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1

The Children's Performance Outcome Measures: Results after Six Months.  

ERIC Educational Resources Information Center

This report describes the implementation and first 6 months of data collection of the required performance outcome measures for children receiving mental health services in Florida, as required under Florida's 1994 Government Performance and Accountability Act. This summary is of data received from August 1996 to January 1997 and includes data for…

Massey, Tom; Kershaw, Mary Ann; Armstrong, Mary; Shepard, Jennifer; Wir, Liang

2

Measuring Course Learning Outcomes  

ERIC Educational Resources Information Center

Accreditation criteria of programs require effective learning outcomes, assessment with documented procedures, tools, results, and actions to close the assessment loop with broad faculty involvement. This article describes a methodology for providing quantitative measurement of a course's learning outcomes. The methodology uses a linkage matrix…

Keshavarz, Mohsen

2011-01-01

3

Measuring burn injury outcomes.  

PubMed

Burn injury affects all facets of life. Burn care has improved over time. Improved survival after burn injury has resulted in a shift in outcome measurement from inpatient morbidity and mortality to long-term functional and health-related quality-of-life measures. Integration of professionals from different disciplines has enabled burn centers to develop collaborative methods of assessing the quality of care delivered to patients with burns based on their ability to reintegrate into their normal physical, social, psychological, and functional activities. Burn outcomes will continue to develop on the foundation that has been built and will generate evidence-based best practices in the future. PMID:25085096

Palmieri, Tina L; Przkora, Rene; Meyer, Walter J; Carrougher, Gretchen J

2014-08-01

4

Measures for improving treatment outcomes for patients with epilepsy--results from a large multinational patient-physician survey.  

PubMed

In this large-scale, multinational, descriptive survey, we sought to identify measures for improving treatment outcomes for individuals with epilepsy. As a framework, questions relating specifically to each of the five steps of the 'patient-physician journey', namely, patient identification (omitted in this survey), diagnosis, choice of drug, disease and drug information, and patient monitoring were asked. Overall, 337 physicians and 1150 patients across France, Germany, and the United States returned questionnaires. Results indicated that 16% of the patients were initially misdiagnosed. Treatment choice was driven by efficacy, safety, experience with a drug (physician only), and convenience (patient only). Physicians were identified as the primary source of information for patients, and, as expected, better informed patients were found to adhere better to their therapy than those who were less well informed. Approximately 50% of the patients had not seen their specialist in the last year, which indicates poor follow-up; furthermore, important topics such as seizures, treatment, and its side effects were not discussed at every visit. Specialists, but not primary care practitioners (PCPs), consistently reported discussing all topics more frequently than their patients, suggesting that specialists may overestimate the clarity of their questions. There was also substantial disparity in the reasons cited for nonadherence - patients overwhelmingly cited forgetfulness, while both PCPs and specialists cited complacency, forgetfulness, and tolerability. We also noted a disparity between physicians and their patients, as well as between PCPs and specialists, in their views on the impact of epilepsy on patients' lives. Our results indicate multiple opportunities to intervene at all stages of the patient-physician journey to improve treatment outcomes. We provide practical suggestions to achieve the most from these opportunities. PMID:24704566

Groenewegen, André; Tofighy, Azita; Ryvlin, Philippe; Steinhoff, Bernhard J; Dedeken, Peter

2014-05-01

5

Advancing PROMIS’s methodology: results of the Third Patient-Reported Outcomes Measurement Information System (PROMIS®) Psychometric Summit  

PubMed Central

In 2002, the NIH launched the ‘Roadmap for Medical Research’. The Patient-Reported Outcomes Measurement Information System (PROMIS®) is one of the Roadmap’s key aspects. To create the next generation of patient-reported outcome measures, PROMIS utilizes item response theory (IRT) and computerized adaptive testing. In 2009, the NIH funded the second wave of PROMIS studies (PROMIS II). PROMIS II studies continue PROMIS’s agenda, but also include new features, including longitudinal analyses and more sociodemographically diverse samples. PROMIS II also includes increased emphasis on pediatric populations and evaluation of PROMIS item banks for clinical research and population science. These aspects bring new psychometric challenges. To address this, investigators associated with PROMIS gathered at the Third Psychometric Summit in September 2010 to identify, describe and discuss pressing psychometric issues and new developments in the field, as well as make analytic recommendations for PROMIS. The summit addressed five general themes: linking, differential item functioning, dimensionality, IRT models for longitudinal applications and new IRT software. In this article, we review the discussions and presentations that occurred at the Third PROMIS Psychometric Summit. PMID:22098283

Carle, Adam C; Cella, David; Cai, Li; Choi, Seung W; Crane, Paul K; Curtis, S McKay; Gruhl, Jonathan; Lai, Jin-Shei; Mukherjee, Shubhabrata; Reise, Steven P; Teresi, Jeanne A; Thissen, David; Wu, Eric J; Hays, Ron D

2012-01-01

6

Clinical outcome measures in multiple sclerosis.  

PubMed

Clinical outcome measures are indispensable when studying the natural course of multiple sclerosis (MS) and critical for determining the effect of an intervention. For these purposes clinical outcome measures should be valid, reliable, and responsive. Moreover they should assess clinically relevant aspects of the disease. Given the nature of the disease, outcome measures in MS should be able to capture multiple clinical dimensions. Long-term disability-free survival is the ultimate goal of MS treatment. Since the observation period in clinical trials is too short to get a final answer on that outcome, clinicians and researchers rely on extrapolation of the results beyond the treatment period. Yet the long-term predictive value of most outcome measures (e.g., relapse rate) used for short-term responses has not yet been determined. The expanded disability status scale (EDSS) is the outcome measure that is most often included in MS studies. The EDSS appeals to most neurologists as it is the result of a standardized neurologic examination and neurologists know it well. However, when considered critically, the EDSS has serious weaknesses from a clinimetric point of view that limit its value as an outcome measure in MS. The search for an alternative outcome measure that can fulfill all essential requirements and will be accepted by the scientific community, clinicians, and regulatory agencies is a huge challenge. PMID:24507527

Uitdehaag, Bernard M J

2014-01-01

7

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

8

Measuring Inclusive Education Outcomes in Alberta, Canada  

ERIC Educational Resources Information Center

This study details the results of a review of the academic and public sector literature on measuring inclusive education in large systems. It highlights some outcomes drawn from the international literature on inclusion that might be indicative of the presence and quality of inclusive education in an effort to develop a set of outcomes for…

Loreman, Tim

2014-01-01

9

Outcome measures in haemophilia: a systematic review.  

PubMed

Haemophilia A and B are hereditary X-linked disorders due to deficiency (or absence) of coagulation factor VIII or IX, respectively. Bleeding risk is related to the severity of factor deficiency. Repeated joint bleeding can lead to a severe haemophilic arthropathy resulting in disabilities. Outcome measurements in persons with haemophilia (PWH) have been limited to laboratory evaluation (factor VIII or IX levels) and clinical outcomes (such as bleeding frequency), morbidity (for example linked with arthropathy) and mortality. Due to the new standard of care of PWH, there is a need to consider other outcome measures, such as the early detection and quantification of joint disease, health-related quality of life (QoL) and economic or cost-utility analyses. To investigate this, we performed a 10-yr systematic overview of outcome measures in haemophilia. Only clinical trials including at least 20 patients with haemophilia A or B were included. To facilitate the search strategy, eight issues of outcome measures were selected: physical scores, imaging technique scores, functional scores, QoL measurement, mortality, bleeding frequency, cost and outcome and bone mineral density. The results of these will be discussed. Clearly defined outcomes in haemophilia care are important for many reasons, to evaluate new treatments, to justify treatment strategies, to allow a good follow-up, to perform studies and to allocate resources. The use of such scoring systems is clearly recommended by experts in haemophilia care. However, most centres do not perform such scores outside clinical trials due to reasons such as lack of time and resources. PMID:24957102

Boehlen, Françoise; Graf, Lukas; Berntorp, Erik

2014-08-01

10

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

11

Results of a two-year pilot study of clinical outcome measures in collagen VI- and laminin alpha2-related congenital muscular dystrophies.  

PubMed

Potential therapies are currently under development for two congenital muscular dystrophy (CMD) subtypes: collagen VI-related muscular dystrophy (COL6-RD) and laminin alpha 2-related dystrophy (LAMA2-RD). However, appropriate clinical outcome measures to be used in clinical trials have not been validated in CMDs. We conducted a two-year pilot study to evaluate feasibility, reliability, and validity of various outcome measures, particularly the Motor Function Measure 32, in 33 subjects with COL6-RD and LAMA2-RD. In the first year, outcome measures tested included: Motor Function Measure 32 (MFM32), forced vital capacity (FVC) percent predicted sitting, myometry, goniometry, 10-meter walk, Egen Klassification 2, and PedsQL(TM) Generic and Neuromuscular Cores. In the second year, we added the North Star Ambulatory Assessment (NSAA), Hammersmith Functional Motor Scale (HFMS), timed functional tests, Measure of Activity Limitations (ACTIVLIM), Quality of Upper Extremity Skills Test (QUEST), and Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue subscale. The MFM32 showed strong inter-rater (0.92) and internal consistency (0.96) reliabilities. Concurrent validity for the MFM32 was supported by large correlations (range 0.623-0.936) with the following: FVC, NSAA, HFMS, timed functional tests, ACTIVLIM, and QUEST. Significant correlations of the MFM32 were also found with select myometry measurements, mainly of the proximal extremities and domains of the PedsQL(TM) scales focusing on physical health and neuromuscular disease. Goniometry measurements were less reliable. The Motor Function Measure is reliable and valid in the two specific subtypes of CMD evaluated, COL6-RD and LAMA2-RD. The NSAA is useful as a complementary outcome measure in ambulatory individuals. Preliminary concurrent validity of several other clinical outcome measures was also demonstrated for these subtypes. PMID:25307854

Meilleur, Katherine G; Jain, Minal S; Hynan, Linda S; Shieh, Ching-Yi; Kim, Eunice; Waite, Melissa; McGuire, Michelle; Fiorini, Courtney; Glanzman, Allan M; Main, Marion; Rose, Kristy; Duong, Tina; Bendixen, Roxanna; Linton, Melody M; Arveson, Irene C; Nichols, Carmel; Yang, Kelly; Fischbeck, Kenneth H; Wagner, Kathryn R; North, Kathryn; Mankodi, Ami; Grunseich, Christopher; Hartnett, Elizabeth J; Smith, Michaele; Donkervoort, Sandra; Schindler, Alice; Kokkinis, Angela; Leach, Meganne; Foley, A Reghan; Collins, James; Muntoni, Francesco; Rutkowski, Anne; Bönnemann, Carsten G

2015-01-01

12

Learning Outcomes across Disciplines and Professions: Measurement and Interpretation  

ERIC Educational Resources Information Center

Learning outcomes of higher education are a quality tool in a changing higher education landscape but cannot be seen as neutral measures across professions and disciplines. Survey results from graduates and recent graduates indicate that prevailing measures of learning outcomes yield the same result within and across disciplinary and professional…

Caspersen, Joakim; Frølich, Nicoline; Karlsen, Hilde; Aamodt, Per Olaf

2014-01-01

13

Cancer Outcomes Measurement Working Group (COMWG)  

Cancer.gov

The importance of outcomes assessment is increasingly recognized by multiple agencies involved in cancer research. To address the diverse needs of users, it is critical to assess the state of the science of outcomes measurement and identify priorities for future research and practice.

14

Testing Multiple Outcomes in Repeated Measures Designs  

ERIC Educational Resources Information Center

This study investigates procedures for controlling the familywise error rate (FWR) when testing hypotheses about multiple, correlated outcome variables in repeated measures (RM) designs. A content analysis of RM research articles published in 4 psychology journals revealed that 3 quarters of studies tested hypotheses about 2 or more outcome

Lix, Lisa M.; Sajobi, Tolulope

2010-01-01

15

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

16

Challenges in Measuring Outcomes Following Digital Replantation  

PubMed Central

In the early period of replantation surgery, the emphasis was on digit survival. Subsequently, with better microsurgical techniques and instrumentation, the focus has shifted to function and in recent years to consideration of cost-effectiveness. Despite over 40 years of effort in refining digital replantation surgery, a rigorous evaluation of the outcomes of digital replantation has not been performed. This is because of the many confounding variables that influence outcome comparisons. These variables include the mechanism of injury (guillotine, crush, avulsion), the injury itself (total, near total, subtotal, partial amputation), and the surgical procedure (replantation, revascularization). In addition, the traditional outcome measures (two-point discrimination, range of motion, grip strength, or the ability to return to work) are reported inconsistently and vary widely among publications. All these factors make meaningful comparison of outcomes difficult. The recent emphasis on outcome research and cost-effectiveness necessitates a rethinking in the way we report outcomes of digital replantation. In this article, the authors summarize the challenges in assessing outcomes of digital replantation and explain the need to measure outcomes using rigorous clinical research designs that incorporate cost-effectiveness studies in the research protocol. PMID:24872766

Sebastin, Sandeep J.; Chung, Kevin C.

2013-01-01

17

Measurement Properties of Outcome Measures for Vitiligo A Systematic Review  

E-print Network

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.

unknown authors

18

The Development of NOAA Education Common Outcome Performance Measures (Invited)  

NASA Astrophysics Data System (ADS)

The National Oceanic and Atmospheric Administration (NOAA) Education Council has embarked on an ambitious Monitoring and Evaluation (M&E) project that will allow it to assess education program outcomes and impacts across the agency, line offices, and programs. The purpose of this internal effort is to link outcome measures to program efforts and to evaluate the success of the agency's education programs in meeting the strategic goals. Using an outcome-based evaluation approach, the NOAA Education Council is developing two sets of common outcome performance measures, environmental stewardship and professional development. This presentation will examine the benefits and tradeoffs of common outcome performance measures that collect program results across a portfolio of education programs focused on common outcomes. Common outcome performance measures have a few benefits to our agency and to the climate education field at large. The primary benefit is shared understanding, which comes from our process for writing common outcome performance measures. Without a shared and agreed upon set of definitions for the measure of an outcome, the reported results may not be measuring the same things and would incorrectly indicate levels of performance. Therefore, our writing process relies on a commitment to developing a shared set of definitions based on consensus. We hope that by taking the time to debate and coming to agreement across a diverse set of programs, the strength of our common measures can indicate real progress towards outcomes we care about. An additional benefit is that these common measures can be adopted and adapted by other agencies and organizations that share similar theories of change. The measures are not without their drawbacks, and we do make tradeoffs as part of our process in order to continue making progress. We know that any measure is necessarily a narrow slice of performance. A slice that may not best represent the unique and remarkable contribution of an individual program, but does reflect a variety of contributions along a single dimension across a large portfolio of programs. The process has ended up pushing our working group to call for even more measures, to capture an increasing number of dimensions that reflect the nature of the portfolio of programs. This past year we have been working on developing two sets of common outcome performance measures for professional development (PD) and stewardship education programs. The outcome we chose for PD programs was the use of what was learned in the educator's practice. The outcome we chose for stewardship programs was the stewardship behaviors that participants learn and practice. The measurement of these outcomes will inform whether our strategies are having their intended impact. By knowing how and how much these outcomes are occurring as a result of our program, we can improve program performance over time. The common outcome performance measures help demonstrate how these programs engage audiences in supporting NOAA's mission. As AGU climate literacy community continues to grow, it is important to consider an approach to demonstrate the community's contribution to the Nation's climate literacy. Development of common outcome performance measures is one approach that could help focus the community in meeting its goals.

Baek, J.

2013-12-01

19

General Outcome Measures for Verbal Operants  

ERIC Educational Resources Information Center

A general outcome measure (GOM) can be used to show progress towards a long-term goal. GOMs should sample domains of behavior across ages, be sensitive to change over time, be inexpensive and easy to use, and facilitate decision making. Skinner's (1957) analysis of verbal behavior may benefit from the development of GOM. To develop GOM, we…

Kubina, Richard M., Jr.; Wolfe, Pamela; Kostewicz, Douglas E.

2009-01-01

20

Biobehavioral measures as outcomes: a cautionary tale.  

PubMed

This article discusses the use of biobehavioral measures as outcomes for health care intervention studies. Effect size (ES) values for salivary cortisol and observation-based measures of pain and agitation were examined. Effects pre to post treatment were assessed separately for nursing home residents with and without acute psychotic symptoms. This study revealed large positive effects on both pain and agitation measures in the group with acute psychotic symptoms and small-to-medium positive effects on these same measures in the group without acute psychotic symptoms. In both of these groups, the ES values were not consistently positive on the cortisol measures. Prior to determining whether a measure can be used to estimate minimum clinically important differences, it is essential to consider if the biomarker will be responsive to therapy in the populations and contexts being studied. PMID:24158972

Kovach, Christine R; Woods, Diana Lynn; Devine, Elizabeth C; Logan, Brent R; Raff, Hershel

2014-01-01

21

Outcome measures for studying patients with low back pain.  

PubMed

There is growing recognition in the treatment of back pain that patient perspectives are essential in judging the results of treatment. Improving the patient's "quality of life" is often the main goal of therapy. Thus, although clinical research in the past has focused on physiologic outcomes, such as range of motion, muscle strength, or neurologic deficits, increasing attention is being given to the rigorous measurement of symptoms, functional status, role function, satisfaction with treatment, and health care costs. In many cases, these so-called "soft" outcomes can be measured with a level of reproducibility similar to more conventional clinical data such as imaging test results. Because symptoms and functional outcomes are sometimes only loosely associated with physiologic phenomena, the former outcomes should be measured directly. Modern questionnaires for measuring patient quality of life combine the expertise of social scientists and clinicians and have demonstrated validity. Furthermore, they have some important advantages over simple ratings of "excellent, good, fair, and poor" outcomes, or work status alone. Several modern instruments for measuring health-related quality of life in patients with low back pain are reviewed briefly, describing their content and length. Wider use of these instruments would help to increase clinician familiarity with their meaning and avoid duplication of effort in questionnaire development. PMID:7801179

Deyo, R A; Andersson, G; Bombardier, C; Cherkin, D C; Keller, R B; Lee, C K; Liang, M H; Lipscomb, B; Shekelle, P; Spratt, K F

1994-09-15

22

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

PubMed Central

Background Network meta-analysis (NMA) enables simultaneous comparison of multiple treatments while preserving randomisation. When summarising evidence to inform an economic evaluation, it is important that the analysis accurately reflects the dependency structure within the data, as correlations between outcomes may have implication for estimating the net benefit associated with treatment. A multivariate NMA offers a framework for evaluating multiple treatments across multiple outcome measures while accounting for the correlation structure between outcomes. Methods The standard NMA model is extended to multiple outcome settings in two stages. In the first stage, information is borrowed across outcomes as well across studies through modelling the within-study and between-study correlation structure. In the second stage, we make use of the additional assumption that intervention effects are exchangeable between outcomes to predict effect estimates for all outcomes, including effect estimates on outcomes where evidence is either sparse or the treatment had not been considered by any one of the studies included in the analysis. We apply the methods to binary outcome data from a systematic review evaluating the effectiveness of nine home safety interventions on uptake of three poisoning prevention practices (safe storage of medicines, safe storage of other household products, and possession of poison centre control telephone number) in households with children. Analyses are conducted in WinBUGS using Markov Chain Monte Carlo (MCMC) simulations. Results Univariate and the first stage multivariate models produced broadly similar point estimates of intervention effects but the uncertainty around the multivariate estimates varied depending on the prior distribution specified for the between-study covariance structure. The second stage multivariate analyses produced more precise effect estimates while enabling intervention effects to be predicted for all outcomes, including intervention effects on outcomes not directly considered by the studies included in the analysis. Conclusions Accounting for the dependency between outcomes in a multivariate meta-analysis may or may not improve the precision of effect estimates from a network meta-analysis compared to analysing each outcome separately. PMID:25047164

2014-01-01

23

42 CFR 410.146 - Diabetes outcome measurements.  

Code of Federal Regulations, 2011 CFR

... 2011-10-01 2011-10-01 false Diabetes outcome measurements. 410.146 Section...MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.146...

2011-10-01

24

42 CFR 410.146 - Diabetes outcome measurements.  

Code of Federal Regulations, 2014 CFR

... 2014-10-01 2014-10-01 false Diabetes outcome measurements. 410.146 Section...MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.146...

2014-10-01

25

42 CFR 410.146 - Diabetes outcome measurements.  

Code of Federal Regulations, 2013 CFR

... 2013-10-01 2013-10-01 false Diabetes outcome measurements. 410.146 Section...MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.146...

2013-10-01

26

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

27

42 CFR 486.318 - Condition: Outcome measures.  

Code of Federal Regulations, 2010 CFR

42 Public Health 5 2010-10-01...Condition: Outcome measures. 486.318 Section 486.318 Public Health CENTERS FOR MEDICARE...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Condition: Outcome measures. (a)...

2010-10-01

28

The International Dermatology Outcome Measures Group: Formation of patient-centered outcome measures in dermatology.  

PubMed

As quality standards are increasingly in demand throughout medicine, dermatology needs to establish outcome measures to quantify the effectiveness of treatments and providers. The International Dermatology Outcome Measures Group was established to address this need. Beginning with psoriasis, the group aims to create a tool considerate of patients and providers using the input of all relevant stakeholders in assessment of disease severity and response to treatment. Herein, we delineate the procedures through which consensus is being reached and the future directions of the project. PMID:25486914

Gottlieb, Alice B; Levin, Adriane A; Armstrong, April W; Abernethy, April; Duffin, Kristina Callis; Bhushan, Reva; Garg, Amit; Merola, Joseph F; Maccarone, Mara; Christensen, Robin

2015-02-01

29

Child Outcome Measures in the Study of Child Care Quality  

ERIC Educational Resources Information Center

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…

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

2006-01-01

30

Risk measures The main result  

E-print Network

Outline Risk measures The main result A collection of risk measures Dual representations of risk measures Georg Ch. Pflug May 7, 2005 Georg Ch. Pflug Dual representations of risk measures #12;Outline Risk measures The main result A collection of risk measures Risk measures The main result A collection of risk

Pflug, Georg

31

Breast Cancer EDGE Task Force Outcomes: Clinical Measures of Pain  

PubMed Central

Background Pain is one of the most commonly reported impairments after breast cancer treatment affecting anywhere from 16-73% of breast cancer survivors Despite the high reported incidence of pain from cancer and its treatments, the ability to evaluate cancer pain continues to be difficult due to the complexity of the disease and the subjective experience of pain. The Oncology Section Breast Cancer EDGE Task Force was created to evaluate the evidence behind clinical outcome measures of pain in women diagnosed with breast cancer. Methods The authors systematically reviewed the literature for pain outcome measures published in the research involving women diagnosed with breast cancer. The goal was to examine the reported psychometric properties that are reported in the literature in order to determine clinical utility. Results Visual Analog Scale, Numeric Rating Scale, Pressure Pain Threshold, McGill Pain Questionnaire, McGill Pain Questionnaire – Short Form, Brief Pain Inventory and Brief Pain Inventory – Short Form were highly recommended by the Task Force. The Task Force was unable to recommend two measures for use in the breast cancer population at the present time. Conclusions A variety of outcome measures were used to measure pain in women diagnosed with breast cancer. When assessing pain in women with breast cancer, researchers and clinicians need to determine whether a unidimensional or multidimensional tool is most appropriate as well as whether the tool has strong psychometric properties. PMID:25346950

Harrington, Shana; Gilchrist, Laura; Sander, Antoinette

2014-01-01

32

Outcome measurements in hand and upper limb surgery.  

PubMed

Of marginal importance only 20 years ago, outcome measurement has become one of the most widely published topics in medical literature. The concept of global health is described by the International Classification of Function, Disability and Health. Today, the surgeon's perspective is no longer sufficient to evaluate global health condition of a patient. The patient cannot be reduced to an organ. Outcome measurement must take into consideration body structures and function (symptoms, organ function) as reviewed by a professional, the individual's functional health status in terms of activity and evaluated by the patient himself, and his participation in his social environment. These principles are now being applied to our specialty and it is essential to know them to be able to collect, analyze and publish valid results. This review article defines the rules for using clinical outcome tools, provides the most widely used clinical and self-evaluation forms for our specialty as well as instructions for their use. Global outcome is usually obtained by arithmetic addition of scores; which is a simple but questionable method. The sieving and radar charts can be used for a more comprehensible representation showing areas of relative strength and relative weakness on a graph, as well as depicting general overall performance. The reliability of data is also affected by declaration of conflicts of interest, negligence or fraud. The level of evidence is questionable as long as a data verification system is not implemented. PMID:24993591

Dubert, T

2014-09-01

33

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, Zachary; Levashov, Yurii; /SLAC; ,

2011-08-18

34

Outcome measurement in the ACL deficient knee — what's the score?  

Microsoft Academic Search

There is increasing pressure within the United Kingdom for transparent assessment of the performance of every doctor along with the procedures they perform. Unfortunately, the validation of the outcome measures used to assess such procedures has been questioned. This has been well illustrated in the anterior cruciate ligament (ACL) deficient knee. Over 54 different outcome measures used to assess the

David S. Johnson; Roger B. Smith

2001-01-01

35

Attitudes of mental health staff to routine outcome measurement  

Microsoft Academic Search

Background: Routine outcome measurement is mandated in public mental health services in Australia, but uptake and compliance are variable. This may be because of uncertainties and resistances among clinicians. Aims: To survey attitudes and practices to routine outcome measurement among staff in adult area mental health services and to elucidate their correlates. Method: As part of a larger study, a

Tom Trauer; Tom Callaly; Helen Herrman

2009-01-01

36

Outcomes 'out of africa': the selection and implementation of outcome measures for palliative care in Africa  

PubMed Central

Background End-of-life care research across Africa is under-resourced and under-developed. A central issue in research in end-of-life care is the measurement of effects and outcomes of care on patients and families. Little is known about the experiences of health professionals' selection and implementation of outcome measures (OM) in clinical care, research, audit, or teaching in Africa. Methods An online survey was undertaken of those using outcome measures across the region, as part of the PRISMA project. A questionnaire addressing the use of OMs was developed for a similar survey in Europe and adapted for Africa. Participants were sampled through the contacts database of APCA. Invitation emails were sent out in January 2010 and reminders in February 2010. Results 168/301 invited contacts (56%) from 24 countries responded, with 78 respondents having previously used OM (65% in clinical practice, 12% in research and 23% for both). Main reasons for not using OM were a lack of guidance/training on using and analysing OM, with 49% saying that they would use the tools if this was provided. 40% of those using OM in clinical practice used POS, and 80% used them to assess, evaluate and monitor change. The POS was also the main tool used in research, with the principle criteria for use being validation in Africa, access to the tool and time needed to complete it. Challenges to the use of tools were shortage of time and resources, lack of guidance and training for the professionals, poor health status of patients and complexity of OM. Researchers also have problems analysing OM data. The APCA African POS was the most common version of the POS used, and was reported as a valuable tool for measuring outcomes. Respondents indicated the ideal outcome tool should be short, multi-dimensional and easy to use. Conclusion This was the first survey on professionals' views on OM in Africa. It showed that the APCA African POS was the most frequently OM used. Training and support are needed to help professionals utilise OM in palliative care, and OMs have an ongoing and important role in palliative care in Africa. PMID:22221932

2012-01-01

37

Core Outcome Measures in Effectiveness Trials (COMET) initiative: protocol for an international Delphi study to achieve consensus on how to select outcome measurement instruments for outcomes included in a ‘core outcome set’  

PubMed Central

Background The Core Outcome Measures in Effectiveness Trials (COMET) initiative aims to facilitate the development and application of ‘core outcome sets’ (COS). A COS is an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease or trial population. The overall aim of the Core Outcome Measurement Instrument Selection (COMIS) project is to develop a guideline on how to select outcome measurement instruments for outcomes included in a COS. As part of this project, we describe our current efforts to achieve a consensus on the methods for selecting outcome measurement instruments for outcomes to be included in a COS. Methods/Design A Delphi study is being performed by a panel of international experts representing diverse stakeholders with the intention that this will result in a guideline for outcome measurement instrument selection. Informed by a literature review, a Delphi questionnaire was developed to identify potentially relevant tasks on instrument selection. The Delphi study takes place in a series of rounds. In the first round, panelists were asked to rate the importance of different tasks in the selection of outcome measurement instruments. They were encouraged to justify their choices and to add other relevant tasks. Consensus was reached if at least 70% of the panelists considered a task ‘highly recommended’ or ‘desirable’ and if no opposing arguments were provided. These tasks will be included in the guideline. Tasks that at least 50% of the panelists considered ‘not relevant’ will be excluded from the guideline. Tasks that were indeterminate will be taken to the second round. All responses of the first round are currently being aggregated and will be fed back to panelists in the second round. A third round will only be performed if the results of the second round require it. Discussion Since the Delphi method allows a large group of international experts to participate, we consider it to be the preferred consensus-based method for our study. Based upon this consultation process, a guideline will be developed on instrument selection for outcomes to be included in a COS. PMID:24962012

2014-01-01

38

Measuring Outcomes in Urogynecologic Surgery: “Perspective is Everything” – A Review  

PubMed Central

Over 10 years have passed since the first US National Institutes of Health consensus panel considered standardization of definitions of pelvic floor conditions and criteria utilized for reporting pelvic floor research study outcomes. The literature is replete with pelvic floor outcome studies; however, a consistent standardized approach to the evaluation of patients and characterization of outcomes is still needed. The purpose of this overview is to describe how the use of outcome measures have evolved over time and attempt to help readers utilize the best measures for their clinical and research needs. PMID:22930213

Parker-Autry, Candace Y.; Barber, Matthew D.; Kenton, Kimberly; Richter, Holly E.

2013-01-01

39

Outcomes measurement in healthcare. New imperatives for professional nursing practice.  

PubMed

Quality of healthcare is measurable and nurses in all settings are increasingly being expected to actively participate in identifying and measuring patient outcomes. To do so requires an understanding of the tools and processes currently being used to measure the quality of healthcare in this country. This article provides an overview of current efforts in the healthcare field to develop a shared outcome language and standardized national quality indicators. The challenges professional nurses face in identifying and measuring nursing-sensitive patient outcomes and the responsibility to use that data to shape nursing practice are emphasized. PMID:10690106

Huston, C J

1999-01-01

40

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

41

A review of outcome measures used in cleft care.  

PubMed

This article provides a summary of the main outcome measures currently available and in use within modern cleft care. The fact that there are such a diverse range, including surgical, orthodontic, dental, speech and patient satisfaction measures, is a reflection of the complex, multidisciplinary and longitudinal nature of the care provided. The use of such measures of outcome is essential in the auditing and drive for continued improvements in the standards of care for patients affected with cleft lip and palate. PMID:24521752

Jones, Timothy; Al-Ghatam, Rana; Atack, Nikki; Deacon, Scott; Power, Rosie; Albery, Liz; Ireland, Tony; Sandy, Jonathan

2014-06-01

42

REPORT ON STUDENT LEARNING OUTCOMES & ASSESSMENT MEASURES: MUSIC  

E-print Network

and academic achievement relative to career/academic goals · Alumni and Graduating Student Surveys · ExitREPORT ON STUDENT LEARNING OUTCOMES & ASSESSMENT MEASURES: MUSIC OUTCOMES Music graduates will understand and demonstrate: · Knowledge of music cultural heritage and history · Appreciation for musical

Wurtele, Eve Syrkin

43

Measuring Outcomes and Setting Standards: A Brief Overview.  

ERIC Educational Resources Information Center

This paper presents an overview of a plenary panel entitled "Measuring Outcomes and Setting Standards in Languages Education.""Outcomes" implies what learners take away from their course, while the term "standards" seems commonly to have at least two senses: first it may imply some yardstick or framework against which learner performance, the…

Ingram, D. E.

44

Arthroscopic Management of Femoroacetabular Impingement: Early Outcomes Measures  

Microsoft Academic Search

Purpose: The purpose of this study was to evaluate the early outcomes of arthroscopic management of femoroacetabular impingement (FAI). Methods: Ninety-six consecutive patients (100 hips) with radiographically documented FAI were treated with hip arthroscopy, labral debridement or repair\\/ refixation, proximal femoral osteoplasty, or acetabular rim trimming (or some combination thereof). Outcomes were measured with the impingement test, modified Harris Hip

Christopher M. Larson; M. Russell Giveans

2008-01-01

45

Measuring Assistive Technology Outcomes in Schools Using Functional Assessment.  

ERIC Educational Resources Information Center

Activities of Project OATS (Outcomes of Assistive Technology in the Schools) are described, including identification and piloting of existing assessment instruments for use as an outcome measure, examining the validity of the School Function Assessment, and field testing the School Function Assessment-Assistive Technology Version, an adaptation of…

Silverman, Michelle Kaye; Stratman, Kristine Freiberg; Smith, Roger O.

2000-01-01

46

Relating acoustics and human outcome measures in hospitals  

NASA Astrophysics Data System (ADS)

Hospital noise has been an area of concern for medical professionals and researchers for the last century. Researchers have attempted to characterize the soundscape of hospital wards and have made some preliminary links between noise and human outcomes. In the past, most of the research has used traditional acoustic metrics. These traditional metrics, such as average sound level, are readily measured using sound level meters and have been the primary results reported in previous studies. However, it has been shown that these traditional metrics may be insufficient in fully characterizing the wards. The two studies presented here use traditional metrics and nontraditional metrics to define the soundscape of hospital wards. The uncovered links, between both sound level metrics and psychoacoustic metrics and patient physiological measurements, are discussed. Correlations and risk ratios demonstrate the presence and the strength of these relationships. These results demonstrate the relationships between hospital acoustics and patient physiological arousal. Additionally, the effects of adding absorption in a hospital ward are presented. Sound level, sound power, reverberation time and other acoustic metrics are directly affected. The speech intelligibility in these wards is evaluated in order to highlight the temporal nature of speech intelligibility. With both studies combined, both traditional and nontraditional acoustic measures are shown to have statistically significant relationships to both patient and staff outcomes.

Hsu, Timothy Yuan-Ting

47

Clinical outcomes resulting from telemedicine interventions: a systematic review  

PubMed Central

Background The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based. Methods Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis). All included articles were abstracted and graded for quality and direction of the evidence. Results A total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery. Conclusions Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective. PMID:11737882

2001-01-01

48

Clinically Important Changes in Acute Pain Outcome Measures  

Microsoft Academic Search

The purpose of this study was to validate the changes in acute pain measurement scales that are most strongly associated with a patient-determined indicator of clinical importance. Measures of pain intensity and pain relief are commonly used outcomes in therapeutic clinical trials. Recent studies of the properties of acute pain measures have provided data defining the cut-off points that are

John T Farrar; Jesse A Berlin; Brian L Strom

2003-01-01

49

Results of a National Survey of State Protective Services Programs: Assessing Risk and Defining Victim Outcomes  

Microsoft Academic Search

A national survey of state adult protective services programs (APS) was conducted to collect information about the current status of documentation systems, risk assessment protocols, and outcome measures in adult protective services interventions. Fifty responses were received from 48 states, the District of Columbia, and Guam. The results highlight the wide variation in the state protective services programs, not only

Carolyn Stahl Goodrich

1997-01-01

50

Selective dorsal rhizotomy in Hong Kong: multidimensional outcome measures.  

PubMed

We prospectively case series study evaluated the short-term effectiveness of selective dorsal rhizotomy plus physiotherapy. Twenty children with spastic cerebral palsy, selected for selective dorsal rhizotomy (mean age, 8.57 years; range, 5.96-11.18 years), were assessed before, and 6 and 12 months after, selective dorsal rhizotomy. Main outcome measures included the Modified Ashworth Scale, passive range of joint movement, the Gross Motor Function Measure, the Pediatric Evaluation of Disability Inventory, the Canadian Occupational Performance Measure, and three-dimensional gait analysis. The results confirmed that selective dorsal rhizotomy plus physiotherapy provided a statistically significant reduction of spasticity, functional improvements in mobility and self-care performance, and increased participation in social situations in our study group (85% exhibited normal intelligence, and 90% belonged to Gross Motor Function Classification System levels I-III). The Gross Motor Function Measure proved to be sensitive in documenting motor functional changes, except for children at Gross Motor Function Classification System level I. Instrumental three-dimensional gait analysis with kinematics and kinetics data analysis confirmed gait improvements in children of higher motor function. The Canadian Occupational Performance Measure indicated improvements in social participation. PMID:18555169

Chan, Sophelia Hoi-Shan; Yam, Kwong Yiu; Yiu-Lau, Beverley Pui-Heung; Poon, Candice Yuen-Ching; Chan, Nerita Nar-Chi; Cheung, Ho Man; Wu, Morris; Chak, Wai Kwong

2008-07-01

51

IBADAN KNEE/HIP OSTEOARTHRITIS OUTCOME MEASURE: PROCESS OF DEVELOPMENT  

PubMed Central

The development of instruments for the assessment of therapeutic intervention has been an age long practice. However, many of the published instruments do not have detailed information on how the instruments were developed. It is necessary for authors to provide detailed (step by step) information on how measuring scales/instruments are developed. The Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM) was developed as a Nigerian-environment and culture-friendly instrument for the assessment of the effectiveness of therapeutic interventions in individuals with osteoarthritis of the knee and/or hip. This article outlines the steps involved in developing an outcome measure using IKHOAM as a template. PMID:25161423

Odole, A.C.; Odunaiya, N.A.; Akinpelu, A.O.

2013-01-01

52

Outcome measures in chronic low back pain  

Microsoft Academic Search

The purpose of this prospective, single site cohort quasi-experimental study was to determine the responsiveness of the numerical\\u000a rating scale (NRS), Roland–Morris disability questionnaire (RMDQ), Oswestry disability index (ODI), pain self-efficacy questionnaire\\u000a (PSEQ) and the patient-specific functional scale (PSFS) in order to determine which would best measure clinically meaningful\\u000a change in a chronic low back pain (LBP) population. Several patient-based

Elaine F. MaughanJeremy; Jeremy S. Lewis

2010-01-01

53

The Relationship between University Rankings and Outcomes Measurement  

ERIC Educational Resources Information Center

This paper examines the relationship between university ranks and outcome measurements. Many students select the university that they will attend based on these rankings In this paper the rankings conducted by two studies are examined. U.S. News and World Report rankings are based upon measures of the quality of input, retention while in school…

Ding, Chuanfu; Jalbert, Terrance; Landry, Steven P.

2007-01-01

54

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

55

Clinicians' Attitudes Towards Outcome and Process Monitoring: A Validation of the Outcome Measurement Questionnaire.  

PubMed

Valid and reliable instruments to measure monitoring attitudes of clinicians are scarce. The influence of sociodemographics and professional characteristics on monitoring attitudes is largely unknown. First, we investigated the factor structure and reliability of the Outcome Measurement Questionnaire among a sample of Flemish mental health professionals (n = 170). Next, we examined the relationship between clinicians' sociodemographic and professional characteristics and monitoring attitudes. Construct validity was determined using a confirmatory factor analysis. Internal consistency was ascertained using Cronbach's alpha. Mean level differences in monitoring attitudes related to clinicians' gender, work setting, level of education and psychotherapeutic training, were investigated using ANOVAs. The relationships between clinicians' age, clinical experience and attitudes were calculated using the Pearson correlation coefficient. A model with one general factor and a method factor referring to reverse-worded items best fitted our data. Internal consistency was good. Clinicians with psychotherapeutic training reported more favorable monitoring attitudes than those without such training. Compared to clinicians working in subsidized outpatient services, private practitioners and clinicians from inpatient mental health clinics had more positive attitudes. Results highlight the need for sustained and targeted training, with particular focus on transforming measurement data into meaningful clinical support tools. PMID:25315180

Smits, Dave F; Claes, Laurence; Stinckens, Nele; Smits, Dirk J M

2014-10-15

56

Ongoing therapeutic trials and outcome measures for Duchenne muscular dystrophy.  

PubMed

Muscular dystrophy is a heterogeneous group of genetic disorders characterised by progressive muscle tissue degeneration. No effective treatment has been discovered for these diseases. Preclinical and clinical studies aimed at the development of new therapeutic approaches have been carried out, primarily in subjects affected with dystrophinopathies (Duchenne and Becker muscular dystrophy). In this review, we outline the current therapeutic approaches and past and ongoing clinical trials, highlighting both the advantages and limits of each one. The experimental designs of these trials were based on different rationales, including immunomodulation, readthrough strategies, exon skipping, gene therapy, and cell therapy. We also provide an overview of available outcome measures, focusing on their reliability in estimating meaningful clinical improvement in order to aid in the design of future trials. This perspective is extremely relevant to the field considering the recent development of novel therapeutic approaches that will result in an increasing number of clinical studies over the next few years. PMID:23775131

Govoni, Alessandra; Magri, Francesca; Brajkovic, Simona; Zanetta, Chiara; Faravelli, Irene; Corti, Stefania; Bresolin, Nereo; Comi, Giacomo P

2013-12-01

57

Conceptual and methodological advances in child-reported outcomes measurement  

PubMed Central

Increasingly, clinical, pharmaceutical and translational research studies use patient-reported outcomes as primary and secondary end points. Obtaining this type of information from children themselves is now possible, but effective assessment requires developmentally sensitive conceptual models of child health and an appreciation for the rapid change in children’s cognitive capacities. To overcome these barriers, outcomes researchers have capitalized on innovations in modern measurement theory, qualitative methods for instrument development and new computerized technologies to create reliable and valid methods for obtaining self-reported health data among 8–17-year-old children. This article provides a developmentally focused framework for selecting child-report health assessment instruments. Several generic health-related quality of life instruments and the assessment tools developed by the NIH-sponsored Patient-Reported Outcome Measurement Information System network are discussed to exemplify advances in the measurement of children’s self-reported health, illness, wellbeing and quality of life. PMID:20715916

Bevans, Katherine B; Riley, Anne W; Moon, JeanHee; Forrest, Christopher B

2011-01-01

58

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

59

Clinical Practices and Outcomes in Elderly Hemodialysis Patients: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)  

PubMed Central

Summary Background and objectives Demand for hemodialysis among elderly patients is increasing worldwide. Although clinical care of this high-risk group is complex and challenging, no guidelines exist to inform hemodialysis practices. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides a unique opportunity to assess dialysis practices and associated outcomes among elderly versus younger patients on chronic in-center hemodialysis in 12 countries. Design, setting, participants, & measurements Clinical characteristics, dialysis practices, and outcomes of elderly versus younger patients were compared among participants in four DOPPS regions in 2005 through 2007. Results Although participant mean age increased over time in all DOPPS countries, the percentage of elderly varied widely. Overall, comorbidities and malnutrition were more common in the elderly. Fistulae were used less frequently among elderly versus younger patients in Europe and North America but not in Australia, New Zealand, and Japan. No difference in treatment time was observed between elderly and younger patients after normalizing for body weight. In all regions, ultrafiltration rates were lower among elderly patients. Elderly patients reported poorer quality of life with respect to the physical but not mental component scores. Mortality risk was three- to sixfold higher in the elderly group, whereas causes of death overall were similar for elderly and younger patients. Conclusions Elderly patients represent a different proportion of DOPPS participants across countries, possibly reflecting differences in policies and clinical practices. In general, hemodialysis practices in the elderly reflected each region's clinical patterns, with some variation by age group depending upon the practice. PMID:21734085

Tong, Lin; Tentori, Francesca; Akiba, Takashi; Karaboyas, Angelo; Gillespie, Brenda; Akizawa, Tadao; Pisoni, Ronald L.; Bommer, Juergen; Port, Friedrich K.

2011-01-01

60

Outcomes Research Branch | PROMIS and PCAR: Measuring Outcomes from the Patient's Perspective  

Cancer.gov

To sustain PROMIS moving forward, it is one of four NIH health measurement systems that comprise the new Person-Centered Assessment Resource (PCAR) initiative. The other three systems are the NIH Toolbox for Assessment of Neurological and Behavioral Function, the Quality of Life Outcomes in Neurological and Behavioral Function (Neuro-QOL), and the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me). PCAR was funded in 2014 as a cooperative agreement and held its first meeting in September.

61

Real Impact Solutions for Better Measurement and Improved Outcomes Microsoft Dynamics AX 2012 for  

E-print Network

Real Impact Solutions for Better Measurement and Improved Outcomes Microsoft Dynamics AX 2012 and improved outcomes in education. Doing more with less requires educational institutions to modernize policies, control budgets, operate with accountability and better measure and improve outcomes

Bernstein, Phil

62

Deconstructing race and ethnicity: implications for measurement of health outcomes.  

PubMed

A crucial issue for health researchers is how to measure health and health-related behaviors across racial/ethnic groups. This commentary outlines an approach that involves the deconstruction of race/ethnicity, which clarifies the independent influences of acculturation, quality of education, socioeconomic class, and racial socialization on outcomes of interest. Research on the influence of these variables on health outcomes in general, and cognitive test performance specifically, is presented. This research indicates that when variables such as quality of education, wealth, and perceived racism are taken into account, the effect of race/ethnicity on health outcomes is greatly reduced. In other words, race/ethnicity serves as a proxy for these more meaningful variables, and explicit measurement of these constructs will improve research of health within majority and minority ethnic groups. PMID:17060816

Manly, Jennifer J

2006-11-01

63

Health-related quality of life in patients with brain tumors: limitations and additional outcome measures.  

PubMed

Health-related quality of life (HRQOL) is a multidimensional concept used to measure patients' functioning and well-being. In recent decades, HRQOL has become an important (secondary) outcome measure in clinical trials for brain tumor patients. It could be questioned, however, whether HRQOL is the only useful outcome measure for assessing the level of functioning and well-being of these patients. As described in this review, several general methodological issues can hamper the interpretation of HRQOL data collected in the oncology setting. Additionally, because brain tumor patients have a progressive brain disease resulting in cognitive impairments, patient-reported outcomes may not always be the most informative and accurate measures of HRQOL in brain tumor patients. Supplementary or alternative measures, such as proxy-rated HRQOL measures and measures of instrumental activities of daily living, may provide a more complete picture of brain tumor patients' functioning in daily life. PMID:23666388

Dirven, Linda; Reijneveld, Jacob C; Aaronson, Neil K; Bottomley, Andrew; Uitdehaag, Bernard M J; Taphoorn, Martin J B

2013-07-01

64

Measuring and Documenting Outcomes: Going beyond Tradition in Program Evaluation.  

ERIC Educational Resources Information Center

The evaluation of systemic educational reforms entails a paradigm shift among evaluators who must change the lens through which they look at the reforms. This paper proposes methodological and design alternatives to measure nontraditional outcomes, such as changes in policy, over the lifespan of the reforms. Systemic reforms include intended and…

Davila, Norma

65

Knowledge Retention as a Latent Outcome Measure in Distance Learning.  

ERIC Educational Resources Information Center

Describes two experiments that investigated the retention of knowledge as a latent measure of learning outcome in video teletraining courses, one for air traffic controllers and one for military training. Discusses the merits of knowledge retention as a construct for examining initial evidence of learning, especially for training related to the…

Wisher, Robert A.; Curnow, Christina K.; Seidel, Robert J.

2001-01-01

66

Self-Help Groups: Problems of Measuring Outcome  

ERIC Educational Resources Information Center

Self-help groups provide help and support for members in dealing with their problems and improving their psychological function and effectiveness. This paper focuses on the multitude of technical issues surrounding the evaluation of the effectiveness or outcome of self-help groups, especially what, when, and whom to measure. (Author/JEL)

Lieberman, Morton A.; Bond, Gary R.

1978-01-01

67

Understanding the outcomes measures used in Huntington disease pharmacologicaltrials: A systematic review  

PubMed Central

Background The identification of the gene mutation causing Huntington disease has raised hopes for new treatments to ease symptoms and slow functional decline. As such, there has been a push towards designing efficient pharmacological trials (i.e., drug trials), especially with regard to selecting outcomes measures that are both brief and sensitive to changes across the course of the disease, from subtle prodromal changes, to more severe end-stage changes. Objectives Recently, to aid in efficient development of new HD research studies, the National Institute of Neurological Disorders and Stroke (NINDS) published recommendations for measurement selection in HD. While these recommendations are helpful, many of the recommended measures have little published data in HD. As such, we conducted a systematic review of the literature to identify the most common outcomes measures used in HD clinical trials. Methods Major medical databases, including PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, were used to identify peer-reviewed journal articles in English from 2001 through April 2013; 151 pharmacological trials were identified. Results The majority of HD clinical trials employed clinician-reported outcomes measures (93%); patient reported outcome measures (11%) and observer reported outcome measures (3%) were used with much less frequency. Conclusions We provide a review of the most commonly used measures across these trials, compare these measures to the clinical recommendations made by the NINDS working groups, and provide recommendations for selecting measures for future clinical trials that meet the Food and Drug Administration standards. PMID:25300328

Carlozzi, Noelle E; Miciura, Angela; Migliore, Nicholas; Dayalu, Praveen

2014-01-01

68

Extremely large nuchal translucency measurement predicts adverse pregnancy outcome.  

PubMed

Abstract A prospective study was conducted to determine the outcome of pregnancies with 1st trimester nuchal translucency measurement of ? 6.5 mm. The risk of fetal abnormalities increases with enlarging nuchal translucency, being around 45% with a measurement of ? 6.5 mm. A total of 27,144 women with singleton pregnancies participated in the combined Down syndrome screening within the public healthcare system in Northern Finland. The study period was 1 May 2002 to 31 May 2009. The nuchal translucency measurement was ? 6.5 mm in 16 cases (0.06%). Pregnancy outcome was normal in one case (6.3%). The risk of abnormality was higher in our study than reported in the literature. According to our study, immediate diagnostic tests should be offered after an nuchal translucency measurement of ? 6.5 mm. We should also consider analysis of fetal micro-deletions associated with certain syndromes. PMID:25020113

Pitkanen, S; Laitinen, P; Yla-Outinen, A; Heikkila, M; Honkasalo, T; Ryynanen, M; Marttala, J

2015-01-01

69

Medical specialty boards can help measure graduate medical education outcomes.  

PubMed

U.S. graduate medical education (GME) training institutions are under increasing scrutiny to measure program outcomes as a demonstration of accountability for the sizeable funding they receive from the federal government. The Accreditation Council for Graduate Medical Education (ACGME) is a potential agent of measuring GME accountability but has no interaction with physicians after residency training is completed. American Board of Medical Specialty (ABMS) member boards interact with physicians throughout their careers through maintenance of certification (MOC) and are a potential source of valuable data on physician competency and quality of care, both of which could be used to measure GME accountability.The authors propose that ABMS boards and the ACGME deepen their existing relationship to better assess residency training outcomes. ABMS boards have a wealth of data on physicians collected as a by-product of MOC and business operations. Further, many ABMS boards collect practice demographics and scope-of-practice information through MOC enrollment surveys or recertification examination questionnaires. These data are potentially valuable in helping residencies know what their graduates are doing in practice. Part 4 of MOC generally involves assessment of the quality of care delivered in practice, and ABMS boards could share these deidentified data with the ACGME and residency programs to provide direct feedback on the practice outcomes of graduates.ABMS member boards and the ACGME should broaden their long-standing relationship to further develop shared roles and data-sharing mechanisms to better inform residencies and the public about GME training outcomes. PMID:24871232

Peterson, Lars E; Carek, Peter; Holmboe, Eric S; Puffer, James C; Warm, Eric J; Phillips, Robert L

2014-06-01

70

Clinical outcome data for symptomatic breast cancer: the breast cancer clinical outcome measures (BCCOM) project  

Microsoft Academic Search

Background:Data collection for screen-detected breast cancer in the United Kingdom is fully funded, which has led to improvements in clinical practice. However, data on symptomatic cancer are deficient, and the aim of this project was to monitor the current practice.Methods:A data set was designed together with surrogate outcome measures to reflect best practice. Data from cancer registries initially required the

T Bates; O Kearins; I Monypenny; C Lagord; G Lawrence

2009-01-01

71

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

72

Clinical outcomes resulting from telemedicine interventions: a systematic review  

Microsoft Academic Search

BACKGROUND: The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office\\/hospital-based. METHODS: Data sources for the study included deports of studies

William R Hersh; Mark Helfand; James Wallace; Dale Kraemer; Patricia Patterson; Susan Shapiro; Merwyn Greenlick

2001-01-01

73

LDEF radiation measurements: preliminary results  

NASA Technical Reports Server (NTRS)

The Long Duration Exposure Facility (LDEF), retrieved by the Space Shuttle mission STS-32 after nearly 6 yr in orbit, is the focus of a broad-based study of the radiation environment in low Earth orbit (LEO) and its effects on materials. A combination of passive techniques has been used to study this environment via detectors which were contained in experiments aboard the LDEF spacecraft and through analysis of induced radioactivities. Preliminary results for absorbed dose measurements and for induced activities in various materials are presented. A number of effects have been observed which reflect the anisotropy of the charged particle flux in low Earth orbit. Quantitative results from these measurements should provide an accurate means of confirming environmental flux models and techniques for predicting radiation encountered in future LEO missions, particularly those of extended duration.

Harmon, B. A.; Fishman, G. J.; Parnell, T. A.; Benton, E. V.; Frank, A. L.

1992-01-01

74

[Total anorectal reconstruction after proctocolectomy: surgical results and functional outcome].  

PubMed

The aim of this report is to describe a novel technical approach to total anorectal reconstruction and show surgical results and functional outcome. The technique is an innovative surgery to restore gastrointestinal perineal continuity after coloproctectomy in patients with familial adenomatous polyposis. We made the internal anal sphincter replacement with demucosated small bowel plication, the external anal sphincter replacement with an artificial bowel sphincter (ABS) and the restitution of intestinal transit with and ileal "S" pouch. After 12 months follow-up the control of gas is irregular, normal continence to solid stool was achieved with only occasional minimal soiling after defecation. The Jorge-Wexner incontinence score is 6 (moderate incontinence). The fecal incontinence quality of life (FIQL) comparing stoma vs. non-stomas, shows a relevant clinical difference, with improvement in all scales. This study has limitations because it is preliminary, observational and with no control group. We conclude that this recent surgical technique requires expertise in pelvic floor surgery and management of fecal incontinence. The surgeon should be able not only to introduce an artificial anal sphincter, but also to make the plication of intestinal muscle layer to create a zone of high pressure in anal canal and the ileal pouch. PMID:24516957

Lumi, Carlos Miguel; Muñoz, Juan Pablo; Miravalle, Omar Rubén; Masciangoli, Guillermo; La Rosa, Luciana

2013-12-01

75

Outcome measures in acute gout: a systematic literature review  

PubMed Central

Objective Five core domains have been endorsed by Outcomes Measures in Rheumatology (OMERACT) for acute gout: pain, joint swelling, joint tenderness, patient global assessment, and activity limitation. The aim of this work was to evaluate instruments for these domains according to the OMERACT filter: truth, feasibility, and discrimination. Methods A systematic search strategy for instruments used to measure the acute gout core domains was formulated. For each method, articles were assessed by two reviewers to summarise information according to the specific components of the OMERACT filter. Results Seventy-seven articles and abstracts met the inclusion criteria. Pain was most frequently reported (76 studies, 20 instruments). The pain instruments used most often were 100mm visual analog scale (VAS) and 5-point Likert scale. Both methods have high feasibility, face and content validity, within- and between-group discrimination. Four-point Likert scales assessing index joint swelling and tenderness have been used in numerous acute gout studies; these instruments are feasible, with high face and content validity, and show within- and between-group discrimination. Five-point patient global assessment of response to treatment (PGART) scales are feasible and valid, and show within- and between-group discrimination. Measures of activity limitations were infrequently reported, and insufficient data were available to make definite assessments of the instruments for this domain. Conclusion Many different instruments have been used to assess the acute gout core domains. Pain VAS and 5-point Likert scales, 4-point Likert scales of index joint swelling and tenderness and 5-point PGART instruments meet the criteria for the OMERACT filter. PMID:24334652

Dalbeth, Nicola; Zhong, Cathy S; Grainger, Rebecca; Khanna, Dinesh; Khanna, Puja P; Singh, Jasvinder A; McQueen, Fiona M; Taylor, William J

2014-01-01

76

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. PMID:22184464

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

2012-01-01

77

Towards measurement of outcome for patients with varicose veins  

Microsoft Academic Search

OBJECTIVE--To develop a valid and reliable outcome measure for patients with varicose veins. DESIGN--Postal questionnaire survey of patients with varicose veins. SETTING--Surgical outpatient departments and training general practices in Grampian region. SUBJECTS--373 patients, 287 of whom had just been referred to hospital for their varicose veins and 86 who had just consulted a general practitioner for this condition and, for

A M Garratt; L M Macdonald; D A Ruta; I T Russell; J K Buckingham; Z H Krukowski

1993-01-01

78

Inside Quality Reform: Early Results on Using Outcomes for Improvement  

ERIC Educational Resources Information Center

This article offers evidence on ways in which assessment of student learning outcomes made a difference for some academic institutions in the United States. It offers perspectives on the internal changes that took place, especially within academic programmes. Even after the capacity for assessment was developed, challenges remained in evaluating…

El-Khawas, Elaine

2014-01-01

79

Tophus measurement as an outcome measure for clinical trials of chronic gout: progress and research priorities.  

PubMed

Despite the recognition that tophus regression is an important outcome measure in clinical trials of chronic gout, there is no agreed upon method of tophus measurement. A number of methods have been used in clinical trials of chronic gout, from simple physical measurement techniques to more complex advanced imaging methods. This article summarizes methods of tophus measurement and discusses their properties. Physical measurement using Vernier calipers meets most aspects of the Outcome Measures in Rheumatology (OMERACT) filter. Rigorous testing of the complex methods, particularly with respect to reliability and sensitivity to change, is needed to determine the appropriate use of these methods. Further information is also required regarding which method of physical measurement is best for use in future clinical trials. The need to develop and test a patient-reported outcome measure of tophus burden is also highlighted. PMID:21724716

Dalbeth, Nicola; McQueen, Fiona M; Singh, Jasvinder A; MacDonald, Patricia A; Edwards, N Lawrence; Schumacher, H Ralph; Simon, Lee S; Stamp, Lisa K; Neogi, Tuhina; Gaffo, Angelo L; Khanna, Puja P; Becker, Michael A; Taylor, William J

2011-07-01

80

Stroboscopic Parameters Reported as Voice Outcome Measures in Patients Treated for Laryngeal Cancer: A Systematic Review  

PubMed Central

Background A systematic review of the use of stroboscopy as a treatment outcome measure of vocal fold function in patients treated for laryngeal cancer is presented. Methods Computerized literature searches were performed. Eligible articles were admitted when stroboscopy was used to measure vocal fold function before and after treatment in patients with laryngeal cancer. Data extracted included: tumor stage and location, treatment modality, stroboscopy parameters, parameter scale, number of raters, rater reliability, methodology, and level of evidence. Results Of 520 articles retrieved, 11 studies met inclusion criteria. A total of twenty-four parameters were reported. Rating scales and rater reliability varied. Discussion Major methodological differences exist in studies using stroboscopic findings as voice outcome measures in patients’ post-cancer treatment. These differences lead to equivocal findings when assessing the utility of stroboscopy as an outcome measure. Standardized, reliable scoring and reporting systems for laryngeal stroboscopic examinations are needed. PMID:25339842

Focht, Kendrea L.; Martin-Harris, Bonnie; Bonilha, Heather Shaw

2013-01-01

81

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

82

Lessons from the National Outcomes Measurement System (NOMS).  

PubMed

Significant reforms in education are changing the way school-based speech-language pathologists document and provide treatment. Faced with resource constraints and new mandates for accountability, clinicians are being pressured to demonstrate the value and impact of their services. To assist clinicians with meeting these challenges, the American Speech-Language-Hearing Association developed the National Outcomes Measurement System (NOMS) as a way to determine the effectiveness of school-based speech and language services. Data collected from NOMS are used to discuss: the effects of speech and language intervention on a student's ability to perform in the classroom, the key factors influencing progress for preschoolers with articulation disorders, and the impact of a clinician's caseload size on the outcomes students achieve. PMID:14533056

Schooling, Tracy L

2003-08-01

83

Using ‘dead or dependent’ as an outcome measure in clinical trials in Parkinson's disease  

PubMed Central

Background Simple, robust, sensitive and clinically meaningful outcome measures are required for neuroprotective trials in Parkinson's disease (PD). We explored the feasibility of a composite binary outcome measure, ‘dead or dependent’, in such trials using data from a prospective follow-up study of an incident cohort of PD patients. Methods Two hundred incident patients had an annual follow-up, including assessment of the Hoehn-Yahr stage (H-Y) and Schwab and England Activities of Daily Living Scale (S&E). Annual scores were converted into binary variables (H-Y <3 vs H-Y ?3, and S&E ?80% vs S&E <80%). A new outcome of ‘dead or dependent’ was also created, with dependence in activities of daily living defined as S&E <80%. Using these data, sample sizes were calculated for a hypothetical three-year randomised trial in which the trial outcome was defined by a binary clinical variable, all-cause mortality, or PD-related mortality. Results At 3?years, 18.0% of patients were dead and 38.4% were dead or dependent. At 80% power, large sample sizes were required if PD-related mortality (n=1938 per study arm) or all-cause mortality (n=734) were used as the outcome, even for large treatment effects (30% reduction in relative risk). The new outcome of ‘death or dependency’ required the smallest sample sizes of all the outcome measures (n=277 for 30% reduction in relative risk, 627 for a 20% reduction). Conclusions ‘Death or dependency’ is a feasible and potentially useful outcome measure in PD trials of neuroprotective agents, but further work is required to validate its use and define dependency. PMID:24854405

McGhee, David; Parker, Alexander; Fielding, Shona; Zajicek, John; Counsell, Carl

2015-01-01

84

Pediatric stroke outcome measure: predictor of multiple impairments in childhood stroke.  

PubMed

The ability to anticipate deficits would help with implementation of interventions for children affected by stroke. The pediatric stroke outcome measure (measure) measures neurological impairment after stroke, but there has been little research examining the relationship between the measure and functional outcomes. We hypothesized the Measure correlates with cognitive and behavioral outcomes. Thirty-six children with stroke were assessed with the Measure, and tested for cognitive ability, problem behavior, adaptive behavior, and social participation. We examined the correlation between the total Measure and outcomes and determined how subscale scores associated with outcomes. Higher total Measure scores correlated with poorer outcomes in cognitive ability, problem behaviors, adaptive behaviors, and social participation. Specific subscale scores correlated with poorer outcomes in multiple domains. The total Measure can be used to anticipate poor outcomes in multiple domains after stroke and can help the clinician in the treatment of children as they recover. PMID:24163399

Lo, Warren; Gordon, Anne L; Hajek, Christine; Gomes, Alison; Greenham, Mardee; Anderson, Vicki; Yeates, Keith O; Mackay, Mark T

2014-11-01

85

Quantum interferometry with binary-outcome measurements in the presence of phase diffusion  

NASA Astrophysics Data System (ADS)

Optimal measurement scheme with an efficient data processing is important in quantum-enhanced interferometry. Here we prove that for a general binary-outcome measurement, the simplest data processing based on inverting the average signal can saturate the Cramér-Rao bound. This idea is illustrated by binary-outcome homodyne detection, even-odd photon counting (i.e., parity detection), and zero-nonzero photon counting that have achieved super-resolved interferometric fringe and shot-noise limited sensitivity in coherent-light Mach-Zehnder interferometer. The roles of phase diffusion are investigated in these binary-outcome measurements. We find that the diffusion degrades the fringe resolution and the achievable phase sensitivity. Our analytical results confirm that the zero-nonzero counting can produce a slightly better sensitivity than that of the parity detection, as demonstrated in a recent experiment.

Feng, X. M.; Jin, G. R.; Yang, W.

2014-07-01

86

Health outcomes in diabetics measured with Minnesota Community Measurement quality metrics  

PubMed Central

Objective Our objective was to understand the relationship between optimal diabetes control, as defined by Minnesota Community Measurement (MCM), and adverse health outcomes including emergency department (ED) visits, hospitalizations, 30-day rehospitalization, intensive care unit (ICU) stay, and mortality. Patients and methods In 2009, we conducted a retrospective cohort study of empaneled Employee and Community Health patients with diabetes mellitus. We followed patients from 1 September 2009 until 30 June 2011 for hospitalization and until 5 January 2014 for mortality. Optimal control of diabetes mellitus was defined as achieving the following three measures: low-density lipoprotein (LDL) cholesterol <100 mg/mL, blood pressure <140/90 mmHg, and hemoglobin A1c <8%. Using the electronic medical record, we assessed hospitalizations, ED visits, ICU stays, 30-day rehospitalizations, and mortality. The chi-square or Wilcoxon rank-sum tests were used to compare those with and without optimal control. We used Cox proportional hazard models to estimate the associations between optimal diabetes mellitus status and each outcome. Results We identified 5,731 empaneled patients with diabetes mellitus; 2,842 (49.6%) were in the optimal control category. After adjustment, we observed that non-optimally controlled patients had higher risks for hospitalization (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.00–1.23), ED visits (HR 1.15; 95% CI 1.06–1.25), and mortality (HR 1.29; 95% CI 1.09–1.53) than diabetic patients with optimal control. No differences were observed in ICU stay or 30-day rehospitalization. Conclusion Diabetic patients without optimal control had higher risks of adverse health outcomes than those with optimal control. Patients with optimal control defined by the MCM were associated with decreased morbidity and mortality.

Takahashi, Paul Y; St Sauver, Jennifer L; Finney Rutten, Lila J; Jacobson, Robert M; Jacobson, Debra J; McGree, Michaela E; Ebbert, Jon O

2015-01-01

87

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

88

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

89

Measurement properties of patient-reported outcome measures (PROMS) in Patellofemoral Pain Syndrome: A systematic review.  

PubMed

This systematic review investigated the measurement properties of disease-specific patient-reported outcome measures used in Patellofemoral Pain Syndrome. Two independent reviewers conducted a systematic search of key databases (MEDLINE, EMBASE, AMED, CINHAL+ and the Cochrane Library from inception to August 2013) to identify relevant studies. A third reviewer mediated in the event of disagreement. Methodological quality was evaluated using the validated COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) tool. Data synthesis across studies determined the level of evidence for each patient-reported outcome measure. The search strategy returned 2177 citations. Following the eligibility review phase, seven studies, evaluating twelve different patient-reported outcome measures, met inclusion criteria. A 'moderate' level of evidence supported the structural validity of several measures: the Flandry Questionnaire, Anterior Knee Pain Scale, Functional Index Questionnaire, Eng and Pierrynowski Questionnaire and Visual Analogue Scales for 'usual' and 'worst' pain. In addition, there was a 'Limited' level of evidence supporting the test-retest reliability and validity (cross-cultural, hypothesis testing) of the Persian version of the Anterior Knee Pain Scale. Other measurement properties were evaluated with poor methodological quality, and many properties were not evaluated in any of the included papers. Current disease-specific outcome measures for Patellofemoral Pain Syndrome require further investigation. Future studies should evaluate all important measurement properties, utilising an appropriate framework such as COSMIN to guide study design, to facilitate optimal methodological quality. PMID:24997774

Green, Andrew; Liles, Clive; Rushton, Alison; Kyte, Derek G

2014-12-01

90

Goal specificity: a proxy measure for improvements in environmental outcomes in collaborative governance.  

PubMed

Collaborative governance critics continually call for evidence to support its prevalent use. As is often the case in environmental policy, environmental outcomes occur at a rate incompatible with political agendas. In addition, a multitude of possibly confounding variables makes it difficult to correlate collaborative governance processes with environmental outcomes. The findings of this study offer empirical evidence that collaborative processes have a measurable, beneficial effect on environmental outcomes. Through the use of a unique paired-waterbody design, our dataset reduced the potential for confounding variables to impact our environmental outcome measurements. The results of a path analysis indicate that the output of setting specific pollutant reduction goals is significantly related to watershed partnerships' level of attainment of their environmental improvement goals. The action of setting specific goals (e.g. percentage of load reductions in pollutant levels) is fostered by sustained participation from partnership members throughout the lifecycle of the collaborative. In addition, this study demonstrates the utility of logic modeling for environmental planning and management, and suggests that the process of setting specific pollutant reduction goals is a useful proxy measure for reporting progress towards improvements in environmental outcomes when long-term environmental data are not available. PMID:25083592

Biddle, Jennifer C; Koontz, Tomas M

2014-12-01

91

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

92

Systematic review of outcome measures in trials of pediatric anaphylaxis treatment  

PubMed Central

Background Considerable heterogeneity has been observed in the selection and reporting of disease-specific pediatric outcome measures in randomized controlled trials (RCTs). This makes interpretation of results and comparison across trials challenging. Outcome measures in pediatric anaphylaxis trials have never previously been systematically assessed. This systematic review (SR) identified and assessed outcome measures used in RCTs of anaphylaxis treatment in children. As a secondary objective, this SR assessed the evidence for current treatment modalities for anaphylaxis in the pediatric population. Methods We searched MEDLINE, EMBASE, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL from 2001 until December 2012. We also searched websites listing ongoing trials. We included randomized and controlled trials of anaphylaxis treatment in patients 0–18 years of age. Two authors independently assessed articles for inclusion. Results No published studies fulfilled the inclusion criteria. Conclusions There is an alarming absence of RCTs evaluating the treatments for anaphylaxis in children. High quality studies are needed and are possible to design, despite the severe and acute nature of this condition. Consensus about the selection and validation of appropriate outcome measures will enhance the quality of research and improve the care of children with anaphylaxis. Trial registration CRD42012002685 PMID:24950840

2014-01-01

93

Entanglement-assisted guessing of complementary measurement outcomes  

NASA Astrophysics Data System (ADS)

Heisenberg's uncertainty principle implies that if one party (Alice) prepares a system and randomly measures one of two incompatible observables, then another party (Bob) cannot perfectly predict the measurement outcomes. This implication assumes that Bob does not possess an additional system that is entangled to the measured one; indeed, the seminal paper of Einstein, Podolsky, and Rosen (EPR) showed that maximal entanglement allows Bob to perfectly win this guessing game. Although not in contradiction, the observations made by EPR and Heisenberg illustrate two extreme cases of the interplay between entanglement and uncertainty. On the one hand, no entanglement means that Bob's predictions must display some uncertainty. Yet on the other hand, maximal entanglement means that there is no more uncertainty at all. Here we follow an operational approach and give an exact relation—an equality—between the amount of uncertainty as measured by the guessing probability and the amount of entanglement as measured by the recoverable entanglement fidelity. From this equality, we deduce a simple criterion for witnessing bipartite entanglement and an entanglement monogamy equality.

Berta, Mario; Coles, Patrick J.; Wehner, Stephanie

2014-12-01

94

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

E-print Network

Recommendations for the Use of Common Outcome Measures in Pediatric Traumatic Brain Injury Research. Yeates14 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

O'Toole, Alice J.

95

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

96

Nonadherence in dialysis patients: prevalence, measurement, outcome, and psychological determinants.  

PubMed

Nonadherence to aspects of the management of End-Stage Kidney Disease (ESKD) is common. Estimates of nonadherence vary with assessment method. Whilst readily available and free from report bias, physiological proxies-frequently used as measures of adherence-are often confounded by clinical factors including residual kidney function and dialysis adequacy. Despite variation in estimates of its prevalence, it is clear that suboptimal adherence to dialysis prescriptions, medication and diet can lead to adverse clinical outcomes. Several factors can help explain nonadherence in ESKD including mood, self-efficacy, social support, illness, and treatment perceptions. Psychological interventions have been shown to improve ESKD adherence, yet achieving long-term behavior change remains challenging. Identifying individuals who struggle to adhere to aspects of the dialysis regime, and tailoring theory-led interventions to improve and support adherence is a clear clinical need requiring further empirical enquiry. PMID:24164416

Clark, Sarah; Farrington, Ken; Chilcot, Joseph

2014-01-01

97

Functional outcome measures for NF1-associated optic pathway glioma clinical trials  

PubMed Central

Objective: The goal of the Response Evaluation in Neurofibromatosis and Schwannomatosis Visual Outcomes Committee is to define the best functional outcome measures for future neurofibromatosis type 1 (NF1)-associated optic pathway glioma (OPG) clinical trials. Methods: The committee considered the components of vision, other ophthalmologic parameters affected by OPG, potential biomarkers of visual function, and quality of life measures to arrive at consensus-based, evidence-driven recommendations for objective and measurable functional endpoints for OPG trials. Results: Visual acuity (VA) assessments using consistent quantitative testing methods are recommended as the main functional outcome measure for NF1-OPG clinical trials. Teller acuity cards are recommended for use as the primary VA endpoint, and HOTV as a secondary endpoint once subjects are old enough to complete it. The optic disc should be assessed for pallor, as this appears to be a contributory variable that may affect the interpretation of VA change over time. Given the importance of capturing patient-reported outcomes in clinical trials, evaluating visual quality of life using the Children's Visual Function Questionnaire as a secondary endpoint is also proposed. Conclusions: The use of these key functional endpoints will be essential for evaluating the efficacy of future OPG clinical trials. PMID:24249802

Avery, Robert A.; Allen, Jeffrey C.; Ardern-Holmes, Simone L.; Bilaniuk, Larissa T.; Ferner, Rosalie E.; Gutmann, David H.; Listernick, Robert; Martin, Staci; Ullrich, Nicole J.; Liu, Grant T.

2013-01-01

98

Validation of GAITRite and PROMIS as high-throughput physical function outcome measures following ACL reconstruction.  

PubMed

New healthcare demands for quality measures of elective procedures, such as anterior cruciate ligament (ACL) reconstructive surgery, warrant the establishment of high throughput outcomes for high volume clinics. To this end, we evaluated the PROMIS and GAITRite as physical function outcome measures to quantify early healing and post-operative complications in 106 patients at pre-operative and 3, 10, 20 and 52 weeks post-ACL reconstruction with bone-tendon-bone autograft, and compared the results to the current IKDC validated outcome measure. The results showed that both PROMIS and GAITRite were significantly quicker to administer versus IKDC (p<0.0001). Additional advantages were that PROMIS and GAITRite detected a significant decrease in physical function at 3 weeks post-operative, and a significant improvement at 10 weeks post-operative versus pre-operative (p<0.001), which were not detected with IKDC. GAITRite was limited by a low ceiling that could not detect improvement of physical function beyond 20 weeks, while both PROMIS and IKDC detected significant improvement out to 52 weeks post-operative (p<0.001). Linear regressions demonstrated a significant relationship between IKDC and PROMIS, with a combined correlation value of 0.8954 (p<0.001) for all time points. Finally, ROC curve analysis demonstrated that PROMIS is a diagnostic test for poor outcomes. PMID:24532421

Papuga, M Owen; Beck, Christopher A; Kates, Stephen L; Schwarz, Edward M; Maloney, Michael D

2014-06-01

99

Comparison of IKDC and SANE Outcome Measures Following Knee Injury in Active Female Patients  

PubMed Central

Background: Knee injury among young, active female patients remains a public health issue. Clinicians are called upon to pay greater attention to patient-oriented outcomes to evaluate the impact of these injuries. Little agreement exists on which outcome measures are best, and clinicians cite several barriers to their use. Single Assessment Numerical Evaluation (SANE) may provide meaningful outcome information while lessening the time burden associated with other patient-oriented measures. Hypothesis: The SANE and International Knee Documentation Committee (IKDC) scores would be strongly correlated in a cohort of young active female patients with knee injuries from preinjury through 1-year follow-up and that a minimal clinically important difference (MCID) could be calculated for the SANE score. Study Design: Observational prospective cohort. Methods: Two hundred sixty-three subjects completed SANE and IKDC at preinjury by recall, time of injury, and 3, 6, and 12 months postinjury. Pearson correlation coefficients were used to assess the association between SANE and IKDC. Repeated-measures analysis of variance was used to determine differences in SANE and IKDC over time. MCID was calculated for SANE using IKDC MCID as an anchor. Results: Moderate to strong correlations were seen between SANE and IKDC (0.65-0.83). SANE, on average, was 2.7 (95% confidence interval, 1.5-3.9; P < 0.00) units greater than IKDC over all time points. MCID for the SANE was calculated as 7 for a 6-month follow-up and 19 for a 12-month follow-up. Conclusion: SANE scores were moderately to strongly correlated to IKDC scores across all time points. Reported MCID values for the SANE should be utilized to measure meaningful changes over time for young, active female patients with knee injuries. Clinical Relevance: Providing clinicians with patient-oriented outcome measures that can be obtained with little clinician and patient burden may allow for greater acceptance and use of outcome measures in clinical settings. PMID:24427427

Winterstein, Andrew P.; McGuine, Timothy A.; Carr, Kathleen E.; Hetzel, Scott J.

2013-01-01

100

The impact of performance incentives on child health outcomes: results from a cluster randomized controlled trial in the Philippines.  

PubMed

Improving clinical performance using measurement and payment incentives, including pay for performance (or P4P), has, so far, shown modest to no benefit on patient outcomes. Our objective was to assess the impact of a P4P programme on paediatric health outcomes in the Philippines. We used data from the Quality Improvement Demonstration Study. In this study, the P4P intervention, introduced in 2004, was randomly assigned to 10 community district hospitals, which were matched to 10 control sites. At all sites, physician quality was measured using Clinical Performance Vignettes (CPVs) among randomly selected physicians every 6 months over a 36-month period. In the hospitals randomized to the P4P intervention, physicians received bonus payments if they met qualifying scores on the CPV. We measured health outcomes 4-10 weeks after hospital discharge among children 5 years of age and under who had been hospitalized for diarrhoea and pneumonia (the two most common illnesses affecting this age cohort) and had been under the care of physicians participating in the study. Health outcomes data collection was done at baseline/pre-intervention and 2 years post-intervention on the following post-discharge outcomes: (1) age-adjusted wasting, (2) C-reactive protein in blood, (3) haemoglobin level and (4) parental assessment of child's health using general self-reported health (GSRH) measure. To evaluate changes in health outcomes in the control vs intervention sites over time (baseline vs post-intervention), we used a difference-in-difference logistic regression analysis, controlling for potential confounders. We found an improvement of 7 and 9 percentage points in GSRH and wasting over time (post-intervention vs baseline) in the intervention sites relative to the control sites (P ? 0.001). The results from this randomized social experiment indicate that the introduction of a performance-based incentive programme, which included measurement and feedback, led to improvements in two important child health outcomes. PMID:24134922

Peabody, John W; Shimkhada, Riti; Quimbo, Stella; Solon, Orville; Javier, Xylee; McCulloch, Charles

2014-08-01

101

Optimal functional outcome measures for assessing treatment for Dupuytren’s disease: a systematic review and recommendations for future practice  

PubMed Central

Background Dupuytren's disease of the hand is a common condition affecting the palmar fascia, resulting in progressive flexion deformities of the digits and hence limitation of hand function. The optimal treatment remains unclear as outcomes studies have used a variety of measures for assessment. Methods A literature search was performed for all publications describing surgical treatment, percutaneous needle aponeurotomy or collagenase injection for primary or recurrent Dupuytren’s disease where outcomes had been monitored using functional measures. Results Ninety-one studies met the inclusion criteria. Twenty-two studies reported outcomes using patient reported outcome measures (PROMs) ranging from validated questionnaires to self-reported measures for return to work and self-rated disability. The Disability of Arm, Shoulder and Hand (DASH) score was the most utilised patient-reported function measure (n=11). Patient satisfaction was reported by eighteen studies but no single method was used consistently. Range of movement was the most frequent physical measure and was reported in all 91 studies. However, the methods of measurement and reporting varied, with seventeen different techniques being used. Other physical measures included grip and pinch strength and sensibility, again with variations in measurement protocols. The mean follow-up time ranged from 2 weeks to 17 years. Conclusions There is little consistency in the reporting of outcomes for interventions in patients with Dupuytren’s disease, making it impossible to compare the efficacy of different treatment modalities. Although there are limitations to the existing generic patient reported outcomes measures, a combination of these together with a disease-specific questionnaire, and physical measures of active and passive individual joint Range of movement (ROM), grip and sensibility using standardised protocols should be used for future outcomes studies. As Dupuytren’s disease tends to recur following treatment as well as extend to involve other areas of the hand, follow-up times should be standardised and designed to capture both short and long term outcomes. PMID:23575442

2013-01-01

102

Measuring outcome expectancy value of leisure-time physical activity for african americans.  

PubMed

A scale was adapted from existing scales to measure the outcome expectancy value (EV) as one of contributory factors to leisure-time physical activity (LTPA) and was administered to 649 African American adults. The eligible participants (N = 569) for the analysis were split into three subsamples (rate = 0.5 : 0.25 : 0.25) respectively for Exploratory Factor Analysis (N = 285) and cross-validation (N = 142 for the calibration group and N = 142 for the validation group) to evaluate the psychometric properties of the scale. Item analysis of the scale provided adequate psychometric properties. The 2-factor solution with positive and negative outcome EV subscales was supported based on the exploratory factor analysis and the multiple-group confirmatory factor analysis for both the calibration and validation samples. The results support the factorial construct validity and criterion validity of the outcome EV scale applied to assess LTPA in a sample of church-going African Americans. PMID:24438219

Li, Kaigang; Seo, Dong-Chul; Torabi, Mohammad R

2015-01-01

103

Measuring Outcomes in Adult Weight Loss Studies That Include Diet and Physical Activity: A Systematic Review  

PubMed Central

Background. Measuring success of obesity interventions is critical. Several methods measure weight loss outcomes but there is no consensus on best practices. This systematic review evaluates relevant outcomes (weight loss, BMI, % body fat, and fat mass) to determine which might be the best indicator(s) of success. Methods. Eligible articles described adult weight loss interventions that included diet and physical activity and a measure of weight or BMI change and body composition change. Results. 28 full-text articles met inclusion criteria. Subjects, settings, intervention lengths, and intensities varied. All studies measured body weight (?2.9 to ?17.3?kg), 9 studies measured BMI (?1.1 to ?5.1?kg/m2), 20 studies measured % body fat (?0.7 to ?10.2%), and 22 studies measured fat mass (?0.9 to ?14.9?kg). All studies found agreement between weight or BMI and body fat mass or body fat % decreases, though there were discrepancies in degree of significance between measures. Conclusions. Nearly all weight or BMI and body composition measures agreed. Since body fat is the most metabolically harmful tissue type, it may be a more meaningful measure of health change. Future studies should consider primarily measuring % body fat, rather than or in addition to weight or BMI.

Millstein, Rachel A.

2014-01-01

104

Measuring functional outcomes in therapeutic trials for chronic disease.  

PubMed

For clinical trials of many chronic diseases, the outcome of greatest interest may be patient function. Unfortunately, most scales for measuring functional status are crude and rarely consider important psychosocial impacts of disease. This paper briefly considers the pressures for improving functional status measurement, proposes six criteria for assessing functional or "health status" scales, and selectively reviews representative instruments using these criteria. Older functional classifications and many scales used for quality-of-care assessment are narrowly focussed on physical function. Their reliability, validity, and sensitivity to clinical changes are generally unknown. Traditional scales of "Activities of Daily Living" are similarly focussed on physical function, and are most appropriate for severely disabled inpatients. A new generation of "health status" instruments offers wider applicability, more comprehensiveness, and feasibility for clinical applications. Their validity and reliability are generally quite good. None of the instruments reviewed, however, has yet demonstrated convincing success as a "transition" variable (sensitivity to small but clinically important changes). Based on this analysis, future investigation should seek to (1) define the optimal balance between brevity on the one hand, and comprehensiveness and reliability on the other, (2) describe the sensitivity of scales to clinically important changes, and (3) directly compare existing instruments to aid selection by investigators who are considering their use in clinical trials. PMID:6488807

Deyo, R A

1984-09-01

105

Measuring nurse-sensitive patient outcomes across specialty units.  

PubMed

In efforts to quantify the quality of care delivered to patients within their systems, nursing administrators are being called on to both privately and publicly report nursing-sensitive outcomes for their institutions. Accurate reporting with appropriate patient population or risk adjustment is essential if the reported outcomes are to provide meaningful data to consumers and providers. At present there are no effective mechanisms available that can sufficiently adjust nursing-sensitive outcomes to assure reliable reporting. This study suggests that specialty unit classification may be one method by which nursing-sensitive outcomes can be accurately reported. PMID:12385166

Whitman, Gayle R; Kim, Yookyung; Davidson, Lynda J; Wolf, Gail A; Wang, Shiaw-Ling

2002-01-01

106

Factors influencing the use of outcome measures in physical therapy practice.  

PubMed

Use of outcome measures in physical therapy practice is central to evaluating the effectiveness of treatment interventions, providing accountability and addressing quality of physical therapy programs. There is limited discussion on barriers and facilitators to using outcome measures in physical therapy practice. The purpose of this study was to identify factors that influence a physical therapist when deciding to use outcome measures in clinical practice. Participants were 21 physical therapists, seven each from skilled nursing facilities, outpatient clinics, and inpatient rehabilitation facilities. A grounded theory approach was used for interview and data collection. Common themes were determined from the data and a theory developed to explain the rationale behind physical therapists' decisions to use or not use outcome measures in clinical practice. Three overlapping themes related to (1) concepts of time, (2) knowledge, and (3) facility culture were indentified as factors influencing the use of outcome measures. A fourth encompassing theme, professionalism, identified the value placed on the use of outcome measures in practice. Data revealed that therapists require more information on the outcome measures available, and this information needs to be easily accessible within the workplace. Therapists value information generated by using outcome measures in the clinical setting, but need information on what measures are available and psychometric properties. Information must be easily accessible and measures easy to use. Newer graduates and recent learners have a foundation in the use of outcome measures, but more needs to be done in the clinic and through continuing education to promote increased use and understanding. PMID:21877943

Wedge, Frances M; Braswell-Christy, Jennifer; Brown, Cynthia J; Foley, Kathleen T; Graham, Cecilia; Shaw, Sharon

2012-02-01

107

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

108

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. PMID:12810423

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

2003-01-01

109

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

110

A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures  

PubMed Central

Background The Health of the Nation Outcome Scales was developed to routinely measure outcomes for adults with mental illness. Comparable instruments were also developed for children and adolescents (the Health of the Nation Outcome Scales for Children and Adolescents) and older people (the Health of the Nation Outcome Scales 65+). All three are being widely used as outcome measures in the United Kingdom, Australia and New Zealand. There is, however, no comprehensive review of these instruments. This paper fills this gap by reviewing the psychometric properties of each. Method Articles and reports relating to the instruments were retrieved, and their findings synthesised to assess the instruments' validity (content, construct, concurrent, predictive), reliability (test-retest, inter-rater), sensitivity to change, and feasibility/utility. Results Mostly, the instruments perform adequately or better on most dimensions, although some of their psychometric properties warrant closer examination. Conclusion Collectively, the Health of the Nation Outcome Scales family of measures can assess outcomes for different groups on a range of mental health-related constructs, and can be regarded as appropriate for routinely monitoring outcomes. PMID:16313678

Pirkis, Jane E; Burgess, Philip M; Kirk, Pia K; Dodson, Sarity; Coombs, Tim J; Williamson, Michelle K

2005-01-01

111

Global hypothesis testing for high-dimensional repeated measures outcomes  

PubMed Central

High-throughput technology in metabolomics, genomics, and proteomics gives rise to high dimension, low sample size data when the number of metabolites, genes, or proteins exceeds the sample size. For a limited class of designs, the classic ‘univariate approach’ for Gaussian repeated measures can provide a reasonable global hypothesis test. We derive new tests that not only accurately allow more variables than subjects, but also give valid analyses for data with complex between-subject and within-subject designs. Our derivations capitalize on the dual of the error covariance matrix, which is nonsingular when the number of variables exceeds the sample size, to ensure correct statistical inference and enhance computational efficiency. Simulation studies demonstrate that the new tests accurately control Type I error rate and have reasonable power even with a handful of subjects and a thousand outcome variables. We apply the new methods to the study of metabolic consequences of vitamin B6 deficiency. Free software implementing the new methods applies to a wide range of designs, including one group pre-intervention and post-intervention comparisons, multiple parallel group comparisons with one-way or factorial designs, and the adjustment and evaluation of covariate effects. PMID:22161561

Chi, Yueh-Yun; Gribbin, Matthew; Lamers, Yvonne; Gregory, Jesse F.; Muller, Keith E.

2012-01-01

112

Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM joint taskforce on perioperative outcome measures.  

PubMed

There is a need for large trials that test the clinical effectiveness of interventions in the field of perioperative medicine. Clinical outcome measures used in such trials must be robust, clearly defined and patient-relevant. Our objective was to develop standards for the use of clinical outcome measures to strengthen the methodological quality of perioperative medicine research. A literature search was conducted using PubMed and opinion leaders worldwide were invited to nominate papers that they believed the group should consider. The full texts of relevant articles were reviewed by the taskforce members and then discussed to reach a consensus on the required standards. The report was then circulated to opinion leaders for comment and review. This report describes definitions for 22 individual adverse events with a system of severity grading for each. In addition, four composite outcome measures were identified, which were designed to evaluate postoperative outcomes. The group also agreed on standards for four outcome measures for the evaluation of healthcare resource use and quality of life. Guidance for use of these outcome measures is provided, with particular emphasis on appropriate duration of follow-up. This report provides clearly defined and patient-relevant outcome measures for large clinical trials in perioperative medicine. These outcome measures may also be of use in clinical audit. This report is intended to complement and not replace other related work to improve assessment of clinical outcomes following specific surgical procedures. PMID:25058504

Jammer, Ib; Wickboldt, Nadine; Sander, Michael; Smith, Andrew; Schultz, Marcus J; Pelosi, Paolo; Leva, Brigitte; Rhodes, Andrew; Hoeft, Andreas; Walder, Bernhard; Chew, Michelle S; Pearse, Rupert M

2015-02-01

113

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. PMID:22403596

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

2012-01-01

114

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. PMID:23738230

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

115

Factors predicting outcome of vitrectomy for diabetic macular oedema: results of a prospective study  

PubMed Central

Aim To determine preoperative demographic, clinical, and optical coherence tomography (OCT) factors which might predict the visual and anatomical outcome at 1?year in patients undergoing vitrectomy and inner limiting membrane peel for diabetic macular oedema (DMO). Methods A prospective, interventional case series of 33 patients who completed 1?year follow up. Measurements were taken preoperatively and at 1?year. Outcome measures were logMAR visual acuity (VA) and OCT macular thickness. A priori explanatory variables included baseline presence of clinical and/or OCT signs suggesting macular traction, grade of diabetic maculopathy, posterior vitreous detachment, fluorescein leakage and ischaemia on angiography, presence of subretinal fluid, and peroperative indocyanine green (ICG) use. Results 33 patients completed 1?year follow up. On average VA deteriorated by 0.035 logMAR (p?=?0.40). Macular thickness significantly improved by a mean of 139??m (95% CI; 211 to 67, p<0.001). Patients with evidence of clinical and/or OCT macular traction significantly improved logMAR acuity (logMAR improvement ?=?0.08) compared with patients without traction (logMAR deterioration 0.11, p?=?0.01). Presence of subretinal fluid significantly predicted worse postoperative result (p?=?0.01) Conclusion On average, patients showed a statistically significant improvement in central macular thickness following treatment but a marginal acuity worsening. Presence of subretinal fluid on OCT is hypothesised to be exudative rather than tractional in nature. The visual benefit of vitrectomy for DMO in this study was limited to patients who exhibit signs of macular traction either clinically and/or on OCT. PMID:16361663

Shah, S P; Patel, M; Thomas, D; Aldington, S; Laidlaw, D A H

2006-01-01

116

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. PMID:8616351

Paterson, C.

1996-01-01

117

Usefulness of the Nursing Home Quality Measures and Quality Indicators for Assessing Skilled Nursing Facility Rehabilitation Outcomes  

PubMed Central

Objective To examine the usefulness of the nursing home quality indicators and nursing home quality measures for differentiating among providers from a rehabilitation outcomes perspective. Design Retrospective. Setting Skilled nursing facilities (SNFs) across the United States. Participants A total of 211 SNFs. Interventions Not applicable. Main Outcome Measures All quality indicators, all quality measures except for CWLS01 (residents who lose too much weight), and a set of rehabilitation outcomes including residualized FIM motor gain, the percentage of patients discharged to community, and the percentage of patients reporting “quite a lot” or “completely” prepared to manage their care at discharge from SNF-based rehabilitation. Results No quality measures correlated with any rehabilitation outcomes. Residualized FIM motor gain did not correlate with any quality indicators or quality measures. Only 1 quality indicator—prevalence of daily use of restraints (QI 22)—correlated with the rehabilitation indicator community discharge percentage. The third rehabilitation indicator, prepared to manage care at discharge, correlated (negatively) only with QI 18 incidence of decrease in range of motion. Among the rehabilitation outcomes, residualized FIM motor gain correlated significantly with both community discharge percentage and prepared to manage care at discharge. Conclusions Patients and referrers choosing SNF-based medical rehabilitation need tools that differentiate among prospective providers from a rehabilitation outcomes perspective. Data in this study indicate that nursing home quality indicators and quality measures are inadequate for this purpose. PMID:16876545

Silverstein, Burton; Findley, Patricia A.; Bode, Rita K.

2007-01-01

118

Longer term quality of life and outcome in stroke patients: is the Barthel index alone an adequate measure of outcome?  

Microsoft Academic Search

OBJECTIVES: To consider whether the Barthel Index alone provides sufficient information about the long term outcome of stroke. DESIGN: Cross sectional follow up study with a structured interview questionnaire and measures of impairment, disability, handicap, and general health. The scales used were the hospital anxiety and depression scale, mini mental state examination, Barthel index, modified Rankin scale, London handicap scale,

P R Wilkinson; C D Wolfe; F G Warburton; A G Rudd; R S Howard; R W Ross-Russell; R Beech

1997-01-01

119

Psychometric validation of patient-reported outcome measures assessing chronic constipation  

PubMed Central

Background Measures assessing treatment outcomes in previous CC clinical trials have not met the requirements described in the US Food and Drug Administration’s guidance on patient-reported outcomes. Aim Psychometric analyses using data from one Phase IIb study and two Phase III trials of linaclotide for the treatment of chronic constipation (CC) were conducted to document the measurement properties of patient-reported CC Symptom Severity Measures. Study methods Each study had a multicenter, randomized, double-blind, placebo-controlled, parallel-group design, comparing placebo to four doses of oral linaclotide taken once daily for 4 weeks in the Phase IIb dose-ranging study (n=307) and to two doses of linaclotide taken once daily for 12 weeks in the Phase III trials (n=1,272). The CC Symptom Severity Measures addressing bowel function (Bowel Movement Frequency, Stool Consistency, Straining) and abdominal symptoms (Bloating, Abdominal Discomfort, Abdominal Pain) were administered daily using interactive voice-response system technology. Intraclass correlations, Pearson correlations, factor analyses, F-tests, and effect sizes were computed. Results The CC Symptom Severity Measures demonstrated satisfactory test–retest reliability and construct validity. Factor analyses indicated one factor for abdominal symptoms and another for bowel symptoms. Known-groups F-tests substantiated the discriminating ability of the CC Symptom Severity Measures. Responsiveness statistics were moderate to strong, indicating that these measures are capable of detecting change. Conclusion In large studies of CC patients, linaclotide significantly improved abdominal and bowel symptoms. These psychometric analyses support the reliability, validity, discriminating ability, and responsiveness of the CC Symptom Severity Measures for evaluating treatment outcomes in the linaclotide clinical studies. PMID:25298737

Nelson, Lauren M; Williams, Valerie SL; Fehnel, Sheri E; Carson, Robyn T; MacDougall, James; Baird, Mollie J; Tourkodimitris, Stavros; Kurtz, Caroline B; Johnston, Jeffrey M

2014-01-01

120

Measurement issues when assessing quality of life outcomes for different types of hernia mesh repair  

PubMed Central

INTRODUCTION The NHS is required to collect data from patient reported outcome measures (PROMs) for inguinal hernia surgery. We explored the use of one such measure, the Carolinas Comfort Scale® (CCS), to compare long-term outcomes for patients who received two different types of mesh. The CCS questionnaire asks about mesh sensation, pain and movement limitations, and combines the answers into a total score. PATIENTS AND METHODS A total of 684 patients were treated between January 2007 and August 2008 and were followed up in November 2009. RESULTS Data on 215 patients who met the inclusion criteria were available (96 patients who received Surgipro™ mesh and 119 who received Parietene™ Progrip™ mesh). Recurrence rates were similar in the Surgipro™ group (2/96, 2.1%) and Progrip™ group (3/118, 2.5%) (Fisher's exact test = 1.0). Chronic pain occurred less frequently in the Surgipro™ group (11/95, 11.6%) than in the Progrip™ group (22/118, 18.6%) (p<0.157). Overall, 90% of CCS total scores indicated a good outcome (scores of 10 or less out of 115). A principal component analysis of the CCS found that responses clustered into two subscales: ‘mesh sensation’ and ‘pain+movement limitations’. The Progrip™ group had a slightly higher mesh sensation score (p<0.051) and similar pain+movement limitations scores (p<0.120). CONCLUSIONS In this study of quality of life outcomes related to different mesh types, the CCS subscales were more sensitive to differences in outcome than the total CCS score for the whole questionnaire. Future research should consider using the CCS subscales rather than the CCS total score. PMID:21944792

Zaborszky, Andras; Gyanti, Rita; Barry, John A; Saxby, Brian K; Bhattacharya, Panchanan; Hasan, Fazal A

2011-01-01

121

Connecting Stuttering Management and Measurement: V. Deduction and Induction in the Development of Stuttering Treatment Outcome Measures and Stuttering Treatments  

ERIC Educational Resources Information Center

Background: The development of evidence-based practice, which is increasingly popular in stuttering treatment, is closely linked to the development of outcome measures. Aims: Two approaches to the development of stuttering treatment outcome measures are outlined. The first is the deductive, top-down approach, where the development of specific…

Onslow, Mark

2006-01-01

122

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

123

Upper Extremity-Specific Measures of Disability and Outcomes in Orthopaedic Surgery  

PubMed Central

Outcome measures may consist of simple questions or they may be more complex instruments that evaluate multiple interrelated domains that influence patient function. Outcome measures should be relevant to patients, easy to use, reliable, valid, and responsive to clinical changes. The Disabilities of the Arm, Shoulder and Hand score can be used to measure disability for any region of the upper limb. Joint and disease-specific outcome measures have been developed for the shoulder, the elbow, and the wrist and hand. Many of these measures would benefit from further research into their validity, reliability, and optimal applicability. PMID:22298061

Smith, Matthew V.; Calfee, Ryan P.; Baumgarten, Keith M.; Brophy, Robert H.; Wright, Rick W.

2012-01-01

124

The RTOG Outcomes Model: economic end points and measures.  

PubMed

Recognising the value added by economic evaluations of clinical trials and the interaction of clinical, humanistic and economic end points, the Radiation Therapy Oncology Group (RTOG) has developed an Outcomes Model that guides the comprehensive assessment of this triad of end points. This paper will focus on the economic component of the model. The Economic Impact Committee was founded in 1994 to study the economic impact of clinical trials of cancer care. A steep learning curve ensued with considerable time initially spent understanding the methodology of economic analysis. Since then, economic analyses have been performed on RTOG clinical trials involving treatments for patients with non-small cell lung cancer, locally-advanced head and neck cancer and prostate cancer. As the care of cancer patients evolves with time, so has the economic analyses performed by the Economic Impact Committee. This paper documents the evolution of the cost-effectiveness analyses of RTOG from performing average cost-utility analysis to more technically sophisticated Monte Carlo simulation of Markov models, to incorporating prospective economic analyses as an initial end point. Briefly, results indicated that, accounting for quality-adjusted survival, concurrent chemotherapy and radiation for the treatment of non-small cell lung cancer, more aggressive radiation fractionation schedules for head and neck cancer and the addition of hormone therapy to radiation for prostate cancer are within the range of economically acceptable recommendations. The RTOG economic analyses have provided information that can further inform clinicians and policy makers of the value added of new or improved treatments. PMID:15013920

Konski, Andre; Watkins-Bruner, Deborah

2004-03-01

125

Patient reported outcome measures (PROMs) in primary care: an observational pilot study of seven generic instruments  

PubMed Central

Background Patient reported outcome measures (PROMs) have been introduced in studies to assess healthcare performance. The development of PROMs for primary care poses specific challenges, including a preference for generic measures that can be used across diseases, including early phases or mild conditions. This pilot study aimed to explore the potential usefulness of seven generic measures for assessing health outcomes in primary care patients. Methods A total of 300 patients in three general practices were invited to participate in the study, shortly after their visit to the general practitioner. Patients received a written questionnaire, containing seven validated instruments, focused on patient empowerment (PAM-13 or EC-17), quality of life (EQ-5D or SF-12), mental health (GHQ-12), enablement (PEI) and perceived treatment effect (GPE). Furthermore, questions on non-specific symptoms and number of GP contacts were included. After 4 weeks patients received a second, identical, questionnaire. Response and missing items, total scores and dispersion, responsiveness, and associations between instruments and other measures were examined. Results A total of 124 patients completed the questionnaire at baseline, of whom 98 completed it both at baseline and 4 weeks later (response rate: 32.7%). The instruments had a full completion rate of 80% or higher. Differences between baseline and follow up were significant for the EQ-5D (p?=?0.026), SF-12 PCS (p?=?0.026) and the GPE (p?=?0.006). A strong correlation (r???0.6) was found between the SF-12 MCS and GHQ-12, at both baseline measurement and after four weeks. Other observed associations between instruments were moderately strong. No strong correlations were found between instruments and non-specific symptoms or number of GP contacts. Conclusions The present study is among the first to explore the use of generic patient-reported outcome measures in primary care. It provides several leads for developing a generic PROM questionnaire in primary care as well as for potential limitations of such instruments. PMID:24884544

2014-01-01

126

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. PMID:21644810

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

127

Performance theory based outcome measurement in engineering education and training  

Microsoft Academic Search

An approach is presented to improve engineering education that is based on new concepts of systems performance and classic feedback theory. An important aspect is the use of general systems performance theory (GSPT) to provide a performance model of the educational system and as a basis for the key outcome metrics: the volumes of performance capacity envelopes of individual students.

William E. Dillon; George V. Kondraske; Louis J. Everett; Richard A. Volz

2000-01-01

128

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. PMID:23552509

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

129

Growth, head growth, and neurocognitive outcome in children born very preterm: methodological aspects and selected results.  

PubMed

In light of the growing number of surviving children born very preterm, there is an increasing focus on their long-term outcomes in terms of growth, metabolic status, and neurocognitive development. Therefore, it is of importance to follow such children from birth onwards with the aim of identifying the causes of atypical development, developing preventative measures, and improving outcomes. Since such long-term follow-up needs to be conducted with the least possible burden, clinical investigations such as anthropometry and neurocognitive tests, if conducted rigorously, will continue to have a predominant role. The aim of this review is to discuss the complexity of longitudinal anthropometry in children born very preterm and to provide an overview of the main studies that have examined associations between growth, in particular head growth, and neurocognitive outcomes at around school age. PMID:25251724

Ranke, Michael B; Krägeloh-Mann, Ingeborg; Vollmer, Brigitte

2015-01-01

130

Environmental outcome-based management: Using environmental goals and measures in the Chesapeake Bay program  

SciTech Connect

Attention is focused on the following: Establishing Environmental Outcome-Based Management; Chesapeake Bay Program Environmental Indicators; Managing for Environmental Results; Future Directions; and Appendices.

NONE

1999-07-01

131

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. PMID:8518640

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

1993-01-01

132

Cerebral atrophy as outcome measure in short-term phase 2 clinical trials in multiple sclerosis  

PubMed Central

Introduction Cerebral atrophy is a compound measure of the neurodegenerative component of multiple sclerosis (MS) and a conceivable outcome measure for clinical trials monitoring the effect of neuroprotective agents. In this study, we evaluate the rate of cerebral atrophy in a 6-month period, investigate the predictive and explanatory value of other magnetic resonance imaging (MRI) measures in relation to cerebral atrophy, and determine sample sizes for future short-term clinical trials using cerebral atrophy as primary outcome measure. Methods One hundred thirty-five relapsing–remitting multiple sclerosis patients underwent six monthly MRI scans from which the percentage brain volume change (PBVC) and the number and volume of gadolinium (Gd)-enhancing lesions, T2 lesions, and persistent black holes (PBH) were determined. By means of multiple linear regression analysis, the relationship between focal MRI variables and PBVC was assessed. Sample size calculations were performed for all patients and subgroups selected for enhancement or a high T2 lesion load at baseline. Results A significant atrophy occurred over 6 months (PBVC?=??0.33%, SE?=?0.061, p?outcome measure in short-term clinical trials with feasible sample size requires a potent drug to obtain sufficient power. PMID:20049424

Boden, B.; Dattola, V.; Knol, D. L.; Filippi, M.; Kappos, L.; Fazekas, F.; Wagner, K.; Pohl, C.; Sandbrink, R.; Polman, C. H.; Uitdehaag, B. M. J.; Barkhof, F.

2010-01-01

133

The Measure of Professorial Productivity: Using Student Learning Outcomes Criteria. ASHE Annual Meeting Paper.  

ERIC Educational Resources Information Center

This paper considers the viability and applicability of student learning outcomes used as a measure of professorial productivity. While student learning outcomes need to be assessed in order to evaluate faculty productivity, examination of student learning as a concept reveals the difficulty of finding consensus on how to define it. The issue is…

Bock, Marianne T.

134

The National Outcomes Measurement System for Pediatric Speech-Language Pathology  

ERIC Educational Resources Information Center

Purpose: The American Speech-Language-Hearing Association's (ASHA's) National Outcomes Measurement System (NOMS) was developed in the late 1990s. The primary purpose was to serve as a source of data for speech-language pathologists (SLPs) who found themselves called on to provide empirical evidence of the functional outcomes associated with their…

Mullen, Robert; Schooling, Tracy

2010-01-01

135

Longitudinal imaging studies in schizophrenia: the relationship between brain morphology and outcome measures.  

PubMed

Imaging studies have tried to identify morphological outcome measures of schizophrenia in the last two decades. In particular, longitudinal studies have reported a correlation between larger ventricles, decreased prefrontal volumes and worse outcome. This would potentially allow to isolate subtypes of schizophrenia patients with a worse prognosis and more evident biological impairments, ultimately helping in designing specific rehabilitation interventions. PMID:21261215

Bellani, Marcella; Dusi, Nicola; Brambilla, Paolo

2010-01-01

136

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

137

Measuring the Quality of VET Using the Student Outcomes Survey. Occasional Paper  

ERIC Educational Resources Information Center

The aim of this report is to examine the potential use of information from the Student Outcomes Survey, including the use of student course satisfaction information and post-study outcomes, as a means of determining markers of training quality. In an analysis of the student course satisfaction measures, the authors found there are very small…

Lee, Wang-Sheng; Polidano, Cain

2010-01-01

138

Multiple Measures of Outcome in Assessing a Prison-Based Drug Treatment Program  

ERIC Educational Resources Information Center

Evaluations of prison-based drug treatment programs typically focus on one or two dichotomous outcome variables related to recidivism. In contrast, this paper uses multiple measures of outcomes related to crime and drug use to examine the impact of prison treatment. Crime variables included self-report data of time to first illegal activity,…

Prendergast, Michael L.; Hall, Elizabeth A.; Wexler, Harry K.

2003-01-01

139

Results.  

ERIC Educational Resources Information Center

Describes the Collegiate Results Instrument (CRI), which measures a range of collegiate outcomes for alumni 6 years after graduation. The CRI was designed to target alumni from institutions across market segments and assess their values, abilities, work skills, occupations, and pursuit of lifelong learning. (EV)

Zemsky, Robert; Shaman, Susan; Shapiro, Daniel B.

2001-01-01

140

Quality of life measurement and outcome in aphasia  

PubMed Central

Background Quality of life (QL) can be defined as the individual’s perception of their own well-being. Aphasia is the most important potential consequence of stroke and has a profound effect on a patient’s life, causing emotional distress, depression, and social isolation, due to loss of language functions. Aims To draw up a QL questionnaire for aphasics (QLQA) focusing particularly on difficulties in interpersonal relationships and on the loss of independence as a result of language disorders. We reported the results of a psychometric evaluation of this measure. Moreover, we experimentally focused on the differences in QLQA between patients affected only by neurological motor impairment and hemiparetic patients with aphasia (PWA) in order to verify the specific role of aphasia on QL. We also explored if the QLQA is sensitive to the severity of aphasia and to the time elapsing from the stroke. Methods A total of 146 consecutive PWA and 37 control subjects were enrolled to evaluate the reliability (internal consistency and test–retest reliability) and validity of the QLQA, using standard psychometric methods. Patients were divided into acute (within 3 months since stroke) and chronic (beyond 3 months) groups, and into mild and severe according to the severity of aphasia. The experimental group of only acute PWA was compared to control subjects, with right hemispherical lesion and without aphasia in QLQA total and partial scores. Results The QLQA had good internal consistency and test–retest reliability. Acute and chronic PWA and mild and severe ones differed in QLQA total, communication, and autonomy subscales. No differences were found in psychological condition. Between aphasic and control patients, significant differences were found in all QLQA subscales. Conclusion The QLQA is a valid measure of QL in PWA, contributing to a better distinction between severe and mild aphasia, and it is sensitive also to the variations in QL depending on the time interval from stroke. PMID:24368886

Spaccavento, Simona; Craca, Angela; Del Prete, Marina; Falcone, Rosanna; Colucci, Antonia; Di Palma, Angela; Loverre, Anna

2014-01-01

141

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. PMID:22533667

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

2012-01-01

142

Results and outcome of neurosurgical treatment for extradural metastases in the cervical spine  

Microsoft Academic Search

Summary ¶Metastatic lesions are the most common spinal extradural tumours. Significant advances in their neurosurgical management have been made in the last two decades. This retrospective study was undertaken to summarise the long-term results of surgery and the outcome of patients with cervical spine metastases. Sixty-two patients with cervical spine metastases who underwent instrumented spinal surgery at a single centre

V. Heidecke; N. G. Rainov; W. Burkert

2003-01-01

143

Female College Students’ Media Use and Academic Outcomes: Results from a Longitudinal Cohort Study  

PubMed Central

This longitudinal study describes women’s media use during their first year of college and examines associations between media use and academic outcomes. Female students (N = 483, Mage = 18.1 years) reported on their use of 11 media forms and their grade point average, academic behaviors, academic confidence, and problems affecting schoolwork. Allowing for multi-tasking, women reported nearly 12 hours of media use per day; use of texting, music, the Internet, and social networking was heaviest. In general, media use was negatively associated with academic outcomes after controlling for prior academics and demographics. Exceptions were newspaper reading and music listening, which were positively associated with academic outcomes. There were significant indirect effects of magazine reading and social networking on GPA via academic behaviors, confidence, and problems. Results show that female college students are heavy users of new media, and that some forms of media use may adversely impact academic performance. PMID:24505554

Walsh, Jennifer L.; Fielder, Robyn L.; Carey, Kate B.; Carey, Michael P.

2013-01-01

144

Female College Students' Media Use and Academic Outcomes: Results from a Longitudinal Cohort Study.  

PubMed

This longitudinal study describes women's media use during their first year of college and examines associations between media use and academic outcomes. Female students (N = 483, Mage = 18.1 years) reported on their use of 11 media forms and their grade point average, academic behaviors, academic confidence, and problems affecting schoolwork. Allowing for multi-tasking, women reported nearly 12 hours of media use per day; use of texting, music, the Internet, and social networking was heaviest. In general, media use was negatively associated with academic outcomes after controlling for prior academics and demographics. Exceptions were newspaper reading and music listening, which were positively associated with academic outcomes. There were significant indirect effects of magazine reading and social networking on GPA via academic behaviors, confidence, and problems. Results show that female college students are heavy users of new media, and that some forms of media use may adversely impact academic performance. PMID:24505554

Walsh, Jennifer L; Fielder, Robyn L; Carey, Kate B; Carey, Michael P

2013-09-01

145

Measuring Tools for Functional Outcomes in Total Knee Arthroplasty  

Microsoft Academic Search

Total knee arthroplasty has come under increasing scrutiny attributable to the fact that it is a high-volume, high-cost medical\\u000a intervention in an era of increasingly scarce medical resources. Health-related quality-of-life outcomes have been developed\\u000a such that healthcare providers might determine how good an intervention is and whether it is cost-effective. Total knee arthroplasty\\u000a has been subjected to disease-specific, patient-specific, global

Robert B. Bourne

2008-01-01

146

Mapping health outcome measures from a stroke registry to EQ-5D weights  

PubMed Central

Purpose To map health outcome related variables from a national register, not part of any validated instrument, with EQ-5D weights among stroke patients. Methods We used two cross-sectional data sets including patient characteristics, outcome variables and EQ-5D weights from the national Swedish stroke register. Three regression techniques were used on the estimation set (n?=?272): ordinary least squares (OLS), Tobit, and censored least absolute deviation (CLAD). The regression coefficients for “dressing“, “toileting“, “mobility”, “mood”, “general health” and “proxy-responders” were applied to the validation set (n?=?272), and the performance was analysed with mean absolute error (MAE) and mean square error (MSE). Results The number of statistically significant coefficients varied by model, but all models generated consistent coefficients in terms of sign. Mean utility was underestimated in all models (least in OLS) and with lower variation (least in OLS) compared to the observed. The maximum attainable EQ-5D weight ranged from 0.90 (OLS) to 1.00 (Tobit and CLAD). Health states with utility weights <0.5 had greater errors than those with weights ?0.5 (P?outcome measures from a stroke register into preference-based utilities to study the development of stroke care over time, and to compare with other conditions in terms of utility. PMID:23496957

2013-01-01

147

Peer-led seeking safety: results of a pilot outcome study with relevance to public health.  

PubMed

Abstract There is a rich history of peer-led recovery efforts related to substance use disorder (SUD). Yet we know of no peer-led approaches for co-occurring SUD and trauma-related problems. This combination is widespread, has impact on multiple life domains, and presents major recovery challenges. In this pilot, we evaluated peer-led Seeking Safety (SS). SS is the most evidence-based and widely implemented therapy for SUD with co-occurring PTSD or other trauma-related problems. Eighteen women in residential substance-abuse treatment participated. All met SUD criteria (primarily opiate and cocaine dependence); most had a comorbid mental health disorder; and they had elevated trauma-related symptoms. The 25 SS topics were conducted twice-weekly. Participants were assessed at baseline and end-of-treatment, with some measures also collected monthly. Results showed significant positive outcomes in trauma-related problems (the Trauma Symptom Checklist-40); psychopathology (the Brief Symptom Inventory); functioning (the BASIS-32, including impulsive-addictive behavior); self-compassion (the Self-Compassion Scale); and SS coping skills. Effect sizes were consistently large. SS satisfaction and fidelity ratings were high. Substance use levels could not be assessed due to the residential setting. Qualitative data indicated enthusiasm for peer-SS by both peers and staff. Study limitations, future research, and public health relevance are discussed. PMID:25188699

Najavits, Lisa M; Hamilton, Nancy; Miller, Niki; Griffin, Jackie; Welsh, Thomas; Vargo, Mark

2014-01-01

148

Adult experience of mental health outcomes as a result of intimate partner violence victimisation: a systematic review  

PubMed Central

Background Intimate partner violence (IPV) has been known to adversely affect the mental health of victims. Research has tended to focus on the mental health impact of physical violence rather than considering other forms of violence. Objective To systematically review the literature in order to identify the impact of all types of IPV victimisation on various mental health outcomes. Method A systematic review of 11 electronic databases (2004–2014) was conducted. Fifty eight papers were identified and later described and reviewed in relation to the main objective. Results Main findings suggest that IPV can have increasing adverse effects on the mental health of victims in comparison with those who have never experienced IPV or those experiencing other traumatic events. The most significant outcomes were associations between IPV experiences with depression, posttraumatic stress disorder, and anxiety. Findings confirm previous observations that the severity and extent of IPV exposure can increase mental health symptoms. The effect of psychological violence on mental health is more prominent than originally thought. Individual differences such as gender and childhood experience of violence also increase IPV risk and affect mental health outcomes in diverse ways. Conclusions Psychological violence should be considered as a more serious form of IPV which can affect the mental health of victims. Experiencing more than one form of IPV can increase severity of outcomes. Researchers should look at IPV as a multi-dimensional experience. A uniformed definition and measure of IPV could help advance knowledge and understanding of this disparaging global issue. PMID:25279103

Lagdon, Susan; Armour, Cherie; Stringer, Maurice

2014-01-01

149

Challenges in measuring outcomes for caregivers of people with mental health problems  

PubMed Central

Patient-reported outcomes (PROs) are increasingly important in health care and mental health research. Furthermore, caregivers become partners in care for patients with mental disorders, and health workers are more attentive to the expectations and needs of caregivers. A number of outcomes for caregivers are measured and used in daily practice in order to promote actions to improve health care systems and progress in research on the impact of mental disorders on their caregivers. This paper proposes an inventory of the different outcomes and different measurement tools used to assess the impact of disorders, raising a number of methodological and conceptual issues that limit the relevance of measurement tools and complicate their use. Finally, we propose some recommendations promoting the development of relevant outcome measures for caregivers and their integration into current systems of care. PMID:25152655

Zendjidjian, Xavier Y.; Boyer, Laurent

2014-01-01

150

Brief Tool to Measure Risk-Adjusted Surgical Outcomes in Resource-Limited Hospitals  

PubMed Central

Objectives To develop and validate a risk-adjusted tool with fewer than 10 variables to measure surgical outcomes in resource-limited hospitals. Design All National Surgical Quality Improvement Program (NSQIP) preoperative variables were used to develop models to predict inpatient mortality. The models were built by sequential addition of variables selected based on their area under the receiver operator characteristic curve (AUROC) and externally validated using data based on medical record reviews at 1 hospital outside the data set. Setting Model development was based on data from the NSQIP from 2005 to 2009. Validation was based on data from 1 nonurban hospital in the United States from 2009 to 2010. Patients A total of 631 449 patients in NSQIP and 239 patients from the validation hospital. Main Outcome Measures The AUROC value for each model. Results The AUROC values reached higher than 90% after only 3 variables (American Society of Anesthesiologists class, functional status at time of surgery, and age). The AUROC values increased to 91% with 4 variables but did not increase significantly with additional variables. On validation, the model with the highest AUROC was the same 3-variable model (0.9398). Conclusions Fewer than 6 variables may be necessary to develop a risk-adjusted tool to predict inpatient mortality, reducing the cost of collecting variables by 95%. These variables should be easily collectable in resource-poor settings, including low- and middle-income countries, thus creating the first standardized tool to measure surgical outcomes globally. Research is needed to determine which of these limited-variable models is most appropriate in a variety of clinical settings. PMID:22987164

Anderson, Jamie E.; Lassiter, Randi; Bickler, Stephen W.; Talamini, Mark A.; Chang, David C.

2014-01-01

151

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

152

Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006  

PubMed Central

There is widespread recognition that consistency between research centres in the ways that patients with tinnitus are assessed and outcomes following interventions are measured would facilitate more effective co-operation and more meaningful evaluations and comparisons of outcomes. At the first Tinnitus Research Initiative meeting held in Regensburg in July 2006 an attempt was made through workshops to gain a consensus both for patient assessments and for outcome measurements. It is hoped that this will contribute towards better cooperation between research centres in finding and evaluating treatments for tinnitus by allowing better comparability between studies. PMID:17956816

Langguth, B.; Goodey, R.; Azevedo, A.; Bjorne, A.; Cacace, A.; Crocetti, A.; Del Bo, L.; De Ridder, D.; Diges, I.; Elbert, T.; Flor, H.; Herraiz, C.; Sanchez, T. Ganz; Eichhammer, P.; Figueiredo, R.; Hajak, G.; Kleinjung, T.; Landgrebe, M.; Londero, A.; Lainez, M.J.A.; Mazzoli, M.; Meikle, M.B.; Melcher, J.; Rauschecker, J.P.; Sand, P.G.; Struve, M.; Van de Heyning, P.; Van Dijk, P.; Vergara, R.

2014-01-01

153

The Effect of Donor Age on Corneal Transplantation Outcome: Results of the Cornea Donor Study  

PubMed Central

Objective To determine whether graft survival over a 5-year follow-up period using corneal tissue from donors older than 65 years of age is similar to graft survival using corneas from younger donors. Design Multi-center prospective, double-masked, controlled clinical trial Participants 1090 subjects undergoing corneal transplantation for a moderate risk condition (principally Fuchs’ dystrophy or pseudophakic corneal edema); 11 subjects with ineligible diagnoses were not included Methods 43 participating eye banks provided corneas from donors in the age range of 12 to 75 with endothelial cell densities of 2300 to 3300 cells/mm2, using a random approach without respect to recipient factors. The 105 participating surgeons at 80 sites were masked to information about the donor cornea including donor age. Surgery and post-operative care were performed according to the surgeons’ usual routines. Subjects were followed for five years. Main Outcome Measures Graft failure, defined as a regraft or a cloudy cornea that was sufficiently opaque as to compromise vision for a minimum of three consecutive months. Results The 5-year cumulative probability of graft survival was 86% in both the <66.0 donor age group and the ?66.0 donor age group (difference = 0%, upper limit of one-sided 95% confidence interval = 4%). In a statistical model with donor age as a continuous variable, there was not a significant relationship between donor age and outcome (P=0.11). Three graft failures were due to primary donor failure, 8 to uncorrectable refractive error, 48 to graft rejection, 46 to endothelial decompensation (23 of which had a prior, resolved episode of probable or definite graft rejection), and 30 to other causes. The distribution of the causes of graft failure did not differ between donor age groups. Conclusions Five-year graft survival for cornea transplants at moderate risk for failure is similar using corneas from donors ? 66.0 years and donors < 66.0 years. Surgeons and patients now have evidence that corneas comparable in quality to those used in this study from donors through age 75 years are suitable for transplantation. PMID:18387407

2009-01-01

154

Application of the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS®) to Mental Health Research  

PubMed Central

Background The Patient-Reported Outcomes Measurement Information System (PROMIS) is a National Institutes of Health initiative to develop item banks measuring patient-reported outcomes (PROs) and to create and make available a computerized adaptive testing system (CAT) that allows for efficient and precise assessment of PROs in clinical research and practice. Aims of the Study Based on the presentation from a symposium on “Evidence-based Outcomes in Psychiatry: Updates on Measurement Using Patient-Reported Outcomes (PRO)” at the 2011 American Psychiatry Association Convention, this paper provides an overview of PROMIS and its application to mental health research. Methods The PROMIS methodology for item bank development and testing is described, with a focus on the implications of this work for mental health research. Results Utilizing qualitative item review and state-of-the-art applications of item response theory (IRT), PROMIS investigators have developed, tested, and released item banks measuring physical, mental, and social health components. Ongoing efforts continue to add new item banks and further validate existing banks. Discussion PROMIS provides item banks measuring several domains of interest to mental health researchers including emotional distress, social function, and sleep. PROMIS methodology also provides a rigorous standard for the development of new mental health measures. Implications for Health Care Provision Web-based CAT or administration of short forms derived from PROMIS item banks provide efficient and precise dimensional estimates of clinical outcomes that can be utilized to monitor patient progress and assess quality improvement. Implications for Future Research Use of the dimensional PROMIS metrics (and co-calibration of the PROMIS item banks with existing PROs) will allow comparisons of mental health and related health outcomes across disorders and studies. PMID:22345362

Riley, William T.; Pilkonis, Paul; Cella, David

2013-01-01

155

Outcome of carpal tunnel release - Correlation with wrist and wrist-palm anthropomorphic measurements.  

PubMed

Wrist and wrist-palm measurements have been associated with the diagnosis of carpal tunnel syndrome. We found no reported study about how this correlation affects the outcome after surgery. We investigated the role of the measurements in predicting outcome after open carpal tunnel release. A total of 131 patients (88 female, 43 male) responded to our postal questionnaire using the Boston Carpal Tunnel assessment (65% response rate) at a minimum of 9 months post-operatively. Symptom and functional scores showed a strong correlation. There was no statistical difference in the outcome between wrist ratio (?0.7 vs <0.7), wrist-palm ratio (?0.41 vs <0.41) and gender, but a better functional score was very weakly correlated with a higher wrist ratio. A very large study would be needed to show any statistical correlation between both measurement and outcome. PMID:24554691

Lee, L H; Al-Maiyah, M; Al-Bahrani, R Z; Bhargava, A; Auyeung, J; Stothard, J

2015-02-01

156

Gender Disparities in HIV Treatment Outcomes Following Release From Jail: Results From a Multicenter Study  

PubMed Central

Objectives We assessed gender differences in longitudinal HIV treatment outcomes among HIV-infected jail detainees transitioning to the community. Methods Data were from the largest multisite prospective cohort study of HIV-infected released jail detainees (n = 1270)—the Enhancing Linkages to HIV Primary Care and Services in Jail Setting Initiative, January 2008 and March 2011, which had 10 sites in 9 states. We assessed baseline and 6-month HIV treatment outcomes, stratifying by gender. Results Of 867 evaluable participants, 277 (31.9%) were women. Compared with men, women were more likely to be younger, non-Hispanic White, married, homeless, and depressed, but were similar in recent alcohol and heroin use. By 6 months postrelease, women were significantly less likely than men to experience optimal HIV treatment outcomes, including (1) retention in care (50% vs 63%), (2) antiretroviral therapy prescription (39% vs 58%) or optimal antiretro-viral therapy adherence (28% vs 44%), and (3) viral suppression (18% vs 30%). In multiple logistic regression models, women were half as likely as men to achieve viral suppression. Conclusions HIV-infected women transitioning from jail experience greater comorbidity and worse HIV treatment outcomes than men. Future interventions that transition people from jail to community-based HIV clinical care should be gender-specific. PMID:24432878

Meyer, Jaimie P.; Zelenev, Alexei; Wickersham, Jeffrey A.; Williams, Chyvette T.; Teixeira, Paul A.; Altice, Frederick L.

2014-01-01

157

Core outcome measures for opioid abuse liability laboratory assessment studies in humans: IMMPACT recommendations  

PubMed Central

A critical component in development of opioid analgesics is assessment of their abuse liability (AL). Standardization of approaches and measures used in assessing AL has the potential to facilitate comparisons across studies, research laboratories, and drugs. The goal of this report is to provide consensus recommendations regarding core outcome measures for assessing abuse potential of opioid medications in humans in a controlled laboratory setting. Although many of the recommended measures are appropriate for assessing the AL of medications from other drug classes, the focus here is on opioid medications because they present unique risks from both physiological (e.g., respiratory depression, physical dependence) and public health (e.g., individuals in pain) perspectives. A brief historical perspective on AL testing is provided and then those measures that can be considered primary and secondary outcomes and possible additional outcomes in AL assessment are discussed. These outcome measures include: (1) subjective effects (some of which comprise the primary outcome measures, including drug liking); (2) physiological responses; (3) drug self-administration behavior; and (4) cognitive and psychomotor performance. Prior to presenting recommendations for standardized approaches and measures to be used in AL assessments, the appropriateness of using these measures in clinical trials with patients in pain is discussed. PMID:22998781

Comer, Sandra D.; Zacny, James P.; Dworkin, Robert H.; Turk, Dennis C.; Bigelow, George E.; Foltin, Richard W.; Jasinski, Donald R.; Sellers, Edward M.; Adams, Edgar H.; Balster, Robert; Burke, Laurie B.; Cerny, Igor; Colucci, Robert D.; Cone, Edward; Cowan, Penney; Farrar, John T.; Haddox, J. David; Haythornthwaite, Jennifer A.; Hertz, Sharon; Jay, Gary W.; Johanson, Chris-Ellyn; Junor, Roderick; Katz, Nathaniel P.; Klein, Michael; Kopecky, Ernest A.; Leiderman, Deborah B.; McDermott, Michael P.; O’Brien, Charles; O’Connor, Alec B.; Palmer, Pamela P.; Raja, Srinivasa N.; Rappaport, Bob A.; Rauschkolb, Christine; Rowbotham, Michael C.; Sampaio, Cristina; Setnik, Beatrice; Sokolowska, Marta; Stauffer, Joseph W.; Walsh, Sharon L.

2012-01-01

158

The utility of the PedsQL™ Rheumatology Module as an outcome measure in juvenile fibromyalgia  

PubMed Central

Objective The PedsQL™ Rheumatology Module is currently the only available measure of disease-specific Quality of Life (QOL) for children and adolescents with juvenile fibromyalgia (JFM) but limited information has been published about the psychometric properties of the instrument specifically in JFM. The objective of this study was to assess the reliability, validity and sensitivity to change of the 5 scales (pain and hurt, daily activities, treatment, worry and communication) of the patient and parent-proxy versions of the PedsQL™ Rheumatology Module in the context of a randomized clinical trial in JFM. Methods The entire PedsQL™ Rheumatology Module was administered as a supplementary outcome measure at pre-treatment, post-treatment and 6-month follow-up assessments of 114 children and adolescents with JFM enrolled in a trial testing the efficacy of cognitive-behavioral therapy (CBT). Results Results indicated that internal consistency reliabilities for the scales were adequate to strong (Cronbach ?s 0.68 - 0.86). Parent-proxy and child reports on most scales (except for daily activities and communication) showed moderate correlations (Spearman rs 0.33-0.45). Support for construct validity was found based on comparing child and parent reports with other related measures of pain and functioning (Visual Analog Scale pain ratings and the Functional Disability Inventory). Finally, sensitivity to change was demonstrated by significant changes in 4/5 of the scales (excluding the daily activities scale) after treatment. Conclusion The PedsQL™ Rheumatology Module generally appears to have good utility for use in JFM patients but some caveats to interpretation of the specific scales in this population are discussed. Key words: PedsQL™ Rheumatology Module, quality of life, juvenile fibromyalgia, outcome measurement PMID:23686969

Joffe, Naomi E.; Lynch-Jordan, Anne; Ting, Tracy V.; Arnold, Lesley M.; Hashkes, Philip J.; Lovell, Daniel J.; Passo, Murray H.; Powers, Scott W.; Schikler, Kenneth N.; Kashikar-Zuck, Susmita

2013-01-01

159

Model-based estimation of measures of association for time-to-event outcomes  

PubMed Central

Background Hazard ratios are ubiquitously used in time to event applications to quantify adjusted covariate effects. Although hazard ratios are invaluable for hypothesis testing, other adjusted measures of association, both relative and absolute, should be provided to fully appreciate studies results. The corrected group prognosis method is generally used to estimate the absolute risk reduction and the number needed to be treated for categorical covariates. Methods The goal of this paper is to present transformation models for time-to-event outcomes to obtain, directly from estimated coefficients, the measures of association widely used in biostatistics together with their confidence interval. Pseudo-values are used for a practical estimation of transformation models. Results Using the regression model estimated through pseudo-values with suitable link functions, relative risks, risk differences and the number needed to treat, are obtained together with their confidence intervals. One example based on literature data and one original application to the study of prognostic factors in primary retroperitoneal soft tissue sarcomas are presented. A simulation study is used to show some properties of the different estimation methods. Conclusions Clinically useful measures of treatment or exposure effect are widely available in epidemiology. When time to event outcomes are present, the analysis is performed generally resorting to predicted values from Cox regression model. It is now possible to resort to more general regression models, adopting suitable link functions and pseudo values for estimation, to obtain alternative measures of effect directly from regression coefficients together with their confidence interval. This may be especially useful when, in presence of time dependent covariate effects, it is not straightforward to specify the correct, if any, time dependent functional form. The method can easily be implemented with standard software. PMID:25106903

2014-01-01

160

Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding: Results in 90 patients  

Microsoft Academic Search

Background\\/Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is a new therapy for variceal bleeding. Immediate technical and short-term clinical results have been reported. This study was undertaken to evaluate mid-term outcome after TIPS in patients who successfully underwent the procedure for variceal bleeding. Methods: Ninety patients were followed up prospectively by clinical examination and radiological shunt evaluation including Doppler sonography and

Jeanne M. Laberge; Kenneth A. Somberg; John R. Lake; Roy L. Gordon; Robert K. Kerlan; Nancy L. Ascher; John P. Roberts; Margaret M. Simor; Catherine A. Doherty; Judith Hahn; Peter BachettiI; Ernest J. Ring

1995-01-01

161

New measures to establish the evidence base for medical education: identifying educationally sensitive patient outcomes.  

PubMed

Researchers lack the rich evidence base and benchmark patient outcomes needed to evaluate the effectiveness of medical education practice and guide policy. The authors offer a framework for medical education research that focuses on physician-influenced patient outcomes that are potentially sensitive to medical education. Adapting the concept of ambulatory care sensitive conditions, which provided traction to health services research by defining benchmark patient outcomes to measure health system performance, the authors introduce the concept and propose the adoption of educationally sensitive patient outcomes and suggest two measures: patient activation and clinical microsystem activation. They assert that the ultimate goal of medical education is to ensure that measurement of future physicians' competence and skills is based not only on biomedical knowledge and critical clinical skills but also on the ability to translate these competencies into effective patient- and systems-level outcomes. The authors consider methodological approaches and challenges to measuring such outcomes and argue for large, multiinstitutional, prospective cohort studies and the development of a national Database for Research in Education in Academic Medicine to provide the needed infrastructure. They advocate taking the next steps to establish an educational evidence base to guide the academic medical centers of the 21st century in aligning medical education practice with health care delivery that meets the needs of individuals and populations. PMID:20520038

Kalet, Adina L; Gillespie, Colleen C; Schwartz, Mark D; Holmboe, Eric S; Ark, Tavinder K; Jay, Melanie; Paik, Steve; Truncali, Andrea; Hyland Bruno, Julia; Zabar, Sondra R; Gourevitch, Marc N

2010-05-01

162

Validity and responsiveness of the Core Outcome Measures Index (COMI) for the neck  

Microsoft Academic Search

Purpose  Patient-orientated outcome questionnaires are essential to evaluate treatment success. To compare different treatments, hospitals,\\u000a and surgeons, standardised questionnaires are required. The present study examined the validity and responsiveness of the\\u000a Core Outcome Measurement Index for neck pain (COMI-neck), a short, multidimensional outcome instrument.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Questionnaires were completed by patients with degenerative problems of the cervical spine undergoing cervical disc arthroplasty\\u000a before

C. D. Fankhauser; U. Mutter; E. Aghayev; A. F. Mannion

163

42 CFR 410.146 - Diabetes outcome measurements.  

Code of Federal Regulations, 2010 CFR

...condition. (ii) Use of insulin or oral agents. (iii) Height and weight by date. (iv) Results and date of last lipid test. (v) Results and date of last HbA1C. (vi) Information on self-monitoring (frequency and results)....

2010-10-01

164

Auranofin improves outcome in early rheumatoid arthritis. Results from a 2-year, double blind placebo controlled study.  

PubMed

The effect of early initiation of auranofin (AF) therapy on outcome measures was studied in a controlled 24-month double blind trial in 138 patients with early rheumatoid arthritis (RA) using an intent to treat approach. Patients were randomized to AF or placebo but in case of insufficient effect or intolerable adverse events, they switched to open disease modifying antirheumatic drug therapy. Patients who started AF fared significantly better in improved joint swelling. Stanford Health Assessment Questionnaire index, Keitel functional test, and mental depression, and furthermore, radiologic progression was significantly retarded. Our results support a disease modifying beneficial effect of AF in early active RA.se PMID:14552308

Borg, G; Allander, E; Lund, B; Berg, E; Brodin, U; Pettersson, H; Trang, L

1988-12-01

165

Towards Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions  

PubMed Central

Purpose Graduate medical education (GME) plays a key role in the U.S. health care workforce, defining its overall size and specialty distribution, and influencing physician practice locations. Medicare provides nearly $10 billion annually to support GME, and faces growing policymaker interest in creating accountability measures. The purpose of this study was to develop and test candidate GME outcome measures related to physician workforce. Method The authors performed a secondary analysis of data from the American Medical Association Physician Masterfile, National Provider Identifier file, Medicare claims, and National Health Service Corps, measuring the number and percentage of graduates from 2006 to 2008 practicing in high-need specialties and underserved areas aggregated by their U.S. GME program. Results Average overall primary care production rate was 25.2% for the study period, although this is an overestimate since hospitalists could not be excluded. Of 759 sponsoring institutions, 158 produced no primary care graduates, and 184 produced more than 80%. An average of 37.9% of Internal Medicine residents were retained in primary care, including hospitalists. Mean general surgery retention was 38.4%. Overall, 4.8% of graduates practiced in rural areas; 198 institutions produced no rural physicians, and 283 institutions produced no Federally Qualified Health Center or Rural Health Clinic physicians. Conclusions GME outcomes are measurable for most institutions and training sites. Specialty and geographic locations vary significantly. These findings can inform educators and policy-makers during a period of increased calls to align the GME system with national health needs. PMID:23752037

Chen, Candice; Petterson, Stephen; Phillips, Robert L.; Mullan, Fitzhugh; Bazemore, Andrew; O'Donnell, Sarah D.

2013-01-01

166

Outcome Measures in Relapsing-Remitting Multiple Sclerosis: Capturing Disability and Disease Progression in Clinical Trials  

PubMed Central

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease that manifests as acute relapses and progressive disability. As a primary endpoint for clinical trials in MS, disability is difficult to both characterize and measure. Furthermore, the recovery from relapses and the rate of disability vary considerably among patients. Given these challenges, investigators have developed and studied the performance of various outcome measures and surrogate endpoints in MS clinical trials. This review defines the outcome measures and surrogate endpoints used to date in MS clinical trials and presents challenges in the design of both adult and pediatric trials. PMID:24883205

Lavery, Amy M.; Verhey, Leonard H.; Waldman, Amy T.

2014-01-01

167

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

168

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

169

Outcome measurement in HEDIS: can risk adjustment save the low birth weight measure?  

PubMed Central

OBJECTIVE. To evaluate whether adjusting the Health Plan Employer Data and Information Set (HEDIS) low birth weight (LBW) measure for maternal risk factors is feasible and improves its validity as a quality indicator. DATA SOURCE: The Washington State Birth Event Record Data for calendar years 1989 and 1990, including birth certificate data matched with mothers' and infants' hospital discharge records, with 5,837 records of singlet on infants identified as LBW (< 2,500 g) and a 25 percent sample ( n = 31,570) of the normal-weight births ( measure, we assessed health plan readiness to produce a risk-adjusted measure. PRINCIPAL FINDINGS: An LBW indicator that is adjusted for maternal risks represents health plan performance better than the unadjusted rate. In the most parsimonious risk adjustment model LBW risk was higher for mothers with a history of prior preterm birth , LBW, or fet al death . Risk was also high er for primiparas or mothers with high parity, mothers less than 19 years of age, and primiparas over age 35. In a model adding race to these obstetric factors, black, Asian/Pacific Islander, or other non-white, non-Hispanic race were also significantly associated with higher LBW risk. While adjusting for maternal risk improved the LBW measure's validity, the rate adjustment magnitude was small (0.17 percentage points) for the most plausible model. Th is may not be mean in gf ul clinically or for measuring differences in quality. The costs and data collection requirements of risk adjustment could be substantial for health plans lacking access to State birth records data. CONCLUSIONS Selection of risk adjusters for quality measures depends on judgments of their effect, legitimacy, and feasibility. A comprehensive examination of validity and feasibility is needed to understand to what extent outcome measures represent quality and how their value compares to their cost of collection . PMID:16148953

Inkelas, M; Decristofaro, A H; McGlynn, E A; Keeler, E B

2000-01-01

170

Surrogacy assessment using principal stratification when surrogate and outcome measures are multivariate normal.  

PubMed

In clinical trials, a surrogate outcome variable (S) can be measured before the outcome of interest (T) and may provide early information regarding the treatment (Z) effect on T. Using the principal surrogacy framework introduced by Frangakis and Rubin (2002. Principal stratification in causal inference. Biometrics 58, 21-29), we consider an approach that has a causal interpretation and develop a Bayesian estimation strategy for surrogate validation when the joint distribution of potential surrogate and outcome measures is multivariate normal. From the joint conditional distribution of the potential outcomes of T, given the potential outcomes of S, we propose surrogacy validation measures from this model. As the model is not fully identifiable from the data, we propose some reasonable prior distributions and assumptions that can be placed on weakly identified parameters to aid in estimation. We explore the relationship between our surrogacy measures and the surrogacy measures proposed by Prentice (1989. Surrogate endpoints in clinical trials: definition and operational criteria. Statistics in Medicine 8, 431-440). The method is applied to data from a macular degeneration study and an ovarian cancer study. PMID:24285772

Conlon, Anna S C; Taylor, Jeremy M G; Elliott, Michael R

2014-04-01

171

Beyond Brain Mapping: Using Neural Measures to Predict Real-World Outcomes  

PubMed Central

One goal of social science in general, and of psychology in particular, is to understand and predict human behavior. Psychologists have traditionally used self-report measures and performance on laboratory tasks to achieve this end. However, these measures are limited in their ability to predict behavior in certain contexts. We argue that current neuroscientific knowledge has reached a point where it can complement other existing psychological measures in predicting behavior and other important outcomes. This brain-as-predictor approach integrates traditional neuroimaging methods with measures of behavioral outcomes that extend beyond the immediate experimental session. Previously, most neuroimaging experiments focused on understanding basic psychological processes that could be directly observed in the laboratory. However, recent experiments have demonstrated that brain measures can predict outcomes (e.g., purchasing decisions, clinical outcomes) over longer timescales in ways that go beyond what was previously possible with self-report data alone. This approach can be used to reveal the connections between neural activity in laboratory contexts and longer-term, ecologically valid outcomes. We describe this approach and discuss its potential theoretical implications. We also review recent examples of studies that have used this approach, discuss methodological considerations, and provide specific guidelines for using it in future research. PMID:24478540

Berkman, Elliot T.; Falk, Emily B.

2013-01-01

172

The Medical Outcomes Study. An application of methods for monitoring the results of medical care  

Microsoft Academic Search

The Medical Outcomes Study was designed to (1) determine whether variations in patient outcomes are explained by differences in system of care, clinician specialty, and clinicians' technical and interpersonal styles and (2) develop more practical tools for the routine monitoring of patient outcomes in medical practice. Outcomes included clinical end points; physical, social, and role functioning in everyday living; patients'

Alvin R. Tarlov; Ware John E. Jr; Sheldon Greenfield; Eugene C. Nelson; Edward Perrin; Michael Zubkoff

1989-01-01

173

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

174

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

175

Validation of the Insomnia Severity Index as an outcome measure for insomnia research  

Microsoft Academic Search

Background: Insomnia is a prevalent health complaint that is often difficult to evaluate reliably. There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints.Objective: This paper reports on the clinical validation of the Insomnia Severity Index (ISI) as a brief screening measure of insomnia and as an outcome measure

Célyne H Bastien; Annie Vallières; Charles M Morin

2001-01-01

176

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

177

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

178

Changes and sex differences in patient reported outcomes in rheumatoid factor positive RA–results from a community based study  

PubMed Central

Background Patient reported outcomes (PROs) are important measures in rheumatoid arthritis (RA). A register of patients with RA from all rheumatology care providers in Malmö, Sweden, was established in 1997 and has been continually updated. This register includes virtually all the RA patients in the area. The aim of this study was to analyse PROs in surveys of this population conducted between 1997 and 2009, and to assess differences in treatment and outcome in male and female patients. Method In 1997, 2002, 2005 and 2009, questionnaires were sent to the RA patients in the register (n?=?1016 in 1997; n?=?916 in 2002; n?=?1625 in 2005; n?=?1700 in 2009). Response rates varied between 62 % and 74 %, and 72-74 % was women. Questionnaire data included medication and measures of disability and health related quality of life. Data on rheumatoid factor (RF) tests were retrieved from the databases of the two clinical immunology laboratories in the area. In order to limit the impact of changes in the case mix over time, the study was restricted to RF positive patients. The analyses were stratified by sex. Results Patients reported less severe outcomes for all measures in the later surveys compared to 1997, and patients’ global disease activity assessment and self-reported pain were further improved in 2009 compared to 2005. Treatment with biologics increased over time from 1997 (none) to 2009 (29%), with no difference between men and women. Visual analogue scales (0-100) for patients’ global assessment of disease activity [mean 45 (95 % CI (45-47) vs. 38 (35-40)] and pain [mean 46 (44-49) vs. 38 (36-40)] decreased from 1997 to 2009, with numerically greater improvement in male patients. The mean SF-36 physical component scores also improved, and were higher in men than in women in all surveys. Conclusion Pharmacologic treatment of RA became more extensive over time, and there was improvement in all PROs. Despite similar treatment, male patients reported better outcomes, in particular for pain and physical function, compared to female patients. We suggest that patient reported outcomes should be reported separately in male and female patients with RA. PMID:24552546

2014-01-01

179

Scale Model Thruster Acoustic Measurement Results  

NASA Technical Reports Server (NTRS)

Subscale rocket acoustic data is used to predict acoustic environments for full scale rockets. Over the last several years acoustic data has been collected during horizontal tests of solid rocket motors. Space Launch System (SLS) Scale Model Acoustic Test (SMAT) was designed to evaluate the acoustics of the SLS vehicle including the liquid engines and solid rocket boosters. SMAT is comprised of liquid thrusters scalable to the Space Shuttle Main engines (SSME) and Rocket Assisted Take Off (RATO) motors scalable to the 5-segment Reusable Solid Rocket Motor (RSTMV). Horizontal testing of the liquid thrusters provided an opportunity to collect acoustic data from liquid thrusters to characterize the acoustic environments. Acoustic data was collected during the horizontal firings of a single thruster and a 4-thruster (Quad) configuration. Presentation scope. Discuss the results of the single and 4-thruster acoustic measurements. Compare the measured acoustic levels of the liquid thrusters to the Solid Rocket Test Motor V - Nozzle 2 (SRTMV-N2).

Kenny, R. Jeremy; Vargas, Magda B.

2013-01-01

180

Use and interpretation of routine outcome measures in forensic mental health.  

PubMed

The present study aimed to both pilot a method of monitoring mental health nurses' use of routine outcome measures (ROM) and to examine the precision of ratings made with these tools within a forensic mental health environment. The audit protocol used in the present study was found to be effective in evaluating both the accuracy with which nurses were able to interpret ROM items and their degree of adherence with local procedures for completing such instruments. Moreover, the results suggest that despite these ROM having been developed for use in general mental health settings, they could be interpreted and rated with an adequate degree of reliability by nurses in a forensic mental health context. However, difficulties were observed in the applicability of several components of these tools within a forensic environment. Recommendations for future research and implications for practice are discussed. PMID:25196647

Shinkfield, Gregg; Ogloff, James

2015-02-01

181

Evidence for Whom? ASHA's National Outcomes Measurement System  

ERIC Educational Resources Information Center

The growth of managed care and increasing demands by school systems resulted in of a number of new audiences looking for the evidence underlying the practice of speech-language pathology (SLP). Third-party payers, operating in an environment emphasizing ''return-on-investment,'' sought data linking expenditures on SLP services with tangible…

Mullen, Robert

2004-01-01

182

Defining the clinically important difference in pain outcome measures  

Microsoft Academic Search

The purpose of this study was to determine the levels of change on standard pain scales that represent clinically important differences to patients. Data from analgesic studies are often difficult to interpret because the clinical importance of the results is not obvious. Differences between groups, as summarized by a change in mean values over time, can be difficult to apply

John T. Farrar; Russell K. Portenoy; Jesse A. Berlin; Judith L. Kinman; Brian L. Strom

2000-01-01

183

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

184

Measuring outcomes in outpatient child psychiatry: Reliable improvement, deterioration, and clinically significant improvement.  

PubMed

Given the increasing interest in demonstrating effectiveness in psychiatric treatment, the current paper seeks to advance outcome measurement in child psychiatry by demonstrating how more informative analytic strategies can be used to evaluate treatment in a real world setting using a brief, standardized parent-report measure. Questionnaires were obtained at intake for 1294 patients. Of these, 695 patients entered treatment and 531 (74%) had complete forms at intake and follow-up. Using this sample, we analyzed the data to determine effect sizes, rates of reliable improvement and deterioration, and rates of clinically significant improvement. Findings highlighted the utility of these approaches for evaluating treatment outcomes. Further suggestions for improving outcome measurement and evaluation are provided. PMID:23838693

Murphy, J Michael; Blais, Mark; Baer, Lee; McCarthy, Alyssa; Kamin, Hayley; Masek, Bruce; Jellinek, Michael

2015-01-01

185

Evaluating the impact of California's full service partnership program using a multidimensional measure of outcomes.  

PubMed

This study evaluates the impact of California's full-service partnership (FSP) program using a multidimensional measure of outcomes. The FSP program is a key part of California's 2005 Mental Health Services Act. Secondary data were collected from the Consumer Perception Survey, the Client and Service Information System, and the Data Collection and Reporting System, all data systems which are maintained by the California Department of Mental Health. The analytic sample contained 39,681 observations of which 588 were FSP participants (seven repeated cross-sections from May 2005 to May 2008). We performed instrumental variables (IV) limited information maximum likelihood and IV Tobit analyses. The marginal monthly improvement in outcomes of services for FSP participants was approximately 3.5 % higher than those receiving usual care with the outcomes of the average individual in the program improving by 33.4 %. This shows that the FSP program is causally effective in improving outcomes among the seriously mentally ill. PMID:23456598

Brown, Timothy Tyler; Hong, Juliette S; Scheffler, Richard M

2014-05-01

186

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. PMID:18308980

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

2008-01-01

187

Implementation and outcomes of telephone disclosure of clinical BRCA1/2 test results?  

PubMed Central

Objectives: With an increasing demand for genetic services, effective and efficient delivery models for genetic testing are needed. Methods: In this prospective single-arm communication study, participants received clinical BRCA1/2 results by telephone with a genetic counselor and completed surveys at baseline, after telephone disclosure (TD) and after in-person clinical follow-up. Results: Sixty percent of women agreed to participate; 73% of decliners preferred in-person communication. Anxiety decreased from baseline to post-TD (p = 0.03) and satisfaction increased (p < 0.01). Knowledge did not change significantly from baseline to post-TD, but was higher post-clinical follow-up (p = 0.04). Cancer patients had greater declines in state anxiety and African-American participants reported less increase in satisfaction. 28% of participants did not return for in-person clinical follow-up, particularly those with less formal education, and higher post-disclosure anxiety and depression (p < 0.01). Conclusions: Telephone disclosure of BRCA1/2 test results may not be associated with negative cognitive and affective responses among willing patients, although some subgroups may experience less favorable responses. Some patients do not return for in-person clinical follow-up and longitudinal outcomes are unknown. Practice implications: Further evaluation of longitudinal outcomes of telephone disclosure and differences among subgroups can inform how to best incorporate telephone communication into delivery of genetic services. PMID:24075727

Patrick-Miller, Linda; Egleston, Brian L.; Daly, Mary; Stevens, Evelyn; Fetzer, Dominique; Forman, Andrea; Bealin, Lisa; Rybak, Christina; Peterson, Candace; Corbman, Melanie; Bradbury, Angela R.

2014-01-01

188

Relationship Between 1-Hour Glucose Challenge Test Results and Perinatal Outcomes  

PubMed Central

Objective To estimate the relationship between 1-hour 50 gm glucose challenge test (GCT) values and perinatal outcomes. Methods This was a secondary analysis of data from a multicenter treatment trial of mild gestational diabetes mellitus (GDM). Women with GCT 135199 mg/dL completed a 3-hour oral glucose tolerance test (OGTT). Mild GDM was defined as fasting glucose less than 95 mg/dL and two or more abnormal OGTT values: 1-hour 180 mg/dL or more; 2-hour 155 mg/dL or more; 3-hour 140 mg/dL or more. Our study included untreated women with GCT 135–139 mg/dL, GCT 140–199 mg/dL, and a comparison group with GCT less than 120 mg/dL. Primary outcomes included a perinatal composite (stillbirth, neonatal death, hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia, and birth trauma), large for gestational age (LGA, birth weight above the 90th percentile based on gender and race specific norms) and macrosomia (greater than 4,000gm). Results There were 436 women with GCT less than120 mg/dL and 1,403 with GCT 135 mg/dL or more (GCT 135–139, n=135; 140–199, n=1,268). The composite perinatal outcome occurred in 25.6% of those with GCT less than 120 mg/dL compared with 21.1% for GCT 135–139 mg/dL, and 35.3% for GCT 140–199 mg/dL. Rates of LGA by group were 6.6%, 6.8% and 12.4%, respectively. Rates of macrosomia by group were 7.8%, 6.1% and 12.1%, respectively. Compared with GCT less than 120 mg/dL, the adjusted odds ratios (OR) (95% confidence intervals [CI]) for GCT values of 140–199 mg/dL were 1.48 (1.14–1.93) for the composite outcome, 1.97 (1.29–3.11) for LGA, and 1.61(1.07–2.49) for macrosomia. For GCT values 135–139 mg/dL, adjusted ORs and 95% CIs were 0.75 (0.45–1.21), 1.04 (0.44–2.24) and 0.75 (0.30–1.66), respectively. The subcategories with GCT values 140–144 mg/dL and 145–149 mg/dL were also associated with an increase in selected outcomes when compared with those with GCT less than 120 mg/dL. Conclusions Glucose challenge test values of 135–139 mg/dL were not associated with adverse outcomes compared with GCT less than 120 mg/dL; however, GCT values 140 mg/dL or more were associated with an increase in odds of the composite perinatal outcome, LGA and macrosomia. PMID:23812458

Figueroa, Dana; Landon, Mark B.; Mele, Lisa; Spong, Catherine Y.; Ramin, Susan M.; Casey, Brian; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; Sciscione, Anthony; Catalano, Patrick; Harper, Margaret; Saade, George; Caritis, Steve N.; Sorokin, Yoram; Peaceman, Alan M.; Tolosa, Jorge E.

2014-01-01

189

Development of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) Gastrointestinal Symptom Scales  

PubMed Central

OBJECTIVES The National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS®) is a standardized set of patient-reported outcomes (PROs) that cover physical, mental, and social health. The aim of this study was to develop the NIH PROMIS gastrointestinal (GI) symptom measures. METHODS We first conducted a systematic literature review to develop a broad conceptual model of GI symptoms. We complemented the review with 12 focus groups including 102 GI patients. We developed PROMIS items based on the literature and input from the focus groups followed by cognitive debriefing in 28 patients. We administered the items to diverse GI patients (irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), systemic sclerosis (SSc), and other common GI disorders) and a census-based US general population (GP) control sample. We created scales based on confirmatory factor analyses and item response theory modeling, and evaluated the scales for reliability and validity. RESULTS A total of 102 items were developed and administered to 865 patients with GI conditions and 1,177 GP participants. Factor analyses provided support for eight scales: gastroesophageal reflux (13 items), disrupted swallowing (7 items), diarrhea (5 items), bowel incontinence/soilage (4 items), nausea and vomiting (4 items), constipation (9 items), belly pain (6 items), and gas/bloat/flatulence (12 items). The scales correlated significantly with both generic and disease-targeted legacy instruments, and demonstrate evidence of reliability. CONCLUSIONS Using the NIH PROMIS framework, we developed eight GI symptom scales that can now be used for clinical care and research across the full range of GI disorders. PMID:25199473

Spiegel, Brennan M.R.; Hays, Ron D.; Bolus, Roger; Melmed, Gil Y.; Chang, Lin; Whitman, Cynthia; Khanna, Puja P.; Paz, Sylvia H.; Hays, Tonya; Reise, Steve; Khanna, Dinesh

2014-01-01

190

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 PMID:24175130

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

2013-01-01

191

SAGE III solar ozone measurements: Initial results  

NASA Technical Reports Server (NTRS)

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 approx.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 approx.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.

2006-01-01

192

Definitions and Outcome Measures of Clinical Trials Regarding Opioid-induced Constipation: A Systematic Review.  

PubMed

Opioid-induced constipation (OIC) is a frequent symptom in patients treated with opioids and impacts the patients' quality of life. However, there is no generally accepted definition for OIC. The aims of this study were to identify definitions for OIC in clinical trials and Cochrane Reviews and to compile assessment tools and outcome measures that were used in clinical trials. In a systematic review, 5 databases (MEDLINE, PubMed, The Cochrane Library, Web of Science, and EMBASE) were searched to identify clinical trials assessing OIC in adult patients or healthy volunteers. Studies published between 1993 and August 2013 were included. A total of 1488 studies were retrieved and 47 publications were included in the analysis. A minority of the publications (n=16, 34%) provided a clear definition for OIC. The definitions were highly variable and the present or recent history of opioid therapy was frequently (n=6, 38%) not included in these definitions. Of 46 clinical trials, 17 (37%) relied exclusively on objective measures such as bowel movement frequency, whereas another 17 studies additionally included patient-reported outcome measures such as, "feeling of incomplete bowel evacuation." Few trials (n=7, 15%) assessed the patient-reported global burden of OIC. Standard definitions and outcome measures are necessary (i) for consistency in OIC diagnosis in clinical practice and clinical trials; and (ii) to assure comparability of trial findings (eg, in meta-analyses). An OIC definition and outcome measures are proposed. PMID:25356996

Gaertner, Jan; Siemens, Waldemar; Camilleri, Michael; Davies, Andrew; Drossman, Douglas A; Webster, Lynn R; Becker, Gerhild

2015-01-01

193

Responsiveness and uniqueness of the pediatric outcomes data collection instrument compared to the gross motor function measure for measuring orthopaedic and neurosurgical outcomes in cerebral palsy.  

PubMed

The Pediatrics Outcomes Data Collection Instrument (PODCI) is a valid and reliable measure of functional health status in children with acute and chronic musculoskeletal disorders, including cerebral palsy (CP), but its responsiveness has not been documented specifically for this population. The Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI) are the only two instruments validated specifically as evaluative measures for CP, and while widely used, they are limited by a ceiling effect when assessing higher-functioning children. The PEDI is further restricted to children who are 7 years old or less. The goal of this study was to evaluate the responsiveness, and secondarily the uniqueness, of the PODCI compared with the GMFM for evaluating surgical outcomes in CP. Changes in the GMFM and PODCI Parent forms were assessed at two time points in 64 children with spastic CP who underwent muscle-tendon lengthenings (MT; n = 22) or neurosurgical spasticity reduction consisting of either selective dorsal rhizotomy (SDR; n = 18) or intrathecal baclofen pump implantation (ITB; n = 11) or who had no surgery between assessments (n = 13). The GMFM Total score was responsive to change after both MT surgery and SDR, with a nearly equivalent magnitude of change in both groups. However, the PODCI Global Function Scale was responsive to changes only after MT surgery, with improvement in the Sports and Physical Function subscale particularly prominent. No significant changes were noted in the ITB group for either measure. PMID:16199947

Damiano, Diane L; Gilgannon, Marc D; Abel, Mark F

2005-01-01

194

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. PMID:20127172

McGrady, Meghan E.; Rosenthal, Susan L.

2010-01-01

195

Outcomes of Secondary Laminoplasty for Patients with Unsatisfactory Results after Anterior Multilevel Cervical Surgery  

PubMed Central

Objective To investigate the causes for failed anterior cervical surgery and the outcomes of secondary laminoplasty. Methods Seventeen patients failed anterior multilevel cervical surgery and the following conservative treatments between Feb 2003 and May 2011 underwent secondary laminoplasty. Outcomes were evaluated by the Japanese Orthopaedic Association (JOA) Scale and visual analogue scale (VAS) before the secondary surgery, at 1 week, 2 months, 6 months, and the final visit. Cervical alignment, causes for revision and complications were also assessed. Results With a mean follow-up of 29.7±12.1 months, JOA score, recovery rate and excellent to good rate improved significantly at 2 months (p<0.05) and maintained thereafter (p>0.05). Mean VAS score decreased postoperatively (p<0.05). Lordotic angle maintained during the entire follow up (p>0.05). The causes for secondary surgery were inappropriate approach in 3 patients, insufficient decompression in 4 patients, adjacent degeneration in 2 patients, and disease progression in 8 patients. Complications included one case of C5 palsy, axial pain and cerebrospinal fluid leakage, respectively. Conclusion Laminoplasty has satisfactory results in failed multilevel anterior surgery, with a low incidence of complications.

Liu, Hong-Wei; Chen, Liang; Xu, Nan-Wei; Yang, Hui-Lin

2015-01-01

196

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. PMID:23181515

2012-01-01

197

Drug-resistant focal sleep related epilepsy: results and predictors of surgical outcome.  

PubMed

In this study we report the results of surgery in a large population of patients affected by drug-resistant focal sleep related epilepsy (SRE) and the identified prognostic factors. We conducted a retrospective analysis of a case series of 955 patients operated on for drug-resistant focal epilepsy from 1997 to 2009. Ninety-five patients with focal SRE and a follow-up of at least 2 years were identified. Presurgical, surgical and histopathological variables were analyzed. Risk of seizures recurrence was assessed by univariate and multivariate analysis. Mean age at epilepsy onset was 5.6 ± 4.9 years. MRI revealed a focal abnormality in 78.9% of cases. Sixty-two percent of patients required a Stereo-EEG investigation. The cortical resection involved the frontal lobe in 61.1% of cases, while in 38.9% an extrafrontal resection was performed. Focal cortical dysplasia (FCD) type II was the most frequent histopathological finding. Mean postoperative follow-up was 82.3 months. Seventy-three patients (76.8%) were in Engel's class I. At univariate analysis, variables associated with a favorable outcome were: absence of Stereo-EEG investigation; positive MRI; complete removal of the epileptogenic zone (EZ); presence of FCD type II and FCD type IIb. A diagnosis of FCD type I was associated with postoperative recurrence of seizures. Multivariate analysis identified the complete removal of the EZ and FCD type I as independent predictors of a favorable and unfavorable outcome respectively. SRE can frequently originate outside the frontal lobe and a favorable surgical outcome is achieved in three-fourths of cases independently from the location of the EZ. PMID:24679947

Losurdo, Anna; Proserpio, Paola; Cardinale, Francesco; Gozzo, Francesca; Tassi, Laura; Mai, Roberto; Francione, Stefano; Castana, Laura; Lo Russo, Giorgio; Casaceli, Giuseppe; Sartori, Ivana; Della Marca, Giacomo; Cossu, Massimo; Nobili, Lino

2014-07-01

198

Outcome Measurement  

E-print Network

New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adap-tation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made.The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed in the United States of America. (BS/MVY) 9 8 7 6 5 4 3 2 1 springeronline.com

Michael A. Devita; Kenneth Hillman M. D; Rinaldo Bellomo M. D; Implementation; Michael A. Devita; M. D. Kenneth Hillman; Rinaldo Bellomo M. D

199

Social and behavioral research in genomic sequencing: approaches from the Clinical Sequencing Exploratory Research Consortium Outcomes and Measures Working Group  

PubMed Central

The routine use of genomic sequencing in clinical medicine has the potential to dramatically alter patient care and medical outcomes. To fully understand the psychosocial and behavioral impact of sequencing integration into clinical practice, it is imperative that we identify the factors that influence sequencing-related decision making and patient outcomes. In an effort to develop a collaborative and conceptually grounded approach to studying sequencing adoption, members of the National Human Genome Research Institute's Clinical Sequencing Exploratory Research Consortium formed the Outcomes and Measures Working Group. Here we highlight the priority areas of investigation and psychosocial and behavioral outcomes identified by the Working Group. We also review some of the anticipated challenges to measurement in social and behavioral research related to genomic sequencing; opportunities for instrument development; and the importance of qualitative, quantitative, and mixed-method approaches. This work represents the early, shared efforts of multiple research teams as we strive to understand individuals' experiences with genomic sequencing. The resulting body of knowledge will guide recommendations for the optimal use of sequencing in clinical practice. PMID:24625446

Gray, Stacy W.; Martins, Yolanda; Feuerman, Lindsay Z.; Bernhardt, Barbara A.; Biesecker, Barbara B.; Christensen, Kurt D.; Joffe, Steven; Rini, Christine; Veenstra, David; McGuire, Amy L.

2014-01-01

200

Measurement of Educational Progress in the Context of Local Demographics: Using General Outcome Measurement as a Basis for the Development and Use of Local Norms  

ERIC Educational Resources Information Center

General outcome measurement, a specific type of formative evaluation, can be used to assess progress toward long-term academic goals. Curriculum-based measurement is a widely used type of general outcome measurement. When used to develop local norms, curriculum-based measurement data are helpful in making individual student and systems-level…

Koehler-Hak, Kathrine M.

2014-01-01

201

Antimicrobial stewardship-qualitative and quantitative outcomes: the role of measurement.  

PubMed

Overuse and misuse of antibiotics have contributed to the growing problem of antimicrobial resistance and serious side effects including Clostridium difficile infection. The Centers for Disease Control and Prevention estimates that more than 2 million people are infected by multidrug-resistant organisms every year. They propose that promoting antimicrobial stewardship programs (ASP) is an essential component to combat this growing threat. One of the major barriers in implementing effective ASP is the availability of reliable measures which reflect intervention effectiveness. Measuring ASP can be divided into four categories: antimicrobial consumption, process measures, outcome measures, and financial. This article reviews the strengths and weaknesses of the current measures. PMID:25230602

Septimus, Ed

2014-11-01

202

Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting  

Microsoft Academic Search

BACKGROUND: To assist clinicians and researchers in choosing outcome measures for patients with chronic obstructive pulmonary disease attending routine outpatient clinics, a comparative assessment was undertaken of four questionnaires designed to reflect the patients' perception of their physical and emotional health in terms of their feasibility, validity, reliability, and responsiveness to health change. METHODS: Two condition specific questionnaires, the St

R. Harper; J. E. Brazier; J. C. Waterhouse; S. J. Walters; N. M. Jones; P. Howard

1997-01-01

203

Development of a multiple sclerosis functional composite as a clinical trial outcome measure  

Microsoft Academic Search

Summary The primary clinical outcome measure for evaluating multiple sclerosis in clinical trials has been Kurtzke's expanded disability status scale (EDSS). New therapies appear to favourably impact the course of multiple sclerosis and render continued use of placebo control groups more difficult. Consequently, future trials are likely to compare active treatment groups which will most probably require increased sample sizes

Gary R. Cutter; Monika L. Baier; Richard A. Rudick; Diane L. Cookfair; Jill S. Fischer; John Petkau; Karl Syndulko; Brian G. Weinshenker; Jack P. Antel; Christian Confavreux; George W. Ellison; Fred Lublin; Aaron E. Miller; Stephen M. Rao; Stephen Reingold; Alan Thompson; Ernest Willoughby

1999-01-01

204

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

205

Core Outcome Measures in Effectiveness Trials http://www.comet-initiative.org/home  

E-print Network

Core Outcome Measures in Effectiveness Trials http://www.comet-initiative.org/home Paula Williamson · Funding: MRC (MRP,) European Commission (FP7) · COMET Management Group: Doug Altman, Jane Blazeby, Mike Clarke · COMET project coordinator: Elizabeth Gargon · FP7 collaborators: Peter Tugwell, Maarten Boers

Applebaum, David

206

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

207

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

208

Achieving Consensus on Leadership Competencies and Outcome MeasuresThe Pediatric Pulmonary Centers' Experience  

Microsoft Academic Search

Pediatric Pulmonary Centers (PPCs) are federally funded interdisciplinary leadership training programs aiming to improve the health of families and children. This article describes the process PPCs used to efficiently and effectively achieve consensus on leadership training competencies and outcome measures among a large and diverse group of health professionals. Phase 1 used a modified Delphi technique to develop an initial

Julie A. Mcdougal; C. Michael Brooks; Mark Albanese

2005-01-01

209

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

210

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

211

Mokken scales for testing both pre- and postintervention: An analysis of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) before and after counseling.  

PubMed

Mokken scaling is increasingly being applied to assessing the extent to which clinical scales possess clinically useful properties, especially invariant item ordering (IIO). These scales are often used to track progress in symptoms over time to evaluate the success of an intervention. Such interventions are designed to affect psychopathological trait levels overall but may in some cases act disproportionately on some symptoms over others. As a result, there is no guarantee that the item orderings of a clinical scale will be preserved between the point at which individuals begin treatment and the point at which they can be considered recovered. In these situations, many of the potential benefits of IIO are undermined because an IIO identified at either time point will not be informative about changes in symptoms over time. In this study, we aimed to assess the extent to which the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) retained the same item orderings in a sample of individuals when initially presenting for counseling treatment and when discharged. From the 34 items of the CORE-OM we found a subset of 10 items exhibiting monotonicity, invariant item ordering, and highly similar item orderings when measured at both time points. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:25068914

Murray, Aja L; McKenzie, Karen; Murray, Kara R; Richelieu, Marc

2014-12-01

212

Risk of retinal detachment following cataract extraction: results from the International Cataract Surgery Outcomes Study.  

PubMed Central

AIMS: To estimate the risk of retinal detachment (RD) following cataract extraction in Denmark, and to compare the risk with that following cataract extraction in the USA, and with that in a sample of Danish patients who did not have ocular surgery. METHODS: A sample was created from the administrative Danish Hospital Register and included 19,252 patients who underwent first eye cataract surgery between 1985 and 1987, and who were 50 years of age or older. The patients were then followed for 4-6 years using the register data. The design and definition of events were identical to the US National Study of Cataract Outcomes. RESULTS: In Denmark a 4 year cumulative risk of hospitalisation for RD of 0.93% (95% confidence interval (CI) 0.71-1.16) was observed following an extracapsular cataract extraction with a lens implant. A similar cumulative risk of RD was reported from the US study. Thus, no difference in outcomes concerning risk of RD was shown between Denmark and the USA. In a multivariate analysis younger age, male sex, and intracapsular cataract extraction were all associated with higher risk of postoperative RD. A reference group of 7636 people not undergoing any ocular surgery was created and the incidence of RD in this group was calculated. During the sixth year following cataract surgery, the incidence of RD in the cataract group was still 7.5 (95% CI 1.6-22.0) times higher than that observed in the reference group. PMID:8949710

Norregaard, J C; Thoning, H; Andersen, T F; Bernth-Petersen, P; Javitt, J C; Anderson, G F

1996-01-01

213

[Quality of nursing diagnoses, interventions and outcomes: criteria and operationalization of the measurement instrument Q-DIO].  

PubMed

Financial, legal and professional demands require the nursing profession to render its contribution to patient care transparent. Due to the lack of research-based tools, the instrument Quality of Nursing Diagnoses, Interventions and Outcomes (Q-DIO) was developed. The aims of this article are to describe the criteria and the operationalisation of an instrument to measure the quality of documented nursing diagnoses, nursing interventions, and nursing outcomes; and to present the instrument. The criteria for the instrument were developed on the basis of a theoretical framework and systematic literature reviews and operationalised into items. Eight experts were involved in face validity and content validity testing. Preliminary testing of inter-rater reliability was also conducted. Development of this instrument results in operationalisation and findings of pretesting. Literature-based criteria were developed into 29 items. All items utilise a scale of 3 to 5 points. The experts corroborated content validity and inter-rater agreement of 88.25% on the 29 items. The measurement instrument Q-DIO provides the result of this study. The strength of the Q-DIO lies in its capacity to measure the quality of documented nursing diagnoses in conjunction with corresponding interventions and nursing-sensitive outcomes. Further testing of the validity and reliability of the Q-DIO is recommended. PMID:18850537

Müller-Staub, Maria; Needham, Ian; Lunney, Margaret; Odenbreit, Matthias; Lavin, Marie Ann; van Achterberg, Theo

2008-10-01

214

The influence of central review on outcome associations in childhood malignant gliomas: results from the CCG-945 experience.  

PubMed Central

To examine the influence of the pathology review mechanism on the results of analyses of therapeutic efficacy and biological prognostic correlates for pediatric high-grade gliomas, we evaluated the effects of using single-expert review or consensus review, as alternatives to institutional classification, in determining outcome results of a large randomized trial. The study group was the randomized cohort of Children's Cancer Group study 945, which compared efficacy of 2 chemotherapy regimens adjuvant to surgery and radiation. Trial eligibility required institutional histopathologic diagnosis of high-grade glioma. Sections of study tumors also were centrally reviewed, initially by a study review neuropathologist and subsequently by 5 neuropathologists, including the review pathologist. Reviews were independent, and reviewers were masked to clinical factors and outcomes, and consensus diagnoses of the panel were then established. Among 172 eligible patients, 42 tumors were classified as discordant on single-expert review and 51 on consensus review. Progression-free survival probabilities calculated for patients with tumors classified as high-grade gliomas by either single-expert or consensus review were inferior to those for the overall, institutionally diagnosed cohort. However, conclusions of the study regarding relative efficacy of treatment and clinical and molecular outcome correlates were unaffected by diagnosis method. Resection extent, proliferation index, and p53 expression were associated strongly with outcome, regardless of diagnosis method. However, comparisons between arms in which inclusion was determined by different review criteria for each arm caused spurious conclusions about efficacy differences between treatments. We conclude that the pathology review mechanism had little effect on within-trial comparisons of therapeutic effects or prognostic correlates in this randomized study, but strongly influenced survival distributions that were calculated for each treatment arm. These results support the implementation of expedited central review in therapeutic studies involving childhood malignant gliomas as a way to prospectively identify and exclude cases with discordant diagnoses and indicate the need for additional measures, such as molecular assessments, to increase the reproducibility of neuropathologic classification for these tumors. PMID:12816726

Pollack, Ian F.; Boyett, James M.; Yates, Allan J.; Burger, Peter C.; Gilles, Floyd H.; Davis, Richard L.; Finlay, Jonathan L.

2003-01-01

215

Creating a Novel Video Vignette Stroke Preparedness Outcome Measure Using a Community-Based Participatory Approach.  

PubMed

Evaluating the efficacy of behavioral interventions for rare outcomes is a challenge. One such topic is stroke preparedness, defined as inteventions to increase stroke symptom recognition and behavioral intent to call 911. Current stroke preparedness intermediate outcome measures are centered on written vignettes or open-ended questions and have been shown to poorly reflect actual behavior. Given that stroke identification and action requires aural and visual processing, video vignettes may improve on current measures. This article discusses an approach for creating a novel stroke preparedness video vignette intermediate outcome measure within a community-based participatory research partnership. A total of 20 video vignettes were filmed of which 13 were unambiguous (stroke or not stroke) as determined by stroke experts and had test discrimination among community participants. Acceptable reliability, high satisfaction, and cultural relevance were found among the 14 community respondents. A community-based participatory approach was effective in creating a video vignette intermediate outcome. Future projects should consider obtaining expert and community feedback prior to filming all the video vignettes to improve the proportion of vignettes that are usable. While content validity and preliminary reliability were established, future studies are needed to confirm the reliability and establish construct validity. PMID:25367896

Skolarus, Lesli E; Murphy, Jillian B; Dome, Mackenzie; Zimmerman, Marc A; Bailey, Sarah; Fowlkes, Sophronia; Morgenstern, Lewis B

2014-11-01

216

MEASURING AND IMPROVING RESPIRATORY OUTCOMES IN CYSTIC FIBROSIS LUNG DISEASE: OPPORTUNITIES AND CHALLENGES TO THERAPY  

PubMed Central

Cystic fibrosis (CF) is a life-shortening disease with significant morbidity. Despite overall improvements in survival, patients with CF experience frequent pulmonary exacerbations and declining lung function, which often accelerates during adolescence. New treatments target steps in the pathogenesis of lung disease, such as the basic defect in CF (CF Transmembrane Conductance Regulator [CFTR]), pulmonary infections, inflammation, and mucociliary clearance. These treatments offer hope but also present challenges to patients, clinicians, and researchers. Comprehensive assessment of efficacy is critical to identify potentially beneficial treatments. Lung function and pulmonary exacerbation are the most commonly used outcome measures in CF clinical research. Other outcome measures under investigation include measures of CFTR function; biomarkers of infection, inflammation, lung injury and repair; and patient-reported outcomes. Molecular diagnostics may help elucidate the complex CF airway microbiome. As new treatments are developed for patients with CF, efforts should be made to balance treatment burden with quality of life. This review highlights emerging treatments, obstacles to optimizing outcomes, and key future directions for research. PMID:19833563

Zemanick, Edith T.; Harris, J. Kirk; Conway, Steven; Konstan, Michael W.; Marshall, Bruce; Quittner, Alexandra L.; Retsch-Bogart, George; Saiman, Lisa; Accurso, Frank J.

2010-01-01

217

Relationships among functional outcome measures used for assessing children with ambulatory CP.  

PubMed

In ambulatory children with cerebral palsy (CP), practitioners often examine outcomes using measures related to functions necessary for daily life. The Gross Motor Function Measure (GMFM) Dimensions D and E, Pediatric Outcomes Data Collection Instrument (PODCI) Parent and Child versions, Gillette Functional Assessment Questionnaire (FAQ) Walking subscale, Functional Independence Measure for Children (WeeFIM), Pediatric Quality of Life Inventory (PedsQL), temporal-spatial gait parameters, and O(2) cost during ambulation were selected for study. Cross-sectional data were collected in a prospective multicenter study of 562 participants with CP (339 males, 223 females), between 4 and 18 years of age (mean age 11y 1mo). There were 240 classified as Gross Motor Function Classification System Level I, 196 as Level II, and 126 as Level III. The tools that had the best interrelationships and underlying constructs predominately measured changes in physical function. These included portions of the FAQ, Parent PODCI, WeeFIM, and GMFM. GMFM Dimensions D and E exhibited a very strong relationship. Temporal-spatial gait parameters and O2 cost measures represented a different construct of physical function. The Child PODCI reports and both the Parent and Child PedsQL reports did not relate well to other measures, suggesting a pattern of answers not related to question content. The Parent PODCI, the FAQ Walking subscale, and GMFM Dimension E were found to be an appropriate minimum set of instruments for assessment of functional outcomes in patients with ambulatory CP. PMID:17489806

Sullivan, Elroy; Barnes, Douglas; Linton, Judith L; Calmes, Janine; Damiano, Diane; Oeffinger, Donna; Abel, Mark; Bagley, Anita; Gorton, George; Nicholson, Diane; Rogers, Sarah; Tylkowski, Chester

2007-05-01

218

Measuring function after hip and knee surgery: the evidence to support performance-based functional outcome tasks.  

PubMed

Accurate, reproducible outcome measures are essential for the evaluation of any orthopaedic procedure, in both clinical practice and research. Commonly used patient-reported outcome measures (PROMs) have drawbacks such as 'floor' and 'ceiling' effects, limitations of worldwide adaptability and an inability to distinguish pain from function. They are also unable to measure the true outcome of an intervention rather than a patient's perception of that outcome. Performance-based functional outcome tools may address these problems. It is important that both clinicians and researchers are aware of these measures when dealing with high-demand patients, using a new intervention or implant, or testing a new rehabilitation protocol. This article provides an overview of some of the clinically-validated performance-based functional outcome tools used in the assessment of patients undergoing hip and knee surgery. PMID:25371452

Konan, S; Hossain, F; Patel, S; Haddad, F S

2014-11-01

219

The supraorbital eyebrow approach in children: clinical outcomes, cosmetic results, and complications.  

PubMed

OBJECT The supraorbital eyebrow approach utilizes an eyebrow skin incision to fashion a supraorbital craniotomy for exposure of the subfrontal corridor. This provides anterolateral access to surgical lesions in the anterior cranial fossa, parasellar regions, brainstem, and medial temporal lobe. With use of the endoscope, further areas can be accessed. This approach has been applied effectively in adults, but questions remain about its use in children-specifically with regard to adequate working space, effectiveness for achieving the desired results, cosmesis, and complications. METHODS The authors conducted a retrospective review of more than 450 cases involving patients of all ages who had undergone a supraorbital eyebrow approach performed by the senior author (C.T.) from 1995 to 2013. Only cases involving patients younger than 18 years with a minimum follow-up of 6 weeks were included in this study. All inpatient and outpatient records were retrospectively reviewed and clinical/operative outcomes, cosmetic results, and complications were recorded. In the present article, the authors briefly describe the surgical approach and highlight any differences in applying it in children. RESULTS Fifty-four pediatric patients who had undergone a supraorbital eyebrow approach met inclusion criteria. The pathological conditions consisted mostly of tumors or other resectable lesions. In a total of 51 resectable lesions, 44 surgeries resulted in a gross-total (100%) resection and 7 cases resulted in subtotal (50%-99%) resection. The endoscope assisted and expanded visualization or provided access to areas not reached by standard microscopic visualization in all cases. Cosmetic outcomes were excellent. In all cases, the incisional scar was barely visible at 6 weeks. In 3 cases a minor bone defect was observed on the forehead. Given the small size of the frontal sinus in children, no frontal sinus breaches occurred. Additionally, no CSF leak or wound infection was identified. CONCLUSIONS The supraorbital eyebrow approach is extremely effective in achieving desired results in properly selected cases in patients of all pediatric age ranges, from infants to teenagers. There is sufficient working space for the endoscope and all instruments, allowing for endoscopic assistance and bimanual surgical technique. Cosmetic results are excellent, and complications related to the approach are minimal. PMID:25396702

Dlouhy, Brian J; Chae, Michael P; Teo, Charles

2015-01-01

220

The WHO-DAS II: Measuring Outcomes of Hearing Aid Intervention for Adults  

PubMed Central

The World Health Organization's Disability Assessment Scale II (WHO-DAS II) is a generic health-status instrument that provides six domain scores and a total, aggregate score. Two of the domain scores, communication and participation, and the total score, have good validity, internal-consistency reliability, and test-retest stability in individuals with adult-onset hearing loss. As such, these two domain scores and the total WHO-DAS II score may be useful as generic outcome measures to assess the effectiveness of hearing aid intervention for this population. Before the use of the WHO-DAS II in hearing aid clinical trials, however, the responsiveness of the instrument and the short- and long-term outcomes to hearing aid intervention had to be determined. Responsiveness and outcomes were assessed in 380 veterans (approximately half received hearing aids and half served as controls) by examining group differences, effect-size estimates, and individual differences as a function of hearing aid intervention. For comparison, data also were obtained on two disease-specific measures, the APHAB and the HHIE. The WHO-DAS II communication domain and total scores were sufficiently responsive to hearing aid intervention for use in future studies in which group differences are to be detected. The WHO-DAS II participation domain was not sufficiently responsive to hearing aid intervention. The APHAB and HHIE, both disease-specific measures, were more sensitive to hearing aid intervention than the generic measure. The short- and long-term outcomes of hearing aid intervention were also examined in the present study. Group outcomes for hearing aid intervention can be expected to be stable for at least 6 months when measured by WHO-DAS II total score and for at least 12 months when measured by the WHO-DAS II communication domain scores. Effect-size estimates and examination of the number of individuals exhibiting change scores exceeding 90% critical differences for true changes in scores indicate that for clinical applications, disease-specific instruments are more useful than the WHO-DAS II. The findings of this study support the use of the WHO-DAS II as a generic measure in hearing aid trials research so as to allow for comparisons of health-status outcomes across different diseases or disorders. PMID:16244759

McArdle, Rachel; Chisolm, Theresa H.; Abrams, Harvey B.; Wilson, Richard H.; Doyle, Patrick J.

2005-01-01

221

Incidence and Outcomes of Desmoplastic Small Round Cell Tumor: Results from the Surveillance, Epidemiology, and End Results Database  

PubMed Central

Desmoplastic small round cell tumor (DSRCT) is a rare but highly fatal malignancy. Due to the rarity of this neoplasm, no large population based studies exist. Procedure. This is a retrospective cohort analysis. Incidence rates were calculated based on sex and ethnicity and compared statistically. Gender-, ethnicity-, and treatment- based survival were calculated using the Kaplan-Meier method. Results. A total of 192 cases of DSRCT were identified. Peak incidence age was between 20 and 24 years. Age-adjusted incidence rate for blacks was 0.5 cases/million and for whites was 0.2 cases/million (P = 0.037). There was no statistically significant difference in survival based on gender or ethnicity. When adjusted for age, there was no statistically significant difference in survival amongst patients who received radiation therapy compared to those who did not (HRadj = 0.73; 95% CI 0.49, 1.11). There was a statistically significant survival advantage for patients who received radiation after surgery compared to those who did not (HR 0.49; 95% CI 0.30, 0.79). Conclusion. DSRCT is more common in males and in people of African-American descent. Although overall survival remains poor, radiation therapy following surgery seems to improve outcome in these patients. PMID:25431592

Lettieri, Christina K.; Hingorani, Pooja

2014-01-01

222

Assessing patient outcomes in acute exacerbations of chronic bronchitis: The measure your medical outcome profile (MYMOP), medical outcomes study 6-item general health survey (MOS6A) and EuroQol (EQ-5D)  

Microsoft Academic Search

There is little published information on the measurement of health status or quality of life in acute exacerbations of chronic\\u000a bronchitis. The measure yourself medical outcome profile (MYMOP), the medical outcomes study 6-item general health survey\\u000a (MOS-6A), and EuroQoL (EQ-5D) were evaluated in 81 patients with acute exacerbations of Type-1 chronic bronchitis presenting\\u000a at a single general practice centre in

C. Paterson; C. E. Langan; G. A. McKaig; P. M. Anderson; G. D. H. Maclaine; L. B. Rose; S. J. Walker; M. J. Campbell

2000-01-01

223

Search Results: Measures - Team Science Toolkit  

Cancer.gov

Academy of Management Measure Chest The website was developed by Research Methods Division (RMD) of the Academy of Management to provide organizational researchers a reference list of existing scales.

224

Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research  

PubMed Central

This paper proposes a historical excursus of studies that have investigated the therapeutic alliance and the relationship between this dimension and outcome in psychotherapy. A summary of how the concept of alliance has evolved over time and the more popular alliance measures used in literature to assess the level of alliance are presented. The proposal of a therapeutic alliance characterized by a variable pattern over the course of treatment is also examined. The emerging picture suggests that the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures. In our opinion, with regard to the relationship between the therapeutic alliance and outcome of psychotherapy, future research should pay special attention to the comparison between patients’ and therapists’ assessments of the therapeutic alliance. This topic, along with a detailed examination of the relationship between the psychological disorder being treated and the therapeutic alliance, will be the subject of future research projects. PMID:22028698

Ardito, Rita B.; Rabellino, Daniela

2011-01-01

225

Can transit-time flow measurement improve graft patency and clinical outcome in patients undergoing coronary artery bypass grafting?  

PubMed

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was if transit-time flow measurement (TTFM) can improve graft patency and clinical outcome in patients undergoing coronary surgery. Altogether 102 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The papers considered for the analysis focus attention on three major topics: intraoperative graft verification with the aim of improving immediate graft patency; predictive power of early- and mid-term graft patency and clinical outcome. Among TTFM parameters, according to different authors, mean graft flow is set at 10 or 15 ml/min; pulsatility index is set at three or five; insufficiency ratio is set by 3 or 4%. We conclude that TTFM is a reliable method to verify intraoperative graft patency. There is some evidence that checking graft patency intraoperatively may improve mid-term outcomes. PMID:20682631

Di Giammarco, Gabriele; Rabozzi, Roberto

2010-11-01

226

Outcome Rating Scale and Session Rating Scale in Psychological Practice: Clinical Utility of Ultra-Brief Measures  

ERIC Educational Resources Information Center

The validity and reliability of the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) were evaluated against existing longer measures, including the Outcome Questionnaire-45, Working Alliance Inventory, Depression Anxiety Stress Scale-21, Quality of Life Scale, Rosenberg Self-Esteem Scale and General Self-efficacy Scale. The measures

Campbell, Alistair; Hemsley, Samantha

2009-01-01

227

What Do Patients Consider to Be the Most Important Outcomes for Effectiveness Studies on Migraine Treatment? Results of a Delphi Study  

PubMed Central

Background The outcome measures most frequently used in studies on the effectiveness of migraine treatment are whether the patient is free of pain, nausea, and free of photophobia/phonophobia within two hours. However, no patient-centred outcome measures are available. Therefore, we performed an online Delphi procedure to compile a list of outcome measures deemed most important to migraine patients. Methods From a large database of migraine patients, we randomly selected 150 males and 150 females patients. We asked the open-ended question: ‘If a new medicine was developed for migraine attacks, what would you wish the effect of this medication to be?’ In the second and third rounds, we presented the answers of the first round and asked the patients to rate the importance of each item. Results The initial response rate was 56% (n?=?169). In the subsequent rounds the response rates were 90% (n?=?152), and 97% (n?=?147), respectively. Patients wanted their attack medication to treat the headache within 30 min, to prevent the attack from getting worse, to ensure they could function properly within 1 h, and prevent the recurrence of symptoms during the same day. Conclusions The currently used outcome measures in migraine research do not sufficiently reflect the wishes of patients. Patients want the medication to work faster, to take away pain at an earlier stage, to make them able to function properly quickly, and to prevent recurrence. These aspects should be considered in future evaluation of new attack medication for migraine. PMID:24932784

Smelt, Antonia F. H.; Louter, Mark A.; Kies, Dennis A.; Blom, Jeanet W.; Terwindt, Gisela M.; van der Heijden, Geert J. M. G.; De Gucht, Véronique; Ferrari, Michel D.; Assendelft, Willem J. J.

2014-01-01

228

26 CFR 801.6 - Business results measures.  

Code of Federal Regulations, 2011 CFR

...2011-04-01 2011-04-01 false Business results measures. 801.6 Section 801.6...INTERNAL REVENUE SERVICE § 801.6 Business results measures. (a) In general. The business results measures will consist of numerical...

2011-04-01

229

26 CFR 801.6 - Business results measures.  

Code of Federal Regulations, 2010 CFR

...2010-04-01 false Business results measures. 801...REVENUE SERVICE § 801.6 Business results measures. (a) In general. The business results measures will...of office time; (7) Cycle time; (8) Number...

2010-04-01

230

The case for an international patient-reported outcomes measurement information system (PROMIS®) initiative.  

PubMed

Patient-reported outcomes (PROs) play an increasingly important role in clinical practice and research. Modern psychometric methods such as item response theory (IRT) enable the creation of item banks that support fixed-length forms as well as computerized adaptive testing (CAT), often resulting in improved measurement precision and responsiveness. Here we describe and discuss the case for developing an international core set of PROs building from the US PROMIS® network.PROMIS is a U.S.-based cooperative group of research sites and centers of excellence convened to develop and standardize PRO measures across studies and settings. If extended to a global collaboration, PROMIS has the potential to transform PRO measurement by creating a shared, unifying terminology and metric for reporting of common symptoms and functional life domains. Extending a common set of standardized PRO measures to the international community offers great potential for improving patient-centered research, clinical trials reporting, population monitoring, and health care worldwide. Benefits of such standardization include the possibility of: international syntheses (such as meta-analyses) of research findings; international population monitoring and policy development; health services administrators and planners access to relevant information on the populations they serve; better assessment and monitoring of patients by providers; and improved shared decision making.The goal of the current PROMIS International initiative is to ensure that item banks are translated and culturally adapted for use in adults and children in as many countries as possible. The process includes 3 key steps: translation/cultural adaptation, calibration, and validation. A universal translation, an approach focusing on commonalities, rather than differences across versions developed in regions or countries speaking the same language, is proposed to ensure conceptual equivalence for all items. International item calibration using nationally representative samples of adults and children within countries is essential to demonstrate that all items possess expected strong measurement properties. Finally, it is important to demonstrate that the PROMIS measures are valid, reliable and responsive to change when used in an international context.IRT item banking will allow for tailoring within countries and facilitate growth and evolution of PROs through contributions from the international measurement community. A number of opportunities and challenges of international development of PROs item banks are discussed. PMID:24359143

Alonso, Jordi; Bartlett, Susan J; Rose, Matthias; Aaronson, Neil K; Chaplin, John E; Efficace, Fabio; Leplège, Alain; Lu, Aiping; Tulsky, David S; Raat, Hein; Ravens-Sieberer, Ulrike; Revicki, Dennis; Terwee, Caroline B; Valderas, Jose M; Cella, David; Forrest, Christopher B

2013-01-01

231

Outcomes Assessment for Beginning and Intermediate Spanish: One Program's Process and Results  

ERIC Educational Resources Information Center

Outcomes assessment is a process by which an academic unit defines and articulates its program goals and assesses its attainment of those goals. This article chronicles one language division's efforts at outcomes assessment for beginning and intermediate Spanish. The evidence used for program assessment consisted of WebCAPE placement scores,…

Houston, Tony

2005-01-01

232

Intraoperative graft flow measurements during coronary artery bypass surgery predict in-hospital outcomes.  

PubMed

Transit-time flowmetry enables immediate intraoperative assessment of blood flow parameters in coronary artery bypass grafts (CABG). The present study assesses the predictive value of measured graft flows on early and medium-term outcomes. All cardiac surgery patients with measured graft flows were included. The last intraoperative flow measurements recorded using the Medtronic Butterfly Flowmetry system were used for analysis. Patients were separated into two groups: patients with normal flow in all grafts or patients with abnormal flow > or =1 graft. Any pulsatility index (pulsatility index=min-max flow/mean flow) < or =5 was determined to be normal flow. The study population included 985 patients. Nineteen percent of patients had abnormal flow in > or =1 graft. Overall in-hospital mortality was 4.7% and not significant between the two groups. After adjusting for covariates, the in-hospital composite outcome for adverse cardiac events was more prevalent in the abnormal flow group (31% vs. 17%; P<0.0001) with an odds ratio of 1.7 (CI 1.1-2.7). Survivors to discharge had a mean follow-up of 1.8 years. However, abnormal flow was not an independent predictor of the medium-term mortality and readmission to hospital for cardiac reason following discharge. Our findings suggest that abnormal flows measured intraoperatively are independently associated with short-term in-hospital adverse outcome. PMID:18467427

Herman, Christine; Sullivan, John A; Buth, Karen; Legare, Jean-Francois

2008-08-01

233

Breast Reduction versus Breast Reduction Plus Implants: A Comparative Study with Measurements and Outcomes  

PubMed Central

Background: Breast reduction is well-known to provide an improvement in physical symptoms. However, measurements show that this procedure is less effective in restoring upper-pole fullness. Breast implants effectively augment the upper pole. This study was undertaken to determine the effectiveness and safety of this treatment combination. Methods: This retrospective study consists of 3 parts: (1) a clinical study, (2) breast measurements, and (3) an outcome study. Eighty consecutive women undergoing breast reduction (n = 56) or breast reduction plus implants (n = 24) were evaluated. All breast implants were inserted submuscularly. All patients were treated with the same vertical reduction technique, using a medially based pedicle and intraoperative nipple positioning. Measurements were compared between preoperative photographs and photographs taken at least 3 months after surgery (n = 51). Patient surveys (n= 56) were evaluated. Results: There was no significant difference in complication or reoperation rates between groups. Both procedures elevated the breast mound and lower-pole level and increased the breast parenchymal ratio (upper-pole area/lower-pole area). Breast implants significantly increased upper-pole projection (P < 0.01). All surveyed patients who had simultaneous implants reported that they were pleased with their decision. Physical symptoms were reduced in both groups. Patient satisfaction was 92.5% for breast reduction and 93.8% for breast reduction plus implants. Both groups reported an improvement in quality of life. Conclusions: Vertical breast reduction with a medial pedicle may be combined safely and effectively with breast implants in patients who desire upper-pole fullness. PMID:25587515

2014-01-01

234

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. (SLD)

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

1999-01-01

235

Measuring Competition: Inconsistent Definitions, Inconsistent Results  

ERIC Educational Resources Information Center

There is a developing literature examining how charter schools, through the effects of competition, impact performance in public school districts and district-run public schools, also known as the second-level effects of competition. What follows is an examination of how competition is measured in this literature that offers a critique of existing…

Linick, Matthew Allen

2014-01-01

236

Systematic review of treatment effectiveness and outcome measures for enthesitis in psoriatic arthritis.  

PubMed

Enthesitis is a characteristic feature of psoriatic arthritis (PsA) and is important in disease pathogenesis and classification. Use of clinical outcome measures for enthesitis is heterogeneous, and only 1 measure has been specifically developed and validated in PsA. Ultrasound and magnetic resonance imaging assessments of enthesitis may have advantages over clinical examination but are insufficiently studied. As part of an update of treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), we performed a systematic literature review and identified randomized controlled trials with enthesitis outcomes in PsA. For each treatment agent we calculated treatment effect sizes (where applicable) and graded the level of evidence. PMID:25362713

Orbai, Ana-Maria; Weitz, Joshua; Siegel, Evan L; Siebert, Stefan; Savage, Laura J; Aydin, Sibel Z; Luime, Jolanda J; Elkayam, Ori; Neerinckx, Barbara; Urbancek, Slavo; de Vlam, Kurt; Ritchlin, Christopher T

2014-11-01

237

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

Microsoft Academic Search

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

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

1993-01-01

238

Worker productivity outcome measures: OMERACT filter evidence and agenda for future research.  

PubMed

The objective of the Outcome Measures in Rheumatology (OMERACT) Worker Productivity working group is to identify worker productivity outcome measures that meet the requirements of the OMERACT filter. At the OMERACT 11 Workshop, we focused on the at-work limitations/productivity component of worker productivity (i.e., presenteeism) - an area with diverse conceptualization and instrumentation approaches. Various approaches to quantify at-work limitations/productivity (e.g., single-item global and multi-item measures) were examined, and available evidence pertaining to OMERACT truth, discrimination, and feasibility were presented to conference participants. Four candidate global measures of presenteeism were put forth for a plenary vote to determine whether current evidence meets the OMERACT filter requirements. Presenteeism globals from the Work Productivity and Activity Impairment Questionnaire (72% support) and Rheumatoid Arthritis-specific Work Productivity Survey (71% support) were endorsed by conference participants; however, neither the presenteeism global item from the Health and Work Performance Questionnaire nor the Quantity and Quality method achieved the level of support required for endorsement at the present time. The plenary was also asked whether the central item from the Work Ability Index should also be considered as a candidate measure for potential endorsement in the future. Of participants at the plenary, 70% supported this presenteeism global measure. Progress was also made in other areas through discussions at individual breakout sessions. Topics examined include the merits of various multi-item measures of at-work limitations/productivity, methodological issues related to interpretability of outcome scores, and approaches to appraise and classify contextual factors of worker productivity. Feedback gathered from conference participants will inform the future research agenda of the working group. PMID:24128774

Tang, Kenneth; Boonen, Annelies; Verstappen, Suzanne M M; Escorpizo, Reuben; Luime, Jolanda J; Lacaille, Diane; Fautrel, Bruno; Bosworth, Ailsa; Cifaldi, Mary; Gignac, Monique A M; Hofstetter, Cathy; Leong, Amye; Montie, Pam; Petersson, Ingemar F; Purcaru, Oana; Bombardier, Claire; Tugwell, Peter S; Beaton, Dorcas E

2014-01-01

239

Clinical outcome measures for trials in Duchenne muscular dystrophy: report from International Working Group meetings  

PubMed Central

In June 2010, 25 representatives from Europe and the US met in Washington, DC, USA, to discuss clinical outcome measures in Duchenne muscular dystrophy (DMD) in the context of clinical trial design and analysis. The workshop was organized in response to a September 2009 European Medicines Agency meeting where a clear directive was given that an international consensus needs to be developed that provides a foundation for age-appropriate clinical outcome measures for use in clinical trials of emerging therapeutics for DMD. Data were presented from eight multicenter longitudinal datasets, representing nearly 1900 patients over a 20-year time period. This experience confirmed the feasibility of repeated evaluations performed at multiple sites and addressed several core issues in drug development for DMD, such as the ‘new’ natural history in the steroidera, reliability and sensitivity of specific outcome measures, as well as disease staging and patient selection. These data form a valuable asset for academic investigators, pharmaceutical sponsors and regulatory agencies involved in DMD therapeutics. The group remains committed working together on a number of collaborative goals to support the therapeutics development effort in this orphan disease and to make these data available to stakeholders working in the field. PMID:22639722

Bushby, Kate; Connor, Edward

2012-01-01

240

Mercury in fish and adverse reproductive outcomes: results from South Carolina  

PubMed Central

Background Mercury is a metal with widespread distribution in aquatic ecosystems and significant neurodevelopmental toxicity in humans. Fish biomonitoring for total mercury has been conducted in South Carolina (SC) since 1976, and consumption advisories have been posted for many SC waterways. However, there is limited information on the potential reproductive impacts of mercury due to recreational or subsistence fish consumption. Methods To address this issue, geocoded residential locations for live births from the Vital Statistics Registry (1995–2005, N?=?362,625) were linked with spatially interpolated total mercury concentrations in fish to estimate potential mercury exposure from consumption of locally caught fish. Generalized estimating equations were used to test the hypothesis that risk of low birth weight (LBW, <2,500 grams) or preterm birth (PTB, <37 weeks clinical gestation) was greater among women living in areas with elevated total mercury in fish, after adjustment for confounding. Separate analyses estimated term LBW and PTB risks using residential proximity to rivers with fish consumption advisories to characterize exposure. Results Term LBW was more likely among women residing in areas in the upper quartile of predicted total mercury in fish (odds ratio [OR]?=?1.04; 95% confidence interval [CI]: 1.00-1.09) or within 8 kilometers of a river with a ‘do not eat’ fish advisory (1.05; 1.00-1.11) compared to the lowest quartile, or rivers without fish consumption restrictions, respectively. When stratified by race, risks for term LBW or PTB were 10-18% more likely among African-American (AA) mothers living in areas with the highest total fish mercury concentrations. Conclusions To our knowledge, this is the first study to examine the relationship between fish total mercury concentrations and adverse reproductive outcomes in a large population-based sample that included AA women. The ecologic nature of exposure assessment in this study precludes causal inference. However, the results suggest a need for more detailed investigations to characterize patterns of local fish consumption and potential dose–response relationships between mercury exposure and adverse reproductive outcomes, particularly among AA mothers. PMID:25127892

2014-01-01

241

The chemotherapy-induced peripheral neuropathy outcome measures standardization study: from consensus to the first validity and reliability findings  

PubMed Central

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and dose-limiting complication of cancer treatment. Thus far, the impact of CIPN has not been studied in a systematic clinimetric manner. The objective of the study was to select outcome measures for CIPN evaluation and to establish their validity and reproducibility in a cross-sectional multicenter study. Patients and methods After literature review and a consensus meeting among experts, face/content validity were obtained for the following selected scales: the National Cancer Institute-Common Toxicity Criteria (NCI-CTC), the Total Neuropathy Score clinical version (TNSc), the modified Inflammatory Neuropathy Cause and Treatment (INCAT) group sensory sumscore (mISS), the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, and CIPN20 quality-of-life measures. A total of 281 patients with stable CIPN were examined. Validity (correlation) and reliability studies were carried out. Results Good inter-/intra-observer scores were obtained for the TNSc, mISS, and NCI-CTC sensory/motor subscales. Test–retest values were also good for the EORTC QLQ-C30 and CIPN20. Acceptable validity scores were obtained through the correlation among the measures. Conclusion Good validity and reliability scores were demonstrated for the set of selected impairment and quality-of-life outcome measures in CIPN. Future studies are planned to investigate the responsiveness aspects of these measures. PMID:22910842

Cavaletti, G.; Cornblath, D. R.; Merkies, I. S. J.; Postma, T. J.; Rossi, E.; Frigeni, B.; Alberti, P.; Bruna, J.; Velasco, R.; Argyriou, A. A.; Kalofonos, H. P.; Psimaras, D.; Ricard, D.; Pace, A.; Galiè, E.; Briani, C.; Dalla Torre, C.; Faber, C. G.; Lalisang, R. I.; Boogerd, W.; Brandsma, D.; Koeppen, S.; Hense, J.; Storey, D.; Kerrigan, S.; Schenone, A.; Fabbri, S.; Valsecchi, M. G.; Mazzeo, A.; Pace, A.; Pessino, A.; Schenone, A.; Toscano, A.; Argyriou, A.A.; Brouwer, B.; Frigeni, B.; Piras, B.; Briani, C.; Dalla Torre, C.; Dominguez Gonzalez, C.; Faber, C. G.; Tomasello, C.; Binda, D.; Brandsma, D.; Cortinovis, D.; Psimaras, D.; Ricard, D.; Storey, D.; Cornblath, D.R.; Galiè, E.; Lindeck Pozza, E.; Rossi, E.; Vanhoutte, E.K.; Lanzani, F.; Pastorelli, F.; Altavilla, G.; Cavaletti, G.; Granata, G.; Kalofonos, H.P.; Ghignotti, I.; Merkies, I.S.J.; Bruna, J.; Hense, J.; Heimans, J.J.; Mattavelli, L.; Padua, L.; Reni, L.; Bakkers, M.; Boogerd, M.; Campagnolo, M.; Cazzaniga, M.; Eurelings, M.; Leandri, M.; Lucchetta, M.; Penas Prado, M.; Russo, M.; Valsecchi, M.G.; Piatti, M.L.; Alberti, P.; Bidoli, P.; Grant, R.; Plasmati, R.; Velasco, R.; Lalisang, R.I.; Meijer, R.J.; Fabbri, S.; Dorsey, S. G.; Galimberti, S.; Kerrigan, S.; Koeppen, S.; Postma, T.J.; Boogerd, W.; Grisold, W.

2013-01-01

242

Cardiovascular outcome associations among cardiovascular magnetic resonance measures of arterial stiffness: the Dallas heart study  

PubMed Central

Background Cardiovascular magnetic resonance (CMR) has been validated for the noninvasive assessment of total arterial compliance and aortic stiffness, but their associations with cardiovascular outcomes is unknown. The purpose of this study was to evaluate associations of CMR measures of total arterial compliance and two CMR measures of aortic stiffness with respect to future cardiovascular events. Methods The study consisted of 2122 Dallas Heart Study participants without cardiovascular disease who underwent CMR at 1.5 Tesla. Aortic stiffness was measured by CMR-derived ascending aortic distensibility and aortic arch pulse wave velocity. Total arterial compliance was calculated by dividing left ventricular stroke volume by pulse pressure. Participants were monitored for cardiovascular death, non-fatal cardiac events, and non-fatal extra-cardiac vascular events over 7.8?±?1.5 years. Cox proportional hazards regression was used to assess for associations between CMR measures and cardiovascular events. Results Age, systolic blood pressure, and resting heart rate were independently associated with changes in ascending aortic distensibility, arch pulse wave velocity, and total arterial compliance (all p?measures of arterial stiffness are associated with future cardiovascular events. Total arterial compliance and aortic distensibility may be stronger predictors of nonfatal cardiac events, while pulse wave velocity may be a stronger predictor of nonfatal extra-cardiac vascular events. PMID:24886531

2014-01-01

243

The Effect of Ethical Signals on Recruitment Outcomes: Two Studies with Convergent Results  

E-print Network

The applicant decision making process is a complex one. During the recruitment process, signals from the organization provide information to the candidates and affect important recruitment outcomes. Ethics is one area the organization can utilize...

Degrassi, Sandra W.

2010-10-12

244

CT-Guided Lumbar Sympathectomy: Results and Analysis of Factors Influencing the Outcome  

SciTech Connect

Purpose: To prospectively analyze the effectiveness of computed tomography-guided percutaneous lumbar sympathectomy (CTLS) in patients with peripheral arterial occlusive disease in relation to angiographic findings and vascular risk factors. Methods: Eighty-three patients were treated by CTLS. After clinical evaluation of the risk profile and diagnostic intraarterial digital subtraction arteriography, 14 patients underwent unilateral, and 69 bilateral one-level treatment. Follow-up studies took place on the day following the intervention, after 3 weeks, and after 3 months. Results: A total of 152 interventions were performed in 83 patients. After 3 months, clinical examination of 54 patients (5 patients had died, 24 were lost to follow-up) revealed improvement in 46% (25/54), no change in 39% (21/54), and worsening (amputation) in 15% (8/54). There was no significant statistical correlation among any of the analyzed factors (diabetes mellitus, arterial hypertension, smoking, hyperlipidemia, obesity, hyperuricemia, number of risk factors, ankle-arm index, and angiography score) and the outcome after CTLS. Three major complications occurred: one diabetic patient developed a retroperitoneal abscess 2 weeks after CTLS, and in two other patients ureteral strictures were detected 3 months and 2 years after CTLS, respectively. Conclusion: As no predictive criteria for clinical improvement in an individual patient could be identified, CTLS, as a safe procedure, should be employed on a large scale in patients who are unsuitable for treatment by angioplasty or revascularization.

Heindel, Walter; Ernst, Stefan; Manshausen, Gudrun [Department of Diagnostic Radiology, University of Cologne Medical School, D-50924 Cologne (Germany); Gawenda, Michael [Department of Surgery, University of Cologne Medical School, D-50924 Cologne (Germany); Siemens, Peter; Krahe, Thomas [Department of Diagnostic Radiology, University of Cologne Medical School, D-50924 Cologne (Germany); Walter, Michael [Department of Surgery, University of Cologne Medical School, D-50924 Cologne (Germany); Lackner, Klaus [Department of Diagnostic Radiology, University of Cologne Medical School, D-50924 Cologne (Germany)

1998-07-15

245

Survey and online discussion groups to develop a patient-rated outcome measure on acceptability of treatment response in vitiligo  

PubMed Central

Background Vitiligo is a chronic depigmenting skin disorder which affects around 0.5-1% of the world’s population. The outcome measures used most commonly in trials to judge treatment success focus on repigmentation. Patient-reported outcome measures of treatment success are rarely used, although recommendations have been made for their inclusion in vitiligo trials. This study aimed to evaluate the face validity of a new patient-reported outcome measure of treatment response, for use in future trials and clinical practice. Method An online survey to gather initial views on what constitutes treatment success for people with vitiligo or their parents/carers, followed by online discussion groups with patients to reach consensus on what constitutes treatment success for individuals with vitiligo, and how this can be assessed in the context of trials. Participants were recruited from an existing database of vitiligo patients and through posts on the social network sites Facebook and Twitter. Results A total of 202 survey responses were received, of which 37 were excluded and 165 analysed. Three main themes emerged as important in assessing treatment response: a) the match between vitiligo and normal skin (how well it blends in); b) how noticeable the vitiligo is and c) a reduction in the size of the white patches. The majority of respondents said they would consider 80% or more repigmentation to be a worthwhile treatment response after 9 months of treatment. Three online discussion groups involving 12 participants led to consensus that treatment success is best measured by asking patients how noticeable their vitiligo is after treatment. This was judged to be best answered using a 5-point Likert scale, on which a score of 4 or 5 represents treatment success. Conclusions This study represents the first step in developing a patient reported measure of treatment success in vitiligo trials. Further work is now needed to assess its construct validity and responsiveness to change. PMID:24929563

2014-01-01

246

Developing a patient-centered outcome measure for complementary and alternative medicine therapies I: defining content and format  

PubMed Central

Background Patients receiving complementary and alternative medicine (CAM) therapies often report shifts in well-being that go beyond resolution of the original presenting symptoms. We undertook a research program to develop and evaluate a patient-centered outcome measure to assess the multidimensional impacts of CAM therapies, utilizing a novel mixed methods approach that relied upon techniques from the fields of anthropology and psychometrics. This tool would have broad applicability, both for CAM practitioners to measure shifts in patients' states following treatments, and conventional clinical trial researchers needing validated outcome measures. The US Food and Drug Administration has highlighted the importance of valid and reliable measurement of patient-reported outcomes in the evaluation of conventional medical products. Here we describe Phase I of our research program, the iterative process of content identification, item development and refinement, and response format selection. Cognitive interviews and psychometric evaluation are reported separately. Methods From a database of patient interviews (n = 177) from six diverse CAM studies, 150 interviews were identified for secondary analysis in which individuals spontaneously discussed unexpected changes associated with CAM. Using ATLAS.ti, we identified common themes and language to inform questionnaire item content and wording. Respondents' language was often richly textured, but item development required a stripping down of language to extract essential meaning and minimize potential comprehension barriers across populations. Through an evocative card sort interview process, we identified those items most widely applicable and covering standard psychometric domains. We developed, pilot-tested, and refined the format, yielding a questionnaire for cognitive interviews and psychometric evaluation. Results The resulting questionnaire contained 18 items, in visual analog scale format, in which each line was anchored by the positive and negative extremes relevant to the experiential domain. Because of frequent informant allusions to response set shifts from before to after CAM therapies, we chose a retrospective pretest format. Items cover physical, emotional, cognitive, social, spiritual, and whole person domains. Conclusions This paper reports the success of a novel approach to the development of outcome instruments, in which items are extracted from patients' words instead of being distilled from pre-existing theory. The resulting instrument, focused on measuring shifts in patients' perceptions of health and well-being along pre-specified axes, is undergoing continued testing, and is available for use by cooperating investigators. PMID:22206345

2011-01-01

247

The cultural adaptability of intermediate measures of functional outcome in schizophrenia.  

PubMed

The Measurement and Treatment Research to Improve Cognition in Schizophrenia initiative was designed to encourage the development of cognitive enhancing agents for schizophrenia. For a medication to receive this indication, regulatory agencies require evidence of improvement in both cognition and functional outcome. Because medication trials are conducted across multiple countries, we examined ratings of the cross-cultural adaptability of 4 intermediate measures of functional outcome (Independent Living Scales, UCSD Performance-based Skills Assessment, Test of Adaptive Behavior in Schizophrenia, Cognitive Assessment Interview [CAI]) made by experienced clinical researchers at 31 sites in 8 countries. English-speaking research staff familiar with conducting medication trials rated the extent to which each subscale of each intermediate measure could be applied to their culture and to subgroups within their culture based on gender, geographic region, ethnicity, and socioeconomic status on the Cultural Adaptation Rating Scale. Ratings suggested that the CAI would be easiest to adapt across cultures. However, in a recent study, the CAI was found to have weaker psychometric properties than some of the other measures. Problems were identified for specific subscales on all the performance-based assessments across multiple countries. India, China, and Mexico presented the greatest challenges in adaptation. For international clinical trials, it would be important to use the measures that are most adaptable, to adapt subscales that are problematic for specific countries or regions, or to develop a battery composed of the subscales from different instruments that may be most acceptable across multiple cultures with minimal adaptation. PMID:21134973

Velligan, Dawn I; Rubin, Maureen; Fredrick, Megan M; Mintz, Jim; Nuechterlein, Keith H; Schooler, Nina R; Jaeger, Judith; Peters, Nancy M; Buller, Raimund; Marder, Stephen R; Dube, Sanjay

2012-05-01

248

[Psychometric properties of Q-DIO, an instrument to measure the quality of documented nursing diagnoses, interventions and outcomes].  

PubMed

The instrument Q-DIO was developed in the years 2005 till 2006 to measure the quality of documented nursing diagnoses, interventions, and nursing sensitive patient outcomes. Testing psychometric properties of the Q-DIO (Quality of nursing Diagnoses, Interventions and Outcomes.) was the study aim. Instrument testing included internal consistency, test-retest reliability, interrater reliability, item analyses, and an assessment of the objectivity. To render variation in scores, a random strata sample of 60 nursing documentations was drawn. The strata represented 30 nursing documentations with and 30 without application of theory based, standardised nursing language. Internal consistency of the subscale nursing diagnoses as process showed Cronbach's Alpha 0.83 [0.78, 0.88]; nursing diagnoses as product 0.98 [0.94, 0.99]; nursing interventions 0.90 [0.85, 0.94]; and nursing-sensitive patient outcomes 0.99 [0.95, 0.99]. With Cohen's Kappa of 0.95, the intrarater reliability was good. The interrater reliability showed a Kappa of 0.94 [0.90, 0.96]. Item analyses confirmed the fulfilment of criteria for degree of difficulty and discriminative validity of the items. In this study, Q-DIO has shown to be a reliable instrument. It allows measuring the documented quality of nursing diagnoses, interventions and outcomes with and without implementation of theory based, standardised nursing languages. Studies for further testing of Q-DIO in other settings are recommended. The results implicitly support the use of nursing classifications such as NANDA, NIC and NOC. PMID:20361409

Müller-Staub, Maria; Lunney, Margaret; Lavin, Mary Ann; Needham, Ian; Odenbreit, Matthias; van Achterberg, Theo

2010-04-01

249

A Combined Measure of Procedural Volume and Outcome to Assess Hospital Quality of Colorectal Cancer Surgery, a Secondary Analysis of Clinical Audit Data  

PubMed Central

Objective To identify, on the basis of past performance, those hospitals that demonstrate good outcomes in sufficient numbers to make it likely that they will provide adequate quality of care in the future, using a combined measure of volume and outcome (CM-V&O). To compare this CM-V&O with measures using outcome-only (O-O) or volume-only (V-O), and verify 2010-quality of care assessment on 2011 data. Design Secondary analysis of clinical audit data. Setting The Dutch Surgical Colorectal Audit database of 2010 and 2011, the Netherlands. Participants 8911 patients (test population, treated in 2010) and 9212 patients (verification population, treated in 2011) who underwent a resection of primary colorectal cancer in 89 Dutch hospitals. Main Outcome Measures Outcome was measured by Observed/Expected (O/E) postoperative mortality and morbidity. CM-V&O states 2 criteria; 1) outcome is not significantly worse than average, and 2) outcome is significantly better than substandard, with ‘substandard care’ being defined as an unacceptably high O/E threshold for mortality and/or morbidity (which we set at 2 and 1.5 respectively). Results Average mortality and morbidity in 2010 were 4.1 and 24.3% respectively. 84 (94%) hospitals performed ‘not worse than average’ for mortality, but only 21 (24%) of those were able to prove they were also ‘better than substandard’ (O/E<2). For morbidity, 42 hospitals (47%) met the CM-V&O. Morbidity in 2011 was significantly lower in these hospitals (19.8 vs. 22.8% p<0.01). No relationship was found between hospitals' 2010 performance on O-O en V-O, and the quality of their care in 2011. Conclusion CM-V&O for morbidity can be used to identify hospitals that provide adequate quality and is associated with better outcomes in the subsequent year. PMID:24558418

Kolfschoten, Nikki E.; Marang-van de Mheen, Perla J.; Wouters, Michel W. J. M.; Eddes, Eric-Hans; Tollenaar, Rob A. E. M.; Stijnen, Theo; Kievit, Job

2014-01-01

250

Blastocyst culture and transfer: analysis of results and parameters affecting outcome in two in vitro fertilization programs  

Microsoft Academic Search

Objective: To determine whether previously described advanced blastocyst development and high implantation rates are confirmed in an expanded multicenter trial.Design: Retrospective review.Setting: Two private assisted reproductive technology units.Patient(s): One hundred seventy-four patients who underwent blastocyst culture and transfer.Intervention(s): Culture of all pronucleate embryos in sequential media to the blastocyst stage (day 5) followed by ET.Main Outcome Measure(s): The number and

William B Schoolcraft; David K Gardner; Terry Schlenker; David R Meldrum

1999-01-01

251

Bridging Differences in Outcomes of Pharmacoepidemiological Studies: Design and First Results of the PROTECT Project  

PubMed Central

Background: Observational pharmacoepidemiological (PE) studies on drug safety have produced discrepant results that may be due to differences in design, conduct and analysis. Purpose: The pharmacoepidemiology work-package (WP2) of the Pharmacoepidemiological Research on Outcomes of Therapeutics by a European ConsorTium (PROTECT) project aims at developing, testing and disseminating methodological standards for design, conduct and analysis of pharmacoepidemiological studies applicable to different safety issues using different databases across European countries. This article describes the selection of the safety issues and the description of the databases to be systematically studied. Methods: Based on two consensus meetings and a literature search, we selected five drug-adverse event (AE) pairs to be evaluated in different databases. This selection was done according to pre-defined criteria such as regulatory and public health impact, and the potential to investigate a broad range of methodological issues. Results: The selected drug-AE pairs are: 1) inhaled long-acting beta-2 agonists and acute myocardial infarction; 2) antimicrobials and acute liver injury; 3) antidepressants and/or benzodiazepines and hip fracture; 4) anticonvulsants and suicide/suicide attempts; and 5) calcium channel blockers and malignancies. Six European databases, that will be used to evaluate the drug-AE pairs retrospectively, are also described. Conclusion: The selected drug-AE pairs will be evaluated in PE studies using common protocols. Based on consistencies and discrepancies of these studies, a framework for guiding methodological choices will be developed. This will increase the usefulness and reliability of PE studies for benefit-risk assessment and decision-making. PMID:24218995

Abbing-Karahagopian, Victoria; Kurz, Xavier; de Vries, Frank; van Staa, Tjeerd P.; Alvarez, Yolanda; Hesse, Ulrik; Hasford, Joerg; Liset van, Dijk; Francisco J. de, Abajo; Weil, John G.; Lamiae Grimaldi, -Bensouda; Egberts, Antoine C.G.; Robert F., Reynolds; Olaf H., Klungel

2014-01-01

252

Scale Model Thruster Acoustic Measurement Results  

NASA Technical Reports Server (NTRS)

The Space Launch System (SLS) Scale Model Acoustic Test (SMAT) is a 5% scale representation of the SLS vehicle, mobile launcher, tower, and launch pad trench. The SLS launch propulsion system will be comprised of the Rocket Assisted Take-Off (RATO) motors representing the solid boosters and 4 Gas Hydrogen (GH2) thrusters representing the core engines. The GH2 thrusters were tested in a horizontal configuration in order to characterize their performance. In Phase 1, a single thruster was fired to determine the engine performance parameters necessary for scaling a single engine. A cluster configuration, consisting of the 4 thrusters, was tested in Phase 2 to integrate the system and determine their combined performance. Acoustic and overpressure data was collected during both test phases in order to characterize the system's acoustic performance. The results from the single thruster and 4- thuster system are discussed and compared.

Vargas, Magda; Kenny, R. Jeremy

2013-01-01

253

Measuring Spatial Infiltration in Stormwater Control Measures: Results and Implications  

EPA Science Inventory

This presentation will provide background information on research conducted by EPA-ORD on the use of soil moisture sensors in bioretention/bioinfiltration technologies to evaluate infiltration mechanisms and compares monitoring results to simplified modeling assumptions. A serie...

254

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. PMID:21778493

Humphreys, Keith; Kivlahan, Daniel R.; Harris, Alex H. S.

2011-01-01

255

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

ERIC Educational Resources Information Center

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…

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

2014-01-01

256

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

PubMed Central

Study Design Concurrent prospective randomized and observational cohort studies. Objective To assess the 8-year outcomes of surgery vs. non-operative care. Summary of Background Data 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 Advantages were seen for surgery in intent-to-treat analyses for the randomized cohort for all primary and secondary outcomes other than work status; however, with extensive non-adherence to treatment assignment (49% patients assigned to non-operative therapy receiving surgery versus 60% of patients assigned to surgery) these observed effects were relatively small and not statistically significant for primary outcomes (BP, PF, ODI). Importantly, the overall comparison of secondary outcomes was significantly greater with surgery in the intent-to-treat analysis (sciatica bothersomeness [p > 0.005], satisfaction with symptoms [p > 0.013], and self-rated improvement [p > 0.013]) in long-term follow-up. An as-treated analysis showed clinically meaningful surgical treatment effects for primary outcome measures (mean change Surgery vs. Non-operative; treatment effect; 95% CI): BP (45.3 vs. 34.4; 10.9; 7.7 to 14); PF (42.2 vs. 31.5; 10.6; 7.7 to 13.5) and ODI (?36.2 vs. ?24.8; ?11.2; ?13.6 to ?9.1). Conclusion Carefully selected patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operatively treated patients; there was little to no degradation of outcomes in either group (operative and non-operative) from 4 to 8 years. PMID:24153171

Lurie, Jon D.; Tosteson, Tor D.; Tosteson, Anna N. A.; Zhao, Wenyan; Morgan, Tamara S.; Abdu, William A.; Herkowitz, Harry; Weinstein, James N.

2014-01-01

257

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

258

Getting Results: Outcomes Management and the Annie E. Casey Foundations Jobs Initiative.  

ERIC Educational Resources Information Center

The Anne E. Casey Foundation (AECF) funded replications of effective jobs projects to achieve better job placement and retention for low-income, young adults. The six projects funded, collectively called the Jobs Initiative (JI), in Denver, Milwaukee, New Orleans, Philadelphia, Seattle, and St. Louis, used an outcomes framework developed by The…

Giloth, Robert; Phillips, William

259

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

260

PBL-GIS in Secondary Geography Education: Does It Result in Higher-Order Learning Outcomes?  

ERIC Educational Resources Information Center

This article presents research on evaluating problem-based learning using GIS technology in a Singapore secondary school. A quasi-experimental research design was carried to test the PBL pedagogy (PBL-GIS) with an experimental group of students and compare their learning outcomes with a control group who were exposed to PBL but not GIS. The…

Liu, Yan; Bui, Elisabeth N.; Chang, Chew-Hung; Lossman, Hans G.

2010-01-01

261

Periodontal Research: Basics and beyond – Part II (Ethical issues, sampling, outcome measures and bias)  

PubMed Central

A good research beginning refers to formulating a well-defined research question, developing a hypothesis and choosing an appropriate study design. The first part of the review series has discussed these issues in depth and this paper intends to throw light on other issues pertaining to the implementation of research. These include the various ethical norms and standards in human experimentation, the eligibility criteria for the participants, sampling methods and sample size calculation, various outcome measures that need to be defined and the biases that can be introduced in research. PMID:24174747

Avula, Haritha

2013-01-01

262

Models for the analysis of repeated continuous outcome measures in clinical trials.  

PubMed

Repeated continuous outcome measures are common in clinical trials. In this tutorial style paper, using data collected from a trial evaluating an intervention for managing asthma and chronic obstructive pulmonary disease, we demonstrate ways of statistically analysing such data to answer frequently encountered clinical research questions. We illustrate the use of linear mixed effects modelling in doing so and discuss its advantages over several other commonly used approaches. The methods described in this paper can easily be carried out using standard statistical software. PMID:24268035

De Livera, Alysha M; Zaloumis, Sophie; Simpson, Julie A

2014-02-01

263

An overview of animal models of pain: disease models and outcome measures  

PubMed Central

Pain is ultimately a perceptual phenomenon. It is built from information gathered by specialized pain receptors in tissue, modified by spinal and supraspinal mechanisms, and integrated into a discrete sensory experience with an emotional valence in the brain. Because of this, studying intact animals allows the multidimensional nature of pain to be examined. A number of animal models have been developed, reflecting observations that pain phenotypes are mediated by distinct mechanisms. Animal models of pain are designed to mimic distinct clinical diseases to better evaluate underlying mechanisms and potential treatments. Outcome measures are designed to measure multiple parts of the pain experience including reflexive hyperalgesia measures, sensory and affective dimensions of pain and impact of pain on function and quality of life. In this review we discuss the common methods used for inducing each of the pain phenotypes related to clinical pain syndromes, as well as the main behavioral tests for assessing pain in each model. PMID:24035349

Gregory, N; Harris, AL; Robinson, CR; Dougherty, PM; Fuchs, PN; Sluka, KA

2013-01-01

264

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. PMID:22510537

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

2012-01-01

265

Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME)  

PubMed Central

Summary This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6–7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure. What's already known about this topic? Many different scales have been used to measure eczema, making it difficult to compare trials in meta-analyses and hampering improvements in clinical practice. HOME core outcome measures must pass the OMERACT (Outcome Measures in Rheumatology) filter of truth (validity), discrimination (sensitivity to change and responsiveness) and feasibility (ease of use, costs, time to perform and interpret). It has been previously agreed as part of the consensus process that four domains should be measured by the core outcomes: clinical signs, patient-reported symptoms, long-term control and health-related quality of life. What does this study add? Progress was made towards developing a core outcome set for measuring eczema in clinical trials. The group established the essential items to be included in the outcome measure for the clinical signs of eczema and was able to recommend a scale for the core set. The remaining three domains of patient-reported symptoms, long-term control and health-related quality of life require further work and meetings to determine the core outcome measures. PMID:24980543

Chalmers, JR; Schmitt, J; Apfelbacher, C; Dohil, M; Eichenfield, LF; Simpson, EL; Singh, J; Spuls, P; Thomas, KS; Admani, S; Aoki, V; Ardeleanu, M; Barbarot, S; Berger, T; Bergman, JN; Block, J; Borok, N; Burton, T; Chamlin, SL; Deckert, S; DeKlotz, CC; Graff, LB; Hanifin, JM; Hebert, AA; Humphreys, R; Katoh, N; Kisa, RM; Margolis, DJ; Merhand, S; Minnillo, R; Mizutani, H; Nankervis, H; Ohya, Y; Rodgers, P; Schram, ME; Stalder, JF; Svensson, A; Takaoka, R; Teper, A; Tom, WL; von Kobyletzki, L; Weisshaar, E; Zelt, S; Williams, HC

2014-01-01

266

Intracytoplasmic morphologically selected sperm injection results in improved clinical outcomes in couples with previous ICSI failures or male factor infertility: a meta-analysis.  

PubMed

The objective of this study was to perform the first meta-analysis to compare conventional intracytoplasmic sperm injection (ICSI) outcomes and intracytoplasmic morphologically selected sperm injection (IMSI) outcomes in couples with previous ICSI failures (IF) or male factor infertility (MF). A systematic review was performed by searching Medline database to identify articles reporting on the comparison between ICSI and IMSI outcomes in couples with IF or MF. The main outcome measures were the implantation, pregnancy and miscarriage rates. Thirteen studies fulfilled our predetermined criteria. The overall results of meta-analysis for implantation (OR: 2.88; CI: 2.13-3.89), pregnancy (OR: 2.07; CI: 1.22-3.50) and miscarriage rates (OR: 0.31; CI: 0.14-0.67) were in favor of IMSI in couples with IF. Additionally, the overall result of meta-analysis for implantation (OR: 1.56; CI: 1.11-2.18) and pregnancy rate (OR: 1.61; CI: 1.17-2.23) were in favor of IMSI in couples with MF. IMSI increases the odds of implantation by 50% and pregnancy by 60% in couples with MF. In light of improved clinical outcomes, we recommend promoting the IMSI method in couples with MF. Moreover, IMSI results in a 3-fold increase in implantation rate, a 2-fold increase in pregnancy rate and a 70% decrease in miscarriage rate as compared to ICSI in couples with IF, however, as no randomized evidence exists, randomized studies are needed to confirm the IMSI benefits in couples with IF. PMID:25461360

Setti, Amanda S; Braga, Daniela P A F; Figueira, Rita C S; Iaconelli, Assumpto; Borges, Edson

2014-12-01

267

PETCO2 measurement and feature extraction of capnogram signals for extubation outcomes from mechanical ventilation.  

PubMed

Capnography is a continuous and noninvasive method for carbon dioxide (CO2) measurement, and it has become the standard of care for basic respiratory monitoring for intubated patients in the intensive care unit. In addition, it has been used to adjust ventilatory parameters during mechanical ventilation (MV). However, a substantial debate remains as to whether capnography is useful during the process of weaning and extubation from MV during the postoperative period. Thus, the main objective of this study was to present a new use for time-based capnography data by measuring the end-tidal CO2 pressure ([Formula: see text]), partial pressure of arterial CO2 ([Formula: see text]) and feature extraction of capnogram signals before extubation from MV to evaluate the capnography as a predictor of outcome extubation in infants after cardiac surgery. Altogether, 82 measurements were analysed, 71.9% patients were successfully extubated, and 28.1% met the criteria for extubation failure within 48?h. The ROC-AUC analysis for quantitative measure of the capnogram showed significant differences (p < 0.001) for: expiratory time (0.873), slope of phase III (0.866), slope ratio (0.923) and ascending angle (0.897). In addition, the analysis of [Formula: see text] (0.895) and [Formula: see text] (0.924) obtained 30?min before extubation showed significant differences between groups. The [Formula: see text] mean value for success and failure extubation group was 39.04?mmHg and 46.27?mmHg, respectively. It was also observed that high CO2 values in patients who had returned MV was 82.8? ± ?21?mmHg at the time of extubation failure. Thus, [Formula: see text] measurements and analysis of features extracted from a capnogram can differentiate extubation outcomes in infant patients under MV, thereby reducing the physiologic instability caused by failure in this process. PMID:25582400

Rasera, Carmen C; Gewehr, Pedro M; Domingues, Adriana Maria T

2015-02-01

268

Approach to Outcome Measurement in the Prevention of Thrombosis in Surgical and Medical Patients  

PubMed Central

This article provides the rationale for the approach to making recommendations primarily used in four articles of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines: orthopedic surgery, nonorthopedic surgery, nonsurgical patients, and stroke. Some of the early clinical trials of antithrombotic prophylaxis with a placebo or no treatment group used symptomatic VTE and fatal PE to measure efficacy of the treatment. These trials suggest a benefit of thromboprophylaxis in reducing fatal PE. In contrast, most of the recent clinical trials comparing the efficacy of alternative anticoagulants used a surrogate outcome, asymptomatic DVT detected at mandatory venography. This outcome is fundamentally unsatisfactory because it does not allow a trade-off with serious bleeding; that trade-off requires knowledge of the number of symptomatic events that thromboprophylaxis prevents. In this article, we review the merits and limitations of four approaches to estimating reduction in symptomatic thrombosis: (1) direct measurement of symptomatic thrombosis, (2) use of asymptomatic events for relative risks and symptomatic events from randomized controlled trials for baseline risk, (3) use of baseline risk estimates from studies that did not perform surveillance and relative effect from asymptomatic events in randomized controlled trials, and (4) use of available data to estimate the proportion of asymptomatic events that will become symptomatic. All approaches have their limitations. The optimal choice of approach depends on the nature of the evidence available. PMID:22315260

Eikelboom, John W.; Gould, Michael K.; Garcia, David A.; Crowther, Mark; Murad, M. Hassan; Kahn, Susan R.; Falck-Ytter, Yngve; Francis, Charles W.; Lansberg, Maarten G.; Akl, Elie A.; Hirsh, Jack

2012-01-01

269

Construct validity of the FOCUS© (Focus on the Outcomes of Communication Under Six): a communicative participation outcome measure for preschool children  

PubMed Central

Objective The aim of this study was to establish the construct validity of the Focus on the Outcomes of Communication Under Six (FOCUS©). This measure is reflective of concepts in the International Classification of Functioning Disability and Health – Children and Youth framework. It was developed to capture ‘real-world’ changes (e.g. communicative participation) in preschoolers' communication following speech-language intervention. Method A pre–post design was used. Fifty-two parents of 3- to 6-year-old preschoolers attending speech-language therapy were included as participants. Speech-language therapists provided individual and/or group intervention to preschoolers. Intervention targeted: articulation/phonology, voice/resonance, expressive/receptive language, play, and use of augmentative devices. Construct validity for communicative participation was assessed using pre-intervention and post-intervention parent interviews using the FOCUS© and the communication and socialization domains of the Vineland Adaptive Behavior Scales-II (VABS-II). Results Significant associations were found between the FOCUS©, measuring communicative participation, and the VABS-II domains for: (i) pre-intervention scores in communication (r = 0.53, P < 0.001; 95% CI 0.30–0.70) and socialization (r = 0.67, P < 0.001; 95% CI 0.48–0.80); (ii) change scores over-time in communication (r = 0.45, P < 0.001; 95% CI 0.201–0.65) and socialization (r = 0.39, P = 0.002; 95% CI 0.13–0.60); and (iii) scores at post-intervention for communication (r = 0.53, P < 0.001; 95% CI 0.30–0.70) and for socialization (r = 0.37, P = 0.003; 95% CI 0.11–0.50). Conclusions The study provided evidence on construct validity of the FOCUS© for evaluating real-world changes in communication. We believe that the FOCUS© is a useful measure of communicative participation. PMID:23763249

Washington, K; Thomas-Stonell, N; Oddson, B; McLeod, S; Warr-Leeper, G; Robertson, B; Rosenbaum, P

2013-01-01

270

Measuring Outcome in an Early Intervention Program for Toddlers with Autism Spectrum Disorder: Use of a Curriculum-Based Assessment  

PubMed Central

Measuring progress of children with autism spectrum disorder (ASD) during intervention programs is a challenge faced by researchers and clinicians. Typically, standardized assessments of child development are used within research settings to measure the effects of early intervention programs. However, the use of standardized assessments is not without limitations, including lack of sensitivity of some assessments to measure small or slow progress, testing constraints that may affect the child's performance, and the lack of information provided by the assessments that can be used to guide treatment planning. The utility of a curriculum-based assessment is discussed in comparison to the use of standardized assessments to measure child functioning and progress throughout an early intervention program for toddlers with risk for ASD. Scores derived from the curriculum-based assessment were positively correlated with standardized assessments, captured progress masked by standardized assessments, and early scores were predictive of later outcomes. These results support the use of a curriculum-based assessment as an additional and appropriate method for measuring child progress in an early intervention program. Further benefits of the use of curriculum-based measures for use within community settings are discussed. PMID:24711926

Bacon, Elizabeth C.; Schreibman, Laura; Stahmer, Aubyn C.; Pierce, Karen; Courchesne, Eric

2014-01-01

271

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

272

Aggressive therapy in patients with early arthritis results in similar outcome compared with conventional care: the STREAM randomized trial  

PubMed Central

Objective. To compare the effects of aggressive tight control therapy and conventional care on radiographic progression and disease activity in patients with early mild inflammatory arthritis. Methods. Patients with two to five swollen joints, Sharp–van der Heijde radiographic score (SHS) <5 and symptom duration ?2 years were randomized between two strategies. Patients with a definite non-RA diagnosis were excluded. The protocol of the aggressive group aimed for remission (DAS?Outcome measures after 2 years were SHS (primary), remission rate and HAQ score (secondary). Results. Eighty-two patients participated (60% ACPA positive). In the aggressive group (n?=?42), 19 patients were treated with adalimumab. In the conventional care group (n?=?40), 24 patients started with hydroxychloroquin (HCQ), 2 with sulfasalazine (SSZ) and 14 with MTX. After 2 years, the median SHS increase was 0 [interquartile range (IQR) 0–1.1] and 0.5 (IQR 0–2.5), remission rates were 66 and 49% and HAQ decreased with a mean of ?0.09 (0.50) and ?0.25 (0.59) in the aggressive and conventional care group, respectively. All comparisons were non-significant. Conclusion. In patients with early arthritis of two to five joints, both aggressive tight-control therapy including adalimumab and conventional therapy resulted in remission rates around 50%, low radiographic damage and excellent functional status after 2 years. However, full disease control including radiographic arrest in all patients remains an elusive target even in moderately active early arthritis. Trial registration. Dutch Trial Register, http://www.trialregister.nl/, NTR 144. PMID:22166255

van Eijk, Izhar C.; Nielen, Markus M. J.; van der Horst-Bruinsma, Irene; Tijhuis, Gerard J.; Boers, Maarten; Dijkmans, Ben A. C.

2012-01-01

273

Comparison of length of stay and outcomes of patients with positive versus negative blood culture results  

PubMed Central

In the United States, sepsis is the leading cause of death in critically ill patients. The fatality rate for severe sepsis is about 40%, and treatment costs over $16 billion annually. It is critical to identify and treat the source of sepsis. While there are varying guidelines determining when to draw blood for culture, at Baylor University Medical Center at Dallas, blood cultures are ordered for patients with new onset of fever, immunosuppression, or a suspicion of an underlying infectious etiology. We conducted a retrospective study of patients who had blood cultures after hospital admission or in the emergency department in December 2013. We compared length of stay and outcomes of patients with positive versus negative blood cultures. There was no significant difference for length of stay or outcomes among patients with positive and negative blood cultures. For patients admitted from the emergency department, there was a longer length of stay for patients with positive cultures; however, the overall prognosis was not worse. PMID:25552786

Hozhabri, Neda S. T.; Armstrong, Kris; Puthottile, Jason; Benavides, Raul; Beal, Stacy

2015-01-01

274

Depression symptom clusters and their predictive value for treatment outcomes: results from an individual patient data meta-analysis of duloxetine trials.  

PubMed

We evaluated individual patient data from phase II to IV clinical trials of duloxetine in major depressive disorder (MDD) (34 studies, 13,887 patients). Our goal was to identify clusters of patients with similar depressive symptom patterns at baseline, as measured by the 17-item Hamilton Depression Rating Scale (HAMD-17), and to investigate their respective predictive value of outcomes as measured by the HAMD-17 total score. Five clusters were identified at baseline: 1) "Lack of insight"; 2) "Sleep/sexual/somatic"; 3) "Typical MDD"; 4) "Gastrointestinal/weight loss"; and 5) "Mild MDD". However, it should be noted that cluster descriptors are not mutually exclusive. Analyses of the HAMD-17 total score results over time were performed using the 18 randomized placebo and/or actively controlled studies representing 6723 patients. At the end of acute treatment (ranging from 4 to 36 weeks), different levels of effect sizes for active therapy (64.5% duloxetine) vs. placebo were detected by cluster. In 3 out of 5 clusters (representing about 80% of the patients), the effect size was significantly different from 0, in favor of active therapy. The effect size was largest in those clusters with severe somatic symptoms ("Sleep/sexual/somatic" cluster [-0.4170], and "Gastrointestinal/weight loss" cluster [-0.338]). In conclusion, our cluster analysis identified 5 clinically relevant MDD patient clusters with specific mean treatment outcomes. Identification of MDD clusters may help to improve outcomes by adapting MDD treatment to particular clinical profiles. PMID:24572681

Schacht, Alexander; Gorwood, Philip; Boyce, Philip; Schaffer, Ayal; Picard, Hernan

2014-06-01

275

Enhancing rigour in the validation of patient reported outcome measures (PROMs): bridging linguistic and psychometric testing  

PubMed Central

Background A strong consensus exists for a systematic approach to linguistic validation of patient reported outcome measures (PROMs) and discrete methods for assessing their psychometric properties. Despite the need for robust evidence of the appropriateness of measures, transition from linguistic to psychometric validation is poorly documented or evidenced. This paper demonstrates the importance of linking linguistic and psychometric testing through a purposeful stage which bridges the gap between translation and large-scale validation. Findings Evidence is drawn from a study to develop a Welsh language version of the Beck Depression Inventory-II (BDI-II) and investigate its psychometric properties. The BDI-II was translated into Welsh then administered to Welsh-speaking university students (n?=?115) and patients with depression (n?=?37) concurrent with the English BDI-II, and alongside other established depression and quality of life measures. A Welsh version of the BDI-II was produced that, on administration, showed conceptual equivalence with the original measure; high internal consistency reliability (Cronbach’s alpha?=?0.90; 0.96); item homogeneity; adequate correlation with the English BDI-II (r?=?0.96; 0.94) and additional measures; and a two-factor structure with one overriding dimension. Nevertheless, in the student sample, the Welsh version showed a significantly lower overall mean than the English (p?=?0.002); and significant differences in six mean item scores. This prompted a review and refinement of the translated measure. Conclusions Exploring potential sources of bias in translated measures represents a critical step in the translation-validation process, which until now has been largely underutilised. This paper offers important findings that inform advanced methods of cross-cultural validation of PROMs. PMID:22682500

2012-01-01

276

The 'Global Outcomes Score': a quality measure, based on health outcomes, that compares current care to a target level of care.  

PubMed

The quality of health care is measured today using performance measures that calculate the percentage of people whose health conditions are managed according to specified processes or who meet specified treatment goals. This approach has several limitations. For instance, each measure looks at a particular process, risk factor, or biomarker one by one, and each uses sharp thresholds for defining "success" versus "failure." We describe a new measure of quality called the Global Outcomes Score (GO Score), which represents the proportion of adverse outcomes expected to be prevented in a population under current levels of care compared to a target level of care, such as 100 percent performance on certain clinical guidelines. We illustrate the use of the GO Score to measure blood pressure and cholesterol care in a longitudinal study of people at risk of atherosclerotic diseases, or hardening of the arteries. In that population the baseline GO Score was 40 percent, which indicates that the care being delivered was 40 percent as effective in preventing myocardial infarctions and strokes as our target level of care. The GO Score can be used to assess the potential effectiveness of different interventions such as prevention activities, tests, and treatments. PMID:23129674

Eddy, David M; Adler, Joshua; Morris, Macdonald

2012-11-01

277

Behavioral outcome measures used for human neural stem cell transplantation in rat stroke models  

PubMed Central

Stroke is a leading cause of death and disability, leading to the development of various stroke models to test new treatments, most commonly in the rat. Human stroke trials focus on disability, related primarily to neurological deficits. To better model the clinical application of these treatments, many behavioral tests have been developed using the rat stroke model. We performed a systematic review of all the behavioral outcome measures used in published studies of human neural stem cell transplantation in rat stroke models. The reviewed tests include motor, sensory, cognitive, activity, and combination tests. For each test, we give a brief description, trace the origin of the test, and discuss test performance in the reviewed studies. We conclude that while many behavioral tests are available for this purpose, there does not appear to be consensus on an optimal testing strategy. PMID:22053257

Jensen, Matthew B.; Han, Dong Y.; Sawaf, Abdullah Al; Krishnaney-Davison, Rajeev

2011-01-01

278

Patient-reported outcome measures: an on-line system empowering patient choice.  

PubMed

An innovative web-based system was developed to allow patient-reported outcome measures (PROMs) to be easily administered. Stakeholders guided the design and implementation. The software gives patients access to their current and previous scores. This pilot study focused on patients undergoing arthroscopic subacromial decompression, evaluated using the Oxford shoulder score (OSS). Patients showing good improvement in their OSS were offered the choice to return for routine follow-up clinic appointments, or continue rehabilitation, reassured by their improved score. Thirty-six of 117 patients were eligible. Thirty of these (83%) were opted to avoid further clinics. PROMs 2.0 can be used for any medical intervention with a validated PROM. Evolution and refinement is ongoing. Funding has been granted for 12 primary and secondary healthcare trusts to implement PROMs 2.0. Further work is needed to assess economic impact, patient views and satisfaction with the process. PMID:24013090

Wilson, J; Arshad, F; Nnamoko, N; Whiteman, A; Ring, J; Roy, B

2014-01-01

279

Quantitative measures of damage to subchondral bone are associated with functional outcome following treatment of displaced acetabular fractures.  

PubMed

Current analysis of displaced acetabular fractures is limited in its ability to predict functional outcome. This study aimed to (1) quantify initial acetabular damage following acetabular fracture through measurement of subchondral bone density and fracture lines, and (2) evaluate associations between acetabular damage and functional outcomes following fracture. Subchondral bone intensity maps were created for 24 patients with unilateral acetabular fractures. Measures of crack length and density differences between corresponding regions in the fractured acetabuli, normalized by the unfractured side, were generated from preoperative CT images. Damage measures were compared to quality of life survey data collected for each patient at least 2 years post-injury (Musculoskeletal Functional Assessment [MFA] and Short Form-36 [SF-36], with specific focus on parameters that best describe patients' physical health). CT image quantification of initial damage to acetabular subchondral bone was associated with functional outcome post-injury. In general, damage as quantified through differences in density in the superior dome region (zones 8 and 12) and the central anterior region of the acetabulum (zone 3) were found to be the strongest significant predictors of functional outcome (adjusted R(2) = 0.3-0.45, p < 0.05). Damage to the superior dome was predictive of worse functional outcome whereas damage to the central anterior region indicated a better functional outcome. Once automated, this approach may form a basis to score acetabular fractures toward improving clinical prognoses. PMID:23940014

Lubovsky, Omri; Kreder, Michael; Wright, David A; Kiss, Alex; Gallant, Aimee; Kreder, Hans J; Whyne, Cari M

2013-12-01

280

Patient Characteristics Associated with Buprenorphine/Naloxone Treatment Outcome for Prescription Opioid Dependence: Results from a Multisite Study  

PubMed Central

Background Prescription opioid dependence is a growing problem, but little research exists on its treatment, including patient characteristics that predict treatment outcome. Methods A secondary analysis of data from a large multisite, randomized clinical trial, the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study (POATS) was undertaken to examine baseline patient characteristics (N=360) associated with success during 12-week buprenorphine/naloxone treatment for prescription opioid dependence. Baseline predictor variables included self-reported demographic and opioid use history information, diagnoses assessed via the Composite International Diagnostic Interview, and historical opioid use and related information from the Pain And Opiate Analgesic Use History. Results In bivariate analyses, pre-treatment characteristics associated with successful opioid use outcome included older age, past-year or lifetime diagnosis of major depressive disorder, initially obtaining opioids with a medical prescription to relieve pain, having only used opioids by swallowing or sublingual administration, never having used heroin, using an opioid other than extended-release oxycodone most frequently, and no prior opioid dependence treatment. In multivariate analysis, age, lifetime major depressive disorder, having only used opioids by swallowing or sublingual administration, and receiving no prior opioid dependence treatment remained as significant predictors of successful outcome. Conclusions This is the first study to examine characteristics associated with treatment outcome in patients dependent exclusively on prescription opioids. Characteristics associated with successful outcome after 12 weeks of buprenorphine/naloxone treatment include some that have previously been found to predict heroin-dependent patients’ response to methadone treatment and some specific to prescription opioid-dependent patients receiving buprenorphine/naloxone. PMID:23333292

Dreifuss, Jessica A.; Griffin, Margaret L.; Frost, Katherine; Fitzmaurice, Garrett M.; Potter, Jennifer Sharpe; Fiellin, David A.; Selzer, Jeffrey; Hatch-Maillette, Mary; Sonne, Susan C.; Weiss, Roger D.

2012-01-01

281

Fuzzy risk perception: correlates of "fuzzy" and specific measures of outcome likelihood in young drinkers.  

PubMed

Promoting informed choices about alcohol use requires understanding the nature of drinkers' risk perceptions and how these influence decision-making. Fuzzy trace theory states that people use imprecise "fuzzy" risk representations, which are based on the broad cognitive and affective meanings of risk-related experiences, whereas traditionally used measures request precise unitary estimations. Fuzzy representations may be less affected by defensive self-enhancement biases inherent in unitary estimates and better predictors of decision outcomes because they better reflect risk-related affect. Conversely, unitary estimates are based in specific experience and should be better associated with objective risk. Fuzziness was operationalized as a bounded range of undergraduate drinkers' lowest and highest "possibly true" estimates of likelihood for eight alcohol-related outcomes on an unmarked scale anchored by the terms "no chance" and "certain." This allowed comparison to unitary estimates and objective alcohol-related risk (Alcohol Use Disorders Identification Test [AUDIT] scores). Consistent with self-enhancement, unitary estimates were lower than bounded estimate midpoints. An accountability manipulation, which reduces self-enhancement, increased unitary but not bounded estimates. These effects were stronger in participants scoring highly on defensive coping. Bounded estimates were better predicted by risk-related affect and they more strongly predicted intention to reduce drinking. Unitary measures were better predicted by AUDIT scores. Accountability manipulations suppress heuristic thought, reduced correlations between bounded estimates and affect and intention, and eliminated unitary and bounded differences in prediction of AUDIT scores. Drinkers prefer fuzzy representations that reflect affective information when making decisions, but improving risk-based decisions may involve combining the best elements of bounded and unitary representations. PMID:23795979

Brown, Stephen L; Nowlan, Leanne; Taylor, Paul J; Morley, Andy M

2013-06-01

282

Pregnancy Outcome in Systemic Lupus Erythematosus (SLE) is Improving: Results from a Case Control Study and Literature Review  

PubMed Central

Objectives For women who suffer from systemic lupus erythematosus (SLE), pregnancy can be a concern, placing the mother and fetus at risk. Our objectives were to assess the risk of adverse pregnancy outcome, disease flares, fertility rate, and co-morbidities in SLE women compared to healthy controls. We also systematically reviewed the literature available on pregnancy outcome in SLE to compare our results to other published data. Our hypothesis was that pregnancy outcome in SLE is improving over time. Methods A case-control study comparing self-report of the above-mentioned parameters in SLE (N=108) vs healthy controls or patients with non-inflammatory musculoskeletal (MSK) disorders (N=134) was performed. Data were collected using a self-administered questionnaire. Proportions, means and odds ratios were calculated. We searched and quantified the literature on pregnancy outcome, lupus reactivation and fertility rate. Data were summarized and presented in mean % ± SEM and median % with interquartile range (IQR). Results Gynecological history, fertility rate and age at first pregnancy in SLE patients were comparable to controls. Eighteen percent of SLE patients reported a flare and 18% reported an improvement of symptoms during pregnancy. Twenty-four percent of lupus patients had at least one preterm delivery vs 5% in controls (OR =8.32, p = 0.0008), however other pregnancy outcomes (miscarriage, therapeutic abortion, stillbirth and neonatal death rate) did not differ between the groups. Thyroid problems were reported to be more likely in SLE patients (p = 0.02), but the prevalence of other co-morbidities was similar to controls. A literature review demonstrated that fertility was not affected in SLE patients. Lupus reactivations are common during pregnancy (36.5% ± SEM 3.3%). Most agreed that SLE pregnancies had more fetal loss (19.5% ± SEM 1.6%) and preterm births (25.5% ± SEM 2.2%) when compared to the general population. Over time, the rate of SLE peripartum flares has improved (p = 0.002) and the proportion of pregnancies resulting in live birth has increased (p = 0.024). The frequency of fetal death has not significantly changed. Our findings from the case-control study were, in general, consistent with the literature including the frequency of fetal death, neonatal death, live births and pregnancy rate. Conclusion Prematurity (25.5% ± SEM 2.2%) and fetal death (19.5% ± SEM 1.6%) in SLE pregnancy are still a concern. However, new strategies with respect to pregnancy timing and multidisciplinary care have improved maternal and fetal outcome in SLE. PMID:19156224

Yan Yuen, Sai; Krizova, Adriana; Ouimet, Janine M; Pope, Janet E

2008-01-01

283

Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAC registry  

PubMed Central

Worldwide, rivaroxaban is increasingly used for stroke prevention in atrial fibrillation and treatment of venous thromboembolism, but little is known about rivaroxaban-related bleeding complications in daily care. Using data from a prospective, noninterventional oral anticoagulation registry of daily care patients (Dresden NOAC registry), we analyzed rates, management, and outcome of rivaroxaban-related bleeding. Between October 1, 2011, and December 31, 2013, 1776 rivaroxaban patients were enrolled. So far, 762 patients (42.9%) reported 1082 bleeding events during/within 3 days after last intake of rivaroxaban (58.9% minor, 35.0% of nonmajor clinically relevant, and 6.1% major bleeding according to International Society on Thrombosis and Haemostasis definition). In case of major bleeding, surgical or interventional treatment was needed in 37.8% and prothrombin complex concentrate in 9.1%. In the time-to-first-event analysis, 100-patient-year rates of major bleeding were 3.1 (95% confidence interval 2.2-4.3) for stroke prevention in atrial fibrillation and 4.1 (95% confidence interval 2.5-6.4) for venous thromboembolism patients, respectively. In the as-treated analysis, case fatality rates of bleeding leading to hospitalizations were 5.1% and 6.3% at days 30 and 90 after bleeding, respectively. Our data indicate that, in real life, rates of rivaroxaban-related major bleeding may be lower and that the outcome may at least not be worse than that of major vitamin K antagonist bleeding, and probably better. This trial was registered at www.clinicaltrials.gov as identifier #NCT01588119. PMID:24859362

Förster, Kati; Pannach, Sven; Ebertz, Franziska; Gelbricht, Vera; Thieme, Christoph; Michalski, Franziska; Köhler, Christina; Werth, Sebastian; Sahin, Kurtulus; Tittl, Luise; Hänsel, Ulrike; Weiss, Norbert

2014-01-01

284

Health-Related Quality of Life Measures in Genetic Disorders: an Outcome Variable for Consideration in Clinical Trials  

PubMed Central

The field of medical genetics is rapidly advancing, and therapeutic options to treat genetic syndromes are becoming increasingly available. An understanding of the pathophysiology of various genetic disorders has provided researchers the opportunity to propose and test pharmacologic agents in preclinical murine models with hopes of translation to human trials. The development of clinical trials can be costly and time consuming, particularly for rare conditions. Pilot feasibility studies should be performed when designing clinical trials for genetic disorders. The development and selection of appropriate outcome measures are particularly paramount in the implementation of clinical trials. The selection of inappropriate outcome measures can lead to non-measurable differences or clinically insignificant findings. In addition, just as age appropriate measures are needed, some instruments may not apply to populations with specific genetic disorders that have significant cognitive and physical impairment, as the measures may not be sensitive enough to identify clinically significant changes. .In the last decade health-related quality of life measures (HRQOL) have been increasingly included as an outcome measure in clinical trials. While traditional clinical outcomes are important, these newly developed instruments should be considered along with clinical indicators as measures of effect in clinical trials of interventions in genetic disorders. PMID:19621444

Stevenson, David A.; Carey, John C.

2009-01-01

285

Unraveling the Differential Effects of Motivational and Skills, Social, and Self-Management Measures from Traditional Predictors of College Outcomes  

ERIC Educational Resources Information Center

The authors report on a large-scale study examining the effects of self-reported psychosocial factors on 1st-year college outcomes. Using a sample of 14,464 students from 48 institutions, the authors constructed hierarchical regression models to measure the predictive validity of the Student Readiness Inventory, a measure of psychosocial factors.…

Robbins, Steven B.; Allen, Jeff; Casillas, Alex; Peterson, Christina Hamme; Le, Huy

2006-01-01

286

Capability Deprivation and Income Poverty in the United States, 1994 and 2004: Measurement Outcomes and Demographic Profiles  

ERIC Educational Resources Information Center

Shifting focus from income to capability signifies an important milestone toward accurately measuring poverty and deprivation. This paper operationalizes capability deprivation in the United States and compares measurement outcomes among various capability approaches and between capability and income spaces. Of the three capability approaches…

Wagle, Udaya R.

2009-01-01

287

Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727  

PubMed Central

Background A substantial number of valid outcome measures have been developed to measure health in adult musculoskeletal and childhood disability. Regrettably, national initiatives have merely resulted in changes in attitude, while utilization remains unacceptably low. This study will compare the effectiveness and mediators of two different knowledge transfer (KT) interventions in terms of their impact on changing knowledge and behavior (utilization and clinical reasoning) related to health outcome measures. Method/Design Physical and occupational therapists (n = 144) will be recruited in partnership with the national professional associations to evaluate two different KT interventions with the same curriculum: 1) Stakeholder-Hosted Interactive Problem-Based Seminar (SHIPS), and 2) Online Problem-Based course (e-PBL). SHIPS will consist of face-to-face problem-based learning (PBL) for 2 1/2 days with outcome measure developers as facilitators, using six problems generated in consultation with participants. The e-PBL will consist of a 6-week web-based course with six generic problems developed by content experts. SHIPS will be conducted in three urban centers in Canada. Participants will be block-allocated by a minimization procedure to either of the two interventions to minimize any prognostic differences. Trained evaluators at each site will conduct chart audits and chart-stimulated recall. Trained interviewers will conduct semi-structured interviews focused on identifying critical elements in KT and implementing practice changes. Interviews will be transcribed verbatim. Baseline predictors including demographics, knowledge, attitudes/barriers regarding outcome measures, and Readiness to Change will be assessed by self-report. Immediately post-intervention and 6 months later, these will be re-administered. Primary qualitative and quantitative evaluations will be conducted 6-months post-intervention to assess the relative effectiveness of KT interventions and to identify elements that contribute to changing clinical behavior. Chart audits will determine the utilization of outcome measures (counts). Incorporation of outcome measures into clinical reasoning will be assessed using an innovative technique: chart-stimulated recall. Discussion A strategy for optimal transfer of health outcome measures into practice will be developed and shared with multiple disciplines involved in primary and specialty management of musculoskeletal and childhood disability. PMID:16820055

MacDermid, Joy C; Solomon, Patty; Law, Mary; Russell, Dianne; Stratford, Paul

2006-01-01

288

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. PMID:19401688

Apolone, G; Corli, O; Caraceni, A; Negri, E; Deandrea, S; Montanari, M; Greco, M T

2009-01-01

289

Interviewing to develop Patient-Reported Outcome (PRO) measures for clinical research: eliciting patients’ experience  

PubMed Central

Patient-reported outcome (PRO) measures must provide evidence that their development followed a rigorous process for ensuring their content validity. To this end, the collection of data is performed through qualitative interviews that allow for the elicitation of in-depth spontaneous reports of the patients’ experiences with their condition and/or its treatment. This paper provides a review of qualitative research applied to PRO measure development. A clear definition of what is a qualitative research interview is given as well as information about the form and content of qualitative interviews required for developing PRO measures. Particular attention is paid to the description of interviewing approaches (e.g., semi-structured and in-depth interviews, individual vs. focus group interviews). Information about how to get prepared for a qualitative interview is provided with the description of how to develop discussion guides for exploratory or cognitive interviews. Interviewing patients to obtain knowledge regarding their illness experience requires interpersonal and communication skills to facilitate patients’ expression. Those skills are described in details, as well as the skills needed to facilitate focus groups and to interview children, adolescents and the elderly. Special attention is also given to quality assurance and interview training. The paper ends on ethical considerations since interviewing for the development of PROs is performed in a context of illness and vulnerability. Therefore, it is all the more important that, in addition to soliciting informed consent, respectful interactions be ensured throughout the interview process. PMID:24499454

2014-01-01

290

A systematic review of patient-reported outcome measures in clinical vestibular research  

PubMed Central

Objective To identify the most commonly-used patient-reported outcome (PRO) measures in clinical vestibular research, and assess their test characteristics and applicability to study age-related vestibular loss (ARVL) in clinical trials. Data Sources We performed a systematic review of the PubMed, CINAHL, and PsycINFO databases from 1950 to August 13, 2013. Study Selection PRO measures were defined as outcomes that capture the subjective experience of the patient, such as symptoms, functional status, health perceptions, and quality of life. Two independent reviewers selected studies that used PRO measures in clinical vestibular research. Disparities were resolved with consensus between the reviewers. Of 2260 articles initially found on literature search, 255 full-text articles were retrieved for assessment. One-hundred and four studies met inclusion criteria for data collection. Data Extraction PRO measures were identified by two independent reviewers. The four most commonly used PROs were evaluated for their applicability to the condition of ARVL. Specifically, for these four PROs, data were collected pertaining to instrument test-retest reliability, item domains, and target population of the instrument. Data Synthesis A total of 50 PRO instruments were identified. The four most frequently utilized PROs were the Dizziness Handicap Inventory (DHI), the Activities-specific Balance Confidence (ABC) scale, the Vertigo Symptom Scale (VSS), and the Visual Analogue Scale (VAS). Of these four PROs, three were validated for use in patients with vestibular disease, and one was validated in community-dwelling older individuals with balance impairments. Items across the four PROs were categorized into three domains based on the International Classification of Functioning, Disability and Health: Activity, Participation, and Body Functions and Structures. Conclusions None of the most commonly-used PRO instruments were validated for use in community-dwelling older adults specifically with ARVL. Nevertheless, the three common domains of items identified across these four PRO instruments may be generalizable to older adults and provide a basis for developing a PRO instrument designed to evaluate the effectiveness of interventions targeted to ARVL. PMID:25305629

Fong, Eric; Li, Carol; Aslakson, Rebecca; Agrawal, Yuri

2014-01-01

291

Polycyclic aromatic hydrocarbons (PAHs) as determinants of various anthropometric measures of birth outcome.  

PubMed

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental contaminants that are known to induce oxidative stress. There have been several reports about the link between PAH exposure and complications in pregnancy. This cross-sectional study was conducted to: (1) measure the levels of benzo(a)anthracene (BaA), chrysene (Ch), benzo(b)fluoranthene (BbF), benzo(a)pyrene (BaP), and dibenzo(a,h)anthracene (DBahA) in placentas and maternal and -umbilical cord blood obtained at delivery from 1578 women between June 2005 and 2006 in the area of Al-Kharj, Saudi Arabia; (2) assess their influence on various anthropometric measures of birth outcome taking into consideration the carcinogenic properties of these PAHs; and (3) determine the degree of PAH-related oxidative DNA damage and birth outcome. Among the five tested PAHs, only BaP was carcinogenic; therefore, the levels of the other four probable or possible carcinogenic PAHs (BaA, Ch, BaF, and DBahA) were summed as ?4-PAHs. Levels of 1-hydroxypyrene (1-HP) were determined in maternal urine samples as a biomarker of PAH internal dose. Urinary cotinine (COT) was measured as an index of smoking. The following markers of oxidative stress were selected: malondialdehyde (MDA) in cord (C-MDA) and maternal (M-MDA) serum and 8-hydroxy-2-deoxyguanosine (8-OHdG) in maternal urine. None of the tested PAHs was found in maternal or cord blood. However, all five PAH compounds were detected in placentas; Ch was the highest (6.582 ?g/kg dry wt.), and BaA was the lowest (0.236 ?g/kg dry wt.). The mean concentration of urinary 1-HP found in this study was 0.216 ± 0.856 ?g/g Cr. After adjusting for gestational age and other confounding variables, regression models revealed an inverse relationship between placental weight, cord length and placental BaP. A similar trend was observed between cord length and ?4-PAHs in placental tissues. Urinary 1-HP, though, cannot be used as an unequivocal biomarker of PAH exposure, but it can be an appropriate indicator of exposure to environmental tobacco smoke (ETS). The data demonstrate that ETS exposure (as measured by urinary COT) may adversely affect birth outcome as shown by reduced head circumference, birth weight, and birth length, as well as increased cephalization index. The positive relationship between 8-OHdG levels and 1-HP in urine provides evidence of an oxidative stress mechanism. Although this study provides no direct evidence of an association between PAH exposure and DNA damage, increased oxidative stress in the form of lipid peroxidation significantly affected various birth measures. Therefore, there is a need for studies regarding PAH exposure and its associated biological effects to determine the extent of potential fetal damage as well as possible long-term effects, such as cancer. PMID:23314068

Al-Saleh, Iman; Alsabbahen, Ammar; Shinwari, Neptune; Billedo, Grisellhi; Mashhour, Abdullah; Al-Sarraj, Yaser; Mohamed, Gamal El Din; Rabbah, Abdullah

2013-02-01

292

Prenatal Methamphetamine Exposure and Neonatal and Infant Neurobehavioral Outcome: Results from the IDEAL Study  

PubMed Central

Background Methamphetamine (MA) use among pregnant women is an increasing problem in the United States. How MA use during pregnancy affects neonatal and infant neurobehavior is unknown. Methods The Infant Development, Environment, and Lifestyle (IDEAL) study screened 34,833 subjects at 4 clinical centers. 17,961 were eligible and 3,705 were consented, among which 412 were enrolled for longitudinal follow-up. Exposed subjects were identified by self-report and/or GC/MS confirmation of amphetamine and metabolites in meconium. Comparison subjects were matched (race, birth weight, maternal education, insurance), denied amphetamine use and had a negative meconium screen. Both groups included prenatal alcohol, tobacco and marijuana use, but excluded use of opiates, lysergic acid diethylamide, or phencyclidine. The NICU Network Neurobehavioral Scale (NNNS) was administered within the first 5 days of life and again at one month to 380 enrollees (185 exposed, 195 comparison). ANOVA tested exposure effects on NNNS summary scores at birth and one month. GLM repeated measures analysis assessed the effect of MA exposure over time on the NNNS scores with and without covariates. Results By one month of age, both groups demonstrated higher quality of movement (P=.029), less lethargy (P=.001), and fewer asymmetric reflexes (P=.012), with no significant differences in NNNS scores between the exposed and comparison groups. Over the first month of life, arousal increased in exposed infants but decreased in comparison infants (p=.031) and total stress was decreased in exposed infants with no change in comparison infants (p=.026). Conclusions Improvement in total stress and arousal were observed in MA-exposed newborns by one month of age relative to the newborn period. PMID:24588296

Kiblawi, Zeina N.; Smith, Lynne M.; Diaz, Sabrina D.; LaGasse, Linda L.; Derauf, Chris; Newman, Elana; Shah, Rizwan; Arria, Amelia; Huestis, Marilyn; Haning, William; Strauss, Arthur; DellaGrotta, Sheri; Dansereau, Lynne M.; Neal, Charles; Lester, Barry

2013-01-01

293

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

294

Developing Tools to Measure Quality in Congenital Catheterization and Interventions: The Congenital Cardiac Catheterization Project on Outcomes (C3PO)  

PubMed Central

The broad range of relatively rare procedures performed in pediatric cardiac catheterization laboratories has made the standardization of care and risk assessment in the field statistically quite problematic. However, with the growing number of patients who undergo cardiac catheterization, it has become imperative that the cardiology community overcomes these challenges to study patient outcomes. The Congenital Cardiac Catheterization Project on Outcomes was able to develop benchmarks, tools for measurement, and risk adjustment methods while exploring procedural efficacy. Based on the success of these efforts, the collaborative is pursuing a follow-up project, the Congenital Cardiac Catheterization Project on Outcomes—Quality Improvement, aimed at improving the outcomes for all patients undergoing catheterization for congenital heart disease by reducing radiation exposure. PMID:25114756

2014-01-01

295

Measurement of costs and scales for outcome evaluation in health economic studies of Parkinson's disease.  

PubMed

Health economic studies in Parkinson's disease (PD) have become increasingly common in recent years. Because several methodologies and instruments have been used to assess cost and outcomes in PD, the Movement Disorder Society (MDS) commissioned a Task Force to assess their properties and make recommendations regarding their use. A systematic literature review was conducted to explore the use of those instruments in PD and to determine which should be selected for this review. We assessed approaches to evaluate cost of illness (COI), cost effectiveness, and cost utilities, which include the use of direct (standard gamble, time trade-off. and visual analogue scales) and indirect instruments to measure health status and utilities. No validated instruments/models were identified for the evaluation of COI or cost-effectiveness in patients with PD; therefore, no instruments in this group are recommended. Among utility instruments, only a few of these outcome instruments have been used in the PD population, and only limited psychometric data are available for these instruments with respect to PD. Because psychometric data for further utility instruments in conditions other than PD already exist, the standard gamble and time trade-off methods and the EQ-5D (a European quality-of-life health states instrument) and Health Utility Index instruments met the criteria for scales that are "recommended (with limitations)," but only the EQ-5D has been assessed in detail in PD patients. The MDS Task Force recommends further study of these instruments in the PD population to establish core psychometric properties. For the assessment of COI, the Task Force considers the development of a COI instrument specifically for PD, like that available for Alzheimer's disease. PMID:23861335

Dodel, Richard; Jönsson, Bengt; Reese, Jens Peter; Winter, Yaroslav; Martinez-Martin, Pablo; Holloway, Robert; Sampaio, Cristina; R?ži?ka, Evžen; Hawthorne, Graeme; Oertel, Wolfgang; Poewe, Werner; Stebbins, Glenn; Rascol, Oliver; Goetz, Christopher G; Schrag, Anette

2014-02-01

296

Measuring mental health and wellbeing outcomes for children and adolescents to inform practice and policy: a review of child self-report measures.  

PubMed

There is a growing appetite for mental health and wellbeing outcome measures that can inform clinical practice at individual and service levels, including use for local and national benchmarking. Despite a varied literature on child mental health and wellbeing outcome measures that focus on psychometric properties alone, no reviews exist that appraise the availability of psychometric evidence and suitability for use in routine practice in child and adolescent mental health services (CAMHS) including key implementation issues. This paper aimed to present the findings of the first review that evaluates existing broadband measures of mental health and wellbeing outcomes in terms of these criteria. The following steps were implemented in order to select measures suitable for use in routine practice: literature database searches, consultation with stakeholders, application of inclusion and exclusion criteria, secondary searches and filtering. Subsequently, detailed reviews of the retained measures' psychometric properties and implementation features were carried out. 11 measures were identified as having potential for use in routine practice and meeting most of the key criteria: 1) Achenbach System of Empirically Based Assessment, 2) Beck Youth Inventories, 3) Behavior Assessment System for Children, 4) Behavioral and Emotional Rating Scale, 5) Child Health Questionnaire, 6) Child Symptom Inventories, 7) Health of the National Outcome Scale for Children and Adolescents, 8) Kidscreen, 9) Pediatric Symptom Checklist, 10) Strengths and Difficulties Questionnaire, 11) Youth Outcome Questionnaire. However, all existing measures identified had limitations as well as strengths. Furthermore, none had sufficient psychometric evidence available to demonstrate that they could reliably measure both severity and change over time in key groups. The review suggests a way of rigorously evaluating the growing number of broadband self-report mental health outcome measures against standards of feasibility and psychometric credibility in relation to use for practice and policy. PMID:24834111

Deighton, Jessica; Croudace, Tim; Fonagy, Peter; Brown, Jeb; Patalay, Praveetha; Wolpert, Miranda

2014-01-01

297

Bluetooth radio network performance: measurement results and simulation models  

Microsoft Academic Search

When designing new communication systems, results from simulations determine a large part of the system parameters. As simulations simplify reality according to the investigated aspects, the results obtained strongly depend on the assumptions made for the simplifications. This paper now presents real-life measurement results obtained in a Bluetooth radio network testbed and compares these results with models used in radio

Kirsten Matheus; Sverker Magnusson

2004-01-01

298

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. PMID:20205751

2010-01-01

299

Risk constraint measures developed for the outcome-based strategy for tank waste management  

SciTech Connect

This report is one of a series of supporting documents for the outcome-based characterization strategy developed by PNNL. This report presents a set of proposed risk measures with risk constraint (acceptance) levels for use in the Value of Information process used in the NCS. The characterization strategy has developed a risk-based Value of Information (VOI) approach for comparing the cost-effectiveness of characterizing versus mitigating particular waste tanks or tank clusters. The preference between characterizing or mitigating in order to prevent an accident depends on the cost of those activities relative to the cost of the consequences of the accident. The consequences are defined as adverse impacts measured across a broad set of risk categories such as worker dose, public cancers, ecological harm, and sociocultural impacts. Within each risk measure, various {open_quotes}constraint levels{close_quotes} have been identified that reflect regulatory standards or conventionally negotiated thresholds of harm to Hanford resources and values. The cost of consequences includes the {open_quotes}costs{close_quote} of exceeding those constraint levels as well as a strictly linear costing per unit of impact within each of the risk measures. In actual application, VOI based-decision making is an iterative process, with a preliminary low-precision screen of potential technical options against the major risk constraints, followed by VOI analysis to determine the cost-effectiveness of gathering additional information and to select a preferred technical option, and finally a posterior screen to determine whether the preferred option meets all relevant risk constraints and acceptability criteria.

Harper, B.L.; Gajewski, S.J.; Glantz, C.L. [and others

1996-09-01

300

Synthesis and review: delivering on conservation promises: the challenges of managing and measuring conservation outcomes  

NASA Astrophysics Data System (ADS)

Growing threats and limited resources have always been the financial realities of biodiversity conservation. As the conservation sector has matured, however, the accountability of conservation investments has become an increasingly debated topic, with two key topics being driven to the forefront of the discourse: understanding how to manage the risks associated with our conservation investments and demonstrating that our investments are making a difference through evidence-based analyses. A better understanding of the uncertainties associated with conservation decisions is a central component of managing risks to investments that is often neglected. This focus issue presents both theoretical and applied approaches to quantifying and managing risks. Furthermore, transparent and replicable approaches to measuring impacts of conservation investments are noticeably absent in many conservation programs globally. This focus issue contains state of the art conservation program impact evaluations that both demonstrate how these methods can be used to measure outcomes as well as directing future investments. This focus issue thus brings together current thinking and case studies that can provide a valuable resource for directing future conservation investments.

Adams, Vanessa M.; Game, Edward T.; Bode, Michael

2014-08-01

301

Measuring the outcomes of day hospital attendance: a comparison of the Barthel Index and London Handicap Scale  

Microsoft Academic Search

Objective: To assess the ability of two scales to measure the effects of attendance at a geriatric day hospital.Design: ‘Before-and-after’ measurements. Setting: Day hospital serving a defined, urban, catchment area. Subjects: One hundred and three consecutive new patients over a three-month period.Intervention: Day hospital attendance for as long as the multidisciplinary team thought warranted.Outcome measures: Barthel Index and London Handicap

Rowan H Harwood; Shah Ebrahim

2000-01-01

302

Perioperative measures to improve outcome after subarachnoid hemorrhage-revisiting the concept of secondary brain injury.  

PubMed

Progress in the management of aneurysmal subarachnoid hemorrhage (SAH) is reflected most clearly in a continuously decreasing case fatality rate over the last decades. The purpose of the present review is to identify the relevant factors responsible for this progress and to outline future possibilities of improvement. Although data on intracerebral hemorrhage and ischemic stroke are less homogeneous, the respective data suggest that reduction of case fatalities could also be achieved with these types of stroke. Therefore, advances of general neurocritical care may be the common denominator responsible for the decreasing case fatality rates. Additionally, a change in practice with regard to treatment of elderly patients that is more active may also be a factor. Regarding SAH, the majority of unfavorable outcomes is still related to early or delayed cerebral injury. Therefore, efforts to pharmacologically prevent secondary neuronal damage are likely to play a certain role in achieving improvement in overall outcome. However, the data from previous randomized clinical trials conducted during the last three decades does not strongly support this. A clear benefit has only been proven for oral nimodipine, whereas other calcium antagonists and the rho-kinase inhibitors were not conclusively shown to have a significant effect on functional outcome, and all other tested substances disappointed in clinical trials. Regarding ischemic stroke and traumatic brain injury, intensive clinical research has also been conducted during the last 30 years to improve outcome and to minimize secondary neuronal injury. For ischemic stroke, treatment focusing on reversal of the primary pathomechanism, such as thrombolysis, proved effective, but none of the pharmacological neuroprotective concepts resulted in any benefit. To date, decompressive hemicraniectomy has been the only effective effort focused at reducing secondary damage that resulted in a clear reduction of mortality. In the case of traumatic brain injury, none of the pharmacological or other efforts to limit secondary damage met our hopes. In summary, although limited, pharmacotherapy to limit delayed neuronal injury is more effective for SAH than for ischemic stroke and traumatic brain injury. The disappointing results of most trials addressing secondary damage force one to question the general concept of mechanisms of secondary damage that do not also have a positive side in the natural course of the disease. For example, in the case of SAH, the data from the Cooperative Study from the 1960s showed that vasospasm to some degree protects against rerupture of unsecured aneurysms. Thus, one could argue from an evolutionary standpoint that the purpose of vasospasm was not exclusively a detrimental or suicide pathomechanism, but an attempt to protect against life-threating aneurysm rerupture. Because of the above-discussed arguments, SAH may indeed differ from ischemic stroke and traumatic brain injury with regard to the usefulness of blocking secondary mechanisms pharmacologically. Further efforts to limit vasospasm should therefore be made, and the most promising drugs, calcium antagonists, deserve further development. Because, with various drugs, systemic side effects counteracted the local beneficial effect, future efforts should focus on topical administration of drugs instead of systemic administration. Furthermore, efforts for a better understanding of the variations of the calcium channels and the interplay between the different types of calcium channels should be made. PMID:25366626

Steiger, Hans-Jakob; Beez, Thomas; Beseoglu, Kerim; Hänggi, Daniel; Kamp, Marcel A

2015-01-01

303

A Prospective Cohort Study of the Effects of Lower Extremity Orthopaedic Surgery on Outcome Measures in Ambulatory Children With Cerebral Palsy  

PubMed Central

Background Lower-extremity musculotendinous surgery is standard treatment for ambulatory children with deformities such as joint contractures and bony torsions resulting from cerebral palsy (CP). However, evidence of efficacy is limited to retrospective, uncontrolled studies with small sample sizes focusing on gait variables and clinical examination measures. The aim of this study was to prospectively examine whether lower-extremity musculotendinous surgery in ambulatory children with CP improves impairments and function measured by gait and clinical outcome tools beyond changes found in a concurrent matched control group. Methods Seventy-five children with spastic CP (Gross Motor Function Classification System levels I to III, age 4 to 18 y) that underwent surgery to improve gait were individually matched on the basis of sex, Gross Motor Function Classification System level, and CP subtype to a nonsurgical cohort, minimizing differences in age and Gross Motor Function Measure Dimension E. At baseline and at least 12 months after baseline or surgery, participants completed gait analysis and Gross Motor Function Measure, and parents completed outcome questionnaires. Mean changes at follow-up were compared using analysis of covariance adjusted for baseline differences. Results Surgery ranged from single-level soft tissue release to multilevel bony and/or soft tissue procedures. At follow-up, after correcting for baseline differences, Gillette Gait Index, Pediatric Outcomes Data Collection Instrument Expectations, and Pediatric Quality of Life Inventory (PedsQL) Physical Functioning improved significantly for the surgical group compared with the nonsurgical group, which showed minimal change. Conclusions On the basis of a matched concurrent data set, there was significant improvement in function after 1 year for a surgical group compared with a nonsurgical group as measured by the Gillette Gait Index, with few significant changes noted in outcome measures. Changes over 1 year are minimal in the nonsurgical group, supporting the possibility of ethically performing a randomized controlled trial using nonsurgical controls. Level of Evidence Therapeutic level 2. Prospective comparative study. PMID:19934707

Gorton, George Edwin; Abel, Mark F.; Oeffinger, Donna J.; Bagley, Anita; Rogers, Sarah P.; Damiano, Diane; Romness, Mark; Tylkowski, Chester

2010-01-01

304

Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures  

PubMed Central

Background Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. Methods Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance. Results The majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69%) and total hospital costs (70%); however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30), patients lost to follow-up (n = 42) and estimates of effect or random variability (n = 35); inappropriate use of statistical tests (n = 55); and failure to adjust for established confounders (n = 37). Conclusions Future research should include an expanded focus on the specific structures of care that differentiate hospitalists from other inpatient physician groups as well as the development of better conceptual and statistical models that identify and measure underlying mechanisms driving provider-outcome associations in quality. PMID:21592322

2011-01-01

305

Family Outcomes: Policy & Practice  

E-print Network

Kansas Division of Early Childhood February 24, 2005 Family Outcomes: Policy & Practice Jean Ann Summers PhD, Beach Center on Disability Nina Zuna Doctoral Student, Beach Center on Disability Kerry Lida Doctoral Student, Beach Center...” of services must be reported IFSP supports family outcomes through… Services to assist families in meeting child needs Measurable results of child and family progress Services in the natural environment Family directed assessment of resources, priorities...

Zuna, Nina

2005-05-05

306

Standard uncertainty in each measurement result explicit or implicit  

Microsoft Academic Search

Concepts given in the ISO Guide will have the chance to be used widely in science, engineering, industry and commerce only if their realizations will be simple enough. According to the ISO Guide the complete statement of a measurement result should contain information about standard uncertainty of measurement. Because the uncertainty was traditionally expressed as confidence interval, the ISO Guide

Zdenko Godec

1997-01-01

307

Magnetic Measurement Results in the AGS Cold Snake HSD601  

E-print Network

Magnetic Measurement Results in the AGS Cold Snake HSD601 (a.k.a. DSM101) Animesh Jain in the Cold Snake (HSD601) · Integral dipole field in the main helical magnet: ­ Full excitation curve using Animesh Jain, BNL 3 Measurements in the Cold Snake (Contd.) · Axial scans using 51 mm long coil: ­ 67

Ohta, Shigemi

308

Asymptotic results for fitting marginal hazards models from stratified case-cohort studies with multiple disease outcomes  

PubMed Central

In stratified case-cohort designs, samplings of case-cohort samples are conducted via a stratified random sampling based on covariate information available on the entire cohort members. In this paper, we extended the work of Kang & Cai (2009) to a generalized stratified case-cohort study design for failure time data with multiple disease outcomes. Under this study design, we developed weighted estimating procedures for model parameters in marginal multiplicative intensity models and for the cumulative baseline hazard function. The asymptotic properties of the estimators are studied using martingales, modern empirical process theory, and results for finite population sampling. PMID:22442642

Kang, Sangwook; Cai, Jianwen

2010-01-01

309

Detecting differences in quality of care: the sensitivity of measures of process and outcome in treating acute myocardial infarction.  

PubMed Central

The merits or otherwise of publishing hospital specific death rates are much debated. This article compares the relative sensitivity of measures of process and outcome to differences in quality of care for the hospital treatment of myocardial infarction. Aspects of hospital care that have a proved impact on mortality from myocardial infarction are identified, and the results from meta-analysis and large randomised controlled trials are used to estimate the impact that optimal use of these interventions would have on mortality in a typical district general hospital. Sample size calculations are then performed to determine how many years of data would be needed to detect significant differences between hospitals. A comparison is then made with the amount of data that would be needed to detect significant differences if information about process of care was being collected. Process measures based on the results of randomised controlled trials were found to be able to detect relevant differences between hospitals that would not be identified by comparing hospital specific mortality, which is an insensitive indicator of the quality of care. Images p795-a PMID:7580444

Mant, J.; Hicks, N.

1995-01-01

310

The Use of Occupational Licensure Examination Results in Outcomes Assessment. AIR 1994 Annual Forum Paper.  

ERIC Educational Resources Information Center

This paper discusses the validity of licensure examination results as an indicator of the performance of higher educational institutions. Licensure examination scores are available to departments for a variety of disciplines and analysis is best performed within the departments. The quality of feedback may dictate the usefulness of results. Using…

Bragg, Theresa A.

311

Measuring perceived health outcomes in non-western culture: does SF-36 have a place?  

PubMed

This study explored the usefulness of a generic health assessment tool SF-36 in measuring perceived health outcomes in a developing-country setting. The adapted Bangla version was administered in 10 villages of Matlab sub-district in Bangladesh during second half of 1999. Respondents included currently-married males and females selected randomly from households stratified according to their association with women-focused development interventions of BRAC. Findings revealed that the respondents from BRAC households perceived their health status marginally better than the poor non-member group in most domains studied, sometimes significantly so, e.g. general and mental health (p < 0.05). The respondents from BRAC reported better 'current health' than their non-member counterparts. The gender difference in assessment of health status was noted among the groups. Age, education, and poverty were important determinants of perceived health status. SF-36 proved to be a useful tool for self-assessment of health status and group comparison when properly modified for cross-cultural adaptation. PMID:12659414

Ahmed, Syed Masud; Rana, A K M Masud; Chowdhury, Mushtaque; Bhuiya, Abbas

2002-12-01

312

Outcomes in Ethnic Minority Renal Transplant Recipients Receiving Everolimus versus Mycophenolate: Comparative Risk Assessment Results From a Pooled Analysis  

PubMed Central

Background Everolimus (EVR) has demonstrated good efficacy after renal transplantation. Racial disparities in clinical outcomes after de novo renal transplantation are well documented; whether the efficacy of EVR varies based on recipient ethnicity is unknown. We conducted a comparative risk assessment of EVR by ethnicity. Methods Data on 2004 renal transplant recipients from three EVR studies were pooled to identify the impact of ethnicity on efficacy outcomes across EVR dosing groups and control groups. Ethnic groups compared were African Americans, non-U.S. blacks, Asians, Hispanics, and Caucasians. EVR groups received either 1.5 or 3 mg per day, with either standard-dose cyclosporine or reduced-dose cyclosporine. Control groups received mycophenolic acid (MPA) with standard-dose cyclosporine. Composite efficacy failure endpoint was graft loss, death, biopsy-proven acute rejection, or lost to follow-up. Adjusted odds ratios were calculated using a logistic regression model. Results The proportion of renal transplant recipients who met the composite endpoint was African Americans (46%), non-U.S. black (35%), Caucasian (31%), Hispanic (28%), and Asian (25%). The odds of meeting the composite endpoint were significantly (P=0.0001) greater for African Americans versus Caucasians but did not differ among the other ethnic groups (ethnic groups were only compared with Caucasians). EVR and MPA were associated with similar efficacy among each of the ethnic groups. Conclusion In this pooled data analysis in more than 2000 renal transplant recipients, EVR versus MPA resulted in similar composite endpoint incidence events across ethnicities. Consistent with previously published data, African Americans had poorer clinical outcomes. EVR is efficacious regardless of ethnicity. PMID:24345868

Melancon, Keith; Mulgaonkar, Shamkant P.; Delcoro, Carlos; Wiland, Anne; McCague, Kevin; Shihab, Fuad S.

2013-01-01

313

Predicting long-term outcome after traumatic brain injury using repeated measurements of glasgow coma scale and data mining methods.  

PubMed

Previous studies have identified some clinical parameters for predicting long-term functional recovery and mortality after traumatic brain injury (TBI). Here, data mining methods were combined with serial Glasgow Coma Scale (GCS) scores and clinical and laboratory parameters to predict 6-month functional outcome and mortality in patients with TBI. Data of consecutive adult patients presenting at a trauma center with moderate-to-severe head injury were retrospectively analyzed. Clinical parameters including serial GCS measurements at emergency department, 7th day, and 14th day and laboratory data were included for analysis (n?=?115). We employed artificial neural network (ANN), naïve Bayes (NB), decision tree, and logistic regression to predict mortality and functional outcomes at 6 months after TBI. Favorable functional outcome was achieved by 34.8 % of the patients, and overall 6-month mortality was 25.2 %. For 6-month functional outcome prediction, ANN was the best model, with an area under the receiver operating characteristic curve (AUC) of 96.13 %, sensitivity of 83.50 %, and specificity of 89.73 %. The best predictive model for mortality was NB with AUC of 91.14 %, sensitivity of 81.17 %, and specificity of 90.65 %. Sensitivity analysis demonstrated GCS measurements on the 7th and 14th day and difference between emergency room and 14th day GCS score as the most influential attributes both in mortality and functional outcome prediction models. Analysis of serial GCS measurements using data mining methods provided additional predictive information in relation to 6-month mortality and functional outcome in patients with moderate-to-severe TBI. PMID:25637541

Lu, Hsueh-Yi; Li, Tzu-Chi; Tu, Yong-Kwang; Tsai, Jui-Chang; Lai, Hong-Shiee; Kuo, Lu-Ting

2015-02-01

314

Resource utilization in patients with schizophrenia who initiated risperidone long-acting therapy: results from the Schizophrenia Outcomes Utilization Relapse and Clinical Evaluation (SOURCE)  

PubMed Central

Background Schizophrenia is a chronic mental health disorder associated with increased hospital admissions and excessive utilization of outpatient services and long-term care. This analysis examined health care resource utilization from a 24-month observational study of patients with schizophrenia initiated on risperidone long-acting therapy (RLAT). Methods Schizophrenia Outcomes Utilization Relapse and Clinical Evaluation (SOURCE) was a 24-month observational study designed to examine real-world treatment outcomes by prospectively following patients with schizophrenia initiated on RLAT. At baseline visit, prior hospitalization and ER visit dates were obtained for the previous 12 months and subsequent hospitalization visit dates were obtained at 3-month visits, if available. The health care resource utilization outcomes measures observed in this analysis were hospitalizations for any reason, psychiatric-related hospitalizations, and emergency room (ER) visits. Incidence density analysis was used to assess pre-event and postevent rates per person-year (PY). Results The primary medical resource utilization analysis included 435 patients who had a baseline visit, ?1 postbaseline visits after RLAT initiation, and valid hospitalization dates. The number of hospitalizations and ER visits per PY declined significantly (p < .0001) after initiation with RLAT. A 41% decrease (difference of -0.29 hospitalizations per PY [95% CI: -0.39 to -0.18] from baseline) in hospitalizations for any reason, a 56% decrease (a difference of -0.35 hospitalizations per PY [95% CI: -0.44 to -0.26] from baseline) in psychiatric-related hospitalizations, and a 40% decrease (-0.26 hospitalizations per PY [95% CI: -0.44 to -0.10] from baseline) in ER visits were observed after the baseline period. The percentage of psychiatric-related hospitalizations decreased significantly after RLAT initiation, and patients had fewer inpatient hospitalizations and ER visits (all p < .0001). Conclusion The results suggest that treatment with RLAT may result in decreased hospitalizations for patients with schizophrenia. Trial Registration ClinicalTrials.gov: NCT00246194 PMID:21999370

2011-01-01

315

An Overview of Children’s Oral Health-Related Quality of Life Assessment: From Scale Development to Measuring Outcomes  

PubMed Central

The objectives of this paper are to present an overview of children’s oral-health related quality of life and include specific applications for using quality of life (QoL) assessment in dental research. The process of developing pediatric oral health-related quality of life measures, in particular the Child Oral Health Impact Profile (COHIP), is outlined. Examples of children’s OHRQoL measurement in caries research are also provided. QoL outcomes are presented and discussed in the context of caries research. Lastly, the relevance of measuring clinically meaningful difference in the context of measuring outcomes research is highlighted with recommendations for future research. PMID:24107604

Genderson, M. W.; Sischo, L.; Markowitz, K.; Fine, D.; Broder, H. L.

2013-01-01

316

The Effectiveness of Substance Abuse Treatment in Illinois: Results of the Illinois Statewide Treatment Outcomes Project  

E-print Network

The Effectiveness of Substance Abuse Treatment in Illinois: Results of the Illinois Statewide Department of Human Services Office of Alcoholism and Substance Abuse (OASA), Melanie Whitter, Associate by the Substance Abuse Prevention and Treatment federal block grant. #12;ACKNOWLEDGMENTS The Illinois Department

Illinois at Chicago, University of

317

Results of Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial  

Microsoft Academic Search

BACKGROUND: Restenosis after percutaneous coronary intervention (PCI) is a major problem affecting 15% to 30% of patients after stent placement. No oral agent has shown a beneficial effect on restenosis or on associated major adverse cardiovascular events. In limited trials, the oral agent tranilast has been shown to decrease the frequency of angiographic restenosis after PCI. METHODS AND RESULTS: In

D. R. Holmes; J. R. Granett; J. J. Popma; P. J. Fitzgerald; D. Fischman; J. J. Ferguson; A. M. Lincoff; S. Goldberg; J. A. Brinker; R. Chan; B. R. Davis; M. Poland; A. M. Zeiher; J. T. Willerson; S. B. King; L. M. Shapiro; M. Savage; J. M. Lablanche; J. E. Tcheng; L. Grip; P. W. J. C. Serruys

2002-01-01

318

Outcomes of Treatment for Alcohol Problems: Current Methods, Problems, and Results.  

ERIC Educational Resources Information Center

Discusses current methods, problems, and results of psychological treatment for alcohol abuse, including alcoholism. Addresses external and internal validity problems specific to issues regarding who is treated for alcohol problems, and treatment and patient factors that predict response to alcoholism treatment. Reviews current data on…

Nathan, Peter E.; Skinstad, Anne-Helene

1987-01-01

319

If patient-reported outcome measures are considered key health-care quality indicators, who is excluded from participation?  

PubMed

Patient-reported outcome measures have received increasing attention with regard to ensuring quality improvement across the health service. However, there is a risk that people with disabilities and low literacy are systematically excluded from the development of these measures as well as their application in clinical practice. This editorial highlights some of these risks and the potential consequences of exclusion for these groups. PMID:22512658

Kroll, Thilo; Wyke, Sally; Jahagirdar, Deepa; Ritchie, Karen

2014-10-01

320

The Relationship Between Content Area General Outcome Measurement and Statewide Testing in Sixth-Grade World History  

Microsoft Academic Search

The purpose of the present study was to extend validity research on a content area general outcome measurement tool known as vocabulary matching. Previous research has reported moderately strong to strong correlations between the group-administered vocabulary-matching measure and a standardized assessment instrument. The present study extended the validity research to a statewide accountability assessment. A diverse sample of 146 sixth-grade

Paul Mooney; Kevin S. McCarter; Jodie Schraven; Beth Haydel

2010-01-01

321

Capability Deprivation and Income Poverty in the United States, 1994 and 2004: Measurement Outcomes and Demographic Profiles  

Microsoft Academic Search

Shifting focus from income to capability signifies an important milestone toward accurately measuring poverty and deprivation.\\u000a This paper operationalizes capability deprivation in the United States and compares measurement outcomes among various capability\\u000a approaches and between capability and income spaces. Of the three capability approaches examined, the factor score absolute\\u000a approach suggests a greater extent of deprivation and more comprehensive demographic

Udaya R. Wagle

2009-01-01

322

Impact of an Abdominal Binder on Speech Outcomes in People With Tetraplegic Spinal Cord Injury: Perceptual and Acoustic Measures  

PubMed Central

Background: An abdominal binder (AB) is routinely used for patients who have suffered a spinal cord injury (SCI) resulting in tetraplegia. It is thought to restore abdominal pressure and consequently improve breathing capacity and reduce postural hypotension in patients who do not have functioning abdominal muscles. Objective: To examine the early effects of an AB on respiratory and speech outcomes. Methods: Thirteen individuals who sustained an acute motor complete SCI between C3 and T1 were assessed after a 6-week trial of using an elasticized AB from the time of first mobilizing in an upright wheelchair. Assessments were made using spirometry and perceptual and acoustics speech measures based on sustained phonation, sentence recitation, and passage reading. Results: Significant improvements were found in the AB-on condition for 3 of 5 respiratory parameters (vital capacity, forced vital capacity, and forced expiratory volume in 1 second). Predominantly mild voice and speech dysfunction were noted in participants. No significant difference was found for any of the acoustic and perceptual speech parameters (maximum phonation time, vocal intensity for sentence recitation, perceptual speech characteristics, or vocal quality) between the AB conditions. Conclusions: Despite the finding that an AB results in significant improvements in respiratory function for individuals with tetraplegic SCI, the current study did not provide evidence that an AB improves speech production. PMID:24574822

Cornwell, Petrea L.

2014-01-01

323

Development of an Online Library of Patient-Reported Outcome Measures in Gastroenterology: The GI-PRO Database  

PubMed Central

OBJECTIVES Because gastrointestinal (GI) illnesses can cause physical, emotional, and social distress, patient-reported outcomes (PROs) are used to guide clinical decision making, conduct research, and seek drug approval. It is important to develop a mechanism for identifying, categorizing, and evaluating the over 100 GI PROs that exist. Here we describe a new, National Institutes of Health (NIH)-supported, online PRO clearinghouse—the GI-PRO database. METHODS Using a protocol developed by the NIH Patient-Reported Outcome Measurement Information System (PROMIS®), we performed a systematic review to identify English-language GI PROs. We abstracted PRO items and developed an online searchable item database. We categorized symptoms into content “bins” to evaluate a framework for GI symptom reporting. Finally, we assigned a score for the methodological quality of each PRO represented in the published literature (0–20 range; higher indicates better). RESULTS We reviewed 15,697 titles (? > 0.6 for title and abstract selection), from which we identified 126 PROs. Review of the PROs revealed eight GI symptom “bins”: (i) abdominal pain, (ii) bloat/gas, (iii) diarrhea, (iv) constipation, (v) bowel incontinence/soilage, (vi) heartburn/reflux, (vii) swallowing, and (viii) nausea/vomiting. In addition to these symptoms, the PROs covered four psychosocial domains: (i) behaviors, (ii) cognitions, (iii) emotions, and (iv) psychosocial impact. The quality scores were generally low (mean 8.88±4.19; 0 (min)?20 (max)). In addition, 51% did not include patient input in developing the PRO, and 41% provided no information on score interpretation. CONCLUSIONS GI PROs cover a wide range of biopsychosocial symptoms. Although plentiful, GI PROs are limited by low methodological quality. Our online PRO library (www.researchcore.org/gipro/) can help in selecting PROs for clinical and research purposes. PMID:24343547

Khanna, Puja; Agarwal, Nikhil; Khanna, Dinesh; Hays, Ron D.; Chang, Lin; Bolus, Roger; Melmed, Gil; Whitman, Cynthia B.; Kaplan, Robert M.; Ogawa, Rikke; Snyder, Bradley; Spiegel, Brennan M.R.

2014-01-01

324

Multivariable Analysis of Outcome Predictors and Adjustment of Main Outcome Results to Baseline Data Profile in Randomized Controlled Trials Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy (SITS-MOST)  

Microsoft Academic Search

Background and Purpose—The Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy (SITS-MOST) unadjusted results demonstrated that intravenous alteplase is well tolerated and that the effects were comparable with those seen in randomized, controlled trials (RCTs) when used in routine clinical practice within 3 hours of ischemic stroke onset. We aimed to identify outcome predictors and adjust the outcomes of the SITS-MOST

Nils Wahlgren; Niaz Ahmed; Niclas Eriksson; Franz Aichner; Erich Bluhmki; Antoni Davalos; Terttu Erila; Gary A. Ford; Martin Grond; Werner Hacke; Michael G. Hennerici; Markku Kaste; Martin Kohrmann; Vincent Larrue; Kennedy R. Lees; Thomas Machnig; Risto O. Roine; Danilo Toni; Geert Vanhooren

325

Early Neurological Outcome of Young Infants Exposed to Selective Serotonin Reuptake Inhibitors during Pregnancy: Results from the Observational SMOK Study  

PubMed Central

Background Use of selective serotonin reuptake inhibitors (SSRI) during pregnancy is common while the effect on the infant’s neurological outcome is unknown. Our objective was to determine the effects of prenatal SSRI-exposure on the infants’ neurological functioning, adjusted for maternal mental health. Methods A prospective observational study from May 2007 to April 2010. The study groups comprised 63 SSRI-exposed infants (SSRI group) and 44 non-exposed infants (non-SSRI group). Maternal depression and anxiety were measured using questionnaires. The main outcome measures during the first week after birth and at three to four months were the quality of the infants’ general movements (GMs) according to Prechtl and a detailed motor optimality score. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for abnormal GM quality in the SSRI and non-SSRI groups, and adjusted for maternal depression, anxiety, and other confounders. The study was registered under 53506435 in the ISRCTN. Findings All infants were born around term. During the first week, abnormal GMs occurred more frequently in the SSRI group than in the non-SSRI group (59% versus 33%) and the median MOS was lower (13 versus 18). The OR for abnormal GMs in the SSRI versus the non-SSRI group was 3·0 (95% CI, 1.3 to 6.9) and increased after adjustment for confounders. At three to four months, more SSRI-exposed infants had monotonous movements (48% versus 20%) with lower median MOSs (26 versus 28). The OR for monotonous movements was 3·5 (95% CI, 1.5 to 8.6) and increased after adjusting for confounders. Interpretation Prenatal exposure to SSRI had an adverse effect on early neurological functioning as reflected by GM quality, irrespective of maternal depression and anxiety, and other confounders. Physicians should take this into account in consultation with parents. PMID:23785389

de Vries, Nathalie K. S.; van der Veere, Christine N.; Reijneveld, Sijmen A.; Bos, Arend F.

2013-01-01

326

Uniqueness of Quantum States Compatible with Given Measurement Results  

E-print Network

We discuss the uniqueness of quantum states compatible with given results for measuring a set of observables. For a given pure state, we consider two different types of uniqueness: (1) no other pure state is compatible with the same measurement results and (2) no other state, pure or mixed, is compatible with the same measurement results. For case (1), it is known that for a d-dimensional Hilbert space, there exists a set of 4d-5 observables that uniquely determines any pure state. We show that for case (2), 5d-7 observables suffice to uniquely determine any pure state. Thus there is a gap between the results for (1) and (2), and we give some examples to illustrate this. The case of observables corresponding to reduced density matrices (RDMs) of a multipartite system is also discussed, where we improve known bounds on local dimensions for case (2) in which almost all pure states are uniquely determined by their RDMs. We further discuss circumstances where (1) can imply (2). We use convexity of the numerical range of operators to show that when only two observables are measured, (1) always implies (2). More generally, if there is a compact group of symmetries of the state space which has the span of the observables measured as the set of fixed points, then (1) implies (2). We analyze the possible dimensions for the span of such observables. Our results extend naturally to the case of low rank quantum states.

Jianxin Chen; Hillary Dawkins; Zhengfeng Ji; Nathaniel Johnston; David Kribs; Frederic Shultz; Bei Zeng

2012-12-14

327

[Comparison of remote results outcomes of stenting and eversion endarterectomy from internal carotid arteries].  

PubMed

Presented in the article are comparative results of carotid angioplasty with stenting (CAS) and eversion carotid endarterectomy (ECEA) in the remote period of follow up. The study included a total of 92 patients. Of these, 33 were subjected to CAS (Group I) and 59 underwent a total of 63 ECEAs (Group II). Depending upon the presence or absence of symptoms of cerebrovascular insufficiency (CVI), as well as based on assessment of risk factors for surgical intervention, the patients were subdivided into four subgroups: a) low-risk asymptomatic b) low-risk symptomatic, c) high-risk asymptomatic and d) high-risk symptomatic. We followed up remote results in 31 Group I patients (94%) up to 70 months (mean period of follow up amounted to 25±17 months), and in 36 Group II patients up to for up to 65 months (mean duration of the follow up amounting to 37±20 months). There was no statistically significant difference (P >0.05) between subgroups of patients along such parameters as severe or mild stroke, myocardial infarction, stroke-related death, or myocardial infarction related death. CAS and ECEA are equally highly efficient techniques of preventing acute cerebral circulation impairments in the remote period of follow up in patients of both high and low risk of surgical intervention. PMID:22929682

Sidorov, A A; Kokov, L S; Belo'artsev, D F; Tsygankov, V N; Shutikhina, I V; Goncharov, A I

2012-01-01

328

Predisposing factors for bacterial vaginosis, treatment efficacy and pregnancy outcome among term deliveries; results from a preterm delivery study  

PubMed Central

Background Bacterial vaginosis (BV) during pregnancy is associated with an increased risk of preterm delivery but little is known about factors that could predict BV. We have analyzed if it is possible to identify a category of pregnant women that should be screened for BV, and if BV would alter the pregnancy outcome at term; we have also studied the treatment efficacy of clindamycin. Methods Prospective BV screening and treatment study of 9025 women in a geographically defined region in southeast Sweden. BV was defined as a modified Nugent score of 6 and above. Data was collected from the Swedish Medical Birth Register. Women allocated to treatment were supplied with vaginal clindamycin cream. The main outcome goals were to identify factors that could predict BV. Results Vaginal smears were consistent with BV criteria in 9.3%. Logistic regression indicates a significant correlation between smoking and BV (p < 0.001) and a greater prevalence of BV in the lower age groups (p < 0.001). We found no correlation between BV and history of preterm deliveries, previous miscarriages, extra-uterine pregnancies, infertility problems or reported history of urinary tract infections–factors that earlier have been associated with BV. Treatment with clindamycin cream showed a cure rate of 77%. Less than 1% of women with a normal vaginal smear in early pregnancy will develop BV during the pregnancy. There was no association between BV and the obstetric outcome among women who delivered at term. Women with BV, both treated patients and nontreated, had the same obstetric outcome at term as women with normal vaginal flora. Conclusion BV is more than twice as common among smokers, and there is a higher prevalence in the younger age group. However these two markers for BV do not suffice as a tool for screening, and considering the lack of other risk factors associated with BV, screening of all pregnant women might be a strategy to follow in a program intended to reduce the number of preterm births. PMID:17953762

Larsson, P-G; Fåhraeus, Lars; Carlsson, Bodil; Jakobsson, Tell; Forsum, Urban

2007-01-01

329

Some Results of Magnetic Field Measurements in Young Stars  

NASA Astrophysics Data System (ADS)

Results of magnetic field measurements in CTTSs BP Tau and RW Aur are presented. Geometry and time variability of global magnetic field of these stars are discussed. Based on our observations and on the B|| measurements available to date, we argue that, in the case of BP Tau, at least in the He I 5876 line formation region, the magnetic field of the star is not stationary and can be restructured in a time of the order of several hours.

Smirnov, Daniil A.; Chuntonov, G. A.; Lamzin, Sergei A.

2007-08-01

330

School Context and Educational Outcomes: Results from a Quasi-Experimental Study.  

PubMed

In this study we draw on data from a quasi-experimental study to test whether moving into a subsidized housing development in an affluent suburb yields educational benefits to the children of residents, compared to the educations they would have received had they not moved into the development. Results suggest that resident children experienced a significant improvement in school quality compared with a comparison group of students whose parents also had applied for residence. Parents who were residents of the development also displayed higher levels of school involvement compared with the comparison group of non-resident parents, and their children were exposed to significantly lower levels of school disorder and violence within school and spent more time reading outside of school. Living in the development did not influence GPA directly, but did indirectly increase GPA by increasing the time residents spent reading outside of school. PMID:25342878

Casciano, Rebecca; Massey, Douglas S

2012-03-01

331

School Context and Educational Outcomes: Results from a Quasi-Experimental Study  

PubMed Central

In this study we draw on data from a quasi-experimental study to test whether moving into a subsidized housing development in an affluent suburb yields educational benefits to the children of residents, compared to the educations they would have received had they not moved into the development. Results suggest that resident children experienced a significant improvement in school quality compared with a comparison group of students whose parents also had applied for residence. Parents who were residents of the development also displayed higher levels of school involvement compared with the comparison group of non-resident parents, and their children were exposed to significantly lower levels of school disorder and violence within school and spent more time reading outside of school. Living in the development did not influence GPA directly, but did indirectly increase GPA by increasing the time residents spent reading outside of school. PMID:25342878

Casciano, Rebecca; Massey, Douglas S.

2013-01-01

332

Systematic Review of the Properties of Tools Used to Measure Outcomes in Anxiety Intervention Studies for Children with Autism Spectrum Disorders  

PubMed Central

Background Evidence about relevant outcomes is required in the evaluation of clinical interventions for children with autism spectrum disorders (ASD). However, to date, the variety of outcome measurement tools being used, and lack of knowledge about the measurement properties of some, compromise conclusions regarding the most effective interventions. Objectives This two-stage systematic review aimed to identify the tools used in studies evaluating interventions for anxiety for high-functioning children with ASD in middle childhood, and then to evaluate the tools for their appropriateness and measurement properties. Methods Electronic databases including Medline, PsychInfo, Embase, and the Cochrane database and registers were searched for anxiety intervention studies for children with ASD in middle childhood. Articles examining the measurement properties of the tools used were then searched for using a methodological filter in PubMed, and the quality of the papers evaluated using the COSMIN checklist. Results Ten intervention studies were identified in which six tools measuring anxiety and one of overall symptom change were used as primary outcomes. One further tool was included as it is recommended for standard use in UK children's mental health services. Sixty three articles on the properties of the tools were evaluated for the quality of evidence, and the quality of the measurement properties of each tool was summarised. Conclusions Overall three questionnaires were found robust in their measurement properties, the Spence Children's Anxiety Scale, its revised version – the Revised Children's Anxiety and Depression Scale, and also the Screen for Child Anxiety Related Emotional Disorders. Crucially the articles on measurement properties provided almost no evidence on responsiveness to change, nor on the validity of use of the tools for evaluation of interventions for children with ASD. PROSPERO Registration number CRD42012002684. PMID:24465519

Wigham, Sarah; McConachie, Helen

2014-01-01

333

Developing a patient-centered outcome measure for complementary and alternative medicine therapies II: Refining content validity through cognitive interviews  

PubMed Central

Background Available measures of patient-reported outcomes for complementary and alternative medicine (CAM) inadequately capture the range of patient-reported treatment effects. The Self-Assessment of Change questionnaire was developed to measure multi-dimensional shifts in well-being for CAM users. With content derived from patient narratives, items were subsequently focused through interviews on a new cohort of participants. Here we present the development of the final version in which the content and format is refined through cognitive interviews. Methods We conducted cognitive interviews across five iterations of questionnaire refinement with a culturally diverse sample of 28 CAM users. In each iteration, participant critiques were used to revise the questionnaire, which was then re-tested in subsequent rounds of cognitive interviews. Following all five iterations, transcripts of cognitive interviews were systematically coded and analyzed to examine participants' understanding of the format and content of the final questionnaire. Based on this data, we established summary descriptions and selected exemplar quotations for each word pair on the final questionnaire. Results The final version of the Self-Assessment of Change questionnaire (SAC) includes 16 word pairs, nine of which remained unchanged from the original draft. Participants consistently said that these stable word pairs represented opposite ends of the same domain of experience and the meanings of these terms were stable across the participant pool. Five pairs underwent revision and two word pairs were added. Four word pairs were eliminated for redundancy or because participants did not agree on the meaning of the terms. Cognitive interviews indicate that participants understood the format of the questionnaire and considered each word pair to represent opposite poles of a shared domain of experience. Conclusions We have placed lay language and direct experience at the center of questionnaire revision and refinement. In so doing, we provide an innovative model for the development of truly patient-centered outcome measures. Although this instrument was designed and tested in a CAM-specific population, it may be useful in assessing multi-dimensional shifts in well-being across a broader patient population. PMID:22206409

2011-01-01

334

[Treatment and outcome of Crohn's disease without initial complications. Results of a retrospective, multicenter Tunisian study].  

PubMed

The purpose of this study was to estimate and achieve the factors that have an influence on the evolution of the Chron's disease. This study was done in 124 patients reaching the diagnosis of Chron's disease between 1988 and 1997. The evolution of this disease was achieved in 87 patients. The Chron's disease was inactive among 31 patients (35-6%)--with discontinous evolution in 42 patients (48.3%) and active chronic in 14 patients (16-1%). The active chronic form of Chron's disease was twice more frequent among the smokers and the patients with age above 40 years--but this difference has no statistical significance. The indication of surgical treatment was realised in 21 patients and it takes place as result of failure of medical treatment in 16 patients (76-2%)--an abcess in 2 patents (9-5%) and iatrogenic perforation in 1 patient (4-8%). The age-sexe-smoke--the intensity of the initial attack and the nature of the treatment had no influence in the need of the surgical interfference. The Chron's disease showed the less severe evolution in this study--the age above 40 years and the consumption of smoke increased the frequency of active chronic form. PMID:12416354

Cheikh, Imed; Ben Ammar, Ahmed; Essid, Mejda; Azzouz, Messadak; Ettahri, Nabil; Krichene, Mohamed; Bouzaidi, Slim; Ennajar, Taoufik

2002-04-01

335

Assessment of root canal treatment outcomes performed by Turkish dental students: results after two years.  

PubMed

The aim of this study was to evaluate radiographically the periapical status and technical standard of root canal therapies performed by a group of undergraduate dental students in Turkey two years following completion of the treatments. A random sample of 264 patients who received root canal treatment from undergraduate students at the Yeditepe University Faculty of Dentistry in 2009 were recalled after two years. The study sample consisted of 319 root-filled teeth in 158 dental patients (females=97, males=61) who presented to the student clinics during that time frame. For each root-filled tooth, two periapical radiographs were examined to identify the periapical status, one showing pre-treatment and the other showing post-treatment status. The quality of endodontic treatment was examined according to the distance between the end of root filling and radiographic apex and the density of the obturation according to presence of voids within the root filling material. This examination found that 54.2 percent of roots had fillings of acceptable length, while 37.3 percent were short, 7.8 percent were overfilled, and 0.6 percent was unfilled; 2.5 percent of the teeth were observed with broken root canal instruments. After two years, PAI scores of teeth with acceptable length of root canal filling (0-2 mm from the radiographic apex) were found to be lower than those of the overfilling and short filling cases (>2mm) (p<0.01). Moreover, voids were detected in the root canal fillings of 52.7 percent of endodontically treated teeth. The PAI scores of root fillings with inadequate density were significantly higher than adequate ones (p<0.01). Although endodontic treatments performed by undergraduate students do not appear to be unqualified compared to those performed by general practitioners, more emphasis must be placed on the technical quality of endodontic treatment to obtain better results. PMID:23576596

Ilgüy, Dilhan; Ilgüy, Mehmet; Fisekçioglu, Erdogan; Ersan, Nilüfer; Tanalp, Jale; Dölekoglu, Semanur

2013-04-01

336

Effects of exercise on biobehavioral outcomes of fatigue during cancer treatment: results of a feasibility study.  

PubMed

Cancer treatment is associated with decreased hemoglobin (Hb) concentration and aerobic fitness (VO2 max), which may contribute to cancer-related fatigue (CRF) and decreased quality of life (QoL). Endurance exercise may attenuate CRF and improve QoL, but the mechanisms have not been thoroughly investigated. Objectives. To (a) determine the feasibility of conducting an exercise intervention among women receiving treatment for breast cancer; (b) examine the effects of exercise on Hb and VO2 max and determine their association with changes in CRF and QoL; and (c) investigate changes in selected inflammatory markers. Methods. Fourteen women receiving chemotherapy for Stages I-II breast cancer were randomly assigned to exercise (n = 7) or usual care (n = 7). Women in the exercise group performed supervised, individualized treadmill exercise 2-3 times/week for the duration of chemotherapy (9-12 weeks). Data were collected 4 times over 15-16 weeks. Results. Recruitment rate was 45.7%. Sixteen women consented and 14 completed the trial, for a retention rate of 87.5%. Adherence to exercise protocol was 95-97%, and completion of data collection was 87.5-100%. Exercise was well tolerated. VO2 max was maintained at prechemotherapy levels in exercisers but declined in the usual-care group (p < .05). Hb decreased (p < .001) in all participants as they progressed through chemotherapy. Exercise did not have significant effects on CRF or QoL. Changes in inflammatory markers favored the exercise group. Conclusions. Exercise during chemotherapy may protect against chemotherapy-induced decline in VO2 max but not Hb concentration. PMID:25504949

Al-Majid, Sadeeka; Wilson, Lori D; Rakovski, Cyril; Coburn, Jared W

2015-01-01

337

A systematic review of risk factors associated with accidental falls, outcome measures and interventions to manage fall risk in non-ambulatory adults.  

PubMed

Abstract Purpose: To systematically review peer-reviewed literature pertaining to risk factors, outcome measures and interventions managing fall risk in non-ambulatory adults. Methods: Twenty-one papers were selected for inclusion from databases including PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Scopus, Consumer Health Complete and Web of Science. Selected studies involved a description of fall related risk factors, outcomes to assess fall risk and intervention studies describing protocols to manage fall risk in non-ambulatory adults. Studies were selected by two reviewers and consultation provided by a third reviewer. Results: The most frequently cited risk factors/characteristics associated with falls included: wheelchair related characteristics, transfer activities, impaired seated balance and environmental factors. The majority of the outcomes were found to evaluate seated postural control. One intervention study was identified describing a protocol targeting specific problems of individual participants. A global fall prevention program was not identified. Conclusion: Several risk factors associated with falls were identified and must be understood by clinicians to better serve their clients. To improve objective assessment, a comprehensive outcome assessment specific to non-ambulatory adults is needed. Finally, additional research is needed to examine the impact of structured protocols to manage fall risk in non-ambulatory adults. Implications for Rehabilitation Falls are a common health concern for non-ambulatory adults. Risk factors commonly associated with falls include wheelchair related characteristics, transfer activities, impaired seated balance and environmental factors. Limited outcome measures are available to assess fall risk in non-ambulatory adults. Clinicians must be aware of the known risk factors and provide comprehensive education to their clients on the potential for falls. Additional research is needed to develop and evaluate protocols to clinically manage fall risk. PMID:25354146

Rice, Laura A; Ousley, Cherita; Sosnoff, Jacob J

2014-10-29

338

Large volume unresectable locally advanced non-small cell lung cancer: acute toxicity and initial outcome results with rapid arc  

PubMed Central

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 prescription was 66Gy in 33 fractions to mean PTV. Delivery was performed with two partial arcs with a 6 MV photon beam. Results From a dosimetric point of view, RA allowed us to respect most planning objectives on target volumes and organs at risk. In particular: for GTV D1% = 105.6 ± 1.7%, D99% = 96.7 ± 1.8%, D5%-D95% = 6.3 ± 1.4%; contra-lateral lung mean dose resulted in 13.7 ± 3.9Gy, for spinal cord D1% = 39.5 ± 4.0Gy, for heart V45Gy = 9.0 ± 7.0Gy, for esophagus D1% = 67.4 ± 2.2Gy. Delivery time was 133 ± 7s. At three months partial remission > 50% was observed in 56% of patients. Acute toxicities at 3 months showed 91% with grade 1 and 9% with grade 2 esophageal toxicity; 18% presented grade 1 and 9% with grade 2 pneumonia; no grade 3 acute toxicity was observed. The short follow-up does not allow assessment of local control and progression free survival. Conclusions RA proved to be a safe and advantageous treatment modality for NSCLC with large volumes. Long term observation of patients is needed to assess outcome and late toxicity. PMID:20950469

2010-01-01

339

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

340

Recent Jet Results and Precision s Measurements from HERA  

E-print Network

in many bins, designed for gluon PDF fit. #12;Charged Current Multijets at ZEUS Homer Wolfe JetsRecent Jet Results and Precision s Measurements from HERA Homer Wolfe University of Wisconsin Jets and s at HERA 1/16 #12;Deep Inelastic Scattering at HERA Homer Wolfe Jets and s at HERA 2/16 Jet

341

Outcomes of lower extremity orthopedic surgery in ambulatory children with cerebral palsy with and without gait analysis: results of a randomized controlled trial.  

PubMed

This study examined the impact of gait analysis on surgical outcomes in ambulatory children with cerebral palsy (CP) through a randomized controlled trial. 156 children with CP (94 male; age 10.2 ± 3.7 years) underwent gait analysis and were randomized to two groups: Gait Report group (N = 83), where the referring surgeon received the patient's gait analysis report, and Control group (N = 73), where the surgeon did not receive the gait report. Outcomes were assessed pre- and 1.3 ± 0.5 years post-operatively. An intent-to-treat analysis compared outcomes between the two groups. Outcome measures included the Gillette Functional Activity Questionnaire (FAQ), Gait Deviation Index (GDI), oxygen cost, gross motor function measure, Child Health Questionnaire (CHQ), Pediatric Outcomes Data Collection Instrument (PODCI), and Pediatric Evaluation and Disability Inventory. The outcomes that differed significantly between groups were change in health from the CHQ, which was rated as much better for 56% (46/82) of children in the Gait Report group compared with 38% (28/73) in the Control group (p = 0.04), and upper extremity physical function from the PODCI. Gait outcomes (FAQ and GDI) improved more when over half of the recommendations for a patient were followed or the recommended extent of surgery (none, single, or multi-level) was done (p ? 0.04). On average, however, only 42% of the recommendations were followed in the Gait Report group, compared with 35% in the Control group (p = 0.23). This is much less than the >85% reported in previous studies and may account for the lack of differences between groups for some of the outcome measures. PMID:23219787

Wren, Tishya A L; Otsuka, Norman Y; Bowen, Richard E; Scaduto, Anthony A; Chan, Linda S; Dennis, Sandra W; Rethlefsen, Susan A; Healy, Bitte S; Hara, Reiko; Sheng, Minya; Kay, Robert M

2013-06-01

342

Characterizing the relationship between fMRI derived measures and clinical outcomes in vascular lesion patients  

PubMed Central

Background and Purpose Functional magnetic resonance imaging (fMRI) has proven to be an effective component of pretreatment planning in patients harboring a variety of different brain lesions. Our group has recently reported significant relationships concerning distances between brain tumor border and area of functional activation (Lesion-to-Activation-Distance; LAD) with regard to patient morbidity and mortality. This study further examines the relationship between LAD, focusing on a host of vascular lesions, and pre- and posttreatment morbidity. Materials and Methods This study included a sample population (n=106) of patients with vascular lesions, primarily arteriovenous malformations (AVM) and cavernomas. These patients underwent pretreatment fMRI-based motor mapping (n=72) or language mapping (n=84). The impact of LAD and other variables derived from the patient medical record were analyzed with respect to functional deficits in terms of morbidity (weakness and/or aphasia). Results In patients with no pretreatment deficits, there was trend for a significant relationship between Wernicke's area LAD and posttreatment language deficits. In patients with or without pretreatment deficits, a trend toward significance was observed between sensorimotor LAD and posttreatment motor deficits. Additionally, lesion type (AVMs or cavernomas) impacted posttreatment deficits with more patients with cavernomas showing posttreatment language deficits than patients with AVMs. This difference was however not observed for posttreatment motor deficits. Conclusion These findings suggest that the proximity of a vascular lesion to sensorimotor and language areas is a relevant parameter in estimating patient prognosis in the peri-operative period. Additionally, vascular lesion type and existence of pretreatment deficits play a significant role in outcomes. PMID:23544414

Regner, Michael F.; Young, Brittany M.; Radtke, Andrew; Pankratz, Joshua; Holdsworth, Ryan L.; Baniulis, Dovile; Kornder, Nicole K.; Voss, Jed; Austin, Benjamin P.; Moritz, Chad; Meyerand, Elizabeth M.; Prabhakaran, Vivek

2013-01-01

343

DWPF STARTUP FRIT VISCOSITY MEASUREMENT ROUND ROBIN RESULTS  

SciTech Connect

A viscosity standard is needed to replace the National Institute of Standards and Technology (NIST) glasses currently being used to calibrate viscosity measurement equipment. The current NIST glasses are either unavailable or less than ideal for calibrating equipment to measure the viscosity of high-level waste glasses. This report documents the results of a viscosity round robin study conducted on the Defense Waste Processing Facility (DWPF) startup frit. DWPF startup frit was selected because its viscosity-temperature relationship is similar to most DWPF and Hanford high-level waste glass compositions. The glass underwent grinding and blending to homogenize the large (100 lb) batch. Portions of the batch were supplied to the laboratories (named A through H) for viscosity measurements following a specified temperature schedule with a temperature range of 1150 C to 950 C and with an option to measure viscosity at lower temperatures if their equipment was capable of measuring at the higher viscosities. Results were used to fit the Vogel-Tamman-Fulcher and Arrhenius equations to viscosity as a function of temperature for the entire temperature range of 460 C through 1250 C as well as the limited temperature interval of approximately 950 C through 1250 C. The standard errors for confidence and prediction were determined for the fitted models.

Crum, Jarrod V.; Edwards, Tommy B.; Russell, Renee L.; Workman, Phyllis J.; Schweiger, Michael J.; Schumacher, Ray F.; Smith, Donald E.; Peeler, David K.; Vienna, John D.

2012-07-31

344

Preliminary Results from the Smoke Aerosol Measurement Experiment - Reflight  

NASA Astrophysics Data System (ADS)

Preliminary results are presented from the Reflight of the Smoke Aerosol Measurement Experiment (SAME- R) which was conducted during Expedition 24 (July- September 2010). The reflight experiment built upon the results of the original flight during Expedition 15 by adding diagnostic measurements and expanding the test matrix. Five different materials representative of those found in spacecraft (Teflon, Kapton, cotton, silicone rubber and Pyrell) were heated to temperatures below the ignition point with conditions controlled to provide repeatable sample surface temperatures and air flow. Particle size determinations were made using aerosol instruments and by capturing particles for ground based examination in a Transmission Electron Microscope (TEM). Overall the majority of the average smoke particle sizes were found to be in the 200 to 400 nanometer range with the some of the quiescent cases producing substantially larger particles. When combined with particle morphology data from the TEM analysis, these results can be used to guide the design of future smoke detectors.

Urban, D. L.; Ruff, G. A.; Mulholland, G. W.; Yuan, Z.; Cleary, T.; Yang, J.; Meyer, M. E.; Bryg, V. M.

2012-01-01

345

Measuring International Service Outcomes: Implications for International Social Work Field Placements  

ERIC Educational Resources Information Center

International field placements are a unique educational opportunity for social work students to develop the skills they need for social work practice in a globalized world; however, outcomes of international placements have not been rigorously studied. This article reports on the International Volunteer Impacts Survey (IVIS), a 48-item survey…

Lough, Benjamin J.; McBride, Amanda Moore; Sherraden, Margaret S.

2012-01-01

346

MEASURING SUCESS: HOW CENSUSATSCHOOL ENGAGES CANADIAN STUDENTS IN ACTIVE LEARNING OUTCOMES  

Microsoft Academic Search

This paper examines the experiential process of statistical learning involved in Statistics Canada's Census at School project. It profiles students' learning outcomes and the contribution of classroom teachers, pre-service teachers, school boards and senior management of Statistics Canada in the project's success. NEW EXPECTATIONS FOR STUDENT LEARNING The Information age demands the teaching and learning of new skills in data

Mary Townsend

2006-01-01

347

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

348

Measurement results of DIPIX pixel sensor developed in SOI technology  

NASA Astrophysics Data System (ADS)

The development of integration type pixel detectors presents interest for physics communities because it brings optimization of design, simplicity of production-which means smaller cost, and reduction of detector material budget. During the last decade a lot of research and development activities took place in the field of CMOS Silicon-On-Insulator (SOI) technology resulting in improvement in wafer size, wafer resistivity and MIM capacitance. Several ideas have been tested successfully and are gradually entering into the application phase. Some of the novel concepts exploring SOI technology are pursued at KEK; several prototypes of dual mode integration type pixel (DIPIX) have been recently produced and described. This report presents initial test results of some of the prototypes including tests obtained with the infrared laser beams and Americium (Am-241) source. The Equivalent Noise Charge (ENC) of 86 e - has been measured. The measured performance demonstrates that SOI technology is a feasible choice for future applications.

Ahmed, Mohammed Imran; Arai, Yasuo; Idzik, Marek; Kapusta, Piotr; Miyoshi, Toshinobu; Turala, Michal

2013-08-01

349

Liposome Bupivacaine for Postsurgical Analgesia in Adult Patients Undergoing Laparoscopic Colectomy: Results from Prospective Phase IV Sequential Cohort Studies Assessing Health Economic Outcomes?  

PubMed Central

Background Opioid-based postsurgical analgesia exposes patients undergoing laparoscopic colectomy to elevated risk for gastrointestinal motility problems and other opioid-related adverse events (ORAEs). The purpose of our research was to investigate postsurgical outcomes, including opioid consumption, hospital length of stay, and ORAE risk associated with a multimodal analgesia regimen, employing a single administration of liposome bupivacaine as well as other analgesics that act by different mechanisms. Methods We analyzed combined results from 6 Phase IV, prospective, single-center studies in which patients undergoing laparoscopic colectomy received opioid-based intravenous patient-controlled analgesia (PCA) or multimodal analgesia incorporating intraoperative administration of liposome bupivacaine. As-needed rescue therapy was available to all patients. Primary outcome measures were postsurgical opioid consumption, hospital length of stay, and hospitalization costs. Secondary measures included time to first rescue opioid use, patient satisfaction with analgesia (assessed using a 5-point Likert scale), and ORAEs. Results Eighty-two patients underwent laparoscopic colectomy and did not meet intraoperative exclusion criteria (PCA n = 56; multimodal analgesia n = 26). Compared with the PCA group, the multimodal analgesia group had significantly lower mean total postsurgical opioid consumption (96 vs 32 mg, respectively; P < 0.0001) and shorter median postsurgical hospital length of stay (3.0 vs 4.0 days; P = 0.0019). Geometric mean costs were $11,234 and $13,018 in the multimodal analgesia and PCA groups, respectively (P = 0.2612). Median time to first rescue opioid use was longer in the multimodal analgesia group versus PCA group (1.1 hours vs 0.6 hours, respectively; P=0.0003). ORAEs were experienced by 41% of patients receiving intravenous opioid PCA and 8% of patients receiving multimodal analgesia (P = 0.0019). Study limitations included use of an open-label, nonrandomized design; small population size; and the inability to isolate treatment-related effects specifically attributable to liposome bupivacaine. Conclusions Compared with intravenous opioid PCA, a liposome bupivacaine-based multimodal analgesia regimen reduced postsurgical opioid use, hospital length of stay, and ORAEs, and may lead to improved postsurgical outcomes following laparoscopic colectomy. PMID:25031661

Candiotti, Keith A.; Sands, Laurence R.; Lee, Edward; Bergese, Sergio D.; Harzman, Alan E.; Marcet, Jorge; Kumar, Anjali S.; Haas, Eric

2013-01-01

350

A 10-year review of quality improvement monitoring in pain management: recommendations for standardized outcome measures.  

PubMed

Quality measurement in health care is complex and in a constant state of evolution. Different approaches are necessary depending on the purpose of the measurement (e.g., accountability, research, improvement). Recent changes in health care accreditation standards are driving increased attention to measurement of the quality of pain management for improvement purposes. The purpose of this article is to determine what indicators are being used for pain quality improvement, compare results across studies, and provide specific recommendations to simplify and standardize future measurement of quality for hospital-based pain management initiatives. Pain management quality improvement monitoring experience and data from 1992 to 2001 were analyzed from 20 studies performed at eight large hospitals in the United States. Hospitals included: the University of Wisconsin Hospital and Clinics, Madison; Texas Medical Center, Houston; McAllen Medical Center, McAllen, TX; San Francisco General Hospital, San Francisco; Rush-Presbyterian-St. Luke's Medical Center and Northwestern Memorial Hospital, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York; and Kaiser Sunnyside Medical Center of Kaiser Permanente Northwest, Clackamas, OR. Analyses of data led to consensus on six quality indicators for hospital-based pain management. These indicators include: the intensity of pain is documented with a numeric or descriptive rating scale; pain intensity is documented at frequent intervals; pain is treated by a route other than intramuscular; pain is treated with regularly administered analgesics, and when possible, a multimodal approach is used; pain is prevented and controlled to a degree that facilitates function and quality of life; and patients are adequately informed and knowledgeable about pain management. Although there are no perfect measures of quality, longitudinal data support the validity of a core set of indicators that could be used to obtain benchmark data for quality improvement in pain management in the hospital setting. PMID:12454804

Gordon, Debra B; Pellino, Teresa A; Miaskowski, Christine; McNeill, Jeanette Adams; Paice, Judith A; Laferriere, Daniel; Bookbinder, Marilyn

2002-12-01

351

Surgeon’s experiences of receiving peer benchmarked feedback using patient-reported outcome measures: a qualitative study  

PubMed Central

Background The use of patient-reported outcome measures (PROMs) to provide healthcare professionals with peer benchmarked feedback is growing. However, there is little evidence on the opinions of professionals on the value of this information in practice. The purpose of this research is to explore surgeon’s experiences of receiving peer benchmarked PROMs feedback and to examine whether this information led to changes in their practice. Methods This qualitative research employed a Framework approach. Semi-structured interviews were undertaken with surgeons who received peer benchmarked PROMs feedback. The participants included eleven consultant orthopaedic surgeons in the Republic of Ireland. Results Five themes were identified: conceptual, methodological, practical, attitudinal, and impact. A typology was developed based on the attitudinal and impact themes from which three distinct groups emerged. ‘Advocates’ had positive attitudes towards PROMs and confirmed that the information promoted a self-reflective process. ‘Converts’ were uncertain about the value of PROMs, which reduced their inclination to use the data. ‘Sceptics’ had negative attitudes towards PROMs and claimed that the information had no impact on their behaviour. The conceptual, methodological and practical factors were linked to the typology. Conclusion Surgeons had mixed opinions on the value of peer benchmarked PROMs data. Many appreciated the feedback as it reassured them that their practice was similar to their peers. However, PROMs information alone was considered insufficient to help identify opportunities for quality improvements. The reasons for the observed reluctance of participants to embrace PROMs can be categorised into conceptual, methodological, and practical factors. Policy makers and researchers need to increase professionals’ awareness of the numerous purposes and benefits of using PROMs, challenge the current methods to measure performance using PROMs, and reduce the burden of data collection and information dissemination on routine practice. PMID:24972784

2014-01-01

352

The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR): A Measure of Health-Related Quality of Life and Quality of Life for Patients with Pulmonary Hypertension  

Microsoft Academic Search

Objective: No outcome measures specific to pulmonary hypertension (PH) currently exist. The aim of the study was to develop health-related\\u000a quality of life (symptoms and functioning) scales and a quality of life scale that would allow comprehensive, accurate and\\u000a valid patient-reported outcome assessment in clinical studies. Methods: The content of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) was derived from

S. P. McKenna; N. Doughty; D. M. Meads; L. C. Doward; J. Pepke-Zaba

2006-01-01

353

Trigeminal Neurosensory Deficit and Patient Reported Outcome Measures: The Effect on Quality of Life  

PubMed Central

Objectives To investigate the effect of persistent neurosensory disturbance of the lingual nerve (LN) or inferior alveolar nerve (IAN) on general health and oral health- related quality of life (QoL). Methods The study design was a case-control study. Patients with persistent neurosensory deficit of LN or IAN after lower third molar surgery (for 12 months or more) were the study group. The control group was an age and gender matched sample of patients who had dental extractions or lower third molar surgeries without trigeminal neurosensory deficit. The outcome variables were the general health and oral health-related QoL. General health-related QoL was assessed using the 36-item Short Form Health Survey (SF-36) and oral health-related QoL using the 14-item Short Form Oral Health Impact Profile (OHIP-14). Differences in SF-36 scores and OHIP-14 scores between the groups were compared. Results Forty-eight subjects (24 cases and 24 controls) were recruited. When compared to the control group, patients with neurosensory deficits had poorer Mental-Health Component Scores (MCS) (p?=?0.005), General Health (p?=?0.023), Vitality (p?=?0.048), Social Functioning (p?=?0.003), Role-emotion (p?=?0.008) and Mental Health (p?=?0.022). The OHIP-14 scores were also significantly worse in this patients with neurosensory deficits compared with the control group (p?=?0.002). When compared within the study group, older patient with neurosensory deficit was found to correlate with worse Physical Health Component Scores (PCS) (p?=?0.02) and OHIP-14 scores (p?=?0.02), while more severe visualized analog scaling rating of numbness was correlated with a worse PCS (p?=?0.034). Conclusions Patients with persistent LN or IAN deficit after lower third molar surgery have poorer health-related QoL and poorer oral health-related QoL than those without such deficits. PMID:24204820

Leung, Yiu Yan; McGrath, Colman; Cheung, Lim Kwong

2013-01-01

354

Birth outcome measures and maternal exposure to heavy metals (lead, cadmium and mercury) in Saudi Arabian population.  

PubMed

This cross-sectional study was conducted to assess the association between exposure to heavy metals (lead, cadmium and mercury) during pregnancy and birth outcomes in 1578 women aged 16-50 years who delivered in Al-Kharj hospital, Saudi Arabia, in 2005 and 2006. The levels of lead, cadmium and mercury were measured in umbilical cord blood, maternal blood and the placenta. Outcome variables were anthropometric measures taken at birth, along with the risk of being small-for-gestational age (SGA). We selected the 10th percentile as the cutoff for dichotomizing measures of birth outcome. Cadmium, despite its partial passage through the placenta had the most prominent effect on several measures of birth outcome. After adjustment for potential confounders, logistic regression models revealed that crown-heel length (p=0.034), the Apgar 5-minute score (p=0.004), birth weight (p=0.015) and SGA (p=0.049) were influenced by cadmium in the umbilical cord blood. Significant decreases in crown-heel length (p=0.007) and placental thickness (p=0.022) were seen with higher levels of cadmium in maternal blood. As placental cadmium increased, cord length increased (p=0.012) and placental thickness decreased (p=0.032). Only lead levels in maternal blood influenced placental thickness (p=0.011). Mercury in both umbilical cord and maternal blood was marginally associated with placental thickness and placental weight, respectively. Conversely, placental mercury levels significantly influenced head circumference (p=0.017), the Apgar 5-minute score (p=0.01) and cord length (p=0.026). The predictions of these models were further assessed with the area under the curve (AUC) of the receiver operating curves (ROCs), which were modest (larger than 0.5 and smaller than 0.7). The independence of gestational age or preterm births on the observed effect of metals on some measures of birth outcome, suggested detrimental effects of exposure on fetal development. The magnitude of the estimated effects might not necessarily be of clinical significance for infants but may have a considerable public-health relevance given the high prevalence of exposure to heavy metals. Further research should be conducted to confirm these findings and to evaluate their long-term risks, if any. PMID:23735463

Al-Saleh, Iman; Shinwari, Neptune; Mashhour, Abdullah; Rabah, Abdullah

2014-03-01

355

Comparison of ablation stake measurements and Airborne Laser Scanning results  

NASA Astrophysics Data System (ADS)

Ablation measurements using ablation stakes are a well-established method in glaciology, which sees a lot of use. However, ablation stakes cannot always be installed and read at a sufficient number of points on a glacier or on multiple glaciers, due to limited personnel and financial capacities or because of inaccessible areas due to dangerous zones (crevasses, rock falls, avalanches) or remote terrain. Furthermore, ablation stakes only enable measurements of surface melt, whereas basal or internal melt processes as well as surface change related to glacier dynamics cannot be measured. Multi temporal Airborne laser scanning (ALS) can provide high resolution and very accurate topographic information for the whole glacier area, which allows the calculation of the difference in surface height and therefore - if the density profile is known or can be estimated - the determination of the local mass balance, including processes like basal melt at least to a certain degree. To gain a better understanding of the differences between ablation stake readings and differential ALS data at the stake locations, the results of both methods have been compared in detail. At Langenferner, a glacier in the Italian Eastern Alps, where mass balance measurements have been carried out since 2004, three ALS campaigns have been conducted at the end of the hydrological year in 2005, 2010 and 2013. There are about 30 ablation stakes installed at the glacier, which have been read during or very close to the time of the flight campaigns. The ablation measurements are then compared to the surface differences calculated from ALS data at the locations of the ablation stakes. To take the movement of the stakes due to glacier dyanmics into account, the position of the stakes has been measured with a differential GPS.

Rieg, Lorenzo; Galos, Stephan; Klug, Christoph; Sailer, Rudolf

2014-05-01

356

Results of ozone measurements in Northern Germany: A case study  

NASA Technical Reports Server (NTRS)

At most of the German ozone recording stations which have records over a sufficiently long period, the results of the summer months of 1989 showed the highest values since the beginning of the measurements. One of the reasons for this phenomenon was the high duration of sunshine in that summer; for example, in Potsdam near Berlin in May 1989 the sunshine duration was the highest in May since the beginning of the records in 1893. For that reason we selected this summer for a case study. The basis for the study was mainly the ozone measuring stations of the network of Lower Saxony and the Federal Office of Environment (Umweltbundesamt). The results of these summer measurements point to intense sources of ozone, probably in form of gaseous precursors, in the Middle German industrial areas near Leipzig and Halle and in Northwestern Czechoslovakia, with coal-mining, chemical and petrochemical industries, coking plants and others. The maps of average ozone concentrations, number or days with high ozone maxima, ozone-windroses of the stations, etc., suggest that these areas could be a main source of precursors and of photochemical ozone production in summer smog episodes in Central Europe. Stations on the North Sea coast, at which early ozone measurements were made by our institute in 1973/74 are compared with similarly located stations of the Lower Saxon network in 1989 and the results show a reversal of the ozone-windroses. In 1973/74, the highest ozone concentrations were correlated with wind directions from the sea while in 1989 these concentrations were correlated with directions from the continent. In the recent years, photochemical ozone production on the continent is probably predominant, while in former years the higher ozone content of the maritime subpolar air masses has been explained by stratospheric-tropospheric exchange.

Schmidt, Manfred

1994-01-01

357

Hypoxic Prostate/Muscle PO{sub 2} Ratio Predicts for Outcome in Patients With Localized Prostate Cancer: Long-Term Results  

SciTech Connect

Purpose: To correlate tumor oxygenation status with long-term biochemical outcome after prostate brachytherapy. Methods and Materials: Custom-made Eppendorf PO{sub 2} microelectrodes were used to obtain PO{sub 2} measurements from the prostate (P), focused on positive biopsy locations, and normal muscle tissue (M), as a control. A total of 11,516 measurements were obtained in 57 men with localized prostate cancer immediately before prostate brachytherapy was given. The Eppendorf histograms provided the median PO{sub 2}, mean PO{sub 2}, and % <5 mm Hg or <10 mm Hg. Biochemical failure (BF) was defined using both the former American Society of Therapeutic Radiation Oncology (ASTRO) (three consecutive raises) and the current Phoenix (prostate-specific antigen nadir + 2 ng/mL) definitions. A Cox proportional hazards regression model evaluated the influence of hypoxia using the P/M mean PO{sub 2} ratio on BF. Results: With a median follow-up time of 8 years, 12 men had ASTRO BF and 8 had Phoenix BF. On multivariate analysis, P/M PO{sub 2} ratio <0.10 emerged as the only significant predictor of ASTRO BF (p = 0.043). Hormonal therapy (p = 0.015) and P/M PO{sub 2} ratio <0.10 (p = 0.046) emerged as the only independent predictors of the Phoenix BF. Kaplan-Meier freedom from BF for P/M ratio <0.10 vs. {>=}0.10 at 8 years for ASTRO BF was 46% vs. 78% (p = 0.03) and for the Phoenix BF was 66% vs. 83% (p = 0.02). Conclusions: Hypoxia in prostate cancer (low mean P/M PO{sub 2} ratio) significantly predicts for poor long-term biochemical outcome, suggesting that novel hypoxic strategies should be investigated.

Turaka, Aruna [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Buyyounouski, Mark K., E-mail: mark.buyyounouski@fccc.edu [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Hanlon, Alexandra L. [School of Nursing, University of Pennsylvania, Philadelphia, PA (United States); Horwitz, Eric M. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Greenberg, Richard E. [Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA (United States); Movsas, Benjamin [Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI (United States)

2012-03-01

358

The quality of spine surgery from the patient's perspective. Part 1: the Core Outcome Measures Index in clinical practice.  

PubMed

The Core Outcome Measures Index (COMI) is a short, multidimensional outcome instrument, with excellent psychometric properties, that has been recommended for use in monitoring the outcome of spinal surgery from the patient's perspective. This study examined the feasibility of implementation of COMI and its performance in clinical practice within a large Spine Centre. Beginning in March 2004, all patients undergoing spine surgery in our Spine Centre (1,000-1,200 patients/year) were asked to complete the COMI before and 3, 12 and 24 months after surgery. The COMI has one question each on back (neck) pain intensity, leg/buttock (arm/shoulder) pain intensity, function, symptom-specific well being, general quality of life, work disability and social disability, scored as a 0-10 index. At follow-up, patients also rated the global effectiveness of surgery, and their satisfaction with their treatment in the hospital, on a five-point Likert scale. After some fine-tuning of the method of administration, completion rates for the pre-op COMI improved from 78% in the first year of operation to 92% in subsequent years (non-response was mainly due to emergencies or language or age issues). Effective completion rates at 3, 12 and 24-month follow-up were 94, 92 and 88%, respectively. The 12-month global outcomes (from N = 3,056 patients) were operation helped a lot, 1,417 (46.4%); helped, 860 (28.1%); helped only little, 454 (14.9%); did not help, 272 (8.9%); made things worse, 53 (1.7%). The mean reductions in COMI score for each of these categories were 5.4 (SD2.5); 3.1 (SD2.2); 1.3 (SD1.7); 0.5 (SD2.2) and -0.7 (SD2.2), respectively, yielding respective standardised response mean values ("effect sizes") for each outcome category of 2.2, 1.4, 0.8, 0.2 and 0.3, respectively. The questionnaire was feasible to implement on a prospective basis in routine practice, and was as responsive as many longer spine outcome questionnaires. The shortness of the COMI and its multidimensional nature make it an attractive option to comprehensively assess all patients within a given Spine Centre and hence avoid selection bias in reporting outcomes. PMID:19319578

Mannion, Anne F; Porchet, F; Kleinstück, F S; Lattig, F; Jeszenszky, D; Bartanusz, V; Dvorak, J; Grob, D

2009-08-01

359

Predictive Validity of Callous-unemotional Traits Measured in Early Adolescence with Respect to Multiple Antisocial Outcomes  

PubMed Central

This study investigated the predictive validity of youth callous-unemotional (CU) traits, as measured in early adolescence (grade 7) by the Antisocial Process Screening Device (APSD; Frick & Hare, 2001), in a longitudinal sample (N = 754). Antisocial outcomes, assessed in adolescence and early adulthood, included self-reported general delinquency from 7th grade through 2-years post-high school; self-reported serious crimes through 2-years post-high school, juvenile and adult arrest records through 1-year post-high school; and antisocial personality disorder symptoms and diagnosis at 2-years post-high school. CU traits measured in 7th grade were highly predictive of five of the six antisocial outcomes: general delinquency, juvenile and adult arrests, and early adult antisocial personality disorder criterion count and diagnosis, over and above prior and concurrent conduct problem behavior (i.e., criterion counts of oppositional defiant disorder and conduct disorder) and ADHD (criterion count). Incorporating a CU traits specifier for those with a diagnosis of conduct disorder improved the positive prediction of antisocial outcomes, with a very low false positive rate. There was minimal evidence of moderation by sex, race, or urban/rural status. Urban/rural status moderated one finding, with being from an urban area associated with stronger relations between CU traits and adult arrests. Findings clearly support the inclusion of CU traits as a specifier for the diagnosis of CD, at least with respect to predictive validity. PMID:20939651

McMahon, Robert J.; Witkiewitz, Katie; Kotler, Julie S.

2013-01-01

360

Measuring the contribution of nursing to quality, patient safety, and health care outcomes.  

PubMed

In 2004, the National Quality Forum (NQF) endorsed a set of voluntary consensus standards for nursing-sensitive care that quantifies nursing's contribution to patient safety, health care outcomes, and a professional work environment. Since endorsement, these consensus standards have been the basis for research, quality improvement, and policy setting. This article provides a summary of NQF's consensus development process and various efforts that have cascaded from the endorsement of these consensus standards. PMID:17470769

Kurtzman, Ellen T; Corrigan, Janet M

2007-02-01

361

The relationship between the neighbourhood environment and adverse birth outcomes. — Measures of the Food Environment  

Cancer.gov

Intrauterine growth retardation and preterm birth are more frequent in African-American women and women of lower socio-economic status, but the reasons for these disparities are not fully understood. The physical and social environments in which these women live may contribute to these disparities. We conducted a multilevel study to explore whether conditions of mothers' neighbourhood of residence contribute to adverse birth outcomes independent of individual-level determinants.

362

Multivariate analysis of the Fugl-Meyer outcome measures assessing the effectiveness of GENTLE/S robot-mediated stroke therapy  

PubMed Central

Background Robot-mediated therapies offer entirely new approaches to neurorehabilitation. In this paper we present the results obtained from trialling the GENTLE/S neurorehabilitation system assessed using the upper limb section of the Fugl-Meyer (FM) outcome measure. Methods We demonstrate the design of our clinical trial and its results analysed using a novel statistical approach based on a multivariate analytical model. This paper provides the rational for using multivariate models in robot-mediated clinical trials and draws conclusions from the clinical data gathered during the GENTLE/S study. Results The FM outcome measures recorded during the baseline (8 sessions), robot-mediated therapy (9 sessions) and sling-suspension (9 sessions) was analysed using a multiple regression model. The results indicate positive but modest recovery trends favouring both interventions used in GENTLE/S clinical trial. The modest recovery shown occurred at a time late after stroke when changes are not clinically anticipated. Conclusion This study has applied a new method for analysing clinical data obtained from rehabilitation robotics studies. While the data obtained during the clinical trial is of multivariate nature, having multipoint and progressive nature, the multiple regression model used showed great potential for drawing conclusions from this study. An important conclusion to draw from this paper is that this study has shown that the intervention and control phase both caused changes over a period of 9 sessions in comparison to the baseline. This might indicate that use of new challenging and motivational therapies can influence the outcome of therapies at a point when clinical changes are not expected. Further work is required to investigate the effects arising from early intervention, longer exposure and intensity of the therapies. Finally, more function-oriented robot-mediated therapies or sling-suspension therapies are needed to clarify the effects resulting from each intervention for stroke recovery. PMID:17309791

Amirabdollahian, Farshid; Loureiro, Rui; Gradwell, Elizabeth; Collin, Christine; Harwin, William; Johnson, Garth

2007-01-01

363

Outcome measures to evaluate new technology for tonsillectomy: preliminary experience with Coblation  

NASA Astrophysics Data System (ADS)

Evaluating the benefits of new surgical technologies does not end with the observation of successful instrument-to- tissue interaction. The impact of new technologies in medicine today is also gauged by improvements in patients' daily activities and performance. We present our outcomes assessment tool for judging the value of applying a novel tonsillectomy technique, plasma- mediated ablation using Coblation technology. Plasma- mediated ablation (PMA) achieves soft tissue resection in the oropharynx by energizing protons to break bonds. Less heat is released, allowing for less thermal injury, and possibly less pain, than with tonsillectomy performed using electrocautery alone. Children undergoing tonsillectomy by PMA, were evaluated using our outcomes-based scale, which asked families to report the degree of interruption of normal activities for the patient and their family during the post-tonsillectomy recovery period. A preliminary review of several outcomes assessments exemplify the benefits and limitations of this tool. The tracking of valuable data is weighed against the limitations of a short time course relative to the duration of disability, and a poor response rate. Future work aims to improve this data collection tool to allow application to other new technologies in otolaryngology.

Shah, Udayan K.; Puchalski, Robert; Briggs, Marianne; Chiavacci, Rosetta; Galinkin, Jeffrey

2001-05-01

364

Short and Long Term Measures of Anxiety Exhibit Opposite Results  

PubMed Central

Animal models of human diseases of the central nervous system, generalized anxiety disorder included, are essential for the study of the brain-behavior interface and obligatory for drug development; yet, these models fail to yield new insights and efficacious drugs. By increasing testing duration hundredfold and arena size tenfold, and comparing the behavior of the common animal model to that of wild mice, we raise concerns that chronic anxiety might have been measured at the wrong time, for the wrong duration, and in the wrong animal. Furthermore, the mice start the experimental session with a short period of transient adaptation to the novel environment (habituation period) and a long period reflecting the respective trait of the mice. Using common measures of anxiety reveals that mice exhibit opposite results during these periods suggesting that chronic anxiety should be measured during the post-habituation period. We recommend tools for measuring the transient period, and provide suggestions for characterizing the post habituation period. PMID:23119008

Fonio, Ehud; Benjamini, Yoav; Golani, Ilan

2012-01-01

365

Atmospheric Measurements by the Geoscience Laser Altimeter System: Initial Results  

NASA Technical Reports Server (NTRS)

The Geoscience Laser Altimeter System launched in early 2003 is the first satellite instrument in space to globally observe the distribution of clouds and aerosol through laser remote sensing. The instrument is a basic backscatter lidar that operates at two wavelengths, 532 and 1064 nm. The mission data products for atmospheric observations include the calibrated, observed, attenuated backscatter cross section for cloud and aerosol; height detection for multiple cloud layers; planetary boundary layer height; cirrus and aerosol optical depth and the height distribution of aerosol and cloud scattering cross section profiles. The data is expected to significantly enhance knowledge in several areas of atmospheric science, in particular the distribution, transport and influence of atmospheric aerosol. Measurements of the coverage and height of polar and cirrus cloud should be significantly more accurate than previous global measurement. Initial result from the first several months of operation will be presented.

Spinhirne, J. D.; Palm, S. P.; Hlavka, D. L.; Hart, W. D.; Mahesh, A.; Welton, E. J.

2003-01-01

366

Results of precision mass measurements from CARIBU with the CPT  

NASA Astrophysics Data System (ADS)

An array of neutron-rich nuclides from the CAlifornium Rare Isotope Breeder Upgrade (CARIBU) at ANL beyond ^132Sn has been subjected to precision mass measurements with the Canadian Penning Trap mass spectrometer, including many never-before-measured nuclides. Neutron-separation energies calculated directly from these results provide essential input to models of the astrophysical r-process. Trends in binding energies far from stability provide input to nuclear mass models and identify regions of deformation. Additional nuclear structure information can be extracted from symmetry energy and observations of isomeric states. Implications for all of these topics will be discussed as well as future plans with the more intense CARIBU source.

van Schelt, J.; Lascar, D.; Savard, G.; Clark, J. A.; Greene, J. P.; Levand, A. F.; Sun, T.; Zabransky, B. J.; Caldwell, S.; Sternberg, M. G.; Chaudhuri, A.; Sharma, K. S.; Li, G.

2011-10-01

367

Parent-Child Interaction Therapy for Children Born Premature: A Case Study and Illustration of Vagal Tone as a Physiological Measure of Treatment Outcome  

PubMed Central

Evidence-based psychosocial interventions for externalizing behavior problems in children born premature have not been reported in the literature. This single-case study describes Parent-Child Interaction Therapy (PCIT) with a 23-month-old child born at 29 weeks gestation weighing 1,020 grams, who presented with significant externalizing behavior problems. Treatment outcome was assessed using standard measures of maternal and child functioning and observational measures of the parent-child interaction, as well as a physiological measure of heart rate variability (i.e., vagal tone) used to assess parasympathetic control in the child. Maternal reports of child behavior problems and their own stress and depressive symptoms decreased after treatment. Behavioral observations demonstrated improved parenting practices and child compliance, and vagal tone showed comparable increases as well. Results suggest that PCIT is a promising psychosocial intervention for children born premature with externalizing behavior problems, and that vagal tone may be a useful measure of treatment outcome. PMID:20428470

Bagner, Daniel M.; Sheinkopf, Stephen J.; Miller-Loncar, Cynthia L.; Vohr, Betty R.; Hinckley, Matthew; Eyberg, Sheila M.; Lester, Barry M.

2010-01-01

368

National Roundtable on Outcome Measures in Child Welfare Services (2nd, San Antonio, Texas, April 7-9, 1994): Summary of the Proceedings.  

ERIC Educational Resources Information Center

The second annual roundtable represents an on-going effort to share knowledge and information and to develop a common agenda and measure the achievement outcomes in child welfare. This roundtable's goals included: (1) reviewing and selecting appropriate outcomes for children and families in child welfare systems; (2) building understanding of a…

American Humane Association, Englewood, CO. Children's Div.

369

Mindfulness: A systematic review of instruments to measure an emergent patientreported outcome (PRO)  

PubMed Central

Purpose Mindfulness has emerged as an important health concept based on evidence that mindfulness interventions reduce symptoms and improve health-related quality of life. The objectives of this study were to systematically assess and compare the properties of instruments to measure self-reported mindfulness. Methods Ovid Medline®, CINAHL®, and PsycINFO® were searched through May 2012, and articles were selected if their primary purpose was development or evaluation of the measurement properties (validity, reliability, responsiveness) of a self-report mindfulness scale. Two reviewers independently evaluated the methodological quality of the selected studies using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. Discrepancies were discussed with a third reviewer, and scored by consensus. Finally, a level of evidence approach was used to synthesize results and study quality. Results Our search strategy identified a total of 2,588 articles. Forty-six articles, reporting 79 unique studies, met inclusion criteria. Ten instruments quantifying mindfulness as a unidimensional scale (n=5) or as a set of 2 to 5 subscales (n=5) were reviewed. The Mindful Attention Awareness Scale (MAAS) was evaluated by the most studies (n=27), and had positive overall quality ratings for most of the psychometric properties reviewed. The Five Facet Mindfulness Questionnaire (FFMQ) received the highest possible rating (“consistent findings in multiple studies of good methodological quality”) for two properties, internal consistency and construct validation by hypothesis testing. However, none of the instruments had sufficient evidence of content validity. Comprehensiveness of construct coverage had not been assessed; qualitative methods to confirm understanding and relevance were absent. In addition, estimates of test-retest reliability, responsiveness, or measurement error to guide users in protocol development or interpretation of scores were lacking. Conclusions Current mindfulness scales have important conceptual differences, and none can be strongly recommended based solely on superior psychometric properties. Important limitations in the field are the absence of qualitative evaluations and accepted external referents to support construct validity. Investigators need to proceed cautiously before optimizing any mindfulness intervention based on the existing scales. PMID:23539467

Park, Taehwan; Reilly-Spong, Maryanne

2013-01-01

370

Presentation and outcomes among patients with isolated myeloid sarcoma: a Surveillance, Epidemiology, and End Results database analysis.  

PubMed

Isolated myeloid sarcoma (MS) is a rare extramedullary presentation of acute myeloid leukemia (AML). Little is known about MS outcomes due to its rarity. A population-based analysis of MS using the Survival, Epidemiology, and End Results (SEER) database was performed. We identified 345 patients, aged 15 or older, diagnosed with isolated MS between 1973 and 2010. Overall survival (OS) was calculated and compared between MS and non-MS AML using the log-rank test. Survival was also evaluated based upon the primary site of disease presentation. The 3-year survival rate for MS (0.319; 95% confidence interval [CI]: 0.267-0.371) was greater than for non-MS AML (0.172; 95% CI: 0.168-0.175). There was variation in survival based on the site of involvement. The survival rates for isolated MS involving the pelvis/genitourinary organs, eyes/gonads and gastrointestinal mucosa appeared to be slightly improved when compared to primary sites of soft tissues, lymphatic/hematopoietic tissues or nervous system. PMID:25213180

Movassaghian, Maryam; Brunner, Andrew M; Blonquist, Traci M; Sadrzadeh, Hossein; Bhatia, Ashmeet; Perry, Ashley M; Attar, Eyal C; Amrein, Philip C; Ballen, Karen K; Neuberg, Donna S; Fathi, Amir T

2014-10-01

371

Genetic deletion of Fatty Acid Amide Hydrolase results in improved long-term outcome in chronic autoimmune encephalitis.  

PubMed

The enzyme Fatty Acid Amide Hydrolase (FAAH) is a key regulator of the endogenous levels of a family of biologically active lipid mediators, the fatty acid amides. These include anandamide, oleoyl ethanolamide and palmitoyl ethanolamide, and their effects are mediated by a variety of downstream targets including cannabinoid receptors and peroxisome proliferator-activated receptors (PPARs). Activation of both of these may have anti-inflammatory and neuroprotective effects. Levels of all three mediators are low in normal nervous tissue, but substantially elevated in mice lacking FAAH as a result of genetic deletion. There is a long anecdotal history of cannabis use by patients suffering from multiple sclerosis, and preclinical studies have indicated beneficial effects of cannabinoid receptor stimulation on both long-term outcome and acute muscle spasm in rodent models of multiple sclerosis (experimental autoimmune encephalitis; EAE). Thus far no report has appeared on the effect of inhibition of FAAH on the progression of EAE. Using a chronic mouse EAE model, we present data indicating that mice lacking FAAH experience an initial inflammatory phase of EAE similar in severity to wild type controls, but exhibited a more substantial clinical remission compared to wild type mice. PMID:18501510

Webb, Michael; Luo, Lin; Ma, Jing Ying; Tham, Chui-Se

2008-07-01

372

Outcome of alloanergized haploidentical bone marrow transplantation after ex vivo costimulatory blockade: results of 2 phase 1 studies  

PubMed Central

We report the outcomes of 24 patients with high-risk hematologic malignancies or bone marrow failure (BMF) who received haploidentical bone marrow transplantation (BMT) after ex vivo induction of alloantigen-specific anergy in donor T cells by allostimulation in the presence of costimulatory blockade. Ninety-five percent of evaluable patients engrafted and achieved full donor chimerism. Despite receiving a median T-cell dose of 29 ×106/kg, only 5 of 21 evaluable patients developed grade C (n = 4) or D (n = 1) acute graft-versus-host disease (GVHD), with only one attributable death. Twelve patients died from treatment-related mortality (TRM). Patients reconstituted T-cell subsets and immunoglobulin levels rapidly with evidence of in vivo expansion of pathogen-specific T cells in the early posttransplantation period. Five patients reactivated cytomegalovirus (CMV), only one of whom required extended antiviral treatment. No deaths were attributable to CMV or other viral infections. Only 1 of 12 evaluable patients developed chronic GVHD. Eight patients survive disease-free with normal performance scores (median follow-up, 7 years). Thus, despite significant early TRM, ex vivo alloanergization can support administration of large numbers of haploidentical donor T cells, resulting in rapid immune reconstitution with very few viral infections. Surviving patients have excellent performance status and a low rate of chronic GVHD. PMID:18617635

Davies, Jeff K.; Gribben, John G.; Brennan, Lisa L.; Yuk, Dongin; Nadler, Lee M.

2008-01-01

373

New results of magnetic field measurements for BP Tau  

NASA Astrophysics Data System (ADS)

We present measurements of the longitudinal magnetic field component B ? of the young star BP Tau in the He I 5876 emission line formation region, i.e., in the accretion flow near the stellar surface. The values obtained (?1.7 kG and ?1.0 kG in 2000 and 2001, respectively) agree with the results of similar measurements by other authors. At the same time, we show that the previously obtained field strength at the magnetic pole, B p, and the inclination of the magnetic axis to the rotation axis, ?, are untrustworthy. In our opinion, based on the B ? measurements available to date, it is not possible to conclude whether the star’s magnetic field is a dipole one or has a more complex configuration and to solve the question of whether this field is stationary. However, we argue that at least in the He I 5876 line formation region, the star’s magnetic field is not stationary and can be restructured in a time of the order of several hours. Nonstationary small-scale magnetic fields of active regions on the stellar surface and/or magnetospheric field line reconnection due to the twisting of these field lines as the star rotates could be responsible for the short-term magnetic field variability. It seems highly likely that there are no strictly periodic variations in brightness and emission line profiles in BP Tau due to the irregular restructuring of the star’s magnetic field.

Chuntonov, G. A.; Smirnov, D. A.; Lamzin, S. A.

2007-01-01

374

Measurement of novel biomarkers to predict chronic heart failure outcomes and left ventricular remodeling.  

PubMed

Myocardial remodeling is pivotal in the progression and complication of chronic heart failure (HF). We assessed serial measurement of five biomarkers with biologic links to remodeling (biglycan, secreted frizzled-related protein 3, endostatin, insulin-like growth factor binding protein 7 [IGFBP7], mimecan) in 142 patients with HF followed through 882 office visits. IGFBP7 and mimecan were most associated with events; in fully adjusted models, lower IGFBP7 concentrations across visits independently predicted fewer events (odds ratio [OR]?= 0.83; 95 % confidence interval [CI]?= 0.73-0.95, p = 0.01). Subjects with rising mimecan had greater decrease in left ventricular end diastolic (p = 0.07) and systolic (p = 0.01) volumes, greater increase in ejection fraction (p = 0.02), and had lowest event rates. Statistical models suggested several HF medications might lead to changes in both IGFBP7 and mimecan values. The results suggest serial measurement of IGFBP7 provides prognostic information, while changes in mimecan provide unique information regarding myocardial remodeling. PMID:24309956

Motiwala, Shweta R; Szymonifka, Jackie; Belcher, Arianna; Weiner, Rory B; Baggish, Aaron L; Gaggin, Hanna K; Bhardwaj, Anju; Januzzi, James L

2014-03-01

375

Effect of early active range of motion rehabilitation on outcome measures after partial meniscectomy.  

PubMed

Range of motion (ROM) exercises are accepted as being an essential part of post-operative knee rehabilitation but there is little research to support this treatment. Our purpose was to determine whether a specific early, active ROM intervention using a bicycle ergometer equipped with an adjustable pedal arm offered measurable benefit to post-operative partial meniscectomy patients. Thirty-one subjects were randomly assigned to experimental or control groups. The experimental group rode a stationary bicycle equipped with the pedal arm device six times over 2 weeks post-operatively under the supervision of a physical therapist while the control group did not. Subjective measures of gait were significantly different with a positive experimental group response to the supervised exercise with improved gait performance at weeks 1, 2 and 4 after surgery (P < or = 0.05). Early, protected active ROM exercise on a bicycle ergometer equipped with an adjustable pedal arm demonstrated promising results in patients after partial meniscectomy. PMID:19280178

Kelln, Brent M; Ingersoll, Christopher D; Saliba, Susan; Miller, Mark D; Hertel, Jay

2009-06-01

376

Fan Noise Source Diagnostic Test: LDV Measured Flow Field Results  

NASA Technical Reports Server (NTRS)

Results are presented of an experiment conducted to investigate potential sources of noise in the flow developed by two 22-in. diameter turbofan models. The R4 and M5 rotors that were tested were designed to operate at nominal take-off speeds of 12,657 and 14,064 RPMC, respectively. Both fans were tested with a common set of swept stators installed downstream of the rotors. Detailed measurements of the flows generated by the two were made using a laser Doppler velocimeter system. The wake flows generated by the two rotors are illustrated through a series of contour plots. These show that the two wake flows are quite different, especially in the tip region. These data are used to explain some of the differences in the rotor/stator interaction noise generated by the two fan stages. In addition to these wake data, measurements were also made in the R4 rotor blade passages. These results illustrate the tip flow development within the blade passages, its migration downstream, and (at high rotor speeds) its merging with the blade wake of the adjacent (following) blade. Data also depict the variation of this tip flow with tip clearance. Data obtained within the rotor blade passages at high rotational speeds illustrate the variation of the mean shock position across the different blade passages.

Podboy, Gary C.; Krupar, Martin J.; Hughes, Christopher E.; Woodward, Richard P.

2003-01-01

377

The potential of the Child Health Utility 9D Index as an outcome measure for child dental health  

PubMed Central

Background The Child Health Utility 9D (CHU9D) is a relatively new generic child health-related quality of life measure (HRQoL)—designed to be completed by children—which enables the calculation of utility values. The aim is to investigate the use of the CHU9D Index as an outcome measure for child dental health in New Zealand. Method A survey was conducted of children aged between 6 and 9 years attending for routine dental examinations in community clinics in Dunedin (New Zealand) in 2012. The CHU9D, a HRQoL, was used, along with the Child Perceptions Questionnaire (CPQ), a validated oral health-related quality of life (OHRQoL) measure. Socio-demographic characteristics (sex, age, ethnicity and household deprivation) were recorded. Dental therapists undertook routine clinical examinations, with charting recorded for each child for decayed, missing and filled deciduous teeth (dmft) at the d3 level. Results One hundred and forty 6-to-9-year-olds (50.7% female) took part in the study (93.3% participation rate). The mean d3mft was 2.4 (SD?=?2.6; range 0 to 9). Both CHU9D and CPQ detected differences in the impact of dental caries, with scores in the expected direction: children who presented with caries had higher scores (indicating poorer OHRQoL) than those who were free of apparent caries. Children with no apparent caries had a higher mean CHU9D score than those with caries (indicating better HRQoL). The difference for the CPQ was statistically significant, but for CHU9D the difference was not significant. When the two indices were compared, there was a significant difference in mean CHU9D scores by the prevalence of CPQ and subscale impacts with children experiencing no impacts having mean CHU9D scores closer to 1.0 (representing perfect health). Conclusion The CHU9D may be useful in dental research. Further exploration in samples with different caries experience is required. The use of the CHU9D in child oral health studies will enable the calculation of quality-adjusted life years (QALYs) for use in economic evaluation. PMID:25027722

2014-01-01

378

Ranking of physiotherapeutic evaluation methods as outcome measures of stifle functionality in dogs  

PubMed Central

Background Various physiotherapeutic evaluation methods are used to assess the functionality of dogs with stifle problems. Neither validity nor sensitivity of these methods has been investigated. This study aimed to determine the most valid and sensitive physiotherapeutic evaluation methods for assessing functional capacity in hind limbs of dogs with stifle problems and to serve as a basis for developing an indexed test for these dogs. A group of 43 dogs with unilateral surgically treated cranial cruciate ligament deficiency and osteoarthritic findings was used to test different physiotherapeutic evaluation methods. Twenty-one healthy dogs served as the control group and were used to determine normal variation in static weight bearing and range of motion. The protocol consisted of 14 different evaluation methods: visual evaluation of lameness, visual evaluation of diagonal movement, visual evaluation of functional active range of motion and difference in thrust of hind limbs via functional tests (sit-to-move and lie-to-move), movement in stairs, evaluation of hind limb muscle atrophy, manual evaluation of hind limb static weight bearing, quantitative measurement of static weight bearing of hind limbs with bathroom scales, and passive range of motion of hind limb stifle (flexion and extension) and tarsal (flexion and extension) joints using a universal goniometer. The results were compared with those from an orthopaedic examination, force plate analysis, radiographic evaluation, and a conclusive assessment. Congruity of the methods was assessed with a combination of three statistical approaches (Fisher’s exact test and two differently calculated proportions of agreeing observations), and the components were ranked from best to worst. Sensitivities of all of the physiotherapeutic evaluation methods against each standard were calculated. Results Evaluation of asymmetry in a sitting and lying position, assessment of muscle atrophy, manual and measured static weight bearing, and measurement of stifle passive range of motion were the most valid and sensitive physiotherapeutic evaluation methods. Conclusions Ranking of the various physiotherapeutic evaluation methods was accomplished. Several of these methods can be considered valid and sensitive when examining the functionality of dogs with stifle problems. PMID:23566355

2013-01-01

379

Perkins Core Performance Measures: Results and Targets, 1999-2000.  

ERIC Educational Resources Information Center

This document describes the Virginia Community College System (VCCS) Core Indicators for the Perkins III Core Performance Standards and Measures. Core indicators and measures include: (1) student attainment, measured by academic and technical skills; (2) completion, measured by graduation rate; (3) placement and persistence, measured by placement,…

McHewitt, Earl R.; Taylor, Garry

380

Bowel Perfusion Measured with Dynamic Contrast-enhanced Ultrasound Predicts Treatment Outcome in Patients with Crohn's Disease  

PubMed Central

Background: To improve management of patients with Crohn's disease (CD), objective measurements of the degree of local inflammation in the gastrointestinal wall are needed. Increased microvessel density and perfusion are typical features of acute inflammation and can be estimated with contrast-enhanced ultrasound (CEUS). The aim of the study was to investigate whether CEUS can provide prognostic information about patients treated medically for an acute exacerbation of CD. Methods: Fourteen patients with CD who received medical treatment for acute exacerbation with systemic steroids or tumor necrosis factor–? inhibitors were prospectively recruited. The patients were examined with clinical scoring, blood tests, and CEUS at time 0, 1, 3, and 12 months after initiation of the treatment. Outcome was treatment efficacy or treatment failure defined as change in medical treatment after 1 month or later. The perfusion analysis was performed with a commercially available software program that analyzes the contrast intensity in a selected area, fits the data to a standardized time-intensity curve, and derives several relative perfusion parameters. Results: Six of the 14 patients had treatment failure during the study period. There was a significant difference between the groups for peak contrast enhancement (P = 0.013), rate of wash-in (P = 0.020) and wash-out (P = 0.008), and the area under the time-intensity curve in the wash-in phase (0.013) at the examination 1 month after the start of treatment. Conclusions: Perfusion analysis of the intestinal wall with CEUS 1 month after starting treatment in patients with CD can provide prognostic information regarding treatment efficacy. PMID:25185684

Saevik, Fredrik; Hausken, Trygve; Ødegaard, Svein; Gilja, Odd H.

2014-01-01

381

Survival Outcomes in Resected Extrahepatic Cholangiocarcinoma: Effect of Adjuvant Radiotherapy in a Surveillance, Epidemiology, and End Results Analysis  

SciTech Connect

Purpose: The benefit of adjuvant radiotherapy (RT) after surgical resection for extrahepatic cholangiocarcinoma has not been clearly established. We analyzed survival outcomes of patients with resected extrahepatic cholangiocarcinoma and examined the effect of adjuvant RT. Methods and Materials: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 2003. The primary endpoint was the overall survival time. Cox regression analysis was used to perform univariate and multivariate analyses of the following clinical variables: age, year of diagnosis, histologic grade, localized (Stage T1-T2) vs. regional (Stage T3 or greater and/or node positive) stage, gender, race, and the use of adjuvant RT after surgical resection. Results: The records for 2,332 patients were obtained. Patients with previous malignancy, distant disease, incomplete or conflicting records, atypical histologic features, and those treated with preoperative/intraoperative RT were excluded. Of the remaining 1,491 patients eligible for analysis, 473 (32%) had undergone adjuvant RT. After a median follow-up of 27 months (among surviving patients), the median overall survival time for the entire cohort was 20 months. Patients with localized and regional disease had a median survival time of 33 and 18 months, respectively (p < .001). The addition of adjuvant RT was not associated with an improvement in overall or cause-specific survival for patients with local or regional disease. Conclusion: Patients with localized disease had significantly better overall survival than those with regional disease. Adjuvant RT was not associated with an improvement in long-term overall survival in patients with resected extrahepatic bile duct cancer. Key data, including margin status and the use of combined chemotherapy, was not available through the SEER database.

Vern-Gross, Tamara Z. [Department of Radiation Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, NC (United States); Shivnani, Anand T., E-mail: Anand.Shivnani@usoncology.com [Department of Radiation Oncology, Baylor-Irving Cancer Center, Irving, TX (United States); Chen, Ke [Department of Mathematical Sciences, University of Texas-Dallas, Richardson, TX (United States); Lee, Christopher M. [Department of Radiation Oncology, Cancer Care Northwest, Spokane, WA (United States); Tward, Jonathan D. [Department of Radiation Oncology, Huntsman Cancer Center, University of Utah, Salt Lake City, UT (United States); MacDonald, O. Kenneth [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Crane, Christopher H. [Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX (United States); Talamonti, Mark S. [Department of Surgery, Northshore University Healthsystem, Evanston, IL (United States); Munoz, Louis L. [Department of Radiation Oncology, Texas Cancer Center at Medical City Dallas, Dallas, TX (United States); Small, William [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL (United States)

2011-09-01

382

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

PubMed Central

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 evaluation of claims made about a drug or medical product in its labeling. By explicitly addressing the review issues identified in this guidance, sponsors can increase the efficiency of their endpoint discussions with the FDA during the product development process, streamline the FDA's review of PRO endpoint adequacy, and provide optimal information about the patient's perspective of treatment benefit at the time of product approval. A PRO is a measurement of any aspect of a patient's health status that comes directly from the patient (i.e., without the interpretation of the patient's responses by a physician or anyone else). In clinical trials, a PRO instrument can be used to measure the impact of an intervention on one or more aspects of patients' health status, hereafter referred to as PRO concepts, ranging from the purely symptomatic (response of a headache) to more complex concepts (e.g., ability to carry out activities of daily living), to extremely complex concepts such as quality of life, which is widely understood to be a multidomain concept with physical, psychological, and social components. Data generated by a PRO instrument can provide evidence of a treatment benefit from the patient perspective. For this data to be meaningful, however, there should be evidence that the PRO instrument effectively measures the particular concept that is studied. Generally, findings measured by PRO instruments may be used to support claims in approved product labeling if the claims are derived from adequate and well-controlled investigations that use PRO instruments that reliably and validly measure the specific concepts at issue. The glossary defines many of the terms used in this guidance. In particular, the term instrument refers to the actual questions or items contained in a questionnaire or interview schedule along with all the additional information and documentation that supports the use of these items in producing a PRO measure (e.g., interviewer training and instructions, scoring and interpretation manual). The term conceptual framework refers to how items are grouped according to subconcepts or domains (e.g., the item walking without help may be grouped with another item, walking with difficulty, within the domain of ambulation, and ambulation may be further grouped into the concept of physical ability). FDA's guidance documents, including this guidance, do not establish legally enforceable responsibilities. Instead, guidance documents describe the Agency's current thinking on a topic and should be viewed only as recommendations, unless specific regulatory or statutory requirements are cited. The use of the word should in Agency guidance documents means that something is suggested or recommended but not required. First publication of the Draft Guidance by the Food and Drug Administration- February 2006. PMID:17034633

2006-01-01

383

LDEF: Dosimetric measurement results (AO 138-7 experiment)  

NASA Technical Reports Server (NTRS)

One of the objectives of the AO 138-7 experiment on board the Long Duration Exposure Facility (LDEF) was a total dose measurement with Thermo Luminescent Detectors (TLD 100). Two identical packages, both of them including five TLD's inside various aluminum shields, are exposed to the space environment in order to obtain the absorbed dose profile. Radiation fluence received during the total mission length was computed, taking into account the trapped particles (AE8 and AP8 models during solar maximum and minimum periods) and the cosmic rays; due to the magnetospheric shielding the solar proton fluences are negligible on the LDEF orbit. The total dose induced by these radiations inside a semi infinite plane shield of aluminum are computed with the radiation transport codes available at DERTS. The dose profile obtained is in good agreement with the evaluation by E.V. Benton. TLD readings are performed after flight; due to the mission duration increase a post flight calibration was necessary in order to cover the range of the in flight induced dose. The results obtained, similar (plus or minus 30 percent) for both packages, are compared with the dose profile computation. For thick shields it seems that the measurements exceed the forecast (about 40 percent). That can be due to a cosmic ray and trapped proton contributions coming from the backside (assumed as perfectly shielded by the LDEF structure in the computation), or to an underestimate of the proton or cosmic ray fluences. A fine structural shielding analysis should be necessary in order to determine the origin of this slight discrepancy between forecast and in flight measurements. For the less shielded dosimeters, mainly exposed to the trapped electron flux, a slight overestimation of the dose (less than 40 percent) appears. Due to the dispersion of the TLD's response, this cannot be confirmed. In practice these results obtained on board LDEF, with less than a factor 1.4 between measurements and forecast, reinforce the validity of the computation methods and models used for the long term evaluation of the radiation levels (flux and dose) encountered in space on low inclination and altitude Earth orbits.

Bourrieau, J.

1993-01-01

384

Among health care professionals effective communication is vital to achieve the best patient outcomes possible. Improving communication and other teamwork skills will result in improved  

E-print Network

outcomes possible. Improving communication and other teamwork skills will result in improved performance by the faculty should result in improved communication skills of our trainees and ultimately improved patient Among health care professionals effective communication is vital to achieve the best patient

385

A Qualitative Exploration of Patient and Clinician Views on Patient Reported Outcome Measures in Child Mental Health and Diabetes Services.  

PubMed

Patient Reported Outcome Measures (PROMs) are increasingly being recommended for use in both mental and physical health services. The present study is a qualitative exploration of the views of young people, mothers, and clinicians on PROMs. Semi-structured interviews were conducted with a sample of n = 10 participants (6 young people, 4 clinicians) from mental health services and n = 14 participants (4 young people, 7 mothers, 3 clinicians) from a diabetes service. For different reasons, young people, mothers, and clinicians saw feedback from PROMs as having the potential to alter the scope of clinical discussions. PMID:25179754

Wolpert, Miranda; Curtis-Tyler, Katherine; Edbrooke-Childs, Julian

2014-09-01

386

The patient-reported outcome (PRO) consortium: filling measurement gaps for PRO end points to support labeling claims.  

PubMed

The importance of appropriately and effectively incorporating the patient's voice into the evaluation of new medical products has been recognized and affirmed by regulators.(1,2,3) Patient-reported outcomes (PROs) are increasingly being assessed in clinical trials to quantify treatment benefits such as symptom relief and improved functioning. Translating PRO-based treatment benefits into labeling claims can provide information to physicians and patients and assist in prescribing decisions.(4,5) Hence, standardizing the valid and reliable measurement of PRO end points is critical. PMID:21993428

Coons, S J; Kothari, S; Monz, B U; Burke, L B

2011-11-01

387

Leading Horses to Water: Lessons from a Decade of Helping Psychological Therapy Services Use Routine Outcome Measurement to Improve Practice.  

PubMed

We summarise the recent reflections of five thought leaders in the field of routine outcome measurement (ROM) for psychological therapy, and then add our own experience of introducing a national ROM system in the UK. We highlight, in particular, the post-implementation challenge of securing data of sufficient reliability to help inform service quality improvements. We ground our conclusions and recommendations in the rapidly evolving discipline of implementation science, and offer a best practice model for applying research recommendations in practice settings. In this context we portray ROM implementation as significant organizational change that benefits from rigorous process and clearly defined, well-communicated targets. PMID:25179755

Mellor-Clark, John; Cross, Simone; Macdonald, James; Skjulsvik, Tommy

2014-09-01

388

45 CFR 287.145 - What measures will be used to determine NEW Program outcomes?  

Code of Federal Regulations, 2010 CFR

...2010-10-01 false What measures will be used to determine NEW...AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE NATIVE...Operations § 287.145 What measures will be used to determine NEW...own performance standards and measures to ensure...

2010-10-01

389

Methods and preliminary measurement results of liquid Li wettability  

SciTech Connect

A test of lithium wettability was performed in high vacuum (< 3 × 10{sup ?4} Pa). High magnification images of Li droplets on stainless steel substrates were produced and processed using the MATLAB{sup ®} program to obtain clear image edge points. In contrast to the more standard “?/2” or polynomial fitting methods, ellipse fitting of the complete Li droplet shape resulted in reliable contact angle measurements over a wide range of contact angles. Using the ellipse fitting method, it was observed that the contact angle of a liquid Li droplet on a stainless steel substrate gradually decreased with increasing substrate temperature. The critical wetting temperature of liquid Li on stainless steel was observed to be about 290?°C.

Zuo, G. Z., E-mail: zuoguizh@ipp.ac.cn; Hu, J. S.; Ren, J.; Sun, Z.; Yang, Q. X.; Li, J. G. [Institute of Plasma Physics, Chinese Academy of Sciences, Hefei 230031 (China)] [Institute of Plasma Physics, Chinese Academy of Sciences, Hefei 230031 (China); Zakharov, L. E.; Mansfield, D. K. [Princeton Plasma Physics Laboratory, MS-27 P.O. Box 451, Princeton, New Jersey 08543 (United States)] [Princeton Plasma Physics Laboratory, MS-27 P.O. Box 451, Princeton, New Jersey 08543 (United States)

2014-02-15

390

Measuring socioeconomic status in multicountry studies: results from the eight-country MAL-ED study  

PubMed Central

Background There is no standardized approach to comparing socioeconomic status (SES) across multiple sites in epidemiological studies. This is particularly problematic when cross-country comparisons are of interest. We sought to develop a simple measure of SES that would perform well across diverse, resource-limited settings. Methods A cross-sectional study was conducted with 800 children aged 24 to 60 months across eight resource-limited settings. Parents were asked to respond to a household SES questionnaire, and the height of each child was measured. A statistical analysis was done in two phases. First, the best approach for selecting and weighting household assets as a proxy for wealth was identified. We compared four approaches to measuring wealth: maternal education, principal components analysis, Multidimensional Poverty Index, and a novel variable selection approach based on the use of random forests. Second, the selected wealth measure was combined with other relevant variables to form a more complete measure of household SES. We used child height-for-age Z-score (HAZ) as the outcome of interest. Results Mean age of study children was 41 months, 52% were boys, and 42% were stunted. Using cross-validation, we found that random forests yielded the lowest prediction error when selecting assets as a measure of household wealth. The final SES index included access to improved water and sanitation, eight selected assets, maternal education, and household income (the WAMI index). A 25% difference in the WAMI index was positively associated with a difference of 0.38 standard deviations in HAZ (95% CI 0.22 to 0.55). Conclusions Statistical learning methods such as random forests provide an alternative to principal components analysis in the development of SES scores. Results from this multicountry study demonstrate the validity of a simplified SES index. With further validation, this simplified index may provide a standard approach for SES adjustment across resource-limited settings. PMID:24656134

2014-01-01