\\u000a The diagnosis of schizophrenia can only be made in the presence of a loss of functioning in domains such as employment, independent\\u000a living, and social functioning. Accurately measuring functioning is central to research on the course of the disorder, treatment\\u000a and rehabilitation outcomes, and biosocial factors in schizophrenia. Assessments of functional disability have described three\\u000a dimensions of functioning: functional capacity,
Elizabeth Bromley; John S. Brekke
The goals of the present publication are (a) to identify standardised methods and tools applied in clinical trials and cohort studies to assess key functional aspects in HNC, using the Brief ICF Core Set for head and neck cancer (ICF-HNC) as a reference and (b) to propose a set of sound standardised methods and tools suitable to assess functional problems in HNC. This work contributed to the development of practical ICF-HNC based guidelines targeting the standardised measurement of functional outcomes in HNC follow-up and clinical research in Germany. A systematic review of randomised and clinical controlled trials, and observational studies in HNC were carried out to identify standardised methods and tools. Suitable methods and tools were then selected based on pre-defined criteria. 210 assessment methods and tools were identified in 136 studies: 146 patients reported outcomes (PRO) and 64 tools rated by health professionals. Altogether 59 tools were considered suitable to be included in guidelines: four side effects classifications, two performance status scales, 31 PROs, 10 assessment criteria for clinical examinations, seven assessment methods and tools for the evaluation of technical, equipment-based procedures and five technical, equipment-based procedures. It was possible to identify and select sound and standardised assessment methods and tools for almost all functioning areas defined in the ICF-HNC. Since no tool sufficiently covers support provision by immediate family and by health professionals as well as economic self-sufficiency, we recommend a corresponding update of existing tools. PMID:24114063
Stier-Jarmer, Marita; Sabariego, Carla; Cieza, Alarcos; Harréus, Ulrich; Tschiesner, Uta
Functional outcomes of clinical trials are often reported as number of dependencies in activities of daily living (ADLs). Quality-weighting for the ADLs has not been reported. We designed and pilot-tested ADLIB (ADL Index Builder), a multimedia computer program, that presents ADL health states to subjects and elicits from subjects a rating for the quality of life of each health state. Subjects, who were patients over age 50 without previous computer experience, found the program easy to use. Health care professionals specializing in geriatrics confirmed that the ADL presentations used in the program are in accord with typical practice in scoring ADLs. We plan to use the program to obtain population-based preference ratings that can be used to assess efficacy of clinical trials and to provide quality-weights for cost-effectiveness analysis. PMID:8130598
Goldstein, M K; Michelson, D; Clarke, A E; Lenert, L A
Functional outcomes of clinical trials are often reported as number of dependencies in activities of daily living (ADLs). Quality-weighting for the ADLs has not been reported. We designed and pilot-tested ADLIB (ADL Index Builder), a multimedia computer program, that presents ADL health states to subjects and elicits from subjects a rating for the quality of life of each health state. Subjects, who were patients over age 50 without previous computer experience, found the program easy to use. Health care professionals specializing in geriatrics confirmed that the ADL presentations used in the program are in accord with typical practice in scoring ADLs. We plan to use the program to obtain population-based preference ratings that can be used to assess efficacy of clinical trials and to provide quality-weights for cost-effectiveness analysis. Images Fig. 2
Goldstein, M. K.; Michelson, D.; Clarke, A. E.; Lenert, L. A.
Functional outcomes of clinical trials are often re - ported as number of dependencies in activities of daily living (ADLs.) Quality-weighting for the ADLs has not been reported. We designed and pilot-tested ADLIB (ADL Index Builder), a multi media computer program, that presents ADL health states to subjects and elicits from subjects a rating for the quality of life of
Mary Kane Goldstein; David Michelson; Ann E. Clarke; Leslie A. Lenert
The Brief Assessment of Cognition in Schizophrenia (BACS) assesses five different domains of cognitive function with six tests, and takes about 30-35 minutes to complete in patients with schizophrenia. Previous work has demonstrated the reliability of this measure, and its sensitivity to the deficits of schizophrenia. However, the relationship of this brief cognitive measure to functional outcome has not been determined. Further, future registration trials for potentially cognitive enhancing compounds may not only assess efficacy with cognitive performance measures, but with assessments of real-world functional outcome and functional capacity. The purpose of this study was to determine the relationship between the BACS and a potential co-primary measure for treatment studies of cognition in schizophrenia, and to determine if such a measure accounts for significant variance in functioning beyond that provided by cognitive function. The current study assessed 60 patients with schizophrenia over the course of six months. Cognitive functions were measured with the BACS. Functional capacity was measured with the UCSD Performance-based Skills Assessment (UPSA). Real-world functional outcome was measured with the Independent Living Skills Inventory (ILSI). BACS composite scores were significantly correlated with functional capacity as measured by the UPSA (r = .65, df = 55, p < .001), and real-world functional outcome as assessed by the ILSI (r = .37, df = 56, p = .005). In multiple regression analyses, UPSA scores did not account for additional variance in real-world functioning beyond that accounted for by the BACS. These data suggest that brief cognitive assessments such as the BACS are able to assess aspects of cognition that are related to important functional measures in clinical trials of cognitive enhancement. They also suggest that the measures being considered as potential co-primary indicators of cognitive function for registration trials are significantly correlated with cognition as assessed by brief cognitive assessments. PMID:16484097
Keefe, Richard S E; Poe, Margaret; Walker, Trina M; Harvey, Philip D
Effective healthcare delivery necessitates evaluation of the effect of interventions in the form of outcome assessment. Treatment effect includes measurement of how the patient feels, functions and survives following healthcare interventions. In haemophilia, which is a rare bleeding disorder, outcome assessment was characterized by a lack of validated outcome measurement tools and the challenges of hemophilia study design to collect outcome data. The aim of this communication is to share current thinking and, through practical examples, provide a state of the art practice in the assessment of hemophilia outcomes from a healthcare provider, patient/family and funder perspective. This discussion is timely and particularly relevant to the care of people with hemophilia on the eve of a number of novel hemophilia treatment products which are about to be licensed for use, specifically the long-acting factor VIII and factor IX concentrates. The first section by Dr Blanchet gives an overview of the tools currently available for assessment of structure/function, patient activities and patient participation in hemophilia healthcare delivery, pointing out the challenge of developing new tools and appropriate validation of currently available tools. The second section by Mr Brian O'Mahony emphasizes the essential collaboration and partnership between healthcare providers and people with hemophilia in collating the outcome data. In the third and final section, Mr Leigh McJames, gives a funder's perspective of the desirable outcomes of hemophilia care. PMID:24762286
Blanchette, V S; O'Mahony, B; McJames, L; Mahlangu, J N
Background: The role of neuropsychological deficits in predicting functional outcome in patients with aphasia and neglect at the end of rehabilitation after stroke has been poorly investigated. This was the aim of this prospective study evaluated using a Functional Independence Measure (FIM) instrument. Methods: Patients with a primary diagnosis of cerebrovascular accident [125 patients with aphasia, 45 with neglect and
Bernardo Gialanella; Cristina Ferlucci
Available studies did not clarify whether a language examination may predict functional and motor outcome in patients with\\u000a aphasia undergoing rehabilitation. This was the aim of the current study. Language examination considered in this study was\\u000a the Aachen Aphasia Test (AAT). One hundred fifty-six patients with a primary diagnosis of acute cerebrovascular accident of\\u000a left hemisphere were included: 105 with
Background Dupuytren's disease of the hand is a common condition affecting the palmar fascia, resulting in progressive flexion deformities of the digits and hence limitation of hand function. The optimal treatment remains unclear as outcomes studies have used a variety of measures for assessment. Methods A literature search was performed for all publications describing surgical treatment, percutaneous needle aponeurotomy or collagenase injection for primary or recurrent Dupuytren’s disease where outcomes had been monitored using functional measures. Results Ninety-one studies met the inclusion criteria. Twenty-two studies reported outcomes using patient reported outcome measures (PROMs) ranging from validated questionnaires to self-reported measures for return to work and self-rated disability. The Disability of Arm, Shoulder and Hand (DASH) score was the most utilised patient-reported function measure (n=11). Patient satisfaction was reported by eighteen studies but no single method was used consistently. Range of movement was the most frequent physical measure and was reported in all 91 studies. However, the methods of measurement and reporting varied, with seventeen different techniques being used. Other physical measures included grip and pinch strength and sensibility, again with variations in measurement protocols. The mean follow-up time ranged from 2 weeks to 17 years. Conclusions There is little consistency in the reporting of outcomes for interventions in patients with Dupuytren’s disease, making it impossible to compare the efficacy of different treatment modalities. Although there are limitations to the existing generic patient reported outcomes measures, a combination of these together with a disease-specific questionnaire, and physical measures of active and passive individual joint Range of movement (ROM), grip and sensibility using standardised protocols should be used for future outcomes studies. As Dupuytren’s disease tends to recur following treatment as well as extend to involve other areas of the hand, follow-up times should be standardised and designed to capture both short and long term outcomes.
A foundation principle of professionalism is listening carefully to clients’ needs. This paper reviews current studies that have sought to listen to the needs of people with aphasia and their families. The preliminary evidence to date suggests that people with aphasia have goals that cover the bio-psycho-social spectrum but place a lot of importance on functional outcomes such as participation
Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome. PMID:24980579
Ghogawala, Zoher; Resnick, Daniel K; Watters, William C; Mummaneni, Praveen V; Dailey, Andrew T; Choudhri, Tanvir F; Eck, Jason C; Sharan, Alok; Groff, Michael W; Wang, Jeffrey C; Dhall, Sanjay S; Kaiser, Michael G
The Child and Adolescent Functional Assessment Scale (CAFAS) provides information on psychological impairment, including a score for the child's overall functioning as well as scale scores for eight psychosocial areas: school, work, home, community relationships, moods, self-harmful behavior, substance use, and abnormal thinking. This symposium…
Hodges, Kay; Landsverk, John; Heflinger, Craig Anne; Simpkins, Celeste G.; Daniels, La Vonne; Clements, Lisa
The majority of women with pelvic organ prolapse and stress urinary incontinence report more than one symptom that affects urinary, bowel, or sexual function. Most research studies on outcomes following surgery for pelvic organ prolapse and stress incontinence focus on anatomic outcomes and relief of symptoms specific to prolapse and/or stress incontinence. Pelvic symptoms related to voiding function such as de novo urgency or incontinence, bowel function, and sexual function are clinically important outcomes but are infrequently reported. Deterioration of pelvic symptoms postoperatively is associated with decreased patient satisfaction, which underscores the importance of effectively assessing functional and anatomic treatment outcomes. Future studies of reconstructive pelvic surgery should routinely include multiple domain functional outcomes specifically addressing voiding, defecatory, and sexual function.
Segal, Saya; Arya, Lily A.; Smith, Ariana L.
Objectives To study the measurement properties of a joint specific patient reported outcome measure, a measure of capability and a general health-related quality of life (HRQOL) tool in a large cohort of patients with a hip fracture. Methods Responsiveness and associations between the Oxford Hip Score (a hip specific measure: OHS), ICEpop CAPability (a measure of capability in older people: ICECAP-O) and EuroQol EQ-5D (general health-related quality of life measure: EQ-5D) were assessed using data available from two large prospective studies. The three outcome measures were assessed concurrently at a number of fixed follow-up time-points in a consecutive sequence of patients, allowing direct assessment of change from baseline, inter-measure associations and validity using a range of statistical methods. Results ICECAP-O was not responsive to change. EQ-5D was responsive to change from baseline, with an estimated standardised effect size for the two datasets of 0.676 and 0.644 at six weeks and four weeks respectively; this was almost as responsive to change as OHS (1.14 at four weeks). EQ-5D correlated strongly with OHS; Pearson correlation coefficients were 0.74, 0.77 and 0.70 at baseline, four weeks and four months. EQ-5D is a moderately good predictor of death at 12 months following hip fracture. Furthermore, EQ-5D reported by proxies (relatives and carers) behaves similarly to self-reported scores. Conclusions Our findings suggest that a general HRQOL tool such as EQ-5D could be used to measure outcome for patients recovering from hip fracture, including those with cognitive impairment. Cite this article: Bone Joint Res 2014;3:69–75.
Parsons, N.; Griffin, X. L.; Achten, J.; Costa, M. L.
There has been a marked increase in attention to the measurement of “outcomes” after speech-language intervention for adult aphasia. Consumers, speech-language pathologists (SLPs), and funding sources desire evidence of therapy outcomes that improve communication and enhance the quality of life for people with aphasia. While many assessment tools are available to measure outcomes after aphasia therapy, there is little information
Nina Simmons-Mackie; Aura Kagan
The functional outcomes related to treating patients afflicted with tooth loss are an important hallmark in substantiating prosthodontic intervention. The Oral Rehabilitation Outcomes Network (ORONet) conducted two international workshops to develop a core set of outcome measures, including a functional domain. The process followed the general format used in the Outcome Measures in Rheumatology (OMERACT) workshops to develop consensus for clinical outcome measures in arthritis research, which included: developing a comprehensive list of potential outcomes in the literature; submitting them to a filter for validity, clinical discrimination, and feasibility; and ranking those measures meeting all the filter criteria for relative value. The search was conducted to include functional assessments of speech, swallowing, mastication, nutrition, sensation, and motor function as they relate to dental implant therapies. This literature review surveyed 173 papers that produced some result of these descriptors in the functional domain. Of these, 67 papers reported on functional assessments and further defined objective and subjective outcomes. Many of these results were patient-perceived improvements in function, while others were objective assessments based on established methodologies and instruments. Objective evaluations of masticatory function and speech may meet criteria for validity and discriminability for selected interventions, but are generally not feasible for routine use in clinical care settings. The current recommendation is to employ a well-validated survey instrument that covers mastication and speech, such as the Oral Health Impact Profile (OHIP-14, short form), recognizing that patient perceptions of function may differ from objective ability. PMID:23998137
Bassi, Francesco; Carr, Alan B; Chang, Ting-Ling; Estafanous, Emad W; Garrett, Neal R; Happonen, Risto-Pekka; Koka, Sreenivas; Laine, Juhani; Osswald, Martin; Reintsema, Harry; Rieger, Jana; Roumanas, Eleni; Salinas, Thomas J; Stanford, Clark M; Wolfaardt, Johan
Describes an outcomes assessment plan developed by the Lake Land College (Illinois) nursing program, which is organized around formative and summative evaluations of twelve graduate program outcomes. Quantitative and qualitative data collected by students are submitted in a portfolio format. The faculty tool for assessing the portfolios is…
Ruholl, Linda Hatke
Participants in a teacher workshop compared these two approaches to learning outcomes in adult numeracy: (1) teaching mathematical skills and (2) using and applying mathematics from real life. The first approach was illustrated by an Ontario, Canada, program based on traditional school math, whose outcomes are skill-based and are the following:…
Ciancone, Tom; Tout, Dave
Learning outcomes define the veterinary curriculum and inform students about what they must be able to demonstrate to succeed. Stakeholder consultation during their development ensures that programme learning outcomes equip graduates to contribute to the veterinary profession. Effective learning outcomes form a hierarchy linking the programme, its courses and tasks. Clear outcomes direct students towards higher quality learning by indicating the achievements intended, but leave scope for emergent learning outcomes. Defined technical competencies fit within this overarching framework, complementing higher order learning. Mapping is used to align learning outcomes horizontally and vertically so students are systematically guided towards entry-level competence and professional independence. Constructively aligned learning and assessment tasks ensure learners spend the focused time required to sequentially develop programme outcomes. Assessment by staff, peers and other stakeholders certifies achievement of intended outcomes. Effective assessment also empowers students to define and achieve their own learning outcomes, so they develop the habits of autonomous life-long learning. Evaluation of the quality and consistency of achieved outcomes informs ongoing programme improvement. If we are going to achieve the objectives of this set of papers, i.e. to improve public health education globally (Rev. sci. tech. Off. int. Epiz. 28  2009), then it is essential that they be well defined in the learning outcomes statement of all veterinary schools. PMID:20128490
Taylor, R M
Indicators of current issues and concerns in the assessment of science teaching and learning outcomes are discussed. The greatest public attention to science test scores is devoted to scores from assessments that are external to schools, including national assessments such as the National Assessment of Educational Progress (NAEP), international…
Helgeson, Stanley L.
Schizophrenia is characterized by significant heterogeneity in outcome. The last decades have witnessed a significant interest in identifying factors that can moderate or influence clinical and functional outcomes in people with schizophrenia. One factor of particular interest is neurocognition, as performance on various measures of cognitive abilities, such as memory, attention, and executive functions, have been consistently related to functional outcome and, to a lesser extent, clinical outcome. This review aims to provide an up-to-date description of recent studies examining the association between neurocognition and clinical and (or) functional outcomes. In the first section, studies examining neurocognitive performance in relation to clinical outcome are examined. When clinical outcome is defined dichotomously (for example, comparing remitted and nonremitted), verbal memory performance consistently exhibits a strong association with clinical status, with the poor outcome group showing the largest deficits. In the second section, studies exploring the relation between neurocognition and various dimensions of functional outcome are reviewed. These dimensions include independent living, social functioning, and vocational functioning, among others. Again, a strong link between neurocognitive deficits and impairments in several aspects of functioning clearly emerges from this review. Finally, several measurement issues are discussed that pertain to the need to standardize definitions of clinical and (or) functional outcomes, the importance of defining cognitive domains consistently across studies, and distinguishing between one's competence to perform tasks and what one actually does in everyday life. Addressing these measurement issues will be key to studies examining the development of effective interventions targeting neurocognitive functions and their impact on clinical and functional outcomes. PMID:24444318
Lepage, Martin; Bodnar, Michael; Bowie, Christopher R
Schizophrenia is characterized by significant heterogeneity in outcome. The last decades have witnessed a significant interest in identifying factors that can moderate or influence clinical and functional outcomes in people with schizophrenia. One factor of particular interest is neurocognition, as performance on various measures of cognitive abilities, such as memory, attention, and executive functions, have been consistently related to functional outcome and, to a lesser extent, clinical outcome. This review aims to provide an up-to-date description of recent studies examining the association between neurocognition and clinical and (or) functional outcomes. In the first section, studies examining neurocognitive performance in relation to clinical outcome are examined. When clinical outcome is defined dichotomously (for example, comparing remitted and nonremitted), verbal memory performance consistently exhibits a strong association with clinical status, with the poor outcome group showing the largest deficits. In the second section, studies exploring the relation between neurocognition and various dimensions of functional outcome are reviewed. These dimensions include independent living, social functioning, and vocational functioning, among others. Again, a strong link between neurocognitive deficits and impairments in several aspects of functioning clearly emerges from this review. Finally, several measurement issues are discussed that pertain to the need to standardize definitions of clinical and (or) functional outcomes, the importance of defining cognitive domains consistently across studies, and distinguishing between one’s competence to perform tasks and what one actually does in everyday life. Addressing these measurement issues will be key to studies examining the development of effective interventions targeting neurocognitive functions and their impact on clinical and functional outcomes.
Lepage, Martin; Bodnar, Michael; Bowie, Christopher R
Results of treatment for critical limb ischemia have traditionally focused on physician-oriented end points related to limb salvage surgery. Although numerous studies have demonstrated excellent patency and limb salvage after surgical revascularization procedures, survival in this patient population is poor, comorbidities reducing quality of life are rampant, and recovery from limb salvage surgery can be prolonged and complicated despite "success" as defined by traditional reporting methods. Patient-oriented outcome end points, such as health- related quality of life and functional status, are essential in defining optimal treatment options for the population of patients with critical limb ischemia. This area of research remains in its infancy, but will become increasingly important as the population of patients with critical limb ischemia and treatment options for these patients continue to expand. The current status and future outlook of functional and quality of life assessment of patients with critical limb ischemia is reviewed. PMID:17544035
Landry, Gregory J
The incidence of CHD is about 0.8%, meaning 12.5 cases per 1000 life births. Errors in the morphogenesis\\u000aof a normal four-chambered heart result in congenital heart disease (CHD), the most\\u000acommon form of birth defects. Heart formation is a complex morphogenetic process that requires\\u000acorrect function of 1) various embryological developmental regions (including the heart fields and\\u000athe neural
In the case of community colleges and their students, expectations and outcomes are varied, pervasive, and open to question. The measures of success that are typically applied to senior colleges (e.g., degrees awarded) are not sufficient. While progress toward degree attainment is a valid measure for those recent high school students who aspire to…
Brawer, Florence B.
Abstract This article reports on a three-year study of information literacy instruction in Canadian academic libraries, focusing on the outcomes of instruction in terms of tests of information literacy skills and interviews with students that explored their experiences of information literacy instruction. Particular emphasis is given to investigating instructional effectiveness and assessing learning outcomes,with respect to identifying those institutional and
Heidi Julien; Stuart Boon
There has been a marked increase in attention to the measurement of ''outcomes'' after speech-language intervention for adult aphasia. Consumers, speech-language pathologists (SLPs), and funding sources desire evidence of therapy outcomes that improve communication and enhance the quality of life for people with aphasia. While many assessment…
Simmons-Mackie, Nina; Threats, Travis T.; Kagan, Aura
This report describes assessment and outcomes at Isothermal Community College (ICC) (North Carolina), focusing on four areas: institutional assessment, program assessment, classroom (course) assessment, and individual student assessment. Competencies and their criteria are outlined and include: (1) communications--upon completion of an associate's…
Womack, Nancy H., Comp.
Current evidence indicates that fracture healing assessment is limited to the use of one or two domains (such as pain, range of motion or mobility) in any single study. Functional outcome measures, which include physician-rated or observer-based impairment ratings and patient self-reported or observer-based activity limitation measures, better position the effectiveness of a given intervention towards patient-important outcomes. Health status measures, for example, cover a wide-range of physical, emotional, and social health dimensions. In this paper, we will examine the utility of metrics to assess fracture healing that are important to both the patient and provider, with selected examples from the recent literature. We recommend outcome measures with established and verified reliability and validity. Policy-makers and other stakeholders need to have an accurate assessment of treatment outcome that includes changes in function over time-adequate measures, should be re-applied at periodic intervals. PMID:24857028
Hoang-Kim, A; Miclau, T; Goldhahn, J; Nijman, T H; Poolman, R W
The Developmental Audit[R] is a comprehensive means of assessment and treatment planning that identifies the coping strategies underlying a youth's maladaptive and self-defeating behavior. This is a strength-based assessment that engages youth in conflict in the process of generating solutions rather than focusing on deficits. This process…
The primary treatment for obstetric sphincter injury is overlapping sphincteroplasty. However, despite restoration of the anatomy, only 65 percent of patients are fully continent. PURPOSE: This study was undertaken to determine if postoperative biofeedback improved continence in patients with poor functional outcomes after sphincteroplasty. METHOD: Outcomes of 28 patients who underwent electromyographic biofeedback training after sphincteroplasty for obstetric sphincter injury
L. L. Jensen; A. C. Lowry
In 1990, North Country Community College (NCCC) in New York developed an outcome assessment plan as a response to a requirement of the State University of New York. The planning process began in summer 1989 with an inventory of current assessment processes and a review of their effectiveness. A new plan was then developed, reviewed, and refined.…
Rice, Gail Rogers; Pope, Sandra
Brazil has developed an encompassing system for quality assessment of higher education, the National System of Higher Education Evaluation (SINAES), which includes a test for assessing learning outcomes at the undergraduate level, the National Exam of Student Performance (ENADE). The present system has been running since 2004, and also serves as…
Pedrosa, Renato H. L.; Amaral, Eliana; Knobel, Marcelo
The objective of this work is to suggest a process for improving the assessment of educational outcomes in universities. Improved accountability and assessment has become an important direction in academic institutional research, but the underlying question--how best to accomplish this goal is an open question. A framework is first described which…
Maples, Glenn; Greco, Anna M.; Tanner, John R.
Discriminatory ability of several pediatric outcome tools was assessed relative to Gross Motor Function Classification System (GMFCS) level in patients with cerebral palsy. Five hundred and sixty-two patients (400 with diplegia, 162 with hemiplegia; 339 males, 223 females; age range 4-18y, mean 11y 1mo [SD 3y 7mo]), classified as GMFCS Levels I to…
Bagley, Anita M; Gorton, George; Oeffinger, Donna; Barnes, Douglas; Calmes, Janine; Nicholson, Diane; Damiano, Diane; Abel, Mark; Kryscio, Richard; Rogers, Sarah; Tylkowski, Chester
State departments of education routinely conduct assessments of educational outcomes—most often through statewide achievement testing. It is important to evaluate the participation of students with disabilities in these activities because the data produced by such efforts help direct education programs and policies that may have an impact on all students. In this paper, we present the major findings from a
James G. Shriner; Cheri J. Gilman; Martha L. Thurlow; James E. Ysseldyke
Describes the Virginia-Maryland Regional College of Veterinary Medicine's use of outcomes assessment (OA) as part of the accreditation review process for the American Veterinary Medical Association. Discusses its nine OA survey instruments and use of resulting data during accreditation. (EV)
Black, Leslie S.; Turnwald, Grant H.; Meldrum, James B.
This paper describes the development of a system for assessing transfer program outcomes (TPO), using the effort at Oakton Community College (OCC) as an example. While originally designed to provide timely information on senior institutions as experienced by transfer students, TPO appeared to do considerably more. System highlights included more…
Kirby, Emily B.
Describes the Ontario college system's Prior Learning Assessment program for adult learners, focusing on outcomes and characteristics of students completing the process at Seneca College from April 1994 to February 1995. Indicates that of 77 participants, 46 were female, the mean age was 31, and 81% passed the process successfully. (BCY)
How can student outcomes assessment (SOA) be incorporated into ones courses and teaching? The purposes of this article are to explore a process enacted in the Department of Agronomy at Iowa State University using SOA to: (i) develop a clearer understanding of what students should learn in a course, (ii) determine how a course or courses fit within…
Cook, Michelle D.; Wiedenhoeft, Mary H.; Polito, Thomas A.; Gibson, Lance R.; Pogranichniy, Sherry; Mullen, Russ E.
This study evaluated the influence of language of implementation on functional analysis outcomes for a child with a severe intellectual disability from a Spanish-speaking home. Challenging behavior was assessed during 5-min sessions under 4 conditions; attention, play-verbal, play-nonverbal, and demand and across 2 phases; implementation in…
Rispoli, Mandy; O'Reilly, Mark; Lang, Russell; Sigafoos, Jeff; Mulloy, Austin; Aguilar, Jeannie; Singer, George
Tumours are known to be heterogeneous, yet typical treatment plans consider them as a single unit. This may influence treatment outcomes. However, treatment cannot be customised to intra-tumour variation without a method to establish outcomes at an intra-tumour scale. This work proposes a method to both assess and measure outcomes locally within tumours. Methods: Four patients were scanned at two post-surgery time points using contrast enhanced MRI and 3,4-dihydroxy-6-[18F]-fluoro-L-phenylalanine (18F-DOPA) PET. The shell of active tumour tissue is divided into a set of small subregions at both time points. Local outcome is measured from changes in subregion volume over time. The utility of the proposed approach is evaluated by measuring the correlation between PET uptake and documented growth. Correlation with overall survival time was also examined. Results: Local outcomes were heterogeneous and evidence of a positive correlation between local 18F-DOPA uptake and local progression was observed. Conclusions: Given that intra-tumour outcomes are heterogeneous the consistently positive correlation between FDOPA uptake and progression, local analysis of tumours could prove useful for treatment planning.
Dowson, Nicholas; Thomas, Paul; Gal, Yaniv; Fay, Michael; Jeffree, Rosalind L.; Winter, Craig; Coulthard, Alan; Smith, Jye; Bourgeat, Pierrick; Salvado, Olivier; Crozier, Stuart; Rose, Stephen
This manual, which provides extensive new instructions for administering the Functional Assessment Inventory (FAI), is intended to enable counselors to begin using the inventory without undergoing any special training. The first two sections deal with the need for functional assessment and issues in the development and use of the inventory. The…
Crewe, Nancy M.; Athelstan, Gary T.
Background: This is a case series of 76 knees of 62 patients who underwent upper tibial valgus osteotomy for treatment of medial compartment osteoarthritis during a 20-year period and who were followed for a mean of 7.6 years. Methods: The patients were evaluated by validated outcome assessment systems of general health status short form (SF- 36), the Western Ontario McMaster
G. H. Shahcheraghi; P. Zarae; M. Javid; B. Mahmoodian
We evaluated interrater agreement across multiple respondents on anecdotal assessments and compared cases in which agreement was obtained with outcomes of functional analyses. Experiment 1 evaluated agreement among multiple respondents on the function of problem behavior for 27 individuals across 42 target behaviors using the Motivation Assessment Scale (MAS) and the Questions about Behavioral Function (QABF). Results showed that at least 4 of 5 respondents agreed on the primary maintaining consequence for 52% (22 of 42) of target behaviors with the MAS and 57% (24 of 42) with the QABF. Experiment 2 examined correspondence between the anecdotal assessment results and functional analysis results for 7 individuals for whom at least 4 of 5 respondents showed agreement in Experiment 1. Correspondence with functional analysis results was observed in 6 of 7 cases with the QABF and in 4 of 7 cases with the MAS. Implications of these outcomes for the utility of anecdotal assessments are discussed.
Smith, Carla M.; Smith, Richard G.; Dracobly, Joseph D.; Pace, Amy Peterson
In this article, we describe a systematic approach to designing, implementing, and evaluating functional assessment-based interventions developed by Umbreit, Ferro, Liaupsin, and Lane (2007), implemented in a job-share classroom with two first-grade students. One student was at risk for emotional and behavioral disorders (EBD) according to…
Lane, Kathleen Lynne; Eisner, Shanna L.; Kretzer, James; Bruhn, Allison L.; Crnobori, Mary; Funke, Laura; Lerner, Tara; Casey, Amy
This report examines the clinical performance of three very similar total hip arthroplasty designs with distinctly different bearing surfaces used over the course 10-17 years. Clinical outcomes assessments for each group are compared in the context of varying implant related costs related to the latest technology at the time of surgery. Eighty-one surgeries were studied and differ by bearing surface. In this study, 36 hips are ceramic on polyethylene, 27 are metal on polyethylene and 18 are metal on metal. All polyethylene components are nonhighly cross-linked. The ceramic on polyethylene group has younger patients, on average, and higher percentage of patients with significant polyethylene wear. These groups have an average follow-up time of 8.6 years when assessing functional hip scores, thigh pain, groin pain, revision surgeries and radiographic osteolysis. The implant purchasing cost at the time of surgery was assessed to determine if a correlation exists between outcomes and the more technologically advanced implants use at the time of surgery. Based on midterm clinical outcome assessment, no correlation between initial hospital cost and clinical outcomes of one bearing surface over another can be found. PMID:25002938
Parsons, Christopher; Batson, Ryan; Reighard, Shane; Tanner, Stephanie; Snider, Becky; Pace, Thomas B
This report examines the clinical performance of three very similar total hip arthroplasty designs with distinctly different bearing surfaces used over the course 10-17 years. Clinical outcomes assessments for each group are compared in the context of varying implant related costs related to the latest technology at the time of surgery. Eighty-one surgeries were studied and differ by bearing surface. In this study, 36 hips are ceramic on polyethylene, 27 are metal on polyethylene and 18 are metal on metal. All polyethylene components are nonhighly cross-linked. The ceramic on polyethylene group has younger patients, on average, and higher percentage of patients with significant polyethylene wear. These groups have an average follow-up time of 8.6 years when assessing functional hip scores, thigh pain, groin pain, revision surgeries and radiographic osteolysis. The implant purchasing cost at the time of surgery was assessed to determine if a correlation exists between outcomes and the more technologically advanced implants use at the time of surgery. Based on midterm clinical outcome assessment, no correlation between initial hospital cost and clinical outcomes of one bearing surface over another can be found.
Parsons, Christopher; Batson, Ryan; Reighard, Shane; Tanner, Stephanie; Snider, Becky; Pace, Thomas B.
Discriminatory ability of several pediatric outcome tools was assessed relative to Gross Motor Function Classification System (GMFCS) level in patients with cerebral palsy. Five hundred and sixty-two patients (400 with diplegia, 162 with hemiplegia; 339 males, 223 females; age range 4-18y, mean 11y 1mo [SD 3y 7mo]), classified as GMFCS Levels I to III, participated in this prospective multicenter, cross-sectional study. All tools were completed by parents and participants when appropriate. Effect size indices (ESIs) for parametric variables and odds ratios for non-parametric data quantified the magnitude of differences across GMFCS levels. Binary logistic regression models determined discrimination, and receiver operating characteristic curves addressed sensitivity and specificity. Between Levels I and II, the most discriminatory tools were Gross Motor Function Measure (GMFM-66), velocity, and WeeFIM Mobility. Between Levels II and III, the most discriminatory tools were GMFM Dimension E, Pediatric Functional Independence Measure (WeeFIM) Self-Care and Mobility, cadence, and Gillette Functional Assessment Questionnaire Question 1. Large ESIs were noted for Parent and Child reports of Pediatric Outcomes Data Collection Instrument (PODCI) Sports & Physical Function, Parent report of PODCI Global Function, GMFM Dimension E, and GMFM-66 across all GMFCS level comparisons. The least discriminatory tools were the Quality of Life and cognition measures; however, these are important in comprehensive assessments of treatment effects. PMID:17355473
Bagley, Anita M; Gorton, George; Oeffinger, Donna; Barnes, Douglas; Calmes, Janine; Nicholson, Diane; Damiano, Diane; Abel, Mark; Kryscio, Richard; Rogers, Sarah; Tylkowski, Chester
Background Head position practice has been shown to influence pill-swallowing ability, but the impact of head position on measures of swallowing outcomes has not yet been studied with fiber-optic endoscopic evaluation of swallowing (FEES). The primary purpose of this study was to determine whether head position impacts penetration-aspiration scale scores and/or post-swallow pharyngeal residue as assessed by FEES. Documenting the incidence of pharyngeal residue and laryngeal penetration and aspiration in a normal population was a secondary goal. Methods Adults without swallowing difficulties (N?=?84) were taught a pill swallowing technique based on learning five head positions and were asked to practice with small, hard candies (e.g., TicTacs) for two weeks. Then they demonstrated swallowing in each of the head positions for two conditions, liquid and purée, while undergoing FEES. Results Out of 840 examined swallows, one event of aspiration and 5 events of penetration occurred. During practice >50% participants found positions they preferred over the center position for swallowing but head position was not associated with penetration-aspiration scores assessed by FEES. Significant associations and non-significant trends were found between pharyngeal residue and three variables: age, most preferred head position, and least preferred head position. Conclusion Head position during swallowing (head up) and age greater than 40 years may result in increased pharyngeal residue but not laryngeal penetration or aspiration.
In this article, we describe a systematic approach to designing, implementing, and evaluating functional assessment-based interventions developed by Umbreit, Ferro, Liaupsin, and Lane (2007), implemented in a job-share classroom with two first-grade students. One student was at risk for emotional and behavioral disorders (EBD) according to systematic screenings that were implemented as part of regular school practices and one student
Objective: To assess the indications and effectiveness of laparoscopic ovarian transposition before pelvic irradiation for a gynecologic cancer.Design: Prospective study.Setting: A gynecologic oncology department in a French anti-cancer center.Patient(s): Twenty-four patients treated for pelvic cancer.Intervention(s): Laparoscopic ovarian transposition to paracolic gutters. Uterine conservation in 18 patients.Main Outcome Measure(s): Clinical and laboratory follow-up tests of ovarian function.Result(s): Bilateral laparoscopic ovarian transposition
Philippe Morice; Damienne Castaigne; Christine Haie-Meder; Patricia Pautier; Janah El Hassan; Pierre Duvillard; Alain Gerbaulet; Guy Michel
Spinal nerve roots often sustain compression injuries. We used a Wistar rat model of the cauda equina syndrome to investigate such injuries. Rapid transient compression of the cauda equina was produced using a balloon catheter. The results were assessed by daily neurological examination and somatosensory evoked potential (SEP) recording before surgery and ten weeks after decompression. Compression of the spinal nerves induced changes in the SEP which persisted for up to ten weeks after decompression, but it had no effect on the final neurological outcome. Our study shows the importance of early surgical decompression for cauda equina syndrome. PMID:9250763
Sayegh, F E; Kapetanos, G A; Symeonides, P P; Anogiannakis, G; Madentzidis, M
Background Supracricoid laryngectomy is an organ preservation surgical technique for early-stage glottic tumors. Modified supracricoid laryngectomy using sternohyoid muscles for neoglottis reconstruction is a new surgical technique. This report evaluates oncological and functional outcomes of this new technique and its feasibility in elderly patients. Methods Clinical records from 21 consecutive patients affected by glottic cancer and treated by modified SCL between 2004 and 2009 were retrospectively reviewed. Postoperative parameters and quality of voice after modified SCL were retrospectively reviewed. Actuarial overall survival, disease-specific survival rates, and recurrence-free survival rates were assessed. The functional and oncological outcomes of patients over 65 years were compared with those of patients younger than 65 years of age. Results There were no postoperative complications and all of the patients had complete swallowing rehabilitation. Twenty of the 21 patients had decannulation. Two patients received total laryngectomy for locoregional relapse. Overall survival and disease-specific survival rates were 100%. Recurrence-free survival rates were 90.1% and 90% in patients younger and older than 65 years of age, respectively. The larynx preservation index was lower in patients who were older than 65 years of age. The postoperative courses with regard to functional outcome and voice quality in elderly patients were similar to those of patients younger than 65 years of age. Conclusion Modified SCL is a new open organ preservation surgical technique that is oncologically safe. The positive functional and oncological outcomes of this surgical procedure allow it to be performed in elderly patients.
Allegra, Eugenia; Franco, Teresa; Trapasso, Serena; Domanico, Rossana; La Boria, Alessandro; Garozzo, Aldo
Learning outcomes and their assessment has given rise to considerable debate as to whether outcomes should be graded or just pass/fail. Assessment models employing learning outcomes have been used for some time in the United Kingdom (UK) in further education programs for example National Vocational Qualifications (NVQs) and General National…
Partial contents: Achieving Better Acquisition Outcomes,Major Weapon System Portfolio Analysis, DOD Has Increased Its Commitment In Major Defense Acquisitions Programs...,. But DOD Outcomes Are Not Improving, 2008 Weapon System Assessments, Little Evidenc...
The documentation of treatment outcomes has gained increased importance as those responsible for paying for healthcare focus on the delivery of cost-effective care. The practitioner and researcher, challenged with documenting the clinical significance of their endeavors, must depend on conceptually appropriate, valid and reliable instruments. Outcomes of particular relevance for sleep disorders include self-reported general symptoms, subjective and objective daytime
Terri E Weaver
SYNOPSIS Assessment of patient reported outcomes (PROs) has been shown to provide important information to assist with clinical decision-making. There has been significant progress in the field of PROs over the last two decades with the introduction of a variety of validated disease- and symptom-specific instruments. The Functional Assessment of Cancer Therapy-Melanoma (FACT-M) is a melanoma-specific module to accompany the FACT-General which has been validated to assess health-related quality of life (HRQOL) for patients with all stages of melanoma. Melanoma-specific health state utilities, which are essential for calculating quality adjusted life years and performing cost-effectiveness studies, have also been reported from a number of studies. Assessment of PROs should be incorporated into routine clinical practice to inform clinicians and researchers of the patient perspective for clinical decision-making and to evaluate the effects of psychosocial and medical interventions.
Cormier, Janice N.; Askew, Robert L.
The issue of outcome assessment is receiving increased attention in the area of higher education, generally, and in the fields of public and business administration, more specifically. A variety of methodologies are available for such assessments. This article argues that survey methodology is the most appropriate approach and presents a model for designing survey-based outcome assessments. In addition, an example
Sue R. Faerman; Kary D. Jablonka
In the past, it has taken several years to accumulate a sufficient number of subjects in the community-based studies to arrive at generalized conclusions. With an ongoing database, such as resides at CFAR-UDSMR, it is possible to collect a large number of cases within a relatively short period of time. Further, it is relatively easy to perform continuous monitoring in order to determine trends that may be occurring as a result of the changing scenes in health care delivery. It has been possible to uncover patterns of scoring the functional status of patients that reveal a consistent picture of an underlying biology of disability and predictable characteristics in patients' courses through the rehabilitation process. Newer analytic methods have allowed one to predict expected recovery patterns. This new information will allow one to better measure and manage outcomes, to improve the quality of care, to improve cost-effectiveness, and to better manage financial risk. These are the tools necessary for clinicians to incorporate into practice, as expectations with respect to outcomes and reimbursement for health care are changing. All of the marks associated with FIM and UDSMR belong to the Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. PMID:10573718
Gresham, G E; Granger, C V; Linn, R T; Kulas, M A
There is a wide range of assessment techniques for tinnitus, but no consensus has developed concerning how best to measure either the presenting features of tinnitus or the effects of tinnitus treatments. Standardization of reliable and valid tinnitus measures would provide many advantages including improving the uniformity of diagnostic and screening criteria between clinics and facilitating comparison of treatment outcomes obtained at different sites. This chapter attempts to clarify issues involved in developing self-report questionnaires for the assessment of tinnitus. While the tinnitus questionnaires that are currently available provide valuable information on which to base diagnostic and screening decisions, they were not originally developed in such a way as to maximize their sensitivity to treatment-related changes in tinnitus. As a result, their construct validity for measuring treatment benefit has not received appropriate attention. In this paper, special emphasis is devoted to the use of effect sizes as an estimate of the ability of questionnaires (and their individual items) to measure changes associated with treatment. We discuss the criteria relevant to evaluating the effectiveness of a questionnaire for diagnostic purposes vs. for treatment-evaluation purposes, and we present a detailed illustration of how the various criteria have been applied in a recent questionnaire development effort. PMID:17956815
Meikle, M B; Stewart, B J; Griest, S E; Martin, W H; Henry, J A; Abrams, H B; McArdle, R; Newman, C W; Sandridge, S A
Objective: To characterize relationships between self-reported co-morbidity and functional outcomes in community-dwelling older adults, and to assess whether the impact of co-morbidity persists even after adjustment for baseline functional status.Design: Prospective observational study. We examined associations between self-reported co-morbidity at baseline and functional outcomes at one year, with and without adjustment for baseline functional status.Setting: Outpatient clinics at a managed
Sally K Rigler; Stephanie Studenski; Dennis Wallace; Dean M Reker; Pamela W Duncan
Assessing the outcomes of interventions in mental health care is both important and challenging. The aim of this paper is to advance the field of outcomes research by proposing a taxonomy of the decisions that clinicians and researchers need to consider when evaluating outcomes. Our taxonomy has eight components, framed as decisions: Whose outcome will be considered? Which scientific stage is being investigated? What outcome domain(s) matter? What level of assessment will be used? Will clinical and/or recovery outcomes be assessed? Whose perspective will be considered? Will deficits and/or strengths be the focus? Will invariant or individualized measures be preferred? We propose a future focus on understanding what matters most to people using mental health services, and on the use of measures rated by service users as the primary approach to evaluating outcome.
Thornicroft, Graham; Slade, Mike
The purpose of this study was to determine the use and perceived usefulness of outcomes assessment methods in health information management programs. Additional characteristics of the outcomes assessment practices were recognized. The findings were evaluated for significant differences in results based on age of the program, type of institution,…
Provides a brief overview of the process of outcomes assessment and examples of its application in professional health science education. Provides a background for other articles in this issue describing ongoing activities in outcomes assessment in veterinary education and for programs considering developing a plan. Focuses on health professions…
Trent, Ava M.
This paper examines rationales, aspirations, assumptions and methods shaping an international assessment of learning outcomes: the OECD's Assessment of Higher Education Learning Outcomes (AHELO) feasibility study. The first part of the paper is analytical, exploring formative rationales, and shaping contexts and normative perspectives that frame…
Coates, Hamish; Richardson, Sarah
The systematic assessment of the social and affective outcomes of inclusion has been lagging behind the assessment of academic outcomes. This is particularly problematic in view of research evidence supporting concerns about peer rejection and bullying. In this article, Norah Frederickson and Elizabeth Simmonds, of University College London, and…
Frederickson, Norah; Simmonds, Elizabeth; Evans, Lynda; Soulsby, Chris
This paper identifies the various factors driving the outcomes assessment movement, contrasts the old paradigm with the model now espoused by regional accreditors, discusses the six-step process of student outcomes assessment, emphasizes faculty ownership of the process to prevent administrative usurpation, and proposes specific strategies to…
DeBoy, James L.; Monsilovich, Sally B.; DeBoy, Joanne R.
This study was aimed at finding effective ways of organising peer assessment of written assignments in the context of teaching history at university level. To discover features yielding optimal results, several peer assessment designs were developed, implemented in courses and their learning outcomes evaluated. Outcomes were defined in terms of…
van den Berg, Ineke; Admiraal, Wilfried; Pilot, Albert
In the care of patients with voice disorders, physicians, speech pathologists, and other health care professionals routinely make diagnoses, recommend treatment, and evaluate outcomes. Although objective and subjective measures exist, unfortunately, there is no widely accepted, valid method for classifying voice disorders and assessing outcome after voice treatment. In the present research, the relationship between two previously created multivariate objective voice function indices, the weighted odds ratio index and the multivariate logistic regression index, and subjective assessment of voice function was evaluated. Twenty-three adult patients presenting to a speech science laboratory for evaluation of voice disorders were studied in this prospective observational study together with 12 normal volunteers as controls. Vocal function was measured on 14 different parameters with a protocol that included a multichannel input for simultaneous assessment of acoustic and physiological parameters. Each patient was recorded reading the standard passage "The North Wind and the Sun," and recordings were then evaluated by the GRBAS scale. Overall, there was a statistically significant relationship between the weighted odds ratio index and multivariate logistic regression index and mean GRBAS scores. This research demonstrates that the voice function values calculated from two different multivariate objective voice function indices are significantly associated with subjective voice assessments. These multivariate objective voice indices may be appropriate for use in clinical trials and outcomes research on treatment effectiveness for voice disorders. PMID:9596217
Piccirillo, J F; Painter, C; Fuller, D; Haiduk, A; Fredrickson, J M
Chronic kidney disease affects millions of Americans. Many drugs are eliminated from the body by the kidneys. As renal function declines due to the disease, drugs that are normally eliminated by the kidneys can accumulate, potentially leading to toxicity. Assessing kidney function in patients is essential in determining the appropriate dose of medications to achieve the desired clinical outcome while minimizing the potential for toxicity. PMID:20629469
Dong, Kimberly; Quan, David J
A comprehensive review of the medical literature from 1950 to 1998 revealed 79 articles examining associations between rehabilitation interventions and functional outcome after stroke. This body of literature was critically analyzed, using established techniques, to reveal factors that were consistently associated with functional outcome after stroke. The following rehabilitation interventions after stroke appear to have a strong relationship with improved functional outcome at hospital discharge and follow-up: increased functional skills on admission to rehabilitation, early initiation of rehabilitation services, and rehabilitation in an interdisciplinary versus multidisciplinary setting. The following rehabilitation interventions after stroke appear to have a weak relationship with improved functional outcome at hospital discharge and follow-up: use of specialized types of therapy services and greater intensity of therapy services. The current literature is too limited to allow an assessment of the relationship of the following factors after stroke and functional outcome: specific types of non-inpatient rehabilitation services. PMID:10326901
Cifu, D X; Stewart, D G
Background: Periosteal osteosarcoma is an uncommon variant of osteosarcoma which constitutes less than 2% of all osteosarcomas. Whereas adequate surgical excision remains the cornerstone of treatment, the role of chemotherapy in this tumor is still unclear. Existing literature contains very few single center studies on the outcomes for periosteal osteosarcomas and any additional information will help in better understanding of these uncommon lesions. This study aims to evaluate the oncologic and functional outcomes of treatment of periosteal osteosarcoma treated at our institute. Materials and Methods: A retrospective analysis of 18 cases of periosteal osteosarcoma treated between January 2001 and December 2010 was carried out. There were 12 males and 6 females. The mean age at presentation was 16.3 years (range 5-26 years). Tibia and femur were the most common sites (n = 8). 16 of 18 patients received chemotherapy, 16 had limb sparing resection, one had an amputation and one had rotationplasty. Of the 16 patients with limb salvage, conventional wide excision was done in 11 cases. In 5 cases tumor was excised with hemicortical excision. Of the 11 cases treated with wide excisions, 4 patients underwent an osteoarticular resection and in 7 patients a joint preserving segmental intercalary resection was done. Results: All patients were available for followup. Surgical margins were free in all patients. A good response to chemotherapy was seen in 4/11 cases and poor in 6/11 cases. In one case the histological response was not discernible due to predominant chondromyxoid nature of the tumor. The median followup was 61 months (range: 18-130 months). There were two local recurrences (11%) at 9 and 18 months postsurgery. Pulmonary metastasis subsequently occurred in 4 cases (22%). Fourteen patients are currently alive and continuously disease free. Disease free survival at 5 years was 77.8% and overall survival (OVS) was 83.3%. Patients without marrow involvement had a better OVS at 5 years when compared with patients with marrow involvement (90% vs. 75%) (P = 0.23). Conclusion: Surgical excision remains the mainstay of treatment. Intramedullary involvement may suggest aggressive disease biology. The role of chemotherapy is still debatable and multicenter studies are needed to provide guidelines.
Gulia, Ashish; Puri, Ajay; Pruthi, Manish; Desai, Saral
In the report, the Committee on NASA Education Program outcomes of the National Research Council has advised the National Aeronautics and Space Administration (NASA) about its education programs, precollege through postdoctoral. The committee examined the...
Our objective was to evaluate the relation between age, gender, initial functional, cognitive and motor condition, spasticity, diabetes mellitus, and functional outcome after rehabilitation of stroke patients. Eighty-eight patients who had suffered stroke were administered in this study. Participants were stroke patients undergoing rehabilitation in Istanbul Physical Treatment and Rehabilitation Training and Research Hospital. Functional condition (Functional Independence Measurement (FIM)), spasticity (Ashworth Scale), cognitive condition (Mini Mental State Evaluation (MMSE)), post-treatment FIM were measured. A significant positive association between MMSE at admission and the functional discharge measures was observed. A significant positive association Brunnstrom (upper lower extremity assessment) scores and the functional discharge measures was observed. A significant positive association between spasticity at admission and the functional discharge measures was observed. In conclusions, the admission functional, motor, cognition condition, age, spasticity were a significant predictors of total and motor FIM score at discharge, but not gender and diabetes mellitus. PMID:20037216
One?, Kadrye; Yalçinkaya, Ebru Yilmaz; Toklu, Banu Cetnkaya; Ca?lar, Nil
The purpose of this study was to investigate whether diabetes mellitus may affect the functional outcome of hip fractured patients. We studied 759 consecutive patients admitted for hip fracture rehabilitation, out of whom 18.2% were diabetics. The functional outcomes of diabetics and nondiabetics were assessed by the functional independence measurement scale (FIM) at admission and discharge. Data were analyzed by t-tests, Pearson correlation, and chi-square test as well as by multiple logistic regression analysis. Compared with nondiabetics, diabetic patients were slightly younger (p=0.003) and more hyperlipidemic (p=0.01), had a higher prevalence of previous stroke (p=0.03) and lower cognitive Mini-Mental State Examination (MMSE) scores (p=0.007). Absolute and relative FIM parameters, at admission and discharge, were similar in both groups. A multiple logistic regression analysis showed that diabetes was independently, and inversely, associated with male gender [odds ratio (OR), 2.11 (95% CI, 1.41-3.18)] and higher admission motor-FIM [OR, 1.05 (95% CI, 1.03-1.07)], whereas higher cognitive scores upon admission emerged as being "protective" for being in the motor-FIM gain <20 [OR, 0.94 (95% CI, 0.91-0.97)]. However, diabetes was not associated with any of the parameters indicating unsuccessful rehabilitation. The findings suggest that there is no difference in the functional outcome of diabetic and nondiabetic patients, presenting for rehabilitation after surgery of hip fractures. Diabetes should not be considered as adversely affecting rehabilitation of such patients. PMID:16359740
Mizrahi, E H; Fleissig, Y; Arad, M; Adunsky, A
Educators who have been through accreditation are well aware of the need for outcomes-based learning and assessment. However, there are misunderstandings about what outcomes based assessment is, and how it can improve teaching and learning. We understand that accreditation requirements can be a reason for adopting outcomes-based assessment, but our real goal is to convey to our readers how outcomes-based
Steve Rigby; Melissa Dark
This review examines the available literature on neuropsychological outcomes of stroke and the literature on the ability of specific areas of neuropsychological deficit to predict functional stroke outcome. The literature reviewed indicates that post-stroke deficits in executive function, memory, language, and speed of processing are common, with those identified as having progressive ‘post-stroke dementia’ presenting with a similar, though more
Suzanne Barker-Collo; Valery Feigin
Objective: ADHD is associated with poor functional outcomes. The objectives were to investigate the prevalence of functional impairment and occupational status in a clinically referred sample of adults with ADHD and explore factors predicting occupational outcome. Method: A sample of 149 adults with a confirmed diagnosis of ADHD participated in…
Gjervan, Bjorn; Torgersen, Terje; Nordahl, Hans M.; Rasmussen, Kirsten
Context Prospective studies of childhood attention deficit/hyperactivity disorder (ADHD) have not extended beyond early adulthood. Objective To test whether children diagnosed with ADHD at mean age 8 (probands) have worse educational, occupational, economic, social, marital outcomes; higher rates of ongoing ADHD, antisocial personality disorder (ASPD), substance disorders (SD); adult onset psychiatric disorders, psychiatric hospitalizations and incarcerations, than non-ADHD comparisons, at mean age 41. To test for: positive associations between probands’ ongoing ADHD and ASPD, and SD’s; and for worse social and occupational functioning in probands without ongoing psychiatric disorders, than comparisons. Design Prospective, 33 year follow-up study, with blind clinical assessments. Setting Research clinic. Participants 135 Caucasian males with ADHD in childhood, free of conduct disorder, and 136 male comparisons without childhood ADHD (65% and 76% of original cohort, respectively). Main Outcome Measures Occupational, economic, and educational attainment; marital history; occupational and social functioning; ongoing and lifetime psychiatric disorders; psychiatric hospitalizations, and incarcerations. Results Probands had significantly worse educational, occupational, economic, social outcomes, and more divorces than comparisons; higher rates of ongoing ADHD (22% vs 5%, p<.001), ASPD (16% vs 0%, p<.001)and SD (14% vs 5%, p<.01), but not more mood or anxiety disorders (p’s=.36 and .33). Ongoing ADHD was weakly related to ongoing SD (phi=.19, p=.04), and ASPD+SD (phi=.20, p=.04). Lifetime, probands had significantly more ASPD and SD’s, but not mood or anxiety disorders, and more psychiatric hospitalizations and incarcerations than comparisons. Relative to comparisons, psychiatric disorders with onsets at age 21 or beyond were not significantly elevated in probands. Probands without ongoing psychiatric disorders had worse social, but not occupational, functioning. Conclusions The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after age 20. Findings highlight the importance of extended monitoring and treatment of children with ADHD.
Klein, Rachel G.; Mannuzza, Salvatore; Ramos Olazagasti, Maria A.; Roizen Belsky, Erica; Hutchison, Jesse A.; Lashua-Shriftman, Erin; Castellanos, F. Xavier
Object Cerebral cavernous malformations have been studied widely, but the natural history of brainstem cavernous malformations (CMs) is not well defined, and hemorrhages caused by brainstem CMs are devastating. The goal of this study was to quantify the hemorrhage risks and functional outcomes of patients with brainstem CMs. Methods This prospective, longitudinal, cohort study included patients with brainstem CMs diagnosed between 1985 and 2012. The clinical courses of all patients were recorded. Predictors of hemorrhage and the overall untreated outcomes were evaluated. Results A total of 331 patients (46.5% female) were included, with a mean follow-up duration of 6.5 years. The annual hemorrhage rates in patients initially presenting with hemorrhage with (n = 215) or without (n = 34) focal neurological deficits were 15.9% and 12.4%, respectively. However, the annual hemorrhage rate was 8.7% in patients initially presenting without hemorrhage (n = 82). The risk factors for hemorrhage were female sex (hazard ratio [HR] 1.445, p = 0.041), prior hemorrhage (HR 1.277, p = 0.029), and perilesional edema (HR 1.830, p = 0.002). Overall, neurological function at the most recent assessment was improved compared with neurological function at diagnosis. Additionally, 307 patients (92.7%) improved or stabilized, 268 (81.0%) lived independently, and 95 (28.7%) completely recovered. Predictors favoring complete recovery were no prospective hemorrhage (HR 1.958, p = 0.001), younger age (HR 1.268, p = 0.001), and small lesion size (HR 1.578, p = 0.004). Conclusions Patients' initial presentation predicts their prospective annual hemorrhage rate. This study suggests that several strong risk factors for hemorrhage and predictors of brainstem CM outcomes may enable clinicians to evaluate the potential hemorrhage risks of their patients and design personalized treatments. PMID:24785325
Li, Da; Hao, Shu-Yu; Jia, Gui-Jun; Wu, Zhen; Zhang, Li-Wei; Zhang, Jun-Ting
We present the results of a postal survey on the outcome of sports injuries treated in an Accident and Emergency Department which shows that this is unsuitable for assessing their outcome. There are, however, some points of interest relating to associated morbidity and satisfaction with treatment in the Accident and Emergency Department.
Pickard, M A; Tullett, W M; Patel, A R
A project was conducted to assess Family Studies bachelor's degree graduates' use of learning outcomes from course competencies in personal finance, family lifespan development, intervention, and advocacy and policy, and to determine how they apply these learning outcomes to their workplace, family, and community roles. Alumni surveys completed by…
Johnson, Cheryl A.; Heath, Claudia J.
Six existing clinical scoring systems for assessing outcome after calcaneal fracture are reviewed. All were applied to a diverse group of 75 patients who had sustained this injury. Stepwise multiple regression analysis was used to identify the most relevant variables within these systems. Based on this, a simplified and rational outcome scoring system was devised. This system was then tested
P. S. Kerr; D. L. Prothero; R. M. Atkins
The results of a 1-year project undertaken to place the outcome method for assessing quality of medical care in perspective and to develop disease-specific short-term outcome measures are summarized. The first volume of the full report summarized herein p...
R. H. Brook A. D. Avery
This article describes a method for the assessment of professional student outcomes (performance-type outcomes or soft skills). The method is based upon group activities, research on modern electrical engineering topics by individual students, classroom presentations on chosen research topics, final presentations, and technical report writing.…
Keshavarz, Mohsen; Baghdarnia, Mostafa
Sustainability assessment methods for building projects have a major role to play in introducing sustainability values and principles into mainstream construction practice. The paper reflects on potential measures that should advance building assessment practice in fostering sustainable construction and it advocates a redefinition of the objectives of building assessment methods. Arguably, the current emphasis in the building process and building
Ewelina Kaatz; David S. Root; Paul A. Bowen; Richard C. Hill
This article intends to inform physical education teachers about the current research describing the relationship between physical education performance outcomes as identified by the national physical education standards (i.e., regular participation in physical activity, physical fitness, motor competence; National Association of Physical…
Castelli, Darla M.; Hillman, Charles H.
The aim of the study is three-fold: (i) to analyze association between early subjective functional outcome of total joint arthroplasty (TJA) and patient-related risk factors; (ii) to evaluate the six-month subjective functional outcome of TJA as compared with subjective functional status of non-operated outpatients; (iii) to evaluate TJA self-perceived amelioration rates compared to the status of an age-matched sample from
B. Caracciolo; S. Giaquinto
Intraoperative neurophysiologic monitoring provides objective measures of nervous system function that are of value when operating in proximity to the brain stem. Real-time measurements of function can be correlated to operative manipulations in order to reduce the risk of damage in critically important regions. Techniques for evaluating brain stem function clinically and electrophysiologically are presented along with their applications during surgery of the brain stem. PMID:8353442
Sclabassi, R J; Kalia, K K; Sekhar, L; Jannetta, P J
Describes the multifaceted process for assessing students over the course of their undergraduate degree work in the Department of Theater and Dance at Appalachian State University in North Carolina. (SR)
Cole, Susan S.
Background context: The existing literature lacks a functional outcome study addressing instrumented posterior lumbar fusion surgery in physically active patients. Furthermore, results of operative versus nonoperative treatment in these patients are not clear. Purpose: To evaluate patient-assessed function, pain, and satisfaction and military job performance between servicemen treated operatively and nonoperatively. Study design\\/setting: This is a nonrandomized analysis of consecutive
Major Robert W Molinari; Major Tad Gerlinger
Direct measures provide for the direct examination or observation of student knowledge or skills against measurable learning outcomes. ABET has been putting increasing emphasis on direct measures for a program to demonstrate its achievement of program outcomes and educational objectives. In this paper, an approach for assessment of course outcomes using direct measures is presented. The knowledge and skills described by the course outcomes are mapped to specific problems on homework and exams. Throughout the semester the instructor keeps track of the performance of each student on each course outcome. At the end of the semester students receive letter grades as usual. But in addition each student receives a score on the scale of 1-to-5 for every course outcome indicating how well he/she achieved each outcome. The data (scores) coming from each course are used at the program level to assess the program outcomes. The paper provides an example and concludes with recommendations for other institutions that may choose to adapt a similar approach.
Introduction: Course outcomes have been assessed by examining the congruence between statements of commitment to change (CTCs) and course objectives. Other forms of postcourse reflective exercises (for example, impact and unmet-needs statements) have not been examined for congruence with course objectives or their utility in assessing course…
Lockyer, Jocelyn M.; Fidler, Herta; Hogan, David B.; Pereles, Laurie; Wright, Bruce; Lebeuf, Christine; Gerritsen, Cory
Presents a rationale for the use of outcomes assessment and identifies three competing assessment perspectives that examine quality: looking at users from the perspective of the academic library; looking at libraries from the users' perspectives; and libraries in the life of the institution. Discusses information literacy, and differentiating…
Dugan, Robert E.; Hernon, Peter
Worldwide, economic and other factors are pressing institutions of higher education to assess student learning to insure that graduates acquire the skills and competencies demanded in the 21st century. This paper summarises the status of undergraduate student learning outcomes assessment at accredited colleges and universities in the United…
Kuh, George D.; Ewell, Peter T.
The initial stages of development and implementation of assessment plans for engineering programs at Kuwait University have been completed. The plans include a structured process that translates educational objectives into measurable outcomes at the program and course levels, necessary assessment instruments, and feedback channels for corrective action. This paper presents the experience in developing such plans.
Andreas P. Christoforou; Mohammad D. Al-Ansary; Ahmet S. Yigit; Aziz Tayfun; Adel A. Aly; Haitham Lababidi; Faridah Ali; Ibrahim S. Nashawi; Mohamed Zribi
Invalid outcomes of the US Air Force's (AF) cycle ergometry assessment were analyzed from data collected at five AF bases. An AF member can receive one of three results from the assessment: Pass, Fail, or Invalid. Analysis revealed that 1548 of 9437 tests...
G. DeWolfe S. Chao D. Richardson S. Constable P. Flatten
Purpose Impaired functional outcome is common after a low anterior resection (LAR). Pelvic floor rehabilitation (PFR) might improve functional outcome after a LAR. The aim of this systematic review is to evaluate the effectiveness of PFR in improving functional outcome. Methods PubMed, Embase, and the Cochrane Library were searched using the terms fecal incontinence, colorectal neoplasm/surgery, LAR, rectal cancer, anterior resection syndrome, bowel habit, pelvic floor, training, therapy, physical therapy, rehabilitation and biofeedback. Of the 125 identified records, 5 articles were included. Results The 5 included studies reported on 321 patients, of which 286 patients (89%) underwent pelvic floor training. Three studies included patients with anterior resection syndrome after a LAR while the remaining studies included a series of patients after a LAR. Functional outcome was mostly assessed by using the Wexner incontinence scale. Quality of life was assessed in one study, and in three studies, rectal manometry was performed. After PFR, the functional outcome was improved in four studies, as was the quality of life. Conclusion This systematic review demonstrated that PFR is useful for improving the functional outcome after a LAR. The data are extracted from studies of limited quality, but the available evidence points to the effectiveness of the procedure.
Visser, Wilhelmina S; te Riele, Wouter W; Boerma, Djamila; van Ramshorst, Bert
The sports clinician faces multiple treatment options when dealing with overload injuries, and it is important to evaluate their outcomes. Multiple scores exist, some clincian rated (CRO), others patient rated (PRO), the latter being currently favoured. This review presents some of these scores and we selected the ones we feel are the most appropriate for a sports clinician. We considered these common problems: tennis elbow, rotator cuff issues, groin pain, patellofemoral pain syndrome, achilles tendinopathy and ankle instability. In addition, an activity level score is useful to weigh the result in the context of return to performance. These scores help to create a common language between therapists and to evaluate treatments objectively. PMID:22913001
Bonfanti, S; Gremion, G; Gojanovic, B
Differential sensitivity to change of three measures of men who participated in cardiac rehabilitation was measured to evaluate the hypothesis that measures that enhance subjective health and well-being are more appropriate to assess change than are measures of psychopathology. Rehabilitation subjects, but not control subjects, reported a decrease…
During the last 10 years, we have witnessed an impressive increase in the number of studies examining knowledge about osteoporosis. The aim of the present paper is to examine the status of research on knowledge about osteoporosis by reviewing and analyzing the current literature as it pertains to assessment of knowledge about osteoporosis, factors associated with knowledge, and relationship between
Unemployment wage data were evaluated to assess employment, job retention, and wage progression for graduates of Community Jobs (CJ), a short-term public job creation program for the hard to employ in the state of Washington. The following were among the findings: (1) 66% of all participants were employed after graduating from CJ; (2) 53% were…
Case, Annette; Burchfield, Erin; Sommers, Paul
The term "functional communication" refers to the skills and knowledge possessed by an individual, from which that individual's competence or effectiveness may be inferred. Part one of this two-part book identifies and describes conceptual and methodological issues involved in evaluating, or empirically describing, the major components of…
Larson, Carl; And Others
Neonatal stroke is a condition that leads to disability in later life, and as yet there is no effective treatment. Recently, erythropoietin (EPO) has been shown to be cytoprotective following brain injury and may promote neurogenesis. However, the effect of EPO on functional outcome and on morphologic changes in neonatal subventricular zone (SVZ) following experimental neonatal stroke has not been described. We used a transient focal model of neonatal stroke in P10 rat. Injury was documented by diffusion weighted MRI during occlusion. Immediately upon reperfusion, either EPO (5U/gm) or vehicle was administered intraperitoneally and animals were allowed to grow for 2 wk. Sensorimotor function was assessed using the cylinder rearing test and then brains were processed for volumetric analysis of the SVZ. Stroke induced SVZ expansion proportional to hemispheric volume loss. EPO treatment markedly preserved hemispheric volume and decreased the expansion of SVZ unilaterally. Furthermore, EPO treatment significantly improved the asymmetry of forelimb use following neonatal stroke. This functional improvement directly correlated with the amount of preserved hemispheric volume. These results suggest EPO may be a candidate in the treatment of neonatal stroke. PMID:15879287
Chang, Yun Sil; Mu, Dezhi; Wendland, Michael; Sheldon, R Ann; Vexler, Zinaida S; McQuillen, Patrick S; Ferriero, Donna M
Spinal nerve roots often sustain compression injuries. We used a Wistar rat model of the cauda equina syndrome to investigate such injuries. Rapid transient compression of the cauda equina was produced using a balloon catheter. The results were assessed by daily neurological examination and somatosensory evoked potential (SEP) recording before surgery and ten weeks after decompression. Compression of the spinal
Fares E. Sayegh; George A. Kapetanos; Pan P. Symeonides; George Anogiannakis; Minas Madentzidis
Organ preservation regimens that combine chemotherapy and radiotherapy (chemoradiotherapy) are increasingly used as the primary treatment of laryngeal and pharyngeal cancers. Meta-analytic data show a survival benefit with combined modality therapy, but the functional sequelae can be significant. Dysphagia is recognized as a common and often devastating late effect of chemoradiotherapy. This review examines functional outcomes after chemoradiotherapy for laryngeal and pharyngeal cancers, with a particular emphasis on dysphagia. Topics examined include the burden of dysphagia after chemoradiation, pathophysiology of dysphagia, baseline functioning, recommendations to improve long-term function, and voice outcomes.
Hutcheson, Katherine A.; Lewin, Jan S.
There is a growing body of literature about assessment in higher education. Much of it is devoted to advocating the benefits of assessment, describing how assessment initiatives and programs might be organized within an institution, identifying key attributes of successful assessment projects (leadership, resources, faculty engagement), and…
Bers, Trudy H.
This retrospective cohort study investigated the possible interrelations of GFR and functional outcome in elderly hip fracture patients. The final analyses comprised 499 consecutive patients undergoing standard medical, surgical and rehabilitation treatment in an orthogeriatric unit of a tertiary care hospital. Functional outcomes were assessed by Functional Independence Measurement (FIM™) scores. Kidney function was assessed by blood urea and creatinine,
Abraham Adunsky; Eliyahu H. Mizrahi; Alexander Kaplan; Elena Purits; Anna Waitzman; Marina Arad
Hall KM, Bushnik T, Lakisic-Kazazic B, Wright J, Cantagallo A. Assessing traumatic brain injury outcome measures for long-term follow-up of community-based individuals. Arch Phys Med Rehabil 2001;82:367-74. Objectives: To determine which outcome measures are best and least suited for assessing long-term functional outcome of individuals with traumatic brain injury (TBI) in the community. Design: Survey of participants in the community
Karyl M. Hall; Tamara Bushnik; Bajazeda Lakisic-Kazazic; Jerry Wright; Anna Cantagallo
Apolipoprotein E (apoE), the major apolipoprotein in the central nervous system, has been shown to influence neurologic disease progression and response to neurologic injury in a gene-specific manner. Presence of the APOE4 allele is associated with poorer response to traumatic brain injury and ischemic stroke, but the association between APOE genotype and outcome following aneurysmal subarachnoid hemorrhage (SAH) remains unclear. The purpose of this project was to investigate the association between APOE genotype and outcome after SAH. We also explored the association of APOE4 genotype and cerebral vasospasm (CV) presence in a subsample of our population with available angiographic data. A sample of 206 aneurysmal SAH participants had APOE genotyping performed, Glasgow outcome scores (GOS) and modified Rankin scores (MRS) collected at 3 and 6 months after aneurysm rupture. No significant association was found between the presence of the APOE4 genotype and functional outcomes controlling for age, race, size of hemorrhage (Fisher grade), and severity of injury (Hunt & Hess grade). However when controlling for CV and the covariates listed above, individuals with the APOE4 allele had worse functional outcomes at both time points. The presence of the APOE2 allele was not associated with functional outcomes even when considering presence of CV. There was no difference in mortality associated with APOE4 presence, APOE2 presence, or presence of CV. These findings suggest APOE4 allele is associated with poor outcome after aneurysmal SAH. PMID:19017669
Gallek, Matthew J; Conley, Yvette P; Sherwood, Paula R; Horowitz, Michael B; Kassam, Amin; Alexander, Sheila A
To ensure that industrial hygiene professionals continue to be prepared for current and future trends, it is important to regularly assess the value of their education. Described here are the results of discussions with employers and a mailed survey of graduates. Comparisons are made with past mailed surveys of both groups. Two sets of discussions were held in late 2005 with employers of industrial hygienists and other health and safety professionals. Twenty-eight participants were asked to discuss current and future needs for professionals in their organization and economic sector, their expectations for knowledge and skills when hiring professionals, methods for finding and hiring, and the importance of ABET accreditation. At the same time, a survey was mailed to 71 industrial hygiene students graduating in the last 15 years. Respondents were asked to rank the value of and their proficiency in 42 competencies. Questions also assessed employment experience, certification, the importance of ABET accreditation, and demographic characteristics. There was a lot of agreement between the two stakeholder groups (employers and graduates) about the most important skill and knowledge areas. Most employers identified communicating effectively and exposure assessment among the most important skills, with designing and initiating research as among the least. Hazard recognition, exposure measurement principles, and personal protective equipment were the most highly ranked knowledge areas. Employers discussed the need for good "business skills" such as teamwork, communication, and project management, and the importance of problem-solving skills. Graduates reported that skills in the areas of recognition, evaluation, and control were most valuable in their first jobs and generally reported high levels of proficiency in these skill areas. There was a similar dichotomy in opinions about accreditation within each stakeholder group. The reputation of the academic program was important when making hiring decisions; accreditation became an important factor only when a program's reputation was not known. Graduates strongly supported ongoing accreditation but did not apply or attend on the basis of accreditation. PMID:19204864
Brosseau, Lisa; Fredrickson, Ann
Purpose of Review The greater utilization of partial nephrectomy and ablative procedures has increased the incidence of patients presenting with local renal recurrence. The choice to either perform a partial or radical nephrectomy in these situations can be a challenging decision. Recent Findings Repeat and salvage partial nephrectomy, while challenging and potentially associated with increased complications, offers patients the ability to maintain excellent renal functional outcomes and promising oncologic outcomes at intermediate follow up. Summary Surgeons should be familiar with the surgical complications and the functional and oncologic outcomes of re-operative nephron-sparing surgery. Recent data and outcome analysis support utilization of these procedures in patients presenting with either local recurrence or de novo lesions in the ipsilateral kidney.
Shuch, Brian; Linehan, W. Marston; Bratslavsky, Gennady
This commentary considers the merits of exploring different public health delivery systems among developed countries to consider which models are most effective. It challenges the conventional focus on delivery of services or functions and asks why we are not primarily interested in delivery of better public health outcomes for our populations. Achieving these outcomes requires the commitment of all sectors of our respective communities and the deployment of a range of delivery systems tailored to the national political and cultural context.
The relationship of neurocognitive course with clinical and functional outcomes in psychosis is not well known, especially in the long term. The aim of the study was to examine the clinical and neuropsychological course of first-episode psychosis patients at 5-year follow-up and analyze the relationship of cognitive performance with clinical and functional outcome. The 5-year follow-up was conducted with 26 first-episode psychosis patients. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale, manic and depressive symptoms by the Young Mania Rating Scale and Hamilton Depression Rating Scale respectively, and psychosocial functioning by the Functioning Assessment Short Test. The cognitive domains were assessed by the Wechsler Adult Intelligence Scale, the Wisconsin Card Sorting Test, the Trail Making Test, the Verbal Fluency Test, the Stroop Colour-Word Test and the Wechsler Memory Scale. Patients showed symptomatic improvement in the follow-up except in negative psychotic symptoms. There was also improvement in most cognitive domains except in working memory and processing speed in the follow-up. Working memory impairment was associated to negative psychotic symptoms and poor functional outcomes. Negative symptoms mediated the relationship between working memory and outcome. Therefore, negative symptoms should be a primary target of treatment to improve functional outcomes. PMID:22985548
González-Ortega, Itxaso; de Los Mozos, Vanesa; Echeburúa, Enrique; Mezo, Maria; Besga, Ariadna; Ruiz de Azúa, Sonia; González-Pinto, Asunción; Gutierrez, Miguel; Zorrilla, Iñaki; González-Pinto, Ana
As nurse practitioners (NPs) assume an increasing role in providing care to hospitalized patients, measuring the impact of their care on patient outcomes and quality of care measures becomes a necessary component of performance evaluation. Developing metrics that relate to quality of care measures as well as patient outcomes based on the specific practices of an NP can help to specifically identify the impact of NP care in hospital and ambulatory care settings. New opportunities have arisen for highlighting NP outcomes that can be used to structure NP-associated metrics including the Hospital Value-Based Purchasing Program and the Joint Commission's practice evaluation standards. This manuscript discusses the use of NP-associated metrics for assessing the outcomes of NP care on patient care as well as on quality of care measures. PMID:24170592
Kapu, April N; Kleinpell, Ruth
To achieve the goals and objectives of program educational objectives, our Manufacturing Engineering (MANE) program at Virginia State University developed a curriculum that provides students with balanced coverage of ABET and the University core requirements. The program outcomes have been adopted considering the University and school mission, program objectives, (a) through (k) defined by Accreditation Board for Engineering and Technology (ABET), and specific outcomes for manufacturing engineering as defined by the Society of Manufacturing Engineering (SME). Our MANE program focuses on the areas of automation, quality, manufacturing process, engineering analysis and manufacturing design to prepare students for successful careers in manufacturing engineering and allied professions. This paper presents a brief description of the major components of our assessment that fulfill the ABET criteria for continuous improvement requirements. The assessment process and evaluation of the program outcomes are discussed along with the results as well.
Ansari, Jahangir; Javaheri, Amir; Tompkins, Stephen S. (Stephen Stern), 1938-; Williamson, Keith
Six commonly used instruments for assessment of eating disorders were analyzed. Effect size results from Erford et al.'s (2013) meta-analysis for the treatment of bulimia nervosa were used to compare each scale's ability to measure treatment outcomes for bulimia nervosa. Effect size comparisons indicated higher overall effect sizes using…
Sandberg, Katie; Erford, Bradley T.
Accreditation, budget, and accountability pressures at the institution and program levels lead to the involvement of faculty in assessment-based activities. Increasingly, programs are being expected to document student learning beyond traditional course grades. The use of outcomes as a tool to improve learning relies heavily on the active…
Weaver-Kaulis, Amy; Crutsinger, Christy
Reports on first and current occupations of sociology majors in order to assess education outcomes in the field. Earnings of males and females, graduate degree status and income, changes in prestige, and choice of graduate program are explored. Implications for the teaching of sociology are discussed. (KO)
Watts, W. David; Ellis, Ann Marie
Many questionnaires attempt to assess the quality of life of individuals who are visually impaired (that is, those who are blind or have low vision), but few apply to those who are undergoing visual rehabilitation and hence are difficult to adapt as an outcome measure Massof & Rubin, 2001). The Reading Behavior Inventory (RBI) was developed as a…
Goodrich, Gregory L.; Kirby, Jennine; Wood, Jennifer; Peters, Laura
BACKGROUND: Objective assessment of motor function is frequently used to evaluate outcome after surgical treatment of carpal tunnel syndrome (CTS). However a range of outcome measures are used and there appears to be no consensus on which measure of motor function effectively captures change. The purpose of this systematic review was to identify the methods used to assess motor function
Jo Geere; Rachel Chester; Swati Kale; Christina Jerosch-Herold
PurposeThe encouraging initial results of gastrocystoplasty led us to perform it for failed bladder exstrophy closure. We assess the functional outcome of the augmented bladder and evaluate complications related directly to use of the stomach in this specific group of children.
ALAA EL-GHONEIMI; CONRAD MULLER; JEAN M. GUYS; MICHEL COQUET; GERARD MONFORT
Outcome expectations, an important element of social cognitive theory, have been associated with physical activity in older adults. Yet, the measurement of this construct has often adopted a unidimensional approach. We examined the validity of a theoretically consistent three-factor (physical, social, and self-evaluative) outcome expectations exercise scale in middle-aged and older adults (N = 320; M age = 63.8). Participants completed questionnaires assessing outcome expectations, physical activity, self-efficacy, and health status. Comparisons of the hypothesized factor structure with competing models indicated that a three-factor model provided the best fit for the data. Construct validity was further demonstrated by significant association with physical activity and self-efficacy and differential associations with age and health status. Further evidence of validity and application to social cognitive models of physical activity is warranted.
Wojcicki, Thomas R.; White, Siobhan M.
Background: Subdural hematoma (SDH) is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005), yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44%) were discharged home, 16 (36%) discharged to nursing home or rehab, 6 (13%) to hospice and 3 (7%) died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.
Mulligan, Patrick; Raore, Bethwel; Liu, Shuling; Olson, Jeffrey J.
This study aimed to prospectively evaluate patient satisfaction by means of the Rhinoplasty Outcome Evaluation (ROE) questionnaire before and after functional septorhinoplasty. We carefully selected 62 patients (mean age, 31.8 years; 28 men, 34 women) who underwent open functional septorhinoplasty in the Otorhinolaryngology and Head Neck Surgery Department of Su?ehri State Hospital. Satisfaction analyses were carried out by means of the ROE questionnaire both before the surgery and at least 4 weeks after the surgery. Patients were divided according to age (? 25 vs >25 years) and follow-up duration (? 6 vs >6 months). In addition, patients were grouped according to their satisfaction scores: 0 to less than 50, bad outcome (group B); 50 to less than 75, good outcome (group G); and 75 or greater, perfect outcome (group P). The mean satisfaction score in all the patients significantly increased after functional septorhinoplasty (from 24.8 ± 14.6 to 70.1 ± 17.3; P < 0.001). Moreover, the increment in mean satisfaction scores did not differ with age or follow-up duration. We conclude that the ROE questionnaire can help surgeons select suitable candidates for functional septorhinoplasty who will most benefit from the surgery. PMID:24531253
Balikci, Hasan Huseyin; Gurdal, M Mustafa
Background: Growing evidence suggests that white matter hyperintensities (WMHs) are implicated in stroke recurrence and mortality, and their location can be a critical factor. This study evaluated the impact of periventricular WMHs (PVWMHs) and subcortical WMHs (SWMHs) on poststroke functional outcomes. Methods: Brain MRI was performed on 187 acute ischemic stroke patients (57.8% male; mean age = 64.3 years) recruited
Li-Min Liou; Chien-Fu Chen; Yuh-Cherng Guo; Hsiu-Ling Cheng; Hui-Lin Lee; Jui-Sheng Hsu; Ruey-Tay Lin; Hsiu-Fen Lin
Pannexin (Px, Panx) channels have been implicated in several physiological and pathological processes. We recently studied the potential contribution of pannexins in ischemic brain damage using Px1-/- Px2-/- mice and provided evidence that (1) the release of IL-1? and hemichannel function in astrocytes are, in contrast to published data, not affected by the absence of Px1 and Px2, (2) channel function in neurons lacking Px1 and Px2 is impaired and (3) Px1-/- Px2-/- mice had a better functional outcome and smaller infarcts than wild-type mice when subjected to ischemic stroke. Here, we further investigate the neurological outcome of wild-type and pannexin double-knockout mice 48 h after permanent occlusion of the distal middle cerebral artery (MCAO). Pannexin double-knockout mice (Px1-/- Px2-/-) were less impaired in parameters such as exploration, anxiety, sensorimotor function and behavioral symmetry.
Bargiotas, Panagiotis; Krenz, Antje; Monyer, Hannah; Schwaninger, Markus
Objective: To review measures used to assess treatment response in patients with attention-deficit/hyperactivity disorder (ADHD) across the life span. Data Sources: Keyword searches of English-language articles in the PubMed database up to and including the May 4, 2011, index date were performed with the search strings (1) (attention deficit disorder with hyperactivity [MeSH] OR ADHD) AND (outcome assessment [MeSH] OR adaptation of life skills OR executive function [MeSH]) and (2) (attention deficit disorder with hyperactivity [MeSH] OR ADHD) AND (function OR functioning OR quality of life [MeSH]). Study Selection: Articles found through this search were then selected based on relevance to the topic area; no specific quality criteria were applied. Data Extraction: Narrative review. Results: The vast majority of studies assessing ADHD treatments have measured treatment response using ADHD symptom measures. Additional domains relevant for assessing treatment response among children and adults with ADHD include functional impairment, quality of life, adaptive life skills, and executive function. Validated rating scales exist for assessing these additional domains, but there has been minimal research evaluating the sensitivity of these instruments for detecting treatment response in pediatric and adult samples. Conclusions: Assessment of treatment outcomes in ADHD should move beyond symptom assessment to incorporate measures of functioning, quality of life, adaptive skills, and executive function, especially when assessing long-term treatment response. The authors recommend a potential battery and schedule of measures that could be used to more comprehensively assess treatment response in patients with ADHD.
Weiss, Margaret D.
Social cognitive impairments are common, detectable across a wide range of tasks, and appear to play a key role in explaining poor outcome in schizophrenia and related psychotic disorders. However, little is known about the underlying factor structure of social cognition in people with psychotic disorders due to a lack of exploratory factor analyses using a relatively comprehensive social cognitive assessment battery. In a sample of 85 outpatients with psychosis, we examined the factor structure and clinical/functional correlates of eight indexes derived from five social cognition tasks that span the domains of emotional processing, social perception, attributional style, and Theory of Mind. Exploratory factor analysis revealed three factors with relatively low inter-correlations that explained a total of 54% of the variance: (1) Hostile attributional style, (2) Lower-level social cue detection, and (3) Higher-level inferential and regulatory processes. None of the factors showed significant correlations with negative symptoms. Factor 1 significantly correlated with clinical symptoms (positive, depression-anxiety, agitation) but not functional outcome, whereas Factors 2 and 3 significantly correlated with functional outcome (functional capacity and real-world social and work functioning) but not clinical symptoms. Furthermore, Factor 2 accounted for unique incremental variance in functional capacity, above and beyond non-social neurocognition (measured with MATRICS Consensus Cognitive Battery) and negative symptoms. Results suggest that multiple separable dimensions of social cognition can be identified in psychosis, and these factors show distinct patterns of correlation with clinical features and functional outcome.
Mancuso, Francesco; Horan, William P.; Kern, Robert S.; Green, Michael F.
Although typical functional analyses often produce clear outcomes, some studies have reported ambiguous results that cannot be interpreted. Such undifferentiated outcomes may occur if test conditions do not include relevant antecedent or consequent events. Clinicians then may try to modify the functional analysis conditions to include those events. Hanley, Iwata, and McCord (2003) reviewed the functional analysis literature through the year 2000 and described idiosyncratic variables included in modified functional analyses. The objective of the present review was to present a quantitative analysis of idiosyncratic antecedents and consequences in modified functional analyses during the past decade (2001 to 2010). We discuss the range of stimulus parameters tested and the assessment strategies used for informing the modified analysis conditions.
Schlichenmeyer, Kevin J.; Roscoe, Eileen M.; Rooker, Griffin W.; Wheeler, Emily E.; Dube, William V.
Although typical functional analyses often produce clear outcomes, some studies have reported ambiguous results that cannot be interpreted. Such undifferentiated outcomes may occur if test conditions do not include relevant antecedent or consequent events. Clinicians then may try to modify the functional analysis conditions to include those events. Hanley, Iwata, and McCord (2003) reviewed the functional analysis literature through 2000 and described idiosyncratic variables included in modified functional analyses. The objective of the present review was to present a quantitative analysis of idiosyncratic antecedents and consequences in modified functional analyses during the past decade (2001 to 2010). We discuss the range of stimulus parameters tested and the assessment strategies used for informing the modified analysis conditions. PMID:24114110
Schlichenmeyer, Kevin J; Roscoe, Eileen M; Rooker, Griffin W; Wheeler, Emily E; Dube, William V
Background/Aim: Hirschsprung's disease (HD) is one of the most common causes resulting in lower intestinal obstruction in children with atypical clinical symptoms and inconspicuous morphological findings by barium enema X-ray. Recently, this situation has been largely ameliorated by improvement of instrument for measurement of anorectal pressure. By now, anorectal manometry has been regarded as a routine means for functional assessment and diagnosis of HD. It is accurate in nearly all cases of HD with characteristic absence of rectoanal inhibitory reflex. Different surgical modalities of treatment are available and Swenson's operation is one of the surgical procedures done for HD. Anorectal manometric findings may change after Swenson's operation with improvement of rectoanal inhibitory reflex in some cases. We aimed to evaluate functional results after Swenson's operation for HD using anorectal manometry. Patients and Methods: Between 1996 and 2005, 52 patients were diagnosed with HD and operated upon by Swenson's operation in Gastroenterology Center, Mansoura University. There were 33 males (63.46%) and 19 females (36.54%) with a mean age of 3.29 ± 1.6, (range 2-17 years). Anorectal manometry and rectal muscle biopsy were done preoperatively for diagnosis but after operation anorectal manometry was done after every six months and then yearly. Results: All of the 52 patients showed absent rectoanal inhibitory reflex on manometric study with relatively higher resting anal canal pressure and within normal squeeze pressure. Postoperatively, there were 35 continent patients (67.31%) with 11 patients (21.15%) showing minor incontinence and six (11.54%) with major incontinence. On the other side, there were five patients (9.62%) with persistent constipation after operation (three due to anal stricture and two due to residual aganglionosis). Postoperative manometric study showed some improvement in anal sensation with the rectoanal inhibitory reflex becoming intact in six patients (11.54%) four years after operation. Conclusion: Anorectal manometry is a more reliable method for diagnosis of HD than barium enema X-ray but for final diagnosis, it is reasonable to combine anorectal manometry with tissue biopsy. Functional outcome after Swenson's operation for HD may improve in some patients complaining of incontinence or constipation. Anorectal manometry may show improvement of the parameters after Swenson's operation.
Gad El-Hak, Nabil A.; El-Hemaly, Mohamed M.; Negm, Emad H.; El-Hanafy, Ehab A.; AbdEl Messeh, Magdy H.; AbdEl Bary, Hala H.
Wetlands perform various functions of vital socio-ecological significance. To avoid further loss of functions, functional assessment techniques for management purposes are important to develop for different wetland classes. Our aim was to assess the biotic functions of urban-forested wetlands, and to evaluate specific functional assessment models in an urban setting. The models were adopted from the low gradient riverine wetlands
Sami Ullah; S. P. Faulkner
Discusses the difficulties many chemical engineering faculty face in assessing learning outcomes of education and explains the steps of rubric development which aims to assess students based on individual outcomes. (Contains 17 references.) (YDS)
Newell, James A.; Dahm, Kevin D.; Newell, Heidi L.
Assessment of global functioning is an important consideration in treatment outcome research; yet, there is little guidance on its evidence-based assessment for children with autism spectrum disorders. This study investigated the utility and validity of clinician-rated global functioning using the Developmental Disability-Child Global Assessment…
White, Susan W.; Smith, Laura A.; Schry, Amie R.
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.
Lakhanpal, Shuchi; Aggarwal, Asha; Kaur, Gurcharan
Oncological and functional prognostic factors for patients with foot sarcomas have yet to be clarified. This study was undertaken to identify the prognostic factors for oncological and functional outcomes and the significance of adjuvant radiotherapy in achieving local control in patients with foot sarcomas. We reviewed 31 consecutive patients with soft tissue (24), and bone (7) sarcomas arising in the foot and analyzed the impact of patient characteristics on the functional and oncological outcomes. There were seven cases with clear cell or epithelioid sarcomas. Two of the 31 cases experienced local recurrence despite the fact that only two cases received adjuvant radiotherapy. Sixteen out of 18 cases of soft tissue sarcomas with limb salvage surgery underwent reconstructive procedures for soft tissue defects. Amputation required as a surgical treatment (p=0.002) was a poor prognostic factor. Larger size (p=0.029) and bone reconstruction (p=0.018) were poor prognostic factors for local recurrence-free survival, and amputation (p=0.001) and bone reconstruction (p=0.008) for metastasis-free survival in patients with soft tissue sarcomas. No significant factors were derived in patients with bone sarcomas. Larger size (p=0.021), amputation (p=0.016) and bone reconstruction (p=0.03) were poor prognostic factors affecting function in patients with soft tissue sarcomas, and hindfoot site (p=0.028) and amputation (p=0.028) were poor prognostic factors affecting function in patients with bone sarcomas. Surgery with a negative operative margin and reconstructive procedures achieved good local control and function. Patients that had tumors with larger size, necessitating amputation or bone reconstruction, required novel multimodal treatment in order to improve their outcomes.
KOZAWA, EIJI; NISHIDA, YOSHIHIRO; NAKASHIMA, HIROATSU; TSUKUSHI, SATOSHI; TORIYAMA, KAZUHIRO; KAMEI, YUZURU; ISHIGURO, NAOKI
Introduction: Anterior Cruciate Ligament (ACL) is as one of the most frequently injured ligaments in the modern contact sports scenario. Graft fixations can be achieved during anterior cruciate ligament (ACL) reconstructions by using either bioabsorbable screws or metal screws. The objective of this study was to compare the functional outcomes after bioabsorbable and metallic interference screw fixations in arthroscopic anterior cruciate ligament reconstructions done by using hamstring grafts. Materials and Methods: This was a prospective, randomized study. Patients in Group 1 received bioabsorbable interference screws and patients in Group 2 received metallic interference screws. Arthroscopic assisted, anterior cruciate ligament reconstructions with the use of hamstring grafts which were fixed proximally with endobuttons and distally with bioabsorbable or metallic interference screws, were undertaken. Progress in functional outcomes was assessed by using Mann Whitney U- test. Functional outcomes in the two groups were compared by using independent t-test. Observation and Results: In each group, there were statistically significant improvements in functional outcomes over successive follow-ups, which were seen on basis on Mann-Whitney U-test. The comparison of functional outcomes between the two groups, done by using independent t-test, showed no statistically significant differences between the two groups at 3 months, 6 months and 1 year of follow-up. p-value <0.05 was considered to be significant in our study. Conclusion: In our prospective study of comparison of functional outcomes between bioabsorbable and metallic interference screws in arthroscopic anterior cruciate ligament reconstuctions, which were evaluated by using Tegner activity scale and Lysholm knee scoring scale for a period of 1 year, no statistically significant difference was found. However, further authentication is required by doing long term studies.
Rai, Deepak K; Kannampilly, Antony J
There has been much research concerning functional assessment over the past 20 years, but several important research considerations have yet to be explained. One is the comparison of different types of functional assessment (e.g., experimental functional analysis and non-experimental functional assessment). The current study aims to compare the…
Herzinger, Caitlin V.; Campbell, Jonathan M.
All general education courses at the San Jose State University, including those in the sciences, must present a detailed assessment plan of student learning, prior to certification for offering. The assessment plan must state a clear methodology for acquiring data on student achievement of the learning outcomes for the specific course category, as well as demonstrate how students fulfill a strong writing requirement. For example, an online course in oceanography falls into the Area R category, the Earth and Environment, through which a student should be able to demonstrate an understanding of the methods and limits of scientific investigation; distinguish science from pseudo-science; and apply a scientific approach to answer questions about the Earth and environment. The desired learning outcomes are shared with students at the beginning of the course and subsequent assessments on achieving each outcome are embedded in the graded assignments, which include a critical thinking essay, mid-term exam, poster presentation in a symposium-style format, portfolio of web-based work, weekly discussions on an electronic bulletin board, and a take-home final exam, consisting of an original research grant proposal. The diverse nature of the graded assignments assures a comprehensive assessment of student learning from a variety of perspectives, such as quantitative, qualitative, and analytical. Formative assessment is also leveraged into learning opportunities, which students use to identify the acquisition of knowledge. For example, pre-tests are used to highlight preconceptions at the beginning of specific field studies and post-testing encourages students to present the results of small research projects. On a broader scale, the assessment results contradict common misperceptions of online and hybrid courses. Student demand for online courses is very high due to the self-paced nature of learning. Rates of enrollment attrition match those of classroom sections, if students are informed of the instructor's expectations at the beginning of the course. The level of faculty-student and student-student communication is very high, both in terms of quantity and quality, and exceeds that experienced in classroom sections. Student scores on graded assignments compare favorably to classroom sections. Overall, online courses offer a cost-effective means of addressing top priority issues, including increasing student access to learning, accelerating rates of graduation, and improving outreach to K-12 educators, especially those working on credential requirements.
Reed, D. L.
This study was aimed at investigating the outcomes of an activity-based assessment (BIA) compared with standard assessment (SA) for evaluating clients undergoing psychiatric occupational therapy. Patients admitted to a psychiatric occupational therapy unit were randomized into the BIA or the SA assessment. The outcome indicators were (a) clients' satisfaction with the occupational therapy during the assessment period, (b) clients' awareness of capacities and occupational problems, (c) satisfaction with the assessment among the referring physicians, and (d) outcomes of the intervention following the assessment, in terms of changes in occupational performance and satisfaction. The groups did not differ in awareness of occupational problems, but the BIA group was more satisfied than the SA group with the support of their contact person and with the group leader during the period of assessment. Furthermore, physicians receiving feedback on patients in the BIA group were more satisfied than those receiving feedback on patients in the SA group. However, the groups did not differ concerning change during the treatment period in occupational performance or satisfaction. Thus, there was no difference between the assessment methods regarding the outcomes of the treatment following assessment. Minor advantages from the patients' perspective were found, in terms of better satisfaction in the BIA group, and from the referring physicians' perspective the BIA clearly seemed more satisfying than the SA. Thus, the findings showed that the BIA possessed better qualities than the SA regarding the indicators pertaining to satisfaction, but not concerning awareness of capacities and problems or the outcome of the subsequent treatment. PMID:18609248
Eklund, Mona; Ornsberg, Lena; Ekström, Christina; Jansson, Birgitta; Kjellin, Lars
Arthralgia affects postmenopausal breast cancer survivors (BCSs) receiving aromatase inhibitors (AIs). This study aims to establish the feasibility of studying the impact of yoga on objective functional outcomes, pain, and health-related quality of life (HR-QOL) for AI-associated arthralgia (AIAA). Postmenopausal women with stage I to III breast cancer who reported AIAA were enrolled in a single-arm pilot trial. A yoga program was provided twice a week for 8 weeks. The Functional Reach (FR) and Sit and Reach (SR) were evaluated as primary outcomes. Pain, as measured by the Brief Pain Inventory (BPI), self-reported Patient Specific Functional Scale (PSFS), and Functional Assessment of Cancer Therapy-Breast (FACT-B) were secondary outcomes. Paired t tests were used for analysis, and 90% provided data for assessment at the end of the intervention. Participants experienced significant improvement in balance, as measured by FR, and flexibility, as measured by SR. The PSFS improved from 4.55 to 7.21, and HR-QOL measured by FACT-B also improved; both P < .05. The score for the Pain Severity subscale of the BPI reduced. No adverse events nor development or worsening of lymphedema was observed. In all, 80% of participants adhered to the home program. Preliminary data suggest that yoga may reduce pain and improve balance and flexibility in BCSs with AIAA. A randomized controlled trial is needed to establish the definitive efficacy of yoga for objective functional improvement in BCSs related to AIAA. PMID:21733988
Galantino, Mary Lou; Desai, Krupali; Greene, Laurie; Demichele, Angela; Stricker, Carrie Tompkins; Mao, Jun James
Against the background of the growing evidence that the patient's functioning significantly influences the course and outcome of schizophrenia, the aims of this analysis were to examine what proportion of patients achieve functional outcome criteria after 1 year, and to identify clinical and sociodemographic predictive factors for functional remission. Patients with the diagnosis of schizophrenia who were treated as inpatients at the beginning of the study were examined within a naturalistic follow-up trial. The present study reports on the time frame from admission to discharge of an inpatient treatment period and the 1-year follow-up assessment. The Global Assessment of Functioning (GAF) Scale and Social and Occupational Functioning Assessment Scale (SOFAS) were evaluated with respect to functional outcome, whereas Positive and Negative Syndrome Scale (PANSS) scores were rated as psychopathological outcome measures. Functional remission thresholds were defined according to a GAF score of ?61 points and a SOFAS score ?61 points. Symptomatic remission criteria were applied according to the remission criteria of the Schizophrenia Working Group. The Strauss-Carpenter Prognostic Scale (SCPS), the Phillips Premorbid Adjustment Scale, medical history, sociodemographic and psychopathologic parameters were evaluated in order to find valuable predictors for functional remission. One year after discharge from inpatient treatment, 211 out of 474 patients were available for analysis according to both rating scales used to assess functional remission (GAF and SOFAS). Forty-seven percent of patients fulfilled criteria for functional remission (GAF and SOFAS) at discharge and 51% of patients at the 1-year follow-up visit. With regard to symptomatic remission criteria, the corresponding remitter rates were 61% of patients at discharge and 54% at the 1-year follow-up visit. Forty-two percent of patients fulfilled both remission criteria at discharge and 37% at the 1-year follow-up visit. A significant association was found between functional and symptomatic remission at discharge and at the 1-year follow-up visit. The strongest predictors for functional remission at the 1-year follow-up visit were: a higher SCPS total score at admission, a lower number of previous hospitalizations, a status of employment, lower scores in all PANSS subscales at discharge, a better premorbid social adjustment, the occurrence of a first psychotic episode, a younger age, a lower PANSS negative subscore at admission, a status of being an early responder, a shorter duration of inpatient treatment, a later age of onset, and female gender. PMID:22421065
Spellmann, Ilja; Riedel, Michael; Schennach, Rebecca; Seemüller, Felix; Obermeier, Michael; Musil, Richard; Jäger, Markus; Schmauß, Max; Laux, Gerd; Pfeiffer, Herbert; Naber, Dieter; Schmidt, Lutz G; Gaebel, Wolfgang; Klosterkötter, Joachim; Heuser, Isabella; Maier, Wolfgang; Lemke, Matthias R; Rüther, Eckart; Klingberg, Stefan; Gastpar, Markus; Möller, Hans-Jürgen
The outcomes of very low birth weight survivors born in the early post-neonatal intensive care era have now been reported to young adulthood in several longitudinal cohort studies, and more recently from large Scandinavian national databases. The latter reports corroborate the findings that despite disabilities, a significant majority of very low birth weight survivors are leading productive lives, and are functioning better than expected. This is reassuring, but there are still concerns about future psychopathology, cardiovascular and metabolic problems as they approach middle age. Although these findings may not be directly applicable to the current survivors of modern neonatal intensive care, they do provide a yardstick by which to project the outcomes of future survivors until more contemporaneous data are available. PMID:24289905
The nature of residual cognitive deficits after out of hospital cardiac arrest (OHCA) is incompletely described and has never been defined against a cardiac control (CC) group. The objective of this study is to examine neuropsychological outcomes 3 months after OHCA in patients in a “middle range” of acute severity. Thirty prospective OHCA admissions with coma >1 day and responsive but confused at 1 week, and 30 non-OHCA coronary care admissions were administered standard tests in five cognitive domains. OHCA subjects fell into two deficit profiles. One group (N = 20) had mild memory deficits and borderline psychomotor deficits compared to the CC group; 40% had returned to work. The other group (N = 10) had severe impairments in all domains. Coma duration was associated with group. Neither group had a high prevalence of depression. For most patients within the “middle range” of acute severity of OHCA, cognitive and functional outcomes at 3 months were encouraging.
Alexander, Michael P.; Lafleche, Ginette; Schnyer, David; Lim, Chun; Verfaellie, Mieke
This article operationally describes and empirically validates a composite outcome measure developed for use in a multisite alcohol treatment matching study. Using empirically based clinical guidelines to establish alcohol consumption and alcohol-related problems criteria, 1,726 subjects were classified as abstinent, moderate drinking without problems, heavy drinking or problems, or heavy drinking and problems at intake and 3, 6, 9, 12, and 15 months postintake. Subjects with poorer composite outcome also had poorer outcomes related to quantity and frequency of alcohol consumption, alcohol-related problems, serum gamma-glutamyltranspeptidase and other nonalcohol-related measures assessing psychiatric dysfunction, psychosocial functioning, and purpose or meaning in life. Differences in the present composite measure relative to other categorical measures used in research to date and the potential for incorporating nonalcohol-specific variables into composite measures are discussed. PMID:10069555
Cisler, R A; Zweben, A
Three hundred and twenty-six consecutively admitted patients with functional psychotic illnesses to which no diagnostic classification had been applied were followed up after 2.5 years. They were examined in social, clinical and psychological terms and the CATEGO programme and DSM-III criteria were applied to data concerning the index episode to derive diagnostic classifications. The deterioration in occupational functioning and the hospital careers of patients with diagnostic classifications of schizophrenia were worse than those in the other groups and positive and negative features were also more severe in patients with a classification of schizophrenia. By contrast, no differences in psychological test performance were found between the groups based upon diagnostic classification. Impaired psychological test performance was found and it was strongly related to concurrent mental state abnormalities, particularly negative symptoms. It is concluded that the diagnostic classifications used were of limited value in predicting outcome in functional psychosis. PMID:1352049
Johnstone, E C; Frith, C D; Crow, T J; Owens, D G; Done, D J; Baldwin, E J; Charlette, A
Background: The ICH Score is a commonly used clinical grading scale for outcome after acute intracerebral hemorrhage (ICH) and has been validated for 30-day mortality, but not long-term functional outcome. The goals of this study were to assess whether the ICH Score accurately stratifies patients with regard to 12-month functional outcome and to further delineate the pace of recovery of patients during the first year post-ICH. Methods: We performed a prospective observational cohort study of all patients with acute ICH admitted to the emergency departments of San Francisco General Hospital and UCSF Medical Center from June 1, 2001, through May 31, 2004. Components of the ICH Score (admission Glasgow Coma Scale score, initial hematoma volume, presence of intraventricular hemorrhage, infratentorial ICH origin, and age) were recorded along with other clinical characteristics. Patients were then assessed with the modified Rankin Scale (mRS) at hospital discharge, 30 days, and 3, 6, and 12 months post-ICH. Results: Of 243 patients, 95 (39%) died during initial acute hospitalization. The ICH Score accurately stratified patients with regard to 12-month functional outcome for various dichotomous cutpoints along the mRS (p < 0.05). Many patients continued to improve across the first year, with a small number of patients becoming disabled or dying due to late events unrelated to the initial ICH. Conclusions: The ICH Score is a valid clinical grading scale for long-term functional outcome after acute intracerebral hemorrhage (ICH). Many ICH patients improve after hospital discharge and this improvement may continue even after 6 months post-ICH. GLOSSARY CHR = Committee on Human Research; ED = emergency department; GCS = Glasgow Coma Scale; ICH = intracerebral hemorrhage; IVH = intraventricular hemorrhage; mRS = modified Rankin Scale; SFGH = San Francisco General Hospital.
Hemphill, J Claude; Farrant, Mary; Neill, Terry A.
National systemic reform initiatives point to the need for a more focused science curriculum and better curriculum materials for teachers to use (aligned with science standards, instructional methods, and assessment/accountability measures). Assessment developers face the difficult task of identifying and revealing what students actually know that is relevant to curricular goals. The SCALE-uP Project at the George Washington University has attempted to create such assessments using an adapted rigorous set of criteria based on an assessment item analysis procedure developed by the American Association for the Advancement of Science Project 2061. The procedure evaluates an assessment task's potential to reveal whether students have attained "a well-defined component of knowledge or acquired a particular skill" (Stern and Ahlgren, 2002). To determine students' scientific understanding of what causes the Earth's seasons, the SCALE-uP Project focuses on a single Benchmark from Benchmarks for Science Literacy (AAAS, 1993) that include both empirical observations and theoretical statements related to the target concept (Earth's seasons). In the conceptual model guiding our assessment development, we believe the target concept, articulated through the Benchmark (4B,6-8, #4), represents a single coherent knowledge structure and mental model stored in memory that students can recall or access when needed to explain relevant phenomena or solve tasks. Therefore, students that possess the concept of the Earth's seasons would be expected to respond to phenomena related to seasons with consistent and coherent responses to probes and representations related to the Benchmark idea. The instrument development procedure compares assessment outcomes (cognitive model/framework) of about 30 general 7th grade students with little previous classroom exposure to learning about the seasons, to high achieving 8th graders who have studied the seasons, and to introductory astronomy college students, who presumably understand the reasons for Earth's seasons. In this paper, we report on the results of the initial administrations of the instrument for these three groups.
Faubert, R. M.; Pyke, C.; Lynch, S.; Ochsendorf, R.
Background Severe sepsis is a common cause for admission to the general medical ward. Previous work has demonstrated substantial new long-term disability in patients with severe sepsis, but the short-term functional outcomes of patients admitted to the general medical floor -- where the majority of severe sepsis is treated -- are largely unknown. Methods A retrospective cohort study was performed of patients initially admitted to non-ICU medical wards at a tertiary care academic medical center. Severe sepsis was confirmed by three physician reviewers, using the International Consensus Conference definition of sepsis. Baseline functional status, disposition location, and receipt of post-acute skilled care were recorded using a structured abstraction instrument. Results 3,146 discharges had severe sepsis by coding algorithm; from a random sample of 111 patients, 64 had the diagnosis of severe sepsis confirmed by reviewers. The mean age of the 64 patients was 63.5 years +/- 18.0. Prior to admission, 80% of patients lived at home and 50.8% of patients were functionally independent. Inpatient mortality was 12.5% and 37.5% of patients were discharged to a nursing facility. Of all patients in the cohort, 50.0% were discharged home, and 66.7% of patients who were functionally independent at baseline were discharged to home. Conclusions New physical debility is a common feature of severe sepsis in patients initially cared for on the general medical floor. Debility occurs even in those with good baseline physical function. Interventions to improve the poor functional outcomes of this population are urgently needed.
Background and aim Trunk performance is an important predictor of functional outcome after stroke. However, the percentage of explained variance varies considerably between studies. This may be explained by the stroke population examined, the different scales used to assess trunk performance and the time points used to measure outcome. The aim of this multicentre study was to examine the predictive validity of the Trunk Impairment Scale (TIS) and its subscales when predicting the Barthel Index score at 6?months after stroke. Methods A total of 102 subjects were recruited in three European rehabilitation centres. Participants were assessed on admission (median time since stroke onset 20?days) and 6?months after stroke. Correlation analysis and forward stepwise multiple regression analysis were used to model outcome. Results The best predictors of the Barthel Index scores at 6?months after stroke were total TIS score (partial R2?=?0.52, p<.0001) and static sitting balance subscale score (partial R2?=?0.50, p<.0001) on admission. The TIS score on admission and its static sitting balance subscale were stronger predictors of the Barthel Index score at 6?months than the Barthel Index score itself on admission. Conclusions This study emphasises the importance of trunk performance, especially static sitting balance, when predicting functional outcome after stroke. The TIS is recommended as a prediction instrument in the rehabilitation setting when considering the prognosis of stroke patients. Future studies should address the evolution of trunk performance over time and the evaluation of treatment interventions to improve trunk performance.
Verheyden, Geert; Nieuwboer, Alice; De Wit, Liesbet; Feys, Hilde; Schuback, Birgit; Baert, Ilse; Jenni, Walter; Schupp, Wilfried; Thijs, Vincent; De Weerdt, Willy
Identifying biosignatures to assess the probability of response to an antidepressant for patients with major depressive disorder (MDD) is critically needed. Functional connectivity MRI (fcMRI) offers the promise to provide such a measure. Previous work with fcMRI demonstrated that the correlation in signal from one region to another is a measure of functional connectivity. In this pilot work, a baseline non-task fcMRI was acquired in 14 adults with MDD who were free of all medications. Participants were then treated for 8 weeks with an antidepressant and then clinically re-evaluated. Probabilistic anatomic regions of interest (ROI) were defined for 16 brain regions (eight for each hemisphere) previously identified as being important in mood disorders. These ROIs were used to determine mean time courses for each individual's baseline non-task fcMRI. The correlations in time courses between 16 brain regions were calculated. These calculated correlations were considered to signify measures of functional connectivity. The degree of connectivity for each participant was correlated with treatment outcome. Among 13 participants with 8 weeks follow-up data, connectivity measures in several regions, especially the subcallosal cortex, were highly correlated with treatment outcome. These connectivity measures could provide a means to evaluate how likely a patient is to respond to an antidepressant treatment. Further work using larger samples is required to confirm these findings and to assess if measures of functional connectivity can be used to predict differential outcomes between antidepressant treatments.
Kozel, F. Andrew; Rao, Uma; Lu, Hanzhang; Nakonezny, Paul A.; Grannemann, Bruce; McGregor, Tamara; Croarkin, Paul E.; Mapes, Kimberly S.; Tamminga, Carol A.; Trivedi, Madhukar H.
Background To evaluate if plasma levels of midregional pro-adrenomedullin (MR-proADM) improve prediction of functional outcome in ischemic stroke. Methods In 168 consecutive ischemic stroke patients, plasma levels of MR-proADM were measured within 24 hours from symptom onset. Functional outcome was assessed by the modified Rankin Scale (mRS) at 90 days following stroke. Logistic regression, receiver operating characteristics (ROC) curve analysis, net reclassification improvement (NRI), and Kaplan-Meier survival analysis were applied. Results Plasma MR-proADM levels were found significantly higher in patients with unfavourable (mRS 3–6) compared to favourable (mRS 0–2) outcomes. MR-proADM levels were entered into a predictive model including the patients' age, National Institutes of Health Stroke Scale (NIHSS), and the use of recanalization therapy. The area under the ROC curve did not increase significantly. However, category-free NRI of 0.577 (p<0.001) indicated a significant improvement in reclassification of patients. Furthermore, MR-proADM levels significantly improved reclassification of patients in the prediction of outcome by the Stroke Prognostication using Age and NIHSS-100 (SPAN-100; NRI?=?0.175; p?=?0.04). Kaplan-Meier survival analysis showed a rising risk of death with increasing MR-proADM quintiles. Conclusions Plasma MR-proADM levels improve prediction of functional outcome in ischemic stroke when added to the patients' age, NIHSS on admission, and the use of recanalization therapy. Levels of MR-proADM in peripheral blood improve reclassification of patients when the SPAN-100 is used to predict the patients' functional outcome.
Gattringer, Thomas; Simmet, Nicole E.; Scharnagl, Hubert; Bocksrucker, Christoph; Lampl, Christian; Storch, Maria K.; Stojakovic, Tatjana; Fazekas, Franz
Background and Purpose We evaluate associations between the severity of magnetic resonance perfusion-weighted imaging abnormalities, as assessed by the hypoperfusion intensity ratio (HIR), on infarct progression and functional outcome in the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2 (DEFUSE 2). Methods Diffusion-weighted magnetic resonance imaging and perfusion-weighted imaging lesion volumes were determined with the RAPID software program. HIR was defined as the proportion of TMax >6 s lesion volume with a Tmax >10 s delay and was dichotomized based on its median value (0.4) into low versus high subgroups as well as quartiles. Final infarct volumes were assessed at day 5. Initial infarct growth velocity was calculated as the baseline diffusion-weighted imaging (DWI) lesion volume divided by the delay from symptom onset to baseline magnetic resonance imaging. Total Infarct growth was determined by the difference between final infarct and baseline DWI volumes. Collateral flow was assessed on conventional angiography and dichotomized into good and poor flow. Good functional outcome was defined as modified Rankin Scale ?2 at 90 days. Results Ninety-nine patients were included; baseline DWI, perfusion-weighted imaging, and final infarct volumes increased with HIR quartiles (P<0.01). A high HIR predicted poor collaterals with an area under the curve of 0.73. Initial infarct growth velocity and total infarct growth were greater among patients with a high HIR (P<0.001). After adjustment for age, DWI volume, and reperfusion, a low HIR was associated with good functional outcome: odds ratio=4.4 (95% CI, 1.3–14.3); P=0.014. Conclusions HIR can be easily assessed on automatically processed perfusion maps and predicts the rate of collateral flow, infarct growth, and clinical outcome.
Olivot, Jean Marc; Mlynash, Michael; Inoue, Manabu; Marks, Michael P.; Wheeler, Hayley M.; Kemp, Stephanie; Straka, Matus; Zaharchuk, Gregory; Bammer, Roland; Lansberg, Maarten G.; Albers, Gregory W.
Endoscopic laser cricopharyngeal myotomy is an effective treatment for cricopharyngeal dysfunction, but concern remains over the risk of serious complications following the procedure. Some authors have therefore considered endoscopic laser cricopharyngeal myotomy with mucosal repair; however, outcome data for the procedure is scanty. This study aims to identify functional outcomes in a series of patients following endoscopic laser cricopharyngeal myotomy with mucosal repair. Endoscopic laser cricopharyngeal myotomy with mucosal repair was performed on 38 subjects in two centres over a period of 33 months. Pre- and post-operative outcomes were evaluated in 32 subjects using the Sydney Swallow Questionnaire and Reflux Symptom Index. An improvement in swallowing scores was seen in 30 subjects (94 %, p < 0.001). The Reflux Symptom Index improved 28 subjects (88 %, p < 0.001). Mean procedure time was 58 min. One subject (2.6 %) developed mediastinitis following surgery, and four experienced (12.5 %) a recurrence of dysphagic symptoms. Endoscopic laser cricopharyngeal myotomy with mucosal repair is an effective treatment for cricopharyngeal dysfunction. The complication rate observed in this study was comparable or lower than previously reported studies into endoscopic laser cricopharyngeal myotomy without mucosal repair. Larger studies may be required to determine the additional benefit of mucosal repair over endoscopic laser cricopharyngeal myotomy alone. PMID:24337898
Dale, O T; Mackeith, S; Burgess, C A; Rourke, T J; Winter, S C; Corbridge, R J
Background. Cortisol is a stress-related hormone with a robust circadian rhythm where levels typically peak in the morning hours and decline across the day. Although acute cortisol increases resulting from stressors are adaptive, chronic elevated cortisol levels are associated with poor functioning. Studies have shown age-related changes in cortisol levels. The present study investigated the relationship between salivary diurnal cortisol and functional outcomes among older adults undergoing inpatient post-acute rehabilitation. Methods. Thirty-two older adults (mean age 78 years; 84% men) in a Veterans Administration inpatient post-acute rehabilitation unit were studied. Functional outcomes were assessed with the motor component of the Functional Independence Measure (mFIM; where mFIM change = discharge ? admission score). Saliva samples were collected on 1 day at wake time, 45 minutes later, 11:30 AM, 2 PM, 4:30 PM, and bedtime. We analyzed the relationship between cortisol measures and functional outcomes, demographics, and health measures. Results. The analyses consistently showed that greater functional improvement (mFIM change) from admission to discharge was associated with lower comorbidity scores and higher cortisol levels at 2 PM, 4:30 PM, and bedtime. A morning cortisol rise was also associated with greater mFIM change. Conclusions. Measurement of cortisol in saliva may be a useful biological marker for identification of patients who are “at risk” of lower benefits from inpatient rehabilitation services and who may require additional assistance or intervention during their post-acute care stay.
Fiorentino, Lavinia; Saxbe, Darby; Alessi, Cathy A.; Woods, Diana Lynn
Cognitive impairments are often under diagnosed in stroke patients with good functional outcome. There is a need for a cognitive screening instrument that is sufficiently sensitive to cognitive impairments in these stroke patients. For this goal, we tested the feasibility and validity of the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS). Stroke patients with good functional outcome (Barthel Index 19/20) within 1 year poststroke were administered the BNIS and a brief neuropsychological assessment (NPA) including tests for perception, language, memory, attention, reasoning, and executive functioning. We compared the BNIS with the NPA to investigate its feasibility, internal consistency, floor and ceiling effects, concurrent validity, sensitivity and specificity. Fifty-four stroke patients were included. It took significantly less time to administer the BNIS (median = 16 minutes) than the NPA (median = 32.7 minutes). The BNIS showed good internal consistency (alpha = .82) and no floor or ceiling effects. The recommended cutoff values yielded good sensitivity and low to good specificity, depending on age. Except for perception (Spearman correlation .33), BNIS domain scores were significantly (0.44-0.55) associated with matching neuropsychological tests. This study provides promising results for the BNIS as a measure to detect cognitive impairments in stroke patients with good functional outcome. PMID:23472712
Boosman, Hileen; Visser-Meily, Johanna M A; Post, Marcel W M; Duits, Annelien; van Heugten, Caroline M
Aim: Assessing educational outcomes in high-risk populations is crucial for defining long-term outcomes. As standardized tests are costly and time-consuming, we assessed the use of the Teacher Academic Attainment Scale (TAAS) as an outcome measure. Method: Three hundred and forty three children in mainstream schools aged 10 to 11 years (144 males,…
Johnson, Samantha; Marlow, Neil; Wolke, Dieter
Background Approximately 12% of operations for traumatic neuropathy are for patients with segmental nerve loss and less than 50% of these injuries obtain meaningful functional recovery. Polyethylene glycol (PEG) therapy has been shown to improve functional outcomes after nerve severance and we hypothesized this therapy could also benefit nerve autografting. Methods A segmental rat sciatic nerve injury model was used, whereby a 0.5 cm defect was repaired with an autograft using microsurgery. Experimental animals were treated with solutions containing methylene blue (MB) and PEG; control animals did not receive PEG. Compound Actions Potentials (CAPs) were recorded before nerve transection, after solution therapy, and at 72 hours postoperatively. The animals underwent behavioral testing at 24 and 72 hours postoperatively. After sacrifice, nerves were fixed, sectioned, and immunostained to allow for quantitative morphometric analysis. Results The introduction of hydrophilic polymers greatly improved morphological and functional recovery of rat sciatic axons at 1–3 days following nerve autografting. PEG therapy restored CAPs in all animals and CAPs were still present 72 hours postoperatively. No CAPS were detectable in control animals. Footfall asymmetry scores and sciatic functional index scores were significantly improved for PEG therapy group at all time points (p <0.05 and p<0.001; p <0.001 and p <0.01). Sensory and motor axon counts were increased distally in nerves treated with PEG compared to control (p = 0.0189 and p = 0.0032). Conclusions PEG therapy improves early physiologic function, behavioral outcomes, and distal axonal density after nerve autografting.
Sexton, Kevin W.; Pollins, Alonda C.; Cardwell, Nancy L.; Del Corral, Gabriel A.; Bittner, George D.; Shack, R. Bruce; Nanney, Lillian B.; Thayer, Wesley P.
Resection of advanced gingivo-buccal tumors results in a posterolateral mandibular and large soft tissue defect. Because of large soft tissue requirement, these defects are difficult to reconstruct using a single osteocutaneous flap. A double free flap reconstruction of such defects is recommended. However, double flap may not be feasible in certain situations. In this study, we objectively evaluated functional and cosmetic outcomes following single soft-tissue flap reconstruction in a group of patients where double flap reconstruction was not feasible. Patient and defect characteristics were obtained from charts. The speech and swallowing functions of patients were prospectively assessed by a dedicated therapist. The cosmetic outcome of reconstruction was evaluated by an independent observer. Fifty-six patients with large soft tissue and segmental posterolateral mandible defect, reconstructed with anterolateral thigh or pectoralis major flap from May 2009 till December 2010 were included. In this series, none of the flaps were lost; two patients with pectoralis major flap developed partial skin paddle loss. Most of the patients developed mandibular drift; however, majority of these patients had no postoperative trismus. All patients resumed regular or soft solid oral diet. The mean speech intelligibility was more than 70%. Majority of patients had satisfactory cosmetic outcome. The defects were classified into regions resected to develop a reconstruction algorithm for optimal reconstruction using a free or pedicle flap. In conclusion, patients with large oro-mandibular defect undergoing single soft tissue flap reconstruction have satisfactory functional and cosmetic outcome. PMID:23255307
Kekatpure, Vikram D; Manjula, B V; Mathias, Smita; Trivedi, Nirav P; Selvam, Sumithra; Kuriakose, Moni Abraham
Problems of sexual function and fertility in long-term survivors (?5 years) of haematological malignancy are often neglected in clinic. Our centre carried out a questionnaire study in this population addressing patient-perceived fertility and sexual function. 718 patients responded (56% of those invited; 39% Hodgkin, 45% non-Hodgkin lymphoma, 16% acute leukaemia). Respondent women were more likely to remain childless than a normal control population. Self-reported infertility was more likely in men than women [odds ratio (OR) 1·77, P = 0·001]. Myeloablative therapy increased the likelihood of childlessness (OR 2·48, P = 0·004). Few attended fertility support services (12%). 24% of men banked sperm and 29% of these used the sample, of which 46% resulted in successful pregnancy. Fertility clinic attendance and sperm storage was more likely post-1990 (OR 4·05, P < 0·001; OR 5·05, P < 0·001 respectively). Reporting a negative impact of cancer on sexual function was more common in women than men (OR 2·20, P < 0·001), and increased with current age and age at diagnosis (by 3-4% per year, P ? 0·001) but decreased with longer follow-up (by 2%/year, P = 0·005). Patients on anti-depressants and those reporting cancer-related body change/appearance concerns more frequently reported a negative impact (P < 0·04 and P < 0·03 respectively). These self-reported outcomes confirm literature findings, suggest improvement over time, but highlight a need for involvement of support services. PMID:24236665
Greaves, Paul; Sarker, Shah-Jalal; Chowdhury, Kashfia; Johnson, Rachel; Matthews, Janet; Matthews, Rebecca; Smith, Matthew; Korszun, Ania; Gribben, John G; Lister, T Andrew
The chemical engineering programme at the United Arab Emirates University is designed to fulfil the Accreditation Board for Engineering and Technology (ABET) (A-K) EC2000 criteria. The Department of Chemical & Petroleum Engineering has established a well-defined process for outcomes assessment for the chemical engineering programme in order to…
Abu-Jdayil, Basim; Al-Attar, Hazim
OBJECTIVE Disruptive mood dysregulation disorder (DMDD) is a new disorder for DSM-5 that is uncommon and frequently co-occurs with other psychiatric disorders. Here, the authors test whether meeting diagnostic criteria for this disorder in childhood predicts adult diagnostic and functional outcomes. METHOD In a prospective, population-based study, individuals were assessed with structured interviews up to six times in childhood and adolescence (ages 10 to 16 years; 5,336 observations of 1,420 youths) for symptoms of DMDD and three times in young adulthood (ages 19, 21, and 24-26 years; 3,215 observations of 1,273 young adults) for psychiatric and functional outcomes (health, risky/illegal behavior, financial/educational functioning, and social functioning). RESULTS Young adults with a history of childhood DMDD had elevated rates of anxiety and depression and were more likely to meet criteria for more than one adult disorder relative to comparison subjects with no history of childhood psychiatric disorders (noncases) or individuals meeting criteria for psychiatric disorders other than DMDD in childhood or adolescence (psychiatric comparison subjects). Participants with a history of DMDD were more likely to have adverse health outcomes, be impoverished, have reported police contact, and have low educational attainment as adults compared with either psychiatric or noncase comparison subjects. CONCLUSIONS The long-term prognosis of children with DMDD is one of pervasive impaired functioning that in many cases is worse than that of other childhood psychiatric disorders. PMID:24781389
Copeland, William E; Shanahan, Lilly; Egger, Helen; Angold, Adrian; Costello, E Jane
Several oral and topical medications are available for the treatment of onychomycosis, a widespread fungal infection of the nail. Since efficacy criteria vary greatly among clinical trials for onychomycosis treatment, it is difficult for physicians to compare outcomes and determine the appropriate therapy for a given patient. The present analysis evaluates the efficacy criteria used in intention-to-treat clinical trials of itraconazole, terbinafine, and 8% ciclopirox nail lacquer, drugs approved by the US FDA for the treatment of onychomycosis. Efficacy parameters often appear to use subjective assessment tools and may not include the actual size measurement of the affected target nail as an efficacy variable. Parameters, which assess both mycologic and clinical cure, are frequently omitted from clinical trials. Not surprisingly, clinical trials with stringent efficacy criteria, which assess both mycologic and clinical response/cure without use of subjective methods, appear to have the lowest rates for both therapeutic response and complete cure. Thus, an evaluation of treatment options for onychomycosis cannot solely compare success/failure rates in clinical trials, but requires a critical appraisal of the efficacy criteria utilized in those trials. PMID:15186193
Werschler, W Philip; Bondar, George; Armstrong, David
Advances in treatment technologies and development of evidence-base d standards of care demand better methods for routine assessment of outcomes for schiz- ophrenia in systems of care. This article describes the development and psychometrics of a new instrument to assess outcomes of routine care for persons with schizophrenia in service systems. Candidate items for the Schizophrenia Care and Assessment Program
Anthony F. Lehman; Ellen P. Fischer; Leticia Postrado; Janine Delahanty; Bryan M. Johnstone; Patricia A. Russo; William H. Crown
Objective: To compare the functional outcomes attained by persons with paraplegia using the Walkabout Orthosis (WO) and the Isocentric Reciprocal Gait Orthosis (IRGO).Design: A randomized crossover design.Patients: Ten subjects with complete lesions between T9-T12.Interventions: Over two 8-week periods, subjects were taught to use each orthosis in conjunction with elbow crutches.Main Outcome Measures: After each 8-week training period, subjects were assessed
Lisa A. Harvey; Merrick B. Smith; Glen M. Davis; Stella Engel
Objective To compare functional status between women with and without postpartum depression (PPD). Methods A two-group cross-sectional design compared functional status between 23 women with and 23 women without PPD. Participants were 6 to 26 weeks postpartum, and from obstetric practices in the Northeastern United States. Structured clinical interviews were used to establish diagnoses of PPD. Participants were matched on type of delivery, weeks postpartum, and parity. Participants compared current functioning to pre-pregnancy functioning utilizing the Inventory of Functional Status After Childbirth. The Postpartum Depression Screening Scale was used to measure PPD severity. Hierarchical multiple and logistic regression models were used to analyze data. Results Controlling for infant gender, number of nighttime infant awakenings, and income, PPD predicted lower personal (P<0.001), household (P<0.05), and social functioning (P<0.001), but no difference in infant care. Women with PPD were 12 times less likely to achieve pre-pregnancy functional levels. Conclusions Interventions are needed to address household, social, and personal functioning in women with PPD. Clinicians may find functional assessment is a useful adjunct and a less threatening way to screen and monitor treatment for PPD.
Deficits in everyday living skills and social skills are associated with the pervasive disability seen in schizophrenia. Cognitive impairments are determinants of these skills deficits and it is known that positive and negative symptoms add to the influence of cognitive impairments for prediction of real-world outcomes. This study examined the relative importance of cognitive impairments measured with a neuropsychological battery, performance-based measures of social and everyday living skills, and positive and negative symptoms for the prediction of real-world outcomes in social and residential domains. In contrast to most previous studies, we examined the importance of individual symptoms, as well as total subscale scores, for predicting clinician rated outcomes in 194 older outpatients with schizophrenia. Symptoms were rated with the Positive and Negative Syndrome Scale; everyday living skills were measured by the UCSD Performance-based Skills Assessment; and social skills were measured with the Social Skills Performance Assessment. For prediction of real-world social outcomes, blunted affect and passive-apathetic social withdrawal accounted for all of the predicted variance, while social competence and cognitive impairments did not enter the final equation. For residential functioning, everyday living skills were the most important predictor, followed by lack of spontaneity. The positive symptoms of hallucinatory behavior and suspiciousness also predicted real-world residential outcomes. These results suggest that real-world disability is the product of a complex array of ability deficits and symptoms, indicating interventions will need to be carefully targeted. For social and everyday living outcomes, variance accounted for by the entire array of predictive variables was less than 40%, suggesting that other factors, such as social and cultural influences, are involved as well. PMID:19775869
Leifker, Feea R; Bowie, Christopher R; Harvey, Philip D
Sarcopenia is the loss of muscle mass and strength, which in the elderly can result in disability and affect functional outcomes after hospitalization. The aim of this study was to evaluate the functional outcomes and mortality during hospitalization and at three months post-discharge, according to the presence of sarcopenia. Prospective study of 99 patients (38.4% men, aged 84.6) admitted in a subacute geriatric care unit who underwent a rehabilitation intervention. Main outcomes were mortality and functional improvement at discharge and at three-month follow-up. Sarcopenia was assessed by handgrip strength (hydraulic dynamometer) and by body composition bioimpedance. Forty-six (46.5%) patients met diagnostic criteria of sarcopenia. Patients with sarcopenia had a worse prior functional status than those without the condition (Barthel Index: 64.2±22.8 vs 73.3±21.8; p=0.04) but both groups had similar functional decline at admission (Barthel Index: 24±15.1 vs 28.5±15.2; p=0.1) and achieved similar functional improvement at discharge (20.4±18.3 vs 27.4±21; p=0.08). Barthel Index at discharge remained comparatively worse in patients with sarcopenia (44.2±26.6 vs 55.9±26.7; p=0.03). After completing a 3-month at-home rehabilitation program, no changes in functional capacity were observed in patients with sarcopenia; their peers improved their Barthel Index scores (45.5±24.8 vs 61.6±26.6; p=0.007). Mortality rates at 3-month follow-up did not differ between groups. In conclusion, patients with sarcopenia had a worse functional status, similar functional improvement during hospitalization and a lack of recovery after returning home. Further studies are needed to establish long-terms effects on mortality. PMID:24726179
Sánchez-Rodríguez, Dolores; Marco, Ester; Miralles, Ramon; Fayos, Mónica; Mojal, Sergio; Alvarado, Martha; Vázquez-Ibar, Olga; Escalada, Ferran; Muniesa, Josep M
Background: Dual plate fixation in comminuted bicondylar tibial plateau fractures remains controversial. Open reduction and internal fixation, specifically through compromised soft tissues, has historically been associated with major wound complications. Alternate methods of treatment have been described, each with its own merits and demerits. We performed a retrospective study to evaluate the functional outcome of lateral and medial plate fixation of Schatzker type V and VI fractures through an anterolateral approach, and a medial minimally invasive approach or a posteromedial approach. Materials and Methods: We treated 46 tibial plateau fractures Schatzker type V and VI with lateral and medial plates through an anterolateral approach and a medial minimal invasive approach over an 8 years period. Six patients were lost to followup. Radiographs in two planes were taken in all cases. Immediate postoperative radiographs were assessed for quality of reduction and fixation. The functional outcome was evaluated according to the Oxford Knee Score criteria on followup. Results: Forty patients (33 men and 7 women) who completed the followup were included in the study. There were 20 Schatzker type V fractures and 20 Schatzker type VI fractures. The mean duration of followup was 4 years (range 1-8 years). All patients had a satisfactory articular reduction defined as ?2 mm step-off or gap as assessed on followup. All patients had a good coronal and sagittal plane alignment, and articular width as assessed on supine X-rays of the knee in the anteroposterior (AP) and lateral views. The functional outcome, as assessed by the Oxford Knee Score, was excellent in 30 patients and good in 10 patients. All patients returned to their pre-injury level of activity and employment. There were no instances of deep infection. Conclusions: Dual plate fixation of severe bicondylar tibial plateau fractures is an excellent treatment option as it provides rigid fixation and allows early knee mobilization. Careful soft tissue handling and employing minimal invasive techniques minimizes soft tissue complications.
Prasad, G Thiruvengita; Kumar, T Suresh; Kumar, R Krishna; Murthy, Ganapathy K; Sundaram, Nandkumar
Anthropometry and clinical examination best evaluate the morphology of repaired cleft lip and nose. An original, accurate, and practical image analysis of the lip and nose, which takes advantage of the mathematic, geometric, and organizational capabilities of public domain NIH-Image software (http://rsb.info.nih.gov/nih-image/), has been developed and tested over the past 6 years. A modified structured physical examination form that complements this analysis is under study. Accuracy of NIH-Image-based anthropometry was compared with direct measurements of 22 linear distances on the lip and nose. Twenty-five sets of direct measurements were taken, prospectively, on 15 children with repaired cleft lip over a 6-year period. The results were submitted to regression analysis. Then, relevant lip and nasal tip aesthetics were evaluated by the measuring capabilities of NIH-Image to create a quantitative assessment tool. For each episode, 15 possible faults were weighted, according to aesthetics and deformity, to provide an adverse score. The sum of the 5 lip scores, 10 nose scores, and combination gave respective grades. The analysis was modified to stratify congenital deformity to relate severity of disease to outcome. This analysis was applied to digitized images of 19 consecutive children, immediately prior to repair of complete unilateral cleft lip and nose, at the time of palate repair, and annually from the age of 3 to 6 years. There were 19 NIH-Image-based measurements of the congenital deformity and 35 measurements of surgical results; four children had three sets of records, eight had two sets, and seven had one set Descriptive statistics were applied. Following 556 paired direct and computer-assisted measurements, exceptional linear correlation was shown with a Pearson R coefficient of 0.96. The best correlation was lines within the plane of the camera lens, with the average difference ranging between 0.025 and 0.997 mm. Visual inspection of frontal and submental photographs of excellent, good, and poor results substantiates the ability of this analysis to quantify and grade a spectrum of relevant cleft lip and nasal anatomy. For these 19 patients, there was a broad range of performance scores, approximating a normal distribution. The mean of the NIH-Image-based analysis scores, 16.91, was a (very) good grade. A single standard deviation of 6.88 extended up into excellent and down to fair. The congenital analysis indicated a range of deformity. Comparing deformity with outcome, simple regression analysis had a coefficient of determination (R2) of 0.223, indicative of a weak positive relationship. An accurate and practical morphologic computer-assisted outcome assessment of repaired cleft lip and nasal deformity has been developed. There is a weak direct correlation between severity of deformity and outcome. Testing in multiple clinics is warranted. PMID:10323693
Hurwitz, D J; Ashby, E R; Llull, R; Pasqual, J; Tabor, C; Garrison, L; Gillen, J; Weyant, R
A sample of Chinese children in Shanghai, People’s Republic of China, initially aged 8 and 10 years, participated in this four-year longitudinal project. Information on social functioning including sociability-leadership, aggression-disruption, and shyness-sensitivity was collected from peer assessments in the original study. Data on indexes of social and school adjustment, including peer acceptance, teachers’ perceptions of school-related competence, leadership, academic achievement,
Xinyin Chen; Kenneth H. Rubin; Bo-shu Li; Dan Li
Communication abnormalities are hallmark features of schizophrenia. Despite the prevalence and persistence of these symptoms, little is known about their functional implications. In this study, we examined, in a sample of chronically institutionalized schizophrenia patients (N=317), whether two types of communication abnormalities (i.e., verbal underproductivity and disconnected speech) had differential relationships with social and adaptive outcomes. Baseline ratings of verbal underproductivity, disconnected speech, global cognitive performance, and clinical symptoms, were entered into stepwise regression analyses to examine their relationship with 2.5 year social and adaptive outcomes. At baseline, disconnected speech was significantly associated with socially impolite behavior, while verbal underproductivity was associated with social disengagement and impaired friendships. Both types of communication abnormalities were significantly associated with other types of social skills. Verbal underproductivity predicted follow-up social skills, social engagement, and friendships, accounting for more variance than cognition or symptoms. In contrast to social outcomes, adaptive outcomes were predicted by baseline neurocognition and clinical symptoms, but not communication abnormalities. These findings provide evidence for specific relationships of communication disorder subtypes with diverse impairments in social functions. In this chronically institutionalized sample, communication disorder was a stronger predictor of social, but not adaptive, outcomes than neurocognition or clinical symptoms.
Bowie, Christopher R.; Harvey, Philip D.
There is a lack of biomarkers in schizophrenia and the mechanisms underlying the observed deficits in social functioning are poorly understood. This cohort study aimed to explore whether neurotransmitter neuropeptide Y (NPY) in cerebrospinal fluid (CSF) from patients with schizophrenia is correlated to social function and clinical variables. A further aim was to determine whether baseline levels of NPY were associated with subsequent 3-year outcome. Fifty-six consecutively admitted patients with schizophrenia were included and underwent lumbar puncture and symptom ratings before antipsychotic treatment. NPY levels in CSF were determined by radioimmunoassay. Social function (Social Competence and Social Interest) was assessed by Nurses' Observation Scale for Inpatient Evaluation while psychiatric symptoms were rated using the Comprehensive Psychopathological Rating Scale. Three-year outcome was assessed with the Strauss-Carpenter Outcome Scale. Cross-sectional analysis showed a correlation between level of NPY and Social Competence at index admission (r(s)=0.37, p<0.05). The longitudinal analysis (i.e., at the 3-year follow-up) indicated that, for each standard deviation increase in baseline NPY, there was an increased risk of being unemployed (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.07-3.82), having moderate or severe symptoms (OR 3.09, CI 1.30-7.32) or being hospitalized at least 6 months the previous year (OR 3.24, CI 1.09-9.64). However, NPY was not correlated to Social Interest or clinical variables at index admission. In conclusion, NPY levels in CSF are correlated to Social Competence and seem to predict some aspects of longitudinal outcome in schizophrenia. PMID:24799298
Stålberg, Gabriella; Ekselius, Lisa; Lindström, Leif H; Larhammar, Dan; Bodén, Robert
Post-traumatic hypopituitarism (PTHP) has been linked to disability and decreased quality of life. However, no studies have addressed the long-term consequences of PTHP in adults with severe traumatic brain injury (TBI) only. In this study, we evaluated the relationship between pituitary function, quality of life, and functioning in 51 patients (16-65 years of age) with severe TBI who were admitted to Sahlgrenska University Hospital, Gothenburg from 1999 to 2002. The patients were assessed once, 2-10 years after trauma. Data from the time of injury were collected retrospectively to adjust for injury severity. Outcome measures included hormonal testing, the Short Form-36 Health Survey, the Glasgow outcome scale-extended, and a self-report questionnaire specifically designed for this study and based on the International Classification of Functioning, Disability and Health. Of 51 patients, 14 (27.5%) presented with PTHP, and 11 (21.6%) had isolated growth hormone deficiency. Patients with PTHP were more often overweight at follow-up (p=0.01); the higher body mass index was partially explained by PTHP (R2 change=0.07, p=0.001). Otherwise no significant correlation was found among PTHP, functioning, or patient-reported quality of life. This study-which is unique in the homogeneity of the patients, the long follow-up time, and the use of injury severity as an outcome predictor-did not confirm results from previous studies linking PTHP to a worse outcome. Therefore, screening for PTHP might be restricted to specific subgroups such as overweight patients, indicating growth hormone deficiency. PMID:23121499
Ulfarsson, Trandur; Arnar Gudnason, Gudni; Rosén, Thord; Blomstrand, Christian; Sunnerhagen, Katharina Stibrant; Lundgren-Nilsson, Asa; Nilsson, Michael
This article reports data from a large-scale assessment using the Family Outcomes Survey with families participating in early intervention. The study was designed to determine how families describe themselves with regard to outcomes achieved, the extent to which outcomes are interrelated, and the extent to which child, family, and program factors…
Raspa, Melissa; Bailey, Donald B., Jr.; Olmsted, Murrey G.; Nelson, Robin; Robinson, Nyle; Simpson, Mary Ellen; Guillen, Chelsea; Houts, Renate
Stereotype threat research shows that women's math performance can be reduced by activating gender-based math stereotypes. Models of stereotype threat assert that threat reduces cognitive functioning, thereby accounting for its negative effects. This work provides a more detailed understanding of the cognitive processes through which stereotype threat leads women to underperform at math and to take risks, by examining which basic executive functions (inhibition, shifting, and updating) account for these outcomes. In Experiments 1 and 2, women under threat showed reduced inhibition, reduced updating, and reduced math performance compared with women in a control condition (or men); however, only updating accounted for women's poor math performance under threat. In Experiment 3, only updating accounted for stereotype threat's effect on women's math performance, whereas only inhibition accounted for the effect of threat on risk-taking, suggesting that distinct executive functions can account for different stereotype threat-related outcomes. PMID:24345711
Rydell, Robert J; Van Loo, Katie J; Boucher, Kathryn L
The manual outlines a procedure for qualitatively assessing the functions and values of bottomland hardwoods (BLH). The procedure is based on the Wetland Evaluation Technique (WET) and is referred to as WET-BLH. Wetland functions are the physical, chemica...
P. R. Adamus R. D. Smith
In the present article, the authors want to present the results of a retrospectively evaluated consecutive series of patients with surgically treated isolated orbital floor fractures (OFF; "blow-out fractures") concerning the functional outcome after OFF and give detailed recommendations based on the clinical and radiological findings. A series of 60 patients with isolated OFF over a 5-year period needing surgically repair at the same institution were evaluated. Patient data were analysed in terms of preoperative and postoperative clinical parameters and radiological findings. The analysed parameters were type of fracture, diplopia, gaze restriction, enophthalmos, materials used for repair, surgical approach and timing of the surgical intervention. Burst type fractures were more often found than punched-out fractures. The most frequently used surgical approach was a preseptal transconjunctival approach. An overall decrease of gaze restriction (93%), diplopia (89%) and enophthalmos (86%) was observed. According to the fracture size, we used Ethisorb patches in smaller fractures and resorbable or titanium meshes or autologous bone in larger fractures in most cases. Patients who underwent surgery more than 7 days after the trauma showed better results with regard to an improvement of diplopia and motility disturbances than patients who were treated immediately. In indicated cases, the surgical repair of OFF leads to very good results if the anatomical and functional properties of the orbit and its contents are respected. The applied strategy and means presented in our study proved of value and can therefore be recommended. PMID:21858424
Poeschl, Paul W; Baumann, Arnulf; Dorner, Guido; Russmueller, Guenter; Seemann, Rudolf; Fabian, Ferenc; Ewers, Rolf
The Measurement and Treatment Research to Improve Cognition in Schizophrenia initiative was designed to encourage the development of cognitive enhancing agents for schizophrenia. For a medication to receive this indication, regulatory agencies require evidence of improvement in both cognition and functional outcome. Because medication trials are conducted across multiple countries, we examined ratings of the cross-cultural adaptability of 4 intermediate measures of functional outcome (Independent Living Scales, UCSD Performance-based Skills Assessment, Test of Adaptive Behavior in Schizophrenia, Cognitive Assessment Interview [CAI]) made by experienced clinical researchers at 31 sites in 8 countries. English-speaking research staff familiar with conducting medication trials rated the extent to which each subscale of each intermediate measure could be applied to their culture and to subgroups within their culture based on gender, geographic region, ethnicity, and socioeconomic status on the Cultural Adaptation Rating Scale. Ratings suggested that the CAI would be easiest to adapt across cultures. However, in a recent study, the CAI was found to have weaker psychometric properties than some of the other measures. Problems were identified for specific subscales on all the performance-based assessments across multiple countries. India, China, and Mexico presented the greatest challenges in adaptation. For international clinical trials, it would be important to use the measures that are most adaptable, to adapt subscales that are problematic for specific countries or regions, or to develop a battery composed of the subscales from different instruments that may be most acceptable across multiple cultures with minimal adaptation.
Rubin, Maureen; Fredrick, Megan M.; Mintz, Jim; Nuechterlein, Keith H.; Schooler, Nina R.; Jaeger, Judith; Peters, Nancy M.; Buller, Raimund; Marder, Stephen R.; Dube, Sanjay
The Measurement and Treatment Research to Improve Cognition in Schizophrenia initiative was designed to encourage the development of cognitive enhancing agents for schizophrenia. For a medication to receive this indication, regulatory agencies require evidence of improvement in both cognition and functional outcome. Because medication trials are conducted across multiple countries, we examined ratings of the cross-cultural adaptability of 4 intermediate measures of functional outcome (Independent Living Scales, UCSD Performance-based Skills Assessment, Test of Adaptive Behavior in Schizophrenia, Cognitive Assessment Interview [CAI]) made by experienced clinical researchers at 31 sites in 8 countries. English-speaking research staff familiar with conducting medication trials rated the extent to which each subscale of each intermediate measure could be applied to their culture and to subgroups within their culture based on gender, geographic region, ethnicity, and socioeconomic status on the Cultural Adaptation Rating Scale. Ratings suggested that the CAI would be easiest to adapt across cultures. However, in a recent study, the CAI was found to have weaker psychometric properties than some of the other measures. Problems were identified for specific subscales on all the performance-based assessments across multiple countries. India, China, and Mexico presented the greatest challenges in adaptation. For international clinical trials, it would be important to use the measures that are most adaptable, to adapt subscales that are problematic for specific countries or regions, or to develop a battery composed of the subscales from different instruments that may be most acceptable across multiple cultures with minimal adaptation. PMID:21134973
Velligan, Dawn I; Rubin, Maureen; Fredrick, Megan M; Mintz, Jim; Nuechterlein, Keith H; Schooler, Nina R; Jaeger, Judith; Peters, Nancy M; Buller, Raimund; Marder, Stephen R; Dube, Sanjay
Background It has been suggested that maternal vitamin D status in pregnancy influences the risk of asthma and atopy in the offspring. The epidemiological evidence to support these claims is conflicting and may reflect chance findings and differences in how vitamin D was assessed. Objective To examine the association between blood total maternal 25-hydroxy vitamin D (25(OH)D) concentrations in pregnancy and offspring asthma, atopy and lung function in the largest birth cohort study to date. Methods Participants were largely of white European origin and resident in the South West of England. We examined the associations of maternal 25(OH)D concentrations in pregnancy with the following outcomes in the offspring: wheeze, asthma, atopy, eczema, hayfever, at mean age 7.5 years (n = 3652–4696 depending on outcome), IgE at 7 years (n = 2915) and lung function and bronchial responsiveness at mean age 8.7 years (n = 3728–3784). Results Sixty-eight per cent of mothers had sufficient (> 50 nmol/L) concentrations of 25(OH)D, 27% were insufficient (27.5–49.99 nmol/L) and 5% were deficient (< 27.5 nmol/L). There was no evidence to suggest that maternal 25(OH)D concentration in pregnancy was associated with any respiratory or atopic outcome in the offspring. These findings remained after adjustment for season of measurement and for potential confounders. There was also no evidence that these relationships followed a non-linear form and no evidence that either deficient or high concentrations of maternal 25(OH)D were associated with atopic or respiratory outcomes. Conclusions We found no evidence that maternal blood 25(OH)D concentration in pregnancy is associated with childhood atopic or respiratory outcomes.
Wills, A K; Shaheen, S O; Granell, R; Henderson, A J; Fraser, W D; Lawlor, D A
Background It is unclear if volume-outcome relationships exist in inpatient rehabilitation. Objectives Assess associations between facility volumes and two patient-centered outcomes in the three most common diagnostic groups in inpatient rehabilitation. Research Design We used hierarchical linear and generalized linear models to analyze administrative assessment data from patients receiving inpatient rehabilitation services for stroke (n=202,423), lower extremity fracture (n=132,194), or lower extremity joint replacement (n=148,068) between 2006 and 2008 in 717 rehabilitation facilities across the U.S. Facilities were assigned to quintiles based on average annual diagnosis-specific patient volumes. Measures Discharge functional status (FIM instrument) and probability of home discharge. Results Facility-level factors accounted for 6–15% of the variance in discharge FIM total scores and 3–5% of the variance in home discharge probability across the 3 diagnostic groups. We used the middle volume quintile (Q3) as the reference group for all analyses and detected small, but statistically significant (p < .01) associations with discharge functional status in all three diagnosis groups. Only the highest volume quintile (Q5) reached statistical significance, displaying higher functional status ratings than Q3 each time. The largest effect was observed in FIM total scores among fracture patients, with only a 3.6-point difference in Q5 and Q3 group means. Volume was not independently related to home discharge. Conclusions Outcome-specific volume effects ranged from small (functional status) to none (home discharge) in all three diagnostic groups. Patients with these conditions can be treated locally rather than at higher-volume regional centers. Further regionalization of inpatient rehabilitation services is not needed for these conditions.
Graham, James E.; Deutsch, Anne; O'Connell, Ann A.; Karmarkar, Amol M.; Granger, Carl V.; Ottenbacher, Kenneth J.
Objective To evaluate whether early neurofunctional assessment may be useful in predicting neurodevelopmental outcome in children of very low birth weight (VLBW). Design Observational longitudinal study. Settings Northern Italy. Patients A total of 250 VLBW children (129 boys, 121 girls) born consecutively 1996–1999. Main outcome measures Neurodevelopment at 36?months of chronological age, classified in accordance with the classification of Tardieu and the International classification of functioning. Results Of the infants exhibiting normal neurodevelopment (n ?=? 183) or major dysfunction (n ?=? 17) at 3?months of corrected age, 72% and 94% respectively did not change their score during the study. Minor dysfunctions at 3?months of corrected age were transient in 17 (34%) children. After adjustment for neonatal variables, neurodevelopment at 3?months of corrected age remained predictive of dysfunction at 36?months (odds ratio ?=? 4.33, 95% confidence interval 2.05 to 9.12). If the results for the normal and minor dysfunction groups were pooled, the predictive qualities of the 3?month neurofunctional assessment were: sensitivity 0.5, specificity 0.99, positive predictive value 0.94, negative predictive value 0.93. Conclusion Early neurofunctional evaluation may be useful in predicting later neurodevelopmental outcome in VLBW children.
Picciolini, O; Gianni, M L; Vegni, C; Fumagalli, M; Mosca, F
Background 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. Methods/design In a randomized controlled trial (RCT) we will test the effect of a pre-operative neuromuscular trainingprogram versus an attention control program on lower extremity function – before and after surgery. We will enroll 80 participants, aged between 55–90 years, who are scheduled for TKR. In this single-blinded RCT, the intervention group will receive a minimum of 8 and a maximum of 24 training sessions plus 3 educational sessions of the knee school. The control group will receive the 3 educational sessions only. Assessments are performed immediately before and after the intervention (before surgery), at 6?weeks, 3?months and 12?months (after surgery). The primary outcome will include the Chair Stand Test as a measure of leg strength and reaction time. Secondary outcomes are knee function and pain assessed with the self-reported Knee Injury and Osteoarthritis Outcome Score (KOOS). All measurements will be carried out by a specially trained physical therapist, blinded to group allocation. Discussion To our knowledge this is the first single-blinded RCT to test the effect of pre-operative neuromuscular training plus knee school against knee school alone – on knee function and pain, assessed immediately after the interventions prior to surgery and repeatedly after surgery. Trial registration Clinical Trials NCT00913575
Assessment of higher order learning outcomes such as critical thinking, problem solving and creativity has remained a challenge for universities. While newer technologies such as social networking tools have the potential to support these intended outcomes, academics' assessment practice is slow to change. University mission statements and unit…
McNeill, Margot; Gosper, Maree; Xu, Jing
The assessment of higher-education student learning outcomes is an important component in understanding the strengths and weaknesses of academic and general education programs. This study illustrates the application of diagnostic classification models, a burgeoning set of statistical models, in assessing student learning outcomes. To facilitate…
Jurich, Daniel P.; Bradshaw, Laine P.
This paper describes the development of a comprehensive assessment instrument to examine the multiple outcomes of entrepreneurship education for engineering students. It is targeted at senior-level students enrolled in capstone engineering design courses and is part of a larger study intended to clarify the relationship between faculty beliefs and practices, program characteristics, and student outcomes. The assessment draws on survey
Nathalie Duval-Couetil; Teri Reed-Rhoads; Shiva Haghighi
Adverse outcome pathways (AOP) are used to describe the linkage of biological events from a molecular initiating point, to individual-level-endpoints relevant to risk assessment. This study was done to assess toxicity outcomes for the conazole fungicide propiconazole based on a p...
This investigation sought to operationalize a comprehensive theoretical model, the Trauma Outcome Process Assessment, and test it empirically with structural equation modeling. The Trauma Outcome Process Assessment reflects a robust body of research and incorporates known ecological factors (e.g., family dynamics, social support) to explain…
Borja, Susan E.; Callahan, Jennifer L.
The use of standardized tests for outcome assessment has grown dramatically in recent years. Two driving factors have been the No Child Left Behind legislation, and the increase in outcome assessment measures by accrediting agencies such as AACSB, the international accrediting body for business schools. Despite the growth in usage, little effort…
Wright, Robert E.
OBJECTIVESTo assess outcome after elective treatment for unruptured intracranial aneurysms.METHODSOf 193 consecutive patients with subarachnoid haemorrhage 626 first degree relatives (parents, siblings, children) were screened with magnetic resonance angiography. Subsequently, 18 relatives underwent elective angiography and operation. Outcome was assessed in terms of impairments (neurological examination), disabilities (Barthel index), handicaps (Rankin scale), and quality of life (sickness impact profile (SIP)
Theodora W M Raaymakers
The prognostic value of electromyography (EMG) and its significance to estimate facial function outcome after acute facial palsy is still unclear. We retrospectively analysed the EMG reports of 494 patients with acute facial palsy treated from 1995 to 2005 in a tertiary referral centre. Initial and final facial functions were assessed by the House-Brackmann (HB) scale. Serial EMG results were classified into neurapraxia, axonotmesis/neurotmesis, mixed lesion, complete recovery, defective healing, or not classifiable. Initial HB was II-IV in 321 patients and V-VI in 173 cases. The aetiology was idiopathic palsy in 294, iatrogenic lesion in 86, traumatic in 52, Herpes zoster in 37, and of various origin in 25 patients. EMG revealed neurapraxia in 300 patients, axonotmesis/neurotmesis in 95 patients, and mixed lesion in 23 cases. EMG was not meaningful in 76 patients. The follow-up time ranged from 0.3-264 months. Final EMG revealed a full recovery in 160 patients, whereas 219 patients showed signs of defective healing. In 155 patients, EMG was not significant to classify the final outcome. The predictive EMG value for poor outcome was 77-86% and for recovery 53%. The mean EMG recovery time was 2.3 months. Mean time for defective healing was 4.3 months. Final HB was normal (HB I) in 323 patients, HB II-IV in 115 patients, and V-VI in 46 patients. We conclude that EMG has a high predictive value for unfavourable outcome after acute facial palsy. EMG is more sensible to detect signs of defective healing than clinical evaluation of facial function. PMID:17611766
Grosheva, Maria; Guntinas-Lichius, Orlando
Background Although injuries due to circular saws are very common all over the world, there is surprisingly little information available about their functional outcomes. As the socioeconomic impact of these injuries is immense and determined by the casualties' disability and impairment, it is the objective of this study to present data on the functional outcome, disability, and impairment of hand injuries due to electric circular saws. Methods Patients treated from 1999 through 2007 for circular saw-related hand injuries were contacted and asked for clinical follow-up assessment. The clinical follow-up protocol consisted of a physical examination and an assessment of static muscle power (grip and pinch strength). For assessment of the subjective experience of the patients regarding their injury-related disability and impairment, the DASH follow-up questionnaire was used. The occupational impact of these injuries was measured by number of lost working days. Finally, safety-related behaviour of the patients was investigated. Results 114 Patients were followed-up on average 52 months after the injury. Average in-house treatment was 8.8 days. Average time lost from work was 14.8 weeks. A significant reduction of static muscle testing parameters compared with the uninjured hand was revealed for grip strength, tip pinch, key pinch, and palmar pinch. Average DASH score was 17.4 (DASH work 15.8, DASH sports/music 17.7). Most patients had more than ten years experience in using these power tools. Conclusion The everyday occurrence of circular saw-related hand injuries followed by relatively short periods of in-house treatment might distort the real dimension of the patients' remaining disability and impairment. While the trauma surgeon's view is generally confined to the patients' clinical course, the outcome parameters in this follow-up investigation, with loss of working time as the key factor, confirm that the whole socioeconomic burden is much greater than the direct cost of treatment.
Background Thyroid-stimulating hormone (TSH) concentrations are frequently altered in acute ischemic stroke patients. It is becoming increasingly apparent that various hormones in the hypothalamus-pituitary-thyroid axis may be associated with functional stroke outcome. We have previously shown that white matter hyperintensities (WMH) of presumed vascular origin are strong indicators of functional outcome. It is unclear whether an association exists between WMH and TSH. We therefore sought to determine whether TSH levels, measured in acute ischemic stroke patients, are associated with WMH and functional outcome. Methods We analyzed all first ischemic stroke patients who participated in the Berlin ‘Cream & Sugar’ Study (NCT 01378468) and completed a 1-year follow-up assessment from January 2009 to March 2013. Patients were stratified into 3 groups: (1) low TSH (0.1-0.44 ?U/ml); (2) normal TSH (0.44-2.5 ?U/ml), and (3) high TSH (2.5-20 ?U/ml). WMH were assessed using the Fazekas and Wahlund visual rating scales. Functional outcome was assessed using the modified Rankin Scale and was performed via telephone at 1 year by a certified rater. Results 183 patients were included [median age 66, interquartile range (IQR) 54-75; 33% females; median National Institute of Health Stroke Scale 3, IQR 1-4, range 0-24]. Venous samples were collected a median of 4 days (IQR 3-5) following initial symptom onset between 8 and 9 a.m. following a 10-hour fast. Patients with normal TSH levels (n = 132; 72%) had significantly higher rates of prestroke diabetes than patients with high TSH levels (normal TSH 17%; high TSH 1%; p = 0.03). Additionally, patients with normal TSH levels tended to have higher estimated glomerular filtration rates than patients with high and low TSH concentrations (normal TSH median estimated glomerular filtration rates: 83 ml/min/1.73 m2; high TSH median estimated glomerular filtration rates: 76 ml/min/1.73 m2; low TSH median: 78 ml/min/1.73 m2; p = 0.068). Logistical regression analysis force-adjusted for age (quartiles), NIHSS (quartiles), prestroke diabetes status, and stroke subtype revealed significant associations between WMH and TSH [Wahlund scores: odds ratio 2.547, 95% confidence interval (CI) 1.159-5.598, p = 0.020; Fazekas scores: odds ratio 2.530, 95% CI 1.115-5.741, p = 0.003]. Functional outcome was not significantly associated with TSH levels in univariate or multivariate models. Conclusion TSH levels are independently associated with WMH in acute ischemic stroke patients. Based on our findings, we cannot recommend assessing TSH to estimate the 1-year functional outcome following ischemic stroke.
Leonards, Christopher O.; Schneider, Harald J.; Liman, Thomas G.; Fiebach, Jochen B.; Endres, Matthias; Ebinger, Martin
Objective Cognitive deficits are associated with disability in people with schizophrenia so treatment of cognitive impairment has been proposed as an intervention to reduce disability. However, studies relying on patient self-report have found very minimal relationships between ratings of real-world functioning and cognitive performance, raising questions about the measurement of real-world functioning as a treatment outcome. The Validation of Everyday Real-world Outcomes (VALERO) study was conducted to evaluate functional rating scales and to identify the rating scale or scales most robustly related to performance-based measures of cognition and everyday living skills. Method 198 adults with schizophrenia were tested with the neurocognitive measures from the MATRICS Consensus cognitive Battery and performed the UCSD performance-based skills assessment-Brief and advanced finances subtest from the Everyday Functioning Battery. They and a friend, relative, clinician, or case manager also reported their everyday functioning on 6 ratings scales: Social Behavior Schedule, Social Adjustment Scale, Heinrichs Carpenter Quality of Life Scale, Specific Levels of Functioning, Independent Living skills Survey, and Life Skills Profile. Best judgment ratings were generated by an interviewer who administered the rating scales to patients and informants. Results Statistical analyses developed an ability latent trait that reflected scores on the three performance-based (i.e., ability) measures and canonical correlation analysis related interviewer ratings to the latent trait. The overall fit of the model with all six rating scales was good: ?2 = 78.100, df = 56, p = .027, and RMSEA = .078. Individual rating scales that did not improve the fit of the model were systematically deleted and a final model with two rating scales fit the data: ?2 = 32.059, df = 24, p = .126, RMSEA = .072. A regression analysis found that the Specific Levels of Functioning was a superior predictor of the three-performance based ability measures. Conclusions We found that systematic assessments of real world functioning are related to performance on neurocognitive and functional capacity measures. Of the six rating scales evaluated, the Specific Levels of Functioning (SLOF) was best in this study. Use of a single rating scale provides a very efficient assessment of real-world functioning that accounts for considerable variance in performance-based scores.
Harvey, Philip D.; Raykov, Tenko; Twamley, Elizabeth; Vella, Lea; Heaton, Robert K.; Patterson, Thomas L.
Health-related quality of life (HRQOL) is an important outcome in pediatric epilepsy surgery, but there are few studies that utilize presurgical ratings to assess the effect of surgery on HRQOL. We collected parental ratings on the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 28 children who participated in neuropsychological assessment before and after epilepsy surgery. Our results revealed significant improvements in overall HRQOL after surgery, especially in physical and social activities. These changes were apparent despite generally unchanged intellectual and psychological functioning. Children with better seizure outcome had more improvement in HRQOL; however, improvements were not statistically different among children with Engel class I, II, and III outcomes. Our results suggest that children can experience significant improvements in HRQOL following epilepsy surgery even when neuropsychological functioning remains unchanged. Moreover, improvements in HRQOL appear evident in children who experience any worthwhile improvement in seizure control (Engel class III or better). PMID:23631952
Titus, Jeffrey B; Lee, Amy; Kasasbeh, Aimen; Thio, Liu Lin; Stephenson, Jennifer; Steger-May, Karen; Limbrick, David D; Smyth, Matthew D
Objective: C-reactive protein, a well known marker of inflammation is being investigated as a probable marker of predicting acute cardiovascular events and its severity. The aim of the present study was to assess the possible role of highly-sensitivity C-reactive protein (hs-CRP) in predicting short-term functional outcome of ischemic stroke. Methodology: A prospective study was conducted on subjects admitted with first attack of confirmed ischemic stroke. It included 50 male and 52 female. Serum hs-CRP was measured in the 2(nd) (CRP-D2) and 5(th) days (CRP-D5) post-stroke. Modified Rankin scale (MRS) was measured in all subjects in the 2(nd) (MRS-D2), 5(th) days (MRS-D5) and also 3 month (MRS-M3) after stroke to assess the short-term functional outcome and mortality of subjects. Results: The mean age of the patients was 71.75±11.44 years. The mortality rate was 47.1% in the third months after stroke. There was no significant correlation between CRP-D2 and MRS-M3 and also between CRP-D5 and MRS-M3 (P>0.05). However there was a significant association between high CRP-D2 (CRP>3) and MRS-M3 and also between high CRP-D5 and MRS-M3 (P<0.005). Conclusion: This study showed that the value of CRP by itself could not predict the severity of short-term functional disability and it might not be useful as a clinical tool for predicting outcome. PMID:24353532
Taheraghdam, Aliakbar; Aminnejad, Siamak; Pashapour, Ali; Rikhtegar, Reza; Ghabili, Kamyar
Objective: C-reactive protein, a well known marker of inflammation is being investigated as a probable marker of predicting acute cardiovascular events and its severity. The aim of the present study was to assess the possible role of highly-sensitivity C-reactive protein (hs-CRP) in predicting short-term functional outcome of ischemic stroke. Methodology: A prospective study was conducted on subjects admitted with first attack of confirmed ischemic stroke. It included 50 male and 52 female. Serum hs-CRP was measured in the 2nd (CRP-D2) and 5th days (CRP-D5) post-stroke. Modified Rankin scale (MRS) was measured in all subjects in the 2nd (MRS-D2), 5th days (MRS-D5) and also 3 month (MRS-M3) after stroke to assess the short-term functional outcome and mortality of subjects. Results: The mean age of the patients was 71.75±11.44 years. The mortality rate was 47.1% in the third months after stroke. There was no significant correlation between CRP-D2 and MRS-M3 and also between CRP-D5 and MRS-M3 (P>0.05). However there was a significant association between high CRP-D2 (CRP>3) and MRS-M3 and also between high CRP-D5 and MRS-M3 (P<0.005). Conclusion: This study showed that the value of CRP by itself could not predict the severity of short-term functional disability and it might not be useful as a clinical tool for predicting outcome.
Taheraghdam, Aliakbar; Aminnejad, Siamak; Pashapour, Ali; Rikhtegar, Reza; Ghabili, Kamyar
Objective To evaluate the functional and oncologic outcomes of transoral laser microsurgery (TLM) in patients with previously untreated supraglottic carcinoma compared with salvage cases after radiation-based treatment. Methods We conducted a retrospective case-control study at a single academic tertiary care institution. Functional outcomes were stratified by prior radiation, and assessed at baseline, <1 week postoperatively, and last follow-up. Results Five patients underwent TLM for previously untreated disease and five previously radiated patients underwent salvage TLM for local failure. No patient required tracheostomy. There was no local recurrence after TLM as primary therapy and none required radiotherapy. One salvage patient developed local recurrence. Length of feeding tube dependence (p=0.049) and rates of chronic aspiration (>1 month postoperatively, p=0.048) were significantly higher in salvage TLM cases compared with previously untreated cases. Median PSS-HN Understandability of Speech scores were 75 (“usually understandable”) in the salvage group compared with 100 (“always understandable”) in the previously untreated group. Conclusions Both local control and function were superior in previously untreated patients compared with salvage patients. Our findings provide support for the use of TLM as a primary treatment modality for selected supraglottic carcinomas, but also suggest a potential for functional recovery in both previously untreated and salvage cases.
Hutcheson, Katherine A.; Jantharapattana, Kitti; Barringer, Denise A.; Lewin, Jan S.; Holsinger, F. Christopher
Fifty-seven patients underwent shoulder arthrodesis with a single plate. The technique utilized included both glenohumeral and acromiohumeral arthrodesis. A 10-hole plate was used for internal fixation. The position utilized was 30° abduction, 30° internal rotation, and 30° flexion. Forty-six patients underwent the procedure for brachial plexus injury, six patients for multidirectional shoulder instability, two patients for osteoarthritis, two patients for failed total shoulder arthroplasties, and one for infection. The patients were independently reviewed by a research clinician and their function assessed according to their ability to perform activities of daily living, subjective satisfaction with the procedure, and the degree of pain they felt in their shoulder. Fifty-four shoulders fused within 10° of the desired position. Three patients required secondary bone grafting. The complication rate was 14%. Patient satisfaction was highest in those patients undergoing the procedure for brachial plexus injury, osteoarthritis, and failed total shoulder arthroplasty (p = 0.0046). Four patients with multidirectional shoulder instability continued to complain of instability in spite of solid arthrodesis (p < 0.01). The difference in the cumulative activities of daily living score between the brachial plexus injury and poor hand function group and the multidirectional shoulder instability group and patients with other diagnoses was significant (p = 0.0001). Preoperative diagnosis, hand function, and work status were significant determinants of patient satisfaction and the cumulative activities of daily living score (p = 0.0001). PMID:22959501
Richards, R R; Beaton, D; Hudson, A R
Introduction Obesity rates continue to rise and more total hip arthroplasty procedures are being performed in progressively younger, obese patients. Hence, maintenance of long term physical function will become very important for quality of life, functional independence and hip prosthesis survival. Presently, there are no reviews of the long term efficacy of total hip arthroplasty on physical function. This review: 1) synopsized available data regarding obesity effects on long term functional outcomes after total hip arthroplasty, and 2) suggested future directions for research. Methods A literature search was conducted from 1965 to January of 2011 for studies that evaluated long term functional outcomes at one year or longer after THA in obese (body mass index values ?30?kg/m2) and non-obese patients (body mass index <30?kg/m2). Results Five retrospective studies and 18 prospective studies were identified as those that assessed physical function before surgery out to???one year after total hip arthroplasty. Study sample sizes ranged from 108–18,968 and followed patients from one to twenty years. Total hip arthroplasty confers significant pain reduction and improvement in quality of life irrespective of body mass index. Functional improvement occurred after total hip arthroplasty among all studies, but obese patients generally did not attain the same level of physical function by the follow-up time point. Discussion Uncontrolled obesity after total hip arthroplasty is related to worsening of comorbidities and excessive health care costs over the long term. Aggressive and sustainable rehabilitation strategies that include physical exercise, psychosocial components and behavior modification may be highly useful in maximizing and maintaining weight loss after total hip arthroplasty.
This prospective cross-sectional multicenter study assessed the relationships between Gross Motor Function Classification System (GMFCS) level and scores on outcome tools used in pediatric orthopedics. Five hundred and sixty-two participants with cerebral palsy (CP; 339 males, 223 females; age range 4-18y, mean age 11y 1mo [SD 3y 7mo]; 400 with diplegia, 162 with hemiplegia; GMFCS Levels I-III;) completed the study. The Functional Assessment Questionnaire (FAQ), Gross Motor Function Measure (GMFM) Dimensions D and E, Pediatric Quality of Life Inventory (PedsQL), the Pediatric Outcomes Data Collection Instrument (PODCI), Pediatric Functional Independence Measure (WeeFIM), temporal-spatial gait parameters, and O(2) cost were collected during one session. Descriptive characteristics are reported by GMFCS level clinicians can use for comparison with individual children. Tools with a direct relationship between outcome scores and GMFCS levels were the PODCI Parent and Child Global Function, Transfers & Basic Mobility, and Sports and Physical Function; PODCI Parent Upper Extremity Function; WeeFIM Self-care and Mobility; FAQ Question 1; GMFM Dimensions D and E; GMFM-66; O(2) cost; and temporal-spatial gait parameters. Child report scores differed significantly higher than Parent scores for six of eight PODCI subscales and three of four PedsQL dimensions. Children classified into different GMFCS levels function differently. PMID:17355472
Oeffinger, Donna; Gorton, George; Bagley, Anita; Nicholson, Diane; Barnes, Douglas; Calmes, Janine; Abel, Mark; Damiano, Diane; Kryscio, Richard; Rogers, Sarah; Tylkowski, Chester
Physical therapy intervention for children with cerebral palsy (CP) is focused on reducing neurological impairments, improving strength, and preventing the development of secondary impairments in order to improve functional outcomes. However, relationship between motor impairments and functional outcome has not been proved definitely. This study…
Park, Eun-Young; Kim, Won-Ho
Background The aim of the study was to review the degree to which the long-term outcome and ongoing morbidity in Currarino syndrome (CS)\\u000a has been established.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Analysis of previously published reports that have included long-term outcome data in CS and review of five additional patients\\u000a with CS.\\u000a \\u000a \\u000a \\u000a \\u000a Results Overall, long-term outcomes of children born with CS are not well described. Malignancy has
Atsushi Yoshida; Kiki Maoate; Russell Blakelock; Stephen Robertson; Spencer Beasley
Neurologic manifestations are prominent characteristic of West Nile virus (WNV) infection. The aim of this article was to describe neurological manifestations in patients with WNV neuroinvasive disease and their functional outcome at discharge in the first human outbreak of WNV infection in Serbia. The study enrolled patients treated in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia in Belgrade, with serological evidence of acute WNV infection who presented with meningitis, encephalitis and/or acute flaccid paralyses (AFP). Functional outcome at discharge was assessed using modified Rankin Scale (mRS) and Barthel index. Fifty-two patients were analysed. Forty-four (84.6 %) patients had encephalitis, eight (15.4 %) had meningitis, and 13 (25 %) had AFP. Among patients with AFP, 12 resembled poliomyelitis and one had clinical and electrodiagnostic findings consistent with polyradiculoneuritis. Among patients with encephalitis, 17 (32.7 %) had clinical signs of rhombencephalitis, and eight (15.4 %) presented with cerebellitis. Respiratory failure with subsequent mechanical ventilation developed in 13 patients with WNE (29.5 %). Nine (17.3 %) patients died, five (9.6 %) were functionally dependent (mRS 3-5), and 38 (73.1 %) were functionally independent at discharge (mRS 0-2). In univariate analysis, the presence of AFP, respiratory failure and consciousness impairment were found to be predictors of fatal outcome in patients with WNV neuroinvasive disease (p < 0.001, p < 0.001, p = 0.018, respectively). The outbreak of human WNV infection in Serbia caused a notable case fatality ratio, especially in patients with AFP, respiratory failure and consciousness impairment. Rhombencephalitis and cerebellitis could be underestimated presentations of WNV neuroinvasive disease. PMID:24687895
Popovic, Natasa; Milosevic, Branko; Urosevic, Aleksandar; Poluga, Jasmina; Popovic, Nada; Stevanovic, Goran; Milosevic, Ivana; Korac, Milos; Mitrovic, Nikola; Lavadinovic, Lidija; Nikolic, Jelena; Dulovic, Olga
Background Analyzing the neuronal organizational structures and studying the changes in the behavior of the organism is key to understanding cognitive functions of the brain. Although some studies have indicated that spatiotemporal firing patterns of neuronal populations have a certain relationship with the behavioral responses, the issues of whether there are any relationships between the functional networks comprised of these cortical neurons and behavioral tasks and whether it is possible to take advantage of these networks to predict correct and incorrect outcomes of single trials of animals are still unresolved. Methodology/Principal Findings This paper presents a new method of analyzing the structures of whole-recorded neuronal functional networks (WNFNs) and local neuronal circuit groups (LNCGs). The activity of these neurons was recorded in several rats. The rats performed two different behavioral tasks, the Y-maze task and the U-maze task. Using the results of the assessment of the WNFNs and LNCGs, this paper describes a realization procedure for predicting the behavioral outcomes of single trials. The methodology consists of four main parts: construction of WNFNs from recorded neuronal spike trains, partitioning the WNFNs into the optimal LNCGs using social community analysis, unsupervised clustering of all trials from each dataset into two different clusters, and predicting the behavioral outcomes of single trials. The results show that WNFNs and LNCGs correlate with the behavior of the animal. The U-maze datasets show higher accuracy for unsupervised clustering results than those from the Y-maze task, and these datasets can be used to predict behavioral responses effectively. Conclusions/Significance The results of the present study suggest that a methodology proposed in this paper is suitable for analysis of the characteristics of neuronal functional networks and the prediction of rat behavior. These types of structures in cortical ensemble activity may be critical to information representation during the execution of behavior.
Lu, Hu; Yang, Shengtao; Lin, Longnian; Li, Baoming; Wei, Hui
We evaluated the utility of an assessment for identifying tasks for the functional analysis demand condition with 4 individuals who had been diagnosed with autism. During the demand assessment, a therapist presented a variety of tasks, and observers measured problem behavior and compliance to identify demands associated with low levels of…
Roscoe, Eileen M.; Rooker, Griffin W.; Pence, Sacha T.; Longworth, Lynlea J.
We aimed to validate a more rapid, yet reliable means of assessing physical function (PF) for patients with prostate cancer. The sample included 128 prostate cancer patients recruited from urology and general oncology clinics at two Chicago-area hospitals. The main outcome measures were: A 36-item PF item bank that included a 5-item short form (BriefPF) and the 10-item PF subscale (PF-10) from the Medical Outcomes Study SF-36. Validity, information function, and relative precision (calculated using Rasch analysis and raw scores) of the BriefPF were compared to the PF-10 and the full PF item bank. We found that the BriefPF and PF-10 were strongly correlated (r = 0.85) with the PF bank, and all three scales differentiated patients according to performance status (FPF bank(2,124) = 32.51 P < 0.001, FPF-10(2,121) = 27.35 P < 0.001, FBriefPF (2,123) = 38.40 P < 0.001). BriefPF has excellent precision relative to the PF-10 in measuring patients with different performance status levels. The Rasch-based information function indicated that the BriefPF was more informative than PF-10 in measuring moderate to higher functioning patients. Hence, the BriefPF offers a parsimonious and precise measure of PF for use among men with prostate cancer, and may aid in the timely inclusion of patient-reported outcomes in treatment decision-making.
Lai, Jin-Shei; Bode, Rita; Wee, Hwee-Lin; Eton, David; Cella, David
This paper presents the development and the use of performance criteria that could be used for detailed assessment of specific students performance in the program outcomes listed for Engineering programs (EAC Criterion 3, a-k outcomes), Engineering Technology programs (TAC Criterion 2, a-k outcomes) and Computer Science programs (CAC criterion 1, a-i outcomes). Performance criteria have been used to break down each program outcome into concrete measurable actions students are expected to be able to perform to demonstrate proficiency in the outcome. For each of the listed outcomes for the ABET Accreditation bodies, detailed performance criteria are presented in this paper. Suggestions on how the performance criteria can be used in a program are described in detail to allow selective adoption of the performance criteria for different programs and for different courses. The methodology for defining and using the performance criteria enables faculty to (1) fully understand the outcomes, (2) understand a range of performance criteria that need to be measured for each outcome, and (3) remove any ambiguity in the interpretation of the outcomes. In addition, it makes it possible to identify the critical skill-sets to measure for each outcome and makes assessment meaningful to the various programs.
Background Treadmill walking is commonly used to evaluate walking impairment and efficacy of treatment for intermittent claudication (IC) in clinical and research settings. Although this is an important measure, it does not provide information about how patients perceive the effects of their treatments on more global measures of health-related quality of life (HRQOL). Methods PubMed/Medline was searched to find publications about the most commonly used questionnaires to assess functional status and/or general and disease-specific HRQOL in patients with PAD who experience IC. Inclusion criteria for questionnaires were based on existence of a body of literature in symptomatic PAD. Results Six general questionnaires and 7 disease-specific questionnaires are included with details about the number of domains covered and how each tool is scored. The Medical Outcomes Study Short Form 36 item questionnaire and Walking Impairment Questionnaire are currently the most used general and disease-specific questionnaires at baseline and following treatment for IC, respectively. Conclusions The use of tools which assess functional status and HRQOL has importance in both the clinical and research areas to assess treatment efficacy from the patient perspective. Therefore, assessing HRQOL in addition to treadmill-measured walking ability provides insight as to effects of treatments on patient outcomes and may help guide therapy.
Mays, Ryan J.; Casserly, Ivan P.; Kohrt, Wendy M.; Ho, P. Michael; Hiatt, William R.; Nehler, Mark R.; Regensteiner, Judith G.
Objective: Although a staged Fontan strategy allows for an excellent outcome in high-risk patients, an impaired ventricular function remains a significant factor of early\\/late mortality and morbidity. This study evaluated the clinical outcome of the Fontan operation in patients with impaired ventricular function. Methods: A retrospective review was performed on 217 patients who had undergone the Fontan operation between 1991
Yasuhiro Kotani; Shingo Kasahara; Yasuhiro Fujii; Ko Yoshizumi; Yu Oshima; Shin-ichi Otsuki; Teiji Akagi; Shunji Sano
While research on portfolio assessment (PA) has focused largely on the summative aspects of writing assessment, not much has been done to find out its formative potential. Drawing upon student questionnaires and student and teacher interview data, this paper aims to explore the formative functions of PA and, specifically, how the formative…
Lam, Ricky; Lee, Icy
One-hundred seventy-three studies that employed functional assessment were evaluated with respect to types of challenging behaviors studied and the functions identified that maintained those behaviors. For most studies, two to three behaviors were targeted. Of the 38 different challenging behaviors identified, self-injurious behavior (SIB) and…
Matson, Johnny L.; Sipes, Megan; Horovitz, Max; Worley, Julie A.; Shoemaker, Mary E.; Kozlowski, Alison M.
This review examined differences in functional outcomes and patient satisfaction when shortened dental arches are left untreated compared to their restoration to complete arch lengths with different prosthodontic interventions. Methods A protocol was developed according to the criteria for a systematic review. All relevant databases were searched to identify appropriate clinical trials regardless of language or publication status. Predetermined eligibility criteria were applied, trial quality assessed and data extracted for each study. Relevant outcomes assessed were: functioning ability, patient satisfaction and harmful effects on oral structures. Results Searches yielded 101 articles: 81 from electronic databases and 20 from reference lists of retrieved articles (PEARLing searches). Sixty-nine citations were assessed for eligibility after removing 32 duplicate records. After reading titles and abstracts, a total of 41 records were excluded and the full-texts of the remaining 28 records were read. Only 21 records were included for the SR because 7 records were excluded after reading the full-text reports. These 21 records report the outcomes of four randomized controlled trials (RCTs) and one non-randomized clinical trial (CT) which were pre-specified and used for this review. No on-going studies were found and no eligible studies were excluded for failure to report the reviewer’s pre-specified outcomes. Outcomes were reported in the retrieved 21 articles. A narrative explanation of the pre-specified outcomes is reported for the 3 comparison groups (which were based on the different interventions used for the individual clinical trials). The shortened dental arch as a treatment option is encouraging in terms of functioning, patient satisfaction and cost-effectiveness. By using only high quality studies it was expected that the results would be more reliable when making conclusions and recommendations, but some of the included studies had to be downgraded due to methodological errors.
Khan, Saadika; Musekiwa, Alfred; Chikte, Usuf M. E.; Omar, Ridwaan
Authors of paper present distant functional outcomes of treatment and physiotherapy of tibial eminence fractures basing on clinical material covering years from 1998 to 2006, that make up 15 patients, 7 women (46.7%) and 8 men (53.3%), aged between 18 and 57 years, on average 37.5-years-old. Subject fractures ware classified basing on Meyers i McKeever criteria, however obtained outcomes basing on IKDC (International Knee Documentation Committee) system. Obtained outcomes persuade authors to standpoint, that inoperative treatment of fractures type I leads to good functional outcomes, operative treatment of fracture type II leads to good functional outcomes too and operative treatment of fracture type III and III+ leads to sufficient outcomes. PMID:20201332
Nowak, Sebastian; Golec, Edward; Golec, Joanna; Szczygie?, Elzbieta; Ciszek, Elzbieta; Walocha, Jerzy; Mizia, Ewa
A survey of academic and administrative staff involved in budgeting in four small-to-medium Ontario universities gathered information on budgeting attitudes as they relate to content, context, process, environmental outcomes, and personal factors. Differences between administrators and faculty were also investigated. (MSE)
Schell, Bernadette; Tarnopolsky, Debra
A decision maker may experience regret when a choice he makes results in a more adverse outcome than a different choice would have yielded. Analogously, he may experience rejoice when his choice resulted in better outcomes. We used fMRI to investigate the neural correlates of regret and rejoice where payoffs are in terms of a non-monetary medium. Incentives were created using painful outcomes in the form of mild electrical shocks to the foot and the possibility of avoiding them. We hypothesized that the neural response to a painful outcome resulting from an individual’s choice would also reflect the degree of regret as measured by the likelihood that alternative choices would have yielded the same adverse outcome. Similarly, when an individual avoids a potential shock, he would experience a degree of rejoice that correlates with the probability he had of receiving the shock. For example, winning a bet when winning was unlikely, even if the outcome is the same, evokes more rejoice than winning when it was highly probable. Our results suggest that activation of a cortical network, consisting of the medial orbitofrontal cortex, left superior frontal cortex, right angular gyrus, and left thalamus, correlates with the degree of regret. A different network, including the rostral anterior cingulate, left hippocampus, left ventral striatum, and brainstem/midbrain correlated with rejoice. The right inferior orbitofrontal cortex, pre-supplementary motor area, anterior cingulate, and posterior cingulate showed similar patterns of activation with both regret and rejoice, suggesting that these regions may be associated with surprise from the realization of relatively unlikely events. Our results suggest that distinct, but overlapping networks are involved in the experiences of regret and rejoice.
Chandrasekhar, Pammi V.S.; Capra, C. Monica; Moore, Sara; Noussair, Charles; Berns, Gregory S.
This manual outlines a procedure for qualitatively assessing the functions and values of bottomland hardwoods (BLH). he procedure is based on the Wetland Evaluation Technique (WET) and for this reason is referred to as WET-BLH. etland functions are the physical, chemical, and bio...
Discusses the need to examine effectiveness of services to children and families in central and eastern Europe, focusing on programs in Hungary. Notes that financial considerations and differences in objectives have increased the importance of outcomes measurement. Reports that the pilot implementation of "Looking After Children" materials…
Purpose – The objective of this empirical study is to apply the methodology commonly used to performance appraisal and examine if outcomes achieved by ratees bias rater's judgment of ratee ethical behavior. Design\\/methodology\\/approach – Two studies were conducted: in study 1 the participants were undergraduate business students and in study 2, the participants were MBA students but who were also
Robert L. Cardy; T. T. Selvarajan
The demand for quantitative assessment by external agencies and internal administrators can leave post-secondary instructors confused about the nature and purpose of learning outcomes and fearful that the demand is simply part of the increasing corporatization of the university system. This need not be the case. Writing learning outcomes has a…
Ascough, Richard S.
The Longitudinal Assessment of Comprehensive School Reform Implementation and Outcomes (LACIO) responds to the No Child Left Behind Act's requirement for an evaluation of the federal Comprehensive School Reform (CSR) program. The legislation stipulates two broad goals for the evaluation: (1) to evaluate the implementation and outcomes achieved by…
Tushnet, Naida C., Flaherty, John, Jr., Smith, And
The Process/Outcome Evaluation Model (POEM) is proposed to guide in the development of more holistic evaluations of both the learning process and the resultant outcomes of that process. POEM consists of four major components that employ multiple evaluation techniques and strategies resulting in a composite assessment of the totality of a learning…
Kovalik, Cindy L.; Dalton, David W.
The value of schizophrenic inpatients' initial global assessments of treatment in the prediction of outcome was investigated. Within 3 days of admission, 31 patients with an acute paranoid schizophrenic psychosis according to ICD-10 rated on a visual analog scale to what extent they believed the treatment they were receiving was right for them. Outcome criteria were overall clinical changes measured
Matthias Bröker; Frank Röhricht; Stefan Priebe
In a prospective study 568 patients admitted to a mixed medical and surgical intensive therapy unit (ITU) were assessed using the Apache II severity of illness score to predict outcome. Their outcome was also predicted subjectively by a doctor and nurse on admission. There were 260 deaths in the group. The subjective predictions were compared with the Apache II predictions
R. J. Marks; R. S. Simons; R. A. Blizzard; D. R. G. Browne
The report is a summary of a two-volume final report of a contract to develop measures of short-term outcome for eight common health problems. The first volume is a conceptual overview of the role of outcome information in quality assessment, including an...
A. D. Avery R. H. Brook
This study was conducted because limited research has occurred in the area of co-curricular student learning outcomes assessment, which has resulted in confusion within the student affairs profession on how to develop and implement assessment plans. The purpose of this study was to examine high-quality assessment practices of student affairs…
Green, Adam S.; Jones, Elizabeth; Aloi, Susan
We evaluated the reliability of 8-hydroxy-2'-deoxyguanosine (8-OHdG), and determined its ability to predict functional outcomes in stroke survivors. The rehabilitation effect on 8-OHdG and functional outcomes were also assessed. Sixty-one stroke patients received a 4-week rehabilitation. Urinary 8-OHdG levels were determined by liquid chromatography-tandem mass spectrometry. The test-retest reliability of 8-OHdG was good (interclass correlation coefficient=0.76). Upper-limb motor function and muscle power determined by the Fugl-Meyer Assessment (FMA) and Medical Research Council (MRC) scales before rehabilitation showed significant negative correlation with 8-OHdG (r=-0.38, r=-0.30; p<0.05). After rehabilitation, we found a fair and significant correlation between 8-OHdG and FMA (r=-0.34) and 8-OHdG and pain (r=0.26, p<0.05). Baseline 8-OHdG was significantly correlated with post-treatment FMA, MRC, and pain scores (r=-0.34, -0.31, and 0.25; p<0.05), indicating its ability to predict functional outcomes. 8-OHdG levels were significantly decreased, and functional outcomes were improved after rehabilitation. The exploratory study findings conclude that 8-OHdG is a reliable and promising biomarker of oxidative stress and could be a valid predictor of functional outcomes in patients. Monitoring of behavioral indicators along with biomarkers may have crucial benefits in translational stroke research. PMID:24743892
Hsieh, Yu-Wei; Lin, Keh-Chung; Korivi, Mallikarjuna; Lee, Tsong-Hai; Wu, Ching-Yi; Wu, Kuen-Yuh
We evaluated the reliability of 8-hydroxy-2?-deoxyguanosine (8-OHdG), and determined its ability to predict functional outcomes in stroke survivors. The rehabilitation effect on 8-OHdG and functional outcomes were also assessed. Sixty-one stroke patients received a 4-week rehabilitation. Urinary 8-OHdG levels were determined by liquid chromatography–tandem mass spectrometry. The test-retest reliability of 8-OHdG was good (interclass correlation coefficient = 0.76). Upper-limb motor function and muscle power determined by the Fugl-Meyer Assessment (FMA) and Medical Research Council (MRC) scales before rehabilitation showed significant negative correlation with 8-OHdG (r = ?0.38, r = ?0.30; p < 0.05). After rehabilitation, we found a fair and significant correlation between 8-OHdG and FMA (r = ?0.34) and 8-OHdG and pain (r = 0.26, p < 0.05). Baseline 8-OHdG was significantly correlated with post-treatment FMA, MRC, and pain scores (r = ?0.34, ?0.31, and 0.25; p < 0.05), indicating its ability to predict functional outcomes. 8-OHdG levels were significantly decreased, and functional outcomes were improved after rehabilitation. The exploratory study findings conclude that 8-OHdG is a reliable and promising biomarker of oxidative stress and could be a valid predictor of functional outcomes in patients. Monitoring of behavioral indicators along with biomarkers may have crucial benefits in translational stroke research.
Hsieh, Yu-Wei; Lin, Keh-Chung; Korivi, Mallikarjuna; Lee, Tsong-Hai; Wu, Ching-Yi; Wu, Kuen-Yuh
Two first-year engineering mathematics courses used computer-aided assessment (CAA) to provide students with opportunities for formative assessment via a series of weekly quizzes. Most students used the assessment until they achieved very high (>90%) quiz scores. Although there is a positive correlation between these quiz marks and the final…
Hannah, John; James, Alex; Williams, Phillipa
Peer assessment is very various in its implementation. Six studies of peer assessment are reviewed, four of them in higher education. A literature review is followed by five empirical studies. Strengths and weaknesses of each study are considered and issues are raised. Variables in peer assessment needing further exploration are extricated--in…
Topping, Keith J.
There is sparse systematic examination of the potential for growth as well as distress that may occur for some adult survivors of childhood sexual abuse. The presented study explored posttraumatic growth and its relationship with negative posttrauma outcomes within the specific population of survivors of childhood sexual abuse (N = 40). Results showed that 95% of the participants experienced clinically
Jane Shakespeare-Finch; Therese de Dassel
In its recent history, the U.S. Forest Service is among many federal land management agencies struggling with questions concerning why its planning procedures are sometimes inefficient, perform poorly in the eyes of the public, and fail to deliver outputs that advance agency mission. By examining a representative sample of National Environmental Policy Act (NEPA) processes conducted by the agency between 2007 and 2009, we provide new insights into what drives outcomes in these planning processes. We examined team leaders' perceptions of the following outcomes: achievement of agency goals and NEPA mandates, process efficiency, public relations, and team outcomes. The most consistently important predictors of positive outcomes were team harmony and a clearly empowered team leader. Other factors, such as perceptions of the use of best science, a clear and unambiguous purpose and need, team turnover (personnel changes during the process), extra-agency engagement, and intra-agency relations, were also important, but played a less consistent role. The findings suggest the importance of empowering team leaders and team members through enhancing elements of discretion, responsibility, clear role definition, collaborative interdisciplinary deliberation, and perceived self-efficacy. The results also suggest the importance of genuine concern and respect for participating publics and effective inter-agency coordination. PMID:22562009
Stern, Marc J; Predmore, S Andrew
There is sparse systematic examination of the potential for growth as well as distress that may occur for some adult survivors of childhood sexual abuse. The presented study explored posttraumatic growth and its relationship with negative posttrauma outcomes within the specific population of survivors of childhood sexual abuse (N = 40). Results…
Shakespeare-Finch, Jane; de Dassel, Therese
Purpose To evaluate the clinical features, and anatomical and visual outcomes in patients with closed-globe contusion injury involving the posterior segment. Methods Retrospective review of posterior segment contusion injuries admitted to our tertiary referral center. Results In all, 115 patients (115 eyes) with complete data were reviewed. Surgery had been performed in 79 (69%) patients. The mean follow-up period was 6 months (range, 2–34 months). Retinal detachment, in 31% of eyes, was the most frequently encountered posterior segment pathology. The presence of retinal detachment was associated with poor visual outcome (<20/100), (P<0.001). Coexisting (five patients, 4%) and postoperative proliferative vitreoretinopathy (PVR) (two patients, 2%) was the main cause of failure in these cases. A significant positive correlation was obtained between initial and final visual acuity levels in both the medical treatment group and the surgical treatment group (P<0.05). The presenting visual acuity of <20/400 was associated with poor visual outcome (P<0.05 for both groups). Poor visual outcome in 13 patients with successful repair of retinal detachment was due to the macular lesions and the optic atrophy. Conclusion Retinal detachment was the most frequently encountered posterior segment pathology subsequent to closed-globe contusion injuries. In addition to macular scarring and optic nerve damage, development of PVR has prognostic significance in these eyes.
Cuneyt Erdurman, F; Sobaci, G; Acikel, C H; Ceylan, M O; Durukan, A H; Hurmeric, V
An adolescent female with multiple handicaps and a long history of severely disruptive behavior participated in a functional assessment linked directly to specific revisions in her school curriculum. During Phase 1, reversal designs were used to test hypotheses pertaining to antecedent and curricular influences on problem behavior. During Phase 2, a multiple baseline across afternoon and morning time periods demonstrated that the curricular revisions were effective in eliminating severely disruptive behavior and increasing on-task responding. Data also showed that inappropriate "psychotic" speech was reduced and appropriate social interactions were increased. Follow-up results showed that the changes were maintained throughout the school year. Questionnaire data provided social validation of the procedures and outcomes. The findings are discussed in relation to their implications for functional assessment, individualized curricula, and positive programming for students with disabilities and serious behavior problems.
Dunlap, G; Kern-Dunlap, L; Clarke, S; Robbins, F R
Objectives The aim of this study was to explore the left ventricular (LV) deformation changes and the potential impact of deformation on outcome in patients with proven light-chain (AL) amyloidosis and LV hypertrophy. Background Cardiac involvement in AL amyloidosis patients is associated with poor outcome. Detecting regional cardiac function by advanced non-invasive techniques might be favorable for predicting outcome. Methods LV longitudinal, circumferential and radial peak systolic strains (Ssys) were assessed by speckle tracking imaging (STI) in 44 biopsy-proven systemic AL amyloidosis patients with LV hypertrophy (CA) and in 30 normal controls. Patients were divided into compensated (n?=?18) and decompensated (n?=?26) group based on clinical assessment and followed-up for a median period of 345 days. Results Ejection fraction (EF) was preserved while longitudinal Ssys (LSsys) was significantly reduced in both compensated and decompensated groups. Survival was significantly reduced in decompensated group (35% vs. compensated 78%, P?=?0.001). LSsys were similar in apical segments and significantly reduced in basal segments between two patient groups. LSsys at mid-segments were significantly reduced in all LV walls of decompensated group. Patients were further divided into 4 subgroups according to the presence or absence of reduced LSsys in no (normal), only basal (mild), basal and mid (intermediate) and all segments of the septum (severe). This staging revealed continuously worse prognosis in proportion to increasing number of segments with reduced LSsys (mortality: normal 14%, mild 27%, intermediate 67%, and severe 64%). Mid-septum LSsys<11% suggested a 4.8-fold mortality risk than mid-septum LSsys?11%. Multivariate regression analysis showed NYHA class and mid-septum LSsys were independent predictors for survival. Conclusions Reduced deformation at mid-septum is associated with worse prognosis in systemic amyloidosis patients with LV hypertrophy.
Herrmann, Sebastian; Cikes, Maja; Stork, Stefan; Beer, Meinrad; Gaudron, Philipp Daniel; Morbach, Caroline; Knop, Stefan; Geissinger, Eva; Ertl, Georg; Bijnens, Bart; Weidemann, Frank
Outcomes in depression treatment research include both changes in symptom severity and functional impairment. Symptom measures tend to be the standard outcome but we argue that there are benefits to considering functional outcomes. An exhaustive literature review shows that the relationship between symptoms and functioning remains unexpectedly weak and often bidirectional. Changes in functioning often lag symptom changes. As a result, functional outcomes might offer depression researchers more critical feedback and better guidance when studying depression treatment outcomes. The paper presents a case for the necessity of both functional and symptom outcomes in depression treatment research by addressing three aims–1) review the research relating symptoms and functioning, 2) provide a rationale for measuring both outcomes, and 3) discuss potential artifacts in measuring functional outcomes. The three aims are supported by an empirical review of the treatment outcome and epidemiological literatures.
McKnight, Patrick E.; Kashdan, Todd B.
CONTEXT Prospective studies of childhood attention-deficit/hyperactivity disorder (ADHD) have not extended beyond early adulthood. OBJECTIVE To examine whether children diagnosed as having ADHD at a mean age of 8 years (probands) have worse educational, occupational, economic, social, and marital outcomes and higher rates of ongoing ADHD, antisocial personality disorder (ASPD), substance use disorders (SUDs), adult-onset psychiatric disorders, psychiatric hospitalizations, and incarcerations than non-ADHD comparison participants at a mean age of 41 years. DESIGN Prospective, 33-year follow-up study, with masked clinical assessments. SETTING Research clinic. PARTICIPANTS A total of 135 white men with ADHD in childhood, free of conduct disorder, and 136 men without childhood ADHD (65.2% and 76.4% of original cohort, respectively). MAIN OUTCOME MEASURES Occupational, economic, and educational attainment; marital history; occupational and social functioning; ongoing and lifetime psychiatric disorders; psychiatric hospitalizations; and incarcerations. RESULTS Probands had significantly worse educational, occupational, economic, and social outcomes; more divorces; and higher rates of ongoing ADHD (22.2% vs 5.1%, P < .001), ASPD (16.3% vs 0%, P < .001), and SUDs (14.1% vs 5.1%, P = .01) but not more mood or anxiety disorders (P = .36 and .33) than did comparison participants. Ongoing ADHD was weakly related to ongoing SUDs (? = 0.19, P = .04), as well as ASPD with SUDs (? = 0.20, P = .04). During their lifetime, probands had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants. Relative to comparisons, psychiatric disorders with onsets at 21 years or older were not significantly elevated in probands. Probands without ongoing psychiatric disorders had worse social, but not occupational, functioning. CONCLUSIONS The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after 20 years of age. Findings highlight the importance of extended monitoring and treatment of children with ADHD. PMID:23070149
Klein, Rachel G; Mannuzza, Salvatore; Olazagasti, María A Ramos; Roizen, Erica; Hutchison, Jesse A; Lashua, Erin C; Castellanos, F Xavier
Traumatic brain injury (TBI) is common and debilitating. Randomized trials of interventions for TBI ideally assess effectiveness by using long-term functional neurological outcomes, but such outcomes are difficult to obtain and costly. If there is little change between functional status at hospital discharge versus 6 months, then shorter-term outcomes may be adequate for use in future clinical trials. Using data from a previously published multi-center, randomized, placebo-controlled TBI clinical trial, we evaluated patterns of missing outcome data, changes in functional status between hospital discharge and 6 months, and three prognostic models to predict long-term functional outcome from covariates available at hospital discharge (functional measures, demographics, and injury characteristics). The Resuscitation Outcomes Consortium Hypertonic Saline trial enrolled 1282 TBI patients, obtaining the primary outcome of 6-month Glasgow Outcome Score Extended (GOSE) for 85% of patients, but missing the primary outcome for the remaining 15%. Patients with missing outcomes had less-severe injuries, higher neurological function at discharge (GOSE), and shorter hospital stays than patients whose GOSE was obtained. Of 1066 (83%) patients whose GOSE was obtained both at hospital discharge and at 6-months, 71% of patients had the same dichotomized functional status (severe disability/death vs. moderate/no disability) after 6 months as at discharge, 28% had an improved functional status, and 1% had worsened. Performance was excellent (C-statistic between 0.88 and 0.91) for all three prognostic models and calibration adequate for two models (p values, 0.22 and 0.85). Our results suggest that multiple imputation of the standard 6-month GOSE may be reasonable in TBI research when the primary outcome cannot be obtained through other means. PMID:24552494
Zelnick, Leila R; Morrison, Laurie J; Devlin, Sean M; Bulger, Eileen M; Brasel, Karen J; Sheehan, Kellie; Minei, Joseph P; Kerby, Jeffrey D; Tisherman, Samuel A; Rizoli, Sandro; Karmy-Jones, Riyad; van Heest, Rardi; Newgard, Craig D
Motivation Time-course microarray experiments study the progress of gene expression along time across one or several experimental conditions. Most developed analysis methods focus on the clustering or the differential expression analysis of genes and do not integrate functional information. The assessment of the functional aspects of time-course transcriptomics data requires the use of approaches that exploit the activation dynamics of the functional categories to where genes are annotated. Methods We present three novel methodologies for the functional assessment of time-course microarray data. i) maSigFun derives from the maSigPro method, a regression-based strategy to model time-dependent expression patterns and identify genes with differences across series. maSigFun fits a regression model for groups of genes labeled by a functional class and selects those categories which have a significant model. ii) PCA-maSigFun fits a PCA model of each functional class-defined expression matrix to extract orthogonal patterns of expression change, which are then assessed for their fit to a time-dependent regression model. iii) ASCA-functional uses the ASCA model to rank genes according to their correlation to principal time expression patterns and assess functional enrichment on a GSA fashion. We used simulated and experimental datasets to study these novel approaches. Results were compared to alternative methodologies. Results Synthetic and experimental data showed that the different methods are able to capture different aspects of the relationship between genes, functions and co-expression that are biologically meaningful. The methods should not be considered as competitive but they provide different insights into the molecular and functional dynamic events taking place within the biological system under study.
Nueda, Maria Jose; Sebastian, Patricia; Tarazona, Sonia; Garcia-Garcia, Francisco; Dopazo, Joaquin; Ferrer, Alberto; Conesa, Ana
While the assessment movement has spanned more than two decades, there is great variation in its degree of implementation among community colleges throughout the country. Building on literature in the field, this chapter discusses and gives examples of concepts and major areas involved in the assessment of student learning at the institutional…
Serban, Andreea M.
In England, early years education services and the children and who attend them are the subject of increasing scrutiny and assessment. While these assessments offer a number of benefits in terms of tracking child development and ensuring the efficient use of public monies, they also impose restrictions to practice, limits to understandings of…
Campbell-Barr, Verity; Lavelle, Marie; Wickett, Karen
The higher education system in the Commonwealth of Virginia in the United States provides a case model for how discussions regarding educational quality and assessment of that quality have affected institutions' policy decisions and implementation. Using Levin's (1998) policy analysis framework, this essay explores how assessment of student…
Active participation in learning activities and reviewing assessment activity can facilitate learners engaged in these processes. This case study reports student experiences of the process of peer assessment with teacher guidance in a group project for a first-year nursing course with 153 students. Twenty groups of students were assigned roles in…
Hodgson, Paula; Chan, Kitty; Liu, Justina
In this review we discuss practical considerations for the assessment of brown adipose tissue in rodent models, focusing on mice. The central aim of the review is to provide a critical appraisal of the utility of specialized techniques for assessing brown adipose tissue function in vivo. We cover several of the most common specialized methods for analysing brown adipose tissue function in vivo, including assessment of maximal thermogenic capacity by indirect calorimetry and the measurement of sympathetic tone to brown adipose tissue. While these techniques are powerful, they are not readily available to all laboratories; therefore we also cover several simple measurements that, particularly in combination, can be used to determine if a mouse model is likely to have alterations in brown adipose tissue function. Such techniques include: pair feeding, analysis of brown adipose tissue lipid content and mRNA and protein markers of brown adipose tissue activation.
Virtue, Sam; Vidal-Puig, Antonio
Background To assess the association of diabetes with postoperative limitation of activities of daily living (ADLs) after primary total knee arthroplasty (TKA). Methodology/Principal Findings We used the prospectively collected data from the Mayo Clinic Total Joint Registry to assess the association of diabetes and diabetes with complications with moderate-severe ADL limitation 2- and 5-years after primary TKA. Multivariable logistic regression with general estimating equations adjusted for preoperative ADL limitation, comorbidity and demographic and clinical covariates. Odds ratio (OR) and 95% confidence interval (CI) are presented. 7,139 primary TKAs at 2-years and 4,234 at 5-years constituted the cohorts. In multivariable-adjusted analyses, diabetes was associated with higher odds of moderate-severe limitation at 2- and 5-years, 1.71 (95% CI: 1.26, 2.32; P?=?0.001) and 1.66 (95% CI: 1.13, 2.46; P?=?0.01). Respective ORs for patients with diabetes with complications were 2.73 (95% CI: 1.47, 5.07; P?=?0.001) and 2.73 (95% CI: 1.21, 6.15; P?=?0.016). Sensitivity analyses that adjusted for anxiety and depression or anxiety, depression and ipsilateral hip involvement showed minimal attenuation of magnitude of the association. Conclusions/Significance In this large study of patients who underwent primary TKA, diabetes as well as its severity were independently associated with poorer functional outcome. Given the increasing rates of both diabetes as well as arthroplasty, more insight is needed into disease-related and treatment-related factors that underlie this higher risk of ADL limitation in patients with diabetes. Poor functional outcomes may be preventable by modifying the control of diabetes and associated comorbidity in pre- and post-arthroplasty periods.
Singh, Jasvinder A.; Lewallen, David G.
Little data exists assessing the relationship between functional limitations in children with cerebral palsy (CP) and their participation in everyday activities. This prospective study evaluates the relationship between the Pediatric Outcomes Data Collection Instrument (PODCI), a functional health-related quality of life instrument for children…
Gates, Philip E.; Otsuka, Norman Y.; Sanders, James O.; McGee-Brown, Jeanie
The impact of surgery on outcome of adult patients with low-grade gliomas is controversial. Without prospective randomized treatment trials, one is primarily dependent on retrospective studies to address this issue. This paper reviews the recent clinical series of low-grade gliomas in which the association between extent of resection (EOR) and outcome could be analyzed. Functional stimulation mapping methods will be
Mitchel S. Berger; Robert C. Rostomily
Risk-and-resistance models identify factors that predict psychosocial adjustment to pediatric chronic illness, including sickle cell disease (SCD), but have not been applied to understand health outcomes. The study objectives were to examine prospectively the relationship of coping and family functioning with health outcomes for adolescents with SCD, accounting for sociodemographic and psychosocial risk. Forty-one adolescents and their families (41 primary caregivers, 9 second caregivers, and 15 healthy siblings) completed paper-and-pencil measures of coping and family functioning at a baseline assessment (time 1). At both time 1 and time 2 (1 y later), disease severity, SCD complications, healthcare utilization, and average hemoglobin level were derived from medical file reviews. Time 1 disease-related parenting stress predicted time 2 health outcomes; however, there were no significant associations for coping. Families concordant in reporting lower family functioning had teens with increased disease severity and greater healthcare utilization. Examination of moderation of disease-related parenting stress by a risk index showed main effects for risk and for disease-related parenting stress for time 2 disease severity and time 2 healthcare utilization. Interaction effects were not significant. Efforts to explore specific mechanisms by which adaptive family functioning contributes to health outcomes for adolescents with SCD should continue, with particular attention to addressing the potential role of multiple sociodemographic and psychosocial risk variables. PMID:17984693
Barakat, Lamia P; Patterson, Chavis A; Weinberger, Beverley Slome; Simon, Katherine; Gonzalez, Elizabeth R; Dampier, Carlton
Using a survey, compared relative values assigned by Tufts veterinary alumni to questions about skills, training, attitudes, and behaviors with those of veterinary employers and faculty. Also assessed their perceptions of future employment opportunities. (EV)
Kleine, Lawrence J.; Terkla, Dawn Geronimo; Kimball, Grayson
A preliminary provisional assessment of the prospects for the establishment of an adequate technology assessment function and the implications of the assessment function for the public decision process are presented. Effects of the technology assessment function on each phase of the public decision process and briefly explored. Significant implications during the next decade are projected with respect to the following phases: invention and development of alternative means (technological configurations); evaluation, selection and promotion of preferred courses of action; and modification of statutory scheme or social action program as an outcome of continuing monitoring and appraisal.
Mayo, L. H.
In this study, long-term intellectual functioning and school-related behavioural outcomes were assessed in a patient sample that underwent invasive treatment for congenital heart disease (ConHD) between 1990 and 1995. The Wechsler Intelligence Scale for Children-Revised was used to measure intellectual functioning and the Teacher's Report Form to…
Spijkerboer, A. W.; Utens, E. M. W. J.; Bogers, A. J. J. C.; Verhulst, F. C.; Helbing, W. A.
We investigated the effect of taurine on inflammatory cytokine expression, on astrocyte activity and cerebral edema and functional outcomes, following traumatic brain injury (TBI) in rats. 72 rats were randomly divided into sham, TBI and Taurine groups. Rats subjected to moderate lateral fluid percussion injury were injected intravenously with taurine (200mg/kg) or saline immediately after injury or daily for 7days. Functional outcome was evaluated using Modified Neurological Severity Score (mNSS). Glial fibrillary acidic protein (GFAP) of the brain was measured using immunofluorescence. Concentration of 23 cytokines and chemokines in the injured cortex at 1 and 7days after TBI was assessed by Luminex xMAP technology. The results showed that taurine significantly improved functional recovery except 1day, reduced accumulation of GFAP and water content in the penumbral region at 7days after TBI. Compared with the TBI group, taurine significantly suppressed growth-related oncogene (GRO/KC) and interleukin (IL)-1? levels while elevating the levels of regulated on activation, normal T cell expressed and secreted (RANTES) at 1day. And taurine markedly decreased the level of 17 cytokine: eotaxin, Granulocyte colony-stimulating factor (G-CSF), Granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-gamma (IFN-?), IL-1?, IL-1?, IL-4, IL-5, IL-6, IL-10, IL-12p70, IL-13, IL-17, leptin, monocyte chemotactic protein-1 (MCP-1), tumor necrosis factor-alpha (TNF-?), vascular endothelial growth factor (VEGF), and only increased the level of MIP-1? in a week. The results suggest that taurine effectively mitigates the severity of brain damage in TBI by attenuating the increase of astrocyte activity and edema as well as pro-inflammatory cytokines. PMID:24530657
Su, Y; Fan, W; Ma, Z; Wen, X; Wang, W; Wu, Q; Huang, H
Treatment for medulloblastoma during childhood impairs neurocognitive function in survivors. While those diagnosed at younger ages are most vulnerable, little is known about the long-term neurocognitive, functional, and physical outcomes in survivors as they approach middle age. In this retrospective cohort study, we assessed 20 adults who were treated with surgery and radiotherapy for medulloblastoma during childhood (median age at assessment, 21.9 years [range, 18–47 years]; median time since diagnosis, 15.5 years [range, 6.5–42.2 years]). Nine patients also underwent chemotherapy. Cross-sectional analyses of current neurocognitive, functional, and physical status were conducted. Data from prior neuropsychological assessments were available for 18 subjects; longitudinal analyses were used to model individual change over time for those subjects. The group was well below average across multiple neurocognitive domains, and 90% had required accommodations at school for learning disorders. Longer time since diagnosis, but not age at diagnosis, was associated with continued decline in working memory, a common sign of aging. Younger age at diagnosis was associated with lower intelligence quotient and academic achievement scores, even many years after treatment had been completed. The most common health complications in survivors were hearing impairment, second cancers, diabetes, hypertension, and endocrine deficiencies. Adult survivors of childhood medulloblastoma exhibit signs of early aging regardless of how young they were at diagnosis. As survival rates for brain tumors continue to improve, these neurocognitive and physical sequelae may become evident in survivors diagnosed at different ages across the lifespan. It will become increasingly important to identify factors that contribute to risk and resilience in this growing population.
Edelstein, Kim; Spiegler, Brenda J.; Fung, Sharon; Panzarella, Tony; Mabbott, Donald J.; Jewitt, Natalie; D'Agostino, Norma Mammone; Mason, Warren P.; Bouffet, Eric; Tabori, Uri; Laperriere, Normand; Hodgson, David C.
The assessment of student learning outcomes in integrated courses is particularly challenging. This article reviews a range of assessment studies conducted over two decades by a community college that requires integrated Learning Communities for the transfer degree. This review highlights methodologies, findings, and lessons learned from these…
Dunlap, Lynn; Pettitt, Maureen
This article presents the outcomes of the Mobile Technologies Pilot Project for the Assessment and Learning in Practice Settings (ALPS) Centre for Excellence in Teaching and Learning (CETL). ALPS is a partnership of five Higher Education Institutions (HEI) that aims to develop and improve assessment, and thereby learning, in practice settings for…
Dearnley, Christine; Taylor, Jill; Hennessy, Scott; Parks, Maria; Coates, Catherine; Haigh, Jackie; Fairhall, John; Riley, Kevin; Dransfield, Mark
This paper investigates whether performance in progressive assessment necessarily influences the outcome in the end-of-semester final examination using the experience of an introductory postgraduate statistics course at a large Australian university. The average score on progressive assessments was higher than that of the final examination.…
Alauddin, Mohammad; Khan, Asaduzzaman
Purpose: The purpose of this paper is threefold: first, to introduce a conceptual model for assessing undergraduate student learning outcomes and satisfaction that involves concepts drawn from the services marketing and assessment literatures; second, to illustrate the utility of the model as implemented in an academic department (geography)…
Duque, Lola C.; Weeks, John R.
This study focused on the intended learning outcomes, curriculum and assessment in the science curriculum offered at a regional independent Middle School in the state of Victoria, Australia. In-school assessment has indicated that the current science curriculum of this Middle School may not develop students' skills in scientific literacy as effectively as intended. One hypothesis to explain this deficit is
Reid J. Smith
Background: Opioid analgesics are the cornerstone of management for malignant pain. Their use in managing chronic, nonmalignant pain, albeit controversial, has increased in recent years. The decisions about whether to initiate opioid therapy or continue it over time should be guided by a comprehensive patient assessment. During long-term treatment, this assessment should focus on a broad range of outcomes, each
Steven D Passik; Kenneth L Kirsh; Laurie Whitcomb; Russell K Portenoy; Nathaniel P Katz; Leah Kleinman; Sheri L Dodd; Jeffrey R Schein
This manual is designed to help school personnel conduct functional behavior assessments (FBAs) and to develop effective behavior intervention plans (BIPs). The manual begins by providing background information on FBAs including: (1) the four-stage model of collaborative problem solving that is used to conduct FBAs and develop subsequent BIPs,…
Nelson, J. Ron; Roberts, Maura L.; Smith, Deborah J.
BACKGROUND: Conducting a pragmatic randomised trial in primary care is often accompanied by practical problems. Such problems are seldom reported and may constitute useful lessons for researchers planning future trials. AIM: To address the difficulties involved in patient recruitment and to present measures to minimise bias during outcome assessment. METHOD: A recently conducted trial comparing the effects of corticosteroid injections and physiotherapy for painful stiff shoulder was used to illustrate problems related to patient recruitment and outcome assessment. RESULTS: Recruitment of patients was not without difficulties despite careful preparation. Recruitment was discontinued after 20 months, when 109 of the intended 120 patients had been admitted to the trial. The shoulder trial mainly included patient-oriented subjective outcome measures. Subgroup analyses demonstrated that patient preferences might have had some influence on outcome. CONCLUSIONS: General practitioners might be willing or unwilling to participate in research for many reasons. The researcher should take these motivations into account when inviting physicians to take part in research. Strategies to enhance enrolment should be prepared before the start of the trial. When blinding of patients is problematic, patient preferences should be assessed before randomisation and their influence on the outcome studied. Although involving a blinded independent observer enables a more objective assessment of outcome, the success of blinding should be clearly evaluated.
van der Windt, D A; Koes, B W; van Aarst, M; Heemskerk, M A; Bouter, L M
Optimal surgical planning and decision making surrounding surgical interventions requires patient-specific risk assessment which incorporates patient pre-operative clinical assessment and clinical literature. In this paper, we utilized population-based data analysis to construct surgical outcome predictive models for spinal fusion surgery using hospital, patient and admission characteristics. We analyzed population data from the Nationwide Inpatient Sample (NIS) –a nationally representative database– to identify data elements affecting inpatient mortality, length of stay, and disposition status for patients receiving spinal fusion surgery in the years 2004–2008. In addition to outcomes assessment, we want to make the analytic model results available to clinicians and researchers for pre-operative surgical risk assessment, hospital resource allocation, and hypothesis generation for future research without an individual patient data management burden. Spinal fusion was the selected prototype procedure due to it being a high volume and typically inpatient procedure where patient risk factors will likely affect clinical outcomes.
AbuSalah, Ahmad M.; Melton, Genevieve B.; Adam, Terrence J.
The study investigated a potential relationship between level of executive functioning and rates of delay discounting (i.e., the subjective decrease in the value of an outcome if its delivery is delayed). University students completed an executive-functioning questionnaire and then a delay-discounting task involving four different outcomes (money, cigarettes, dating partner, body image). Results showed that the overall measure of executive
Jeffrey N. Weatherly; F. Richard Ferraro
The authors make distant evaluation of functional and radiological outcomes after operative treatment of peritrochanteric femur fractures using Dynamic Hip Stabilizer (DSB). It was done basing on clinical material of 1998-2005 years. 142 patients were included into the study, 89 women (62.7%) and 53 men (37.3%), aged between 53-97 years (average 77 years). Boyd and Gryffin classification was used for evaluation of type of fracture, Harris criterions was used for evaluation of functional outcomes, and Golec's criterions was used for evaluation of radiological outcomes. Obtained outcomes confirm usefulness of DSB for treatment of type I and II according to Boyd and Griffin classification. Poor outcomes were obtained in type III and IV. PMID:18669107
Sienkiewicz, Dariusz; Golec, Edward; Nowak, Sebastian; Golec, Joanna; Szczygie?, Elzbieta; Plewa, Alicja
Osteoarthritis (OA) is a prevalent musculoskeletal disease that results in pain and low quality of life for patients, as well as enormous medical and socioeconomic burdens. The molecular mechanisms responsible for the initiation and progression of OA are still poorly understood. As such, mouse models of the disease are having increasingly important roles in OA research owing to the advancements of microsurgical techniques and the use of genetically modified mice, as well as the development of novel assessment tools. In this Review, we discuss available mouse models of OA and applicable assessment tools in studies of experimental OA. PMID:24662645
Fang, Hang; Beier, Frank
The general use of bilateral rather than separate renal function evaluation has led to the publication of conflicting results concerning the effect of percutaneous transluminal renal angioplasty (PTRA) on renal function, especially in patients with atherosclerotic renal artery stenosis. The aim of this study was to evaluate prospectively, in standardized conditions, split renal function (SRF) and GFR outcome after successful
AGNES LA BATIDE-ALANORE; MICHEL AZIZI; MARC FROISSART; ALAIN RAYNAUD; PIERRE-FRANCOIS PLOUIN
The foundation of head and neck reconstruction is based on two pillars: the restoration of function and the restoration of aesthetics. The objective of this article is to provide insight into how to prevent undesirable functional and aesthetic outcome after the initial procedure and also to provide solutions for enhancement of functional and aesthetic outcome with secondary procedures. Functional and aesthetic outcome enhancement is discussed in relation to the individual structures within the oral cavity, for the mandible, and for facial reconstruction. Normal prerequisites for all individual structures are described, and key points for restoration of these functional and aesthetic issues are proposed. In addition, further suggestions to improve suboptimal results after initial reconstructive surgery are presented. Understanding the function and aesthetics of the area to be reconstructed will allow appropriate planning and management of the initial reconstruction. Secondary enhancement should be attainable by minor procedures rather than a requirement to redo the initial reconstruction.
Hofer, Stefan O.P.; Payne, Caroline E.
Assessment of diastolic function and left ventricular filling pressures in the setting of both normal and reduced systolic function is of major importance particularly in patients with dyspnea. Since multiple echocardiography parameters are used to assess diastolic function each with some limitations, a comprehensive approach should be applied. Transmitral Doppler flow should be evaluated in combination with newer, less load dependent Doppler techniques. Tissue Doppler imaging provides accurate, well validated data regarding diastolic properties and filling pressures of the left ventricle. Tissue Doppler imaging should be the part of a routine echocardiography study due to its ease of use and high reproducibility. Pulmonary vein Doppler and flow propagation velocity should be incorporated into the evaluation when needed. PMID:17785223
Pirat, Bahar; Zoghbi, William A
Background Progression to chronic renal failure involves accelerated atherosclerosis and vascular calcification. Oxidative stress and endothelial dysfunction play a role in renal failure pathophysiology. In addition to improving vascular health and function, proanthocyanidins have been shown to exert renoprotective effects in animal models. Thus we hypothesize that proanthocyanidins may contribute to the maintenance of healthy renal function. Objective Determine the association of habitual proanthocyanidin intake with renal function and the risk of clinical renal outcomes in a population of elderly women. Design 948 women aged over 75 y, free of prevalent renal disease at baseline, were randomly selected from ambulant Caucasian women. Proanthocyanidin consumption was determined using a validated food frequency questionnaire and the United States Department of Agriculture proanthocyanidin food content database. Fasting serum cystatin C and creatinine were assessed at baseline. Renal failure hospitalisations and deaths were assessed over 5 years of follow-up through the Western Australia Data Linkage System. Results Compared to participants with low consumption, participants in the highest tertile of proanthocyanidin intake had a 9% lower cystatin C concentration (P<0.001). High proanthocyanidin consumers were at 50% lower risk of moderate chronic kidney insufficiency, and 65% lower risk of experiencing a 5-year renal disease event (P<0.05). These relationships remained significant following adjustment for renal disease risk factors and diet-related potential confounders. Conclusion Increased consumption of proanthocyanidins was associated with better renal function and substantially reduced renal associated events, which has been supported by mechanistic and animal model data. Proanthocyanidin intake should be further examined as a dietary contributor to better renal health.
Ivey, Kerry L.; Lewis, Joshua R.; Lim, Wai H.; Lim, Ee M.; Hodgson, Jonathan M.; Prince, Richard L.
Background.?Although tenofovir disoproxil fumarate (TDF) use has increased as part of first-line antiretroviral therapy (ART) across sub-Saharan Africa, renal outcomes among patients receiving TDF remain poorly understood. We assessed changes in renal function and mortality in patients starting TDF- or non-TDF-containing ART in Lusaka, Zambia. Methods.?We included patients aged ?16 years who started ART from 2007 onward, with documented baseline weight and serum creatinine. Renal dysfunction was categorized as mild (estimated glomerular filtration rate [eGFR], 60-89 mL/min), moderate (30-59 mL/min), or severe (<30 mL/min) according to the chronic kidney disease-epidemiology (CKD-EPI) formula. Differences in eGFR during ART were analyzed using linear mixed-effect models. The odds of developing moderate or severe eGFR decrease and mortality were assessed using logistic and competing risk regression, respectively. Results.?We included 62 230 adults, of which 38 716 (62.2%) initiated a TDF-based regimen. The proportion with moderate or severe renal dysfunction at baseline was lower in the TDF than in the non-TDF group (1.9% vs 4.0%). Among patients with no or mild renal dysfunction, those receiving TDF were more likely to develop moderate (adjusted odds ratio, 3.11; 95% confidence interval, 2.52-3.87) or severe ( 2.43; 1.80-3.28) eGFR decrease, although the incidence in such episodes was low. Among patients with moderate or severe renal dysfunction at baseline, renal function improved independently of ART regimen, and mortality rates were similar in both treatment groups. Conclusions.?TDF use did not attenuate renal function recovery or increase the mortality rate in patients with renal dysfunction. Further studies are needed to determine the role of routine renal function monitoring before and during ART use in Africa. PMID:24585558
Mulenga, Lloyd; Musonda, Patrick; Mwango, Albert; Vinikoor, Michael J; Davies, Mary-Ann; Mweemba, Aggrey; Calmy, Alexandra; Stringer, Jeffrey S; Keiser, Olivia; Chi, Benjamin H; Wandeler, Gilles
AIM: To evaluate the status of anorectal function after repeated transanal endoscopic microsurgery (TEM). METHODS: Twenty-one patients undergoing subtotal colectomy with ileorectal anastomosis were included. There were more than 5 large (> 1 cm) polyps in the remaining rectum (range: 6-20 cm from the anal edge). All patients, 19 with villous adenomas and 2 with low-grade adenocarcinomas, underwent TEM with submucosal endoscopic excision at least twice between 2005 and 2011. Anorectal manometry and a questionnaire about incontinence were carried out at week 1 before operation, and at weeks 2 and 3 and 6 mo after the last operation. Anal resting pressure, maximum squeeze pressure, maximum tolerable volume (MTV) and rectoanal inhibitory reflexes (RAIR) were recorded. The integrity and thickness of the internal anal sphincter (IAS) and external anal sphincter (EAS) were also evaluated by endoanal ultrasonography. We determined the physical and mental health status with SF-36 score to assess the effect of multiple TEM on patient quality of life (QoL). RESULTS: All patients answered the questionnaire. Apart from negative RAIR in 4 patients, all of the anorectal manometric values in the 21 patients were normal before operation. Mean anal resting pressure decreased from 38 ± 5 mmHg to 19 ± 3 mmHg (38 ± 5 mmHg vs 19 ± 3 mmHg, P = 0.000) and MTV from 165 ± 19 mL to 60 ± 11 mL (165 ± 19 mL vs 60 ± 11 mL, P = 0.000) at month 3 after surgery. Anal resting pressure and MTV were 37 ± 5 mmHg (38 ± 5 mmHg vs 37 ± 5 mmHg, P = 0.057) and 159 ± 19 mL (165 ± 19 mL vs 159 ± 19 mL, P = 0.071), respectively, at month 6 after TEM. Maximal squeeze pressure decreased from 171 ± 19 mmHg to 62 ± 12 mmHg (171 ± 19 mmHg vs 62 ± 12 mmHg, P = 0.000) at week 2 after operation, and returned to normal values by postoperative month 3 (171 ± 19 vs 166 ± 18, P = 0.051). RAIR were absent in 4 patients preoperatively and in 12 (?2 = 4.947, P = 0.026) patients at month 3 after surgery. RAIR was absent only in 5 patients at postoperative month 6 (?2 = 0.141, P = 0.707). Endosonography demonstrated that IAS disruption occurred in 8 patients, and 6 patients had temporary incontinence to flatus that was normalized by postoperative month 3. IAS thickness decreased from 1.9 ± 0.6 mm preoperatively to 1.3 ± 0.4 mm (1.9 ± 0.6 mm vs 1.3 ± 0.4 mm, P = 0.000) at postoperative month 3 and increased to 1.8 ± 0.5 mm (1.9 ± 0.6 mm vs 1.8 ± 0.5 mm, P = 0.239) at postoperative month 6. EAS thickness decreased from 3.7 ± 0.6 mm preoperatively to 3.5 ± 0.3 mm (3.7 ± 0.6 mm vs 3.5 ± 0.3 mm, P = 0.510) at month 3 and then increased to 3.6 ± 0.4 mm (3.7 ± 0.6 mm vs 3.6 ± 0.4 mm, P = 0.123) at month 6 after operation. Most patients had frequent stools per day and relatively high Wexner scores in a short time period. While actual fecal incontinence was exceptional, episodes of soiling were reported by 3 patients. With regard to the QoL, the physical and mental health status scores (SF-36) were 56.1 and 46.2 (50 in the general population), respectively. CONCLUSION: The anorectal function after repeated TEM is preserved. Multiple TEM procedures are useful for resection of multi-polyps in the remaining rectum.
Zhang, Hong-Wei; Han, Xiao-Dong; Wang, Yu; Zhang, Pin; Jin, Zhi-Ming
Several contributions in "Biochemistry and Molecular Biology Education" have highlighted the role of visualization tools and the importance of developing students' visual literacy in biochemistry education. In this forum, the authors suggest that more focus is needed on the assessment of student learning, and they advance…
Herraez, Angel; Costa, Manuel Joao
Background The removal of brain tumors in peri-eloquent or eloquent cortex risks causing new neurological deficits in patients. The assessment of the functionality of peri-lesional tissue is essential to avoidance of postoperative neurological morbidity. Objective To evaluate preoperative magnetoencephalography (MEG)-based functional connectivity as a predictor of short- and medium-term neurological outcome after removal of gliomas in peri-eloquent and eloquent areas. Methods Resting-state whole-brain MEG recordings were obtained from 79 consecutive subjects with focal brain gliomas near or within motor, sensory, or language areas. Neural activity was estimated using adaptive spatial filtering. The mean imaginary coherence between voxels in and around brain tumors was compared to contralesional voxels and used as an index of their functional connectivity with the rest of the brain. The connectivity values of the tissue resected during surgery were correlated to the early (one week post-operatively) and medium-term (six months post-operatively) neurological morbidity. Results Patients undergoing resection of tumors with decreased functional connectivity had a 29% rate of new neurological deficit 1 week after surgery and a 0% rate at 6-month follow-up. Patients undergoing resection of tumors with increased functional connectivity had a 60% rate of new deficit at 1 week and a 25% rate at 6 months. Conclusion MEG connectivity analysis gives a valuable preoperative evaluation of the functionality of the tissue surrounding tumors in peri-eloquent and eloquent areas. These data may be used to optimize pre-operative patient counseling and surgical strategy.
Tarapore, Phiroz E.; Martino, Juan; Guggisberg, Adrian G.; Owen, Julia; Honma, Susanne M.; Findlay, Anne; Berger, Mitchel S.; Kirsch, Heidi E.; Nagarajan, Srikantan S.
Background Minimally invasive laparoscopic radical prostatectomy (LRP) has proven equally effective as open surgery in terms of cancer control and peroperative complication rate with less bleeding and postoperative pain. However, long-term follow-up data after LRP are scarce, especially as related to quality of life (QoL). Aim To compare QoL and functional outcomes at least 10 years after LRP with a population-based control group matched for age and region. Methods Follow-up data were obtained by mailed questionnaires from patients who responded anonymously to five international questionnaires (EQ-5D, QLQ-C30, QLQ-PR25, IPSS, and IIEF). We collected self-reported outcome data directly from 49 patients who underwent LRP more than 10 years ago in our centre. The results of the patients' overall QoL and urinary continence rates were compared with 918 controls matched for region and age. Results Forty-two patients (86%) and 808 (88%) controls reported having no urinary leakage. Only 11 patients (24%) still had sexual activities 10 years after LRP, and three were without erectile dysfunction. There was no difference in four of five statements of the self-assessed QoL questionnaires between the LRP and control group. Anxiety level was higher in the LRP group (44%) than in the control group (23%). Conclusion Patients reported high self-assessed QoL, although they also reported low sexual activity 10 years after LRP. Prevalence of urinary leakage was similar in both groups. However, anxiety was more common in LRP patients.
Eriksson, Hans G.
Introduction The aims of this present study were firstly to assess the outcome, including functional course, in anti-Jo1 positive patients with antisynthetase syndrome (ASS), and secondly to determine predictive parameters of poor outcome in these patients. Methods The medical records of 86 consecutive anti-Jo1 patients with ASS were reviewed in 4 academic centers. Results 13 patients (15.1%) achieved remission of ASS, whereas 55 (63.9%) improved and 18 (20.9%) deteriorated in their clinical status. Both steroid and cytotoxic drugs could be discontinued in only 4.7% of patients. ASS was associated with decreased quality of life at long-term follow-up: only 69.2% of patients considered to be in remission experienced a return to previous normal activities; and 24.7% of other patients with non-remitting ASS still had a marked reduction of activities (as shown by the disability scale of the Health Assessment Questionnaire). Decreased quality of life was further due to calcinosis cutis (8.1%) and adverse effects of steroid therapy (36%). Factors associated with ASS deterioration were older age, pulmonary and esophageal involvement, calcinosis cutis and cancer. Higher anti-Jo1 levels were further associated with disease severity in ASS patients. Conclusions The present study shows high morbidity related to ASS. Furthermore, we suggest that patients with predictive factors of ASS deterioration may require more aggressive therapy. Our findings also suggest that in anti-Jo1 patients with severe esophageal manifestations, combined high dose steroids and intravenous immunoglobulins might be proposed as the first line therapy. Finally, as cancer occurred in 14% of anti-Jo1 patients, our findings underscore that the search for cancer should be performed in these patients.
Study design:Review by the spinal cord outcomes partnership endeavor (SCOPE), which is a broad-based international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations.Objectives:Assessment of current and evolving tools for evaluating human spinal cord injury (SCI) outcomes for both clinical diagnosis and clinical research studies.Methods:a framework for the appraisal of evidence of metric
M S Alexander; K D Anderson; F Biering-Sorensen; A R Blight; R Brannon; T N Bryce; G Creasey; A Catz; A Curt; W Donovan; J Ditunno; P Ellaway; N B Finnerup; D E Graves; B A Haynes; A W Heinemann; A B Jackson; M V Johnston; C Z Kalpakjian; N Kleitman; A Krassioukov; K Krogh; D Lammertse; S Magasi; M J Mulcahey; B Schurch; A Sherwood; J D Steeves; S Stiens; D S Tulsky; H J A van Hedel; G Whiteneck
Cleft lip/palate (CLP) patients need an interdisciplinary team approach for optimal treatment, care and results. Evaluation of the treatment outcomes is essential to allow for identification and implementation of the highest possible standard of care. The aim of this paper is to present the less invasive methods of assessment of treatment outcomes by evaluation of dental arch relationships in both unilateral and bilateral CLP. PMID:21302393
Wangsrimongkol, Tasanee; Jansawang, Wallop
Background Poor pain and function outcomes are undesirable after an elective surgery such as total hip or knee arthroplasty (THA/TKA). Recent studies have indicated that the presence of contralateral joint influences outcomes of THA/TKA, however the impact of ipsilateral knee/hip involvement on THA/TKA outcomes has not been explored. The objective of this study was to assess the association of ipsilateral knee/hip joint involvement on short-term and medium-term pain and function outcomes after THA/TKA. Methods In this retrospective study of prospectively collected data, we used the data from the Mayo Clinic Total Joint Registry to assess the association of ipsilateral knee or hip joint involvement with moderate to severe pain and moderate to severe activity limitation at 2-year and 5-year follow-up after primary and revision THA and TKA using multivariable-adjusted logistic regression analyses. Results At 2 years, 3,823 primary THA, 4,701 primary TKA, 1,218 revision THA and 725 revision TKA procedures were studied. After adjusting for multiple covariates, ipsilateral knee pain was significantly associated with outcomes after primary THA (all P values <0.01): (1) moderate to severe pain: at 2 years, odds ratio (OR), 2.3 (95% confidence interval (CI) 1.5 to 3.6); at 5 years, OR 1.8 (95% CI 1.1 to 2.7); (2) moderate to severe activity limitation: at 2 years, OR 3.1 (95% CI 2.3 to 4.3); at 5 years, OR 3.6 (95% CI 2.6 to 5.0). Ipsilateral hip pain was significantly associated with outcomes after primary TKA (all P values <0.01): (1) moderate to severe pain: at 2 years, OR 3.3 (95% CI 2.3 to 4.7); at 5 years, OR 1.8 (95% CI 1.1 to 2.7); (2) moderate to severe activity limitation: at 2 years, OR 3.6 (95% CI 2.6 to 4.9); at 5 years, OR 2.2 (95% CI 1.6 to 3.2). Similar associations were noted for revision THA and TKA patients. Conclusions To the best of our knowledge, this is the first study showing that the presence of ipsilateral joint involvement after THA or TKA is strongly associated with poor pain and function outcomes. A potential way to improve outcomes is to address ipsilateral lower extremity joint involvement.
This paper outlines the clinical application of CBCT for assessment of treatment outcomes, and discusses current work to superimpose digital dental models and 3D photographs. Superimposition of CBCTs on stable structures of reference now allow assessment of 3D dental, skeletal and soft tissue changes for both growing and non-growing patients. Additionally, we describe clinical findings from CBCT superimpositions in assessment of surgery and skeletal anchorage treatment.
Cevidanes, Lucia H.C.; Oliveira, Ana Emilia Figueiredo; Grauer, Dan; Styner, Martin; Proffit, William R.
Objective To describe the long-term influence of meniscectomy on pain, functional limitations, and muscular performance. To assess the effects of radiographic osteoarthritis (OA), gender and age on these outcomes in patients with meniscectomy.Design 159 subjects (35 women), mean age 53 years, were examined 19 (17–22) years after open meniscectomy. Self-reported symptoms and function were assessed, performance tests were carried out
E. M. Roos; A. Östenberg; H. Roos; C. Ekdahl; L. S. Lohmander
Abstract The aim of this study was to determine functional connectivity among patients with pediatric bipolar disorder (PBD) who are responders to pharmacotherapy and those who are nonresponders, and learn how they differ from healthy controls (HC) while performing a task that engages affective and cognitive neural systems. PBD participants (n=34; 13.4±2.3 years) were defined as responders if there was ?50% improvement in Young Mania Rating Scale (YMRS) scores (n=22) versus nonresponders with <50% improvement (n=12) with one of three mood stabilizing medications (divalproex, risperidone, or lamotrigine). HC (n=14; 14.2±3.1 years) participants also were scanned at baseline and follow-up. During functional magnetic resonance imaging, participants performed a color-matching task in which they had to match the color of positive, negative, or neutral words with colored dots. Independent component analysis was used to identify functionally connected networks across the whole brain, which were subsequently interrogated using region-of-interest analyses to test for group differences. A frontolimbic network was identified that showed impaired functional integration in PBD relative to HC when participants viewed negatively valenced words. PBD medication responders showed greater connectivity of the amygdala into the network before and after treatment compared with nonresponders, with responders showing a pattern more similar to HC than to nonresponders. Regardless of medication type, the degree of amygdala functional connectivity predicted medication response as well as the improvement in YMRS scores across responders and nonresponders. These findings suggest that increased functional integration of the amygdala within the frontolimbic network might be a biomarker of general mood stabilizer medication responsivity in bipolar disorder.
Wegbreit, Ezra; Ellis, James A.; Nandam, Aneesh; Fitzgerald, Jacklynn M.; Passarotti, Alessandra M.; Stevens, Michael C.
Prognostic models applied in medicine must be validated on independent samples, before their use can be recommended. The assessment of calibration, i.e., the model's ability to provide reliable predictions, is crucial in external validation studies. Besides having several shortcomings, statistical techniques such as the computation of the standardized mortality ratio (SMR) and its confidence intervals, the Hosmer-Lemeshow statistics, and the Cox calibration test, are all non-informative with respect to calibration across risk classes. Accordingly, calibration plots reporting expected versus observed outcomes across risk subsets have been used for many years. Erroneously, the points in the plot (frequently representing deciles of risk) have been connected with lines, generating false calibration curves. Here we propose a methodology to create a confidence band for the calibration curve based on a function that relates expected to observed probabilities across classes of risk. The calibration belt allows the ranges of risk to be spotted where there is a significant deviation from the ideal calibration, and the direction of the deviation to be indicated. This method thus offers a more analytical view in the assessment of quality of care, compared to other approaches. PMID:21373178
Finazzi, Stefano; Poole, Daniele; Luciani, Davide; Cogo, Paola E; Bertolini, Guido
Purpose Ependymoma is less commonly found in the supratentorial brain and has known clinical and molecular features that are unique. Our single institution series provides valuable information about disease control for supratentorial ependymoma and the complications of supratentorial irradiation in children. Methods and Materials A total of 50 children with newly diagnosed supratentorial ependymoma were treated with adjuvant radiation therapy (RT); 36 were using conformal methods after 1996. The median age at RT was 6.5 years (range, 1–18.9). The entire group was characterized according to sex (girls = 27), race (Caucasian = 43), extent of resection (gross-total = 46), and tumor grade (anaplastic = 28). The conformal RT group was prospectively evaluated for neurological, endocrine and cognitive effects. Results With a median follow-up of 9.1 years from the start of RT for survivors (range 0.2–23.2), the 10-year progression-free and overall survival were 73% + 7% and 76% + 6%, respectively. None of the evaluated factors was prognostic for disease control. Local and distant failures were evenly divided among the 16 patients who experienced progression. Eleven patients died from disease and one from CNS necrosis. Seizure disorders were present in 17 patients and 4 were considered to be clinically disabled. Clinically significant cognitive effects were limited to children with difficult to control seizures. Average values for IQ and academic achievement (reading, spelling, and math) were within the range of normal through 10 years of follow-up. Central hypothyroidism was the most commonly treated endocrinopathy. Conclusion RT may be administered with acceptable risks for complications in children with supratentorial ependymoma. These results suggest that outcomes for these children are improving and that complications may be limited by use of focal irradiation methods.
Landau, Efrat; Boop, Frederick A.; Conklin, Heather M.; Wu, Shengjie; Xiong, Xiaoping; Merchant, Thomas E.
URSSA is the Undergraduate Research Student Self-Assessment, an online survey instrument for programs and departments to use in assessing the student outcomes of undergraduate research (UR). URSSA focuses on what students learn from their UR experience, rather than whether they liked it. The online questionnaire includes both multiple-choice and open-ended items that focus on students' gains from undergraduate research. These gains include skills, knowledge, deeper understanding of the intellectual and practical work of science, growth in confidence, changes in identity, and career preparation. Other items probe students' participation in important research-related activities that lead to these gains (e.g. giving presentations, having responsibility for a project). These activities, and the gains themselves, are based in research and thus constitute a core set of items. Using these items as a group helps to align a particular program assessment with research-demonstrated outcomes. Optional items may be used to probe particular features that are augment the research experience (e.g. field trips, career seminars, housing arrangements). The URSSA items are based on extensive, interview-based research and evaluation work on undergraduate research by our group and others. This grounding in research means that URSSA measures what we know to be important about the UR experience The items were tested with students, revised and re-tested. Data from a large pilot sample of over 500 students enabled statistical testing of the items' validity and reliability. Optional items about UR program elements were developed in consultation with UR program developers and leaders. The resulting instrument is flexible. Users begin with a set of core items, then customize their survey with optional items to probe students' experiences of specific program elements. The online instrument is free and easy to use, with numeric results available as raw data, summary statistics, cross-tabs, and graphs, and as raw, downloadable data. Finally, URSSA has high content validity based on its research grounding and rigorous development. We will present examples of how URSSA has been used in evaluations of UR programs. A multi-year evaluation of a university-based UR program shows that URSSA items are sensitive to differences in students' prior level of experience with research. For example, experienced student researchers reported greater gains than did their peers new to UR in understanding the process of research and in coming to see themselves as scientists. These differences are consistent with interview data that suggest a developmental progression of gains as students pursue research and gain confidence in their ability to contribute meaningfully. A second example comes from a multi-site evaluation of sites funded by the National Science Foundation's Research Experience for Undergraduates (REU) program in Biology. This study acquired data from nearly 800 students at some 60 Bio REU sites in 2010 and 2011. Results reveal differences in gains among demographic groups, and the general strength of these well-planned programs relative to a comparison sample of UR programs that are not part of REU. Our presentation will demonstrate the evaluative use of URSSA and its potential applications to undergraduate research in the geosciences.
Laursen, S. L.; Weston, T. J.; Thiry, H.
There are multiple imaging modalities available for the assessment of pregnant women with known or suspected cardiac disease. Because of its safety and general availability, echocardiography is the preferred study of choice for the evaluation of ventricular function, valvular heart disease, congenital heart disease, evaluation of the aorta, and the estimation of cardiac hemodynamics in a pregnant patient. Cardiac MRI can be performed, especially for diseases of the aorta and complex congenital heart disease. Radiation exposure for the fetus and the mother will be discussed in the use of CT angiography, nuclear imaging, and left-heart catheterization including coronary angiography for specific indications in the pregnant woman. The use of exercise testing during pregnancy for functional assessment will be presented. PMID:25037513
Waksmonski, Carol A
Prevalence of heart failure with preserved left ventricular ejection fraction amounts to 50% of all cases with heart failure.\\u000a Diagnosis assessment requires evidence of left ventricular diastolic dysfunction. Currently, echocardiography is the method\\u000a of choice for diastolic function testing in clinical practice. Various applications are in use and recommended criteria are\\u000a followed for classifying the severity of dysfunction. Cardiovascular magnetic
Jos J. M. Westenberg
Purpose Good cancer pain control requires appropriate assessment and treatment. The purpose of this study was to examine the relationships among physician, nurse practitioner, and nurse knowledge, documentation of assessment, treatment, and pain reduction in cancer patients seen in ambulatory settings. Method The study method included an assessment of pain knowledge of providers (physicians, nurse practitioners, and nurses) who worked in cancer clinics and a retrospective review of patients' records treated for cancer-related pain in their clinics. Fifty-eight providers from eight cancer clinics completed the knowledge questionnaire; 56 patient records were reviewed for assessment, treatment, and outcome data. Pain relief, the outcome, was obtained from documentation at the next clinic visit. Results Of the 54 patient records that documented pain relief at the next clinic visit, 61.9% reported no relief. Chi square analysis revealed clinics with a higher level of pain knowledge documented a greater number of elements of an ideal pain assessment (p=0.03) but was unrelated to treatment and pain relief reported. Assessment and treatment were unrelated to reported pain relief at the next clinic visit. Conclusion These data suggest that providers' pain knowledge is related to pain assessment but not treatment or outcome. In addition, these data showed no relationship between assessment, treatment prescribed, and pain relief in these ambulatory settings.
Wells, Nancy; McDowell, M. Rachel; Hendricks, Patty; Dietrich, Mary S.; Murphy, Barbara
Background Following the onset of focal ischemic stroke, the brain experiences a series of alterations including infarct evolvement, cellular proliferation in the penumbra, and behavioral deficits. However, systematic study on the temporal and spatial dependence of these alterations has not been provided. Results Using multiple approaches, we assessed stroke outcomes by measuring brain injury, dynamic cellular and glial proliferation, and functional deficits at different times up to two weeks after photothrombosis (PT)-induced ischemic stroke in adult mice. Results from magnetic resonance imaging (MRI) and Nissl staining showed a maximal infarction, and brain edema and swelling 1–3 days after PT. The rate of Bromodeoxyuridine (Brdu)-labeled proliferating cell generation is spatiotemporal dependent in the penumbra, with the highest rate in post ischemic days 3–4, and higher rate of proliferation in the region immediate to the ischemic core than in the distant region. Similar time-dependent generation of proliferating GFAP+ astrocytes and Iba1+ microglia/macrophage were observed in the penumbra. Using behavioral tests, we showed that PT resulted in the largest functional deficits during post ischemic days 2–4. Conclusion Our study demonstrated that first a few days is a critical period that causes brain expansion, cellular proliferation and behavioral deficits in photothrombosis-induced ischemic model, and proliferating astrocytes only have a small contribution to the pools of proliferating cells and reactive astrocytes.
There is little debate about the importance of preparing nursing graduates to provide culturally sensitive care to an increasingly diverse society. However, it is difficult for nurse educators to fit learning experiences that help students develop cultural competence into already full programs and create mechanisms to evaluate the results. This article describes a study to assess the impact of a study abroad program on developing cultural competence, including cultural awareness, sensitivity, knowledge, and skills. Results from the Cultural Awareness Survey, reflective journals, and interviews illustrate how the study abroad experience influenced the development of components of cultural competence and might influence clinical practice. Results suggest effective teaching strategies to assist students in becoming culturally competent are experiential in nature and include role modeling, reflective activities, and group discussion. PMID:22616405
Carpenter, Linda J; Garcia, Alexandra A
Objectives External counterpulsation (ECP) is a non-invasive method being investigated for ischaemic stroke. We aimed to explore predictors of good functional outcome for ECP-treated ischaemic stroke patients who completed a minimum of 10 sessions. Methods We analysed our ECP registry of ischaemic stroke patients with cerebral large artery stenosis who underwent ECP therapy at the Prince of Wales Hospital from 2004 to 2010. We included 155 patients who completed at least 10 sessions of ECP and had 3-month follow-up data as well as 52 medical controls. Functional outcomes were dichotomised into good outcome (modified Rankin Scale (mRS) 0–2) and bad outcome (mRS 3–6). We compared the differences in two groups in terms of demographics, medical history and parameters of ECP treatment. Results At 3?months after stroke, 70.5% of patients who finished the whole course of ECP had a good outcome (only 46.5% in the unfinished group and 38.5% in the medical group). Among all 207 recruited cases, 119 (57.5%) patients had a good outcome at 3?months after stroke. Compared with the bad outcome group, patients in the good outcome group were younger and had a lower baseline National Institutes of Health Stroke Scale (NIHSS) and longer ECP therapy duration. Multivariate logistic regression showed that ECP duration (OR 1.032), baseline NIHSS (OR 0.734) and age (OR 0.961) were independent predictors for a favourable outcome. Conclusions Duration of ECP therapy is first found to be an important predictor for good outcome of ECP-treated ischaemic stroke patients, in addition to the well-known prognostic factors such as age and NIHSS.
Lin, Wenhua; Han, Jinghao; Chen, Xiangyan; Xiong, Li; Leung, Ho Wan; Leung, Thomas W; Soo, Yannie; Wong, Lawrence Ka Sing
OBJECTIVE To explore the associations of thigh computed tomography (CT)-derived measures of body composition with functional outcomes in patients with rheumatoid arthritis (RA). METHODS Patients with RA underwent bilateral mid-femoral quantitative CT for measurement of thigh fat area (TFA), muscle area (TMA), and muscle density (TMD). The associations of thigh composition measures with disability and physical performance, measured with the Health Assessment Questionnaire (HAQ), Valued Life Activities (VLA) scale, and Short Physical Performance Battery (SPPB), were explored for the total cohort and by gender, controlling for pertinent demographic, lifestyle, and RA disease and treatment covariates. RESULTS A total of 152 RA patients were studied. Among potential determinants of TMD, higher age, higher duration of sedentary activity, longer RA duration, higher tender joint count, higher serum IL-6 levels, use of glucocorticoids, and non-use of hydroxychloroquine were all significantly associated with lower TMD in multivariable modeling. RA characteristics accounted for 77% of the explainable variability in TMD. When co-modeled, higher TFA and lower TMD, but not lower TMA, were significantly and independently associated with higher HAQ scores, lower SF-36 total physical scores, lower composite SPPB scores, and a greater proportion of affected obligatory VLAs. CONCLUSIONS Thigh CT-derived measures of body composition, particularly fat area and muscle density, were strongly associated with disability and physical performance in RA patients, with RA disease features as potential determinants. Efforts to reduce fat and improve muscle quality may reduce disability in this population with impaired physical functioning.
Kramer, Henry R; Fontaine, Kevin R; Bathon, Joan M; Giles, Jon T
Introduction. Glottic carcinoma can be successfully diagnosed in its early stages and treated with high percentage of success. Organ preservation and optimal functional outcomes could be achieved with wide array of surgical techniques for early glottic cancer, including endoscopic approaches or open laryngeal preserving procedures, making surgery the preferred method of treatment of early glottic carcinoma in the last few years. Material and Methods. Prospective study was done on 59 patients treated for Tis and T1a glottic carcinoma over a one-year time period in a tertiary medical center. Patients were treated with endoscopic laser cordectomy (types II–IV cordectomies according to European Laryngological Society classification of endoscopic cordectomies) and open cordectomy through laryngofissure. Follow-up period was 60 months. Clinical and oncological results were followed postoperatively. Voice quality after the treatment was assessed using multidimensional voice analysis 12 months after the treatment. Results. There were no significant differences between oncological and functional results among two groups of patients, though complications were more frequent in patients treated with open cordectomy. Conclusion. Endoscopic laser surgery should be the first treatment of choice in treatment of early glottic carcinomas, though open approach through laryngofissure should be available for selected cases where anatomical factors present limiting adequate tumor removal.
Milovanovic, Jovica; Jotic, Ana; Djukic, Vojko; Pavlovic, Bojan; Trivic, Aleksandar; Krejovic-Trivic, Sanja; Milovanovic, Andjela; Milovanovic, Aleksandar; Artiko, Vera; Banko, Bojan
Prostate growth is dependent on circulating androgens, which can be influenced by hepatic function. Liver disease has been suggested to influence prostate cancer (CaP) incidence. However, the effect of hepatic function on CaP outcomes has not been investigated. A total of 1181 patients who underwent radical prostatectomy (RP) between 1988 and 2008 at four Veterans Affairs hospitals that comprise the
L L Bañez; R M Loftis; S J Freedland; J C Presti; W J Aronson; C L Amling; C J Kane; M K Terris
Industry has consistently identified lack of experience in manufacturing processes as one of the key competency gaps among new engineering graduates. This paper will discuss a laboratory based Manufacturing Processes course that provides hands-on manufacturing experience to students. In addition to standard theoretical concepts, the course uses team-based projects that help students gain hands-on experience with selected manufacturing processes. The projects start with simple components that can be made on a single machine such as a lathe or a mill, and progress to the manufacture and assembly of a fully functional mechanism. This approach introduces students to the issues involved in putting together a non-trivial assembly. Multiple evaluation tools including surveys, focus-groups, and actual observations, were used to determine the effectiveness of the approach used. The results indicate that this is an effective way of addressing industry concerns.
In the September 2010 issue of JGME, the Pediatric Milestones Working Group published "The Pediatrics Milestones: Conceptual Framework, Guiding Principles, and Approach to Development", a document that describes the construction of the first iteration of the Pediatric Milestones. These Milestones were developed by the Working Group as a group of practical behavioral expectations for each of the 52 sub-competencies. In constructing these Milestones, the authors were cognizant of the need to ground the Milestones themselves in evidence, theories or other conceptual frameworks that would provide the basis for the ontogeny of development for each sub-competency. During this next phase of the Milestones development, the process will continue with consultation with content experts and consideration of assessment of Milestones. We have described possible measurement tools, explored threats to validity, establishment of benchmarks, and possible approaches to reporting of performance. The vision of the Pediatrics Milestone Project is to understand the development of a pediatrician from entry into medical school through the twilight of a physician's career, and the work will require a collaborative effort of the undergraduate and graduate medical education communities, and the accrediting and certifying bodies. PMID:22132281
Hicks, Patricia J; Englander, Robert; Schumacher, Daniel J; Burke, Ann; Benson, Bradley J; Guralnick, Susan; Ludwig, Stephen; Carraccio, Carol
A growing body of research is investigating the potential contribution of mitochondrial function to the etiology of type 2 diabetes. Numerous in vitro, in situ, and in vivo methodologies are available to examine various aspects of mitochondrial function, each requiring an understanding of their principles, advantages, and limitations. This review provides investigators with a critical overview of the strengths, limitations and critical experimental parameters to consider when selecting and conducting studies on mitochondrial function. In vitro (isolated mitochondria) and in situ (permeabilized cells/tissue) approaches provide direct access to the mitochondria, allowing for study of mitochondrial bioenergetics and redox function under defined substrate conditions. Several experimental parameters must be tightly controlled, including assay media, temperature, oxygen concentration, and in the case of permeabilized skeletal muscle, the contractile state of the fibers. Recently developed technology now offers the opportunity to measure oxygen consumption in intact cultured cells. Magnetic resonance spectroscopy provides the most direct way of assessing mitochondrial function in vivo with interpretations based on specific modeling approaches. The continuing rapid evolution of these technologies offers new and exciting opportunities for deciphering the potential role of mitochondrial function in the etiology and treatment of diabetes.
Kane, Daniel A.; Lanza, Ian R.; Neufer, P. Darrell
Total pharyngolaryngectomy (PL) reconstruction with an ileocolon free flap not only restores swallowing but also provides potential for speech. We report our surgical technique, functional outcome and quality of life (QoL) of 17 (15 males and two females) patients who underwent total PL/voice reconstruction with an ileocolon free flap between 2004 and 2009. The patients were retrospectively reviewed and swallowing, speech and QoL evaluated. Speech intelligibility was assessed using Hirose and Chen scoring systems, in addition to sound spectrogram analysis. QoL was evaluated using the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) in conjunction with the disease-specific Head & Neck Cancer Module (QLQ-H&N35). The mean age of patients was 49 (range 35-69) years and the mean follow-up period was 22 (range 6-72) months. There was one partial flap failure and another flap was successfully salvaged. Swallowing function was achieved by 16 (94%) patients at 4 weeks, whilst 12 (71%) demonstrated moderate-to-excellent speech intelligibility. There were no cases of aspiration pneumonia. QLQ-C30 global QoL and functional subscales indicated patients had average-to-good functioning. Comparison of QLQ-H&N35 scores with EORTC reference values indicated our patients had greater difficulty with social contact, mouth opening and weight gain. Total PL/voice reconstruction with the ileocolon free flap is a viable option in selected patients, who desire autologous voice reconstruction. A low complication rate and reasonable QoL support this reconstructive method. PMID:21236743
Karri, Vasu; Yang, Ming-Chin; Chung, Kuo-Piao; Chen, Shih-Heng; Mardini, Samir; Chen, Hung-Chi
Presents a strategy for the curricular design and assessment of one multidisciplinary program goal: understanding human behavior. Discusses how to assess a desired outcome based on four specific areas: (1) organizational context; (2) articulation of a learning model; (3) program design and implementation; and (4) outcomes assessment. (Author/KDR)
Keith, Bruce; Meese, Michael J.; Efflandt, Scott; Malinowski, Jon C.; LeBoeuf, Joseph; Gallagher, Martha; Hurley, John; Green, Charles
Background: Many studies in literature have supported the role of wrist arthroscopy as an adjunct to the stable fixation of unstable intraarticular distal radial fractures. This article focuses on the surgical technique, indications, advantages, and results using wrist arthroscopy to assess articular reduction and evaluates the treatment of carpal ligament injuries and triangular fibrocartilage complex (TFCC) injuries in conjunction with the stable fixation of distal radial fractures. Materials and Methods: We retrospectively evaluated 27 patients (16 males and 11 females), who underwent stable fixation of intraarticular distal radial fractures with arthroscopic evaluation of the articular reduction and repair of associated carpal injuries. As per the AO classification, they were 9 C 1, 12 C2, 2 C3, 3 B 1, and 1 B2 fractures. The final results were evaluated by modified Mayo wrist scoring system. The average age was 41 years (range: 18-68 years). The average followup was of 26 months (range 24-52 months). Results: Five patients needed modification of the reduction and fixation after arthroscopic joint evaluation. Associated ligament lesions found during the wrist arthroscopy were TFCC tears (n=17), scapholunate ligament injury (n=8), and luno-triquetral ligament injury (n=1). Five patients had combined injuries i.e. included TFCC tear, scapholunate and/or lunotriquetral ligament tear. There were 20 excellent, 3 good, and 4 fair results using this score. Conclusion: The radiocarpal and mid carpal arthroscopy is a useful adjunct to stable fixation of distal radial fractures.
Khanchandani, Prakash; Badia, Alejandro
Our objective was to describe a new endpoint for amyotrophic lateral sclerosis (ALS), the Combined Assessment of Function and Survival (CAFS). CAFS ranks patients' clinical outcomes based on survival time and change in the ALS Functional Rating Scale-Revised (ALSFRS-R) score. Each patient's outcome is compared to every other patient's outcome, assigned a score, and the summed scores are ranked. The mean rank score for each treatment group can then be calculated. A higher mean CAFS score indicates a better group outcome. Historically, ALS clinical trials have assessed survival and function as independent endpoints. Combined endpoints have been used in other diseases to decrease the confounding effect of mortality on analysis of functional outcomes. We explored the application of a similar approach in ALS, the CAFS endpoint, which was used as a pre-specified secondary analysis in a phase II study of dexpramipexole. Those results and some hypothetical examples based on modeling exercises are presented here. CAFS is the primary endpoint of a dexpramipexole phase III study in ALS. In conclusion, the CAFS is a robust statistical tool for ALS clinical trials and appropriately accounts for and weights mortality in the analysis of function. PMID:23323713
Berry, James D; Miller, Robert; Moore, Dan H; Cudkowicz, Merit E; van den Berg, Leonard H; Kerr, Douglas A; Dong, Yingwen; Ingersoll, Evan W; Archibald, Donald
Numerous autoimmune-inflammatory rheumatic diseases have been associated with accelerated atherosclerosis or other types of vasculopathy leading to an increase in cardiovascular disease incidence. In addition to traditional cardiovascular risk factors, endothelial dysfunction is an important early event in the pathogenesis of atherosclerosis, contributing to plaque initiation and progression. Endothelial dysfunction is characterized by a shift of the actions of the endothelium toward reduced vasodilation, a proinflammatory and a proadhesive state, and prothrombic properties. Therefore, assessment of endothelial dysfunction targets this vascular phenotype using several biological markers as indicators of endothelial dysfunction. Measurements of soluble adhesion molecules (ICAM-1, VCAM-1, E-selectin), pro-thrombotic factors (thrombomodulin, von Willebrand factor, plasminogen activator inhibitor-1) and inflammatory cytokines are most often performed. Regarding the functional assessment of the endothelium, the flow-mediated dilatation of conduit arteries is a non-invasive method widely used in pathophysiological and interventional studies. In this review, we will briefly review the most relevant information upon endothelial dysfunction mechanisms and explorations. We will summarize the similarities and differences in the biological and functional assessments of the endothelium in different autoimmune diseases. PMID:24412013
Benhamou, Y; Bellien, J; Armengol, G; Gomez, E; Richard, V; Lévesque, H; Joannidès, R
The aim of this cross-sectional study was to investigate the association between sedative load and functional outcomes in community-dwelling older Australian men. A total of 1696 males aged ? 70 years, enrolled in the Concord Health and Ageing in Men Project, were studied. Participants underwent assessments during 2005-2007. Sedative load was computed using a published model. Outcomes included activities of daily living (ADL), instrumental activities of daily living (IADL), physical performance measures and a clinical diagnosis of cognitive impairment. Of the participants, 15.3% took medications with sedative properties. After adjusting for age, education, depressive symptoms and comorbidities, participants who took one medication with sedation as a prominent side effect (sedative load = 1) had odds ratio (OR) of 2.15 (95% confidence interval, CI: 1.20-3.85) for ADL disability, compared with participants with sedative load = 0. Participants who took at least one primary sedative or two medications with sedation as a prominent side effect (sedative load ? 2) had an OR of 1.55 (95% CI: 1.02-2.35) for IADL disability, compared with participants with sedative load = 0. The mean 6-m walking speed (P = 0.001) and grip strength (P = 0.003) were significantly different between sedative load groups in unadjusted models only. No association between sedative load and poorer performance on balance and chair stands tests or cognitive impairment was observed. Participants with sedative load of one were more likely to report ADL disability, whereas participants with sedative load of ?2 were more likely to report IADL disability. Higher sedative load was not associated with poorer physical performance or cognitive impairment in older Australian men. PMID:22849300
Gnjidic, Danijela; Le Couteur, David G; Hilmer, Sarah N; Cumming, Robert G; Blyth, Fiona M; Naganathan, Vasi; Waite, Louise; Handelsman, David J; Bell, John Simon; J S, Bell
A problem in the study and treatment of functional disability in schizophrenia is that factors other than competence (what one can do) can limit real-world performance (what one does). We examined predictors of the competence-performance discrepancy in both adaptive and interpersonal domains. Patients with schizophrenia (N = 96) were evaluated at baseline of a clinical treatment study. Discrepancy scores were created by considering each subject's competence relative to their real-world performance in interpersonal and adaptive behaviour domains. Logistic regression analyses revealed that for the interpersonal competence-performance discrepancy, living in a group home, better neurocognition, more time spent in the hospital since a first episode of psychosis, and a longer first hospitalization predicted a greater discrepancy between interpersonal competence and performance measures. For adaptive behaviour, shorter time since most recent hospitalization, more depressive symptoms, greater number of months of first hospitalization, older age at baseline, younger age at first hospitalization, and more time spent in the hospital since a first episode of psychosis predicted a greater adaptive competence-performance discrepancy. A different pattern of demographic and clinical features may limit the extent to which patients are deploying interpersonal versus adaptive skills in everyday life. PMID:21944429
Gupta, Maya; Bassett, Emma; Iftene, Felicia; Bowie, Christopher R
A systematic clinical analysis of skeletal muscle function is presented. Tests range from assessment of muscle weakness with a new hand-held dynamometer (the "Hammersmith Myometer") to studies of the contractile properties of the quadriceps and adductor pollicis muscles described in terms of the force generated at different frequencies of stimulation of the motor nerve, the force-sustaining capability and the time course of relaxation following a brief tetanus. A new measure of the energy-exchanging capacity of muscle is given by the Myothermogram (MTG - so named by analogy with the Electromyogram - EMG). The technique measures metabolic heat production in muscles when maximally activated by voluntary effort or electrical stimulation and the heat changes during sustained contractions. The MTG offers a practical means for assessing in normal and diseased human muscle the metabolic capacity, economy of force maintenance and fatigue mechanisms. Needle biopsy provides safe, rapid and repeatable access to muscle for diagnosis, studies of chemical energy exchange and the correlation of function and metabolism with constituent muscle fibre types. This approach provides a possible basis for recognising the functional disorder and for evaluating the effects of physiotherapy and drug treatments in patients with neuromuscular disorders. PMID:667414
Edwards, R H
An outcomes-based assessment instrument was devised to screen patients for learning problems that would impede patient education in cardiac rehabilitation. Criteria for seven barriers were established: hearing, language, cultural, religious, vision, cognitive, emotional). Points of data collection and a rationale for collection were identified.…
Hernandez, Teri L.; Rupnow, Jana M.; Currie, Kristi A.; Procious, James K.; Adams, Jenny
A broad range of health problems are related to disasters. Insight into these health problems is needed for targeted disaster management. Disaster health outcome assessment can provide insight into the health effects of disasters. During the 15th World Congress on Disaster and Emergency Medicine in Amsterdam (2007), experts in the field of disaster epidemiology discussed important aspects of disaster health
B. van den Berg; L. Grievink; K. Gutschmidt; T. Lang; S. Palmer; M. Ruijten; R. Stumpel; J. Yzermans
What difference do your career programs and services make in clients' lives? How do you know? Answer these questions and more. Learn a practical approach to learning outcomes assessment that helps you tell the story of your career programs and services, celebrate your successes, and continuously improve your practice. Within this monograph, you…
Makela, Julia Panke; Rooney, Gail S.
We developed a rubric to assess several of our department's undergraduate student learning outcomes (SLOs). Target SLOs include applications of principles of research methodology, using appropriate statistics, adherence to the Publication Manual of the American Psychological Association, and written communication skills. We randomly sampled 20…
Thaler, Nicholas; Kazemi, Ellie; Huscher, Crystal
The abative effects of a 10-min period of free access to a participant's most preferred edible on preference assessment outcomes was examined using a multielement design with three individuals diagnosed with autism. Four moderately preferred edible items were identified for each participant; access to these edibles was then regulated throughout…
Chappell, Nick; Graff, Richard B.; Libby, Myrna E.; Ahearn, William H.
Peer-assessed outcomes were examined at the end of treatment (14 months after study entry) for 285 children (226 boys, 59 girls) with attention deficit hyperactivity disorder (ADHD) who were rated by their classmates (2,232 classmates total) using peer sociometric procedures. All children with ADHD were participants in the Multimodal Treatment…
Hoza, Betsy; Gerdes, Alyson C.; Mrug, Sylvie; Hinshaw, Stephen P.; Bukowski, William M.; Gold, Joel A.; Arnold, L. Eugene; Abikoff, Howard B.; Conners, C. Keith; Elliott, Glen R.; Greenhill, Laurence L.; Hechtman, Lily; Jensen, Peter S.; Kraemer, Helena C.; March, John S.; Newcorn, Jeffrey H.; Severe, Joanne B.; Swanson, James M.; Vitiello, Benedetto; Wells, Karen C.; Wigal, Timothy
The goal of this article consists of describing the calibration of an instrument to assess quality of life-related personal outcomes using Rasch analysis. The sample was composed of 3.029 recipients of social services from Catalonia (Spain) and was selected using a probabilistic polietapic sample design. Results related to unidimensionality, item…
Gomez, Laura Elisabet; Arias, Benito; Verdugo, Miguel Angel; Navas, Patricia
This article explores the organizational impediments and facilitators that influence the implementation of student learning outcomes assessment (SLOA). This review points to the importance of culture, leadership, and organizational policies to the implementation of SLOA. However, we need to approach research differently, both conceptually and…
Introduction: Although there is increasing focus on provider behavior change as an outcome of continuing medical education (CME), it has long been known that an increase in knowledge alone is rarely sufficient to induce such change. The Personal Learning Plan (PLP), designed to motivate and assess CME learning, was partly derived from SMART goals…
Reed, Virginia A.; Schifferdecker, Karen E.; Turco, Mary G.
An analysis of results of treatment of 212 patients with peritonitis of different etiology allowed the author to establish main factors (clinical and laboratory), responsible for the level of lethality. A scheme of assessment of the outcome of the disease is proposed. It has advantages over the Mannheim Peritonitis Index. PMID:19241827
Gamzatov, Kh A
Fifty-eight recent graduates (1998-2008) from the joint Washington State University (WSU) and University of Idaho (UI) BiState School of Food Science program and 27 of their employers participated in a survey assessing learning outcomes based on the 2001 Institute of Food Technologists (IFT) core competencies for undergraduate food science…
Bohlscheid, Jeffri; Clark, Stephanie
A study investigated the extent to which alternate assessment scores for 41 12th-graders in Kentucky's Alternate Portfolio Program for students with significant disabilities correlated with a measure of post-school outcomes approximately one year after completing school. No significant relationship was found between these two measures. (Contains…
Kleinert, Harold L.; Garrett, Brent; Towles, Elizabeth; Garrett, Michelle; Nowak-Drabik, Karen; Waddell, Christina; Kearns, Jacqueline Farmer
The focus and purpose of master's degree student affairs preparation programs is to prepare students to become competent student affairs practitioners. Program assessments, especially those focused on outcomes are important metrics for understanding the role and impact of student affairs professional preparation programs. A well designed…
Kuk, Linda; Banning, James
In 1991, the New Jersey Board of Higher Education's College Outcomes Evaluation Program (COEP) was canceled due to lack of state funding. Despite the cancellation, 17 community colleges formed the New Jersey County College Project on General Education to develop goals, objectives, and assessment criteria for general education. The Project grounds…
Three findings emerged from 12 Hong Kong student nurses' descriptions of their experiences of portfolio assessment: (1) despite initial anxiety, all favored portfolio use; (2) portfolios had positive academic and affective outcomes; and (3) unexpectedly, spontaneous collaborative learning and increased motivation resulted. (Contains 35…
Tiwari, Agnes; Tang, Catherine
Colleges and universities throughout the country are increasingly coming under pressure from accrediting institutions and legislative bodies to implement comprehensive outcomes assessment initiatives designed to measure and document student performance. Over the past ten years pressure has been directed towards colleges to reshape their current…
Fleishman, Joseph H.
In the latest decades assessment in education has become a very controversial issue in many western countries, and especially so in the Nordic countries, where the controversy became most passionate in Norway. It was really not a debate about whether or not formal marks should be used in communication of educational outcomes for the individual…
The various assessment methods available to Political Science Departments each have their pros and cons. Standardized tests may be seen as an efficient and a less labor-intensive way to collect data on student-learning outcomes (SLOs), but these lack contextual information. Exit interviews and works collected from capstone courses may provide…
Cole, Alexandra; De Maio, Jennifer
Objective: This study examined intermediate outcomes of a faith-based prisoner reentry program by assessing how client spirituality related to client- and program-level characteristics, investigating differences between completers and terminators, and examining how religious preference, religiosity/spirituality, religious salience, and…
Roman, Caterina G.; Wolff, Ashley; Correa, Vanessa; Buck, Janeen
Develops a model whereby information literacy competencies are formally adopted as learning outcomes for an undergraduate business curriculum. The information competencies are some of the mission driven competencies developed by a College of Business Administration at a regional university in keeping with the Association to Advance Collegiate Schools of Business standards. In one class, develops an assessment instrument to measure
Ann M. Fiegen; Bennett Cherry; Kathleen Watson
This guide is intended for college and university administrators responsible for designing and implementing a model for assessment of student outcomes and institutional effectiveness. The first chapter explains use of the handbook and introduces the institutional effectiveness paradigm on which it is based. The second chapter explains the model…
Nichols, James O.
The use of case reports for assessing the developmental consequences of prenatal drug exposure is limited by the inability to determine the incidence of adverse outcomes and by the high likelihood for bias. Yet, because it is impossible to conduct clinical trials for the assessme...
The volume presents in detail the results of a study designed to develop outcome criteria and standards for use in assessing the quality of care delivered to patients with one of eight different conditions or surgical procedures. Eight chapters follow, on...
A. D. Avery L. J. Harris N. E. Solomon R. H. Brook T. Lelah
Our objective was to provide a synthesis of measurement properties for performance-based outcome measures used to evaluate physical function in children with haemophilia. A systematic review of articles published in English using Medline, PEDro, Cinahl and The Cochrane Library electronic databases was conducted. Studies were included if a performance-based method, clinical evaluation or measurement tool was used to record an aspect of physical function in patients with haemophilia aged ? 18 years. Recording of self-perceived or patient-reported physical performance, abstracts, unpublished reports, case series reports and studies where the outcome measure was not documented or cross-referenced was excluded. Description of outcome measures, patient characteristics, measurement properties for construct validity, internal consistency, repeatability, responsiveness and feasibility was extracted. Data synthesis of 41 studies evaluating 14 measures is reported. None of the outcome measures demonstrated the requirements for all the measurement properties. Data on validity and test-retest repeatability were most lacking together with studies of sufficient size. Measurement of walking and muscle strength demonstrated good repeatability and discriminative properties; however, correlation with other measures of musculoskeletal impairment requires investigation. The Haemophilia Joint Health Score demonstrated acceptable construct validity, internal consistency and repeatability, but the ability to discriminate changes in physical function is still to be determined. Rigorous evaluation of the measurement properties of performance-based outcome measures used to monitor physical function of children with haemophilia in larger collaborative studies is required. PMID:24252123
Stephensen, D; Drechsler, W I; Scott, O M
This paper focuses on deep and meaningful learning approaches and outcomes associated with online and blended communities of inquiry. Applying mixed methodology for the research design, the study used transcript analysis, learning outcomes, perceived learning, satisfaction, and interviews to assess learning processes and outcomes. The findings for…
Akyol, Zehra; Garrison, D. Randy
Background. Multiple regression is the best technique for the simultaneous analysis of the contributions of multiple risk factors to a surgical outcome. A probability analysis is used to determine the relative contribution of individual factors to the overall outcome being assessed. We used these techniques to determine which of the potential risk factors had the greatest impact on adverse outcomes
Edward H. Livingston; Clifford Y. Ko
PURPOSE This study was designed to evaluate rectocele repair using collagen mesh.METHODS 32 female patients underwent surgical repair using collagen mesh. Outcome was assessed in 29 patients and preoperative assessment included standardized questionnaire, clinical examination, and defecography. At the six-month follow-up, patients answered a standardized questionnaire and underwent clinical examination. At the 12-month follow-up, patients answered a standardized questionnaire, underwent clinical examination,
Daniel Altman; Jan Zetterström; Annika López; Bo Anzén; Christian Falconer; Fredrik Hjern; Anders Mellgren
Background Due to the osseous distribution of prostate cancer metastases, progression is more readily identified than response in prostate cancer clinical trials. As a result, there is an increased focus on progression free survival (PFS) as a phase II endpoint. PFS, however, is vulnerable to inter-study design variability. We sought to identify and quantify this variability and the resultant error in PFS across prostate cancer clinical trials. Methods We reviewed phase II clinical trials of cytotoxic agents in castrate metastatic prostate cancer over 5-years to evaluate the policies determining extent of disease and the definitions of disease progression. A simulation model was created to define the degree of error in estimating PFS in 3 hypothetical cohorts (median PFS of 12, 24, and 36 weeks) when the frequency of outcome assessments varies. Results Imaging policies for trial entry were heterogeneous, as were the type, timing, and indications for outcome assessments. In the simulation, error in the reported PFS varied according to the interval between assessments. The difference between the detected and the true PFS could vary as much as 6.4 weeks per cycle, strictly resulting from the variability of assessment schedules tested. Conclusions Outcome assessment policies are highly variable in phase II studies of castration-resistant prostate cancer patients, despite published guidelines designed to standardize authenticating disease progression. The estimated error in PFS can exceed 6 weeks per cycle, just due to variations in the assessment schedules. Comparisons of PFS times from different studies must be made with circumspection.
Gignac, Gretchen A.; Morris, Michael J.; Heller, Glenn; Schwartz, Lawrence H.; Scher, Howard I.
Background/Aim: Information about functional outcome and quality of life after esophagectomy and esophageal reconstruction (ER) for the treatment of esophageal cancer, as evaluated by the patients themselves is limited. We aimed to study the post-surgical outcome of such patients to detect for the development of any complications that may arise from the surgery as well as to evaluate their quality of life following the surgery. Methods: From 1993 to 2003, 240 patients with stage I, II, or III esophageal carcinoma underwent esophagectomy at Razi Teaching Hospital located in the north of Iran. Of these, 192 patients filled out a questionnaire during a 2-year period (ranging from 12 to 48 months after surgical reconstruction). Among them, there were 134 men (69%) and 58 women (31%), and the mean age at the time of ER was 48 years (ranging from 22 to 75 years). Transhiatal esophagectomy, extended esophagectomy (three field operation), and Ivor-Lewis resection were done in 142 (73.95%), 30 (15.62%), and 20 patients (10.42%), respectively. Intestinal continuity after esophageal resection was established with stomach in 154 patients (80%), colon in 28 patients (14%), and small bowel in 10 patients (5.2%). Cervical anastomosis was established in 172 patients (89.6%), while intrathoracic anastomosis was performed in 20 patients (10.4%). Results: After ER, 66 patients (34.4%) suffered from dysphagia to solids and 50 patients (26%) required at least one or three postoperative dilatations for alleviation of symptoms. Gastroesophageal reflux was seen in 32 patients (16.66%) and was more common in thoracic anastomosis patients than in cervical anastomosis patients. Heartburn was present in 33 cases (17%), 30 of whom required medication (37%). The number of meals per day was three to four in 116 patients (60%), more than four in 51 patients (29%), and less than three in 19 patients (9.82%). The number of bowel movement per day increased in 52 patients (27%), decreased in 60 cases (31%), and unchanged in 80 patients (41%). Weight gain was reported by 38 patients (19.8%), and weight loss was reported by 50 patients (26%). No change in weight occurred in 100 patients (52%). Overall satisfaction was excellent in 29 patients (15%). Overall quality of life (work, pain-relief, vitality, and emotional status) was lower than in general population. Age, sex, and stage of cancer did not affect the functional outcome but affected the quality of life. Also patients who received cervical anastomosis and ER with colon had significantly fewer reflux symptoms. Most of the patients with colon reconstruction gained weight. Conclusions: Self-assessment of postoperative ER by the patients after esophagectomy for malignant disease demonstrates that undesirable symptoms are frequently present at short- and long-term follow-ups. Short- and long-term functional outcome is affected by the type of reconstruction after esophagectomy. Results of this study suggest that colon graft in ER is significantly advantageous compared with other methods because of the ability of patients to gain weight and avoid developing postoperative reflux.
Aghajanzadeh, Manochehr; Safarpour, Feizollah; Koohsari, M. Reza; Ghanaei, Farborz M.; Bodaghi, Sadigheh M.; Tozandehgani, Hadi
BackgroundRelationships between early deficits of lung function, infant airway pathology and outcome in symptomatic infants are unclear. A study was undertaken to determine the associations between early lung function, airway histology and inflammation in symptomatic infants with the continuance of respiratory symptoms, lung function and subsequent use of inhaled asthma medication at the age of 3 years.Methods53 children who underwent
Kristiina Malmström; Anna S Pelkonen; L Pekka Malmberg; Seppo Sarna; Harry Lindahl; Merja Kajosaari; Markku Turpeinen; Sejal Saglani; Andy Bush; Tari Haahtela; Peter K Jeffery; Mika J Mäkelä
Background: This study investigates the role of IQ, autistic traits and challenging behaviours in affecting adult outcomes among adolescents who receive special educational assistance. Methods: A total of 58 participants were recruited from an ongoing longitudinal study. All received assessments of IQ, behavioural patterns (using the Childhood…
McGeown, H. R.; Johnstone, E. C.; McKirdy, J.; Owens, D. C.; Stanfield, A. C.
Longitudinal growth patterns are routinely seen in medical studies where individual growth and population growth are followed up over a period of time. Many current methods for modeling growth presuppose a parametric relationship between the outcome and time (e.g., linear and quadratic); however, these relationships may not accurately capture growth over time. Functional mixed-effects (FME) models provide flexibility in handling longitudinal data with nonparametric temporal trends. Although FME methods are well developed for continuous, normally distributed outcome measures, nonparametric methods for handling categorical outcomes are limited. We consider the situation with binomially distributed longitudinal outcomes. Although percent correct data can be modeled assuming normality, estimates outside the parameter space are possible, and thus, estimated curves can be unrealistic. We propose a binomial FME model using Bayesian methodology to account for growth curves with binomial (percentage) outcomes. The usefulness of our methods is demonstrated using a longitudinal study of speech perception outcomes from cochlear implant users where we successfully model both the population and individual growth trajectories. Simulation studies also advocate the usefulness of the binomial model particularly when outcomes occur near the boundary of the probability parameter space and in situations with a small number of trials. Copyright © 2014 John Wiley & Sons, Ltd. PMID:24723495
Kliethermes, Stephanie; Oleson, Jacob
Executive functioning (EF) is examined among children and adolescents once diagnosed with an autism spectrum disorder (ASD), but who no longer meet diagnostic criteria. These individuals have average social and language skills, receive minimal school support and are considered to have achieved "optimal outcomes" (OOs). Since residual impairments in these individuals might be expected in deficits central to autism, and in developmentally advanced skills, EF was examined in 34 individuals who achieved OOs, 43 individuals with high-functioning autism (HFA), and 34 typically developing (TD) peers. Groups were matched on age (M = 13.49), gender, and nonverbal IQ (NVIQ) but differed on verbal IQ (VIQ; HFA < TD, OO). On direct assessment, all three groups demonstrated average EF; however, the OO and HFA groups exhibited more impulsivity and less efficient planning and problem-solving than the TD group, and more HFA participants exhibited below average inhibition than did OO and TD participants. Parent-report measures revealed average EF among the OO and TD groups; however, the OO group exhibited more difficulty than the TD group on set-shifting and working memory. HFA participants demonstrated more difficulty on all parent-reported EF domains, with a clinical impairment in attention-shifting. Results suggest that EF in OO appears to be within the average range, even for functions that were impaired among individuals with HFA. Despite their average performance, however, the OO and TD groups differed on measures of impulsivity, set-shifting, problem-solving, working memory, and planning, suggesting that the OO group does not have the above-average EF scores of the TD group despite their high-average IQs. PMID:23731181
Troyb, Eva; Rosenthal, Michael; Eigsti, Inge-Marie; Kelley, Elizabeth; Tyson, Katherine; Orinstein, Alyssa; Barton, Marianne; Fein, Deborah
The capacity of the blood enzyme glutamate oxaloacetate transaminase (GOT) to remove glutamate from the brain by means of blood glutamate degradation has been shown in experimental models to be an efficient and novel neuroprotective tool against ischemic stroke; however, the beneficial effects of this enzyme should be tested in patients with stroke to validate these results. This study aims to investigate the association of GOT levels in blood with clinical outcome in patients with acute ischemic stroke. In two clinical independent studies, we found that patients with poor outcome show higher glutamate and lower GOT levels in blood at the time of admission. Lower GOT levels and higher glutamate levels were independently associated with poorer functional outcome at 3 months and higher infarct volume. These findings show a clear association between high blood glutamate levels and worse outcome and vice versa for GOT, presumably explained by the capacity of this enzyme to metabolize blood glutamate. PMID:21266984
Campos, Francisco; Sobrino, Tomás; Ramos-Cabrer, Pedro; Castellanos, Mar; Blanco, Miguel; Rodríguez-Yáñez, Manuel; Serena, Joaquín; Leira, Rogelio; Castillo, José
In Alzheimer's disease (AD), placebo-controlled long-term studies of cholinesterase inhibitors (ChEIs) are not permitted for ethical reasons. Therefore, in these studies, patients' outcomes on cognitive and functional assessment scales must be compared with mathematical models or historical data from untreated cohorts. PubMed and previously published long-term extensions of clinical trials and naturalistic studies of ChEIs were examined to identify empirical statistical models and other approaches, such as use of data from historical cohorts or extrapolated changes from extension studies, that were used to draw comparisons between ChEI-treated and untreated patients. The models and methods were described. It is essential to be aware of the limitations of comparisons made with these approaches. Prediction models based on ChEI-treated patients can be used in the studies of new treatments when those treatments are added to ChEIs. More sophisticated models that also accommodate patient-specific characteristics should be developed for comparisons in future long-term AD studies. PMID:23689074
The IFFANIAM study (Impact of frailty and functional status in elderly patients with ST segment elevation myocardial infarction undergoing primary angioplasty) is an observational multicenter registry to assess the impact of frailty and functional status on outcomes of elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty. STEMI patients age 75 years or older undergoing primary angioplasty will be extensively studied during admission in 4 tertiary care Hospitals in Spain, assessing their baseline functional status (Barthel index, Lawton-Brody index), frailty (Fried criteria, FRAIL scale [fatigue, resistance, ambulation, illnesses, and loss of weight]), comorbidities (Charlson index), nutritional status (Mini Nutritional Assessment-Short Form), and quality of life (Seattle Angina Questionnaire). Participants will be managed according current recommendations. The primary outcome will be the description of 1-year mortality, its causes, and associated factors. Secondary outcomes will be functional capacity and quality of life. Results will help to better understand the impact of frailty and functional ability on outcomes in elderly STEMI patients undergoing primary angioplasty, thus potentially contributing to improving their clinical management. Higher life expectancy has resulted in a large segment of elderly population and an increase in myocardial infarction in these patients. This calls attention to healthcare systems to focus on promoting methods to improve the clinical management of this population. PMID:24114768
Ariza-Solé, Albert; Formiga, Francesc; Vidán, Maria T; Bueno, Héctor; Curós, Antoni; Aboal, Jaime; Llibre, Cinta; Rueda, Ferran; Bernal, Eva; Cequier, Angel
Hallux valgus is one of the commonest conditions of the foot and has been reported to affect nearly half of the adult population. It is most effectively treated by a corrective osteotomy of which there a numerous subtypes. The Mau osteotomy confers the greatest structural stability but is not thought to provide adequate correction of moderate-severe deformities. Accordingly, complications such as under correction and non-union are common. The aim of this study was to determine the functional outcome in patients with moderate-severe hallux valgus following a Mau osteotomy. A retrospective review of 23 patients with moderate-severe hallux valgus treated by Mau osteotomy was conducted. Patients were assessed clinically by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system and radiologically by measuring the first intermetatarsal (IM) and hallux abductovalgus angles (HAV). The mean AOFAS score had improved from 47 preoperatively to 92 postoperatively (P<0.01). Additionally, preoperative HAV and IM angles improved from 39o and 15o respectively to 15o and 9o respectively (P<0.01). There were no cases of undercorrection or non-union. In this series, the Mau osteotomy was able to achieve good correction of the IM and HAV angles in patients with moderate-severe hallux valgus. This was reflected in a significantly higher postoperative AOFAS score. Contrary to other studies there were no cases of undercorrection and despite allowing patients to fully weight-bear postoperatively there were no cases of non-union.
Thangarajah, Tanujan; Ahmed, Usman; Malik, Shahbaz; Tillu, Abhay
We prospectively followed an ethnically and socioeconomically diverse sample of preadolescent girls with ADHD (n?=?140) and matched comparison girls (n?=?88) over a period of 10 years, from middle childhood through late adolescence/young adulthood. Our aim was to examine the ability of childhood measures of executive function (EF) to predict functional outcomes at follow-up. Measures of EF comprised the childhood predictors, with academic, socioemotional, occupational, and global functioning serving as young adult criterion measures. Results indicated that childhood EF - particularly measures of global EF and working memory - predicted academic and occupational functioning across our entire sample (independent of diagnostic group status), but diagnostic status (ADHD versus comparison) moderated the association between (a) working memory and reading achievement and (b) a global EF measure and suspensions/expulsions. That is, in the ADHD group, low working memory predicted poor reading scores and impaired global EF predicted higher suspensions/expulsions, but this was not the case in the comparison group. Overall, these results extend previous findings of associations between EF and adolescent outcomes in girls with and without ADHD into young adulthood. Findings continue to suggest the importance of assessing and developing interventions that target EF impairments early in life in order to prevent long-term difficulties across a range of important functional domains. PMID:22124540
Miller, Meghan; Nevado-Montenegro, Adriana J; Hinshaw, Stephen P
The ASSESS Neutralization module (Neutralization) is part of the Analytic System and Software for Evaluation of Safeguards and Security (ASSESS), a vulnerability assessment tool. Neutralization models a fire fight between security inspectors (SIs) and adversaries. This paper reports that a comparison has been made between actual outcomes of police and small military engagements and the results predicted by the Neutralization module for similar scenarios. The results of this comparison show a surprising correlation between predicted outcomes (based on numbers of combatants, weapon types, and exposures, etc.) and the actual outcomes of the engagements analyzed. The importance of this analysis is that given the defenders have intelligence on actual adversary characteristics or are protecting against a design basis threat, defense capabilities can be evaluated before an engagement. Results could then be used to develop a favorable probability of a desired outcome. For example, law enforcement agencies are frequently able to compile the number of criminals, types of weaponry, willingness to use force, etc., from analysis of crime scenes.
Gardner, B.H.; Snell, M.K.; Paulus, W.K. (Sandia National Labs., Albuquerque, NM (United States))
Objective: 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. Method: 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). Results: 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. Conclusions: 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. Citation: Bandla H; Franco RA; Simpson D; Brennan K; McKanry J; Bragg D. Assessing learning outcomes and cost effectiveness of an online sleep curriculum for medical students. J Clin Sleep Med 2012;8(4):439-443.
Bandla, Hari; Franco, Rose A.; Simpson, Deborah; Brennan, Kimberly; McKanry, Jennifer; Bragg, Dawn
Dixon and Johnson (Analysis of Gambling Behavior 2007, 1:44-49) introduced the Gambling Functional Assessment (GFA), which attempts to identify the consequences that may be maintaining a person's gambling behavior. The present study had 949 introductory psychology students complete the GFA, with 124 of them completing the measure a second time 12 weeks later. Measures of internal consistency were quite good regardless of whether "non-gamblers" were included or excluded. Test-retest reliability was somewhat mixed, with Escape scores yielding substandard coefficients, especially among females. Both internal and test-retest reliability were typically poorer for female respondents. In general, the GFA performed within the limits of acceptable reliability, and coefficients compared favorably with similar measures. Future investigations will need to determine the reliability and validity of the instrument, especially as it pertains to its intended population, pathological gamblers. PMID:18810609
Miller, Joseph C; Meier, Ellen; Weatherly, Jeffrey N
Objectives To determine whether cognitive behavioral social skills training (CBSST) is an effective psychosocial intervention to improve functioning in older consumers with schizophrenia, and whether defeatist performance attitudes are associated with change in functioning in CBSST. Design An 18-month, single-blind, randomized controlled trial. Setting Outpatient clinic at a university-affiliated Veterans Affairs hospital. Participants Veteran and non-veteran consumers with schizophrenia or schizoaffective disorder (N=79) age 45–78. Interventions CBSST was a 36-session, weekly group therapy that combined cognitive behavior therapy with social skills training and problem solving training to improve functioning. The comparison intervention, goal-focused supportive contact (GFSC), was supportive group therapy focused on achieving functioning goals. Measurements Blind raters assessed functioning (primary outcome: Independent Living Skills Survey) CBSST skill mastery, positive and negative symptoms, depression, anxiety, defeatist attitudes, self-esteem, and life satisfaction. Results Functioning trajectories over time were significantly more positive in CBSST than in GFSC, especially for participants with more severe defeatist performance attitudes. Greater improvement in defeatist attitudes was also associated with better functioning in CBSST, but not GFSC. Both treatments showed comparable significant improvements in amotivation, depression, anxiety, positive self-esteem and life satisfaction. Conclusions CBSST is an effective treatment to improve functioning in older consumers with schizophrenia, and both CBSST and other supportive goal-focused interventions can reduce symptom distress, increase motivation and self esteem, and improve life satisfaction. Participants with more severe defeatist performance attitudes may benefit most from cognitive behavioral interventions that target functioning.
Granholm, Eric; Holden, Jason; Link, Peter C.; McQuaid, John R.; Jeste, Dilip V.
We asked patients to assess their functional health status by completing the SF-36. Over 2 years, we studied 1,000 patients (average age, 58 years; 50% male; 25% white; 36% diabetic) in three outpatient, staff-assisted hemodialysis units. We used both the eight-scale scores and two-component summary scores to study the relationship between baseline functional health status and clinical outcomes. The physical
Peter B. DeOreo
Objective: To determine the evidence for physical therapy interventions aimed at improving functional outcome after stroke.Methods: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, PEDro, EMBASE and DocOnline were searched for controlled studies. Physical therapy was divided into 10 intervention categories, which were analysed separately. If statistical pooling (weighted summary effect sizes) was not
R PS Van Peppen; G Kwakkel; S Wood-Dauphinee; H JM Hendriks; Ph J Van der Wees; J Dekker
In (10), Kalai investigated the probability of a rational outcome for a generalized social welfare function (GSWF) on three alternatives, when the individual preferences are uni- form and independent. In this paper we generalize the results of (10) to a wider class of distributions of the individual preferences, and obtain new lower and upper bounds for the probability of a
The authors investigated 8 specific forms of social aggression (SA) in terms of the functions they serve, the characteristics of the peers targeted by them, and the outcomes associated with using the behaviors. Two hundred and seventeen fifth- and seventh-grade boys and girls completed a structured daily diary for 5 consecutive days in their…
Dyches, Karmon D.; Mayeux, Lara
We present our experience with 30 patients on functional outcomes of patients with anoxic brain injury (ABI, n=15) due to cardiac etiologies from freestanding inpatient rehabilitation hospital. A convenience sample of patient with traumatic brain injury (TBI, n=15) with similar demographic characteristic to ABI was used for comparison on indices of activity of daily living, cognition, mobility as well as
Mrugeshkumar K. Shah; Alexios G. Carayannopoulos; David T. Burke; Samir Al-Adawi
Purpose: Neurogenic thoracic outlet syndrome (NTOS) in the absence of bony and electrodiagnostic abnormalities, often referred to as disputed NTOS, remains enigmatic. Optimal treatment, especially the role of surgery, is controversial. The long-term functional outcome of a cohort of patients undergoing independent medical examination for disputed NTOS with symptoms sufficiently severe to cause inability to work forms the basis for
Gregory J. Landry; Gregory L. Moneta; Lloyd M. Taylor; James M. Edwards; John M. Porter
Purpose: We performed a retrospective review of our database to evaluate surgical and functional outcomes in men undergoing radical perineal prostatectomy (RPP) versus radical retropubic prostatectomy (RRP) after previous prostate surgery. Patients and Methods: A total of 616 men underwent RPP at our institution. A retrospective review of these patients showed that 59 had a history of previous surgical approach
Vittorio Imperatore; Francesco Cantiello; Ferdinando Fusco; Mariateresa Iannuzzo; Sergio Di Meo; Ciro Imbimbo; Vincenzo Mirone
The authors investigated 8 specific forms of social aggression (SA) in terms of the functions they serve, the characteristics of the peers targeted by them, and the outcomes associated with using the behaviors. Two hundred and seventeen fifth- and seventh-grade boys and girls completed a structured daily diary for 5 consecutive days in their English classes. Participants reported on their
Karmon D. Dyches; Lara Mayeux
With medical advances, more individuals with cerebral palsy (CP) syndromes who reside in developed countries are surviving to adolescence and adulthood. However, there continues to be a paucity of research examining long-term health, functional activities, and participatory outcomes over their life-course. This article reviews the current…
Frisch, Dana; Msall, Michael E.
Although asthma is characterized as an inflammatory disease, recent reports highlight the importance of pulmonary physiology outcome measures to the clinical assessment of asthma control and risk of asthma exacerbation. Murine models of allergic inflammatory airway disease have been widely used to gain mechanistic insight into the pathogenesis of asthma; however, several aspects of murine models could benefit from improvement. This review focuses on aligning lung mechanics measures made in mice with those made in humans, with an eye toward improving the translational utility of these measures. A brief description of techniques available to measure murine lung mechanics is provided along with a methodological consideration of their utilization. How murine lung mechanics outcome measures relate to pulmonary physiology measures conducted in humans is discussed and we recommend that, like human studies, outcome measures be standardized for murine models of asthma.
Walker, Julia K. L.; Kraft, Monica; Fisher, John T.
Testing for outcome or performance can take many forms; including multiple iterations of self-reported measures of function (an assessment of the individual’s perceived dysfunction) and/or clinical special tests (which are primarily assessments of impairments). Typically absent within these testing mechanisms is whether or not one can perform a specific task associated with function. The paper will operationally define function, discuss the construct of function within the disablement model, will overview the multi-dimensional nature of ‘function’ as a concept, will examine the current evidence for functional testing methods, and will propose a functional testing continuum. Limitations of functional performance testing will be discussed including recommendations for future research.
Reiman, Michael P; Manske, Robert C
Background Restorative proctocolectomy with ileopouch-anal anastomosis (IPAA) is the treatment of choice for intractable or complicated ulcerative colitis (UC). Debate exists concerning outcomes of IPAA in the elderly and literature data are scarce. We report our experience of IPAA in older population. Methods We gathered data on a prospective database of patients undergoing IPAA for UC over 70 years of age in our Unit from January 1990 through January 2010. Patients were compared with randomly selected younger controls on a 1:3 ratio. Patients underwent IPAA in 2 or 3 stages. Demographical data, disease characteristics, comorbidities, concomitant medications, peri-operative management, intra- and post-operative complications were analyzed. Function and quality of life were assessed by clinical visit and Inflammatory Bowel Disease Questionnaire 1 and 3 years after ileostomy takedown. Results Twenty-seven elderly patients underwent IPAA for UC in the study period; these were compared with 81 younger controls. The former had more comorbidities and higher ASA score. All patients underwent loop-ileostomy closure. There were no differences between groups concerning the rate of major complications, but elderly patients more frequently had nuisances due to stoma output. Younger patients experienced significantly more episodes of small bowel obstruction. No significant differences in bowel control and health-related quality of life was observed, except for an higher rate of elderly patients taking antidiarrhoeals at 1-year follow-up; this observation was not confirmed at 3-year follow-up. A minimal decrease in continence was observed, but this did not affect overall satisfaction. Conclusions IPAA can be safely offered to selected elderly UC patients who are strongly motivated and with no clinical disturbances of continence. In experienced hands no differences are likely to be expected concerning complications, quality of life and function. Results are stable with time and comparable to those of younger patients.
Background. Kidney disease is a risk factor for mortality and cardiovascular disease in older adults, but the separate and combined effects of albuminuria and cystatin C, a novel marker of glomerular filtration, are not known. Methods. We examined associations of these markers with mortality and cardiovascular outcomes during a median follow-up of 8.3 years in 3291 older adults in the Cardiovascular Health Study. Kidney disease was assessed using urinary albumin/creatinine ratio (ACR), cystatin C and Modification of Diet in Renal Disease estimated glomerular filtration rate (eGFR). We defined subgroups based on presence of microalbuminuria (MA, ACR > 30 mg/g) and categories of normal kidney function (cystatin C < 1.0 mg/L and eGFR > 60 mL/min/1.73 m2); preclinical kidney disease (cystatin C level > 1.0 mg/l but eGFR > 60 mL/min/1.73 m2); and chronic kidney disease (CKD) (eGFR < 60 mL/min/1.73 m2). Cox proportional hazards models were used to examine associations between these six subgroups and all-cause or cardiovascular mortality, myocardial infarction and heart failure. Results. One thousand one hundred fifty (34.9%) had normal kidney function (12.2% with MA), 1518 (46.1%) had preclinical kidney disease (17.9% with MA) and 622 (18.9%) had CKD (47% with MA). After adjustment, the presence of either preclinical kidney disease or MA was associated with an over 50% increase in mortality risk; the presence of both was associated with a 2.4-fold mortality risk. Those with CKD and MA were at highest risk, with a nearly 4-fold mortality risk. Conclusion. Elevated cystatin C and albuminuria are common, identify different subsets of the older population, and are independent, graded risk factors for cardiovascular disease and mortality.
Rifkin, Dena E.; Katz, Ronit; Chonchol, Michel; Fried, Linda F.; Cao, Jie; de Boer, Ian H.; Siscovick, David S.; Shlipak, Michael G.; Sarnak, Mark J.
Background High body mass index (BMI) is associated with diseases of the hip joint and subsequent total hip arthroplasty (THA). Less\\u000a is known about the effects of BMI on the functional postoperative status after THA in obese patients. The purpose of this\\u000a study was therefore to quantify the role of high preoperative BMI on long-term pain status and functional outcome after
André Busato; Christoph Röder; Sylvia Herren; Stefan Eggli
PurposeTo study the effect of orbital tumors on visual functions and highlight the factors predictive of visual outcome after surgery.MethodsA prospective interventional study compared visual function parameters and fundus changes, before and after surgery, in eyes having well-defined orbital tumors with the normal fellow eye. These included visual acuity (VA), refractive error, keratometry changes, color vision, Goldmann visual field (GVF),
D Singh; N Pushker; M S Bajaj; R Saxena; S Sharma; S Ghose
Background and Purpose Symptomatic steno-occlusion (SYSO) in acute ischemic stroke has a significant impact on treatment options and prognosis. However, the prevalence, distribution, clinical characteristics, and outcome of SYSO are not well known. Methods We retrospectively identified 3,451 patients hospitalized because of ischemic stroke within 24 hours of symptom onset at 9 stroke centers in South Korea. Patients who did not undergo magnetic resonance imaging were excluded. SYSO was defined as stenosis or occlusion of cerebral arteries with relevant ischemic lesions in the corresponding arterial territory. The number, location, and severity of SYSOs and their effects on functional outcome were analyzed. Results In total, 1,929 of 3,057 subjects (63.1%) had SYSO. The most frequently affected vessels were the middle cerebral artery (34.6%), extracranial internal carotid artery (14%), vertebral artery (12.4%), and basilar artery (8.7%). SYSO predicted poor outcome on the modified Rankin Scale 3-6 (odds ratio, 1.77; 95% confidence interval, 1.46-2.15) with adjustments. Involvement of 2 or more vessels was observed in 30.6% of patients with SYSO and independently increased the risk of poor outcome (odds ratio, 2.76; 95% confidence interval, 2.12-3.59). The severity of SYSO was associated with outcome and showed a significant dose-response trend (P<0.001). The effect of SYSO on outcome did not significantly differ by individual arterial location (P for contrast=0.21). Conclusions Approximately 60% of patients with acute ischemic stroke had SYSO, and the severity and number were inversely correlated with outcome. The results suggest that SYSO could predict stroke outcome.
Kang, Jihoon; Park, Tai Hwan; Lee, Kyung Bok; Park, Jong-Moo; Ko, Youngchai; Lee, Soo Joo; Hong, Keun-Sik; Cho, Yong-Jin; Lee, Ji Sung; Lee, Juneyoung; Lee, Byung-Chul; Yu, Kyung-Ho; Kim, Dae-Hyun; Cha, Jae-Kwan; Lee, Jun; Jang, Myung Suk; Han, Moon-Ku
Open-field behavioral scoring is widely used to assess spinal cord injury (SCI) outcomes, but has limited usefulness in describing subtle changes important for posture and locomotion. Additional quantitative methods are needed to increase the resolution of locomotor outcome assessment. This study used gait analysis at multiple speeds (GAMS) across a range of mild-to-severe intensities of thoracic SCI in the rat. Overall, Basso, Beattie, and Bresnahan (BBB) scores and subscores were assessed, and detailed automated gait analysis was performed at three fixed walking speeds (3.5, 6.0, and 8.5?cm/sec). Variability in hindpaw brake, propel, and stance times were analyzed further by integrating across the stance phase of stepping cycles. Myelin staining of spinal cord sections was used to quantify white matter loss at the injury site. Varied SCI intensity produced graded deficits in BBB score, BBB subscores, and spinal cord white matter and total volume loss. GAMS measures of posture revealed decreased paw area, increased limb extension, altered stance width, and decreased values for integrated brake, propel, and stance. Measures of coordination revealed increased stride frequency concomitant with decreased stride length, resulting in deviation from consistent forelimb/hindlimb coordination. Alterations in posture and coordination were correlated to impact severity. GAMS results correlated highly with functional and histological measures and revealed differential relationships between sets of GAMS dynamics and cord total volume loss versus epicenter myelin loss. Automated gait analysis at multiple speeds is therefore a useful tool for quantifying nuanced changes in gait as an extension of histological and observational methods in assessing SCI outcomes. PMID:24405378
Krizsan-Agbas, Dora; Winter, Michelle K; Eggimann, Linda S; Meriwether, Judith; Berman, Nancy E; Smith, Peter G; McCarson, Kenneth E
Purpose The purpose of this study is to report our short-term functional outcome for 14 children with arthrogryposis multiplex congenita (AMC) who underwent multiple surgical procedures at an early age. Methods During the period 2002–2010, 14 children (11 males and three females) with AMC underwent multiple surgical procedures to treat deformities of the lower and upper limbs. About 81 procedures were performed, at a rate of 5.9 procedures per child. The mean age at the last follow-up was 5.9 years. The average follow-up period was 3.6 years (range, 1.5–6 years). The functional outcome assessment included walking ability and the activities of daily living for the upper limb function. Results At the last follow-up visit, six (43%) children (four males, two females) with a mean age of 8.3 years (range, 4–15) were independent walkers. Three children (males) with a mean age of 3.5 years (range, 2.5–5) were able to walk, but with support. One child (male), 3 years old, was a household ambulator. Three children (two males, one female) with a mean age of 4.2 years (range, 2.5–6) were nonfunctional ambulators. The last child (male) was nonambulatory at the age of 5 years. Activities of daily living were severely affected in the nonambulatory child. One child in the nonfunctional ambulators group had limitations in the activities of daily living; however, upper limb function was not affected in the remaining 12 children. Conclusion We believe that aggressive surgical treatment using multiple operations at an early age can improve the short-term functional and clinical outcomes of children with AMC.
Obeidat, Moutasem M; Audat, Ziad; Khriesat, Wadah
Background 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. Methods 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. Results 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. Conclusions 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.
Background Activation of hyaluronic acid (HA) and associated enzyme synthesis has been demonstrated in experimental stroke animal models. Our study aimed to investigate the plasma levels of HA in acute stroke patients and the associations between HA levels and functional outcome. Methods This was a multicenter case–control study. Acute stroke patients and age- and sex-matched non-stroke controls were recruited. Plasma levels of HA in acute stroke patients were determined at <48 hours and at 48 to 72 hours after stroke onset by standard ELISA. Favorable functional outcome was defined as modified Rankin scale ?2 at 3 months after stroke. Results The study included 206 acute stroke patients, including 43 who had intracerebral hemorrhage and 163 who had ischemic stroke, and 159 controls. The plasma levels of HA in the acute stroke patients were significantly higher than those in the controls (219.7?±?203.4 ng/ml for <48 hours and 343.1?±?710.3 ng/ml for 48 to 72 hours versus 170.4?±?127.9 ng/ml in the controls; both P?0.05). For intracerebral hemorrhage patients, HA ?500 ng/ml (<48 hours) was an independent favorable outcome predictor (P?=?0.016). For ischemic stroke patients, an inverted U-shaped association between plasma HA (48 to 72 hours) and outcome was noted, indicating that ischemic stroke patients with too high or too low plasma HA levels tended to have an unfavorable outcome. Conclusion HA plasma level was elevated in patients with acute stroke, and can predict 3-month functional outcome, particularly for patients with intracerebral hemorrhage.
Background and Purpose Multiple studies suggest that statin use prior to acute ischemic stroke (AIS) is associated with improved functional outcome. However, available evidence is conflicting, and several published reports are limited by small sample sizes. We therefore investigated the effect of antecedent use of statins on stroke outcome by performing a meta-analysis of all results from published studies as well as our own unpublished data. Methods We performed a systematic literature search and meta-analysis of studies investigating the association between pre-stroke statin use and clinical outcome, and included additional data from 126 pre-stroke statin users and 767 non-users enrolled at our Institution. A total of 12 studies, comprising 2013 statin users and 9682 non- users were meta-analyzed using a random effects model. We also meta-analyzed results for individual TOAST stroke subtypes to determine whether the effect of statin use differed across subtypes, using the Breslow-Day (BD) test. Results Meta-analysis of all available data identified an association between pre-stroke statin use and improved functional outcome (Odds Ratio = 1.62, 95% Confidence Interval: 1.39 -1.88), but we uncovered evidence of publication bias. The effect of statin use on functional outcome was found to be larger for small vessel strokes compared to other subtypes (BD p = 0.008). Conclusions Antecedent use of statins is associated with improved outcome in AIS patients. This association appears to be stronger in patients with small vessel stroke subtype. However, evidence of publication bias in the existing literature suggests these findings should be interpreted with caution.
Biffi, A; Devan, WJ; Anderson, CD; Cortellini, L; Furie, KL; Rosand, J; Rost, NS
Assessment of outcome following Deep Brain Stimulation (DBS) has traditionally focused on symptom specific and quality of life measures. Greater attention needs to be paid to the diversity of patient goals and values, as well as recognition of the shifting nature of those goals over the course of DBS therapy. We report preliminary data from an empirical study examining patients’ goals with respect to DBS in the treatment of Parkinson disease. We argue that a multifaceted assessment of outcome over time, including well validated symptom measures, quality of life, functional and patient specific metrics, is ethically necessary in order to fulfill fiduciary and professional responsibilities. These assessments should be augmented with a deliberative multi-disciplinary process of review and evaluation. Such an approach will lead to improved inform consent, promote better clinical research, and facilitate good patient care by providing a systematic mechanism for capturing and acting on important patient insights. These processes become increasingly critical as DBS begins to be applied to neuropsychiatric disorders.
Kubu, C. S.; Ford, P. J.
Groundwater is a difficult resource to manage because hydrogeologic systems are typically poorly resolved and additional data are expensive to collect. We have developed an approach to quantifying the likely economic value of additional hydrologic data. The approach is based on combined analysis of cost, benefits of projected outcomes and multimodel hydrologic analyses. The approach is aimed at making quantitative use of uncertainty in hydrologic predictions to assess the potential benefit of discriminatory proposed data. In this poster we explain the structure of Outcome Prioritized Assessment (OPA) and demonstrate its application to the design of a monitoring network for water resource management. A specific example will be chosen from several existing studies including the design of a groundwater pump and treat facility; the design of a well field for water supply; and the design of a recharge basin network to optimally capture seasonally available water supplies.
Bayley, T. W.; Shipman, T.; Thomasson, M. J.; Ferre, P. A.
New healthcare demands for quality measures of elective procedures, such as anterior cruciate ligament (ACL) reconstructive surgery, warrant the establishment of high throughput outcomes for high volume clinics. To this end, we evaluated the PROMIS and GAITRite as physical function outcome measures to quantify early healing and post-operative complications in 106 patients at pre-operative and 3, 10, 20 and 52 weeks post-ACL reconstruction with bone-tendon-bone autograft, and compared the results to the current IKDC validated outcome measure. The results showed that both PROMIS and GAITRite were significantly quicker to administer versus IKDC (p<0.0001). Additional advantages were that PROMIS and GAITRite detected a significant decrease in physical function at 3 weeks post-operative, and a significant improvement at 10 weeks post-operative versus pre-operative (p<0.001), which were not detected with IKDC. GAITRite was limited by a low ceiling that could not detect improvement of physical function beyond 20 weeks, while both PROMIS and IKDC detected significant improvement out to 52 weeks post-operative (p<0.001). Linear regressions demonstrated a significant relationship between IKDC and PROMIS, with a combined correlation value of 0.8954 (p<0.001) for all time points. Finally, ROC curve analysis demonstrated that PROMIS is a diagnostic test for poor outcomes. PMID:24532421
Papuga, M Owen; Beck, Christopher A; Kates, Stephen L; Schwarz, Edward M; Maloney, Michael D
Background Reliable outcome measures are essential for preclinical modeling of spinal cord injury (SCI) in primates. Measures need to be sensitive to both increases and decreases in function in order to demonstrate potential positive or negative effects of therapeutics. Objectives To develop behavioral tests and analyses to assess recovery of function after SCI in the nonhuman primate. Methods In all, 24 male rhesus macaques were subjected to complete C7 lateral hemisection. The authors scored recovery of function in an open field and during hand tasks in a restraining chair. In addition, EMG analyses were performed in the open field, during hand tasks, and while animals walked on a treadmill. Both control and treated monkeys that received candidate therapeutics were included in this report to determine whether the behavioral assays were capable of detecting changes in function over a wide range of outcomes. Results The behavioral assays are shown to be sensitive to detecting a wide range of motor functional outcomes after cervical hemisection in the nonhuman primate. Population curves on recovery of function were similar across the different tasks; in general, the population recovers to about 50% of baseline performance on measures of forelimb function. Conclusions The behavioral outcome measures that the authors developed in this preclinical nonhuman primate model of SCI can detect a broad range of motor recovery. A set of behavioral assays is an essential component of a model that will be used to test efficacies of translational candidate therapies for SCI.
Nout, Yvette S.; Ferguson, Adam R.; Strand, Sarah C.; Moseanko, Rod; Hawbecker, Stephanie; Zdunowski, Sharon; Nielson, Jessica L.; Roy, Roland R.; Zhong, Hui; Rosenzweig, Ephron S.; Brock, John H.; Courtine, Gregoire; Edgerton, V. Reggie; Tuszynski, Mark H.; Beattie, Michael S.; Bresnahan, Jacqueline C.
Objectives: To evaluate the outcomes (using validated outcome tools) and cost benefits of functional endoscopic sinus surgery in a population of severely asthmatic patients with chronic rhinosinusitis. Methods: A prospective cohort study was conducted. The study comprised consecutive patients diagnosed with asthma and chronic rhinosinusitis for whom medical treatment had failed and who were scheduled for functional endoscopic sinus surgery. General health and disease-specific outcome questionnaires were completed pre- and post-operatively. Costs associated with both functional endoscopic sinus surgery and out-patient visits to a comprehensive asthma clinic were calculated. Results: A total of 47 patients completed the surveys. The average improvement in Chronic Sinusitis Survey scores following functional endoscopic sinus surgery was 17 per cent. The average reduction in out-patient asthma clinic visits was 50 per cent, which translates to an average cost saving of $1035 Canadian dollars per patient per year. Conclusion: Functional endoscopic sinus surgery is a cost-effective treatment modality for asthmatic patients with chronic rhinosinusitis. This information is important for: the distribution and planning of resources, prioritising health programmes, and establishing practice guidelines. PMID:24877745
Al Badaai, Y; Valdés, C J; Samaha, M
Objective To determine the association of the underlying diagnosis with limitation in activities of daily living (ADLs) and pain in patients undergoing primary total knee arthroplasty (TKA). Methods Prospectively collected data from the Mayo Clinic Total Joint Registry were used to assess the association of diagnosis with moderate-severe limitation in activities of daily living (ADLs) and moderate-severe pain and at 2- and 5-years after primary TKA using multivariable-adjusted logistic regression analyses. We calculated odds ratios (OR) and 95% confidence intervals (CI). Results There were 7,139 primary TKAs at 2-years and 4,234 at 5-years. In multivariable-adjusted analyses, compared to rheumatoid arthritis (RA)/inflammatory arthritis, osteoarthritis (OA) was associated with significantly lower odds ratio (OR) [95% confidence interval (CI)] of moderate-severe ADL limitation with OR of 0.5 [95% CI: 0.3, 0.8] (p=0.004) at 2-years, and 0.5 [95% CI, 0.3, 0.9] (p=0.02) at 5-years. There was no significant association of diagnosis of OA with moderate-severe pain at 2-years with OR of 1.2 [0.5, 2.7] (p=0.68) or at 5-years with OR of 1.0 [0.3, 3.7] (p=1.0). Conclusion We found patients with OA who underwent primary TKA had better ADL outcomes compared to patients with RA/inflammatory arthritis at 2- and 5-years. On the other hand, the pain outcomes did not differ in OA vs. RA after primary TKA. This suggests discordant effect of underlying diagnosis on pain and function outcomes after TKA. These novel findings can be used to better inform both patients and surgeons about expected pain and function outcomes after primary TKA.
Singh, Jasvinder A.; Lewallen, David G.
Mobile health tools that enable clinicians and researchers to monitor the type, quantity, and quality of everyday activities of patients and trial participants have long been needed to improve daily care, design more clinically meaningful randomized trials of interventions, and establish cost-effective, evidence-based practices. Inexpensive, unobtrusive wireless sensors, including accelerometers, gyroscopes, and pressure-sensitive textiles, combined with Internet-based communications and machine-learning algorithms trained to recognize upper- and lower-extremity movements, have begun to fulfill this need. Continuous data from ankle triaxial accelerometers, for example, can be transmitted from the home and community via WiFi or a smartphone to a remote data analysis server. Reports can include the walking speed and duration of every bout of ambulation, spatiotemporal symmetries between the legs, and the type, duration, and energy used during exercise. For daily care, this readily accessible flow of real-world information allows clinicians to monitor the amount and quality of exercise for risk factor management and compliance in the practice of skills. Feedback may motivate better self-management as well as serve home-based rehabilitation efforts. Monitoring patients with chronic diseases and after hospitalization or the start of new medications for a decline in daily activity may help detect medical complications before rehospitalization becomes necessary. For clinical trials, repeated laboratory-quality assessments of key activities in the community, rather than by clinic testing, self-report, and ordinal scales, may reduce the cost and burden of travel, improve recruitment and retention, and capture more reliable, valid, and responsive ratio-scaled outcome measures that are not mere surrogates for changes in daily impairment, disability, and functioning.
Dobkin, Bruce H.; Dorsch, Andrew
The majority of Australian weeds are exotic plant species that were intentionally introduced for a variety of horticultural and agricultural purposes. A border weed risk assessment system (WRA) was implemented in 1997 in order to reduce the high economic costs and massive environmental damage associated with introducing serious weeds. We review the behaviour of this system with regard to eight years of data collected from the assessment of species proposed for importation or held within genetic resource centres in Australia. From a taxonomic perspective, species from the Chenopodiaceae and Poaceae were most likely to be rejected and those from the Arecaceae and Flacourtiaceae were most likely to be accepted. Dendrogram analysis and classification and regression tree (TREE) models were also used to analyse the data. The latter revealed that a small subset of the 35 variables assessed was highly associated with the outcome of the original assessment. The TREE model examining all of the data contained just five variables: unintentional human dispersal, congeneric weed, weed elsewhere, tolerates or benefits from mutilation, cultivation or fire, and reproduction by vegetative propagation. It gave the same outcome as the full WRA model for 71% of species. Weed elsewhere was not the first splitting variable in this model, indicating that the WRA has a capacity for capturing species that have no history of weediness. A reduced TREE model (in which human-mediated variables had been removed) contained four variables: broad climate suitability, reproduction in less or than equal to 1year, self-fertilisation, and tolerates and benefits from mutilation, cultivation or fire. It yielded the same outcome as the full WRA model for 65% of species. Data inconsistencies and the relative importance of questions are discussed, with some recommendations made for improving the use of the system. PMID:18339471
Weber, Jason; Dane Panetta, F; Virtue, John; Pheloung, Paul
Objective: Functional outcomes were measured over a 12-month period in children and adolescents with attention deficit hyperactivity disorder (ADHD) after they received monotherapy. Design: Prospective, observational, noninterventional study. Setting: Conducted in six non-Western countries. Participants: Outpatients 6 to 17 years of age with a verified diagnosis of ADHD in accordance with the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR), together with their physicians, decided to initiate or switch treatment for ADHD. Patients were prescribed pharmacological monotherapy: methylphenidate (n=221), nootropic agents (n=91), or atomoxetine (n=234). Measurements: Patients were followed for changes in their functional status and quality of life, which were assessed with the Child Health and Illness Profile–Child Edition (CHIP-CE) Achievement domain. Results: At the end of the study, a mean improvement on the CHIP-CE Achievement domain score was observed for all countries and therapies except in Taiwan, where patients received atomoxetine, and in Lebanon, where patients received methylphenidate. No patient experienced a serious adverse event during the study. Four patients discontinued due to a treatment-emergent adverse event. Conclusion: After 12 months of treatment, clinical and functional outcomes were improved in children and adolescents from non-Western countries who initiated and remained on their prescribed pharmacological monotherapy.
Altin, Murat; El-Shafei, Ahmed A; Yu, Maria; Desaiah, Durisala; Treuer, Tamas; Zavadenko, Nikolay; Gao, Hong Yun
Background Mechanomyography (MMG) has been extensively applied in clinical and experimental practice to examine muscle characteristics including muscle function (MF), prosthesis and/or switch control, signal processing, physiological exercise, and medical rehabilitation. Despite several existing MMG studies of MF, there has not yet been a review of these. This study aimed to determine the current status on the use of MMG in measuring the conditions of MFs. Methodology/Principal Findings Five electronic databases were extensively searched for potentially eligible studies published between 2003 and 2012. Two authors independently assessed selected articles using an MS-Word based form created for this review. Several domains (name of muscle, study type, sensor type, subject's types, muscle contraction, measured parameters, frequency range, hardware and software, signal processing and statistical analysis, results, applications, authors' conclusions and recommendations for future work) were extracted for further analysis. From a total of 2184 citations 119 were selected for full-text evaluation and 36 studies of MFs were identified. The systematic results find sufficient evidence that MMG may be used for assessing muscle fatigue, strength, and balance. This review also provides reason to believe that MMG may be used to examine muscle actions during movements and for monitoring muscle activities under various types of exercise paradigms. Conclusions/Significance Overall judging from the increasing number of articles in recent years, this review reports sufficient evidence that MMG is increasingly being used in different aspects of MF. Thus, MMG may be applied as a useful tool to examine diverse conditions of muscle activity. However, the existing studies which examined MMG for MFs were confined to a small sample size of healthy population. Therefore, future work is needed to investigate MMG, in examining MFs between a sufficient number of healthy subjects and neuromuscular patients.
Islam, Md. Anamul; Sundaraj, Kenneth; Ahmad, R. Badlishah; Ahamed, Nizam Uddin
Aims: To correlate the age at surgery, liver function tests, and hepatic and portal tract histo-pathological changes with surgical outcome in the form of disappearance of jaundice in extrahepatic biliary atresia (EHBA). Materials and Methods: This is a retrospective study of 39 cases of EHBA. There were 19 males and 10 females. Kasai's portoenterostomy (KPE) along with liver biopsy was performed in these patients; for purpose of correlation this biopsy was considered to be the preoperative biopsy. These patients were divided into three groups based upon surgical outcome: (A) disappearance of jaundice; (B) initial disappearance of jaundice with recurrence after 3 months; and (C) persistence of jaundice. Postoperatively, liver function tests and liver biopsies were repeated at 3 months after the KPE. Results: There were 11 patients in group A (28%), 21 patients in group B (54%), and seven patients in group C (18%). The age at surgery was comparable in all the three groups. The postoperative levels of serum bilirubin, alkaline phosphatase (ALP), and gamma glutamyl transpeptidase (GGTP) showed statistically significant improvement as compared with the preoperative levels in group A and B patients. Patients belonging to group C showed no improvement in the liver functions following surgery. The preoperative hepatic histopathological changes (hepatocellular alteration, cholestasis, bile ductular proliferation, and bile duct inflammation) showed a significant difference among the three groups; patients with lesser degrees of pre-existing histopathological changes had better outcome following surgery. Fibrosis was seen in all the three groups preoperatively but the difference was not statistically significant. Group C had significant fibrosis in more than 50% patients. Additional findings, viz. ductal plate malformation (9 patients, 23%) and giant cell transformation (19 patients, 49%) did not show any correlation with surgical outcomes. Conclusions: The liver function tests and the histopathological features appeared to affect the final surgical outcome of these patients. Higher degree of cholestasis, hepatocellular alteration, bile ductule proliferation, bile duct inflammation showed definite correlation with poor surgical outcome. High grade hepatic fibrosis and portal edema showed a trend towards poor outcome but did not achieve statistical significance.
Gupta, Lucky; Gupta, Siddhartha D.; Bhatnagar, Veereshwar
This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 patients selected randomly from six orthodontic treatment centers throughout China. Six different assessments of treatment outcome were made by each orthodontist using data from the three information sources separately and in combination. Each assessment included both ranking and grading for each patient. The rankings of each of the 69 judges for the 108 patients were correlated with the rankings of each of the other judges yielding 13?873 Spearman rs values, ranging from -0.08 to +0.85. Of these, 90% were greater than 0.4, showing moderate-to-high consistency among the 69 orthodontists. In the combined evaluations, study casts were the most significant predictive component (R(2)=0.86, P<0.000 1), while the inclusion of lateral cephalometric films and facial photographs also contributed to a more comprehensive assessment (R(2)=0.96, P<0.000 1). Grading scores for SC+LX and SC+PH were highly significantly correlated with those for SC+LX+PH (r(SC+LX)vs.(SC+LX+PH)=0.96, r(SC+PH)vs.(SC+LX+PH)=0.97), showing that either SC+LX or SC+PH is an excellent substitute for all three combined assessment. PMID:24136673
Song, Guang-Ying; Zhao, Zhi-He; Ding, Yin; Bai, Yu-Xing; Wang, Lin; He, Hong; Shen, Gang; Li, Wei-Ran; Baumrind, Sheldon; Geng, Zhi; Xu, Tian-Min
Hallux valgus is one of the commonest conditions of the foot and has been reported to affect nearly half of the adult population. It is most effectively treated by a corrective osteotomy of which there a numerous subtypes. The Mau osteotomy confers the greatest structural stability but is not thought to provide adequate correction of moderate-severe deformities. Accordingly, complications such as under correction and non-union are common. The aim of this study was to determine the functional outcome in patients with moderate-severe hallux valgus following a Mau osteotomy. A retrospective review of 23 patients with moderate-severe hallux valgus treated by Mau osteotomy was conducted. Patients were assessed clinically by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system and radiologically by measuring the first intermetatarsal (IM) and hallux abductovalgus angles (HAV). The mean AOFAS score had improved from 47 preoperatively to 92 postoperatively (P<0.01). Additionally, preoperative HAV and IM angles improved from 39(o) and 15(o) respectively to 15(o) and 9(o) respectively (P<0.01). There were no cases of undercorrection or non-union. In this series, the Mau osteotomy was able to achieve good correction of the IM and HAV angles in patients with moderate-severe hallux valgus. This was reflected in a significantly higher postoperative AOFAS score. Contrary to other studies there were no cases of undercorrection and despite allowing patients to fully weight-bear postoperatively there were no cases of non-union. PMID:24416481
Thangarajah, Tanujan; Ahmed, Usman; Malik, Shahbaz; Tillu, Abhay
In Support of Prior Learning Assessment and Outcomes Assessment of Prior Learning Assessment Programs. Proceedings of the National Institute on the Assessment of Experiential Learning (Princeton, New Jersey, June 12-15, 1993).
This publication contains two papers from the 1993 National Institute on the Assessment of Experiential Learning. "In Support of Prior Learning Assessment" (Rebecca C. Hull) highlights arguments in opposition to the acceptance of prior learning assessment and the responses that might best counter these arguments. "Outcomes Assessment of Prior…
Dagavarian, Debra A., Ed.
Background A new surgical technique, the Perineal Stapled Prolapse resection (PSP) for external rectal prolapse was introduced in a feasibility study in 2008. This study now presents the first results of a larger patient group with functional outcome in a mid-term follow-up. Methods From December 2007 to April 2009 PSP was performed by the same surgeon team on patients with external rectal prolapse. The prolapse was completely pulled out and then axially cut open with a linear stapler at three and nine o'clock in lithotomy position. Finally, the prolapse was resected stepwise with the curved Contour® Transtar™ stapler at the prolapse's uptake. Perioperative morbidity and functional outcome were prospectively measured by appropriate scores. Results 32 patients participated in the study; median age was 80 years (range 26-93). No intraoperative complications and 6.3% minor postoperative complications occurred. Median operation time was 30 minutes (15-65), hospital stay 5 days (2-19). Functional outcome data were available in 31 of the patients after a median follow-up of 6 months (4-22). Preoperative severe faecal incontinence disappeared postoperatively in 90% of patients with a reduction of the median Wexner score from 16 (4-20) to 1 (0-14) (P < 0.0001). No new incidence of constipation was reported. Conclusions The PSP is an elegant, fast and safe procedure, with good functional results. Trial registration ISRCTN68491191
Background and purpose Successful treatment of prosthetic hip joint infection (PI) means elimination of infection and restored hip function. However, functional outcome is rarely studied. We analyzed the outcome of the strict use of a treatment algorithm for PI. Patients and methods The study groups included 22 hips with 1-stage exchange for PI (group 1), 22 matched hips revised for aseptic loosening (controls), and 50 hips with 2-stage exchange (group 2). Relapse of infection, Harris hip score (HHS), limping, use of crutches, reoperations, complications, and radiographic changes were compared between the groups. Results There was 1 relapse of infection, which occurred in group 2. In group 1, the mean HHS was 84; 4 of 19 patients were limping and 2 required 2 crutches, which was similar to the control results. In group 2, scores were lower and complication rates higher. The use of a Burch-Schneider ring and the presence of a deficient trochanter impaired function. There were no differences in radiographic outcome between the groups. Interpretation With the algorithm used, infection can be cured with high reliability. With a 1-stage procedure, mobility is maintained. After 2-stage procedures, function was impaired due to there being more previous surgery and more serious infection.
Purpose. The management of unstable distal radial fractures in the superelderly (?80 years old) remains controversial. The aim of this study was to compare the functional outcome of super-elderly patients with and without malunion after a distal radial fracture. Methods. We identified 51 superelderly patients living independently with displaced fractures from a prospective database of 4024 patients with distal radial fractures. Activities of daily living, presence of wrist pain, whether the wrist had returned to its normal level function, grip strength and ROM were recorded. The dorsal angulation was measured radiographically. Results. There were 17 (33.3%) patients defined to have a malunion. The outcomes of the independent patients with and without malunion were compared at a mean follow-up of 15 months. No difference was observed in activities of daily living (P = 0.28), wrist pain (P = 0.14), whether the wrist had returned to its normal level function (P = 0.25), grip strength (P = 0.31), or ROM (P = 0.41). An increasing degree of dorsal angulation correlated with diminished ROM (P = 0.038), but did not correlate with activities of daily living (P = 0.10). Conclusions. Malunion of the distal radius does not influence the functional outcome of independent superelderly patients.
Clement, N. D.; Duckworth, A. D.; Court-Brown, C. M.; McQueen, M. M.
Hypotheses about the mechanisms of action by which a treatment affects a clinical outcome may prompt consideration of an alternative outcome as a potential surrogate. In many cases, due to costs or other factors, the candidate for surrogacy will only be measured for patients randomized to a substudy within the main trial. In this situation, the substudy patients provide information about links between the true and surrogate outcomes and the treatment, and these links can be exploited, using methods for handling missing covariates, to allow available information for patients not in the substudy to be incorporated into the analysis. The increased precision with which the treatment effect can be estimated using these methods, compared with using substudy data alone, in turn allows more precise estimates of measures of surrogacy. This paper reviews and compares some methods for handling missing covariate data and applies the methodology to a large heart attack trial, in order to investigate the properties of four measures for assessing the extent to which early response to thrombolytic therapy, as measured by an improvement in coronary blood flow, can be regarded as a surrogate for 30-day survival following heart attack. Design issues for substudies intended to assess treatment mechanisms are also considered. In particular, we consider how the precision of surrogate measures varies with the size of the substudy relative to the main trial. The results suggest that for reasonable surrogates, substudies substantially smaller than the main study can extract most of the available information regarding surrogacy. PMID:16217855
Galbraith, Sally; Marschner, Ian C; Simes, John
Assessment of global functioning is an important consideration in treatment outcome research; yet, there is little guidance on its evidence-based assessment for children with autism spectrum disorders. This study investigated the utility and validity of clinician-rated global functioning using the Developmental Disability-Child Global Assessment Scale in a sample of higher functioning adolescents with autism spectrum disorders and comorbid anxiety disorders enrolled in a randomized controlled trial (n = 30). Pretreatment Developmental Disability-Child Global Assessment Scale scores correlated with severity of autism spectrum disorders core symptoms (r = -.388, p = .034), pragmatic communication (r = .407, p = .032), and verbal ability (r = .449, p = .013) and did not correlate with severity of anxiety symptoms or with parent-reported adaptive behavior. Change in Developmental Disability-Child Global Assessment Scale scores during treatment was associated with autism spectrum disorders symptomatic improvement (r = .414, p = .040) and with improved general communication (r = .499, p = .013). Results support the importance of assessing global functioning in addition to symptom change and treatment response in clinical trials. PMID:23965288
White, Susan W; Smith, Laura A; Schry, Amie R
Objective To examine the influence of post-symptom-onset pregnancy on disease outcome in women with inflammatory polyarthritis (IP). Methods A total of 631 women, aged <48 years at symptom onset, were registered with the Norfolk Arthritis Register (NOAR) between 1990 and 2004. Functional disability was assessed using the Stanford Health Assessment Questionnaire (HAQ). Blood was tested for rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA). The date and outcome of all pregnancies were reported during a median follow-up of 7 years. Linear random effects models were used to examine HAQ score over time, by pregnancy status. Results were then stratified for RF and ACPA status. Results In all, 72 women had a post-onset pregnancy (Po-P) including 45 women who were pregnant at a follow-up assessment. Pregnancy was generally associated with lower HAQ scores over time than non-pregnancy. The 10 ACPA-positive women who had a Po-P had significantly worse subsequent HAQ scores. Conclusion Overall, Po-P is associated with lower HAQ scores, compared to no Po-P. This may reflect a beneficial effect of pregnancy on disease outcome, or that predominantly women with milder disease become pregnant. In women with the worst predicted outcome (APCA positive), Po-P is associated with a worse outcome than no pregnancy.
Camacho, E M; Farragher, T M; Lunt, M; Verstappen, S M M; Bunn, D; Symmons, D P M
This study examined preoperative preparations, complications, and physical and functional outcomes of male-to-female sex reassignment\\u000a surgery (SRS), based on reports by 232 patients, all of whom underwent penile-inversion vaginoplasty and sensate clitoroplasty,\\u000a performed by one surgeon using a consistent technique. Nearly all patients discontinued hormone therapy before SRS and most\\u000a reported that doing so created no difficulties. Preoperative electrolysis to
Anne A. Lawrence
Objectives. Anterior rectal resection with partial removal of the internal sphincter is an option for low rectal cancer. The objective of this study was to evaluate the functional outcome after this intersphincteric rectal resection.Methods. Anal continence was evaluated by anorectal manometry and a standardized questionnaire (Wexner Score) in 33 patients 28±15 weeks and 100±45 weeks, respectively, after intersphincteric resection. Nineteen
B. Bittorf; U. Stadelmaier; J. Göhl; W. Hohenberger; K. E. Matzel
We describe and analyze a longitudinal diffusion tensor imaging (DTI) study relating changes in the microstructure of intracranial white matter tracts to cognitive disability in multiple sclerosis patients. In this application the scalar outcome and the functional exposure are measured longitudinally. This data structure is new and raises challenges that cannot be addressed with current methods and software. To analyze the data, we introduce a penalized functional regression model and inferential tools designed specifically for these emerging types of data. Our proposed model extends the Generalized Linear Mixed Model by adding functional predictors; this method is computationally feasible and is applicable when the functional predictors are measured densely, sparsely or with error. An online appendix compares two implementations, one likelihood-based and the other Bayesian, and provides the software used in simulations; the likelihood-based implementation is included as the lpfr() function in the R package refund available on CRAN. PMID:22679339
Goldsmith, Jeff; Crainiceanu, Ciprian M; Caffo, Brian; Reich, Daniel
OBJECTIVE: To evaluate the association between extubation failure and outcomes (clinical and functional) in patients with traumatic brain injury (TBI). METHODS: A prospective cohort study involving 311 consecutive patients with TBI. The patients were divided into two groups according to extubation outcome: extubation success; and extubation failure (defined as reintubation within 48 h after extubation). A multivariate model was developed in order to determine whether extubation failure was an independent predictor of in-hospital mortality. RESULTS: The mean age was 35.7 ± 13.8 years. Males accounted for 92.3%. The incidence of extubation failure was 13.8%. In-hospital mortality was 4.5% and 20.9% in successfully extubated patients and in those with extubation failure, respectively (p = 0.001). Tracheostomy was more common in the extubation failure group (55.8% vs. 1.9%; p < 0.001). The median length of hospital stay was significantly greater in the extubation failure group than in the extubation success group (44 days vs. 27 days; p = 0.002). Functional status at discharge was worse among the patients in the extubation failure group. The multivariate analysis showed that extubation failure was an independent predictor of in-hospital mortality (OR = 4.96; 95% CI, 1.86-13.22). CONCLUSIONS: In patients with TBI, extubation failure appears to lengthen hospital stays; to increase the frequency of tracheostomy and of pulmonary complications; to worsen functional outcomes; and to increase mortality.
dos Reis, Helena Franca Correia; Almeida, Monica Lajana Oliveira; da Silva, Mario Ferreira; Rocha, Mario de Seixas
Participation in youth sports can be very beneficial, but children with Attention Deficit Hyperactivity Disorder (ADHD) may participate less often and less successfully. The current study evaluated functional sports outcomes for children with ADHD who attended an intensive behavioral treatment program that included a sports training component, and it compared outcomes to children with ADHD who did not attend the program. Results suggest that treatment resulted in significant improvements in many aspects of children's sports functioning, including knowledge of game rules, in vivo game performance, and fundamental skill tasks (motor proficiency, ability to trap a soccer ball appropriately, reduced handball penalties in soccer, and improved ability to catch a baseball). Parents also reported improved sports skills and good sportsmanship in the treatment group. No differences between groups were evident on additional skill tasks evaluating accurately kicking a soccer ball, throwing a baseball, or hitting a baseball off a tee. These results suggest intensive behavioral intervention that includes sports training can significantly improve functional sports outcomes for young children with ADHD. PMID:24362766
O'Connor, Briannon C; Fabiano, Gregory A; Waschbusch, Daniel A; Belin, Peter J; Gnagy, Elizabeth M; Pelham, William E; Greiner, Andrew R; Roemmich, James N
Background and purpose 10-year survival rates after unicompartmental knee replacement (UKR) have been up to 97% in single-center studies, but they have been as low as 80% in studies from arthroplasty registers. Few studies have evaluated short-term functional outcome and its improvement with time. We determined the time course of functional outcome as evaluated by the knee injury and osteoarthritis outcome score (KOOS) over the first 2 years after Oxford medial UKR. Patients and methods In a prospective multicenter study, we included 99 unselected knees (96 patients, mean age 65 (51–80) years, 57 women) operated with Oxford medial UKR at 3 hospitals in the southeast of Norway between November 2003 and October 2006. Data were collected by independent investigators preoperatively and at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. KOOS and range of motion (ROM) were determined at all follow-ups. Results Mean KOOS values for pain and activities of daily living were improved already after 6 weeks, and increased between each time point up to 2 years postoperatively. However, no statistically significant improvements were seen after 6 months. Mean active and passive ROM gradually improved up to 2 years after UKR, and were then better than before surgery. Interpretation Most of the expected improvements in pain and function after UKR are achieved within 6 months of surgery. Only minimal improvement can be expected beyond this time.
A number of indices designed to assess ecosystem function were applied to an existing benthic macrofaunal dataset collected following recent marine aggregate extraction activity at the Hastings Shingle Bank (UK). The objective of the study was to assess the use of these different functional metrics, some incorporating biological traits analysis, to investigate the rate of recovery in ecosystem function after
Keith M. Cooper; Christopher R. S. Barrio Froján; Emma Defew; Matthew Curtis; Annelise Fleddum; Lucy Brooks; David M. Paterson
This investigation developed the Wheelchair Users Functional Assessment (WUFA©). Because no functional out- come tools exist that include many of the daily activities that are needed to be independent by individuals using manual wheel- chairs, development of an appropriate tool was deemed impor- tant. Although the Functional Independence Measure (FIM™) can be used to assess disability in those using a
Rhonda K. Stanley; Deborah J. Stafford; Elizabeth Rasch; Mary M. Rodgers
Background Health status, dyspnea and psychological status are important clinical outcomes in chronic obstructive pulmonary disease (COPD). However, forced expiratory volume in one second (FEV1) measured by spirometry, the standard measurement of airflow limitation, has only a weak relationship with these outcomes in COPD. Recently, in addition to spirometry, impulse oscillometry (IOS) measuring lung resistance (R) and reactance (X) is increasingly being used to assess pulmonary functional impairment. Methods We aimed to identify relationships between IOS measurements and patient-reported outcomes in 65 outpatients with stable COPD. We performed pulmonary function testing, IOS, high-resolution computed tomography (CT), and assessment of health status using the St. George's Respiratory Questionnaire (SGRQ), dyspnea using the Medical Research Council (MRC) scale and psychological status using the Hospital Anxiety and Depression Scale (HADS). We then investigated the relationships between these parameters. For the IOS measurements, we used lung resistance at 5 and 20 Hz (R5 and R20, respectively) and reactance at 5 Hz (X5). Because R5 and R20 are regarded as reflecting total and proximal airway resistance, respectively, the fall in resistance from R5 to R20 (R5-R20) was used as a surrogate for the resistance of peripheral airways. X5 was also considered to represent peripheral airway abnormalities. Results R5-R20 and X5 were significantly correlated with the SGRQ and the MRC. These correlation coefficients were greater than when using other objective measurements of pulmonary function, R20 on the IOS and CT instead of R5-R20 and X5. Multiple regression analyses showed that R5-R20 or X5 most significantly accounted for the SGRQ and MRC scores. Conclusions IOS measurements, especially indices of peripheral airway function, are significantly correlated with health status and dyspnea in patients with COPD. Therefore, in addition to its simplicity and non-invasiveness, IOS may be a useful clinical tool not only for detecting pulmonary functional impairment, but also to some extent at least estimating the patient's quality of daily life and well-being.
This study explores the use of a risk assessment instrument based on the Illinois CANTS-17B in the child protection services division of a large urban public social services agency. It addresses the usefulness of the instrument as an outcome measure tool, that is, as means of measuring successful case outcomes based on reductions in maltreatment risk between case opening and
Charles Gene Lyle; Elliott Graham
We prospectively followed an ethnically and socioeconomically diverse sample of preadolescent girls with ADHD (n = 140) and matched comparison girls (n = 88) over a period of 5 years, from middle childhood through early/mid-adolescence. Our aim was to examine the ability of measures of childhood executive function (EF) to predict functional…
Miller, Meghan; Hinshaw, Stephen P.
Subjective outcomes may exaggerate intervention effects compared to objectively measured outcomes. We compared effect estimates for clinical failure and all-cause mortality clinical trials of antibiotic treatment for pneumonia. A systematic review of randomized controlled trials assessing adults with pneumonia, comparing different antibiotics, published between 2005 and 2012 was undertaken. We compared the intervention to the control arm. The all-cause mortality in the intention-to-treat population and clinical failure as defined by the study investigators for the primary analyzed population were the primary outcomes examined. Risk ratios (RRs) with 95 % confidence intervals (CIs) were pooled, using a fixed effect model. Meta-regression was used to examine the impact of clinical failure on the mortality effect size. Thirty-six trials were included, of which 30 were industry-sponsored and 30 were non-inferiority trials. There was no difference between the effect on mortality for intervention versus control (RR 1.02, 95 % CI 0.91-1.16) and clinical failure (RR 1.01, 95 % CI 0.93-1.10), without significant heterogeneity in both analyses. In double-blind trials with adequate sequence generation and concealment, there was a significant advantage to the intervention for clinical failure (RR 0.86, 95 % CI 0.76-0.98), but not for mortality (RR 0.96, 95 % CI 0.76-1.21). RRs for clinical failure did not explain the variability in the RRs for mortality significantly, with a meta-regression coefficient of 0.32 (95 % CI -0.21-0.85). In non-inferiority trials of antibiotic treatment for pneumonia, we did not find evidence for bias induced by the use of a subjective outcome overall. The small number of trials without sponsorship precludes an adequate assessment of sponsorship effects. PMID:24352842
Avni, T; Shiber-Ofer, S; Leibovici, L; Paul, M