Effects of noninvasive ventilation on sleep outcomes in amyotrophic lateral sclerosis.

Science.gov (United States)

Katzberg, Hans D; Selegiman, Adam; Guion, Lee; Yuan, Nancy; Cho, Sungho C; Katz, Jonathan S; Miller, Robert G; So, Yuen T

2013-04-15

The objective was to study the effects on noninvasive ventilation on sleep outcomes in patient with ALS, specifically oxygenation and overall sleep quality. Patients with ALS who met criteria for initiation of NIV were studied with a series of 2 home PSG studies, one without NIV and a follow-up study while using NIV. Primary outcome was a change in the maximum overnight oxygen saturation; secondary outcomes included change in mean overnight oxygen saturation, apnea and hypopnea indexes, sleep latency, sleep efficiency, sleep arousals, and sleep architecture. A total of 94 patients with ALS were screened for eligibility; 15 were enrolled; and 12 completed study procedures. Maximum overnight oxygen saturation improved by 7.0% (p = 0.01) and by 6.7% during REM sleep (p = 0.02) with NIV. Time spent below 90% oxygen saturation was also significant-ly better with NIV (30% vs 19%, p NIV. NIV had no effect on sleep efficiency (mean change 10%), arousal index (7 to 12), or sleep stage distribution (Friedman chi-squared = 0.40). NIV improved oxygenation but showed no significant effects on sleep efficiency, sleep arousals, restful sleep, or sleep architecture. The net impact of these changes for patients deserves further study in a larger group of ALS patients.

The effect of health information technology implementation in Veterans Health Administration hospitals on patient outcomes.

Science.gov (United States)

Spetz, Joanne; Burgess, James F; Phibbs, Ciaran S

2014-03-01

The impact of health information technology (HIT) in hospitals is dependent in large part on how it is used by nurses. This study examines the impact of HIT on the quality of care in hospitals in the Veterans Health Administration (VA), focusing on nurse-sensitive outcomes from 1995 to 2005. Data were obtained from VA databases and original data collection. Fixed-effects Poisson regression was used, with the dependent variables measured using the Agency for Healthcare Research and Quality Inpatient Quality Indicators and Patient Safety Indicators software. Dummy variables indicated when each facility began and completed implementation of each type of HIT. Other explanatory variables included hospital volume, patient characteristics, nurse characteristics, and a quadratic time trend. The start of computerized patient record implementation was associated with significantly lower mortality for two diagnoses but significantly higher pressure ulcer rates, and full implementation was associated with significantly more hospital-acquired infections. The start of bar-code medication administration implementation was linked to significantly lower mortality for one diagnosis, but full implementation was not linked to any change in patient outcomes. The commencement of HIT implementation had mixed effects on patient outcomes, and the completion of implementation had little or no effect on outcomes. This longitudinal study provides little support for the perception of VA staff and leaders that HIT has improved mortality rates or nurse-sensitive patient outcomes. Future research should examine patient outcomes associated with specific care processes affected by HIT. Copyright © 2014 Elsevier Inc. All rights reserved.

Effects of hospital care environment on patient mortality and nurse outcomes.

Science.gov (United States)

Aiken, Linda H; Clarke, Sean P; Sloane, Douglas M; Lake, Eileen T; Cheney, Timothy

2008-05-01

The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education. Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited. Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed. Care environments were measured using the practice environment scales of the Nursing Work Index. Outcomes included nurse job satisfaction, burnout, intent to leave, and reports of quality of care, as well as mortality and failure to rescue in patients. Nurses reported more positive job experiences and fewer concerns with care quality, and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments. Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care.

Gender Differences in the Effects of Behavioral Problems on School Outcomes

DEFF Research Database (Denmark)

Kristoffersen, Jannie H. G.; Smith, Nina

Questionnaire (SDQ) of about 6,000 children born in 1990-92 in a large region in Denmark. The sample is merged with register information on parents and students observed until the age of 19. We find significant and large negative coefficients of the externalizing behavioral indicators. The effects tend......Behavioral problems are important determinants of school outcomes and later success in the labor market. We analyze whether behavioral problems affect girls and boys differently with respect to school outcomes. The study is based on teacher and parent evaluations of the Strength and Difficulties...... to be larger when based on parents' SDQ scores compared to teachers' SDQ scores. According to our estimations, the school outcomes for girls with abnormal externalizing behavior are not significantly different from those of boys with the same behavioral problems. A decomposition of the estimates indicates...

The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF.

Science.gov (United States)

Mogensen, Ulrik M; Køber, Lars; Kristensen, Søren L; Jhund, Pardeep S; Gong, Jianjian; Lefkowitz, Martin P; Rizkala, Adel R; Rouleau, Jean L; Shi, Victor C; Swedberg, Karl; Zile, Michael R; Solomon, Scott D; Packer, Milton; McMurray, John J V

2017-06-01

Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE-I enalapril, on coronary outcomes in PARADIGM-HF. We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including, in addition, MI, stroke, and resuscitated sudden death, and iii) a post hoc coronary composite of CV-death, non-fatal MI, angina hospitalization or coronary revascularization. At baseline, of 8399 patients, 3634 (43.3%) had a prior MI and 4796 (57.1%) had a history of any coronary artery disease. Among all patients, compared with enalapril, sacubitril/valsartan reduced the risk of the primary outcome (HR 0.80 [0.73-0.87], Psacubitril/valsartan group, compared with the enalapril group, only CV death was reduced significantly. Compared with enalapril, sacubitril/valsartan reduced the risk of both the primary endpoint and a coronary composite outcome in PARADIGM-HF. Additional studies on the effect of sacubitril/valsartan on atherothrombotic outcomes in high-risk patients are merited. Copyright © 2017 Elsevier Inc. All rights reserved.

The effect of electronic monitoring feedback on medication adherence and clinical outcomes: A systematic review.

Science.gov (United States)

van Heuckelum, Milou; van den Ende, Cornelia H M; Houterman, Anne E J; Heemskerk, Charlotte P M; van Dulmen, Sandra; van den Bemt, Bart J F

2017-01-01

This study aims to assess the efficacy of Electronic Monitoring Feedback (EMF) as an intervention to improve medication adherence (i.e. dose- or full adherence) and clinical outcomes in adult patients. A systematic search was performed in Medline, EMBASE, PsycINFO and Web of Science and reported according to the PRISMA guidelines. Randomised controlled trials (RCTs) comparing EMF with usual care were identified to systematically summarise the evidence for use of EMF in improving medication adherence and clinical outcomes. The GRADE approach was used to assess the quality of the body of evidence. Of 9,993 initially-identified studies, ten studies (four of high-quality and six of low-quality) were included. The sample size of the studies included varied from 18 to 205 patients. Four of the six studies (66.7%) reported a significant positive effect of EMF on mean dose adherence levels, whereas a significant positive effect of EMF on mean full adherence levels was found in all of the included studies (100%, five out of five of the studies included). A significant positive effect of EMF on clinical outcomes was reported in one of the seven studies included. The overall effect of EMF on mean dose- and full adherence was positive and the overall effect of EMF on clinical outcomes was inconclusive. Considering the positive effect of EMF on medication adherence, EMF might be a promising intervention to enhance medication adherence. However, the effect of EMF on clinical outcomes was inconclusive. Prior to implementing EMF in clinical practice, future research with high-quality studies (e.g. adequate sample sizes, follow-up periods and no interfering co-interventions) is required to examine the (long-term) efficacy of EMF.

Effects of electronic health information technology implementation on nursing home resident outcomes.

Science.gov (United States)

Pillemer, Karl; Meador, Rhoda H; Teresi, Jeanne A; Chen, Emily K; Henderson, Charles R; Lachs, Mark S; Boratgis, Gabriel; Silver, Stephanie; Eimicke, Joseph P

2012-02-01

To examine the effects of electronic health information technology (HIT) on nursing home residents. The study evaluated the impact of implementing a comprehensive HIT system on resident clinical, functional, and quality of care outcome indicators as well as measures of resident awareness of and satisfaction with the technology. The study used a prospective, quasi-experimental design, directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area. No statistically significant impact of the introduction of HIT on residents was found on any outcomes, with the exception of a significant negative effect on behavioral symptoms. Residents' subjective assessment of the HIT intervention were generally positive. The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes. The single negative finding suggests that further investigation is needed on possible impact on resident behavior. © The Author(s) 2012

Effects of economic crises on population health outcomes in Latin America, 1981–2010: an ecological study

Science.gov (United States)

Williams, Callum; Gilbert, Barnabas James; Zeltner, Thomas; Watkins, Johnathan; Atun, Rifat; Maruthappu, Mahiben

2016-01-01

Objectives The relative health effects of changes in unemployment, inflation and gross domestic product (GDP) per capita on population health have not been assessed. We aimed to determine the effect of changes in these economic measures on mortality metrics across Latin America. Design Ecological study. Setting Latin America (21 countries), 1981–2010. Outcome measures Uses multivariate regression analysis to assess the effects of changes in unemployment, inflation and GDP per capita on 5 mortality indicators across 21 countries in Latin America, 1981–2010. Country-specific differences in healthcare infrastructure, population structure and population size were controlled for. Results Between 1981 and 2010, a 1% rise in unemployment was associated with statistically significant deteriorations (pinflation rate was associated with significant deteriorations (pinflation, significant deteriorations (pinflation. Conclusions Rises in unemployment and inflation are associated with long-lasting deteriorations in several population health outcomes. Unemployment exerted much larger effects on health than inflation. In contrast, changes in GDP per capita had almost no association with the explored health outcomes. Contrary to neoclassical development economics, policymakers should prioritise amelioration of unemployment if population health outcomes are to be optimised. PMID:26739715

The effects of affective and cognitive empathy on adolescents' behavior and outcomes in conflicts with mothers.

Science.gov (United States)

Van Lissa, Caspar J; Hawk, Skyler T; Meeus, Wim H J

2017-06-01

The current study investigated whether manipulations of affective and cognitive empathy have differential effects on observed behavior and self-reported outcomes in adolescent-mother conflict discussions. We further examined how these situational empathy inductions interact with preexisting empathic dispositions. To promote ecological validity, we conducted home visits to study conflict discussions about real disagreements in adolescent-mother relationships. We explored the roles of sex, age, and maternal support and power as covariates and moderators. Results indicated that the affective empathy manipulation had no significant effects on behavior, although a trend in the hypothesized direction suggested that affective empathy might promote active problem solving. The cognitive empathy manipulation led to lower conflict escalation and promoted other-oriented listening for adolescents low in dispositional cognitive empathy. State-trait interactions indicated that the empathy manipulations had significant effects on self-reported outcomes for adolescents lower in dispositional empathic concern. For these adolescents, both manipulations promoted outcome satisfaction, but only the cognitive manipulation promoted perceived fairness. This suggests that cognitive empathy, in particular, allows adolescents to distance themselves from the emotional heat of a conflict and listen to mothers' point of view, leading to outcomes perceived as both satisfying and fair. These findings are relevant for interventions and clinicians because they demonstrate unique effects of promoting affective versus cognitive empathy. Because even these minimal manipulations promoted significant effects on observed behavior and self-reported outcomes, particularly for low-empathy adolescents, stronger structural interventions are likely to have marked benefits. Copyright © 2017 Elsevier Inc. All rights reserved.

Serum C-reactive protein concentration in preeclamptic women: Effect on pregnancy outcome

Directory of Open Access Journals (Sweden)

Sharmin Sultana

2016-07-01

Full Text Available Background: Preeclampsia is a multisystem disorder of unknown etiology characterized by development of hyperten­sion to the extent of 140/90 mm of Hg or more with proteinuria after the 20th gestational week in a previously normoten­sive and non protein uric women. According to the National High blood presure Working group (NHBPEP and Ameri­can college of obstetricans and Gynecologiests (ACOG hypertension in pregnancy is defined as a diastolic blood pressure of 90 mm Hg or higher after 20 weeks of gestation in a woman with previously normal blood pressure (NHBPEP, 2000; ACOG, 2002. If the disease is allowed to progress to the HELLP syndrome or eclampsia, maternal morbidity and mortality increases. The majority of perinatal losses are related to placental insufficiency, which causes intrauterine growth retardation, prematurity associated with preterm delivery, or abruptio placentae. Objectives: This study tried to explore the effect of serum C reactive protein concentration in preeclamptic women and its effect on pregnancy outcome.Methods: This case control study included 60 third trimester pregnant women (30 normotensive and 30 preeclamptic who attended Department of Obstetrics and Gynaecology, BIRDEM and DMCH, during July 2009 and June 2010. Estimation of serum C reactive protein (CRP concentrations was done by liquid phase immunoprecipitation assay and turbulometry at DMC.Results: Mean (±SD age showed no significant difference between groups; however, BMI, SBP, DBP and CRP were significantly (P<0.001 high in case group. Gravidity and ANC showed no significant variation between groups. CRP concentration was significantly high case group. Gestational age was significantly low in case group resulting in higher preterm delivery. No significant variation was observed regarding fetal outcome; however, birth weight was significantly low and neonatal complication was also significantly high in case group.Conclusion: CRP concentration was high in

Finding benefits from acculturative stress among Asian Americans: Self-reflection moderating the mediating effects of ethnocultural empathy on positive outcomes.

Science.gov (United States)

Wei, Meifen; Li, Chun-I; Wang, Cixin; Ko, Stacy Y

2016-11-01

This study examined a moderated mediation model to see whether self-reflection moderated (a) the association between acculturative stress and ethnocultural empathy and (b) the indirect effects of acculturative stress on 2 positive outcomes (i.e., bicultural competence and making positive sense of adversity) through ethnocultural empathy. A total of 330 Asian American college students from a West coast university participated in an online survey. Results from PROCESS supported hypotheses. First, self-reflection significantly moderated the effects of acculturative stress on ethnocultural empathy. Specifically, the effect of acculturative stress on ethnocultural empathy was significantly positive for those with lower self-reflection. Conversely, this effect was not significant for those with higher self-reflection, but ethnocultural empathy was consistently high across all levels of acculturative stress for those with higher self-reflection. Post hoc exploratory analyses examined the moderated mediation model using each of the 5 domains of acculturative stress as predictors; results supported the moderated mediation hypotheses for 2 domains, discrimination and cultural isolation. Second, self-reflection significantly moderated the indirect effects of acculturative stress on 2 positive outcomes through ethnocultural empathy. Results from conditional indirect effects suggested that the indirect effects of acculturative stress on 2 positive outcomes through ethnocultural empathy were significantly positive for those with lower self-reflection. Conversely, the indirect effects were not significant for those with higher self-reflection, but the 2 positive outcomes stayed high at all levels of acculturative stress. Post hoc analyses found that 5 of 6 components of bicultural competence used as outcome variables supported the moderation mediation hypotheses. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The Effects of Smoking and Obesity on ICSI Outcomes: A Retrospective Analysis

Directory of Open Access Journals (Sweden)

Bülent Haydardedeoğlu

2010-04-01

Full Text Available Cigarette smoking and obesity are both common health problems in developed and developing countries and are associated with an increased morbidity and mortality. The fecundity rate is found to be decreased by both smoking and obesity in unassisted reproduction in large epidemiologic studies. In the literature, the effects of obesity and smoking on ICSI are demonstrated separately. Our current study aims to reveal the effects of smoking together with obesity on ICSI outcomes. Our result showed that there was no statistically significant difference of outcomes between smokers and nonsmokers in all BMI groups which scheduled to GnRH Agonist ICSI cycle.

Effectiveness differences of ranitidine and omeprazole in prevention of stress ulcer and its effect on pneumonia occurrence and outcome of acute stroke patients

Science.gov (United States)

Batubara, C. A.; Ritarwan, K.; Rambe, A. S.

2018-03-01

Stress ulcer is one ofacute stroke complications. Giving ranitidine or omeprazole may prevent stress ulcer, but may increase the occurrence of pneumonia. Thus, it will affect the outcome of acute stroke. The method was experimental with a randomized control-group pretest - posttest design. This study divided the subjects into two groups, ranitidine 300mg and omeprazole 20mg group.We observed the patients whether stress ulcer or pneumonia occurred during hospitalization. Then, we measured the outcome by the National Institutes of Health Stroke Scaleand modified Rankin Scale. There were 32 subjects in this study. Only 1 (3.1%) subject suffered stress ulcer, and 3 (3.1%) suffered pneumonia in ranitidine group. Moreover, 2 (6.2%) subjects suffered pneumonia in omeprazole group. The differences were not significant between the two groups (p = 0.31 and p = 0.54). There was no significant effect and difference effect on the administration of both medications to the outcome at day 14. These results indicate that ranitidine and omeprazole have anequal effectiveness in the prevention of stress ulcer and also have equal effect on the occurrence of pneumonia, and both have no effect on the outcome of acute stroke patients.

Effects of E-cigarette Advertising Messages and Cues on Cessation Outcomes.

Science.gov (United States)

Jo, Catherine L; Golden, Shelley D; Noar, Seth M; Rini, Christine; Ribisl, Kurt M

2018-01-01

We examined effects of e-cigarette ad messages and visual cues on outcomes related to combustible cigarette smoking cessation: smoking cessation intention, smoking urges, and immediate smoking behavior. US adult smokers (N = 3293) were recruited through Amazon Mechanical Turk and randomized to condition in a 3 (message: e-cigarette use anywhere, harm reduction, control) × 2 (e-cigarette cue presence or absence) between-subjects experiment. Stimuli were print ads for cigarette-like e-cigarettes ("cigalikes") that were manipulated for the experimental conditions. We conducted ANOVA and logistic regression analyses to investigate effects of the manipulations. Message effects on cessation intention and smoking urges were not statistically significant. There was no evidence of cue effects or message × cue interactions across outcomes. Contrary to expectations, e-cigarette use anywhere and harm reduction messages were associated with lower odds of immediate smoking than the control message (AOR EUA = 0.75, 95%CI = 0.58, 0.97, p = .026; AOR HR = 0.72, 95%CI = 0.55, 0.93, p = .013). E-cigarette use anywhere and harm reduction messages may encourage smoking cessation, given the observed reduction in immediate smoking. E-cigarette cues may not influence smoking cessation outcomes. Future studies should investigate whether message effects are a result of smokers believing e-cigarettes to be effective cessation aids.

Formal conditions for the significance-effect

DEFF Research Database (Denmark)

Thellefsen, Torkild Leo; Sørensen, Bent; Thellefsen, Martin

2006-01-01

The significance-effect is the right effect of meaning caused upon an interpreting mind. The right effect is understood as the right interpretation of an intended meaning caused by a sign communicated by an utterer. In the article, which is inspired by Charles S. Peirce's doctrine of signs, his s...... semeiotics and his theory of communication, we account for the formal conditions that have to be present for the release of the significance-effect....

Confidence Intervals for Effect Sizes: Compliance and Clinical Significance in the "Journal of Consulting and Clinical Psychology"

Science.gov (United States)

Odgaard, Eric C.; Fowler, Robert L.

2010-01-01

Objective: In 2005, the "Journal of Consulting and Clinical Psychology" ("JCCP") became the first American Psychological Association (APA) journal to require statistical measures of clinical significance, plus effect sizes (ESs) and associated confidence intervals (CIs), for primary outcomes (La Greca, 2005). As this represents the single largest…

29 CFR 452.5 - Effect of violation on outcome.

Science.gov (United States)

2010-07-01

... 29 Labor 2 2010-07-01 2010-07-01 false Effect of violation on outcome. 452.5 Section 452.5 Labor... DISCLOSURE ACT OF 1959 General Considerations § 452.5 Effect of violation on outcome. Since the remedy under... affected the outcome of an election” 5 the Secretary as a matter of policy will not file suit to enforce...

Temporal pole abnormalities in temporal lobe epilepsy with hippocampal sclerosis: Clinical significance and seizure outcome after surgery.

Science.gov (United States)

Di Gennaro, Giancarlo; D'Aniello, Alfredo; De Risi, Marco; Grillea, Giovanni; Quarato, Pier Paolo; Mascia, Addolorata; Grammaldo, Liliana G; Casciato, Sara; Morace, Roberta; Esposito, Vincenzo; Picardi, Angelo

2015-11-01

To assess the clinical significance of temporal pole abnormalities (temporopolar blurring, TB, and temporopolar atrophy, TA) in patients with temporal lobe epilepsy (TLE) and hippocampal sclerosis (HS) with a long post-surgical follow-up. We studied 60 consecutive patients with TLE-HS and 1.5 preoperative MRI scans who underwent surgery and were followed up for at least 5 years (mean follow-up 7.3 years). Based on findings of pre-surgical MRI, patients were classified according to the presence of TB or TA. Groups were compared on demographic, clinical, neuropsychological data, and seizure outcome. TB was found in 37 (62%) patients, while TA was found in 35 (58%) patients, always ipsilateral to HS, with a high degree of overlap (83%) between TB and TA (pepilepsy onset, side of surgery, seizure frequency, seizure outcome, and neuropsychological outcome. On the other hand, they were significantly older, had a longer duration of epilepsy, and displayed lower preoperative scores on several neuropsychological tests. Similar findings were observed for TA. Multivariate analysis corroborated the association between temporopolar abnormalities and age at onset, age at surgery (for TB only), and lower preoperative scores on some neuropsychological tests. Temporopolar abnormalities are frequent in patients with TLE-HS. Our data support the hypothesis that TB and TA are caused by seizure-related damages. These abnormalities did not influence seizure outcome, even after a long-term post-surgical follow-up. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Howling at the moon? The effect of lunar phases on post-surgical pain outcome.

Science.gov (United States)

Komann, Marcus; Weinmann, Claudia; Meissner, Winfried

2014-05-01

Many people are convinced that lunar phases influence their lives - despite the fact that a lot of studies have shown that this belief is wrong. In this article, we investigate the effect of lunar phases on acute post-surgical pain and on treatment-related side effects. We hypothesize that there is no influence. The data for the study were collected in 2010 and 2011 in 10 international hospitals participating in the research project PAIN OUT. Hospitalized patients were asked for their pain after surgery and pain treatment side effects using numerical ratings scales from 0 to 10. We applied Kurskal-Wallis H-tests to find out if the four moon phases show significant differences in 14 outcome variables. Afterwards, we adjusted for age, gender and three tracer surgeries. A total of 12,224 patient data sets were assessed. For most variables and sub-groups, there is no lunar effect on the observed outcome variables. The only items that show statistically significant differences are pain interference with sleep (p = 0.01) and drowsiness (p = 0.01). The only sub-groups that show statistically significant connections to lunar phases in some variables are men (7 out of 14 variables significant) and elderly people (4 out of 14 variables significant). Even in the statistically significant sub-groups, the differences are small and only show up in some variables. We conclude that lunar phases have no effect on post-surgical pain or its side effects. The hypothesis holds. Thus, there is no reason for patients to postpone surgeries or to fear surgeries on any given date.

Effectiveness of a Multilevel Workplace Health Promotion Program on Vitality, Health, and Work-Related Outcomes.

Science.gov (United States)

Hendriksen, Ingrid J M; Snoijer, Mirjam; de Kok, Brenda P H; van Vilsteren, Jeroen; Hofstetter, Hedwig

2016-06-01

Evaluation of the effectiveness of a workplace health promotion program on employees' vitality, health, and work-related outcomes, and exploring the influence of organizational support and the supervisors' role on these outcomes. The 5-month intervention included activities at management, team, and individual level targeting self-management to perform healthy behaviors: a kick-off session, vitality training sessions, workshops, individual coaching, and intervision. Outcome measures were collected using questionnaires, health checks, and sickness absence data at baseline, after the intervention and at 10 months follow-up. For analysis linear and generalized mixed models were used. Vitality, work performance, sickness absence, and self-management significantly improved. Good organizational support and involved supervisors were significantly associated with lower sickness absence. Including all organizational levels and focusing on increasing self-management provided promising results for improving vitality, health, and work-related outcomes.

Rising statin use and effect on ischemic stroke outcome

Directory of Open Access Journals (Sweden)

Haymore Joseph

2004-03-01

Full Text Available Abstract Background Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors have neuroprotective effects in experimental stroke models and are commonly prescribed in clinical practice. The aim of this study was to determine if patients taking statins before hospital admission for stroke had an improved clinical outcome. Methods This was an observational study of 436 patients admitted to the National Institutes of Health Suburban Hospital Stroke Program between July 2000 and December 2002. Self-reported risk factors for stroke were obtained on admission. Stroke severity was determined by the admission National Institutes of Health Stroke Scale score. Good outcome was defined as a Rankin score Results There were 436 patients with a final diagnosis of ischemic stroke; statin data were available for 433 of them. A total of 95/433 (22% of patients were taking a statin when they were admitted, rising from 16% in 2000 to 26% in 2002. Fifty-one percent of patients taking statins had a good outcome compared to 38% of patients not taking statins (p = 0.03. After adjustment for confounding factors, statin pretreatment was associated with a 2.9 odds (95% CI: 1.2–6.7 of a good outcome at the time of hospital discharge. Conclusions The proportion of patients taking statins when they are admitted with stroke is rising rapidly. Statin pretreatment was significantly associated with an improved functional outcome at discharge. This finding could support the early initiation of statin therapy after stroke.

Effect of scleral buckle removal on strabismus surgery outcomes after retinal detachment repair

Science.gov (United States)

Chang, Jee Ho; Hutchinson, Amy; Zhang, Monica; Lambert, Scott R.

2015-01-01

Background/Aims To investigate the effect of scleral buckle removal on the outcomes of strabismus surgery in patients with a prior history of retinal detachment surgery. Methods We reviewed the medical records of 18 patients who underwent strabismus surgery following a scleral buckling procedure at one institution. We investigated the effect of multiple variables on outcome, including: gender, age, surgeon, number of strabismus surgeries, adjustable suture use, previous pars plana vitrectomy, preoperative best-corrected visual acuity and time of surgery. Outcomes were considered successful if there was ≤ 10 prism diopter (PD) residual horizontal and/or ≤ 4 PD residual vertical deviation. Outcomes were analyzed statistically using Fisher's exact test and Mann-Whitney test. Results Strabismus surgery coupled with scleral buckle removal was associated with a higher rate of success (success with buckle removal, 62.5%; success without buckle removal, 10.0%; p=0.04). There were no significant difference in preoperative findings between the scleral buckle removal and non- removal groups. No retinal redetachments occurred after scleral buckle removal. Conclusion In our series, scleral buckle removal was associated with improved surgical outcome in patients with strabismus following a scleral buckling procedure. PMID:24299332

Negative life events have detrimental effects on in-vitro fertlization outcome.

Science.gov (United States)

Yilmaz, Nafiye; Kahyaoglu, İnci; İnal, Hasan Ali; Görkem, Ümit; Devran, Aysun; Mollamahmutoglu, Leyla

2015-09-01

The aim of this study was to investigate the effect of negative life events on in-vitro-fertilization (IVF) outcome. Depression and negative life events were measured using Beck Depression Inventory (BDI) and List of Recent Events in 83 women attending the IVF clinic of a tertiary research and education hospital with the diagnosis of unexplained infertility between January 2013 and August 2013. Demographic features, stimulation parameters, depression scores, and negative life events of pregnant and non-pregnant participants were compared and the relation between negative life events, depression scores, and IVF outcome was investigated. Women who did not achieve a pregnancy experienced more negative life events than women who became pregnant (77.2% vs. 23.1%) (p > 0.001). The number of patients with moderate-to-severe depression (BDI scores > 16) was higher in the non-pregnant group than pregnant group (49.1% vs. 26.9%), however the difference was not statistically significant (p = 0.057). Clinical pregnancy showed a significant moderate negative correlation with the number of negative life events (r = -0.513, p = 0.001), but the correlation between clinical pregnancy and BDI scores was not statistically significant (r = -0.209, p = 0.059). Stressful life events have a negative influence on the quality of life, which eventually affects in IVF outcome, possibly through maladaptive lifestyle behavior.

Immigrant and Native Children's Cognitive Outcomes and the Effect of Ethnic Concentration in Danish Schools

DEFF Research Database (Denmark)

Jensen, Peter; Wurtz Rasmussen, Astrid

are still important factors in determining the child.s cognitive outcome. However, the negative effect of ethnic concentration in the school is only significant for the native Danish children. Finally, there is a strong positive effect on the children.s cognitive outcome of speaking Danish at home....... to the ethnic concentration in the schools they attend and their relatively low socioeconomic status. Instrumenting for ethnic concentration reveals that even after taking into consideration that individuals may sort across neighborhoods, ethnic concentration in the school and the child's own ethnicity...

The Effect of Local Smokefree Regulations on Birth Outcomes and Prenatal Smoking.

Science.gov (United States)

Bartholomew, Karla S; Abouk, Rahi

2016-07-01

Objectives We assessed the impact of varying levels of smokefree regulations on birth outcomes and prenatal smoking. Methods We exploited variations in timing and regulation restrictiveness of West Virginia's county smokefree regulations to assess their impact on birthweight, gestational age, low birthweight, very low birthweight, preterm birth, and prenatal smoking. We conducted regression analysis using state Vital Statistics individual-level data for singletons born to West Virginia residents between 1995-2010 (N = 293,715). Results Only more comprehensive smokefree regulations were associated with statistically significant favorable effects on birth outcomes in the full sample: Comprehensive (workplace/restaurant/bar ban) demonstrated increased birthweight (29 grams, p workplace/restaurant ban) demonstrated a small decrease in very low birthweight (-0.2 %, p workplace ban) was associated with a 23 g (p < 0.01) decrease in birthweight; Limited (partial ban) had no effect. Comprehensive's improvements extended to most maternal groups, and were broadest among mothers 21+ years, non-smokers, and unmarried mothers. Prenatal smoking declined slightly (-1.7 %, p < 0.01) only among married women with Comprehensive. Conclusions Regulation restrictiveness is a determining factor in the impact of smokefree regulations on birth outcomes, with comprehensive smokefree regulations showing promise in improving birth outcomes. Favorable effects on birth outcomes appear to stem from reduced secondhand smoke exposure rather than reduced prenatal smoking prevalence. This study is limited by an inability to measure secondhand smoke exposure and the paucity of data on policy implementation and enforcement.

Effects of Mindfulness Interventions on Health Outcomes in Older Lesbian/Bisexual Women.

Science.gov (United States)

Ingraham, Natalie; Eliason, Michele J; Garbers, Samantha; Harbatkin, Dawn; Minnis, Alexandra M; McElroy, Jane A; Haynes, Suzanne G

2016-07-07

Lesbian and bisexual (LB) women are at higher risk for obesity, but no reported interventions focus on older LB women who are overweight or obese. The Healthy Weight in Lesbian and Bisexual Women study funded five programs (n = 266 LB women age ≥40); two examined effects of mindfulness interventions on health outcomes. Analysis of variance and regression measured the impact of mindfulness-based programs on health behaviors and quality of life (MCS). Outcomes were also compared between intervention sites (mindfulness vs. standard weight loss approaches). Mindful Eating Questionnaire (MEQ) subscale scores improved significantly from preassessment to postassessment in mindfulness interventions. LB women who reported an increase (top tertile) in mindful eating had the most significant increase in MCS scores (35.3%) compared with those with low gains (low and medium tertile) in mindfulness (3.8%). MEQ score increase predicted 40.8% of the variance (adjusted) in MCS score, R(2) = .431, F(6,145) = 18.337, p mindfulness were significantly related to increases in physical activity and some nutrition outcomes. Mindfulness intervention sites showed within-person improvements in MCS and fruit and vegetable intake, whereas standard intervention sites showed within-person decreases in alcohol intake and increases in physical activity level. Although weight loss was not a primary outcome at the mindfulness sites, small but significant weight loss and weight-to-height ratio decreases were reported at all five sites. Increases in mindfulness were associated with a number of significant self-reported health improvements, including a great increase in perceived mental health quality of life. Mindfulness may be a promising practice to address health issues in aging LB women. Copyright © 2016 Jacobs Institute of Women's Health. All rights reserved.

To Assess the Effect of Maternal BMI on Obstetrical Outcome

Science.gov (United States)

Lakhanpal, Shuchi; Aggarwal, Asha; Kaur, Gurcharan

2012-06-01

AIMS: To assess the effect of maternal BMI on complications in pregnancy, mode of delivery, complications of labour and delivery.METHODS:A crossectional study was carried out in the Obst and Gynae department, Kasturba Hospital, Delhi. The study enrolled 100 pregnant women. They were divided into 2 groups based on their BMI, more than or equal to 30.0 kg/m2 were categorized as obese and less than 30 kg/m2 as non obese respectively. Maternal complications in both types of patients were studied.RESULTS:CONCLUSION: As the obstetrical outcome is significantly altered due to obesity, we can improve maternal outcome by overcoming obesity. As obesity is a modifiable risk factor, preconception counseling creating awareness regarding health risk associated with obesity should be encouraged and obstetrical complications reduced.

Funding source and primary outcome changes in clinical trials registered on ClinicalTrials.gov are associated with the reporting of a statistically significant primary outcome: a cross-sectional study [v2; ref status: indexed, http://f1000r.es/5bj

Directory of Open Access Journals (Sweden)

Sreeram V Ramagopalan

2015-04-01

Full Text Available Background: We and others have shown a significant proportion of interventional trials registered on ClinicalTrials.gov have their primary outcomes altered after the listed study start and completion dates. The objectives of this study were to investigate whether changes made to primary outcomes are associated with the likelihood of reporting a statistically significant primary outcome on ClinicalTrials.gov. Methods: A cross-sectional analysis of all interventional clinical trials registered on ClinicalTrials.gov as of 20 November 2014 was performed. The main outcome was any change made to the initially listed primary outcome and the time of the change in relation to the trial start and end date. Findings: 13,238 completed interventional trials were registered with ClinicalTrials.gov that also had study results posted on the website. 2555 (19.3% had one or more statistically significant primary outcomes. Statistical analysis showed that registration year, funding source and primary outcome change after trial completion were associated with reporting a statistically significant primary outcome. Conclusions: Funding source and primary outcome change after trial completion are associated with a statistically significant primary outcome report on clinicaltrials.gov.

Combined spinal-epidural analgesia in labour: its effects on delivery outcome

Directory of Open Access Journals (Sweden)

Suneet Kaur Sra Charanjit Singh

2016-06-01

Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55 or Non-CSE (n = 55 group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%. The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

Effect of metformin on maternal and neonatal outcomes in pregnant obese non-diabetic women: A meta-analysis

Directory of Open Access Journals (Sweden)

Ahmed Elmaraezy

2017-09-01

Full Text Available Background: Metformin reduces maternal and neonatal weight gain in gestational diabetes mellitus; however, this effect is poorly investigated in non-diabetic women. Objective: We performed this meta-analysis to investigate the effect of metformin intake during pregnancy on maternal and neonatal outcomes in obese non-diabetic women. Materials and Methods: We searched Medline, EMBASE, and Cochrane CENTRAL for eligible randomized controlled trials addressing the efficacy of metformin in pregnant obese non-diabetic women. Data were extracted and analyzed using RevMan software (Version 5.3. Neonatal birth weight was the key outcome. Secondary outcomes included maternal weight gain, the incidence of preeclampsia, and neonatal adverse effects (miscarriage, stillbirth and congenital anomalies. Results: Pooled data from two RCTs (n=843 showed that metformin caused a significant reduction in maternal gestational weight gain (MD-1.35, 95% CI: [2.08, -0.630], compared to placebo. The summary effect-estimate did not favor either of the two groups in terms of reduction of neonatal birth weight Z score (MD-0.09, 95% CI: [0.23, 0.06]. Metformin was associated with 41% reduction in the risk of preeclampsia; however, this reduction was not statistically significant [RR 0.59, 95% CI: [0.03, 11.46]. None of the neonatal adverse events including stillbirth [RR 1.14, 95% CI: 0.42, 3.10] and congenital anomalies (RR= 1.36, 95% CI: [0.58, 3.21] differed significantly between the two groups. Conclusion: For obese pregnant women, metformin could decrease gestational weight gain with no significant reduction in neonatal birth weight. In light of the current evidence, metformin should not be used to prevent poor pregnancy outcomes in obese non-diabetic women.

The effect of platelet-rich plasma on clinical outcomes in lateral epicondylitis.

Science.gov (United States)

Ahmad, Zafar; Brooks, Roger; Kang, Sertaz-Niel; Weaver, Holly; Nunney, Ian; Tytherleigh-Strong, Graham; Rushton, Neil

2013-11-01

To evaluate the evidence for application of platelet-rich plasma (PRP) in lateral epicondylitis. We carried out a systematic review of the current evidence on the effects of PRP in lateral epicondylitis on clinical outcomes. We performed a comprehensive search of the PubMed, Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Embase databases using various combinations of the commercial names of each PRP preparation and "lateral epicondylitis" (with its associated terms), looking specifically at human studies. Data validity was assessed and collected on clinical outcome. Nine studies met the inclusion criteria, of which 5 were randomized controlled trials. Two cohort studies showed that PRP improved clinical satisfaction scores. One case-control study showed that PRP yielded a significantly greater improvement in symptoms compared with bupivacaine. Two randomized controlled trials compared the effect of injections of PRP and blood. Only 1 of the studies noted a significant difference at the 6-week time point. Three randomized controlled trials compared corticosteroids with PRP. Two of the smaller trials, which had follow-up periods of 6 weeks and 3 months, showed no significant difference between treatment groups. The largest randomized controlled trial found that PRP had significant benefit compared with corticosteroids with regard to pain and Disabilities of the Arm, Shoulder and Hand scores at 1- and 2-year time points. This review highlights the limited but evolving evidence for the use of PRP in lateral epicondylitis; however, further research is required to understand the concentration and preparation that facilitate the best clinical outcome. Characterizing the timing of the intervention would optimize the health economics behind the decision to treat for the patient and health care provider. Level III, systematic review of Level I to III studies. Copyright © 2013 Arthroscopy Association of North America. Published by

15 CFR 971.602 - Significant adverse environmental effects.

Science.gov (United States)

2010-01-01

... Environmental Effects § 971.602 Significant adverse environmental effects. (a) Determination of significant adverse environmental effects. The Administrator will determine the potential for or the occurrence of any significant adverse environmental effect or impact (for the purposes of sections 103(a)(2)(D), 105(a)(4), 106...

Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU®).

Science.gov (United States)

Huber, Stephan; Biberthaler, Peter; Delhey, Patrick; Trentzsch, Heiko; Winter, Hauke; van Griensven, Martijn; Lefering, Rolf; Huber-Wagner, Stefan

2014-09-03

Blunt thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially. Hence, the aim of this study was to identify the influence of critical structural damages on mortality. All patients in the database of the TraumaRegister DGU® (TR-DGU) from 2002-2011 with AIS Chest ≥ 2, blunt trauma, age of 16 or older and an ISS ≥ 16 were analyzed. Outcome parameters were in-hospital mortality as well as ventilation time in patients surviving the initial 14 days after trauma. 22613 Patients were included (mean ISS 30.5 ± 12.6; 74.7% male; Mean Age 46.1 ± 197 years; mortality 17.5%; mean duration of ventilation 7.3 ± 11.5; mean ICU stay 11.7 ± 14.1 days). Only a limited number of specific injuries had a significant impact on survival. Major thoracic vessel injuries (AIS ≥5), bilateral lung contusion, bilateral flail chest, structural heart injury (AIS ≥3) significantly influence mortality in study patients. Several extrathoracic factors (age, blood transfusion, systolic blood pressure and extrathoracic severe injuries) were also predictive of increased mortality. Most injuries of the thoracic wall had no or only a moderate effect on the duration of ventilation. Injuries to the lung (laceration, contusion or pneumothoraces) had a moderate prolonging effect. Cardiac injuries and severe injuries to the thoracic vessels induced a substantially prolonged ventilation interval. We demonstrate quantitatively the influence of specific structural damages of the chest on critical outcome parameters. While most injuries of the chest wall have no or only limited impact in the study collective, injuries to the lung overall show adverse outcome. Injuries to the heart or thoracic vessels have a devastating prognosis following blunt

Substance abuse during pregnancy: effect on pregnancy outcomes.

Science.gov (United States)

Pinto, S M; Dodd, S; Walkinshaw, S A; Siney, C; Kakkar, P; Mousa, H A

2010-06-01

To determine the contribution of drug use to maternal and perinatal complications, controlling for social confounders. This is a retrospective cohort study of 247 drug-using women and 741 controls over a 4-year period from 1997 to 2000. Cases were identified from the drug dependency register. Three controls for each woman with substance abuse were selected from the delivery suite records, with calliper matching by year of delivery (any control patient who delivered within 6 months before or after the date of delivery of a drug-using woman was considered as a potential match) and district of residence (post code). The primary outcomes of interest were preterm birth, abruption, pre-eclampsia, intrauterine growth restriction and low birth weight. There were statistically significantly more preterm births amongst drug-using women (relative risk (RR) 2.5, 95% confidence interval (CI) 1.6-3.8), with preterm births complicating 25% of births amongst drug users. The incidence of low birth weight was 30.8% amongst drug-using women compared to 8% in control women (RR 3.6, CI 2.4-5.4), and the incidence of growth restriction was 25%, significantly higher than the control group (RR 3.82, CI 2.4-6.1). The risk of abruption was also higher (RR 2.74, CI 1.1-7.0). Of note is the extremely low incidence of pre-eclampsia among drug users, even after controlling for the confounder effects of parity and smoking. Despite multidisciplinary co-ordinated antenatal care, women with substance abuse during pregnancy are at significant risk of adverse obstetric and perinatal outcome, controlling for social confounders. A limitation of the study is that the sample size was not large enough to clearly assess individual drugs. This is the first study to highlight low incidence of pre-eclampsia among drug users over and above the effect of smoking. Further research is needed to elucidate the underlying biological reason for the lack of pre-eclampsia in women with substance abuse during pregnancy

Effects of emergency cervical cerclage on pregnancy outcome: a retrospective study of 158 cases.

Science.gov (United States)

Zhu, Li-Qiong; Chen, Hui; Chen, Li-Bin; Liu, Ying-Lin; Tian, Jian-Ping; Wang, Yun-Hui; Zhang, Rui; Zhang, Jian-Ping

2015-05-15

The aim of this study was to evaluate the effectiveness and safety of emergency cervical cerclage in women with advanced cervical dilatation and bulging of fetal membranes. The study included 158 women who underwent emergency cervical cerclage because of cervix dilatation and protruding membranes in mid-trimester at Sun Yat-sen Memorial Hospital of Sun Yat-sen University. Pregnancy outcomes and pregnancy outcome related to clinical features were analyzed retrospectively. Analysis revealed that the placement of emergency cerclage led to the delivery of live infants with a success rate of 82.28%. The mean interval between cerclage and delivery was 52.16.±26.62 days, with a mean gestation at delivery of 30.3±4.7 weeks and a mean birth weight of 1934.69±570.37 g. No severe maternal complications such as maternal death, hematosepsis, and hysterorrhexis occurred after the operation. Two women (1.25%) had laceration of the cervix, 1 woman (0.61%) suffered pulmonary edema, and 2 women (1.25%) developed deep vein thrombosis (DVT). There were significant correlations between the pregnancy outcome and risk factors, including any presenting symptoms, cervical dilatation, postoperative white blood cell count, and C-reactive protein (CRP) value. No significant difference was found in women with good vs. poor outcome in terms of maternal age and obstetric histories. Emergency cervical cerclage is effective in prolonging pregnancy and improving neonatal outcome in women with cervical incompetence. It should be considered a viable option for women with a dilated cervix in mid-trimester.

Effect of maternal age on maternal and neonatal outcomes after assisted reproductive technology

DEFF Research Database (Denmark)

Wennberg, Anna Lena; Opdahl, Signe; Bergh, Christina

2016-01-01

weeks), low birth weight (LBW; mortality (≥28 weeks). Adjusted odds ratios (AORs) were calculated. Associations between maternal age and outcomes were analyzed. RESULT(S): The risk of placenta previa (AOR 4.11-6.05), cesarean delivery (AOR 1......OBJECTIVE: To compare the effect of maternal age on assisted reproductive technology (ART) and spontaneous conception (SC) pregnancies regarding maternal and neonatal complications. DESIGN: Nordic retrospective population-based cohort study. Data from national ART registries were cross.......18-1.50), PTB (AOR 1.23-2.19), and LBW (AOR 1.44-2.35) was significantly higher in ART than in SC pregnancies for most maternal ages. In both ART and SC pregnancies, the risk of HDP, placenta previa, cesarean delivery, PTB, LBW, and SGA changed significantly with age. The AORs for adverse neonatal outcomes...

Effect of invasive EEG monitoring on cognitive outcome after left temporal lobe epilepsy surgery.

Science.gov (United States)

Busch, Robyn M; Love, Thomas E; Jehi, Lara E; Ferguson, Lisa; Yardi, Ruta; Najm, Imad; Bingaman, William; Gonzalez-Martinez, Jorge

2015-10-27

The objective of this cohort study was to compare neuropsychological outcomes following left temporal lobe resection (TLR) in patients with epilepsy who had or had not undergone prior invasive monitoring. Data were obtained from an institutional review board-approved, neuropsychology registry for patients who underwent epilepsy surgery at Cleveland Clinic between 1997 and 2013. A total of 176 patients (45 with and 131 without invasive EEG) met inclusion criteria. Primary outcome measures were verbal memory and language scores. Other cognitive outcomes were also examined. Outcomes were assessed using difference in scores from before to after surgery and by presence/absence of clinically meaningful decline using reliable change indices (RCIs). Effect of invasive EEG on cognitive outcomes was estimated using weighting and propensity score adjustment to account for differences in baseline characteristics. Linear and logistic regression models compared surgical groups on all cognitive outcomes. Patients with invasive monitoring showed greater declines in confrontation naming; however, when RCIs were used to assess clinically meaningful change, there was no significant treatment effect on naming performance. No difference in verbal memory was observed, regardless of how the outcome was measured. In secondary outcomes, patients with invasive monitoring showed greater declines in working memory, which were no longer apparent using RCIs to define change. There were no outcome differences on other cognitive measures. Results suggest that invasive EEG monitoring conducted prior to left TLR is not associated with greater cognitive morbidity than left TLR alone. This information is important when counseling patients regarding cognitive risks associated with this elective surgery. © 2015 American Academy of Neurology.

Effect of quality chronic disease management for alcohol and drug dependence on addiction outcomes.

Science.gov (United States)

Kim, Theresa W; Saitz, Richard; Cheng, Debbie M; Winter, Michael R; Witas, Julie; Samet, Jeffrey H

2012-12-01

We examined the effect of the quality of primary care-based chronic disease management (CDM) for alcohol and/or other drug (AOD) dependence on addiction outcomes. We assessed quality using (1) a visit frequency based measure and (2) a self-reported assessment measuring alignment with the chronic care model. The visit frequency based measure had no significant association with addiction outcomes. The self-reported measure of care-when care was at a CDM clinic-was associated with lower drug addiction severity. The self-reported assessment of care from any healthcare source (CDM clinic or elsewhere) was associated with lower alcohol addiction severity and abstinence. These findings suggest that high quality CDM for AOD dependence may improve addiction outcomes. Quality measures based upon alignment with the chronic care model may better capture features of effective CDM care than a visit frequency measure. Copyright © 2012 Elsevier Inc. All rights reserved.

A tool for evaluating the potential for cost-effective outcomes measurement

Directory of Open Access Journals (Sweden)

Somasekhar MM

2012-04-01

Full Text Available Melinda M Somasekhar1, Alfred Bove2, Chris Rausch1, James Degnan3, Cathy T King1, Arnold Meyer11The Albert J Finestone, MD, Office for Continuing Medical Education, 2Section of Cardiology, Temple University School of Medicine, Philadelphia, PA, USA; 3Measurement and Research Center, Temple University, Philadelphia, PA, USAAbstract: Cost related to higher-level outcomes measurement is often very high. However, the cost burden is felt even more by smaller, less well-funded continuing medical education (CME programs. It is possible to overcome financial and participant-related barriers to measuring Level 6 outcomes, which are patient health outcomes. The Temple University School of Medicine’s Office for Continuing Medical Education developed a sequential tool for attaining cost-effective outcomes measurement for determining the likelihood of a CME intervention to produce significant changes in physician performance. The appropriate selection of the CME topic and specific practice change indictors drive this tool. This tool walks providers through a simple YES or NO decision-making list that guides them toward an accurate prediction of potential programmatic outcomes. Factors considered during the decision-making process include whether: (a the intended change(s will have a substantial impact on current practice; (b the intended practice change(s are well supported by clinical data, specialty organization/government recommendations, expert opinion, etc; (c the potential change(s affects a large population; (d external factors, such as system pressures, media pressures, financial pressures, patient pressures, safety pressures, etc, are driving this intended change in performance; (e there is a strong motivation on the part of physicians to implement the intended change(s; and (f the intended change(s is relatively easy to implement within any system of practice. If each of these questions can be responded to positively, there is a higher likelihood

Effect of Gastrointestinal Malformations on the Outcomes of Patients With Congenital Heart Disease.

Science.gov (United States)

Mery, Carlos M; De León, Luis E; Rodriguez, J Rubén; Nieto, R Michael; Zhang, Wei; Adachi, Iki; Heinle, Jeffrey S; Kane, Lauren C; McKenzie, E Dean; Fraser, Charles D

2017-11-01

The goal of this study was to assess the effect of associated gastrointestinal malformations (GI) on the outcomes of patients undergoing congenital heart operations. Neonates and infants with thoracic (esophageal atresia, tracheoesophageal fistula) and abdominal (duodenal stenosis/atresia, imperforate anus, Hirschsprung disease) GI malformations undergoing congenital heart operations between 1995 and 2015 were included. Two control groups were created, one for each group. Patients were matched by diagnosis, procedure, history of prematurity, presence of genetic syndrome, and a propensity score including weight and year of operation. The cohort included 383 patients: 52 (14%) with thoracic GI malformations and 98 (25%) thoracic GI controls, 80 (21%) with abdominal GI malformations and 153 (40%) abdominal GI controls. Median follow-up was 6 years (range, 16 days to 20 years). Patients with thoracic GI malformations had longer length of stay (p malformations and controls. Patients with thoracic GI malformations have worse perioperative outcomes than controls, but their long-term survival does not seem to be significantly different. Abdominal GI malformations do not have a significant effect on outcomes. The presence of GI malformations should likely not preclude patients from undergoing congenital heart operations, but careful family counseling is necessary, especially for thoracic GI malformations. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Optimizing aesthetic outcomes for breast reconstruction in patients with significant macromastia or ptosis

Directory of Open Access Journals (Sweden)

Wojciech Dec

2018-06-01

Full Text Available Background: Achieving excellent aesthetic outcomes in reconstruction of large or ptotic breasts is especially challenging. Incorporating a Wise pattern into the mastectomy design is effective in reducing the excess breast skin, however it increases the risk of mastectomy skin necrosis. The aim of this study is to describe surgical maneuvers which optimize aesthetic outcomes, anticipate flap volume requirements, and limit mastectomy skin necrosis in autologous reconstruction in patients with macromastia and grade III ptosis. Methods: This is a retrospective review of operative and clinical records of patients who underwent unilateral or bilateral breast reconstruction with autologous tissue between August 2015 and May 2017. Patients were divided into macromastia and ptosis groups. Key surgical maneuvers for safely achieving aesthetically optimal results were identified. Results: A total of 29 breasts were successfully reconstructed in 19 patients with a Wise pattern mastectomy skin reduction. Free flap weights were similar in both groups, mastectomy weights were greater in the macromastia group, p < 0.05. Complications were limited to three cases of wound breakdown and one case of mastectomy skin necrosis. Total number of revision stages was reduced in unilateral reconstructions when a contralateral breast reduction or mastopexy was performed during the first stage. Conclusions: A Wise pattern can safely and effectively be incorporated into a mastectomy incision design in patients who are not candidates for a nipple sparing mastectomy. Optimal aesthetics are achieved with similar volume flaps for both macromastia and ptosis patients. In cases of unilateral breast reconstruction a contralateral breast reduction or mastopexy should be performed at the time of the immediate breast reconstruction. Keywords: Breast reconstruction, Aesthetic breast reconstruction, Macromastia breast reconstruction, Ptosis breast reconstruction

Effects of main actor, outcome and affect on biased braking speed judgments

Directory of Open Access Journals (Sweden)

Ola Svenson

2012-05-01

Full Text Available Subjects who judged speed in a driving scenario overestimated how fast they could decelerate when speeding compared to when keeping within the speed limit (Svenson, 2009. The purpose of the present studies were to replicate studies conducted in Europe with subjects in the U.S., to study the influence of speed unit (kph vs. mph, affective reactions to outcome (collision and identity of main actor (driver on braking speed judgments. The results replicated the European findings and the outcome affective factor (passing a line/killing a child and the actor factor (subject/driver in general had significant effects on judgments of braking speed. The results were related to psychological theory and applied implications were discussed.

The effect of behavior disorders on ocular trauma and visual outcome in children in Middle Delta, Egypt

Directory of Open Access Journals (Sweden)

Rabab Elseht

2017-01-01

Child behavior disorders and abnormal parenting style were significantly associated with ocular trauma in children. In addition, certain types and characters of trauma were effective in the visual outcome.

National socioeconomic indicators are associated with outcomes after aneurysmal subarachnoid hemorrhage: a hierarchical mixed-effects analysis.

Science.gov (United States)

Guha, Daipayan; Ibrahim, George M; Kertzer, Joshua D; Macdonald, R Loch

2014-11-01

Although heterogeneity exists in patient outcomes following subarachnoid hemorrhage (SAH) across different centers and countries, it is unclear which factors contribute to such disparities. In this study, the authors performed a post hoc analysis of a large international database to evaluate the association between a country's socioeconomic indicators and patient outcome following aneurysmal SAH. An analysis was performed on a database of 3552 patients enrolled in studies of tirilazad mesylate for aneurysmal SAH from 1991 to 1997, which included 162 neurosurgical centers in North and Central America, Australia, Europe, and Africa. Two primary outcomes were assessed at 3 months after SAH: mortality and Glasgow Outcome Scale (GOS) score. The association between these outcomes, nation-level socioeconomic indicators (percapita gross domestic product [GDP], population-to-neurosurgeon ratio, and health care funding model), and patientlevel covariates were assessed using a hierarchical mixed-effects logistic regression analysis. Multiple previously identified patient-level covariates were significantly associated with increased mortality and worse neurological outcome, including age, intraventricular hemorrhage, and initial neurological grade. Among national-level covariates, higher per-capita GDP (p funding model was not a significant predictor of either primary outcome. Higher per-capita gross GDP and population-to-neurosurgeon ratio were associated with improved outcome after aneurysmal SAH. The former result may speak to the availability of resources, while the latter may be a reflection of better outcomes with centralized care. Although patient clinical and radiographic phenotypes remain the primary predictors of outcome, this study shows that national socioeconomic disparities also explain heterogeneity in outcomes following SAH.

Effect of edaravone on favorable outcome in patients with acute cerebral large vessel occlusion: subanalysis of RESCUE-Japan Registry.

Science.gov (United States)

Miyaji, Yuki; Yoshimura, Shinichi; Sakai, Nobuyuki; Yamagami, Hiroshi; Egashira, Yusuke; Shirakawa, Manabu; Uchida, Kazutaka; Kageyama, Hirohito; Tomogane, Yusuke

2015-01-01

The data of the nationwide prospective registry of acute cerebral large vessel occlusion (LVO; RESCUE-Japan Registry) were analyzed to know the effect of edaravone, a free radical scavenger, on clinical outcome at 90 days after onset. In this registry, patients with acute cerebral LVO admitted within 24 h after onset were prospectively registered. The effect of various factors including endovascular treatment (EVT), intravenous recombinant tissue plasminogen activator (IV rt-PA), and other medication including edaravone on favorable outcome (modified Rankin scale 0-1) was analyzed. Of the 1,454 registered patients, 1,442 patients (99.2%) had the information of edaravone were analyzed. In total, edaravone group had more patients with favorable outcome compared to non-edaravone group (22.9% vs. 13.8%, p = 0.0006). Edaravone increased favorable outcome in patients treated with IV rt-PA (29.4% vs. 11.1%, p = 0.0107), but not with EVT (21.2% vs. 13.9%, p = 0.309). Logistic regression analysis revealed that higher National Institutes of Health Stroke Scale (NIHSS) score on admission [odds ratio (OR) 0.875, 95% confidence interval (CI) 0.858-0.894] and advanced age (OR 0.963, 95%CI 0.952-0.975) were significantly related to unfavorable outcome. In contrast, IV rt-PA (OR 2.489, 95%CI 1.867-3.319), EVT (OR 1.375, 95%CI 1.013-1.865), and edaravone (OR 1.483, 95%CI 1.027-2.143) were significantly associated with favorable outcome. This analysis indicated that IV rt-PA, EVT, and edaravone were effective to obtain favorable outcome in patients with acute LVO. Combination IV rt-PA with edaravone was more effective.

Dynamic and heterogeneous effects of sibling death on children's outcomes.

Science.gov (United States)

Fletcher, Jason; Vidal-Fernandez, Marian; Wolfe, Barbara

2018-01-02

This paper explores the effects of experiencing the death of a sibling on children's developmental outcomes. Recent work has shown that experiencing a sibling death is common and long-term effects are large. We extend understanding of these effects by estimating dynamic effects on surviving siblings' cognitive and socioemotional outcomes, as well as emotional and cognitive support by parents. Using the Children of the National Longitudinal Survey of Youth 1979 (CNLSY79), we find large initial effects on cognitive and noncognitive outcomes that decline over time. We also provide evidence that the effects are larger if the surviving child is older and less prominent if the deceased child was either disabled or an infant, suggesting sensitive periods of exposure. Auxiliary results show that parental investments in the emotional support of surviving children decline following the death of their child.

Neurolinguistic programming: a systematic review of the effects on health outcomes.

Science.gov (United States)

Sturt, Jackie; Ali, Saima; Robertson, Wendy; Metcalfe, David; Grove, Amy; Bourne, Claire; Bridle, Chris

2012-11-01

Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. To evaluate the effects of NLP on health-related outcomes. Systematic review of experimental studies. The following data sources were searched: MEDLINE, PsycINFO, ASSIA, AMED, CINAHL, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4-20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain. There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes.

Effect of Continuous Assessment on Learning Outcomes on Two Chemical Engineering Courses: Case Study

Science.gov (United States)

Tuunila, R.; Pulkkinen, M.

2015-01-01

In this paper, the effect of continuous assessment on the learning outcomes of two chemical engineering courses is studied over a several-year period. Average grades and passing percentages of courses after the final examination are reported and also student feedback on the courses is collected. The results indicate significantly better learning…

The effect of very low-calorie diets on renal and hepatic outcomes: a systematic review

Directory of Open Access Journals (Sweden)

Roll

2013-10-01

Full Text Available Catherine Rolland,1 Alexandra Mavroeidi,2 Kelly L Johnston,3 John Broom1,31Centre for Obesity Research and Epidemiology (CORE, Faculty of Health and Social Care, Robert Gordon University, Aberdeen, Scotland, UK; 2School of Medical Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, Scotland, UK; 3LighterLife Ltd, Harlow, Essex, UKAbstract: Very low-calorie diets (VLCDs are an effective means by which to induce clinically significant weight loss. However, their acceptance by health care practitioners and the public is generally lower than that for other nonsurgical weight loss methods. Whilst there is currently little evidence to suggest they have any detrimental effect on hepatic and renal health, data assessing these factors remain limited. We carried out a systematic review of the literature on randomized controlled trials that had a VLCD component and that reported outcomes for hepatic and renal health, published between January 1980 and December 2012. Cochrane criteria were followed, and eight out of 196 potential articles met the inclusion criteria. A total of 548 participants were recruited across the eight studies. All eight studies reported significant weight loss following the VLCD. Changes in hepatic and renal outcomes were variable but generally led to either no change or improvements in either of these. Due to the heterogeneity in the quality and methodology of the studies included, the effect of VLCDs on hepatic and renal outcomes remains unclear at this stage. Further standardized research is therefore required to fully assess the impact of VLCDs on these outcome measures, to better guide clinical practice.Keywords: obesity, liver, kidney, weight loss, health

Studying physician effects on patient outcomes: physician interactional style and performance on quality of care indicators.

Science.gov (United States)

Franks, Peter; Jerant, Anthony F; Fiscella, Kevin; Shields, Cleveland G; Tancredi, Daniel J; Epstein, Ronald M

2006-01-01

Many prior studies which suggest a relationship between physician interactional style and patient outcomes may have been confounded by relying solely on patient reports, examining very few patients per physician, or not demonstrating evidence of a physician effect on the outcomes. We examined whether physician interactional style, measured both by patient report and objective encounter ratings, is related to performance on quality of care indicators. We also tested for the presence of physician effects on the performance indicators. Using data on 100 US primary care physician (PCP) claims data on 1,21,606 of their managed care patients, survey data on 4746 of their visiting patients, and audiotaped encounters of 2 standardized patients with each physician, we examined the relationships between claims-based quality of care indicators and both survey-derived patient perceptions of their physicians and objective ratings of interactional style in the audiotaped standardized patient encounters. Multi-level models examined whether physician effects (variance components) on care indicators were mediated by patient perceptions or objective ratings of interactional style. We found significant physician effects associated with glycohemoglobin and cholesterol testing. There was also a clinically significant association between better patient perceptions of their physicians and more glycohemoglobin testing. Multi-level analyses revealed, however, that the physician effect on glycohemoglobin testing was not mediated by patient perceived physician interaction style. In conclusion, similar to prior studies, we found evidence of an apparent relationship between patient perceptions of their physician and patient outcomes. However, the apparent relationships found in this study between patient perceptions of their physicians and patient care processes do not reflect physician style, but presumably reflect unmeasured patient confounding. Multi-level modeling may contribute to better

Effects of a strategy to improve offender assessment practices: Staff perceptions of implementation outcomes.

Science.gov (United States)

Welsh, Wayne N; Lin, Hsiu-Ju; Peters, Roger H; Stahler, Gerald J; Lehman, Wayne E K; Stein, Lynda A R; Monico, Laura; Eggers, Michele; Abdel-Salam, Sami; Pierce, Joshua C; Hunt, Elizabeth; Gallagher, Colleen; Frisman, Linda K

2015-07-01

This implementation study examined the impact of an organizational process improvement intervention (OPII) on a continuum of evidence based practices related to assessment and community reentry of drug-involved offenders: Measurement/Instrumentation, Case Plan Integration, Conveyance/Utility, and Service Activation/Delivery. To assess implementation outcomes (staff perceptions of evidence-based assessment practices), a survey was administered to correctional and treatment staff (n=1509) at 21 sites randomly assigned to an Early- or Delayed-Start condition. Hierarchical linear models with repeated measures were used to examine changes in evidence-based assessment practices over time, and organizational characteristics were examined as covariates to control for differences across the 21 research sites. Results demonstrated significant intervention and sustainability effects for three of the four assessment domains examined, although stronger effects were obtained for intra- than inter-agency outcomes. No significant effects were found for Conveyance/Utility. Implementation interventions such as the OPII represent an important tool to enhance the use of evidence-based assessment practices in large and diverse correctional systems. Intra-agency assessment activities that were more directly under the control of correctional agencies were implemented most effectively. Activities in domains that required cross-systems collaboration were not as successfully implemented, although longer follow-up periods might afford detection of stronger effects. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The Effects of a Cluster Randomized Controlled Workplace Intervention on Sleep and Work-Family Conflict Outcomes in an Extended Care Setting.

Science.gov (United States)

Marino, Miguel; Killerby, Marie; Lee, Soomi; Klein, Laura Cousino; Moen, Phyllis; Olson, Ryan; Kossek, Ellen Ernst; King, Rosalind; Erickson, Leslie; Berkman, Lisa F; Buxton, Orfeu M

2016-12-01

To evaluate the effects of a workplace-based intervention on actigraphic and self-reported sleep outcomes in an extended care setting. Cluster randomized trial. Extended-care (nursing) facilities. US employees and managers at nursing homes. Nursing homes were randomly selected to intervention or control settings. The Work, Family and Health Study developed an intervention aimed at reducing work-family conflict within a 4-month work-family organizational change process. Employees participated in interactive sessions with facilitated discussions, role-playing, and games designed to increase control over work processes and work time. Managers completed training in family-supportive supervision. Primary actigraphic outcomes included: total sleep duration, wake after sleep onset, nighttime sleep, variation in nighttime sleep, nap duration, and number of naps. Secondary survey outcomes included work-to-family conflict, sleep insufficiency, insomnia symptoms and sleep quality. Measures were obtained at baseline, 6-months and 12-months post-intervention. A total of 1,522 employees and 184 managers provided survey data at baseline. Managers and employees in the intervention arm showed no significant difference in sleep outcomes over time compared to control participants. Sleep outcomes were not moderated by work-to-family conflict or presence of children in the household for managers or employees. Age significantly moderated an intervention effect on nighttime sleep among employees (p=0.040), where younger employees benefited more from the intervention. In the context of an extended-care nursing home workplace, the intervention did not significantly alter sleep outcomes in either managers or employees. Moderating effects of age were identified where younger employees' sleep outcomes benefited more from the intervention.

The effect of electronic medical record adoption on outcomes in US hospitals

Directory of Open Access Journals (Sweden)

Lee Jinhyung

2013-02-01

Full Text Available Abstract Background The electronic medical record (EMR is one of the most promising components of health information technology. However, the overall impact of EMR adoption on outcomes at US hospitals remains unknown. This study examined the relationship between basic EMR adoption and 30-day rehospitalization, 30-day mortality, inpatient mortality and length of stay. Methods Our overall approach was to compare outcomes for the two years before and two years after the year of EMR adoption, at 708 acute-care hospitals in the US from 2000 to 2007. We looked at the effect of EMR on outcomes using two methods. First, we compared the outcomes by quarter for the period before and after EMR adoption among hospitals that adopted EMR. Second, we compared hospitals that adopted EMR to those that did not, before and after EMR adoption, using a generalized linear model. Results Hospitals adopting EMR experienced 0.11 (95% CI: -0.218 to −0.002 days’ shorter length of stay and 0.182 percent lower 30-day mortality, but a 0.19 (95% CI: 0.0006 to 0.0033 percent increase in 30-day rehospitalization in the two years after EMR adoption. The association of EMR adoption with outcomes also varied by type of admission (medical vs. surgical. Conclusions Previous studies using observational data from large samples of hospitals have produced conflicting results. However, using different methods, we found a small but statistically significant association of EMR adoption with outcomes of hospitalization.

Video games do affect social outcomes: a meta-analytic review of the effects of violent and prosocial video game play.

Science.gov (United States)

Greitemeyer, Tobias; Mügge, Dirk O

2014-05-01

Whether video game play affects social behavior is a topic of debate. Many argue that aggression and helping are affected by video game play, whereas this stance is disputed by others. The present research provides a meta-analytical test of the idea that depending on their content, video games do affect social outcomes. Data from 98 independent studies with 36,965 participants revealed that for both violent video games and prosocial video games, there was a significant association with social outcomes. Whereas violent video games increase aggression and aggression-related variables and decrease prosocial outcomes, prosocial video games have the opposite effects. These effects were reliable across experimental, correlational, and longitudinal studies, indicating that video game exposure causally affects social outcomes and that there are both short- and long-term effects.

Outcome Indicators on Interprofessional Collaboration Interventions for Elderly

Directory of Open Access Journals (Sweden)

Giannoula Tsakitzidis

2016-05-01

Full Text Available    Background: Geriatric care increasingly needs more multidisciplinary health care services to deliver the necessary complex and continuous care. The aim of this study is to summarize indicators of effective interprofessional outcomes for this population. Method: A systematic review is performed in the Cochrane Library, Pubmed (Medline, Embase, Cinahl and Psychinfo with a search until June 2014. Results: Overall, 689 references were identified of which 29 studies met the inclusion criteria. All outcome indicators were summarized in three categories: collaboration, patient level outcome and costs. Seventeen out of 24 outcome indicators within the category of ‘collaboration’ reached significant difference in advantage of the intervention group. On ‘patient outcome level’ only 15 out of 32 outcome parameters met statistical significance. In the category of ‘costs’ only one study reached statistical significance. Discussion and conclusion: The overall effects of interprofessional interventions for elderly are positive, but based on heterogeneous outcomes. Outcome indicators of interprofessional collaboration for elderly with a significant effect can be summarized in three main categories: ‘collaboration’, patient level’ and ‘costs’. For ‘collaboration’ the outcome indicators are key elements of collaboration, involved disciplines, professional and patient satisfaction and quality of care. On ‘patient level’ the outcome indicators are pain, fall incidence, quality of life, independence for daily life activities, depression and agitated behaviour, transitions, length of stay in hospital, mortality and period of rehabilitation. ‘Costs’ of interprofessional interventions on short- and long-term for elderly need further investigation. When organizing interprofessional collaboration or interprofessional education these outcome indicators can be considered as important topics to be addressed. Overall more research is

Cost-effectiveness analysis of repeat fine-needle aspiration for thyroid biopsies read as atypia of undetermined significance.

Science.gov (United States)

Heller, Michael; Zanocco, Kyle; Zydowicz, Sara; Elaraj, Dina; Nayar, Ritu; Sturgeon, Cord

2012-09-01

The 2007 National Cancer Institute (NCI) conference on Thyroid Fine-Needle Aspiration (FNA) introduced the category atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS). Repeat FNA in 3 to 6 months was recommended for low-risk patients. Compliance with these recommendations has been suboptimal. We hypothesized that repeat FNA would be more effective than diagnostic lobectomy, with decreased costs and improved rates of cancer detection. Cost-effectiveness analysis was performed in which we compared diagnostic lobectomy with repeat FNA. A Markov model was developed. Outcomes and probabilities were identified from literature review. Third-party payer costs were estimated in 2010 US dollars. Outcomes were weighted by use of the quality-of-life utility factors, yielding quality-adjusted life years (QALYs). Monte Carlo simulation and sensitivity analysis were used to examine the uncertainty of probability, cost, and utility estimates. The diagnostic lobectomy strategy cost $8,057 and produced 23.99 QALYs. Repeat FNA cost $2,462 and produced 24.05 QALYs. Repeat FNA was dominant until the cost of FNA increased to $6,091. Dominance of the repeat FNA strategy was not sensitive to the cost of operation or the complication rate. The NCI recommendations for repeat FNA regarding follow-up of AUS/FLUS results are cost-effective. Improving compliance with these guidelines should lead to less overall costs, greater quality of life, and fewer unnecessary operations. Copyright © 2012 Mosby, Inc. All rights reserved.

Effects of maternal psychotropic drug dosage on birth outcomes

Directory of Open Access Journals (Sweden)

Michielsen LA

2013-12-01

Full Text Available Laura A Michielsen,1 Frank MMA van der Heijden,1 Paddy KC Janssen,2 Harold JH Kuijpers11Vincent van Gogh Institute for Psychiatry, Venlo, the Netherlands; 2Department of Pharmacy, VieCuri Medical Centre, Venlo, the NetherlandsBackground: The aim of this retrospective study was to explore the relationship between psychotropic medication dosage and birth outcomes.Methods: A total of 136 women were enrolled, who had an active mental disorder, were taking medication to prevent a relapse, or had a history of postpartum depression or psychosis. Medication use was evaluated for the three trimesters and during labor. Based on the defined daily dose, medication use was classified into three groups. Primary outcome variables included the infant gestational age at birth, birth weight, and Apgar scores at one and 5 minutes.Results: Our study showed a significantly higher incidence of Apgar score ≤7 at 5 minutes in women taking psychotropic drugs as compared with the group taking no medication, respectively (16.3% versus 0.0%, P=0.01. There was no significant difference between the two groups in Apgar score at one minute or in gestational age and birth weight. The results showed no significant differences in gestational age, birth weight, or Apgar scores for a low–intermediate or high dose of a selective serotonin reuptake inhibitor and for a low or intermediate dose of an antipsychotic.Conclusion: This study does not indicate a relationship between doses of selective serotonin reuptake inhibitors and antipsychotics and adverse neonatal outcomes.Keywords: pregnancy, psychotropic medication, dosage, birth outcomes

Effect of casemix funding on outcomes in patients admitted to hospital with suspected unstable angina.

Science.gov (United States)

Kerr, G D; Dunt, D; Gordon, I R

1998-01-19

To determine the effect of the introduction of casemix funding on resource utilisation and clinical outcomes in patients admitted to hospital with suspected unstable angina. A prospective cohort study with a 6-month follow-up. A suburban community hospital in Melbourne, Victoria. 336 consecutive patients admitted to the coronary care unit with suspected unstable angina before (156) and after (180) the introduction of casemix funding. Introduction of casemix funding in July 1993. Indices of resource utilisation: length of stay in hospital, length of stay in the coronary care unit, and total cost of investigations (pathology and radiology). Rates of serious cardiac events during hospital stay and after discharge. Readmissions within 28 days and 6 months of discharge. After the introduction of casemix funding there was a 1% increase in duration of hospital stay and a 5% increase in time spent in the coronary care unit, but neither of these increases was statistically significant. However, there was a significant reduction in total cost of investigations (39% decrease; 95% confidence interval, 14%-70%; P Casemix funding had no effect on short term clinical outcomes but resulted in significantly reduced investigation costs.

Predicting meaningful outcomes to medication and self-help treatments for binge-eating disorder in primary care: The significance of early rapid response.

Science.gov (United States)

Grilo, Carlos M; White, Marney A; Masheb, Robin M; Gueorguieva, Ralitza

2015-04-01

We examined rapid response among obese patients with binge-eating disorder (BED) in a randomized clinical trial testing antiobesity medication and self-help cognitive-behavioral therapy (shCBT), alone and in combination, in primary-care settings. One hundred four obese patients with BED were randomly assigned to 1 of 4 treatments: sibutramine, placebo, shCBT + sibutramine, or shCBT + placebo. Treatments were delivered by generalist primary-care physicians and the medications were given double-blind. Independent assessments were performed by trained and monitored doctoral research clinicians monthly throughout treatment, posttreatment (4 months), and at 6- and 12-month follow-ups (i.e., 16 months after randomization). Rapid response, defined as ≥65% reduction in binge eating by the fourth treatment week, was used to predict outcomes. Rapid response characterized 47% of patients, was unrelated to demographic and baseline clinical characteristics, and was significantly associated, prospectively, with remission from binge eating at posttreatment (51% vs. 9% for nonrapid responders), 6-month (53% vs. 23.6%), and 12-month (46.9% vs. 23.6%) follow-ups. Mixed-effects model analyses revealed that rapid response was significantly associated with greater decreases in binge-eating or eating-disorder psychopathology, depression, and percent weight loss. Our findings, based on a diverse obese patient group receiving medication and shCBT for BED in primary-care settings, indicate that patients who have a rapid response achieve good clinical outcomes through 12-month follow-ups after ending treatment. Rapid response represents a strong prognostic indicator of clinically meaningful outcomes, even in low-intensity medication and self-help interventions. Rapid response has important clinical implications for stepped-care treatment models for BED. clinicaltrials.gov: NCT00537810 (PsycINFO Database Record (c) 2015 APA, all rights reserved).

A model-based correction for outcome reporting bias in meta-analysis.

Science.gov (United States)

Copas, John; Dwan, Kerry; Kirkham, Jamie; Williamson, Paula

2014-04-01

It is often suspected (or known) that outcomes published in medical trials are selectively reported. A systematic review for a particular outcome of interest can only include studies where that outcome was reported and so may omit, for example, a study that has considered several outcome measures but only reports those giving significant results. Using the methodology of the Outcome Reporting Bias (ORB) in Trials study of (Kirkham and others, 2010. The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews. British Medical Journal 340, c365), we suggest a likelihood-based model for estimating the effect of ORB on confidence intervals and p-values in meta-analysis. Correcting for bias has the effect of moving estimated treatment effects toward the null and hence more cautious assessments of significance. The bias can be very substantial, sometimes sufficient to completely overturn previous claims of significance. We re-analyze two contrasting examples, and derive a simple fixed effects approximation that can be used to give an initial estimate of the effect of ORB in practice.

Effects of metformin on pregnancy outcomes in women with polycystic ovary syndrome

Science.gov (United States)

Zeng, Xian-Ling; Zhang, Ya-Fei; Tian, Quan; Xue, Yan; An, Rui-Fang

2016-01-01

Abstract Aim: The aim of the study is to evaluate the effects of metformin on pregnancy outcomes in women with polycystic ovary syndrome (PCOS). Methods: We searched electronic databases and bibliographies of relevant papers to identify studies comparing the pregnancy outcomes in the metformin group with those in the placebo or blank control group. Then, we did this meta-analysis based on the PRISMA guidelines. The primary outcomes included early pregnancy loss (EPL), preterm delivery, term delivery, and gestational diabetes mellitus (GDM). Secondary outcomes included pregnancy-induced hypertension (PIH), intrauterine growth restriction (IUGR), fetal malformation, vaginal delivery (VD), cesarean section (CS), and metformin's side effects, such as nausea or gastrointestinal discomfort. Certainly, data about neonatal death and macrosomia were analyzed if data available. Results: Finally, 13 studies including 5 randomized controlled trials (RCT) and 8 cohort studies involving 1606 pregnant women with PCOS were analyzed. The pooled OR of EPL was 0.19 with obvious statistical significance, manifesting that metformin help to lower the rate of EPL (95% CI 0.12–0.28, P metformin showed the advantage of reducing the prevalence of preterm delivery (OR 0.37, 95% CI 0.20–0.68, P = 0.002). In addition, metformin could promote term delivery greatly and the pooled OR was 5.23 with sharp statistical difference (95% CI 3.12–8.75, P Metformin treatment in women with PCOS throughout pregnancy could increase the possibility of term delivery, VD and reduce the risk of EPL, preterm labor, pregnancy complications such as GDM and PIH, with no serious side effects. Moreover, metformin was not teratogenic based on the limited data. So we may recommend metformin treatment for women with PCOS during the whole pregnancy period for it is quite beneficial and safe for both mothers and babies. PMID:27603343

The effect of a health promotion intervention for construction workers on work-related outcomes: results from a randomized controlled trial.

Science.gov (United States)

Viester, Laura; Verhagen, Evert A L M; Bongers, Paulien M; van der Beek, Allard J

2015-08-01

The objective of the present study is to investigate the effects of a worksite health promotion intervention on musculoskeletal symptoms, physical functioning, work ability, work-related vitality, work performance, and sickness absence. In a randomized controlled design, 314 construction workers were randomized into an intervention group (n = 162) receiving personal coaching, tailored information, and materials, and a control group (n = 152) receiving usual care. Sickness absence was recorded continuously in company records, and questionnaires were completed before, directly after the 6-month intervention period, and 12 months after baseline measurements. Linear and logistic regression analyses were performed to determine intervention effects. No significant changes at 6 or 12 months of follow-up were observed in musculoskeletal symptoms, physical functioning, work ability, work-related vitality, work performance, and sickness absence as a result of the intervention. This study shows that the intervention was not statistically significantly effective on secondary outcomes. Although the intervention improved physical activity, dietary, and weight-related outcomes, it was not successful in decreasing musculoskeletal symptoms and improving other work-related measures. Presumably, more multifaceted interventions are required to establish significant change in these outcomes.

Korean Red Ginseng exhibits no significant adverse effect on disease activity in patients with rheumatoid arthritis: a randomized, double-blind, crossover study

Directory of Open Access Journals (Sweden)

Soo-Kyung Cho

2018-04-01

Full Text Available Background: Panax ginseng is a well-known immune modulator, and there is concern that its immune-enhancing effects may negatively affect patients with rheumatoid arthritis (RA by worsening symptoms or increasing the risk of adverse effects from other drugs. In this randomized, crossover clinical trial, we evaluated the impact of Korean Red Ginseng (KRG on disease activity and safety in RA patients. Methods: A total of 80 female RA patients were randomly assigned to either the KRG (2 g/d, n = 40 treatment or placebo (n = 40 groups for 8 wk, followed by crossover to the other treatment group for an additional 8 wk. The primary outcome was the disease flare rate, defined as worsening disease activity according to the disease activity score 28 joints-erythrocyte sedimentation rate (DAS28-ESR. The secondary outcomes were development of adverse events (AEs and patient reported outcomes. Outcomes were evaluated at baseline and 8 wk and 16 wk. The outcomes were compared using the Chi-square test. Results: Of the 80 patients, 70 completed the full study. Their mean age was 51.9 yr, and most exhibited low disease activity (mean DAS28-ESR 3.5 ± 1.0 at enrollment. After intervention, the flare rate was 3.7% in each group. During KRG treatment, 10 AEs were reported, while five AEs were developed with placebo; however, this difference was not statistically significant (p = 0.16. Gastrointestinal- and nervous system-related symptoms were frequent in the KRG group. Conclusion: KRG is not significantly associated with either disease flare rate or the rate of AE development in RA patients. Keywords: effect, Korean Red Ginseng, rheumatoid arthritis, safety

Effect of periodontal therapy on pregnancy outcome in women affected by periodontitis.

Science.gov (United States)

Tarannum, Fouzia; Faizuddin, Mohamed

2007-11-01

There is convincing evidence to suggest that infections affecting the mother during pregnancy may produce alterations in the normal cytokine- and hormone-regulated gestation, which could result in preterm labor, premature rupture of membranes, and preterm birth (PTB). Studies in the late 1990s associated periodontitis with preterm low birth weight (PLBW) deliveries, and this may have similar pathogenic mechanisms as other maternal infections. This study determined the effect of non-surgical periodontal therapy on pregnancy outcome. A total of 200 pregnant women with periodontitis were randomly assigned to treatment and control groups. Detailed data about previous and current pregnancies were obtained. All women received a full-mouth periodontal examination, including oral hygiene index-simplified, bleeding index, and clinical attachment level. The women in the treatment group received non-surgical periodontal therapy during the gestational period, and those in the control group received periodontal treatment after delivery. Periodontal therapy included plaque control instructions and scaling and root planing performed under local anesthesia. The outcome measures assessed were gestational age and birth weight of the infant. PTB was recorded when delivery occurred at PTBs in the treatment group and 68 PTBs in the control group. Twenty-six LBW infants were recorded in the treatment group, and 48 LBW infants were noted in the control group. The mean gestational ages were 33.8+/-2.8 weeks and 32.7+/-2.8 weeks in the treatment and control groups, respectively. The difference was statistically significant at P<0.006. The mean birth weight was 2,565.3+/-331.2 g in the treatment group and 2,459.6+/-380.7 g in the control group, with the difference being statistically significant at P<0.044. A multiple regression model showed a significant effect of periodontal treatment on birth outcomes. Non-surgical periodontal therapy can reduce the risk for preterm births in mothers who

The effect of omega-3 supplementation on pregnancy outcomes by smoking status.

Science.gov (United States)

Kuper, Spencer G; Abramovici, Adi R; Jauk, Victoria C; Harper, Lorie M; Biggio, Joseph R; Tita, Alan T

2017-10-01

nonsmokers. Omega-3 supplementation was associated with a lower risk of spontaneous preterm delivery in smokers (relative risk, 0.56, 95% confidence interval, 0.36-0.87) but not in nonsmokers (relative risk 1.04, 95% confidence interval 0.84-1.29); P value for interaction = 0.013. Low birth weight was also less frequent in smokers receiving omega-3 supplementation (relative risk 0.57, 95% confidence interval 0.36-0.90) compared with nonsmokers (relative risk 0.93, 95% confidence interval 0.71-1.24); P value for interaction = 0.047. The effect on other secondary outcomes did not differ significantly between smokers and nonsmokers. Omega-3 supplementation in smokers may have a protective effect against recurrent spontaneous preterm delivery and low birth weight. Copyright © 2017 Elsevier Inc. All rights reserved.

Differential effects of parenting in preterm and full-term children on developmental outcomes.

Science.gov (United States)

Maupin, Angela N; Fine, Jodene Goldenring

2014-12-01

To examine the relations between preterm birth, parenting behavior during early childhood, cognitive development, and social-emotional outcomes at Kindergarten entry, and to determine whether parenting behavior differentially influences this developing system in children born preterm compared to children born full-term. The nationally representative sample comprised 3600 full-term and 1300 preterm children born in the US in the year 2001. All children who entered Kindergarten and who participated in data collection at 9 months, 24 months, and Kindergarten entry were included in the study. Measures of parenting behavior were collected at 9 and 24 months and cognitive development at 24 months via home visits. Social-emotional outcomes were assessed at Kindergarten entry via parent and teacher report. Multiple-sample Structural Equation Modeling was used to analyze group differences in a model whereby early childhood parenting behavior predicted cognitive outcomes, and social-emotional outcomes at Kindergarten entry, and indirectly predicted social-emotional outcomes via early cognitive processes. The full sample developmental model indicated excellent fit to the data. Preterm birth status indirectly influenced social-emotional outcomes at Kindergarten entry via its effect on early childhood parenting behavior and cognitive development. The multi-sample model revealed significant differences in the way in which early parenting behavior exerted its influence on outcomes at Kindergarten entry in preterm children compared to full-term children. For preterm children, parenting indirectly influenced social-emotional outcomes via early cognitive functioning. Findings highlight the importance of early identification and targeted parenting programs to support early cognitive development in preterm children. Copyright © 2014 Elsevier Ltd. All rights reserved.

Confidence intervals for effect sizes: compliance and clinical significance in the Journal of Consulting and clinical Psychology.

Science.gov (United States)

Odgaard, Eric C; Fowler, Robert L

2010-06-01

In 2005, the Journal of Consulting and Clinical Psychology (JCCP) became the first American Psychological Association (APA) journal to require statistical measures of clinical significance, plus effect sizes (ESs) and associated confidence intervals (CIs), for primary outcomes (La Greca, 2005). As this represents the single largest editorial effort to improve statistical reporting practices in any APA journal in at least a decade, in this article we investigate the efficacy of that change. All intervention studies published in JCCP in 2003, 2004, 2007, and 2008 were reviewed. Each article was coded for method of clinical significance, type of ES, and type of associated CI, broken down by statistical test (F, t, chi-square, r/R(2), and multivariate modeling). By 2008, clinical significance compliance was 75% (up from 31%), with 94% of studies reporting some measure of ES (reporting improved for individual statistical tests ranging from eta(2) = .05 to .17, with reasonable CIs). Reporting of CIs for ESs also improved, although only to 40%. Also, the vast majority of reported CIs used approximations, which become progressively less accurate for smaller sample sizes and larger ESs (cf. Algina & Kessleman, 2003). Changes are near asymptote for ESs and clinical significance, but CIs lag behind. As CIs for ESs are required for primary outcomes, we show how to compute CIs for the vast majority of ESs reported in JCCP, with an example of how to use CIs for ESs as a method to assess clinical significance.

Effects of Adolescent Sport Practice on Health Outcomes of Adult Amateur Endurance Cyclists: Adulthood Is Not Too Late to Start.

Science.gov (United States)

Munguia-Izquierdo, Diego; Mayolas-Pi, Carmen; Peñarrubia-Lozano, Carlos; Paris-Garcia, Federico; Bueno-Antequera, Javier; Oviedo-Caro, Miguel Angel; Legaz-Arrese, Alejandro

2017-11-01

We investigated the effects of adolescent sport practice on the training, performance, and health outcomes of adult amateur endurance cyclists and compared health outcomes of 3 adult groups: amateur endurance cyclists who practiced sports during adolescence, amateur endurance cyclists who did not practice sports during adolescence, and inactive individuals. In 859 (751 men and 108 women) adult cyclists and 718 inactive subjects (307 men and 411 women), we examined adolescent sport practice, current training status, quality of life, quality of sleep, anxiety and depression, and cardiometabolic risk: body mass index, physical activity, physical fitness, adherence to Mediterranean diet, and alcohol and tobacco consumption. Independent of gender, no significant differences in training, performance, or health outcomes were observed between amateur endurance cyclists who practiced sports during adolescence and those who did not. Independent of gender, cyclists reported significantly better health outcomes than inactive individuals in all variables, except depression. Training, performance, and health outcomes did not differ between adult amateur endurance cyclists who practiced sports during adolescence and those who did not, but their health outcomes were significantly improved compared with inactive individuals, except for depression.

The Effects of Vasospasm and Re-Bleeding on the Outcome of Patients with Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysm.

Science.gov (United States)

Filipce, Venko; Caparoski, Aleksandar

2015-01-01

Vasospasm and re-bleeding after subarachnoid hemorrhage from ruptured intracranial aneurysm are devastating complication that can severely affect the outcome of the patients. We are presenting a series of total number of 224 patients treated and operated at our Department due to subarachnoid hemorrhage, out of which certain number developed vasospasm and re-bleeding. We are evaluating the effect of these complications on the outcome of the patients according to the Glasgow Outcome Scale at the day of discharge. In our experience both vasospasm and ReSAH can significantly influence the outcome of patients with subarachnoid hemorrhage from ruptured intracranial aneurysm.

Calculating Clinically Significant Change: Applications of the Clinical Global Impressions (CGI) Scale to Evaluate Client Outcomes in Private Practice

Science.gov (United States)

Kelly, Peter James

2010-01-01

The Clinical Global Impressions (CGI) scale is a therapist-rated measure of client outcome that has been widely used within the research literature. The current study aimed to develop reliable and clinically significant change indices for the CGI, and to demonstrate its application in private psychological practice. Following the guidelines…

Arthroscopic Debridement for Primary Degenerative Osteoarthritis of the Elbow Leads to Significant Improvement in Range of Motion and Clinical Outcomes: A Systematic Review.

Science.gov (United States)

Sochacki, Kyle R; Jack, Robert A; Hirase, Takashi; McCulloch, Patrick C; Lintner, David M; Liberman, Shari R; Harris, Joshua D

2017-12-01

The purpose of this investigation was to determine whether arthroscopic debridement of primary elbow osteoarthritis results in statistically significant and clinically relevant improvement in (1) elbow range of motion and (2) clinical outcomes with (3) low complication and reoperation rates. A systematic review was registered with PROSPERO and performed using PRISMA guidelines. Databases were searched for studies that investigated the outcomes of arthroscopic debridement for the treatment of primary osteoarthritis of the elbow in adult human patients. Study methodological quality was analyzed. Studies that included post-traumatic arthritis were excluded. Elbow motion and all elbow-specific patient-reported outcome scores were eligible for analysis. Comparisons between preoperative and postoperative values from each study were made using 2-sample Z-tests (http://in-silico.net/tools/statistics/ztest) using a P value osteoarthritis results in statistically significant and clinically relevant improvement in elbow range of motion and clinical outcomes with low complication and reoperation rates. Systematic review of level IV studies. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Who Are You More Likely to Help? The Effects of Expected Outcomes and Regulatory Focus on Prosocial Performance

Science.gov (United States)

Xiao, Fengqiu; Zheng, Zhiwei; Zhang, Heyi; Xin, Ziqiang; Chen, Yinghe; Li, Yiwei

2016-01-01

Prosocial behavior refers to a broad category of actions that benefit other people or the society. Compared with other factors that affect prosocial performance, prosocial outcomes, consisting of prosocial gains and prosocial non-losses have received less attention up to now. In the current research, we explored the influences of different types of expected outcomes and regulatory focus on prosocial performance. Studies 1a and 1b examined the differences in prosocial performance elicited by prosocial gain (e.g., enhancing others’ access to clean water) and prosocial non-loss outcomes (e.g., protecting others from suffering dirty water). We found that the expected prosocial non-loss outcomes induced greater prosocial performance compared with the expected prosocial gain outcomes. Studies 2a and 2b examined the effects of dispositional and situational regulatory focus on prosocial loss aversion. We found that differences in prosocial performance between two expected prosocial outcomes were reduced when promotion focus was primed; whereas a primed prevention focus did not significantly increase this difference. Additionally, participants displayed a greater prosocial loss aversion in the prevention focus condition than in the promotion focus condition. The reason for the non-significant interaction between regulatory focus and expected prosocial outcome was discussed. PMID:27824909

Who Are You More Likely to Help? The Effects of Expected Outcomes and Regulatory Focus on Prosocial Performance.

Directory of Open Access Journals (Sweden)

Fengqiu Xiao

Full Text Available Prosocial behavior refers to a broad category of actions that benefit other people or the society. Compared with other factors that affect prosocial performance, prosocial outcomes, consisting of prosocial gains and prosocial non-losses have received less attention up to now. In the current research, we explored the influences of different types of expected outcomes and regulatory focus on prosocial performance. Studies 1a and 1b examined the differences in prosocial performance elicited by prosocial gain (e.g., enhancing others' access to clean water and prosocial non-loss outcomes (e.g., protecting others from suffering dirty water. We found that the expected prosocial non-loss outcomes induced greater prosocial performance compared with the expected prosocial gain outcomes. Studies 2a and 2b examined the effects of dispositional and situational regulatory focus on prosocial loss aversion. We found that differences in prosocial performance between two expected prosocial outcomes were reduced when promotion focus was primed; whereas a primed prevention focus did not significantly increase this difference. Additionally, participants displayed a greater prosocial loss aversion in the prevention focus condition than in the promotion focus condition. The reason for the non-significant interaction between regulatory focus and expected prosocial outcome was discussed.

The effects of a multiple family therapy on adolescents with eating disorders: an outcome study.

Science.gov (United States)

Gelin, Zoé; Fuso, Silvana; Hendrick, Stephan; Cook-Darzens, Solange; Simon, Yves

2015-03-01

Multiple Family Therapy (MFT) has gained increasing popularity in the treatment of eating disorders and many programs have been developed over the past decade. Still, there is little evidence in the literature on the effectiveness on MFT for treating eating disorders. The present study examines the effects of a particular model of Multiple Family Therapy on eating disorder symptoms, quality of life, and percentage of Expected Body Weight (%EBW) in adolescents with eating disorders (ED). Eighty-two adolescents with ED, aged between 11 and 19 years, were assessed before and after treatment using the Eating Disorders Inventory 2 (EDI-2), the Outcome Questionnaire 45 (OQ-45) and %EBW. Results showed a significant increase in %EBW between the beginning and end of treatment, with a large effect size. 52.4% of patients achieved an EBW above 85%. Symptoms relative to all EDI dimensions (except for bulimia) significantly decreased during treatment. The three dimensions related to quality of life assessment also improved over the course of MFT. At the end of treatment, 70.7% of patients had a total OQ-45 score below clinical significance. This study suggests that Multiple Family Therapy may benefit adolescents with eating disorders, with improvement on several outcome measures (%EBW, ED symptoms, and quality of life). However, the lack of a comparison group entails caution when drawing conclusions. © 2014 Family Process Institute.

Low-dose vaporized cannabis significantly improves neuropathic pain.

Science.gov (United States)

Wilsey, Barth; Marcotte, Thomas; Deutsch, Reena; Gouaux, Ben; Sakai, Staci; Donaghe, Haylee

2013-02-01

We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling medium-dose (3.53%), low-dose (1.29%), or placebo cannabis with the primary outcome being visual analog scale pain intensity. Psychoactive side effects and neuropsychological performance were also evaluated. Mixed-effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the 2 active dose groups' results (P > .7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo versus low-dose, 2.9 for placebo versus medium-dose, and 25 for medium- versus low-dose. As these NNTs are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well tolerated, and neuropsychological effects were of limited duration and readily reversible within 1 to 2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. The analgesia obtained from a low dose of delta-9-tetrahydrocannabinol (1.29%) in patients, most of whom were experiencing neuropathic pain despite conventional treatments, is a clinically significant outcome. In general, the effect sizes on cognitive testing were consistent with this minimal dose. As a result, one might not anticipate a significant impact on daily functioning. Published by Elsevier Inc.

Effect of hypertensive disorders during pregnancy on neonatal outcomes and umbilical artery flow

Directory of Open Access Journals (Sweden)

Dong-mei ZHENG

2013-09-01

Full Text Available Objective　To observe the effect of hypertensive disorders during pregnancy (HDP on neonatal outcomes and umbilical artery flow. Methods　A prospective cohort study method was employed, and 60 pregnant women met the HDP diagnostic criteria (HDP group, aged 31.2±6.0 years, gestation time 251.0±9.0d, hospitalized from Sep. 2011 to May. 2012, and delivered live-born infants and 63 pregnant women with normal blood pressure and without medical or surgical ailments (control group, aged 30.2±2.8 years, gestation time 251.9±7.7d, hospitalized in the the same period, and had live birth were involved in present study. The indexes of umbilical artery blood flow were measured, the adverse neonatal outcomes (neonatal asphyxia, low birth weight babies and premature labor were recorded, and the correlation was analyzed between the adverse neonatal outcomes and the indexes of umbilical artery blood flow. Results　The incidence of adverse neonatal outcomes (neonatal asphyxia, low birth weight newborns and premature labor was higher in HDP group (58.3%, 45.0% and 53.3%, respectively than in control group (6.3%, 3.2% and 3.2%, respectively, P<0.05. The results of umbilical artery blood flow indexes, including pulsatility index (PI, resistance index (RI and systolic/diastolic ratio (S/D in HDP group (0.897±0.176, 0.588±0.701 and 2.655±0.346, respectively were significantly higher than in control group (0.741±0.123, 0.525±0.650 and 2.120±0.364, respectively, P<0.05. The indexes of umbilical artery blood flow (PI, RI and S/D in newborns with adverse outcomes were significantly higher than in those newborn without adverse outcomes. Multivariate logistic regression revealed a positive correlation between RI and adverse neonatal outcomes. Conclusions　The indexes of umbilical artery blood flow appear to be abnormal in pregnant women with HDP, and adverse neonatal conditions (neonatal asphyxia, low birth weight newborns and premature labor are prone to

Evaluating the Effect of Mother – Baby Skin- to- Skin Care on Neonatal Outcomes in Preterm Infants

Directory of Open Access Journals (Sweden)

M Kalhor

2016-08-01

Full Text Available Introduction: Involving the parents in caring of premature newborns is one of the best and effective manners for preventing the hospitalization of premature newborns. The present study aimed to evaluate the effect of mother – baby skin- to- skin care on neonatal outcomes in preterm infants, in Kosar hospital. Methods: This was a descriptive comparative study conducted on 400 nulliparous women with premature infants admitted to neonatal intensive care unit of Kosar hospital during April 2012 and March 2015. Sampling was performed via convenience sampling. Sample population divided into two groups, one of them 200, the kangaroo care and non- care groups. The data were obtained by a researcher prepared check list, including mother’s demographic characteristics and neonatal outcomes. Both descriptive and statistical analysis methods were applied. For analyzing the data, chi-square test, t-test, and logistic regression tests was applied (P 0.05. In the intervention group, the relationship between maternal variables and neonatal outcome was significant (P <0.05. Conclusion: Mother – baby skin- to- skin care has a positive effect on neonatal outcomes. Thus, supporting and awareness of premature infants’ mothers in order to implement this type of care can reduce the neonatal complications. Moreover, it is effective in decreasing the treatment costs.

The effect of paternal factors on perinatal and paediatric outcomes

DEFF Research Database (Denmark)

Oldereid, Nan B; Wennerholm, Ulla-Britt; Pinborg, Anja

2018-01-01

BACKGROUND: Maternal factors, including increasing childbearing age and various life-style factors, are associated with poorer short- and long-term outcomes for children, whereas knowledge of paternal parameters is limited. Recently, increasing paternal age has been associated with adverse obstet...... IMPLICATIONS: Although the increased risks of adverse outcome in offspring associated with paternal factors and identified in this report represent serious health effects, the magnitude of these effects seems modest....

Effect of probiotics on respiratory, gastrointestinal and nutritional outcomes in patients with cystic fibrosis: A systematic review.

Science.gov (United States)

Anderson, Jacqueline L; Miles, Caitlin; Tierney, Audrey C

2017-03-01

An increasing body of research investigating the use of probiotics to improve health outcomes in patients with cystic fibrosis (CF) prompted the need to systematically assess and summarise the relevant literature. An electronic search of five databases and three trial databases was conducted. Studies describing the administration of probiotics to patients with CF older than 2years, with a comparator group on respiratory, gastrointestinal and nutritional outcomes were included. Three pre-post studies and six randomised controlled trials met the inclusion criteria. Overall studies showed a positive effect of probiotics on reducing the number of pulmonary exacerbations and decreasing gastrointestinal inflammation. There was limited effect of probiotics on other outcomes and inadequate evidence for the effects of specific probiotic species and strains. The findings suggest that probiotics may improve respiratory and gastrointestinal outcomes in a stable CF clinic population with no reported evidence of harm. There is inadequate evidence at this time to recommend a specific species, strain or dose of probiotic as likely to be of significant benefit. Copyright © 2016 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Cost-effectiveness analysis in severe mental illness : Outcome measures selection

NARCIS (Netherlands)

Stant, A. Dennis; Buskens, Erik; Jenner, Jack A.; Wiersma, Durk; TenVergert, Elisabeth M.

Background: Most economic evaluations conducted in mental healthcare did not include widely recommended preference-based health outcomes like the QALY (Quality-Adjusted Life Years). Instead, studies have mainly been designed as cost-effectiveness analyses that include single outcome measures aimed

Clinically significant bleeding in incurable cancer patients: effectiveness of hemostatic radiotherapy

International Nuclear Information System (INIS)

Cihoric, Nikola; Crowe, Susanne; Eychmüller, Steffen; Aebersold, Daniel M; Ghadjar, Pirus

2012-01-01

This study was performed to evaluate the outcome after hemostatic radiotherapy (RT) of significant bleeding in incurable cancer patients. Patients treated by hemostatic RT between November 2006 and February 2010 were retrospectively analyzed. Bleeding was assessed according to the World Health Organization (WHO) scale (grade 0 = no bleeding, 1 = petechial bleeding, 2 = clinically significant bleeding, 3 = bleeding requiring transfusion, 4 = bleeding associated with fatality). The primary endpoint was bleeding at the end of RT. Key secondary endpoints included overall survival (OS) and acute toxicity. The bleeding score before and after RT were compared using the Wilcoxon signed rank test. Time to event endpoints were estimated using the Kaplan Meier method. Overall 62 patients were analyzed including 1 patient whose benign cause of bleeding was pseudomyxoma peritonei. Median age was 66 (range, 37–93) years. Before RT, bleeding was graded as 2 and 3 in 24 (39%) and 38 (61%) patients, respectively. A median dose of 20 (range, 5–45) Gy of hemostatic RT was applied to the bleeding site. At the end of RT, there was a statistically significant difference in bleeding (p < 0.001); it was graded as 0 (n = 39), 1 (n = 12), 2 (n = 6), 3 (n = 4) and 4 (n = 1). With a median follow-up of 19.3 (range, 0.3-19.3) months, the 6-month OS rate was 43%. Forty patients died (65%); 5 due to bleeding. No grade 3 or above acute toxicity was observed. Hemostatic RT seems to be a safe and effective treatment for clinically and statistically significantly reducing bleeding in incurable cancer patients

Causal Effects of Career-Technical Education on Postsecondary Work Outcomes of Individuals with High-Incidence Disabilities

Science.gov (United States)

Lee, Heok In; Rojewski, Jay W.; Gregg, Noel

2016-01-01

Using data from the National Longitudinal Transition Study-2, a propensity score analysis revealed significant causal effects for a secondary career and technical education (CTE) concentration on the postsecondary work outcomes of adolescents with high-incidence disabilities. High school students identified as CTE concentrators (three or more high…

Contemporary Management of Acute Aortic Occlusion Has Evolved but Outcomes Have Not Significantly Improved.

Science.gov (United States)

Robinson, William P; Patel, Rupal K; Columbo, Jesse A; Flahive, Julie; Aiello, Francesco A; Baril, Donald T; Schanzer, Andres; Messina, Louis M

2016-07-01

Most existing series of acute aortic occlusion (AAO) predate the changes in surgical and endovascular therapy of the last 2 decades. We examined the contemporary management and outcomes of AAO. We reviewed consecutive patients with AAO at a tertiary referral center from 2004 to 2012. Outcomes were stratified and compared according to etiology and procedure performed. AAO in 29 patients was due to in situ thrombosis in 21 (72%) and embolism in 8 (28%) patients. Vascular patients with embolism were on average older (77 ± 7 vs. 66 ± 12 years, P = 0.02) and had higher rates of atrial fibrillation (100% vs. 20%, P = 0.0002) and congestive heart failure (75% vs. 0%, P = 0.0001) in comparison with those with in situ thrombosis. Neurologic deficit was present in 16 (55%) patients. Six patients (21%) presented with bilateral paresis/paralysis secondary to spinal cord or lumbosacral plexus ischemia, and primary neurologic etiology was investigated before vascular consultation was obtained in 4 of these 6 patients. Of the 29 patients, 28 (97%) underwent revascularization including transfemoral embolectomy (n = 6), transperitoneal aortoiliac thrombectomy (n = 2), axillobifemoral bypass (n = 10), aortobifemoral bypass (n = 6), and endovascular therapy including thrombolysis, angioplasty ± stenting (n = 4). In-hospital mortality was 31% and did not vary significantly according to etiology (embolism 38% vs. in situ thrombosis 29%, P = 0.67). In-hospital mortality varied widely according to procedure (transfemoral embolectomy 50%, aortoiliac thrombectomy 100%, axillobifemoral bypass 30%, aortobifemoral bypass 0%, and endovascular therapy 25%, P = 0.08). Major morbidity (59%), length of stay (8.6 ± 8.0 days), and discharge to a rehabilitation facility (50%) did not vary by etiology or procedure. At a media follow-up of 361 ± 460 days (range 3-2014), overall survival was 42%. There were no amputations among 20 survivors of initial

Can Trainees Effectively Deliver Dialectical Behavior Therapy for Individuals With Borderline Personality Disorder? Outcomes From a Training Clinic.

Science.gov (United States)

Rizvi, Shireen L; Hughes, Christopher D; Hittman, Alexandra D; Vieira Oliveira, Pedro

2017-12-01

The aim of the current study was to evaluate the effectiveness of a 6-month course of comprehensive dialectical behavior therapy (DBT) provided in a training clinic with doctoral students as therapists and assessors. Clinical outcomes for 50 individuals with borderline personality disorder (80% female, M age = 29.52 [SD = 9.64]) are reported. Reliable change indices and clinical significance were calculated for measures. Finally, our results were benchmarked against a "gold standard" randomized clinical trial (RCT; McMain et al., 2009). Analyses with both the full sample and the treatment completers indicate significant reductions in mental health symptomatology that were reliable, clinically and statistically significant, and comparable in effect size to the benchmarked RCT. This DBT training clinic produced good outcomes, comparable to that of a large RCT. Results have implications for who can provide DBT treatment, as well as improving access to DBT in community settings where training clinics may be located. © 2017 Wiley Periodicals, Inc.

Effects of surgeon variability on oncologic and functional outcomes in a population-based setting.

Science.gov (United States)

Carlsson, Sigrid; Berglund, Anders; Sjoberg, Daniel; Khatami, Ali; Stranne, Johan; Bergdahl, Svante; Lodding, Pär; Aus, Gunnar; Vickers, Andrew; Hugosson, Jonas

2014-03-06

Oncologic and functional outcomes after radical prostatectomy (RP) can vary between surgeons to a greater extent than is expected by chance. We sought to examine the effects of surgeon variation on functional and oncologic outcomes for patients undergoing RP for prostate cancer in a European center. The study comprised 1,280 men who underwent open retropubic RP performed by one of nine surgeons at an academic institution in Sweden between 2001 and 2008. Potency and continence outcomes were measured preoperatively and 18 months postoperatively by patient-administered questionnaires. Biochemical recurrence (BCR) was defined as a prostate-specific antigen (PSA) value > 0.2 ng/mL with at least one confirmatory rise. Multivariable random effect models were used to evaluate heterogeneity between surgeons, adjusting for case mix (age, PSA, pathological stage and grade), year of surgery, and surgical experience. Of 679 men potent at baseline, 647 provided data at 18 months with 122 (19%) reporting potency. We found no evidence for heterogeneity of potency outcomes between surgeons (P = 1). The continence rate for patients at 18 months was 85%, with 836 of the 979 patients who provided data reporting continence. There was statistically significant heterogeneity between surgeons (P = 0.001). We did not find evidence of an association between surgeons' adjusted probabilities of functional recovery and 5-year probability of freedom from BCR. Our data support previous studies regarding a large heterogeneity among surgeons in continence outcomes for patients undergoing RP. This indicates that some patients are receiving sub-optimal care. Quality assurance measures involving performance feedback, should be considered. When surgeons are aware of their outcomes, they can improve them to provide better care to patients.

Imprinting alterations in sperm may not significantly influence ART outcomes and imprinting patterns in the cord blood of offspring.

Science.gov (United States)

Tang, Li; Liu, Zichao; Zhang, Ruopeng; Su, Cunmei; Yang, Wenjuan; Yao, Youlin; Zhao, Shuhua

2017-01-01

An increase in imprinting disorders in children conceived though assisted reproductive technologies (ARTs) has been the subject of several reports. The transmission of imprinting errors from the sperm of infertile fathers is believed to be a possible reason for the increased occurrence of these disorders. However, whether the imprinting alterations in sperm affect ART outcomes and the imprinting of offspring is unclear. In the current study, we analyzed the methylation of H19, SNRPN and KCNQ1OT1 by pyrosequencing sperm samples from 97 infertile patients and 31 proven fertile males as well as cord blood samples from 13 infantswho were conceived by infertile parents through intracytoplasmic sperm injection (ICSI) and 30 healthy newborns who were conceived naturally. After four cases were excluded owing to the lack of a sequencing signal, the infertile patients were subgrouped into normal (69 cases) and abnormal (24 cases) imprinting groups according to the reference range set by the control group. Between the groups, there were no significant differences in ART outcomes. Significantly different levels of methylation were detected in H19, but none of the imprinted genes were determined to be outside of the methylation reference range set by the values derived from the naturally conceived controls. Three CpG loci were found to be significantly hypomethylated in the maternally imprinted gene KCNQ1OT1 in two patients from the abnormal imprinting group, none of which were caused by sperm imprinting errors. In addition, the paternal H19 gene exhibited discrepant methylation patterns between the sperm controls and the cord blood controls. Our data suggest that increased imprinting errors in the sperm of infertile patients do not have an obvious influence on ART outcomes or the imprinting of offspring.

The Effectiveness of Nursing Education on Clinical Outcomes of Patients With Heart Failure: A Systematic Review

Directory of Open Access Journals (Sweden)

Kollia

2016-04-01

Full Text Available Context Many nursing educational approaches have been applied on patients with heart failure (HF to improve their outcomes. The results of these approaches on outcomes of patients with HF remain controversial. Evidence Acquisition The aim of this study was to highlight the importance of nursing education to improve the outcomes of patients with HF, such as self-care behaviour, quality of life, mortality, readmission and hospitalization rates. A systematic review was conducted in the MEDLINE database on investigations punished from 2000 to 2012. The search terms used were self-care, heart failure, nursing, and education. A total of 22 studies complied with the eligibility criteria for this review. Results The findings of the reviewed studies showed that self-care behaviour of patients who received nursing education improved significantly. No significant improvement was noticed in the health-related quality of life. Additionally, there was no significant reduction in readmission, hospitalization and mortality rates of patients after implementing this educational process. Conclusions The effectiveness of nursing education on self-care behaviour of HF patients was clearly demonstrated. Methodological differences in development and implementation of education programs, made the comparison between the results of the studies difficult.

Effect size calculation in meta-analyses of psychotherapy outcome research.

Science.gov (United States)

Hoyt, William T; Del Re, A C

2018-05-01

Meta-analysis of psychotherapy intervention research normally examines differences between treatment groups and some form of comparison group (e.g., wait list control; alternative treatment group). The effect of treatment is normally quantified as a standardized mean difference (SMD). We describe procedures for computing unbiased estimates of the population SMD from sample data (e.g., group Ms and SDs), and provide guidance about a number of complications that may arise related to effect size computation. These complications include (a) incomplete data in research reports; (b) use of baseline data in computing SMDs and estimating the population standard deviation (σ); (c) combining effect size data from studies using different research designs; and (d) appropriate techniques for analysis of data from studies providing multiple estimates of the effect of interest (i.e., dependent effect sizes). Clinical or Methodological Significance of this article: Meta-analysis is a set of techniques for producing valid summaries of existing research. The initial computational step for meta-analyses of research on intervention outcomes involves computing an effect size quantifying the change attributable to the intervention. We discuss common issues in the computation of effect sizes and provide recommended procedures to address them.

A tool for evaluating the potential for cost-effective outcomes measurement.

Science.gov (United States)

Somasekhar, Melinda M; Bove, Alfred; Rausch, Chris; Degnan, James; King, Cathy T; Meyer, Arnold

2012-01-01

Cost related to higher-level outcomes measurement is often very high. However, the cost burden is felt even more by smaller, less well-funded continuing medical education (CME) programs. It is possible to overcome financial and participant-related barriers to measuring Level 6 outcomes, which are patient health outcomes. The Temple University School of Medicine's Office for Continuing Medical Education developed a sequential tool for attaining cost-effective outcomes measurement for determining the likelihood of a CME intervention to produce significant changes in physician performance. The appropriate selection of the CME topic and specific practice change indictors drive this tool. This tool walks providers through a simple YES or NO decision-making list that guides them toward an accurate prediction of potential programmatic outcomes. Factors considered during the decision-making process include whether: (a) the intended change(s) will have a substantial impact on current practice; (b) the intended practice change(s) are well supported by clinical data, specialty organization/government recommendations, expert opinion, etc; (c) the potential change(s) affects a large population; (d) external factors, such as system pressures, media pressures, financial pressures, patient pressures, safety pressures, etc, are driving this intended change in performance; (e) there is a strong motivation on the part of physicians to implement the intended change(s); and (f) the intended change(s) is relatively easy to implement within any system of practice. If each of these questions can be responded to positively, there is a higher likelihood that the intended practice-related change(s) will occur. Such change can be measured using a simpler and less costly methodology.

Competitive outcome of Daphnia-Simocephalus experimental microcosms: salinity versus priority effects.

Directory of Open Access Journals (Sweden)

Cláudia Loureiro

Full Text Available Competition is a major driving force in freshwaters, especially given the cyclic nature and dynamics of pelagic food webs. Competition is especially important in the initial species assortment during colonization and re-colonization events, which depends strongly on the environmental context. Subtle changes, such as saline intrusion, may disrupt competitive relationships and, thus, influence community composition. Bearing this in mind, our objective was to assess whether low salinity levels (using NaCl as a proxy alter the competitive outcome (measured as the rate of population biomass increase of Daphnia-Simocephalus experimental microcosms, taking into account interactions with priority effects (sequential species arrival order. With this approach, we aimed to experimentally demonstrate a putative mechanism of differential species sorting in brackish environments or in freshwaters facing secondary salinization. Experiments considered three salinity levels, regarding NaCl added (0.00, 0.75 and 1.50 g L(-1, crossed with three competition scenarios (no priority, priority of Daphnia over Simocephalus, and vice-versa. At lower NaCl concentrations (0.00 and 0.75 g L(-1, Daphnia was a significantly superior competitor, irrespective of the species inoculation order, suggesting negligible priority effects. However, the strong decrease in Daphnia population growth at 1.50 g L(-1 alleviated the competitive pressure on Simocephalus, causing an inversion of the competitive outcome in favour of Simocephalus. The intensity of this inversion depended on the competition scenario. This salinity-mediated disruption of the competitive outcome demonstrates that subtle environmental changes produce indirect effects in key ecological mechanisms, thus altering community composition, which may lead to serious implications in terms of ecosystem functioning (e.g. lake regime shifts due to reduced grazing and biodiversity.

The effect of albendazole treatment on seizure outcomes in patients with symptomatic neurocysticercosis.

Science.gov (United States)

Romo, Matthew L; Wyka, Katarzyna; Carpio, Arturo; Leslie, Denise; Andrews, Howard; Bagiella, Emilia; Hauser, W Allen; Kelvin, Elizabeth A

2015-11-01

Randomized controlled trials have found an inconsistent effect of anthelmintic treatment on long-term seizure outcomes in neurocysticercosis. The objective of this study was to further explore the effect of albendazole treatment on long-term seizure outcomes and to determine if there is evidence for a differential effect by seizure type. In this trial, 178 patients with active or transitional neurocysticercosis cysts and new-onset symptoms were randomized to 8 days of treatment with albendazole (n=88) or placebo (n=90), both with prednisone, and followed for 24 months. We used negative binomial regression and logistic regression models to determine the effect of albendazole on the number of seizures and probability of recurrent or new-onset seizures, respectively, over follow-up. Treatment with albendazole was associated with a reduction in the number of seizures during 24 months of follow-up, but this was only significant for generalized seizures during months 1-12 (unadjusted rate ratio [RR] 0.19; 95% CI: 0.04-0.91) and months 1-24 (unadjusted RR 0.06; 95% CI: 0.01-0.57). We did not detect a significant effect of albendazole on reducing the number of focal seizures or on the probability of having a seizure, regardless of seizure type or time period. Albendazole treatment may be associated with some symptomatic improvement; however, this association seems to be specific to generalized seizures. Future research is needed to identify strategies to better reduce long-term seizure burden in patients with neurocysticercosis. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Adverse Effect of Spasticity on 3-Month Poststroke Outcome Using a Population-Based Model

Directory of Open Access Journals (Sweden)

S. R. Belagaje

2014-01-01

Full Text Available Several devices and medications have been used to address poststroke spasticity. Yet, spasticity’s impact on outcomes remains controversial. Using data from a cohort of 460 ischemic stroke patients, we previously published a validated multivariable regression model for predicting 3-month modified Rankin Score (mRS as an indicator of functional outcome. Here, we tested whether including spasticity improved model fit and estimated the effect spasticity had on the outcome. Spasticity was defined by a positive response to the question “Did you have spasticity following your stroke?” on direct interview at 3 months from stroke onset. Patients who had expired by 90 days (n=30 or did not have spasticity data available (n=102 were excluded. Spasticity affected the 3-month functional status (β=0.420, 95 CI=0.194 to 0.645 after accounting for age, diabetes, leukoaraiosis, and retrospective NIHSS. Using spasticity as a covariable, the model’s R2 changed from 0.599 to 0.622. In our model, the presence of spasticity in the cohort was associated with a worsened 3-month mRS by an average of 0.4 after adjusting for known covariables. This significant adverse effect on functional outcomes adds predictive value beyond previously established factors.

Effect of 131I therapy on outcomes of Graves' ophthalmopathy

International Nuclear Information System (INIS)

Wang Renfei; Tan Jian; Zhang Guizhi; Yin Liang

2011-01-01

Objective: To analyze the correlation between the therapeutic effect of Graves' hyperthyroidism and the outcomes of Graves' ophthalmopathy after 131 I therapy, and to explore the effect of 131 I treatment on turnout of Graves' ophthalmopathy. Methods: Six hundreds and fifty-two patients of Graves' disease accompanied with Graves' ophthalmopathy, received one-time 131 I treatment according to routine procedure. We recorded exophthalmometer readings, the signs and symptoms of eyes before therapy. Regular follow-up and appraisal of curative effect were carried out. Results: At least six months after 131 I therapy, the effective rate of Graves' hyperthyroidism and Graves' ophthalmopathy were 94.3% and 73.3% respectively. The total effective rate of hyperthyroidism with ophthalmopathy was 71.2%. There was a significant correlation between the prognosis of Graves' ophthalmopathy and therapeutic efficacy of hyperthyroidism (r=0.302, P 131 I therapy (χ 2 =0.296, P>0.05). Conclusions: The key to treat Graves' ophthalmopathy is the cure of Graves' hyperthyroidism through 131 I therapy. The timely diagnosis and replacement treatment of hypothyroidism can effectively avoid the aggravation of Graves' ophthalmopathy after 131 I therapy. (authors)

Risk factors influencing the treatment outcome in diabetic macular oedema

Directory of Open Access Journals (Sweden)

Gupta Amod

1996-01-01

Full Text Available A multivariate analysis was done on 96 eyes to evaluate the effect of various risk factors on the final visual outcome after laser photocoagulation for clinically significant macular oedema (CSME in diabetic retinopathy. Advanced age of the patient, large size of CSME and poor baseline visual acuity were found to be significantly associated with poorer outcome (p<0.05. The association of nephropathy and hypertension with poorer visual outcome was of boderline significance (p = 0.054 and 0.07, respectively. Wavelength of the laser (argon or krypton used for treatment did not significantly influence the outcome.

Adverse Effects of Smoking on Outcomes of Orthopaedic Surgery

OpenAIRE

Sheung-tung Ho

2017-01-01

Smoking has many adverse effects on the musculoskeletal system, particularly on the outcomes after orthopaedic surgery. Smoking is associated with surgical site infection and postoperative wound complications after spine surgery, total joint arthroplasty, and fracture fixation; nonunion after spinal fusion, ankle fusion, osteotomy, and internal fixation and bone grafting for scaphoid nonunion; worse outcomes after lumbar disc prolapse, spinal stenosis, and cervical myelopathy surgery; peripro...

Paradoxical effects of alcohol information on alcohol outcome expectancies.

Science.gov (United States)

Krank, Marvin D; Ames, Susan L; Grenard, Jerry L; Schoenfeld, Tara; Stacy, Alan W

2010-07-01

Cognitive associations with alcohol predict both current and future use in youth and young adults. Much cognitive and social cognitive research suggests that exposure to information may have unconscious influences on thinking and behavior. The present study assessed the impact of information statements on the accessibility of alcohol outcome expectancies. The 2 studies reported here investigated the effects of exposure to alcohol statements typical of informational approaches to prevention on the accessibility of alcohol outcome expectancies. High school and university students were presented with information statements about the effects of alcohol and other commercial products. The alcohol statements were taken from expectancy questionnaires. Some of these statements were presented as facts and others as myths. The retention of detailed information about these statements was manipulated by (i) divided attention versus focused attention or (ii) immediate versus delayed testing. Accessibility of personal alcohol outcome expectancies was subsequently measured using an open-ended question about the expected effects of alcohol. Participants reported more alcohol outcomes seen during the information task as personal expectations about the effects of alcohol use than similar unseen items. Paradoxically, myth statements were also more likely to be reported as expectancies than unseen items in all conditions. Additionally, myth statements were generated less often than fact statements only under the condition of immediate testing with strong content processing instructions. These observations are consistent with findings from cognitive research where familiarity in the absence of explicit memory can have an unconscious influence on performance. In particular, the exposure to these items in an informational format increases accessibility of the seen items even when the participants were told that they were myths. The findings have implications for the development of

Pre-Treatment Deep Curettage Can Significantly Reduce Tumour Thickness in Thick Basal Cell Carcinoma While Maintaining a Favourable Cosmetic Outcome When Used in Combination with Topical Photodynamic Therapy

International Nuclear Information System (INIS)

Christensen, E.; Mork, C.; Foss, O. A.

2011-01-01

Topical photodynamic therapy (PDT) has limitations in the treatment of thick skin tumours. The aim of the study was to evaluate the effect of pre-PDT deep curettage on tumour thickness in thick (≥2 mm) basal cell carcinoma (BCC). Additionally, 3-month treatment outcome and change of tumour thickness from diagnosis to treatment were investigated. At diagnosis, mean tumour thickness was 2.3 mm (range 2.0-4.0). Pre- and post-curettage biopsies were taken from each tumour prior to PDT. Of 32 verified BCCs, tumour thickness was reduced by 50% after deep curettage (ρ≤0.001) . Mean tumour thickness was also reduced from diagnosis to treatment. At 3-month followup, complete tumour response was found in 93% and the cosmetic outcome was rated excellent or good in 100% of cases. In conclusion, deep curettage significantly reduces BCC thickness and may with topical PDT provide a favourable clinical and cosmetic short-term outcome.

Effects of a Workplace Intervention Targeting Psychosocial Risk Factors on Safety and Health Outcomes

Science.gov (United States)

Hammer, Leslie B.; Truxillo, Donald M.; Bodner, Todd; Rineer, Jennifer; Pytlovany, Amy C.; Richman, Amy

2015-01-01

The goal of this study was to test the effectiveness of a workplace intervention targeting work-life stress and safety-related psychosocial risk factors on health and safety outcomes. Data were collected over time using a randomized control trial design with 264 construction workers employed in an urban municipal department. The intervention involved family- and safety-supportive supervisor behavior training (computer-based), followed by two weeks of behavior tracking and a four-hour, facilitated team effectiveness session including supervisors and employees. A significant positive intervention effect was found for an objective measure of blood pressure at the 12-month follow-up. However, no significant intervention results were found for self-reported general health, safety participation, or safety compliance. These findings suggest that an intervention focused on supervisor support training and a team effectiveness process for planning and problem solving should be further refined and utilized in order to improve employee health with additional research on the beneficial effects on worker safety. PMID:26557703

Effects of a Workplace Intervention Targeting Psychosocial Risk Factors on Safety and Health Outcomes

Directory of Open Access Journals (Sweden)

Leslie B. Hammer

2015-01-01

Full Text Available The goal of this study was to test the effectiveness of a workplace intervention targeting work-life stress and safety-related psychosocial risk factors on health and safety outcomes. Data were collected over time using a randomized control trial design with 264 construction workers employed in an urban municipal department. The intervention involved family- and safety-supportive supervisor behavior training (computer-based, followed by two weeks of behavior tracking and a four-hour, facilitated team effectiveness session including supervisors and employees. A significant positive intervention effect was found for an objective measure of blood pressure at the 12-month follow-up. However, no significant intervention results were found for self-reported general health, safety participation, or safety compliance. These findings suggest that an intervention focused on supervisor support training and a team effectiveness process for planning and problem solving should be further refined and utilized in order to improve employee health with additional research on the beneficial effects on worker safety.

Significant regional differences in Denmark in outcome after cochlear implants in children

DEFF Research Database (Denmark)

Percy-Smith, Lone; Busch, Georg Walter; Sandahl, Minna

2012-01-01

The objectives of the present study were to study regional differences in outcome for a paediatric cochlear implant (CI) population after the introduction of universal neonatal hearing screening (UNHS) and bilateral implantation in Denmark....

Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes

Directory of Open Access Journals (Sweden)

Yakoob Mohammad

2011-04-01

, the SGA outcome remained significant only in women with mean body mass index (BMI ≥ 22 kg/m2. There was an increased risk of neonatal mortality in studies with majority of births at home [RR = 1.47, 95% CI: 1.13-1.92]; such an effect was not evident where ≥ 60% of births occurred in facility settings [RR = 0.94, 95% CI: 0.81-1.09]. Overall there was no increase in the risk of neonatal mortality [RR = 1.05, 95% CI: 0.92 – 1.19 (fixed model]. Conclusion This review provides evidence of a significant benefit of MMN supplementation during pregnancy on reducing SGA births as compared to iron-folate, with no significant increase in the risk of neonatal mortality in populations where skilled birth care is available and majority of births take place in facilities. Given comparability of impacts on maternal anemia, the decision to replace iron-folate with multiple micronutrients during pregnancy may be taken in the context of available services in health systems and birth outcomes monitored.

How significant is the ‘significant other’? Associations between significant others’ health behaviors and attitudes and young adults’ health outcomes

Directory of Open Access Journals (Sweden)

Berge Jerica M

2012-04-01

Full Text Available Abstract Background Having a significant other has been shown to be protective against physical and psychological health conditions for adults. Less is known about the period of emerging young adulthood and associations between significant others’ weight and weight-related health behaviors (e.g. healthy dietary intake, the frequency of physical activity, weight status. This study examined the association between significant others’ health attitudes and behaviors regarding eating and physical activity and young adults’ weight status, dietary intake, and physical activity. Methods This study uses data from Project EAT-III, a population-based cohort study with emerging young adults from diverse ethnic and socioeconomic backgrounds (n = 1212. Logistic regression models examining cross-sectional associations, adjusted for sociodemographics and health behaviors five years earlier, were used to estimate predicted probabilities and calculate prevalence differences. Results Young adult women whose significant others had health promoting attitudes/behaviors were significantly less likely to be overweight/obese and were more likely to eat ≥ 5 fruits/vegetables per day and engage in ≥ 3.5 hours/week of physical activity, compared to women whose significant others did not have health promoting behaviors/attitudes. Young adult men whose significant other had health promoting behaviors/attitudes were more likely to engage in ≥ 3.5 hours/week of physical activity compared to men whose significant others did not have health promoting behaviors/attitudes. Conclusions Findings suggest the protective nature of the significant other with regard to weight-related health behaviors of young adults, particularly for young adult women. Obesity prevention efforts should consider the importance of including the significant other in intervention efforts with young adult women and potentially men.

The effect of learning models and emotional intelligence toward students learning outcomes on reaction rate

Science.gov (United States)

Sutiani, Ani; Silitonga, Mei Y.

2017-08-01

This research focused on the effect of learning models and emotional intelligence in students' chemistry learning outcomes on reaction rate teaching topic. In order to achieve the objectives of the research, with 2x2 factorial research design was used. There were two factors tested, namely: the learning models (factor A), and emotional intelligence (factor B) factors. Then, two learning models were used; problem-based learning/PBL (A1), and project-based learning/PjBL (A2). While, the emotional intelligence was divided into higher and lower types. The number of population was six classes containing 243 grade X students of SMAN 10 Medan, Indonesia. There were 15 students of each class were chosen as the sample of the research by applying purposive sampling technique. The data were analyzed by applying two-ways analysis of variance (2X2) at the level of significant α = 0.05. Based on hypothesis testing, there was the interaction between learning models and emotional intelligence in students' chemistry learning outcomes. Then, the finding of the research showed that students' learning outcomes in reaction rate taught by using PBL with higher emotional intelligence is higher than those who were taught by using PjBL. There was no significant effect between students with lower emotional intelligence taught by using both PBL and PjBL in reaction rate topic. Based on the finding, the students with lower emotional intelligence were quite hard to get in touch with other students in group discussion.

EVALUATION OF PROGNOSTIC SIGNIFICANCE FOR BIOCHEMICAL MARKERS OF OXIDATIVE STRESS, ENDOGENOUS INTOXICATION AND VASCULAR REGULATION IN THE DEVELOPMENT OF UNFAVORABLE OUTCOMES IN PATIENTS WITH SEPSIS

Directory of Open Access Journals (Sweden)

E. V. Klychnikova

2016-01-01

Full Text Available Background. Due to the significant infectious complications mortality, the search for prognostic biochemical markers of sepsis development in critically ill patients is relevant.Material and methods. The study involved 57 patients; in 40 cases sepsis developed. The control group included 17 patients where sepsis did not develop. The study was performed on day 1–2, 5–7 and 10–12 after admission. The intensity of oxidative stress was assessed by the level of malondialdehyde (MDA and total antioxidant activity of blood serum (TAA. The endogenous intoxication was assessed by the concentration of medium molecular weight peptides (MMWPs, total and effective albumin concentration (TAC, EAC in serum. The disturbance of endogenous vascular regulation was assessed by the level of stable metabolites of nitric oxide (NOx in serum and the concentration of angiotensin converting enzyme (ACE.Results. It has been found that MDA may be a prognostic index of poor outcome on day 5–7 after admission (relative risk (RR=1.141, confidence interval (CI 95% (1.033; 1.259, р=0.09; NOx level may be a predictor of a poor outcome on day 1–2 (RR=1.026, CI 95% (0.999; 1.055, р=0.064, as well as on day 10–12 (RR=1.012, CI 95% (1.000; 1.023, р=0.098 together with ACE concentration (RR=1.034, CI 95% (1.007; 1.062, р=0.015; MMWP254 level (RR=11.195, CI 95% (1.571; 79.771, р=0.016 and MMWP280 level (RR=17.370, CI 95% (1.568; 192.455, р=0.02 are significant predictors of a poor outcome on day 1–2 and 5–7 as well (MMWP254 — RR=4626.791, CI 95% (7.903; 27808.629, р=0.009 and MMWP280 — RR=1331.590, CI 95% (5.006; 354179.342, р=0.012.Conclusion. We identified prognostically significant signs of unfavorable outcomes of septic process: decrease in NOx; growth of ACE concentration; increase in MDA and decrease in TAA; increase in MMWPs; decrease in TAC and EAC.

Instrumental variable estimation of treatment effects for duration outcomes

NARCIS (Netherlands)

G.E. Bijwaard (Govert)

2007-01-01

textabstractIn this article we propose and implement an instrumental variable estimation procedure to obtain treatment effects on duration outcomes. The method can handle the typical complications that arise with duration data of time-varying treatment and censoring. The treatment effect we

Effects of Outcomes and Random Arbitration on Emotions in a Competitive Gambling Task

Science.gov (United States)

Bediou, Benoit; Mohri, Christelle; Lack, Jeremy; Sander, David

2011-01-01

Research on self-serving biases in judgments and decision-making suggests that individuals first evaluate the outcomes they get, and then the procedures by which these outcomes were obtained. Evidence also suggests that the appraisal of the former (outcome favorability) can bias the appraisal of the latter (procedural fairness). We investigated the nature of the emotions that are elicited by these appraisals by using a new paradigm in which participants performed a choice task between pairs of competing gambles against a virtual opponent. Conflicts (when the participant selected the same gamble as his virtual opponent) were resolved by a neutral arbitrator who either confirmed the participant’s choice (“pro-self”) or attributed his gamble to the virtual opponent (“pro-competitor”). Trials in which the participant and his virtual opponent selected different gambles (“no-conflict”) served as a control condition. In order to validate this new task, emotional reactions to the outcomes of the gambles were measured using self-reports, skin conductance responses, and facial electromyography (zygomaticus, corrugator, and frontalis). In no-conflict trials, effects of counterfactual thinking and social comparison resulted in (i) increased happiness as well as SCR and zygomaticus activity for wins compared to losses (valence effect) and for high compared to low gains (magnitude effect), and (ii) increased anger, regret, disappointment, and envy for losses compared to wins (valence effect). More importantly, compared to no-conflict trials and to pro-self awards with similar outcomes, pro-competitor awards increased subjective reports of anger for unfavorable outcomes, and increased happiness and guilt for favorable outcomes. Although the outcomes were independent from the arbitrators’ decisions, and both the arbitrators’ decisions and the outcomes were kept equally likely, individuals tended to attribute their outcomes to unfair arbitrators, reacting

Effects of eustachian tube function in outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media

Directory of Open Access Journals (Sweden)

Malakooti B

2001-07-01

Full Text Available Chronic otitis media is a common disease which can lead to serious complications or even death. Betterment of eustachian tube function is effective on results of operations. The main goal of this study was to determine the effect of eustachian tube function on outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media. We prospectively studied 126 patients who underwent these operations in Amir Alam hospital in 1998. Eustachian tube function, technique of operation, use of silastic, age, sex, presence of cholesteatoma were evaluated in each patient and graft vascularization after 6 to 8 weeks of surgery was considered as successful outcome. Among 126 ears, 59 had good ETF and among those 59 ears 88.1% or 52 had successful outcome. Among 67 patients with poor ETF 46 or 68.7% got successful results. This significant difference shows the role of Eustachian tube function on the result of surgery.

Agency attribution: event-related potentials and outcome monitoring.

Science.gov (United States)

Bednark, Jeffery G; Franz, Elizabeth A

2014-04-01

Knowledge about the effects of our actions is an underlying feature of voluntary behavior. Given the importance of identifying the outcomes of our actions, it has been proposed that the sensory outcomes of self-made actions are inherently different from those of externally caused outcomes. Thus, the outcomes of self-made actions are likely to be more motivationally significant for an agent. We used event-related potentials to investigate the relationship between the perceived motivational significance of an outcome and the attribution of agency in the presence of others. In our experiment, we assessed agency attribution in the presence of another agent by varying the degree of contiguity between participants' self-made actions and the sensory outcome. Specifically, we assessed the feedback correct-related positivity (fCRP) and the novelty P3 measures of an outcome's motivational significance and unexpectedness, respectively. Results revealed that both the fCRP and participants' agency attributions were significantly influenced by action-outcome contiguity. However, when action-outcome contiguity was ambiguous, novelty P3 amplitude was a reliable indicator of agency attribution. Prior agency attributions were also found to influence attribution in trials with ambiguous and low action-outcome contiguity. Participants' use of multiple cues to determine agency is consistent with the cue integration theory of agency. In addition to these novel findings, this study supports growing evidence suggesting that reinforcement processes play a significant role in the sense of agency.

The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF

DEFF Research Database (Denmark)

Mogensen, Ulrik M.; Køber, Lars; Kristensen, Søren L.

2017-01-01

Background Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE......-I enalapril, on coronary outcomes in PARADIGM-HF. Methods and results We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including...... patients, compared with enalapril, sacubitril/valsartan reduced the risk of the primary outcome (HR 0.80 [0.73–0.87], P 

Neurolinguistic programming: a systematic review of the effects on health outcomes

Science.gov (United States)

Sturt, Jackie; Ali, Saima; Robertson, Wendy; Metcalfe, David; Grove, Amy; Bourne, Claire; Bridle, Chris

2012-01-01

Background Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. Aim To evaluate the effects of NLP on health-related outcomes. Design and setting Systematic review of experimental studies. Method The following data sources were searched: MEDLINE®, PsycINFO, ASSIA, AMED, CINAHL®, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. Results Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4–20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, Peffect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes. PMID:23211179

Some Factors Effected Student's Calculus Learning Outcome

Science.gov (United States)

Rajagukguk, Wamington

2016-01-01

The purpose of this study is to determine the factors effected calculus learning outcome of the student. This study was conducted with 176 respondents, which were selected randomly. The data were obtained by questionnaire, and then analyzed by using multiple regressions, and correlation, at level of a = 0.05. The findings showed there is the…

Cognitive Behavioral Therapy for insomnia with Veterans: evaluation of effectiveness and correlates of treatment outcomes.

Science.gov (United States)

Trockel, Mickey; Karlin, Bradley E; Taylor, C Barr; Manber, Rachel

2014-02-01

This paper examines the effectiveness of Cognitive Behavioral Therapy for insomnia (CBT-I) in Veterans and the effects of two process measures on CBT-I outcomes: 1) therapist ratings of patient adherence and 2) patient ratings of therapeutic alliance. Data are from 316 therapists in the Department of Veterans Affairs CBT-I Training Program and 696 patients receiving CBT-I from therapists undergoing training. Mixed effects model results indicate Insomnia Severity Index scores decreased from 20.7 at baseline to 10.9 (d = 2.3) during a typical course of CBT-I. Patients with highest tercile compared to those with lowest tercile adherence achieved, on average, 4.1 points greater reduction in ISI scores (d = 0.95). The effect of therapeutic alliance on change in insomnia severity was not significant after adjusting for adherence to CBT-I. These results support the effectiveness and feasibility of large-scale training in and implementation of CBT-I and indicate that greater focus on patient adherence may lead to enhanced outcomes. The current findings suggest that CBT-I therapists and training programs place greater emphasis on attending to and increasing patient adherence. Published by Elsevier Ltd.

The effect of antenatal education in small classes on obstetric and psycho-social outcomes

DEFF Research Database (Denmark)

Brixval, Carina Sjöberg; Axelsen, Solveig Forberg; Andersen, Stig Krøger

2014-01-01

The aims of antenatal education contain both outcomes related to pregnancy, birth and parenthood. Both content and methods of antenatal education have changed over time without evidence of effects on relevant outcomes. The effect of antenatal education in groups, with participation of a small num......-analysis aims to assess the effects of antenatal education in small groups on obstetric as well as psycho-social outcomes....

The Effects of Low Birth Weight on School Performance and Behavioral Outcomes of Elementary School Children in Oman

Directory of Open Access Journals (Sweden)

M. Mazharul Islam

2015-07-01

Full Text Available Objectives: Our study aimed to examine the effects of low birth weight (LBW on the school performance and behavior of elementary school children in Oman. Methods: Data were gathered through a cross-sectional survey of nine elementary schools from the Muscat and A’Dhahirah regions. The study utilized a unique database created by linking information from the children’s health cards and current academic and behavioral performance records. Information on children’s performance in various areas such as language, mathematics, science, information technology, sports, and behavior were obtained from the school registers. Birth weight (BW and selected sociodemographic data were obtained from the copy of their health cards kept by each school. A total of 542 elementary school children aged 7–11 years, who had completed grades 2–4, were surveyed.  Results: Data from the school register revealed a very high rate (17.7% of LBW and, overall, 12% of the children exhibited below average performance on selected outcome measures. The below average school performance varied from 5–17% across the six selected areas of school performance. The highest rate of below average performance was observed in science (17%, followed by arithmetic and language (16% each. BW showed significant differential effects on school performance and behavioral outcomes, which remained significant after controlling for the effect of potential confounders. It was found that LBW children were 2–6 times more likely to have poorer school performance in all areas than their normal BW peers. Conclusion: Early intervention programs or special care for LBW children in school could be an effective means of improving educational outcomes and the behavior of these children. Attempts should be made to reduce or prevent poor pregnancy outcomes, which, in turn, would reduce the cost of the health, education, and social services systems.

The Effects of Antenatal Corticosteroids on Short- and Long-Term Outcomes in Small-for-Gestational-Age Infants

Science.gov (United States)

Ishikawa, Hiroshi; Miyazaki, Ken; Ikeda, Tomoaki; Murabayashi, Nao; Hayashi, Kazutoshi; Kai, Akihiko; Ishikawa, Kaoru; Miyamoto, Yoshihiro; Nishimura, Kunihiro; Kono, Yumi; Kusuda, Satoshi; Fujimura, Masanori

2015-01-01

Aim: To evaluate the effect of antenatal corticosteroids (ANS) on short- and long-term outcomes in small-for-gestational age (SGA) infants. Methods: A retrospective database analysis was performed. A total of 1,931 single infants (birth weight <1,500 g) born at a gestational age between 22 weeks and 33 weeks 6 days who were determined to be SGA registered in the Neonatal Research Network Database in Japan between 2003 and 2007 were evaluated for short-term outcome and long-term outcome. Results: ANS was administered to a total of 719 infants (37%) in the short-term outcome evaluation group and 344 infants (36%) in the long-term outcome evaluation group. There were no significant differences between the ANS group and the no-ANS group for primary short-term outcome (adjusted odds ratio (OR) 0.73; 95% confidence interval (CI) 0.45-1.20; P-value 0.22) or primary long-term outcome (adjusted OR 0.69; 95% CI 0.40-1.17; P-value 0.17). Conclusions: Our results show that ANS does not affect short- or long-term outcome in SGA infants when the birth weight is less than 1500 g. This study strongly suggests that administration of ANS resulted in few benefits for preterm FGR fetuses. PMID:25897289

Effects of Elevated Ambient Temperature on Reproductive Outcomes and Offspring Growth Depend on Exposure Time

Directory of Open Access Journals (Sweden)

Huda Yahia Hamid

2012-01-01

Full Text Available Reproductive performance has been shown to be greatly affected by changes in environmental factors, such as temperature. However, it is also crucial to identify the particular stage of pregnancy that is most adversely affected by elevated ambient temperature. The aims of this study were to determine the effect on reproductive outcomes of exposure to elevated ambient temperature during different stages of pregnancy and to determine the effect of prenatal heat stress on offspring growth. Sixty pregnant rats were used in this study. The rats were divided equally into four groups as group 1 (control, group 2 (exposed to elevated temperature following implantation, group 3 (exposed to elevated temperature during pre- and periimplantation, and group 4 (exposed to elevated temperature during pre- and periimplantation and following implantation. Groups 3 and 4 had prolonged gestation periods, reduced litter sizes, and male-biased sex ratios. Moreover, the growth patterns of group 3 and 4 pups were adversely affected by prenatal exposure to elevated temperature. The differences between group 1 and group 3 and between group 1 and group 4 were highly significant. However, no significant differences were observed between groups 1 and 2 in the gestation length, sex ratios, and growth patterns. Thus, it can be concluded that exposure to elevated ambient temperature during pre- and periimplantation has stronger adverse effects on reproductive outcomes and offspring growth than postimplantation exposure.

Making the business case for enhanced depression care: the National Institute of Mental Health-harvard Work Outcomes Research and Cost-effectiveness Study.

Science.gov (United States)

Wang, Philip S; Simon, Gregory E; Kessler, Ronald C

2008-04-01

Explore the business case for enhanced depression care and establish a return on investment rationale for increased organizational involvement by employer-purchasers. Literature review, focused on the National Institute of Mental Health-sponsored Work Outcomes Research and Cost-effectiveness Study. This randomized controlled trial compared telephone outreach, care management, and optional psychotherapy to usual care among depressed workers in large national corporations. By 12 months, the intervention significantly improved depression outcomes, work retention, and hours worked among the employed. Results of the Work Outcomes Research and Cost-effectiveness Study trial and other studies suggest that enhanced depression care programs represent a human capital investment opportunity for employers.

Relationship between Smoking and Outcomes after Cubital Tunnel Release.

Science.gov (United States)

Crosby, Nicholas E; Nosrati, Naveed N; Merrell, Greg; Hasting, Hill

2018-04-01

Several studies have drawn a connection between cigarette smoking and cubital tunnel syndrome. One comparison article demonstrated worse outcomes in smokers treated with transmuscular transposition of the ulnar nerve. However, very little is known about the effect that smoking might have on patients who undergo ulnar nerve decompression at the elbow. The purpose of this study is to evaluate the effect of smoking preoperatively on outcomes in patients treated with ulnar nerve decompression. This study used a survey developed from the comparison article with additional questions based on outcome measures from supportive literature. Postoperative improvement was probed, including sensation, strength, and pain scores. A thorough smoking history was obtained. The study spanned a 10-year period. A total of 1,366 surveys were mailed to former patients, and 247 surveys with adequate information were returned. No significant difference was seen in demographics or comorbidities. Patients who smoked preoperatively were found to more likely relate symptoms of pain. Postoperatively, nonsmoking patients generally reported more favorable improvement, though these findings were not statistically significant. This study finds no statistically significant effect of smoking on outcomes after ulnar nerve decompression. Finally, among smokers, there were no differences in outcomes between simple decompression and transposition.

Effect of marital status on the outcome of patients undergoing elective or urgent coronary revascularization.

Science.gov (United States)

Barbash, Israel M; Gaglia, Michael A; Torguson, Rebecca; Minha, Sa'ar; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

2013-10-01

Marriage confers various health advantages in the general population. However, the added value of marriage among patients who undergo percutaneous coronary intervention (PCI) beyond the standard cardiovascular risk factors is not clear. This study aimed to assess the effects of marital status on outcomes of patients undergoing elective or urgent PCI. Clinical observational analysis of consecutive patients undergoing elective or urgent PCI from 1993 to 2011 was performed. Patients were stratified by marital status, comparing married to unmarried patients. Clinical outcome up to 12 months was obtained by telephone contact or office visit. A total of 11,216 patients were included in the present analysis; 55% were married and 45% unmarried. Significant differences in baseline characteristics were noted, including a lower prevalence of hypertension (86% vs 88%), diabetes (34% vs 38%), and smoking (19% vs 25%) among married vs unmarried patients, respectively (P married patients had a higher prevalence of hypercholesterolemia and family history of coronary artery disease. Early and late major adverse cardiac event rates were significantly lower for married vs unmarried patients up to 1 year (13.3% vs 8.2%, P Married status was independently associated with improved outcome in multivariable analysis (hazard ratio 0.7, 95% CI 0.6-0.9). Married patients who undergo urgent or elective PCI have superior short- and long-term outcomes up to 1 year when compared with unmarried patients. These benefits persist after adjustment for multiple traditional cardiovascular risk factors. © 2013.

Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes.

Science.gov (United States)

Stevens, Bonnie J; Yamada, Janet; Estabrooks, Carole A; Stinson, Jennifer; Campbell, Fiona; Scott, Shannon D; Cummings, Greta

2014-01-01

Hospitalized children frequently receive inadequate pain assessment and management despite substantial evidence to support effective pediatric pain practices. The objective of this study was to determine the effect of a multidimensional knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ), on procedural pain practices and clinical outcomes for children hospitalized in medical, surgical and critical care units. A prospective cohort study compared 16 interventions using EPIQ and 16 standard care (SC) units in 8 Canadian pediatric hospitals. Chart reviews at baseline (time 1) and intervention completion (time 2) determined the nature and frequency of painful procedures and of pain assessment and pain management practices. Trained pain experts evaluated pain intensity 6 months post-intervention (time 3) during routine, scheduled painful procedures. Generalized estimating equation models compared changes in outcomes between EPIQ and SC units over time. EPIQ units used significantly more validated pain assessment tools (Ppatients who received analgesics (P=0.03) and physical pain management strategies (P=0.02). Mean pain intensity scores were significantly lower in the EPIQ group (P=0.03). Comparisons of moderate (4-6/10) and severe (7-10/10) pain, controlling for child and unit level factors, indicated that the odds of having severe pain were 51% less for children in the EPIQ group (adjusted OR: 0.49, 95% CI: 0.26-0.83; P=0.009). EPIQ was effective in improving practice and clinical outcomes for hospitalized children. Additional exploration of the influence of contextual factors on research use in hospital settings is required to explain the variability in pain processes and clinical outcomes. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

The effects of pilates on mental health outcomes: A meta-analysis of controlled trials.

Science.gov (United States)

Fleming, Karl M; Herring, Matthew P

2018-04-01

This meta-analysis estimated the population effect size for Pilates effects on mental health outcomes. Articles published prior to August 2017 were located with searches of Pubmed, Medline, Cinahl, SportDiscus, Science Direct, PsychINFO, Web of Science, and Cochrane Controlled Trial Register using combinations of: Pilates, Pilates method, mental health, anxiety, and depression. Eight English-language publications that included allocation to a Pilates intervention or non-active control and a measure of anxiety and/or depressive symptoms at baseline and after the Pilates intervention were selected. Participant and intervention characteristics, anxiety and depressive symptoms and other mental health outcomes, including feelings of energy and fatigue and quality of life, were extracted. Hedges' d effect sizes were computed, study quality was assessed, and random effects models estimated sampling error and population variance. Pilates resulted in significant, large, heterogeneous reductions in depressive (Δ = 1.27, 95%CI: 0.44, 2.09; z = 3.02, p ≤ 0.003; N = 6, n = 261) and anxiety symptoms (Δ = 1.29, 95%CI: 0.24, 2.33; z = 2.40, p ≤ 0.02; N = 5, n = 231) and feelings of fatigue (Δ = 0.93, 95%CI: 0.21, 1.66; z = 2.52, p ≤ 0.012; N = 3, n = 161), and increases in feelings of energy (Δ = 1.49, 95%CI: 0.67, 2.30; z = 3.57, p Pilates improves mental health outcomes. Rigorously designed randomized controlled trials, including those that compare Pilates to other empirically-supported therapies, are needed to better understand Pilates' clinical effectiveness and plausible mechanisms of effects. Copyright © 2018 Elsevier Ltd. All rights reserved.

The effects of palatal lengthening on the functional and speech outcomes after submucous cleft palate repair.

Science.gov (United States)

Ezzat, Abdelrahman E M; El-Begermy, Marwa M; Eid, Mustafa I; Akel, Mabrouk M

2016-02-29

This study was designed to compare intravelar veloplasty with and without V-Y pushback palatoplasty regarding postoperative functional and speech outcomes. is to find out the importance and influence of palatal lengthening on the functional and speech outcomes after SMCP repair. This is a prospective randomized comparative study of 20 patients divided into 2 equal groups. The study was conducted between February 2008 and January 2015. Radical Intravelar Veloplasty (RIVVP group): included 10 patients with a mean age of 5.539±1.335 years and V-Y Pushback Pharyngoplasty and Radical Intravelar Veloplasty (VYP+RIVVP group): included 10 patients with a mean age of 5.688±1.341 years for non-syndromic SMCP. Academic tertiary care medical centres. In both groups there was a significant change in Eustachian tube function, nasal emission and nasal tone of voice postoperatively than preoperatively, while there was no significant difference between both groups in the postoperative outcomes as regards the same parameters (ET function, nasal emission and resonance) (p=0.558, 0.563 and 0.164 respectively). However, there was a significant difference between both groups as regards palatal lengthening, no statistically significant difference was present between both groups as regards the postoperative mean pharyngeal gap, using videoendoscopic analysis. In conclusion, RIVVP and VYP+RIVVP are both effective methods to repair non-syndromic SMCP. Moreover, the lengthening of the palate in non-syndromic SMCP is an unnecessary process.

Effects of Cooperative E-Learning on Learning Outcomes

Science.gov (United States)

Yeh, Shang-Pao; Fu, Hsin-Wei

2014-01-01

This study aims to discuss the effects of E-Learning and cooperative learning on learning outcomes. E-Learning covers the dimensions of Interpersonal communication, abundant resources, Dynamic instruction, and Learning community; and, cooperative learning contains three dimensions of Cooperative motive, Social interaction, and Cognition…

The effect of driven exercise on treatment outcomes for adolescents with anorexia and bulimia nervosa.

Science.gov (United States)

Stiles-Shields, Colleen; DclinPsy, Bryony Bamford; Lock, James; Le Grange, Daniel

2015-05-01

This study investigated the prevalence of driven exercise (DE) and its role in treatment outcome for adolescents with bulimia nervosa (BN) and anorexia nervosa (AN). Participants were 201 adolescents with an eating disorder (ED) (80 with BN and 121 with AN) presenting for outpatient treatment at two specialist clinics. All adolescents participated in one of two randomized controlled trials. Descriptive statistics were conducted to evaluate the presence and frequency of baseline DE. Exploratory hierarchical regressions were used to evaluate the effect of baseline DE on treatment outcomes. About 66.3% of adolescents with BN and 23.1% of adolescents with AN presented with baseline DE. The presence of baseline DE predicted significantly worse outcomes for adolescents with AN in terms of ED symptom severity (ps adolescents with BN (ps adolescents with BN and AN. However, DE may be related to different constructs for adolescents with AN than those with BN, suggesting differences in treatment needs. © 2014 Wiley Periodicals, Inc.

Effects of outcomes and random arbitration on emotions in a competitive gambling task

Directory of Open Access Journals (Sweden)

Benoit eBediou

2011-10-01

Full Text Available The affective events theory proposes that the evaluation of distributive and procedural justice map onto primary and secondary appraisal sequence, respectively. However, self-serving biases suggest that one dimension (outcome favorability can bias the other (procedural fairness. For the first time, we investigated the emotional correlates of this phenomenon. Participants performed a choice task between pairs of competing gambles against a virtual opponent. Conflicts (when the participant selected the same gamble as his virtual opponent were resolved by a neutral arbitrator who either confirmed the participant’s choice (pro-self or attributed his gamble to the virtual opponent (pro-competitor. Trials in which the participant and his virtual opponent selected different gambles (no-conflict served as a control condition. Emotional reactions to the outcomes of the gambles were measured using self-reports, skin conductance responses and facial electromyography (zygomaticus, corrugator and frontalis.In no-conflict trials, effects of counterfactual thinking and social comparison resulted in (i increased happiness as well as SCR and zygomaticus activity for wins compared to losses (valence effect and for high compared to low gains (magnitude effect, and (ii increased anger, regret, disappointment and envy for losses compared to wins (valence effect. More importantly, compared to no-conflict trials and to pro-self awards with similar outcomes, pro-competitor awards increased subjective reports of anger for unfavorable outcomes, and increased happiness and guilt for favorable outcomes. Although the outcomes were independent from the arbitrators’ decisions, and both the arbitrators’ decisions and the outcomes were kept equally likely, individuals tended to attribute their outcomes to unfair arbitrators, reacting emotionally, especially when the modification of their initial choice for a gamble led to a negative outcome.

Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors

Energy Technology Data Exchange (ETDEWEB)

Kim, Yeo Ju [Inha University Hospital, Department of Radiology, Incheon (Korea); Lee, Joon Woo; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seongnam-si, Gyeongi-do (Korea); Kim, Ki-Jeong; Chung, Sang-Ki; Kim, Hyun-Jib [Seoul National University Bundang Hospital, Department of Neurosurgery, Gyeongi-do (Korea); Park, Jeong Mi [The Catholic University of Korea, Department of Radiology, St. Mary' s Hospital, College of Medicine, Seoul (Korea)

2010-08-15

To investigate the short-term therapeutic effect of percutaneous vertebroplasty (PVP) for intravertebral cleft (IVC) and to analyze possible outcome predictors. After retrospective review of spot radiographs during PVP, 23 patients were included in this study. Age, sex, symptom duration, functional status, injected cement volume, and type of approach were evaluated using patients' medical and operative records. The following factors were analyzed on radiographs, MRI, dual bone densitometry, spot radiographs during PVP, and CT: anatomical location of the fracture, bone mineral density, morphology of the fracture, IVC morphology, presence of surrounding non-enhanced area and bone marrow edema, degeneration of adjacent discs, co-existing old compression fractures, patterns of cement opacification, pre-procedural kyphosis, and post-procedural kyphosis correction. Effectiveness was defined as a much-improved state or no pain after 1 week, 1 month, and 2 months. Statistical analyses were conducted to evaluate the relationship between those factors and therapeutic outcome using Fisher's exact test, Chi-squared test, and the Mann-Whitney U test. Percutaneous vertebroplasty of IVC was effective in 16 out of 23 (69.6%) patients after 1 week and 1 month and 15 out of 23 (65.2%) patients after 2 months. Post-procedural kyphosis correction {>=}5 and poor functional status (full dependency) were more common in the ineffective group after 1 week and 2 months respectively (P = 0.047, P = 0.02). Kyphotic correction {>=}5 was related to pre-procedural kyphosis {>=}15 (P = 0.018). Functional status was related to subsequent fracture (P = 0.005). Other factors were not statistically significant (P > 0.05). Percutaneous vertebroplasty on osteoporotic vertebral compression fractures (VCF) with IVC was effective in only about 69.6% of patients after the first week and month and in 65.2% of patients after 2 months. Post-procedural kyphosis correction {>=}5 was associated with

Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors

International Nuclear Information System (INIS)

Kim, Yeo Ju; Lee, Joon Woo; Kang, Heung Sik; Kim, Ki-Jeong; Chung, Sang-Ki; Kim, Hyun-Jib; Park, Jeong Mi

2010-01-01

To investigate the short-term therapeutic effect of percutaneous vertebroplasty (PVP) for intravertebral cleft (IVC) and to analyze possible outcome predictors. After retrospective review of spot radiographs during PVP, 23 patients were included in this study. Age, sex, symptom duration, functional status, injected cement volume, and type of approach were evaluated using patients' medical and operative records. The following factors were analyzed on radiographs, MRI, dual bone densitometry, spot radiographs during PVP, and CT: anatomical location of the fracture, bone mineral density, morphology of the fracture, IVC morphology, presence of surrounding non-enhanced area and bone marrow edema, degeneration of adjacent discs, co-existing old compression fractures, patterns of cement opacification, pre-procedural kyphosis, and post-procedural kyphosis correction. Effectiveness was defined as a much-improved state or no pain after 1 week, 1 month, and 2 months. Statistical analyses were conducted to evaluate the relationship between those factors and therapeutic outcome using Fisher's exact test, Chi-squared test, and the Mann-Whitney U test. Percutaneous vertebroplasty of IVC was effective in 16 out of 23 (69.6%) patients after 1 week and 1 month and 15 out of 23 (65.2%) patients after 2 months. Post-procedural kyphosis correction ≥5 and poor functional status (full dependency) were more common in the ineffective group after 1 week and 2 months respectively (P = 0.047, P = 0.02). Kyphotic correction ≥5 was related to pre-procedural kyphosis ≥15 (P = 0.018). Functional status was related to subsequent fracture (P = 0.005). Other factors were not statistically significant (P > 0.05). Percutaneous vertebroplasty on osteoporotic vertebral compression fractures (VCF) with IVC was effective in only about 69.6% of patients after the first week and month and in 65.2% of patients after 2 months. Post-procedural kyphosis correction ≥5 was associated with poor outcomes

Shareholders proposals, vote outcome, and board composition

Directory of Open Access Journals (Sweden)

Amani Khaled Bouresli

2008-07-01

Full Text Available This paper examines the variables that affect vote outcome in shareholder proposals. We found that sponsor identity, proposal type, and board composition play a significant role in determining vote outcome. Furthermore, we found that the interaction between the prior performance with board composition is significant and has a negative coefficient. We conducted nonparametric tests to investigate changes in board’s major characteristics before and after targeting. The results indicate that some changes in management and boards occur after shareholder proposals. These changes, however, are unrelated to variables that impact vote outcome. We conclude that shareholders proposals are not effective at changing company behavior or corporate governance

Effect of melatonin supplementation on pregnancy outcome in Wistar-Kyoto and Sprague-Dawley rats.

Science.gov (United States)

Singh, Harbindar Jeet; Saleh, Hisham Ibrahim; Gupalo, Sergey; Omar, Effat

2013-04-25

Although melatonin supplementation is known to influence numerous physiological functions, little is however known of its effects on pregnancy outcome. This study investigated the effects of melatonin supplementation on pregnancy outcome in Wistar-Kyoto (WKY) and Sprague-Dawley (SD) rats aged 12-13 weeks. Upon confirmation of proestrus, each female rat was housed overnight with a male of the same strain. On the next morning, following confirmation of mating (vaginal smear), WKY female rats were isolated into individual metabolic cages and given 0, 25, 50 or 100 mg/kg per day of melatonin in drinking water from day 1 of pregnancy to day 21 postpartum. SD females were given 0 or 100 mg/kg per day of melatonin. Maternal weight, duration of pregnancy, litter size, birth weight and body weight of pups up to day 42, and pup mortality were recorded. Data were analyzed using ANOVA for repeated measures. Compared to controls, maternal weight gain during pregnancy was significantly lower in melatonin-supplemented dams (P melatonin-supplemented dams (P melatonin (P melatonin was significantly lower than controls (P melatonin respectively, and all pup deaths occurred after day 21 of weaning. The results suggest that melatonin supplementation during antenatal and postpartum period appears to adversely affect litter size, pup growth and mortality in WKY and SD rats. The precise mechanism causing the death is not clear.

Side effect of acting on the world: Acquisition of action-outcome statistic relation alters visual interpretation of action outcome

Directory of Open Access Journals (Sweden)

Takahiro eKawabe

2013-09-01

Full Text Available Humans can acquire the statistical features of the external world and employ them to control behaviors. Some external events occur in harmony with an agent’s action, and thus humans should also be able to acquire the statistical features between an action and its external outcome. We report that the acquired action-outcome statistical features alter the visual appearance of the action outcome. Pressing either of two assigned keys triggered visual motion whose direction was statistically biased either upward or downward, and observers judged the stimulus motion direction. Points of subjective equality (PSE for judging motion direction were shifted repulsively from the mean of the distribution associated with each key. Our Bayesian model accounted for the PSE shifts, indicating the optimal acquisition of the action-effect statistical relation. The PSE shifts were moderately attenuated when the action-outcome contingency was reduced. The Bayesian model again accounted for the attenuated PSE shifts. On the other hand, when the action-outcome contiguity was greatly reduced, the PSE shifts were greatly attenuated, and however, the Bayesian model could not accounted for the shifts. The results indicate that visual appearance can be modified by prediction based on the optimal acquisition of action-effect causal relation.

Effects of eustachian tube function in outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media1

Directory of Open Access Journals (Sweden)

Malakooti B

2000-07-01

Full Text Available Chronic otitis media is a common disease which can lead to serious complications or even death. Betterment of eustachian tube function is effective on results of operations. The main goal of this study was to determine the effect of eustachian tube function on outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media. We prospectively studied 126 patients who underwent these operations in Amir Alam hospital in 1998. Eustachian tube function, technique of operation, use of silastic, age, sex, presence of cholesteatoma were evaluated in each patient and graft vascularization after 6 to 8 weeks of surgery was considered as successful outcome. Among 126 ears, 59 had good ETF and among those 59 ears 88.1% or 52 had successful outcome. Among 67 patients with poor ETF 46 or 68.7% got successful results. This significant difference shows the role of Eustachian tube function on the result of surgery.

Effects of outcome on the covariance between risk level and brain activity in adolescents with internet gaming disorder

Directory of Open Access Journals (Sweden)

Xin Qi

2016-01-01

Full Text Available Individuals with internet gaming disorder (IGD often have impaired risky decision-making abilities, and IGD-related functional changes have been observed during neuroimaging studies of decision-making tasks. However, it is still unclear how feedback (outcomes of decision-making affects the subsequent risky decision-making in individuals with IGD. In this study, twenty-four adolescents with IGD and 24 healthy controls (HCs were recruited and underwent functional magnetic resonance imaging while performing the balloon analog risk task (BART to evaluate the effects of prior outcomes on brain activity during subsequent risky decision-making in adolescents with IGD. The covariance between risk level and activation of the bilateral ventral medial prefrontal cortex, left inferior frontal cortex, right ventral striatum (VS, left hippocampus/parahippocampus, right inferior occipital gyrus/fusiform gyrus and right inferior temporal gyrus demonstrated interaction effects of group by outcome (P < 0.05, AlphaSim correction. The regions with interactive effects were defined as ROI, and ROI-based intergroup comparisons showed that the covariance between risk level and brain activation was significantly greater in adolescents with IGD compared with HCs after a negative outcome occurred (P < 0.05. Our results indicated that negative outcomes affected the covariance between risk level and activation of the brain regions related to value estimation (prefrontal cortex, anticipation of rewards (VS, and emotional-related learning (hippocampus/parahippocampus, which may be one of the underlying neural mechanisms of disadvantageous risky decision-making in adolescents with IGD.

Significance and outcome of nuclear anaplasia and mitotic index in prostatic adenocarcinomas.

Science.gov (United States)

Kır, Gozde; Sarbay, Billur Cosan; Gumus, Eyup

2016-10-01

The Gleason grading system measures architectural differentiation and disregards nuclear atypia and the cell proliferation index. Several studies have reported that nuclear grade and mitotic index (MI) are prognostically useful. This study included 232 radical prostatectomy specimens. Nuclear anaplasia (NA) was determined on the basis of nucleomegali (at least 20µm); vesicular chromatin; eosinophilic macronucleoli, nuclear lobulation, and irregular thickened nuclear membranei. The proportion of area of NA was recorded in each tumor in 10% increments. The MI was defined as the number of mitotic figures in 10 consecutive high-power fields (HPF). In univariate analysis, significant differences included associations between biochemical prostate-specific antigen recurrence (BCR) and Gleason score, extraprostatic extension, positive surgical margin, the presence of high-pathologic stage, NA≥10% of tumor area, MI≥3/10 HPF, and preoperative prostate-specific antigen. In a stepwise Cox regression model, a positive surgical margin, the presence of a NA≥10% of tumor area, and a MI of≥3/10 HPF were independent predictors of BCR after radical prostatectomy. NA≥10% of tumor area appeared to have a stronger association with outcome than MI≥3/10 HPF, as still associated with BCR when Gleason score was in the model. The results of our study showed that, in addition to the conventional Gleason grading system, NA, and MI are useful prognostic parameters while evaluating long-term prognosis in prostatic adenocarcinoma. Copyright © 2016 Elsevier Inc. All rights reserved.

Maternal Preeclampsia and Neonatal Outcomes

Directory of Open Access Journals (Sweden)

Carl H. Backes

2011-01-01

Full Text Available Preeclampsia is a multiorgan, heterogeneous disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Optimal strategies in the care of the women with preeclampsia have not been fully elucidated, leaving physicians with incomplete data to guide their clinical decision making. Because preeclampsia is a progressive disorder, in some circumstances, delivery is needed to halt the progression to the benefit of the mother and fetus. However, the need for premature delivery has adverse effects on important neonatal outcomes not limited to the most premature infants. Late-preterm infants account for approximately two thirds of all preterm deliveries and are at significant risk for morbidity and mortality. Reviewed is the current literature in the diagnosis and obstetrical management of preeclampsia, the outcomes of late-preterm infants, and potential strategies to optimize fetal outcomes in pregnancies complicated by preeclampsia.

Specifying the effects of physician's communication on patients' outcomes: A randomised controlled trial.

Science.gov (United States)

van Osch, Mara; van Dulmen, Sandra; van Vliet, Liesbeth; Bensing, Jozien

2017-08-01

To experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain. Using a 2×2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants' outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed. Positive affect-oriented communication reduced anxiety (pcommunication. Positive expectations increased feelings of self-efficacy (pcommunication and a positive expectation reduced anxiety (p=0.02), increased outcome expectancies (p=0.01) and satisfaction (p=0.001). Being empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients' outcomes for the best. Continued medical training is needed to harness placebo-effects of medical communication into practice. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of amnioinfusion for meconium stained amniotic fluid on perinatal outcome.

Science.gov (United States)

Ashfaq, F; Shah, A A

2004-06-01

To see the effect of amnioinfusion on perinatal outcome in cases of meconium staining of liquor. This study was conducted in department of Obstetrics and Gynaecology, unit 1, Jinnah Postgraduate Medical Centre, Karachi, from 1st January 1998 to 31st December 2000. Four hundred patients were included in this study, assigning 200 for amnioinfusion and 200 as control. All patients were matched in both the groups with respect to age, antenatal booking, parity, gestational age, stage of labour, colour of amniotic fluid and fetal birth weight. Both the groups were found to be comparable. The rate of Caesarean section was found to be 37% in amnioinfusion group, which collaborates with other international studies. The fetal outcome was better i.e. 91% alive and healthy, after amnioinfusion due to dilution of meconium stained amniotic fluid with physiological solutions. The perinatal outcome was recorded by Apgar score at 5 minutes. The perinatal morbidity and mortality both were significantly lowered and was found to be 6% as compared to 14% in control, which was also noticed by less number of admissions in nursery i.e. 12% and perinatal deaths. The incidence of meconium aspiration syndrome was found to be 56% in control and was reduced to 22% after amnioinfusion in the other arm of the study. These results are very encouraging and suggestion can be safely made that in future amnioinfusion will be the ideal method of preventing fetal distress due to meconium stained amniotic fluid.

Effect of analgesic therapy on clinical outcome measures in a randomized controlled trial using client-owned dogs with hip osteoarthritis

Directory of Open Access Journals (Sweden)

Malek Sarah

2012-10-01

Full Text Available Abstract Background Pain and impaired mobility because of osteoarthritis (OA is common in dogs and humans. Efficacy studies of analgesic drug treatment of dogs with naturally occurring OA may be challenging, as a caregiver placebo effect is typically evident. However, little is known about effect sizes of common outcome-measures in canine clinical trials evaluating treatment of OA pain. Forty-nine client-owned dogs with hip OA were enrolled in a randomized, double-blinded placebo-controlled prospective trial. After a 1 week baseline period, dogs were randomly assigned to a treatment (ABT-116 – transient receptor potential vanilloid 1 (TRPV1 antagonist, Carprofen – non-steroidal anti-inflammatory drug (NSAID, Tramadol - synthetic opiate, or Placebo for 2 weeks. Outcome-measures included physical examination parameters, owner questionnaire, activity monitoring, gait analysis, and use of rescue medication. Results Acute hyperthermia developed after ABT-116 treatment (P P ≤ 0.01 and tramadol (P ≤ 0.001 led to improved mobility assessed by owner questionnaire. Nighttime activity was increased after ABT-116 treatment (P = 0.01. Kinetic gait analysis did not reveal significant treatment effects. Use of rescue treatment decreased with treatment in the ABT-116 and Carprofen groups (P R ≥ ±0.40, P ≤ 0.005. Placebo treatment effects were evident with all variables studied. Conclusion Treatment of hip OA in client-owned dogs is associated with a placebo effect for all variables that are commonly used for efficacy studies of analgesic drugs. This likely reflects caregiver bias or the phenomenon of regression to the mean. In the present study, outcome measures with significant effects also varied between groups, highlighting the value of using multiple outcome measures, as well as an a priori analysis of effect size associated with each measure. Effect size data from the present study could be used to inform design of future trials studying

The Hijdra scale has significant prognostic value for the functional outcome of Fisher grade 3 patients with subarachnoid hemorrhage.

Science.gov (United States)

Bretz, Julia S; Von Dincklage, Falk; Woitzik, Johannes; Winkler, Maren K L; Major, Sebastian; Dreier, Jens P; Bohner, Georg; Scheel, Michael

2017-09-01

Despite its high prevalence among patients with aneurysmal subarachnoid hemorrhage (aSAH) and high risk of delayed cerebral ischemia (DCI), the Fisher grade 3 category remains a poorly studied subgroup. The aim of this cohort study has been to investigate the prognostic value of the Hijdra sum scoring system for the functional outcome in patients with Fisher grade 3 aSAH, in order to improve the risk stratification within this Fisher category. Initial CT scans of 72 prospectively enrolled patients with Fisher grade 3 aSAH were analyzed, and cisternal, ventricular, and total amount of blood were graded according to the Hijdra scale. Additionally, space-occupying subarachnoid blood clots were assessed. Outcome was evaluated after 6 months. Within the subgroup of Fisher grade 3, aSAH patients with an unfavorable outcome showed a significantly larger cisternal Hijdra sum score (HSS: 21.1 ± 5.2) than patients with a favorable outcome (HSS: 17.6 ± 5.9; p = 0.009). However, both the amount of ventricular blood (p = 0.165) and space-occupying blood clots (p = 0.206) appeared to have no prognostic relevance. After adjusting for the patient's age, gender, tobacco use, clinical status at admission, and presence of intracerebral hemorrhage, the cisternal and total HSS remained the only independent parameters included in multivariate logistic regression models to predict functional outcome (p Fisher 3 category. We suggest that the Hijdra scale is a practically useful prognostic instrument for the risk evaluation after aSAH and should be applied more often in the clinical setting.

THE EFFECT OF DIFFERENT CORRECTIVE FEEDBACK METHODS ON THE OUTCOME AND SELF CONFIDENCE OF YOUNG ATHLETES

Directory of Open Access Journals (Sweden)

George Tzetzis

2008-09-01

Full Text Available This experiment investigated the effects of three corrective feedback methods, using different combinations of correction, or error cues and positive feedback for learning two badminton skills with different difficulty (forehand clear - low difficulty, backhand clear - high difficulty. Outcome and self-confidence scores were used as dependent variables. The 48 participants were randomly assigned into four groups. Group A received correction cues and positive feedback. Group B received cues on errors of execution. Group C received positive feedback, correction cues and error cues. Group D was the control group. A pre, post and a retention test was conducted. A three way analysis of variance ANOVA (4 groups X 2 task difficulty X 3 measures with repeated measures on the last factor revealed significant interactions for each depended variable. All the corrective feedback methods groups, increased their outcome scores over time for the easy skill, but only groups A and C for the difficult skill. Groups A and B had significantly better outcome scores than group C and the control group for the easy skill on the retention test. However, for the difficult skill, group C was better than groups A, B and D. The self confidence scores of groups A and C improved over time for the easy skill but not for group B and D. Again, for the difficult skill, only group C improved over time. Finally a regression analysis depicted that the improvement in performance predicted a proportion of the improvement in self confidence for both the easy and the difficult skill. It was concluded that when young athletes are taught skills of different difficulty, different type of instruction, might be more appropriate in order to improve outcome and self confidence. A more integrated approach on teaching will assist coaches or physical education teachers to be more efficient and effective

Effect of pharmacogenetics on plasma lumefantrine pharmacokinetics and malaria treatment outcome in pregnant women.

Science.gov (United States)

Mutagonda, Ritah F; Kamuhabwa, Appolinary A R; Minzi, Omary M S; Massawe, Siriel N; Asghar, Muhammad; Homann, Manijeh V; Färnert, Anna; Aklillu, Eleni

2017-07-03

Pregnancy has considerable effects on the pharmacokinetic properties of drugs used to treat uncomplicated Plasmodium falciparum malaria. The role of pharmacogenetic variation on anti-malarial drug disposition and efficacy during pregnancy is not well investigated. The study aimed to examine the effect of pharmacogenetics on lumefantrine (LF) pharmacokinetics and treatment outcome in pregnant women. Pregnant women with uncomplicated falciparum malaria were enrolled and treated with artemether-lumefantrine (ALu) at Mkuranga and Kisarawe district hospitals in Coast Region of Tanzania. Day-7 LF plasma concentration and genotyping forCYP2B6 (c.516G>T, c.983T>C), CYP3A4*1B, CYP3A5 (*3, *6, *7) and ABCB1 c.4036A4G were determined. Blood smear for parasite quantification by microscopy, and dried blood spot for parasite screening and genotyping using qPCR and nested PCR were collected at enrolment up to day 28 to differentiate between reinfection from recrudescence. Treatment response was recorded following the WHO protocol. In total, 92 pregnant women in their second and third trimester were included in the study and 424 samples were screened for presence of P. falciparum. Parasites were detected during the follow up period in 11 (12%) women between day 7 and 28 after treatment and PCR genotyping confirmed recrudescent infection in 7 (63.3%) women. The remaining four (36.4%) pregnant women had reinfection: one on day 14 and three on day 28. The overall PCR-corrected treatment failure rate was 9.0% (95% CI 4.4-17.4). Day 7 LF concentration was not significantly influenced by CYP2B6, CYP3A4*1B and ABCB1 c.4036A>G genotypes. Significant associations between CYP3A5 genotype and day 7 plasma LF concentrations was found, being higher in carriers of CYP3A5 defective variant alleles than CYP3A5*1/*1 genotype. No significant influence of CYP2B6, CYP3A5 and ABCB1 c.4036A>Genotypes on malaria treatment outcome were observed. However, CYP3A4*1B did affect malaria treatment outcome in

Effect of inborn versus outborn delivery on clinical outcomes in ventilated preterm neonates: secondary results from the NEOPAIN trial.

Science.gov (United States)

Palmer, Kristine G; Kronsberg, Shari S; Barton, Bruce A; Hobbs, Charlotte A; Hall, Richard W; Anand, K J S

2005-04-01

The objective of this study was to evaluate the effect of birth center (inborn versus outborn) on morbidity and mortality for preterm neonates (23 to 32 weeks) using data collected prospectively within a uniform protocol. Secondary analyses of data from the NEurologic Outcomes and Pre-emptive Analgesia In Neonates (NEOPAIN) trial (n=898) were performed to evaluate the effect of inborn versus outborn delivery on neonatal outcomes, including the occurrence of severe intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), chronic lung disease (CLD), and mortality. Outborn babies were more likely to have severe IVH (p=0.0005); this increased risk persisted after controlling for severity of illness. When adjustments for antenatal steroids were added, the effect of birth center was no longer significant. Neither the occurrences of PVL or CLD nor mortality were significantly different between the inborn and outborn infants. Outborn babies are more likely to have severe IVH than inborn babies, perhaps because their mothers are less likely to receive antenatal steroids. Improvements in antenatal steroid administration to high-risk women may substantially reduce neonatal morbidity.

Parent socialization effects in different cultures: significance of directive parenting.

Science.gov (United States)

Sorkhabi, Nadia

2012-06-01

In this article, the controversy of divergent findings in research on parental socialization effects in different cultures is addressed. Three explanations intended to address divergent findings of socialization effects in different cultures, as advanced by researchers who emphasize cultural differences, are discussed. These include cultural differences in socialization values and goals of parents, parental emotional and cognitive characteristics associated with parenting styles, and adolescents' interpretations or evaluations of their parents' parenting styles. The empirical evidence for and against each of these arguments is examined and an alternative paradigm for understanding and empirical study of developmental outcomes associated with parenting styles in different cultures is suggested. Baumrind's directive parenting style is presented as an alternative to the authoritarian parenting style in understanding the positive developmental effects associated with "strict" parenting in cultures said to have a collectivist orientation. Directions for research on the three explanations are mentioned.

Testing a hierarchy-of-effects model: pathways from awareness to outcomes in the VERB campaign 2002-2003.

Science.gov (United States)

Bauman, Adrian; Bowles, Heather R; Huhman, Marian; Heitzler, Carrie D; Owen, Neville; Smith, Ben J; Reger-Nash, Bill

2008-06-01

The McGuire hierarchy-of-effects (HOE) model, used extensively in mass-media interventions to describe the mechanisms for understanding effects, has not been tested in physical activity campaigns. Data collected at baseline (2002) and follow-up (2003) surveys in the VERB evaluation were used in structural equation modeling to test pathways and hierarchies of campaign effects. Population-based cohort of youth aged 9-13 years (N=2364) for whom complete baseline and follow-up data were available. Awareness of the VERB campaign, understanding of the VERB message, attitude toward being active, outcome expectations, and physical activity participation. Among youth aged 9-13 years (tweens) in the study cohort, significant paths were identified between awareness and understanding (0.72, pmodel and suggest that increased awareness and understanding were the key proximal effects that led to behavior change. A distinct sequence of effects, which bypassed attitudes and outcome expectations, was found for these U.S. young people. The findings could inform the design of future campaigns to address youth physical activity.

Effects of outcome on the covariance between risk level and brain activity in adolescents with internet gaming disorder.

Science.gov (United States)

Qi, Xin; Yang, Yongxin; Dai, Shouping; Gao, Peihong; Du, Xin; Zhang, Yang; Du, Guijin; Li, Xiaodong; Zhang, Quan

2016-01-01

Individuals with internet gaming disorder (IGD) often have impaired risky decision-making abilities, and IGD-related functional changes have been observed during neuroimaging studies of decision-making tasks. However, it is still unclear how feedback (outcomes of decision-making) affects the subsequent risky decision-making in individuals with IGD. In this study, twenty-four adolescents with IGD and 24 healthy controls (HCs) were recruited and underwent functional magnetic resonance imaging while performing the balloon analog risk task (BART) to evaluate the effects of prior outcomes on brain activity during subsequent risky decision-making in adolescents with IGD. The covariance between risk level and activation of the bilateral ventral medial prefrontal cortex, left inferior frontal cortex, right ventral striatum (VS), left hippocampus/parahippocampus, right inferior occipital gyrus/fusiform gyrus and right inferior temporal gyrus demonstrated interaction effects of group by outcome ( P  brain activation was significantly greater in adolescents with IGD compared with HCs after a negative outcome occurred ( P  brain regions related to value estimation (prefrontal cortex), anticipation of rewards (VS), and emotional-related learning (hippocampus/parahippocampus), which may be one of the underlying neural mechanisms of disadvantageous risky decision-making in adolescents with IGD.

The effects of psychotherapy treatment on outcome in bulimia nervosa: Examining indirect effects through emotion regulation, self-directed behavior, and self-discrepancy within the mediation model.

Science.gov (United States)

Peterson, Carol B; Berg, Kelly C; Crosby, Ross D; Lavender, Jason M; Accurso, Erin C; Ciao, Anna C; Smith, Tracey L; Klein, Marjorie; Mitchell, James E; Crow, Scott J; Wonderlich, Stephen A

2017-06-01

The purpose of this investigation was to examine the indirect effects of Integrative Cognitive-Affective Therapy (ICAT-BN) and Cognitive-Behavioral Therapy-Enhanced (CBT-E) on bulimia nervosa (BN) treatment outcome through three hypothesized maintenance variables: emotion regulation, self-directed behavior, and self-discrepancy. Eighty adults with BN were randomized to 21 sessions of ICAT-BN or CBT-E. A regression-based bootstrapping approach was used to test the indirect effects of treatment on outcome at end of treatment through emotion regulation and self-directed behavior measured at mid-treatment, as well as the indirect effects of treatment at follow-up through emotion regulation, self-directed behavior, and self-discrepancy measured at end of treatment. No significant differences in outcome between treatment conditions were observed, and no significant direct or indirect effects were found. Examination of the individual paths within the indirect effects models revealed comparable treatment effects. Across treatments, improvements in emotion regulation and self-directed behavior between baseline and mid-treatment predicted improvements in global eating disorder scores but not binge eating and purging frequency at end of treatment. Baseline to end of treatment improvements in emotion regulation and self-directed behavior also predicted improvements in global eating disorder scores at follow-up. Baseline to end of treatment improvements in emotion regulation predicted improvements in binge eating and baseline to end of treatment increases in positive self-directed behavior predicted improvements in purging at follow-up. These findings suggest that emotion regulation and self-directed behavior are important treatment targets and that ICAT-BN and CBT-E are comparable in modifying these psychological processes among individuals with BN. © 2017 Wiley Periodicals, Inc.

Hypnosis Intervention Effects on Sleep Outcomes: A Systematic Review.

Science.gov (United States)

Chamine, Irina; Atchley, Rachel; Oken, Barry S

2018-02-15

Sleep improvement is a promising target for preventing and modifying many health problems. Hypnosis is considered a cost-effective and safe intervention with reported benefits for multiple health conditions. There is a growing body of research assessing the efficacy of hypnosis for various health conditions in which sleep was targeted as a primary or secondary outcome. This review aimed to investigate the effects of hypnosis interventions on sleep, to describe the hypnotic procedures, and to evaluate potential adverse effects of hypnosis. We reviewed studies (prior to January 2017) using hypnosis in adults for sleep problems and other conditions comorbid with sleep problems, with at least one sleep outcome measure. Randomized controlled trials and other prospective studies were included. One hundred thirty-nine nonduplicate abstracts were screened, and 24 of the reviewed papers were included for qualitative analysis. Overall, 58.3% of the included studies reported hypnosis benefit on sleep outcomes, with 12.5% reporting mixed results, and 29.2% reporting no hypnosis benefit; when only studies with lower risk of bias were reviewed the patterns were similar. Hypnosis intervention procedures were summarized and incidence of adverse experiences assessed. Hypnosis for sleep problems is a promising treatment that merits further investigation. Available evidence suggests low incidence of adverse events. The current evidence is limited because of few studies assessing populations with sleep complaints, small samples, and low methodological quality of the included studies. Our review points out some beneficial hypnosis effects on sleep but more high-quality studies on this topic are warranted. © 2018 American Academy of Sleep Medicine

The effects of teenage fatherhood on young adult outcomes.

Science.gov (United States)

Fletcher, Jason M; Wolfe, Barbara L

2012-01-01

This paper uses national longitudinal data and several new empirical strategies to examine the consequences of teenage fatherhood. The key contribution is to compare economic outcomes of young fathers to young men whose partners experienced a miscarriage rather than a live birth. The results suggest that teenage fatherhood decreases years of schooling and the likelihood of receiving a high school diploma and increases general educational development receipt. Teenage fatherhood also appears to increase early marriage and cohabitation, and has mixed short-term effects on several labor market outcomes.

Overall outcomes following early interventions for intracranial arteriovenous malformations with hematomas.

Science.gov (United States)

Bir, Shyamal C; Maiti, Tanmoy Kumar; Konar, Subhas; Nanda, Anil

2016-01-01

We evaluated the timing and predictors of surgical intervention for intracranial arteriovenous malformations (AVM) with hematoma. A ruptured intracranial AVM with hematoma is an emergency condition, and the optimal timing for surgical intervention is not well understood. In addition, the outcome predictors of surgical intervention have rarely been reported. We identified and analyzed 78 patients treated with microsurgical resection for pathologically proven AVM at Louisiana State University Health in Shreveport from February 1992 to December 2004. All 78 patients were diagnosed with ruptured AVM before surgery. The independent variables, including patient demographics, timing of surgery, location of the AVM and comorbidities were analyzed to assess outcome. The results of this series revealed that surgical intervention after 48hours resulted in poor outcomes for patients with hematoma, following a ruptured AVM. Several other prognostic factors, including younger age (11-40years), Spetzler-Martin Grade I and II, and AVM in a supratentorial location, had significant positive effects on outcomes. However, hypertension, smoking, and a prior embolization showed significant negative effects on outcomes after surgery. The multiple logistic regression analyses also revealed that the timing of surgical intervention had a significant effect on outcomes in patients with hematoma following ruptured AVM. Early intervention is the key to success in these patients. Published by Elsevier Ltd.

Long-term effects of a 12-week exercise training program on clinical outcomes in idiopathic pulmonary fibrosis.

Science.gov (United States)

Vainshelboim, Baruch; Oliveira, Jose; Fox, Benjamin Daniel; Soreck, Yafit; Fruchter, Oren; Kramer, Mordechai Reuven

2015-06-01

Idiopathic pulmonary fibrosis (IPF) is a chronic, devastating, lung disease, with few therapeutic options. Data are limited with respect to the long-term effect of exercise training (ET) in IPF. This study sought to evaluate the long-term effects of a 12-week ET program on clinical outcomes in IPF patients. Thirty-four IPF patients were randomly allocated to ET or control groups. ET group participated in a 12-week supervised exercise program, while the control group continued with regular medical treatment alone. Exercise capacity, 30 s-chair-stand test for leg strength, dyspnea, and Saint George's Respiratory Questionnaire (SGRQ) for quality of life (QOL) were assessed at baseline and re-evaluated at 11 months from baseline. In addition, at 30-month time point from baseline, the impact of the 12-week intervention was analyzed with respect to survival and cardio-respiratory-related hospitalizations. Thirty-two patients completed the 12-week intervention and 28 patients (14 in each group) were re-evaluated. At 11-month follow-up, no significant differences between the groups and time effect were demonstrated for most outcomes. ET group showed preserved values at the baseline level while the control group showed a trend of deterioration. Only the 30 s-chair-stand test (mean difference 3 stands, p = 0.01) and SGRQ (mean difference -6 units, p = 0.037) were significantly different between the groups. At 30 months, the survival analysis showed three deaths, eight hospitalizations occurred in the control group versus one death, one lung transplantation and seven hospitalizations in the ET group, with no significant differences between groups. At 11-month follow-up, the 12-week ET program showed clinical outcomes were preserved at baseline levels with some maintenance of improvements in leg strength and QOL in the ET group. The control group showed a trend of deterioration in the outcomes. At 30 months, the 12-week ET program did not show benefits in prognosis although

Homeostatic study of the effects of sportswear color on the contest outcome

Science.gov (United States)

Yuan, Jian-Qin; Liu, Timon Cheng-Yi; Wu, Ren-Le; Ruan, Chang-Xiong; He, Li-Mei; Liu, Song-Hao

2008-12-01

There are effects of sportswear color on the contest outcome. It has been explained from the psychological and perceptual viewpoints, respectively. It was studied by integrating the homeostatic theory of exercise training and autonomic nervous model of color vision in this paper. It was found that the effects of sportswear color on the contest outcome depend on autonomic nervous homeostasis (ANH). Color can be classified into hot color such as red, orange and yellow and cold color such as green, blue and violet. If the athletes have been in ANH, there are no effects of sportswear color on the contest outcome. If the autonomic nervous system is far from ANH due to exercise induced fatigue, wearing cold color had no predominance for cold-hot matches, and wearing white had no predominance for white-color matches.

Learned predictiveness and outcome predictability effects are not simply two sides of the same coin.

Science.gov (United States)

Thorwart, Anna; Livesey, Evan J; Wilhelm, Francisco; Liu, Wei; Lachnit, Harald

2017-10-01

The Learned Predictiveness effect refers to the observation that learning about the relationship between a cue and an outcome is influenced by the predictive relevance of the cue for other outcomes. Similarly, the Outcome Predictability effect refers to a recent observation that the previous predictability of an outcome affects learning about this outcome in new situations, too. We hypothesize that both effects may be two manifestations of the same phenomenon and stimuli that have been involved in highly predictive relationships may be learned about faster when they are involved in new relationships regardless of their functional role in predictive learning as cues and outcomes. Four experiments manipulated both the relationships and the function of the stimuli. While we were able to replicate the standard effects, they did not survive a transfer to situations where the functional role of the stimuli changed, that is the outcome of the first phase becomes a cue in the second learning phase or the cue of the first phase becomes the outcome of the second phase. Furthermore, unlike learned predictiveness, there was little indication that the distribution of overt attention in the second phase was influenced by previous predictability. The results suggest that these 2 very similar effects are not manifestations of a more general phenomenon but rather independent from each other. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Preoperative and perioperative factors effect on adolescent idiopathic scoliosis surgical outcomes.

Science.gov (United States)

Sanders, James O; Carreon, Leah Y; Sucato, Daniel J; Sturm, Peter F; Diab, Mohammad

2010-09-15

Prospective multicenter database. To identify factors associated with outcomes from adolescent idiopathic scoliosis (AIS) surgery outcomes and especially poor results. Because AIS is rarely symptomatic during adolescence, excellent surgical results are expected. However, some patients have poor outcomes. This study seeks to identify factors correlating with results and especially those making poor outcomes more likely. Demographic, surgical, and radiographic parameters were compared to 2-year postoperative Scoliosis Research Society (SRS) scores in 477 AIS surgical patients using stepwise linear regression to identify factors predictive of 2-year domain and total scores. Poor postoperative score patients (>2 SD below mean) were compared using t tests to those with better results. The SRS instrument exhibited a strong ceiling effect. Two-year scores showed more improvement with greater curve correction (self-image, pain, and total), and were worse with larger body mass index (pain, mental, total), larger preoperative trunk shift (mental and total), larger preoperative Cobb (self-image), and preoperative symptoms (function). Poor results were more common in those with Lenke 3 curve pattern (pain), less preoperative coronal imbalance, trunk shift and rib prominence (function), preoperative bracing (self-image), and anterior procedures (mental). Poor results also had slightly less average curve correction (50% vs. 60%) and larger curve residuals (31° vs. 23°). Complications, postoperative curve magnitude, and instrumentation type did not significantly contribute to postoperative scores, and no identifiable factors contributed to satisfaction. Curve correction improves patient's self-image whereas pain and poor function before surgery carry over after surgery. Patients with less spinal appearance issues (higher body mass index, Lenke 3 curves) are less happy with their results. Except in surgical patient selection, many of these factors are beyond physician control.

Effect of transformational leadership on job satisfaction and patient safety outcomes.

Science.gov (United States)

Boamah, Sheila A; Spence Laschinger, Heather K; Wong, Carol; Clarke, Sean

Improving patient safety within health care organizations requires effective leadership at all levels. The objective of this study was to investigate the effects of nurse managers' transformational leadership behaviors on job satisfaction and patient safety outcomes. A random sample of acute care nurses in Ontario (N = 378) completed the crosssectional survey. Hypothesized model was tested using structural equation modeling. The model fit the data acceptably. Transformational leadership had a strong positive influence on workplace empowerment, which in turn increased nurses' job satisfaction and decreased the frequency of adverse patient outcomes. Subsequently, job satisfaction was related to lower adverse events. The findings provide support for managers' use of transformational leadership behaviors as a useful strategy in creating workplace conditions that promote better safety outcomes for patients and nurses. Copyright © 2017 Elsevier Inc. All rights reserved.

Cultural effects on the association between election outcomes and face-based trait inferences

Science.gov (United States)

Adolphs, Ralph; Alvarez, R. Michael

2017-01-01

How competent a politician looks, as assessed in the laboratory, is correlated with whether the politician wins in real elections. This finding has led many to investigate whether the association between candidate appearances and election outcomes transcends cultures. However, these studies have largely focused on European countries and Caucasian candidates. To the best of our knowledge, there are only four cross-cultural studies that have directly investigated how face-based trait inferences correlate with election outcomes across Caucasian and Asian cultures. These prior studies have provided some initial evidence regarding cultural differences, but methodological problems and inconsistent findings have complicated our understanding of how culture mediates the effects of candidate appearances on election outcomes. Additionally, these four past studies have focused on positive traits, with a relative neglect of negative traits, resulting in an incomplete picture of how culture may impact a broader range of trait inferences. To study Caucasian-Asian cultural effects with a more balanced experimental design, and to explore a more complete profile of traits, here we compared how Caucasian and Korean participants’ inferences of positive and negative traits correlated with U.S. and Korean election outcomes. Contrary to previous reports, we found that inferences of competence (made by participants from both cultures) correlated with both U.S. and Korean election outcomes. Inferences of open-mindedness and threat, two traits neglected in previous cross-cultural studies, were correlated with Korean but not U.S. election outcomes. This differential effect was found in trait judgments made by both Caucasian and Korean participants. Interestingly, the faster the participants made face-based trait inferences, the more strongly those inferences were correlated with real election outcomes. These findings provide new insights into cultural effects and the difficult question of

Cultural effects on the association between election outcomes and face-based trait inferences.

Science.gov (United States)

Lin, Chujun; Adolphs, Ralph; Alvarez, R Michael

2017-01-01

How competent a politician looks, as assessed in the laboratory, is correlated with whether the politician wins in real elections. This finding has led many to investigate whether the association between candidate appearances and election outcomes transcends cultures. However, these studies have largely focused on European countries and Caucasian candidates. To the best of our knowledge, there are only four cross-cultural studies that have directly investigated how face-based trait inferences correlate with election outcomes across Caucasian and Asian cultures. These prior studies have provided some initial evidence regarding cultural differences, but methodological problems and inconsistent findings have complicated our understanding of how culture mediates the effects of candidate appearances on election outcomes. Additionally, these four past studies have focused on positive traits, with a relative neglect of negative traits, resulting in an incomplete picture of how culture may impact a broader range of trait inferences. To study Caucasian-Asian cultural effects with a more balanced experimental design, and to explore a more complete profile of traits, here we compared how Caucasian and Korean participants' inferences of positive and negative traits correlated with U.S. and Korean election outcomes. Contrary to previous reports, we found that inferences of competence (made by participants from both cultures) correlated with both U.S. and Korean election outcomes. Inferences of open-mindedness and threat, two traits neglected in previous cross-cultural studies, were correlated with Korean but not U.S. election outcomes. This differential effect was found in trait judgments made by both Caucasian and Korean participants. Interestingly, the faster the participants made face-based trait inferences, the more strongly those inferences were correlated with real election outcomes. These findings provide new insights into cultural effects and the difficult question of

Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review.

Science.gov (United States)

Kruse, Clemens Scott; Beane, Amanda

2018-02-05

Health information technology (HIT) has been introduced into the health care industry since the 1960s when mainframes assisted with financial transactions, but questions remained about HIT's contribution to medical outcomes. Several systematic reviews since the 1990s have focused on this relationship. This review updates the literature. The purpose of this review was to analyze the current literature for the impact of HIT on medical outcomes. We hypothesized that there is a positive association between the adoption of HIT and medical outcomes. We queried the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE) by PubMed databases for peer-reviewed publications in the last 5 years that defined an HIT intervention and an effect on medical outcomes in terms of efficiency or effectiveness. We structured the review from the Primary Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and we conducted the review in accordance with the Assessment for Multiple Systematic Reviews (AMSTAR). We narrowed our search from 3636 papers to 37 for final analysis. At least one improved medical outcome as a result of HIT adoption was identified in 81% (25/37) of research studies that met inclusion criteria, thus strongly supporting our hypothesis. No statistical difference in outcomes was identified as a result of HIT in 19% of included studies. Twelve categories of HIT and three categories of outcomes occurred 38 and 65 times, respectively. A strong majority of the literature shows positive effects of HIT on the effectiveness of medical outcomes, which positively supports efforts that prepare for stage 3 of meaningful use. This aligns with previous reviews in other time frames. ©Clemens Scott Kruse, Amanda Beane. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.02.2018.

Pregnancy after bariatric surgery: the effect of time-to-conception on pregnancy outcomes.

Science.gov (United States)

Yau, Patricia O; Parikh, Manish; Saunders, John K; Chui, Patricia; Zablocki, Tara; Welcome, Akuezunkpa Ude

2017-11-01

At our medical center, female patients who have undergone bariatric surgery are advised to defer pregnancy for 2 years after surgery to avoid the following complications and their potential consequences for the fetus: inadequate gestational weight gain, inadequate postsurgical weight loss, hyperemesis gravidarum, nutritional deficiencies, gestational diabetes, and gestational hypertension. To examine the effect of time from surgery to conception on pregnancy course and outcomes in bariatric patients. University. We identified 73 pregnancies in 54 women who became pregnant after undergoing bariatric surgery. Surgery to conception interval was compared between pregnancies that were carried to delivery and 8 pregnancies that resulted in spontaneous abortion. Of 41 pregnancies that were carried to delivery, 26 occurred in women who had undergone surgery less than 2 years before conception, and 15 occurred in women who had undergone surgery greater than 2 years before conception. Gestational age at delivery, number of neonatal intensive care unit admissions, gestational weight gain, hyperemesis gravidarum, nutritional deficiencies, gestational diabetes, and gestational hypertension during pregnancy were compared for the 2 groups. Eight patients who had spontaneous abortion had a significantly shorter time from surgery to conception. There were no significant differences between our 2 groups in rates of preterm deliveries, neonatal intensive care unit admission, gestational weight gain, hyperemesis, nutritional deficiencies, gestational diabetes, or gestational hypertension. Becoming pregnant within the first 2 years after bariatric surgery appears to have no effect on pregnancy course and outcomes. Women who miscarried had a significantly lower mean surgery to conception interval. These results fail to show an increased rate of pregnancy complications during the first 2 years after bariatric surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by

Effect of early vs. late tracheostomy on clinical outcomes in critically ill pediatric patients.

Science.gov (United States)

Lee, J-H; Koo, C-H; Lee, S-Y; Kim, E-H; Song, I-K; Kim, H-S; Kim, C-S; Kim, J-T

2016-10-01

Few studies investigated the optimal timing for tracheostomy and its influence on the clinical outcomes in critically ill pediatric patients. This study evaluated the differences in clinical outcomes between early and late tracheostomy in pediatric intensive care unit (ICU) patients. We assessed 111 pediatric patients. Patients who underwent a tracheostomy within 14 days of mechanical ventilation (MV) were assigned to the early tracheostomy group, whereas those who underwent tracheostomy after 14 days of MV were included in the late tracheostomy group. Clinical outcomes, including mortality, duration of MV, length of ICU and hospital stays, and incidence of ventilator-associated pneumonia (VAP) were compared between the groups. Of the 111 pediatric patients, 61 and 50 were included in the early and late tracheostomy groups, respectively. Total MV duration and the length of ICU and hospital stay were significantly longer in the late tracheostomy group than in the early tracheostomy group (all P tracheostomy was 2.6 and 3.8 in the early and late tracheostomy groups, respectively. There were no significant differences in mortality rate between the groups. No severe complications were associated with tracheostomy itself. Tracheostomy performed within 14 days after the initiation of MV was associated with reduced duration of MV and length of ICU and hospital stay. Although there was no effect on mortality rate, children may benefit from early tracheostomy without severe complications. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

The prognostic significance of HOTAIR for predicting clinical outcome in patients with digestive system tumors.

Science.gov (United States)

Ma, Gaoxiang; Wang, Qiaoyan; Lv, Chunye; Qiang, Fulin; Hua, Qiuhan; Chu, Haiyan; Du, Mulong; Tong, Na; Jiang, Yejuan; Wang, Meilin; Zhang, Zhengdong; Wang, Jian; Gong, Weida

2015-12-01

Although some studies have assessed the prognostic value of HOTAIR in patients with digestive system tumors, the relationship between the HOTAIR and outcome of digestive system tumors remains unknown. The PubMed was searched to identify the eligible studies. Here, we performed a meta-analysis with 11 studies, including a total of 903 cases. Pooled hazard ratios (HRs) and 95 % confidence interval (CI) of HOTAIR for cancer survival were calculated. We found that the pooled HR elevated HOTAIR expression in tumor tissues was 2.36 (95 % CI 1.88-2.97) compared with patients with low HOTAIR expression. Moreover, subgroup analysis revealed that HOTAIR overexpression was also markedly associated with short survival for esophageal squamous cell carcinoma (HR 2.19, 95 % CI 1.62-2.94) and gastric cancer (HR 1.66, 95 % CI 1.02-2.68). In addition, up-regulated HOTAIR was significantly related to survival of digestive system cancer among the studies with more follow-up time (follow time ≥ 5 years) (HR 2.51, 95 % CI 1.99-3.17). When stratified by HR resource and number of patients, the result indicated consistent results with the overall analysis. Subgroup analysis on ethnicities did not change the prognostic influence of elevated HOTAIR expression. Additionally, we conducted an independent validation cohort including 71 gastric cancer cases, in which patients with up-regulated HOTAIR expression had an unfavorable outcome with HR of 2.10 (95 % CI 1.10-4.03). The results suggest that aberrant HOTAIR expression may serve as a candidate positive marker to predict the prognosis of patients with carcinoma of digestive system.

Breastfeeding and maternal alcohol use: Prevalence and effects on child outcomes and fetal alcohol spectrum disorders.

Science.gov (United States)

May, Philip A; Hasken, Julie M; Blankenship, Jason; Marais, Anna-Susan; Joubert, Belinda; Cloete, Marise; de Vries, Marlene M; Barnard, Ronel; Botha, Isobel; Roux, Sumien; Doms, Cate; Gossage, J Phillip; Kalberg, Wendy O; Buckley, David; Robinson, Luther K; Adnams, Colleen M; Manning, Melanie A; Parry, Charles D H; Hoyme, H Eugene; Tabachnick, Barbara; Seedat, Soraya

2016-08-01

Determine any effects that maternal alcohol consumption during the breastfeeding period has on child outcomes. Population-based samples of children with fetal alcohol spectrum disorders (FASD), normally-developing children, and their mothers were analyzed for differences in child outcomes. Ninety percent (90%) of mothers breastfed for an average of 19.9 months. Of mothers who drank postpartum and breastfed (MDPB), 47% breastfed for 12 months or more. In case control analyses, children of MDPB were significantly lighter, had lower verbal IQ scores, and more anomalies in comparisons controlling for prenatal alcohol exposure and final FASD diagnosis. Utilizing a stepwise logistic regression model adjusting for nine confounders of prenatal drinking and other maternal risks, MDPB were 6.4 times more likely to have a child with FASD than breastfeeding mothers who abstained from alcohol while breastfeeding. Alcohol use during the period of breastfeeding was found to significantly compromise a child's development. Copyright © 2016 Elsevier Inc. All rights reserved.

The prognostic significance of UCA1 for predicting clinical outcome in patients with digestive system malignancies.

Science.gov (United States)

Liu, Fang-Teng; Dong, Qing; Gao, Hui; Zhu, Zheng-Ming

2017-06-20

Urothelial Carcinoma Associated 1 (UCA1) was an originally identified lncRNA in bladder cancer. Previous studies have reported that UCA1 played a significant role in various types of cancer. This study aimed to clarify the prognostic value of UCA1 in digestive system cancers. The meta-analysis of 15 studies were included, comprising 1441 patients with digestive system cancers. The pooled results of 14 studies indicated that high expression of UCA1 was significantly associated with poorer OS in patients with digestive system cancers (HR: 1.89, 95 % CI: 1.52-2.26). In addition, UCA1 could be as an independent prognostic factor for predicting OS of patients (HR: 1.85, 95 % CI: 1.45-2.25). The pooled results of 3 studies indicated a significant association between UCA1 and DFS in patients with digestive system cancers (HR = 2.50; 95 % CI = 1.30-3.69). Statistical significance was also observed in subgroup meta-analysis. Furthermore, the clinicopathological values of UCA1 were discussed in esophageal cancer, colorectal cancer and pancreatic cancer. A comprehensive retrieval was performed to search studies evaluating the prognostic value of UCA1 in digestive system cancers. Many databases were involved, including PubMed, Web of Science, Embase and Chinese National Knowledge Infrastructure and Wanfang database. Quantitative meta-analysis was performed with standard statistical methods and the prognostic significance of UCA1 in digestive system cancers was qualified. Elevated level of UCA1 indicated the poor clinical outcome for patients with digestive system cancers. It may serve as a new biomarker related to prognosis in digestive system cancers.

The Effect of Principal's Leadership Style on School Environment and Outcome

Science.gov (United States)

Al-Safran, Eissa; Brown, David; Wiseman, Alexander

2014-01-01

The main objective of this study was to investigate the effect of principal's leadership style on school outcome. This study focused on the indirect relationship between the leadership style and the school environment. An additional objective was to investigate the impact of culture on leadership style as related to school environment and outcome.…

Life-span development of self-esteem and its effects on important life outcomes.

Science.gov (United States)

Orth, Ulrich; Robins, Richard W; Widaman, Keith F

2012-06-01

We examined the life-span development of self-esteem and tested whether self-esteem influences the development of important life outcomes, including relationship satisfaction, job satisfaction, occupational status, salary, positive and negative affect, depression, and physical health. Data came from the Longitudinal Study of Generations. Analyses were based on 5 assessments across a 12-year period of a sample of 1,824 individuals ages 16 to 97 years. First, growth curve analyses indicated that self-esteem increases from adolescence to middle adulthood, reaches a peak at about age 50 years, and then decreases in old age. Second, cross-lagged regression analyses indicated that self-esteem is best modeled as a cause rather than a consequence of life outcomes. Third, growth curve analyses, with self-esteem as a time-varying covariate, suggested that self-esteem has medium-sized effects on life-span trajectories of affect and depression, small to medium-sized effects on trajectories of relationship and job satisfaction, a very small effect on the trajectory of health, and no effect on the trajectory of occupational status. These findings replicated across 4 generations of participants--children, parents, grandparents, and their great-grandparents. Together, the results suggest that self-esteem has a significant prospective impact on real-world life experiences and that high and low self-esteem are not mere epiphenomena of success and failure in important life domains. 2012 APA, all rights reserved

The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles

Directory of Open Access Journals (Sweden)

Zhao Jing

2012-11-01

Full Text Available Abstract Background To study the effect of endometrial thickness and pattern measured using ultrasound upon pregnancy outcomes in patients undergoing IVF-ET. Method One thousand nine hundred thirty-three women undergoing IVF treatment participated in the study. We assessed and recorded endometrial patterns and thickness on the day of human chorionic gonadotropin (hCG administration. Receiver operator curves (ROC were used to determine the predictive accuracy of endometrial thickness. Cycles were divided into 3 groups depending on the thickness (group 1: ≤ 7 mm; group 2: > 7 mm to ≤ 14 mm; group 3: > 14 mm. Each group was subdivided into three groups according to the endometrial pattern as follows: pattern A (a triple-line pattern consisting of a central hyperechoic line surround by two hypoechoic layers; pattern B (an intermediate isoechogenic pattern with the same reflectivity as the surrounding myometrium and a poorly defined central echogenic line; and pattern C (homogenous, hyperechogenic endometrium. Clinical outcomes such as implantation and clinical pregnancy rates were analyzed. Results The endometrial thickness predicts pregnancy outcome with high sensitivity and specificity. The cutoff value was 9 mm. The implantation rate and clinical pregnancy rate in group 3 were 39.1% and 63.5%, respectively, which were significantly higher than those in group 2 (33.8% and 52.1%, respectively and group 1 (13% and 25.5%, respectively. Among those with Pattern A, the implantation rate and clinical pregnancy rate were 35.3% and 55.2%, respectively, which were significantly higher than among women with Pattern B (32.1% and 50.9%, respectively and Pattern C (23.4% and 37.4%, respectively. In groups 1 and 3, clinical pregnancy and implantation rates did not show any significant differences between different endometrial patterns (P > 0.05, whereas in group 2, the clinical pregnancy rate and implantation rate in women with pattern A were

Subpopulation Treatment Effect Pattern Plot (STEPP) analysis for continuous, binary, and count outcomes.

Science.gov (United States)

Yip, Wai-Ki; Bonetti, Marco; Cole, Bernard F; Barcella, William; Wang, Xin Victoria; Lazar, Ann; Gelber, Richard D

2016-08-01

For the past few decades, randomized clinical trials have provided evidence for effective treatments by comparing several competing therapies. Their successes have led to numerous new therapies to combat many diseases. However, since their conclusions are based on the entire cohort in the trial, the treatment recommendation is for everyone, and may not be the best option for an individual. Medical research is now focusing more on providing personalized care for patients, which requires investigating how patient characteristics, including novel biomarkers, modify the effect of current treatment modalities. This is known as heterogeneity of treatment effects. A better understanding of the interaction between treatment and patient-specific prognostic factors will enable practitioners to expand the availability of tailored therapies, with the ultimate goal of improving patient outcomes. The Subpopulation Treatment Effect Pattern Plot (STEPP) approach was developed to allow researchers to investigate the heterogeneity of treatment effects on survival outcomes across values of a (continuously measured) covariate, such as a biomarker measurement. Here, we extend the Subpopulation Treatment Effect Pattern Plot approach to continuous, binary, and count outcomes, which can be easily modeled using generalized linear models. With this extension of Subpopulation Treatment Effect Pattern Plot, these additional types of treatment effects within subpopulations defined with respect to a covariate of interest can be estimated, and the statistical significance of any observed heterogeneity of treatment effect can be assessed using permutation tests. The desirable feature that commonly used models are applied to well-defined patient subgroups to estimate treatment effects is retained in this extension. We describe a simulation study to confirm that the proper Type I error rate is maintained when there is no treatment heterogeneity, and a power study to show that the statistics have

Developing self-regulation for dietary temptations: intervention effects on physical, self-regulatory and psychological outcomes.

Science.gov (United States)

McKee, Heather C; Ntoumanis, Nikos

2014-12-01

We aimed to investigate whether a self-regulatory skills intervention can improve weight loss-related outcomes. Fifty-five participants (M BMI = 32.60 ± 4.86) were randomized into self-regulation training and advice groups and received two training workshops and weekly practice tasks. The self-regulation training group was trained to use six self-regulatory skills: Delayed gratification, thought control, goal setting, self-monitoring, mindfulness, and coping. The advice group received dietary and physical activity advice for weight loss. Physical, self-regulatory, and psychological measures were taken at baseline, end of intervention (week 8) and at follow-up (week 12). Using intention-to-treat analysis, weight, waist circumference, body fat and body mass index (BMI) were significantly reduced at follow-up for both groups. There were significant increases in all six self-regulatory skills and the psychological measures of self-efficacy, self-regulatory success, and physical self-worth for both groups. Results indicate that self-regulatory skills training might be as effective as dietary and physical activity advice in terms of weight loss and related outcomes.

Effect of pre-operative neuromuscular training on functional outcome after total knee replacement

DEFF Research Database (Denmark)

Huber, Erika O; de Bie, Rob A; Roos, Ewa M.

2013-01-01

Total Knee Replacement (TKR) is the standard treatment for patients with severe knee osteoarthritis (OA). Significant improvement in pain and function are seen after TKR and approximately 80% of patients are very satisfied with the outcome. Functional status prior to TKR is a major predictor...... of outcome after the intervention. Thus, improving functional status prior to surgery through exercise may improve after surgery outcome. However, results from several previous trials testing the concept have been inconclusive after surgery....

The Effect of Empowerment and Self-Determination on Health Outcomes.

Science.gov (United States)

Garces-Ozanne, Arlene; Kalu, Edna Ikechi; Audas, Richard

2016-12-01

There remains a persistent gap in health outcomes between wealthy and poor countries. Basic measures such as life expectancy and infant and under-five mortality remain divergent, with preventable deaths being unacceptably high, despite significant efforts to reduce these disparities. We examine the impact of empowerment, measured by Freedom House's ratings of country's political rights and civil liberties, while controlling for per capita gross domestic product, secondary school enrollment, and income inequality, on national health outcomes. Using data from 1970 to 2013 across 149 countries, our results suggest, quite strongly, that higher levels of empowerment have a significant positive association with life expectancy, particularly for females, and lower rates of infant and under-five mortality. Our results point to the need for efforts to stimulate economic growth be accompanied with reforms to increase the levels empowerment through increasing political rights and civil liberties. © 2016 Society for Public Health Education.

The effect of antenatal education in small classes on obstetric and psycho-social outcomes

DEFF Research Database (Denmark)

Brixval, Carina Sjöberg; Axelsen, Solveig Forberg; Lauemøller, Stine Glenstrup

2015-01-01

of small group antenatal education on obstetric and psycho-social outcomes. CONCLUSIONS: Insufficient evidence exists as to whether antenatal education in small classes is effective in regard to obstetric and psycho-social outcomes. We recommend updating this review following the emergence of well......, with participation of a small number of participants, may differ from the effect of other forms of antenatal education due to, for example, group dynamic. The objective of this systematic review is to assess the effects of antenatal education in small groups on obstetric as well as psycho-social outcomes. METHODS...

Assessing learning outcomes and cost effectiveness of an online sleep curriculum for medical students.

Science.gov (United States)

Bandla, Hari; Franco, Rose A; Simpson, Deborah; Brennan, Kimberly; McKanry, Jennifer; Bragg, Dawn

2012-08-15

Sleep disorders are highly prevalent across all age groups but often remain undiagnosed and untreated, resulting in significant health consequences. To overcome an inadequacy of available curricula and learner and instructor time constraints, this study sought to determine if an online sleep medicine curriculum would achieve equivalent learner outcomes when compared with traditional, classroom-based, face-to-face instruction at equivalent costs. Medical students rotating on a required clinical clerkship received instruction in 4 core clinical sleep-medicine competency domains in 1 of 2 delivery formats: a single 2.5-hour face-to-face workshop or 4 asynchronous e-learning modules. Immediate learning outcomes were assessed in a subsequent clerkship using a multiple-choice examination and standardized patient station, with long-term outcomes assessed through analysis of students' patient write-ups for inclusion of sleep complaints and diagnoses before and after the intervention. Instructional costs by delivery format were tracked. Descriptive and inferential statistical analyses compared learning outcomes and costs by instructional delivery method (face-to-face versus e-learning). Face-to-face learners, compared with online learners, were more satisfied with instruction. Learning outcomes (i.e., multiple-choice examination, standardized patient encounter, patient write-up), as measured by short-term and long-term assessments, were roughly equivalent. Design, delivery, and learner-assessment costs by format were equivalent at the end of 1 year, due to higher ongoing teaching costs associated with face-to-face learning offsetting online development and delivery costs. Because short-term and long-term learner performance outcomes were roughly equivalent, based on delivery method, the cost effectiveness of online learning is an economically and educationally viable instruction platform for clinical clerkships.

Effects of placental infarctions on the fatal outcome in pregnancies complicated by hypertension

International Nuclear Information System (INIS)

Salgado, S.S.; Pathmeswaran, A.

2008-01-01

To determine the frequency of placental infarcts and its effects on the fetal outcome in pregnancies complicated by hypertension. Placentae of 150 normotensive women and 200 hypertensive women were studied to detect the number of placentae with infarctions. Apgar score, birth weight and the head circumference of the newborns were measured and analyzed. The frequency of placental infarcts was significantly higher in hypertensive group (30%) compared to normotensive group (18.7%). An association between placental infarction and low Apgar score of the newborn was seen in the hypertensive group (p<0.001). The difference in the birth weight of the newborns in hypertensive and normotensive groups in relation to placental infarction was statistically significant (2.2 vs. 3.1 kg, p<0.001). A highly significant difference was observed in the head circumference of the newborns of hypertensive group compared to normotensive group in relation to placental infarctions (30.7 cm vs. 32.3 cm, p<0.001). The frequency of placental infarcts was higher in hypertensive women when compared to normotensives. Placental infarctions had an adverse effect on growth and development of the newborns. This information can be useful in planning and management of future pregnancies. (author)

Provider volume and outcomes for oncological procedures.

LENUS (Irish Health Repository)

Killeen, S D

2012-02-03

BACKGROUND: Oncological procedures may have better outcomes if performed by high-volume providers. METHODS: A review of the English language literature incorporating searches of the Medline, Embase and Cochrane collaboration databases was performed. Studies were included if they involved a patient cohort from 1984 onwards, were community or population based, and assessed health outcome as a dependent variable and volume as an independent variable. The studies were also scored quantifiably to assess generalizability with respect to any observed volume-outcome relationship and analysed according to organ system; numbers needed to treat were estimated where possible. RESULTS: Sixty-eight relevant studies were identified and a total of 41 were included, of which 13 were based on clinical data. All showed either an inverse relationship, of variable magnitude, between provider volume and mortality, or no volume-outcome effect. All but two clinical reports revealed a statistically significant positive relationship between volume and outcome; none demonstrated the opposite. CONCLUSION: High-volume providers have a significantly better outcome for complex cancer surgery, specifically for pancreatectomy, oesphagectomy, gastrectomy and rectal resection.

Effects of metformin on pregnancy outcomes in women with polycystic ovary syndrome: A meta-analysis.

Science.gov (United States)

Zeng, Xian-Ling; Zhang, Ya-Fei; Tian, Quan; Xue, Yan; An, Rui-Fang

2016-09-01

The aim of the study is to evaluate the effects of metformin on pregnancy outcomes in women with polycystic ovary syndrome (PCOS). We searched electronic databases and bibliographies of relevant papers to identify studies comparing the pregnancy outcomes in the metformin group with those in the placebo or blank control group. Then, we did this meta-analysis based on the PRISMA guidelines. The primary outcomes included early pregnancy loss (EPL), preterm delivery, term delivery, and gestational diabetes mellitus (GDM). Secondary outcomes included pregnancy-induced hypertension (PIH), intrauterine growth restriction (IUGR), fetal malformation, vaginal delivery (VD), cesarean section (CS), and metformin's side effects, such as nausea or gastrointestinal discomfort. Certainly, data about neonatal death and macrosomia were analyzed if data available. Finally, 13 studies including 5 randomized controlled trials (RCT) and 8 cohort studies involving 1606 pregnant women with PCOS were analyzed. The pooled OR of EPL was 0.19 with obvious statistical significance, manifesting that metformin help to lower the rate of EPL (95% CI 0.12-0.28, P metformin showed the advantage of reducing the prevalence of preterm delivery (OR 0.37, 95% CI 0.20-0.68, P = 0.002). In addition, metformin could promote term delivery greatly and the pooled OR was 5.23 with sharp statistical difference (95% CI 3.12-8.75, P Metformin treatment in women with PCOS throughout pregnancy could increase the possibility of term delivery, VD and reduce the risk of EPL, preterm labor, pregnancy complications such as GDM and PIH, with no serious side effects. Moreover, metformin was not teratogenic based on the limited data. So we may recommend metformin treatment for women with PCOS during the whole pregnancy period for it is quite beneficial and safe for both mothers and babies.

The Effects of World War II on Economic and Health Outcomes across Europe

Science.gov (United States)

Kesternich, Iris; Siflinger, Bettina; Smith, James P.; Winter, Joachim K.

2013-01-01

We investigate long-run effects of World War II on socio-economic status and health of older individuals in Europe. We analyze data from SHARELIFE, a retrospective survey conducted as part of SHARE in Europe in 2009. SHARELIFE provides detailed data on events in childhood during and after the war for over 20,000 individuals in 13 European countries. We construct several measures of war exposure—experience of dispossession, persecution, combat in local areas, and hunger periods. Exposure to war and more importantly to individual-level shocks caused by the war significantly predicts economic and health outcomes at older ages. PMID:24850973

Effect of local endometrial injury on pregnancy outcomes in ovum donation cycles.

Science.gov (United States)

Dain, Lena; Ojha, Kamal; Bider, David; Levron, Jacob; Zinchenko, Viktor; Walster, Sharon; Dirnfeld, Martha

2014-10-01

To evaluate the effect of local endometrial injury (LEI) on clinical outcomes in ovum donation recipients. Retrospective cohort analysis of ovum donation cycles conducted from 2005 to 2012. Two private IVF centers. Total 737 ovum donation cycles. LEI by endometrial "scratch" with the use of a Pipelle catheter. Clinical pregnancy and live birth rates. No statistically significant differences were found in clinical pregnancy rates and live birth rates in cycles subjected to LEI compared with those without. Combination of LEI with fibroid uterus resulted with significantly higher clinical pregnancy rates compared with LEI in normal uterine anatomy. This is the first study done in ovum recipients who underwent LEI by a "scratch" procedure after failed implantation. Unlike most previous reports, which found improved pregnancy rates with the use of "scratch effect" or "minor endometrial injury" after repeated implantation failures in standard IVF with own eggs, we did not find any changes in implantation rates in a population of egg recipients following this procedure. In view of a possible positive effect of LEI in cycles with a previous four or more failures, prospective randomized controlled studies are warranted to better define the target population who may benefit from this intervention. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Developmental cascade effects of the New Beginnings Program on adolescent adaptation outcomes.

Science.gov (United States)

McClain, Darya Bonds; Wolchik, Sharlene A; Winslow, Emily; Tein, Jenn-Yun; Sandler, Irwin N; Millsap, Roger E

2010-11-01

Using data from a 6-year longitudinal follow-up sample of 240 youth who participated in a randomized experimental trial of a preventive intervention for divorced families with children ages 9-12, the current study tested alternative cascading pathways by which the intervention decreased symptoms of internalizing disorders, symptoms of externalizing disorders, substance use, and risky sexual behavior and increased self-esteem and academic performance in mid- to late adolescence (15-19 years old). It was hypothesized that the impact of the program on adolescent adaptation outcomes would be explained by progressive associations between program-induced changes in parenting and youth adaptation outcomes. The results supported a cascading model of program effects in which the program was related to increased mother-child relationship quality that was related to subsequent decreases in child internalizing problems, which then was related to subsequent increases in self-esteem and decreases in symptoms of internalizing disorders in adolescence. The results were also consistent with a model in which the program increased maternal effective discipline that was related to decreased child externalizing problems, which was related to subsequent decreases in symptoms of externalizing disorders, less substance use, and better academic performance in adolescence. There were no significant differences in the model based on level of baseline risk or adolescent gender. These results provide support for a cascading pathways model of child and adolescent development.

Comparative Effectiveness of Usual Source of Care Approaches to Improve End-of-Life Outcomes for Children With Intellectual Disability.

Science.gov (United States)

Lindley, Lisa C; Cozad, Melanie J

2017-09-01

Children with intellectual disability (ID) are at risk for adverse end-of-life outcomes including high emergency room utilization and hospital readmissions, along with low hospice enrollment. The objective of this study was to compare the effectiveness of usual source of care approaches to improve end-of-life outcomes for children with ID. We used longitudinal California Medicaid claims data. Children were included who were 21 years with fee-for-service Medicaid claims, died between January 1, 2007, and December 31, 2010, and had a moderate-to-profound ID diagnosis. End-of-life outcomes (i.e., hospice enrollment, emergency room utilization, hospital readmissions) were measured via claims data. Our treatments were usual source of care (USC) only vs. usual source of care plus targeted case management (USC plus TCM). Using instrumental variable analysis, we compared the effectiveness of treatments on end-of-life outcomes. Ten percent of children with ID enrolled in hospice, 73% used the emergency room, and 20% had three or more hospital admissions in their last year of life. USC plus TCM relative to USC only had no effect on hospice enrollment; however, it significantly reduced the probability of emergency room utilization (B = -1.29, P life outcomes for children with ID. Further study of the extent of UCS and TCM involvement in reducing emergency room utilization and hospital readmissions at end of life is needed. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Clinical and patient reported outcomes of bleaching effectiveness.

Science.gov (United States)

Klaric Sever, Eva; Budimir, Zrinka; Cerovac, Matea; Stambuk, Mario; Par, Matej; Negovetic Vranic, Dubravka; Tarle, Zrinka

2018-01-01

The objective of this study is to evaluate clinical and patient reported outcomes of different bleaching products. Thirty participants were randomly divided into three bleaching groups (n = 10). Bleaching was performed with high concentrations of hydrogen peroxide (HP) - Boost (40%) and Dash (30%), and with prefabricated splints Bite&White (6% HP). Tooth colour was measured before, immediately after, and 1 and 6 months after the bleaching by using classical shade guide and spectrophotometer. Tooth hypersensitivity was self-rated by patients on the Wong-Baker's face scale. Patient satisfaction was evaluated on a 7-point Likert-type scales that measured perceived performance and importance of different characteristics of bleaching treatment. All products were effective in teeth colour change (ΔE > 3.3), which was significantly higher for Boost (p = .016) and Dash (p = .024) than Bite&White treatment. Perception of hypersensitivity was the highest in Boost group, followed by Dash and Bite&White treatment. Most of the patients were satisfied with final tooth colour, length and comfort during treatment, but were dissatisfied with the stability of bleached tooth colour. Materials with the higher concentrations of bleaching agent demonstrated greater bleaching effectiveness than at-home bleaching product, but also a greater hypersensitivity. Lengthening the treatment process, but achieving a more stable tooth colour may improve the perceived value of a bleaching service.

Effects of Nutritional Interventions during Pregnancy on Infant and Child Cognitive Outcomes: A Systematic Review and Meta-Analysis

Directory of Open Access Journals (Sweden)

Rachael M. Taylor

2017-11-01

Full Text Available Background: Epidemiological studies have demonstrated that folate, iodine and iron intake during pregnancy impacts on foetal brain development and cognitive function. However, in human studies, the relationship with other dietary nutrients is less clear. Objective: This systematic review aims to critically appraise the current literature and meta-analyses results from nutritional interventions during pregnancy that aimed to optimise infant and child cognitive outcomes. Design: Ten electronic databases were searched for articles published up to August 2017. The search was limited to articles published in English. Randomised controlled trials (RCTs testing the impact of any nutritional intervention (dietary counselling, education, nutrient supplementation, fortified foods and/or foods during pregnancy on cognitive outcomes of children (<10 years old. Two independent reviewers assessed study eligibility and quality using the American Dietetic Association quality criteria checklist for primary research. Standardised mean differences were used for nine cognitive domains to measure effects for meta-analyses. Results: A total of 34 RCTs were included (21 studies included children aged less than 35 months, 10 studies included children aged 36–60 months and 3 studies included children aged 61–119 months. The types of nutritional interventions included nutrient supplements, whole foods, fortified foods and nutrition education. The following nine cognition outcomes: attention, behaviour, crystallised intelligence, fluid intelligence, global cognition, memory, motor skills, visual processing, and problem solving were not significantly impacted by nutritional interventions, although 65% of studies conducted post-hoc data analyses and were likely to be underpowered. Although, long chain polyunsaturated fatty acids (LCPUFA supplementation was associated with a marginal increase in crystallised intelligence (Effect size (ES: 0.25; 95% confidence interval

The effects of vitamin D supplementation on maternal and neonatal outcome: A randomized clinical trial

Directory of Open Access Journals (Sweden)

Mahdieh Mojibian

2015-11-01

Full Text Available Background: Vitamin D supplementation during pregnancy has been supposed to defend against adverse gestational outcomes. Objective: This randomized clinical trial study was conducted to assess the effects of 50,000 IU of vitamin D every two weeks supplementation on the incidence of gestational diabetes (GDM, gestational hypertension, preeclampsia and preterm labor, vitamin D status at term and neonatal outcomes contrasted with pregnant women that received 400 IU vitamin D daily. Materials and Methods: 500 women with gestational age 12-16 weeks and serum 25 hydroxy vitamin D (25 (OH D less than 30 ng/ml randomly categorized in two groups. Group A received 400 IU vitamin D daily and group B 50,000 IU vitamin D every 2 weeks orally until delivery. Maternal and Neonatal outcomes were assessed in two groups. Results: The incidence of GDM in group B was significantly lower than group A (6.7% versus 13.4% and odds ratio (95% Confidence interval was 0.46 (0.24-0.87 (P=0.01. The mean ± SD level of 25 (OH D at the time of delivery in mothers in group B was significantly higher than A (37.9 ± 19.8 versus 27.2 ± 18.8 ng/ml, respectively (P=0.001. There were no differences in the incidence of preeclampsia, gestational hypertension, preterm labor, and low birth weight between two groups. The mean level of 25 (OH D in cord blood of group B was significantly higher than group A (37.9 ± 18 versus 29.7 ± 19ng/ml, respectively. Anthropometric measures between neonates were not significantly different. Conclusion: Our study showed 50,000 IU vitamin D every 2 weeks decreased the incidence of GDM.

Residual pathological stage at radical cystectomy significantly impacts outcomes for initial T2N0 bladder cancer.

Science.gov (United States)

Isbarn, Hendrik; Karakiewicz, Pierre I; Shariat, Shahrokh F; Capitanio, Umberto; Palapattu, Ganesh S; Sagalowsky, Arthur I; Lotan, Yair; Schoenberg, Mark P; Amiel, Gilad E; Lerner, Seth P; Sonpavde, Guru

2009-08-01

We hypothesized that in patients with T2N0 stage disease at transurethral bladder tumor resection a lower residual cancer stage (P1N0 or less) at radical cystectomy may correlate with improved outcomes relative to those with residual P2N0 disease. We analyzed 208 patients with T2N0 stage disease at transurethral bladder tumor resection whose tumors were organ confined at radical cystectomy (P2 or lower, pN0). None received perioperative chemotherapy. Kaplan-Meier as well as univariable and multivariable Cox regression models addressed the effect of residual pT stage at radical cystectomy on recurrence and cancer specific mortality rates. Covariates consisted of age, gender, grade, lymphovascular invasion, carcinoma in situ, number of lymph nodes removed and year of surgery. Residual pT stage at radical cystectomy was P0 in 24 (11.5%) patients, Pa in 9 (4.3%), PCIS in 22 (10.6%), P1 in 35 (16.8%) and P2 in 118 (56.7%). Median followup of censored patients was 55.7 months for recurrence and 52.1 months for cancer specific mortality analyses. The 5-year recurrence-free survival rates of patients with P0/Pa/PCIS, P1 and P2 stage disease were 100%, 85% and 75%, respectively. The 5-year cancer specific survival rates for the same cohorts were 100%, 93% and 81%, respectively. On multivariable analysis the effect of residual stage P1 or lower at radical cystectomy achieved independent predictor status for recurrence (adjusted HR 0.20, p = 0.002) and cancer specific mortality (adjusted HR 0.24, p = 0.02). Down staging from initial T2N0 bladder cancer at transurethral bladder tumor resection to lower stage at radical cystectomy significantly reduces recurrence and cancer specific mortality. Further validation of this finding is warranted.

The silver effect of admission glucose level on excellent outcome in thrombolysed stroke patients.

Science.gov (United States)

Rosso, Charlotte; Baronnet, Flore; Diaz, Belen; Le Bouc, Raphael; Frasca Polara, Giulia; Moulton, Eric Jr; Deltour, Sandrine; Leger, Anne; Crozier, Sophie; Samson, Yves

2018-05-18

Higher admission glucose levels (AGL) are associated with less favorable outcome in thrombolysis. But, could AGL's impact on outcome vary by onset-to-treatment (OTT) time? Is hyperglycemia associated with a shorter therapeutic time window for excellent outcome for thrombolysed stroke patients? We assessed predictive values of AGL, baseline NIHSS, age, and OTT time quartiles on excellent outcome (3-month modified Rankin score of 0-1) in 773 patients treated by rt-Pa. We added the AGL × OTT time quartile interaction in the model and separately analyzed the predictive values of AGL, age, and NIHSS for each OTT time quartile if the interaction was significant. AGL, baseline NIHSS, age, and OTT time quartiles were significant predictors. When added in the model, the AGL × OTT interaction was significant (OR: 0.96, 95% CI: 0.94-0.99, p: 0.0009). AGL was predictive only during the third OTT time quartile (181-224 min). During this period, the predicted rate of excellent outcome was 16% for AGL = 6.5 mmol/L and 8% for AGL = 8 mmol/L. The rate of excellent outcome was not decreased in hyperglycemic patients for OTT time ≤ 180 min (20 vs. 24.5% p: 0.37), but was decreased for OTT time > 180 min (9.6 vs. 26.7% p: 0.00001). Similar results were found in patients with MCA recanalization, but not in patients without recanalization. The therapeutic time window for excellent outcome is shortened in hyperglycemic patients. This would support the design of "freezing penumbra" randomized trials based on ultra-early AGL control.

Significant Learning Experiences and Ignatian Pedagogy: A Case Study of Curricula, Academic Practices, and Graduate Outcomes in Jesuit Universities' Honors Programs

Science.gov (United States)

Pampel, Robert

2017-01-01

This qualitative, multisite case study used Dee Fink's taxonomy of significant learning as a lens through which to examine the curricular structure, academic practices, and graduate outcomes for honors programs at Jesuit colleges and universities in the United States. Special attention was given to the distinctive quality of Ignatian pedagogy and…

Prosthetists' perceptions and use of outcome measures in clinical practice: Long-term effects of focused continuing education.

Science.gov (United States)

Hafner, Brian J; Spaulding, Susan E; Salem, Rana; Morgan, Sara J; Gaunaurd, Ignacio; Gailey, Robert

2017-06-01

Continuing education is intended to facilitate clinicians' skills and knowledge in areas of practice, such as administration and interpretation of outcome measures. To evaluate the long-term effect of continuing education on prosthetists' confidence in administering outcome measures and their perceptions of outcomes measurement in clinical practice. Pretest-posttest survey methods. A total of 66 prosthetists were surveyed before, immediately after, and 2 years after outcomes measurement education and training. Prosthetists were grouped as routine or non-routine outcome measures users, based on experience reported prior to training. On average, prosthetists were just as confident administering measures 1-2 years after continuing education as they were immediately after continuing education. In all, 20% of prosthetists, initially classified as non-routine users, were subsequently classified as routine users at follow-up. Routine and non-routine users' opinions differed on whether outcome measures contributed to efficient patient evaluations (79.3% and 32.4%, respectively). Both routine and non-routine users reported challenges integrating outcome measures into normal clinical routines (20.7% and 45.9%, respectively). Continuing education had a long-term impact on prosthetists' confidence in administering outcome measures and may influence their clinical practices. However, remaining barriers to using standardized measures need to be addressed to keep practitioners current with evolving practice expectations. Clinical relevance Continuing education (CE) had a significant long-term impact on prosthetists' confidence in administering outcome measures and influenced their clinical practices. In all, approximately 20% of prosthetists, who previously were non-routine outcome measure users, became routine users after CE. There remains a need to develop strategies to integrate outcome measurement into routine clinical practice.

Effect of opium use on short-term outcome in patients undergoing coronary artery bypass surgery.

Science.gov (United States)

Safaii, Nasser; Kazemi, Babak

2010-02-01

Data regarding the effect of opium use on short-term outcome in patients undergoing coronary artery bypass surgery are limited. We sought to assess the morbidity and in-hospital mortality of current and past users compared the data with those from nonusers of opium after coronary artery bypass grafting (CABG). This is a descriptive analytical review of prospectively collected data on 782 consecutive male patients who underwent isolated CABG between January 2005 and December 2007. Of these, 708 (90.5%) were nonusers, 56 (7.1%) were current users, and 18 (2.3%) were former opium users of more than 4 weeks. The effect of opium usage on clinical, admission, and outcome variables were analyzed. Current opium users were younger (P = 0.004) and more likely to be cigarette smokers (P = 0.0004). Other demographic characteristics, major coronary risk factors, rates of postoperative complications, intensive care unit readmission, postoperative length of stay, and in-hospital mortality did not differ among the three groups. Current opium users needed less analgesic postoperatively (P = 0.0001), were significantly less compliant with medical and dietary recommendations after discharge (P opium (P opium is a significant predictor of rehospitalization with a cardiac cause within 6 months of CABG surgery. This may be partly due to the low compliance of these patients with treatment recommendations.

The Differential Outcomes Effect in Pigeons (Columba livia: Is It Truly Anticipatory?

Directory of Open Access Journals (Sweden)

Marijn Kouwenhoven

Full Text Available We used delay-interval interference to investigate the nature of the differential outcomes effect (DOE in pigeons. Birds were trained on a delayed matching-to-sample (DMS task under either common outcome or differential outcome conditions, and then presented with visual interference during the delay period. Consistent with previous literature, the common outcomes birds were slower to learn the DMS task than the differential outcomes birds. The common outcome birds were also more impaired by the visual interference than the differential outcomes birds. Our findings are consistent with the view that the birds trained with common outcomes were likely remembering the sample stimulus during the delay period, and hence were disrupted by the visual interference, whereas the birds trained with differential outcomes were likely relying on the different emotional reactions elicited by the different outcomes to guide their choice behaviour, and hence were less affected by the visual interference. Our findings suggest that the DOE is not truly evidence of anticipatory mediation of short-term retention in pigeons, but rather emotionally driven decision making, which is not truly anticipatory in nature.

Effects of reducing blood pressure on cardiovascular outcomes and mortality in patients with type 2 diabetes: Focus on SGLT2 inhibitors and EMPA-REG OUTCOME.

Science.gov (United States)

Scheen, André J

2016-11-01

Empagliflozin, a sodium-glucose cotransporter type 2 (SGLT2) inhibitor, has shown a remarkable reduction in cardiovascular and all-cause mortality in patients with type 2 diabetes (T2D) and antecedents of cardiovascular disease in the EMPA-REG OUTCOME trial. This effect has been attributed to a hemodynamic rather than a metabolic effect, partly due to the osmotic/diuretic effect of empagliflozin and to the reduction in arterial blood pressure. The present review will: (1) summarize the results of specific studies having tested the blood pressure lowering effects of SGLT2 inhibitors; (2) describe the results of meta-analyses of trials having evaluated the effects on mortality and cardiovascular outcomes of lowering blood pressure in patients with T2D, with a special focus on baseline and target blood pressures; (3) compare the cardiovascular outcome results in EMPA-REG OUTCOME versus other major trials with antihypertensive agents in patients with T2D; and (4) evaluate post-hoc analyses from EMPA-REG OUTCOME, especially subgroups of patients of special interest regarding the blood pressure lowering hypothesis. Although BP reduction associated to empagliflozin therapy may partly contribute to the benefits reported in EMPA-REG OUTCOME, other mechanisms most probably play a greater role in the overall CV protection and reduction in mortality observed in this trial. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The long-term effects of the Houston Child Advocates, Inc., program on children and family outcomes.

Science.gov (United States)

Waxman, Hersh C; Houston, W Robert; Profilet, Susan M; Sanchez, Betsi

2009-01-01

The objective of the study is to investigate the longitudinal effects of the Houston Child Advocates, Inc., program on children's outcomes. The treatment group consisted of children in the court system that were assigned Child Advocates volunteers, and the comparison children were chosen randomly from a similar population of children. The treatment group had significantly higher scores on the protective factor and family functioning measures and received more social services than those in the comparison group. Children in the treatment group also had significantly fewer placement changes and did better academically and behaviorally in school than children in the comparison group.

The Positive Effect of Resilience on Stress and Business Outcomes in Difficult Work Environments.

Science.gov (United States)

Shatté, Andrew; Perlman, Adam; Smith, Brad; Lynch, Wendy D

2017-02-01

To examine whether resilience has a protective effect in difficult work environments. A survey of 2063 individuals measured individual resilience, stress, burnout, sleep problems, likelihood of depression, job satisfaction, intent to quit, absences, and productivity. It also measured work characteristics: job demands, job influence, and social support. Multivariate and logistic regression models examined the main effects and interactions of resilience and job characteristics. High strain work environments (high demand, low influence, and low support) have an unfavorable effect on all outcomes. Resilience has a protective effect on all outcomes. For stress, burnout, and sleep, higher resilience has a more protective effect under low-strain conditions. For depression, absence and productivity, resilience has a more protective effect when job strain is high. Workers with high resilience have better outcomes in difficult work environments.

Composite scores in comparative effectiveness research: counterbalancing parsimony and dimensionality in patient-reported outcomes.

Science.gov (United States)

Schwartz, Carolyn E; Patrick, Donald L

2014-07-01

When planning a comparative effectiveness study comparing disease-modifying treatments, competing demands influence choice of outcomes. Current practice emphasizes parsimony, although understanding multidimensional treatment impact can help to personalize medical decision-making. We discuss both sides of this 'tug of war'. We discuss the assumptions, advantages and drawbacks of composite scores and multidimensional outcomes. We describe possible solutions to the multiple comparison problem, including conceptual hierarchy distinctions, statistical approaches, 'real-world' benchmarks of effectiveness and subgroup analysis. We conclude that comparative effectiveness research should consider multiple outcome dimensions and compare different approaches that fit the individual context of study objectives.

rTMS of the dorsomedial prefrontal cortex for major depression: safety, tolerability, effectiveness, and outcome predictors for 10 Hz versus intermittent theta-burst stimulation.

Science.gov (United States)

Bakker, Nathan; Shahab, Saba; Giacobbe, Peter; Blumberger, Daniel M; Daskalakis, Zafiris J; Kennedy, Sidney H; Downar, Jonathan

2015-01-01

Conventional rTMS protocols for major depression commonly employ stimulation sessions lasting >30 min. However, recent studies have sought to improve costs, capacities, and outcomes by employing briefer protocols such as theta burst stimulation (iTBS). To compare safety, effectiveness, and outcome predictors for DMPFC-rTMS with 10 Hz (30 min) versus iTBS (6 min) protocols, in a large, naturalistic, retrospective case series. A chart review identified 185 patients with a medication-resistant major depressive episode who underwent 20-30 sessions of DMPFC-rTMS (10 Hz, n = 98; iTBS, n = 87) at a single Canadian clinic from 2011 to 2014. Clinical characteristics of 10 Hz and iTBS patients did not differ prior to treatment, aside from significantly higher age in iTBS patients. A total 7912 runs of DMPFC-rTMS (10 Hz, 4274; iTBS, 3638) were administered, without any seizures or other serious adverse events, and no significant differences in rates of premature discontinuation between groups. Dichotomous outcomes did not differ significantly between groups (Response/remission rates: Beck Depression Inventory-II: 10 Hz, 40.6%/29.2%; iTBS, 43.0%/31.0%. 17-item Hamilton Rating Scale for Depression: 10 Hz, 50.6%/38.5%; iTBS, 48.5%/27.9%). On continuous outcomes, there was no significant difference between groups in pre-treatment or post-treatment scores, or percent improvement on either measure. Mixed-effects modeling revealed no significant group-by-time interaction on either measure. Both 10 Hz and iTBS DMPFC-rTMS appear safe and tolerable at 120% resting motor threshold. The effectiveness of 6 min iTBS and 30 min 10 Hz protocols appears comparable. Randomized trials comparing 10 Hz to iTBS may be warranted. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Effects of in utero tributyltin chloride exposure in the rat on pregnancy outcome.

Science.gov (United States)

Adeeko, Adedayo; Li, Daming; Forsyth, Don S; Casey, Valerie; Cooke, Gerard M; Barthelemy, Johanna; Cyr, Daniel G; Trasler, Jacquetta M; Robaire, Bernard; Hales, Barbara F

2003-08-01

Tributyltin, an organotin, is ubiquitous in the environment. The consumption of contaminated marine species leads to human dietary exposure to this compound. Tributyltin is an endocrine disruptor in many wildlife species and inhibits aromatase in mammalian placental and granulosa-like tumor cell lines. We investigated the effects of tributyltin chloride exposure on pregnancy outcome in the Sprague-Dawley rat. Timed pregnant rats were gavaged either with vehicle (olive oil) or tributyltin chloride (0.25, 2.5, 10, or 20 mg/kg) from days 0-19 or 8-19 of gestation. On gestational day 20, dams were sacrificed, and pregnancy outcome was determined. Tributyltin and its metabolites (dibutyltin, monobutyltin) were measured in maternal blood by gas chromatography. Both tributyltin and dibutyltin were present in maternal blood at approximately equal concentrations, whereas monobutyltin contributed minimally to total organotins. Organotin concentrations increased in a dose-dependent pattern in dams, independent of the window of exposure. Tributyltin chloride administration significantly reduced maternal weight gain only at the highest dose (20 mg/kg); a significant increase in post-implantation loss and decreased litter sizes, in addition to decreased fetal weights, was observed in this group. Tributyltin chloride exposure did not result in external malformations, nor was there a change in sex ratios. However, exposure to 0.25, 2.5, or 10 mg/kg tributyltin chloride from gestation days (GD) 0-19 resulted in a significant increase in normalized anogenital distances in male fetuses; exposure from days 8-19 had no effect. There was a dramatic increase in the incidence of low weight (exposure to 20 mg/kg tributyltin chloride. Delayed ossification of the fetal skeleton was observed after in utero exposure to either 10 mg/kg or 20 mg/kg tributyltin chloride. Serum thyroxine and triiodothyronine levels were reduced significantly in dams exposed to 10 and 20 mg/kg tributyltin chloride

Effect of socioeconomic status disparity on child language and neural outcome: how early is early?

Science.gov (United States)

Hurt, Hallam; Betancourt, Laura M

2016-01-01

It is not news that poverty adversely affects child outcome. The literature is replete with reports of deleterious effects on developmental outcome, cognitive function, and school performance in children and youth. Causative factors include poor nutrition, exposure to toxins, inadequate parenting, lack of cognitive stimulation, unstable social support, genetics, and toxic environments. Less is known regarding how early in life adverse effects may be detected. This review proposes to elucidate "how early is early" through discussion of seminal articles related to the effect of socioeconomic status on language outcome and a discussion of the emerging literature on effects of socioeconomic status disparity on brain structure in very young children. Given the young ages at which such outcomes are detected, the critical need for early targeted interventions for our youngest is underscored. Further, the fiscal reasonableness of initiating quality interventions supports these initiatives. As early life adversity produces lasting and deleterious effects on developmental outcome and brain structure, increased focus on programs and policies directed to reducing the impact of socioeconomic disparities is essential.

Cultural effects on the association between election outcomes and face-based trait inferences.

Directory of Open Access Journals (Sweden)

Chujun Lin

Full Text Available How competent a politician looks, as assessed in the laboratory, is correlated with whether the politician wins in real elections. This finding has led many to investigate whether the association between candidate appearances and election outcomes transcends cultures. However, these studies have largely focused on European countries and Caucasian candidates. To the best of our knowledge, there are only four cross-cultural studies that have directly investigated how face-based trait inferences correlate with election outcomes across Caucasian and Asian cultures. These prior studies have provided some initial evidence regarding cultural differences, but methodological problems and inconsistent findings have complicated our understanding of how culture mediates the effects of candidate appearances on election outcomes. Additionally, these four past studies have focused on positive traits, with a relative neglect of negative traits, resulting in an incomplete picture of how culture may impact a broader range of trait inferences. To study Caucasian-Asian cultural effects with a more balanced experimental design, and to explore a more complete profile of traits, here we compared how Caucasian and Korean participants' inferences of positive and negative traits correlated with U.S. and Korean election outcomes. Contrary to previous reports, we found that inferences of competence (made by participants from both cultures correlated with both U.S. and Korean election outcomes. Inferences of open-mindedness and threat, two traits neglected in previous cross-cultural studies, were correlated with Korean but not U.S. election outcomes. This differential effect was found in trait judgments made by both Caucasian and Korean participants. Interestingly, the faster the participants made face-based trait inferences, the more strongly those inferences were correlated with real election outcomes. These findings provide new insights into cultural effects and the

Effect of cocaine use on outcomes in traumatic brain injury

Directory of Open Access Journals (Sweden)

Jacky T Yeung

2013-01-01

Full Text Available Context: Animal and molecular studies have shown that cocaine exerts a neuroprotective effect against cerebral ischemia. Aims: To determine if the presence of cocaine metabolites on admission following traumatic brain injury (TBI is associated with better outcomes. Settings and Design: Level-1 trauma center, retrospective cohort. Materials and Methods: After obtaining Institutional Review Board (IRB approval, the trauma registry was searched from 2006 to 2009 for all patients aged 15-55 years with blunt head trauma and non-head AIS <3. Exclusion criteria were pre-existing brain pathology and death within 30 min of admission. The primary outcome was in-hospital mortality; secondary outcomes were hospital length of stay (LOS, and Glasgow Outcome Score (GOS. Statistical Analysis: Logistic regression was used to determine the independent effect of cocaine on mortality. Hospital LOS was compared with multiple linear regression. Results: A total of 741 patients met criteria and had drug screens. The screened versus unscreened groups were similar. Cocaine positive patients were predominantly African-American (46% vs. 21%, P < 0.0001, older (40 years vs. 30 years, P < 0.0001, and had ethanol present more often (50.7% vs. 37.8%, P = 0.01. There were no differences in mortality (cocaine-positive 1.4% vs. cocaine-negative 2.7%, P = 0.6 on both univariate and multivariate analysis. Conclusions: Positive cocaine screening was not associated with mortality in TBI. An effect may not have been detected because of the low mortality rate. LOS is affected by many factors unrelated to the injury and may not be a good surrogate for recovery. Similarly, GOS may be too coarse a measure to identify a benefit.

[Effects of prophylactic chemotherapy on outcomes and prognosis of patients older than 40 years with invasive mole].

Science.gov (United States)

Jiang, S Y; Li, L; Zhao, J; Xiang, Y; Wan, X R; Feng, F Z; Ren, T; Yang, J J

2017-06-25

Objective: To discuss the effects of prophylactic chemotherapy on the outcomes and prognosis of invasive mole patients. Methods: One hundred and fifteen invasive mole (IM) patients older than 40 years were registered in Peking Union Medical Collage Hospital.Eleven of them were treated with prophylactic chemotherapy before diagnosed as IM prophylactic chemotherapy group, while the other 104 cases received therapeutic chemotherapy after diagnosed as IM (non-prophylactic chemotherapy group). The general clinical data (including age, clinical stage, risk factor score), treatment, outcomes and relapse of patients were retrospectively compared between two groups. Results: (1) The age of prophylactic chemotherapy group and non-prophylactic chemotherapy group were (47±5) versus (46±4) years old. Ratio of clinical stageⅠ-Ⅱ were 3/11 versus 29.8% (31/104), clinical stage Ⅲ-Ⅳ were 8/11 versus 70.2% (73/104). Ratio of risk factor score 0-6 were 11/11 versus 84.6% (88/104), risk factor score >6 were 0 versus 15.4% (16/104). There were no significant statistical differences between two groups in age, clinical stage or risk factor score (all P> 0.05). (2) Treatment: the total chemotherapy courses between prophylactic chemotherapy group and non-prophylactic chemotherapy group (median 7 versus 5) were significantly different ( Z= 3.071, P= 0.002). There were no significant statistical differences between two groups in the chemotherapy courses until negative conversion of β-hCG, consolidation chemotherapy courses, total therapeutic chemotherapy courses or ratio of hysterectomy (all P> 0.05). (3) Outcomes and relapse: between the prophylactic chemotherapy group and the non-prophylactic chemotherapy group, the complete remission rate were 11/11 versus 98.1%(102/104), the relapse rate were 0 versus 1.0%(1/102). There were no significant difference between the two groups in outcomes or relapse rate ( P> 0.05). Conclusions: Prophylactic chemotherapy does not substantially

The delay effect on outcome evaluation: results from an Event-related Potential study

Directory of Open Access Journals (Sweden)

Chen eQu

2013-11-01

Full Text Available Behavioral studies demonstrate that the timing of receiving gains or losses affects decision-making, a phenomenon known as temporal discounting, as participants are inclined to prefer immediate rewards over delayed ones and vice versa for losses. The present study used the event-related potential (ERP technique with a simple gambling task to investigate how delayed rewards and losses affected the brain activity in outcome evaluations made by 20 young adults. Statistical analysis revealed a larger feedback related negativity (FRN effect between loss and gain following immediate outcomes than following future outcomes. In addition, delay impacted FRN only in gain conditions, with delayed winning eliciting a more negative FRN than immediatewinning. These results suggest that temporal discounting and sign effect could be encoded in the FRN in the early stage of outcome evaluation.

Anthropogenic effects on interaction outcomes: examples from insect-microbial symbioses in forest and savanna ecosystems

DEFF Research Database (Denmark)

Six, Diana L.; Thomas-Poulsen, Michael; Hansen, Allison K.

2011-01-01

The influence of humans on ecosystem dynamics has been, and continues to be, profound. Anthropogenic effects are expected to amplify as human populations continue to increase. Concern over these effects has given rise to a large number of studies focusing on impacts of human activities...... of mutualisms can be to an equally varied set of anthropogenic influences. We also show how alterations of mutualisms may ramify throughout affected systems. We stress that researchers must be cognizant that many observed changes in the behaviors, abundances, and distributions of organisms due to human...... activities are likely to be mediated by mutualists which may alter predictions and actual outcomes in significant ways....

The Effect of Empowerment and Self-Determination on Health Outcomes

Science.gov (United States)

Garces-Ozanne, Arlene; Kalu, Edna Ikechi; Audas, Richard

2016-01-01

There remains a persistent gap in health outcomes between wealthy and poor countries. Basic measures such as life expectancy and infant and under-five mortality remain divergent, with preventable deaths being unacceptably high, despite significant efforts to reduce these disparities. We examine the impact of empowerment, measured by Freedom…

Effect of balanced protein energy supplementation during pregnancy on birth outcomes

Directory of Open Access Journals (Sweden)

Bhutta Zulfiqar A

2011-04-01

Full Text Available Abstract Background The nutritional status of the mother prior to and during pregnancy plays a vital role in fetal growth and development, and maternal undernourishment may lead to adverse perinatal outcomes including intrauterine growth restriction (IUGR. Several macronutrient interventions had been proposed for adequate protein and energy supplementation during pregnancy. The objective of this paper was to review the effect of balanced protein energy supplementation during pregnancy on birth outcomes. This paper is a part of a series of reviews undertaken for getting estimates of effectiveness of an intervention for input to Lives Saved Tool (LiST model. Methods A literature search was conducted on PubMed, Cochrane Library and WHO regional data bases to identify randomized trials (RCTs and quasi RCTs that evaluated the impact of balanced protein energy supplementation in pregnancy. Balanced protein energy supplementation was defined as nutritional supplementation during pregnancy in which proteins provided less than 25% of the total energy content. Those studies were excluded in which the main intervention was dietary advice to pregnant women for increase in protein energy intake, high protein supplementation (i.e. supplementation in which protein provides at least 25% of total energy content, isocaloric protein supplementation (where protein replaces an equal quantity of non-protein energy content, or low energy diet to pregnant women who are either overweight or who exhibit high weight gain earlier in gestation. The primary outcomes were incidence of small for gestational age (SGA birth, mean birth weight and neonatal mortality. Quality of evidence was evaluated according to the Child Health Epidemiology Reference group (CHERG adaptation of Grading of Recommendations Assessment, Development and Evaluation (GRADE criteria. Results The final number of studies included in our review was eleven comprising of both RCTs and quasi-RCTs. Our meta

Effect decomposition in the presence of an exposure-induced mediator-outcome confounder

Science.gov (United States)

VanderWeele, Tyler J.; Vansteelandt, Stijn; Robins, James M.

2014-01-01

Methods from causal mediation analysis have generalized the traditional approach to direct and indirect effects in the epidemiologic and social science literature by allowing for interaction and non-linearities. However, the methods from the causal inference literature have themselves been subject to a major limitation in that the so-called natural direct and indirect effects that are employed are not identified from data whenever there is a variable that is affected by the exposure, which also confounds the relationship between the mediator and the outcome. In this paper we describe three alternative approaches to effect decomposition that give quantities that can be interpreted as direct and indirect effects, and that can be identified from data even in the presence of an exposure-induced mediator-outcome confounder. We describe a simple weighting-based estimation method for each of these three approaches, illustrated with data from perinatal epidemiology. The methods described here can shed insight into pathways and questions of mediation even when an exposure-induced mediator-outcome confounder is present. PMID:24487213

Acute Effect of Virtual Reality Exercise Bike Games on College Students' Physiological and Psychological Outcomes.

Science.gov (United States)

Zeng, Nan; Pope, Zachary; Gao, Zan

2017-07-01

Commercially available virtual reality (VR) exercise systems are extensively used in many health domains among clinical populations. However, evidence regarding the efficacy of this technology on healthy adults' health-related outcomes is unknown. This pilot study compared physiological and psychological responses following exercise on a VR-based exercise bike (VirZoom) and traditional stationary exercise bike. Twelve healthy college students (9 females; M age  = 25.01, SD = ± 4.74; M BMI  = 22.84, SD = ± 3.68) completed two separate 20-minute exercise sessions on the VR-based exercise bike and traditional stationary exercise bike. Blood pressure (BP), ratings of perceived exertion, self-efficacy, and enjoyment were assessed as primary outcomes. Dependent t-tests indicated no significant differences in mean systolic or diastolic BP changes from pre to postexercise between the VR-based exercise and traditional stationary biking sessions (all p > 0.05). Notably, participants reported significantly higher ratings of perceived exertion (p < 0.05, Cohen's d = 0.68) during the traditional exercise biking session compared with VR-based exercise biking session. However, participants had significantly higher self-efficacy (p < 0.05, Cohen's d = -0.83) and enjoyment (p < 0.05, Cohen's d = -0.89) during the VR-based exercise biking session compared with traditional stationary biking. The commercially available VR-based exercise bike (VirZoom) may be considered an effective, enjoyable, and motivating physical activity tool. Further interventions with larger and more diverse samples and examinations of more health-related outcomes are warranted to determine optimal application of VR-based exercise programming among various populations.

Effect of smoking status and nicotine dependence on pain intensity and outcome of treatment in Indian patients with temporomandibular disorders: A longitudinal cohort study.

Science.gov (United States)

Katyayan, Preeti Agarwal; Katyayan, Manish Khan

2017-01-01

Evidence regarding the association of smoking with various forms of chronic musculoskeletal pain is vast, but that with temporomandibular disorders (TMD) is scarce. The aims of this study are to evaluate the effect of smoking status (SS) and nicotine dependence (ND) on TMD pain intensity and treatment outcome in an Indian population with TMD. Nine hundred and sixty-two patients with TMD were selected for this longitudinal cohort study. Lifetime SS was evaluated and patients were classified as current smokers (YS), former smokers (FS), or nonsmokers (NS). The Fagerstrom test was used to evaluate the ND of YS. Pain intensity was evaluated using visual analog scale scores. Six months posttreatment, the pain intensity was again recorded. The effect of treatment was evaluated using a global transition outcome measure and categorized as treatment success or failure. A minimum 30% reduction in pain was used as a criterion for categorizing patients as those who had gotten "better." Data obtained from the study were compared using Chi-square tests, paired samples t -tests, and one-way ANOVA tests. The criterion for statistical significance for all analyses was set at P = 0.05. Among groups of SS, YS showed the maximum pain intensity at baseline and posttreatment. The outcome of treatment was most successful in NS and least in FS. The number of patients who had gotten "better" after treatment was significantly highest in NS. There was no significant difference between groups of ND with respect to pain intensity, treatment outcome, or "better" patients. Among Indian patients with TMD, smokers reported significantly greater pain intensity and poorer response to treatment than NS. Pain intensity or treatment outcome was independent of ND.

Can UK NHS research ethics committees effectively monitor publication and outcome reporting bias?

Science.gov (United States)

Begum, Rasheda; Kolstoe, Simon

2015-07-25

Publication and outcome reporting bias is often caused by researchers selectively choosing which scientific results and outcomes to publish. This behaviour is ethically significant as it distorts the literature used for future scientific or clinical decision-making. This study investigates the practicalities of using ethics applications submitted to a UK National Health Service (NHS) research ethics committee to monitor both types of reporting bias. As part of an internal audit we accessed research ethics database records for studies submitting an end of study declaration to the Hampshire A research ethics committee (formerly Southampton A) between 1st January 2010 and 31st December 2011. A literature search was used to establish the publication status of studies. Primary and secondary outcomes stated in application forms were compared with outcomes reported in publications. Out of 116 studies the literature search identified 57 publications for 37 studies giving a publication rate of 32%. Original Research Ethics Committee (REC) applications could be obtained for 28 of the published studies. Outcome inconsistencies were found in 16 (57%) of the published studies. This study showed that the problem of publication and outcome reporting bias is still significant in the UK. The method described here demonstrates that UK NHS research ethics committees are in a good position to detect such bias due to their unique access to original research protocols. Data gathered in this way could be used by the Health Research Authority to encourage higher levels of transparency in UK research.

The Effect of Campaign-Generated Interpersonal Communication on Campaign-Targeted Health Outcomes: A Meta-Analysis.

Science.gov (United States)

Jeong, Michelle; Bae, Rosie Eungyuhl

2017-06-16

This study examined the effect of mass media campaign-generated conversations on campaign-targeted health outcomes, via a systematic meta-analysis of 28 studies (including 124 sub-studies and a total of 138,898 participants). The study also conducted a series of moderation analyses to examine the conditions under which interpersonal communication has larger effects on bringing about the desired outcomes. The findings of this meta-analysis indicate that campaign-generated conversations have a positive effect on inducing campaign-targeted outcomes (OR = 1.28) and show that this effect is moderated by health topic addressed by the campaign, the type of outcome being targeted by the campaign, and with whom people converse, along with several other campaign-relevant and study-relevant variables. The implications of these findings for future research are discussed.

The effect of taping versus semi-rigid bracing on patient outcome and satisfaction in ankle sprains: a prospective, randomized controlled trial

Directory of Open Access Journals (Sweden)

Lardenoye Sacha

2012-05-01

Full Text Available Abstract Background Functional treatment is a widely used and generally accepted treatment for ankle sprain. A meta-analysis comparing the different functional treatment options could not make definitive conclusions regarding the effectiveness, and until now, little was known about patient satisfaction in relation to the outcome. Methods Patients with acute ankle sprain received rest, ice, compression and elevation with an compressive bandage at the emergency department. After 5-7 days, 100 patients with grade II and III sprains were randomized into two groups: one group was treated with tape and the other with a semi-rigid ankle brace, both for 4 weeks. Post-injury physical and proprioceptive training was standardized. As primary outcome parameter patient satisfaction and skin complications were evaluated using a predefined questionnaire and numeric rating scale. As secondary outcome parameter the ankle joint function was assessed using the Karlsson scoring scale and range of motion. Results Patient-reported comfort and satisfaction during treatment with a semi-rigid brace was significantly increased. The rate of skin complication in this group was significantly lower compared to the tape group (14.6% versus 59.1%, P  Conclusion Treatment of acute ankle sprain with semi-rigid brace leads to significantly higher patient comfort and satisfaction, both with similar good outcome.

Glucose administration after traumatic brain injury exerts some benefits and no adverse effects on behavioral and histological outcomes.

Science.gov (United States)

Shijo, Katsunori; Ghavim, Sima; Harris, Neil G; Hovda, David A; Sutton, Richard L

2015-07-21

The impact of hyperglycemia after traumatic brain injury (TBI), and even the administration of glucose-containing solutions to head injured patients, remains controversial. In the current study adult male Sprague-Dawley rats were tested on behavioral tasks and then underwent surgery to induce sham injury or unilateral controlled cortical impact (CCI) injury followed by injections (i.p.) with either a 50% glucose solution (Glc; 2g/kg) or an equivalent volume of either 0.9% or 8% saline (Sal) at 0, 1, 3 and 6h post-injury. The type of saline treatment did not significantly affect any outcome measures, so these data were combined. Rats with CCI had significant deficits in beam-walking traversal time and rating scores (p's beam-walking deficits were not affected by Glc versus Sal treatments. Persistent post-CCI deficits in forelimb contraflexion scores and forelimb tactile placing ability were also not differentially affected by Glc or Sal treatments. However, deficits in latency to retract the right hind limb after limb extension were significantly attenuated in the CCI-Glc group (p < 0.05 versus CCI-Sal). Both CCI groups were significantly impaired in a plus maze test of spatial working memory on days 4, 9 and 14 post-surgery (p < 0.001 versus sham), and there was no effect of Glc versus Sal on this cognitive outcome measure. At 15 days post-surgery the loss of cortical tissue volume (p < 0.001 versus sham) was significantly less in the CCI-Glc group (30.0%; p < 0.05) compared to the CCI-Sal group (35.7%). Counts of surviving hippocampal hilar neurons revealed a significant (~40%) loss ipsilateral to CCI (p < 0.001 versus sham), but neuronal loss in the hippocampus was not different in the CCI-Sal and CCI-Glc groups. Taken together, these results indicate that an early elevation of blood glucose may improve some neurological outcomes and, importantly, the induction of hyperglycemia after isolated TBI did not adversely affect any sensorimotor, cognitive or

Effects of maternal obesity on early and long-term outcomes for offspring

Directory of Open Access Journals (Sweden)

Stirrat LI

2014-03-01

Full Text Available Laura I Stirrat,1,2 Rebecca M Reynolds2,3 1Medical Research Council Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK; 2Tommy's Centre for Maternal and Fetal Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK; 3Endocrinology Unit, University/British Heart Foundation Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK Abstract: The prevalence of maternal obesity has increased significantly in recent years, and obesity is currently the most common comorbidity of pregnancy. Pregnancies of obese women are often defined as "high-risk" for the purposes of clinical care, with many well documented risks to the mother and developing baby. Maternal physiology and metabolism is dysregulated in the context of obesity, which may contribute to some of the adverse outcomes during pregnancy. Furthermore, maternal obesity has been hypothesized to cause harmful effects for the developing baby through "early life programming." This review will examine evidence from human studies for outcomes of offspring from obese women during pregnancy, during labor, during the neonatal period, and later in life. Keywords: pregnancy, short-term, physiology, metabolism, early life programming, neonatal complications, adverse intrauterine environment

On the Diverse Outcome of Communication Partner Training of Significant Others of People with Aphasia: An Experimental Study of Six Cases

Science.gov (United States)

Eriksson, Karin; Hartelius, Lena; Saldert, Charlotta

2016-01-01

Background: Communication partner training (CPT) has been shown to improve the communicative environment of people with aphasia. Interaction-focused training is one type of training that provides an individualized intervention to participants. Although shown to be effective, outcomes have mostly been evaluated in non-experimental case studies.…

Geographic inequities in liver allograft supply and demand: does it affect patient outcomes?

Science.gov (United States)

Rana, Abbas; Kaplan, Bruce; Riaz, Irbaz B; Porubsky, Marian; Habib, Shahid; Rilo, Horacio; Gruessner, Angelika C; Gruessner, Rainer W G

2015-03-01

Significant geographic inequities mar the distribution of liver allografts for transplantation. We analyzed the effect of geographic inequities on patient outcomes. During our study period (January 1 through December 31, 2010), 11,244 adult candidates were listed for liver transplantation: 5,285 adult liver allografts became available, and 5,471 adult recipients underwent transplantation. We obtained population data from the 2010 United States Census. To determine the effect of regional supply and demand disparities on patient outcomes, we performed linear regression and multivariate Cox regression analyses. Our proposed disparity metric, the ratio of listed candidates to liver allografts available varied from 1.3 (region 11) to 3.4 (region 1). When that ratio was used as the explanatory variable, the R(2) values for outcome measures were as follows: 1-year waitlist mortality, 0.23 and 1-year posttransplant survival, 0.27. According to our multivariate analysis, the ratio of listed candidates to liver allografts available had a significant effect on waitlist survival (hazards ratio, 1.21; 95% confidence interval, 1.04-1.40) but was not a significant risk factor for posttransplant survival. We found significant differences in liver allograft supply and demand--but these differences had only a modest effect on patient outcomes. Redistricting and allocation-sharing schemes should seek to equalize regional supply and demand rather than attempting to equalize patient outcomes.

[Rapid resolution of acute subdural haematoma with significant impact on clinical outcome].

Science.gov (United States)

Capion, Tenna; Lilja-Cyron, Alexander; Kelsen, Jesper

2017-09-04

A 73-year-old woman was admitted to hospital due to anaemia. She suffered a minor head trauma and deteriorated to deep unconsciousness. A CT revealed an acute subdural haematoma (ASDH). Initially, she was not found to be a candidate for neurosurgical intervention, but within 24 hours her level of consciousness improved dramatically, and a renewed CT showed resolution of the ASDH. She underwent acute craniotomy with good outcome. This illustrates the importance of re-evaluation of patients with intracranial haemorrhage.

The long-term effect of premier pay for performance on patient outcomes.

Science.gov (United States)

Jha, Ashish K; Joynt, Karen E; Orav, E John; Epstein, Arnold M

2012-04-26

Pay for performance has become a central strategy in the drive to improve health care. We assessed the long-term effect of the Medicare Premier Hospital Quality Incentive Demonstration (HQID) on patient outcomes. We used Medicare data to compare outcomes between the 252 hospitals participating in the Premier HQID and 3363 control hospitals participating in public reporting alone. We examined 30-day mortality among more than 6 million patients who had acute myocardial infarction, congestive heart failure, or pneumonia or who underwent coronary-artery bypass grafting (CABG) between 2003 and 2009. At baseline, the composite 30-day mortality was similar for Premier and non-Premier hospitals (12.33% and 12.40%, respectively; difference, -0.07 percentage points; 95% confidence interval [CI], -0.40 to 0.26). The rates of decline in mortality per quarter at the two types of hospitals were also similar (0.04% and 0.04%, respectively; difference, -0.01 percentage points; 95% CI, -0.02 to 0.01), and mortality remained similar after 6 years under the pay-for-performance system (11.82% for Premier hospitals and 11.74% for non-Premier hospitals; difference, 0.08 percentage points; 95% CI, -0.30 to 0.46). We found that the effects of pay for performance on mortality did not differ significantly among conditions for which outcomes were explicitly linked to incentives (acute myocardial infarction and CABG) and among conditions not linked to incentives (congestive heart failure and pneumonia) (P=0.36 for interaction). Among hospitals that were poor performers at baseline, mortality was similar in the two groups of hospitals at the start of the study (15.12% and 14.73%; difference, 0.39 percentage points; 95% CI, -0.36 to 1.15), with similar rates of improvement per quarter (0.10% and 0.07%; difference, -0.03 percentage points; 95% CI, -0.08 to 0.02) and similar mortality rates at the end of the study (13.37% and 13.21%; difference, 0.15 percentage points; 95% CI, -0.70 to 1.01). We

Effect of dementia on outcomes of elderly patients with hemorrhagic peptic ulcer disease based on a national administrative database.

Science.gov (United States)

Murata, Atsuhiko; Mayumi, Toshihiko; Muramatsu, Keiji; Ohtani, Makoto; Matsuda, Shinya

2015-10-01

Little information is available on the effect of dementia on outcomes of elderly patients with hemorrhagic peptic ulcer disease at the population level. This study aimed to investigate the effect of dementia on outcomes of elderly patients with hemorrhagic peptic ulcer based on a national administrative database. A total of 14,569 elderly patients (≥80 years) who were treated by endoscopic hemostasis for hemorrhagic peptic ulcer were referred to 1073 hospitals between 2010 and 2012 in Japan. We collected patients' data from the administrative database to compare clinical and medical economic outcomes of elderly patients with hemorrhagic peptic ulcers. Patients were divided into two groups according to the presence of dementia: patients with dementia (n = 695) and those without dementia (n = 13,874). There were no significant differences in in-hospital mortality within 30 days and overall mortality between the groups (odds ratio; OR 1.00, 95 % confidence interval; CI 0.68-1.46, p = 0.986 and OR 1.02, 95 % CI 0.74-1.41, p = 0.877). However, the length of stay (LOS) and medical costs during hospitalization were significantly higher in patients with dementia compared with those without dementia. The unstandardized coefficient for LOS was 3.12 days (95 % CI 1.58-4.67 days, p peptic ulcer disease.

Structure, Processes, and Retrospective Outcomes From an Intensive Comprehensive Aphasia Program.

Science.gov (United States)

Babbitt, Edna M; Worrall, Linda; Cherney, Leora R

2015-11-01

This study describes the structure, processes, and outcomes of an intensive comprehensive aphasia program (ICAP). The aim was to identify treatment gains and determine if outcomes were significantly different between participants grouped according to severity and type of aphasia, and time postonset. Data from 74 first-time ICAP participants were analyzed. Pre- and posttreatment scores on the Western Aphasia Battery-Revised and other impairment and participation measures were compared using paired t tests. Analyses of variance were used to compare outcomes related to aphasia severity (severe, moderate, and mild aphasia), aphasia type (fluent, nonfluent), and chronicity (0-6 months postonset, 7-12 months postonset, and 12+ months postonset). Participants made significant changes on all impairment and participation measures. Large effect sizes were noted for one participation and three impairment measures. Medium effect sizes were noted for one impairment and three participation measures. There was no significant difference among groups on any factor. ICAPs can have a significant effect on the language impairment and participation of people with aphasia, but further research is required to determine if the effect is comparable to other types of service delivery.

EFFECTS OF THE INQUIRY TRAINING AND MOTIVATION LEARNING AGAINST LEARNING OUTCOMES IN HIGH SCHOOL PHYSICS STUDENTS

Directory of Open Access Journals (Sweden)

Vika Andini

2014-12-01

Full Text Available This study aims to: determine the significance of differences in physics learning outcomes of students with learning models Inquiry Training and conventional models, knowing the significance of differences in physics learning outcomes of students who have learning motivation high and low, low motivation, the interaction model of learning and motivation to learn physics in improving student learning outcomes. The sample in this study conducted in a cluster random sampling of two classes, where the first class as a class experiment applied learning models and Inquiry Training as a second grade class learning model Conventional control applied. The instrument used in this study is the result of learning physics instruments in the form of 20 multiple-choice questions and motivation questionnaire  by 25 statements has been declared valid and reliable. From the results of this study concluded that the learning outcomes of students who are taught by Training Inquiry learning model is better than conventional models of learning outcomes. Learning outcomes of students who have high motivation to learn is better than the learning outcomes of students who have a low learning motivation. Inquiry learning model training and motivation interact in affecting student learning outcomes.

The economic effect and outcome of delaying oral food challenges.

Science.gov (United States)

Couch, Christopher; Franxman, Tim; Greenhawt, Matthew

2016-05-01

Food specific IgE (sIgE) is a useful marker to assess predictability of oral food challenge (OFC) outcome. A threshold of less than 2 kUA/L for peanut, egg, and milk has been proposed as a 50% negative predictive value at which patients may pass an OFC. To assess the economic effect and outcome of delaying OFCs. A retrospective analysis was performed for peanut, egg, and milk OFCs conducted between 2001 and 2012 at a tertiary food allergy referral center. Delayed OFC was defined as greater than 12 months from the time the sIgE level became less than 2 kUA/L. Time to OFC was explored in association with skin prick test result (wheal size), OFC outcome, and the economic effect of delay. Of 319 challenges, 173 OFCs were delayed (54.2%) by a mean time of 35.5 months (range, 13-123 months) vs a mean time of 4.2 months in the 146 challenges that were not delayed (P care system. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Modifying effect of prenatal care on the association between young maternal age and adverse birth outcomes.

Science.gov (United States)

Vieira, C L; Coeli, C M; Pinheiro, R S; Brandão, E R; Camargo, K R; Aguiar, F P

2012-06-01

The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes. A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction. Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes. Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Effects of alcohol, initial gambling outcomes, impulsivity, and gambling cognitions on gambling behavior using a video poker task.

Science.gov (United States)

Corbin, William R; Cronce, Jessica M

2017-06-01

Drinking and gambling frequently co-occur, and concurrent gambling and drinking may lead to greater negative consequences than either behavior alone. Building on prior research on the effects of alcohol, initial gambling outcomes, impulsivity, and gambling cognitions on gambling behaviors using a chance-based (nonstrategic) slot-machine task, the current study explored the impact of these factors on a skill-based (strategic) video poker task. We anticipated larger average bets and greater gambling persistence under alcohol relative to placebo, and expected alcohol effects to be moderated by initial gambling outcomes, impulsivity, and gambling cognitions. Participants (N = 162; 25.9% female) were randomly assigned to alcohol (target BrAC = .08g%) or placebo and were given $10 to wager on a simulated video poker task, which was programmed to produce 1 of 3 initial outcomes (win, breakeven, or lose) before beginning a progressive loss schedule. Despite evidence for validity of the video poker task and alcohol administration paradigm, primary hypotheses were not supported. Individuals who received alcohol placed smaller wagers than participants in the placebo condition, though this effect was not statistically significant, and the direction of effects was reversed in at-risk gamblers (n = 41). These findings contradict prior research and suggest that alcohol effects on gambling behavior may differ by gambling type (nonstrategic vs. strategic games). Interventions that suggest alcohol is universally disinhibiting may be at odds with young adults' lived experience and thus be less effective than those that recognize the greater complexity of alcohol effects. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The Effect of Blood Transfusion on Outcomes in Aortic Surgery.

Science.gov (United States)

Velasquez, Camilo A; Singh, Mrinal; Bin Mahmood, Syed Usman; Brownstein, Adam J; Zafar, Mohammad A; Saeyeldin, Ayman; Ziganshin, Bulat A; Elefteriades, John A

2017-09-01

The use of blood transfusion in cardiac surgery varies widely. The beneficial effects of blood products are offset by an increase in morbidity and mortality. Despite multiple studies showing an association between blood product exposure and adverse short- and long-term events, it is difficult to determine causality. Nevertheless, the implication is sufficient to warrant the search for alternative strategies to reduce the use of blood products while providing a standard of care that optimizes postoperative outcomes. Aortic surgery, in particular, is associated with an increased risk of bleeding requiring a blood transfusion. There is a paucity of evidence within aortic surgery regarding the deleterious effects of blood products. Here, we review the current evidence regarding patient outcomes after blood transfusion in cardiac surgery, with special emphasis on aortic surgery.

Interventional study plan to investigate the training effects on physical and psychological outcomes awareness of smoking in teenagers.

Science.gov (United States)

Mohamadian, Fathola; Baghri, Maryam; Delpisheh, Ali; Veisani, Yousef

2017-01-01

Studies have found that nearly 90% of the first use of tobacco takes place before high school graduation (teenagers) and training discussion due to prevention can be useful, therefore, here, we aimed to determine the effects of training on awareness of cigarette outcomes (physical and psychological) in male teenagers. We conducted an interventional study using Solomon's four-group plan, which used a two-stage cluster sampling in four groups (two experimental groups and two control groups). The three sessions of at least 2 h of education intervention including visual displaying using photo, film, and short scientific texts were held for the interventional group. After 1 month, all four groups took posttest, and research groups were followed up after 8 months of intervention. All data were analyzed using one-way analysis of variance and covariance in SPSS. According to the results, the mean of posttest scores had increased rather than pretest scores, and generally, a significant difference was observed ( P ≤ 0.001). These results were significant in the aspect of both physical and psychological outcomes awareness. The difference between the mean of scores in follow-up period and posttest was not statistically significant, and it shows training retention after 8 months ( P training, it is possible to increase the awareness of teenagers about physical and psychological outcomes of cigarette smoking that this can have an important role in smoking prevention.

Patient-reported outcomes (PROs): the significance of using humanistic measures in clinical trial and clinical practice.

Science.gov (United States)

Refolo, P; Minacori, R; Mele, V; Sacchini, D; Spagnolo, A G

2012-10-01

Patient-reported outcome (PRO) is an "umbrella term" that covers a whole range of potential types of measurement but it is used specifically to refer to all measures quantifying the state of health through the evaluation of outcomes reported by the patient himself/herself. PROs are increasingly seen as complementary to biomedical measures and they are being incorporated more frequently into clinical trials and clinical practice. After considering the cultural background of PROs - that is the well known patient-centered model of medicine -, their historical profile (since 1914, the year of the first outcome measure) and typologies, the paper aims at debating their methodological complexity and implementation into practice. Some clinical trials and therapeutic managements utilizing patient-centered measures will be also analyzed.

The Portuguese version of the Outcome Questionnaire (OQ-45): Normative data, reliability, and clinical significance cut-offs scores.

Science.gov (United States)

Machado, Paulo P P; Fassnacht, Daniel B

2015-12-01

The Outcome Questionnaire (OQ-45) is one of the most extensively used standardized self-report instruments to monitor psychotherapy outcomes. The questionnaire is designed specifically for the assessment of change during psychotherapy treatments. Therefore, it is crucial to provide norms and clinical cut-off values for clinicians and researchers. The current study aims at providing study provides norms, reliability indices, and clinical cut-off values for the Portuguese version of the scale. Data from two large non-clinical samples (high school/university, N = 1,669; community, N = 879) and one clinical sample (n = 201) were used to investigate psychometric properties and derive normative data for all OQ-45 subscales and the total score. Significant and substantial differences were found for all subscales between the clinical and non-clinical sample. The Portuguese version also showed adequate reliabilities (internal consistency, test-retest), which were comparable to the original version. To assess individual clinical change, clinical cut-off values and reliable change indices were calculated allowing clinicians and researchers to monitor and evaluate clients' individual change. The Portuguese version of the OQ-45 is a reliable instrument with comparable Portuguese norms and cut-off scores to those from the original version. This allows clinicians and researchers to use this instrument for evaluating change and outcome in psychotherapy. This study provides norms for non-clinical and clinical Portuguese samples and investigates the reliability (internal consistency and test-retest) of the OQ-45. Cut-off values and reliable change index are provided allowing clinicians to evaluate clinical change and clients' response to treatment, monitoring the quality of mental health care services. These can be used, in routine clinical practice, as benchmarks for treatment progress and to empirically base clinical decisions such as continuation of treatment or considering

The Effects of the Previous Outcome on Probabilistic Choice in Rats

Science.gov (United States)

Marshall, Andrew T.; Kirkpatrick, Kimberly

2014-01-01

This study examined the effects of previous outcomes on subsequent choices in a probabilistic-choice task. Twenty-four rats were trained to choose between a certain outcome (1 or 3 pellets) versus an uncertain outcome (3 or 9 pellets), delivered with a probability of .1, .33, .67, and .9 in different phases. Uncertain outcome choices increased with the probability of uncertain food. Additionally, uncertain choices increased with the probability of uncertain food following both certain-choice outcomes and unrewarded uncertain choices. However, following uncertain-choice food outcomes, there was a tendency to choose the uncertain outcome in all cases, indicating that the rats continued to “gamble” after successful uncertain choices, regardless of the overall probability or magnitude of food. A subsequent manipulation, in which the probability of uncertain food varied within each session as a function of the previous uncertain outcome, examined how the previous outcome and probability of uncertain food affected choice in a dynamic environment. Uncertain-choice behavior increased with the probability of uncertain food. The rats exhibited increased sensitivity to probability changes and a greater degree of win–stay/lose–shift behavior than in the static phase. Simulations of two sequential choice models were performed to explore the possible mechanisms of reward value computations. The simulation results supported an exponentially decaying value function that updated as a function of trial (rather than time). These results emphasize the importance of analyzing global and local factors in choice behavior and suggest avenues for the future development of sequential-choice models. PMID:23205915

Significant Returns in Engagement and Performance with a Free Teaching App

Science.gov (United States)

Green, Alan

2016-01-01

Pedagogical research shows that teaching methods other than traditional lectures may result in better outcomes. However, lecture remains the dominant method in economics, likely due to high implementation costs of methods shown to be effective in the literature. In this article, the author shows significant benefits of using a teaching app for…

The effect of duration of untreated psychosis and treatment delay on the outcomes of prolonged early intervention in psychotic disorders

DEFF Research Database (Denmark)

Albert, Nikolai; Melau, Marianne; Jensen, Heidi

2017-01-01

to the prolonged treatment with regards to disorganized and negative dimension. For participants with short duration from first symptom until start of SEI treatment there was a significant difference on the negative dimension favoring the prolonged OPUS treatment. The finding of an effect of prolonged treatment......The duration of untreated psychosis (DUP) has been shown to have an effect on outcome after first-episode psychosis. The premise of specialized early intervention (SEI) services is that intervention in the early years of illness can affect long-term outcomes. In this study, we investigate whether...... DUP affects treatment response after 5 years of SEI treatment compared to 2 years of SEI treatment. As part of a randomized controlled trial testing the effect of prolonged SEI treatment 400 participants diagnosed within the schizophrenia spectrum were recruited. For this specific study participants...

Effects of reducing blood pressure on renal outcomes in patients with type 2 diabetes: Focus on SGLT2 inhibitors and EMPA-REG OUTCOME.

Science.gov (United States)

Scheen, A J; Delanaye, P

2017-04-01

Empagliflozin, a sodium-glucose cotransporter type 2 (SGLT2) inhibitor, has enabled remarkable reductions in cardiovascular and all-cause mortality as well as in renal outcomes in patients with type 2 diabetes (T2D) and a history of cardiovascular disease in the EMPA-REG OUTCOME. These results have been attributed to haemodynamic rather than metabolic effects, in part due to the osmotic/diuretic action of empagliflozin and the reduction in arterial blood pressure (BP). The present narrative review includes the results of meta-analyses of trials evaluating the effects on renal outcomes of lowering BP in patients with T2D, with a special focus on the influence of baseline and achieved systolic BP, and compares the renal outcome results of the EMPA-REG OUTCOME with those of other major trials with inhibitors of the renin-angiotensin system in patients with T2D and the preliminary findings with other SGLT2 inhibitors, and also evaluates post hoc analyses from the EMPA-REG OUTCOME of special interest as regards the BP-lowering hypothesis and renal function. While systemic BP reduction associated to empagliflozin therapy may have contributed to the renal benefits reported in EMPA-REG OUTCOME, other local mechanisms related to kidney homoeostasis most probably also played a role in the overall protection observed in the trial. Copyright © 2017. Published by Elsevier Masson SAS.

The effect of Using Mind Mapping and Learning Styles to Geography Learning outcomes of Junior High School Students

Directory of Open Access Journals (Sweden)

Sigit Purwoko

2015-02-01

Full Text Available Pengaruh Penggunaan Peta Pikiran dan Gaya Belajar terhadap Hasil Belajar Geografi Siswa SMP Abstract: This study aimed to determine the effect of the use of mind maps, learning styles and inter-action using a mind map learning style on geography learning outcomes. This study was a quasi-experimental study, with a 2 x 3 factorial design study subject consisted of two classes of class VII G as experimental class and class VII F as a control class. Variables consisted of: (1 the dependent variable is the student learning outcomes; (2 the independent variable is the use of mind maps; and (3 is the moderator variable learning styles. Geography learning outcomes were measured using an objective test, whereas learning styles with questionnaires. Measurement data are then analyzed using ANOVA two paths with SPSS v.7. Results of data analysis using ANOVA two path showed that: (1 the use of mind maps significantly effect on learning outcomes geography; (2 learning style does not significantly affect the results of learning geography; and (3 there is no interaction between the use of mind maps and learning style on learning outcomes. Key Words: mind maps, learning styles, learning outcomes   Abstrak: Penelitian ini bertujuan untuk mengetahui pengaruh penggunaan peta pikiran, gaya belajar dan interaksi penggunaan peta pikiran dengan gaya belajar terhadap hasil belajar geografi. Penelitian ini merupakan penelitian eksperimen semu, dengan desain faktorial 2 x 3. Subjek penelitian terdiri dari dua kelas yaitu kelas VII G sebagai kelas eksperimen dan kelas VII F sebagai kelas kontrol. Variabel penelitian terdiri dari: (1 variabel terikat adalah hasil belajar siswa; (2 variabel bebas adalah pengguna-an peta pikiran; dan (3 variabel moderator adalah gaya belajar. Hasil belajar geografi diukur menggunakan tes objektif, sedangkan gaya belajar dengan angket. Data hasil pengukuran dianalisis menggunakan anova dua jalur dengan bantuan SPSS v.7. Hasil analisis data

Assessing clinical significance of treatment outcomes using the DASS-21.

Science.gov (United States)

Ronk, Fiona R; Korman, James R; Hooke, Geoffrey R; Page, Andrew C

2013-12-01

Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change. (c) 2013 APA, all rights reserved.

77 FR 48995 - Draft National Toxicology Program (NTP) Monograph on Developmental Effects and Pregnancy Outcomes...

Science.gov (United States)

2012-08-15

... Program (NTP) Monograph on Developmental Effects and Pregnancy Outcomes Associated With Cancer... the panel completes its peer review of the draft monograph. Topic: Peer review of the draft NTP Monograph on Developmental Effects and Pregnancy Outcomes Associated with Cancer Chemotherapy Use during...

Effects of new ways of working on work hours and work location, health and job-related outcomes.

Science.gov (United States)

Nijp, Hylco H; Beckers, Debby G J; van de Voorde, Karina; Geurts, Sabine A E; Kompier, Michiel A J

2016-01-01

New ways of working (NWW) is a type of work organization that is characterized by temporal and spatial flexibility, often combined with extensive use of information and communication technologies (ICT) and performance-based management. In a three-wave intervention study, we examined the effects of NWW on both the organization of work (changes in control over time and place of work; working hours and work location; and other key job characteristics), and on employees' outcomes (work-nonwork balance; health and well-being; and job-related outcomes). We applied a quasi-experimental design within a large Dutch financial company (N = 2,912). We studied an intervention group (n = 2,391) and made comparisons with a reference group (n = 521). There were three study waves: (i) one/two months before, and (ii) 4 months and (iii) 10 months after implementation of NWW. Repeated measures analyses of covariance (involving 361 participants from the intervention group and 80 participants from the reference group) showed a large and significant shift from hours worked at the office to hours worked at home after implementation of NWW. Accordingly, commuting time was reduced. Employees remained working on week days and during day time. Psychosocial work-characteristics, work-nonwork balance, stress, fatigue, and job-related outcomes remained favourable and largely unaffected, but the health score in the intervention group decreased (medium effect). These findings suggest that the implementation of NWW does not necessarily lead to changes in psychosocial work characteristics, well-being or job-related outcomes.

How effective are interventions to improve social outcomes among offenders with personality disorder: a systematic review.

Science.gov (United States)

Connell, Catriona; Furtado, Vivek; McKay, Elizabeth A; Singh, Swaran P

2017-11-17

Offenders with personality disorder are supported by health, criminal justice, social care and third sector services. These services are tasked with reducing risk, improving health and improving social outcomes. Research has been conducted into interventions that reduce risk or improve health. However, interventions to improve social outcomes are less clearly defined. To review the effectiveness of interventions to improve social outcomes we conducted a systematic review using Cochrane methodology, expanded to include non-randomised trials. Anticipated high heterogeneity of the studies informed narrative synthesis. Eleven studies met inclusion criteria. Five contained extractable data. No high-quality studies were identified. Outcomes measured clustered around employment and social functioning. Interventions vary and their mechanisms for influencing social outcomes are poorly operationalised. Although change was observed in employment rates, there was no evidence for the effectiveness of these interventions. There is a lack of evidence for effective interventions that improve social outcomes. Further research is recommended to reach consensus on the outcomes of importance, identify the factors that influence these and design theoretically-informed and evidence-based interventions.

Impact of Project Leadership Facets on Project Outcome

Directory of Open Access Journals (Sweden)

Arslan Ayub

2015-08-01

Full Text Available The study analyzes the role of project leadership facets on effective project outcome. Numerous such initiatives have already been taken on project outcome/performance in the context of apposite leadership styles or project management. However, the current study is unique in the milieu of project outcome that it introduces a new leadership approach, which throws light on the significance of variant leadership facets on project outcome. The study uses explanatory approach; primary data is collected from project management professionals working in different project organizations. The study uses structural equation model (SEM technique to test the hypothesis. The study found a positive relationship between project leadership facets and project outcome.

The Causal Effects of Grade Retention on Behavioral Outcomes

Science.gov (United States)

Martorell, Paco; Mariano, Louis T.

2018-01-01

This study examines the impact of grade retention on behavioral outcomes under a comprehensive assessment-based student promotion policy in New York City. To isolate the causal effect of grade retention, we implement a fuzzy regression discontinuity (RD) design that exploits the fact that grade retention is largely determined by whether a student…

Effects of management in gestational diabetes mellitus with normal prepregnancy body mass index on pregnancy outcomes and placental ultrastructures: a prospective cohort study.

Science.gov (United States)

Han, Yun; Zheng, Yan-Li; Wu, Ai-Min; Liu, Hong-Bin; Su, Jian-Bin; Lu, Xiao-Yan; Han, Yu-Wen; Ji, Jin-Long; Ji, Ju-Hua; Shi, Yue

2016-12-01

A great quantity of gestational diabetes mellitus with normal prepregnancy body mass index have emerged with the new criteria of gestational diabetes mellitus in China based on the International Diabetes in Pregnancy Consensus group criteria, and understanding placental changes and how they affect outcomes are necessary in order to develop effective management approach. The aim of this study was to prospectively explore the effect of active management starting from the late second trimester in gestational diabetes mellitus women with normal prepregnancy body mass index on pregnancy outcomes and placental ultrastructures, and to provide scientific evidences for optimizing the management of gestational diabetes mellitus in China. Gestational diabetes mellitus women with normal prepregnancy body mass index in the same period of this prospective cohort study were divided into intervention group (n = 51) and control group (n = 55). The intervention group was managed rigorously, while the control group received conventional prenatal cares. The glucose profile, gestational weight gain and pregnancy outcomes were followed up and placental ultrastructures were observed and recorded by transmission electron microscopy. The blood glucose level and gestational weight gain in intervention group were significantly better controlled than those in control group (P gestational age were significantly lower in intervention group than in control group (P gestational age (P gestational diabetes mellitus women with normal prepregnancy body mass index can improve pregnancy outcomes and placental ultrastructures, and the abnormal placental ultrastructure might be closely associated with the undesirable glycemic control and adverse pregnancy outcomes.

Retail price as an outcome measure for the effectiveness of drug law enforcement.

Science.gov (United States)

Bright, David A; Ritter, Alison

2010-09-01

One outcome measure of law enforcement effectiveness is the reduction in drug consumption which occurs as a result of law enforcement interventions. A theoretical relationship between drug consumption and retail price has promoted the use of retail price as a surrogate measure for consumption. In the current article, retail price is examined as a potential outcome measure for the effectiveness of law enforcement. The predictions regarding the relationship between law enforcement intensity and price are only partially supported by research. Explanations for the disconnect between the drug law enforcement activity and retail price include: rapid adaptation by market players, enforcement swamping, assumptions of rational actors, short-run versus long-run effects, structure of the illicit market, simultaneous changes that affect price in perverse ways, the role of violence in markets, and data limitations. Researchers who use retail price as an outcome measure need to take into account the complex relationship between drug law enforcement interventions and the retail price of illicit drugs. Viable outcome measures which can be used as complements to retail price are worth investigation. Copyright 2009 Elsevier B.V. All rights reserved.

The effect of taping versus semi-rigid bracing on patient outcome and satisfaction in ankle sprains: a prospective, randomized controlled trial.

Science.gov (United States)

Lardenoye, Sacha; Theunissen, Ed; Cleffken, Berry; Brink, Peter Rg; de Bie, Rob A; Poeze, Martijn

2012-05-28

Functional treatment is a widely used and generally accepted treatment for ankle sprain. A meta-analysis comparing the different functional treatment options could not make definitive conclusions regarding the effectiveness, and until now, little was known about patient satisfaction in relation to the outcome. Patients with acute ankle sprain received rest, ice, compression and elevation with an compressive bandage at the emergency department. After 5-7 days, 100 patients with grade II and III sprains were randomized into two groups: one group was treated with tape and the other with a semi-rigid ankle brace, both for 4 weeks. Post-injury physical and proprioceptive training was standardized. As primary outcome parameter patient satisfaction and skin complications were evaluated using a predefined questionnaire and numeric rating scale. As secondary outcome parameter the ankle joint function was assessed using the Karlsson scoring scale and range of motion. Patient-reported comfort and satisfaction during treatment with a semi-rigid brace was significantly increased. The rate of skin complication in this group was significantly lower compared to the tape group (14.6% versus 59.1%, P ankle joint was similar between the two treatment groups, as well as reported pain. Treatment of acute ankle sprain with semi-rigid brace leads to significantly higher patient comfort and satisfaction, both with similar good outcome.

Acute effects of alcohol on feedback processing and outcome evaluation during risky decision-making: an ERP study.

Science.gov (United States)

Euser, Anja S; van Meel, Catharina S; Snelleman, Michelle; Franken, Ingmar H A

2011-09-01

Although risky decision-making is one of the hallmarks of alcohol use disorders, relatively little is known about the acute psychopharmacological effects of alcohol on decision-making processes. The present study investigated the acute effects of alcohol on neural mechanisms underlying feedback processing and outcome evaluation during risky decision-making, using event-related brain potentials (ERPs). ERPs elicited by positive and negative feedback were recorded during performance of a modified version of the Balloon Analogue Risk Task in male participants receiving either a moderate dose of alcohol (0.65 g/kg alcohol; n = 32) or a non-alcoholic placebo beverage (n = 32). Overall, there was no significant difference in the mean number of pumps between the alcohol and the placebo condition. However, when analyzing over time, it was found that the alcohol group made more riskier choices at the beginning of the task than the placebo group. ERPs demonstrated that alcohol consumption did not affect early processing of negative feedback, indexed by the feedback-related negativity. By contrast, alcohol-intoxicated individuals showed significantly reduced P300 amplitudes in response to negative feedback as compared to sober controls, suggesting that more elaborate evaluation to losses was significantly diminished. These results suggest that alcohol consumption does not influence the ability to rapidly evaluate feedback valence, but rather the ability to assign sufficient attention to further process motivationally salient outcomes. Blunted P300 amplitudes may reflect poor integration of feedback across trials, particularly adverse ones. Consequently, alcohol may keep people from effectively predicting the probability of future gains and losses based on their reinforcement history.

The effects of prenatal cannabis exposure on fetal development and pregnancy outcomes: a protocol.

Science.gov (United States)

Gunn, Jayleen K L; Rosales, Cecilia B; Center, Katherine E; Nuñez, Annabelle V; Gibson, Steven J; Ehiri, John E

2015-03-13

The effects of exposure to marijuana in utero on fetal development are not clear. Given that the recent legislation on cannabis in the US is likely to result in increased use, there is a need to assess the effects of prenatal cannabis exposure on fetal development and pregnancy outcomes. The objective of this review is to assess the effects of prenatal exposure to cannabis on pregnancy outcomes (including maternal and child outcomes). Major databases will be searched from inception to the latest issue, with the aim of identifying studies that reported the effects of prenatal exposure to cannabis on fetal development and pregnancy outcomes. Two investigators will independently review all titles and abstracts to identify potential articles. Discrepancies will be resolved by repeated review, discussion and consensus. Study quality assessment will be undertaken, using standard protocols. To qualify for inclusion, studies must report at least one maternal or neonatal outcome post partum. Cross-sectional, case-control, cohort and randomised controlled trials published in English will be included. In order to rule out the effects of other drugs that may affect fetal development and pregnancy outcomes, studies will only be included if they report outcomes of prenatal exposure to cannabis while excluding other illicit substances. Data from eligible studies will be extracted, and data analysis will include a systematic review and critical appraisal of evidence, and meta-analysis if data permit. Meta-analysis will be conducted if three or more studies report comparable statistics on the same outcome. The review which will result from this protocol has not already been conducted. Preparation of the review will follow the procedures stated in this protocol, and will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ethical approval of data will not be required since the review will use data that are already available in the

EFFECT OF EPIDURAL ANALGESIA ON LABOR AND ITS OUTCOMES.

Science.gov (United States)

Anwar, Sadia; Anwar, Muhannad Waseem; Ahmad, Sajjad

2015-01-01

Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of. 50 each as per convenience. Patients of any gravidity at term from 37-41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia.

The Cascading Effects of Multiple Dimensions of Implementation on Program Outcomes: a Test of a Theoretical Model.

Science.gov (United States)

Berkel, Cady; Mauricio, Anne M; Sandler, Irwin N; Wolchik, Sharlene A; Gallo, Carlos G; Brown, C Hendricks

2017-12-14

This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents' competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.

Nitrous oxide and perioperative outcomes.

Science.gov (United States)

Ko, Hanjo; Kaye, Alan David; Urman, Richard D

2014-06-01

There is emerging evidence related to the effects of nitrous oxide on important perioperative patient outcomes. Proposed mechanisms include metabolic effects linked to elevated homocysteine levels and endothelial dysfunction, inhibition of deoxyribonucleic acid and protein formation, and depression of chemotactic migration by monocytes. Newer large studies point to possible risks associated with the use of nitrous oxide, although data are often equivocal and inconclusive. Cardiovascular outcomes such as stroke or myocardial infarction were shown to be unchanged in previous studies, but the more recent Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia I trial shows possible associations between nitrous oxide and increased cardiovascular and pulmonary complications. There are also possible effects on postoperative wound infections and neuropsychological function, although the multifactorial nature of these complications should be considered. Teratogenicity linked to nitrous oxide use has not been firmly established. The use of nitrous oxide for routine anesthetic care may be associated with significant costs if complications such as nausea, vomiting, and wound infections are taken into consideration. Overall, definitive data regarding the effect of nitrous oxide on major perioperative outcomes are lacking. There are ongoing prospective studies that may further elucidate its role. The use of nitrous oxide in daily practice should be individualized to each patient's medical conditions and risk factors.

Significance of change in serum bilirubin in predicting left ventricular reverse remodeling and outcomes in heart failure patients with cardiac resynchronization therapy.

Science.gov (United States)

Hosoda, Junya; Ishikawa, Toshiyuki; Matsumoto, Katsumi; Iguchi, Kohei; Matsushita, Hirooki; Ogino, Yutaka; Taguchi, Yuka; Sugano, Teruyasu; Ishigami, Tomoaki; Kimura, Kazuo; Tamura, Kouichi

2017-11-01

Research on the correlation of serum bilirubin level with cardiac function as well as outcomes in heart failure patients with cardiac resynchronization therapy (CRT) has not yet been reported. The aim of this study was to analyze the relationship between change in serum bilirubin level and left ventricular reverse remodeling, and also to clarify the impact of bilirubin change on clinical outcomes in CRT patients. We evaluated 105 consecutive patients who underwent CRT. Patients who had no serum total-bilirubin data at both baseline and 3-9 months' follow-up or had died less than 3 months after CRT implantation were excluded. Accordingly, a total of 69 patients were included in the present analysis. The patients were divided into two groups: decreased bilirubin group (serum total-bilirubin level at follow-up≤that at baseline; n=48) and increased bilirubin group (serum total-bilirubin level at follow-up>that at baseline; n=21). Mean follow-up period was 39.3 months. In the decreased bilirubin group, mean left ventricular end-systolic diameter decreased from 54.5mm to 50.2mm (p=0.001) and mean left ventricular ejection fraction increased significantly from 29.8% to 37.0% (p=0.001). In the increased bilirubin group, there was no significant change in echocardiographic parameters from baseline to follow-up. In Kaplan-Meyer analysis, cardiac mortality combined with heart failure hospitalization in the increased bilirubin group was significantly higher than that in the decreased bilirubin group (log-rank p=0.018). Multivariate Cox regression analysis revealed that increased bilirubin was an independent predictor of cardiac mortality combined with heart failure hospitalization (OR=2.66, p=0.023). The change in serum bilirubin is useful for assessment of left ventricular reverse remodeling and prediction of outcomes in heart failure patients with CRT. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Evaluating significance in linear mixed-effects models in R.

Science.gov (United States)

Luke, Steven G

2017-08-01

Mixed-effects models are being used ever more frequently in the analysis of experimental data. However, in the lme4 package in R the standards for evaluating significance of fixed effects in these models (i.e., obtaining p-values) are somewhat vague. There are good reasons for this, but as researchers who are using these models are required in many cases to report p-values, some method for evaluating the significance of the model output is needed. This paper reports the results of simulations showing that the two most common methods for evaluating significance, using likelihood ratio tests and applying the z distribution to the Wald t values from the model output (t-as-z), are somewhat anti-conservative, especially for smaller sample sizes. Other methods for evaluating significance, including parametric bootstrapping and the Kenward-Roger and Satterthwaite approximations for degrees of freedom, were also evaluated. The results of these simulations suggest that Type 1 error rates are closest to .05 when models are fitted using REML and p-values are derived using the Kenward-Roger or Satterthwaite approximations, as these approximations both produced acceptable Type 1 error rates even for smaller samples.

Effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour or patient outcomes

Science.gov (United States)

Flodgren, Gerd; Pomey, Marie-Pascale; Taber, Sarah A; Eccles, Martin P

2014-01-01

Background Inspection systems are used in health care to promote quality improvements, i.e. to achieve changes in organisational structures or processes, healthcare provider behaviour and patient outcomes. These systems are based on the assumption that externally promoted adherence to evidence-based standards (through inspection/assessment) will result in higher quality of health care. However, the benefits of external inspection in terms of organisational, provider and patient level outcomes are not clear. Objectives To evaluate the effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour and patient outcomes. Search methods We searched the following electronic databases for studies: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, Scopus, HMIC, Index to Theses and Intute from their inception dates up to May 2011. There was no language restriction and studies were included regardless of publication status. We searched the reference lists of included studies and contacted authors of relevant papers, accreditation bodies and the International Organization for Standardisation (ISO), regarding any further published or unpublished work. Selection criteria We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time-series (ITSs) and controlled before and after studies (CBAs) evaluating the effect of external inspection against external standards on healthcare organisation change, healthcare professional behaviour or patient outcomes in hospitals, primary healthcare organisations and other community-based healthcare organisations. Data collection and analysis Two review authors independently applied eligibility criteria, extracted data and assessed the risk of bias of each included study. Since meta-analysis was

Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts.

Science.gov (United States)

Failla, Mathew J; Logerstedt, David S; Grindem, Hege; Axe, Michael J; Risberg, May Arna; Engebretsen, Lars; Huston, Laura J; Spindler, Kurt P; Snyder-Mackler, Lynn

2016-10-01

Rehabilitation before anterior cruciate ligament (ACL) reconstruction (ACLR) is effective at improving postoperative outcomes at least in the short term. Less is known about the effects of preoperative rehabilitation on functional outcomes and return-to-sport (RTS) rates 2 years after reconstruction. The purpose of this study was to compare functional outcomes 2 years after ACLR in a cohort that underwent additional preoperative rehabilitation, including progressive strengthening and neuromuscular training after impairments were resolved, compared with a nonexperimental cohort. We hypothesized that the cohort treated with extended preoperative rehabilitation would have superior functional outcomes 2 years after ACLR. Cohort study; Level of evidence, 3. This study compared outcomes after an ACL rupture in an international cohort (Delaware-Oslo ACL Cohort [DOC]) treated with extended preoperative rehabilitation, including neuromuscular training, to data from the Multicenter Orthopaedic Outcomes Network (MOON) cohort, which did not undergo extended preoperative rehabilitation. Inclusion and exclusion criteria from the DOC were applied to the MOON database to extract a homogeneous sample for comparison. Patients achieved knee impairment resolution before ACLR, and postoperative rehabilitation followed each cohort's respective criterion-based protocol. Patients completed the International Knee Documentation Committee (IKDC) subjective knee form and Knee injury and Osteoarthritis Outcome Score (KOOS) at enrollment and again 2 years after ACLR. RTS rates were calculated for each cohort at 2 years. After adjusting for baseline IKDC and KOOS scores, the DOC patients showed significant and clinically meaningful differences in IKDC and KOOS scores 2 years after ACLR. There was a significantly higher (P < .001) percentage of DOC patients returning to preinjury sports (72%) compared with those in the MOON cohort (63%). The cohort treated with additional preoperative

Effects of performance feedback and coaching on the problem-solving process: Improving the integrity of implementation and enhancing student outcomes

Science.gov (United States)

Lundahl, Allison A.

Schools implementing Response to Intervention (RtI) procedures frequently engage in team problem-solving processes to address the needs of students who require intensive and individualized services. Because the effectiveness of the problem-solving process will impact the overall success of RtI systems, the present study was designed to learn more about how to strengthen the integrity of the problem-solving process. Research suggests that school districts must ensure high quality training and ongoing support to enhance the effectiveness, acceptability, and sustainability of the problem-solving process within an RtI model; however, there is a dearth of research examining the effectiveness of methods to provide this training and support. Consequently, this study investigated the effects of performance feedback and coaching strategies on the integrity with which teams of educators conducted the problem-solving process in schools. In addition, the relationships between problem-solving integrity, teacher acceptability, and student outcomes were examined. Results suggested that the performance feedback increased problem-solving procedural integrity across two of the three participating schools. Conclusions about the effectiveness of the (a) coaching intervention and (b) interventions implemented in the third school were inconclusive. Regression analyses indicated that the integrity with which the teams conducted the problem-solving process was a significant predictor of student outcomes. However, the relationship between problem-solving procedural integrity and teacher acceptability was not statistically significant.

Effects of antenatal diet and physical activity on maternal and fetal outcomes

DEFF Research Database (Denmark)

Rogozińska, Ewelina; Marlin, Nadine; Jackson, Louise

2017-01-01

BACKGROUND: Diet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes. OBJECTIVES: To assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity......, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre...

Systematic review and meta-analysis of the effect of equine assisted activities and therapies on gross motor outcome in children with cerebral palsy.

Science.gov (United States)

Tseng, Sung-Hui; Chen, Hung-Chou; Tam, Ka-Wai

2013-01-01

To evaluate the literature on the efficacy of equine assisted activities and therapies (EAAT) on gross motor outcomes representing the ICF component of body functions and activity in children with cerebral palsy (CP). We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies of hippotherapy (HPOT) and therapeutic horseback riding (TR) for children with spastic CP. Gross motor outcomes, assessed via muscle activity and muscle tone, gait, posture and Gross Motor Function Measures (GMFM) were evaluated. Five TR studies and nine HPOT studies were included. Our meta-analysis indicated that short-term HPOT (total riding time 8-10 min) significantly reduced asymmetrical activity of the hip adductor muscles. HPOT could improve postural control in children with spastic CP, GMFCS level < 5. However, the evidence did not show a statistically significant effect on GMFM after long-term HPOT or TR (total riding time, 8-22 h) in children with spastic CP. This systematic review found insufficient evidence to support the claim that long-term TR or HPOT provide a significant benefit to children with spastic CP. We found no statistically significant evidence of either therapeutic effect or maintenance effects on the gross motor activity status in CP children.

Non-cognitive Child Outcomes and Universal High Quality Child Care

DEFF Research Database (Denmark)

Datta Gupta, Nabanita; Simonsen, Marianne

2010-01-01

universal preschool programs and family day care vis-à-vis home care. We find that, compared to home care, being enrolled in preschool at age three does not lead to significant differences in child outcomes at age seven no matter the gender or the mother's level of education. Family day care, on the other...... hand, seems to significantly deteriorate outcomes for boys whose mothers have a lower level of education. Finally, longer hours in non-parental care lead to poorer child outcomes.......Exploiting a rich panel data child survey merged with administrative records along with a pseudoexperiment generating variation in the take-up of preschool across municipalities, we provide evidence of the effects on non-cognitive child outcomes of participating in large scale publicly provided...

Neonatal and infant outcome in boys and girls born very prematurely.

Science.gov (United States)

Peacock, Janet L; Marston, Louise; Marlow, Neil; Calvert, Sandra A; Greenough, Anne

2012-03-01

Although important new strategies have improved outcomes for very preterm infants, males have greater mortality/morbidity than females. We investigated whether the excess of adverse later effects in males operated through poorer neonatal profile or if there was an intrinsic male effect. Male sex was significantly associated with higher birth weight, death or oxygen dependency (72% vs. 61%, boys vs. girls), hospital stay (97 vs. 86 days), pulmonary hemorrhage (15% vs. 10%), postnatal steroids (37% vs. 21%), and major cranial ultrasound abnormality (20% vs. 12%). Differences remained significant after adjusting for birth weight and gestation. At follow-up, disability, cognitive delay, and use of inhalers remained significant after further adjustment. We conclude that in very preterm infants, male sex is an important risk factor for poor neonatal outcome and poor neurological and respiratory outcome at follow-up. The increased risks at follow-up are not explained by neonatal factors and lend support to the concept of male vulnerability following preterm birth. Data came from the United Kingdom Oscillation Study, with 797 infants (428 boys) born at 23-28 wk gestational age. Thirteen maternal factors, 8 infant factors, 11 acute outcomes, and neurological and respiratory outcomes at follow-up were analyzed. Follow-up outcomes were adjusted for birth and neonatal factors sequentially to explore mechanisms for differences by sex.

Does the Rotator Cuff Tear Pattern Influence Clinical Outcomes After Surgical Repair?

Science.gov (United States)

Watson, Scott; Allen, Benjamin; Robbins, Chris; Bedi, Asheesh; Gagnier, Joel J; Miller, Bruce

2018-03-01

Limited literature exists regarding the influence of rotator cuff tear morphology on patient outcomes. To determine the effect of rotator cuff tear pattern (crescent, U-shape, L-shape) on patient-reported outcomes after rotator cuff repair. Cohort study; Level of evidence, 3. Patients undergoing arthroscopic repair of known full-thickness rotator cuff tears were observed prospectively at regular intervals from baseline to 1 year. The tear pattern was classified at the time of surgery as crescent, U-shaped, or L-shaped. Primary outcome measures were the Western Ontario Rotator Cuff Index (WORC), the American Shoulder and Elbow Surgeons (ASES), and a visual analog scale (VAS) for pain. The tear pattern was evaluated as the primary predictor while controlling for variables known to affect rotator cuff outcomes. Mixed-methods regression and analysis of variance (ANOVA) were used to examine the effects of tear morphology on patient-reported outcomes after surgical repair from baseline to 1 year. A total of 82 patients were included in the study (53 male, 29 female; mean age, 58 years [range, 41-75 years]). A crescent shape was the most common tear pattern (54%), followed by U-shaped (25%) and L-shaped tears (21%). There were no significant differences in outcome scores between the 3 groups at baseline. All 3 groups showed statistically significant improvement from baseline to 1 year, but analysis failed to show any predictive effect in the change in outcome scores from baseline to 1 year for the WORC, ASES, or VAS when tear pattern was the primary predictor. Further ANOVA also failed to show any significant difference in the change in outcome scores from baseline to 1 year for the WORC ( P = .96), ASES ( P = .71), or VAS ( P = .86). Rotator cuff tear pattern is not a predictor of functional outcomes after arthroscopic rotator cuff repair.

Effects of antenatal diet and physical activity on maternal and fetal outcomes

DEFF Research Database (Denmark)

Rogozińska, Ewelina; Marlin, Nadine; Jackson, Louise

2017-01-01

, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions. DATA SOURCES: MEDLINE, EMBASE...... quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions. RESULTS: Diet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI -0.92 to -0.48 kg; 33 studies......: The differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003804. FUNDING: The National Institute for Health Research Health Technology Assessment programme....

Psychological distress and its effect on tuberculosis treatment outcomes in Ethiopia

Directory of Open Access Journals (Sweden)

Habteyes Hailu Tola

2015-11-01

Full Text Available Background: Psychological distress is the major comorbidity among tuberculosis (TB patients. However, its magnitude, associated factors, and effect on treatment outcome have not been adequately studied in low-income countries. Objective: This study aimed to determine the magnitude of psychological distress and its effect on treatment outcome among TB patients on treatment. Design: A follow-up study was conducted in Addis Ababa, Ethiopia, from May to December 2014. Patients (N=330 diagnosed with all types of TB who had been on treatment for 1–2 months were enrolled consecutively from 15 randomly selected health centers and one TB specialized hospital. Data on sociodemographic variables and economic status were collected using a structured questionnaire. The presence of psychological distress was assessed at baseline (within 1–2 months after treatment initiation and end point (6 months after treatment initiation using the 10-item Kessler (K-10 scale. Alcohol use and tobacco smoking history were assessed using WHO Alcohol Use Disorder Identification Test and Australian Smoking Assessment Checklist, respectively. The current WHO TB treatment outcome definition was used to differentiate the end result of each patient at completion of the treatment. Results: The overall psychological distress was 67.6% at 1–2 months and 48.5% at 6 months after treatment initiation. Multiple logistic regression analysis revealed that past TB treatment history [adjusted odds ratio (AOR: 3.76; 95% confidence interval (CI: 1.67–8.45], being on anti-TB and anti-HIV treatments (AOR: 5.35; 95% CI: 1.83–15.65, being unmarried (AOR: 4.29; 95% CI: 2.45–7.53, having alcohol use disorder (AOR: 2.95; 95% CI: 1.25–6.99, and having low economic status (AOR: 4.41; 95% CI: 2.44–7.97 were significantly associated with psychological distress at baseline. However, at 6 months after treatment initiation, only being a multidrug-resistant tuberculosis (MDR-TB patient (AOR: 3

Estimating overall exposure effects for the clustered and censored outcome using random effect Tobit regression models.

Science.gov (United States)

Wang, Wei; Griswold, Michael E

2016-11-30

The random effect Tobit model is a regression model that accommodates both left- and/or right-censoring and within-cluster dependence of the outcome variable. Regression coefficients of random effect Tobit models have conditional interpretations on a constructed latent dependent variable and do not provide inference of overall exposure effects on the original outcome scale. Marginalized random effects model (MREM) permits likelihood-based estimation of marginal mean parameters for the clustered data. For random effect Tobit models, we extend the MREM to marginalize over both the random effects and the normal space and boundary components of the censored response to estimate overall exposure effects at population level. We also extend the 'Average Predicted Value' method to estimate the model-predicted marginal means for each person under different exposure status in a designated reference group by integrating over the random effects and then use the calculated difference to assess the overall exposure effect. The maximum likelihood estimation is proposed utilizing a quasi-Newton optimization algorithm with Gauss-Hermite quadrature to approximate the integration of the random effects. We use these methods to carefully analyze two real datasets. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Effects of ibuprofen, diclofenac, naproxen, and piroxicam on the course of pregnancy and pregnancy outcome: a prospective cohort study

Science.gov (United States)

Nezvalová-Henriksen, K; Spigset, O; Nordeng, H

2013-01-01

Objective To investigate the individual effects of ibuprofen, diclofenac, naproxen, and piroxicam on pregnancy outcome. Design Cohort study. Setting Norwegian population. Population Total of 90 417 women and singleton child pairs. Methods Norwegian Mother and Child Cohort Study and Medical Birth Registry of Norway datasets were used. Main outcome measures Infant survival, congenital malformations, structural heart defects, neonatal complications, haemorrhage during pregnancy and postpartum, asthma at age of 18 months. Results One or more of the four NSAIDs were used by 6511 pregnant women, (7.2%). No effect on infant survival, congenital malformation, or structural heart defect rate was found. Second trimester ibuprofen use was significantly associated with low birth weight (adjusted OR 1.7, 95% CI 1.3 to 2.3) and second and third trimester use was significantly associated with asthma in the 18 month old child (adjusted OR 1.5, 95%CI 1.2 to 1.9 and adjusted OR 1.5, 95%CI 1.1 to 2.1). Second trimester diclofenac use was significantly associated with low birth weight (adjusted OR 3.1, 95% CI 1.1 to 9.0), whereas third trimester use was significantly associated with maternal vaginal bleeding (adjusted OR 1.8, 95% CI 1.1 to 3.0). No associations with other neonatal complications were found. Conclusions The lack of associations with congenital malformations is reassuring. The significant association between diclofenac and ibuprofen use late in pregnancy and maternal bleeding and asthma in the child respectively is consistent with their pharmacological effects. The increased risk of low birth weight may partly have been caused by underlying inflammatory conditions and was reassuringly similar to the expected baseline risk of low birth weight. PMID:23489333

Collaborative writing applications in healthcare: effects on professional practice and healthcare outcomes.

Science.gov (United States)

Archambault, Patrick M; van de Belt, Tom H; Kuziemsky, Craig; Plaisance, Ariane; Dupuis, Audrey; McGinn, Carrie A; Francois, Rebecca; Gagnon, Marie-Pierre; Turgeon, Alexis F; Horsley, Tanya; Witteman, William; Poitras, Julien; Lapointe, Jean; Brand, Kevin; Lachaine, Jean; Légaré, France

2017-05-10

Collaborative writing applications (CWAs), such as wikis and Google Documents, hold the potential to improve the use of evidence in both public health and healthcare. Although a growing body of literature indicates that CWAs could have positive effects on healthcare, such as improved collaboration, behavioural change, learning, knowledge management, and adaptation of knowledge to local context, this has never been assessed systematically. Moreover, several questions regarding safety, reliability, and legal aspects exist. The objectives of this review were to (1) assess the effects of the use of CWAs on process (including the behaviour of healthcare professionals) and patient outcomes, (2) critically appraise and summarise current evidence on the use of resources, costs, and cost-effectiveness associated with CWAs to improve professional practices and patient outcomes, and (3) explore the effects of different CWA features (e.g. open versus closed) and different implementation factors (e.g. the presence of a moderator) on process and patient outcomes. We searched CENTRAL, MEDLINE, Embase, and 11 other electronic databases. We searched the grey literature, two trial registries, CWA websites, individual journals, and conference proceedings. We also contacted authors and experts in the field. We did not apply date or language limits. We searched for published literature to August 2016, and grey literature to September 2015. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-and-after (CBA) studies, interrupted time series (ITS) studies, and repeated measures studies (RMS), in which CWAs were used as an intervention to improve the process of care, patient outcomes, or healthcare costs. Teams of two review authors independently assessed the eligibility of studies. Disagreements were resolved by discussion, and when consensus was not reached, a third review author was consulted. We screened 11,993 studies identified

Effects of asymptomatic rotator cuff pathology on in vivo shoulder motion and clinical outcomes.

Science.gov (United States)

Baumer, Timothy G; Dischler, Jack; Mende, Veronica; Zauel, Roger; van Holsbeeck, Marnix; Siegal, Daniel S; Divine, George; Moutzouros, Vasilios; Bey, Michael J

2017-06-01

The incidence of asymptomatic rotator cuff tears has been reported to range from 15% to 39%, but the influence of asymptomatic rotator cuff pathology on shoulder function is not well understood. This study assessed the effects of asymptomatic rotator cuff pathology on shoulder kinematics, strength, and patient-reported outcomes. A clinical ultrasound examination was performed in 46 asymptomatic volunteers (age: 60.3 ± 7.5 years) with normal shoulder function to document the condition of their rotator cuff. The ultrasound imaging identified the participants as healthy (n = 14) or pathologic (n = 32). Shoulder motion was measured with a biplane x-ray imaging system, strength was assessed with a Biodex (Biodex Medical Systems, Inc., Shirley, NY, USA), and patient-reported outcomes were assessed using the Western Ontario Rotator Cuff Index and visual analog scale pain scores. Compared with healthy volunteers, those with rotator cuff pathology had significantly less abduction (P = .050) and elevation (P = .041) strength, their humerus was positioned more inferiorly on the glenoid (P = .018), and the glenohumeral contact path length was longer (P = .007). No significant differences were detected in the Western Ontario Rotator Cuff Index, visual analog scale, range of motion, or acromiohumeral distance. The differences observed between the healthy volunteers and those with asymptomatic rotator cuff pathology lend insight into the changes in joint mechanics, shoulder strength, and conventional clinical outcomes associated with the early stages of rotator cuff pathology. Furthermore, these findings suggest a plausible mechanical progression of kinematic and strength changes associated with the development of rotator cuff pathology. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Labor stimulation with oxytocin: effects on obstetrical and neonatal outcomes

Directory of Open Access Journals (Sweden)

Pedro Hidalgo-Lopezosa

Full Text Available Abstract Objective: to evaluate the effects of labor stimulation with oxytocin on maternal and neonatal outcomes. Method: descriptive and analytical study with 338 women who gave birth at a tertiary hospital. Obstetric and neonatal variables were measured and compared in women submitted and non-submitted to stimulation with oxytocin. Statistics were performed using Chi-square test, Fisher exact test, Student t-test; and crude Odds Ratio with 95% confidence interval were calculated. A p < 0.05 was considered statistically significant. Results: stimulation with oxytocin increases the rates of cesarean sections, epidural anesthesia and intrapartum maternal fever in primiparous and multiparous women. It has also been associated with low pH values of umbilical cord blood and with a shorter duration of the first stage of labor in primiparous women. However, it did not affect the rates of 3rd and 4th degree perineal lacerations, episiotomies, advanced neonatal resuscitation, 5-minute Apgar scores and meconium. Conclusion: stimulation with oxytocin should not be used systematically, but only in specific cases. These findings provide further evidence to health professionals and midwives on the use of oxytocin during labor. Under normal conditions, women should be informed of the possible effects of labor stimulation with oxytocin.

Effects of a social accountability approach, CARE's Community Score Card, on reproductive health-related outcomes in Malawi: A cluster-randomized controlled evaluation.

Science.gov (United States)

Gullo, Sara; Galavotti, Christine; Sebert Kuhlmann, Anne; Msiska, Thumbiko; Hastings, Phil; Marti, C Nathan

2017-01-01

Social accountability approaches, which emphasize mutual responsibility and accountability by community members, health care workers, and local health officials for improving health outcomes in the community, are increasingly being employed in low-resource settings. We evaluated the effects of a social accountability approach, CARE's Community Score Card (CSC), on reproductive health outcomes in Ntcheu district, Malawi using a cluster-randomized control design. We matched 10 pairs of communities, randomly assigning one from each pair to intervention and control arms. We conducted two independent cross-sectional surveys of women who had given birth in the last 12 months, at baseline and at two years post-baseline. Using difference-in-difference (DiD) and local average treatment effect (LATE) estimates, we evaluated the effects on outcomes including modern contraceptive use, antenatal and postnatal care service utilization, and service satisfaction. We also evaluated changes in indicators developed by community members and service providers in the intervention areas. DiD analyses showed significantly greater improvements in the proportion of women receiving a home visit during pregnancy (B = 0.20, P reproductive health-related outcomes. Further, the CSC builds mutual accountability, and ensures that solutions to problems are locally-relevant, locally-supported and feasible to implement.

Social cognitive markers of short-term clinical outcome in first-episode psychosis.

Science.gov (United States)

Montreuil, Tina; Bodnar, Michael; Bertrand, Marie-Claude; Malla, Ashok K; Joober, Ridha; Lepage, Martin

2010-07-01

In psychotic disorders, impairments in cognition have been associated with both clinical and functional outcome, while deficits in social cognition have been associated with functional outcome. As an extension to a recent report on neurocognition and short-term clinical outcome in first-episode psychosis (FEP), the current study explored whether social cognitive deficits could also identify poor short-term clinical outcome among FEP patients. We defined the social-cognition domain based on the scores from the Hinting Task and the Four Factor Tests of Social Intelligence. Data were collected in 45 FEP patients and 26 healthy controls. The patients were divided into good- and poor-outcome groups based on clinical data at six months following initiation of treatment. Social cognition was compared among 27 poor-outcome, 18 good-outcome, and 26 healthy-control participants. Outcome groups significantly differed in the social cognition domain (z-scores: poor outcome=-2.0 [SD=1.4]; good outcome=-1.0 [SD=1.0]; p=0.005), with both groups scoring significantly lower than the control group (psocial cognition appears to be compromised in all FEP patients compared to healthy controls. More interestingly, significant differences in social cognitive impairments exist between good and poor short-term clinical outcome groups, with the largest effect found in the Cartoon Predictions subtest.

Moderating Effects of Alexithymia on Associations between the Therapeutic Alliance and the Outcome of Brief Psychodynamic-Interpersonal Psychotherapy for Multisomatoform Disorder.

Science.gov (United States)

Probst, Thomas; Sattel, Heribert; Gündel, Harald; Henningsen, Peter; Kruse, Johannes; Schneider, Gudrun; Lahmann, Claas

2017-01-01

This secondary analysis of a trial on brief psychodynamic-interpersonal therapy (PIT) for patients with multisomatoform disorder investigated whether alexithymia moderates the associations between the therapeutic alliance and the outcome of PIT and whether moderating effects of alexithymia remain significant when controlling for depression. Eighty-three patients with multisomatoform disorder receiving PIT were statistically analyzed. Moderation analyses were performed with the SPSS macro PROCESS. The primary outcome (Y), self-reported physical quality of life at 9-month after the end of PIT, was measured with the physical component summary (PCS) of the SF-36 Health Survey. The potential moderator (M) alexithymia was operationalized with the Toronto Alexithymia Scale (TAS-20) at pre-treatment and the predictor (X) the therapeutic alliance was rated by both patients and therapists via the Helping Alliance Questionnaire (HAQ) at the end of PIT. Moreover, the PCS at pre-treatment functioned as covariate in all moderation models. When the patients' alliance ratings were analyzed, alexithymia did not moderate associations between the alliance and the outcome. When the therapists' alliance ratings were evaluated, alexithymia moderated the relationship between the alliance and the outcome ( p  moderating effect of alexithymia was, however, not statistically significant anymore when adding the pre-treatment depression scores (PHQ-9) as a covariate to the moderation model. The results underline the importance of a good therapists' view of the alliance when treating alexithymic patients and highlight the complex interaction between alexithymia and depression. Future studies are needed to extend the scope of research regarding which psychotherapeutic mechanisms of change are beneficial for which patients.

Visual outcome in Japanese patients with Acanthamoeba keratitis.

Science.gov (United States)

Yamazoe, K; Yamamoto, Y; Shimazaki-Den, S; Shimazaki, J

2012-04-01

To identify prognostic factors affecting visual outcome in Acanthamoeba keratitis (AK) treated with topical chlorhexidine gluconate (CHG). A total of 35 eyes in 34 patients with AK were treated with 0.02% topical CHG. Patients were divided into two groups according to the final visual outcome: Group 1, final visual acuity (VA) of 20/25 or greater (22 eyes); Group 2, less than 20/25 (13 eyes). We compared these groups and evaluated the effectiveness of topical CHG compared with outcomes in previous reports. Ring infiltrate was observed more often in Group 2 (4.5% vs 61.5%, OR 33.6, 95% confidence interval (CI) 3.4-333.9, PAK was significantly longer (24.9 days vs 48.4 days, OR 1.03, 95% CI 1.00-1.06, P = 0.04) and VA at initial examination (log MAR) significantly lower (0.47 vs 1.59, OR 25.5, 95% CI 3.4-186.7, PAK. Topical CHG was comparably effective to other treatments, including polyhexamethyl biguanide and propamidine isethionate.

The outcome of ART in males with impaired spermatogenesis

Directory of Open Access Journals (Sweden)

V S Mangoli

2008-01-01

Full Text Available Aims: This study was conducted to evaluate the outcomes of assisted reproductive technology (ART procedures, viz., intrauterine insemination (IUI, in vitro fertilization (IVF and intracytoplasmic sperm injection (ICSI in males with impaired spermatogenesis. Settings and Design: The subjects of the study were infertile couples who were undergoing ART treatment due to male factor indications. The project was designed to correlate the outcome of the ART treatment and its efficacy in different study groups. Methods: Males were grouped as: 1. oligozoospermia (n = 153, 2. asthenoteratozoospermia (n = 158, 3. obstructive azoospermia (n = 110 and 4. nonobstructive azoospermia (n = 58. Patients from groups 1 and 2 were considered for IUI, IVF and ICSI. Those from group 3 were considered for IVF and ICSI and the 4th group underwent only ICSI treatment. Results: Oligozoospermia showed lower pregnancy rates with IUI than with both IVF and ICSI. An average minimum native and postharvest count was obtained to get an acceptable IUI outcome. Asthenoteratozoospermia had the lowest pregnancy rate with IUI as compared to IVF, whereas ICSI showed significantly higher pregnancy rates in this group. Obstructive azoospermia showed significant improvement with ICSI over IVF. In nonobstructive azoospermia, ICSI resulted in a 27.58% pregnancy rate. Conclusion: The IUI outcome was impressive though less effective whereas there was no difference between the IVF and ICSI outcomes in oligozoospermia. In asthenoteratozoospermia, ICSI showed a significant advantage over IUI and IVF, with IUI resulting in poor outcome in this group. In obstructive azoospermia, ICSI had a distinct advantage over IVF whereas in nonobstructive azoospermia, ICSI, the only option, was found to be effective and helpful in achieving an acceptable pregnancy rate.

Moderating Effects of Alexithymia on Associations between the Therapeutic Alliance and the Outcome of Brief Psychodynamic-Interpersonal Psychotherapy for Multisomatoform Disorder

Directory of Open Access Journals (Sweden)

Thomas Probst

2017-12-01

Full Text Available This secondary analysis of a trial on brief psychodynamic-interpersonal therapy (PIT for patients with multisomatoform disorder investigated whether alexithymia moderates the associations between the therapeutic alliance and the outcome of PIT and whether moderating effects of alexithymia remain significant when controlling for depression. Eighty-three patients with multisomatoform disorder receiving PIT were statistically analyzed. Moderation analyses were performed with the SPSS macro PROCESS. The primary outcome (Y, self-reported physical quality of life at 9-month after the end of PIT, was measured with the physical component summary (PCS of the SF-36 Health Survey. The potential moderator (M alexithymia was operationalized with the Toronto Alexithymia Scale (TAS-20 at pre-treatment and the predictor (X the therapeutic alliance was rated by both patients and therapists via the Helping Alliance Questionnaire (HAQ at the end of PIT. Moreover, the PCS at pre-treatment functioned as covariate in all moderation models. When the patients’ alliance ratings were analyzed, alexithymia did not moderate associations between the alliance and the outcome. When the therapists’ alliance ratings were evaluated, alexithymia moderated the relationship between the alliance and the outcome (p < 0.05: a stronger alliance in the therapists’ perspective was beneficial for the outcome only for patients scoring above 61 on the TAS-20. This moderating effect of alexithymia was, however, not statistically significant anymore when adding the pre-treatment depression scores (PHQ-9 as a covariate to the moderation model. The results underline the importance of a good therapists’ view of the alliance when treating alexithymic patients and highlight the complex interaction between alexithymia and depression. Future studies are needed to extend the scope of research regarding which psychotherapeutic mechanisms of change are beneficial for which patients.

Network meta-analysis of multiple outcome measures accounting for borrowing of information across outcomes.

Science.gov (United States)

Achana, Felix A; Cooper, Nicola J; Bujkiewicz, Sylwia; Hubbard, Stephanie J; Kendrick, Denise; Jones, David R; Sutton, Alex J

2014-07-21

Network meta-analysis (NMA) enables simultaneous comparison of multiple treatments while preserving randomisation. When summarising evidence to inform an economic evaluation, it is important that the analysis accurately reflects the dependency structure within the data, as correlations between outcomes may have implication for estimating the net benefit associated with treatment. A multivariate NMA offers a framework for evaluating multiple treatments across multiple outcome measures while accounting for the correlation structure between outcomes. The standard NMA model is extended to multiple outcome settings in two stages. In the first stage, information is borrowed across outcomes as well across studies through modelling the within-study and between-study correlation structure. In the second stage, we make use of the additional assumption that intervention effects are exchangeable between outcomes to predict effect estimates for all outcomes, including effect estimates on outcomes where evidence is either sparse or the treatment had not been considered by any one of the studies included in the analysis. We apply the methods to binary outcome data from a systematic review evaluating the effectiveness of nine home safety interventions on uptake of three poisoning prevention practices (safe storage of medicines, safe storage of other household products, and possession of poison centre control telephone number) in households with children. Analyses are conducted in WinBUGS using Markov Chain Monte Carlo (MCMC) simulations. Univariate and the first stage multivariate models produced broadly similar point estimates of intervention effects but the uncertainty around the multivariate estimates varied depending on the prior distribution specified for the between-study covariance structure. The second stage multivariate analyses produced more precise effect estimates while enabling intervention effects to be predicted for all outcomes, including intervention effects on

The Effect of Childbirth Self-Efficacy on Perinatal Outcomes

Science.gov (United States)

Tilden, Ellen L.; Caughey, Aaron B.; Lee, Christopher S.; Emeis, Cathy

2016-01-01

Objective To synthesize and critique the quantitative literature on measuring childbirth self-efficacy and the effect of childbirth self-efficacy on perinatal outcomes. Data Sources Eligible studies were identified through searching MEDLINE, CINAHL, Scopus, and Google Scholar databases. Study Selection Published research using a tool explicitly intended to measure childbirth self-efficacy and also examining outcomes within the perinatal period were included. All manuscripts were in English and published in peer-reviewed journals. Data Extraction First author, country, year of publication, reference and definition of childbirth self-efficacy, measurement of childbirth self-efficacy, sample recruitment and retention, sample characteristics, study design, interventions (with experimental and quasi-experimental studies), and perinatal outcomes were extracted and summarized. Data Synthesis Of 619 publications, 23 studies published between 1983 and 2015 met inclusion criteria and were critiqued and synthesized in this review. Conclusions There is overall consistency in how childbirth self-efficacy is defined and measured among studies, facilitating comparison and synthesis. Our findings suggest that increased childbirth self-efficacy is associated with a wide variety of improved perinatal outcomes. Moreover, there is evidence that childbirth self-efficacy is a psychosocial factor that can be modified through various efficacy-enhancing interventions. Future researchers will be able to build knowledge in this area through: (a) utilization of experimental and quasi-experimental design; (b) recruitment and retention of more diverse samples; (c) explicit reporting of definitions of terms (e.g. ‘high risk’); (d) investigation of interventions that increase childbirth self-efficacy during pregnancy; and, (e) investigation regarding how childbirth self-efficacy enhancing interventions might lead to decreased active labor pain and suffering. Exploratory research should

Adolescent and parent motivation for change affects psychotherapy outcomes among youth with poorly controlled diabetes.

Science.gov (United States)

Ellis, Deborah A; Berio, Heidi; Carcone, April Idalski; Naar-King, Sylvie

2012-01-01

Investigate effect of baseline motivation for change on treatment fidelity, therapeutic alliance, treatment dose, and treatment outcome in a randomized controlled trial of family therapy for youth with poorly controlled diabetes. Seventy-four adolescents and caregivers completed measures of motivation for change. Measures of fidelity, alliance, dose, and youth health status were collected. Structural equation modeling was used to test the direct and indirect effects of motivation on treatment outcomes. Parent motivation was significantly related to alliance and fidelity. Only alliance was significantly related to posttreatment metabolic control. In adolescent models, only motivation was significantly related to alliance. In both models, motivation had a significant indirect effect on metabolic control through alliance. Findings demonstrate the importance of parent and youth initial motivational status and treatment alliance to treatment outcome among youth with poorly controlled diabetes. Additional research on treatment techniques that promote motivation for change is needed.

Injuries to the upper extremities in polytrauma: limited effect on outcome more than ten years after injury - a cohort study in 629 patients.

Science.gov (United States)

Macke, C; Winkelmann, M; Mommsen, P; Probst, C; Zelle, B; Krettek, C; Zeckey, C

2017-02-01

To analyse the influence of upper extremity trauma on the long-term outcome of polytraumatised patients. A total of 629 multiply injured patients were included in a follow-up study at least ten years after injury (mean age 26.5 years, standard deviation 12.4). The extent of the patients' injury was classified using the Injury Severity Score. Outcome was measured using the Hannover Score for Polytrauma Outcome (HASPOC), Short Form (SF)-12, rehabilitation duration, and employment status. Outcomes for patients with and without a fracture of the upper extremity were compared and analysed with regard to specific fracture regions and any additional brachial plexus lesion. In all, 307 multiply-injured patients with and 322 without upper extremity injuries were included in the study. The groups with and without upper limb injuries were similar with respect to demographic data and injury pattern, except for midface trauma. There were no significant differences in the long-term outcome. In patients with brachial plexus lesions there were significantly more who were unemployed, required greater retraining and a worse HASPOC. Injuries to the upper extremities seem to have limited effect on long-term outcome in patients with polytrauma, as long as no injury was caused to the brachial plexus. Cite this article: Bone Joint J 2017;99-B:255-60. ©2017 The British Editorial Society of Bone & Joint Surgery.

The Stereotype-Matching Effect: Greater Influence on Functioning When Age Stereotypes Correspond to Outcomes

Science.gov (United States)

Levy, Becca R.; Leifheit-Limson, Erica

2009-01-01

Older individuals assimilate, and are targeted by, contradictory positive and negative age stereotypes. It was unknown whether the influence of stereotype valence is stronger when the stereotype content corresponds to the outcome domain. We randomly assigned older individuals to either positive-cognitive, negative-cognitive, positive-physical, or negative-physical subliminal-age-stereotype groups and assessed cognitive and physical outcomes. As predicted, when the age stereotypes corresponded to the outcome domains, their valence had a significantly greater impact on cognitive and physical performance. This suggests that if a match occurs, it is more likely to generate expectations that become self-fulfilling prophecies. PMID:19290757

Effects of mobile gaming patterns on learning outcomes: a literature review

NARCIS (Netherlands)

Schmitz, Birgit; Klemke, Roland; Specht, Marcus

2013-01-01

Schmitz, B., Klemke, R., & Specht, M. (2012). Effects of mobile gaming patterns on learning outcomes: A literature review. International Journal of Technology Enhanced Learning, 4(5-6), 345-358. doi:10.1504/IJTEL.2012.051817

The effects of platelet-rich plasma on recovery time and aesthetic outcome in facial rejuvenation: preliminary retrospective observations.

Science.gov (United States)

Willemsen, Joep C N; van der Lei, Berend; Vermeulen, Karin M; Stevens, Hieronymus P J D

2014-10-01

This study focused on the possible effect of platelet-rich plasma (PRP) on recovery time and aesthetic outcome after facial rejuvenation. We conducted a retrospective analysis with regard to recovery time and the aesthetic improvement after treatment among four groups of patients: those treated with fat grafting only (Group I), those treated with fat grafting and PRP (Group II), those treated with a minimal access cranial suspension (MACS)-lift and fat grafting (Group III), and those treated with a MACS-lift, fat grafting, and PRP (Group IV). For the first part of this study, i.e., evaluation of recovery time after surgery, the following selection criteria were used: nonsmoking females, aged 35-65 years, with a complete documented follow-up. In total, 82 patients were included in the evaluation of patient-reported recovery time. For the second part of the study, i.e., evaluation of potential differences in aesthetic outcome, the records of these 82 patients were screened for the presence of pre- and postoperative standardized photographs in three views (AP, lateral, and oblique), leaving 37 patients to evaluate. A questionnaire was developed to evaluate the aesthetic outcome in all four groups of patients. This questionnaire was given to an expert panel that consisted of ten plastic surgeons. The addition of PRP to a lipofilling procedure resulted in a significant drop in the number of days needed to recover before returning to work or to restart social activities [Group I (no PRP) took 18.9 days vs Group II (PRP) took 13.2 days, p = 0.019]. There seemed to be no effect when PRP was added to a MACS-lift + lipofilling procedure. Also, the aesthetic outcome of the lipofilling and MACS-lift + lipofilling groups that received PRP (Groups II and IV) was significantly better than the groups without PRP (Groups I and III). Adding PRP to facial lipofilling reduces recovery time and improves the overall aesthetic outcome of a MACS-lift. This journal requires that

Sensitivity analysis for direct and indirect effects in the presence of exposure-induced mediator-outcome confounders

Science.gov (United States)

Chiba, Yasutaka

2014-01-01

Questions of mediation are often of interest in reasoning about mechanisms, and methods have been developed to address these questions. However, these methods make strong assumptions about the absence of confounding. Even if exposure is randomized, there may be mediator-outcome confounding variables. Inference about direct and indirect effects is particularly challenging if these mediator-outcome confounders are affected by the exposure because in this case these effects are not identified irrespective of whether data is available on these exposure-induced mediator-outcome confounders. In this paper, we provide a sensitivity analysis technique for natural direct and indirect effects that is applicable even if there are mediator-outcome confounders affected by the exposure. We give techniques for both the difference and risk ratio scales and compare the technique to other possible approaches. PMID:25580387

A randomized clinical trial of the effectiveness of premarital intervention: moderators of divorce outcomes.

Science.gov (United States)

Markman, Howard J; Rhoades, Galena K; Stanley, Scott M; Peterson, Kristina M

2013-02-01

This study examined the effects of premarital relationship intervention on divorce during the first 8 years of first marriage. Religious organizations were randomly assigned to have couples marrying through them complete the Prevention and Relationship Education Program (PREP) or their naturally occurring premarital services. Results indicated no differences in overall divorce rates between naturally occurring services (n = 44), PREP delivered by clergy at religious organizations (n = 66), or PREP delivered by professionals at a university (n = 83). Three moderators were also tested. Measured premaritally and before intervention, the level of negativity of couples' interactions moderated effects. Specifically, couples observed to have higher levels of negative communication in a video task were more likely to divorce if they received PREP than if they received naturally occurring services; couples with lower levels of premarital negative communication were more likely to remain married if they received PREP. A history of physical aggression in the current relationship before marriage and before intervention showed a similar pattern as a moderator, but the effect was only marginally significant. Family-of-origin background (parental divorce and/or aggression) was not a significant moderator of prevention effects across the two kinds of services. Implications for defining risk, considering divorce as a positive versus negative outcome, the practice of premarital relationship education, and social policy are discussed. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Adverse effects of perinatal nicotine exposure on reproductive outcomes.

Science.gov (United States)

Wong, Michael K; Barra, Nicole G; Alfaidy, Nadia; Hardy, Daniel B; Holloway, Alison C

2015-12-01

Nicotine exposure during pregnancy through cigarette smoking, nicotine replacement therapies or e-cigarette use continues to be a widespread public health problem, impacting both fetal and postnatal health. Yet, at this time, there remains limited data regarding the safety and efficacy in using these nicotine products during pregnancy. Notably, reports assessing the effect of nicotine exposure on postnatal health outcomes in humans, including reproductive health, are severely lacking. Our current understanding regarding the consequences of nicotine exposure during pregnancy is limited to a few animal studies, which do not comprehensively address the underlying cellular mechanisms involved. This paper aims to critically review the current knowledge from human and animal studies regarding the direct and indirect effects (e.g. obesity) of maternal nicotine exposure, regardless of its source, on reproductive outcomes in pregnancy and postnatal life. Furthermore, this review highlights several key cellular mechanisms involved in these adverse reproductive deficits including oxidative stress, inflammation, and endoplasmic reticulum (ER) stress. By understanding the interplay of the cellular mechanisms involved, further strategies could be developed to prevent the reproductive abnormalities resulting from exposure to nicotine in utero and influence informed clinical guidelines for pregnant women. © 2015 Society for Reproduction and Fertility.

The effect of maternal dietary diversity on infant outcome of Pregnant ...

African Journals Online (AJOL)

The effect of maternal dietary diversity on infant outcome of Pregnant women. ... East African Journal of Public Health ... can serve as useful predictive indicator of maternal nutrition during pregnancy and the likelihood of delivering LBW babies.

Computerized clinical decision support systems for primary preventive care: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes.

Science.gov (United States)

Souza, Nathan M; Sebaldt, Rolf J; Mackay, Jean A; Prorok, Jeanette C; Weise-Kelly, Lorraine; Navarro, Tamara; Wilczynski, Nancy L; Haynes, R Brian

2011-08-03

Computerized clinical decision support systems (CCDSSs) are claimed to improve processes and outcomes of primary preventive care (PPC), but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs) assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs. We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive. We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63%) RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34%) trials assessed patient outcomes, and four (29%) reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15%) and two (5%) trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects. Evidence supports the effectiveness of CCDSSs for screening and

Clinical Significance of the Prognostic Nutritional Index for Predicting Short- and Long-Term Surgical Outcomes After Gastrectomy: A Retrospective Analysis of 7781 Gastric Cancer Patients.

Science.gov (United States)

Lee, Jee Youn; Kim, Hyoung-Il; Kim, You-Na; Hong, Jung Hwa; Alshomimi, Saeed; An, Ji Yeong; Cheong, Jae-Ho; Hyung, Woo Jin; Noh, Sung Hoon; Kim, Choong-Bai

2016-05-01

To evaluate the predictive and prognostic significance of the prognostic nutritional index (PNI) in a large cohort of gastric cancer patients who underwent gastrectomy.Assessing a patient's immune and nutritional status, PNI has been reported as a predictive marker for surgical outcomes in various types of cancer.We retrospectively reviewed data from a prospectively maintained database of 7781 gastric cancer patients who underwent gastrectomy from January 2001 to December 2010 at a single center. From this data, we analyzed clinicopathologic characteristics, PNI, and short- and long-term surgical outcomes for each patient. We used the PNI value for the 10th percentile (46.70) of the study cohort as a cut-off for dividing patients into low and high PNI groups.Regarding short-term outcomes, multivariate analysis showed a low PNI (odds ratio [OR] = 1.505, 95% CI = 1.212-1.869, P cancer recurrence.

Faculty perceptions of occupational therapy program directors' leadership styles and outcomes of leadership.

Science.gov (United States)

Snodgrass, Jeff; Shachar, Mickey

2008-01-01

This research study investigated the relationship between faculty perceptions of occupational therapy program directors' leadership styles and outcomes of leadership and the effects of moderating demographic and institutional characteristics. Data for this study were collected utilizing the Multifactor Leadership Questionnaire Form 5X and the self-designed Demographic and Institution Questionnaire. The study working sample included 184 graduate occupational therapy faculty members from 98 (65%) of all accredited academic occupational therapy programs in the United States for the 2005-06 academic year. Major findings from the study indicate that, in general, transformational leadership had a significant (p leadership outcomes whereas transactional leadership had a significant (p leadership attribute (although belonging to the transactional leadership construct) was found to be a positive predictor of leadership outcomes. Demographic and institutional characteristics did not have a significant (p > 0.01) influence on perceived leadership styles and leadership outcomes. The results of this research show that the most effective occupational therapy leaders in academia have been found to be those who adopt and utilize a full range of leadership styles that combine both transformational and transactional contingent reward leadership styles and suggest common effectiveness for other allied health fields.

Bilateral versus unilateral cochlear implants in children: a study of spoken language outcomes.

Science.gov (United States)

Sarant, Julia; Harris, David; Bennet, Lisa; Bant, Sharyn

2014-01-01

Although it has been established that bilateral cochlear implants (CIs) offer additional speech perception and localization benefits to many children with severe to profound hearing loss, whether these improved perceptual abilities facilitate significantly better language development has not yet been clearly established. The aims of this study were to compare language abilities of children having unilateral and bilateral CIs to quantify the rate of any improvement in language attributable to bilateral CIs and to document other predictors of language development in children with CIs. The receptive vocabulary and language development of 91 children was assessed when they were aged either 5 or 8 years old by using the Peabody Picture Vocabulary Test (fourth edition), and either the Preschool Language Scales (fourth edition) or the Clinical Evaluation of Language Fundamentals (fourth edition), respectively. Cognitive ability, parent involvement in children's intervention or education programs, and family reading habits were also evaluated. Language outcomes were examined by using linear regression analyses. The influence of elements of parenting style, child characteristics, and family background as predictors of outcomes were examined. Children using bilateral CIs achieved significantly better vocabulary outcomes and significantly higher scores on the Core and Expressive Language subscales of the Clinical Evaluation of Language Fundamentals (fourth edition) than did comparable children with unilateral CIs. Scores on the Preschool Language Scales (fourth edition) did not differ significantly between children with unilateral and bilateral CIs. Bilateral CI use was found to predict significantly faster rates of vocabulary and language development than unilateral CI use; the magnitude of this effect was moderated by child age at activation of the bilateral CI. In terms of parenting style, high levels of parental involvement, low amounts of screen time, and more time spent

Bilateral Versus Unilateral Cochlear Implants in Children: A Study of Spoken Language Outcomes

Science.gov (United States)

Harris, David; Bennet, Lisa; Bant, Sharyn

2014-01-01

Objectives: Although it has been established that bilateral cochlear implants (CIs) offer additional speech perception and localization benefits to many children with severe to profound hearing loss, whether these improved perceptual abilities facilitate significantly better language development has not yet been clearly established. The aims of this study were to compare language abilities of children having unilateral and bilateral CIs to quantify the rate of any improvement in language attributable to bilateral CIs and to document other predictors of language development in children with CIs. Design: The receptive vocabulary and language development of 91 children was assessed when they were aged either 5 or 8 years old by using the Peabody Picture Vocabulary Test (fourth edition), and either the Preschool Language Scales (fourth edition) or the Clinical Evaluation of Language Fundamentals (fourth edition), respectively. Cognitive ability, parent involvement in children’s intervention or education programs, and family reading habits were also evaluated. Language outcomes were examined by using linear regression analyses. The influence of elements of parenting style, child characteristics, and family background as predictors of outcomes were examined. Results: Children using bilateral CIs achieved significantly better vocabulary outcomes and significantly higher scores on the Core and Expressive Language subscales of the Clinical Evaluation of Language Fundamentals (fourth edition) than did comparable children with unilateral CIs. Scores on the Preschool Language Scales (fourth edition) did not differ significantly between children with unilateral and bilateral CIs. Bilateral CI use was found to predict significantly faster rates of vocabulary and language development than unilateral CI use; the magnitude of this effect was moderated by child age at activation of the bilateral CI. In terms of parenting style, high levels of parental involvement, low amounts of

The effect of hospital volume on patient outcomes in severe acute pancreatitis

Directory of Open Access Journals (Sweden)

Shen Hsiu-Nien

2012-08-01

Full Text Available Abstract Background We investigated the relation between hospital volume and outcome in patients with severe acute pancreatitis (SAP. The determination is important because patient outcome may be improved through volume-based selective referral. Methods In this cohort study, we analyzed 22,551 SAP patients in 2,208 hospital-years (between 2000 and 2009 from Taiwan’s National Health Insurance Research Database. Primary outcome was hospital mortality. Secondary outcomes were hospital length of stay and charges. Hospital SAP volume was measured both as categorical and as continuous variables (per one case increase each hospital-year. The effect was assessed using multivariable logistic regression models with generalized estimating equations accounting for hospital clustering effect. Adjusted covariates included patient and hospital characteristics (model 1, and additional treatment variables (model 2. Results Irrespective of the measurements, increasing hospital volume was associated with reduced risk of hospital mortality after adjusting the patient and hospital characteristics (adjusted odds ratio [OR] 0.995, 95% confidence interval [CI] 0.993-0.998 for per one case increase. The patients treated in the highest volume quartile (≥14 cases per hospital-year had 42% lower risk of hospital mortality than those in the lowest volume quartile (1 case per hospital-year after adjusting the patient and hospital characteristics (adjusted OR 0.58, 95% CI 0.40-0.83. However, an inverse relation between volume and hospital stay or hospital charges was observed only when the volume was analyzed as a categorical variable. After adjusting the treatment covariates, the volume effect on hospital mortality disappeared regardless of the volume measures. Conclusions These findings support the use of volume-based selective referral for patients with SAP and suggest that differences in levels or processes of care among hospitals may have contributed to the volume

The Anglo-Scandinavian Cardiac Outcomes Trial: blood pressure-lowering limb: effects in patients with type II diabetes

DEFF Research Database (Denmark)

Ostergren, Jan; Poulter, Neil R; Sever, Peter S

2008-01-01

OBJECTIVE: To compare the effects of two antihypertensive treatment strategies for the prevention of coronary heart disease and other cardiovascular events in the large subpopulation (n=5137) with diabetes mellitus in the blood pressure-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial...... nonsignificantly by 8% (hazard ratio 0.92, confidence interval 0.74-1.15). CONCLUSION: In the large diabetic subgroup in the blood pressure-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial, the benefits of amlodipine-based treatment, compared with atenolol-based treatment, on the incidence of total...... with addition of thiazide as required (atenolol-based). Therapy was titrated to achieve a target blood pressure of less than 130/80 mmHg. RESULTS: The trial was terminated early due to significant benefits on mortality and stroke associated with the amlodipine-based regimen. In patients with diabetes mellitus...

Effects of diabetes mellitus on outcome of patients with first acute myocardial infarction

International Nuclear Information System (INIS)

Samadikhah, J.; Hakim; Yaghoubi, A.R.

2007-01-01

To evaluate the effects of diabetes mellitus (DM) on outcome and survival of patients with first acute Myocardial Infarction (AMI). In 500 patients (358 men and 142 women), 74 (12.6%) were diabetic, and rest of them were non- diabetic. All diabetic patients were divided in to two groups, Group A included 13 patients with type 1 DM and the group B included 61 patients with type 2 DM. Age-Adjusted mortality in one year follow-up for women with DM was 22%, and significantly higher than 13% in women without DM, (relative risk (RR) 1.69 and 95% CI 1.21 to 2.06). Mortality rate for men with DM (21%) and without DM (16%) was also significantly different (RR 1.31 and 95% CI 1.05- 1.62). Painless AMI occurred in 15.4% of patients with type 1 and 14.4% of patients with type 2. One year mortality rate in both type 1 and 2 were 19.6% and 21.3% respectively (p>0.05). According to angiographic data, diabetic patients had more involved arteries than non diabetics (mean 2.62 vs. 2.07 vessels; P<0.05). Left ventricular function study demonstrated 34.03% of diabetic patients had lower (<40%) ejection fraction (EF), while 17.6% of nondiabetic patients had EF<40% (p<0.05). Our results emphasis the role of DM as a risk factor of severity of coronary artery disease and as a predictor of adverse outcome after first AMI. (author)

Transcatheter closure of patent ductus arteriosus: Evaluating the effect of the learning curve on the outcome

Directory of Open Access Journals (Sweden)

Azhar Ahmad

2009-01-01

Full Text Available Background and Objectives : Initial experience with transcatheter closure of patent ductus arteriosus (PDA using detachable coils and Amplatzer duct occluder devices is reported. We evaluated the outcome, complications, and influence of the learning curve, and also assessed the need of surgical backup for such interventional procedures. Methods: From January 2000 to December 2004, 121 patients underwent transcatheter closure of PDA. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for appropriately choosing the occluder device type and size. A second aortic angiogram was performed 10 minutes after device deployment. Echocardiography was repeated at intervals of 24 hours, then at 1, 3, and 6 months after the procedure to assess complications. Stepwise multiple regression analysis was used to assess the role of experience in improving the outcome of the procedure. Results: Of 121 cases, four patients had pulmonary artery embolization of the occluder device which was successfully retrieved in the catheterization laboratory, while two others had embolization that required surgical intervention. Four patients had temporary residual leak, nine had protrusion of the device into the aorta without significant Doppler pressure gradient or hemolysis on follow-up, and five had partial hemodynamically insignificant obstruction to the left pulmonary artery. Statistical analysis showed that the effect of the learning curve and experience was responsible for 93% improvement in the procedural outcome over the five-year study period. Conclusion: Transcatheter occlusion of PDA is safe and effective alternative to surgery. Complications occurred in those with unfavorable duct anatomy and with the use of multiple coils. Surgical backup was important for such interventional procedures. Experience played a major role in the proper choice of device type and size which greatly influenced the outcome of the procedure.

Factors associated with health care access and outcome.

Science.gov (United States)

Paek, Min-So; Lim, Jung-Won

2012-01-01

This study aims to (1) assess ethnic differences in health care access and health outcome between Asian Americans and whites and between Asian American subgroups, (2) examine effects of cultural factors, and (3) investigate moderating effects of health risk behaviors between cultural characteristics and health care access and outcome. Data were derived from the 2007 California Health Interview Survey. Asian Americans (n = 4,462) and whites (n = 4,470) were included. There were significant ethnic differences in health care access and health perception between Asian Americans and Whites and across Asian American subgroups. Health risk behaviors moderated relationships between cultural factors and health care access and outcome. Findings reveal that ethnicity affects an individual's health care access and health perception, and their health behaviors are an important factor that may improve or worsen outcomes. This study may increase our knowledge base of research and interventions to enhance ethnic minority populations' health care accessibility and perceptions.

Effect of adjuvant systemic treatment on cosmetic outcome and late normal-tissue reactions after breast conservation

International Nuclear Information System (INIS)

Johansen, Joergen; Overgaard, Jens; Overgaard, Marie

2007-01-01

.0 (2.0-12.5) and 9.6 (3.3-27.7) in premenopausal and postmenopausal patients, respectively. To circumvent the strong interaction between tamoxifen treatment and axillary irradiation, a subsequent analysis omitting axillary treatment from the multivariate regression showed a significant effect of both tamoxifen and CMF on the occurrence of breast fibrosis with relative risks of 5.3 (CI 1.8-15.8) and 4.4 (1.8-10.3), respectively. Adjuvant systemic treatment with CMF given sequentially to radiotherapy independently predicted an adverse cosmetic outcome as well as increased skin telangiectasia after breast conserving treatment. Due to a strong interaction between tamoxifen administration and radiation to the regional lymph nodes, the effect of tamoxifen on the development of fibrosis could not be fully discerned in this study. Axillary irradiation increased the incidence of moderate to severe breast fibrosis in both premenopausal and postmenopausal patients

Effect of pigtail catheter application on obstetric outcomes in in vitro fertilization/intracytoplasmic sperm injection pregnancies following hyperstimulation syndrome.

Science.gov (United States)

Çağlar Aytaç, Pınar; Kalaycı, Hakan; Yetkinel, Selçuk; Alkaş, Didem; Yüksel Şimşek, Seda; Haydardedeoğlu, Bülent; Bulgan Kılıçdağ, Esra

2017-06-01

To evaluate the effects of percutaneous pigtail catheter drainage on the outcomes of intracytoplasmic sperm injection (ICSI) pregnancies following moderate or severe ovarian hyperstimulation syndrome (OHSS). This retrospective study included 189 patients hospitalized for OHSS following ICSI treatment in a tertiary in vitro fertilization unit between 2006 and 2014. Pigtail catheters were applied in 63 patients; the other 126 patients did not need that treatment. The obstetric reports of 173 patients could be accessed and were examined to investigate the pregnancy outcomes of those with and without catheters. No complications such as infection or vascular or intra-abdominal organ trauma were observed related to the pigtail application. There were no differences in abortus, preterm labor, gestational diabetes mellitus, and preeclampsia ratio between the pigtail and control groups (p>0.05). The rate of readmission to hospital for OHSS was lower in the pigtail group than in the control group although not statistically significant (p=0.08). Pigtail application is a safe and effective method for draining ascites in patients with OHSS after ICSI treatment. The use of pigtail catheters had no adverse effects on the perinatal outcomes of patients hospitalized with OHSS who became pregnant after ICSI treatment. In addition, the percutaneous drainage of ascites via a pigtail catheter helped prevent the readmission of patients with moderate or severe OHSS.

Using patient-reported outcomes in schizophrenia: the Scottish Schizophrenia Outcomes Study.

Science.gov (United States)

Hunter, Robert; Cameron, Rosie; Norrie, John

2009-02-01

The primary aim of the Scottish Schizophrenia Outcomes Study (SSOS) was to assess the feasibility and utility of routinely collecting outcome data in everyday clinical settings. Data were collected over three years in the Scottish National Health Service (NHS). There were two secondary aims of SSOS: first, to compare data from patient-rated, objective, and clinician-rated outcomes, and second, to describe trends in outcome data and service use across Scotland over the three years of the study (2002-2005). This study used a naturalistic, longitudinal, observational cohort design. A representative sample of 1,015 persons with ICD-10 F20-F29 diagnoses (schizophrenia, schizotypal disorders, or delusional disorders) was assessed annually using the clinician-rated measure, the Health of the Nation Outcome Scale (HoNOS), and the patient-reported assessment, the Avon Mental Health Measure (Avon). Objective outcomes data and information on services and interventions were collected. Data were analyzed with regression modeling. Of the 1,015 persons recruited, 78% of the cohort (N=789) completed the study. Over the study period, significant decreases were seen in the number of hospitalizations, incidence of attempted suicide and self-harm, and civil detentions. Avon scores indicated significant improvement on all subscales (behavior, social, access, and mental health) and on the total score. However, HoNOS scores on the behavior and symptom subscales did not change, scores on the impairment subscale increased significantly (indicating increased levels of impairment), and scores on the social subscale decreased significantly (indicating improved social functioning). This study has demonstrated that it is feasible within the Scottish NHS to routinely collect meaningful outcomes data in schizophrenia. Patient-reported assessments were also successfully collected and used in care plans. This model shows that it is possible to incorporate patient-reported assessments into routine

Effect of Sucrose Analgesia, for Repeated Painful Procedures, on Short-term Neurobehavioral Outcome of Preterm Neonates: A Randomized Controlled Trial.

Science.gov (United States)

Banga, Shreshtha; Datta, Vikram; Rehan, Harmeet Singh; Bhakhri, Bhanu Kiran

2016-04-01

Safety of oral sucrose, commonly used procedural analgesic in neonates, is questioned. To evaluate the effect of sucrose analgesia, for repeated painful procedures, on short-term neurobehavioral outcome of preterm neonates. Stable preterm neonates were randomized to receive either sucrose or distilled water orally, for every potentially painful procedure during the first 7 days after enrollment. Neurodevelopmental status at 40 weeks postconceptional age (PCA) measured using the domains of Neurobehavioral Assessment of Preterm Infants scale. A total of 93 newborns were analyzed. The baseline characteristics of the groups were comparable. No statistically significant difference was observed in the assessment at 40 weeks PCA, among the groups. Use of sucrose analgesia, for repeated painful procedures on newborns, does not lead to any significant difference in the short-term neurobehavioral outcome. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effect of epidural analgesia on labor and its outcomes

International Nuclear Information System (INIS)

Fawad, A.; Naz, H.; Nelofar, T.; Abbasi, A.U.N.

2015-01-01

Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. Methods: This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of 50 each as per convenience. Patients of any gravidity at term from 37-41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Conclusion: Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia. (author)

Effectiveness of Splanchnic Nerve Neurolysis for Targeting Location of Cancer Pain: Using the Pain Drawing as an Outcome Variable.

Science.gov (United States)

Novy, Diane M; Engle, Mitchell P; Lai, Emily A; Cook, Christina; Martin, Emily C; Trahan, Lisa; Yu, Jun; Koyyalagunta, Dhanalakshmi

2016-07-01

The effectiveness of splanchnic nerve neurolysis (SNN) for cancer-related abdominal pain has been investigated using numeric pain intensity rating as an outcome variable. The outcome variable in this study used the grid method for obtaining a targeted pain drawing score on 60 patients with pain from pancreatic or gastro-intestinal primary cancers or metastatic disease to the abdominal region. Results demonstrate excellent inter-rater agreement (intra-class correlation [ICC] coefficient at pre-SNN = 0.97 and ICC at within one month post-SNN = 0.98) for the grid method of scoring the pain drawing and demonstrate psychometric generalizability among patients with cancer-related pain. Using the Wilcoxon signed rank test and associated effect sizes, results show significant improvement in dispersion of pain following SNN. Effect sizes for the difference in pre-SNN to 2 post-SNN time points were higher for the pain drawing than for pain intensity rating. Specifically, the effect size difference from pre- to within one month post-SNN was r = 0.42 for pain drawing versus r = 0.23 for pain intensity rating. Based on a smaller subset of patients who were seen within 1 - 6 months following SNN, the effect size difference from pre-SNN was r = 0.46 for pain drawing versus r = 0.00 for pain intensity rating. Collectively, these data support the use of the pain drawing as a reliable outcome measure among patients with cancer pain for procedures such as SNN that target specific location and dispersion of pain.

An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes

Science.gov (United States)

Flodgren, Gerd; Eccles, Martin P; Shepperd, Sasha; Scott, Anthony; Parmelli, Elena; Beyer, Fiona R

2014-01-01

Background There is considerable interest in the effectiveness of financial incentives in the delivery of health care. Incentives may be used in an attempt to increase the use of evidence-based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive, diagnostic and treatment decisions, or both. Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way. Since there are numerous reviews performed within the healthcare area describing the effects of various types of financial incentives, it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals’ behaviour and patient outcomes. Objectives To conduct an overview of systematic reviews that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes. Methods We searched the Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library); Database of Abstracts of Reviews of Effectiveness (DARE); TRIP; MEDLINE; EMBASE; Science Citation Index; Social Science Citation Index; NHS EED; HEED; EconLit; and Program in Policy Decision-Making (PPd) (from their inception dates up to January 2010). We searched the reference lists of all included reviews and carried out a citation search of those papers which cited studies included in the review. We included both Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time series (ITSs) and controlled before and after studies (CBAs) that evaluated the effects of financial incentives on professional practice and patient outcomes, and that reported numerical results of the included individual studies. Two review authors independently extracted data and assessed the methodological quality of each

The Effectiveness of CASAs in Achieving Positive Outcomes for Children.

Science.gov (United States)

Litzelfelner, Pat

2000-01-01

Evaluated effectiveness of court-appointed special advocates (CASAs) in achieving positive outcomes for children in the child welfare system, using data from court and CASA program files on 200 children. Found that CASAs may have reduced the number of placements and court continuances children experienced. More services were provided to children…

The Effects of Chewing Betel Nut with Tobacco and Pre-pregnancy Obesity on Adverse Birth Outcomes Among Palauan Women.

Science.gov (United States)

Berger, Katherine E; Masterson, James; Mascardo, Joy; Grapa, Jayvee; Appanaitis, Inger; Temengil, Everlynn; Watson, Berry Moon; Cash, Haley L

2016-08-01

The small Pacific Island nation of Palau has alarmingly high rates of betel nut with tobacco use and obesity among the entire population including pregnant women. This study aimed to determine the effects of betel nut with tobacco use and pre-pregnancy obesity on adverse birth outcomes. This study used retrospective cohort data on 1171 Palauan women who gave birth in Belau National Hospital in Meyuns, Republic of Palau between 2007 and 2013. The exposures of interest were pre-pregnancy obesity and reported betel nut with tobacco use during pregnancy. The primary outcomes measured were preterm birth and low birth weight among full-term infants. A significantly increased risk for low birth weight among full-term infants was demonstrated among those women who chewed betel nut with tobacco during pregnancy when other known risk factors were controlled for. Additionally, pre-pregnancy obesity was associated with a significantly increased risk for preterm birth when other known risk factors were controlled for. Both betel nut with tobacco use and pre-pregnancy obesity were associated with higher risks for adverse birth outcomes. These findings should be used to drive public health efforts in Palau, as well as in other Pacific Island nations where these studies are currently lacking.

Effect of Emergency Medical Services Use on Hospital Outcomes of Acute Hemorrhagic Stroke.

Science.gov (United States)

Kim, Sola; Shin, Sang Do; Ro, Young Sun; Song, Kyoung Jun; Lee, Yu Jin; Lee, Eui Jung; Ahn, Ki Ok; Kim, Taeyun; Hong, Ki Jeong; Kim, Yu Jin

2016-01-01

It is unclear whether the use of emergency medical services (EMS) is associated with enhanced survival and decreased disability after hemorrhagic stroke and whether the effect size of EMS use differs according to the length of stay (LOS) in emergency department (ED). Adult patients (19 years and older) with acute hemorrhagic stroke who survived to admission at 29 hospitals between 2008 and 2011 were analyzed, excluding those who had symptom-to-ED arrival time of 3 h or greater, received thrombolysis or craniotomy before inter-hospital transfer, or had experienced cardiac arrest, had unknown information about ambulance use and outcomes. Exposure variable was EMS use. Endpoints were survival at discharge and worsened modified Rankin Scale (W-MRS) defined as 3 or greater points difference between pre- and post-event MRS. Adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs) for the outcomes were calculated, including potential confounders (demographic, socioeconomic status, clinical parameter, comorbidity, behavior, and time of event) in the final model and stratifying patients by inter-hospital transfer and by time interval from symptom to ED arrival (S2D). ED LOS, classified into short (hemorrhagic strokes were analyzed in which 75.6% were transported by EMS. For outcome measures, 17.4% and 41.4% were dead and had worsened MRS, respectively. AORs (95% CIs) of EMS were 0.67 (0.51-0.89) for death and 0.74 (0.59-0.92) for W-MRS in all patients. The effect size of EMS, however, was different according to LOS in ED. AORs (95% CIs) for death were 0.74 (0.54-1.01) in short LOS and 0.60 (0.44-0.83) in long LOS group. AORs (95% CIs) for W-MRS were 0.76 (0.60-0.97) in short LOS and 0.68 (0.52-0.88) in long LOS group. EMS transport was associated with lower hospital mortality and disability after acute hemorrhagic stroke. Effect size of EMS use for mortality was significant in patients with long ED LOS. Key  words: emergency medical service; hemorrhagic

Sibling Competition & Growth Tradeoffs. Biological vs. Statistical Significance.

Science.gov (United States)

Kramer, Karen L; Veile, Amanda; Otárola-Castillo, Erik

2016-01-01

Early childhood growth has many downstream effects on future health and reproduction and is an important measure of offspring quality. While a tradeoff between family size and child growth outcomes is theoretically predicted in high-fertility societies, empirical evidence is mixed. This is often attributed to phenotypic variation in parental condition. However, inconsistent study results may also arise because family size confounds the potentially differential effects that older and younger siblings can have on young children's growth. Additionally, inconsistent results might reflect that the biological significance associated with different growth trajectories is poorly understood. This paper addresses these concerns by tracking children's monthly gains in height and weight from weaning to age five in a high fertility Maya community. We predict that: 1) as an aggregate measure family size will not have a major impact on child growth during the post weaning period; 2) competition from young siblings will negatively impact child growth during the post weaning period; 3) however because of their economic value, older siblings will have a negligible effect on young children's growth. Accounting for parental condition, we use linear mixed models to evaluate the effects that family size, younger and older siblings have on children's growth. Congruent with our expectations, it is younger siblings who have the most detrimental effect on children's growth. While we find statistical evidence of a quantity/quality tradeoff effect, the biological significance of these results is negligible in early childhood. Our findings help to resolve why quantity/quality studies have had inconsistent results by showing that sibling competition varies with sibling age composition, not just family size, and that biological significance is distinct from statistical significance.

Sibling Competition & Growth Tradeoffs. Biological vs. Statistical Significance.

Directory of Open Access Journals (Sweden)

Karen L Kramer

Full Text Available Early childhood growth has many downstream effects on future health and reproduction and is an important measure of offspring quality. While a tradeoff between family size and child growth outcomes is theoretically predicted in high-fertility societies, empirical evidence is mixed. This is often attributed to phenotypic variation in parental condition. However, inconsistent study results may also arise because family size confounds the potentially differential effects that older and younger siblings can have on young children's growth. Additionally, inconsistent results might reflect that the biological significance associated with different growth trajectories is poorly understood. This paper addresses these concerns by tracking children's monthly gains in height and weight from weaning to age five in a high fertility Maya community. We predict that: 1 as an aggregate measure family size will not have a major impact on child growth during the post weaning period; 2 competition from young siblings will negatively impact child growth during the post weaning period; 3 however because of their economic value, older siblings will have a negligible effect on young children's growth. Accounting for parental condition, we use linear mixed models to evaluate the effects that family size, younger and older siblings have on children's growth. Congruent with our expectations, it is younger siblings who have the most detrimental effect on children's growth. While we find statistical evidence of a quantity/quality tradeoff effect, the biological significance of these results is negligible in early childhood. Our findings help to resolve why quantity/quality studies have had inconsistent results by showing that sibling competition varies with sibling age composition, not just family size, and that biological significance is distinct from statistical significance.

Better informing decision making with multiple outcomes cost-effectiveness analysis under uncertainty in cost-disutility space.

Science.gov (United States)

McCaffrey, Nikki; Agar, Meera; Harlum, Janeane; Karnon, Jonathon; Currow, David; Eckermann, Simon

2015-01-01

Comparing multiple, diverse outcomes with cost-effectiveness analysis (CEA) is important, yet challenging in areas like palliative care where domains are unamenable to integration with survival. Generic multi-attribute utility values exclude important domains and non-health outcomes, while partial analyses-where outcomes are considered separately, with their joint relationship under uncertainty ignored-lead to incorrect inference regarding preferred strategies. The objective of this paper is to consider whether such decision making can be better informed with alternative presentation and summary measures, extending methods previously shown to have advantages in multiple strategy comparison. Multiple outcomes CEA of a home-based palliative care model (PEACH) relative to usual care is undertaken in cost disutility (CDU) space and compared with analysis on the cost-effectiveness plane. Summary measures developed for comparing strategies across potential threshold values for multiple outcomes include: expected net loss (ENL) planes quantifying differences in expected net benefit; the ENL contour identifying preferred strategies minimising ENL and their expected value of perfect information; and cost-effectiveness acceptability planes showing probability of strategies minimising ENL. Conventional analysis suggests PEACH is cost-effective when the threshold value per additional day at home (1) exceeds $1,068 or dominated by usual care when only the proportion of home deaths is considered. In contrast, neither alternative dominate in CDU space where cost and outcomes are jointly considered, with the optimal strategy depending on threshold values. For example, PEACH minimises ENL when 1=$2,000 and 2=$2,000 (threshold value for dying at home), with a 51.6% chance of PEACH being cost-effective. Comparison in CDU space and associated summary measures have distinct advantages to multiple domain comparisons, aiding transparent and robust joint comparison of costs and multiple

Evaluation of functional outcomes of physical rehabilitation and medical complications in spinal cord injury victims of the Sichuan earthquake.

Science.gov (United States)

Li, Yongqiang; Reinhardt, Jan D; Gosney, James E; Zhang, Xia; Hu, Xiaorong; Chen, Sijing; Ding, Mingpu; Li, Jianan

2012-06-01

To characterize a spinal cord injury (SCI) population from the 2008 Sichuan earthquake in China; to evaluate functional outcomes of physical rehabilitation interventions; to assess potential determinants of rehabilitation effectiveness; and to assess medical complications and management outcomes. A total of 51 earthquake victims with SCI were enrolled and underwent rehabilitation programming. Functional rehabilitation outcomes included ambulation ability, wheelchair mobility and activities of daily living (ADL) assessed with the Modified Barthel Index at the beginning and end of rehabilitation. Effectiveness of rehabilitation and the effect of other predictors were evaluated by mixed effects regression. Outcomes of medical complication management were determined by comparison of the incidence of respective complications at the beginning and end of rehabilitation. Ambulation, wheelchair mobility and ADL were significantly improved with rehabilitation programming. Both earlier rescue and earlier onset of rehabilitation were significant positive predictors of rehabilitation effectiveness, whereas delayed onset of rehabilitation combined with prolonged time to rescue resulted in a lesser positive effect. Medical complications were managed effectively in 63% (pressure ulcers) to 85% (deep vein thrombosis) of patients during rehabilitation. Earthquake victims with SCI may achieve significantly improved functional rehabilitation functional outcomes on a formal, institutional-based physical rehabilitation programme.

Impact of hospital atmosphere on perceived health care outcome.

Science.gov (United States)

Narang, Ritu; Polsa, Pia; Soneye, Alabi; Fuxiang, Wei

2015-01-01

Healthcare service quality studies primarily examine the relationships between patients' perceived quality and satisfaction with healthcare services, clinical effectiveness, service use, recommendations and value for money. These studies suggest that patient-independent quality dimensions (structure, process and outcome) are antecedents to quality. The purpose of this paper is to propose an alternative by looking at the relationship between hospital atmosphere and healthcare quality with perceived outcome. Data were collected from Finland, India, Nigeria and the People's Republic of China. Regression analysis used perceived outcome as the dependent variable and atmosphere and healthcare service quality as independent variables. Findings - Results showed that atmosphere and healthcare service quality have a statistically significant relationship with patient perceived outcomes. The sample size was small and the sampling units were selected on convenience; thus, caution must be exercised in generalizing the findings. The study determined that service quality and atmosphere are considered significant for developing and developed nations. This result could have significant implications for policy makers and service providers developing healthcare quality and hospital atmosphere. Studies concentrate on healthcare outcome primarily regarding population health status, mortality, morbidity, customer satisfaction, loyalty, quality of life, customer behavior and consumption. However, the study exposes how patients perceive their health after treatment. Furthermore, the authors develop the healthcare service literature by considering atmosphere and perceived outcome.

Significance assessment of the external control effects of lecturers

Directory of Open Access Journals (Sweden)

Kurbatova Margarita, V.

2015-06-01

Full Text Available The state policy regarding higher education has changed in the last decade. These changes were part of the efficiency programs of the public sector. Governments of different countries ruined previously existing system of higher education state regulation and attempted to build the quasi-market structure in the higher education industry. Such transformations served as timely and progressive reforms in the recent studies of the economics of education. Substitution of bureaucratic management mechanisms and modern competition managerial tools are articulated. Economic and institutional and sociological studies on the effects of the introduction of quasi-markets and managerial tools in higher education governance oppose to orthodox market approach. They drew attention to the fact that evaluation methods and improve the effectiveness of organizations and employees that are typical of the private sector often produce results that differ from those in the public sector. To assess the consequences of the introduction of managerial tools of external control activities of university lecturers used a methodology based on the allocation of the individual structural components (effects and building on their basis of a multi-level hierarchical model in the research. Each component of the model (single effect is characterized by a degree of significance (importance and the degree of severity. The results of the systematization and assessment of the significance of the effects of external control activity of lecturers of Russian universities implemented in conditions of quasi-market mechanisms of the higher education system are highlighted in the paper.

Effects of diagnosis-related group payment system on appendectomy outcomes.

Science.gov (United States)

Kim, Tae Hyun; Park, Eun-Cheol; Jang, Sung-In; Jang, Suk-Yong; Lee, Sang Ah; Choi, Jae Woo

2016-12-01

The voluntary diagnosis-related group (DRG) payment system was introduced in 2002. Since July 2013, the Korean government has mandated DRG participation for all hospitals. The main purpose of this study was to examine the effects of mandatory DRG participation on various outcome metrics for appendectomy patients. We collected inpatient DRG data for 280,062 appendectomy patients between 2007 and 2014 using the Health Insurance Review and Assessment database. We examined patient outcome metrics such as length of stay (LOS), total medical cost, spillover, and readmission rate, according to hospital size. As a result of DRG participation, the average LOS for patients decreased (adjusted ratio: 0.83 [large hospitals], 0.83 [small hospitals]; 95% confidence interval [CI]: 0.82-0.84, 0.82-0.84), the total medical costs of patients increased (adjusted ratio: 1.23 [large hospitals], 1.35 [small hospitals]; 95% CI: 1.22-1.24, 1.34-1.36), the spillover of patients increased (adjusted ratio: 2.10 [large hospitals], 2.30 [small hospitals]; 95% CI: 2.03-2.18, 2.16-2.45), and the readmission rates of appendectomy patients decreased (adjusted ratio: 0.85 [large hospitals], 0.49 [small hospitals]; 95% CI: 0.77-0.94, 0.42-0.57). The mandatory implementation of the DRG payment system in South Korea has led to significant reductions in LOS and readmission rates for appendectomy patients. However, any resulting expansion of outpatient services may result in unnecessary resource usage rather than improving medical quality. Policy makers should consider the various implications reflected by these results when considering DRGs for other diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of Neonatal Seizures on Cognitive Outcome of Hypoxic-Ischemic Encephalopathy

Directory of Open Access Journals (Sweden)

J Gordon Millichap

2009-10-01

Full Text Available The independent effect of clinical neonatal seizures and their treatment on longterm neurodevelopmental outcome in 77 term newborns at risk for hypoxic-ischemic encephalopathy (HIE was determined in a study at University of California San Francisco.

The Effects of Client-Counselor Racial Matching on Therapeutic Outcome

Science.gov (United States)

Kim, Eunha; Kang, Minchul

2018-01-01

This study explored the effects of ethnic/racial matching on psychotherapy outcomes via the number of counseling sessions attended by clients, using clinical data collected from a university's counseling center. A total sample of 644 clients (193 men, 448 women) was selected and the ethnic/racial distribution of the sample comprised 499…

Effects of albendazole on the clinical outcome and immunological responses in helminth co-infected tuberculosis patients: a double blind randomised clinical trial.

Science.gov (United States)

Abate, E; Elias, D; Getachew, A; Alemu, S; Diro, E; Britton, S; Aseffa, A; Stendahl, O; Schön, T

2015-02-01

Despite several review papers and experimental studies concerning the impact of chronic helminth infection on tuberculosis in recent years, there is a scarcity of data from clinical field studies in highly endemic areas for these diseases. We believe this is the first randomised clinical trial investigating the impact of albendazole treatment on the clinical and immunological outcomes of helminth co-infected tuberculosis patients. A randomised, double-blind, placebo-controlled trial of albendazole (400mg per day for 3 days) in helminth-positive tuberculosis patients was conducted in Gondar, Ethiopia. The primary outcome was clinical improvement (ΔTB score) after 2 months. Among secondary outcomes were changes in the levels of eosinophils, CD4+ T cells, regulatory T cells, IFN-γ, IL-5 and IL-10 after 3 months. A total of 140 helminth co-infected tuberculosis patients were included with an HIV co-infection rate of 22.8%. There was no significant effect on the primary outcome (ΔTB score: 5.6±2.9 for albendazole versus 5.9±2.5 for placebo, P=0.59). The albendazole-treated group showed a decline in eosinophil cells (P=0.001) and IL-10 (P=0.017) after 3 months. In an exploratory analysis after 12 weeks, the albendazole treated group showed a trend towards weight gain compared with the placebo group (11.2±8.5 kg versus 8.2±8.7 kg, P=0.08)). The reductions in eosinophil counts and IL-10 show that asymptomatic helminth infection significantly affects host immunity during tuberculosis and can be effectively reversed by albendazole treatment. The clinical effects of helminth infection on chronic infectious diseases such as tuberculosis merit further characterisation. Copyright © 2014 Australian Society for Parasitology Inc. Published by Elsevier Ltd. All rights reserved.

Cognitive deficits in marijuana users: effects on motivational enhancement therapy plus cognitive behavioral therapy treatment outcome

Science.gov (United States)

Aharonovich, Efrat; Brooks, Adam C; Nunes, Edward V; Hasin, Deborah S

2008-01-01

Clinical variables that affect treatment outcome for marijuana dependent individuals are not yet well understood, including the effects of cognitive functioning. To address this, level of cognitive functioning and treatment outcome were investigated. Twenty marijuana-dependent outpatients were administered a neuropsychological battery at treatment entry. All patients received 12 weekly individual sessions of combined motivational enhancement therapy and cognitive behavioral therapy. The Wilcoxon Exact Test was used to compare cognitive functioning test scores between completers and dropouts, and the Fisher Exact Test was used to compare proportion of negative urines between those with higher and lower scores on the cognitive tests. Marijuana abstinence was unrelated to cognitive functioning. However, dropouts scored significantly lower than completers on measures of abstract reasoning and processing accuracy, providing initial evidence that cognitive functioning plays a role in treatment retention of adult marijuana dependent patients. If supported by further studies, the findings may help inform the development of interventions tailored for cognitively impaired marijuana dependent patients. PMID:18329188

Effect of Payment Model on Patient Outcomes in Outpatient Physical Therapy.

Science.gov (United States)

Charles, Derek; Boyd, Sylvester; Heckert, Logan; Lake, Austin; Petersen, Kevin

2018-01-01

Although the literature has well recognized the effectiveness of physical therapy for treating musculoskeletal injuries, reimbursement is evolving towards value-based or alternative payment models and away from procedure orientated, fee-for-service in the outpatient setting. Alternative models include cased-based clinics, pay-for-performance, out-of-network services, accountable care organizations, and concierge practices. There is the possibility that alternative payment models could produce different and even superior patient outcomes. Physical therapists should be alert to this possibility, and research is warranted in this area to conclude if outcomes in patient care are related to method of reimbursement.

Effect of Manager’s Role in Performance Based Pay on Employee Outcomes

Directory of Open Access Journals (Sweden)

Azman, I

2014-12-01

Full Text Available According to the recent literature pertaining on Islamic based organizational compensation, performance based pay consists of two essential features: communication and performance appraisal. Recent studies in this field highlights that the ability of managers to appropriately communicate pay information and appraise employee performance may have a significant impact on employee outcomes, especially job satisfaction and organizational commitment. Therefore, this study was undertaken to assess the relationship between manager’s role in performance based pay and employee outcomes using self-administered questionnaires collected from employees at a district council in Peninsular Malaysia. The outcomes of the SmartPLS path model analysis showed that pay communication does not act as an important determinant of job satisfaction, but performance appraisal does act as an important determinant of job satisfaction. Conversely, pay communication and performance appraisal act as important determinants of organizational commitment. In addition, this study provides discussion, implications and conclusion

Effects of breakfast eating and eating frequency on body mass index and weight loss outcomes in adults enrolled in an obesity treatment program.

Science.gov (United States)

Megson, Maureen; Wing, Rena; Leahey, Tricia M

2017-08-01

This study examined the effects of breakfast eating and eating frequency on objectively assessed BMI and weight loss outcomes among adults enrolled in obesity treatment. Participants completed measures of breakfast eating and eating frequency before and after treatment and had their height and weight measured. Baseline breakfast eating and eating frequency were not associated with baseline BMI (p = .34, p = .45, respectively) and did not predict weight loss during treatment (p = .36, p = .58, respectively). From pre- to post-treatment, there was no significant change in eating frequency (p = .27) and changes in eating frequency had no impact on weight loss (r = -.08, p = .23). However, increases in breakfast eating during treatment were associated with significantly better weight loss outcomes (r = .26, p eating, those who had either no change or a decrease in daily eating frequency were more likely to achieve a 5% weight loss compared to those who had an increase in daily eating frequency (p = .04). These results suggest that increasing breakfast eating, while simultaneously reducing or keeping eating frequency constant, may improve outcomes in obesity treatment. Experimental studies are needed to further elucidate these effects.

The Relationship between Obsessive Compulsive Personality and Obsessive Compulsive Disorder Treatment Outcomes: Predictive Utility and Clinically Significant Change.

Science.gov (United States)

Sadri, Shalane K; McEvoy, Peter M; Egan, Sarah J; Kane, Robert T; Rees, Clare S; Anderson, Rebecca A

2017-09-01

The evidence regarding whether co-morbid obsessive compulsive personality disorder (OCPD) is associated with treatment outcomes in obsessive compulsive disorder (OCD) is mixed, with some research indicating that OCPD is associated with poorer response, and some showing that it is associated with improved response. We sought to explore the role of OCPD diagnosis and the personality domain of conscientiousness on treatment outcomes for exposure and response prevention for OCD. The impact of co-morbid OCPD and conscientiousness on treatment outcomes was examined in a clinical sample of 46 participants with OCD. OCPD diagnosis and scores on conscientiousness were not associated with poorer post-treatment OCD severity, as indexed by Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, although the relative sample size of OCPD was small and thus generalizability is limited. This study found no evidence that OCPD or conscientiousness were associated with treatment outcomes for OCD. Further research with larger clinical samples is required.

Effect of surgical decompression of spinal metastases in acute treatment - Predictors of neurological outcome.

Science.gov (United States)

Hohenberger, Christoph; Schmidt, Corinna; Höhne, Julius; Brawanski, Alexander; Zeman, Florian; Schebesch, Karl-Michael

2018-06-01

Space-occupying spinal metastases (SM), commonly diagnosed because of acute neurological deterioration, consequently lead to immediate decompression with tumor removal or debulking. In this study, we analyzed a series of patients with surgically treated spinal metastases and explicitly sought to determine individual predictors of functional outcome. 94 patients (26 women, 68 men; mean age 64.0 years) with spinal metastases, who had been surgically treated at our department, were included retrospectively. We reviewed the pre- and postoperative charts, surgical reports, radiographic data for demographics, duration of symptoms, histopathology, stage of systemic disease, co-morbidities, radiographic extension, surgical strategy, neurological performance (Frankel Grade Classification), and the Karnofsky Performance Index (KPI). Emergency surgery within KPI was 60% at admission that had significantly improved at discharge (KPI 70%; p = 0.01). The rate of complications without revision was 4.3%, the revision rate 4.2%. From admission to discharge, pain had been significantly reduced (p = 0.019) and motor deficits significantly improved (p = 0.003). KPI had been significantly improved during in-hospital treatment (median 60 vs 70, p = 0.010). In the multivariable analysis, predictors of poor outcome (KPI < 70) were male sex, multiple metastases, and pre-existing bowel and bladder dysfunction. Median follow up was 2 months. In our series, surgery for spinal metastases (laminectomy, tumor removal, and mass reduction) significantly reduced pain as well as sensory and motor deficits. We identified male sex, multiple metastases, and pre-existing bowel and bladder dysfunction as predictors of negative outcome. Copyright © 2018 Elsevier Ltd. All rights reserved.

Clinical Outcomes Used in Clinical Pharmacy Intervention Studies in Secondary Care

Directory of Open Access Journals (Sweden)

Lene Juel Kjeldsen

2017-05-01

Full Text Available The objective was to investigate type, frequency and result of clinical outcomes used in studies to assess the effect of clinical pharmacy interventions in inpatient care. The literature search using Pubmed.gov was performed for the period up to 2013 using the search phrases: “Intervention(s” and “pharmacist(s” and “controlled” and “outcome(s” or “effect(s”. Primary research studies in English of controlled, clinical pharmacy intervention studies, including outcome evaluation, were selected. Titles, abstracts and full-text papers were assessed individually by two reviewers, and inclusion was determined by consensus. In total, 37 publications were included in the review. The publications presented similar intervention elements but differed in study design. A large variety of outcome measures (135 had been used to evaluate the effect of the interventions; most frequently clinical measures/assessments by physician and health care service use. No apparent pattern was established among primary outcome measures with significant effect in favour of the intervention, but positive effect was most frequently related to studies that included power calculations and sufficient inclusion of patients (73% vs. 25%. This review emphasizes the importance of considering the relevance of outcomes selected to assess clinical pharmacy interventions and the importance of conducting a proper power calculation.

Cue-elicited food seeking is eliminated with aversive outcomes following outcome devaluation.

Science.gov (United States)

Eder, Andreas B; Dignath, David

2016-01-01

In outcome-selective Pavlovian-to-instrumental transfer (PIT), stimuli that are predictive of specific outcomes prime instrumental responses that are associated with these outcomes. Previous human studies yielded mixed evidence in respect to whether the PIT effect is affected by a posttraining devaluation of an outcome, with the PIT effect being preserved after a devaluation of a primary reinforcer (food, drugs) but not following the devaluation of a secondary reinforcer (money). The present research examined whether outcome-selective transfer is eliminated when the devaluation of a primary (liquid) reinforcer is strong and aversive. Experiment 1 confirmed these expectations following a devaluation with bad tasting Tween 20. However, outcome-selective transfer was still observed when the earned (devalued) outcome was not consumed immediately after each test (Experiment 2). These results suggest that the capacity of a Pavlovian cue to motivate a specific response is affected by the incentive value of the shared outcome only when the devaluation yields an aversive outcome that is consumed immediately.

Thalidomide has a significant effect in patients with thalassemia intermedia.

Science.gov (United States)

Li, YunShuan; Ren, Quan; Zhou, Yali; Li, Pingping; Lin, Wanhua; Yin, Xiaolin

2018-01-01

To investigate the effect of thalidomide in patients with thalassemia intermedia. We observed the effect of thalidomide in seven patients with thalassemia intermedia requiring blood transfusion. Four of the patients were transfusion-independent, and three patients were transfusion-dependent. For the four transfusion-independent patients, hemoglobin concentration increased significantly (≥2 g/dl) in three and moderately (1-2 g/dl) in one. After 3 months of treatment, hemoglobin concentration increased 3.2 ± 1.2 g/dl compared to pretreatment. Among the three transfusion-dependent patients, transfusion was terminated after one month of treatment in one patient and decreased >50% in the other two patients, accompanied by an increase in the average hemoglobin concentration. Thalidomide had a significant effect in patients with thalassemia intermedia. Further studies of a larger scale and more rigorous design are warranted.

Evidence on the Effectiveness of Water, Sanitation, and Hygiene (WASH) Interventions on Health Outcomes in Humanitarian Crises: A Systematic Review.

Science.gov (United States)

Ramesh, Anita; Blanchet, Karl; Ensink, Jeroen H J; Roberts, Bayard

2015-01-01

Water, sanitation, and hygiene (WASH) interventions are amongst the most crucial in humanitarian crises, although the impact of the different WASH interventions on health outcomes remains unclear. To examine the quantity and quality of evidence on WASH interventions on health outcomes in humanitarian crises, as well as evaluate current evidence on their effectiveness against health outcomes in these contexts. A systematic literature review was conducted of primary and grey quantitative literature on WASH interventions measured against health outcomes in humanitarian crises occurring from 1980-2014. Populations of interest were those in resident in humanitarian settings, with a focus on acute crisis and early recovery stages of humanitarian crises in low and middle-income countries. Interventions of interest were WASH-related, while outcomes of interest were health-related. Study quality was assessed via STROBE/CONSORT criteria. Results were analyzed descriptively, and PRISMA reporting was followed. Of 3963 studies initially retrieved, only 6 published studies measured a statistically significant change in health outcome as a result of a WASH intervention. All 6 studies employed point-of-use (POU) water quality interventions, with 50% using safe water storage (SWS) and 35% using household water treatment (HWT). All 6 studies used self-reported diarrhea outcomes, 2 studies also reported laboratory confirmed outcomes, and 2 studies reported health treatment outcomes (e.g. clinical admissions). 1 study measured WASH intervention success in relation to both health and water quality outcomes; 1 study recorded uptake (use of soap) as well as health outcomes. 2 studies were unblinded randomized-controlled trials, while 4 were uncontrolled longitudinal studies. 2 studies were graded as providing high quality evidence; 3 studies provided moderate and 1 study low quality evidence. The current evidence base on the impact of WASH interventions on health outcomes in humanitarian

Exploring the Effect of Autism Waiver Services on Family Outcomes

Science.gov (United States)

Eskow, Karen; Pineles, Lisa; Summers, Jean Ann

2011-01-01

This study examined the effect of services provided through Maryland's Home and Community-Based Services Medicaid waiver for children with autism on several outcomes related to families, specifically family quality of life (FQoL) and employment. The purpose of this study was to assess the impact of the services provided through the Maryland autism…

Effect of Zinc Supplementation on Growth Outcomes in Children under 5 Years of Age

Directory of Open Access Journals (Sweden)

Enju Liu

2018-03-01

Full Text Available (1 Background: The effects of zinc supplementation on child growth, and prior reviews of these studies, have shown mixed results. We aim to systematically review and meta-analyze randomized controlled trials evaluating effects of preventive zinc supplementation for 3 months or longer during pregnancy or in children up to age 5 years on pregnancy outcomes and child growth; (2 Methods: We searched PubMed, EMBASE, Cochrane Library, Web of Science, and trial registries for eligible trials up to October 10, 2017. Inclusion selection and data extractions were performed independently and in duplicate. Study quality was evaluated by the Cochrane Risk of Bias tool. Findings were pooled using random effects meta-analysis, with heterogeneity assessed by I2 and τ2 statistic, stratified analyses, and meta-regression, and publication bias by Egger’s and Begg’s tests; (3 Results: Seventy-eight trials with 34,352 unique participants were identified, including 24 during pregnancy and 54 in infancy/childhood. Maternal zinc supplementation did not significantly increase birth weight (weighted mean difference (WMD = 0.08 kg, 95%CI: −0.05, 0.22 or decrease the risk of low birth weight (RR = 0.76, 95%CI: 0.52–1.11. Zinc supplementation after birth increased height (WMD = 0.23 cm, 95%CI: 0.09–0.38, weight (WMD = 0.14 kg, 95%CI: 0.07–0.21, and weight-for-age Z-score (WMD = 0.04, 95%CI: 0.001–0.087, but not height-for-age Z-score (WMD = 0.02, 95%CI: −0.01–0.06 or weight-for-height Z score (WMD = 0.02, 95%CI: −0.03–0.06. Child age at zinc supplementation appeared to modify the effects on height (P-interaction = 0.002 and HAZ (P-interaction = 0.06, with larger effects of supplementation starting at age ≥2 years (WMD for height = 1.37 cm, 95%CI: 0.50–2.25; WMD for HAZ = 0.12, 95%CI: 0.05–0.19. No significant effects of supplementation were found on the risk of stunting, underweight or wasting; (4 Conclusion: Although the possibility of

Striatal Activity and Reward Relativity: Neural Signals Encoding Dynamic Outcome Valuation.

Science.gov (United States)

Webber, Emily S; Mankin, David E; Cromwell, Howard C

2016-01-01

The striatum is a key brain region involved in reward processing. Striatal activity has been linked to encoding reward magnitude and integrating diverse reward outcome information. Recent work has supported the involvement of striatum in the valuation of outcomes. The present work extends this idea by examining striatal activity during dynamic shifts in value that include different levels and directions of magnitude disparity. A novel task was used to produce diverse relative reward effects on a chain of instrumental action. Rats ( Rattus norvegicus ) were trained to respond to cues associated with specific outcomes varying by food pellet magnitude. Animals were exposed to single-outcome sessions followed by mixed-outcome sessions, and neural activity was compared among identical outcome trials from the different behavioral contexts. Results recording striatal activity show that neural responses to different task elements reflect incentive contrast as well as other relative effects that involve generalization between outcomes or possible influences of outcome variety. The activity that was most prevalent was linked to food consumption and post-food consumption periods. Relative encoding was sensitive to magnitude disparity. A within-session analysis showed strong contrast effects that were dependent upon the outcome received in the immediately preceding trial. Significantly higher numbers of responses were found in ventral striatum linked to relative outcome effects. Our results support the idea that relative value can incorporate diverse relationships, including comparisons from specific individual outcomes to general behavioral contexts. The striatum contains these diverse relative processes, possibly enabling both a higher information yield concerning value shifts and a greater behavioral flexibility.

Effects of music therapy and music-assisted relaxation and imagery on health-related outcomes in diabetes education: a feasibility study.

Science.gov (United States)

Mandel, Susan E; Davis, Beth A; Secic, Michelle

2013-01-01

The purpose of the feasibility study was to compare the effects of music-assisted relaxation and imagery, administered via compact disc recording (MARI CD) without therapeutic intervention, to the effects of music therapy (MT), facilitated by a board-certified music therapist, on selected health outcomes of patients enrolled in diabetes self-management education/training (DSME/T). A 3-group, parallel, randomized controlled trial with 199 patients, aged 30 to 85 years with type 1, type 2, or prediabetes was employed. Patients were enrolled in a study from 2 hospital sites and randomly assigned to: DSME/T alone, DSME/T plus MARI CD, or DSME/T plus MT. The MARI CD included researcher-selected music and spoken suggestions, while MT included therapeutic experiences with personally preferred relaxing and energizing music. Outcome measures included blood pressure, glycosylated hemoglobin (A1C), body mass index (BMI), trait anxiety, state anxiety, and stress. There were no statistically significant differences among the 3 conditions in blood pressure, A1C, BMI, trait anxiety, or stress. Significant changes over time were evident in the MT condition from pre- to post-each session in systolic blood pressure, state anxiety, and stress. Blood pressure changes were compared pre- to postprogram for those patients with a comorbidity of hypertension between DSME/T alone and a combined music intervention group (MT and MARI CD). It was found that the music intervention group had a significantly larger decrease in systolic blood pressure. Themes derived from patient narratives further informed the data. The study results support the relationship between DSME/T and improvement on all measured outcomes except blood pressure. Results suggest the feasibility of integrating MARI and MT with DSME/T to potentially lower systolic blood pressure of patients with diabetes and a comorbidity of hypertension. Collaboration between diabetes educators and board-certified music therapists is

The significant impact of framing coils on long-term outcomes in endovascular coiling for intracranial aneurysms: how to select an appropriate framing coil.

Science.gov (United States)

Ishida, Wataru; Sato, Masayuki; Amano, Tatsuo; Matsumaru, Yuji

2016-09-01

OBJECTIVE The importance of a framing coil (FC)-the first coil inserted into an aneurysm during endovascular coiling, also called a lead coil or a first coil-is recognized, but its impact on long-term outcomes, including recanalization and retreatment, is not well established. The purposes of this study were to test the hypothesis that the FC is a significant factor for aneurysmal recurrence and to provide some insights on appropriate FC selection. METHODS The authors retrospectively reviewed endovascular coiling for 280 unruptured intracranial aneurysms and gathered data on age, sex, aneurysm location, aneurysm morphology, maximal size, neck width, adjunctive techniques, recanalization, retreatment, follow-up periods, total volume packing density (VPD), volume packing density of the FC, and framing coil percentage (FCP; the percentage of FC volume in total coil volume) to clarify the associated factors for aneurysmal recurrence. RESULTS Of 236 aneurysms included in this study, 33 (14.0%) had recanalization, and 18 (7.6%) needed retreatment during a mean follow-up period of 37.7 ± 16.1 months. In multivariate analysis, aneurysm size (odds ratio [OR] = 1.29, p < 0.001), FCP < 32% (OR 3.54, p = 0.009), and VPD < 25% (OR 2.96, p = 0.015) were significantly associated with recanalization, while aneurysm size (OR 1.25, p < 0.001) and FCP < 32% (OR 6.91, p = 0.017) were significant predictors of retreatment. VPD as a continuous value or VPD with any cutoff value could not predict retreatment with statistical significance in multivariate analysis. CONCLUSIONS FCP, which is equal to the FC volume as a percentage of the total coil volume and is unaffected by the morphology of the aneurysm or the measurement error in aneurysm length, width, or height, is a novel predictor of recanalization and retreatment and is more significantly predictive of retreatment than VPD. To select FCs large enough to meet the condition of FCP ≥ 32% is a potential relevant factor for better

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.

Effectiveness of a Multilevel Workplace Health Promotion Program on Vitality, Health, and Work-Related Outcomes

NARCIS (Netherlands)

Hendriksen, I.J.M.; Snoijer, M.; Kok, B.P. de; Vlisteren, J. van; Hofstetter, H.

2016-01-01

Objective: Evaluation of the effectiveness of a workplace health promotion program on employees’ vitality, health, and work-related outcomes, and exploring the influence of organizational support and the supervisors’ role on these outcomes. Methods: The 5-month intervention included activities at

Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: a systematic review and meta-analysis.

Science.gov (United States)

Lee, O-Sung; Ahn, Soyeon; Lee, Yong Seuk

2017-07-01

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness and safety of early weight-bearing by comparing clinical and radiological outcomes between early and traditional delayed weight-bearing after OWHTO. A rigorous and systematic approach was used. The methodological quality was also assessed. Results that are possible to be compared in two or more than two articles were presented as forest plots. A 95% confidence interval was calculated for each effect size, and we calculated the I 2 statistic, which presents the percentage of total variation attributable to the heterogeneity among studies. The random-effects model was used to calculate the effect size. Six articles were included in the final analysis. All case groups were composed of early full weight-bearing within 2 weeks. All control groups were composed of late full weight-bearing between 6 weeks and 2 months. Pooled analysis was possible for the improvement in Lysholm score, but there was no statistically significant difference shown between groups. Other clinical results were also similar between groups. Four studies reported mechanical femorotibial angle (mFTA) and this result showed no statistically significant difference between groups in the pooled analysis. Furthermore, early weight-bearing showed more favorable results in some radiologic results (osseointegration and patellar height) and complications (thrombophlebitis and recurrence). Our analysis supports that early full weight-bearing after OWHTO using a locking plate leads to improvement in outcomes and was comparable to the delayed weight-bearing in terms of clinical and radiological outcomes. On the contrary, early weight-bearing was more favorable with respect to some radiologic parameters and complications compared with delayed weight-bearing.

The effect of antenatal education in small classes on obstetric and psycho-social outcomes - a systematic review.

Science.gov (United States)

Brixval, Carina Sjöberg; Axelsen, Solveig Forberg; Lauemøller, Stine Glenstrup; Andersen, Stig Krøger; Due, Pernille; Koushede, Vibeke

2015-02-28

The aims of antenatal education are broad and encompass outcomes related to pregnancy, birth, and parenthood. Both form and content of antenatal education have changed over time without evidence of effects on relevant outcomes. The effect of antenatal education in groups, with participation of a small number of participants, may differ from the effect of other forms of antenatal education due to, for example, group dynamic. The objective of this systematic review is to assess the effects of antenatal education in small groups on obstetric as well as psycho-social outcomes. Bibliographic databases (Medline, EMBASE, CENTRAL, CINAHL, Web of Science, and PsycINFO) were searched. We included randomized and quasi-randomized trials irrespective of language, publication year, publication type, and publication status. Only trials carried out in the Western world were considered in this review. Studies were assessed for bias using the Cochrane risk of bias tool. Results are presented as structured summaries of the included trials and as forest plots. We identified 5,708 records. Of these, 17 studies met inclusion criteria. Studies varied greatly in content of the experimental and control condition. All outcomes were only reported in a single or a few trials, leading to limited or uncertain confidence in effect estimates. Given the heterogeneity in interventions and outcomes and also the high risk of bias of studies, we are unable to draw definitive conclusions as to the impact of small group antenatal education on obstetric and psycho-social outcomes. Insufficient evidence exists as to whether antenatal education in small classes is effective in regard to obstetric and psycho-social outcomes. We recommend updating this review following the emergence of well-conducted randomized controlled trials with a low risk of bias. PROSPERO CRD42013004319.

Do Different Stimulation Protocols Effect Oocyte Quality and IVF Outcomes in IVF-ET?

Directory of Open Access Journals (Sweden)

Nafiye Yilmaz

2016-04-01

Full Text Available Aim: This study was planned to compare the effect of different stimulation protocols (hMG and uFSH on oocyte maturation and in vitro fertilization outcomes. Material and Method: Eighty-two patients admitted Ankara University Obstetrics and Gynecology Clinic- IVF Department were included in this retrospective study. All patients used long GnRH agonist protocol. Fifty-nine patients used human menopausal gonadotropin (hMG (Group 1 and 23 patients used urine derived follicle-stimulating hormone (uFSH (Group 2 for ovulation induction. Maximum follicle diameter, dominant follicle number, endometrial thickness at human chorionic gonadotropin day, duration of induction, dose of gonadotropin, oocyte number and quality, fertilization rate, embryo number and quality, pregnancy rate per cycles and transfer were reported. Results: Maximum follicle diameter, dominant follicle number, immature oocyte number were significantly higher in hMG group vs. uFSH group (p0.05. Discussion: Clinical pregnancy rate was not significantly different in hMG vs. uFSH group. In developing countries, ovarian stimulation agents should be chosen based on patient characteristics and cost.

Effect of the number of Ramadan fasting days on maternal and neonatal outcomes

Directory of Open Access Journals (Sweden)

Hassan Boskabadi

2014-09-01

Full Text Available Introduction: Gynecologists and perinatologists are left with many unanswered questions and concerns regarding fasting during pregnancy and its effects on maternal and neonatal health. The current study was conducted to investigate the correlation between the number of Ramadan fasting days and pregnancy outcomes. Materials & Methods: In this descriptive, analytical study, 641 newborns, whose mothers had fasting experience during pregnancy, were enrolled and allocated to three groups, based on the number of maternal fasting days during pregnancy (group A: ≤10 days, group B: 11-20 days, and group C: 21-30 days. Demographic and anthropometric data of neonates and mothers were recorded. Descriptive statistics, Chi-square, and non-parametric tests were performed for data analysis. Results: No statistically significant difference was found in maternal weight (during the last month of pregnancy, neonatal height, incidence of pre-term labor, or neonatal congenital abnormality in the three groups. Increased number of fasting days was not correlated with decreased neonatal head circumference or weight, while 1- and 5-minute Apgar scores significantly improved (P

Reporting effect sizes as a supplement to statistical significance ...

African Journals Online (AJOL)

The purpose of the article is to review the statistical significance reporting practices in reading instruction studies and to provide guidelines for when to calculate and report effect sizes in educational research. A review of six readily accessible (online) and accredited journals publishing research on reading instruction ...

Analogical reasoning and the differential outcome effect: transitory bridging of the conceptual gap for rhesus monkeys (Macaca mulatta).

Science.gov (United States)

Flemming, Timothy M; Thompson, Roger K R; Beran, Michael J; Washburn, David A

2011-07-01

Monkeys, unlike chimpanzees and humans, have a marked difficulty acquiring relational matching-to-sample (RMTS) tasks that likely reflect the cognitive foundation upon which analogical reasoning rests. In the present study, rhesus monkeys (Macaca mulatta) completed a categorical (identity and nonidentity) RMTS task with differential reward (pellet ratio) and/or punishment (timeout ratio) outcomes for correct and incorrect choices. Monkeys in either differential reward-only or punishment-only conditions performed at chance levels. However, the RMTS performance of monkeys experiencing both differential reward and punishment conditions was significantly better than chance. Subsequently when all animals experienced nondifferential outcomes tests, their RMTS performance levels were at chance. These results indicate that combining differential reward and punishment contingencies provide an effective, albeit transitory, scaffolding for monkeys to judge analogical relations-between-relations. PsycINFO Database Record (c) 2011 APA, all rights reserved

Better Informing Decision Making with Multiple Outcomes Cost-Effectiveness Analysis under Uncertainty in Cost-Disutility Space

Science.gov (United States)

McCaffrey, Nikki; Agar, Meera; Harlum, Janeane; Karnon, Jonathon; Currow, David; Eckermann, Simon

2015-01-01

Introduction Comparing multiple, diverse outcomes with cost-effectiveness analysis (CEA) is important, yet challenging in areas like palliative care where domains are unamenable to integration with survival. Generic multi-attribute utility values exclude important domains and non-health outcomes, while partial analyses—where outcomes are considered separately, with their joint relationship under uncertainty ignored—lead to incorrect inference regarding preferred strategies. Objective The objective of this paper is to consider whether such decision making can be better informed with alternative presentation and summary measures, extending methods previously shown to have advantages in multiple strategy comparison. Methods Multiple outcomes CEA of a home-based palliative care model (PEACH) relative to usual care is undertaken in cost disutility (CDU) space and compared with analysis on the cost-effectiveness plane. Summary measures developed for comparing strategies across potential threshold values for multiple outcomes include: expected net loss (ENL) planes quantifying differences in expected net benefit; the ENL contour identifying preferred strategies minimising ENL and their expected value of perfect information; and cost-effectiveness acceptability planes showing probability of strategies minimising ENL. Results Conventional analysis suggests PEACH is cost-effective when the threshold value per additional day at home ( 1) exceeds $1,068 or dominated by usual care when only the proportion of home deaths is considered. In contrast, neither alternative dominate in CDU space where cost and outcomes are jointly considered, with the optimal strategy depending on threshold values. For example, PEACH minimises ENL when 1=$2,000 and 2=$2,000 (threshold value for dying at home), with a 51.6% chance of PEACH being cost-effective. Conclusion Comparison in CDU space and associated summary measures have distinct advantages to multiple domain comparisons, aiding

Periodontal treatment for preventing adverse pregnancy outcomes

DEFF Research Database (Denmark)

Schwendicke, Falk; Karimbux, Nadeem; Allareddy, Veerasathpurush

2015-01-01

OBJECTIVES: Periodontal treatment might reduce adverse pregnancy outcomes. The efficacy of periodontal treatment to prevent preterm birth, low birth weight, and perinatal mortality was evaluated using meta-analysis and trial sequential analysis. METHODS: An existing systematic review was updated...... risk of random errors. RESULTS: Thirteen randomized clinical trials evaluating 6283 pregnant women were meta-analyzed. Four and nine trials had low and high risk of bias, respectively. Overall, periodontal treatment had no significant effect on preterm birth (odds ratio [95% confidence interval] 0.......79 [0.57-1.10]) or low birth weight (0.69 [0.43-1.13]). Trial sequential analysis demonstrated that futility was not reached for any of the outcomes. For populations with moderate occurrence (periodontal treatment was not efficacious for any of the outcomes...

Decline in Child Marriage and Changes in Its Effect on Reproductive Outcomes in Bangladesh

Science.gov (United States)

2012-01-01

This paper explores the decline in child marriage and changes in its effect on reproductive outcomes of Bangladeshi women, using the 2007 Bangladesh Demographic and Health Survey data. Chi-square tests, negative binomial Poisson regression and binary logistic regression were performed in analyzing the data. Overall, 82% of women aged 20-49 years were married-off before 18 years of age, and 63% of the marriages took place before 16 years of age. The incidence of child marriage was significantly less among the young women aged 20-24 years compared to their older counterparts. Among others, women's education appeared as the most significant single determinant of child marriage as well as decline in child marriage. Findings revealed that, after being adjusted for sociodemographic factors, child marriage compared to adult marriage appeared to be significantly associated with lower age at first birth (OR=0.81, 95% CI=76-0.86), higher fertility (IRR=1.45, 95% WCI=1.35-1.55), increased risk of child mortality (IRR=1.64, 95% WCI=1.44-1.87), decreased risk of contraceptive-use before any childbirths (OR=0.56, 95% CI=0.50-0.63), higher risk of giving three or more childbirth (OR=3.94, 95% CI=3.38-4.58), elevated risk of unplanned pregnancies (OR=1.21, 95% CI=1.02-1.45), increased risk of pregnancy termination (OR=1.16, 95% CI=1.00-1.34), and higher risk of the use of any current contraceptive method (OR=1.20, 95% CI=1.06-1.35). Increased enforcement of existing policies is crucial for the prevention of child marriage. Special programmes should be undertaken to keep girls in school for longer period to raise the age of females at first marriage in Bangladesh and thereby reduce the adverse reproductive outcomes. PMID:23082634

Computerized clinical decision support systems for primary preventive care: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

Directory of Open Access Journals (Sweden)

Wilczynski Nancy L

2011-08-01

Full Text Available Abstract Background Computerized clinical decision support systems (CCDSSs are claimed to improve processes and outcomes of primary preventive care (PPC, but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs. Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement if at least 50% of the relevant study outcomes were statistically significantly positive. Results We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63% RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34% trials assessed patient outcomes, and four (29% reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15% and two (5% trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects. Conclusions

The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain: A Prospective Open-label Study.

Science.gov (United States)

Haroutounian, Simon; Ratz, Yael; Ginosar, Yehuda; Furmanov, Karina; Saifi, Fayez; Meidan, Ronit; Davidson, Elyad

2016-12-01

The objective of this prospective, open-label study was to determine the long-term effect of medicinal cannabis treatment on pain and functional outcomes in participants with treatment-resistant chronic pain. The primary outcome was the change in the pain symptom score on the S-TOPS (Treatment Outcomes in Pain Survey-Short Form) questionnaire at the 6-month follow-up in an intent-to-treat population. Secondary outcomes included the change in S-TOPS physical, social, and emotional disability scales, the pain severity, and pain interference on the Brief Pain Inventory, sleep problems, and the change in opioid consumption. A total of 274 participants were approved for treatment; complete baseline data were available for 206 (intent-to-treat), and complete follow-up data for 176 participants. At follow-up, the pain symptom score improved from median 83.3 (95% confidence interval [CI], 79.2-87.5) to 75.0 (95% CI, 70.8-79.2) (Pmedicinal cannabis in this open-label, prospective cohort resulted in improved pain and functional outcomes, and a significant reduction in opioid use. Results suggest long-term benefit of cannabis treatment in this group of patients, but the study's noncontrolled nature should be considered when extrapolating the results.

The effect of a clinical medical librarian on in-patient care outcomes.

Science.gov (United States)

Esparza, Julia M; Shi, Runhua; McLarty, Jerry; Comegys, Marianne; Banks, Daniel E

2013-07-01

The research sought to determine the effect of a clinical medical librarian (CML) on outcomes of in-patients on the internal medicine service. A prospective study was performed with two internal medicine in-patient teams. Team 1 included a CML who accompanied the team on daily rounds. The CML answered questions posed at the point of care immediately or in emails post-rounds. Patients on Team 2, which did not include a CML, as well as patients who did not require consultation by the CML on Team 1, served as the control population. Numerous clinical and library metrics were gathered on each question. Patients on Team 1 who required an answer to a clinical question were more ill and had a longer length of stay, higher costs, and higher readmission rates compared to those in the control group. Using a matched pair analysis, we showed no difference in clinical outcomes between the intervention group and the control group. This study is the largest attempt to prospectively measure changes in patient outcomes when physicians were accompanied by a CML on rounds. This approach may serve as a model for further studies to define when and how CMLs are most effective.

Effect of Behavior Modification on Outcome in Early- to Moderate-Stage Chronic Kidney Disease: A Cluster-Randomized Trial.

Science.gov (United States)

Yamagata, Kunihiro; Makino, Hirofumi; Iseki, Kunitoshi; Ito, Sadayoshi; Kimura, Kenjiro; Kusano, Eiji; Shibata, Takanori; Tomita, Kimio; Narita, Ichiei; Nishino, Tomoya; Fujigaki, Yoshihide; Mitarai, Tetsuya; Watanabe, Tsuyoshi; Wada, Takashi; Nakamura, Teiji; Matsuo, Seiichi

2016-01-01

Owing to recent changes in our understanding of the underlying cause of chronic kidney disease (CKD), the importance of lifestyle modification for preventing the progression of kidney dysfunction and complications has become obvious. In addition, effective cooperation between general physicians (GPs) and nephrologists is essential to ensure a better care system for CKD treatment. In this cluster-randomized study, we studied the effect of behavior modification on the outcome of early- to moderate-stage CKD. Stratified open cluster-randomized trial. A total of 489 GPs belonging to 49 local medical associations (clusters) in Japan. A total of 2,379 patients (1,195 in group A (standard intervention) and 1,184 in group B (advanced intervention)) aged between 40 and 74 years, who had CKD and were under consultation with GPs. All patients were managed in accordance with the current CKD guidelines. The group B clusters received three additional interventions: patients received both educational intervention for lifestyle modification and a CKD status letter, attempting to prevent their withdrawal from treatment, and the group B GPs received data sheets to facilitate reducing the gap between target and practice. The primary outcome measures were 1) the non-adherence rate of accepting continuous medical follow-up of the patients, 2) the collaboration rate between GPs and nephrologists, and 3) the progression of CKD. The rate of discontinuous clinical visits was significantly lower in group B (16.2% in group A vs. 11.5% in group B, p = 0.01). Significantly higher referral and co-treatment rates were observed in group B (pbehavior modification of CKD patients, namely, significantly lower discontinuous clinical visits, and behavior modification of both GPs and nephrologists, namely significantly higher referral and co-treatment rates, resulting in the retardation of CKD progression, especially in patients with proteinuric Stage 3 CKD. The University Hospital Medical Information

Comparison of the effect of endodontic-periodontal combined lesion on the outcome of endodontic microsurgery with that of isolated endodontic lesion: survival analysis using propensity score analysis.

Science.gov (United States)

Song, Minju; Kang, Minji; Kang, Dae Ryong; Jung, Hoi In; Kim, Euiseong

2018-05-01

The purpose of this retrospective clinical study was to evaluate the effect of lesion types related to endodontic microsurgery on the clinical outcome. Patients who underwent endodontic microsurgery between March 2001 and March 2014 with a postoperative follow-up period of at least 1 year were included in the study. Survival analyses were conducted to compare the clinical outcomes between isolated endodontic lesion group (endo group) and endodontic-periodontal combined lesion group (endo-perio group) and to evaluate other clinical variables. To reduce the effect of selection bias in this study, the estimated propensity scores were used to match the cases of the endo group with those of the endo-perio group. Among the 414 eligible cases, the 83 cases in the endo-perio group were matched to 166 out of the 331 cases in the endo group based on propensity score matching (PSM). The cumulated success rates of the endo and endo-perio groups were 87.3 and 72.3%, respectively. The median success period of the endo-perio group was 12 years (95% CI: 5.507, 18.498). Lesion type was found to be significant according to both Log-rank test (P = 0.002) and Cox proportional hazard regression analysis (P = 0.001). Among the other clinical variables, sex (female or male), age, and tooth type (anterior, premolar, or molar) were determined to be significant in Cox regression analysis (P lesions had a negative effect on the clinical outcome based on an analysis that utilized PSM, a useful statistical matching method for observational studies. Lesion type is a significant predictor of the outcome of endodontic microsurgery.

The Effect of Stent Cell Geometry on Carotid Stenting Outcomes

Energy Technology Data Exchange (ETDEWEB)

Alparslan, Burcu, E-mail: burcu.alparslan@gmail.com [Yozgat State Hospital, Radiology Clinic (Turkey); Nas, Omer Fatih, E-mail: omerfatihnas@gmail.com [Uludag University Faculty of Medicine, Department of Radiology (Turkey); Eritmen, Ulku Turpcu, E-mail: drulkutur@hotmail.com.tr [Special Eregli Anatolia Hospital, Radiology Clinic (Turkey); Duran, Selcen, E-mail: selcenduran16@hotmail.com [Yerkoy State Hospital, Neurology Clinic (Turkey); Ozkaya, Guven, E-mail: ozkaya@uludag.edu.tr [Uludag University Faculty of Medicine, Department of Biostatistics (Turkey); Hakyemez, Bahattin, E-mail: bhakyemez@uludag.edu.tr [Uludag University Faculty of Medicine, Department of Radiology (Turkey)

2016-04-15

PurposeThe aim of this study was to investigate the effect of stent cell geometry on midterm results of carotid artery stenting (CAS).Materials and MethodOne hundred fifty-five patients underwent CAS between February 2010 and December 2012. Ninety-one open- and 84 closed-cell stents were used in this non-randomized, retrospective study. Periprocedural complications were defined as the ones happened during the procedure or within 30 days afterwards. Starting from the 6th month after the procedure, in-stent restenosis was detected with multidetector computed tomography angiography and classified into four groups from focal restenosis to occlusion.ResultsEleven complications were encountered in the periprocedural period (four on the open- and seven on the closed-cell group). Total complication rate was 6.3 % (11/175). No significant difference was detected in terms of periprocedural complications between two groups (p = 0.643). There was statistically significant difference between stent design groups in regard to radiological findings (p = 0.002). Sixteen of open-cell stents and three of closed-cell stents had focal restenosis. One closed-cell stent had diffuse proliferative restenosis and one open-cell stent had total occlusion.ConclusionIn-stent restenosis was more common in open-cell stent group, which have larger free cell area than closed-cell stents. Although our radiologic findings promote us to use closed-cell design if ‘possible’, no difference was detected in terms of clinical outcomes.

Effects of central nervous system drugs on driving: speed variability versus standard deviation of lateral position as outcome measure of the on-the-road driving test.

Science.gov (United States)

Verster, Joris C; Roth, Thomas

2014-01-01

The on-the-road driving test in normal traffic is used to examine the impact of drugs on driving performance. This paper compares the sensitivity of standard deviation of lateral position (SDLP) and SD speed in detecting driving impairment. A literature search was conducted to identify studies applying the on-the-road driving test, examining the effects of anxiolytics, antidepressants, antihistamines, and hypnotics. The proportion of comparisons (treatment versus placebo) where a significant impairment was detected with SDLP and SD speed was compared. About 40% of 53 relevant papers did not report data on SD speed and/or SDLP. After placebo administration, the correlation between SDLP and SD speed was significant but did not explain much variance (r = 0.253, p = 0.0001). A significant correlation was found between ΔSDLP and ΔSD speed (treatment-placebo), explaining 48% of variance. When using SDLP as outcome measure, 67 significant treatment-placebo comparisons were found. Only 17 (25.4%) were significant when SD speed was used as outcome measure. Alternatively, for five treatment-placebo comparisons, a significant difference was found for SD speed but not for SDLP. Standard deviation of lateral position is a more sensitive outcome measure to detect driving impairment than speed variability.

The effect of a pedometer-based community walking intervention "Walking for Wellbeing in the West" on physical activity levels and health outcomes: a 12-week randomized controlled trial

Directory of Open Access Journals (Sweden)

Nimmo Myra

2008-09-01

Full Text Available Abstract Background Recent systematic reviews have suggested that pedometers may be effective motivational tools to promote walking. However, studies tend to be of a relatively short duration, with small clinical based samples. Further research is required to demonstrate their effectiveness in adequately powered, community based studies. Objective Using a randomized controlled trial design, this study assessed the impact of a 12-week graduated pedometer-based walking intervention on daily step-counts, self-reported physical activity and health outcomes in a Scottish community sample not meeting current physical activity recommendations. Method Sixty-three women and 16 men (49.2 years ± 8.8 were randomly assigned to either an intervention (physical activity consultation and 12-week pedometer-based walking program or control (no action group. Measures for step-counts, 7-day physical activity recall, affect, quality of life (n = 79, body mass, BMI, % body fat, waist and hip circumference (n = 76, systolic/diastolic blood pressure, total cholesterol and HDL cholesterol (n = 66 were taken at baseline and week 12. Analyses were performed on an intention to treat basis using 2-way mixed factorial analyses of variance for parametric data and Mann Whitney and Wilcoxon tests for non-parametric data. Results Significant increases were found in the intervention group for step-counts (p p = .02 and positive affect (p = .027. Significant decreases were found in this group for time spent in weekday (p = .003, weekend (p = .001 and total sitting (p = .001 with no corresponding changes in the control group. No significant changes in any other health outcomes were found in either group. In comparison with the control group at week 12, the intervention group reported a significantly greater number of minutes spent in leisure time (p = .008, occupational (p = .045 and total walking (p = .03, and significantly fewer minutes in time spent in weekend (p = .003 and

The Effect of Low Carbohydrate Diets on Fertility Hormones and Outcomes in Overweight and Obese Women: A Systematic Review

Science.gov (United States)

McGrice, Melanie; Porter, Judi

2017-01-01

(1) Background: Medical interventions including assisted reproductive technologies have improved fertility outcomes for many sub-fertile couples. Increasing research interest has investigated the effect of low carbohydrate diets, with or without energy restriction. We aimed to systematically review the published literature to determine the extent to which low carbohydrate diets can affect fertility outcomes; (2) Methods: The review protocol was registered prospectively with Prospective Register for Systematic Reviews (registration number CRD42016042669) and followed Preferred Reporting Items For Systematic Reviews and Meta-Analyses guidelines. Infertile women were the population of interest, the intervention was low carbohydrate diets (less than 45% total energy from carbohydrates), compared to usual diet (with or without co-treatments). Four databases were searched from date of commencement until April 2016; a supplementary Google scholar search was also undertaken. Title and abstract, then full text review, were undertaken independently and in duplicate. Reference lists of included studies and relevant systematic reviews were checked to ensure that all relevant studies were identified for inclusion. Quality assessment was undertaken independently by both authors using the Quality Criteria Checklist for Primary Research. Outcome measures were improved fertility outcomes defined by an improvement in reproductive hormones, ovulation rates and/or pregnancy rates; (3) Results: Seven studies fulfilled the inclusion criteria and were included in the evidence synthesis. Interventions were diverse and included a combination of low carbohydrate diets with energy deficit or other co-treatments. Study quality was rated as positive for six studies, suggesting a low risk of bias, with one study rated as neutral. Of the six studies which reported changes in reproductive hormones, five reported significant improvements post intervention; (4) Conclusion: The findings of these

Treatment Outcome and Maintenance in Systematic Desensitization: Professional versus Paraprofessional Effectiveness.

Science.gov (United States)

Shelton, John L.; Madrazo-Peterson, Rita

1978-01-01

Anxious students were randomly assigned to a wait-list control group; to three groups aided by experienced behavior therapists; or to three groups led by paraprofessionals. Results show paraprofessionals can achieve outcome and maintenance effects equivalent to more rigorously trained professionals. Paraprofessionals can conduct desensitization in…

The Effects of Early Maternal Employment on Later Cognitive and Behavioral Outcomes.

Science.gov (United States)

Han, Wen-Jui; Waldfogel, Jane; Brooks-Gunn, Jeanne

2001-01-01

This study longitudinally followed Non-Hispanic White and African American children to see whether the impact of early maternal employment on cognitive and behavioral outcomes reported at age three and four persisted into school-age years. Results indicated that maternal employment in the first year of a child's life had significant negative…

Chronicity of sexual harassment and generalized work-place abuse: effects on drinking outcomes.

Science.gov (United States)

Rospenda, K M; Richman, J A; Wislar, J S; Flaherty, J A

2000-12-01

This study examined the impact of two forms of interpersonal conflict in the work-place, sexual harassment (SH) and generalized work-place abuse (GWA), on drinking outcomes. We hypothesized that SH and GWA would be associated more strongly with negative outcomes than task-related work stressors, especially when SH and GWA were chronic problems. This was a two-wave panel study. The study was conducted at an urban university in the United States. Participants were 2038 university employees in four occupational groups (faculty, student, clerical and service workers) who responded to both waves of the survey. Data on SH, GWA, task-related stressors and drinking outcomes were gathered from self-report mail questionnaires. Data from 1880 non-abstaining respondents were included in the analyses. SH and GWA experiences were widespread, typically chronic, and tended to co-occur. In regression analyses controlling for demographics, occupational group, prior drinking and task-related stress, GWA chronicity was linked to increased odds of reporting one or more indicators of problem drinking at time 2, in contrast to onset and remission. SH chronicity coupled with no GWA experiences was also significantly related to increased drinking variability. Task-related stressors generally did not explain significant variance in drinking outcomes. SH and GWA may be better predictors of drinking behavior compared to task-related stressors, particularly when harassment is chronic. Increased attention to conflictual relationships in the work-place, the relationship between SH and GWA and the dynamic nature of stressors in general is necessary in future research on drinking behavior.

Effect of estrogen replacement therapy on bone and cardiovascular outcomes in women with turner syndrome: a systematic review and meta-analysis.

Science.gov (United States)

Cintron, Dahima; Rodriguez-Gutierrez, Rene; Serrano, Valentina; Latortue-Albino, Paula; Erwin, Patricia J; Murad, Mohammad Hassan

2017-02-01

Patients with Turner syndrome have adverse bone and cardiovascular outcomes from chronic estrogen deficiency. Hence, long-term estrogen replacement therapy is the cornerstone treatment. The estimates of its effect and optimal use, however, remain uncertain. We aimed to summarize the benefits and harms of estrogen replacement therapy on bone, cardiovascular, vasomotor and quality of life outcomes in patients with Turner syndrome. A comprehensive search of four databases was performed from inception through January 2016. Randomized clinical trials and observational cohort studies studying the effect of estrogen replacement therapy in patients with Turner syndrome under the age of 40 were included. Independently and in duplicate reviewers selected studies, extracted data and assessed risk of bias. Subgroup analyses were based on route of administration and type of estrogen formulation. Twenty-five studies at moderate to high risk of bias (12 randomized trials, 13 cohort studies) with 771 patients were included. Using random-effects models, estrogen replacement therapy showed an increase in bone mineral density [weighted mean change from baseline 0.09 g/cm2 (0.04-0.14)] that differed by type of estrogen but not route of administration. Oral estrogen replacement therapy showed a higher increase in high density lipoprotein cholesterol levels when compared to transdermal [weighted mean difference 9.33 mg/dl (4.82-13.85)] with no significant effect on other lipid fractions. The current evidence suggests possible benefit of estrogen replacement therapy on bone mineral density and high density lipoprotein cholesterol. Whether this improvement translates into changes in patient important outcomes (cardiovascular events or fractures) remains uncertain. Larger randomized clinical trials with direct comparisons on patient important outcomes are necessary.

The effects of family support and work engagement on organizationally valued job outcomes

OpenAIRE

Karatepe, Osman M.

2015-01-01

There are calls for more empirical research about the antecedents and outcomes of work engagement in frontline service jobs in the hospitality management literature. With this realization, using the precepts of the motivational process of the Job Demands-Resources model, the present study aims to develop and test a conceptual model that examines work engagement as a mediator of the effect of family support on organizationally relevant and valued job outcomes. Turnover intentions, job performa...

Effectiveness of motivational interviewing on lifestyle modification and health outcomes of clients at risk or diagnosed with cardiovascular diseases: A systematic review.

Science.gov (United States)

Lee, Windy W M; Choi, K C; Yum, Royce W Y; Yu, Doris S F; Chair, S Y

2016-01-01

altering smoking habits. For physiological outcomes, the review showed that motivational interviewing positively improved client's systolic and diastolic blood pressures but the result was not significant. For psychological outcomes, the review showed that motivational interviewing might have favorable effect on improving clients' depression. For other outcomes, the review showed that motivational interviewing did not differ from usual care or usual care was even more effective. The review showed that motivational interviewing might have favorable effects on changing clients' smoking habits, depression, and three SF-36 domains. For the other outcomes, most of the results were inconclusive. Further studies should be performed to identify the optimal format and frequency of motivational interviewing. Primary research on the effectiveness of motivational interviewing on increasing clients' motivation and their actual changes in healthy behavior is also recommended. Copyright © 2015 Elsevier Ltd. All rights reserved.

Efficacy of a Word- and Text-Based Intervention for Students With Significant Reading Difficulties.

Science.gov (United States)

Vaughn, Sharon; Roberts, Garrett J; Miciak, Jeremy; Taylor, Pat; Fletcher, Jack M

2018-05-01

We examine the efficacy of an intervention to improve word reading and reading comprehension in fourth- and fifth-grade students with significant reading problems. Using a randomized control trial design, we compare the fourth- and fifth-grade reading outcomes of students with severe reading difficulties who were provided a researcher-developed treatment with reading outcomes of students in a business-as-usual (BAU) comparison condition. A total of 280 fourth- and fifth-grade students were randomly assigned within school in a 1:1 ratio to either the BAU comparison condition ( n = 139) or the treatment condition ( n = 141). Treatment students were provided small-group tutoring for 30 to 45 minutes for an average of 68 lessons (mean hours of instruction = 44.4, SD = 11.2). Treatment students performed statistically significantly higher than BAU students on a word reading measure (effect size [ES] = 0. 58) and a measure of reading fluency (ES = 0.46). Though not statistically significant, effect sizes for students in the treatment condition were consistently higher than BAU students for decoding measures (ES = 0.06, 0.08), and mixed for comprehension (ES = -0.02, 0.14).

Anaemia among pregnant women in northern Tanzania: prevalence, risk factors and effect on perinatal outcomes.

Science.gov (United States)

Msuya, Sia E; Hussein, Tamara H; Uriyo, Jacqueline; Sam, Noel E; Stray-Pedersen, Babill

2011-01-01

Anaemia during pregnancy is associated with negative maternal and neonatal outcomes. However, there is limited data regarding prevalence and effects of anaemia during pregnancy in northern Tanzania. The objective of this study was to determine the prevalence and possible risk factors for anaemia and its effect on perinatal outcomes among pregnant women attending antenatal care in Moshi Municipality in northern Tanzania. A cohort of pregnant women aged 14-43 years and in their 3rd trimester, was recruited from two primary health care clinics between June 2002 and March 2004. Interviews, anthropometric measurements and haematological examinations were conducted on 2654 consenting women. Perinatal outcomes were recorded during delivery and at 1 week after delivery. Of the 2654 participants, 47.4% had anaemia (haemoglobin [Hb] anaemia (Hb= 9-10.9g/dl), 9.9% had moderate anaemia (Hb =7- 8.9g/dl), and 2.1% had severe anaemia (Hb Anaemia was significantly more prevalent in HIV-positive (56.4%) than in HIV-negative women (46.7%), (P = 0.01). In logistic regression anaemia was independently associated with maternal HIV (OR= 1.5), malaria (OR= 5.2), clinic of recruitment (OR= 1.5) and low income (OR= 1.9). Pregnant women with anaemia were more likely to have low birth weight (LBW) infants. Compared with non-anaemic women, the risk of LBW was 1.6 times and 4.8 times higher for children born to women with moderate and severe anaemia, respectively. In conclusion, anaemia in pregnancy is a severe public health problem in northern Tanzania. Control of maternal anaemia may be one important strategy to prevent LBW in this setting. Measures to prevent malaria and to control anaemia among all pregnant women irrespective of HIV status, should be strengthened. Outside of the health sector broader approaches for anaemia prevention targeting women of lower income, are required.

Estimation of Causal Mediation Effects for a Dichotomous Outcome in Multiple-Mediator Models using the Mediation Formula

OpenAIRE

Wang, Wei; Nelson, Suchitra; Albert, Jeffrey M.

2013-01-01

Mediators are intermediate variables in the causal pathway between an exposure and an outcome. Mediation analysis investigates the extent to which exposure effects occur through these variables, thus revealing causal mechanisms. In this paper, we consider the estimation of the mediation effect when the outcome is binary and multiple mediators of different types exist. We give a precise definition of the total mediation effect as well as decomposed mediation effects through individual or sets ...

Lunar cycle may have an effect on Shock Wave Lithotripsy related pain outcome.

Science.gov (United States)

Tokgöz, Hüsnü; Yalçınkaya, Soner; İslamoğlu, Ekrem; Karamık, Kaan; Tokgöz, Özlem; Savaş, Murat

2017-12-01

We tried to investigate the effects of lunar phase on Shock Wave Lithotripsy (SWL) related pain. In addition, correlation of various clinical parameters with the pain perception during SWL procedure, were also investigated. A total of 378 patients who underwent first SWL sessions for renal or ureteral stones were prospectively enrolled in the study. The degree of pain perception during the procedure was evaluated with 10-point visual analog scale (VAS) and pain questionnaires. The date of SWL was allocated to dates and times of lunar phases as: newmoon, waxing crescent, first quarter, waxing gibbus, fullmoon, waning gibbus, last quarter and waning gibbus. Mean VAS scores in first quarter (2,41±1,06) were significantly lower when compared to mean VAS scores in waning crescent (3,58±1,83) and waning gibbus (3,42±1,98) ( p=0,005 and 0,041 , respectively). No statistically significant differences were observed when other lunar phases were compared between each other. Mean pain scores were not affected from gender, age, body mass index (BMI) and stone characteristics (stone laterality, burden and location). SWL procedure performed in first quarter of the lunar phase may become less painful. To the best of our knowledge, this is the first study which evaluated the effect of lunar phase on post-SWL pain outcome. Thus, additional randomized studies with larger series may be more informative.

The effect of low birth weight on height, weight and behavioral outcomes in the medium-run

DEFF Research Database (Denmark)

Datta Gupta, Nabanita; Deding, Mette; Lausten, Mette

2013-01-01

as physical growth at ages 6 months, 3½, 7½ and 11 years using data from the Danish Longitudinal Survey of Children. Observing the same children at different points in time enabled us to chart the evolution of anthropometric and behavioral deficits among children born with low birth weight and helped......A number of studies have documented negative long term effects of low birth weight. Yet, not much is known about the dynamics of the process leading to adverse health and educational outcomes in the long run. While previous studies focusing mainly on LBW effects on physical growth and cognitive...... outcomes have found effects of the same size at both school age and young adulthood, others have found a diminishing negative effect over time. The purpose of this paper was to bring new evidence to this issue by analyzing the medium run effects of low birth weight on child behavioral outcomes as well...

Bayesian Nonparametric Estimation of Targeted Agent Effects on Biomarker Change to Predict Clinical Outcome

Science.gov (United States)

Graziani, Rebecca; Guindani, Michele; Thall, Peter F.

2015-01-01

Summary The effect of a targeted agent on a cancer patient's clinical outcome putatively is mediated through the agent's effect on one or more early biological events. This is motivated by pre-clinical experiments with cells or animals that identify such events, represented by binary or quantitative biomarkers. When evaluating targeted agents in humans, central questions are whether the distribution of a targeted biomarker changes following treatment, the nature and magnitude of this change, and whether it is associated with clinical outcome. Major difficulties in estimating these effects are that a biomarker's distribution may be complex, vary substantially between patients, and have complicated relationships with clinical outcomes. We present a probabilistically coherent framework for modeling and estimation in this setting, including a hierarchical Bayesian nonparametric mixture model for biomarkers that we use to define a functional profile of pre-versus-post treatment biomarker distribution change. The functional is similar to the receiver operating characteristic used in diagnostic testing. The hierarchical model yields clusters of individual patient biomarker profile functionals, and we use the profile as a covariate in a regression model for clinical outcome. The methodology is illustrated by analysis of a dataset from a clinical trial in prostate cancer using imatinib to target platelet-derived growth factor, with the clinical aim to improve progression-free survival time. PMID:25319212

The effectiveness of skills training for improving outcomes in supported employment.

Science.gov (United States)

Mueser, Kim T; Aalto, Steve; Becker, Deborah R; Ogden, John S; Wolfe, Rosemarie S; Schiavo, Diane; Wallace, Charles J; Xie, Haiyi

2005-10-01

This study evaluated whether a supplementary skills training program improved work outcomes for clients enrolled in supported employment programs. Thirty-five recently employed clients with severe mental illness who were receiving supported employment services at a free-standing agency were randomly assigned to participate in either the workplace fundamentals program, a skills training program designed to make work more "successful and satisfying," or treatment as usual. Knowledge of workplace fundamentals (for example, identifying workplace stressors, problem solving, and improving job performance) was assessed at baseline and at nine months; employment outcomes and use of additional vocational services were tracked for 18 months. Clients in the workplace fundamentals group (N=17) improved more in knowledge of workplace fundamentals than those in the control group (N=18) at the nine-month follow-up, but the two groups did not differ in the number of hours or days worked, salary earned, or receipt of additional vocational services over the 18-month period. In general, clients in this study had higher educational levels and better employment outcomes than clients in most previous studies of supported employment, making it difficult to detect possible effects of the skills training intervention on work. Supplementary skills training did not improve work outcomes for clients who were receiving supported employment.

Effect of use of insecticide treated nets on birth outcomes among ...

African Journals Online (AJOL)

The major impact of malaria during pregnancy in these regions is caused by persistent or recurrent, predominantly low-grade, sometimes sub-patent, parasitaemia. In Nigeria, malaria has severe negative effects on maternal health and birth outcomes, resulting in maternal anaemia, a high incidence of miscarriages and low ...

The impact of financial and nonfinancial incentives on business-unit outcomes over time.

Science.gov (United States)

Peterson, Suzanne J; Luthans, Fred

2006-01-01

Unlike previous behavior management research, this study used a quasi-experimental, control group design to examine the impact of financial and nonfinancial incentives on business-unit (21 stores in a fast-food franchise corporation) outcomes (profit, customer service, and employee turnover) over time. The results showed that both types of incentives had a significant impact on all measured outcomes. The financial incentive initially had a greater effect on all 3 outcomes, but over time, the financial and nonfinancial incentives had an equally significant impact except in terms of employee turnover. (c) 2006 APA, all rights reserved.

Effects of obesity on rehabilitation outcomes after orthopedic trauma.

Science.gov (United States)

Vincent, Heather K; Seay, Amanda N; Vincent, Kevin R; Atchison, James W; Sadasivan, Kalia

2012-12-01

This study examined whether differences existed in inpatient rehabilitation outcomes and therapy participation in nonobese and obese patients with orthopedic trauma. This was a retrospective study of 294 consecutive patients admitted to an inpatient rehabilitation hospital. Main outcomes included participation in therapy sessions, Functional Independence Measure (FIM) ratings, walking distance and stair climb, length of stay, FIM efficiency (FIM score gain/length of stay), and discharge to home. Data were stratified by patient body mass index values (nonobese, obese, ≥30 kg/m). There were no differences in therapy participation or length of stay between groups. Both total and motor FIM ratings at discharge were lower in obese patients compared with nonobese patients (P obese than in the nonobese group (2.6 ± 1.5 vs. 3.1 ± 1.5 points gained per day; P = 0.05). Walking distance and stair climb ability were similar between groups by discharge. Even morbidly obese patients attained some improvement with independence in walking. Obese patients make significant functional improvement during rehabilitation, but at a lesser magnitude and rate as their nonobese counterparts. Even with morbid obesity, small but important functional gains can occur during rehabilitation for orthopedic trauma.

Outcome of chemotherapy counseling by pharmacists on psychological effects and self esteem among oncology patients in a Government Hospital in Malaysia.

Science.gov (United States)

Ummavathy, P; Sherina, M S; Rampal, L; Siti Irma Fadhilah, I

2015-06-01

Chemotherapy is the most common form of treatment among cancer patients. It is also known to cause many physical and psychological side-effects. This study developed, implemented and evaluated the outcome of a chemotherapy counseling module among oncology patients by pharmacists based on their psychological effects (depression, anxiety) and selfesteem. A randomized, single blind, placebo controlled study was conducted among 162 patients undergoing chemotherapy in a government hospital in Malaysia. Counseling sessions were conducted using the 'Managing Patients on Chemotherapy' module for oncology patients undergoing chemotherapy at each treatment cycle. The outcome of repetitive chemotherapy counseling using the module was determined at baseline, first follow-up, second follow-up and third follow-up. The findings revealed that there was significant improvement in the intervention group as compared to the control group with large effect size on depression (p = 0.001, partial η(2) = 0.394), anxiety (p = 0.001, partial η(2) = 0.232) and self-esteem (p = 0.001, partial η(2) = 0.541). Repetitive counseling using the 'Managing Patients on Chemotherapy' module was found to be effective in improving psychological effects and self-esteem among patients undergoing chemotherapy.

Involving patient research partners has a significant impact on outcomes research: a responsive evaluation of the international OMERACT conferences.

NARCIS (Netherlands)

de Wit, M.P.T.; Abma, T.A.; Koelewijn-van Loon, M.S.; Collins, S.; Kirwan, J

2013-01-01

Objective: To assess the inclusion of patients as international research partners in Outcome Measures in Rheumatology (OMERACT) conferences and how this has influenced the scope and conduct of outcomes research in rheumatology. Design: A thematic content analysis of OMERACT internal documents,

Management of Gestational Diabetes Mellitus: Selfefficacy and Perinatal Outcomes

OpenAIRE

Emine Gerçek; Hakan Şen

2015-01-01

The purpose of this review is to give knowledge about effects on perinatal outcomes of self-efficacy in management of gestational diabetes. Gestational diabetes mellitus (GDM) is a significant health concern due to the potentially adverse outcomes for the mother and the fetus/infant. Close monitoring and treatment of GDM are important to the long-term health of a pregnant woman and her baby. More over, maternal metabolic control during pregnancy may positively impact women’s...

Patient-centered care and its effect on outcomes in the treatment of asthma

Directory of Open Access Journals (Sweden)

Qamar N

2011-06-01

Full Text Available Nashmia Qamar1,*, Andrea A Pappalardo2,*, Vineet M Arora3, Valerie G Press41Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA; 2Internal Medicine-Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA; 3Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA; 4Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA *Drs Qamar and Pappalardo contributed equally to this paperAbstract: Patient-centered care may be pivotal in improving health outcomes for patients with asthma. In addition to increased attention in both research and clinical forums, recent legislation also highlights the importance of patient-centered outcomes research in the Patient Protection and Affordable Care Act. However, whether patient-centered care has been shown to improve outcomes for this population is unclear. To answer this question, we performed a systematic review of the literature that aimed to define current patient-focused management issues, characterize important patient-defined outcomes in asthma control, and identify current and emerging treatments related to patient outcomes and perspectives. We used a parallel search strategy via Medline®, Cochrane Central Register of Controlled Trials, CINAHL® (Cumulative Index to Nursing and Allied Health Literature, and PsycINFO®, complemented with a reference review of key articles that resulted in a total of 133 articles; 58 were interventions that evaluated the effect on patient-centered outcomes, and 75 were descriptive studies. The majority of intervention studies demonstrated improved patient outcomes (44; “positive” results; none showed true harm (0; “negative”; and the remainder were equivocal (14; “neutral”. Key themes emerged relating to patients’ desires for asthma knowledge, preferences for tailored management plans, and

The effect of cigarette and alcohol consumption on birth outcomes

DEFF Research Database (Denmark)

Wüst, Miriam

This paper uses Danish survey and register data to examine the effect of maternal inputs on child health at birth. The paper adds to the literature in several ways: First, while previous studies mainly have focused on maternal smoking, this paper factors in a larger number of maternal health beha...... suggest a dose-response relationship. Robustness checks suggest that the sibling sample represents the population of multiple mothers well and that smoking results are not driven by misclassification of smoking status....... by exploiting variation between siblings. The results of the paper confirm and extend earlier findings. Maternal smoking decreases birth weight and fetal growth, with smaller effects in sibling models. The negative alcohol effect on birth outcomes is pronounced and remains intact in sibling models. Both effects...

A Bayesian Approach to Functional Mixed Effect Modeling for Longitudinal Data with Binomial Outcomes

Science.gov (United States)

Kliethermes, Stephanie; Oleson, Jacob

2014-01-01

Longitudinal growth patterns are routinely seen in medical studies where individual and population growth is followed over a period of time. Many current methods for modeling growth presuppose a parametric relationship between the outcome and time (e.g., linear, quadratic); however, these relationships may not accurately capture growth over time. Functional mixed effects (FME) models provide flexibility in handling longitudinal data with nonparametric temporal trends. Although FME methods are well-developed for continuous, normally distributed outcome measures, nonparametric methods for handling categorical outcomes are limited. We consider the situation with binomially distributed longitudinal outcomes. Although percent correct data can be modeled assuming normality, estimates outside the parameter space are possible and thus estimated curves can be unrealistic. We propose a binomial FME model using Bayesian methodology to account for growth curves with binomial (percentage) outcomes. The usefulness of our methods is demonstrated using a longitudinal study of speech perception outcomes from cochlear implant users where we successfully model both the population and individual growth trajectories. Simulation studies also advocate the usefulness of the binomial model particularly when outcomes occur near the boundary of the probability parameter space and in situations with a small number of trials. PMID:24723495

Significance of autobiographical episodes and spacing effects in incidental memory.

Science.gov (United States)

Toyota, Hiroshi

2013-10-01

Participants were presented with target words on two occasions, and were asked each time to generate a memory of a past episode associated with the targets. Participants were also instructed to rate the importance (significance elaboration) or pleasantness of the pisode (pleasantness elaboration) in an orienting task, followed by an unexpect d recall test. Significance elaboration led to better recall than pleasantness elaboration, but only in the spaced presentation. The spaced presentation led to better tree recall than massed presentation with significance elaboration, but the difference between the two types of presentation was not observed with pleasantness elaboration. These results suggest that the significance of an episode is more critical than the pleasantness of an episode in determining the effectiveness of autobiographical elaboration in facilitating recall.

Effects of a group-based reproductive management extension programme on key management outcomes affecting reproductive performance.

Science.gov (United States)

Brownlie, Tom S; Morton, John M; Heuer, Cord; McDougall, Scott

2015-02-01

A group-based reproductive management extension programme has been designed to help managers of dairy herds improve herd reproductive performance. The aims of this study were, firstly, to assess effects of participation by key decision makers (KDMs) in a farmer action group programme in 2009 and 2010 on six key management outcomes (KMOs) that affect reproductive performance over 2 years (2009-2010 and 2010-2011), and secondly, to describe KDM intentions to change management behaviour(s) affecting each management outcome after participation in the programme. Seasonal calving dairy herds from four regions of New Zealand were enrolled in the study. Intentions to modify management behaviour were recorded using the formal written action plans developed during the extension programme. KMOs assessed were calving pattern of the herd, pre-calving heifer liveweight, pre-calving and premating body condition score (BCS), oestrus detection, anoestrus cow management and bull management. Participation was associated with improvements in heifer liveweight, more heifers calving in the first 6 weeks of the seasonal calving period, premating BCS and oestrus detection. No significant effects were observed on anoestrus cow management or bull management. KDMs with greater numbers of proposed actions had lower 6 week in-calf rates in the second study year than KDMs who proposed fewer actions. A more effective strategy to ensure more appropriate objectives is proposed. Strategies to help KDMs to implement proposed actions more successfully should be investigated to improve the programme further. Copyright © 2014 Elsevier Ltd. All rights reserved.

"Just Dance": The Effects of Exergame Feedback and Controller Use on Physical Activity and Psychological Outcomes.

Science.gov (United States)

Lin, Jih-Hsuan

2015-06-01

In Asia, dance games are among the most popular types of exergames. Whereas traditional dance-based games emphasize step movements on a dance pad, more recent dance games emphasize intuitive dance movements using simple controllers or players' own bodies to "just dance." However, because of limited space and access, young adults in Taiwan often do not use these games. Popular dance videos on YouTube are more readily available to students because these videos can be accessed on a computer. Therefore, the current study examines the effects of interactivity (the role of feedback) and controller use on participants' physiological and psychological outcomes during exergames. The dance game "Just Dance 3" (Ubisoft, Montreuil, France) was chosen as the stimulus for this study. Participants danced through one song for rehearsal and warm-up, followed by three songs for the experiment, which lasted approximately 12 minutes. One hundred twenty-nine college students participated in a 2×2×2 (interactivity, feedback versus no feedback; controller, with versus without; sex, male versus female) between-subject factorial design. A series of 2×2×2 (interactivity, controller, and sex) analyses of variance showed no significant differences in interaction effects on participants' heart rates, blood pressures, body movements, step counts, or perceived psychological outcomes. Dance game videos without feedback are also effective tools for achieving moderate-level exercise intensity. These videos can supplement the limited access to games in Asian countries, such as Taiwan.

A national evaluation of Safe Schools/Healthy Students: outcomes and influences.

Science.gov (United States)

Derzon, James H; Yu, Ping; Ellis, Bruce; Xiong, Sharon; Arroyo, Carmen; Mannix, Danyelle; Wells, Michael E; Hill, Gary; Rollison, Julia

2012-05-01

The Safe Schools/Healthy Students (SS/HS) Initiative has awarded over $2 billion in grants to more than 350 school districts in partnership with local mental health, law enforcement, and juvenile justice agencies. To estimate the impact of grantee characteristics, grant operations, and near-term outcomes in reducing violence and substance use, promoting mental health, and enhancing school safety, logged odds ratios (LORs) were calculated contrasting Year 3 with Baseline performance from grantee-provided data on seven outcome measures. After comparing grantee performance across outcomes and outcomes across grantees, the LORs were entered as dependent variables in a series of meta-regressions in which grantee characteristics, grant operations, and near-term outcomes were tested after controlling for pre-grant characteristics. Findings indicate that the SS/HS Initiative significantly improved most outcomes, that within-grantee performance varied greatly by outcome, and that random-effects meta-regression appreciably decreased the variance available for modeling. The approach demonstrates that the SS/HS Initiative is effective and that locally collected performance data can be used to estimate grantee success in improving youth outcomes. Copyright © 2011 Elsevier Ltd. All rights reserved.

The effectiveness of Internet-based e-learning on clinician behaviour and patient outcomes: A systematic review.

Science.gov (United States)

Sinclair, Peter M; Kable, Ashley; Levett-Jones, Tracy; Booth, Debbie

2016-05-01

The contemporary health workforce has a professional responsibility to maintain competency in practice. However, some difficulties exist with access to ongoing professional development opportunities, particularly for staff in rural and remote areas and those not enrolled in a formal programme of study. E-learning is at the nexus of overcoming these challenges. The benefits of e-learning have been reported in terms of increased accessibility to education, improved self-efficacy, knowledge generation, cost effectiveness, learner flexibility and interactivity. What is less clear, is whether improved self-efficacy or knowledge gained through e-learning influences healthcare professional behaviour or skill development, whether these changes are sustained, and whether these changes improve patient outcomes. To identify, appraise and synthesise the best available evidence for the effectiveness of e-learning programmes on health care professional behaviour and patient outcomes. A systematic review of randomised controlled trials was conducted to assess the effectiveness of e-learning programmes on clinician behaviour and patient outcomes. Electronic databases including CINAHL, Embase, ERIC, MEDLINE, Mosby's Index, Scopus and Cochrane - CENTRAL were searched in July 2014 and again in July 2015. Studies were reviewed and data extracted by two independent reviewers using the Joanna Briggs Institute standardised critical appraisal and data extraction instruments. Seven trials met the inclusion criteria for the analysis. Due to substantial instructional design, subject matter, study population, and methodological variation between the identified studies, statistical pooling was not possible and a meta-analysis could not be performed. Consequently, the findings of this systematic review are presented as a narrative review. The results suggest that e-learning was at least as effective as traditional learning approaches, and superior to no instruction at all in improving health

Effect of metformin on maternal and fetal outcomes in obese pregnant women (EMPOWaR): a randomised, double-blind, placebo-controlled trial.

Science.gov (United States)

Chiswick, Carolyn; Reynolds, Rebecca M; Denison, Fiona; Drake, Amanda J; Forbes, Shareen; Newby, David E; Walker, Brian R; Quenby, Siobhan; Wray, Susan; Weeks, Andrew; Lashen, Hany; Rodriguez, Aryelly; Murray, Gordon; Whyte, Sonia; Norman, Jane E

2015-10-01

Maternal obesity is associated with increased birthweight, and obesity and premature mortality in adult offspring. The mechanism by which maternal obesity leads to these outcomes is not well understood, but maternal hyperglycaemia and insulin resistance are both implicated. We aimed to establish whether the insulin sensitising drug metformin improves maternal and fetal outcomes in obese pregnant women without diabetes. We did this randomised, double-blind, placebo-controlled trial in antenatal clinics at 15 National Health Service hospitals in the UK. Pregnant women (aged ≥16 years) between 12 and 16 weeks' gestation who had a BMI of 30 kg/m(2) or more and normal glucose tolerance were randomly assigned (1:1), via a web-based computer-generated block randomisation procedure (block size of two to four), to receive oral metformin 500 mg (increasing to a maximum of 2500 mg) or matched placebo daily from between 12 and 16 weeks' gestation until delivery of the baby. Randomisation was stratified by study site and BMI band (30-39 vs ≥40 kg/m(2)). Participants, caregivers, and study personnel were masked to treatment assignment. The primary outcome was Z score corresponding to the gestational age, parity, and sex-standardised birthweight percentile of liveborn babies delivered at 24 weeks or more of gestation. We did analysis by modified intention to treat. This trial is registered, ISRCTN number 51279843. Between Feb 3, 2011, and Jan 16, 2014, inclusive, we randomly assigned 449 women to either placebo (n=223) or metformin (n=226), of whom 434 (97%) were included in the final modified intention-to-treat analysis. Mean birthweight at delivery was 3463 g (SD 660) in the placebo group and 3462 g (548) in the metformin group. The estimated effect size of metformin on the primary outcome was non-significant (adjusted mean difference -0·029, 95% CI -0·217 to 0·158; p=0·7597). The difference in the number of women reporting the combined adverse outcome of miscarriage

Effect of granulocyte colony stimulating factor (G-CSF on IVF outcomes in infertile women: An RCT

Directory of Open Access Journals (Sweden)

Maryam Eftekhar

2016-05-01

Full Text Available Background: Despite major advances in assisted reproductive techniques, the implantation rates remain relatively low. Some studies have demonstrated that intrauterine infusion of granulocyte colony stimulating factor (G-CSF improves implantation in infertile women. Objective: To assess the G-CSF effects on IVF outcomes in women with normal endometrial thickness. Materials and methods: In this randomized controlled clinical trial, 100 infertile women with normal endometrial thickness who were candidate for IVF were evaluated in two groups. Exclusion criteria were positive history of repeated implantation failure (RIF, endocrine disorders, severe endometriosis, congenital or acquired uterine anomaly and contraindication for G-CSF (renal disease, sickle cell disease, or malignancy. In G-CSF group (n=50, 300 μg trans cervical intrauterine of G-CSF was administered at the oocyte retrieval day. Controls (n=50 were treated with standard protocol. Chemical, clinical and ongoing pregnancy rates, implantation rate, and miscarriage rate were compared between groups. Results: Number of total and mature oocytes (MII, two pronuclei (2PN, total embryos, transferred embryos, quality of transferred embryos, and fertilization rate did not differ significantly between two groups. So there were no significant differences between groups in chemical, clinical and ongoing pregnancy rate, implantation rate, and miscarriage rate Conclusion: our result showed in normal IVF patients with normal endometrial thickness, the intrauterine infusion of G-CSF did not improve pregnancy outcomes.

Effects of body mass index on the outcomes of percutaneous nephrolithotomy

Directory of Open Access Journals (Sweden)

Cemal Selcuk Isoglu

Full Text Available ABSTRACT Objective To examine the the effect of body mass index (BMI on PNL results and complications with a large number of patients. Materials and Methods A total of 958 patients were included in the study, who underwent percutaneous nephrolithotomy in our clinic between 2008 and 2015. Patients were divided into 2 groups according to their body mass index. Patients with a BMI < 30 kg/m2 were classified as group 1 (n:676 and patients with a BMI ≥ 30 kg/m2 were classified as group 2 (n:282. Achieving stone-free status or having residual stones of ≤ 4 mm were considered as operational success. Results The mean age was 47.9 years for group 1 and 48.9 years for group 2 patients. At postoperative first month CT analysis, residual stone was not observed in 466 patients (69% of group 1 and 20 (72% patients of group 2. There was no significant difference between the groups in terms of stone-free status (p=0.348. There was no significant difference between two groups complications. Also, there was no difference between the groups for requiring additional intervention (p=0.924. No other complications were observed in the patients. Conclusions BMI does not affect the outcomes of percutaneous nephrolithotomy as well as complication rate.

Effect of Smoking Status on Successful Arthrodesis, Clinical Outcome, and Complications After Anterior Lumbar Interbody Fusion (ALIF).

Science.gov (United States)

Phan, Kevin; Fadhil, Matthew; Chang, Nicholas; Giang, Gloria; Gragnaniello, Cristian; Mobbs, Ralph J

2018-02-01

Anterior lumbar interbody fusion (ALIF) is a surgical technique indicated for the treatment of several lumbar pathologies. Smoking has been suggested as a possible cause of reduced fusion rates after ALIF, although the literature regarding the impact of smoking status on lumbar spine surgery is not well established. This study aims to assess the impact of perioperative smoking status on the rates of perioperative complications, fusion, and adverse clinical outcomes in patients undergoing ALIF surgery. A retrospective analysis was performed on a prospectively maintained database of 137 patients, all of whom underwent ALIF surgery by the same primary spine surgeon. Smoking status was defined by the presence of active smoking in the 2 weeks before the procedure. Outcome measures included fusion rates, surgical complications, Short-Form 12, and Oswestry Disability Index. Patients were separated into nonsmokers (n = 114) and smokers (n = 23). Univariate analysis demonstrated that the percentage of patients with successful fusion differed significantly between the groups (69.6% vs. 85.1%, P = 0.006). Pseudarthrosis rates were shown to be significantly associated with perioperative smoking. Results for other postoperative complications and clinical outcomes were similar for both groups. On multivariate analysis, the rate of failed fusion was significantly greater for smokers than nonsmokers (odds ratio 37.10, P = 0.002). The rate of successful fusion after ALIF surgery was found to be significantly lower for smokers compared with nonsmokers. No significant association was found between smoking status and other perioperative complications or adverse clinical outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

User Impact of Literacy on Treatment Outcomes Quality Regional Financial Information System

Directory of Open Access Journals (Sweden)

Iskandar MUDA

2017-06-01

Full Text Available This study aims to determine the effectiveness of the Outcomes of the Quality Regional Financial Information System. The research is an explanatory survey exploration that explains the relationship between some variables. The population of this study is formed by 7 District Municipalities in North Sumatra. The sample comprises 197 respondents; the sampling process is a purposive random one. Variables used include User Literacy, Regional Information System, Role Ambiguity, Training and Local Government Finance Report. Treatment Outcomes Quality systems have a significant effect on the accuracy of Local Government Financial Statement Presentation. Role Ambiguity has no significant effect on the accuracy of Local Government Financial Statement Presentation. Training does not significantly influence the accuracy of Government Financial Statements literacy. The findings of this study provide recommendations for improvement of the performance manager in North Sumatra, which thus supporting the implementation of a good government system.

Feedback-related negativity codes outcome valence, but not outcome expectancy, during reversal learning.

Science.gov (United States)

von Borries, A K L; Verkes, R J; Bulten, B H; Cools, R; de Bruijn, E R A

2013-12-01

Optimal behavior depends on the ability to assess the predictive value of events and to adjust behavior accordingly. Outcome processing can be studied by using its electrophysiological signatures--that is, the feedback-related negativity (FRN) and the P300. A prominent reinforcement-learning model predicts an FRN on negative prediction errors, as well as implying a role for the FRN in learning and the adaptation of behavior. However, these predictions have recently been challenged. Notably, studies so far have used tasks in which the outcomes have been contingent on the response. In these paradigms, the need to adapt behavioral responses is present only for negative, not for positive feedback. The goal of the present study was to investigate the effects of positive as well as negative violations of expectancy on FRN amplitudes, without the usual confound of behavioral adjustments. A reversal-learning task was employed in which outcome value and outcome expectancy were orthogonalized; that is, both positive and negative outcomes were equally unexpected. The results revealed a double dissociation, with effects of valence but not expectancy on the FRN and, conversely, effects of expectancy but not valence on the P300. While FRN amplitudes were largest for negative-outcome trials, irrespective of outcome expectancy, P300 amplitudes were largest for unexpected-outcome trials, irrespective of outcome valence. These FRN effects were interpreted to reflect an evaluation along a good-bad dimension, rather than reflecting a negative prediction error or a role in behavioral adaptation. By contrast, the P300 reflects the updating of information relevant for behavior in a changing context.

Psychosocial predictors of treatment outcome for trauma-affected refugees