during the disease course, as well as concomitant diseases and survival was carefully reviewed. We identified ES in 26 of 953 (2.7%) SLE patients. Twenty-three were women with mean age at SLE diagnosis of 25.7 years. Four (15%) patients had disease onset before the age of 16. In the majority of patients (92%), immune thrombocytopenia and AIHA appeared simultaneously at the beginning of SLE. Active features of SLE were a frequent finding concomitant to ES, especially arthritis (77%), malar rash (61.5%), photosensitivity (57.6%), oral ulcers (34.6%), nephritis (73%), serositis (54%), neuropsychiatric (19%) and pulmonary (15%) manifestations. In addition to this multisystemic disease, 34.6% of our patients had an association with another autoimmune disease such as antiphospholipid syndrome. Recurrence of ES was observed in only four (15%) patients. After follow-up time of 8.72 years, 19 patients (73%) were in remission and seven (27%) patients died. ES is a rare manifestation in SLE, occurring in patients with severe multisystemic SLE manifestations. Treatment strategies frequently used in SLE contribute to longer disease remission and less frequent exacerbation than observed in the general population with ES. Copyright © 2011 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  2. Vascular uterine abnormalities: Comparison of imaging findings and clinical outcomes.

    Science.gov (United States)

    Hugues, Clara; Le Bras, Yann; Coatleven, Frederic; Brun, Jean-Luc; Trillaud, Hervé; Grenier, Nicolas; Cornelis, François

    2015-12-01

    To retrospectively compare the imaging findings and the outcomes for patients with vascular uterine abnormalities (VUA) and to identify prognostic factors. Between 2007 and 2012, 38 patients with vaginal bleeding and abnormal ultrasonographic (US) findings consistent with acquired VUA were consecutively included (mean age 31.6 years, range 19-62). Follow-up was 32 months in mean (1-78 months). Seventeen women (44.7%) started bleeding immediately after curettage, spontaneous miscarriage, trophoblastic disease, or section scars, with the remainder starting bleeding after 8 days to 2 years. All US, CT (n=2), MR (n=5) and angiographic (n=26) images were reviewed and compared to medical reports in order to identify severe VUA requiring treatment, and predictive factors. No information about severity was provided by US, MRI or CT. Twelve patients were successfully managed conservatively. Angiography identified 6 non-severe VUA, corresponding to an isolated uterine hyperemia, and 20 severe VUA, corresponding to an association of a nidus and early venous drainage. Recurrences were more often observed for severe VUA (p=0.001). The hemoglobin level was significantly lower (below 11 g/L) in these cases (p=0.004). Recurrences were significantly more frequently observed for patients with history of dilatation and curettage (p=0.02). Hysterectomy was performed for three patients only (8%). Among the women who wished to have children, 14 (77.8%) were pregnant after 9 months in mean (range 2-23). Recurrence happens more frequently after curettage and in case of anemia or severe VUA findings on angiography, justifying adequate embolization for these patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Clinical outcomes of intermittent antegrade warm versus cold blood cardioplegia.

    Science.gov (United States)

    Baig, Mirza Ahmad Raza; Sher-I-Murtaza, Muhammad; Iqbal, Azhar; Ahmad, Muhammad Zubair; Farhan Ali Rizvi, Hafiz Muhammad; Ahmed, Nosheen; Shair, Alia; Ijaz, Anum

    2015-06-01

    To compare clinical outcome in patients undergoing conventional coronary artery bypass graft surgery who received intermittent antegrade warm blood cardioplegia or intermittent antegrade cold blood cardioplegia for myocardial protection. The observational, prospective non-randomised analytical comparative study was conducted at the Punjab Institute of Cardiology, Lahore, and Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, from September 2012 to October 2013, and comprised patients undergoing coronary artery bypass graft surgery. They were divided into two groups, with Group I having those who received intermittent antegrade warm blood cardioplegia, and Group II having those who received intermittent antegrade cold blood cardioplegia. SPSS 16 was used for statistical analysis. Of the 215 patients, 94(44%) were in Group I, and 121(56%) in Group II. Total surgical time in Group II was 119.26±22.24 minutes compared to 105.73±31.34 in Group I (p >0.0001). Spontaneous resumption of sinus rhythm and peri-operative myocardial infarction was statistically insignificant (p>0.05). There were 21(17.4%) patients in Group II to whom peri-operative myocardial infarction occurred compared to 9(9.6%) in Group I (p=0.10). Intermittent antegrade warm blood cardioplegia showed better myocardial protection in early postoperative period compared to intermittent antegrade cold blood cardioplegia.

  4. Uterine arterial embolization for uterine leiomyoma: efficacy and clinical outcome

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    Park, Jeong Seon; Lee, Do Yon; Kim, Yong Tae; Park, Ki Hyun; Park, Yong Won; Cho, Jae Sung; Kim, Myung Jun [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of); Won, Je Hwan [Ajou Univ. College of Medicine, Suwon (Korea, Republic of); Kang, Byung Chul [Ewha Womans Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-09-01

    To determine the efficacy and clinical outcome of uterine arterial embolization as a new approach to the management of uterine leiomyomas. Uterine arterial embolization was performed in 21 patients aged 26-62(mean, 42) years. Twenty of these had menorrhagia, dysmenorrhea, and mass-related symptoms (low abdominal discomfort, backache, urinary frequency, etc.) and one was diagnosed incidentally. Bilateral uterine arteries were selected individually and polyvinyl alcohol and/or gelfoam was used as an embolic material. Nineteen patients were followed up after embolization. Seventeen (89.5 %)reported satisfactory improvement of symptoms and follow-up sonography three months later showed a 58.5 % reduction in mean myoma volume. In 17 patients (89.5 %), the menstrual cycle returned to normal. All patients experienced pain after the procedure and other complications were vaginal bleeding (26.3 %) and fever (23.8 %). Uterine arterial embolization represents a new approach to the management of uterine leiomyoma-related symptoms. Further investigations and long-term follow-up are, however, enquired.

  5. Clinical outcome of patients with glioblastoma multiforme: Single center experience

    Directory of Open Access Journals (Sweden)

    Özlem Yersal

    2017-12-01

    Full Text Available Glioblastoma multiforme (GBM is the most common and fatal brain tumor in adults. Prognosis remains dismal and median overall survival rarely exceeds 12 months. In this study, we evaluated the demographic and clinical features of Turkish glioblastoma patients from single institute to identify the important prognostic factors which might be related with patient outcomes in this population, retrospectively. Demographic data, clinicopathological data and treatment parameters (i.e. extent of surgical resection, radiotherapy and use of chemotherapy were obtained from medical records. SPSS version 22 was used for all statistical analyses. The median progression-free survival and overall survival was 9,9 and 13,7 months; respectively. The group of patients with the highest mean overall survival had a tumor at the fronto-temporal region, followed by frontal localization. In univariate analysis, age, concurrent chemoradiotherapy and adjuvant temozolomide use were all predictors for both PFS and OS. However, in multivariate analysis, age and concurrent radiotherapy were significant predictors of survival. Patients receiving cyberknife after recurrence had longer OS. We retrospectively evaluated glioblastoma patients from single institute, the results supported previously reported factors that influence survival time in glioblastoma.

  6. Professional outcomes of completing a clinical nutrition fellowship: Cleveland Clinic's 16-year experience.

    Science.gov (United States)

    Rivera, Rene; Kirby, Donald F; Steiger, Ezra; Seidner, Douglas L

    2010-10-01

    Cleveland Clinic has trained 17 physician nutrition specialists since the establishment of its clinical nutrition fellowship (CNF) in 1994. The paths taken by the graduates and whether they continue to practice clinical nutrition are largely unknown. To investigate the professional outcomes of completing a CNF, a survey of graduates was conducted. Fifty-seven percent of respondents (n = 8) applied to another fellowship prior to applying to a CNF. The 2 most common reasons for applying to a CNF were to increase knowledge of clinical nutrition and increase the chance of acquiring a gastroenterology fellowship. Eighty-five percent (n = 10) of graduates found the CNF to be valuable. Eighty-six percent (n = 12) went on to complete a gastroenterology fellowship, and 67% (n = 8) of graduates believed that completing a CNF increased their chances of gaining acceptance to a gastroenterology fellowship. Only 42% (n = 6) of the graduates currently hold professions that specifically dictate the use of clinical nutrition, but 61% (n = 8) reported using clinical nutrition in their daily or weekly practice. Fifty percent (n = 7) of graduates believed that completing a CNF made them more competitive job candidates, but only 21% (n = 3) said that their extra training is reflected in their current salary. It appears that CNFs are being used as a method of subsequently acquiring a gastroenterology or other medical fellowships. Although not working in defined clinical nutrition professions, >50% of graduates continue to apply their CNF skills after completing their training. A small percentage have found dedicated nutrition-based clinical professions.

  7. The effect of femoral and acetabular version on clinical outcomes after arthroscopic femoroacetabular impingement surgery.

    Science.gov (United States)

    Fabricant, Peter D; Fields, Kara G; Taylor, Samuel A; Magennis, Erin; Bedi, Asheesh; Kelly, Bryan T

    2015-04-01

    The impact of proximal femoral and combined femoral and acetabular version on patient-reported outcomes after arthroscopic surgery for femoroacetabular impingement (FAI) remains undefined. The purpose of this study was to identify associations of proximal femoral version as well as combined version (McKibbin index) with disease-specific, validated, patient-reported outcomes following arthroscopic correction of symptomatic FAI. A prospective hip arthroscopy registry was utilized to evaluate 243 patients who underwent arthroscopic surgery to correct FAI. Femoral version and the McKibbin index were measured prospectively on preoperative computed tomography scans. Disease-specific, patient-reported outcomes included the modified Harris hip score (mHHS) and the Hip Outcome Score (HOS) ADL (Activities of Daily Living) and Sports subscales. Disease impact on quality of life was determined with use of the International Hip Outcome Tool (iHOT-33). Comparative analyses were used to evaluate the impact of femoral version on changes in patient-reported outcome scores; multiple regression was used to adjust for potential confounders. The patient cohort contained 243 patients (123 female and 120 male) with a mean age of 29.2 years and a mean postoperative follow-up of twenty-one months (range, twelve to forty-two months). The cohort experienced significant improvements (p < 0.001) in all patient-reported outcome measures, with most patients improving by at least the minimal clinically important difference for all of these measures. The mean improvement was 20 points for the mHHS, 15 for the HOS ADL, 23 for the HOS Sports, and 23 for the iHOT-33. When stratified by femoral version, the postoperative improvements in patients with relative femoral retroversion (<5° anteversion) were clinically important but of significantly smaller magnitude than those in the other version groups. We did not find any associations between the McKibbin index and any patient-reported outcomes

  8. Clinical and functional outcomes of tibial intercalary allograft reconstructions

    Directory of Open Access Journals (Sweden)

    Lucas López Millán

    2012-12-01

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

  9. Clinical features, treatment, and outcome in goats with thymomas: 13 cases (1990-2014).

    Science.gov (United States)

    Hill, Jacqueline A; Fubini, Susan L; Hackett, Richard P

    2017-10-01

    OBJECTIVE To determine the anatomic location and clinical signs of thymoma in goats and long-term outcomes in a subset of goats treated by tumor excision. DESIGN Retrospective case series. ANIMALS 13 goats with a histologic diagnosis of thymoma at the Cornell University Hospital for Animals between 1990 and 2014. PROCEDURES Medical records of goats with thymoma were reviewed and data were evaluated regarding signalment, clinical signs, diagnostic imaging results, thymoma size, treatment, and outcome. Follow-up information was obtained via contact with the owners and review of medical records. RESULTS 8 goats had a mediastinal mass, 4 had a palpable ventral cervical mass, and 1 had both types of masses. Median age at the time of diagnosis was 9.5 years (range, 3 to 12 years). Goats with a mediastinal mass had respiratory distress or marked tachypnea. Six goats were treated surgically, including all 5 with a ventral cervical mass. All 5 goats with a ventral cervical mass survived with no tumor recurrence for ≥ 1 year after excision. Only 2 goats with a mediastinal mass survived to hospital discharge. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the prognosis for goats following excision of ventral cervical thymomas was favorable, whereas goats with mediastinal thymomas appeared more likely to have severe clinical signs and a guarded prognosis.

  10. Hyperglycemia and Clinical Outcome in Aneurysmal Subarachnoid Hemorrhage A Meta-Analysis

    NARCIS (Netherlands)

    Kruyt, Nyika D.; Biessels, Geert Jan; de Haan, Rob J.; Vermeulen, Marinus; Rinkel, Gabriel J. E.; Coert, Bert; Roos, Yvo B. W. E. M.

    2009-01-01

    Background and Purpose-Hyperglycemia may worsen outcome after aneurysmal subarachnoid hemorrhage. We performed a systematic review to investigate the relation between admission hyperglycemia and outcome after aneurysmal subarachnoid hemorrhage. Methods-We included cohort studies or clinical trials

  11. Clinical outcomes of indirect composite restorations for grossly mutilated primary molars: a clinical observation.

    Science.gov (United States)

    Mittal, Neeti; Srivastava, Binita

    2015-01-01

    This study was conducted to report the clinical outcomes and the parental and child satisfaction of onlays for restoring mutilated primary molars. Twenty subjects, ages 3-8 years, with the presence of at least 1 mutilated primary molar (≥3 carious surfaces and a carious surface area ≥3/4 of the occlusal surface) were recruited. This study assessed the clinical success, gingival health, and parent/child satisfaction of 28 indirect composite onlays. The onlays showed a 100% retention rate at 12 months follow-up and a marginal integrity of 96.43%. High rates of satisfactory Alpha ratings for color stability (92.86%), surface texture (92.86%), and anatomic form (100%), coupled with significant improvements in gingival health of the restored teeth (P Indirect composite onlays successfully restored anatomic form and function of the grossly decayed primary molars--with shorter chairside times--while satisfying the esthetic demands of the young pediatric patients.

  12. Regenerative Endodontic Treatment: Report of Two Cases with Different Clinical Management and Outcomes

    Directory of Open Access Journals (Sweden)

    Mehrfam Khoshkhounejad

    2015-11-01

    Full Text Available Endodontic intervention in necrotic immature permanent teeth is usually a clinical challenge. With appropriate case selection, regenerative treatment can be effective, providing a desirable outcome. However, there is still no consensus on the optimal disinfection protocol or the method to achieve predictable clinical outcome. This article presents two cases of regenerative treatment in necrotic immature teeth, using mineral trioxide aggregate (MTA and BiodentineTM as coronal barriers and different irrigants, which led to different clinical outcomes.

  13. The clinical, occupational and financial outcomes associated with a bespoke specialist clinic for military aircrew—a cohort study

    Science.gov (United States)

    Pavitt, A.J.; Pavitt, C.W.; Harron, K.; Jones, M.; Timperley, A.C.; Reid, A.N.C.; Mcloughlin, D.; d'Arcy, J.

    2016-01-01

    Objectives: To assess the clinical, occupational and financial outcomes of a new Clinical Aviation Medicine Service (CAMS) for UK military personnel. Methods: Consecutive patients over a 2 year period were included. Predictors of flying restrictions at referral and final outcome following consultation were modelled using logistic regression. National Health Service (NHS) Payment by Results tariffs and Defence capitation data were used to assess the financial impact of the service. Results: Eight hundred and sixteen new referrals (94.5% male, median age 45 years (range 19–75)) were received and 1025 consultations performed. Cardiovascular disease was the commonest reason for referral. CAMS clinical activity cost at NHS tariff was £453 310 representing a saving of £316 173 (£137 137 delivery cost). In total, 310/816 (38%) patients had employment restrictions on referral and 49.0% of this group returned to full employment following their initial consultation. Compared with cardiology, general medicine and respiratory patients were more likely to have been occupationally restricted prior to referral (50 vs. 35%, OR 1.81; 95% CI 1.18–2.76, P values=0.006 and 53 vs. 35%, OR 2.12; 95% CI 1.15–3.90, P values = 0.016, respectively). Overall 581/816 (71.2%) of patients returned to unrestricted employment while 98/816 (12.0%) were unable to continue in any aircrew role. The service saved 7000 lost working days per year at an estimated occupational saving of ∼£1 million per annum. Conclusions: This bespoke service has allowed rapid, occupationally relevant clinical care to be delivered with both time and financial savings. The model may have significant occupational and financial relevance for other environmental and occupational medical organizations. PMID:26424788

  14. The clinical, occupational and financial outcomes associated with a bespoke specialist clinic for military aircrew-a cohort study.

    Science.gov (United States)

    Pavitt, A J; Pavitt, C W; Harron, K; Jones, M; Timperley, A C; Reid, A N C; Mcloughlin, D; d'Arcy, J; Nicol, E D

    2016-05-01

    To assess the clinical, occupational and financial outcomes of a new Clinical Aviation Medicine Service (CAMS) for UK military personnel. Consecutive patients over a 2 year period were included. Predictors of flying restrictions at referral and final outcome following consultation were modelled using logistic regression. National Health Service (NHS) Payment by Results tariffs and Defence capitation data were used to assess the financial impact of the service. Eight hundred and sixteen new referrals (94.5% male, median age 45 years (range 19-75)) were received and 1025 consultations performed. Cardiovascular disease was the commonest reason for referral. CAMS clinical activity cost at NHS tariff was £453 310 representing a saving of £316 173 (£137 137 delivery cost). In total, 310/816 (38%) patients had employment restrictions on referral and 49.0% of this group returned to full employment following their initial consultation. Compared with cardiology, general medicine and respiratory patients were more likely to have been occupationally restricted prior to referral (50 vs. 35%, OR 1.81; 95% CI 1.18-2.76, P values=0.006 and 53 vs. 35%, OR 2.12; 95% CI 1.15-3.90, P values = 0.016, respectively). Overall 581/816 (71.2%) of patients returned to unrestricted employment while 98/816 (12.0%) were unable to continue in any aircrew role. The service saved 7000 lost working days per year at an estimated occupational saving of ∼£1 million per annum. This bespoke service has allowed rapid, occupationally relevant clinical care to be delivered with both time and financial savings. The model may have significant occupational and financial relevance for other environmental and occupational medical organizations. © Crown copyright 2015.

  15. Clinical/biological outcomes of treatment for pericoronitis.

    Science.gov (United States)

    Blakey, G H; White, R P; Offenbacher, S; Phillips, C; Delano, E O; Maynor, G

    1996-10-01

    This prospective clinical study was designed to determine the clinical and biologic outcomes of treatment for minor signs and symptoms of pericoronitis. Patients (n = 20) with all third molars, presenting consecutively to an academic clinical center for treatment of minor signs and symptoms of pericoronitis, were enrolled in the study. At the initial visit, gingival crevicular fluid (GCF) samples to assess levels of the cytokines interleukin- 1b (IL-1b) IL-1b and prostaglandin E2 (PGE2) as a measure of the host inflammatory response, and plaque samples to identify microorganisms, were collected from the distal of all second molars and the mesial of first molars. Standardized vertical bite wing radiographs were taken to assess alveolar bone height on the distal of the second molars and the inclination and the degree of eruption of the third molar. Full-mouth periodontal probing was conducted to determine probing depths and relative clinical attachment levels (CAL). Pain levels were assessed with Gracely verbal descriptor scales for sensory intensity and unpleasantness and 10-cm visual analog scales. Symptomatic third molar sites were treated with local debridement and irrigation after baseline data collection. One week after entry, data were collected again. Subsequently, the patients were scheduled for removal of all third molars. Data collection was repeated 3 months postsurgery. As controls, data were collected from 12 subjects who had asymptomatic third molars removed previously. At entry, symptomatic mandibular third molars (n = 21) were mostly vertical (n = 18) and at or above the occlusal plane (n = 19). No maxillary teeth had symptoms. Microbial counts were elevated for specific anaerobic microorganisms. GCF IL-1b levels were elevated at the distal of second molars adjacent to symptomatic third molars, as compared with asymptomatic third molars and second molars in control patients. Alveolar bone levels and CAL on the distal of second molars were normal. At

  16. Defining Outcomes for Clinical Trials of Leber Congenital Amaurosis Caused by GUCY2D Mutations.

    Science.gov (United States)

    Jacobson, Samuel G; Cideciyan, Artur V; Sumaroka, Alexander; Roman, Alejandro J; Charng, Jason; Lu, Monica; Choudhury, Shreyasi; Schwartz, Sharon B; Heon, Elise; Fishman, Gerald A; Boye, Shannon E

    2017-05-01

    To determine outcome measures for a clinical trial of Leber congenital amaurosis (LCA) associated with mutations in the GUCY2D gene. Retrospective observational case series. Twenty-eight patients with GUCY2D-LCA (aged 2-59 years) were studied clinically and with chromatic full-field sensitivity testing (FST), optical coherence tomography (OCT), pupillometry, and the NEI Visual Function Questionnaire (VFQ). FST permitted quantitation of cone and rod sensitivity in these patients with severe visual impairment. For most patients, the degree of rod and cone sensitivity losses showed a relationship, thereby providing an opportunity to divide patients into cohorts by severity of rod and cone dysfunction. OCT analyses indicated that retinal structure could be used not only as an objective safety measure but also as an exploratory efficacy outcome. A foveal bulge was not present in 67% of patients. The intensity of inner segment/outer segment (ellipsoid zone line) reflectivity was reduced significantly at the fovea and in the rod-dense superior retina. Based on OCT and FST parameters, most patients had dissociation of structure and function. Abnormal pupillometry sensitivity in the majority of GUCY2D-LCA patients provided another objective efficacy outcome. NEI VFQ scores showed a similar range of findings to those of other severe retinal diseases. Conventional outcome measures, such as visual acuity and the NEI VFQ, will need to be complemented by methods more specific to this GUCY2D-LCA population. Any therapeutic strategy should determine if there is an effect on rod as well as cone function and structure. FST provides a photoreceptor-based subjective outcome; and OCT in 2 retinal regions, fovea and superior retina, can assess photoreceptor structure. A change in the relationship of structure and function away from baseline becomes evidence of efficacy. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Image analysis of liver biopsy samples measures fibrosis and predicts clinical outcome.

    Science.gov (United States)

    Huang, Yi; de Boer, W Bastiaan; Adams, Leon A; MacQuillan, Gerry; Bulsara, Max K; Jeffrey, Gary P

    2014-07-01

    Histopathological scoring of liver fibrosis mainly measures architectural abnormalities and requires a minimum biopsy size (⩾ 10 mm). Liver collagen quantification may allow use of small size biopsies and improve the prediction of clinical outcomes. This study evaluated the ability of the collagen proportional area (CPA) measurement to predict clinical outcomes. Clinical outcomes were determined using population based data-linkage for chronic hepatitis C (CHC) patients from 1992 to 2012. Quantitative digital image analysis of liver biopsies was used for CPA measurement. 533 patients with a biopsy size ⩾ 5 mm were included. Median follow up was 10.5 years. 26 developed hepatocellular carcinoma (HCC), 39 developed liver decompensation and 33 had liver related death. 453 had Metavir F0-F2 and 80 had F3-F4. CPA ranged from 1.3% to 44.6%. CPA and Metavir stage were independently associated with liver related death. Metavir stage, CPA stage and age were independently associated with HCC. CPA stage (C1: 0%-5%, C2: 5%-10%, C3: 10%-20%, C4: >20%) stratified risk and a significant difference in outcomes was present between all CPA stages for HCC and between C2-C3 and C3-C4 for decompensation and liver related death. The 15 year composite endpoint-free survival was 97% for C1, 89% for C2, 60% for C3, 7% for C4. C4 had significantly worse survival than ⩽ C3 (pLiver. Published by Elsevier B.V. All rights reserved.

  18. Adaptive radiotherapy for head-and-neck cancer: initial clinical outcomes from a prospective trial.

    Science.gov (United States)

    Schwartz, David L; Garden, Adam S; Thomas, Jimmy; Chen, Yipei; Zhang, Yongbin; Lewin, Jan; Chambers, Mark S; Dong, Lei

    2012-07-01

    To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma. A total of 24 patients were enrolled in an institutional review board-approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy. With a 31-month median follow-up (range, 13-45 months), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated. This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Clinical Characteristics and Treatment Outcomes of Patients with Macrolide-Resistant Mycobacterium massiliense Lung Disease.

    Science.gov (United States)

    Choi, Hayoung; Kim, Su-Young; Lee, Hyun; Jhun, Byung Woo; Park, Hye Yun; Jeon, Kyeongman; Kim, Dae Hun; Huh, Hee Jae; Ki, Chang-Seok; Lee, Nam Yong; Lee, Seung-Heon; Shin, Sung Jae; Daley, Charles L; Koh, Won-Jung

    2017-02-01

    Macrolide antibiotics are cornerstones in the treatment of Mycobacterium massiliense lung disease. Despite the emergence of resistance, limited data on macrolide-resistant M massiliense lung disease are available. This study evaluated the clinical features and treatment outcomes of patients and the molecular characteristics of macrolide-resistant M massiliense isolates. We performed a retrospective review of medical records and genetic analyses of clinical isolates from 15 patients who had macrolide-resistant M massiliense lung disease between September 2005 and February 2015. Nine patients (60%) had the nodular bronchiectatic form of the disease, and six (40%) had the fibrocavitary form. Before the detection of macrolide resistance, three patients (20%) were treated with macrolide monotherapy, four (27%) with therapy for presumed Mycobacterium avium complex infections, and eight (53%) with combination antibiotic therapy for M massiliense lung disease. The median treatment duration after the detection of resistance was 18.7 months (interquartile range, 11.2 to 39.8 months). Treatment outcomes were poor, with a favorable outcome being achieved for only one patient (7%), who underwent surgery in addition to antibiotic therapy. The 1-, 3-, and 5-year mortality rates were 7, 13, and 33%, respectively. Of the 15 clinical isolates, 14 (93%) had point mutations at position 2058 (n = 9) or 2059 (n = 5) of the 23S rRNA gene, resulting in macrolide resistance. Our study indicates that treatment outcomes are poor and mortality rates are high after the development of macrolide resistance in patients with M massiliense lung disease. Thus, preventing the development of macrolide resistance should be a key consideration during treatment. Copyright © 2017 American Society for Microbiology.

  20. Adaptive Radiotherapy for Head-and-Neck Cancer: Initial Clinical Outcomes From a Prospective Trial

    Energy Technology Data Exchange (ETDEWEB)

    Schwartz, David L., E-mail: dschwartz3@nshs.edu [Department of Radiation Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, NY (United States); Feinstein Institute for Medical Research, Manhasset, NY (United States); Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Garden, Adam S.; Thomas, Jimmy [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Chen Yipei; Zhang Yongbin [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Lewin, Jan; Chambers, Mark S. [Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Dong, Lei [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

    2012-07-01

    Purpose: To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma. Methods and Materials: A total of 24 patients were enrolled in an institutional review board-approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy. Results: With a 31-month median follow-up (range, 13-45 months), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated. Conclusion: This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond.

  1. Tumor endothelial inflammation predicts clinical outcome in diverse human cancers.

    Directory of Open Access Journals (Sweden)

    Sean P Pitroda

    Full Text Available Vascular endothelial cells contribute to the pathogenesis of numerous human diseases by actively regulating the stromal inflammatory response; however, little is known regarding the role of endothelial inflammation in the growth of human tumors and its influence on the prognosis of human cancers.Using an experimental model of tumor necrosis factor-alpha (TNF-α-mediated inflammation, we characterized inflammatory gene expression in immunopurified tumor-associated endothelial cells. These genes formed the basis of a multivariate molecular predictor of overall survival that was trained and validated in four types of human cancer.We report that expression of experimentally derived tumor endothelial genes distinguished pathologic tissue specimens from normal controls in several human diseases associated with chronic inflammation. We trained these genes in human cancer datasets and defined a six-gene inflammatory signature that predicted significantly reduced overall survival in breast cancer, colon cancer, lung cancer, and glioma. This endothelial-derived signature predicted outcome independently of, but cooperatively with, standard clinical and pathological prognostic factors. Consistent with these findings, conditioned culture media from human endothelial cells stimulated by pro-inflammatory cytokines accelerated the growth of human colon and breast tumors in immunodeficient mice as compared with conditioned media from untreated endothelial cells.This study provides the first prognostic cancer gene signature derived from an experimental model of tumor-associated endothelial inflammation. These findings support the notion that activation of inflammatory pathways in non-malignant tumor-infiltrating endothelial cells contributes to tumor growth and progression in multiple human cancers. Importantly, these results identify endothelial-derived factors that could serve as potential targets for therapy in diverse human cancers.

  2. The clinical outcome of thymectomy in myasthenia gravis

    Directory of Open Access Journals (Sweden)

    Mirsharifi R

    2009-02-01

    Full Text Available "nBackground: Myasthenia Gravis (MG is a neuromuscular disorder with weakness of skeletal muscles. Thymectomy is now recognized as a treatment modality in MG. The aim of this study was to evaluate the clinical effect of thymectomy on MG. "nMethods: MG patients with history of thymectomy at a tertiary referral center during twelve year period were included. The medical records were reviewed and telephone survey was conducted to evaluate the effects of thymectomy. "nResults: Sixty MG patients, 46 females and 14 males, aged 30.4±11.1 years, underwent open (n=48 or video-assisted thoracoscopic thymectomy (n=12 during study period. The mean dosage of preoperative pyridostigmine was 235.4±86.2mg/day. This figure reached to 129±18mg/day after thymectomy (p<0.0001. 17 patients (28.3% had complete remission (complete freedom of symptoms without medications. Improve-ment (improved symptoms or less medication requirement was seen in 34 patients (56.6%. There was no response to surgical therapy in six patients (10%. Three patients (5% had experienced progression of disease postoperatively. Overall, benefit of thymectomy was observed in 85% of patients. Age, sex, duration and severity of disease, quantity of preoperative drugs, surgical approach, and presence of thymoma did not affect the outcome. Satisfaction was stated as excellent in 17%, good in 43%, moderate in 35% and poor in 5% of patients after operation. "nConclusion: Thymectomy is an effective treatment for MG which leads to less severity of disease and less drug requirement. It would be considered in all myasthenic patients regardless of age, sex, duration and severity of disease and presence of thymoma.

  3. Adenovirus-associated pneumonia in South African children: Presentation, clinical course and outcome

    Directory of Open Access Journals (Sweden)

    M Zampoli

    2017-02-01

    Full Text Available Background. Viruses have emerged as important aetiological agents of childhood pneumonia. Objective. To investigate the clinical presentation, severity and outcome of adenovirus-associated pneumonia (AVP in children. Methods. A retrospective analysis of AVP cases over 12 months was performed, including demographic, clinical course and outcome (death, persistent lung disease (PLD data. Results. Two hundred and six AVP cases (median age 12 months, interquartile range 6 - 24 were identified; 70 children (34.0% were malnourished and 14 (6.8% were HIV-infected. Twenty-nine children (14.1% developed PLD, which was associated with hypoxia at presentation in 26 cases (89.7%; p=0.01 and necessitated admission to the intensive care unit (ICU in 18 (62.1%; p<0.01; 18/206 children (8.7% died. Admission to the ICU (odds ratio (OR 8.3, 95% confidence interval (CI 2.3 - 29.0 and a positive blood culture (OR 11.2, 95% CI 2.3 - 54.1 were independent risk factors for mortality. Conclusions. Adenovirus is a potential cause of pneumonia and PLD in young children in South Africa. ICU admission and a positive blood culture were associated with poor outcome.

  4. Clinical outcomes with the Kanso™ off-the-ear cochlear implant sound processor.

    Science.gov (United States)

    Mauger, Stefan J; Jones, Marian; Nel, Esti; Del Dot, Janine

    2017-04-01

    To investigate clinical outcomes and subjective ratings of the Kanso™ off-the-ear (OTE) cochlear implant sound processor. Prospective, within-subject design investigating outcomes with a range of single and dual-microphone programmes for Kanso compared to conventional behind-the-ear (BTE) sound processors. Twenty post-lingually hearing-impaired cochlear implant recipients who were experienced Nucleus® 5 or Nucleus® 6 BTE users. No significant difference in performance was found for words in quiet or sentences in co-located noise between the Kanso and Nucleus 6 devices. For the moderately directional Standard programme, no significant difference was found for sentences in spatially separated noise between the Kanso and Nucleus 6 devices, but a performance decrement between 1.4 and 2.0 dB was found in highly directional and adaptive directional programmes. The default Kanso programme, SCAN, provided improvements of 6.9 dB over a single-microphone programme and 2.3 dB over the Standard programme in spatially separated noise. Participants rated Kanso significantly better than their own BTE processor on measures of comfort, look and feel, ease of use, music and overall hearing performance. Dual-microphone directional processing provides significant benefit over a single microphone for OTE processors. This study demonstrates clinical outcomes and acceptance of the Kanso OTE sound processor.

  5. Adult medulloblastoma: clinical characters, prognostic factors, outcomes and patterns of relapse.

    Science.gov (United States)

    Zhang, Na; Ouyang, Taohui; Kang, Huicong; Long, Wang; Thomas, Benjamin; Zhu, Suiqiang

    2015-09-01

    To analyze the clinical characters, prognostic factors, patterns of relapse and treatment outcomes for medulloblastoma in adults. The clinical materials of 73 consecutive adult patients (age, ≥16 years) with medulloblastoma were analyzed retrospectively. Follow-up data were available in 62 patients, ranging from 10 to 142 months (median, 78.4 months). Outcome in survival was assessed by the progression-free survival (PFS) and overall survival (OS). Univariate and multivariate analysis were performed to determine the prognostic factors. Total or near-total tumor resection was achieved in 37 cases (59.7 %), subtotal in 19 cases (30.6 %), and partial resection in 6 cases (9.7 %).Twenty-two patients experienced recurrences, and 45 % percent of all recurrences occurred more than 4 years after initial surgery. The PFS rates at 5 and 8 years were 60.1 and 37.0 %, respectively. The OS rates at 5 and 8 years were 82.6 and 57.3 %, respectively. In univariate analysis, less tumor resection, non-desmoplastic pathology, and brainstem involvement were risk factors for worse PFS and OS (P medulloblastoma, late relapse is common and therefore long-term follow-up is important for evaluating the real impact of treatments. Risk category had prognostic value just for PFS, but not for OS. Complete resection and desmoplastic histology are independently predictive factors for favorable outcomes.

  6. Clinical infectious outcomes associated with biofilm-related bacterial infections: a retrospective chart review

    National Research Council Canada - National Science Library

    Barsoumian, Alice E; Mende, Katrin; Sanchez, Jr, Carlos J; Beckius, Miriam L; Wenke, Joseph C; Murray, Clinton K; Akers, Kevin S

    2015-01-01

    Biofilms are associated with persistent infection. Reports characterizing clinical infectious outcomes and patient risk factors for colonization or infection with biofilm forming isolates are scarce...

  7. Linking residency training effectiveness to clinical outcomes: a quality improvement approach.

    Science.gov (United States)

    Buckley, John D; Joyce, Barbara; Garcia, Audwin Joseph; Jordan, Jack; Scher, Eric

    2010-05-01

    The Accreditation Council for Graduate Medical Education (ACGME)'s Outcome Project requires training programs to use external measures such as quality of care indicators to assess their effectiveness. A practical, quality improvement (QI) process was implemented at Henry Ford Hospital to enhance the training program's educational effectiveness and clinical outcomes. A QI process consisting ofa modified Plan-Do-Study-Act (PDSA) cycle was applied to residency and fellowship curricula in a medical intensive care unit (MICU). The PDSA activities focused on improving clinical outcomes but also outlined educational goals for residents and fellows, defined teaching methods, and determined assessment methods for the ACGME curricula. The improvement process linked clinical outcomes to specific competency-based educational objectives. Residents and fellows received instruction on QI and applied the new curricula to their clinical training in the MICU. Two of seven MICU clinical outcomes demonstrated initial performance below national benchmarks: iatrogenic pneumothorax rate and sepsis-specific mortality. During the QI process, clinical outcomes in both areas improved. Training program directors used the MICU clinical outcomes as indicators of their programs' educational effectiveness. They also assessed individual trainee performance in QI initiatives through direct observation and review of their written summaries of these projects. Training programs can use hospital-tracked clinical outcomes to analyze their educational strengths and weaknesses and accordingly to enhance their educational curricula. Linking competency-based learning objectives for trainees to the clinical outcomes of their patients can improve physician education and patient care.

  8. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2011-03-01

    To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI).

  9. Sagittal range of motion after a spinal fracture : does ROM correlate with functional outcome?

    NARCIS (Netherlands)

    Post, RB; Leferink, VJM

    2004-01-01

    Literature regarding the effect of a spinal fracture and its treatment in terms of resulting spinal range of motion (ROM) is scarce. However, there is need for data regarding sagittal spinal ROM, since many patients who sustain a spinal fracture are concerned about the back mobility they will have

  10. Dissemination of behavioural activation for depression to mental health nurses: training evaluation and benchmarked clinical outcomes.

    Science.gov (United States)

    Ekers, D M; Dawson, M S; Bailey, E

    2013-03-01

    Depression causes significant distress, disability and cost within the UK. Behavioural activation (BA) is an effective single-strand psychological approach which may lend itself to brief training programmes for a wide range of clinical staff. No previous research has directly examined outcomes of such dissemination. A 5-day training course for 10 primary care mental health workers aiming to increase knowledge and clinical skills in BA was evaluated using the Training Acceptability Rating Scale. Depression symptom level data collected in a randomized controlled trial using trainees were then compared to results from meta-analysis of studies using experienced therapists. BA training was highly acceptable to trainees (94.4%, SD 6%). The combined effect size of BA was unchanged by the addition of the results of this evaluation to those of studies using specialist therapists. BA offers a promising psychological intervention for depression that appears suitable for delivery by mental health nurses following brief training. © 2012 Blackwell Publishing.

  11. The significance of clinical experience on learning outcome from resuscitation training-a randomised controlled study

    DEFF Research Database (Denmark)

    Jensen, Morten Lind; Lippert, Freddy; Hesselfeldt, Rasmus

    2008-01-01

    CONTEXT: The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated. AIM: To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome ...... but statistically significant impact on the retention of learning, but not on the immediate learning outcome Udgivelsesdato: 2008/12/4......CONTEXT: The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated. AIM: To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome...... and retention of learning. MATERIALS AND METHODS: This was a prospective single blinded randomised controlled study of the learning outcome from a standard ALS course on a volunteer sample of the entire cohort of newly graduated doctors from Copenhagen University. The outcome measurement was ALS...

  12. Clinical Presentation, Surgical Treatment, and Outcome in Radial Polydactyly.

    Science.gov (United States)

    Dijkman, R R; van Nieuwenhoven, C A; Hovius, S E R; Hülsemann, W

    2016-02-01

    Radial polydactyly or 'thumb duplication' is the most common congenital upper limb anomaly ('CULA') affecting the thumb. The clinical presentation is highly diverse, ranging from an extra thumb floating on a skin bridge to complicated thumb triplications with triphalangeal, deviating, and hypoplastic components. Radial polydactyly can be classified into one of 7 osseous presentations using the Wassel classification, with type IV (45%), type II (20%), and type VII (15%) occurring most frequently. When faced with a radial polydactyly case, hand surgeons specialised in congenital anomalies must weigh the preoperative functional potential and degree of hypoplasia of both thumbs in order to decide whether to resect one thumb and reconstruct the other ('resection and reconstruction'), excise a central part of both thumbs and unite the lateral tissues into one thumb ('the Bilhaut procedure'), transfer the better-developed distal tissues of one thumb onto the better-developed proximal tissues of the other ('on-top plasty'), or discard both severely hypoplastic thumbs and pollicise the index finger. Mere excision of the hypoplastic thumb is rarely indicated since it often requires subsequent revision surgery. Even after being treated by experienced surgeons, about 15% of patients with polydactyly will need additional procedures to correct residual and/or new problems such as deviation from the longitudinal axis and joint instability. Nevertheless, radial polydactyly patients usually achieve unimpaired everyday hand function postoperatively. © Georg Thieme Verlag KG Stuttgart · New York.

  13. A meta-analysis of clinical outcome in patients with total intestinal aganglionosis.

    LENUS (Irish Health Repository)

    Ruttenstock, Elke

    2012-02-01

    Total intestinal aganglionosis (TIA) is the most extreme and rare form of Hirschsprung disease (HD). Until few years ago TIA was considered to be a uniformly fatal condition. Survival has improved in the recent years with the advent of parenteral nutrition, innovative surgical techniques and small bowel transplantation. The purpose of this meta-analysis was to determine the clinical outcome of TIA following various surgical procedures. A meta-analysis of cases of TIA reported in the literature between 1985 and 2009 was performed. Detailed information was recorded regarding the extent of aganglionosis, surgical procedures performed and clinical outcome. In case of survivors, authors of reports were contacted to obtain the up-to-date clinical status of the patient. There were 68 cases of TIA reported worldwide, 40 (58.8%) males and 28 (41.2%) females. 6 (8.8%) patients had extension of aganglionosis up to the stomach, 19 (27.9%) up to the duodenum and 43 (63.2%) patients had aganglionosis up to 20 cm below the duodeno-jejunal flexure. Family history of HD was documented in 10 (14.7%) patients. RET-gene mutation were identified in 10 (71.4%) of the 14 patients investigated of RET germline mutations. Eleven patients (16.2%) died prior to surgical treatment, 25 patients (36.8%) only had jejunostomy, while 20 (29.4%) had Ziegler\\'s myectomy-myotomy. 12 (17.6%) patients received intestinal transplantation (ITx) or combined liver-intestinal transplantation (LITx). Forty-five (66.2%) patients died at ages ranging from 1 day to 8 years. Twenty-three (33.8%) patients were alive; the longest survivor was 10 years old after LITx. Innovative surgical procedures and parenteral nutrition have improved clinical outcome of patients with TIA in recent years. Intestinal transplantation appears promising in the management of TIA.

  14. Management and outcome of clinically evident neck recurrence in patients with papillary thyroid cancer.

    Science.gov (United States)

    Wang, Laura Y; Migliacci, Jocelyn C; Tuttle, R Michael; Shaha, Ashok R; Shah, Jatin P; Patel, Snehal G; Ganly, Ian

    2017-11-01

    The aim of this study was to report our incidence of clinically evident neck recurrence, salvage neck management and subsequent outcomes in patients with papillary thyroid cancer. This is important to know so that patients with thyroid cancer can be properly counselled about the implications of recurrent disease and subsequent outcome. An institutional database of 3664 patients with thyroid cancer operated between 1986 and 2010 was reviewed. Patients with nonpapillary histology and gross residual disease and those with distant metastases at presentation or distant metastases prior to nodal recurrence were excluded from the study. Of these, 99 (3.0%) patients developed clinically evident nodal recurrence. Details of recurrence and subsequent therapy were recorded for each patient. Subsequent disease-specific survival (sDSS), distant recurrence-free survival (sDRFS) and nodal recurrence-free survival (sNRFS) were determined from the date of first nodal recurrence using the Kaplan-Meier method. Of the 99 patients, 59% were female and 41% male. The median age was 41 years (range 5-91). The majority of patients had pT3/4 primary tumours (63%) and were pN+ (78%) at initial presentation. The median time to clinically evident nodal recurrence was 28 months (range: 3-264). Nodal recurrence occurred in the central neck in 15 (15%) patients, lateral neck in 74 (75%) patients and both in 10 (10%) patients. After salvage treatment, the 5-year sDSS was 97.4% from time of nodal recurrence. The 5-year sDRFS and sNRFS were 89.2% and 93.7%, respectively. In our series, isolated clinically evident nodal recurrence occurred in 3.0% of patients. Such patients are successfully salvaged with surgery and adjuvant therapy with sDSS of 97.4% at 5 years. © 2017 John Wiley & Sons Ltd.

  15. Brucellosis in pregnancy: clinical aspects and obstetric outcomes.

    Science.gov (United States)

    Vilchez, Gustavo; Espinoza, Miguel; D'Onadio, Guery; Saona, Pedro; Gotuzzo, Eduardo

    2015-09-01

    Brucellosis is a zoonosis with high morbidity in humans. This disease has gained interest recently due to its re-emergence and potential for weaponization. Pregnant women with this disease can develop severe complications. Its association with adverse obstetric outcomes is not clearly understood. The objective of this study was to describe the obstetric outcomes of brucellosis in pregnancy. Cases of pregnant women with active brucellosis seen at the Hospital Nacional Cayetano Heredia from 1970 to 2012 were reviewed. Diagnostic criteria were a positive agglutination test and/or positive blood/bone marrow culture. Presentation and outcomes data were collected. The Chi-square test was used for nominal variables. A p-value of obstetric outcomes including fetal and maternal/neonatal death. Cases with unexplained spontaneous abortion should be investigated for brucellosis. Prompt treatment is paramount to decrease the devastating outcomes. Copyright © 2015. Published by Elsevier Ltd.

  16. Variation in Care and Clinical Outcomes in Children Hospitalized With Orbital Cellulitis.

    Science.gov (United States)

    Markham, Jessica L; Hall, Matthew; Bettenhausen, Jessica L; Myers, Angela L; Puls, Henry T; McCulloh, Russell J

    2018-01-01

    To describe variation in the care of children hospitalized with orbital cellulitis and to determine associations with length of stay (LOS), emergency department (ED) revisits, and hospital readmissions. By using the Pediatric Health Information System, we performed a multicenter, retrospective study of children aged 2 months to 18 years with a primary International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code for orbital cellulitis from 2007 to 2014. We assessed hospital-level variation in the use of diagnostic tests, corticosteroids, and antibiotics individually and in aggregate for association with outcomes (LOS, ED revisits, readmissions) after risk-adjusting for important clinical and demographic factors. A total of 1828 children met inclusion criteria. Complete blood cell counts (median [interquartile range]: 81.8% [66.7-89.6]), C-reactive protein levels (57.1% [22.2-84.0]), blood cultures (57.9% [48.9-63.6]), and computed tomography imaging (74.7% [66.7-81.0]) were the most frequently performed diagnostic tests, with significant variation observed across hospitals (all P orbital cellulitis experience wide variation in clinical management. Increased hospital-level usage is associated with increased LOS. Our findings highlight a critical need to identify treatment strategies that optimize resource use and outcomes for children hospitalized with orbital cellulitis. Copyright © 2018 by the American Academy of Pediatrics.

  17. Generating method-specific Reference Ranges – A harmonious outcome?

    Directory of Open Access Journals (Sweden)

    Graham R. Lee

    2017-12-01

    Full Text Available Objectives: When laboratory Reference Ranges (RR do not reflect analytical methodology, result interpretation can cause misclassification of patients and inappropriate management. This can be mitigated by determining and implementing method-specific RRs, which was the main objective of this study. Design and methods: Serum was obtained from healthy volunteers (Male + Female, n > 120 attending hospital health-check sessions during June and July 2011. Pseudo-anonymised aliquots were stored (at − 70 °C prior t° analysis on Abbott ARCHITECT c16000 chemistry and i2000SR immunoassay analysers. Data were stratified by gender where appropriate. Outliers were excluded statistically (Tukey method to generate non-parametric RRs (2.5th + 97.5th percentiles. RRs were compared to those quoted by Abbott and UK Pathology Harmony (PH where possible. For 7 selected tests, RRs were verified using a data mining approach. Results: For chemistry tests (n = 23, Upper or Lower Reference Limits (LRL or URL were > 20% different from Abbott ranges in 25% of tests (11% from PH ranges but in 38% for immunoassay tests (n = 13. RRs (mmol/L for sodium (138−144, potassium (3.8–4.9 and chloride (102−110 were considerably narrower than PH ranges (133–146, 3.5–5.0 and 95–108, respectively. The gender difference for ferritin (M: 29–441, F: 8–193 ng/mL was more pronounced than reported by Abbott (M: 22–275, F: 5–204 ng/mL. Verification studies showed good agreement for chemistry tests (mean [SD] difference = 0.4% [1.2%] but less so for immunoassay tests (27% [29%], particularly for TSH (LRL. Conclusion: Where resource permits, we advocate using method-specific RRs in preference to other sources, particularly where method bias and lack of standardisation limits RR transferability and harmonisation. Keywords: Reference Ranges, Method-specific, Harmonisation

  18. Prostate Zonal Volumetry as a Predictor of Clinical Outcomes for Prostate Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Assis, André Moreira de, E-mail: andre.assis@criep.com.br, E-mail: andre.maa@gmail.com; Maciel, Macello Sampaio, E-mail: macielmjs@gmail.com; Moreira, Airton Mota, E-mail: airton.mota@criep.com.br; Paula Rodrigues, Vanessa Cristina de, E-mail: vanessapaular@yahoo.com.br [University of Sao Paulo Medical School, Vascular and Interventional Radiology Unit, Radiology Institute (Brazil); Antunes, Alberto Azoubel, E-mail: antunesuro@uol.com.br; Srougi, Miguel, E-mail: srougi@uol.com.br [University of Sao Paulo Medical School, Urology Department (Brazil); Cerri, Giovanni Guido, E-mail: giovanni-cerri@uol.com.br [University of Sao Paulo Medical School, Radiology Institute (Brazil); Carnevale, Francisco Cesar, E-mail: francisco.carnevale@criep.com.br [University of Sao Paulo Medical School, Vascular and Interventional Radiology Unit, Radiology Institute (Brazil)

    2017-02-15

    PurposeTo determine prostate baseline zonal volumetry and correlate these findings with clinical outcomes for patients who underwent prostate artery embolization (PAE) for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).Materials and MethodsThis is a retrospective study that included patients treated by PAE from 2010 to 2014. Baseline and 6-month follow-up evaluations included prostate MRI with whole prostate (WP) and central gland (CG) volume measurements—as well as prostate zonal volumetry index (ZVi) calculation, defined as the CG/WP volumes relation—the International Prostate Symptom Score (IPSS), and the Quality of life (QoL) index. Baseline WP, CG, and ZVi were statistical compared to IPSS and QoL values at 6 months.ResultsA total of 93 consecutive patients were included, with mean age of 63.4 years (range, 51–86). Clinical failure, defined as IPSS > 7 or QoL > 2, was seen in four cases (4.3%). Mean reductions in prostate volumes after PAE were of 30.6% and 31.2% for WP and CG, respectively (p < 0.0001). Clinical parameters had mean decrease from 21 to 3.3 points for IPSS, and from 4.7 to 1.2 points for QoL (p < 0.0001). Baseline WP, CG, and ZVi correlated to the degree of clinical improvement (p < 0.05 for all). The baseline ZVi cut-off calculated for better clinical outcomes was > 0.45, with 85% sensitivity and 75% specificity.ConclusionsBaseline CG and WP volumes as well as ZVi presented strong correlation with clinical outcomes in patients undergoing PAE, and its assessment should be considered in pre-treatment evaluation whenever possible. Both patients and medical team should be aware of the possibility of less favorable outcomes when ZVi < 0.45.

  19. The Assessment of Patient Clinical Outcome: Advantages, Models, Features of an Ideal Model

    Directory of Open Access Journals (Sweden)

    Mou’ath Hourani

    2016-06-01

    Full Text Available Background: The assessment of patient clinical outcome focuses on measuring various aspects of the health status of a patient who is under healthcare intervention. Patient clinical outcome assessment is a very significant process in the clinical field as it allows health care professionals to better understand the effectiveness of their health care programs and thus for enhancing the health care quality in general. It is thus vital that a high quality, informative review of current issues regarding the assessment of patient clinical outcome should be conducted. Aims & Objectives: 1 Summarizes the advantages of the assessment of patient clinical outcome; 2 reviews some of the existing patient clinical outcome assessment models namely: Simulation, Markov, Bayesian belief networks, Bayesian statistics and Conventional statistics, and Kaplan-Meier analysis models; and 3 demonstrates the desired features that should be fulfilled by a well-established ideal patient clinical outcome assessment model. Material & Methods: An integrative review of the literature has been performed using the Google Scholar to explore the field of patient clinical outcome assessment. Conclusion: This paper will directly support researchers, clinicians and health care professionals in their understanding of developments in the domain of the assessment of patient clinical outcome, thus enabling them to propose ideal assessment models.

  20. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review [Formula: see text].

    Science.gov (United States)

    Lew, Charles Chin Han; Yandell, Rosalie; Fraser, Robert J L; Chua, Ai Ping; Chong, Mary Foong Fong; Miller, Michelle

    2017-07-01

    Malnutrition is associated with poor clinical outcomes among hospitalized patients. However, studies linking malnutrition with poor clinical outcomes in the intensive care unit (ICU) often have conflicting findings due in part to the inappropriate diagnosis of malnutrition. We primarily aimed to determine whether malnutrition diagnosed by validated nutrition assessment tools such as the Subjective Global Assessment (SGA) or Mini Nutritional Assessment (MNA) is independently associated with poorer clinical outcomes in the ICU and if the use of nutrition screening tools demonstrate a similar association. PubMed, CINAHL, Scopus, and Cochrane Library were systematically searched for eligible studies. Search terms included were synonyms of malnutrition, nutritional status, screening, assessment, and intensive care unit. Eligible studies were case-control or cohort studies that recruited adults in the ICU; conducted the SGA, MNA, or used nutrition screening tools before or within 48 hours of ICU admission; and reported the prevalence of malnutrition and relevant clinical outcomes including mortality, length of stay (LOS), and incidence of infection (IOI). Twenty of 1168 studies were eligible. The prevalence of malnutrition ranged from 38% to 78%. Malnutrition diagnosed by nutrition assessments was independently associated with increased ICU LOS, ICU readmission, IOI, and the risk of hospital mortality. The SGA clearly had better predictive validity than the MNA. The association between malnutrition risk determined by nutrition screening was less consistent. Malnutrition is independently associated with poorer clinical outcomes in the ICU. Compared with nutrition assessment tools, the predictive validity of nutrition screening tools were less consistent.

  1. Added value of CT perfusion compared to CT angiography in predicting clinical outcomes of stroke patients treated with mechanical thrombectomy

    Energy Technology Data Exchange (ETDEWEB)

    Tsogkas, Ioannis; Knauth, Michael; Schregel, Katharina; Behme, Daniel; Psychogios, Marios Nikos [University Medicine Goettingen, Department of Neuroradiology, Goettingen (Germany); Wasser, Katrin; Maier, Ilko; Liman, Jan [University Medicine Goettingen, Department of Neurology, Goettingen (Germany)

    2016-11-15

    CTP images analyzed with the Alberta stroke program early CT scale (ASPECTS) have been shown to be optimal predictors of clinical outcome. In this study we compared two biomarkers, the cerebral blood volume (CBV)-ASPECTS and the CTA-ASPECTS as predictors of clinical outcome after thrombectomy. Stroke patients with thrombosis of the M1 segment of the middle cerebral artery were included in our study. All patients underwent initial multimodal CT with CTP and CTA on a modern CT scanner. Treatment consisted of full dose intravenous tissue plasminogen activator, when applicable, and mechanical thrombectomy. Three neuroradiologists separately scored CTP and CTA images with the ASPECTS score. Sixty-five patients were included. Median baseline CBV-ASPECTS and CTA-ASPECTS for patients with favourable clinical outcome at follow-up were 8 [interquartile range (IQR) 8-9 and 7-9 respectively]. Patients with poor clinical outcome showed a median baseline CBV-ASPECTS of 6 (IQR 5-8, P < 0.0001) and a median baseline CTA-ASPECTS of 7 (IQR 7-8, P = 0.18). Using CBV-ASPECTS and CTA-ASPECTS raters predicted futile reperfusions in 96 % and 56 % of the cases, respectively. CBV-ASPECTS is a significant predictor of clinical outcome in patients with acute ischemic stroke treated with mechanical thrombectomy. (orig.)

  2. Higher serum bicarbonate levels within the normal range are associated with better survival and renal outcomes in African Americans

    Science.gov (United States)

    Raphael, Kalani L.; Wei, Guo; Baird, Bradley C.; Greene, Tom; Beddhu, Srinivasan

    2017-01-01

    Recent studies suggest that correcting low serum bicarbonate levels may reduce the progression of kidney disease; however, few patients with chronic kidney disease have low serum bicarbonate. Therefore, we examined whether higher levels of serum bicarbonate within the normal range (20–30 mmol/l) were associated with better kidney outcomes in the African American Study of Kidney Disease and Hypertension (AASK) trial. At baseline and during follow-up of 1094 patients, the glomerular filtration rates (GFR) were measured by iothalamate clearances and events were adjudicated by the outcomes committee. Mean baseline serum bicarbonate, measured GFR, and proteinuria were 25.1 mmol/l, 46 ml/min per 1.73 m2, and 326 mg/g of creatinine, respectively. Each 1 mmol/l increase in serum bicarbonate within the normal range was associated with reduced risk of death, dialysis, or GFR event and with dialysis or GFR event (hazard ratios of 0.942 and 0.932, respectively) in separate multivariable Cox regression models that included errors-in-variables calibration. Cubic spline regression showed that the lowest risk of GFR event or dialysis was found at serum bicarbonate levels near 28–30 mmol/l. Thus, our study suggests that serum bicarbonate is an independent predictor of CKD progression. Whether increasing serum bicarbonate into the high-normal range will improve kidney outcomes during interventional studies will need to be considered. PMID:20962743

  3. The Value of Motion: Patient-Reported Outcome Measures Are Correlated With Range of Motion in Total Ankle Replacement.

    Science.gov (United States)

    Dekker, Travis J; Hamid, Kamran S; Federer, Andrew E; Steele, John R; Easley, Mark E; Nunley, James A; Adams, Samuel B

    2017-12-01

    The proposed benefit of total ankle replacement (TAR) over ankle fusion is preserved ankle motion, thus we hypothesized that an increase in range of motion (ROM) is positively correlated with validated patient-reported outcome measures (PROMs) in individuals receiving TAR. Patients undergoing TAR at a single academic medical center between 2007 and 2013 were evaluated in this study. In addition to a minimum of 2-year follow-up, complete preoperative and postoperative outcome measures for the Foot and Ankle Disability Index (FADI), Short Musculoskeletal Function Assessment (SMFA) Bother and Function Indices, Visual Analog Scale (VAS), and 36-Item Short Form Health Survey (SF-36) were requisite for inclusion. Standardized weightbearing maximum dorsiflexion and plantarflexion sagittal radiographs were obtained and previously described ankle and foot measurements were performed to determine ankle ROM. Eighty-eight patients met inclusion criteria (33 INBONE, 18 Salto-Talaris, 37 STAR). Mean time to final ROM radiographs was 43.8 months (range 24-89 months). All aforementioned PROMs improved between preoperative evaluation and most recent follow-up (  P dorsiflexion was positively associated with FADI, SF-36 MCS, and SMFA Function (  P motion was positively correlated with multiple PROMs. Disease-specific and generic health-related quality of life PROMs demonstrated improvement postoperatively in all domains when evaluating final total range of motion. Patients who undergo TAR for end-stage osteoarthritis with improvement in ROM demonstrate a direct correlation with improved patient-centric metrics and outcome scores. Level III: Retrospective comparative study.

  4. Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Unusual clinical presentations in an endemic region

    Directory of Open Access Journals (Sweden)

    Nurgul Ceran

    Full Text Available Brucellosis is a zoonotic infection and has endemic characteristics. Neurobrucellosis is an uncommon complication of this infection. The aim of this study was to present unusual clinical manifestations and to discuss the management and outcome of a series of 18 neurobrucellosis cases. Initial clinical manifestations consist of pseudotumor cerebri in one case, white matter lesions and demyelinating syndrome in three cases, intracranial granuloma in one case, transverse myelitis in two cases, sagittal sinus thrombosis in one case, spinal arachnoiditis in one case, intracranial vasculitis in one case, in addition to meningitis in all cases. Eleven patients were male and seven were female. The most prevalent symptoms were headache (83% and fever (44%. All patients were treated with rifampicin, doxycycline plus trimethoprim-sulfamethoxazole or ceftriaxone. Duration of treatment (varied 3-12 months was determined on basis of the CSF response. In four patients presented with left mild sequelae including aphasia, hearing loss, hemiparesis. In conclusion, although mortality is rare in neurobrucellosis, its sequelae are significant. In neurobrucellosis various clinical and neuroradiologic signs and symptoms can be confused with other neurologic diseases. In inhabitants or visitors of endemic areas, neurobrucellosis should be kept in mind in cases that have unusual neurological manifestations.

  5. Clinical profile and treatment outcome of febrile infection-related epilepsy syndrome in South Indian children

    Directory of Open Access Journals (Sweden)

    Sandeep B Patil

    2016-01-01

    Full Text Available Purpose: To describe the clinical features and outcome of febrile infection-related epilepsy syndrome (FIRES, a catastrophic epileptic encephalopathy, in a cohort of South Indian children. Materials and Methods: We performed a retrospective chart review of a cohort of children with previously normal development who presented with status epilepticus or encephalopathy with recurrent seizures following a nonspecific febrile illness during the period between January 2007 and January 2012. They were divided into two groups super refractory status epilepticus (SRSE and refractory status epilepticus (RSE depending on the duration and severity of the seizures. Key Findings: Fifteen children who met the inclusion criteria were included for the final analysis. The age of the children at presentation ranged 3-15 years (median 6.3 years. All the children presented with prolonged or recurrent seizures occurring 1-12 days (median 4 days after the onset of fever. Eight children had SRSE while seven children had refractory seizures with encephalopathy. Cerebrospinal fluid (CSF analysis was done in all the children in the acute phase, and the cell count ranged 0-12 cells/μL (median 2 cells/μL with normal sugar and protein levels. Initial neuroimaging done in all children (MRI in 10 and CT in 5, and it was normal in 13 children. Treatment modalities included multiple antiepileptic drugs (AEDs (4-9 drugs (median 5 drugs. Midazolam (MDZ infusion was administered in seven patients. Eight patients required barbiturate coma to suppress the seizure activity. The duration of the barbiturate coma ranged 2-90 days (median 3 days. Steroids were used in 14 children and intravenous immunoglobulin (2 g/kg in 7 children. Three children died in the acute phase. All children were maintained on multiple AEDs till the last follow-up, the number of AEDs ranged 1-6 (median 5 AEDs. The patients with super refractory status in the acute phase were found to be more severely disabled

  6. Recording an Excel(®) Macro to Specify Date Ranges for Clinical Data.

    Science.gov (United States)

    Deochand, Neil; Costello, Mack S; Fuqua, R Wayne

    2016-09-01

    The individuals served by behavior analysts are often funded by Medicaid, insurance companies, or private pay. The first two options usually require progress notes detailing graphically and quantitatively the behavioral outcomes. These progress notes usually come in the form of a written account of milestones achieved or barriers faced, graphical displays of behavioral data, and summary tables. The graphical displays are monthly, quarterly, and annual reports for the individuals that they serve. Microsoft Excel® is one of the most accessible tools by which to accomplish this task; however, presenting the required date ranges can be a time-consuming task. A task analysis is outlined to automate this process and reduce the time taken to accomplish indirect service hours to the clients served.

  7. Buffered Versus Non-Buffered Lidocaine With Epinephrine for Mandibular Nerve Block: Clinical Outcomes.

    Science.gov (United States)

    Phero, James A; Nelson, Blake; Davis, Bobby; Dunlop, Natalie; Phillips, Ceib; Reside, Glenn; Tikunov, Andrew P; White, Raymond P

    2017-04-01

    Outcomes for peak blood levels were assessed for buffered 2% lidocaine with 1:100,000 epinephrine compared with non-buffered 2% lidocaine with 1:100,000 epinephrine. In this institutional review board-approved prospective, randomized, double-blinded, crossover trial, the clinical impact of buffered 2% lidocaine with 1:100,000 epinephrine (Anutra Medical, Research Triangle Park, Cary, NC) was compared with the non-buffered drug. Venous blood samples for lidocaine were obtained 30 minutes after a mandibular nerve block with 80 mg of the buffered or unbuffered drug. Two weeks later, the same subjects were tested with the alternate drug combinations. Subjects also reported on pain on injection with a 10-point Likert-type scale and time to lower lip numbness. The explanatory variable was the drug formulation. Outcome variables were subjects' peak blood lidocaine levels, subjective responses to pain on injection, and time to lower lip numbness. Serum lidocaine levels were analyzed with liquid chromatography-mass spectrometry. Statistical analyses were performed using Proc TTEST (SAS 9.3; SAS Institute, Cary, NC), with the crossover option for a 2-period crossover design, to analyze the normally distributed outcome for pain. For non-normally distributed outcomes of blood lidocaine levels and time to lower lip numbness, an assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3). Statistical significance was set at a P value less than .05 for all outcomes. Forty-eight percent of subjects were women, half were Caucasian, 22% were African American, and 13% were Asian. Median age was 21 years (interquartile range [IQR], 20-22 yr), and median body weight was 147 lb (IQR, 130-170 lb). Median blood levels (44 blood samples) at 30 minutes were 1.19 μg/L per kilogram of body weight. Mean blood level differences of lidocaine for each patient were significantly lower after nerve block with the buffered drug compared with the

  8. clinical characteristics and outcome of patients with upper

    African Journals Online (AJOL)

    NSAIDs) may affect the incidence, age of presentation, site of bleeding and outcome of UGIB. NSAIDs cause gastrointestinal mucosa damage, ulceration and ulcer complication by the inhibition of endogenous prostaglandin synthesis.

  9. Multigenerational Challenges: Team-Building for Positive Clinical Workforce Outcomes

    Science.gov (United States)

    Moore, Jill M; Everly, Marcee; Bauer, Renee

    2016-05-31

    Patient acuity in hospital settings continues to increase, and there is greater emphasis on patient outcomes. The current nursing workforce is comprised of four distinct generational cohorts that include veterans, baby boomers, millennials, and generation Xers. Each group has unique characteristics that add complexity to the workforce and this can add challenges to providing optimal patient care. Team building is one strategy to increase mutual understanding, communication, and respect, and thus potentially improve patient outcomes. In this article, we first briefly define generational cohorts by characteristics, and discuss differing expectations for work/life balance and potential negative outcomes. Our discussion offers team building strategies for positive outcomes, a case scenario, and concludes with resources for team building and organizational opportunities.

  10. Clinical characteristics and abandonment and outcome of treatment in 67 Chinese children with medulloblastoma.

    Science.gov (United States)

    Wang, Chen; Yuan, Xiao-Jun; Jiang, Ma-Wei; Wang, Li-Feng

    2016-01-01

    OBJECT The purpose of this study was to explore the clinical features and outcome of medulloblastoma in Chinese children. The authors analyze the reasons that treatment is abandoned and attempt to provide evidence-based recommendations for improving the prognosis of medulloblastoma in this population. METHODS A total of 67 pediatric cases of newly diagnosed medulloblastoma were included in this study. All of the children were treated at Xinhua Hospital between January 2007 and June 2013. The authors retrospectively analyzed the clinical data, treatment modalities, and outcome. The male-to-female ratio was 2:1, and the patients' median age at diagnosis was 51.96 months (range 3.96-168.24 months). The median duration of follow-up was 32 months (range 3-70 months). RESULTS At the most recent follow-up date, 31 patients (46%) were alive, 30 (45%) had died, and 6 (9%) had been lost to follow-up. The estimated 3-year overall survival and progression-free survival, based on Kaplan-Meier analysis, were 55.1% ± 6.4% and 45.6% ± 6.7%, respectively. Univariate analysis showed that standard-risk group (p = 0.009), postoperative radiotherapy (RT) combined with chemotherapy (p medulloblastoma in Chinese children and the outcome in Western children. Based on our data, treatment abandonment was the major cause of therapeutic failure. Parents' misunderstanding of medulloblastoma played a major role in abandonment, followed by financial and transportation difficulties. Establishment of multidisciplinary treatment teams could improve the prognosis of medulloblastoma in Chinese children.

  11. Pain relief and clinical outcome: from opioids to balanced analgesia

    DEFF Research Database (Denmark)

    Kehlet, H

    1996-01-01

    If it is generally accepted that adequate postoperative pain relief will improve outcome from surgery, several controlled trials demonstrated this only for lower body surgical procedures with epidural and spinal anesthetics. Important effects on outcome were not shown when postoperative opioids...... were administered with patient controlled (PCA) or epidural techniques. However, the most optimal pain relief seems to be best achieved with balanced analgesia techniques using combinations of epidural opioids and local anesthetics and systemic non-steroidal antiinflammatory drugs. Future efforts...

  12. Clinical outcome of stand-alone ALIF compared to posterior instrumentation for degenerative disc disease

    DEFF Research Database (Denmark)

    Udby, Peter M.; Bech-Azeddine, Rachid

    2015-01-01

    advantages when using stand-alone ALIF on outcomes such as ODI, VAS, surgical time, blood loss and patient satisfaction. No study found stand-alone ALIF inferior in chosen outcomes including fusion. In conclusion the pilot study and the literature review, finds similar clinical outcomes and fusion rates...

  13. Clinical and functional outcome of the Thrust Plate Prosthesis: short- and medium-term results.

    Science.gov (United States)

    Steens, W; Rosenbaum, D; Goetze, C; Gosheger, G; van den Daele, R; Steinbeck, J

    2003-08-01

    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.

  14. Clinical outcomes among febrile children aged 2 to 59 months with ...

    African Journals Online (AJOL)

    Through a prospective cohort study designed to investigate clinical outcomes of children treated at the community level, we followed, for 7 days, children aged 2 to 59 months, who had negative mRDT results and were treated with antipyretic medication. Clinical outcomes were assessed on days 3 and 7 post-recruitment.

  15. 77 FR 66848 - Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and...

    Science.gov (United States)

    2012-11-07

    ... HUMAN SERVICES Food and Drug Administration Minimum Clinically Important Difference: An Outcome Metric... the following public workshop entitled ``Minimum Clinically Important Difference: An Outcome Metric in... number of participants from each organization. If time and space permits, onsite registration on Day 1 of...

  16. Beta-blocker use and clinical outcomes after primary vascular surgery

    DEFF Research Database (Denmark)

    Høgh, A.; Lindholt, J.S.; Nielsen, Henrik

    2013-01-01

    To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction.......To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction....

  17. 42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...

    Science.gov (United States)

    2010-10-01

    ... this section for intestine, combined liver-intestine or multivisceral transplants performed at the..., clinical experience, and outcome requirements for initial approval of transplant centers. 482.80 Section... Hospitals Transplant Center Data Submission, Clinical Experience, and Outcome Requirements § 482.80...

  18. Acquired uterine vascular malformations: radiological and clinical outcome after transcatheter embolotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Maleux, Geert; Heye, Sam; Wilms, Guy [University Hospitals Gasthuisberg, Department of Radiology, Leuven (Belgium); Timmerman, Dirk [University Hospitals Gasthuisberg, Department of Obstetrics and Gynecology, Leuven (Belgium)

    2006-02-01

    The purpose of this retrospective study is to assess the radiological and clinical outcome of transcatheter embolization of acquired uterine vascular malformations in patients presenting with secondary postpartum or postabortion vaginal hemorrhage. In a cohort of 17 patients (mean age: 29.7 years; standard deviation: 4.23; range: 25-38 years) 18 embolization procedures were performed. Angiography demonstrated a uterine parenchymal hyperemia with normal drainage into the large pelvic veins (''low-flow uterine vascular malformation'') in 83% (n=15) or a direct arteriovenous fistula (''high-flow uterine vascular malformation'') in 17% (n=3). Clinically, in all patients the bleeding stopped after embolization but in 1 patient early recurrence of hemorrhage occurred and was treated by hysterectomy. Pathological analysis revealed a choriocarcinoma. During follow-up (mean time period: 18.8 months; range: 1-36 months) 6 patients became pregnant and delivered a healthy child. Transcatheter embolization of the uterine arteries, using microparticles, is safe and highly effective in the treatment of a bleeding acquired uterine vascular malformation. In case of clinical failure, an underlying neoplastic disease should be considered. Future pregnancy is still possible after embolization. (orig.)

  19. Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease.

    Science.gov (United States)

    Mitting, Rebecca; Marino, Luise; Macrae, Duncan; Shastri, Nitin; Meyer, Rosan; Pathan, Nazima

    2015-06-01

    Poor growth is a common complication in infants with congenital heart disease. There has been much focus on low birth weight as having increased risk of adverse outcomes following neonatal heart surgery. In this study, we examined whether preoperative nutritional status, measured by admission weight-for-age z score, was associated with postoperative clinical outcome. Retrospective case series. Pediatric Cardiac ICU at the Royal Brompton Hospital. Neonates undergoing surgery for congenital heart disease. Those undergoing ductus arteriosus ligation alone were excluded. Children with coexisting noncardiac morbidity were excluded. Outcome variables included prevalence of postoperative complications (including sepsis, delayed chest closure, renal impairment, and necrotizing enterocolitis), duration of ventilation, intensive care stay, postoperative mortality, and mortality at 1 year after surgery. None. Analysis of patient data only. Two hundred forty-eight neonates fulfilled the entry criteria. Median (interquartile range) age was 7 days (2-15 d), median (interquartile range) weight was 3.3 kg (2.91-3.6 kg), and median weight-for-age z score was -0.77 (-1.44 to 0.01). Twenty-eight children (11%) had a weight-for-age z score of less than -2. There was no evidence that children with lower weight-for-age z score had less severe surgery as measured by the Risk Adjustment for Congenital Heart Surgery 1 score. In multivariable regression analysis, the weight-for-age z at admission had strong correlation with the number of days free of respiratory support (invasive and noninvasive ventilation) at 28 days (p nutritional status as measured by weight-for-age z is associated with adverse short- and long-term outcomes in neonates undergoing surgery for congenital heart disease.

  20. Posterolateral corner reconstruction of the knee: evaluation of a technique with clinical outcomes and stress radiography.

    Science.gov (United States)

    Rios, Clifford G; Leger, Robin R; Cote, Mark P; Yang, Clifford; Arciero, Robert A

    2010-08-01

    Injuries to the posterolateral corner of the knee remain a challenging problem and have been cited frequently as a reason for failure of anterior and posterior cruciate ligament reconstructions. Although several reconstructive techniques currently exist, there are relatively few clinical outcomes data after reconstruction of the posterolateral corner. The study was undertaken to examine the clinical outcomes and provide objective data using arthrometry and stress radiography of a posterolateral corner reconstruction technique. Case series; Level of evidence, 4. A retrospective cohort study of a consecutive series of patients who underwent posterolateral corner reconstruction of the knee was evaluated. The surgery featured dual femoral tunnels, a transfibular tunnel, and a free graft to reconstruct the posterolateral corner of the knee. All patients had concomitant reconstruction of one or both cruciate ligaments. Outcomes were assessed using the Short Form-12, Lysholm, and Tegner knee scores. A clinical examination, KT-2000 arthrometry measurements, single-legged hop quotient, and varus and posterior Telos stress radiographs were obtained and compared with results for the contralateral, uninjured knees. Twenty-four (83%) of 29 consecutive patients were evaluated at a mean 39 months postoperatively (range, 24-81 months). The mean Lysholm and Tegner knee scores were 83 and 6, respectively. The mean difference (+/- standard deviation) in total anterior-posterior side-to-side KT arthrometry measurements was 1.4 +/- 1.3 mm. The varus stress radiographic mean side-to-side difference measured at 20 degrees of flexion was 0.2 +/- 1.9 mm. The mean radiographic posterior tibial displacement with a 15-kg stress at 90 degrees of flexion was 3.2 +/- 4.5 mm in patients undergoing posterior cruciate ligament reconstruction. This reconstruction of the posterolateral corner of the knee with concomitant cruciate ligament reconstruction restores varus and rotational stability at a

  1. Reporting clinical outcomes of breast reconstruction: a systematic review.

    Science.gov (United States)

    Potter, S; Brigic, A; Whiting, P F; Cawthorn, S J; Avery, K N L; Donovan, J L; Blazeby, J M

    2011-01-05

    Breast reconstruction after mastectomy for cancer requires accurate evaluation to inform evidence-based participatory decision making, but the standards of outcome reporting after breast reconstruction have not previously been considered. We used extensive searches to identify articles reporting surgical outcomes of breast reconstruction. We extracted data using published criteria for complication reporting modified to reflect reconstructive practice. Study designs included randomized controlled trials, cohort studies, and case series. The Cochrane Risk of Bias tool was used to critically appraise all study designs. Other criteria used to assess the studies were selection and funding bias, statistical power calculations, and institutional review board approval. Wilcoxon signed rank tests were used to compare the breadth and frequency of study outcomes, and χ² tests were used to compare the number of studies in each group reporting each of the published criteria. All statistical tests were two-sided. Surgical complications following breast reconstruction in 42,146 women were evaluated in 134 studies. These included 11 (8.2%) randomized trials, 74 (55.2%) cohort studies, and 49 (36.6%) case series. Fifty-three percent of studies demonstrated a disparity between methods and results in the numbers of complications reported. Complications were defined by 87 (64.9%) studies and graded by 78 (58.2%). Details such as the duration of follow-up and risk factors for adverse outcomes were omitted from 47 (35.1%) and 58 (43.3%) studies, respectively. Overall, the studies defined fewer than 20% of the complications they reported, and the definitions were largely inconsistent. The results of this systematic review suggest that outcome reporting in breast reconstruction is inconsistent and lacks methodological rigor. The development of a standardized core outcome set is recommended to improve outcome reporting in breast reconstruction.

  2. Clinical disease and laboratory abnormalities in free-ranging desert tortoises in California (1990-1995)

    Science.gov (United States)

    Christopher, Mary M.; Berry, Kristin H.; Henen, Brian T.; Nagy, Kenneth A.

    2003-01-01

    Desert tortoise (Gopherus agassizii) populations have experienced precipitous declines resulting from the cumulative impact of habitat loss and human and disease-related mortality. Diagnosis of disease in live, free-ranging tortoises is facilitated by evaluation of clinical signs and laboratory test results but may be complicated by seasonal and environmental effects. The goals of this study were: 1) to describe and monitor clinical and laboratory signs of disease in adult, free-ranging desert tortoises at three sites in the Mojave Desert of California (USA) between October 1990 and October 1995; 2) to evaluate associations between clinical signs and hematologic, biochemical, serologic, and microbiologic test results; 3) to characterize disease patterns by site, season, and sex; and 4) to assess the utility of diagnostic tests in predicting morbidity and mortality. Venous blood samples were obtained four times per year from tortoises of both sexes at the Desert Tortoise Research Natural Area (DTNA), Goffs/Fenner Valley, and Ivanpah Valley. Tortoises were given a physical examination, and clinical abnormalities were graded by type and severity. Of 108 tortoises, 68.5% had clinical signs of upper respiratory tract disease consistent with mycoplasmosis at least once during the study period. In addition, 48.1% developed moderate to severe shell lesions consistent with cutaneous dyskeratosis. Ulcerated or plaque-like oral lesions were noted on single occasions in 23% of tortoises at Goffs and 6% of tortoises at Ivanpah. Tortoises with oral lesions were significantly more likely than tortoises without lesions to have positive nasal cultures for Mycoplasma agassizii(P=0.001) and to be dehydrated (P=0.0007). Nine tortoises had marked azotemia (blood urea nitrogen [BUN] >100 mg/dl) or persistent azotemia (BUN 63–76 mg/dl); four of these died, three of which had necropsy confirmation of urinary tract disease. Laboratory tests had low sensitivity but high specificity in

  3. Hematology and serum clinical chemistry reference intervals for free-ranging Scandinavian gray wolves (Canis lupus).

    Science.gov (United States)

    Thoresen, Stein I; Arnemo, Jon M; Liberg, Olof

    2009-06-01

    Scandinavian free-ranging wolves (Canis lupus) are endangered, such that laboratory data to assess their health status is increasingly important. Although wolves have been studied for decades, most biological information comes from captive animals. The objective of the present study was to establish reference intervals for 30 clinical chemical and 8 hematologic analytes in Scandinavian free-ranging wolves. All wolves were tracked and chemically immobilized from a helicopter before examination and blood sampling in the winter of 7 consecutive years (1998-2004). Seventy-nine blood samples were collected from 57 gray wolves, including 24 juveniles (24 samples), 17 adult females (25 samples), and 16 adult males (30 samples). Whole blood and serum samples were stored at refrigeration temperature for 1-3 days before hematologic analyses and for 1-5 days before serum biochemical analyses. Reference intervals were calculated as 95% confidence intervals except for juveniles where the minimum and maximum values were used. Significant differences were observed between adult and juvenile wolves for RBC parameters, alkaline phosphatase and amylase activities, and total protein, albumin, gamma-globulins, cholesterol, creatinine, calcium, chloride, magnesium, phosphate, and sodium concentrations. Compared with published reference values for captive wolves, reference intervals for free-ranging wolves reflected exercise activity associated with capture (higher creatine kinase activity, higher glucose concentration), and differences in nutritional status (higher urea concentration).

  4. Early clinical outcome and complications related to balloon kyphoplasty

    Directory of Open Access Journals (Sweden)

    Martin Bergmann

    2012-06-01

    Full Text Available The treatment of painful osteoporotic vertebral compression fractures using transpedicular cement augmentation has grown significantly over the last two decades. The benefits of balloon kyphoplasty compared to conservative treatment remain controversial and are discussed in the literature. The complication rates of vertebroplasty and kyphoplasty are considered to be low. The focus of this study was the analysis of acute and clinically relevant complications related to this procedure. In our department, all patients treated between February 2002 and February 2011 with percutaneous cement augmentation (372 patients, 522 augmented vertebral bodies were prospectively recorded. Demographic data, comorbidities, fracture types, intraoperative data and all complications were documented. The pre- and postoperative pain-level and neurological status (Frankel-Score were evaluated. All patients underwent a standardized surgical procedure. Two hundred and ninety-seven patients were treated solely by balloon kyphoplasty; 216 females (72.7% and 81 males (27.3%. Average patient age was 76.21 years (±10.71, range 35-98 years. Average American Society Anestesiologists score was 3.02. According to the Orthopedic Trauma Association classification, there were 69 A 1.1 fractures, 177 A 1.2 fractures, 178 A 3.1.1 fractures and 3 A 3.1.3 fractures. Complications were divided into preoperative, intraoperative and postoperative events. There were 4 pre-operative complications: 3 patients experienced persistent pain after the procedure. In one case, the pedicles could not be visualized during the procedure and the surgery was terminated. One hundred and twenty-nine (40.06% of the patients showed intraoperative cement leaking outside the vertebras, one severe hypotension and tachycardia as reaction to the inflation of the balloons, and there was one cardiac arrest during surgery. Postoperative subcutaneous hematomas were observed in 3 cases, 13 patients developed a

  5. Comprehensive reference ranges for hematology and clinical chemistry laboratory parameters derived from normal Nigerian adults.

    Science.gov (United States)

    Miri-Dashe, Timzing; Osawe, Sophia; Tokdung, Monday; Daniel, Monday Tokdung Nenbammun; Daniel, Nenbammun; Choji, Rahila Pam; Mamman, Ille; Deme, Kurt; Damulak, Dapus; Abimiku, Alash'le

    2014-01-01

    Interpretation of laboratory test results with appropriate diagnostic accuracy requires reference or cutoff values. This study is a comprehensive determination of reference values for hematology and clinical chemistry in apparently healthy voluntary non-remunerated blood donors and pregnant women. Consented clients were clinically screened and counseled before testing for HIV, Hepatitis B, Hepatitis C and Syphilis. Standard national blood donors' questionnaire was administered to consented blood donors. Blood from qualified volunteers was used for measurement of complete hematology and chemistry parameters. Blood samples were analyzed from a total of 383 participants, 124 (32.4%) males, 125 (32.6%) non-pregnant females and 134 pregnant females (35.2%) with a mean age of 31 years. Our results showed that the red blood cells count (RBC), Hemoglobin (HB) and Hematocrit (HCT) had significant gender difference (p = 0.000) but not for total white blood count (p>0.05) which was only significantly higher in pregnant verses non-pregnant women (p = 0.000). Hemoglobin and Hematocrit values were lower in pregnancy (P = 0.000). Platelets were significantly higher in females than men (p = 0.001) but lower in pregnant women (p =  .001) with marked difference in gestational period. For clinical chemistry parameters, there was no significant difference for sodium, potassium and chloride (p>0.05) but gender difference exists for Bicarbonate (HCO3), Urea nitrogen, Creatinine as well as the lipids (p0.05). Hematological and Clinical Chemistry reference ranges established in this study showed significant gender differences. Pregnant women also differed from non-pregnant females and during pregnancy. This is the first of such comprehensive study to establish reference values among adult Nigerians and difference observed underscore the need to establish reference values for different populations.

  6. Comprehensive reference ranges for hematology and clinical chemistry laboratory parameters derived from normal Nigerian adults.

    Directory of Open Access Journals (Sweden)

    Timzing Miri-Dashe

    Full Text Available BACKGROUND: Interpretation of laboratory test results with appropriate diagnostic accuracy requires reference or cutoff values. This study is a comprehensive determination of reference values for hematology and clinical chemistry in apparently healthy voluntary non-remunerated blood donors and pregnant women. METHODS AND FINDINGS: Consented clients were clinically screened and counseled before testing for HIV, Hepatitis B, Hepatitis C and Syphilis. Standard national blood donors' questionnaire was administered to consented blood donors. Blood from qualified volunteers was used for measurement of complete hematology and chemistry parameters. Blood samples were analyzed from a total of 383 participants, 124 (32.4% males, 125 (32.6% non-pregnant females and 134 pregnant females (35.2% with a mean age of 31 years. Our results showed that the red blood cells count (RBC, Hemoglobin (HB and Hematocrit (HCT had significant gender difference (p = 0.000 but not for total white blood count (p>0.05 which was only significantly higher in pregnant verses non-pregnant women (p = 0.000. Hemoglobin and Hematocrit values were lower in pregnancy (P = 0.000. Platelets were significantly higher in females than men (p = 0.001 but lower in pregnant women (p =  .001 with marked difference in gestational period. For clinical chemistry parameters, there was no significant difference for sodium, potassium and chloride (p>0.05 but gender difference exists for Bicarbonate (HCO3, Urea nitrogen, Creatinine as well as the lipids (p0.05. CONCLUSIONS: Hematological and Clinical Chemistry reference ranges established in this study showed significant gender differences. Pregnant women also differed from non-pregnant females and during pregnancy. This is the first of such comprehensive study to establish reference values among adult Nigerians and difference observed underscore the need to establish reference values for different populations.

  7. The association between glycemic control and clinical outcomes after kidney transplantation.

    Science.gov (United States)

    Ramirez, Sofronio C; Maaske, Jill; Kim, Yoojin; Neagu, Valeriu; DeLange, Susan; Mazhari, Alaleh; Gao, Weihua; Emanuele, Mary Ann; Emanuele, Nicholas; Baldwin, David; Mihailescu, Dan V

    2014-09-01

    To analyze the relationship between glycemic control after renal transplantation and subsequent graft function and complications. We conducted a retrospective chart review of 202 consecutive patients undergoing kidney transplantation to analyze the association between perioperative and chronic glycemic control and clinical outcomes of rejection, infection, and hospital readmission during the first year after kidney transplantation. Mean in-hospital blood glucose (BG) was 157 ± 34.5 mg/dL. Mean hemoglobin A1c (HbA1c) during the first 12 months posttransplantation was 6.84 ± 1.46%. Fiftyfour patients (27%) were treated for acute or chronic rejection, 88 (44%) for infection, and 149 (74%) patients were readmitted at least once within the first year after transplantation. There were no significant differences in the risks for rejection, infection, or readmission across the 5 mean initial inpatient BG or subsequent HbA1c quintiles. In addition, there was no significant relationship between the percentage of BG measurements that fell in the "tight control" range of 80 to 110 mg/dL for each patient and any of the outcomes. We did not find an association between glycemic control (perioperative or chronic) and the outcomes of graft rejection, infection, or hospital readmission in the first 12 months after renal transplantation. Our results suggest that "near normal" glycemic targets are not necessary for managing hyperglycemia after renal transplantation.

  8. Left Ventricular Function and Clinical Outcome among Patients with ...

    African Journals Online (AJOL)

    failure Subjects: Sixty four consecutive patients with provisional diagnosis of peripartum cardiomyopathy who were referred to a cardiac clinic at Hindu Mandal Hospital. Interventions: A detailed past and present medical history, clinical examination as well as echocardiographic evaluation were performed. After initiating ...

  9. The clinical outcome of lateral mass fixation after decompressive ...

    African Journals Online (AJOL)

    Ahmed Yehya

    2014-10-11

    Oct 11, 2014 ... pain and brachialgia. In group I, neck pain improved in 68.8% and brachialgia improved in 83.3% but in group II, neck pain improved in 46.7% and brachialgia improved in 61.5%. Myelopathy and sphincteric disturbance showed clinical improvement but without clinically significant difference of both groups.

  10. The development of a clinical outcomes survey research application: Assessment Center.

    Science.gov (United States)

    Gershon, Richard; Rothrock, Nan E; Hanrahan, Rachel T; Jansky, Liz J; Harniss, Mark; Riley, William

    2010-06-01

    The National Institutes of Health sponsored Patient-Reported Outcome Measurement Information System (PROMIS) aimed to create item banks and computerized adaptive tests (CATs) across multiple domains for individuals with a range of chronic diseases. Web-based software was created to enable a researcher to create study-specific Websites that could administer PROMIS CATs and other instruments to research participants or clinical samples. This paper outlines the process used to develop a user-friendly, free, Web-based resource (Assessment Center) for storage, retrieval, organization, sharing, and administration of patient-reported outcomes (PRO) instruments. Joint Application Design (JAD) sessions were conducted with representatives from numerous institutions in order to supply a general wish list of features. Use Cases were then written to ensure that end user expectations matched programmer specifications. Program development included daily programmer "scrum" sessions, weekly Usability Acceptability Testing (UAT) and continuous Quality Assurance (QA) activities pre- and post-release. Assessment Center includes features that promote instrument development including item histories, data management, and storage of statistical analysis results. This case study of software development highlights the collection and incorporation of user input throughout the development process. Potential future applications of Assessment Center in clinical research are discussed.

  11. The development of a clinical outcomes survey research application: Assessment CenterSM

    Science.gov (United States)

    Rothrock, Nan E.; Hanrahan, Rachel T.; Jansky, Liz J.; Harniss, Mark; Riley, William

    2013-01-01

    Introduction The National Institutes of Health sponsored Patient-Reported Outcome Measurement Information System (PROMIS) aimed to create item banks and computerized adaptive tests (CATs) across multiple domains for individuals with a range of chronic diseases. Purpose Web-based software was created to enable a researcher to create study-specific Websites that could administer PROMIS CATs and other instruments to research participants or clinical samples. This paper outlines the process used to develop a user-friendly, free, Web-based resource (Assessment CenterSM) for storage, retrieval, organization, sharing, and administration of patient-reported outcomes (PRO) instruments. Methods Joint Application Design (JAD) sessions were conducted with representatives from numerous institutions in order to supply a general wish list of features. Use Cases were then written to ensure that end user expectations matched programmer specifications. Program development included daily programmer “scrum” sessions, weekly Usability Acceptability Testing (UAT) and continuous Quality Assurance (QA) activities pre- and post-release. Results Assessment Center includes features that promote instrument development including item histories, data management, and storage of statistical analysis results. Conclusions This case study of software development highlights the collection and incorporation of user input throughout the development process. Potential future applications of Assessment Center in clinical research are discussed. PMID:20306332

  12. MRI for appendicitis in pregnancy: is seeing believing? clinical outcomes in cases of appendix nonvisualization.

    Science.gov (United States)

    Al-Katib, Sayf; Sokhandon, Farnoosh; Farah, Michael

    2016-12-01

    The primary objective of this study was to determine the clinical outcomes in cases of appendix nonvisualization with MRI in pregnant patients with suspected appendicitis and the implications of appendix nonvisualization for excluding appendicitis. Fifty-eight pregnant patients with suspected appendicitis evaluated with MRI at three centers from a single institution were retrospectively reviewed by three radiologists with varying levels of abdominal imaging experience. All scans were performed on a 1.5-Tesla Siemens unit. Cases were evaluated for diagnostic quality, visualization of the appendix, presence of appendicitis, and alternate diagnoses. Clinical outcomes were gathered from the electronic medical record. Of the 58 patients who underwent MRI for suspected appendicitis, 50 cases were considered adequate diagnostic quality by all three radiologists. The rate of appendix visualization among the three radiologists ranged from 60 to 76% (p = 0.44). The appendix was nonvisualized by at least one of the three radiologists in 25 cases (50%). Of these, none had a final diagnosis of appendicitis including one patient who underwent appendectomy. MRI suggested an alternate diagnosis in 6 (24%) patients with appendix nonvisualization. For the three reviewers, the agreement level on whether or not the appendix was visualized on the MRI had a Light's kappa value of 0.526, indicating a "moderate" level of agreement (p value appendicitis confers a significant reduction in the risk of appendicitis compared to all comers as long as the study is adequate diagnostic quality and there are no secondary signs of appendicitis present.

  13. Outcome measures and psychomotor skills related to shoulder conditions for clinical orthopedic training.

    Science.gov (United States)

    Mahomed, Surreya; Al-Obaidi, Saud; Al-Zoabi, Baker

    2008-01-01

    This study was designed to assess the ability of physical therapy (PT) students to utilize selected outcome measures such as range of motion (ROM), pain and a number of psychomotor skills and to determine the efficacy of treatment they carried out during orthopedic clinical training. The clinical education booklets in orthopedics of all PT students over a 6-year period were reviewed. Students' application of psychomotor skills such as peripheral joint mobilizations (PJM), proprioceptive neuromuscular facilitation (PNF) techniques, therapeutic exercise techniques as well as utilization of basic outcome measures such as ROM and pain were analyzed with descriptive statistics and paired t test. A majority of students used PJM techniques (78.6%) and PNF techniques (58.6%). The paired t test indicated that treatment interventions used by the students were associated with improved shoulder joint ROM and decreased pain levels (p < 0.001). At the same time, therapeutic exercises were employed by the students after PJM and PNF. The most common 'comparable joint sign' was limitation in shoulder abduction ROM, which occurred in 44% of patients seen by the students. PT students' application of PJM, PNF, and therapeutic exercise improved ROM and decreased pain in patients with shoulder pathologies. (c) 2008 S. Karger AG, Basel.

  14. Disorganization at the stage of schizophrenia clinical outcome: Clinical-biological study.

    Science.gov (United States)

    Nestsiarovich, A; Obyedkov, V; Kandratsenka, H; Siniauskaya, M; Goloenko, I; Waszkiewicz, N

    2017-05-01

    According to the multidimensional model of schizophrenia, three basic psychopathological dimensions constitute its clinical structure: positive symptoms, negative symptoms and disorganization. The latter one is the newest and the least studied. Our aim was to discriminate disorganization in schizophrenia clinical picture and to identify its distinctive biological and socio-psychological particularities and associated genetic and environmental factors. We used SAPS/SANS psychometrical scales, scales for the assessment of patient's compliance, insight, social functioning, life quality. Neuropsychological tests included Wisconsin Card Sorting Test (WCST), Stroop Color-Word test. Neurophysiological examination included registration of P300 wave of the evoked cognitive auditory potentials. Environmental factors related to patient's education, family, surrounding and nicotine use, as well as subjectively significant traumatic events in childhood and adolescence were assessed. Using PCR we detected SNP of genes related to the systems of neurotransmission (COMT, SLC6A4 and DRD2), inflammatory response (IL6, TNF), cellular detoxification (GSTM1, GSTT1), DNA methylation (MTHFR, DNMT3b, DNMT1). Disorganization is associated with early schizophrenia onset and history of psychosis in family, low level of insight and compliance, high risk of committing delicts, distraction errors in WCST, lengthened P300 latency of evoked cognitive auditory potentials, low-functional alleles of genes MTHFR (rs1801133) and DNMT3b (rs2424913), high level of urbanicity and psychotraumatic events at early age. Severe disorganization at the stage of schizophrenia clinical outcome is associated with the set of specific biological and social-psychological characteristics that indicate its epigenetic nature and maladaptive social significance. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome

    Directory of Open Access Journals (Sweden)

    Jensen Gunnar

    2011-01-01

    Full Text Available Abstract Background Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units. Methods We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA, which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score were analysed with a regression model. Results The sample comprised 192 adolescents admitted during one year (response rate 87%. Mean age was 15.7 years (range 10-18 and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4. The largest groups of main diagnostic conditions were affective (28% and externalizing (26% disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement in the HoNOSCA total score was 5.1 (SD 6.2, with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission

  16. Clinical characteristics and outcomes of acquired hemophilia A: experience at a single center in Japan.

    Science.gov (United States)

    Ogawa, Yoshiyuki; Yanagisawa, Kunio; Uchiumi, Hideki; Ishizaki, Takuma; Mitsui, Takeki; Gouda, Fumito; Ieko, Masahiro; Ichinose, Akitada; Nojima, Yoshihisa; Handa, Hiroshi

    2017-07-01

    Acquired hemophilia A (AHA), which is caused by autoantibodies against coagulation factor VIII (FVIII) is a rare, life-threatening bleeding disorder, the incidence of which appears to be increasing in Japan as the population ages. However, the clinical characteristics, treatment, and outcomes of AHA remain difficult to establish due to the rarity of this disease. We retrospectively analyzed data from 25 patients (median age 73 years; range 24-92 years; male n = 15) diagnosed with AHA between 1999 and 2015 at Gunma University Hospital. We identified autoimmune diseases and malignancy as underlying conditions in four and three patients, respectively. Factor VIII activity was significantly decreased in all patients (median 2.0%; range <1.0-8.0) by FVIII inhibitor (median 47.0 BU/mL; range 2.0-1010). Among 71 bleeding events, subcutaneous or intramuscular hemorrhage was the most prevalent. Seventeen patients required bypassing agents. Twenty-two (91.7%) of 24 patients treated with immunosuppressive agents achieved complete response (CR) during a median of 57.5 days (range 19-714 days). Although three patients (12%) relapsed and seven (28%) died of infection, none of the deaths were related to bleeding. Although most of our patients achieved CR after immunosuppressive therapy, the rate of infection-related mortality was unsatisfactorily high.

  17. Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: a systematic review.

    Science.gov (United States)

    Chiapasco, Matteo; Zaniboni, Marco

    2009-09-01

    To analyze the clinical outcomes of endosseous implants following guided bone regeneration (GBR) procedures to correct dehiscence/fenestration defects associated with implant placement. METHODS/SEARCH STRATEGY: A Medline search was performed for human studies published in English focusing on GBR procedures for the correction of dehiscence/fenestration defects associated with the placement of screw-shaped titanium implants. The selected studies had to include at least 10 consecutively treated patients with a minimum follow-up of 12 months after the start of prosthetic loading. The clinical outcomes in terms of the complication rate of the GBR procedure, implant survival, and stability of marginal soft tissues around implants were evaluated. Seven publications were included in this review. A total of 238 patients received 374 implants. Defects were treated with resorbable or non-resorbable membranes, in association with or without graft materials. Patients were followed for 1-10 years after the start of prosthetic loading. In the postoperative period, 20% of the non-resorbable membranes and 5% of the resorbable ones underwent exposure/infection. However, in the majority of cases, a complete or an almost complete coverage of the initial defect was obtained. The overall survival rate of implants, irrespective of the type of membrane and grafting materials, was 95.7% (range: 84.7-100%). No significant modifications of probing depth and/or variation of clinical attachment level around implants were observed during the follow-up period. Despite the favorable results obtained, it was difficult to draw a significant conclusion as far as the more reliable grafting material and membrane barrier for the correction of dehiscence/fenestration defects are concerned, due to the limited sample of patients and the wide variety of grafting materials and membranes, used alone or in combination. Moreover, due to the lack of randomized clinical trials, it was impossible to demonstrate

  18. Clinical outcomes of percutaneous plasma disc coagulation therapy for lumbar herniated disc diseases.

    Science.gov (United States)

    Kim, Sang Hyun; Kim, Sung Chul; Cho, Ki Hong

    2012-01-01

    This is prospective study of clinical outcomes of percutaneous plasma disc coagulation Therapy (PDCT) in patients with herniated lumbar disc disease (HLD) to evaluate the safety and efficacy in its clinical application and usefulness as a reliable alternative to microscopic discectomy. Forty-six patients were enrolled in this study from April 2006 to June 2010. All patients had one-level HLD. Disc degeneration was graded on routine T2-weighted magnetic resonance Image (MRI) using the Pfirrmann's grading system and all index levels were grade 3 and grade 4. Indications for surgery were radiculopathy caused by disc protrusion with soft consistency. MRI was done at one month after the procedure in all patients to check post-PDCT change. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. This study was approved by the Institutional Review Board of our institution. The age of the study population ranged from 16 to 59 years with a mean age of 37.2 years. There were 29 males and 17 females in this study. The mean period of clinical follow-up was 21 months. The average preoperative VAS score for radiculopathy was 7.4±1.4, while the final follow-up VAS score was 1.4±0.7 (p<0.001). In MacNab's criteria, 41 patients (89.1%) had achieved favorable improvement (excellent and good) until later follow-up. There were one patient from infection and two patients who needed to convert to open discectomy. PDCT is a safe and efficient treatment modality in a selective patient with HLD.

  19. Clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion in primary versus revision surgery

    OpenAIRE

    Hentenaar, B.; Spoor, A. B.; Malefijt, J. de Waal; Diekerhof, C. H.; den Oudsten, B. L.

    2016-01-01

    Purpose The aim of this study is to compare the clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion (MI-PLIF) in revision and primary cases. Methods In a retrospective study, we compared the clinical and radiological results of MI-PLIF for lytic spondylolisthesis (n?=?28) and recurrent radiculopathy after herniated disc surgery (n?=?28). Clinical outcome was assessed using the visual analogue score (VAS) and Oswestry Disability Index (ODI). Quality of lif...

  20. ORIGINAL ARTICLES Clinical predictors of outcome in acute upper ...

    African Journals Online (AJOL)

    transfusion; and (ii) alive within 1 month of initial presentation. Patients were followed up at 1 month after hospital discharge. Blood transfusion was taken to be a poor-outcome event because of the laboratory, medical and nursing expertise required in its administration, as well as being an indicator of significant bleeding.

  1. Clinical presentations and outcome of severe community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Mousa Elshamly

    2016-10-01

    Conclusion: SCAP occurs more frequently in those with comorbidities. The most frequent isolated causative organism of SCAP is S. pneumoniae, Influenza H1N1 and S. aureus. SCAP is associated with significant mortality, early recognition and prompt treatment may improve outcome.

  2. Immunologic and clinical outcomes of children on HAART: A ...

    African Journals Online (AJOL)

    BACKGROUND: The nature of human immunodeficiency virus infection in children has changed from an often fatal to a treatable chronic condition with highly active antiretroviral therapy. The outcome of the therapy depends on multiple factors such as non-adherence to treatment, selection of resistant viral strains, drug ...

  3. Clinical Outcomes after Open Locked Intramedullary Nailing of ...

    African Journals Online (AJOL)

    2017-12-05

    Dec 5, 2017 ... Background: Femoral shaft fractures are common injuries in adults. Closed locked intramedullary nailing is the recommended treatment for femoral shaft fractures due to its high union rate. Objective: The objective of this study is to determine the outcome of management of closed femoral shaft fractures in ...

  4. Clinical predictors of outcome in patients with inflammatory dilated cardiomyopathy.

    Directory of Open Access Journals (Sweden)

    Konstantinos Karatolios

    Full Text Available The study objectives were to identify predictors of outcome in patients with inflammatory dilated cardiomyopathy (DCMi.From 2004 to 2008, 55 patients with biopsy-proven DCMi were identified and followed up for 58.2±19.8 months. Predictors of outcome were identified in a multivariable analysis with a Cox proportional hazards analysis. The primary endpoint was a composite of death, heart transplantation and hospitalization for heart failure or ventricular arrhythmias.For the primary endpoint, a QTc interval >440msec (HR 2.84; 95% CI 1.03-7.87; p = 0.044, a glomerular filtration rate (GFR 440msec, a GFR<60ml/min/1.73m2 and worsening of NYHA classification during follow-up were univariate predictors of adverse prognosis. In contrast, NYHA classification at baseline, left ventricular ejection fraction, atrial fibrillation, treatment with digitalis or viral genome detection were not related to outcome. After multivariable analysis, a GFR <60ml/min/1.73m2 remained independently associated with adverse outcome.

  5. Factors determining clinical outcomes in intussusception in the ...

    African Journals Online (AJOL)

    The DOS positively predicted a poorer outcome. The positive correlation between CRP levels and DOS was significant. Seven patients required a relook laparotomy after their initial procedure, the most common indication being abdominal compartment syndrome (ACS) (n=3). Sheath dehiscence occurred in 2 cases and an.

  6. ORIGINAL ARTICLES Clinical predictors of outcome in acute upper ...

    African Journals Online (AJOL)

    large areas of South Africa where endoscopy is not readily available. Ideally, to ... be a poor-outcome event because of the laboratory, medical and nursing expertise ... admitted to the Emergency Unit with a diagnosis of haemate- mesis and/or ...

  7. Trend in admissions, clinical features and outcome of preeclampsia ...

    African Journals Online (AJOL)

    Introduction: Hypertensive disorders in pregnancy (HDP) are a major cause of maternal morbidity and mortality. We aimed at determining the trends in admission, profiles and outcomes of women admitted for preeclampsia and eclampsia to an intensive care unit (ICU) in Cameroon. Methods: A retrospective study involving ...

  8. Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity.

    Science.gov (United States)

    Gajdosik, R L; Bohannon, R W

    1987-12-01

    Clinical measurement of range of motion is a fundamental evaluation procedure with ubiquitous application in physical therapy. Objective measurements of ROM and correct interpretation of the measurement results can have a substantial impact on the development of the scientific basis of therapeutic interventions. The purpose of this article is to review the related literature on the reliability and validity of goniometric measurements of the extremities. Special emphasis is placed on how the reliability of goniometry is influenced by instrumentation and procedures, differences among joint actions and body regions, passive versus active measurements, intratester versus intertester measurements, and different patient types. Our discussion of validity encourages objective interpretation of the meaning of ROM measurements in light of the purposes and the limitations of goniometry. We conclude that clinicians should adopt standardized methods of testing and should interpret and report goniometric results as ROM measurements only, not as measurements of factors that may affect ROM.

  9. Assessment of The Clinical Outcome of IM rod Fxation in The Treatment of Tibial Congenital Pseudoarthrosis

    Directory of Open Access Journals (Sweden)

    Mehdi Ramezan Shirazi

    2009-08-01

    Full Text Available Background:Pseudoarthrosis of the tibia poses one of the most challenging treatment problems in all of orthopedics.The goal of the study was to assess the clinical outcome of intramedullary rod fixation in its treatment.Methods:The results of the management for nine patients with pseudoarthrosis of the tibia with IM rod fixation were reviewed retrospectively between 1986 - 2006. The mean duration of follow up was 8.95 years (range,3.5 months to 14.2 years.The   mean age of the patients at the latest follow up was 13.5 years (range, 9 to 23 years.Results:Initial union of the fracture site occurred in seven of nine patients with the mean duration of 7.6 months (range, 3.5 to 15.5 months.Five patients had limb length discrepancy with the mean of 7.2 cm (range,1.5 - 12 cm.Three of them were treated with tibia lengthening procedure with the Ilizarov method.One had a peroneal nerve palsy postoperatively.Two patients had refracture treated with casting and rod exchange. Electrical stimulation was applied in two patients but it was impossible to predict how much it played a role in the union.Conclusion: IM rod fixation technique has a satisfactory functional outcome.The   technique has a high level of acceptance by parents and patients. It should be recommended as the treatment of choice for the management of congenital pseudoarthrosis of the tibia.  

  10. Intra-Cluster Correlation Estimates for HIV-related Outcomes from Care and Treatment Clinics in Dar es Salaam, Tanzania.

    Science.gov (United States)

    Barnhart, Dale; Hertzmark, Ellen; Liu, Enju; Mungure, Ester; Muya, Aisa N; Sando, David; Chalamilla, Guerino; Ulenga, Nzovu; Bärnighausen, Till; Fawzi, Wafaie; Spiegelman, Donna

    2016-12-15

    Researchers planning cluster-randomized controlled trials (cRCTs) require estimates of the intra-cluster correlation coefficient (ICC) from previous studies for sample size calculations. This paper fills a persistent gap in the literature by providing estimates of ICCs for many key HIV-related clinical outcomes. Data from HIV-positive patients from 47 HIV care and treatment clinics in Dar es Salaam, Tanzania were used to calculate ICCs by site of enrollment or site of ART initiation for various clinical outcomes using cross-sectional and longitudinal data. ICCs were estimated using linear mixed models where either clinic of enrollment or clinic of ART initiation served as the random effect. ICCs ranged from 0 to 0.0706 (95% CI: 0.0447, 0.1098). For most outcomes, the ICCs were large enough to meaningfully affect sample size calculations. For binary outcomes, the ICCs for event prevalence at baseline tended to be larger than the ICCs for later cumulative incidences. For continuous outcomes, the ICCs for baseline values tended to be larger than the ICCs for the change in values from baseline. The ICCs for HIV-related outcomes cannot be ignored when calculating sample sizes for future cluster-randomized trials. The differences between ICCs calculated from baseline data alone and ICCs calculated using longitudinal data demonstrate the importance of selecting an ICC that reflects a study's intended design and duration for sample size calculations. While not generalizable to all contexts, these estimates provide guidance for future researchers seeking to design adequately powered cRCTs in Sub-Saharan African HIV treatment and care clinics.

  11. CLINICAL HISTORY AND OUTCOME OF 59 PATIENTS WITH IDIOPATHIC HYPERPROLACTINEMIA

    NARCIS (Netherlands)

    SLUIJMER, AV; LAPPOHN, RE

    Objective: To investigate the clinical course of hyperprolactinemia without demonstrable cause. Design: Prospective study of all patients with idiopathic hyperprolactinemia first seen between 1974 and 1985. Setting: Outpatient Department of University Hospital. Patients: Fifty-nine patients followed

  12. Clinical manifestations in patients with SOS1 mutations range from Noonan syndrome to CFC syndrome.

    Science.gov (United States)

    Narumi, Yoko; Aoki, Yoko; Niihori, Tetsuya; Sakurai, Masahiro; Cavé, Hélène; Verloes, Alain; Nishio, Kimio; Ohashi, Hirofumi; Kurosawa, Kenji; Okamoto, Nobuhiko; Kawame, Hiroshi; Mizuno, Seiji; Kondoh, Tatsuro; Addor, Marie-Claude; Coeslier-Dieux, Anne; Vincent-Delorme, Catherine; Tabayashi, Koichi; Aoki, Masashi; Kobayashi, Tomoko; Guliyeva, Afag; Kure, Shigeo; Matsubara, Yoichi

    2008-01-01

    Noonan syndrome (NS) and cardio-facio-cutaneous (CFC) syndrome are autosomal dominant disorders characterized by heart defects, facial dysmorphism, ectodermal abnormalities, and mental retardation. There is a significant clinical overlap between NS and CFC syndrome, but ectodermal abnormalities and mental retardation are more frequent in CFC syndrome. Mutations in PTPN11 and KRAS have been identified in patients with NS and those in KRAS, BRAF and MAP2K1/2 have been identified in patients with CFC syndrome, establishing a new role of the RAS/MAPK pathway in human development. Recently, mutations in the son of sevenless gene (SOS1) have also been identified in patients with NS. To clarify the clinical spectrum of patients with SOS1 mutations, we analyzed 24 patients with NS, including 3 patients in a three-generation family, and 30 patients with CFC syndrome without PTPN11, KRAS, HRAS, BRAF, and MAP2K1/2 (MEK1/2) mutations. We identified two SOS1 mutations in four NS patients, including three patients in the above-mentioned three-generation family. In the patients with a CFC phenotype, three mutations, including a novel three amino-acid insertion, were identified in one CFC patient and two patients with both NS and CFC phenotypes. These three patients exhibited ectodermal abnormalities, such as curly hair, sparse eyebrows, and dry skin, and two of them showed mental retardation. Our results suggest that patients with SOS1 mutations range from NS to CFC syndrome.

  13. Are clinical photographs appropriate to determine the maximal range of motion of the knee?

    Science.gov (United States)

    Verhaegen, Filip; Ganseman, Yannick; Arnout, Nele; Vandenneucker, Hilde; Bellemans, Johan

    2010-12-01

    Goniometry is a commonly used method for the clinical assessment of range of motion (ROM) of the knee. A digital photograph of the knee in maximal flexion and extension could provide a more objective way to assess the ROM. The aim of our study was to investigate the reliability of the use of digital photographs as a method for measuring the ROM of the knee. Four observers examined 49 patients. Digital photographs of the knee in maximal flexion and extension were compared with standard clinical goniometric measurements in the same position. We observed higher intra-observer reliability for the digital method in flexion (p goniometry. The extension results were numerically lower when using goniometry compared to the digital method (p reliability for extension was lower compared to flexion. The intraobserver standard error of measurement (SEM) of the digital method was smaller than the goniometric SEM; the digital method thus appeared more reliable. Measuring maximal flexion and extension on digital photographs is more reliable for both extension and flexion compared to standard goniometric measurements.

  14. Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage: Influence on clinical course and predictors of clinical outcome.

    Science.gov (United States)

    Bashir, Asma; Andresen, Morten; Bartek, Jiri; Cortsen, Marie; Eskesen, Vagn; Wagner, Aase

    2016-02-01

    Intra-arterial nimodipine (IAN) has shown a promising effect on cerebral vasospasm (CV) after aneurysmal subarachnoid haemorrhage. At our institution, Rigshospitalet, IAN treatment has been used since 2009, but the short- and long-term clinical efficacy of IAN has not yet been assessed. The purpose was to evaluate the efficacy and clinical outcome of IAN treatment of symptomatic CV, and to assess the predictors of clinical outcome. Medical records of 25 patients undergoing a total of 41 IAN treatment sessions were retrospectively reviewed. Data on angiographic results, blood-flow velocities and the clinical condition before and after the IAN treatment were recorded. Predictors of the clinical outcome were assessed with a linear regression model. Positive angiographic response was achieved in 95.1% of 41 IAN treatment sessions. Flow-velocity measurements showed no relationship with angiographic responses of IAN. The immediate clinical improvement was observed in three patients (12%). Five patients (20%) had a favourable outcome at discharge and at three-month follow-up; 10 patients (40%) had a moderate to poor outcome; and the rest (40%) died. Increased number of affected vessels and number of procedures carried out per patient, and a trend toward an increased delay time from symptomatic CV to confirming angiographic CV and thus instituting IAN treatment predicted the poor clinical outcome. IAN treatment appears to be effective in reversing angiographic CV. However, it is not always effective in reversing clinical deterioration, as several other factors including treatment delay affect the clinical course. © The Author(s) 2016.

  15. Neurofeedback and biofeedback with 37 migraineurs: a clinical outcome study

    OpenAIRE

    Lappin Martha S; Stokes Deborah A

    2010-01-01

    Abstract Background Traditional peripheral biofeedback has grade A evidence for effectively treating migraines. Two newer forms of neurobiofeedback, EEG biofeedback and hemoencephalography biofeedback were combined with thermal handwarming biofeedback to treat 37 migraineurs in a clinical outpatient setting. Methods 37 migraine patients underwent an average of 40 neurofeedback sessions combined with thermal biofeedback in an outpatient biofeedback clinic. All patients were on at least one typ...

  16. Clinical predictors of genetic testing outcomes in hypertrophic cardiomyopathy.

    Science.gov (United States)

    Ingles, Jodie; Sarina, Tanya; Yeates, Laura; Hunt, Lauren; Macciocca, Ivan; McCormack, Louise; Winship, Ingrid; McGaughran, Julie; Atherton, John; Semsarian, Christopher

    2013-12-01

    Genetic testing for hypertrophic cardiomyopathy has been commercially available for almost a decade; however, low mutation detection rate and cost have hindered uptake. This study sought to identify clinical variables that can predict probands with hypertrophic cardiomyopathy in whom a pathogenic mutation will be identified. Probands attending specialized cardiac genetic clinics across Australia over a 10-year period (2002-2011), who met clinical diagnostic criteria for hypertrophic cardiomyopathy and who underwent genetic testing for hypertrophic cardiomyopathy were included. Clinical, family history, and genotype information were collected. A total of 265 unrelated individuals with hypertrophic cardiomyopathy were included, with 138 (52%) having at least one mutation identified. The mutation detection rate was significantly higher in the probands with hypertrophic cardiomyopathy with an established family history of disease (72 vs. 29%, P < 0.0001), and a positive family history of sudden cardiac death further increased the detection rate (89 vs. 59%, P < 0.0001). Multivariate analysis identified female gender, increased left-ventricular wall thickness, family history of hypertrophic cardiomyopathy, and family history of sudden cardiac death as being associated with greatest chance of identifying a gene mutation. Multiple mutation carriers (n = 16, 6%) were more likely to have suffered an out-of-hospital cardiac arrest or sudden cardiac death (31 vs. 7%, P = 0.012). Family history is a key clinical predictor of a positive genetic diagnosis and has direct clinical relevance, particularly in the pretest genetic counseling setting.

  17. Clinical and social outcomes of adolescent self harm: population based birth cohort study

    Science.gov (United States)

    Heron, Jon; Crane, Catherine; Hawton, Keith; Lewis, Glyn; Macleod, John; Tilling, Kate; Gunnell, David

    2014-01-01

    Objectives To investigate the mental health, substance use, educational, and occupational outcomes of adolescents who self harm in a general population sample, and to examine whether these outcomes differ according to self reported suicidal intent. Design Population based birth cohort study. Setting Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort of children born in 1991-92. Participants Data on lifetime history of self harm with and without suicidal intent were available for 4799 respondents who completed a detailed self harm questionnaire at age 16 years. Multiple imputation was used to account for missing data. Main outcome measures Mental health problems (depression and anxiety disorder), assessed using the clinical interview schedule-revised at age 18 years, self reported substance use (alcohol, cannabis, cigarette smoking, and illicit drugs) at age 18 years, educational attainment at age 16 and 19 years, occupational outcomes at age 19 years, and self harm at age 21 years. Results Participants who self harmed with and without suicidal intent at age 16 years were at increased risk of developing mental health problems, future self harm, and problem substance misuse, with stronger associations for suicidal self harm than for non-suicidal self harm. For example, in models adjusted for confounders the odds ratio for depression at age 18 years was 2.21 (95% confidence interval 1.55 to 3.15) in participants who had self harmed without suicidal intent at age 16 years and 3.94 (2.67 to 5.83) in those who had self harmed with suicidal intent. Suicidal self harm, but not self harm without suicidal intent, was also associated with poorer educational and employment outcomes. Conclusions Adolescents who self harm seem to be vulnerable to a range of adverse outcomes in early adulthood. Risks were generally stronger in those who had self harmed with suicidal intent, but outcomes were also poor among those who had self harmed without suicidal

  18. CLINICAL OUTCOME OF PENETRATING KERATOPLASTY IN CORNEAL OPACITIES OF DIFFERENT AETIOLOGY- A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Dipak Bhuyan

    2017-01-01

    Full Text Available BACKGROUND Corneal transplantation or grafting is an operation in which abnormal corneal host tissue is replaced by healthy donor cornea. According to the World Health Organization (WHO, corneal diseases are among the major causes of vision loss and blindness in the world today after cataract and glaucoma. The aim of the study is to- 1. Evaluate the different aetiology of corneal opacity including active infective aetiology as indicated for penetrating keratoplasty. 2. Determine the clinical outcome of penetrating keratoplasty in relation to graft survival, graft rejection and peri-operative complications in different aetiology groups. 3. Determine the final visual outcome. MATERIALS AND METHODS Candidates for keratoplasty were selected from- 1. Eye Bank of Regional Institute of Ophthalmology (R.I.O. 2. R.I.O OPD. The study period was from September 2014 to August 2015. 30 cases were taken in the study. Descriptive statistics were applied to analyse the data wherever necessary. RESULTS 34.6±19.73 yrs. (mean±SD was the mean age at which transplants were done in the study. Out of total 30 cases, 13 (43.33% and 17 (56.66% were male and female, respectively. The different indications for penetrating keratoplasty are- Post ulcer corneal opacity in 14 cases (46.66%, posttraumatic corneal opacity 9 cases (30%, pseudophakic bullous keratopathy 4 cases (13.33%, corneal dystrophy in 2 cases (6.66% and non-healing corneal ulcer in 1 case (3.33%. 16 cases (53.33% showed clear graft till the last follow up while 11 (33.33% cases showed partially clear graft resulting in improved visual outcome while 3 cases (10.00% of the grafts were opaque due to graft failure. CONCLUSION The major indications for penetrating keratoplasty in this part of the world are post ulcer and posttraumatic corneal opacity and majority of them are illiterate agricultural workers who failed to get adequate treatment on time. Graft survival rate is high, which can be attributed to the

  19. Medical Malpractice in Uveitis: A Review of Clinical Entities and Outcomes.

    Science.gov (United States)

    Reddy, Ashvini K; Engelhard, Stephanie B; Shah, Christopher T; Sim, Austin J; Thorne, Jennifer E

    2016-08-11

    To guide risk management in uveitis. Retrospective review of malpractice verdicts, rulings, and settlements. The WestLaw® database was reviewed for lawsuits related to uveitis in the United States from 1930-2014. Twenty-five cases met inclusion criteria, and 48% of these were infectious. Overall, 64% of outcomes favored the defendant ophthalmologist. The most common diagnoses were viral retinitis (28%), iritis (12%), syphilis (8%), and toxoplasmosis (8%). Seven suits (28%) were resolved by settlement, with mean adjusted indemnities of $724,302 (median, $409,390; range, $127,837-2,021,887). Two cases (8%) resulted in plaintiff verdict, with adjusted awards of $1,399,800 and $630,799. Despite being a rare diagnosis, viral retinitis (especially acute retinal necrosis) is the most common clinical entity associated with litigation in uveitis and should be considered early. Educating patients about potential adverse events, early testing for syphilis, and maintaining a positive relationship may also minimize risk.

  20. Clinical outcomes of pars plicata anterior vitrectomy: 2-year results

    Directory of Open Access Journals (Sweden)

    Priya Narang

    2015-01-01

    Full Text Available Purpose: To demonstrate the safety and outcome of a surgical approach that uses pars plicata site for anterior vitrectomy during phacoemulsification procedure complicated by posterior capsule rupture and residual cortical matter. Design: Single center, retrospective, interventional, noncomparative study. Materials and Methods: Medical records of a consecutive series of 35 eyes of 35 patients who underwent pars plicata anterior vitrectomy (PPAV were reviewed. The main outcome measures were corrected and uncorrected distance visual acuity (CDVA, UDVA, early and late postoperative complications and intraocular pressure (IOP. Ultrasound biomicroscopic (UBM evaluation of sclerotomy site and spectral domain optical coherence tomography analysis for central macular thickness (CMT was performed. The final visual outcome at 2 years was evaluated. Results: At 2 years follow-up, the mean postoperative UDVA (logarithm of the minimum angle of resolution [logMAR] and CDVA (logMAR was 0.49 ± 0.26 and 0.19 ± 0.14, respectively. There was no significant change in the IOP (P = 0.061 and the mean CMT at 2 years was 192.5 ± 5.54 mm. The postoperative UBM image of the sclerotomy site at 8 weeks demonstrated a clear wound without any vitreous adhesion or incarceration. Intraoperative hyphema was seen in 1 (2.8% case and postoperative uveitis was seen in 2 (5.7% cases, which resolved with medications. No case of an iatrogenic retinal break or retinal detachment was reported. Conclusions: PPAV enables a closed chamber approach, allows thorough cleanup of vitreous in the pupillary plane and anterior chamber and affords better access to the subincisional and retropupillary cortical remnant with a significant visual outcome and an acceptable complication rate.

  1. Different biofilms, different disease? A clinical outcomes study.

    Science.gov (United States)

    Foreman, Andrew; Wormald, Peter-John

    2010-08-01

    A potential role for biofilms in Chronic Rhinosinusitis (CRS) has been proposed, and the adverse impact they have on disease severity and postoperative outcomes has also been well described. Recent advances have allowed the species within the biofilms of CRS patients to be clearly characterized. This study investigates whether different biofilm species have different disease outcomes. Retrospective review. Twenty-four patients with medically recalcitrant CRS undergoing Endoscopic Sinus Surgery (ESS), in whom we had previously characterized their biofilms using fluorescence in situ hybridization (FISH), were reviewed a median of 11 months after their surgery. They were evaluated for preoperative disease markers and evidence of on-going disease in the postoperative period. Thirty-seven biofilms were identified in the 24 patients. Almost half had polymicrobial biofilms. The presence of polymicrobial, rather than single-species biofilms adversely affected preoperative disease severity but did not alter postsurgical outcome. Patients with single organism Haemophilus influenzae biofilms presented with mild disease symptomatically and radiologically and achieved normal mucosa a short time after their surgery. Conversely, patients with Staphlococcus aureus in their biofilm makeup had more severe disease and a more complicated postoperative course. The effect of Pseudomonas aeruginosa and fungal biofilms is less clear. Different biofilm species are associated with different disease phenotypes. H. influenzae biofilms are typically found in patients with mild disease, whereas S. aureus is associated with a more severe, surgically recalcitrant pattern.

  2. The clinical presentation and outcome of urothelial atypia on biopsy of the bladder.

    Science.gov (United States)

    Ziemba, Justin B; Golan, Ron; Skokan, Alexander; Patel, Darshan; Feldman, Michael D; Bing, Zhanyong; Guzzo, Thomas J

    2014-07-01

    To examine the presentation and clinical outcome of patients diagnosed with reactive urothelial atypia (RUA) or urothelial atypia of unknown significance (AUS) on tissue biopsy of the bladder. We performed a retrospective cohort study of all patients who were diagnosed with either RUA or AUS on biopsy of the bladder at our institution from November 2000 to May 2008. Excluded from the analysis were patients with a history of or a concurrent diagnosis of urothelial carcinoma. A total of 66 patients were available for final analysis. The mean patient age at diagnosis was 63 years (range: 18-89 years). There were 46 men (70%) and 20 women (30%). The indication for cystoscopic examination included lower urinary tract symptoms in 29 (44%), gross hematuria in 17 (26%), microscopic hematuria in 12 (18%), urolithiasis in 2 (3%), and hydronephrosis in 6 (9%) patients. On biopsy, 54 (82%) had RUA and 12 (18%) had AUS. The mean follow-up was 36 months (range: 0-271 months). During this period, 37 (56%) patients underwent at least 1 additional cystoscopy with negative result. None of the 66 (0%) patients developed biopsy-proven urothelial carcinoma. Urothelial atypia is common in men older than 60 years and often presents with either hematuria or lower urinary tract symptoms. Both RUA and AUS have a similar benign clinical course. Therefore, after diagnosis, further intervention or surveillance is unnecessary. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Clinical Outcome of Metacarpophalangeal Joint Dislocation of the Thumb in Children: Case Series of 10 Patients.

    Science.gov (United States)

    Khursheed, Omar; Haq, Ansarul; Rashid, Shakir; Manzoor, Nazeefa; Shiekh, Sarwar; Mushtaq, Muzaffar

    2016-04-01

    Dislocation of the metacarpophalangeal joint of the thumb in children is an uncommon entity. The aim of this study was to evaluate the clinical outcome of pediatric patients with metacarpophalangeal joint dislocation of the thumb. Ten pediatric patients with metacarpophalangeal joint dislocation of the thumb were evaluated. Patients were studied prospectively over a period of 3 years. Parameters studied included patient demographics, type of dislocation, management, and any complications. Mean age of patients was 6.8 years (range: 3-12 years). Seven patients underwent closed reduction and three patients were managed by open reduction. Of the total 10 patients, excellent results were obtained in 9 patients. One of the patients who reported on the fourth day of trauma and was managed by open reduction had mild joint stiffness with a range of motion of 10 to 40 degrees at final follow-up. None of these patients had infection or instability. After thorough clinical and radiological examination, closed reduction can be done in incomplete and simple complete dislocations of metacarpophalangeal joint of the thumb. Repeated closed reduction should be avoided in complex complete injuries. Early mobilization is advised to prevent joint stiffness.

  4. Timing of Surgery and Rehabilitation to Optimize Outcome for Patients with Multiple Ligament Knee Injuries: A Multicenter Clinical Trial

    Science.gov (United States)

    2016-10-01

    delayed surgery, early surgical management of MLKIs leads to better clinical outcomes, but is associated with a higher risk of loss of motion and joint...laxity and range of motion with 4) no increased risk of complications. The overarching objectives for the CTDA are to: 1) further develop the...or anticipated problems or delays and actions or plans to resolve them There were significant delays in executing subcontract and data use

  5. Correlation of Clinical and Dosimetric Factors With Adverse Pulmonary Outcomes in Children After Lung Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Venkatramani, Rajkumar, E-mail: rvenkatramani@chla.usc.edu [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Kamath, Sunil [Department of Pulmonology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Wong, Kenneth [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Olch, Arthur J. [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Radiation Oncology, University of Southern California, Los Angeles, California (United States); Malvar, Jemily [Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Sposto, Richard [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Goodarzian, Fariba [Department of Radiology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Freyer, David R. [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Keens, Thomas G. [Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Department of Pulmonology, Children' s Hospital Los Angeles, Los Angeles, California (United States); and others

    2013-08-01

    Purpose: To identify the incidence and the risk factors for pulmonary toxicity in children treated for cancer with contemporary lung irradiation. Methods and Materials: We analyzed clinical features, radiographic findings, pulmonary function tests, and dosimetric parameters of children receiving irradiation to the lung fields over a 10-year period. Results: We identified 109 patients (75 male patients). The median age at irradiation was 13.8 years (range, 0.04-20.9 years). The median follow-up period was 3.4 years. The median prescribed radiation dose was 21 Gy (range, 0.4-64.8 Gy). Pulmonary toxic chemotherapy included bleomycin in 58.7% of patients and cyclophosphamide in 83.5%. The following pulmonary outcomes were identified and the 5-year cumulative incidence after irradiation was determined: pneumonitis, 6%; chronic cough, 10%; pneumonia, 35%; dyspnea, 11%; supplemental oxygen requirement, 2%; radiographic interstitial lung disease, 40%; and chest wall deformity, 12%. One patient died of progressive respiratory failure. Post-irradiation pulmonary function tests available from 44 patients showed evidence of obstructive lung disease (25%), restrictive disease (11%), hyperinflation (32%), and abnormal diffusion capacity (12%). Thoracic surgery, bleomycin, age, mean lung irradiation dose (MLD), maximum lung dose, prescribed dose, and dosimetric parameters between V{sub 22} (volume of lung exposed to a radiation dose ≥22 Gy) and V{sub 30} (volume of lung exposed to a radiation dose ≥30 Gy) were significant for the development of adverse pulmonary outcomes on univariate analysis. MLD, maximum lung dose, and V{sub dose} (percentage of volume of lung receiving the threshold dose or greater) were highly correlated. On multivariate analysis, MLD was the sole significant predictor of adverse pulmonary outcome (P=.01). Conclusions: Significant pulmonary dysfunction occurs in children receiving lung irradiation by contemporary techniques. MLD rather than prescribed

  6. Yoga & Cancer Interventions: A Review of the Clinical Significance of Patient Reported Outcomes for Cancer Survivors

    Directory of Open Access Journals (Sweden)

    S. Nicole Culos-Reed

    2012-01-01

    Full Text Available Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004–2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies.

  7. Clinical features and treatment outcomes of vasoproliferative tumors in Indian participants

    Directory of Open Access Journals (Sweden)

    Jaydeep Avinash Walinjkar

    2018-01-01

    Full Text Available Purpose: The aim of the study was to describe the clinical features and treatment outcomes of vasoproliferative tumors (VPT in Indian participants. Methods: This study design was a retrospective case series in a tertiary eye care center. Case records of patients diagnosed with VPT from 2011 to 2015 were reviewed, and their demographic details, clinical presentation, and treatment outcomes were documented. Baseline and follow-up visual acuity and tumor dimensions were statistically compared by applying paired t-test. Statistical analysis used SPSS version 14. Results: Twenty-two tumors from 19 eyes of 17 patients were included. Mean age at presentation was 43.5 years (range: 15–68 years. Mean presenting best-corrected visual acuity (BCVA was + 1.10 logMAR. Sixty-eight percent eyes had secondary tumors. Most common association of secondary VPT was Coats disease followed by retinal vasculitis, polypoidal choroidal vasculopathy, familial exudative vitreoretinopathy, and traumatic chorioretinopathy. Ten tumors (45% involved the inferior quadrant. Tumor-associated features were intra/subretinal exudates, vitritis, subretinal fluid, vitreous hemorrhage, preretinal fibrosis, epiretinal membrane, and subretinal blood. Treatment included cryotherapy, intravitreal or oral steroids, laser photocoagulation, cryotherapy with encirclage, cryotherapy with anti-vascular endothelial growth factor, and observation. Complications included tumor recurrence, retinal detachment, raised intraocular pressure, neovascularization of iris, and cataract. Ninety-five percent VPT regressed at mean 21 months (Median: 17 months; Range: 3–64 months. Mean final BCVA was + 1.21 logMAR. Conclusion: VPTs are commonly unilateral, unifocal, and located anterior to equator in inferior fundus. Secondary tumors are more common than primary tumors. Treatment achieves tumor regression in majority of cases.

  8. Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: a prospective analysis.

    Science.gov (United States)

    Joseph, Bellal; Pandit, Viraj; Aziz, Hassan; Kulvatunyou, Narong; Hashmi, Ammar; Tang, Andrew; O'Keeffe, Terence; Wynne, Julie; Vercruysse, Gary; Friese, Randall S; Rhee, Peter

    2014-03-01

    Patients receiving antiplatelet medications are considered to be at an increased risk for traumatic intracranial hemorrhage after blunt head trauma. However, most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate clinical outcomes and the requirement of a repeat head computed tomography (RHCT) in patients on preinjury clopidogrel therapy. Patients with traumatic brain injury with intracranial hemorrhage on initial head CT were prospectively enrolled. Patients on preinjury clopidogrel were matched with patients exclusive of antiplatelet and anticoagulation therapy using a propensity score in a 1:1 ratio for age, Glasgow Coma Scale (GCS), head Abbreviated Injury Scale (h-AIS), Injury Severity Score (ISS), neurologic examination, and platelet transfusion. Outcome measures were progression on RHCT scan and need for neurosurgical intervention. A total of 142 patients with intracranial hemorrhage on initial head CT scan (clopidogrel, 71; no clopidogrel, 71) were enrolled. The mean (SD) age was 70.5 (15.1) years, 66% were male, median GCS score was 14 (range, 3-15), and median h-AIS (ISS) was 3 (range, 2-5). The mean (SD) platelet count was 210 (101), and 61% (n = 86) of the patients received platelet transfusion. Patients on preinjury clopidogrel were more likely to have progression on RHCT (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.1-7.1) and RHCT as a result of clinical deterioration (OR, 2.1; 95% CI, 1.8-3.5). The overall rate of neurosurgical intervention was 4.2% (n = 6). Patients on clopidogrel therapy were more likely to require a neurosurgical intervention (OR, 1.8; 95% CI, 1.4-3.1). Preinjury clopidogrel therapy is associated with progression of initial insult on RHCT scan and need for neurosurgical intervention. Preinjury clopidogrel therapy as an independent variable should warrant the need for a routine RHCT scan in patients with traumatic brain injury. Prognostic study, level I; therapeutic

  9. Development and initial outcomes of an upper gastrointestinal multidisciplinary clinic.

    Science.gov (United States)

    Brown, Anna; Wylie, Neil; Rodgers, Michael; Casement, Jonathan; McIlree, Neil; Gray, Lindsay; Mulholland, Glen; Volkova, Vicki; van der Watt, Erna; Booth, Michael; Koea, Jonathan

    2016-07-01

    Patients with upper gastrointestinal cancer are often comorbid and require complex surgical treatments for their cancers, meaning that their preoperative assessment can be based around numerous outpatient assessments with multiple services. A multidisciplinary clinic (MDC) was developed for the assessment of patients with confirmed or suspected upper gastrointestinal cancers. Face-to-face meetings were held between stakeholder services at Waitemata District Health Board, and clinic resource allocated. Significant IT modification of existing clinic booking software was required. Between September 2014, and September 2015, there were a total of 165 new patient, and 710 follow-up appointments. All new patients were seen by a surgeon and then other specialties. Of the 165 new patient appointments, 146 (88%) patients had a definitive treatment plan in place and were cleared by anaesthesia and intensive care at the end of the clinic. Staff and patients report high levels of satisfaction for the clinic. A dedicated MDC has provided a single forum where complex patients can be reviewed, and a definitive treatment plan formulated in nearly 90% of patients, even when this involves multiple medical and paramedical specialties with high levels of patient and clinician satisfaction.

  10. Skull base surgery for tumors in children: long-term clinical and functional outcome.

    Science.gov (United States)

    Hayhurst, Caroline; Williams, Dawn; Yousaf, Jawad; Richardson, David; Pizer, Barry; Mallucci, Conor

    2013-05-01

    Skull base tumors in children are rare but require complex approaches with potential morbidity to the developing craniofacial skeleton, in addition to tumor-related morbidity. Reports of long-term clinical and functional outcome following skull base approaches in children are scarce. The authors report long-term outcome in children with tumors undergoing multidisciplinary skull base surgery. A retrospective analysis was undertaken of children undergoing surgery at a single institution between 1998 and 2008 for benign and malignant lesions of the anterior, middle, or posterior cranial base. Patients with craniopharyngioma, pituitary tumors, and optic glioma were excluded. Histology, surgical morbidity, length of hospital stay, progression-free survival, and adjuvant therapy were recorded. Functional and cognitive outcome was assessed prospectively using the Late Effects Severity Score (LESS). Twenty-three children ranging in age from 13 months to 15 years underwent skull base approaches for resection of tumors during the study period. The median follow-up duration was 60 months. Tumor types included meningioma, schwannoma, rhabdomyosarcoma, neuroblastoma, angiofibroma, and chordoma. Complete resection was achieved in 12 patients (52%). Thirteen patients (57%) had benign histology. The median hospital stay was 7 days. There were 3 deaths, 1 perioperative and 2 from tumor progression. Two patients had CSF leakage (9%) and 2 developed meningitis. Two children (9%) had residual neurological deficit at last follow-up evaluation. Thirteen (59%) of 22 surviving patients received adjuvant therapy. The majority of the patients remain in mainstream education and 19 of the 20 surviving children have an LESS of 3 or lower. Children tolerate complex skull base procedures well, with minimal surgical-related morbidity as well as good long-term tumor control rates and functional outcomes from maximal safe resection combined with adjuvant treatment when required.

  11. Do Modic changes have an impact on clinical outcome in lumbar spine surgery?

    DEFF Research Database (Denmark)

    Laustsen, Aske Foldbjerg; Bech-Azeddine, Rachid

    2016-01-01

    PURPOSE: To provide a systematic literature review of the impact of preoperative Modic changes (MCs) on the clinical outcome following lumbar spine surgery for degenerative lumbar spine disease. METHODS: A PubMed search until 31 October 2015 was performed to identify publications correlating...... preoperative MC with clinical outcome in patients undergoing spine surgery. RESULTS: Inclusion criteria were met by 14 articles (7 prospective and 7 retrospective studies) representing a total of 1652 surgical patients, of which at least 804 (>49 %) showed MC. Of the 14 publications, 6 concerned discectomy (n...... a larger patient material, focus on MCID, and include known confounding factors of the clinical outcome of spine surgery in the analysis....

  12. Social variables affecting mate preferences, copulation and reproductive outcome in a pack of free-ranging dogs.

    Directory of Open Access Journals (Sweden)

    Simona Cafazzo

    Full Text Available Mating and reproductive outcome is often determined by the simultaneous operation of different mechanisms like intra-sexual competition, mating preferences and sexual coercion. The present study investigated how social variables affected mating outcome in a pack of free-ranging dogs, a species supposed to have lost most features of the social system of wolves during domestication. We found that, although the pack comprised multiple breeding individuals, both male copulation success and female reproductive success were positively influenced by a linear combination of dominance rank, age and leadership. Our results also suggest that mate preferences affect mating outcome by reinforcing the success of most dominant individuals. In particular, during their oestrous period bitches clearly searched for the proximity of high-ranking males who displayed affiliative behaviour towards them, while they were more likely to reject the males who intimidated them. At the same time, male courting effort and male-male competition for receptive females appeared to be stronger in the presence of higher-ranking females, suggesting a male preference for dominant females. To our knowledge, these results provide the first clear evidence of social regulation of reproductive activities in domestic dogs, and suggest that some common organizing mechanisms may contribute to shape the social organization of both dogs and wolves.

  13. Clinical outcome of subchromosomal events detected by whole‐genome noninvasive prenatal testing

    Science.gov (United States)

    Helgeson, J.; Wardrop, J.; Boomer, T.; Almasri, E.; Paxton, W. B.; Saldivar, J. S.; Dharajiya, N.; Monroe, T. J.; Farkas, D. H.; Grosu, D. S.

    2015-01-01

    Abstract Objective A novel algorithm to identify fetal microdeletion events in maternal plasma has been developed and used in clinical laboratory‐based noninvasive prenatal testing. We used this approach to identify the subchromosomal events 5pdel, 22q11del, 15qdel, 1p36del, 4pdel, 11qdel, and 8qdel in routine testing. We describe the clinical outcomes of those samples identified with these subchromosomal events. Methods Blood samples from high‐risk pregnant women submitted for noninvasive prenatal testing were analyzed using low coverage whole genome massively parallel sequencing. Sequencing data were analyzed using a novel algorithm to detect trisomies and microdeletions. Results In testing 175 393 samples, 55 subchromosomal deletions were reported. The overall positive predictive value for each subchromosomal aberration ranged from 60% to 100% for cases with diagnostic and clinical follow‐up information. The total false positive rate was 0.0017% for confirmed false positives results; false negative rate and sensitivity were not conclusively determined. Conclusion Noninvasive testing can be expanded into the detection of subchromosomal copy number variations, while maintaining overall high test specificity. In the current setting, our results demonstrate high positive predictive values for testing of rare subchromosomal deletions. © 2015 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd. PMID:26088833

  14. Renal function trajectories and clinical outcomes in acute heart failure.

    Science.gov (United States)

    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

    2014-01-01

    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

  15. Clinical Outcomes and Survivorship of Lateral Unicompartmental Knee Arthroplasty: Does Surgical Approach Matter?

    Science.gov (United States)

    Edmiston, Tori A; Manista, Gregory C; Courtney, P Maxwell; Sporer, Scott M; Della Valle, Craig J; Levine, Brett R

    2017-09-21

    Lateral unicompartmental knee arthroplasty (UKA) has been shown to be an effective procedure to treat isolated lateral compartment osteoarthritis with excellent long-term survivorship. Whether a medial parapatellar approach or a lateral parapatellar approach is superior in lateral UKA is unknown. The purpose of this study was to determine if there is a difference in intermediate-term clinical outcomes in patients undergoing lateral UKA through a lateral vs medial parapatellar approach. We retrospectively reviewed a consecutive series of 65 patients who underwent lateral UKA with a minimum of 2-year follow-up. Fifty-two patients (80%) had a lateral approach and 13 (20%) a medial parapatellar approach. Patient demographics, preoperative and postoperative radiographic findings, need for revision surgery, Knee Society Score, and range of motion were assessed. Overall survivorship was 94% at a mean of 82 months; with the sample size available for study, there was no difference in survivorship between the groups. There was no difference in Knee Society Score or revision to total knee arthroplasty (5% vs 7%, P = 1.000) between the medial and lateral approach groups. Comparatively, the lateral approach group did have significantly greater postoperative flexion (123.6° vs 116.5°, P = .006) and greater improvement in flexion from preoperative measurements (3.0 vs -8.0°, P = .010). Although our sample size was small, we could not demonstrate a difference in revision rates or clinical outcome scores when comparing a lateral or a medial approach with lateral UKA at intermediate-term follow-up. A lateral approach did have greater postoperative flexion, but its clinical significance remains undetermined. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Long-term clinical outcomes of combined BPTB ACL reconstruction and popliteus tendon plasty.

    Science.gov (United States)

    Marcacci, Maurilio; Bonanzinga, Tommaso; Grassi, Alberto; Musiani, Costanza; Benzi, Andrea; Marcheggiani Muccioli, Giulio Maria; Vaccari, Vittorio; Zaffagnini, Stefano

    2015-10-01

    A deficiency of posterolateral structures significantly increases the varus load on the ACL, while a chronic ACL lesion, the increased tibial rotation and the repetitive non-physiological knee motion, could affect and damage the integrity of the popliteus tendon. Therefore, the aim of the present study was to report the very long clinical outcomes of a combined single-bundle BPTB ACL reconstruction and popliteus plasty according to Bousquets technique, for the treatment of combined chronic anterior and posterolateral laxities. Fifteen patients that underwent combined ACL reconstruction and popliteal plasty according to Bousquets technique were available at mean 26.8 ± 1.0 years (range 25.4-28.0 years). All the patients were evaluated clinically and 13 by means of KT-1000 Arthrometer as well. Subjective evaluation was performed with the subjective IKDC, WOMAC and a 0-10 VAS for pain scales. At clinical evaluation, 10 patients (67 %) presented a negative anterior drawer test; Lachman test was negative in nine patients (60 %); the varus stress test was negative in eight (53 %); and the dial test was negative in all but one patient (93 %). Only two patients (15 %) presented a side-to-side difference >5 mm at the instrumented laxity evaluation. The combined single-bundle BPTB ACL reconstruction and popliteal plasty according to Bousquets technique were able to produce very good long-term results, in terms of knee stability, subjective outcomes, functional results and return to sport activity, in case of chronic anterior and posterolateral laxities. Retrospective case series, Level IV.

  17. Clinical Features, Imaging Characteristics, and Long-term Outcome of Dogs with Cranial Meningocele or Meningoencephalocele.

    Science.gov (United States)

    Lazzerini, K; Gutierrez-Quintana, R; José-López, R; McConnell, F; Gonçalves, R; McMurrough, J; De Decker, S; Muir, C; Priestnall, S L; Mari, L; Stabile, F; De Risio, L; Loeffler, C; Tauro, A; Rusbridge, C; Rodenas, S; Añor, S; de la Fuente, C; Fischer, A; Bruehschwein, A; Penderis, J; Guevar, J

    2017-03-01

    The term meningoencephalocele (MEC) describes a herniation of cerebral tissue and meninges through a defect in the cranium, whereas a meningocele (MC) is a herniation of the meninges alone. To describe the clinical features, magnetic resonance imaging (MRI) characteristics, and outcomes of dogs with cranial MC and MEC. Twenty-two client-owned dogs diagnosed with cranial MC or MEC. Multicentric retrospective descriptive study. Clinical records of 13 institutions were reviewed. Signalment, clinical history, neurologic findings and MRI characteristics as well as treatment and outcome were recorded and evaluated. Most affected dogs were presented at a young age (median, 6.5 months; range, 1 month - 8 years). The most common presenting complaints were seizures and behavioral abnormalities. Intranasal MEC was more common than parietal MC. Magnetic resonance imaging identified meningeal enhancement of the protruded tissue in 77% of the cases. Porencephaly was seen in all cases with parietal MC. Cerebrospinal fluid (CSF) analysis identified mild abnormalities in 4 of 11 cases. Surgery was not performed in any affected dog. Seventeen patients were treated medically, and seizures were adequately controlled with anti-epileptic drugs in 10 dogs. Dogs with intranasal MEC and mild neurologic signs had a fair prognosis with medical treatment. Although uncommon, MC and MEC should be considered as a differential diagnosis in young dogs presenting with seizures or alterations in behavior. Medical treatment is a valid option with a fair prognosis when the neurologic signs are mild. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  18. Cultures of diabetic foot ulcers without clinical signs of infection do not predict outcomes.

    Science.gov (United States)

    Gardner, Sue E; Haleem, Ambar; Jao, Ying-Ling; Hillis, Stephen L; Femino, John E; Phisitkul, Phinit; Heilmann, Kristopher P; Lehman, Shannon M; Franciscus, Carrie L

    2014-10-01

    We examined associations between ulcer bioburden and ulcer outcomes in neuropathic diabetic foot ulcers (DFUs) that lacked clinical signs of infection. Three dimensions of bioburden (i.e., microbial load, microbial diversity, and the presence of likely pathogens) were measured at baseline using swab cultures obtained by Levine's technique. Subjects were assessed every 2 weeks for 26 weeks to determine the rate of healing and development of infection-related complications. Foot ulcers were off-loaded using total-contact casts and routinely debrided. To establish associations between bioburden and rate of healing, Cox proportional hazards and least squares regression were used after adjusting for ulcer depth, surface area, and duration. A total of 77 subjects completed the study. Sixty-five (84.4%) had ulcers that healed during follow-up; weeks-to-closure ranged from 2 to 26 (median 4.0). Mean (± SD) percent reduction in surface area/week was 25.0% (± 23.33). Five (6.5%) of the DFUs developed an infection-related complication. None of the bioburden dimensions (i.e., microbial load, microbial diversity, or presence of likely pathogens) was significantly associated with weeks-to-closure or percent reduction in surface area per week. Weeks-to-closure was best predicted by ulcer duration, depth, and surface area (c-statistic = 0.75). Culturing DFUs that showed no clinical signs of infection had no predictive value for outcomes of DFUs managed with total-contact casts and routine debridement. These findings support recommendations of the Infectious Disease Society of America that culturing and antibiotics should be avoided in treating DFUs that show no clinical signs of infection. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  19. Research setting versus clinic setting: Which produces better outcomes in cognitive therapy for depression?

    Science.gov (United States)

    Gibbons, Carly R; Stirman, Shannon Wiltsey; Derubeis, Robert J; Newman, Cory F; Beck, Aaron T

    2013-06-01

    To compare the outcomes of cognitive therapy for depression under controlled and clinically representative conditions, while holding several therapist and clinical assessment factors constant. Treatment outcomes for a sample of 23 adults with a primary diagnosis of Major Depressive Disorder who received cognitive therapy in an outpatient clinic were compared with outcomes of 18 clients who were treated in the cognitive therapy condition of a large, multi-site randomized clinical trial of treatments for depression. All participants had been treated by one of two therapists who served as clinicians in both settings. Individuals in the two samples were diagnostically and demographically similar (approximately 50% Female, 83% White). A variety of client characteristics, assessed prior to treatment, as well as the outcomes of treatment, were examined. Significantly superior treatment outcomes were observed in the individuals treated in the research study, relative to clients in the outpatient clinic, and the difference was not accounted for by intake characteristics. Individuals treated by the therapists in the RCT experienced almost three times as much improvement in depressive symptoms as clients seen in the outpatient setting. If replicated, the findings suggest that differences exist between treatment outcomes in research and outpatient settings and that these differences may not simply be due to therapist experience and training, or differences in patient populations. Future research should further examine the impact of fidelity monitoring, treatment expectation and motivation, and the duration and timing of treatment protocols on clinical outcomes.

  20. Arm exercise stress perfusion imaging predicts clinical outcome.

    Science.gov (United States)

    Chan, Albert K; Ilias-Khan, Nasreen A; Xian, Hong; Inman, Cindi; Martin, Wade H

    2011-12-01

    Treadmill exercise capacity in resting metabolic equivalents (METs) and stress hemodynamic, electrocardiographic (ECG), and myocardial perfusion imaging (MPI) responses are independently predictive of adverse clinical events. However, limited data exist for arm ergometer stress testing (AXT) in patients who cannot perform leg exercise because of lower extremity disabilities. We sought to determine the extent to which AXT METs, hemodynamic, ECG, and MPI responses to arm exercise add independent incremental value to demographic and clinical variables for prediction of all-cause mortality, myocardial infarction (MI), or late coronary revascularization, individually or as a composite. A prospective cohort of 186 patients aged 64 ± 10 (SD) yr, unable to perform lower extremity exercise, underwent AXT MPI for clinical reasons between 1997 and 2002, and were followed for 62 ± 23 mo, to an endpoint of death or 12/31/2006. Average annual rates were 5.4% for mortality, 2.2% for MI, 2.5% for late coronary revascularization, and 8.0% for combined events. After adjustment for age and clinical variables, AXT METs [P ECG (P ECG (P leg exercise because of lower extremity disabilities, AXT METs are as important as MPI for prediction of mortality alone and death and MI combined, and a positive AXT ECG prognosticates MI alone and death and MI combined.

  1. The impact of antioxidant supplementation on clinical outcomes in ...

    African Journals Online (AJOL)

    Pubmed, Google Scholar and Science Direct electronic databases were searched for papers published between January 1990 and June 2010. Selection criteria: Randomised controlled trials were selected for inclusion if they investigated the effects of antioxidant supplementation in the critically ill and reported on clinically ...

  2. Clinical Supervision and Its Outcomes: Teachers and Principals Report.

    Science.gov (United States)

    Holifield, Mitchell; Cline, Daniel

    1997-01-01

    A survey of 900 teachers and 300 principals examined the effectiveness of the clinical-supervision model used in U.S. secondary schools. Respondents valued collaboration in setting time for observations and analyzing data during a postobservation conference. Principals were commonly responsible for both supervising and evaluating teachers. Both…

  3. Aetiological agents, clinical features and outcome of septicaemia in ...

    African Journals Online (AJOL)

    Summary. The present study sought to determine the preva- lence, clinical features and bacterial aetiological agents of septicaemia in post~neonatal infants (age 1—12 months) presenting with fever at the University College Hospital,. Ibadan, Nigeria. Study Setting: It was carried out at the Otunba Tunwase. Children ...

  4. Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia

    DEFF Research Database (Denmark)

    Arendrup, Maiken Cavling; Sulim, Sofia; Holm, Anette

    2011-01-01

    needed longer incubation. Species distribution varied by age, prior antifungal treatment (57% occurrence of C. glabrata, Saccharomyces cerevisiae, or C. krusei in patients with prior antifungal treatment versus 28% occurrence in those without it; P = 0.007), and clinical specialty (61% occurrence of C...

  5. Clinical features and outcomes of ANCA-associated renal vasculitis

    Directory of Open Access Journals (Sweden)

    Sidy Mohamed Seck

    2012-01-01

    Full Text Available To determine the patterns and outcomes of the pauci-immune vasculitis in the nephrology department at hospital La Conception in Marseille, we conducted a retrospective study including all patients with diagnosis of pauci-immune renal vasculitis between January 1, 2000 and December 31, 2007. Among 33 cases, 25 were diagnosed as Wegener granulomatosis (WG, seven as microscopic polyangitis (MPA and one as Churg-Strauss syndrome (SCS. The median age of the patients was 57.7 years and the sex-ratio (M/F was 1.6. The visceral mani-festations included kidneys (100% of patients, lungs (75%, ENT (52% of WG, and nervous system (57% of MPA. The mean serum creatinine at admission was 3.3 mg/dL. Renal biopsies revealed a pauci-immune crescentic gromerulonephritis in 96% of the cases. Two patients with WG received plasmapheresis and seven patients required emergency hemodialysis. Induction therapy comprised cyclophosphamide IV and corticosteroids, while maintenance therapy included azathioprine for the majority of patients. Eighty four percent of the patients experienced complete remission after induction therapy. During maintenance therapy relapses were more frequent among patients with MPA (28% compared to WG cases (12%. After 35 months of follow-up, eight patients ended on chronic hemodialysis, and five patients died. ANCA associated vasculitis are frequent in our patients. Long-term outcomes are relatively good despite a mortality rate of 15% and 25% of the patients entering dialysis after three years of follow-up.

  6. Cardiac asthma in elderly patients: incidence, clinical presentation and outcome

    Directory of Open Access Journals (Sweden)

    Ray Patrick

    2007-05-01

    Full Text Available Abstract Background Cardiac asthma is common, but has been poorly investigated. The objective was to compare the characteristics and outcome of cardiac asthma with that of classical congestive heart failure (CHF in elderly patients. Methods Prospective study in an 1,800-bed teaching hospital. Results Two hundred and twelve consecutive patients aged ≥ 65 years presenting with dyspnea due to CHF (mean age of 82 ± 8 years were included. Findings of cardiac echocardiography and natriuretic peptides levels were used to confirm CHF. Cardiac asthma patients were defined as a patient with CHF and wheezing reported by attending physician upon admission to the emergency department. The CHF group (n = 137 and the cardiac asthma group (n = 75, differed for tobacco use (34% vs. 59%, p 2 (47 ± 15 vs. 41 ± 11 mmHg, p Conclusion Patients with cardiac asthma represented one third of CHF in elderly patients. They were more hypercapnic and experienced more distal airway obstruction. However, outcomes were similar.

  7. Clinical Outcome after Endoscopic Endonasal Resection of Tuberculum Sella Meningiomas.

    Science.gov (United States)

    Elshazly, Khaled; Kshettry, Varun R; Farrell, Christopher J; Nyquist, Gurston; Rosen, Marc; Evans, James J

    2017-10-10

    In select cases, the endoscopic endonasal approach (EEA) has distinct advantages for resection of tuberculum sella meningiomas (TSM). To report the extent of resection (EOR), complication rates, and outcomes in a large series of TSM treated by the EEA. Twenty-five consecutive TSM cases treated by EEA from 2008 to 2016 were retrospectively reviewed. Patient history, imaging, volumetric EOR, complications, and outcomes are presented. Mean patient age was 53.9 yr, with female predominance (84%). Preoperatively, 84% of patients had vision impairment and 68% had optic canal tumor invasion. The tumor was abutting or partially encasing the anterior cerebral artery in 14 (56%) and 3 (12%) patients, respectively. The supraclinoid internal carotid artery (ICA) was partially or completely encased in 4 (16%) and 4 (16%) patients, respectively. Gross total resection (GTR) was achieved in 19/25 (76%) cases. Complete ICA encasement was the most common reason for subtotal resection. Among patients without complete ICA encasement, GTR was achieved in 19/20 (95%) patients. Optic canal invasion, tumor volume, intratumoral calcifications, and partial vascular encasement were not limiting factors for GTR. Eighty-eight percent of patients with preoperative visual impairment had improvement or normalization of vision. No patient experienced permanent visual deterioration or new permanent pituitary dysfunction. Cerebrospinal fluid leakage occurred in 2 (8%) cases. The EEA for resection of TSM provides high rates of GTR and visual improvement with a low rate of complications. Direct contact or partial encasement of the ICA and anterior cerebral artery does not limit the EOR.

  8. A CLINICAL STUDY OF OUTCOME OF LABOUR IN TRANSVERSE LIE

    Directory of Open Access Journals (Sweden)

    Vijayalakshmi

    2015-08-01

    Full Text Available Transverse lie complicates approximately 0.5% of birth and may result in neglected or impacted shoulder presentation leading to obstructed labour, rupture uterus and postpartum haemorrhage which may result in death of the mother, if not adequately managed in labour . A prospective observational study done in VI MS B ellary, Karnataka, aim of the study was to know the maternal and fetal outcome, to study caesarean rate, maternal and neonatal complications following caesarean. Objective of the study is to analyse the various modes of outcome of transverse lie to kno w the fetal and maternal mortality and morbidity , to improve the conditions which decreases these rates and guide us for better management of these cases. Out of 6116 deliveries100 cases were transverse lie during 2year period from April 1999 to January 20 01. Out of 100 cases , 76 were caesarean sections, 48 were live births, 7 were neonatal deaths, 45 were still births. Maternal morbidity was 2 cases required subtotal hysterectomy. There were no maternal deaths. Elective caesarean section should be advised in all booked cases with transverse lie at term, after ruling out congenital anomalies of the fetus by anomaly scan.

  9. The Almost-Normal Liver Biopsy: Presentation, Clinical Associations, and Outcome.

    Science.gov (United States)

    Czeczok, Thomas W; Van Arnam, John S; Wood, Laura D; Torbenson, Michael S; Mounajjed, Taofic

    2017-09-01

    Liver biopsies obtained for abnormal liver enzymes or unexplained ascites occasionally appear histologically almost normal. The differential diagnosis for these cases is challenging because literature addressing this topic is lacking. We aimed to establish a differential diagnosis and determine clinical associations and outcomes for almost-normal liver biopsies. Ninety-seven histologically almost-normal liver biopsies were collected from 2 institutions. All cases lacked significant inflammation, fatty change, biliary tract disease, vascular disease, nodular regenerative hyperplasia, iron overload, inherited metabolic or storage disorder, viral hepatitis, or fibrosis. Biopsies for follow-up of known liver diseases were excluded. Transplant biopsies, lesion-directed biopsies, biopsies obtained during bariatric surgery, liver donor biopsies, and biopsies to evaluate methotrexate toxicity were excluded. Clinical (including follow-up) and laboratory data were collected. The frequency of almost-normal liver biopsies was 0.6% and 3.7% at the 2 institutions. The most common biopsy indications were elevated liver biochemistries or clinical findings that suggested portal hypertension. In 70 patients (72%), an associated clinical abnormality was identified; the most common were autoimmune systemic inflammatory conditions (18%), vascular/ischemic events (13%), metabolic syndrome (11%), drug effects (8%), and inflammatory conditions of the gastrointestinal tract (7%). The median follow-up period was 4.3 years (range=0 to 10 y); detailed clinical follow-up was available for 66 patients (68%). Liver biochemistries normalized in 32 patients (48.5%) and remained elevated in 34 (51.5%). Seven patients (7.2%) eventually developed chronic liver disease (autoimmune hepatitis [n=3], primary biliary cirrhosis [n=3], cryptogenic cirrhosis [n=1]). This multicenter study determines the differential diagnosis for almost-normal liver biopsies; this will guide pathologists in subsequent workup

  10. Sputum biomarkers and the prediction of clinical outcomes in patients with cystic fibrosis.

    Directory of Open Access Journals (Sweden)

    Theodore G Liou

    Full Text Available Lung function, acute pulmonary exacerbations (APE, and weight are the best clinical predictors of survival in cystic fibrosis (CF; however, underlying mechanisms are incompletely understood. Biomarkers of current disease state predictive of future outcomes might identify mechanisms and provide treatment targets, trial endpoints and objective clinical monitoring tools. Such CF-specific biomarkers have previously been elusive. Using observational and validation cohorts comprising 97 non-transplanted consecutively-recruited adult CF patients at the Intermountain Adult CF Center, University of Utah, we identified biomarkers informative of current disease and predictive of future clinical outcomes. Patients represented the majority of sputum producers. They were recruited March 2004-April 2007 and followed through May 2011. Sputum biomarker concentrations were measured and clinical outcomes meticulously recorded for a median 5.9 (interquartile range 5.0 to 6.6 years to study associations between biomarkers and future APE and time-to-lung transplantation or death. After multivariate modeling, only high mobility group box-1 protein (HMGB-1, mean=5.84 [log ng/ml], standard deviation [SD] =1.75 predicted time-to-first APE (hazard ratio [HR] per log-unit HMGB-1=1.56, p-value=0.005, number of future APE within 5 years (0.338 APE per log-unit HMGB-1, p<0.001 by quasi-Poisson regression and time-to-lung transplantation or death (HR=1.59, p=0.02. At APE onset, sputum granulocyte macrophage colony stimulating factor (GM-CSF, mean 4.8 [log pg/ml], SD=1.26 was significantly associated with APE-associated declines in lung function (-10.8 FEV(1% points per log-unit GM-CSF, p<0.001 by linear regression. Evaluation of validation cohorts produced similar results that passed tests of mutual consistency. In CF sputum, high HMGB-1 predicts incidence and recurrence of APE and survival, plausibly because it mediates long-term airway inflammation. High APE-associated GM

  11. Subclinical hypothyroidism in children and adolescents: a wide range of clinical, biochemical, and genetic factors involved.

    Science.gov (United States)

    Rapa, Anna; Monzani, Alice; Moia, Stefania; Vivenza, Daniela; Bellone, Simonetta; Petri, Antonella; Teofoli, Francesca; Cassio, Alessandra; Cesaretti, Graziano; Corrias, Andrea; de Sanctis, Vincenzo; Di Maio, Salvatore; Volta, Cecilia; Wasniewska, Malgorzata; Tatò, Luciano; Bona, Gianni

    2009-07-01

    The aim of the study was to examine clinical characteristics, biochemical parameters, and TSH-R gene variations in children and adolescents with subclinical hypothyroidism (SH) in order to evaluate their pattern of distribution in SH. We enrolled 88 patients, each having at least two TSH measurements above the upper limit of the reference range with normal free thyroid hormones and negative thyroid autoantibodies. Clinical characteristics included height, weight, family history of thyroid diseases, thyroid volume, and echogenicity at ultrasonography. Biochemical parameters included TSH, free thyroid hormones, thyroid autoantibodies, and adjusted daily urinary iodine excretion (UIE). Genetic variations in the TSH-R gene were assessed. The prevalence of overweight/obesity, positive family history of thyroid diseases, and thyroid hypoechogenicity was 28.4, 45.5, and 22.7%, respectively. Median TSH was higher in overweight/obese patients than in normal-weight ones (7.4 vs. 5.7 muIU/ml; P = 0.04) and in overweight/obese patients with hypoechogenicity than in those with normal ultrasound pattern (8.5 vs. 6.8 muIU/ml; P = 0.04). Adjusted daily UIE was lower in subjects without than in those with a positive family history of thyroid diseases (81 vs. 120 mug/d; P = 0.001). The prevalence of a positive family history of thyroid diseases was 1.9-fold higher in patients with nonsynonymous mutations in the TSH-R gene than in patients without any mutation (80 vs. 42%; P = 0.03). A novel mutation at position 1559 in exon 10 (W520X) was detected in one child. Overweight/obesity, thyroid hypoechogenicity, and nonsynonymous mutations in the TSH-R gene are characterizing features of a large portion of SH children.

  12. Erythropoietin in the general population: reference ranges and clinical, biochemical and genetic correlates.

    Directory of Open Access Journals (Sweden)

    Niels Grote Beverborg

    Full Text Available Although erythropoietin has been used for decades in the treatment of anemia, data regarding endogenous levels in the general population are scarce. Therefore, we determined erythropoietin reference ranges and its clinical, biochemical and genetic associations in the general population.We used data from 6,777 subjects enrolled in the Prevention of REnal and Vascular ENd-stage Disease (PREVEND study. Fasting venous blood samples were obtained in the morning from all participants from 2001-2003. Serum erythropoietin concentrations were measured using a fully automated chemiluminescent enzyme-labeled immunometric assay. A genome-wide association study was performed to identify genetic determinants.Mean age (± SD was 53 ± 12 years and 50% were female. Median (IQR erythropoietin concentrations were 7.6 (5.8-9.9 IU/L in men and 7.9 (6.0-10.6 IU/L in women. A strong positive correlation was found between erythropoietin and waist circumference, glucose and systolic blood pressure (all P < 0.05. In subjects with normal renal function there was a strong exponential relation between hemoglobin and erythropoietin, whereas in renal impairment (eGFR < 60 mL/min/1.73m² this relation was linear (men or absent (women (P < 0.001 for interaction. Single-nucleotide polymorphisms at the HBS1L-MYB locus were shown to be related to erythropoietin levels (P < 9x10-21, more significantly than other erythrocyte parameters.We provide age-specific reference ranges for endogenous serum erythropoietin. Erythropoietin levels are positively associated with the components of the metabolic syndrome, except cholesterol. We show that even mild renal failure blunts erythropoietin production and propose the HBS1L-MYB locus as a regulator of erythropoietin.

  13. How are we measuring clinically important outcome for operative treatments in sports medicine?

    Science.gov (United States)

    Nwachukwu, Benedict U; Runyon, R Scott; Kahlenberg, Cynthia A; Gausden, Elizabeth B; Schairer, William W; Allen, Answorth A

    2017-05-01

    Minimal clinically important difference (MCID) and other measures of minimum clinical importance are increasingly recognized as important clinical considerations for evaluating the efficacy of an intervention. As our interpretation of clinical outcome evolves beyond statistical significance, psychometric properties such as MCID will be increasingly important to various stakeholders in the orthopaedic community. The purpose of this study was to: 1) describe the state of clinically important outcome reporting and 2) describe the methods used to derive these psychometric values for sports medicine patients undergoing operative treatments. A review of the MEDLINE database was performed. Studies primarily deriving and reporting clinically important outcome measures for operative interventions in sports medicine were included. Demographic, methodological and psychometric properties of included studies were extracted. Level of Evidence and the Newcastle Ottawa Scale (NOS) were used to assess study quality. Statistical analysis was primarily descriptive. Fifteen studies met inclusion criteria; 10 of the 15 studies were Level II evidence and mean NOS score was 5.3/9. Minimal detectable change (MDC) was the most commonly derived measure of clinical importance, calculated in 53.3% of studies, followed by MCID, calculated in 40.0% of studies. A combination of distribution and anchor-based methods was the most commonly used method to determine clinical importance (N = 7, 46.7%) followed by distribution only (N = 5, 33.3%). Predictors of clinically important change were reported in four studies and were most commonly related to pre-operative functional score. MDC and the MCID are the most commonly reported measures of clinically important outcome after operative treatment in sports medicine. A combination of both distribution and anchor-based methods is commonly used to derive these values. More attention should be paid to reporting outcomes that are clinically important and

  14. Clinical Characteristics and Outcomes of Juvenile and Adult Dermatomyositis

    OpenAIRE

    Na, Sang-Jun; Kim, Seung Min; Sunwoo, Il Nam; Choi, Young-Chul

    2009-01-01

    Dermatomyositis (DM) is an idiopathic inflammatory myopathy with bimodal onset age distribution. The age of onset is between 5-18 yr in juvenile DM and 45-64 yr in adult DM. DM has a distinct clinical manifestation characterized by proximal muscle weakness, skin rash, extramuscular manifestations (joint contracture, dysphagia, cardiac disturbances, pulmonary symptoms, subcutaneous calcifications), and associated disorders (connective tissue disease, systemic autoimmune diseases, malignancy). ...

  15. Clinical Outcome After Arthroscopic Debridement and Microfracture for Osteochondritis Dissecans of the Capitellum

    NARCIS (Netherlands)

    Bexkens, Rens; van den Ende, Kim I. M.; Ogink, Paul T.; van Bergen, Christiaan J. A.; van den Bekerom, Michel P. J.; Eygendaal, Denise

    2017-01-01

    Background: Various surgical treatment techniques have been developed to treat capitellar osteochondritis dissecans; however, the optimal technique remains the subject of ongoing debate. Purpose: To evaluate clinical outcomes after arthroscopic debridement and microfracture for advanced capitellar

  16. Off pump vs on pump coronary artery bypass grafting: Perioperative complications and early clinical outcomes

    Directory of Open Access Journals (Sweden)

    Ayman El Naggar

    2012-03-01

    Conclusion: Off pump CABG is safe and associated with good clinical outcome and can be considered alternative to conventional CABG as treatment modality for surgical coronary revascularization but this will need large scale study to establish this technique.

  17. Certified Nurse Aides and Scope of Practice: Clinical Outcomes and Patient Safety.

    Science.gov (United States)

    McMullen, Tara L; Resnick, Barbara; Hansen, Jennie Chin; Miller, Nancy; Rubinstein, Robert

    2015-12-01

    To understand the impact of scope of practice and allowable certified nurse aide (CNA) tasks across states, the current study compared clinical outcomes in states with a basic scope of practice versus those that allowed for an expanded scope. The current study used data from the Minimum Data Set as well as staffing data from the Centers for Medicare and Medicaid Services. Clinical outcomes included: (a) percent of residents whose need for help with daily activities has increased, (b) percent of high-risk residents with pressure ulcers, (c) percent of residents who self-report moderate to severe pain, (d) percent of residents experiencing one or more falls with major injury, and (e) CNA staffing hours. There was no difference in clinical outcomes between states with expanded or basic scopes. Many factors influence clinical outcomes among residents and additional staffing and facility characteristics should be considered in future studies. Copyright 2015, SLACK Incorporated.

  18. Clinical outcome, proteome kinetics and angiogenic factors in serum after thermoablation of colorectal liver metastases

    NARCIS (Netherlands)

    Wertenbroek, Marieke W. J. L. A. E.; Schepers, Marianne; Kamminga-Rasker, Hannetta J.; Bottema, Jan T.; Kobold, Anneke C. Muller; Roelofsen, Han; de Jong, Koert P.

    2013-01-01

    Background: Thermoablation is used to treat patients with unresectable colorectal liver metastases (CRLM). We analyze clinical outcome, proteome kinetics and angiogenic markers in patients treated by cryosurgical ablation (CSA) or radiofrequency ablation (RFA). Methods: 205 patients underwent CSA (n

  19. Clinical outcome and radiographic results after operative treatment of Scheuermann's disease

    NARCIS (Netherlands)

    Poolman, R. W.; Been, H. D.; Ubags, L. H.

    2002-01-01

    The aim of this prospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome, and to report complications and instrumentation failure after operative treatment of Scheuermann's disease using a combined anterior and posterior spondylodesis. The loss of sagittal

  20. Clinical laboratory detection of AmpC β-lactamase: does it affect patient outcome?

    National Research Council Canada - National Science Library

    Rand, Kenneth H; Turner, Bradley; Seifert, Hilary; Hansen, Christine; Johnson, Judith A; Zimmer, Andrea

    2011-01-01

    Plasmid-mediated AmpC-producing Escherichia coli and Klebsiella pneumoniae have been associated with poor clinical outcomes, but they are not readily identified in hospital microbiology laboratories...

  1. Zoonotic bacterial meningitis in adults: clinical characteristics, etiology, treatment and outcome

    NARCIS (Netherlands)

    van Samkar, A.

    2016-01-01

    In this thesis, we describe the clinical characteristics, etiology, treatment and outcome of zoonotic bacterial meningitis. Each chapter describes meningitis patients infected by a specific zoonotic pathogen, such as Streptococcus equi, Streptococcuis suis, Capnocytophaga canimorsus, Campylobacter

  2. Deteriorated clinical outcome in coronary artery disease patients with a high prevalence of Porphyromonas gingivalis infection

    Directory of Open Access Journals (Sweden)

    Daisuke Tezuka

    2016-06-01

    Conclusions: P. gingivalis was identified by sensitive detection in patients with CAD, diagnosed by coronary CTA. P. gingivalis in oral saliva can be a potential marker which is associated with clinical outcomes in patients with CAD.

  3. Serum zinc levels as a predictor of clinical features and outcome of ...

    African Journals Online (AJOL)

    Serum zinc levels as a predictor of clinical features and outcome of paediatric acute lower respiratory infections in Nigeria. RM Ibraheem, WBR Johnson, AA Abdulkarim, MB Abdulkadir, D Oladele, SA Biliaminu ...

  4. Clinical practices and outcomes in elderly hemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

    Science.gov (United States)

    Canaud, Bernard; Tong, Lin; Tentori, Francesca; Akiba, Takashi; Karaboyas, Angelo; Gillespie, Brenda; Akizawa, Tadao; Pisoni, Ronald L; Bommer, Juergen; Port, Friedrich K

    2011-07-01

    Demand for hemodialysis among elderly patients is increasing worldwide. Although clinical care of this high-risk group is complex and challenging, no guidelines exist to inform hemodialysis practices. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides a unique opportunity to assess dialysis practices and associated outcomes among elderly versus younger patients on chronic in-center hemodialysis in 12 countries. Clinical characteristics, dialysis practices, and outcomes of elderly versus younger patients were compared among participants in four DOPPS regions in 2005 through 2007. Although participant mean age increased over time in all DOPPS countries, the percentage of elderly varied widely. Overall, comorbidities and malnutrition were more common in the elderly. Fistulae were used less frequently among elderly versus younger patients in Europe and North America but not in Australia, New Zealand, and Japan. No difference in treatment time was observed between elderly and younger patients after normalizing for body weight. In all regions, ultrafiltration rates were lower among elderly patients. Elderly patients reported poorer quality of life with respect to the physical but not mental component scores. Mortality risk was three- to sixfold higher in the elderly group, whereas causes of death overall were similar for elderly and younger patients. Elderly patients represent a different proportion of DOPPS participants across countries, possibly reflecting differences in policies and clinical practices. In general, hemodialysis practices in the elderly reflected each region's clinical patterns, with some variation by age group depending upon the practice.

  5. Clinical Practices and Outcomes in Elderly Hemodialysis Patients: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

    Science.gov (United States)

    Tong, Lin; Tentori, Francesca; Akiba, Takashi; Karaboyas, Angelo; Gillespie, Brenda; Akizawa, Tadao; Pisoni, Ronald L.; Bommer, Juergen; Port, Friedrich K.

    2011-01-01

    Summary Background and objectives Demand for hemodialysis among elderly patients is increasing worldwide. Although clinical care of this high-risk group is complex and challenging, no guidelines exist to inform hemodialysis practices. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides a unique opportunity to assess dialysis practices and associated outcomes among elderly versus younger patients on chronic in-center hemodialysis in 12 countries. Design, setting, participants, & measurements Clinical characteristics, dialysis practices, and outcomes of elderly versus younger patients were compared among participants in four DOPPS regions in 2005 through 2007. Results Although participant mean age increased over time in all DOPPS countries, the percentage of elderly varied widely. Overall, comorbidities and malnutrition were more common in the elderly. Fistulae were used less frequently among elderly versus younger patients in Europe and North America but not in Australia, New Zealand, and Japan. No difference in treatment time was observed between elderly and younger patients after normalizing for body weight. In all regions, ultrafiltration rates were lower among elderly patients. Elderly patients reported poorer quality of life with respect to the physical but not mental component scores. Mortality risk was three- to sixfold higher in the elderly group, whereas causes of death overall were similar for elderly and younger patients. Conclusions Elderly patients represent a different proportion of DOPPS participants across countries, possibly reflecting differences in policies and clinical practices. In general, hemodialysis practices in the elderly reflected each region's clinical patterns, with some variation by age group depending upon the practice. PMID:21734085

  6. Clinical trials and systematic reviews addressing similar interventions for the same condition do not consider similar outcomes to be important: a case study in HIV/AIDS.

    Science.gov (United States)

    Saldanha, Ian J; Li, Tianjing; Yang, Cui; Owczarzak, Jill; Williamson, Paula R; Dickersin, Kay

    2017-04-01

    The usefulness of clinical trials and systematic reviews is compromised when they report different outcomes. We compared outcomes in reviews of HIV/AIDS and the trials included in the reviews. We examined all Cochrane reviews of HIV/AIDS (as of June 2013) that included ≥1 trial and the trials that the reviews included. We compared outcomes within subgroups defined by type of intervention: clinical management, biomedical prevention, behavioral prevention, and health services. We included 84 reviews that encompassed 524 trials. Although the median number of outcomes per trial (8) and per review (7.5) was similar, the trials reported a considerably greater number of unique outcomes than the reviews (779 vs. 218), ranging from 2.3 times greater (clinical management) to 5.4 times greater (behavioral prevention). High proportions of trial outcomes were not in any review: 68% (clinical management) to 83% (behavioral prevention). Lower proportions of review outcomes were not in any trial: 11% (clinical management) to 39% (health services). Outcomes in trials and reviews are not well aligned for appropriate inclusion of trial results in reviews and meta-analyses. Differences in perspectives, goals, and constraints between trialists and reviewers may explain differences in outcomes they consider important. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  7. Clinical epidemiology of premenstrual disorder: informing optimized patient outcomes

    Science.gov (United States)

    Robinson, Lynne LL; Ismail, Khaled MK

    2015-01-01

    Premenstrual disorders encompass a spectrum that ranges from mild cyclical psychological and somatic symptoms to the rarer but much-more-severe premenstrual dysphoric disorder. This condition is serious and the etiology is unclear, but possible causes include genetic factors, hormonal fluctuations, and neurotransmitter dysfunctions. Differentiation from other affective disorders can be difficult but is key to providing appropriate management. This comprehensive review will discuss the most-recent classification of premenstrual disorders, etiology, diagnosis, and potential current management strategies. PMID:26451123

  8. Anterior Migration After Bryan Cervical Disc Arthroplasty: The Relationship Between Hyperlordosis and its Impact on Clinical Outcomes.

    Science.gov (United States)

    Lei, Tao; Tong, Tong; Miao, Dechao; Gao, Xianda; Xu, Jiaxin; Zhang, Di; Shen, Yong

    2017-05-01

    Various modifications have been tested to prevent kyphosis after Bryan cervical disc arthroplasty (CDA). However, the migration of Bryan prostheses has not been systematically studied. This study investigated the cause of anterior migration (AM) and assessed the effect of AM on clinical and radiographic outcomes. We retrospectively reviewed 46 consecutive patients who underwent modified Bryan CDA between August 2006 and December 2010. We measured functional spinal unit, angle of operative disc space, range of motion, and sagittal alignment of cervical spine preoperatively, postoperatively, and at the final follow-up, and compared these values between the AM and non-AM groups. Clinical outcome was evaluated by scores for Japanese Orthopaedic Association, Neck Disability Index, and visual analog scale. AM occurred in 9/46 (19.6%) patients. Clinical outcomes in both groups were significantly improved compared with the preoperative scores (P < 0.05). However, the postoperative and final follow-up angle of operative disc space was more lordotic and the postoperative functional spinal unit significantly higher in patients in the AM group compared with the non-AM group (P < 0.05). At the final follow-up, patients with AM had significantly higher Neck Disability Index and neck visual analog scale scores (P < 0.05), partially restricted range of motion (4.9° vs. 7.4°; P < 0.05), and adjacent segment degeneration at 6 vertebral levels (46.2%). The intermediate clinical outcomes for patients treated with modified Bryan CDA were satisfactory; however, overcorrection of segmental lordosis may lead to AM of the prosthesis, which could restrict patient range of motion and cause postoperative neck pain. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Developing core outcome measurement sets for clinical trials: OMERACT filter 2.0

    NARCIS (Netherlands)

    Boers, Maarten; Kirwan, John R.; Wells, George; Beaton, Dorcas; Gossec, Laure; D'Agostino, Maria-Antonietta; Conaghan, Philip G.; Bingham, Clifton O.; Brooks, Peter; Landewé, Robert; March, Lyn; Simon, Lee S.; Singh, Jasvinder A.; Strand, Vibeke; Tugwell, Peter

    2014-01-01

    Lack of standardization of outcome measures limits the usefulness of clinical trial evidence to inform health care decisions. This can be addressed by agreeing on a minimum core set of outcome measures per health condition, containing measures relevant to patients and decision makers. Since 1992,

  10. Core outcome measurement instruments for clinical trials in non-specific low back pain

    NARCIS (Netherlands)

    Chiarotto, Alessandro; Boers, Maarten; Deyo, Richard A; Buchbinder, Rachelle; Corbin, Terry P; Costa, Leonardo O P; Foster, Nadine E; Grotle, Margreth; Koes, Bart W; Kovacs, Francisco M; Christine Lin, Chung-Wei; Maher, Chris G; Pearson, Adam M; Peul, Wilco C; Schoene, Mark L; Turk, Dennis C; van Tulder, Maurits W; Terwee, Caroline B; Ostelo, Raymond W

    2017-01-01

    To standardize outcome reporting in clinical trials of patients with non-specific low back pain (LBP), an international multidisciplinary panel recommended physical functioning, pain intensity, and health-related quality of life (HRQoL) as core outcome domains. Given the lack of consensus on

  11. Psychosocial outcome in patients at clinical high risk of psychosis: a prospective follow-up

    NARCIS (Netherlands)

    Salokangas, Raimo K. R.; Nieman, Dorien H.; Heinimaa, Markus; Svirskis, Tanja; Luutonen, Sinikka; From, Tiina; von Reventlow, Heinrich Graf; Juckel, Georg; Linszen, Don; Dingemans, Peter; Birchwood, Max; Patterson, Paul; Schultze-Lutter, Frauke; Klosterkötter, Joachim; Ruhrmann, Stephan

    2013-01-01

    In patients at clinical high risk (CHR) of psychosis, transition to psychosis has been the focus of recent studies. Their broader outcome has received less attention. We studied psychosocial state and outcome in CHR patients. In the European Prediction of Psychosis Study, 244 young help-seeking CHR

  12. Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

    DEFF Research Database (Denmark)

    Veselka, Josef; Jensen, Morten Kvistholm; Liebregts, Max

    2016-01-01

    AIMS: The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still...

  13. Clinical Presentation, Aetiology, and Outcomes of Meningitis in a Setting of High HIV and TB Prevalence

    OpenAIRE

    Thinyane, Keneuoe Hycianth; Motsemme, Keanole Mofona; Cooper, Varsay Jim Lahai

    2015-01-01

    Meningitis causes significant morbidity and mortality globally. The aim of this study was to study the clinical presentation, aetiology, and outcomes of meningitis among adult patients admitted to Queen Mamohato Memorial Hospital in Maseru, Lesotho, with a diagnosis of meningitis. A cross-sectional study was conducted between February and April 2014; data collected included presenting signs and symptoms, laboratory results, and clinical outcomes. Descriptive statistics were used to summarise ...

  14. Dimensions of socioeconomic status and clinical outcome after primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jakobsen, Lars; Niemann, Troels; Thorsgaard, Niels

    2012-01-01

    The association between low socioeconomic status (SES) and high mortality from coronary heart disease is well-known. However, the role of SES in relation to the clinical outcome after primary percutaneous coronary intervention remains poorly understood.......The association between low socioeconomic status (SES) and high mortality from coronary heart disease is well-known. However, the role of SES in relation to the clinical outcome after primary percutaneous coronary intervention remains poorly understood....

  15. Specific ranges of anti-Mullerian hormone and antral follicle count correlate to provide a prognostic indicator for IVF outcome.

    Science.gov (United States)

    Keane, Kevin; Cruzat, Vincius Fernandes; Wagle, Susbin; Chaudhary, Nitin; Newsholme, Philip; Yovich, John

    2017-03-01

    Advanced female age correlates with reduced ovarian reserve (OR) and is the primary factor underlying the limitation of success rates in Assisted Reproductive Technology (ART). Currently, predicted ovarian response to gonadotrophin stimulation is determined using transvaginal ultrasound to measure antral follicle count (AFC), an indirect measure of OR. However, assessing the level of anti-Mullerian hormone (AMH) has more recently been shown to correlate with OR, and its application has been adopted widely. This retrospective study was designed to determine the relationship between novel ranges of AMH and AFC in patients undergoing ART. There was a positive correlation between AMH and AFC category (r=0.458, P0.05), but even more reliant on female age. Finally, the number of oocytes collected was positively correlated with AMH and AFC grading, while oocyte and embryo utilization rates were negatively correlated. Overall, both OR markers were positively and strongly related with each other, and when individual AMH readings were categorised into specific novel ranges, they demonstrated a more robust correlation with AFC groupings. Taken together, applying patient AMH within specific ranges may lead to a better estimation of OR and IVF outcomes. Copyright © 2016. Published by Elsevier Urban & Partner Sp. z o.o.

  16. Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions

    DEFF Research Database (Denmark)

    El-Galaly, Tarec Christoffer; Hutchings, Martin; Juul Mylam, Karen

    Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions......Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions...

  17. Outcomes of Older Adults with Burn Injury: University Clinical Center of Kosovo.

    Science.gov (United States)

    B Duci, Shkelzen; M Arifi, Hysni; R Ahmeti, Hasan; K Zatriqi, Violeta; A Buja, Zejn; T Hoxha, Enver; Y Mekaj, Agon

    2015-07-01

    Advances in burn care over the past 50 years have brought about remarkable improvement in mortality rates such that survival has become an expected outcome even in patients with extensive injuries. Although these improvements have occurred in all age groups, survival in older adults still lags far behind that in younger cohorts. This study determines the outcomes of older adults with burn injury in University Clinical Center of Kosovo. This is a retrospective study that includes 56 burn patients, older than 60 years who were admitted at the Department of Plastic Surgery, between 1 January 2004 and 31 December 2013. Data processing was done with the statistical package of Stat 3. From the statistical parameters the structural index, arithmetic median, and standard deviation were calculated. Fifty six burned patient older than 60 years were included during a 10-year period. Of the 56 elderly patients 29 were women and 27 were men with a mean age of 66.7 years (range, 60-85 years). The differences were not statistically significant for both genders regarding the causes of burn injury. Considering the gradual increase of the elderly population in our country based on the data of the Ministry of Public Services, an increase is expected to the incidence of burn injuries in the population of this category of our country.

  18. Clinical and functional outcomes and treatment options for paediatric elbow dislocations: Experiences of three trauma centres.

    Science.gov (United States)

    Subasi, M; Isik, M; Bulut, M; Cebesoy, O; Uludag, A; Karakurt, L

    2015-07-01

    Although elbow dislocations are seen rarely in children, their management remains controversial. In this study, over a 7 years period, we evaluated retrospectively the clinical and functional results of paediatric elbow dislocations managed in three different trauma centres. Pure dislocations and dislocations with associated injuries were evaluated separately. In total 56 patients met the inclusion criteria. The number of patients without additional injury was 22 out of which according to the Robert's criteria, 15 children (68%) had an excellent, four (18%) a good, one (5%) a fair, and two (9%) a poor outcome. From the thirty-four patients that had associated injuries, two (6%) had an excellent, 6 (18%) a good, 10 (29%) a fair and 16 (47%) a poor result. Overall, patients with pure dislocation were found to have a better range of motion compared to patients with dislocation and associated injuries. Prolonged follow ups, and effective rehabilitation programs are required in order to expect good outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Translating the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) into Lithuanian.

    Science.gov (United States)

    Viliū nienė, Rima; Evans, Chris; Hilbig, Jan; Pakalniškienė, Vilmantė; Danilevičiūtė, Vita; Laurinaitis, Eugenijus; Navickas, Alvydas

    2013-10-01

    There are no standardized tools in Lithuanian feasible for ongoing routine use to measure the effectiveness of psychotherapeutic treatment. The CORE-OM is a widely used 34-item self-report measure for such purpose. To explore the reliability, validity and sensitivity of the Lithuanian translation of CORE-OM questionnaire. A validation study of the CORE-OM was conducted in the psychiatric clinic attached to Vilnius University. A Lithuanian translation of the English original CORE-OM was prepared by a team of translators. Then 39 psychotherapy outpatients and 187 students were asked to complete the Lithuanian version of the CORE-OM; 66 were tested twice to determine test-retest stability. Analysis included both internal and test-retest reliability, acceptability, influence of gender, principal component analysis and criteria for reliable and clinically significant change. Internal and test-retest reliability were good (0.61-0.94), though somewhat lower for the risk domain (α: 0.57-0.79, Spearman's rho 0.25-0.60). Differences between scores of the clinical and non-clinical samples were large and significant (P < 0.001). Some of the Lithuanian criteria for clinically significant change were a bit lower than those of the original UK criteria (e.g. well-being) and others higher (symptoms, functioning, overall score), illustrating the need for local exploration. In spite of small differences in psychometric properties from the original, the Lithuanian version of the CORE-OM was reliable and sensitive in both clinical and non-clinical settings. It has the potential to become a practical, sensitive and reliable tool for psychotherapists in Lithuania.

  20. Geriatric nutritional risk index, muscle function, quality of life and clinical outcome in hemodialysis patients.

    Science.gov (United States)

    Beberashvili, Ilia; Azar, Ada; Sinuani, Inna; Shapiro, Gregory; Feldman, Leonid; Sandbank, Judith; Stav, Kobi; Efrati, Shai

    2016-12-01

    The geriatric nutritional risk index (GNRI) has been reported as a useful predictor of prognosis in maintenance hemodialysis (MHD) patients, demonstrating GNRI less than 90 as a marker of a poorer nutritional status and significantly increased mortality. We tested whether GNRI as a whole associated stronger with clinical and laboratory surrogates of nutrition and inflammation, muscle function, health-related quality of life (QoL), and predicts all-cause and cardiovascular (CV) morbidity and mortality in this population better than its individual components (albumin and body weight to ideal body weight ratio). A prospective observational study with a median follow-up of 30 months (interquartile range - 19-41 months) was performed on 352 MHD outpatients (38.0% women) with a mean age of 67.4 ± 13.2 years. All-cause and cardiovascular hospitalization and mortality, GNRI, handgrip strength (HGS), body composition parameters (anthropometry and bioimpedance) and short form 36 (SF-36) quality-of-life scores were measured. Multivariate linear regression analyses were performed to obtain adjusted correlations. Receiver operating characteristic (ROC) curves were generated and multivariate Cox proportional hazards models were applied to identify the predictive value of GNRI and its components separately. GNRI positively correlated with total score (r = 0.15, P patients didn't stand up to multivariable adjustments. For each one unit increase in baseline GNRI levels, the first hospitalization hazard ratio (HR) after adjustments for confounders was 0.98 (95% confidence interval (CI), 0.97 to 0.99) and the first CV event HR was 0.98 (95% CI, 0.97 to 0.99); all-cause death HR was 0.97 (95% CI, 0.96 to 0.99) and CV death HR was 0.97 (95% CI, 0.95-0.99). Albumin was related to QoL and clinical outcomes with higher strength and magnitude than GNRI. Despite the significant relationship with clinical outcomes and QOL, GNRI is not better and is even slightly worse than albumin

  1. Preliminary Outcomes from an Integrated Pediatric Mental Health Outpatient Clinic.

    Science.gov (United States)

    Maslow, Gary R; Banny, Adrienne; Pollock, McLean; Stefureac, Kristen; Rosa, Kendra; Walter, Barbara Keith; Hobbs Knutson, Katherine; Lucas, Joseph; Heilbron, Nicole

    2017-10-01

    An estimated 1 in 5 children in the United States meet criteria for a diagnosable mental disorder, yet fewer than 20% receive mental health services. Unmet need for psychiatric treatment may contribute to patterns of increasing use of the emergency department. This article describes an integrated pediatric evaluation center designed to prevent the need for treatment in emergency settings by increasing access to timely and appropriate care for emergent and critical mental health needs. Preliminary results showed that the center provided rapid access to assessment and treatment services for children and adolescents presenting with a wide range of psychiatric concerns. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. A core outcomes set for clinical trials of interventions for young adults with type 1 diabetes

    DEFF Research Database (Denmark)

    Byrne, Molly; O'Connell, Anthony; Egan, Aoife M

    2017-01-01

    that 70% of consensus group participants voted for their inclusion. RESULTS: Eight core outcomes were agreed for inclusion in the final COS: measures of diabetes-related stress; diabetes-related quality of life; number of severe hypoglycaemic events; self-management behaviour; number of instances...... outcomes for young adults with type 1 diabetes (T1DM) is hampered by inconsistent use of outcome measures. This population frequently struggles to manage their condition and reports suboptimal clinical outcomes. Our aim was to conduct an international, e-Delphi consensus study to identify a core outcome...... set (COS) that key stakeholders (young adults with T1DM, diabetes health professionals, diabetes researchers and diabetes policy makers) consider as essential outcomes for future intervention research. METHODS: Using a list of 87 outcomes generated from a published systematic review, we administered...

  3. [Assessment of individual clinical outcomes: regarding an electroconvulsive therapy case].

    Science.gov (United States)

    Iraurgi, Ioseba; Gorbeña, Susana; Martínez-Cubillos, Miren-Itxaso; Escribano, Margarita; Gómez-de-Maintenant, Pablo

    2015-01-01

    Evaluation of therapeutic results and of the efficacy and effectiveness of treatments is an area of interest both for clinicians and researchers. In general, randomized controlled trial designs have been used as the methodology of choice in which intergroup comparisons are made having a minimum of participants in each arm of treatment. However, these procedures are seldom used in daily clinical practice. Despite this fact, the evaluation of treatment results for a specific patient is important for the clinician in order to address if therapeutic goals have been accomplished both in terms of statistical significance and clinical meaningfulness. The methodology based on the reliable change index (Jacobson y Truax)1 provides an estimate of these two criteria. The goal of this article is to propose a procedure to apply the methodology with a single case study of a woman diagnosed with major depression and treated with electroconvulsive therapy. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

  4. [Functional electrostimulation for drop foot treatment : Clinical outcome].

    Science.gov (United States)

    Yao, D; Jakubowitz, E; Ettinger, S; Claassen, L; Plaass, C; Stukenborg-Colsman, C; Daniilidis, K

    2017-03-01

    Neurologic paralysis of the foot due to damage to the central nervous system is primarily caused by a cerebral insult. The ankle-foot orthosis (AFO), which is the classical conservative treatment option, is associated with drawbacks, e.g., increased contractures, limited mobilization from the sitting position, and cosmetic aspects. Functional external electrostimulation (FES) is an suitable treatment method for patients with a central lesion and intact peroneal nerve. Based on this method, the neuroprosthesis is a dynamic therapy option in the form of an implantable nerve stimulator (ActiGait® system, Otto Bock, Duderstadt, Germany) which is placed directly on the motor branch of the peroneus nerve and results in active foot lifting. The aim of the present study is to evaluate the clinical effect of the ActiGait® system with regard to its suitability for everyday use by means of gait tests with an emphasis on time-distance parameters and to compare it with the current literature. In this retrospective study, the clinical results after implantation of the ActiGait® system are presented and evaluated. In summary, the implantation of a neuroprosthesis in patients with stroke-related drop foot represents a sensible and promising therapy option.

  5. Hypertensive thalamic hemorrhage. Clinical symptoms and outcomes in 40 cases

    Energy Technology Data Exchange (ETDEWEB)

    Munaka, Masahiro; Nishikawa, Michio; Hirai, Osamu; Kaneko, Takaaki; Watanabe, Syu; Fukuma, Jun; Handa, Hajime

    1988-12-01

    In the past six years, we have had experience with 40 patients with hypertensive thalamic hemorrhages, as verified by CT scan at our hospital within 24 hours. These patients were classified into the following three groups according to the location of the bleeding point and the size of the hematoma: (1) anteromedial (4 cases), (2) posterolateral (16 cases), and (3) massive (20 cases). The (1) and (2) hematomas were small (less than 3 cm in diameter), while those in (3) were large (more than 3 cm in diameter). Twenty cases (50% of all the thalamic hematomas) were small hematomas. The characteristic clinical symptoms of the anteromedial type were a mild disturbance of consciousness and thalamic dementia, while those of the posterolateral type were motor and sensory disturbance, and thalamic aphasia, respectively. Twenty cases (50%) were large hematomas. The clinical symptoms of these cases were mainly consciousness disturbance; 7 of them expired. Based on this experience, it may be considered that the patients whose hematoma size was larger than 3 cm had a poor prognosis and that the patients with the posterolateral type had a poor functional diagnosis.

  6. The relationship of individual characteristics, perceived worksite support and perceived creativity to clinical nurses' innovative outcome.

    Science.gov (United States)

    Tsai, Hsiu-Min; Liou, Shwu-Ru; Hsiao, Ya-Chu; Cheng, Ching-Yu

    2013-09-01

    To understand the relationship of individual characteristics, perceived worksite support and perceived personal creativity to clinical nurses' innovative outcome (receiving the Nursing Innovation Award). Since the idea of applying creativity and innovation to clinical nursing practice and management was first advocated in the Nursing Administration Quarterly in 1982, the topic of nursing innovation has gained worldwide attention. To increase the prevalence of nursing innovation, it is important to identify and understand the related factors that influence nurses' innovative outcome. This study used a cross-sectional descriptive survey design. A self-administered questionnaire was completed by 32 award winners and 506 nonawarded clinical nurses in Taiwan. The level of creativity perceived by all participants was moderate-to-high. Individual characteristics (r = 0·61) and worksite support (r = 0·27) were both correlated with perceived creativity. Individual characteristics and worksite support showed some correlation as well (r = 0·21). Individual characteristics and worksite support could predict perceived creativity after controlling for demographic variables, but only individual characteristics had an effect on innovative outcome. Perceived creativity did not have mediation effects either between individual characteristics and innovative outcome or between worksite support and innovative outcome. Clinical nurses' individual characteristics had a direct relationship to innovative outcome, whereas neither worksite support nor creativity was correlated with innovative outcome. Although worksite support did not show effects on innovative outcome, it was related to both perceived creativity and individual characteristics. As suggested by other scholars, there might be other related factors between creativity and innovative outcome. Although worksite support did not have effect on clinical nurses' innovative outcome, it was related to individual characteristics

  7. Serum magnesium levels and clinical outcome of aneurysmal subarachnoid hemorrhage: a study in 60 patients

    Directory of Open Access Journals (Sweden)

    Habibi Z

    2008-06-01

    Full Text Available Background: Hypomagnesemia is commonly encountered in patients with a wide variety of diseases including subarachnoid hemorrhage (SAH, cardiovascular emergencies, head trauma, migraine attacks, seizure and preeclampsia. It seems to be associated with a poor clinical outcome. This study considers the prevalence and temporal distribution of hypomagnesemia after aneurysmal SAH and its correlation with the severity of SAH, delayed cerebral ischemia (DCI as well as the neurological outcome after a period of three months.Methods: Between 2003 and 2008, 60 patients were admitted to the emergency ward of Imam Khomeini Hospital with acute SAH. Serum magnesium levels were measured during the first 72 hours, days 4-7, and second and third weeks after SAH. The three-month outcome was assessed according to the Glasgow Outcome Scale (GOS. Clinical SAH grading was performed according to the criteria of the World Federation of Neurological Surgeons (WFNS and the patients were allocated to "Good" (GOS = 4, 5 and "Poor" (GOS= 1-3 outcome groups. The prevalence of hypomagnesemia was assessed in both patient groups. Fisher exact test was used to analyze data.Results: Hypomagnesemia occurred in 22% of patients during the first 72 hours after SAH. It was associated with more prevalent DCI (p<0.05, whereas low serum magnesium levels during days 4-7 17% of patients and the second week (22% of patients after SAH were correlated with poor clinical outcome (p<0.05. No correlation was found between first 72 hour-hypomagnesemia and poor clinical outcome at three months.Conclusion: Hypomagnesemia occurs after aneurysmal SAH and it may predict the occurrence of DCI, while low serum magnesium levels during days 4-7 and within the second week of event predict poor clinical outcome at three months. Treatment of this electrolyte disturbance may have a favourable effect on the clinical outcome of patients with aneurysmal SAH.

  8. Unravelling the Mystery Between Structure and Sustained Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    Edward Keystone

    2016-07-01

    Full Text Available Targeted biologics have revolutionised the treatment and outlook of patients with inflammatory joint diseases. The combination of high-cost long-term therapy straining healthcare systems with impending expiry of key biologics patents has led to heightened interest in the development of biosimilars. The expanding landscape of biosimilars has triggered, in healthcare providers, the need to explore the option to non-medically switch stable patients from costly reference products to less expensive alternatives. Currently, there are many unknowns surrounding the effects of non-medical switching on patient outcomes and cost-effectiveness. Prof Edward Keystone opened the symposium by discussing the constantly evolving landscape of biologics, highlighting that their high cost is becoming an increasing challenge and has created the issue of non-medical switching. Dr Leigh Revers provided a background to the structural and functional relationships of biologic therapies, stressing the need for careful control of the manufacturing processes of these large and complex molecules. Prof Keystone presented the long-term data currently available for anti-tumour necrosis factor (anti-TNF agents and examined how sustainability of response can be influenced by multiple factors. Prof Thomas Dörner concluded the symposium by stressing the importance of the prescribing doctor being in control of which biologics their patients receive to ensure effective pharmacovigilance. The challenge of non-medical switching was discussed along with the potential trial designs that could help to determine if biologics and biosimilars could be interchangeable.

  9. Improving Clinical Outcomes for Patients With Class III Heart Failure.

    Science.gov (United States)

    Shapiro, Melissa; Bires, Angela Macci; Waterstram-Rich, Kristen; Cline, Thomas W

    Heart failure (HF) is a serious medical problem in the United States and is placing a financial strain on the health care system. It is the leading cause of mortality and as the overall incidence continues to increase, so does the economic impact on the health care system. Innovative treatment options, in the form of disease management programs and implantable cardiac devices, such as the CorVue capable implantable cardioverter defibrillator (ICD) pacemaker, offer the promise of an enhanced quality of life and reduced mortality. Even with these advances, HF continues to be a challenge. Studies reviewing HF management programs have shown promising results. However, more studies are needed to determine which combination of HF management interventions has the greatest financial impact and yields the best patient outcomes. The objective of the research study was to compare 30-day readmission rates of patients implanted with the CorVue capable ICD pacemaker with patients with congestive heart failure (CHF) with no implanted device. The aim of the research focused on the usefulness of intrathoracic impedance monitoring alerts in guiding empirical treatment of patients with CHF to prevent HF readmissions. Methodology included a retrospective medical chart review, comparing 30-day readmission events among patients with class III CHF who received home health intervention with similar patients implanted with the CorVue ICD.

  10. Clinician-Reported Outcome Assessments of Treatment Benefit: Report of the ISPOR Clinical Outcome Assessment Emerging Good Practices Task Force.

    Science.gov (United States)

    Powers, John H; Patrick, Donald L; Walton, Marc K; Marquis, Patrick; Cano, Stefan; Hobart, Jeremy; Isaac, Maria; Vamvakas, Spiros; Slagle, Ashley; Molsen, Elizabeth; Burke, Laurie B

    2017-01-01

    A clinician-reported outcome (ClinRO) assessment is a type of clinical outcome assessment (COA). ClinRO assessments, like all COAs (patient-reported, observer-reported, or performance outcome assessments), are used to 1) measure patients' health status and 2) define end points that can be interpreted as treatment benefits of medical interventions on how patients feel, function, or survive in clinical trials. Like other COAs, ClinRO assessments can be influenced by human choices, judgment, or motivation. A ClinRO assessment is conducted and reported by a trained health care professional and requires specialized professional training to evaluate the patient's health status. This is the second of two reports by the ISPOR Clinical Outcomes Assessment-Emerging Good Practices for Outcomes Research Task Force. The first report provided an overview of COAs including definitions important for an understanding of COA measurement practices. This report focuses specifically on issues related to ClinRO assessments. In this report, we define three types of ClinRO assessments (readings, ratings, and clinician global assessments) and describe emerging good measurement practices in their development and evaluation. The good measurement practices include 1) defining the context of use; 2) identifying the concept of interest measured; 3) defining the intended treatment benefit on how patients feel, function, or survive reflected by the ClinRO assessment and evaluating the relationship between that intended treatment benefit and the concept of interest; 4) documenting content validity; 5) evaluating other measurement properties once content validity is established (including intra- and inter-rater reliability); 6) defining study objectives and end point(s) objectives, and defining study end points and placing study end points within the hierarchy of end points; 7) establishing interpretability in trial results; and 8) evaluating operational considerations for the implementation of

  11. The clinical outcome of cesarean scar pregnancies implanted "on the scar" versus "in the niche".

    Science.gov (United States)

    Kaelin Agten, Andrea; Cali, Giuseppe; Monteagudo, Ana; Oviedo, Johana; Ramos, Joanne; Timor-Tritsch, Ilan

    2017-05-01

    The term cesarean scar pregnancy refers to placental implantation within the scar of a previous cesarean delivery. The rising numbers of cesarean deliveries in the last decades have led to an increased incidence of cesarean scar pregnancy. Complications of cesarean scar pregnancy include morbidly adherent placenta, uterine rupture, severe hemorrhage, and preterm labor. It is suspected that cesarean scar pregnancies that are implanted within a dehiscent scar ("niche") behave differently compared with those implanted on top of a well-healed scar. To date there are no studies that have compared pregnancy outcomes between cesarean scar pregnancies implanted either "on the scar" or "in the niche." The purpose of this study was to determine the pregnancy outcome of cesarean scar pregnancy implanted either "on the scar" or "in the niche." This was a retrospective 2-center study of 17 patients with cesarean scar pregnancy that was diagnosed from 5-9 weeks gestation (median, 8 weeks). All cesarean scar pregnancies were categorized as either implanted or "on the scar" (group A) or "in the niche" (group B), based on their first-trimester transvaginal ultrasound examination. Clinical outcomes based on gestational age at delivery, mode of delivery, blood loss at delivery, neonate weight and placental histopathologic condition were compared between the groups with the use of the Mann-Whitney U test. Myometrial thickness overlying the placenta was compared among all the patients who required hysterectomy and those who did not with the use of the Mann-Whitney U test. Myometrial thickness was also correlated with gestational age at delivery with the use of Spearman's correlation. Group A consisted of 6 patients; group B consisted of 11 patients. Gestational age at delivery was lower in group B (median, 34 weeks; range, 20-36 weeks) than in group A (median, 38 weeks; range, 37-39 weeks; P=.001). In group A, 5 patients were delivered via cesarean delivery (with normal placenta), and

  12. Association of Parasite Load Levels in Amniotic Fluid With Clinical Outcome in Congenital Toxoplasmosis.

    Science.gov (United States)

    Yamamoto, Lidia; Targa, Lília S; Sumita, Laura M; Shimokawa, Paulo T; Rodrigues, Jonatas C; Kanunfre, Kelly A; Okay, Thelma S

    2017-08-01

    To correlate neonatal and infant clinical outcome with parasite load in amniotic fluid (AF). We conducted a retrospective cohort study of 122 children whose mothers had toxoplasmosis during pregnancy. The children were monitored from birth to 12 months old. Stored AF samples were obtained at maternal diagnosis and tested by quantitative polymerase chain reaction. Gestational age at maternal infection, quantitative polymerase chain reaction results, neonatal anti-Toxoplasma gondii immunoglobulin (Ig) M, and clinical outcome at 12 months were correlated. Maternal infection occurred in 18 of 122 (14.7%) and 104 of 122 (85.2%) women in the first and second trimesters, respectively. At birth, IgM was present in 107 of 122 (87.7%) neonates and 36 (29.5%) were symptomatic. Of these, half occurred in the first and the other half in the second trimester and 6 of 36 had severe infections (16.7% of symptomatic, 4.9% of total), all infected in the first trimester. Parasite load levels were highly variable (median 35 parasites/mL, range 2-30,473). Logistic regression correlated symptomatic infection with gestational age (odds ratio [OR] 0.47, CI 0.31-0.73) and parasite load (OR 2.04, CI 1.23-3.37), but not with positive IgM (OR 6.81, CI 0.86-53.9). Negative correlations were found between gestational age and parasite load (rs -0.780, CI -0.843 to -0.696), gestational age and symptoms (rs -0.664, CI -0.755 to -0.547), but not gestational age and IgM (rs -0.136, CI -0.311 to 0.048). Parasite load levels distributed by percentile showed that all symptomatic patients appeared from the 75th percentile and all severe infections from the 95th percentile. Load rankings showed doubled the OR for each 20 parasite/mL increment. Parasite load was associated with symptomatic infections (area under the curve 0.959, CI 0.908-0.987) as well as gestational age (area under the curve 0.918, CI 0.855-0.960) and both parameters combined (area under the curve 0.969, CI 0.920-0.992). Parasite load in

  13. Clinical outcomes of repeat autologous cultivated limbal epithelial transplantation for ocular surface burns.

    Science.gov (United States)

    Basu, Sayan; Ali, Hasnat; Sangwan, Virender S

    2012-04-01

    To report the clinical outcomes of repeat autologous cultivated limbal epithelial transplantation in patients with recurrence of limbal stem cell deficiency after a failed primary procedure. Retrospective case series. This study included 50 patients, above 8 years of age, with clinically diagnosed unilateral limbal stem cell deficiency following ocular surface burns, treated between 2001 and 2010. Following failure of primary surgery all patients underwent a repeat limbal biopsy from the unaffected eye. The limbal cells were expanded ex vivo on a human amniotic membrane substrate for 10 to 14 days using a completely xeno-free explant culture technique. The resulting cultured epithelial monolayer and amniotic membrane were transplanted onto the patient's affected eye. All patients underwent a comprehensive ophthalmic examination of both eyes at every follow-up visit. Postoperative corneal surface stability, change in visual acuity, and complications were objectively analyzed. At a mean follow-up of 2.3±1.4 (median: 1.96, range: 1 to 7.5) years, 33 of the 50 recipient eyes (66%) maintained a completely epithelialized, avascular, and clinically stable corneal surface. A 2-line improvement in visual acuity was seen in 38 of the 50 recipient eyes (76%). None of the donor eyes developed any clinical features of ocular surface disease, conjunctival overgrowth of the donor site, or decrease in vision throughout the follow-up period. Repeat autologous cultivated limbal epithelial transplantation successfully restores corneal epithelial stability and improves vision in eyes with recurrence of limbal stem cell deficiency, following failed primary surgery for ocular burns, without adversely affecting donor eyes. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures.

    Science.gov (United States)

    Little, M W; Oakley, T; Briggs, J H; Sutcliffe, J A; Allouni, A K; Makris, G; Bratby, M J; Tapping, C R; Patel, R; Wigham, A; Anthony, S; Phillips-Hughes, J; Uberoi, R

    2016-10-01

    To assess the factors contributing to the technical and clinical success of colorectal stenting for large bowel obstruction. 268 cases of colonic stenting for large bowel obstruction were performed in 249 patients of mean age of 72 years (28-98) between 2006 and 2013. The majority of strictures were due to malignant disease, 244/268 (91 %). Diverticular strictures accounted for 24/268 (9 %). Overall technical success rate was 81 % (217/268), with a clinical success rate of 65 % (174/268). Duration of symptoms ranged from 0 to 180 days (mean 8 days). Technical success rate was seen to decrease with increasing symptom duration. For symptom duration of less than 1 week, technical success was 85.4 % (181/212) versus 69.6 % (39/56) for those with symptoms of greater than a week (p < 0.05). Clinical success rates fell from 71.3 % (107/150) to 59.3 % (70/118) (p < 0.05) when attempting to stent lesions of greater than 5 cm. There was also a significant reduction in clinical success when stenting lesions on a bend rather than a straight segment of colon 75.7 % (109/144) versus 59.7 % (74/124) (p < 0.05). A total of 20 (7.46 %) perforations were identified during the study. Stent migration occurred in 6.6 % of cases. In-stent stenosis occurred in 3.3 %. The overall 30-day all cause mortality rate was 9 %. Lesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.

  15. Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures

    Energy Technology Data Exchange (ETDEWEB)

    Little, M. W.; Oakley, T.; Briggs, J. H.; Sutcliffe, J. A.; Allouni, A. K.; Makris, G.; Bratby, M. J.; Tapping, C. R.; Patel, R.; Wigham, A.; Anthony, S.; Phillips-Hughes, J.; Uberoi, R., E-mail: Raman.uberoi@ouh.nhs.uk [Oxford University Hospitals NHS Foundation Trust, Department of Interventional Radiology, John Radcliffe Hospital (United Kingdom)

    2016-10-15

    AimsTo assess the factors contributing to the technical and clinical success of colorectal stenting for large bowel obstruction.Methodology268 cases of colonic stenting for large bowel obstruction were performed in 249 patients of mean age of 72 years (28–98) between 2006 and 2013. The majority of strictures were due to malignant disease, 244/268 (91 %). Diverticular strictures accounted for 24/268 (9 %).ResultsOverall technical success rate was 81 % (217/268), with a clinical success rate of 65 % (174/268). Duration of symptoms ranged from 0 to 180 days (mean 8 days). Technical success rate was seen to decrease with increasing symptom duration. For symptom duration of less than 1 week, technical success was 85.4 % (181/212) versus 69.6 % (39/56) for those with symptoms of greater than a week (p < 0.05). Clinical success rates fell from 71.3 % (107/150) to 59.3 % (70/118) (p < 0.05) when attempting to stent lesions of greater than 5 cm. There was also a significant reduction in clinical success when stenting lesions on a bend rather than a straight segment of colon 75.7 % (109/144) versus 59.7 % (74/124) (p < 0.05). A total of 20 (7.46 %) perforations were identified during the study. Stent migration occurred in 6.6 % of cases. In-stent stenosis occurred in 3.3 %. The overall 30-day all cause mortality rate was 9 %.ConclusionLesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.

  16. A study of the clinical profile and outcome of spina bifida

    Directory of Open Access Journals (Sweden)

    Theophilus Nikita Kumar

    2016-02-01

    Full Text Available Neural tube defects (NTDs are a group of congenital anomalies characterized by defects in dorsal midline structures, including neural tissue, dura, muscle, bone and/or skin. The clinical presentations and the follow-up of these patients requires attention to various end organs besides the nervous system. To evaluate the clinical profile and surgical outcome of children with spina bifida. Out of a total of 74 patients treated at our institute for spina bifida between June 2013 to august 2015, 74 cases of spina bifida were analyzed retrospectively and prospectively. The clinical profile, radiological findings and urodynamic studies were recorded. Craniospinal MRI was done in patients to screen for Arnold Chiari malformations and monitoring of hydrocephalus was done as a management protocol at our institute for these children. All these patients except two underwent surgery for correction and closure of the spinal defect. Associated anomalies were treated accordingly. They were clinically assessed over a mean follow up period of 1.3years, ranging from 2months to 2½ years. 73% of the patients presented in the neonatal age group. Of which, 72% presented with a visible sac over the back.72% of the cases were Myelomeningocoeles. 79% of the defects were in the lumbosacral region.30% presented with sensorimotor loss or bladder bowel incontinence. Sensorimotor improvement was seen in 12.5% after repairing the defect with the help of physiotherapy and braces. 30% of the patients were diagnosed to have hydrocephalus, of which 33% required a CSF diversion procedure. The postoperative course of spina bifida repair was found to be uneventful in 90% of the patients

  17. Clinical patterns and outcomes of status epilepticus in patients with tuberous sclerosis complex

    Science.gov (United States)

    Shehata, Hatem S; AbdelGhaffar, Hadeer Mahmoud; Nasreldin, Mohammed; Elmazny, Alaa; Abdelalim, Ahmed; Sabbah, Asmaa; Shalaby, Nevin M

    2017-01-01

    Introduction Refractory epilepsy is a common clinical manifestation in patients with tuberous sclerosis complex (TSC), which can be complicated by many life-threatening conditions, such as status epilepticus (SE). However, very few reports mention the patterns and semiology of SE in those patients. Objective To study the clinical characteristics and outcomes of SE in TSC patients. Materials and methods This observational, prospective study was carried out on 36 Egyptian children with definite TSC. Clinical history, general and neurological examination and psychometric evaluation by standard questionnaires were used to explore characteristics of epileptic manifestations and clinical patterns of SE. All included patients were required to have long-term video electroencephalograms (EEGs) and brain MRI performed. Results A total of 32 attacks of SE were recorded in 21 patients (58.3%) in our cohort during a follow-up period of 2.8±1.1 years; of those patients, 15 had convulsive status, 7 had non-convulsive SE, 6 had refractory/super-refractory SE and 14 patients had a history of infantile spasms (epileptic spasms). The duration of status ranged from 40 to 150 min (mean ± standard deviation: 90±15). Fourteen patients with SE had severe mental retardation, 9 had autistic spectrum disorder and 22 had severe epileptogenic EEG findings. Patients with SE had higher tuber numbers (mean: 9.6), 5 patients had subependymal giant cell astrocytomas and 2 patients had their SE after receiving everolimus. Conclusions The incidence of SE in our patient sample is high (>50%); severe mental retardation, autistic features, history of infantile spasm (epileptic spasms) and high tuber burden are risk factors for developing SE. PMID:28721058

  18. Clinical outcomes of gastric polyps and neoplasms in patients with familial adenomatous polyposis

    Science.gov (United States)

    Nakamura, Keiko; Nonaka, Satoru; Nakajima, Takeshi; Yachida, Tatsuo; Abe, Seiichiro; Sakamoto, Taku; Suzuki, Haruhisa; Yoshinaga, Shigetaka; Oda, Ichiro; Matsuda, Takahisa; Sekine, Shigeki; Kanemitsu, Yukihide; Katai, Hitoshi; Saito, Yutaka; Hirota, Seiichi

    2017-01-01

    Background and study aims Familial adenomatous polyposis (FAP) is an autosomal dominant syndrome caused by a germline mutation in the adenomatous polyposis coli (APC) gene, characterized by the presence of more than 100 adenomatous polyps in the colorectum. The upper gastrointestinal tract is an extracolonic site for malignancy in patients with FAP. The frequency of death in Japanese patients with FAP because of gastric cancer is 2.8 % and that because of colon cancer is 60.6 %. Few studies have reported upper gastrointestinal diseases in patients with FAP. In the present study, we investigated the clinical outcomes of patients with FAP diagnosed with gastric neoplasms. Patients and methods We enrolled 80 patients with FAP who underwent esophagogastroduodenoscopy from October 1997 to December 2011. We investigated patient characteristics, endoscopic findings of gastric lesions, treatment outcomes, and long-term courses. Results Fundic gland polyposis was observed in 51 patients (64 %) and gastric neoplasms in 22 patients (28 %), including 20 with non-invasive and 2 with invasive neoplasm. Of the 26 neoplasms, 11 were treated by endoscopic resection (ER) and 4 by surgical resection. Metachronous gastric neoplasms were observed in 7 patients (15 lesions) and treated by ER, except for in 1 patient. No patients died of gastric lesions during a median follow-up period of 6.5 years (range, 0 – 14). Conclusion Because gastric lesions including gastric cancers in patients with FAP did not cause any deaths, they can be considered to have favorable prognoses. Early detection of gastric neoplasms through an appropriate follow-up interval may have contributed to these good outcomes. PMID:28271094

  19. Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome.

    Science.gov (United States)

    Mente, Johannes; Geletneky, Beate; Ohle, Marc; Koch, Martin Jean; Friedrich Ding, Paul Georg; Wolff, Diana; Dreyhaupt, Jens; Martin, Nicolas; Staehle, Hans Joerg; Pfefferle, Thorsten

    2010-05-01

    The use of mineral trioxide aggregate (MTA) might improve the prognosis of teeth after pulp exposure. The treatment outcome of teeth after direct pulp capping, either with mineral trioxide aggregate (MTA) or calcium hydroxide (controls), was investigated, taking into account possible confounding factors. One hundred forty-nine patients treated between 2001 and 2006 who received direct pulp capping treatment in 167 teeth met the inclusion criteria. Treatment was performed by supervised undergraduate students (72%) and dentists (28%). Assessment of clinical and radiographic outcomes was performed by calibrated examiners 12-80 months after treatment (median, 27 months). One hundred eight patients (122 treated teeth) were available for follow-up (72.5% recall rate). A successful outcome was recorded for 78% of teeth (54 of 69) in the MTA group and for 60% of teeth (32 of 53) in the the calcium hydroxide group. The univariate analysis (generalized estimation equations model [GEE model] showed a significant difference in the success rate (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.05-5.32; P = .04). In the multiple analysis (GEE model), the OR is marginally inside the nonsignificant range (OR, 0.43; 95% CI, 0.19-1.02; P = .05) when conspicuous confounding factors are stabilized (univariate analysis). Multiple analysis showed that teeth that were permanently restored >or=2 days after capping had a significantly worse prognosis in both groups (OR, 0.24; 95% CI, 0.09-0.66; P = .01). MTA appears to be more effective than calcium hydroxide for maintaining long-term pulp vitality after direct pulp capping. The immediate and definitive restoration of teeth after direct pulp capping should always be aimed for. Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  20. Clinical profile and outcome of renal tubular disorders in children: A single center experience

    Directory of Open Access Journals (Sweden)

    B Vijay Kiran

    2014-01-01

    Full Text Available Tubular disorders form a significant proportion of pediatric kidney diseases and are an important differential diagnosis of failure to thrive (FTT in children. Data regarding their outcome is scarce from India. We evaluated the clinical profile of these children and studied the outcome in terms of their growth and renal failure. This is a retrospective longitudinal study of all children with renal tubular disorders attending a tertiary care pediatric nephrology center from 2005 to 2010. Growth and renal outcomes were assessed by Z scores and estimated glomerular filtration rate at diagnosis and. The common disorders encountered were distal renal tubular acidosis (d-RTA (44%, Bartter-like (Bartter′s and Gitelman syndromes (22% followed by hereditary Fanconi syndrome (cystinosis and idiopathic Fanconi syndrome (13% and few cases of nephrogenic diabetes insipidus, hypophosphatemic rickets and idiopathic hypercalciuria. Male: female ratio was 1.22. The median age at diagnosis was 1.5 (range 0.13-11 years. Growth failure was the presenting feature in 86% of children followed by polyuria (60% and bone deformities (47%. In 60% of children with hereditary Fanconi syndrome, nephropathic cystinosis was diagnosed, all of whom progressed to stage III chronic kidney disease (CKD within 3.41 ± 1.42 years. With appropriate therapy, catch-up growth was noted in d-RTA and Bartter syndrome. Renal tubular disorders usually present with FTT. d-RTA is the most common etiology followed by Bartter-like syndrome. Renal function is preserved in all these disorders except for nephropathic cystinosis, who ultimately progressed to CKD. With appropriate and inexpensive therapy, these children do grow well.

  1. Clinical features and outcomes in patients with disseminated toxoplasmosis admitted to intensive care: a multicenter study.

    Science.gov (United States)

    Schmidt, Matthieu; Sonneville, Romain; Schnell, David; Bigé, Naike; Hamidfar, Rebecca; Mongardon, Nicolas; Castelain, Vincent; Razazi, Keyvan; Marty, Antoine; Vincent, François; Dres, Martin; Gaudry, Stephane; Luyt, Charles Edouard; Das, Vincent; Micol, Jean-Baptiste; Demoule, Alexandre; Mayaux, Julien

    2013-12-01

    Characteristics and outcomes of adult patients with disseminated toxoplasmosis admitted to the intensive care unit (ICU) have rarely been described. We performed a retrospective study on consecutive adult patients with disseminated toxoplasmosis who were admitted from January 2002 through December 2012 to the ICUs of 14 university-affiliated hospitals in France. Disseminated toxoplasmosis was defined as microbiological or histological evidence of disease affecting >1 organ in immunosuppressed patients. Isolated cases of cerebral toxoplasmosis were excluded. Clinical data on admission and risk factors for 60-day mortality were collected. Thirty-eight patients were identified during the study period. Twenty-two (58%) had received an allogeneic hematopoietic stem cell transplant (median, 61 [interquartile range {IQR}, 43-175] days before ICU admission), 4 (10%) were solid organ transplant recipients, and 10 (27%) were infected with human immunodeficiency virus (median CD4 cell count, 14 [IQR, 6-33] cells/µL). The main indications for ICU admission were acute respiratory failure (89%) and shock (53%). The 60-day mortality rate was 82%. Allogeneic hematopoietic stem cell transplant (hazard ratio [HR] = 2.28; 95% confidence interval [CI], 1.05-5.35; P = .04) and systolic cardiac dysfunction (HR = 3.54; 95% CI, 1.60-8.10; P toxoplasmosis leading to ICU admission has a poor prognosis. Recipients of allogeneic hematopoietic stem cell transplant appear to have the highest risk of mortality. We identified systolic cardiac dysfunction as a major determinant of outcome. Strategies aimed at preventing this fatal opportunistic infection may improve outcomes.

  2. Clinical outcomes and safety of distal biceps repair using a modified entry point.

    Science.gov (United States)

    Baba, Mohammed; Leon, Johanna Viktoria; Symes, Michael; Dorrestijn, Oscar; Young, Allan; Cass, Benjamin

    2017-05-01

    The purpose of this study is to determine the safety of a one-incision technique for distal biceps repair with modified repair entry point in regards to the distance from the posterior interosseous nerve (PIN). Secondly, we present the clinical results of patients having undergone this procedure. Ten cadaveric specimens were dissected to reveal the radial tuberosity. Two 1.6-mm guidewires were inserted into the radial tuberosity, one centrally, and one 5-mm more proximal. Both guidewires penetrated the dorsal cortex, and posterior dissection revealed their exit points. The distance from the PIN and each wire was determined using a vernier calliper. The functional outcomes of 10 patients' post repair were reviewed. Performance was determined using strength and range of motion (ROM) measurements. Functional impairment was assessed using the disability of the arm, shoulder and hand outcome measure (DASH score). The uninjured side was used as a control. The mean distance from the centre of the radial tuberosity to the PIN was 7.33 mm with a centrally placed wire, compared with 10.92 mm when measuring from the proximal guidewire (P < 0.05). Supination and flexion strengths were 83 and 90% of the uninjured side, respectively. There was a mean of 1.5° loss of flexion and 0° loss of extension. Loss of pronation and supination ROM were 0.5° and 4.5° on average, respectively. Average DASH score was 6.3. We recommend a 5-mm more proximal entry point for insertion of the guidewire during distal biceps repair. This poses less risk to the PIN without significant functional impairment. Our outcomes are comparable with those reported in the literature. © 2016 Royal Australasian College of Surgeons.

  3. Ultrasonic vs. hand instrumentation in periodontal therapy: clinical outcomes.

    Science.gov (United States)

    Krishna, Ranjitha; De Stefano, Jamie A

    2016-06-01

    Periodontal disease is the most common oral disease in adults. Traditional nonsurgical periodontal therapy involves subgingival removal of hard and soft deposits on the root surface, along with maintenance of good oral hygiene. Nonsurgical periodontal therapy can either be definitive or part of the initial phase before surgical therapy. Mechanical therapy, either with hand or ultrasonic instrumentation, is the keystone of nonsurgical periodontal therapy. This requires considerable amounts of time and a high level of operator skill. The use of appropriate instruments greatly increases clinical efficiency. This article discusses the use of ultrasonic and hand instrumentation, along with recent advances, and the benefits of adjunctive therapy during nonsurgical periodontal therapy. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Infratentorial posterior circulation stroke in a Nigerian population: Clinical characteristics, risk factors, and predictors of outcome

    Directory of Open Access Journals (Sweden)

    Lukman Femi Owolabi

    2016-01-01

    Full Text Available Background: Posterior circulation stroke (PCS, though less common, differs from stroke in anterior circulation in many aspects. Relatively, it portends a poorer prognosis. However, there is a paucity of data from African countries, in particular, where stroke is a menace. Objective: The study aimed to evaluate the etiology, clinical characteristics, outcome, and predictors of outcome in a cohort of patients with IPCS in Northwestern Nigeria. Materials and Methods: Out of 595 patients with stroke, we prospectively analyzed 57 patients with PCS in a Tertiary Care Center in Kano, Northwestern Nigeria. Patients were analyzed for demographic data, risk factors, clinical characteristics, stroke subtypes, mortality, and predictors of mortality. Results: Posterior circulation ischemic stroke accounted for 57 (9.6% of 595 of all strokes seen in the study period. They comprised 44 males (mean age 47.8 ± 17.7 and 13 females (mean age 46.3 ± 13.7. Overall, their age ranged between 24 and 90 (mean age 47.4 ± 16.7. However, 52.7% of the patients were < 45 years of age. The most common site affected was the cerebellum seen in 33 (57.9% patients. Hypertension was the most common risk factor (86%. Headache and vertigo were the most common features accounting for 83.6% and 86.3%, respectively. Thirty-eight (66.7% patients had an ischemic stroke. Twenty-one (36.8% of the patients died during the 1-month period of follow-up. Independent predictors of death in the study were hyperglycemia on admission and hemorrhagic stroke. Conclusions: IPCS occurred in a relatively younger age group. Headache and vertigo were the most common symptoms. The independent predictors of death in the study were hyperglycemia at presentation and hemorrhagic stroke.

  5. Clinical significance of pneumatosis intestinalis - correlation of MDCT-findings with treatment and outcome

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    Treyaud, Marc-Olivier; Duran, Rafael; Knebel, Jean-Francois; Meuli, Reto A.; Schmidt, Sabine [Lausanne University Hospital, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Zins, Marc [Fondation Hopital St Joseph, Department of Radiology, Paris (France)

    2017-01-15

    To evaluate the clinical significance of pneumatosis intestinalis (PI) including the influence on treatment and outcome. Two radiologists jointly reviewed MDCT-examinations of 149 consecutive emergency patients (53 women, mean age 64, range 21-95) with PI of the stomach (n = 4), small (n = 68) and/or large bowel (n = 96). PI extension, distribution and possibly associated porto-mesenteric venous gas (PMVG) were correlated with other MDCT-findings, risk factors, clinical management, laboratory, histopathology, final diagnosis and outcome. The most frequent cause of PI was intestinal ischemia (n = 80,53.7 %), followed by infection (n = 18,12.1 %), obstructive (n = 12,8.1 %) and non-obstructive (n = 10,6.7 %) bowel dilatation, unknown aetiologies (n = 8,5.4 %), drugs (n = 8,5.4 %), inflammation (n = 7,4.7 %), and others (n = 6,4 %). Neither PI distribution nor extension significantly correlated with underlying ischemia. Overall mortality was 41.6 % (n = 62), mostly related to intestinal ischemia (p = 0.003). Associated PMVG significantly correlated with underlying ischemia (p = 0.009), as did the anatomical distribution of PMVG (p = 0.015). Decreased mural contrast-enhancement was the only other MDCT-feature significantly associated with ischemia (p p < 0.001). Elevated white blood count significantly correlated with ischemia (p = 0.03). In emergency patients, ischemia remains the most common aetiology of PI, showing the highest mortality. PI with associated PMVG is an alerting sign. PI together with decreased mural contrast-enhancement indicates underlying ischemia. (orig.)

  6. Transurethral front-firing Greenlight bladder autoaugmentation for bladder contracture: technique and clinical outcomes.

    Science.gov (United States)

    Bao, Ji-Ming; Tan, Wan-Long; Wang, Bing-Wei; Qiu, Xiao-Fu; Liu, Bai-Chuan; Zhong, Rui-Lun; Li, Gao-Yuan; Yang, Guo-Sheng

    2016-04-01

    To describe a novel transurethral front-firing Greenlight bladder autoaugmentation for the treatment of bladder contracture and report initial clinical outcomes. Between April 2014 and August 2015, five patients diagnosed with contracted bladder were all refractory to conservative treatment and received novel transurethral autoaugmentation. CT scan and urodynamics examination were conducted before operation for disease assessment. Mucosal and muscular layers of bladder wall in fundus were incised vertically and horizontally with front-firing Greenlight laser to enlarge bladder capacity in the operation. Imaging examination and periodical urodynamics study were performed to evaluate the clinical outcomes of the procedure in postoperative follow-up. Transurethral front-firing Greenlight bladder autoaugmentation was performed successfully on all the patients. The mean operative time was 59 min (range 52-65 min) with no significant blood loss. Urodynamic parameters of these patients after operation improved significantly compared with those before operation. Average maximum cystometric capacity (Vmax) increased from 91.2 to 333 ml (p < 0.01), average maximum flow rate (Qmax) ascended from 12.6 to 18.62 ml/min (p < 0.01), and average flow rate (Q(ave)) also increased from 5.74 to 13.18 ml/min (p < 0.01). At the last follow-up, all the patients could void spontaneously with good bladder emptying and their symptoms improved significantly. Our novel transurethral front-firing Greenlight bladder autoaugmentation is a safe and effective treatment for contracted bladders. Future studies with larger sample size and long-term follow-up are needed to confirm our findings.

  7. Superior cerebellar artery aneurysms: incidence, clinical presentation and midterm outcome of endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Peluso, Jo P.P.; Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2007-09-15

    The aim of this retrospective study was to determine the incidence, clinical presentation and midterm clinical and imaging outcome of endovascular treatment of 34 superior cerebellar artery (SCA) aneurysms in 33 patients. Between January 1995 and January 2007, 2,112 aneurysms were treated in our institution, and 36 aneurysms in 35 patients were located on the SCA (incidence 1.7%). Two of three distal SCA aneurysms were excluded. All the remaining 34 SCA aneurysms, of which 22 (65%) were ruptured and 12 (35%) were unruptured, in 33 patients were treated by endovascular techniques. There were 6 men and 27 women ranging from 29-72 years. In 14 patients (42%) multiple aneurysms were present. Initial angiographic occlusion was (near) complete in 32 aneurysms (94%) and incomplete in 2 aneurysms (6%). Complications leading to permanent morbidity or death occurred in two patients (6.1%, 95% CI 0.6 to 20.60%). Outcome at 6 months follow-up in 31 surviving patients was GOS5 in 26 (84%), GOS4 in 4 (13%) and GOS3 in 1 patient (3%). There were no episodes of (re)bleeding during 118 patient-years of follow-up. The 6-month angiographic follow up in 28 SCA aneurysms and extended angiographic follow-up in 19 showed stable occlusion in 27 aneurysms. No additional treatments were performed. SCA aneurysms are rare with an incidence of 1.7% of treated aneurysms at our institution. They are frequently associated with other aneurysms. Endovascular treatment is effective and safe in excluding the aneurysms from the circulation. (orig.)

  8. Long-term clinical outcomes of Iranian veterans with unilateral transfemoral amputation.

    Science.gov (United States)

    Ebrahimzadeh, Mohammad H; Fattahi, Asieh Sadat

    2009-01-01

    To study long-term outcome of unilateral above-knee amputation. Long-term clinical symptoms and functional status of above-knee amputees are not well documented. The purpose of this study was to document the long-term outcome of war related above-knee amputations. The study consisted of a comprehensive assessment and examination and review of history and wartime medical records of 31 Iranian above-knee amputees from the Iraq-Iran war by using a detailed questionnaire. The average follow-up was 17.5 years (range from 15 to 22 years). All patients were males and had been combatants. The most common agent of war injury was a shell with an incidence of 45.1%, while land mines and direct bullet shots were the following causes of war injury resulting in amputation in 41.9% and 12.9%, respectively. Clinical symptoms included phantom sensation in 27 patients (87%), phantom pain in 14 patients (45.1%), phantom movement in 5 patients (16.1%) patients and stump pain in 20 patients (64.5%). Additionally, 19 patients (61.2%) suffered from back pain, 17 patients (54.8%) complained of contra lateral (non-amputated) knee pain and 4 patients (14.8%) complained of ipsilateral hip pain. Seventeen patients (54%) reported psychological problems. Eighteen cases (58%) were employed or had been employed for multiple years after amputation. All patients (100%) were married and 30 (96.7%) had offspring. The study showed that our patients had significant rates of amputation symptoms after an average of two decades of amputation, but on the other hand good family and social function of the patients were recorded. Amputation is not a static disability but a progressive deteriorating condition that affects the health condition of the amputee over time.

  9. Clinical presentation and outcome of epidemic Kaposi sarcoma in Ugandan children.

    Science.gov (United States)

    Gantt, Soren; Kakuru, Abel; Wald, Anna; Walusansa, Victoria; Corey, Lawrence; Casper, Corey; Orem, Jackson

    2010-05-01

    Kaposi sarcoma (KS) is one of the most common pediatric cancers in sub-Saharan Africa. Few data are available about the clinical presentation or response to treatment of children with epidemic (HIV-associated) KS. Medical records of all children with KS and HIV infection referred to the Uganda Cancer Institute in Kampala, Uganda from October 2004 to June 2007 were reviewed. Charts were abstracted for age, sex, location of KS lesions at presentation, biopsy results, CD4 T-cell count and percentage, and KS treatment and outcome. Seventy-three children with epidemic KS were identified, 37 males and 36 females. The median age was 10.1 years (range 2-18). KS presented with lymph node (LN) involvement in 60% of cases. The median absolute and percentage CD4 T-cells at presentation were 210 cells/microl and 7.4%, respectively. Those children with lymphadenopathic KS were younger (mean difference 3.7 years; P = 0.01) and had higher CD4 T-cell counts (mean difference 242 cells/microl; P = 0.03) than those without LN involvement. Of 32 patients for whom outcome data were available, a complete response to chemotherapy and/or antiretroviral therapy was documented in 20 (62.5%) patients. In comparison to cutaneous involvement, LN involvement of epidemic KS occurs at younger ages and at higher CD4 levels. This clinical presentation may reflect recent infection with human herpesvirus 8 followed by a rapid progression to malignancy. Favorable response to treatment was observed in the majority of cases, but prospective studies are needed to determine optimal management.

  10. Clinical outcomes and efficacy of transforaminal lumbar endoscopic discectomy

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    Cezmi Çagri Türk

    2015-01-01

    Full Text Available Background: Transforaminal lumbar endoscopic discectomy (TLED is a minimally invasive procedure for removing lumbar disc herniations. This technique was initially reserved for herniations in the foraminal or extraforaminal region. This study concentrated on our experience regarding the outcomes and efficacy of TLED. Materials and Methods: A total of 105 patients were included in the study. The patients were retrospectively evaluated for demographic features, lesion levels, numbers of affected levels, visual analog scores (VASs, Oswestry disability questionnaire scale scores and MacNab pain relief scores. Results: A total of 48 female and 57 male patients aged between 25 and 64 years (mean: 41.8 years underwent TLED procedures. The majority (83% of the cases were operated on at the levels of L4-5 and L5-S1. Five patients had herniations at two levels. There were significant decreases between the preoperative VAS scores collected postoperatively at 6 months (2.3 and those collected after 1-year (2.5. Two patients were referred for microdiscectomy after TLED due to unsatisfactory pain relief on the 1 st postoperative day. The overall success rate with respect to pain relief was 90.4% (95/105. Seven patients with previous histories of open discectomy at the same level reported fair pain relief after TLED. Conclusions: Transforaminal lumbar endoscopic discectomy is a safe and effective alternative to microdiscectomy that is associated with minor tissue trauma. Herniations that involved single levels and foraminal/extraforaminal localizations were associated with better responses to TLED.

  11. Clinical outcome of deep brain stimulation for Parkinson's disease.

    Science.gov (United States)

    Deuschl, Günther; Paschen, Steffen; Witt, Karsten

    2013-01-01

    Deep brain stimulation is one of the most effective treatments of Parkinson's disease (PD). This report summarizes the state of the art as at January 2013. Stimulation of the subthalamic nucleus is the most commonly used approach. It improves the core motor symptoms better than medication in patients with advanced disease. It also improves the majority of nonmotor symptoms, such as mood, impulse control disorders, sleep, and some autonomic dysfunctions. Quality of life (QoL) is improved significantly more than with medication. Long-term data show that the treatment is effective for up to 10 years, but the late appearance of l-dopa-resistant symptoms is seemingly not influenced. Internal globus pallidus (GPi) stimulation is less well studied but seems to have similar short-term efficacy. Importantly l-dopa use cannot be reduced with GPi DBS, which is a major disadvantage for patients suffering from medication side-effects, although gait may be influenced more positively. Although short-term QoL improvement seems to be similar to that for subthalamic nucleus (STN) DBS - gait and speech may be better improved - long-term data are rare for GPi DBS. Thalamic stimulation in the ventral intermediate nucleus (VIM) is applied only in tremor-dominant elderly patients. The treatment improves the dopa-sensitive symptoms and effectively reduces fluctuations leading to an overall QoL improvement. Although most of the controlled studies have been on advanced PD, the recently published EARLYSTIM study suggests that even patients with a very short duration of their fluctuations and dyskinesia are doing significantly better with neurostimulation in terms of QoL and all major motor outcome parameters. © 2013 Elsevier B.V. All rights reserved.

  12. Associated anomalies and clinical outcome in children with ectopic kidney

    Directory of Open Access Journals (Sweden)

    Cagla Serpil Dogan

    2017-01-01

    Full Text Available Urological anomalies can be seen in children with renal ectopia (RE and can result in renal impairment. Therefore, we evaluated associated anomalies and renal outcome in our patients with RE. Sixty-eight children who were diagnosed with RE between January 2009–May 2014 were retrospectively studied. A total of 68 patients, 36 (52.9% boys, with a median age of 67 months (4–201 and a median follow-up period of 14 months (3–113 were included in the study. Simple RE (S-RE was found in 51 (75% patients, of which 46 were unilateral and five were bilateral (discoid kidney. Crossed RE (C-RE was detected in 17 (25% patients. Voiding cystourethrogram was performed in 21/51 (41.2% patients in S-RE group and 5/17 (29.4% in C-RE group. We did not find vesicoureteral reflux (VUR in any of the patients with C-RE, whereas, in S-RE group, VUR was demonstrated in six (6/21 - 28.6% patients. Pelviureteric junction obstruction in ectopic kidney was found in two patients with S-RE and one with C-RE. Two patients (2/17 - 11.7% had neurogenic bladder due to meningomyelocele, accompanied by imperforate anus in C-RE group. There were no significant differences in other associated urological anomalies between two groups. Renal impairment developed mostly in patients with additional urinary anomaly. The children with RE may have associated urinary anomalies, of which VUR is the most common. Complete urological investigation and regular follow-up are required in selected cases.

  13. Clinical outcome and follow-up of prenatal hydronephrosis

    Directory of Open Access Journals (Sweden)

    Afshin Safaei Asl

    2012-01-01

    Full Text Available Hydronephrosis is probably the most common congenital abnormality detected prenatally by ultrasonography This study was performed to determine the cause and outcome of prenatal hydronephrosis in our hospital. A total of 45 infants, with 57 prenatally hydronephrotic renal units, were enrolled into this study. For the purpose of this study, the degree of hydronephrosis was defined as mild, moderate or severe. Postnatal ultrasonography was performed as soon as possible in those with bilateral hyronephrosis and 3-7 days after birth in those with unilateral hydronephrosis. Voiding cystourethrogram was performed in 6-8 weeks time. In the absence of vesicoureteral reflux (VUR, Diethylenetriamene penta acetate scan was performed to exclude obstructive uropathy. There were 29 males and 16 females (male:female ratio 1.8:1, and unilateral and bilateral hydronephrosis were seen in 33 (73% and 12 (27% of the cases, res-pectively. Hydronephrosis was caused by ureteropelvic junction obstruction (UPJO in 20 (44.5%, VUR in 10 (22.2%, ureterovesical junction obstruction in four (8.9 %, posteriorurethral valves in four (8.9 %, UPJO with VUR in two (4.4% and non-VUR non-obstructive in one (2.2%. During follow-up, 16 patients (35.5% required operative intervention while seven (15.5% improved spontaneously. Fetal hydronephrosis needs close follow-up during both ante-natal and postnatal periods. In this study, the most common cause for hydronephrosis were UPJO and VUR. Also seen in this study is the noteworthy point that mild fetal hydronephrosis is relatively benign and does not require surgical intervention in most cases and surgery should be performed only if there is renal function compromise. Prenatal consultation with a pediatric nephrologist and urologist is useful in decreasing parental anxiety and facilitating postnatal management.

  14. Clinical outcome of confluent laser photoablation for retinopathy of prematurity.

    Science.gov (United States)

    Fallaha, Nicole; Lynn, Michael J; Aaberg, Thomas M; Lambert, Scott R

    2002-04-01

    During the past decade, laser photoablation has supplanted cryotherapy as the standard treatment for threshold retinopathy of prematurity (ROP). We evaluated the progression and the complication rate in a cohort of infants with threshold ROP treated with a confluent technique. We retrospectively studied 47 patients with ROP (91 eyes), treated with confluent diode laser photoablation. Four main outcomes were evaluated: (1) the rate of progression, (2) the frequency of laser retreatment, (3) postoperative complications, and (4) postoperative refractive error. A mean of 1943 +/- 912 laser burns were administered in a confluent pattern to 91 eyes with threshold ROP. Progression to stage 4 or 5 disease occurred in 13 of 29 eyes (44.8%) with zone I and posterior zone II and in 2 of 51 eyes (3.9%) with anterior zone II ROP (P =.01). Eyes with anterior zone II ROP that received more than or equal to 2000 burns progressed more than those that received fewer than 2000 burns. Only 1 eye (1%) needed a supplemental laser treatment. Postoperative complications included corneal edema (2.3%), anterior segment ischemia (2.3%), vitreous hemorrhage (7.9%), posterior synechiae (2.3%), cataract (4.9%), and macular ectopia (12%). The mean spherical equivalent at the last follow-up was -4.52 +/- 5.63 D. In our series, infants received more laser burns than infants reported in the literature receiving scatter or near-confluent treatment. While confluent treatment almost eliminated supplemental treatment, it was associated with a similar rate of progression and complications as has been reported with other patterns of laser treatment.

  15. Gas-containing brain abscess: Etiology, clinical characteristics, and outcome

    Directory of Open Access Journals (Sweden)

    Tsung-Ming Su

    2014-12-01

    meticulous surgical treatment are the only way to obtain a favorable outcome.

  16. Intradialytic Hypoxemia and Clinical Outcomes in Patients on Hemodialysis.

    Science.gov (United States)

    Meyring-Wösten, Anna; Zhang, Hanjie; Ye, Xiaoling; Fuertinger, Doris H; Chan, Lili; Kappel, Franz; Artemyev, Mikhail; Ginsberg, Nancy; Wang, Yuedong; Thijssen, Stephan; Kotanko, Peter

    2016-04-07

    Intradialytic hypoxemia has been recognized for decades, but its associations with outcomes have not yet been assessed in a large patient cohort. Our retrospective cohort study was conducted between January of 2012 and January of 2015. We recorded blood oxygen saturation every minute during hemodialysis in patients with arteriovenous access. A 6-month baseline period with at least 10 treatments with oxygen saturation measurements preceded a 12-month follow-up. Patients were stratified by the presence or absence of prolonged intradialytic hypoxemia defined as oxygen saturation hypoxemia. These patients were older (+3.6 years; 95% confidence interval, 0.8 to 6.3), had longer dialysis vintage (+1.2 years; 95% confidence interval, 0.3 to 2.1), and had higher prevalence of congestive heart failure (+10.8%; 95% confidence interval, 1.6 to 20.7) and chronic obstructive pulmonary disease (+13%; 95% confidence interval, 5 to 21.2). They also resembled an inflammatory phenotype, with lower serum albumin levels (-0.1 g/dl; 95% confidence interval, -0.2 to 0) and higher neutrophil-to-lymphocyte ratios (+1; 95% confidence interval, 0.5 to 1.6). They had lower hemoglobin levels (-0.2 g/dl; 95% confidence interval, -0.4 to 0) and required more erythropoietin (+1374 U per hemodialysis treatment; 95% confidence interval, 343 to 2405). During follow-up, all-cause hospitalization (1113 hospitalizations; univariate hazard ratio, 1.46; 95% confidence interval, 1.22 to 1.73) and mortality (89 deaths; adjusted hazard ratio, 1.98; 95% confidence interval, 1.14 to 3.43) were higher in patients with prolonged intradialytic hypoxemia. Prolonged intradialytic hypoxemia was associated with laboratory indicators of inflammation, higher erythropoietin requirements, and higher all-cause hospitalization and mortality. Copyright © 2016 by the American Society of Nephrology.

  17. Clinical outcomes of percutaneous coronary intervention in patients turned down for surgical revascularization.

    Science.gov (United States)

    Sukul, Devraj; Seth, Milan; Dixon, Simon R; Zainea, Mark; Slocum, Nicklaus K; Pielsticker, Elizabeth J; Gurm, Hitinder S

    2017-07-01

    We examined clinical outcomes following percutaneous coronary intervention (PCI) in patients turned down for surgical revascularization across a broad population. Prior studies suggest that surgical ineligibility is associated with increased mortality in patients with unprotected left main or multivessel coronary artery disease undergoing PCI. This study included consecutive patients who underwent PCI in a multicenter registry in Michigan from January 2010 to December 2014. Surgical ineligibility required documentation indicating that a cardiac surgeon deemed the patient ineligible for surgery. In-hospital outcomes included mortality (primary outcome), cardiogenic shock, cerebrovascular accident, contrast-induced nephropathy (CIN), and a new requirement for dialysis (NRD). Of 99,370 patients at 33 hospitals with on-site surgical backup, 1,922 (1.9%) were surgically ineligible. The rate of ineligibility did not vary by hospital (range: 1.5-2.5%; P = 0.79). Overall, there were no major differences in baseline characteristics or outcomes between surgically ineligible patients and the rest (i.e., nonineligible patients): mortality (0.52% vs. 0.52%; P > 0.5), cardiogenic shock (0.68% vs. 0.73%; P > 0.5), cerebrovascular accident (0.05% vs. 0.19%; P = 0.28), NRD (0.16% vs. 0.19%; P > 0.5), CIN (2.7% vs. 2.3%; P = 0.27). Among 1,074 patients who underwent unprotected left main PCI, 20 (1.9%) were surgically ineligible and experienced increased rates of mortality (20.0% vs. 5.3%; P = 0.022; adjusted OR = 7.38; P < 0.001) and other complications as compared to the remainder. PCI in a broad population of surgically ineligible patients is generally safe. However, among patients who underwent unprotected left main PCI, those deemed surgically ineligible experienced significantly worse outcomes as compared to the rest. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  18. Clinical outcomes following inpatient penicillin allergy testing: A systematic review and meta-analysis.

    Science.gov (United States)

    Sacco, K A; Bates, A; Brigham, T J; Imam, J S; Burton, M C

    2017-09-01

    A documented penicillin allergy is associated with increased morbidity including length of hospital stay and an increased incidence of resistant infections attributed to use of broader-spectrum antibiotics. The aim of the systematic review was to identify whether inpatient penicillin allergy testing affected clinical outcomes during hospitalization. We performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library over the past 20 years. Inpatients having a documented penicillin allergy that underwent penicillin allergy testing were included. Twenty-four studies met eligibility criteria. Study sample size was between 24 and 252 patients in exclusively inpatient cohorts. Penicillin skin testing (PST) with or without oral amoxicillin challenge was the main intervention described (18 studies). The population-weighted mean for a negative PST was 95.1% [CI 93.8-96.1]. Inpatient penicillin allergy testing led to a change in antibiotic selection that was greater in the intensive care unit (77.97% [CI 72.0-83.1] vs 54.73% [CI 51.2-58.2], P<.01). An increased prescription of penicillin (range 9.9%-49%) and cephalosporin (range 10.7%-48%) antibiotics was reported. Vancomycin and fluoroquinolone use was decreased. Inpatient penicillin allergy testing was associated with decreased healthcare cost in four studies. Inpatient penicillin allergy testing is safe and effective in ruling out penicillin allergy. The rate of negative tests is comparable to outpatient and perioperative data. Patients with a documented penicillin allergy who require penicillin should be tested during hospitalization given its benefit for individual patient outcomes and antibiotic stewardship. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

  19. Clinical outcomes for Early Childhood Caries (ECC): the influence of health locus of control.

    Science.gov (United States)

    Chase, I; Berkowitz, R J; Proskin, H M; Weinstein, P; Billings, R

    2004-06-01

    To assess the relationship between clinical outcomes for children treated for ECC and health locus of control. The study cohort consisted of 79 children (42 males, 37 females) treated for ECC; age range was 2.3-7.3 years (mean 4.2 years) at the time of entry into the study. A questionnaire [developed by DeVellis et al., 1993] was administered to each child's parent(s) on the day of dental surgery. This questionnaire examined the expectation that healthcare outcomes in children are influenced by one of the following loci of control: Professional, Parent, Child, Media, Fate and Divine. The cohort was evaluated for new caries lesions at 6 months post dental surgery. Relapse was defined as the presence of new smooth surface caries lesions. For each locus, the scores for the Relapse versus Non-relapse groups (returning patients) and the scores for the returning versus non-returning patients were compared using t-tests. 57 children (72%) returned for follow-up and 21 of these 57 (37%) relapsed. No statistically significant difference for Relapse versus Non-relapse groups was indicated with respect to the scores for any locus parameter (p values ranged from 0.35 to 0.95). Returning parents (N=57) versus non- returning parents (N=22) exhibited statistically significant differences with respect to the Parent, Divine and Fate loci. Returning parents exhibited higher scores on the Parent locus (p=0.0392) and lower scores on the Fate (p=0.0024) and Divine (p=0.0031) loci. 1). The relapse rate (37%) was high and rapid for children treated for ECC; 2). no meaningful difference existed between the Relapse versus Non-relapse groups with respect to each health locus of control parameter; 3). parents who returned for follow-up care appeared to have an internal health locus of control while those who did not return had an external locus.

  20. Clinical manifestation, diagnosis, management, and treatment outcome of pericarditis in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Buppajamrntham, Tanas; Palavutitotai, Nattawan; Katchamart, Wanruchada

    2014-12-01

    To investigate the clinical manifestations, diagnosis, etiology, management, and outcomes of patients with systemic lupus erythematosus (SLE) and pericarditis The authors retrospectively reviewed the records of 81 patients who were diagnosed of SLE according to the American College of Rheumatology criteria and had 82 episodes of pericarditis between 2002 and 2010. The diagnosis of pericarditis was defined as the presence of pericardial effusion alone by echocardiography or having 2 out of 4 of the following criteria: retrosternal pain, pericardial friction rub, widespread ST-segment elevation, and new/worsening pericardial effusion. Most of them (92%) were female with the median disease duration (range) of 1 (0-312) month. Cardiac tamponade occurred in 16% (95% CI 8.72-25.58%). There was no statistically significant difference between patients who developed tamponade and those who did not. The causes ofpericarditis included active SLE (93%), and suspected tuberculosis (TB) (5%), with 2% inconclusive. In patients with lupus pericarditis, 71% had other active organ involvement. Most lupus pericarditis patients (79%) had good response to steroid or NSAIDs. Diagnosis of TB pericarditis was made by clinical suspicion without microbiological or pathological evidence. In an endemic area of TB, lupus pericarditis was still the most common cause of pericarditis in SLE. Most patients responded well to steroid.

  1. Between a bug and a hard place: Trypanosoma cruzi genetic diversity and the clinical outcomes of Chagas disease

    Science.gov (United States)

    Messenger, Louisa A; Miles, Michael A; Bern, Caryn

    2015-01-01

    Over the last 30 years, concomitant with successful transnational disease control programs across Latin America, Chagas disease has expanded from a neglected, endemic parasitic infection of the rural poor to an urbanized chronic disease, and now a potentially emergent global health problem. Trypanosoma cruzi infection has a highly variable clinical course, ranging from complete absence of symptoms to severe and often fatal cardiovascular and/or gastrointestinal manifestations. To date, few correlates of clinical disease progression have been identified. Elucidating a putative role for T. cruzi strain diversity in Chagas disease pathogenesis is complicated by the scarcity of parasites in clinical specimens and the limitations of our contemporary genotyping techniques. This article systematically reviews the historical literature, given our current understanding of parasite genetic diversity, to evaluate the evidence for any association between T. cruzi genotype and chronic clinical outcome, risk of congenital transmission or reactivation and orally transmitted outbreaks. PMID:26162928

  2. Clinical Outcome of Femoral Osteotomy in Patients with Legg-Calve´-Perthes Disease

    Directory of Open Access Journals (Sweden)

    Mohammad Hallaj Moghadam

    2013-12-01

    Full Text Available Background: Legg-Calve´-Perthes disease is a juvenile idiopathic osteonecrosis in which the blood supply of femoral head is not sufficient and the bone dies provisionally. The aim of this study is to evaluate outcome of Femoral osteotomy in children with LCPD in our University Hospital.   Methods: In a descriptive analytic study, between 2008 and 2013, patients with the diagnosis of Legg-Calve’-Perthes confirmed with lateral pillar calcification of B and B/C border were entered and patients were encouraged to come to an outpatient clinic for follow-up. Descriptive analysis of the demographics was performed and relation between variables was tested using a two-sided Student’s t test with statistical significance set at (p=0.05. Results: Mean age of patients was 9±1.3 years, with the range of 4 to 12 years old. 25 patients (86.2% were male and 4 patients (13.4% female. There was no positive family history in patients. 17 patients (58.6% had history of trauma. Duration of symptom presentation was 7±6.3 months, with the range of 3 to 36 months. In 20 of patients (69% left hip and in 12 (41.4% right hip was involved. There was significant relation between femoral head asymmetry, trochanter enlargement (P=0.04, acetabolum changes (P

  3. Comparison of clinical and functional outcome between surgical treatment and carbon ion radiotherapy for pelvic chondrosarcoma.

    Science.gov (United States)

    Outani, Hidetatsu; Hamada, Kenichiro; Imura, Yoshinori; Oshima, Kazuya; Sotobori, Tsukasa; Demizu, Yusuke; Kakunaga, Shigeki; Joyama, Susumu; Imai, Reiko; Okimoto, Tomoaki; Naka, Norifumi; Kudawara, Ikuo; Ueda, Takafumi; Araki, Nobuhito; Kamada, Tadashi; Yoshikawa, Hideki

    2016-02-01

    As there are no reports of studies in patients with pelvic chondrosarcoma treated with carbon ion radiotherapy (CIRT), the aim of this study was to evaluate the applicability of CIRT for patients with chondrosarcoma of the pelvis. The medical records of 31 patients with chondrosarcoma of the pelvis treated either by surgical resection or by CIRT between 1983 and 2014 were reviewed. There were 22 males and 9 females with a median age of 43 years (range 16-77 years). The median duration of follow-up was 66 months (range 5-289 months). Twenty-four patients underwent surgery, and 7 patients received CIRT (70.4 GyE in 16 fractions over 4 weeks). The overall local recurrence rate was 32 %, and the estimated overall 5- and 10-year survival rates were 72 and 57 %, respectively. The mean Musculoskeletal Tumor Society functional score was 59 %. The treatment procedures (surgery or CIRT) did not affect overall survival (P = 0.347). However, the patients who underwent surgery had impaired function compared with those who received CIRT (P = 0.03). Although more patients need to be monitored to assess the clinical and functional outcomes of CIRT for patients with chondrosarcoma of the pelvis, this treatment might offer an acceptable alternative.

  4. Clinical Outcome of Femoral Osteotomy in Patients with Legg-Calve´-Perthes Disease

    Directory of Open Access Journals (Sweden)

    Mohammad Hallaj Moghadam

    2013-12-01

    Full Text Available   Background: Legg-Calve´-Perthes disease is a juvenile idiopathic osteonecrosis in which the blood supply of femoral head is not sufficient and the bone dies provisionally. The aim of this study is to evaluate outcome of Femoral osteotomy in children with LCPD in our University Hospital.   Methods: In a descriptive analytic study, between 2008 and 2013, patients with the diagnosis of Legg-Calve’-Perthes confirmed with lateral pillar calcification of B and B/C border were entered and patients were encouraged to come to an outpatient clinic for follow-up. Descriptive analysis of the demographics was performed and relation between variables was tested using a two-sided Student’s t test with statistical significance set at (p=0.05. Results: Mean age of patients was 9±1.3 years, with the range of 4 to 12 years old. 25 patients (86.2% were male and 4 patients (13.4% female. There was no positive family history in patients. 17 patients (58.6% had history of trauma. Duration of symptom presentation was 7±6.3 months, with the range of 3 to 36 months. In 20 of patients (69% left hip and in 12 (41.4% right hip was involved. There was significant relation between femoral head asymmetry, trochanter enlargement (P=0.04, acetabolum changes (P

  5. Service quality and clinical outcomes: an example from mental health rehabilitation services in England.

    Science.gov (United States)

    Killaspy, Helen; Marston, Louise; Omar, Rumana Z; Green, Nicholas; Harrison, Isobel; Lean, Melanie; Holloway, Frank; Craig, Tom; Leavey, Gerard; King, Michael

    2013-01-01

    Current health policy assumes better quality services lead to better outcomes. To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes. Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes. A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life. Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.

  6. Clinical Profile, Maternal and Fetal Outcomes of Acute Hepatitis E in ...

    African Journals Online (AJOL)

    obstetric and fetal outcomes. Hence, this study was undertaken to study clinical profile of hepatitis E infection in pregnancy, to evaluate the maternal and fetal complications of this infection and to compare the clinical features of hepatitis E in pregnant women to those in non-pregnant women. Subjects and Methods. This was ...

  7. Clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion in primary versus revision surgery

    NARCIS (Netherlands)

    Hentenaar, B.; Spoor, A. B.; Malefijt, J. de Waal; Diekerhof, C. H.; den Oudsten, B. L.

    2016-01-01

    Purpose The aim of this study is to compare the clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion (MI-PLIF) in revision and primary cases. Methods In a retrospective study, we compared the clinical and radiological results of MI-PLIF for lytic

  8. The impact of data errors on the outcome of randomized clinical trials

    NARCIS (Netherlands)

    Buyse, Marc; Squifflet, Pierre; Coart, Elisabeth; Quinaux, Emmanuel; Punt, Cornelis J. A.; Saad, Everardo D.

    2017-01-01

    Background/aims: Considerable human and financial resources are typically spent to ensure that data collected for clinical trials are free from errors. We investigated the impact of random and systematic errors on the outcome of randomized clinical trials. Methods: We used individual patient data

  9. Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy

    NARCIS (Netherlands)

    Eijk, J.J.J. van; Dalton, H.R.; Ripellino, P.; Madden, R.G.; Jones, C.; Fritz, M.; Gobbi, C.; Melli, G.; Pasi, E.; Herrod, J.; Lissmann, R.F.; Ashraf, H.H.; Abdelrahim, M.; Masri, O.; Fraga, M.; Benninger, D.; Kuntzer, T.; Aubert, V.; Sahli, R.; Moradpour, D.; Blasco-Perrin, H.; Attarian, S.; Gerolami, R.; Colson, P.; Giordani, M.T.; Hartl, J.; Pischke, S.; Lin, N.X.; McLean, B.N.; Bendall, R.P.; Panning, M.; Peron, J.M.; Kamar, N.; Izopet, J.; Jacobs, B.C.; Alfen, N. van; Engelen, B.G.M. van

    2017-01-01

    OBJECTIVE: To determine the clinical phenotype and outcome in hepatitis E virus-associated neuralgic amyotrophy (HEV-NA). METHODS: Cases of NA were identified in 11 centers from 7 European countries, with retrospective analysis of demographics, clinical/laboratory findings, and treatment and

  10. Clinical outcome of adalimumab therapy in patients with ulcerative colitis previously treated with infliximab

    DEFF Research Database (Denmark)

    Christensen, Katrine Risager; Steenholdt, Casper; Brynskov, Jørn

    2015-01-01

    clinical outcomes of ADL therapy in a clinical setting where infliximab (IFX) had been used as first choice of anti-TNF agent, and followed by ADL as second line agent. METHODS: Retrospective, observational single-center cohort study including all ulcerative colitis patients treated with ADL at a tertiary...

  11. Early-Onset Psychoses: Comparison of Clinical Features and Adult Outcome in 3 Diagnostic Groups

    Science.gov (United States)

    Ledda, Maria Giuseppina; Fratta, Anna Lisa; Pintor, Manuela; Zuddas, Alessandro; Cianchetti, Carlo

    2009-01-01

    A comparison of clinical features and adult outcome in adolescents with three types of psychotic disorders: schizophrenic (SPh), schizoaffective (SA) and bipolar with psychotic features (BPP). Subjects (n = 41) were finally diagnosed (DSM-IV criteria) with SPh (n = 17), SA (n = 11) or BPP (n = 13). Clinical evaluation took place at onset and at a…

  12. Persistent systemic inflammation is associated with poor clinical outcomes in COPD

    DEFF Research Database (Denmark)

    Agustí, Alvar; Edwards, Lisa D; Rennard, Stephen I

    2012-01-01

    Because chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, the identification of specific clinical phenotypes is key to developing more effective therapies. To explore if the persistence of systemic inflammation is associated with poor clinical outcomes in COPD we assessed...

  13. 76 FR 45271 - Review and Qualification of Clinical Outcome Assessments; Public Workshop

    Science.gov (United States)

    2011-07-28

    ... principles for clinical outcome assessments (COAs) for use in clinical trials for new drugs. COAs include.... Because the qualification process is separate from the drug marketing application process, qualification... focus on FDA review principles specific to all type of COAs, i.e., PRO, ClinRO, and ObsRO measures. More...

  14. Can adventurous training have a role in improving clinical outcomes?

    Science.gov (United States)

    Mellor, A; Jackson, S; Hardern, R

    2012-06-01

    The aim of military adventurous training (AT) is "to develop, through authorised challenging pursuits and within an outdoor environment, leadership and the qualities necessary to enhance the performance of military personnel during peace and war". An increasing amount of effort is being applied by all three services to increase participation in AT to achieve these, largely immeasurable, aims. Existing guidance to Commanding Officers dictates that, where possible, 20% of a unit strength should undertake some form of AT annually with 5% taking part in an overseas expedition. In a speech in 2008 Alan Johnson, the then Secretary of State for Health, acknowledged that for Armed Forces medical personnel 'just as important as clinical skills are issues such as leadership, communication, adaptability and teamwork." Controlled exposure to risk, discomfort and personal hardship is a common theme for both AT activities and military deployments. Both General Medical Council competencies for all doctors and the Royal College of Anaesthetists military module include elements which can effectively be taught and developed through training in an outdoors environment. These skills include communication skills, leadership, risk assessment and interdisciplinary working. In this review the value of AT in training doctors to develop those attributes is examined.

  15. Titanium oral implants: surface characteristics, interface biology and clinical outcome

    Science.gov (United States)

    Palmquist, Anders; Omar, Omar M.; Esposito, Marco; Lausmaa, Jukka; Thomsen, Peter

    2010-01-01

    Bone-anchored titanium implants have revolutionized oral healthcare. Surface properties of oral titanium implants play decisive roles for molecular interactions, cellular response and bone regeneration. Nevertheless, the role of specific surface properties, such as chemical and phase composition and nanoscale features, for the biological in vivo performance remains to be established. Partly, this is due to limited transfer of state-of-the-art preparation techniques to complex three-dimensional geometries, analytical tools and access to minute, intact interfacial layers. As judged by the available results of a few randomized clinical trials, there is no evidence that any particular type of oral implant has superior long-term success. Important insights into the recruitment of mesenchymal stem cells, cell–cell communication at the interface and high-resolution imaging of the interface between the surface oxide and the biological host are prerequisites for the understanding of the mechanisms of osseointegration. Strategies for development of the next generation of material surface modifications for compromised tissue are likely to include time and functionally programmed properties, pharmacological modulation and incorporation of cellular components. PMID:20591849

  16. Predictive factors of clinical outcome in older surgical patients.

    Science.gov (United States)

    Bo, Mario; Cacello, Elena; Ghiggia, Federica; Corsinovi, Laura; Bosco, Francesca

    2007-01-01

    We aimed to identify predictors of mortality and length of stay-in hospital in older surgical patients. In 294 patients (mean age 74.1+/-6.4 years, 153 men), consecutively admitted to four surgery units of a university-teaching hospital to receive elective surgery (ES, 56.5%) or urgent surgery (US, 43.5%), the following variables were evaluated: demographics, clinical history (hypertension, diabetes mellitus (DM), coronary heart disease (CHD), heart failure (HF), cerebrovascular accidents, chronic obstructive pulmonary disease (COPD), active neoplasm, cognitive impairment, immobilization, pressure ulcers), physiopathology (Acute Physiology and Chronic Health Evaluation, APACHE, II), cognition/function (Short Portable Mental Status Questionnaire, SPMSQ; activity of daily living, ADL; instrumental activity of daily living, IADL), comorbidity (Cumulative Illness Rating Scale, CIRS, 1 and 2) and anesthesiology (American Score Anesthesiologist, ASA). The vital status of the patient at 1 month after discharge and the duration of hospitalization were recorded. One-month mortality rate was 6.1%. Low hemoglobin and body mass index (BMI) values, increasing ASA score, and, only in US patients, ADL dependence and higher CIRS 1 score, were independently predictive of mortality. Low hemoglobin levels and, only in ES patients, higher CIRS 1 score were associated with prolonged hospitalization. Prognostic indicators specific to older people have limited value in mortality models in elderly surgical patients.

  17. Diabetes, bone and glucose-lowering agents: clinical outcomes.

    Science.gov (United States)

    Schwartz, Ann V

    2017-07-01

    Older adults with diabetes are at higher risk of fracture and of complications resulting from a fracture. Hence, fracture risk reduction is an important goal in diabetes management. This review is one of a pair discussing the relationship between diabetes, bone and glucose-lowering agents; an accompanying review is provided in this issue of Diabetologia by Beata Lecka-Czernik (DOI 10.1007/s00125-017-4269-4 ). Specifically, this review discusses the challenges of accurate fracture risk assessment in diabetes. Standard tools for risk assessment can be used to predict fracture but clinicians need to be aware of the tendency for the bone mineral density T-score and the fracture risk assessment tool (FRAX) to underestimate risk in those with diabetes. Diabetes duration, complications and poor glycaemic control are useful clinical markers of increased fracture risk. Glucose-lowering agents may also affect fracture risk, independent of their effects on glycaemic control, as seen with the negative skeletal effects of the thiazolidinediones; in this review, the potential effects of glucose-lowering medications on fracture risk are discussed. Finally, the current understanding of effective fracture prevention in older adults with diabetes is reviewed.

  18. Determination of the minimal clinically important difference on the Australian therapy outcome measures for occupational therapy (AusTOMs-OT).

    Science.gov (United States)

    Unsworth, Carolyn Anne; Coulson, Melissa; Swinton, Luchie; Cole, Helen; Sarigiannis, Mary

    2015-01-01

    Outcome measures must be responsive to change (able to show statistically significant change) and must also produce information on the degree of change that is clinically significant, or the minimal clinically important difference (MCID). This research sought to establish the MCID for four domains of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT). Using a criterion approach, 30 international clinicians were surveyed about their perceptions of the MCID for AusTOMs-OT. Second, using a distribution-based approach, the MCID was calculated as half of the standard deviation (SD) of the AusTOMs-OT raw scores for a sample of 787 clients. Just over half the clinicians surveyed indicated that a one-point change represented the MCID for AusTOMs-OT for three domains, and 0.5-point change showed MCID for the final domain. The data analysed for the distribution-based calculation indicated that the half SD ranged from 0.51 to 0.61. Using both criterion and distribution-based approaches, this research empirically demonstrated that a change on the four domains of the AusTOMs-OT of between 0.51 and 1 point shows MCID. Considering these findings, and for ease of clinical interpretation, it is recommended that a one-point shift be adopted as the MCID across all domains. The AusTOMs-OT have been previously shown to be valid and reliable outcome measures for use with all client groups across all settings including rehabilitation. So that rehabilitation professionals can interpret outcomes data from AusTOMs-OT, information must be available on the degree of change that is clinically significant (also referred to as the minimal clinically important difference or MCID). Using empirical calculations as well as clinician opinion, it is recommended that a one-point shift be used as the minimal clinically important difference for the AusTOMs-OT.

  19. Common Factor Mechanisms in Clinical Practice and Their Relationship with Outcome.

    Science.gov (United States)

    Gaitan-Sierra, Carolina; Hyland, Michael E

    2015-01-01

    This study investigates three common factor mechanisms that could affect outcome in clinical practice: response expectancy, the affective expectation model and motivational concordance. Clients attending a gestalt therapy clinic (30 clients), a sophrology (therapeutic technique) clinic (33 clients) and a homeopathy clinic (31 clients) completed measures of expectancy and the Positive Affect and Negative Affect Schedule (PANAS) before their first session. After 1 month, they completed PANAS and measures of intrinsic motivation, perceived effort and empowerment. Expectancy was not associated with better outcome and was no different between treatments. Although some of the 54 clients who endorsed highest expectations showed substantial improvement, others did not: 19 had no change or deteriorated in positive affect, and 18 had the same result for negative affect. Intrinsic motivation independently predicted changes in negative affect (β = -0.23). Intrinsic motivation (β = 0.24), effort (β = 0.23) and empowerment (β = 0.20) independently predicted positive affect change. Expectancy (β = -0.17) negatively affected changes in positive affect. Clients found gestalt and sophrology to be more intrinsically motivating, empowering and effortful compared with homeopathy. Greater improvement in mood was found for sophrology and gestalt than for homeopathy clients. These findings are inconsistent with response expectancy as a common factor mechanism in clinical practice. The results support motivational concordance (outcome influenced by the intrinsic enjoyment of the therapy) and the affective expectation model (high expectations can lead for some clients to worse outcome). When expectancy correlates with outcome in some other studies, this may be due to confound between expectancy and intrinsic enjoyment. Common factors play an important role in outcome. Intrinsic enjoyment of a therapeutic treatment is associated with better outcome. Active engagement with a

  20. Are we failing clinical trials? A case for strong aggregate outcomes.

    Science.gov (United States)

    Joyce, D W; Tracy, D K; Shergill, S S

    2018-01-01

    Clinical trials in psychiatry inherit methods for design and statistical analysis from evidence-based medicine. However, trials in other clinical disciplines benefit from a more specific relationship between instruments that measure disease state (e.g. biomarkers, clinical signs), the underlying pathology and diagnosis such that primary outcomes can be readily defined. Trials in psychiatry use diagnosis (i.e. a categorical label for a syndrome) as a proxy for the underlying disorder, and outcomes are defined, for example, as a percentage change in a univariate total score on some clinical instrument. We label this approach to defining outcomes weak aggregation of disease state. Univariate measures are necessary, because statistical methodology is both tractable and well-developed for scalar outcomes, but we show that weak aggregate approaches do not capture disease state sufficiently, potentially leading to loss of information about response to intervention. We demonstrate how multivariate disease state can be captured using geometric concepts of spaces defined over routine clinical instruments, and show how clinically meaningful disease states (e.g. representing different profiles of symptoms, recovery or remission) can be defined as prototypes (geometric locations) in these spaces. Then, we show how to derive univariate (scalar) measures, which capture patient's relationships to these prototypes and argue these represent strong aggregates of disease state that may be a better basis for outcome measures. We demonstrate our proposal using a large publically available dataset. We conclude by discussing the impact of strong aggregates for analyses in traditional and novel trial designs.

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

    Directory of Open Access Journals (Sweden)

    Trujillo A

    2016-06-01

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

  2. Medical students as health educators at a student-run free clinic: improving the clinical outcomes of diabetic patients.

    Science.gov (United States)

    Gorrindo, Phillip; Peltz, Alon; Ladner, Travis R; Reddy, India; Miller, Bonnie M; Miller, Robert F; Fowler, Michael J

    2014-04-01

    Student-run free clinics (SRFCs) provide service-learning opportunities for medical students and care to underserved patients. Few published studies, however, support that they provide high-quality care. In this study, the authors examined the clinical impact of a medical student health educator program for diabetic patients at an SRFC. In 2012, the authors retrospectively reviewed the electronic medical records of diabetic patients who established care at Shade Tree Clinic in Nashville, Tennessee, between 2008 and 2011. They compared clinical outcomes at initial presentation to the clinic and 12 months later. They analyzed the relationship between the number of patient-student interactions (touchpoints) and change in hemoglobin A1c values between these two time points and compared the quality of care provided to best-practice benchmarks (process and outcomes measures). The authors studied data from 45 patients. Mean hemoglobin A1c values improved significantly from 9.6 to 7.9, after a mean of 12.5 ± 1.5 months (P patients were screened during clinic visits, whereas a low to moderate percentage met benchmarks for A1c, LDL, and blood pressure levels. These findings demonstrate that a medical student health educator program at an SRFC can provide high-quality diabetes care and facilitate clinical improvement one year after enrollment, despite inherent difficulties in caring for underserved patients. Future studies should examine the educational and clinical value of care provided at SRFCs.

  3. Food Addiction in Gambling Disorder: Frequency and Clinical Outcomes

    Science.gov (United States)

    Jiménez-Murcia, Susana; Granero, Roser; Wolz, Ines; Baño, Marta; Mestre-Bach, Gemma; Steward, Trevor; Agüera, Zaida; Hinney, Anke; Diéguez, Carlos; Casanueva, Felipe F.; Gearhardt, Ashley N.; Hakansson, Anders; Menchón, José M.; Fernández-Aranda, Fernando

    2017-01-01

    Background: The food addiction (FA) model is receiving increasing interest from the scientific community. Available empirical evidence suggests that this condition may play an important role in the development and course of physical and mental health conditions such as obesity, eating disorders, and other addictive behaviors. However, no epidemiological data exist on the comorbidity of FA and gambling disorder (GD), or on the phenotype for the co-occurrence of GD+FA. Objectives: To determine the frequency of the comorbid condition GD+FA, to assess whether this comorbidity features a unique clinical profile compared to GD without FA, and to generate predictive models for the presence of FA in a GD sample. Method: Data correspond to N = 458 treatment-seeking patients who met criteria for GD in a hospital unit specialized in behavioral addictions. Results: Point prevalence for FA diagnosis was 9.2%. A higher ratio of FA was found in women (30.5%) compared to men (6.0%). Lower FA prevalence was associated with older age. Patients with high FA scores were characterized by worse psychological state, and the risk of a FA diagnosis was increased in patients with high scores in the personality traits harm avoidance and self-transcendence, and low scores in cooperativeness (R2 = 0.18). Conclusion: The co-occurrence of FA in treatment-seeking GD patients is related to poorer emotional and psychological states. GD treatment interventions and related behavioral addictions should consider potential associations with problematic eating behavior and aim to include techniques that aid patients in better managing this behavior. PMID:28421009

  4. Clinical factors adversely affecting early outcome after brain infarction

    Directory of Open Access Journals (Sweden)

    Charles André

    1994-06-01

    Full Text Available PURPOSE AND METHODS: One-hundred-and-nine consecutive patients admitted during the acute phase of a CT-confirmed brain infarction (BI were studied. Putative adverse influence of demographic and stroke risk factors, previous medical history, clinical presentation, initial and follow-up neurological examination, initial general evaluation, laboratory findings, chest X-ray and electrocardiographic findings, treatment, and topography and etiology of the ischemic insult was analysed. The end-point for assessment was early death (within 30 days. Statistical analysis was performed with univariate analysis and multiple regression. RESULTS: The main adverse factors related to an increased death risk during the first 30 days were, in decreasing order of importance: coma 48-72 hours after admission; stroke occuring in already hospitalized patients; Babinski sign on admission; minor degrees of impairment of consciousness 48-72 hours after admission; stroke related to large artery atherothrombosis and to embolism; a history of early impairment of consciousness; cardiac failure on admission. In 53 lucid patients on admission, only a history of congestive heart failure (CHF was associated with a reduced survival rate. In 56 patients with impaired consciousness, the presence of a Babinski sign increased death risk, but the main factor predicting a high case-fatality rate was the persistence of consciousness disturbances after48-72 hours. CONCLUSIONS: The presence of impairment of consciousness, especially coma, 2-3 days after disease onset, and a history of CHF greatly increase the early case fatality rate in patients with acute BI presenting with or without consciousness disturbances at admission, respectively. The use of a prognostic algorythm considering these few variables seems to predict the approximate 30-day fatality rates.

  5. Dandy-Walker Malformation: A Clinical and Surgical Outcome Analysis.

    Science.gov (United States)

    Bokhari, Iram; Rehman, Lal; Hassan, Sher; Hashim, M Sattar

    2015-06-01

    To determine the clinical presentations, complications and mortality in patients with Dandy-Walker Malformation (DWM) after surgery i.e., shunt with y-connector. Case series. Neurosurgery Ward, JPMC, Karachi, from January 2009 to December 2013. Cases of DWM, with associated hydrocephalus, further confirmed on CT scan of brain, were admitted through OPD. Those who were previously operated, those with other associated co-morbid or anomalies were excluded from this study. Combined drainage of the ventricular system and posterior fossa cyst, via dual shunt i.e. cystoperitoneal and ventriculoperitoneal shunt with y-connector was performed in all patients. Complications and mortality after surgical intervention in these patients were noted upto one month after surgery. The data analysis for descriptive statistics was done on SPSS version 20. In this study of 70 patients, majority of the patients were female aged between 1 - 2 years. Hydrocephalus was the predominant symptom as being present in all patients, followed by cerebellar signs in 60 (86%), and other in 5 (7.14%) patients. Complications of surgery were infection and shunt fracture dislocation in 7 (10%) each, malpositioning and shunt blockage in 6 (8.5%) each within one month of surgery, intracranial haemorrhage in 5 (7.14%) patients. Only one patient (1.42%) expired after surgical intervention. In DWM, the commonest presentation is that of hydrocephalus. Shunt malfunction and infection are the commonest complication after shunting. Dual shunt with y-connector has the lowest mortality when compared with other methods for treatment of shunt with y-connector.

  6. The influence of preoperative spinal sagittal balance on clinical outcomes after microendoscopic laminotomy in patients with lumbar spinal canal stenosis.

    Science.gov (United States)

    Dohzono, Sho; Toyoda, Hiromitsu; Matsumoto, Tomiya; Suzuki, Akinobu; Terai, Hidetomi; Nakamura, Hiroaki

    2015-07-01

    More information about the association between preoperative anterior translation of the C-7 plumb line and clinical outcomes after decompression surgery in patients with lumbar spinal canal stenosis (LSS) would help resolve problems for patients with sagittal imbalance. The authors evaluated whether preoperative sagittal alignment of the spine affects low-back pain and clinical outcomes after microendoscopic laminotomy. This study was a retrospective review of prospectively collected surgical data. The study comprised 88 patients with LSS (47 men and 41 women) who ranged in age from 39 to 86 years (mean age 68.7 years). All patients had undergone microendoscopic laminotomy at Osaka City University Graduate School of Medicine from May 2008 through October 2012. The minimum duration of clinical and radiological follow-up was 6 months. All patients were evaluated by Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low-back pain, leg pain, and leg numbness before and after surgery. The distance between the C-7 plumb line and the posterior corner of the sacrum (sagittal vertical axis [SVA]) was measured on lateral standing radiographs of the entire spine obtained before surgery. Radiological factors and clinical outcomes were compared between patients with a preoperative SVA ≥ 50 mm (forward-bending trunk [F] group) and patients with a preoperative SVA sagittal plane did not affect JOA scores after microendoscopic laminotomy in patients with LSS. However, low-back pain was worse for patients with preoperative anterior translation of the C-7 plumb line than for those without.

  7. Microvascular decompression for classic trigeminal neuralgia: determination of minimum clinically important difference in pain improvement for patient reported outcomes.

    Science.gov (United States)

    Reddy, Vishruth K; Parker, Scott L; Patrawala, Samit A; Lockney, Dennis T; Su, Pei-Fang; Mericle, Robert A

    2013-05-01

    Outcomes studies use patient-reported outcome (PRO) measurements to assess treatment effectiveness, but can lack direct clinical meaning. Minimum clinically important difference (MCID) calculation provides a point estimate of the critical threshold needed to achieve clinically relevant treatment effectiveness. MCID remains uninvestigated for microvascular decompression (MVD), a common surgical procedure for trigeminal neuralgia. We aimed to determine MCID for the most commonly used PRO measures of pain after MVD: Visual Analog Scale (VAS) and Barrow Neurological Institute Pain Scale (BNI-PS). Sixty consecutive patients with classic trigeminal neuralgia who decided to undergo MVD by a single surgeon were prospectively assessed with VAS and BNI-PS preoperatively and 2 years postoperatively. Three anchors were used to assign each patient's outcome. We then used 3 well-established, anchor-based methods to calculate MCID. Patients experienced significant improvement in both VAS (9.9 vs. 2.0, P MCID. The 3 MCID calculation methods generated a range of MCID values for each of the PROs (VAS: 1.40-8.87, BNI-PS: 0.95-3.26). MVD-specific MCID is highly variable based on calculation technique. Some of these calculations appear to either overestimate or underestimate the patients' preoperative expectations. When the different MCID methods are averaged, the results are clinically appropriate and consistent with preoperative expectations. The average MCID for VAS is 6.25 and for BNI-PS is 2.44.

  8. Ruptured corpus luteal cyst: Prediction of clinical outcomes with CT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Myoung Seok; Moon, Min Hoan; Woo, Hyun Sik; Sung, Chang Kyu; Jeon, Hye Won; Lee, Taek Sang [SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2017-08-01

    To evaluate the determinant pretreatment CT findings that can predict surgical intervention for patients suffering from corpus luteal cyst rupture with hemoperitoneum. From January 2009 to December 2014, a total of 106 female patients (mean age, 26.1 years; range, 17–44 years) who visited the emergency room of our institute for acute abdominal pain and were subsequently diagnosed with ruptured corpus luteal cyst with hemoperitoneum were included in the retrospective study. The analysis of CT findings included cyst size, cyst shape, sentinel clot sign, ring of fire sign, hemoperitoneum depth, active bleeding in portal phase and attenuation of hemoperitoneum. The comparison of CT findings between the surgery and conservative management groups was performed with the Mann-Whitney U test or chi-square test. Logistic regression analysis was used to determine significant CT findings in predicting surgical intervention for a ruptured cyst. Comparative analysis revealed that the presence of active bleeding and the hemoperitoneum depth were significantly different between the surgery and conservative management groups and were confirmed as significant CT findings for predicting surgery, with adjusted odds ratio (ORs) of 3.773 and 1.318, respectively (p < 0.01). On the receiver-operating characteristic curve analysis for hemoperitoneum depth, the optimal cut-off value was 5.8 cm with 73.7% sensitivity and 58.6% specificity (Az = 0.711, p = 0.004). In cases with a hemoperitoneum depth > 5.8 cm and concurrent active bleeding, the OR for surgery increased to 5.786. The presence of active bleeding and the hemoperitoneum depth on a pretreatment CT scan can be predictive warning signs of surgery for a patient with a ruptured corpus luteal cyst with hemoperitoneum.

  9. [Survey of cachexia in digestive system cancer patients and its impact on clinical outcomes].

    Science.gov (United States)

    Sun, Yandong; Zhang, Bo; Han, Yusong; Jiang, Yi; Zhuang, Qiulin; Gong, Yuda; Wu, Guohao

    2014-10-01

    To investigate cachexia in hospitalized patients with digestive system cancer and evaluate its impact on clinical outcomes. By analyzing the clinical data of 5118 hospitalized patients with digestive system cancer in Zhongshan Hospital of Fudan University from January 2012 to December 2013, cachexia was investigated and clinical outcomes between cachexia patients and non-cachexia patients was compared. The total cachexia rate of hospitalized patients with digestive system cancer was 15.7%(803/5118). The highest rate of cachexia was 34.0%(89/262) in patients with pancreatic cancer followed by gastric cancer 22.4%(261/1164), colon cancer 21.7%(146/672), and rectal cancer 20.1%(117/581). In cachexia group and non-cachexia group, the overall completion rate of radical resection was 67.1%(539/803) and 74.5%(3214/4315) respectively(Pdigestive system cancer. Cachexia has significant adverse effects on clinical outcomes in hospitalized patients with digestive system cancer.

  10. Henoch-Schönlein purpura outcome in children: A ten-year clinical study

    Directory of Open Access Journals (Sweden)

    Spasojević-Dimitrijeva Brankica

    2011-01-01

    Full Text Available Introduction. Henoch-Schönlein purpura (HSP is the most common vasculitis of childhood. It is characterized by symptoms including nonthrombocytopenic purpura, abdominal pain, haematuria/proteinuria, and arthralgia/arthritis. The pleiomorphism of clinical signs in HSP could be confused with other conditions or other vasculitis forms. Objective. Evaluation of HSP clinical presentation, the onset and severity of renal manifestation in affected children and their outcome. Methods. A retrospective study of 49 patients diagnosed with HSP was conducted from September 1999 to September 2009. Children with severe renal manifestations (nephrotic range proteinuria, with or without nephrotic or nephritic syndrome have undergone kidney biopsy. Results. Twenty-five patients developed renal manifestations after onset of the disease. In our study child’s older age was a risk factor for association with HSP nephritis. Six of the patients required kidney biopsy. They were successfully treated with various immunosuppressive protocols, as well as three of nine patients with nephrotic range proteinuria. Two patients developed most severe form of HSP nephritis, nephrotic-nephritic syndrome with histology grade IIIb/IVb. During the study period (average follow-up 6 years, all patients had a normal global renal function with mild proteinuria in only two cases. The prognosis of renal involvement was better than reports from other patient series. Conclusion. Long-term morbidity of HSP is predominantly attributed to renal involvement. During the study period, no patient had renal insufficiency or end stage renal disease after various combinations of immunosuppressive treatment. It is recommended that patients with HSP nephritis are followed for longer periods of time with a regular measurement of renal function and proteinuria.

  11. Preimplantation Flow Testing of Ahmed Glaucoma Valve and the Early Postoperative Clinical Outcome.

    Science.gov (United States)

    Jones, Emma; Alaghband, Pouya; Cheng, Jason; Beltran-Agullo, Laura; Sheng Lim, Kin

    2013-01-01

    The Ahmed glaucoma valve (AGV) implant is designed to prevent early postoperative hypotony. There is evidence of variation in hypotony rates in clinical trials which may be due to surgical technique variation, entry site leakage or valve defects from 'over priming'. We describe a simple preimplantation gravity driven test to assess valve function after priming that may reduce hypotony rates. Retrospective case note review. An in vivo flow test of AGVs, based on the gravity driven test was introduced prior to implantation. The onset and offset of flow through the valve was measured by altering the height of a bottle of balanced saline solution. We rejected the AGV, if there was fluid still flowing at 10 cm (7 mm Hg) or if there was no flow at 17 cm of water (12 mm Hg). The AGV implantation surgery was without mitomycin C, with a 25G needle entry tract, a corneal or scleral patch graft tube cover and without intracameral viscoelastic. Twenty Ahmed valves were implanted in 16 patients between July 2008 and October 2009. Test failure resulted in four AGV being rejected. The mean preoperative pressure was 29 mm Hg (range, 10-57 mm Hg) and the intraocular pressure (IOP) at 7 days postoperatively was 15 mm Hg (range, 3-52 mm Hg). Hypotony, defined as an IOP of less than 5 mm Hg on two consecutive assessments, was present in two eyes (10%). In vivo flow testing is an important safety check for the AGV. There are also other mechanisms after implantation that can cause an unexpected high or low IOP. How to cite this article: Jones E, Alaghband P, Cheng J, Beltran-Agullo L, Lim KS. Preimplantation Flow Testing of Ahmed Glaucoma Valve and the Early Postoperative Clinical Outcome. J Current Glau Prac 2013;7(1):1-5.

  12. Prophylactic peritoneal dialysis following cardiopulmonary bypass in children is associated with decreased inflammation and improved clinical outcomes.

    Science.gov (United States)

    Sasser, William C; Dabal, Robert J; Askenazi, David J; Borasino, Santiago; Moellinger, Ashley B; Kirklin, James K; Alten, Jeffrey A

    2014-01-01

    To investigate impact of prophylactic peritoneal dialysis (PD) on clinical outcomes and inflammatory cytokines in children following cardiac surgery with cardiopulmonary bypass. Prospective before-and-after nonrandomized cohort study. Pediatric cardiovascular intensive care unit in tertiary hospital. Fifty-two consecutive neonates and infants at high risk for postoperative fluid overload following cardiopulmonary bypass. All had PD catheters placed during primary cardiac surgery. Initial 27 patients were managed with passive peritoneal drainage and diuretics (controls). Following 25 patients were started on prophylactic PD in immediate postoperative period and managed per PD protocol (+PD). Cumulative fluid balance, indices of disease severity, and clinical outcomes were prospectively collected. Plasma interleukin-6 and interleukin-8 were measured immediately before-and-after cardiopulmonary bypass and at 24 and 48 hours post-cardiopulmonary bypass. Demographics, diagnoses, and intraoperative variables were similar. Median net fluid balance was more negative in +PD at 24 hours, -24 mL/kg (interquartile range: -62, 11) vs. +18 mL/kg (interquartile range: -26, 11), P = .003, and 48 hours, -88 mL/kg (interquartile range: -132, -54) vs. -46 mL/kg (interquartile range: -84, -12), P = .004. +PD had median 55 mL/kg less fluid intake at 24 hours, P = .058. Peritoneal drain, urine, and chest tube output were comparable over first 24 hours. Mean inotrope score was lower in +PD at 24 hours. +PD had earlier sternal closure--24 hours (interquartile range: 20, 40) vs. 63 hours (interquartile range: 44, 72), P < .001--and a trend toward shorter duration of mechanical ventilation--71 hours (interquartile range: 49, 135) vs. 125 hours (interquartile range: 70, 195), P = .10. +PD experienced lower serum concentrations of interleukin-6 and interleukin-8 at 24 hours. Prophylactic PD is associated with greater net negative fluid balance, decreased inotrope requirements, and

  13. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease.

    Science.gov (United States)

    Sabatine, Marc S; Giugliano, Robert P; Keech, Anthony C; Honarpour, Narimon; Wiviott, Stephen D; Murphy, Sabina A; Kuder, Julia F; Wang, Huei; Liu, Thomas; Wasserman, Scott M; Sever, Peter S; Pedersen, Terje R

    2017-05-04

    evolocumab (2.1% vs. 1.6%). In our trial, inhibition of PCSK9 with evolocumab on a background of statin therapy lowered LDL cholesterol levels to a median of 30 mg per deciliter (0.78 mmol per liter) and reduced the risk of cardiovascular events. These findings show that patients with atherosclerotic cardiovascular disease benefit from lowering of LDL cholesterol levels below current targets. (Funded by Amgen; FOURIER ClinicalTrials.gov number, NCT01764633 .).

  14. Clinical infectious outcomes associated with biofilm-related bacterial infections: a retrospective chart review.

    Science.gov (United States)

    Barsoumian, Alice E; Mende, Katrin; Sanchez, Carlos J; Beckius, Miriam L; Wenke, Joseph C; Murray, Clinton K; Akers, Kevin S

    2015-06-07

    Biofilms are associated with persistent infection. Reports characterizing clinical infectious outcomes and patient risk factors for colonization or infection with biofilm forming isolates are scarce. Our institution recently published a study examining the biofilm forming ability of 205 randomly selected clinical isolates. This present study aims to identify potential risk factors associated with these isolates and assess clinical infectious outcomes. 221 clinical isolates collected from 2005 to 2012 and previously characterized for biofilm formation were studied. Clinical information from the associated patients, including demographics, comorbidities, antibiotic usage, laboratory values, and clinical infectious outcomes, was determined retrospectively through chart review. Duplicate isolates and non-clinical isolates were excluded from analysis. Associations with biofilm forming isolates were determined by univariate analysis and multivariate analysis. 187 isolates in 144 patients were identified for analysis; 113 were biofilm producers and 74 were not biofilm producers. Patients were primarily male (78 %) military members (61 %) with combat trauma (52 %). On multivariate analysis, the presence of methicillin-resistant Staphylococcus aureus (p biofilm producing isolate group. Infectious outcomes of patients with non-biofilm forming isolates, including cure, relapse/reinfection, and chronic infection, were similar to infectious outcomes of patients with biofilm-forming isolates. Mortality with initial infection was higher in the biofilm producing isolate group (16 % vs 5 %, p = 0.01) but attributable mortality was low (1 of 14). No characteristics examined in this study were found to be associated with relapse/reinfection or chronic infection on multivariate analysis. Bacteria species, but not clinical characteristics, were associated with biofilm formation on multivariate analysis. Biofilm forming isolates and non-biofilm forming isolates had similar infectious

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

    Science.gov (United States)

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

    2017-06-01

    Complex regional pain syndrome (CRPS) is a persistent pain condition that remains incompletely understood and challenging to treat. Historically, a wide range of different outcome measures have been used to capture the multidimensional nature of CRPS. This has been a significant limiting factor in the advancement of our understanding of the mechanisms and management of CRPS. In 2013, an international consortium of patients, clinicians, researchers, and industry representatives was established, to develop and agree on a minimum core set of standardised outcome measures for use in future CRPS clinical research, including but not limited to clinical trials within adult populations. The development of a core measurement set was informed through workshops and supplementary work, using an iterative consensus process. "What is the clinical presentation and course of CRPS, and what factors influence it?" was agreed as the most pertinent research question that our standardised set of patient-reported outcome measures should be selected to answer. The domains encompassing the key concepts necessary to answer the research question were agreed as follows: pain, disease severity, participation and physical function, emotional and psychological function, self-efficacy, catastrophizing, and patient's global impression of change. The final core measurement set included the optimum generic or condition-specific patient-reported questionnaire outcome measures, which captured the essence of each domain, and 1 clinician-reported outcome measure to capture the degree of severity of CRPS. The next step is to test the feasibility and acceptability of collecting outcome measure data using the core measurement set in the CRPS population internationally.

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

    Science.gov (United States)

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

    2017-01-01

    Complex Regional Pain Syndrome (CRPS) is a persistent pain condition that remains incompletely understood and challenging to treat. Historically, a wide range of different outcome measures have been used to capture the multidimensional nature of CRPS. This has been a significant limiting factor in the advancement of our understanding of the mechanisms and management of CRPS. In 2013, an international consortium of patients, clinicians, researchers and industry representatives was established, to develop and agree on a minimum core set of standardised outcome measures for use in future CRPS clinical research, including but not limited to clinical trials within adult populations The development of a core measurement set was informed through workshops and supplementary work, using an iterative consensus process. ‘What is the clinical presentation and course of CRPS, and what factors influence it?’ was agreed as the most pertinent research question that our standardised set of patient-reported outcome measures should be selected to answer. The domains encompassing the key concepts necessary to answer the research question were agreed as: pain, disease severity, participation and physical function, emotional and psychological function, self efficacy, catastrophizing and patient's global impression of change. The final core measurement set included the optimum generic or condition-specific patient-reported questionnaire outcome measures, which captured the essence of each domain, and one clinician reported outcome measure to capture the degree of severity of CRPS. The next step is to test the feasibility and acceptability of collecting outcome measure data using the core measurement set in the CRPS population internationally. PMID:28178071

  17. Potent autologous and heterologous neutralizing antibody responses occur in HIV-2 infection across a broad range of infection outcomes.

    Science.gov (United States)

    de Silva, Thushan I; Aasa-Chapman, Marlén; Cotten, Matthew; Hué, Stéphane; Robinson, James; Bibollet-Ruche, Frederic; Sarge-Njie, Ramu; Berry, Neil; Jaye, Assan; Aaby, Peter; Whittle, Hilton; Rowland-Jones, Sarah; Weiss, Robin

    2012-01-01

    Few studies have explored the role of neutralizing antibody (NAb) responses in controlling HIV-2 viremia and disease progression. Using a TZM-bl neutralization assay, we assessed heterologous and autologous NAb responses from a community cohort of HIV-2-infected individuals with a broad range of disease outcomes in rural Guinea-Bissau. All subjects (n = 40) displayed exceptionally high heterologous NAb titers (50% inhibitory plasma dilution or 50% inhibitory concentration [IC(50)], 1:7,000 to 1:1,000,000) against 5 novel primary HIV-2 envelopes and HIV-2 7312A, whereas ROD A and 3 primary envelopes were relatively resistant to neutralization. Most individuals also showed high autologous NAb against contemporaneous envelopes (78% of plasma-envelope combinations in 69 envelopes from 21 subjects), with IC(50)s above 1:10,000. No association between heterologous or autologous NAb titer and greater control of HIV-2 was found. A subset of envelopes was found to be more resistant to neutralization (by plasma and HIV-2 monoclonal antibodies). These envelopes were isolated from individuals with greater intrapatient sequence diversity and were associated with changes in potential N-linked glycosylation sites but not CD4 independence or CXCR4 use. Plasma collected from up to 15 years previously was able to potently neutralize recent autologous envelopes, suggesting a lack of escape from NAb and the persistence of neutralization-sensitive variants over time, despite significant NAb pressure. We conclude that despite the presence of broad and potent NAb responses in HIV-2-infected individuals, these are not the primary forces behind the dichotomous outcomes observed but reveal a limited capacity for adaptive selection and escape from host immunity in HIV-2 infection.

  18. Acute viral bronchiolitis: Physician perspectives on definition and clinically important outcomes.

    Science.gov (United States)

    Fernandes, Ricardo M; Andrade, Maria Gabriela; Constant, Carolina; Malveiro, Duarte; Magalhães, Manuel; Abreu, Daisy; Azevedo, Inês; Sousa, Eduarda; Salgado, Rizério; Bandeira, Teresa

    2016-07-01

    Two key limitations hamper intervention research in bronchiolitis: the absence of a clear definition of disease, and the heterogeneous choice of outcome measures in current clinical trials. We assessed how paediatricians and general practitioners (GPs) perceived definition and clinically important outcomes in bronchiolitis. A nationwide online survey (ABBA study) was conducted through the Portuguese Society of Paediatrics and GPs' mailing lists. We assessed agreement with statements on bronchiolitis definition, and participants were asked to score the relative importance of several outcomes. Principal component analysis (PCA) explored dimensions underlying disease definition. Outcomes were ranked by mean score and proportion given highest score. We included 514 paediatricians and 165 GPs (overall 59% were board-certified). Most paediatricians (76.5%) agreed with a definition based on coryza, wheezing and/or crackles/rales, compared to 38.1% GPs (P first episode of wheeze). We retained three dimensions on PCA: one based on coryza, rales/crepitations and no sudden onset; another on number of episodes and age; and a third on wheeze. Dimensions varied by physician specialization and training (P bronchiolitis have considerable variability and often mismatch those of clinical trials. Rating of important outcomes was consistent. Our results highlight the need for a robust standardized definition of acute bronchiolitis in infants and support the development of a core outcome set for future clinical trials. Pediatr Pulmonol. 2016;51:724-732. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  19. Surgical Stabilization of Pelvic and Acetabular Fractures: A Review on the Determinants of Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    SS Sathappan

    2010-03-01

    Full Text Available AIM: Pelvic and acetabular fractures are associated with high-energy trauma. The aim of this study was to identify factors that are associated with specific clinical outcomes following treatment for these fractures. METHODS: A consecutive series of 30 patients who had surgical intervention for either pelvic or acetabular fractures formed the sample for this study. Clinical variables reviewed were: age, associated injuries, number of surgical procedures, time to surgery and post-operative complications. Clinical outcomes were assessed using Matta’s grading of post- operative fracture reduction alignment, and functional outcomes were graded using D'Aubigne & Postel’s Hip scoring system. RESULTS: Study subjects included twelve pelvic fractures and eighteen acetabular fractures. Patients older than 50 years of age had poorer hip scores despite surgery. Earlier fracture fixation (within five days was associated with better hip scores. Patients with acetabular fractures generally had better functional outcomes than patients with pelvic fractures (mean hip score 15.0 vs. 13.5. Closer anatomical reduction of acetabular fractures was associated with better functional outcome. CONCLUSION: Improved clinical outcomes are associated with younger age, fewer concomitant injuries, shorter time interval to surgery and more closely approximated anatomical fracture reduction.

  20. Newborns with diaphragmatic hernia: initial chest radiography does not have a role in predicting clinical outcome

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    Holt, Peter D.; Berdon, Walter E. [Department of Radiology, Children' s Hospital of New York-Presbyterian, 3959 Broadway, CHN 325, NY 10032, New York (United States); Arkovitz, Marc S.; Stolar, Charles J. [Department of Surgery, Children' s Hospital of New York-Presbyterian, 3959 Broadway, CHN 325, NY 10032, New York (United States)

    2004-06-01

    The management of life-threatening congenital diaphragmatic hernia (CDH) has undergone significant change over the last two decades. When CDH was felt to be a surgical emergency treated promptly after birth, survival rates of 50% were typical. Recent changes in medical management of these patients prior to surgery have had a dramatic influence on clinical outcome with survival rates over 80%. This study was performed to assess under the current 80% survival rates whether there is predictive value in the appearance of the initial chest radiograph and clinical outcome in patients with CDH. Initial chest radiographs on 56 newborns with CDH were retrospectively reviewed for percent aeration of ipsilateral lung, percent aeration of contralateral lung, percent mediastinal shift, and content of hernia and correlated with clinical outcome. There was no significant relationship between radiographic analysis of the percent of ipsilateral lung aeration (P=0.43), contralateral aeration (P=0.52) mediastinal shift (P=0.18), or content of hernia and clinical outcome. All CDH lesions tend to ''look the same'' on radiographs, regardless of favorable or fatal outcome. Chest radiography serves to confirm the diagnosis of CDH, but does not predict outcome. (orig.)

  1. Newborns with diaphragmatic hernia: initial chest radiography does not have a role in predicting clinical outcome.

    Science.gov (United States)

    Holt, Peter D; Arkovitz, Marc S; Berdon, Walter E; Stolar, Charles J

    2004-06-01

    The management of life-threatening congenital diaphragmatic hernia (CDH) has undergone significant change over the last two decades. When CDH was felt to be a surgical emergency treated promptly after birth, survival rates of 50% were typical. Recent changes in medical management of these patients prior to surgery have had a dramatic influence on clinical outcome with survival rates over 80%. This study was performed to assess under the current 80% survival rates whether there is predictive value in the appearance of the initial chest radiograph and clinical outcome in patients with CDH. Initial chest radiographs on 56 newborns with CDH were retrospectively reviewed for percent aeration of ipsilateral lung, percent aeration of contralateral lung, percent mediastinal shift, and content of hernia and correlated with clinical outcome. There was no significant relationship between radiographic analysis of the percent of ipsilateral lung aeration (P=0.43), contralateral aeration (P=0.52) mediastinal shift (P=0.18), or content of hernia and clinical outcome. All CDH lesions tend to "look the same" on radiographs, regardless of favorable or fatal outcome. Chest radiography serves to confirm the diagnosis of CDH, but does not predict outcome. Copyright 2004 Springer-Verlag

  2. Endothelin 1 levels in relation to clinical presentation and outcome of Henoch Schonlein purpura

    Directory of Open Access Journals (Sweden)

    Moustaki M

    2008-09-01

    Full Text Available Abstract Background Henoch Schonlein purpura (HSP is a common vasculitis of small vessels whereas endothelin-1 (ET-1 is usually reported elevated in vasculities and systematic inflammation. The aim of the present study was to investigate whether ET-1 levels are correlated with the clinical presentation and the outcome of HSP. Methods The study sample consisted of thirty consecutive patients with HSP. An equal number of healthy patients of similar age and the same gender were served as controls. The patients' age range was 2–12.6 years with a mean ± SD = 6.3 ± 3 years. All patients had a physical examination with a renal, and an overall clinical score. Blood and urinary biochemistry, immunology investigation, a skin biopsy and ET-1 measurements in blood and urine samples were made at presentation, 1 month later and 1 year after the appearance of HSP. The controls underwent the same investigation with the exception of skin biopsy. Results ET-1 levels in plasma and urine did not differ between patients and controls at three distinct time points. Furthermore the ET-1 were not correlated with the clinical score and renal involvement was independent from the ET-1 measurements. However, the urinary ET-1 levels were a significant predictor of the duration of the acute phase of HSP (HR = 0.98, p = 0.032, CI0.96–0.99. The ET-1 levels did not correlate with the duration of renal involvement. Conclusion Urinary ET-1 levels are a useful marker for the duration of the acute phase of HSP but not for the length of renal involvement.

  3. Clinical associations, biological risk factors and outcomes of cerebral venous sinus thrombosis.

    Science.gov (United States)

    Gunes, Hafize Nalan; Cokal, Burcu Gokce; Guler, Selda Keskin; Yoldas, Tahir Kurtulus; Malkan, Umit Yavuz; Demircan, Cemile Sencer; Yon, Mehmet Ilker; Yoldas, Zeynep; Gunes, Gursel; Haznedaroglu, Ibrahim Celalettin

    2016-12-01

    Objective Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease affecting young adults. The majority of the patients are female. The aim of this study is to assess the clinical associations, risk factors and outcomes of the patients with CVST. Methods The data of 75 patients with CVST admitted to our hospital between 2006 and 2016 were reviewed. Demographic and clinical features and the thrombophilic risk factors of the patients were recorded. The localizations of the thrombi were determined and modified Rankin score at the time of onset and discharge were calculated. Results The majority of our patients (78.7%) were female. Median age was 35 years (16-76). The most common symptom was headache (86.7%). In 82.6% of our patients, inherited or acquired risk factors for thrombosis were detected. Transverse sinus was the most common site of thrombosis followed by sigmoid and superior sagittal sinuses. Two thirds of the patients had involvement of multiple sinuses. The patients with the involvement of sagittal sinus had better disability at the time of admittance ( p = 0.013) while the number of involved sinuses was correlated worse disability ( p = 0.015). The neurologic states in the majority of the patients were improved by the end of the hospitalization period ( p = 0.001). There was no significant difference in disability score at discharge between men and women ( p = 0.080). No patient with CVST died in the hospitalization period. Conclusions This study is one of the largest cohort studies on CVST in our region. The results of the study disclosed that CVST had wide range of clinical manifestations and non-specific symptoms at the beginning. For that reason, in especially high risk groups for thrombosis, the diagnosis of CVST should be kept in mind.

  4. Clinical Outcome of Arthroscopic Remplissage as Augmentation During Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability.

    Science.gov (United States)

    Miyamoto, Ryosuke; Yamamoto, Atsushi; Shitara, Hitoshi; Ichinose, Tsuyoshi; Shimoyama, Daisuke; Sasaki, Tsuyoshi; Hamano, Noritaka; Kobayashi, Tsutomu; Osawa, Toshihisa; Takagishi, Kenji

    2017-01-01

    We aimed to assess functional outcomes and postoperative recurrence rate associated with the remplissage procedure used for bone augmentation with Bankart repair in patients with Hill-Sachs lesions after shoulder dislocation. Preoperative computed tomography was performed to check for bony Bankart lesions,calculate the bone defect rate, and estimate the risk for re-dislocation. Functional and clinical scores were assessed preoperatively and at three months, six months, and one year postoperatively. Between 2011 and 2014, 18 patients (17 male; age at surgery, 29.0±10.4 years; 18 affected shoulders) underwent arthroscopic Bankart repair with arthroscopic remplissage (remplissage group), and 18 sex- and age-matched controls underwent arthroscopic Bankart repair alone (control group). The incidence of bony Bankart lesion and glenoid bone defect was significantly higher in the remplissage group. No complications, re-dislocation, or re-subluxation was noted during or after the operation. Postoperatively, the range of motion and muscular weakness alleviated with time, and the clinical scores improved significantly from the preoperative values. However, the remplissage group showed significantly restricted shoulder flexion, abduction, internal rotation and external rotation even at one year postoperatively. Compared to the control group, the remplissage group showed significantly lower Rowe scores preoperatively, and both Rowe scores and University of California-Los Angeles scale scores remained significantly lower throughout the one-year follow-up. Despite some restriction of external rotation, remplissage leads to better clinical scores and no recurrence, providing a valid means of augmentation for Bankart repair in high-risk patients with engaged Hill-Sachs lesion.

  5. Positive outcomes influence the rate and time to publication, but not the impact factor of publications of clinical trial results.

    Science.gov (United States)

    Suñé, Pilar; Suñé, Josep Maria; Montoro, J Bruno

    2013-01-01

    Publication bias may affect the validity of evidence based medical decisions. The aim of this study is to assess whether research outcomes affect the dissemination of clinical trial findings, in terms of rate, time to publication, and impact factor of journal publications. All drug-evaluating clinical trials submitted to and approved by a general hospital ethics committee between 1997 and 2004 were prospectively followed to analyze their fate and publication. Published articles were identified by searching Pubmed and other electronic databases. Clinical study final reports submitted to the ethics committee, final reports synopses available online and meeting abstracts were also considered as sources of study results. Study outcomes were classified as positive (when statistical significance favoring experimental drug was achieved), negative (when no statistical significance was achieved or it favored control drug) and descriptive (for non-controlled studies). Time to publication was defined as time from study closure to publication. A survival analysis was performed using a Cox regression model to analyze time to publication. Journal impact factors of identified publications were recorded. Publication rate was 48·4% (380/785). Study results were identified for 68·9% of all completed clinical trials (541/785). Publication rate was 84·9% (180/212) for studies with results classified as positive and 68·9% (128/186) for studies with results classified as negative (pimpact factor between positive (median 6·308, interquartile range: 3·141-28·409) and negative result studies (median 8·266, interquartile range: 4·135-17·157). Clinical trials with positive outcomes have significantly higher rates and shorter times to publication than those with negative results. However, no differences have been found in terms of impact factor.

  6. Clinical Profile, Treatment, and Visual Outcome of Ocular Toxocara in a Tertiary Eye Care Centre.

    Science.gov (United States)

    Sahu, Ekta S; Pal, Bikramjit; Sharma, Tarun; Biswas, Jyotirmay

    2016-11-30

    To determine the clinical features, treatment, and visual outcome in ocular toxocariasis. A total of 16 cases diagnosed as ocular toxocariasis clinically and/or serologically were analyzed retrospectively. The mean age of the patients was 22.6 years. Cases were categorized into three clinical types with peripheral granuloma (43.7%) as the most common presentation. Of the patients, 10 (62.5%) had positive serum ELISA for T. canis; five (31.2%) received combination treatment with anthelmintic and corticosteroid, and eight (50%) patients had vitreous surgery. The visual outcome in eyes which underwent surgery was better, however the difference in medically and surgically treated groups was insignificant (p = 0.11). There was also no difference in visual outcome among the three clinical groups (p = 0.20). Ocular toxocariasis has a varied presentation spectrum. Serum ELISA for T. canis aids in diagnosis. The difference in visual outcome among clinical and treatment groups was insignificant. However, in general, ocular toxocariasis resulted in a poor visual outcome.

  7. Laparoscopic Repair of Intrathoracic Stomach: Clinical and Health-related Quality of Life Outcomes.

    Science.gov (United States)

    Karim, Muhammad A; Maloney, Jay; Ali, AbdulMajid

    2016-12-01

    This study aims to evaluate the clinical and quality of health outcomes in patients undergoing laparoscopic repair of intrathoracic stomach with or without gastric volvulus. From January 2007 to December 2013, a prospectively maintained data, of patients undergoing surgical repair of intrathoracic stomach, with or without gastric volvulus, was reviewed. Patient demographics, ASA grade, diagnostic technique, semiurgent/emergency status, type of volvulus if present, details of surgery and perioperative complications were recorded. Validated SF-36 questionnaires were completed by patients to record preoperative and postoperative quality of life (QoL) status. Patients managed by nonoperative measures were excluded from the study. Thirty patients were identified with intrathoracic stomach. Fourteen patients had gastric volvulus. Twenty-seven patients (10 emergency, 17 semiurgent) underwent laparoscopic repair of intrathoracic stomach and were included in the study. Mean operating time was 156 (SD, 37.5; range, 105 to 230) minutes. All 27 operations were completed by laparoscopic approach. There was no conversion to open procedure or mortality at 30 days. Mean hospital stay was 5.2 (range, 1 to 15) days. There were 3 (11%) early postoperative complications. One (3.7%) patient developed recurrence at 2 years which required reoperation. Mean follow-up was 10.5 (range, 1 to 36) months. ASA grade and operative time determined the postoperative hospital stay (P=0.001, 0.001, respectively), whereas body mass index and age were shown to have no influence. Patient-reported QoL scores improved across all scales of the health questionnaire after surgery especially bodily pain, social functioning, and physical functioning. Laparoscopic surgery is a safe and effective treatment option for intrathoracic stomach, with or without gastric volvulus. It is associated with low rates of complications and recurrence. Self-reported patient data shows significant improvement to overall Qo

  8. A comparison of direct and indirect methods for the estimation of health utilities from clinical outcomes.

    Science.gov (United States)

    Hernández Alava, Mónica; Wailoo, Allan; Wolfe, Fred; Michaud, Kaleb

    2014-10-01

    Analysts frequently estimate health state utility values from other outcomes. Utility values like EQ-5D have characteristics that make standard statistical methods inappropriate. We have developed a bespoke, mixture model approach to directly estimate EQ-5D. An indirect method, "response mapping," first estimates the level on each of the 5 dimensions of the EQ-5D and then calculates the expected tariff score. These methods have never previously been compared. We use a large observational database from patients with rheumatoid arthritis (N = 100,398). Direct estimation of UK EQ-5D scores as a function of the Health Assessment Questionnaire (HAQ), pain, and age was performed with a limited dependent variable mixture model. Indirect modeling was undertaken with a set of generalized ordered probit models with expected tariff scores calculated mathematically. Linear regression was reported for comparison purposes. Impact on cost-effectiveness was demonstrated with an existing model. The linear model fits poorly, particularly at the extremes of the distribution. The bespoke mixture model and the indirect approaches improve fit over the entire range of EQ-5D. Mean average error is 10% and 5% lower compared with the linear model, respectively. Root mean squared error is 3% and 2% lower. The mixture model demonstrates superior performance to the indirect method across almost the entire range of pain and HAQ. These lead to differences in cost-effectiveness of up to 20%. There are limited data from patients in the most severe HAQ health states. Modeling of EQ-5D from clinical measures is best performed directly using the bespoke mixture model. This substantially outperforms the indirect method in this example. Linear models are inappropriate, suffer from systematic bias, and generate values outside the feasible range. © The Author(s) 2013.

  9. Clinical outcome of femoral osteotomy in patients with legg-calve´-perthes disease.

    Science.gov (United States)

    Moghadam, Mohammad Hallaj; Moradi, Ali; Omidi-Kashani, Farzad

    2013-12-01

    Legg-Calve´-Perthes disease is a juvenile idiopathic osteonecrosis in which the blood supply of femoral head is not sufficient and the bone dies provisionally. The aim of this study is to evaluate outcome of Femoral osteotomy in children with LCPD in our University Hospital. In a descriptive analytic study, between 2008 and 2013, patients with the diagnosis of Legg-Calve'-Perthes confirmed with lateral pillar classification of B and B/C were entered and patients were encouraged to come to an outpatient clinic for follow-up. Descriptive analysis of the demographics was performed and relation between variables was tested using a two-sided Student's t test with statistical significance set at 0.05. Mean age of patients was 9±1.3 years, with the range of 4 to 12 years old. 25 patients (86.2%) were male and 4 patients (13.4%) female. There was no positive family history in patients. 17 patients (58.6%) had history of trauma. Duration of symptom presentation was 7±6.3 months, with the range of 3 to 36 months. In 20 of patients (69%) left hip and in 12 (41.4%) right hip was involved. There was significant relation between femoral head asymmetry, trochanter enlargement (P=0.04), acetabolum changes (P<0.001), femoral neck shortening (P<0.001). There was no relation between age (P=0.28) and duration of disease (P=0.8) with femoral neck shortening. Intertrochanteric osteotomy led to improvement in pain, limping and increased range of motion. Subluxation before surgery is one of the criteria, which could influence further prognosis. Acetabulum changes and femoral neck shortening are two factors seriously affect hip ROM.

  10. Coronary artery disease and symptomatic severe aortic valve stenosis: clinical outcomes after transcatheter aortic valve implantation.

    Directory of Open Access Journals (Sweden)

    Jennifer eMancio

    2015-04-01

    Full Text Available Background: The impact of coronary artery disease (CAD on outcomes after transcatheter aortic valve implantation (TAVI has not been clarified. Furthermore, less is known about the indication and strategy of revascularization in these high risk patients. Aims: This study sought to determine the prevalence and prognostic impact of CAD in patients undergoing TAVI, and to assess the safety and feasibility of percutaneous coronary intervention (PCI before TAVI.Methods: Patients with severe aortic stenosis (AS undergoing TAVI were included into a prospective single centre registry from 2007 to 2012. Clinical outcomes were compared between patients with and without CAD. In some patients with CAD it was decided to perform elective PCI before TAVI after decision by the Heart Team. The primary endpoints were 30-day and 2-year all-cause mortality.Results: A total of 91 consecutive patients with mean age of 79±9 years (52% men underwent TAVI with a median follow-up duration of 16 months (interquartile range of 27.6 months. CAD was present on 46 patients (51%. At 30-day, the incidences of death were similar between CAD and non-CAD patients (9% and 5%, p=0.44, but at 2 years were 50% in CAD patients and 24% in non-CAD patients (crude hazard ratio with CAD, 2.2; 95% confidence interval [CI], 1.1 to 4.6; p=0.04. Adjusting for age, gender, left ventricular ejection fraction and glomerular filtration rate the hazard of death was 2.6-fold higher in patients with CAD (95% CI, 1.1 to 6.0; p=0.03. Elective PCI before TAVI was performed in 13 patients (28% of CAD patients. There were no more adverse events in patients who underwent TAVI+PCI when compared with those who underwent isolated TAVI. Conclusions: In severe symptomatic AS who underwent TAVI, CAD is frequent and adversely impacts long-term outcomes, but not procedure outcomes. In selected patients, PCI before TAVI appears to be feasible and safe.

  11. A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases.

    Science.gov (United States)

    Goodwin, C Rory; Sankey, Eric W; Liu, Ann; Elder, Benjamin D; Kosztowski, Thomas; Lo, Sheng-Fu L; Fisher, Charles G; Clarke, Michelle J; Gokaslan, Ziya L; Sciubba, Daniel M

    2016-05-01

    OBJECT Surgical procedures and/or adjuvant therapies are effective modalities for the treatment of symptomatic spinal metastases. However, clinical results specific to the skin cancer spinal metastasis cohort are generally lacking. The purpose of this study was to systematically review the literature for treatments, clinical outcomes, and survival following the diagnosis of a skin cancer spinal metastasis and evaluate prognostic factors in the context of spinal skin cancer metastases stratified by tumor subtype. METHODS The authors performed a literature review using PubMed, Embase, CINAHL, and Web of Science to identify articles since 1950 that reported survival, clinical outcomes, and/or prognostic factors for the skin cancer patient population with spinal metastases. The methodological quality of reviews was assessed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) tool. RESULTS Sixty-five studies met the preset criteria and were included in the analysis. Of these studies, a total of 25, 40, 25, and 12 studies included patients who underwent some form of surgery, radiotherapy, chemotherapy, or observation alone, respectively. Sixty-three of the 65 included studies were retrospective in nature (Class of Evidence [CoE] IV), and the 2 prospective studies were CoE II. Based on the studies analyzed, the median overall survival for a patient with a spinal metastasis from a primary skin malignancy is 4.0 months; survival by tumor subtype is 12.5 months for patients with basal cell carcinoma (BCC), 4.0 months for those with melanoma, 4.0 months for those with squamous cell carcinoma, 3.0 months for those with pilomatrix carcinoma, and 1.5 months for those with Merkel cell carcinoma (p < 0.0001). The overall percentage of known continued disease progression after spine metastasis diagnosis was 40.1% (n = 244/608, range 25.0%-88.9%), the rate of known recurrence of the primary skin cancer lesion was 3.5% (n = 21/608, range 0

  12. A Qualitative Study of US Clinical Ethics Services: Objectives and Outcomes.

    Science.gov (United States)

    McClimans, Leah; Pressgrove, Geah; Rhea, James

    2016-01-01

    The quality of clinical ethics services in health care organizations is increasingly seen as an important aspect of the overall quality of care. But measuring this quality is difficult because there is a lack of clarity and consensus regarding the objectives of clinical ethics and the best outcome domains to measure. The aim of this qualitative study is to explore the views of experts about the objectives and outcomes of clinical ethics services in the US. We interviewed 19 experts in clinical ethics, focusing on the appropriate objectives and outcomes of a clinical ethics service (CES). Participants were selected using a purposive snowball sampling strategy. The development of the interview protocol was informed by the clinical ethics literature as well as by research and theories that inform clinical ethics practice. Interviews were conducted by phone, recorded, and transcribed for individual analysis. Analysis proceeded through the development of a codebook of categories using QDA Miner software. Our experts identified 12 objectives and nine outcomes. Some of these identifications were familiar (e.g., mediation and satisfaction) and some were novel (e.g., be of service and transformation). We found that experts are divided in their emphasis on the kinds of objectives that are most important. In terms of outcomes, our experts were concerned with the appropriateness of different proxy and direct measures. This study provides the perspectives of a select group of experts on the objectives and outcomes appropriate for a CES in the United States. The themes identified will be used in future research to inform a Delphi study to refine and obtain expert consensus.

  13. Clinical, operational and economic outcomes of point-of-care blood gas analysis in COPD patients.

    Science.gov (United States)

    Oliver, Paloma; Buno, Antonio; Alvarez-Sala, Rodolfo; Fernandez-Calle, Pilar; Alcaide, Maria Jose; Casitas, Raquel; Garcia-Quero, Cristina; Madero, Rosario; Gomez-Rioja, Ruben; Iturzaeta, Jose Manuel

    2015-04-01

    Arterial blood gas analysis is relevant in chronic obstructive pulmonary disease (COPD) management. The aim of this study was to evaluate whether the use of a blood gas analyzer in pulmonology departments improves the clinical, operational and economic outcomes when compared with clinical laboratory measurements. It is an observational prospective study. 112 patients were selected. After specimen collection, the measurement was performed both in pulmonology office as point-of-care and in laboratory. We evaluated clinical outcomes (modification of the indication of long-term oxygen therapy (LTOT) according to results, changes in blood gas analysis results, relationship of the partial pressure of oxygen (PaO2) obtained in the medical visit and velocity of change of the PaO2, influence of total haemoglobin concentration and the change in PaO2), operational outcomes (turnaround time (TAT) from specimen collection to receiving the blood gas analysis report) and economic outcomes (overall cost per process of patient care). There were discrepancies in the indication of LTOT in 13.4% of patients. All parameters showed changes. PaO2 levels showed changes in 2 ways, though they frequently increase over time. The correlation was not good in the other two clinical outcomes. The median TATs in pulmonology office were 1 min versus 79 in laboratory, with 52 min for specimen preparation and transport and 17 min for TAT intralaboratory. The overall cost for the 112 patients in pulmonology office and laboratory was 16,769.89€ and 22,260.97€ respectively. The use of a blood gas analyzer in a pulmonology office improves clinical, operational and economic outcomes when compared with clinical laboratory. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  14. Clinical outcomes following bioresorbable scaffold implantation for bifurcation lesions: Overall outcomes and comparison between provisional and planned double stenting strategy.

    Science.gov (United States)

    Kawamoto, Hiroyoshi; Latib, Azeem; Ruparelia, Neil; Miyazaki, Tadashi; Sticchi, Alessandro; Naganuma, Toru; Sato, Katsumasa; Figini, Filippo; Chieffo, Alaide; Carlino, Mauro; Montorfano, Matteo; Colombo, Antonio

    2015-10-01

    The aim of this study was to investigate clinical outcomes of patients treated with a provisional stenting (PS) versus a double stenting (DS) strategy for coronary bifurcation lesions with bioresorbable scaffolds (BRS). There are limited data available with regards to outcomes following BRS implantation for bifurcation lesions. A total of 132 bifurcation lesions treated with BRS between 2012 and 2014 were analyzed. Of the total of 132 bifurcation lesions, 10 lesions were treated without crossover stenting. 99 lesions (81%) were treated with a PS strategy and 23 lesions (19%) with a DS strategy. The DS group consisted of patients with a greater number of true bifurcation lesions (PS 52.0% vs. DS 91.3%: P strategy was employed. Larger studies are eagerly awaited to determine longer-term follow-up of this treatment strategy. © 2015 Wiley Periodicals, Inc.

  15. Crossing the Evidence Chasm: Building Evidence Bridges from Process Changes to Clinical Outcomes

    Science.gov (United States)

    Kendrick, David C.; Bu, Davis; Pan, Eric; Middleton, Blackford

    2007-01-01

    Objective Although demand for information about the effectiveness and efficiency of health care information technology grows, large-scale resource-intensive randomized controlled trials of health care information technology remain impractical. New methods are needed to translate more commonly available clinical process measures into potential impact on clinical outcomes. Design The authors propose a method for building mathematical models based on published evidence that provides an evidence bridge between process changes and resulting clinical outcomes. This method combines tools from systematic review, influence diagramming, and health care simulations. Measurements The authors apply this method to create an evidence bridge between retinopathy screening rates and incidence of blindness in diabetic patients. Results The resulting model uses changes in eye examination rates and other evidence-based population parameters to generate clinical outcomes and costs in a Markov model. Conclusion This method may serve as an alternative to more expensive study designs and provide useful estimates of the impact of health care information technology on clinical outcomes through changes in clinical process measures. PMID:17329720

  16. Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations.

    Science.gov (United States)

    Marques, André C; Calderaro, Daniela; Yu, Pai C; Gualandro, Danielle M; Carmo, Gabriel A L; Azevedo, Fernanda R; Pastana, Adriana F; Lima, Eneas M O; Monachini, Maristela; Caramelli, Bruno

    2014-12-01

    Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (pcardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.

  17. The role of clinical pathway on the outcomes of ischemic stroke patients at Bethesda Hospital Yogyakarta

    Directory of Open Access Journals (Sweden)

    Francisca Diana Alexandra, Iwan Dwiprahasto, Rizaldy Pinzon

    2014-04-01

    Full Text Available Stroke becomes world health problem all over the world because it is the causal factor of high mortality and disability. Good and well-organized process of healthcare service will improve the outcome of the patients with stroke. Clinical pathway may be used as clear standard to help reduce unnecessary variations of medical treatment and measure. The study aimed at finding out the correlation between the use of clinical pathway and the outcome of the patients with ischemic stroke in Bethesda Hospital Yogyakarta. It was an observational and analytic study with cohort restorative study design. The author compared the outcomes of acute ischemic stroke between the group with clinical pathway and the group without the clinical pathway. Data was collected using consecutive sampling from the electronic registry and medical record data of the patients from January 1st, 2011 to December 31st, 2011. It was conducted to 124 patients with ischemic stroke assigned to two groups (the first groups of 62 patients with clinical pathway and the second groups of 62 patients without clinical pathway. The basic characteristics of the two groups were the same. The results of the analysis showed that there was a significant decrease in the incidence of complication and a significant increase in the use of antiplatelete drugs, antidiabetic drugs and statin as secondary preventive measure of the recurrent stroke. There was not any significant difference in the duration of the hospitalized healthcare, the financing and the mortality between the two observation groups. The study indicated that the use of the clinical pathway in the stroke treatment improved the outcome of the patients with stroke. It was necessary to conduct further study to evaluate the effectiveness of the clinical pathway in improving the outcome of the patients with bigger number of the subjects and the longer period of time.

  18. Comparing patients with spinal cord infarction and cerebral infarction: clinical characteristics, and short-term outcome

    OpenAIRE

    Naess H; Romi,

    2011-01-01

    Halvor Naess, Fredrik RomiDepartment of Neurology, Haukeland University Hospital, N-5021 Bergen, NorwayBackground: To compare the clinical characteristics, and short-term outcome of spinal cord infarction and cerebral infarction.Methods: Risk factors, concomitant diseases, neurological deficits on admission, and short-term outcome were registered among 28 patients with spinal cord infarction and 1075 patients with cerebral infarction admitted to the Department of Neurology, Haukeland Universi...

  19. The frequency, cost, and clinical