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\\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,
|A critical measure of intervention effectiveness is durability over time. Still, few studies have examined the long-term outcomes of support derived from a functional behavioral assessment as well as enablers and barriers that contribute to or impede successful outcomes. In the current study, a functional behavioral assessment was conducted with…
Kern, Lee; Gallagher, Patricia; Starosta, Kristin; Hickman, Wesley; George, Michael
The number of oral cavity and oropharyngeal cancer survivors is rising. By 2030, oropharyngeal cancers are projected to account for almost half of all head and neck cancers. Normal speech, swallowing, and respiration can be disrupted by adverse effects of tumor and cancer therapy. This review summarizes clinically distinct functionaloutcomes of patients with oral cavity and oropharyngeal cancers, methods of pretreatment functionalassessments, strategies to reduce or prevent functional complications, and posttreatment rehabilitation considerations. PMID:23910476
Functionaloutcomes 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.
Medialization thyroplasty (MT) is the most widely used laryngeal framework phonosurgical procedure for managing glottic incompetence secondary to unilateral vocal fold paralysis (UVFP). The aim of the study was to evaluate the functionaloutcomes of MT in 32 UVFP patients, comparing multidimensional perceptual and instrumental measures of voice before and after surgery, and to evaluate how close to normal that postoperative voice measure became. Video laryngostroboscopy (VLS), auditory perceptive evaluation of voice, the patients' self-evaluation of hoarseness on the Visual Analogue Scale (VAS) and calculation of the Voice Handicap Index (VHI), analysis of objective acoustic voice parameters, quantitative assessment of phonetograms and measurement of maximum phonation time were conducted. Vocal function was evaluated before the surgery and for the period from 1 month to 3 years (Mo 1.0 month; Me 2.0 months) after MT. VLS confirmed remarkable medialization of the paralyzed vocal fold. As a consequence, hoarseness and breathiness were found to be significantly decreased after MT. Pitch and intensity range and phonetogram area were significantly increased. A significant decrease of jitter, shimmer and normalized noise energy reflected improvement of the stability of acoustic signal and a more efficient pattern of phonation. Thus, the perceptual and acoustic voice parameters studied showed statistically significant differences (P < 0.001) between preoperative and postoperative voices, and these objective measurements of voice changes provided accurate and documentary evidence of the results of surgical treatment. A high degree of patient satisfaction with the MT was confirmed by a significant decrease of VHI and hoarseness on VAS. Thus, results of the present investigation confirm the functionality and effectiveness of MT in patient voice rehabilitation with UVFP. However, the means of acoustic voice parameters measured in the study did not reach normal limits, probably because of the remaining underlying condition of UVFP. PMID:16133469
Uloza, Virgilijus; Pribuisiene, Ruta; Saferis, Viktoras
|Investigated differences in family narratives between mothers with and those without current depressive symptoms as an indicator of family functioning. Found that Family Narrative Consortium measures of narrative coherence distinguished level of symptom severity. Found that more coherent narratives were associated with marital satisfaction,…
A retrospective multi-centre study was carried out in order to compare outcomes between cemented and uncemented total hip arthoplasties (THA). A quantitative orthopaedic outcomeassessment scoring system was devised in order to relate functionaloutcome to a numerical score, to allow comparison between treatments and amongst centres. The system combined a radiographic score and a clinical score. Lower scores reflect better outcomes than higher scores. Consecutive cases of THA were included from two specialist practices between July 2002 and December 2005. The study included 46 THA patients (22 uncemented THA followed for 8.3 +/- 4.7M and 24 cemented THA for 26.0 +/- 15.7M) with a mean age of 4.4 +/- 3.3 years at surgery. Multi-variable linear and logistical regression analyses were performed with adjustments for age at surgery, surgeon, follow-up time, uni- versus bilateral disease, gender and body weight. The differences between treatment groups in terms of functional scores or total scores were not significant (p > 0.05). Radiographic scores were different between treatment groups. However, these scores were usually assessed within two months of surgery and proved unreliable predictors of functionaloutcome (p > 0.05). The findings reflect relatively short-term follow-up, especially for the uncemented group, and do not include clinician-derived measures, such as goniometry and thigh circumference. Longer-term follow-up for the radiographic assessments is essential. A prospective study including the clinician-derived outcomes needs to be performed in order to validate the outcome instrument in its modified form. PMID:18536848
Iwata, D; Broun, H C; Black, A P; Preston, C A; Anderson, G I
We assessed the outcome after simultaneous multiple operations performed on 18 children with spastic diplegia, with emphasis on the changes in the physiological cost index (PCI) of walking. Fourteen patients had a measurable reduction at one year, but the more severely affected patients took up to two years to reach a new functional plateau. The level of the preoperative PCI allows prediction of the outcome of surgery in terms of reducing the effort of walking, or improving its appearance only. Intrapelvic intramuscular psoas tenotomy produced an improvement of hip flexion deformity in 15 of 17 patients without the loss of muscle power to initiate the swing phase. Fractional lengthening corrected hamstring tightness in 17 cases, and the mean popliteal angle was reduced from 63 degrees preoperatively to 30.2 degrees, with almost complete resolution of the fixed knee flexion deformity present in ten patients. Distal transfer of the rectus femoris, when it was shown to be contracting inappropriately, improved the knee flexion arc during walking from a mean of 28.3 degrees to 45.2 degrees. PMID:8496229
Describing the development of an outcomeassessment method for accreditation, the authors discuss development of criterion definitions and the evaluation of results from a pilot study using student portfolios. The subsequent design of an outcomeassessment tool to provide concrete, objective data, the evolution of the evaluation process using this tool, and how the outcome data are currently used for curriculum evaluation are discussed. PMID:9416088
Martin, J H; Kinnick, V L; Hummel, F; Clukey, L; Baird, S C
This study determines how performance on the simple, low exertion FunctionalAssessment Screening Test (FAST) relates to performance on more extensive physical and psychological testing. One hundred eighty-eight persons with chronic back disability and 17 spine healthy volunteers underwent the FAST (three 2-min static tests [kneeling, stooping, and squatting] and two 5-min tests [repetitive stooping and repetitive twisting while standing]),
Carolyn M. Ruan; Andrew J. Haig; Michael E. Geisser; Karen Yamakawa; Rodney L. Buchholz
OBJECTIVE: We report on the functionaloutcomes and complications of the modified U-shaped ileal neobladder as a new technique following radical cystectomy. MATERIALS AND METHODS: Between January 2005 and March 2010, 56 patients (36 men and 20 women, mean age 62.3 years) with invasive bladder cancer were considered good candidates for orthotopic urinary diversion. All had radical cystectomy with bilateral pelvic lymphadenectomy and orthotopic bladder substitution by a modified U-shaped ileal neobladder reservoir. Of the patients, 49 (87.5%) had transitional cell carcinoma; 7 had squamous cell carcinoma. None of the patients had positive lymph nodes after pathologic examination of the specimen. Functionaloutcomes and complications were all recorded in detail. RESULTS: During the mean (range) follow-up of 26.3 (14-37) months, there were no deaths related to the procedure. Early complications developed in 15 patients, whereas 7 patients had late complications. Hyperchloremic metabolic acidosis occurred in 2 patients, but neither of them developed hypovitaminosis of B12. None of the patients had local and/or distant recurrences. The daytime continence rate was 96% and the nocturnal continence rate was 76%. The mean (SD, range) neobladder capacity and residual urine volume was 340.9 (240-450) and 22.7 (13-36) ml, respectively. The mean (SD, range) voided volume and maximum flow rate were 317.9 (226-431) and 16.2 (12.2-21.2) ml/s, respectively. Furthermore, there were no significant differences in any variables assessed in this study between men and women patients. CONCLUSIONS: The modified U-shaped ileal neobladder provides satisfactory functionaloutcomes and acceptable complication rate. It is considered a safe and technically feasible surgical procedure. PMID:22749690
This project was conducted to provide an objective measure of the relationship between older adults scores on a set of driving assessment tools and their (serious point) violations and crashes over a period of 18 months following the assessments. An addit...
The Pediatric Outcomes Data Collection Instrument (PODCI) questionnaire was used to quantify functional abilities of a group of unilateral upper extremity deficiency (U-UED) patients and compare them with "normal" control children. Sixty-four consecutive patients with U-UED were assessed. Parents and adolescent (ages 11-21) patients responded. Underlying diagnosis, amputation level, and type of prosthesis were recorded. Scores were compared for congenital versus traumatic etiologies for patients with various amputation levels, and for patients using prostheses versus those not using prostheses. In both parent and patient responses, PODCI scores were significantly lower than "normal" for upper extremity function and sports. Scores were similar for congenital and acquired amputees. Responses from adolescent patients showed progressively decreasing scores for upper extremity, transfers, sports, and global function with progressively proximal amputation levels. Patients using prostheses with different terminal devices did not significantly differ. Parent responses for prosthesis wearers showed lower comfort/pain scores (ie, increased pain) than non-prosthesis wearers, but no significant differences in function, including upper extremity function. PMID:15832164
Lerman, Joel A; Sullivan, Elroy; Barnes, Douglas A; Haynes, Richard J
|A "meta-assessment" was done of 13 pilot projects on student outcomesassessment in a variety of disciplines at 11 campuses in the California State University (CSU) system. These projects had developed both quantitative and qualitative strategies for collecting data on student learning outcomes. The meta-assessment was designed to identify key…
California State Univ., Long Beach. Office of the Chancellor.
|This report on best practices in outcomesassessment contains two parts: "Institutional Resources" and "Other Resources." Commission staff and consultants have selected several exemplary comprehensive outcomesassessment plans or components of plans from institutions that recently completed their decennial evaluations and from periodic review…
Middle States Commission on Higher Education, Philadelphia, PA.
The purpose of this article is to provide an overview and perspective of the available options for clinical outcomes evaluation of articular cartilage repair in the knee. A nonsystematic literature review of reported clinical measures for functional, qualitative, and quantitative structural outcomes evaluation after knee articular cartilage repair was performed. Several outcome scores have been validated for articular cartilage repair in the knee with the International Knee Documentation Committee score, Lysholm score, and Knee injury Osteoarthritis Outcome Score being reported most frequently. Activity measures including Tegner and Marx activity scales and the rate of return to sports have direct practical relevance for athletically active patients. Macroscopic and histological assessment provides important structural information about repair cartilage quality and quantity. In addition, magnetic resonance imaging (MRI) outcome scoring and functional MRI are gaining increasing popularity and promise less invasive systematic assessment. In summary, clinical outcome evaluation after cartilage repair can be performed by various established and validated functionaloutcome instruments as well as several evolving outcome parameters that provide clinically relevant outcome information for researchers, clinicians, and patients. PMID:23341156
To query the minimally invasive urological literature from 2006 to the middle of 2010, focusing on complications and functionaloutcome reporting in laparoscopic radical prostatectomy (LRP) and robot-assisted LRP (RALP), to see if there has been an improvement in the overall reporting of complications. We performed a Medline search using the Medical Subject Heading terms 'prostatectomy', 'laparoscopy', 'robotics', and 'minimally invasive'. We then applied the Martin criteria for complications reporting to the selected articles. We identified 51 studies for a total of 32,680 patients. When excluding functionaloutcomes the outpatient complications reporting was 20/51 (39.2%). In all, 35% and 43% of papers did not list any method for recording continence and potency, respectively. A complication grading system was only used in 30 studies (58.8%). Of the 16 papers using a grading scale in 2006-2007, only 31.3% used the Clavien system, compared with 69% from 2008 to the first half of 2010. In all, 27% of papers used some form of risk-factor analysis for complications. Multivariate analysis was used in 43% of papers, 29% looked at body mass index, while one looked at prostate weight, and another age. There has been an overall improvement in complications reporting in the minimally invasive RP literature since 2005. However, most studies still do not fulfil many of the criteria necessary for standardised complication reporting. Functionaloutcome reporting remains poor and unstandardised. Given our current reliance on observational studies, increased efforts should be made to standardise all complication outcomes reporting. PMID:21951696
Hakimi, A Ari; Faleck, David M; Sobey, Steven; Ioffe, Edward; Rabbani, Farhang; Donat, Sherri M; Ghavamian, Reza
We investigated the use of a popular measure, the Children and Adolescent FunctionalAssessment Scale (CAFAS), in treatment\\u000a outcome research. The sample included 70 children who had been discharged from an elementary therapeutic classroom (Intensive\\u000a Mental Health Program). Significant relationships were found between decreases in CAFAS scores and optimal educational placement,\\u000a contributing to evidence of the scale’s discriminant validity. Clinically
Kimberlee M. Roy; Michael C. Roberts; Eric M. Vernberg; Camille J. Randall
This paper describes the structure content, and measurement characteristics of a course-level questionnaire designed to gather from students course-specific information that responds to both local assessment needs and ABET requirements. In addition to basic academic and personal background characteristics, the questionnaire gathers information on a course's teaching and learning activities and student-reported learning gains attributed to the course. The outcomes
Patrick T. Terenzini; Alberto F. Cabrera; Carol L. Colbeck
Reports on renal graft outcome after kidney-alone (KA) and simultaneous pancreas-kidney (SPK) transplants have focused on graft survival instead of function. The aim of this study is to compare renal graft outcome after KA and SPK using graft function and survival as the measures of outcome. The records of 102 transplants performed in type I diabetics from 10/90 to 9/96 were reviewed (SPK 42, KA 60). Serum creatinine (Cr) and calculated glomerular filtration rate (GFR) were used as estimates of graft function. Cr were similar in SPK and KA on day 3 (4.8 +/- 2.9 vs. 4.8 +/- 2.8 mg/dl, P = 0.9) and day 7 (2.5 +/- 1.8 vs. 3.0 +/- 2.5 mg/dl, P = 0.3). GFR was higher KA at 6 months (57 +/- 18 vs. 51 +/- 12 ml/min, P = 0.08), 1 yr (55 +/- 23 vs. 51 +/- 11 ml/min, P = 0.4) and 3 yr (60 +/- 22 vs. 42 +/- 16 ml/min, P = 0.03). Kidney graft survival was similar in KA and SPK at 1 and 5 yr (87% vs. 89% and 44% vs. 47%, P = 0.8). Immunologic failure of the renal graft occurred more frequently in SPK (58% vs. 48%, P = 0.04) whereas death with function was more common in KA (33% vs. 17%, P = 0.04). In KA, risk factors for failure of the renal graft included acute rejection (P = 0.008, relative risk or rr = 3.4) and African American recipient (P = 0.06, rr = 2.8). In SPK, risk factors included donor age > 40 yr (P = 0.05, rr = 5.3) and African American donor (P = 0.03, rr = 4.5). Logistic regression analysis revealed the following risk factors for GFR < 50 ml/min at 1 yr: acute rejection (P = 0.03, rr = 2.2) and Cr > 3 mg/dl on day 7 (P = 0.06, rr = 2.3). In conclusion, although renal graft survival was similar after KA and SPK, better graft function was observed in KA at 3 yr. Assessment of renal graft function allows us to evaluate outcome from a different perspective than graft survival, and these two measures of outcome complement each other. PMID:9575395
Douzdjian, V; Bunke, C M; Baillie, G M; Uber, L; Rajagopalan, P R
This article explores application of a taxonomic approach in legal research pedagogy to outcomesassessment based on Prof. Paul Callister's adaptation of Bloom's Taxonomy of Educational Objectives which integrates instructional design and learning activities compatible with formative assessment during the learning process and summative assessment at its conclusion. It reviews the development of outcomesassessment initiatives by legal educators and
Our objective was to investigate functionaloutcome in primary lateral sclerosis (PLS). We followed a group of 24 patients with PLS. Clinical (ALSFRS), respiratory, and neurophysiological (electromyography and transcranial magnetic stimulation) evaluations were performed at entry and regularly over the follow-up period. The time taken for a greater than 10% decrease in ALSFRS compared to the first assessment was defined as the dichotomous outcome; prognostic factors were evaluated using the Cox proportional hazard model. Results demonstrated that the median age at symptom onset was 54 years (range 28-75 years). In 46% symptoms began in the lower limbs, in 21% in the upper limbs and in 33% in bulbar muscles. The median symptom duration at first visit was 3.1 years (range 0.9-11.7 years). At last follow-up the median disease duration was 9.9 years (range 4.2-17.6 years). The median follow-up time was 4.6 years (range 2.1-11 years). We excluded from final analysis three patients with positive family history. Older age at onset (p?=?0.019) was related to more rapid functional impairment; gender, forced vital capacity, region of onset and neurophysiological changes did not predict outcome. In conclusion, age is the most critical prognostic factor for functionaloutcome in PLS. PMID:22957717
Almeida, Vânia; de Carvalho, Mamede; Scotto, Manuel; Pinto, Susana; Pinto, Anabela; Ohana, Benjamim; Swash, Michael
Background Outcomesassessment is being used increasingly to shape practice patterns in all areas of medicine. Although outcomesassessment\\u000a is not a new concept, the widespread application of outcomes measurement for modifying practice is novel. Instead of focusing\\u000a on results of interventions in highly controlled environments, outcomes studies usually report results as they occur in uncontrolled,\\u000a real-world environments. Recently, the Society,
S. B. Archer; M. M. Sims; R. Giklich; B. Traverso; B. Laycock; B. M. Wolfe; K. N. Apfelgren; R. J. Fitzgibbons; J. G. Hunter
A survey of 22 dental-hygiene-program directors found that programs routinely and effectively assess student outcomes and use the information for program improvements and to demonstrate accountability. Both policy and faculty/administrative support were deemed important to implementation. Time constraints were a major barrier. Outcomes-assessment…
|Reviewed 38 social skills training studies which used social-learning or social-cognitive approach and were published between 1976 and 1985, analyzing methods of outcomeassessment. Recommended outcome measures, often not adequately measured, included generalization and durability of treatment effects, and functional analysis of relationship…
In order to provide effective health care to patients, clinicians must rely on their ability to accurately diagnose disease and to prognosticate the outcomes. Prognostic studies have received considerable attention in health science and medicine in relation to patient outcomes. However, little effort has been spent on evaluating prognostic accuracy. The purpose of this paper is to present a comprehensive review of the methods for assessing prognostic accuracy in patient outcome prediction. The strengths and limitations of these approaches are critically appraised. We argue that we need to consider incorporating accuracy assessment for predicting patient outcomes both in clinical practice and in research. PMID:18211637
Patients participating in a modern prospective orthopaedic trauma database may be asked to complete many functionaloutcome measures, adding to the burden of study participation. This prospective study assessed the utility and responsiveness of the generic Short Form 36 (SF-36) and the disease specific Short Musculoskeletal FunctionAssessment (SMFA) and the Western Ontario McMaster Osteoarthritis (WOMAC) questionnaires in 55 patients treated operatively for tibial plateau fractures with the goal of determining if there was clear benefit of using multiple measures in a lower extremity peri-articular fracture population. There was very good correlation between all three scores at 6 and 12 months, indicating they are measuring similar factors. Responsiveness was assessed using the standard response mean (SRM), proportion of patients attaining the minimal clinically important difference (MCID) between 6 and 12 months, and floor and ceiling effects. The SRM for the SF-36 was statistically higher than the SRM for the SMFA or the WOMAC. Significantly more patients were found to have a MCID between 6 and 12 months post-surgery based on the SF-36 than the other two functional scores. There was no floor effect found on any of the 3 functional scores evaluated; however, a significant ceiling effect was noted with the WOMAC but not with the SF-36 or the SMFA. These results, along with the usefulness of the SF-36 for comparing disease burden across populations, favour the SF-36 as the instrument of choice in assessingfunctionaloutcome in patients with tibial plateau fractures. PMID:23246562
Dattani, R; Slobogean, G P; O'Brien, P J; Broekhuyse, H M; Blachut, P A; Guy, P; Lefaivre, K A
Aim: The long term outcomes of congenital hydrocephalus are still not clearly known despite it being a common clinical condition. Several clinical, radiological factors were correlated to predict the functionaloutcomes. This study aimed to correlate the clinical, radiological parameters with the regional functionaloutcomes of the brain. Materials and Methods: Children with congenital hydrocephalus were divided into Group A with hydrocephalus alone and Group B hydrocephalus with spina bifida. Ventriculoperitoneal shunt surgery was performed by the same surgeon. CT scans and neuropsychological assessments were performed before and serially after the shunt. The clinical and the radiological findings were correlated with the developmental levels during the follow-up. Results: There were 25 children in Group A and 15 children in Group B; 72% in Group A and 93% in Group B were less than 6 months of age at the time of treatment. Forty percent in Group A and 92% in Group B had the signs of hydrocephalus at admission. Cerebrospinal fluid (CSF) diversion results in the reduction in ventricular dilatation and corresponding increase in the cortical mantle thickness. The ventricular size and the cortical mantle thickness were measured serially and correlated with the development in the neuropsychological function. In this study, 80% in Group B reached near normal development in comparison to 33% in Group A. We have noticed a significant correlation in the increase in the regional cortical mantle thickness with corresponding improvement in the functional development. This clearly ratifies the improvement in the frontal and parietal areas having their distinctive effect on the functional development of the child. Conclusion: Early CSF diversion and timely intervention seems to benefit functional recovery. It is interesting to note that reconstitution of cortical mantle in different areas of the brain showing corresponding improvement in their respective areas. Large ventricles (head circumference more than 50 cm) recurrent subdural collections and repeated shunt obstructions have a bad influence on the long-term outcome. Unlike the previous belief the children with myelomeningocele can have equal benefit in terms of neuropsychological development after the shunt surgery.
|In this article, we report the planning and implementation of an oral assessment component in a first-year pure mathematics module of a degree course in mathematics. Our aim was to examine potential barriers to using oral assessments, explore the advantages and disadvantages compared to existing common assessment methods and document the outcomes…
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
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 functionaloutcomes after sphincteroplasty. METHOD: Outcomes of 28 patients who underwent electromyographic biofeedback training after sphincteroplasty for obstetric sphincter injury
The perceptions of college faculty regarding outcomesassessment were explored using a qualitative interview research approach. Three faculty members at a liberal arts college in the United States were interviewed about their understandings, reactions to, and concerns regarding the assessment movement. Faculty members differed in their…
The Office of Policy and Evaluation of the U.S. Department of State's Bureau of Educational and Cultural Affairs (ECA) contracted with SRI International to conduct an outcomeassessment of the Tibetan Scholarship Program (TSP). The purpose of this evaluation is to determine if the program has been successful in meeting these goals. The assessment…
The vast majority of hospitals use clinical ethics consultation (CEC) as a service to address ethical issues in patient care. Both proponents and critics alike recognize a need to evaluate CEC. I review three outcomes of CEC that have been formally evaluated: healthcare cost, clinical indicators in the intensive care unit, and user satisfaction. These outcome indicators cannot be used to evaluate the worth of CEC because they are contingent and outside of the consultant's control. However, the failure of outcomes-based assessment poses no threat to CEC since the service is continually justified by the fundamental necessity of resolving ethical problems in patient care. While outcome indicators can be used as heuristics to investigate quality issues in CEC, process indicators can capture the quality of CEC more directly. Therefore, further research should be directed toward developing process-based conceptual models for CEC and various methods for assessing these processes. PMID:23967789
|Purpose: This paper aims to describe the relationship between functional health literacy level and smoking cessation outcomes. Design/methodology/approach: Participants in an inpatient smoking cessation program in a mid-western city in the USA were enrolled and the Short Test of Functional Health Literacy in Adults was administered while the…
Varekojis, Sarah M.; Miller, Larry; Schiller, M. Rosita; Stein, David
Purpose: This paper aims to describe the relationship between functional health literacy level and smoking cessation outcomes. Design/methodology/approach: Participants in an inpatient smoking cessation program in a mid-western city in the USA were enrolled and the Short Test of Functional Health Literacy in Adults was administered while the…
Varekojis, Sarah M.; Miller, Larry; Schiller, M. Rosita; Stein, David
\\u000a Abstract\\u000a Severe cerebral venous thrombosis (CVT) is a rare cerebrovascular condition which in the more severe cases warrants intensive\\u000a care treatment. While the outcome in the majority of uncomplicated CVT cases is good, it may be fatal in more affected patients.\\u000a We provide long-term functional and quality of life (QOL) outcome data in the form of a retrospective analysis of
Andreas Bender; Gernot Schulte-Altedorneburg; Thomas E. Mayer; Thomas Pfefferkorn; Tobias Birnbaum; Berend Feddersen; Hartmut Brückmann; Hans-Walter Pfister; Andreas Straube
This paper provides information and results of self-assessments done at the Callaway plant. It stresses the vital needs and substantial benefits from these continual self-improvement efforts. Callaway plant staff use a variety of methods and techniques to do self-assessments with the focus on outcomes. The Callaway plant is a Westinghouse four-loop plant in the state of Missouri and has been operational since 1984.
Hughes, G. [Union Electric, Fulton, MO (United States)
The purpose of this study was to assess the outcome of predoctoral orthodontic dental education in an American dental school. A test was used that measured the clinical abilities of dental students in the diagnosis of malocclusion in children, as well as their didactic abilities in answering select questions from recent national board examinations in orthodontics. The records of 7
Brenda B. Brightman; Mark G. Hans; Gary R. Wolf; Hinsdale Bernard
Outcome measures for smoking cessation are reviewed and evaluated, including 3 self-report measures and 3 biochemical validation measures. Point prevalence reflects the percentage of participants taking action, prolonged abstinence reflects those in the maintenance stage, and continuous abstinence reflects those who progress from action to maintenance without lapsing or relapsing. Biochemical assessments are primarily measures of point prevalence abstinence. The
Wayne F. Velicer; James O. Prochaska; Joseph S. Rossi; Matthew G. Snow
The final report was developed under grant No. HS 06344 by the Back Pain OutcomeAssessment Team for the Agency for Health Care Policy and Research (AHCPR). Back pain is a leading reason for physician visits, hospitalization, and work disability. The team...
How can student outcomesassessment (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.
|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…
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…
Cognitive dysfunction is a core feature of schizophrenia. Deficits are moderate to severe across several domains, including attention, working memory, verbal learning and memory, and executive functions. These deficits pre-date the onset of frank psychosis and are stable throughout the course of the illness in most patients. Over the past decade, the focus on these deficits has increased dramatically with the recognition that they are consistently the best predictor of functionaloutcomes across outcome domains and patient samples. Recent treatment studies, both pharmacological and behavioral, suggest that cognitive deficits are malleable. Other research calls into question the meaningfulness of cognitive change in schizophrenia. In this article, we review cognitive deficits in schizophrenia and focus on their treatment and relationship to functionaloutcome.
Hyposplenic patients are at risk of overwhelming post-splenectomy infection (OPSI), which carries mortality of up to 70%. Therefore, preventive measures are warranted. However, patients with diminished splenic function are difficult to identify. In this review we discuss immunological, haematological and scintigraphic parameters that can be used to measure splenic function. IgM memory B cells are a potential parameter for assessing splenic function; however, more studies are necessary for its validation. Detection of Howell–Jolly bodies does not reflect splenic function accurately, whereas determining the percentage of pitted erythrocytes is a well-evaluated method and seems a good first-line investigation for assessing splenic function. When assessing spleen function, 99mTc-labelled, heat-altered, autologous erythrocyte scintigraphy with multimodality single photon emission computed tomography (SPECT)-CT technology is the best approach, as all facets of splenic function are evaluated. In conclusion, although scintigraphic methods are most reliable, they are not suitable for screening large populations. We therefore recommend using the percentage of pitted erythrocytes, albeit suboptimal, as a first-line investigation and subsequently confirming abnormal readings by means of scintigraphy. More studies evaluating the value of potentially new markers are needed.
Lammers, A. J. J.; Bennink, R. J.; ten Berge, I. J. M.; Speelman, P.; Hoekstra, J. B. L.
The trend towards preoperative adjuvant and neoadjuvant therapies in selected patients with rectal cancer has led to increases in sphincter preservation with a limited understanding of the factors governing unsatisfactory functionaloutcomes. Data would suggest the need for a more selective use of standard radiotherapeutic fields in low- to intermediate-risk cases where there appears to be limited survival or locoregional recurrence benefit and where there is under-reported toxicity. This article discusses the complex factors which impact on functionaloutcome following open rectal cancer surgery particularly when it is accompanied by adjuvant therapy. PMID:19780324
Columbus State University is under pressure to reduce the number of "unproductive grades” in its introductory science classes, to increase the number of STEM majors, and to assess the level of attainment of science outcomes in its general education courses for accreditation documentation. The authors designed a study to examine affective, cognitive, social, and classroom factors as predictors of success in science while also attempting to document the link between introductory "gateway to science major” course outcomes and the general education program. One of the factors probed is the match between students’ understanding of important learning outcomes of the course and the instructor's stated priorities. A very real risk in content focused courses (e.g., astronomy) is the mismatch between the university's stated outcomes for a general education science course (e.g., critical thinking) and the instructor's content related outcomes. This mismatch may become a barrier for students taking `required’ courses as they may not comprehend the rationale for the requirement, fail to engage in the course, and consequently receive a failing grade. Another possible factor affecting student success in science is the student reasoning level. Students who are concrete thinkers may not be as successful in introductory science classes that require advanced logical thinking about unfamiliar concepts. The authors hope to use the results of this study to help inform university practices such as placement into introductory science courses and for future faculty development.
Background and Purpose—The function-related group (FRG) classification is based on functionalassessment and has been assumed to encompass the effects of different patterns and severity of neurological impairments. This assumption may not be correct. It has been proposed as a means of comparing rehabilitation outcome across institutions. If neurological impairments significantly affect FRG outcome, then higher FRG outcome scores may
In outcome based learning, learning outcomes (knowledge, skills and competences) to be achieved by learners are in the focal point of the learning process. All educational activities and resources need to be related to the intended learning outcomes of a learning module or course, in order to assist the learners in successfully achieving the intended learning outcomes at the end
Raquel M. Crespo; Jad Najjar; Michael Derntl; Derick Leony; Susanne Neumann; Petra Oberhuemer; Michael Totschnig; Bernd Simon; Israel Gutierrez Rojas; Carlos Delgado Kloos
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
|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…
Smith, Carla M.; Smith, Richard G.; Dracobly, Joseph D.; Pace, Amy Peterson
BACKGROUND: A wide range of outcomes have been assessed in trials of interventions for carpal tunnel syndrome (CTS), however there appears to be little consensus on what constitutes the most relevant outcomes. The purpose of this systematic review was to identify the outcomesassessed in randomized clinical trials of surgical interventions for CTS and to compare these to the concepts
OBJECTIVE: The main aim of the study was to analyze the outcomes of clavicle fractures in adults treated non-surgically and to evaluate the clinical effects of displacement, fracture patterns, fracture location, fracture comminution, shortening and fracture union on shoulder function. METHODS: Seventy clavicle fractures were non-surgically treated in the Orthopedics Department at the Tuanku Ja'afar General Hospital, a tertiary care hospital in Seremban, Malaysia, an average of six months after injury. The clavicle fractures were treated conservatively with an arm sling and a figure-eight splint for three weeks. No attempt was made to reduce displaced fractures, and the patients were allowed immediate free-shoulder mobilization, as tolerated. They were prospectively evaluated clinically and radiographically. Shoulder function was evaluated using the Constant scoring technique. RESULTS: There were statistically significant functionaloutcome impairments in non-surgically treated clavicle fractures that correlated with the fracture type (comminution), the fracture displacement (21 mm or more), shortening (15 mm or more) and the fracture union (malunion). CONCLUSION: This article reveals the need for surgical intervention to treat clavicle fractures and improve shoulder functionaloutcomes.
Bajuri, Mohd Yazid; Maidin, S; Rauf, A; Baharuddin, M; Harjeet, S
Discusses the role of performance assessment in outcome-based education. Compares the relationship and interplay between the two related paradigms and presents guidelines of assessment programs in outcome-based education. (Author/CCM)
As the methods for the functional analysis of problem behavior have continued to develop, there has been a greater focus on the specificity of controlling variables, both antecedents and consequences. Accelerating research interest in the role of antecedents reveals that a large array of stimulus variables can influence the rate of problem behavior. Indeed, the variety of these stimuli is so great that it is sometimes possible to overlook specific stimulus variables during initial assessment. The present study shows that a failure to identify these very specific (idiosyncratic) stimulus variables is serious because their presence can systematically alter the outcomes of functional analyses that are designed to assess the motivation of problem behavior. Guidelines are therefore discussed concerning when to suspect that idiosyncratic stimuli might be acting to influence assessment data, thereby promoting a search for additional stimulus variables whose identification can aid in improving the design of functional analysis conditions.
|This article provides a general description of the features and steps of the functional behavioral assessment (FBA) process. It is organized around frequently asked questions and provides information on who conducts an FBA, when an FBA should be done, the components of an FBA, and outcomes of an FBA. (Contains references.) (CR)|
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 functionaloutcomes 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 functionaloutcome 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.
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
Summary 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
Introduction: Detailed information on functionaloutcome after open abdominal aortic aneurysm (AAA) repair is sparse. Information about functionaloutcome of open AAA repair is essential to allow comparison of treatment modalities. Methods: To determine the functionaloutcome of patients after open repair of AAA, we reviewed 154 consecutive, nonemergency open repairs of infrarenal AAAs between 1990 and 1997 and each
W. Kent Williamson; Alexander D. Nicoloff; Lloyd M. Taylor; Gregory L. Moneta; Gregory J. Landry; John M. Porter
This study reviews feeding tube placement outcomes in 69 ALS outpatients seen at an outpatient interdisciplinary ALS clinic in British Columbia, Canada. The objective was to determine at which point the risks outweigh the benefits of tube placement by reviewing outcomes against parameters of respiratory function, nutritional status and speech and swallowing deterioration. The study was a retrospective review of tube placements between January 2000 and 2005, analysing data on respiratory function (forced vital capacity and respiratory status), weight change from usual body weight (UBW) and speech/swallowing deterioration using ALS Severity Score ratings (Hillel et al., 1989) at time of tube placement. Results show a statistically significant association between nutritional status and successful tube placement outcomes (p=0.003), and none between respiratory status, speech/swallowing variables, or number of deteriorated variables in each patient. Study findings were impacted by lack of available respiratory data. The only study variable that predicted successful tube placement outcome was a body weight greater than or equal to 74% UBW at time of tube placement. In the absence of access to respiratory testing, the relatively simple assessment of weight may assist patients and caregivers in appropriate decisions around tube placement. PMID:19714540
White matter (WM) lesions are the classic pathological hallmarks of multiple sclerosis (MS). However, MRI-based WM lesion load shows relatively poor correlation with functionaloutcome, resulting in the “clinico-radiological paradox” of MS. Unlike lesion based measures, volumetric MRI assessment of brain atrophy shows a strong correlation with functionaloutcome, and the presence of early atrophy predicts a worse disease course.
I. Pirko; A. J. Johnson; Yi Chen; D. M. Lindquist; A. K. Lohrey; J. Ying; R. Scott Dunn
|This article describes the development and implementation of assessment in a new outcome-based marketing curriculum that was developed using a zero-based approach. Outcomes for the marketing curriculum were specified at the program, department, course, and lesson levels. Direct embedded assessments as well as indirect assessment methods were used…
Social and occupational functioning difficulties are a characteristic feature of schizophrenia, and a growing body of evidence suggests that deficits in social cognition contribute significantly to these functional impairments. The present study sought to investigate whether the association between social cognition and social functioning in schizophrenia would be mediated by self-reported levels of empathy. Thirty outpatients with a diagnosis of schizophrenia or schizoaffective disorder, and twenty-five healthy controls completed a well-validated facial affect processing task (Ekman 60-faces facial task from the Facial Expressions of Emotion - Stimuli and Tests; FEEST), The Awareness of Social Inference Test (TASIT; to assess emotion perception and complex social cognitive skills such as the detection of sarcasm and deceit, from realistic social exchanges), and measures of self-reported empathy and social functioning. Participants with schizophrenia performed more poorly than controls in identifying emotional states from both FEEST and TASIT stimuli, and were impaired in their ability to comprehend counterfactual information in social exchanges, including sarcasm and lies, on the TASIT. Impairment in the comprehension of sarcasm was associated with higher empathic personal distress, and lower recreational functioning. Impairment in the identification of the emotions of others was found to be associated with lower satisfaction and lower empathic fantasy. However, empathy could not be explored as a mediator of associations between social cognition and functionaloutcome, due to lack of common associations with functionaloutcome measures. These findings have implications for the remediation of specific social cognitive deficits with respect to improving functionaloutcomes in schizophrenia. PMID:20609567
Fecal incontinence is a symptom attributable to a variety of disorders affecting one or more factors that maintain continence. Objective assessments should complement symptom assessments as outcome measures in therapeutic trials; conceivably, these assessments may also predict the response to therapy. Consistent with existing trends, most therapeutic trials should incorporate anal sphincter pressures and rectal sensation as outcome variables, paying
Measures of socral functioning are gaining increasing attention as important outcome criteria in evaluation of psychiatric treatment. This article reviews approaches to conceptualization and measurement of social functioning in mental health treatment outcome evaluation, and enumerates several reasons why their contribution to outcome research is valuable. The value of these measures, however, is jeopardized by lack of attention to problems
Apathy is considered one of the negative symptoms of schizophrenia, but its natural history and relationship to other clinical characteristics have not been systematically studied. The purpose of this cross-sectional study was to measure the level of apathy in schizophrenia and its relation to other symptoms and functionaloutcome. Twenty-eight patients with schizophrenia, and receiving antipsychotic treatment, were assessed with the Apathy Evaluation Scale (AES). The mean level of apathy of patients with schizophrenia, as rated by the AES, was significantly higher than that of matched healthy control subjects. In the patients, apathy was not significantly correlated with positive symptoms or depressive symptoms. It was significantly correlated with the item "emotional withdrawal" on the negative subscale of the Positive and Negative Syndrome Scale (PANSS), but was not correlated with the overall negative subscale score. Apathy was more highly associated with functionaloutcome than were other symptom measures, and it was independently associated with functionaloutcome above and beyond other negative symptoms. It was not associated with observed interest in playing a video game or performance on a simulated clerical task. PMID:12892861
Kiang, Michael; Christensen, Bruce K; Remington, Gary; Kapur, Shitij
In order to design information retrieval (IR) learning environments and instruction, it is important to explore learning outcomes of different pedagogical solutions. Learning outcomes have seldom been evaluated in IR instruction. The particular focus of this study is the assessment of learning outcomes in an experimental, but naturalistic, learning environment compared to more traditional instruction. The 57 participants of an
There is a paucity of information examining quality of life (QOL) and functional results after anorectal surgery. We aim to prospectively evaluate postoperative QOL, pain, functionaloutcomes, and satisfaction for a large cohort of patients undergoing anorectal surgery. Data were prospectively accrued for consecutive patients undergoing anorectal operations from June 2009 to September 2010. Preoperative and postoperative electronic questionnaires were completed. QOL was evaluated by the European QOL index (EQ-5D) and functional results with the Fecal Incontinence Severity Index (FISI). Satisfaction was assessed: 1) Are you satisfied with surgery? 2) Would you recommend surgery to others? Responses were reported: 1 to 5 (1 = not at all; 5 = a lot). Pain was scored: 1 (no pain) to 10 (worst). One hundred ninety-five patients, 111 (56.9%) females, median age 44 years (range, 18 to 93 years), underwent anorectal surgery for abscess, condyloma, fissure, fistula, hemorrhoids, incontinence, pilonidal disease, pouch problems, tumors, and prolapse. Overall, pain improved significantly with improved QOL (P = 0.03). This correlated with overall postoperative satisfaction (92.4%). A total of 87.7 per cent of patients would recommend their surgery to others. The FISI was similar pre- and postoperatively (P = 0.18) and did not worsen postoperatively irrespective of surgical indication and procedure. Most patients were satisfied after anorectal surgery, which correlated with improved pain and QOL. Functionaloutcomes did not worsen. This will help counsel patients preoperatively and allay anxiety about postoperative function. PMID:22964203
Malaysian engineering education is now embracing an Outcome Based Education (OBE) approach. This approach emphasizes on the outcomes, as opposed to the process in an educational strategy. The approach now becomes one of the important for an engineering degree to obtain accreditation from the Malaysian Engineering Accreditation Council (EAC). The approach is relatively new in the country, and it requires
M. S. Jaafar; N. K. Nordin; R. Wagiran; A. Aziz; M. J. M. M. Noor; M. R. Osman; J. Noorzaei; F. N. A. Abdulaziz
A follow?up study of alumni of a gerontology certificate program was designed to answer the following questions: (1) What were the outcomes for alumni, and were successful graduates differentiable by characteristics distinguishing them at entry into the program? (2) What were the subjective expectations of the alumni and do they perceive that the outcomes have met their expectations? (3) If
|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…
|The purpose of this study was to determine the use and perceived usefulness of outcomesassessment methods in health information management programs. Additional characteristics of the outcomesassessment practices were recognized. The findings were evaluated for significant differences in results based on age of the program, type of institution,…
The purpose of this study was to determine the use and perceived usefulness of outcomesassessment methods in health information management programs. Additional characteristics of the outcomesassessment practices were recognized. The findings were evaluated for significant differences in results based on age of the program, type of institution,…
The obstacles encountered in an outcomesassessment process were studied, focusing on the specific obstacles that prevent program administration from successfully completing the outcomesassessment process and the degree to which these obstacles operate. Of 135 dental hygiene education program directors surveyed, 107 responded, completing a…
Two key questions related to implementing the ABET EC2000 criteria are how to effectively use valuable faculty time and how to effectively evaluate outcomesassessment data to make improvements in a program. An outcomesassessment model to address these issues is presented. In this model, faculty time is limited to the evaluation of courses and the review of summarized results
The Australian Capital Territory (ACT) community health service successfully introduced a single point of entry and single assessment process for its community health services at the same time as the ACT government moved to outcomes-based funding. This article discusses an attempt to measure the outcomes of the single assessment process, which was part of a larger study to explore the
|This paper covers the application of functional behavioral assessment (FBA) to treatment of problem behavior in residential facilities. Basic behavioral concepts are covered with emphasis on antecedent events and their importance in assessment and treatment. The paper focuses on two types of assessment, the behavioral interview and A-B-C…
To determine the aesthetic and functionaloutcomes of the most invasive approach to oral cavity/oropharyngeal lesions, the lip-splitting mandibulotomy approach (LSMA), versus the least invasive, the trans-oral approach (TOA). Retrospective paired-cohort study. Thirty-six patients with oral/oropharyngeal cancers treated with primary surgical extirpation, bilateral neck dissections and adjuvant radiation therapy were enrolled. Half underwent LSMA and half TOA. Patients were paired into gender, age and follow-up time matched cohorts. The primary outcome measure was overall patient satisfaction with scar cosmesis assessed with a 10-point Likert scale. Clinician and naïve viewer ratings of disfigurement in addition to the validated Vancouver scar scale (VSS) and patient and observer scar assessment scale (POSAS) were completed. Functionaloutcomes included lower-lip sensation and movement as well as oral continence assessment. LSMA patients had very high satisfaction and low perceptions of disfigurement with no statistically significant differences between cohorts (p>.05). VSS and POSAS results failed to demonstrate significant differences between groups (p>.05). Naïve observers, however, found the LSMA to be more disfiguring than TOA scars (p=.03). No significant differences in lower-lip sensation to touch, two-point discrimination or temperature distinction were found (p>.05). House-Brackman and movement symmetry scores were significantly indifferent between cohorts (p>.05). Video-fluoroscopic swallowing studies showed no difference in oral continence between cohorts (p>.05). The LSMA provides satisfactory scarring and low self-perception of disfigurement for patients. Moreover, the LSMA does not impact lower-lip sensation, movement or oral continence. PMID:20619720
Dziegielewski, Peter T; O'Connell, Daniel A; Rieger, Jana; Harris, Jeffrey R; Seikaly, Hadi
Education programs at all levels must be able to demonstrate successful program outcomes. Grades alone do not represent a comprehensive measurement methodology for assessing student learning outcomes at either the course or program level. The development and application of assessment rubrics provides an unequivocal measurement methodology to ensure a quality learning experience by providing a foundation for improvement based on qualitative and quantitatively measurable, aggregate course and program outcomes. Learning outcomes are the embodiment of the total learning experience and should incorporate assessment of both qualitative and quantitative program outcomes. The assessment of qualitative measures represents a challenge for educators in any level of a learning program. Nursing provides a unique challenge and opportunity as it is the application of science through the art of caring. Quantification of desired student learning outcomes may be enhanced through the development of assessment rubrics designed to measure quantitative and qualitative aspects of the nursing education and learning process. They provide a mechanism for uniform assessment by nursing faculty of concepts and constructs that are otherwise difficult to describe and measure. A protocol is presented and applied to a doctoral nursing education program with recommendations for application and transformation of the assessment rubric to other education programs. Through application of these specially designed rubrics, all aspects of an education program can be adequately assessed to provide information for program assessment that facilitates the closure of the gap between desired and actual student learning outcomes for any desired educational competency. PMID:20567217
Raup, Glenn H; King, Jeff; Hughes, Romana J; Faidley, Natasha
Alzheimer's disease is a common disorder in the elderly, and a cure is not currently available. This article summarises the intervention studies that have been done in Alzheimer's disease research and discusses assessment tools and outcome measures used in these studies. Current approaches are broadening their definition of positive outcome beyond improvement or maintenance of cognitive functioning. These new areas
Functional capacity is an integral component of the pre-operative evaluation of the cardiac patient for non-cardiac surgery. Stair climbing capacity has peri-operative prognostic importance. It may predict survival after lung resection and complications after major non-cardiac surgery. However, stair climbing cannot determine the aerobic metabolic capacity necessary to survive the peri-operative stress response. The potential benefits and current limitations of cardiopulmonary exercise testing to determine peri-operative aerobic capacity are discussed. Principles for the selection of an appropriate screening test of aerobic function are put forward. PMID:15918830
This document describes six different approaches to outcomesassessments, approaches that are named in the titles of chapters 2 through 7. The chapters and authors are as follows: "Perspectives on Assessment Policy and Practice" (Bragg, Harmon); "Total Quality Management" (Bragg); "Assessing Student Success" (Harmon); "Value-Added Assessment"…
Breast cancer survivors experience cognitive difficulties following chemotherapy, yet the effects of these deficits on functionaloutcomes have not been systematically evaluated. This study assessed the relationships between postchemotherapy cognitive difficulties and functionaloutcomes. Forty-six women with breast cancer were seen at 1-month postchemotherapy; data were collected on cognitive functioning, psychological variables, and physical symptoms. Wilcoxon signed-rank analyses revealed cognitive
Stephanie A. Reid-Arndt; Albert Yee; Michael C. Perry; Catherine Hsieh
|Objective: To assess the value of maternal and self-ratings of adolescent depression by investigating the extent to which these reports predicted a range of mental health and functionaloutcomes 4 years later. The potential influence of mother's own depressed mood on her ratings of adolescent depression and suicidal ideation on adolescent outcome…
Rice, Frances; Lifford, Kate J.; Thomas, Hollie V.; Thapar, Anita
Capstone experiences such as design projects, laboratory projects, projects with industry, and research projects are excellent opportunities for program assessment. One method for using capstone experiences for program assessment is to develop rubrics to allow qualitative assessment information to be quantified in a consistent manner. The summative results of the assessment process can be used to improve the program, thereby
Objective: To provide an overview of clinical outcomesassessment, discuss the classification of outcomes measures, present considerations for choosing outcomes scales, identify the importance of assessing clinical outcomes, and describe the critical link between the utilization of disablement models and clinical outcomesassessment. Background: Clinical outcomes are the end result of health care services. Clinical outcomesassessment is based on the conceptual framework of disablement models and serves as the measurement method for the collection of patient-oriented evidence, a concept central to evidence-based practice. Description: Clinical outcomes management refers to the use of outcomes measures in the course of routine clinical care and provides athletic trainers with a mechanism to assess treatment progress and to measure the end results of the services they provide. Outcomes measures can be classified as either clinician based or patient based. Clinician-based measures, such as range of motion and strength, are taken directly by clinicians. Patient-based measures solicit a patient's perception as to health status in the form of questionnaires and survey scales. Clinician-based measures may assist with patient evaluation, but patient-based measures should always be included in clinical assessment to identify what is important to the patient. Clinical and Research Advantages: Evidence-based athletic training practice depends on clinical outcomes research to provide the foundation of patient-oriented evidence. The widespread use of clinical outcomesassessment, based on the disablement model framework, will be necessary for athletic trainers to demonstrate the effectiveness of therapies and interventions, the provision of patient-centered care, and the development of evidence-based practice guidelines.
Valovich McLeod, Tamara C; Snyder, Alison R; Parsons, John T; Curtis Bay, R; Michener, Lori A; Sauers, Eric L
Two theories of assessingfunction knowledge were compared for intuitive physics. The choice assessment theory, derived from Piaget, presents subjects with two physical situations, each specified by the values of two physical variables; subjects choose the situation which will yield the greater value of a dependent variable. Functional measurement presents subjects with a single physical situation; subjects make a quantitative estimate of the dependent variable. Forty subjects made both choice and functional measurement responses for two situations of intuitive physics. The choice theory showed substantial frequencies of stepwise rules, implying that subjects failed to integrate the two given physical variables. Functional measurement, in contrast, showed that most subjects integrated the two variables, following exact addition or multiplication rules. It is concluded that functional measurement gives a more correct assessment of function knowledge and should be useful in science instruction.
The purpose of this study was to assess the predictors of functionaloutcome after right hemisphere stroke at 6-month follow up in patients with or without thrombolytic treatment. Thrombolysis did not predict functionaloutcome in instrumental activities of daily living (IADL). Lower acute phase basic activities of daily living (ADL) measured by the Barthel Index was a statistically significant predictor of IADL when adjusted for age and education (p = .015) and had borderline significance (p = .076) as a predictor of functionaloutcome when adjusted for severity of stroke at admission. When stroke severity was taken into account also higher age became a statistically significant (p = .039) predictor of functionaloutcome. The acute phase neuropsychological symptoms predicted the functionaloutcome in unadjusted analyses but when adjusted for age, education, and severity of stroke no independent association was found. PMID:22145931
Losoi, H; Kettunen, J E; Laihosalo, M; Ruuskanen, E-I; Dastidar, P; Koivisto, A-M; Jehkonen, M
Optical aggregometry, traditionally used to assess platelet function, is highly dependent on sample preparation and technical procedure; as a result, data from various laboratories can be quite variable. In a study designed to assess the sources of variation, it was determined that the total standard deviation ranged from 3.6% to 7.7%. The assay variation by one analyst on one aggregometer
Nancy S. Nicholson; Susan G. Panzer-Knodle; Neal F. Haas; Beatrice B. Taite; James A. Szalony; Jimmy D. Page; Larry P. Feigen; David M. Lansky; Anita K. Salyers
The Accreditation Board for Engineering and Technology (ABET) criteria for assessing learning outcomes requires that each program have in place an assessment process with documented results on program improvements. The program must not rely only on self-reported surveys but it must include direct, observable measures of outcomes. Evidence of how students achieve these outcomes in the curriculum must me included.
The Electrical & Electronic Engineering department at California State University, Sacramento, USA, formed an Industry Liaison Council in 1998 to assist in evaluating program educational objectives, and their outcomesassessment process. With the help of the Council, they have successfully used site visits to industry to validate program outcomes and improve their program. A team of department faculty visits a
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…
|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…
BACKGROUND: When patients experience a substantial health state change, they may undergo changes in the underlying meaning of their self-report to standardized outcome measures. These response shifts can reflect changes in the patient's internal standards, values or conceptualization of quality of life. We investigated the presence of changing values (reprioritization response shift) in a longitudinal cohort of spine surgery patients. METHODS: Spinal decompression surgery patients (mean age 52 years; 39 % female, 36 % working) provided visual analogue scale (VAS) back and leg pain items, the Short-Form-36 (SF-36v1), and the Oswestry Disability Index (ODI) data pre- and post-surgery (n pre = 169; n 6weeks = 102; n 3months = 106; n 6months = 68). Improved and No-Effect patient groups were compared using the VAS minimally important difference (±15 points) as a cutoff. Reprioritization response shift detection was based on change in the relative importance of the SF-36 domains for group discrimination pre- and post-surgery. RESULTS: The Improved group evidenced significant post-surgery differences from the No-Effect group on bodily pain, general health, physical functioning, social functioning, vitality, and the ODI. The relative importance analysis showed a differential effect with bodily pain (p < 0.01) and physical functioning (p < 0.05) becoming more important, and role physical (p < 0.01) becoming less important post-surgery in distinguishing the Improved group as compared to the No-Effect group. The Improved patients also evidenced stronger associations between bodily pain and physical functioning, vitality and general health (p < 0.05). The No-Effect group evidenced increased inter-correlations of bodily pain with social functioning, mental health, and general health (p < 0.05). CONCLUSIONS: Patients who report clinically significant change in leg and back pain post-surgery using VAS pain scores are also distinguished by increased importance of bodily pain and physical functioning, and decreased importance of role physical. Bodily pain is primarily reflective of physical item response post-surgery among Improved patients, but reflects physical, social, and emotional item response among No-Effect patients. These changes in values may reflect a "moving goal post" in outcomeassessment that complicates the interpretation of mean differences over time on standard spine outcome measures. PMID:23519975
Schwartz, Carolyn E; Sajobi, Tolulope T; Lix, Lisa M; Quaranto, Brian R; Finkelstein, Joel A
Sipuleucel-T(TradeName) is a recently approved treatment for asymptomatic or minimally symptomatic metastatic castrate-resistant prostate cancer. This technology assessment is a systematic review of clinical outcomes of sipuleucel-T treatment. The review ...
C. J. Bonnell D. Mark D. J. Samson K. M. Ziegler N. Aronson
The Maine Women's Health Study assessed the outcomes of hysterectomy and nonsurgical treatment for common noncancerous gynecological conditions. The study was a prospective cohort study of 798 women ages 25 to 50 years undergoing hysterectomy for any nonc...
\\u000a Objective: The Pain Disability Questionnaire (PDQ) is a new functionalassessment instrument designed for evaluating chronic disabling musculoskeletal disorders. It is useful for assessingfunction\\/disability as affected by pain. This is the first study to assess the predictive validity of the PDQ in its relationship to 1-year post-treatment work- and health-related outcomes in a chronic disabling occupational musculoskeletal disorder (CDOMD)
Robert J. Gatchel; Tom G. Mayer; Brian R. Theodore
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…
Breast cancer survivors experience cognitive difficulties following chemotherapy, yet the effects of these deficits on functionaloutcomes have not been systematically evaluated. This study assessed the relationships between post-chemotherapy cognitive difficulties and functionaloutcomes. Forty-six women with breast cancer were seen at 1-month post-chemotherapy; data were collected on cognitive functioning, psychological variables, and physical symptoms. Wilcoxon Signed Rank analyses revealed cognitive deficits in executive functioning and verbal fluency. Subsequent regression analyses demonstrated that poorer executive functioning was associated with decreased productivity, community involvement, and social role functioning. Poorer quality of life was predicted by depression and reluctance to seek social support, but not cognitive functioning. These findings indicate that executive functioning deficits are associated with important functionaloutcomes among breast cancer survivors 1-month post-chemotherapy. Thus, treatment efforts should focus on addressing cognitive, as well as psychological and physical, issues among cancer survivors.
Reid-Arndt, Stephanie A.; Yee, Albert; Perry, Michael C.; Hsieh, Catherine
|The American College Personnel Association's (ACPA's) Sustainability Task Force partnered with the Commission on Assessment and Evaluation with the goal of creating assessment tools to help ACPA members effectively measure student learning around sustainability. Towards these ends, Kimberly Yousey-Elsener (StudentVoice), Diana Richter Keith…
ACPA College Student Educators International, 2011
Objective: ADHD is associated with significant functional impairment in adults. The present study examined functionaloutcomes following 6-month double-blind treatment with either atomoxetine or placebo. Method: Patients were 410 adults (58.5% male) with DSM-IV—defined ADHD. They were randomly assigned to receive either atomoxetine 40 mg\\/day to 80 mg\\/day (n = 271) or placebo (n = 139). The primary functionaloutcome
Lenard A. Adler; Thomas J. Spencer; Louise R. Levine; Janet L. Ramsey; Roy Tamura; Douglas Kelsey; Susan G. Ball; Albert J. Allen; Joseph Biederman
The aim of this prospective study was to assess treatment outcome and impact on quality of life of prosthodontic rehabilitation with implant-retained prostheses in head–neck cancer patients. Fifty patients were evaluated by standardized questionnaires and clinical assessment. All received the implants during ablative tumour surgery in native bone in the interforaminal area. About two-thirds of the patients (n=31) needed radiotherapy
P. J. Schoen; G. M. Raghoebar; J. Bouma; H. Reintsema; F. R. Burlage; J. L. N. Roodenburg; A. Vissink
Text Version... Assess score reliability (test-retest or ... rater) and construct validity • Establish administration ... materials • Document measure development • Prepare ... More results from www.fda.gov/downloads/drugs/developmentapprovalprocess
Defining malnutrition and nutrition risk has been a topic of many papers and discussions throughout the modern literature. Multiple definitions have been proposed, ranging from simple body weight measurements to a more all-encompassing concept looking at disease-specific inflammatory states. Biochemical markers, elements of a history examination, physical examination findings, calculations, and technical tests have all been proposed to help further characterize and delineate those who might be at risk for malnutrition, translating to an increased risk of adverse outcomes after major surgery. The purpose of this paper is to summarize some of the most utilized and most reliable ways to determine nutrition status within the scope of the North American Surgical Nutrition Summit (2012) and discuss how to incorporate these methods into the way that patients are screened preoperatively for elective surgery. PMID:24009247
Lawson, Christy M; Daley, Brian J; Sams, Valerie G; Martindale, Robert; Kudsk, Kenneth A; Miller, Keith R
Objective: This work evaluated the mortality and functionaloutcomes of premature infants sustaining intraventricular hemorrhage (IVH). These outcomes were analyzed for their association with IVH severity, development of hydrocephalus and need for ventriculoperitoneal (VP) shunt insertion. Methods: A retrospective review was performed of neonates at the Children’s Hospital of Eastern Ontario who sustained IVH (1989–2005). Logistic regression tested demographic predictors
Michael Vassilyadi; Zachary Tataryn; Mohammed F. Shamji; Enrique C. G. Ventureyra
Purpose The long-term outcome in spina bifida–Chiari II–hydrocephalus complex is poorly understood. Traditional neurosurgical outcome\\u000a measures are crude. Neuropsychological testing is increasingly important in outcomeassessment. We investigated the health,\\u000a disability, lifestyle and cognitive function in adults who had myelomeningocoele closure at birth.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Adult patients under routine follow-up were assessed in a joint neurosurgery\\/neuropsychology clinic. Patients completed lifestyle\\u000a questionnaires, the hydrocephalus
Michael D. Jenkinson; Sophie Campbell; Caroline Hayhurst; Simon Clark; Jothy Kandasamy; Maggie K. Lee; Ann Flynn; Peter Murphy; Conor L. Mallucci
|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…
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…
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
|Outcomesassessments are gaining great attention in higher education because of increased demand for accountability. These assessments are widely used by U.S. higher education institutions to measure students' college-level knowledge and skills, including students who speak English as a second language (ESL). For the past decade, the increasing…
Lakin, Joni M.; Elliott, Diane Cardenas; Liu, Ou Lydia
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.
PurposeWe studied the efficacy, functionaloutcome and morphological changes following extracorporeal shock wave lithotripsy (ESWL*) of renal calculi in a pediatric population.*Dornier Medical Systems, Inc., Marietta, Georgia.
Mahesh C. Goel; Narender S. Baserge; R. V. Ramesh Babu; Sanjay Sinha; Rakesh Kapoor
Statement of problem. From the dental professional’s standpoint, implant rehabilitation offers dramatically improved treatment alternatives to orally disabled patients. However, what a patient perceives as important to their function and satisfaction with their prostheses may be quite different from what the dentist believes are significant health-related improvements. Purpose. To resolve this problem, a series of investigations were designed to measure
Jocelyne S. Feine; Eric Dufresne; Pierre Boudrias; James P. Lund
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
Discontinuation of mechanical ventilation in critically ill patients is a challenging task and involves a careful weighting of the benefits of early extubation and the risks of premature spontaneous breathing trial. Recently, apart from studying different physiological variables by means of descriptive statistical tests, breathing pattern variability analysis has been performed for the assessment of weaning readiness. A limited number of clinical studies implementing different weaning protocols in heterogeneous groups of patients and using a variable set of signal processing techniques have appeared in the critical care literature, with varying results. The purpose of this review article is 3-fold: (1) to describe the different signal processing techniques being implemented for the assessment of weaning readiness, (2) to provide insight into the pathophysiological mechanisms that may govern breath-to-breath variability/complexity in health and disease, and (3) to present results from the critical care literature derived from the application of biosignal analysis tools for the identification of possible weaning indices. PMID:19592203
Papaioannou, Vasilios; Dragoumanis, Christos; Pneumatikos, Ioannis
In recent years greater attention has been paid to develop learning outcomes for academic programs and then to develop methods to assess these learning outcomes. Generally speaking, there are two kinds of outcomes: course outcomes and program outcomes. Assessments of these learning outcomes in institutions of higher education are mandated by the accrediting organizations. This paper describes a methodology used
High-resolution magnetic resonance cine imaging (cine-MRI) allows for a non-invasive assessment of ventricular function and mass in normal mice and in genetically and surgically modified mouse models of cardiac disease. The assessment of myocardial mass and function by cine-MRI does not rely on geometric assumptions, as the hearts are covered from the base to the apex, typically by a stack of two-dimensional images. The MR data acquisition is then followed by image segmentation of specific cine frames in each slice to obtain geometric and functional parameters, such as end-diastolic volume (EDV), end-systolic volume (ESV) or ejection fraction (EF). This technique has been well established in clinical routine application and it is now also becoming the reference method in experimental cardiovascular MRI. The cine images are typically acquired in short- and long-axis orientations of the heart to facilitate an accurate assessment of cardiac functional parameters. These views can be difficult to identify, particularly in animals with diseased hearts. Furthermore, data analysis can be the source of a systematic error, mainly for myocardial mass measurement. We have established protocols that allow for a quick and reproducible way of obtaining the relevant cardiac views for cine-MRI, and for accurate image analysis. PMID:21874489
Introduction: Cancer is the leading cause of death and the second most common cause of hospitalisation in Singapore. Significant functional gains are achievable with cancer rehabilitation yet there are no formal cancer rehabilitation programmes in Singapore. This study aims to describe the demographics, clinical characteristics, complications and functionaloutcomes of cancer patients undergoing comprehensive inpatient rehabilitation at our unit and
|Objective: ADHD is associated with significant functional impairment in adults. The present study examined functionaloutcomes following 6-month double-blind treatment with either atomoxetine or placebo. Method: Patients were 410 adults (58.5% male) with "DSM-IV"--defined ADHD. They were randomly assigned to receive either atomoxetine 40 mg/day…
Adler, Lenard A.; Spencer, Thomas J.; Levine, Louise R.; Ramsey, Janet L.; Tamura, Roy; Kelsey, Douglas; Ball, Susan G.; Allen, Albert J.; Biederman, Joseph
With growing recognition that some population subgroups are particularly vulnerable to receiving suboptimal health care and achieving poor health outcomes, innovative techniques are required for collecting and evaluating health outcomes data. Research is also needed to better understand the causal pathways linking vulnerability with health outcomes. This article focuses on patients with a chronic illness (cancer) who also have low literacy and/or poor English language skills. We summarize the association among literacy, language, ethnicity, and health outcomes; describe innovative technologies to enhance communication; and discuss the advantages of using psychometric measurement models in health outcomesassessment. Results from our ongoing research projects are presented, including the development of an audiovisual computer-based testing platform for self-administration of questionnaires. Such innovative multimedia technologies allow patients with limited or even no reading ability to participate in outcomesassessment and have the potential to be incorporated into a clinical setting with minimal burden on staff and patients. Appropriate methods are also needed to evaluate measurement equivalence across diverse patient groups, that is, the extent to which items in a questionnaire perform similarly across groups. Item response theory measurement models provide a strategy for differentiating between measurement bias and real differences that may exist between groups. Recommendations for clinical practice and research are offered specifically to address medically underserved and vulnerable populations. PMID:12692770
The relationship of neurocognitive course with clinical and functionaloutcomes 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 functionaloutcome. 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 FunctioningAssessment 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 functionaloutcomes. Negative symptoms mediated the relationship between working memory and outcome. Therefore, negative symptoms should be a primary target of treatment to improve functionaloutcomes. 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
.\\u000a Objective: Disability and mortality represent the most relevant clinical outcome after acute ischemic stroke. However, validated and\\u000a comprehensive prognostic models for recovery have not been developed. An accurate model including all previously suggested\\u000a independent outcome predictors could improve the design and analysis of clinical trials. We therefore developed prognostic\\u000a models for functional dependence and death after 100 days in
Christian Weimar; Andreas Ziegler; Inke R. König; Hans-Christoph Diener
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
Effective treatment of femoral head osteonecrosis (FHON) requires early diagnosis and accurate assessment of the disease severity. The ability to predict in the early stages the risk of collapse is important for selecting a joint salvage procedure. The aim of the present study was to evaluate the outcome in patients treated with vascularized fibular grafts in relation to preoperative MR
Athanasios E. Bassounas; Apostolos H. Karantanas; Dimitrios I. Fotiadis; Konstantinos N. Malizos
|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
The Office of Policy and Evaluation of the Bureau of Educational and Cultural Affairs of the U.S. Department of State contracted with SRI International to conduct a series of assessments of outcomes and impacts of various specialized exchange programs under the overall umbrella of the Fulbright Educational Exchange Program, the U.S. government's…
Focus Groups, used heavily in marketing and public relations, can be valuable tools, as well, for assessingoutcomes of MPA programs. By capitalizing on the human tendency to discuss issues and ideas in groups, focus groups depend on interaction to shape opinions and encourage an exchange of ideas. Focus groups, usually consisting of from seven to ten participants and led
Study objective: The mass casualty triage system known as simple triage and rapid treatment (START) has been widely used in the United States since the 1980s. However, no outcomesassessment has been conducted after a disaster to determine whether assigned triage levels match patients' actual clinical status. Researchers hypothesize that START achieves at least 90% sensitivity and specificity for each
Christopher A. Kahn; Carl H. Schultz; Ken T. Miller; Craig L. Anderson
|The purpose of the present study is to gain more insight into the relationship between students' approaches to learning and students' quantitative learning outcomes, as a function of the different components of problem-solving that are measured within the assessment. Data were obtained from two sources: the revised two factor study process…
Gijbels, David; Van de Watering, Gerard; Dochy, Filip; Van den Bossche, Piet
The later developmental trajectory of young children diagnosed early with global developmental delay was determined. Using a prospective study, preschool children diagnosed with global developmental delay were systematically reassessed during the early school years with standardized developmental and functionaloutcome measures (Battelle Developmental Inventory and Vineland Adaptive Behavior Scale). Of an original cohort of 99 children assessed and diagnosed at
Michael Shevell; Annette Majnemer; Robert W. Platt; Richard Webster; Rena Birnbaum
|The objective of this study was to assess the possible causes of hemiplegic shoulder pain (HSP) in Turkish patients with stroke, to identify the correlation between HSP and clinical factors, and to review the effects of HSP on functionaloutcomes. A total of 187 consecutive patients with stroke were evaluated for the presence of HSP and for the…
This study examined the role of two distinct factors of emotion, positive (PA) and negative affect (NA), in adjustment to a chronic rheumatic disease, systemic sclerosis (SSc). Ninety-two patients with a confirmed diagnosis of SSc completed self-report measures assessing PA and NA (Positive and Negative Affect Schedule), coping (Revised Ways of Coping Checklist), and functionaloutcomes (pain and disability measured
Ingunn Hansdottir; Vanessa L. Malcarne; Daniel E. Furst; Michael H. Weisman; Philip J. Clements
Over the past two decades, there has been considerable progress in the assessment of function and disability among older persons. Tests of physical performance are now routinely included in longitudinal studies to measure functional limitations, which are considered the building blocks of functioning. In addition, new strategies have been developed to assess the presence and onset of disability and to expand the scope of disability assessments beyond traditional indicators of difficulty and dependence. Contemporary measurement technologies, such as item response theory and computer adaptive testing, show great promise in the assessment of functional status and disability, but prospective studies are needed to demonstrate their true value, particularly to identify the circumstances in which their use will improve the assessment of functionaloutcomes in older persons. Another high priority for future research is to validate and further refine strategies to more completely and accurately ascertain the occurrence of disability among older persons.
Background and Purpose Light-to-moderate alcohol consumption has been associated with reduced risk of total and ischemic stroke. However, data on the relationship between alcohol consumption and functionaloutcomes from stroke is sparse. Method Prospective cohort study among 21,862 men enrolled in the Physicians’ Health Study who provided information on alcohol consumption at baseline, had no prior history of stroke or transient ischemic attack (TIA). Alcohol consumption was divided into five categories: <1 drink/week, 1 drink/week, 2–4 drinks/week, 5–6 drinks/week and ?1 drink/day. Possible functionaloutcomes included TIA, modified Rankin Scale (MRS)=0–1, MRS=2–3, and MRS=4–6. We used multinomial logistic regression to evaluate the relationship between levels of alcohol consumption and functionaloutcomes from stroke. Results During a mean of 21.6 years of follow-up, 767 TIAs and 1393 strokes (1157 ischemic, 222 hemorrhagic and 14 unknown type) occurred. Men who consumed 1 drink/week had lowest associated odds for any outcome. Compared with men who did not experience a TIA or stroke and who consumed <1 drink/week, men who consumed 1 drink/week had odds ratio (95% confidence interval) for total stroke of 0.85 (0.60–1.21) for MRS=0–1, 0.84 (0.64–1.10) for MRS=2–3, and 0.60 (0.37–0.97) for MRS=4–6. The OR for TIA was 0.95 (0.73–1.22). The pattern of association did not substantially differ for ischemic and hemorrhagic stroke. Higher alcohol consumption showed no association with functionaloutcome after stroke. Conclusions Our data do not show strong associations between alcohol consumption and functionaloutcome after stroke. Modest beneficial associations exist with low alcohol consumption.
Rist, Pamela M.; Berger, Klaus; Buring, Julie E.; Kase, Carlos S.; Gaziano, J. Michael; Kurth, Tobias
Cognitive Behavioral Social Skills Training (CBSST) is a 24-session weekly group therapy intervention to improve functioning in people with schizophrenia. In our prior randomized clinical trial comparing treatment as usual (TAU) with TAU plus group CBSST (Granholm, E., McQuaid, J.R., McClure, F.S., Auslander, L., Perivoliotis, D., Pedrelli, P., Patterson, T., Jeste, D.V., 2005. A randomized controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. Am. J. Psychiatry 162, 520-529.), participants with schizophrenia in CBSST showed significantly better functionaloutcome than participants in TAU. The present study was a secondary analysis of neuropsychological predictors of functionaloutcome in our prior CBSST trial. We examined (1) whether neuropsychological impairment at baseline moderated functionaloutcome in CBSST relative to TAU, and (2) whether improvement in neuropsychological abilities mediated improvement in functionaloutcome in CBSST. Attention, verbal learning/memory, speed of processing, and executive functions were assessed at baseline, end of treatment, and 12-month follow-up. Greater severity of neuropsychological impairment at baseline predicted poorer functionaloutcome for both treatment groups (nonspecific predictor), but the interaction between severity of neuropsychological impairment and treatment group was not significant (no moderation). Effect sizes for the difference between treatment groups on functionaloutcome measures at 12-month follow-up were similar for participants with relatively mild (d=.44-.64) and severe (d=.29-.60) neuropsychological impairment. Results also did not support the hypothesis that improvement in neuropsychological abilities mediated improvement in functioning in CBSST. Adding CBSST to standard pharmacologic care, therefore, improved functioning relative to standard care alone, even for participants with severe neuropsychological impairment, and this improvement in functioning was not related to improvement in neuropsychological abilities in CBSST. PMID:18222648
Granholm, Eric; McQuaid, John R; Link, Peter C; Fish, Scott; Patterson, Thomas; Jeste, Dilip V
Endovascular coiling has been used increasingly as an alternative to neurosurgical clipping for treating subarachnoid hemorrhage secondary to aneurysm rupture. In a retrospective cohort review on the treatment methods of aneurysm rupture in Hospital Kuala Lumpur over the period of five years (2005-2009) a total of 268 patients were treated. These patients were broadly categorized into two groups based on their treatment mode for ruptured aneurysms. Statistical analysis was determined using Chi- Square tests to study these associations. In our study, 67.5% of patients presented with Good World Federation of Neurosurgical Societies (WFNS) grade (WFNS1-2) while 32.5% patients presented with Poor WFNS prior to intervention. In our outcome, it was noted that 60.4% had good functionaloutcome (mRS grade 0-2) as compared to 39.6% patients who had poor mRS(modified rankin scale) outcome (mRS 3-6). In the good WFNS group, 76% of patients in clipping group had a good mRS outcome while, 86.5% patients in coiling group had good mRS outcome (p=0.114). In poor WFNS presentation, it was noted that in 77.3% patients in clipping group, had poor mRS outcome. Similarly with poor WFNS presentation, 83.3% of patient in coiling group had poor outcome. (p=1.00). Hence when we control the WFNS group, there was no significant association between treatment group (clipping and coiling) and mRS outcome at 6 months. The outcome of patient is determined by initial clinical presentation (WFNS grade) and influenced by requirement of Extraventricular drain (EVD) in presence of hydrocephalus, CSF infection and pneumonia. Therefore the decision regarding treatment option needs to be individualized based on the presentation of the patient. PMID:23770950
Introduction Vertebral body compression fractures secondary to osteoporosis or malignant osteolysis are an increasingly common problem.\\u000a The primary purpose of our study was to assessfunctionaloutcomes of kyphoplasty for the treatment of osteoporotic and osteolytic\\u000a vertebral compression fractures. Our secondary purpose was to compare such functionaloutcomes in patients with osteoporosis\\u000a versus multiple myeloma.\\u000a \\u000a \\u000a \\u000a Methods The 314 consecutive patients prospectively included
A. Jay Khanna; Mary Kay Reinhardt; Daisuke Togawa; Isador H Lieberman
The ability of electrodermal variables to predict negative symptoms and functionaloutcome over a 1-year period in schizophrenia was investigated in 78 young, recent-onset outpatients. Patients were stabilized on standardized med- ication and largely free of psychotic symptoms. Higher levels of both tonic (skin conductance level, nonspecific skin conductance response rate) and phasic (number of skin conductance orienting responses) activity
Anne M. Schell; Michael E. Dawson; Anthony Rissling; Joseph Ventura; Kenneth L. Subotnik; Michael J. Gitlin; Keith H. Nuechterlein
Objective: To analyze and compare the functionaloutcome in adhesive capsulitis after manipulation under anaesthesia and keeping the extremity in abduction and external rotation combined with local steroid injection v\\/s manipulation under anaesthesia combined with local steroid alone, in terms of range of motion. Methods: A comparative prospective study was done at the department of Orthopedics Surgery, Liaquat National Hospital,
The future of nuclear medicine procedures, as understood within our current economic climate, depends upon its ability to provide relevant clinical information at similar or lower comparative costs. With an ever-increasing emphasis on cost containment, outcomeassessment forms the basis of preserving the quality of patient care. Today, outcomesassessment encompasses a wide array of subjects including clinical, economic, and humanistic (i.e., quality of life) outcomes. For nuclear cardiology, evidence-based medicine would require a threshold level of evidence in order to justify the added cost of any test in a patient's work-up. This evidence would include large multicenter, observational series as well as randomized trial data in sufficiently large and diverse patient populations. The new movement in evidence-based medicine is also being applied to the introduction of new technologies, in particular when comparative modalities exist. In the past 5 years, we have seen a dramatic shift in the quality of outcomes data published in nuclear cardiology. This includes the use of statistically rigorous risk-adjusted techniques as well as large populations (i.e., > 500 patients) representing multiple diverse medical care settings. This has been the direct result of the development of multiple outcomes databases that have now amassed thousands of patients worth of data. One of the benefits of examining outcomes in large patient datasets is the ability to assess individual endpoints (e.g., cardiac death) as compared with smaller datasets that often assess combined endpoints (e.g., death, myocardial infarction, or unstable angina). New technologies for the diagnosis of coronary artery disease have contributed to the rising costs of care. In the United States and in Europe, costs of care have risen dramatically, consuming an ever-increasing amount of available resources. The overuse of diagnostic angiography often leads to unnecessary revascularization that does not lead to improvement in outcome. Thus, the potential exists that stress SPECT imaging, a highly effective diagnostic tool, could effect substantial change in reducing inappropriate use of an invasive procedure resulting in cost effective cardiac care. A synthesis of current economic evidence in gated SPECT imaging will be presented. In conclusion, a current state of the evidence review is presented on the clinical and economic data using nuclear cardiology imaging. PMID:10967624
Shaw, L J; Miller, D D; Berman, D S; Hachamovitch, R
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 (outcomeassessment [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.
An approach to assessing the environmental outcomes and changes in peoples’ livelihoods resulting from landscape-scale conservation\\u000a interventions was developed for three locations in Africa. Simple sets of performance indicators were developed through participatory\\u000a processes that included a variety of stakeholders. The selection of indicators was designed to reflect wider landscape processes,\\u000a conservation objectives and as local peoples’ preferred scenarios. This
Jeffrey Sayer; Bruce Campbell; Lisa Petheram; Mark Aldrich; Manuel Ruiz Perez; Dominque Endamana; Zacharie-L Nzooh Dongmo; Louis Defo; Stephen Mariki; Nike Doggart; Neil Burgess
Objective To obtain the exposure-response functions that could be used in health-based risk assessment of particulate air pollution in China. Methods Meta analysis was conducted on the literatures on air particulate matter and its adverse health outcomes in China and worldwide. Results For each health outcome from morbidity to mortality changes, the relative risks were estimated when the concentration of
HAI-DONG KAN; BING-HENG CHEN; CHANG-HONG CHEN; BING-YAN WANG; QING-YAN FU
Quantifying the importance of treatment outcomes by measuring preferences allows construction of aggregate outcome indicators that reflect the relative importance of multiple outcomes, trade-offs between outcomes, and the perspectives of different stakeholders. However, standard preference assessment methods are cognitively complex and may be particularly challenging for persons with schizophrenia and other serious mental illnesses. Preferences may not be meaningful or comparable across stakeholder groups if the groups do not use the methods in similar ways. This study combined qualiative and quantitative methods to compare comprehension and decision strategies across three standard preference assessment methods (Rating Scale, Time Tradeoff, and Paired Comparison) in 2 stakeholder groups (consumers of schizophrenia treatment and clinicians). Results indicate that the Rating Scale method is likely to yield the most valid and comparable preference values because it is well understood and acceptable to both consumers and clinicians. Both groups found the Time Tradeoff method difficult to use and poorly suited to evaluating schizophrenia outcomes. PMID:15224446
Background Neurocognitive functioning in schizophrenia has received considerable attention because of its robust prediction of functionaloutcome. Psychiatric symptoms, in particular negative symptoms, have also been shown to predict functionaloutcome, but have garnered much less attention. The high degree of intercorrelation among all of these variables leaves unclear whether neurocognition has a direct effect on functionaloutcome or whether that relationship to functionaloutcome is partially mediated by symptoms. Methods A meta-analysis of 73 published English language studies (total n = 6519) was conducted to determine the magnitude of the relationship between neurocognition and symptoms, and between symptoms and functionaloutcome. A model was tested in which symptoms mediate the relationship between neurocognition and functionaloutcome. Functionaloutcome involved measures of social relationships, school and work functioning, and laboratory assessments of social skill. Results Although negative symptoms were found to be significantly related to neurocognitive functioning (p < .01) positive symptoms were not (p = .97). The relationship was moderate for negative symptoms (r=?.24, n = 4757, 53 studies), but positive symptoms were not at all related to neurocogniton (r = .00, n= 1297, 25 studies). Negative symptoms were significantly correlated with functionaloutcome (r =?.42, p<.01), and again the correlation was higher than for positive symptoms (r = ?.03, p = .55). Furthermore, our findings support a model in which negative symptoms significantly mediate the relationship between neurocognition and functionaloutcome (Sobel test p <.01). Conclusions Although neurocognition and negative symptoms are both predictors of functionaloutcome, negative symptoms might at least partially mediate the relationship between neurocognition and outcome.
Ventura, Joseph; Hellemann, Gerhard S.; Thames, April D.; Koellner, Vanessa; Nuechterlein, Keith H.
Axillary wound with complete vasculonervous section are rare in adults, males between 20 and 30 years being more affected. In children these lesions are even more rarely encountered. Immediate surgical repair of vascular and nervous sections is recommended. Neurological impalement may be severe when all nervous trunks in the axilla are affected. Recovery of the motor and sensitive deficit is a long process and is often partial, good functionaloutcome being rare. Recovery in children is supposed to be better due to a more rapid regenerative capacity of the nerves. We present the case of a 9-year-old boy with axillary wound and complete section of axillary artery, median, ulnar, radial and musculocutaneous nerves and medial cutaneous nerve of arm. Vascular reconstruction with venous graft and epiperineural nerve reconstruction was done. Kinetotherapy and physiotherapy was part of recovery treatment. Follow up at 15 months confirmed very good functionaloutcomes with almost complete motor and sensitive function of the limb. PMID:20209776
We examined the clinical features of patients with pontine infarction in the acute stage and the factors affecting functional prognosis and outcome. Lesions, neurological manifestations at initial physical status examinations, cognitive function, swallowing function and outcome [activities of daily living (ADL), status of nutritional intake at discharge and destination after discharge] were evaluated in 68 patients (47 males and 21 females) who had pontine lesions with acute phase cerebral infarction. The mean length of stay was 24.4 days. The symptoms (number of patients) observed included paralysis (50), dysarthria (47), ataxia (18), diplopia (11), dysphagia (49) and poor cognitive performance (37). The types of lesions (number of patients) included lacunar infarcts in the ventral pontine area (15), lacunar infarcts in the dorsal pontine area (13) and large lacunar infarcts (LLIs) (41). After hospital discharge, 23 patients were discharged home, 44 were transferred to another hospital and 1 died. Twenty-three patients were on a regular diet, 22 were receiving a dysphagia diet and 22 were on enteral feeding at discharge. Patients with LLIs more frequently had poor cognitive performance, paralysis, dysphagia at discharge and a tendency for a longer length of stay compared with patients who had lacunar infarct. Most patients who returned home were those who were younger in age, had fewer neurological symptoms, had better cognitive function and ADL performance, and could ingest food. In an acute hospital, age, neurological symptoms, ADL, cognitive function, and dysphagia were considered important factors for determining the outcome in patients with pontine infarction. PMID:21979558
Maeshima, S; Osawa, A; Miyazaki, Y; Takeda, H; Tanahashi, N
Several studies have regarded proximal gastrectomy (PG) as optimal compared to total gastrectomy (TG) for upper stomach cancer. In addition to the traditional outcomes of complication and mortality, change in functional status should be considered as another relevant outcome in aging generations. However, there has been no community-based appraisal of functionaloutcomes between PG and TG. Using an administrative database, we compared functionaloutcomes between PG and TG. Among 12,508 patients who survived for ?15 years and underwent open gastrectomy between 2008 and 2010, we examined patient characteristics, comorbidities, functional status estimated by the Barthel index (BI) at admission and discharge, complications, ICU care, ventilation administration, blood transfusion, operating room time, resumption of oral intake, length of stay and total charges. With reference to distal gastrectomy (DG), we performed multivariate analyses to assess the impacts of PG and TG on complications and BI deterioration. A total of 434 PGs and 4,941 TGs were observed in 148 and 295 hospitals, respectively. Patient characteristics, care process, resumption of oral intake, operating room time, length of stay and total charges were also significantly different among the three gastrectomy types. PG, TG and DG were not associated with complications or functional deterioration. Patient characteristics, preoperative blood transfusion and longer operating room time were significantly associated with more complications and BI deterioration. Since patient case mix and longer operating room time were associated with poor outcomes, physicians should recognize the role of PG and might optimally challenge and complete gastrectomies within the appropriate indications.
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 functionaloutcome, whereas Factors 2 and 3 significantly correlated with functionaloutcome (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 functionaloutcome.
Mancuso, Francesco; Horan, William P.; Kern, Robert S.; Green, Michael F.
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 functionaloutcome, whereas Factors 2 and 3 significantly correlated with functionaloutcome (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 functionaloutcome. PMID:21112743
Mancuso, Francesco; Horan, William P; Kern, Robert S; Green, Michael F
Clinical interpretation of health services research based on administrative databases is limited by the lack of patient-reported functionaloutcome measures. Reoperation, as a surrogate measure for poor outcome, may be biased by preferences of patients and surgeons and may even be planned a priori. Other available administrative data outcomes, such as postoperative cross sectional imaging (PCSI), may better reflect changes in functionaloutcome. The purpose was to determine if postoperative events captured from administrative databases, namely reoperation and PCSI, reflect outcomes as derived by validated functionaloutcome measures (short form 36 scores, Oswestry disability index) for patients who underwent discretionary surgery for specific degenerative conditions of the lumbar spine such as disc herniation, spinal stenosis, degenerative spondylolisthesis, and isthmic spondylolisthesis. After reviewing the records of all patients surgically treated for disc herniation, spinal stenosis, degenerative spondylolisthesis, and isthmic spondylolisthesis at our institution, we recorded the occurrence of PCSI (MRI or CT-myelograms) and reoperations, as well as demographic, surgical, and functionaloutcome data. We determined how early (within 6 months) and intermediate (within 18 months) term events (PCSI and reoperations) were associated with changes in intermediate (minimum 1 year) and late (minimum 2 years) term functionaloutcome, respectively. We further evaluated how early (6-12 months) and intermediate (12-24 months) term changes in functionaloutcome were associated with the subsequent occurrence of intermediate (12-24 months) and late (beyond 24 months) term adverse events, respectively. From 148 surgically treated patients, we found no significant relationship between the occurrence of PCSI or reoperation and subsequent changes in functionaloutcome at intermediate or late term. Similarly, earlier changes in functionaloutcome did not have any significant relationship with subsequent occurrences of adverse events at intermediate or late term. Although it may be tempting to consider administrative database outcome measures as proxies for poor functionaloutcome, we cannot conclude that a significant relationship exists between the occurrence of PCSI or reoperation and changes in functionaloutcome. PMID:19816717
Omoto, Daniel; Bederman, S Samuel; Yee, Albert J M; Kreder, Hans J; Finkelstein, Joel A
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 functionalassessment 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. Functionaloutcome 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.
Background: Cervical spondylotic myelopathy (CSM) is serious consequence of cervical intervertebral disk degeneration. Morbidity ranges from chronic neck pain, radicular pain, headache, myelopathy leading to weakness, and impaired fine motor coordination to quadriparesis and/or sphincter dysfunction. Surgical treatment remains the mainstay of treatment once myelopathy develops. Compared to more conventional surgical techniques for spinal cord decompression, such as anterior cervical discectomy and fusion, laminectomy, and laminoplasty, patients treated with corpectomy have better neurological recovery, less axial neck pain, and lower incidences of postoperative loss of sagittal plane alignment. The objective of this study was to analyze the outcome of corpectomy in cervical spondylotic myelopathy, to assess their improvement of symptoms, and to highlight complications of the procedure. Materials and Methods: Twenty-four patients underwent cervical corpectomy for cervical spondylotic myelopathy during June 1999 to July 2005.The anterior approach was used. Each patient was graded according to the Nuricks Grade (1972) and the modified Japanese Orthopaedic Association (mJOA) Scale (1991), and the recovery rate was calculated. Results: Preoperative patients had a mean Nurick's grade of 3.83, which was 1.67 postoperatively. Preoperative patients had a mean mJOA score of 9.67, whereas postoperatively it was 14.50. The mean recovery rate of patients postoperatively was 62.35% at a mean follow-up of 1 year (range, 8 months to 5 years).The complications included one case (4.17%) of radiculopathy, two cases (8.33%) of graft displacement, and two cases (8.33%) of screw back out/failure. Conclusions: Cervical corpectomy is a reliable and rewarding procedure for CSM, with functional improvement in most patients.
We investigated whether protein-energy malnutrition (PEM) exacerbates brain injury in global ischemia. It was hypothesized that PEM would increase secondary brain damage by worsening ischemia-induced depletion of glutathione (GSH) and increasing oxidative stress. Adult male gerbils were fed an adequate protein (12.5%; C) or low protein (2%; PEM) diet for 4 weeks and subjected to 5 min of bilateral carotid artery occlusion (Ischemia) or sham surgery (Sham). At 12 h post-ischemia, GSH and markers of oxidative stress were measured in hippocampus and neocortex. The remaining gerbils were tested in the open field on days 3, 7, and 10, with viable hippocampal CA1 neurons assessed on day 10. Although the habituation of C-Ischemia gerbils in the open field was normal by day 7, PEM-Ischemia gerbils failed to habituate even by day 10 and spent greater time in the outer zone (P < 0.05). Mean (+/-SEM) total number of viable CA1 neurons at 10 days post-ischemia were C-Sham = 713 (13), C-Ischemia = 264 (48), PEM-Sham = 716 (12), and PEM-Ischemia = 286 (66). Although PEM did not increase CA1 neuron loss caused by ischemia, a subset (4/12) of PEM-Ischemia gerbils showed dramatic reactive gliosis accompanied by extensive neuronal loss. Hippocampal protein thiols were decreased by PEM and ischemia. Although the mechanism is yet to be established, the finding that PEM worsens functionaloutcome following global ischemia is clinically relevant since 16% of elderly are nutritionally compromised at the time of admission for stroke. PMID:16171806
Bobyn, P Joan; Corbett, Dale; Saucier, Deborah M; Noyan-Ashraf, M Hossein; Juurlink, Bernhard H J; Paterson, Phyllis G
It is unclear if functional-somatic symptoms in adolescents increase the risk for future psychiatric disorders. Therefore, the outcome and continuity of adolescent self-reported functional-somatic symptoms in young adulthood were assessed. Self-reported data on functional-somatic symptoms from an ongoing epidemiological study in children started in 1983 were analyzed. Participants were adolescents aged 11-18 who filled out standardized questionnaires in 1989 and 1991 and who were reassessed in 1997 when they were young adults between ages 19 and 26. Outcome measures were research psychiatric diagnoses and self-reported functional-somatic symptoms in 1997. Functional-somatic symptoms were associated with other measures of psychopathology in adolescents. Adolescents with specific functional-somatic symptoms tended to report the same symptom along with other symptoms at follow-up. Adolescent self-reported functional-somatic symptoms did not increase the risk for future psychiatric disorders. Young adults with functional-somatic complaints were diagnosed more often than controls with depressive disorders and anxiety disorders, but not with antisocial personality disorders and substance use disorders. Adolescent self-reported functional-somatic symptoms were common and enduring but were not predictive for psychiatric disorders in young adulthood. Adolescents and young adults who complain of multiple functional-somatic complaints should be assessed for the presence of a psychiatric disorder particularly depression or anxiety. PMID:11958361
Dhossche, D; Ferdinand, R; van der Ende, J; Verhulst, F
Objective: To increase our knowledge of neurological recovery and functionaloutcome of patients with spinal cord injuries in order to make more successful rehabilitation programmes based on realistic goals.Design: Descriptive analysis of data gathered in an information system.Setting: Rehabilitation centre in The Netherlands with special department for patients with spinal cord injuries.Subjects: Fifty-five patients with traumatic spinal cord lesions admitted
M C Schönherr; J W Groothoff; G A Mulder; W H Eisma
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.
We evaluated the morphologic and functionaloutcome as well as the extent of satisfaction following surgical treatment in 41 patients with progressive neuropathic scoliosis. The mean follow-up time was 5.6 years (range 2.5–20 years), and follow-up rate was 97.6%. Posterior spine fusion was performed with new instrumentation techniques (Luque\\/Luque-Galveston, CD, ISOLA) in 29 patients, with extension onto the sacrum in
B. Frischhut; W. Sterzinger; F. Rachbauer; T. Klestil; M. Krismer; R. Bauer
Presents a model for establishing a community college student outcomesassessment program, listing types of student outcomes that should be assessed, and sources of information and measures typically used to assess the outcomes. Reviews steps in program development and in tailoring the program to the college. (DMM)
Synopsis Describing the status of children with CP and quantifying change in their status are two central challenges to research and clinical management of CP. The science of assessing and reporting status is outcome measurement and it is rapidly developing in the arena of CP. Due to the large number of domains to measure, the variability of CP manifestations, and a limited number of ‘gold standard’ evaluations, creating an accurate, comprehensive, responsive, and broadly applicable measurement strategy is a serious endeavor. Currently, a range of outcome measures are available to address CP issues across the spectrum of disability. The use of these measures, and others yet to be developed, will provide researchers and clinicians the best means to understand CP and the effects of treatments.
There are few studies regarding functionaloutcome and lesion extent on diffusion-weighted MRI (DWI) in patients with posterior\\u000a circulation (PC) infarction. The aim of our study was to assess whether a newly proposed posterior circulation Alberta Stroke\\u000a Program Early CT Score (pc-ASPECTS) on DWI is useful for predicting functionaloutcome in PC patients. One hundred thirty-two\\u000a patients with first-ever ischemic
Background: Limb length discrepancy and its effects on patient function have been discussed in depth in the literature with respect to hip arthroplasty but there are few studies that have examined the effect on function of limb length discrepency following total knee arthroplasty (TKA). The aim of this study was to determine whether limb length discrepancy after TKA in patients with bilateral osteoarthritis of knee with varus deformity affects functionaloutcome. Materials and Methods: Fifty-four patients with bilateral osteoarthritis of knee with varus deformity, who were operated for total knee arthroplasty from 1996 to 2008, were reviewed retrospectively. The patients were divided into two groups. Thirty patients (mean age 64 years) were operated for unilateral TKA and thirty patients (mean age 65.8 years) were operated for bilateral total knee arthroplasty. Six patients underwent staged surgery and were included in both groups as the time interval between the two surgeries was more than the minimum 6-month follow-up period specified for inclusion in the study. The limb length discrepancy was measured and statistically correlated with the functional component of the Knee Society Score. Result: In the unilateral group (n=30), the mean limb length discrepancy was 1.53 cm (range: 0-3 cm) and the mean functional score was 73 (range: 45-100). In the bilateral group (n=30), the mean limb length discrepancy was 0.5 cm (range: 0-2 cm) and the mean functional score was 80.67 (range: 0-100). A statistically significant negative correlation was found between limb length discrepancy and functional score in the unilateral group (Spearman correlation coefficient, r =?0.52, P=0.006), while no statistically significant correlation was found in the bilateral group (Spearman correlation coefficient, r = ?0.141, P=0.458). Conclusion: Limb length discrepancy affects functionaloutcome after total knee arthroplasty, especially so in patients of bilateral osteoarthritis with varus deformity undergoing surgery of only one knee.
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...
Takayasu's arteritis (TAK) is a rare, chronic large-vessel vasculitis (LVV) that predominantly affects aorta, its major branches, and the pulmonary arteries. Segmental stenosis, occlusion, dilatation, or aneurysm formation may occur in the vessel wall during the course of the disease. The vascular involvement can be shown with different imaging modalities to make the diagnosis of TAK. Conventional angiography, the gold standard method for initial diagnosis, seems to be replaced with the new imaging modalities such as magnetic resonance angiography (MRA) and (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in recent years. The data coming from the new studies support that MRA and FDG-PET are also promising for the assessment of disease activity. Prognosis is possibly getting better with lower mortality in recent years; however, it is difficult to assess the widely different vascular intervention rates among the clinical series. Leflunomide, TNF-? antagonists, and tocilizumab are new options in patients resistant to conventional therapies. There is a clear need to develop a validated set of outcome measures for use in clinical trials of TAK. The OMERACT Vasculitis Working Group has taken on this task and aims to develop a core set of outcomes for LVV. PMID:23271611
The capacity to process three-dimensional facial surfaces to objectively assessoutcomes of craniomaxillofacial care is urgently required. Available surface registration techniques depart from conventional facial anthropometrics by not including anatomical relationship in their analysis. Current registrations rely on the manual selection of areas or points that have not moved during surgery, introducing subjectivity. An improved technique is proposed based on the concept of an anthropometric mask (AM) combined with robust superimposition. The AM is the equivalent to landmark definitions, as used in traditional anthropometrics, but described in a spatially dense way using (?10.000) quasi-landmarks. A robust superimposition is performed to align surface images facilitating accurate measurement of spatial differences between corresponding quasi-landmarks. The assessment describes magnitude and direction of change objectively and can be displayed graphically. The technique was applied to three patients, without any modification and prior knowledge: a 4-year-old boy with Treacher-Collins syndrome in a resting and smiling pose; surgical correction for hemimandibular hypoplasia; and mandibular hypoplasia with staged orthognathic procedures. Comparisons were made with a reported closest-point (CP) strategy. Contrasting outcomes were found where the CP strategy resulted in anatomical implausibility whilst the AM technique was parsimonious to expected differences. PMID:22103995
We assessed confounding of associations between short-term effects of air pollution and health outcomes by influenza using Hong Kong mortality and hospitalization data for 1996-2002. Three measures of influenza were defined: (i) intensity: weekly proportion of positive influenza viruses, (ii) epidemic: weekly number of positive influenza viruses ?4% of the annual number for ?2 consecutive weeks, and (iii) predominance: an epidemic period with co-circulation of respiratory syncytial virus <2% of the annual positive isolates for ?2 consecutive weeks. We examined effects of influenza on associations between nitrogen dioxide (NO 2), sulfur dioxide (SO 2), particulate matter with aerodynamic diameter ?10 ?m (PM 10) and ozone (O 3) and health outcomes including all natural causes mortality, cardiorespiratory mortality and hospitalization. Generalized additive Poisson regression model with natural cubic splines was fitted to control for time-varying covariates to estimate air pollution health effects. Confounding with influenza was assessed using an absolute difference of >0.1% between unadjusted and adjusted excess risks (ER%). Without adjustment, pollutants were associated with positive ER% for all health outcomes except asthma and stroke hospitalization with SO 2 and stroke hospitalization with O 3. Following adjustment, changes in ER% for all pollutants were <0.1% for all natural causes mortality, but >0.1% for mortality from stroke with NO 2 and SO 2, cardiac or heart disease with NO 2, PM 10 and O 3, lower respiratory infections with NO 2 and O 3 and mortality from chronic obstructive pulmonary disease with all pollutants. Changes >0.1% were seen for acute respiratory disease hospitalization with NO 2, SO 2 and O 3 and acute lower respiratory infections hospitalization with PM 10. Generally, influenza does not confound the observed associations of air pollutants with all natural causes mortality and cardiovascular hospitalization, but for some pollutants and subgroups of cardiorespiratory mortality and respiratory hospitalization there was evidence to suggest confounding by influenza.
Thach, Thuan-Quoc; Wong, Chit-Ming; Chan, King-Pan; Chau, Yuen-Kwan; Neil Thomas, G.; Ou, Chun-Quan; Yang, Lin; Peiris, Joseph S. M.; Lam, Tai-Hing; Hedley, Anthony J.
OBJECTIVE—To assess the survival rate and functionaloutcome in elderly patients with space occupying supratentorial infarction who underwent hemicraniectomy compared with those who received medical treatment alone.?METHODS—All patients older than 55 years with space occupying middle cerebral artery (MCA) infarction treated in our clinic between January 1998 and July 1999 were included in this retrospective analysis. Patients were eligible for decompressive surgery if they were younger than 75 and had no severe comorbidity. Hemicraniectomy was performed regardless of the affected hemisphere. All patients were followed up for assessment of functionaloutcome; data were assessed according to the Barthel index and modified Rankin scale and cover a period of 3 to 9 months after infarction.?RESULTS—Twelve out of 24 patients underwent hemicraniectomy. Eight patients who were operated on survived; only one patient died of transtentorial herniation, three other deaths were due to medical complications. None of the survivors had a Barthel score above 60 or a Rankin score below 4. Nine out of 12 medically treated patients died of transtentorial herniation, one patient died of medical complications. The two surviving patients had a Barthel score below 60 and a Rankin score of 4.?CONCLUSIONS—Craniectomy in elderly patients with space occupying MCA infarction improves survival rates compared with medical treatment alone. However, functionaloutcome and level of independence are poor. Craniectomy in elderly patients should not be performed unless a prospective randomised trial proves beneficial.??
Holtkamp, M; Buchheim, K; Unterberg, A; Hoffmann, O; Schielke, E; Weber, J; Masuhr, F
In this article, we review five instruments for assessing female sexual dysfunction (FSD): the Brief Index of Sexual Functioning for Women (BISF-W; Taylor, Rosen, & Leiblum, 1994), the Changes in Sexual Functioning Questionnaire (CSFQ; Clayton, McGarvy, & Clavet, 1997), the Derogatis Interview for Sexual Functioning (DISF\\/DISFSR; Derogatis, 1997), the Female Sexual Function Index (FSFI; Rosen et al., 2000), and the
Platelets (PLTs), play a key role in hemostasis, clot stability and retraction as well as in vascular repair and anti-microbial host defense. Upon vessel wall damage, PLTs undergo a highly regulated set including adhesion, spreading, aggregation, release reactions as well as exposure of procoagulant surfaces to rapidly form a hemostatic plug that occludes the site of damage. When PLT function is impaired, the bleeding risk increases, but (hyperreactive) PLTs are also involved in many pathophysiological events like thrombosis, vessel constriction, atherogenesis, tumor growth and metastasis, inflammation including atherosclerosis and the subsequent formation of arterial thrombi resulting in stroke and myocardial infarction. While hereditary PLT function disorders are very rare, acquired PLT function abnormalities occur in the course of many diseases and can be associated with many drugs, i.e., non-steroidal anti-inflammatorics, antibiotics or heparin. Therefore, apart from disease diagnosis, severity, and prognosis, assessment of PLT function also serves for identifying the efficacy of anti-PLT therapy and PLT hyperfunction as a possible predictor for thromboembolic events. Since PLTs undergo a lot of measurable changes during storage ex-vivo, one effort of transfusion medicine is the quality monitoring of PLT concentrates (PCs), but also the detection of donors with PLT dysfunction and the determination of patients in which PLT transfusions are effective. The majority of PLT tests focus only on PLT functions involved directly in hemostasis including adhesion/aggregation, coagulation, and clot retraction. Traditional tests, almost complex, time-consuming, and poorly specified, are meanwhile enriched by more user friendly and easy-to-use point-of-care tests on fully automated instruments within whole blood without the requirement of sample processing. These tests help identifying surgical patients at increased risk of post-operative bleeding or with resistance to anti-PLT therapy, therefore at increased risk of thromboembolism. However, up to now, no study shows real outcome benefits by including these tests into the disease management. To date, no function test is suitable to address all distinct steps of PLT activation or reliably predict PLT behavior in vivo following transfusion. PMID:21601530
Patient-reported outcomes (PROs), such as symptom scales or more broad-based health-related quality-of-life measures, play an important role in oncology clinical trials. They frequently are used to help evaluate cancer treatments, as well as for supportive and palliative oncology care. To be most beneficial, these PROs must be relevant to patients and clinicians, valid, and easily understood and interpreted. The Patient-Reported Outcomes Measurement Information System (PROMIS) Network, part of the National Institutes of Health Roadmap Initiative, aims to improve appreciably how PROs are selected and assessed in clinical research, including clinical trials. PROMIS is establishing a publicly available resource of standardized, accurate, and efficient PRO measures of major self-reported health domains (eg, pain, fatigue, emotional distress, physical function, social function) that are relevant across chronic illnesses including cancer. PROMIS is also developing measures of self-reported health domains specifically targeted to cancer, such as sleep/wake function, sexual function, cognitive function, and the psychosocial impacts of the illness experience (ie, stress response and coping; shifts in self-concept, social interactions, and spirituality). We outline the qualitative and quantitative methods by which PROMIS measures are being developed and adapted for use in clinical oncology research. At the core of this activity is the formation and application of item banks using item response theory modeling. We also present our work in the fatigue domain, including a short-form measure, as a sample of PROMIS methodology and work to date. Plans for future validation and application of PROMIS measures are discussed. PMID:17991929
Garcia, Sofia F; Cella, David; Clauser, Steven B; Flynn, Kathryn E; Lad, Thomas; Lai, Jin-Shei; Reeve, Bryce B; Smith, Ashley Wilder; Stone, Arthur A; Weinfurt, Kevin
The use of radiation therapy and\\/or chemotherapy in advanced head and neck cancer is increasing in popularity, driven by the notion that sparing the organs of speech and swallowing from surgical resection will also spare function. This critical review of the literature considered functionaloutcomes after organ preservation to assess the impact of such treatment on speech, swallowing and quality
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.
One measure of the effectiveness of institutional trauma and burn management based on collected patient data involves the computation of a standard normal Z statistic. A potential weakness of the measure arises from incomplete patient data. In this paper, we apply methods of fractional programming and global optimization to efficiently calculate bounds on the computed effectiveness of an institution. The measure of effectiveness (i.e., the trauma outcomefunction) is briefly described, the optimization problems associated with its upper and lower bounds are defined and characterized, and appropriate solution procedures are developed. We solve an example problem to illustrate the method. PMID:10117152
Falk, J E; Palocsay, S W; Sacco, W J; Copes, W S; Champion, H R
Objective. In developed countries, the functional status scores of patients with poor preoperative scores undergoing total joint replacement (TJR) improve more following TJR than those for patients with better preoperative scores. However, those with better preoperative scores achieve the best postoperative functionaloutcomes. We determined whether similar associations exist in a developing country. Methods. Dominican patients undergoing total hip or knee replacement completed WOMAC and SF-36 surveys preoperatively and at 12-month follow-up. Patients were stratified into low-, medium- and high-scoring preoperative groups based on their preoperative WOMAC function scores. We examined the associations between the baseline functional status of these groups and two outcomes-improvement in functional status over 12 months and functional status at 12 months-using analysis of variance with multivariable linear regression. Results. Patients who scored the lowest preoperatively made the greatest gains in function and pain relief following their TJRs. However, there were no significant differences in pain or function at 12-month follow-up between patients who scored low and those who scored high on preoperative WOMAC and SF-36 surveys. Conclusion. Patients with poor preoperative functional status had greater improvement but similar 12-month functionaloutcomes compared with patients who had a higher level of function before surgery. These results suggest that a policy of focusing scarce resources on patients with worse functional status in developing countries may optimize improvement following TJR without threatening functionaloutcome. Additional research is needed to confirm these findings in other developing countries and to understand why these associations vary between patients in the Dominican Republic and patients from developed countries. PMID:23748412
Dempsey, Kyle E; Collins, Jamie E; Ghazinouri, Roya; Alcantara, Luis; Thornhill, Thomas S; Katz, Jeffrey N
Patients with schizophrenia have impaired everyday living and social outcomes. Performance-based measures, including neuropsychological (NP) performance and functional capacity (FC) measures have demonstrated usefulness in predicting these outcomes. We examined the correlation of demographic factors (race, age, and education) and FC measures, and the relative ability of NP performance, FC, and demographic factors to predict real-world outcomes in social, vocational, and residential domains in 194 outpatients with schizophrenia. Age, education, sex, and racial status were significantly, but modestly, associated with performance-based measures of everyday functioning, while, in addition, age and education had a similar modest relationship with social competence. Age, but none of the other demographic variables, contributed to the prediction of all three domains of everyday functioning. Functional capacity variables predicted everyday outcomes even when demographic variables were entered into a predictive equation first. These data suggest a similar and modest but detectable effect of demographic factors on performance-based measures of functional capacity as seen with NP performance in schizophrenia populations. Older age contributed to poorer everyday functioning even after consideration of functional capacity, which seems similar to findings in healthy populations without clinically notable cognitive decline. PMID:22272559
Gould, Felicia; Bowie, Christopher R; Harvey, Philip D
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 outcomesassessment for the chemical engineering programme in order to ensure that its graduates achieve the programme educational objectives. Different direct and
|A promising approach to addressing challenging behavior in schools is to develop and implement "function-based interventions" (Dunlap et al., 2006; Hanley, Iwata, & McCord, 2003). Function-based interventions are individualized interventions in which five key outcomes of functionalassessment (i.e., identification of challenging behavior,…
The objective of this article was to (1) review the engineering and medical literature to structure the available information concerning the assessment of spasticity in the neurological population; (2) to discuss the strengths and weaknesses of the different methods currently in use in spasticity assessment; and (3) make recommendations for future efforts in spasticity outcomeassessment. Spasticity textbooks, Web sites, and OVID, IEEE, and Medline searches from 1966 through 2003 of spasticity, quantitative measure, or outcomeassessment in the rehabilitation population were used as data sources. Over 500 articles were reviewed. Articles that discussed outcome measures used to assess interventions and evaluation of spasticity were included. Authors reviewed the articles looking at inclusion criteria, data collection, methodology, assessment methods, and conclusions for validity and relevance to this article. Issues such as clinical relevance, real-world function and lack of objectivity, and time consumed during performance are important issues for spasticity assessment. Some measures such as the Ashworth Scale remain in common use secondary to ease of use despite their obvious functional limitations. More functionaloutcome goals are plagued by being more time consuming and a general inability to demonstrate changes after an intervention. This may be secondary to the other factors that combine with spasticity to cause dysfunction at that level. Quantitative metrics can provide more objective measurements but their clinical relevance is sometimes problematic. The assessment of spasticity outcome is still somewhat problematic. Further work is necessary to develop measures that have real-world functional significance to both the individuals being treated and the clinicians. A lack of objectivity is still a problem. In the future it is important for clinicians and the engineers to work together in the development of better outcome measures. PMID:15247825
|Functional analysis (FA) methodology is the most precise method for identifying variables that maintain problem behavior. Occasionally, however, results of an FA may be influenced by idiosyncratic sensitivity to aspects of the assessment conditions. For example, data from several studies suggest that inclusion of a tangible condition during an FA…
Rooker, Griffin W.; Iwata, Brian A.; Harper, Jill M.; Fahmie, Tara A.; Camp, Erin M.
Detailed data on living donor age, and its interplay with recipient age, in predicting allograft and recipient outcomes are wanting. We used the Scientific Registry of Transplant Recipients (2000-2009, n = 49 589) to assess the effect of living donor age on delayed graft function (DGF), total graft failure, death-censored graft failure, death with graft function, and graft failure with death as a competing risk using logistic and Cox proportional hazards models. Potential nonlinear associations were modeled using fractional polynomial functions. There was a significant 1.87-fold increase in the adjusted odds of DGF in the oldest versus youngest age groups. The 10-year adjusted hazard ratios (HR) for total graft failure, death-censored graft failure, and death with graft function increased in a nonlinear fashion across the range of living donor age studied. Graft failure was most accentuated in the youngest recipient age groups in competing risk models. Adjustment for renal function at 6- and 12-months post-transplant markedly attenuated the association between living donor age and graft/patient outcomes. Our findings confirm the important influence of living donor age on transplant outcomes and provide detailed estimates of risk across the living donor age continuum. PMID:23384401
For international service-learning to thrive, it must document student learning outcomes that accrue to participants. The approaches to international service-learning assessment must be compelling to a variety of stakeholders. Recent large-scale projects in study abroad learning outcomesassessment--including the Georgia Learning Outcomes of…
Objective To assess the sensitivity of a newly developed brief measure of oral health-related quality of life (OQOL). Methods Self-assessed oral health and OQOL were measured in three groups of patients who had presented for either prophylaxis (n = 32), endodontic care (n = 15), or for a denture (n = 16) in a dental school setting before and after treatment. Main outcome measures included the single-item self-report of oral health (OH-1) and the 6- and 12-item versions of a new OQOL instrument. General linear modeling was used to compute means of self-reported oral health by treatment group. Results Of the 63 patients who completed the baseline questionnaire, 44 (70 percent) returned questionnaires after treatment. The sample averaged 43 ± 15 years, 48 percent male and 55 percent with some college education. Ethnic representation included 35 percent White, 33 percent Black, and 32 percent other – mostly Latino. The mean self-reported number of teeth was 20.6. In terms of sensitivity, significant differences were observed between the treatment groups on the items assessing being upset (P < 0.05), feeling depressed (P < 0.05), and uncomfortable about the appearance of teeth or dentures (P < 0.05). However, magnitude of change, as measured by an effect size, was characterized as minimal to small in the recall and endodontic groups and borderline moderate in the denture group. Conclusion The measure was sensitive to differences within groups, with a small to borderline magnitude of change.
For years, total laryngectomy was the only treatment option for patients with intermediate to advanced laryngeal cancer. Over the past two decades, great progress has been made in the management of this disease, with multimodality approaches aimed at laryngeal preservation reshaping the treatment landscape. In the era of chemoradiation, greater focus and attention are now directed toward functional laryngeal preservation--not simply "organ preservation." The continued development and integration of new treatment approaches, including organ preservation surgery (eg, transoral minimally invasive surgery of the head and neck, supracricoid partial laryngectomy), intensity-modulated radiotherapy, and targeted molecular therapies, offer the potential to improve clinical outcomes, function, and quality of life. Incorporation of these new approaches advances the concept of personalized medicine, with treatment strategies tailored to the circumstances and future of each patient. PMID:18377831
Background: Orthotopic reconstruction following cystectomy has evolved in an attempt to restore anatomy and function to as close as possible to the preoperative state. We review the renal and functionaloutcomes of patients who underwent cystectomy and neobladder reconstruction at our institution. Methods: Between December 2003 and October 2007, 31 patients underwent cystectomy with Studer neobladder reconstruction at the Ottawa Hospital, Ottawa, Ontario, Canada. Follow-up data were obtained regarding renal function (serum creatinine, ?mol/L), continence, urinary flow rates and post-void residual (PVR) at 3, 6 and 12 months after surgery. Change in creatinine from preoperative baseline was calculated and analyzed by student t-test to determine if there was a significant rise in creatinine. Results: There was a statistically significant increase in creatinine from preoperative baseline, with an average increase of 17.3 ?mol/L, 21.8 ?mol/L and 26.3 ?mol/L at 3, 6 and 12 months, respectively. Six patients developed hydronephrosis. Excluding patients with hydronephrosis, there continued to be a statistically significant rise in creatinine with an average increase of 11.9 ?mol/L, 14.7 ?mol/L and 19.4 ?mol/L at 3, 6 and 12 months, respectively. At 1 year, daytime continence was achieved by 89% of patients; 70% were continent at night. Interpretation: Orthotopic neobladders have excellent functionaloutcomes with low rates of incontinence, which improved throughout follow-up. A significant proportion of patients developed hydronephrosis, highlighting the need for close follow-up to prevent reversible renal deterioration. Creatinine increased during follow-up irrespective of the development of hydronephrosis, but the clinical significance is unknown.
Lantz, Andrea G.; Saltel, M. Eric; Cagiannos, Ilias
Assessment of functionaloutcome can be used as a measure of the effectiveness of intervention during recovery from a burn injury. This pilot study identifies the factors that are likely to be most important for determining standardized functionaloutcome measures for children after a burn injury; it highlights the contribution of these factors to variations in children's postburn outcomes. A focus group of 8 parents and a self-report questionnaire administered to 12 children and 13 parents were the means of obtaining information for this exploratory study. Itching was found to be one of the primary impairments that contributed to reduced functionaloutcome during skin healing after a burn injury. The activities of children who had been burned that were most frequently affected by the injury (as reported by parents) were schoolwork and sports; these were closely followed by sleeping, playing with other children, and unliked activities. Least affected activities were enjoying the family, eating, seeing friends, watching television, and bathing or showering. Eighty-five percent of parents reported at least some level of interference with the listed daily activities. Burn injuries are likely to cause interference with several aspects of a patient's daily life. As a result, families require ongoing support and monitoring. Further research should longitudinally compare the performance of children who have been burned with other children and adolescents. PMID:10501323
The School FunctionAssessment (SFA) was developed to provide information on students’ abilities to meet functional demands of the elementary school program. This judgment-based, criterion-referenced assessment supports a comprehensive, detailed examination of the extent to which students with a variety of disabilities are performing important school-related functional tasks and activities such as moving around the school, using classroom materials, interacting
Wendy J. Coster; Marisa C. Mancini; Larry H. Ludlow
Methods: A randomised control trial was conducted to assess the effect of tongue acupuncture (TAC) in 33 CP children. The subjects were randomised to treatment (n = 22) with TAC or control (n = 11). Clinical outcome was evaluated using the gross motor function measure (GMFM) and the pediatric evaluation of disability inventory (PEDI). Results: The increase in mean GMFM score was significantly greater in the treatment than in the control group (p = 0.042). Conclusion: An improvement in motor function of CP subjects is seen following a short course of acupuncture.
Clinical interpretation of health services research based on administrative databases is limited by the lack of patient-reported\\u000a functionaloutcome measures. Reoperation, as a surrogate measure for poor outcome, may be biased by preferences of patients\\u000a and surgeons and may even be planned a priori. Other available administrative data outcomes, such as postoperative cross sectional\\u000a imaging (PCSI), may better reflect changes
Daniel Omoto; S. Samuel Bederman; Albert J. M. Yee; Hans J. Kreder; Joel A. Finkelstein
Objective: Routine outcomeassessment in adult mental health services involves the ongoing assessment of patient-level outcomes. Use of outcomes to inform treatment is widely recommended, but seldom implemented. The goals of this review were (i) to identify principles that have been proposed for implementing routine outcomeassessment, (ii) to identify the full range of outcome domains that have been proposed
The efficacy of parent–child psychotherapies is widely recognized today. There are, however, less data on predictive factors\\u000a for outcome in infants and toddlers and their parents. The aim of this study was to highlight predictive factors for outcome\\u000a after a brief psychotherapy in a population of 49 infants and toddlers aged 3–30 months presenting functional or behavioral\\u000a disorders. Two assessments were
M. J. Hervé; M. Paradis; C. Rattaz; S. Lopez; V. Evrard; M. White-Koning; M. Maury
Objective: To compare the functionaloutcomes 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
The objective was to analyze the metric properties of the Jankovic Rating Scale (JRS) and a self-rating patient response outcome scale, the Blepharospasm Disability Index (BSDI), in blepharospasm patients. Data from a randomized, double-blind, active-control clinical trial in 300 patients with blepharospasm treated with either botulinum toxin type A (Botox) or NT201 (Xeomin) were used to evaluate the metric properties of the JRS and the BSDI compared with the Patient Evaluation of Global Response (PEGR) and Global Assessment Scale (GAS). The internal consistency of the BSDI was high, Cronbach's Alpha = 0.88, and the retest reliability of the BSDI single items was adequate, Spearman's rank coefficient = 0.453 < r < 0.595. The correlation between JRS sum score and BSDI weighted mean score was r = 0.487 (baseline) and r = 0.737 (control visit), respectively. Using the GAS and PEGR, the results suggest that a change of 2 points in the JRS and of 0.7 points in the BSDI are clinically meaningful. JRS and BSDI are objective indicators of clinical efficacy as suggested by their good validity when compared with physicians' and patients' rating scales. Both, JRS and BSDI, can be used to reliably assess blepharospasm in treatment trials. PMID:19053054
Jankovic, Joseph; Kenney, Christopher; Grafe, Susanne; Goertelmeyer, Roman; Comes, George
Optimal surgical therapy for low anorectal anomalies remains controversial. We compared functionaloutcome after correction of perineal fistula in boys with either anoplasty (AP) or limited posterior sagittal anorectoplasty (PSARP). Thirty-nine boys from two centres treated for perineal fistula with either AP (n = 24) or PSARP (n = 15) from 1996 to 2001 underwent prospective follow-up for functionaloutcome. In order to minimize heterogeneity of the study groups, only boys with perineal fistula were included. Functionaloutcome was assessed using a validated bowel function score (maximum score 20). Day and night time wetting as well as the age at potty training were also recorded. An independent nurse specialist interviewed caregivers. AP and PSARP groups were comparable regarding age, associated malformations and frequency of sacral dysplasia. No significant differences between the groups were observed in the overall median bowel function score, AP 18 (11-20) versus PSARP 18 (11-20), or in the age at potty training, AP 32 (14-66) versus PSARP 36 (18-60). Covering colostomy was employed significantly (P < 0.05) more often with PSARP (10/15) than with AP (1/24). Surgery for local complications was carried out significantly (P < 0.05) more often after PSARP (5/15) than after AP (2/24). Two patients in both groups required a temporary salvage colostomy. Overall functionaloutcome is comparable after AP and PSARP for perineal fistula in boys. As a more straightforward procedure AP is safer and less prone to complications avoiding the need for covering colostomy. PMID:17001487
Pakarinen, Mikko P; Goyal, Anju; Koivusalo, Antti; Baillie, Colin; Turnock, Rick; Rintala, Risto J
|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.
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
Discussed is a comprehensive, ecologically based paradigm applicable across cultures and created to assess the effects of abusive traumatic experiences, the Trauma Outcome Process Assessment (TOPA) model (Rasmussen, 1999, 2004, 2007; Rasmussen, Burton, & Christopherson, 1992). The TOPA model comprehensively assesses the risk and protective factors and trauma outcomes that contribute to self-destructive and\\/or abusive behavior in youth. TOPA interventions
|Educators and therapists implement assistive technology to maximize educational outcomes of students with disabilities. However, few measure the outcomes of interventions because of a lack of valid measurement tools. This study investigated whether an assistive technology supplement for the School FunctionAssessment demonstrates an important…
Developing effective interventions for students with challenging behaviors may require functional behavioral assessment (FBA), now mandated by IDEA '97. While the assistance of students, parents, and teachers is crucial, it is the educational diagnostician who likely will be responsible for orchestrating the tasks involved in conducting a proper FBA. It stands to reason that diagnosticians, as assessment professionals, must be
MicroCog: Assessment of Cognitive Functioning version 2.1 (Powell, D. H., Kaplan, E. F., Whitla, D., Catlin, R., and Funkenstein, H. H. (1993). The Psychological corporation, San Antonio, TX.) is one of the first computerized assessment batteries commercially developed to detect early signs of cognitive impairment. This paper reviews its psychometric characteristics and relates them to its clinical utility. It concludes
The comprehensive geriatric assessment (VGI) is a diagnostic process dynamic, structured, multidimensional and interdisciplinary to detect problems and needs of older people to develop an intervention strategy, although scientific evidence should not apply to all groups elderly. The VGI is developed by an interdisciplinary team, which plays a key role nursing. The framework nurse and nursing conceptual models, especially the 11 functional health patterns, enable the multidimensional assessment and subsequent intervention. The VGI covers four areas, clinic, mental, social and functional, although its axis, its importance and globalization concept is functionalassessment. For this we have the history, physical examination and a series of specific instruments, geriatric assessment scales. They are a complement to, not only the VGI axis. PMID:23951672
Casado Verdejo, Inés; Iglesias Guerra, José Antonio
For epidemiologic studies that evaluate the relation between potential exposures to environmental chemicals and adverse outcomes, accurate assessments of exposures and health outcomes are needed. Three prospective cohort studies recently evaluated the relation between exposure, as assessed by biomonitoring, of pregnant women to organophosphorus pesticides and several birth outcomes. Here these three studies are compared in terms of the exposure scenarios and exposure assessments. The primary focus is on the exposure assessments, all of which employ biomonitoring but use different approaches, which may contribute to the different findings. These approaches and how they may contribute to different relations between exposure and birth outcomes are examined.
|One-hundred seventy-three studies that employed functionalassessment 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.
The Clinical OutcomesAssessment Toolkit (COAT) was created through a collaboration between the University of California, Los Angeles and Brigham and Women's Hospital to address the challenge of gathering, formatting, and abstracting data for clinical outcomes and performance measurement research. COAT provides a framework for the development of information pipelines to transform clinical data from its original structured, semi-structured, and
OBJECTIVE To evaluate how age affects functionaloutcome and quality of life after ileal pouch anal anastomosis (IPAA). SUMMARY BACKGROUND DATA Because of the limited number of older patients undergoing IPAA, it has been difficult to assessfunctionaloutcome and quality of life stratified by age. METHODS IPAA was performed in 1895 patients. Patients were stratified by age into <45 (n = 1410), 46-55 (n = 289), 56-65 (n = 154), and more than 65 years (n = 42). Outcome was assessed prospectively. Results are presented at 1, 3, 5, and 10 years after surgery.RESULTS Patients were followed for 4.6 +/- 3.7 years (maximum, 17 years). Pouch failure occurred in 4.1% (pouch excision or permanent diversion). Incontinence and night time seepage were more common in older patients. There were minor differences in the quality of life, health, energy and happiness between age groups, with a slight benefit for those under 45 years. Fourteen percent or fewer patients experienced social, sexual or work restrictions. Overall, 96% of patients were happy to have undergone their surgery, and 98% recommended it to others. Although the respective figures were 89% and 96% in the over-65 age group, the difference was not significant. CONCLUSIONS These data provide a unique assessment of outcome after IPAA at multiple time points. Although functionaloutcome after IPAA is not as good in older patients, appropriate case selection confers acceptable function and quality of life to patients of all ages. PMID:12894015
Delaney, Conor P; Fazio, Victor W; Remzi, Feza H; Hammel, Jeff; Church, James M; Hull, Tracy L; Senagore, Anthony J; Strong, Scott A; Lavery, Ian C
The introduction of functional rehabilitation for patients with Achilles tendon rupture has dramatically changed treatment programs for this condition. The authors introduced a functional weight-bearing protocol for patients with an acute Achilles tendon rupture treated operatively and nonoperatively in 2002. They hypothesized that no significant differences would exist in the rerupture rates and functionaloutcomes between the groups. Between 2002 and 2008, the authors collected data on 80 consecutive patients treated with a weight-bearing functional orthosis for complete Achilles tendon rupture. Following evidence-based counseling, 51 patients chose nonoperative treatment and 29 chose operative treatment. Outcome measures included rerupture rates, other complications, and functional scoring. The nonoperative group was a decade older (median age, 47 years [range, 27-80 years]) than the operative group (median age, 37 years [range, 24-55 years]). Rerupture was noted in 2 (4%) patients in the nonoperative treatment group and 1 (3%) patient in the operative group. Two (7%) patients in the operative group developed superficial wound infections and reported no nerve injuries. Median Achilles Tendon Total Rupture Score was 82 points in the nonoperative group and 94 in the operative group. Median Victorian Institute of Sports Assessment-Achilles tendinopathy questionnaire scores were 60 and 91 for the nonoperative and operative groups, respectively. Both groups had low rerupture rates. Functional scores, using the newly validated Achilles Tendon Total Rupture Score, were lower in the nonoperative group. PMID:23937753
Jackson, Gillian; Sinclair, Victoria F; McLaughlin, Charles; Barrie, James
|This article provides guidance on the use of functional behavioral assessment (FBA) techniques to identify the function of problem behaviors by recording antecedents and consequences of each behavior. It includes a case study illustrating application of FBA as well as a sample form for recording observations, developing a behavioral hypothesis,…
Shippen, Margaret E.; Simpson, Robert G.; Crites, Steven A.
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...
This study reports an independent audit of two aspects of orthognathic surgery, namely control of inter-alar width and mandibular outline asymmetry. Measurements were taken from standardized photographs of a consecutive series of 27 patients, using an on-screen digitizing program (IPTool). All patients had undergone bimaxillary osteotomies involving maxillary impaction and/or advancement, by one surgeon, using a cinch suture for nasal width control. Nine-twelve months after surgery, inter-alar width had increased by just 0.08 cm mean (SD 0.3). Four patients showed an increase of just over 2mm, whilst six showed a small reduction. Based on ratios of size (area) and shape (compactness) of the right and left mandibular segments, there was a small overall improvement in mandibular symmetry (0.019 and 0.005 respectively). Whilst in most of the patients the need for surgery was primarily the correction of antero-posterior and vertical discrepancies, five patients with demonstrable asymmetry showed a clear improvement. In three patients whose asymmetry scores were very mild pre-treatment, there was a small, measured increase in asymmetry, but not to a degree that would be clinically noticeable. At a time when 3D imaging is still unavailable to many clinicians, the results of this study suggest that appropriate measurements taken from carefully standardized conventional photographs can provide a valid and objective means of assessing treatment outcome. PMID:19804924
Edler, R J; Wertheim, D; Greenhill, D; Jaisinghani, A
Background To investigate the relation between maternal thyroid function and the outcome of external cephalic version (ECV) in breech presentation. Methods Prospective cohort study in 141 women (? 35 weeks gestation) with a singleton fetus in breech. Blood samples for assessing thyroid function were taken prior to ECV. Main outcome measure was the relation between maternal thyroid function and ECV outcome indicated by post ECV ultrasound. Results ECV success rate was 77/141 (55%), 41/48 (85%) in multipara and 36/93 (39%) in primipara. Women with a failed ECV attempt had significantly higher TSH concentrations than women with a successful ECV (p < 0.001). Multiple logistic regression showed that TSH (OR: 0.52, 95% CI: 0.30-0.90), nulliparity (OR: 0.11, 95% CI: 0.03-0.36), frank breech (OR: 0.30, 95% CI: 0.10-0.93) and placenta anterior (OR: 0.31, 95% CI: 0.11-0.85) were independently related to ECV success. Conclusions Higher TSH levels increase the risk of ECV failure. Trial registration number ClinicalTrials.gov: NCT00516555
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 assessfunctional 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 assessfunctional 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.
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
|Faculty at The University of Akron Wayne College, the two-year regional branch campus of the University of Akron, developed and implemented a plan to assess student learning in 1997. The plan was based on an embedded outcomes model, linking course-level student learning outcomes to program outcomes for each of six technical associate degree…
Background and Purpose—Proven behavioral assessment strategies for testing potential therapeutic agents in rat stroke models are needed. Few studies include tasks that demand higher levels of sensorimotor and cognitive function. Because behavioral outcome and rate of recovery vary among ischemia models, there is a need to characterize and compare performance on specific tasks across models. Methods—To this end, sensorimotor and
Robin L. Roof; Gerald P. Schielke; Xiaodan Ren; Edward D. Hall
Objectives. Polymyositis (PM) and dermatomyositis (DM) are characterized by impaired muscle function with a majority of patients developing sustained disability. The aim of this study was to evaluate the patient's individual priorities (patient preference) of disabilities most important to improve in PM/DM using the MacMaster Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), to correlate the MACTAR to myositis outcomes and to evaluate its test-retest reliability. Methods. Twenty-eight patients with PM/DM performed recommended outcomes as well as the MACTAR, which was performed twice with one week apart. Results. Sexual activity, walking, biking, social activities, and sleep constituted the predominating disabilities. Seventy-two and 33% of the identified disabilities were not covered by items of the Health Assessment Questionnaire and the Myositis Activities Profile. Correlations between the MACTAR and health-related quality of life measures were rs = ?0.67–0.73, correlations with measures of activities of daily living and participation in society were rs = 0.51–0.60 with lower correlations for other outcomes. Intraclass correlation (ICC) and weighted Kappa (Kw) coefficients were 0.83 and 0.68, respectively, for test-retest reliability of the MACTAR. Conclusions. The MACTAR interview had promising measurement properties and identified patient preference disabilities in PM/DM that were not covered by recommended outcomes.
Alemo Munters, Li; van Vollenhoven, Ronald F.; Alexanderson, Helene
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 functionaloutcome. Because medication trials are conducted across multiple countries, we examined ratings of the cross-cultural adaptability of 4 intermediate measures of functionaloutcome (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
Background The functionaloutcome and quality of life after sphincter-saving operations for ulcerative colitis have not been previously\\u000a assessed in Indian patients whose dietary habits and socio-cultural practices differ considerably from those in western countries.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and methods Between 1996 and 2002, we performed 46 J-pouch ileoanal anastomoses (IPAA), for patients with ulcerative colitis. Thirty-eight\\u000a of these patients had had their ileostomy
Poststroke spasticity (PSS) is associated with significant consequences for a patient's functional status and quality of life. Nonetheless, no uniform definition of spasticity exists that can be utilized across clinical research settings, and difficulties in validating proper assessment tools--both clinical and nonclinical--complicate the ability to evaluate and appropriately treat spasticity. Consequently, the current state of defining, assessing, and treating spasticity requires improved consistency and ongoing validation as clinical research efforts advance. When selecting clinical measures for PSS assessment (e.g., the Modified Ashworth, Tone Assessment, Tardieu, Modified Rankin, and Disability Assessment scales, and the Barthel Index), it is critical to understand the levels of impairment or functional limitation each tool assesses as well as their benefits and limitations. The use of quantitative methods--such as electrophysiologic, biomechanical, and imaging techniques--adjunctive to traditional clinical measures also allows for sensitivity in quantifying the abnormal muscle activity associated with spasticity. In addition to accurate evaluation and assessment of PSS, realistic treatment goal setting for patients as well as family members and caregivers is critical, because it promotes motivation and cooperation as well as proper management of expectations and can favorably affect recovery. Goal attainment scaling has been shown to help organize, focus, and clarify the aims of treatment, thereby enhancing the PSS rehabilitative process. Furthermore, integration of therapeutic modalities and treatment strategies, including both nonpharmacologic intervention and pharmacotherapy, is also important for improved outcomes. PMID:23319484
Sunnerhagen, Katharina S; Olver, John; Francisco, Gerard E
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
|Many postsecondary institutions currently administer standardized tests of general college outcomes; more than a quarter of Association of American Colleges and Universities (AAC&U) member institutions do so. Using standardized tests for accountability purposes has been contentious mainly because these tests do not measure every important outcome…
Steedle, Jeffrey; Kugelmass, Heather; Nemeth, Alex
Many postsecondary institutions currently administer standardized tests of general college outcomes; more than a quarter of Association of American Colleges and Universities (AAC&U) member institutions do so. Using standardized tests for accountability purposes has been contentious mainly because these tests do not measure every important outcome…
Steedle, Jeffrey; Kugelmass, Heather; Nemeth, Alex
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.
A survey was conducted of the member institutions of the National Association of State Universities and Land Grant Colleges (NASULGC) to determine the status of outcomesassessment on their campuses, as well as the usefulness of the NASULGC "Statement of Principles on OutcomesAssessment." Seventy-three institutions (response rate = 49 percent)…
|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…
Objectives To assess the growth of quality of life measures and to examine the availability of measures across specialties. Design Systematic searches of electronic databases to identify developmental and evaluative work relating to health outcome measures assessed by patients. Main outcome measures Types of measures: disease or population specific, dimension specific, generic, individualised, and utility. Specialties in which measures have
Andrew Garratt; Louise Schmidt; Anne Mackintosh; Ray Fitzpatrick
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...
The objective of this study was to obtain information from providers of a behavioral health service and from decision makers for organizations interacting with that service (external contacts) on their attitudes regarding outcomesassessment in their clinical practice. The goal of obtaining the information was to use it in development of a formal OutcomesAssessment Program for the service. The
|The use of standardized tests for outcomeassessment has grown dramatically in recent years. Two driving factors have been the No Child Left Behind legislation, and the increase in outcomeassessment measures by accrediting agencies such as AACSB, the international accrediting body for business schools. Despite the growth in usage, little effort…
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 internalizing distress (e.g., anxiety, depression), externalizing distress (e.g., aggression), and recovery outcomes following traumatic events.
Purpose: To determine the short-term effects of physiotherapy triage assessments on self-reported pain, functioning, and general well-being and quality of life in people with low back-related disorders. Methods: Participants with low back–related complaints were recruited from those referred to a spinal triage assessment program delivered by physiotherapists (PTs). Before undergoing the triage assessment, the participants completed a battery of questionnaires covering a range of sociodemographic, clinical, and psychosocial features. The study used the Numeric Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI), and the Medical Outcomes Survey 36-item short-form version 2 (SF-36v2) to assess self-reported pain, function, and quality of life. Baseline measures and variables were analyzed using a descriptive analysis method (ie, proportions, means, medians). Paired samples t-tests or Wilcoxon matched-pair signed-rank tests were used to analyze the overall group differences between the pretest and posttest outcome measures where appropriate. Results: A total of 108 out of 115 (93.9%) participants completed the posttest survey. The Physical Component Summary of the SF36v2 was the only measure that demonstrated significant improvement (P < 0.001). Conclusion: A spinal triage assessment program delivered by PTs can be viewed as a complex intervention that may have the potential to affect a wide range of patient-related outcomes. Further research is needed to examine the long-term outcomes and explore potential mechanisms of improvement using a biopsychosocial framework.
The management of ureteropelvic junction (UPJ) obstruction has evolved over the past 20 years in response to the development of new technology. Open surgery is still the reference standard against which all other surgical interventions must be measured. The surgical approach has, however, gone through rapid changes, and the open procedure initially described has evolved considerably. Endoscopic and laparoscopic approaches have largely supplanted open pyeloplasty for the majority of primary ureteropelvic junction obstruction cases. Laparoscopic approaches provide a balance between a highly successful technique in all patients and improved postoperative recovery. It has been shown to improve postoperative outcomes with shorter recovery times and hospital stays, and to provide equivalent functional results with a success rate of 95%. Nevertheless, laparoscopic pyeloplasty is not a simple procedure. There are a certain number of disadvantages, such as the limited range of laparoscopic instrument movement, the two dimensional image, the unfamiliar hand-eye coordination and the relatively inefficient ergonomic position. Since 2000, however, robots have provided a magnified three-dimensional view giving a greater degree of freedom. This system has simplified suturing and has improved precision of the operating technique. However, the system is very expensive and, providing it is available in their institution, it seems easier for beginners to learn the robotic technique. Additionally, it has similar success rates (both radiological and clinical) to those obtained with open techniques. PMID:20096181
Stormwater runoff causes environmental problems such as flooding, soil erosion, and water pollution. Conventional stormwater management has focused primarily on flood reduction, while a new generation of decentralized stormwater solutions yields ancillary benefits such as healthier aquatic habitat, improved surface water quality, and increased water table recharge. Previous research has estimated values for flood reduction from stormwater management, but no estimates exist for the willingness to pay (WTP) for some of the other environmental benefits of alternative approaches to stormwater control. This paper uses a choice experiment survey of households in Champaign-Urbana, Illinois, to estimate the values of several attributes of stormwater management outcomes. We analyzed data from 131 surveyed households in randomly selected neighborhoods. We find that people value reduced basement flooding more than reductions in yard or street flooding, but WTP for basement flood reduction in the area only exists if individuals are currently experiencing significant flooding themselves. Citizens value both improved water quality and improved hydrologic function and aquatic habitat from runoff reduction. Thus, widespread investment in low impact development stormwater solutions could have very large total benefits, and stormwater managers should be wary of policies and infrastructure plans that reduce flooding at the expense of water quality and aquatic habitat.
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.
Objective: Construction and validation of a new instrument, the Brain Injury Community Rehabilitation Outcome scales, to assess problems experienced by brain-injured patients living in the community.Design: Seventy-six items describing aspects of personal and social functioning were generated. Two hundred thirty-five patients and\\/or their carers (separately) rated the items on 6-point scales, and patients retrospectively rated their functioning before injury. Seven
Jane H. Powell; Karen Beckers; Richard J. Greenwood
Background: The efficacy of surgical evacuation in patients with intracerebral hemorrhage (ICH) remains unclear for recovery of motor function. The relationship between improvement of motor functionoutcome and sequential change of fractional anisotropy (FA) values was investigated in patients with ICH, to explore whether motor functionoutcome can be predicted in the early phase. Indication of the surgical hematoma evacuation
OBJECTIVE: To examine functional status outcomes among patients with a coronary artery bypass graft (CABG) over time (ie, at baseline; 3 months, 6 months, and 12 months after surgery) and the impact of selected patient characteristics (ie, age, sex, comorbidities, and cardiac rehabilitation participation) on functionaloutcomes.DESIGN: A prospective, repeated-measures design was used to examine functional status in patients with
Susan Barnason; Lani Zimmerman; Angie Anderson; Shirley Mohr-Burt; Janet Nieveen
Level of kidney function as a risk factor for cardiovascular outcomes in the elderly.BackgroundThere is a high prevalence of both reduced kidney function as well as cardiovascular disease (CVD) in the elderly. We evaluated whether the level of kidney function is an independent risk factor for CVD outcomes in the Cardiovascular Health Study (CHS), a cohort of subjects whose age
Guruprasad Manjunath; Hocine Tighiouart; Josef Coresh; Bonnie Macleod; Deeb N. Salem; John L. Griffith; Andrew S. Levey; Mark J. Sarnak
This research investigates selected South Dakota science educational outcomes as a function of selected educational reform policies. In the state of South Dakota, echoing divergent reform initiatives from "A Nation at Risk" to "No Child Left Behind," new guidelines and requirements have been instituted. Yet, very little effort has been made to assess the progress of these educational changes. In this study, selected educational outcomes-SAT8/9/10 scores-as a function of selected South Dakota educational reform policies were examined. School districts, ranked in the top and bottom five percent of socioeconomic status (SES) in the state, were selected for analysis. Comparison on student's science educational outcomes was also be made between the two major ethnic populations-Caucasians and Native Americans. All research questions were stated in the null form for hypothesis for statistical testing. Critical t was the statistic technique used to test the hypotheses. The findings revealed that the selected reform policies in South Dakota appeared to assist students from the higher socioeconomic backgrounds to perform better than pupils from the lower socioeconomic backgrounds. The academic performance for the ethnic and social class minorities remained unchanged within the study timeline for reform. Examined from the prism of Michael Apple's critical theory, the selected South Dakota reform policies have paid little attention to the issues of social equality. Continuing and collective efforts to promote equitable reform policies for enhancing the learning experience of all children in South Dakota seem necessary.
The purpose of this study was to compare the functional status of children with acquired and congenital lower limb loss after 3 weeks and 6 months of prosthetic rehabilitation. Forty-one children aged between 8 and 17 years participated in the study. The children underwent prosthetic fitting, prosthetic training and rehabilitation after physiotherapy evaluations. Gait patterns and weight bearing values were assessed, and the Amputee Mobility Predictor (AMP) Questionnaire was applied. The congenital group had better gait patterns, weight bearing values and AMP scores in the initial assessment and after 3 weeks. The statistical analyses of the same parameters after 6 months showed that there were no significant differences between the two groups (P>0.05). It was determined that all congenital patients and only 16 of 20 acquired patients were wearing their prostheses for more than 8 h a day. When the outcomes of the first assessments were compared, the congenital group showed a better functional level, gait pattern and weight bearing value. At the end of 6 months, an improvement was observed in the functional level, gait pattern and weight bearing value in both the groups. The functional state, gait pattern and weight bearing value of children with limb loss can be improved if they actively use their prosthesis. PMID:21394040
Clinical experience suggests that application of the fundamental principles of rehabilitation medicine can improve the care of patients with cancer. Despite the high incidence of neurological and functional deficits in patients affected by brain tumours (BTs), rehabilitation treatment of this population is not as well established as it is for patients with other neurological conditions. To assessfunctionaloutcome in brain tumour inpatients who underwent early rehabilitation after surgery. 75 patients who had undergone neurosurgery for primary BTs and 75 patients affected by stroke were enrolled in a case-control study. All patients were evaluated by means of a core set of clinical scales (Functional Independence Measure, Sitting Balance score, Standing Balance score, Hauser Index, Massachusetts General Hospital Functional Ambulation Classification). Patients were evaluated before the beginning (T0) and at the end (T1) of rehabilitation treatment. The neurorehabilitation programme consisted of individual 60-min sessions of treatment, administered once a day, six days a week, for four consecutive weeks. Speech therapy was included when aphasia was diagnosed. All the measures of outcome were indicative of substantial improvements for neuro-oncological and for stroke patients (P = 0.000). Analysis of subgroups showed that patients affected by meningioma achieved better results (in efficiency terms) as regards independence in activities of daily living (P = 0.02) and mobility (P = 0.04) compared with patients affected by glioblastoma or stroke. Rehabilitation after surgery can improve functionaloutcome, justifying the delivery of rehabilitation services, even during the acute phase, to BTs inpatients, irrespective of tumour type. PMID:22124725
The Evans tenodesis is an operative treatment for chronic ankle instability with good short-term results. The disadvantage of impaired hind foot kinematics and restricted motion has been described, and only few reports of long-term results can be found. No techniques have been used to assess the outcome objectively. We wanted to determine whether a modified Evans procedure led to a satisfactory clinical and functionaloutcome. Nineteen patients were available at a 10-year follow-up. The clinical examination included a detailed questionnaire and stress radiographs. Foot function was evaluated with plantar pressure distribution measurements during walking and peroneal reaction time measurements elicited on a rapidly tilting platform (recorded with surface electromyography). High subjective patient satisfaction was contrasted with a high rate of residual instability, pain, and swelling. The radiographs showed an increased number of exostoses. The gait analysis revealed reduced peak pressures under the lateral heel and increased values under the longitudinal arch. The reaction times of the peroneal muscles were shorter on the operated side (significant: peroneus longus). The persistent clinical problems as well as the functional changes indicate that the disturbed ankle joint kinematics permanently alter foot function and may subsequently support the development of arthrosis. Therefore, the Evans procedure should only be applied if anatomical reconstruction of the lateral ankle ligaments is not feasible. PMID:9429877
Rosenbaum, D; Becker, H P; Sterk, J; Gerngross, H; Claes, L
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 functionaloutcomes 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 functionaloutcomes 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.
\\u000a A broad array of biochemical tests are used to assess the various functions of the liver and evaluate patients with suspected\\u000a or established liver disease. These tests are collectively referred to as “liver function tests,” a term that is often criticized\\u000a because the most commonly used tests—the aminotransferases and alkaline phosphatase—are not true measures of liver synthetic,\\u000a excretory, or metabolic
Hamed Khalili; Barham Abu Dayyeh; Lawrence S. Friedman
|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 functionaloutcomes. However, relationship between motor impairments and functionaloutcome has not been proved definitely. This study…
The primary goal of this study was to evaluate whether women with alcohol problems report differences in their strength of endorsement of specific positive outcome expectancies as a function of alcoholic beverage type. Fifty-four participants completed the Beverage Expectancy Questionnaire (BEQ) that assessed five specific positive outcome expectancies across three different beverage types (i.e., wine, beer, hard liquor). Participants endorsed
Kris Devoulyte; Sherry H. Stewart; Jennifer A. Theakston
Background The effects of multiple injuries on the neurological and functionaloutcomes of patients with traumatic spinal cord injury (SCI) are debated—some groups have shown that subjects with multiple injuries have the same neurological and functionaloutcomes of those without them, whereas others have found that SCI patients with associated traumatic brain injury have worse functional status at admission and discharge and longer rehabilitation stays than patients without brain injury. Thus, the aim of this study was to compare the outcomes of SCI subjects with or without multiple injuries. Methods A total of 245 patients with a traumatic SCI during the first rehabilitation stay after the development of the lesion (202 males and 43 females; age 39.8 ± 17 years; lesion to admission time 51.1 ± 58 days) were examined on a referral basis. Patients were assessed using the following measures: American Spinal Injury Association standards, Barthel Index, Rivermead Mobility Index, and Walking Index for Spinal Cord Injury. The statistical analysis comprised Poisson regression models with relative risks and 95% confidence intervals, adjusted for the following confounders: age, sex, lesion level, and ASIA impairment scale (AIS) grade. Student’s T test was used to compare the outcomes of patients divided by AIS impairment and lesion level. Results SCI patients with and without multiple injuries differed significantly with regard to the level and completeness of the lesion. Overall, patients with multiple injuries had worse functional status at admission and discharge than monotraumatic subjects. However, when adjusted for neurological features, the populations had comparable functional and neurological status at admission and discharge and similar rates of complications and discharge destinations. The separate analysis per each level of lesion/AIS grade showed that in some groups, patients with multiple injuries had a significant longer length of stay or worse functional status at rehabilitation admission (but not at discharge) than their monotraumatic counterparts. Conclusions Multiple injuries do not affect the neurological or rehabilitative prognosis of spinal cord injuries. At discharge, patients with spinal cord injuries with and without multiple injuries achieved similar results with regard to neurological and functional improvement. Some groups of patients with multiple injuries had a longer length of stay.
Traces functionalassessment (FA) in school settings to early contributions by B. F. Skinner. FA plays an important role in behavior analysis, and the value of this approach in dealing with behavior problems in many settings has long been evident. Although interest in FA in school settings has only recently become widespread, FA in education has a…
Ervin, Ruth A.; Ehrhardt, Kristal E.; Poling, Alan
|Functional behavioral assessment (FBA) is the process of identifying the events in the environment that consistently precede and follow challenging behavior. The use of FBA has increased significantly following the reauthorization of the Individuals with Disabilities Education Act in 1997, which mandated FBAs be conducted when children with…
|The purpose of this study was to investigate the effectiveness of training special education teachers in the process of functional behavioral assessment (FBA) and subsequent development of recommendations to promote behavior change. An original evaluation instrument was developed that included measures of special education teachers' knowledge of…
|Functional behavioral assessment (FBA) is the process of identifying the events in the environment that consistently precede and follow challenging behavior. The use of FBA has increased significantly following the reauthorization of the Individuals with Disabilities Education Act in 1997, which mandated FBAs be conducted when children with…
|This article synthesizes information from the special education literature about functional behavioral assessments (FBAs), including the law and FBA, working definitions, basic assumptions underlying FBA, the role of the diagnosticians, the role of special educators, the steps to conducting an FBA, the methods of FBA, and tools for the…
Functional behavioral assessment (FBA) is the process of identifying the events in the environment that consistently precede and follow challenging behavior. The use of FBA has increased significantly following the reauthorization of the Individuals with Disabilities Education Act in 1997, which mandated FBAs be conducted when children with disabilities demonstrate challenging behavior. The purposes of this paper are to review
Functionaloutcome after retrograde femoral intramedullary nailing was investigated in 35 patients older than 60 years (mean, 86 years) with 36 fractures, comprising 15 (41.7%) shaft and 21 (58.3%) distal fractures; overall, 7 (19.4%) periprosthetic fractures occured. Twenty-two (62.9%) of 35 patients were evaluated at a mean 16.5-month follow-up with the Lyshom-Gillquist score and the SF-8 questionaire. Primary union rate was 97.8%, with no significant differences in duration of surgery, bone healing, mobilization, and weight bearing among different fracture types; periprosthetic fractures revealed a significantly delayed mobilization (P=.03). Complications occured significantly more often among distal femoral fractures (P=.009), including all revision surgeries. The most frequently encountered complication was loosening of distal locking bolts (n=3). Lysholm score results were mainly influenced by age-related entities and revealed fair results in all fractures (mean in the femoral shaft fracture group, 78.1 vs mean in the distal femoral fracture group, 74.9; P=.69), except in the periprosthetic subgroup, which had good results (mean, 84.8; P=.23). This group also had increased physical parameters according to SF-8 score (P=.026). No correlation existed between SF-8 physical parameters and patient age or surgery delay, whereas a negative correlation existed between patient age and SF-8 mental parameters (P=.012). Retrograde femoral intramedullary nailing is commonly used in elderly patients due to reliable bone healing, minimal soft tissue damage, and immediate full weight bearing. It also offers a valid alternative to antegrade nailing in femoral shaft fractures. PMID:22691657
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
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.
Outcome after anterior spinal fusion has mainly been studied radiologically and reported fusion rates vary greatly. The aim of this study was to investigate radiological and long-term clinical outcome. The study comprised 120 consecutive patients, operated on during the period 1979–1987, with single-or two-level anterior interbody spinal fusion due to disc degeneration or isthmic spondylolisthesis with lumbar instability. In 64
F. B. Christensen; B. Karlsmose; E. S. Hansen; C. E. Bringer
Objectives: Although stroke associated with small vessel disease (SSVD) can induce both motor and cognitive impairment, the latter has received less attention. We aimed to evaluate the frequency of the varying severity levels of cognitive impairment, the determinants of severe cognitive impairment, and the association of cognitive impairment with functionaloutcome after SSVD. Methods: Consecutive patients admitted to hospital because of SSVD were assessed at 3 months after stroke. We performed a semi-structured clinical interview to screen for cognitive symptoms. Severity of cognitive symptoms was graded according to the Clinical Dementia Rating Scale (CDR). Performance on psychometric tests (Mini-Mental State Examination, Alzheimer's Disease Assessment Scale (cognition subscale), Mattis Dementia Rating Scale (initiation/perseverence subscale; MDRS I/P)) of patients of different CDR gradings was compared with that of 42 healthy controls. Basic demographic data, vascular risk factors, stroke severity (National Institute of Health Stroke Scale; NIHSS), pre-stroke cognitive decline (Informant Questionnaire on Cognitive Decline in the Elderly; IQCODE), functionaloutcome (Barthel index; BI), Instrumental Activities Of Daily Living; IADL), and neuroimaging features (site of recent small infarcts, number of silent small infarcts, white matter changes) were also compared among the groups. Regression analyses were performed to find predictors of severe cognitive impairment and poor functionaloutcome. Results: Among the 75 included patients, 39 (52%) complained of cognitive symptoms. The number of patients in each CDR grading was as follows: 39 (52%) had a CDR of 0, 26 (34.7%) had a CDR of 0.5, 10 (13.3%) had a CDR of ?1. Pre-stroke IQCODE and previous stroke predicted CDR?1. The NIHSS was associated with more impaired BI. The NIHSS and MDRS I/P contributed most to impaired IADL. Conclusions: Half of the patients with SSVD complained of varying severity of cognitive problems 3 months after stroke. Pre-stroke cognitive decline and previous stroke predict severe cognitive impairment post stroke. Stroke severity and executive dysfunction contribute most to a poor functionaloutcome.
Background: Lower-extremity injury severity scoring systems were developed to assist surgeons in decision-making regarding whether to amputate or perform limb salvage after high-energy trauma to the lower extremity. These scoring systems have been shown to not be good predictors of limb amputation or salvage. This study was performed to evaluate the clinical utility of the five commonly used lower-extremity injury severity scoring systems as predictors of final functionaloutcome. Methods: We analyzed data from a cohort of patients who participated in a multicenter prospective study of clinical and functionaloutcomes after high-energy lower-extremity trauma. Injury severity was assessed with use of the Mangled Extremity Severity Score; the Limb Salvage Index; the Predictive Salvage Index; the Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score; and the Hannover Fracture Scale-98. Functionaloutcomes were measured with use of the physical and psychosocial domains of the Sickness Impact Profile at both six months and two years following hospital discharge. Four hundred and seven subjects for whom the reconstruction regimen was considered successful at six months were included in the analysis. We used partial correlation statistics and multiple linear regression models to quantify the association between injury severity scores and Sickness Impact Profile outcomes with the subjects' ages held constant. Results: The mean age of the patients was thirty-six years (interquartile range, twenty-six to forty-four years); 75.2% were male and 24.8% were female. The median Sickness Impact Profile scores were 15.2 and 6.0 points at six and twenty-four months, respectively. The analysis showed that none of the scoring systems were predictive of the Sickness Impact Profile outcomes at six or twenty-four months to any reasonable degree. Likewise, none were predictive of patient recovery between six and twenty-four months postoperatively as measured by a change in the scores in either the physical or the psychosocial domain of the Sickness Impact Profile. Conclusions: Currently available injury severity scores are not predictive of the functional recovery of patients who undergo successful limb reconstruction. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.
Ly, Thuan V.; Travison, Thomas G.; Castillo, Renan C.; Bosse, Michael J.; MacKenzie, Ellen J.
|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
BACKGROUND: Although injuries due to circular saws are very common all over the world, there is surprisingly little information available about their functionaloutcomes. 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 functionaloutcome, disability, and impairment of hand
Matthias Frank; Juliane Hecht; Matthias Napp; Joern Lange; Rico Grossjohann; Dirk Stengel; Uli Schmucker; Axel Ekkernkamp; Peter Hinz
A comprehensive review of the medical literature from 1950 to 1998 revealed 79 articles examining associations between rehabilitation interventions and functionaloutcome after stroke. This body of literature was critically analyzed, using established techniques, to reveal factors that were consistently associated with functionaloutcome after stroke. The following rehabilitation interventions after stroke appear to have a strong relationship with improved
Our objectives were to evaluate whether low knee confidence at baseline is associated with poor baseline-to-3-year physical functionoutcome in the Osteoarthritis Initiative (OAI). Knee confidence was assessed using an item from the KOOS instrument. Physical function was assessed using self-report (WOMAC function, SF-12 physical component scale) and performance-based (20 m walk, chair stand test) measures. Poor functionoutcome was defined as moving into a worse function group or remaining in the 2 worst function groups between baseline and 3 years. Logistic regression was used to evaluate the relationship between baseline knee confidence and poor baseline-to-3-year functionoutcome, adjusting for potential confounders. The sample included 3975 men and women with or at higher risk to develop knee OA. 37-53% had poor baseline-to-3-year functionoutcome. For both self-report measures, increasingly worse knee confidence was associated with a greater risk of poor functionoutcome and trend tests supported a graded response [e.g., for WOMAC, adjusted OR (95% CI) for worsening confidence categories: 1.26 (1.07, 1.49), 1.43 (1.16, 1.77), 2.05 (1.49, 2.82), p for trend <.0001]. Similar associations between confidence and performance-based functionoutcome were observed but statistical significance did not persist in adjusted analyses. Factors independently associated with poor functionoutcome for all 4 outcome measures were depressive symptoms, comorbidity, BMI, and joint space narrowing. Worse knee confidence at baseline was independently associated with greater risk of poor functionoutcome by self-report measures, with evidence of a graded response; the relationship was not significant for the performance measures in the fully adjusted models.
Context Development of pharmacologic and behavioral interventions for cancer-related fatigue (CRF) requires adequate measures of this symptom. A guidance document from the Food and Drug Administration offers criteria for the formulation and evaluation of patient-reported outcome measures used in clinical trials to support drug or device labeling claims. Methods An independent working group, ASCPRO (Assessing Symptoms of Cancer Using Patient-Reported Outcomes), has begun developing recommendations for the measurement of symptoms in oncology clinical trials. The recommendations of the Fatigue Task Force for measurement of CRF are presented here. Results There was consensus that CRF could be measured effectively in clinical trials as the sensation of fatigue or tiredness, impact of fatigue/tiredness on usual functioning or as both sensation and impact. The ASCPRO Fatigue Task Force constructed a definition and conceptual model to guide measurement of CRF. ASCPRO recommendations do not endorse a specific fatigue measure but clarify how to evaluate and implement fatigue assessments in clinical studies. The selection of a CRF measure should be tailored to the goals of the research. Measurement issues related to various research environments were also discussed. Conclusion There exist in the literature good measures of CRF for clinical trials with strong evidence of clarity and comprehensibility to patients, content and construct validity, reliability, sensitivity to change in conditions in which one would expect them to change (assay sensitivity), and sufficient evidence to establish guides for interpreting changes in scores. Direction for future research is discussed.
Barsevick, Andrea M.; Cleeland, Charles S.; Manning, Donald C.; O'Mara, Ann M.; Reeve, Bryce B.; Scott, Jane A.; Sloan, Jeff A.
Examines the scientific concept of evaporation. Attempts to show how students develop their understanding through the levels of the Structure of the Observed Learning Outcome (SOLO) taxonomy. Shows how designing learning experiences to suit the learners' developmental stages in understanding a concept is paramount to the overall growth of the…
Examined effects of family structure on adequacy of prenatal care and birth outcomes using data for 18,594 women who experienced either live birth, fetal death, or infant death in 1988. Found major differences in effect of family structure across racial/ethnic groups. Effect of family structure was less important for black or white women than for…
|Background: While studies have increasingly investigated deficits in reaction time (RT) and RT variability in children with attention deficit/hyperactivity disorder (ADHD), few studies have examined the effects of stimulant medication on these important neuropsychological outcome measures. Methods: 316 children who participated in the Multimodal…
Epstein, Jeffery N.; Conners, C. Keith; Hervey, Aaron S.; Tonev, Simon T.; Arnold, L. Eugene; Abikoff, Howard B.; Elliott, Glen; Greenhill, Laurence L.; Hechtman, Lily; Hoagwood, Kimberly; Hinshaw, Stephen P.; Hoza, Betsy; Jensen, Peter S.; March, John S.; Newcorn, Jeffrey H.; Pelham, William E.; Severe, Joanne B.; Swanson, James M.; Wells, Karen; Vitiello, Benedetto; Wigal, Timothy
Background: While studies have increasingly investigated deficits in reaction time (RT) and RT variability in children with attention deficit/hyperactivity disorder (ADHD), few studies have examined the effects of stimulant medication on these important neuropsychological outcome measures. Methods: 316 children who participated in the Multimodal…
Epstein, Jeffery N.; Conners, C. Keith; Hervey, Aaron S.; Tonev, Simon T.; Arnold, L. Eugene; Abikoff, Howard B.; Elliott, Glen; Greenhill, Laurence L.; Hechtman, Lily; Hoagwood, Kimberly; Hinshaw, Stephen P.; Hoza, Betsy; Jensen, Peter S.; March, John S.; Newcorn, Jeffrey H.; Pelham, William E.; Severe, Joanne B.; Swanson, James M.; Wells, Karen; Vitiello, Benedetto; Wigal, Timothy
|Education and human service organizations providing services to people with intellectual and closely related developmental disabilities are increasingly being impacted by the supports paradigm, the quality of life concept, and the evaluation of personal outcomes. In this article the authors discuss the relationship among these three areas,…
van Loon, Jos; Claes, Claudia; Vandevelde, Stijn; Van Hove, Geert; Schalock, Robert L.
Objectives To review the various methods of outcomesassessment used for effectiveness studies comparing retropubic radical prostatectomy\\u000a (RRP), laparoscopic radical prostatectomy (LRP), and robotic-assisted laparoscopic prostatectomy (RALP).\\u000a \\u000a \\u000a \\u000a \\u000a Methods A review of the peer reviewed literature was performed for reported series of RRP, LRP, and RALP using Pubmed and MEDLINE\\u000a with emphasis on comparing perioperative, functional, and oncologic outcomes. Common methods used for
Keith J. Kowalczyk; Hua-yin Yu; William Ulmer; Stephen B. Williams; Jim C. Hu
Arterial baroreflex is one of the key mechanisms responsible for the homeostasis maintenance within the cardiovascular system. Through the modulation of sympathetic and parasympathetic drive within the autonomic nervous system, baroreflex enables to stabilize arterial blood pressure and maintain perfusion within critical organs (e.g. brain, heart). This review provides the physiological background of the baroreflex functioning and describes the methodology for assessing the arterial baroreflex sensitivity (BRS). Decreased BRS reflects autonomic imbalance and predicts unfavorable outcome in cardiovascular diseases accompanied by the autonomic dysfunction, such as arterial hypertension and heart failure. BRS assessment methods can be divided into those that are performed in resting conditions (the measurements of spontaneous BRS, e.g. the sequence or spectral analysis method) and methods with the application of the external stimuli, which may be either non-invasive (e.g. the controlled breathing method) or invasive (e.g. the phenylephrine method). PMID:24052991
This article argues that while the importance of assessment in academic advising is clear and the current emphasis on defining and measuring student learning outcomes represents an essential component of any comprehensive advising assessment plan, an even more comprehensive understanding of programme assessment is needed. Drawing upon business literature related to Kaplan and Norton's balanced scorecard and an expanded model
This article argues that while the importance of assessment in academic advising is clear and the current emphasis on defining and measuring student learning outcomes represents an essential component of any comprehensive advising assessment plan, an even more comprehensive understanding of programme assessment is needed. Drawing upon business…
|For over 20 years, educators and administrators across North America have heatedly debated the value of large-scale student assessment. Throughout the history of schooling in British Columbia, large-scale student assessmentoutcomes have traditionally served to inform broader societal goals. Realistically, "assessment of" group learning (as…
|This article argues that while the importance of assessment in academic advising is clear and the current emphasis on defining and measuring student learning outcomes represents an essential component of any comprehensive advising assessment plan, an even more comprehensive understanding of programme assessment is needed. Drawing upon business…
|Although the new Educational Policy and Accreditation Standards (EPAS) represent a shift from measuring learning outcomes to core competencies, results from assessments conducted prior to this shift continue to provide useful information for program-level assessment and can serve as a baseline as programs redesign assessments for reaffirmation.…
Meyer-Adams, Nancy; Potts, Marilyn K.; Koob, Jeffrey J.; Dorsey, Catherine J.; Rosales, Anna M.
Although the new Educational Policy and Accreditation Standards (EPAS) represent a shift from measuring learning outcomes to core competencies, results from assessments conducted prior to this shift continue to provide useful information for program-level assessment and can serve as a baseline as programs redesign assessments for reaffirmation.…
Meyer-Adams, Nancy; Potts, Marilyn K.; Koob, Jeffrey J.; Dorsey, Catherine J.; Rosales, Anna M.
|The report discusses outcomesassessment plans for Connecticut community colleges. It presents a variety of tools for use in assessing course, program, and general education goals. Demonstrations of competence, measures of quality, and justifications of costs have become essential components of institutional effectiveness. A good assessment plan…
The implementation of outcomes-based assessment and reporting systems in edu- cational programs has been accompanied by a range of political and technical problems, including tensions between the summative and formative purposes of assessment and doubts surrounding the validity and reliability of teacher- constructed assessment tasks. This article examines ways in which these problems have been manifested and addressed, using two
Establishing measurement equivalence is important because inaccurate assessment may lead to incorrect estimates of effects\\u000a in research, and to suboptimal decisions at the individual, clinical level. Examination of differential item functioning (DIF)\\u000a is a method for studying measurement equivalence. An item (i.e., one question in a longer scale) exhibits DIF if the item\\u000a response differs across groups (e.g., gender, race),
A shift in emphasis from educational inputs to academic outcomes as the basis for judgements of educational quality in many parts of the world has intensified efforts to develop assessment practices that provide convincing evidence that students have achieved or made progress towards the graduate learning outcomes specified for a programme of study. Examples of sound and feasible practice are
The focus of the paper is the development of a novel conceptual framework that aims to remedy a critical mis-specification in prior research on the impact of financial aid on academic outcomes: the blending of the effect of aid eligibility with the influence of aid amounts on academic outcomes. To assess the impact of aid amounts received on college graduation
|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…
Tushnet, Naida C., Flaherty, John, Jr., Smith, And
The purpose of this paper is to assess the effect of prenatal care on birth outcome, based on the case of Taiwan. The determinants affecting a woman’s pregnancy resolution, infant birth outcome, and demand for prenatal care are also estimated. The study makes use of a national survey on the knowledge of, attitude toward, and practice of family planning and
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
Improving functionaloutcome, in addition to alleviating psychotic symptoms, is now a major treatment objective in schizophrenia research. Given the large body of evidence suggesting pharmacological treatments generally have minimal effects on indices of functioning, research has turned to psychosocial rehabilitation programs. Among these, neurocognitive and social cognitive interventions are at the forefront of this field and are argued to target core deficits inherent to the schizophrenia illness. However, to date, research trials have primarily focused on chronic schizophrenia populations, neglecting the early psychosis groups who are often as severely impaired in social and occupational functioning. This theoretical paper will outline the rationale for investigating adjunctive cognitive-based interventions in the early phases of psychotic illness, critically examine the current approach strategies used in these interventions, and assess the evidence supporting certain training programs for improving functionaloutcome in early psychosis. Potential pathways for future research will be discussed.
Nurse educators need predictors of failure for early intervention. This study investigated the predictability of fundamentals, mental health, and pharmacology standardized assessment scores to identify the risk of baccalaureate students' failure on the NCLEX-RN. Using logistic regression the pharmacology assessment score was predictive with 73.7% accuracy. Use of the pharmacology assessment can assist in early identification of at-risk students in efforts to better prepare for the NCLEX-RN examination. PMID:23407195
The objective of this paper is to consider key evidence that treatment of vitamin D insufficiency has measurable clinical benefits for the musculoskeletal system in the elderly. The outcomes considered are increased bone mass, decreased rates of bone loss, improved muscle performance, reduced risk o...
|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…
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
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
Purpose: Although patency data for lower extremity bypass grafts are readily available, few reports have focused on patients' satisfaction after surgical reconstruction for claudication. We reviewed our experience with surgical treatment for claudication, focusing on late outcome from the patients' perspective to further refine surgical decision making in patients with intermittent claudication.Patients and Methods: From February 1987 through April 1994,
Simona Zannetti; Gilbert J. L'Italien; Richard P. Cambria
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
ObjectivesThis study was designed to determine the relevance of a proposed classification for advanced heart failure (HF). Profiles based on clinical assessment of congestion and perfusion at the time of hospitalization were compared with subsequent outcomes.
Anju Nohria; Sui W Tsang; James C Fang; Eldrin F Lewis; John A Jarcho; Gilbert H Mudge; Lynne W Stevenson
Introduction Transanal endoscopic microsurgery (TEM) is a minimal invasive technique for local excision of rectal tumours. The procedure is performed via a rectoscope with a diametre of 4 cm. The aim of this prospective study was to assess both functionaloutcome and quality of life after TEM. Patients and methods Between 2004 and 2006, 47 patients were studied prior to and at least 6 months after TEM. Demographics, operative details and post-operative complications were recorded. Functionaloutcome was determined using the Faecal Incontinence Severity Index (FISI). Quality of life was measured using the EuroQol EQ-5D questionnaire and the Faecal Incontinence Quality of Life (FIQL) score. Results Six months after surgery, median FISI score was found to be decreased (p? 0.01), depicting an improvement in faecal continence. This improvement was most significant in tumours within 7 cm from the dentate line (p?=?0.01). From the patients’ perspective, post-operative quality of life was found to be higher (p? 0.02). A significant improvement was observed in two of the four FIQLS domains (embarrassment, p?=?0.03; lifestyle, p?=?0.05). The domains of lifestyle, coping and behaviour and embarrassment were correlated with the FISI (all p?0.05). Conclusion This study indicates TEM has no deteriorating effect on faecal continence. Moreover, once the tumour has been excised using TEM, quality of life is improved.
Gosselink, M. P.; Neijenhuis, P. A.; Schouten, W. R.; Tollenaar, R. A. E. M.; de Graaf, E. J. R.
To assess whether mental health counseling and other health services were associated with functional health outcomes of unaccompanied\\u000a Sudanese refugee minors in the U.S., this study was a descriptive survey of 304 Sudanese refugee minors in foster care through\\u000a the U.S. Unaccompanied Refugee Minors Program (URMP). Functional health outcomes included scores of Child Health Questionnaire\\u000a (CHQ) scales and questions regarding
Paul L. Geltman; Wanda Grant-Knight; Heidi Ellis; Jeanne M. Landgraf
Cleft lip is an anomaly that primarily affects aesthetics, whereas cleft palate is an anomaly that primarily affects function, particularly speech. In fact, the main reason for repairing the palate is to provide adequate structure and function for normal speech production. Despite undergoing palatoplasty surgery, 20 to 30% of children with repaired cleft palate will demonstrate some degree of velopharyngeal dysfunction, resulting in abnormal speech. Velopharyngeal dysfunction is also seen in individuals without a history of cleft palate for various reasons. Because the symptoms of velopharyngeal dysfunction have a variety of causes, a comprehensive evaluation is very important to make the appropriate recommendations for treatment. The purpose of this article is to discuss the clinical assessment of velopharyngeal function for speech, using low-tech and "no-tech" procedures. PMID:21948642
For this report, the authors described the initial activities of the Cancer Patient-Reported Outcomes Measurement Information System (PROMIS)-Sexual Function domain group, which is part of the National Institutes of Health Roadmap Initiative to develop brief questionnaires or individually tailored assessments of quality-of-life domains. Presented are a literature review of sexual function measures used in cancer populations and descriptions of the domains found in those measures. By using a consensus-driven approach, an electronic bibliographic search was conducted for articles that were published from 1991 to 2007, and 486 articles were identified for in-depth review. In total, 257 articles reported the administration of a psychometrically evaluated sexual function measure to individuals who were diagnosed with cancer. Apart from the University of California-Los Angeles Prostate Cancer Index, the International Index of Erectile Function, and the Female Sexual Function Index, the 31 identified measures have not been tested widely in cancer populations. Most measures were multidimensional and included domains related to the sexual response cycle and to general sexual satisfaction. The current review supports the need for a flexible, psychometrically robust measure of sexual function for use in oncology settings and strongly justifies the development of the PROMIS-Sexual Function instrument. When the PROMIS-Sexual Function instrument is available publicly, cancer clinicians and researchers will have another measure with which to assess patient-reported sexual functionoutcomes in addition to the few legacy measures that were identified through this review. PMID:19195044
Jeffery, Diana D; Tzeng, Janice P; Keefe, Francis J; Porter, Laura S; Hahn, Elizabeth A; Flynn, Kathryn E; Reeve, Bryce B; Weinfurt, Kevin P
OBJECTIVES—To assessoutcome after elective treatment for unruptured intracranial aneurysms.?METHODS—Of 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) and short form-36 (SF-36)) 3 months and 1 year after operation; it was compared with baseline measurements.?RESULTS—Before angiography all patients had a normal neurological examination, optimal Barthel and Rankin scores, and a quality of life similar to that in a reference population. Three months postoperatively five patients (28%; 95% confidence interval (95% CI) 10-54%) had neurological impairments (one after angiography), two (11%; 95% CI 1-35%) had a decrease in Barthel index, and 15 (83%; 95% CI 59-96%) had suboptimal Rankin scores (none was dependent in daily living). Quality of life (SIP and SF-36) was reduced for most domains. After 1 year, five patients still had neurological impairments, all had an optimal Barthel index, and eight (47%; 95% CI 23-72%) had suboptimal Rankin scores. Quality of life returned to baseline levels for all SIP and most SF-36 domains.?CONCLUSIONS—Treatment of unruptured aneurysms has a considerable short term negative impact on functional health and quality of life in most patients, despite the low rate of impairments. Outcome improves markedly but not completely within 1 year after operation.??
|Assessment of general education has a long history, although relative to the age of liberal education and educational evaluation it is a very recent development. One of the first recorded efforts to comprehensively assess student achievement in higher education in the United States occurred in the late 1920s and early 1930s, when many…
Assessment of general education has a long history, although relative to the age of liberal education and educational evaluation it is a very recent development. One of the first recorded efforts to comprehensively assess student achievement in higher education in the United States occurred in the late 1920s and early 1930s, when many institutions…
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. PMID:23520284
Perry, Christopher G R; Kane, Daniel A; Lanza, Ian R; Neufer, P Darrell
Left ventricular function and B-type natriuretic peptide (BNP) assessments are used to predict mortality in septic patients. Left atrial function has never been used to prognosticate outcome in septic patients. Objectives: To assess if deterioration of left atrial function in patients with severe sepsis and septic shock could predict mortality. Methods: We studied 30 patients with severe sepsis or septic shock with a mean age of 49.8±16.17. Echocardiographic parameters were measured on admission, Day 4, and Day 7, which comprised left ventricular ejection fraction (EF), and atrial function that is expressed as atrial ejection force (AEF). All patients were subjected to BNP assay as well. Multivariate analyses adjusted for APACHE II score was used for mortality prediction. Results: The underlying source for sepsis was lung in 10 patients (33%), blood in 7 patients (23.3%), abdomen in 7 patients (23.7%), and 3 patients (10%) had UTI as a cause of sepsis. Only one patient had CNS infection. In-hospital mortality was 23.3% (7 patients). Admission EF showed a significant difference between survivors and non survivors, 49.01±6.51 vs.. 56.44±6.93% (P<0.01). On the other hand, admission AEF showed insignificant changes between the same groups, 10.9±2.81 vs. 9.41±2.4 k/dynes P=0.21, while BNP was significantly higher in the non survivors, 1123±236.08 vs. 592.7±347.1 pg/ml (P<0.001). The predicatable variables for mortality was Acute Physiology and Chronic Health Evaluation II score, BNP, then EF. Conclusion: In septic patients, left atrial function unlike the ventricular function and BNP levels can not be used as an independent predictor of mortality.
The discovery of the endothelium as a crucial organ for the regulation of the vasculature to physiological needs and the recognition of endothelial dysfunction as a key pathological condition - which is associated with most if not all cardiovascular risk factors - led to a tremendous boost of endothelial research in the past 3 decades. Despite the possibility to measure endothelial function in the individual and its widespread use in research, its use as a clinical tool in daily medicine is not established yet. We review the most common methods to assess vascular function in humans and discuss their advantages and disadvantages. Furthermore we give an overview about clinical settings were endothelial function measurements may be valuable in individual patients. Specifically, we provide information why endothelial function is not only a risk marker for cardiovascular risk but may also provides prognostic information beyond commonly used risk scores in primary prevention, and in patients with already established coronary disease. We conclude, that non-invasive endothelial function measurements provide valuable additional information, however, to ascertain its use for daily clinical practice, future research should determine whether endothelial function can be used to guide treatment in the individual and if this translates into better outcomes.
Flammer, Andreas J.; Anderson, Todd; Celermajer, David S.; Creager, Mark A.; Deanfield, John; Ganz, Peter; Hamburg, Naomi; Luscher, Thomas F.; Shechter, Michael; Taddei, Stefano; Vita, Joseph A; Lerman, Amir
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
Background: The McLean–Harvard First-Episode Project recruited affective and nonaffective patients at their first lifetime psychiatric hospitalization.Methods: Baseline evaluation and 6-month follow-up in 257 cases yielded recovery outcomes defined by syndromal (absence of DSM-IV criteria for a current episode) and functional (vocational and residential status at least at baseline levels) status. Time to recovery was assessed by survival analysis, and risk
Mauricio Tohen; Stephen M Strakowski; Carlos Zarate; John Hennen; Andrew L Stoll; Trisha Suppes; Gianni L Faedda; Bruce M Cohen; Priscilla Gebre-Medhin; Ross J Baldessarini
PURPOSE: The aim of this study was to assess the functionaloutcome and the quality of life of laparoscopic-assisted ileal pouch-anal anastomosis compared with conventional ileal pouch-anal anastomosis. Further, body image and cosmesis were evaluated in both groups. METHODS: Sixteen patients who underwent a laparoscopic-assisted ileal pouch-anal anastomosis between March 1996 and September 1999 were matched with 19 patients who
M. S. Dunker; W. A. Bemelman; J. F. M. Slors; P. van Duijvendijk; D. J. Gouma
Objective To evaluate associations between human immunodeficiency virus (HIV) disease severity and psychiatric and functionaloutcomes in youth with perinatal HIV infection. Design Cross-sectional analysis of entry data from an observational, prospective 2-year study. Logistic and linear regression models adjusted for potential confounders were used. Setting Twenty-nine sites of the International Maternal Pediatrics Adolescent AIDS Clinical Trials Group study in the United States and Puerto Rico. Participants Youth aged 6 to 17 years who had HIV infection (N=319). Main Exposures Antiretroviral treatment and perinatal HIV infection. Main Outcome Measures Youth and primary care-givers were administered an extensive battery of measures that assessed psychiatric symptoms; cognitive, social, and academic functioning; and quality of life. Results Characteristics of HIV were a current CD4 percentage of 25% or greater (74% of participants), HIV RNA levels of less than 400 copies/mL (59%), and current highly active antiretroviral therapy (81%). Analyses indicated associations of past and current Centers for Disease Control and Prevention class C designation with less severe attention-deficit/hyperactivity disorder inattention symptoms, older age at nadir CD4 percentage and lower CD4 percentage at study entry with more severe conduct disorder symptoms, higher RNA viral load at study entry with more severe depression symptoms, and lower CD4 percentage at study entry with less severe symptoms of depression. There was little evidence of an association between specific antiretroviral therapy and severity of psychiatric symptoms. A lower nadir CD4 percentage was associated with lower quality of life, worse Wechsler Intelligence Scale for Children Coding Recall scores, and worse social functioning. Conclusion Human immunodeficiency virus illness severity markers are associated with the severity of some psychiatric symptoms and, notably, with cognitive, academic, and social functioning, all of which warrant additional study. Trial Registration clinicaltrials.gov Identifier: NCT00100542
Background The proportion of total hip arthroplasties (THAs) associated with corticosteroid use is uncertain, and the mechanisms of corticosteroid-induced osteonecrosis remain unknown. We sought to evaluate the clinical and radiographic outcomes, complications and satisfaction with THA among patients with corticosteroid-induced osteonecrosis. Methods We retrospectively assessedfunctionaloutcome at a minimum 1-year follow-up using the Western Ontario and MacMaster Universities Arthritis Index (WOMAC); Oxford Hip Score; Short Form (SF)-12; University of California, Los Angeles (UCLA) Activity; and patient satisfaction scores. Results We included 31 patients (35 hips). The average follow-up was 20 (range 12–55) months, and the average age at surgery was 47 (range 19–78) years. At follow-up, patients showed significant improvement in all 4 components of the WOMAC (means: function 84, stiffness 75, pain 86, global 84), Oxford-12 (mean 83) and SF-12 (means: mental 40 and physical 48) scores. However, there was no significant improvement in the UCLA Activity scores. Mean patient satisfaction scores were good for pain relief (86), function (80), recreation (77.5) and overall results of surgery (86). Radiographic review at follow-up showed that all components were well fixed with no evidence of loosening. The complication rate was high (17%), with 6 complications in 5 patients (6 of 35 hips). Four patients (4 of 35 hips; 11%) required reoperations. Conclusion Total hip arthroplasty in patients with corticosteroid-induced osteonecrosis of the femoral head is successful in reducing pain and improving function; however, the rate of complications and reoperation is high.
Rahman, Wael A.; Garbuz, Donald S.; Masri, Bassam A.
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 functionaloutcomes. 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
Mitochondria play a major role in cellular function, not only as a major site of ATP production, but also by regulating energy expenditure, apoptosis signaling, and production of reactive oxygen species. Altered mitochondrial function is reported to be a key underlying mechanism of many pathological states and in the aging process. Measurements conducted using intact mitochondria isolated from fresh tissue provides distinct information regarding the function of these organelles that complements conventional mitochondrial assays using previously frozen tissue as well as in vivo assessment using techniques such as magnetic resonance spectroscopy. This chapter describes the process by which mitochondria are isolated from small amounts of human skeletal muscle obtained by needle biopsy and two approaches used to assess mitochondrial oxidative capacity and other key components of mitochondrial physiology. We first describe a bioluminescent approach for measuring the rates of mitochondrial ATP production. Firefly luciferase catalyzes a light-emitting reaction whereby the substrate luciferin is oxidized in an ATP-dependent manner. A luminometer is used to quantify the light signal which is proportional to ATP concentration. We also review a method involving polarographic measurement of oxygen consumption. Measurements of oxygen consumption, which previously required large amounts of tissue, are now feasible with very small amounts of sample obtained by needle biopsy due to recent advances in the field of high-resolution respirometry. We illustrate how careful attention to substrate combinations and inhibitors allows an abundance of unique functional information to be obtained from isolated mitochondria, including function at various energetic states, oxidative capacity with electron flow through distinct complexes, coupling of oxygen consumption to ATP production, and membrane integrity. These measurements, together with studies of mitochondrial DNA abundance, mRNA and protein expression, and synthesis rates of mitochondrial proteins provide insightful mechanistic information about mitochondria in a variety of tissue types.
Patient-reported outcomes (PROs) for men with erectile dysfunction (ED) have blossomed in the published literature and at professional conferences. These outcomes have been central to study the science of ED itself and to evaluate efficacy of treatment for men with ED. In this review article we highlight and distinguish among seven key PROs: the International Index of Erectile Function, for
Valid measurement of health outcomes require instruments that are meaningful to those who use them. Clinicians, patients, and others involved in health care have different perspectives on health conditions that are likely to lead to different interpretations of outcome measures and reductions in the accuracy and validity of outcome measurements. This study used paraphrase procedures, a systematic approach for evaluating respondent comprehension, to evaluate descriptions designed for use in studies of schizophrenia treatment outcomes. In four stakeholder groups directly and indirectly involved in schizophrenia treatment (clinicians, patients, patients' families, and the general public), the paraphrase procedures identified comprehension problems that could compromise measurement quality and yielded specific information to guide improvement of the outcome descriptions. The paraphrase procedures detected comprehension problems that were not identified by respondents. This study suggests that systematic assessment of comprehension can improve the quality of health outcome measurement. PMID:12629923
Background Aim of this study is to thoroughly assess pretreatment organ function in advanced head and neck cancer through various clinical outcome measures and patients' views. Methods A comprehensive, multidimensional assessment was used, that included quality of life, swallowing, mouth opening, and weight changes. Fifty-five patients with stage III-IV disease were entered in this study prior to organ preserving (chemoradiation) treatment. Results All patients showed pretreatment abnormalities or problems, identified by one or more of the outcome measures. Most frequent problems concerned swallowing, pain, and weight loss. Interestingly, clinical outcome measures and patients' perception did no always concur. E.g. videofluoroscopy identified aspiration and laryngeal penetration in 18% of the patients, whereas only 7 patients (13%) perceived this as problematic; only 2 out of 7 patients with objective trismus actually perceived trismus. Conclusion The assessment identified several problems already pre-treatment, in this patient population. A thorough assessment of both clinical measures and patients' views appears to be necessary to gain insight in all (perceived) pre-existing functional and quality of life problems.
BACKGROUND: There are a limited number of studies related to quality of life and functionaloutcome after revision total knee arthroplasty (TKA). The present study aimed to identify predictors of functionaloutcome after revision TKA for aseptic failure. METHODS: One hundred seventy-five patients with mean age of 66.6years (range, 35-88) who underwent revision TKA for aseptic failure at our institute from 2003 to 2007 were identified. Short-form 36 (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC) and Knee Society Scores (KSS) collected preoperatively and at 2years follow up were evaluated. Univariate and multivariate analyses were performed to determine predictors of functionaloutcome in studied patients. RESULTS: Both physical and mental dimensions of SF-36, pain, functional, and stiffness subscales of WOMAC and both functional and clinical scores of KSS improved significantly after revision TKA (p<0.001). In the multivariate analysis, male gender, a lower Charlson comorbidity index, and higher preoperative functional KSS were predictors of higher functional KSS at 2years after revision. Lower preoperative pain and higher clinical KSS were predictors of better outcome as measured by pain scale of WOMAC. Body mass index (BMI) and preoperative clinical KSS were significant predictors of function and stiffness as measured by WOMAC. CONCLUSIONS: BMI is a modifiable predictor of functionaloutcome after revision TKA. Moreover, patients with higher preoperative functional scores appear to have better postoperative function. LEVEL OF EVIDENCE: Level II. PMID:23159149
Kasmire, Kathryn E; Rasouli, Mohammad R; Mortazavi, S M Javad; Sharkey, Peter F; Parvizi, Javad
Background The primary aim of this study was to assess drug treatment adherence in patients with bipolar disorder and to identify factors associated with adherence. The secondary aim was to analyze the impact of suboptimal adherence on clinical and functionaloutcomes. Methods A cross-sectional study was conducted in a sample of outpatients receiving an oral antipsychotic drug. Medication adherence was assessed combining the 10-item Drug Attitude Inventory, the Morisky Green Adherence Questionnaire, and the Compliance Rating Scale. Logistic regression was used to determine significant variables associated with suboptimal adherence to medication. Results Three hundred and three patients were enrolled into the study. The mean age was 45.9 ± 12.8 years, and 59.7% were females. Sixty-nine percent of patients showed suboptimal adherence. Disease severity and functioning were significantly worse in the suboptimal group than in the adherent group. Multivariate analysis showed depressive polarity of the last acute episode, presence of subsyndromal symptoms, and substance abuse/dependence to be significantly associated with suboptimal treatment adherence (odds ratios 3.41, 2.13, and 1.95, respectively). Conclusion A high prevalence of nonadherence was found in an outpatient sample with bipolar disorder. Identification of factors related to treatment adherence would give clinicians the opportunity to select more adequately patients who are eligible for potential adherence-focused interventions.
Montes, Jose Manuel; Maurino, Jorge; de Dios, Consuelo; Medina, Esteban
|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.
Objective To determine whether Neonatal Intensive Care Unit Network Neurobehavior Scales (NNNS) at 44 weeks predict motor outcome at 2 years in preterm infants from the Maternal Lifestyles Study (MLS). Study design Data were collected on all preterm infants (<36 weeks) in the MLS who had an NNNS at 44 weeks (n=395) and neurologic exam at 12–36 months or Bayley Psychomotor Development Index (PDI) at 24 months (n=270). Logistic regression analyzed NNNS summary scores associated with Cerebral Palsy (CP) or PDI <70, while controlling for birth weight 1250g. Results Eighteen of 395 infants (5%) had CP; 24 of 270 infants (9%) had PDI <70. CP was associated with low quality of movement (OR 1.95, 95% CI 1.24–3.06, p=0.004) and high lethargy (OR 1.67, 95% CI 1.01–2.76, p=0.045). The model contributed 19% of the variance in CP diagnosis at 12–36 months (R2=0.19, p<0.001). Low PDI was associated with low handling (OR 1.83; 95% CI 1.12–2.99, p=0.017), low quality of movement (OR 2.16; 95%CI 1.38–3.38, p=0.001), and hypotonia (OR 1.63; 95% CI 1.14–2.32, p=0.007). The model contributed 26% of the variance in PDI <70 at 24 months (R2=0.26, p<0.001). Conclusions The neurobehavioral profile of underarousal in 44 week preterm infants may predict poor motor outcome.
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. PMID:21367970
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
Literature exists to suggest that the severity of traumatic brain injury (TBI) is positively associated with the severity of functional impairment. However, potential mediators of this relationship have not been studied systematically. In the present study, we evaluated a model hypothesized to explain the relationship between TBI severity and functional impairment in 87 patients with moderate-to-severe TBI, studied longitudinally. Using
Yuri Rassovsky; Paul Satz; Mark S. Alfano; Roger K. Light; Kenneth Zaucha; David L. McArthur; David Hovda
|Current educational policies require the participation of students with disabilities in state assessments. Their participation has raised a number of issues, among them the need for accommodations. In this article we consider the role that assistive technology (AT) can play to alleviate current accommodations demands, and highlight research and…
Thurlow, Martha; Tindal, Gerald; Powers, Richard; Lewis, Preston; Laitusis, Cara Cahalan; Breslin-Larson, Joan
The present study illustrates an extension of Kamata's (2001) restricted form of the hierarchical generalized linear model that provides a multilevel longitudinal Rasch measurement model appropriate for use with polytomous responses. This extension can be used to assess average and interindividual change in the latent trait of interest,…
|Nineteen adults who stutter participated in a 3-week intensive stuttering modification treatment program (the Successful Stuttering Management Program [SSMP]). A series of 14 fluency and affective-based measures were assessed before treatment, immediately after treatment, and 6 months after treatment. Measures included stuttering frequency; the…
Blomgren, Michael; Roy, Nelson; Callister, Thomas; Merrill, Ray M.
Objectives To describe the epidemiology of perioperative anemia in patients with hip fracture and assess the relationship between the hemoglobin measurements and clinical outcomes. Design Prospective observational cohort study. Setting Four university and community teaching hospitals. Patients A consecutive cohort of 550 patients who underwent surgery for hip fracture and survived to discharge from August 1997 and August 1998 were evaluated and followed prospectively. Main Outcome Measures Deaths, readmissions and Functional Independence Motor mobility scores within 60 days of discharge. Results Anemia (defined as hemoglobin <12.0 g/dL) was present in 40.4% of patients on admission, 45.6% at the presurgery nadir, 93.0% at the postsurgery nadir, and 84.6% near discharge. The mean drop in hemoglobin after surgery was 2.8 ± 1.6 g/dL. In multivariate analyses, higher hemoglobin levels on admission were associated with shorter lengths of hospital stay and lower odds of death and readmission even after controlling for a broad range of prefracture patient characteristics, clinical status on discharge, and use of blood transfusion. Admission and preoperative anemia was not associated with risk-adjusted Functional Independence Motor mobility scores. In multivariable analyses, higher postoperative hemoglobin was associated with shorter length of stay and lower readmission rates, but did not effect rates of death or Functional Independence Motor mobility scores. Conclusions Substantial declines in hemoglobin were common in patients with hip fracture. Higher preoperative hemoglobin was associated with shorter length of stay and lower odds of death and readmission within 60 days of discharge. Postoperative hemoglobin was also related to length of stay and readmission rates.
Halm, Ethan A.; Wang, Jason J.; Boockvar, Kenneth; Penrod, Joan; Silberzweig, Stacey B.; Magaziner, Jay; Koval, Kenneth J.; Siu, Albert L.
In this era of evidence-based mental health care, traditional forms of depth-oriented psychotherapy and psychological assessment have been marginalized in graduate training in clinical psychology. As a counterpoint, this article presents the evaluation and treatment of an adolescent client, along with an outcomeassessment, and illustrates ways that aspects of traditional psychological testing, including the Rorschach (Exner, 1986) and the
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…
The Public Offender Counselor Inventory was developed to assess counseling outcomes in prisons. The instrument was written to be relevant to the special needs of inmates. This instrument was successfully utilized to assess the results of groups conducted with female prisoners with drug problems. (Author)
|Institutions of higher education are increasingly being held more accountable for assessing student learning both in and out of their classrooms along with reporting results to their stakeholders. The purpose of this study, which examined assessment of student learning outcomes in undergraduate park and recreation academic programs, was two-fold:…
|This report details the activities, findings, and actions that have made up Germanna Community College's (Virginia) student outcomesassessment program in specific reporting areas for 2000-2001. The following sections comprise the report: (1) an executive summary; (2) a report on assessment activities in five general education areas, including…
The Behavior and Symptom Identification Scale (BASIS-32) was developed to assess mental health outcomes among patients with severe illness treated on inpatient programs. However, its applicability and utility to those treated in outpatient programs has not been determined. The objective of this study was to assess reliability, validity, and sensitivity to change of the BASIS-32 among mental health consumers treated
Susan V. Eisen; Marsha Wilcox; H. Stephen Leff; Elizabeth Schaefer; Melissa A. Culhane
Measurement of respiratory muscle strength is useful in order to detect respiratory muscle weakness and to quantify its severity. In patients with severe respiratory muscle weakness, vital capacity is reduced but is a non-specific and relatively insensitive measure. Conventionally, inspiratory and expiratory muscle strength has been assessed by maximal inspiratory and expiratory mouth pressures sustained for 1 s (PImax and PEmax) during maximal static manoeuvre against a closed shutter. However, PImax and PEmax are volitional tests, and are poorly reproducible with an average coefficient of variation of 25%. The sniff manoeuvre is natural and probably easier to perform. Sniff pressure, and sniff transdiaphragmatic pressure are more reproducible and useful measure of diaphragmatic strength. Nevertheless, the sniff manoeuvre is also volition-dependent, and submaximal efforts are most likely to occur in patients who are ill or breathless. Non-volitional tests include measurements of twitch oesophageal, gastric and transdiaphragmatic pressure during bilateral electrical and magnetic phrenic nerve stimulation. Electrical phrenic nerve stimulation is technically difficult and is also uncomfortable and painful. Magnetic phrenic nerve stimulation is less painful and transdiaphragmatic pressure is reproducible in normal subjects. It is a relatively easy test that has the potential to become a widely adopted method for the assessment of diaphragm strength. The development of a technique to measure diaphragmatic sound (phonomyogram) during magnetic phrenic nerve stimulation opens the way for noninvasive assessment of diaphragmatic function.
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.
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.
Optimal surgical therapy for low anorectal anomalies remains controversial. We compared functionaloutcome after correction of perineal fistula in boys with either anoplasty (AP) or limited posterior sagittal anorectoplasty (PSARP). Thirty-nine boys from two centres treated for perineal fistula with either AP (n = 24) or PSARP (n = 15) from 1996 to 2001 underwent prospective follow-up for functionaloutcome. In order to minimize
Mikko P. Pakarinen; Anju Goyal; Antti Koivusalo; Colin Baillie; Rick Turnock; Risto J. Rintala
Even among the most high-functioning individuals with autism, there is a wide range of variation in outcome. This study examined within-child factors, such as temperament, that contribute to variation in social outcomes, the most salient area of deficit among individuals with high-functioning autism (HFA). Approach\\/withdrawal tendencies and effortful control were used to predict variation in symptoms and social skills. A
The objective of this thesis was to gain a better understanding of the relationship between ischemic lesion characteristics and long-term functionaloutcome of stroke survivors. The relationship between volume and localization of the ischemic cerebral lesion and the long-term functionaloutcome of first-ever ischemic middle cerebral artery stroke survivors was studied. Volume and localization was obtained with conventional Magnetic Resonance
Objective: To develop an outcome measure of functional status in preschool children with limb deficiency.Design: Parents of preschool children with limb deficiency completed self-report measures during a routine medical clinic visit.Setting: Outpatient pediatric clinic.Participants: Fifty-two parents of children (ages 4 to 7) with acquired or congenital limb deficiency.Main Outcome Measure: The newly developed Child Amputee Prosthetics Project Functional Status Inventory
Sheri D. Pruitt; James W. Varni; Michael Seid; Yoshio Setoguchi
While mainstream economic models assume that individuals treat probabilities objectively, many people tend to overestimate the likelihood of improbable events and underestimate the likelihood of probable events. However, a biological account for why probabilities would be treated this way does not yet exist. While undergoing fMRI, we presented individuals with a series of lotteries, defined by the voltage of an impending cutaneous electric shock and the probability with which the shock would be received. During the prospect phase, neural activity that tracked the probability of the expected outcome was observed in a circumscribed network of brain regions that included the anterior cingulate, visual, parietal, and temporal cortices. Most of these regions displayed responses to probabilities consistent with nonlinear probability weighting. The neural responses to passive lotteries predicted 79% of subsequent decisions when individuals were offered choices between different lotteries, and exceeded that predicted by behavior alone near the indifference point.
Berns, Gregory S.; Capra, C. Monica; Chappelow, Jonathan; Moore, Sara; Noussair, Charles
Congenital hypothyroidism (CH), usually of the primary and permanent variety, is an eminently preventable cause of growth retardation and mental handicap whose outlook has been transformed by newborn screening, usually involving the measurement of capillary thyroid stimulating hormone (TSH). Severe primary CH, due for example to athyreosis, may result in subtle cognitive, behavioural and sensori-motor deficits, but the extent to which these can be offset by optimal postnatal diagnosis and management remains uncertain. This is because the available adult follow-up data reflect the outcome of previous management in the 1970's and 1980's, and also because the accurate neuro-psychological assessment of children is difficult, particularly in the preschool population. There is an urgent need to develop new consensus guidelines and to ensure that the children managed according to such guidelines are systematically and prospectively assessed so that good quality outcome data become available. In this review, key recommendations in the management of CH include: screening at day 3 so that severely affected infants can begin treatment within the first 10 days of life; setting the TSH referral cut-off at 8-10 mU/L; adopting a disciplined diagnostic algorithm to evaluate referred cases, with measurement of venous free thyroxine (T4), TSH and thyroglobulin combined with dual ultrasound and radioisotope imaging; initial treatment with a T4 dose of 50 ?g daily in infants weighing ? 2.5 kg and 15 ?g/kg/day in infants weighing < 2.5 kg followed by weekly review until thyroid function is normalised; and maintenance of free T4 levels between 15-26 pmol/L and TSH between 0.5-5 mU/L thereafter to avoid both under- and overtreatment. PMID:23154163
In this prospective study we analysed the oncological and functional results of transoral robotic surgery (TORS) to find out if it was suitable as a minimally invasive treatment for oropharyngeal cancer. Between April 2008 and September 2011, 39 patients with oropharyngeal cancer were treated by TORS. We assessed overall and disease-free survival by the Kaplan-Meier test, and we used videopharyngography and the functionaloutcome swallowing scale (FOSS) to evaluate swallowing. We used nasometry to estimate hypernasality, and acoustic waveform analysis to evaluate the voice. Thirty-seven patients (95%) had histologically clear margins of resection. Overall survival at 2 years was 96% and disease-free survival 92%. An oral diet was tolerable after a mean of 6 (range 1-18) days. No serious swallowing difficulties were seen on the videopharyngogram. Thirty-six of 38 patients could swallow well (97%) with FOSS scores ranging from 0 to 2 (1 patient had a poor score but was able to take an oral diet after postural training). Voices were maintained close to the normal range on the acoustic waveform analysis. The oncological and functional results of TORS were quite acceptable for the treatment of oropharyngeal cancer. TORS is a valid treatment for selected patients with oropharyngeal cancer. PMID:23063012
Park, Young Min; Kim, Won Shik; Byeon, Hyung Kwon; Lee, Sei Young; Kim, Se-Heon
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 functionaloutcomes. 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
Functional disability and quality of life in rheumatoid arthritis (RA) are key outcomes that determine patients' demand for care, and influence their compliance and satisfaction with treatment. In the past decade, there has been a shift from physician-focused assessment toward methods based on the postulate that patients can better report their perceptions of health impairment. There are several disease-specific and
The aim of this study was to investigate the effect of the cognitive impairment on functional status in patients with subacute stroke. Fifty-two patients with subacute stroke were included in the study. Mini mental state examination (MMSE) test was used for the evaluation of cognitive status. Patients were separated into two groups according to their cognitive functions. Functional follow-up parameters were activities of daily living (ADL), global recovery and ambulation status. All patients were evaluated on admission to rehabilitation unit, at discharge and 6 months after discharge. Forty-four patients were completed the study. Mean age was 66 and 57 years; disease duration on admission was 4,8 and 3,5 months in the cognitively impaired and normal groups, respectively. Significant improvement was found in terms of functional follow-up parameters in both groups at discharge (P < .05). Functional follow-up parameters did not show statistically significant difference between the groups. But community ambulation rate was higher in cognitively normal group at the sixth month visit. As a result of this study, inpatient rehabilitation was effective both cognitively normal and impaired subacute stroke patients.
Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change. (PsycINFO Database Record (c) 2013 APA, all rights reserved). PMID:23730826
Ronk, Fiona R; Korman, James R; Hooke, Geoffrey R; Page, Andrew C
Objectives To compare 18- to 22-month cognitive scores and neurodevelopmental impairment (NDI) in 2 time periods using the National Institute of Child Health and Human Development’s Neonatal Research Network assessment of extremely low birth weight infants with the Bayley Scales of Infant Development, Second Edition (Bayley II) in 2006–2007 (period 1) and using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III), with separate cognitive and language scores, in 2008–2011 (period 2). Study design Scores were compared with bivariate analysis, and regression analyses were run to identify differences in NDI rates. Results Mean Bayley III cognitive scores were 11 points higher than mean Bayley II cognitive scores. The NDI rate was reduced by 70% (from 43% in period 1 to 13% in period 2; P < .0001). Multivariate analyses revealed that Bayley III contributed to a decreased risk of NDI by 5 definitions: cognitive score <70 and <85, cognitive or language score <70; cognitive or motor score <70, and cognitive, language, or motor score <70 (P < .001). Conclusion Whether the Bayley III is overestimating cognitive performance or whether it is a more valid assessment of emerging cognitive skills than the Bayley II is uncertain. Because the Bayley III identifies significantly fewer children with disability, it is recommended that all extremely low birth weight infants be offered early intervention services at the time of discharge from the neonatal intensive care unit, and that Bayley scores be interpreted with caution.
Vohr, Betty R.; Stephens, Bonnie E.; Higgins, Rosemary D.; Bann, Carla M.; Hintz, Susan R.; Epi, MS; Das, Abhik; Newman, Jamie E.; Peralta-Carcelen, Myriam; Yolton, Kimberly; Dusick, Anna M.; Evans, Patricia W.; Goldstein, Ricki F.; Ehrenkranz, Richard A.; Pappas, Athina; Adams-Chapman, Ira; Wilson-Costello, Deanne E.; Bauer, Charles R.; Bodnar, Anna; Heyne, Roy J.; Vaucher, Yvonne E.; Dillard, Robert G.; Acarregui, Michael J.; McGowan, Elisabeth C.; Myers, Gary J.; Fuller, Janell
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. PMID:22432455
Wegbreit, Ezra; Ellis, James A; Nandam, Aneesh; Fitzgerald, Jacklynn M; Passarotti, Alessandra M; Pavuluri, Mani N; Stevens, Michael C
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.
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
Objectives: To assess whether supracricoid laryngectomy with cricohiodoepiglottopexy could successfully reach the cure and preserve the voice in glottic laryngeal cancer, we studied 27 patients with T2\\/T3 squamous cell carcinoma of the larynx treated in our institution with cricohiodoepiglottopexy. Study design: A retrospective analysis has been carried out between 1995 through 1997. We classified 11 patients as T2N0M0 and 16
Roberto A. Lima; Emilson Q. Freitas; Jacob Kligerman; Fernando L. Dias; Mauro M. Barbosa; Geraldo M. Sa; Izabella C. Santos; Terence Farias
The prediction of treatment outcome will require a clinically dedicated and comprehensive information system to gather a sizable data file on each individual, covering patient assessment, treatment and treatment outcome. The computer interview represents an information system capable of routinely gathering a large portion of this information. However, current methods of data analysis cannot adequately handle the information complexity associated with psychiatric treatment. Computer simulation is a method ideally suited to the investigation of complex subject matter and is proposed as a means to forecast the treatment outcome of actual patients under various conditions of treatment.
The advantages and limitations of using functional methods are discussed in the context of identifying undernutrition and hunger in children in the united States. At this time many of these methods have been used only in developing countries where undernutrition is more serious. However, there is great need to investigate whether, when and how undernu trition in the United States
Background Poor pain and functionoutcomes 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 functionoutcomes 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 functionoutcomes. A potential way to improve outcomes is to address ipsilateral lower extremity joint involvement.
Preschool children diagnosed with either global developmental delay (GDD) or developmental language impairment (DLI) were reassessed during their early school years with standardized developmental (Battelle Developmental Inventory [BDI]) and functional (Vineland Adaptive Behavior Scale [VABS]) outcome measures. Of an original cohort of 99 children with GDD and 70 children with DLI assessed and diagnosed at a mean age of 3 years 5 months (SD 1.1) and 3 years 7 months (SD 0.7) respectively, 48 children (34 [71%] males) with GDD and 43 children (36 [84%] males) with DLI were reassessed at a mean age of 7 years 4 months (SD 0.9) and 7 years 5 months (SD 0.7) respectively. The overall total mean BDI score for children with GDD was 66.4 (SD 4.3) versus 71.9 (SD 8.2) for children with DLI (p=0.002). On each subdomain of the BDI, except communication, mean scores for the GDD group were significantly lower than for the DLI group (p<0.05). Similarly, the VABS total score for the GDD group was significantly lower than for the DLI group (p<0.001). For each subdomain of the VABS, the GDD group scored significantly lower than the DLI group (p<0.001). The proportion of children falling below meaningful cut-offs on the outcome measures selected was significantly higher for those initially diagnosed with GDD. Preschool diagnosis of either GDD or DLI has later prognostic validity with regard to persisting developmental and functional deficits. PMID:16174311
Background The aim of this research was to study the clinical characteristics and mortality and disability outcomes of patients who present distinct risk profiles for functional decline at admission. Methods Multicenter, prospective cohort study conducted between 2006 and 2009 in three hospitals in the Netherlands in consecutive patients of ?65 years, acutely admitted and hospitalized for at least 48 hours. Nineteen geriatric conditions were assessed at hospital admission, and mortality and functional decline were assessed until twelve months after admission. Patients were divided into risk categories for functional decline (low, intermediate or high risk) according to the Identification of Seniors at Risk-Hospitalized Patients. Results A total of 639 patients were included, with a mean age of 78 years. Overall, 27%, 33% and 40% of the patients were at low, intermediate or high risk, respectively, for functional decline. Low-risk patients had fewer geriatric conditions (mean 2.2 [standard deviation [SD] 1.3]) compared with those at intermediate (mean 3.8 [SD 2.1]) or high risk (mean 5.1 [SD 1.8]) (p<0.001). Twelve months after admission, 39% of the low-risk group had an adverse outcome, compared with 50% in the intermediate risk group and 69% in the high risk group (p<0.001). Conclusion By using a simple risk assessment instrument at hospital admission, patients at low, intermediate or high risk for functional decline could be identified, with distinct clinical characteristics and outcomes. This approach should be tested in clinical practice and research and might help appropriately tailor patient care.
Buurman, Bianca M.; Hoogerduijn, Jita G.; van Gemert, Elisabeth A.; de Haan, Rob J.; Schuurmans, Marieke J.; de Rooij, Sophia E.
GWAS studies of autoimmune disorders have yielded hundreds of replicated associations, but moving from genetic association to functional studies with potential clinical relevance is a challenge. Leveraging GWAS data, Lee et al. now identify FOXO3 activity as predictive of disease severity in Crohn's disease and rheumatoid arthritis as well as malaria, likely by acting through regulation of cytokine production in monocytes. PMID:24074853
The auditory implant provides a new mechanism for hearing when a hearing aid is not enough. It is the only medical technology\\u000a able to functionally restore a human sense i.e. hearing. The auditory implant is very different from a hearing aid. Hearing\\u000a aids amplify sound. Auditory implants compensate for damaged or non-working parts of the inner ear because they can
S. Di Girolamo; A. Saccoccio; P. G. Giacomini; F. Ottaviani
Establishing measurement equivalence is important because inaccurate assessment may lead to incorrect estimates of effects in research, and to suboptimal decisions at the individual, clinical level. Examination of differential item functioning (DIF) is a method for studying measurement equivalence. An item (i.e., one question in a longer scale) exhibits DIF if the item response differs across groups (e.g., gender, race), controlling for an estimate of the construct being measured. A distinction between applications in health, as contrasted with other settings such as educational and aptitude testing, is that there are many health-related constructs and multiple measures of each, few of which have received much critical evaluation. Discussed in this article are several methods for detection of differential item functioning (DIF), including non-parametric and parametric methods such as logistic regression, and those based on item response theory. Basic definitions and criteria for DIF detection are provided, as are steps in performing the analyses. Recommendations are presented and future directions discussed. PMID:17443420
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
Setting up learning outcomes with linked assessments is a best practice in science education. In biology teaching, faculty are beginning to establish learning outcomes and assessments in the style of concept inventories. At a recent meeting of biology faculty who have designed concept inventories, the characteristics and uses of concept inventories were defined. Concept inventories used as pre- and post-measures of student learning provide a window into students’ understanding of key concepts of a discipline and serve as a tool to motivate faculty toward evidence-based teaching habits. A movement for the development of a microbiology concept inventory is suggested.
. Functioning extraadrenal paragangliomas represent more than 10% of all pheochromocytomas, occur at diverse anatomic\\u000a locations, and are said to have a higher malignancy rate than intraadrenal pheochromocytomas. Sixty-six patients had surgery\\u000a for catecholamine-producing paragangliomas between 1952 and 1992. Median follow-up was 8.8 years. Median age was 40 years\\u000a (11–67 years); the male\\/female ratio was 29:37. Familial disease occurred in
Diarmuid S. O’Riordain; Clive S. Grant; J. Aidan Carney; Jon A. van Heerden
OBJECTIVE To explore the associations of thigh computed tomography (CT)-derived measures of body composition with functionaloutcomes 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
Background Good clinical care of prostate cancer patients after radical prostatectomy depends on careful assessment of post-operative morbidities, yet physicians do not always judge patient symptoms accurately. Logistical problems associated with using paper questionnaire limit their use in the clinic. We have implemented a web-interface ("STAR") for patient-reported outcomes after radical prostatectomy. Methods We analyzed data on the first 9 months of clinical implementation to evaluate the validity of the STAR questionnaire to assessfunctionaloutcomes following radical prostatectomy. We assessed response rate, internal consistency within domains, and the association between survey responses and known predictors of sexual and urinary function, including age, time from surgery, nerve sparing status and co-morbidities. Results Of 1581 men sent an invitation to complete the instrument online, 1235 responded for a response rate of 78%. Cronbach's alpha was 0.84, 0.86 and 0.97 for bowel, urinary and sexual function respectively. All known predictors of sexual and urinary function were significantly associated with survey responses in the hypothesized direction. Conclusions We have found that web-based assessment of functional recovery after radical prostatectomy is practical and feasible. The instrument demonstrated excellent psychometric properties, suggested that validity is maintained when questions are transferred from paper to electronic format and when patients give responses that they know will be seen by their doctor and added to their clinic record. As such, our system allows ready implementation of patient-reported outcomes into routine clinical practice.
Several approaches to the treatment of cognitive impairments and their functional consequences for persons diagnosed with schizophrenia and schizoaffective disorder have been developed in recent years. This article focuses on the use of Cognitive adaptation training (CAT), a psychosocial intervention that seeks to bypass cognitive impairments in schizophrenia in an effort to improve functionaloutcomes. CAT relies on the use
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
Since the first procedure performed in 2000, robotic-assisted radical prostatectomy (RARP) has been rapidly gaining increasing acceptance from both urologists and patients. Today, RARP is the dominant treatment option for localised prostate cancer (PCa) in the United States, despite the absence of any prospective randomised trial comparing RARP with other procedures. Robotic systems have been introduced in an attempt to reduce the difficulty involved in performing complex laparoscopic procedures and the related steep learning curve. The recognised advantages of this kind of minimally invasive surgery are three-dimensional (3D) vision, ten-fold magnification, Endowrist technology with seven degrees of freedom, and tremor filtration. In this article, we examine this technique and report its functional (in terms of urinary continence and potency) and oncologic results. We also evaluate the potential advantages of RARP in comparison with open and laparoscopic procedures.
Objectives External counterpulsation (ECP) is a non-invasive method being investigated for ischaemic stroke. We aimed to explore predictors of good functionaloutcome 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. Functionaloutcomes 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
Although bariatric surgery is the most effective intervention for severe obesity, a significant minority of participants fail to achieve or maintain optimal weight loss at extended follow-up. Accumulating evidence suggests that adherence to prescribed postoperative recommendations, including attendance at follow-up appointments and dietary and physical activity, is related to improved weight loss outcomes. However, adherence to these guidelines presents a significant challenge for many patients, potentially due in part to deficits in cognitive function. In this paper, we briefly examine current literature of adherence on postoperative weight loss outcomes, and review emerging evidence that the cognitive dysfunction present in a subset of obese individuals is related to weight loss outcomes following bariatric procedures. We then extend these findings, positing a role for cognitive function in moderating the relationship between adherence and postoperative outcomes. PMID:23934274
Galioto, Rachel; Gunstad, John; Heinberg, Leslie J; Spitznagel, Mary Beth
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.
Objective: To develop a new outcome measure in response to the increasing demands for cost effectiveness analyses and empirically derived outcome instruments in the treatment of pediatric limb deficiency. This article describes the development, refinement, and initial psychometric properties of the Child Amputee Prosthetics Project-Functional Status Inventory (CAPP-FSI).Design: Parents of children with limb deficiency were surveyed during routine clinic visits.Setting:
Objective: To describe the conceptual foundation, development, and initial psychometric analyses of a new outcome measure of functional status in toddlers with limb deficiency.Design: Parents of children with limb deficiency completed self-report measures during a routine medical clinic visit.Setting: Outpatient orthopedic pediatric clinic.Participants: Twenty parents (mothers) of children (ages 1 to 4 years) with acquired or congenital limb deficiency.Main Outcome
Sheri D. Pruitt; Michael Seid; James W. Varni; Yoshio Setoguchi
Purpose: In the treatment of patients with locally advanced primary or locally recurrent rectal cancer, much attention is focused on the oncologic outcome. Little is known about the functionaloutcome. In this study, the functionaloutcome after a multimodality treatment for locally advanced primary and locally recurrent rectal cancer is analyzed.Methods and Materials: Between 1994 and 1999, 55 patients with
Guido H. H Mannaerts; Harm J. T Rutten; Hendrik Martijn; Patrick E. J Hanssens; Theo Wiggers
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
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 outcomesassessment that helps you tell the story of your career programs and services, celebrate your successes, and continuously improve your practice. Within this monograph, you…
|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.
BACKGROUND: Outcome reporting bias (ORB) occurs when variables are selected for publication based on their results. This can impact upon the results of a meta-analysis, biasing the pooled treatment effect estimate. The aim of this paper is to show how to assess a systematic review and corresponding trial reports for ORB using an example review of intravenous and nebulised magnesium
Kerry Dwan; Carrol Gamble; Ruwanthi Kolamunnage-Dona; Shabana Mohammed; Colin Powell; Paula R Williamson
This qualitative phenomenological study sought to describe the lived experiences of full- time faculty engaged in undergraduate learning outcomesassessment at the program or general education level in baccalaureate or master's nonprofit or public institutions of higher education regionally accredited by the Higher Learning Commission. The ten…
Purpose: This paper is the first part of a comprehensive report about a research study that aims to assess the relationship between the university experience and student outcomes as a means of determining a university's success in meeting its educational goals. Design/methodology/approach: It focuses on the research methodology deployed.…
|Review of social cognitive theory constructs of self-efficacy and self-regulated learning is applied to academic advising for the purposes of assessing student learning. A brief overview of the history of student learning outcomes in higher education is followed by an explanation of self-efficacy and self-regulated learning constructs and how…
This article describes a scale measuring dispositional optimism, defined in terms of generalized outcome expectancies. Two preliminary studies assessed the scale’s psychometric properties and its relationships with several other instruments. The scale was then used in a longitudinal study of symptom reporting among a group of undergraduates. Specifically, respondents were asked to complete three questionnaires 4 weeks before the end
|Colleges and universities throughout the country are increasingly coming under pressure from accrediting institutions and legislative bodies to implement comprehensive outcomesassessment initiatives designed to measure and document student performance. Over the past ten years pressure has been directed towards colleges to reshape their current…
To propose recommendations for implementing an outcomes-based assessment program review in a California community college district, a grounded theory analysis was performed within the district. The findings generated were cross-referenced with findings from a multi-institutional case study analysis. A key finding from the cross-reference was the…
To propose recommendations to implement outcomes-based assessment program review in a California Community College District, a grounded theory analysis was performed within the district. The findings generated were cross-referenced with findings from a multi-institutional case study analysis. A key finding from the cross-reference was the need for…
Summary A battery of objective measurements of cosmetic outcome was performed on 114 patients who had been treated by breast-preservation techniques for breast cancer. Cosmetic breast retraction, as determined by Breast Retraction Assessment (BRA) measurements, was significantly greater in patients who underwent extensive primary tumor resection, were more than 60 years old, weighed more than 150 lbs, or had a
Richard D. Pezner; Mary P. Patterson; James A. Lipsett; Tamara Odom-Maryon; Nayana L. Vora; Jeffrey Y. C. Wong; Kenneth H. Luk
|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 outcomesassessment that helps you tell the story of your career programs and services, celebrate your successes, and continuously improve your practice. Within this monograph, you…
|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…
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 student, as most people seem
INTRODUCTION: Clinical observations and animal models provide evidence that the development of acute lung injury (ALI), a phenomenon of acute diffuse lung inflammation in critically ill patients, is influenced by genetic factors. Association studies are the main tool for exploring common genetic variations underlying ALI susceptibility and\\/or outcome. We aimed to assess the quality of positive genetic association studies with
Carlos Flores; Maria del Mar Pino-Yanes; Jesús Villar
|Peer-assessedoutcomes 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
A variety of measures are currently used to assess psychosocial outcome (quality of life) in cardiac rehabilitation programmes. However, there is no consensus on the most appropriate instruments to use. Instruments that are not sufficiently responsive to change in cardiac populations are unsuitable as audit tools as they underrepresent the benefits of programme attendance. To identify the most responsive instruments
The effectiveness of this learning approach was evaluated by means of the final assessments and pub- lished learning outcomes. In particular, transcripts from peer-to-peer sessions of synchronous communi- cation were analysed, using the SOLO taxonomy, to establish the extent to which deep learning had taken place. The development of deep learning was studied week by week through the transcripts of
Frances Slack; Martin D. Beer; Gillian Armitt; Sharon Green
In order to develop a preliminary core set of disease outcome measures for use in clinical trials of idiopathic inflammatory myopathies (IIM), we evaluated those measures used in previous trials, assessed the validation of published instruments and discussed these at an international consensus conference. The initial proposals were further refined by a multidisciplinary group of adult and paediatric specialists experienced
F. W. Miller; L. G. Rider; Y.-L. Chung; R. Cooper; K. Danko; V. Farewell; I. Lundberg; C. Morrison; L. Oakley; I. Oakley; C. Pilkington; J. Vencovsky; K. Vincent; D. L. Scott; D. A. Isenberg; Moricz Zs
|To propose recommendations to implement outcomes-based assessment program review in a California Community College District, a grounded theory analysis was performed within the district. The findings generated were cross-referenced with findings from a multi-institutional case study analysis. A key finding from the cross-reference was the need…
OBJECTIVE: Our purpose was to evaluate the influence of employment and physical exertion on pregnancy outcome as quantified by kilocalories expended each day. STUDY DESIGN: This prospective study assessed 2743 pregnant women who received prenatal care and were delivered at the major perinatal center in Western Australia between May 1989 and November 1991. All women completed an extensive questionnaire on
Everett F. Magann; Sharon F. Evans; John P. Newnham
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
Addressing the increasing psychological needs on campus is a central mission of most college counseling centers. In addition, many centers are expected to contribute to student academic success and retention. Through the use of outcomes based assessment, which examines the needs, expectations, and perceptions of students, counseling centers can…
To meet accountability challenges from a customer-satisfaction perspective, an urban institution of higher education has developed an integrated approach to studying the freshman year experience in order to develop comprehensive outcomes measures for assessing freshman success. Multiple sources of data (freshman satisfaction survey data,…
To meet higher education's challenge of accountability from a customer-satisfaction perspective, one urban institution has developed an integrated approach to studying the freshman-year experience in order to develop comprehensive outcome measures for assessing freshman success. Multiple sources of data (freshman satisfaction survey data, enrollment data, and academic performance data) are integrated into a database that provides the institution with a
A set of PharmD program curricular outcomes form the foundation of a doctor of pharmacy (PharmD) curriculum and are critical to the development of both the structure\\/courses of the curriculum and the assessment plan for the program. A goal for developing these outcomes is to craft a set of clear, concise, assessable statements that accurately reflect competencies of the generalist
Katherine A. Kelley; James D. Coyle; James W. McAuley; Robert A. Buerki; Sylvan G. Frank
The aim of the present study was to evaluate patients' perception of their functionaloutcome at 6 and 12 months after surgical correction for hallux valgus using the Foot Function Index Revised short form. A total of 59 patients underwent 68 osseous and soft tissue procedures for the correction of hallux valgus deformity from January 2009 through December 2010. The outcome analysis was based on the validated patient questionnaire, the Foot Function Index Revised. The preoperative data were collected on the day of the patient's surgery using the Foot Function Index Revised short-form questionnaire. The postoperative data were collected at 6 and 12 months after the patient's initial surgical date using the same validated questionnaire. The cumulative Foot Function Index Revised score and the scores in each subscale demonstrated statistically significant data at both 6 and 12 months of follow-up. On average, the Foot Function Index Revised scores had improved by 39% at 6 months and 50% at 12 months. The improvement in all scores indicated an improvement in health-related foot function after hallux valgus surgery, evidencing effective surgical intervention. Expectations are the best predictors of patient satisfaction, and the present study has provided statistically significant data to allow physicians to establish realistic outcomes after surgical correction for hallux valgus deformity. PMID:23651697
Dux, Katherine; Smith, Nicholas; Rottier, Francis J
Echocardiographic assessment of right ventricular function remains difficult and challenging. However, there is considerable clinical need for a simple, reproducible, and reliable parameter of right ventricular function in patients with right-sided heart disease. The purpose of this study was to assess the clinical value of a Doppler-derived index, combining systolic and diastolic intervals of the right cycle, in assessing global
Chuwa Tei; Karl S. Dujardin; David O. Hodge; Kent R. Bailey; Michael D. McGoon; A. Jamil Tajik; James B. Seward
This study focuses on the mid-term (four years) and long-term (ten years) functionaloutcome of patients treated nonoperatively for a type A spinal fracture without primary neurological deficit. Functionaloutcome was measured using the visual analogue scale spine score (VAS) and the Roland–Morris disability questionnaire (RMDQ). The 50 patients included were on average 41.2 years old at the time of injury. Four years post injury, a mean VAS score of 74.5 and a mean RMDQ score of 4.9 were found. Ten years after the accident, the mean VAS and RMDQ scores were 72.6 and 4.7, respectively (NS). No significant relationships were found between the difference scores of the VAS and RMDQ compared with age, gender, fracture sub-classification, and time between measurements. Three (6%) patients had a poor long-term outcome. None of the patients required surgery for late onset pain or progressive neurological deficit. Functionaloutcome after a nonoperatively treated type A spinal fracture is good, both four and ten years post injury. For the group as a whole, four years after the fracture a steady state exists in functionaloutcome, which does not change for ten years at least after the fracture.
Post, R. B.; Leferink, V. J. M.; Dijkstra, P. U.; ten Duis, H. J.
Although cognitive ability is a known predictor of real-world functioning in schizophrenia, there has been an expanded interest in understanding the mechanisms by which it explains real-world functioning in this population. We examined the extent to which functional capacity (i.e., skills necessary to live independently) mediated the relationship between cognitive ability and both observer and self-reported real-world functioning in 138 outpatients with schizophrenia. Functional capacity significantly mediated the relations between cognitive ability and observer-rated real-world functioning, but not self-reported real-world functioning, with small to medium effect sizes observed for all outcomes. The role of cognitive ability in observer versus self-reported real-world functioning may be explained by different mechanisms. PMID:23984631
Ho, Jennifer S; Moore, Raeanne C; Davine, Taylor; Cardenas, Veronica; Bowie, Christopher R; Patterson, Thomas L; Mausbach, Brent T
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
Elderly, chronically ill patients' ability to stay at home is dependent on their capacity to perform activities of daily living (ADLs). The Outcome and Assessment Information Set (OASIS) defines ADLs and can be evaluated in various ways. The purpose of this research was to evaluate these approaches and make recommendations for use in research. Several different approaches to the evaluation
The incidence and etiology of sexual difficulties for women with survivable cancer were studied. Women with early stage gynecologic cancer (n = 47) were assessed after their diagnosis but prio r to treatment and then reassess~ at 4, 8, and 12 months posttreatment. Sexual and medical outcomes were compared with data from members of two matched comparison groups who were
Barbara L. Andersen; Barrie Anderson; Charles DeProsse
The objectives of this paper are two-fold: to examine first, if the change from positive to negative alcohol and any other substance use status from baseline assessment to the onset of the first session (i.e., pre-treatment phase) occurs in adolescents, that is, Assessment Reactivity (AR); second, whether AR predicts treatment outcome. Participants were 177 adolescents with alcohol and other substance use disorders (AOSUD) in a 9-weekly group sessions of cognitive behavioral therapy. Drug urinalysis results at baseline assessment, first and last session and self-report for alcohol use were used as outcome measures. Participants showed a highly significant shift to non-use of both alcohol and of other substances from intake assessment to first session and from first to last session. Alcohol and substance use at first session predicted use at last session. This is the first study in youth asserting Assessment Reactivity as a valid construct during the pretreatment phase. AR should be considered in any analysis targeting treatment outcomes. PMID:19042325
Kaminer, Yifrah; Burleson, Joseph A; Burke, Rebecca
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 functionaloutcomes 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
Behavioral health providers are increasingly called upon to develop outcomes strategies that highlight opportunities for performance improvement and assess in turn the impact of applying total quality management (TQM) principles to treatment outcomes. This article describes the evolution of an outcomesassessment program at a private psychiatric facility, and presents two case studies of the integration of outcomes data into clinical decision-making. In Study I, outcomes data were used to identify patterns in the responsiveness to treatment of child/adolescent patients with behavioral disorders and document changes in improvement rates following the application of continuous quality improvement (CQI) principles within the inpatient services. In Study II, improvements sought in the outcomes methodology resulted in improved response rates, improved data quality, and new opportunities for both clinical intervention and staff development. Benefits of committing to outcomesassessment over the long haul to facilitate empirically driven planning processes are described. PMID:24011414
Objective To investigate the value of transoesophageal echocardiography in the assessment of commissural morphology and prediction of outcome after balloon mitral valvotomy (BMV). Design Prospective study. Setting Tertiary cardiac referral centre. Patients 72 consecutive patients (mean age 61.3 years, range 38–89 years) referred for BMV. Interventions Transoesophageal echocardiography was performed immediately before BMV and the mitral commissures were scanned systematically. Anterolateral and posteromedial commissures were scored individually according to whether non?calcified fusion was absent (0), partial (1), or extensive (2). Calcified commissures usually resist splitting and scored 0. Scores for each commissure were combined giving an overall commissure score for each valve of 0–4, higher scores reflecting increased likelihood of commissural splitting. Valve anatomy was also graded by the method of Wilkins et al, which does not include commissural assessment. Main outcome measures Patients were divided into outcome groups: A (good) and B (suboptimal). “Good” was defined as final valve area >?1.5?cm2 with a >?25% increase in area and absence of severe mitral regurgitation judged by echocardiography. Results Valve area increased from a mean (SD) of 1.1 (0.28)?cm2 to 1.8 (0.46)?cm2. Commissure scores were higher in group A than in group B (p?0.01), scores ??2 predicting a good outcome with positive and negative accuracy of 67% and 82%, respectively (p?0.001). Commissure score was the strongest independent predictor of outcome. Conclusion Transoesophageal echocardiographic assessment of commissural morphology predicts outcome after BMV, adding significantly to the Wilkins score.
Sutaria, N; Shaw, T R D; Prendergast, B; Northridge, D
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
The review chapter of pulmonary functionassessment in small mammals first discusses basic principles and methods such as assessment of various pressures, volumes and flows. The three types of plethysmographs (pressure, flow and barometric) used by animal physiologists are evalua...
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.
Introduction Only limited data are available on consent and satisfaction of patients receiving specialized neurocritical care. In this study we (i) analyzed the extent of retrospective consent to neurocritical care--given by patients or their relatives--depending on functionaloutcome one year after hospital stay, and (ii) identified predisposing factors for retrospective agreement to neurocritical care. Methods We investigated 704 consecutive patients admitted to a nonsurgical neurocritical care unit over a period of 2 years (2006 through 2007). Demographic and clinical parameters were analyzed, and the patients were grouped according to their diagnosis. Functionaloutcome, retrospective consent to neurocritical care, and satisfaction with hospital stay was obtained by mailed standardized questionnaires. Logistic regression analyses were calculated to determine independent predictors for consent. Results High consent and satisfaction after neurointensive care (91% and 90%, respectively) was observed by those patients who reached an independent life one year after neurointensive care unit (ICU) stay. However, only 19% of surviving patients who were functionally dependent retrospectively agreed to neurocritical care. Unfavorable functionaloutcome and the diagnosis of stroke were independent predictors for missing retrospective consent. Conclusions Retrospective agreement to neurocritical care is influenced by functionaloutcome. Especially in severely affected stroke patients who cannot communicate their preferences regarding life-sustaining therapy, neurocritical care physicians should balance the expected burdens and benefits of treatment to meet the patients' putative wishes. Efforts should be undertaken to identify predictors for severe disability after neurocritical care.
OBJECTIVES: To evaluate if cardiac dysfunctions are important in assessing the outcome in newborns with Bronchopulmonary Dysplasia (BPD), by evaluating cardiac functions with N-terminal prohormone of brain natriüretic peptide (NT-proBNP) levels, M-mode and tissue doppler echocardiography at 6-12 mo of age. METHODS: Twenty eight patients were retrospectively classified as mild, moderate and severe according to the diagnostic criterias for BPD. All cases were assessed with standard M-mode, tissue doppler echocardiography and NT-proBNP levels. Control group consisted of 28 healthy infants, having similar postnatal ages as patients and were assessed with standard M-mode and tissue doppler echocardiography. RESULTS: The age of patients with BPD was 9.8?±?2.3 mo and control group was 9.5?±?2.6 mo. There was no significant difference between the postnatal ages of two groups (p?>?0.05). Neither pulmonary hypertension nor pulmonary/tricuspid regurgitation was detected. The M-mode echocardiography measurements did not differ between patients and control group (p?>?0.05). Tissue doppler echocardiography, tricuspid valve medial segment early diastolic myocardial relaxation velocity (TME') measurements of patients were found significantly lower, peak transtricuspid filling velocity in the early diastole (TE)/TME' ratios and isovolumetric relaxation time (IVRT) measurements were found significantly higher than control group (p?0.05). Tricuspid E, TE/TLE' (Tricuspid valve lateral segment early diastolic myocardial relaxation velocity), TE/RVLE'(Right ventricular lateral segment early diastolic myocardial relaxation velocity), TE/TME' levels were also found as significantly abnormal in patients with severe BPD. A significant correlation was found between right ventricular diastolic disfunctions and severity of BPD (p?0.05). No statistically significant difference was found between NT-proBNP levels, BPD stages and tissue doppler echocardiography measurements (p?>?0.05). CONCLUSIONS: This is the first study evaluating cardiac findings in patients with BPD by tissue doppler echocardiography and NT-proBNP at the same time. On the basis of cardiac evaluations, tissue doppler echocardiography measurements were found as significant and specific for the early assessment of right ventricular diastolic disfunctions. PMID:23504480
Negative symptoms of schizophrenia represent a heterogeneous psychopathological domain. Both categorical and dimensional approaches have been proposed to reduce negative symptoms heterogeneity. In the present 5-year follow-up study, long-term stability and impact on outcome of different aspects of negative symptoms were investigated. Following a categorical approach, long-term stability and outcome of deficit schizophrenia (DS), in comparison with nondeficit schizophrenia (NDS), were assessed. Following a dimensional approach, the factor structure and stability of broadly defined negative symptoms and the ability of the identified factors to predict functionaloutcome were investigated. DS and NDS subjects included in a previous study were invited to participate. Fifty-one out of 58 patients previously diagnosed as DS and 44 out of 54 NDS patients were included in the present study. The DS/NDS categorization was confirmed in 82.4% of DS and 79.6% of NDS subjects. At follow-up, DS patients showed more severe negative symptoms and greater social dysfunction than NDS ones. Schedule for the Deficit Syndrome (SDS) severity scores loaded on two factors: "Poor Emotional Expression" and "Avolition" and the factor structure was stable after 5 years. Avolition was associated to social outcome measures and Poor Emotional Expression to functioning in household activities. Psychosocial outcome was predicted by SDS factors reflecting the severity of broadly defined negative symptoms, but not by the DS/NDS categorization. This might lend support to the recent shift of research focus from the categorical approach focusing on the presence of primary and enduring negative symptoms to the investigation of key domains of broadly defined negative symptoms. PMID:23608244
Background Shoulder pain is a common complication of a stroke which can impede participation in rehabilitation programs and has been associated with poorer outcomes. The evidence base for current medical and therapeutic management options of hemiplegic shoulder pain is limited. This study will evaluate the use of suprascapular nerve block injection as part of an interdisciplinary approach to the treatment of shoulder pain following stroke. The technique has previously been proven safe and effective in the treatment of shoulder pain associated with rheumatoid arthritis and degenerative shoulder conditions but its usefulness in a stroke population is unclear. Methods/Design A double blind randomised placebo controlled trial will assess the effect of a suprascapular nerve block compared with placebo in a population of 66 stroke patients. The trial will measure effect of injection on the primary outcome of pain, and secondary outcomes of function and quality of life. Measurements will take place at baseline, and 1, 4 and 12 weeks post intervention. Both groups will continue to receive routine physiotherapy and standard ward care. Discussion The results of this study could reduce pain symptoms in persons with mechanical shoulder pain post stroke and provide improvement in upper limb function. Trial Registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12609000621213.
Background Neurogenic claudication (NC) is a common symptom in patients with lumbar spinal stenosis (LSS). The Neurogenic Claudication Outcome Score (NCOS) is a very short instrument for measuring functional status in these patients. This study aimed to translate and validate the NCOS in Iran. Methods This was a prospective clinical validation study. The 'forward-backward' procedure was applied to translate the NCOS from English into Persian (Iranian language). A total of 84 patients with NC were asked to respond to the questionnaire at two points in time: at preoperative and at postoperative (6 months follow-up) assessments. The Oswestry Disabiltiy Index (ODI) also was completed for patients. To test reliability, the internal consistency was assessed by Cronbach's alpha coefficient. Validity was evaluated using known groups comparison and criterion validity (convergent validity). Internal responsiveness of the NCOS to the clinical intervention (surgery) also was assessed comparing patients’ pre- and postoperative scores. Results The Cronbach’s alpha coefficients for the NCOS at preoperative and postoperative assessments were 0.77 and 0.91, respectively. Known groups analysis showed satisfactory results. The instrument discriminated well between sub-groups of patients who differed in claudication distance as measured by the Self-Paced Walking Test (SPWT). The change in the ODI after surgery was strongly correlated with change in the NCOS, lending support to its good convergent validity (r?=?0.81; P?0.001). Further analysis also indicated that the questionnaire was responsive to the clinical intervention (surgery) as expected (P?0.0001). Conclusion In general, the Iranian version of the NCOS performed well and the findings suggest that it is a reliable and valid measure of functionality in patients with lumbar spinal stenosis who are suffering from neurogenic claudication.
Formally stating and assessing student learning outcomes (SLOs) is a new focus for California community colleges required by the 2002 Accreditation Standards. This paper, the first in a series, explores one aspect of this sea change across the state: the emergence of a new group of faculty leaders, Student Learning Outcomes and Assessment…
This study evaluated the longitudinal stability and functional correlates of social cognition during the early course of schizophrenia. Fifty-five first-episode schizophrenia patients completed baseline and 12-month follow-up assessments of 3 key domains of social cognition (emotional processing, theory of mind, and social/relationship perception), as well as clinical ratings of real-world functioning and symptoms. Scores on all 3 social cognitive tests demonstrated good longitudinal stability with test-retest correlations exceeding .70. Higher baseline and 12-month social cognition scores were both robustly associated with significantly better work functioning, independent living, and social functioning at the 12-month follow-up assessment. Furthermore, cross-lagged panel analyses were consistent with a causal model in which baseline social cognition drove later functionaloutcome in the domain of work, above and beyond the contribution of symptoms. Social cognitive impairments are relatively stable, functionally relevant features of early schizophrenia. These results extend findings from a companion study, which showed stable impairments across patients in prodromal, first-episode, and chronic phases of illness on the same measures. Social cognitive impairments may serve as useful vulnerability indicators and early clinical intervention targets.
Horan, William P.; Green, Michael F.; DeGroot, Michael; Fiske, Alan; Hellemann, Gerhard; Kee, Kimmy; Kern, Robert S.; Lee, Junghee; Sergi, Mark J.; Subotnik, Kenneth L.; Sugar, Catherine A.; Ventura, Joseph; Nuechterlein, Keith H.
This study evaluated the longitudinal stability and functional correlates of social cognition during the early course of schizophrenia. Fifty-five first-episode schizophrenia patients completed baseline and 12-month follow-up assessments of 3 key domains of social cognition (emotional processing, theory of mind, and social/relationship perception), as well as clinical ratings of real-world functioning and symptoms. Scores on all 3 social cognitive tests demonstrated good longitudinal stability with test-retest correlations exceeding .70. Higher baseline and 12-month social cognition scores were both robustly associated with significantly better work functioning, independent living, and social functioning at the 12-month follow-up assessment. Furthermore, cross-lagged panel analyses were consistent with a causal model in which baseline social cognition drove later functionaloutcome in the domain of work, above and beyond the contribution of symptoms. Social cognitive impairments are relatively stable, functionally relevant features of early schizophrenia. These results extend findings from a companion study, which showed stable impairments across patients in prodromal, first-episode, and chronic phases of illness on the same measures. Social cognitive impairments may serve as useful vulnerability indicators and early clinical intervention targets. PMID:21382881
Horan, William P; Green, Michael F; DeGroot, Michael; Fiske, Alan; Hellemann, Gerhard; Kee, Kimmy; Kern, Robert S; Lee, Junghee; Sergi, Mark J; Subotnik, Kenneth L; Sugar, Catherine A; Ventura, Joseph; Nuechterlein, Keith H
There remains controversy regarding the most sensitive and valid outcomeassessments to use in multiple sclerosis (MS) clinical trials. A double blind, placebo controlled, parallel group multicenter clinical trial to evaluate the clinical efficacy of cyclosporine A in chronic progressive MS incorporated several major clinical and performance outcomeassessment modalities and a large sample size, both of which provide a unique opportunity to explore the relationship among MS disease status and the various outcome measures over time. The measures included a structured neurological examination, the Kurtzke Functional System scales and Expanded Disability Status Score, and the Incapacity Status Scale from the MS Minimal Record of Disability, the Harvard Ambulation Index, and neuroperformance testing. A test-retest reliability index, principal component analyses and a signal-to-noise ratio metric were used to comparatively evaluate the reliability, validity and sensitivity to disease progression of the various outcomeassessments. The goal was to provide a rational basis for selection of behavioral outcomeassessments in future MS clinical trials by identifying the primary dimensions of MS measured by the candidate outcomeassessments and providing an objective basis for selecting tests that are most sensitive to MS disease and its progression over a two year trial period. We conclude that the components of the major clinical and performance measures show excellent reliability and cross validation. Principal component analyses of all outcomeassessments yielded six primary underlying factors for describing disease status in chronic progressive MS that included lower extremity/pyramidal dysfunction, cerebellar/brainstem and upper extremity dysfunction, somatosensory dysfunction, visual dysfunction, mental or intellectual dysfunction and bowel/bladder problems. Signal-to-noise ratios indicated that upper and lower extremity composites of neuroperformance test items provided the most sensitive indicators of MS disease progression in the placebo group over the 2 year trial period. PMID:9345379
Syndulko, K; Ke, D; Ellison, G W; Baumhefner, R W; Myers, L W; Tourtellotte, W W
Traumatic brain injury (TBI) is a common cause of disability in childhood. While the outcomes of TBI sustained in school years has been heavily researched, very little is known about the impact of TBI in infants and young children. The aim of this study was to investigate the impact of TBI on executive function (EF) in children who sustained a
Louise M. Crowe; Cathy Catroppa; Franz E. Babl; Vicki Anderson
|This study of a national sample of elders served by the Independent Living Program for Older Individuals Who Are Blind found that, overall, they were highly satisfied with the quality and timeliness of services and help in achieving independent living goals. A slight improvement was found in their perceptions of functionaloutcomes from 1999 to…
Moore, J. Elton; Steinman, Bernard A.; Giesen, J. Martin; Frank, John J.
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
Purpose To analyse the anatomical and functionaloutcome of surgery for primary rhegmatogenous retinal detachment (RRD) in highly myopic eyes.Methods We retrospectively reviewed the medical records of 111 high myopic patients (111 eyes) with primary RRD treated by scleral buckling or pars plana vitrectomy in a tertiary referral university hospital. The postoperative retinal status and best-corrected visual acuity were recorded.
The aim of this review was to examine the literature on the effects of surgery of the spastic hand in children with cerebral palsy on functionaloutcome and muscle coordination. We performed a search of the relevant literature in Medline, Embase, and Biological Abstracts from 1966 to June 2006. The search resulted in eight studies on the effect of…
van Munster, Judith C.; Maathuis, Karel G. B.; Haga, Nienke; Verheij, Nienke P.; Nicolai, Jean-Philippe A.; Hadders-Algra, Mijna