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1

Validating the Measurement of Real-World Functional Outcomes: Phase I Results of the VALERO Study  

PubMed Central

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.

2013-01-01

2

Outcome measures in childhood asthma.  

PubMed

Although evidence suggests that asthma onset occurs early in childhood, many standard asthma outcome measures are either impractical or unreliable in preschool-aged children. In this population, for instance, patient history and symptom reports rely on the observations of caregivers, who tend to underreport their child's asthma symptoms. Furthermore, the use of conventional measures of pulmonary function such as spirometry may be impractical in very young children. Recent clinical studies have used a variety of techniques to measure symptoms, pulmonary function, and cellular mediators of inflammation. Outcomes such as discontinuation and exacerbation rates, frequency of daytime and nocturnal symptoms, and caregiver assessments of quality of life can be useful measures in evaluating outcomes in young children with asthma. Some measures, such as plethysmography and inflammatory marker analysis, may be suitable options for assessing pulmonary function and predicting asthma susceptibility in preschool-aged children. Indeed, altered levels of inflammatory markers, including immunoglobulin E, interleukin-10, and exhaled nitric oxide, may be useful tools in diagnosing asthma, evaluating interventions, and assessing future risks for asthma symptomatology in very young children. Whether 1 or more of these outcome measures will prove useful clinically in improving the diagnosis and management of childhood asthma remains uncertain, although early research results are encouraging. PMID:11826255

Skoner, David P

2002-02-01

3

Finding the Data: A Start-Up List of Outcome Measures with Annotations. A Companion Document to "The Case for Shifting to Results-Based Accountability."  

ERIC Educational Resources Information Center

Shifting to results-based accountability is a difficult stage in reforming family and children's services. Heretofore, these services have been more concerned with the number of clients seen or papers processed than in their clients' quality of life. This document should help communities find the data they need to measure qualitative outcomes. It…

Brown, Brett; Weitz, Judith

4

Measuring Economic Outcomes of Cancer  

Microsoft Academic Search

Investigation of cancer prevention, screening, and treatment has generally centered on outcome measures related to tradition- ally conceived burden of illness—measures that reflect changes in patient symptoms, functionality, and longevity or mortality. Although the economic outcomes have not regularly been col- lected as a primary endpoint in cancer research, there appears to be an increasing incidence of trials and observational

Dennis G. Fryback; Benjamin M. Craig

2004-01-01

5

Development of outcome measures for autoimmune dermatoses.  

PubMed

Validated outcome measures are essential in monitoring disease severity. Specifically in dermatology, which relies heavily on the clinical evaluation of the patient and not on laboratory values and radiographic tests, outcome measures help standardize patient care. Validated cutaneous scoring systems, much like standardized laboratory values, facilitate disease management and follow therapeutic response. Several cutaneous autoimmune dermatoses, specifically cutaneous lupus erythematosus (CLE), dermatomyositis (DM), and pemphigus vulgaris (PV), lack such outcome measures. As a result, evaluation of disease severity and patients' response to therapy over time is less reliable. Ultimately, patient care is compromised. These diseases, which are often chronic and relapsing and remitting, are also often refractory to treatment. Without outcome measures, new therapies cannot be systematically assessed in these diseases. Clinical trials that are completed without standardized outcome measures produce less reliable results. Therefore, the development of validated outcome measures in these autoimmune dermatoses is critical. However, the process of developing these tools is as important, if not more so, than their availability. This review examines the steps that should be considered when developing outcome measures, while further examining their importance in clinical practice and trials. Finally, this review more closely looks at CLE, DM, and PV and addresses the recent and ongoing progress that has been made in the development of their outcome measures. PMID:17985101

Gaines, Elizabeth; Werth, Victoria P

2007-11-06

6

Measuring Gambling Outcomes Among College Students  

Microsoft Academic Search

The present research describes the proposal and validation of three gambling outcome measures, the Gambling Quantity and Perceived Norms Scale (GQPN), the Gambling Problem Index (GPI), and the Gambling Readiness to Change Questionnaire (GRTC).The study consisted of 560 undergraduate college students who completed a survey including the newly constructed measures and other measures designed to assess convergent validity. Results confirmed

Clayton Neighbors; Ty W. Lostutter; Mary E. Larimer; Ruby Y. Takushi

2002-01-01

7

Measuring Gambling Outcomes Among College Students  

PubMed Central

The present research describes the proposal and validation of three gambling outcome measures, the Gambling Quantity and Perceived Norms Scale (GQPN), the Gambling Problem Index (GPI), and the Gambling Readiness to Change Questionnaire (GRTC). The study consisted of 560 undergraduate college students who completed a survey including the newly constructed measures and other measures designed to assess convergent validity. Results confirmed good reliability and convergent validity of all three measures. Implications for evaluating efficacy of treatment and prevention interventions are detailed.

Neighbors, Clayton; Lostutter, Ty W.; Larimer, Mary E.; Takushi, Ruby Y.

2006-01-01

8

Participant Perception of Recovery as Criterion to Establish Importance of Improvement for Constraint-Induced Movement Therapy Outcome Measures: Results From a Preliminary  

Microsoft Academic Search

Changes in function following constraint-induced movement therapy (CIMT) are characterized primarily by improvements in performance; however, the importance of these outcome measures to the participant may be unclear. The primary purpose of this study was to determine whether either change scores or raw follow-up scores for the Motor Activity Log amount scale (MALa) and the Wolf Motor Function Test (WMFT)

Stacy L Fritz; Steven Z George; Steven L Wolf

9

Core Outcomes Measures for Inguinal Hernia Repair  

Microsoft Academic Search

Background: Demands on the medical profession to develop performance measures and demonstrate cost-effectiveness make it imperative that a uniform approach to the measurement of outcomes for common conditions be adopted. We report here on patient acceptance, response rates, and utility of a new set of core outcomes measures for patients with inguinal hernia (IH), which incorporates patient reporting of outcomes.Methods:

Richard E Burney; Katherine R Jones; Jane Wilson Coon; Darby K Blewitt; Ann Herm; Melissa Peterson

1997-01-01

10

Results and outcomes of unicompartmental knee arthroplasty.  

PubMed

Precise outcome evaluation is mandatory to improve analysis of the results of knee replacement procedures. Patients' expectations toward surgery and activity levels have increased with changes in patient populations and improvement of surgical results. It is difficult, however, to accurately assess outcomes because objective evaluation of patient function performed only by a surgeon remains highly inaccurate. New methods of objective evaluation after unicompartmental knee arthroplasty have been developed. These devices provide information about range of motion and patient function during daily activities. This article provides up-to-date information concerning the different tools of function evaluation after unicompartmental knee arthroplasty. PMID:23827833

Ollivier, Matthieu; Parratte, Sebastien; Argenson, Jean-noël

2013-04-29

11

Integrative medicine outcomes: what should we measure?  

PubMed

The outcomes of Integrative medicine (IM) that combine biomedicine with traditional, complementary and alternative medicine (TCAM) are broad, reflecting the integration. IM is concerned with acute and chronic diseases, holistic approaches, and health promotion and wellness. Before commencing a research program in a primary care IM clinic, stakeholders were interviewed about IM outcomes. Everyone thought Physical Health and Mental Health were important. Those with a more holistic view of health thought a broader range of topics should be measured. Less important topics were lifestyle; health-related aspects of life satisfaction and quality of life; and healthcare evaluation. However, no one thought these should be excluded. Spirituality was the most contentious. Some commended its inclusion. For others, once religiousness and God were removed, the remaining elements should be relocated to the domains of mental health and life satisfaction. The results highlight the importance of consulting stakeholders before measuring outcomes. PMID:23337560

Hunter, Jennifer; Corcoran, Katherine; Leeder, Stephen; Phelps, Kerryn

2012-11-06

12

Beyond outcomes: measuring procedural utility  

Microsoft Academic Search

People not only obtain utility from actual outcomes but also from the conditions which lead to these outcomes. The paper proposes an economic concept of this notion of procedural utility. Preferences beyond outcome can be manifold. We distinguish procedural utility people get from institutions as such, i.e., from how allocative and redistributive decisions are taken, procedural utility from activities towards

Bruno S. Frey; Alois Stutzer

2005-01-01

13

Sexual Functioning Along the Cancer Continuum: Focus Group Results from the Patient-Reported Outcomes Measurement Information System (PROMIS(TM))  

PubMed Central

Objective Cancer and treatments for cancer affect specific aspects of sexual functioning and intimacy; however, limited qualitative work has been done in diverse cancer populations. As part of an effort to improve measurement of self-reported sexual functioning, we explored the scope and importance of sexual functioning and intimacy to patients across cancer sites and along the continuum of care. Methods We conducted 16 diagnosis- and sex-specific focus groups with patients recruited from the Duke University tumor registry and oncology/hematology clinics (N=109). A trained note taker produced field notes summarizing the discussions. An independent auditor verified field notes against written transcripts. The content of the discussions was analyzed for major themes by two independent coders. Results Across all cancers, the most commonly discussed cancer- or treatment-related effects on sexual functioning and intimacy were fatigue, treatment-related hair loss, weight gain, and organ loss or scarring. Additional barriers were unique to particular diagnoses, such as shortness of breath in lung cancer, gastrointestinal problems in colorectal cancers, and incontinence in prostate cancer. Sexual functioning and intimacy were considered important to quality of life. While most effects of cancer were considered negative, many participants identified improvements to intimacy after cancer. Conclusion Overall evaluations of satisfaction with sex life did not always correspond to specific aspects of functioning (e.g. erectile dysfunction), presenting a challenge to researchers aiming to measure sexual functioning as an outcome. Health care providers should not assume that level of sexual impairment determines sexual satisfaction and should explore cancer patients’ sexual concerns directly.

Flynn, Kathryn E.; Jeffery, Diana D.; Keefe, Francis J.; Porter, Laura S.; Shelby, Rebecca A.; Fawzy, Maria R.; Gosselin, Tracy K.; Reeve, Bryce B.; Weinfurt, Kevin P.

2010-01-01

14

Outcome measures in inflammatory rheumatic diseases  

PubMed Central

Inflammatory rheumatic diseases are generally multifaceted disorders and, therefore, measurement of multiple outcomes is relevant to most of these diseases. Developments in outcome measures in the rheumatic diseases are promoted by the development of successful treatments. Outcome measurement will increasingly deal with measurement of low levels of disease activity and avoidance of disease consequences. It is an advantage for patient management and knowledge transfer if the same outcomes are used in practice and in trials. Continuous measures of change are generally the most powerful and, therefore, are preferred as primary outcomes in trials. For daily clinical practice, outcome measures should reflect the patients' state and have to be easily derivable. The objective of this review is to describe recent developments in outcome measures for inflammatory rheumatic diseases for trials and clinical practice, with an emphasis on rheumatoid arthritis.

2009-01-01

15

Measurement Properties of Outcome Measures for Vitiligo: A Systematic Review.  

PubMed

OBJECTIVE To summarize and critically appraise the evidence on the measurement properties of clinician-, patient-, and observer-reported outcomes, measuring any construct of interest in patients with all types of vitiligo. DATA SOURCES Electronic databases including PubMed (1948 to July 2011), OVID EMBASE (1980 to July 2011), and CINAHL (EBSCOhost) (1982 to July 2011) were searched. STUDY SELECTION Two authors independently screened all records for eligibility. For inclusion, the study population had to include patients with vitiligo, for which outcome measures were developed or evaluated on their measurement properties. The initial search retrieved 1249 records, of which 14 articles met the inclusion criteria. DATA EXTRACTION Characteristics of the included instruments, study population, and results of the measurement properties were extracted. The Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) 4-point checklist, combined with quality criteria for measurement properties, was used to calculate the overall level of evidence per measurement property of each instrument. Independent extraction and assessment was performed by 2 authors. DATA SYNTHESIS Eleven different measurement instruments were identified. Strong evidence was found for a positive internal consistency of the Dermatology Life Quality Index. For other instruments, the evidence of measurement properties was limited or unknown. CONCLUSIONS Recommendations on the use of specific outcome measures for vitiligo should be formulated with caution because current evidence is insufficient owing to a low number of studies with poor methodological quality and unclear clinical relevance. To recommend outcome measures for vitiligo, further research on measurement properties of clinical relevant outcome measures for vitiligo according to COSMIN quality criteria is needed. PMID:22986764

Vrijman, Charlotte; Homan, May Linthorst; Limpens, Jacqueline; van der Veen, Wietze; Wolkerstorfer, Albert; Terwee, Caroline B; Spuls, Phyllis I

2012-09-17

16

Demographic Correlates of Fatigue in the US General Population: Results from the Patient-Reported Outcomes Measurement Information System (PROMIS) Initiative  

PubMed Central

Objective To investigate demographic correlates of fatigue in the US general population using a new instrument developed by the Patient-Reported Outcome Measurement Information System (PROMIS). First, we examined correlations between the new PROMIS instrument and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and the SF-36v2 Vitality subscale. Based on prior findings, we further examined several demographic correlates of fatigue: whether women would report higher levels of fatigue compared to men, and whether married people would experience lower levels of fatigue compared to unmarried people. We also explored the relationship between age, education, and fatigue. Methods Analyses were based on fatigue ratings by 666 individuals from the general population. Fatigue was assessed with the new PROMIS instrument, the FACIT-F, and the SF-36v2 Vitality subscale. Differences in fatigue were examined with independent samples t-tests and univariate ANOVAs. Results The three fatigue instruments were highly intercorrelated. Confirming prior reports, women reported higher levels of fatigue than men. Married participants reported significantly less fatigue than their unmarried counterparts. Univariate ANOVAs yielded a main effect for participants’ age; younger participants gave significantly higher fatigue ratings. We also found a main effect for participants’ education. Participants with a masters or doctoral degree had significantly lower ratings of fatigue than participants with some college education and education up to high school. Conclusion Female gender, not being married, younger age and lower educational attainment were each associated with increased fatigue in the general population and the three fatigue instruments performed equally well in detecting the observed associations.

Junghaenel, Doerte U.; Christodoulou, Christopher; Lai, Jin-Shei; Stone, Arthur A.

2013-01-01

17

Measuring Outcomes in Children's Services.  

ERIC Educational Resources Information Center

Outcomes evaluation can provide program managers and clinical directors in child welfare, juvenile justice, child mental health, and child protective services the necessary tools for program quality assurance and accountability. This guide describes the outcomes evaluation process and provides a summary of articles and reports detailing current…

Christner, Anne Marshall, Ed.

18

Choosing a patient-reported outcome measure  

Microsoft Academic Search

There has been much philosophical interest regarding the ‘hierarchy of evidence’ used to determine which study designs are\\u000a of most value for reporting on questions of effectiveness, prognosis, and so on. There has been much less philosophical interest\\u000a in the choice of outcome measures with which the results of, say, an RCT or a cohort study are presented. In this

Leah M. McClimansJohn; John Browne

2011-01-01

19

Measuring Assistive Technology Outcomes in Writing.  

ERIC Educational Resources Information Center

|This column examines issues associated with measuring assistive technology outcomes in writing. Following an introduction to assistive technology and writing, it looks specifically at design, measurement, analysis, and decision making factors in the process of creating an outcomes system for measuring the impact of assistive technology on…

Edyburn, Dave

2003-01-01

20

Association between Gender, Process of Care Measures, and Outcomes in ACS in India: Results from the Detection and Management of Coronary Heart Disease (DEMAT) Registry  

PubMed Central

Background Studies from high-income countries have shown that women receive less aggressive diagnostics and treatment than men in acute coronary syndromes (ACS), though their short-term mortality does not appear to differ from men. Data on gender differences in ACS presentation, management, and outcomes are sparse in India. Methods and Results The Detection and Management of Coronary Heart Disease (DEMAT) Registry collected data from 1,565 suspected ACS patients (334 women; 1,231 men) from ten tertiary care centers throughout India between 2007–2008. We evaluated gender differences in presentation, in-hospital and discharge management, and 30-day death and major adverse cardiovascular event (MACE; death, re-hospitalization, and cardiac arrest) rates. Women were less likely to present with STEMI than men (38% vs. 55%, p<0.001). Overall inpatient diagnostics and treatment patterns were similar between men and women after adjustment for potential confounders. Optimal discharge management with aspirin, clopidogrel, beta-blockers, and statin therapy was lower for women than men, (58% vs. 65%, p?=?0.03), but these differences were attenuated after adjustment (OR?=?0.86 (0.62, 1.19)). Neither the outcome of 30-day mortality (OR?=?1.40 (0.62, 3.16)) nor MACE (OR?=?1.00 (0.67, 1.48)) differed significantly between men and women after adjustment. Conclusions ACS in-hospital management, discharge management, and 30-day outcomes did not significantly differ between genders in the DEMAT registry, though consistently higher treatment rates and lower event rates in men compared to women were seen. These findings underscore the importance of further investigation of gender differences in cardiovascular care in India.

Pagidipati, Neha J.; Huffman, Mark D.; Jeemon, Panniyammakal; Gupta, Rajeev; Negi, Prakash; Jaison, Thannikot M.; Sharma, Satyavan; Sinha, Nakul; Mohanan, Padinhare; Muralidhara, B. G.; Bijulal, Sasidharan; Sivasankaran, Sivasubramonian; Puri, Vijay K.; Jose, Jacob; Reddy, K. Srinath; Prabhakaran, Dorairaj

2013-01-01

21

Outcome measurement in forensic mental health research: an evaluation  

Microsoft Academic Search

Measuring change resulting from healthcare interventions is critical to evaluating their usefulness. The choice of outcome measure is an important part of such evaluations and is driven by assumptions about what is likely to change and how best to capture this. Despite its importance, forensic mental health has paid little attention to determining which are the best measures of outcome.

Jenny Yiend; Jemma C. Chambers; Tom Burns; Helen Doll; Seena Fazel; Asha Kaur; Lesley Sutton; Ray Fitzpatrick

2011-01-01

22

Reference Undulator Measurement Results  

SciTech Connect

The LCLS reference undulator has been measured 22 times during the course of undulator tuning. These measurements provide estimates of various statistical errors. This note gives a summary of the reference undulator measurements and it provides estimates of the undulator tuning errors. We measured the reference undulator many times during the tuning of the LCLS undulators. These data sets give estimates of the random errors in the tuned undulators. The measured trajectories in the reference undulator are stable and straight to within {+-}2 {micro}m. Changes in the phase errors are less than {+-}2 deg between data sets. The phase advance in the cell varies by less than {+-}2 deg between data sets. The rms variation between data sets of the first integral of B{sub x} is 9.98 {micro}Tm, and the rms variation of the second integral of B{sub x} is 17.4 {micro}Tm{sup 2}. The rms variation of the first integral of B{sub y} is 6.65 {micro}Tm, and the rms variation of the second integral of B{sub y} is 12.3 {micro}Tm{sup 2}. The rms variation of the x-position of the fiducialized beam axis is 35 {micro}m in the final production run This corresponds to an rms uncertainty in the K value of {Delta}K/K = 2.7 x 10{sup -5}. The rms variation of the y-position of the fiducialized beam axis is 4 {micro}m in the final production run.

Wolf, Z

2011-08-18

23

Development of outcome measures for autoimmune dermatoses  

Microsoft Academic Search

Validated outcome measures are essential in monitoring disease severity. Specifically in dermatology, which relies heavily\\u000a on the clinical evaluation of the patient and not on laboratory values and radiographic tests, outcome measures help standardize\\u000a patient care. Validated cutaneous scoring systems, much like standardized laboratory values, facilitate disease management\\u000a and follow therapeutic response. Several cutaneous autoimmune dermatoses, specifically cutaneous lupus erythematosus

Elizabeth Gaines; Victoria P. Werth

2008-01-01

24

Sleep-Wake Functioning Along the Cancer Continuum: Focus Group Results From the Patient-Reported Outcomes Measurement Information System (PROMIS(TM))  

PubMed Central

Objective Cancer and its treatments disturb sleep-wake functioning; however, there is little information available on the characteristics and consequences of sleep problems associated with cancer. As part of an effort to improve measurement of sleep-wake functioning, we explored the scope of difficulties with sleep in a diverse group of patients diagnosed with cancer. Methods We conducted 10 focus groups with patients recruited from the Duke University tumor registry and oncology/hematology clinics. Separate groups were held with patients scheduled to begin or currently undergoing treatment for breast, prostate, lung, colorectal, hematological, and other cancer types and with patients who were in posttreatment follow-up. The content of the focus group discussions was transcribed and analyzed for major themes by independent coders. Results Participants reported causes of sleep disturbance common in other populations, such as pain and restless legs, but they also reported causes that may be unique to cancer populations, including abnormal dreams, anxiety about cancer diagnosis and recurrence, night sweats, and problems with sleep positioning. Many participants felt that sleep problems reduced their productivity, concentration, social interactions, and overall quality of life. Many also shared beliefs about the increased importance of sleep when fighting cancer. Conclusions The findings underscore the need for interventions that minimize the negative impact of cancer and its treatments on sleep. This study will inform efforts now underway to develop a patient-reported measure of sleep-wake functioning that reflects the breadth of concepts considered important by patients with cancer.

Flynn, Kathryn E.; Shelby, Rebecca A.; Mitchell, Sandra A.; Fawzy, Maria R.; Hardy, N. Chantelle; Husain, Aatif M.; Keefe, Francis J.; Krystal, Andrew D.; Porter, Laura S.; Reeve, Bryce B.; Weinfurt, Kevin P.

2009-01-01

25

Roadmap to Patient-Focused Outcome Measurement in ...  

Center for Drug Evaluation (CDER)

... Roadmap to Patient-Focused Outcome Measurement in Clinical Trials (text version). (PDF version - 463KB). Step One: Understanding ... More results from www.fda.gov/drugs/developmentapprovalprocess/drugdevelopmenttoolsqualificationprogram

26

Outcome Measures for Outpatient Hypoglycemia Prevention Studies  

PubMed Central

Systems are being developed that utilize algorithms to predict impending hypoglycemia using commercially available continuous glucose monitoring (CGM) devices and to discontinue insulin delivery if hypoglycemia is predicted. In outpatient studies designed to test such systems, CGM-measured glycemic indices will not only be important outcome measures of efficacy but, in certain cases, will be the only good outcome. This is especially true in short-term studies designed to reduce hypoglycemia since the event rate for severe hypoglycemic events is too low for it to be a good outcome, and milder hypoglycemia often will be variably detected. Continuous glucose monitoring inaccuracy can be accounted for in the study design by increasing sample size and/or study duration.

Beck, Roy W; Kollman, Craig; Xing, Dongyuan; Buckingham, Bruce A; Chase, H. Peter

2011-01-01

27

Birth Outcome Measures and Infant Mortality  

Microsoft Academic Search

Recent studies have proposed alternative birth outcome measures as means of assessing infant mortality risk; nevertheless,\\u000a there hasn’t yet been an integrated analysis of these approaches. We review 14 strategies, including various combinations\\u000a of birth weight, gestational age, fetal growth rate, and Apgar scores—as predictors of early neonatal, late neonatal, and\\u000a postneonatal mortality, and infant mortality. Using the NCHS linked

Sai MaBrian; Brian Karl Finch

2010-01-01

28

Outcome Measures in Spinal Cord Injury  

PubMed Central

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 properties was used to examine outcome tools or tests for accuracy, sensitivity, reliability and validity for human SCI. Results imaging, neurological, functional, autonomic, sexual health, bladder/bowel, pain, and psycho-social tools were evaluated. Several specific tools for human SCI studies have or are being developed to allow the more accurate determination for a clinically meaningful benefit (improvement in functional outcome or quality of life) being achieved as a result of a therapeutic intervention. Conclusion significant progress has been made, but further validation studies are required to identify the most appropriate tools for specific targets in a human SCI study or clinical trial.

Alexander, Marcalee S.; Anderson, Kim; Biering-Sorensen, Fin; Blight, Andrew R.; Brannon, Ruth; Bryce, Thomas; Creasey, Graham; Catz, Amiram; Curt, Armin; Donovan, William; Ditunno, John; Ellaway, Peter; Finnerup, Nanna B.; Graves, Daniel E.; Haynes, Beth Ann; Heinemann, Allen W.; Jackson, Amie B.; Johnston, Mark; Kalpakjian, Claire Z.; Kleitman, Naomi; Krassioukov, Andrei; Krogh, Klaus; Lammertse, Daniel; Magasi, Susan; Mulcahey, MJ; Schurch, Brigitte; Sherwood, Arthur; Steeves, John D.; Stiens, Steven; Tulsky, David S.; van Hedel, Hubertus J.A.; Whiteneck, Gale

2009-01-01

29

Health outcomes assessment in vulnerable populations: measurement challenges and recommendations.  

PubMed

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 outcomes assessment. 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 outcomes assessment 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

Hahn, Elizabeth A; Cella, David

2003-04-01

30

Clinical outcome measures for research in multiple sclerosis.  

PubMed

The development of new and more sensitive clinical outcome measures for research in multiple sclerosis (MS) has been fueled by the development of effective therapies. As such, active arm comparison studies that require more sensitive clinical outcome measures are now commonplace. The Kurtzke Expanded Disability Status Scale (EDSS), the most widely used measure of neurologic impairment in MS, is particularly designed for classifying patients with respect to disease severity but has been criticized for its noninterval scaling, emphasis on ambulation status, relatively reduced sensitivity in the mid and upper ranges of scores, and absence of adequate cognitive and visual components. In response to perceived difficulties with the EDSS, the National Multiple Sclerosis Society Clinical Outcomes Assessment Task Force has developed the Multiple Sclerosis Functional Composite (MSFC). The MSFC includes three components that yield objective and quantitative results: 1) the timed 25-ft walk, 2) the nine-hole peg test, and 3) the 3-second paced auditory serial addition test. This scale has the advantages of continuous scoring with a composite Z score, standardized protocols, and high degrees of reliability and validity. Candidate visual function outcome measures for the MSFC, including the low-contrast Sloan letter chart, are currently under investigation. In addition to measures of neurologic impairment, health-related quality of life (HRQOL) measures have gained increasing importance as clinical trial outcome measures. The MS Quality of Life Inventory, a disease-specific HRQOL measure, has been developed to capture self-reported neurologic dysfunction and the impact of MS upon activities of daily living. MS clinical trials of the future, particularly active-arm comparison studies, will require more sensitive clinical outcome measures such as the MSFC. Measures of visual function and HRQOL should also be incorporated to capture the broad scope of neurologic impairment and disability in MS populations. PMID:11756863

Balcer, L J

2001-12-01

31

Comparison of Nurse Staffing Measurements in Staffing-Outcomes Research.  

PubMed

BACKGROUND:: Investigators have used a variety of operational definitions of nursing hours of care in measuring nurse staffing for health services research. However, little is known about which approach is best for nurse staffing measurement. OBJECTIVE:: To examine whether various nursing hours measures yield different model estimations when predicting patient outcomes and to determine the best method to measure nurse staffing based on the model estimations. DATA SOURCES/SETTING:: We analyzed data from the University HealthSystem Consortium for 2005. The sample comprised 208 hospital-quarter observations from 54 hospitals, representing information on 971 adult-care units and about 1 million inpatient discharges. METHODS:: We compared regression models using different combinations of staffing measures based on productive/nonproductive and direct-care/indirect-care hours. Akaike Information Criterion and Bayesian Information Criterion were used in the assessment of staffing measure performance. RESULTS:: The models that included the staffing measure calculated from productive hours by direct-care providers were best, in general. However, the Akaike Information Criterion and Bayesian Information Criterion differences between models were small, indicating that distinguishing nonproductive and indirect-care hours from productive direct-care hours does not substantially affect the approximation of the relationship between nurse staffing and patient outcomes. CONCLUSIONS:: This study is the first to explicitly evaluate various measures of nurse staffing. Productive hours by direct-care providers are the strongest measure related to patient outcomes and thus should be preferred in research on nurse staffing and patient outcomes. PMID:23222530

Park, Shin Hye; Blegen, Mary A; Spetz, Joanne; Chapman, Susan A; A De Groot, Holly

2012-12-01

32

42 CFR 410.146 - Diabetes outcome measurements.  

Code of Federal Regulations, 2010 CFR

... 2010-10-01 2010-10-01 false Diabetes outcome measurements. 410.146 Section...MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.146...

2010-10-01

33

42 CFR 410.146 - Diabetes outcome measurements.  

Code of Federal Regulations, 2010 CFR

... 2009-10-01 2009-10-01 false Diabetes outcome measurements. 410.146 Section...MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.146...

2009-10-01

34

42 CFR 410.146 - Diabetes outcome measurements.  

Code of Federal Regulations, 2012 CFR

... 2012-10-01 2012-10-01 false Diabetes outcome measurements. 410.146 Section...MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.146...

2012-10-01

35

Measures of Social Functioning in Psychiatric Outcome Research  

Microsoft Academic Search

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

Martha Beattie; John Stevenson

1984-01-01

36

Using outcome measures to provide excellence in Alzheimer care  

Microsoft Academic Search

Outcome measures have been widely touted as a valuable tool to guarantee quality assurance in healthcare settings. Recently, a number offactors have conspired to make outcome-based measurement more feasible. This paper describes the advantages of utilizing outcome measures, continuous quality improvement methods and consumer based input to ensure excellence in long term care.

Joan Hyde; Jennifer Hillygus; Becca Levy; Sue Levkoff

1998-01-01

37

42 CFR 486.318 - Condition: Outcome measures.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 false Condition: Outcome measures. 486.318 Section 486.318 Public...Requirements § 486.318 Condition: Outcome measures. (a) With the exception of OPOs...must meet all 3 of the following outcome measures: (1) The OPO's...

2012-10-01

38

Measuring outcomes of school nursing services.  

PubMed

Considerable information exists about the impact of school health services on student health and academic achievement. Much less information exists about the specific impact of school nursing services. This article reports on a Washington State project that studied documentation of outcomes of school nurse interventions, the scope of the school nurse role, and the infrastructure necessary to report outcomes of school nursing. A literature review about outcomes of school nursing was conducted. Twenty-two leaders in school nurse issues were interviewed. The literature review yielded 15 articles documenting positive outcomes of school nursing. Interview analysis revealed leader ideas about important outcomes of school nurse services and the infrastructure needed to document the impact of school nursing. The existing literature on positive outcomes addresses a limited portion of the school nurse role. Components of infrastructure necessary to document outcomes are delineated. Resources for infrastructure development are discussed. PMID:12463773

Stock, Jacqueline L; Larter, Nanci; Kieckehefer, Gail M; Thronson, Gayle; Maire, Judy

2002-12-01

39

The Day-to-Day Acute Effect of Wake Therapy in Patients with Major Depression Using the HAM-D6 as Primary Outcome Measure: Results from a Randomised Controlled Trial  

PubMed Central

Background This paper reports day-to-day data for from a one-week intervention phase, part of a 9-weeks randomised parallel study with patient having major depression (data from weekly visits have been reported). Wake therapy (sleep deprivation) has an established antidepressant effect with onset of action within hours. Deterioration on the following night’s sleep is, however, common, and we used daily light therapy and sleep time stabilisation as a preventive measure. In particular, we evaluated the day-to-day acute effect of and tolerance to sleep deprivation and examined predictors of response. Methods Patients were assessed at psychiatric inpatient wards. In the wake group (n?=?36), patients did three wake therapies in combination with light therapy each morning together with sleep time stabilisation. In the exercise group (n?=?38), patients did daily exercise. Hamilton subscale scores were primary outcome (not blinded), secondary outcome was self-assessment data from the Preskorn scale and sleep. Results Patients in the wake therapy group had an immediate, large, stable, and statistically significant better antidepressant effect than patients in the exercise group with response rates at day5 of 75.0%/25.1% and remission rates of 58.6%/6.0%, respectively. The response and remission rates were diminished at day8 with response rates of 41.9%/10.1% and remission rates of 19.4%/4.7%, respectively. Patients and ward personnel found the method applicable with few side effects. Positive diurnal variation (mood better in the evening) predicted a larger response to wake therapy. In the wake group napping on days after intervention predicted greater deterioration on day8. Conclusions The intervention induced an acute antidepressant response without relapse between wake nights but with a diminishing effect after intervention. Development is still needed to secure maintenance of response. Avoiding napping in the days after wake therapy is important. Trial Registration Clinical trials.gov NCT00149110

Martiny, Klaus; Refsgaard, Else; Lund, Vibeke; Lunde, Marianne; S?rensen, Lene; Thougaard, Britta; Lindberg, Lone; Bech, Per

2013-01-01

40

Update on morphea: part II. Outcome measures and treatment.  

PubMed

Morphea is a rare fibrosing disorder of the skin and underlying tissues. The underlying pathogenesis of morphea is not completely understood at this time, but ultimately results in an imbalance of collagen production and destruction. Evidence-based treatment options of morphea are limited secondary to the rarity of the disease, and the lack of universally used validated outcome measures. The most commonly used outcome measures are skin scores, computerized surface area measurement, durometer, cutometer, thermography, and ultrasound measurements. The Localized Scleroderma Cutaneous Assessment Tool is a promising recently validated skin scoring tool that allows differentiation between activity and damage, is sensitive to change, and requires no additional equipment. The most robust data in the treatment of morphea exists for methotrexate in combination with systemic steroids and ultraviolet A1. PMID:21238824

Fett, Nicole; Werth, Victoria P

2011-02-01

41

67 FR 57248 - Proposed Collection, Comment Request, Study of the Results of Outcomes-Based Evaluation Training...  

Federal Register 2010, 2011, 2012, 2013

...Results of Outcomes-Based Evaluation Training for National Leadership Grants and State Program Grants AGENCY: Institute of Museum...study of the status of outcomes- measurement by IMLS National Leadership and State Program grantees and factors that influence...

2002-09-09

42

The Alcohol Treatment Outcome Measure (ATOM): A new clinical tool for standardising outcome measurement for alcohol treatment  

Microsoft Academic Search

Whilst many instruments have been developed for screening and treatment outcome evaluation studies in the alcohol and other drug treatment (AOD) sector, very few are suitable for routine, ongoing use by clinicians. The aim of the current study was to assess the psychometric properties of the Alcohol Treatment Outcome Measure (ATOM). The ATOM was designed to measure the key outcomes

Melanie Simpson; Peter Lawrinson; Jan Copeland; Peter Gates

2009-01-01

43

Child outcome measures in the study of child care quality.  

PubMed

This article assesses whether there are methodological problems with child outcome measures that may contribute to the small associations between child care quality and child outcomes found in the literature. Outcome measures used in 65 studies of child care quality published between 1979 and December 2005 were examined, taking the previous review by Vandell and Wolfe (2000) as the starting point. Serious methodological problems were not pervasive for child outcome measures. However, methodological concerns were most prevalent among measures of socioemotional development. Furthermore, psychometric information on outcome measures was often missing from published reports, and health outcomes and approaches to learning were infrequently studied. Future research should address alignment issues between aspects of quality and the specific child outcomes chosen for study. PMID:16966677

Zaslow, Martha; Halle, Tamara; Martin, Laurie; Cabrera, Natasha; Calkins, Julia; Pitzer, Lindsay; Margie, Nancy Geyelin

2006-10-01

44

Outcome After Microdiscectomy: Results of a Prospective Single Institutional Study  

Microsoft Academic Search

BackgroundAlthough lumbar microdiscectomy is one of the most frequently performed spinal procedures, little consensus exists in the literature regarding results. Whereas retrospective reports boast success rates as high as 98%, prospective studies are less sanguine with statistics in the 73–77% range.MethodsProspective single-institution outcome study of all patients undergoing virgin unilateral single-level microdiscectomies by study surgeons November 1990 to March 1992.

Matthew R Quigley; Jeffrey Bost; Joseph C Maroon; Amr Elrifai; Matthew Panahandeh

1998-01-01

45

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

Microsoft Academic Search

One outcome measure of law enforcement effectiveness is the reduction in drug consumption which occurs as a result of law enforcement interventions. A theoretical relationship between drug consumption and retail price has promoted the use of retail price as a surrogate measure for consumption. In the current article, retail price is examined as a potential outcome measure for the effectiveness

David A. Bright; Alison Ritter

2010-01-01

46

Patient-based measures of outcome in plastic surgery: current approaches and future directions  

Microsoft Academic Search

Objectives. To evaluate current approaches to patient-based outcome measurement in plastic surgery and make recommendations for future research.Methods. Comprehensive review of the plastic surgery literature relevant to patient-based outcomes.Results. Two main types of patient-based outcome measure have been used in the plastic surgery literature: generic and disease-specific. The majority of studies using generic measures investigate aspects of psychological functioning with

S. J Cano; J. P Browne; D. L Lamping

2004-01-01

47

Outcome as a Measure of Quality of Care in Oncology  

PubMed Central

Objectives: Measurement of outcomes is increasingly employed as an indicator of the quality of clinical care. The most commonly measured outcome in many clinical studies, especially in oncology, still remains the overall survival rate. Sultan Qaboos University Hospital (SQUH), Oman, is striving for excellence through quality management. In seeking continual improvement, quality measurement exercises have been initiated throughout the Hospital. We present the overall survival rate of four of the ten most common cancers diagnosed in Oman. Methods: The cancers included non-Hodgkin’s lymphoma (NHL), Hodgkin’s lymphoma (HL), breast cancer, and stomach cancer. The studies were all retrospective and had been conducted previously. For present purposes, only the overall survival was compared with studies both from the region, and with bench-mark studies. Results: For NHL, with a median follow-up of 8 months, the 2-year overall survival rate was 64%; 90% for low risk, 55% for intermediate risk, and 15% for high risk groups. For HL, the 5-year overall survival rate was 64%; 76% for low risk and 42% for high risk. For breast cancer, the 5-year survival rate was 67%; percentages were 88%, 75% and 59% for Groups I, II, and III respectively. For gastric cancer, the 5-year survival rate was 16.5 %; 24% for the non-metastatic group. Conclusion: The outcome of patients with early stages and fewer adverse prognostic factors is comparable to what has been reported in the international literature; however, the outcome is inferior for patients presenting with advanced stage disease and several adverse prognostic factors.

Burney, Ikram A; Al Moundhri, Mansour S; Rizvi, Azhar J; Ganguly, Shyam S; Al Abri, Rashid; Ashrafi, Rafi A

2008-01-01

48

Calibration of measures for psychotherapy outcome studies.  

PubMed

Many findings in psychology, including those in psychotherapy, lack interpretability because measures are not in any meaningful metric. Measures need to be calibrated so as to endow them with inherent meaning. In particular, it is important to calibrate measures against behaviors and real events in people's lives. Approaches to calibrating measures include calibration against direct personal experience, against cross-experiential equivalents, and against cross-modal equivalents, to reflect empirically established behavioral implications as well as just noticeable differences in behavior or between people. Psychological measures may never be as closely calibrated as those for physical properties, but wider reporting of unstandardized regression equations would be of great help. Psychological measures also need to be calibrated against each other so as to permit easy transformations of values or substitutions of measures. Finally, greater standardization of measures is recommended so as to produce better bases for calibration. PMID:8870543

Sechrest, L; McKnight, P; McKnight, K

1996-10-01

49

Quality of life measurement: bibliographic study of patient assessed health outcome measures  

Microsoft Academic Search

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

2002-01-01

50

Using learning outcome measures to assess doctoral nursing education.  

PubMed

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

2010-06-21

51

Measuring outcomes in a child psychiatry inpatient unit  

Microsoft Academic Search

The aim of this article is to examine clinical outcomes in a child psychiatry inpatient unit using dedicated measures. Clinicians completed contextual (Paddington Complexity Scale - PCS) and clinical change (Health of the Nation Outcome Scales for Children and Adolescents - HoNOSCA) questionnaires on admission and discharge for consecutive admissions to the unit between 1999 and 2007 (n=167). Mean changes

M Garralda; Gillian Rose; Ruth Dawson

2008-01-01

52

What Do They Measure? Comparing Three Learning Outcomes Assessments  

ERIC Educational Resources Information Center

|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

2010-01-01

53

Direct Measures for Course Outcomes Assessment for ABET Accreditation  

NSDL National Science Digital Library

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.

Gurocak, Hakan

2009-09-09

54

Outcome measures for fecal incontinence: anorectal structure and function  

Microsoft Academic Search

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

Adil E Bharucha

2004-01-01

55

What Do They Measure? Comparing Three Learning Outcomes Assessments  

ERIC Educational Resources Information Center

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

2010-01-01

56

Measuring outcomes of care following a single assessment process  

Microsoft Academic Search

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

Susan Nancarrow

2005-01-01

57

Educational Outcome Measurement in Developing Countries.  

ERIC Educational Resources Information Center

Fiscal and other economic constraints facing developing nations underscore the need for careful and detailed planning for education focused on the identified purposes. Until recently educational requirements have been measured in terms of inputs. Effectiveness measurements change the basis for judging the educational system from such input or…

Kiros, Fassil G.; And Others

58

Does routine ultrasound scanning improve outcome in pregnancy? Meta-analysis of various outcome measures  

Microsoft Academic Search

OBJECTIVE--To evaluate the effectiveness of routine ultrasound scanning in pregnancy by a meta-analysis of various outcome measures. DESIGN--Meta-analysis of randomised controlled trials evaluating the effect of routine ultrasound scanning on perinatal mortality and morbidity. Live birth rate (that is, live births per pregnancy) is included as a measure of pregnancy outcome in addition to the conventional perinatal mortality. SUBJECTS--15,935 pregnancies

H C Bucher; J G Schmidt

1993-01-01

59

Making the Best Match: Selecting Outcome Measures for Clinical Trials and Outcome Studies  

PubMed Central

Selecting an appropriate outcome measure is a critical step in designing valid and useful clinical trials and outcome studies. This selection process needs to extend beyond examining basic psychometric properties to consider additional features of instruments that may affect their validity and utility for the study’s purpose. This article discusses these additional factors and their potential impact on outcome measurement. Guidelines are proposed to help clinical researchers and consumers of clinical research literature evaluate the match between the study purpose, population, and instrument.

2013-01-01

60

Laparoscopic Versus Open Appendectomy: A Comparison of Primary Outcome Measures  

PubMed Central

Background/Aim: The aim of the study was to compare laparoscopic and open appendectomy (OA) in terms of primary outcome measures. Study design: A randomized controlled trial. Place and duration of the study: Khyber Teaching Hospital, Peshawar, Pakistan, February 2008 to December 2009. Patients and Methods: A total of 160 patients were divided into two groups, A and B. Group A patients were subjected to laparoscopic appendectomy (LA), whereas Group B patients were subjected to OA. Data regarding age, gender, and primary outcome measures, such as hospital stay, operative duration, and postoperative complication, were recorded and analyzed. Percentages were calculated for categorical data, whereas numerical data were represented as mean ± SD. Chi-square test and t test were used to compare categorical and numerical variables, respectively. Probability ? 0.05 (P ? 0.05) was considered significant. Results: After randomization, 72 patients in group A and 75 patients in group B were analyzed. The mean age of patients in groups A and B was 23.09 ± 8.51 and 23.12 ± 10.42 years, respectively, (P = 0.981). The mean hospital stay was 1.52 ± 0.76 days in group A and 1.70 ± 1.06 days in group B (P = 0.294). The mean operative duration in group A and B were 47.54 ± 12.82 min and 31.36 ± 11.43 min, respectively (P < 0.001). Pain (overall level) was significantly less in group A compared with group B (P = 0.004). The two groups were comparable in terms of other postoperative complications, such as hematoma (P = 0.87), paralytic ileus (P = 0.086), urinary retention (P = 0.504), and wound infection (P = 0.134). Conclusion: LA is an equivalent procedure and not superior to OA in terms of primary outcome measures.

Khalil, Jawad; Muqim, Roohul; Rafique, Mohammad; Khan, Mansoor

2011-01-01

61

Measuring outcomes in craniofacial and pediatric plastic surgery.  

PubMed

This article discusses the measurement of outcomes in craniofacial and pediatric plastic surgery, using examples of craniosynostosis and cleft lip and/or palate (CLP). The challenges in measuring the standard outcomes of function, aesthetics, and health-related quality of life are discussed, along with the importance of developing evidence and studying quality improvement in this specialty. The need to define specific and comprehensive goals is discussed with a focus on patient-reported outcomes (PROs). Examples from the development of the CLEFT-Q, a PRO instrument for patients with CLP, are provided to support the need to seek the patient perspective. PMID:23506771

Wong, Karen W Y; Forrest, Christopher R; Goodacre, Tim E E; Klassen, Anne F

2012-12-21

62

d-outcome measurement for a nonlocality test  

NASA Astrophysics Data System (ADS)

For the purpose of a nonlocality test, we propose a general correlation observable of two parties by utilizing local d-outcome measurements with SU(d) transformations and classical communications. Generic symmetries of the SU(d) transformations and correlation observables are found for the test of nonlocality. It is shown that these symmetries dramatically reduce the number of numerical variables, which is important for numerical analysis of nonlocality. A linear combination of the correlation observables, which is reduced to the Clauser-Horne-Shimony-Holt (CHSH) Bell's inequality for two outcome measurements, leads to the Collins-Gisin-Linden-Massar-Popescu (CGLMP) nonlocality test for d-outcome measurement. As a system to be tested for its nonlocality, we investigate a continuous-variable (CV) entangled state with d measurement outcomes. It allows the comparison of nonlocality based on different numbers of measurement outcomes on one physical system. In our example of the CV state, we find that a pure entangled state of any degree violates Bell's inequality for d(>=2) measurement outcomes when the observables are of SU(d) transformations.

Son, W.; Lee, Jinhyoung; Kim, M. S.

2004-12-01

63

Discrimination ability of prediction models for ordinal outcomes: relationships between existing measures and a new measure.  

PubMed

In this paper, we focus on measures to evaluate discrimination of prediction models for ordinal outcomes. We review existing extensions of the dichotomous c-index-which is equivalent to the area under the receiver operating characteristic (ROC) curve--suggest a new measure, and study their relationships. The volume under the ROC surface (VUS) scores sets of cases including one case from each outcome category. VUS considers sets as either correctly or incorrectly ordered by the model. All other existing measures assess pairs of cases. We propose an ordinal c-index (ORC) that is set-based but, contrary to VUS, scores sets more gradually by indicating the closeness of the model-based ordering to the perfect ordering. As a result, the ORC does not decrease rapidly as the number of outcome categories increases. It turns out that the ORC can be rewritten as the average of pairwise c-indexes. Hence, the ORC has both a set- and pair-based interpretation. There are several relationships between the existing measures, leading to only two types of existing measures: a prevalence-weighted average of pairwise c-indexes and the VUS. Our suggested measure ORC positions itself in between as it is set-based but turns out to equal an unweighted average of pairwise c-indexes. The measures are demonstrated through a case study on the prediction of six-month outcome after traumatic brain injury. In conclusion, the set-based nature and graded scoring system make the ORC an attractive measure with a simple interpretation, together with its prevalence-independence that is a natural property of a discrimination measure. PMID:22711459

Van Calster, Ben; Van Belle, Vanya; Vergouwe, Yvonne; Steyerberg, Ewout W

2012-06-19

64

Patient-reported outcome measures in spine surgery.  

PubMed

The ultimate goals of intervention for spinal pathology are to improve the patient's quality of life, restore function, and relieve pain. Traditional clinician-based assessments typically fall short of adequately addressing these important outcomes because these assessments are inherently biased and may not describe patients' perception of their state of health. Patient-reported outcome measures have been developed to obtain quantitative data regarding general health quality, function, and pain. These data can aid the clinician in stratifying the severity of the disorder to formulate an appropriate treatment plan. This information also can be followed over time to assess treatment efficacy. Patient-reported outcome measures have become increasingly important with increased scrutiny of quality of care. Given the increasing importance and use of patient-reported outcome measures, knowledge regarding proper implementation of these tools is essential for accurate assessment of general health quality, function, and pain. PMID:23378373

McCormick, John D; Werner, Brian C; Shimer, Adam L

2013-02-01

65

Use of Patient Self-Report Oral Health Outcome Measures in Assessment of Dental Treatment Outcomes  

PubMed Central

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.

Wright, Wanda G.; Jones, Judith A.; Spiro, Avron; Rich, Sharron E.; Kressin, Nancy R.

2012-01-01

66

Measuring cognitive outcomes in a pre-clinical bioethics course.  

PubMed

Medical schools universally accept the idea that bioethics courses are essential components of education, but few studies which measure outcomes (i.e., knowledge or retention) have demonstrated their educational value in the literature. The goal of this study was to examine whether core concepts of a pre-clinical bioethics course were learned and retained. Over the course of 2 years, a pre-test comprising 25 multiple-choice questions was administered to two classes (2008-2010) of first-year medical students prior to the start of a 15-week ethics course, and an identical post-test was administered at the end of the course. A total of 189 students participated. Paired t tests showed a significant difference between pre-test scores and post-test scores. The pre-test average score was 69.8 %, and the post-test average was 82.6 %, an increase of 12.9 % after the ethics course. The pre- and post-test results also suggested a shift in difficulty level of the questions, with students finding identical questions easier after the intervention. Given the increase in post-test scores after the 15-week intervention, the study suggests that core concepts in medical ethics were learned and retained. These results demonstrate that an introductory bioethics course can improve short-term outcomes in knowledge and comprehension, and should provide impetus to educators to demonstrate improved educational outcomes in ethics at higher levels of B.S. Bloom's Taxonomy of Learning. PMID:23316464

Fernandes, Ashley K; Borges, Nicole; Rodabaugh, Heather

2012-04-28

67

Outcome Measures in Bone Metastases Clinical Trials  

Microsoft Academic Search

Bone metastases are the most common manifestation of metastatic disease in advanced cancers. Management of bone metastases\\u000a is increasingly multidisciplinary in nature and as a result, we have witnessed an increased survival of this population. Therefore,\\u000a there is an increased need to accurately monitor the benefits and side effects of these treatments. This chapter will outline\\u000a the trials and tribulations

Amanda Hird; Edward Chow

68

Translating the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) into Lithuanian.  

PubMed

Abstract Vili? nien? R, Evans C, Hilbig J, Pakalniškien? V, Danilevi?i? t? V, Laurinaitis E, Navickas A. Translating the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) into Lithuanian. Nord J Psychiatry 2012;Early Online:1-7. Background: There are no standardized tools in Lithuanian feasible for ongoing routine use to measure the effectiveness of psychotherapeutic treatment. The CORE-OM is a widely used 34-item self-report measure for such purpose. Aims: To explore the reliability, validity and sensitivity of the Lithuanian translation of CORE-OM questionnaire. Methods: A validation study of the CORE-OM was conducted in the psychiatric clinic attached to Vilnius University. A Lithuanian translation of the English original CORE-OM was prepared by a team of translators. Then 39 psychotherapy outpatients and 187 students were asked to complete the Lithuanian version of the CORE-OM; 66 were tested twice to determine test-retest stability. Analysis included both internal and test-retest reliability, acceptability, influence of gender, principal component analysis and criteria for reliable and clinically significant change. Results: Internal and test-retest reliability were good (0.61-0.94), though somewhat lower for the risk domain (?: 0.57-0.79, Spearman's rho 0.25-0.60). Differences between scores of the clinical and non-clinical samples were large and significant (P < 0.001). Some of the Lithuanian criteria for clinically significant change were a bit lower than those of the original UK criteria (e.g. well-being) and others higher (symptoms, functioning, overall score), illustrating the need for local exploration. Conclusions: In spite of small differences in psychometric properties from the original, the Lithuanian version of the CORE-OM was reliable and sensitive in both clinical and non-clinical settings. It has the potential to become a practical, sensitive and reliable tool for psychotherapists in Lithuania. • CORE-OM; outcome measures; psychotherapy; reliability; validation. PMID:23228157

Vili? Nien?, Rima; Evans, Chris; Hilbig, Jan; Pakalniškien?, Vilmant?; Danilevi?i?t?, Vita; Laurinaitis, Eugenijus; Navickas, Alvydas

2012-12-11

69

Measuring outcomes in children's rehabilitation: A decision protocol  

Microsoft Academic Search

Objective: To develop and test the feasibility and clinical utility of a computerized self-directed software program designed to enable service providers in children's rehabilitation to make decisions about the most appropriate outcome measures to use in client and program evaluation.Design: A before-and-after design was used to test the feasibility and initial impact of the decision-making outcome software in improving knowledge

Mary Law; Gillian King; Dianne Russell; Elizabeth MacKinnon; Patricia Hurley; Christine Murphy

1999-01-01

70

Outcome instruments to measure frailty: A systematic review  

Microsoft Academic Search

Frailty is one of the greatest challenges for healthcare professionals. The level of frailty depends on several interrelated factors and can change over time while different interventions seem to be able to influence the level of frailty. Therefore, an outcome instrument to measure frailty with sound clinimetric properties is needed. A systematic review on evaluative measures of frailty was performed

N. M. de Vries; J. B. Staal; C. D. van Ravensberg; J. S. M. Hobbelen; M. G. M. Olde Rikkert; M. W. G. Nijhuis-van der Sanden

2011-01-01

71

Outcome measurement in multiple sclerosis: detection of clinically relevant improvement  

Microsoft Academic Search

Because the development of new treatments in multiple sclerosis as well as the awareness of the importance of patient-oriented measures have become more important in the last two decades, new outcome measures have been developed with the aim of being more responsive to change and more clinically relevant to patients. The ability to detect improvement is sparsely studied. In the

L. M. van Winsen; J. J. Kragt; E. L. Hoogervorst; C. H. Polman; B. M. J. Uitdehaag

2010-01-01

72

Can Neuropathic Screening Tools Be Used As Outcome Measures?  

Microsoft Academic Search

ObjectiveTo examine whether the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) screening tool can satisfy Rasch model expectations and therefore be transformed into an interval level measurement scale, suitable for use as an outcome measure in clinical studies.

Robert D. Searle; Michael I. Bennett; Alan Tennant

2011-01-01

73

OMERACT: An international initiative to improve outcome measurement in rheumatology  

Microsoft Academic Search

OMERACT is the acronym for an international, informally organized network initiated in 1992 aimed at improving outcome measurement in rheumatology. Chaired by an executive committee, it organizes consensus conferences in a 2-yearly cycle that circles the globe. Data driven recommendations are prepared and updated by expert working groups. Recommendations include core sets of measures for most of the major rheumatologic

Peter Tugwell; Maarten Boers; Peter Brooks; Lee Simon; Vibeke Strand; Leanne Idzerda

2007-01-01

74

Early antitoxin treatment in wound botulism results in better outcome.  

PubMed

Wound botulism in 7 heroin 'skin poppers' produced ophthalmoplegia and descending paralysis. Rapid recovery occurred in 2 who received the antitoxin within the fourth day of symptom onset. A poor outcome was seen in 4 who received the antitoxin after the eighth day of symptoms and 1 who did not receive the antitoxin. Early antitoxin administration is important in achieving a favorable outcome. PMID:12646758

Chang, Gregory Youngnam; Ganguly, Gautam

2003-01-01

75

Retrograde femoral nailing in elderly patients: outcome and functional results.  

PubMed

Functional outcome after retrograde femoral intramedullary nailing was investigated in 35 patients older than 60 years (mean, 86 years) with 36 fractures, comprising 15 (41.7%) shaft and 21 (58.3%) distal fractures; overall, 7 (19.4%) periprosthetic fractures occured. Twenty-two (62.9%) of 35 patients were evaluated at a mean 16.5-month follow-up with the Lyshom-Gillquist score and the SF-8 questionaire. Primary union rate was 97.8%, with no significant differences in duration of surgery, bone healing, mobilization, and weight bearing among different fracture types; periprosthetic fractures revealed a significantly delayed mobilization (P=.03). Complications occured significantly more often among distal femoral fractures (P=.009), including all revision surgeries. The most frequently encountered complication was loosening of distal locking bolts (n=3). Lysholm score results were mainly influenced by age-related entities and revealed fair results in all fractures (mean in the femoral shaft fracture group, 78.1 vs mean in the distal femoral fracture group, 74.9; P=.69), except in the periprosthetic subgroup, which had good results (mean, 84.8; P=.23). This group also had increased physical parameters according to SF-8 score (P=.026). No correlation existed between SF-8 physical parameters and patient age or surgery delay, whereas a negative correlation existed between patient age and SF-8 mental parameters (P=.012). Retrograde femoral intramedullary nailing is commonly used in elderly patients due to reliable bone healing, minimal soft tissue damage, and immediate full weight bearing. It also offers a valid alternative to antegrade nailing in femoral shaft fractures. PMID:22691657

Neubauer, Thomas; Krawany, Manfred; Leitner, Lukas; Karlbauer, Alois; Wagner, Michael; Plecko, Michael

2012-06-01

76

Evaluating outcomes of palliative photodynamic therapy: instrument development and preliminary results  

NASA Astrophysics Data System (ADS)

Background: Subjective measures are considered the gold standard in palliative care evaluation, but no studies have evaluated palliative photodynamic therapy (PDT) subjectively. If PDT is to be accepted as a palliative therapy for later-stage obstructing esophageal and lung cancer, evidence of its effectiveness and acceptability to patients must be made known. Study Design/Materials and Methods: This ongoing study's major aim is to evaluate subjective outcomes of PDT in patients with obstructing esophageal and lung cancer. Existing measures of health status, dysphagia and performance status were supplemented with an instrument developed to evaluate PDT symptom relief and side effect burden, the PDT Side Effects Survey (PSES). Results: PDT patients treated with porfimer sodium (Photofrin) and 630-nm light experienced reduced dysphagia grade and stable performance status for at least one month after PDT (N= 10-17), but these effects did not necessarily persist at three months. Fatigue, appetite and quality of life may be the most burdensome issues for these patients. Conclusions: Preliminary data suggest that the PSES is an acceptable and valid tool for measuring subjective outcomes of palliative PDT. This study is the first attempt to systematically evaluate subjective outcomes of palliative PDT. Multi-center outcomes research is needed to draw generalizable conclusions that will establish PDT's effectiveness in actual clinical practice and enhance the wider adoption of PDT as a cancer symptom relief modality.

Goodell, Teresa T.; Bargo, Paulo R.; Jacques, Steven L.

2002-06-01

77

Early Antitoxin Treatment in Wound Botulism Results in Better Outcome  

Microsoft Academic Search

Wound botulism in 7 heroin ‘skin poppers’ produced ophthalmoplegia and descending paralysis. Rapid recovery occurred in 2 who received the antitoxin within the fourth day of symptom onset. A poor outcome was seen in 4 who received the antitoxin after the eighth day of symptoms and 1 who did not receive the antitoxin. Early antitoxin administration is important in achieving

Gregory Youngnam Chang; Gautam Ganguly

2003-01-01

78

Predicting Outcome in Behavioral Parent Training: Expected and Unexpected Results  

Microsoft Academic Search

This study examined the relationships among clinical utility and treatment outcome variables in Behavioral Parent Training (BPT). The sample included 21 mothers with 3–8 year-old children with significant externalizing behavior problems who received treatment for Oppositional Defiant Disorder. The primary aim was to relate two treatment feasibility variables, client resistance and treatment acceptability, to maternal ratings of child improvement. We

Elizabeth P. MacKenzie; Paula J. Fite; John E. Bates

2004-01-01

79

Children's Program Outcome Review Team: 2002 Evaluation Results.  

ERIC Educational Resources Information Center

The Children's Program Outcome Review Team (CPORT), under the direction of the Tennessee Commission on Children and Youth, collects and analyzes data to improve service delivery to children and families involved in state custody. Using the Quality Service Review methodology, the Commission conducted 282 intensive case reviews on a random sample of…

Wade, Patricia C.

80

Validation of the Focus on the Outcomes of Communication under Six outcome measure  

PubMed Central

Aim The aim of this study was to establish the construct validity of the Focus on the Outcomes of Communication Under Six (FOCUS©),a tool designed to measure changes in communication skills in preschool children. Method Participating families' children (n=97; 68 males, 29 females; mean age 2y 8mo; SD 1.04y, range 10mo–4y 11mo) were recruited through eight Canadian organizations. The children were on a waiting list for speech and language intervention. Parents completed the Ages and Stages Questionnaire – Social/Emotional (ASQ-SE) and the FOCUS three times: at assessment and at the start and end of treatment. A second sample (n=28; 16 males 12 females) was recruited from another organization to correlate the FOCUS scores with speech, intelligibility and language measures. Second sample participants ranged in age from 3 years 1 month to 4 years 9 months (mean 3y 11mo; SD 0.41y). At the start and end of treatment, children were videotaped to obtain speech and language samples. Parents and speech–language pathologists (SLPs) independently completed the FOCUS tool. SLPs who were blind to the pre/post order of the videotapes analysed the samples. Results The FOCUS measured significantly more change (p<0.01) during treatment than during the waiting list period. It demonstrated both convergent and discriminant validity against the ASQ-SE. The FOCUS change corresponded to change measured by a combination of clinical speech and language measures (?=0.31, p<0.05). Conclusion The FOCUS shows strong construct validity as a change-detecting instrument.

Thomas-Stonell, Nancy; Oddson, Bruce; Robertson, Bernadette; Rosenbaum, Peter

2013-01-01

81

Measuring Educational Outcomes: Vocational Education and Training. Conference Paper  

ERIC Educational Resources Information Center

|The vocational education and training (VET) sector has a long tradition of measuring and reporting outcomes. The public face of this is the "Annual National Report of the Australian Vocational Education and Training System" published (and tabled in the Commonwealth Parliament) since 1994. The reporting framework has undergone a number of changes…

Karmel, Tom

2009-01-01

82

Factors predicting work status 3 months after injury: results from the Prospective Outcomes of Injury Study  

PubMed Central

Objective Few studies examine predictors of work status following injury beyond injuries presenting to a hospital or emergency department. This paper examines the combined influences of socio-demographic, occupational, injury and pre-existing health and lifestyle factors as predictors of work status 3?months after hospitalised and non-hospitalised injury in a cohort of injured New Zealand workers. Design Prospective cohort study. Setting The Prospective Outcomes of Injury Study, New Zealand. Participants 2626 workforce active participants were identified from the Prospective Outcomes of Injury Study; 11 participants with missing outcome responses were excluded. Primary and secondary outcome measures The primary outcome of interest was ‘not working’ at the time of interview. Results 720 (27%) reported ‘not working’ 3?months after injury. The most important pre-injury predictors of not working following injury found by multidimensional modelling were as follows: low or unknown income, financial insecurity, physical work tasks, temporary employment, long week schedules, obesity, perceived threat to life and hospital admission. Contrary to expectations, workers reporting less frequent exercise pre-injury had lower odds of work absence. Pre-injury psychosocial and health factors were not associated with not working. Conclusion Certain pre-injury socio-demographic, physical work, work organisation, lifestyle and injury-related factors were associated with not working 3?months after injury. If these findings are confirmed, intervention strategies aimed at improving return to work should address multiple dimensions of both the worker and the workplace.

Davie, Gabrielle; Ameratunga, Shanthi; Derrett, Sarah

2012-01-01

83

Outcome measures in palliative care for advanced cancer patients: a review  

Microsoft Academic Search

Summary Information generated using outcome measures to measure the effectiveness of palliative care interventions is potentially invaluable. Depending on the measurement tool employed the results can be used to monitor clinical care, carry out comparative research, provide audit data or inform purchas- ing decisions. However, the data collected can only ever be as good as the method used to obtain

Julie Hearn; Irene J. Higginson

84

Severe outcome of children following trauma resulting from road accidents  

Microsoft Academic Search

Objective  The aim of the study was to determine the risk factors of a severe outcome for children severely injured [killed or with an Injury Severity Score (ISS) ?16] in a road accident.Materials and methods  Casualties that occurred between 1996 and 2001 which involved children under 14 years of age were assessed in a population-based study based on data included in a French

Etienne Javouhey; Anne-Céline Guérin; Emmanuèle Amoros; Mouloud Haddak; Amina Ndiaye; Daniel Floret; Mireille Chiron

2006-01-01

85

OMERACT: An international initiative to improve outcome measurement in rheumatology  

PubMed Central

OMERACT is the acronym for an international, informally organized network initiated in 1992 aimed at improving outcome measurement in rheumatology. Chaired by an executive committee, it organizes consensus conferences in a 2-yearly cycle that circles the globe. Data driven recommendations are prepared and updated by expert working groups. Recommendations include core sets of measures for most of the major rheumatologic conditions. Since 2002 patients have been actively engaged in the process.

Tugwell, Peter; Boers, Maarten; Brooks, Peter; Simon, Lee; Strand, Vibeke; Idzerda, Leanne

2007-01-01

86

Degenerative Spondylolisthesis: Does Fusion Method Influence Outcome? Four-Year Results of the Spine Patient Outcomes Research Trial (SPORT)  

PubMed Central

Study Design Clinical trial sub-group analysis Objective To compare outcomes of different fusion techniques treating degenerative spondylolisthesis (DS). Summary of Background Data Surgery has been shown to be more effective than non-operative treatment out to four years.1,2 Questions remain regarding the differential effect of fusion technique. METHODS Surgical candidates from 13 centers in 11 states with at least 12 weeks of symptoms and confirmatory imaging showing stenosis and DS were studied. In addition to standard decompressive laminectomy, one of three fusion techniques was employed at the surgeon’s discretion: posterolateral in situ fusion (PLF); posterolateral instrumented fusion with pedicle screws (PPS); or PPS plus interbody fusion (360°). Main outcome measures were the SF-36 Bodily Pain (BP) and Physical Function (PF) scales and the modified Oswestry Disability Index (ODI) assessed at 6 weeks, 3 months, 6 months, and yearly to 4 years. The as-treated analysis combined the randomized and observational cohorts using mixed longitudinal models adjusting for potential confounders. RESULTS Of 380 surgical patients, 21% (N= 80) received a PLF; 56% (N=213) received a PPS; 17% (N=63) received a 360°; and 6% (N=23) had decompression only without fusion. Early outcomes varied, favoring PLF compared to PPS at 6 weeks (PF: 12.73 vs. 6.22, p<0.020) and 3 months (PF: 25.24 vs.18.95, p<0.025) and PPS compared to 360° at 6 weeks (ODI: ?14.46 vs. ?9.30, p<0.03) and 3 months (ODI: ?22.30 vs. ?16.78, p<0.02). At two years, 360° had better outcomes: BP: 39.08 vs. 29.17 PLF, p<0.011; and vs. 29.13 PPS, p<0.002; PF; 31.93 vs. 23.27 PLF, p<0.021; and vs. 25.29 PPS, p<0.036. However, these differences were not maintained at 3- and 4-year follow-up, when there were no statistically significant differences between the three fusion groups. CONCLUSIONS In patients with degenerative spondylolisthesis and associated spinal stenosis, no consistent differences in clinical outcomes were seen among fusion groups over four years.

Abdu, William A.; Lurie, Jon D.; Spratt, Kevin F.; Tosteson, Anna N.A.; Zhao, Wenyan; Tosteson, Tor D.; Herkowitz, Harry; Longely, Michael; Boden, Scott D.; Emery, Sanford; Weinstein, James N.

2013-01-01

87

Does mechanical pleurodesis result in better outcomes than chemical pleurodesis for recurrent primary spontaneous pneumothorax?  

PubMed Central

A best-evidence topic was written according to a structured protocol. The question addressed was whether mechanical pleurodesis results in better outcomes in comparison with chemical pleurodesis in patients undergoing surgery for recurrent primary spontaneous pneumothorax. A total of 542 papers were found using the reported searches, of which 6 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found compared the outcomes of mechanical and chemical pleurodesis and also focused on the outcomes of the different methods of mechanical pleurodesis: pleural abrasion and pleurectomy. Reported measures were operative mortality, mean operation time, post-operative bleeding, persistent air leaks, chest drain duration, pain levels, pneumonia, respiratory failure, wound infection, pulmonary function, re-exploration for bleeding and air leak, hospital stay, recurrence and re-operation for recurrence. One large cohort study compared the outcomes of mechanical and chemical talc pleurodesis and reported a significant reduction in recurrence with talc pleurodesis in comparison with pleurectomy (1.79 vs. 9.15%, P = 0.00018). Another large cohort study, analysing pleural abrasion, pleurectomy and talc pleurodesis, both in isolation and in combination with apical bullectomy, reported the highest rate of recurrence in bullectomy plus abrasion patients (1.4%) followed by bullectomy plus talc pleurodesis patients (0.4%). No recurrence was seen with other techniques. The reported freedom from surgery at 10-year follow-up was 98.9% with talc pleurodesis, 97.5% with pleurectomy and 96.4% with pleural abrasion, however, with no statistical significance. A prospective randomized study, a retrospective case series review and two smaller cohort studies compared the outcomes of pleural abrasion and pleurectomy as different techniques of mechanical pleurodesis and reported statistically significant shorter operation times, lower rates of post-operative bleeding, re-exploration and pain observed with pleural abrasion and lower rates of recurrence with pleurectomy. Three studies reported the outcomes of apical bullectomy or wedge resection with recurrence rates ranging from 0.4 to 6.2%. We conclude that there is a very similar outcome profile in the comparison of mechanical and chemical pleurodesis, with modest evidence suggesting lower rates of recurrence with chemical talc pleurodesis.

Sepehripour, Amir H.; Nasir, Abdul; Shah, Rajesh

2012-01-01

88

Does mechanical pleurodesis result in better outcomes than chemical pleurodesis for recurrent primary spontaneous pneumothorax?  

PubMed

A best-evidence topic was written according to a structured protocol. The question addressed was whether mechanical pleurodesis results in better outcomes in comparison with chemical pleurodesis in patients undergoing surgery for recurrent primary spontaneous pneumothorax. A total of 542 papers were found using the reported searches, of which 6 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found compared the outcomes of mechanical and chemical pleurodesis and also focused on the outcomes of the different methods of mechanical pleurodesis: pleural abrasion and pleurectomy. Reported measures were operative mortality, mean operation time, post-operative bleeding, persistent air leaks, chest drain duration, pain levels, pneumonia, respiratory failure, wound infection, pulmonary function, re-exploration for bleeding and air leak, hospital stay, recurrence and re-operation for recurrence. One large cohort study compared the outcomes of mechanical and chemical talc pleurodesis and reported a significant reduction in recurrence with talc pleurodesis in comparison with pleurectomy (1.79 vs. 9.15%, P = 0.00018). Another large cohort study, analysing pleural abrasion, pleurectomy and talc pleurodesis, both in isolation and in combination with apical bullectomy, reported the highest rate of recurrence in bullectomy plus abrasion patients (1.4%) followed by bullectomy plus talc pleurodesis patients (0.4%). No recurrence was seen with other techniques. The reported freedom from surgery at 10-year follow-up was 98.9% with talc pleurodesis, 97.5% with pleurectomy and 96.4% with pleural abrasion, however, with no statistical significance. A prospective randomized study, a retrospective case series review and two smaller cohort studies compared the outcomes of pleural abrasion and pleurectomy as different techniques of mechanical pleurodesis and reported statistically significant shorter operation times, lower rates of post-operative bleeding, re-exploration and pain observed with pleural abrasion and lower rates of recurrence with pleurectomy. Three studies reported the outcomes of apical bullectomy or wedge resection with recurrence rates ranging from 0.4 to 6.2%. We conclude that there is a very similar outcome profile in the comparison of mechanical and chemical pleurodesis, with modest evidence suggesting lower rates of recurrence with chemical talc pleurodesis. PMID:22184464

Sepehripour, Amir H; Nasir, Abdul; Shah, Rajesh

2011-12-18

89

Nuchal translucency measurement and pregnancy outcome after assisted conception versus spontaneously conceived twins  

Microsoft Academic Search

BACKGROUND: Nuchal translucency (NT) measurement for Down's syndrome screening or detecting various fetal anomalies is a reliable sonographic marker. This study evaluates the contribution of NT screening in spontaneously conceived and assisted conception twin pregnancies. METHODS AND RESULTS: Maternal age at measurement, chorionicity, ultrasound features, karyotype results and pregnancy outcome were recorded prospect- ively and compared in 83 assisted reproduction

R. Maymon; E. Jauniaux; A. Holmes; Y. M. Wiener; E. Dreazen; A. Herman

2001-01-01

90

Barriers to completion of patient reported outcome measures.  

PubMed

Patient Reported Outcomes Measures (PROMs) are commonly used in total joint arthroplasty (TJA) to assess surgical outcomes. However certain patient populations may be underrepresented due to lower survey completion rates. The purpose of this study is to evaluate factors that influence PROM completion rates for 1997 TJA patients between 7/1/2007 and 12/31/2010. Completion rates were lower among patients who were over 75, Hispanic or Black, had Medicare or Medicaid, TKA patients and revision TJA patients (P<0.05 for all comparisons). Having multiple risk factors further reduced completion rates (P<0.001). Overall participation increased significantly during the study period, after electronic data capture methods were introduced. Awareness of these factors may help physicians and researchers improve participation of all patient populations so they are well represented in TJA outcomes research. PMID:23890831

Schamber, Elizabeth M; Takemoto, Steven K; Chenok, Kate Eresian; Bozic, Kevin J

2013-07-25

91

PERFORMANCE METRICS: AN OVERVIEW OF ECOLOGICAL "OUTCOME" MEASUREMENT AT EPA  

EPA Science Inventory

The terms "Accountability" and "Outcome" are becoming ubiquitous in government agencies. The impetus for demonstrating results from government-sponsored research and regulation comes from Congress (e.g., statutes like the Government Performance Results Act of 1993 and reports fro...

92

Measuring Participation: The Patient-Reported Outcomes Measurement Information System Experience  

PubMed Central

Objectives To describe the lessons learned in the initial development of PROMIS social function item banks. Design Development and testing of two item pools within a general population to create item banks that measure ability-to-participate and satisfaction-with-participation in social activities. Setting Administration via the Internet. Participants General population members (N=956) of a national polling organization registry participated; data for 768 and 778 participants used in the analysis. Interventions Not applicable. Main Outcome Measures Measures of ability-to-participate and satisfaction-with-participation in social activities. Results Fifty six items measuring the ability-to-participate were essentially unidimensional but did not fit an IRT model. As a result, item banks were not developed for these items. Of the 56 items measuring satisfaction-with-participation, 14 items measuring social roles and 12 items measuring discretionary activities were unidimensional and met IRT model assumptions. Two 7-item short forms were also developed. Conclusions Four lessons, mostly concerning item content, were learned in the development of banks measuring social function. These lessons led to item revisions that are being tested in subsequent studies.

Bode, Rita K.; Hahn, Elizabeth A.; DeVellis, Robert; Cella, David

2013-01-01

93

Current approaches to measuring health outcomes in pediatric research.  

PubMed

Because improving health is the ultimate goal of a health care system, the measurement of health outcomes in research is a logical and important goal for the evaluation of the impact of health services. Although health can be defined in various ways, here we employ a conceptualization that has several domains including longevity, disease, comfort, perceived well being, activity, achievement, and resilience. Given that health is such a broad concept, the difficult task for outcomes research is to provide the means of measuring it. As this brief summary of current work indicates, a number of approaches have been used in recent pediatric studies. Most focus on a small subset of health concerns. However, some studies have attempted to broaden the assessment of health outcome either by using multiple health measures or developing multidimensional instruments for measuring health. Care must be taken in evaluating the usefulness of any of the instruments until sufficient data are obtained as to their reliability and validity. Further work in this area is needed, particularly with regards to multidimensional approaches, which are beginning to provide a more sensitive and comprehensive means of assessing the impact of health services. PMID:7820199

Vivier, P M; Bernier, J A; Starfield, B

1994-10-01

94

Recent results from COMPASS muon scattering measurements  

SciTech Connect

A sample of recent results in muon scattering measurements from the COMPASS experiment at CERN will be reviewed. These include high energy processes with longitudinally polarised proton and deuteron targets. High energy polarised measurements provide important constraints for studying the nucleon spin structure and thus permit to test the applicability of the theoretical framework of factorisation theorems and perturbative QCD. Specifically, latest results on longitudinal quark polarisation, quark helicity densities and gluon polarisation will be reviewed.

Capozza, Luigi [Irfu/SPhN - CEA Saclay, 91190 Gif-sur-Yvette (France); Collaboration: COMPASS Collaboration

2012-10-23

95

Health Outcomes After Prostatectomy or Radiotherapy for Prostate Cancer: Results From the Prostate Cancer Outcomes Study  

Microsoft Academic Search

Background: Radical prostatectomy and external beam ra- diotherapy are the two major therapeutic options for treat- ing clinically localized prostate cancer. Because survival is often favorable regardless of therapy, treatment decisions may depend on other therapy-specific health outcomes. In this study, we compared the effects of two treatments on urinary, bowel, and sexual functions and on general health- related quality-of-life

Arnold L. Potosky; Julie Legler; Peter C. Albertsen; Janet L. Stanford; Frank D. Gilliland; Ann S. Hamilton; J. William Eley; Robert A. Stephenson; Linda C. Harlan

96

Pitfalls and Opportunities in Measuring Patient Outcomes in Lupus  

Microsoft Academic Search

Health outcomes and their measures used as end points in systemic lupus erythematosus (SLE) patient care and clinical trials\\u000a have been varied and are still evolving. Although significant reductions in morbidity and mortality in SLE have been achieved,\\u000a the medications approved for SLE have remained the same during the past 50 years. Despite the pressing need, aggressive advocacy\\u000a in the community,

Meenakshi Jolly

2010-01-01

97

Measuring mathematics self-efficacy as a learning outcome  

Microsoft Academic Search

We report the construction and validation of a self-report ‘Mathematics self-efficacy (MSE)’ instrument, designed to measure this construct as a learning outcome of students following post-compulsory mathematics programmes. The sample ranged across two programmes: a traditional preparation for university study in mathematical subjects (Advanced level) and an innovative ‘modelling’-based programme intended to widen participation in mathematics through use of technology

Maria Pampaka; Irene Kleanthous; Graeme D. Hutcheson; Geoff Wake

2011-01-01

98

Measuring patient-reported outcomes in advanced gastric cancer  

PubMed Central

Background Gastric cancer (GC), one of the most common cancers in the world, is often diagnosed at an advanced stage and associated with a poor prognosis. Quality of life and patient-reported outcomes (PROs) are important considerations when treating GC patients. The aim of this study was to identify existing PRO instruments that would be appropriate for use in GC trials. Methods Data were obtained from a systematic literature review and interviews with clinical experts. A literature search was conducted using OVID (EMBASE and MEDLINE) and yielded 1,008 abstracts; 92 assessed PROs in an advanced GC. Results Key symptoms and functional impacts identified through the literature and expert input included abdominal pain or pain at the site of distant metastases, dysphagia and other symptoms related to eating, and digestive symptoms. The liver and lungs were the most frequent locations of metastases, leading to dyspnea, abdominal fullness, and jaundice. Symptoms related to changes in bowel habits appeared to be more frequent and pronounced in Asian patients, possibly due to the higher prevalence of GC in the body of the stomach in this population. The five most commonly used PRO instruments were identified, but their validity in advanced-stage GC patients remains unclear. Conclusions The symptoms and functional impacts identified here should be confirmed with robust input from advanced-stage GC patients. Optimal measurement of PROs in GC should account for patient burden and possible differences between Asian and non-Asian patients.

Xu, Jianming; Evans, TR Jeffry; Coon, Cheryl; Copley-Merriman, Kati; Su, Yun

2013-01-01

99

First results of Soret Coefficient Measurement Experiment  

NASA Astrophysics Data System (ADS)

The scope of the Soret Coefficient Measurement Experiment (SCM) is to measure the Soret coefficient in 20 binary organic mixtures and aqueous solutions. Because of the limited mass and power budget, this can be considered as a difficult technical challenge. It has been performed in the Solution Growth Facility in non fully nominal conditions and this has an impact on the accuracy of the measurements obtained as discussed in this presentation. However, the high values obtained for the species segregation in microgravity give very valuable results. They allow for a better understanding of ground based measurements and a definition, using the SCM results as standards, of the best technique to be used. The values of the Soret coefficients will be used in the investigation of the role of the Soret effect in interfacial instabilities (Marangoni-Benard instabilities in binary mixtures), on morphological instabilities of a planar solidification front and striations and on the buoyancy induced instabilities (Rayleigh-Benard instabilities).

van Vaerenbergh, St.; Legros, J.-Cl.; Dupin, J.-Ch

1995-08-01

100

Predicting treatment outcome on three measures for post-traumatic stress disorder.  

PubMed

The aim of the present study was to investigate predictors of treatment outcome for Posttraumatic Stress Disorder (PTSD) after treatment completion and at 15-months follow-up (n = 48), in a trial of Eye Movement Desensitisation and Reprocessing (EMDR) versus Imaginal Exposure and Cognitive Restructuring (E+CR). Factors associated with treatment outcome were investigated using regression analyses with the mean change scores in three assessor and self-rated PTSD symptomatology measures, including the Clinician-Administered PTSD Scale (CAPS), the Impact of Events Scale (IES) and the PTSD Symptom Checklist (PCL) from pre- to post-treatment and pre-treatment to follow-up as the dependent variables and demographics, trauma, clinical and personality measures as independent variables. Irrespective to outcome measures and assessment points it was found that four variables were able to predict significantly treatment outcome. These included baseline PTSD symptomatology, number of sessions, gender and therapy type. Overall, our results showed that it is difficult to use pre-treatment variables as a powerful and reliable tool for predicting treatment outcome, as significant predictors were found to be sample-specific and outcome measure-specific. Clinical relevance of the present results and directions for future research are discussed. PMID:16915361

Karatzias, Athanasios; Power, Kevin; McGoldrick, Theresa; Brown, Keith; Buchanan, Robin; Sharp, Donald; Swanson, Vivien

2007-02-01

101

Measuring the psychological outcomes of falling: a systematic review.  

PubMed

The objectives were to identify fall-related psychological outcome measures and to undertake a systematic quality assessment of their key measurement properties. A Cochrane review of fall-prevention interventions in older adults was used to identify fall-related psychological measurements. PubMed, CINAHL, and PsycINFO were systematically searched to identify instruments not used in trials and papers reporting the methodological quality of relevant measures. Reference lists of articles were searched for additional literature, and researchers were contacted. Two reviewers undertook quality extraction relating to content, population, reliability, validity, responsiveness, practicality, and feasibility. Twenty-five relevant papers were identified. Twenty-three measures met the inclusion criteria: six single-item questions, Falls Efficacy Scale (FES), revised FES, modified FES, FES-UK, Activities-specific Balance and Confidence Scale (ABC), ABC-UK, Confidence in maintaining Balance Scale, Mobility Efficacy Scale, adapted FES, amended FES, Survey of Activities and Fear of Falling in the Elderly (SAFFE), University of Illinois at Chicago Fear of Falling Measure, Concern about Falling Scale, Falls Handicap Inventory, modified SAFFE, Consequences of Falling Scale, and Concern about the Consequences of Falling Scale. There is limited evidence about the measurement properties of single-item measures. Several multiitem measures obtained acceptable reliability and validity, but there is less evidence regarding responsiveness, practicality, and feasibility. Researchers should select measures based on the constructs they intend to study. Further research is needed to establish and compare the instruments' measurement properties. PMID:15743297

Jørstad, Ellen C; Hauer, Klaus; Becker, Clemens; Lamb, Sarah E

2005-03-01

102

Mathematics Placement Test: Typical Results with Unexpected Outcomes  

ERIC Educational Resources Information Center

Based on the results of a prior case-study analysis of mathematics placement at one university, the mathematics department developed and piloted a mathematics placement test. This article describes the implementation process for a mathematics placement test and further analyzes the test results for the pilot group. As an unexpected result, the…

Ingalls, Victoria

2011-01-01

103

Mathematics Placement Test: Typical Results with Unexpected Outcomes  

ERIC Educational Resources Information Center

|Based on the results of a prior case-study analysis of mathematics placement at one university, the mathematics department developed and piloted a mathematics placement test. This article describes the implementation process for a mathematics placement test and further analyzes the test results for the pilot group. As an unexpected result, the…

Ingalls, Victoria

2011-01-01

104

How do validated measures of functional outcome compare with commonly used outcomes in administrative database research for lumbar spinal surgery?  

Microsoft Academic Search

Clinical interpretation of health services research based on administrative databases is limited by the lack of patient-reported\\u000a functional outcome 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

2010-01-01

105

Recent results from tokamak divertor plasma measurements  

SciTech Connect

New diagnostics have been developed to address key divertor physics questions, including: target plate heat flux reduction by radiation, basic edge transport issues, and plasma wall interactions (PWI) such as erosion. A system of diagnostics measures the target plate heat flux (imaging IR thermography) and particle flux (probes, pressure and Penning gauges, and visible emission arrays). Recently, T{sub e},n{sub e}, and P{sub e} (electron pressure) have been measured in 2-D with divertor Thomson Scattering. During radiative divertor operation T{sub e} is less than 2 eV, indicating that new atomic processes are important. Langmuir probes measure higher T{sub e} in some cases. In addition, the measured P{sub e} near the separatrix at the target plate is lower than the midplane pressure, implying radial momentum transport. Bolometer arrays, inverted with reconstruction algorithms, provide the 2-D core and divertor radiation profiles. Spectroscopic measurements identify the radiating species and provide information on impurity transport; both absolute chordal measurements and tomographic reconstructions of images are used. Either intrinsic carbon or an inert species (e.g., injected Ne) are usually observed, and absolute particle inventories are obtained. Computer codes are both benchmarked with the experimental data and provide important consistency checks. Several techniques are used to measure fundamental plasma transport and fluctuations, including probes and reflectometry. PWI issues are studied with in-situ coupons and insertable samples (DiMES). Representative divertor results from DIII-D with references to results on other tokamaks will be presented.

Allen, S.L.

1996-05-01

106

How do validated measures of functional outcome compare with commonly used outcomes in administrative database research for lumbar spinal surgery?  

PubMed

Clinical interpretation of health services research based on administrative databases is limited by the lack of patient-reported functional outcome 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 functional outcome. The purpose was to determine if postoperative events captured from administrative databases, namely reoperation and PCSI, reflect outcomes as derived by validated functional outcome 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 functional outcome 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 functional outcome, respectively. We further evaluated how early (6-12 months) and intermediate (12-24 months) term changes in functional outcome 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 functional outcome at intermediate or late term. Similarly, earlier changes in functional outcome 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 functional outcome, we cannot conclude that a significant relationship exists between the occurrence of PCSI or reoperation and changes in functional outcome. PMID:19816717

Omoto, Daniel; Bederman, S Samuel; Yee, Albert J M; Kreder, Hans J; Finkelstein, Joel A

2009-10-09

107

Longitudinal Comparison of Measures for Health Outcomes. The Beaver Dam Health Outcomes Study. Abstract, Executive Summary, and Final Report.  

National Technical Information Service (NTIS)

This study, 'Longitudinal Comparison of Measures for Health Outcomes,' has become known as the Beaver Dam Health Outcomes Study (BDHOS). Its purpose was to measure the health status and health-related quality of life of older adults in a community populat...

D. G. Fryback

1997-01-01

108

Connecting Stuttering Management and Measurement: I. Core Speech Measures of Clinical Process and Outcome  

ERIC Educational Resources Information Center

|Background: There will always be a place for stuttering treatments designed to eliminate or reduce stuttered speech. When those treatments are required, direct speech measures of treatment process and outcome are needed in clinical practice. Aims: Based on the contents of published clinical trials of such treatments, three "core" measures of…

Shenker, Rosalee C.

2006-01-01

109

Cocaine withdrawal severity and urine toxicology results from treatment entry predict outcome in medication trials for cocaine dependence  

Microsoft Academic Search

Both cocaine withdrawal symptoms, measured by an instrument called the Cocaine Selective Severity Assessment (CSSA), and urine toxicology results obtained at the start of treatment have been shown to predict treatment outcome in outpatient cocaine dependence treatment. This study further evaluates the predictive validity of the CSSA and urine toxicology results, alone and in combination. Subjects included 76 cocaine-dependent individuals

Kyle M. Kampman; Joseph R. Volpicelli; Frank Mulvaney; Margaret Rukstalis; Arthur I. Alterman; Helen Pettinati; Robert M. Weinrieb; Charles P. O'Brien

2002-01-01

110

Goal Attainment Scaling. A responsive measure of client outcomes.  

PubMed

Goal Attainment Scaling (GAS) was developed by Kiresuk and Sherman in 1968. Although highly criticized in the early years of its conception, GAS is beginning to be recognized as a reliable, valid, and responsive outcome measurement approach. This article describes the application of GAS, using elderly home health care clients as an example. Reliability and validity issues are examined. Criticism of GAS is often based on traditional psychometric assumptions associated with normative assessment and does not reflect the evaluative nature of the GAS methodology. The advantages and limitations of GAS are discussed. Goal Attainment Scaling has the potential to demonstrate the important contribution home health care programs make to clients by measuring the change that has occurred during their admission to the program. This kind of information is required by policy makers, case managers, and home health care providers to develop policy, allocate limited resources, and offer appropriate and effective services. PMID:10025309

Forbes, D A

1998-12-01

111

Outcome measurement in multiple sclerosis: detection of clinically relevant improvement.  

PubMed

Because the development of new treatments in multiple sclerosis as well as the awareness of the importance of patient-oriented measures have become more important in the last two decades, new outcome measures have been developed with the aim of being more responsive to change and more clinically relevant to patients. The ability to detect improvement is sparsely studied. In the present study we evaluate the responsiveness of the Expanded Disability Status Scale and two quantitative tests (the timed 25-foot walk test and the nine-hole peg test) separately and in combination, to detect improvement after intravenous methylprednisolone. The Expanded Disability Status Scale, the timed 25-foot walk test and the nine-hole peg test were assessed in 112 multiple sclerosis patients before and 6 weeks after intravenous methylprednisolone. In addition patients were asked to rate their change as an anchor to evaluate the performance of the tests. Combining the timed 25-foot walk test and the nine-hole peg test turned out to be the optimal combination of measures to predict patient perceived improvement (positive predictive value of 67% and a negative predictive value of 59%, likelihood ratio of positive test 2.31 (95% confidence interval 1.08-4.95)). In the higher Expanded Disability Status Scale range (4.5 and higher), for all measures a significant change was more often perceived as clinically relevant than in the lower disability range. The Expanded Disability Status Scale seems not to be the preferred outcome of choice to detect patient perceived improvement in multiple sclerosis, especially in the lower Expanded Disability Status Scale range. Combining the timed walk test and the nine-hole peg test can improve the sensitivity to detect clinically relevant changes without conceding with respect to specificity. PMID:20086019

van Winsen, Lisa M L; Kragt, Jolijn J; Hoogervorst, Erwin L J; Polman, Chris H; Uitdehaag, Bernard M J

2010-01-19

112

Use of Continuous Glucose Monitoring as an Outcome Measure in Clinical Trials  

PubMed Central

Abstract Objective Although developed to be a management tool for individuals with diabetes, continuous glucose monitoring (CGM) also has potential value for the assessment of outcomes in clinical studies. We evaluated using CGM as such an outcome measure. Research Design and Methods Data were analyzed from six previously completed inpatient studies in which both CGM (Freestyle Navigator™ [Abbott Diabetes Care, Alameda, CA] or Guardian® [Medtronic, Northridge, CA]) and reference glucose measurements were available. The analyses included 97 days of data from 93 participants with type 1 diabetes (age range, 5–57 years; mean, 18±12 years). Results Mean glucose levels per day were similar for the CGM and reference measurements (median, 148?mg/dL vs. 143?mg/dL, respectively; P=0.92), and the correlation of the two was high (r=0.89). Similarly, most glycemia metrics showed no significant differences comparing CGM and reference values, except that the nadir glucose tended to be slightly lower and peak glucose slightly higher with reference measurements than CGM measurements (respective median, 59?mg/dL vs. 66?mg/dL [P=0.05] and 262?mg/dL vs. 257?mg/dL [P=0.003]) and glucose variability as measured with the coefficient of variation was slightly lower with CGM than reference measurements (respective median, 31% vs. 35%; P<0.001). Conclusions A reasonably high degree of concordance exists when comparing outcomes based on CGM measurements with outcomes based on reference blood glucose measurements. CGM inaccuracy and underestimation of the extremes of hyperglycemia and hypoglycemia can be accounted for in a clinical trial's study design. Thus, in appropriate settings, CGM can be a very meaningful and feasible outcome measure for clinical trials.

Calhoun, Peter; Kollman, Craig

2012-01-01

113

Technical Characteristics of General Outcome Measures (GOMs) in Reading for Students With Significant Cognitive Disabilities  

Microsoft Academic Search

This study examined the technical characteristics of newly created general outcome measures (GOMs) in reading for students with significant cognitive disabilities. The participants were 31 students with significant cognitive disabilities, and the GOMs used produced reliable data. Early results establishing the validity of the GOMs suggest that Rimes, K–4 Science Content Word Identification, Simple Sentence Maze, and Fry's Word Identification

Teri Wallace; Renáta Tichá; Kathy Gustafson

2010-01-01

114

Technical Characteristics of General Outcome Measures (GOMs) in Reading for Students with Significant Cognitive Disabilities  

ERIC Educational Resources Information Center

|This study examined the technical characteristics of newly created general outcome measures (GOMs) in reading for students with significant cognitive disabilities. The participants were 31 students with significant cognitive disabilities, and the GOMs used produced reliable data. Early results establishing the validity of the GOMs suggest that…

Wallace, Teri; Ticha, Renata; Gustafson, Kathy

2010-01-01

115

Quantitative measurement of vertigo frequency: preliminary results.  

PubMed

Persons who experience vertigo often describe their symptoms as a sensation of oscillations. Based on such a description, a pilot study was performed to determine if the frequency of the vertigo sensation could be quantified in a manner analogous to tone matching in tinnitus treatment. Fifteen subjects were tested using a virtual image system that consisted of a head mounted display showing a scene that oscillated horizontally or vertically at an adjustable frequency. Subjects were asked to adjust the direction and frequency to match their typical vertigo sensation. Results show that most persons with chronic vertigo had symptoms that could be realistically simulated by vection induced by the oscillating scene and that matched to a consistent specific frequency. They reported an average frequency of 1.09 Hz (range 0.27 to 3.3 Hz, SD 0.25). The large majority (13 out of 15) matched to a horizontal stimulus. Subjects that gave particularly high subjective ratings of the similarity of the motion sensation (7-8 out of 10) from the vection to their vertigo had lower frequency matches (average 0.61 +/- 0.25). Repeated measurements in 4 subjects 8 to 27 days later showed consistent results. This vertigo measurement technique may be used in the future to assess the ability of vestibular rehabilitation to reduce chronic vertigo. Identification of a specific frequency of chronic vertigo may be important in the specification of rehabilitation exercises. PMID:14646024

Zalewski-Zaragoza, Robert Aureo; Viirre, Erik Scott

2003-01-01

116

Using Cross-Cultural Dimensions Exercises to Improve and Measure Learning Outcomes in International Business Courses  

ERIC Educational Resources Information Center

|This article proposes an approach for using cross-cultural dimensions exercises to improve and measure learning outcomes in international business courses. The following key issues are highlighted: (a) what are the targeted learning outcomes to be assessed, (b) how to measure the accomplishment of these learning outcomes, (c) the input measures

Zainuba, Mohamed; Rahal, Ahmad

2012-01-01

117

Long-term Results of Percutaneous Lumbar Decompression for LSS: Two-Year Outcomes.  

PubMed

OBJECTIVE:: The aim of this report was to evaluate the long-term effectiveness and safety of mild lumbar decompression for the treatment of neurogenic claudication associated with lumbar spinal stenosis. This technique uses a percutaneous dorsal approach to remove small portions of ligament and lamina, thereby restoring space and decompressing the spinal canal. MATERIALS AND METHODS:: Two-year data are reported for 45 patients treated with mild decompression at 11 US sites. Outcome measures included the Visual Analog Scale (VAS), Oswestry Disability Index, and Zurich Claudication Questionnaire. Safety was monitored throughout the procedural and follow-up period for all patients. Interim data are included for these patients at 1 week, 6 months, and 1-year follow-up. RESULTS:: Seventy-one percent of patients reported improvement in VAS at the end of the reporting period. At 2 years, patients demonstrated a statistically significant reduction of pain as measured by VAS, and improvement in physical function and mobility was significant as measured by Zurich Claudication Questionnaire and Oswestry Disability Index. Tukey honestly significant different test found significant improvement in all outcome measures from baseline to each follow-up interval. Further, major improvement occurred by 1-week follow-up and showed no difference between each subsequent follow-up, signifying considerable stability and durability of the initial result over time. No major device or intraprocedural adverse events were reported. DISCUSSION:: In this report of 2-year follow-up on 45 patients treated with mild percutaneous lumbar decompression, patients experienced statistically significant pain relief and improved functionality. PMID:23446067

Chopko, Bohdan W

2013-02-26

118

The King's Outcome Scale for Childhood Head Injury and Injury Severity and Outcome Measures in Children with Traumatic Brain Injury  

ERIC Educational Resources Information Center

The aim of this study was to relate discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) category to injury severity and detailed outcome measures obtained in the first year post-traumatic brain injury (TBI). We used a prospective cohort study. Eighty-one children with TBI were studied: 29 had severe, 15 moderate, and 37 mild TBI. The…

Calvert, Sophie; Miller, Helen E.; Curran, Andrew; Hameed, Biju; McCarter, Renee; Edwards, Richard J.; Hunt, Linda; Sharples, Peta Mary

2008-01-01

119

Development of the FOCUS (Focus on the Outcomes of Communication under Six), a Communication Outcome Measure for Preschool Children  

ERIC Educational Resources Information Center

|Aim: Our aim was to develop an outcome measure, called Focus on the Outcomes of Communication Under Six (FOCUS), that captures real-world changes in preschool children's communication. Conceptually grounded in the World Health Organization International Classification of Functioning, Disability and Health framework, the FOCUS items were derived…

Thomas-Stonell, Nancy L.; Oddson, Bruce; Robertson, Bernadette; Rosenbaum, Peter L.

2010-01-01

120

The King's Outcome Scale for Childhood Head Injury and Injury Severity and Outcome Measures in Children with Traumatic Brain Injury  

ERIC Educational Resources Information Center

|The aim of this study was to relate discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) category to injury severity and detailed outcome measures obtained in the first year post-traumatic brain injury (TBI). We used a prospective cohort study. Eighty-one children with TBI were studied: 29 had severe, 15 moderate, and 37 mild TBI.…

Calvert, Sophie; Miller, Helen E.; Curran, Andrew; Hameed, Biju; McCarter, Renee; Edwards, Richard J.; Hunt, Linda; Sharples, Peta Mary

2008-01-01

121

Emergency Medical Services Outcomes Project (EMSOP) IV: Pain measurement in out-of-hospital outcomes research  

Microsoft Academic Search

The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. In prior work (EMSOP I), discomfort had the highest weighted score among outcome categories for the top 3 adult conditions (ie, minor trauma, respiratory distress, chest pain) and the first and third highest rankings for children's conditions (ie, minor

Ronald F. Maio; Herbert G. Garrison; Daniel W. Spaite; Jeffrey S. Desmond; Mary Ann Gregor; Ian G. Stiell; C. Gene Cayten; John L. Chew; Ellen J. MacKenzie; David R. Miller; Patricia J. O'Malley

2002-01-01

122

Evaluating Social Work Education: A Review of Outcomes, Measures, Research Designs and Practicalities  

Microsoft Academic Search

This review considers how the outcomes of social work education can be identified with reference to Kirkpatrick's framework of levels of outcomes and Kraiger et al.’s general model of learning outcomes. It presents examples of different approaches to the measurement of outcomes and to the use of research designs in social work education and interprofessional education involving social workers and

John Carpenter

2011-01-01

123

SAGE III solar ozone measurements: Initial results  

NASA Astrophysics Data System (ADS)

Results from two retrieval algorithms, ``o3_aer'' and ``o3_mlr'', used for SAGE III solar occultation ozone measurements in the stratosphere and upper troposphere are compared. The main differences between these two retrieved (version 3.0) ozone are found at altitudes above 40 km and below 15 km. Compared to correlative measurements, the SAGE II type ozone retrievals (o3_aer) provide better precisions above 40 km and do not induce artificial hemispheric differences in upper stratospheric ozone. The multiple linear regression technique (o3_mlr), however, can yield slightly more accurate ozone (by a few percent) in the lower stratosphere and upper troposphere. By using SAGE III (version 3.0) ozone from both algorithms and in their preferred regions, the agreement between SAGE III and correlative measurements is shown to be ~5% down to 17 km. Below 17 km SAGE III ozone values are systematically higher, by 10% at 13 km, and a small hemispheric difference (a few percent) appears. Compared to SAGE III and HALOE, SAGE II ozone has the best accuracy in the lowest few kilometers of the stratosphere. Estimated precision in SAGE III ozone is about 5% or better between 20 and 40 km and ~10% at 50 km. The precision below 20 km is difficult to evaluate because of limited coincidences between SAGE III and sondes. SAGE III ozone values are systematically slightly larger (2-3%) than those from SAGE II but the profile shapes are remarkably similar for altitudes above 15 km. There is no evidence of any relative drift or time dependent differences between these two instruments for altitudes above 15-20 km.

Wang, Hsiang-Jui; Cunnold, Derek M.; Trepte, Chip; Thomason, Larry W.; Zawodny, Joseph M.

2006-02-01

124

Case Management Outcomes and Measures: A Social Work Source Book.  

National Technical Information Service (NTIS)

The purpose of the document is to delineate outcomes that healthcare managers can use to evaluate the impact of case management on patient care and health care service utilization. Outcomes presented in the document were selected because they appeared in ...

B. S. Bialk

1997-01-01

125

Measures of attentional bias and relational responding are associated with behavioral treatment outcome for cocaine dependence  

PubMed Central

Background Psychosocial interventions for substance dependence have demonstrated efficacy. However, the mechanisms by which specific intervention strategies exert their effect have not been clearly identified. Objective This study investigated the prospective relationships between two psychological processes, an attentional bias towards cocaine stimuli and beliefs about the consequences of cocaine use, and treatment outcome. Method Twenty-five cocaine dependent participants enrolled in a 6-month outpatient treatment program that included voucher incentives for abstinence. All participants were asked to complete two implicit assessment procedures, a Drug Stroop protocol and an Implicit Relational Assessment Procedure (IRAP), as well as explicit measures of cocaine craving and the consequences of cocaine use, prior to beginning treatment. Pearson-correlation coefficients tested the prospective relationships between treatment outcome and the implicit and explicit assessments. Results Stronger implicit beliefs about the positive effects of cocaine use prior to treatment were associated with poorer treatment outcome when an escalating voucher incentive program was in place. Further, an attentional bias for cocaine-related stimuli was associated with better treatment outcome when an escalating voucher incentive program was removed. No association between cocaine use beliefs and treatment outcome was found when beliefs were measured with self-report instruments. Conclusions and Scientific Significance These findings highlight the potential utility of performance based measures for delineating the psychological mechanisms associated with variation in response to treatment for drug dependence.

Carpenter, Kenneth M.; Martinez, Diana; Vadhan, Nehal P.; Barnes-Holmes, Dermot; Nunes, Edward V.

2012-01-01

126

Predicting prosthetic rehabilitation outcome in lower limb amputee patients with the functional independence measure  

Microsoft Academic Search

Objective: To determine the value of the Functional Independence Measure (FIM) score as a prognostic indicator for prosthetic use in the lower limb amputee patient.Design: Cohort study of 41 patients with lower limb amputations.Setting: University hospital rehabilitation unit.Main Outcome Measures: FIM motor subscore and Houghton Scale for prosthetic use.Results: FIM score on admission did not correlate with prosthetic use as

Eric Chung-Ching Leung; Perry Joel Rush; Michael Devlin

1996-01-01

127

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

PubMed

One outcome measure of law enforcement effectiveness is the reduction in drug consumption which occurs as a result of law enforcement interventions. A theoretical relationship between drug consumption and retail price has promoted the use of retail price as a surrogate measure for consumption. In the current article, retail price is examined as a potential outcome measure for the effectiveness of law enforcement. The predictions regarding the relationship between law enforcement intensity and price are only partially supported by research. Explanations for the disconnect between the drug law enforcement activity and retail price include: rapid adaptation by market players, enforcement swamping, assumptions of rational actors, short-run versus long-run effects, structure of the illicit market, simultaneous changes that affect price in perverse ways, the role of violence in markets, and data limitations. Researchers who use retail price as an outcome measure need to take into account the complex relationship between drug law enforcement interventions and the retail price of illicit drugs. Viable outcome measures which can be used as complements to retail price are worth investigation. PMID:20083399

Bright, David A; Ritter, Alison

2010-01-18

128

Results and analysis of the GLONASS measurements  

NASA Astrophysics Data System (ADS)

With the purpose of improving the national geodetic reference frame an establishment of the new Fundamental Astro-Geodetic network (FAGN), based mainly on the combined use of GPS and GLONASS measurements, is now carried out in Russia. From the geodetic point of view, the advantages of combining both systems are numerous, especially in the urban, mountain and near polar areas. More than 30 permanent core sites of this network are provided with the dual GPS/GLONASS receivers. Several core sites of the FAGN network are collocated with the existing IERS stations, equipped with the SLR, VLBI and DORIS instruments. Now the constellation of the GLONASS consists of 24 satellites at three orbital planes, 8 satellites in each. Inclination of the orbit is 64.80, height 19100 km and revolution time 11h 15min. Analysis of the GLONASS data, obtained at the IGS sites, including most of the Russian sites, have been made with the use of GIPSY-OASIS 2 software. Results of estimation of GLONASS orbital parameters and station coordinates were compared with the GPS estimations at the collocated sites. Both solutions are related to the ITRF2005 coordinate system. Differences between solutions are in the limit of a few cm. The means of improvement of the GLONASS solution and adjustment of the GLONASS coordinate system with the ITRF are considered.

Suriya, Tatevyan

2012-07-01

129

Measuring Academic Outcomes...and Identifying What Influences Them. AIR 1989 Annual Forum Paper.  

ERIC Educational Resources Information Center

A study was conducted to measure the student outcomes of academic (university transfer) programs and identify the factors related to those outcomes. Six British Columbia (Canada) community colleges participated in the study by surveying 5,770 of their former students. The survey measured four student outcomes, and the analysis tested several…

Cousineau, John; Landon, Bruce

130

Goal Attainment Scaling as an Outcome Measure in Randomized Controlled Trials of Psychosocial Interventions in Autism  

PubMed Central

Goal attainment scaling (GAS) holds promise as an idiographic approach for measuring outcomes of psychosocial interventions in community settings. GAS has been criticized for untested assumptions of scaling level (i.e., interval or ordinal), inter-individual equivalence and comparability, and reliability of coding across different behavioral observation methods. We tested assumptions of equality between GAS descriptions for outcome measurement in a randomized trial (i.e., measurability, equidistance, level of difficulty, comparability of behavior samples collected from teachers vs. researchers and live vs. videotape). Results suggest GAS descriptions can be evaluated for equivalency, that teacher collected behavior samples are representative, and that varied sources of behavior samples can be reliably coded. GAS is a promising measurement approach. Recommendations are provided to ensure methodological quality.

McGrew, John H.; Toland, Michael D.

2012-01-01

131

?-ADDUCIN POLYMORPHISM ASSOCIATED WITH INCREASED RISK OF ADVERSE CARDIOVASCULAR OUTCOMES: RESULTS FROM INVEST-GENES  

PubMed Central

Background The ?-adducin (ADD1) Gly460Trp polymorphism has been associated with hypertension and response to diuretic therapy, but controversy exists. Methods The present study was conducted to prospectively investigate the relationship between the ADD1 Gly460Trp polymorphism, diuretic use, and adverse cardiovascular outcomes among 5,979 hypertensive coronary artery disease patients, who participated in the INternational VErapamil SR-trandolapril STudy (INVEST) and provided genomic DNA. The primary outcome was defined as first occurrence of nonfatal stroke, nonfatal myocardial infarction, or all-cause death. Secondary outcomes were the components of the primary outcome. Ancestry informative markers were used to control for population stratification. Results In Blacks, ADD1 variant carriers were at higher risk for a primary outcome event than wild-type homozygotes (adjusted hazard ratio (HR) 2.62; 95% confidence interval (CI) 1.23–5.58; p = .012), with a similar trend in Whites and Hispanics, albeit a smaller magnitude of effect (adjusted HR 1.43, 0.86–2.39 in Hispanics; 1.24, 0.90–1.71 in Whites). Secondary outcome analysis showed that the all-cause death was driving the differences in primary outcomes by genotype. There was no interaction between the ADD1 polymorphism and diuretic use for either primary outcome or secondary outcomes. Conclusions In hypertensive patients with coronary artery disease, black ADD1 variant carriers showed a 2.6-fold excess risk for a primary outcome event and an 8-fold increase risk of death. White and Hispanic ADD1 variant carriers showed an increased but nonsignificant excess risk. However, the effect of diuretic use on risk of cardiovascular outcomes did not vary by ADD1 carrier status.

Gerhard, Tobias; Gong, Yan; Beitelshees, Amber L.; Mao, Xianyun; Lobmeyer, Maximilian T.; Cooper-DeHoff, Rhonda M.; Langaee, Taimour Y.; Schork, Nicholas J.; Shriver, Mark D.; Pepine, Carl J.; Johnson, Julie A.

2008-01-01

132

Measuring patient satisfaction for the Quality and Outcomes Framework.  

PubMed

The general medical services (GMS) contract Quality and Outcomes Framework (QOF) awards up to 70 points for measuring patient satisfaction with either the Improving Practices Questionnaire (IPQ) or the General Practice Assessment Questionnaire (GPAQ). The usefulness of data collected depends crucially on the validity and reliability of the measurement instrument. The literature was reviewed to assess the validity and reliability of these questionnaires. The literature was searched for peer-review publications that assessed the reliability and validity of the IPQ and GPAQ, using online literature databases and hand-searching of references up to June 2006. One paper claimed to assess the validity and reliability of the IPQ. No paper reported the reliability and validity of the GPAQ, but three papers assessed an earlier version (the GPAS). No published evidence could be found that the IPQ, GPAQ, or GPAS have been validated against external criteria. The GPAS was found to have acceptable reliability and test-retest reliability. Neither of the instruments mandated by the GMS contract has been formally assessed for reliability: their reproducibility remains unknown. The validation of the two questionnaires approved by the QOF to assess patient satisfaction with general practice appears to be suboptimal. It is recommended that future patient experience surveys are piloted for validity and reliability before being implemented widely. PMID:17761061

Hankins, Matthew; Fraser, Alice; Hodson, Andrew; Hooley, Claire; Smith, Helen

2007-09-01

133

Lymph node density in oral cavity cancer: results of the International Consortium for Outcomes Research.  

PubMed

Background:Lymph node density (LND) has previously been reported to reliably predict recurrence risk and survival in oral cavity squamous cell carcinoma (OSCC). This multicenter international study was designed to validate the concept of LND in OSCC.Methods:The study included 4254 patients diagnosed as having OSCC. The median follow-up was 41 months. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional control and distant metastasis rates were calculated using the Kaplan-Meier method. Lymph node density (number of positive lymph nodes/total number of excised lymph nodes) was subjected to multivariate analysis.Results:The OS was 49% for patients with LND?0.07 compared with 35% for patients with LND>0.07 (P<0.001). Similarly, the DSS was 60% for patients with LND?0.07 compared with 41% for those with LND>0.07 (P<0.001). Lymph node density reliably stratified patients according to their risk of failure within the individual N subgroups (P=0.03). A modified TNM staging system based on LND ratio was consistently superior to the traditional system in estimating survival measures.Conclusion:This multi-institutional study validates the reliability and applicability of LND as a predictor of outcomes in OSCC. Lymph node density can potentially assist in identifying patients with poor outcomes and therefore for whom more aggressive adjuvant treatment is needed. PMID:24064974

Patel, S G; Amit, M; Yen, T C; Liao, C T; Chaturvedi, P; Agarwal, J P; Kowalski, L P; Ebrahimi, A; Clark, J R; Cernea, C R; Brandao, S J; Kreppel, M; Zöller, J; Fliss, D; Fridman, E; Bachar, G; Shpitzer, T; Bolzoni, V A; Patel, P R; Jonnalagadda, S; Robbins, K T; Shah, J P; Gil, Z

2013-09-24

134

Interpretation of the dosimetric results of three uniformity regularization methods in terms of expected treatment outcome.  

PubMed

In IMRT treatment plan optimization there are various methods that try to regularize the variation of dose nonuniformity using purely dosimetric measures. However, although these methods can help in finding a good dose distribution, they do not provide any information regarding the expected treatment outcome. When a treatment plan optimization is performed using biological measures, the final goal should be some indication about the expected tumor control or normal tissue complications, which is the primary goal of treatment planning (the association of treatment configurations and dose prescription with the treatment outcome). In this study, this issue is analyzed distinguishing the dose-oriented treatment plan optimization from the response-oriented optimization. Three different dose distributions were obtained by using a dose-based optimization technique, an EUD-based optimization without applying any technique for regularizing the nonuniformity of the dose distribution, and an EUD-based optimization using a variational regularization technique, which controls dose nonuniformity. The clinical effectiveness of the three dose distributions was investigated by calculating the response probabilities of the tumors and organs-at-risk (OARs) involved in two head and neck and prostate cancer cases. The radiobiological models used are the linear-quadratic-Poisson and the Relative Seriality models. Furthermore, the complication-free tumor control probability and the biologically effective uniform dose (D) were used for treatment plan evaluation and comparison. The radiobiological comparison shows that the EUD-based optimization using L-curve regularization gives better results than the EUD-based optimization without regularization and dose-based optimization in both clinical cases. Concluding, it appears that the applied dose nonuniformity regularization technique is expected to improve the effectiveness of the optimized IMRT dose distributions. However, more patient cases are needed to validate the statistical significance of the results and conclusions presented in this paper. PMID:19070235

Mavroidis, Panayiotis; Komisopoulos, Georgios; Lind, Bengt K; Papanikolaou, Nikos

2008-11-01

135

Reliability and Validity of the Outcome Rating Scale: A Replication Study of a Brief Clinical Measure.  

National Technical Information Service (NTIS)

There is an industry-wide trend toward making outcome evaluation a routine part of therapeutic services, yet most measures are infeasible for everyday clinical use. Consequently, the Outcome Rating Scale (ORS) was developed and recently validated by its a...

D. L. Bringhurst C. W. Watson S. D. Miller B. L. Duncan

2004-01-01

136

Current measures of metabolic heterogeneity within cervical cancer do not predict disease outcome  

PubMed Central

Background A previous study evaluated the intra-tumoral heterogeneity observed in the uptake of F-18 fluorodeoxyglucose (FDG) in pre-treatment positron emission tomography (PET) scans of cancers of the uterine cervix as an indicator of disease outcome. This was done via a novel statistic which ostensibly measured the spatial variations in intra-tumoral metabolic activity. In this work, we argue that statistic is intrinsically non-spatial, and that the apparent delineation between unsuccessfully- and successfully-treated patient groups via that statistic is spurious. Methods We first offer a straightforward mathematical demonstration of our argument. Next, we recapitulate an assiduous re-analysis of the originally published data which was derived from FDG-PET imagery. Finally, we present the results of a principal component analysis of FDG-PET images similar to those previously analyzed. Results We find that the previously published measure of intra-tumoral heterogeneity is intrinsically non-spatial, and actually is only a surrogate for tumor volume. We also find that an optimized linear combination of more canonical heterogeneity quantifiers does not predict disease outcome. Conclusions Current measures of intra-tumoral metabolic activity are not predictive of disease outcome as has been claimed previously. The implications of this finding are: clinical categorization of patients based upon these statistics is invalid; more sophisticated, and perhaps innately-geometric, quantifications of metabolic activity are required for predicting disease outcome.

2011-01-01

137

Measuring Training Results: Key to Managerial Commitment.  

ERIC Educational Resources Information Center

|The author discusses application of Del Gaizo's four-level evaluation model to a business communications skills course for support and secretarial staff. The four measurement levels are (1) happiness, (2) learning, (3) practical application, and (4) bottom line. (CH)|

Bell, James D.; Kerr, Deborah L.

1987-01-01

138

Laser radar mesospheric temperature measurements: Preliminary results  

NASA Astrophysics Data System (ADS)

Resonant scattering with a laser radar was used to measure the Doppler width of the atmospheric sodium line. By reducing the bandwidth of the laser pulse used for measuring sodium density to about 0.1 pm. the temperature at mesospheric heights can be determined by measuring the width of the sodium D sub 2 line. To accomplish this, the laser wavelength and bandwidth must be sufficiently stable to integrate the return signals over several laser shots. Preliminary measurements were made by introducing an additional Fabry-Perot etalon, of high optical quality, in the laser cavity, to reduce the bandwidth. The small wavelength scan was accomplished by heating the etalon. Returns from 90 Km reproduce the shape of the D sub 2 line, indicating a temperature of about 240 K.

Kirchhoff, V. W. J. H.; Clemesha, B. R.; Simonich, D. M.

1978-04-01

139

How Good Are Clinical Severity and Outcome Measures for Psoriasis?: Quantitative Evaluation in a Systematic Review  

Microsoft Academic Search

A large number of clinical measures of psoriasis are used in clinical trials and daily practice. These measures lack uniformity and validation. However, valid outcome and severity measures for psoriasis are a prerequisite for fully informative clinical research and evidence-based medicine. The purpose of this study was to identify all clinical measures of psoriasis severity and outcome in use and

Phyllis I Spuls; Lidian L A Lecluse; Marie-Louise N F Poulsen; Jan D Bos; Robert S Stern; Tamar Nijsten

2010-01-01

140

Clinical outcomes measures for assessment of longevity in the dental implant literature: ORONet approach.  

PubMed

The Oral Rehabilitation Outcomes Network (ORONet) Longevity Working Group undertook a search of the literature from 1995 to 2009 on randomized controlled trials related to longevity of osseointegrated implants. Outcomes measures used in these studies were identified and subjected to the OMERACT component criteria of truth, validity, and feasibility. Through this process, it was a challenge to identify clinical outcomes measures that fully met the criteria. An attenuated version of the component criteria was applied, and clinical measures were identified for implant outcomes, prosthetic outcomes, and indices. A recommendation on standardized reporting periods was also presented for future consideration. The endpoint of the evaluation process is to develop consensus on clinical outcomes measures that can be applied across broad populations for osseointegrated implant care. The present ORONet initiative represents a beginning toward continual improvement and consensus development for clinical outcomes measures for osseointegrated implants. PMID:23837161

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

141

Accountability in Continuing Education: Measuring Noncredit Student Outcomes.  

ERIC Educational Resources Information Center

Although only Ohio has issued statewide standards for noncredit continuing education and a few other states have looked at such a process, most of the literature on student outcomes focuses exclusively on degree-credit programs. A college, university, or state system might want to assess continuing education outcomes for the following reasons: to…

Clagett, Craig A.; McConochie, Daniel D.

1991-01-01

142

Using Quality of Life to Evaluate Outcomes and Measure Effectiveness  

ERIC Educational Resources Information Center

|Evaluating the outcomes achieved by service providers who assist people with intellectual disabilities is extremely important in terms of ascertaining whether service providers achieve their goals. Furthermore, knowledge of the outcomes achieved by service providers better equips those charged with managing them to make strategic decisions to…

Kober, Ralph; Eggleton, Ian R. C.

2009-01-01

143

Predictors of outcome in patients with degenerative cervical spondylotic myelopathy undergoing surgical treatment: results of a systematic review.  

PubMed

PURPOSE: To conduct a systematic review of the literature to determine important clinical predictors of surgical outcome in patients with cervical spondylotic myelopathy (CSM). METHODS: A literature search was performed using MEDLINE, MEDLINE in Process, EMBASE and Cochrane Database of Systematic Reviews. Selected articles were evaluated using a 14-point modified SIGN scale and classified as either poor (<7), good (7-9) or excellent (10-14) quality of evidence. For each study, the association between various clinical factors and surgical outcome, evaluated by the (modified) Japanese Orthopaedic Association scale (mJOA/JOA), Nurick score or other measures, was defined. The results from the EXCELLENT studies were compared to the combined results from the EXCELLENT and GOOD studies which were compared to the results from all the studies. RESULTS: The initial search yielded 1,677 citations. Ninety-one of these articles, including three translated from Japanese, met the inclusion and exclusion criteria and were graded. Of these, 16 were excellent, 38 were good and 37 were poor quality. Based on the excellent studies alone, a longer duration of symptoms was associated with a poorer outcome evaluated on both the mJOA/JOA scale and Nurick score. A more severe baseline score was related with a worse outcome only on the mJOA/JOA scale. Based on the GOOD and EXCELLENT studies, duration of symptoms and baseline severity score were consistent predictors of mJOA/JOA, but not Nurick. Age was an insignificant predictor of outcome on any of the functional outcomes considered. CONCLUSION: The most important predictors of outcome were preoperative severity and duration of symptoms. This review also identified many other valuable predictors including signs, symptoms, comorbidities and smoking status. PMID:23386279

Tetreault, Lindsay A; Karpova, Alina; Fehlings, Michael G

2013-02-01

144

A transuranic aerosol measurement system: Preliminary results  

SciTech Connect

We have completed the design, fabrication, and assembly of a computer-based prototype system for the measurement of transuranic aerosols in the workplace and environment. This system (called WOTAMS for Workplace Transuranic Aerosol Measurement System) incorporates two detectors: (1) an in-line solid-state alpha detector that sends out an alarm the moment a transuranic release occurs, and (2) an in-vacuum detector that increases off-line-analysis sensitivity. The in-line sensitivity of the system is better than 5.0 MPC-h, and the in-vacuum sensitivity exceeds 0.5 MPC-h. 5 refs., 8 figs., 1 tab.

Prevo, C.T.; Kaifer, R.C.; Rueppel, D.W.; Delvasto, R.M.; Biermann, A.H.; Phelps, P.L.

1986-10-01

145

Validity and responsiveness of the patient evaluation measure as an outcome measure for carpal tunnel syndrome.  

PubMed

The aim of this study was to assess the validity of the Patient Evaluation Measure questionnaire (PEM) as an outcome measure in carpal tunnel syndrome. The PEM was compared to the DASH questionnaire and to objective measurements of hand function. We also compared its responsiveness to changes following carpal tunnel release with that of the DASH score. Twenty-four patients completed the PEM and DASH questionnaires before and 3 months after open carpal tunnel release. Grip strength, static two-point discrimination and the nine-hole peg test were measured. There was a significant correlation between individual items of the PEM and the objective measures. There was also strong correlation between PEM and DASH scores. The PEM showed a greater responsiveness to change (effect size 0.97) than the DASH score (effect size 0.49). The PEM correlates well with objective measures of hand function and the DASH score when used in carpal tunnel syndrome. It is more responsive to change than the DASH score. It is very simple to complete and score and is an appropriate and practical outcome measure in carpal tunnel syndrome. PMID:15936130

Hobby, J L; Watts, C; Elliot, D

2005-08-01

146

Review of OPEX Activities and Measurement Results.  

National Technical Information Service (NTIS)

A summary is given of the measurements carried out in the framework of OPEX (OLYMPUS Propagation Experimenters Group). In particular, the progress since mid-1990 is presented. In this period two OPEX meetings were held, OPEX 14 (Oct. 1990) and OPEX 15 (Ap...

B. Arbesser-rastburg

1991-01-01

147

Outcome measures for psoriasis severity: a report from the GRAPPA 2012 annual meeting.  

PubMed

At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in Stockholm, Sweden, dermatology members provided summaries of ongoing work with outcome measures for psoriasis severity. Controversies around the physician global assessment (PGA) were summarized, including discussions of variations and limitations of the static PGA instruments in use. The Psoriasis Outcome Measures project was introduced, with a goal of developing measures for use in clinical trials and practice. This project will follow the Outcome Measures in Rheumatology (OMERACT) process and may become a model for outcome measures of other dermatologic diseases. PMID:23908537

Callis Duffin, Kristina; Gottlieb, Alice B

2013-08-01

148

Measuring outcomes of family-centered intervention: development of the Life Participation for Parents (LPP).  

PubMed

Raising a child with disabilities impacts the ability of parents to participate in life situations. This paper describes the development of a new instrument, Life Participation for Parents, to measure outcomes of pediatric therapy on parental participation. Items were reviewed by six occupational therapists with experience in pediatrics and instrument development. The number of items was reduced to 23. The resultant instrument was completed by 29 parents of children with disabilities. Their scores were reviewed by the nine occupational therapists working with the children. Parent and therapist respondents were interviewed regarding item content. Instrument responses were evaluated for internal consistency. The respondents confirmed the face and content validity of the construct, variability in responses, and readability of the items. Good internal consistency for items was demonstrated (Cronbach's alpha .85). The preliminary results indicate that the Life Participation for Parents is a promising tool for evaluating parental issues and measuring parent outcomes in family-centered practice. PMID:19401926

Fingerhut, Patricia E

2009-01-01

149

The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review  

PubMed Central

Background Allied Health Professionals today are required, more than ever before, to demonstrate their impact. However, despite at least 20 years of expectation, many services fail to deliver routine outcome measurement in practice. This systematic review investigates what helps and hinders routine outcome measurement of allied health professionals practice. Methods A systematic review protocol was developed comprising: a defined search strategy for PsycINFO, MEDLINE and CINHAL databases and inclusion criteria and systematic procedures for data extraction and quality appraisal. Studies were included if they were published in English and investigated facilitators and/or barriers to routine outcome measurement by allied health professionals. No restrictions were placed on publication type, design, country, or year of publication. Reference lists of included publications were searched to identify additional papers. Descriptive methods were used to synthesise the findings. Results 960 papers were retrieved; 15 met the inclusion criteria. Professional groups represented were Physiotherapy, Occupational Therapy, and Speech and Language Therapy. The included literature varied in quality and design. Facilitators and barriers to routine outcome measurement exist at individual, managerial and organisational levels. Key factors affecting professionals’ use of routine outcome measurement include: professionals’ level of knowledge and confidence about using outcome measures, and the degree of organisational and peer-support professionals received with a view to promoting their work in practice. Conclusions Whilst the importance of routinely measuring outcomes within the allied health professions is well recognised, it has largely failed to be delivered in practice. Factors that influence clinicians’ ability and desire to undertake routine outcome measurement are bi-directional: they can act as either facilitators or barriers. Routine outcome measurement may only be deliverable if appropriate action is taken at individual therapist, team, and organisational levels of an organisation.

2012-01-01

150

Effectiveness of a measurement feedback system on outcome in rheumatoid arthritis: a controlled clinical trial  

PubMed Central

Background: With the help of a measurement feedback system, the treatment strategy for individual patients with rheumatoid arthritis (RA) can be adjusted to achieve optimal control of disease activity. Objective: To study whether a measurement feedback system is effective in reducing disease activity in patients with RA. Methods: Forty eight rheumatologists and 264 patients participated in a controlled clinical trial. A three month control period was followed by a 12 month period, where feedback on disease activity, disability, and damage was provided to the rheumatologist. The primary outcome measure was the rheumatoid arthritis disease activity index (RADAI). Results: The feedback system was used for 142/228 (62%) patients. Disease modifying antirheumatic drug changes occurred in 69/169 (41%) patients. In patients with high disease activity and feedback use (n=70), the RADAI decreased in the feedback period by –0.27 points per 30 days (p<0.05), as compared with the control period. Patients for whom the feedback system was used had a better outcome than non-users. Conclusion: Much more training on the use of a feedback system and outcome measures, as well as the inclusion of explicit treatment guidelines will be necessary to increase the clinical use of measurement feedback and, possibly, to reduce disease activity for a larger number of patients with RA.

Fransen, J; Stucki, G; Twisk, J; Chamot, A; Gerster, J; Langenegger, T; Seitz, M; Michel, B; m the

2003-01-01

151

Reliability and Validity of Outcome Expectancy-Related Measures in Physical Education  

ERIC Educational Resources Information Center

The purpose of this study was to examine the reliability and validity of outcome likelihood, outcome value, and outcome expectancy using data collected from students in secondary school physical education classes. Dependent measures were examined for construct, concurrent, and predictive validity, as well as internal and temporal reliability. The…

Gao, Zan; Liu, Yuanlong; Lodewyk, Ken; Zhang, Tao; Kosma, Maria

2011-01-01

152

Development of a preliminary diabetes dietary satisfaction and outcomes measure for patients with type 2 diabetes  

Microsoft Academic Search

Adopting dietary lifestyle changes for diabetes management is often difficult for patients; yet the health-related quality of life (HRQOL) outcomes of dietary management for the patient are not extensively developed in the HRQOL assessments now widely used in diabetes research. This study developed a preliminary instrument, the diabetes dietary satisfaction and outcomes measure, to assess outcomes of individuals' experiences in

S. S. Ahlgren; J. A. Shultz; L. K. Massey; B. C. Hicks; C. Wysham

2004-01-01

153

Transforming Course Evaluations into a Meaningful Measure of Student Outcomes Achievement  

ERIC Educational Resources Information Center

|Over the past few years, the author had the good fortune to engage many faculty and administrators in conversations about student outcomes assessment. The author has discovered that many faculty and administrators associate course valuations with student outcomes assessment measures. He also found that no items about student learning outcomes are…

McCullough, Christopher A.

2008-01-01

154

Measuring outcomes in primary care: a patient generated measure, MYMOP, compared with the SF-36 health survey.  

PubMed Central

OBJECTIVE--To assess the sensitivity to within person change over time of an outcome measure for practitioners in primary care that is applicable to a wide range of illness. DESIGN--Comparison of a new patient generated instrument, the measure yourself medical outcome profile (MYMOP), with the SF-36 health profile and a five point change score; all scales were completed during the consultation with' practitioners and repeated after four weeks. 103 patients were followed up for 16 weeks and their results charted; seven practitioners were interviewed. SETTING--Established practice of the four NHS general practitioners and four of the private complementary practitioners working in one medical centre. SUBJECTS--Systematic sample of 218 patients from general practice and all 47 patients of complementary practitioners; patients had had symptoms for more than seven days. OUTCOME MEASURES--Standardised response mean and index of responsiveness; view of practitioners. RESULTS--The index of responsiveness, relating to the minimal clinically important difference, was high for MYMOP: 1.4 for the first symptom, 1.33 for activity, and 0.85 for the profile compared with < 0.45 for SF-36. MYMOP's validity was supported by significant correlation between the change score and the change in the MYMOP score and the ability of this instrument to detect more improvement in acute than in chronic conditions. Practitioners found that MYMOP was practical and applicable to all patients with symptoms and that its use increased their awareness of patients' priorities. CONCLUSION--MYMOP shows promise as an outcome measure for primary care and for complementary treatment. It is more sensitive to change than the SF-36 and has the added bonus of improving patient-practitioner communication.

Paterson, C.

1996-01-01

155

Monthly results of measurements: November 1998.  

National Technical Information Service (NTIS)

This report of the O.P.R.I. (Office of Protection against Ionizing Radiations) exposes the principal results concerning the routine monitoring of environmental radioactivity in France: atmospheric dusts, rainwater, surface water, underground water, sewage...

1998-01-01

156

Monthly Results of Measurements, May 1987.  

National Technical Information Service (NTIS)

This report of the SCPRI exposes an interpretation of the principal results concerning the routine monitoring of environmental radioactivity in France: atmospheric dusts, rainwater, surface waters, underground water, drinking water, sewage water, food cha...

1987-01-01

157

Monthly Results of Measurements April 1987.  

National Technical Information Service (NTIS)

This report of the SCPRI exposes an interpretation of the principal results concerning the routine monitoring of environmental radioactivity in France: atmospheric dusts, rainwater, surface water, underground water, sewage water, drinking water, food chai...

1987-01-01

158

A primer on lower extremity outcome measurement instruments.  

PubMed Central

Tracing the roots of lower extremity outcome scales is an interesting and somewhat bemusing journey. A large number of different grading methods can be found with limited reliability and/or validity testing. The usefulness of these instruments in the assessment of patient outcomes after lower extremity interventions is worrisome. This article focuses on the most commonly used scales and demonstrates an alarming and incestuous pattern of cross-validation with moderate to weak associations between potentially unreliable and crudely validated original instruments.

Saltzman, C. L.; Mueller, C.; Zwior-Maron, K.; Hoffman, R. D.

1998-01-01

159

Therapy outcome measures for allied health practitioners in Australia: the AusTOMs  

Microsoft Academic Search

Objective. The aim of this study was to develop a valid and reliable measure of therapy outcome for three allied health profes- sions in Australia: speech pathology, occupational therapy, and physiotherapy. The Australian Therapy Outcome Measures (AusTOMs) enable measurement of the differences in client profiles and patterns of services provision across health care settings. In this paper we describe phase

ALISON PERRY; MEG MORRIS; CAROLYN UNSWORTH; STEPHEN DUCKETT; JEMMA SKEAT; KAREN DODD; NICHOLAS TAYLOR; KAREN REILLY

2004-01-01

160

Predicting treatment-outcome in cocaine dependence from admission urine drug screen and peripheral serotonergic measures  

Microsoft Academic Search

We investigated whether urine drug screens (UDS) at admission and platelet paroxetine binding, a measure of serotonin transporter sites, were related to outcome measures for cocaine patients in treatment. Tritiated paroxetine binding sites on platelets were assayed and UDS were obtained for 105 African American cocaine-dependent outpatients. Outcome measures included number of negative urines, days in treatment, dropouts, and number

Ashwin A Patkar; Charles C Thornton; Wade H Berrettini; Edward Gottheil; Stephen P Weinstein; Kevin P Hill

2002-01-01

161

Evaluation of the CORE outcome measure in a therapeutic forensic setting  

Microsoft Academic Search

This study seeks to establish whether the published test characteristics of the CORE (Clinical Outcomes in Routine Evaluation Measure) outcome measure can be reproduced in a therapeutic forensic setting. The measure has been designed to address the needs of psychological therapy services for clinical, audit and management feedback regardless of the clinical setting, mode of therapy, or specific problems (clinical

Helena McCloskey

2001-01-01

162

Issues in the definition and measurement of drinking outcomes in alcoholism treatment research.  

PubMed

This article reviews methodological and conceptual issues regarding the choice of drinking outcome measures in alcoholism treatment research. The following issues are discussed: Should drinking outcomes be conceptualized in terms of an underlying unitary disorder, or should provision be made for independent outcomes that cover a wide variety of dimensions? Which drinking outcomes are typically measured in treatment evaluation studies and how are they operationalized? What are the empirical associations among drinking outcome measures? If multiple outcomes are measured, which should be given primary importance? Over what period of time should treatment outcome be evaluated? What procedures can be used to detect, correct or prevent the response bias associated with verbal report methods? Because outcome measures need to fit the hypotheses and practical needs of a particular study, it is unlikely that complete standardization can be achieved across all studies. Nevertheless, given the importance of drinking outcomes and the need for economy, two primary dependent measures are recommended: (1) proportion of available drinking days abstinent; and (2) intensity of drinking, as defined by the total amount consumed (in ounces absolute alcohol) during the follow-up period divided by the number of actual drinking days. This article also proposes a strategy that may help to guide the selection of outcome measures in future research. PMID:7722986

Babor, T F; Longabaugh, R; Zweben, A; Fuller, R K; Stout, R L; Anton, R F; Randall, C L

1994-12-01

163

Use of Outcome Measures in Managing Neck Pain: An International Multidisciplinary Survey  

PubMed Central

Purpose: To determine the outcome measures practice patterns in the neck pain management of various health disciplines. Methods: A survey of 381 clinicians treating patients with neck pain was conducted. Results: Respondents were more commonly male (54%) and either chiropractors (44%) or physiotherapists (32%). The survey was international (24 countries with Canada having the largest response (44%)). The most common assessment was a single-item pain assessment (numeric or visual analog) used by 75% of respondents. Respondents sometimes or routinely used the Neck Disability Index (49%), the Patient Specific Functional Scale (28%), and the Disabilities of the Arm, Shoulder and Hand (32%). Work status was recorded in terms of time lost by more than 50% of respondents, but standardized measures of work limitations or functional capacity testing were rarely used. The majority of respondents never used fear of movement, psychological distress, quality of life, participation measures, or global ratings of change (< 10% routinely use). Use of impairment measurers was prevalent, but the type selected was variable. Quantitative sensory testing was used sometimes or routinely by 53% of respondents, whereas 26% never used it. Ratings of segmental joint mobility were commonly used to assess motion (44% routinely use), whereas 66% of respondents never used inclinometry. Neck muscle strength, postural alignment and upper extremity coordination were assessed sometimes or routinely by a majority of respondents (>56%). With the exception of numeric pain ratings and verbal reporting of work status, all outcomes measures were less frequently used by physicians. Years of practice did not affect practice patterns, but reimbursement did affect selection of some outcome measures. Conclusions: Few outcome measures are routinely used to assess patients with neck pain other than a numeric pain rating scale. A comparison of practice patterns to current evidence suggessts overutilization of some measures that have questionable reliability and underutilization of some with better supporting evidence. This practice analysis suggests that there is substantial need to implement more consistent outcome measurement in practice. International consensus and better clinical measurement evidence are needed to support this.

MacDermid, Joy C; Walton, David M; Cote, Pierre; Santaguida, P. Lina; Gross, Anita; Carlesso, Lisa

2013-01-01

164

Paraphrase procedures for assessing comprehension of health outcome measures: an illustration from schizophrenia research.  

PubMed

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

Shumway, Martha; Chouljian, Tandy L; Rozewicz, Francine

2003-03-01

165

Interpretation of Magnetotelluric Results Using Laboratory Measurements  

NASA Astrophysics Data System (ADS)

Magnetotelluric (MT) surveying is a remote sensing technique of the crust and mantle based on electrical conductivity that provides constraints to our knowledge of the structure and composition of the Earth's interior. This paper presents a review of electrical measurements in the laboratory applied to the understanding of MT profiles. In particular, the purpose of such a review is to make the laboratory technique accessible to geophysicists by pointing out the main caveats regarding a careful use of laboratory data to interpret electromagnetic profiles. First, this paper addresses the main issues of cross-spatial-scale comparisons. For brevity, these issues are restricted to reproducing in the laboratory the texture, structure of the sample as well as conditions prevailing in the Earth's interior (pressure, temperature, redox conditions, time). Second, some critical scientific questions that have motivated laboratory-based interpretation of electromagnetic profiles are presented. This section will focus on the characterization of the presence and distribution of hydrogen in the Earth's crust and mantle, the investigation of electrical anisotropy in the asthenosphere and the interpretation of highly conductive field anomalies. In a last section, the current and future challenges to improve quantitative interpretation of MT profiles are discussed. These challenges correspond to technical improvements in the laboratory and the field as well as the integration of other disciplines, such as petrology, rheology and seismology.

Pommier, Anne

2013-04-01

166

Costs of asthma in Italy: results of the SIRIO (Social Impact of Respiratory Integrated Outcomes) study.  

PubMed

Bronchial asthma is a costly disease and the correlated social impact is ever increasing. The aim of the Social Impact of Respiratory Integrated Outcomes (SIRIO) study was to measure the health resources consumption and the costs generated in 1 year by asthmatic patients investigated in a real-life setting. This bottom-up, observational, prospective, multicentric study was based on the collection of demographic, clinical, diagnostic, therapeutic and outcome data of 577 patients with bronchial asthma who reported spontaneously to the pneumology centers involved in the study. Of these, 485 patients (300 f, mean age 49.2 years+/-16.3 S.D.) were eligible for analysis. At the baseline visit, the asthma severity was as follows: 26.2% intermittent, 37.1% mild persistent, 29.5% moderate, and 6.6% severe. In the 12 months prior to enrollment, 243 patients (50.1%) had visited the general practitioner (GP); 349 (72%) consulted a National Health Service (NHS) specialist; 68 (14%) utilized Emergency Care; and 50 (10.3%) had been admitted to hospital on account of asthma, with a total of 2059 work days lost. At the end of the 1-year survey, asthma severity changed as follows: 32.8% intermittent, 38.1% mild persistent, 23.7% moderate, and 4.3% severe, with a substantial drop in corresponding outcomes: 39.6% visited their GP, 51.5% visited an NHS specialist, 5.2% used Emergency Care, and 4.3% were admitted to hospital. Compared to baseline, the total average cost per patient decreased globally by 17.9% (p<0.001) after the 1-year survey. In conclusion, during the study period we observed a significant decline in health resources consumption and thus in asthma cost of illness, even though specific costs for the pharmaceutical treatment of asthma increased substantially. These results are likely due to a more strict control of patients and to their more appropriate clinical management. PMID:17822890

Dal Negro, R W; Micheletto, C; Tosatto, R; Dionisi, M; Turco, P; Donner, C F

2007-09-05

167

Exploring Outcome Measures for Exercise Intervention in People with Parkinson's Disease  

PubMed Central

Background. It is widely believed that exercise improves mobility in people with Parkinson's disease (PD). However, it is difficult to determine whether a specific type of exercise is the most effective. The purpose of this study was to determine which outcome measures were sensitive to exercise intervention and to explore the effects of two different exercise programs for improving mobility in patients with PD. Methods. Participants were randomized into either the Agility Boot Camp (ABC) or treadmill training; 4x/week for 4 weeks. Outcome measures were grouped by the International Classification of Function/Disability (ICF). To determine the responsiveness to exercise, we calculated the standardized response means. t-tests were used to compare the relative benefits of each exercise program. Results. Four of five variables at the structure/function level changed after exercise: turn duration (P = 0.03), stride velocity (P = 0.001), peak arm speed (P = 0.001), and horizontal trunk ROM during gait (P = 0.02). Most measures improved similarly for both interventions. The only variable that detected a difference between groups was postural sway in ABC group (F = 4.95; P = 0.03). Conclusion. Outcome measures at ICF body structure/function level were most effective at detecting change after exercise and revealing differences in improvement between interventions.

King, L. A.; Salarian, A.; Mancini, M.; Priest, K. C.; Nutt, J.; Serdar, A.; Wilhelm, J.; Schlimgen, J.; Smith, M.; Horak, F. B.

2013-01-01

168

Physician empathy: Definition, outcome-relevance and its measurement in patient care and medical education  

PubMed Central

Objective: The present study gives a brief introduction into the definition of physician empathy (PE) and its influence on patients’ health outcomes. Furthermore we present assessment instruments to measure PE from the perspective of the patient and medical student. The latter topic will be explored in detail as we conducted a pilot study on the German versions of two self-assessment instruments of empathy, which are mostly used in medical education research, namely the “Jefferson Scale of Physician Empathy, Student Version” (JSPE-S) and the “Interpersonal Reactivity Index” (IRI). Methods: We first present an overview of the current empirical and theoretical literature on the definition and outcome-relevance of PE. Additionally, we conducted basic psychometric analyses of the German versions of the JSPE-S and the IRI. Data for this analyses is based on a cross-sectional pilot-survey in N=44 medical students and N=63 students of other disciplines from the University of Cologne. Results: PE includes the understanding of the patient as well as verbal and non-verbal communication, which should result in a helpful therapeutic action of the physician. Patients’ health outcomes in different healthcare settings can be improved considerably from a high quality empathic encounter with their clinician. Basic psychometric results of the German JSPE-S and IRI measures show first promising results. Conclusion: PE as an essential and outcome-relevant element in the patient-physician relationship requires more consideration in the education of medical students and, thus, in medical education research. The German versions of the JSPE-S and IRI measures seem to be promising means to evaluate these education aims and to conduct medical education research on empathy.

Neumann, Melanie; Scheffer, Christian; Tauschel, Diethard; Lutz, Gabriele; Wirtz, Markus; Edelhauser, Friedrich

2012-01-01

169

CHoice of Outcome In Cbt for psychosEs (CHOICE): the development of a new service user-led outcome measure of CBT for psychosis.  

PubMed

Outcome measures for cognitive behavior therapy for psychosis (CBTp) have been derived from pharmacological studies, focusing on symptom change rather than outcomes such as distress or fulfillment. This study presents the development and psychometric properties of a new outcome measure (CHoice of Outcome In Cbt for psychosEs [CHOICE]), which reflects more strongly the aims of CBTp and the priorities of service users. Service users who had received CBTp participated in focus groups to discuss their outcome priorities, using a topic guide generated by a panel of experts in CBTp. A qualitative thematic analysis was undertaken to reach consensus on themes and generate items. Response scales were constructed for 3 dimensions: severity, satisfaction, and importance. The resulting questionnaire was piloted with service users who had not received CBTp, stratified by service type, ethnicity, and first language to ensure that it was user friendly and applicable prior to CBTp. The psychometric properties of the measure were then examined in a sample of 152 service users. Twenty-four items, and 2 of the dimensions (severity and satisfaction), were retained in the final measure. A factor analysis revealed a single psychological recovery factor interspersed throughout with both CBTp and recovery items. Test-retest reliability, construct validity, and sensitivity to change following CBTp were confirmed. The CHOICE measure is unique in being the first psychometrically adequate service user-led outcome measure of CBTp. It provides the opportunity to examine the evidence base for CBTp with an assessment approach that prioritizes service user definitions of recovery and CBT aims. PMID:19880823

Greenwood, Kathryn E; Sweeney, Angela; Williams, Sally; Garety, Philippa; Kuipers, Elizabeth; Scott, Jan; Peters, Emmanuelle

2009-10-30

170

Molecular Imaging Research in the Outcomes Era: Measuring Outcomes for Individualized Cancer Therapy  

Microsoft Academic Search

Summary Advances in molecular imaging, combined with the goal of personalized cancer therapy, call for new approaches to clinical study design for trials testing imaging to guide therapy. The role of cancer imaging must expand and move beyond tumor detection and localization to incorporate quantitative evaluation of regional tumor phenotype. Imaging study design and outcome analysis must move beyond metrics

David A. Mankoff; Finbarr O' Sullivan; William E Barlow; Kenneth A Krohn

2007-01-01

171

26 CFR 801.6 - Business results measures.  

Code of Federal Regulations, 2013 CFR

...2013-04-01 false Business results measures. 801.6 Section 801.6 Internal...SERVICE § 801.6 Business results measures. (a) In general. The business results measures will consist of numerical scores...

2013-04-01

172

Research Paper: Communication Outcomes of Critical Imaging Results in a Computerized Notification System  

Microsoft Academic Search

ObjectiveCommunication of abnormal test results in the outpatient setting is prone to error. Using information technology can improve communication and improve patient safety. We standardized processes and procedures in a computerized test result notification system and examined their effectiveness to reduce errors in communication of abnormal imaging results.DesignWe prospectively analyzed outcomes of computerized notification of abnormal test results (alerts) that

Hardeep Singh; Harvinder S. Arora; Meena S. Vij; Raghuram Rao; Myrna M. Khan; Laura A. Petersen

2007-01-01

173

Development of a New Patient-Reported Outcome Measure for Breast Surgery: The BREAST-Q  

Microsoft Academic Search

Background: Measuring patient-reported outcomes has become increasingly important in cosmetic and reconstructive breast surgery. The objective of this study was to develop a new patient-reported outcome measure to assess the unique outcomes of breast surgery patients. Methods: Patientinterviews,focusgroups,expertpanels,andaliteraturereview were used to develop a conceptual framework and a list of questionnaire items. Three procedure-specific questionnaires (augmentation, reduction, and recon- struction) were

Andrea L. Pusic; Anne F. Klassen; Amie M. Scott; Jennifer A. Klok; Peter G. Cordeiro; Stefan J. Cano

2009-01-01

174

Possible clinical outcome measures for clinical trials in patients with multiple sclerosis  

PubMed Central

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease with both clinical and pathological heterogeneity. The complexity of the MS population has offered challenges to the measurement of MS disease progression in therapeutic trials. The current standard clinical outcome measures are relapse rate, Expanded Disability Severity Scale (EDSS), and the MS Functional Composite (MSFC). These measures each have strengths and some weakness. Two additional measures, the six-minute walk and accelerometry, show promise in augmenting current measures. MS therapeutics is a quickly advancing field which requires sensitive clinical outcome measures that can detect small changes in disability that reliably reflect long-term changes in sustained disease progression in a complex population. A single clinical outcome measure of sustained disease progression may remain elusive. Rather, an integration of current and new outcome measures may be most appropriate and utilization of different measures depending on the MS population and stage of the disease may be preferred.

Goldman, Myla D.; Motl, Robert W.; Rudick, Richard A.

2010-01-01

175

Optimizing healthcare at the population level: results of the improving cardiovascular outcomes in Nova Scotia partnership.  

PubMed

Disease management is increasingly considered a valid strategy in the chronic care of our aging patient populations with multiple diseases. The Improving Cardiovascular Outcomes in Nova Scotia (ICONS) project examined whether a community-oriented health management partnership would lead to enhanced care and improved outcomes across an entire healthcare system. ICONS was a prospective cohort study, with baseline and repeated measurements of care and outcomes fed back to all project partners, along with other interventions aimed at optimizing care; preceding interval cohorts served as controls to post-intervention cohorts. The setting was the province of Nova Scotia, whose population is approximately 950,000. All 34,060 consecutive adult patients hospitalized in Nova Scotia with acute myocardial infarction (AMI), unstable angina (UA) or congestive heart failure (CHF) October 1997-March 2002 were included. Interventions were a combination of serial audits and feedbacks of practices and outcomes, web-based publication of findings, newsletter-based education and reminders, physician small-group workshops, pharmacy monitoring and compliance programs, care maps, algorithms, discharge forms and patient information cards. Rates of use of evidence-based marker therapies were the primary outcome measure. Secondary measures included one-year, all-cause mortality and re-hospitalization. Evidence-based prescription practices, for all target diseases, continuously and markedly improved over time. At the population level, there were no changes in one-year mortality for any disease state, although use of proven therapies predicted survival at the individual level throughout the five-year period for all disease states. Rates of re-hospitalization decreased significantly for all disease states over the course of ICONS; but most traditional positive and negative predictors of this outcome, like advanced age and use of proven therapies, respectively, were not predictive. ICONS demonstrated that provider prescribing patterns and patient re-hospitalization rates were continuously improved in three disease states and across an entire health system, through a community partnership model of disease management that was sustained over a long time. Further studies are needed to better understand the drivers and modifiers of patient outcomes at the population level. PMID:18362518

Cox, Jafna; Johnstone, David; Nemis-White, Joanna; Montague, Terrence

2008-01-01

176

Measuring intranodal pressure and lymph viscosity to elucidate mechanisms of arthritic flare and therapeutic outcomes  

PubMed Central

Rheumatoid arthritis (RA) is a chronic autoimmune disease with episodic flares in affected joints, whose etiology is largely unknown. Recent studies in mice demonstrated alterations in lymphatics from affected joints precede flares. Thus, we aimed to develop novel methods for measuring lymph node pressure and lymph viscosity in limbs of mice. Pressure measurements were performed by inserting a glass micropipette connected to a pressure transducer into popliteal lymph nodes (PLN) or axillary lymph nodes (ALN) of mice and determined that the lymphatic pressures were 9 and 12 cm of water, respectively. We are also developing methods for measuring lymph viscosity in lymphatic vessels afferent to PLN, which can be measured by multi-photon fluorescence recovery after photobleaching (MP-FRAP) of FITC-BSA injected into the hind footpad. These results demonstrate the potential of lymph node pressure and lymph viscosity measurements, and warrant future studies to test these outcomes as biomarkers of arthritic flare.

Bouta, Echoe M.; Wood, Ronald W.; Perry, Seth W.; Brown, Edward; Ritchlin, Christopher T.; Xing, Lianping; Schwarz, Edward M.

2012-01-01

177

Standardizing the definition and measurement of catheter-related infection in home care: a proposed outcome measurement system.  

PubMed

The growth of home health care has not been met with an equal level of clinical outcome data to objectively evaluate the quality and cost effectiveness of care provided in that sector. In response, outcome based initiatives have been introduced to address this issue. However, none have adequately addressed the incidence and impact of catheter-related infection (CRI) in the home due to the complexities of measurement in this environment. An outcomes-oriented process to standardize the definition, measurement and reporting of CRI has been developed that addresses the realities of home care in order to foster continued outcomes research and standardized comparisons between providers. PMID:10554735

Zimay, D L

1999-06-01

178

Directly measured secondhand smoke exposure and COPD health outcomes  

Microsoft Academic Search

BACKGROUND: Although personal cigarette smoking is the most important cause and modulator of chronic obstructive pulmonary disease (COPD), secondhand smoke (SHS) exposure could influence the course of the disease. Despite the importance of this question, the impact of SHS exposure on COPD health outcomes remains unknown. METHODS: We used data from two waves of a population-based multiwave U.S. cohort study

Mark D Eisner; John Balmes; Edward H Yelin; Patricia P Katz; S Katherine Hammond; Neal Benowitz; Paul D Blanc

2006-01-01

179

Self-reported Instrument for Measuring Student Learning Outcomes  

Microsoft Academic Search

Project PROCEED is dedicated towards providing more hands-on and project-centered classroom learning opportunities in the mechanical engineering department at The University of Texas at Austin. One of the challenges of PROCEED is assessing its impact on student learning. We have been developing and piloting an instrument for assessing how well these PROCEED courses are satisfying the departmental student learning outcomes.

Theresa L. Jones

180

Development of a Scale to measure outcome expectancy in alcoholics  

Microsoft Academic Search

Self-efficacy theory postulates that altering expectation of personal mastery is the major cognitive process involved in behavior change. Two classes of expectancy are discussed: (a) efficacy expectancy: the belief or confidence one has in being able to successfully perform a specific behavior, and (b) outcome expectancy: the belief one has about the consequences that will follow successful performance. Application of

Karen E. Solomon; Helen M. Annis

1989-01-01

181

ABNORMAL UTERINE BLEEDING: A REVIEW OF PATIENT-BASED OUTCOME MEASURES  

PubMed Central

Objectives: To summarize and evaluate the patient-based outcome measures (PBOMs) that have been used to study women with abnormal uterine bleeding (AUB) Design: Systematic review Setting: Original articles that used at least one PBOM and were conducted within a population of women with AUB Patients: Women with AUB Interventions: The titles, abstracts, and studies were systematically reviewed for eligibility. PBOMs used in eligible studies were summarized. Essential psychometric properties were identified and a list of criteria for each property was generated. Main Outcome Measures: “Quality” of individual PBOMs as determined using the listed criteria for psychometric properties. Results: Nine hundred eighty three studies referenced AUB and patient reported outcomes. Of these, eighty studies met the eligibility criteria. Fifty different instruments were used to evaluate amount of bleeding, bleeding related symptoms, or menstrual bleeding-specific quality of life. The “quality” of each of these instruments was evaluated on eight psychometric properties. The majority of instruments had no documentation of reliability, precision, or feasibility. There was not satisfactory evidence that any one instrument completely addressed all eight psychometric properties. Conclusions: Studies of women with AUB are increasingly utilizing PBOMs. Many different PBOMs were used; however no single instrument completely addressed eight important measurement properties

Matteson, Kristen A.; Boardman, Lori A.; Munro, Malcolm G.; Clark, Melissa A.

2009-01-01

182

Outcome measures: evolution in clinical trials of neurological/functional recovery in spinal cord injury.  

PubMed

The need to determine the beneficial effect of the treatment of spinal cord injury (SCI) requires clearly defined standardized measures of the severity of injury and how well the function is restored. Improved neurological recovery should be linked to increased capacity to perform tasks such as walking, reaching and grasping, which results in meaningful gains in mobility and self-care. Measurements of recovery, capacity, mobility and self-care are the outcomes used to determine the benefits from the treatment and have evolved over the last century with contributions by the mentors and protégés of Sir Ludwig Guttmann, whom we honor today. Randomized clinical trials in the past 20 years have taught us many lessons as to which outcome measures have the greatest validity and reliability. The International Standards for Neurological Classification of SCI have become the clinical gold standard for measurement of severity, but would benefit from pathophysiological surrogates to better understand the mechanisms of recovery. Measurements of walking capacity have emerged as valid/reliable/responsive and upper extremity measures are in development, which help distinguish neurological improvement from rehabilitation adaptation. Performance of self-care and mobility has been linked to capacity and severity outcomes. In addition, new partnerships between clinical trial entities, professional societies, industry and federal agencies should facilitate identification of priorities and uniformity of measurement standards. Our ultimate goal is to improve the quality of life of those individuals with SCI whom we serve, but we must focus our investigative efforts carefully, systematically and rigorously as clinical scientists. PMID:20125111

Ditunno, J F

2010-02-02

183

Standardized routine outcome measurement: Pot holes in the road to recovery  

Microsoft Academic Search

Routine 'outcome measurement' is currently being introduced across Australian mental health services. This paper asserts that routine standardized outcome measurement in its current form can only provide a crude and narrow lens through which to witness recovery. It has only a limited capacity to capture the richness of people's recovery journeys or provide information that can usefully inform care. Indeed,

Richard Lakeman

2004-01-01

184

The Impact of a "Healthy Youth" Learning Community on Student Learning Outcome Measures  

ERIC Educational Resources Information Center

|Learning communities are becoming increasingly popular in the quest for enhancing student learning. The purpose of this study is to examine the impact of the "Healthy Youth" Learning Community on student learning outcome measures. In this study, the authors compared student learning outcome measures of students enrolled in those sections of HED…

Butler, Karen L.; Dawkins, Phyllis Worthy

2008-01-01

185

Theoretical framework and methodological development of common subjective health outcome measures in osteoarthritis: a critical review  

Microsoft Academic Search

Subjective measures involving clinician ratings or patient self-assessments have become recognised as an important tool for the assessment of health outcome. The value of a health outcome measure is usually assessed by a psychometric evaluation of its reliability, validity and responsiveness. However, psychometric testing involves an accumulation of evidence and has recognised limitations. It has been suggested that an evaluation

Beth Pollard; Marie Johnston; Diane Dixon

2007-01-01

186

Working Memory and the Observed Effectiveness of Recasts on Different L2 Outcome Measures  

ERIC Educational Resources Information Center

This study examined whether the observed effectiveness of recasts is influenced by the type of outcome measure used and whether different aspects of working memory are differentially associated with learners' performance on the various outcome measures. The participants were 90 learners of English as a foreign language, who were randomly assigned…

Revesz, Andrea

2012-01-01

187

Neonatal ultrasound results following very preterm birth predict adolescent behavioral and cognitive outcome.  

PubMed

This study investigated the association between different neonatal ultrasonographic classifications and adolescent cognitive, educational, and behavioral outcomes following very preterm birth. Participants included a group of 120 adolescents who were born very preterm (<33 weeks of gestation), subdivided into three groups according to their neonatal cerebral ultrasound (US) classifications: (a) normal (N = 69), (b) periventricular hemorrhage (PVH, N = 37), and (c) PVH with ventricular dilatation (PVH + DIL, N = 14), and 50 controls. The cognitive functions assessed were full-scale IQ, phonological and semantic verbal fluency, and visual-motor integration. Educational outcomes included reading and spelling; behavioral outcomes were assessed with the Rutter Parents' Scale and the Premorbid Adjustment Scale (PAS). Adolescent outcome scores were compared among the four groups. A main effect for group was observed for full-scale IQ, Rutter Parents' Scale total scores, and PAS total scores, after controlling for gestational age, socioeconomic status and gender, with the PVH + DIL group showing the most impaired scores compared to the other groups. The current results demonstrate that routine neonatal ultrasound classifications are associated with later cognitive and behavioral outcome. Neonatal ultrasounds could aid in the identification of subgroups of children who are at increased risk of neurodevelopmental problems. These at risk subgroups could then be referred to appropriate early intervention services. PMID:21253994

Nosarti, C; Walshe, M; Rushe, T M; Rifkin, L; Wyatt, J; Murray, R M; Allin, M P

2011-01-01

188

Influences, usage, and outcomes of Internet health information searching: Multivariate results from the Pew surveys  

Microsoft Academic Search

Summary This paper provides results from seven major nationally representative datasets (two in detail) from the Pew Internet and American Life Project to answer two primary questions: (1) what influences people to seek online health informa- tion and (2) what influences their perceived outcomes from having access to this information? Cross-tabulations, logistic regressions, and multidimensional scaling are applied to these

Ronald E. Rice

2006-01-01

189

Chemical Dependency Treatment Outcomes of Residents in Anesthesiology: Results of a Survey  

Microsoft Academic Search

Substance abuse is a potentially lethal occupational hazard confronting anesthesiology residents. We present the results of a survey sent to all United States anesthesiology training programs regarding experi- ence with and outcomes of chemically dependent resi- dents from 1991 to 2001. The response rate was 66%. Eighty percent reported experience with impaired resi- dents and 19% reported at least one

Gregory B. Collins; Mark S. McAllister; Mark Jensen; Timothy A. Gooden

2005-01-01

190

An outcome-based learning model to identify emerging threats : experimental and simulation results.  

SciTech Connect

The authors present experimental and simulation results of an outcome-based learning model as it applies to the identification of emerging threats. This model integrates judgment, decision making, and learning theories to provide an integrated framework for the behavioral study of emerging threats.

Martinez-Moyano, I. J.; Conrad, S. H.; Andersen, D. F.; Decision and Information Sciences; SNL; Univ. at Albany

2007-01-01

191

Clinical Outcome Assessment (COA): Frequently Asked ...  

Center for Drug Evaluation (CDER)

... measures, clinician-reported outcome (ClinRO) measures, observer-reported outcome (ObsRO) measures, and performance outcome measures. ... More results from www.fda.gov/drugs/developmentapprovalprocess/drugdevelopmenttoolsqualificationprogram

192

MEASURING THE RELATIONSHIP BETWEEN COSTS AND OUTCOMES: THE EXAMPLE OF ACUTE MYOCARDIAL INFARCTION IN GERMAN HOSPITALS.  

PubMed

In this paper, we propose a methodological approach to measure the relationship between hospital costs and health outcomes. We propose to investigate the relationship for each condition or disease area by using patient-level data. We examine health outcomes as a function of costs and other patient-level variables by using the following: (1) two-stage residual inclusion with Murphy-Topel adjustment to address costs being endogenous to health outcomes, (2) random-effects models in both stages to correct for correlation between observation, and (3) Cox proportional hazard models in the second stage to ensure that the available information is exploited. To demonstrate its application, data on mortality following hospital treatment for acute myocardial infarction (AMI) from a large German sickness fund were used. Provider reimbursement was used as a proxy for treatment costs. We relied on the Ontario Acute Myocardial Infarction Mortality Prediction Rules as a disease-specific risk-adjustment instrument. A total of 12,284 patients with treatment for AMI in 2004-2006 were included. The results showed a reduction in hospital costs by €100 to increase the hazard of dying, that is, mortality, by 0.43%. The negative association between costs and mortality confirms that decreased resource input leads to worse outcomes for treatment after AMI. Copyright © 2013 John Wiley & Sons, Ltd. PMID:23696223

Stargardt, Tom; Schreyögg, Jonas; Kondofersky, Ivan

2013-05-21

193

Review of patient-reported outcome measures in chronic hepatitis C  

PubMed Central

Background Chronic hepatitis C (CHC) and its treatment are associated with a variety of patient-reported symptoms and impacts. Some CHC symptoms and impacts may be difficult to evaluate through objective clinical testing, and more easily measured through patient self-report. This literature review identified concepts raised by CHC patients related to symptoms, impacts, and treatment effects, and evaluated integration of these concepts within patient-reported outcome (PRO) measures. The goal of this work was to provide recommendations for incorporation of PRO measurement of concepts that are relevant to the CHC experience into CHC clinical trial design. Methods A three-tiered literature search was conducted. This included searches on concepts of importance, PRO measures used in clinical trials, and existing PRO measures. The PRO Concept Search focused on reviewing issues raised by CHC patients about CHC symptoms, disease impact, and treatment effects. The CHC Trials with PRO Endpoints Search reviewed clinical trials with PRO endpoints to assess differences between treatments over time. The PRO Measure Search reviewed existing PRO measures associated with the concepts of interest. Results This multi-tiered approach identified five key concepts of interest: depression/anxiety, fatigue, flu-like symptoms, cognitive function, insomnia. Comparing these five concepts of interest to the PRO measures in published CHC clinical trials showed that, while treatment of CHC may decrease health-related quality of life in a number of mental and physical domains, the PRO measures that were utilized in published clinical trials inadequately covered the concepts of interest. Further review of 18 existing PRO measures of the concepts of interest showed only four of the 18 were validated in CHC populations. Conclusions This review identified several gaps in the literature regarding assessment of symptoms and outcomes reported as important by CHC patients. Further research is needed to ensure that CHC clinical trials evaluate concepts that are important to patients and include measures that have evidence supporting content validity, reliability, construct validity, and responsiveness.

2012-01-01

194

Comparison of ASSESS neutralization module results with actual small force engagement outcomes  

SciTech Connect

The ASSESS Neutralization module (Neutralization) is part of the Analytic System and Software for Evaluation of Safeguards and Security (ASSESS), a vulnerability assessment tool. Neutralization models a fire fight between security inspectors (SIs) and adversaries. This paper reports that a comparison has been made between actual outcomes of police and small military engagements and the results predicted by the Neutralization module for similar scenarios. The results of this comparison show a surprising correlation between predicted outcomes (based on numbers of combatants, weapon types, and exposures, etc.) and the actual outcomes of the engagements analyzed. The importance of this analysis is that given the defenders have intelligence on actual adversary characteristics or are protecting against a design basis threat, defense capabilities can be evaluated before an engagement. Results could then be used to develop a favorable probability of a desired outcome. For example, law enforcement agencies are frequently able to compile the number of criminals, types of weaponry, willingness to use force, etc., from analysis of crime scenes.

Gardner, B.H.; Snell, M.K.; Paulus, W.K. (Sandia National Labs., Albuquerque, NM (United States))

1991-01-01

195

Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study.  

PubMed Central

OBJECTIVE: To monitor pregnancies in women with pre-existent insulin dependent diabetes for pregnancy loss, congenital malformations, and fetal growth in a geographically defined area of north west England. DESIGN: Population cohort study. SETTING: 10 maternity units in Cheshire, Lancashire, and Merseyside which had no regional guidelines for the management of pregnancy in diabetic women. SUBJECTS: 462 pregnancies in 355 women with insulin dependent diabetes from the 10 centres over five years (1990-4 inclusive). MAIN OUTCOME MEASURES: Numbers and rates of miscarriages, stillbirths, and neonatal and postneonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age. RESULTS: Among 462 pregnancies, 351 (76%) resulted in a liveborn infant, 78 (17%) aborted spontaneously, nine (2%) resulted in stillbirth, and 24 (5%) were terminated. Of the terminations, nine were for congenital malformation. The stillbirth rate was 25.0/1000 total births (95% confidence interval 8.9 to 41.1) compared with a population rate of 5.0/1000, and infant mortality was 19.9/1000 live births (5.3 to 34.6) compared with 6.8/1000. The prevalence of congenital malformations was 94.0/1000 live births (63.5 to 124.5) compared with 9.7/1000 in the general population. When corrected for gestational age, mean birth weight in the sample was 1.3 standard deviations greater than that of infants of non-diabetic mothers. Infants with congenital malformations weighed less than those without. CONCLUSION: In an unselected population the infants of women with pre-existent insulin dependent diabetes mellitus have a 10-fold greater risk of a congenital malformation and a fivefold greater risk of being stillborn than infants in the general population. Further improvements in the management of pregnancy in diabetic women are needed if target of the St Vincent declaration of 1989 is to be met.

Casson, I. F.; Clarke, C. A.; Howard, C. V.; McKendrick, O.; Pennycook, S.; Pharoah, P. O.; Platt, M. J.; Stanisstreet, M.; van Velszen, D.; Walkinshaw, S.

1997-01-01

196

Recommendations for the Use of Common Outcome Measures in Pediatric Traumatic Brain Injury Research  

PubMed Central

Abstract This article addresses the need for age-relevant outcome measures for traumatic brain injury (TBI) research and summarizes the recommendations by the inter-agency Pediatric TBI Outcomes Workgroup. The Pediatric Workgroup's recommendations address primary clinical research objectives including characterizing course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements (CDE) Workgroups, the Pediatric TBI Outcomes Workgroup adopted the standard three-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in pediatric TBI from each identified domain including academics, adaptive and daily living skills, family and environment, global outcome, health-related quality of life, infant and toddler measures, language and communication, neuropsychological impairment, physical functioning, psychiatric and psychological functioning, recovery of consciousness, social role participation and social competence, social cognition, and TBI-related symptoms. In the second tier, supplemental measures were recommended for consideration in TBI research focusing on specific topics or populations. In the third tier, emerging measures included important instruments currently under development, in the process of validation, or nearing the point of published findings that have significant potential to be superior to measures in the core and supplemental lists and may eventually replace them as evidence for their utility emerges.

Wilde, Elisabeth A.; Anderson, Vicki A.; Bedell, Gary; Beers, Sue R.; Campbell, Thomas F.; Chapman, Sandra B.; Ewing-Cobbs, Linda; Gerring, Joan P.; Gioia, Gerard A.; Levin, Harvey S.; Michaud, Linda J.; Prasad, Mary R.; Swaine, Bonnie R.; Turkstra, Lyn S.; Wade, Shari L.; Yeates, Keith O.

2012-01-01

197

Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomised controlled trial.  

PubMed

The international randomised targeted intraoperative radiotherapy (TARGIT) trial has demonstrated evidence of non-inferiority between the novel technique of TARGIT (intra-operative radiotherapy with Intrabeam(®)) and conventional external beam radiotherapy (EBRT) in women with early breast cancer in terms of the primary outcome measure of risk of local relapse within the treated breast. Cosmesis is an increasingly important outcome of breast conserving treatment with both surgery and radiotherapy contributing to this. It was unknown if the single high dose of TARGIT may lead to damaging fibrosis and thus impair cosmesis further, so we objectively evaluated the aesthetic outcome of patients within the TARGIT randomised controlled trial. We have used an objective assessment tool for evaluation of cosmetic outcome. Frontal digital photographs were taken at baseline (before TARGIT or EBRT) and yearly thereafter for up to 5 years. The photographs were analysed by BCCT.core, a validated software which produces a composite score based on symmetry, colour and scar. 342 patients were assessed, median age at baseline 64 years (IQR 59-68). The scores were dichotomised into Excellent and Good (EG), and Fair and Poor (FP). There were statistically significant increases in the odds of having an outcome of EG for patients in the TARGIT group relative to the EBRT group at year 1 (OR 2.07, 95 % CI 1.12-3.85, p = 0.021) and year 2 (OR 2.11, 95 % CI 1.0-4.45, p = 0.05). Following a totally objective assessment in a randomised setting, the aesthetic outcome of patients demonstrates that those treated with TARGIT have a superior cosmetic result to those patients who received conventional external beam radiotherapy. PMID:23877341

Keshtgar, Mohammed R S; Williams, Norman R; Bulsara, Max; Saunders, Christobel; Flyger, Henrik; Cardoso, Jaime S; Corica, Tammy; Bentzon, Neils; Michalopoulos, Nikolaos V; Joseph, David J

2013-07-23

198

Patient perspective of measuring treatment efficacy: the Rheumatoid Arthritis Patient Priorities for Pharmacological Interventions (RAPP-PI) outcomes  

PubMed Central

Background Collaboration with patients with rheumatoid arthritis (RA) highlights that outcomes important to them include fatigue, coping and life enjoyment. However, these are not commonly measured in clinical trials. There is little evidence about which outcomes patients would prioritise, nor what factors influence patients’ prioritisation. Objective To develop a complementary core set with patients to promote inclusion of their priority outcomes in pharmacological interventions. Methods Nominal groups were conducted with RA patients to rank 63 outcomes generated from previous in-depth interviews. A multi-centre postal survey provided the final selection of core outcomes for the RAPP-PI, in which RA patients rated the importance of the priority outcomes from the nominal groups and ranked the top 6. Results 26 patients participated in 5 nominal group discussions, and reduced the 63 initial outcomes to 32 most important. 254 participants in the survey ranked priority treatment outcomes to form the RAPP-PI: pain, activities of daily living, joint damage, mobility, life enjoyment, independence, fatigue, and valued activities. The 8 priorities represent three domains of treatment outcomes: direct impact of RA, psychosocial well-being, and function/participation. Chi-squared tests showed that disease severity, disease duration, gender and patients’ perceptions of managing, self-efficacy and normality influenced the selection of priority treatment outcomes. Conclusion Collaboration with patients has captured their perspective of priority outcomes from pharmacological interventions. Whilst there is some overlap with professional core outcomes, the additional use of this complementary set will give a broader evaluation of effectiveness of interventions from the key stakeholders: patients.

Sanderson, T; Morris, M; Calnan, M; Richards, P; Hewlett, S

2010-01-01

199

In vivo electrical conductivity measurements during and after tumor electroporation: conductivity changes reflect the treatment outcome  

NASA Astrophysics Data System (ADS)

Electroporation is the phenomenon in which cell membrane permeability is increased by exposing the cell to short high-electric-field pulses. Reversible electroporation treatments are used in vivo for gene therapy and drug therapy while irreversible electroporation is used for tissue ablation. Tissue conductivity changes induced by electroporation could provide real-time feedback of the treatment outcome. Here we describe the results from a study in which fibrosarcomas (n = 39) inoculated in mice were treated according to different electroporation protocols, some of them known to cause irreversible damage. Conductivity was measured before, within the pulses, in between the pulses and for up to 30 min after treatment. Conductivity increased pulse after pulse. Depending on the applied electroporation protocol, the conductivity increase after treatment ranged from 10% to 180%. The most significant conclusion from this study is the fact that post-treatment conductivity seems to be correlated with treatment outcome in terms of reversibility.

Ivorra, Antoni; Al-Sakere, Bassim; Rubinsky, Boris; Mir, Lluis M.

2009-10-01

200

Measurement of Harm Outcomes in Older Adults after Hospital Discharge: Reliability and Validity  

PubMed Central

Objectives. Defining and validating a measure of safety contributes to further validation of clinical measures. The objective was to define and examine the psychometric properties of the outcome “incidents of harm.” Methods. The Incident of Harm Caregiver Questionnaire was administered to caregivers of older adults discharged from hospital by telephone. Caregivers completed daily logs for one month and medical charts were examined. Results. Test-retest reliability (n = 38) was high for the occurrence of an incident of harm (yes/no; kappa = 1.0) and the type of incident (agreement = 100%). Validation against daily logs found no disagreement regarding occurrence or types of incidents. Validation with medical charts found no disagreement regarding incident occurrence and disagreement in half regarding incident type. Discussion. The data support the Incident of Harm Caregiver Questionnaire as a reliable and valid estimation of incidents for this sample and are important to researchers as a method to measure safety when validating clinical measures.

Douglas, Alison; Letts, Lori; Eva, Kevin; Richardson, Julie

2012-01-01

201

Do intervention fidelity and dose influence outcomes? Results from the move to improve worksite physical activity program.  

PubMed

The purpose of this paper is to evaluate the implementation of the Move to Improve worksite physical activity program using a four step framework that includes the following: (i) defining the active ingredients, (ii) using good methods to measure implementation, (iii) monitoring implementation and (iv) relating implementation to outcomes. The intervention active ingredients consisted of a goal setting behavior change program, a team competition and environmental supports. Intervention fidelity and dose were measured by surveys administered to site co-ordinators, team captains and employees. Implementation was monitored by the use of biweekly assessments that tracked individual physical activity levels and through weekly reports of the project director and site co-ordinators. Latent growth modeling was conducted to determine whether intervention outcomes were affected by site implementation (i.e. fidelity) and/or participation by employees (i.e. dose). Results showed high levels of intervention fidelity, moderate to high levels of intervention dose delivered and moderate levels of the intervention dose received. Level of implementation affected the degree of change in vigorous physical activity (Mean = 5.4 versus 2.2; chi(2) = 4.9, df = 1), otherwise outcome measures were unaffected by fidelity and dose. These findings suggest that practitioners should focus more energy assuring that the core components are fully implemented and be less concerned about the level of participation. PMID:19168573

Wilson, Mark G; Basta, Tania B; Bynum, Bethany H; DeJoy, David M; Vandenberg, Robert J; Dishman, Rod K

2009-01-23

202

The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS?  

PubMed Central

OBJECTIVE--To assess the validity, reliability, and acceptability of the short form 36 (SF 36) health survey questionnaire (a shortened version of a battery of 149 health status questions) as a measure of patient outcome in a broad sample of patients suffering from four common clinical conditions. DESIGN--Postal questionnaire, followed up by two reminders at two week intervals. SETTING--Clinics and four training practices in north east Scotland. SUBJECTS--Over 1700 patients aged 16-86 with one of four conditions--low back pain, menorrhagia, suspected peptic ulcer, or varicose veins--and a comparison sample of 900 members of the general population. MAIN OUTCOME MEASURES--The eight scales within the SF36 health profile. RESULTS--The response rate exceeded 75% in the patient population (1310 respondents). The SF36 satisfied rigorous psychometric criteria for validity and internal consistency. Clinical validity was shown by the distinctive profiles generated for each condition, each of which differed from that in the general population in a predictable manner. Furthermore, SF36 scores were lower in referred patients than in patients not referred and were closely related to general practitioners' perceptions of severity. CONCLUSIONS--These results provide support for the SF36 as a potential measure of patient outcome within the NHS. The SF36 seems acceptable to patients, internally consistent, and a valid measure of the health status of a wide range of patients. Before it can be used in the new health service, however, its sensitivity to changes in health status over time must also be tested.

Garratt, A M; Ruta, D A; Abdalla, M I; Buckingham, J K; Russell, I T

1993-01-01

203

Early Oxygenation and Ventilation Measurements After Pediatric Cardiac Arrest: Lack of Association With Outcome  

PubMed Central

Objectives To explore oxygenation and ventilation status early after cardiac arrest in infants and children. We hypothesize that hyperoxia is common and associated with worse outcome after pediatric cardiac arrest. Design Retrospective cohort study. Setting Fifteen hospitals within the Pediatric Emergency Care Applied Research Network. Patients Children who suffered a cardiac arrest event and survived for at least 6 hours after return of circulation. Interventions None. Measurements and Main Results Analysis of 195 events revealed that abnormalities in oxygenation and ventilation are common during the initial 6 hours after pediatric cardiac arrest. Hyperoxia was frequent, affecting 54% of patients. Normoxia was documented in 34% and hypoxia in 22% of patients. These percentages account for a 10% overlap of patients who had both hyperoxia and hypoxia. Ventilation status was more evenly distributed with hyperventilation observed in 38%, normoventilation in 29%, and hypoventilation in 46%, with a 13% overlap of patients who had both hyperventilation and hypoventilation. Derangements in both oxygenation and ventilation were common early after cardiac arrest such that both normoxia and normocarbia were documented in only 25 patients (13%). Neither oxygenation nor ventilation status was associated with outcome. After controlling for potential confounders, arrest location and rhythm were significantly associated with worse outcome; however, hyperoxia was not (odds ratio for good outcome, 1.02 [0.46, 2.84]; p = 0.96). Conclusions Despite recent resuscitation guidelines that advocate maintenance of normoxia and normoventilation after pediatric cardiac arrest, this is uncommonly achieved in practice. Although we did not demonstrate an association between hyperoxia and worse outcome, the small proportion of patients kept within normal ranges limited our power. Preclinical data suggesting potential harm with hyperoxia remain compelling, and further investigation, including prospective, large studies involving robust recording of physiological derangements, is necessary to further advance our understanding of this important topic.

Bennett, Kimberly Statler; Clark, Amy E.; Meert, Kathleen L.; Topjian, Alexis A.; Schleien, Charles L.; Shaffner, Donald H.; Dean, J. Michael; Moler, Frank W.

2013-01-01

204

A Healthy Bottom Line: Healthy Life Expectancy as an Outcome Measure for Health Improvement Efforts  

PubMed Central

Context: Good health is the most important outcome of health care, and healthy life expectancy (HLE), an intuitive and meaningful summary measure combining the length and quality of life, has become a standard in the world for measuring population health. Methods: This article critically reviews the literature and practices around the world for measuring and improving HLE and synthesizes that information as a basis for recommendations for the adoption and adaptation of HLE as an outcome measure in the United States. Findings: This article makes the case for adoption of HLE as an outcome measure at the national, state, community, and health care system levels in the United States to compare the effectiveness of alternative practices, evaluate disparities, and guide resource allocation. Conclusions: HLE is a clear, consistent, and important population health outcome measure that can enable informed judgments about value for investments in health care.

Stiefel, Matthew C; Perla, Rocco J; Zell, Bonnie L

2010-01-01

205

Functional status in limb deficiency: Development of an outcome measure for preschool children  

Microsoft Academic Search

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

1998-01-01

206

Measuring communicative participation using the FOCUS©1: Focus on the Outcomes of Communication Under Six  

PubMed Central

Background The FOCUS© is a new outcome tool for use by both parents and clinicians that measures changes in the communicative participation skills of preschool children. Changes in communicative participation skills as measured by the FOCUS were compared across three groups of children: those with speech impairments only (SI), those with language impairments only (LI) and those with both speech and language impairments (S/LI). Methods Participating families (n = 112, 75 male children) were recruited through 13 Canadian organizations. Children ranged from 10 months to 6 years 0 months (mean = 2.11 years; SD = 1.18 years) and attended speech-language intervention. Parents completed the FOCUS at the start and end of treatment. There were 23 children in the SI group, 62 children in the LI group and 27 children in the S/LI group. The average amount of the children's therapy varied from 7 to 10 h. Results The FOCUS captures changes in communicative participation for children with a range of communication disorder types and severities. All three groups of children made clinically important improvements according to their FOCUS scores (MCID ? 16 points). The FOCUS captured improvements in intelligibility, independent communication, play and socialization. Conclusions The FOCUS measured positive changes in communicative participation skills for all three groups of children after 7–10 h of speech-language therapy. An outcome measure that targets only specific speech and language skills would miss many of the important social function changes associated with speech-language treatment.

Thomas-Stonell, N; Washington, K; Oddson, B; Robertson, B; Rosenbaum, P

2013-01-01

207

Effect of anxiety on treatment presentation and outcome: Results from the Marijuana Treatment Project  

PubMed Central

Despite emerging evidence of the efficacy of psychotherapies for marijuana dependence, variability in outcome exists. This study examined the role of anxiety on treatment involvement and outcome. Four questions were examined: (1) is greater anxiety associated with greater impairment at baseline; (2) is baseline anxiety related to greater marijuana use and problems following treatment; (3) does adding cognitive-behavioral therapy (CBT) to motivation enhancement therapy (MET) reduce anxiety relative to MET alone; (4) are reductions in anxiety associated with better outcomes. The sample was comprised of 450 marijuana dependent patients in the Marijuana Treatment Project. Marijuana use and anxiety were measured at pretreatment and 4- and 9-month follow-ups. At baseline, anxiety was linked to more marijuana-related problems. CBT was associated with less anxiety at follow-up compared to MET alone. Reductions in anxiety were related to less marijuana use. In fact, reduction in anxiety from baseline to 4-month follow-up was associated with less marijuana use at 9-months, but reduction in marijuana use did not predict subsequent anxiety. Data suggest anxiety is an important variable that deserves further attention in marijuana dependence treatment.

Buckner, Julia D.; Carroll, Kathleen M.

2009-01-01

208

Longitudinal Prediction of Child Outcomes from Differing Measures of Parenting in a Low-Income Sample  

ERIC Educational Resources Information Center

This study examined predictions from preschool parenting measures to middle childhood cognitive and socioemotional child outcomes to explore whether parenting assessment methodologies that require more time, training, and expense yield better predictions of child outcomes than less intensive methodologies. Mother-child dyads (N=278) in low-income…

Zaslow, Martha J.; Weinfield, Nancy S.; Gallagher, Megan; Hair, Elizabeth C.; Ogawa, John R.; Egeland, Byron; Tabors, Patton O.; De Temple, Jeanne M.

2006-01-01

209

Measuring neurodevelopmental outcome in neonatal trials: a continuing and increasing challenge.  

PubMed

The need for outcome evaluations as part of clinical trials has never been greater. In this paper, issues around the design and data collection of such outcome evaluations are discussed in relation to how they may be best collected and the options available. There is a need for organisation of such evaluations and consistency of measures between trials to optimise efficiency. PMID:23839983

Marlow, Neil

2013-07-09

210

Measuring Outcomes in Alzheimer's Disease Research: Assessment of the Effectiveness of Interventions  

Microsoft Academic Search

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

Stacey Wood; Jeffrey L. Cummings

1999-01-01

211

Microdiscectomy compared with standard discectomy: an old problem revisited with new outcome measures within the framework of a spine surgical registry  

Microsoft Academic Search

Studies comparing the relative merits of microdiscectomy and standard discectomy report conflicting results, depending on\\u000a the outcome measure of interest. Most trials are small, and few have employed validated, multidimensional patient-orientated\\u000a outcome measures, considered essential in outcomes research. In the present study, data were collected prospectively from\\u000a six surgeons participating in a surgical registry. Inclusion criteria were: lumbar\\/lumbosacral degenerative disease;

F. Porchet; V. Bartanusz; F. S. Kleinstueck; F. Lattig; D. Jeszenszky; D. Grob; A. F. Mannion

2009-01-01

212

Measuring Quality of Life and Patient Satisfaction After Body Contouring: A Systematic Review of Patient-Reported Outcome Measures  

Microsoft Academic Search

Evidence-Based Background: In both cosmetic and postbariatric body contouring populations, the primary determinants of success are patient satisfaction and quality of life (QOL). These patient-reported outcomes (PRO) are ideally measured with specially-designed, procedure- or condition-specific questionnaires.Objective: The authors identify and appraise all patient-reported outcome (PRO) measures (questionnaires) developed for patients undergoing body contouring surgery.Methods: MEDLINE, EMBASE, PsychINFO, Ebase, CINAHL, HAPI,

Patrick L. Reavey; Anne F. Klassen; Stefan J. Cano; Colleen McCarthy; Amie Scott; J. Peter Rubin; Michele Shermak; Andrea L. Pusic

2011-01-01

213

A 'learning platform' approach to outcome measurement in fragile X syndrome: a preliminary psychometric study  

PubMed Central

Background Clinical trials of medications to alleviate the cognitive and behavioural symptoms of individuals with fragile X syndrome (FXS) are now underway. However, there are few reliable, valid and/or sensitive outcome measures available that can be directly administered to individuals with FXS. The majority of assessments employed in clinical trials may be suboptimal for individuals with intellectual disability (ID) because they require face-to-face interaction with an examiner, taxing administration periods, and do not provide reinforcement and/or feedback during the test. We therefore examined the psychometric properties of a new computerised ‘learning platform’ approach to outcome measurement in FXS. Method A brief computerised test, incorporated into the Discrete Trial Trainer© – a commercially available software program designed for children with ID – was administered to 13 girls with FXS, 12 boys with FXS and 15 matched ID controls aged 10 to 23 years (mental age = 4 to 12 years). The software delivered automated contingent access to reinforcement, feedback, token delivery and prompting procedures (if necessary) on each trial to facilitate responding. The primary outcome measure was the participant’s learning rate, derived from the participant’s cumulative record of correct responses. Results All participants were able to complete the test and floor effects appeared to be minimal. Learning rates averaged approximately five correct responses per minute, ranging from one to eight correct responses per minute in each group. Test–retest reliability of the learning rates was 0.77 for girls with FXS, 0.90 for boys with FXS and 0.90 for matched ID controls. Concurrent validity with raw scores obtained on the Arithmetic subtest of the Wechsler Intelligence Scale for Children-III was 0.35 for girls with FXS, 0.80 for boys with FXS and 0.56 for matched ID controls. The learning rates were also highly sensitive to change, with effect sizes of 1.21, 0.89 and 1.47 in each group respectively following 15 to 20, 15-min sessions of intensive discrete trial training conducted over 1.5 days. Conclusions These results suggest that a learning platform approach to outcome measurement could provide investigators with a reliable, valid and highly sensitive measure to evaluate treatment efficacy, not only for individuals with FXS but also for individuals with other ID.

Hall, S. S.; Hammond, J. L.; Hirt, M.; Reiss, A. L.

2012-01-01

214

Achievements in mental health outcome measurement in Australia: Reflections on progress made by the Australian Mental Health Outcomes and Classification Network (AMHOCN)  

PubMed Central

Background Australia’s National Mental Health Strategy has emphasised the quality, effectiveness and efficiency of services, and has promoted the collection of outcomes and casemix data as a means of monitoring these. All public sector mental health services across Australia now routinely report outcomes and casemix data. Since late-2003, the Australian Mental Health Outcomes and Classification Network (AMHOCN) has received, processed, analysed and reported on outcome data at a national level, and played a training and service development role. This paper documents the history of AMHOCN’s activities and achievements, with a view to providing lessons for others embarking on similar exercises. Method We conducted a desktop review of relevant documents to summarise the history of AMHOCN. Results AMHOCN has operated within a framework that has provided an overarching structure to guide its activities but has been flexible enough to allow it to respond to changing priorities. With no precedents to draw upon, it has undertaken activities in an iterative fashion with an element of ‘trial and error’. It has taken a multi-pronged approach to ensuring that data are of high quality: developing innovative technical solutions; fostering ‘information literacy’; maximising the clinical utility of data at a local level; and producing reports that are meaningful to a range of audiences. Conclusion AMHOCN’s efforts have contributed to routine outcome measurement gaining a firm foothold in Australia’s public sector mental health services.

2012-01-01

215

Family Adherence as a Predictor of Child Outcome in an Intervention for Pediatric Obesity: Different Outcomes for Self-Report and Objective Measures  

Microsoft Academic Search

This study examined the relations between specific adherence variables and child outcomes among a sample of 60 families participating in a family-based pediatric obesity program. Adherence was measured using both objective and self-report methods. Family adherence to the treatment protocol significantly predicted child outcomes. However, parent self-report measures of adherence were better predictors of child outcome than objective measures. The

Michael M. Steele; Ric G. Steele; Heather L. Hunter

2009-01-01

216

Measuring Quality of Care for Vulnerable Children: Challenges and Conceptualization of a Pediatric Outcome Measure of Quality  

Microsoft Academic Search

This article addresses conceptual and practical issues in the assessment of pediatric health care quality, outlines a conceptual model for measuring quality, and describes on-going research to validate an outcome measure of health care quality for vulnerable children. Pediatric quality measurement is distinct from that for adults due to development, dependence, differential epidemiology, demographic factors, and differences between the child

Michael Seid; James W. Varni; Paul S. Kurtin

2000-01-01

217

Timing and directions for administration of questionnaires affect outcomes measurement.  

PubMed

We used data from two pilot studies to compare the change in patients' self-reported health-related quality of life after participation in two nearly identical Department of Veterans Affairs (VA) Blind Rehabilitation Center (BRC) programs, the Southwestern BRC in Tucson, Arizona, and the BRC at the VA hospital in Hines, Illinois. Researchers at the Southwestern BRC administered the National Eye Institute Visual Functioning Questionnaire as directed by the developer. Researchers at the Hines BRC modified the directions to consider use of low-vision devices. Interval person-ability and item-difficulty measures estimated from patient responses pre- and postrehabilitation were compared with these same measures obtained at follow-up. At the Southwestern BRC, no change was reported in either person or item measures 3 months after rehabilitation. At the Hines BRC, improvement was seen in both the person and item measures when measurements were made immediately following rehabilitation. Because a temporary halo effect may explain the higher ratings at discharge, veterans from the Hines cohort were contacted by telephone and administered the same instrument 3 years later. For these subjects, the improvement noted in the person measure disappeared at follow-up, while the improvement in the item measure was maintained. PMID:17310429

Stelmack, Joan A; Babcock-Parziale, Judith L; Head, Daniel N; Wolfe, Gregory S; Fakhoury, Nader E; Wu, Shelley M; Massof, Robert W

218

Instructional technology and the measurement of learing outcomes: Some questions  

Microsoft Academic Search

Measures which assess student achievement in terms of a criterion standard provide information as to the degree of competence attained by a particular student which is independent of reference to the performance of others.\\

Robert Glaser

1963-01-01

219

Measuring the effects of conservation program special services: Client education, fuel assistance, and other indirect outcomes  

SciTech Connect

Conservation program special services are program components that have been designed into the package of program services. As a result, a quantifiable measure of the effectiveness of these services on program goals and objectives is difficult to obtain. Methods that have been designed to control for confounding effects of intercorrelated program services are usually inadequate. For instance, effective education is multi-faceted; the most desirable characteristics of education cannot be separated from one another and individually assessed. Many special services like client education and non-energy impacts (e.g., fuel assistance, quality control of weatherization work, weatherization activity that improves comfort, etc.) are receiving increasing attention from policy-makers. Not only is energy savings an important measure of program success, but indirect outcomes like the benefits of client education, reductions in average and absolute customer delinquent accounts, improvements in comfort, and the affordability, quality, and longevity of housing are also important measures of a program's success in delivering services to the community. In this paper the author will examine the potential effects of client education, fuel assistance, and other indirect outcomes of residential energy conservation programs. 39 refs., 2 figs., 3 tabs.

White, D.L.

1991-01-01

220

Outcome Classification of Preschool Children With Autism Spectrum Disorders Using MRI Brain Measures  

Microsoft Academic Search

ObjectiveTo test the hypothesis that a combination of magnetic resonance imaging (MRI) brain measures obtained during early childhood distinguish children with autism spectrum disorders (ASD) from typically developing children and is associated with functional outcome.

Natacha Akshoomoff; Catherine Lord; Alan J. Lincoln; Rachel Y. Courchesne; Ruth A. Carper; Jeanne Townsend; Eric Courchesne

2004-01-01

221

Measurable Outcomes of Workforce Development and the Economic Impact of Attending a North Carolina Community College.  

ERIC Educational Resources Information Center

|Examines North Carolina's measurable outcomes of workforce development and the economic impact of attending a community college in the state. Focuses on the performance reporting system and includes a discussion about using the data to inform policy. (VWC)|

Gracie, Larry W.

1998-01-01

222

Measurable Outcomes of Workforce Development and the Economic Impact of Attending a North Carolina Community College.  

ERIC Educational Resources Information Center

Examines North Carolina's measurable outcomes of workforce development and the economic impact of attending a community college in the state. Focuses on the performance reporting system and includes a discussion about using the data to inform policy. (VWC)

Gracie, Larry W.

1998-01-01

223

Infant-parent attachment: Definition, types, antecedents, measurement and outcome  

PubMed Central

Attachment theory is one of the most popular and empirically grounded theories relating to parenting. The purpose of the present article is to review some pertinent aspects of attachment theory and findings from attachment research. Attachment is one specific aspect of the relationship between a child and a parent with its purpose being to make a child safe, secure and protected. Attachment is distinguished from other aspects of parenting, such as disciplining, entertaining and teaching. Common misconceptions about what attachment is and what it is not are discussed. The distinction between attachment and bonding is provided. The recognized method to assess infant-parent attachment, the Strange Situation procedure, is described. In addition, a description is provided for the four major types of infant-parent attachment, ie, secure, insecure-avoidant, insecure-resistant and insecure-disorganized. The antecedents and consequences of each of the four types of infant-parent attachment are discussed. A special emphasis is placed on the description of disorganized attachment because of its association with significant emotional and behavioural problems, and poor social and emotional outcomes in high-risk groups and in the majority of children who have disorganized attachment with their primary caregiver. Practical applications of attachment theory and research are presented.

Benoit, Diane

2004-01-01

224

The King's Outcome Scale for Childhood Head Injury and injury severity and outcome measures in children with traumatic brain injury.  

PubMed

The aim of this study was to relate discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) category to injury severity and detailed outcome measures obtained in the first year post-traumatic brain injury (TBI). We used a prospective cohort study. Eighty-one children with TBI were studied: 29 had severe, 15 moderate, and 37 mild TBI. The male:female ratio was 1.8:1. The mean age was 11 years 10 months (SD 3.6, range 5-16y). Discharge KOSCHI categories were good (n=34), moderate (n=39), severe (n=6), and unclassifiable (n=2). KOSCHI category correlated strongly with admission Glasgow Coma Score, length of hospital stay, and post-traumatic amnesia. It also correlated significantly with Verbal IQ and Performance IQ (Wechsler); measures of attention; health status (Health Utilities Index [HUI]); health-related quality of life (Pediatric Quality of Life Inventory [PedsQL]); depressive symptoms (Birleson Depression Scale) assessed within 3 months postTBI; and with Verbal IQ, selective attention (map mission), and HUI and PedsQL domains assessed at least 6 months post-TBI discharge. KOSCHI did not correlate with behaviour or executive function. We conclude that the KOSCHI scored at hospital discharge correlates with severity of injury and some cognitive, health status, and HRQL outcomes early after TBI. It is not helpful at predicting later difficulties, or behavioural and emotional problems. PMID:18422680

Calvert, Sophie; Miller, Helen E; Curran, Andrew; Hameed, Biju; McCarter, Renée; Edwards, Richard J; Hunt, Linda; Sharples, Peta Mary

2008-04-14

225

PRION-1 scales analysis supports use of functional outcome measures in prion disease  

PubMed Central

Objectives: Human prion diseases are heterogeneous but invariably fatal neurodegenerative disorders with no known effective therapy. PRION-1, the largest clinical trial in prion disease to date, showed no effect of the potential therapeutic quinacrine on survival. Although there are several limitations to the usefulness of survival as an outcome measure, there have been no comprehensive studies of alternatives. Methods: To address this we did comparative analyses of neurocognitive, psychiatric, global, clinician-rated, and functional scales, focusing on validity, variability, and impact on statistical power over 77 person-years follow-up in 101 symptomatic patients in PRION-1. Results: Quinacrine had no demonstrable benefit on any of the 8 scales (p > 0.4). All scales had substantial numbers of patients with the worst possible score at enrollment (Glasgow Coma Scale score being least affected) and were impacted by missing data due to disease progression. These effects were more significant for cognitive/psychiatric scales than global, clinician-rated, or functional scales. The Barthel and Clinical Dementia Rating scales were the most valid and powerful in simulated clinical trials of an effective therapeutic. A combination of selected subcomponents from these 2 scales gave somewhat increased power, compared to use of survival, to detect clinically relevant effects in future clinical trials of feasible size. Conclusions: Our findings have implications for the choice of primary outcome measure in prion disease clinical trials. Prion disease presents the unusual opportunity to follow patients with a neurodegenerative disease through their entire clinical course, and this provides insights relevant to designing outcome measures in related conditions.

Mead, S.; Ranopa, M.; Gopalakrishnan, G.S.; Thompson, A.G.B.; Rudge, P.; Wroe, S.; Kennedy, A.; Hudson, F.; MacKay, A.; Darbyshire, J.H.; Walker, A.S.

2011-01-01

226

Item Response Theory and Computerized Adaptive Testing: Implications for Outcomes Measurement in Rehabilitation  

Microsoft Academic Search

Objective: To evaluate computerized adaptive testing (CAT) measures of rehabilitation outcomes.\\u000aStudy Design: Physical functioning questions were calibrated via item response theory (IRT) and administered with CAT software.\\u000aSubjects: 485 adults interviewed during postacute care rehabilitation (simulation study) and 26 adults who completed CAT and personal interviews (CAT pilot study).\\u000aMain Outcome Measures: Patient acceptance and respondent burden, reliability, and

Ware John E. Jr; Barbara Gandek; Samuel J. Sinclair; Jakob B. Bjorner

2005-01-01

227

Measuring program performance in methadone treatment using in-treatment outcomes: An illustration  

Microsoft Academic Search

Quality measurement and quality assurance in substance abuse treatment have, over the past few years, become a major policy\\u000a issue. In addition, there is interest in the degree to which client outcomes can play a role in measuring treatment program\\u000a performance. This article discusses the movement toward outcome-based performance measureemnt in substance abuse treatment.\\u000a Examples of the products that such

Charles D. Phillips; Robert L. Hubbard; George Dunteman; Douglas L. Fountain; Dorynne Czechowicz; James R. Cooper

1995-01-01

228

Psychometric Evaluation of Health-Related Work Outcome Measures For Musculoskeletal Disorders: A Systematic Review  

Microsoft Academic Search

Introduction: This systematic review evaluated the quality of psychometric properties of self-report health-related work outcome measures\\u000a for patients with musculoskeletal disorders. Methods: Electronic searches of MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between 1980\\u000a and December 2006 were conducted for peer-reviewed studies that evaluated self-report work outcome measures for patients with\\u000a musculoskeletal disorders. The eligibility

Renee M. Williams; Gloria Schmuck; Shannon Allwood; Matthew Sanchez; Ryan Shea; Glenn Wark

2007-01-01

229

A European consensus on outcome measures for psychosocial intervention research in dementia care  

Microsoft Academic Search

Psychosocial intervention makes a vital contribution to dementia care. However, the lack of consensus about which outcome measures to use to evaluate effectiveness prevents meaningful comparisons between different studies and interventions. This study used an iterative collaborative, evidence-based approach to identify the best of currently available outcome measures for European psychosocial intervention research. This included consensus workshops, a web-based pan-European

E. Moniz-Cook; M. J. F. J. Vernooy-Dassen; R. Woods; F. Verhey; R. Chattat; M. DE Vugt; M. O’connell; J. Harrison; E. Vasse; R. M. Dröes

2008-01-01

230

Outcome measures in systemic sclerosis: An update on instruments and current research  

Microsoft Academic Search

Substantial progress has been made in the past 10 years in the development and validation of outcome measures and refinement\\u000a of trial methodology for systemic sclerosis (scleroderma, SSc). These advances in outcome measures have focused mostly on\\u000a specific organ systems involved in SSc. Many of these new tools have been validated and subsequently adapted for use in multicenter\\u000a clinical trials.

Dinesh Khanna; Peter A. Merkel

2007-01-01

231

Sexual health outcome measures for individuals with a spinal cord injury: a systematic review  

Microsoft Academic Search

Study Design:A systematic review of all sexual health outcome measures reporting psychometric properties for a spinal cord injury (SCI) population.Objectives:To evaluate the psychometric evidence for sexual health outcome measures used in a SCI population in order to (1) determine the clinical relevance of current tools and (2) suggest recommendations for future tool development.Setting:Vancouver, British Columbia, Canada.Methods:Electronic databases were searched for

C E Abramson; K E McBride; K J Konnyu; S L Elliott

2008-01-01

232

Toddlers with limb deficiency: Conceptual basis and initial application of a functional status outcome measure  

Microsoft Academic Search

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

1999-01-01

233

Patient reported outcome measures: a model-based classification system for research and clinical practice  

Microsoft Academic Search

Purpose  The umbrella term Patient Reported Outcomes (PRO) has been successfully proposed for instruments measuring perceived health\\u000a outcomes, but its relationship to current conceptual models remains to be established. Our aim was to develop a classification\\u000a system for PRO measures based on a valid conceptual model.\\u000a \\u000a \\u000a \\u000a Methods  We reviewed models and classification schemes of health outcomes and integrated them in a common

Jose M. Valderas; Jordi Alonso

2008-01-01

234

Outcome measures in chronic obstructive pulmonary disease (COPD): strengths and limitations  

PubMed Central

Current methods for assessing clinical outcomes in COPD mainly rely on physiological tests combined with the use of questionnaires. The present review considers commonly used outcome measures such as lung function, health status, exercise capacity and physical activity, dyspnoea, exacerbations, the multi-dimensional BODE score, and mortality. Based on current published data, we provide a concise overview of the principles, strengths and weaknesses, and discuss open questions related to each methodology. Reviewed is the current set of markers for measuring clinically relevant outcomes with particular emphasis on their limitations and opportunities that should be recognized when assessing and interpreting their use in clinical trials of COPD.

2010-01-01

235

Process and outcome measures using nursing sensitive indicators  

Microsoft Academic Search

Measuring the impact of high quality nursing care has become an imperative driven by several issues during the past several years. Current challenges surrounding the nursing shortage and the decreasing nursing workforce projected for the next decade alone have raised serious questions about the effect fewer registered nurses (RNs) will have on the quality of health care. In addition, heightened

Susan M Grant; Lorie Wild; Jeanne Vincent

2004-01-01

236

Chronic Obstructive Pulmonary Disease Outcome Measurements: What's Important? What's Useful?  

Microsoft Academic Search

The severity of chronic obstructive pulmonary disease (COPD) and patients' response to therapy are difficult to assess. The traditional measure, spirometry, correlates poorly with important clinical fea- tures of the disease, such as survival and quality of life (QOL). Moreover, COPD has recently been recognized as a systemic dis- ease,anditssystemicmanifestations,suchasweightlossandmuscle weakness, are only poorly related to lung function. Therefore, al-

Nicholas J. Gross

2005-01-01

237

Treatment of mental slowness: How to evaluate treatment effects. A systematic review of outcome measures  

Microsoft Academic Search

Brain-damaged patients with slow mental processes may be taught compensatory strategies that might enable them to minimise disabilities and participation problems in daily life. The effects of the application of compensatory strategies should be measured in these domains of functioning. We systematically reviewed existing outcome measures used to evaluate the consequences of mental slowness. We classified measures into four categories:

Ieke Winkens; Caroline M. Van Heugten; Luciano Fasotti; Derick T. Wade

2011-01-01

238

Approaches to risk-adjusting outcome measures applied to criminal justice involvement after community service  

Microsoft Academic Search

The ethic offairness in program evaluation requires that measures of behavioral health agency performance be sensitive to differences in those agencies' caseload composition. The authors describe two traditional approaches to the statistical risk adjustment of outcome measures (stratification weighting and pre-post measurement) that are designed to account for differences in caseload composition and introduce a method that incorporates the strengths

Steven M. Banks; John A. Pandiani; Janet Bramley

2001-01-01

239

RELATION OVER TIME BETWEEN FACIAL MEASUREMENTS AND COGNITIVE OUTCOMES IN FETAL ALCOHOL EXPOSED CHILDREN  

PubMed Central

Background The identification of individuals exposed prenatally to alcohol can be challenging, with only those having the characteristic pattern of facial features, CNS abnormality, and growth retardation receiving a clinical diagnosis of fetal alcohol syndrome (FAS). Methods 17 anthropometric measurements were obtained at 5 and 9 years from 125 Cape Town, South African children, studied since birth. The children were divided into 3 groups: FAS or partial FAS (PFAS), heavily exposed nonsyndromal (HE), and non-alcohol exposed controls (C). Anthropometric measurements were evaluated for mean group differences. Logistic regression models were used to identify the subset of anthropometric measures that best predicted group membership. Anthropometric measurements were examined at the two ages in relation to prenatal alcohol exposure obtained prospectively from the mothers during pregnancy. Correlation of these facial measurements with key neurobehavioral outcomes including WISC-IV IQ and eyeblink conditioning was used to assess their utility as indicators of alcohol-related central nervous system impairment. Results Significant group differences were found for the majority of the anthropometric measures, with means of these measures smaller in the FAS/PFAS compared with HE or C. Upper facial widths, ear length, lower facial depth, and eye widths were consistent predictors distinguishing those exposed to alcohol from those who were not. Using longitudinal data, unique measures were identified that predicted facial anomalies at one age but not the other, suggesting the face changes as the individual matures. 41% of the FAS/PFAS group met criteria for microtia at both ages. Three of the predictive anthropometric measures were negatively related to measures of prenatal alcohol consumption, and all were positively related to at least one neurobehavioral outcome. Conclusions The analysis of longitudinal data identified a common set of predictors, as well as some that are unique at each age. Prenatal alcohol exposure appears to have its primary effect on brain growth, reflected by smaller forehead widths, and may suppress neural crest migration to the branchial arches, reflected by deficits in ear length and mandibular dimensions. These results may improve diagnostic resolution and enhance our understanding of the relation between the face and the neuropsychological deficits that occur.

Foroud, Tatiana; Wetherill, Leah; Vinci-Booher, Sophia; Moore, Elizabeth S.; Ward, Richard E.; Hoyme, H. Eugene; Robinson, Luther K.; Rogers, Jeffrey; Meintjes, Ernesta M.; Molteno, Christopher D.; Jacobson, Joseph L.; Jacobson, Sandra W.

2012-01-01

240

Defining, Conceptualizing, and Measuring Fidelity of Implementation and Its Relationship to Outcomes in K-12 Curriculum Intervention Research  

ERIC Educational Resources Information Center

Education researchers are being asked to conduct rigorous, scientifically based studies of K-12 curriculum interventions; therefore, the need for measuring fidelity of implementation and empirically relating it to outcomes (the chief rationale for this review) is warranted to ensure internal and external validity. The results of this review…

O'Donnell, Carol L.

2008-01-01

241

Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance  

Microsoft Academic Search

This guidance describes how the FDA evaluates patient-reported outcome (PRO) instruments used as effectiveness endpoints in clinical trials. It also describes our current thinking on how sponsors can develop and use study results measured by PRO instruments to support claims in approved product labeling (see appendix point 1). It does not address the use of PRO instruments for purposes beyond

2006-01-01

242

Standardizing patient-reported outcomes assessment in cancer clinical trials: a patient-reported outcomes measurement information system initiative.  

PubMed

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

2007-11-10

243

Psychological ownership: theoretical extensions, measurement and relation to work outcomes  

Microsoft Academic Search

Summary Viewing psychological ownership as a positive resource for impacting human performance in organizations, the present study investigated the components of an expanded view of psychological ownership. Confirmatory factor analyses on a proposed measure of psycho- logical ownership provided support for a positively-oriented, ''promotion-focused'' aspect of psychological ownership comprised of four dimensions: self-efficacy, accountability, sense of belongingness and self-identity. In

James B. Avey; Bruce J. Avolio; Craig D. Crossley; Fred Luthans

2009-01-01

244

Harmonising Outcome Measures for Eczema (HOME). Report from the First International Consensus Meeting (HOME 1), 24 July 2010, Munich, Germany.  

PubMed

Current clinical research in eczema (atopic dermatitis) is hampered by a profusion of outcome measures, most of which have not been developed or tested adequately. The first Harmonising Outcome Measures for Eczema meeting (HOME 1) was an exploratory meeting to determine whether there was sufficient interest and enthusiasm in the international scientific community to form a collaborative group to define a minimum set of core outcomes for future eczema (atopic dermatitis) research. The meeting was open to all participants of the 6th Georg Rajka Symposium/International Symposium on Atopic Dermatitis/New Trends in Allergy VII meeting in Munich, 22-24 July 2010. Approximately 40 individuals attended. Prior to the meeting, an international Delphi exercise was performed to develop consensus-based sets of core outcome domains for eczema for 'controlled trials' and 'clinical recordkeeping'. The results of this Delphi exercise were presented at the meeting and critically discussed by the attendees. The constructive group discussion identified several important issues for future eczema outcomes research such as the degree to which patients and carers can be involved and the importance of involving colleagues from countries not represented at the meeting. In summary, this exploratory meeting indicated a genuine interest in the academic eczema community to form an international multiprofessional group dedicated to harmonizing outcomes research in eczema. The group decided to continue collaboratively with the HOME initiative. PMID:21137114

Schmitt, J; Williams, H

2010-12-01

245

The rheumatoid foot: a systematic literature review of patient-reported outcome measures  

PubMed Central

Background The foot is often the first area of the body to be systematically affected by rheumatoid arthritis. The multidimensional consequences of foot problems for patients can be subjectively evaluated using patient-reported outcome measures (PROMs). However, there is currently no systematic review which has focused specifically upon the PROMs available for the foot with rheumatoid arthritis. The aim of this systematic review was to appraise the foot-specific PROMs available for the assessment and/or evaluation of the foot affected with rheumatoid arthritis. Methods A systematic search of databases was conducted according to pre-defined inclusion/exclusion criteria. PROMs identified were reviewed in terms of: conceptual bases, quality of construction, measurement aims and evidence to support their measurement properties. Results A total of 11 PROMs were identified and 5 papers that provided evidence for the measurement properties of some of the PROMs. Only one of the PROMs was found to be RA disease-specific. The quality of construction, pretesting and presence of evidence for their measurement properties was found to be highly variable. Conceptual bases of many of the PROMs was either restricted or based on reductionist biomedical models. All of the PROMs were found to consist of fixed scales. Conclusions There is a need to develop an RA-disease and foot-specific PROM with a greater emphasis on a biopsychosocial conceptual basis, cognitive pre-testing methods, patient preference-based qualities and evidence to support the full complement of measurement properties.

2010-01-01

246

Appearance scales to measure cosmetic outcomes of healed lacerations  

Microsoft Academic Search

To develop an appearance scale that will allow the objective and scientific comparison of the cosmetic results of healed lacerations, 33 photographs of healed lacerations and incisions with variable cosmetic results were shown to four plastic surgeons. These plastic surgeons were asked to independently rate the photographs on two separate occasions using two scales, a Visual Analogue Scale and a

J. V Quinn; A. E Drzewiecki; I. G Stiell; T. J Elmslie

1995-01-01

247

Evaluating Faculty Perceptions of Student Learning Outcomes: A Rasch Measurement Analysis  

ERIC Educational Resources Information Center

Background: The importance of assessing student learning outcomes has demanded attention from most everyone involved in the higher education enterprise, as accreditation and funding implications are often linked to the results. Faculty, however, are often critical of the assessment process because outcomes assessment is costly with regard to time,…

Royal, Kenneth D.

2010-01-01

248

Evaluating Faculty Perceptions of Student Learning Outcomes: A Rasch Measurement Analysis  

ERIC Educational Resources Information Center

|Background: The importance of assessing student learning outcomes has demanded attention from most everyone involved in the higher education enterprise, as accreditation and funding implications are often linked to the results. Faculty, however, are often critical of the assessment process because outcomes assessment is costly with regard to…

Royal, Kenneth D.

2010-01-01

249

The impact of the Spine Patient Outcomes Research Trial (SPORT) results on orthopaedic practice.  

PubMed

The benefits of spinal surgery for relief of low back and leg pain in patients with degenerative spinal disorders have long been debated. The Spine Patient Outcomes Research Trial (SPORT) was designed to address the need for high-quality, prospectively collected data in support of such interventions. SPORT was intended to provide an evidential basis for spinal surgery in appropriate patients, as well as comparative and cost-effectiveness data. The trial studied the outcomes of the surgical and nonsurgical management of three conditions: intervertebral disk herniation, degenerative spondylolisthesis, and lumbar spinal stenosis. Both surgical and nonsurgical care of intervertebral disk herniation resulted in significant improvement in symptoms of low back and leg pain. Still, the treatment effect of surgery for intervertebral disk herniation was less than that seen in patients who underwent surgical versus nonsurgical treatment of degenerative spondylolisthesis and lumbar spinal stenosis. Across SPORT, more significant degrees of improvement with surgery were noted in chronic conditions of lumbar spinal stenosis and lumbar spinal stenosis with spondylolisthesis. In addition, no catastrophic progressions to neurologic deficit occurred as a result of watchful waiting. PMID:22382288

Asghar, Ferhan A; Hilibrand, Alan S

2012-03-01

250

De novo supernumerary marker chromosome originating from chromosome 17 resulting in a normal pregnancy outcome.  

PubMed

We report here a prenatal case with de novo supernumerary marker chromosome originating from chromosome 17 in non-mosaic form resulting in normal pregnancy outcome. In this case, a 26-year-old pregnant woman was referred for amniocenthesis and microdeletion Fluorescence In Situ Hybridization (FISH) testing at 18 weeks of gestation due to history of a previous child with Angelman Syndrome. PWS/AS region deletion was excluded by FISH. A de novo supernumerary, non-satellited, monocentric marker chromosome was detected during conventional cytogenetic analysis. With the use of FISH testing, it was found that the marker chromosome originated from chromosome 17. Additionally, the marker chromosome was found not to contain the Smith-Magenis and Miller Dieker syndrome regions. After detailed review of the literature, genetic counseling was given to the family, and the family decided to continue the pregnancy to term. A female child was born at term without any phenotypical abnormalities and clinical complications. Follow-up at 15 months-of-age revealed no developmental abnormalities. To our knowledge, our patient is the first reported prenatal case with a de novo monocentric, supernumerary marker chromosome derived from chromosome 17 in a non-mosaic form that resulting in normal pregnancy outcome. PMID:21614990

Yakut, S; Cetin, Z; Berker-Karauzum, S; Mihci, E; Mendilcioglu, I; Luleci, G

2011-01-01

251

Effects of high-flux hemodialysis on clinical outcomes: results of the HEMO study.  

PubMed

Among the 1846 patients in the HEMO Study, chronic high-flux dialysis did not significantly affect the primary outcome of the all-cause mortality (ACM) rate or the main secondary composite outcomes, including the rates of first cardiac hospitalization or ACM, first infectious hospitalization or ACM, first 15% decrease in serum albumin levels or ACM, or all non-vascular access-related hospitalizations. The high-flux intervention, however, seemed to be associated with reduced risks of specific cardiac-related events. The relative risks (RR) for the high-flux arm, compared with the low-flux arm, were 0.80 [95% confidence interval (CI), 0.65 to 0.99] for cardiac death and 0.87 (95% CI, 0.76 to 1.00) for the composite of first cardiac hospitalization or cardiac death. Also, the effect of high-flux dialysis on ACM seemed to vary, depending on the duration of prior dialysis. This report presents secondary analyses to further explore the relationship between the flux intervention and the duration of dialysis with respect to various outcomes. The patients were stratified into a short-duration group and a long-duration group, on the basis of the mean duration of dialysis of 3.7 yr before randomization. In the subgroup that had been on dialysis for >3.7 yr, randomization to high-flux dialysis was associated with lower risks of ACM (RR, 0.68; 95% CI, 0.53 to 0.86; P = 0.001), the composite of first albumin level decrease or ACM (RR, 0.74; 95% CI, 0.60 to 0.91; P = 0.005), and cardiac deaths (RR, 0.63; 95% CI, 0.43 to 0.92; P = 0.016), compared with low-flux dialysis. No significant differences were observed in outcomes related to infection for either duration subgroup, however, and the trends for beneficial effects of high-flux dialysis on ACM rates were considerably weakened when the years of dialysis during the follow-up phase were combined with the prestudy years of dialysis in the analysis. For the subgroup of patients with <3.7 yr of dialysis before the study, assignment to high-flux dialysis had no significant effect on any of the examined clinical outcomes. These data suggest that high-flux dialysis might have a beneficial effect on cardiac outcomes. Because these results are derived from multiple statistical comparisons, however, they must be interpreted with caution. The subgroup results that demonstrate that patients with different durations of dialysis are affected differently by high-flux dialysis are interesting and require further study for confirmation. PMID:14638924

Cheung, Alfred K; Levin, Nathan W; Greene, Tom; Agodoa, Lawrence; Bailey, James; Beck, Gerald; Clark, William; Levey, Andrew S; Leypoldt, John K; Ornt, Daniel B; Rocco, Michael V; Schulman, Gerald; Schwab, Steve; Teehan, Brendan; Eknoyan, Garabed

2003-12-01

252

The International Collaboration on Air Pollution and Pregnancy Outcomes: Initial Results  

PubMed Central

Background: The findings of prior studies of air pollution effects on adverse birth outcomes are difficult to synthesize because of differences in study design. Objectives: The International Collaboration on Air Pollution and Pregnancy Outcomes was formed to understand how differences in research methods contribute to variations in findings. We initiated a feasibility study to a) assess the ability of geographically diverse research groups to analyze their data sets using a common protocol and b) perform location-specific analyses of air pollution effects on birth weight using a standardized statistical approach. Methods: Fourteen research groups from nine countries participated. We developed a protocol to estimate odds ratios (ORs) for the association between particulate matter ? 10 ?m in aerodynamic diameter (PM10) and low birth weight (LBW) among term births, adjusted first for socioeconomic status (SES) and second for additional location-specific variables. Results: Among locations with data for the PM10 analysis, ORs estimating the relative risk of term LBW associated with a 10-?g/m3 increase in average PM10 concentration during pregnancy, adjusted for SES, ranged from 0.63 [95% confidence interval (CI), 0.30–1.35] for the Netherlands to 1.15 (95% CI, 0.61–2.18) for Vancouver, with six research groups reporting statistically significant adverse associations. We found evidence of statistically significant heterogeneity in estimated effects among locations. Conclusions: Variability in PM10–LBW relationships among study locations remained despite use of a common statistical approach. A more detailed meta-analysis and use of more complex protocols for future analysis may uncover reasons for heterogeneity across locations. However, our findings confirm the potential for a diverse group of researchers to analyze their data in a standardized way to improve understanding of air pollution effects on birth outcomes.

Rich, David Q.; Glinianaia, Svetlana V.; Leem, Jong Han; Wartenberg, Daniel; Bell, Michelle L.; Bonzini, Matteo; Brauer, Michael; Darrow, Lyndsey; Gehring, Ulrike; Gouveia, Nelson; Grillo, Paolo; Ha, Eunhee; van den Hooven, Edith H.; Jalaludin, Bin; Jesdale, Bill M.; Lepeule, Johanna; Morello-Frosch, Rachel; Morgan, Geoffrey G.; Slama, Remy; Pierik, Frank H.; Pesatori, Angela Cecilia; Sathyanarayana, Sheela; Seo, Juhee; Strickland, Matthew; Tamburic, Lillian; Woodruff, Tracey J.

2011-01-01

253

The Autism Impact Measure (AIM): Initial Development of a New Tool for Treatment Outcome Measurement.  

PubMed

The current study describes the development and psychometric properties of a new measure targeting sensitivity to change of core autism spectrum disorder (ASD) symptoms, the Autism Impact Measure (AIM). The AIM uses a 2-week recall period with items rated on two corresponding 5-point scales (frequency and impact). Psychometric properties were examined using a large sample (n = 440) of children with ASD enrolled in the Autism Treatment Network. The exploratory factor analysis indicated four factors and resulted in a 25-item questionnaire with excellent overall model fit. Test-retest reliability, cross-informant reliability, and convergent validity with other measures of ASD symptoms and overall functioning were strong. The AIM is a reliable and valid measure of frequency and impact of core ASD symptoms. PMID:23748386

Kanne, Stephen M; Mazurek, Micah O; Sikora, Darryn; Bellando, Jayne; Branum-Martin, Lee; Handen, Benjamin; Katz, Terry; Freedman, Brian; Powell, Mary Paige; Warren, Zachary

2013-06-01

254

An intervention study to reduce adverse pregnancy outcomes as a result of syphilis in Mozambique  

PubMed Central

Objectives: To create and evaluate an alternative screening approach among pregnant women in order to reduce adverse pregnancy outcome as a result of syphilis in Mozambique. Methods: Four suburban antenatal clinics, two "control" and two "intervention" clinics, were compared regarding syphilis screening and treatment. Pregnant women with positive rapid plasma reagin (RPR) test (n=929) were enrolled, 453 in the intervention and 476 in the control clinics. In control clinics the normal routine regarding syphilis screening was followed for 383 women remaining for follow up. In intervention clinics nurse midwives were trained to perform the RPR test. RPR seropositive cases were immediately treated on site by the nurse midwives and the partners were invited to come any afternoon for treatment. In the third trimester (around 30 weeks) a new RPR test was performed and all women with positive RPR test results were again treated and the partners were invited to come for treatment. Results: At delivery, the drop out rate was 15.7% in the intervention and 20.1% in the control group. The perinatal mortality was significantly higher in the control group than in the intervention group, 3.4% v 1.3% (p=0.030). At delivery the intervention group had significantly more negative RPR results—40.9% v 24.2% (p=0.000). Conclusion: More active training of nurse midwives in antenatal care to perform on site RPR tests, to give syphilis treatment, and to notify partners results in improved perinatal outcome and more seronegative parturient women. Key Words: syphilis; intervention; pregnancy; Mozambique

Osman, N; Challis, K; Folgosa, E; Cotiro, M; Bergstrom, S

2000-01-01

255

Patient-reported outcomes measurement and management with innovative methodologies and technologies  

Microsoft Academic Search

Successful integration of modern psychometrics and advanced informatics in patient-reported outcomes (PRO) measurement and\\u000a management can potentially maximize the value of health outcomes research and optimize the delivery of quality patient care.\\u000a Unlike the traditional labor-intensive paper-and-pencil data collection method, item response theory-based computerized adaptive\\u000a testing methodologies coupled with novel technologies provide an integrated environment to collect, analyze and present

Chih-Hung Chang

2007-01-01

256

Clinical predictors of dysphagia and aspiration risk: Outcome measures in acute stroke patients  

Microsoft Academic Search

Daniels SK, Ballo LA, Mahoney M-C, Foundas AL. Clinical predictors of dysphagia and aspiration risk: outcome measures in acute stroke patients. Arch Phys Med Rehabil 2000;81:1030-3. Objective: To use an established dysphagia clinical screening system to evaluate outcomes in acute stroke patients. Design: Case-control study. Setting: Tertiary care center. Participants: Acute stroke patients (n = 56) consecutively referred to a

Stephanie K. Daniels; Lindsay A. Ballo; Mary-Claudia Mahoney; Anne L. Foundas

2000-01-01

257

Guidelines and quality measures: do they improve outcomes of patients with community-acquired pneumonia?  

PubMed

Community-acquired pneumonia (CAP) has a significant impact in terms of morbidity, mortality, and cost of care. Guidelines play an important role in the management of this disease, and evidence supporting the positive effects of guidelines on outcomes in patients with CAP is substantial. However, evidence supporting many of the CAP quality indicators is low, and pay-for-performance measures do not seem to influence clinically important outcomes. Future CAP quality indicators should incorporate evidence-based interventions. PMID:23398866

Johnstone, Jennie; Mandell, Lionel

2013-03-01

258

Functional status in children with limb deficiency: Development and initial validation of an outcome measure  

Microsoft Academic Search

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:

Sheri D. Pruitt; James W. Varni; Yoshio Setoguchi

1996-01-01

259

Alcohol and Other Drug Dependence Severity Among Older Adults in Treatment: Measuring Characteristics and Outcomes  

Microsoft Academic Search

The number of older adults is increasing, yet little is known about their responses to treatment for substance dependence. While age-appropriate measures have been developed for depression and alcohol screening among older adults, severity and outcome measurement for this population has not been addressed. The purpose of the present study was (1) to add to the limited but growing literature

Valerie J. Slaymaker; Patricia Owen

2008-01-01

260

Characterization of Potential Outcome Measures for Future Clinical Trials in Fragile X Syndrome  

ERIC Educational Resources Information Center

|Clinical trials targeting recently elucidated synaptic defects in fragile X syndrome (FXS) will require outcome measures capable of assessing short-term changes in cognitive functioning. Potentially useful measures for FXS were evaluated here in a test-retest setting in males and females with FXS (N = 46). Good reproducibility, determined by an…

Berry-Kravis, Elizabeth; Sumis, Allison; Kim, Ok-Kyung; Lara, Rebecca; Wuu, Joanne

2008-01-01

261

Outcomes Measurement in Voice Disorders: Application of an Acoustic Index of Dysphonia Severity  

ERIC Educational Resources Information Center

|Purpose: The purpose of this experiment was to assess the ability of an acoustic model composed of both time-based and spectral-based measures to track change following voice disorder treatment and to serve as a possible treatment outcomes measure. Method: A weighted, four-factor acoustic algorithm consisting of shimmer, pitch sigma, the ratio of…

Awan, Shaheen N.; Roy, Nelson

2009-01-01

262

Academic library performance measures and undergraduates' library use and educational outcomes  

Microsoft Academic Search

This study investigated the relationship between an institution's academic library performance measures and undergraduates' library use and educational outcomes. The sample consisted of 7,958 undergraduates attending 36 colleges and universities representing four institutional types. Regression analyses determined the relationship between academic library performance measures and library use and self-reported gains in critical thinking while controlling for undergraduates' background characteristics and

Ethelene Whitmire

2002-01-01

263

Outcome Classification of Preschool Children with Autism Spectrum Disorders Using Mri Brain Measures.  

ERIC Educational Resources Information Center

Objective: To test the hypothesis that a combination of magnetic resonance imaging (MRI) brain measures obtained during early childhood distinguish children with autism spectrum disorders (ASD) from typically developing children and is associated with functional outcome. Method: Quantitative MRI technology was used to measure gray and white matter…

Akshoomoff, Natacha; Lord, Catherine; Lincoln, Alan J.; Courchesne, Rachel Y.; Carper, Ruth A.; Townsend, Jeanne; Courchesne, Eric

2004-01-01

264

Proposed preliminary core set measures for disease outcome assessment in adult and juvenile idiopathic inflammatory myopathies  

Microsoft Academic Search

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

2001-01-01

265

Measuring and reporting quality of life outcomes in clinical trials in cystic fibrosis: a critical review  

Microsoft Academic Search

Good quality clinical trials are essential to inform the best cystic fibrosis (CF) management and care, by determining and comparing the effectiveness of new and existing therapies and drug delivery systems. The formal inclusion of quality of life (QoL) as an outcome measure in CF clinical trials is becoming more common. Both an appropriate QoL measure and sound methodology are

Janice Abbott; Anna Hart

2005-01-01

266

Persistent organ dysfunction plus death: a novel, composite outcome measure for critical care trials  

PubMed Central

Introduction Due to resource limitations, few critical care interventions have been rigorously evaluated with adequately powered randomized clinical trials (RCTs). There is a need to improve the efficiency of RCTs in critical care so that more definitive high quality RCTs can be completed with the available resources. The objective of this study was to validate and demonstrate the utility of a novel composite outcome measure, persistent organ dysfunction (POD) plus death, for clinical trials of critically ill patients. Methods We performed a secondary analysis of a dataset from a prospective randomized trial involving 38 intensive care units (ICUs) in Canada, Europe, and the United States. We define POD as the persistence of organ dysfunction requiring supportive technologies during the convalescent phase of critical illness and it is present when a patient has an ongoing requirement for vasopressors, dialysis, or mechanical ventilation at the outcome assessments time points. In 600 patients enrolled in a randomized trial of nutrition therapy and followed prospectively for six months, we evaluated the prevalence of POD and its association with outcome. Results At 28 days, 2.3% of patients had circulatory failure, 13.7% had renal failure, 8.7% had respiratory failure, and 27.2% had died, for an overall prevalence of POD + death = 46.0%. Of survivors at Day 28, those with POD, compared to those without POD, had a higher mortality rate in the six-month follow-up period, had longer ICU and hospital stays, and a reduced quality of life at three months. Given these rates of POD + death and using a two-sided Chi-squared test at alpha = 0.05, we would require 616 patients per arm to detect a 25% relative risk reduction (RRR) in mortality, but only 286 per arm to detect the same RRR in POD + mortality. Conclusions POD + death may be a valid composite outcome measure and compared to mortality endpoints, may reduce the sample size requirements of clinical trials of critically ill patients. Further validation in larger clinical trials is required.

2011-01-01

267

Advancing Outcome Measures for the New Era of Drug Development in Cystic Fibrosis  

PubMed Central

The growing pipeline of candidate drugs for cystic fibrosis (CF) is challenging clinical trial research. There has been a shift from evaluating drugs aimed at treating the secondary manifestations of CF to evaluating drugs targeted toward the primary prevention of chronic lung disease. As CF is an orphan disease, there is a fundamental need to assess new therapies efficiently and accurately by mechanisms that best use the number of available patients. This need can be addressed with the continued advancement and refinement of CF outcome measures. We begin by presenting an overview of the outcome measures currently used in CF clinical studies, defined and categorized in terms of one of the three main classes of endpoints: clinical efficacy measures, surrogate endpoints, and biomarkers. To move forward efficiently, clinical research in CF is dependent on the development of new outcomes able to capture biologic and clinical response to novel therapeutic approaches. We conclude with a discussion of the criteria by which all new outcome measures should be evaluated. A systematic, rigorous approach to outcome measure development is needed to provide the tools necessary for evaluating new therapies and moving drugs out of the pipeline and into the CF clinic.

Mayer-Hamblett, Nicole; Ramsey, Bonnie W.; Kronmal, Richard A.

2007-01-01

268

Disability outcome measures in multiple sclerosis clinical trials: current status and future prospects.  

PubMed

Many of the available disability outcome measures used in clinical trials of multiple sclerosis are insensitive to change over time, inadequately validated, or insensitive to patient-perceived health status or quality of life. Increasing focus on therapies that slow or reverse disability progression makes it essential to refine existing measures or to develop new tools. Major changes to the expanded disability status scale should be avoided to prevent the loss of acceptance by regulators as a measure for primary outcomes in trials that provide substantial evidence of effectiveness. Rather, we recommend practical refinements. Conversely, although substantial data support the multiple sclerosis functional composite as an alternative measure, changes to its component tests and scoring method are needed. Novel approaches, including the use of composite endpoints, patient-reported outcomes, and measurement of biomarkers, show promise as adjuncts to the current disability measures, but are insufficiently validated to serve as substitutes. A collaborative approach that involves academic experts, regulators, industry representitives, and funding agencies is needed to most effectively develop disability outcome measures. PMID:22516081

Cohen, Jeffrey A; Reingold, Stephen C; Polman, Chris H; Wolinsky, Jerry S

2012-05-01

269

Prospective clinical trial comparing outcome measures between Furlow and von Langenbeck Palatoplasties for UCLP.  

PubMed

The goal of this prospective randomized clinical trial was to compare 2 cohorts of standardized cleft patients with regard to functional speech outcome and the presence or absence of palatal fistulae. The 2 cohorts are randomized to undergo either a conventional von Langenbeck repair with intravelar velarplasty or the double-opposing Z-plasty Furlow procedure. A prospective 2 × 2 × 2 factorial clinical trial was used in which each subject was randomly assigned to 1 of 8 different groups: 1 of 2 different lip repairs (Spina vs. Millard), 1 of 2 different palatal repair (von Langenbeck vs. Furlow), and 1 of 2 different ages at time of palatal surgery (9-12 months vs. 15-18 months). All surgeries were performed by the same 4 surgeons. A cul-de-sac test of hypernasality and a mirror test of nasal air emission were selected as primary outcome measures for velopharyngeal function. Both a surgeon and speech pathologist examined patients for the presence of palatal fistulae. In this study, the Furlow double-opposing Z-palatoplasty resulted in significantly better velopharyngeal function for speech than the von Langenbeck procedure as determined by the perceptual cul-de-sac test of hypernasality. Fistula occurrence was significantly higher for the Furlow procedure than for the von Langenbeck. Fistulas were more likely to occur in patients with wider clefts and when relaxing incisions were not used. PMID:21042188

Williams, William N; Seagle, M Brent; Pegoraro-Krook, Maria Ines; Souza, Telma V; Garla, Luis; Silva, Marcos L; Machado Neto, José S; Dutka, Jeniffer C R; Nackashi, John; Boggs, Steve; Shuster, Jonathan; Moorhead, Jacquelyn; Wharton, William; Graciano, Maria I G; Pimentel, Maria C; Feniman, Mariza; Piazentin-Penna, Silvia H A; Kemker, Joseph; Zimmermann, Maria C; Bento-Gonçalvez, Cristina; Borgo, Hilton; Marques, Ilza L; Martinelli, Angela P M C; Jorge, José C; Antonelli, Patrick; Neves, Josiane F A; Whitaker, Melina E

2011-02-01

270

Outcome measures for Charcot-Marie-Tooth disease: clinical and neurofunctional assessment in children.  

PubMed

Charcot-Marie-Tooth (CMT) disease is the most common inherited neuromuscular disorder, presenting with symptoms often occurring since childhood, and showing a progressive course. At present, there are no valid and reliable measures for evaluation of impairment and disability in the pediatric population. The aim of this study was to determine the usefulness of outcome measures, commonly used in adult patients, in CMT children. We report the results of a comprehensive evaluation of 21 children affected with CMT type 1A, including clinical examinations, measure of hand and foot muscle strength with a hand-held dynamometer, and the following scales: CMT Neuropathy Score or its clinical component CMT Examination Score, Overall Neuropathy Limitations Scale (ONLS), Walk-12 questionnaire, and nine-hole peg test (9-HPT). Hand grip, three-point pinch, and foot dorsiflexion strength were significantly lower than age/sex equivalent in almost all cases. 9-HPT was significantly abnormal in 62% of patients and CMT Examination Score was <10 points in all cases. ONLS showed presence of minor disability in the upper limbs in 57% and mild abnormalities of gait in 71% of patients. Overall, these scales demonstrated limited potential to measure disability and severity of the disease confirming that it is necessary to identify specific scales for children with CMT. PMID:22003938

Pagliano, Emanuela; Moroni, Isabella; Baranello, Giovanni; Magro, Anita; Marchi, Alessia; Bulgheroni, Sara; Ferrarin, Maurizio; Pareyson, Davide

2011-09-01

271

Interactive conference voting. The OMERACT II Committee. Outcome Measures in Rheumatoid Arthritis Clinical Trial Conference.  

PubMed

We describe and analyze opinion polling results from interactive voting procedures undertaken before and after presentations during the Outcome Measures in Rheumatoid Arthritis Clinical Trials Conference (OMERACT II) in Ottawa, Canada, June 30-July 2, 1994. The scoring procedure was a matched voting design; when a participant used the same keypad at the beginning and end of voting, change within a participant could be estimated. Participants, experienced in the rheumatic diseases included clinicians, researchers, methodologists, regulators, and representatives of the pharmaceutical industry. Patients under consideration were those with any rheumatic diseases. Questions were constructed to evaluate the change in voting behavior expected from the content of the presentation. Statistically significant and substantively important changes were evident in most questions. PMID:7562790

Goldsmith, C H; Duku, E; Brooks, P M; Boers, M; Tugwell, P S; Baker, P

1995-07-01

272

Low Back Pain Subgroups using Fear-Avoidance Model Measures: Results of a Cluster Analysis  

PubMed Central

Objectives The purpose of this secondary analysis was to test the hypothesis that an empirically derived psychological subgrouping scheme based on multiple Fear-Avoidance Model (FAM) constructs would provide additional capabilities for clinical outcomes in comparison to a single FAM construct. Methods Patients (n = 108) with acute or sub-acute low back pain (LBP) enrolled in a clinical trial comparing behavioral physical therapy interventions to classification based physical therapy completed baseline questionnaires for pain catastrophizing (PCS), fear-avoidance beliefs (FABQ-PA, FABQ-W), and patient-specific fear (FDAQ). Clinical outcomes were pain intensity and disability measured at baseline, 4-weeks, and 6-months. A hierarchical agglomerative cluster analysis was used to create distinct cluster profiles among FAM measures and discriminant analysis was used to interpret clusters. Changes in clinical outcomes were investigated with repeated measures ANOVA and differences in results based on cluster membership were compared to FABQ-PA subgrouping used in the original trial. Results Three distinct FAM subgroups (Low Risk, High Specific Fear, and High Fear & Catastrophizing) emerged from cluster analysis. Subgroups differed on baseline pain and disability (p’s<.01) with the High Fear & Catastrophizing subgroup associated with greater pain than the Low Risk subgroup (p<.01) and the greatest disability (p’s<.05). Subgroup × time interactions were detected for both pain and disability (p’s<.05) with the High Fear & Catastrophizing subgroup reporting greater changes in pain and disability than other subgroups (p’s<.05). In contrast, FABQ-PA subgroups used in the original trial were not associated with interactions for clinical outcomes. Discussion These data suggest that subgrouping based on multiple FAM measures may provide additional information on clinical outcomes in comparison to determining subgroup status by FABQ-PA alone. Subgrouping methods for patients with LBP should include multiple psychological factors to further explore if patients can be matched with appropriate interventions.

Beneciuk, Jason M.; Robinson, Michael E.; George, Steven Z.

2012-01-01

273

Facilitating Clinical Outcomes Assessment through the Automated Identification of Quality Measures for Prostate Cancer Surgery  

PubMed Central

Objectives The College of American Pathologists (CAP) Category 1 quality measures, tumor stage, Gleason score, and surgical margin status, are used by physicians and cancer registrars to categorize patients into groups for clinical trials and treatment planning. This study was conducted to evaluate the effectiveness of an application designed to automatically extract these quality measures from the postoperative pathology reports of patients having undergone prostatectomies for treatment of prostate cancer. Design An application was developed with the Clinical Outcomes Assessment Toolkit that uses an information pipeline of regular expressions and support vector machines to extract CAP Category 1 quality measures. System performance was evaluated against a gold standard of 676 pathology reports from the University of California at Los Angeles Medical Center and Brigham and Women's Hospital. To evaluate the feasibility of clinical implementation, all pathology reports were gathered using administrative codes with no manual preprocessing of the data performed. Measurements The sensitivity, specificity, and overall accuracy of system performance were measured for all three quality measures. Performance at both hospitals was compared, and a detailed failure analysis was conducted to identify errors caused by poor data quality versus system shortcomings. Results Accuracies for Gleason score were 99.7%, tumor stage 99.1%, and margin status 97.2%, for an overall accuracy of 98.67%. System performance on data from both hospitals was comparable. Poor clinical data quality led to a decrease in overall accuracy of only 0.3% but accounted for 25.9% of the total errors. Conclusion Despite differences in document format and pathologists' reporting styles, strong system performance indicates the potential of using a combination of regular expressions and support vector machines to automatically extract CAP Category 1 quality measures from postoperative prostate cancer pathology reports.

D'Avolio, Leonard W.; Litwin, Mark S.; Rogers, Selwyn O.; Bui, Alex A.T.

2008-01-01

274

The effects of outcome misclassification and measurement error on the design and analysis of therapeutic equivalence trials.  

PubMed

In any clinical trial, the use of imperfect diagnostic procedures or laboratory techniques may lead to misclassification and measurement error in the primary outcome. Although the effects of non-differential outcome misclassification and measurement error on conventional superiority trials have been extensively investigated, less is known about the impact of these errors on the results and interpretation of therapeutic equivalence trials. In this paper we formally investigate the effects of outcome misclassification and measurement error on the estimates of treatment effects, type I error rate, and power of equivalence trials. Our results indicate that, contrary to what one may expect based on the well known attenuating effects of non-differential error in conventional studies, these errors do not always favour the goal of demonstrating equivalence. The magnitude and direction of the influence depend on a number of factors including the nature of the outcome variable, specific formulation of equivalence, size of the error rates, and assumptions regarding the true treatment effect. PMID:11439421

Kim, M Y; Goldberg, J D

2001-07-30

275

Assessing outcomes of health and medical research: do we measure what counts or count what we can measure?  

PubMed

Governments world wide are increasingly demanding outcome measures to evaluate research investment. Health and medical research outputs can be considered as gains in knowledge, wealth and health. Measurement of the impacts of research on health are difficult, particularly within the time frames of granting bodies. Thus evaluations often measure what can be measured, rather than what should be measured. Traditional academic metrics are insufficient to demonstrate societal benefit from public investment in health research. New approaches that consider all the benefits of research are needed. PMID:17597545

Wells, Robert; Whitworth, Judith A

2007-06-28

276

Response categories and anger measurement: do fewer categories result in poorer measurement?  

Microsoft Academic Search

Background  Anger is a key long-term outcome from trauma exposure, regardless of trauma type, and it is implicated as a moderator of response\\u000a to treatment. It therefore seems important that anger is assessed in both epidemiological studies of trauma sequelae and in\\u000a intervention evaluation research. This study explored the measurement properties of a recently investigated anger scale, the\\u000a Dimensions of Anger

Graeme Hawthorne; Joanne Mouthaan; David Forbes; Raymond W. Novaco

2006-01-01

277

Deconstructing Therapy Outcome Measurement with Rasch Analysis of a Measure of General Clinical Distress: The Symptom Checklist-90-Revised  

ERIC Educational Resources Information Center

Rasch analysis was used to illustrate the usefulness of item-level analyses for evaluating a common therapy outcome measure of general clinical distress, the Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1994). Using complementary therapy research samples, the instrument's 5-point rating scale was found to exceed clients' ability to make…

Elliott, Robert; Fox, Christine M.; Beltyukova, Svetlana A.; Stone, Gregory E.; Gunderson, Jennifer; Zhang, Xi

2006-01-01

278

Measuring the outcome of contact tracing. 2. The responsibilities of the health worker and the outcome of contact investigations.  

PubMed Central

The previous paper (Satin and Mills, 1978) concerned information on patients who were interviewed by health workers in five selected clinics; information on the contacts named by these patients was similarly analysed. This paper describes and evaluates the activities of the health workers and the outcome of contact investigations. At all stages of the contact tracing process, differences were observed between men and women. It was found that more than half of the male contacts and half the female contacts were known to have been examined. Of those contacts examined, at least two-thirds of them attended the same clinic as the patient who had named them, and 85% of these contacts were found to have a treatable condition. It will be seen that the concept of success or effectiveness of contact tracing is complex in definition and measurement.

Mills, A; Satin, A

1978-01-01

279

Application of Information Technology: The Clinical Outcomes Assessment Toolkit: A Framework to Support Automated Clinical Records-based Outcomes Assessment and Performance Measurement Research  

Microsoft Academic Search

The Clinical Outcomes Assessment 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

Leonard W. D'Avolio; Alex A. T. Bui

2008-01-01

280

Incorporating Results of a Provider Attitudes Survey in Development of an Outcomes Assessment Program  

Microsoft Academic Search

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 outcomes assessment in their clinical practice. The goal of obtaining the information was to use it in development of a formal Outcomes Assessment Program for the service. The

Pamela Moriearty; Radmila Bogdanich; Nina Dexter; Earl Loschen

1999-01-01

281

Validation of a core outcome measure for palliative care in Africa: the APCA African Palliative Outcome Scale  

Microsoft Academic Search

BACKGROUND: Despite the burden of progressive incurable disease in Africa, there is almost no evidence on patient care or outcomes. A primary reason has been the lack of appropriate locally-validated outcome tools. This study aimed to validate a multidimensional scale (the APCA African Palliative Outcome Scale) in a multi-centred international study. METHODS: Validation was conducted across 5 African services and

Richard Harding; Lucy Selman; Godfrey Agupio; Natalya Dinat; Julia Downing; Liz Gwyther; Thandi Mashao; Keletso Mmoledi; Tony Moll; Lydia Mpanga Sebuyira; Barbara Panjatovic; Irene J Higginson

2010-01-01

282

Multipoint incremental motor unit number estimation as an outcome measure in ALS  

PubMed Central

Background: Improved outcome measures are necessary to reduce sample size and increase power in amyotrophic lateral sclerosis (ALS) clinical trials. Motor unit number estimation (MUNE) is a potentially attractive tool. MUNE methods previously employed in multicenter trials exhibited excessive variability and were prone to artifact. Objective: To evaluate a modification of standard incremental MUNE in a multicenter natural history study of subjects with ALS. Methods: Fifty healthy subjects were evaluated twice and 71 subjects with ALS were studied repeatedly for up to 500 days. Side and nerve studied was based on clinical examination findings. Nerves were stimulated at 3 specified locations and 3 increments were obtained at each location. Average single motor unit action potential (SMUP) amplitude was calculated by adding the amplitude of the third increment at each location and dividing by 9; SMUP was divided into maximum CMAP amplitude to determine the MUNE. Results: Test-retest variability was 9% in normal subjects. Average MUNE for normal subjects was 225 (±87), and was 41.9 (±39) among subjects with ALS at baseline. Subjects with ALS showed clear decrements over time, with an overage rate of decline of approximately 9% per month. SMUP amplitude increased with time in a fashion consistent with the known pathophysiology of ALS. Conclusion: Multipoint incremental MUNE has a number of attributes that make it attractive as an outcome measure in ALS and other diseases characterized by motor unit loss. It can be rapidly performed on any EMG machine and has repeatability and rates of decline that favorably compare to other previously described methods.

Watson, M.L.; Simionescu, L.; Caress, J.B.; Burns, T.M.; Maragakis, N.J.; Benatar, M.; David, W.S.; Sharma, K.R.; Rutkove, S.B.

2011-01-01

283

Outcome Measures of Chinese Herbal Medicine for Coronary Heart Disease: An Overview of Systematic Reviews  

PubMed Central

Objective. The aim of this overview was to summarize the outcome measures of Chinese herbal medicine (CHM) as the treatment of coronary heart disease (CHD) based on available systematic reviews (SRs), so as to display the current situation and evaluate the potential benefits and advantages of CHM on CHD. Methods. An extensive search included the Cochrane Database of Systematic Reviews, MEDLINE, and 4 databases in Chinese. SRs of CHM for CHD were included. Besides evaluating and summarizing the outcome measures, we also estimated the quality of the included reviews by PRISMA (preferred reporting items for systematic reviews and meta-analyses). Data were extracted according to predefined inclusion criteria by two independent reviewers. Results. 46 articles were included. 20 kinds of CHM were reviewed. 7 SRs were concerned with myocardial infarction (MI), 38 SRs were related to angina pectoris. 11 SRs had primary endpoints, while others focused on secondary endpoints to evaluate CHM for CHD such as angina pectoris and electrocardiogram (ECG). One SR reported more adverse effects of CHM for CHD and of the SRs analyzed quality of life. Many CHM appeared to have significant effect on improving symptoms, ECG, biomarkers and so on. However, most SRs failed to make a definite conclusion for the effectiveness of CHM in CHD patients due specifically to the poor evidence. And according to PRISMA we found most of the trials in the SRs were of low quality. Conclusion. Primary endpoints were not used widely. The benefits of CHM for CHD need to be confirmed in the future with RCTs of more persuasive primary endpoints and high-quality SRs.

Luo, Jing; Xu, Hao

2012-01-01

284

RETURN OF NORMAL GAIT AS AN OUTCOME MEASUREMENT IN ACL RECONSTRUCTED PATIENTS. A SYSTEMATIC REVIEW  

PubMed Central

Background: Current clinical outcome measurements may overestimate the long term success of anterior cruciate ligament reconstruction (ACLR). There is a need to understand biomechanics of the knee joint during daily activities. This systematic review provides a comprehensive overview of the literature related to gait in patients following ACLR. The purpose of this systematic review was to investigate the available literature and provide a comprehensive overview of kinematic and kinetic variables that present during gait in patients after ACLR. Methods: A literature search was performed in AMED, CINAHL, EMBASE, Medline and Scopus between January 2000 and October 2012. Inclusion criteria included articles written in English, German or Dutch, and those reporting on gait analysis in patients after ACLR. Kinematic and/or kinetic data of the uninjured and ACLR knee and healthy controls (CTRL) were outcome measurements of interest. Each study's methodological quality was assessed using the Critical Appraisal Skills Programme critical appraisal tool. Results: Twenty two studies fulfilled the inclusion criteria. A total of 479 patients with a mean age of 27.3 were examined. Time between the injury and surgery and ranged from 3 weeks to 5.7 years. Gait analysis was done at a mean of 29.3 months after surgery. Gait was found to be altered in the sagittal, frontal and transverse planes after ACLR and may take months or years to normalize, if normalization occurs at all. Conclusion: Patients after ACLR have altered gait patterns that can persist for up to five years after surgery. It is imperative that rehabilitation techniques are examined in order to minimize changes in knee biomechanics during gait, as they have the potential to impact on the development of osteoarthritis. Level of evidence: 3a

Benjaminse, A.; van Eck, C. F.; Webster, K. E.; Schot, L.; Otten, E.

2013-01-01

285

Measurement of Religiosity/Spirituality in Adolescent Health Outcomes Research: Trends and Recommendations  

PubMed Central

The relationship between religious/spiritual (R/S) factors and adolescent health outcomes has been studied for decades; however, the R/S measurement tools used may not be developmentally relevant for adolescents. A systematic literature review was conducted to review and evaluate trends in measuring R/S in adolescent health outcomes research. In this review a total of 100 articles met criteria for inclusion. Relatively few (n = 15) included adolescent-specific R/S measures or items accounting for developmentally relevant issues such as parental religiosity or age-appropriate language. Future R/S and health research with adolescents would be strengthened by incorporating developmentally relevant R/S measurement tools, psychometrics, and multidimensional measures.

McGrady, Meghan E.; Rosenthal, Susan L.

2010-01-01

286

Results of Screened-Room Measurements on NIST Standard Radiators.  

National Technical Information Service (NTIS)

The National Institute of Standards and Technology (NIST) has recently developed a spherical-dipole standard radiator for use in electromagnetic interference and compatibility (EMI/EMC) applications. This report discusses results of a study of measurement...

G. Koepke J. Randa

1993-01-01

287

Health economics research into supporting carers of people with dementia: A systematic review of outcome measures  

PubMed Central

Advisory bodies, such as the National Institute for Health and Clinical Excellence (NICE) in the UK, advocate using preference based instruments to measure the quality of life (QoL) component of the quality-adjusted life year (QALY). Cost per QALY is used to determine cost-effectiveness, and hence funding, of interventions. QALYs allow policy makers to compare the effects of different interventions across different patient groups. Generic measures may not be sensitive enough to fully capture the QoL effects for certain populations, such as carers, so there is a need to consider additional outcome measures, which are preference based where possible to enable cost-effectiveness analysis to be undertaken. This paper reviews outcome measures commonly used in health services research and health economics research involving carers of people with dementia. An electronic database search was conducted in PubMed, Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment database. Studies were eligible for inclusion if they included an outcome measure for carers of people with dementia. 2262 articles were identified. 455 articles describing 361 studies remained after exclusion criteria were applied. 228 outcome measures were extracted from the studies. Measures were categorised into 44 burden measures, 43 mastery measures, 61 mood measures, 32 QoL measures, 27 social support and relationships measures and 21 staff competency and morale measures. The choice of instrument has implications on funding decisions; therefore, researchers need to choose appropriate instruments for the population being measured and the type of intervention undertaken. If an instrument is not sensitive enough to detect changes in certain populations, the effect of an intervention may be underestimated, and hence interventions which may appear to be beneficial to participants are not deemed cost-effective and are not funded. If this is the case, it is essential that additional outcome measures which detect changes in broader QoL are included, whilst still retaining preference based utility measures such as EQ-5D to allow QALY calculation for comparability with other interventions.

2012-01-01

288

Free hemoglobin concentration in severe sepsis: methods of measurement and prediction of outcome  

PubMed Central

Introduction Hemolysis can be induced in sepsis via various mechanisms, its pathophysiological importance has been demonstrated in experimental sepsis. However, no data on free hemoglobin concentrations in human sepsis are available. In the present study we measured free hemoglobin in patients with severe sepsis as well as in postoperative patients using four methods. It was our aim to determine the potential value of free hemoglobin as a biomarker for diagnosis and outcome of severe sepsis in critical illness. Methods Plasma concentration of free hemoglobin was determined in patients with severe sepsis (n = 161) and postoperative patients (n = 136) on day 1 of diagnosis and surgery. For the measurement of free hemoglobin, an enzyme linked immunosorbent assay and three spectrophotometric algorithms were used. Moreover, SAPS II- and SOFA scores as well as procalcitonin concentration and outcome were determined. Kaplan-Meier analysis was performed and odds ratios were determined after classification of free hemoglobin concentrations in a high and low concentration group according to the median. For statistical evaluation the Mann-Whitney test and logistic regression analysis were used. Results In non-survivors of severe sepsis, free hemoglobin concentration was twice the concentration compared to survivors. Thirty-day survival of patients, as evidenced by Kaplan-Meier analysis, was markedly lower in patients with high free hemoglobin concentration than in patients with low free hemoglobin concentration. Best discrimination of outcome was achieved with the spectrophotometric method of Harboe (51.3% vs. 86.4% survival, p < 0.001; odds ratio 6.1). Multivariate analysis including free hemoglobin, age, SAPS II- and SOFA-score and procalcitonin demonstrated that free hemoglobin, as determined by all 4 methods, was the best and an independent predictor for death in severe sepsis (p = 0.022 to p < 0.001). Free hemoglobin concentrations were not significantly different in postoperative and septic patients in three of four assays. Thus, free hemoglobin can not be used to diagnose severe sepsis in critical illness. Conclusions Free hemoglobin is an important new predictor of survival in severe sepsis.

2012-01-01

289

Free hemoglobin concentration in severe sepsis: methods of measurement and prediction of outcome.  

PubMed

ABSTRACT: INTRODUCTION: Hemolysis can be induced in sepsis via various mechanisms, its pathophysiological importance has been demonstrated in experimental sepsis. However, no data on free hemoglobin concentrations in human sepsis are available. In the present study we measured free hemoglobin in patients with severe sepsis as well as in postoperative patients using four methods. It was our aim to determine the potential value of free hemoglobin as a biomarker for diagnosis and outcome of severe sepsis in critical illness. METHODS: Plasma concentration of free hemoglobin was determined in patients with severe sepsis (n = 161) and postoperative patients (n = 136) on day 1 of diagnosis and surgery. For the measurement of free hemoglobin, an enzyme linked immunosorbent assay and three spectrophotometric algorithms were used. Moreover, SAPS II- and SOFA scores as well as procalcitonin concentration and outcome were determined. Kaplan-Meier analysis was performed and odds ratios were determined after classification of free hemoglobin concentrations in a high and low concentration group according to the median. For statistical evaluation the Mann-Whitney test and logistic regression analysis were used. RESULTS: In non-survivors of severe sepsis, free hemoglobin concentration was twice the concentration compared to survivors. Thirty-day survival of patients, as evidenced by Kaplan-Meier analysis, was markedly lower in patients with high free hemoglobin concentration than in patients with low free hemoglobin concentration. Best discrimination of outcome was achieved with the spectrophotometric method of Harboe (51.3% vs. 86.4% survival, p < 0.001; odds ratio 6.1). Multivariate analysis including free hemoglobin, age, SAPS II- and SOFA-score and procalcitonin demonstrated that free hemoglobin, as determined by all 4 methods, was the best and an independent predictor for death in severe sepsis (p = 0.022 to p < 0.001). Free hemoglobin concentrations were not significantly different in postoperative and septic patients in three of four assays. Thus, free hemoglobin can not be used to diagnose severe sepsis in critical illness. CONCLUSIONS: Free hemoglobin is an important new predictor of survival in severe sepsis. PMID:22800762

Adamzik, Michael; Hamburger, Tim; Petrat, Frank; Peters, Jürgen; de Groot, Herbert; Hartmann, Matthias

2012-07-16

290

Outcomes of Empirical Eating Disorder Phenotypes in a Clinical Female Sample: Results from a Latent Class Analysis  

Microsoft Academic Search

Background\\/Aims: To empirically classify phenotypes of eating disorders (ED) using latent class analysis (LCA), and to validate this classification based on clinical outcomes. Methods: LCA was applied to 968 inpatients. The resultant classes were validated by clinical outcomes including mortality. Results: A 5-class solution showed the best fit. The symptoms of latent class 1 (LC1; 26% of the sample) resembled

Agnes Dechartres; Caroline Huas; Nathalie Godart; Maud Pousset; Alexandra Pham; Snezana M. Divac; Frederic Rouillon; Bruno Falissard

2011-01-01

291

Using the Invitational Teaching Survey (ITS) and the Student Attitudinal Outcome Measures (SAOM) to Improve Teaching.  

ERIC Educational Resources Information Center

This paper presents data currently available on two new self-administered student-rating questionnaires that can facilitate the professional growth of teachers by giving them feedback about classroom interactions: (1) the Invitational Teaching Survey (ITS); and (2) the Student Attitudinal Outcome Measures (SAOM). The ITS, developed within the…

Amos, Lundee W.; And Others

292

Stimulus, Task, and Learning Effects on Measures of Temporal Resolution: Implications for Predictors of Language Outcome  

ERIC Educational Resources Information Center

Purpose: Some studies find that temporal processing ability predicts language outcome whereas other studies do not. Resolution of this debate is hindered by the variety of temporal measures used, nonsensory loading of the tasks, and differential amounts of practice across studies. The goal of this study was to examine the effects of stimulus…

Smith, Nicholas A.; Trainor, Laurel J.; Gray, Kellie; Plantinga, Judy A.; Shore, David I.

2008-01-01

293

National Outcome Measures for Early Childhood Development: Development of an Indicator-Based Reporting Framework  

ERIC Educational Resources Information Center

|The Council of Australian Governments released the National Early Childhood Development Strategy, Investing in the Early Years in July 2009 (COAG 2009). One of the key reform priorities in the strategy is to build better information and a solid evidence base, and establishing national outcome measures for early childhood development has been…

Australian Institute of Health and Welfare, 2011

2011-01-01

294

Challenges of General Outcomes Measurement in the RTI Progress Monitoring of Linguistically Diverse Exceptional Learners  

ERIC Educational Resources Information Center

|The assessment for accurate identification and appropriate instruction of English language learners (ELLs) with learning-related disabilities has remained a chronic source of concern. One source of concern that has gone relatively unchallenged is the use of general outcomes measurement (GOMs). The authors examine the problems and challenges of…

Barrera, Manuel; Liu, Kristin Kline

2010-01-01

295

Side Effects of Minocycline Treatment in Patients with Fragile X Syndrome and Exploration of Outcome Measures  

ERIC Educational Resources Information Center

|Minocycline can rescue the dendritic spine and synaptic structural abnormalities in the fragile X knock-out mouse. This is a review and preliminary survey to document side effects and potential outcome measures for minocycline use in the treatment of individuals with fragile X syndrome. We surveyed 50 patients with fragile X syndrome who received…

Utari, Agustini; Chonchaiya, Weerasak; Rivera, Susan M.; Schneider, Andrea; Hagerman, Randi J.; Faradz, Sultana M. H.; Ethell, Iryna M.; Nguyen, Danh V.

2010-01-01

296

The rheumatoid foot: a systematic literature review of patient-reported outcome measures  

Microsoft Academic Search

BACKGROUND: The foot is often the first area of the body to be systematically affected by rheumatoid arthritis. The multidimensional consequences of foot problems for patients can be subjectively evaluated using patient-reported outcome measures (PROMs). However, there is currently no systematic review which has focused specifically upon the PROMs available for the foot with rheumatoid arthritis. The aim of this

Steven Walmsley; Anita E Williams; Mike Ravey; Andrea Graham

2010-01-01

297

Development of an Outcome Measurement Tool for a Teen Parent Wraparound Program  

ERIC Educational Resources Information Center

This article chronicles the search for and development of an outcome measurement tool for teen parents receiving community-based wraparound services. The criteria for selecting functional assessment tools available in the literature is presented along with the barriers experienced in using two of these well-cited tools. The rationale for in-house…

Fries, Derrick; Carney, Karen J.; Blackman-Urteaga, Laura; Savas, Sue Ann

2012-01-01

298

Measuring Outcomes of Family-Centered Intervention: Development of the Life Participation for Parents (LPP)  

ERIC Educational Resources Information Center

|Raising a child with disabilities impacts the ability of parents to participate in life situations. This paper describes the development of a new instrument, Life Participation for Parents, to measure outcomes of pediatric therapy on parental participation. Items were reviewed by six occupational therapists with experience in pediatrics and…

Fingerhut, Patricia E.

2009-01-01

299

Challenges of General Outcomes Measurement in the RTI Progress Monitoring of Linguistically Diverse Exceptional Learners  

ERIC Educational Resources Information Center

The assessment for accurate identification and appropriate instruction of English language learners (ELLs) with learning-related disabilities has remained a chronic source of concern. One source of concern that has gone relatively unchallenged is the use of general outcomes measurement (GOMs). The authors examine the problems and challenges of…

Barrera, Manuel; Liu, Kristin Kline

2010-01-01

300

Clinical Utility of the Modified Stroop Task as a Treatment Outcome Measure: Questions Raised  

ERIC Educational Resources Information Center

Data from an outpatient treatment trial for anorexia nervosa were examined to gain preliminary insights as to whether the modified Stroop colour-naming task might offer a useful measure of treatment outcome. It was hypothesised that interference for eating-, weight- and shape-related words on a modified version on the Stroop colour-naming task…

Ball, Jillian R.; Mitchell, Philip B.; Touyz, Stephen W.; Griffiths, Rosalyn A.; Beumont, Pierre J. V.

2004-01-01

301

National Outcome Measures for Early Childhood Development: Development of an Indicator-Based Reporting Framework  

ERIC Educational Resources Information Center

The Council of Australian Governments released the National Early Childhood Development Strategy, Investing in the Early Years in July 2009 (COAG 2009). One of the key reform priorities in the strategy is to build better information and a solid evidence base, and establishing national outcome measures for early childhood development has been…

Australian Institute of Health and Welfare, 2011

2011-01-01

302

Student Identification with Business Education Models: Measurement and Relationship to Educational Outcomes  

ERIC Educational Resources Information Center

|Although management scholars have provided a variety of metaphors to describe the role of students in management courses, researchers have yet to explore students' identification with the models and how they are linked to educational outcomes. This article develops a measurement tool for students' identification with business education models and…

Halbesleben, Jonathon R. B.; Wheeler, Anthony R.

2009-01-01

303

Clinical Utility of the Modified Stroop Task as a Treatment Outcome Measure: Questions Raised  

ERIC Educational Resources Information Center

|Data from an outpatient treatment trial for anorexia nervosa were examined to gain preliminary insights as to whether the modified Stroop colour-naming task might offer a useful measure of treatment outcome. It was hypothesised that interference for eating-, weight- and shape-related words on a modified version on the Stroop colour-naming task…

Ball, Jillian R.; Mitchell, Philip B.; Touyz, Stephen W.; Griffiths, Rosalyn A.; Beumont, Pierre J. V.

2004-01-01

304

A "Learning Platform" Approach to Outcome Measurement in Fragile X Syndrome: A Preliminary Psychometric Study  

ERIC Educational Resources Information Center

|Background: Clinical trials of medications to alleviate the cognitive and behavioural symptoms of individuals with fragile X syndrome (FXS) are now underway. However, there are few reliable, valid and/or sensitive outcome measures available that can be directly administered to individuals with FXS. The majority of assessments employed in clinical…

Hall, S. S.; Hammond, J. L.; Hirt, M.; Reiss, A. L.

2012-01-01

305

The EPSILON study: aims outcome measures, study sites and patient sample [ch 1  

Microsoft Academic Search

The development and translation of assessment instruments in mental health is a complex process, which becomes increasingly important in a uniting Europe. The major aim of the European Commission BIOMED-funded multi-site study, the European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study, was to produce standardised versions in several European languages of instruments measuring five key concepts

Thomas Becker; Martin Knapp; Helle Charlotte Knudsen; Aart H. Schene; Michele Tansella; Graham Thornicroft; José Luis Vázquez-Barquero; stgr EPSILON

2006-01-01

306

Measurement of social participation outcomes in rehabilitation of veterans with traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) is a significant concern in the veteran population, and the Department of Veteran Affairs (VA) has devoted substantial healthcare resources to the rehabilitation of veterans with TBI. Evaluating the outcomes of these rehabilitation activities requires measuring whether they meaningfully improve veterans' lives, especially with regard to community and vocational participation, which are strongly linked to perceived quality of life. In January 2010, the VA Rehabilitation Research and Development Service convened an invitational conference focused on outcome measurement in rehabilitation with a specific focus on veterans' community and vocational participation. This article reports on the working group, addressing the issues of conceptualizing and operationalizing such participation outcome measures for veterans with TBI; we discuss conceptual models of participation, review participation subdomains and their instruments of measurement, and identify current research issues and needs. Two avenues are identified for advancing participation measurement in veterans with TBI. First, we describe suggestions to facilitate the immediate implementation of participation measurement into TBI clinical practice and rehabilitation (cont) research within the VA healthcare system. Second, we describe recommendations for future VA research funding initiatives specific to improving the measurement of participation in veterans with TBI. PMID:22492344

Stiers, William; Carlozzi, Noelle; Cernich, Alison; Velozo, Craig; Pape, Theresa; Hart, Tessa; Gulliver, Suzy; Rogers, Margaret; Villarreal, Edgar; Gordon, Shalanda; Gordon, Wayne; Whiteneck, Gale

2012-01-01

307

Is the Patient Outcomes of Surgery (POS)Hand\\/Arm Questionnaire a Reliable, Valid and Responsive Measurement of Patient-Based Outcomes in Hand and Upper Limb Surgery?  

Microsoft Academic Search

The purpose of our study was to evaluate a new region-specific outcome measure in hand and upper limb surgery: the Patient Outcomes of Surgery (POS)-Hand\\/Arm questionnaire using the generic Short Form Health Survey (SF)-36 questionnaire as a ‘gold standard’ comparative measure. The POS-Hand\\/Arm preop questionnaire and the SF-36 questionnaire were completed by 214 patients on the day of their hand

A. D. SCOTT; O. MUSA; F. AL-HASSANI; G. L. JONES; M. B. HOBSON; J. G. MILLER

2009-01-01

308

Recent Results of Solar Neutrino Measurement in Super-Kamiokande  

Microsoft Academic Search

The results of solar neutrino data from the first phase of super-Kamiokande are presented. super-Kamiokande can measure not only the solar neutrino flux but also its energy spectrum and its time variations such as day vs. night and seasonal differences. This information can severely restrict parameters of solar neutrino oscillation. From the combination of several experiments' results with those of

Yusuke Koshio

2003-01-01

309

Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living  

PubMed Central

Background Few studies have directly compared the competing approaches to identifying frailty in more vulnerable older populations. We examined the ability of two versions of a frailty index (43 vs. 83 items), the Cardiovascular Health Study (CHS) frailty criteria, and the CHESS scale to accurately predict the occurrence of three outcomes among Assisted Living (AL) residents followed over one year. Methods The three frailty measures and the CHESS scale were derived from assessment items completed among 1,066 AL residents (aged 65+) participating in the Alberta Continuing Care Epidemiological Studies (ACCES). Adjusted risks of one-year mortality, hospitalization and long-term care placement were estimated for those categorized as frail or pre-frail compared with non-frail (or at high/intermediate vs. low risk on CHESS). The area under the ROC curve (AUC) was calculated for select models to assess the predictive accuracy of the different frailty measures and CHESS scale in relation to the three outcomes examined. Results Frail subjects defined by the three approaches and those at high risk for decline on CHESS showed a statistically significant increased risk for death and long-term care placement compared with those categorized as either not frail or at low risk for decline. The risk estimates for hospitalization associated with the frailty measures and CHESS were generally weaker with one of the frailty indices (43 items) showing no significant association. For death and long-term care placement, the addition of frailty (however derived) or CHESS significantly improved on the AUC obtained with a model including only age, sex and co-morbidity, though the magnitude of improvement was sometimes small. The different frailty/risk models did not differ significantly from each other in predicting mortality or hospitalization; however, one of the frailty indices (83 items) showed significantly better performance over the other measures in predicting long-term care placement. Conclusions Using different approaches, varying degrees of frailty were detected within the AL population. The various approaches to defining frailty were generally more similar than dissimilar with regard to predictive accuracy with some exceptions. The clinical implications and opportunities of detecting frailty in more vulnerable older adults require further investigation.

2012-01-01

310

American Society of Nuclear Cardiology project on myocardial perfusion imaging: Measuring outcomes in response to emerging guidelines  

Microsoft Academic Search

Patient outcomes One of the most important impacts of ongoing health care reform has been the attention focused on health care outcomes. To assess whether a treatment or treatment strategy is effective and, in particular, whether it is cost-effective, measurement of patient outcomes is increasingly emphasized. There is a large variation between countries and between regions within the United States

Raymond S. Gibbons

1996-01-01

311

The subjective health of older women: Measuring outcomes in relation to prevention  

Microsoft Academic Search

Images of women as they age are strongly influenced by social, economic and historical forces. Questionnaires which purport\\u000a to measure the subjective health of older women have been influenced by these images in terms of their design and content,\\u000a the concepts underlying item selection and the interpretation of responses. There has been a failure within both medicine\\u000a and outcome measurement

Sonja M. Hunt

2000-01-01

312

Correlation of Return to Work Outcomes and Hand Impairment Measures Among Workers with Traumatic Hand Injury  

Microsoft Academic Search

Introduction Hand impairment is a common and serious occupational injury among workers because it can affect the outcome to return to\\u000a work (RTW) and even cause permanent dysfunction. The hand measures can directly describe the primary hand function and limitation.\\u000a This study investigated the correlation of RTW and the overall hand impairment measures in the workers with traumatic hand\\u000a injury.

Jer-Hao ChangMingyi; Mingyi Wu; Chia-Ling Lee; Yue-Liang Guo; Haw-Yen Chiu

2011-01-01

313

Different approaches to the measurement of therapist empathy and their relationship to therapy outcomes  

Microsoft Academic Search

Correlated measures of therapist empathy (N. Kagan's, et al, Affective Sensitivity Scale, the Interpersonal Checklist, A. Langield's Role Construct Repertory Test, R. Carkhuff's Empathetic Understanding in Interpersonal Process Scale, and the G. Barrett-Lennard Relationship Inventory) with each other, with R. Carkhuff and B. Berenson's Self-Exploration in Interpersonal Process Scale, and with the Tennessee Self-Concept Scale and MMPI measures of outcome.

Robert R. Kurtz; Donald L. Grummon

1972-01-01

314

Effects of High-Flux Hemodialysis on Clinical Outcomes: Results of the HEMO Study  

Microsoft Academic Search

Among the 1846 patients in the HEMO Study, chronic high-flux dialysis did not significantly affect the primary outcome of the all-cause mortality (ACM) rate or the main secondary composite outcomes, including the rates of first cardiac hospital- ization or ACM, first infectious hospitalization or ACM, first 15% decrease in serum albumin levels or ACM, or all non-vascular access-related hospitalizations. The

ALFRED K. CHEUNG; NATHAN W. LEVIN; TOM GREENE; LAWRENCE AGODOA; JAMES BAILEY; GERALD BECK; WILLIAM CLARK; ANDREW S. LEVEY; JOHN K. LEYPOLDT; DANIEL B. ORNT; MICHAEL V. ROCCO; GERALD SCHULMAN; STEVE SCHWAB; BRENDAN TEEHAN; GARABED EKNOYAN

315

Does Change in Perception Following Counseling Result in Improved Quitting Outcome Among Malaysian Smokers?  

PubMed

OBJECTIVE: The authors examined the effects that change in perception about the advantages and disadvantages of smoking and quitting had on quitting outcome among smokers enrolled in a program for smoking cessation. METHODS: A total of 185 smokers from 2 public universities who were interested in quitting received smoking cessation counseling on understanding the risks and benefits of quitting (or smoking) in addition to a course of free nicotine replacement therapy (NRT). A decisional balance questionnaire (DBQ) was administered at baseline and at 2 months postcounseling to determine and assess changes in smoking perception. RESULTS: After counseling, 72.3% of smokers had reduced their perceptions about the advantages of smoking, and 66.4% had increased perceptions of disadvantages of smoking. At the eighth week, 51 participants (27%) had quit. Smokers who had reduced perceptions of the advantages of smoking had significantly higher quit rates compared with those with no improvement in perception (82.6% vs 17.4%; odds ratio = 2.47; 95% confidence interval = 1.00-6.10). CONCLUSION: After counseling, smokers did change their perception of the advantages and disadvantages of smoking during the quitting process. These changes are associated with a higher likelihood of smoking cessation. PMID:22199150

Yasin, Siti Munira; Masilamani, Retneswari; Ming, Moy Foong; Koh, David

2011-12-23

316

A Geometric Morphometric Approach to the Analysis of Lip Shape during Speech: Development of a Clinical Outcome Measure  

PubMed Central

Objective assessments of lip movement can be beneficial in many disciplines including visual speech recognition, for surgical outcome assessment in patients with cleft lip and for the rehabilitation of patients with facial nerve impairments. The aim of this study was to develop an outcome measure for lip shape during speech using statistical shape analysis techniques. Lip movements during speech were captured from a sample of adult subjects considered as average using a three-dimensional motion capture system. Geometric Morphometrics was employed to extract three-dimensional coordinate data for lip shape during four spoken words decomposed into seven visemes (which included the resting lip shape). Canonical variate analysis was carried out in an attempt to statistically discriminate the seven visemes. The results showed that the second canonical variate discriminated the resting lip shape from articulation of the utterances and accounted for 17.2% of the total variance of the model. The first canonical variate was significant in discriminating between the utterances and accounted for 72.8% of the total variance of the model. The outcome measure was created using the 95% confidence intervals of the canonical variate scores for each subject plotted as ellipses for each viseme. The method and outcome model is proposed as reference to compare lip movement during speech in similar population groups.

Popat, Hashmat; Richmond, Stephen; Zhurov, Alexei I.; Rosin, Paul L.; Marshall, David

2013-01-01

317

Transsphenoidal microsurgery for Cushing's disease: initial outcome and long-term results.  

PubMed

Untreated Cushing's disease and the resultant chronically elevated glucocorticoid levels lead to severe metabolic disturbances, including diabetes mellitus, obesity, hypertension, muscle wasting, and osteoporosis. Although transsphenoidal resection has become the standard of care for Cushing's disease with high initial success rates, little information is available on the long-term morbidity and mortality of patients in remission compared with patients with recurrent or persistent Cushing's disease after such treatment. We therefore conducted a retrospective study of 289 patients with Cushing's disease who underwent transsphenoidal microsurgery for an ACTH-secreting adenoma at a tertiary care center exclusively by one surgeon (C.B.W.). Postoperative remission was achieved in 82% (n = 236) of patients, with best initial remission rates observed in patients with grade I (86%) and II (83%) or stage 0 (88%), A (94%), and B (100%) tumors. Male gender, larger tumor size, and higher stage predicted poorer initial outcome. Long-term follow-up was obtained on 178 patients, with a median follow-up time of 11.1 yr (range, 0.6-24.1 yr). Thirteen of 150 (9%) of patients in initial remission developed recurrent disease, and 12 patients underwent additional treatment. At last follow-up, only two of these patients had active disease. However, of the 28 patients with initial persistent disease who had follow-up greater than 6 months, 10 patients continued to have active disease at last follow-up. Although overall survival rates in patients with initial remission did not differ significantly from expected compared with the general population based on age and sex distribution, patients with initial persistent disease had a significant increase in mortality compared with the expected mortality. Thus, successful treatment of Cushing's disease is associated with normal long-term survival. These results suggest that patients with persistent Cushing's disease require early and aggressive intervention to attempt to prevent this excess mortality. PMID:15579802

Hammer, Gary D; Tyrrell, J Blake; Lamborn, Kathleen R; Applebury, Carol B; Hannegan, Elizabeth T; Bell, Scott; Rahl, Riva; Lu, Amy; Wilson, Charles B

2004-12-01

318

Resurfacing hip replacement and cemented total hip replacement have equivalent outcome at one year in ?a disease matched population: a case-control study of patient reported outcome measures.  

PubMed

Resurfacing hip replacement has demonstrated good survival and outcomes for cohorts of younger male patients, but few controlled studies exist. In this study we compared patient reported outcome measures and satisfaction scores at one year following resurfacing hip replacement in 69 male patients with two control groups of equal numbers undergoing cemented total hip replacement: aged-matched patients and disease matched patients. At one year we found no difference in improvement in patient reported outcome measures between patients undergoing resurfacing hip replacement and disease matched patients, whereas patients undergoing resurfacing hip replacement had a statistically significant improvement in Oxford Hip Score compared to the age-matched controls (p<0.047) although this was below the minimally clinically detectable difference. Resurfacing hip replacement and total ?hip replacement both confer increase in patient reported outcome scores and high patient satisfaction at one year. The results of this study will allow better counselling of patients and help inform ?treatment decisions. PMID:23813167

Ray, Robbie; Goudie, Ewan B; Jenkins, Paul; Gaston, Paul

2013-05-27

319

Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients' views  

PubMed Central

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.

2009-01-01

320

Effect of prior lumbar discectomy on outcome of lumbar fusion: a prospective analysis using the SF-36 measure.  

PubMed

This study prospectively measured patient-reported quality-of-life outcome in patients undergoing fusion for recurrent symptoms after prior discectomy. Analysis of SF-36 data revealed statistically significant improvement in physical function, social function, and bodily pain 1 year postoperatively. Analysis of variance revealed significant interactions based on worker's compensation, litigation status, educational level, and age. The results support the conclusion that the SF-36 is a useful and applicable tool for measuring patient perception and quality-of-life parameters after spinal surgery. SF-36 outcomes demonstrated a reasonable level of success for lumbar fusion in revision spine surgery, with the most significant improvements noted in the categories of pain, physical function, and social function. PMID:9811097

Glassman, S D; Minkow, R E; Dimar, J R; Puno, R M; Raque, G H; Johnson, J R

1998-10-01

321

Characterization of potential outcome measures for future clinical trials in fragile X syndrome.  

PubMed

Clinical trials targeting recently elucidated synaptic defects in fragile X syndrome (FXS) will require outcome measures capable of assessing short-term changes in cognitive functioning. Potentially useful measures for FXS were evaluated here in a test-retest setting in males and females with FXS (N = 46). Good reproducibility, determined by an interclass correlation (ICC) or weighted kappa (kappa) of 0.7-0.9 was seen for RBANS List and Story Memory, NEPSY Tower, Woodcock-Johnson Spatial Relations and the commissions score from the Carolina Fragile X Project Continuous Performance Test (CPT). This study demonstrates the feasibility of generating test profiles containing reliability data, ability levels required for test performance, and refusal rates to assist with choice of outcome measures in FXS and other cohorts with cognitive disability. PMID:18369716

Berry-Kravis, Elizabeth; Sumis, Allison; Kim, Ok-Kyung; Lara, Rebecca; Wuu, Joanne

2008-03-28

322

Do intervention fidelity and dose influence outcomes? Results from the Move to Improve worksite physical activity program  

Microsoft Academic Search

The purpose of this paper is to evaluate the implementation of the Move to Improve worksite physical activity program using a four step framework that includes the following: (i) de- fining the active ingredients, (ii) using good methods to measure implementation, (iii) mon- itoring implementation and (iv) relating imple- mentation to outcomes. The intervention active ingredients consisted of a goal

Mark G. Wilson; Tania B. Basta; Bethany H. Bynum; David M. DeJoy; Robert J. Vandenberg; Rod K. Dishman

2009-01-01

323

Measuring systems of hard to get objects: problems with analysis of measurement results  

Microsoft Academic Search

The problem accessibility of metrological parameters features of objects appeared in many measurements. Especially if it is biological object which parameters very often determined on the basis of indirect research. Accidental component predominate in forming of measurement results with very limited access to measurement objects. Every measuring process has a lot of conditions limiting its abilities to any way processing

Grazyna Gilewska

2005-01-01

324

SCIAMACHY lunar occultation water vapor measurements: retrieval and validation results  

NASA Astrophysics Data System (ADS)

SCIAMACHY (SCanning Imaging Absorption spectroMeter for Atmospheric CHartographY) lunar occultation measurements have been used to derive vertical profiles of stratospheric water vapor for the Southern Hemisphere in the near infrared (NIR) spectral range of 1350-1420 nm. The focus of this study is to present the retrieval methodology including the sensitivity studies and optimizations for the implementation of the radiative transfer model on SCIAMACHY lunar occultation measurements. The study also includes the validation of the data product with the collocated measurements from two satellite occultation instruments and two instruments measuring in limb geometry. The SCIAMACHY lunar occultation water vapor measurement comparisons with the ACE-FTS (Atmospheric Chemistry Experiment Fourier Transform Spectrometer) instrument have shown an agreement of 5% on the average that is well within the reported biases of ACE in the stratosphere. The comparisons with HALOE (Halogen Occultation Experiment) have also shown good results where the agreement between the instruments is within 5%. The validations of the lunar occultation water vapor measurements with MLS (Microwave Limb Sounder) instrument are exceptionally good, varying between 1.5 to around 4%. The validations with MIPAS (Michelson Interferometer for Passive Atmospheric Sounding) are in the range of 10%. A validated dataset of water vapor vertical distributions from SCIAMACHY lunar occultation measurements is expected to facilitate the understanding of physical and chemical processes in the southern mid-latitudes and the dynamical processes related to the polar vortex.

Azam, F.; Bramstedt, K.; Rozanov, A.; Weigel, K.; Bovensmann, H.; Stiller, G. P.; Burrows, J. P.

2012-10-01

325

SCIAMACHY lunar occultation water vapor measurements: retrieval and validation results  

NASA Astrophysics Data System (ADS)

SCIAMACHY lunar occultation measurements have been used to derive vertical profiles of stratospheric water vapor for the Southern Hemisphere in the near infrared (NIR) spectral range of 1350-1420 nm. The focus of this study is to present the retrieval methodology including the sensitivity studies and optimizations for the implementation of the radiative transfer model on SCIAMACHY lunar occultation measurements. The study also includes the validation of the data product with the collocated measurements from two satellite occultation instruments and two instruments measuring in limb geometry. The SCIAMACHY lunar occultation water vapor measurements comparisons with the ACE-FTS instrument have shown an agreement of 5% on the average that is well within the reported biases of ACE in the stratosphere. The comparisons with HALOE have also shown good results where the agreement between the instruments is within 5%. The validations of the lunar occultation water vapor measurements with MLS instrument are exceptionally good varying between 1.5 to around 4%. The validations with MIPAS are in the range of 10%. A validated dataset of water vapor vertical distributions from SCIAMACHY lunar occultation measurements is expected to facilitate the understanding of physical and chemical processes in the southern mid-latitudes and the dynamical processes related to polar vortex.

Azam, F.; Bramstedt, K.; Rozanov, A.; Weigel, K.; Bovensmann, H.; Stiller, G. P.; Burrows, J. P.

2012-02-01

326

Assessment of Aging Individuals with Down Syndrome in Clinical Trials: Results of Baseline Measures  

ERIC Educational Resources Information Center

|A major challenge to developing therapeutic interventions for cognitive loss and dementia in aging individuals with Down syndrome (DS) is the selection of appropriate outcome measures. This report describes the adaptation of the Brief Praxis Test (a nonverbal cognitive test) as a primary outcome measure, as well as the selection of secondary…

Sano, Mary; Aisen, Paul S.; Dalton, Arthur J.; Andrews, Howard F.; Tsai, Wei-Yann

2005-01-01

327

Clinical validity of outcome pain measures in naturally occurring canine osteoarthritis  

PubMed Central

Background The conceptual validity of kinetic gait analysis and disability outcome assessment methods has guided their use in the assessment of pain caused by osteoarthritis (OA). No consensus on the best clinical methods for pain evaluation in canine OA exists, particularly, when evaluating treatments where a smaller treatment effect is anticipated than with pharmacological pain killers. This study thus aimed at determining the technical validity of some clinical endpoints on OA pain in dogs using the green-lipped mussel (GLM)-enriched diet. Twenty-three adult dogs with clinical OA completed the prospective controlled study. All the dogs were fed a balanced diet over a 30-day control period followed by a GLM-enriched diet over a 60-day period. The kinetic gait analysis parameter (PVFBW, peak vertical force adjusted for body weight change), electrodermal activity (EDA), and a standardized multifactorial pain questionnaire (MFQ) were performed on day (D) 0 (inclusion), D30 (start) and D90 (end). The owners completed a client-specific outcome measures (CSOM) instrument twice a week. Motor activity (MA) was continuously recorded in seven dogs using telemetered accelerometric counts. We hypothesized that these methods would produce convergent results related to diet changes. A Type I error of 0.05 was adjusted to correct for the multiplicity of the primary clinical endpoints. Results Neither the EDA nor the MFQ were found reliable or could be validated. Changes in the PVFBW (Padj?=?0.0004), the CSOM (Padj?=?0.006) and the MA intensity (Padj?=?0.02) from D0 to D90 suggested an effect of diet(s). Only the PVFBW clearly increased after the GLM-diet (Padj?=?0.003). The CSOM exhibited a negative relationship with the PVFBW (P?=?0.02) and MA duration (P?=?0.02). Conclusions The PVFBW exhibited the best technical validity for the characterization of the beneficial effect of a GLM-enriched diet. The CSOM and MA appeared less responsive following a GLM-diet, but these measures appeared complementary to gait analysis. Apparently, the CSOM provides the capacity to rely on pain OA assessment influenced by both lameness quantification (PVFBW) and physical functioning (MA).

2012-01-01

328

The Relationship Between Safety Culture and Patient Outcomes: Results From Pilot Meta-Analyses.  

PubMed

Patient safety continues to be a serious health concern in acute-care hospitals. Safety culture has been a frequent target for patient safety improvement over the past decade, based on recommendations from the Institute of Medicine and its use in industry. However, the relationship between safety culture and patient safety in acute-care hospitals has yet to be systematically examined. Thus, a meta-analysis was devised to examine the relationship between patient safety outcomes and safety culture in that setting. Due to the limited empirical research reports available, five small pilot meta-analyses were conducted, examining the relationship between safety culture and each of the following: pressure ulcers, falls, medication errors, nurse-sensitive outcomes, and post-operative outcomes. No significant relationships of any size were identified. An assessment of the relevant literature is presented, offering potential explanations for this surprising finding and an agenda for future research. PMID:23743508

Groves, Patricia S

2013-06-01

329

Radionecrosis induced by stereotactic radiosurgery of brain metastases: results of surgery and outcome of disease.  

PubMed

Sterotactic radiosurgery (SRS) is an effective and commonly employed therapy for metastatic brain tumors. Among complication of this treatment, symptomatic focal cerebral radionecrosis (RN) occurs in 2-10 % of cases. The large diffusion of combined therapies as SRS followed by WBRT and/or CHT, has significantly amplified the number of patients who potentially might be affected by this pathology and neurosurgeons are increasingly called to treat suspected area of RN. Results of surgery of RN in patients with brain metastases are rarely reported in literature, a standardization of diagnostic work-up to correctly identify RN is still lacking and the timing and indications in favour of surgical therapy over medical treatments are not clear as well. In this retrospective study, we review current concept related to RN and analyze the outcome of surgical treatment in a series of 15 patients previously submitted to SRS for brain metastases and affected by suspected radionecrotic lesions. After surgery, all patients except one neurologically improved. No intra-operative complications occurred. Brain edema improved in all patients allowing a reduction or even suspension of corticosteroid therapy. Pure RN was histologically determined in 7 cases; RN and tumor recurrence in the other 8. Overall median survival was 19 months. An aggressive surgical attitude may be advisable in symptomatic patients with suspected cerebral RN, to have histologic confirmation of the lesion, to obtain a long-lasting relief from the mass effect and brain edema and to improve the overall quality of life, sparing a prolonged corticosteroid therapy. PMID:23525948

Telera, Stefano; Fabi, Alessandra; Pace, Andrea; Vidiri, Antonello; Anelli, Vincenzo; Carapella, Carmine Maria; Marucci, Laura; Crispo, Francesco; Sperduti, Isabella; Pompili, Alfredo

2013-03-25

330

Assessing methods for measurement of clinical outcomes and quality of care in primary care practices  

PubMed Central

Purpose To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices. Methods This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources. Results Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening. Conclusions Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and linkage of information from multiple sources that would be required for such assessments.

2012-01-01

331

Indirect Measurements around the Knee — Recent Results from KASCADE  

NASA Astrophysics Data System (ADS)

In the presented analysis of air shower data measured with the KASCADE experiment energy spectra for five mass groups are reconstructed. The results show a change of composition towards heavier elements across the knee but also demonstrate an insufficient description of the data by the used hadronic interaction models QGSJet and SIBYLL.

Ulrich, Holger; Antoni, T.; Apel, W. D.; Badea, F.; Bekk, K.; Bercuci, A.; Blümer, H.; Bozdog, H.; Brancus, I. M.; Büttner, C.; Chilingarian, A.; Daumiller, K.; Doll, P.; Engel, R.; Engler, J.; Feßler, F.; Gils, H. J.; Glasstetter, R.; Haungs, A.; Heck, D.; Hörandel, J. R.; Kampert, K.-H.; Klages, H. O.; Maier, G.; Mathes, H. J.; Mayer, H. J.; Milke, J.; Müller, M.; Obenland, R.; Oehlschläger, J.; Ostapchenko, S.; Petcu, M.; Rebel, H.; Risse, A.; Risse, M.; Roth, M.; Schieler, H.; Scholz, J.; Thouw, T.; Ulrich, H.; Vardanyan, A.; van Buren, J.; Weindl, A.; Wochele, J.; Zabierowski, J.; Zagromski, S.

332

The economics of mitigation and remediation measures - preliminary results  

NASA Astrophysics Data System (ADS)

Today there exists a high spatial density of orbital debris objects at about 800 km altitude. The control of the debris population in this region is important for the long-term evolution of the debris environment. The future debris population is investigated by simulations using the software tool LUCA (Long-Term Orbit Utilization Collision Analysis). It is likely that in the future there will occur more catastrophic collisions. Debris objects generated during such events may again trigger further catastrophic collisions. Current simulations have revealed that the number of debris objects will increase in the future. In a long-term perspective, catastrophic collisions may become the dominating mechanism in generating orbital debris. In this study it is investigated, when the situation will become unstable. To prevent this instability it is necessary to implement mitigation and maybe even remediation measures. It is investigated how these measures affect the future debris environment. It is simulated if the growth of the number of debris objects can be interrupted and how much this may cost. Different mitigation scenarios are considered. Furthermore also one remediation measure, the active removal of high-risk objects, is simulated. Cost drivers for the different measures are identified. It is investigated how selected measures are associated with costs. The goal is to find out which economic benefits may result from mitigation or remediation. First results of a cost benefit analyses are presented.

Wiedemann, Carsten; Flegel, Sven Kevin; Vörsmann, Peter; Gelhaus, Johannes; Moeckel, Marek; Braun, Vitali; Kebschull, Christopher; Metz, Manuel

2012-07-01

333

Evidence for association of hyperprolinemia with schizophrenia and a measure of clinical outcome.  

PubMed

There are multiple genetic links between schizophrenia and a deficit of proline dehydrogenase (PRODH) enzyme activity. However, reports testing for an association of schizophrenia with the resulting proline elevation have been conflicting. The objectives of this study were to investigate whether hyperprolinemia is associated with schizophrenia, and to measure the relationship between plasma proline, and clinical features and symptoms of schizophrenia. We performed a cross-sectional case-control study, comparing fasting plasma proline in 90 control subjects and 64 schizophrenic patients and testing for association of mild to moderate hyperprolinemia with schizophrenia. As secondary analyses, the relationship between hyperprolinemia and five measures of clinical onset, symptoms and outcome were investigated. Patients had significantly higher plasma proline than matched controls (p<0.0001), and categorical analysis of gender adjusted hyperprolinemia showed a significant association with schizophrenia (OR 6.15, p=0.0003). Hyperprolinemic patients were significantly older at their first hospitalization (p=0.015 following correction for multiple testing). While plasma proline level was not related to total, positive or negative symptoms, hyperprolinemic status had a significant effect on length of hospital stay (p=0.005), following adjustment for race, BPRS score, and cross-sectional time from admission to proline measurement. Mild to moderate hyperprolinemia is a significant risk factor for schizophrenia, and may represent an intermediate phenotype in the disease. Hyperprolinemic patients have a significantly later age of first psychiatric hospitalization, suggestive of later onset, and hospital stays 46% longer than non-hyperprolinemic subjects. These findings have implications in the etiology of schizophrenia, and for the clinical management of these patients. PMID:21645996

Clelland, Catherine L; Read, Laura L; Baraldi, Amanda N; Bart, Corinne P; Pappas, Carrie A; Panek, Laura J; Nadrich, Robert H; Clelland, James D

2011-06-08

334

Intercomparison of spectroradiometers for solar spectral irradiance measurements preliminary results  

NASA Astrophysics Data System (ADS)

This paper describes the preliminary results of an intercomparison of spectroradiometers for direct (DNI) and global normal incidence (GNI) irradiance in the visible (VIS) and near infrared (NIR) region. Seven institutions and six spectroradiometers, representing different technologies and manufacturers were involved. All instruments were able to measure GNI; a restricted sub-group of four instruments had the possibility to also measure DNI when equipped with proper collimators. Prior to the intercomparison, all participating institutions calibrated their own instrument(s) according to their usual procedures in order to verify the entire calibration and traceability chain.

Galleano, R.; Zaaiman, W.; Morabito, P.; Minuto, A.; Spena, A.; Bartocci, S.; Fucci, R.; Leanza, G.; Pavanello, D.; Virtuani, A.; Fasanaro, D.; Catena, M.; Norton, M.

2012-10-01

335

Preliminary Results from a Mercury Dry Deposition Measurement Methods Intercomparison  

NASA Astrophysics Data System (ADS)

Over the past fifteen years, a number of intensive field campaigns and measurement networks have provided valuable information on the estimated rates of mercury wet deposition to sensitive ecosystems throughout the world. In contrast, the ability to place bounds on the rates of mercury dry deposition has been hampered by the relative lack of direct measurements of this process. Recently, a number of researchers have performed measurements of mercury dry deposition using a variety of direct and indirect measurement techniques. While these studies have provided important information regarding the potential rates of mercury dry deposition to natural surfaces, little is known about the comparability of the results utilizing these different measurement approaches. During the month of August 2008, a mercury dry deposition measurement methods comparison was conducted in Ann Arbor, Michigan over a nine-day period. Seven research groups participated in the study, with the following measurement approaches: water, cation exchange membrane, chemically treated filter and turf surrogate surfaces; and several micrometeorological modeling methods. Continuous monitoring was conducted for ambient meteorological conditions and elemental, oxidized and particulate mercury concentrations. Preliminary results suggest that study-average mercury dry deposition estimates ranged from 0.17 to 0.59 ng/m2/hour for the group of pure-water surrogate surfaces, the cation exchange membrane and a micrometeorological flux gradient approach. The turf surrogate surface, BrCl spiked-water surface and a gold-coated quartz fiber filter surface resulted in significantly higher mercury dry deposition estimates, with the latter two approaches having been designed to measure total mercury dry deposition. Given that the turf surrogate surface and the cation exchange membrane samplers were designed for long-term deployment (up to one week), these methods were deployed for an additional series of four one-week periods. The turf surrogate surface again resulted in a significantly greater estimate of mercury dry deposition (1.59 ng/m2/hour) than that obtained using the cation exchange membrane (0.19 ng/m2/hour). When the turf surrogate surface estimate was adjusted for total surface area, as opposed to its footprint area, the deposition estimate (0.17 ng/m2/hour) was more consistent with that obtained from the cation exchange membrane.

Marsik, F. J.; Brooks, S.; Gustin, M. S.; Holsen, T.; Landis, M.; Prestbo, E. M.; Poissant, L.

2009-12-01

336

Outcomes of cardiac surgery in patients age ?80 years: results from the National Cardiovascular Network  

Microsoft Academic Search

OBJECTIVESThe purpose of this study was to evaluate characteristics and outcomes of patients age ?80 undergoing cardiac surgery.BACKGROUNDPrior single-institution series have found high mortality rates in octogenarians after cardiac surgery. However, the major preoperative risk factors in this age group have not been identified. In addition, the additive risks in the elderly of valve replacement surgery at the time of

Karen P Alexander; Kevin J Anstrom; Lawrence H Muhlbaier; Ralph D Grosswald; Peter K Smith; Robert H Jones; Eric D Peterson

2000-01-01

337

Aggressive management of juvenile dermatomyositis results in improved outcome and decreased incidence of calcinosis  

Microsoft Academic Search

Background: Long-term consequences of juvenile dermatomyositis (JDM) include onset of calcinosis and subsequent functional impairment. Historic incidence of calcinosis has been reported between approximately 23% and 70%. Recent reports note improved outcome with high-dose steroids, yet the incidence of calcinosis has remained above 30%. Objective: We attempted to determine whether rapid, aggressive disease management can prevent calcinosis and improve functional

Rita E. Fisler; Marilyn G. Liang; Robert C. Fuhlbrigge; Ali Yalcindag; Robert P. Sundel

2002-01-01

338

Prostate cancer outcomes among older men: insurance status comparisons results from CaPSURE database  

Microsoft Academic Search

With growing number of older adults in the United States and complexity of issues related to Medicare and other insurances more research is needed to evaluate an effectiveness of the different insurance types in prevention, screening and treatment of cancer. With prostate cancer being highly prevalent disease in older men, the importance of appropriate treatment and favorable outcomes is imperative.

N Sadetsky; E P Elkin; D M Latini; J DuChane; P R Carroll

2008-01-01

339

Cross-sectional and longitudinal construct validity of two rotator cuff disease-specific outcome measures  

PubMed Central

Background Disease-specific Quality Of Life (QOL) measures are devised to assess the impact of a specific disease across a spectrum of important domains of life. The purpose of this study was to examine the cross-sectional and longitudinal construct validity (sensitivity to change) of two rotator cuff disease-specific measures, the Rotator Cuff-Quality Of Life (RC-QOL) and the Western Ontario Rotator Cuff (WORC) index, in relation to one another and to other joint and limb specific measures in the same population of the patients suffering from rotator cuff pathology. Methods Participants enrolled were consecutive patients who received physical therapy for management of impingement syndrome or received treatment following rotator cuff repair, acromioplasty or decompression surgeries. All subjects received physical therapy treatment and completed four outcome measures at 3 single points (initial, interim, and final). Cross-sectional convergent validity was assessed at each of the 3 time-points by correlating the WORC and RC-QOL's scores to each other and to two alternative scales; a joint-specific scale, the American Shoulder and Elbow Surgeons (ASES) standardized shoulder assessment form and a limb-specific measure, the Upper Extremity Functional Index (UEFI). Non-parametric statistics (Spearman's rho and Wilcoxon-Mann-Whitney tests) examined the construct validity. The standardized response mean (SRM) was used to examine sensitivity to change. Results Forty-one participants entered the study and their scores were compared at 3 cross sectional single points. The correlation coefficients among the 4 measures varied from 0.60 to 0.91. Correlation between corresponding domains of the WORC and RC-QOL varied from 0.45 to 0.85. The known group validity was not significantly different among individual sub-scores and total scores. The final SRMs were (1.42), (1.43), (1.44), and (1.54) for the ASES, RCQOL, WORC, and UEFI respectively. Conclusion The WORC and RC-QOL exhibit similar cross-sectional convergent validity in patients suffering from rotator cuff pathology. The sensitivity to change was very close among all scores, with the UEFI having the highest sensitivity. Further research is needed to examine the extent to which each physical or emotional domain contributes to prognostic or therapeutic decision-making.

Razmjou, Helen; Bean, Andrea; van Osnabrugge, Varda; MacDermid, Joy C; Holtby, Richard

2006-01-01

340

Outcomes of Antiretroviral Therapy in Vietnam: Results from a National Evaluation  

PubMed Central

Objectives Vietnam has significantly scaled up its national antiretroviral therapy (ART) program since 2005. With the aim of improving Vietnam’s national ART program, we conducted an outcome evaluation of the first five years of the program in this concentrated HIV epidemic where the majority of persons enrolled in HIV care and treatment services are people who inject drugs (PWID). The results of this evaluation may have relevance for other national ART programs with significant PWID populations. Design Retrospective cohort analysis of patients at 30 clinics randomly selected with probability proportional to size among 120 clinics with at least 50 patients on ART. Methods Charts of patients whose ART initiation was at least 6 months prior to the study date were abstracted. Depending on clinic size, either all charts or a random sample of 300 charts were selected. Analyses were limited to treatment-naïve patients. Multiple imputations were used for missing data. Results Of 7,587 patient charts sampled, 6,875 were those of treatment-naïve patients (74.4% male, 95% confidence interval [CI]: 72.4–76.5, median age 30, interquartile range [IQR]: 26–34, 62.0% reported a history of intravenous drug use, CI: 58.6–65.3). Median baseline CD4 cell count was 78 cells/mm3 (IQR: 30–162) and 30.4% (CI: 25.8–35.1) of patients were at WHO stage IV. The majority of patients started d4T/3TC/NVP (74.3%) or d4T/3TC/EFV (18.6%). Retention rates after 6, 12, 24, and 36 months were 88.4% (CI: 86.8–89.9), 84.0% (CI: 81.8–86.0), 78.8% (CI: 75.7–81.6), and 74.6% (CI: 69.6–79.0). Median CD4 cell count gains after 6, 12, 24, and 36 months were 94 (IQR: 45–153), 142 (IQR: 78–217), 213 (IQR: 120–329), and 254 (IQR: 135–391) cells/mm3. Patients who were PWID showed significantly poorer retention. Conclusions The study showed good retention and immunological response to ART among a predominantly PWID group of patients despite advanced HIV infections at baseline.

Nguyen, Duc Bui; Do, Nhan Thi; Shiraishi, Ray W.; Le, Yen Ngoc; Tran, Quang Hong; Huu Nguyen, Hai; Medland, Nicholas; Nguyen, Long Thanh; Struminger, Bruce Baird

2013-01-01

341

Statistical approaches to assessing single and multiple outcome measures in dry eye therapy and diagnosis.  

PubMed

Dry eye is a multifactorial disease which would require a broad spectrum of test measures in the monitoring of its treatment and diagnosis. However, studies have typically reported improvements in individual measures with treatment. Alternative approaches involve multiple, combined outcomes being assessed by different statistical analyses. In order to assess the effect of various statistical approaches to the use of single and combined test measures in dry eye, this review reanalyzed measures from two previous studies (osmolarity, evaporation, tear turnover rate, and lipid film quality). These analyses assessed the measures as single variables within groups, pre- and post-intervention with a lubricant supplement, by creating combinations of these variables and by validating these combinations with the combined sample of data from all groups of dry eye subjects. The effectiveness of single measures and combinations in diagnosis of dry eye was also considered. PMID:24112230

Tomlinson, Alan; Hair, Mario; McFadyen, Angus

2013-07-09

342

Estimating the Effect of a Predictor Measured by Two Informants on a Continuous Outcome: A Comparison of Methods  

PubMed Central

Investigators sometimes use information about a given variable obtained from multiple informants. We focus on estimating the effect of a predictor on a continuous outcome, when that predictor cannot be observed directly but is measured by two informants. We describe various approaches to using information from two informants to estimate a regression or correlation coefficient for the effect of the (true) predictor on the outcome. These approaches include methods we refer to as single informant, simple average, optimal weighted average, principal components analysis, and classical measurement error. Each of these five methods effectively uses a weighted average of the informants' reports as a proxy for the true predictor in calculating the correlation or regression coefficient. We compare the performance of these methods in simulation experiments that assume a rounded congeneric measurement model for the relationship between the informants' reports and a true predictor that is a mixture of zeros and positively-distributed continuous values. We also compare the methods' performance in a real data example -the relationship between vigorous physical activity (the predictor) and body mass index (the continuous outcome). The results of the simulations and the example suggest that the simple average is a reasonable choice when there are only two informants.

Javaras, Kristin N.; Goldsmith, H. Hill; Laird, Nan M.

2011-01-01

343

THE MISMATCH BETWEEN INCOME MEASURES AND DIRECT OUTCOME MEASURES OF POVERTY  

Microsoft Academic Search

A key finding of recent poverty research is that there is a significant mismatch between poverty measured using an income approach and poverty measured directly in terms of observed deprivation or other indicators of unacceptably low living standards. The mismatch is substantial and is typically in the range of 50% to 60%. This paper takes this mismatch as a springboard

Bryan Perry

2002-01-01

344

Modifying the Clinical Outcomes in Routine Evaluation Measure for Use with People Who Have a Learning Disability  

ERIC Educational Resources Information Center

|There are few reliable self-report measures suitable for people with a learning disability in reporting psychological distress. This study examines the modification of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), exploring its reliability, using two different presentation styles. One style included a sequencing task then…

Marshall, Keith; Willoughby-Booth, Simon

2007-01-01

345

The Ohio Scales Youth Form: Expansion and Validation of a Self-Report Outcome Measure for Young Children  

ERIC Educational Resources Information Center

|We examined the validity and reliability of a self-report outcome measure for children between the ages of 8 and 11. The Ohio Scales Problem Severity scale is a brief, practical outcome measure available in three parallel forms: Parent, Youth, and Agency Worker. The Youth Self-Report form is currently validated for children ages 12 and older. The…

Dowell, Kathy A.; Ogles, Benjamin M.

2008-01-01

346

Risk-adjusted infection rates in surgery: a model for outcome measurement in hospitals developing new quality improvement programmes  

Microsoft Academic Search

Assessment of healthcare quality is a major challenge in countries such as Hungary where there is limited experience with measurement of patient outcomes. We sought to develop the capacity for valid outcome measurement in Hungarian hospitals using surgical site infection (SSI) surveillance as a model and to identify areas for improvement by comparing SSI rates in Hungarian hospitals to benchmarks

L Gulácsi; Zs. Tatár Kiss; D. A Goldmann; W. C Huskins

2000-01-01

347

From Radical Mastectomy to Breast-Conserving Therapy and Oncoplastic Breast Surgery: A Narrative Review Comparing Oncological Result, Cosmetic Outcome, Quality of Life, and Health Economy  

PubMed Central

Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view.

Kaviani, Ahmad; Sodagari, Nassim; Sheikhbahaei, Sara; Eslami, Vahid; Hafezi-Nejad, Nima; Safavi, Amin; Noparast, Maryam; Fitoussi, Alfred

2013-01-01

348

Measuring outcomes in outpatient child psychiatry: The contribution of electronic technologies and parent report  

Microsoft Academic Search

The objective of this study was to evaluate the impact of electronic technologies on the completion of a standardized rating form in an outpatient child psychiatry clinic, and the feasibility of adding a parent-report measure to the form. An electronic Outcomes Rating Form (e-ORF) was used in conjunction with a web-based patient tracking system and digital pens which allowed form

J. Michael Murphy; Bruce Masek; Rebecca Babcock; Michael Jellinek; Joseph Gold; Stacey Drubner; Ken Sklar; Karen Hacker

2011-01-01

349

Full polarimetry measurements of stimulated electromagnetic emissions: First results  

NASA Astrophysics Data System (ADS)

A theory and technique for the measurements of the full state of polarization (SOP) for wideband electromagnetic HF emissions from the ionosphere are introduced. The technique was employed in a recent experiment at the Sura ionospheric HF pumping facility near Nizhniy Novgorod, Russia, to measure the full SOP of stimulated electromagnetic emissions (SEE) in their steady state. Measurements were made for O-mode polarized pump waves at two different frequencies: one below and one slightly above the fourth electron gyroharmonic frequency. The wideband spectral parameters measured in this experiment include the horizontal intensity, the degree of horizontal circular polarization, the degree of horizontal polarization and the tilt angle of the horizontal polarization ellipse. Evaluation of the data collected demonstrates that the technique can be used for HF polarimetry and that, in particular, such measurements provide useful new diagnostics for SEE. Among the most important results regarding the polarimetry of SEE were low degrees of circular polarization in the frequency range between the peak of the broad upshifted maximum and the pump; some SEE features had degree of circularity and tilt angle values that were consistent with slightly oblique waves indicative of a distributed SEE source region; and the pump was found to have changed from an initial left-handed polarized state to a right-handed polarized state during steady state.

Carozzi, T. D.; Thidé, B.; Leyser, T. B.; Komrakov, G.; Frolov, V.; Grach, S.; Sergeev, E.

2001-10-01

350

Major Results from MRO, MO, and MGS Accelerometer Experiment Measurements  

NASA Astrophysics Data System (ADS)

The 2006 Mars Reconnaissance Orbiter (MRO) Accelerometer Experiment measurements above 100km give neutral densities and inferred neutral temperatures over the entire Southern Hemisphere of Mars. When combined with our previous accelerometer experiments on Mars Global Surveyor and Mars Odyssey global measurements are obtained showing variations with latitude, seasons, day/night, aphelion/perihelion, and solar activity. The measurements also show a stability of climatology when compared with MEX Stellar Occultation measurements. Temperatures are found to be fairly constant within 40° latitude of the equator rising with altitude due to solar euv radiation absorption at higher altitudes. Exospheric temperatures are discovered to be near 130 K on the nightside (3am) and near 200K on the dayside (3pm). MTGCM models are about the same as observed at night, but somewhat warmer than observed on the dayside. The cooler dayside observations may indicate somewhat less atmospheric escape than the MTGCM temperatures would predict. We have discovered winter polar warming in the lower thermosphere from the accelerometer measurements. Apparently, meridional flow from the summer to winter hemisphere results in strong adiabatic heating near the winter pole causing the warming. This effect is stronger at winter North Pole than winter South Pole apparently due to the planet being near perihelion at North Pole winter.

Keating, G.; Bougher, S.; Theriot, M.; Tolson, R.

2007-08-01

351

Development and Validation of a Multifactorial Treatment Outcome Measure for Eating Disorders.  

ERIC Educational Resources Information Center

|Developed a brief self-report inventory to evaluate treatment outcome for anorexia and bulimia nervosa, the Multifactorial Assessment of Eating Disorders, and evaluated the instrument in a series of studies involving 1,054 women. Results support a stable factor structure and satisfactory reliability and validity, and establish normative data.…

Anderson, Drew A.; Williamson, Donald A.; Duchmann, Erich G.; Gleaves, David H.; Barbin, Jane M.

1999-01-01

352

Salvage Radical Prostatectomy: Outcome Measured by Serum Prostate Specific Antigen Levels  

Microsoft Academic Search

We reviewed our experience with salvage radical prostatectomy for locally recurrent cancer in 40 patients to assess the current complication rate and the results using prostate specific antigen (PSA) as an indicator of treatment outcome and to identify better criteria for the selection of appropriate candidates for this operation. Most recurrent cancers were detected by digital rectal examination (26 patients)

Eamonn Rogers; Makoto Ohori; Vahan S. Kassabian; Thomas M. Wheeler; Peter T. Scardino

1995-01-01

353

Quality of Medical Care Assessment Using Outcome Measures: Volume II. Eight Disease-Specific Applications.  

National Technical Information Service (NTIS)

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

1976-01-01

354

Results from the G0 forward angle measurement  

SciTech Connect

The results from the G0 forward angle experiment are reported in this talk. The parity-violating asymmetry of elastic e-p scattering has been measured within the range of the four-momentum transfer (Q2) from 0.12 to 1.0 (GeV/c)2, which yields linear combinations of the strange electric and magnetic form factors of the nucleon, G{sub E}{sup s} + etaG{sub M}{sup s}, in the same Q2 range. The G0 results, combined with the measurements from other experiments, indicate that G{sub E}{sup s} and G{sub M}{sup s} are both likely non-zero.

J. Liu

2006-07-01

355

Simplifications in analyzing positron emission tomography data: effects on outcome measures.  

PubMed

Initial validation studies of new radiotracers generally involve kinetic models that require a measured arterial input function. This allows for the separation of tissue binding from delivery and blood flow effects. However, when using a tracer in a clinical setting, it is necessary to eliminate arterial blood sampling due to its invasiveness and the extra burden of counting and analyzing the blood samples for metabolites. In some cases, it may also be necessary to replace dynamic scanning with a shortened scanning period some time after tracer injection, as is done with FDG (F-18 fluorodeoxyglucose). These approximations represent loss of information. In this work, we considered several questions related to this: (1) Do differences in experimental conditions (drug treatments) or populations affect the input function, and what effect, if any, does this have on the final outcome measure? (2) How do errors in metabolite measurements enter into results? (3) What errors are incurred if the uptake ratio is used in place of the distribution volume ratio? (4) Is one- or two-point blood sampling any better for FDG data than the standardized uptake value? and (5) If blood sampling is necessary, what alternatives are there to arterial blood sampling? The first three questions were considered in terms of data from human dynamic positron emission tomography (PET) studies under conditions of baseline and drug pretreatment. Data from [11C]raclopride studies and those from the norepinephrine transporter tracer (S,S)-[11C]O-methyl reboxetine were used. Calculation of a metabolic rate for FDG using the operational equation requires a measured input function. We tested a procedure based on two blood samples to estimate the plasma integral and convolution that occur in the operational equation. There are some tracers for which blood sampling is necessary. Strategies for brain studies involve using the internal carotids in estimating the radioactivity after correcting for partial volume and spillover in order to eliminate arterial sampling. Some venous blood samples are still required for metabolite measurements. The ultimate solution to the problem of arterial sampling may be a wrist scanner, which acts as a small PET camera for imaging the arteries in the wrist. This is currently under development. PMID:17921027

Logan, Jean; Alexoff, David; Kriplani, Aarti

2007-08-27

356

Aerodynamics of Dragonfly in Hover: Force measurements and PIV results  

NASA Astrophysics Data System (ADS)

We useda pair of dynamically scaled robotic dragonfly model wings to investigate the aerodynamic effects of wing-wing interaction in dragonflies. We follow the wing kinematics of real dragonflies in hover, while systematically varied the phase difference between the forewing and hindwing. Instantaneous aerodynamic forces and torques were measured on both wings, while flow visualization and PIV results were obtained. The results show that, in hovering flight, wing-wing interaction causes force reduction for both wings at most of the phase angle differences except around 0 degree (when the wings are beating in-phase).

Deng, Xinyan; Hu, Zheng

2009-11-01

357

Using discrete choice experiments to estimate a preference-based measure of outcome—An application to social care for older people  

Microsoft Academic Search

This paper reports the results of a study that used discrete choice experiment (DCE) methodology to estimate quality weights for a of social care outcome measure. To reflect different states of need, a five-dimensional profile measure was developed. Experimental design techniques were used to derive a sample of states for which preferences were elicited. The DCE approach was employed to

Mandy Ryan; Ann Netten; Diane Skåtun; Paul Smith

2006-01-01

358

[Assertive community treatment in Japan: results of fidelity measurements].  

PubMed

Mental health system reform oriented toward realizing the transition from "institution-based medical treatment" to "community-based care" is now taking place in Japan. Although the number of psychiatric beds is slow to decrease, community resources are increasing, and differentiation of those services is the next challenge. Assertive Community Treatment (ACT) is a service which provides 24/7 community outreach by a multidisciplinary team to persons with severe mental illness. Currently, some 10 to 15 ACT teams are providing services in Japan; this number is far from adequate. This is due to the lack of direct funding for ACT in the current mental health system. However, ACT is increasing as a result of combining available funding sources, such as psychiatric home visit nursing and welfare funding. The ACT Network, a voluntary association, was established to disseminate ACT and ensure its quality. Fidelity scales measure faithfulness to the original model. DACTS, a fidelity scale developed in the U.S., is widely used to measure ACT fidelity. In Japan, ACT Network implements a Japanese version of fidelity measurement for ACT around Japan. Results of fidelity measurements of 12 ACT teams in 2009 showed that the ACT teams were providing services which adhered more closely to the original model than in the previous year, but problems remained. Some issues, such as increasing care management in services, can be addressed through maturation of ACT teams, but other issues, such as relatively low service density and allocation of employment specialists, cannot be resolved without a funding mechanism. To disseminate ACT and support more people with severe mental illness in the community, it is necessary to build ACT into the community mental health system with sufficient funding, and to monitor its quality using measures such as fidelity scales. PMID:21815473

Setoya, Yutaro

2011-01-01

359

Autologous stem cell transplantation for primary refractory Hodgkin's disease: results and clinical variables affecting outcome  

Microsoft Academic Search

Background: Patients with primary refractory Hodgkin's disease (PR-HD) have a dismal prognosis when treated with conventional salvage chemotherapy. We analyzed time to treatment failure (TTF), overall sur- vival (OS) and clinical variables influencing the outcome in patients undergoing autologous stem cell trans- plantation (ASCT) for PR-HD and reported to the Grupo Español de Linfomas\\/Trasplante Autólogo de Médula Ósea (GEL\\/TAMO). Patients

M. Constans; A. Sureda; M. J. Terol; R. Arranz; M. D. Caballero; A. Iriondo; I. Jarque; E. Carreras; J. M. Moraleda; D. Carrera; A. León; A. López; C. Albó; J. Díaz-Mediavilla; P. Fernández-Abellán; J. C. García-Ruiz; F. Hernández-Navarro; R. Mataix; J. Petit; M. J. Pascual; J. Rifón; J. García-Conde; J. M. Fernández-Rañada; M. V. Mateos; J. Sierra; E. Conde

2003-01-01

360

Liver transplantation outcomes for early-stage hepatocellular carcinoma: results of a multicenter study.  

PubMed

The incidence of hepatocellular carcinoma (HCC), a frequent and incurable complication of cirrhosis, continues to rise. Orthotopic liver transplantation (OLT) has been proposed as a treatment for unresectable, intrahepatic HCC limited in extent to the Milan criteria adopted by the United Network of Organ Sharing (UNOS) in 1998. More recently, somewhat less restrictive University of California, San Francisco (UCSF)10, criteria were proposed. To examine the long-term outcomes of OLT for HCC patients and to assess the UNOS policy of assigning weighted allocation points to patients with HCC, we retrospectively analyzed 144 patients (113 after 1998) with HCC who underwent OLT over an 11-year period at 3 institutions from UNOS Region 1. We compared their outcomes with 525 patients (272 after 1998) who underwent OLT for nonmalignant liver disease. The 1- and 5-year survival rates were 80.3% and 46.7%, respectively, for patients with HCC and 81.5% and 70.6%, respectively, for patients without HCC (P = .020). However, there was no difference in survival between HCC and non-HCC patients after implementation of disease-specific allocation for HCC in 1998. A higher proportion of the HCC cohort was older and male and had chronic HCV infection and alcoholic liver disease. In univariate analysis, having alpha-fetoprotein (AFP) levels of 10 ng/mL or less and meeting clinical and pathologic UCSF criteria were each significant predictors of improved survival (P = .005, P = .02, and P = .03, respectively). AFP greater than 10 ng/mL and exceeding pathologic UCSF criteria were also significant predictors of recurrence (P = .003 and P = .02, respectively). In conclusion, taken together, our data suggest that OLT is an acceptable option for patients with early HCC and that UCSF criteria predict outcome better than Milan or UNOS criteria. Regardless of which criteria are adopted to define eligibility, strict adherence to the criteria is important to achieve acceptable outcomes. PMID:15497158

Leung, Jessica Y; Zhu, Andrew X; Gordon, Fredric D; Pratt, Daniel S; Mithoefer, Abigail; Garrigan, Kathryn; Terella, Adam; Hertl, Martin; Cosimi, A Benedict; Chung, Raymond T

2004-11-01

361

Arthroscopic Release of the Long Head of the Biceps TendonFunctional Outcome and Clinical Results  

Microsoft Academic Search

Background: Treatment of chronic, refractory biceps tendinitis remains controversial. The authors sought to evaluate clinical and functional outcomes of arthroscopic release of the long head of the biceps tendon.Hypothesis: In specific cases of refractory biceps tendinitis, site-specific release of the long head of the biceps tendon may yield relief of pain and symptoms.Study Design: Case series; Level of evidence, 4.Methods:

Anne M. Kelly; Mark C. Drakos; Stephen Fealy; Samuel A. Taylor; Stephen J. OBrien

2005-01-01

362

Management Strategies and Determinants of Outcome in Acute Major Pulmonary Embolism: Results of a Multicenter Registry  

Microsoft Academic Search

Objectives. The present study investigated current management strategies as well as the clinical course of acute major pulmonary embolism.Background. The clinical outcome of patients with acute pulmonary embolism who present with overt or impending right heart failure has not yet been adequately elucidated.Methods. The 204 participating centers enrolled a total of 1,001 consecutive patients. The inclusion criteria were based on

Wolfgang Kasper; Stavros Konstantinides; Annette Geibel; Manfred Olschewski; Fritz Heinrich; Klaus D Grosser; Klaus Rauber; Stein Iversen; Matthias Redecker; Joachim Kienast

1997-01-01

363

Surgical versus Non-Operative Treatment for Lumbar Disc Herniation: Four-Year Results for the Spine Patient Outcomes Research Trial (SPORT)  

PubMed Central

Study Design Concurrent prospective randomized and observational cohort study. Objectives To assess the 4-year outcomes of surgery vs. non-operative care. Background Although randomized trials have demonstrated small short-term differences in favor of surgery, long-term outcomes comparing surgical to non-operative treatment remain controversial. Methods Surgical candidates with imaging-confirmed lumbar intervertebral disc herniation meeting SPORT eligibility criteria enrolled into prospective randomized (501 participants) and observational cohorts (743 participants) at 13 spine clinics in 11 US states. Interventions were standard open discectomy versus usual non-operative care. Main outcome measures were changes from baseline in the SF-36 Bodily Pain (BP) and Physical Function (PF) scales and the modified Oswestry Disability Index (ODI - AAOS/Modems version) assessed at 6 weeks, 3 and 6 months, and annually thereafter. Results Non-adherence to treatment assignment caused the intent-to-treat analyses to underestimate the treatment effects. In the 4-year combined as-treated analysis, those receiving surgery demonstrated significantly greater improvement in all the primary outcome measures (mean change Surgery vs. Non-operative; treatment effect; 95% CI): BP (45.6 vs. 30.7; 15.0; 11.8 to 18.1), PF (44.6 vs. 29.7; 14.9; 12.0 to 17.8) and ODI (?38.1 vs. ?24.9; ?13.2; ?15.6 to ?10.9). The percent working was similar between the surgery and non-operative groups, 84.4% vs. 78.4% respectively. Conclusion In a combined as-treated analysis at 4 years, patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operatively treated patients in all primary and secondary outcomes except work status. Trial Registration Spine Patient Outcomes Research Trial (SPORT): Intervertebral Disc Herniation; #NCT00000410; http://www.clinicaltrials.gov/ct/show/NCT00000410?order=2

Weinstein, James N.; Lurie, Jon D.; Tosteson, Tor D.; Tosteson, Anna N. A.; Blood, Emily; Abdu, William A.; Herkowitz, Harry; Hilibrand, Alan; Albert, Todd; Fischgrund, Jeffrey

2009-01-01

364

Prospective Validation that Vulnerable Plaque Associated with Major Adverse Outcomes Have Larger Plaque Volume, Less Dense Calcium, and More Non-Calcified Plaque by Quantitative, Three-Dimensional Measurements Using Intravascular Ultrasound with Radiofrequency Backscatter Analysis : Results from the ATLANTA I Study.  

PubMed

Whether quantitative, two-dimensional, and three-dimensional plaque measurements by intravascular ultrasound with radiofrequency backscatter (IVUS/VH) are different between intermediate lesions with or without major adverse cardiovascular events (MACE) is unknown. IVUS/VH-derived parameters were compared in 60 patients with an intermediate coronary lesion (40-70 %) between lesions that did or did not result in MACE over 12 months. IVUS/VH measurements were done at the site of the minimal lumen area (MLA) and on a per-plaque basis, defined by 40 % plaque burden. Pre-specified, adjudicated MACE events occurred in 5 of 60 patients (8.3 %). MACE lesions had larger plaque burden (65 % vs. 53 %, p?=?0.004), less dense calcium (6.6 % vs. 14.7 %, p?=?0.05), and more non-calcified plaque, mostly fibrofatty kind (17.6 % vs. 10 %, p?=?0.02). Intermediate coronary lesions associated with MACE at 12 months have more plaque, less dense calcium, and more non-calcified plaque, particularly fibrofatty tissue by IVUS/VH. PMID:23695823

Vazquez-Figueroa, Jesus G; Rinehart, Sarah; Qian, Zhen; Joshi, Parag H; Sharma, Abhinav; Lee, James; Anderson, Hunt; Murrieta, Laura; Wilmer, Charles; Carlson, Harold; Taylor, Kenneth; Ballard, William; Karmpaliotis, Dimitri; Kalynych, Anna; Brown, Charles; Voros, Szilard

2013-05-22

365

Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis.  

PubMed

OBJECTIVE To evaluate how age affects functional outcome 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 assess functional outcome 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 functional outcome 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

2003-08-01

366

Patient-reported outcome measures for sleep disorders and related problems: clinical and research applications.  

PubMed

Patients with sleep disorders are most concerned with the impact of these diseases on their quality of life. Patient-reported outcome (PRO) measurement tools, which assess aspects of a patient's health status that come directly from the patient, are well suited to evaluate quality of life related to sleep disorders. Although PRO data are subjective, they can be quantified, evaluated for reliability and reproducibility, and used to answer questions of clinical and research importance. This article reviews various PRO measure tools used for sleep disorders in clinical and research settings. These instruments may play a role in screening, diagnosis, and monitoring of various sleep disorders. PMID:23732593

Medarov, Boris I; Victorson, David E; Judson, Marc A

2013-06-01

367

Results from the BABAR Fully Inclusive Measurement of B? Xs?  

SciTech Connect

We present preliminary results from a lepton-tagged fully-inclusive measurement of B {yields} X{sub s}{gamma} decays, where X{sub s} is any strange hadronic state. Results are based on a BABAR data set of 88.5 million B{bar B} pairs at the {Upsilon}(4S) resonance. We present a reconstructed photon energy spectrum in the {Upsilon}(4S) frame, and partial branching fractions above minimum reconstructed photon energies of 1.9, 2.0, 2.1 and 2.2 GeV. We then convert these to measurements of partial branching fractions and truncated first and second moments of the true photon energy distribution in the B rest frame, above the same minimum photon energy values. The full correlation matrices between the first and second moments are included to allow fitting to any parameterized theoretical calculation. We also measure the direct CP asymmetry {Alpha}{sub CP}(B {yields} X{sub s+d{gamma}}) (based on the charge of the tagging lepton) above a reconstructed photon energy of 2.2 GeV.

Aubert, B.; Barate, R.; Boutigny, D.; Couderc, F.; Karyotakis, Y.; Lees, J.P.; Poireau, V.; Tisserand, V.; Zghiche, A.; /Annecy, LAPP; Grauges, E.; /Barcelona, IFAE; Palano, A.; Pappagallo, M.; Pompili, A.; /Bari U. /INFN, Bari; Chen, J.C.; Qi, N.D.; Rong, G.; Wang, P.; Zhu, Y.S.; /Beijing, Inst. High Energy Phys.; Eigen, G.; Ofte, I.; Stugu, B. /University of Bergen, Institute of Physics, N-5007 Bergen, Norway /LBL, Berkeley /UC, Berkeley /Birmingham U. /Ruhr U., Bochum /Bristol U. /British Columbia U. /Brunel U. /Novosibirsk, IYF /UC, Irvine /UCLA /UC, Riverside /UC, San Diego /UC, Santa Barbara /UC, Santa Cruz /Caltech /Cincinnati U. /Colorado U. /Colorado State U. /Dortmund U. /Dresden, Tech. U. /Ecole Polytechnique /Edinburgh U. /Ferrara U. /INFN, Ferrara /Frascati /Genoa U. /INFN, Genoa /Harvard U. /Heidelberg U. /Imperial Coll., London /Iowa U. /Iowa State U. /Orsay, LAL /LLNL, Livermore /Liverpool U. /Queen Mary, U. of London /Royal Holloway, U. of London /Louisville U. /Manchester U. /Maryland U. /Massachusetts U., Amherst /MIT, LNS /McGill U. /Milan U. /INFN, Milan /Mississippi U. /Montreal U. /Mt. Holyoke Coll. /Naples U. /INFN, Naples /NIKHEF, Amsterdam /Notre Dame U. /Ohio State U. /Oregon U. /Padua U. /INFN, Padua /Paris U., VI-VII /Pennsylvania U. /Perugia U. /INFN, Perugia /Pisa U. /INFN, Pisa /Prairie View A-M /Princeton U. /Rome U. /INFN, Rome /Rostock U. /Rutherford /DAPNIA, Saclay /University of South Carolina, Columbia, South Carolina 29208, USA /SLAC /Stanford U., Phys. Dept. /SUNY, Stony Brook /Tennessee U. /Texas U. /Texas U., Dallas /Turin U. /INFN, Turin /Trieste U. /INFN, Trieste /Valencia U., IFIC /Vanderbilt U. /Victoria U. /Warwick U. /Wisconsin U., Madison /Yale U. /Yale U. /Yale U. /Yale U. /Yale U. /Yale U.

2005-09-20

368

The Cultural Adaptability of Intermediate Measures of Functional Outcome in Schizophrenia*  

PubMed Central

The Measurement and Treatment Research to Improve Cognition in Schizophrenia initiative was designed to encourage the development of cognitive enhancing agents for schizophrenia. For a medication to receive this indication, regulatory agencies require evidence of improvement in both cognition and functional outcome. Because medication trials are conducted across multiple countries, we examined ratings of the cross-cultural adaptability of 4 intermediate measures of functional outcome (Independent Living Scales, UCSD Performance-based Skills Assessment, Test of Adaptive Behavior in Schizophrenia, Cognitive Assessment Interview [CAI]) made by experienced clinical researchers at 31 sites in 8 countries. English-speaking research staff familiar with conducting medication trials rated the extent to which each subscale of each intermediate measure could be applied to their culture and to subgroups within their culture based on gender, geographic region, ethnicity, and socioeconomic status on the Cultural Adaptation Rating Scale. Ratings suggested that the CAI would be easiest to adapt across cultures. However, in a recent study, the CAI was found to have weaker psychometric properties than some of the other measures. Problems were identified for specific subscales on all the performance-based assessments across multiple countries. India, China, and Mexico presented the greatest challenges in adaptation. For international clinical trials, it would be important to use the measures that are most adaptable, to adapt subscales that are problematic for specific countries or regions, or to develop a battery composed of the subscales from different instruments that may be most acceptable across multiple cultures with minimal adaptation.

Rubin, Maureen; Fredrick, Megan M.; Mintz, Jim; Nuechterlein, Keith H.; Schooler, Nina R.; Jaeger, Judith; Peters, Nancy M.; Buller, Raimund; Marder, Stephen R.; Dube, Sanjay

2012-01-01

369

Evaluation of Clinical Outcomes for Gastric Bypass Surgery: Results from a Comprehensive Follow-up Study  

Microsoft Academic Search

Background  Laparoscopic gastric bypass (LGB) surgery markedly increases percent excess weight loss (%EWL) and obesity-related co-morbidities.\\u000a However, poor study quality and minimal exploration of clinical, behavioral, and psychosocial mechanisms of weight loss have\\u000a characterized research to date.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We conducted a comprehensive assessment of n=100 LGB patients surveyed 2–3 years following surgery using standardized measures.\\u000a \\u000a \\u000a \\u000a \\u000a Results  Mean %EWL at follow-up was 59.1±17.2%. This

Garry Welch; Cheryl Wesolowski; Sofija Zagarins; Jay Kuhn; John Romanelli; Jane Garb; Nancy Allen

2011-01-01

370

Measuring 35S of Aerosol Sulfate: Techniques and First Results  

NASA Astrophysics Data System (ADS)

On a global and regional level, the cycling of sulfur in the environment has consequences for air quality, human health, and may contribute to global climate change. Due to its multiple oxidation states, the sulfur cycle is very complex and poorly understood. Stable isotopes are currently used to understand reaction pathways as well as sources and sinks of sulfurous compounds in the environment. Sulfur also has one short lived (?1/2 ~87 d) radioactive isotope (35S) which is continuously made in the atmosphere by the cosmic ray spallation of argon, is then quickly oxidized to 35SO2 and enters the atmospheric sulfur cycle. The short-lived radioactive nature of this isotope of sulfur provides us with potentially powerful tracer for understanding the time scales at which sulfur is oxidized, deposited, and transported in the atmosphere and the deposition of atmospheric sulfate into rivers and water catchments. However, despite its potential, the use of 35S as a tracer of aerosol chemistry has not been fully exploited, Here we present details of instrumental set up for measuring 35S in aerosol sulfate and some preliminary results of measurements of 35S abundances in aerosols from Riverside (inland) and La Jolla (coastal) CA and discuss the sensitivity and limitations of the measurements in providing insights into day/night aerosol chemistry (Riverside) as well as the uptake of SO2 pollution in coastal environments by sea-salt aerosols. Also, we present preliminary results from measurement of sulfate in river water in Ecuador before and after precipitation events.

Brothers, L. A.; Dominguez, G.; Bluen, B.; Corbin, A.; Abramian, A.; Thiemens, M. H.

2007-12-01

371

Measuring systems of hard to get objects: problems with analysis of measurement results  

NASA Astrophysics Data System (ADS)

The problem accessibility of metrological parameters features of objects appeared in many measurements. Especially if it is biological object which parameters very often determined on the basis of indirect research. Accidental component predominate in forming of measurement results with very limited access to measurement objects. Every measuring process has a lot of conditions limiting its abilities to any way processing (e.g. increase number of measurement repetition to decrease random limiting error). It may be temporal, financial limitations, or in case of biological object, small volume of sample, influence measuring tool and observers on object, or whether fatigue effects e.g. at patient. It's taken listing difficulties into consideration author worked out and checked practical application of methods outlying observation reduction and next innovative methods of elimination measured data with excess variance to decrease of mean standard deviation of measured data, with limited aomunt of data and accepted level of confidence. Elaborated methods wee verified on the basis of measurement results of knee-joint width space got from radiographs. Measurements were carried out by indirectly method on the digital images of radiographs. Results of examination confirmed legitimacy to using of elaborated methodology and measurement procedures. Such methodology has special importance when standard scientific ways didn't bring expectations effects.

Gilewska, Grazyna

2005-02-01

372

Item Response Theory and Health Outcomes Measurement in the 21st Century  

PubMed Central

Item response theory (IRT) has a number of potential advantages over classical test theory in assessing self-reported health outcomes. IRT models yield invariant item and latent trait estimates (within a linear transformation), standard errors conditional on trait level, and trait estimates anchored to item content. IRT also facilitates evaluation of differential item functioning, inclusion of items with different response formats in the same scale, and assessment of person fit and is ideally suited for implementing computer adaptive testing. Finally, IRT methods can be helpful in developing better health outcome measures and in assessing change over time. These issues are reviewed, along with a discussion of some of the methodological and practical challenges in applying IRT methods.

Hays, Ron D.; Morales, Leo S.; Reise, Steve P.

2006-01-01

373

Local Intraarterial Fibrinolysis of Thromboemboli Occurring during Endovascular Treatment of Intracerebral Aneurysm: A Comparison of Anatomic Results and Clinical Outcome  

Microsoft Academic Search

PURPOSE: We describe our therapeutic strategy and correlate the anatomic results and clinical outcomes in patients who received immediate fibrinolytic therapy for thromboembolic complications occurring during endovascular treatment of an intracerebral aneurysm. METHODS: The medical records and angiographic examinations of 19 patients were re- viewed. All endovascular procedures were performed with the patients under general anesthesia and fully heparinized. Thirteen

M. Cronqvist; L. Pierot; A. Boulin; C. Cognard; L. Castaings; J. Moret

374

Application of Terahertz Radiation to Soil Measurements: Initial Results  

PubMed Central

Developing soil sensors with the possibility of continuous online measurement is a major challenge in soil science. Terahertz (THz) electromagnetic radiation may provide the opportunity for the measurement of organic material density, water content and other soil parameters at different soil depths. Penetration depth and information content is important for a functional soil sensor. Therefore, we present initial research on the analysis of absorption coefficients of four different soil samples by means of THz transmission measurements. An optimized soil sample holder to determine absorption coefficients was used. This setup improves data acquisition because interface reflections can be neglected. Frequencies of 340 GHz to 360 GHz and 1.627 THz to 2.523 THz provided information about an existing frequency dependency. The results demonstrate the potential of this THz approach for both soil analysis and imaging of buried objects. Therefore, the THz approach allows different soil samples to be distinguished according to their different absorption properties so that relations among soil parameters may be established in future.

Dworak, Volker; Augustin, Sven; Gebbers, Robin

2011-01-01

375

Measuring dosage: a key factor when assessing the relationship between prenatal case management and birth outcomes.  

PubMed

To assess whether a measure of prenatal case management (PCM) dosage is more sensitive than a dichotomous PCM exposure measure when evaluating the effect of PCM on low birthweight (LBW) and preterm birth (PTB). We constructed a retrospective cohort study (N = 16,657) of Iowa Medicaid-insured women who had a singleton live birth from October 2005 to December 2006; 28 % of women received PCM. A PCM dosage measure was created to capture duration of enrollment, total time with a case manager, and intervention breadth. Propensity score (PS)-adjusted odds ratios (ORs), and 95 % confidence intervals (95 % CIs) were calculated to assess the risk of each outcome by PCM dosage and the dichotomous PCM exposure measure. PS-adjusted ORs of PTB were 0.88 (95 % CI 0.70-1.11), 0.58 (95 % CI 0.47-0.72), and 1.43 (95 % CI 1.23-1.67) for high, medium, and low PCM dosage, respectively. For LBW, the PS-adjusted ORs were 0.76 (95 % CI 0.57-1.00), 0.64 (95 % CI 0.50-0.82), and 1.36 (95 % CI 1.14-1.63), for high, medium, and low PCM dosage, respectively. The PCM dichotomous participation measure was not significantly associated with LBW (OR = 0.95, 95 % CI 0.82-1.09) or PTB (0.97, 95 % CI 0.87-1.10). The reference group in each analysis is No PCM. PCM was associated with a reduced risk of adverse pregnancy outcomes for Medicaid-insured women in Iowa. PCM dosage appeared to be a more sensitive measure than the dichotomous measure of PCM participation. PMID:23010864

Slaughter, Jaime C; Issel, L Michele; Handler, Arden S; Rosenberg, Deborah; Kane, Debra J; Stayner, Leslie T

2013-10-01

376

Primary outcome indices in illicit drug dependence treatment research: systematic approach to selection and measurement of drug use end-points in clinical trials  

PubMed Central

Aims Clinical trials test the safety and efficacy of behavioral and pharmacological interventions in drug-dependent individuals. However, there is no consensus about the most appropriate outcome(s) to consider in determining treatment efficacy or on the most appropriate methods for assessing selected outcome(s). We summarize the discussion and recommendations of treatment and research experts, convened by the US National Institute on Drug Abuse, to select appropriate primary outcomes for drug dependence treatment clinical trials, and in particular the feasibility of selecting a common outcome to be included in all or most trials. Methods A brief history of outcomes employed in prior drug dependence treatment research, incorporating perspectives from tobacco and alcohol research, is included. The relative merits and limitations of focusing on drug-taking behavior, as measured by self-report and qualitative or quantitative biological markers, are evaluated. Results Drug-taking behavior, measured ideally by a combination of self-report and biological indicators, is seen as the most appropriate proximal primary outcome in drug dependence treatment clinical trials. Conclusions We conclude that the most appropriate outcome will vary as a function of salient variables inherent in the clinical trial, such as the type of intervention, its target, treatment goals (e.g. abstinence or reduction of use) and the perspective being taken (e.g. researcher, clinical program, patient, society). It is recommended that a decision process, based on such trial variables, be developed to guide the selection of primary and secondary outcomes as well as the methods to assess them.

Donovan, Dennis M.; Bigelow, George E.; Brigham, Gregory S.; Carroll, Kathleen M.; Cohen, Allan J.; Gardin, John G.; Hamilton, John A.; Huestis, Marilyn A.; Hughes, John R.; Lindblad, Robert; Marlatt, G. Alan; Preston, Kenzie L.; Selzer, Jeffrey A.; Somoza, Eugene C.; Wakim, Paul G.; Wells, Elizabeth A.

2012-01-01

377

Dynamic patient data bases: the foundation of an integrated approach to outcome measures for the healthcare professionals.  

PubMed

In recent years there has been a tremendous need among healthcare professionals to assess the effectiveness, efficiency, and appropriateness of the patient care services being provided through criteria-based outcome and program evaluation. Although the need for a tool which could evaluate the effectiveness of patient care is widely recognized, such an undertaking has been severely limited due to the lack of any automated means to collect and analyze patient data on a routine, continuous basis within a clinical setting. We have developed and implemented at Mineral Springs Hospital, Banff, Alberta an integrated and automated hospital information system that not only continuously collects administrative, financial, and patient data, but also contains an intelligent component for automated outcome measure and program evaluation. The system collects various non-duplicated data elements from each routine work process within the facility on a continuous basis. Through the creation of a dynamic patient database, data is transformed into information--a powerful decision support tool. The system provides flexible user-defined reports in patient-specific resource utilization, direct and/or indirect specific financial costs, result reporting of each intervention, service provided and user-defined criteria-based outcome, and program evaluation. The system design incorporates expert rules, dynamic data entry forms, quantitative models, and user-defined access control. Using information derived from the dynamic common database, managers and front-line clinicians can easily evaluate and modify management decisions or careplans on a macro or micro level. An external review is planned to evaluate whether the system has helped the assessment of effectiveness, efficiency and appropriateness of healthcare services being provided at the hospital. The fundamental concept behind the system design is that the patient is the center of activity for data collection. The system provides the answers to the 5 W's (who, what, where, when, and why) together with intervention and service result reports. A dynamic common patient database is the center of the system and is accessible to all with proper authorization. Common data elements are collected from routine work flow without extra data entry and this information is subsequently shared. Data collection is a continuous process. We believe that every process is the outcome of another sub-process or event. The design of the dynamic patient database incorporates patient-specific costing and outcome evaluation, user-defined flexible data entry forms, user-defined access control, outcome evaluation rules and information semantic rules. Such a patient database would provide the flexibility needed to accommodate diverse methodologies to evaluate outcomes whether it they be medical, cost, access and/or other combination of measures. The system was developed on a PC-based Network technology, using FOXPRO (XBase) as the database development tool incorporating advanced technology such as distributed processing and fault tolerant computing. We chose PC-based technology because it is economical, having relatively low maintenance costs and requires no major dependency on vendors. The developed system produces patient-specific reports with many dimensions. The reports are user-defined. The system reports general data, CMG, RGN, LOS, Expected LOS, and other user-defined demographic data. Resource utilization, financial costs, and result reportings are produced together with rule-based outcome assessments of any type of measures, including, but not limited to, pre-set functional/health goals, user satisfaction, clinicianUs text or codified comments etc. It provides the framework for continually capturing data at a practical, work-flow level. The incorporation of a dynamic patient database as the driving forece of an integrated, rule-based administration, financial and patient data system will provdie the tools for healthcar PMID:8591238

Kwok, H K; Stevens, N

1995-01-01

378

The longer-term health outcomes for children born as a result of IVF treatment. Part II--Mental health and development outcomes.  

PubMed

BACKGROUND Limited data exist with regard to longer-term mental health and psychological functioning of children born from IVF treatment. With the known adverse perinatal outcome for children born from IVF treatment, it would be expected that there is a negative impact upon their mental development. METHODS A search strategy restricted to studies relating to the medical condition of children of at least 1 year of age, born from IVF treatment was performed to include case series, data linkage and prospective studies published from 1 January 2000 to 1 April 2012. RESULTS Limited long-term follow-up data suggest that there is an increase in the incidence of cerebral palsy and neurodevelopmental delay related to the confounders of prematurity and low birthweight. Previous reports of associations with autism and attention-deficit disorder are believed to be related to maternal and obstetric factors. There exists a potential increase in the prevalence of early adulthood clinical depression and binge drinking in the offspring of IVF, with the reassuring data of no changes with respect to cognitive development, school performance, social functioning and behaviour. Whether these potential associations are related to the IVF treatment, the adverse obstetric outcomes associated with IVF treatment, the genetic or subsequent environmental influences on the children is yet to be determined. CONCLUSIONS In general, the longer-term mental and emotional health outcome for children born from IVF treatment is reassuring, and is very similar to that of naturally conceived children; however, further studies are required to explore any association with depression, and its causality in more detail. PMID:23449643

Hart, Roger; Norman, Robert J

2013-02-28

379

Prediction of outcome after paraquat poisoning by measurement of the plasma paraquat concentration  

PubMed Central

Background: Paraquat is a herbicide with a good occupational safety record, but a high mortality after intentional ingestion that has proved refractory to treatment. For nearly three decades paraquat concentration–time data have been used to predict the outcome following ingestion. However, none of the published methods has been independently or prospectively validated. We aimed to use prospectively collected data to test the published predictive methods and to determine if any is superior. Methods: Plasma paraquat concentrations were measured on admission for 451 patients in 10 hospitals in Sri Lanka as part of large prospective cohort study. All deaths in hospital were recorded; patients surviving to hospital discharge were followed up after 3 months to detect delayed deaths. Five prediction methods that are based on paraquat concentration–time data were then evaluated in all eligible patients. Results: All methods showed comparable performance within their range of application. For example, between 4- and 24-h prediction of prognosis was most variable between Sawada and Proudfoot methods but these differences were relatively small [specificity 0.96 (95% CI: 0.90–0.99) vs. 0.89 (0.82–0.95); sensitivity 0.57 vs. 0.79, positive and negative likelihood ratios 14.8 vs. 7.40 and 0.44 vs. 0.23 and positive predictive values 0.96 vs. 0.92, respectively]. Conclusions: All five published methods were better at predicting death than survival. These predictions may also serve as tools to identify patients who need treatment and for some assessment to be made of new treatments that are trialled without a control group.

Senarathna, L.; Eddleston, M.; Wilks, M.F.; Woollen, B.H.; Tomenson, J.A.; Roberts, D.M.

2009-01-01

380

Outpatient systemic antimycotic and antifungal use in Europe: New outcome measure provides new insight.  

PubMed

To broaden our understanding of outpatient systemic antimycotic and antifungal use in Europe, use data in defined daily doses (DDD) were complemented with data in packages and the results were compared. Within the European Surveillance of Antimicrobial Consumption project and using the Anatomical Therapeutic Chemical (ATC) classification, data on outpatient use of all 14 antimycotics (12) and antifungals (2) for systemic use (ATC J02 and D01B), aggregated at the level of the active substance, were collected for 2009. Their use was expressed in DDD per 1000 inhabitants per day (DID) and in packages per 1000 inhabitants per day (PID) (WHO Collaborating Centre for Drug Statistics Methodology ATC/DDD version 2011). In total, 24 countries delivered data in DID; 13 countries also delivered data in PID. In DID, Belgium had the highest (3.24 DID) and Romania the lowest (0.38 DID) total outpatient antimycotic and antifungal use. In PID, Greece had the highest (0.44 PID) and Sweden the lowest (0.08 PID) use. In DID, terbinafine was the most used substance in 19/24 countries (10/13 countries providing DID and PID data). In PID, fluconazole was the most used substance in all 13 countries. Combining DID and PID data substantially improved the interpretation of total outpatient antimycotic and antifungal use in Europe, and both outcome measures should be used for surveillance of these compounds. High use of fluconazole in PID might be more relevant for surveillance of antimicrobial consumption in relation to resistance than high use of terbinafine in DID. PMID:23993932

Adriaenssens, Niels; Coenen, Samuel; Versporten, Ann; Goossens, Herman

2013-08-11

381

The SF36 as an outcome measure of services for end stage renal failure  

PubMed Central

OBJECTIVE: To evaluate the use of the short form 36 (SF36) as a measure of health related quality of life of patients with end stage renal failure, document the results, and investigate factors, including mode of treatment, which may influence it. DESIGN: Cross sectional survey of patients with end stage renal failure, with the standard United Kingdom version of the SF36 supplemented by specific questions for end stage renal failure. SETTING: A teaching hospital renal unit. SUBJECTS AND METHODS: 660 patients treated at the Sheffield Kidney Institute by haemodialysis, peritoneal dialysis, and transplantation. Internal consistency, percentage of maximal or minimal responses, SF36 scores, effect sizes, correlations between independent predictor variables and individual dimension scores of the SF36. Multiple regression analysis of the SF36 scores for the physical functioning, vitality, and mental health dimensions against treatment, age, risk (comorbidity) score, and other independent variables. RESULTS: A high response rate was achieved. Internal consistency was good. There were no floor or ceiling effects other than for the two "role" dimensions. Overall health related quality of life was poor compared with the general population. Having a functioning transplant was a significant predictor of higher score in the three dimensions (physical functioning, vitality, and mental health) for which multiple regression models were constructed. Age, sex, comorbidity, duration of treatment, level of social and emotional support, household numbers, and hospital dialysis were also (variably) significant predictors. CONCLUSIONS: The SF36 is a practical and consistent questionnaire in this context, and there is evidence to support its construct validity. Overall the health related quality of life of these patients is poor, although transplantation is associated with higher scores independently of the effect of age and comorbidity. Age, comorbidity, and sex are also predictive of the scores attained in the three dimensions studied. Further studies are required to ascertain whether altering those predictor variables which are under the influence of professional carers is associated with changes in health related quality of life, and thus confirm the value of this outcome as a measure of quality of care.

Wight, J. P.; Edwards, L.; Brazier, J.; Walters, S.; Payne, J. N.; Brown, C. B.

1998-01-01

382

Self-report measures for assessing treatment outcomes in cardiac surgery patients.  

PubMed

Patient self-report measures are increasingly valued as outcome variables in health services research studies. In this article, the authors describe the Functional Status, Health Related Quality of Life, Life Satisfaction, and Patient Satisfaction scales included in the Processes, Structures, and Outcomes of Cardiac Surgery (PSOCS) cooperative study underway within the Department of Veterans Affairs health care system. In addition to reporting on the baseline psychometric characteristics of these instruments, the authors compared preoperative Medical Outcomes Study SF-36 data from the study patients with survey data from a probability sample of the US population and with preoperative data on cardiac surgery patients from a high volume private sector surgical practice. Descriptive analyses indicate that the SF-36 profiles for all of the cardiac patients are highly similar. The Veterans Affairs and private sector patients report diminished physical functioning, physical role functioning, and emotional role functioning as well as reduced energy relative to an age-matched comparison sample. At the same time, however, the Veterans Affairs patients evidenced lower levels of capacity on most of the SF-36 dimensions relative to the private sector patients. PMID:7475415

McCarthy, M J; Shroyer, A L; Sethi, G K; Moritz, T E; Henderson, W G; Grover, F L; London, M J; Gibbs, J O; Lansky, D; Miller, D

1995-10-01

383

A repeated measures model for analysis of continuous outcomes in sequential parallel comparison design studies.  

PubMed

Previous authors have proposed the sequential parallel comparison design (SPCD) to address the issue of high placebo response rate in clinical trials. The original use of SPCD focused on binary outcomes, but recent use has since been extended to continuous outcomes that arise more naturally in many fields, including psychiatry. Analytic methods proposed to date for analysis of SPCD trial continuous data included methods based on seemingly unrelated regression and ordinary least squares. Here, we propose a repeated measures linear model that uses all outcome data collected in the trial and accounts for data that are missing at random. An appropriate contrast formulated after the model has been fit can be used to test the primary hypothesis of no difference in treatment effects between study arms. Our extensive simulations show that when compared with the other methods, our approach preserves the type I error even for small sample sizes and offers adequate power and the smallest mean squared error under a wide variety of assumptions. We recommend consideration of our approach for analysis of data coming from SPCD trials. PMID:23355369

Doros, Gheorghe; Pencina, Michael; Rybin, Denis; Meisner, Allison; Fava, Maurizio

2013-01-27

384

A Core Outcome Measures Index (COMI) for Patients Undergoing Hip Arthroplasty.  

PubMed

Outcome is best assessed with both generic and disease-specific instruments, but using many, lengthy questionnaires increases the burden, quality, and cost of data collection.We evaluated a short, hip-oriented Core Outcome Measures Index (COMI-hip), comprising six items (pain, function, symptom-specific well-being, quality of life, and disability) extracted from established full-length questionnaires; 214 consecutive total hip arthroplasty (THA) patients participated. Scores for the single items and sum-score of COMI-hip correlated well with those of the full-length instruments (r= -0.56 to -0.88). At 6 and 12 months' follow-up, the COMI-hip showed similar responsiveness (Cohen's d for effect size, 1.36-3.08) to the full-length questionnaires (1.65-2.34). The COMI-hip proved a simple but valid outcome instrument in THA patients. Its brevity renders it a potentially valuable instrument for routine use. PMID:23523492

Impellizzeri, Franco M; Mannion, Anne F; Naal, Florian D; Leunig, Michael

2013-03-20

385

Insomnia and Objectively Measured Sleep Disturbances Predict Treatment Outcome in Depressed Patients Treated with Psychotherapy or Psychotherapy-Pharmacotherapy Combinations  

PubMed Central

Objective Insomnia and objectively measured sleep disturbances predict poor treatment outcomes in patients with major depressive disorder (MDD). However, prior research has utilized individual clinical trials with relatively small sample sizes and has focused on insomnia symptoms or objective measures, but not both. The present study is a secondary analysis that examines the degree to which insomnia, objective sleep disturbances, or their combination, predicts depression remission following pharmacotherapy and/or psychotherapy treatment. Methods Participants were 711 depressed patients drawn from six clinical trials. Remission status, defined as a score of ? 7 on the Hamilton Rating Scale for Depression (HDRS) over two consecutive months, served as the primary outcome. Insomnia was assessed via the 3 sleep items on the HDRS. Objectively measured short sleep duration (total sleep time < = 6 hours), and prolonged sleep latency (SL >30 minutes) or wakefulness after sleep onset (WASO>30) were derived from in-laboratory polysomnographic (PSG) sleep studies. Logistic regression predicted the odds of non-remission according to insomnia, each of the objective sleep disturbances, or their combination, after adjusting for age, sex, treatment modality, and baseline depressive symptoms. Results Prolonged sleep latency alone (OR = 1.82; CI: 1.23, 2.70) or in combination with insomnia (OR = 2.03; CI: 1.13, 3.95) predicted increased risk of non-remission. In addition, insomnia and sleep duration individually and in combination were each associated with a significantly increased risk of non-remission (p’s < .05). Conclusion Findings suggest that objectively measured prolonged sleep latency and short sleep duration independently, or in conjunction with insomnia are risk factors for poor depression treatment outcome.

Troxel, W.M.; Kupfer, D.J.; Reynolds, C.F.; Frank, E.; Thase, M.; Miewald, J.; Buysse, D.J.

2011-01-01

386

Methionine synthase reductase deficiency results in adverse reproductive outcomes and congenital heart defects in mice  

PubMed Central

Low dietary folate and polymorphisms in genes of folate metabolism can influence risk for pregnancy complications and birth defects. Methionine synthase reductase (MTRR) is required for activation of methionine synthase, a folate- and vitamin B12-dependent enzyme. A polymorphism in MTRR (p.I22M), present in the homozygous state in 25% of many populations, may increase risk for neural tube defects. To examine the impact of MTRR deficiency on early development and congenital heart defects, we used mice harboring a gene-trapped (gt) allele in Mtrr. Female mice (Mtrr+/+, Mtrr+/gt, and Mtrrgt/gt) were mated with male Mtrr+/g mice. Reproductive outcomes and cardiac phenotype (presence of defects and myocardial thickness) were assessed at E14.5. Mtrr-deficient mothers had more resorptions and more delayed embryos per litter (resorptions per litter: 0.29 ± 0.13; 1.21 ± 0.41; 1.87 ± 0.38 and delayed embryos per litter: 0.07 ± 0.07; 0.14 ± 0.14; 0.60 ± 0.24 in Mtrr+/+, Mtrr+/gt, and Mtrrgt/gt mothers respectively). Placentae of Mtrrgt/gt mothers were smaller and their embryos were smaller, with myocardial hypoplasia and a higher incidence of ventricular septal defects (VSD) per litter (0; 0.57 ± 0.30; 1.57 ± 0.67 in Mtrr+/+, Mtrr+/gt, and Mtrrgt/gt groups respectively). Embryonic Mtrrgt/gt genotype was associated with reduced embryonic length, reduced embryonic and placental weight, and higher incidence of VSD, but did not affect myocardial thickness or embryonic delay. We conclude that Mtrr deficiency adversely impacts reproductive outcomes and cardiac development in mice. These findings may have implications for nutritional prevention of heart defects, particularly in women with the common MTRR polymorphism.

Deng, Liyuan; Elmore, C. Lee; Lawrance, Andrea K.; Matthews, Rowena G.; Rozen, Rima

2011-01-01

387

The impact of surgery for oral cancer on quality of life as measured by the Medical Outcomes Short Form 36  

Microsoft Academic Search

Quality of life evaluation is an important measure of outcome following the treatment of head and neck cancer. The aim of this study was to evaluate the quality of life of patients undergoing primary surgery for oral and oropharyngeal squamous cell carcinoma. 50 consecutive patients with previously untreated oral cancer were assessed using using two questionnaires, the Medical Outcomes Short

S. N Rogers; G Humphris; D Lowe; J. S Brown; E. D Vaughan

1998-01-01

388

Cognitive interviewing methodology in the development of a pediatric item bank: a patient reported outcomes measurement information system (PROMIS) study  

Microsoft Academic Search

BACKGROUND: The evaluation of patient-reported outcomes (PROs) in health care has seen greater use in recent years, and methods to improve the reliability and validity of PRO instruments are advancing. This paper discusses the cognitive interviewing procedures employed by the Patient Reported Outcomes Measurement Information System (PROMIS) pediatrics group for the purpose of developing a dynamic, electronic item bank for

Debra E Irwin; James W Varni; Karin Yeatts; Darren A DeWalt

2009-01-01

389

Clinical trial methodology of pain treatment studies: selection and measurement of self-report primary outcomes for efficacy.  

PubMed

The past century has seen immense progress in the advancement of methodology to evaluate efficacy of treatment interventions for acute and chronic pain. Continuing challenges revolve around how to best select and measure primary efficacy outcomes for a given analgesic trial. Recognizing the complex, multidimensional, sensory and emotional nature of pain and applying psychometric techniques have facilitated the development of several valid and reliable self-report measures that evaluate pain intensity, pain relief, and other important outcome domains relevant to pain treatment. In the setting of emerging new pain treatment strategies, careful consideration must be given to match current or novel outcome measures to the specific goals of a proposed trial. Future research is needed to directly compare current methods with newer measurement approaches for the critical goal of maximizing validity, reliability, and utility of different outcome measures in clinical trials of pain treatment. PMID:21610560

Gilron, Ian; Jensen, Mark P

390

Some lessons to be learned from a decade of general education outcomes assessment with the ACT COMP measures  

Microsoft Academic Search

In the last decade, the ACT COMP Composite Exam and Objective Test have been the most frequently used standardized measures of cognitive general education outcomes. This article reviews the literature addressing uses of the COMP measures in order to evaluate valid and reliable uses of the COMP measures. It concludes that worthwhile evaluations of uses of the COMP measures can

Donald B. Yarbrough

1992-01-01

391

Physical activity level as an outcome measure for use in cancer cachexia trials: a feasibility study  

Microsoft Academic Search

Purpose  Cancer cachexia impacts on treatment options, quality of life and survival. New treatments are emerging but need to be assessed\\u000a using outcomes which patients find meaningful. One approach is the measurement of physical activity levels by small lightweight\\u000a monitors, but experience is limited in cancer patients.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  This study formally assessed the acceptability of wearing an ActivPAL™ monitor for

Matthew Maddocks; Anthony Byrne; Colin D. Johnson; Richard H. Wilson; Kenneth C. H. Fearon; Andrew Wilcock

2010-01-01

392

Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage  

Microsoft Academic Search

Purpose  To investigate the predictive power of progesterone combined with beta human chorionic gonadotropin (?-HCG) measurements in\\u000a the outcome of threatened miscarriage.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This retrospective study was conducted on 245 intrauterine pregnant women from January 2006 to October 2008. 175 women with\\u000a threatened miscarriages who consulted for vaginal bleeding received exogenous progesterone supplements. There were 108 patients\\u000a with ongoing pregnancies until delivery

Lijun Duan; Denglu Yan; Weiyue Zeng; Xiao Yang; Qiang Wei

2011-01-01

393

Why Health Care Process Performance Measures Can Have Different Relationships to Outcomes for Patients and Hospitals: Understanding the Ecological Fallacy  

PubMed Central

Relationships between health care process performance measures (PPMs) and outcomes can differ in magnitude and even direction for patients versus higher level units (e.g., health care facilities). Such discrepancies can arise because facility-level relationships ignore PPM–outcome relationships for patients within facilities, may have different confounders than patient-level PPM–outcome relationships, and may reflect facility effect modification of patient PPM–outcome relationships. If a patient-level PPM is related to better patient outcomes, that care process should be encouraged. However, the finding in a multilevel analysis that the proportion of patients receiving PPM care across facilities nevertheless is linked to poor hospital outcomes would suggest that interventions targeting the health care facility also are needed.

Humphreys, Keith; Kivlahan, Daniel R.; Harris, Alex H. S.

2011-01-01

394

New simulation and measurement results on gateable DEPFET devices  

NASA Astrophysics Data System (ADS)

To improve the signal to noise level, devices for optical and x-ray astronomy use techniques to suppress background events. Well known examples are e.g. shutters or frame-store Charge Coupled Devices (CCDs). Based on the DEpleted P-channel Field Effect Transistor (DEPFET) principle a so-called Gatebale DEPFET detector can be built. Those devices combine the DEPFET principle with a fast built-in electronic shutter usable for optical and x-ray applications. The DEPFET itself is the basic cell of an active pixel sensor build on a fully depleted bulk. It combines internal amplification, readout on demand, analog storage of the signal charge and a low readout noise with full sensitivity over the whole bulk thickness. A Gatebale DEPFET has all these benefits and obviates the need for an external shutter. Two concepts of Gatebale DEPFET layouts providing a built-in shutter will be introduced. Furthermore proof of principle measurements for both concepts are presented. Using recently produced prototypes a shielding of the collection anode up to 1 • 10-4 was achieved. Predicted by simulations, an optimized geometry should result in values of 1 • 10-5 and better. With the switching electronic currently in use a timing evaluation of the shutter opening and closing resulted in rise and fall times of 100ns.

Bähr, Alexander; Aschauer, Stefan; Hermenau, Katrin; Herrmann, Sven; Lechner, Peter H.; Lutz, Gerhard; Majewski, Petra; Miessner, Danilo; Porro, Matteo; Richter, Rainer H.; Schaller, Gerhard; Sandow, Christian; Schnecke, Martina; Schopper, Florian; Stefanescu, Alexander; Strüder, Lothar; Treis, Johannes

2012-07-01

395

Measuring outcomes in acute neurorehabilitation in General Hospital setting - our experience.  

PubMed

In General Hospital setting, where varieties of patients are included in neurorehabilitation process, set of multidisciplinary functional tests were established, as a routine in daily work. Tests were done by physiotherapists and occupational therapists who were members of rehabilitation team. Our aim was to select the tests which can be used as a routine and are applicable for different neurological impairments in daily work. Tests were applied to inpatients admitted to the Medical, Trauma, Neurology and Neurosurgery wards in the Rashid Hospital, DOHMS, Dubai. Fifty inpatients with different neurological impairments admitted to totally 8 wards, were tested in the beginning of rehabilitation process and on discharge from the hospital. Nine tests were used as standardized tests for measuring motor, cognitive, focal impairment, ADL activities and disability: Motricity Index, Trunk Control Test, Standing Balance score, Functional Ambulation Categories test, Mini Mental State Examination, Canadian Neurological Scale, Action Research Arm test, Bartel Index and Functional Independent Measurements. FIM, Motricity Index and Trunk Control Test were applicable for all tested patients, with required adaptation for different neurological conditions within the same score. Other tests were not applicable for all patients as routine, but there were very useful for certain number of patients as a measurement of functional improvement. It is very important to have proper setup of tests, which are simple, reliable and valid for measuring impairment, disability and handicap and which can be used as standardized part of assessment protocol. Also, they must be applicable for different neurological impairments to monitor treatment progress. Combination of tests performed by different professionals and comprehensive approach of all team members is very important for measuring outcomes in rehabilitation and evaluating patient's impairment and disability. Proper hospital setup, optimal number of staff, good communication and team work are leading to better outcome in neurorehabilitation process. PMID:16995851

Muji?-Skiki?, Emela; Trebinjac, Suad; Avdi?, Dijana; Dzumhur-Sari?, Amra

2006-08-01

396

Moderate energy restriction with high protein diet results in healthier outcome in women  

PubMed Central

Background The present study compares two different weight reduction regimens both with a moderately high protein intake on body composition, serum hormone concentration and strength performance in non-competitive female athletes. Methods Fifteen normal weighted women involved in recreational resistance training and aerobic training were recruited for the study (age 28.5 ± 6.3 yr, height 167.0 ± 7.0 cm, body mass 66.3 ± 4.2 kg, body mass index 23.8 ± 1.8, mean ± SD). They were randomized into two groups. The 1 KG group (n = 8; energy deficit 1100 kcal/day) was supervised to reduce body weight by 1 kg per week and the 0.5 KG group (n = 7; energy deficit 550 kcal/day) by 0.5 kg per week, respectively. In both groups protein intake was kept at least 1.4 g/kg body weight/day and the weight reduction lasted four weeks. At the beginning of the study the energy need was calculated using food and training diaries. The same measurements were done before and after the 4-week weight reduction period including total body composition (DXA), serum hormone concentrations, jumping ability and strength measurements Results During the 4-week weight reduction period there were no changes in lean body mass and bone mass, but total body mass, fat mass and fat percentage decreased significantly in both groups. The changes were greater in the 1 KG group than in the 0.5 KG group in total body mass (p < 0.001), fat mass (p < 0.001) and fat percentage (p < 0.01). Serum testosterone concentration decreased significantly from 1.8 ± 1.0 to 1.4 ± 0.9 nmol/l (p < 0.01) in 1 KG and the change was greater in 1 KG (30%, p < 0.001) than in 0.5 KG (3%). On the other hand, SHBG increased significantly in 1 KG from 63.4 ± 17.7 to 82.4 ± 33.0 nmol/l (p < 0.05) during the weight reducing regimen. After the 4-week period there were no changes in strength performance in 0.5 KG group, however in 1 KG maximal strength in bench press decreased (p < 0.05) while endurance strength in squat and counter movement jump improved (p < 0.05) Conclusion It is concluded that a weight reduction by 0.5 kg per week with ~1.4 g protein/kg body weight/day can be recommended to normal weighted, physically active women instead of a larger (e.g. 1 kg per week) weight reduction because the latter may lead to a catabolic state. Vertical jumping performance is improved when fat mass and body weight decrease. Thus a moderate weight reduction prior to a major event could be considered beneficial for normal built athletes in jumping events.

2010-01-01

397

Progress Towards a Core Set of Outcome Measures in Small-vessel Vasculitis. Report from OMERACT 9  

PubMed Central

The past decade has seen a substantial increase in the number and quality of clinical trials of new therapies for vasculitis, including randomized, controlled, multicenter trials that have successfully incorporated measures of disease activity and toxicity. However, because current treatment regimens for severe disease effectively induce initial remission and reduce mortality, future trials will focus on any of several goals including: (a) treatment of mild—moderate disease; (b) prevention of chronic damage; (c) reduction in treatment toxicity; or (d) more subtle differences in remission induction or maintenance. Thus, new trials will require outcome measure instruments that are more precise and are better able to detect effective treatments for different disease states and measure chronic manifestations of disease. The OMERACT Vasculitis Working Group comprises international clinical investigators with expertise in vasculitis who, since 2002, have worked collaboratively to advance the refinement of outcome measures in vasculitis, create new measures to address domains of illness not covered by current research approaches, and harmonize outcome assessment in vasculitis. The focus of the OMERACT group to date has been on outcome measures in small-vessel vasculitis with an overall goal of creating a core set of outcome measures for vasculitis, each of which fulfills the OMERACT filter of truth, discrimination, feasibility, and identifying additional domains requiring further research. This process has been informed by several ongoing projects providing data on outcomes of disease activity, disease-related damage, multidimensional health-related quality of life, and patient-reported ratings of the burden of vasculitis.

MERKEL, PETER A.; HERLYN, KAREN; MAHR, ALFRED D.; NEOGI, TUHINA; SEO, PHILIP; WALSH, MICHAEL; BOERS, MAARTEN; LUQMANI, RAASHID

2011-01-01

398

EARLINET correlative measurements for CALIPSO: First intercomparison results  

Microsoft Academic Search

A strategy for European Aerosol Research Lidar Network (EARLINET) correlative measurements for Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) has been developed. These EARLINET correlative measurements started in June 2006 and are still in progress. Up to now, more than 4500 correlative files are available in the EARLINET database. Independent extinction and backscatter measurements carried out at high-performance EARLINET

Gelsomina Pappalardo; Ulla Wandinger; Lucia Mona; Anja Hiebsch; Ina Mattis; Aldo Amodeo; Albert Ansmann; Patric Seifert; Holger Linné; Arnoud Apituley; Lucas Alados Arboledas; Dimitris Balis; Anatoli Chaikovsky; Giuseppe D'Amico; Ferdinando De Tomasi; Volker Freudenthaler; Elina Giannakaki; Aldo Giunta; Ivan Grigorov; Marco Iarlori; Fabio Madonna; Rodanthi-Elizabeth Mamouri; Libera Nasti; Alexandros Papayannis; Aleksander Pietruczuk; Manuel Pujadas; Vincenzo Rizi; Francesc Rocadenbosch; Felicita Russo; Franziska Schnell; Nicola Spinelli; Xuan Wang; Matthias Wiegner

2010-01-01

399

Patient-reported outcome measures in the NHS: new methods for analysing and reporting EQ-5D data.  

PubMed

In a landmark move, the UK Department of Health (DH) has introduced the routine collection of patient-reported outcome measures (PROMs) to measure the performance of health-care providers. From April 2009, generic (EQ-5D) and condition-specific PROMs are being collected from patients before and after four surgical procedures; eventually this will be extended to include a wide range of other NHS services. The aim of this article is to report analysis of the EQ-5D data generated from a pilot study commissioned by the DH and to consider the implications for the use of EQ-5D data in performance indicators and measures of patient benefit. We present two new methods that we have developed for analysing and displaying EQ-5D profile data: a Paretian Classification of Health Change and a health profile grid. We show that EQ-5D profile data can be readily analysed to generate insights into the nature of changes in patient-reported health that would be obscured by summarising these profiles by their index scores, or focusing just on the post operative outcomes. Our methods indicate differences between providers and between sub-groups of patients. Our results also show striking differences in changes in EQ-5D profiles between surgical procedures, which require further investigation. PMID:20623685

Devlin, Nancy J; Parkin, David; Browne, John

2010-08-01

400

Non-physician clinician provided HIV treatment results in equivalent outcomes as physician-provided care: a meta-analysis  

PubMed Central

Introduction A severe healthcare worker shortage in sub-Saharan Africa is inhibiting the expansion of HIV treatment. Task shifting, the transfer of antiretroviral therapy (ART) management and initiation from doctors to nurses and other non-physician clinicians, has been proposed to address this problem. However, many health officials remain wary about implementing task shifting policies due to concerns that non-physicians will provide care inferior to physicians. To determine if non-physician-provided HIV care does result in equivalent outcomes to physician-provided care, a meta-analysis was performed. Methods Online databases were searched using a predefined strategy. The results for four primary outcomes were combined using a random effects model with sub-groups of non-physician-managed ART and -initiated ART. TB diagnosis rates, adherence, weight gain and patient satisfaction were summarized qualitatively. Results Mortality (N=59,666) had similar outcomes for non-physicians and physicians, with a hazard ratio of 1.05 (CI: 0.88–1.26). The increase in CD4 levels at one year, as a difference in means of 2.3 (N=17,142, CI: ?12.7–17.3), and viral failure at one year, as a risk ratio of 0.89 (N=10,344, CI: 0.65–1.23), were similar for physicians and non-physicians. Interestingly, loss to follow-up (LTFU) (N=53,435) was reduced for non-physicians with a hazard ratio of 0.72 (CI: 0.56–0.94). TB diagnosis rates, adherence and weight gain were similar for non-physicians and physicians. Patient satisfaction appeared higher for non-physicians in qualitative components of studies and was attributed to non-physicians spending more time with patients as well as providing more holistic care. Conclusions Non-physician-provided HIV care results in equivalent outcomes to care provided by physicians and may result in decreased LTFU rates.

Emdin, Connor A; Chong, Nicholas J; Millson, Peggy E

2013-01-01

401

[Standards and outcome measures in cardiovascular rehabilitation. Position paper GICR/IACPR].  

PubMed

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic problem in Italy. Costs and resources required are increasing in close correlation to both the improved quality of care and to the population ageing. There is an overwhelming evidence of the efficacy of cardiac rehabilitation (CR) in terms of reduction in morbidity and mortality after acute cardiac events. CR services are by definition multi-factorial and comprehensive. Furthermore, systematic analysis and monitoring of the process of delivery and outcomes is of paramount importance. The aim of this position paper promoted by the Italian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR) is to provide specific recommendations to assist CR staff in the design, evaluation and development of their care delivery organization. The position paper should also assist health care providers, insurers, policy makers and consumers in the recognition of the quality of care requirements, standards and outcome measure, quality and performance indicators, and professional competence involved in such organization and programs. The position paper i) include comprehensive CR definition and indications, ii) describes priority criteria based on the clinical risk for admission to both inpatient or outpatient CR, and iii) defines components and technological, structural and organizing requirements for inpatient or outpatient CR services, with specific indicators and standards, performance measures and required professional skills. A specific chapter is dedicated to the requirements for highly specialized CR services for patients with more advanced cardiovascular diseases. PMID:23659104

Griffo, Raffaele; Ambrosetti, Marco; Furgi, Giuseppe; Carlon, Roberto; Chieffo, Carmine; Favretto, Giuseppe; Febo, Oreste; Corrà, Ugo; Fattirolli, Francesco; Giannuzzi, Pantaleo; Greco, Cesare; Piepoli, Massimo F; Temporelli, Pier Luigi; Tramarin, Roberto; Urbinati, Stefano

2012-12-01

402

Cerebellar Alterations and Gait Defects as Therapeutic Outcome Measures for Enzyme Replacement Therapy in ?-Mannosidosis  

PubMed Central

?-Mannosidosis is a rare lysosomal storage disease with accumulation of undegraded mannosyl-linked oligosaccharides in cells throughout the body, most notably in the CNS. This leads to a broad spectrum of neurological manifestations, including progressive intellectual impairment, disturbed motor functions and cerebellar atrophy. To develop therapeutic outcome measures for enzyme replacement therapy (ERT) that could be used for human patients, a gene knockout model of ?-mannosidosis in mice was analyzed for CNS pathology and motor deficits. In the cerebellar molecular layer, ?-mannosidosis mice display clusters of activated Bergman glia, infiltration of phagocytic macrophages and accumulation of free cholesterol and gangliosides (GM1), notably in regions lacking Purkinje cells. ?-mannosidosis brain lysates also displayed increased expression of Lamp1 and hyperglycosylation of the cholesterol binding protein NPC2. Detailed assessment of motor function revealed age-dependent gait defects in the mice that resemble the disturbed motor function in human patients. Short-term ERT partially reversed the observed cerebellar pathology with fewer activated macrophages and astrocytes but unchanged levels of hyperglycosylated NPC2, gangliosides and cholesterol. The present study demonstrates cerebellar alterations in ?-mannosidosis mice that relate to the motor deficits and pathological changes seen in human patients and can be used as therapeutic outcome measures.

Damme, Markus; Stroobants, Stijn; Walkley, Steven U.; Lullmann-Rauch, Renate; D`Hooge, Rudi; Fogh, Jens; Saftig, Paul; Lubke, Torben; Blanz, Judith

2011-01-01

403

The factor structure and psychometric properties of the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) in Norwegian clinical and non-clinical samples  

PubMed Central

Background The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) is a 34-item instrument developed to monitor clinically significant change in out-patients. The CORE-OM covers four domains: well-being, problems/symptoms, functioning and risk, and sums up in two total scores: the mean of All items, and the mean of All non-risk items. The aim of this study was to examine the psychometric properties of the Norwegian translation of the CORE-OM. Methods A clinical sample of 527 out-patients from North Norwegian specialist psychiatric services, and a non-clinical sample of 464 persons were obtained. The non-clinical sample was a convenience sample consisting of friends and family of health personnel, and of students of medicine and clinical psychology. Students also reported psychological stress. Exploratory factor analysis (EFA) was employed in half the clinical sample. Confirmatory (CFA) factor analyses modelling the theoretical sub-domains were performed in the remaining half of the clinical sample. Internal consistency, means, and gender and age differences were studied by comparing the clinical and non-clinical samples. Stability, effect of language (Norwegian versus English), and of psychological stress was studied in the sub-sample of students. Finally, cut-off scores were calculated, and distributions of scores were compared between clinical and non-clinical samples, and between students reporting stress or no stress. Results The results indicate that the CORE-OM both measures general (g) psychological distress and sub-domains, of which risk of harm separates most clearly from the g factor. Internal consistency, stability and cut-off scores compared well with the original English version. No, or only negligible, language effects were found. Gender differences were only found for the well-being domain in the non-clinical sample and for the risk domain in the clinical sample. Current patient status explained differences between clinical and non-clinical samples, also when gender and age were controlled for. Students reporting psychological distress during last week scored significantly higher than students reporting no stress. These results further validate the recommended cut-off point of 1 between clinical and non-clinical populations. Conclusions The CORE-OM in Norwegian has psychometric properties at the same level as the English original, and could be recommended for general clinical use. A cut-off point of 1 is recommended for both genders.

2013-01-01

404

An outcome measure of functionality in patients with lumber spinal stenosis: a validation study of the Iranian version of Neurogenic Claudication Outcome Score (NCOS)  

PubMed Central

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?measure of functionality in patients with lumbar spinal stenosis who are suffering from neurogenic claudication.

2012-01-01

405

Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group  

PubMed Central

Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8–55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes.

Apolone, G; Corli, O; Caraceni, A; Negri, E; Deandrea, S; Montanari, M; Greco, M T

2009-01-01

406

Early Outcome After Off-Pump Versus On-Pump Coronary Bypass Surgery Results From a Randomized Study  

Microsoft Academic Search

Background—The use of cardiopulmonary bypass during coronary artery bypass surgery (CABG) has been associated with substantial morbidity. The recent introduction of cardiac stabilizers facilitates CABG without cardiopulmonary bypass (off-pump CABG), but it is unknown whether cardiac outcome after off-pump surgery is similar to that for the on-pump procedure. Methods and Results—In a multicenter trial, 281 patients (mean age 61 years,

Diederik van Dijk; Arno P. Nierich; Erik W. L. Jansen; Hendrik M. Nathoe; Willem J. L. Suyker; Jan C. Diephuis; Wim-Jan van Boven; Cornelius Borst; Erik Buskens; Diederick E. Grobbee; Etienne O. Robles de Medina

407

Large volume unresectable locally advanced non-small cell lung cancer: acute toxicity and initial outcome results with rapid arc  

Microsoft Academic Search

BACKGROUND: To report acute toxicity, initial outcome results and planning therapeutic parameters in radiation treatment of advanced lung cancer (stage III) with volumetric modulated arcs using RapidArc (RA). METHODS: Twenty-four consecutive patients were treated with RA. All showed locally advanced non-small cell lung cancer with stage IIIA-IIIB and with large volumes (GTV:299 ± 175 cm3, PTV:818 ± 206 cm3). Dose

Marta Scorsetti; Pierina Navarria; Pietro Mancosu; Filippo Alongi; Simona Castiglioni; Raffaele Cavina; Luca Cozzi; Antonella Fogliata; Sara Pentimalli; Angelo