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1

Outcomes Measurement  

Cancer.gov

Evaluating and improving methods for measuring cancer outcomes is critically important for NCI's initiatives to enhance the quality of cancer care, reduce cancer-related health disparities, and better understand the individual and population burden of disease. The Applied Research Program's initiatives in this area include developing resources for researchers to learn about psychometric and other tools that aid in assessing and developing outcomes measures.

2

Measuring Outcomes.  

ERIC Educational Resources Information Center

Describes the California Community Colleges' goal to advance the state's economic growth through quality economic development programs. Discusses the importance of assessment and presents the results of an outcome evaluation, stating that California will collect $1.42 in taxes over the next 10 years for every dollar it spent on economic…

Kirschenmann, Sandy; Lane, Theodore

2001-01-01

3

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

4

Results From a Prospective Acute Inpatient Rehabilitation Database: Clinical Characteristics and Functional Outcomes using the Functional Independence Measure  

Microsoft Academic Search

Introduction: Rehabilitation improves functional outcomes, but there is little data on the profiles and outcomes of patients undergoing inpatient rehabilitation in Singapore. The aims of this paper were to document the clinical characteristics and functional outcomes, using the Functional Independence Measure (FIM), of all patients admitted to an inpatient rehabilitation unit in a tertiary teaching hospital, and to identify and

Yee Sien Ng; Chek Wai Bok; Yi Chiong

2007-01-01

5

Depression measures in outcomes research  

Microsoft Academic Search

ABSTRACT. Vahle VJ, Andresen EM, Hagglund KJ. Depression measures in outcomes research. Arch Phys Med Rehabil 2000;81 Suppl 2:S53-S62. Objective: To review critically the measures used to screen for depression for disability outcomes research and to recommend measures and needed research. Date Sources: Review of literature pertaining to the development, testing, and use of depression measures for outcomes research. Study

Victoria J. Vahle; Elena M. Andresen; Kristofer J. Hagglund

2000-01-01

6

Measuring Outcomes in Hand Surgery  

PubMed Central

Synopsis Methods for measuring outcomes after hand and upper extremity surgery continue to evolve, yet remain inconsistent in quality. In this article we review the use of patient-reported outcomes measures in upper extremity surgery patients, and provides a practical guide to questionnaire selection, assessment, and utilization. We also present the future direction of health services research, and how it will drive changes in measuring outcomes in hand surgery. PMID:18298996

Giladi, Aviram M.; Chung, Kevin C.

2012-01-01

7

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

8

Thermal imaging as outcome measure  

Microsoft Academic Search

This issue of Thermology international contains a number of papers, which report the medical use of therma imaging as an outcome measure in dermatology, surgery, neurology and sports medicine. In principle, thermal imaging can be applied in medince either as a diagnostic test or as outcome measure in clinical trials (1). Although the technique started as diagnostic procedure for breast

K. Ammer

9

Reliability of instrumented movement analysis as outcome measure in Charcot-Marie-Tooth disease: results from a multitask locomotor protocol.  

PubMed

Some neurodegenerative diseases at early stage may not drastically affect basic gait ability, whereas more demanding locomotor tasks are more prone to disease-induced abnormalities. In this study, we evaluated the interday test-retest reliability, 4-6 weeks apart, of instrumented movement analysis on a group of 20 subjects with Charcot-Marie-Tooth (CMT) disease considering a set of kinematic and kinetic curves and related parameters obtained during natural walking (NW) and faster walking, heel and toe-walking, step ascending and descending. Results showed that the reliability was good for NW, with the exception of trunk curves, pelvic tilt and EMG profiles (moderate reliability), and trunk ROM in sagittal/transverse plane (poor reliability). Comparing our results with literature, CMT patients did not present a greater variability during NW than healthy subjects or patients with diseases of CNS. Additional locomotor tasks showed a slight reduction of reliability, although the moderate-to-good level shown in NW was almost never reduced to poor. Most of SEM values (absolute measurement errors) were smaller than 5°, a clinically acceptable threshold. In particular THS, an ankle joint related parameter computed across heel and toe-walking tasks, showed an optimal reliability (ICC=0.95, SEM=2.7°) and correlation with CMT clinical scores. Toe and heel-walking and step ascending tasks maximised the number of parameters with a moderate-to-good correlation with patients' clinical status. We concluded that, in addition to natural walking, more challenging locomotor tasks are good candidates to provide reliable and sensitive outcome measures for CMT patients. PMID:21511477

Ferrarin, M; Bovi, G; Rabuffetti, M; Mazzoleni, P; Montesano, A; Moroni, I; Pagliano, E; Marchi, A; Marchesi, C; Beghi, E; Pareyson, D

2011-05-01

10

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

11

TEFTOM: A Promising General Trauma Expectation/Outcome Measure—Results of a Validation Study on Pan-American Ankle and Distal Tibia Trauma Patients  

PubMed Central

Background. In orthopedics, there is no instrument specifically designed to assess patients' expectations of their final surgery outcome in general trauma populations. We developed the Trauma Expectation Factor Trauma Outcome Measure (TEFTOM) to investigate the fulfilment of patients' expectations one year after surgery as a measure of general trauma surgical outcomes. The aim of this paper was to assess the psychometric characteristics of this new general trauma outcome measure. Methods. The questionnaire was tested in 201 ankle and distal tibia fracture patients scheduled for surgery. Patients were followed up for twelve months. The TEFTOM questionnaire was evaluated for its criterion validity, internal consistency, reproducibility, and responsiveness. Results. TOM showed good criterion validity against the American Academy of Orthopaedic Surgeons Foot and Ankle Scale (Pearson's correlation coefficient = 0.69–0.77). Internal consistency was acceptable for TEF (Cronbach's alpha = 0.65–0.76) and excellent for TOM (Cronbach's alpha = 0.76–0.85). Reproducibility was moderate to very good (intraclass coefficient correlation (ICC) ?0.67) for TEF and very good (ICC ?0.92) for TOM. TOM also proved to be responsive to changes in patients' condition over time (Wald test; P < 0.001). Conclusions. TEFTOM is a promising tool for measuring general trauma outcomes in terms of patients' expectation fulfilment that proved to be valid, internally consistent, reproducible, and responsive to change. PMID:24967116

Suk, Michael; Buckley, Richard E.; Paccola, Cleber A. J.; Lorich, Dean G.; Helfet, David L.; Hanson, Beate

2013-01-01

12

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

13

Aesthetic and functional results after breast conserving surgery as correlates of quality of life measured by a German version of the Breast Cancer Treatment Outcome Scale (BCTOS).  

PubMed

This prospective cohort study was carried out to develop a German version of the Breast Cancer Treatment Outcome Scale (BCTOS) and to examine the relations of aesthetic and functional outcome after breast conserving surgery with quality of life (QoL). The study included 189 patients with one-sided, early stage breast cancer. A factor analysis indicated three internally consistent scales of the German BCTOS: Aesthetic Status, Functional Status and Breast Sensitivity Status. QoL was measured by the EORTC Quality of Life Questionnaire C30-BR23 (EORTC). All BCTOS scales were correlated with scales of the EORTC. Correlation magnitudes ranged from 0.24 to 0.67 (p < 0.001). A multiple regression analyses confirmed these results. The analysis of relevant covariates demonstrated that younger patients revealed poorer status on all BCTOS scales. Aesthetic and functional outcome seems to be closely related to quality of Life. The German BCTOS demonstrated to be a useful instrument. PMID:20627726

Heil, Joerg; Holl, Simone; Golatta, Michael; Rauch, Geraldine; Rom, Joachim; Marmé, Frederik; Gebauer, Gerhard; Sohn, Christof

2010-12-01

14

Outcomes measurement requires nursing to shift to outcome-based practice.  

PubMed

The measurement of outcomes to demonstrate the effectiveness of nursing care delivered is essential. This article will outline the history of outcomes measurement in nursing, the definition and levels of outcomes, the differentiation between process interventions and outcome statements, and the monitoring of outcomes at the staff nurse and case manager levels. Care management methodologies to assist in outcome management will be discussed. In the end, the development of nursing knowledge and innovation in care strategies and advanced clinical decision making is dependent on the measurement of intermediate and end result outcomes. PMID:10765244

Hill, M

1999-01-01

15

Second step: testing-outcome measurements.  

PubMed

Despite worldwide enthusiasm for endoscopic surgery, this new technology is now on the top of McKinlay's "product life circle curve." Critical questions are being asked about its benefits and burdens, but the concepts applied and the methodologies used for technology assessment are in a similar position as endoscopic surgery and need a critical evaluation. (1) There are incorrect and outdated concepts for the scientific basis of surgery (surgical theory) including the basic sciences involved; biomedicine still dominates, but assessment of outcome after operations is no longer possible without clinical epidemiology and social psychology. (2) Based on an outdated scientific theory for surgery, an outdated concept of disease is still propagated. It is denoted as mechanical and is based solely on biomedicine. Human subjects are reduced to biologic machines, and outcomes measurement excludes most dimensions of functioning and well-being. To achieve a valid result for outcome measures, a hermeneutic approach must be combined with the mechanical approach. (3) Based on an outdated model of disease, the outcomes used in endoscopic surgery rely too much on traditional measures, such as mortality rate, complication rate, hospital stay, and especially an endless list of biochemical mediators. Their alterations during the perioperative period have not yet been shown to be related to clinical or hermeneutic outcomes. A new method of assessment for clinical trials in endoscopic surgery and for other surgical problems is outlined, such as for surgical infections and for surgical oncology. It includes an index of recovery and objective health status assessed by the doctor, a quality-of-life self-report by the patient, and the true endpoint concept as a critical weighting of both types of outcome by patients and doctors. PMID:10415201

Lorenz, W; Troidl, H; Solomkin, J S; Nies, C; Sitter, H; Koller, M; Krack, W; Roizen, M F

1999-08-01

16

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

PubMed

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

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

2012-09-17

17

Understanding and measuring child welfare outcomes.  

PubMed

The new "Children's and Family Services Reviews" (CFSR) process focuses on the effectiveness of services to children and families by measuring client outcomes. This article reviews the research literature related to child welfare outcomes in order to provide a context for federal accountability efforts. It also summarizes the 2001 federal mandate to hold states accountable for child welfare outcomes and describes California's response to this mandate. Implications of the outcomes literature review and measurement problems in the CFSR process suggest CSFR measures do not always capture meaningful outcomes. Recommendations for change are made. PMID:19064447

D'Andrade, Amy; Osterling, Kathy Lemon; Austin, Michael J

2008-01-01

18

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

19

Understanding and Measuring Child Welfare Outcomes  

Microsoft Academic Search

The new “Children's and Family Services Reviews” (CFSR) process focuses on the effectiveness of services to children and families by measuring client outcomes. This article reviews the research literature related to child welfare outcomes in order to provide a context for federal accountability efforts. It also summarizes the 2001 federal mandate to hold states accountable for child welfare outcomes and

Amy Dandrade; Kathy Lemon Osterling; Michael J. Austin

2008-01-01

20

Health Outcome after Major Trauma: What Are We Measuring?  

PubMed Central

Importance Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients. Objective To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma. Data Sources MEDLINE, EMBASE, and CINAHL (from 2006–2012) were searched for studies evaluating health outcome after traumatic injuries. Study selection and data extraction Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts. Results 34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%). Conclusion Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care. PMID:25051353

Hoffman, Karen; Cole, Elaine; Playford, E. Diane; Grill, Eva; Soberg, Helene L.; Brohi, Karim

2014-01-01

21

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

22

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.

23

Measures of outcomes for children and youth  

Microsoft Academic Search

ABSTRACT. Lollar DJ, Simeonsson RJ, Nanda U. Measures of outcomes for children and youth. Arch Phys Med Rehabil 2000;81 Suppl 2:S46-S52. Objective: To provide an overview of the issues related to the measurement of disability outcomes among children and on an assessment of selected instruments. Data Sources: Published scientific English literature in the area of child development, public health, and

Donald J. Lollar; Rune J. Simeonsson; Upasana Nanda

2000-01-01

24

Measures of social outcomes in disability research  

Microsoft Academic Search

ABSTRACT. Dijkers MPJM, Whiteneck G, El-Jaroudi R. Measures of social outcomes in disability research. Arch Phys Med Rehabil 2000;81 Suppl 2:S63-S80. Objectives: To describe instruments that have been developed to quantify (aspects of) social outcomes in research on persons with a disability, and to evaluate the clinimetric characteristics of some of the more prominent and promising measures. Data Sources: Literature

Marcel P. J. M. Dijkers; Gale Whiteneck; Rana El-Jaroudi

2000-01-01

25

Outcome measures in osteoarthritis: Randomized controlled trials  

Microsoft Academic Search

Accepted outcome measures in randomized controlled trials (RCTs) in osteoarthritis (OA) include patient-reported assessments\\u000a of physical function and health-related quality of life (HRQOL). Available data can inform treatment decisions when statistically\\u000a significant changes are viewed in terms of clinically important improvements. Patient-reported outcomes validated in OA include\\u000a global assessments of pain, disease activity, and disease-specific and generic measures of physical

Vibeke Strand; Ariella Kelman

2004-01-01

26

Meaningful outcome measures in cardiac surgery.  

PubMed

The most common cardiac surgical procedures are coronary artery bypass graft surgery and aortic or mitral valve repair or replacement. Underlying conditions include coronary artery disease and heart failure, manifesting as exertional angina, dyspnea, and poor exercise tolerance. The major goals of surgery are to alleviate symptoms and improve patient survival. These, therefore, should inform the choice of primary outcome measures in clinical studies enrolling patients undergoing cardiac surgery. Studies focusing on surrogate outcome measures are relied on all too often. Many are of questionable significance and often have no convincing relationship with patient outcome. Traditional "hard endpoint" outcome measures include serious complications and death with the former including myocardial infarction (MI) and stroke. Such serious adverse outcomes are commonly collected in registries, but because they occur infrequently, they need to be large to reliably detect true associations and treatment effects. For this reason, some investigators combine several outcomes into a single composite endpoint. Cardiovascular trials commonly use major adverse cardiac events (MACEs) as a composite primary endpoint. However, there is no standard definition for MACE. Most include MI, stroke, and death; others include rehospitalization for heart failure, revascularization, cardiac arrest, or bleeding complications. An influential trial in noncardiac surgery found that perioperative beta-blockers reduced the risk of MI but increased the risk of stroke and death. Such conflicting findings challenge the veracity of such composite endpoints and raise a far more important question: which of these endpoints, or even others that were unmeasured, are most important to a patient recovering from surgery? Given the primary aims of cardiac surgery are to relieve symptoms and improve good quality survival, it is disability-free survival that is the ultimate outcome measure. The question then becomes: what is disability and how should it be quantified after cardiac surgery? PMID:24779115

Myles, Paul S

2014-03-01

27

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

28

College Outcome Measures Project. COMP Annual Report 1978.  

ERIC Educational Resources Information Center

The College Outcome Measures Project (COMP) was organized to design, develop, validate, and disseminate assessment instruments and procedures to measure and evaluate the knowledge and skills that undergraduate students are expected to acquire as a result of general or liberal education programs, as well as those important to effective functioning…

American Coll. Testing Program, Iowa City, IA.

29

Measuring Program Outcomes: Using Retrospective Pretest Methodology.  

ERIC Educational Resources Information Center

Used longitudinal data from 307 mothers of firstborn infants participating in a home-visitation, child abuse prevention program in a retrospective pretest methodology. Results shows that when response shift bias was present, the retrospective pretest methodology produced a more legitimate assessment of program outcomes than did the traditional…

Pratt, Clara C.; McGuigan, William M.; Katsev, Aphra R.

2000-01-01

30

Clinical outcome measures for Cutaneous Lupus Erythematosus  

PubMed Central

Cutaneous lupus erythematosus is a clinically heterogeneous group of rare skin diseases that only rarely have been subjected to controlled clinical trials. This may be have been partly due to a lack of suitable validated outcome instruments. Recently the FDA mandated that organ specific trials for lupus erythematosus need to use a combination of different outcome measures. The patient’s condition needs to be assessed in terms of quality of life, the patient’s global response and organ specific instruments that measure activity of the disease as well as damage due to the disease. For the skin the only formally validated and published instrument is currently the Cutaneous Lupus Erythematosis Disease Area and Severity Index (CLASI). This paper discusses the background of the development of the CLASI as well as issues related to its use and interpretation in the context of clinical research of CLE. PMID:20693208

Albrecht, Joerg; Werth, Victoria P.

2011-01-01

31

Understanding patient reported outcome measures (PROMs).  

PubMed

Patient-reported outcome measures (PROMs) have been identified as being measures of a patient's health status or health-related quality of life, allowing for health status information to be collected from patients before and after an intervention through completion of a questionnaire. The information collected will provide an indication of the outcomes or quality of care delivered to NHS Patients. The collection of data commenced in April 2009 for specific conditions; NHS-funded unilateral hip replacements, unilateral knee replacements, groin hernia surgery or varicose vein surgery. PROMs will be developed for further conditions in the future, however, at present there are none relating to tissue viability or leg ulceration. PMID:21378673

Ousey, Karen; Cook, Leanne

2011-02-01

32

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

33

Biobehavioral Measures as Outcomes: A Cautionary Tale  

PubMed Central

This article discusses the use of biobehavioral measures as outcomes for healthcare intervention studies. Effect size (ES) values for salivary cortisol, and observation-based measures of pain and agitation are examined. Effects pre to post treatment were assessed separately for nursing home (NH) 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 if 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

2013-01-01

34

Outcome Measures in Spinal Cord Injury  

PubMed Central

Study Design review by the Spinal Cord Outcomes Partnership Endeavor (SCOPE), which is a broad-based international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations. Objectives assessment of current and evolving tools for evaluating human spinal cord injury (SCI) outcomes for both clinical diagnosis and clinical research studies. Methods a framework for the appraisal of evidence of metric properties was used to examine outcome tools or tests for accuracy, sensitivity, reliability and validity for human SCI. Results imaging, neurological, functional, autonomic, sexual health, bladder/bowel, pain, and psycho-social tools were evaluated. Several specific tools for human SCI studies have or are being developed to allow the more accurate determination for a clinically meaningful benefit (improvement in functional outcome or quality of life) being achieved as a result of a therapeutic intervention. Conclusion significant progress has been made, but further validation studies are required to identify the most appropriate tools for specific targets in a human SCI study or clinical trial. PMID:19381157

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

2009-01-01

35

Assessing Hospital-Based Wellness Services using an Outcome Measurement System  

Microsoft Academic Search

This article describes the process and results of an effort to develop an outcome measurement system for evaluating and improving hospital-based wellness programs and services. The authors defined a set of outcome measures for each of the wellness programs and services offered by the hospital and piloted health-related outcome and patient satisfaction measures in the following four different types of

James Gibbs; Kristienne Kattapong; Julie St. John; Robert F. Kushner

2002-01-01

36

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

37

42 CFR 410.146 - Diabetes outcome measurements.  

Code of Federal Regulations, 2010 CFR

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

2010-10-01

38

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

39

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

40

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

41

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

42

Measuring the Outcomes of a Pharmacy Continuing Education Program.  

ERIC Educational Resources Information Center

To determine if, as the result of a pharmacy continuing education program on professional liability, the behavior of participants would persist for eight months, a study was undertaken that measured three learning outcomes: knowledge of concepts; attitudes about professional standards and their relationship to malpractice; and self-reports of…

McKennell, Thomas M; Grussing, Paul G.

1979-01-01

43

The Higher Education Outcome Measures Identification Study. A Descriptive Summary.  

ERIC Educational Resources Information Center

This document is intended to inform NCHEMS constituents and other interested persons about the results of the Higher Education Outcome Measures Identification Study (OMIS) conducted by the National Center for Higher Education Management Systems at WICHE in spring 1974. The purpose of the study was to help practitioners and researchers gain a…

Micek, Sidney S.; Arney, William Ray

44

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

45

Outcome Measures for Clinical Trials in Fragile X Syndrome  

PubMed Central

Objective Progress in basic neuroscience has led to identification of molecular targets for treatment in fragile X syndrome (FXS) and other neurodevelopmental disorders, however, there is a gap in translation to targeted therapies in humans. One major obstacle to the demonstration of efficacy in human trials has been the lack of generally accepted endpoints to assess improvement in function in individuals with FXS. To address this problem, the NIH convened a meeting of leading scientists and clinicians with the goal of identifying and standardizing outcome measures for use as potential endpoints in clinical trials in FXS. Methods Participants in the meeting included FXS experts, experts in the design and implementation of clinical trials and measure development, and representatives from advocacy groups, industry, and federal agencies. Results The group generated recommendations for optimal outcome measures in cognitive, behavioral, and biomarker/medical domains, including additional testing and validation of existing measures, and development of new measures in areas of need. Although no one endpoint or set of endpoints could be identified that met all criteria as an optimal measure, recommendations are presented in this report. Conclusion The report is expected to guide the selection of measures in clinical trials and lead to the use of a more consistent battery of measures across trials. Further, this will help to direct research toward gaps in the development of validated FXS-specific outcome measures, and to assist with interpretation of clinical trial data by creating templates for measurement of treatment efficacy. PMID:24042082

Berry-Kravis, Elizabeth; Hessl, David; Abbeduto, Leonard; Reiss, Allan L.; Beckel-Mitchener, Andrea; Urv, Tiina K.

2013-01-01

46

Latest CMB Measurement Results  

NASA Astrophysics Data System (ADS)

We have allocated time in this special session to capture the latest developments in balloon-borne and ground-based CMB measurements. The speaker for this oral presentation will be chosen at a later date in order to best highlight emerging results. This session also includes presentations from current CMB experiments in a parallel poster session. Time-permitting, the latest community plans for future CMB measurement facilities may also be discussed.

Bock, James

2014-01-01

47

RASCH ANALYSIS OF CLINICAL OUTCOME MEASURES IN SPINAL MUSCULAR ATROPHY  

PubMed Central

Introduction Trial design for SMA depends on meaningful rating scales to assess outcomes. In this study Rasch methodology was applied to 9 motor scales in spinal muscular atrophy (SMA). Methods Data from all 3 SMA types were provided by research groups for 9 commonly used scales. Rasch methodology assessed the ordering of response option thresholds, tests of fit, spread of item locations, residual correlations, and person separation index. Results Each scale had good reliability. However, several issues impacting scale validity were identified, including the extent that items defined clinically meaningful constructs and how well each scale measured performance across the SMA spectrum. Conclusions The sensitivity and potential utility of each SMA scale as outcome measures for trials could be improved by establishing clear definitions of what is measured, reconsidering items that misfit and items whose response categories have reversed thresholds, and adding new items at the extremes of scale ranges. PMID:23836324

CANO, STEFAN J.; MAYHEW, ANNA; GLANZMAN, ALLAN M.; KROSSCHELL, KRISTIN J.; SWOBODA, KATHRYN J.; MAIN, MARION; STEFFENSEN, BIRGIT F.; BÉRARD, CAROLE; GIRARDOT, FRANÇOISE; PAYAN, CHRISTINE A.M.; MERCURI, EUGENIO; MAZZONE, ELENA; ELSHEIKH, BAKRI; FLORENCE, JULAINE; HYNAN, LINDA S.; IANNACCONE, SUSAN T.; NELSON, LESLIE L.; PANDYA, SHREE; ROSE, MICHAEL; SCOTT, CHARLES; SADJADI, REZA; YORE, MACKENSIE A.; JOYCE, CYNTHIA; KISSEL, JOHN T.

2015-01-01

48

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

Microsoft Academic Search

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

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

2011-01-01

49

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

50

Changes over time of psychoacoustic outcome measurements are not a substitute for subjective outcome measurements in acute tinnitus.  

PubMed

The aim of this study was to assess correlations between the changes over time of various tinnitus measurements. A longitudinal prospective study comparing two test moments was performed: before treatment and after 90 days. Tinnitus assessment consisted of psychoacoustic outcome measurements (minimal masking level and loudness matching at 1 kHz) and subjective outcome measurements (Tinnitus Impairment Questionnaire, Tinnitus Questionnaire and Numeric Rating Scale of loudness and annoyance). Additionally, the effect size was measured. 35 subjects were included in this study. The subjects had a permanent, non-pulsatile tinnitus acquired <3 months previously. Weak or no significant correlations were found between ?psychoacoustic outcome measurements and ?subjective outcome measurements. The effect size showed that subjective outcome measurements were the most responsive to measure change in tinnitus complaints. We can conclude that psychoacoustic outcome measurements of tinnitus cannot substitute subjective outcome measurements in patients with acute tinnitus. The authors recommend subjective outcome measurements as primary outcome measurements in a clinical setting. In research, however, it is meaningful to quantify tinnitus in both ways. PMID:24395086

Rabau, Sarah; Cox, Tony; Punte, Andrea Kleine; Waelkens, Brecht; Gilles, Annick; Wouters, Kristien; de Varebeke, Sebastien Janssens; Van de Heyning, Paul

2015-03-01

51

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

52

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

53

Measuring outcomes in randomized prospective trials in palliative care.  

PubMed

Palliative care aims to improve the quality of life of patients and their families and reduce suffering from life-threatening illness. In assessing palliative care efficacy, researchers must consider a broad range of potential outcomes, including those experienced by the patient's family/caregivers, clinicians, and the health care system. The purpose of this article is to summarize the discussions and recommendations of an Outcomes Working Group convened to advance the palliative care research agenda, particularly in the context of randomized controlled trials. These recommendations address the conceptualization of palliative care outcomes, sources of outcomes data, application of outcome measures in clinical trials, and the methodological challenges to outcome measurement in palliative care populations. As other fields have developed and refined methodological approaches that address their particular research needs, palliative care researchers must do the same to answer important clinical questions in rigorous and credible ways. PMID:17532180

Mularski, Richard A; Rosenfeld, Kenneth; Coons, Stephen Joel; Dueck, Amylou; Cella, David; Feuer, David J; Lipscomb, Joseph; Karpeh, Martin S; Mosich, Tom; Sloan, Jeff A; Krouse, Robert S

2007-07-01

54

Semantic-based online Outcome-based education measurement system  

Microsoft Academic Search

This paper proposes an online Outcome-based Education (OBE) Measurement System, which promotes a centralized OBE data repository for an institution, allowing concurrent online transactions between distributed multi-users. A well-known OBE framework currently being followed by most higher learning institutions in Malaysia is based on the four to seven levels of learning outcomes; a hierarchy commonly composed of course outcomes, program

Norliza Zaini; Mohd. Fuad Abdul Latip; Hasmila Omar

2011-01-01

55

The Harmonizing Outcome Measures for Eczema (HOME) roadmap: a methodological framework to develop core sets of outcome measurements in dermatology.  

PubMed

Core outcome sets (COSs) are consensus-derived minimum sets of outcomes to be assessed in a specific situation. COSs are being increasingly developed to limit outcome-reporting bias, allow comparisons across trials, and strengthen clinical decision making. Despite the increasing interest in outcomes research, methods to develop COSs have not yet been standardized. The aim of this paper is to present the Harmonizing Outcomes Measures for Eczema (HOME) roadmap for the development and implementation of COSs, which was developed on the basis of our experience in the standardization of outcome measurements for atopic eczema. Following the establishment of a panel representing all relevant stakeholders and a research team experienced in outcomes research, the scope and setting of the core set should be defined. The next steps are the definition of a core set of outcome domains such as symptoms or quality of life, followed by the identification or development and validation of appropriate outcome measurement instruments to measure these core domains. Finally, the consented COS needs to be disseminated, implemented, and reviewed. We believe that the HOME roadmap is a useful methodological framework to develop COSs in dermatology, with the ultimate goal of better decision making and promoting patient-centered health care. PMID:25186228

Schmitt, Jochen; Apfelbacher, Christian; Spuls, Phyllis I; Thomas, Kim S; Simpson, Eric L; Furue, Masutaka; Chalmers, Joanne; Williams, Hywel C

2015-01-01

56

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

57

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

58

Direct Measures for Course Outcomes Assessment for ABET Accreditation  

NSDL National Science Digital Library

Direct measures provide for the direct examination or observation of student knowledge or skills against measurable learning outcomes. ABET has been putting increasing emphasis on direct measures for a program to demonstrate its achievement of program outcomes and educational objectives. In this paper, an approach for assessment of course outcomes using direct measures is presented. The knowledge and skills described by the course outcomes are mapped to specific problems on homework and exams. Throughout the semester the instructor keeps track of the performance of each student on each course outcome. At the end of the semester students receive letter grades as usual. But in addition each student receives a score on the scale of 1-to-5 for every course outcome indicating how well he/she achieved each outcome. The data (scores) coming from each course are used at the program level to assess the program outcomes. The paper provides an example and concludes with recommendations for other institutions that may choose to adapt a similar approach.

Gurocak, Hakan

59

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

Microsoft Academic Search

Objectives To assess the growth of quality of life measures and to examine the availability of measures across specialties. Design Systematic searches of electronic databases to identify developmental and evaluative work relating to health outcome measures assessed by patients. Main outcome measures Types of measures: disease or population specific, dimension specific, generic, individualised, and utility. Specialties in which measures have

Andrew Garratt; Louise Schmidt; Anne Mackintosh; Ray Fitzpatrick

2002-01-01

60

Outcome Based Performance Measures for Illinois Citizens with Disabilities.  

ERIC Educational Resources Information Center

This manual presents suggested measures which are designed to examine the outcomes of support and service provision on the lives of people with disabilities in Illinois. Included are 30 measures for people and 16 measures for organizations. The measures were developed after initial input from people with disabilities participating in a Community…

Accreditation Council on Services for People with Disabilities, Landover, MD.

61

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

PubMed Central

Background This paper reports day-to-day data for from a one-week intervention phase, part of a 9-weeks randomised parallel study with patient having major depression (data from weekly visits have been reported). Wake therapy (sleep deprivation) has an established antidepressant effect with onset of action within hours. Deterioration on the following night’s sleep is, however, common, and we used daily light therapy and sleep time stabilisation as a preventive measure. In particular, we evaluated the day-to-day acute effect of and tolerance to sleep deprivation and examined predictors of response. Methods Patients were assessed at psychiatric inpatient wards. In the wake group (n?=?36), patients did three wake therapies in combination with light therapy each morning together with sleep time stabilisation. In the exercise group (n?=?38), patients did daily exercise. Hamilton subscale scores were primary outcome (not blinded), secondary outcome was self-assessment data from the Preskorn scale and sleep. Results Patients in the wake therapy group had an immediate, large, stable, and statistically significant better antidepressant effect than patients in the exercise group with response rates at day5 of 75.0%/25.1% and remission rates of 58.6%/6.0%, respectively. The response and remission rates were diminished at day8 with response rates of 41.9%/10.1% and remission rates of 19.4%/4.7%, respectively. Patients and ward personnel found the method applicable with few side effects. Positive diurnal variation (mood better in the evening) predicted a larger response to wake therapy. In the wake group napping on days after intervention predicted greater deterioration on day8. Conclusions The intervention induced an acute antidepressant response without relapse between wake nights but with a diminishing effect after intervention. Development is still needed to secure maintenance of response. Avoiding napping in the days after wake therapy is important. Trial Registration Clinical trials.gov NCT00149110 PMID:23840645

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

2013-01-01

62

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

63

How to Measure Outcomes of Peripheral Nerve Surgery  

PubMed Central

Synopsis Evaluation of outcomes after peripheral nerve surgeries include a number of assessment methods that reflect different aspects of recovery, including reinnervation, tactile gnosis, integrated sensory and motor function, pain and discomfort, neurophysiological and patient- reported outcomes. This review makes a list of measurements addressing these aspects as well as advantage and disadvantage of each tool. Because of complexities of neurophysiology, assessment remains a difficult process, which requires researchers focus on measurements best relevant to specific conditions and research questions. PMID:23895715

Wang, Yirong; Sunitha, Malay; Chung, Kevin C.

2013-01-01

64

Educational Outcome Measurement in Developing Countries.  

ERIC Educational Resources Information Center

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

Kiros, Fassil G.; And Others

65

Validity and reliability of patient reported outcomes used in Psoriasis: results from two randomized clinical trials  

PubMed Central

Background Two Phase III randomized controlled clinical trials were conducted to assess the efficacy, safety, and tolerability of weekly subcutaneous administration of efalizumab for the treatment of psoriasis. Patient reported measures of psoriasis-related functionality and health-related quality of life and of psoriasis-related symptom assessments were included as part of the trials. Objective To assess the reliability, validity, and responsiveness of the patient reported outcome measures that were used in the trials – the Dermatology Life Quality Index (DLQI), the Psoriasis Symptom Assessment (PSA) Scale, and two itch measures, a Visual Analog Scale (VAS) and the National Psoriasis Foundation (NPF) itch measure. Methods Subjects aged 18 to 70 years with moderate to severe psoriasis for at least 6 months were recruited into the two clinical trials (n = 1095). Internal consistency reliability was evaluated for all patient reported outcomes at baseline and at 12 weeks. Construct validity was evaluated by relations among the different patient reported outcomes and between the patient reported outcomes and the clinical assessments (Psoriasis Area and Severity Index; Overall Lesion Severity Scale; Physician's Global Assessment of Change) assessed at baseline and at 12 weeks, as was the change over the course of the 12 week portion of the trial. Results Internal consistency reliability ranged from 0.86 to 0.95 for the patient reported outcome measures. The patient reported outcome measures were all shown to have significant construct validity with respect to each other and with respect to the clinical assessments. The four measures also demonstrated significant responsiveness to change in underlying clinical status of the patients over the course of the trial, as measured by the independently assessed clinical outcomes. Conclusions The DLQI, the PSA, VAS, and the NPF are considered useful tools for the measurement of dermatology-related limitations of functional ability and the frequency, severity and impact of psoriasis symptoms on patients' lives and psoriasis-related quality of life. PMID:14613569

Shikiar, Richard; Bresnahan, Brian W; Stone, Stephen P; Thompson, Christine; Koo, John; Revicki, Dennis A

2003-01-01

66

Directly measured second hand smoke exposure and asthma health outcomes  

PubMed Central

Background: Because they have chronic airway inflammation, adults with asthma could have symptomatic exacerbation after exposure to second hand smoke (SHS). Surprisingly, data on the effects of SHS exposure in adults with asthma are quite limited. Most previous epidemiological studies used self-reported SHS exposure which could be biased by inaccurate reporting. In a prospective cohort study of adult non-smokers recently admitted to hospital for asthma, the impact of SHS exposure on asthma health outcomes was examined. Methods: Recent SHS exposure during the previous 7 days was directly measured using a personal nicotine badge (n = 189) and exposure during the previous 3 months was estimated using hair nicotine and cotinine levels (n = 138). Asthma severity and health status were ascertained during telephone interviews, and subsequent admission to hospital for asthma was determined from computerised utilisation databases. Results: Most of the adults with asthma were exposed to SHS, with estimates ranging from 60% to 83% depending on the time frame and methodology. The highest level of recent SHS exposure, as measured by the personal nicotine badge, was related to greater asthma severity (mean score increment for highest tertile of nicotine level 1.56 points; 95% CI 0.18 to 2.95), controlling for sociodemographic covariates and previous smoking history. Moreover, the second and third tertiles of hair nicotine exposure during the previous month were associated with a greater baseline prospective risk of hospital admission for asthma (HR 3.73; 95% CI 1.04 to 13.30 and HR 3.61; 95% CI 1.0 to 12.9, respectively). Conclusions: Directly measured SHS exposure appears to be associated with poorer asthma outcomes. In public health terms, these results support efforts to prohibit smoking in public places. PMID:16192366

Eisner, M; Klein, J; Hammond, S; Koren, G; Lactao, G; Iribarren, C

2005-01-01

67

[Requirements for patient-oriented results of research on stroke outcome].  

PubMed

Because assessing the requirements for patient-oriented outcome research on stroke rests on numerous prerequisites, these have to be defined beforehand, at least in a general sense. They consist of the epidemiological dimensions of stroke and related societal challenges; the special features of this disease entity with resulting numerous outcome dimensions; the structure, processes and results of the management of stroke; current outcome measurements with their patient-relevant results including quality of life; and the great importance of individually adapted prevention of recurrences and secondary events, as well as adequate treatment of associated diseases or sequelae. It is only on this basis that in the end those features can be formulated that are needed for patient-relevant outcome research. PMID:16688664

Wagner, M

2006-05-12

68

Definitions and outcome measures for mucous membrane pemphigoid: recommendations of an international panel of experts.  

PubMed

Mucous membrane pemphigoid encompasses a group of autoimmune bullous diseases with a similar phenotype characterized by subepithelial blisters, erosions, and scarring of mucous membranes, skin, or both. Although knowledge about autoimmune bullous disease is increasing, there is often a lack of clear definitions of disease, outcome measures, and therapeutic end points. With clearer definitions and outcome measures, it is possible to directly compare the results and data from various studies using meta-analyses. This consensus statement provides accurate and reproducible definitions for disease extent, activity, outcome measures, end points, and therapeutic response for mucous membrane pemphigoid and proposes a disease extent score, the Mucous Membrane Pemphigoid Disease Area Index. PMID:25443626

Murrell, Dedee F; Marinovic, Branka; Caux, Frederic; Prost, Catherine; Ahmed, Razzaque; Wozniak, Katarzyna; Amagai, Masayuki; Bauer, Johann; Beissert, Stefan; Borradori, Luca; Culton, Donna; Fairley, Janet A; Fivenson, David; Jonkman, Marcel F; Marinkovich, M Peter; Woodley, David; Zone, John; Aoki, Valeria; Bernard, Philippe; Bruckner-Tuderman, Leena; Cianchini, Giuseppe; Venning, Vanessa; Diaz, Luis; Eming, Rudiger; Grando, Sergei A; Hall, Russell P; Hashimoto, Takashi; Herrero-González, Josep E; Hertl, Michael; Joly, Pascal; Karpati, Sarolta; Kim, Jaehwan; Chan Kim, Soo; Korman, Neil J; Kowalewski, Cezary; Lee, Sang Eun; Rubenstein, David R; Sprecher, Eli; Yancey, Kim; Zambruno, Giovanna; Zillikens, Detlef; Doan, Serge; Daniel, Benjamin S; Werth, Victoria P

2015-01-01

69

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

70

Advances in Patient-Reported Outcomes: The NIH PROMIS® Measures  

PubMed Central

Patient-reported outcomes (PRO) are questionnaire measures of patients’ symptoms, functioning, and health-related quality of life. They are designed to provide important clinical information that generally cannot be captured with objective medical testing. In 2004, the National Institutes of Health launched a research initiative to improve the clinical research enterprise by developing state-of-the-art PROs. The NIH Patient-Reported Outcomes Measurement System (PROMIS) and Assessment Center are the products of that initiative. Adult, pediatric, and parent-proxy item banks have been developed by using contemporary psychometric methods, yielding rapid, accurate measurements. PROMIS currently provides tools for assessing physical, mental, and social health using short-form and computer-adaptive testing methods. The PROMIS tools are being adopted for use in clinical trials and translational research. They are also being introduced in clinical medicine to assess a broad range of disease outcomes. Recent legislative developments in the United States support greater efforts to include patients’ reports of health experience in order to evaluate treatment outcomes, engage in shared decision-making, and prioritize the focus of treatment. PROs have garnered increased attention by the Food and Drug Administration (FDA) for evaluating drugs and medical devices. Recent calls for comparative effectiveness research favor inclusion of PROs. PROs could also potentially improve quality of care and disease outcomes, provide patient-centered assessment for comparative effectiveness research, and enable a common metric for tracking outcomes across providers and medical systems.

Broderick, Joan E.; DeWitt, Esi Morgan; Rothrock, Nan; Crane, Paul K.; Forrest, Christopher B.

2013-01-01

71

Measuring Violence Risk and Outcomes among Mexican American Adolescent Females  

ERIC Educational Resources Information Center

Central to the development of culturally competent violence prevention programs for Hispanic youth is the development of psychometrically sound violence risk and outcome measures for this population. A study was conducted to determine the psychometric properties of two commonly used violence measures, in this case for Mexican American adolescent…

Cervantes, Richard C.; Duenas, Norma; Valdez, Avelardo; Kaplan, Charles

2006-01-01

72

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

73

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

74

Development of an outcome measurement system for service planning for children and youth with special needs  

PubMed Central

Aim?This study described the process used in developing an outcome measurement framework for system planning to improve services for children and youth with special needs and their families in a Canadian province. The study reports the results of several parent-completed measures, which would be useful in service planning as well as the acceptability and utility of these measures for use by families and service centres. Methods/results?Development of a theoretical framework, consultation with key stakeholders, testing the utility of selected outcome measures and initial dissemination of results were critical elements in the successful development of an outcome system. Consultation with stakeholders confirmed use of the International Classification of Functioning, Disability and Health and the child-within-family-within community model as theoretical frameworks while building valuable partnerships and identifying potential barriers to implementation. Pilot testing showed three outcome measures were feasible for families to complete and the measures provided information about services for children that was valuable to families as well as service providers. Gaps in service delivery were identified and the need for better communication between service providers and communities to facilitate integrated services was highlighted. Conclusion?The findings from this study can be used to implement an outcome measurement system for children with special needs and may serve as a resource for international researchers who are working to develop valid tools as well as outcome systems that are useful for system planning. PMID:22845889

Kertoy, M K; Russell, D J; Rosenbaum, P; Jaffer, S; Law, M; McCauley, D; Gorter, J W

2013-01-01

75

Foreword: emergence of efficiency in health outcome measurement.  

PubMed

Psychosocial measurement in the 21st Century is a dynamic field that is addressing challenges unthinkable even a generation ago. Sophisticated methods and modern technology has brought psychometrics to the cusp of scientific objectivity. This Foreword provides historical context and intellectual foundations for appreciating contemporary psychometric advancements, as well as a perspective on issues that are determining future advances. Efficiency in outcome measurement is one of these forces driving future advances. Efficiency, however, can easily become conflated with expediency, and neither can substitute for effectiveness. Blind efficiency runs risk of degrading measurement properties. Likewise, measurement advancement without accommodation to ordinary needs leads to practical rejection. Bouchard presents a biographical link between scientific physics and Rasch models that opened the door for fundamental psychosocial measurement. Symposium papers presented in this issue present a broad range of ideas about contemporary psychosocial measurement. Granger summarizes key ideas underlying achievement of objective, fundamental measurement. Massof, then, Stenner and Stone present alternative perspectives on scientific knowledge systems, which are prominent landmarks on the psychometric horizon. Fisher and Burton describe fundamental measurement methodology in diagnosis and implementation of technology, which will consolidate isolated and redundant constructs in PROMIS. Hart presents an overview on computer adaptive testing, which is the vanguard in health outcome measurement. Kisala and Tulsky present a qualitative strategy that is improving sensitivity and validity of new outcome measures. Their diversity reflects an intense competition of ideas about solving measurement problems. Their collection together in this special issue is a milestone and tribute to scientific ingenuity. PMID:20847470

Bezruczko, Nikolaus

2010-01-01

76

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.

77

Interpreting Outcome Measures in Vocational Education: A Final Report.  

ERIC Educational Resources Information Center

A project regarding the interpretability of data on vocational education outcome data was done (1) to determine how different definitions of the vocational student and relatedness of training to employment might affect the interpretability of vocational education impact data; (2) to synthesize the current literature and approaches measuring job…

McKinney, Floyd L.; And Others

78

Conceptualizing Outcome and Impact Measures for Intelligence Services  

ERIC Educational Resources Information Center

Introduction: The purpose of this qualitative, exploratory study is to clarify ambiguous concepts in intelligence services literature specifically related to measurement of intelligence outcomes and impact. Method: Face to face interviews were held with five subject experts from various intelligence fields and countries regarding their…

Gainor, Rhiannon; Bouthillier, France

2014-01-01

79

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

80

OMERACT: An international initiative to improve outcome measurement in rheumatology  

PubMed Central

OMERACT is the acronym for an international, informally organized network initiated in 1992 aimed at improving outcome measurement in rheumatology. Chaired by an executive committee, it organizes consensus conferences in a 2-yearly cycle that circles the globe. Data driven recommendations are prepared and updated by expert working groups. Recommendations include core sets of measures for most of the major rheumatologic conditions. Since 2002 patients have been actively engaged in the process. PMID:18039364

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

2007-01-01

81

Outcome Measurement in Clinical Genetics Services: A Systematic Review of Validated Measures  

Microsoft Academic Search

ObjectiveThis systematic review aimed to inform researchers and policymakers about what validated outcome measures are available to evaluate clinical genetics services (CGS) and the need for new measures.

Katherine Payne; Stuart Nicholls; Marion McAllister; Rhona MacLeod; Dian Donnai; Linda M. Davies

2008-01-01

82

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

EPA Science Inventory

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

83

Measure Once, Cut Twice – Adding Patient-Reported Outcome Measures to the Electronic Health Record for Comparative Effectiveness Research  

PubMed Central

Objective This paper presents the current state of patient-reported outcome measures, and explains new opportunities for leveraging the recent adoption of electronic health records to expand the application of patient-reported outcomes in both clinical care and comparative effectiveness research. Study Design and Setting Historic developments of patient-reported outcome, electronic health record, and comparative effectiveness research are analyzed in two dimensions: patient-centeredness and digitization. We pose the question: “What needs to be standardized around the collection of patient-reported outcomes in electronic health records for comparative effectiveness research?” Results We identified three converging trends: the progression of patient-reported outcomes toward greater patient centeredness and electronic adaptation; the evolution of electronic health records into personalized and fully digitized solutions; the shift toward patient-oriented comparative effectiveness research. Related to this convergence, we propose an architecture for patient-reported outcome standardization that could serve as a first step toward a more comprehensive integration of patient-reported outcomes with electronic health record for both practice and research. Conclusion The science of patient-reported outcome measurement has matured sufficiently to be integrated routinely into electronic health records and other e-health solutions to collect data on an ongoing basis for clinical care and comparative effectiveness research. Further efforts and ideally coordinated efforts from various stakeholders are needed to refine the details of the proposed framework for standardization. PMID:23849145

Wu, Albert W.; Kharrazi, Hadi; Boulware, L. Ebony; Snyder, Claire F.

2013-01-01

84

Resolving the problem of definite outcomes of measurements  

E-print Network

The core of the measurement problem, namely the problem of definite outcomes, remains unresolved. This paper shows that Josef Jauch's 1968 reduced density operator or "local state" solution is the correct answer, even though Jauch raised doubts about it at the time and many have questioned it since. In addition to Jauch's argument, a new argument based on the non-local entanglement between the measured quantum system and its measuring apparatus shows that relativity's ban on instant signaling implies the observed outcomes must be the definite local (or reduced) states. Experiments in 1990 with entangled photon pairs provide insight into the global measurement state, showing it to be a superposition only of correlations, not of quantum states. Nature's measurement strategy is to shift the superposition from the detected quantum system to the correlations between this system and its detector, allowing both system and detector to collapse locally into incoherent mixtures of definite outcomes while the global state maintains its unitary evolution. This solution implies a revision of the standard eigenvalue-eigenstate link, but this neither alters nor contradicts other quantum principles. Three frequent objections to this solution are rebutted.

Art Hobson

2015-02-23

85

Using Patient Reported Outcome Measures to Improve Service Effectiveness (UPROMISE): Training clinicians to Use Outcome Measures in Child Mental Health.  

PubMed

Patient reported outcome measures (PROMs) are prevalent in child mental health services. In this point of view, we discuss our experience of training clinicians to use PROMs and to interpret and discuss feedback from measures. Findings from pre-post observational data from clinicians who attended either a 1- or 3-day training course showed that clinicians in both courses had more positive attitudes and higher levels of self-efficacy regarding administering measures and using feedback after training. We hope that this special issue will lead the way for future research on training clinicians to use outcome measures so that PROMs may be a source of clinically useful practice based evidence. PMID:25331446

Edbrooke-Childs, Julian; Wolpert, Miranda; Deighton, Jessica

2014-10-21

86

Current approaches to measuring health outcomes in pediatric research.  

PubMed

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

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

1994-10-01

87

Novel Outcome Measures for Clinical Trials in Cystic Fibrosis  

PubMed Central

Cystic fibrosis (CF) is a common inherited condition caused by mutations in the gene encoding the CF transmembrane regulator protein. With increased understanding of the molecular mechanisms underlying CF and the development of new therapies there comes the need to develop new outcome measures to assess the disease, its progression and response to treatment. As there are limitations to the current endpoints accepted for regulatory purposes, a workshop to discuss novel endpoints for clinical trials in CF was held in Anaheim, California in November 2011. The pros and cons of novel outcome measures with potential utility for evaluation of novel treatments in CF were critically evaluated. The highlights of the 2011 workshop and subsequent advances in technologies and techniques that could be used to inform the development of clinical trial endpoints are summarized in this review. Pediatr Pulmonol. © 2014 The Authors. Pediatric Pulmonology published by Wiley Periodicals, Inc. PMID:25641878

Tiddens, Harm AWM; Puderbach, Michael; Venegas, Jose G; Ratjen, Felix; Donaldson, Scott H; Davis, Stephanie D; Rowe, Steven M; Sagel, Scott D; Higgins, Mark; Waltz, David A

2015-01-01

88

Outcome-Driven Thresholds for Home Blood Pressure Measurement  

PubMed Central

The lack of outcome-driven operational thresholds limits the clinical application of home blood pressure (BP) measurement. Our objective was to determine an outcome-driven reference frame for home BP measurement. We measured home and clinic BP in 6470 participants (mean age, 59.3 years; 56.9% women; 22.4% on antihypertensive treatment) recruited in Ohasama, Japan (n=2520); Montevideo, Uruguay (n=399); Tsurugaya, Japan (n=811); Didima, Greece (n=665); and nationwide in Finland (n=2075). In multivariable-adjusted analyses of individual subject data, we determined home BP thresholds, which yielded 10-year cardiovascular risks similar to those associated with stages 1 (120/80 mm Hg) and 2 (130/85 mm Hg) prehypertension, and stages 1 (140/90 mm Hg) and 2 (160/100 mm Hg) hypertension on clinic measurement. During 8.3 years of follow-up (median), 716 cardiovascular end points, 294 cardiovascular deaths, 393 strokes, and 336 cardiac events occurred in the whole cohort; in untreated participants these numbers were 414, 158, 225, and 194, respectively. In the whole cohort, outcome-driven systolic/diastolic thresholds for the home BP corresponding with stages 1 and 2 prehypertension and stages 1 and 2 hypertension were 121.4/77.7, 127.4/79.9, 133.4/82.2, and 145.4/86.8 mm Hg; in 5018 untreated participants, these thresholds were 118.5/76.9, 125.2/79.7, 131.9/82.4, and 145.3/87.9 mm Hg, respectively. Rounded thresholds for stages 1 and 2 prehypertension and stages 1 and 2 hypertension amounted to 120/75, 125/80, 130/85, and 145/90 mm Hg, respectively. Population-based outcome-driven thresholds for home BP are slightly lower than those currently proposed in hypertension guidelines. Our current findings could inform guidelines and help clinicians in diagnosing and managing patients. PMID:23129700

Niiranen, Teemu J.; Asayama, Kei; Thijs, Lutgarde; Johansson, Jouni K.; Ohkubo, Takayoshi; Kikuya, Masahiro; Boggia, José; Hozawa, Atsushi; Sandoya, Edgardo; Stergiou, George S.; Tsuji, Ichiro; Jula, Antti M.; Imai, Yutaka; Staessen, Jan A.

2013-01-01

89

Comparison of Alternative Primary Outcome Measures for Use in Lupus Nephritis Clinical Trials  

PubMed Central

Objective Clinical trials of therapies for lupus nephritis have used many different primary outcome measures, ranging from complete response to time to end-stage renal disease. The objective of this study was to compare several possible outcome measures, using data from a large, multicenter trial of abatacept in lupus nephritis, to gain insight into which outcome measure, if any, was best able to discern differences among treatment groups. Methods Study patients received either abatacept or placebo, on a background of mycophenolate mofetil and glucocorticoids. Using data from this trial, the following primary outcome measures at 24 and 52 weeks were compared: complete response rate, major clinical response rate, total response rate (complete plus partial response), improvement in proteinuria, improvement in estimated glomerular filtration rate, and frequency of treatment failure. Time to complete response was also evaluated. Results Complete response rate, major clinical response rate, and time to complete response were the measures that best discriminated between the abatacept groups and placebo, and the sensitivities of these 3 measures were comparable. For these measures, sample sizes of 50 patients would have been sufficient to demonstrate a statistically significant difference between treatment and control at 52 weeks. Each of the other measures also discriminated between treatment and control, but much larger group sizes would have been required to determine statistical significance. Conclusion The choice of primary outcome measure can substantially influence the ability to detect therapeutic benefit in lupus nephritis trials. This study suggests that complete response rate, major clinical response rate at 52 weeks, and time to complete response may be the most sensitive outcome measures for detecting differences among therapeutic regimens. PMID:23529285

Wofsy, David; Hillson, Jan L.; Diamond, Betty

2015-01-01

90

Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs)  

PubMed Central

In recent years, there has been an increased focus on placing patients at the center of health care research and evaluating clinical care in order to improve their experience and ensure that research is both robust and of maximum value for the use of medicinal products, therapy, or health services. This paper provides an overview of patients’ involvement in clinical research and service evaluation along with its benefits and limitations. We describe and discuss patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs), including the trends in current research. Both the patient-reported experiences measures (PREMs) and patient and public involvement (PPI) initiative for including patients in the research processes are also outlined. PROs provide reports from patients about their own health, quality of life, or functional status associated with the health care or treatment they have received. PROMs are tools and/or instruments used to report PROs. Patient report experiences through the use of PREMs, such as satisfaction scales, providing insight into the patients’ experience with their care or a health service. There is increasing international attention regarding the use of PREMS as a quality indicator of patient care and safety. This reflects the ongoing health service commitment of involving patients and the public within the wider context of the development and evaluation of health care service delivery and quality improvement. PMID:25114561

Weldring, Theresa; Smith, Sheree M.S.

2013-01-01

91

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

92

Measuring Stress Before and During Pregnancy: A Review of Population-Based Studies of Obstetric Outcomes  

PubMed Central

Objectives Mounting evidence from clinic and convenience samples suggests that stress is an important predictor of adverse obstetric outcomes. Using a proposed theoretical framework, this review identified and synthesized the population-based literature on the measurement of stress prior to and during pregnancy in relation to obstetric outcomes. Methods Population-based, peer-reviewed empirical articles that examined stress prior to or during pregnancy in relation to obstetric outcomes were identified in the PubMed and PsycInfo databases. Articles were evaluated to determine the domain(s) of stress (environmental, psychological, and/or biological), period(s) of stress (preconception and/or pregnancy), and strength of the association between stress and obstetric outcomes. Results Thirteen studies were evaluated. The identified studies were all conducted in developed countries. The majority of studies examined stress only during pregnancy (n=10); three examined stress during both the preconception and pregnancy periods (n=3). Most studies examined the environmental domain (e.g., life events) only (n=9), two studies examined the psychological domain only, and two studies examined both. No study incorporated a biological measure of stress. Environmental stressors before and during pregnancy were associated with worse obstetric outcomes, although some conflicting findings exist. Conclusions Few population-based studies have examined stress before or during pregnancy in relation to obstetric outcomes. Although considerable variation exists in the measurement of stress across studies, environmental stress increased the risk for poor obstetric outcomes. Additional work using a lifecourse approach is needed to fill the existing gaps in the literature and to develop a more comprehensive understanding of the mechanisms by which stress impacts obstetric outcomes. PMID:23447085

Witt, Whitney; Litzelman, Kristin; Cheng, Erika R; Wakeel, Fathima; Barker, Emily S.

2013-01-01

93

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

94

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

PubMed Central

Abstract Objective Although developed to be a management tool for individuals with diabetes, continuous glucose monitoring (CGM) also has potential value for the assessment of outcomes in clinical studies. We evaluated using CGM as such an outcome measure. Research Design and Methods Data were analyzed from six previously completed inpatient studies in which both CGM (Freestyle Navigator™ [Abbott Diabetes Care, Alameda, CA] or Guardian® [Medtronic, Northridge, CA]) and reference glucose measurements were available. The analyses included 97 days of data from 93 participants with type 1 diabetes (age range, 5–57 years; mean, 18±12 years). Results Mean glucose levels per day were similar for the CGM and reference measurements (median, 148?mg/dL vs. 143?mg/dL, respectively; P=0.92), and the correlation of the two was high (r=0.89). Similarly, most glycemia metrics showed no significant differences comparing CGM and reference values, except that the nadir glucose tended to be slightly lower and peak glucose slightly higher with reference measurements than CGM measurements (respective median, 59?mg/dL vs. 66?mg/dL [P=0.05] and 262?mg/dL vs. 257?mg/dL [P=0.003]) and glucose variability as measured with the coefficient of variation was slightly lower with CGM than reference measurements (respective median, 31% vs. 35%; P<0.001). Conclusions A reasonably high degree of concordance exists when comparing outcomes based on CGM measurements with outcomes based on reference blood glucose measurements. CGM inaccuracy and underestimation of the extremes of hyperglycemia and hypoglycemia can be accounted for in a clinical trial's study design. Thus, in appropriate settings, CGM can be a very meaningful and feasible outcome measure for clinical trials. PMID:23013201

Calhoun, Peter; Kollman, Craig

2012-01-01

95

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

ERIC Educational Resources Information Center

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

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

2010-01-01

96

Floating knee injuries: Results of treatment and outcomes  

PubMed Central

Background: Floating knee, referred to as ipsilateral fractures of the femur and tibia, is usually associated with several complications and mortality. This study was designed to present our experience with treatment of this injury throughout; age, sex, mechanism of injury, associated injuries, method and results of treatment, and complications of floating knee are discussed. Materials and Methods: This retrospective study was performed between January 2006 and December 2011. All patients with floating knee injuries who were admitted to the referral educational hospitals were included. The information about the 238 cases of floating knee injuries were gathered through the 254,620 trauma files and after excluding 18 patients who died within 6 months, the remaining files were studied and the target information was recorded. Results: The most frequent age group was 20-29 years (44.5%). The floating knee injuries were more common in males (85.5%). Type (D) according to “the classification of Letts and Vincent” was observed in 38.9% cases. The most frequent mechanism of injury was car to motorcycles accidents (48.2%). The most common associated injury was pelvic fractures (86.8%). Open reduction and internal fixation was the common type of treatment (70%). The most common early and late complications were knee hemarthrosis in 31 cases (14%) and knee osteoarthritis in 30 cases (13.6%), respectively. Death during the 5 years follow up was due to circulatory disruption, followed by deep vein thrombosis (61%). There was a significant relation between the age and outcomes as it worsens with age (P-value < 0.05). Conclusion: This study revealed that the complication rate associated with floating knee injuries remained high, regardless of the used treatment regimen and surgeons should focus on reducing complications while treating it. PMID:24523801

Nouraei, Mohammad Hadi; Hosseini, Alireza; Zarezadeh, Abolghasem; Zahiri, Mohammad

2013-01-01

97

Measuring learning outcomes of Bachelor degree program in outcome-based education  

Microsoft Academic Search

Learning outcomes are skill and ability acquired shortly after the conclusion of a learning session, which is typically a 14-week semester in undergraduate engineering degree program. In this report, a 4 year programme offering 130 credit hours is chosen as an example. One of the criteria in Outcome Based Education is the assessment of learning outcomes as achievement indicator for

Chit Siang Soh; Kia Hock Tan; Kim Ho Yeap; Vooi Voon Yap; Yun Thung Yong

2010-01-01

98

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

99

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

100

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

PubMed Central

Background Psychosocial interventions for substance dependence have demonstrated efficacy. However, the mechanisms by which specific intervention strategies exert their effect have not been clearly identified. Objective This study investigated the prospective relationships between two psychological processes, an attentional bias towards cocaine stimuli and beliefs about the consequences of cocaine use, and treatment outcome. Method Twenty-five cocaine dependent participants enrolled in a 6-month outpatient treatment program that included voucher incentives for abstinence. All participants were asked to complete two implicit assessment procedures, a Drug Stroop protocol and an Implicit Relational Assessment Procedure (IRAP), as well as explicit measures of cocaine craving and the consequences of cocaine use, prior to beginning treatment. Pearson-correlation coefficients tested the prospective relationships between treatment outcome and the implicit and explicit assessments. Results Stronger implicit beliefs about the positive effects of cocaine use prior to treatment were associated with poorer treatment outcome when an escalating voucher incentive program was in place. Further, an attentional bias for cocaine-related stimuli was associated with better treatment outcome when an escalating voucher incentive program was removed. No association between cocaine use beliefs and treatment outcome was found when beliefs were measured with self-report instruments. Conclusions and Scientific Significance These findings highlight the potential utility of performance based measures for delineating the psychological mechanisms associated with variation in response to treatment for drug dependence. PMID:22220556

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

2012-01-01

101

Measuring the Outcome of Biomedical Research: A Systematic Literature Review  

PubMed Central

Background There is an increasing need to evaluate the production and impact of medical research produced by institutions. Many indicators exist, yet we do not have enough information about their relevance. The objective of this systematic review was (1) to identify all the indicators that could be used to measure the output and outcome of medical research carried out in institutions and (2) enlist their methodology, use, positive and negative points. Methodology We have searched 3 databases (Pubmed, Scopus, Web of Science) using the following keywords: [Research outcome* OR research output* OR bibliometric* OR scientometric* OR scientific production] AND [indicator* OR index* OR evaluation OR metrics]. We included articles presenting, discussing or evaluating indicators measuring the scientific production of an institution. The search was conducted by two independent authors using a standardised data extraction form. For each indicator we extracted its definition, calculation, its rationale and its positive and negative points. In order to reduce bias, data extraction and analysis was performed by two independent authors. Findings We included 76 articles. A total of 57 indicators were identified. We have classified those indicators into 6 categories: 9 indicators of research activity, 24 indicators of scientific production and impact, 5 indicators of collaboration, 7 indicators of industrial production, 4 indicators of dissemination, 8 indicators of health service impact. The most widely discussed and described is the h-index with 31 articles discussing it. Discussion The majority of indicators found are bibliometric indicators of scientific production and impact. Several indicators have been developed to improve the h-index. This indicator has also inspired the creation of two indicators to measure industrial production and collaboration. Several articles propose indicators measuring research impact without detailing a methodology for calculating them. Many bibliometric indicators identified have been created but have not been used or further discussed. PMID:25837969

Thonon, Frédérique; Boulkedid, Rym; Delory, Tristan; Rousseau, Sophie; Saghatchian, Mahasti; van Harten, Wim; O’Neill, Claire; Alberti, Corinne

2015-01-01

102

Predicting Outcome in Behavioral Parent Training: Expected and Unexpected Results  

ERIC Educational Resources Information Center

This study examined the relationships among clinical utility and treatment outcome variables in Behavioral Parent Training (BPT). The sample included 21 mothers with 3-8 year-old children with significant externalizing behavior problems who received treatment for Oppositional Defiant Disorder. The primary aim was to relate two treatment…

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

2004-01-01

103

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

104

Children's Program Outcome Review Team: 2001 Evaluation Results.  

ERIC Educational Resources Information Center

In its eighth year of evaluating children's services in the state, the Children's Program Outcome Review Team (CPORT), under the direction of the Tennessee Commission on Children and Youth, continued to collect and analyze data to improve service delivery to children and families involved in state custody. Using the Quality Service Review…

Wade, Patricia C.

105

Children's Program Outcome Review Team: 2000 Evaluation Results.  

ERIC Educational Resources Information Center

In its seventh year of evaluating children's services, the Children's Program Outcome Review Team (CPORT), under the direction of the Tennessee Commission on Children and Youth, continued to collect and analyze data to improve service delivery to children and families involved in state custody. The CPORT evaluation for 2000 collected and organized…

Wade, Patricia C.

106

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

ERIC Educational Resources Information Center

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

Wade, Patricia C.

107

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

108

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

109

Network measures predict neuropsychological outcome after brain injury  

PubMed Central

Hubs are network components that hold positions of high importance for network function. Previous research has identified hubs in human brain networks derived from neuroimaging data; however, there is little consensus on the localization of such hubs. Moreover, direct evidence regarding the role of various proposed hubs in network function (e.g., cognition) is scarce. Regions of the default mode network (DMN) have been frequently identified as “cortical hubs” of brain networks. On theoretical grounds, we have argued against some of the methods used to identify these hubs and have advocated alternative approaches that identify different regions of cortex as hubs. Our framework predicts that our proposed hub locations may play influential roles in multiple aspects of cognition, and, in contrast, that hubs identified via other methods (including salient regions in the DMN) might not exert such broad influence. Here we used a neuropsychological approach to directly test these predictions by studying long-term cognitive and behavioral outcomes in 30 patients, 19 with focal lesions to six “target” hubs identified by our approaches (high system density and participation coefficient) and 11 with focal lesions to two “control” hubs (high degree centrality). In support of our predictions, we found that damage to target locations produced severe and widespread cognitive deficits, whereas damage to control locations produced more circumscribed deficits. These findings support our interpretation of how neuroimaging-derived network measures relate to cognition and augment classic neuroanatomically based predictions about cognitive and behavioral outcomes after focal brain injury. PMID:25225403

Warren, David E.; Power, Jonathan D.; Bruss, Joel; Denburg, Natalie L.; Waldron, Eric J.; Sun, Haoxin; Petersen, Steven E.; Tranel, Daniel

2014-01-01

110

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

ERIC Educational Resources Information Center

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

Cousineau, John; Landon, Bruce

111

Nonprofit Organizations and Outcome Measurement: From Tracking Program Activities to Focusing on Frontline Work  

ERIC Educational Resources Information Center

Why do we continue to see evidence that nonprofit staff feel like outcome measurement is missing important aspects of their work? Based on an analysis of over 1,000 pages of material in 10 outcome measurement guides and a focused literature review of frontline work in three types of nonprofit organizations, this article shows that existing outcome

Benjamin, Lehn M.

2012-01-01

112

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

PubMed Central

Goal attainment scaling (GAS) holds promise as an idiographic approach for measuring outcomes of psychosocial interventions in community settings. GAS has been criticized for untested assumptions of scaling level (i.e., interval or ordinal), inter-individual equivalence and comparability, and reliability of coding across different behavioral observation methods. We tested assumptions of equality between GAS descriptions for outcome measurement in a randomized trial (i.e., measurability, equidistance, level of difficulty, comparability of behavior samples collected from teachers vs. researchers and live vs. videotape). Results suggest GAS descriptions can be evaluated for equivalency, that teacher collected behavior samples are representative, and that varied sources of behavior samples can be reliably coded. GAS is a promising measurement approach. Recommendations are provided to ensure methodological quality. PMID:22271197

McGrew, John H.; Toland, Michael D.

2012-01-01

113

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

114

Measuring outcomes in orthopaedics: implementation of an outcomes program in an outpatient orthopaedic practice.  

PubMed

With increased demand to provide quality care for patients, orthopaedic practices will need to develop ways to efficiently collect and manage data to support the care that they provide. An outcomes management program must be efficient and consistent to provide good data. This article describes the implementation of an outcomes program at one large private orthopaedic practice within an academic medical setting. PMID:25401206

Rodts, Mary F; Glanzman, Renée; Gray, Adam; Johnson, Randal; Viellieu, Dennis; Hachem, Fadi

2014-01-01

115

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. PMID:25525513

Millstein, Rachel A.

2014-01-01

116

Enhancing the patient involvement in outcomes: a study protocol of personalised outcome measurement in the treatment of substance misuse  

PubMed Central

Background Involving patients in treatment is becoming increasingly popular in mental health [Sales & Alves: Personalized evaluation of psychological treatments: A review of tools and research designs, submitted]. However, in substance misuse treatment settings, the patient perspective about treatment tends to be overlooked. This has been cited as a key priority by Orford et al. [Addiction, 103: 875-885, 2008] who included patient feedback about treatment as one of ten areas requiring an urgent paradigm shift in addiction research and practice. This project will apply an innovative method to involve substance misuse patients in psychological therapies, by asking them to suggest topics to evaluate their treatment. These topics suggested by patients can be written as a list of personalised items, so-called as patient-generated outcome measures (PGOM). Despite its patient-friendly features, PGOM’s have never been used in this population, which is what this project aims to overcome. Methods/design This project is part of an International Exchange Platform on Personalising Addiction Treatment. Data will be collected in two phases (pre-post study and focus groups with patients) to explore the following: 1). How reliable and sensitive to change are PGOM’s and standardised measures in substance misuse treatment? 2). Do PGOM’s add relevant information to standardised measures? 3). What are the views of substance misuse patients about personalised outcome assessment? 4). Development of guidelines on using PGOM’s in this population Discussion This research will potentially demonstrate the diversity of personal problems among patients seeking substance misuse treatment, suggesting the relevance of PGOM as a method to personalise outcome measurement and, ultimately, guiding treatment provision. It is expected that, as in previous studies, PGOM’s will be perceived as helpful and patient-friendly tools, where patients may express their own concerns in a semi-structured setting. Similarly to other populations, we also expect PGOM’s to be reliable, valid and sensitive to clinical changes in substance misuse treatment, as well as more content informative than their standardised counterparts. If these results are achieved, we might hypothesize that PGOM’s are a potentially valid supplement to traditional standardised scales, by providing a closer insight to what motivates patients to participate in substance misuse treatment programmes. PMID:24341378

2013-01-01

117

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

118

A view from health services research and outcomes measurement.  

PubMed

Depicted in this presentation is the relationship of the aims of the original articles in this issue--using theory in a substantive way; introducing a strong focus on the organization as a contributor to patient, provider, and system outcomes; accounting for organizational level; and moving the field toward a view of research utilization as an intermediate, not terminal, outcome--to outcomes research in health services generally and in nursing health services research more specifically. The insights and innovations described in this set of articles contribute significantly to the literature on research use in healthcare, specifically including the need to account more fully for organizational structure and hierarchy than has been the case to date in health services outcomes research, as well as a strong intimation that research use is not only an important intervening variable in the causal chain producing outcomes at the patient, provider, and system levels but also a latent or unobservable variable. PMID:17625476

Sales, Anne E

2007-01-01

119

The interdependence of behavioral and somatic health: implications for conceptualizing health and measuring treatment outcomes  

PubMed Central

Purpose The interdependence of behavioral and somatic aspects of various health conditions warrants greater emphasis on an integrated care approach. Theory We propose that integrated approaches to health and wellness require comprehensive and empirically-valid outcome measures to assess quality of care. Method We discuss the transition from independent to integrated treatment approaches and provide examples of new systems for integrated assessment of treatment outcome. Results Evidence suggests that support for an independent treatment approach is waning and momentum is building towards more integrated care. In addition, research evidence suggests integrated care improves health outcomes, and both physicians and patients have favorable impressions of integrated care. Conclusions As treatment goals in the integrated perspective expand to take into account the intimate relationships among mental illness, overall health, and quality of life, clinicians need to develop outcome measures that are similarly comprehensive. Discussion Increased recognition, by researchers, providers, and insurers, of the interdependence between behavioral and physical health holds great promise for innovative treatments that could significantly improve patients' lives. PMID:17627294

LaBrie, Richard A.; LaPlante, Debi A.; Peller, Allyson J.; Christensen, Donald E.; Greenwood, Kristina L.; Straus, John H.; Garmon, Michael S.; Browne, Cheryl; Shaffer, Howard J.

2007-01-01

120

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

Microsoft Academic Search

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

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

2005-01-01

121

Implementing patient reported outcome measures (PROMs) in palliative care - users' cry for help  

PubMed Central

Background Patient-reported outcome measurement (PROM) plays an increasingly important role in palliative care. A variety of measures exists and is used in clinical care, audit and research. However, little is known about professionals' views using these measures. The aim of this study is to describe the use and experiences of palliative care professionals with outcome measures. Methods A web-based online survey was conducted in Europe and Africa. Professionals working in clinical care, audit and research in palliative care were invited to the survey via national palliative care associations and various databases. Invitation e-mails were sent with a link to the questionnaire. Results Overall participation rate 42% (663/1592), overall completion rate 59% (392/663). The majority of respondents were female (63.4%), mean age 46 years (SD 9). 68.1% respondents from Europe and 73.3% from Africa had experiences with outcome measures in palliative care. Non-users reported time constraints, burden, lack of training and guidance as main reasons. In clinical care/audit, assessment of patients' situation, monitoring changes and evaluation of services were main reasons for use. Choice of OMs for research was influenced by validity of the instrument in palliative care and comparability with international literature. Main problems were related to patient characteristics, staff, and outcome measures. Participants expressed the need for more guidance and training in the use of PROMs. Conclusions Professionals need more support for the use and implementation of PROMs in clinical practice and research through training and guidance in order to improve patient care. PMID:21507232

2011-01-01

122

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

123

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

Microsoft Academic Search

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

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

2004-01-01

124

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

PubMed Central

Purpose: To determine the outcome measures practice patterns in the neck pain management of various health disciplines. Methods: A survey of 381 clinicians treating patients with neck pain was conducted. Results: Respondents were more commonly male (54%) and either chiropractors (44%) or physiotherapists (32%). The survey was international (24 countries with Canada having the largest response (44%)). The most common assessment was a single-item pain assessment (numeric or visual analog) used by 75% of respondents. Respondents sometimes or routinely used the Neck Disability Index (49%), the Patient Specific Functional Scale (28%), and the Disabilities of the Arm, Shoulder and Hand (32%). Work status was recorded in terms of time lost by more than 50% of respondents, but standardized measures of work limitations or functional capacity testing were rarely used. The majority of respondents never used fear of movement, psychological distress, quality of life, participation measures, or global ratings of change (< 10% routinely use). Use of impairment measurers was prevalent, but the type selected was variable. Quantitative sensory testing was used sometimes or routinely by 53% of respondents, whereas 26% never used it. Ratings of segmental joint mobility were commonly used to assess motion (44% routinely use), whereas 66% of respondents never used inclinometry. Neck muscle strength, postural alignment and upper extremity coordination were assessed sometimes or routinely by a majority of respondents (>56%). With the exception of numeric pain ratings and verbal reporting of work status, all outcomes measures were less frequently used by physicians. Years of practice did not affect practice patterns, but reimbursement did affect selection of some outcome measures. Conclusions: Few outcome measures are routinely used to assess patients with neck pain other than a numeric pain rating scale. A comparison of practice patterns to current evidence suggessts overutilization of some measures that have questionable reliability and underutilization of some with better supporting evidence. This practice analysis suggests that there is substantial need to implement more consistent outcome measurement in practice. International consensus and better clinical measurement evidence are needed to support this. PMID:24115972

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

2013-01-01

125

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

126

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

127

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

128

42 CFR 486.318 - Condition: Outcome measures.  

Code of Federal Regulations, 2014 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS...and Conditions for Coverage: Organ Procurement Organizations Organ Procurement Organization Outcome...cycle: (i) The number of organs transplanted per standard...

2014-10-01

129

42 CFR 486.318 - Condition: Outcome measures.  

Code of Federal Regulations, 2010 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS...and Conditions for Coverage: Organ Procurement Organizations Organ Procurement Organization Outcome...cycle: (i) The number of organs transplanted per standard...

2010-10-01

130

42 CFR 486.318 - Condition: Outcome measures.  

Code of Federal Regulations, 2013 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS...and Conditions for Coverage: Organ Procurement Organizations Organ Procurement Organization Outcome...cycle: (i) The number of organs transplanted per standard...

2013-10-01

131

42 CFR 486.318 - Condition: Outcome measures.  

Code of Federal Regulations, 2012 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS...and Conditions for Coverage: Organ Procurement Organizations Organ Procurement Organization Outcome...cycle: (i) The number of organs transplanted per standard...

2012-10-01

132

42 CFR 486.318 - Condition: Outcome measures.  

Code of Federal Regulations, 2011 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS...and Conditions for Coverage: Organ Procurement Organizations Organ Procurement Organization Outcome...cycle: (i) The number of organs transplanted per standard...

2011-10-01

133

Identifying best practice through benchmarking and outcome measurement.  

PubMed

Collecting and analyzing various types of data are essential to identifying areas for improvement. Data collection and analysis are routinely performed in hospitals and are even required by some regulatory agencies. Realization of the full benefits, which may be achieved through collection and analysis of data, should be actively pursued to prevent a meaningless exercise in paperwork. Internal historical comparison of data may be helpful but does not achieve the ultimate goal of identifying external benchmarks in order to determine best practice. External benchmarks provide a means of comparison with similar facilities, allowing the identification of processes needing improvement. The specialty of ophthalmology presents unique practice situations that are not comparable with other specialties, making it imperative to benchmark against other facilities where quick surgical case time, efficient surgical turnover times, low infection rates, and cost containment are essential and standard operations. Important data to benchmark include efficiency data, financial data, and quality or patient outcome data. After identifying facilities that excel in certain aspects of performance, it is necessary to analyze how their procedures help them achieve these favorable results. Careful data collection and analysis lead to improved practice and patient care. PMID:15709351

Lanier, Lynne

2004-01-01

134

Similarities in outcomes for men and women after drug misuse treatment: results from the National Treatment Outcome Research Study (NTORS).  

PubMed

The National Treatment Outcome Research Study (NTORS) is a prospective, multi-site treatment outcome study of drug misusers in the UK. This paper reports the characteristics and problems of male and female clients at intake to treatment, and changes in substance use, health problems, and criminal behaviour at follow-up. The sample comprised 753 subjects (552 men and 201 women) followed-up 1 year after starting treatment in 54 programmes chosen to be representative of the main national treatment modalities. Men and women presented to treatment with different problems and characteristics. Women reported more frequent cocaine use, greater health problems, and were more likely to have a drug-using partner and be responsible for children. Despite different profiles of problems, men and women both made significant reductions in their problem behaviours following treatment. At 1-year follow-up, men and women reported reductions in drug use, health problems and criminal behaviour. However, women did not reduce their alcohol consumption significantly, and improvements in crime were less pronounced than for men. After controlling for pretreatment differences, gender was not predictive of any of the outcome measures reported. PMID:12745357

Stewart, Duncan; Gossop, Michael; Marsden, John; Kidd, Tara; Treacy, Samantha

2003-03-01

135

Validation of quick DASH outcome measure in breast cancer survivors for upper extremity disability  

PubMed Central

OBJECTIVE To validate the quickDASH as a patient-reported outcome measure for assessing upper extremity disability in breast cancer survivors. DESIGN Large cross-sectional survey SETTING Ambulatory care center at a university hospital PARTICIPANTS Postmenopausal women with stage I to III hormone receptor-positive breast cancer currently taking a third-generation aromatase inhibitor (N = 150) INTERVENTIONS Not applicable MAIN OUTCOME MEASURE QuickDASH, an 11- item self-administered questionnaire assesses global arm function over the past seven days. RESULTS 148 (99%) of 150 surveys were scorable. The factor analysis demonstrated one factor with Eigen value of 6.7, which explains 61% of variance. Score was reliable with Cronbach’s ?=0.93. The test-retest reliability was 0.78 over two weeks. The mean quickDASH score for all patients was 19(SD19). Those with upper extremity arthralgias reported higher quickDASH scores than controls without pain (26 vs. 12, P=0.001). Those with frozen shoulder pain also reported higher quickDASH scores than controls without pain (37 vs. 15, P=0.001). CONCLUSION The quickDASH instrument is a convenient, reliable, and valid patient-reported outcome measure to assess upper extremity disability in breast cancer patients. PMID:24095658

LeBlanc, M; Stineman, M; DeMichele, A; Stricker, C; Mao, JJ

2014-01-01

136

Typology of Learning Outcomes in Cognitive Domain: What Is Said vs. What Is Measured  

ERIC Educational Resources Information Center

Based on extensive literature review, this study reports the result of a meta analysis of learning outcome studies and presents an integrated typology of content types and learning outcomes. Examining the ERIC database for learning studies conducted from 1992 until 2006 shows that most empirical studies have assessed the learning outcome at lower…

Lim, Doo H.; Yoon, Seung Won; Son, Su Jin; Park, Sunyoung

2007-01-01

137

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

PubMed Central

Rheumatoid arthritis (RA) is a chronic autoimmune disease with episodic flares in affected joints, whose etiology is largely unknown. Recent studies in mice demonstrated alterations in lymphatics from affected joints precede flares. Thus, we aimed to develop novel methods for measuring lymph node pressure and lymph viscosity in limbs of mice. Pressure measurements were performed by inserting a glass micropipette connected to a pressure transducer into popliteal lymph nodes (PLN) or axillary lymph nodes (ALN) of mice and determined that the lymphatic pressures were 9 and 12 cm of water, respectively. We are also developing methods for measuring lymph viscosity in lymphatic vessels afferent to PLN, which can be measured by multi-photon fluorescence recovery after photobleaching (MP-FRAP) of FITC-BSA injected into the hind footpad. These results demonstrate the potential of lymph node pressure and lymph viscosity measurements, and warrant future studies to test these outcomes as biomarkers of arthritic flare. PMID:22172039

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

2012-01-01

138

Survey of Outcomes Measurement in Research on Character Education Programs. NCEE 2009-006  

ERIC Educational Resources Information Center

Character education programs are school-based programs that have as one of their objectives promoting the character development of students. This report systematically examines the outcomes that were measured in evaluations of a delimited set of character education programs and the research tools used for measuring the targeted outcomes. The…

Person, Ann E.; Moiduddin, Emily; Hague-Angus, Megan; Malone, Lizabeth M.

2009-01-01

139

Evaluating complementary and alternative medicine interventions: in search of appropriate patient-centered outcome measures  

Microsoft Academic Search

BACKGROUND: Central to the development of a sound evidence base for Complementary and Alternative Medicine (CAM) interventions is the need for valid, reliable and relevant outcome measures to assess whether the interventions work. We assessed the specific needs for a database that would cover a wide range of outcomes measures for CAM research and considered a framework for such a

Marja J Verhoef; Laura C Vanderheyden; Trish Dryden; Devon Mallory; Mark A Ware

2006-01-01

140

Measures for the Final Common Core of Constructs. The Project on State-Level Child Outcomes.  

ERIC Educational Resources Information Center

The Project on State-Level Child Outcomes, a federal project designed to improve the measurement of child outcomes in state welfare evaluations and in other state data systems. This document provides measures for the common core of constructs that state representatives developed at the second national-level meeting of the Project's planning phase.…

Child Trends, Inc., Washington, DC.

141

Review of Goal Attainment Scaling as a Useful Outcome Measure in Psychogeriatric Patients with Cognitive Disorders  

Microsoft Academic Search

Background: Since evidence-based interventions are the standard, there is an urgent need for more information concerning individual ways of measuring clinically relevant outcomes of interventions in cognitive disorders such as dementia. Goal Attainment Scaling (GAS) seems to offer a meaningful outcome measure. Aim: To examine the applicability of GAS in psychogeriatric patients with cognitive disorders. Methods: A systematic review was

Sharon F. M. Bouwens; Caroline M. van Heugten; Frans R. J. Verhey

2008-01-01

142

The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle  

PubMed Central

Background Routine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Within Child and Adolescent Mental Health Services (CAMHS) in the UK the adoption of ROM in CAMHS has been supported by both national and local initiatives (such as government strategies, local commissioning policy, and research). Methods With the aim of assessing how these policies and initiatives may have influenced the uptake of ROM within two different CAMHS we report the findings of two case-note audits: a baseline audit conducted in January 2011 and a re-audit conducted two years later in December 2012-February 2013. Results The findings show an increase in both the single and repeated use of outcome measures from the time of the original audit, with repeated use (baseline and follow-up) of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) scale increasing from 10% to 50% of cases. Re-audited case-notes contained more combined use of different outcome measures, with greater consensus on which measures to use. Outcome measures that were applicable across a wide range of clinical conditions were more likely to be used than symptom-specific measures, and measures that were completed by the clinician were found more often than measures completed by the service user. Conclusions The findings show a substantial improvement in the use of outcome measures within CAMHS. These increases in use were found across different service organisations which were subject to different types of local service priorities and drivers. PMID:24139139

2013-01-01

143

New tools--new models to integrate outcomes into quality measurement.  

PubMed

Nurse managers are faced with a changing health care system that values measurement of outcomes and performance. Today's nurse managers are confronted with the need for information to make decisions that translate information into knowledge about health care outcomes, effectiveness, efficiency, and quality. These same nurse managers are being held accountable for the efforts of nurses to enhance the health of the public. New models of evidence and outcomes integrated into the models of nursing process are required to measure quality in this new environment. Yet the measurement of outcomes and the measurement of quality should be united in this new paradigm. The author describes new tools available from the Agency for Health Care Policy and Research that could assist nurse managers in delivering and developing computerized patient record systems that capture the evidence, the clinical indicators, and the performance measures to assist in describing the outcomes of care. PMID:9887862

McCormick, K A

1998-09-01

144

Standardizing ED-based migraine clinical research: a data-driven analysis of commonly-used trial outcome measures  

PubMed Central

Introduction Although many high quality migraine clinical trials have been performed in the emergency department (ED) setting, almost as many different primary outcome measures have been used, making data aggregation and meta-analysis difficult. We assessed commonly used migraine trial outcomes in two ways. First, we examined the association of each commonly used outcome versus the following patient-centered variable: the research subject’s wish, when asked 24 hours after investigational medication administration, to receive the same medication the next time they presented to an ED with migraine (“would take again”). We chose this variable as the criterion standard because it provides a simple, dichotomous, clinically sensible outcome, which allows migraineurs to factor important intangibles of efficacy and adverse effects of treatment into an overall assessment of care. The second part of our analysis assessed how sensitive to true efficacy each outcome measure was by calculating sample size requirements based on results observed in previously conducted clinical trials. Methods Secondary analysis of data previously collected in four ED-based migraine randomized trials performed between 2003 and 2007. In each of these trials, subjects were asked 24 hours after administration of an investigational medication whether or not they would want to receive the same medication the next time they came to the ED with a migraine. Odds ratios (ORs) with 95%CI, adjusted for gender and medication received, were calculated as measures of association between the most commonly used outcome measures and “would take again”. The sensitivity of each outcome measure to treatment efficacy was determined by calculating the sample size that would be required to detect a statistically significant result using estimates of that outcome obtained in two clinical trials. Results Data from 378 subjects were used for this analysis. Adjusted ORs for association of “would take again” and other commonly used primary headache outcomes are as follows: achieving a pain-free state by two hours, OR = 3.1 (95% CI 1.8, 5.4); sustained pain-free status, OR=4.5 (95%CI 1.9, 11.0); no need for rescue medication, OR = 3.7 (95% CI 2.1, 6.6). An improvement on a standardized 11-point pain scale of ?33% had an adjusted OR = 5.2 (95% CI, 2.2, 12.4). The best performing alternate outcome, ?33% improvement, correctly classified 288 subjects and misclassified 77 subjects when compared to “would take again”. ?33% improvement and pain free by two hours required the smallest sample sizes, while sustained pain free and “would take again” required many more subjects. Conclusions “Would take again’ was associated with all migraine outcome measures we examined. No individual outcome was more closely associated with “would take again” than any other. Even the best performing alternate outcome misclassified more than twenty percent of subjects. However, sample sizes based on “would take again” tended to be larger than other outcome measures. On the basis of these findings and this outcome measure’s inherent patient-centered focus, we propose “would take again” be included as a secondary outcome in all ED migraine trials. PMID:20078439

Friedman, Benjamin W; Bijur, Polly E; Lipton, Richard B

2010-01-01

145

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

146

Measuring Learning Outcomes in Higher Education: Motivation Matters  

ERIC Educational Resources Information Center

With the pressing need for accountability in higher education, standardized outcomes assessments have been widely used to evaluate learning and inform policy. However, the critical question on how scores are influenced by students' motivation has been insufficiently addressed. Using random assignment, we administered a multiple-choice test and an…

Liu, Ou Lydia; Bridgeman, Brent; Adler, Rachel M.

2012-01-01

147

Constructing a Consensus-based Prevention Outcome Measurement Instrument.  

ERIC Educational Resources Information Center

Describes Ohio's Prevention Evaluation Project (PEP), that developed a questionnaire to assess behavioral and attitudinal outcomes in primary drug abuse prevention programs targeting young people aged twelve to seventeen. One of PEP's principal achievements was the inclusion of community prevention program providers in the evaluation instrument…

Siegal, Harvey A.; Lane, D. Timothy; Falck, Russel S.; Wang, Jichuan; Carlson, Robert G.; Rahman, Ahmmed; Chambers, Deborah T.

2001-01-01

148

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

149

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

150

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

SciTech Connect

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

Mavroidis, Panayiotis; Komisopoulos, Georgios; Lind, Bengt K.; Papanikolaou, Nikos [Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, Sweden and Department of Medical Physics, Larissa University Hospital, Larissa (Greece); Department of Medical Physics, Larissa University Hospital, Larissa (Greece); Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, Stockholm (Sweden); Department of Medical Physics, Cancer Therapy and Research Center, San Antonio, Texas 78229 (United States)

2008-11-15

151

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

152

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

153

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

154

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

ERIC Educational Resources Information Center

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

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

2006-01-01

155

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

156

Assessing the Psychological Changes of Gifted Students Attending a Residential High School with an Outcome Measurement  

ERIC Educational Resources Information Center

This study examined the psychological changes that 272 students experienced while attending a residential school for gifted adolescents in the Midwest. This article shares the quantitative portion of a mixed-methods study. Outcome measurement data from the Youth Outcome Questionnaire Self-Report 2.0 (YOQ-SR) tracked students' level of…

Rollins, Marlon R.; Cross, Tracy L.

2014-01-01

157

Discrimination measures for survival outcomes: connection between the AUC and the predictiveness curve  

E-print Network

Discrimination measures for survival outcomes: connection between the AUC and the predictiveness of survival outcomes and enables to evaluate the discriminative power of prognostic models. We establish and discrimination of prognostic models. It also highlights that accurate estimates of the conditional absolute risk

Paris-Sud XI, Université de

158

High Density Limit of the Distribution of the Outcome of Eeg-Measurements  

NASA Astrophysics Data System (ADS)

Using EEG measurements one gets information on the densities of excited neurons located in the regions of the brain. Up to now there exist different hypothesises concerning the distribution of the random outcomes of EEG measurements. Using classical models for describing brain activities it turned out to be difficult to explain the observed properties of these outcomes. We will describe the distribution of the random outcomes of EEG measurements and certain conditional distributions in terms of a high density limit. These considerations are based on a quantum statistical model of the process of recognition that was developed in the last years (cf. [1] - [10]).

Fichtner, K.-H.; Fichtner, L.; Freudenberg, W.; Ohya, M.

2013-01-01

159

Conservation Covenants on Private Land: Issues with Measuring and Achieving Biodiversity Outcomes in Australia  

NASA Astrophysics Data System (ADS)

Conservation covenants and easements have become essential tools to secure biodiversity outcomes on private land, and to assist in meeting international protection targets. In Australia, the number and spatial area of conservation covenants has grown significantly in the past decade. Yet there has been little research or detailed policy analysis of conservation covenanting in Australia. We sought to determine how conservation covenanting agencies were measuring the biodiversity conservation outcomes achieved on covenanted properties, and factors inhibiting or contributing to measuring these outcomes. In addition, we also investigated the drivers and constraints associated with actually delivering the biodiversity outcomes, drawing on detailed input from covenanting programs. Although all conservation covenanting programs had the broad aim of maintaining or improving biodiversity in their covenants in the long term, the specific stated objectives of conservation covenanting programs varied. Programs undertook monitoring and evaluation in different ways and at different spatial and temporal scales. Thus, it was difficult to determine the extent Australian conservation covenanting agencies were measuring the biodiversity conservation outcomes achieved on covenanted properties on a national scale. Lack of time available to covenantors to undertake management was one of the biggest impediments to achieving biodiversity conservation outcomes. A lack of financial resources and human capital to monitor, knowing what to monitor, inconsistent monitoring methodologies, a lack of benchmark data, and length of time to achieve outcomes were all considered potential barriers to monitoring the biodiversity conservation outcomes of conservation covenants.

Fitzsimons, James A.; Carr, C. Ben

2014-09-01

160

Conservation covenants on private land: issues with measuring and achieving biodiversity outcomes in Australia.  

PubMed

Conservation covenants and easements have become essential tools to secure biodiversity outcomes on private land, and to assist in meeting international protection targets. In Australia, the number and spatial area of conservation covenants has grown significantly in the past decade. Yet there has been little research or detailed policy analysis of conservation covenanting in Australia. We sought to determine how conservation covenanting agencies were measuring the biodiversity conservation outcomes achieved on covenanted properties, and factors inhibiting or contributing to measuring these outcomes. In addition, we also investigated the drivers and constraints associated with actually delivering the biodiversity outcomes, drawing on detailed input from covenanting programs. Although all conservation covenanting programs had the broad aim of maintaining or improving biodiversity in their covenants in the long term, the specific stated objectives of conservation covenanting programs varied. Programs undertook monitoring and evaluation in different ways and at different spatial and temporal scales. Thus, it was difficult to determine the extent Australian conservation covenanting agencies were measuring the biodiversity conservation outcomes achieved on covenanted properties on a national scale. Lack of time available to covenantors to undertake management was one of the biggest impediments to achieving biodiversity conservation outcomes. A lack of financial resources and human capital to monitor, knowing what to monitor, inconsistent monitoring methodologies, a lack of benchmark data, and length of time to achieve outcomes were all considered potential barriers to monitoring the biodiversity conservation outcomes of conservation covenants. PMID:25053159

Fitzsimons, James A; Carr, C Ben

2014-09-01

161

The delay effect on outcome evaluation: results from an event-related potential study  

PubMed Central

Behavioral studies demonstrate that the timing of receiving gains or losses affects decision-making, a phenomenon known as temporal discounting, as participants are inclined to prefer immediate rewards over delayed ones and vice versa for losses. The present study used the event-related potential technique with a simple gambling task to investigate how delayed rewards and losses affected the brain activity in outcome evaluations made by 20 young adults. Statistical analysis revealed a larger feedback-related negativity (FRN) effect between loss and gain following immediate outcomes than following future outcomes. In addition, delay impacted FRN only in gain conditions, with delayed winning eliciting a more negative FRN than immediate winning. These results suggest that temporal discounting and sign effect could be encoded in the FRN in the early stage of outcome evaluation. PMID:24312036

Qu, Chen; Huang, Yunyun; Wang, Yuru; Huang, Yu-Xia

2013-01-01

162

Critical analysis of outcome measures used in the assessment of carpal tunnel syndrome  

PubMed Central

Clinicians and researchers are confounded by the various outcome measures used for the assessment of carpal tunnel syndrome (CTS). In this study, we critically analysed the conceptual framework, validity, reliability, responsiveness and appropriateness of some of the commonly used CTS outcome measures. Initially, we conducted an extensive literature search to identify all of the outcome measures used in the assessment of CTS patients, which revealed six different carpal tunnel outcome measures [Boston Carpal Tunnel Questionnaire (BCTQ), Michigan Hand Outcome Questionnaire (MHQ), Disability of Arm, Shoulder and Hand (DASH), Patient Evaluation Measure (PEM), clinical rating scale (Historical-Objective (Hi-Ob) scale) and Upper Extremity Functional Scale (UEFS)]. We analysed the construction framework, development process, validation process, reliability, internal consistency (IC), responsiveness and limitations of each of these outcome measures. Our analysis reveals that BCTQ, MHQ and PEM have comprehensive frameworks, good validity, reliability and responsiveness both in the hands of the developers, as well as independent researchers. The UEFS and Hi-Ob scale need validation and reliability testing by independent researchers. Region-specific measures like DASH have good frameworks and, hence, a potential role in the assessment of CTS but they require more validation in exclusive carpal tunnel patients. PMID:17370071

Priyanka, P.; Gul, Arif; Ilango, Balakrishnan

2007-01-01

163

Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors  

PubMed Central

Background Post-thrombotic syndrome is a manifestation of chronic venous insufficiency following deep venous thrombosis. This systematic review was conducted to critically evaluate pediatric evidence on frequency of occurrence, validity of outcome measures, and prognostic indicators of post-thrombotic syndrome. Design and Methods A comprehensive literature search of original reports revealed 19 eligible studies, totaling 977 patients with upper/lower extremity deep venous thrombosis. Calculated weighted mean frequency of post-thrombotic syndrome was 26% (95% confidence interval: 23–28%) overall, and differed significantly by prospective/non-prospective analysis and use/non-use of a standardized outcome measure. Results Standardized post-thrombotic syndrome outcome measures included an adaptation of the Villalta scale, the Clinical-Etiologic-Anatomic-Pathologic classification, and the Manco-Johnson instrument. Data on validity were reported only for the Manco-Johnson instrument. No publications on post-thrombotic syndrome-related quality of life outcomes were identified. Candidate prognostic factors for post-thrombotic syndrome in prospective studies included use/non-use of thrombolysis and plasma levels of factor VIII activity and D-dimer. Conclusions Given that affected children must endure chronic sequelae for many decades, it is imperative that future collaborative pediatric prospective cohort studies and trials assess as key objectives and outcomes the incidence, severity, prognostic indicators, and health impact of post-thrombotic syndrome, using validated measures. PMID:20595095

Goldenberg, Neil A.; Donadini, Marco P.; Kahn, Susan R.; Crowther, Mark; Kenet, Gili; Nowak-Göttl, Ulrike; Manco-Johnson, Marilyn J.

2010-01-01

164

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

165

Life space mapping: Preliminary results from the development of a new method for investigating counselling outcomes  

Microsoft Academic Search

Counselling outcomes are often measured in terms of standardised questionnaires. Though efficient for large numbers of participants, this method cannot capture the unique and subtle ‘shifts’ that clients often report when qualitative methods are utilised. Further, such questionnaires usually focus on the individual, missing the wider social implications of therapy. This paper presents the preliminary findings from a study that

Brian Rodgers

2006-01-01

166

An evaluation of interrupted and uninterrupted measurement of vocal stereotypy on perceived treatment outcomes.  

PubMed

The type of procedure used to measure a target behavior may directly influence the perceived treatment outcomes. In the present study, we examined the influence of different data-analysis procedures on the outcomes of two commonly used treatments on the vocal stereotypy of 2 children with an autism spectrum disorder. In Study 1, we compared an interrupted and uninterrupted data-analysis procedure to measure vocal stereotypy during the implementation of response interruption and redirection (RIRD). The results showed that the interrupted data-analysis procedure overestimated the effectiveness of RIRD. In Study 2, we examined the influence of different data-analysis procedures on the interpretation of the relative effects of 2 different treatments for vocal stereotypy. Specifically, we compared interrupted and uninterrupted data-analysis procedures during the implementation of RIRD and noncontingent reinforcement (NCR) as a treatment for vocal stereotypy. The results showed that, as in Study 1, the interrupted data-analysis procedure overestimated the effectiveness of RIRD; however, this effect was not apparent with NCR. These findings suggest that different types of data analysis can influence the perceived success of a treatment. PMID:24764249

Carroll, Regina A; Kodak, Tiffany

2014-01-01

167

Assessment of murine lung mechanics outcome measures: alignment with those made in asthmatics  

PubMed Central

Although asthma is characterized as an inflammatory disease, recent reports highlight the importance of pulmonary physiology outcome measures to the clinical assessment of asthma control and risk of asthma exacerbation. Murine models of allergic inflammatory airway disease have been widely used to gain mechanistic insight into the pathogenesis of asthma; however, several aspects of murine models could benefit from improvement. This review focuses on aligning lung mechanics measures made in mice with those made in humans, with an eye toward improving the translational utility of these measures. A brief description of techniques available to measure murine lung mechanics is provided along with a methodological consideration of their utilization. How murine lung mechanics outcome measures relate to pulmonary physiology measures conducted in humans is discussed and we recommend that, like human studies, outcome measures be standardized for murine models of asthma. PMID:23408785

Walker, Julia K. L.; Kraft, Monica; Fisher, John T.

2013-01-01

168

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

169

Comparison of commonly used orthopaedic outcome measures using palm-top computers and paper surveys  

Microsoft Academic Search

Introduction: Measuring patient-perceived outcomes following orthopaedic procedures have become an important component of clinical research and patient care. General and disease-specific outcomes measures have been developed and applied in orthopaedics to assess the patients’ perceived health status. Unfortunately, paper-based, self-administered instruments remain inefficient for collecting data because of: (a) missing data (b) respondent error, and (c) the costs to administer

Khaled J. Saleh; David M. Radosevich; Rida A. Kassim; Mohamed Moussa; Darrell Dykes; Helena Bottolfson; Terence J. Gioe; Harry Robinson

2002-01-01

170

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

Microsoft Academic Search

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

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

2007-01-01

171

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

Microsoft Academic Search

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

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

2008-01-01

172

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

173

Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"?  

PubMed

There has been a surge of interest in the functional consequences of neurocognitive deficits in schizophrenia. The published literature in this area has doubled in the last few years. In this paper, we will attempt to confirm the conclusions from a previous review that certain neurocognitive domains (secondary verbal memory, immediate memory, executive functioning as measured by card sorting, and vigilance) are associated with functional outcome. In addition to surveying the number of replicated findings and tallying box scores of results, we will approach the review of the studies in a more thorough and empirical manner by applying a meta-analysis. Lastly, we will discuss what we see as a key limitation of this literature, specifically, the relatively narrow selection of predictor measures. This limitation has constrained identification of mediating variables that may explain the mechanisms for these relationships. PMID:10755673

Green, M F; Kern, R S; Braff, D L; Mintz, J

2000-01-01

174

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

Microsoft Academic Search

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

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

2011-01-01

175

The online measurement of hemodialysis dose (Kt): Clinical outcome as a function of body surface area  

Microsoft Academic Search

The online measurement of hemodialysis dose (Kt): Clinical outcome as a function of body surface area.BackgroundRecent advances enable the direct measurement of small molecule clearance, Kecn, during each dialysis. Average Kecn and treatment length, t, are multiplied giving total clearance, Kt. The body surface area (BSA) is a fixed transformation of height and weight and is a well recognized measure

Edmund G. Lowrie; ZHENSHENG LI; NORMA OFSTHUN; J. Michael Lazarus

2005-01-01

176

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

177

Predictors of Poor Outcomes After Transcatheter Aortic Valve Replacement: Results from the PARTNER Trial  

PubMed Central

Background Transcatheter Aortic Valve Replacement (TAVR) has emerged as a less invasive option for valve replacement for high-risk patients with severe aortic stenosis. However, not all patients derive a mortality or quality of life (QoL) benefit from TAVR. As such, we sought to build and validate a prediction model to identify patients at high risk for a poor outcome after TAVR, using a novel definition of outcome that integrates QoL with mortality. Methods and Results We examined QoL and mortality outcomes among 2137 patients who underwent TAVR in the PARTNER randomized trial or the associated continued access registry. QoL was assessed using the Overall Summary Scale of the Kansas City Cardiomyopathy Questionnaire (KCCQ-OS, range 0-100; higher=better) at baseline and at 1, 6, and 12 months. A poor 6-month outcome—defined as death, KCCQ-OS <45, or a decrease in KCCQ-OS by ?10 points compared with baseline—occurred in 704 patients (33%). A multivariable model was constructed using a split-sample design to identify a parsimonious set of covariates to identify patients at high-risk for poor outcome. The resulting model demonstrated adequate discrimination (c-index=0.66) and good calibration with the observed data and performed similarly in the separate validation cohort. Based on pre-procedure characteristics alone, the model identified 211 patients (10% of the population) with a ?50% likelihood of a poor outcome after TAVR. These individuals were more likely to have low body weights, low mean aortic valve gradients, oxygen-dependent lung disease, and poor baseline functional and cognitive status. A second model that explored predictors of poor outcome at 1 year identified similar predictors as the original model and was able to identify 1102 patients (52%) with ?50% likelihood and 178 (8%) with ?70% likelihood of a poor 1-year outcome after TAVR Conclusions Using a large, multicenter cohort of patients undergoing TAVR, we have developed and validated predictive models that can identify patients at high-risk for a poor outcome after TAVR. These models may help guide treatment choices and offer patients realistic expectations of outcomes based on their presenting characteristics. PMID:24958751

Arnold, Suzanne V.; Reynolds, Matthew R.; Lei, Yang; Magnuson, Elizabeth A.; Kirtane, Ajay J.; Kodali, Susheel K.; Zajarias, Alan; Thourani, Vinod H.; Green, Philip; Rodés-Cabau, Josep; Beohar, Nirat; Mack, Michael J.; Leon, Martin B.; Cohen, David J.

2014-01-01

178

Instructional technology and the measurement of learing outcomes: Some questions  

Microsoft Academic Search

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

Robert Glaser

1963-01-01

179

Placental miRNA Expression Profiles Associated with Measures of Infant Neurobehavioral Outcomes  

PubMed Central

Background A growing body of research suggests that the intrauterine environment influences fetal neurodevelopment by altering the functional placental epigenome. A number of miRNAs are expressed in the placenta, may be sensitive to dysregulation by environmental exposures, and are associated with adverse pregnancy outcomes. Our study aimed to identify relationships between placental miRNA expression and newborn neurobehavior. Methods We examined the association between the expression of miR-16, miR-21, miR-93, miR-135b, miR-146a, and miR-182 in total RNA from the placentas of 86 term infants as measured by quantitative real-time PCR and newborn neurobehavioral outcomes as assessed using the NICU Network Neurobehavioral Scales (NNNS). Results Bivariate analysis revealed that placental miR-16 expression is negatively associated with attention score (p=0.006), while expression of miR-146a and miR-182 are both positively associated with quality of movement score (p=0.016 and p=0.016, respectively). Controlling for potential confounders, high miR-16 expression is significantly associated with reduced attention score (p=0.04), and high miR-146a expression and high miR-182 expression are significantly associated with increased quality of movement score (p=0.04 and p=0.01, respectively). Conclusions These results suggest that placental miRNA expression is associated with early neurobehavioral outcomes and miRNAs in the placenta may contribute to the developmental origins of infant neurobehavior. PMID:23783433

Maccani, Matthew A.; Padbury, James F.; Lester, Barry M.; Knopik, Valerie S.; Marsit, Carmen J.

2013-01-01

180

Process and outcome measures using nursing sensitive indicators  

Microsoft Academic Search

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

Susan M Grant; Lorie Wild; Jeanne Vincent

2004-01-01

181

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

182

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

183

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

184

The measurement properties of modified Rivermead mobility index and modified functional ambulation classification as outcome measures for Chinese stroke patients.  

PubMed

Valid, reliable, responsive and practical outcome measures are essential for treatment planning and outcome assessment. This study aimed to examine the measurement properties of Modified Rivermead Mobility Index (MRMI) and Modified Functional Ambulation Classification (MFAC) in Chinese stroke patients. The content validity, responsiveness, predictive validity, test-retest reliability, internal consistency and factor structure of the MRMI were examined. The content validity, discriminative power and inter-rater agreement of the MFAC were investigated. A total of 456 Chinese stroke patients were recruited. Evidence of good content validity, high responsiveness, adequate predictive validity, excellent test-retest reliability with 1.3-point as minimum detectable change in 95% confidence interval, high internal consistency and unidimensionality was obtained for the MRMI. Good content validity, sufficient discriminative power and excellent inter-rater agreement were demonstrated for the MFAC. Both the MRMI and MFAC have good to excellent measurement properties and are recommended as routine outcome measures for Chinese stroke patients. PMID:24400683

Tsang, Raymond Chi-Chung; Chau, Rosanna Mei-Wa; Cheuk, Terence Hau-Wai; Cheung, Benny Shu-Pui; Fung, Donna Mei-Yee; Ho, Ester Yuk-Lai; Ip, Ellen Mei-Lun; Ko, Betty Pik-Ha; Lee, Jimson Yuk-Lam; Liu, Alan Kin-Lun; Ng, Vivien Pui-Ling; Tang, Robert Shun-Keung; To, Karen Wing-Sau; Tsang, Claudia Pui-Ling

2014-07-01

185

A new framework for measuring the quality of outcomes-based engineering education  

Microsoft Academic Search

Rapid technological development, coupled with the recent growth of new engineering specialty areas, has led to the development of outcomes-based criteria for engineering education by a range of international engineering professional bodies. The emergence of outcomes-based approaches requires new instruments to measure the success, or otherwise, of engineering programs offered by Universities. This paper generated a theory-based preliminary conceptual framework

B. K. Chong; F. Crowther

2005-01-01

186

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

187

An outcome measure of functionality and pain in patients with low back disorder: A validation study of the Iranian version of Core Outcome Measures Index  

PubMed Central

Background: Lumbar Disc Herniation (LDH) and Lumbar Spinal Stenosis (LSS) are the most common diagnoses of low back and leg pain symptoms. This study aimed to cross-culturally translate, and validate the Core Outcome Measures Index (COMI) in Iran. Methods: The translation and cross-cultural adaptation of the original questionnaire were performed in accordance with published guidelines. A total of 121 patients with LDH or LSS were asked to respond to the questionnaire at two points in time: Pre and postoperative assessments (6 months follow-up). The Oswestry Disability Index (ODI) also was completed. To test the reliability, the internal consistency was assessed by Cronbach's alpha coefficient, and validity was assessed using convergent validity. Responsiveness to change also was assessed for comparing patients’ pre and postoperative scores. Results: The Cronbach's alpha coefficients for the COMI at pre and postoperative assessments ranged from 0.79 to 0.82, indicating a good internal consistency. The change in the ODI after surgery was strongly correlated with change in the COMI, lending support to its good convergent validity (r = 0.79 for LDH and r = 0.77 for LSS; P < 0.001). In addition, the correlation of each item with its hypothesized subscale of the COMI showed satisfactory results suggesting, that the items had a substantial association with the subscale, representing the concept. Further analysis also indicated that the questionnaire was responsive to change (P < 0.0001). Conclusion: The Iranian version of COMI performed well, and the findings suggest that it is a reliable and valid measure of back pain treatment evaluation among LDH and lumbar canal stenosis patients.

Mohammadi, Hasan Reza; Azimi, Parisa; Zali, Alireza; Montazeri, Ali

2015-01-01

188

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

PubMed

Rheumatoid arthritis (RA) is a chronic autoimmune disease with episodic flares in affected joints; the etiology of RA is largely unknown. Recent studies in mice demonstrated that alterations in lymphatics from affected joints precede flares. Thus, we aimed to develop novel methods for measuring lymph node pressure and lymph viscosity in limbs of mice. Pressure measurements were performed by inserting a glass micropipette connected to a pressure transducer into popliteal lymph nodes (PLN) or axillary lymph nodes (ALN) of mice; subsequently, we determined that the lymphatic pressures of water were 9 and 12 cm, respectively. We are also developing methods for measuring lymph viscosity in lymphatic vessels afferent to PLN, which can be measured by multiphoton fluorescence recovery after photobleaching (MP-FRAP) of fluorescein isothiocyanate-labeled bovine serum albumin (FITC-BSA) injected into the hind footpad. These results demonstrate the potential of lymph node pressure and lymph viscosity measurements, and future studies to test these outcomes as biomarkers of arthritic flare are warranted. PMID:22172039

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

2011-12-01

189

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

PubMed Central

Introduction Due to resource limitations, few critical care interventions have been rigorously evaluated with adequately powered randomized clinical trials (RCTs). There is a need to improve the efficiency of RCTs in critical care so that more definitive high quality RCTs can be completed with the available resources. The objective of this study was to validate and demonstrate the utility of a novel composite outcome measure, persistent organ dysfunction (POD) plus death, for clinical trials of critically ill patients. Methods We performed a secondary analysis of a dataset from a prospective randomized trial involving 38 intensive care units (ICUs) in Canada, Europe, and the United States. We define POD as the persistence of organ dysfunction requiring supportive technologies during the convalescent phase of critical illness and it is present when a patient has an ongoing requirement for vasopressors, dialysis, or mechanical ventilation at the outcome assessments time points. In 600 patients enrolled in a randomized trial of nutrition therapy and followed prospectively for six months, we evaluated the prevalence of POD and its association with outcome. Results At 28 days, 2.3% of patients had circulatory failure, 13.7% had renal failure, 8.7% had respiratory failure, and 27.2% had died, for an overall prevalence of POD + death = 46.0%. Of survivors at Day 28, those with POD, compared to those without POD, had a higher mortality rate in the six-month follow-up period, had longer ICU and hospital stays, and a reduced quality of life at three months. Given these rates of POD + death and using a two-sided Chi-squared test at alpha = 0.05, we would require 616 patients per arm to detect a 25% relative risk reduction (RRR) in mortality, but only 286 per arm to detect the same RRR in POD + mortality. Conclusions POD + death may be a valid composite outcome measure and compared to mortality endpoints, may reduce the sample size requirements of clinical trials of critically ill patients. Further validation in larger clinical trials is required. PMID:21418560

2011-01-01

190

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

191

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

192

The Incremental Value of Self-Reported Mental Health Measures in Predicting Functional Outcomes of Veterans  

Microsoft Academic Search

Research on patient-centered care supports use of patient\\/consumer self-report measures in monitoring health outcomes. This\\u000a study examined the incremental value of self-report mental health measures relative to a clinician-rated measure in predicting\\u000a functional outcomes among mental health service recipients. Participants (n?=?446) completed the Behavior and Symptom Identification Scale, the Brief Symptom Inventory, and the Veterans\\/Rand Short\\u000a Form-36 at enrollment in

Susan V. Eisen; Kathryn A. Bottonari; Mark E. Glickman; Avron Spiro; Mark R. Schultz; Lawrence Herz; Robert Rosenheck; Ethan S. Rofman

2011-01-01

193

Multiple trauma in children: predicting outcome and long-term results  

PubMed Central

Objective To analyze the management of pediatric trauma and the efficacy of the Pediatric Trauma Score (PTS) in classifying injury severity and predicting prognosis. Design A retrospective case series. Setting The Children’s Hospital of Eastern Ontario, a major pediatric trauma centre. Patients One hundred and forty-nine traumatized children with 2 or more injuries to 1 body system or a single injury to 2 or more body systems. Interventions Use of the PTS and Glasgow Coma Scale score in trauma management. Main outcome measures Types of injuries sustained, complications, missed injuries, psychosocial effects and residual deficiencies. Results The average PTS was 8.5 (range from ?3 to 11). The total number of injuries sustained was 494, most commonly closed head injury (86). Forty-two percent of children with an average trauma score of 8.5 were treated surgically. There were 13 missed injuries, and complications were encountered in 57 children, the most common being secondary to fractures. Forty-eight (32%) children had residual long-term deficiency, most commonly neurologic deficiency secondary to head injury. Conclusions Fractures should be stabilized early to decrease long-term complications. A deficiency of the PTS is the weighting of open fractures of a minor bone. For example, metacarpal fracture is given the same weight as an open fracture of the femur. Neuropsychologic difficulties secondary to trauma are a major sequela of trauma in children. PMID:11939656

Letts, Mervyn; Davidson, Darin; Lapner, Peter

2002-01-01

194

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

195

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

196

A Systematic Review of Patient-Reported Outcome Instruments Measuring Sleep Dysfunction in Adults  

Microsoft Academic Search

Sleep dysfunction can manifest in several ways, ranging from insomnia to somnolence, and from disrupted sleep to lack of restful sleep. Measuring sleep dysfunction is an area of active research and there exist a number of patient-reported outcome instruments that measure various aspects of sleep dysfunction. However, these instruments have not been evaluated systematically. We used a conceptual model of

Emily Beth Devine; Zafar Hakim; Jesse Green

2005-01-01

197

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

Microsoft Academic Search

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

Valerie J. Slaymaker; Patricia Owen

2008-01-01

198

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

199

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

200

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

201

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

202

Evaluating implementation of a rapid response team: considering alternative outcome measures  

PubMed Central

Objective Determine the prolonged effect of rapid response team (RRT) implementation on failure to rescue (FTR). Design Longitudinal study of institutional performance with control charts and Bayesian change point (BCP) analysis. Setting Two academic hospitals in Midwest, USA. Participants All inpatients discharged between 1 September 2005 and 31 December 2010. Intervention Implementation of an RRT serving the Mayo Clinic Rochester system was phased in for all inpatient services beginning in September 2006 and was completed in February 2008. Main Outcome Measure Modified version of the AHRQ FTR measure, which identifies hospital mortalities among medical and surgical patients with specified in-hospital complications. Results A decrease in FTR, as well as an increase in the unplanned ICU transfer rate, occurred in the second-year post-RRT implementation coinciding with an increase in RRT calls per month. No significant decreases were observed pre- and post-implementation for cardiopulmonary resuscitation events or overall mortality. A significant decrease in mortality among non-ICU discharges was identified by control charts, although this finding was not detected by BCP or pre- vs. post-analyses. Conclusions Reduction in the FTR rate was associated with a substantial increase in the number of RRT calls. Effects of RRT may not be seen until RRT calls reach a sufficient threshold. FTR rate may be better at capturing the effect of RRT implementation than the rate of cardiac arrests. These results support prior reports that short-term studies may underestimate the impact of RRT systems, and support the need for ongoing monitoring and assessment of outcomes to facilitate best resource utilization. PMID:24402406

Moriarty, James P.; Schiebel, Nicola E.; Johnson, Matthew G.; Jensen, Jeffrey B.; Caples, Sean M.; Morlan, Bruce W.; Huddleston, Jeanne M.; Huebner, Marianne; Naessens, James M.

2014-01-01

203

Measuring health outcomes of adolescents: report from a pilot study.  

PubMed

There is a need to understand the practicality, validity and reliability of using utility measures with children and adolescents. We designed a pilot study in order to help guide the selection of an appropriate health-related quality-of-life (HRQoL) questionnaire for adolescents to be used in the context of a large randomised controlled trial (RCT) of family therapy versus standard treatment for adolescents aged 11-17 years. The pilot study was carried out on a school sample of adolescents in the same age range as the RCT. Adolescents were asked to fill in three HRQoL questionnaires: the standard EQ-5D, the licensed Health Utilities Index HUI, and the child-friendly version of the standard EQ-5D: the EQ-5D for youth (EQ-5D-Y). This report explores the problems with the language and concepts embodied within those HRQoL questionnaires and open discussion regarding how we can value the health of adolescents for cost-utility analysis in a larger study. PMID:21785871

Oluboyede, Yemi; Tubeuf, Sandy; McCabe, Chris

2013-02-01

204

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

205

Randomized controlled trials 3: measurement and analysis of patient-reported outcomes.  

PubMed

The study of patient-reported outcomes, now common in clinical research, had its origins in social and scientific developments during the latter twentieth century. Patient-reported outcomes comprise functional and health status, health-related quality of life, and quality of life. The terms overlap and are used inconsistently, and these reports of experience should be distinguished from expressions of preference regarding health states. Regulatory standards from the USA and European Union provide some guidance regarding reporting of patient-reported outcomes. The determination that measurement of patient-reported outcomes is important depends in part on the balance between subjective and objective outcomes of the health problem under study. Instrument selection depends to a large extent on practical considerations. A number of instruments can be identified that are frequently used in particular clinical situations. The domain coverage of commonly used generic short forms varies substantially. Individualized measurement of quality of life is possible, but resource intensive. Focus groups are useful, not only for scale development but also to confirm the appropriateness of existing instruments.Under classical test theory, validity and reliability are the critical characteristics of tests. Under item response theory, validity remains central, but the focus moves from the reliability of scales to the relative levels of traits in individuals and items' relative difficulty. Plans for clinical studies should include an explicit model of the relationship of patient-reported outcomes to other parameters, as well as definition of the magnitude of difference in patient-reported outcomes that will be considered important. It is particularly important to minimize missing patient-reported outcome data; to a limited extent, a variety of statistical techniques can mitigate the consequences of missing data. PMID:25694311

Richardson, Michelle M; Grobert, Megan E; Meyer, Klemens B

2015-01-01

206

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 antiretroviral 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

207

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

208

Outcome measures for primary Sjögren's syndrome: a comprehensive review.  

PubMed

Lymphocytic infiltration of different exocrine and non-exocrine epithelia is the pathological hallmark of primary Sjögren's syndrome, whereas involvement of salivary and lachrymal glands with the clinical counterpart of dry eye and dry mouth are the predominant features of the disease, together with fatigue and musculoskeletal pain. In addition, systemic manifestations, like arthritis, skin vasculitis, peripheral neuropathy, glomerulonephritis, may also be present in a consistent number of patients. As result, clinical features in SS can be divided into two facets: the benign subjective but disabling manifestations such as dryness, pain and fatigue, and the systemic manifestations. In the past decades, great efforts have been made to develop valid tools for the assessment of these both facets. Disease specific questionnaires such as Profile of Fatigue and Discomfort (PROFAD) and Sicca Symptom Inventory (SSI) have been proposed for evaluation of patients' symptoms, whereas different composite indexes have been suggested for the assessment of systemic disease activity. After that, an international project supported by EULAR, emerged to develop consensus disease activity indexes: the EULAR Sjögren's Syndrome Patients Reported Index (ESSPRI), and the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), a systemic activity index to assess systemic manifestations. Both EULAR indexes have been developed in an international collaboration to be consensual. Both indices have now been validated in a large independent international cohort. They both have been shown to be feasible, valid and reliable instruments. Also, we have found that these two scores did not correlate, suggesting that these two indexes assess two different disease components that poorly overlap, but were complementary. The sensitivity to change of both scores has been assessed, they are both able to detect change, however, ESSDAI score, like other systemic score, is more sensitive to change than ESSPRI and other patient scores. Current work is ongoing to define disease activity levels and clinically important changes for defining significant clinical improvement with the systemic score ESSDAI, and ESSPRI. We hope that this increased knowledge on the way to assess patients with primary SS, along with the emergence of new targeted therapy, will put a great input in the improvement of conduction of clinical trials in pSS. PMID:24411404

Seror, Raphaèle; Theander, Elke; Bootsma, Hendrika; Bowman, Simon J; Tzioufas, Athanasios; Gottenberg, Jacques-Eric; Ramos-Casals, Manel; Dörner, Thomas; Ravaud, Philippe; Mariette, Xavier; Vitali, Claudio

2014-06-01

209

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

210

Inequalities in multiple health outcomes by education, sex, and race in 93 US counties: Why we should measure them all  

PubMed Central

Introduction Regular reporting of health inequalities is essential to monitoring progress of efforts to reduce health inequalities. While reporting of population health became increasingly common, reporting of a subpopulation group breakdown of each indicator of the health of the population is rarely a standard practice. This study reports education-, sex-, and race-related inequalities in four health outcomes in each of the selected 93 counties in the United States in a systematic and comparable manner. Methods This study is a cross-sectional analysis of large, publicly available data, 2008, 2009, and 2010 Behavioral Risk Factor Surveillance System (BRFSS) Selected Metropolitan/Micropolitan Area Risk Trends (SMART) and 2008, 2009, and 2010 United States Birth Records from the National Vital Statistics System. The study population is American adults older than 25 years of age residing in the selected 93 counties, representing about 30% of the US population, roughly equally covering all geographic regions of the country. Main outcome measures are: (1) Attribute (group characteristic)-specific inequality: education-, sex-, or race-specific inequality in each of the four health outcomes (poor or fair health, poor physical health days, poor mental health days, and low birthweight) in each county; (2) Overall inequality: the average of these three attribute-specific inequalities for each health outcome in each county; and (3) Summary inequality in total morbidity: the weighted average of the overall inequalities across the four health outcomes in each county. Results The range of inequality across the counties differed considerably by health outcome; inequality in poor or fair health had the widest range and the highest median among inequalities in all health outcomes. In more than 70% of the counties, education-specific inequality was the largest in all health outcomes except for low birthweight. Conclusions It is feasible to extend population health reporting to include reporting of a subpopulation group breakdown of each indicator of the health of the population at a small jurisdictional level using publicly available data. No single group characteristic or health outcome represents the whole picture of health inequalities in a population. Examining multiple group characteristics and outcomes in a comparable manner is essential in reporting health inequalities. PMID:24927805

2014-01-01

211

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

212

Direct and Indirect Measures of Learning Outcomes in an MSW Program: What Do We Actually Measure?  

ERIC Educational Resources Information Center

This study offers a unique perspective on assessment of learning by comparing results from direct and indirect measures in a social work graduate program across two campuses of a single university. The findings suggest that students' perceptions of learning are not necessarily reflective of content and applied skills mastery. Perception of…

Calderon, Orly

2013-01-01

213

A Novel Socioeconomic Measure Using Individual Housing Data in Cardiovascular Outcome Research  

PubMed Central

Background: To assess whether the individual housing-based socioeconomic status (SES) measure termed HOUSES was associated with post-myocardial infarction (MI) mortality. Methods: The study was designed as a population-based cohort study, which compared post-MI mortality among Olmsted County, Minnesota, USA, residents with different SES as measured by HOUSES using Cox proportional hazards models. Subjects’ addresses at index date of MI were geocoded to real property data to formulate HOUSES (a z-score for housing value, square footage, and numbers of bedrooms and bathrooms). Educational levels were used as a comparison for the HOUSES index. Results: 637 of the 696 eligible patients with MI (92%) were successfully geocoded to real property data. Post-MI survival rates were 60% (50–72), 78% (71–85), 72% (60–87), and 87% (81–93) at 2 years for patients in the first (the lowest SES), second, third, and fourth quartiles of HOUSES, respectively (p < 0.001). HOUSES was associated with post-MI all-cause mortality, controlling for all variables except age and comorbidity (p = 0.036) but was not significant after adjusting for age and comorbidity (p = 0.24). Conclusions: Although HOUSES is associated with post-MI mortality, the differential mortality rates by HOUSES were primarily accounted for by age and comorbid conditions. HOUSES may be useful for health disparities research concerning cardiovascular outcomes, especially in overcoming the paucity of conventional SES measures in commonly used datasets. PMID:25396769

Bang, Duk Won; Manemann, Sheila M.; Gerber, Yariv; Roger, Veronique L.; Lohse, Christine M.; Rand-Weaver, Jennifer; Krusemark, Elizabeth; Yawn, Barbara P.; Juhn, Young J.

2014-01-01

214

Measuring public health practice and outcomes in chronic disease: a call for coordination.  

PubMed

A strategic opportunity exists to coordinate public health systems and services researchers' efforts to develop local health department service delivery measures and the efforts of divisions within the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) to establish outcome indicators for public health practice in chronic disease. Several sets of outcome indicators developed by divisions within NCCDPHP and intended for use by state programs can be tailored to assess outcomes of interventions within smaller geographic areas or intervention settings. Coordination of measurement efforts could potentially allow information to flow from the local to the state to the federal level, enhancing program planning, accountability, and even subsequent funding for public health practice. PMID:25689196

Porterfield, Deborah S; Rogers, Todd; Glasgow, LaShawn M; Beitsch, Leslie M

2015-04-01

215

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

216

Measurement of religiosity/spirituality in adolescent health outcomes research: trends and recommendations.  

PubMed

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

Cotton, Sian; McGrady, Meghan E; Rosenthal, Susan L

2010-12-01

217

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

PubMed

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

Jones, Carys; Edwards, Rhiannon Tudor; Hounsome, Barry

2012-01-01

218

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

219

Comparative study of outcome measures and analysis methods for traumatic brain injury trials.  

PubMed

Batteries of functional and cognitive measures have been proposed as alternatives to the Extended Glasgow Outcome Scale (GOSE) as the primary outcome for traumatic brain injury (TBI) trials. We evaluated several approaches to analyzing GOSE and a battery of four functional and cognitive measures. Using data from a randomized trial, we created a "super" dataset of 16,550 subjects from patients with complete data (n=331) and then simulated multiple treatment effects across multiple outcome measures. Patients were sampled with replacement (bootstrapping) to generate 10,000 samples for each treatment effect (n=400 patients/group). The percentage of samples where the null hypothesis was rejected estimates the power. All analytic techniques had appropriate rates of type I error (?5%). Accounting for baseline prognosis either by using sliding dichotomy for GOSE or using regression-based methods substantially increased the power over the corresponding analysis without accounting for prognosis. Analyzing GOSE using multivariate proportional odds regression or analyzing the four-outcome battery with regression-based adjustments had the highest power, assuming equal treatment effect across all components. Analyzing GOSE using a fixed dichotomy provided the lowest power for both unadjusted and regression-adjusted analyses. We assumed an equal treatment effect for all measures. This may not be true in an actual clinical trial. Accounting for baseline prognosis is critical to attaining high power in Phase III TBI trials. The choice of primary outcome for future trials should be guided by power, the domain of brain function that an intervention is likely to impact, and the feasibility of collecting outcome data. PMID:25317951

Alali, Aziz S; Vavrek, Darcy; Barber, Jason; Dikmen, Sureyya; Nathens, Avery B; Temkin, Nancy R

2015-04-15

220

Universal health outcome measures for older persons with multiple chronic conditions  

PubMed Central

Older adults with multiple chronic conditions (MCC) require considerable health services and complex care. As health status is affected along multiple dimensions by the persistence and progression of diseases and courses of treatments, well-validated universal outcome measures across diseases are needed for research, clinical care and administrative purposes. An expert panel meeting held by the National Institute on Aging (NIA) in September 2011 recommends that older persons with MCC complete a brief initial composite measure that includes general health, pain, fatigue, and physical, mental health and social role function, along with gait speed measurement. Suitable composite measures include the Short-form 8 (SF-8) and 36 (SF-36) and the Patient Reported Outcomes Measurement Information System29-item Health Profile (PROMIS-29). Based on responses to items within the initial measure, short follow-on measures should be selectively targeted to the following areas: symptom burden, depression, anxiety and daily activities. Persons unable to walk a short distance for gait speed should be assessed using a physical function scale. Remaining gaps to be considered for measure development include disease burden, cognitive function and caregiver burden. Routine outcome assessment of MCC patients could facilitate system-based care improvement and clinical effectiveness research. PMID:23194184

2012-01-01

221

Cognitive and Typing Outcomes Measured Simultaneously with Slow Treadmill Walking or Sitting: Implications for Treadmill Desks  

PubMed Central

Purpose This study compared cognitive (attention, learning, and memory) and typing outcomes during slow treadmill walking or sitting. Seventy-five healthy individuals were randomly assigned to a treadmill walking group (n=37; 23 female) or sitting group (n=38; 17 female). Methods The treadmill walking group completed a series of tests while walking at 1.5 mph. The sitting group performed the same tests while sitting at a standard desk. Tests performed by both groups included: the Rey Auditory Verbal Learning Test and a modified version of the Paced Auditory Serial Attention Test. In addition, typing performance was evaluated. Results Participants in the treadmill walking group performed worse on the Rey Auditory Verbal Learning Test for total learning than the sitting group; the main effect was significant (F(1,73)=4.75, p=0.03, ?p2=0.06); however, short- and long-delay recall performance did not differ between groups (p>0.05). For the Paced Auditory Serial Attention Test, total number of correct responses was lower in the treadmill walking group relative to the sitting group; the main effect was significant (F(1,73)=4.97, p=0.03, ?p2=0.06). The performance of both groups followed the same learning slope (Group x Trial interactions were not significant) for the Rey Auditory Verbal Learning Test and Paced Auditory Serial Attention Test. Individuals in the treadmill walking group performed significantly worse for all measures of typing (p<0.05). Conclusion Walking on a treadmill desk may result in a modest difference in total learning and typing outcomes relative to sitting, but those declines may not outweigh the benefit of the physical activity gains from walking on a treadmill. PMID:25874910

Larson, Michael J.; LeCheminant, James D.; Hill, Kyle; Carbine, Kaylie; Masterson, Travis; Christenson, Ed

2015-01-01

222

A geometric morphometric approach to the analysis of lip shape during speech: development of a clinical outcome measure.  

PubMed

Objective assessments of lip movement can be beneficial in many disciplines including visual speech recognition, for surgical outcome assessment in patients with cleft lip and for the rehabilitation of patients with facial nerve impairments. The aim of this study was to develop an outcome measure for lip shape during speech using statistical shape analysis techniques. Lip movements during speech were captured from a sample of adult subjects considered as average using a three-dimensional motion capture system. Geometric Morphometrics was employed to extract three-dimensional coordinate data for lip shape during four spoken words decomposed into seven visemes (which included the resting lip shape). Canonical variate analysis was carried out in an attempt to statistically discriminate the seven visemes. The results showed that the second canonical variate discriminated the resting lip shape from articulation of the utterances and accounted for 17.2% of the total variance of the model. The first canonical variate was significant in discriminating between the utterances and accounted for 72.8% of the total variance of the model. The outcome measure was created using the 95% confidence intervals of the canonical variate scores for each subject plotted as ellipses for each viseme. The method and outcome model is proposed as reference to compare lip movement during speech in similar population groups. PMID:23451213

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

2013-01-01

223

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

PubMed Central

Objective assessments of lip movement can be beneficial in many disciplines including visual speech recognition, for surgical outcome assessment in patients with cleft lip and for the rehabilitation of patients with facial nerve impairments. The aim of this study was to develop an outcome measure for lip shape during speech using statistical shape analysis techniques. Lip movements during speech were captured from a sample of adult subjects considered as average using a three-dimensional motion capture system. Geometric Morphometrics was employed to extract three-dimensional coordinate data for lip shape during four spoken words decomposed into seven visemes (which included the resting lip shape). Canonical variate analysis was carried out in an attempt to statistically discriminate the seven visemes. The results showed that the second canonical variate discriminated the resting lip shape from articulation of the utterances and accounted for 17.2% of the total variance of the model. The first canonical variate was significant in discriminating between the utterances and accounted for 72.8% of the total variance of the model. The outcome measure was created using the 95% confidence intervals of the canonical variate scores for each subject plotted as ellipses for each viseme. The method and outcome model is proposed as reference to compare lip movement during speech in similar population groups. PMID:23451213

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

2013-01-01

224

A Measurement Feedback System (MFS) Is Necessary to Improve Mental Health Outcomes  

ERIC Educational Resources Information Center

The importance of measurement feedback system (MFS) for the improvement of mental health services for youths is discussed. As feedback obtained from clients and families is subject to distortions, a standardized MFS including clinical processes, contexts, outcomes, and feedback to clinicians and supervisors is necessary for improvement in quality…

Bickman, Leonard

2008-01-01

225

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

226

Risk Adjustment for Measuring Health Outcomes: An Application in VA Long term Care  

Microsoft Academic Search

An empirically derived risk adjustment model is useful in distinguishing among facilities in their quality of care. We used Veterans Affairs (VA) administrative databases to develop and validate a risk adjustment model to predict decline in functional status, an important outcome measure in long-term care, among patients residing in VA long-term care facilities. This model was used to compare facilities

Amy K. Rosen; Jeanne Wu; Bei-Hung Chang; Dan R. Berlowitz; Carter Rakovski; Arlene S. Ash; Mark A. Moskowitz

2001-01-01

227

Outcome of therapy for sexually abused children: A repeated measures study  

Microsoft Academic Search

The outcome of abuse-focused treatment was examined in a sample of 105 sexually abused children, 71 of whom completed 3 months of treatment or longer. Symptom change was measured with the Trauma Symptom Checklist for Children (TSCC; Briere, in press) and the Children's Depression Inventory (CDI; Kovacs, 1983, 1992), administered at 3 month intervals. The CDI and all TSCC scales

John Briere

1995-01-01

228

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

229

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

230

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

231

Patient reported outcome measures following specialist nurse-led clinics in preparation for breast reconstruction surgery  

Microsoft Academic Search

We compared patient reported outcome measures following information given about breast reconstruction surgery by either a specialist nurse or operating consultant surgeon using a comparative and validated questionnaire. One hundred and nineteen patients considering breast reconstruction were seen by a single consultant plastic surgeon (60 participants) or by a single specialist nurse (59 participants). Response rates to the questionnaires were

Caroline L. E. Osborne; Fiona G. Court; Joseph M. O’Donoghue; Sue E. Keeton; Sara Heary; Kirsty M. Blyth; Bridie Grant

2010-01-01

232

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

ERIC Educational Resources Information Center

Goal attainment scaling (GAS) holds promise as an idiographic approach for measuring outcomes of psychosocial interventions in community settings. GAS has been criticized for untested assumptions of scaling level (i.e., interval or ordinal), inter-individual equivalence and comparability, and reliability of coding across different behavioral…

Ruble, Lisa; McGrew, John H.; Toland, Michael D.

2012-01-01

233

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

234

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

PubMed

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

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

2012-01-01

235

Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994.  

PubMed Central

OBJECTIVE: To determine whether the St Vincent declaration (1989) target of diabetic pregnancy outcome approximating non-diabetic pregnancy outcome in near to being achieved. DESIGN: Prospective collection of population based information on pregnancies in women with diabetes from all participating hospitals. SETTING: District general and teaching hospitals of the former Northern region. SUBJECTS: 111 diabetic women booking with pregnancy during 1 January to 31 December 1994. MAIN OUTCOME MEASURES: Diabetic control, perinatal mortality rate, fetal abnormality rate. RESULTS: The perinatal mortality rate was 48/1000 for diabetic pregnancies compared with 8.9/1000 for the background population (odds ratio 5.38; 95% confidence interval 2.27 to 12.70) and the neonatal mortality rate was 59/1000 compared with 3.9/1000 (15.0; 6.77 to 33.10). Two late neonatal deaths were due to congenital heart defects. Six per cent of all fetal losses (6/109 cases) were due to major malformations. The congenital malformation rate was 83/1000 compared with 21.3/1000 (3.76; 2.00 to 7.06) in the background population. CONCLUSIONS: Diabetic pregnancy remains a high risk state with perinatal mortality and fetal malformation rates much higher than in the background population. PMID:9274546

Hawthorne, G.; Robson, S.; Ryall, E. A.; Sen, D.; Roberts, S. H.; Ward Platt, M. P.

1997-01-01

236

Operationalising the capability approach for outcome measurement in mental health research.  

PubMed

Amartya Sen's multidimensional capability approach focuses on the importance of freedoms to be or do things people have reason to value. It is an alternative to standard utilitarian welfarism, the theoretical approach to quality-adjusted life years (QALYs) and cost-utility analyses. Despite the limitations of the utility approach in capturing non-health benefits and broader welfare inequalities, there have been very limited applications of the capability approach in the mental health context where these issues are imperative. We report the development and application of a multidimensional instrument, the OxCAP-MH, which aims to operationalise the capability approach for outcome measurement in mental health research. The study was carried out as part of an ongoing programme on community coercion experienced by service users with severe and enduring mental illness being treated using Community Treatment Orders. Capabilities data were collected at baseline in the OCTET RCT for 333 'revolving door' mental health service users who were in involuntary hospital treatment at the time of recruitment in England (2008-2011). The research focused on the identification of capabilities domains most affected by mental illness and their association with socio-demographic and clinical factors and other measures of well-being such as the EQ-5D and Global Assessment of Functioning (GAF) scales. The OxCAP-MH item response rate was 90%-68%. There were significant correlations between service users' overall capability scores and the GAF, EQ-5D VAS and EQ-5D-3L utilities (corr = 0.249, 0.514, 0.415, respectively). The most affected capability domains were: 'Daily activities', 'Influencing local decisions', 'Enjoying recreation', 'Planning one's life' and 'Discrimination'. Age had a mixed effect, while female service users and those with a primary diagnosis of schizophrenia or longer illness duration reported significantly lower capability scores. The results support the feasibility and validity of directly measuring human capabilities for the mentally ill and the potential for applying the approach to outcome measurement. PMID:24331898

Simon, Judit; Anand, Paul; Gray, Alastair; Rugkåsa, Jorun; Yeeles, Ksenija; Burns, Tom

2013-12-01

237

Interdisciplinary strategies for arrhythmia program development: measuring quality, performance, and outcomes  

Microsoft Academic Search

Evidence-based medicine has provided the foundation for refinement of the guideline development process and the emergence\\u000a of the disciplines of measuring quality, performance, and outcomes. With implementation of electronic medical records as part\\u000a of healthcare reform, multiple aspects of these disciplines will be incorporated into clinical cardiac electrophysiology.\\u000a Performance measures and quality metrics will assume an influential role in the

N. A. Mark Estes; Munther Homoud; Jonathan Weinstock; Caroline Foote; Ania Garlitski; Mark Link; Afshin Ehsan

2011-01-01

238

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

239

Quantitative Liver Function Tests Improve the Prediction of Clinical Outcomes in Chronic Hepatitis C: Results from the HALT-C Trial  

PubMed Central

Risk for future clinical outcomes is proportional to the severity of liver disease in patients with chronic hepatitis C. We measured disease severity by quantitative liver function tests (QLFTs) to determine cutoffs for QLFTs that identified patients who were at low and high risk for a clinical outcome. Two hundred twenty seven participants in the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial underwent baseline QLFTs and were followed for a median of 5.5 years for clinical outcomes. QLFTs were repeated in 196 patients at month 24 and in 165 patients at month 48. Caffeine elimination rate (k), antipyrine (AP) clearance (Cl), MEGX concentration, methionine breath test (MBT), galactose elimination capacity (GEC), dual cholate (CA) clearances and shunt, and perfused hepatic mass (PHM) and liver and spleen volumes (SPECT) were measured. Baseline QLFTs were significantly worse (p=0.0017 to <0.0001) and spleen volumes larger (p<0.0001) in the 54 patients who subsequently experienced clinical outcomes. QLFT cutoffs that characterized patients as “low” and “high risk” for clinical outcome yielded hazard ratios ranging from 2.21 (95%CI 1.29–3.78) for GEC to 6.52 (95%CI 3.63–11.71) for CA Cloral. QLFTs independently predicted outcome in models with Ishak fibrosis score, platelet count, and standard laboratory tests. In serial studies, patients with “high risk” results for CA Cloral or PHM had a nearly 15-fold increase in risk for clinical outcome. Less than 5% of patients with “low risk” QLFTs experienced a clinical outcome. Conclusion QLFTs independently predict risk for future clinical outcomes. By improving risk assessment, QLFTs could enhance noninvasive monitoring, counseling, and management of patients with chronic hepatitis C. PMID:22030902

Everson, Gregory T.; Shiffman, Mitchell L.; Hoefs, John C.; Morgan, Timothy R.; Sterling, Richard K.; Wagner, David A.; Lauriski, Shannon; Curto, Teresa M.; Stoddard, Anne; Wright, Elizabeth C.

2011-01-01

240

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

241

Self-control in children: a multimethod examination of treatment outcome measures.  

PubMed

This investigation consisted of a multimethod evaluation of treatment outcome measures that have been developed to assess self-control in children. Subjects were 132 children from the fourth, fifth, and sixth grades. Each child's homeroom teacher and one other classroom teacher independently completed the Self-Control Rating Scale (SCRS), the Teacher's Self-Control Rating Scale (TSCRS), and the 10-item Conners Teacher Rating Scale (TRS). Parents of 41 children completed the Teacher's Self-Control Rating Scale and the Conners Teacher Rating Scale. Children completed the Children's Perceived Self-Control Scale (CPSC) and were administered the Matching Familiar Figure Test (MFF). Results showed high internal consistency reliability for the TSCRS, SCRS, TRS, and MFF latency scores. CPSCS and MFF error scores demonstrated low reliability (r alpha's = .58 and .61, respectively). Interrater reliability between teachers was considered acceptable for the TSCRS but not for the SCRS and TRS. Correlations between teacher and parent ratings on the TSCRS and TRS were low (r's = .37 to .50). Correlations between children's latency scores on the MFF and teachers and parent ratings were very low, r's = .01 to .19, as was the correlation with children's self-ratings on the CPSCS (r = .07). Correlations between rating scales and MFF error scores also were low. The findings suggest that considerable construct confusion does exist between measures designed to assess self-control and impulsivity in children. PMID:3950214

Reynolds, W M; Stark, K D

1986-03-01

242

Preliminary results of radiation measurements on EURECA  

NASA Technical Reports Server (NTRS)

The eleven-month duration of the EURECA mission allows long term radiation effects to be studied similarly to those of the Long Duration Exposure Facility (LDEF). Basic data can be generated for projections of crew doses and electronic and computer reliability on spacecraft missions. A radiation experiment has been designed for EURECA which uses passive integrating detectors to measure average radiation levels. The components include a Trackoscope, which employs fourteen plastic nuclear track detector (PNTD) stacks to measure the angular dependence of LET (greater than or equal to 6 keV/microns) radiation. Also included are TLD's for total absorbed doses, thermal/resonance neutron detectors (TRND's) for low energy neutron fluences and a thick PNTD stack for depth dependence measurements. LET spectra are derived from the PNTD measurements. Preliminary TLD results from seven levels within the detector array show that integrated doses inside the flight canister varied from 18.8 plus or minus 0.6 cGy to 38.9 plus or minus 1.2 cGy. The TLD's oriented toward the least shielded direction averaged 53 percent higher in dose than those oriented away from the least shielded direction (minimum shielding toward the least shielded direction varied from 1.13 to 7.9 g/cm(exp 2), Al equivalent). The maximum dose rate on EURECA (1.16 mGy/day) was 37 percent of the maximum measured on LDEF and dose rates at all depths were less than measured on LDEF. The shielding external to the flight canister covered a greater solid angle about the canister than in the LDEF experiments.

Benton, E. V.; Frank, A. L.

1995-01-01

243

Preliminary results of radiation measurements on EURECA  

NASA Technical Reports Server (NTRS)

The eleven-month duration of the EURECA mission allows long-term radiation effects to be studied similarly to those of the Long Duration Exposure Facility (LDEF). Basic data can be generated for projections to crew doses and electronic and computer reliability on spacecraft missions. A radiation experiment has been designed for EURECA which uses passive integrating detectors to measure average radiation levels. The components include a Trackoscope, which employs fourteen plastic nuclear track detector (PNTD) stacks to measure the angular dependence of high LET (greater than or equal to 6 keV/micro m) radiation. Also included are TLD's for total absorbed doses, thermal/resonance neutron detectors (TRND's) for low energy neutron fluences and a thick PNTD stack for depth dependence measurements. LET spectra are derived from the PNTD measurements. Preliminary TLD results from seven levels within the detector array show that integrated does inside the flight canister varied from 18.8 +/- 0.6 cGy to 38.9 +/- 1.2 cGy. The TLD's oriented toward the least shielded direction averaged 53% higher in dose than those oriented away from the least shielded direction (minimum shielding toward the least shielded direction varied from 1.13 to 7.9 g/cm(exp 2), Al equivalent). The maximum dose rate on EURECA (1.16 mGy/day) was 37% of the maximum measured on LDEF and dose rates at all depths were less than measured on LDEF. The shielding external to the flight canister covered a greater solid angle about the canister than the LDEF experiments.

Benton, E. V.; Frank, A. L.

1995-01-01

244

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

PubMed

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 ACL deficient knee have been identified, few of which were formally assessed at their initial publication. For those most frequently used the Lysholm (I and II) knee scoring scale and Tegner activity score are the only ones to have been adequately validated prior to use. The Cincinnati rating system and International Knee Documentation Committee (IKDC) form were not assessed and the reliability of both measures has since been questioned. Appropriately tested newer measures include the IKDC subjective knee evaluation form, Mohtadi's ACL quality of life outcome measure and the Knee injury and osteoarthritis outcome score (KOOS). We recommend use of the Lysholm II knee scoring scale and Tegner activity score for clinical follow-up of patients and for use as a gold standard to which future measures can be compared. These have their deficiencies and will ultimately require replacement. In view of the international standing of its authors, the IKDC subjective knee evaluation form is likely to be used in preference to the KOOS despite its attractions. For long-term clinical trials the SF-36 should also be used. Further research is required to produce suitable measures for assessing the ACL deficient knee and this work should be appropriately funded. PMID:11248569

Johnson, D S; Smith, R B

2001-03-01

245

“Spin” in wound care research: the reporting and interpretation of randomized controlled trials with statistically non-significant primary outcome results or unspecified primary outcomes  

PubMed Central

Background Spin in the reporting of randomized controlled trials, where authors report research in a way that potentially misrepresents results and mislead readers, has been demonstrated in the broader medical literature. We investigated spin in wound care trials with (a) no statistically significant result for the primary outcome and (b) no clearly specified primary outcome. Methods We searched the Cochrane Wounds Group Specialised Register of Trials for randomized controlled trials (RCTs). Eligible studies were: Parallel-group RCTs of interventions for foot, leg or pressure ulcers published in 2004 to 2009 (inclusive) with either a clearly identified primary outcome for which there was a statistically non-significant result (Cohort A) or studies that had no clear primary outcome (Cohort B). We extracted general study details. For both Cohorts A and B we then assessed for the presence of spin. For Cohort A we used a pre-defined process to assess reports for spin. For Cohort B we aimed to assess spin by recording the number of positive treatment effect claims made. We also compared the number of statistically significant and non-significant results reported in the main text and the abstract looking specifically for spin in the form of selective outcome reporting. Results Of the 71 eligible studies, 28 were eligible for Cohort A; of these, 71% (20/28) contained spin. Cohort B contained 43 studies; of these, 86% (37/43) had abstracts that claimed a favorable treatment claim. Whilst 74% (32/43) of main text results in Cohort B included at least one statistically non-significant result, this was not reflected in the abstract where only 28% contained (12/43) at least one statistically non-significant result. Conclusions Spin is a frequent phenomenon in reports of RCTs of wound treatments. Studies without statistically significant results for the primary outcome used spin in 71% of cases. Furthermore, 33% (43/132) of reports of wound RCTs did not specify a primary outcome and there was evidence of spin and selective outcome reporting in the abstracts of these. Readers should be wary of only reading the abstracts of reports of RCTs of wound treatments since they are frequently misleading regarding treatment effects. PMID:24195770

2013-01-01

246

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

PubMed

Cost related to higher-level outcomes measurement is often very high. However, the cost burden is felt even more by smaller, less well-funded continuing medical education (CME) programs. It is possible to overcome financial and participant-related barriers to measuring Level 6 outcomes, which are patient health outcomes. The Temple University School of Medicine's Office for Continuing Medical Education developed a sequential tool for attaining cost-effective outcomes measurement for determining the likelihood of a CME intervention to produce significant changes in physician performance. The appropriate selection of the CME topic and specific practice change indictors drive this tool. This tool walks providers through a simple YES or NO decision-making list that guides them toward an accurate prediction of potential programmatic outcomes. Factors considered during the decision-making process include whether: (a) the intended change(s) will have a substantial impact on current practice; (b) the intended practice change(s) are well supported by clinical data, specialty organization/government recommendations, expert opinion, etc; (c) the potential change(s) affects a large population; (d) external factors, such as system pressures, media pressures, financial pressures, patient pressures, safety pressures, etc, are driving this intended change in performance; (e) there is a strong motivation on the part of physicians to implement the intended change(s); and (f) the intended change(s) is relatively easy to implement within any system of practice. If each of these questions can be responded to positively, there is a higher likelihood that the intended practice-related change(s) will occur. Such change can be measured using a simpler and less costly methodology. PMID:22573943

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

2012-01-01

247

Patient-Reported Shoulder Outcome Measures Utilized in Breast Cancer Survivors: A Systematic Review  

PubMed Central

Objective 1) To identify English Language published patient-reported upper extremity outcome measures used in breast cancer research and 2) To examine construct validity and responsiveness in patient-reported upper extremity outcome measures used in breast cancer research. Data Sources PubMed, CINAHL and ProQuest MEDLINE® databases were searched up to February 5, 2013. Study Selection Studies were included if a patient-reported upper extremity outcome measure was administered, the participants were diagnosed with breast cancer, and published in English. Data Extraction Eight hundred and sixty-five articles were screened. Fifty-nine full text articles were assessed for eligibility. A total of 46 articles met the initial eligibility criteria for aim 1. Eleven of these articles reported mean and standard deviations for the outcome scores, and included a comparison group analysis for aim 2. Data Synthesis Construct validity was evaluated by calculating effect sizes for known group differences in 6 studies using the Disabilities of Arm, Shoulder and Hand (DASH), Penn Shoulder Score, Shoulder Disability Questionnaire-Dutch, and 10 Questions by Wingate (Wingate). Responsiveness was analyzed comparing a treatment and control group by calculating the coefficient of responsiveness in 5 studies for the DASH and Wingate. Conclusions Eight different patient-reported upper extremity outcome measures have been reported in the peer-review literature for women with breast cancer, some (n=3) were specifically developed for breast cancer survivors and others that were not (n=5). Based on the current evidence we recommend administering the DASH to assess patient-reported upper extremity function in breast cancer survivors because the DASH had most consistently large effects sizes for construct validity and responsiveness. Future large studies are needed for more definitive recommendations. PMID:23932969

Harrington, Shana; Michener, Lori A; Kendig, Tiffany; Miale, Susan; George, Steven Z

2014-01-01

248

Systematic literature review of patient-reported outcome measures used in assessment and measurement of sleep disorders in chronic obstructive pulmonary disease  

PubMed Central

Background Sleep problems are common in patients with chronic obstructive pulmonary disease (COPD), but the validity of patient-reported outcome measures (PROMs) that measure sleep dysfunction has not been evaluated. We have reviewed the literature to identify disease-specific and non-disease-specific sleep PROMs that have been validated for use in COPD patients. The review also examined the psychometric properties of identified sleep outcome measures and extracted point and variability estimates of sleep instruments used in COPD studies. Methods The online EMBASE, MEDLINE, PsycINFO, and SCOPUS databases for all years to May 2014 were used to source articles for the review. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Criteria from the Medical Outcomes Trust Scientific Advisory Committee guidelines were used to evaluate the psychometric properties of all sleep PROMs identified. Results One COPD-specific and six non-COPD-specific sleep outcome measures were identified and 44 papers met the review selection criteria. We only identified one instrument, the COPD and Asthma Sleep Impact Scale, which was developed specifically for use in COPD populations. Ninety percent of the identified studies used one of two non-disease-specific sleep scales, ie, the Pittsburgh Sleep Quality Index and/or the Epworth Sleep Scale, although neither has been tested for reliability or validity in people with COPD. Conclusion The results highlight a need for existing non-disease-specific instruments to be validated in COPD populations and also a need for new disease-specific measures to assess the impact of sleep problems in COPD. PMID:25709424

Garrow, Adam P; Yorke, Janelle; Khan, Naimat; Vestbo, Jørgen; Singh, Dave; Tyson, Sarah

2015-01-01

249

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

PubMed Central

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 minocycline for at least 2 weeks and found that the most common reported side effect is gastrointestinal difficulty, including loss of appetite. The families reported an improvement in language and behavioral areas. Outcome measures in the design of future randomized clinical trials should include both behavioral and language measures. As with any other treatments, we emphasize that randomized clinical trials are needed to determine the efficacy of minocycline in fragile X syndrome. PMID:20687826

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

2014-01-01

250

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

251

Assessing traumatic brain injury outcome measures for long-term follow-up of community-based individuals  

Microsoft Academic Search

Hall KM, Bushnik T, Lakisic-Kazazic B, Wright J, Cantagallo A. Assessing traumatic brain injury outcome measures for long-term follow-up of community-based individuals. Arch Phys Med Rehabil 2001;82:367-74. Objectives: To determine which outcome measures are best and least suited for assessing long-term functional outcome of individuals with traumatic brain injury (TBI) in the community. Design: Survey of participants in the community

Karyl M. Hall; Tamara Bushnik; Bajazeda Lakisic-Kazazic; Jerry Wright; Anna Cantagallo

2001-01-01

252

Recommendations for a Core Outcome Set for Measuring Standing Balance in Adult Populations: A Consensus-Based Approach  

PubMed Central

Background Standing balance is imperative for mobility and avoiding falls. Use of an excessive number of standing balance measures has limited the synthesis of balance intervention data and hampered consistent clinical practice. Objective To develop recommendations for a core outcome set (COS) of standing balance measures for research and practice among adults. Methodology A combination of scoping reviews, literature appraisal, anonymous voting and face-to-face meetings with fourteen invited experts from a range of disciplines with international recognition in balance measurement and falls prevention. Consensus was sought over three rounds using pre-established criteria. Data sources The scoping review identified 56 existing standing balance measures validated in adult populations with evidence of use in the past five years, and these were considered for inclusion in the COS. Results Fifteen measures were excluded after the first round of scoring and a further 36 after round two. Five measures were considered in round three. Two measures reached consensus for recommendation, and the expert panel recommended that at a minimum, either the Berg Balance Scale or Mini Balance Evaluation Systems Test be used when measuring standing balance in adult populations. Limitations Inclusion of two measures in the COS may increase the feasibility of potential uptake, but poses challenges for data synthesis. Adoption of the standing balance COS does not constitute a comprehensive balance assessment for any population, and users should include additional validated measures as appropriate. Conclusions The absence of a gold standard for measuring standing balance has contributed to the proliferation of outcome measures. These recommendations represent an important first step towards greater standardization in the assessment and measurement of this critical skill and will inform clinical research and practice internationally. PMID:25768435

Sibley, Kathryn M.; Howe, Tracey; Lamb, Sarah E.; Lord, Stephen R.; Maki, Brian E.; Rose, Debra J.; Scott, Vicky; Stathokostas, Liza; Straus, Sharon E.; Jaglal, Susan B.

2015-01-01

253

Clinical validity of outcome pain measures in naturally occurring canine osteoarthritis  

PubMed Central

Background The conceptual validity of kinetic gait analysis and disability outcome assessment methods has guided their use in the assessment of pain caused by osteoarthritis (OA). No consensus on the best clinical methods for pain evaluation in canine OA exists, particularly, when evaluating treatments where a smaller treatment effect is anticipated than with pharmacological pain killers. This study thus aimed at determining the technical validity of some clinical endpoints on OA pain in dogs using the green-lipped mussel (GLM)-enriched diet. Twenty-three adult dogs with clinical OA completed the prospective controlled study. All the dogs were fed a balanced diet over a 30-day control period followed by a GLM-enriched diet over a 60-day period. The kinetic gait analysis parameter (PVFBW, peak vertical force adjusted for body weight change), electrodermal activity (EDA), and a standardized multifactorial pain questionnaire (MFQ) were performed on day (D) 0 (inclusion), D30 (start) and D90 (end). The owners completed a client-specific outcome measures (CSOM) instrument twice a week. Motor activity (MA) was continuously recorded in seven dogs using telemetered accelerometric counts. We hypothesized that these methods would produce convergent results related to diet changes. A Type I error of 0.05 was adjusted to correct for the multiplicity of the primary clinical endpoints. Results Neither the EDA nor the MFQ were found reliable or could be validated. Changes in the PVFBW (Padj?=?0.0004), the CSOM (Padj?=?0.006) and the MA intensity (Padj?=?0.02) from D0 to D90 suggested an effect of diet(s). Only the PVFBW clearly increased after the GLM-diet (Padj?=?0.003). The CSOM exhibited a negative relationship with the PVFBW (P?=?0.02) and MA duration (P?=?0.02). Conclusions The PVFBW exhibited the best technical validity for the characterization of the beneficial effect of a GLM-enriched diet. The CSOM and MA appeared less responsive following a GLM-diet, but these measures appeared complementary to gait analysis. Apparently, the CSOM provides the capacity to rely on pain OA assessment influenced by both lameness quantification (PVFBW) and physical functioning (MA). PMID:22963751

2012-01-01

254

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

255

Reporting outcome measures of functional constipation in children from 0 to 4 years of age.  

PubMed

Functional constipation (FC) often begins in the first year of life. Although standard definitions and criteria have been formulated to describe FC, these are rarely used in research and clinical practice. The aim of the study is to systematically assess how definitions and outcome measures are defined in therapeutic randomized controlled trials (RCTs) of infants with FC. PubMed, EMBASE, and Cochrane databases were searched. Studies were included if it was a (systematic review of) therapeutic RCT, children ?4 years old, they had FC, a clear definition of constipation was provided, and were written in English. Quality was assessed using the Delphi list. A total of 1115 articles were found; only 5 studies fulfilled the inclusion criteria. Four different definitions were used, of which only 2 used the internationally accepted Rome III criteria. Defecation frequency was used as primary outcome in all included trials and stool consistency in 3 trials. Two trials involving infants investigated new infant formulas, whereas the third RCT evaluated the efficacy of a probiotic strain. The 2 trials including infants up to 4 years of age compared polyethylene glycol without electrolytes (PEG4000) with lactulose and milk of magnesia. All of the trials used nonvalidated parental diaries. Different definitions and outcome measures for FC in infants are used in RCTs. Disappointingly, there is a lack of well-designed therapeutic trials in infants with constipation. To make comparison between future trials possible, standard definitions, core outcomes, and validated instruments are needed. PMID:25406527

Kuizenga-Wessel, Sophie; Benninga, Marc A; Tabbers, Merit M

2015-04-01

256

Laparoscopic surgery for rectal cancer: oncological results and clinical outcome of 225 patients  

Microsoft Academic Search

Introduction  The efficacy and feasibility of laparoscopic resection for rectal cancer has been proved, but the results of prospective,\\u000a randomized studies are not yet available. Here we present a prospective observational study evaluating oncological and clinical\\u000a outcome after laparoscopic surgery in patients with rectal cancer.\\u000a \\u000a \\u000a \\u000a Patients and Methods  Between January 1998 and March 2005, 225 patients with rectal adenocarcinoma underwent laparoscopic surgery

Ayman Agha; Alois Fürst; Johanna Hierl; Igors Iesalnieks; Gabriel Glockzin; Matthias Anthuber; Karl-Walter Jauch; Hans J. Schlitt

2008-01-01

257

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  

Microsoft Academic Search

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

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

2006-01-01

258

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

PubMed Central

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

2013-01-01

259

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

260

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

ERIC Educational Resources Information Center

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

Marshall, Keith; Willoughby-Booth, Simon

2007-01-01

261

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

262

Preliminary Results From the Champ Occultation Measurements  

NASA Astrophysics Data System (ADS)

Champ collects 200-250 globally distributed GPS occultations every day providing a wealth of information on atmospheric parameters such as pressure, temperature, humidity between 0-60 km altitude and electron density above 60 km altitude. There are several aspects to the Champ occultation measurements which distinguish them from prior measurements (such as from GPS/MET, Oersted and SAC-C): (1) They are taken during solar maximum; (2) they are collected with a new generation receiver ("BlackJack") which provides high quality L1 and L2 measurements even when the DoD anti-spoofing of the GPS signal is turned on; (3) the tracking loop in the receiver is optimized to allow the occulted signal to descend very low in the atmosphere (<1km from the surface). A further distinction comes from the fact that selective availability (the dithering of the GPS clocks) was permanently turned off by DoD, therefore reducing or eliminating the need for 1-second ground measurements previously used to difference out high frequency GPS clock drifts. This talk will present results obtained at JPL from the early Champ occultation data sets, first collected in February, 2001, and will address the specific issues listed above. Specifically, we will present (a) statistics on how low in the atmosphere occultations are able to probe as a function of geographical latitudes and humidity conditions; (b) the limitations on higher altitude atmospheric retrievals (between 30-60 km) caused by the ionosphere at different local times and solar conditions, including comparisons to GPS/MET data taken during solar minimum; (c) individual and statistical comparisons of temperature and water vapor to atmospheric analyses such as NCEP and ECMWF and other data sets such as radiosondes; (d) the impact of including or excluding high rate ground data.

Hajj, G.; Dong, D.; Iijima, B.; Kuang, D.; Kursinski, R.; Mannucci, A.; Meehan, T.; Romans, L.; de la Torre Juárez, M.; Yunck, T.

2001-05-01

263

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

264

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

265

Measuring Student Outcomes in Postsecondary Vocational Education: Using Wage Record Data.  

ERIC Educational Resources Information Center

Describes a study that used a wage-record database to determine, after five years, the educational and employment outcomes of 1988 vocational education graduates and program completers of Washington State community colleges. Analyzes results related to student ethnicity, salaries, and gender and discusses implications for colleges and legislators.…

Azari, Cynthia E.

1996-01-01

266

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

267

Deconstructing Therapy Outcome Measurement With Rasch Analysis of a Measure of General Clinical Distress: The Symptom Checklist90-Revised  

Microsoft Academic Search

Rasch analysis was used to illustrate the usefulness of item-level analyses for evaluating a common therapy outcome measure of general clinical distress, the Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1994). Using complementary therapy research samples, the instrument's 5-point rating scale was found to exceed clients' ability to make reliable discriminations and could be improved by collapsing it into a 3-point version (combining

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

2006-01-01

268

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. PMID:25674342

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

2015-01-01

269

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

PubMed

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

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

2011-01-01

270

Quality of life as an outcome measure in the treatment of alcohol dependence  

PubMed Central

Background: Quality of life has emerged as an important treatment outcome measure for alcohol dependence whose natural course comprises of remission and relapse. Materials and Methods: The purpose of this study was to examine the prospective change in Quality of life (QoL) in 56 patients aged 18-45 years of alcohol dependence over a three months’ period and compare it with QoL of 150 age- and gender- matched healthy controls using WHOQoL-BREF. Severity of alcohol dependence and drinking parameters were assessed. Results: Significant improvement in QoL of patients of alcohol dependence over three months’ abstinence. The physical, psychological, social, and environment domains of QoL in alcohol dependence subjects were significantly lower before treatment initiation than the healthy controls. Alcoholic liver disease emerged as a predictor of improvement in psychological and social domains of QoL. Conclusion: The study confirms poor quality of life in patients of alcohol dependence before intervention. The regular follow-up with the family members in out-patient setting enables the patients achieve complete abstinence, thereby improving their quality of life. PMID:24459373

Srivastava, Shruti; Bhatia, Manjeet S.

2013-01-01

271

Self-control in children: A multimethod examination of treatment outcome measures  

Microsoft Academic Search

This investigation consisted of a multimethod evaluation of treatment outcome measures that have been developed to assess self-control in children. Subjects were 132 children from the fourth, fifth, and sixth grades. Each child's homeroom teacher and one other classroom teacher independently completed the Self-Control Rating Scale (SCRS), the Teacher's Self-Control Rating Scale (TSCRS), and the 10-item Conners Teacher Rating Scale

William M. Reynolds; Kevin D. Stark

1986-01-01

272

Training working memory and fluid intelligence in older adults: developing measures and exploring outcomes  

E-print Network

at the psychological functioning of this group of older participants with the aim of improving overall well-being and coping. They integrated aspects of the two previous training modules by including information on aspects of GMT such as organising and breaking... SEPTEMBER 2012 Training working memory and fluid intelligence in older adults: Developing measures and exploring outcomes Sinéad Hynes This thesis is submitted for the degree of Doctor of Philosophy...

Hynes, Sinéad

2013-04-16

273

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

274

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

PubMed Central

Background: The findings of prior studies of air pollution effects on adverse birth outcomes are difficult to synthesize because of differences in study design. Objectives: The International Collaboration on Air Pollution and Pregnancy Outcomes was formed to understand how differences in research methods contribute to variations in findings. We initiated a feasibility study to a) assess the ability of geographically diverse research groups to analyze their data sets using a common protocol and b) perform location-specific analyses of air pollution effects on birth weight using a standardized statistical approach. Methods: Fourteen research groups from nine countries participated. We developed a protocol to estimate odds ratios (ORs) for the association between particulate matter ? 10 ?m in aerodynamic diameter (PM10) and low birth weight (LBW) among term births, adjusted first for socioeconomic status (SES) and second for additional location-specific variables. Results: Among locations with data for the PM10 analysis, ORs estimating the relative risk of term LBW associated with a 10-?g/m3 increase in average PM10 concentration during pregnancy, adjusted for SES, ranged from 0.63 [95% confidence interval (CI), 0.30–1.35] for the Netherlands to 1.15 (95% CI, 0.61–2.18) for Vancouver, with six research groups reporting statistically significant adverse associations. We found evidence of statistically significant heterogeneity in estimated effects among locations. Conclusions: Variability in PM10–LBW relationships among study locations remained despite use of a common statistical approach. A more detailed meta-analysis and use of more complex protocols for future analysis may uncover reasons for heterogeneity across locations. However, our findings confirm the potential for a diverse group of researchers to analyze their data in a standardized way to improve understanding of air pollution effects on birth outcomes. PMID:21306972

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

2011-01-01

275

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

276

Determination of the minimal clinically important difference on the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs - OT).  

PubMed

Abstract Purpose: Outcome measures must be responsive to change (able to show statistically significant change) and must also produce information on the degree of change that is clinically significant, or the minimal clinically important difference (MCID). This research sought to establish the MCID for four domains of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs - OT). Methods: Using a criterion approach, 30 international clinicians were surveyed about their perceptions of the MCID for AusTOMs - OT. Second, using a distribution-based approach, the MCID was calculated as half of the standard deviation (SD) of the AusTOMs - OT raw scores for a sample of 787 clients. Results: Just over half the clinicians surveyed indicated that a one-point change represented the MCID for AusTOMs - OT for three domains, and 0.5-point change showed MCID for the final domain. The data analysed for the distribution-based calculation indicated that the half SD ranged from 0.51 to 0.61. Conclusion: Using both criterion and distribution-based approaches, this research empirically demonstrated that a change on the four domains of the AusTOMs - OT of between 0.51 and 1 point shows MCID. Considering these findings, and for ease of clinical interpretation, it is recommended that a one-point shift be adopted as the MCID across all domains. Implications for Rehabilitation The AusTOMs - OT have been previously shown to be valid and reliable outcome measures for use with all client groups across all settings including rehabilitation. So that rehabilitation professionals can interpret outcomes data from AusTOMs - OT, information must be available on the degree of change that is clinically significant (also referred to as the minimal clinically important difference or MCID). Using empirical calculations as well as clinician opinion, it is recommended that a one-point shift be used as the minimal clinically important difference for the AusTOMs - OT. PMID:25144830

Unsworth, Carolyn Anne; Coulson, Melissa; Swinton, Luchie; Cole, Helen; Sarigiannis, Mary

2014-08-21

277

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

278

Primary outcome indices in illicit drug dependence treatment research: systematic approach to selection and measurement of drug use end-points in clinical trials  

PubMed Central

Aims Clinical trials test the safety and efficacy of behavioral and pharmacological interventions in drug-dependent individuals. However, there is no consensus about the most appropriate outcome(s) to consider in determining treatment efficacy or on the most appropriate methods for assessing selected outcome(s). We summarize the discussion and recommendations of treatment and research experts, convened by the US National Institute on Drug Abuse, to select appropriate primary outcomes for drug dependence treatment clinical trials, and in particular the feasibility of selecting a common outcome to be included in all or most trials. Methods A brief history of outcomes employed in prior drug dependence treatment research, incorporating perspectives from tobacco and alcohol research, is included. The relative merits and limitations of focusing on drug-taking behavior, as measured by self-report and qualitative or quantitative biological markers, are evaluated. Results Drug-taking behavior, measured ideally by a combination of self-report and biological indicators, is seen as the most appropriate proximal primary outcome in drug dependence treatment clinical trials. Conclusions We conclude that the most appropriate outcome will vary as a function of salient variables inherent in the clinical trial, such as the type of intervention, its target, treatment goals (e.g. abstinence or reduction of use) and the perspective being taken (e.g. researcher, clinical program, patient, society). It is recommended that a decision process, based on such trial variables, be developed to guide the selection of primary and secondary outcomes as well as the methods to assess them. PMID:21781202

Donovan, Dennis M.; Bigelow, George E.; Brigham, Gregory S.; Carroll, Kathleen M.; Cohen, Allan J.; Gardin, John G.; Hamilton, John A.; Huestis, Marilyn A.; Hughes, John R.; Lindblad, Robert; Marlatt, G. Alan; Preston, Kenzie L.; Selzer, Jeffrey A.; Somoza, Eugene C.; Wakim, Paul G.; Wells, Elizabeth A.

2012-01-01

279

Racial differences in iron measures and outcomes observed during an iron reduction trial in peripheral arterial disease.  

PubMed

Elevated body iron (ferritin) levels may contribute to adverse health outcomes. Racial differences in iron measures and clinical outcomes were observed during an iron reduction trial in peripheral arterial disease. At entry, Black compared with White participants had higher ferritin and lower red cell measures, as well as differing ferritin and percent transferrin saturation (%TS) responses, and HDL/LDL ratios associated with statin use. Lower hematocrit levels during follow-up resulted in fewer phlebotomies, less iron unloading (ferritin reduction, p=.035) and 32% less iron removed in Black compared with White participants randomized to iron reduction. Improved primary (all-cause mortality) and secondary (death plus non-fatal myocardial infarction and stroke) outcomes among White participants correlated with lower ferritin levels (p=.005 and p=.053, respectively) and higher %TS levels (p<.001 and p=.001 respectively), associations not observed in Black participants. Variant iron homeostasis contributory to racial health disparities warrants personalized intervention strategies and race-specific clinical trial design. PMID:25702740

Zacharski, Leo R; Shamayeva, Galina; Chow, Bruce K; DePalma, Ralph G

2015-02-01

280

The Selection and Use of Outcome Measures in Palliative and End-of-Life Care Research: The MORECare International Consensus Workshop  

PubMed Central

Context A major barrier to widening and sustaining palliative care service provision is the requirement for better selection and use of outcome measures. Service commissioning is increasingly based on patient, carer, and service outcomes as opposed to service activity. Objectives To generate recommendations and consensus for research in palliative and end-of-life care on the properties of the best outcome measures, enhancing the validity of proxy-reported data and optimal data collection time points. Methods An international expert “workshop” was convened and an online consensus survey was undertaken using the MORECare Transparent Expert Consultation to generate recommendations and level of agreement. We focused on three areas: 1) measurement properties, 2) use of proxies, and 3) measurement timing. Data analysis comprised descriptive analysis of aggregate scores and collation of narrative comments. Results There were 31 workshop attendees; 29 recommendations were included in the online survey, completed by 28 experts. The top three recommendations by area were the following: 1) the properties of the best outcome measures are responsive to change over time and capture clinically important data, 2) to enhance the validity of proxy data requires clear and specific guidelines to aid lay individuals' and/or professionals' completion of proxy measures, and 3) data collection time points need clear identification to establish a baseline. Conclusion Outcome measurement in palliative and end-of-life care requires the use of psychometrically robust measures that are clinically responsive, with defined data collection time points to establish a baseline and clear administration guidelines to complete proxy measures. To further the field requires clinical imperatives to more closely inform recommendations on outcome measurement. PMID:23628515

Evans, Catherine J.; Benalia, Hamid; Preston, Nancy J.; Grande, Gunn; Gysels, Marjolein; Short, Vicky; Daveson, Barbara A.; Bausewein, Claudia; Todd, Chris; Higginson, Irene J.

2013-01-01

281

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...enforcement results are data, statistics,...

2010-04-01

282

Psoriasis outcome measures: a report from the GRAPPA 2012 annual meeting.  

PubMed

Psoriasis is a multisystem disease. The cutaneous and musculoskeletal manifestations (psoriatic arthritis) are well recognized. However, the other manifestations of psoriatic disease including metabolic syndrome, atherosclerotic cardiovascular disease, depression, poor self-esteem, and self-destructive habits including obesity, smoking and excess alcohol consumption are underappreciated. At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members addressed the need to develop uniform, validated, standardized outcome measures for psoriatic disease, measures that are useful to all stakeholders including patients, physicians, regulators, and payers. PMID:23908539

Gottlieb, Alice B; Armstrong, April W

2013-08-01

283

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

284

Reexploration for periampullary carcinoma: resectability, perioperative results, pathology, and long-term outcome.  

PubMed Central

OBJECTIVE: This single-institution experience retrospectively reviews the outcomes of patients undergoing reexploration for periampullary carcinoma at a high-volume center. SUMMARY BACKGROUND DATA: Many patients are referred to tertiary centers with periampullary carcinoma after their tumors were deemed unresectable at previous laparotomy. In carefully selected patients, tumor resection is often possible; however, the perioperative results and long-term outcome have not been well defined. METHODS: From November 1991 through December 1997, 78 patients who underwent previous exploratory laparotomy and/or palliative surgery for suspected periampullary carcinoma underwent reexploration. The operative outcome, resectability rate, pathology, and long-term survival rate were compared with 690 concurrent patients who had not undergone previous exploratory surgery. RESULTS: Fifty-two of the 78 patients (67%) undergoing reexploration underwent successful resection by pancreaticoduodenectomy; the remaining 26 patients (34%) were deemed to have unresectable disease. Compared with the 690 patients who had not undergone recent related surgery, the patients in the reoperative group were similar with respect to gender, race, and resectability rate but were significantly younger. The distribution of periampullary cancers by site in the reoperative group undergoing pancreaticoduodenectomy (n = 52) was 60%, 19%, 15%, and 6% for pancreatic, ampullary, distal bile duct, and duodenal tumors, respectively. These figures were similar to the 65%, 14%, 16% and 5% for resectable periampullary cancers found in the primary surgery group (n = 460). Intraoperative blood loss and transfusion requirements did not differ between the two groups. However, the mean operative time was 7.4 hours in the reoperative group, significantly longer than in the control group. On pathologic examination, reoperative patients had smaller tumors, and the percentage of patients with positive lymph nodes in the resection specimen was significantly less. The incidence of positive margins was similar between the two groups. Postoperative lengths of stay, complication rates, and perioperative mortality rates were not higher in reoperative patients. The long-term survival rate was similar between the two resected groups, with a median survival of 24 months in the reoperative group and 20 months in those without previous exploration. CONCLUSIONS: These data demonstrate that patients undergoing reoperation for periampullary carcinoma have similar resectability, perioperative morbidity and mortality, and long-term survival rates as patients undergoing initial exploration. The results suggest that selected patients considered to have unresectable disease at previous surgery should undergo restaging and reexploration at specialized high-volume centers. PMID:10077052

Sohn, T A; Lillemoe, K D; Cameron, J L; Pitt, H A; Huang, J J; Hruban, R H; Yeo, C J

1999-01-01

285

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

286

Prediction of responders for outcome measures of Locomotor Experience Applied Post Stroke trial  

PubMed Central

The Locomotor Experience Applied Post Stroke rehabilitation trial found equivalent walking outcomes for body weight-supported treadmill plus overground walking practice versus home-based exercise that did not emphasize walking. From this large database, we examined several clinically important questions that provide insights into recovery of walking that may affect future trial designs. Using logistic regression analyses, we examined predictors of response based on a variety of walking speed-related outcomes and measures that captured disability, physical impairment, and quality of life. The most robust predictor was being closer at baseline to the primary outcome measure, which was the functional walking speed thresholds of 0.4 m/s (household walking) and 0.8 m/s (community walking). Regardless of baseline walking speed, a younger age and higher Berg Balance Scale score were relative predictors of responding, whether operationally defined by transitioning beyond each speed boundary or by a continuous change or a greater than median increase in walking speed. Of note, the cutoff values of 0.4 and 0.8 m/s had no particular significance compared with other walking speed changes despite their general use as descriptors of functional levels of walking. No evidence was found for any difference in predictors based on treatment group. Clinical Trial Registration ClinicalTrials.gov; NCT00243919, “Locomotor Experience Applied Post Stroke Trial”; http://www.clinicaltrials.gov PMID:24805892

Dobkin, Bruce H. K.; Nadeau, Stephen E.; Behrman, Andrea L.; Wu, Samuel S.; Rose, Dorian K.; Bowden, Mark; Studenski, Stephanie; Lu, Xiaomin; Duncan, Pamela W.

2015-01-01

287

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

Microsoft Academic Search

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

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

2011-01-01

288

Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study.  

PubMed Central

OBJECTIVE: To determine whether raised plasma glucose concentration independently influences outcome after acute stroke or is a stress response reflecting increased stroke severity. DESIGN: Long-term follow up study of patients admitted to an acute stroke unit. SETTING: Western Infirmary, Glasgow. SUBJECTS: 811 patients with acute stroke confirmed by computed tomography. Analysis was restricted to the 750 non-diabetic patients. MAIN OUTCOME MEASURES: Survival time and placement three months after stroke. RESULTS: 645 patients (86%) had ischaemic stroke and 105 patients (14%) haemorrhagic stroke. Cox's proportional hazards modelling with stratification according to Oxfordshire Community Stroke Project categories identified increased age (relative hazard 1.36 per decade; 95% confidence interval 1.21 to 1.53), haemorrhagic stroke (relative hazard 1.67; 1.22 to 2.28), time to resolution of symptoms > 72 hours (relative hazard 2.15; 1.15 to 4.05), and hyperglycaemia (relative hazard 1.87; 1.43 to 2.45) as predictors of mortality. The effect of glucose concentration on survival was greatest in the first month. CONCLUSIONS: Plasma glucose concentration above 8 mmol/l after acute stroke predicts a poor prognosis after correcting for age, stroke severity, and stroke subtype. Raised plasma glucose concentration is therefore unlikely to be solely a stress response and should arguably be treated actively. A randomised trial is warranted. PMID:9158464

Weir, C. J.; Murray, G. D.; Dyker, A. G.; Lees, K. R.

1997-01-01

289

Observer bias in randomized clinical trials with measurement scale outcomes: a systematic review of trials with both blinded and nonblinded assessors  

PubMed Central

Background: Clinical trials are commonly done without blinded outcome assessors despite the risk of bias. We wanted to evaluate the effect of nonblinded outcome assessment on estimated effects in randomized clinical trials with outcomes that involved subjective measurement scales. Methods: We conducted a systematic review of randomized clinical trials with both blinded and nonblinded assessment of the same measurement scale outcome. We searched PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, HighWire Press and Google Scholar for relevant studies. Two investigators agreed on the inclusion of trials and the outcome scale. For each trial, we calculated the difference in effect size (i.e., standardized mean difference between nonblinded and blinded assessments). A difference in effect size of less than 0 suggested that nonblinded assessors generated more optimistic estimates of effect. We pooled the differences in effect size using inverse variance random-effects meta-analysis and used metaregression to identify potential reasons for variation. Results: We included 24 trials in our review. The main meta-analysis included 16 trials (involving 2854 patients) with subjective outcomes. The estimated treatment effect was more beneficial when based on nonblinded assessors (pooled difference in effect size ?0.23 [95% confidence interval (CI) ?0.40 to ?0.06]). In relative terms, nonblinded assessors exaggerated the pooled effect size by 68% (95% CI 14% to 230%). Heterogeneity was moderate (I2 = 46%, p = 0.02) and unexplained by metaregression. Interpretation: We provide empirical evidence for observer bias in randomized clinical trials with subjective measurement scale outcomes. A failure to blind assessors of outcomes in such trials results in a high risk of substantial bias. PMID:23359047

Hróbjartsson, Asbjørn; Thomsen, Ann Sofia Skou; Emanuelsson, Frida; Tendal, Britta; Hilden, Jørgen; Boutron, Isabelle; Ravaud, Philippe; Brorson, Stig

2013-01-01

290

Pharmacological treatment and other predictors of treatment outcomes in previously untreated patients with schizophrenia: results from the European Schizophrenia Outpatient Health Outcomes (SOHO) study.  

PubMed

The present study aimed to compare health outcomes and tolerability according to antipsychotic medication (olanzapine, risperidone or an oral typical antipsychotic) after 6 months of treatment in a group of 919 schizophrenic patients who had never previously been treated with antipsychotics. Demographic and clinical predictors of outcome were also identified. Data were extracted from the Schizophrenia Outpatient Health Outcomes (SOHO) study, a prospective, observational study of schizophrenia treatment in 10 European countries. Patients who initiated olanzapine were more likely to have a clinical response than those in the risperidone cohort, and had a greater improvement in quality of life than patients in the risperidone or typical antipsychotic cohorts. High negative and depression symptom scores at baseline and the presence of extrapyramidal symptoms at baseline predicted a worse clinical response, whereas hostile behaviour, paid employment and substance abuse predicted a better clinical outcome. The olanzapine cohort gained more weight than patients in the risperidone cohort, but no significant difference in weight gain was observed between olanzapine and the oral typical antipsychotic cohort. The results should be interpreted conservatively due to the observational study design. PMID:15933480

Gasquet, Isabelle; Haro, Josep Maria; Novick, Diego; Edgell, Eric T; Kennedy, Liam; Lepine, Jean Pierre

2005-07-01

291

Child welfare outcomes revisited  

Microsoft Academic Search

The use of outcome measures in child welfare has been part of agency and academic discussions for at least two decades. In 1989, McDonald, Lieberman, Poertner and Hornby contributed to the implementation of an outcome focus through the publication of “Child Welfare Standards for Success.” That paper presented the results of a comprehensive review of published and unpublished research that

Cyndie Murray; Thomas P. McDonald

2000-01-01

292

Joint modelling of repeated measurements and time-to-event outcomes: flexible model specification and exact likelihood inference  

PubMed Central

Random effects or shared parameter models are commonly advocated for the analysis of combined repeated measurement and event history data, including dropout from longitudinal trials. Their use in practical applications has generally been limited by computational cost and complexity, meaning that only simple special cases can be fitted by using readily available software. We propose a new approach that exploits recent distributional results for the extended skew normal family to allow exact likelihood inference for a flexible class of random-effects models. The method uses a discretization of the timescale for the time-to-event outcome, which is often unavoidable in any case when events correspond to dropout. We place no restriction on the times at which repeated measurements are made. An analysis of repeated lung function measurements in a cystic fibrosis cohort is used to illustrate the method. PMID:25866468

Barrett, Jessica; Diggle, Peter; Henderson, Robin; Taylor-Robinson, David

2015-01-01

293

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

294

Functional outcome following a large head total hip arthroplasty: A retrospective analysis of mid term results  

PubMed Central

Background: One of the reasons that hip resurfacing and large head metal on metal (MOM) total hip arthroplasty (THA) became popular in Asia was the possible increased range of movement and thereby improved function of the hip joint. Due to concerns of MOM articulation an alternative bearing was sought. Hence, a shift from large head MOM to large head ceramic on ceramic (COC) was made. The aim of this study was to compare the functional outcome including range of motion (ROM) and dislocation rates following large head MOM and large head COC THA. Materials and Methods: Retrospectively, 39 primary THA with large head MOM with a mean age of 56 years (range 36-72 years) and average followup of 54 months (range 38-70 months) were compared with 23 primary THA with large head COC bearing with a mean age of 48 years (range 36-68 years) and an average followup of 18 months (range 12-26 months). Functional outcome was assessed using the Modified Harris Hip Score. Dislocation rate and ROM were compared. Results: Global ROM averaged 248 degrees with MOM group and 252 degrees with the COC group. One patient with metal bearing had dislocation at an average 3 year followup which required revision THA while there were no complications in the COC group. MHHS averaged 89 points in MOM and 94 in COC THR. Conclusion: This study has shown that large head ceramic on ceramic THA is a good alternative to large head metal on metal THA with comparable dislocation rates and range of movements and without complications of metallosis in Asian patients. PMID:25143647

Agarwala, Sanjay; Mohrir, Ganesh; Moonot, Pradeep

2014-01-01

295

Recovery in the outpatient setting: 36-month results from the Schizophrenia Outpatients Health Outcomes (SOHO) study.  

PubMed

Recovery is an important outcome of schizophrenia that has not been well defined or researched. Using a stringent definition of recovery that included long-lasting symptomatic and functional remission as well as an adequate quality of life for a minimum of 24 months and until the 36-month visit, we determined the frequency and predictors of recovery in patients with schizophrenia during 3 years of antipsychotic treatment in the prospective, observational Schizophrenia Outpatients Health Outcomes (SOHO) study. Of the 6642 patients analysed, 33% achieved long-lasting symptomatic remission, 13% long-lasting functional remission, 27% long-lasting adequate quality of life, and 4% achieved recovery during the 3 year follow-up period. Logistic regression analysis revealed that social functioning at study entry (having good occupational/vocational status, living independently and being socially active) and adherence with medication were factors significantly associated with achieving recovery. Higher negative symptom severity, higher BMI and lack of effectiveness as the reason for change of medication at baseline were baseline factors associated with a lower likelihood of achieving recovery. Treatment with olanzapine was also associated with a higher frequency of recovery compared with risperidone, quetiapine, typical antipsychotics (oral, depot) and patients taking two or more antipsychotic medications. There were no differences among the patients taking olanzapine, clozapine and amisulpride. Predictors of long-lasting symptomatic remission, functional remission and adequate quality of life were also independently analysed. Although the results should be interpreted conservatively due to the observational, non-randomised study design, they indicate that only a small proportion of patients with schizophrenia achieve recovery and suggest that social functioning, medication adherence and type of antipsychotic are important predictors of recovery. PMID:19070991

Novick, Diego; Haro, Josep Maria; Suarez, David; Vieta, Eduard; Naber, Dieter

2009-03-01

296

The factor structure and psychometric properties of the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) in Norwegian clinical and non-clinical samples  

PubMed Central

Background The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) is a 34-item instrument developed to monitor clinically significant change in out-patients. The CORE-OM covers four domains: well-being, problems/symptoms, functioning and risk, and sums up in two total scores: the mean of All items, and the mean of All non-risk items. The aim of this study was to examine the psychometric properties of the Norwegian translation of the CORE-OM. Methods A clinical sample of 527 out-patients from North Norwegian specialist psychiatric services, and a non-clinical sample of 464 persons were obtained. The non-clinical sample was a convenience sample consisting of friends and family of health personnel, and of students of medicine and clinical psychology. Students also reported psychological stress. Exploratory factor analysis (EFA) was employed in half the clinical sample. Confirmatory (CFA) factor analyses modelling the theoretical sub-domains were performed in the remaining half of the clinical sample. Internal consistency, means, and gender and age differences were studied by comparing the clinical and non-clinical samples. Stability, effect of language (Norwegian versus English), and of psychological stress was studied in the sub-sample of students. Finally, cut-off scores were calculated, and distributions of scores were compared between clinical and non-clinical samples, and between students reporting stress or no stress. Results The results indicate that the CORE-OM both measures general (g) psychological distress and sub-domains, of which risk of harm separates most clearly from the g factor. Internal consistency, stability and cut-off scores compared well with the original English version. No, or only negligible, language effects were found. Gender differences were only found for the well-being domain in the non-clinical sample and for the risk domain in the clinical sample. Current patient status explained differences between clinical and non-clinical samples, also when gender and age were controlled for. Students reporting psychological distress during last week scored significantly higher than students reporting no stress. These results further validate the recommended cut-off point of 1 between clinical and non-clinical populations. Conclusions The CORE-OM in Norwegian has psychometric properties at the same level as the English original, and could be recommended for general clinical use. A cut-off point of 1 is recommended for both genders. PMID:23521746

2013-01-01

297

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

298

Attachment characteristics and treatment outcome following inpatient psychotherapy: Results of a multisite study  

Microsoft Academic Search

The authors evaluated 617 patients at hospital admission using an interpersonal interview analyzed with the Adult Attachment Prototype Rating (Strauss, Lobo-Drost, & Pilkonis, 1999) in nine different psychotherapeutic hospitals. Attachment characteristics derived from this method served as predictors of treatment outcome. Outcome was quantified in all sites using the Symptom Checklist-90-Revised, Inventory of Interpersonal Problems, and, in a subsample, the

Bernhard Strauss; Helmut Kirchmann; Jochen Eckert; Audrey Lobo-Drost; Andrea Marquet; Rainer Papenhausen; Robert Mosheim; Wilfried Biebl; Anette Liebler; Klaus-Peter Seidler; Karin Schreiber-Willnow; Dankwart Mattke; Robert Mestel; Elke Daudert; Ralf Nickel; Henning Schauenburg; Diether Höger

2006-01-01

299

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.

300

Item Banks for Measuring Emotional Distress From the Patient-Reported Outcomes Measurement Information System (PROMIS®): Depression, Anxiety, and Anger  

PubMed Central

The authors report on the development and calibration of item banks for depression, anxiety, and anger as part of the Patient-Reported Outcomes Measurement Information System (PROMIS®). Comprehensive literature searches yielded an initial bank of 1,404 items from 305 instruments. After qualitative item analysis (including focus groups and cognitive interviewing), 168 items (56 for each construct) were written in a first person, past tense format with a 7-day time frame and five response options reflecting frequency. The calibration sample included nearly 15,000 respondents. Final banks of 28, 29, and 29 items were calibrated for depression, anxiety, and anger, respectively, using item response theory. Test information curves showed that the PROMIS item banks provided more information than conventional measures in a range of severity from approximately ?1 to +3 standard deviations (with higher scores indicating greater distress). Short forms consisting of seven to eight items provided information comparable to legacy measures containing more items. PMID:21697139

Pilkonis, Paul A.; Choi, Seung W.; Reise, Steven P.; Stover, Angela M.; Riley, William T.; Cella, David

2011-01-01

301

Measuring psychosocial outcomes: is the consumer or the professional the best judge?  

PubMed Central

In this review, we explore professionally-driven and consumer-driven paradigms in measuring psychosocial outcomes for cancer care. Early measures of psychosocial well-being focussed on clinically-derived concepts of dysfunction. Recent literature reflects a paradigm shift toward a consumer-driven approach to the conceptualisation and measurement of psychosocial well-being. The key distinction between the two approaches rests on whether the professional or consumer retains judgement authority and raises the question of whether it is necessary to include both perspectives in research and practice. Research is proposed to clarify our interpretation of these approaches with a view to devising novel interventions to benefit patient well-being. PMID:23431992

Paul, C; Sanson-Fisher, R; Carey, M

2013-01-01

302

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

303

Moving beyond Mindfulness: Defining Equanimity as an Outcome Measure in Meditation and Contemplative Research  

PubMed Central

In light of a growing interest in contemplative practices such as meditation, the emerging field of contemplative science has been challenged to describe and objectively measure how these practices affect health and well-being. While “mindfulness” itself has been proposed as a measurable outcome of contemplative practices, this concept encompasses multiple components, some of which, as we review here, may be better characterized as equanimity. Equanimity can be defined as an even-minded mental state or dispositional tendency toward all experiences or objects, regardless of their origin or their affective valence (pleasant, unpleasant, or neutral). In this article we propose that equanimity be used as an outcome measure in contemplative research. We first define and discuss the inter-relationship between mindfulness and equanimity from the perspectives of both classical Buddhism and modern psychology and present existing meditation techniques for cultivating equanimity. We then review psychological, physiological, and neuroimaging methods that have been used to assess equanimity, either directly or indirectly. In conclusion, we propose that equanimity captures potentially the most important psychological element in the improvement of well-being, and therefore should be a focus in future research studies. PMID:25750687

Gard, Tim; Hoge, Elizabeth A.; Hölzel, Britta K.; Kerr, Catherine; Lazar, Sara W.; Olendzki, Andrew; Vago, David R.

2014-01-01

304

Heart rate variability measured early in patients with evolving acute coronary syndrome and 1-year outcomes of rehospitalization and mortality  

PubMed Central

Objective This study sought to examine the prognostic value of heart rate variability (HRV) measurement initiated immediately after emergency department presentation for patients with acute coronary syndrome (ACS). Background Altered HRV has been associated with adverse outcomes in heart disease, but the value of HRV measured during the earliest phases of ACS related to risk of 1-year rehospitalization and death has not been established. Methods Twenty-four-hour Holter recordings of 279 patients with ACS were initiated within 45 minutes of emergency department arrival; recordings with ?18 hours of sinus rhythm were selected for HRV analysis (number [N] =193). Time domain, frequency domain, and nonlinear HRV were examined. Survival analysis was performed. Results During the 1-year follow-up, 94 patients were event-free, 82 were readmitted, and 17 died. HRV was altered in relation to outcomes. Predictors of rehospitalization included increased normalized high frequency power, decreased normalized low frequency power, and decreased low/high frequency ratio. Normalized high frequency >42 ms2 predicted rehospitalization while controlling for clinical variables (hazard ratio [HR] =2.3; 95% confidence interval [CI] =1.4–3.8, P=0.001). Variables significantly associated with death included natural logs of total power and ultra low frequency power. A model with ultra low frequency power <8 ms2 (HR =3.8; 95% CI =1.5–10.1; P=0.007) and troponin >0.3 ng/mL (HR =4.0; 95% CI =1.3–12.1; P=0.016) revealed that each contributed independently in predicting mortality. Nonlinear HRV variables were significant predictors of both outcomes. Conclusion HRV measured close to the ACS onset may assist in risk stratification. HRV cut-points may provide additional, incremental prognostic information to established assessment guidelines, and may be worthy of additional study. PMID:25143740

Harris, Patricia R E; Stein, Phyllis K; Fung, Gordon L; Drew, Barbara J

2014-01-01

305

Outcomes of cataract surgery in Pakistan: results from The Pakistan National Blindness and Visual Impairment Survey  

PubMed Central

Aim To evaluate the outcomes of cataract surgery in Pakistan. Methods Cross?sectional, nationally representative sample of 16?507 adults (aged ?30?years). Each underwent interview, logarithm of the minimum angle of resolution visual acuity (VA), autorefraction, examination of optic disc. Those with <6/12 VA on presentation underwent best?corrected VA and dilated biomicroscopic ocular examination. Results 1317 subjects (633 men) had undergone surgery in one or both eyes. Of the 1788 operated eyes, 1099 (61%) had undergone intracapsular cataract extraction (ICCE) and 607 (34%) extracapsular surgery with an intraocular lens (ECCE+IOL). Presenting VA: 275 (15.4%) eyes: 6/12 or better; 253 (14.1) <6/12 ?6/18; 632 (35.3%) 6/18 to 6/60; 85 (4.8%): 6/60 to 3/60; 528 (29.5%): <3/60. With “best” refractive correction, these values were: 563 (31.5%), 332 (18.6%), 492 (27.5%), 61 (3.4%), 334 (18.7%), respectively. Of the 1498 eyes with VA ?6/12 on presentation, 352 (23.5%) were the result of coincident disease, 800 (53.4%) refractive error and 320 (21.4%) operative complications. Eye camp surgery (OR 1.72, p?=?0.002), ICCE (OR 3.78; p<0.001), rural residence (OR 1.36, p?=?0.01), female gender (OR 1.55, p<0.001) and illiteracy (OR 2.44, p<0.001) were associated with VA of <6/18. More recent ICCE surgeries were associated with a poorer outcome. The ratio of ECCE+IOL:ICCE in the last 3?years was 1.2:1, compared with 1:3.3 ?4?years before the survey. Conclusion Almost a third of cataract operations result in a presenting VA of <6/60, which could be halved by appropriate refractive correction. This study highlights the need for an improvement in quality of surgery with a more balanced distribution of services. PMID:17151060

Bourne, Rupert; Dineen, Brendan; Jadoon, Zahid; Lee, Pak S; Khan, Aman; Johnson, Gordon J; Foster, Allen; Khan, Daud

2007-01-01

306

Day-to-day measurement of patient-reported outcomes in exacerbations of chronic obstructive pulmonary disease  

PubMed Central

Background Exacerbations of chronic obstructive pulmonary disease (COPD) are a major burden to patients and to society. Little is known about the possible role of day-to-day patient-reported outcomes during an exacerbation. This study aims to describe the day-to-day course of patient-reported health status during exacerbations of COPD and to assess its value in predicting clinical outcomes. Methods Data from two randomized controlled COPD exacerbation trials (n = 210 and n = 45 patients) were used to describe both the feasibility of daily collection of and the day-to-day course of patient-reported outcomes during outpatient treatment or admission to hospital. In addition to clinical parameters, the BORG dyspnea score, the Clinical COPD Questionnaire (CCQ), and the St George’s Respiratory Questionnaire were used in Cox regression models to predict treatment failure, time to next exacerbation, and mortality in the hospital study. Results All patient-reported outcomes showed a distinct pattern of improvement. In the multivariate models, absence of improvement in CCQ symptom score and impaired lung function were independent predictors of treatment failure. Health status and gender predicted time to next exacerbation. Five-year mortality was predicted by age, forced expiratory flow in one second % predicted, smoking status, and CCQ score. In outpatient management of exacerbations, health status was found to be less impaired than in hospitalized patients, while the rate and pattern of recovery was remarkably similar. Conclusion Daily health status measurements were found to predict treatment failure, which could help decision-making for patients hospitalized due to an exacerbation of COPD. PMID:23766644

Kocks, Jan Willem H; van den Berg, Jan Willem K; Kerstjens, Huib AM; Uil, Steven M; Vonk, Judith M; de Jong, Ynze P; Tsiligianni, Ioanna G; van der Molen, Thys

2013-01-01

307

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

PubMed Central

Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view. PMID:24167743

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

2013-01-01

308

A transuranic aerosol measurement system: Preliminary results  

SciTech Connect

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

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

1986-10-01

309

Evaluation of Cause of Deaths' Validity Using Outcome Measures from a Prospective, Population Based Cohort Study in Tehran, Iran  

PubMed Central

Objective The aim of this study was to evaluate the validity of cause of death stated in death certificates in Tehran using outcome measures of the Tehran Lipid and Glucose Study (TLGS), an ongoing prospective cohort study. Methods The cohort was established in 1999 in a population of 15005 people, 3 years old and over, living in Tehran; 3551 individuals were added to this population three years later. As part of cohort's outcome measures, deaths occurring in the cohort are investigated by a panel of medical specialists (Cohort Outcome Panel-COP) and underlying cause of death is determined for each death. The cause of death assigned in a deceased's original death certificate was evaluated against the cause of death determined by COP and sensitivity and positive predictive values (PPV) were determined. In addition, determinants of assigning accurate underlying cause of death were determined using logistic regression model. Result A total of 231 death certificates were evaluated. The original death certificates over reported deaths due to neoplasms and underreported death due to circulatory system and transport accidents. Neoplasms with sensitivity of 0.91 and PPV of 0.71 were the most valid category. The disease of circulatory system showed moderate degree of validity with sensitivity of 0.67 and PPV of 0.78. The result of logistic regression indicated if the death certificate is issued by a general practitioner, there is 2.3 (95% CI 1.1, 5.1) times chance of being misclassified compared with when it is issued by a specialist. If the deceased is more than 60 years, the chance of misclassification would be 2.5 times (95% CI of 1.1, 5.9) compared with when the deceased is less than 60 years. PMID:22355365

Khalili, Davood; Mosavi-Jarrahi, Alireza; Eskandari, Fatemeh; Mousavi-Jarrahi, Yasaman; Hadaegh, Farzad; Mohagheghi, Mohammadali; Azizi, Fereidoun

2012-01-01

310

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

311

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

312

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

313

Higher Chest Wall Dose Results in Improved Locoregional Outcome in Patients Receiving Postmastectomy Radiation  

SciTech Connect

Purpose: Randomized trials demonstrating decreased locoregional recurrence (LRR) and improved overall survival (OS) in women receiving postmastectomy radiation therapy (PMRT) used up to 50 Gy to the chest wall (CW), but in practice, many centers boost the CW dose to {>=}60 Gy, despite lack of data supporting this approach. We evaluated the relationship between CW dose and clinical outcome. Methods and Materials: We retrospectively reviewed medical records of 582 consecutively treated patients who received PMRT between January 1999 and December 2009. We collected data on patient, disease, treatment characteristics, and outcomes of LRR, progression-free survival (PFS) and OS. Results: Median follow-up from the date of diagnosis was 44.7 months. The cumulative 5-year incidence of LRR as first site of failure was 6.2%. CW dose for 7% (43 patients) was {<=}50.4 Gy (range, 41.4-50.4 Gy) and 93% received >50.4 Gy (range, 52.4-74.4 Gy). A CW dose of >50.4 Gy vs. {<=}50.4 Gy was associated with lower incidence of LRR, a 60-month rate of 5.7% (95% confidence interval [CI], 3.7-8.2) vs. 12.7% (95% CI, 4.5-25.3; p = 0.054). Multivariate hazard ratio (HR) for LRR controlling for race, receptor status, and stage was 2.62 (95% CI, 1.02-7.13; p = 0.042). All LRR in the low-dose group occurred in patients receiving 50 to 50.4 Gy. Lower CW dose was associated with worse PFS (multivariate HR, 2.73; 95% CI, 1.64-4.56; p < 0.001) and OS (multivariate HR, 3.88; 95% CI, 2.16-6.99; p < 0.001). Conclusions: The addition of a CW boost above 50.4 Gy resulted in improved locoregional control and survival in this cohort patients treated with PMRT for stage II-III breast cancer. The addition of a CW boost to standard-dose PMRT is likely to benefit selected high-risk patients. The optimal technique, target volume, and patient selection criteria are unknown. The use of a CW boost should be studied prospectively, as has been done in the setting of breast conservation.

Panoff, Joseph E.; Takita, Cristiane [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); Hurley, Judith [Department of Medicine, Division of Hematology and Oncology, Miller School of Medicine, University of Miami, Miami, Florida (United States); Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); Reis, Isildinha M. [Department of Epidemiology and Public Health and Sylvester Division of Biostatistics, University of Miami Miller School of Medicine, Miami, Florida (United States); Sylvester Division of Biostatistics and Bioinformatics Core, University of Miami Miller School of Medicine, Miami, Florida (United States); Zhao, Wei [Sylvester Division of Biostatistics and Bioinformatics Core, University of Miami Miller School of Medicine, Miami, Florida (United States); Rodgers, Steven E. [Department of Medicine, Division of Hematology and Oncology, Miller School of Medicine, University of Miami, Miami, Florida (United States); Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); Gunaseelan, Vijayalakshmi [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); Wright, Jean L., E-mail: Jwright3@med.miami.edu [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States)

2012-03-01

314

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

PubMed Central

Study Design Concurrent prospective randomized and observational cohort study. Objectives To assess the 4-year outcomes of surgery vs. non-operative care. Background Although randomized trials have demonstrated small short-term differences in favor of surgery, long-term outcomes comparing surgical to non-operative treatment remain controversial. Methods Surgical candidates with imaging-confirmed lumbar intervertebral disc herniation meeting SPORT eligibility criteria enrolled into prospective randomized (501 participants) and observational cohorts (743 participants) at 13 spine clinics in 11 US states. Interventions were standard open discectomy versus usual non-operative care. Main outcome measures were changes from baseline in the SF-36 Bodily Pain (BP) and Physical Function (PF) scales and the modified Oswestry Disability Index (ODI - AAOS/Modems version) assessed at 6 weeks, 3 and 6 months, and annually thereafter. Results Non-adherence to treatment assignment caused the intent-to-treat analyses to underestimate the treatment effects. In the 4-year combined as-treated analysis, those receiving surgery demonstrated significantly greater improvement in all the primary outcome measures (mean change Surgery vs. Non-operative; treatment effect; 95% CI): BP (45.6 vs. 30.7; 15.0; 11.8 to 18.1), PF (44.6 vs. 29.7; 14.9; 12.0 to 17.8) and ODI (?38.1 vs. ?24.9; ?13.2; ?15.6 to ?10.9). The percent working was similar between the surgery and non-operative groups, 84.4% vs. 78.4% respectively. Conclusion In a combined as-treated analysis at 4 years, patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operatively treated patients in all primary and secondary outcomes except work status. Trial Registration Spine Patient Outcomes Research Trial (SPORT): Intervertebral Disc Herniation; #NCT00000410; http://www.clinicaltrials.gov/ct/show/NCT00000410?order=2 PMID:19018250

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

2009-01-01

315

Evidence for the validity of grouped self-assessments in measuring the outcomes of educational programs.  

PubMed

There is compelling empirical evidence in support of the use of grouped self-assessment data to measure program outcomes. However, other credible research has clearly shown that self-assessments are poor predictors of individual achievement such that the validity of self-assessments has been called into question. Based on the reanalysis of two previously published studies and an analysis of two original studies, we show that grouped self-assessments may be good predictors of and hence valid measures of performance at the group level, an outcome commonly used in program evaluation studies. We found statistically significant correlation coefficients (between 0.56 and 0.87), when comparing across performance items using the group means of self-assessments with the group means of individual achievement on criterion tests. We call for further research into the conditions and circumstances in which grouped self-assessments are used, so that they can be employed more effectively and confidently by program evaluators, decision makers, and researchers. PMID:23396128

D'Eon, Marcel F; Trinder, Krista

2014-12-01

316

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

317

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

318

Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty  

Microsoft Academic Search

BACKGROUND: Physical performance measures play an important role in the measurement of outcome in patients undergoing hip and knee arthroplasty. However, many of the commonly used measures lack information on their psychometric properties in this population. The purposes of this study were to examine the reliability and sensitivity to change of the six minute walk test (6MWT), timed up and

Deborah M Kennedy; Paul W Stratford; Jean Wessel; Jeffrey D Gollish; Dianne Penney

2005-01-01

319

Long term outcome in adolescents with Hodgkin's lymphoma: poor results using regimens designed for adults.  

PubMed

It is unclear whether the outcome in adolescents with Hodgkin's lymphoma is as good as that in children and there are no prospective randomized trials comparing regimes used in children and adults in this setting. We have therefore performed an analysis of 210 adolescent patients diagnosed with Hodgkin's lymphoma between 1970-1997 and registered on the database held by the British National Lymphoma Investigation. Patients were treated according to adult regimens current at the time of their diagnosis. The complete response rate recorded in 209 patients was 76%. This was highly dependent on disease stage being 95% in patients with localized disease but 63% in those with advanced disease. The 5 year event free survival for the whole cohort was 50% falling to 41% at 20 years with overall survival of 81% falling to 68% at 5 and 20 years respectively. There is no significant difference in the 3 decades pertaining to this analysis. Of the 62 deaths in this cohort, 70% were due to Hodgkin's lymphoma but of the 13 deaths occurring beyond 10 years, only 3 were due to Hodgkin's lymphoma, the reminder being attributable to the late effects of therapy. Results from paediatric groups have been much more encouraging than those presented from this cohort. It seems the use of risk-adjusted combined modality therapy with minimization of radiation fields and doses and reduction of anthracycline and alkylator exposure has been successful in children and should be used in adolescents. PMID:15370209

Yung, L; Smith, P; Hancock, B W; Hoskin, P; Gilson, D; Vernon, C; Linch, D C

2004-08-01

320

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

321

Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty.  

PubMed

To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score (CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score. PMID:25793164

Booker, Simon; Alfahad, Nawaf; Scott, Martin; Gooding, Ben; Wallace, W Angus

2015-03-18

322

Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty  

PubMed Central

To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score (CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score. PMID:25793164

Booker, Simon; Alfahad, Nawaf; Scott, Martin; Gooding, Ben; Wallace, W Angus

2015-01-01

323

Adolescent Outcome Measures in the NLSY97 Family Process Data Set: Variation by Race and Socioeconomic Conditions  

Microsoft Academic Search

This study uses nationally representative data from the National Longitudinal Surveys of Youth 1997 to analyze adolescent outcome indexes (delinquency, substance use, and emotional and behavior problems) by gender, race, household income, and family structure. Results from analysis of variance show that family structure is correlated with better adolescent outcomes, even after controlling for gender, race, and household income. For

Erin K. Holmes; Hinckley A. Jones-Sanpei; Randal D. Day

2009-01-01

324

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

325

Measuring Outcomes in Mental Health Services for Older People: An evaluation of the Health of the Nation Outcome Scales for elderly people (HoNOS65+)  

Microsoft Academic Search

The Health of the Nation Outcome Scales (HoNOS) family of measures is routinely used in mental health services in the New Zealand, Australia, and the United Kingdom. However, the psychometric properties of the HoNOS65+ for elderly people have not been extensively evaluated. The aim of the present study was to examine the validity, reliability, and sensitivity to change of the

Susan B. Gee; Matthew J. Croucher; John Beveridge

2010-01-01

326

Recent results from satellite beacon measurements  

NASA Technical Reports Server (NTRS)

A review is made of the techniques for measuring ionospheric electron content, the most important parameter in the study of transionospheric propagation. Data collected since 1964 have yielded a synoptic description of the behavior of the electron content in mid-latitudes. Empirical relationships between the level of solar activity and the electron content have been developed permitting the prognostication of the electron content values. Marked discrepancies between prognostication and observation which occur during ionospheric storms are being studied to identify their causes. Electron content bite-outs during solar eclipses fall off with distance from totality more rapidly than simple theory predicts suggesting the action of eclipse induced neutral winds. Gravity waves propagating in the thermosphere leave a signature in the electron content records. Studies of such records have allowed the identification of the position of the gravity wave source, and its radiation pattern.

Da Rosa, A. V.

1974-01-01

327

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

328

A study of mefloquine treatment for progressive multifocal leukoencephalopathy: results and exploration of predictors of PML outcomes.  

PubMed

Immune reconstitution has improved outcomes for progressive multifocal leukoencephalopathy (PML), a potentially lethal brain disease caused by JC virus (JCV). However, an antiviral treatment to control JCV is needed when immune reconstitution is delayed or not possible. On the basis of in vitro efficacy, this study evaluated the effect of mefloquine on PML and factors that may predict PML outcomes. This 38-week, open-label, randomized, parallel-group, proof-of-concept study compared patients with PML who received standard of care (SOC) with those who received SOC plus mefloquine (250 mg for 3 days, then 250 mg weekly). Patients randomized to SOC could add mefloquine treatment at week 4. The primary endpoint was change from baseline to weeks 4 and 8 in JCV DNA copy number (load) in cerebrospinal fluid (CSF). Exploratory analyses evaluated factors that might correlate with clinical outcome. The majority of enrolled patients were HIV positive. Preplanned interim data analyses suggested that the study was unlikely to successfully demonstrate a significant difference between groups; therefore, the study was terminated prematurely. There was no significant difference between groups in CSF JCV DNA loads or clinical/MRI findings. Decrease in CSF JCV DNA load from baseline to week 4 was associated with a better clinical outcome at 16 weeks, as measured by Karnofsky scores. This study found no evidence of anti-JCV activity by mefloquine. An early decrease of CSF JCV DNA load appears to be associated with a better clinical outcome. PMID:23733308

Clifford, David B; Nath, Avindra; Cinque, Paola; Brew, Bruce J; Zivadinov, Robert; Gorelik, Leonid; Zhao, Zhenming; Duda, Petra

2013-08-01

329

"Psychometric properties of three patient reported outcome measures for the assessment of shoulder disability after neck dissection"  

PubMed

Background Patient-reported outcome measures evaluating shoulder disability after neck dissection (ND) have not been sufficiently validated. We assessed the psychometric properties of the Shoulder Disability Questionnaire (SDQ), Neck Dissection Impairment Index (NDII) and the Shoulder Pain and Disability Index (SPADI) in patients after ND. Methods 107 patients completed the SDQ, NDII and SPADI on 4 occasions over 6 months, and underwent physical examination. We assessed internal consistency, test-retest reliability, clinical- and construct validity, and responsiveness to change. The possibility of combining the NDII and SPADI items into a single scale was explored by Rasch-analysis. Results All questionnaires exhibited good reliability and validity. We were successful in fitting a Rasch model to the data. Conclusion The results support the suitability of the SDQ, NDII and the SPADI for use in ND patients. Combining the SPADI and NDII in a single Rasch-scale improves item difficulty distribution, but reduces variability and discriminative ability. Head Neck, 2014. PMID:25224150

Stuiver, Martijn M; Ten Tusscher, Marieke R; van Opzeeland, Anita; Brendeke, Wim; Lindeboom, Robert; Dijkstra, Pieter U; Aaronson, N K

2014-09-15

330

Beyond FEV1 in COPD: a review of patient-reported outcomes and their measurement  

PubMed Central

Patients with chronic obstructive pulmonary disease (COPD) present with a variety of symptoms and pathological consequences. Although primarily viewed as a respiratory disease, COPD has both pulmonary and extrapulmonary effects, which have an impact on many aspects of physical, emotional, and mental well-being. Traditional assessment of COPD relies heavily on measuring lung function, specifically forced expiratory volume in 1 second (FEV1). However, the evidence suggests that FEV1 is a relatively poor correlate of symptoms such as breathlessness and the impact of COPD on daily life. Furthermore, many consequences of the disease, including anxiety and depression and the ability to perform daily activities, can only be described and reported reliably by the patient. Thus, in order to provide a comprehensive view of the effects of interventions in clinical trials, it is essential that spirometry is accompanied by assessments using patient-reported outcome (PRO) instruments. We provide an overview of patient-reported outcome concepts in COPD, such as breathlessness, physical functioning, and health status, and evaluate the tools used for measuring these concepts. Particular attention is given to the newly developed instruments emerging in response to recent regulatory guidelines for the development and use of PROs in clinical trials. We conclude that although data from the development and validation of these new PRO instruments are emerging, to build the body of evidence that supports the use of a new instrument takes many years. Furthermore, new instruments do not necessarily have better discriminative or evaluative properties than older instruments. The development of new PRO tools, however, is crucial, not only to ensure that key COPD concepts are being reliably measured but also that the relevant treatment effects are being captured in clinical trials. In turn, this will help us to understand better the patient’s experience of the disease. PMID:23093901

Jones, Paul; Miravitlles, Marc; van der Molen, Thys; Kulich, Karoly

2012-01-01

331

Three Measures of Forest Fire Smoke Exposure and Their Associations with Respiratory and Cardiovascular Health Outcomes in a Population-Based Cohort  

PubMed Central

Background: During the summer of 2003 numerous fires burned in British Columbia, Canada. Objectives: We examined the associations between respiratory and cardiovascular physician visits and hospital admissions, and three measures of smoke exposure over a 92-day study period (1 July to 30 September 2003). Methods: A population-based cohort of 281,711 residents was identified from administrative data. Spatially specific daily exposure estimates were assigned to each subject based on total measurements of particulate matter (PM) ? 10 ?m in aerodynamic diameter (PM10) from six regulatory tapered element oscillating microbalance (TEOM) air quality monitors, smoke-related PM10 from a CALPUFF dispersion model run for the study, and a SMOKE exposure metric for plumes visible in satellite images. Logistic regression with repeated measures was used to estimate associations with each outcome. Results: The mean (± SD) exposure based on TEOM-measured PM10 was 29 ± 31 ?g/m3, with an interquartile range of 14–31 ?g/m3. Correlations between the TEOM, smoke, and CALPUFF metrics were moderate (0.37–0.76). Odds ratios (ORs) for a 30-?g/m3 increase in TEOM-based PM10 were 1.05 [95% confidence interval (CI), 1.03–1.06] for all respiratory physician visits, 1.16 (95% CI, 1.09–1.23) for asthma-specific visits, and 1.15 (95% CI, 1.00–1.29) for respiratory hospital admissions. Associations with cardiovascular outcomes were largely null. Conclusions: Overall we found that increases in TEOM-measured PM10 were associated with increased odds of respiratory physician visits and hospital admissions, but not with cardiovascular health outcomes. Results indicating effects of fire smoke on respiratory outcomes are consistent with previous studies, as are the null results for cardiovascular outcomes. Some agreement between TEOM and the other metrics suggests that exposure assessment tools that are independent of air quality monitoring may be useful with further refinement. PMID:21659039

Brauer, Michael; MacNab, Ying C.; Kennedy, Susan M.

2011-01-01

332

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

333

Quality of Life Should Be Considered the Primary Outcome for Measuring Success of Endometrial Ablation  

Microsoft Academic Search

Study ObjectiveTo compare clinical and quality of life outcomes by validated instruments after endometrial ablation by four methods, and determine the primary outcome that most reflects procedure success.

Jason A. Abbott; Jed Hawe; Ray Garry

2003-01-01

334

Objective measures of subjective experience: the use of therapist notes in process-outcome research.  

PubMed

Computerized linguistic measures of emotional engagement, and reflective and affective language, previously applied to session transcripts, were applied to notes of 14 treatments by candidates under supervision at the New York Psychoanalytic Society and Institute, covering the five decades from the 1950s to the 1990s. The findings indicate a strong relationship between candidates' subjective experience as represented unintentionally in the linguistic style of their case notes and the effectiveness of their clinical work. The treatments were evaluated for effectiveness by experienced clinicians using the Global Assessment of Functioning (GAF) and the Psychodynamic Functioning Scales of Høglend and colleagues; a Composite Clinical Effectiveness (CCE) measure was constructed based on level and change in these measures. The Mean High Weighted Referential Activity Dictionary (MHW), a computerized measure of emotional engagement developed in the framework of Bucci's theory of multiple coding and the referential process, showed a positive correlation of .73 with CCE. The Hostility subcategory of the Negative Affect Dictionary (ANH) showed a negative correlation, -.48, with CCE. In a multiple regression analysis, these two variables accounted for over three-quarters of the variance in the CCE. Implications of the findings for process/outcome research and supervision and evaluation of trainees are discussed. PMID:23006121

Bucci, Wilma; Maskit, Bernard; Hoffman, Leon

2012-06-01

335

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

336

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

337

A patient reported outcome measure (PROM) assessing quality of care in the urology hospital outpatient setting.  

PubMed

A prospective blind PROM (patient reported outcome measure) study performed in our urology department examined the outpatient-clinic experience. 104 questionnaires were completed. 23 patients (22%) felt the waiting times for appointments was excessive. 13 patients (13%) experienced difficulty in contacting administrative staff. 98 patients (94%) considered the waiting areas good but 31 patients (31%) considered lack of privacy an issue. Consultants saw 65 patients (63%). 62 patients (60%) expected to be seen by a consultant. 32 patients (31%) felt consultation with a different doctor on return visits was unsatisfactory. 76 patients (73%) "fully trusted" their doctors. 78 patients (75%) rated their visit excellent, 10 patients (10%) added comments. Despite frustration with waiting times, the experience of patients reflects a positive rapport and trust between patient and doctor. PMID:25282974

Alsinnawi, M; Dowling, C M; McKeown, S; Flynn, R; McDermott, T E D; Grainger, R; Thornhill, J A

2014-09-01

338

Teacher, parent, and peer reports of early aggression as screening measures for long-term maladaptive outcomes: Who provides the most useful information?  

PubMed Central

Objective This study compared the ability of teacher, parent, and peer reports of aggressive behavior in early childhood to accurately classify cases of maladaptive outcomes in late adolescence and early adulthood. Method Weighted kappa analyses determined optimal cut points and relative classification accuracy among teacher, parent, and peer reports of aggression assessed for 691 students (54% male; 84% African American, 13% White) in the fall of first grade. Outcomes included antisocial personality, substance use, incarceration history, risky sexual behavior, and failure to graduate from high school on time. Results Peer reports were the most accurate classifier of all outcomes in the full sample. For most outcomes, the addition of teacher or parent reports did not improve overall classification accuracy once peer reports were accounted for. Additional gender-specific and adjusted kappa analyses supported the superior classification utility of the peer report measure. Conclusion The results suggest that peer reports provided the most useful classification information of the three aggression measures. Implications for targeted intervention efforts which use screening measures to identify at-risk children are discussed. PMID:24512126

Clemans, Katherine H.; Musci, Rashelle J.; Leoutsakos, Jeannie-Marie S.; Ialongo, Nicholas S.

2014-01-01

339

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

340

Examining Student Spiritual Outcomes as a Result of a General Education Religion Course  

ERIC Educational Resources Information Center

In an era in which part-time faculty are becoming a higher proportion of the teaching faculty on most campuses, this study addressed the question of whether student learning outcomes in religious education courses are significantly influenced by whether the instructor teaches in a full- or part-time capacity in the Department of Religion. We…

Hilton, John, III; Plummer, Kenneth

2013-01-01

341

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

342

Goals, Motivation for, and Outcomes of Personal Learning through Networks: Results of a Tweetstorm  

ERIC Educational Resources Information Center

Recent developments in the use of social media for learning have posed serious challenges for learners. The information overload that these online social tools create has changed the way learners learn and from whom they learn. An investigation of learners' goals, motivations and expected outcomes when using a personal learning network is…

Sie, Rory L. L.; Pataraia, Nino; Boursinou, Eleni; Rajagopal, Kamakshi; Margaryan, Anoush; Falconer, Isobel; Bitter-Rijpkema, Marlies; Littlejohn, Allison; Sloep, Peter B.

2013-01-01

343

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

Microsoft Academic Search

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

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

2000-01-01

344

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

ERIC Educational Resources Information Center

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…

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

2010-01-01

345

(B) ABET Criterion 3: Outcomes Met By Course Content Course #: BEE 427 Title: Water Sampling and Measurement in Environmental Analysis  

E-print Network

and Measurement in Environmental Analysis Semester/Year: Fall 2006 Instructor: Larry D. Geohring Identify______ Name of Instructor: __Larry D. Geohring________ Course Outcomes Specific to Course ABET a- criteria How_________________________________________ __ Course Title: _ Water Sampling and Measurement in Environmental Analysis ___ Instructor: __Larry D

Walter, M.Todd

346

Clinical appropriateness: a key factor in outcome measure selection: the 36 item short form health survey in multiple sclerosis  

Microsoft Academic Search

OBJECTIVESUnderstanding the properties of an outcome measure is essential in choosing the appropriate instrument and interpreting the information it generates. The MOS 36 item short form health survey questionnaire (SF-36) is widely acknowledged as the gold standard generic measure of health status; few studies however have evaluated its use for clinical trials in multiple sclerosis. Its clinical appropriateness, internal consistency

J A Freeman; J C Hobart; D W Langdon; A J Thompson

2000-01-01

347

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

348

Health-related quality of life, satisfaction, and economic outcome measures in studies of prostate cancer screening and treatment, 1990-2000.  

PubMed

Prostate cancer outcomes research incorporates a broad spectrum of endpoints, from clinical or intermediate endpoints, such as tumor shrinkage or patient compliance, to final endpoints, such as survival or disease-free survival. Three types of nontraditional endpoints that are of growing interest-health-related quality of life (QOL), satisfaction with care, and economic cost impact-hold the promise of improving our ability to understand the full burden of prostate cancer screening and treatment. In this article we review the last decade's published literature regarding the health-related QOL, satisfaction, and economic outcomes of prostate cancer screening and treatment to determine the "state of the science" of outcomes measurement. The focus is the enumeration of the types of outcome measurement used in the studies not the determination of the results of the studies. Studies were identified by searching Medline (1990-2000). Articles were included if they presented original data on any patient-centered outcome (including costs or survival alone) for men screened and treated for prostate cancer. Review papers were excluded unless they were quantitative syntheses of the results of other primary studies. Economic and decision analytic papers were included if they presented information on outcomes of real or hypothetical patient cohorts. Each retrieved article was reviewed by one of the authors. Included papers were assigned one primary, mutually exclusive study design. For the "primary data" studies, information was abstracted on care setting, dates of the study, sample size, racial distribution, age, tumor differentiation, tumor stage, survival, statistical power, and types of outcomes measures (QOL-generic, QOL-cancer specific, QOL-prostate cancer specific, satisfaction, costs, utilities, and other). For the "economic and decision analytic" papers, information was abstracted on stage of disease, age range, outcomes, costs, and whether utilities were measured. Of the 198 included papers, there were 161 primary data papers categorized as follows: randomized trial (n = 28), nonrandomized trial (n = 13), prospective or retrospective cohort study (n = 55), case-control study (n = 0), cross-sectional study (n = 63), and meta-analysis (n = 2). The remaining 37 papers were economic and decision analytic papers. Among the 149 primary data papers that contained patient outcome data, there were 42 standard instruments used, accounting for 44% (179 of 410) of the measures overall. Almost three-quarters (71%) of papers included one, two, or three outcomes measures of all types (standard and nonstandard); three papers included seven outcomes measures, and one paper included nine. Over the 11-year time period, there was a nonstatistically significant trend toward more frequent use of standardized QOL instruments and a statistically significant trend toward increased reporting of race (P = .003). Standardization of measurement of health-related QOL, satisfaction with care, and economic cost effect among men screened and treated for prostate cancer is needed. A core set of similar questions, both generic and disease-specific, should ideally be asked in every study, although investigators should be encouraged to include additional question sets as appropriate to individual studies to get a more complete picture of how patients screened and treated for this condition are doing over time. PMID:15504921

McNaughton-Collins, Mary; Walker-Corkery, Elizabeth; Barry, Michael J

2004-01-01

349

Relation Between Dose of Loop Diuretics and Outcomes in a Heart Failure Population: Results of the ESCAPE Trial  

PubMed Central

Background We examined the relation of maximal in-hospital diuretic dose to weight loss, changes in renal function, and mortality in hospitalised heart failure (HF) patients. Methods In ESCAPE, 395 patients received diuretics in-hospital. Weight was measured at baseline, discharge, and every other day before discharge. Weight loss was defined as the difference between baseline and last in-hospital weight. Mortality was assessed using a log-logistic model with non-zero background. Results Median weight loss: 2.8 kg (0.7, 6.1); mean: 3.7 kg (22% of values <0). Weight loss and maximum in-hospital dose were correlated (p = 0.0007). Baseline weight, length of stay, and baseline brain natriuretic peptide were significant predictors of weight loss. After adjusting for these, dose was not a significant predictor of weight loss. A strong relation between dose and mortality was seen (p = 0.003), especially at >300 mg/day. Dose remained a significant predictor of mortality after adjusting for baseline variables that significantly predicted mortality. Correlation between maximal dose and creatinine level change was not significant (r = 0.043; p = 0.412) Conclusions High diuretic doses during HF hospitalisation are associated with increased mortality and poor 6-month outcome. PMID:17719273

Hasselblad, Vic; Stough, Wendy Gattis; Shah, Monica R.; Lokhnygina, Yuliya; O’Connor, Christopher M.; Califf, Robert M.; Adams, Kirkwood F.

2007-01-01

350

Can MR Measurement of Renal Artery Flow and Renal Volume Predict the Outcome of Percutaneous Transluminal Renal Angioplasty?  

SciTech Connect

Purpose: Predicting therapeutic benefit from percutaneous transluminal renal angioplasty (PTRA) in patients with renal artery stenosis (RAS) remains difficult. This study investigates whether magnetic resonance (MR)-based renal artery flow measurements relative to renal parenchymal volume can predict clinical outcome following PTRA.Methods: The data on 23 patients (13 men, 10 women; age range 47-82 years, mean age 64 years) were analyzed. The indication for treatment was hypertension (n = 18) or renal insufficiency (n = 5). Thirty-four cases of RAS were identified: bilateral disease was manifest in 11 and unilateral disease in 12 patients. The MR imaging protocol included a breath-hold, cardiac-gated cine phase-contrast sequence for renal flow measurement and a fast multiplanar spoiled gradient-echo sequence for renal volume measurement. MR measurements were performed on the day prior to and the day following PTRA. Clinical success was defined as (a) a reduction in diastolic blood pressure > 15% or (b) a reduction in serum creatinine > 20%. Kidneys were categorized as normal volume or low volume. A renal flow index (RFI) was calculated by dividing the renal flow (ml/min) by the renal volume (cm{sup 3}).Results: Clinical success was observed in 11 patients. Twelve patients did not benefit from angioplasty. Normal kidney volume was seen in 10 of 11 responders and in 8 of 12 nonresponders, resulting in a sensitivity of 91%, specificity of 33%, a positive predictive value (PPV) of 56% and a negative predictive value (NPV) of 80%. A RFI below a threshold of 1.5 ml/min/cm{sup 3} predicted successful outcome with 100% sensitivity, 33% specificity, 58% PPV, and 100% NPV. The combination of normal renal volume and a RFI below 1.5 ml/min/cm{sup 3} identified PTRA responders with a sensitivity of 91%, a specificity of 67%, a PPV of 71%, and a NPV of 89%. PTRA resulted in a greater increase in renal flow in responders compared with nonresponders (p < 0.001).Conclusion: A combination of cine phase-contrast MR renal flow and parenchymal volume measurements enables identification of patients benefiting from PTRA with a high sensitivity and NPV, but only moderate specificity and PPV.

Binkert, Christoph A.; Debatin, Jorg F. [Department of Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zuerich (Switzerland); Schneider, Ernst [Department of Internal Medicine, Angiology Division, University Hospital Zurich, Raemistrasse 100, CH-8091 Zuerich (Switzerland); Hodler, Juerg [Department of Radiology, University Hospital Balgrist, Forchstrasse 340, CH-8008 Zuerich (Switzerland); Ruehm, Stefan G. [Department of Radiology, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen (Germany); Schmidt, Michaela [Department of Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zuerich (Switzerland); Hoffmann, Ulrich [Department of Internal Medicine, Angiology Division, University Hospital Zurich, Raemistrasse 100, CH-8091 Zuerich (Switzerland)

2001-07-15

351

Routine outcome measurement in mental health service consumers: Who should provide support for the self-assessments?  

PubMed

This study examined whether mental health community service users completed outcome self-reports differently when assessments were supervised by internal vs. external staff. The examination of potential differences between the two has useful implications for mental health systems that take upon themselves the challenge of Routine Outcome Measurement (ROM), as it might impact allocation of public resources and managed care program planning. 73 consumers completed the Manchester Short Assessment of Quality of Life (MANSA), a shortened version of the Recovery Assessment Scale (RAS), and a functioning questionnaire. Questionnaires were administered, once using support provided by internal staff and once using support provided by external professional staff, with a one-month time interval and in random order. A MANOVA Repeated Measures showed no differences in outcomes of quality of life and recovery between internal and external support. Functioning scores were higher for the internal support when the internal assessments were performed first. Overall, except for the differences in functioning assessment, outcome scores were not determined by the supporting agency. This might indicate that when measuring quality of life and recovery, different supporting methods can be used to gather outcome measures and internal staff might be a good default agency to do this. Differences found in functioning assessment are discussed. PMID:25748604

Gelkopf, Marc; Pagorek-Eshel, Shira; Trauer, Tom; Roe, David

2015-06-01

352

Assessing severity of illness and outcomes of treatment in children with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME): a systematic review of patient-reported outcome measures (PROMs).  

PubMed

Chronic Fatigue Syndrome or Myalgic Encephalomyelitis (CFS/ME) in children is characterized by persistent or recurrent debilitating fatigue which results in a substantial reduction in activity. There is a growing interest in the use of questionnaires, or patient-reported outcome measures (PROMs), to assess how patients function and feel in relation to their health and associated healthcare. However, guidance for PROM selection for children with CFS/ME does not exist. We reviewed the quality and acceptability of PROMs used with children with CFS/ME to inform recommendations for practice. We conducted a systematic review of PROMs completed by children with CFS/ME. The quality of the evaluative studies and the reviewed measures were assessed against recommended criteria using an appraisal framework and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. We sought evidence of measurement (reliability, validity, responsiveness, interpretability, data quality) and practical properties (acceptability, relevance, feasibility). Sixteen articles were included in the review, providing evidence of reliability and/or validity for 13 PROMs. Of these, five were child-specific (one health-related quality-of-life; four emotional well-being) and eight were not (four emotional well-being, three fatigue-specific; and one generic). All measures had limited evidence of measurement properties and no evidence of practical properties. Recommendations for patient-reported assessment are difficult to make because of limited evidence of the quality and acceptability of PROMs for children with CFS/ME. The appraisal method highlighted significant methodological and quality issues which must be addressed in future research. There is a lack of qualitative evidence describing the outcomes of healthcare that are important to children with CFS/ME, and the relevance or appropriateness of available measures. Future PROM development and evaluation in this group must seek to involve children collaboratively to ensure that the outcomes that children care about are assessed in an acceptable way. PMID:24661148

Haywood, K L; Collin, S M; Crawley, E

2014-11-01

353

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

354

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

PubMed Central

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

2014-01-01

355

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

356

Application of the OMERACT filter to measures of core outcome domains in recent clinical studies of acute gout  

PubMed Central

Objective To determine the extent to which instruments that measure core outcome domains in acute gout fulfil the OMERACT filter requirements of truth, discrimination and feasibility. Methods Patient-level data from four randomised controlled trials of agents designed to treat acute gout and one observational study of acute gout were analysed. For each available measure construct validity, test-retest reliability, within-group change using effect size, between-group change using the Kruskall-Wallis statistic and repeated measures generalised estimating equations were assessed. Floor and ceiling effects were also assessed and MCID was estimated. These analyses were presented to participants at OMERACT 11 to help inform voting for possible endorsement. Results There was evidence for construct validity and discriminative ability for 3 measures of pain (0 to 4 Likert, 0 to 10 numeric rating scale, 0 to 100 mm visual analogue scale). Likewise, there appears to be sufficient evidence for a 4-point Likert scale to possess construct validity and discriminative ability for physician assessment of joint swelling and joint tenderness. There was some evidence for construct validity and within-group discriminative ability for the Health Assessment Questionnaire as a measure of activity limitations, but not for discrimination between groups allocated to different treatment. Conclusions There is sufficient evidence to support measures of pain (using Likert, numeric rating scale or visual analogue scales), joint tenderness and swelling (using Likert scale) as fulfilling the requirements of the OMERACT filter. Further research on a measure of activity limitations in acute gout clinical trials is required. PMID:24429178

Taylor, William J; Redden, David; Dalbeth, Nicola; Schumacher, H Ralph; Edwards, N Lawrence; Simon, Lee S; John, Markus R; Essex, Margaret N; Watson, Douglas J; Evans, Robert; Rome, Keith; Singh, Jasvinder A

2014-01-01

357

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

358

School absence rates as outcome measures in studies of children with chronic illness.  

PubMed

Health care providers are caring for growing numbers of children with chronic illnesses and research on the effects of various interventions with these children are being increasingly published. Data from a variety of sources indicate that children with chronic illness miss more school than their healthy peers. The relative ease with which school attendance data can be obtained and analyzed and the implications of excessive school absence for children's academic performance, social adjustment, and ultimate capacity to function in society suggest that school absence rates deserve to be more broadly emphasized in research on chronic illness in childhood. Although school absence rates have not been widely used as outcome measures in such studies they do reflect a wide variety of aspects of children's health status and have been shown to be responsive to interventions with children with various physical and mental health problems. Since these rates reflect both health and non-health related factors it is important that investigators recognize the nonspecific nature of this measure and account for non-health related influences either by sampling or analytic techniques. PMID:3760108

Weitzman, M

1986-01-01

359

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

360

Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda  

Microsoft Academic Search

An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation.\\u000a This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes.\\u000a This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability,\\u000a adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal\\u000a definitions. We

Enola Proctor; Hiie Silmere; Ramesh Raghavan; Peter Hovmand; Greg Aarons; Alicia Bunger; Richard Griffey; Melissa Hensley

2011-01-01

361

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

362

Outcome Based Education Performance Measurement: A Rasch-based Longitudinal Assessment Model to measure Information Management Courses LO's  

Microsoft Academic Search

Malaysia Qualification Framework, 2005 (MQF) promotes outcome based education (OBE) learning process. OBE calls for the evaluation of the course's Learning Outcomes (CLO) as specified in the Program Specification. This good practice is implemented in the Faculty of Information Technology and Quantitative Science, Universiti Teknologi MARA (FTMSK) teaching and learning processes which was duly certified to ISO 9001:2000. Assessment methods

AZLINAH MOHAMED; ISO QMS

363

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

364

Comparing contents of outcome measures in cerebral palsy using the International Classification of Functioning (ICF-CY): a systematic review.  

PubMed

The International Classification of Functioning children and youth version (ICF-CY) provides a universal framework for defining and classifying functioning and disability in children worldwide. To facilitate the application of the ICF in practice, ICF based-tools like the "ICF Core Sets" are being developed. In the context of the development of the ICF-CY Core Sets for children with Cerebral Palsy (CP), the aims of this study were as follows: to identify and compare the content of outcome measures used in studies of children with CP using the ICF-CY coding system; and to describe the most frequently addressed areas of functioning in those studies. We searched multiple databases likely to capture studies involving children with CP from January 1998 to March 2012. We included all English language articles that studied children aged 2-18 years and described an interventional or observational study. Constructs of the outcome measures identified in studies were linked to the ICF-CY by two trained professionals. We found 231 articles that described 238 outcome measures. The outcome measures contained 2193 concepts that were linked to the ICF-CY and covered 161 independent ICF-CY categories. Out of the 161 categories, 53 (33.5%) were related to body functions, 75 (46%) were related to activities/participation, 26 (16.1%) were related to environmental factors, and 7 (4.3%) were related to body structures. This systematic review provides information about content of measures that may guide researchers and clinicians in their selection of an outcome measure for use in a study and/or clinical practice with children with CP. PMID:24051208

Schiariti, Veronica; Klassen, Anne F; Cieza, Alarcos; Sauve, Karen; O'Donnell, Maureen; Armstrong, Robert; Mâsse, Louise C

2014-01-01

365

Accuracy of the DIBELS oral reading fluency measure for predicting third grade reading comprehension outcomes.  

PubMed

We evaluated the validity of DIBELS (Dynamic Indicators of Basic Early Literacy Skills) ORF (Oral Reading Fluency) for predicting performance on the Florida Comprehensive Assessment Test (FCAT-SSS) and Stanford Achievement Test (SAT-10) reading comprehension measures. The usefulness of previously established ORF risk-level cutoffs [Good, R.H., Simmons, D.C., and Kame'enui, E.J. (2001). The importance and decision-making utility of a continuum of fluency-based indicators of foundational reading skills for third-grade high-stakes outcomes. Scientific Studies of Reading, 5, 257-288.] for third grade students were evaluated on calibration (n(S1)=16,539) and cross-validation (n(S2)=16,908) samples representative of Florida's Reading First population. The strongest correlations were the third (February/March) administration of ORF with both FCAT-SSS and SAT-10 (r(S)=.70-.71), when the three tests were administered concurrently. Recalibrated ORF risk-level cut scores derived from ROC (receiver-operating characteristic) curve analyses produced more accurate identification of true positives than previously established benchmarks. The recalibrated risk-level cut scores predict performance on the FCAT-SSS equally well for students from different socio-economic, language, and race/ethnicity categories. PMID:19083363

Roehrig, Alysia D; Petscher, Yaacov; Nettles, Stephen M; Hudson, Roxanne F; Torgesen, Joseph K

2008-06-01

366

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

367

Positive aspects of patients’ state: A measure for assessing outcome and predicting follow-up of treatment for depression  

Microsoft Academic Search

Most psychotherapy outcome studies in the field of depression focus on changes in depressive symptoms and impairment of functioning. The present article reports on the General Life Functioning Scale (GLF), a measure of more positive aspects of a patient's experience, specifically the patient's sense of well-being and feeling that he or she can cope with problems that arise. The development

Irene Elkin; Alisa Ainbinder; Sun-Young Park; Jane Yamaguchi

2006-01-01

368

Using General Outcome Measures to Predict Student Performance on State-Mandated Assessments: An Applied Approach for Establishing Predictive Cutscores  

ERIC Educational Resources Information Center

Cutscores for reading and math (general outcome measures) to predict passage on New York state-mandated assessments were created by using a freely available Excel workbook. The authors used linear regression to create the cutscores and diagnostic indicators were provided. A rationale and procedure for using this method is outlined. This method…

Leblanc, Michael; Dufore, Emily; McDougal, James

2012-01-01

369

Designing Reading Comprehension Assessments for Reading Interventions: How a Theoretically Motivated Assessment Can Serve as an Outcome Measure  

ERIC Educational Resources Information Center

When designing a reading intervention, researchers and educators face a number of challenges related to the focus, intensity, and duration of the intervention. In this paper, we argue there is another fundamental challenge--the nature of the reading outcome measures used to evaluate the intervention. Many interventions fail to demonstrate…

O'Reilly, Tenaha; Weeks, Jonathan; Sabatini, John; Halderman, Laura; Steinberg, Jonathan

2014-01-01

370

Intelligibility as a Clinical Outcome Measure Following Intervention with Children with Phonologically Based Speech-Sound Disorders  

ERIC Educational Resources Information Center

Background: The effectiveness of two treatment approaches (phonological therapy and articulation therapy) for treatment of 14 children, aged 4;0-6;7 years, with phonologically based speech-sound disorder (SSD) has been previously analysed with severity outcome measures (percentage of consonants correct score, percentage occurrence of phonological…

Lousada, M.; Jesus, Luis M. T.; Hall, A.; Joffe, V.

2014-01-01

371

The sensitivity of three commonly used outcome measures to detect change amongst patients receiving inpatient rehabilitation following stroke  

Microsoft Academic Search

Objective: To investigate the sensitivity of three commonly used functional outcome measures to detect change over time in subjects receiving inpatient rehabilitation post stroke.Design: Subjects were assessed within one week of admission and one week of discharge from an inpatient rehabilitation facility. Several parameters of sensitivity were calculated, including floor and ceiling effects, the percentage of subjects showing no change

C K English; S L Hillier; K Stiller; A Warden-Flood

2006-01-01

372

Outcome Measurement Using Naturalistic Language Samples: A Feasibility Pilot Study Using Language Transcription Software and Speech and Language Therapy Assistants  

ERIC Educational Resources Information Center

The ultimate aim of intervention for children with language impairment is an improvement in their functional language skills. Baseline and outcome measurement of this is often problematic however and practitioners commonly resort to using formal assessments that may not adequately reflect the child's competence. Language sampling,…

Overton, Sarah; Wren, Yvonne

2014-01-01

373

Patient-Reported Outcomes Measurement Information System (PROMIS): efficient, standardized tools to measure self-reported health and quality of life.  

PubMed

All nurses are interested in the effects of diseases and treatments on individuals. Patient-reported outcome (PRO) measures are used to obtain self-reported information about symptoms, function, perceptions, and experiences. However, there are challenges to their use, including multiple measures of the same concept, widely varying quality, excessive length and complexity, and difficulty comparing findings across studies and conditions. To address these challenges, the National Institutes of Health funded the Patient-Reported Outcomes Measurement Information System (PROMIS), a web-based repository of valid and reliable PRO measures of health concepts relevant to clinician and researchers. Through the PROMIS Assessment Center, clinicians and researchers can access PRO measures, administer computerized adaptive tests, collect self-report data, and report instant health assessments. The purpose of this article was to summarize the development and validation of the PROMIS measures and to describe its current functionality as it relates to nursing science. PMID:25015409

Bevans, Margaret; Ross, Alyson; Cella, David

2014-01-01

374

A qualitative process evaluation of electronic session-by-session outcome measurement in child and adolescent mental health services  

PubMed Central

Background Regular monitoring of patient progress is important to assess the clinical effectiveness of an intervention. Recently, initiatives within UK child and adolescent mental health services (CAMHS) have advocated the use of session-by-session monitoring to continually evaluate the patient’s outcome throughout the course of the intervention. However, the feasibility and acceptability of such regular monitoring is unknown. Method Semi-structured qualitative interviews were conducted with clinicians (n?=?10), administrative staff (n?=?8) and families (n?=?15) who participated in a feasibility study of an electronic session-by-session outcome monitoring tool, (SxS), which is based on the Strengths and Difficulties Questionnaire (SDQ). This study took place in three CAMHS clinics in Nottinghamshire. The interview transcripts were thematically analysed. Results We found clinicians accepted the need to complete outcome measures, particularly valuing those completed by the patient. However, there were some difficulties with engaging clinicians in this practice and in the training offered. Generally, patients were supportive of completing SxS in the waiting room prior to the clinic session and assistance with the process from administrative staff was seen to be a key factor. Clinicians and families found the feedback reports created from SxS to be helpful for tracking progress, facilitating communication and engagement, and as a point of reflection. The use of technology was considered positively, although some technological difficulties hindered the completion of SxS. Clinicians and families appreciated the brevity of SxS, but some were concerned that a short questionnaire could not adequately encapsulate the complexity of the patient’s issues. Conclusions The findings show the need for appropriate infrastructure, mandatory training, and support to enable an effective system of session-by-session monitoring. Our findings indicate that clinicians, administrative staff and young people and their parents/carers would support regular monitoring if the system is easy to implement, with a standard ‘clinic-wide’ adoption of the procedure, and the resulting data are clinically useful. PMID:24731701

2014-01-01

375

Developing an outcome measure for excessive saliva management in MND and an evaluation of saliva burden in Sheffield.  

PubMed

There are few studies providing evidence to guide the management of oropharyngeal secretion problems in motor neuron disease (MND). There is a lack of a suitable outcome measure for evaluating management strategies. We applied several potential outcome measures for assessing excessive secretions to patients with MND who attended the Sheffield Care and Research Centre for Motor Neurone Disease between 21 November 2012 and 15 May 2013. These measures were the CSS-MND, a symptom rating scale, and the Drool and Wipe quotient, which were designed to semi-objectively measure patients' drooling. Of the 143 patients seen in clinic during the study period, 58 had symptoms of excessive secretions, and of whom 50 agreed to participate in the study. Semi-objective measures failed to effectively identify patients complaining of secretion problems. The CSS-MND had a relatively low internal consistency (Cronbach's alpha 0.539; n = 50); however, analysis of the inter-item correlations suggested the appearance of low internal consistency was because the scale was measuring a variety of saliva related symptoms that did not necessarily influence each other. The scale correlated well with patient reported symptom impact (r = 0.673, n = 50). In conclusion, the CSS-MND would be a useful outcome measure in studies assessing the management of oropharyngeal secretion problems. PMID:25225845

McGeachan, Alexander J; Hobson, Esther V; Shaw, Pamela J; McDermott, Christopher J

2015-03-01

376

Plasma cytokine measurements augment prognostic scores as indicators of outcome in patients with severe sepsis.  

PubMed

Despite recent advances in the prospective identification of the patient with sepsis who may benefit from anti-inflammatory or antithrombotic therapies, successful treatment regimens have been fairly modest. We have explored whether determination of several proinflammatory cytokine or mediator concentrations can complement physiologic scoring systems to identify patients with severe sepsis who will survive or expire within 28 days. The design of the study included an exploratory analysis performed in conjunction with a prospective, randomized, double-blind, placebo-controlled, multicenter, clinical trial and involved 33 academic institutions in the United States. One hundred twenty-four patients with severe sepsis with or without septic shock were included in this analysis. Blood samples were obtained at baseline and on days 1 through 4, and were evaluated for proinflammatory and anti-inflammatory cytokine concentrations, as well as for procalcitonin and total protein C levels. Baseline concentrations and changes in the concentrations of these mediators were evaluated in relationship to the Acute Physiology and Chronic Health Evaluation (APACHE) II and multiple organ dysfunction (MOD) scores, and 28-day all-cause mortality. Using univariate logistic regression analyses, APACHE II and MOD scores, age (but not gender), and baseline plasma interleukin (IL)-6 and soluble tumor necrosis factor receptor (sTNFR) 1 (log transformed) concentrations were all predictive of increased 28-day all-cause mortality (P < 0.01). Baseline total protein C, IL-8, IL-10, TNF-alpha, and procalcitonin concentrations, and the change in plasma cytokine concentrations from baseline over the initial 4 days were not useful in predicting outcome. Selected baseline proinflammatory cytokine concentrations and APACHE II score were correlated (P < 0.01). IL-6 concentration is a strong candidate for predicting clinical outcome in patients with severe sepsis alone, or when combined with the APACHE II or MOD scores. The potential usefulness of the combination of cytokine measurements and prognostic scores to identify patients who may benefit from treatment with anti-inflammatory or antithrombotic therapies should be further evaluated. PMID:15897799

Oberholzer, Andreas; Souza, Sonia M; Tschoeke, Sven K; Oberholzer, Caroline; Abouhamze, Amer; Pribble, John P; Moldawer, Lyle L

2005-06-01

377

Left Ventricular Mass in Dialysis Patients, Determinants and Relation with Outcome. Results from the COnvective TRansport STudy (CONTRAST)  

PubMed Central

Background and Objectives Left ventricular mass (LVM) is known to be related to overall and cardiovascular mortality in end stage kidney disease (ESKD) patients. The aims of the present study are 1) to determine whether LVM is associated with mortality and various cardiovascular events and 2) to identify determinants of LVM including biomarkers of inflammation and fibrosis. Design, Setting, Participants, & Measurements Analysis was performed with data of 327 ESKD patients, a subset from the CONvective TRAnsport STudy (CONTRAST). Echocardiography was performed at baseline. Cox regression analysis was used to assess the relation of LVM tertiles with clinical events. Multivariable linear regression models were used to identify factors associated with LVM. Results Median age was 65 (IQR: 54–73) years, 203 (61%) were male and median LVM was 227 (IQR: 183–279) grams. The risk of all-cause mortality (hazard ratio (HR)?=?1.73, 95% CI: 1.11–2.99), cardiovascular death (HR?=?3.66, 95% CI: 1.35–10.05) and sudden death (HR?=?13.06; 95% CI: 6.60–107) was increased in the highest tertile (>260grams) of LVM. In the multivariable analysis positive relations with LVM were found for male gender (B?=?38.8±10.3), residual renal function (B?=?17.9±8.0), phosphate binder therapy (B?=?16.9±8.5), and an inverse relation for a previous kidney transplantation (B?=??41.1±7.6) and albumin (B?=??2.9±1.1). Interleukin-6 (Il-6), high-sensitivity C-reactive protein (hsCRP), hepcidin-25 and connective tissue growth factor (CTGF) were not related to LVM. Conclusion We confirm the relation between a high LVM and outcome and expand the evidence for increased risk of sudden death. No relationship was found between LVM and markers of inflammation and fibrosis. Trial Registration Controlled-Trials.com ISRCTN38365125 PMID:24505249

Mostovaya, Ira M.; Bots, Michiel L.; van den Dorpel, Marinus A.; Goldschmeding, Roel; den Hoedt, Claire H.; Kamp, Otto; Levesque, Renée; Mazairac, Albert H. A.; Penne, E. Lars; Swinkels, Dorine W.; van der Weerd, Neelke C.; ter Wee, Piet M.; Nubé, Menso J.; Blankestijn, Peter J.; Grooteman, Muriel P. C.

2014-01-01

378

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

379

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

380

Interpreting scores on multiple sclerosis-specific patient reported outcome measures (the PRIMUS and U-FIS)  

PubMed Central

Background The PRIMUS is a Multiple Sclerosis (MS)-specific suite of outcome measures including assessments of QoL (PRIMUS QoL, scored 0-22) and activity limitations (PRIMUS Activities, scored 0-30). The U-FIS is a measure of fatigue impact (scored 0-66). These measures have been fully validated previously using an MS sample with mixed diagnoses. The aim of the present study was to validate the measures further in a specifically Relapse Remitting MS (RRMS) sample and to provide preliminary evidence of the responder definitions (RD; also known as minimal important difference) for these instruments. Methods Data were derived from a multi-country efficacy trial of MS patients with assessments at baseline and 12 months. Baseline data were used to assess the internal reliability and validity of the measures. Both anchor-based and distribution-based approaches were employed for estimating RD. Anchor-based estimates were based on published RD values for the EQ-5D and were assessed for those improving and deteriorating separately. Distribution-based estimates were based on standard error of measurement (SEM), change score equivalent to 0.30, and change score equivalent to 0.50, effect sizes (ES). Results The sample included 911 RRMS patients (67.3% female, age mean (SD) 36.2 (8.4) years, duration of MS mean (SD) 4.8 (5.2) years). Results showed that the PRIMUS and U-FIS had good internal consistency. Appropriate correlations were observed with comparator instruments and both measures were able to distinguish between participants based on Expanded Disability Status Scale scores and time since diagnosis. The anchor-based and distribution-based RD estimates were: PRIMUS Activities range = 1.2-2.3, PRIMUS QoL range = 1.0-2.2, and U-FIS range = 2.4-7.0. Conclusions The results show that the PRIMUS and U-FIS are valid instruments for use with RRMS patients. The analyses provide preliminary information on how to interpret scores on the scales. These data will be useful for assessing treatment efficacy and for powering clinical studies. Trial Reference Number ClinicalTrials.gov Identifier NCT00340834. PMID:20937112

2010-01-01

381

Determining skill level in myoelectric prosthesis use with multiple outcome measures.  

PubMed

To obtain more insight into how the skill level of an upper-limb myoelectric prosthesis user is composed, the current study aimed to (1) portray prosthetic handling at different levels of description, (2) relate results of the clinical level to kinematic measures, and (3) identify specific parameters in these measures that characterize the skill level of a prosthesis user. Six experienced transradial myoelectric prosthesis users performed a clinical test (Southampton Hand Assessment Procedure [SHAP]) and two grasping tasks. Kinematic measures were end point kinematics, joint angles, grasp force control, and gaze behavior. The results of the clinical and kinematic measures were in broad agreement with each other. Participants who scored higher on the SHAP showed overall better performance on the kinematic measures. They had smaller movement times, had better grip force control, and needed less visual attention on the hand. The results showed that time was a key parameter in prosthesis use and should be one of the main focus aspects of rehabilitation. The insights from this study are useful in rehabilitation practice because they allow therapists to specifically focus on certain parameters that may result in a higher level of skill for the prosthesis user. PMID:23408215

Bouwsema, Hanneke; Kyberd, Peter J; Hill, Wendy; van der Sluis, Corry K; Bongers, Raoul M

2012-01-01

382

Remission and relapse in the outpatient care of schizophrenia: three-year results from the Schizophrenia Outpatient Health Outcomes study.  

PubMed

Remission and relapse are clinical outcomes of increasing interest in schizophrenia. We analyzed remission and relapse, and the sociodemographic and clinical factors associated with these outcomes, in the usual care of schizophrenia using the 3-year, follow-up data from a large cohort of outpatients with schizophrenia taking part in the prospective, observational, European Schizophrenia Outpatient Health Outcomes study. Of the 6516 patients analyzed for remission, 4206 (64.6%) achieved remission during the 3-year, follow-up period. Logistic regression analysis revealed that being female, having a good level of social functioning at study entry, and a shorter duration of illness were factors significantly associated with achieving remission. Treatment with olanzapine was also associated with a higher frequency of remission compared with other antipsychotic agents. A Kaplan-Meier survival curve estimated that relapse occurred in approximately 25% of the patients who achieved remission, with the risk of relapse remaining constant during the follow-up period. Shorter duration of illness, having hostile behaviors, and substance abuse were factors associated with a higher risk of relapse, whereas good level of social functioning and the use of olanzapine and clozapine were associated with a lower risk of relapse. In conclusion, the 3-year results of the Schizophrenia Outpatient Health Outcomes study indicate that the likelihood of remission decreases over the longitudinal course of schizophrenia, but risk of relapse is maintained even after 3 years of achieving remission severity levels. Results suggest that treatment with olanzapine is associated with a better chance of achieving remission than other antipsychotics. Moreover, the use of olanzapine and clozapine is associated with a lower risk of relapse compared with risperidone, quetiapine, and typical antipsychotics. The results should be interpreted conservatively because of the observational, nonrandomized study design. PMID:17110813

Haro, Josep Maria; Novick, Diego; Suarez, David; Alonso, Jordi; Lépine, Jean Pierre; Ratcliffe, Mark

2006-12-01

383

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

384

[Periinsular hemispherotomy: surgical technique, intraoperative EEG monitoring and results on seizure outcome].  

PubMed

Peri-insular hemispherotomy is a surgical technique used in the treatment of drug-resistant epilepsy of hemispheric origin. It is based on the exposure of insula and semi-circular sulci, providing access to the lateral ventricle through a supra- and infra-insular window. From inside the ventricle, a parasagittal callosotomy is performed. The basal and medial portion of the frontal lobe is isolated. Projections to the anterior commissure are interrupted at the time of amygdala resection. The hippocampal tail and fimbria-fornix are disrupted posteriorly. We report our experience of 18 cases treated with this approach. More than half of them presented with congenital epilepsy. Neuronavigation was useful in precisely determining the center and extent of the craniotomy, as well as the direction of tractotomies and callosotomy, allowing minimal exposure and blood loss. Intra-operative monitoring by scalp EEG on the contralateral hemisphere was used to follow the progression of the number of interictal spikes during the disconnection procedure. Approximately 90% of patients were in Engel's Class I. We observed one case who presented with transient postoperative neurological deterioration probably due to CSF overdrainage and documented one case of incomplete disconnection in a patient presenting with hemimegalencephaly who needed a second operation. We observed a good correlation between a significant decrease in the number of spikes at the end of the procedure and seizure outcome. Peri-insular hemispherotomy provides a functional disconnection of the hemisphere with minimal resection of cerebral tissue. It is an efficient technique with a low complication rate. Intra-operative EEG monitoring might be used as a predictive factor of completeness of the disconnection and consequently, seizure outcome. PMID:18436264

Pollo, C; Debatisse, D; Pralong, E; Levivier, M

2008-05-01

385

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

386

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

387

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

388

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

389

Use of patient-reported outcomes to measure symptoms and health related quality of life in the clinic.  

PubMed

There is increasing interest in the use of patient-reported outcomes (PROs) in routine practice in cancer care to measure symptoms and health related quality of life (HRQOL). PROs are designed to capture the patient's perspective of their care and treatment, and complement the traditional clinical outcomes of survival and toxicity assessment. Integrating routine collection and feedback of PROs has been found to improve care for patients on both an individual level, through improved communication and management of symptoms, and at an organizational level, by enabling aggregation of data to compare performance. This article reviews the benefits and challenges of introducing patient-reported assessments into routine clinical practice. Methods for choosing a questionnaire; collection and presentation of results; timing and frequency of administration as well as clinician training methods to aid the ability of clinicians to integrate the use of PROs into their own practice are described. Electronic PRO capture and integration with electronic health records seems to provide the most effective method for seamless integration into existing patient care pathways. Case studies from our own practice illustrate the issues raised. Electronic methods enabling immediate collection, scoring and interpretation of the data, as well as real-time data capture, email alert systems and individualized, online self-management advice may enable severe symptoms to be managed in a more timely manner. Evaluation methods are described to establish the effectiveness of the PRO intervention. Engaging stakeholders throughout the process of initial consultation and development, during delivery and evaluation is key to success. Future work needs to focus on the effectiveness of PROs in longer-term follow-up of patients in routine care and the relationship between the PRO severity grading and clinician severity grading using the Common Terminology Criteria of Adverse Events (CTCAE). PMID:25448486

Gilbert, Alexandra; Sebag-Montefiore, David; Davidson, Susan; Velikova, Galina

2015-03-01

390

Measuring outcomes of hospital care using multiple risk-adjusted indexes.  

PubMed

Using existing data sources, we developed three risk-adjusted measures of hospital quality: the risk-adjusted mortality index (RAMI), the risk-adjusted readmissions index (RARI), and the risk-adjusted complication index (RACI). We describe the construction and validation of each of these indexes. After these measures were developed, we tested the relationships among the three indexes using a sample of 300 hospitals. Actual numbers of adverse events were observed for each hospital and compared to the number predicted by the RAMI, RARI, and RACI models. Then each hospital was ranked on each index. Our results showed that no relationship existed between a hospital's ranking on any one of these indexes and its ranking on the other two indexes. This result provides some evidence that no measure of quality should be used by itself to represent different aspects of the quality of hospital care. Adequate overall measures of hospital quality will need to include multiple measures in order to be credible and to reflect the complexity of hospital care. The findings suggest that consumers, payers, and policymakers cannot simply choose one hospitalwide measure, such as the mortality rate, to validly represent a hospital's performance: those hospitals with high rankings on their mortality rates do not necessarily rank high on their readmission rates or complication rates. PMID:1917500

DesHarnais, S; McMahon, L F; Wroblewski, R

1991-10-01

391

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

392

Population-Based Stroke Atlas for Outcome Prediction: Method and Preliminary Results for Ischemic Stroke from CT  

PubMed Central

Background and Purpose Knowledge of outcome prediction is important in stroke management. We propose a lesion size and location-driven method for stroke outcome prediction using a Population-based Stroke Atlas (PSA) linking neurological parameters with neuroimaging in population. The PSA aggregates data from previously treated patients and applies them to currently treated patients. The PSA parameter distribution in the infarct region of a treated patient enables prediction. We introduce a method for PSA calculation, quantify its performance, and use it to illustrate ischemic stroke outcome prediction of modified Rankin Scale (mRS) and Barthel Index (BI). Methods The preliminary PSA was constructed from 128 ischemic stroke cases calculated for 8 variants (various data aggregation schemes) and 3 case selection variables (infarct volume, NIHSS at admission, and NIHSS at day 7), each in 4 ranges. Outcome prediction for 9 parameters (mRS at 7th, and mRS and BI at 30th, 90th, 180th, 360th day) was studied using a leave-one-out approach, requiring 589,824 PSA maps to be analyzed. Results Outcomes predicted for different PSA variants are statistically equivalent, so the simplest and most efficient variant aiming at parameter averaging is employed. This variant allows the PSA to be pre-calculated before prediction. The PSA constrained by infarct volume and NIHSS reduces the average prediction error (absolute difference between the predicted and actual values) by a fraction of 0.796; the use of 3 patient-specific variables further lowers it by 0.538. The PSA-based prediction error for mild and severe outcomes (mRS?=?[2]–[5]) is (0.5–0.7). Prediction takes about 8 seconds. Conclusions PSA-based prediction of individual and group mRS and BI scores over time is feasible, fast and simple, but its clinical usefulness requires further studies. The case selection operation improves PSA predictability. A multiplicity of PSAs can be computed independently for different datasets at various centers and easily merged, which enables building powerful PSAs over the community. PMID:25121979

Nowinski, Wieslaw L.; Gupta, Varsha; Qian, Guoyu; Ambrosius, Wojciech; Kazmierski, Radoslaw

2014-01-01

393

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

394

The future (history) of socioeconomic measurement and implications for improving health outcomes among African Americans.  

PubMed

Socioeconomic status (SES) has powerful and complex impacts on health, and understanding the relationship between SES and health is essential for long-term improvements in the health of populations. In addition, in the United States, the impact of SES on health is inextricably intertwined with racial and ethnicity status and the historical development and maintenance of health disparities. Most of the literature documenting this relationship has focused on individual-level socioeconomic factors. There are sound theoretical reasons and some empirical support to suggest that socioeconomic resources at both individual and neighborhood levels have strong influences on health outcomes such as disease, disability, and mortality. However, these relationships have been inadequately examined to date. In this article, the term "ecological SES" will be used to denote SES at geographic group levels. As the United States attempts to achieve the goals of the Department of Health and Human Services' Healthy People 2010 program, understanding ecological SES and its impacts on health will be crucial. We review the theory, some of the empirical evidence, and likely future for the measurement and use of a broader approach to SES and offer a specific research paradigm for examining these issues. We focus in particular on one racial-ethnic group that experiences health disparity, that is, African Americans. We use our ongoing project investigating physical frailty in urban African Americans to illustrate the importance of a multilevel approach to understanding the impacts of socioeconomic resources on health and the potential implications for efforts to prevent or reverse frailty. PMID:16282572

Andresen, Elena M; Miller, Douglas K

2005-10-01

395

Modest Increase in Peak VO2 is Related to Better Clinical Outcomes in Chronic Heart Failure Patients: Results from Heart Failure and a Controlled Trial to Investigate Outcomes of Exercise Training (HF-ACTION)  

PubMed Central

Background The prognostic ability of a single measurement of peak oxygen uptake (VO2) is well established in patients with chronic heart failure (HF). The relation between a change in peak VO2 and clinical outcomes is not well defined. Methods and Results This investigation determined if an increase in peak VO2 was associated with a lower risk of the primary endpoint of time to all-cause mortality or all-cause hospitalization and three secondary endpoints. In Heart Failure and a Controlled Trial to Investigate Outcomes of Exercise Training (HF-ACTION), an exercise training trial for patients with systolic HF, cardiopulmonary exercise tests were performed at baseline and approximately three months later in 1620 participants. Median peak VO2 in the combined sample increased from 15.0 (11.9–18.0 Q1–Q3) to 15.4 (12.3–18.7 Q1–Q3) mL-kg?1-min?1. Every 6% increase in peak VO2, adjusted for other significant predictors, was associated with a 5% lower risk of the primary endpoint (HR = 0.95; CI = 0.93–0.98; p < 0.001); a 4% lower risk of the secondary endpoint of time to cardiovascular mortality or cardiovascular hospitalization (HR = 0.96; CI = 0.94–0.99; p < 0.001); an 8% lower risk of cardiovascular mortality or HF hospitalization (HR = 0.92; CI = 0.88–0.96; p < 0.001) and a 7% lower all-cause mortality (HR = 0.93; CI = 0.90–0.97; p < 0.001). Conclusions Among patients with chronic systolic HF, a modest increase in peak VO2 over three months was associated with a more favorable outcome. Monitoring the change in peak VO2 for such patients may have benefit in assessing prognosis. PMID:22773109

Swank, Ann M.; Horton, John; Fleg, Jerome L.; Fonarow, Gregg C.; Keteyian, Steven; Goldberg, Lee; Wolfel, Gene; Handberg, Eileen M.; Bensimhon, Dan; Illiou, Marie-Christine; Vest, Marianne; Ewald, Greg; Blackburn, Gordon; Leifer, Eric; Cooper, Lawton; Kraus, William E.

2013-01-01