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Sample records for significant outcome predictor

  1. Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome.

    PubMed

    Schlegl, Sandra; Diedrich, Alice; Neumayr, Christina; Fumi, Markus; Naab, Silke; Voderholzer, Ulrich

    2016-05-01

    This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory-2 (EDI-2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m(2). Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI-2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI-2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non-responders. PMID:26603278

  2. Psychosocial predictors of treatment outcome for trauma-affected refugees

    PubMed Central

    Sonne, Charlotte; Carlsson, Jessica; Bech, Per; Vindbjerg, Erik; Mortensen, Erik Lykke; Elklit, Ask

    2016-01-01

    Background The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment outcome. Objective The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. Method The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients’ past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed. Results Overall, the total score of the CTP Predictor Index was significantly correlated to pre- to post treatment score changes on the majority of the ratings mentioned above. While employment status was the only single item significantly correlated to HTQ-score changes, a number of single items from the CTP Predictor Index correlated significantly with changes in depression and anxiety symptoms, but the size of the correlation coefficients were modest. Conclusions The total score of the CTP Predictor Index correlated significantly with outcomes on most

  3. Predictors of Driving Outcomes in Advancing Age

    PubMed Central

    Emerson, Jamie L.; Johnson, Amy M.; Dawson, Jeffrey D.; Uc, Ergun Y.; Anderson, Steven W.

    2012-01-01

    This study aimed to develop predictive models for real-life driving outcomes in older drivers. Demographics, driving history, on-road driving errors, and performance on visual, motor, and neuropsychological test scores at baseline were assessed in 100 older drivers (ages 65–89 years [72.7]). These variables were used to predict time to driving cessation, first moving violation, or crash. Using Cox proportional hazards regression models, significant individual predictors for driving cessation were greater age and poorer scores on Near Visual Acuity, Contrast Sensitivity, Useful Field of View, Judgment of Line Orientation, Trail Making Test-Part A, Benton Visual Retention Test, Grooved Pegboard, and a composite index of overall cognitive ability. Greater weekly mileage, higher education, and “serious” on-road errors predicted moving violations. Poorer scores from Trail Making Test-Part B or Trail Making Test (B-A) and serious on-road errors predicted crashes. Multivariate models using “off-road” predictors revealed (1) age and Contrast Sensitivity as best predictors for driving cessation; (2) education, weekly mileage, and Auditory Verbal Learning Task-Recall for moving violations; and (3) education, number of crashes over the past year, Auditory Verbal Learning Task-Recall, and Trail Making Test (B-A) for crashes. Diminished visual, motor, and cognitive abilities in older drivers can be easily and noninvasively monitored with standardized off-road tests, and performances on these measures predict involvement in motor vehicle crashes and driving cessation, even in the absence of a neurological disorder. PMID:22182364

  4. Developmental trajectories of clinically significant attention-deficit/hyperactivity disorder (ADHD) symptoms from grade 3 through 12 in a high-risk sample: Predictors and outcomes.

    PubMed

    Sasser, Tyler R; Kalvin, Carla B; Bierman, Karen L

    2016-02-01

    Developmental trajectories of clinically significant attention-deficit/hyperactivity (ADHD) symptoms were explored in a sample of 413 children identified as high risk because of elevated kindergarten conduct problems. Symptoms of inattention and hyperactivity-impulsivity were modeled simultaneously in a longitudinal latent class analyses, using parent reports collected in Grades 3, 6, 9, and 12. Three developmental trajectories emerged: (1) low levels of inattention and hyperactivity (low), (2) initially high but then declining symptoms (declining), and (3) continuously high symptoms that featured hyperactivity in childhood and early adolescence and inattention in adolescence (high). Multinomial logistic regressions examined child characteristics and family risk factors as predictors of ADHD trajectories. Relative to the low class, children in the high and declining classes displayed similar elevations of inattention and hyperactivity in early childhood. The high class was distinguished from the declining class by higher rates of aggression and hyperactivity at school and emotion dysregulation at home. In contrast, the declining class displayed more social isolation at home and school, relative to the low class. Families of children in both high and declining trajectory classes experienced elevated life stressors, and parents of children in the high class were also more inconsistent in their discipline practices relative to the low class. By late adolescence, children in the high class were significantly more antisocial than those in the low class, with higher rates of arrests, school dropout, and unemployment, whereas children in the declining class did not differ from those in the low trajectory class. The developmental and clinical implications of these findings are discussed. PMID:26854506

  5. Therapeutic hypothermia after cardiac arrest: outcome predictors

    PubMed Central

    Leão, Rodrigo Nazário; Ávila, Paulo; Cavaco, Raquel; Germano, Nuno; Bento, Luís

    2015-01-01

    Objective The determination of coma patient prognosis after cardiac arrest has clinical, ethical and social implications. Neurological examination, imaging and biochemical markers are helpful tools accepted as reliable in predicting recovery. With the advent of therapeutic hypothermia, these data need to be reconfirmed. In this study, we attempted to determine the validity of different markers, which can be used in the detection of patients with poor prognosis under hypothermia. Methods Data from adult patients admitted to our intensive care unit for a hypothermia protocol after cardiac arrest were recorded prospectively to generate a descriptive and analytical study analyzing the relationship between clinical, neurophysiological, imaging and biochemical parameters with 6-month outcomes defined according to the Cerebral Performance Categories scale (good 1-2, poor 3-5). Neuron-specific enolase was collected at 72 hours. Imaging and neurophysiologic exams were carried out in the 24 hours after the rewarming period. Results Sixty-seven patients were included in the study, of which 12 had good neurological outcomes. Ventricular fibrillation and electroencephalographic theta activity were associated with increased likelihood of survival and improved neurological outcomes. Patients who had more rapid cooling (mean time of 163 versus 312 minutes), hypoxic-ischemic brain injury on magnetic resonance imaging or neuron-specific enolase > 58ng/mL had poor neurological outcomes (p < 0.05). Conclusion Hypoxic-ischemic brain injury on magnetic resonance imaging and neuron-specific enolase were strong predictors of poor neurological outcomes. Although there is the belief that early achievement of target temperature improves neurological prognoses, in our study, there were increased mortality and worse neurological outcomes with earlier target-temperature achievement. PMID:26761469

  6. Predictors of surgical outcome and their assessment.

    PubMed

    Mannion, Anne F; Elfering, Achim

    2006-01-01

    The relatively high rate of failed back surgery has prompted the search for "risk factors" to predict the result of spinal surgery in a given individual. However, the literature reveals few unequivocal predictors and they often explain a relatively low proportion of variance in outcome. This suggests that we have a long way to go before being able to rest easily, having refused someone surgery on the basis of unfavourable baseline characteristics. The best recommendation is to ensure, firstly, that the indication for surgery is absolutely clear-cut (i.e. that surgically remediable pathology exists) and then to consider the various factors that may influence the "typical" outcome. Consistent risk factors for a poor outcome regarding return-to-work include long-term sick leave/receipt of disability benefit. Hence, every effort should be made to keep the individual in the workforce, despite the ongoing symptoms and plans for surgery. In patients with a particularly heavy job, consultation with occupational physicians might later ease the patient's way back into the workplace. Patients with degenerative disorders and/or comorbidity should be counselled that few of them will have complete/lasting pain relief or a complete return to pre-morbid function. Patients with a high level of distress may benefit from psychological treatment, before and/or accompanying the surgical treatment. The opportunity (time), encouragement (education and positive messages), and resources (referral to appropriate support services) to modify risk factors that are indeed modifiable should be offered, and realistic expectations should be discussed with the patient before the decision to operate is made. PMID:16320033

  7. Clinical predictors of outcome in encephalitis.

    PubMed Central

    Kennedy, C R; Duffy, S W; Smith, R; Robinson, R O

    1987-01-01

    Twenty five patients with encephalitis were studied prospectively, and their clinical and virological features compared with outcome. Among 22 patients with laboratory confirmation of virus infection, evidence of direct effect on the central nervous system by the virus occurred significantly more often both in those with a monophasic illness compared with those with a biphasic illness, and in those with focal neurological signs localising in the cerebral hemispheres compared with those without such signs. Young age at presentation, low score on the Glasgow coma scale, disruption of oculocephalic responses, and laboratory evidence of virus infection within the central nervous system were significantly associated with poor outcome. Computed tomography results, concentrations of creatine phosphokinase BB isoenzyme in cerebrospinal fluid, and procoagulant activity in cerebrospinal fluid were not predictive of outcome. PMID:3688920

  8. Marital History and the Prior Relationship as Predictors of Positive and Negative Outcomes among Wife Caregivers.

    ERIC Educational Resources Information Center

    Kramer, Betty J.

    1993-01-01

    Investigated interpersonal vulnerability variables (marital history and quality of relationship prior to onset of Alzheimer's disease), caregiver resources, and appraisals of stressors as predictors of positive and negative outcomes among 72 wife caregivers. All variables were significant predictors of depression and quality of life even after…

  9. Lumbar disk herniation surgery: outcome and predictors.

    PubMed

    Sedighi, Mahsa; Haghnegahdar, Ali

    2014-12-01

    Study Design A retrospective cohort study. Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated

  10. Frailty as a predictor of short-term adverse outcomes

    PubMed Central

    Coelho, Tiago; Paúl, Constança; Gobbens, Robbert J.J.

    2015-01-01

    The objectives of this study were to compare how different frailty measures (Frailty Phenotype/FP, Groningen Frailty Indicator/GFI and Tilburg Frailty Indicator/TFI) predict short-term adverse outcomes. Secondarily, adopting a multidimensional approach to frailty (integral conceptual model–TFI), this study aims to compare how physical, psychological and social frailty predict the outcomes. A longitudinal study was carried out with 95 community-dwelling elderly. Participants were assessed at baseline for frailty, determinants of frailty, and adverse outcomes (healthcare utilization, quality of life, disability in basic and instrumental activities of daily living/ADL and IADL). Ten months later the outcomes were assessed again. Frailty was associated with specific healthcare utilization indicators: the FP with a greater utilization of informal care; GFI with an increased contact with healthcare professionals; and TFI with a higher amount of contacts with a general practitioner. After controlling for the effect of life-course determinants, comorbidity and adverse outcome at baseline, GFI predicted IADL disability and TFI predicted quality of life. The effect of the FP on the outcomes was not significant, when compared with the other measures. However, when comparing TFI’s domains, the physical domain was the most significant predictor of the outcomes, even explaining part of the variance of ADL disability. Frailty at baseline was associated with adverse outcomes at follow-up. However, the relationship of each frailty measure (FP, GFI and TFI) with the outcomes was different. In spite of the role of psychological frailty, TFI’s physical domain was the determinant factor for predicting disability and most of the quality of life. PMID:26246968

  11. Separable Attentional Predictors of Language Outcome

    PubMed Central

    Salley, Brenda; Panneton, Robin K.; Colombo, John

    2014-01-01

    The aim of this study was to examine the combined influences of infants attention and use of social cues in the prediction of their language outcomes. This longitudinal study measured infants' visual attention on a distractibility task (11 months), joint attention (14 months), and language outcomes (word –object association, 14 months; MBCDI vocabulary size and multi-word productions at 18 months of age). Path analyses were conducted for two different language outcomes. The analysis for vocabulary revealed unique direct prediction from infants' visual attention on a distractibility task (i.e., maintaining attention to a target event in the presence of competing events) and joint attention (i.e., more frequent response to tester's bids for attention) for larger vocabulary size at outcome; this model accounted for 48% of variance in vocabulary, after controlling for baseline communication status (assessed at 11 months). The analysis for multi-word productions yielded direct effects for infants' distractibility, but not joint attention; this model accounted for 45% of variance in multi-word productions, again after controlling for baseline communication status. Indirect effects were not significant in either model. Results are discussed in light of the unique predictive role of attentional factors and social/attention cues for emerging language. PMID:25342932

  12. Gyrification brain abnormalities as predictors of outcome in anorexia nervosa.

    PubMed

    Favaro, Angela; Tenconi, Elena; Degortes, Daniela; Manara, Renzo; Santonastaso, Paolo

    2015-12-01

    Gyrification brain abnormalities are considered a marker of early deviations from normal developmental trajectories and a putative predictor of poor outcome in psychiatric disorders. The aim of this study was to explore cortical folding morphology in patients with anorexia nervosa (AN). A MRI brain study was conducted on 38 patients with AN, 20 fully recovered patients, and 38 healthy women. Local gyrification was measured with procedures implemented in FreeSurfer. Vertex-wise comparisons were carried out to compare: (1) AN patients and healthy women; (2) patients with a full remission at a 3-year longitudinal follow-up assessment and patients who did not recover. AN patients exhibited significantly lower gyrification when compared with healthy controls. Patients with a poor 3-year outcome had significantly lower baseline gyrification when compared to both healthy women and patients with full recovery at follow-up, even after controlling for the effects of duration of illness and gray matter volume. No significant correlation has been found between gyrification, body mass index, amount of weight loss, onset age, and duration of illness. Brain gyrification significantly predicted outcome at follow-up even after controlling for the effects of duration of illness and other clinical prognostic factors. Although the role of starvation in determining our findings cannot be excluded, our study showed that brain gyrification might be a predictor of outcome in AN. Further studies are needed to understand if brain gyrification abnormalities are indices of early neurodevelopmental alterations, the consequence of starvation, or the interaction between both factors. PMID:26374960

  13. Predictors of two-year outcome among psychiatric outpatients.

    PubMed

    Harder, D W; Greenwald, D F; Strauss, J S; Kokes, R F; Ritzler, B A; Gift, T E

    1990-05-01

    This study hypothesized that social competence and clinical factors previously associated with psychiatric outcome among inpatients would be effective predictors of outcome among outpatients (N = 77) as well. Intake and 2-year outcome status were assessed multidimensionally with absolute-level and residualized indices of functioning, overall clinical status, and symptomatology. Menninger health-sickness proved to be the best single predictor, although Phillips premorbid functioning, Strauss-Carpenter prognosis, social class, and diagnostic severity also predicted well to outcome. Patterns of associated predictor/outcome variable clusters were described. Results suggest that a general social competence factor predicts to psychiatric outcome across the entire range of disorders, but that life events stress does not. PMID:2347928

  14. Neurocognitive Predictors of Reading Outcomes for Children with Reading Disabilities

    ERIC Educational Resources Information Center

    Frijters, Jan C.; Lovett, Maureen W.; Steinbach, Karen A.; Wolf, Maryanne; Sevcik, Rose A.; Morris, Robin D.

    2011-01-01

    This study reports on several specific neurocognitive process predictors of reading outcomes for a sample of 278 children with reading disabilities. Three categories of response (i.e., poor, average, and good) were formed via growth curve models of six reading outcomes. Two nested discriminant function analyses were conducted to evaluate the…

  15. The Offspring of Alcoholics: Outcome Predictors.

    ERIC Educational Resources Information Center

    el-Guebaly, Nady

    1982-01-01

    Reviews risk of psychosocial problems related to drinking among "grown-up" children of alcoholics. Argues that genetic predisposition is best predictor available; this may be more influential near severe end of alcoholism spectrum, may be less influential in females, and may lead to differences in symptomatology and management. (Author/CMG)

  16. Time-course pattern of blood 25-hydroxycholecalciferol is a significant predictor of survival outcome in metastatic colorectal cancer: a clinical practice-based study.

    PubMed

    Obermannova, R; Dusek, L; Greplova, K; Jarkovsky, J; Sterba, J; Vyzula, R; Demlova, R; Zdrazilova-Dubska, L; Valik, D

    2015-01-01

    Vitamin D deficiency has been implicated in the epidemiology of common malignancies including colorectal cancer. We studied consecutive blood levels of 25-hydroxycholecalciferol (25-OHD) in relation to other clinical and laboratory variables in metastatic colorectal cancer patients to ascertain whether their variations may be prognostic or predictive parameters of survival outcomes. Eighty four patients treated with first-line oxaliplatin-based chemotherapy with or without bevacizumab were included. The patients were enrolled on the intent-to-treat basis considering their performance status, comorbidities and laboratory parameters to be medically apt for intensive chemotherapy. Overall survival and progression-free survival were selected as the primary outcomes. Progression free survival and overall survival medians were 15.4 months and 41.2 months, respectively. The cut-off levels of 40 nmol/l for 25-OHD and 11 µg/l for first CEA were identified to be clinical decision levels stratifying patients to the respective prognostic groups. We found that the most consistent outcome predictors were i) any patient surgery, ii) CEA and, independently, iii) time-related blood levels of 25-OHD. We confirmed fundamental and consistent vitamin D deficiency in metastatic colorectal cancer. We demonstrated that all patients with at least one blood level above 40 nmol/l versus all below this cut-off showed profound differences in their disease outcomes. The primary disease stage or time to metastatic stage did not influence the predictive power of blood 25-OHD levels, implying that the time-course pattern of 25-OHD but not the first single measurement may be an independent prognostic factor. PMID:26458311

  17. Predictors of CBT outcome in older adults with GAD.

    PubMed

    Hundt, Natalie E; Amspoker, Amber B; Kraus-Schuman, Cynthia; Cully, Jeffrey A; Rhoades, Howard; Kunik, Mark E; Stanley, Melinda A

    2014-12-01

    The current study is a secondary analysis of data from a randomized controlled trial of CBT for late-life GAD (Stanley et al., 2014) which provided an opportunity to examine predictors of outcome among those who received CBT. Participants were 150 older adults who were randomized to receive 10 sessions of CBT. Completer analyses found that homework completion, number of sessions attended, lower worry severity, lower depression severity, and recruitment site predicted 6-month worry outcome on the PSWQ-A, whereas homework completion, credibility of the therapy, lower anxiety severity, and site predicted 6-month anxiety outcome on the STAI-T. In intent-to-treat multivariate analyses, however, only initial worry and anxiety severity, site, and number of sessions completed predicted treatment outcome. These results are largely consistent with predictors of outcome in younger adults and suggest that lower initial symptom severity and variables consistent with greater engagement in treatment predict outcome. PMID:25445074

  18. Predictors of CBT Outcome in Older Adults with GAD

    PubMed Central

    Hundt, Natalie E.; Amspoker, Amber B.; Kraus-Schuman, Cynthia; Cully, Jeffrey A.; Rhoades, Howard; Kunik, Mark E.; Stanley, Melinda A.

    2014-01-01

    The current study is a secondary analysis of data from a randomized controlled trial of CBT for late-life GAD (Stanley et al., 2014) which provided an opportunity to examine predictors of outcome among those who received CBT. Participants were 150 older adults who were randomized to receive 10 sessions of CBT. Completer analyses found that homework completion, number of sessions attended, lower worry severity, lower depression severity, and recruitment site predicted 6-month worry outcome on the PSWQ-A, whereas homework completion, credibility of the therapy, lower anxiety severity, and site predicted better 6-month anxiety outcome on the STAI-T. In intent-to-treat multivariate analyses, however, only initial worry and anxiety severity, site, and number of sessions completed predicted treatment outcome. These results are largely consistent with predictors of outcome in younger adults and suggest that lower initial symptom severity and variables consistent with greater engagement in treatment predict outcome. PMID:25445074

  19. Longitudinal Predictors of Outcomes for Adults With Autism Spectrum Disorder: Systematic Review.

    PubMed

    Kirby, Anne V; Baranek, Grace T; Fox, Leslie

    2016-04-01

    To generate an evidence-based understanding of longitudinal predictors of social outcomes (i.e., employment, social relationships/participation, independent living) of adults with autism spectrum disorder (ASD), we conducted a systematic literature review of publications since 2000. Twelve publications deriving from eight study samples fit inclusion/exclusion criteria for the review. In these publications, statistically significant predictors of social outcomes fell into five categories: (a) personal characteristics, (b) individual functioning, (c) family context, (d) services, and (e) other factors (i.e., peer influence, health status). However, only two studies demonstrated high methodological quality, and only one category of predictors-individual functioning-was identified across multiple study samples. To inform practices for youth with ASD, there remains a need for high-quality outcome research related to adults with ASD to better understand predictors, especially related to environmental factors such as related to the family and services received. PMID:27504878

  20. Separable Attentional Predictors of Language Outcome

    ERIC Educational Resources Information Center

    Salley, Brenda; Panneton, Robin K.; Colombo, John

    2013-01-01

    The aim of this study was to examine the combined influences of infants' attention and use of social cues in the prediction of their language outcomes. This longitudinal study measured infants' visual attention on a distractibility task (11 months), joint attention (14 months), and language outcomes (word-object association, 14 months;…

  1. Statistical significance of climate sensitivity predictors obtained by data mining

    NASA Astrophysics Data System (ADS)

    Caldwell, Peter M.; Bretherton, Christopher S.; Zelinka, Mark D.; Klein, Stephen A.; Santer, Benjamin D.; Sanderson, Benjamin M.

    2014-03-01

    Several recent efforts to estimate Earth's equilibrium climate sensitivity (ECS) focus on identifying quantities in the current climate which are skillful predictors of ECS yet can be constrained by observations. This study automates the search for observable predictors using data from phase 5 of the Coupled Model Intercomparison Project. The primary focus of this paper is assessing statistical significance of the resulting predictive relationships. Failure to account for dependence between models, variables, locations, and seasons is shown to yield misleading results. A new technique for testing the field significance of data-mined correlations which avoids these problems is presented. Using this new approach, all 41,741 relationships we tested were found to be explainable by chance. This leads us to conclude that data mining is best used to identify potential relationships which are then validated or discarded using physically based hypothesis testing.

  2. Predictors of outcomes of psychological treatments for disordered gambling: A systematic review.

    PubMed

    Merkouris, S S; Thomas, S A; Browning, C J; Dowling, N A

    2016-08-01

    This systematic review aimed to synthesise the evidence relating to pre-treatment predictors of gambling outcomes following psychological treatment for disordered gambling across multiple time-points (i.e., post-treatment, short-term, medium-term, and long-term). A systematic search from 1990 to 2016 identified 50 articles, from which 11 socio-demographic, 16 gambling-related, 21 psychological/psychosocial, 12 treatment, and no therapist-related variables, were identified. Male gender and low depression levels were the most consistent predictors of successful treatment outcomes across multiple time-points. Likely predictors of successful treatment outcomes also included older age, lower gambling symptom severity, lower levels of gambling behaviours and alcohol use, and higher treatment session attendance. Significant associations, at a minimum of one time-point, were identified between successful treatment outcomes and being employed, ethnicity, no gambling debt, personality traits and being in the action stage of change. Mixed results were identified for treatment goal, while education, income, preferred gambling activity, problem gambling duration, anxiety, any psychiatric comorbidity, psychological distress, substance use, prior gambling treatment and medication use were not significantly associated with treatment outcomes at any time-point. Further research involving consistent treatment outcome frameworks, examination of treatment and therapist predictor variables, and evaluation of predictors across long-term follow-ups is warranted to advance this developing field of research. PMID:27372437

  3. Prestroke family interaction as a predictor of stroke outcome.

    PubMed

    Evans, R L; Bishop, D S; Matlock, A L; Stranahan, S; Halar, E M; Noonan, W C

    1987-08-01

    The Family of Assessment Device and clinical data for 60 stroke patients were used to predict outcome at six months and one year poststroke. Ratings of behavior control and affective responsiveness of the family predicted number of days of rehospitalization during the study. Problem solving scores, family communication skills, and patient self-care ability predicted family-rated patient adjustment. Family function was a better predictor of hospital stay than baseline ratings of typical predictors of stroke outcome. Family function represents an area for potential stroke intervention that may have more relevance to efficient health care delivery and the clinical status of stroke patients than has previously been noted. PMID:3619614

  4. Anterior cruciate ligament reconstruction and rehabilitation: predictors of functional outcome

    PubMed Central

    DELLA VILLA, FRANCESCO; RICCI, MARGHERITA; PERDISA, FRANCESCO; FILARDO, GIUSEPPE; GAMBERINI, JACOPO; CAMINATI, DANIELE; DELLA VILLA, STEFANO

    2015-01-01

    Surgical reconstruction of an injured anterior cruciate ligament (ACL) leads to full recovery of function and sports activity in a high percentage of cases. The aim of the present study was to analyze variables related to the patient, the surgical technique and the post-surgical rehabilitation methods, seeking to identify predictors of outcome and recovery time after ACL reconstruction. One hundred and four patients (81 M, 23 F) undergoing a step-based rehabilitation protocol after ACL reconstruction were evaluated. 43.2% of them had an isolated ACL lesion, whereas 56.8% had one or more concurrent injuries. Data relating to personal characteristics, surgery and post-operative management were collected and analyzed for correlation. Clinical outcome was evaluated with IKDC subjective score and the Tegner score, and the time to reach full recovery was noted as well. Young patients with a higher pre-injury Tegner activity level or who practice sport at professional level, no concurrent capsular lesions and no postoperative knee bracing had better clinical results and took shorter time to recover. Also, a higher percentage of on-the-field rehabilitation sessions, and absence of significant muscle strength deficits at the first knee isokinetic test emerged as rehabilitation-related factors leading to a better post-surgical outcome. Personal, surgical and rehabilitation factors should be considered in order to optimize patient management and maximize the expected results. Further studies are needed to find the strongest factors in different patients. Level of evidence Level IV, retrospective study. PMID:26904523

  5. Preschool Predictors of Kindergarten Language Outcomes

    ERIC Educational Resources Information Center

    Walk, Anne; Matsuo, Hisako; Giovanoni, Alex

    2015-01-01

    The aim of the present study is to explore a variety of cognitive and social variables which are most relevant to children's linguistic success in an educational setting. The study examines kindergarten English language outcomes in classrooms containing monolingual English speaking children and bilingual children who speak English and one other…

  6. Predictors of outcome in HSV encephalitis.

    PubMed

    Singh, Tarun D; Fugate, Jennifer E; Hocker, Sara; Wijdicks, Eelco F M; Aksamit, Allen J; Rabinstein, Alejandro A

    2016-02-01

    This study aims to explore the clinical features, radiological findings, management and the factors influencing prognosis in PCR-confirmed herpes simplex virus encephalitis (HSE). This is a retrospective review of consecutive patients diagnosed with HSE at Mayo Clinic, Rochester, MN, between January 1995 and December 2013. Only HSE cases confirmed by PCR were included. Univariate and multivariate analysis was used to identify factors associated with good (modified Rankin Scale of 0-2) or poor outcome (mRS of 3-6) at hospital discharge and 1-year follow-up. We identified 45 patients with HSE. Median age was 66 (IQR 53.5-78) years. HSE was caused by HSV-1 in 33 cases and by HSV-2 in 9. Nearly half had seizures upon admission or during hospitalization. The most common regions involved on MRI were the temporal lobe in 35 (87.5%), insula in 28 (70.0%), frontal lobe in 27 (67.5%) and thalamus in 11 (27.5%) patients. MRI pattern was quite homogeneous with HSV-1 infection, but much more heterogeneous with HSV-2. Good outcome at discharge and at 6-12 months was seen in 16 (35.6%) and 27 (65.9%) patients, respectively. On multivariate analyses, older age (p = 0.001), coma (p = 0.008), restricted diffusion on MRI (p = 0.005) and acyclovir started after the first day of admission (p = 0.050) were associated with poor outcome at discharge. Older age, development of coma, presence of restricted diffusion on brain MRI and delay in the administration of acyclovir portend poor outcome in HSE. Conversely, presence of seizures, focal neurological deficits, EEG abnormalities and location or extension of FLAIR/T2 abnormalities did not influence functional outcome. PMID:26568560

  7. Predictors of Substance Abuse Treatment Outcomes in Tennessee.

    ERIC Educational Resources Information Center

    Kedia, Satish; Williams, Charles

    2003-01-01

    Identifies and analyzes several variables important in predicting the likelihood of abstinence among substance abuse clients. Data was collected from 1,350 clients treated for alcohol or drug abuse in residential, halfway house, or outpatient facilities. Analyzing 22 variables as possible treatment outcome predictors, results found one…

  8. Change in Autism Classification with Early Intervention: Predictors and Outcomes

    ERIC Educational Resources Information Center

    Ben Itzchak, Esther; Zachor, Ditza A.

    2009-01-01

    The current study characterized stability and changes of autism diagnostic classification with intervention in very young children and examined pre-treatment predictors and post-intervention outcome. Sixty-eight children diagnosed with autism, aged 18-35 months (M = 25.4, SD = 4.0) participated in the study. Children underwent comprehensive…

  9. Anxiety, Stress and Social Support: Prenatal Predictors of Obstetrical Outcomes.

    ERIC Educational Resources Information Center

    Nethercut, Gail; Adler, Nancy

    The role of anxiety, stress, and social support in predicting negative obstetrical outcomes was examined in a high-risk group of pregnant women. The predictor variables were assessed with separate self-report scales, including The Sarason Life Experience Survey, the Spielberger State/Trait Inventory, and a modified version of the Lazarus and Cohen…

  10. Relational Aggression in Middle Childhood: Predictors and Adolescent Outcomes

    ERIC Educational Resources Information Center

    Spieker, Susan J.; Campbell, Susan B.; Vandergrift, Nathan; Pierce, Kim M.; Cauffman, Elizabeth; Susman, Elizabeth J.; Roisman, Glenn I.

    2012-01-01

    This study examined gender differences in the level and developmental course of relational aggression in middle childhood, as well as early predictors and outcomes of relational aggression, after controlling for concurrent physical aggression. Relational (RAgg) and Physical aggression (PAgg) scores for 558 boys and 545 girls at the ages of eight…

  11. Multifactorial analysis of predictors of outcome in pediatric intracranial ependymoma.

    PubMed

    Ridley, Lee; Rahman, Ruman; Brundler, Marie-Anne; Ellison, David; Lowe, James; Robson, Keith; Prebble, Emma; Luckett, Inga; Gilbertson, Richard J; Parkes, Sheila; Rand, Vikki; Coyle, Beth; Grundy, Richard G

    2008-10-01

    Pediatric ependymomas are enigmatic tumors, and their clinical management remains one of the more difficult in pediatric oncology. The identification of biological correlates of outcome and therapeutic targets remains a significant challenge in this disease. We therefore analyzed a panel of potential biological markers to determine optimal prognostic markers. We constructed a tissue microarray from 97 intracranial tumors from 74 patients (WHO grade II-III) and analyzed the candidate markers nucleolin, telomerase catalytic subunit (hTERT; antibody clone 44F12), survivin, Ki-67, and members of the receptor tyrosine kinase I (RTK-I) family by immunohistochemistry. Telomerase activity was determined using the in vitro-based telomere repeat amplification protocol assay, and telomere length was measured using the telomere restriction fragment assay. Primary tumors with low versus high nucleolin protein expression had a 5-year event-free survival of 74%+/-13% and 31%+/-7%, respectively. Multivariate analysis identified low nucleolin expression to be independently associated with a more favorable prognosis (hazard ratio=6.25; 95% confidence interval, 1.6-24.2; p=0.008). Ki-67 and survivin correlated with histological grade but not with outcome. Immunohistochemical detection of the RTK-I family did not correlate with grade or outcome. Telomerase activity was evident in 19 of 22 primary tumors, with telomere lengthening and/or maintenance occurring in five of seven recurrent cases. Low nucleolin expression was the single most important biological predictor of outcome in pediatric intracranial ependymoma. Furthermore, telomerase reactivation and maintenance of telomeric repeats appear necessary for childhood ependymoma progression. These findings require corroboration in a clinical trial setting. PMID:18701711

  12. Predicting math outcomes: reading predictors and comorbidity.

    PubMed

    Fletcher, Jack M

    2005-01-01

    This commentary addresses issues concerning (a) the measurement of numbers, letters, and words versus cognitive processes in early screening batteries, and (b) comorbid associations of reading, math, and attention disorders. Based on reading prediction studies, assessments that include numbers should be most predictive of math outcomes. However, given the comorbid association of reading, math, and attention disorders, measures sensitive to reading and attention difficulties may be necessary in early screening batteries for math disabilities. PMID:16122061

  13. Significant predictors of patients' uncertainty in primary brain tumors.

    PubMed

    Lin, Lin; Chien, Lung-Chang; Acquaye, Alvina A; Vera-Bolanos, Elizabeth; Gilbert, Mark R; Armstrong, Terri S

    2015-05-01

    Patients with primary brain tumors (PBT) face uncertainty related to prognosis, symptoms and treatment response and toxicity. Uncertainty is correlated to negative mood states and symptom severity and interference. This study identified predictors of uncertainty during different treatment stages (newly-diagnosed, on treatment, followed-up without active treatment). One hundred eighty six patients with PBT were accrued at various points in the illness trajectory. Data collection tools included: a clinical checklist/a demographic data sheet/the Mishel Uncertainty in Illness Scale-Brain Tumor Form. The structured additive regression model was used to identify significant demographic and clinical predictors of illness-related uncertainty. Participants were primarily white (80 %) males (53 %). They ranged in age from 19-80 (mean = 44.2 ± 12.6). Thirty-two of the 186 patients were newly-diagnosed, 64 were on treatment at the time of clinical visit with MRI evaluation, 21 were without MRI, and 69 were not on active treatment. Three subscales (ambiguity/inconsistency; unpredictability-disease prognoses; unpredictability-symptoms and other triggers) were different amongst the treatment groups (P < .01). However, patients' uncertainty during active treatment was as high as in newly-diagnosed period. Other than treatment stages, change of employment status due to the illness was the most significant predictor of illness-related uncertainty. The illness trajectory of PBT remains ambiguous, complex, and unpredictable, leading to a high incidence of uncertainty. There was variation in the subscales of uncertainty depending on treatment status. Although patients who are newly diagnosed reported the highest scores on most of the subscales, patients on treatment felt more uncertain about unpredictability of symptoms than other groups. Due to the complexity and impact of the disease, associated symptoms, and interference with functional status, comprehensive assessment of patients

  14. Breast reconstruction following conservative mastectomies: predictors of complications and outcomes

    PubMed Central

    Voineskos, Sophocles H.; Frank, Simon G.

    2015-01-01

    Breast reconstruction can be performed using a variety of techniques, most commonly categorized into an alloplastic approach or an autologous tissue method. Both strategies have certain risk factors that influence reconstructive outcomes and complication rates. In alloplastic breast reconstruction, surgical outcomes and complication rates are negatively impacted by radiation, smoking, increased body mass index (BMI), hypertension, and prior breast conserving therapy. Surgical factors such as the type of implant material, undergoing immediate breast reconstruction, and the use of fat grafting can improve patient satisfaction and aesthetic outcomes. In autologous breast reconstruction, radiation, increased BMI, certain previous abdominal surgery, smoking, and delayed reconstruction are associated with higher complication rates. Though a pedicled transverse rectus abdominis myocutaneous (TRAM) flap is the most common type of flap used for autologous breast reconstruction, pedicled TRAMs are more likely to be associated with fat necrosis than a free TRAM or deep inferior epigastric perforator (DIEP) flap. Fat grafting can also be used to improve aesthetic outcomes in autologous reconstruction. This article focuses on factors, both patient and surgical, that are predictors of complications and outcomes in breast reconstruction. PMID:26645003

  15. Breast reconstruction following conservative mastectomies: predictors of complications and outcomes.

    PubMed

    Voineskos, Sophocles H; Frank, Simon G; Cordeiro, Peter G

    2015-12-01

    Breast reconstruction can be performed using a variety of techniques, most commonly categorized into an alloplastic approach or an autologous tissue method. Both strategies have certain risk factors that influence reconstructive outcomes and complication rates. In alloplastic breast reconstruction, surgical outcomes and complication rates are negatively impacted by radiation, smoking, increased body mass index (BMI), hypertension, and prior breast conserving therapy. Surgical factors such as the type of implant material, undergoing immediate breast reconstruction, and the use of fat grafting can improve patient satisfaction and aesthetic outcomes. In autologous breast reconstruction, radiation, increased BMI, certain previous abdominal surgery, smoking, and delayed reconstruction are associated with higher complication rates. Though a pedicled transverse rectus abdominis myocutaneous (TRAM) flap is the most common type of flap used for autologous breast reconstruction, pedicled TRAMs are more likely to be associated with fat necrosis than a free TRAM or deep inferior epigastric perforator (DIEP) flap. Fat grafting can also be used to improve aesthetic outcomes in autologous reconstruction. This article focuses on factors, both patient and surgical, that are predictors of complications and outcomes in breast reconstruction. PMID:26645003

  16. Predictors and outcomes of proactivity in the socialization process.

    PubMed

    Wanberg, C R; Kammeyer-Mueller, J D

    2000-06-01

    This 3-wave longitudinal study aimed to extend current understanding of the predictors and outcomes of employee proactivity (involving information seeking, feedback seeking, relationship building, and positive framing) in the socialization process. Two personality variables, extraversion and openness to experience, were associated with higher levels of proactive socialization behavior. Of the proactive behaviors studied, feedback seeking and relationship building were highlighted in their importance because of their various relationships with the work-related outcomes assessed in this study (e.g., social integration, role clarity, job satisfaction, intention to turnover, and actual turnover). The results also highlighted the importance of 2 control variables (opportunity to interact with others on the job and skill level of the new job) in the experience of socialization into a new job. PMID:10900812

  17. Predictors of Treatment Outcomes among Depressed Women with Childhood Sexual Abuse Histories

    PubMed Central

    Cort, Natalie A.; Gamble, Stephanie A.; Smith, Phillip N.; Chaudron, Linda H.; Lu, Naiji; He, Hua; Talbot, Nancy L.

    2012-01-01

    Background A notable portion (21%) of female patients receiving treatment for depression in community mental health centers (CMHC) has childhood sexual abuse (CSA) histories. Treatment outcomes in this population are heterogeneous; identifying factors associated with differential outcomes could inform treatment development. This exploratory study begins to address the gap in what is known about predictors of treatment outcomes among depressed women with sexual abuse histories. Method Seventy women with major depressive disorder and CSA histories in a CMHC were randomly assigned to Interpersonal Psychotherapy (n = 37) or usual care (n = 33). Using generalized estimating equations, we examined four pre-treatment predictor domains (i.e., sociodemographic characteristics, clinical features, social and physical functioning, and trauma features) potentially related to depression treatment outcomes. Results Among sociodemographic characteristics, Black race/ethnicity, public assistance income, and unemployment were associated with less depressive symptom reduction over the course of treatment. Two clinical features, chronic depression and borderline personality disorder, were also related to less reduction in depressive symptoms across the treatment period. Conclusion Our results demonstrate the clinical relevance of attending to predictors of depressed women with CSA histories being treated in public sector mental health centers. Particular sociodemographic characteristics and clinical features among these women may be significant indicators of risk for relatively poorer treatment outcomes. PMID:22570264

  18. Early Phonological and Sociocognitive Skills as Predictors of Later Language and Social Communication Outcomes

    ERIC Educational Resources Information Center

    Chiat, Shula; Roy, Penny

    2008-01-01

    Background: Previous studies of outcome for children with early language delay have focused on measures of early language as predictors of language outcome. This study investigates whether very early processing skills (VEPS) known to underpin language development will be better predictors of specific language and social communication outcomes than…

  19. Brainstem encephalitis: etiologies, treatment, and predictors of outcome

    PubMed Central

    Tan, Ik Lin; Mowry, Ellen M.; Steele, Sonya U.; Pardo, Carlos A.; McArthur, Justin C.; Nath, Avindra

    2016-01-01

    Brainstem encephalitis (BE) is an uncommon condition. We sought to characterize clinical presentations, etiologies, response to treatment, and predictors of outcome. We performed a retrospective review of non–HIV infected patients diagnosed with BE at Johns Hopkins Hospital (January 1997–April 2010). We characterized clinical and paraclinical features, and used regression models to assess associations with poor outcome. BE was diagnosed in 81 patients. An etiology was identified in 58 of 81 (71.6 %) of cases, most of which were confirmed or probable inflammatory/autoimmune conditions. Of the remaining 23 cases in which a specific diagnosis remained undefined, clinical presentation, CSF, neuroimaging studies, and outcomes were similar to the inflammatory/autoimmune group. Brain biopsy identified a specific diagnosis in 7 of 14 patients (50 %). Fifteen patients (18.5 %) either died or had a poor outcome. In multivariate logistic regression models, a higher CSF protein (per 5 mg/dl, OR = 1.11, 95 % CI: 1.03–1.20), a higher CSF glucose (per 5 mg/dl, OR = 1.36, 95 % CI: 1.09–1.70), and higher serum glucose (per 5 mg/dl, OR = 1.27, 95 % CI: 1.06–1.52) were independently associated with increased odds of poor outcome. Inflammatory and non-infectious conditions accounted for most cases of BE. Higher CSF protein and glucose were independently associated with poor outcome. In immunocompetent patients with BE of undefined etiology despite extensive investigation, a trial of immunosuppressive treatment may be warranted, though deterioration clinically or on magnetic resonance imaging should prompt a brain biopsy. PMID:23749332

  20. System and individual outcomes and their predictors in services and support for people with IDD.

    PubMed

    Tichá, Renáta; Hewitt, Amy; Nord, Derek; Larson, Sherri

    2013-10-01

    The growth and advancement of community-based services for people with intellectual and developmental disabilities (IDD) have resulted in vast changes in the long-term services and support landscape as well as in expected outcomes of service systems for service recipients. Investments in IDD research have been made to provide a deeper understanding of these outcomes and to explain them. This article summarizes outcomes and their predictors through systems and individual lenses by examining the research and findings of the Administration on Intellectual and Developmental Disabilities' Data Projects of National Significance that address residential services, employment services, costs of services, and individual outcomes. The article also discusses challenges and debates associated with outcome-related research and poses future research questions. PMID:24303819

  1. Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion.

    PubMed

    Cobo Soriano, Javier; Sendino Revuelta, Marcos; Fabregate Fuente, Martín; Cimarra Díaz, Ignacio; Martínez Ureña, Paloma; Deglané Meneses, Roberto

    2010-11-01

    There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of "disc herniation", less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results. PMID:20135333

  2. Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

    PubMed Central

    Sendino Revuelta, Marcos; Cimarra Díaz, Ignacio; Martínez Ureña, Paloma; Deglané Meneses, Roberto

    2010-01-01

    There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of “disc herniation”, less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results. PMID:20135333

  3. Predictors of posttraumatic outcomes following the 1999 Taiwan earthquake.

    PubMed

    Chang, Chia-Ming; Connor, Kathryn M; Lai, Te-Jen; Lee, Li-Ching; Davidson, Jonathan R T

    2005-01-01

    This cross-sectional study examined 10-month outcomes in survivors after the 1999 earthquake in Taiwan. Two hundred fifty-two randomly selected subjects were interviewed to assess the following: categorical assignment to full or partial posttraumatic stress disorder (PTSD/PTSS), symptoms of PTSD, and general psychiatric morbidity. Using regression models, the following potential independent predictor variables were evaluated: age, gender, earthquake exposure, previous trauma, current depression, and general well-being. Variables predictive of PTSD/PTSS included female gender and current depression. Current depression and impaired well-being were predicted by greater PTSD severity. Greater psychiatric morbidity was predicted by female gender, current depression, number of traumatic experiences, and impaired well-being. These variables, particularly female gender, current depression, and impaired well-being, should be considered in assessing earthquake survivors who are at increased risk for developing posttraumatic sequelae. PMID:15674133

  4. Predictors of treatment outcome among Asian pathological gamblers (PGs): clinical, behavioural, demographic, and treatment process factors.

    PubMed

    Guo, Song; Manning, Victoria; Thane, Kyaw Kyaw Wai; Ng, Andrew; Abdin, Edimansyah; Wong, Kim Eng

    2014-03-01

    Research on predictors of treatment outcome among pathological gamblers (PGs) is inconclusive and dominated by studies from Western countries. Using a prospective longitudinal design, the current study examined demographic, clinical, behavioural and treatment programme predictors of gambling frequency at 3, 6 and 12-months, among PGs treated at an addiction clinic in Singapore. Measures included the Hospital anxiety and depression scale, gambling symptom assessment scale (GSAS), personal well-being index (PWI), treatment perception questionnaire and gambling readiness to change scale. Treatment response in relation to changes in symptom severity, personal wellbeing and abstinence were also assessed. Abstinence rates were 38.6, 46.0 and 44.4 % at 3, 6 and 12-months respectively. Significant reductions in gambling frequency, GSAS, and improvement in PWI were reported between baseline and subsequent outcome assessments, with the greatest change occurring in the initial three months. No demographic, clinical, behavioural or treatment programme variable consistently predicted outcome at all three assessments, though treatment satisfaction was the most frequent significant predictor. However, being unemployed, having larger than average debts, poor treatment satisfaction and attending fewer sessions at the later stages of treatment were associated with significantly poorer outcomes, up to 1-year after initiating treatment. These findings show promise for the effectiveness of a CBT-based treatment approach for the treatment of predominantly Chinese PGs. Clinical implications and suggestions for future research are discussed. Taken together, the findings suggest early treatment satisfaction is paramount in improving short-term outcomes, with baseline gambling behaviour and treatment intensity playing a more significant role in the longer term. PMID:22945784

  5. Temperament and Impulsivity Predictors of Smoking Cessation Outcomes

    PubMed Central

    López-Torrecillas, Francisca; Perales, José C.; Nieto-Ruiz, Ana; Verdejo-García, Antonio

    2014-01-01

    Aims Temperament and impulsivity are powerful predictors of addiction treatment outcomes. However, a comprehensive assessment of these features has not been examined in relation to smoking cessation outcomes. Methods Naturalistic prospective study. Treatment-seeking smokers (n = 140) were recruited as they engaged in an occupational health clinic providing smoking cessation treatment between 2009 and 2013. Participants were assessed at baseline with measures of temperament (Temperament and Character Inventory), trait impulsivity (Barratt Impulsivity Scale), and cognitive impulsivity (Go/No Go, Delay Discounting and Iowa Gambling Task). The outcome measure was treatment status, coded as “dropout” versus “relapse” versus “abstinence” at 3, 6, and 12 months endpoints. Participants were telephonically contacted and reminded of follow-up face to face assessments at each endpoint. The participants that failed to answer the phone calls or self-reported discontinuation of treatment and failed to attend the upcoming follow-up session were coded as dropouts. The participants that self-reported continuing treatment, and successfully attended the upcoming follow-up session were coded as either “relapse” or “abstinence”, based on the results of smoking behavior self-reports cross-validated with co-oximetry hemoglobin levels. Multinomial regression models were conducted to test whether temperament and impulsivity measures predicted dropout and relapse relative to abstinence outcomes. Results Higher scores on temperament dimensions of novelty seeking and reward dependence predicted poorer retention across endpoints, whereas only higher scores on persistence predicted greater relapse. Higher scores on the trait dimension of non-planning impulsivity but not performance on cognitive impulsivity predicted poorer retention. Higher non-planning impulsivity and poorer performance in the Iowa Gambling Task predicted greater relapse at 3 and 6 months and 6 months

  6. Changes in Body Composition in Anorexia Nervosa: Predictors of Recovery and Treatment Outcome

    PubMed Central

    Arcelus, Jon; Sánchez, Isabel; Riesco, Nadine; Jiménez-Murcia, Susana; González-Gómez, Jana; Granero, Roser; Custal, Nuria; Montserrat-Gil de Bernabé, Monica; Tárrega, Salomé; Baños, Rosa M.; Botella, Cristina; de la Torre, Rafael; Fernández-García, José C.; Fernández-Real, José M.; Frühbeck, Gema; Gómez-Ambrosi, Javier; Tinahones, Francisco J.; Crujeiras, Ana B.; Casanueva, Felipe F.; Menchón, José M.; Fernández-Aranda, Fernando

    2015-01-01

    The restoration of body composition (BC) parameters is considered to be one of the most important goals in the treatment of patients with anorexia nervosa (AN). However, little is known about differences between AN diagnostic subtypes [restricting (AN-R) and binge/purging (AN-BP)] and weekly changes in BC during refeeding treatment. Therefore, the main objectives of our study were twofold: 1) to assess the changes in BC throughout nutritional treatment in an AN sample and 2) to analyze predictors of BC changes during treatment, as well as predictors of treatment outcome. The whole sample comprised 261 participants [118 adult females with AN (70 AN-R vs. 48 AN-BP), and 143 healthy controls]. BC was measured weekly during 15 weeks of day-hospital treatment using bioelectrical impedance analysis (BIA). Assessment measures also included the Eating Disorders Inventory-2, as well as a number of other clinical indices. Overall, the results showed that AN-R and AN-BP patients statistically differed in all BC measures at admission. However, no significant time×group interaction was found for almost all BC parameters. Significant time×group interactions were only found for basal metabolic rate (p = .041) and body mass index (BMI) (p = .035). Multiple regression models showed that the best predictors of pre-post changes in BC parameters (namely fat-free mass, muscular mass, total body water and BMI) were the baseline values of BC parameters. Stepwise predictive logistic regressions showed that only BMI and age were significantly associated with outcome, but not with the percentage of body fat. In conclusion, these data suggest that although AN patients tended to restore all BC parameters during nutritional treatment, only AN-BP patients obtained the same fat mass values as healthy controls. Put succinctly, the best predictors of changes in BC were baseline BC values, which did not, however, seem to influence treatment outcome. PMID:26600309

  7. Neutropenic Sepsis in the ICU: Outcome Predictors in a Two-Phase Model and Microbiology Findings

    PubMed Central

    Kruse, Jan M.; Jenning, Thomas; Rademacher, Sibylle; Arnold, Renate; Schmitt, Clemens A.; Jörres, Achim; Enghard, Philipp; Oppert, Michael

    2016-01-01

    Objective. Patients with neutropenic sepsis have a poor prognosis. We aimed to identify outcome predictors and generate hypotheses how the care for these patients may be improved. Methods. All 12.352 patients admitted between 2006 and 2011 to the medical ICUs of our tertiary university center were screened for neutropenia; out of 558 patients identified, 102 fulfilled the inclusion criteria and were analyzed. Severity markers and outcome predictors were assessed. Results. The overall ICU mortality was 54.9%. The severity of sepsis and the number of organ failures predicted survival of the primary septic episode (APACHE II 22.8 and 29.0; SOFA 7.3 and 10.1, resp.). In the recovery phase, persistent organ damage and higher persistent C-reactive protein levels were associated with a poor outcome. Blood transfusions and CMV infection correlated with an unfavorable prognosis. Ineffective initial antibiotic therapy, fungal infections, and detection of multiresistant bacteria displayed a particularly poor outcome. Infections with coagulase-negative staphylococci and enterococci were associated with a significantly higher mortality and a high degree of systemic inflammation. Conclusion. Patients with persistent organ dysfunction show an increased mortality in the further course of their ICU stay. Early antimicrobial treatment of Gram-positive cocci may improve the outcome of these patients. PMID:27195148

  8. Surgical Predictors of Clinical Outcome following Revision ACL Reconstruction

    PubMed Central

    Wright, Rick W.

    2016-01-01

    Objectives: Revision ACL reconstruction has been documented to have worse outcomes compared with primary ACL reconstructions. The reasons why remain unknown. The purpose of this study was to determine either previous or current surgical factors noted at the time of ACL revision reconstruction predicts activity level, sports function, and OA symptoms at two year follow-up. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, and a series of validated patient reported outcome instruments (IKDC, KOOS, WOMAC, and Marx activity rating score). Patients were followed up for 2 years, and asked to complete the identical set of outcome instruments. Regression analysis was used to control for age, gender, BMI, activity level, baseline outcome scores, revision number, time since last ACLR, and a variety of previous and current surgical variables, in order to assess the surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: 1205 patients met the inclusion criteria and were successfully enrolled. 697 (58%) were males, with a median cohort age of 26 years. The median time since their last ACL reconstruction was 3.4 years. Baseline characteristics of the cohort are summarized in Table 1. At 2 years, follow-up was obtained on 82% (989/1205). Both previous as well as current surgical factors were found to be significant drivers of poorer outcomes at 2 years (Table 2). The most consistent surgical factors driving outcome in revision patients were prior surgical technique, prior tibial tunnel position, current femoral fixation and having a notchplasty. Having a previous arthrotomy compared to the one incision technique resulted in significantly poorer outcomes on the IKDC (odds ratio=0.41; 95% CI=0.17-0.95; p=0.037) and KOOS pain, sports/rec, and QOL subscales (OR range=0.23-0.42; 95% CI=0.10-0.97; p<0

  9. Readmission After Robot-assisted Radical Cystectomy: Outcomes and Predictors at 90-Day Follow-up

    PubMed Central

    Al-Daghmin, Ali; Aboumohamed, Ahmed; Din, Rakeeba; Khan, Aabroo; Raza, Syed Johar; Sztorc, Jenna; Mehedint, Diana; Sharif, Mohammad; Shi, Yi; Wilding, Gregory; Guru, Khurshid A.

    2015-01-01

    OBJECTIVE To characterize the outcomes and predictors of readmission after robot-assisted radical cystectomy (RARC) during early (30-day) and late (31–90–day) postoperative periods. METHODS We retrospectively evaluated our prospectively maintained RARC quality assurance database of 272 consecutive patients operated between 2005 and 2012. We evaluated the relationship of readmission with perioperative outcomes and examined possible predictors during the postoperative period. RESULTS Overall 30- and 90-day mortality was 0.7% and 4.8%, respectively, with 25.5% patients readmitted within 90 days after RARC (61% of them were readmitted within 30 days and 39% were readmitted between 31–90 days postoperatively). Infection-related problems were the most common cause of readmission during early and late periods. Overall operative time and obesity were significantly associated with readmission (P = .034 and .033, respectively). Body mass index and female gender were independent predictors of 90-day readmission (P = .004 and .014, respectively). Having any type of complication correlated with 90-day readmission (P = .0045); meanwhile, when complications were graded on the basis of Clavien grading system, only grade 1–2 complications statistically correlated with readmission (P = .046). Four patients needed reoperation (2 patients in early “for appendicitis and adhesive small bowel obstruction” and 2 in late “for ureteroenteric stricture” readmission); meanwhile, 6 patients needed percutaneous procedures (4 patients in early “1 for anastomotic leak and 3 for pelvic collections” and 2 “for pelvic collections and ureterocutaneous fistula” in late readmission). CONCLUSION The rate of readmission within 90 days after RARC is significant. Female gender and body mass index are independent predictors of readmission. Outcomes at 90 days provide more thorough results, essential to proper patient counseling. PMID:24468509

  10. Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD.

    PubMed

    Navaneethan, Sankar D; Roy, Jason; Tao, Kelvin; Brecklin, Carolyn S; Chen, Jing; Deo, Rajat; Flack, John M; Ojo, Akinlolu O; Plappert, Theodore J; Raj, Dominic S; Saydain, Ghulam; Sondheimer, James H; Sood, Ruchi; Steigerwalt, Susan P; Townsend, Raymond R; Dweik, Raed A; Rahman, Mahboob

    2016-03-01

    Pulmonary hypertension (PH) is associated with poor outcomes in the dialysis and general populations, but its effect in CKD is unclear. We evaluated the prevalence and predictors of PH measures and their associations with long-term clinical outcomes in patients with nondialysis-dependent CKD. Chronic Renal Insufficiency Cohort (CRIC) Study participants who had Doppler echocardiography performed were considered for inclusion. PH was defined as the presence of estimated pulmonary artery systolic pressure (PASP) >35 mmHg and/or tricuspid regurgitant velocity (TRV) >2.5 m/s. Associations between PH, PASP, and TRV and cardiovascular events, renal events, and all-cause mortality were examined using Cox proportional hazards models. Of 2959 eligible participants, 21% (n=625) had PH, with higher rates among those with lower levels of kidney function. In the multivariate model, older age, anemia, lower left ventricular ejection fraction, and presence of left ventricular hypertrophy were associated with greater odds of having PH. After adjusting for relevant confounding variables, PH was independently associated with higher risk for death (hazard ratio, 1.38; 95% confidence interval, 1.10 to 1.72) and cardiovascular events (hazard ratio, 1.23; 95% confidence interval, 1.00 to 1.52) but not renal events. Similarly, TRV and PASP were associated with death and cardiovascular events but not renal events. In this study of patients with CKD and preserved left ventricular systolic function, we report a high prevalence of PH. PH and higher TRV and PASP (echocardiographic measures of PH) are associated with adverse outcomes in CKD. Future studies may explain the mechanisms that underlie these findings. PMID:26386072

  11. Predictors of poor hospital discharge outcome in acute stroke due to atrial fibrillation.

    PubMed

    Tian, Melissa J; Tayal, Ashis H; Schlenk, Elizabeth A

    2015-02-01

    Atrial fibrillation (AF) is a frequent cause of acute ischemic stroke that results in severe neurological disability and death despite treatment with intravenous thrombolysis (intravenous recombinant tissue plasminogen activator [rtPA]). We performed a retrospective review of a single-center registry of patients treated with intravenous rtPA for stroke. The purposes of this study were to compare intravenous rtPA treated patients with stroke with and without AF to examine independent predictors of poor hospital discharge outcome (in-hospital death or hospital discharge to a skilled nursing facility, long-term acute care facility, or hospice care). A univariate analysis was performed on 144 patients receiving intravenous rtPA for stroke secondary to AF and 190 patients without AF. Characteristics that were significantly different between the two groups were age, initial National Institutes of Health Stroke Scale score, length of hospital stay, gender, hypertension, hyperlipidemia, smoking status, presence of large cerebral infarct, and hospital discharge outcome. Bivariate logistic regression analysis indicated that patients with stroke secondary to AF with a poor hospital discharge outcome had a greater likelihood of older age, higher initial National Institutes of Health Stroke Scale scores, longer length of hospital stay, intubation, and presence of large cerebral infarct compared with those with good hospital discharge outcome (discharged to home or inpatient rehabilitation or signed oneself out against medical advice). A multivariate logistic regression analysis showed that older age, longer length of hospital stay, and presence of large cerebral infarct were independent predictors of poor hospital discharge outcome. These predictors can guide nursing interventions, aid the multidisciplinary treating team with treatment decisions, and suggest future directions for research. PMID:25503541

  12. Epidemiology, outcomes, and predictors of mortality in hospitalized adults with Clostridium difficile infection.

    PubMed

    Khanna, Sahil; Gupta, Arjun; Baddour, Larry M; Pardi, Darrell S

    2016-08-01

    Studies have demonstrated an increasing Clostridium difficile infection (CDI) incidence in hospitals and the community, with increasing morbidity and mortality. In this study, we analyzed data from the National Hospital Discharge Survey (NHDS) to evaluate CDI epidemiology, outcomes, and predictors of mortality in hospitalized adults. We identified cases of CDI (and associated comorbid conditions) from NHDS data from 2005 through 2009 using ICD-9 codes. Weighted univariate and multivariate analyses were performed to ascertain CDI incidence, associations between CDI and outcomes [length of stay (LOS), colectomy, all-cause in-hospital mortality, and discharge to a care facility], and predictors of all-cause in-hospital mortality. Of an estimated 162 million adult inpatients, 1.26 million (0.8 %) had CDI. The overall CDI incidence is 77.8/10,000 hospitalizations, with no statistically significant change over the study period. On multivariate analysis, after adjusting for age, gender, and comorbid conditions, CDI is an independent predictor of longer LOS (mean difference, 2.35 days), all-cause mortality [odds ratio (OR) 1.45], colectomy (OR 1.41), and discharge to a care facility (OR 2.12) (all P < 0.001). Elderly patients have a higher CDI incidence and worse outcomes than younger adults. The strongest predictors of all-cause mortality in patients with CDI include age 65 years or older, colectomy, and coagulation abnormalities. Despite stable CDI incidence and advances in management, CDI is associated with increased LOS, colectomy, all-cause in-hospital mortality, and discharge to a care facility in hospitalized, especially elderly, adults. Age older than 65 years should be added to the severity criteria for CDI. PMID:26694494

  13. Congenital cystic adenomatoid malformation in the fetus: natural history and predictors of outcome.

    PubMed

    Miller, J A; Corteville, J E; Langer, J C

    1996-06-01

    Cystic adenomatoid malformation (CCAM) is a rare lesion that often is diagnosed by prenatal ultrasonography. Outcome varies from hydrops and fetal death to resolution before birth. The authors reviewed their 7-year experience with 17 fetuses diagnosed with CCAM by prenatal ultrasonography to determine the natural history of the lesion and to identify factors that might predict outcome. Of the 17 fetuses, five died during intrauterine life (3 terminations, 2 fetal deaths); four of them had hydrops. Twelve fetuses were carried to term. Only one had prenatal intervention: a thoracoamniotic shunt at 24 weeks. All 12 infants survived and underwent resection. Only four required neonatal support (1 extracorporeal membrane oxygenation, 2 ventilator, 1 oxygen). The initial CCAM:chest ratio, degree of mediastinal shift at time of diagnosis, location of CCAM, and age at time of diagnosis did not correlate with outcome. Sonographically predicted pathological type did not correlate with pathological diagnosis after surgery, or with outcome. The only accurate predictors of outcome were presence of hydrops (all died) and decrease in size of CCAM during gestation (all survived). The outcome for fetuses with CCAM may be better than previously recognized. Many of the lesions decrease in size, despite significant mediastinal shift and lung compression at the time of diagnosis. Fetal intervention should be considered only for fetuses with hydrops. Others should be monitored with serial ultrasonography. Parental counseling, especially regarding pregnancy termination, should reflect the positive outcome noted in most cases. PMID:8783108

  14. Rehabilitation Predictors of Clinical Outcome following Revision ACL Reconstruction

    PubMed Central

    Wright, Rick W.; Group, Mars

    2016-01-01

    Objectives: Revision ACL reconstruction has been documented to have worse outcomes compared with primary ACL reconstructions. The reasons why remain unknown. The purpose of this study was to determine whether rehabilitation-related factors prescribed at the time of ACL revision reconstruction significantly influence two year outcomes, as well as the incidence of incurring a subsequent re-operation. Our hypothesis was that immediate versus passive, active range of motion (ROM) and weightbearing will result in improved outcomes without incidence of subsequent surgery. Use of postoperative and functional return to sport braces will not improve return to sports function. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, prescribed post-op and rehabilitation instructions (ie. timing of weightbearing, timing of passive and active ROM, use of postoperative and return to sport braces) and a series of validated patient reported outcome instruments (IKDC, KOOS, and Marx activity rating score). Patients were followed up for 2 years, and asked to complete the identical set of outcome instruments. Because meniscal repair, meniscal transplants, HTOs, concurrent ligamentous reconstructions, and certain chondral treatments (ie. microfracture, abrasion arthroplasty, mosiacplasty, etc) are known to affect prescribed rehab treatments, patients with these pathologies were excluded from the analyses. Regression analysis was used to control for age, gender, activity level, baseline outcome scores, and the above-mentioned rehabilitation-related variables, in order to assess the risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: A total of 843 patients met the inclusion criteria and were successfully enrolled. 482 (57%) were males, with a median cohort age of 27 years. Baseline characteristics of the cohort are

  15. Overall Well-Being as a Predictor of Health Care, Productivity, and Retention Outcomes in a Large Employer

    PubMed Central

    Shi, Yuyan; Coberley, Carter R.; Pope, James E.

    2013-01-01

    Abstract Employers struggle with the high cost of health care, lost productivity, and turnover in their workforce. The present study aims to understand the association between overall well-being and these employer outcomes. In a sample of 11,700 employees who took the Well-being Assessment, the authors used multivariate linear and logistic regression to investigate overall well-being as a predictor of health care outcomes (total health care expenditure, emergency room visits, hospitalizations), productivity outcomes (unscheduled absence, short-term disability leave, presenteeism, job performance ratings), and retention outcomes (intention to stay, voluntary turnover, involuntary turnover). Testing this hypothesis both cross-sectionally and longitudinally, the authors investigated the association between baseline well-being and these outcomes in the following year, and the relationship between change in overall well-being and change in these outcomes over 1 year. The results demonstrated that baseline overall well-being was a significant predictor of all outcomes in the following year when holding baseline employee characteristics constant. Change in overall well-being over 1 year also was significantly associated with the change in employer outcomes, with the exception that the relationship to change in manager-rated job performance was marginally significant. The relationships between overall well-being and outcomes suggest that implementing a well-being improvement solution could have a significant bottom and top line impact on business performance. (Population Health Management 2013;16:397–405) PMID:23480368

  16. Overall well-being as a predictor of health care, productivity, and retention outcomes in a large employer.

    PubMed

    Sears, Lindsay E; Shi, Yuyan; Coberley, Carter R; Pope, James E

    2013-12-01

    Employers struggle with the high cost of health care, lost productivity, and turnover in their workforce. The present study aims to understand the association between overall well-being and these employer outcomes. In a sample of 11,700 employees who took the Well-being Assessment, the authors used multivariate linear and logistic regression to investigate overall well-being as a predictor of health care outcomes (total health care expenditure, emergency room visits, hospitalizations), productivity outcomes (unscheduled absence, short-term disability leave, presenteeism, job performance ratings), and retention outcomes (intention to stay, voluntary turnover, involuntary turnover). Testing this hypothesis both cross-sectionally and longitudinally, the authors investigated the association between baseline well-being and these outcomes in the following year, and the relationship between change in overall well-being and change in these outcomes over 1 year. The results demonstrated that baseline overall well-being was a significant predictor of all outcomes in the following year when holding baseline employee characteristics constant. Change in overall well-being over 1 year also was significantly associated with the change in employer outcomes, with the exception that the relationship to change in manager-rated job performance was marginally significant. The relationships between overall well-being and outcomes suggest that implementing a well-being improvement solution could have a significant bottom and top line impact on business performance. PMID:23480368

  17. Clinical, Electroencephalographic, and Neuroradiological Outcome Predictors in Acute Nonhypoxic Encephalopathy: A Nine-Year Cohort Study.

    PubMed

    Sutter, Raoul; Kaplan, Peter W

    2016-01-01

    Marked impairment of consciousness, brain lesion on neuroimaging, and nonreactive electroencephalographic (EEG) background activity are established outcome predictors in patients with hypoxic encephalopathy. In this observational cohort study, we aimed to assess the predictive value of clinical, neuroimaging and EEG characteristics for outcome in different types of acute nonhypoxic encephalopathic patients. All adult intensive care unit patients from a tertiary academic medical care center with clinical and EEG evidence of acute nonhypoxic encephalopathy were included from 2004 to 2012. Clinical data, neuroimaging studies, EEG characteristics, and outcome were assessed. In-hospital death was the main outcome. Median age of 262 patients was 65 years (range 18-98 years). Mortality was 12.6%. In Poisson regression analyses, older age (P=.02), intracranial hemorrhage (P=.008), coma (P=.012), and nonreactive EEG background activity (P<.0001) were independently associated with death with nonreactive EEG being the strongest predictor (relative risk 3.74; 95% confidence interval 2.02-6.91). Subgroup analysis revealed no significant effect modification for the predictive value of nonreactive EEG by the presence or absence of coma and different types of acute brain lesions. In conclusion, this study identifies and quantifies the independent predictive value of older age, intracranial hemorrhage, coma, and nonreactive EEG for death, in patients with different types of acute nonhypoxic encephalopathy. These results add further credence to the limited body of evidence that EEG provides important prognostic information in different types of acute encephalopathy not related to hypoxic brain injury. Further studies are warranted to analyze the robustness of this predictor in larger subpopulations with specific etiologies of acute nonhypoxic encephalopathies. PMID:25828484

  18. Predictors of Outcomes in a Performance Ladder Program.

    ERIC Educational Resources Information Center

    Dicks, Robert H.; McHenry, James D.

    1985-01-01

    Investigated variables from initial inmate evaluations at a state penitentiary as predictors of inmate success in behavioral ladder program. Results indicated that academic test variables were best predictors of overall success level, attitudes, and work habits. Personality variables and one interview observation variable were also found to be…

  19. Surgical treatment for nasal polyposis: predictors of outcome.

    PubMed

    Grgić, Marko Velimir; Ćupić, Hrvoje; Kalogjera, Livije; Baudoin, Tomislav

    2015-12-01

    Nasal polyps recur in approximately one-third of patients after surgical treatment. It would be beneficial to be able to predict the patients in whom we might expect recurrence and to predict the clinical outcome after surgery. The study included 30 patients operated for nasal polyps. Removed polyps were analyzed by immunohistochemical analysis for IL-5, IgE, vascular endothelial growth factor and eosinophilic infiltration. These parameters together with preoperative CT score were used as independent variables, and subjective score improvement after 2 years was used as a dependent variable in multiple linear regression analysis. Furthermore, the patients were divided into two groups: low and high polyp tissue immunoreactivity. The Chi-squared test was used to determine whether polyp immunoreactivity influences polyp recurrence and subjective score. Preoperative CT score had a slightly positive correlation with subjective score after 2 years. High eosinophil infiltration significantly predicted a higher risk for polyp recurrence. High IL-5 positivity was related to greater risk for polyp recurrence than low IL-5 reactivity but not significantly. IgE and VEGF reactivity in polyp specimens did not have any effect on polyp recurrence. High eosinophilic infiltration in polyps can predict worse outcome after surgical treatment of chronic rhinosinusitis with nasal polyposis. IgE and VEGF do not have prognostic significance to polyp recurrence after surgery. The preoperative extent of disease measured by CT score had a slightly positive correlation with worse outcome after surgery. PMID:25634061

  20. Evaluation of Cardiopulmonary Resuscitation (CPR) for Patient Outcomes and their Predictors

    PubMed Central

    Singh, Swati; Grewal, Anju; Gautam, Parshotam L; Luthra, Neeru; Tanwar, Gayatri; Kaur, Amarpreet

    2016-01-01

    Introduction Cardiac arrest continues to be a common cause of in-hospital deaths. Even small improvements in survival can translate into thousands of lives saved every year. Aim The aim of our prospective observational study was to elicit the outcomes and predictors of in-hospital cardiopulmonary resuscitation among adult patients. Settings and Design All in-hospital adult patients (age >14) who suffered cardiac arrest & were attended by a Code Blue Team between 1st January 2012 & 30th April 2013 were part of the study. Materials and Methods The cardiopulmonary resuscitation (CPR) was assessed in terms of: Response time, Presenting initial rhythm, Time to first defibrillation, Duration of CPR and Outcome (Return of spontaneous circulation (ROSC), Glasgow outcome scale (GOS) at discharge). Statistical Analysis Age, GOS and mean response time were analysed using t-test and ANOVA. Logistic regression was applied to determine the significance of the various factors in determining mortality. Results ROSC was achieved in 44% of a total of 127 patients included in our study. Asystole/Pulseless electrical activity (PEA) was the most common presenting rhythm (87.5%). The survival to discharge was seen in 7.1% patients of whom only 3.9% patients had good neurological outcome. Regression and survival analysis depicted achievement of ROSC during CPR, absence of co-morbidities and shorter response time of code blue team as predictors of good outcome. Conclusion We found poor outcome of CPR after in-hospital cardiac arrest. This was mainly attributed to an initial presenting rhythm of Asystole/PEA in most cases and delayed response times. PMID:26894150

  1. Low magnesium is not a significant predictor of hard events in acute myocardial infarction

    PubMed Central

    Vassalle, Cristina; Battaglia, Debora; Vannucci, Alessandro; Chatzianagnostou, Kyriazoula; Landi, Patrizia; Arvia, Caterina; Carpeggiani, Clara

    2016-01-01

    Background Although magnesium (Mg) has recognized cardioprotective properties and hypomagnesemia is common in patients with acute myocardial infarction (AMI), data regarding the role of Mg as prognostic factor for adverse events are scarce, as well as there are conflicting results on the use of Mg as adjuvant therapy in AMI. Aim To evaluate the role of Mg as predictor for hard events (HE, all cause death, and nonfatal myocardial infarction) in AMI patients. Design and patients We studied 406 AMI patients (306 males, age: 67 ± 12 years, mean ± SD). Patient data were collected from the Institute electronic databank which saves demographic, clinical, instrumental, therapeutical and follow-up data of all patients admitted to our Coronary Unit. Results During a mean follow-up period of 21 ± 18 months, the combined endpoint accounted for 63 HE, 44 (11%) deaths (35 cardiac deaths), 19 (5%) nonfatal MI. The multiple regression model identified glycemia as the only independent determinant of Mg in AMI pts. (T value = − 2.8, standard coefficient = − 0.15, p < 0.01). The Kaplan–Meier survival estimates failed to show a significantly worst outcome in patients presenting low Mg (< 0.783 mmol/L, 25th percentile). Aging (> 67 years—50th percentile), and ejection fraction (< 40%) remained as prognostic factors for HE in the adjusted Cox multivariate proportional hazard model (HR = 2.8, 95% CI = 1.6–5, p < 0.001; HR = 3.2, 95% CI = 1.9–5.3 p < 0.001, respectively). Conclusion The present findings do not support a significant role of low Mg as predictor for HE in AMI. PMID:27051600

  2. Predictors and Moderators of Treatment Outcome in the Pediatric Obsessive Compulsive Treatment Study (POTS I)

    ERIC Educational Resources Information Center

    Garcia, Abbe Marrs; Sapyta, Jeffrey J.; Moore, Phoebe S.; Freeman, Jennifer B.; Franklin, Martin E.; March, John S.; Foa, Edna B.

    2010-01-01

    Objective: To identify predictors and moderators of outcome in the first Pediatric OCD Treatment Study (POTS I) among youth (N = 112) randomly assigned to sertraline, cognitive behavioral therapy (CBT), both sertraline and CBT (COMB), or a pill placebo. Method: Potential baseline predictors and moderators were identified by literature review. The…

  3. Predictors of Outcome for Children Receiving Intensive Behavioral Intervention in a Large, Community-Based Program

    ERIC Educational Resources Information Center

    Perry, Adrienne; Cummings, Anne; Geier, Jennifer Dunn; Freeman, Nancy L.; Hughes, Susan; Managhan, Tom; Reitzel, Jo-Ann; Williams, Janis

    2011-01-01

    This study reports on predictors of outcome in 332 children, aged 2-7 years, enrolled in the community-based Intensive Behavioral Intervention (IBI) program in Ontario, Canada. Data documenting children's progress were reported in an earlier publication (Perry et al., 2008). The present paper explores the degree to which four predictors (measured…

  4. Predictors of outcome in outpatients with anxiety disorders: the Leiden routine outcome monitoring study.

    PubMed

    Schat, A; van Noorden, M S; Noom, M J; Giltay, E J; van der Wee, N J A; Vermeiren, R R J M; Zitman, F G

    2013-12-01

    Little is known about the predictors of outcome in anxiety disorders in naturalistic outpatient settings. We analyzed 2-year follow-up data collected through Routine Outcome Monitoring (ROM) in a naturalistic sample of 917 outpatients in psychiatric specialty care in order to identify factors predicting outcome. We included patients with panic disorder with or without agoraphobia, agoraphobia without panic, social phobia, or generalized anxiety disorder. Main findings from Cox regression analyses demonstrated that several socio-demographic variables (having a non-Dutch ethnicity [HR = 0.71)], not having a daily occupation [HR = 0.76]) and clinical factors (having a diagnosis of agoraphobia [HR = 0.67], high affective lability [HR = 0.80] and behavior problems [HR = 0.84]) decreased chances of response (defined as 50% reduction of anxiety severity) over the period of two years. Living with family had a protective predictive value [HR = 1.41]. These results may imply that factors that could be thought to limit societal participation, are associated with elevated risk of poor outcome. A comprehensive ROM screening process at intake may aid clinicians in the identification of patients at risk of chronicity. PMID:24074517

  5. Acculturative and Psychological Predictors of Academic-Related Outcomes Among Cambodian American High School Students

    PubMed Central

    Dinh, Khanh T.; Weinstein, Traci L.; Kim, Su Yeong; Ho, Ivy K.

    2009-01-01

    This study examined the acculturative and psychosocial predictors of academic-related outcomes among Cambodian American high school students from an urban school district in the state of Massachusetts. Student participants (N = 163) completed an anonymous survey that assessed demographic characteristics, acculturative experiences, intergenerational conflict, depression, and academic-related outcomes. The main results indicated that acculturative and psychosocial variables were significant predictors of academic-related outcomes. Specifically, students' Cambodian cultural orientation was positively associated with their beliefs about the utility of education and sense of school membership, while students' Anglo/White cultural orientation was positively associated with their grade point average, educational aspirations, and sense of school membership. Results also indicated that Cambodian cultural orientation was negatively associated with intergenerational conflict, which in turn was associated with depression. This study provides important information to developers of school-based and family-based prevention and intervention programs by highlighting the acculturative challenges and how academic success can be fostered for Cambodian American students. PMID:20011458

  6. Intrinsic motivation as a predictor of work outcome after vocational rehabilitation in schizophrenia.

    PubMed

    Saperstein, Alice M; Fiszdon, Joanna M; Bell, Morris D

    2011-09-01

    Intrinsic motivation is a construct commonly used in explaining goal-directed behavior. In people with schizophrenia, intrinsic motivation is usually subsumed as a feature of negative symptoms or underlying neurocognitive dysfunction. A growing literature reflects an interest in defining and measuring motivational impairment in schizophrenia and in delineating the specific role of intrinsic motivation as both an independent predictor and a mediator of psychosocial functioning. This cross-sectional study examined intrinsic motivation as a predictor of vocational outcomes for 145 individuals with schizophrenia and schizoaffective disorder participating in a 6-month work rehabilitation trial. Correlation and mediation analyses examined baseline intrinsic motivation and negative symptoms in relation to work hours and work performance. Data support a significant relationship between intrinsic motivation and negative symptoms and significant correlations with outcome variables, such that lower negative symptoms and greater intrinsic motivation were associated with better work functioning. Moreover, in this sample, intrinsic motivation fully mediated the relationships between negative symptoms, work productivity, and work performance. These results have significant implications on the design of work rehabilitation interventions for people with schizophrenia and support a role for targeting intrinsic motivation directly to influence vocational functioning. Future directions for research and intervention are discussed. PMID:21878781

  7. Treatment Outcome and Predictors of Internet Guided Self-Help for Obsessive-Compulsive Disorder.

    PubMed

    Diefenbach, Gretchen J; Wootton, Bethany M; Bragdon, Laura B; Moshier, Samantha J; Tolin, David F

    2015-11-01

    Internet-guided self-help (iGSH) has amassed significant empirical support for a variety of psychiatric conditions; however, it is not known who responds best to these treatments. This open trial examined the clinical outcomes and predictors of a 17-week iGSH program for obsessive-compulsive disorder (OCD). Therapist support was provided either in person or by phone 9 times for an average of 13minutes per session. Twenty-four patients initiated treatment, and 17 of these (70.8%) completed. Results of the intent-to-treat sample indicated statistically significant improvements at posttreatment with large treatment effects for OCD symptoms as assessed by the Yale Brown Obsessive-Compulsive Scale (d=0.87), and small to moderate improvements in depression (d=0.19), functioning (d=0.53), and quality of life (d=-0.18). These outcomes were largely maintained over a 6-month follow-up. Readiness to reduce avoidance of OCD triggers and attendance to therapist sessions were moderately associated with posttreatment response, and correctly classified the responder status (defined as clinically significant change) of nearly 9 out of 10 patients at posttreatment. These same variables did not predict responder status at 6-month follow-up. These results lend further empirical support to iGSH as a treatment for OCD and provide direction on the development of predictor models to identify patients who are and are not likely to acutely respond to iGSH. PMID:26520219

  8. Medical and Social Factors as Predictors of Outcome in Infant Tracheostomy

    PubMed Central

    Singer, Lynn T.; Hill, Betsy P.; Orlowski, James P.; Doershuk, Carl F.

    2016-01-01

    Summary We examined the relative impact of infant tracheostomy in comparison to. associated medical and social factors, on developmental outcome as part of a cross-sectional follow-up of 32 children. These children had no mental retardation, physical handicap, or severe neurological problems, but had a history of long-term tracheostomy in infancy, ranging from 3 to 146 months duration. Medical factors evaluated included prematurity, neurological status, severity of illness, and number of weeks hospitalized. Social factors included parental education and occupation. Outcome measures included IQ, language quotient, growth parameters, and behavioral competence. Correlation analyses, stepwise multiple regression analyses, and t-tests were used. Early medical illnesses were significant predictors of cognitive, language, and growth outcome. Severity of medical complications at birth and the presence of any neurological problem predicted 49% of the variance in IQ at follow-up. Social class was the only variable to predict behavioral outcome, accounting for 28% of the variance. For children without confounding medical conditions, tracheostomy had a negative impact on overall language and auditory comprehension. Once children with confounding medical risk factors were removed from the sample, children with history of infant tracheostomy exhibited significantly lower overall mean lanugage scores (106 versus 120), and lower mean language comprehension scores (104 versus 119) than a matched comparison group. PMID:1722034

  9. Predictors of Employment Outcomes for State-Federal Vocational Rehabilitation Consumers with HIV/AIDS

    ERIC Educational Resources Information Center

    Jung, Youngoh; Schaller, James; Bellini, James

    2010-01-01

    In this study, the authors investigated the effects of demographic, medical, and vocational rehabilitation service variables on employment outcomes of persons living with HIV/AIDS. Binary logistic regression analyses were conducted to determine predictors of employment outcomes using two groups drawn from Rehabilitation Services Administration…

  10. Predictors of visual and anatomical outcomes for neovascular age-related macular degeneration treated with bevacizumab

    PubMed Central

    MA, CHAORAN; BAI, LIANG; LEI, CHUNLING; WU, CHANGRUI; SHI, QIANG; HU, FENG; HAO, ZHENXUAN; MA, LE

    2015-01-01

    The present study aimed to evaluate the predictive factors for visual and anatomical outcomes in neovascular age-related macular degeneration (AMD) patients treated with intravitreal bevacizumab (IVB). A total of 113 patients with neovascular AMD received IVB treatment. The best corrected visual acuity (BCVA), central retinal thickness (CRT) and total macular volume (TMV) were assessed before the injection, and at 1, 2, 3 and 9 months after surgery. Changes in BCVA and these optical coherence tomography (OCT) outcomes from baseline were compared, and independent predictors were evaluated by logistic regression models. During the treatment, logarithm of the minimum angle of resolution (logMAR) significantly decreased from 1.12 to 0.83, and reductions in OCT parameters were earlier and larger. Baseline BCVA was associated with the changes in BCVA and CRT, whereas baseline OCT features significantly affected their own changes. Larger baseline logMAR and OCT features were more likely to experience a greater proportion of ≥50 µm reduction in CRT (P<0.05). The BCVA decreases were positively associated with the reductions in CRT (r=0.34, P<0.01) and TMV (r=0.41, P<0.01). Among patients with neovascular AMD, IVB resulted in earlier significant decreases in TMV and CRT, suggesting that these OCT anatomical outcomes may be considered as more sensitive responders to evaluate the treatment effects of bevacizumab. PMID:26171156

  11. Determinants of healthcare utilisation and predictors of outcome in colorectal cancer patients from Northern Iran.

    PubMed

    Semnani, S; Noorafkan, Z; Aryaie, M; Sedaghat, S-M; Moghaddami, A; Kazemnejhad, V; Khorasaninejhad, R; Ghasemi-Kebria, F; Roshandel, G

    2016-03-01

    We aimed to assess healthcare utilisation (HU), its determinants, as well as its relationship with survival in colorectal cancer (CRC) patients. This study was conducted on incident CRC cases from Northern Iran. Information on HU was collected using a valid questionnaire, considering eight diagnostic and four therapeutic services. The results were categorised as good and poor HU. Multivariate logistic regression analysis was used to assess the relationship between HU and other variables. Cox regression analysis was performed to determine major predictors of survival. In total, 227 new cases of CRC were enrolled. HU could be assessed in 218 subjects (96%). Living in rural areas was the strongest variable related to poor HU (adjusted OR, odds ratio = 2.65; CI, confidence interval: 1.30-5.40). The median survival time was 40.5 months. The 1-, 3- and 5-year survival rates were 71%, 52% and 44% respectively. Cox regression analysis showed a significant lower survival rate in patients with poor HU (HR = 2.3; CI: 1.46-3.64). HU was an independent predictor of survival in our CRC patients. Patients' place of residence was a significant determinant of HU. Regarding its effects on patients' outcome, HU and its determinants should be considered in designing CRC controlling programmes in our region and similar high-risk populations. PMID:25801407

  12. Predictors of clinically significant weight loss and participant retention in an insurance-sponsored community-based weight management program.

    PubMed

    Abildso, Christiaan G; Zizzi, Sam; Fitzpatrick, Sean J

    2013-07-01

    Health insurance providers are a logical partner in providing third-party payment for behavioral weight loss programming, but little evidence of predictors of improved outcomes or retention in large, insurance-sponsored lifestyle programming is available. The purpose was to determine predictors of weight loss and retention in an insurance-sponsored, community-based weight management program. Current and former participants (N = 2,106) were recruited to complete a program evaluation survey. Respondents' survey and objective outcome data (n = 766) were analyzed using logistic regression procedures to understand the factors predictive of clinically-significant (5%) weight loss and program retention (>6 months). Clinically significant weight loss was predicted by completing more than 6 months of the program, positive ratings of staff interaction, and social support from friends on success. Ratings of positive impact of site hours of operation, nurse calls, and availability of safe places to be active and feeling comfortable at the site were predictive of program retention. Modifiable intervention, social factors, and site-level factors were predictive of clinically significant weight loss and program retention, providing fodder for further study and dissemination to current providers and to a broader network of health promotion professionals. PMID:23075503

  13. Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study

    PubMed Central

    Beslow, Lauren A; Licht, Daniel J; Smith, Sabrina E; Storm, Phillip B; Heuer, Gregory G; Zimmerman, Robert A; Feiler, Alana M; Kasner, Scott E; Ichord, Rebecca N; Jordan, Lori C

    2010-01-01

    Background and Purpose To describe features of children with intracerebral hemorrhage (ICH) and to determine predictors of short-term outcome in a single-center prospective cohort study. Methods Single-center prospective consecutive cohort study of spontaneous ICH in children age 1-18 years from January 2006 to June 2008. Exclusion criteria were inciting trauma; intracranial tumor; isolated epidural, subdural, intraventricular, or subarachnoid hemorrhage; hemorrhagic transformation of ischemic stroke; and cerebral sinovenous thrombosis. Hospitalization records were abstracted. Follow-up assessments included outcome scores using the Pediatric Stroke Outcome Measure (PSOM) and King's Outcome Scale for Childhood Head Injury (KOSCHI). ICH volumes and total brain volumes (TBV) were measured by manual tracing. Results Twenty-two patients, median age of 10.3 years (range 4.2-16.6 years), had presenting symptoms of headache in 77%, focal deficits 50%, altered mental status 50%, and seizures 41%. Vascular malformations caused hemorrhage in 91%. Surgical treatment (hematoma evacuation, lesion embolization or excision) was performed during acute hospitalization in 50%. One patient died acutely. At median follow-up of 3.5 months (range 0.3-7.5 months), 71% of survivors had neurological deficits; 55% had clinically significant disability. Outcome based on PSOM and KOSCHI scores was worse in patients with ICH volume >2% of TBV (p=0.023) and altered mental status at presentation (p = 0.005). Conclusions Spontaneous childhood ICH was due mostly to vascular malformations. Acute surgical intervention was commonly performed. Although death was rare, 71% of survivors had persisting neurological deficits. Larger ICH volume and altered mental status predicted clinically significant disability. PMID:20019325

  14. Personality predictors of academic outcomes: big five correlates of GPA and SAT scores.

    PubMed

    Noftle, Erik E; Robins, Richard W

    2007-07-01

    The authors examined relations between the Big Five personality traits and academic outcomes, specifically SAT scores and grade-point average (GPA). Openness was the strongest predictor of SAT verbal scores, and Conscientiousness was the strongest predictor of both high school and college GPA. These relations replicated across 4 independent samples and across 4 different personality inventories. Further analyses showed that Conscientiousness predicted college GPA, even after controlling for high school GPA and SAT scores, and that the relation between Conscientiousness and college GPA was mediated, both concurrently and longitudinally, by increased academic effort and higher levels of perceived academic ability. The relation between Openness and SAT verbal scores was independent of academic achievement and was mediated, both concurrently and longitudinally, by perceived verbal intelligence. Together, these findings show that personality traits have independent and incremental effects on academic outcomes, even after controlling for traditional predictors of those outcomes. ((c) 2007 APA, all rights reserved). PMID:17605593

  15. Educational skills: long-term outcome and predictors following paediatric traumatic brain injury.

    PubMed

    Catroppa, Cathy; Anderson, Vicki A; Muscara, Frank; Morse, Sue A; Haritou, Flora; Rosenfeld, Jeffrey V; Heinrich, Liesl M

    2009-10-01

    Given that reading, spelling and arithmetic skills are acquired through childhood, their development may be compromised following a childhood traumatic brain injury (TBI). The present study examined educational skills (reading accuracy, spelling and arithmetic) at a mean follow-up interval of 6.8 years post-injury in children who had sustained a mild, moderate, or severe TBI at two ages: 'Young' (age at injury: 3-7 years, n = 48) and 'Old': (age at injury: 8-12 years, n = 36). Comparisons between the young and old TBI groups resulted in inconsistent findings. While a dose-response relationship for severity was evident for the young group, this was not always the case for the old group. Significant predictors of outcome included both severity and acute intellectual function. PMID:19306233

  16. Outcome-adaptive randomization for a delayed outcome with a short-term predictor: imputation-based designs.

    PubMed

    Kim, Mi-Ok; Liu, Chunyan; Hu, Feifang; Lee, J Jack

    2014-10-15

    Delay in the outcome variable is challenging for outcome-adaptive randomization, as it creates a lag between the number of subjects accrued and the information known at the time of the analysis. Motivated by a real-life pediatric ulcerative colitis trial, we consider a case where a short-term predictor is available for the delayed outcome. When a short-term predictor is not considered, studies have shown that the asymptotic properties of many outcome-adaptive randomization designs are little affected unless the lag is unreasonably large relative to the accrual process. These theoretical results assumed independent identical delays, however, whereas delays in the presence of a short-term predictor may only be conditionally homogeneous. We consider delayed outcomes as missing and propose mitigating the delay effect by imputing them. We apply this approach to the doubly adaptive biased coin design (DBCD) for motivating pediatric ulcerative colitis trial. We provide theoretical results that if the delays, although non-homogeneous, are reasonably short relative to the accrual process similarly as in the iid delay case, the lag is also asymptotically ignorable in the sense that a standard DBCD that utilizes only observed outcomes attains target allocation ratios in the limit. Empirical studies, however, indicate that imputation-based DBCDs performed more reliably in finite samples with smaller root mean square errors. The empirical studies assumed a common clinical setting where a delayed outcome is positively correlated with a short-term predictor similarly between treatment arm groups. We varied the strength of the correlation and considered fast and slow accrual settings. PMID:24889540

  17. Donor Hemodynamics as a Predictor of Outcomes After Kidney Transplantation From Donors After Cardiac Death.

    PubMed

    Allen, M B; Billig, E; Reese, P P; Shults, J; Hasz, R; West, S; Abt, P L

    2016-01-01

    Donation after cardiac death is an important source of transplantable organs, but evidence suggests donor warm ischemia contributes to inferior outcomes. Attempts to predict recipient outcome using donor hemodynamic measurements have not yielded statistically significant results. We evaluated novel measures of donor hemodynamics as predictors of delayed graft function and graft failure in a cohort of 1050 kidneys from 566 donors. Hemodynamics were described using regression line slopes, areas under the curve, and time beyond thresholds for systolic blood pressure, oxygen saturation, and shock index (heart rate divided by systolic blood pressure). A logistic generalized estimation equation model showed that area under the curve for systolic blood pressure was predictive of delayed graft function (above median: odds ratio 1.42, 95% confidence interval [CI] 1.06-1.90). Multivariable Cox regression demonstrated that slope of oxygen saturation during the first 10 minutes after extubation was associated with graft failure (below median: hazard ratio 1.30, 95% CI 1.03-1.64), with 5-year graft survival of 70.0% (95%CI 64.5%-74.8%) for donors above the median versus 61.4% (95%CI 55.5%-66.7%) for those below the median. Among older donors, increased shock index slope was associated with increased hazard of graft failure. Validation of these findings is necessary to determine the utility of characterizing donor warm ischemia to predict recipient outcome. PMID:26361242

  18. Predictors of outcome in early-onset psychosis: a systematic review

    PubMed Central

    Díaz-Caneja, Covadonga M; Pina-Camacho, Laura; Rodríguez-Quiroga, Alberto; Fraguas, David; Parellada, Mara; Arango, Celso

    2015-01-01

    Given the global burden of psychotic disorders, the identification of patients with early-onset psychosis (EOP; that is, onset before the age of 18) at higher risk of adverse outcome should be a priority. A systematic search of Pubmed, Embase, and PsycInfo (1980 through August 2014) was performed to identify longitudinal observational studies assessing correlates and/or predictors of clinical, functional, cognitive, and biological outcomes in EOP. Seventy-five studies were included in the review. Using multivariate models, the most replicated predictors of worse clinical, functional, cognitive, and biological outcomes in EOP were premorbid difficulties and symptom severity (especially of negative symptoms) at baseline. Longer duration of untreated psychosis (DUP) predicted worse clinical, functional, and cognitive outcomes. Higher risk of attempting suicide was predicted by greater severity of psychotic illness and of depressive symptoms at the first episode of psychosis. Age at onset and sex were not found to be relevant predictors of outcome in most multivariate models, whereas studies using bivariate analyses yielded inconsistent results. Lower intelligence quotient at baseline predicted lower insight at follow-up, worse functional outcomes, and a diagnostic outcome of schizophrenia. Biological predictors of outcome in EOP have been little studied and have not been replicated. Lower levels of antioxidants at baseline predicted greater brain volume changes and worse cognitive functioning at follow-up, whereas neuroimaging markers such as regional cortical thickness and gray matter volume at baseline predicted remission and better insight at follow-up, respectively. EOP patients with poorer premorbid adjustment and prominent negative symptoms at initial presentation are at risk of poor outcome. They should therefore be the target of careful monitoring and more intensive interventions to address whether the disease course can be modified in this especially severely

  19. Pretreatment PSA Velocity as a Predictor of Disease Outcome Following Radical Radiation Therapy

    SciTech Connect

    Palma, David . E-mail: dpalma@bccancer.bc.ca; Tyldesley, Scott; Blood, Paul; Liu, Mitchell; Morris, James; Pickles, Tom

    2007-04-01

    Purpose: Pretreatment prostate-specific antigen velocity (PSAV) greater than 2.0 ng/mL/year has been identified as a predictor of disease-specific survival (DSS) and overall survival (OS) after radiotherapy for prostate adenocarcinoma. This study aimed to independently verify if pretreatment PSAV is associated with biochemical disease-free survival (bDFS), DSS, or OS in men undergoing radiation therapy. Methods and Materials: A total of 473 patients treated with radiation therapy for localized prostate cancer formed the study cohort. No men received neoadjuvant or adjuvant hormones. Kaplan-Meier and Cox regression analysis were used to evaluate if PSAV predicted disease endpoints. Results: Men with a PSAV greater than 2.0 ng/mL/year had a shorter bDFS compared with men with a PSAV of 2.0 ng/mL/year or less (median, bDFS 68 months vs. 97 months; p = 0.0003). However, on multivariate analysis, PSAV was no longer a significant predictor of bDFS in the entire cohort (p = 0.09). PSAV did not predict DSS or OS (p = 0.55 and p = 0.99, respectively). In patients with high-risk disease, PSAV predicted bDFS on univariate (p = 0.0002) and multivariate (p = 0.02) analysis, but not DSS or OS. Conclusion: Pretreatment PSAV greater than 2.0 ng/mL/year is associated with reduced bDFS. However, PSAV is an independent predictor of bDFS only in high-risk patients. PSAV does not predict survival outcomes.

  20. Predictors of clinical outcome after minimally invasive percutaneous nephrolithotomy for renal calculus.

    PubMed

    Li, Zhao-Lun; Deng, Qian; Chong, Tie; Zhang, Peng; Li, He-Cheng; Li, Hong-Liang; Chen, Hai-Wen; Gan, Wei-Min

    2015-08-01

    To investigate all the predictors of operative duration, hospital stay and stone-free rate post-minimally invasive percutaneous nephrolithotomy (MPCNL) and to establish a logistic regression formula to predict the probability of stone-free post-MPCNL. From August 2009 to August 2012, 396 patients were enrolled in the present study. The patients' characteristics, history, laboratory examination and imaging information were used as independent variables, and operative duration, hospital stay, residuals (≥4 mm) as outcomes. Univariate and multiple regression analysis were performed to determine independent variables. According to the result of multiple logistic regression analysis, a logistic regression formula was established to predict the stone-free probability post-MPCNL. The predictors of operative duration were type of stones and stone burden. Factors affecting hospital stay included leucocytes, stone burden, type of stones and hemoglobin. Residuals were significantly related with stone burden and type of stones. With the above results, we developed a logistic regression formula, which can effectively predict the probability of stone-free with 91.7% of sensitivity, 70.4% of specificity and 85.9% of overall accuracy. PMID:25896255

  1. Physiological and Computed Tomographic Predictors of Outcome from Lung Volume Reduction Surgery

    PubMed Central

    Washko, George R.; Martinez, Fernando J.; Hoffman, Eric A.; Loring, Stephen H.; Estépar, Raúl San José; Diaz, Alejandro A.; Sciurba, Frank C.; Silverman, Edwin K.; Han, MeiLan K.; DeCamp, Malcolm; Reilly, John J.

    2010-01-01

    of emphysema and its distribution are weak but statistically significant predictors of outcome after LVRS. PMID:19965810

  2. Predictors of Outcome in Traumatic Brain Injury: New Insight Using Receiver Operating Curve Indices and Bayesian Network Analysis

    PubMed Central

    Zador, Zsolt; Sperrin, Matthew; King, Andrew T.

    2016-01-01

    Background Traumatic brain injury remains a global health problem. Understanding the relative importance of outcome predictors helps optimize our treatment strategies by informing assessment protocols, clinical decisions and trial designs. In this study we establish importance ranking for outcome predictors based on receiver operating indices to identify key predictors of outcome and create simple predictive models. We then explore the associations between key outcome predictors using Bayesian networks to gain further insight into predictor importance. Methods We analyzed the corticosteroid randomization after significant head injury (CRASH) trial database of 10008 patients and included patients for whom demographics, injury characteristics, computer tomography (CT) findings and Glasgow Outcome Scale (GCS) were recorded (total of 13 predictors, which would be available to clinicians within a few hours following the injury in 6945 patients). Predictions of clinical outcome (death or severe disability at 6 months) were performed using logistic regression models with 5-fold cross validation. Predictive performance was measured using standardized partial area (pAUC) under the receiver operating curve (ROC) and we used Delong test for comparisons. Variable importance ranking was based on pAUC targeted at specificity (pAUCSP) and sensitivity (pAUCSE) intervals of 90–100%. Probabilistic associations were depicted using Bayesian networks. Results Complete AUC analysis showed very good predictive power (AUC = 0.8237, 95% CI: 0.8138–0.8336) for the complete model. Specificity focused importance ranking highlighted age, pupillary, motor responses, obliteration of basal cisterns/3rd ventricle and midline shift. Interestingly when targeting model sensitivity, the highest-ranking variables were age, severe extracranial injury, verbal response, hematoma on CT and motor response. Simplified models, which included only these key predictors, had similar performance (pAUCSP = 0

  3. Predictors of Functional Outcome Among Stroke Patients in Lima, Peru

    PubMed Central

    Abanto, Carlos; Ton, Thanh G.N.; Tirschwell, David L.; Montano, Silvia; Quispe, Yrma; Gonzales, Isidro; Valencia, Ana; Calle, Pilar; Garate, Arturo; Zunt, Joseph

    2013-01-01

    Background Due to the aging population in low- and middle-income countries, cerebrovascular disease is expected to remain a leading cause of death. Little has been published about stroke in Peru. Aims We conducted a retrospective cohort study of hospitalized stroke patients at a referral center hospital in Lima, Peru to explore factors associated with functional outcome among stroke patients. Methods We identified 579 patients hospitalized for ischemic stroke or intracerebral hemorrhage stroke at the National Institute of Neurologic Sciences in Lima, Peru in 2008 and 2009. A favorable outcome was defined as a modified Rankin score of ≤2 at discharge. Results The mean age was 63.3 years; 75.6% had ischemic stroke; the average length of stay was 17.3 days. At hospital discharge, 231 (39.9%) had a favorable outcome. The overall mortality rate was 5.2%. In multivariate models, the likelihood of having a favorable outcome decreased linearly with increasing age (p=0.02) and increasing NIHSS (p=0.02). Favorable outcome was also associated with male gender (relative risk [RR]=1.2; 95% confidence interval [CI]: 1.0, 1.5) and divorced status (RR=1.3, 95% CI: 1.1, 1.7). Patients on Salud Integral de Salud (public assistance-type insurance, SIS) (RR=0.7, 95% CI: 0.5,1.0) were also less likely to have a favorable outcome. Conclusions Favorable outcome after stroke was independently associated with younger age, lower NIHSS score, male gender, being divorced, and not being on SIS insurance. These findings suggest further study of worse functional outcomes in patients with SIS insurance and confirm the importance of risk adjustment for age, stroke severity (NIHSS) and other socioeconomic factors in outcomes studies. Future studies should preferentially assess outcome at 30-days and 6-months to provide more reliable comparisons and allow additional study of Peruvian end-of-life decision-making and care. PMID:23352681

  4. Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Johnson, William R.; Makani, Amun; Wall, Andrew J.; Hosseini, Ali; Hampilos, Perry; Li, Guoan; Gill, Thomas J.

    2015-01-01

    Background: Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. Purpose: To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed. Results: Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017). Conclusion: Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction

  5. [F-18] FDG-PET/CT parameters as predictors of outcome in inoperable NSCLC patients

    PubMed Central

    Nappi, Antonio; Gallicchio, Rosj; Simeon, Vittorio; Nardelli, Anna; Pelagalli, Alessandra; Zupa, Angela; Vita, Giulia; Venetucci, Angela; Di Cosola, Michele; Barbato, Francesco; Storto, Giovanni

    2015-01-01

    Background We evaluated the prognostic significance of standardized uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) in [F-18] FDG PET/CT findings in patients with inoperable non-small-cell lung cancer (NSCLC). Patients and methods. One hundred and three patients (mean age, 65.6 ± 16 years) underwent [F-18] FDG PET/CT before the chemotherapy. The SUVmax value, the MTV (cm3; 42% threshold) and the TLG (g) were registered. The patients were followed up to 18 months thereafter (range 12–55 months). Failure to respond without progression, progression and/or disease-related death constituted surrogate end-points. The optimal SUVmax, MTV and TLG cut-off to predict the patients’ outcome were estimated. PET/CT results were then related to disease outcome (progression free survival; PFS). Results The Kaplan-Meier survival analysis for SUVmax showed a significant shorter PFS in patients presenting with lower values as compared to those with higher (p < 0.05, log-rank test). MTV and TLG were not suitable for predicting PFS apart from the subset of patients with mediastinal nodal involvement. Conclusions Despite the availability of new tools for the quantitative assessment of disease activity on PET/CT, the SUVmax rather than MTV and TLG remains the only predictor for PFS in NSCLC patients. MTV holds a value only when concomitant nodal involvement occurs. PMID:26834517

  6. Process Predictors of the Outcome of Group Drug Counseling

    ERIC Educational Resources Information Center

    Crits-Christoph, Paul; Johnson, Jennifer E.; Connolly Gibbons, Mary Beth; Gallop, Robert

    2013-01-01

    Objective: This study examined the relation of process variables to the outcome of group drug counseling, a commonly used community treatment, for cocaine dependence. Method: Videotaped group drug counseling sessions from 440 adult patients (23% female, 41% minority) were rated for member alliance, group cohesion, participation, self-disclosure,…

  7. Predictors of Study Abroad Intent, Participation, and College Outcomes

    ERIC Educational Resources Information Center

    Luo, Jiali; Jamieson-Drake, David

    2015-01-01

    This study examined US undergraduate students' intent to study abroad upon college entry and their actual participation in study abroad during their undergraduate years, correlating the college outcomes of three cohorts to identify trends. The findings show that study abroad intent and participation are interrelated and shaped by an array of…

  8. Planning in Middle Childhood: Early Predictors and Later Outcomes

    ERIC Educational Resources Information Center

    Friedman, Sarah L.; Scholnick, Ellin K.; Bender, Randall H.; Vandergrift, Nathan; Spieker, Susan; Pasek, Kathy Hirsh; Keating, Daniel P.; Park, Yoonjung

    2014-01-01

    Data from 1,364 children and families who participated in the National Institute of Child Health and Human Development's Study of Early Child Care and Youth Development were analyzed to track the early correlates and later academic outcomes of planning during middle childhood. Maternal education, through its effect on parenting quality when…

  9. Predictors of Parenting and Infant Outcomes for Impoverished Adolescent Parents

    ERIC Educational Resources Information Center

    Whitson, Melissa L.; Martinez, Andrew; Ayala, Carmen; Kaufman, Joy S.

    2011-01-01

    Adolescent mothers and their children are at risk for a myriad of negative outcomes. This study examined risk and protective factors and their impact on a sample (N = 172) of impoverished adolescent mothers. Multiple regression analyses revealed that depressed adolescent mothers report higher levels of parenting stress and that their children are…

  10. Predictors of Outcome following Acquired Brain Injury in Children

    ERIC Educational Resources Information Center

    Johnson, Abigail R.; DeMatt, Ellen; Salorio, Cynthia F.

    2009-01-01

    Acquired brain injury (ABI) in children and adolescents can result from multiple causes, including trauma, central nervous system infections, noninfectious disorders (epilepsy, hypoxia/ischemia, genetic/metabolic disorders), tumors, and vascular abnormalities. Prediction of outcomes is important, to target interventions, allocate resources,…

  11. Predictors of Outcomes after Arthroscopic Double-row Rotator Cuff Repair in 155 Cases

    PubMed Central

    Katthagen, Jan Christoph; Millett, Peter J.; Espinoza-Ervin, Christopher; Horan, Marilee P.; Ho, Charles P.; Warth, Ryan J.; Dornan, Grant

    2016-01-01

    Objectives: The purpose of this study was to analyze predictors of clinical outcomes of knotted versus knotless double-row self-reinforcing rotator cuff repairs of full-thickness rotator cuff tears with propensity score matching. Methods: Patients with arthroscopic repair of full-thickness rotator cuff tears involving the supraspinatus tendon using either a knotted or knotless linked, self-reinforcing double-row technique were included in the study. Preoperative subjective evaluation was performed using the ASES and SF-12 PCS scores. After a minimum two-year follow-up period, ASES and SF-12 PCS scores were collected again along with the SANE score, the QuickDASH score, and patient satisfaction. All data were collected prospectively and retrospectively reviewed. Postoperative ASES and SF-12 PCS scores were then modeled using inverse propensity score weighting in a multiple linear regression model (MLR) with multiple imputations. Age, sex, baseline ASES score, length of follow-up, number of anchors, worker’s compensation, previous cuff repair, and double-row repair technique (knotted or knotless) were the covariates used in this model. Results: 155 shoulders in 151 patients (109 men, 42 women; mean age at time of surgery 59±10 years) were eligible for inclusion. Outcomes data were available for 130 of 148 shoulders (87.8%) after exclusion of seven shoulders (4.5%) that underwent revision rotator cuff repair before final follow up (n=33/39 in the knotted group [84.6%]; n=97/109 [88.9%] in the knotless group).The mean follow-up was 2.9 years (range, 2.0-5.4 years). Overall, postoperative outcomes scores were significantly improved when compared to preoperative baselines (p<0.05), with a median postoperative ASES score of 97 for the entire cohort. Our model showed that previous rotator cuff repair had a significant negative effect on postoperative ASES (β = -12.7, p<0.001) and SF-12 PCS scores (β = -5.0, p = 0.036). A workers’ compensation claim (β = -10.6, p

  12. Cholestatic hepatitis C following liver transplantation: an outcome-based histological definition, clinical predictors, and prognosis.

    PubMed

    Verna, Elizabeth C; Abdelmessih, Rita; Salomao, Marcela A; Lefkowitch, Jay; Moreira, Roger K; Brown, Robert S

    2013-01-01

    Cholestatic hepatitis C virus (HCV) is a rare form of recurrent HCV following liver transplantation (LT) without specific diagnostic criteria. An outcome-based method to improve its diagnosis and a description of its prognosis are needed. All 1-year post-LT protocol liver biopsy samples and biopsy samples initially reported to show cholestatic HCV from patients transplanted with HCV between February 2002 and December 2009 were reviewed for the inflammation grade, the fibrosis stage, and 4 cholestatic HCV features: ductular proliferation, canalicular cholestasis with or without intracellular cholestasis, hepatocyte swelling with or without lobular disarray, and sinusoidal/pericellular fibrosis. We used patient and graft survival to define histological criteria for cholestatic HCV, and compared the clinical features of these patients to those of patients with minimal or significant post-LT fibrosis. One hundred seventy-nine patients were analyzed, the median age was 56 years, and 73% were male. Patients with 3 or more of the 4 cholestatic HCV criteria had significantly worse survival (log-rank P < 0.001) regardless of the fibrosis stage, and this was used as our novel definition of cholestatic HCV. Using this definition, we found that 27 patients (15%) had cholestatic HCV, 53 (30%) had significant fibrosis (stage ≥ 2/4), and 99 (55%) had minimal fibrosis (stage < 2/4). The final model for clinical predictors of cholestatic HCV included donor age [odds ratio (OR) = 1.37 per decade, P = 0.04] and previous rejection (Banff grade ≥ 5; OR = 4.19, P = 0.002). Total bilirubin was the strongest laboratory predictor of cholestatic HCV (area under the curve = 0.93), whereas the HCV viral load was not a significant predictor. The final model of post-LT survival included the pathology group {cholestatic HCV [hazard ratio (HR) = 6.07, P < 0.001] and significant fibrosis (HR = 2.53, P = 0.02)}, donor age (HR = 1.49 per decade, P < 0.001), and cold ischemia time (HR = 1.11 per

  13. Predictors and Moderators of Outcome in Family-Based Treatment for Adolescent Bulimia Nervosa

    ERIC Educational Resources Information Center

    Le Grange, Daniel; Crosby, Ross D.; Lock, James

    2008-01-01

    The predictors and moderators of treatment outcome for adolescents with bulimia nervosa (BN) are explored among those who participated in family based treatment or individual supportive psychotherapy. It is concluded that family-based treatment of BN may be most effective in those cases with low levels of eating disorder psychopathology.

  14. Predictors and Outcomes of Parental Involvement with High School Students in Science

    ERIC Educational Resources Information Center

    Shumow, Lee; Lyutykh, Elena; Schmidt, Jennifer A.

    2011-01-01

    Demographic and psychological predictors of parent involvement with their children's science education both at home and at school were examined during high school. Associations between both types of parent involvement and numerous academic outcomes were tested. Data were collected from 244 high school students in 12 different science classrooms…

  15. Hospital-Based Behavior Modification Program for Adolescents: Evaluation and Predictors of Outcome.

    ERIC Educational Resources Information Center

    Al Ansari, Ahmed; And Others

    1996-01-01

    Evaluates a short-term residential program utilizing a behavior modification program in an outpatient unit for adolescents with mostly conduct problems. Evaluation indicated predictors of outcome, including: age, gender, diagnosis, length of stay, father's presence, other treatments received, and presence of learning problems. Factors such as…

  16. Predictors of Substance Use and Family Therapy Outcome among Physically and Sexually Abused Runaway Adolescents

    ERIC Educational Resources Information Center

    Slesnick, Natasha; Bartle-Haring, Suzanne; Gangamma, Rashmi

    2006-01-01

    There is a dearth of research that examines the impact of family systems therapy on problems among sexually and/or physically abused youth. Given this void, differential outcome and predictors of substance use change were evaluated for abused, as compared with nonabused, runaway adolescents who were randomly assigned to family therapy or treatment…

  17. Predictors and Health-Related Outcomes of Positive Body Image in Adolescent Girls: A Prospective Study

    ERIC Educational Resources Information Center

    Andrew, Rachel; Tiggemann, Marika; Clark, Levina

    2016-01-01

    This study aimed to investigate prospective predictors and health-related outcomes of positive body image in adolescent girls. In so doing, the modified acceptance model of intuitive eating was also examined longitudinally. A sample of 298 girls aged 12 to 16 years completed a questionnaire containing measures of body appreciation, potential…

  18. Predictors of Vocational Rehabilitation Return-to-Work Outcomes in Workers' Compensation.

    ERIC Educational Resources Information Center

    Blackwell, Terry L.; Leierer, Stephen L.; Haupt, Stephanie; Kampitsis, Angeliki

    2003-01-01

    The postinjury return-to-work (RTW) status of 502 injured workers in Montana who were referred for vocational rehabilitation services between 1984 and 1991 was examined to determine which variables improved the capacity to predict RTW outcomes after injury. Predictor variables included age, education, attorney involvement, mandated vocational…

  19. Outcome and predictors of cardiopulmonary resuscitation among patients admitted in Medical Intensive Care Unit in North India

    PubMed Central

    Bansal, Amit; Singh, Tirath; Ahluwalia, Gautam; Singh, Parminder

    2016-01-01

    Background: Outcome and predictors of survival after cardiopulmonary resuscitation (CPR) in Intensive Care Units (ICUs) have been extensively studied in western world, but data from developing countries is sparse. Objectives: To study the outcome and predictors of survival after CPR in a Medical ICU (MICU) of a tertiary level teaching hospital in North India. Materials and Methods: A 1-year prospective cohort study. Results: Of 105 in-MICU CPRs, forty patients (38.1%) achieved return of spontaneous circulation (ROSC). Only one patient (0.9%) survived up to hospital discharge. The predictors of ROSC were ventricular tachycardia/ventricular fibrillation as first monitored rhythm, intubation during CPR and CPR duration ≤ 10 min. CPR duration > 10 min was a significant factor for resuscitation failure. Conclusions: The rate of survival to hospital discharge after in-MICU CPRs is extremely poor. Our data may aid treating physicians, resuscitation teams, and families in understanding the likely outcome of patients after in-MICU CPRs. PMID:27076727

  20. Predictors of surgical outcome in thoracic ossification of the ligamentum flavum: focusing on the quantitative signal intensity

    PubMed Central

    Zhang, JingTao; Wang, LinFeng; Li, Jie; Yang, Peng; Shen, Yong

    2016-01-01

    The association between intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) and surgical outcome in thoracic ossification of the ligamentum flavum (OLF) remains controversial. We aimed to determine the impact of signal change ratio (SCR) on thoracic OLF surgical outcomes. We retrospectively reviewed 96 cases of thoracic OLF surgery and investigated myelopathy severity, symptom duration, MRI and computed tomographic findings, surgical technique and postoperative recoveries. Surgical outcomes were evaluated according to the modified Japanese Orthopaedic Association (JOA) score and recovery rate. JOA recovery rate <50% was defined as a poor surgical outcome. By multivariate logistic regression analysis, we identified risk factors associated with surgical outcomes. Forty patients (41.7%) had a recovery rate of <50%. In receiver operating characteristic (ROC) curves, the optimal preoperative SCR cutoff value as a predictor of poor surgical outcome was 1.54. Multivariate logistic regression analysis revealed that a preoperative SCR ≥1.54 and symptom duration >12 months were significant risk factors for a poor surgical outcome. These findings suggest that preoperative SCR and duration of symptoms were significant risk factors of surgical outcome for patients with thoracic OLF. Patients with preoperative SCR ≥1.54 can experience poor postoperative recovery. PMID:26960572

  1. Predictors of outcome of multidisciplinary treatment in chronic widespread pain: an observational study

    PubMed Central

    2013-01-01

    Background The effectiveness of multidisciplinary treatment in chronic widespread pain (CWP) is limited. The considerable heterogeneity among patients is a likely explanation. Knowledge on predictors of the outcome of multidisciplinary treatment can help to optimize treatment effectiveness. The purpose of this study was to identify predictors of multidisciplinary treatment outcome in patients with CWP. Methods Data were used from baseline and 6 months follow-up measurements of a prospective cohort study of 120 CWP. Regression models were used to assess whether baseline variables predicted treatment outcome. Outcome domains included: pain, pain interference, depression, and global perceived effect (GPE). Potential predictors included: psychological distress, illness and self-efficacy beliefs, fear-avoidance beliefs and behaviour, symptoms, disability, and socio-demographic factors. Results Greater improvement in pain was predicted by more pain at baseline and male gender. Greater improvement in interference of pain in daily life was predicted by more interference of pain in daily life at baseline, lower levels of anxiety, a stronger belief in personal control, less belief in consequences, male gender, and a higher level of education. Greater improvement in depression was predicted by higher baseline values of depression, stronger beliefs in personal control, and a higher level of education. Better outcome on GPE was predicted by less pain, less fatigue, and a higher level of education. Conclusion Less anxiety, stronger beliefs in personal control, less belief in consequences, less pain, less fatigue, higher level of education, and male gender are predictors of better outcome of multidisciplinary treatment in CWP. Tailoring treatment to these specific patient characteristics or selecting eligible patients for multidisciplinary treatment may further improve treatment outcome. PMID:23577981

  2. An adaptive resampling test for detecting the presence of significant predictors

    PubMed Central

    McKeague, Ian W.; Qian, Min

    2015-01-01

    This paper investigates marginal screening for detecting the presence of significant predictors in high-dimensional regression. Screening large numbers of predictors is a challenging problem due to the non-standard limiting behavior of post-model-selected estimators. There is a common misconception that the oracle property for such estimators is a panacea, but the oracle property only holds away from the null hypothesis of interest in marginal screening. To address this difficulty, we propose an adaptive resampling test (ART). Our approach provides an alternative to the popular (yet conservative) Bonferroni method of controlling familywise error rates. ART is adaptive in the sense that thresholding is used to decide whether the centered percentile bootstrap applies, and otherwise adapts to the non-standard asymptotics in the tightest way possible. The performance of the approach is evaluated using a simulation study and applied to gene expression data and HIV drug resistance data. PMID:27073292

  3. Natriuretic peptides: diagnostic tools and predictors of heart failure outcome.

    PubMed

    Isakson, Susan R; Gardetto, Nancy J; Maisel, Alan S

    2006-11-01

    Congestive heart failure (CHF) is a progressive disease whose outcome largely depends on early, accurate and prompt diagnosis, accompanied by evidence-based treatment. The explosion of uptake of natriuretic peptides (NPs) in clinical practice belies an understanding of how peptides are used. The signal for NP release is the same signal that causes symptoms of CHF, such as increased wall stress. Thus, NPs can reliably add to the information a physician brings to the table as they attempt to diagnose the acutely dyspneic patient with CHF. Additionally, NPs have strong prognostic utility in the emergency room and the hospital. Monitoring of NPs during treatment for acute CHF may help manage the patient. In the future, it is possible that NPs will play a more prominent role in early detection of left ventricular dysfunction as well as guiding chronic CHF treatment. PMID:19804259

  4. First-ever ischemic stroke in elderly patients: predictors of functional outcome following carotid artery stenting.

    PubMed

    Lin, Chih-Ming; Chang, Yu-Jun; Liu, Chi-Kuang; Yu, Cheng-Sheng; Lu, Henry Horng-Shing

    2016-01-01

    Age is an important risk factor for stroke, and carotid artery stenosis is the primary cause of first-ever ischemic stroke. Timely intervention with stenting procedures can effectively prevent secondary stroke; however, the impact of stenting on various periprocedural physical functionalities has never been thoroughly investigated. The primary aim of this study was to investigate whether prestenting characteristics were associated with long-term functional outcomes in patients presenting with first-ever ischemic stroke. The secondary aim was to investigate whether patient age was an important factor in outcomes following stenting, measured by the modified Rankin scale (mRS). In total, 144 consecutive patients with first-ever ischemic stroke who underwent carotid artery stenting from January 2010 to November 2014 were included. Clinical data were obtained by review of medical records. The Barthel index (BI) and mRS were used to assess disability before stenting and at 12-month follow-up. In total, 72/144 patients showed improvement (mRS[+]), 71 showed stationary and one showed deterioration in condition (mRS[-]). The prestenting parameters, ratio of cerebral blood volume (1.41 vs 1.2 for mRS[-] vs mRS[+]), BI (75 vs 85), and high-sensitivity C-reactive protein (hsCRP 5.0 vs 3.99), differed significantly between the two outcome groups (P<0.05). The internal carotid artery/common carotid artery ratio (P=0.011), BI (P=0.019), ipsilateral internal carotid artery resistance index (P=0.003), and HbA1c (P=0.039) were all factors significantly associated with patient age group. There was no significant association between age and poststenting outcome measured by mRS with 57% of patients in the ≥75 years age group showing mRS(-) and 43% showing mRS(+) (P=0.371). Our findings indicate that in our elderly patient series, carotid artery stenting may benefit a significant proportion of carotid stenotic patients regardless of age. Ratio of cerebral blood volume, BI, and

  5. First-ever ischemic stroke in elderly patients: predictors of functional outcome following carotid artery stenting

    PubMed Central

    Lin, Chih-Ming; Chang, Yu-Jun; Liu, Chi-Kuang; Yu, Cheng-Sheng; Lu, Henry Horng-Shing

    2016-01-01

    Age is an important risk factor for stroke, and carotid artery stenosis is the primary cause of first-ever ischemic stroke. Timely intervention with stenting procedures can effectively prevent secondary stroke; however, the impact of stenting on various periprocedural physical functionalities has never been thoroughly investigated. The primary aim of this study was to investigate whether prestenting characteristics were associated with long-term functional outcomes in patients presenting with first-ever ischemic stroke. The secondary aim was to investigate whether patient age was an important factor in outcomes following stenting, measured by the modified Rankin scale (mRS). In total, 144 consecutive patients with first-ever ischemic stroke who underwent carotid artery stenting from January 2010 to November 2014 were included. Clinical data were obtained by review of medical records. The Barthel index (BI) and mRS were used to assess disability before stenting and at 12-month follow-up. In total, 72/144 patients showed improvement (mRS[+]), 71 showed stationary and one showed deterioration in condition (mRS[−]). The prestenting parameters, ratio of cerebral blood volume (1.41 vs 1.2 for mRS[−] vs mRS[+]), BI (75 vs 85), and high-sensitivity C-reactive protein (hsCRP 5.0 vs 3.99), differed significantly between the two outcome groups (P<0.05). The internal carotid artery/common carotid artery ratio (P=0.011), BI (P=0.019), ipsilateral internal carotid artery resistance index (P=0.003), and HbA1c (P=0.039) were all factors significantly associated with patient age group. There was no significant association between age and poststenting outcome measured by mRS with 57% of patients in the ≥75 years age group showing mRS(−) and 43% showing mRS(+) (P=0.371). Our findings indicate that in our elderly patient series, carotid artery stenting may benefit a significant proportion of carotid stenotic patients regardless of age. Ratio of cerebral blood volume, BI, and

  6. Daily mood-drinking slopes as predictors: A new take on drinking motives and related outcomes

    PubMed Central

    Mohr, Cynthia D.; Brannan, Debi; Wendt, Staci; Jacobs, Laurie; Wright, Robert; Wang, Mo

    2014-01-01

    Motivational models of alcohol consumption have articulated the manner in which positive and negative experiences motivate drinking in unique social contexts (e.g., Cooper, Frone, Russell & Mudar, 1995). Daily process methodology, in which daily events, moods and drinking behaviors are reported daily or multiple times per day, has been used to examine behavioral patterns that are consistent with discrete motivations. We advance the notion that repeated patterns of drinking in various social contexts as a function of positive or negative mood increases can provide evidence of individual-level if-then drinking signatures, which in turn can predict drinking-related outcomes. The purpose of this study was to examine the utility of slopes to predict longer term drinking motivations and alcohol problems, employing a daily process study of non-clinical moderate alcohol drinkers (N=47; 49% women). Participants responded to thrice daily interviews administered via handheld computer for 30 days, followed by a longitudinal telephone survey for 12 months. Participants’ daily mood-drinking relationships were extracted from HLM and employed as predictors of 12-month outcomes in multiple regression analyses. Daily mood-drinking patterns demonstrated significant variability across persons, such that moderate drinkers could be reliably differentiated based on those patterns in terms of distinct drinking-related outcomes. Among the results, negative mood-solitary drinking slopes were associated with lower subsequent coping motives; yet, positive mood-solitary drinking slopes were predictive of higher coping and lower social motives. Conversely, positive mood-social drinking associations were predictive of higher enhancement motives and b-MAST scores. Results are interpreted in light of motivational models of consumption. PMID:23647154

  7. Daily mood-drinking slopes as predictors: a new take on drinking motives and related outcomes.

    PubMed

    Mohr, Cynthia D; Brannan, Debi; Wendt, Staci; Jacobs, Laurie; Wright, Robert; Wang, Mo

    2013-12-01

    Motivational models of alcohol consumption have articulated the manner in which positive and negative experiences motivate drinking in unique social contexts (e.g., M. L. Cooper, M. R. Frone, M. Russell & P. Mudar, 1995, Drinking to regulate positive and negative emotions: A motivational model of alcohol use, Journal of Personality and Social Psychology, Vol. 69, pp. 990-1005). Daily process methodology, in which daily events, moods, and drinking behaviors are reported daily or multiple times per day, has been used to examine behavioral patterns that are consistent with discrete motivations. We advance the notion that repeated patterns of drinking in various social contexts as a function of positive or negative mood increases can provide evidence of individual-level if-then drinking signatures, which in turn can predict drinking-related outcomes. The purpose of this study was to examine the utility of slopes to predict longer term drinking motivations and alcohol problems by employing a daily-process study of nonclinical moderate alcohol drinkers (N = 47; 49% women). Participants responded to thrice daily interviews administered via handheld computer for 30 days, followed by a longitudinal telephone survey for 12 months. Participants' daily mood-drinking relationships were extracted from hierarchical linear modeling and employed as predictors of 12-month outcomes in multiple regression analyses. Daily mood-drinking patterns demonstrated significant variability across persons, such that moderate drinkers could be reliably differentiated based on those patterns in terms of distinct drinking-related outcomes. Among the results, negative-mood-solitary-drinking slopes were associated with lower subsequent coping motives but positive-mood-solitary-drinking slopes were predictive of higher coping and lower social motives. Conversely, positive-mood-social-drinking associations were predictive of higher enhancement motives and brief Michigan Alcoholism Screening Test scores

  8. Predictors and Outcomes of Infection-Related Hospital Admissions of Heart Failure Patients

    PubMed Central

    Korenfeld, Roman; Fuchs, Shmuel

    2013-01-01

    Background Infections are one of the most common causes for hospitalization of patients with heart failure (HF). Yet, little is known regarding the prevalence and predictors of different types of acute infections as well as their impact on outcome among this growing population. Methods and Results We identified all patients aged 50 or older with a major diagnosis of HF and at least one echocardiography examination who had been hospitalized over a 10-year period (January 2000 and December 2009). Infection-associated admissions were identified according to discharge diagnoses. Among 9,335 HF patients, 3530 (38%) were hospitalized at least once due to infections. The most frequent diagnoses were respiratory infection (52.6%) and sepsis/bacteremia (23.6%) followed by urinary (15.7%) and skin and soft tissue infections (7.8%). Hospitalizations due to infections compared to other indications were associated with increased 30-day mortality (13% vs. 8%, p<0.0001). These higher mortality rates were predominately related to respiratory infections (OR 1.28 [95% CI 1.09, 1.5]) and sepsis\\bacteremia (OR 3.13 [95% CI 2.6, 3.7]). Important predictors for these serious infections included female gender, chronic obstructive pulmonary disease, past myocardial infarction and echocardiography-defined significant right (RV) but not left ventricular dysfunction. Conclusions Major infection-related hospitalizations are frequent among patients with HF and are associated with increased mortality rates. Elderly female patients with multiple comorbidities and those with severe RV dysfunction are at higher risk for these infections. PMID:24009684

  9. An investigation of predictors of NCLEX-RN outcomes among nursing content standardized tests.

    PubMed

    Yeom, Yei-Jin

    2013-12-01

    In order to meet increased demands for qualified registered nurses and prevent negative effects from graduates' failure on the National Council Licensure Examination-Registered Nurse, it is important to promote students' success in the exam. The purpose of this study was to investigate effective predictors of NCLEX-RN outcomes on the first attempt among nursing content standardized tests (adult medical-surgical, fundamentals for nursing, pharmacology, maternal-newborn, nursing care of children, mental health, community health, and leadership and management) conducted throughout the nursing program. NCLEX-RN outcomes and individual adjusted scores on the standardized tests of 151 graduates from the traditional baccalaureate nursing program of a public university located in the Midwest from May 2010 to December 2011 were analyzed by a t-test and logistic regression. The participants included 118 graduates who passed and 33 graduates who failed the NCLEX-RN on the first attempt. Significant statistical differences were found between the two groups with NCLEX-RN success and failure in the individual adjusted scores on all of the standardized tests except the fundamental for nursing (p=.62) and nursing care of children (p=.759) standardized tests. In addition, logistic regression indicated that the overall regression models were significant in predicting both NCLEX-RN success and failure. Adult medical-surgical, pharmacology, and community health standardized tests were central to the prediction of both NCLEX-RN success and failure; however, a much lower percentage of NCLEX-RN failure than success was classified. It can be concluded that the adult medical-surgical, pharmacology, and community health standardized tests were effective in predicting NCLEX-RN success and not effective in predicting NCLEX-RN failure on the first attempt. The NCLEX-RN success predictors can be utilized to identify students at risk and provide early remediation. After early remediation is

  10. Annexin A2 and S100A10 are independent predictors of serous ovarian cancer outcome.

    PubMed

    Lokman, Noor A; Pyragius, Carmen E; Ruszkiewicz, Andrew; Oehler, Martin K; Ricciardelli, Carmela

    2016-05-01

    Annexin A2, a calcium phospholipid binding protein, has been shown to play an important role in ovarian cancer metastasis. This study examined whether annexin A2 and S100A10 can be used as prognostic markers in serous ovarian cancer. ANXA2 and S100A10 gene expressions were assessed in publicly available ovarian cancer data sets and annexin A2 and S100A10 protein expressions were assessed by immunohistochemistry in a uniform cohort of stage III serous ovarian cancers (n = 109). Kaplan-Meier and Cox regression analyses were performed to assess the relationship between annexin A2 or S100A10 messenger RNA (mRNA) and protein expressions with clinical outcome. High ANXA2 mRNA levels in stage III serous ovarian cancers were associated with reduced progression-free survival (PFS; P = 0.023) and overall survival (OS; P = 0.0038), whereas high S100A10 mRNA levels predicted reduced OS (P = 0.0019). Using The Cancer Genome Atlas data sets, ANXA2 but not S100A10 expression was associated with higher clinical stage (P = 0.005), whereas both ANXA2 and S100A10 expressions were associated with the mesenchymal molecular subtype (P < 0.0001). Kaplan-Meier and Cox regression analyses showed that high stromal annexin A2 immunostaining was significantly associated with reduced PFS (P = 0.013) and OS (P = 0.044). Moreover, high cytoplasmic S100A10 staining was significantly associated with reduced OS (P = 0.027). Multivariate Cox regression analysis showed stromal annexin A2 (P = 0.009) and cytoplasmic S100A10 (P = 0.016) levels to be independent predictors of OS. Patients with high stromal annexin A2 and high cytoplasmic S100A10 expressions had a 3.4-fold increased risk of progression (P = 0.02) and 7.9-fold risk of ovarian cancer death (P = 0.04). Our findings indicate that together annexin A2 and S100A10 expressions are powerful predictors of serous ovarian cancer outcome. PMID:26925708

  11. Efficacy and Outcome Predictors of Gonadotropin Treatment for Male Congenital Hypogonadotropic Hypogonadism

    PubMed Central

    Liu, Zhaoxiang; Mao, Jangfeng; Wu, Xueyan; Xu, Hongli; Wang, Xi; Huang, Bingkun; Zheng, Junjie; Nie, Min; Zhang, Hongbing

    2016-01-01

    Abstract Gonadotropin induces masculinization and spermatogenesis in men with congenital hypogonadotropic hypogonadism (CHH). However, large cohort studies for the efficacy and reliable predictors of this therapy need to be conducted. The aim of this study was to investigate the efficacy of gonadotropin treatment in a large cohort of male CHH patients and analyze putative predictors for successful spermatogenesis. This retrospective study included 223 CHH azoospermic patients without puberty development treated between 2005 and 2014. All patients received combined human chorionic gonadotropin (HCG) and human menopausal gonadotropin (HMG) and were followed up for >6 months (5109 person-months). Serum total testosterone level, testicular size, spermatogenesis, and pregnancy outcome were recorded at each visit. After gonadotropin therapy, testicular size was enlarged from 2.1 ± 1.6 to 8.1 ± 4.6 mL (P < 0.001) and serum total testosterone was elevated from 0.9 ± 0.5 to 15.1 ± 8.2 nmol/L (P < 0.001). Spermatogenesis (>0/mL) occurred at a median period of 15 months (95% confidence interval 13.5–16.5). Larger basal testicular volume (P = 0.012) and noncryptorchidism history (P = 0.028) are independent predictors for earlier sperm appearance. Sixty four percent (143/223) of patients succeeded in producing sperms and the average time for initial sperm detection was 14 ± 8 months. However, their sperm concentrations (11.7 [2.1, 24.4] million/mL) and sperm progressive motility (A + B 36.9% ± 20.2%) are significantly lower than World Health Organization standards. Of the 34 patients who desired for fathering children, 19 patients impregnanted their partners during the treatment. Gonadotropin therapy induces spermatogenesis in male CHH patients. A larger basal testicular size and noncryptorchidism history are favorable indicators for earlier spermatogenesis. PMID:26945370

  12. Neuroimaging characteristics of ruptured aneurysm as predictors of outcome after aneurysmal subarachnoid hemorrhage: pooled analyses of the SAHIT cohort.

    PubMed

    Jaja, Blessing N R; Lingsma, Hester; Steyerberg, Ewout W; Schweizer, Tom A; Thorpe, Kevin E; Macdonald, R Loch

    2016-06-01

    OBJECT Neuroimaging characteristics of ruptured aneurysms are important to guide treatment selection, and they have been studied for their value as outcome predictors following aneurysmal subarachnoid hemorrhage (SAH). Despite multiple studies, the prognostic value of aneurysm diameter, location, and extravasated SAH clot on computed tomography scan remains debatable. The authors aimed to more precisely ascertain the relation of these factors to outcome. METHODS The data sets of studies included in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository were analyzed including data on ruptured aneurysm location and diameter (7 studies, n = 9125) and on subarachnoid clot graded on the Fisher scale (8 studies; n = 9452) for the relation to outcome on the Glasgow Outcome Scale (GOS) at 3 months. Prognostic strength was quantified by fitting proportional odds logistic regression models. Univariable odds ratios (ORs) were pooled across studies using random effects models. Multivariable analyses were adjusted for fixed effect of study, age, neurological status on admission, other neuroimaging factors, and treatment modality. The neuroimaging predictors were assessed for their added incremental predictive value measured as partial R(2). RESULTS Spline plots indicated outcomes were worse at extremes of aneurysm size, i.e., less than 4 or greater than 9 mm. In between, aneurysm size had no effect on outcome (OR 1.03, 95% CI 0.98-1.09 for 9 mm vs 4 mm, i.e., 75th vs 25th percentile), except in those who were treated conservatively (OR 1.17, 95% CI 1.02-1.35). Compared with anterior cerebral artery aneurysms, posterior circulation aneurysms tended to result in slightly poorer outcome in patients who underwent endovascular coil embolization (OR 1.13, 95% CI 0.82-1.57) or surgical clipping (OR 1.32, 95% CI 1.10-1.57); the relation was statistically significant only in the latter. Fisher CT subarachnoid clot burden was related to outcome in a gradient manner. Each

  13. SOARing Into Strategic Planning: Engaging Nurses to Achieve Significant Outcomes.

    PubMed

    Wadsworth, Barbara; Felton, Fiona; Linus, Rita

    2016-01-01

    In 2013, a new system chief nursing officer engaged the nursing leaders and staff in an Appreciative Inquiry process utilizing strengths, opportunities, aspirations, and results (SOAR), and a Journey of Excellence to assess and understand the current environment. The ultimate goal was to engage all nurses in strategic planning and goal setting to connect their patient care to the system strategic initiatives. This work led to the creation of a nursing vision, a revised professional practice model and greater council alignment, resulting in significant positive change and ongoing advancement throughout the system. The shared decision-making structure was key to the process with a direct connection of each council's goals, leading to the successful achievement of 34 of the 36 goals in 2 years. This article outlines the process, tools, and staff engagement strategies used to achieve system-wide success. This methodology has improved the outcomes across the organization in both small and system-wide work groups. This work can easily be replicated and adapted to help disparate staffs brought together through mergers or acquisitions to become aligned as a new team. This process, model, and framework, provides structure and results in significant outcomes that recognizes and celebrates the work of individual entities while aligning future strategies and goals. PMID:27584888

  14. Behavioral Economic Predictors of Brief Alcohol Intervention Outcomes

    PubMed Central

    Murphy, James G.; Dennhardt, Ashley A.; Martens, Matthew P.; Yurasek, Ali M.; Skidmore, Jessica R.; MacKillop, James; McDevitt-Murphy, Meghan E.

    2015-01-01

    Objective The present study attempted to determine if behavioral economic indices of elevated alcohol reward value, measured before and immediately after a brief alcohol intervention, predict treatment response. Method Participants were 133 heavy drinking college students (49.6% female, 51.4% male; 64.3% Caucasian, 29.5% African American) who were randomized to one of three conditions: motivational interviewing plus personalized feedback (BMI), computerized personalized feedback intervention (e-CHUG), and assessment only. Results Baseline levels of alcohol demand significantly predicted drinks per week and alcohol problems at 1-month (demand intensity= maximum expenditure) and 6-month (relative discretionary expenditures on alcohol) follow-up. BMI and e-CHUG were associated with an immediate post-session reduction in alcohol demand (p < .001, ηρ2 = .29) that persisted at the 1-month follow-up, with greater post-session reductions in the BMI condition (p = .02, ηρ2 = .06). Reductions in demand intensity and Omax (maximum expenditure) immediately post-intervention significantly predicted drinking reductions at one-month follow up (p = .04, ΔR2 = .02 & p = .01, ΔR2 = .03, respectively). Reductions in relative discretionary expenditures on alcohol at 1-month significantly predicted drinking (p = .002, ΔR2 = .06,) and alcohol problem (p < .001, ΔR2 = .13) reductions at the 6-month follow-up. Conclusions These results suggest that behavioral economic reward value indices may function as risk factors for poor intervention response and as clinically-relevant markers of change in heavy drinkers. PMID:26167945

  15. Predictors of poor outcome in gastrointestinal bleeding in emergency department

    PubMed Central

    Kaya, Ender; Karaca, Mehmet Ali; Aldemir, Deniz; Ozmen, M Mahir

    2016-01-01

    AIM: To determine the prognostic risk factors of gastrointestinal bleeding in emergency department cases. METHODS: The trial was a retrospective single-center study involving 600 patients over 18-years-old and carried out with approval by the Institutional Ethics Committee. Patient data included demographic characteristics, symptoms at admission, past medical history, vital signs, laboratory results, endoscopy and colonoscopy results, length of hospital stay, need of intensive care unit (ICU) admission, and mortality. Mortality rate was the principal endpoint of the study, while duration of hospital stay, required interventional treatment, and admission to the ICU were secondary endpoints. RESULTS: The mean age of patients was 61.92-years-old. Among the 600 total patients, 363 (60.5%) underwent upper gastrointestinal endoscopy and the most frequent diagnoses were duodenal ulcer (19.2%) and gastric ulcer (12.8%). One-hundred-and-fifteen (19.2%) patients required endoscopic treatment, 20 (3.3%) required surgical treatment, and 5 (0.8%) required angiographic embolization. The mean length of hospital stay was 5.21 ± 5.85 d. The mortality rate was 6.3%. The ICU admission rate was 5.3%. Patients with syncope, higher blood glucose levels, and coronary artery disease had significantly higher ICU admission rates (P = 0.029, P = 0.043, and P = 0.002, respectively). Patients with low thrombocyte levels, high creatinine, high international normalized ratio, and high serum transaminase levels had significantly longer hospital stay (P = 0.02, P = 0.001, P = 0.019, and P = 0.005, respectively). Patients who died had significantly higher serum blood urea nitrogen and creatinine levels (P = 0.016 and P = 0.038), and significantly lower mean blood pressure and oxygen saturation (P = 0.004 and P = 0.049). Malignancy and low Glasgow coma scale (GCS) were independent predictive factors of mortality. CONCLUSION: Prognostic factors for gastrointestinal bleeding in emergency room cases

  16. Decompressive hemicraniectomy: predictors of functional outcome in patients with ischemic stroke.

    PubMed

    Daou, Badih; Kent, Anthony P; Montano, Maria; Chalouhi, Nohra; Starke, Robert M; Tjoumakaris, Stavropoula; Rosenwasser, Robert H; Jabbour, Pascal

    2016-06-01

    OBJECT Patients presenting with large-territory ischemic strokes may develop intractable cerebral edema that puts them at risk of death unless intervention is performed. The purpose of this study was to identify predictors of outcome for decompressive hemicraniectomy (DH) in ischemic stroke. METHODS The authors conducted a retrospective electronic medical record review of 1624 patients from 2006 to 2014. Subjects were screened for DH secondary to ischemic stroke involving the middle cerebral artery, internal carotid artery, or both. Ninety-five individuals were identified. Univariate and multivariate analyses were performed for an array of clinical variables in relationship to functional outcome according to the modified Rankin Scale (mRS). Clinical outcome was assessed at 90 days and at the latest follow-up (mean duration 16.5 months). RESULTS The mean mRS score at 90 days and at the latest follow-up post-DH was 4. Good functional outcome was observed in 40% of patients at 90 days and in 48% of patient at the latest follow-up. The mortality rate at 90 days was 18% and at the last follow-up 20%. Univariate analysis identified a greater likelihood of poor functional outcome (mRS scores of 4-6) in patients with a history of stroke (OR 6.54 [95% CI1.39-30.66]; p = 0.017), peak midline shift (MLS) > 10 mm (OR 3.35 [95% CI 1.33-8.47]; p = 0.011), or a history of myocardial infarction (OR 8.95 [95% CI1.10-72.76]; p = 0.04). Multivariate analysis demonstrated elevated odds of poor functional outcome associated with a history of stroke (OR 9.14 [95% CI 1.78-47.05]; p = 0.008), MLS > 10 mm (OR 5.15 [95% CI 1.58-16.79; p = 0.007), a history of diabetes (OR 5.63 [95% CI 1.52-20.88]; p = 0.01), delayed time from onset of stroke to DH (OR 1.32 [95% CI 1.02-1.72]; p = 0.037), and evidence of pupillary dilation prior to DH (OR 4.19 [95% CI 1.06-16.51]; p = 0.04). Patients with infarction involving the dominant hemisphere had higher odds of unfavorable functional outcome at 90

  17. Predictors and Outcomes of Health Related Quality of Life in Caregivers of Cardiothoracic Transplant Recipients

    PubMed Central

    Myaskovsky, Larissa; Posluszny, Donna M.; Schulz, Richard; DiMartini, Andrea F.; Switzer, Galen E.; Dabbs, Annette DeVito; McNulty, Mary L.; Kormos, Robert L.; Toyoda, Yoshiya; Dew, Mary Amanda

    2012-01-01

    Cardiothoracic transplant programs generally require that transplant recipients have family caregivers to assist them post-transplant. The burden of caregiving on the family members remains poorly understood. If caregivers’ well-being is compromised by caregiving, it may bode poorly for transplant recipients’ own health in the long-term post-transplant. We examined caregiver HRQOL during the first year after their family member’s transplant, its predictors, and its relationship to subsequent patient survival. Adult (aged 18+) caregivers of 242 cardiothoracic transplant recipients (lung=134; heart=108) completed assessments of demographics, psychosocial characteristics, and caregiver burden at 2 months post-transplant, and HRQOL at 2, 7 and 12 months post-transplant. Recipients’ survival time was obtained from medical records. Caregiver HRQOL was generally high across the first year post-transplant in emotional and social functioning; caregiver physical functioning significantly worsened. There were no differences by type of recipient transplant. Greater caregiver burden predicted poorer caregiver HRQOL in several physical domains at 12 months post-transplant. Transplant recipients whose caregivers had lower perceived general health at 12 months post-transplant showed poorer survival rates during the subsequent 7 years of follow-up. Transplant teams should identify those caregivers at risk for poorer general health post-transplant in order to maximize positive outcomes for the entire family. PMID:22958758

  18. Race/Ethnicity, Education, and Treatment Parameters as Moderators and Predictors of Outcome in Binge Eating Disorder

    PubMed Central

    Thompson-Brenner, Heather; Franko, Debra L.; Thompson, Douglas R.; Grilo, Carlos M.; Boisseau, Christina L.; Roehrig, James P.; Richards, Lauren K.; Bryson, Susan W.; Bulik, Cynthia M.; Crow, Scott J.; Devlin, Michael J.; Gorin, Amy A.; Kristeller, Jean L.; Masheb, Robin; Mitchell, James E.; Peterson, Carol B.; Safer, Debra L.; Striegel, Ruth H.; Wilfley, Denise E.; Wilson, G. Terence

    2014-01-01

    Objective Binge eating disorder (BED) is prevalent among individuals from minority racial/ethnic groups and among individuals with lower levels of education, yet the efficacy of psychosocial treatments for these groups has not been examined in adequately powered analyses. This study investigated the relative variance in treatment retention and post-treatment symptom levels accounted for by demographic, clinical, and treatment variables as moderators and predictors of outcome. Method Data were aggregated from eleven randomized, controlled trials of psychosocial treatments for BED conducted at treatment sites across the United States. Participants were N = 1,073 individuals meeting criteria for BED including n = 946 Caucasian, n = 79 African American, and n = 48 Hispanic/Latino participants. Approximately 86% had some higher education; 85% were female. Multi-level regression analyses examined moderators and predictors of treatment retention, Eating Disorder Examination (EDE) global score, frequency of objective bulimic episodes (OBEs), and OBE remission. Results Moderator analyses of race/ethnicity and education were non-significant. Predictor analyses revealed African Americans were more likely to drop out of treatment than Caucasians, and lower level of education predicted greater post-treatment OBEs. African Americans showed a small but significantly greater reduction in EDE global score relative to Caucasians. Self-help treatment administered in a group showed negative outcomes relative to other treatment types, and longer treatment was associated with better outcome. Conclusions Observed lower treatment retention among African Americans and lesser treatment effects for individuals with lower levels of educational attainment are serious issues requiring attention. Reduced benefit was observed for shorter treatment length and self-help administered in groups. PMID:23647283

  19. Predictors of Mortality and Long-term Outcomes in Treated Cushing's Disease: A Study of 346 Patients

    PubMed Central

    Lambert, Jessica K.; Goldberg, Levana; Fayngold, Sofia; Kostadinov, Jane; Post, Kalmon D.

    2013-01-01

    Context: Active Cushing's disease (CD) confers a 4-fold increase in mortality and is associated with significant morbidities. Although excess mortality risk may persist even after CD treatment, predictors of risk in treated CD are not well understood. Objective: To identify predictors of mortality, cardiovascular (CV) disease, and recurrence after long-term follow-up among patients with treated CD. Design, Setting, and Patients: A retrospective chart review was conducted to evaluate patients with CD who underwent transsphenoidal adenectomy with a single surgeon. Outcome Measures: Patients were categorized based on disease response after initial treatment. Cox proportional hazard models identified predictors of mortality, recurrence, and CV outcomes in the overall cohort and each subgroup. Results: Three hundred forty-six subjects were included. Mean age was 39.9 years, and mean duration of follow-up was 6.3 years (range, 1 mo to 30 y). Duration of exposure to excess glucocorticoids, estimated by duration of symptoms before diagnosis until remission was achieved by any means, was 40.0 months. Multivariate analyses demonstrated that duration of glucocorticoid exposure elevated the risk of death (P = .038), as did older age at diagnosis (P = 0.0001) and preoperative ACTH concentration (P = .007). Among patients who achieved remission, depression increased the hazard of death (P < .01). Male sex, age at diagnosis, diabetes, and depression elevated the risk of CV disease (P < .05). Conclusion: Long-term follow-up of a large cohort of treated patients with CD identified several novel predictors of mortality. These data illustrate the importance of early recognition and treatment of CD. Long-term follow-up, with management of persistent comorbidities, is needed even after successful treatment of CD. PMID:23393167

  20. Sleep problems: predictor or outcome of media use among emerging adults at university?

    PubMed

    Tavernier, Royette; Willoughby, Teena

    2014-08-01

    The pervasiveness of media use in our society has raised concerns about its potential impact on important lifestyle behaviours, including sleep. Although a number of studies have modelled poor sleep as a negative outcome of media use, a critical assessment of the literature indicates two important gaps: (i) studies have almost exclusively relied on concurrent data, and thus have not been able to assess the direction of effects; and (ii) studies have largely been conducted with children and adolescents. The purpose of the present 3-year longitudinal study, therefore, was to examine whether both sleep duration and sleep problems would be predictors or outcomes of two forms of media use (i.e. television and online social networking) among a sample of emerging adults. Participants were 942 (71.5% female) university students (M = 19.01 years, SD = 0.90) at Time 1. Survey measures, which were assessed for three consecutive years starting in the first year of university, included demographics, sleep duration, sleep problems, television and online social networking use. Results of a cross-lagged model indicated that the association between sleep problems and media use was statistically significant: sleep problems predicted longer time spent watching television and on social networking websites, but not vice versa. Contrary to our hypotheses, sleep duration was not associated with media use. Our findings indicate no negative effects of media use on sleep among emerging adults, but instead suggest that emerging adults appear to seek out media as a means of coping with their sleep problems. PMID:24552437

  1. Navajo Culture and Family Influences on Academic Success: Traditionalism Is Not a Significant Predictor of Achievement among Navajo Youth.

    ERIC Educational Resources Information Center

    Willeto, Angela A. A.

    1999-01-01

    A study of 451 Navajo youths attending 11 high schools in the Navajo Nation found no relationship between their academic achievement and their cultural attachments and practices. Families modestly influenced educational outcomes, but being female was a stronger predictor of academic success. An appendix describes study variables. (Contains 42…

  2. BMI, HOMA-IR, and Fasting Blood Glucose Are Significant Predictors of Peripheral Nerve Dysfunction in Adult Overweight and Obese Nondiabetic Nepalese Individuals: A Study from Central Nepal

    PubMed Central

    Thapa, Lekhjung; Rana, P. V. S.

    2016-01-01

    Objective. Nondiabetic obese individuals have subclinical involvement of peripheral nerves. We report the factors predicting peripheral nerve function in overweight and obese nondiabetic Nepalese individuals. Methodology. In this cross-sectional study, we included 50 adult overweight and obese nondiabetic volunteers without features of peripheral neuropathy and 50 healthy volunteers to determine the normative nerve conduction data. In cases of abnormal function, the study population was classified on the basis of the number of nerves involved, namely, “<2” or “≥2.” Multivariable logistic regression analysis was carried out to predict outcomes. Results. Fasting blood glucose (FBG) was the significant predictor of motor nerve dysfunction (P = 0.039, 95% confidence interval (CI) = 1.003–1.127). Homeostatic model assessment of insulin resistance (HOMA-IR) was the significant predictor (P = 0.019, 96% CI = 1.420–49.322) of sensory nerve dysfunction. Body mass index (BMI) was the significant predictor (P = 0.034, 95% CI = 1.018–1.577) in case of ≥2 mixed nerves' involvement. Conclusion. FBG, HOMA-IR, and BMI were significant predictors of peripheral nerve dysfunction in overweight and obese Nepalese individuals. PMID:27200189

  3. BMI, HOMA-IR, and Fasting Blood Glucose Are Significant Predictors of Peripheral Nerve Dysfunction in Adult Overweight and Obese Nondiabetic Nepalese Individuals: A Study from Central Nepal.

    PubMed

    Thapa, Lekhjung; Rana, P V S

    2016-01-01

    Objective. Nondiabetic obese individuals have subclinical involvement of peripheral nerves. We report the factors predicting peripheral nerve function in overweight and obese nondiabetic Nepalese individuals. Methodology. In this cross-sectional study, we included 50 adult overweight and obese nondiabetic volunteers without features of peripheral neuropathy and 50 healthy volunteers to determine the normative nerve conduction data. In cases of abnormal function, the study population was classified on the basis of the number of nerves involved, namely, "<2" or "≥2." Multivariable logistic regression analysis was carried out to predict outcomes. Results. Fasting blood glucose (FBG) was the significant predictor of motor nerve dysfunction (P = 0.039, 95% confidence interval (CI) = 1.003-1.127). Homeostatic model assessment of insulin resistance (HOMA-IR) was the significant predictor (P = 0.019, 96% CI = 1.420-49.322) of sensory nerve dysfunction. Body mass index (BMI) was the significant predictor (P = 0.034, 95% CI = 1.018-1.577) in case of ≥2 mixed nerves' involvement. Conclusion. FBG, HOMA-IR, and BMI were significant predictors of peripheral nerve dysfunction in overweight and obese Nepalese individuals. PMID:27200189

  4. Predictors of outcome of mitral valve prolapse in patients with the Marfan syndrome.

    PubMed

    Rybczynski, Meike; Treede, Hendrik; Sheikhzadeh, Sara; Groene, Eike F; Bernhardt, Alexander M J; Hillebrand, Mathias; Mir, Thomas S; Kühne, Kristine; Koschyk, Dietmar; Robinson, Peter N; Berger, Jürgen; Reichenspurner, Hermann; Meinertz, Thomas; von Kodolitsch, Yskert

    2011-01-15

    Mitral valve prolapse has a prevalence of 2% to 3% in the general population, with adverse outcomes such as mitral valve regurgitation (MVR), heart failure, and endocarditis. Predictors of outcomes are used in idiopathic mitral valve prolapse for the timing of surgery, but such predictors are unknown in Marfan syndrome. Therefore, a population-based cohort study of 112 patients (49 male, 63 female; mean age 34 ± 15 years) with classic Marfan syndrome and mitral valve prolapse with moderate or less MVR at baseline was conducted. During 4.6 ± 3.6 years of follow-up, progression of MVR was observed in 41 patients and valve-related events, which comprised mitral valve endocarditis (7 events), heart failure (5 events), and mitral valve surgery (25 events), were observed in 31 patients. Multivariate Cox proportional-hazards regression analysis identified a flail mitral leaflet (hazard ratio [HR] 3.262, 95% confidence interval [CI] 1.406 to 7.566, p = 0.006) and increased indexed end-systolic left ventricular diameters (HR 1.113, 95% CI 1.043 to 1.188, p = 0.001) as independent predictors of progression of MVR. Similarly, mitral valve-related events were independently predicted by a flail mitral leaflet (HR 5.343, 95% CI 2.229 to 12.808, p <0.001), and mild (HR 14.336, 95% CI 1.873 to 109.755, p = 0.01) or moderate (HR 16.849, 95% CI 2.205 to 128.76, p = 0.006) degree of MVR. Conversely, aortic dilatation, dural ectasia, and sporadic mode of inheritance were not associated with outcome. In conclusion, the same clinical determinants that predict outcomes in idiopathic mitral valve prolapse also predict outcomes in mitral valve prolapse associated with Marfan syndrome. PMID:21211604

  5. Teres Minor Hypertrophy is a Common and Negative Predictor of Outcomes after Rotator Cuff Repair

    PubMed Central

    Tokish, John M.; Thigpen, Charles A.; Kissenberth, Michael J.; Hunt, Quinn; Tolan, Stefan John; Swinehart, S. Dane; Shelley, Christina; Hawkins, Richard J.

    2016-01-01

    patients without an infraspinatus tear, teres minor hypertrophy was still present in 19/40 (48%) of patients. Teres minor hypertrophy had a significant, negative effect ASES scores after rotator cuff repair in patients with and without infraspinatus tearing, infraspinatus atrophy, and fatty infiltrative changes(P<0.05). In general, the presence of teres minor hypertrophy demonstrated a 15% lower score (Figure 1) than when no hypertrophy was present, and this was consistent across all tear sizes, independent of Goutallier changes. Conclusion: Teres minor hypertrophy is a common finding in the setting of rotator cuff tearing, including in the absence of infraspinatus tearing. Contrary to previous publications, the presence of teres minor hypertrophy in patients with rotator cuff repair does not appear to be protective as a compensatory mechanism. While further study is necessary to determine the mechanism or implication of teres minor hypertrophy in setting of rotator cuff repair, our results show it is not a positive predictor of outcomes following rotator cuff repair. Summary Sentence: The mechanism of teres minor hypertrophy was found to be a negative predictor in rotator cuff repair after pre and post-op measures were collected on patients undergoing cuff repair.

  6. Echo-Doppler determinants of outcomes in patients with unoperated significant mitral regurgitation in current era

    PubMed Central

    Rafique, Asim M; Zarrini, Parham; Singh, Nirmal; Beigel, Roy; Tadwalkar, Rigved; Chonde, Meshe; Slipczuk, Leandro; Cercek, Bojan; Kar, Saibal; Siegel, Robert J

    2016-01-01

    Objective One-half of patients with severe symptomatic mitral regurgitation (MR) do not undergo surgery due to comorbidities. We evaluated prognosticators of outcomes in patients with unoperated significant MR. Methods In this observational study, we retrospectively evaluated medical records of 75 consecutive patients with unoperated significant MR. Results All-cause mortality was 39% at 5 years. Non-survivors (n=29) versus survivors (n=46) were: older (77±9.8 vs 68±14, p=0.006), had higher New York Heart Association (NYHA) class (2.7±0.8 vs 2.3±0.8, p=0.037), higher brain natriuretic peptide (1157±717 vs 427±502 pg/mL, p=0.024, n=18), more coronary artery disease (61% vs 35%, p=0.031), more frequent left ventricular ejection fraction <50% (20.7% vs 4.3%, p=0.026), more functional MR (41% vs 22%, p=0.069), higher mitral E/E′ (12.7±4.6 vs 9.8±4, p=0.008), higher pulmonary artery systolic pressure (PASP; 52.6±18.7 vs 36.7±14, p <0.001), more ≥3+ tricuspid regurgitation (28% vs 4%, p=0.005) and more right ventricular dysfunction (26% vs 6%, p=0.035). Significant predictors of 5-year mortality were PASP (p=0.001) and E/E′ (p=0.011) using multivariate regression analysis. Conclusions Patients with unoperated significant MR have high mortality. Elevated PASP and mitral E/E′ were the most significant predictors of 5-year survival in patients with unoperated significant MR. Current American College of Cardiology (ACC)/American Heart Association (AHA) guidelines provide a limited incorporation of echo-Doppler parameters in the preoperative risk stratification of patients with severe MR. PMID:27547425

  7. Comparison of Substance Use Typologies as Predictors of Sexual Risk Outcomes in African American Adolescent Females.

    PubMed

    Swartzendruber, Andrea; Sales, Jessica M; Brown, Jennifer L; DiClemente, Ralph J; Rose, Eve S

    2016-01-01

    African American female adolescents have a disproportionate risk of sexually transmitted infections (STIs) and other adverse sexual health outcomes. Both alcohol and marijuana use have been shown to predict sexual risk among young African American women. However, no studies have attempted to differentiate alcohol and marijuana typologies use as predictors of sexual risk outcomes exclusively among adolescents who use these substances. This study compared recent alcohol and/or marijuana use as predictors of sexual risk outcomes over 18 months among 182 African American female adolescents. African American females (14-20 years) completed interviews at baseline, 6-, 12-, and 18-months. At each assessment, pregnancy testing was conducted and self-collected vaginal swab specimens were assayed for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae using DNA amplification. Logistic subject-specific random-intercept models compared sexual risk outcomes during follow-up among adolescents who reported recent use of alcohol only (AO), marijuana only (MO) or both substances (A + M) at the baseline assessment. Relative to baseline AO use, baseline MO use predicted condom non-use at last sex. Relative to AO use, A + M use predicted pregnancy. Relative to MO use, A + M use predicted pregnancy and acquisition of T. vaginalis and any STI. The results suggest that African American female adolescents who use A + M may represent a priority population for STI, HIV, and pregnancy prevention efforts. PMID:25929200

  8. Predictors of poor response during asthma therapy differ with definition of outcome

    PubMed Central

    Rogers, Angela J; Tantisira, Kelan G; Fuhlbrigge, Anne L; Litonjua, Augusto A; Lasky-Su, Jessica A; Szefler, Stanley J; Strunk, Robert C; Zeiger, Robert S; Weiss, Scott T

    2009-01-01

    Aims To evaluate phenotypic and genetic variables associated with a poor long-term response to inhaled corticosteroid therapy for asthma, based independently on lung function changes or asthma exacerbations. Materials & methods We tested 17 phenotypic variables and polymorphisms in FCER2 and CRHR1 in 311 children (aged 5–12 years) randomized to a 4-year course of inhaled corticosteroid during the Childhood Asthma Management Program (CAMP). Results Predictors of recurrent asthma exacerbations are distinct from predictors of poor lung function response. A history of prior asthma exacerbations, younger age and a higher IgE level (p < 0.05) are associated with recurrent exacerbations. By contrast, lower bronchodilator response to albuterol and the minor alleles of RS242941 in CRHR1 and T2206C in FCER2 (p < 0.05) are associated with poor lung function response. Poor lung function response does not increase the risk of exacerbations and vice versa (p = 0.72). Conclusion Genetic and phenotypic predictors of a poor long-term response to inhaled corticosteroids differ markedly depending on definition of outcome (based on exacerbations vs lung function). These findings are important in comparing outcomes of clinical trials and in designing future pharmacogenetic studies. PMID:19663668

  9. Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study.

    PubMed

    Andrew, Rachel; Tiggemann, Marika; Clark, Levina

    2016-03-01

    This study aimed to investigate prospective predictors and health-related outcomes of positive body image in adolescent girls. In so doing, the modified acceptance model of intuitive eating was also examined longitudinally. A sample of 298 girls aged 12 to 16 years completed a questionnaire containing measures of body appreciation, potential predictors, and a range of health outcomes, at 2 time points separated by 1 year. Longitudinal change regression models showed that perceived body acceptance by others (positively), self-objectification and social comparison (negatively), and body appreciation (positively) prospectively predicted intuitive eating 1 year later, consistent with the acceptance model of intuitive eating. Perceived body acceptance by others was the only proposed predictor to prospectively predict an increase in body appreciation over time. Time 1 body appreciation prospectively predicted a decrease in dieting, alcohol, and cigarette use, and an increase in physical activity 1 year later. In particular, girls with low body appreciation were more likely than girls with high body appreciation to take up alcohol and cigarette use between time points. The results highlight body appreciation as an important target for interventions designed to prevent or delay the uptake of alcohol and cigarette consumption among girls. More broadly, they suggest that a positive body image can confer considerable benefit for adolescent girls. PMID:26727595

  10. Predictors of Poor Outcomes in Critically Ill Adults with Hematologic Malignancy

    PubMed Central

    Cornish, Marion; Butler, Michael B.; Green, Robert S.

    2016-01-01

    Background. Patients with hematologic malignancy (HM) often require intensive care unit (ICU) admission due to organ failure through disease progression or treatment-related complications. Objective. To determine mortality and prognostic variables in adult patients with HM who were admitted to ICU. Methods. Structured chart review of all adult patients (age ≥ 18 years) with HM admitted to ICU of a Canadian tertiary care hospital between 2004 and 2014. Outcome measures included mortality (ICU, 30-day, 60-day, and 12-month). Logistic regression was performed to determine predictors of mortality. Results. Overall, there were 206 cases of HM admitted to the ICU during the study (mean age: 51.3 ± 13.6 years; 60% male). Median stay was 3 days, with 14.1% requiring prolonged ICU admission. ICU mortality was 45.6% and increased to 59.2% at 30 days, 62.6% at 60 days, and 74.3% at 12 months. Predictors of increased ICU mortality included mechanical ventilation requirement and vasopressor therapy requirement, while admission to ICU postoperatively and having myeloma were associated with decreased mortality. Conclusions. Patients admitted to ICU with HM have high mortality (45.6%), which increased to 74.3% at 1 year. Analysis of multiple variables identified critical illness, postsurgical admission, and myeloma as predictors of patient outcomes. PMID:27445571

  11. Predictors and Moderators of Treatment Outcome in the Pediatric Obsessive Compulsive Treatment Study (POTS I)

    PubMed Central

    Garcia, Abbe Marrs; Sapyta, Jeffrey J.; Moore, Phoebe S.; Freeman, Jennifer B.; Franklin, Martin E.; March, John S.; Foa, Edna B.

    2010-01-01

    Objective To identify predictors and moderators of outcome in the first Pediatric OCD Treatment Study (POTS I) among youth (N=112) randomly assigned to sertraline, cognitive behavioral therapy (CBT), both sertraline and CBT (COMB), or a pill placebo. Method Potential baseline predictors and moderators were identified by literature review. The outcome measure was an adjusted week 12 predicted score for the Children’s Yale Brown Obsessive Compulsive Scale (CY-BOCS). Main and interactive effects of treatment condition and each candidate predictor or moderator variable were examined using GLM on the adjusted predicted week 12 CY-BOCS scores. Results Youth with lower OCD severity, less OCD-related functional impairment, greater insight, fewer comorbid externalizing symptoms, and lower levels of family accommodation showed greater improvement across treatment conditions than their counterparts after acute POTS treatment. Those with a family history of OCD had a six-fold decrease in effect size in CBT monotherapy relative to their counterparts in CBT without a family history of OCD. Conclusions Greater attention is needed to build optimized intervention strategies for more complex youth with OCD. Youth with a family history of OCD are not likely to benefit from CBT unless offered in combination with an SSRI. PMID:20855047

  12. Distress Screening in a Multidisciplinary Lung Cancer Clinic: Prevalence and Predictors of Clinically-Significant Distress

    PubMed Central

    Graves, Kristi D.; Arnold, Susanne M.; Love, Celia L.; Kirsh, Kenneth L.; Moore, Pamela G.; Passik, Steven D.

    2007-01-01

    Summary Screening for distress in cancer patients is recommended by the National Comprehensive Cancer Network, and a Distress Thermometer has previously been developed and empirically-validated for this purpose. The present study sought to determine the rates and predictors of distress in a sample of patients being seen in a multidisciplinary lung cancer clinic. Consecutive patients (N = 333) were recruited from an outpatient multidisciplinary lung cancer clinic to complete the Distress Thermometer, an associated Problem Symptom List, and two questions about interest in receiving help for symptoms. Over half (61.6%) of patients reported distress at a clinically significant level, and 22.5% of patients indicated interest in receiving help with their distress and/or symptoms. Problems in the areas of family relationships, emotional functioning, lack of information about diagnosis/treatment, physical functioning, and cognitive functioning were associated with higher reports of distress. Specific symptoms of depression, anxiety, pain and fatigue were most predictive of distress. Younger age was also associated with higher levels of distress. Distress was not associated with other clinical variables, including stage of illness or medical treatment approach. Similar results were obtained when individuals who had not yet received a definitive diagnosis of lung cancer (n = 134) were excluded from analyses; however, family problems and anxiety were no longer predictive of distress. Screening for distress in a multidisciplinary lung cancer clinic is feasible and a significant number of patients can be expected to meet clinical criteria for distress. Results also highlight younger age and specific physical and psychosocial symptoms as predictive of clinically-significant distress. Identification of the presence and predictors of distress are the first steps toward appropriate referral and treatment of symptoms and problems that contribute to cancer patients’ distress. PMID

  13. Perioperative Blood Transfusion as a Significant Predictor of Biochemical Recurrence and Survival after Radical Prostatectomy in Patients with Prostate Cancer

    PubMed Central

    Kim, Jung Kwon; Kim, Hyung Suk; Park, Juhyun; Jeong, Chang Wook; Ku, Ja Hyeon; Kim, Hyun Hoe; Kwak, Cheol

    2016-01-01

    Purpose There have been conflicting reports regarding the association of perioperative blood transfusion (PBT) with oncologic outcomes including recurrence rates and survival outcomes in prostate cancer. We aimed to evaluate whether perioperative blood transfusion (PBT) affects biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS) following radical prostatectomy (RP) for patients with prostate cancer. Materials and Methods A total of 2,713 patients who underwent RP for clinically localized prostate cancer between 1993 and 2014 were retrospectively analyzed. We performed a comparative analysis based on receipt of transfusion (PBT group vs. no-PBT group) and transfusion type (autologous PBT vs. allogeneic PBT). Univariate and multivariate Cox-proportional hazard regression analysis were performed to evaluate variables associated with BRFS, CSS, and OS. The Kaplan-Meier method was used to calculate survival estimates for BRFS, CSS, and OS, and log-rank test was used to conduct comparisons between the groups. Results The number of patients who received PBT was 440 (16.5%). Among these patients, 350 (79.5%) received allogeneic transfusion and the other 90 (20.5%) received autologous transfusion. In a multivariate analysis, allogeneic PBT was found to be statistically significant predictors of BRFS, CSS, and OS; conversely, autologous PBT was not. The Kaplan-Meier survival analysis showed significantly decreased 5-year BRFS (79.2% vs. 70.1%, log-rank, p = 0.001), CSS (98.5% vs. 96.7%, log-rank, p = 0.012), and OS (95.5% vs. 90.6%, log-rank, p < 0.001) in the allogeneic PBT group compared to the no-allogeneic PBT group. In the autologous PBT group, however, none of these were statistically significant compared to the no-autologous PBT group. Conclusions We found that allogeneic PBT was significantly associated with decreased BRFS, CSS, and OS. This provides further support for the immunomodulation hypothesis for allogeneic

  14. Predictors of outcome in an AIEOP series of childhood ependymomas: a multifactorial analysis

    PubMed Central

    Modena, Piergiorgio; Buttarelli, Francesca R.; Miceli, Rosalba; Piccinin, Elena; Baldi, Caterina; Antonelli, Manila; Morra, Isabella; Lauriola, Libero; Di Rocco, Concezio; Garrè, Maria Luisa; Sardi, Iacopo; Genitori, Lorenzo; Maestro, Roberta; Gandola, Lorenza; Facchinetti, Federica; Collini, Paola; Sozzi, Gabriella; Giangaspero, Felice; Massimino, Maura

    2012-01-01

    Several molecular biomarkers have been suggested as predictors of outcome for pediatric ependymomas but deserve further validation in independent case series. We analyzed intracranial ependymomas belonging to a series of 60 patients prospectively treated according to the protocol sponsored by the Italian Association of Pediatric Hematology-Oncology. We used a tissue microarray to analyze nucleolin (NCL), cyclin-dependent kinase inhibitor 2A (CDKN2A), tumor protein 53 (TP53), and epidermal growth factor receptor (EGFR) by immunohistochemistry and by 1q gain by fluorescent in situ hybridization. The mRNA expression levels of EGFR, human telomerase reverse-transcriptase (HTERT), and Prominin 1 (PROM 1)/CD133 were evaluated by quantitative real-time PCR from cases with fresh-frozen tumor material available. Univariate and multivariate analyses of updated clinical data confirmed the prognostic significance of surgery (P < .01) and tumor grading (P < .05) for both relapse-free survival (RFS) and overall survival (OS). Among biomolecular markers, HTERT mRNA expression emerged with the strongest association with OS at multivariate analysis (hazard ratio [HR] = 9.9; P = .011); the 5–year OS was 84% versus 48% in the subgroups with HTERT median value <6 versus ≥6, respectively (P = .005). Five-year RFS was 46% versus 20% in the subgroups with low versus high NCL protein expression, respectively (P = .004), while multivariate Cox analyses gave suggestively high HRs for high versus low NCL (HR = 1.9; P = .090). The other genes tested were not significant at multivariate analyses, and genetic alterations of CDKN2A, TP53, EGFR, and HTERT loci were rare. The PROM1/CD133 cancer stem cell marker was strongly expressed at both RNA and protein levels in a substantial fraction of cases and was suggestively associated with a more indolent form of the disease. We conclude that NCL and HTERT represent the strongest prognostic biomarkers of RFS and OS, respectively, in our ependymoma

  15. Premotor Symptoms as Predictors of Outcome in Parkinsons Disease: A Case-Control Study

    PubMed Central

    Wu, Yu-Hsuan; Lee, Wei-Ju; Chen, Yi-Huei

    2016-01-01

    Background To evaluate the association between the premotor symptoms and the prognosis of PD. Methods A total of 1213 patients who were diagnosed of PD from January 2001 to December 2008 were selected from the Taiwan’s National Health Insurance Research Database. Patients were traced back to determine the presence of premotor symptoms, including rapid eye movement sleep behavior disorder (RBD), depression, and constipation. Cox’s regression analysis was used to detect the risks between the occurrence of premotor symptoms and the outcome (including death, psychosis, accidental injury, dementia and aspiration pneumonia). In addition, the association between premotor symptoms and levodopa equivalent dosage (LED) was examined. Results Higher occurrence of death, dementia and aspiration pneumonia were identified in PD patients with premotor symptoms than without premotor symptoms (HR 1·69, 95% CI 1·34–2·14, p <0·001 for death; HR 1·63, 95% CI 1·20–2·22, p = 0·002 for dementia; HR 2·45, 95% CI 1·42–4·21, p = 0·001 for aspiration pneumonia). In a comorbidities-stratified analysis, PD patients with premotor symptoms showed significantly high risks of mortality and morbidity (dementia and aspiration pneumonia), especially in the absence of comorbidities. Independent predictors of mortality in PD were found to be higher age, male sex, constipation, RBD, RBD with constipation and depression, and diabetes. Furthermore, no significant differences of LED and subsequent accidental injury were noted between PD patient with or without premotor symptoms. Conclusion Premotor symptoms seem to be not merely risk factors, but also prognostic factors of PD. PMID:27533053

  16. Predictors of outcome in an AIEOP series of childhood ependymomas: a multifactorial analysis.

    PubMed

    Modena, Piergiorgio; Buttarelli, Francesca R; Miceli, Rosalba; Piccinin, Elena; Baldi, Caterina; Antonelli, Manila; Morra, Isabella; Lauriola, Libero; Di Rocco, Concezio; Garrè, Maria Luisa; Sardi, Iacopo; Genitori, Lorenzo; Maestro, Roberta; Gandola, Lorenza; Facchinetti, Federica; Collini, Paola; Sozzi, Gabriella; Giangaspero, Felice; Massimino, Maura

    2012-11-01

    Several molecular biomarkers have been suggested as predictors of outcome for pediatric ependymomas but deserve further validation in independent case series. We analyzed intracranial ependymomas belonging to a series of 60 patients prospectively treated according to the protocol sponsored by the Italian Association of Pediatric Hematology-Oncology. We used a tissue microarray to analyze nucleolin (NCL), cyclin-dependent kinase inhibitor 2A (CDKN2A), tumor protein 53 (TP53), and epidermal growth factor receptor (EGFR) by immunohistochemistry and by 1q gain by fluorescent in situ hybridization. The mRNA expression levels of EGFR, human telomerase reverse-transcriptase (HTERT), and Prominin 1 (PROM 1)/CD133 were evaluated by quantitative real-time PCR from cases with fresh-frozen tumor material available. Univariate and multivariate analyses of updated clinical data confirmed the prognostic significance of surgery (P < .01) and tumor grading (P < .05) for both relapse-free survival (RFS) and overall survival (OS). Among biomolecular markers, HTERT mRNA expression emerged with the strongest association with OS at multivariate analysis (hazard ratio [HR] = 9.9; P = .011); the 5-year OS was 84% versus 48% in the subgroups with HTERT median value <6 versus ≥ 6, respectively (P = .005). Five-year RFS was 46% versus 20% in the subgroups with low versus high NCL protein expression, respectively (P = .004), while multivariate Cox analyses gave suggestively high HRs for high versus low NCL (HR = 1.9; P = .090). The other genes tested were not significant at multivariate analyses, and genetic alterations of CDKN2A, TP53, EGFR, and HTERT loci were rare. The PROM1/CD133 cancer stem cell marker was strongly expressed at both RNA and protein levels in a substantial fraction of cases and was suggestively associated with a more indolent form of the disease. We conclude that NCL and HTERT represent the strongest prognostic biomarkers of RFS and OS, respectively, in our ependymoma

  17. Pedagogical Significance of Wikis: Towards Gaining Effective Learning Outcomes

    ERIC Educational Resources Information Center

    Hewege, Chandana Rathnasiri; Perera, Liyanage Chamila Roshani

    2013-01-01

    Purpose: The purpose of this paper is to explore the effectiveness and pedagogical implications of integrating wikis into the curriculum and the subsequent learning outcomes of a group of Net-Gens who enrolled in an International Marketing course. The research problem of the study is: "What are the learning outcomes and pedagogical implications…

  18. Outcome expectancy as a predictor of treatment response in cognitive behavioral therapy for public speaking fears within social anxiety disorder.

    PubMed

    Price, Matthew; Anderson, Page L

    2012-06-01

    Outcome expectancy, the extent that clients anticipate benefiting from therapy, is theorized to be an important predictor of treatment response for cognitive-behavioral therapy. However, there is a relatively small body of empirical research on outcome expectancy and the treatment of social anxiety disorder. This literature, which has examined the association mostly in group-based interventions, has yielded mixed findings. The current study sought to further evaluate the effect of outcome expectancy as a predictor of treatment response for public-speaking fears across both individual virtual reality and group-based cognitive-behavioral therapies. The findings supported outcome expectancy as a predictor of the rate of change in public-speaking anxiety during both individual virtual reality exposure therapy and group cognitive-behavioral therapy. Furthermore, there was no evidence to suggest that the impact of outcome expectancy differed across virtual reality or group treatments. PMID:21967073

  19. Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction.

    PubMed

    Garber, Adam M; Mentz, Robert J; Al-Khalidi, Hussein R; Shaw, Linda K; Fiuzat, Mona; O'Connor, Christopher M; Velazquez, Eric J

    2016-04-01

    We aimed to characterize the independent predictors of LVT following STEMI and the association with outcomes. The clinical predictors of left ventricular thrombus (LVT) formation after ST-segment elevation myocardial infarction (STEMI) are not well-defined in the contemporary era. We performed a retrospective analysis of STEMI patients at Duke from 2000 to 2011 who had a transthoracic echocardiogram within 90 days post-STEMI and compared patients with and without LVT (LVT+ vs. LVT-). Univariate Cox proportional hazards regression models of baseline characteristics were examined and significant variables were used in a multivariable model to assess adjusted relationships with LVT. A multivariable Cox PH survival model with covariate adjustments was used for assessment of LVT and long-term mortality. Of all eligible patients, 1734 patients met inclusion criteria and 4.3 % (N = 74) had a LVT. LVT+ patients tended to have a history of heart failure (HF) and higher initial troponin compared to LVT- patients. After adjustment, higher heart rate, non-white race, HF severity, and presence of left anterior descending artery (LAD) disease were independent predictors of LVT. There was a trend toward an association between LVT and increased all-cause mortality (HR 1.36; 95 % CI 0.84-2.21, P = 0.22), however this was not statistically significant. LVT was seen in over 4 % of this contemporary post-STEMI population. Several baseline characteristics were independently associated with LVT: Heart rate, HF severity, LAD disease, and non-white race. Prospective studies are warranted to determine whether anticoagulation in patients at increased risk for LVT improves outcomes. PMID:26202909

  20. Infratentorial posterior circulation stroke in a Nigerian population: Clinical characteristics, risk factors, and predictors of outcome

    PubMed Central

    Owolabi, Lukman Femi; Ibrahim, Aliyu; Musa, Ibrahim

    2016-01-01

    Background: Posterior circulation stroke (PCS), though less common, differs from stroke in anterior circulation in many aspects. Relatively, it portends a poorer prognosis. However, there is a paucity of data from African countries, in particular, where stroke is a menace. Objective: The study aimed to evaluate the etiology, clinical characteristics, outcome, and predictors of outcome in a cohort of patients with IPCS in Northwestern Nigeria. Materials and Methods: Out of 595 patients with stroke, we prospectively analyzed 57 patients with PCS in a Tertiary Care Center in Kano, Northwestern Nigeria. Patients were analyzed for demographic data, risk factors, clinical characteristics, stroke subtypes, mortality, and predictors of mortality. Results: Posterior circulation ischemic stroke accounted for 57 (9.6%) of 595 of all strokes seen in the study period. They comprised 44 males (mean age 47.8 ± 17.7) and 13 females (mean age 46.3 ± 13.7). Overall, their age ranged between 24 and 90 (mean age 47.4 ± 16.7). However, 52.7% of the patients were < 45 years of age. The most common site affected was the cerebellum seen in 33 (57.9%) patients. Hypertension was the most common risk factor (86%). Headache and vertigo were the most common features accounting for 83.6% and 86.3%, respectively. Thirty-eight (66.7%) patients had an ischemic stroke. Twenty-one (36.8%) of the patients died during the 1-month period of follow-up. Independent predictors of death in the study were hyperglycemia on admission and hemorrhagic stroke. Conclusions: IPCS occurred in a relatively younger age group. Headache and vertigo were the most common symptoms. The independent predictors of death in the study were hyperglycemia at presentation and hemorrhagic stroke. PMID:26933349

  1. Buprenorphine versus methadone for opioid dependence: predictor variables for treatment outcome.

    PubMed

    Gerra, G; Borella, F; Zaimovic, A; Moi, G; Bussandri, M; Bubici, C; Bertacca, S

    2004-07-15

    need to be interpreted with caution because of the observational clinical methodology and non-random procedure. The present findings provide further support for the utility of BUP in the treatment of opioid dependency and demonstrate efficacy equivalent to that of METH during a clinical procedure. BUP seems to be more effective than METH in patients affected by depressive traits and dysphoria, probably due to antagonist action on kappa-opioid receptors. Psychosocial functioning and addiction severity cannot be used as valuable predictors of BUP treatment outcome. High doses appear to predict a better outcome, in term of negative urines, for both METH and BUP, but not in term of retention for BUP patients. PMID:15225887

  2. Predictors and Outcomes of Limited Resection for Early-Stage Non–Small Cell Lung Cancer

    PubMed Central

    Ayanian, John Z.; Zaslavsky, Alan M.; Nerenz, David R.; Jaklitsch, Michael T.; Rogers, Selwyn O.

    2011-01-01

    Background Lobectomy is considered the standard treatment for early-stage non–small cell lung cancer (NSCLC); however, more limited resections are commonly performed. We examined patient and surgeon factors associated with limited resection and compared postoperative and long-term outcomes between sublobar and lobar resections. Methods A population- and health system–based sample of patients newly diagnosed with stage I or II NSCLC between 2003 and 2005 in five geographically defined regions, five integrated health-care delivery systems, and 15 Veterans Affairs hospitals was observed for a median of 55 months, through May 31, 2010. Predictors of limited resection and postoperative outcomes were compared using unadjusted and propensity score–weighted analyses. All P values are from two-sided tests. Results One hundred fifty-five (23%) patients underwent limited resection and 524 (77%) underwent lobectomy. In adjusted analyses of patient-specific factors, smaller tumor size (P = .004), coverage by Medicare or Medicaid, no insurance or unknown insurance (P = .02), more severe lung disease (P < .001), and a history of stroke (P = .049) were associated with receipt of limited resection. In adjusted analyses of surgeon characteristics, thoracic surgery specialty (P = .02), non–fee-for-service compensation (P = .008), and National Cancer Institute cancer center designation (P = .006) were associated with higher odds of limited resection. Unadjusted 30-day mortality was higher with limited resection than with lobectomy (7.1% vs 1.9%, difference = 5.2%, 95% confidence interval [CI] = 1.5% to 10.8%, P = .003), and the adjusted difference was not statistically significant (6.5% vs 2.9%, difference = 3.6%, 95% CI = −.1% to 9.2%, P = .09). Postoperative complications did not differ by type of surgery (all P > .05). Over the course of the study, a non-statistically significant trend toward improved long-term survival was evident for lobectomy, compared with limited

  3. Significance of Image Guidance to Clinical Outcomes for Localized Prostate Cancer

    PubMed Central

    Zhong, Qiuzi; Gao, Hong; Li, Gaofeng; Xiu, Xia; Wu, Qinhong; Li, Ming; Xu, Yonggang

    2014-01-01

    Purpose. To compare toxicity profiles and biochemical tumor control outcomes between patients treated with image-guided intensity-modulated radiotherapy (IG-IMRT) and non-IGRT intensity-modulated radiotherapy (IMRT) for clinically localized prostate cancer. Materials and Methods. Between 2009 and 2012, 65 patients with localized prostate cancer were treated with IG-IMRT. This group of patients was retrospectively compared with a similar cohort of 62 patients who were treated between 2004 and 2009 with IMRT to the same dose without image guidance. Results. The median follow-up time was 4.8 years. The rectal volume receiving ≥40 and ≥70 Gy was significantly lower in the IG-IMRT group. Grade 2 and higher acute and late GI and GU toxicity rates were lower in IG-IMRT group, but there was no statistical difference. No significant improvement in biochemical control at 5 years was observed in two groups. In a Cox regression analysis identifying predictors for PSA relapse-free survival, only preradiotherapy PSA was significantly associated with biochemical control; IG-IMRT was not a statistically significant indicator. Conclusions. The use of image guidance in the radiation of prostate cancer at our institute did not show significant reduction in the rates of GI and GU toxicity and did not improve the biochemical control compared with IMRT. PMID:25110701

  4. Predictors of outcome in myxoedema coma: a study from a tertiary care centre

    PubMed Central

    Dutta, Pinaki; Bhansali, Anil; Masoodi, Shriq Rashid; Bhadada, Sanjay; Sharma, Navneet; Rajput, Rajesh

    2008-01-01

    Background With the easy availability of thyroid hormone assays, thyroid disorders are now recognised even in a subclinical state. However, patients are still seen with advanced manifestations of the disease, particularly in developing countries. This observational study analysed the predictors of outcome in patients with myxoedema coma and tested the validity of different modules to define morbidity and mortality in these patients. Methods Twenty-three consecutive patients with myxoedema coma who presented from January 1999 to August 2006 were studied. The thyroid function test and random serum cortisol were measured in all patients at the time of admission. Patients were given oral or intravenous (IV) thyroxine with intention to treat with the latter according to availability. Various modules that predict outcome, including Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score, were analysed. SOFA score was repeated every 2 days until the time of discharge or demise. Results Twenty-three patients (20 women; 87%) of 59.5 ± 14.4 years of age (range, 30 to 89 years) were seen during the study period. Nine (39%) patients were diagnosed with hypothyroidism for the first time at the time of presentation of myxoedema coma, whereas 14 (70%) were diagnosed with hypothyroidism previously. However, the treatment defaulters presented early to the hospital and had more severe manifestations than de novo subjects. Nineteen (82%) had thyroprivic (primary) and 4 (17%) had trophoprivic (secondary) hypothyroidism. Fifteen (65%) patients presented in the winter and in 17 (74%) sepsis was the major accompanying comorbidity. Twelve (52%) had a history of diuretic use, thereby delaying the initial diagnosis. Patients who received oral L-thyroxine had no difference in outcome from those receiving IV thyroxine. Twelve (52%) subjects died and sepsis was the predominant cause of death. Various

  5. Outcomes and Predictors of Early Mortality After Continuous-Flow Left Ventricular Assist Device Implantation as a Bridge to Transplantation

    PubMed Central

    2014-01-01

    Left ventricular assist devices (LVADs) are fast becoming standard of care for patients with advanced heart failure. However, despite continuous improvement in VAD technology, there remains a significant early postoperative morbidity and mortality in this extreme patient group. The aim of the current study was to explore the short-term outcomes and predictors for 90 day mortality in the patients after implantation of continuous-flow LVAD. Perioperative clinical, echocardiographic, hemodynamic, and laboratory data of 90 day survivors and nonsurvivors were collected and compared retrospectively. Multivariate logistic regression analysis was performed on univariate predictors for 90 day mortality with an entry criterion of p < 0.1. Between July 2006 and May 2012, 117 patients underwent implantation of a continuous-flow LVAD as a bridge to transplantation: 71 (60.7%) HeartMate II (Thoratec Corp, Pleasanton, CA) and 46 (39.3%) HVAD (HeartWare International, Framingham, MA). All-cause 90 day mortality was 17.1%. Multivariate analysis revealed higher preoperative central venous pressure (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.014–1.378; p = 0.033) and higher age (OR, 1.14; 95% CI, 1.01–1.38; p = 0.045) as the only independent predictors for 90 day mortality. Optimization of preoperative volume status, preload, and right heart function as well as age-based selection of candidates for LVAD support are the critical factors influencing early outcome after continuous-flow LVAD implantation. PMID:24399066

  6. Effectiveness of Large-Scale Community-Based Intensive Behavioral Intervention: A Waitlist Comparison Study Exploring Outcomes and Predictors

    ERIC Educational Resources Information Center

    Flanagan, Helen E.; Perry, Adrienne; Freeman, Nancy L.

    2012-01-01

    File review data were used to explore the impact of a large-scale publicly funded Intensive Behavioral Intervention (IBI) program for young children with autism. Outcomes were compared for 61 children who received IBI and 61 individually matched children from a waitlist comparison group. In addition, predictors of better cognitive outcomes were…

  7. Serum Triglyceride Level: A Predictor of Complications and Outcomes in Acute Pancreatitis?

    PubMed Central

    Tariq, Hassan; Gaduputi, Vinaya; Peralta, Richard; Abbas, Naeem; Nayudu, Suresh Kumar; Thet, Phyo; Zaw, Tin; Hui, Shirley; Chilimuri, Sridhar

    2016-01-01

    Aim. To study serum triglyceride level as a predictor of complications and outcomes in acute pancreatitis. Methods. In this retrospective observational study, 582 patients admitted with acute pancreatitis, who had serum triglyceride levels measured within the first 24 hours, were divided into two groups. The study group consisted of patients with a triglyceride level ≥2.26 mmol/L (group 2) and the control group consisted of triglyceride level of <2.26 mmol/L (group 1). We collected data for baseline demographics, laboratory values, incidence of complications (local and systemic), admission to the intensive care unit (ICU), ICU length of stay, length of total hospital stay, and death in the two groups. Results. A triglyceride level of ≥2.26 mmol/L was found to be an independent predictor of developing altered mental status (p: 0.004), pancreatic necrosis (p: 0.001), acute respiratory distress syndrome (p: 0001), systemic Inflammatory response syndrome (p: 0.001), acute kidney injury (p: 0.001), hospital length of stay (LOS) (p: 0.002), admission to intensive care unit (ICU) (p: 0.002), and ICU LOS (p: 0.003). Conclusion. A triglyceride level of ≥2.26 mmol/L on admission in acute pancreatitis is an independent predictor of developing local and systemic complications, hospital LOS, admission to ICU, and ICU LOS.

  8. Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence

    SciTech Connect

    Bishop, Andrew J.; Tao, Randa; Rebueno, Neal C.; Christensen, Eva N.; Allen, Pamela K.; Wang, Xin A.; Amini, Behrang; Tannir, Nizar M.; Tatsui, Claudio E.; Rhines, Laurence D.; Li, Jing; Chang, Eric L.; Brown, Paul D.; Ghia, Amol J.

    2015-08-01

    Purpose: To investigate local control, survival outcomes, and predictors of local relapse for patients treated with spine stereotactic body radiation therapy. Methods and Materials: We reviewed the records of 332 spinal metastases consecutively treated with stereotactic body radiation therapy between 2002 and 2012. The median follow-up for all living patients was 33 months (range, 0-111 months). Endpoints were overall survival and local control (LC); recurrences were classified as either in-field or marginal. Results: The 1-year actuarial LC and overall survival rates were 88% and 64%, respectively. Patients with local relapses had poorer dosimetric coverage of the gross tumor volume (GTV) compared with patients without recurrence (minimum dose [Dmin] biologically equivalent dose [BED] 23.9 vs 35.1 Gy, P<.001; D98 BED 41.8 vs 48.1 Gy, P=.001; D95 BED 47.2 vs 50.5 Gy, P=.004). Furthermore, patients with marginal recurrences had poorer prescription coverage of the GTV (86% vs 93%, P=.01) compared with those with in-field recurrences, potentially because of more upfront spinal canal disease (78% vs 24%, P=.001). Using a Cox regression univariate analysis, patients with a GTV BED Dmin ≥33.4 Gy (median dose) (equivalent to 14 Gy in 1 fraction) had a significantly higher 1-year LC rate (94% vs 80%, P=.001) compared with patients with a lower GTV BED Dmin; this factor was the only significant variable on multivariate Cox analysis associated with LC (P=.001, hazard ratio 0.29, 95% confidence interval 0.14-0.60) and also was the only variable significant in a separate competing risk multivariate model (P=.001, hazard ratio 0.30, 95% confidence interval 0.15-0.62). Conclusions: Stereotactic body radiation therapy offers durable control for spinal metastases, but there is a subset of patients that recur locally. Patients with local relapse had significantly poorer tumor coverage, which was likely attributable to treatment planning directives that prioritized the

  9. Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study

    PubMed Central

    Ye, Young-Min; Kim, Mi Kyeong; Kang, Hye-Ryun; Kim, Tae-Bum; Sohn, Seong-Wook; Koh, Young-Il; Park, Hye-Kyung; Jang, Gwang Cheon; Kim, Cheol-Woo; Hur, Gyu-Young; Kim, Joo-Hee; Kim, Sang-Heon; Choi, Gil-Soon; Lee, Soo-Keol

    2015-01-01

    Purpose Differences in definitions of the condition, relevant triggers, and the geographical locations of study centers, cause estimates of the prevalence of anaphylaxis to vary. Recent epidemiological data indicate that the incidence of anaphylaxis is rising. Methods To investigate the causes and clinical features of anaphylaxis in Korean adults, factors associated with the severity of the condition, and serious outcomes, a retrospective medical record review was performed on adult patients diagnosed with anaphylaxis between 2007 and 2011 in 15 University Hospitals of South Korea. Results A total of 1,806 cases (52% male, age 16-86 years) were reported. Cutaneous symptoms (84.0%), combined with respiratory (53.9%) and/or cardiovascular (55.4%) symptoms, were the most frequent presentations. Using a recognized grading system, 1,776 cases could be classified as either mild, 340; moderate, 690; or severe, 746. Although eliciting factors varied significantly by age, gender, and regional and seasonal factors, drugs (46.5%; including nonsteroidal anti-inflammatory drugs, antibiotics, and radiocontrast media) were the most common cause of anaphylaxis, followed by foods (24.2%), insect stings (16.4%), exercise (5.9%), and unknown etiology (7.0%). All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. Epinephrine auto-injectors were prescribed for 7.4% of reported cases. Conclusions The principal causes of anaphylaxis in Korean adults were drugs, food, and insect stings. Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes. PMID:25553259

  10. Predictors of treatment attrition among an outpatient clinic sample of youths with clinically significant anxiety.

    PubMed

    Gonzalez, Araceli; Weersing, V Robin; Warnick, Erin M; Scahill, Lawrence D; Woolston, Joseph L

    2011-09-01

    Predictors of treatment attrition were examined in a sample of 197 youths (ages 5-18) with clinically-significant symptoms of anxiety seeking psychotherapy services at a community-based outpatient mental health clinic (OMHC). Two related definitions of attrition were considered: (a) clinician-rated dropout (CR), and (b) CR dropout qualified by phase of treatment (pre, early, or late phases) (PT). Across both definitions, rates of attrition in the OMHC sample were higher than those for anxious youths treated in randomized controlled trials, and comorbid depression symptoms predicted dropout, with a higher rate of depressed youths dropping out later in treatment (after 6 sessions). Using the PT definition, minority status also predicted attrition, with more African-American youths lost pre-treatment. Other demographic (age, gender, single parent status) and clinical (externalizing symptoms, anxiety severity) characteristics were not significantly associated with attrition using either definition. Implications for services for anxious youths in public service settings are discussed. Results highlight the important role of comorbid depression in the treatment of anxious youth and the potential value of targeted retention efforts for ethnic minority families early in the treatment process. PMID:20976618

  11. Moderators and Predictors of Clinical Outcome in a Randomized Trial for Behavior Problems in Pediatric Primary Care

    PubMed Central

    Cheng, Yu; Campo, John V.; Kelleher, Kelly

    2011-01-01

    Objectives To evaluate putative moderator, predictor, and treatment parameter variables in relation to three outcomes in a clinical trial that compared a modular protocol for on-site, nurse-administered intervention (PONI) and enhanced usual care (EUC) for pediatric behavioral problems in primary care. Methods Patients were 163 clinically referred children for behavior problems in six primary care offices. PONI consisted of seven treatment modules adapted from prior treatment trials with this population, whereas EUC involved a facilitated referral to a community provider. Outcome measures were based on standardized scales reflecting one parent-rated aggregate (child dysfunction) and one child-rated aggregate (child health), and diagnostic interviews with both informants (remission in oppositional defiant disorder). Results Moderator analyses revealed that PONI was more effective than EUC in reducing child dysfunction by 12-month follow-up among Caucasian children, whereas EUC was more effective than PONI among non-Caucasian children. In the full sample, child health improvement was predicted by the severity of the child’s depression and anxiety, and level of family conflict. Duration of child exposure to cognitive-behavioral treatment in PONI was related to greater improvement in overall child health, but other treatment parameters were unrelated to outcome. Conclusions These few significant relationships notwithstanding the findings indicate that the two treatments had robust effects on several outcomes and across selected child, parent, family, and treatment variables. The findings extend efforts to incorporate mental health services in pediatric practice. PMID:21335616

  12. Clinical Profile and Predictors of Outcomes in Older Inpatients with Pyelonephritis in a Tertiary Care Hospital in Southern India

    PubMed Central

    Wilson, Benny Paul; Viggeswarpu, Surekha; Sathyendra, Sowmya; Iyyadurai, Ramya; Visvanathan, Renuka; Mathews, Kuruvilla Prasad

    2015-01-01

    Background Pyelonephritis is a serious infection associated with significant morbidity and mortality in the elderly with an estimated annual incidence rate of around 10% from previous studies. Older people are at a higher risk for pyelonephritis due to multiple factors including structural, functional and co-existent conditions. There is very little data on the incidence, clinical features and outcomes among elderly patients with pyelonephritis in India. Materials and Methods We performed a retrospective review of case records of 100 consecutive patients over the age of 60 years with pyelonephritis admitted to a tertiary care hospital. Results One fourth of our patients (26%) did not have fever, 49% had delirium and 52% had systemic inflammatory response syndrome (SIRS). Sixty five percent of the patients were diabetic and 60% had infections caused by extended spectrum beta lactamase (ESBL) producing organisms. As in other studies, the commonest organism isolated was E.coli (49%). A low serum albumin level was a predictor of mortality (p<0.001) and increased length of hospital stay (p<0.005). Delirium was also associated with a poor outcome (p=0.009) in these patients. Patients with pyelonephritis secondary to ESBL producing organisms had a higher length of stay (p<0.005). Conclusion Hypoalbuminemia and delirium predicted poor outcomes in our patients. We found a high prevalence of ESBL infections in this study. Further research is required to assess the efficacy of aggressive management of delirium and low albumin in improving health and cost outcomes. PMID:26557554

  13. Dysmenorrhea among female medical students in King Abdulaziz University: Prevalence, Predictors and outcome

    PubMed Central

    Ibrahim, Nahla Khamis; AlGhamdi, Manar Saleh; Al-Shaibani, Alanoud Nawaf; AlAmri, Fatima Ali; Alharbi, Huda Abdulrahman; Al-Jadani, Arwa Kheder; Alfaidi, Raghad Ahmed

    2015-01-01

    Objective: To determine the prevalence, predictors and outcome of dysmenorrhea among female medical students in King Abdulaziz University (KAU), Jeddah, Saudi Arabia. Methods: A cross-sectional study was conducted among 435 medical students at KAU, Jeddah selected through stratified random sample method. A pre-constructed, validated, self-administered questionnaire was used to collect personal and socio-demographic information. Data about menstrual history, stress, smoking were also collected. The severity of dysmenorrhea was scored by the “Visual Analogue Scale (VAS)”. Descriptive and analytical statistics were conducted. Results: The prevalence of dysmenorrhea was 60.9%. Logistic regression showed that heavy period was the first predictor of dysmenorrhea (aOR=1.94; 95% CI: 1.29- 2.91), followed by stress (aOR=1.90; 95% C.I.: 1.19-3.07). The prevalence of severe dysmenorrhea among the sufferers was 38.6%. Depressed mood was the commonest (80.8%) symptom accompanying dysmenorrhea. Regarding the outcome of dysmenorrhea, 67.5% of the sufferes reported emotional instability, while 28.3% reported absenteeism from the university. Conclusions: A high prevalence of dysmenorrhea was prevalent among medical students in King Abdulaziz University (KAU), Health promotion, screening programs, and stress management courses are recommended. PMID:26870088

  14. Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect

    PubMed Central

    Goudra, Basavana Gouda; Singh, Preet Mohinder; Penugonda, Lakshmi C; Speck, Rebecca M; Sinha, Ashish C

    2014-01-01

    Background: Providing anesthesia for gastrointestinal (GI) endoscopy procedures in morbidly obese patients is a challenge for a variety of reasons. The negative impact of obesity on the respiratory system combined with a need to share the upper airway and necessity to preserve the spontaneous ventilation, together add to difficulties. Materials and Methods: This retrospective cohort study included patients with a body mass index (BMI) >40 kg/m2 that underwent out-patient GI endoscopy between September 2010 and February 2011. Patient data was analyzed for procedure, airway management technique as well as hypoxemic and cardiovascular events. Results: A total of 119 patients met the inclusion criteria. Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available. Frequency of desaturation episodes showed statistically significant relation to previous history of obstructive sleep apnea (OSA). These desaturation episodes were found to be statistically independent of increasing BMI of patients. Conclusion: Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation. With suitable modification of anesthesia technique, it is possible to reduce the incidence of adverse respiratory events in morbidly obese patients undergoing GI endoscopy procedures, thereby avoiding the need for endotracheal intubation. PMID:24574597

  15. Patient and program predictors of 12-month outcomes for homeless veterans following discharge from time-limited residential treatment.

    PubMed

    McGuire, James; Rosenheck, Robert A; Kasprow, Wesley J

    2011-05-01

    The U.S. Department of Veterans Affairs provides transitional residential treatment to homeless veterans through three types of programs: VA-staffed Domiciliary care, and two types of community-based treatment (one funded through locally managed contracts and the other through national grants). This study compared treatment process and outcomes in these three programs and also sought to identify differences in outcome between dually diagnosed veterans, veterans with substance abuse problems or psychiatric problems alone, and those with no psychiatric diagnoses. Altogether, 1,338 veterans admitted to the 3 types of program were recruited to participate in a prospective naturalistic study which evaluated housing, clinical and community adjustment outcomes during the year following discharge. Data on 1,003 veterans for whom psychiatric diagnostic, social climate and length of stay data were available were used to compare participants in the three program types at baseline. Regression models were used to compare outcomes across program and diagnostic types net of baseline differences between study participants, and of differences in social climate and length of stay. The overall follow-up rate across all time points was 72%. Significant differences across programs were observed on only 2 baseline measures as well as on several baseline values of the outcome measures, length of stay and a measure of social climate. Adjusting for veteran baseline differences alone there were no differences in outcomes by program after correction for multiple comparisons. Dually diagnosed veterans had poorer mental health and overall quality of life outcomes. Longer length of stay and more positive social climate were associated with superior outcomes on several measures. The adjusted mean estimate of the proportion of veterans housed at 12 months follow-up was 78%, similar to published outcomes for supported housing. Length of stay, rather than program funding configuration or

  16. Sex differences in sleep apnea predictors and outcomes from home sleep apnea testing

    PubMed Central

    Cairns, Alyssa; Poulos, Greg; Bogan, Richard

    2016-01-01

    Study objectives To evaluate sex differences in predictors of obstructive sleep apnea (OSA) as per outcomes from home sleep apnea testing. Design This was a retrospective analysis of a large repository of anonymous test results and pretest risk factors for OSA. Setting and patients A total of 272,705 patients were referred for home sleep apnea testing from a variety of clinical practices for suspected sleep disordered breathing across North America from 2009 to 2013. Interventions Not applicable. Measurements and results Predictors of OSA (apnea hypopnea index4%≥5) were evaluated by multiple logistic regression; sex differences were evaluated by interaction effects. Middle age was the single most robust predictor of OSA for both sexes and was particularly foretelling for females (P<0.001) even after controlling for measures of adiposity and medical conditions. Females over the age of 45 years were much more likely to have OSA compared to their younger counterparts (78.7% vs 42.5%, respectively; odds ratio: 5.0) versus males (88.1% vs 68.8%, respectively; odds ratio: 3.4). Snoring, although more frequently reported by males, was similarly predictive of OSA for both sexes. Witnessed apneas and measures of adiposity were better predictors of OSA for males than females. Insomnia, depression, and use of sleep medication, although more commonly reported in females, did not predict OSA. Hypertension, although equally reported by both sexes, performed better as a predictor in females (P<0.001), even after controlling for age, measures of adiposity, and other medical conditions. Diabetes, heart disease, stroke, and sleepiness did not contribute unique variance in OSA in adjusted models. Conclusion This study found that males and females report different symptoms upon clinical evaluation for suspected sleep apnea, with some of the “classic” OSA features to be more common in and robustly predictive for males. The finding that advancing age uniquely and robustly

  17. Adherence to Preventive Medications: Predictors and outcomes in the Diabetes Prevention Program

    PubMed Central

    Walker, Elizabeth A.; Molitch, Mark; Kramer, M. Kaye; Kahn, Steven; Ma, Yong; Edelstein, Sharon; Smith, Kellie; Johnson, Mariana Kiefer; Kitabchi, Abbas; Crandall, Jill

    2006-01-01

    OBJECTIVE To evaluate barriers to and strategies for medication adherence and predictors of adherence and the primary outcome in the Diabetes Prevention Program (DPP). RESEARCH DESIGN AND METHODS Within a randomized, controlled primary prevention study for type 2 diabetes, we collected data on study medication adherence, its predictors, and health outcomes in 27 clinical centers across mainland U.S. and Hawaii. Medication arm participants included 2,155 adults with impaired glucose tolerance randomly assigned to either metformin or matched placebo treatment arms. Structured interviews were used to promote medication adherence and to collect data regarding adherence. Adherence was measured by pill count. The primary DPP outcome of type 2 diabetes was assessed by fasting plasma glucose and oral glucose tolerance test. RESULTS Older age-groups were more adherent than the youngest group (P = 0.01) in the metformin group. The most frequently reported barrier to adherence was “forgetting” (22%). Women reported more adverse effects of metformin (15 vs. 10%, P = 0.002) in the metformin group. Odds of nonadherence increased as participants reported more than one barrier (odds ratio 19.1, P < 0.001). Odds of adherence increased as participants reported multiple strategies to take medication (2.69, P < 0.0001). There was a 38.2% risk reduction for developing diabetes for those adherent to metformin compared with those adherent to placebo (P < 0.0003). CONCLUSIONS DPP medication adherence results are unique in primary prevention for a chronic disease in a large multiethnic sample. Our finding that adherence was associated with risk reduction for diabetes supports the development of brief interventions in clinical settings where medication adherence is a challenge. PMID:16936143

  18. Anxiety Disorder-Specific Predictors of Treatment Outcome in the Coordinated Anxiety Learning and Management (CALM) Trial.

    PubMed

    Jakubovski, Ewgeni; Bloch, Michael H

    2016-09-01

    Identifying baseline characteristics associated with treatment outcome in generalized anxiety disorder, panic disorder, social anxiety disorder (SAD) or post-traumatic stress disorder. We performed two secondary analyses of the Coordinated Anxiety Learning and Management trial. Baseline characteristics and their interactions with treatment assignment were analyzed via stepwise logistic regression models and receiver-operating criterion analyses by disorder predicting remission and response for each disorder. Predictors for poor outcome across diagnoses were comorbid depression and low socioeconomic status. Good outcome was associated with positive treatment expectancy and high self-efficacy expectancy. SAD had the lowest rate of remission and response compared to the other anxiety disorders, and differed in respect to its predictors of treatment outcome. Perceived social support predicted treatment outcome in SAD. The special role of SAD among the other anxiety disorders requires further study both because of its worse prognosis and its more specific treatment needs. PMID:26563229

  19. Trauma exposure and refugee status as predictors of mental health outcomes in treatment-seeking refugees

    PubMed Central

    Knipscheer, Jeroen W.; Sleijpen, Marieke; Mooren, Trudy; ter Heide, F. Jackie June; van der Aa, Niels

    2015-01-01

    Aims and method This study aimed to identify predictors of symptom severity for post-traumatic stress disorder (PTSD) and depression in asylum seekers and refugees referred to a specialised mental health centre. Trauma exposure (number and domain of event), refugee status and severity of PTSD and depression were assessed in 688 refugees. Results Symptom severity of PTSD and depression was significantly associated with lack of refugee status and accumulation of traumatic events. Four domains of traumatic events (human rights abuse, lack of necessities, traumatic loss, and separation from others) were not uniquely associated with symptom severity. All factors taken together explained 11% of variance in PTSD and depression. Clinical implications To account for multiple predictors of symptom severity including multiple traumatic events, treatment for traumatised refugees may need to be multimodal and enable the processing of multiple traumatic memories within a reasonable time-frame. PMID:26755950

  20. Outcome Predictors in Prosthetic Joint Infections--Validation of a risk stratification score for Prosthetic Joint Infections in 120 cases.

    PubMed

    Wimmer, Matthias D; Randau, Thomas M; Friedrich, Max J; Ploeger, Milena M; Schmolder, Jan; Strauss, Andreas C; Pennekamp, Peter H; Vavken, Patrick; Gravius, Sascha

    2016-03-01

    Prosthetic joint infections are a major challenge in total joint arthroplasty, especially in times of accumulating drug resistancies. Even though predictive risk classifications are a widely accepted tool to define a suitable treatment protocol a classification is still missing considering the difficulty in treating the -causative pathogen antibiotically. In this study, we present and evaluate a new predictive risk stratification for prosthetic joint infections in 120 cases, treated with a two-stage exchange. Treatment outcomes in 120 patients with proven prosthetic joint infections in hip and knee prostheses were regressed on time of infection, systemic risk factors, local risk factors and the difficulty in treating the causing pathogen. The main outcome variable was "definitely free of infection" after two years as published. Age, gender, and BMI were included as covariables and analyzed in a logistic regression model. 66 male and 54 female patients, with a mean age at surgery of 68.3 years±12.0 and a mean BMI of 26.05±6.21 were included in our survey and followed for 29.0±11.3 months. We found a significant association (p<0.001) between our score and the outcome parameters evaluated. Age, gender and BMI did not show a significant association with the outcome. These results show that our score is an independent and reliable predictor for the cure rate in prosthetic joint infections in hip and knee prostheses treated within a two-stage exchange protocol. Our score illustrates, that there is a statistically significant, sizable decrease in cure rate with an increase in score. In patients with prosthetic joint infections the validation of a risk score may help to identify patients with local and systemic risk factors or with infectious organisms identified as "difficult to treat" prior to the treatment or the decision about the treatment concept. Thus, appropriate extra care should be considered and provided. PMID:26984667

  1. Predictors and Outcomes of Routine Versus Optimal Medical Therapy in Stable Coronary Heart Disease.

    PubMed

    Chun, Soohun; Qiu, Feng; Austin, Peter C; Ko, Dennis T; Mamdani, Muhammad; Wijeysundera, Duminda N; Czarnecki, Andrew; Bennell, Maria C; Wijeysundera, Harindra C

    2015-09-01

    Although randomized studies have shown optimal medical therapy (OMT) to be as efficacious as revascularization in stable coronary heart disease (CHD), the application of OMT in routine practice is suboptimal. We sought to understand the predictors of receiving OMT in stable CHD and its impact on clinical outcomes. All patients with stable CHD based on coronary angiography from October 2008 to September 2011 were identified in Ontario, Canada. OMT was defined as concurrent use of β blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and statin. Aspirin use was not part of the OMT definition because of database limitations. Multivariable hierarchical logistic models identified predictors of OMT in the 12 months after angiography. Cox proportional hazard models with time-varying covariates for OMT and revascularization status examined differences in death and nonfatal myocardial infarction (MI). In these models, patients transitioned among 4 mutually exclusive treatment groups: no OMT and no revascularization, no OMT and revascularization, OMT and no revascularization, OMT and revascularization. Our cohort had 20,663 patients. Over a mean period of 2.5 years, 8.7% had died. Only 61% received OMT within 12 months. The strongest predictor of receiving OMT at 12 months was OMT before the angiogram (odds ratio 14.40, 95% confidence interval [CI] 13.17 to 15.75, p <0.001). Relative to no OMT and nonrevascularized patients, patients on OMT and revascularized had the greatest reduction in mortality (hazard ratio 0.52, 95% CI 0.45 to 0.60, p <0.001) and nonfatal MI (hazard ratio 0.74, 95% CI 0.64 to 0.84, p <0.001). In conclusion, our study highlights the low rate of OMT in stable CHD. Patients who received both OMT and revascularization achieved the greatest reduction in mortality and nonfatal MI. PMID:26119653

  2. Admission selection criteria as predictors of outcomes in an undergraduate medical course: A prospective study

    PubMed Central

    Mercer, Annette; Puddey, Ian B

    2011-01-01

    Background In 1998, a new selection process which utilised an aptitude test and an interview in addition to previous academic achievement was introduced into an Australian undergraduate medical course. Aims To test the outcomes of the selection criteria over an 11-year period. Methods 1174 students who entered the course from secondary school and who enrolled in the MBBS from 1999 through 2009 were studied in relation to specific course outcomes. Regression analyses using entry scores, sex and age as independent variables were tested for their relative value in predicting subsequent academic performance in the 6-year course. The main outcome measures were assessed by weighted average mark for each academic year level; together with results in specific units, defined as either ‘knowledge'-based or ‘clinically’ based. Results Previous academic performance and female sex were the major independent positive predictors of performance in the course. The interview score showed positive predictive power during the latter years of the course and in a range of ‘clinically' based units. This relationship was mediated predominantly by the score for communication skills. Conclusions Results support combining prior academic achievement with the assessment of communication skills in a structured interview as selection criteria into this undergraduate medical course. PMID:21592024

  3. Contextual and intrapersonal predictors of adolescent risky sexual behavior and outcomes.

    PubMed

    Shneyderman, Yuliya; Schwartz, Seth J

    2013-08-01

    The present study was designed to test a model of contextual and intrapersonal predictors of adolescent risky sexual behaviors and of sexually transmitted infection diagnoses. Using Waves I and II from the National Longitudinal Study of Adolescent Health, the authors estimated a structural model in which intrapersonal factors such as adolescents' attitudes about sex, perceived parental norms, knowledge about sexual health, and birth-control self-efficacy partially mediated the effects of contextual factors such as parent-adolescent relationship quality, school connectedness, and exposure to AIDS and pregnancy education on a number of risky sexual behaviors and outcomes: early sex initiation, sex under the influence of substances, condom use at last intercourse, and having been diagnosed with a sexually transmitted infection. Different patterns of direct and mediated effects emerged for each sexual outcome. Results are discussed in terms of the complex interplay between environment and individual and in terms of how, when, and with whom to intervene in order to improve adolescent sexual health outcomes. PMID:22885188

  4. Evaluation of positive and negative predictors of seizure outcomes among patients with immune-mediated epilepsy: a meta-analysis

    PubMed Central

    Dubey, Divyanshu; Farzal, Zehra; Hays, Ryan; Brown, L Steven; Vernino, Steven

    2016-01-01

    Background: The objective of this study was to analyze published literature on autoimmune epilepsy and assess predictors of seizure outcome. Methods: From PubMed and EMBASE databases, two reviewers independently identified publications reporting clinical presentations, management and outcomes of patients with autoimmune epilepsy. A meta-analysis of 46 selected studies was performed. Demographic/clinical variables (sex, age, clinical presentation, epilepsy focus, magnetic resonance imaging [MRI] characteristics, time to diagnosis and initiation of immunomodulatory therapy, and type of immunomodulatory therapy) were compared between two outcome groups (responders and nonresponders). Clinical response was defined as >50% reduction in seizure frequency. Unstandardized effect sizes were collected for the studies for responder and nonresponder groups. Sample size was used as the weight in the meta-analysis. The random effects model was used to account for heterogeneity in the studies. Results: The 46 reports included 186 and 96 patients in responder and nonresponder groups respectively. Mean age of the responders and nonresponders was 43 and 31 years (p < 0.01). Responders were more likely to have cell-surface antibodies (68% versus 39%, p < 0.05), particularly voltage-gated potassium channel complex antibodies (p < 0.01). Mean duration from symptom onset to diagnosis, and symptom onset to initiation of immunomodulation was significantly lower among the responders (75 versus 431 days, p < 0.05, and 80 versus 554, p < 0.01, respectively). There was no outcome difference based on gender, MRI characteristics, seizure type, type of acute immunomodulatory therapy, or use of chronic immunomodulation. Conclusions: Among published cases to date, older age, presence of cell-surface antibodies, early diagnosis and immunomodulatory treatment are associated with better seizure outcomes among patients with autoimmune epilepsy. PMID:27582892

  5. Outcomes and Predictors of Mortality for Patients with Acute Leukemia Admitted to the Intensive Care Unit

    PubMed Central

    Croucher, Danielle; Christian, Michael; Ibrahimova, Narmin; Kumar, Vikram; Jacob, Gabriella; Kiss, Alex

    2016-01-01

    Purpose. The objectives were to describe the management and outcomes of acute leukemia (AL) patients admitted to the ICU and to identify predictors of ICU mortality. Methods. Data was retrospectively collected from the medical records of all patients with AML or ALL admitted to the Mount Sinai Hospital ICU from August 2009 to December 2012. Results. 151 AL patients (117 AML, 34 ALL) were admitted to the ICU. Mean age was 54 (SD 15) years, median APACHE II score was 27 (IQR 22–33), and 50% were female. While in ICU, 128 (85%) patients had sepsis and 56 (37%) had ARDS. The majority of patients required invasive organ support: 94 (62%) required mechanical ventilation while 23 (15%) received renal replacement therapy. Multivariable analysis identified SOFA score (OR 1.18, 95% CI 1.01–1.38) and invasive ventilation (OR 9.64, 95% CI 3.39–27.4) as independent predictors of ICU mortality. Ninety-four (62%) patients survived to ICU discharge. Only 39% of these 94 patients discharged were alive 12 months after ICU admission. Conclusions. AL patients admitted to the ICU had a 62% ICU survival rate; yet only 25% of cohort patients were alive 12 months after ICU admission. Higher admission SOFA scores and invasive ventilation are independently associated with a greater risk of dying in the ICU. PMID:27445524

  6. The biopsychosocial factors that serve as predictors of the outcome of surgical modalities for chronic pain.

    PubMed

    Sertel Berk, Hanife Ozlem

    2010-07-01

    Chronic pain is considered a universal problem in terms of serious impairment in the biopsychosocial functioning of individuals. The psychiatric and psychosocial factors accompanying chronic pain necessitated alterations in classical therapeutic approaches towards chronic pain and resulted in a substantial increase in the number of multidisciplinary pain clinics worldwide. In these pain clinics, the primary goal is not only to predetermine the multiple etiologies playing a role in the acquisition and maintenance of chronic pain, but also to specify whether the individual in pain is psychologically suitable for a surgical intervention for either diagnostic or treatment purposes. This specific question stems from the fact that even though the underlying organic pathologies are similar, the effectiveness of invasive interventions for determining the cause of or attenuating pain may vary between individuals. The most important predictors of adverse outcomes of invasive interventions for chronic pain stated in the literature are primarily depression, anxiety and somatization followed by features of pain such as severity or number of painful body sites. In line with the vast body of research, especially over the previous decade, this small scale review aims to emphasize the interactional roles of biopsychosocial factors on the effectiveness of surgical interventions and to discuss the issues regarding the assessment of these predictors. PMID:20865579

  7. Assessing clinical significance of treatment outcomes using the DASS-21.

    PubMed

    Ronk, Fiona R; Korman, James R; Hooke, Geoffrey R; Page, Andrew C

    2013-12-01

    Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change. PMID:23730826

  8. Is the Authoritarian Trait in Mental Health Workers a Significant Predictor Variable of Patient Assault?

    ERIC Educational Resources Information Center

    Safian-Rush, Donna

    Mental health workers may be assaulted by their violent patients. A study was conducted to examine one predictor variable of aggressive behavior in patients. It was hypothesized that authoritarian traits in the mental health worker could result in more assaults against the mental health worker by patients. Participants (N=32) were mental health…

  9. The Glasgow Prognostic Score (GPS) as a novel and significant predictor of extranodal natural killer/T-cell lymphoma, nasal type.

    PubMed

    Li, Ya-Jun; Jiang, Wen-Qi; Huang, Jia-Jia; Xia, Zhong-Jun; Huang, Hui-Qiang; Li, Zhi-Ming

    2013-05-01

    The Glasgow Prognostic Score (GPS), an inflammation-based prognostic score including C-reactive protein and albumin, shows significant prognostic value in several types of solid tumors. The prognostic value of GPS in lymphoma remains unclear. We performed this study to evaluate the prognostic significance of GPS in extranodal natural killer (NK)/T-cell lymphoma (ENKL). We retrospectively analyzed 164 patients with newly diagnosed ENKL. The prognostic value of GPS was evaluated and compared with that of International Prognostic Index (IPI), Prognostic Index for Peripheral T-cell lymphoma unspecified (PIT), and Korean Prognostic Index (KPI). Patients with higher GPS tended to have more adverse clinical characteristics, lower rates of complete remission (P < 0.001), inferior progression-free survival (PFS, P < 0.001), and inferior overall survival (OS, P < 0.001). Multivariate analysis demonstrated that high GPS, age > 60 years, and elevated LDH were independent adverse predictors of OS. GPS was found superior to IPI, PIT, and KPI in discriminating patients with different outcomes in low-risk groups (all P < 0.05). GPS is an independent predictor of survival outcomes in ENKL. Inflammatory response might play an important role in the progression of ENKL and survival of patients with ENKL. PMID:23423859

  10. Is severely left ventricular dysfunction a predictor of early outcomes in patients with coronary artery bypass graft?

    PubMed Central

    Ahmadi, Seyed Hossein; Karimi, Abbasali; Movahedi, Namvar; Shirzad, Mahmood; Marzban, Mehrab; Tazik, Mokhtar; Aramin, Hermineh; Dowlatshahi, Samaneh; Fathollahi, Mahmood Sheikh

    2010-01-01

    Background Traditionally, the Coronary artery bypass grafting (CABG) surgery outcomes of patients with low ejection fraction (EF) have been worse compared to patients with moderate to good left ventricular function. During the past decade, despite improvements in surgical techniques, the trend in the outcomes of these patients remained unclear. Aim We sought to determine the effect of left ventricular dysfunction on early mortality and morbidity and to specify predictors of early mortality of isolated CABG in a large group of patients EF≤35%. Method We retrospectively analyzed data of 14 819 consecutive patients undergoing isolated CABG from February 2002 to March 2008 at Tehran Heart Center. Patients were divided into two groups based on their LVEF (EF≤35% and EF>35%). Differences in case-mix between patients with EF≤35% and those without were controlled by constructing a propensity score. Results Mean age of our patients was 58.7±9.5 years. EF≤35% was present in 1342 (9.1%) of patients. In-hospital mortality was significantly increased univariate in EF≤35%, while this association diminished after confounders were adjusted for by using the propensity score (p=0.242). Following adjustment it was demonstrated that renal failure, cardiac arrest, heart block, infectious complication, total ventilation time, and total ICU hours were more frequent in patients with EF≤35%. Conclusion We demonstrated EF≤35% was not predictor of in-hospital mortality in patients underwent CABG. Careful preoperative patient selection remains essential in patients with EF≤35% undergoing CABG. PMID:27325945

  11. Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response

    PubMed Central

    Alonso, Pino; Cuadras, Daniel; Gabriëls, Loes; Denys, Damiaan; Goodman, Wayne; Greenberg, Ben D.; Jimenez-Ponce, Fiacro; Kuhn, Jens; Lenartz, Doris; Mallet, Luc; Nuttin, Bart; Real, Eva; Segalas, Cinto; Schuurman, Rick; Tezenas du Montcel, Sophie; Menchon, Jose M.

    2015-01-01

    Background Deep brain stimulation (DBS) has been proposed as an alternative to ablative neurosurgery for severe treatment-resistant Obsessive-Compulsive Disorder (OCD), although with partially discrepant results probably related to differences in anatomical targetting and stimulation conditions. We sought to determine the efficacy and tolerability of DBS in OCD and the existence of clinical predictors of response using meta-analysis. Methods We searched the literature on DBS for OCD from 1999 through January 2014 using PubMed/MEDLINE and PsycINFO. We performed fixed and random-effect meta-analysis with score changes (pre-post DBS) on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) as the primary-outcome measure, and the number of responders to treatment, quality of life and acceptability as secondary measures. Findings Thirty-one studies involving 116 subjects were identified. Eighty-three subjects were implanted in striatal areas—anterior limb of the internal capsule, ventral capsule and ventral striatum, nucleus accumbens and ventral caudate—27 in the subthalamic nucleus and six in the inferior thalamic peduncle. Global percentage of Y-BOCS reduction was estimated at 45.1% and global percentage of responders at 60.0%. Better response was associated with older age at OCD onset and presence of sexual/religious obsessions and compulsions. No significant differences were detected in efficacy between targets. Five patients dropped out, but adverse effects were generally reported as mild, transient and reversible. Conclusions Our analysis confirms that DBS constitutes a valid alternative to lesional surgery for severe, therapy-refractory OCD patients. Well-controlled, randomized studies with larger samples are needed to establish the optimal targeting and stimulation conditions and to extend the analysis of clinical predictors of outcome. PMID:26208305

  12. Predicting the In-Hospital Responsiveness to Treatment of Alcoholics. Social Factors as Predictors of Outcome. Brain Damage as a Factor in Treatment Outcome of Chronic Alcoholic Patients.

    ERIC Educational Resources Information Center

    Mascia, George V.; And Others

    The authors attempt to locate predictor variables associated with the outcome of alcoholic treatment programs. Muscia's study focuses on the predictive potential of: (1) response to a GSR conditioning procedure; (2) several personality variables; and (3) age and IQ measures. Nine variables, reflecting diverse perspectives, were selected as a basis…

  13. Predictors of Outcome in Patients with Cervical Spondylotic Myelopathy Undergoing Unilateral Open-Door Laminoplasty

    PubMed Central

    Shin, Ji-Won; Jin, Sung-Won; Choi, Jong-Il; Kim, Bum-Joon; Kim, Sang-Dae; Lim, Dong-Jun

    2015-01-01

    Objective This study aimed to analyze prognostic factors affecting surgical outcomes of expansive laminoplasty for cervical spondylotic myelopathy (CSM). Methods Using the Frankel scale and Japanese Orthopaedic Association (JOA) scale, we retrospectively reviewed the outcomes of 45 consecutive patients who underwent modified unilateral open-door laminoplasty using hydroxyapatite spacers and malleable titanium miniplates between June 2008 and May 2014. The patients were assigned to the good and poor clinical outcome groups, with good outcome defined as a JOA recovery rate >75%. Results The mean preoperative JOA scale was significantly higher in the good outcome group (14.95±3.21 vs. 10.78±6.07, p<0.001), whereas the preoperative cervical range of motion (ROM) in this group was significantly lower (29.89°±10.11 vs. 44.35°± 8.88, p<0.001). In univariate analysis, a high preoperative JOA scale (odds ratio (OR) 1.271, 95% confidence interval (CI) 1.005-1.607) and low preoperative cervical ROM(OR 0.858, 95% CI 0.786-0.936) were statistically correlated with good outcomes. Furthermore, these factors demonstrated an independent association with clinical outcomes (preoperative JOA scale: OR 1.344, 95% CI 1.019-1.774, p=0.036; preoperative cervical ROM: OR 0.860, 95% CI 0.788-0.940, p=0.001). Conclusion In this study, a high preoperative JOA scale was associated with good clinical outcome after laminoplasty, whereas a higher preoperative cervical spine ROM was associated with poor clinical outcome. This may suggests that cervical mobility and preoperative neurological status affect clinical outcomes of laminoplasty. PMID:26834814

  14. 'Mum's the word': Predictors and outcomes of weight concerns in pre-adolescent and early adolescent girls.

    PubMed

    Thøgersen-Ntoumani, Cecilie; Ng, Johan Yau Yin; Ntoumanis, Nikos; Chatzisarantis, Nikos; Vlachopoulos, Symeon; Katartzi, Ermioni S; Nikitaras, Nikitas

    2016-03-01

    Predictors and outcomes of weight concerns in pre-adolescent and adolescent girls are well known, but few models have incorporated concerns reported directly by mothers as a predictor, and both eating and exercise outcomes. Using questionnaires, a comprehensive model of 232 pre-adolescent and early adolescent girls' weight concerns, eating restraint, and exercise behavior was tested. Structural equation modeling showed that daughters' weight concerns were predicted primarily by their perceptions of their mothers' concerns about the daughters' weight, as well as by daughters' BMI, appearance conversations with friends, and perceived media pressure. Mothers' concerns with their daughters' weight were indirectly associated with daughters' own concerns, via the daughters' perceptions of their mothers' concerns. Daughters' concerns with their weight were a strong predictor of eating restraint, but not exercise behavior. PMID:26803392

  15. Prognostic significance of electrical alternans versus signal averaged electrocardiography in predicting the outcome of electrophysiological testing and arrhythmia-free survival

    NASA Technical Reports Server (NTRS)

    Armoundas, A. A.; Rosenbaum, D. S.; Ruskin, J. N.; Garan, H.; Cohen, R. J.

    1998-01-01

    OBJECTIVE: To investigate the accuracy of signal averaged electrocardiography (SAECG) and measurement of microvolt level T wave alternans as predictors of susceptibility to ventricular arrhythmias. DESIGN: Analysis of new data from a previously published prospective investigation. SETTING: Electrophysiology laboratory of a major referral hospital. PATIENTS AND INTERVENTIONS: 43 patients, not on class I or class III antiarrhythmic drug treatment, undergoing invasive electrophysiological testing had SAECG and T wave alternans measurements. The SAECG was considered positive in the presence of one (SAECG-I) or two (SAECG-II) of three standard criteria. T wave alternans was considered positive if the alternans ratio exceeded 3.0. MAIN OUTCOME MEASURES: Inducibility of sustained ventricular tachycardia or fibrillation during electrophysiological testing, and 20 month arrhythmia-free survival. RESULTS: The accuracy of T wave alternans in predicting the outcome of electrophysiological testing was 84% (p < 0.0001). Neither SAECG-I (accuracy 60%; p < 0.29) nor SAECG-II (accuracy 71%; p < 0.10) was a statistically significant predictor of electrophysiological testing. SAECG, T wave alternans, electrophysiological testing, and follow up data were available in 36 patients while not on class I or III antiarrhythmic agents. The accuracy of T wave alternans in predicting the outcome of arrhythmia-free survival was 86% (p < 0.030). Neither SAECG-I (accuracy 65%; p < 0.21) nor SAECG-II (accuracy 71%; p < 0.48) was a statistically significant predictor of arrhythmia-free survival. CONCLUSIONS: T wave alternans was a highly significant predictor of the outcome of electrophysiological testing and arrhythmia-free survival, while SAECG was not a statistically significant predictor. Although these results need to be confirmed in prospective clinical studies, they suggest that T wave alternans may serve as a non-invasive probe for screening high risk populations for malignant ventricular

  16. Thought Disorder and Communication Deviance as Predictors of Outcome in Youth at Clinical High Risk for Psychosis

    ERIC Educational Resources Information Center

    Bearden, Carrie E.; Wu, Keng Nei; Caplan, Rochelle; Cannon, Tyrone D.

    2011-01-01

    Objective: Given the fundamental role of thought disorder in schizophrenia, subtle communication disturbance may be a valuable predictor of subsequent development of psychosis. Here we examined the contribution of thought and communication disturbance to the prediction of outcome in adolescents identified as putatively prodromal for psychosis.…

  17. Latino and Caucasian Students' Academic and Non-Academic Characteristics as Predictors of Educational Outcomes, High School and Beyond

    ERIC Educational Resources Information Center

    Sanchez, Jafeth Evelyn

    2010-01-01

    The pathway to a postsecondary education is challenging for many students, including students from the growing Latino population in the United States. This research project focused on Latino and Caucasian students' academic and non-academic characteristics as predictors of educational outcomes, high school and beyond. The introduction to the…

  18. Predictors of Outcomes for African Americans in a Rehabilitation State Agency: Implications for National Policy and Practice

    ERIC Educational Resources Information Center

    Balcazar, Fabricio E.; Oberoi, Ashmeet K.; Suarez-Balcazar, Yolanda; Alvarado, Francisco

    2012-01-01

    A review of vocational rehabilitation (VR) data from a Midwestern state was conducted to identify predictors of rehabilitation outcomes for African American consumers. The database included 37,404 African Americans who were referred or self-referred over a period of five years. Logistic regression analysis indicated that except for age and…

  19. Physical significance of least mean squares criterion in nonstationary lattice predictors

    NASA Astrophysics Data System (ADS)

    Martinelli, G.; Orlandi, G.; Prinaricotti, L.; Ragazzini, S.

    1985-06-01

    An acoustical nonstationary model of the vocal tract is discussed. The effectiveness of the nonstationary lattice predictor in recovering the model is illustrated. The reflection coefficients are linearly decomposed on a function basis and the weights of the linear combinations are the new parameters of the model. Parameters are determined by an algorithm similar to Burg's by minimizing the sum of the variances of the forward and backward residuals. Synthetic signals of good approximation are obtained in two examples.

  20. Clinical predictors of surgical outcome in cervical spondylotic myelopathy: an analysis of 248 patients.

    PubMed

    Pumberger, M; Froemel, D; Aichmair, A; Hughes, A P; Sama, A A; Cammisa, F P; Girardi, F P

    2013-07-01

    The purpose of this study was to investigate the clinical predictors of surgical outcome in patients with cervical spondylotic myelopathy (CSM). We reviewed a consecutive series of 248 patients (71 women and 177 men) with CSM who had undergone surgery at our institution between January 2000 and October 2010. Their mean age was 59.0 years (16 to 86). Medical records, office notes, and operative reports were reviewed for data collection. Special attention was focused on pre-operative duration and severity as well as post-operative persistence of myelopathic symptoms. Disease severity was graded according to the Nurick classification. Our multivariate logistic regression model indicated that Nurick grade 2 CSM patients have the highest chance of complete symptom resolution (p < 0.001) and improvement to normal gait (p = 0.004) following surgery. Patients who did not improve after surgery had longer duration of myelopathic symptoms than those who did improve post-operatively (17.85 months (1 to 101) vs 11.21 months (1 to 69); p = 0.002). More advanced Nurick grades were not associated with a longer duration of symptoms (p = 0.906). Our data suggest that patients with Nurick grade 2 CSM are most likely to improve from surgery. The duration of myelopathic symptoms does not have an association with disease severity but is an independent prognostic indicator of surgical outcome. PMID:23814251

  1. Childhood predictors and age 48 outcomes of self-reports and official records of offending

    PubMed Central

    DUBOW, ERIC F.; HUESMANN, L. ROWELL; BOXER, PAUL; SMITH, CATHY

    2014-01-01

    Background The key question is: are self-reports and official records equally valid indicators of criminal offending? Aims We examine the correspondence between self-reports and official records of offending, the similarity of childhood and adolescent individual and contextual predictors of both measures of offending, and the similarity of age 48 correlates of both measures of offending. Methods Men (N = 436) from the Columbia County Longitudinal Study, a sample of all 3rd graders in Columbia County, New York, in 1959–60, participated. The youth, their peers and their parents were interviewed when the youth were age 8; the youth were later interviewed at ages 19, 30 and 48. Results We found moderate to high correspondence between self-reports of having been in trouble with the law and official arrest records. Lifetime self-reports and official records of offending were generally predicted by the same childhood and adolescent variables, and were correlated with many of the same adult outcome measures. By age 48, life-course non-offenders defined by either self-reports or official records had better outcomes than offenders. Conclusions The results validate the use of adolescent and adult self-reports of offending, and the early identification of individuals at risk for adult criminal behaviour through childhood parent and peer reports and adolescent self and peer reports. PMID:25294162

  2. Callous unemotional traits in children with disruptive behavior disorder: Predictors of developmental trajectories and adolescent outcomes.

    PubMed

    Muratori, Pietro; Lochman, John E; Manfredi, Azzurra; Milone, Annarita; Nocentini, Annalaura; Pisano, Simone; Masi, Gabriele

    2016-02-28

    The present study investigated trajectories of Callous Unemotional (CU) traits in youth with Disruptive Behavior Disorder diagnosis followed-up from childhood to adolescence, to explore possible predictors of these trajectories, and to individuate adolescent clinical outcomes. A sample of 59 Italian referred children with Disruptive Behavior Disorder (53 boys and 6 girls, 21 with Conduct Disorder) was followed up from childhood to adolescence. CU traits were assessed with CU-scale of the Antisocial Process Screening Device-parent report. Latent growth curve models showed that CU traits are likely to decrease linearly from 9 to 15 years old, with a deceleration in adolescence (from 12 to 15). There was substantial individual variability in the rate of change of CU traits over time: patients with a minor decrease of CU symptoms during childhood were at increased risk for severe behavioral problems and substance use into adolescence. Although lower level of socio-economic status and lower level of parenting involvement were associated to elevated levels of CU traits at baseline evaluation, none of the considered clinical and environmental factors predicted the levels of CU traits. The current longitudinal research suggests that adolescent outcomes of Disruptive Behavior Disorder be influenced by CU traits trajectories during childhood. PMID:26791396

  3. Frailty and comorbidity are independent predictors of outcome in patients referred for pre-dialysis education

    PubMed Central

    Pugh, Julia; Aggett, Justine; Goodland, Annwen; Prichard, Alison; Thomas, Nerys; Donovan, Kieron; Roberts, Gareth

    2016-01-01

    Background The incidence of chronic kidney disease (CKD) is rising and is likely to continue to do so for the foreseeable future, with the fastest growth seen among adults ≥75 years of age. Elderly patients with advanced CKD are likely to have a higher burden of comorbidity and frailty, both of which may influence their disease outcome. For these patients, treatment decisions can be complex, with the current lack of robust prognostic tools hindering the shared decision-making process. The current study aims to assess the impact of comorbidity and frailty on the outcomes of patients referred for pre-dialysis education. Methods We performed a single-centre study of patients (n = 283) referred for pre-dialysis education between 2010 and 2012. The Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS) were used to assess comorbid disease burden and frailty, respectively. Follow-up data were collected until February 2015. Results The CCI and CFS scores at the time of referral to the pre-dialysis service were independent predictors of mortality. Within the study follow-up period, 76% of patients with a high CFS score at the time of pre-dialysis education had died, with 63% of these patients not commencing dialysis before death. Conclusion A relatively simple frailty scale and comorbidity score could be used to predict survival and better inform the shared decision-making process for patients with advanced kidney disease. PMID:26985387

  4. Serum albumin level during intestinal exfoliative rejection: a potential predictor of graft recovery and patient outcome.

    PubMed

    Zambernardi, Agustina; Gondolesi, Gabriel; Cabanne, Ana; Martinez, María I; Solar, Héctor; Rumbo, Martín; Rumbo, Carolina

    2013-01-01

    Exfoliative rejection is a severe complication after intestinal transplant. The assessment of mucosa histology is restricted to the area reached by endoscopy. We aim to evaluate the serum albumin (SA) value as a parameter of graft damage and clinical prognosis in intestinal exfoliative rejection (ExR). The present study is a retrospective analysis of 11 episodes of ExR occurred in a cohort of 26 patients. SA levels were measured 24 h after diagnosis and twice a week thereafter and then correlated with parameters of clinical and graft histological recovery (HR). During ExR, all patients had very low SA levels, reaching a minimum average of 1.9 ± 0.3 g/dL. According to the value of albumin levels at ExR diagnosis, the patients were grouped finding a correlation with their clinical evolution. Six ExR episodes presented with severe hipoalbuminemia (<2.2 g/dL; p < 0.05) that correlated with worse patient and graft outcome, ranging from graft loss and need for re-transplantation to delayed clinical and HR. SA at ExR diagnosis may be an indicator of the severity of the ExR process, and it could also be used as an early predictor of patient and graft outcome. PMID:23351092

  5. Predictors of short-term treatment outcomes among California's Proposition 36 participants.

    PubMed

    Hser, Yih-Ing; Evans, Elizabeth; Teruya, Cheryl; Huang, David; Anglin, M Douglas

    2007-05-01

    California's voter-initiated Proposition 36 offers non-violent drug offenders community-based treatment as an alternative to incarceration or probation without treatment. This article reports short-term treatment outcomes subsequent to this major shift in drug policy. Data are from 1104 individuals randomly selected from all Proposition 36 participants assessed for treatment in five California counties during 2004. The overall study sample was 30% female, 51% white, 18% Black, 24% Hispanic, and 7% other racial/ethnic groups. The mean+/-SD age was 37+/-10 years. Counties varied considerably in participant characteristics, treatment service intensity, treatment duration, urine testing, and employment and recidivism outcomes, but not in drug use at 3-month follow-up. Controlling for county, logistic regression analysis showed that drug abstinence was predicted by gender (female), employment at baseline (full or part-time), residential (vs. outpatient) stay, low psychiatric severity, frequent urine testing by treatment facility, and more days in treatment. Recidivism was predicted only by shorter treatment duration. Employment predictors included age (younger), gender (male), baseline employment, and lower psychiatric severity. The study findings support drug testing to monitor abstinence and highlight the need to address employment and psychiatric problems among Proposition 36 participants. PMID:17689324

  6. Quality of life, course and predictors of outcomes in community women with EDNOS and common eating disorders.

    PubMed

    Hay, Phillipa; Buttner, Petra; Mond, Jonathan; Paxton, Susan J; Rodgers, Bryan; Quirk, Frances; Darby, Anita

    2010-01-01

    We investigated the 2-year course and putative predictors of outcome of 87 young community women with common eating disorders (n = 59, 68% with Eating Disorder not Otherwise Specified) following a health literacy (informational) intervention. Participants were recruited in 3-phases: community survey, interview and then invitation to a longitudinal study. The health literacy intervention was provided randomly to half participants at baseline and half at 1 year. Eating disorder symptoms and mental health related quality of life (MHQoL), general psychological function, help-seeking, and defence style were assessed at baseline, and after 2 years by questionnaire. Multiple linear regression analyses were used to identify features predictive of eating disorder symptom levels and MHQoL. Eating disorder psychopathology remained high and MHQoL remained poor. In the multivariate models, a higher baseline level of immature defence style significantly predicted higher levels of eating disorder symptoms, poorer MHQoL and more disability as measured by 'days out of role'. In addition, higher educational attainment, baseline general psychological disturbance, lower BMI and having main work outside the home were associated with poorer MHQoL. Women with common eating disorders followed to 2 years continued to be highly symptomatic and have poor quality of life. Psychological features important to outcome included an immature coping style and higher general psychological distress. PMID:20589762

  7. Primary failure of bortezomib in newly diagnosed multiple myeloma--understanding the magnitude, predictors, and significance.

    PubMed

    Cohen, Yael C; Joffe, Erel; Benyamini, Noam; Dimopoulos, Meletios A; Terpos, Evangelos; Trestman, Svetlana; Held-Kuznetsov, Viki; Avivi, Irit; Kastritis, Efstathios

    2016-01-01

    Botezomib-based induction is highly effective for the treatment of newly diagnosed multiple myeloma (NDMM). We investigated the outcomes of NDMM patients who failed to respond to bortezomib-based induction in a 'real-life' clinical setting. In a cohort of 295 consecutive NDMM patients in 3 medical centers, 74 (25%) failed to achieve at least partial response after 4 induction cycles, and were classified as non-responsive. Compared to induction responders, they were older, more frequently anemic, had a higher incidence of del17p and ISS-3, and a worse performance status. In multivariable analysis, bortezomib-based induction failure occurred in 25% of patients and was the strongest independent factor predicting mortality with a 5-fold hazard ratio (95% CI 1.44-8.68). Three-year overall survival in responsive vs. non-responsive patients were 76% vs. 53%, respectively (p < 0.0001). Survival from time of salvage second-line treatment was significantly shorter among induction non-responders vs. responders (25 months vs. not-reached, p = 0.024). PMID:26727104

  8. Predictors and Outcomes of Contralateral Prophylactic Mastectomy Among Breast Cancer Survivors

    PubMed Central

    Graves, Kristi D.; Peshkin, Beth N.; Halbert, Chanita H.; DeMarco, Tiffani A.; Isaacs, Claudine; Schwartz, Marc D.

    2011-01-01

    Background Women affected with breast cancer who carry a BRCA1 or BRCA2 (BRCA1/2) mutation are at risk of developing contralateral breast cancer. To reduce the risk of contralateral breast cancer, some patients opt for prophylactic surgery of the unaffected breast (contralateral prophylactic mastectomy; CPM) in addition to mastectomy of the affected breast. Methods We conducted the present study to determine the predictors and outcomes of CPM in the year following BRCA1/2 genetic counseling and testing. 435 women affected with unilateral breast cancer who received positive or uninformative BRCA1/2 genetic test results completed assessments prior to genetic counseling and testing and 1, 6, and 12 months after receipt of results. Results Prior to testing, 16% had undergone CPM (in conjunction with mastectomy of the affected breast). In the year following testing, 18% with positive test results and 3% with uninformative test results opted for CPM. CPM following testing was associated with a positive genetic test result, younger age at cancer diagnosis (OR = .94), and higher cancer-specific distress at baseline (OR = 3.28). CPM was not associated with distress outcomes at 12-months. Conclusions Following a positive test result, 18% of women previously affected with unilateral breast cancer had a CPM. Women affected with breast cancer at a younger age, particularly those with positive genetic test results and higher cancer-specific distress, are more likely to choose CPM than women who receive uninformative test results and who are less distressed and older at diagnosis. CPM does not appear to impact distress outcomes. PMID:17066320

  9. Outcomes and predictors of very stable INR control during chronic anticoagulation therapy.

    PubMed

    Witt, Daniel M; Delate, Thomas; Clark, Nathan P; Martell, Chad; Tran, Thu; Crowther, Mark A; Garcia, David A; Ageno, Walter; Hylek, Elaine M

    2009-07-30

    For patients on warfarin therapy, an international normalized ratio (INR) recall interval not exceeding 4 weeks has traditionally been recommended. Less frequent INR monitoring may be feasible in stable patients. We sought to identify patients with stable INRs (defined as having INR values exclusively within the INR range) and comparator patients (defined as at least one INR outside the INR range) in a retrospective, longitudinal cohort study. Occurrences of thromboembolism, bleeding, and death were compared between groups. Multivariate logistic regression models were used to identify independent predictors of stable INR control. There were 2504 stable and 3569 comparator patients. The combined rates of bleeding and thromboembolism were significantly lower in stable patients. Independent predictors of stable INR control were age older than 70 years and the absence of comorbid heart failure and diabetes. Stable patients were significantly less likely to have target INR of 3.0 or higher or chronic diseases. We hypothesize that many patients demonstrating stable INR control could be safely treated with INR recall intervals greater than the traditional 4 weeks. PMID:19439733

  10. Activities of daily living as an additional predictor of complications and outcomes in elderly patients with acute myocardial infarction

    PubMed Central

    Nakajima, Hiroyuki; Yoshioka, Jiro; Totsuka, Nobuyuki; Miyazawa, Izumi; Usui, Tatsuya; Urasawa, Nobuyuki; Kobayashi, Takahiro; Mochidome, Tomoaki

    2016-01-01

    Background Age is an important determinant of outcome in acute myocardial infarction (AMI). However, in clinical settings, there is an occasional mismatch between chronological age and physical age. We evaluated whether activities of daily living (ADL), which reflect physical age, also predict complications and prognosis in elderly patients with AMI. Design Single-center, observational, and retrospective cohort study. Methods Preserved ADL and low ADL were defined according to the scale for independence degree of daily living for the disabled elderly by the Japanese Ministry of Health, Labour, and Welfare. We examined 82 consecutive patients aged ≥75 years with AMI who underwent primary percutaneous coronary intervention. Patients were divided into preserved ADL (n=52; mean age, 81.8±4.8 years; male, 59.6%) and low ADL (n=30; mean age, 85.8±4.7 years; male, 40.0%) groups according to prehospital ADL. Results The prevalence of Killip class II–IV and in-hospital mortality rate were significantly higher with low ADL compared to that with preserved ADL (23.1% vs 60.0%, P=0.0019; 5.8% vs 30.0%, P=0.0068, respectively). Multivariate analysis showed that ADL was an independent predictor of Killip class II–IV and 1-year mortality after adjusting for age, sex, and other possible confounders (odds ratio 5.11, 95% confidence interval [CI] 1.52–17.2, P=0.0083; hazard ratio 4.32, 95% CI 1.31–14.3, P=0.017, respectively). Conclusion Prehospital ADL is a significant predictor of heart failure complications and prognosis in elderly patients with AMI undergoing primary percutaneous coronary intervention, irrespective of age and sex. PMID:27601890

  11. Alanine aminotransferase as a predictor of adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy

    PubMed Central

    Ekiz, Ali; Kaya, Basak; Avci, Muhittin Eftal; Polat, Ibrahim; Dikmen, Selin; Yildirim, Gokhan

    2016-01-01

    Objective: To evaluate the associations between adverse perinatal outcomes and serum transaminase levels at the time of diagnosis in patients with intrahepatic cholestasis of pregnancy. Methods: We performed a retrospective analysis of patients hospitalized for evaluation of intrahepatic cholestasis of pregnancy from January 2013 to June 2014 in a tertiary center. Seventy-one patients were divided into two groups according to the presence (Group I) or absence of adverse perinatal outcomes (Group II). Results: The mean aminotransferase levels and conjugated bilirubin levels at the time of diagnosis were significantly higher in Group I than in Group II. Receiver operating characteristic curve analysis revealed that the alanine aminotransferase level could predict adverse perinatal outcomes with 76.47% sensitivity and 78.38% specificity, and the cut-off value was 95 IU/L. Among patients with intrahepatic cholestasis of pregnancy, those with adverse perinatal outcomes were significantly older, had an earlier diagnosis, and had higher alanine aminotransferase levels. Using the 95-IU/L cut-off value, patients with intrahepatic cholestasis of pregnancy had a 3.54-fold increased risk for adverse perinatal outcomes. Conclusions: Patients with intrahepatic cholestasis of pregnancy and high alanineaminotransferase levels should be followed up for possible adverse perinatal outcomes.

  12. Clinical Significance of the Prognostic Nutritional Index for Predicting Short- and Long-Term Surgical Outcomes After Gastrectomy

    PubMed Central

    Lee, Jee Youn; Kim, Hyoung-Il; Kim, You-Na; Hong, Jung Hwa; Alshomimi, Saeed; An, Ji Yeong; Cheong, Jae-Ho; Hyung, Woo Jin; Noh, Sung Hoon; Kim, Choong-Bai

    2016-01-01

    Abstract To evaluate the predictive and prognostic significance of the prognostic nutritional index (PNI) in a large cohort of gastric cancer patients who underwent gastrectomy. Assessing a patient's immune and nutritional status, PNI has been reported as a predictive marker for surgical outcomes in various types of cancer. We retrospectively reviewed data from a prospectively maintained database of 7781 gastric cancer patients who underwent gastrectomy from January 2001 to December 2010 at a single center. From this data, we analyzed clinicopathologic characteristics, PNI, and short- and long-term surgical outcomes for each patient. We used the PNI value for the 10th percentile (46.70) of the study cohort as a cut-off for dividing patients into low and high PNI groups. Regarding short-term outcomes, multivariate analysis showed a low PNI (odds ratio [OR] = 1.505, 95% CI = 1.212–1.869, P <0.001), old age, male sex, high body mass index, medical comorbidity, total gastrectomy, and combined resection to be independent predictors of postoperative complications. Among these, only low PNI (OR = 4.279, 95% CI = 1.760–10.404, P = 0.001) and medical comorbidity were independent predictors of postoperative mortality. For long-term outcomes, low PNI was a poor prognostic factor for overall survival, but not recurrence (overall survival: hazard ratio [HR] = 1.383, 95% CI = 1.221–1.568, P < 0.001; recurrence-free survival: HR = 1.142, 95% CI = 0.985–1.325, P = 0.078). PNI can be used to predict patients at increased risk of postoperative morbidity and mortality. Although PNI was an independent prognostic factor for overall survival, the index was not associated with cancer recurrence. PMID:27149460

  13. Predictors of treatment outcome in an effectiveness trial of cognitive behavioral therapy for children with anxiety disorders.

    PubMed

    Wergeland, Gro Janne H; Fjermestad, Krister W; Marin, Carla E; Bjelland, Ingvar; Haugland, Bente Storm Mowatt; Silverman, Wendy K; Öst, Lars-Göran; Bjaastad, Jon Fauskanger; Oeding, Kristin; Havik, Odd E; Heiervang, Einar R

    2016-01-01

    A substantial number of children with anxiety disorders do not improve following cognitive behavioral therapy (CBT). Recent effectiveness studies have found poorer outcome for CBT programs than what is typically found in efficacy studies. The present study examined predictors of treatment outcome among 181 children (aged 8-15 years), with separation anxiety, social phobia, or generalized anxiety disorder, who participated in a randomized, controlled effectiveness trial of a 10-session CBT program in community clinics. Potential predictors included baseline demographic, child, and parent factors. Outcomes were as follows: a) remission from all inclusion anxiety disorders; b) remission from the primary anxiety disorder; and c) child- and parent-rated reduction of anxiety symptoms at post-treatment and at 1-year follow-up. The most consistent findings across outcome measures and informants were that child-rated anxiety symptoms, functional impairment, a primary diagnosis of social phobia or separation anxiety disorder, and parent internalizing symptoms predicted poorer outcome at post-treatment. Child-rated anxiety symptoms, lower family social class, lower pretreatment child motivation, and parent internalizing symptoms predicted poorer outcome at 1-year follow-up. These results suggest that anxious children with more severe problems, and children of parents with elevated internalizing symptom levels, may be in need of modified, additional, or alternative interventions to achieve a positive treatment outcome. PMID:26583954

  14. Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome

    PubMed Central

    Lin, Chin-Yu; Lin, Yenn-Jiang; Chen, Yun-Yu; Chang, Shih-Lin; Lo, Li-Wei; Chao, Tze-Fan; Chung, Fa-Po; Hu, Yu-Feng; Chong, Eric; Cheng, Hao-Min; Tuan, Ta-Chuan; Liao, Jo-Nan; Chiou, Chuen-Wang; Huang, Jin-Long; Chen, Shih-Ann

    2015-01-01

    Background The prognostic significance of premature atrial complex (PAC) burden is not fully elucidated. We aimed to investigate the relationship between the burden of PACs and long-term outcome. Methods and Results We investigated the clinical characteristics of 5371 consecutive patients without atrial fibrillation (AF) or a permanent pacemaker (PPM) at baseline who underwent 24-hour electrocardiography monitoring between January 1, 2002, and December 31, 2004. Clinical event data were retrieved from the Bureau of National Health Insurance of Taiwan. During a mean follow-up duration of 10±1 years, there were 1209 deaths, 1166 cardiovascular-related hospitalizations, 3104 hospitalizations for any reason, 418 cases of new-onset AF, and 132 PPM implantations. The optimal cut-off of PAC burden for predicting mortality was 76 beats per day, with a sensitivity of 63.1% and a specificity of 63.5%. In multivariate analysis, a PAC burden >76 beats per day was an independent predictor of mortality (hazard ratio: 1.384, 95% CI: 1.230 to 1.558), cardiovascular hospitalization (hazard ratio: 1.284, 95% CI: 1.137 to 1.451), new-onset AF (hazard ratio: 1.757, 95% CI: 1.427 to 2.163), and PPM implantation (hazard ratio: 2.821, 95% CI: 1.898 to 4.192). Patients with frequent PAC had increased risk of mortality attributable to myocardial infarction, heart failure, and sudden cardiac death. Frequent PACs increased risk of PPM implantation owing to sick sinus syndrome, high-degree atrioventricular block, and/or AF. Conclusions The burden of PACs is independently associated with mortality, cardiovascular hospitalization, new-onset AF, and PPM implantation in the long term. PMID:26316525

  15. A biology-driven approach identifies the hypoxia gene signature as a predictor of the outcome of neuroblastoma patients

    PubMed Central

    2010-01-01

    Background Hypoxia is a condition of low oxygen tension occurring in the tumor microenvironment and it is related to poor prognosis in human cancer. To examine the relationship between hypoxia and neuroblastoma, we generated and tested an in vitro derived hypoxia gene signature for its ability to predict patients' outcome. Results We obtained the gene expression profile of 11 hypoxic neuroblastoma cell lines and we derived a robust 62 probesets signature (NB-hypo) taking advantage of the strong discriminating power of the l1-l2 feature selection technique combined with the analysis of differential gene expression. We profiled gene expression of the tumors of 88 neuroblastoma patients and divided them according to the NB-hypo expression values by K-means clustering. The NB-hypo successfully stratifies the neuroblastoma patients into good and poor prognosis groups. Multivariate Cox analysis revealed that the NB-hypo is a significant independent predictor after controlling for commonly used risk factors including the amplification of MYCN oncogene. NB-hypo increases the resolution of the MYCN stratification by dividing patients with MYCN not amplified tumors in good and poor outcome suggesting that hypoxia is associated with the aggressiveness of neuroblastoma tumor independently from MYCN amplification. Conclusions Our results demonstrate that the NB-hypo is a novel and independent prognostic factor for neuroblastoma and support the view that hypoxia is negatively correlated with tumors' outcome. We show the power of the biology-driven approach in defining hypoxia as a critical molecular program in neuroblastoma and the potential for improvement in the current criteria for risk stratification. PMID:20624283

  16. Anxiety as a Predictor of Behavioral Therapy Outcome for Cancer Chemotherapy Patients.

    ERIC Educational Resources Information Center

    Carey, Michael P.; Burish, Thomas G.

    1985-01-01

    Determined if baseline anxiety levels are predictive of outcome on treatments associated with cancer chemotherapy. Results indicated low-anxiety patients reported less anxiety and depression before behavioral training but nonetheless exhibited significantly greater reductions in anxiety, depression, and diastolic blood pressure after training.…

  17. Restricted and Repetitive Behaviors as Predictors of Outcome in Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Troyb, Eva; Knoch, Kelley; Herlihy, Lauren; Stevens, Michael C.; Chen, Chi-Ming; Barton, Marianne; Treadwell, Kimberli; Fein, Deborah

    2016-01-01

    Questions have been raised about the significance of restricted and repetitive behaviors (RRBs) in predicting outcomes of children with Autism Spectrum Disorders (ASDs). Previous studies have yielded mixed findings, but some suggest that the presence of RRBs during preschool years is a negative prognostic indicator for later childhood. This study…

  18. Profiles of the National Institutes of Health Stroke Scale Items as a Predictor of Patient Outcome

    PubMed Central

    Sucharew, Heidi; Khoury, Jane; Moomaw, Charles J; Alwell, Kathleen; Kissela, Brett M; Belagaje, Samir; Adeoye, Opeolu; Khatri, Pooja; Woo, Daniel; Flaherty, Matthew L; Ferioli, Simona; Heitsch, Laura; Broderick, Joseph P; Kleindorfer, Dawn

    2013-01-01

    Background and Purpose Initial National Institutes of Health Stroke Scale (NIHSS) score is highly predictive of outcome after ischemic stroke. We examined if grouping strokes by presence of individual NIHSS symptoms could provide prognostic information additional or alternative to the NIHSS total score. Methods Ischemic strokes from the Greater Cincinnati Northern Kentucky Stroke Study in 2005 were used to develop the model. Latent Class Analysis (LCA) was implemented to form groups of patients with similar retrospective NIHSS (rNIHSS) item responses. Profile group was then used as an independent predictor of discharge modified Rankin and mortality using logistic regression and Cox proportional hazards model. Results A total of 2,112 stroke patients were identified in 2005. Six distinct profiles were characterized. Consistent with the profile patterns, the median rNIHSS total score decreased from profile A “most severe” [median(IQR): 20(15,25)] to profile F “mild” [1(1,2)]. Two profiles falling between these extremes, C and D, both had median rNIHSS total score of 5, but different survival rates. Compared with A, C was associated with 59% risk reduction for death, whereas D with 70%. C patients were more likely to have decreased level of consciousness and abnormal language, whereas D patients were more likely to have abnormal right arm and right leg motor function. Conclusions Six rNIHSS profiles were identifiable using LCA. In particular, two symptom profiles with identical median rNIHSSS were observed with widely disparate outcomes, which may prove useful both clinically and for research studies as an enhancement to the overall NIHSS score. PMID:23704102

  19. Predictors of positive outcomes of a school food provision policy in Australia.

    PubMed

    Pettigrew, Simone; Donovan, Robert J; Jalleh, Geoffrey; Pescud, Melanie

    2014-06-01

    This study identified predictors of parents' and school principals' perceptions of the impact of a Western Australian school food policy. An initial qualitative phase involving focus groups with parents and interviews with school principals, teachers, canteen managers and Parents & Citizens Committee members provided general feedback on the policy and identified various factors that appeared to be related to its successful implementation. In the following quantitative phase of the study, 1200 parents responded to a telephone questionnaire and 310 principals responded to an internet-based questionnaire. The primary outcome variables were, respectively, the extent to which parents reported that their children's diets were healthier as a result of the policy, and the extent to which principals reported that their schools complied with the policy. Logistic regression models were generated for the parent and principal samples. Those parents reporting that their children's diets were healthier were more likely to agree that the policy reflected their beliefs and their children's dietary needs and preferences, that their child talked about the traffic light food classification system and that this system influenced their food choices in the supermarket. Those principals reporting full compliance with the policy were more likely to agree that implementing the policy was not overly difficult. Specific factors facilitating school compliance were canteen manager training and conducive kitchen setup. Provision of appropriate information and training prior to implementation may assist schools in implementing new food policies, thereby enhancing their impact beyond the school environment. PMID:23297338

  20. Recurrence and pseudorecurrence after laparoscopic ventral hernia repair: predictors and patient-focused outcomes.

    PubMed

    Carter, Stacey A; Hicks, Stephanie C; Brahmbhatt, Reshma; Liang, Mike K

    2014-02-01

    Laparoscopic ventral hernia repair (LVHR) is gaining popularity as an option to repair abdominal wall hernias. Bulging after repair remains common after this technique. This study evaluates the incidence and factors associated with bulging after LVHR. Between 2000 and 2010, 201 patients underwent LVHR at two affiliated institutions. Patients who developed recurrence or pseudorecurrence (seroma or eventration) were analyzed with univariate and multivariate analyses to identify predictors of these complications. Of the 201 patients who underwent LVHR, 40 (19.9%) patients developed a seroma, 63 (31.3%) patients had radiographically proven eventration, and 25 (12.4%) patients had a hernia recurrence. On multivariate analysis, seromas were associated with number of prior ventral hernia repairs, surgical site infections, and prostate disease. Mesh eventration was associated with hernia size and surgical technique. Tissue eventration was associated with primary hernias and surgical technique. Hernia recurrence was associated with incisional hernias and mesh type used. Recurrence and pseudorecurrence are important complications after LVHR. Large hernia size, infections, and surgical technique are important clinical factors that affect outcomes after LVHR. PMID:24480213

  1. Cerebral Infarction following Acute Subdural Hematoma in Infants and Young Children: Predictors and Significance of FLAIR Vessel Hyperintensity

    PubMed Central

    MOMOSE, Hiroaki; SORIMACHI, Takatoshi; AOKI, Rie; ATSUMI, Hideki; MATSUMAE, Mitsunori

    A phenomenon of cerebral infarction following acute subdural hematoma (ASDH) in infants and young children, termed cerebral infarction following ASDH (CIASDH), has been well recognized, though both its mechanisms and risk factors have been poorly understood. The purpose of the present study was to investigate the predictors for CIASDH in a population of ASDH, and to evaluate the imaging studies to presume the mechanisms of CIASDH. We retrospectively examined consecutive children 6 years of age or younger, who were diagnosed with ASDH and were admitted to our hospital between 2000 and 2014. In 57 consecutive children with ASDH, 12 (21.1%) developed CIASDH. The multivariate analysis revealed five predictors for CIASDH: presence of seizure, consciousness disturbance at admission, absence of skull fracture, hematoma thickness ≥ 5 mm on computed tomography (CT), and midline shift ≥ 3 mm on CT (p < 0.05). In three of six patients (50%) undergoing magnetic resonance (MR) imaging/fluid-attenuated inversion recovery (FLAIR) within 5 days of admission, serpentine hyperintensities in the subarachnoid space (FLAIR vessel hyperintensities) were demonstrated. MR angiography showed neither occlusion nor stenosis of the cerebral arteries. Single photon emission CT performed at admission in one patient showed a cerebral blood flow reduction in the ASDH side. All the children with CIASDH showed unfavorable outcomes at discharge. Children showing multiple predictors at admission should be carefully observed for development of CIASDH. Evaluation of the imaging studies suggested that a blood flow disturbance in the level of peripheral arteries to microcirculation was one candidate for possible mechanisms to induce the CIASDH. PMID:26041626

  2. Brain function predictors and outcome of weight loss and weight loss maintenance

    PubMed Central

    Szabo-Reed, Amanda N.; Breslin, Florence J.; Lynch, Anthony M.; Patrician, Trisha M.; Martin, Laura E.; Lepping, Rebecca J.; Powell, Joshua N.; Yeh, Hung-Wen (Henry); Befort, Christie A.; Sullivan, Debra; Gibson, Cheryl; Washburn, Richard; Donnelly, Joseph E.; Savage, Cary R.

    2015-01-01

    Obesity rates are associated with public health consequences and rising health care costs. Weight loss interventions, while effective, do not work for everyone, and weight regain is a significant problem. Eating behavior is influenced by a convergence of processes in the brain, including homeostatic factors and motivational processing that are important contributors to overeating. Initial neuroimaging studies have identified brain regions that respond differently to visual food cues in obese and healthy weight individuals that are positively correlated with reports of hunger in obese participants. While these findings provide mechanisms of overeating, many important questions remain. It is not known whether brain activation patterns change after weight loss, or if they change differentially based on amount of weight lost. Also, little is understood regarding biological processes that contribute to long-term weight maintenance. This study will use neuroimaging in participants while viewing food and non-food images. Functional Magnetic Resonance Imaging will take place before and after completion of a twelve-week weight loss intervention. Obese participants will be followed though a 6-month maintenance period. The study will address three aims: 1. Characterize brain activation underlying food motivation and impulsive behaviors in obese individuals. 2. Identify brain activation changes and predictors of weight loss. 3. Identify brain activation predictors of weight loss maintenance. Findings from this study will have implications for understanding mechanisms of obesity, weight loss, and weight maintenance. Results will be significant to public health and could lead to a better understanding of how differences in brain activation relate to obesity. PMID:25533729

  3. Brain function predictors and outcome of weight loss and weight loss maintenance.

    PubMed

    Szabo-Reed, Amanda N; Breslin, Florence J; Lynch, Anthony M; Patrician, Trisha M; Martin, Laura E; Lepping, Rebecca J; Powell, Joshua N; Yeh, Hung-Wen Henry; Befort, Christie A; Sullivan, Debra; Gibson, Cheryl; Washburn, Richard; Donnelly, Joseph E; Savage, Cary R

    2015-01-01

    Obesity rates are associated with public health consequences and rising health care costs. Weight loss interventions, while effective, do not work for everyone, and weight regain is a significant problem. Eating behavior is influenced by a convergence of processes in the brain, including homeostatic factors and motivational processing that are important contributors to overeating. Initial neuroimaging studies have identified brain regions that respond differently to visual food cues in obese and healthy weight individuals that are positively correlated with reports of hunger in obese participants. While these findings provide mechanisms of overeating, many important questions remain. It is not known whether brain activation patterns change after weight loss, or if they change differentially based on amount of weight lost. Also, little is understood regarding biological processes that contribute to long-term weight maintenance. This study will use neuroimaging in participants while viewing food and non-food images. Functional Magnetic Resonance Imaging will take place before and after completion of a twelve-week weight loss intervention. Obese participants will be followed though a 6-month maintenance period. The study will address three aims: 1. Characterize brain activation underlying food motivation and impulsive behaviors in obese individuals. 2. Identify brain activation changes and predictors of weight loss. 3. Identify brain activation predictors of weight loss maintenance. Findings from this study will have implications for understanding mechanisms of obesity, weight loss, and weight maintenance. Results will be significant to public health and could lead to a better understanding of how differences in brain activation relate to obesity. PMID:25533729

  4. Fatigue Is a Predictor for Cardiovascular Outcomes in Patients Undergoing Hemodialysis

    PubMed Central

    Fukuda, Sanae; Shoji, Tetsuo; Inaba, Masaaki; Tsujimoto, Yoshihiro; Tabata, Tsutomu; Okuno, Senji; Yamakawa, Tomoyuki; Okada, Shigeki; Okamura, Mikio; Kuratsune, Hirohiko; Fujii, Hisako; Hirayama, Yoshinobu; Watanabe, Yasuyoshi; Nishizawa, Yoshiki

    2010-01-01

    Background and objectives: Despite potential significance of fatigue and its underlying components in the occurrence of cardiovascular diseases, epidemiologic data showing the link are virtually limited. This study was designed to examine whether fatigue symptoms or fatigue's underlying components are a predictor for cardiovascular diseases in high-risk subjects with ESRD. Design, setting, participants, & measurements: 788 volunteer patients under hemodialysis therapy (506 male, 282 female) completed the survey between October and November 2005, with the follow-up period up to 26 months to monitor occurrence of fatal or nonfatal cardiovascular events. The questionnaire consisted of 64 questions, and promax rotation analysis of the principal component method conceptualized eight fatigue-related factors: fatigue itself, anxiety and depression, loss of attention and memory, pain, overwork, autonomic imbalance, sleep problems, and infection. Results: 14.7% of the patients showed fatigue scores higher than twice the SD of the mean for healthy volunteers. These highly fatigued patients exhibited a significantly higher risk for cardiovascular events (hazard ratio: 2.17; P < 0.01), with the relationship independent of the well-known risk factors, including age, diabetes, cardiovascular disease history, and inflammation and malnutrition markers. Moreover, comparisons of the risk in key subgroups showed that the risk of high fatigue score for cardiovascular events was more prominent in well-nourished patients, including lower age, absence of past cardiovascular diseases, higher serum albumin, and high non-HDL cholesterol. Conclusions: Fatigue can be an important predictor for cardiovascular events in patients with ESRD, with the relationship independent of the nutritional or inflammatory status. PMID:20185601

  5. The adductor pollicis muscle: a poor predictor of clinical outcome in ICU patients.

    PubMed

    Leong Shu-Fen, Claudia; Ong, Venetia; Kowitlawakul, Yanika; Ling, Teh Ai; Mukhopadhyay, Amartya; Henry, Jeya

    2015-01-01

    No nutrition assessment tools specifically tailored for intensive care unit (ICU) patients have been developed and validated in Singapore. Studies conducted in Brazilian populations suggest that the thickness of the adductor pollicis muscle (TAPM) may be used to assess nutritional status and predict mortality of critically ill patients. The aim of this study was to determine if TAPM can be used as a predictive indicator of mortality in Singapore ICU patients. TAPM values were obtained using skinfold calipers in 229 patients admitted to the medical ICU. TAPM measured in both hands showed no significant correlation with either the primary outcome (28-day mortality) or secondary outcomes (hospital outcome and hospital length of stay). This study demonstrated that TAPM does not predict 28-day mortality and hospital outcome, and is not correlated to length of stay in Singapore ICU patients. More studies are necessary to validate the use of TAPM as an anthropometric indicator of ICU outcome in other regions of the world. PMID:26693744

  6. Coexpression of SFRP1 and WIF1 as a prognostic predictor of favorable outcomes in patients with colorectal carcinoma.

    PubMed

    Huang, Shiyong; Zhong, XiaoMing; Gao, Jun; Song, Rongfeng; Wu, Hongyu; Zi, Shuming; Yang, Shijie; Du, Peng; Cui, Long; Yang, Chun; Li, Zikang

    2014-01-01

    Colorectal tumorigenesis is ascribed to the activity of Wnt signaling pathway in a ligand-independent manner mainly through APC and CTNNB1 gene mutations and in a ligand-dependent manner through low expression of Wnt inhibitors such as WNT inhibitory factor 1 (WIF1) and secreted frizzled related protein 1 (SFRP1). In this study we found that WIF1 protein expression was increased and SFRP1 was decreased significantly in CRC tissue versus normal tissue, and high expression of WIF1 was associated with big tumor diameters and deep invasion, and loss of SFRP1 expression was associated with the left lesion site, deep invasion, and high TNM stage. Among the four expression patterns (WIF+/SFRP1+, WIF+/SFRP1-, WIF-/SFRP1+, and WIF-/SFRP1-) only coexpression of WIF1 and SFRP1 (WIF+/SFRP1+) was associated with favorable overall survival, together with low TNM stage, as an independent prognostic factor as shown in a multivariate survival model. The results indicated that WIF1 seemed to play an oncogenic role, while SFRP1 seemed to play an oncosuppressive role although both of them are secreted Wnt antagonists. Coexpression of SFRP1 and WIF1, rather than SFRP1 or WIF1 alone, could be used, together with low TNM stage, as a prognostic predictor of favorable outcomes in CRC. PMID:24949429

  7. Oncogenetics and minimal residual disease are independent outcome predictors in adult patients with acute lymphoblastic leukemia.

    PubMed

    Beldjord, Kheira; Chevret, Sylvie; Asnafi, Vahid; Huguet, Françoise; Boulland, Marie-Laure; Leguay, Thibaut; Thomas, Xavier; Cayuela, Jean-Michel; Grardel, Nathalie; Chalandon, Yves; Boissel, Nicolas; Schaefer, Beat; Delabesse, Eric; Cavé, Hélène; Chevallier, Patrice; Buzyn, Agnès; Fest, Thierry; Reman, Oumedaly; Vernant, Jean-Paul; Lhéritier, Véronique; Béné, Marie C; Lafage, Marina; Macintyre, Elizabeth; Ifrah, Norbert; Dombret, Hervé

    2014-06-12

    With intensified pediatric-like therapy and genetic disease dissection, the field of adult acute lymphoblastic leukemia (ALL) has evolved recently. In this new context, we aimed to reassess the value of conventional risk factors with regard to new genetic alterations and early response to therapy, as assessed by immunoglobulin/T-cell receptor minimal residual disease (MRD) levels. The study was performed in 423 younger adults with Philadelphia chromosome-negative ALL in first remission (265 B-cell precursor [BCP] and 158 T-cell ALL), with cumulative incidence of relapse (CIR) as the primary end point. In addition to conventional risk factors, the most frequent currently available genetic alterations were included in the analysis. A higher specific hazard of relapse was independently associated with postinduction MRD level ≥10(-4) and unfavorable genetic characteristics (ie, MLL gene rearrangement or focal IKZF1 gene deletion in BCP-ALL and no NOTCH1/FBXW7 mutation and/or N/K-RAS mutation and/or PTEN gene alteration in T-cell ALL). These 2 factors allowed definition of a new risk classification that is strongly associated with higher CIR and shorter relapse-free and overall survival. These results indicate that genetic abnormalities are important predictors of outcome in adult ALL not fully recapitulated by early response to therapy. Patients included in this study were treated in the multicenter GRAALL-2003 and GRAALL-2005 trials. Both trials were registered at http://www.clinicaltrials.gov as #NCT00222027 and #NCT00327678, respectively. PMID:24740809

  8. Predictors and outcome of complete removal of colorectal cancer with synchronous lung metastases

    PubMed Central

    NOZAWA, HIROAKI; TANAKA, JUNICHIRO; NISHIKAWA, TAKESHI; TANAKA, TOSHIAKI; KIYOMATSU, TOMOMICHI; KAWAI, KAZUSHIGE; HATA, KEISUKE; KAZAMA, SHINSUKE; YAMAGUCHI, HIRONORI; ISHIHARA, SOICHIRO; SUNAMI, EIJI; KITAYAMA, JOJI; NAKAJIMA, JUN; KOKUDO, NORIHIRO; WATANABE, TOSHIAKI

    2015-01-01

    The prognosis-improving effect of radical surgery has been demonstrated in patients with colorectal cancer (CRC) with liver metastases. However, few studies have examined the effectiveness of treatments for CRC with metastases in organs other than the liver. The aim of the present study was to evaluate the outcome of surgical treatment for CRC with lung metastases. The study retrospectively examined 57 primary CRC patients (28 men, median age of 65 years) with synchronous lung metastases who underwent surgery between 2003 and 2012. Data such as clinicopathological parameters, metastasized organs, and the details of surgery, recurrence and survival periods were extracted and analyzed. Curative resection was performed in 10 patients (‘curative group’). Primary tumors were resected without metastasectomy in 37 patients (‘non-curative group’), whereas 10 underwent stoma surgery (‘stoma group’). All the metastasized lesions were confined to the lung and liver in the curative group. By contrast, 43% of the non-curative/stoma groups had metastases in organs other than the lung and liver. Multivariate analyses indicated the absence of extrahepatic metastases as the only predictor of curative resection in CRC patients with lung metastases. The 3-year overall survival rates for the curative, non-curative and stoma groups were estimated as 74, 20 and 17%, respectively (P=0.0007). In conclusion, curative resection was possible in CRC patients with lung metastases if other disseminated lesions were limited to the liver and this treatment resulted in a longer survival time. Furthermore, palliative resection may contribute to a better prognosis compared to stoma surgery alone in selected cases. PMID:26623047

  9. Neonatal White Matter Abnormalities an Important Predictor of Neurocognitive Outcome for Very Preterm Children

    PubMed Central

    Woodward, Lianne J.; Clark, Caron A. C.; Bora, Samudragupta; Inder, Terrie E.

    2012-01-01

    Background Cerebral white matter abnormalities on term MRI are a strong predictor of motor disability in children born very preterm. However, their contribution to cognitive impairment is less certain. Objective Examine relationships between the presence and severity of cerebral white matter abnormalities on neonatal MRI and a range of neurocognitive outcomes assessed at ages 4 and 6 years. Design/Methods The study sample consisted of a regionally representative cohort of 104 very preterm (≤32 weeks gestation) infants born from 1998–2000 and a comparison group of 107 full-term infants. At term equivalent, all preterm infants underwent a structural MRI scan that was analyzed qualitatively for the presence and severity of cerebral white matter abnormalities, including cysts, signal abnormalities, loss of white matter volume, ventriculomegaly, and corpus callosal thinning/myelination. At corrected ages 4 and 6 years, all children underwent a comprehensive neurodevelopmental assessment that included measures of general intellectual ability, language development, and executive functioning. Results At 4 and 6 years, very preterm children without cerebral white matter abnormalities showed no apparent neurocognitive impairments relative to their full-term peers on any of the domain specific measures of intelligence, language, and executive functioning. In contrast, children born very preterm with mild and moderate-to-severe white matter abnormalities were characterized by performance impairments across all measures and time points, with more severe cerebral abnormalities being associated with increased risks of cognitive impairment. These associations persisted after adjustment for gender, neonatal medical risk factors, and family social risk. Conclusions Findings highlight the importance of cerebral white matter connectivity for later intact cognitive functioning amongst children born very preterm. Preterm born children without cerebral white matter abnormalities on

  10. Geriatric Assessment as a Predictor of Delirium and Other Outcomes in Elderly Cancer Patients

    PubMed Central

    Korc-Grodzicki, Beatriz; Sun, Sung W.; Zhou, Qin; Iasonos, Alexia; Lu, Bryan; Root, James C.; Downey, Robert J.; Tew, William P.

    2016-01-01

    Objective This study aimed to describe the implementation of preoperative geriatric assessment (GA) in patients undergoing major cancer surgery and to determine predictors of postoperative delirium. Summary Background Data Geriatric surgical patients have unique vulnerabilities and are at increased risk of developing postoperative delirium. Methods Geriatricians at Memorial Sloan Kettering Cancer Center risk-stratify surgical patients with solid tumors, aged ≥ 75 years using preoperative GA, which includes basic and instrumental activities of daily living (ADLs, IADLs), cognition (Mini-Cog Test), history of falls, nutritional state, and comorbidities (Charlson Comorbidity Index [CCI]). The Geriatrics Service evaluates patients for postoperative delirium using the Confusion Assessment Method (CAM). A retrospective review was performed. The associations between GA and postoperative outcomes were evaluated. Univariate logistic regression analysis was performed to determine the predictive value of GA for postoperative delirium, and a multivariate model was built. Results In total, 416 patients who received preoperative evaluation by the Geriatrics Service between September 1, 2010, and December 31, 2011, were included. Delirium occurred in 19% of patients. Patients with delirium had longer length of hospital stay (P<0.001) and greater likelihood of discharge to a rehabilitation facility (P<0.001). CCI score, history of falls, dependent on IADL, and abnormal Mini-Cog Test results predicted postoperative delirium on univariate analysis. Developed using a stepwise selection method, a multivariate model to predict delirium is presented including CCI score (P=0.032), dependence IADLs (P=0.011) and falls history (P=0.056). Conclusions Preoperative GA is feasible and may achieve a better understanding of older patients’ perioperative risks, including delirium. PMID:24887981

  11. Time-in-a-Bottle (TIAB): A Longitudinal, Correlational Study of Patterns, Potential Predictors, and Outcomes of Immunosuppressive Medication Adherence in Adult Kidney Transplant Recipients

    PubMed Central

    Russell, Cynthia L.; Ashbaugh, Catherine; Peace, Leanne; Cetingok, Muammer; Hamburger, Karen Q.; Owens, Sarah; Coffey, Deanna; Webb, Andrew; Hathaway, Donna; Winsett, Rebecca P.; Madsen, Richard; Wakefield, Mark R.

    2013-01-01

    This study examined patterns, potential predictors, and outcomes of immunosuppressive medication adherence in a convenience sample of 121 kidney transplant recipients aged 21 years or older from three kidney transplant centers using a theory-based, descriptive, correlational, longitudinal design. Electronic monitoring was conducted for 12 months using the Medication Event Monitoring System. Participants were persistent in taking their immunosuppressive medications, but execution, which includes both taking and timing, was poor. Older age was the only demographic variable associated with medication adherence (r = 0.25; p = 0.005). Of the potential predictors examined, only medication self-efficacy was associated with medication non-adherence, explaining about 9% of the variance (r = 0.31, p = 0.0006). The few poor outcomes that occurred were not significantly associated with medication non-adherence, although the small number of poor outcomes may have limited our ability to detect a link. Future research should test fully powered, theory-based, experimental interventions that include a medication self-efficacy component. PMID:24093614

  12. Documenting Impact of Educational Contexts on Long-Term Outcomes for Students with Significant Disabilities

    ERIC Educational Resources Information Center

    Ryndak, Diane Lea; Alper, Sandra; Hughes, Carolyn; McDonnell, John

    2012-01-01

    Follow-up studies of students with significant disabilities consistently indicate poor post-school outcomes. Although existing research indicates that services in inclusive general education contexts can result in positive short-term outcomes for these individuals during their school years, there are few investigations of the lives of adults with…

  13. Intimate Partner Violence: A Predictor of Worse HIV Outcomes and Engagement in Care

    PubMed Central

    Brant, Julia; Gupta, Shruti; Thorpe, John; Winstead-Derlega, Christopher; Pinkerton, Relana; Laughon, Kathryn; Ingersoll, Karen

    2012-01-01

    Abstract For HIV-infected patients, experiencing multiple traumas is associated with AIDS-related and all-cause mortality, increased opportunistic infections, progression to AIDS, and decreased adherence to therapy. The impact of intimate partner violence (IPV) on adherence and HIV outcomes is unknown. HIV-infected patients recruited from a public HIV clinic participated in this observational cohort study (n=251). Participants completed interviews evaluating IPV and covariates. CD4 count <200 (CD4<200), detectable HIV viral load (VL), and engagement in care (“no show rate” [NSR]) were the outcomes of interest. Medication adherence was not measured. Univariate and multivariate regression analyses were performed with covariates included if p<0.3 in the univariate phase. Seventy-four percent of the participants were male, 55% Caucasian, and 52.2% self-identified as “men who have sex with men.” IPV prevalence was 33.1% with no difference by gender or sexual orientation. In univariate analysis, IPV exposure predicted having a CD4<200 (p=0.005) and a detectable VL (p=0.04) but trended toward significance with a high NSR (p=0.077). Being threatened by a partner was associated with a CD4<200 (p=0.005), a detectable VL (p=0.011), and high NSR (p=0.019) in univariate analysis. In multivariate analysis, IPV predicted having a CD4<200 (p=0.005) and detectable VL (p=0.035). Being threatened by a partner predicted having a CD4<200 (p=0.020), a detectable VL (p=0.007), and a high NSR (p=0.020). Our results suggest IPV impacts biologic outcomes and engagement in care for HIV-infected patients. IPV alone predicts worse biologic outcomes, whereas the specific experience of being threatened by a partner was associated with all three outcomes in univariate and multivariate analyses. PMID:22612519

  14. Procedural Predictors of Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

    SciTech Connect

    Rai, Ansaar T. Jhadhav, Yahodeep; Domico, Jennifer; Hobbs, Gerald R.

    2012-12-15

    Purpose: To identify factors impacting outcome in patients undergoing interventions for acute ischemic stroke (AIS). Materials and Methods: This was a retrospective analysis of patients undergoing endovascular therapy for AIS secondary during a 30 month period. Outcome was based on modified Rankin score at 3- to 6-month follow-up. Recanalization was defined as Thrombolysis in myocardial infarction score 2 to 3. Collaterals were graded based on pial circulation from the anterior cerebral artery either from an ipsilateral injection in cases of middle cerebral artery (MCA) occlusion or contralateral injection for internal carotid artery terminus (ICA) occlusion as follows: no collaterals (grade 0), some collaterals with retrograde opacification of the distal MCA territory (grade 1), and good collaterals with filling of the proximal MCA (M2) branches or retrograde opacification up to the occlusion site (grade 2). Occlusion site was divided into group 1 (ICA), group 2 (MCA with or without contiguous M2 involvement), and group 3 (isolated M2 or M3 branch occlusion). Results: A total of 89 patients were studied. Median age and National Institutes of health stroke scale (NIHSS) score was 71 and 15 years, respectively. Favorable outcome was seen in 49.4% of patients and mortality in 25.8% of patients. Younger age (P = 0.006), lower baseline NIHSS score (P = 0.001), successful recanalization (P < 0.0001), collateral support (P = 0.0008), distal occlusion (P = 0.001), and shorter procedure duration (P = 0.01) were associated with a favorable outcome. Factors affecting successful recanalization included younger age (P = 0.01), lower baseline NIHSS score (P = 0.05), collateral support (P = 0.01), and shorter procedure duration (P = 0.03). An ICA terminus occlusion (P < 0.0001), lack of collaterals (P = 0.0003), and unsuccessful recanalization (P = 0.005) were significantly associated with mortality. Conclusion: Angiographic findings and preprocedure variables can help

  15. Predictors, Neuroimaging Characteristics and Long-Term Outcome of Severe European Tick-Borne Encephalitis: A Prospective Cohort Study

    PubMed Central

    Lenhard, Thorsten; Ott, Daniela; Jakob, Nurith J.; Pham, Mirko; Bäumer, Philipp; Martinez-Torres, Francisco; Meyding-Lamadé, Uta

    2016-01-01

    Background and Objectives Tick-borne encephalitis (TBE) still represents a considerable medical and health economic problem in Europe and entails a potential threat to travellers. The aim of this study was to characterise the conditions of severe TBE by precisely recording its clinical variants, the related neuroimaging features, and the variant-specific long-term outcome and by identifying predictors for severe courses. Methods A cohort of 111 TBE patients (median age 51, range 17–75 years; 42% females) was analysed prospectively. Data were acquired from the department of neurology, University Hospital Heidelberg, and the infectious diseases registry of the Robert-Koch institute Berlin. Neurological status was ascertained by protocol at admission and discharge and the degree of disability was scored using the modified RANKIN Scale (mRS; clinical score addressing neurological disability, range from 0, healthy to 6, dead) at admission and at follow-up. Follow-up examination was conducted by means of a telephone interview. To identify independent predictors for severe TBE and functional outcome, modelled logistic regression was performed. MRI changes were correlated with infection variants. To assess alpha-motor neuron injury patterns, we used high-resolution magnetic resonance neurography (hrMRN). Analyses were performed at the Department of Neurology, University Hospital, University of Heidelberg from April 2004 through September 2014 Results Acute course: 3.6% of patients died during the acute infection. All patients with a lethal course suffered from meningoencephaloradiculitis (MER, 14.4% of the cohort), which is associated with a significantly higher risk of requiring intensive care (p = 0.004) and mechanical ventilation (p<0.001) than menigoencephalitis (ME, 27.9% of the cohort). At admission, both MER and ME groups were severely affected, with the MER group having a statistically higher mRS score (median of 5 in the MER groups versus 4 in the ME group; p<0

  16. Naloxone challenge as a biological predictor of treatment outcome in opiate addicts.

    PubMed

    Jacobsen, L K; Kosten, T R

    1989-01-01

    Thirty seven consecutive applicants to methadone maintenance were assessed for depression and for level of opiate dependence using a 0.8-mg naloxone challenge. Nineteen of the applicants met DSM-III-R criteria for current major depression. At 3-month follow-up, high naloxone challenge test (NCT) scores at intake (high levels of opiate addiction) were found to predict poor program retention and elevated symptoms of depression at follow-up. Reports of heavy current drug use at intake were also associated with poor program retention and with high frequencies of positive urine screens for illicit substances during treatment. Level of addiction and reported amount of drug use at intake independently predicted program retention with a multiple correlation of 0.46 (P less than .01). Although NCT predicted depression at follow-up, depression at intake did not significantly predict treatment outcome, and NCT score predicted outcome independently of psychopathology. PMID:2596440

  17. Predictors of Positive Outcomes in Offspring of Depressed Parents and Non-depressed Parents Across 20 Years

    PubMed Central

    Verdeli, Helen; Wickramaratne, Priya; Warner, Virginia; Mancini, Anthony; Weissman, Myrna

    2014-01-01

    Understanding differences in factors leading to positive outcomes in high-risk and low-risk offspring has important implications for preventive interventions. We identified variables predicting positive outcomes in a cohort of 235 offspring from 76 families in which one, both, or neither parent had major depressive disorder. Positive outcomes were termed resilient in offspring of depressed parents, and competent in offspring of non-depressed parents, and defined by two separate criteria: absence of psychiatric diagnosis and consistently high functioning at 2, 10, and 20 years follow-up. In offspring of depressed parents, easier temperament and higher self-esteem were associated with greater odds of resilient outcome defined by absence of diagnosis. Lower maternal overprotection, greater offspring self-esteem, and higher IQ were associated with greater odds of resilient outcome defined by consistently high functioning. Multivariate analysis indicated that resilient outcome defined by absence of diagnosis was best predicted by offspring self-esteem; resilient outcome defined by functioning was best predicted by maternal overprotection and self-esteem. Among offspring of non-depressed parents, greater family cohesion, easier temperament and higher self-esteem were associated with greater odds of offspring competent outcome defined by absence of diagnosis. Higher maternal affection and greater offspring self-esteem were associated with greater odds of competent outcome, defined by consistently high functioning. Multivariate analysis for each criterion indicated that competent outcome was best predicted by offspring self-esteem. As the most robust predictor of positive outcomes in offspring of depressed and non-depressed parents, self-esteem is an important target for youth preventive interventions. PMID:25374449

  18. Intimate partner violence and Hurricane Katrina: Predictors and associated mental health outcomes

    PubMed Central

    Schumacher, Julie A.; Coffey, Scott F.; Norris, Fran H.; Tracy, Melissa; Clements, Kahni; Galea, Sandro

    2012-01-01

    This study sought to establish the prevalence and correlates of intimate partner violence (IPV) victimization in the six months before and after Hurricane Katrina. Participants were 445 married or cohabiting persons who were living in the 23 southernmost counties of Mississippi at the time of Hurricane Katrina. Data for this study were collected as part of a larger, population-based, representative study. The percentage of women reporting psychological victimization increased from 33.6% prior to Hurricane Katrina to 45.2 % following Hurricane Katrina (p < 0.001). The percentage of men reporting psychological victimization increased from 36.7% to 43.1% (p = 0.01). Reports of physical victimization increased from 4.2% to 8.3% for women (p=.01), but were unchanged for men. Significant predictors of post-Katrina victimization included pre-Katrina victimization, age, educational attainment, marital status and hurricane-related stressors. Reports of IPV were associated with greater risk of post-Katrina depression and posttraumatic stress disorder. Data from the first population-based study to document IPV following a large scale natural disaster suggest that IPV may be an important, but often overlooked public health concern following disasters. PMID:21061866

  19. An audit of the predictors of outcome in status epilepticus from a resource-poor country: a comparison with developed countries.

    PubMed

    Hassan, Haseeb; Rajiv, Keni Ravish; Menon, Ramshekhar; Menon, Deepak; Nair, Muralidharan; Radhakrishnan, Ashalatha

    2016-06-01

    Status epilepticus is a neurological emergency with significant morbidity and mortality. This study describes the clinical profile, treatment, and predictors of outcome of status epilepticus in a tertiary referral centre in a developing country and aims to highlight the similarities and differences from data available from the western world. A retrospective analysis of data of patients treated for status epilepticus was conducted from prospectively maintained records, between January 2000 and September 2010. The demographic data, clinical profile and investigations (including neuroimaging and EEG), aetiology, treatment, and outcomes were studied and compared with data available from the western world. The analysis included 108 events in 84 patients. A single episode of status epilepticus was treated in 72 patients (86%) and multiple status epilepticus events, ranging from two to six per patient, were managed in 12 patients (14%). Mean age was 24.1±20.3 years and 63% were males. The types of status epilepticus included convulsive status in 98 (90.7%), non-convulsive status in seven (6.5%), and myoclonic status in three (2.8%). The majority of events (60%) were remote symptomatic, 16% were acute symptomatic, 16% were of unexplained aetiology, and 8% were progressive symptomatic. In 85 events (79%), status epilepticus could be aborted with first and second-line drugs. The remaining 23 events (21%) progressed to refractory status epilepticus, among which, 13 (56%) were controlled with continuous intravenous midazolam infusion. Case fatality rate was 11%, neurological sequelae were reported in 22%, and 67% returned to baseline. Acute symptomatic status, older age, altered sensorium at the time of admission, and delayed hospitalisation were predictors of poor outcome. Aetiology was the most important determinant of outcome of status epilepticus, as in reports from the western world, with remote symptomatic aetiology secondary to gliosis being the most common

  20. Outcomes of child sexual abuse as predictors of later sexual victimization.

    PubMed

    Reese-Weber, Marla; Smith, Dana M

    2011-06-01

    The association between a history of child sexual abuse (CSA) and specific negative outcomes (attachment, feelings of power, and self-esteem) was explored as was the relationship between those negative outcomes and sexual victimization during the first semester of college. Two groups of freshman college women (67 who had experienced CSA and 55 who had not) completed measures of attachment, feelings of power, and self-esteem at the beginning of their freshman year of college. At the end of their first semester of college, participants (n = 93) provided information about whether they had been sexually assaulted during their first semester of college. The results indicated that participants in the CSA group did not differ on reported attachment anxiety, attachment avoidance, feelings of power, or self-esteem as compared to the control group. However, participants in the CSA group were more like to be sexually victimized during their first semester of college. Finally, logistic regression indicated that the negative outcomes of CSA were significantly related to sexual victimization during the first semester of college, with attachment anxiety playing an important role. Theoretical and practical implications of the findings are discussed. PMID:20587463

  1. The Natural History and Predictors of Outcome Following Biochemical Relapse in the Dose Escalation Era for Prostate Cancer Patients Undergoing Definitive External Beam Radiotherapy

    PubMed Central

    Zumsteg, Zachary S.; Spratt, Daniel E.; Romesser, Paul B.; Pei, Xin; Zhang, Zhigang; Polkinghorn, William; McBride, Sean; Kollmeier, Marisa; Yamada, Yoshiya; Zelefsky, Michael J.

    2016-01-01

    Background The management of biochemical failure (BF) following external beam radiotherapy (EBRT) for prostate cancer is controversial, due to both the heterogeneous disease course following a BF and a lack of clinical trials in this setting. Objective We sought to characterize the natural history and predictors of outcome for patients experiencing BF in a large cohort of men with localized prostate cancer undergoing definitive dose-escalated EBRT. Design, setting, and participants This retrospective analysis included 2694 patients with localized prostate cancer treated with EBRT at a large academic center. Of these, 609 experienced BF, defined as prostate-specific antigen (PSA) nadir + 2 ng/ml. The median follow-up was 83 mo for all patients and 122 mo for BF patients. Intervention(s) All patients received EBRT at doses of 75.6–86.4 Gy. Outcome measurements and statistical analysis The primary objective of this study was to determine predictors of distant progression at the time of BF. Cox proportional hazards models were used in univariate and multivariate analyses of distant metastases (DM), and a competing risks method was used to analyze prostate cancer–specific mortality (PCSM). Results and limitations From the date of BF, the median times to DM and PCSM mortality were 5.4 yr and 10.5 yr, respectively. Shorter posttreatment PSA doubling time, a higher initial clinical tumor stage, a higher pretreatment Gleason score, and a shorter interval from the end of radiotherapy to BF were independent predictors for clinical progression following BF. Patients with two of these risk factors had a significantly higher incidence of DM and PCSM following BF than those with zero or one risk factor. The main limitations of this study are its retrospective nature and heterogeneous salvage interventions. Conclusions Clinical and pathologic factors can help identify patients at high risk of clinical progression following BF. Patient summary In this report, we look at

  2. Enhancing the Number of African Americans Who Pursue STEM PhDs: Meyerhoff Scholarship Program Outcomes, Processes, and Individual Predictors.

    PubMed

    Maton, Kenneth I; Sto Domingo, Mariano R; Stolle-McAllister, Kathleen E; Zimmerman, J Lynn; Hrabowski, Freeman A

    2009-01-01

    The current study examines the outcomes, processes, and individual predictors of pursuit of a STEM PhD among African-American students in the Meyerhoff Scholarship Program. Meyerhoff students were nearly five times more likely than comparison students to pursue a STEM PhD. Program components consistently rated as important were financial scholarship, being part of the Meyerhoff Program community, the Summer Bridge program, study groups, staff academic advising, and summer research opportunities. Furthermore, focus group findings revealed student internalization of key Meyerhoff Program values, including a commitment to excellence, accountability, group success, and giving back. In terms of individual predictors, multinomial logit regression analyses revealed that Meyerhoff students with higher levels of research excitement at college entry were more likely to pursue a STEM PhD. PMID:21841904

  3. Enhancing the Number of African Americans Who Pursue STEM PhDs: Meyerhoff Scholarship Program Outcomes, Processes, and Individual Predictors

    PubMed Central

    Maton, Kenneth I.; Sto Domingo, Mariano R.; Stolle-McAllister, Kathleen E.; Zimmerman, J. Lynn; Hrabowski, Freeman A.

    2011-01-01

    The current study examines the outcomes, processes, and individual predictors of pursuit of a STEM PhD among African-American students in the Meyerhoff Scholarship Program. Meyerhoff students were nearly five times more likely than comparison students to pursue a STEM PhD. Program components consistently rated as important were financial scholarship, being part of the Meyerhoff Program community, the Summer Bridge program, study groups, staff academic advising, and summer research opportunities. Furthermore, focus group findings revealed student internalization of key Meyerhoff Program values, including a commitment to excellence, accountability, group success, and giving back. In terms of individual predictors, multinomial logit regression analyses revealed that Meyerhoff students with higher levels of research excitement at college entry were more likely to pursue a STEM PhD. PMID:21841904

  4. Prognostic significance of electrical alternans versus signal averaged electrocardiography in predicting the outcome of electrophysiological testing and arrhythmia-free survival

    PubMed Central

    Armoundas, A; Rosenbaum, D; Ruskin, J; Garan, H; Cohen, R

    1998-01-01

    Objective—To investigate the accuracy of signal averaged electrocardiography (SAECG) and measurement of microvolt level T wave alternans as predictors of susceptibility to ventricular arrhythmias.
Design—Analysis of new data from a previously published prospective investigation.
Setting—Electrophysiology laboratory of a major referral hospital.
Patients and interventions—43 patients, not on class I or class III antiarrhythmic drug treatment, undergoing invasive electrophysiological testing had SAECG and T wave alternans measurements. The SAECG was considered positive in the presence of one (SAECG-I) or two (SAECG-II) of three standard criteria. T wave alternans was considered positive if the alternans ratio exceeded 3.0.
Main outcome measures—Inducibility of sustained ventricular tachycardia or fibrillation during electrophysiological testing, and 20 month arrhythmia-free survival.
Results—The accuracy of T wave alternans in predicting the outcome of electrophysiological testing was 84% (p < 0.0001). Neither SAECG-I (accuracy 60%; p < 0.29) nor SAECG-II (accuracy 71%; p < 0.10) was a statistically significant predictor of electrophysiological testing. SAECG, T wave alternans, electrophysiological testing, and follow up data were available in 36 patients while not on class I or III antiarrhythmic agents. The accuracy of T wave alternans in predicting the outcome of arrhythmia-free survival was 86% (p < 0.030). Neither SAECG-I (accuracy 65%; p < 0.21) nor SAECG-II (accuracy 71%; p < 0.48) was a statistically significant predictor of arrhythmia-free survival. 
Conclusions—T wave alternans was a highly significant predictor of the outcome of electrophysiological testing and arrhythmia-free survival, while SAECG was not a statistically significant predictor. Although these results need to be confirmed in prospective clinical studies, they suggest that T wave alternans may serve as a non-invasive probe for screening high risk

  5. Serum cortisol level and adrenal reserve as a predictor of patients’ outcome after successful cardiopulmonary resuscitation

    PubMed Central

    Mosaddegh, Reza; Kianmehr, Nahid; Mahshidfar, Babak; Rahmani, Zahra; Aghdam, Hamed; Mofidi, Mani

    2016-01-01

    Introduction: It is thought that pituitary-adrenal axis has a fundamental role in outcome of cardiopulmonary arrest (CPA). This study designed to evaluate the correlation between adrenal reserve and post-resuscitation outcome. Methods: In this clinical trial study, 52 consecutive patients with CPA were enrolled in two emergency departments (EDs) over a 3-month period. Plasma cortisol level was measured at the beginning of CPR. Intravenous adrenocorticotropic hormone (ACTH) stimulation test was carried out after successful CPR, and blood samples were taken at 30 and 60 minutes, and 24 hours thereafter. Patients were divided into two groups: in-hospital death or hospital discharge. Results: In patients who died, baseline and post-ACTH serum cortisol after 30 and 60 minutes and 24 hours were higher than patients who discharged from the hospital, but it was not statistically significant except to that of minute 60 (P=0.49). A model of multivariate logistic regression analysis showed that age and need for vasopressor infusion correlated with mortality. Conclusion: Current study could not show the statistically significant difference in initial and post-ACTH serum cortisol levels between survivor and non-survivor patients with cardiac arrest who had initial successful CPR, except to that of minute 60. PMID:27489598

  6. Pneumonia in rural Malawians under five years old: Treatment outcomes and clinical predictors of death on admission

    PubMed Central

    Mzumara, Suzgo; Mlenga, Maurice; Talipu, Raphael; Kasagila, Eric

    2009-01-01

    ABSTRACT Background High mortality and disability due to pneumonia occur worldwide. The introduction of the Integrated Management of Childhood Illness strategy in Malawi brought with it hope of an improvement in the outcome of pneumonia. However, the risk of death and treatment outcomes remain unknown in many districts. Method The medical records of 466 consecutive patients admitted to the Mchinji District Hospital from January 2004 to January 2006 whose disease met the World Health Organization criteria for pneumonia were reviewed. Data were collected from forms that had been filled out and different treatment outcomes and determinants of death were analysed using logistic regression. Results Of the 466 patients, 62.7% completed treatment, 15.9% had unknown outcomes, 12.9% died, 8.4% were lost to follow-up, 0.8% failed to improve with treatment, and 0.4% were transferred to other facilities. Independent predictors of death were: age less than 2 years, female sex, history of pneumonia, chest retractions, type of pneumonia, and central cyanosis. Conclusion A high proportion of deaths and unknown outcomes occurred among participants. Young age, female sex, history of pneumonia, chest retractions and central cyanosis were associated with death. Mortality from pneumonia may be reduced by close monitoring of these risk factors and by improving health education programmes and communicating these findings to parents and health workers. Further investigations of local reasons for high rates of unknown/unreported outcomes are welcomed.

  7. Pretreatment and process predictors of outcome in interpersonal and cognitive behavioral psychotherapy for binge eating disorder.

    PubMed

    Hilbert, Anja; Saelens, Brian E; Stein, Richard I; Mockus, Danyte S; Welch, R Robinson; Matt, Georg E; Wilfley, Denise E

    2007-08-01

    The present study examined pretreatment and process predictors of individual nonresponse to psychological group treatment of binge eating disorder (BED). In a randomized trial, 162 overweight patients with BED were treated with either group cognitive-behavioral therapy or group interpersonal psychotherapy. Treatment nonresponse, which was defined as nonabstinence from binge eating, was assessed at posttreatment and at 1 year following treatment completion. Using 4 signal detection analyses, greater extent of interpersonal problems prior to treatment or at midtreatment were identified as predictors of nonresponse, both at posttreatment and at 1-year follow-up. Greater pretreatment and midtreatment concerns about shape and weight, among those patients with low interpersonal problems, were predictive of posttreatment nonresponse. Lower group cohesion during the early treatment phase predicted nonresponse at 1-year follow-up. Attention to specific pre- or intreatment predictors could allow for targeted selection into differential or augmented care and could thus improve response to group psychotherapy for BED. PMID:17663618

  8. Problem coping skills, psychosocial adversities and mental health problems in children and adolescents as predictors of criminal outcomes in young adulthood.

    PubMed

    Aebi, Marcel; Giger, Joël; Plattner, Belinda; Metzke, Christa Winkler; Steinhausen, Hans-Christoph

    2014-05-01

    The purpose of this study was to test child and adolescent psychosocial and psychopathological risk factors as predictors of adult criminal outcomes in a Swiss community sample. In particular, the role of active and avoidant problem coping in youths was analysed. Prevalence rates of young adult crime convictions based on register data were calculated. Univariate and multivariate logistic regressions were used to analyse the prediction of adult criminal convictions 15 years after assessment in a large Swiss community sample of children and adolescents (n = 1,086). Risk factors assessed in childhood and adolescence included socio-economic status (SES), migration background, perceived parental behaviour, familial and other social stressors, coping styles, externalizing and internalizing problems and drug abuse including problematic alcohol consumption. The rate of any young adult conviction was 10.1 %. Besides externalizing problems and problematic alcohol consumption, the presence of any criminal conviction in young adulthood was predicted by low SES and avoidant coping even after controlling for the effects of externalizing problems and problematic alcohol use. The other predictors were significant only when externalizing behaviours and problematic alcohol use were not controlled. In addition to child and adolescent externalizing behaviour problems and substance use, low SES and inadequate problem-solving skills, in terms of avoidant coping, are major risk factors of young adult criminal outcomes and need to be considered in forensic research and criminal prevention programs. PMID:23949100

  9. Predictors for Half-Year Outcome of Impairment in Daily Life for Back Pain Patients Referred for Physiotherapy: A Prospective Observational Study

    PubMed Central

    Karstens, Sven; Hermann, Katja; Froböse, Ingo; Weiler, Stephan W.

    2013-01-01

    Background and Objective From observational studies, there is only sparse information available on the predictors of development of impairment in daily life for patients receiving physiotherapy. Therefore, our aim was to identify factors which predict impairment in daily life for patients with back pain 6 months after receiving physiotherapy. Methods We conducted a prospective cohort study with 6-month follow-up. Patients were enrolled for treatment in private physiotherapy practices. Patients with a first physiotherapy referral because of thoracic or low back pain, aged 18 to 65 years were included. Primary outcome impairment was measured utilising the 16-item version of the Musculoskeletal Function Assessment Questionnaire. Therapy was documented on a standardized form. Baseline scores for impairment in daily life, symptom characteristics, sociodemographic and psychosocial factors, physical activity, nicotine consumption, intake of analgesics, comorbidity and delivered primary therapy approach were investigated as possible predictors. Univariate and multiple linear regression analyses were performed. Results A total of 792 patients participated in the study (59% female, mean age 44.4 (SD 11.4), with 6-month follow-up results available from 391 patients. In univariate analysis 17 variables reached significance. In multiple linear regression identified predictors were: impairment in daily life before therapy, mental disorders, duration of the complaints, self-prognosis on work ability, rheumatoid arthritis, age, form of stress at work and physical activity. The variables explain 34% of variance (adjusted R2, p<0.001). Conclusions With minimal information available from observational studies on the predictors of development of back problems for physiotherapy patients, this study adds new knowledge for forming appropriate referral guidelines. Impairment in daily life before therapy, mental disorder as comorbidity and the duration of the complaints can be named as

  10. Procalcitonin Is a Stronger Predictor of Long-Term Functional Outcome and Mortality than High-Sensitivity C-Reactive Protein in Patients with Ischemic Stroke.

    PubMed

    Wang, Chao; Gao, Li; Zhang, Zhi-Guo; Li, Yu-Qian; Yang, Yan-Long; Chang, Tao; Zheng, Long-Long; Zhang, Xing-Ye; Man, Ming-Hao; Li, Li-Hong

    2016-04-01

    Inflammatory markers have been associated with functional outcome and mortality of stroke. We investigated the changes in procalcitonin (PCT) and high-sensitivity C-reactive protein (Hs-CRP) levels during the acute period of ischemic stroke and evaluated the relationship between these levels and the long-term functional outcome and mortality. We prospectively studied 376 patients with acute ischemic stroke (AIS) who were admitted within 24 h after the onset of symptoms. PCT, Hs-CRP, and NIH Stroke Scale (NIHSS) were measured at the time of admission. Long-term functional outcome were measured by modified Rankin scale (mRS) at 1 year after admission. The correlations between the levels of PCT, Hs-CRP, and mortality at 1 year after stroke onset were analyzed. Patients with poor with functional outcome and non-survivors had significantly increased PCT and Hs-CRP levels on admission. Multivariate logistic regression analysis showed that PCT was an independent prognostic marker of 1-year functional outcome and death [odds ratio (OR) 2.33 (95% CI, 1.33-3.44) and 3.11 (2.02-4.43), respectively, P < 0.0001 for both, adjusted for age, NIHSS, other predictors, and vascular risk factors] in patients with AIS. The area under the receiver operating characteristic curve of PCT was 0.77 (95% CI, 0.72-0.83) for functional outcome and 0.88 (95% CI, 0.84-0.93) for mortality. PCT improved the area under the receiver operating characteristic curve of the NIHSS score for functional outcome from 0.74 (95% CI, 0.66-0.81) to 0.85 (95% CI, 0.76-0.92; P < 0.0001) and for mortality from 0.77 (95% CI, 0.70-0.83) to 0.94 (95% CI, 0.89-0.97; P < 0.0001). Serum level of PCT at admission was an independent predictor of long-term functional outcome and mortality after ischemic stroke in Chinese sample. PMID:25650122

  11. Primary Tumor Site as a Predictor of Treatment Outcome for Definitive Radiotherapy of Advanced-Stage Oral Cavity Cancers

    SciTech Connect

    Lin, Chien-Yu; Wang, Hung-Ming; Kang, Chung-Jan; Lee, Li-Yu; Huang, Shiang-Fu; Fan, Kang-Hsing; Chen, Eric Yen-Chao

    2010-11-15

    Purpose: To evaluate the outcome of definitive radiotherapy (RT) for oral cavity cancers and to assess prognostic factors. Methods and Materials: Definitive RT was performed on 115 patients with oral cavity cancers at Stages III, IVA, and IVB, with a distribution of 6%, 47%, and 47%, respectively. The median dose of RT was 72Gy (range, 62-76Gy). Cisplatin-based chemotherapy was administered to 95% of the patients. Eleven patients underwent salvage surgery after RT failure. Results: Eight-eight (76.5%) patients responded partially and 23 (20%) completely; of the patients who responded, 18% and 57%, respectively, experienced a durable effect of treatment. The 3-year overall survival, disease-specific survival, and progression-free survival were 22%, 27%, and 25%, respectively. The 3-year PFS rates based on the primary tumor sites were as follows: Group I (buccal, mouth floor, and gum) 51%, Group II (retromolar and hard palate) 18%, and Group III (tongue and lip) 6% (p < 0.0001). The 3-year progression-free survival was 41% for N0 patients and 19% for patients with N+ disease (p = 0.012). The T stage and RT technique did not affect survival. The patients who underwent salvage surgery demonstrated better 3-year overall survival and disease-specific survival (53% vs. 19%, p = 0.015 and 53% vs. 24%, p = 0.029, respectively). Subsite group, N+, and salvage surgery were the only significant prognostic factors for survival after multivariate analysis. Conclusion: The primary tumor site and neck stage are prognostic predictors in advanced-stage oral cancer patients who received radical RT. The primary tumor extension and RT technique did not influence survival.

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

    ERIC Educational Resources Information Center

    Wallace, Teri; Ticha, Renata; Gustafson, Kathy

    2010-01-01

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

  13. Bundle-Branch Block Morphology and Other Predictors of Outcome After Cardiac Resynchronization Therapy in Medicare Patients

    PubMed Central

    Bilchick, Kenneth C.; Kamath, Sandeep; DiMarco, John P.; Stukenborg, George J.

    2013-01-01

    Background Clinical trials of cardiac resynchronization therapy (CRT) have enrolled a select group of patients, with few patients in subgroups such as right bundle-branch block (RBBB). Analysis of population-based outcomes provides a method to identify real-world predictors of CRT outcomes. Methods and Results Medicare Implantable Cardioverter-Defibrillator Registry (2005 to 2006) data were merged with patient outcomes data. Cox proportional-hazards models assessed death and death/heart failure hospitalization outcomes in patients with CRT and an implantable cardioverter-defibrillator (CRT-D). The 14 946 registry patients with CRT-D (median follow-up, 40 months) had 1-year, 3-year, and overall mortality rates of 12%, 32%, and 37%, respectively. New York Heart Association class IV heart failure status (1-year hazard ratio [HR], 2.23; 3-year HR, 1.98; P<0.001) and age ≥80 years (1-year HR, 1.74; 3-year HR, 1.75; P<0.001) were associated with increased mortality both early and late after CRT-D. RBBB (1-year HR, 1.44; 3-year HR, 1.37; P<0.001) and ischemic cardiomyopathy (1-year HR, 1.39; 3-year HR, 1.44; P<0.001) were the next strongest adjusted predictors of both early and late mortality. RBBB and ischemic cardiomyopathy together had twice the adjusted hazard for death (HR, 1.99; P<0.001) as left BBB and nonischemic cardiomyopathy. QRS duration of at least 150 ms predicted more favorable outcomes in left BBB but had no impact in RBBB. A secondary analysis showed lower hazards for CRT-D compared with standard implantable cardioverter-defibrillators in left BBB compared with RBBB. Conclusions In Medicare patients, RBBB, ischemic cardiomyopathy, New York Heart Association class IV status, and advanced age were powerful adjusted predictors of poor outcome after CRT-D. Real-world mortality rates 3 to 4 years after CRT-D appear higher than previously recognized. PMID:21041691

  14. Sociodemographic Predictors of Breast Reconstruction Procedure Choice: Analysis of the Mastectomy Reconstruction Outcomes Consortium Study Cohort

    PubMed Central

    Ballard, Tiffany N. S.; Kim, Yeonil; Cohen, Wess A.; Hamill, Jennifer B.; Momoh, Adeyiza O.; Pusic, Andrea L.; Kim, H. Myra; Wilkins, Edwin G.

    2015-01-01

    Background. To promote patient-centered care, it is important to understand the impact of sociodemographic factors on procedure choice for women undergoing postmastectomy breast reconstruction. In this context, we analyzed the effects of these variables on the reconstructive method chosen. Methods. Women undergoing postmastectomy breast reconstruction were recruited for the prospective Mastectomy Reconstruction Outcomes Consortium Study. Procedure types were divided into tissue expander-implant/direct-to-implant and abdominally based flap reconstructions. Adjusted odds ratios were calculated from logistic regression. Results. The analysis included 2,203 women with current or previous breast cancer and 202 women undergoing prophylactic mastectomy. Compared with women <40 years old with current or previous breast cancer, those 40 to 59 were significantly more likely to undergo an abdominally based flap. Women working or attending school full-time were more likely to receive an autologous procedure than those working part-time or volunteering. Women undergoing prophylactic mastectomy who were ≥50 years were more likely to undergo an abdominal flap compared to those <40. Conclusions. Our results indicate that sociodemographic factors affect the reconstructive procedure received. As we move forward into a new era of patient-centered care, providing tailored treatment options to reconstruction patients will likely lead to higher satisfaction and better outcomes for those we serve. PMID:26605082

  15. Reflected appraisals and perceived importance of significant others' appraisals as predictors of college athletes' self-perceptions of competence.

    PubMed

    Amorose, Anthony J

    2003-03-01

    This study examined the reflected appraisal process with college athletes (N = 325). Specifically, the study tested (a) the relative influence of the reflected appraisals of mothers, fathers, coaches, and teammates (i.e., how athletes perceive these others view their ability) on athletes' self-perceptions of competence, and (b) whether the importance placed on these significant others as sources of competence information moderated the relationship. Based on a factor analysis, composite variables were formed representing the reflected appraisals of the athletes' parents (i.e., father, mother) and the reflected appraisals of sport-others (i.e., coach, teammates). Regression analyses revealed that the reflected appraisals of parents (beta = .21) and sport-others (beta = .55) predicted self-perceptions of competence (p < .05, R2 = .45). Follow-up analyses determined that the reflected appraisal of sport-others was a significantly stronger predictor. Hierarchical regression analyses revealed that the interaction of reflected appraisals and the importance of significant others did not significantly add to the prediction of self-perceptions of competence (p > .05, deltaR2 = .01) beyond the independent effects of these constructs. Results are discussed in terms of the reflected appraisal process and the influence of significant others on athletes' self-perceptions. PMID:12659477

  16. Dynamic Contrast-Enhanced Magnetic Resonance Imaging as a Predictor of Outcome in Head-and-Neck Squamous Cell Carcinoma Patients With Nodal Metastases

    SciTech Connect

    Shukla-Dave, Amita; Lee, Nancy Y.; Jansen, Jacobus F.A.; Thaler, Howard T.; Stambuk, Hilda E.; Fury, Matthew G.; Patel, Snehal G.; Moreira, Andre L.; Sherman, Eric; Karimi, Sasan; Wang, Ya; Kraus, Dennis; Shah, Jatin P.; Pfister, David G.; and others

    2012-04-01

    Purpose: Dynamic contrast-enhanced MRI (DCE-MRI) can provide information regarding tumor perfusion and permeability and has shown prognostic value in certain tumors types. The goal of this study was to assess the prognostic value of pretreatment DCE-MRI in head and neck squamous cell carcinoma (HNSCC) patients with nodal disease undergoing chemoradiation therapy or surgery. Methods and Materials: Seventy-four patients with histologically proven squamous cell carcinoma and neck nodal metastases were eligible for the study. Pretreatment DCE-MRI was performed on a 1.5T MRI. Clinical follow-up was a minimum of 12 months. DCE-MRI data were analyzed using the Tofts model. DCE-MRI parameters were related to treatment outcome (progression-free survival [PFS] and overall survival [OS]). Patients were grouped as no evidence of disease (NED), alive with disease (AWD), dead with disease (DOD), or dead of other causes (DOC). Prognostic significance was assessed using the log-rank test for single variables and Cox proportional hazards regression for combinations of variables. Results: At last clinical follow-up, for Stage III, all 12 patients were NED. For Stage IV, 43 patients were NED, 4 were AWD, 11 were DOD, and 4 were DOC. K{sup trans} is volume transfer constant. In a stepwise Cox regression, skewness of K{sup trans} (volume transfer constant) was the strongest predictor for Stage IV patients (PFS and OS: p <0.001). Conclusion: Our study shows that skewness of K{sup trans} was the strongest predictor of PFS and OS in Stage IV HNSCC patients with nodal disease. This study suggests an important role for pretreatment DCE-MRI parameter K{sup trans} as a predictor of outcome in these patients.

  17. An Examination of Behavioral Rehearsal During Consultation as a Predictor of Training Outcomes

    PubMed Central

    Kendall, Philip C.; Ringle, Vanesa A.; Read, Kendra L.; Brodman, Douglas A.; Pimentel, Sandra S.; Beidas, Rinad S.

    2013-01-01

    The training literature suggests that ongoing support following initial therapist training enhances training outcomes, yet little is known about what occurs during ongoing support and what accounts for its effectiveness. The present study examined consultation sessions provided to 99 clinicians following training in cognitive-behavioral therapy for youth anxiety. The 104 recorded consultation sessions were coded for content and consultative methods. It was hypothesized that behavioral rehearsal (an active learning technique) would predict therapist adherence, skill, self-efficacy, and satisfaction at post-consultation. Regression analyses found no significant relation, however, clinician involvement during consultation sessions positively moderated the relationship between behavioral rehearsals and skill. Implications, limitations, and future directions are discussed. PMID:23616234

  18. Predictors and Correlates of Homework Completion and Treatment Outcomes in Parent-Child Interaction Therapy

    ERIC Educational Resources Information Center

    Danko, Christina M.; Brown, Tasha; Van Schoick, Lauren; Budd, Karen S.

    2016-01-01

    Background: Behavioral parent training has been demonstrated to be an effective treatment for child behavior problems; however, lack of parent engagement can limit the effectiveness of treatment. Understanding more about predictors and correlates of a specific measure of parent engagement--homework completion--in parent training can help to…

  19. Pretreatment and Process Predictors of Outcome in Interpersonal and Cognitive Behavioral Psychotherapy for Binge Eating Disorder

    ERIC Educational Resources Information Center

    Hilbert, Anja; Saelens, Brian E.; Stein, Richard I.; Mockus, Danyte S.; Welch, R. Robinson; Matt, Georg E.; Wilfley, Denise E.

    2007-01-01

    The present study examined pretreatment and process predictors of individual nonresponse to psychological group treatment of binge eating disorder (BED). In a randomized trial, 162 overweight patients with BED were treated with either group cognitive-behavioral therapy or group interpersonal psychotherapy. Treatment nonresponse, which was defined…

  20. Contextual and Intrapersonal Predictors of Adolescent Risky Sexual Behavior and Outcomes

    ERIC Educational Resources Information Center

    Shneyderman, Yuliya; Schwartz, Seth J.

    2013-01-01

    The present study was designed to test a model of contextual and intrapersonal predictors of adolescent risky sexual behaviors and of sexually transmitted infection diagnoses. Using Waves I and II from the National Longitudinal Study of Adolescent Health, the authors estimated a structural model in which intrapersonal factors such as…

  1. Predictors and Moderators of Acute Outcome in the Treatment for Adolescents with Depression Study (TADS)

    ERIC Educational Resources Information Center

    Curry, John; Rohde, Paul; Simons, Anne; Silva, Susan; Vitiello, Benedetto; Kratochvil, Christopher; Reinecke, Mark; Feeny, Norah; Wells, Karen; Pathak, Sanjeev; Weller, Elizabeth; Rosenberg, David; Kennard, Betsy; Robins, Michele; Ginsburg, Golda; March, John

    2006-01-01

    Objective: To identify predictors and moderators of response to acute treatments among depressed adolescents (N = 439) randomly assigned to fluoxetine, cognitive-behavioral therapy (CBT), both fluoxetine and CBT, or clinical management with pill placebo in the Treatment for Adolescents With Depression Study (TADS). Method: Potential baseline…

  2. Are Social Norms the Best Predictor of Outcomes Among Heavy-Drinking College Students?*

    PubMed Central

    NEIGHBORS, CLAYTON; LEE, CHRISTINE M.; LEWIS, MELISSA A.; FOSSOS, NICOLE; LARIMER, MARY E.

    2008-01-01

    Objective This research was designed to evaluate the relative contribution of social norms, demographics, drinking motives, and alcohol expectancies in predicting alcohol consumption and related problems among heavy-drinking college students. Method Participants included 818 (57.6% women) first-year undergraduates who reported at least one heavy-drinking episode in the previous month. In addition to providing demographic information (gender and fraternity/sorority membership) participants completed Web-based assessments of social norms (perceived descriptive norms regarding typical student drinking, injunctive norms regarding friends’ and parents’ approval), motives (social, enhancement, coping, and conformity), and expectancies and evaluations of positive and negative alcohol effects. Results Regression results indicated that descriptive and injunctive norms were among the best predictors of college student drinking. With respect to alcohol problems, results indicated that coping motives accounted for the largest proportion of unique variance. Finally, results revealed that alcohol consumption mediated the relationships between predictors and problems for social norms, whereas coping motives, negative expectancies, and evaluation of negative effects were directly associated with alcohol problems despite having relatively weak or null unique associations with consumption. Conclusions The results of this study substantiate social norms as being among the best predictors of alcohol consumption in this population and suggest that drinking to cope is a better predictor of problems. The findings are discussed in terms of practical prevention and treatment implications. PMID:17568961

  3. Psychological predictors of short- and medium term outcome in individuals with idiopathic environmental intolerance (IEI) and individuals with somatoform disorders.

    PubMed

    Bailer, Josef; Witthöft, Michael; Rist, Fred

    2008-01-01

    Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity (MCS), is defined as a chronic polysymptomatic condition that cannot be explained by an organic disease. Previous studies suggest that IEI may be a variant of somatoform disorders (SFD), because both disorders overlap with respect to symptoms and psychological features of somatization. However, little is known about the short- and medium-term outcome of IEI and psychological outcome predictors. Two clinical groups (IEI and SFD) and a comparison group (CG) were followed through 32 mo to assess both the outcome, and the extent to which trait anxiety and somatic symptom attribution (assessed at first examination) predict outcome presented 12 and 32 mo later. Outcome measures were the number of self-reported IEI symptoms, IEI triggers, IEI-associated functional impairments, and the number of somatoform symptoms. In addition, the course of the 2 syndromes over the 32-mo follow-up period was investigated with standardized screening scales. The 3 diagnostic groups consisted of 46 subjects with IEI, 38 subjects with SFD but without IEI, and 46 subjects (CG) with neither IEI nor SFD. Syndrome stability was high over the 32-mo follow-up period, and at both follow-ups IEI and non-IEI subjects differed on all IEI outcome measures (symptoms, triggers, functional impairments). Both trait anxiety and somatic attribution (the tendency to attribute common somatic complaints to an illness) predicted outcome. In addition, somatic attribution was found to partially mediate the effect of trait anxiety on outcome in the IEI group. In conclusion, these results suggest that IEI is a chronic and disabling condition and that trait anxiety contributes to the maintenance of the disorder via somatic attributions. PMID:18569575

  4. Preoperative Chemoradiotherapy (CRT) Followed by Laparoscopic Surgery for Rectal Cancer: Predictors of the Tumor Response and the Long-Term Oncologic Outcomes

    SciTech Connect

    Lee, Jong Hoon; Kim, Sung Hwan; Kim, Jun-Gi; Cho, Hyun Min; Shim, Byoung Yong

    2011-10-01

    Purpose: We have evaluated the predictors of a tumor response to chemoradiotherapy (CRT) and the long-term oncologic outcomes of preoperative CRT and laparoscopic surgery for patients who suffer from rectal cancer. Methods and Materials: The study involved 274 patients with locally advanced rectal cancer and who had been treated with preoperative CRT and curative laparoscopic total mesorectal excision between January 2003 and January 2009. We assessed the long-term oncologic outcomes, in terms of recurrence and survival, of the treated patients. Results: Forty-two (15.3%) of the 274 patients had complete pathologic responses (pCR). The pre-CRT carcinoembryonic antigen level was the only significant predictor of a pCR on the multivariate analysis (p = 0.01). The overall survival at 5 years was 73.1%, with a mean survival period of 59.7 months (95% CI, 57.1-62.3). The disease-free survival at 5 years was 67.3% with a mean survival period of 54.7 months (95% CI, 51.7-57.8). The pCR group had a higher rate of overall survival at 5 years than did the non-pCR group, and the difference was significant (86.0% vs. 71.2%; hazard ratio = 0.87; 95% CI, 0.78-0.96; p = 0.03). The cumulative incidences of local and distant recurrences at 5 years were 5.8% and 28.3%, respectively. A total of 84.5% (234 of 274) of the patients had their anal sphincters preserved. Grade 3 or 4 acute and long-term toxic effects occurred in 22.2% and 8.4% of the patients, respectively. Conclusion: Preoperative CRT and laparoscopic surgery seems safe and feasible with favorable long-term outcomes and a high rate of sphincter preservation for the patients with low-lying tumors of the rectum.

  5. Pre-Existing Rotator Cuff Tears as a Predictor of Outcomes in National Football League Athletes

    PubMed Central

    Gibbs, Daniel; Lynch, Thomas Sean; Gomberawalla, M. Mustafa; Schroeder, Greg; LaBelle, Mark; Hollett, Brian P.; Saltzman, Matthew; Nuber, Gordon W.

    2015-01-01

    Objectives: Fifty percent of all athletes at the National Football League (NFL) Combine report having had a shoulder injury at some point during their playing career. Rotator cuff tears are rare injuries in young athletes, but an increasing incidence has been noted amongst competitive football players. It is unknown how pre-existing rotator cuff tears affect career longevity and performance of NFL athletes. In Combine athletes with pre-existing rotator cuff tears, knowledge of outcomes may help athletes and physicians manage expectations of draft potential, career length and performance. Methods: The written medical evaluations of prospective professional American football athletes from 2003-2011 during the NFL Combine were compiled and evaluated. All players were evaluated for the diagnosis of a pre-existing rotator cuff tear and stratified based on whether or not they underwent surgical intervention. Athletes with rotator cuff tears, who were selected in the NFL draft, were matched by age, position, year, and round drafted to control draftees without significant documented shoulder pathology. Career statistics, including a previously established “Performance Score,” were compiled. The continuous variables of each cohort were compared using a Student's t-test. A Chi Squared test was performed to analyze the categorical data. Statistical significance was accepted with a p-value < 0.05. Results: Between the years of 2003 and 2011, 2,965 consecutive athletes were evaluated. Forty-nine athletes were identified with a pre-existing rotator cuff tear; twenty-two of these athletes underwent surgical intervention for their tear and 27 were treated non-operatively. Those who attended the NFL Combine with a history of a rotator cuff tear were significantly less likely to be drafted than those without a previous injury (55.1% vs. 77.5% respectively, p = 0.002) (Table 1A). The 27 drafted athletes with pre-existing rotator cuff tears played significantly fewer years (4.3 vs

  6. Dysfunctional Attitudes Scale Perfectionism: A Predictor and Partial Mediator of Acute Treatment Outcome among Clinically Depressed Adolescents

    PubMed Central

    Jacobs, Rachel H.; Silva, Susan G.; Reinecke, Mark A.; Curry, John F.; Ginsburg, Golda S.; Kratochvil, Christopher J.; March, John S.

    2009-01-01

    The effect of perfectionism on acute treatment outcomes was explored in a randomized controlled trial of 439 clinically depressed adolescents (12–17 years of age) enrolled in the Treatment for Adolescents with Depression Study (TADS) who received cognitive behavior therapy (CBT), fluoxetine, a combination of CBT and FLX, or pill placebo. Measures included the Children’s Depression Rating Scale–Revised, the Suicidal Ideation Questionnaire–Grades 7–9, and the perfectionism subscale from the Dysfunctional Attitudes Scale (DAS). Predictor results indicate that adolescents with higher versus lower DAS perfectionism scores at baseline, regardless of treatment, continued to demonstrate elevated depression scores across the acute treatment period. In the case of suicidality, DAS perfectionism impeded improvement. Treatment outcomes were partially mediated by the change in DAS perfectionism across the 12-week period. PMID:20183664

  7. Conduct Problems in Childhood and Adolescence: Developmental Trajectories, Predictors and Outcomes in a Six-Year Follow Up.

    PubMed

    López-Romero, Laura; Romero, Estrella; Andershed, Henrik

    2015-10-01

    Understanding youth conduct problems requires examination from a developmental perspective, analyzing distinctive pathways across childhood and adolescence, and identifying early predictors which will lead to specific adolescent outcomes. Bearing this in mind, developmental trajectories of conduct problems were identified from a person-oriented perspective, and using data collected from three waves over a six-year period, in a sample of Spanish children aged 6-11 at the onset of the study. Conduct problems showed five distinctive trajectories which were grouped into three major pathways in further analyses: Stable low, Stable high, and Decreasing. Associations with early personality and psychopathic traits, as well as with a wide range of adolescent behavioral and psychosocial outcomes were examined, revealing the Stable high group as exhibiting the highest risk profile. These results contribute to improving our knowledge about one of the most relevant problems in youth populations, and will help in refining interventions strategies by recognizing the developmental heterogeneity of the construct. PMID:25354563

  8. Plasma neutrophil gelatinase-associated lipocalin as a potential predictor of adverse renal outcomes in immunoglobulin A nephropathy

    PubMed Central

    Park, Ga-Young; Yu, Chung-Hoon; Kim, Jun-Seop; Kang, Yun-Jeong; Kwon, Owen; Choi, Ji-Young; Cho, Jang-Hee; Kim, Chan-Duck; Kim, Yong-Lim

    2015-01-01

    Background/Aims Neutrophil gelatinase-associated lipocalin (NGAL) is a well-known biomarker of acute kidney injury. We evaluated the value of plasma NGAL (pNGAL) as an independent predictor of prognosis in immunoglobulin A nephropathy (IgAN). Methods In total, 91 patients with biopsy-proven IgAN at a single center were evaluated. pNGAL was measured using a commercial enzyme-linked immunosorbent assay kit (R&D Systems). Adverse renal outcome was defined as chronic kidney disease (CKD) stage 3 or above at the last follow-up. Pearson correlation coefficient and Cox regression were used for analyses. Results The mean age of all patients (male:female, 48:43) was 35 years (range, 18 to 77). pNGAL ranged between 21.68 and 446.40 ng/mL (median, 123.97) and showed a correlation with age (r = 0.332, p = 0.001), creatinine (r = 0.336, p = 0.001), estimated glomerular filtration rate (r = -0.397, p < 0.001), uric acid (r = 0.289, p = 0.006), and the protein-to-creatinine ratio (r = 0.288, p = 0.006). During a mean follow-up period of 37.6 months, 11 patients (12.1%) had CKD stage 3 or above. In a multivariate Cox regression model, hypertension (hazard ratio [HR], 8.779; 95% confidence interval [CI], 1.526 to 50.496; p = 0.015), proteinuria > 1 g/day (HR, 5.184; 95% CI, 1.124 to 23.921; p = 0.035), and pNGAL (HR, 1.012; 95% CI, 1.003 to 1.022; p = 0.013) were independent predictors associated with adverse renal outcome. Conclusions pNGAL showed strong correlations with other clinical prognostic factors and was also an independent predictor of adverse renal outcome. We suggest pNGAL as a potential predictor for prognosis in IgAN, while further studies are needed to confirm the clinical value. PMID:25995665

  9. Outcome Predictors in First-Ever Ischemic Stroke Patients: A Population-Based Study

    PubMed Central

    Corso, Giovanni; Bottacchi, Edo; Tosi, Piera; Caligiana, Laura; Lia, Chiara; Veronese Morosini, Massimo; Dalmasso, Paola

    2014-01-01

    Background. There is scant population-based information regarding predictors of stroke severity and long-term mortality for first-ever ischemic strokes. The aims of this study were to determine the characteristics of patients who initially presented with first-ever ischemic stroke and to identify predictors of severity and long-term mortality. Methods. Data were collected from the population-based Cerebrovascular Aosta Registry. Between 2004 and 2008, 1057 patients with first-ever ischemic stroke were included. Variables analysed included comorbidities, sociodemographic factors, prior-to-stroke risk factors, therapy at admission and pathophysiologic and metabolic factors. Multivariate logistic regression models, Kaplan-Meier estimates, and Cox proportional Hazards model were used to assess predictors. Results. Predictors of stroke severity at admission were very old age (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.75–5.06), female gender (OR 1.73, 95% CI 1.21–2.40), atrial fibrillation (OR 2.76, 95% CI 1.72–4.44), low ejection fraction (OR 2.22, CI 95% 1.13–4.32), and cardioembolism (OR 2.0, 95% CI 1.36–2.93). Predictors of long-term mortality were very old age (hazard ratio [HR] 2.02, 95% CI 1.65–2.47), prestroke modified Rankin scale 3–5 (HR 1.82; 95% CI 1.46–2.26), Charlson Index ≥2 (HR 1.97; 95% CI 1.62–2.42), atrial fibrillation (HR 1.43, 95% CI 1.04–1.98), and stroke severity (HR 3.54, 95% CI 2.87–4.36). Conclusions. Very old age and cardiac embolism risk factors are the independent predictors of stroke severity. Moreover, these factors associated with other comorbid medical conditions influence independently long-term mortality after ischemic stroke.

  10. Correlation of Multislice CT and Histomorphology in HCC Following TACE: Predictors of Outcome

    SciTech Connect

    Herber, S.; Biesterfeld, S.; Franz, U.; Schneider, J.; Thies, J.; Schuchmann, M.; Dueber, C.; Pitton, M. B.; Otto, G.

    2008-07-15

    accomplished (p = 0.023). In conclusion, TACE provided an acceptable local antitumoral effect in patients scheduled for liver transplantation. Tumor necrosis depended significantly on the degree of arterial devascularization and the accumulation of Lipiodol within the HCC lesions. Unifocal tumors and preserved liver function were positive predictors for a more favorable local antitumoral effect. Poor necrosis rates were found in patients with significant Lipiodol washout and who received a limited number of TACE procedures.

  11. Mandibular advancement devices: indications and predictors of treatment outcome. A review.

    PubMed

    Cuccia, A M; Caradonna, C

    2007-09-01

    Obstructive sleep apnea syndrome (OSAS) is a chronic sleep and respiratory disorder, which causes a partial or total obstruction of the air passage at the upper airway level. Mandibular advancement devices (MADs) have been used in the treatment of snoring, but may be a valid alternative to the continuous nasal positive airway pressure (CPAP) for certain OSAS cases. Therapy by means of MADs arises the interest of the scientific community and now there are many sleep-centres where dentists work as experts in sleep disorders. MADs are instruments of value because they are simple to use, reversible, portable and they generally have a low complication rate. They mechanically increase the oropharyngeal space by advancing the mandible and/or the tongue and reduce pharyngeal collapsibility. More than 60 different MADs are in use, with considerable variations in design. Several studies show that their systematic use produces an evident improvement in the global quality of life as well as in the symptoms of patients with OSAS, especially sleepiness. Even though significant progress has been made in proving the efficacy of MADs for OSAS, the ability to predict the treatment outcome and hence pre-select suitable candidates for this treatment still remains in its early stage. The first aim of this review is to supply to the clinician informations on the cephalometric and polysomnographic parameters that can be used to predict the efficacy of the outcome of MAD therapy in OSAS. Moreover, we examine the cases for which the use of a MAD is indicated. PMID:17938623

  12. Estrogen receptors α and β and aromatase as independent predictors for prostate cancer outcome.

    PubMed

    Grindstad, Thea; Skjefstad, Kaja; Andersen, Sigve; Ness, Nora; Nordby, Yngve; Al-Saad, Samer; Fismen, Silje; Donnem, Tom; Khanehkenari, Mehrdad Rakaee; Busund, Lill-Tove; Bremnes, Roy M; Richardsen, Elin

    2016-01-01

    Androgens are considered important in normal prostate physiology and prostate cancer (PCa) pathogenesis. However, androgen-targeted treatment preventing PCa recurrence is still lacking. This indicates additional mediators contributing to cancer development. We sought to determine the prognostic significance of estrogen receptors, ERα and -β, and the aromatase enzyme in PCa. Tissue microarrays were created from 535 PCa patients treated with radical prostatectomy. Expression of ERα, ERβ and aromatase were evaluated using immunohistochemistry. Representative tumor epithelial (TE) and tumor stromal (TS) areas were investigated separately. Survival analyses were used to evaluate the markers correlation to PCa outcome. In univariate analyses, ERα in TS was associated with delayed time to clinical failure (CF) (p = 0.042) and PCa death (p = 0.019), while ERβ was associated with reduced time to biochemical failure (BF) (p = 0.002). Aromatase in TS and TE was associated with increased time to BF and CF respectively (p = 0.016, p = 0.046). Multivariate analyses supported these observations, indicating an independent prognostic impact of all markers. When stratifying the analysis according to different surgical centers the results were unchanged. In conclusion, significant prognostic roles of ERα, ERβ and aromatase were discovered in the in PCa specimens of our large multicenter cohort. PMID:27610593

  13. Estrogen receptors α and β and aromatase as independent predictors for prostate cancer outcome

    PubMed Central

    Grindstad, Thea; Skjefstad, Kaja; Andersen, Sigve; Ness, Nora; Nordby, Yngve; Al-Saad, Samer; Fismen, Silje; Donnem, Tom; Khanehkenari, Mehrdad Rakaee; Busund, Lill-Tove; Bremnes, Roy M.; Richardsen, Elin

    2016-01-01

    Androgens are considered important in normal prostate physiology and prostate cancer (PCa) pathogenesis. However, androgen-targeted treatment preventing PCa recurrence is still lacking. This indicates additional mediators contributing to cancer development. We sought to determine the prognostic significance of estrogen receptors, ERα and -β, and the aromatase enzyme in PCa. Tissue microarrays were created from 535 PCa patients treated with radical prostatectomy. Expression of ERα, ERβ and aromatase were evaluated using immunohistochemistry. Representative tumor epithelial (TE) and tumor stromal (TS) areas were investigated separately. Survival analyses were used to evaluate the markers correlation to PCa outcome. In univariate analyses, ERα in TS was associated with delayed time to clinical failure (CF) (p = 0.042) and PCa death (p = 0.019), while ERβ was associated with reduced time to biochemical failure (BF) (p = 0.002). Aromatase in TS and TE was associated with increased time to BF and CF respectively (p = 0.016, p = 0.046). Multivariate analyses supported these observations, indicating an independent prognostic impact of all markers. When stratifying the analysis according to different surgical centers the results were unchanged. In conclusion, significant prognostic roles of ERα, ERβ and aromatase were discovered in the in PCa specimens of our large multicenter cohort. PMID:27610593

  14. Self-efficacy, outcome expectations, and fantasies as predictors of alcoholics' postreatment drinking.

    PubMed

    Long, C G; Hollin, C R; Williams, M J

    1998-10-01

    The usefulness of distinguishing between alcoholic patients' expectations and their fantasies about treatment outcome was examined. Results at 6 and 12 months follow-up did not support the results of research with nonalcoholic participants which related better outcomes to a combination of positive expectations and negative fantasies about future drink-related situations. Higher self-efficacy expectancy at intake, however, was associated with better clinical outcome. Findings supported Bandura's (1986) contention that outcome expectations add little information on prediction beyond that explained by self-efficacy expectancy. The clinical implications of these results are discussed. PMID:9781821

  15. Reconstructive Treatment of Ruptured Intracranial Spontaneous Vertebral Artery Dissection Aneurysms: Long-Term Results and Predictors of Unfavorable Outcomes

    PubMed Central

    Huang, Qing-Hai; Xu, Yi; Hong, Bo; Li, Qiang; Liu, Jian-Min; Zhao, Wen-Yuan; Deng, Ben-Qiang

    2013-01-01

    Introduction Few studies focused on predictors of unfavorable outcomes (modified Rankin Scale, 2–6) after reconstructive treatment of the ruptured intracranial spontaneous vertebral artery dissection aneurysms (ris-VADAs), which was evaluated based on 57 reconstructed lesions in this study. Methods Results of 57 consecutive patients (M:F = 29∶28; median age, 48 years; range, 27 to 69 years) harboring 57 ris-VADAs, which were treated with coils combined with single stent(n = 32), double overlapping stents (n = 16), and triple overlapping stents (n = 9) between October 2000 to March 2011, were retrospectively reviewed and analyzed. Results The available (n = 54) mean durations of angiographic and clinical follow-ups were 27 months (range, 12 to 78) and 62 months (range, 12 to 132), respectively. The involvement of PICA (p = 0.004), size of lesions (p = 0.000), quantity of stent (p = 0.001), and coil type (p = 0.002) affected the immediate obliteration grade, which was only risk factor for angiographic recurrences (p = 0.031). Although the post-treatment outcomes did not differ between single stent and multiple stents (p = 0.434), 5 angiographic recurrences, 1 rebleeding and 1 suspected rebleeding, all occurred in partial obliteration after single-stent-assisted coiling. Progressive thrombosis and in-stent obliteration were not detected on follow-up angiograms. Older age (odds ratio [OR] = 1.090; 95% confidence interval [CI], 1.004–1.184; p = 0.040) and unfavorable Hunt-Hess scale (OR = 4.289; 95%CI, 1.232–14.933; p = 0.022) were independent predictors of unfavorable outcomes in the reconstructed ris-VADAs. Conclusions Immediate obliteration grade was only risk factor for angiographic recurrence after reconstructive treatment. Unfavorable Hunt-Hess grade and older age were independent predictors of unfavorable outcomes in ris-VADAs. PMID:23840616

  16. Nutritional Risk Screening 2002 as a Predictor of Outcome During General Ward-Based Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease with Respiratory Failure

    PubMed Central

    Cui, Jinbo; Wan, Qunfang; Wu, Xiaoling; Zeng, Yihua; Jiang, Li; Ao, Dongmei; Wang, Feng; Chen, Ting; Li, Yanli

    2015-01-01

    Background Noninvasive ventilation (NIV) may reduce the need for intubation and mortality associated with chronic obstructive pulmonary disease (COPD) with type II respiratory failure. Early and simple predictors of NIV outcome could improve clinical management. This study aimed to assess whether nutritional risk screening 2002 (NRS2002) is a useful outcome predictor in COPD patients with type II respiratory failure treated by noninvasive positive pressure ventilation (NIPPV). Material/Methods This prospective observational study enrolled COPD patients with type II respiratory failure who accepted NIPPV. Patients were submitted to NRS2002 evaluation upon admission. Biochemical tests were performed the next day and blood gas analysis was carried out prior to NIPPV treatment and 4 hours thereafter. Patients were divided into NRS2002 score ≥3 and NRS2002 score <3 groups and NIV failure rates were compared between both groups. Results Of the 233 patients, 71 (30.5%) were not successfully treated by NIPPV. The failure rate was significantly higher in the NRS2002 score ≥3 group (35.23%) in comparison with patients with NRS2002 score <3 (15.79%) (p<0.05). Multivariate analysis indicated that PaCO2 (OR 1.25, 95%CI 1.172–1.671, p<0.05) prior to NIPPV treatment and NRS2002 score ≥3 (OR 1.76, 95%CI 1.303–2.374, p<0.05) were independent predictive factors for NIPPV treatment failure. Conclusions NRS2002 score ≥3 and PaCO2 values at admission may predict unsuccessful NIPPV treatment of COPD patients with type II respiratory failure and help to adjust therapeutic strategies. NRS2002 is a noninvasive and simple method for predicting NIPPV treatment outcome. PMID:26386778

  17. Nutritional Risk Screening 2002 as a Predictor of Outcome During General Ward-Based Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease with Respiratory Failure.

    PubMed

    Cui, Jinbo; Wan, Qunfang; Wu, Xiaoling; Zeng, Yihua; Jiang, Li; Ao, Dongmei; Wang, Feng; Chen, Ting; Li, Yanli

    2015-01-01

    BACKGROUND Noninvasive ventilation (NIV) may reduce the need for intubation and mortality associated with chronic obstructive pulmonary disease (COPD) with type II respiratory failure. Early and simple predictors of NIV outcome could improve clinical management. This study aimed to assess whether nutritional risk screening 2002 (NRS2002) is a useful outcome predictor in COPD patients with type II respiratory failure treated by noninvasive positive pressure ventilation (NIPPV). MATERIAL AND METHODS This prospective observational study enrolled COPD patients with type II respiratory failure who accepted NIPPV. Patients were submitted to NRS2002 evaluation upon admission. Biochemical tests were performed the next day and blood gas analysis was carried out prior to NIPPV treatment and 4 hours thereafter. Patients were divided into NRS2002 score ≥3 and NRS2002 score <3 groups and NIV failure rates were compared between both groups. RESULTS Of the 233 patients, 71 (30.5%) were not successfully treated by NIPPV. The failure rate was significantly higher in the NRS2002 score ≥3 group (35.23%) in comparison with patients with NRS2002 score <3 (15.79%) (p<0.05). Multivariate analysis indicated that PaCO2 (OR 1.25, 95%CI 1.172-1.671, p<0.05) prior to NIPPV treatment and NRS2002 score ≥3 (OR 1.76, 95%CI 1.303-2.374, p<0.05) were independent predictive factors for NIPPV treatment failure. CONCLUSIONS NRS2002 score ≥3 and PaCO2 values at admission may predict unsuccessful NIPPV treatment of COPD patients with type II respiratory failure and help to adjust therapeutic strategies. NRS2002 is a noninvasive and simple method for predicting NIPPV treatment outcome. PMID:26386778

  18. Genetic variants in combination with early partial improvement as a clinical utility predictor of treatment outcome in major depressive disorder: the result of two pooled RCTs.

    PubMed

    Kato, M; Serretti, A; Nonen, S; Takekita, Y; Wakeno, M; Azuma, J; Kinoshita, T

    2015-01-01

    Pharmacogenetics may allow for a personalized treatment, but a combination with clinical variables may further enhance prediction. In particular, in the present paper, we investigated early partial improvement (EPI) defined as 20% or more improvement by rating scales 2  weeks after treatment, in combination with selected gene variants as a predictor of treatment outcome in patients with major depressive disorder. Two randomized controlled trials with 168 Japanese depressed patients were used. A stepwise multiple linear regression model with HAM-D score change at week 6 as the dependent variable and genotypes, EPI, baseline HAM-D score, age and sex as independent variables was performed in paroxetine, fluvoxamine and milnacipran, respectively, to estimate the prediction of HAM-D change at week 6. In the paroxetine sample, only EPI (P<0.001) was significantly associated with HAM-D change (n=81, R(2)=0.25, P<0.001). In the fluvoxamine sample, 5-HTTLPR La/Lg, S (P=0.029), FGF2 rs1449683C/T (P=0.013) and EPI (P=0.003) were associated with HAM-D change (n=42, R(2)=0.43, P<0.001). In the milnacipran sample, HTR-1A-1019C/G (P=0.001), ADRA2A-1297C/G (P=0.028) and EPI (P<0.001) were associated with outcome (n=45, R(2)=0.71, P<0.001). EPI in combination with genetic variants could be a useful predictor of treatment outcome and could strengthen the practical use of pharmacogenetic data in clinical practice. PMID:25710119

  19. Genetic variants in combination with early partial improvement as a clinical utility predictor of treatment outcome in major depressive disorder: the result of two pooled RCTs

    PubMed Central

    Kato, M; Serretti, A; Nonen, S; Takekita, Y; Wakeno, M; Azuma, J; Kinoshita, T

    2015-01-01

    Pharmacogenetics may allow for a personalized treatment, but a combination with clinical variables may further enhance prediction. In particular, in the present paper, we investigated early partial improvement (EPI) defined as 20% or more improvement by rating scales 2  weeks after treatment, in combination with selected gene variants as a predictor of treatment outcome in patients with major depressive disorder. Two randomized controlled trials with 168 Japanese depressed patients were used. A stepwise multiple linear regression model with HAM-D score change at week 6 as the dependent variable and genotypes, EPI, baseline HAM-D score, age and sex as independent variables was performed in paroxetine, fluvoxamine and milnacipran, respectively, to estimate the prediction of HAM-D change at week 6. In the paroxetine sample, only EPI (P<0.001) was significantly associated with HAM-D change (n=81, R2=0.25, P<0.001). In the fluvoxamine sample, 5-HTTLPR La/Lg, S (P=0.029), FGF2 rs1449683C/T (P=0.013) and EPI (P=0.003) were associated with HAM-D change (n=42, R2=0.43, P<0.001). In the milnacipran sample, HTR-1A-1019C/G (P=0.001), ADRA2A-1297C/G (P=0.028) and EPI (P<0.001) were associated with outcome (n=45, R2=0.71, P<0.001). EPI in combination with genetic variants could be a useful predictor of treatment outcome and could strengthen the practical use of pharmacogenetic data in clinical practice. PMID:25710119

  20. Hemispheric surgery for refractory epilepsy: a systematic review and meta-analysis with emphasis on seizure predictors and outcomes.

    PubMed

    Hu, Wen-Han; Zhang, Chao; Zhang, Kai; Shao, Xiao-Qiu; Zhang, Jian-Guo

    2016-04-01

    OBJECT Conflicting conclusions have been reported regarding several factors that may predict seizure outcomes after hemispheric surgery for refractory epilepsy. The goal of this study was to identify the possible predictors of seizure outcome by pooling the rates of postoperative seizure freedom found in the published literature. METHODS A comprehensive literature search of PubMed, Embase, and the Cochrane Library identified English-language articles published since 1970 that describe seizure outcomes in patients who underwent hemispheric surgery for refractory epilepsy. Two reviewers independently assessed article eligibility and extracted the data. The authors pooled rates of seizure freedom from papers included in the study. Eight potential prognostic variables were identified and dichotomized for analyses. The authors also compared continuous variables within seizure-free and seizure-recurrent groups. Random- or fixed-effects models were used in the analyses depending on the presence or absence of heterogeneity. RESULTS The pooled seizure-free rate among the 1528 patients (from 56 studies) who underwent hemispheric surgery was 73%. Patients with an epilepsy etiology of developmental disorders, generalized seizures, nonlateralization on electroencephalography, and contralateral MRI abnormalities had reduced odds of being seizure-free after surgery. CONCLUSIONS Hemispheric surgery is an effective therapeutic modality for medically intractable epilepsy. This meta-analysis provides useful evidence-based information for the selection of candidates for hemispheric surgery, presurgical counseling, and explanation of seizure outcomes. PMID:26495944

  1. The Impact of Significant Other Expressed Emotion on Patient Outcomes in Chronic Fatigue Syndrome

    PubMed Central

    2014-01-01

    Objective: Previous literature has identified the importance of interpersonal processes for patient outcomes in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), particularly in the context of significant other relationships. The current study investigated expressed emotion (EE), examining the independent effects of critical comments and emotional overinvolvement (EOI) in association with patient outcomes. Method: Fifty-five patients with CFS/ME and their significant others were recruited from specialist CFS/ME services. Significant other EE status was coded from a modified Camberwell Family Interview. Patient outcomes (fatigue severity, disability, and depression) were derived from questionnaire measures. Forty-four patients (80%) completed follow-up questionnaires 6-months after recruitment. Results: Significant other high-EE categorized by both high levels of critical comments and high EOI was predictive of worse fatigue severity at follow-up. High-critical EE was associated with higher levels of patient depressive symptoms longitudinally; depressive symptoms were observed to mediate the relationship between high critical comments and fatigue severity reported at follow-up. There were higher rates of high-EE in parents than in partners, and this was because of higher rates of EOI in parents. Conclusions: Patients with high-EE significant others demonstrated poorer outcomes at follow-up compared with patients in low-EE dyads. One mechanism for this appears to be as a result of increased patient depression. Future research should seek to further clarify whether the role of interpersonal processes in CFS/ME differs across different patient-significant other relationships. The development of significant other-focused treatment interventions may be particularly beneficial for both patients and significant others. PMID:25180548

  2. Utility of brain natriuretic peptide assay as a predictor of short term outcomes in patients presenting with syncope to the emergency department

    PubMed Central

    Isbitan, Ahmad; Elnahar, Yaser; Patel, Kunal; Altheeb, Zaid; Debari, Vincent; Hamdan, Ayman; Shamoon, Fayez

    2016-01-01

    Background Syncope is a common condition that accounts for 3% of emergency department (ED) visits and 1–6% of hospital admissions. Current admissions practices result in marginal diagnostic and therapeutic benefit and consume healthcare resources. Methods This prospective cohort study examined the use of brain natriuretic peptide (BNP) test as a predictor of short term serious outcome in 159 patients who presented to ED with syncope between August 2012 and August 2013 in two tertiary teaching medical centers. Results A total of 41 patients (36%) had serious outcomes within 1 month, 21 of them were in the low BNP group and 20 were in the high BNP group. There was a significantly higher incidence of serious outcomes, myocardial infarction (MI), and life-threatening arrhythmias in the high BNP group. Patients with BNP >250 has an 8.844 fold increase risk of serious outcomes [odds ratio (OR) 8.844, 95% CI: (3.281 to 23.8), P<0.001], a 14.8-fold increase risk of MI [OR =14.8, 95% CI: (1.57 to 139), P=0.011], and a 4.46-fold increase risk life threatening arrhythmia [OR =4.46, 95% CI: (1.15–18.8), P=0.034]. However, there was no statistically significant difference between the two groups in one month mortality, major bleeding, major cardiac procedures or stroke. Conclusions Our study results further validates the ROSE rule and the utility of BNP in risk stratification of syncope patients. This study showed that measuring BNP and adding ROSE rule to the standard evaluation of syncope can sufficiently predict short-term serious outcomes for patients presenting to ED with syncope. PMID:27280086

  3. Client Pretreatment Characteristics as Predictors of Outcome in Brief Therapy for Bulimia.

    ERIC Educational Resources Information Center

    Guiffrida, Douglas A.; Barnes, Kristin L.; Hoskins, Christine M.; Roman, Lisa L.

    2001-01-01

    Presents an overview for college counselors of the literature on bulimia treatment outcomes for purposes of screening, treatment, and referral. Outlines pretreatment characteristics that seem amenable to success in brief therapy, as well as those that do not lead to a positive outcome. (Contains 37 references and 2 tables.) (Author/GCP)

  4. Outcomes of Child Sexual Abuse as Predictors of Later Sexual Victimization

    ERIC Educational Resources Information Center

    Reese-Weber, Marla; Smith, Dana M.

    2011-01-01

    The association between a history of child sexual abuse (CSA) and specific negative outcomes (attachment, feelings of power, and self-esteem) was explored as was the relationship between those negative outcomes and sexual victimization during the first semester of college. Two groups of freshman college women (67 who had experienced CSA and 55 who…

  5. Perceived Social Support and Locus of Control as the Predictors of Vocational Outcome Expectations

    ERIC Educational Resources Information Center

    Isik, Erkan

    2013-01-01

    The purpose of this study was to examine the relationships of vocational outcome expectation to social support which is an environmental factor and locus of control which is a personal factor. With this purpose, using Social Cognitive Career Theory as the theoretical framework, 263 undergraduate students completed Vocational Outcome Expectations…

  6. Outcomes and Predictors in Preschoolers with Speech-Language and/or Developmental Mobility Impairments

    ERIC Educational Resources Information Center

    Washington, Karla N.; Thomas-Stonell, Nancy; McLeod, Sharynne; Warr-Leeper, Genese

    2015-01-01

    The purpose of this article is to describe communicative-participation outcomes measured by the Focus on the Outcomes of Communication Under Six (FOCUS©; Thomas-Stonell et al., 2013) for interventions provided by speech-language pathologists (SLPs) in different community settings for preschoolers with speech-language impairments (Sp/LI) with and…

  7. Parenting, Community, and Religious Predictors of Positive and Negative Developmental Outcomes among Muslim Adolescents

    ERIC Educational Resources Information Center

    Krauss, Steven Eric; Hamzah, Azimi; Ismail, Ismi Arif; Suandi, Turiman; Hamzah, Siti Raba'ah; Dahalan, Dzuhailmi; Idris, Fazilah

    2014-01-01

    Despite existing research on the contribution of social context and religiosity to adolescent behavioral outcomes, few studies have attempted to explore this topic among Muslim adolescents in non-Western settings, looking at both positive and negative outcomes. In response to this gap, the current study explored the effects of three dimensions of…

  8. Clinical epidemiology and predictors of outcome in children hospitalised with influenza A(H1N1)pdm09 in 2009: a prospective national study

    PubMed Central

    Khandaker, Gulam; Zurynski, Yvonne; Ridley, Greta; Buttery, Jim; Marshall, Helen; Richmond, Peter C; Royle, Jenny; Gold, Michael; Walls, Tony; Whitehead, Bruce; McIntyre, Peter; Wood, Nicholas; Booy, Robert; Elliott, Elizabeth J

    2014-01-01

    Background There are few large-scale, prospective studies of influenza A(H1N1)pdm09 in children that identify predictors of adverse outcomes. Objectives We aimed to examine clinical epidemiology and predictors for adverse outcomes in children hospitalised with influenza A(H1N1)pdm09 in Australia. Methods Active hospital surveillance in six tertiary paediatric referral centres (June–September, 2009). All children aged <15 years admitted with laboratory-confirmed influenza A(H1N1)pdm09 were studied. Results Of 601 children admitted with laboratory-confirmed influenza, 506 (84·2%) had influenza A(H1N1)pdm09. Half (51·0%) of children with influenza A(H1N1)pdm09 were previously healthy. Hospital stay was longer in children with pre-existing condition (mean 6·9 versus 4·9 days; P = 0·02) as was paediatric intensive care unit (PICU) stay (7·0 versus 2·3 days; P = 0·005). Rapid diagnosis decreased both antibiotic use and length of hospital and PICU stay. Fifty (9·9%) children were admitted to a PICU, 30 (5·9%) required mechanical ventilation and 5 (0·9%) died. Laboratory-proven bacterial co-infection and chronic lung disease were significant independent predictors of PICU admission (OR 6·89, 95% CI 3·15–15·06 and OR 3·58, 95% CI 1·41–9·07, respectively) and requirement for ventilation (OR 5·61, 95% CI 2·2–14·28 and OR 5·18, 95% CI 1·8–14·86, respectively). Chronic neurological disease was a predictor of admission to PICU (OR 2·30, 95% CI 1·14–4·61). Conclusions During the 2009 pandemic, influenza was a major cause of hospitalisation in tertiary paediatric hospitals. Co-infection and underlying chronic disease increased risk of PICU admission and/or ventilation. Half the children admitted were previously healthy, supporting a role for universal influenza vaccination in children. PMID:25263176

  9. Peripheral arterial disease in the Middle East: Underestimated predictor of worse outcome

    PubMed Central

    El-Menyar, Ayman; Al Suwaidi, Jassim; Al-Thani, Hassan

    2013-01-01

    Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis and is associated with significant morbidity and mortality. The prevalence of PAD in the developed world is approximately 12% among adult population, which is age-dependent and with men being affected slightly more than women. Despite the strikingly high prevalence of PAD, the disease is underdiagnosed. Surprisingly, more than 70% of primary health care providers in the US were unaware of the presence of PAD in their patients. The clinical presentation of PAD may vary from asymptomatic to intermittent claudication, atypical leg pain, rest pain, ischemic ulcers, or gangrene. Claudication is the typical symptomatic expression of PAD. However, the disease may remains asymptomatic in up to 50% of all PAD patients. PAD has also been reported as a marker of poor outcome among patients with coronary artery disease. Despite the fact that the prevalence of atherosclerotic disease is increasing in the Middle East with increasing cardiovascular risk factors (tobacco use, diabetes mellitus and the metabolic syndrome), data regarding PAD incidence in the Middle East are scarce. PMID:24689007

  10. Perceived Control is a Transdiagnostic Predictor of Cognitive-Behavior Therapy Outcome for Anxiety Disorders.

    PubMed

    Gallagher, Matthew W; Naragon-Gainey, Kristin; Brown, Timothy A

    2014-02-01

    Perceived control has been proposed to be a general psychological vulnerability factor that confers an elevated risk for developing anxiety disorders, but there is limited research examining perceived control during cognitive-behavioral therapies (CBT). The present study examined whether treatment resulted in improvements in perceived control, and the indirect effects of CBT on changes in symptoms of obsessive-compulsive disorder, social phobia, generalized anxiety disorder, and panic disorder via changes in perceived control. Participants (n = 606) were a large clinical sample presenting for treatment at an outpatient anxiety disorders clinic. Participants completed a series of self-report questionnaires and a structured clinical interview at an intake evaluation and at two follow-up assessments 12 and 24 months later, with the majority of participants initiating CBT between the first two assessments. Results of latent growth curve models indicated that individuals initiating CBT subsequently reported large increases in perceived control and significant indirect effects of treatment on intraindividual changes in each of the four anxiety disorders examined via intraindividual changes in perceived control. These results suggest that the promotion of more adaptive perceptions of control is associated with recovery from anxiety disorders. Furthermore, the consistent finding of indirect effects across the four anxiety disorders examined underscores the transdiagnostic importance of perceived control in predicting CBT outcomes. PMID:24563563

  11. Clinical and biological predictors of outcome following relapse of CML post-allo-SCT.

    PubMed

    Jain, N A; Ito, S; Tian, X; Kurlander, R; Battiwalla, M; Lu, K; Savani, B N; Malkovska, V; Rezvani, K; Le, R Q; Shenoy, A; Hourigan, C S; Keyvanfar, K; Koklanaris, E; Superata, J; Muranski, P; Barrett, A J; Yong, A S M

    2015-02-01

    Although there are now fewer allo-SCTs performed for CML, leukemic relapse post transplant remains a persistent problem. To better define clinical and biological parameters determining postrelapse outcome, we studied 59 patients with CML relapsing after HLA-identical sibling allo-SCT between 1993 and 2008. Eighteen (30.5%) were transplanted in advanced phase and 41 (69.5%) in chronic phase. With a median follow-up from relapse of 7.9 years, 5-year post relapse survival (PRS) was 62%. Multivariate analysis found disease status at transplant, time to diagnosis of relapse from transplant and pretransplant tyrosine kinase inhibitor (TKI) use as significant factors associated with PRS. Analysis of BCR-ABL transcript expression in the hematopoietic progenitor compartment was performed in 36 patients (22 relapsed, 8 non-relapsed and 6 TKI alone controls). Patients with BCR-ABL expression in their early hematopoietic stem cell compartment (Lineage(-)CD34(+)CD38(-)CD90(+)) had worse survival irrespective of the disease status. We conclude that disease status remains the strongest clinical prognostic factor for PRS in CML following allo-SCT. The persistence of BCR-ABL expression in the progenitor cell compartment in some patients after SCT emphasizes the need to target CML-leukemia stem cells. PMID:25387087

  12. First trimester predictors of diet and birth outcomes in low-income pregnant women.

    PubMed

    Fowles, Eileen R; Gabrielson, Marcena

    2005-01-01

    The purpose1 of this study is to test a model describing the relations of various biopsychosocial, behavioral, and cognitive factors on the health outcomes of nutritional adequacy and infant birth weight in low-income pregnant women. Descriptive, cohort design assessed low-income women (N=55) in their 1st trimester of pregnancy. Eighty percent of the women did not meet the recommended number of food servings outlined in the Food Guide Pyramid. Prepregnant body mass index (BMI) and pregnancy-related dietary changes explained 19% of the variance in nutritional adequacy. Maternal age, prepregnant BMI, nutritional knowledge, and infant gestation at birth explained 52% of the variance in infant birth weight. Nutritional adequacy in the 1st trimester and infant birth weight were not significantly related. Most low-income women are not meeting the nutritional requirements of pregnancy. Careful monitoring of dietary quality may help target women in need of additional nutritional education. Providing nutritional education throughout pregnancy may lead to improved dietary patterns that may reduce low birth weight. PMID:15877540

  13. Electrophysiological Predictors of Clinical Outcome in Traumatic Neuropathies: A Multicenter Prospective Study.

    PubMed

    Ciaramitaro, Palma; Mondelli, Mauro; Rota, Eugenia; Battiston, Bruno; Sard, Arman; Pontini, Italo; Faccani, Giuliano; Migliaretti, Giuseppe; Merola, Aristide; Cocito, Dario; Neuropathies, Italian Network For Traumatic

    2016-01-01

    Objectives. This prospective, observational, multicentre study aims to identify electrodiagnostic (EDX) markers of clinical recovery in patients with traumatic neuropathy (TN) receiving surgical (S) and nonsurgical (NS) treatments. Methods. Subjects referred to the Italian Traumatic Neuropathy Network between 2010 and 2011 (307 patients, for a total of 444 TN) were evaluated with serial clinical/EDX evaluations at 6, 12, 24, and 36 months of follow-up. Results. Primary surgery was performed in 21 subjects with open lesions and evidence of neurotmesis, while closed lesions were treated with either conservative medical approach (216 patients) or secondary surgery (70 patients), according to the clinical spontaneous recovery at 4-6 months. Clinical improvement correlated with the increase of the compound muscle action potential amplitude (OR 3.76; CI 1.61-8.76), particularly in the S group (OR 7.25; CI 1.2-43.87), and with sensory nerve action potential amplitude in the NS group (OR 4.35; CI 1.14-16.69). No correlations were found with needle electromyography qualitative evaluations, changes in maximal voluntary recruitment, age, and gender. Conclusions. Nerve conduction studies (NCS) represent the more accurate neurophysiological markers of clinical outcome in patients with TN. Significance. Serial NCS assessments predict the functional recovery in TN, increasing the accuracy of peripheral nerves surgical decision-making process. PMID:27547450

  14. Electrophysiological Predictors of Clinical Outcome in Traumatic Neuropathies: A Multicenter Prospective Study

    PubMed Central

    Mondelli, Mauro; Battiston, Bruno; Sard, Arman; Pontini, Italo; Faccani, Giuliano; Migliaretti, Giuseppe; Cocito, Dario; Neuropathies, Italian Network for Traumatic

    2016-01-01

    Objectives. This prospective, observational, multicentre study aims to identify electrodiagnostic (EDX) markers of clinical recovery in patients with traumatic neuropathy (TN) receiving surgical (S) and nonsurgical (NS) treatments. Methods. Subjects referred to the Italian Traumatic Neuropathy Network between 2010 and 2011 (307 patients, for a total of 444 TN) were evaluated with serial clinical/EDX evaluations at 6, 12, 24, and 36 months of follow-up. Results. Primary surgery was performed in 21 subjects with open lesions and evidence of neurotmesis, while closed lesions were treated with either conservative medical approach (216 patients) or secondary surgery (70 patients), according to the clinical spontaneous recovery at 4–6 months. Clinical improvement correlated with the increase of the compound muscle action potential amplitude (OR 3.76; CI 1.61–8.76), particularly in the S group (OR 7.25; CI 1.2–43.87), and with sensory nerve action potential amplitude in the NS group (OR 4.35; CI 1.14–16.69). No correlations were found with needle electromyography qualitative evaluations, changes in maximal voluntary recruitment, age, and gender. Conclusions. Nerve conduction studies (NCS) represent the more accurate neurophysiological markers of clinical outcome in patients with TN. Significance. Serial NCS assessments predict the functional recovery in TN, increasing the accuracy of peripheral nerves surgical decision-making process. PMID:27547450

  15. Self-reported immature defense style as a predictor of outcome in short-term and long-term psychotherapy

    PubMed Central

    Laaksonen, Maarit A; Sirkiä, Carlos; Knekt, Paul; Lindfors, Olavi

    2014-01-01

    Objective Identification of pretreatment patient characteristics predictive of psychotherapy outcome could help to guide treatment choices. This study evaluates patients' initial level of immature defense style as a predictor of the outcome of short-term versus long-term psychotherapy. Method In the Helsinki Psychotherapy Study, 326 adult outpatients with mood or anxiety disorder were randomized to individual short-term (psychodynamic or solution-focused) or long-term (psychodynamic) psychotherapy. Their defense style was assessed at baseline using the 88-item Defense Style Questionnaire and classified as low or high around the median value of the respective score. Both specific (Beck Depression Inventory [BDI], Hamilton Depression Rating Scale [HDRS], Symptom Check List Anxiety Scale [SCL-90-Anx], Hamilton Anxiety Rating Scale [HARS]) and global (Symptom Check List Global Severity Index [SCL-90-GSI], Global Assessment of Functioning Scale [GAF]) psychiatric symptoms were measured at baseline and 3–7 times during a 3-year follow-up. Results Patients with high use of immature defense style experienced greater symptom reduction in long-term than in short-term psychotherapy by the end of the 3-year follow-up (50% vs. 34%). Patients with low use of immature defense style experienced faster symptom reduction in short-term than in long-term psychotherapy during the first year of follow-up (34% vs. 19%). Conclusion Knowledge of patients' initial level of immature defense style may potentially be utilized in tailoring treatments. Further research on defense styles as outcome predictors in psychotherapies of different types is needed. PMID:25161816

  16. Temporal lobe surgery in childhood and neuroanatomical predictors of long-term declarative memory outcome.

    PubMed

    Skirrow, Caroline; Cross, J Helen; Harrison, Sue; Cormack, Francesca; Harkness, William; Coleman, Rosie; Meierotto, Ellen; Gaiottino, Johanna; Vargha-Khadem, Faraneh; Baldeweg, Torsten

    2015-01-01

    The temporal lobes play a prominent role in declarative memory function, including episodic memory (memory for events) and semantic memory (memory for facts and concepts). Surgical resection for medication-resistant and well-localized temporal lobe epilepsy has good prognosis for seizure freedom, but is linked to memory difficulties in adults, especially when the removal is on the left side. Children may benefit most from surgery, because brain plasticity may facilitate post-surgical reorganization, and seizure cessation may promote cognitive development. However, the long-term impact of this intervention in children is not known. We examined memory function in 53 children (25 males, 28 females) who were evaluated for epilepsy surgery: 42 underwent unilateral temporal lobe resections (25 left, 17 right, mean age at surgery 13.8 years), 11 were treated only pharmacologically. Average follow-up was 9 years (range 5-15). Post-surgical change in visual and verbal episodic memory, and semantic memory at follow-up were examined. Pre- and post-surgical T1-weighted MRI brain scans were analysed to extract hippocampal and resection volumes, and evaluate post-surgical temporal lobe integrity. Language lateralization indices were derived from functional magnetic resonance imaging. There were no significant pre- to postoperative decrements in memory associated with surgery. In contrast, gains in verbal episodic memory were seen after right temporal lobe surgery, and visual episodic memory improved after left temporal lobe surgery, indicating a functional release in the unoperated temporal lobe after seizure reduction or cessation. Pre- to post-surgical change in memory function was not associated with any indices of brain structure derived from MRI. However, better verbal memory at follow-up was linked to greater post-surgical residual hippocampal volumes, most robustly in left surgical participants. Better semantic memory at follow-up was associated with smaller resection

  17. Portal pressure and blood nitric oxide levels as predictors of outcome in biliary atresia

    PubMed Central

    Khanna, Vikram; Bhatnagar, Veereshwar; Agarwala, Sandeep; Srinivas, Maddur; Das, Nibhriti; Singh, Manoj Kumar

    2016-01-01

    Aim: To evaluate the incidence of portal hypertension (PHT) in biliary atresia (BA) patients and to monitor its progress after Kasai portoenterostomy (KP) by measuring nitric oxide (NO) levels in peripheral blood. Materials and Methods: A prospective cross-sectional study conducted over a period of 2 years. Intraoperative portal pressure (PP) and blood NO levels at presentation, 1-month, 3-month, and 6-month follow-up, were correlated with clinical and biochemical parameters in BA patients. The mean NO level in age-matched control group was 4.64 ± 2.32 μmol/L. Results: Thirty-four BA patients underwent KP over a period of 2 years. The mean age of presentation was 2.7 months (range 1-4 months). The mean intraoperative PP was 21.3 ± 5.4 mmHg. The mean PP in patients aged <60 days, 61–90 days, and >90 days was 18.53 ± 4.45 mmHg, 20.33 ± 3.07 mmHg, and 26.5 ± 5.01 mmHg, respectively. The mean PP in the patients who underwent successful KP was 16.75 ± 3.54 mmHg while for those who continued to have jaundice it was 23.94 ± 4.63 mmHg (P < 0.001). NO levels closely followed the PP as shown by the regression equation NO = 4.79 + 0.64 PP mmHg, R2 = 0.69. The mean NO level at presentation was 18.48 ± 4.17 μmol/L and at 1-month, 3-month, and 6-month follow-up was 11.94 ± 5.62 μmol/L, 10.79 ± 6.02 μmol/L, and 9.93 ± 6.53 μmol/L, respectively (P < 0.001). The difference in NO levels was also statistically significant between the patients who cleared jaundice and those with persisting jaundice. Conclusion: All BA patients had PHT at presentation. PHT worsens with age and has an adverse effect on outcome of KP. NO levels in blood closely follow PP and higher levels are associated with poor outcome. PMID:27046973

  18. Serum lactate as a predictor of early outcomes among trauma patients in Uganda

    PubMed Central

    2014-01-01

    Background Trauma is the leading cause of death in the developed world. Accurate assessment of severity of injuries is critical in informing treatment choices. Current models of assessing severity of injury are not without limitations. The objective of this study therefore was to determine the diagnostic accuracy of serum lactate assays in assessing injury severity and prediction of early outcomes among trauma patients. Methods This was a cross-sectional analytical study. Consecutive series of all eligible patients had a single venous blood sample drawn for lactate assay analysis (index test) and a concurrent Kampala Trauma Score (KTS) II value determination (reference test). Admitted patients were followed up to assess early outcomes (length of hospital stay and mortality). Results Out of the 502 trauma patients recruited, 108 (22%) were severely injured, 394 (78%) had non-severe injuries, and 183 were admitted. There was a significant difference between median (interquartile range (IQR)) lactate levels among the severely injured (4.3 (2.6, 6.6)) and the non-severely injured (2.4 (1.6, 3.5), p < 0.001). After a 72-h follow-up of the admitted patients, 102 (56%) were discharged, 61 (33%) remained in the hospital, 3 (2%) remained in the ICU, and 17 (3%) had died. The area under the receiver operator characteristic (ROC) curve was 0.75 for injury severity. Serum lactate ≥2.0 mmol/l had a hazard ratio of 1.10 (p < 0.001) for emergency department disposition, 4.33 (p = 0.06) for the 72-h non-discharge disposition, and 1.19 (p < 0.001) for 72-h mortality. Serum lactate ≥2.0 mmol/l at admission was useful in discriminating severe from non-severe injuries with a sensitivity of 88%, specificity of 38%, PPV of 30%, and NPV of 92%. Conclusion Hyperlactatemia in an emergency trauma patient suggests a high probability of severe injury. PMID:25097669

  19. Temporal lobe surgery in childhood and neuroanatomical predictors of long-term declarative memory outcome

    PubMed Central

    Skirrow, Caroline; Cross, J. Helen; Harrison, Sue; Cormack, Francesca; Harkness, William; Coleman, Rosie; Meierotto, Ellen; Gaiottino, Johanna; Vargha-Khadem, Faraneh

    2015-01-01

    The temporal lobes play a prominent role in declarative memory function, including episodic memory (memory for events) and semantic memory (memory for facts and concepts). Surgical resection for medication-resistant and well-localized temporal lobe epilepsy has good prognosis for seizure freedom, but is linked to memory difficulties in adults, especially when the removal is on the left side. Children may benefit most from surgery, because brain plasticity may facilitate post-surgical reorganization, and seizure cessation may promote cognitive development. However, the long-term impact of this intervention in children is not known. We examined memory function in 53 children (25 males, 28 females) who were evaluated for epilepsy surgery: 42 underwent unilateral temporal lobe resections (25 left, 17 right, mean age at surgery 13.8 years), 11 were treated only pharmacologically. Average follow-up was 9 years (range 5–15). Post-surgical change in visual and verbal episodic memory, and semantic memory at follow-up were examined. Pre- and post-surgical T1-weighted MRI brain scans were analysed to extract hippocampal and resection volumes, and evaluate post-surgical temporal lobe integrity. Language lateralization indices were derived from functional magnetic resonance imaging. There were no significant pre- to postoperative decrements in memory associated with surgery. In contrast, gains in verbal episodic memory were seen after right temporal lobe surgery, and visual episodic memory improved after left temporal lobe surgery, indicating a functional release in the unoperated temporal lobe after seizure reduction or cessation. Pre- to post-surgical change in memory function was not associated with any indices of brain structure derived from MRI. However, better verbal memory at follow-up was linked to greater post-surgical residual hippocampal volumes, most robustly in left surgical participants. Better semantic memory at follow-up was associated with smaller resection

  20. Biomarkers as outcome predictors in subarachnoid hemorrhage – a systematic review

    PubMed Central

    Hong, Caron M.; Tosun, Cigdem; Kurland, David B.; Gerzanich, Volodymyr; Schreibman, David; Simard, J. Marc

    2015-01-01

    Context Subarachnoid hemorrhage (SAH) has a high fatality rate and many suffer from delayed neurological deficits. Biomarkers may aid in the identification of high-risk patients, guide treatment/management and improve outcome. Objective The aim of this review was to summarize biomarkers of SAH associated with outcome. Methods An electronic database query was completed, including an additional review of reference lists to include all potential human studies. Results A total of 298 articles were identified; 112 were reviewed; 55 studies were included. Conclusion This review details biomarkers of SAH that correlate with outcome. It provides the basis for research investigating their possible translation into the management of SAH patients. PMID:24499240

  1. Predictors and Outcomes of Readmission for Clostridium difficile in a National Sample of Medicare Beneficiaries

    PubMed Central

    Ayturk, M. Didem; Anderson, Fred A.; Santry, Heena P.

    2015-01-01

    Background Rates of Clostridium difficile (CD) infections are increasing. Elderly patients may be at particular risk of recurrent CD infection. Little is known about the risk for CD readmission specifically in this age group. Methods A 5 % random sample of Medicare data (2009–2011) was queried for patients surviving a hospitalization for CD by ICD-9 code. Demographic (age, sex, gender), clinical (Elixhauser index, gastrointestinal comorbidities), and hospitalization (length of stay, ICU admission) characteristics as well as exposure to antibiotics and interim non-CD hospitalization were compared for those with and without a readmission for CD. A multivariable survival analysis was used to determine predictors of readmission. Results Of 7,564 patients surviving a CD hospitalization, 8.5 % were readmitted with CD in a median of 25 days (interquartile range (IQR) 14–57). In multivariable survival analyses, interim non-CD hospital exposure was the strongest predictor of CD readmission (hazard ration (HR) 3.75 95 %, confidence interval (CI) 3.2–4.42). Oral and intravenous/intramuscular (IV/IM) antibiotic use, Elixhauser index, and CD as the primary diagnosis also increased the risk of CD readmission. Discharge to hospice, long-term care or a skilled nursing facility decreased the odds of CD readmission. Conclusion Hospital exposure and antibiotic use put elderly patients at risk of CD readmission. Exposure to these factors should be minimized in the immediate post discharge period. PMID:25408315

  2. Endometrial thickness as a predictor of pregnancy outcomes in 10787 fresh IVF-ICSI cycles.

    PubMed

    Yuan, Xi; Saravelos, Sotirios H; Wang, Qiong; Xu, Yanwen; Li, Tin-Chiu; Zhou, Canquan

    2016-08-01

    This retrospective study assessed the predictive value of endometrial thickness (EMT) on HCG administration day for the clinical outcome of fresh IVF and intracytoplasmic sperm injection (ICSI) cycles. A total of 8690 consecutive women undergoing 10,787 cycles over a 5-year period were included. The 5th, 50th and 95th centiles for EMT were determined as 8, 11 and 15 mm, respectively. Group analysis according to these centiles (Group 1: < 8 mm; Group 2: ≥ 8 and ≤11 mm; Group 3: > 11 and ≤15 mm; Group 4: > 15 mm) demonstrated significant differences (P < 0.001) in clinical pregnancy rates (23.0%, 37.2%, 46.2% and 53.3%, respectively), live birth rates per clinical pregnancy (63.3%, 72.0%, 78.1% and 80.3%, respectively), spontaneous abortion rates (26.7%, 23.8%, 19.9% and 17.5%, respectively), and ectopic pregnancy rates (10.0%, 4.3%, 2.1% and 2.2%, respectively). Logistic regression analyses showed EMT as one of the independent variables predictive of clinical pregnancy (OR = 1.097; P < 0.001), live birth (OR = 1.078; P < 0.001), spontaneous abortion (OR = 0.948; P < 0.001), and ectopic pregnancy (OR = 0.851; P < 0.001). Future research should aim to understand the underlying mechanisms relating EMT to conception, ectopic implantation and spontaneous abortion. PMID:27238372

  3. Predictors of Criminal Justice Outcomes Among Mental Health Courts Participants: The Role of Perceived Coercion and Subjective Mental Health Recovery

    PubMed Central

    Yanos, Philip T.; Kopelovich, Sarah L.; Koerner, Joshua; Alexander, Mary Jane

    2013-01-01

    Internationally, one effort to reduce the number of people with serious mental illness (SMI) in jails and prisons is the development of Mental Health Courts (MHC). Research on MHCs to date has been disproportionately focused on the study of recidivism and re-incarceration over the potential of these problem-solving courts to facilitate mental health recovery and affect the slope or gradient of opportunity for recovery. Despite the strong conceptual links between the MHC approach and the recovery-orientation in mental health, the capacity for MHCs to facilitate recovery has not been explored. This user-informed mental health and criminal justice (MH/CJ) community based participatory (CBPR) study assesses the extent to which MHC practices align with recovery-oriented principles and may subsequently affect criminal justice outcomes. We report on the experiences and perceptions of 51 MHC participants across four metropolitan Mental Health Courts. Specifically, the current study assesses: 1) how defendants’ perceptions of court practices, particularly with regard to procedural justice and coercion, relate to perceptions of mental health recovery and psychiatric symptoms, and, 2) how perceptions of procedural justice and mental health recovery relate to subsequent criminal justice outcomes. The authors hypothesized that perceived coercion and mental health recovery would be inversely related, that perceived coercion would be associated with worse criminal justice outcomes, and perceptions of mental health recovery would be associated with better criminal justice outcomes. Results suggest that perceived coercion in the MHC experience was negatively associated with perceptions of recovery among MHC participants. Perceptions of “negative pressures,” a component of coercion, were important predictors of criminal justice involvement in the 12 month period following MHC admission, even when controlling for other factors that were related to criminal justice outcomes, and

  4. Adjusted Left Atrial Emptying Fraction as a Predictor of Procedural Outcome after Catheter Ablation for Atrial Fibrillation

    PubMed Central

    Im, Sung Il; Kim, Sun Won; Choi, Cheol Ung; Kim, Jin Won; Yong, Hwan Seok; Kim, Eung Ju; Rha, Seung-Woon; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo; Lim, Hong Euy

    2015-01-01

    Structural remodeling of the left atrium is a risk factor for recurrent arrhythmia after catheter ablation for atrial fibrillation; however, data are sparse regarding the role of functional left atrial remodeling in predicting procedural outcomes. We evaluated whether left atrial transport function could be used to predict recurrent atrial fibrillation. From July 2008 through August 2010, we enrolled 202 consecutive patients who underwent catheter ablation for atrial fibrillation (paroxysmal=120, persistent=82). Left atrial volumes (LAVs) were measured by means of multislice computed tomography at every 10% of the R-R interval, and measurements were adjusted for body surface area to yield the LAV index (LAVI) at baseline. The left atrial emptying fraction (LAEF) was calculated according to LAV differences. During the mean follow-up period of 10 ± 4 months after a single ablation procedure, atrial fibrillation recurred in 59 patients (paroxysmal=19, persistent=40). Multivariate analysis revealed that persistent atrial fibrillation, early mitral inflow velocity, LAVImax, LAVImin, LAEF, LAVImax/LAEF, and LAVImin/LAEF were all independent predictors of atrial fibrillation, but the best predictor was LAVImin/LAEF (β=1.329, P=0.001). The cutoff value was 1.61 (mL/m2)/%, and the sensitivity and specificity were 74.6% and 62.2%, respectively (area under the curve=0.761). Our study shows that adjusted left atrial emptying fraction with use of multislice computed tomography might be a useful, noninvasive method to select patients for ablation. PMID:26175632

  5. Vestibulo-ocular monitoring as a predictor of outcome after severe traumatic brain injury

    PubMed Central

    2009-01-01

    Introduction Based on the knowledge that traumatic brainstem damage often leads to alteration in brainstem functions, including the vestibulo-ocular reflex, the present study is designed to determine whether prediction of outcome in the early phase after severe traumatic brain injury is possible by means of vestibulo-ocular monitoring. Methods Vestibulo-ocular monitoring is based on video-oculographic recording of eye movements during galvanic labyrinth polarization. The integrity of vestibulo-ocular reflex is determined from the eye movement response during vestibular galvanic labyrinth polarization stimulation. Vestibulo-ocular monitoring is performed within three days after traumatic brain injury and the oculomotor response compared to outcome after six months (Glasgow Outcome Score). Results Twenty-seven patients underwent vestibulo-ocular monitoring within three days after severe traumatic brain injury. One patient was excluded from the study. In 16 patients oculomotor response was induced, in the remaining 11 patients no oculomotor response was observed. The patients' outcome was classified as Glasgow Outcome Score 1-2 or as Glasgow Outcome Score 3 to 5. Statistical testing supported the hypothesis that those patients with oculomotor response tended to recover (exact two-sided Fisher-Test (P < 10-3)). Conclusions The results indicate that vestibulo-ocular monitoring with galvanic labyrinth polarization performed during the first days after traumatic brain injury helps to predict favourable or unfavourable outcome. As an indicator of brainstem function, vestibulo-ocular monitoring provides a useful, complementary approach to the identification of brainstem lesions by imaging techniques. PMID:19948056

  6. Cognitive and Affective Predictors of Treatment Outcome in Cognitive Processing Therapy and Prolonged Exposure for Posttraumatic Stress Disorder

    PubMed Central

    Rizvi, Shireen L.; Vogt, Dawne S.; Resick, Patricia A.

    2009-01-01

    This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n=145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to drop out of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols. PMID:19595295

  7. Cognitive and affective predictors of treatment outcome in Cognitive Processing Therapy and Prolonged Exposure for posttraumatic stress disorder.

    PubMed

    Rizvi, Shireen L; Vogt, Dawne S; Resick, Patricia A

    2009-09-01

    This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n = 145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to dropout of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols. PMID:19595295

  8. Predictors of outcome after 6 and 12 months following anthroposophic therapy for adult outpatients with chronic disease: a secondary analysis from a prospective observational study

    PubMed Central

    2010-01-01

    , general health) remained significant predictors in both analyses, and three further variables (education level, respiratory disorders, therapy goal) were significant in one analysis. Conclusion In adult outpatients receiving anthroposophic treatment for chronic diseases, symptom improvement after 6 and 12 months was predicted by baseline symptoms, health status, disease duration, education, and therapy goal. Other variables were not associated with the outcome. This secondary predictor analysis of data from a pre-post study does not allow for causal conclusions; the results are hypothesis generating and need verification in subsequent studies. PMID:20682028

  9. Behavioral and Cognitive Predictors of Educational Outcomes in Pediatric Traumatic Brain Injury

    PubMed Central

    Arnett, Anne B.; Peterson, Robin L.; Kirkwood, Michael W.; Taylor, H. Gerry; Stancin, Terry; Brown, Tanya M.; Wade, Shari L.

    2014-01-01

    Research reveals mixed results regarding the utility of standardized cognitive and academic tests to predict educational outcomes in youth following a traumatic brain injury (TBI). Yet, deficits in everyday school-based outcomes are prevalent after pediatric TBI. The current study used path modeling to test the hypothesis that parent ratings of adolescents’ daily behaviors associated with executive functioning (EF) would predict long-term functional educational outcomes following pediatric TBI, even when injury severity and patient demographics were included in the model. Furthermore, we contrasted the predictive strength of the EF behavioral ratings with that of a common measure of verbal memory. A total of 132 adolescents who were hospitalized for moderate to severe TBI were recruited to participate in a randomized clinical intervention trial. EF ratings and verbal memory were measured within 6 months of the injury; functional educational outcomes were measured 12 months later. EF ratings and verbal memory added to injury severity in predicting educational competence post injury but did not predict post-injury initiation of special education. The results demonstrated that measurement of EF behaviors is an important research and clinical tool for prediction of functional outcomes in pediatric TBI. PMID:23790158

  10. Ease of insertion of the laryngeal mask airway in pediatric surgical patients: Predictors of failure and outcome

    PubMed Central

    Asida, SM; Ahmed, SS

    2016-01-01

    Background: Laryngeal mask airway (LMA) is an useful alternative to endotracheal tube for airway management. The risk of life-threatening adverse respiratory events during its use is rare, but we need to know about the risk-adjusted prediction of its insertion failure requiring rescue tracheal intubation and its impact on patient outcome. Materials and Methods: Five hundred patients; 6 months to 12-year-old, American Society of Anesthesiologists I and II scheduled to undergo elective surgical procedures that require general anesthesia were included in this study. LMA was inserted after induction of anesthesia. The insertion conditions, intra, and postoperative events were recorded. Our primary outcome variable was trial success from the first time. Results: We recorded 426 cases (85.2%) of first trial success with clear airway compared to 46 case (9.2%) of second trial success (P ≤ 0.001). Predictors of failure of first attempt of LMA insertion include abnormal airway anatomy (91%), body weight <16 kg and age below 5 years (44%), the use of LMA size of 1 and 1.5 (3.8%), the intraoperative lateral position (3.8%). Conclusion: The data obtained from this study support the use of the LMA as a reliable pediatric supraglottic airway device, demonstrating relatively low failure rates. Predictors of LMA failure in the pediatric surgical population should be independently considered. Trial Registration: The study is registered in the Australian and New Zealand clinical trial registry with the allocated trial number: ACTRN12614000994684. Web address of trial: http://www.ANZCTR.org.au/A CTRN12614000994684.aspx. PMID:27375384

  11. Two-year outcomes after percutaneous mitral valve repair with the MitraClip system: durability of the procedure and predictors of outcome

    PubMed Central

    Toggweiler, Stefan; Zuber, Michel; Sürder, Daniel; Biaggi, Patric; Gstrein, Christine; Moccetti, Tiziano; Pasotti, Elena; Gaemperli, Oliver; Faletra, Francesco; Petrova-Slater, Iveta; Grünenfelder, Jürg; Jamshidi, Peiman; Corti, Roberto; Pedrazzini, Giovanni; Lüscher, Thomas F; Erne, Paul

    2014-01-01

    Objective Analyse 2-year outcomes after MitraClip therapy and identify predictors of outcome. Methods Consecutive patients (n=74) undergoing MitraClip therapy were included in the MitraSWISS registry and followed prospectively. Results A reduction of mitral regurgitation (MR) to ≤ mild was achieved in 32 (43%) patients and to moderate in 31 (42%) patients; 16/63 (25%) patients with initially successful treatment developed recurrent moderate to severe or severe MR during the first year and only 1 patient did so during the second year. At 2 years, moderate or less MR was more frequently present in patients with a transmitral mean gradient <3 mm Hg at baseline (73% vs 23%, p < 0.01) and in patients with a left atrial volume index (LAVI) <50 mL/m2 at baseline (86% vs 52%, p=0.03). More than mild MR post MitraClip, N-terminal probrain natriuretic peptide ≥5000 ng/L at baseline, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) were associated with reduced survival. Conclusions A mean transmitral gradient <3 mm Hg at baseline, an LAVI <50 mL/m2, the absence of COPD and CKD, and reduction of MR to less than moderate were associated with favourable outcome. Given a suitable anatomy, such patients may be excellent candidates for MitraClip therapy. Between 1 and 2 years follow-up, clinical and echocardiographic outcomes were stable, suggesting favourable, long-term durability of the device. PMID:25332799

  12. Go long! Predictors of positive relationship outcomes in long-distance dating relationships.

    PubMed

    Dargie, Emma; Blair, Karen L; Goldfinger, Corrie; Pukall, Caroline F

    2015-01-01

    Little is known about long-distance dating relationships. This study aimed to investigate differences between long-distance dating relationships and geographically close relationships and to explore predictors of relationship quality. Participants were 474 women and 243 men in long-distance dating relationships and 314 women and 111 men in geographically close relationships. Few differences existed between long-distance dating relationships and geographically close relationships, while individual and relationship characteristics predicted relationship quality. These results indicate that individuals in long-distance dating relationships are not at a disadvantage and that relationship and individual characteristics predict relationship quality. This knowledge could be a powerful tool for helping those in long-distance dating relationships. PMID:24274061

  13. Early Adolescent Relationship Predictors of Emerging Adult Outcomes: Youth with and without Type 1 Diabetes

    PubMed Central

    Helgeson, Vicki S.; Palladino, Dianne K.; Reynolds, Kerry A.; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda

    2013-01-01

    Background Emerging adulthood is a high-risk period for mental health problems and risk behaviors for youth generally and for physical health problems among those with type 1 diabetes. Purpose To examine whether adolescents’ relationships with parents and friends predict health and risk behaviors during emerging adulthood. Method Youth with and without diabetes were enrolled at average age 12 and followed for 7 years. Parent and friend relationship variables, measured during adolescence, were used to predict emerging adulthood outcomes: depression, risk behavior, and, for those with diabetes, diabetes outcomes. Results Parent relationship quality predicted decreased depressive symptoms and, for those with diabetes, decreased alcohol use. Parent control predicted increased smoking, reduced college attendance, and, for control participants, increased depressive symptoms. For those with diabetes, parent control predicted decreased depressive symptoms and better self-care. Friend relationship variables predicted few outcomes. Conclusions Adolescent parent relationships remain an important influence on emerging adults’ lives. PMID:24178509

  14. Outcome and Predictors of Stent Thrombosis in the First Romanian Registry of Drug Eluting Stent (RODESINO EXTENSION)

    PubMed Central

    STOICESCU, Claudiu; VINTILA, Vlad; UDROIU, Cristian; FLORESCU, Nicolae; DAWOOD, Aws; CINTEZA, Mircea; VINEREANU, Dragos

    2013-01-01

    ABSTRACT Background: Stent thrombosis (ST) is a rare, but extremely severe complication of PCI. Outside clinical trials, data are limited regarding the risks and the impact of this phenomenon. Aims: To assess prevalence, predictors, and clinical outcome of ST after implantation of drug eluting stents (DES) compared with bare metal stents (BMS), in a large case-control study in a real world scenario, as well as the relation between ST and duration of combined antiplatelet treatment. Methods: In a case-control registry we included 475 patients who received at least 1 DES (sirolimus, zotarolimus, everolimus, paclitaxel), compared with a group of 475 patients who received at least 1 BMS. We used 1.22 DES/patient vs. 1.26 BMS/patient (p=ns), treating 1.02 DES/lesion vs. 1.05 BMS/lesion (p=ns). Main outcome was ST defined by the Academic Research Consortium (ARC) as definite (acute, sub-acute, late), probable, and possible. Results: At 15 months we found 0.8% (4) patients in the DES group vs. 1.1% (5) patients in the BMS group with definite ST (ns); 0.4% (2) patients from each group had acute ST, while 0.4% (2) vs. 0.7% (3) patients had sub-acute ST (both comparisons were ns). None of the patients from the DES group died, whereas two patients with definite ST from the BMS group died, with a case fatality rate of 40% (2/5). 0.2% (1) patient from each group had probable ST (ns) and 0.6% (3) vs. 0.4% (2) patients had possible ST (ns). Independent predictors of stent thrombosis in merged groups were antiplatelet therapy discontinuation (HR 3.8; 95%CI 1.9-7.6; p<0.01), diabetes (HR 2.15; 95%CI 1.4-5.1; p<0.01), a lower left ventricular ejection fraction (EF) (HR 1.1; 95%CI 1.0-1.9; p<0.01 for each 10% decrease), and LAD lesions (HR 1.0; 95%CI, 0.93-1.9; P<0.01). Conclusions: ST is a rare complication (0.95%), similar after DES or BMS implantation. Premature discontinuation of antiplatelet therapy, followed by diabetes and a lower LVEF, are the independent predictors of ST

  15. Body Size Is a Significant Predictor of Congruency in Species Richness Patterns: A Meta-Analysis of Aquatic Studies

    PubMed Central

    Velghe, Katherine; Gregory-Eaves, Irene

    2013-01-01

    Biodiversity losses over the next century are predicted to result in alterations of ecosystem functions that are on par with other major drivers of global change. Given the seriousness of this issue, there is a need to effectively monitor global biodiversity. Because performing biodiversity censuses of all taxonomic groups is prohibitively costly, indicator groups have been studied to estimate the biodiversity of different taxonomic groups. Quantifying cross-taxon congruence is a method of evaluating the assumption that the diversity of one taxonomic group can be used to predict the diversity of another. To improve the predictive ability of cross-taxon congruence in aquatic ecosystems, we evaluated whether body size, measured as the ratio of average body length between organismal groups, is a significant predictor of their cross-taxon biodiversity congruence. To test this hypothesis, we searched the published literature and screened for studies that used species richness correlations as their metric of cross-taxon congruence. We extracted 96 correlation coefficients from 16 studies, which encompassed 784 inland water bodies. With these correlation coefficients, we conducted a categorical meta-analysis, grouping data based on the body size ratio of organisms. Our results showed that cross-taxon congruence is variable among sites and between different groups (r values ranging between −0.53 to 0.88). In addition, our quantitative meta-analysis demonstrated that organisms most similar in body size showed stronger species richness correlations than organisms which differed increasingly in size (radj2 = 0.94, p = 0.02). We propose that future studies applying biodiversity indicators in aquatic ecosystems consider functional traits such as body size, so as to increase their success at predicting the biodiversity of taxonomic groups where cost-effective conservation tools are needed. PMID:23468903

  16. Depression and Geographic Status as Predictors for Coronary Artery Bypass Surgery Outcomes

    ERIC Educational Resources Information Center

    Dao, Tam K.; Chu, Danny; Springer, Justin; Hiatt, Emily; Nguyen, Quang

    2010-01-01

    Purpose: To examine the relationships between depression, geographic status, and clinical outcomes following a coronary artery bypass grafting (CABG) surgery. Methods: Using the 2004 Nationwide Inpatient Sample database, we identified 63,061 discharge records of patients who underwent a primary CABG surgery (urban 57,247 and rural 5,814). We…

  17. Predictors of Short-Term Treatment Outcomes among California's Proposition 36 Participants

    ERIC Educational Resources Information Center

    Hser, Yih-Ing; Evans, Elizabeth; Teruya, Cheryl; Huang, David; Anglin, M. Douglas

    2007-01-01

    California's voter-initiated Proposition 36 offers non-violent drug offenders community-based treatment as an alternative to incarceration or probation without treatment. This article reports short-term treatment outcomes subsequent to this major shift in drug policy. Data are from 1104 individuals randomly selected from all Proposition 36…

  18. Attention across Modalities as a Longitudinal Predictor of Early Outcomes: The Case of Fragile X Syndrome

    ERIC Educational Resources Information Center

    Scerif, Gaia; Longhi, Elena; Cole, Victoria; Karmiloff-Smith, Annette; Cornish, Kim

    2012-01-01

    Background: Fragile X syndrome (FXS) is an early diagnosed monogenic disorder, associated with a striking pattern of cognitive/attentional difficulties and a high risk of poor behavioural outcomes. FXS therefore represents an ideal model disorder to study prospectively the impact of early attention deficits on behaviour. Methods: Thirty-seven boys…

  19. Predictors of Employment Outcomes for Vocational Rehabilitation Consumers With HIV/AIDS: 2002-2007

    ERIC Educational Resources Information Center

    Jung, Youngoh; Bellini, James L.

    2011-01-01

    This study examined the predictability of two employment outcomes--employment status and weekly earnings at closure--from consumer demographic, medical, and service variables for multiple groups of vocational rehabilitation (VR) consumers with HIV/AIDS retrieved from the RSA-911 data for fiscal years 2002 through 2007. A logistic regression…

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

    ERIC Educational Resources Information Center

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

    2008-01-01

    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…

  1. Predictors of Course Outcomes: Early Indicators of Delay in Online Classrooms

    ERIC Educational Resources Information Center

    McElroy, Barbara Woods; Lubich, Bruce H.

    2013-01-01

    Studies have long shown that students who begin or submit their work later tend to have negative academic outcomes. The measures of procrastination used in those studies may not have provided information timely enough for instructor intervention. This article focuses on delay in the online environment among graduate students. We propose two new…

  2. Contextual and Personal Predictors of Adaptive Outcomes under Terror Attack: The Case of Israeli Adolescents

    ERIC Educational Resources Information Center

    Zeidner, Moshe

    2005-01-01

    This paper explores individual differences in perceptions of political violence, strategies for coping with violence, and adaptive outcomes. Data on political violence stress, personal variables, coping strategies, and stress reactions were gathered on a sample of 227 Israeli adolescents in Haifa and Northern Israel confronted with a prolonged…

  3. Heterogeneity in Youth Symptom Trajectories Following Psychiatric Crisis: Predictors and Placement Outcome

    ERIC Educational Resources Information Center

    Halliday-Boykins, Colleen A.; Henggeler, Scott W.; Rowland, Melisa D.; DeLucia, Christian

    2004-01-01

    The authors examined heterogeneity in symptom trajectories among youths following psychiatric crises as well as the psychosocial correlates and placement outcomes associated with identified trajectories. Using semiparametric mixture modeling with 156 youths approved for psychiatric hospitalization, the authors identified 5 trajectories based on…

  4. Intensive Behavioral Treatment for Children with Autism: Four-Year Outcome and Predictors

    ERIC Educational Resources Information Center

    Sallows, Glen O.; Graupner, Tamlynn D.

    2005-01-01

    Twenty-four children with autism were randomly assigned to a clinic-directed group, replicating the parameters of the early intensive behavioral treatment developed at UCLA, or to a parent-directed group that received intensive hours but less supervision by equally well-trained supervisors. Outcome after 4 years of treatment, including cognitive,…

  5. System and Individual Outcomes and Their Predictors in Services and Support for People with IDD

    ERIC Educational Resources Information Center

    Ticha, Renata; Hewitt, Amy; Nord, Derek; Larson, Sherri

    2013-01-01

    The growth and advancement of community-based services for people with intellectual and developmental disabilities (IDD) have resulted in vast changes in the long-term services and support landscape as well as in expected outcomes of service systems for service recipients. Investments in IDD research have been made to provide a deeper…

  6. Managerial Behaviors and Work Group Climate as Predictors of Employee Outcomes.

    ERIC Educational Resources Information Center

    Church, Allan H.

    1995-01-01

    Presents an analysis of the predictive relationships of managerial behavior and work group climate on employee outcomes; 1,428 survey responses were collected during an organizational change in the marketing and sales division of an international pharmaceuticals company. Behaviors of managers and work group members were found to be significantly…

  7. Client Self-Disclosure as a Predictor of Short-Term Outcome in Brief Psychotherapy

    ERIC Educational Resources Information Center

    Sloan, Apryl E.; Kahn, Jeffrey H.

    2005-01-01

    College students differ in their tendencies to self-disclose personal information. The goal of this study was to determine how differing disclosure tendencies among university counseling center clients affect psychotherapy outcomes. Among 22 clients in brief psychotherapy, client tendencies to self-disclose personal information predicted how…

  8. Quality of relationships as predictors of outcomes in people with dementia: a systematic review protocol

    PubMed Central

    Savović, Jelena; Whiting, Penny; Leach, Verity; Richards, Alison; Cullum, Sarah; Cheston, Richard

    2016-01-01

    Introduction Serious adverse outcomes for people with dementia include institutionalisation, hospitalisation, death, development of behavioural and psychiatric symptoms, and reduced quality of life. The quality of the relationship between the person with dementia and their informal/family carer is thought to affect the risk of these outcomes. However, little is known about which aspects of relationship quality are important, or how they affect outcomes for people with dementia. Methods and analysis This will be a systematic review of the literature. Electronic databases MEDLINE, EMBASE, Web of Science, PsycInfo, the Cochrane Database, ALOIS and OpenGrey will be searched from inception. 2 independent reviewers will screen results for eligibility with standardised criteria. Data will be extracted for relevant studies, and information on the associations between relationship quality and dementia outcomes will be synthesised. Meta-analysis will be performed if possible to calculate pooled effect sizes. Narrative synthesis will be performed if study heterogeneity rules out meta-analysis. Ethics and dissemination Ethical review is not necessary as this review summarises data from previous studies. Results will be disseminated via peer-reviewed publication. Results will also be disseminated to a patient and public involvement group and an expert panel for their views on the findings and implications for future work. Trial registration number CRD42015020518. PMID:27044583

  9. Similarity of Outcome Predictors across Opiate, Cocaine, and Alcohol Treatments: Role of Treatment Services.

    ERIC Educational Resources Information Center

    McLellan, A. Thomas; And Others

    1994-01-01

    Outcomes were predicted by similar factors, regardless of drug problem or type of treatment. Greater substance use at follow-up was predicted by greater severity of use at admission, not number of services during treatment. Social adjustment was negatively predicted by more severe psychiatric problems at admission and positively predicted by more…

  10. Teacher (Mis)Perceptions of Preschoolers' Academic Skills: Predictors and Associations with Longitudinal Outcomes

    ERIC Educational Resources Information Center

    Baker, Courtney N.; Tichovolsky, Marianne H.; Kupersmidt, Janis B.; Voegler-Lee, Mary Ellen; Arnold, David H.

    2015-01-01

    Preschool teachers have important impacts on children's academic outcomes, and teachers' misperceptions of children's academic skills could have negative consequences, particularly for low-income preschoolers. This study utilized data gathered from 123 preschool teachers and their 760 preschoolers from 70 low-income, racially diverse centers.…

  11. Schools Engaged in School-Wide Reading Reform: An Examination of the School and Individual Student Predictors of Kindergarten Early Reading Outcomes

    ERIC Educational Resources Information Center

    Fien, Hank; Kame'enui, Edward J.; Good, Roland

    2009-01-01

    This study examined the school and student predictors of early reading outcomes for kindergarten students enrolled in schools that participated in a beginning reading reform program. The study employed a nested design with students nested within schools and applied hierarchical linear modeling analyses to account for the organizational structure…

  12. Outcomes in Young Women With Breast Cancer of Triple-Negative Phenotype: The Prognostic Significance of CK19 Expression

    SciTech Connect

    Parikh, Rahul R.; Yang Qifeng; Higgins, Susan A.; Haffty, Bruce G.

    2008-01-01

    Purpose: Basal-like carcinoma of the breast is associated with genetic instability and aggressive behavior. In this study, we evaluated the luminal cytokeratin marker CK-19 in young women with breast cancer treated with conservative surgery and radiation therapy (CS+RT). Methods: Primary tumor specimens from a cohort of 158 young premenopausal women (range, 25-49 years) treated with CS+RT with a median follow-up of 6.25 years were constructed into a tissue microarray. The array was stained for ER, PR, HER2, CK19, and p53. The molecular profiles were correlated with clinical-pathologic factors, overall, local, and distant relapse-free survival. The association between CK19, other co-variables, and outcome was assessed in a multivariate model. Results: Positive expression of ER, PR, HER-2/neu, CK19, and p53 were 33.1%, 34.5%, 10.0%, 79.5%, and 20.9%, respectively. With 20 local relapses and 38 distant metastases, the 10-year overall, breast relapse-free, and distant relapse-free survival were 79.65%, 87.29%, and 67.35%, respectively. Tumor stage and nodal status were associated with distant relapse-free and overall survival. In multivariate analysis, CK19 negativity was a predictor poor local (RR, 3.54; 95% CI, 1.87-7.65; p < 0.01) distant (RR, 1.44; 95% CI, 0.86-2.70; p = 0.17), and overall survival (RR, 1.89; 95% CI, 1.04-3.55; p = 0.03). Conclusions: Lack of CK19 expression identifies a subset of patients with a significantly higher risk of local relapse. Distant relapse and overall survival rates also correlated with CK19 negativity. Further evaluation of the prognostic significance of basal and luminal cytokeratins in young women with breast cancer is warranted.

  13. Surgical Outcome Predictor in Degenerative Lumbar Spinal Disease Based on Health Related Quality of Life Using Euro-Quality 5 Dimensions Analysis

    PubMed Central

    Lee, Byung Ho; Yang, Jae-Ho; Lee, Hwan-Mo; Park, Jun-Young; Park, Sang-Eun

    2016-01-01

    Purpose We aim to introduce the predictive value of a quantitatively described formula model in a multicenter prospective analysis using the EuroQol-5 dimensions (EQ-5D) health scale to anticipate postoperative improvement in patients with degenerative lumbar spine disease (DLSD). Materials and Methods Quality of life was evaluated in 376 patients from 17 tertiary hospitals before and after spinal decompression and fusion surgery. The five items of the EQ-5D, mobility (M), self-care (S), usual activities (A), pain/discomfort (P), and anxiety/depression (D), were checked as level 1, 2, or 3, with 3 being the worst. A minimal significant change in the calculated EQ-5D (cEQ-5D) was set as 0.05. Logistic regression analysis was performed to predict the highest successful outcome (cEQ-5D improvement after operation >0.05) with the given sets of 5 items of the EQ-5D. Results In the cEQ-5D analysis, among patients with a formula score of S+A+2×P+D≤8, 18/68 (27%) showed significant improvement in the cEQ-5D at 1 year postoperatively (p<0.05). However, in patients with a formula score of ≥9, 265/308 (86%) demonstrated significant improvements in the cEQ-5D at 1 year postoperatively (p<0.05). Conclusion We suggest that S+A+2×P+D≥9 in the EQ-5D can quantitatively describe the better surgical outcome predictors for DLSD. With a definite DLSD lesion confirmed by an imaging study, patients who meet the formula scores of 9 or over and have refractory symptoms to non-operative treatment could be better surgical candidates resulting in satisfactory surgical outcomes of over 86%, than those who scored 8 or lower. PMID:27401654

  14. Openness to Experience as a Predictor and Outcome of Upward Job Changes into Managerial and Professional Positions

    PubMed Central

    Nieß, Christiane; Zacher, Hannes

    2015-01-01

    In industrial and organizational psychology, there is a long tradition of studying personality as an antecedent of work outcomes. Recently, however, scholars have suggested that personality characteristics may not only predict, but also change due to certain work experiences, a notion that is depicted in the dynamic developmental model (DDM) of personality and work. Upward job changes are an important part of employees’ careers and career success in particular, and we argue that these career transitions can shape personality over time. In this study, we investigate the Big Five personality characteristics as both predictors and outcomes of upward job changes into managerial and professional positions. We tested our hypotheses by applying event history analyses and propensity score matching to a longitudinal dataset collected over five years from employees in Australia. Results indicated that participants’ openness to experience not only predicted, but that changes in openness to experience also followed from upward job changes into managerial and professional positions. Our findings thus provide support for a dynamic perspective on personality characteristics in the context of work and careers. PMID:26110527

  15. Openness to experience as a predictor and outcome of upward job changes into managerial and professional positions.

    PubMed

    Nieß, Christiane; Zacher, Hannes

    2015-01-01

    In industrial and organizational psychology, there is a long tradition of studying personality as an antecedent of work outcomes. Recently, however, scholars have suggested that personality characteristics may not only predict, but also change due to certain work experiences, a notion that is depicted in the dynamic developmental model (DDM) of personality and work. Upward job changes are an important part of employees' careers and career success in particular, and we argue that these career transitions can shape personality over time. In this study, we investigate the Big Five personality characteristics as both predictors and outcomes of upward job changes into managerial and professional positions. We tested our hypotheses by applying event history analyses and propensity score matching to a longitudinal dataset collected over five years from employees in Australia. Results indicated that participants' openness to experience not only predicted, but that changes in openness to experience also followed from upward job changes into managerial and professional positions. Our findings thus provide support for a dynamic perspective on personality characteristics in the context of work and careers. PMID:26110527

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

    PubMed Central

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

    1997-01-01

    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

  17. Why Can't We Bet on ISD Outcomes: ISD ``Form'' as a Predictor of Success

    NASA Astrophysics Data System (ADS)

    Newman, Mike; Pan, Shan L.; Pan, Gary

    The record of failure to deliver large-scale information systems (IS) in a timely fashion that offer value to major commercial and public organizations is legendary. Just looking to critical success factors such as top management support and user involvement in order to understand how to deliver better systems can at best be a partial solution. We seem to overlook an obvious area in our organizations: what can we learn from our information system development (ISD) historical patterns? In order to develop this idea we draw on parallels in sport where current performance and behaviour are believed to be closely linked to historical precedents, or “form”. In that domain, historical patterns are a fallible but valuable predictor of success. Our thesis is that past negative patterns in ISD will tend to repeat themselves without radical intervention. Put another way, failure begets failure. After examining the game of football as an allegory for ISD, we look briefly at two organizations that have experienced a pattern of failure in the IS area in the past but have transformed the way they build IS, moving from negative patterns to successful ones. This chapter ends with suggestions for managers charged with developing new IS as to how they might use their understanding of ISD “form” to improve their chances of success.

  18. Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors.

    PubMed

    Akiskal, H S; Walker, P; Puzantian, V R; King, D; Rosenthal, T L; Dranon, M

    1983-05-01

    Twenty percent of a cohort of 206 outpatient depressives with no past bipolar history switched during prospective observation. These 41 probands developed manic periods on the average of 6.4 years (median 4, range 1-25) after their first depressive episode. The change in polarity occurred throughout the life span, but was most common in adolescence and early adulthood. The following variables were found useful in predicting this outcome: onset less than or equal to 25 years, bipolar family history, loaded pedigrees, precipitation by childbirth, hypersomnic-retarded phenomenology, and pharmacologically-mobilized hypomania. Although the respective sensitivities of these findings were relatively low (32-71%), their specificities ranged from 69% to 100% for bipolar outcome; the diagnostic specificity of any 3 of these variables when combined was 98%. When compared with nonbipolar depression, bipolar disorder was seldom chronologically secondary to nonaffective psychiatric disorders. These findings suggest that many young depressives with lethargy and oversleeping are not manifesting a "neurotic" disorder, but rather a precursor of primary bipolar affective disorder. Finally, a psychotically depressed adolescent or young adult with positive bipolar family history should be observed for eventual bipolar outcome, especially when the clinical presentation is that of stupor. PMID:6222091

  19. Clinical Significance of the Prognostic Nutritional Index for Predicting Short- and Long-Term Surgical Outcomes After Gastrectomy: A Retrospective Analysis of 7781 Gastric Cancer Patients.

    PubMed

    Lee, Jee Youn; Kim, Hyoung-Il; Kim, You-Na; Hong, Jung Hwa; Alshomimi, Saeed; An, Ji Yeong; Cheong, Jae-Ho; Hyung, Woo Jin; Noh, Sung Hoon; Kim, Choong-Bai

    2016-05-01

    To evaluate the predictive and prognostic significance of the prognostic nutritional index (PNI) in a large cohort of gastric cancer patients who underwent gastrectomy.Assessing a patient's immune and nutritional status, PNI has been reported as a predictive marker for surgical outcomes in various types of cancer.We retrospectively reviewed data from a prospectively maintained database of 7781 gastric cancer patients who underwent gastrectomy from January 2001 to December 2010 at a single center. From this data, we analyzed clinicopathologic characteristics, PNI, and short- and long-term surgical outcomes for each patient. We used the PNI value for the 10th percentile (46.70) of the study cohort as a cut-off for dividing patients into low and high PNI groups.Regarding short-term outcomes, multivariate analysis showed a low PNI (odds ratio [OR] = 1.505, 95% CI = 1.212-1.869, P <0.001), old age, male sex, high body mass index, medical comorbidity, total gastrectomy, and combined resection to be independent predictors of postoperative complications. Among these, only low PNI (OR = 4.279, 95% CI = 1.760-10.404, P = 0.001) and medical comorbidity were independent predictors of postoperative mortality. For long-term outcomes, low PNI was a poor prognostic factor for overall survival, but not recurrence (overall survival: hazard ratio [HR] = 1.383, 95% CI = 1.221-1.568, P < 0.001; recurrence-free survival: HR = 1.142, 95% CI = 0.985-1.325, P = 0.078).PNI can be used to predict patients at increased risk of postoperative morbidity and mortality. Although PNI was an independent prognostic factor for overall survival, the index was not associated with cancer recurrence. PMID:27149460

  20. The Significance of Rectus Femoris for the Favorable Functional Outcome After Total Femur Replacement

    PubMed Central

    Nakayama, Takayuki; Shimoji, Takashi; Ae, Keisuke; Tanizawa, Taisuke; Gokita, Tabu

    2016-01-01

    Background: In treatment of tumors, we usually reconstruct after resection of the entire femur using only metallic modular endoprostheses among many procedures and defined it as a total femur replacement. We studied the interrelation between the preservation of rectus femoris and the functional outcome after total femur replacement. Methods: We rated the functional outcomes of 21 patients who underwent total femur replacement. We categorized the subjects into 2 groups: group A (rectus femoris preserved) and group B (rectus femoris unpreserved). We examined them based on the Mann-Whitney U test between the 2 groups in average through the Musculoskeletal Tumor Society functional scores. Results: The average score of group A was 20 of 25 (11–25; 80%), whereas the average score of group B was 10 of 25 (4–13; 40%). There was significant difference between the groups (P = 0.00168877). Conclusion: We found that the preservation of rectus femoris is imperative for achieving the favorable functional outcome in total femur replacement.

  1. Pre- and perioperative predictors of short-term clinical outcomes in patients undergoing percutaneous nephrolitholapaxy.

    PubMed

    Olbert, Peter J; Hegele, Axel; Schrader, Andres J; Scherag, André; Hofmann, Rainer

    2007-10-01

    Percutaneous nephrolitholapaxy (PCNL) with modern stone disintegration technologies is the treatment of choice for patients with extensive stone burden or stones refractory to extracorporeal shock wave lithotripsy. However, little is known about factors predicting unfavourable outcome in terms of perioperative complications, residual stone burden or prolonged hospitalization. The aim of this study was to evaluate preoperative, patient- and stone-related parameters that might influence the perioperative course and short-term clinical outcomes. In a prospective study, age, sex, body mass index (BMI), bidimensional size, side, pre-existent urinary tract infection, pre-existent hydronephrosis and previous kidney surgery were used as independent variables in both univariate and multiple regression models in 109 PCNL patients in order to predict the partition of patients rendered stone free at hospital discharge, duration of surgery, length of inpatient hospital stay and the occurrence of major complications. Univariate and multiple regression analysis revealed that stone size was the only factor influencing duration of surgery (P < 0.001) and hospitalization (P = 0.02), but had no predictive potential for major complications. Univariate analysis showed a trend towards longer inpatient hospital stay and clinically relevant residuals in patients with lower BMI (P = 0.05 and 0.06); however, after controlling for the other confounding variables, this was only reproducible for residual stone burden. The other patient- and stone-related factors did not adversely affect the outcome measures. In our patient sample treated with PCNL by LithoClast Master/Ultra we found evidence that large stone burden is a prognostic factor predicting longer surgery and prolonged hospitalization. In addition, patients with lower BMIs might be at higher risk of not being stone free at hospital discharge accompanied by prolonged inpatient treatment. PMID:17786419

  2. Soluble Adhesion Molecules in Patients Coinfected with HIV and HCV: A Predictor of Outcome

    PubMed Central

    Aldámiz-Echevarría, Teresa; Berenguer, Juan; Miralles, Pilar; Jiménez-Sousa, María A.; Carrero, Ana; Pineda-Tenor, Daniel; Díez, Cristina; Tejerina, Francisco; Pérez-Latorre, Leire; Bellón, José M.; Resino, Salvador

    2016-01-01

    Background Higher serum levels of adhesion molecules (sICAM-1 and sVCAM-1) are associated with advanced liver fibrosis in patients coinfected with human immunodeficiency virus and hepatitis C virus. We assessed the relationship between serum levels of adhesion molecules and liver-related events (LRE) or death, in coinfected patients. Methods We studied clinical characteristics and outcomes of 182 coinfected patients with a baseline liver biopsy (58 with advanced fibrosis) and simultaneous plasma samples who were followed for median of 9 years. We used receiver-operating characteristic (ROC) curves to calculate optimized cutoff values (OCV) of sICAM-1 and sVCAM-1, defined as the values with the highest combination of sensitivity and specificity for LRE. We used multivariate regression analysis to test the association between OCVs of sICAM-1 and sVCAM-1 and outcomes. The variables for adjustment were age, HIV transmission category, liver fibrosis, baseline CD4+ T-cell counts, antiretroviral therapy, and sustained virologic response (SVR). Results During the study period 51 patients had SVR, 19 had LRE, and 16 died. The OCVs for LRE were 5.68 Log pg/mL for sICAM-1 and 6.25 Log pg/mL for sVCAM-1, respectively. The adjusted subhazard ratio (aSHR) (95% confidence interval [CI]) of death or LRE, whichever occurred first, for sICAM-1 and sVCAM-1 > OCV were 3.98 ([1.14; 13.89], P = 0.030) and 2.81 ([1.10; 7.19], respectively (P = 0.030). Conclusions Serum levels of sICAM-1 and sVCAM-1 can serve as markers of outcome in HIV/HCV-coinfected patients. Therapies targeting necroinflammatory damage and fibrogenesis may have a role in the management chronic hepatitis C. PMID:26849641

  3. Heart rate recovery is an important predictor of outcomes in patients with connective tissue disease-associated pulmonary hypertension.

    PubMed

    Minai, Omar A; Nguyen, Quyen; Mummadi, Srinivas; Walker, Esteban; McCarthy, Kevin; Dweik, Raed A

    2015-09-01

    Reduced heart rate recovery (HRR) after exercise is associated with increased mortality in cardiac and pulmonary diseases. We sought to evaluate the association between HRR after the 6-minute walk test (6MWT) and outcomes in patients with connective tissue disease-associated pulmonary hypertension (CTD-PH). Data were obtained by review of the medical records. HRR was defined as the difference in heart rate at the end of the 6MWT and after 1 minute (HRR1), 2 minutes (HRR2), and 3 minutes (HRR3) of rest. All patients with pulmonary hypertension and a diagnosis of systemic sclerosis, systemic lupus erythematosus, or mixed connective tissue disease who underwent the 6MWT between August 1, 2009, and October 30, 2011, were included (n = 66). By Kaplan-Meier analysis, HRR1, HRR2, and HRR3 at different cutoff points were all good predictors, with HRR1 of <16 being the best predictor of time to clinical worsening (log-rank P < 0.0001), hospitalization (log-rank P = 0.0001), and survival (log-rank P < 0.003). By proportional hazards regression, patients with HRR1 of <16 were at increased risk of clinical worsening (hazard ratio [HR]: 6.4 [95% confidence interval (CI): 2.6-19.2]; P < 0.0001], hospitalization (HR: 6.6 [95% CI: 2.4-23]; P < 0.0001), and death (HR: 4.5 [95% CI: 1.6-15.7]; P = 0.003). Patients in the highest tercile (HRR1 of ≥19) were unlikely to have a clinical worsening event (HR: 0.1 [95% CI: 0.04-0.5]; P = 0.001], to be hospitalized (HR: 0.1 [95% CI: 0.02-0.5]; P = 0.001), or to die (HR: 0.3 [95% CI: 0.07-0.9]; P = 0.04]. In conclusion, in patients with CTD-PH, abnormal HRR1 (defined as HRR1 of <16) after the 6MWT is a strong predictor of clinical worsening, time to clinical worsening, survival, and hospitalization. PMID:26401258

  4. Primary Tumor Volume Is an Important Predictor of Clinical Outcomes Among Patients With Locally Advanced Squamous Cell Cancer of the Head and Neck Treated With Definitive Chemoradiotherapy

    SciTech Connect

    Strongin, Anna; Yovino, Susannah; Taylor, Rodney; Wolf, Jeffrey; Cullen, Kevin; Zimrin, Ann; Strome, Scott; Regine, William; Suntharalingam, Mohan

    2012-04-01

    Purpose: The tumor volume has been established as a significant predictor of outcomes among patients with head-and-neck cancer undergoing radiotherapy alone. The present study attempted to add to the existing data on tumor volume as a prognostic factor among patients undergoing chemoradiotherapy. Methods and Materials: A total of 78 patients who had undergone definitive chemoradiotherapy for Stage III-IV squamous cell cancer of the hypopharynx, oropharynx, and larynx were identified. The primary tumor volumes were calculated from the treatment planning computed tomography scans, and these were correlated to the survival and tumor control data obtained from the retrospective analysis. Results: The interval to progression correlated with the primary tumor volume (p = .007). The critical cutoff point for the tumor volume was identified as 35 cm{sup 3}, and patients with a tumor volume <35 cm{sup 3} had a significantly better prognosis than those with a tumor volume >35 cm{sup 3} at 5 years (43% vs. 71%, p = .010). Longer survival was also correlated with smaller primary tumor volumes (p = .022). Similarly, patients with a primary tumor volume <35 cm{sup 3} had a better prognosis in terms of both progression-free survival (61% vs. 33%, p = .004) and overall survival (84% vs. 41%, p = < .001). On multivariate analysis, the primary tumor volume was the best predictor of recurrence (hazard ratio 4.7, 95% confidence interval 1.9-11.6; p = .001) and survival (hazard ratio 10.0, 95% confidence interval 2.9-35.1; p = < .001). In contrast, the T stage and N stage were not significant factors. Analysis of variance revealed that tumors with locoregional failure were on average 21.6 cm{sup 3} larger than tumors without locoregional failure (p = .028) and 27.1-cm{sup 3} larger than tumors that recurred as distant metastases (p = .020). Conclusion: The results of our study have shown that the primary tumor volume is a significant prognostic factor in patients with advanced cancer

  5. Predictors and outcomes of posttraumatic stress disorder in World War II veterans exposed to mustard gas.

    PubMed

    Schnurr, P P; Ford, J D; Friedman, M J; Green, B L; Dain, B J; Sengupta, A

    2000-04-01

    Current posttraumatic stress disorder (PTSD) associated with participation in secret military tests of mustard gas during World War II was assessed in 363 male military veterans who were randomly sampled from a registry developed by the Department of Veterans Affairs. Current prevalence was 32% for full PTSD and 10% for partial PTSD. Prevalence of PTSD varied as a function of risk and protective factors, including volunteering, physical symptoms during the tests, and prohibited disclosure. Prediction of partial PTSD was weaker than prediction of full PTSD. Veterans with full PTSD reported poorer physical health, a higher likelihood of several chronic illnesses and health-related disability, greater functional impairment, and higher likelihood of health care use than those with no PTSD. Veterans with partial PTSD also had poorer outcomes than did veterans with no PTSD in a subset of these domains. There is discussion of the traumatic elements of experimental mustard gas exposure, vulnerability to PTSD, and the relevance of these findings to understanding the broad range of outcomes associated with PTSD. PMID:10780126

  6. Regional White Matter Development in Very Preterm Infants: Perinatal Predictors and Early Developmental Outcomes

    PubMed Central

    Rogers, Cynthia E.; Smyser, Tara; Smyser, Christopher D.; Shimony, Joshua; Inder, Terrie E.; Neil, Jeffrey J.

    2015-01-01

    Background Preterm infants are at risk for white matter injury and adverse neurodevelopmental outcomes. Methods Serial diffusion tensor MRI data were obtained from very preterm infants (N=78) born <30 weeks gestation imaged up to four times from 26-42 weeks postmenstrual age. Slopes were calculated for fractional anisotropy (FA) and mean diffusivity (MD) within regions of interest for infants with ≥2 scans (N=50). Sixty-five children underwent neurodevelopmental testing at age two years. Results FA slope for the posterior limb of the internal capsule was greater than other regions. The anterior limb of the internal capsule (ALIC), corpus callosum and optic radiations demonstrated greater FA slope with increasing gestational age. Infants with PDA had lower FA slope in the ALIC. MD slope was lower with prolonged ventilation or lack of antenatal steroids. At age 2 years, lower motor scores were associated with lower FA in the left but higher FA in the right inferior temporal lobe at term-equivalent. Better social-emotional competence was related to lower FA in the left cingulum bundle. Conclusion This study demonstrates regional variability in the susceptibility/sensitivity of white matter maturation to perinatal factors and relationships between altered diffusion measures and developmental outcomes in preterm neonates. PMID:26372513

  7. The role of PET/CT as a prognosticator and outcome predictor in lung cancer.

    PubMed

    Khiewvan, Benjapa; Ziai, Pouya; Houshmand, Sina; Salavati, Ali; Ziai, Peyman; Alavi, Abass

    2016-03-01

    Positron emission tomography/computed tomography (PET/CT) is an important imaging tool for management of lung cancer and can be utilized in diagnosis, staging, restaging, treatment planning and evaluating treatment response. In the past decade PET/CT has proven to be beneficial for the prediction of prognosis and outcome. PET findings before and after treatment, the quantitative PET parameters such as standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) as well as delayed PET/CT imaging can be used to determine patient prognosis and outcome. Other tracers such as hypoxia and proliferation marker tracers may be used for prognostication. The prognostic factors derived from PET/CT imaging help early development of risk-adapted treatment strategies, which provides cost-effective treatment and leads to improved patient management. Here, we discuss findings of studies related to application of PET/CT in lung cancer as well as some technical updates on quantitative PET/CT in lung cancer. PMID:26822467

  8. HYPERGLYCOSYLATED HUMAN CHORIONIC GONADOTROPIN AS AN EARLY PREDICTOR OF PREGNANCY OUTCOMES AFTER IN VITRO FERTILIZATION

    PubMed Central

    Chuan, Sandy; Homer, Michael; Pandian, Raj; Conway, Deirdre; Garzo, Gabriel; Yeo, Lisa; Su, H. Irene

    2014-01-01

    Objective To determine if hyperglycosylated hCG (hhCG), produced by invasive trophoblasts, measured as early as 9 days after egg retrieval can predict ongoing pregnancies (OP) after in vitro fertilization and fresh embryo transfer (IVF-ET). Design Cohort Setting Academic ART center Patients Consecutive patients undergoing IVF-ET Interventions Serum hhCG and hCG levels measured 9 (D9) and 16 (D16) days after egg retrieval Outcome Ongoing pregnancy (OP) beyond 9 weeks of gestation Results OP (62 of 112 participants) was associated with higher D9 levels of hhCG and hCG However, hhCG was detectable in all D9 OP samples, while hCG was detectable in only 22%. D9 hhCG levels >110 pg/mL was 96% specific for OP, yielding a positive predictive value of 95%. Compared to D9 hCG levels, hhCG was more sensitive and had a larger area under the curve (0.87 vs. 0.67). Diagnostic test characteristics were similar between D16 hhCG and hCG levels. Conclusions In patients undergoing assisted reproduction, a test to detect pregnancy early and predict outcomes is highly desirable. HhCG is detectable in serum 9 days after egg retrieval IVF-ET cycles. At this early assessment, hhCG is superior to traditional hCG and highly predictive of ongoing pregnancies. PMID:24355054

  9. Evaluating predictors of competing risk outcomes when censoring depends on time-dependent covariates, with application to safety and efficacy of HIV treatment.

    PubMed

    Lok, Judith J; Hughes, Michael D

    2016-06-15

    We propose a prediction model for the cumulative incidence functions of competing risks, based on a logit link. Because of a concern about censoring potentially depending on time-varying covariates in our motivating human immunodeficiency virus (HIV) application, we describe an approach for estimating the parameters in the prediction models using inverse probability of censoring weighting under a missingness at random assumption. We then illustrate the application of this methodology to identify predictors of the competing outcomes of virologic failure, an efficacy outcome, and treatment limiting adverse event, a safety outcome, among human immunodeficiency virus-infected patients first starting antiretroviral treatment. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26763556

  10. Community-Based Accompaniment Mitigates Predictors of Negative Outcomes for Adults on Antiretroviral Therapy in Rural Rwanda.

    PubMed

    Gupta, Neil; Munyaburanga, Christian; Mutagoma, Mwumvaneza; Niyigena, John W; Kayigamba, Felix; Franke, Molly F; Hedt-Gauthier, Bethany

    2016-05-01

    Clinical, socioeconomic, and access barriers remain a critical problem to antiretroviral (ART) programs in sub-Saharan Africa. Community-based accompaniment (CBA), including daily home visits and psychosocial and socioeconomic support, has been associated with improved patient outcomes at 1 year. We conducted a prospective observational cohort study of 578 HIV-infected adults initiating ART in 2007-2008 with or without CBA in rural Rwanda. Among patients without CBA, those with advanced HIV disease, low CD4 cell counts, lower social support, and transport costs had significantly higher odds of negative outcomes at 1 year; amongst patients who received CBA, only those with low CD4 cell counts had significantly higher odds of negative outcomes at 1 year. CBA also significantly mitigated the effect of transport costs and inaccessibility of services on the likelihood of negative outcome. CBA may be one approach to mitigating known risk factors for negative outcomes for patients on ART in resource-poor settings. PMID:26346334

  11. Factors influencing the outcome of intrauterine insemination (IUI): age, clinical variables and significant thresholds.

    PubMed

    Speyer, B E; Abramov, B; Saab, W; Doshi, A; Sarna, U; Harper, J C; Serhal, P

    2013-10-01

    The aim was to investigate the influence of various biological factors upon the outcome of intrauterine insemination (IUI). The total IUI history (856 cycles) of 352 couples was studied. Live-birth showed a strong negative correlation with female age but no correlation with male age. Antimüllerian hormone (AMH) and antral follicle count (AFC) correlated negatively with female age, and follicle stimulating hormone (FSH) correlated positively. Significant thresholds were found for all three variables, and also for total motile count (TMC) in the prepared sperm. Calculating pregnancy losses per positive pregnancy showed a strong correlation with increasing female age. This was highly significant for biochemical losses but not for fetal heart miscarriages. Male age had no effect on rate of pregnancy loss. In conclusion, female age, FSH, AMH and TMC are good predictive factors for live-birth and therefore relate to essential in vivo steps in the reproductive process. PMID:24127958

  12. Predictors of Adverse Cosmetic Outcome in the RAPID Trial: An Exploratory Analysis

    SciTech Connect

    Peterson, David; Truong, Pauline T.; Parpia, Sameer; Olivotto, Ivo A.; Berrang, Tanya; Kim, Do-Hoon; Kong, Iwa; Germain, Isabelle; Nichol, Alan; Akra, Mohamed; Roy, Isabelle; Reed, Melanie; Fyles, Anthony; Trotter, Theresa; Perera, Francisco; Balkwill, Susan; Lavertu, Sophie; Elliott, Elizabeth; and others

    2015-04-01

    Purpose: To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation (APBI) using 3-dimensional conformal radiation therapy or whole-breast irradiation in the RAPID (Randomized Trial of Accelerated Partial Breast Irradiation) trial. Methods and Materials: Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at 3 years. Adverse cosmesis was defined as a score of fair or poor. Cosmetic deterioration was defined as any adverse change in score from baseline to 3 years. The analysis is based on data from the previously reported interim analysis. Logistic regression models were used to assess the association of risk factors for these outcomes among all patients and those treated with APBI only. Results: Clinicopathologic characteristics were similar between subjects randomized to APBI (n=569) or whole-breast irradiation (n=539). For all subjects, factors associated with adverse cosmesis at 3 years were older age, central/inner tumor location, breast infection, smoking, seroma volume, breast volume, and use of APBI; factors associated with cosmetic deterioration were smoking, seroma volume, and use of APBI (P<.05). For APBI subjects, tumor location, smoking, age, and seroma volume were associated with adverse cosmesis (P<.05), and smoking was associated with cosmetic deterioration (P=.02). An independent association between the V95/whole-breast volume ratio and adverse cosmesis (P=.28) or cosmetic deterioration (P=.07) was not detected. On further exploration a V95/whole-breast volume ratio <0.15 was associated with a lower risk of cosmetic deterioration (p=.04), but this accounted for only 11% of patients. Conclusion: In the RAPID trial, a number of patient tumor and treatment-related factors, including the use of APBI, were associated with adverse cosmesis and cosmetic deterioration. For patients treated with APBI alone, the high-dose treatment

  13. Predictors of fatal outcomes resulting from acute Escherichia coli mastitis in dairy cows.

    PubMed

    Hagiwara, Seiichi; Mori, Kouichiro; Nagahata, Hajime

    2016-06-01

    To evaluate the prognostic criteria for identifying cows at an increased risk of a fatal outcome from acute Escherichia coli mastitis, the potential cut-off values for five diagnostic parameters associated with a high mortality were determined by receiver operator characteristic curve analysis. These criteria were hematocrit value >32%, blood non-esterified fatty acid concentration >0.4 mEq/l, antithrombin activity <120%, platelet count <15 × 10(4)/ml and presence of dysstasia. Exceeding the cut-off values for at least three parameters on day 2 after onset predicted fatality (predictive value 87.5). When these prognostic criteria were applied to 34 clinical cases, cows that met three criteria were seven times more likely to die than cows that met fewer than three criteria. PMID:26875836

  14. Predictors of fatal outcomes resulting from acute Escherichia coli mastitis in dairy cows

    PubMed Central

    HAGIWARA, Seiichi; MORI, Kouichiro; NAGAHATA, Hajime

    2016-01-01

    To evaluate the prognostic criteria for identifying cows at an increased risk of a fatal outcome from acute Escherichia coli mastitis, the potential cut-off values for five diagnostic parameters associated with a high mortality were determined by receiver operator characteristic curve analysis. These criteria were hematocrit value >32%, blood non-esterified fatty acid concentration >0.4 mEq/l, antithrombin activity <120%, platelet count <15 × 104/ml and presence of dysstasia. Exceeding the cut-off values for at least three parameters on day 2 after onset predicted fatality (predictive value 87.5). When these prognostic criteria were applied to 34 clinical cases, cows that met three criteria were seven times more likely to die than cows that met fewer than three criteria. PMID:26875836

  15. Predictors for Clinical Outcomes After Accelerated Partial Breast Intensity-Modulated Radiotherapy

    SciTech Connect

    Reeder, Reed; Carter, Dennis L. Howell, Kathryn; Henkenberns, Phyllis; Tallhamer, Michael; Johnson, Tim; Kercher, Jane; Widner, Jodi; Kaske, Terese; Paul, Devchand; Sedlacek, Scot; Leonard, Charles E.

    2009-05-01

    Purpose: To correlate the treatment planning parameters with the clinical outcomes in patients treated with accelerated partial breast intensity-modulated radiotherapy. Methods and Materials: A total of 105 patients with Stage I breast cancer were treated between February 2004 and March 2007 in a Phase II prospective trial and had detailed information available on the planning target volume (PTV), ipsilateral breast volume (IBV), PTV/IBV ratio, lung volume, chest wall volume, surgery to radiotherapy interval, follow-up interval, breast pain, and cosmesis. The first 7 of these patients were treated to 34 Gy, and the remaining 98 were treated to 38.5 Gy. All patients were treated twice daily for 5 consecutive days. Univariate and multivariate analyses were performed. Results: The median follow-up was 13 months. No recurrences or deaths were observed. Of the 105 patients, 30 reported mild or moderate breast pain in their most recently recorded follow-up visit. The irradiated lung volume (p < 0.05) and chest wall volume receiving >35 Gy (p < 0.01) were associated with pain. The PTV, but not the PTV/IBV ratio, also correlated with pain (p < 0.01 and p = 0.42, respectively). A total of 72 patients reported excellent, 32 reported good, and 1 reported poor cosmesis. Physician-rated cosmesis reported 90 excellent and 15 good. None of the tested variables correlated with the cosmetic outcomes. Conclusion: Radiotherapy to the chest wall (chest wall volume receiving >35 Gy) and to lung correlated with reports of mild pain after accelerated partial breast intensity-modulated radiotherapy. Also, the PTV, but not the PTV/IBV ratio, was predictive of post-treatment reports of pain.

  16. Predictors and Outcomes of Early vs. Later English Language Proficiency Among English Language Learners.

    PubMed

    Halle, Tamara; Hair, Elizabeth; Wandner, Laura; McNamara, Michelle; Chien, Nina

    2012-01-01

    The development of English language learners (ELLs) was explored from kindergarten through eighth grade within a nationally representative sample of first-time kindergartners (N = 19,890). Growth curve analyses indicated that, compared to native English speakers, ELLs were rated by teachers more favorably on approaches to learning, self control, and externalizing behaviors in kindergarten and generally continued to grow in a positive direction on these social/behavioral outcomes at a steeper rate compared to their native English-speaking peers, holding other factors constant. Differences in reading and math achievement between ELLs and native English speakers varied based on the grade at which English proficiency is attained. Specifically, ELLs who were proficient in English by kindergarten entry kept pace with native English speakers in both reading and math initially and over time; ELLs who were proficient by first grade had modest gaps in reading and math achievement compared to native English speakers that closed narrowly or persisted over time; and ELLs who were not proficient by first grade had the largest initial gaps in reading and math achievement compared to native speakers but the gap narrowed over time in reading and grew over time in math. Among those whose home language is not English, acquiring English proficiency by kindergarten entry was associated with better cognitive and behavioral outcomes through eighth grade compared to taking longer to achieve proficiency. Multinomial regression analyses indicated that child, family, and school characteristics predict achieving English proficiency by kindergarten entry compared to achieving proficiency later. Results are discussed in terms of policies and practices that can support ELL children's growth and development. PMID:22389551

  17. Predictors and Outcomes of Early vs. Later English Language Proficiency Among English Language Learners

    PubMed Central

    Halle, Tamara; Hair, Elizabeth; Wandner, Laura; McNamara, Michelle; Chien, Nina

    2011-01-01

    The development of English language learners (ELLs) was explored from kindergarten through eighth grade within a nationally representative sample of first-time kindergartners (N = 19,890). Growth curve analyses indicated that, compared to native English speakers, ELLs were rated by teachers more favorably on approaches to learning, self control, and externalizing behaviors in kindergarten and generally continued to grow in a positive direction on these social/behavioral outcomes at a steeper rate compared to their native English-speaking peers, holding other factors constant. Differences in reading and math achievement between ELLs and native English speakers varied based on the grade at which English proficiency is attained. Specifically, ELLs who were proficient in English by kindergarten entry kept pace with native English speakers in both reading and math initially and over time; ELLs who were proficient by first grade had modest gaps in reading and math achievement compared to native English speakers that closed narrowly or persisted over time; and ELLs who were not proficient by first grade had the largest initial gaps in reading and math achievement compared to native speakers but the gap narrowed over time in reading and grew over time in math. Among those whose home language is not English, acquiring English proficiency by kindergarten entry was associated with better cognitive and behavioral outcomes through eighth grade compared to taking longer to achieve proficiency. Multinomial regression analyses indicated that child, family, and school characteristics predict achieving English proficiency by kindergarten entry compared to achieving proficiency later. Results are discussed in terms of policies and practices that can support ELL children’s growth and development. PMID:22389551

  18. Impact of testicular histopathology as a predictor of sperm retrieval and pregnancy outcome in patients with nonobstructive azoospermia: correlation with clinical and hormonal factors.

    PubMed

    Guler, I; Erdem, M; Erdem, A; Demirdağ, E; Tunc, L; Bozkurt, N; Mutlu, M F; Oktem, M

    2016-09-01

    In this study, our objective was to evaluate the impact of testicular histopathology on the outcome of intracytoplasmic sperm injection (ICSI) cycles of patients with nonobstructive azoospermia and correlate with clinical and hormonal parameters. For this purpose, 271 patients with nonobstructive azospermia (NOA) who underwent testicular sperm extraction (TESE) for ICSI cycles were retrospectively evaluated for sperm retrieval, fertilisation, embryo cleavage, clinical pregnancy and live birth rates among different testicular histology groups. We also correlated hormonal and clinical factors with histological findings. Sperm retrieval and fertilisation rates (FR) were found to be significantly different among all testicular histological groups of NOA except for embryo cleavage, clinical pregnancy and live birth rates. Furthermore, serum follicle stimulating hormone (FSH) level was the most significant variable to predict sperm recovery on TESE. Separate analyses within each testicular histological group revealed that higher FSH was also associated with lower pregnancy rates in only maturation arrest group. In conclusion, testicular histology significantly influences sperm retrieval and FRs but not pregnancy and live birth rates in nonobstructive azoospermia. However, FSH is the best predictor of a successful TESE. PMID:26688565

  19. Clinical relevance vs. statistical significance: Using neck outcomes in patients with temporomandibular disorders as an example.

    PubMed

    Armijo-Olivo, Susan; Warren, Sharon; Fuentes, Jorge; Magee, David J

    2011-12-01

    Statistical significance has been used extensively to evaluate the results of research studies. Nevertheless, it offers only limited information to clinicians. The assessment of clinical relevance can facilitate the interpretation of the research results into clinical practice. The objective of this study was to explore different methods to evaluate the clinical relevance of the results using a cross-sectional study as an example comparing different neck outcomes between subjects with temporomandibular disorders and healthy controls. Subjects were compared for head and cervical posture, maximal cervical muscle strength, endurance of the cervical flexor and extensor muscles, and electromyographic activity of the cervical flexor muscles during the CranioCervical Flexion Test (CCFT). The evaluation of clinical relevance of the results was performed based on the effect size (ES), minimal important difference (MID), and clinical judgement. The results of this study show that it is possible to have statistical significance without having clinical relevance, to have both statistical significance and clinical relevance, to have clinical relevance without having statistical significance, or to have neither statistical significance nor clinical relevance. The evaluation of clinical relevance in clinical research is crucial to simplify the transfer of knowledge from research into practice. Clinical researchers should present the clinical relevance of their results. PMID:21658987

  20. Campus Environment and Student Involvement as Predictors of Outcomes of the Community College Experience. ASHE Annual Meeting Paper.

    ERIC Educational Resources Information Center

    Glover, Jeanette W.

    Student effort, the campus environment, and student age and full- or part-time status have significant effects on outcomes for university students. This study employed the same three sets of independent variables to predict gains in general education and in personal and social development for community college students. The study analyzed data…

  1. Predictors of Longitudinal Outcomes after Unstable Response to Acute Phase Cognitive Therapy for Major Depressive Disorder

    PubMed Central

    Vittengl, Jeffrey R.; Clark, Lee Anna; Thase, Michael E.; Jarrett, Robin B.

    2015-01-01

    After patients with major depressive disorder (MDD) respond to acute-phase cognitive therapy (CT), continuation-phase treatments may be applied to improve long-term outcomes. We clarified which CT responders experience remission, recovery, relapse, and recurrence by testing baseline demographic, clinical, and personality variables. The sample of CT responders at higher risk of relapse (N = 241) was randomized to 8 months of continuation-phase CT (C-CT), double-blinded fluoxetine or pill placebo, and followed 24 months (Jarrett & Thase, 2010). Patients with lower positive emotionality and behavioral activation at the end of acute-phase CT showed increased risk for relapse/recurrence of MDD. In addition, patients with lower positive emotionality and behavioral activation, as well as higher residual depression (including emotional, cognitive, and social facets), showed decreased probability of remission (≥6 continuous weeks of minimal or absent symptoms) after acute-phase CT. Finally, patients with greater residual depression, as well as younger age and earlier MDD onset, showed decreased probability of recovery (≥35 continuous weeks of minimal or absent symptoms) after acute-phase CT. Moderator analyses did not reveal differential prediction across the continuation phase treatment arms. These results may help clinicians gauge the prognoses and need for continuation treatment among MDD patients who respond to acute-phase CT. PMID:25985046

  2. Perioperative Predictors of Extubation Failure and the Effect on Clinical Outcome After Infratentorial Craniotomy.

    PubMed

    Cai, Ye-Hua; Wang, Hai-Tang; Zhou, Jian-Xin

    2016-01-01

    BACKGROUND The purpose of the study was to analyze the risk factors for failed extubation in subjects submitted to infratentorial craniotomy. MATERIAL AND METHODS Patients aged over 18 years who received infratentorial craniotomy for brain tumor resection were consecutively included in this study. Perioperative variables were collected and analyzed. Univariate analyses and multiple logistic regression were used to derive factors related to failed extubation. Patients had follow-up care until either out of hospital or death. RESULTS Throughout the course of the study, 2118 patients were eligible and 94 (4.4%) suffered from extubation failure at some point during their hospital stay. Five factors were recognized as independent risk factors for postoperative failed extubation: craniotomy history, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in blood pressure (BP) during the operation. Failed extubation was related to a higher incidence rate of pneumonia, mortality, unfavorable Glasgow Outcome Scale score, longer stay in the neuro-intensive care unit (ICU) and hospitalization, and higher hospitalization costs compared with successful extubation. CONCLUSIONS History of craniotomy, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in BP during the operation were independent risk factors related to postoperative failed extubation in patients submitted to infratentorial craniotomy. Extubation failure raises the incidences of postoperative pneumonia, mortality, and higher hospitalization costs, and prolongs neuro-ICU and postoperative length of stay. PMID:27404044

  3. Perioperative Predictors of Extubation Failure and the Effect on Clinical Outcome After Infratentorial Craniotomy

    PubMed Central

    Cai, Ye-Hua; Wang, Hai-Tang; Zhou, Jian-Xin

    2016-01-01

    Background The purpose of the study was to analyze the risk factors for failed extubation in subjects submitted to infratentorial craniotomy. Material/Methods Patients aged over 18 years who received infratentorial craniotomy for brain tumor resection were consecutively included in this study. Perioperative variables were collected and analyzed. Univariate analyses and multiple logistic regression were used to derive factors related to failed extubation. Patients had follow-up care until either out of hospital or death. Results Throughout the course of the study, 2118 patients were eligible and 94 (4.4%) suffered from extubation failure at some point during their hospital stay. Five factors were recognized as independent risk factors for postoperative failed extubation: craniotomy history, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in blood pressure (BP) during the operation. Failed extubation was related to a higher incidence rate of pneumonia, mortality, unfavorable Glasgow Outcome Scale score, longer stay in the neuro-intensive care unit (ICU) and hospitalization, and higher hospitalization costs compared with successful extubation. Conclusions History of craniotomy, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in BP during the operation were independent risk factors related to postoperative failed extubation in patients submitted to infratentorial craniotomy. Extubation failure raises the incidences of postoperative pneumonia, mortality, and higher hospitalization costs, and prolongs neuro-ICU and postoperative length of stay. PMID:27404044

  4. Practice Guidelines for the Assessment of Clinically Significant Treatment Outcomes in the Children's Mental Health System.

    PubMed

    Chomycz, Suzanne; Schmidt, Fred

    2016-01-01

    The use of program evaluation to monitor client change and improve intervention effectiveness is gaining increasing importance in the mental health field. However, there is a lack of literature available in community-based clinics for those who desire to evaluate the effectiveness of services. Through this article the authors review the literature on the best methods to assess clinically significant treatment outcomes in community-based children's mental health services. The strengths and weaknesses of commonly recommended methods of evaluating change are discussed (i.e., reliable change index, percentage of improvement, normative comparisons, and effect size) using a dataset from a community-based parenting program (N = 308). PMID:26086975

  5. Computational enzyme design approaches with significant biological outcomes: progress and challenges

    PubMed Central

    Li, Xiaoman; Zhang, Ziding; Song, Jiangning

    2012-01-01

    Enzymes are powerful biocatalysts, however, so far there is still a large gap between the number of enzyme-based practical applications and that of naturally occurring enzymes. Multiple experimental approaches have been applied to generate nearly all possible mutations of target enzymes, allowing the identification of desirable variants with improved properties to meet the practical needs. Meanwhile, an increasing number of computational methods have been developed to assist in the modification of enzymes during the past few decades. With the development of bioinformatic algorithms, computational approaches are now able to provide more precise guidance for enzyme engineering and make it more efficient and less laborious. In this review, we summarize the recent advances of method development with significant biological outcomes to provide important insights into successful computational protein designs. We also discuss the limitations and challenges of existing methods and the future directions that should improve them. PMID:24688648

  6. KIF14 mRNA expression is a predictor of grade and outcome in breast cancer.

    PubMed

    Corson, Timothy W; Gallie, Brenda L

    2006-09-01

    Gain of chromosome 1q is a hallmark of breast cancer, and likely reflects oncogene amplification. We previously identified mitotic kinesin KIF14 (kinesin family member 14) as an overexpressed candidate oncogene in the 1q31.3-1q32.1 minimal region of genomic gain in breast cancer cell lines. KIF14 also showed high expression in other cancers, notably an association with survival in lung tumors. We now report KIF14 expression in 99 primary breast tumors and 10 normal breast controls. Measured by real-time RT-PCR, KIF14 was overexpressed 10-fold on average in tumors relative to normals (t test p = 0.000054); expression increased with grade (ANOVA p = 0.000006). Infiltrating ductal carcinomas had higher KIF14 levels than lobular (p = 0.017), and estrogen receptor (ER) negative tumors had higher KIF14 levels than ER positive tumors (t test p = 0.030). KIF14 expression correlated positively with Ki-67 mRNA level (Spearman r = 0.692, p = 0.000001), fraction of positive nodes (r = 0.227, p = 0.024) and percent invasive cells (r = 0.360, p = 0.0002), and negatively with percent fatty stroma (r = -0.258, p = 0.010) and percent normal epithelium (r = -0.291, p = 0.003). KIF14 expression is thus tumor-specific and increased in more aggressive tumors. Indeed, KIF14 expression predicted overall survival (univariate Cox p = 0.010), with an odds ratio of 3.60 (1.37-9.48), in 50 tumors with available outcome data. KIF14 overexpression also predicted decreased disease-free survival (log-rank p = 0.049). These findings are the first evidence of association between expression of a mitotic kinesin and prognostic variables in breast cancer. PMID:16570270

  7. Predictors and outcomes of increases in creatine phosphokinase concentrations or rhabdomyolysis risk during statin treatment

    PubMed Central

    van Staa, Tjeerd P; Carr, Daniel F; O’Meara, Helen; McCann, Gerry; Pirmohamed, Munir

    2014-01-01

    Aim The aim was to evaluate clinical risk factors associated with myotoxicity in statin users. Methods This was a cohort study of patients prescribed a statin in UK primary care practices contributing to the Clinical Practice Research Datalink. Outcomes of interest were creatine phosphokinase (CPK) concentrations and clinical records of rhabdomyolysis. Results The cohort comprised 641 703 statin users. Simvastatin was most frequently prescribed (66.3%), followed by atorvastatin (24.4%). CPK was measured in 127 209 patients: 81.4% within normal range and 0.7% above four times ULN CPK compared with normal CPK (OR 1.28, 95% CI 1.01, 1.60). Rosuvastatin users had higher risk of >four times ULN CPK (OR 1.62, 95% CI 1.22, 2.15) as did patients with larger daily doses of other statin types. A recent clinical record of myalgia was associated with an increased OR of >four times ULN CPK (OR 1.73, 95% CI 1.37, 2.18). In patients who were rechallenged to statins and had repeat CPK measurements after >four times ULN CPK abnormalities, 54.8% of the repeat CPK values were within normal range, 32.1% between one to three times and 13.0% >four times ULN. Conclusions The frequencies of substantive CPK increases and rhabdomyolysis during statin treatment were low, with highest risks seen in those on large daily doses or interacting drugs and on rosuvastatin. CPK measurements appeared to have been done in a haphazard manner and better guidance is needed. PMID:24602118

  8. Predictors of student outcomes on perceived knowledge and competence of genetic family history risk assessment.

    PubMed

    Collins, Cathleen A; Stiles, Anne S

    2011-01-01

    The publication of the human genome project has launched a number of discoveries set to change the landscape of healthcare. Unfortunately, nursing faculty across the United States report they are unprepared to teach students who will be practicing in the genomic era. The purpose of this study, utilizing Rogers' (2003) Diffusion of Innovation theory as a framework, was to determine the degree to which nursing school characteristics predict graduating undergraduate nursing students' perceived knowledge and competence of genetic family history risk assessment. School characteristics included school size, proximity to a large city, faculty's perceived barriers to diffusion of genomics into nursing practice, faculty innovativeness, faculty who have attended a genetics program for nursing faculty, and the integration of genomics into the curriculum. Faculty and students from 103 nursing schools across the United States participated in the study by completing online surveys. Hierarchical multiple regression was employed to determine how well the independent variables predicted student perceived knowledge and student perceived competence. No combination of the independent variables in this study predicted student knowledge or competence to the degree expected. This could be attributed to a lack of diffusion of genomics content across nursing curricula, based on Rogers' (2003) theory. Other findings included faculty continue to believe they are not competent to teach genomics, and the curriculum is too dense to include more content. However, contrary to prior research, faculty did believe genomics was valuable. The findings of this study give direction for further research into student outcomes and curriculum evaluation after 2011, when a consensus panel working to diffuse genomics into nursing curriculum and practice will have implemented their strategic plan for this diffusion. PMID:21420042

  9. Upper gastrointestinal bleeding in Scotland 2000-2010: Improved outcomes but a significant weekend effect

    PubMed Central

    Ahmed, Asma; Armstrong, Matthew; Robertson, Ishbel; Morris, Allan John; Blatchford, Oliver; Stanley, Adrian J

    2015-01-01

    AIM: To assess numbers and case fatality of patients with upper gastrointestinal bleeding (UGIB), effects of deprivation and whether weekend presentation affected outcomes. METHODS: Data was obtained from Information Services Division (ISD) Scotland and National Records of Scotland (NRS) death records for a ten year period between 2000-2001 and 2009-2010. We obtained data from the ISD Scottish Morbidity Records (SMR01) database which holds data on inpatient and day-case hospital discharges from non-obstetric and non-psychiatric hospitals in Scotland. The mortality data was obtained from NRS and linked with the ISD SMR01 database to obtain 30-d case fatality. We used 23 ICD-10 (International Classification of diseases) codes which identify UGIB to interrogate database. We analysed these data for trends in number of hospital admissions with UGIB, 30-d mortality over time and assessed effects of social deprivation. We compared weekend and weekday admissions for differences in 30-d mortality and length of hospital stay. We determined comorbidities for each admission to establish if comorbidities contributed to patient outcome. RESULTS: A total of 60643 Scottish residents were admitted with UGIH during January, 2000 and October, 2009. There was no significant change in annual number of admissions over time, but there was a statistically significant reduction in 30-d case fatality from 10.3% to 8.8% (P < 0.001) over these 10 years. Number of admissions with UGIB was higher for the patients from most deprived category (P < 0.05), although case fatality was higher for the patients from the least deprived category (P < 0.05). There was no statistically significant change in this trend between 2000/01-2009/10. Patients admitted with UGIB at weekends had higher 30-d case fatality compared with those admitted on weekdays (P < 0.001). Thirty day mortality remained significantly higher for patients admitted with UGIB at weekends after adjusting for comorbidities. Length of

  10. Connecting Stuttering Management and Measurement: IV. Predictors of Outcome for a Behavioural Treatment for Stuttering

    ERIC Educational Resources Information Center

    Block, Susan; Onslow, Mark; Packman, Ann; Dacakis, Georgia

    2006-01-01

    "Background": Clinical trials have shown that behavioural treatments based on variants of prolonged-speech (PS) are best practice for reducing the stuttering rate in adults. However, while stuttering is significantly reduced or eliminated for most adults in the short-term with such treatment, relapse in the longer-term is common. Consequently,…

  11. Evaluating Risk Taking Propensity as a Predictor of the Outcome Dimensions of Medication History Taking.

    ERIC Educational Resources Information Center

    Lively, Buford T.

    1983-01-01

    Senior pharmacy students' level of risk-taking as a personality trait was compared with their performance in medication history interviews in an ambulatory medicine clinic. Effective and efficient interviewers were significantly higher in risk-taking propensity than others. (MSE)

  12. Outcomes of pharmacological management of nocturia with non-antidiuretic agents: does statistically significant equal clinically significant?

    PubMed

    Smith, Ariana L; Wein, Alan J

    2011-05-01

    To evaluate the statistical and clinical efficacy of the pharmacological treatments of nocturia using non-antidiuretic agents. A literature review of treatments of nocturia specifically addressing the impact of alpha blockers, 5-alpha reductase inhibitors (5ARI) and antimuscarinics on reduction in nocturnal voids. Despite commonly reported statistically significant results, nocturia has shown a poor clinical response to traditional therapies for benign prostatic hyperplasia including alpha blockers and 5ARI. Similarly, nocturia has shown a poor clinical response to traditional therapies for overactive bladder including antimuscarinics. Statistical success has been achieved in some groups with a variety of alpha blockers and antimuscarinic agents, but the clinical significance of these changes is doubtful. It is likely that other types of therapy will need to be employed in order to achieve a clinically significant reduction in nocturia. PMID:21518417

  13. Predictors of severity and outcome of global developmental delay without definitive etiologic yield: a prospective observational study

    PubMed Central

    2014-01-01

    Background Although several determinants of global developmental delay (GDD) have been recognized, a significant number of children remain without definitive etiologic diagnosis. The objective of this study was to assess the effect of various prenatal and perinatal factors on the severity and outcome of developmental delay without definitive etiologic yield. Methods From March 2008 to February 2010, 142 children with developmental quotient (DQ) <70 and without definitive etiologic diagnosis, were included. Prenatal and perinatal risk factors known to be associated with disordered neonatal brain function were identified. Participants underwent a thorough investigation, an individualized habilitation plan was recommended, and the children were followed-up regularly for a period of 2 < years. The effect of prenatal and perinatal risk factors on the severity and outcome of GDD was assessed by regression analysis. Results The mean age at enrolment was 31 ± 12 < months, and the mean DQ 52.2 ± 11.4. Prematurity and intrauterine growth restriction (IUGR) were found to be independently associated with lower DQ values. The mean DQ after the 2-year follow-up was 62.5 ± 12.7, and the DQ difference from the enrollment 10.4 ± 8.9 (median 10; range-10 to 42). DQ improvement (defined as a DQ difference?≥?median) was noted in 52.8% of the children. IUGR, low socio-economic status, and poor compliance to habilitation plan were found to be independently associated with poorer developmental outcomes. Conclusions Prematurity and IUGR were found to be significantly and independently related to the severity of GDD in cases without definitive etiologic yield. Poorer 2-year developmental outcome was associated with IUGR, low socioeconomic status and non compliance to habilitation plan. Prematurity was a significant determinant of the outcome only in association with the above mentioned factors. PMID:24521451

  14. Predictors and long-term clinical outcomes of newly developed atrial fibrillation in patients with cardiac implantable electronic devices

    PubMed Central

    Kim, Bum Sung; Chun, Kwang Jin; Hwang, Jin kyung; Park, Seung-Jung; Park, Kyoung-Min; Kim, June Soo; On, Young Keun

    2016-01-01

    Abstract Objective: To evaluate predictors and long-term prognosis of atrial fibrillation (AF) following cardiac implantable electronic device (CIED) implantation in patients without history of AF. Methods: From May 1994 to April 2014, 1825 patients with CIED were enrolled in a retrospective, single-center registry. A total of 880 patients from the registry without prior documented AF history were included in the final analysis and were placed into either non-detected AF (NDAF) group or CIED-detected AF group according to development of AF over a follow-up period of 7 years. AF development was defined as any paroxysmal atrial tachyarrhythmia (atrial rate ≥ 180 beats/min) lasting at least 5 minutes according to CIED records. Results: Overall, 122 (13.8%) of the 880 patients experienced new development of AF during follow-up period. According to multivariate analysis, the independent predictors for development of AF were prior heart failure (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.50–3.85; P < 0.001), prior sinus node dysfunction (HR, 2.33; 95% CI, 1.62–3.55; P < 0.001), and left atrium volume index of 38.5 mL/m2 or more (HR, 2.01; 95% CI, 1.23–3.30; P = 0.005). In CDAF group, the risk of heart failure readmission (adjusted HR, 3.79; 95% CI, 1.99–7.22; P < 0.001) and stroke readmission (adjusted HR, 5.33; 95% CI, 1.58–17.97; P = 0.007) was higher than in nondetected AF group. Conclusion: In patients with CIED, prior history of heart failure, sinus node dysfunction, and LA volume index ≥38.5 mL/m2 were independent predictors of new AF cases. Newly developed AF was significantly associated with increased risk of HF and stroke readmission, according to long-term follow up. PMID:27428213

  15. Polycomb genes expression as a predictor of poor clinical outcome in children with medulloblastoma

    PubMed Central

    Zakrzewski, Krzysztof; Grešner, Sylwia M.; Piaskowski, Sylwester; Zalewska-Szewczyk, Beata; Liberski, Paweł P.

    2010-01-01

    Introduction Medulloblastoma is the most frequent type of embryonal tumor in the pediatric population, accounting for 20–25% of all brain tumors in children. Recently, the suspected contribution of the Polycomb group (PcG) genes in medulloblastoma development was described. PcG genes play an important role in developmental processes; they are also involved in the self-renewal of hematopoietic and neural stem cells as well as in malignant transformation. Purpose In this study, we evaluated the expression of BMI1and PCGF2, members of family of PcG genes, and their potential target, MYC oncogene, and analyzed their association with demographic and clinical data. Materials and methods Thirty-one children (18 males and 13 females, aged from 0.4 to 17 years) with medulloblastoma were included in this study. The gene’s expression level was measured by quantitative real-time PCR, obtained using the two-color multiplexing technique. Results We found that the higher expression levels of BMI1 and PCGF2 genes were associated with significantly decreased patient survival (p = 0.02 and p = 0.012, respectively). Significant differences between gender were found, with a higher expression level of the PCGF2 gene observed among females (p = 0.02). Conclusion Our analysis showed correlation between BMI1 and PCGF2 gene’s expression and survival in children with medulloblastoma. PMID:20717685

  16. Lumbar Spine Injury/Pathology as a Predictor of Outcomes in National Football League Athletes

    PubMed Central

    Lynch, Thomas Sean; Schroeder, Greg; Gibbs, Daniel; Chow, Ian; LaBelle, Mark; Savage, Jason W.; Patel, Alpesh; Hsu, Wellington; Nuber, Gordon W.

    2014-01-01

    Objectives: The purpose of this study is to determine if a pre-existing lumbar diagnosis such as spondylosis, a herniated lumbar disc, or spondylolysis affects a football player’s draft status or his performance and longevity in the NFL. Methods: The written medical evaluations and imaging reports of prospective professional American football athletes from 2003-2011 from one NFL franchise during the NFL combine (annual college football player evaluation prior to the NFL draft) were compiled and evaluated. All players were evaluated for a pre-existing lumbar diagnosis which were compiled from previous injury/medical records including radiographic imaging reports. Those players with a lumbar spine diagnosis and with appropriate radiograph, MRI and CT imaging were included in this study. These athletes were then matched by age, position, year, and round drafted to control draftees without a lumbar spine diagnosis. Career statistics were compiled including length of play and number of games started. Additionally, a previously established “Performance Score” was calculated for all players excluding offensive linemen. The continuous variables of each cohort were compared using a two-sided (tailed) Student’s t-test for normally distributed data. A chi-squared analysis was performed to analyze the categorical data. Statistical significance was accepted with a p < 0.05. Results: Out of a total of 2,965 athletes evaluated from the NFL combine, 414 players were identified with a pre-existing lumbar spine diagnosis. Athletes who attended the NFL combine without a lumbar spine diagnosis were significantly more likely to be drafted than those with one (74% vs. 61% respectively, p < 0.01). There was no difference between the investigational and control group with regard to round drafted, age, year drafted, or position. Overall, athletes with a lumbar spine injury compared to the control group had no difference in the number of years played (4.0 vs. 4.3 years, respectively

  17. One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registry

    PubMed Central

    Puls, Miriam; Lubos, Edith; Boekstegers, Peter; von Bardeleben, Ralph Stephan; Ouarrak, Taoufik; Butter, Christian; Zuern, Christine S.; Bekeredjian, Raffi; Sievert, Horst; Nickenig, Georg; Eggebrecht, Holger; Senges, Jochen; Schillinger, Wolfgang

    2016-01-01

    Aims The transcatheter mitral valve interventions (TRAMI) registry was established in order to assess safety and efficacy of catheter-based mitral valve interventional techniques in Germany, and prospectively enrolled 828 MitraClip patients (median age 76 years, median log. EuroSCORE I 20.0%) between August 2010 and July 2013. We present the 1-year outcome in this MitraClip cohort—which is the largest published to date. Methods and results Seven forty-nine patients (90.5%) were available for 1-year follow-up and included in the following analyses. Mortality, major adverse cardiovascular event rates, and New York Heart Association (NYHA) classes were recorded. Predictors of 1-year mortality were identified by multivariate analysis using a Cox regression model with stepwise forward selection. The 1-year mortality was 20.3%. At 1 year, 63.3% of TRAMI patients pertained to NYHA functional classes I or II (compared with 11.0% at baseline), and self-rated health status (on EuroQuol visual analogue scale) also improved significantly by 10 points. Importantly, a significant proportion of patients regained the complete independence in self-care after MitraClip implantation (independence in 74.0 vs. 58.6% at baseline, P = 0.005). Predictors of 1-year mortality were NYHA class IV (hazard ratio, HR 1.62, P = 0.02), anaemia (HR 2.44, P = 0.02), previous aortic valve intervention (HR 2.12, P = 0.002), serum creatinine ≥1.5 mg/dL (HR 1.77, P = 0.002), peripheral artery disease (HR 2.12, P = 0.0003), left ventricular ejection fraction <30% (HR 1.58, P = 0.01), severe tricuspid regurgitation (HR 1.84, P = 0.003), and procedural failure (defined as operator-reported failure, conversion to surgery, failure of clip placement, or residual post-procedural severe mitral regurgitation) (HR 4.36, P < 0.0001). Conclusions Treatment of significant MR with MitraClip resulted in significant clinical improvements in a high proportion of TRAMI patients after 12 months. In the TRAMI cohort

  18. Predictors of Long-Term Outcome from Intraperitoneal Radioimmunotherapy for Ovarian Cancer

    PubMed Central

    You, Zhiying; Alvarez, Ronald; Partridge, Edward; Grizzle, William; LoBuglio, Albert

    2012-01-01

    Abstract Data was analyzed from 92 patients > 5 years after intraperitoneal (IP) radionuclide therapy (RIT) with 90Y- or 177Lu-CC49 to determine prognostic factors. Patients had CC49 antibody-reactive ovarian cancer confined to the abdominal cavity after primary debulking and chemotherapy. The first 27 patients received IP 177Lu-CC49 alone; the remainder received Interferon (IFN), to increase the expression of the tumor-associated glycoprotein-72 (TAG-72) antigen, +/− IP paclitaxel (25–100 mg/m2) 2 days before RIT. Factors assessed by univariate (and some multivariate) analysis included age, race, body size, interval between initial diagnosis and RIT, interval between 2nd look surgery and RIT, 90Y versus 177Lu, MBq dose, paclitaxel dose, grade of tumor, extent of initial surgery, size of disease deposits prior to RIT, intensity of TAG reactivity, the addition of unlabeled antibody, and the development of human anti-mouse antibody and/or serum sickness after murine antibody. A statistically significant improvement in progression-free survival (p≤0.05) was noted for less bulky disease and younger age. Administration of paclitaxel plus IFN, an immune response, and use of 90Y showed a favorable nonsignificant trend. Dose escalation of radionuclide did not change risk of progression; thus, this therapy may have therapeutic efficacy at modest dose levels. PMID:22239432

  19. Locus of Control, Self-Efficacy, and Task Value as Predictors of Learning Outcome in an Online University Context

    ERIC Educational Resources Information Center

    Joo, Young Ju; Lim, Kyu Yon; Kim, Jiyeon

    2013-01-01

    This study investigates the predictors of learner satisfaction, achievement and persistence in an online university located in South Korea. The specific predictors were learners' locus of control, self-efficacy, and task value, and the mediating effects of learner satisfaction and achievement were also tested. Structural equation modeling (SEM)…

  20. The amplification of c-erb-B2 in cancer-free surgical margins is a predictor of poor outcome in oral squamous cell carcinoma.

    PubMed

    Jelovac, D B; Tepavčević, Z; Nikolić, N; Ilić, B; Eljabo, N; Popović, B; Čarkić, J; Konstantinović, V; Vukadinović, M; Miličić, B; Milašin, J

    2016-06-01

    The tumour subtype, TNM classification, and histopathological data are sometimes not sufficient for understanding and assessing the behaviour of oral cancers. In an attempt to find additional markers of tumour biology and behaviour, this study sought to determine the incidence and consequently the relevance of c-erb-B2, c-Myc, and H-ras gene alterations in tumour-free margins of oral squamous cell carcinoma (OSCC). Fifty samples of OSCC were analyzed for c-erb-B2 and c-Myc amplification by real-time polymerase chain reaction and for H-ras point mutations by sequencing. A relatively high incidence of genetic lesions was detected: 22% of cases had c-erb-B2 and 30% had c-Myc amplification, whilst only 12% harboured H-ras mutations. Kaplan-Meier analysis and the log-rank test showed statistically significant differences in 5-year survival rates and relapse between patients with tumour margins positive for c-erb-B2 amplification and those with margins that were negative (P=0.002). H-ras and c-Myc alterations could not be associated with tumour behaviour. Molecular analysis of margins, targeting cancer genes, could identify additional, independent predictors of risk and outcome in OSCC. PMID:26708050

  1. Previous Adverse Infant Outcomes as Predictors of Preconception Care Use: An Analysis of the 2010 and 2012 Los Angeles Mommy and Baby (LAMB) Surveys.

    PubMed

    Batra, Priya; Higgins, Chandra; Chao, Shin M

    2016-06-01

    Objectives This study aimed to understand the impact of a previous adverse infant outcome (AIO) on use of preconception care prior to a subsequent pregnancy. Methods Responses from the 2010 and 2012 Los Angeles Mommy and Baby Surveys were analyzed. Weighted multivariate logistic regression was employed to identify significant associations between having had a previous AIO (preterm delivery, low birth weight infant, stillbirth, or major birth defect) and receipt of preconception care prior to the most recent pregnancy. Select patient-level covariates were included: chronic disease, age, education level, race/ethnicity, country of birth, insurance status prior to pregnancy and pregnancy intent. Adjustment for missing responses was performed using multiple chained imputation. Results After controlling for covariates, having had a previous AIO was associated with an increased odds of having utilized preconception care in the most recent pregnancy (OR 1.237, p = 0.040). Per the final regression model, a woman reporting a previous AIO and an intended subsequent pregnancy had a 42.4 % likelihood of having used preconception care. Of these women, only 28.8 % reported doing so because of concern regarding a previous birth complication. Discussion Women reporting a previous AIO were more likely to have used preconception care in a subsequent pregnancy. The prevalence of preconception care utilization remained low overall. Pregnancy intent emerged as a strong secondary predictor; any concerted strategy to improve access to preconception care must include initiatives to help ensure that pregnancies are planned. PMID:26679708

  2. The patient-physician relationship in patients with chronic low back pain as a predictor of outcomes after rehabilitation.

    PubMed

    Farin, Erik; Gramm, Lukas; Schmidt, Erika

    2013-06-01

    For patients with chronic diseases, especially those with chronic low back pain, the patient-physician relationship is significant for treatment adherence. In a sample of N = 688 low back pain patients, we examined the hypothesis that aspects of the patient-physician relationship (e.g. satisfaction with care, trust in the physician, patient participation) have a significant association with outcomes (pain, disability, quality of life, pain-related psychological impairment) after a multimodal treatment program (rehabilitation) after adjusting for a number of sociodemographic, medical, and psychological factors. Results show that the patient-physician relationship is significantly associated with the outcome. In the medium term (6 months after rehabilitation), the effect of the patient-physician relationship is clearer than in the short term (end of rehabilitation). In addition, risk factors for less improvement are female gender, higher age, low income, comorbidity, low treatment motivation, fear avoidance beliefs, and external locus of control. Future studies should examine the causal paths between the relationship variables and the outcome variables. PMID:22476813

  3. The AGTR1 gene A1166C polymorphism as a risk factor and outcome predictor of primary intracerebral and aneurysmal subarachnoid hemorrhages.

    PubMed

    Adamski, Mateusz G; Golenia, Aleksandra; Turaj, Wojciech; Baird, Alison E; Moskala, Marek; Dziedzic, Tomasz; Szczudlik, Andrzej; Slowik, Agnieszka; Pera, Joanna

    2014-01-01

    Associations between the angiotensin II type 1 receptor (AGTR1) gene A1166C polymorphism and hypertension, aortic abdominal aneurysms (as a risk factor) as well as cardiovascular disorders (as a risk factor and an outcome predictor) have been demonstrated. We aimed to investigate the role of this polymorphism as risk factors and outcome predictors in primary intracerebral hemorrhage (PICH) and aneurysmal subarachnoid hemorrhage (aSAH). We have prospectively recruited 1078 Polish participants to the study: 261 PICH patients, 392 aSAH patients, and 425 unrelated control subjects. The A1166C AGTR1 gene polymorphism was studied using the tetra-primer ARMS-PCR method. Allele and genotype frequencies were compared with other ethnically different populations. The A1166C polymorphism was not associated with the risk of PICH or aSAH. Among the aSAH patients the AA genotype was associated with a good outcome, defined by a Glasgow Outcome Scale of 4 or 5 (p<0.02). The distribution of A1166C genotypes in our cohort did not differ from other white or other populations of European descent. In conclusion, we found an association between the A1166C AGTR1 polymorphism and outcome of aSAH patients, but not with the risk of PICH or aSAH. PMID:25168322

  4. Correlating MDCT Liver Injury Grade and Clinical Outcome in Patients Without Significant Extra-hepatic Injury.

    PubMed

    Kumar, Ravi; Kumar, Atin; Baliyan, Vinit; Gamanagatti, Shivanand; Bhalla, Ashu Seith; Sharma, Raju; Gupta, Amit; Kumar, Subodh; Misra, M C

    2016-08-01

    The aim of the study was to correlate multi-detector computed tomography (MDCT) grading with clinical severity and outcome in liver trauma patients without significant extrahepatic injury. Over a period of 2 years (2011-2013), all patients showing evidence of liver injury on contrast-enhanced CT (CECT) abdomen and without significant extrahepatic trauma were prospectively included in the study. Correlation between the CT injury grade and outcome in terms of mortality, duration of ICU/hospital stay, fluid and blood requirements, need for intervention and complications were assessed. The significance of the difference in mortality, duration of ICU/hospital stay, fluid requirement and blood requirements among the patients with various injury grades was assessed by Kruskal-Wallis test. The significance of the difference in need for intervention and complications among the patients with various injury grades was assessed by Fisher's exact test. A total of 198 patients were found to have evidence of hepatic injury on CECT. Out of 198 patients, 117 had insignificant extrahepatic trauma. The overall mean age for these 117 patients was 25.74 ± 15.53 (age range 2-84 years). Death rates according to AAST grades were 0 % in grades II and III, 6.89 % in grade IV and 9.09 % in grade V (p = 0.053). The mean ICU and total hospital stay for grade II was 1.32 and 5.91 days, for grade III was 1.76 and 8.48, for grade IV was 2.86 and 10.31 days and for grade V was 6.54 and 12 days, respectively (p = 0.0001 for ICU, p = 0.0003 for total stay). Mean input and fluid deficit according to various grades were 8634/2607 ml for grade II, 9535/2555 ml for grade III, 15,549/6242 ml for grade IV and 19,958/8280 ml for grade V (p value input-0.0016, output-input (fluid deficit)-0.0001). Average unit of RBC and sum of the blood products transfused were 1.73 and 2.26 for grade II, 2.18 and 2.72 for grade III, 3.03 and 6.27 for grade IV, 6.85 and 38.12 for grade V

  5. Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies

    PubMed Central

    Guarda-Nardini, Luca; Manfredini, Daniele; Mion, Marta; Heir, Gary; Marchese-Ragona, Rosario

    2015-01-01

    Aims: The aim of this review is to summarize data from the literature on the predictive value of anatomy-based parameters, as identified by cephalometry, for the efficacy of mandibular advancement devices (MAD) for the treatment of obstructive sleep apnea (OSA). Methods: Articles were initially selected based on their titles or abstracts. Full articles were then retrieved and further scrutinized according to predetermined criteria. Reference lists of selected articles were searched for any missed publications. The selected articles were methodologically evaluated. Results: Of an initial 311 references, 13 were selected that assessed correlations between polysomnographic and cephalometric variables. The majority of studies demonstrated a correlation between treatment effectiveness and features as determined by cephalometric analysis, such as the mandibular plane angle, hyoid bone distance to mandible, antero-posterior diameter of the maxilla, tongue area, cranial base, and soft palate. Conclusions: The mandibular plane angle and the distance between hyoid bone and mandibular plane was found to have a predictive value for MAD effectiveness in OSA patients. However, the relative weak and somewhat inconsistent cephalometric data suggest that decisions based solely on these factors cannot be recommended, especially because an integrated analysis of other risk factors (e.g., age, sex, BMI) should also be taken into account. Citation: Guarda-Nardini L, Manfredini D, Mion M, Heir G, Marchese-Ragona R. Anatomically based outcome predictors of treatment for obstructive sleep apnea with intraoral splint devices: a systematic review of cephalometric studies. J Clin Sleep Med 2015;11(11):1327–1334. PMID:25979102

  6. An investigation of general predictors for cognitive–behavioural therapy outcome for anxiety disorders in a routine clinical setting

    PubMed Central

    Nielsen, Sara Kerstine Kaya; Vangkilde, Signe; Wolitzky-Taylor, Kate B; Daniel, Sarah Ingrid Franksdatter; Hageman, Ida

    2016-01-01

    Introduction Cognitive–behavioural therapy (CBT) is effective for treating anxiety disorders and is offered in most mental health services around the world. However, a relatively large number of patients with anxiety disorders do not benefit from CBT, experience relapses or drop out. Reliable predictors of treatment effects are lacking. The aim of this study is to investigate the predictive value of emotion regulation and attentional control for CBT outcome in a routine setting. Methods and analysis In this prospective and practice-based study, 112 patients with anxiety disorders referred for manual-based group CBT at two psychiatric outpatient clinics will be recruited. Emotion regulation, severity of anxiety and attentional control will be assessed with self-report measures and with an experimental computer-based attentional control task at baseline, post-treatment and at a 6-month follow-up. Emotion regulation will be measured with Difficulties in Emotion Regulation Questionnaire, severity of anxiety will be assessed with Beck Anxiety Inventory and attentional control will be measured with the self-report questionnaire, Attention Control Scale, and with an experimental computer-based attentional control task based on theory of visual attention. Data will be analysed using multilevel mixed-effects modelling. Ethics and dissemination The study is approved by the Danish National Ethical Board, the Department of Psychology Ethical Board, University of Copenhagen and by the Danish Data Protection Agency. Study findings will be disseminated through peer-reviewed journal publications and conference presentations. The Danish Committee System on Health Research Ethics has been notified about the project. Trial registration number NCT02638363. PMID:27016248

  7. Outcome predictors of intra-articular glucocorticoid treatment for knee synovitis in patients with rheumatoid arthritis – a prospective cohort study

    PubMed Central

    2014-01-01

    Introduction Intra-articular glucocorticoid treatment (IAGC) is widely used for symptom relief in arthritis. However, knowledge of factors predicting treatment outcome is limited. The aim of the present study was to identify response predictors of IAGC for knee synovitis in patients with rheumatoid arthritis (RA). Methods In this study 121 RA patients with synovitis of the knee were treated with intra-articular injections of 20 mg triamcinolone hexacetonide. They were followed for six months and the rate of clinical relapse was studied. Non-responders (relapse within 6 months) and responders were compared regarding patient characteristics and knee joint damage as determined by the Larsen-Dale index. In addition, matched samples of serum and synovial fluid were analysed for factors reflecting the inflammatory process (C-reactive protein, interleukin 6, tumour necrosis factor alpha, vascular endothelial growth factor), joint tissue turnover (cartilage oligomeric matrix protein, metalloproteinase 3), and autoimmunity (antinuclear antibodies, antibodies against citrullinated peptides, rheumatoid factor). Results During the observation period, 48 knees relapsed (40%). Non-responders had more radiographic joint damage than responders (P = 0.002) and the pre-treatment vascular endothelial growth factor (VEGF) level in synovial fluid was significantly higher in non-responders (P = 0.002). Conclusions Joint destruction is associated with poor outcome of IAGC for knee synovitis in RA. In addition, higher levels of VEGF in synovial fluid are found in non-responders, suggesting that locally produced VEGF is a biomarker for recurrence of synovial hyperplasia and the risk for arthritis relapse. PMID:24950951

  8. Peak Cardiac Power Measured Non-Invasively with a Bioreactance Technique is a Predictor of Adverse Outcomes in Patients with Advanced Heart Failure

    PubMed Central

    Rosenblum, Hannah; Helmke, Stephen; Williams, Paula; Teruya, Sergio; Jones, Margaret; Burkhoff, Daniel; Mancini, Donna; Maurer, Mathew S.

    2010-01-01

    Summary Background Peak oxygen consumption (VO2) during cardiopulmonary exercise testing (CPET) is a powerful predictor of survival, providing an indirect assessment of cardiac output (CO). Hypothesis Non-invasive indices of CO derived from bioreactance methodology would add significantly to peak VO2 as a means of risk stratifying patients with heart failure. Methods 127 patients (53±14 years of age, 66% male) with heart failure and an average EF = 31±15 underwent a symptom-limited CPET using a bicycle ergometer while measuring CO noninvasively by a bioreactance technique. Peak cardiac power was derived from the product of the peak mean arterial blood pressure and CO divided by 451. Results Follow-up averaged 404±179 days (median, 366 days) to assess end points including death (n=3), heart transplant (n=10), or left ventricular assisted device (LVAD) implantation (n=2). Peak VO2 and peak power had similar area under the curves (0.77 and 0.76), which increased to 0.83 when combined. Kaplan-Meier cumulative survival curves demonstrated different outcomes in the subgroup with a VO2 <14 ml*kg-1*min-1 when stratified by a cardiac power above or below 1.5 Watts (92.2% vs. 82.1% at 1 year and 81.6% vs. 58.3% at last follow-up, p=0.02 by log-rank test). Conclusions Among patients with heart failure, peak cardiac power measured with bioreactance methodology and peak VO2 had similar associations with adverse outcomes and peak power added independent prognostic information to peak VO2 in subjects with advanced disease (e.g. VO2 < 14 ml*kg-1*min-1). PMID:21091609

  9. Predictors of failure of awake regional anesthesia for neonatal hernia repair: data from the General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnoea and neurodevelopmental outcomes

    PubMed Central

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E.; de Graaff, Jurgen C.; Morton, Neil S.; McCann, Mary Ellen; Arnup, Sarah J.; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J.

    2015-01-01

    Background Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia (GAS) study compares neurodevelopmental outcomes following awake RA or GA in otherwise healthy infants. Our aim was to describe success and failure rates of RA in this study and report factors associated with failure. Methods This was a nested cohort study within a prospective randomized, controlled, observer blind, equivalence trial. Seven hundred twenty two infants ≤ 60 weeks postmenstrual age, scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, was analyzed. Possible predictors of failure were assessed including: patient factors, technique, experience of site and anesthetist and type of local anesthetic. Results RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty four patients required conversion to GA and an additional 23 (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (OR = 2.46). Conclusions The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone. PMID:26001028

  10. How significant is the ‘significant other’? Associations between significant others’ health behaviors and attitudes and young adults’ health outcomes

    PubMed Central

    2012-01-01

    Background Having a significant other has been shown to be protective against physical and psychological health conditions for adults. Less is known about the period of emerging young adulthood and associations between significant others’ weight and weight-related health behaviors (e.g. healthy dietary intake, the frequency of physical activity, weight status). This study examined the association between significant others’ health attitudes and behaviors regarding eating and physical activity and young adults’ weight status, dietary intake, and physical activity. Methods This study uses data from Project EAT-III, a population-based cohort study with emerging young adults from diverse ethnic and socioeconomic backgrounds (n = 1212). Logistic regression models examining cross-sectional associations, adjusted for sociodemographics and health behaviors five years earlier, were used to estimate predicted probabilities and calculate prevalence differences. Results Young adult women whose significant others had health promoting attitudes/behaviors were significantly less likely to be overweight/obese and were more likely to eat ≥ 5 fruits/vegetables per day and engage in ≥ 3.5 hours/week of physical activity, compared to women whose significant others did not have health promoting behaviors/attitudes. Young adult men whose significant other had health promoting behaviors/attitudes were more likely to engage in ≥ 3.5 hours/week of physical activity compared to men whose significant others did not have health promoting behaviors/attitudes. Conclusions Findings suggest the protective nature of the significant other with regard to weight-related health behaviors of young adults, particularly for young adult women. Obesity prevention efforts should consider the importance of including the significant other in intervention efforts with young adult women and potentially men. PMID:22469471

  11. High birth weight in a suburban hospital in Cameroon: an analysis of the clinical cut-off, prevalence, predictors and adverse outcomes

    PubMed Central

    Choukem, Simeon-Pierre; Njim, Tsi; Atashili, Julius; Hamilton-Shield, Julian P; Mbu, Robinson

    2016-01-01

    Background and aims High birth weight (HBW) increases the risk of maternal and fetal morbidity and mortality. Its prevalence and adverse outcomes may be reduced if risk factors are identified and managed during pregnancy. The cut-off value for HBW remains debatable. The objectives of this study were to identify the optimal cut-off value and determine the prevalence, predictors and adverse outcomes of HBW in a suburban area of Cameroon. Design A 6-year retrospective register analysis and a 3-month prospective phase. Setting A secondary care level (regional) hospital in the city of Buea (southwest region of Cameroon). Participants Women who delivered in this hospital over a 6-year period (retrospective phase) and consenting pregnant mothers and their infants (singletons, born at >28 weeks gestation) (prospective phase). Outcome measures 90th centile of birth weights; prevalence of HBW defined as birth weight above the 90th centile; sociodemographic, maternal and obstetrical factors associated with HBW; maternal and neonatal adverse outcomes of HBW. Results Of the 4941 newborns reviewed in registers, the 90th centile of birth weights was 3850 g. Using this new cut-off, we obtained a prevalence of 14.0% for HBW in the 200 newborns included in the prospective phase. This was significantly higher than the prevalence (9.5%) yielded when the traditional cut-off of 4000 g was used (p=0.003). None of the factors assessed was independently associated with HBW. Newborns with HBW were more likely to have shoulder dystocia (p<0.01), and their mothers more likely to suffer from prolonged labour (p=0.01) and postpartum haemorrhage (p<0.01). Conclusions The results of this study suggest that the cut-off for HBW in this population should be 3850 g. Thus, 3 of every 10 babies born with HBW in this hospital are likely not receiving optimal postnatal care because 4000 g is currently used to qualify for additional support. PMID:27357199

  12. Predictors of psychopathological outcome during peg-interferon and ribavirin therapy in patients with chronic HCV-correlated hepatitis.

    PubMed

    Dell'Osso, Bernardo; Prati, Gianmaria; Palazzo, M Carlotta; Rumi, Maria Grazia; Cavallaro, Flaminia; Aghemo, Alessio; Colombo, Massimo; Altamura, A Carlo

    2013-01-01

    Peg-interferon (Peg-IFN) and ribavirin (RBV) therapy is reported to induce psychiatric symptoms and syndromes in 20% of patients treated for Hepatitis C Virus (HCV) infection. Present study was aimed to quantify the phenomenon and assess the influence of psychiatric counseling over antiviral completion rate and the use of psychometric tools, in terms of prediction of psychopathological outcome. Ninety-six HCV patients were assessed, before antiviral treatment, by means of the Sheehan Disability Scale (SDS), Mood Disorder Questionnaire (MDQ), Symptom Checklist-90, and Internal State Scale (ISS). Sociodemographic and clinical variables and completion rate were collected. Binary logistic regression was performed to evaluate whether scores were predictive of psychiatric visit, development of psychiatric disorders, and need for treatment. Ninety-five patients (99%) completed antiviral treatment; 27 subjects (29%) needed psychiatric visit: among them, mood disorder was diagnosed in 15 (16%) and were pharmacologically treated. Baseline SDS and MDQ higher scores were found to be predictive of psychiatric visit [odds ratio (OR)=1.258, P<0.001 and OR=1.425, P=0.05, respectively]. Furthermore, higher MDQ score (P=0.017) and ISS hostility scores (OR=1.048, P=0.014) at baseline predicted the subsequent development of mood episodes, while ISS activation correlated negatively (OR=0.948, P=0.009). Finally, the need for treatment was predicted by higher scores at the MDQ and ISS activation items (OR=2.467, P=0.030; OR=0.970, P=0.038). Present findings suggest that psychiatric counseling may be needed in almost 30% of HCV patients on antiviral treatment, with positive influence over the completion rate. Baseline higher scores at psychometric questionnaires-MDQ-in particular, predictors of psychopathological outcome during Peg-IFN and RBV therapy in patients with chronic HCV-correlated hepatitis reflecting individual functioning before starting antiviral therapy and positive history

  13. The Pattern of Leptomeningeal Collaterals on Computed Tomography Angiography is a Strong Predictor of Long Term Functional Outcome in Stroke Patients with Large Vessel Intracranial Occlusion

    PubMed Central

    Lima, Fabricio O.; Furie, Karen L.; Silva, Gisele S.; Lev, Michael H.; Camargo, Érica CS; Singhal, Aneesh B.; Harris, Gordon J.; Halpern, Elkan F.; Koroshetz, Walter J.; Smith, Wade S.; Yoo, Albert J.; Nogueira, Raul G.

    2016-01-01

    Background and purpose The role of non-invasive methods in the evaluation of collateral circulation has yet to be defined. We hypothesized that a favorable pattern of leptomeningeal collaterals, as identified by computed tomography angiography (CTA), correlates with improved outcomes. Methods Data from a prospective cohort study at two university based hospitals where CTA was systematically performed in the acute phase of ischemic stroke were analyzed. Patients with complete occlusion of the intracranial internal carotid artery (ICA) and/or the middle cerebral artery (MCA-M1 or M2 segments) were selected. Leptomeningeal collateral pattern was graded as a three category ordinal variable (less, equal, or greater than the unaffected contralateral hemisphere). Univariate and multivariate analyses were performed to define the independent predictors of good outcome at 6 months (mRS≤2). Results 196 patients were selected. The mean age was 69 ±17 years and the median NIHSS score was 13 (IQR 6-17). In the univariate analysis, age, baseline NIHSS, pre-stroke mRS, ASPECT score, admission blood glucose, history of hypertension, coronary artery disease, congestive heart failure, atrial fibrillation, site of occlusion, and collateral pattern were predictors of outcome. In the multivariate analysis, age (OR 0.95; 95%CI [0.93-0.98], p=0.001), baseline NIHSS (OR 0.75; [0.69-0.83], p<0.001), pre-stroke mRS (OR 0.41; [0.22-0.76], p=0.01), intravenous r-tPA (OR 4.92; [1.83-13.25], p=0.01), diabetes( OR 0.31; [0.01-0.98], p=0.046) and leptomeningeal collaterals (OR 1.93; [1.06-3.34], p=0.03) were identified as independent predictors of good outcome. Conclusion Consistent with angiographic studies, leptomeningeal collaterals on CTA are also a reliable marker of good outcome in ischemic stroke. PMID:20829514

  14. Pre-treatment insomnia as a predictor of single and combination antidepressant outcomes: a CO-MED report

    PubMed Central

    Sung, Sharon C.; Wisniewski, Stephen R.; Luther, James F.; Trivedi, Madhukar H.; Rush, A. John

    2014-01-01

    Background Most patients with major depressive disorder (MDD) report clinically significant sleep problems. Pre-treatment insomnia been associated with poorer treatment outcomes in some antidepressant trials, leading to suggestions that combined treatment regimens may be more successful in this subgroup. This study investigated this question using data from the CO-MED trial. Methods Adult outpatients with chronic and/or recurrent MDD were randomly assigned in 1:1:1 ratio to 28 weeks of single-blind, placebo-controlled antidepressant treatment with (1) escitalopram+placebo, (2) bupropion-sustained-release+escitalopram, or (3) venlafaxine-extended-release+mirtazapine. We compared baseline characteristics, tolerability, and treatment outcomes at 12 and 28 weeks for patients with and without pre-treatment insomnia. Results Of the 665 evaluable patients, the majority (88.3%) reported significant pre-treatment insomnia. Those with pre-treatment insomnia were more likely to be female (69.3% vs. 57.7%) and African-American (29.1% vs 11.8%). Those with pre-treatment insomnia symptoms reported higher rates of concurrent anxiety disorders, lower rates of alcohol and substance use disorders, and greater impairment in psychosocial functioning. The two groups did not differ in either tolerability or treatment outcomes among the three antidepressant treatments. Conclusions Insomnia symptoms, while common in patients with chronic/recurrent MDD, were not predictive of response, remission, or tolerability with either single or combined antidepressant medications. PMID:25497473

  15. Use of the Disability Rating Scale Recovery curve as a predictor of psychosocial outcome following closed-head injury.

    PubMed

    McCauley, S R; Hannay, H J; Swank, P R

    2001-05-01

    Rapid rate of recovery has been associated with better outcome following closed-head injuries, but few studies have compellingly demonstrated this. This study used growth curve analyses of Disability Rating Scale (DRS) scores at acute hospitalization discharge, 1, 3, and 6 months post injury in a sample of 55 patients with a closed-head injury. Six month post-injury outcome measures were taken from significant other (SO) responses on the NYU Head Injury Family Interview (NYU-HIFI) including severity and burden ratings of affective/neurobehavioral disturbance, cognitive deficits, and physical/dependency status. Rate of recovery (linear and curvilinear recovery curve components) was significantly related to the level of affective/neurobehavioral severity, and the severity and burden of SO-perceived cognitive deficits. Only the intercept of the DRS recovery curve was associated with the SO-perceived severity and burden of physical/dependency status. Growth curve modeling is a meaningful and powerful tool in predicting head injury outcome. PMID:11396548

  16. Predictors and treatment outcomes.

    PubMed

    Wagner, Karen Dineen

    2015-11-01

    This month's section of Focus on Childhood and Adolescent Mental Health offers a wide array of clinically relevant topics. Interest in the use of dietary supplements to treat mood disorders has been on the rise. Wozniak and colleagues examined whether high EPA/DHA omega-3 fatty acids and inositol were effective in the treatment of pediatric bipolar spectrum disorders. PMID:26646030

  17. Natural killer cells phenotypic characterization as an outcome predictor of HCV-linked HCC after curative treatments.

    PubMed

    Cariani, Elisabetta; Pilli, Massimo; Barili, Valeria; Porro, Emanuela; Biasini, Elisabetta; Olivani, Andrea; Dalla Valle, Raffaele; Trenti, Tommaso; Ferrari, Carlo; Missale, Gabriele

    2016-08-01

    NK-cell number and function have been associated with cancer progression. A detailed analysis of phenotypic and functional characteristics of NK-cells in HCC is still lacking. NK-cell function is regulated by activating and inhibitory receptors determined by genetic factors and engagement with cognate ligands on transformed or infected cells. We evaluated phenotypic and functional characteristic of NK-cells in HCC patients undergoing curative treatment in relation to clinical outcome. NK-cells from 70 HCC patients undergoing resection or ablative treatment, 18 healthy volunteers and 12 cirrhotic patients with HCV-infection (controls) were phenotypically characterized. Unsupervised clustering based on the frequency of cells expressing different phenotypic NK-cell markers segregated HCC patients into different cohorts that were compared for outcome. NK-cell cytokine production and cytotoxicity were compared between cohorts with different overall survival (OS) and time to disease recurrence (TTR). By multivariate analysis, age, Child-Pugh class and NK-cell phenotypic clustering could independently identify patients with significantly different OS. NK-cells from patients with better outcome expressed higher levels of cytotoxic granules and CD3ζ and lower levels of natural cytotoxic receptors (NCRs) that were co-expressed with the inhibitory receptor NKG2A known to negatively regulate NCR function. Cytotoxic function and IFNγ production were significantly lower in the cohort of patients with worse outcome compared to controls (p < 0.05). Our results show a role for NK-cells in the control of HCC progression and survival providing the basis for the development of immunotherapeutic strategies to potentiate NK-cell response. PMID:27622055

  18. Fibroblast Growth Factor 2-A Predictor of Outcome for Patients Irradiated for Stage II-III Non-Small-Cell Lung Cancer

    SciTech Connect

    Rades, Dirk; Setter, Cornelia; Dahl, Olav; Schild, Steven E.; Noack, Frank

    2012-01-01

    Purpose: The prognostic value of the tumor cell expression of the fibroblast growth factor 2 (FGF-2) in patients with non-small-cell lung cancer (NSCLC) is unclear. The present study investigated the effect of tumor cell expression of FGF-2 on the outcome of 60 patients irradiated for Stage II-III NSCLC. Methods and Materials: The effect of FGF-2 expression and 13 additional factors on locoregional control (LRC), metastasis-free survival (MFS), and overall survival (OS) were retrospectively evaluated. These additional factors included age, gender, Karnofsky performance status, histologic type, histologic grade, T and N category, American Joint Committee on Cancer stage, surgery, chemotherapy, pack-years, smoking during radiotherapy, and hemoglobin during radiotherapy. Locoregional failure was identified by endoscopy or computed tomography. Univariate analyses were performed with the Kaplan-Meier method and the Wilcoxon test and multivariate analyses with the Cox proportional hazard model. Results: On univariate analysis, improved LRC was associated with surgery (p = .017), greater hemoglobin levels (p = .036), and FGF-2 negativity (p <.001). On multivariate analysis of LRC, surgery (relative risk [RR], 2.44; p = .037), and FGF-2 expression (RR, 5.06; p <.001) maintained significance. On univariate analysis, improved MFS was associated with squamous cell carcinoma (p = .020), greater hemoglobin levels (p = .007), and FGF-2 negativity (p = .001). On multivariate analysis of MFS, the hemoglobin levels (RR, 2.65; p = .019) and FGF-2 expression (RR, 3.05; p = .004) were significant. On univariate analysis, improved OS was associated with a lower N category (p = .048), greater hemoglobin levels (p <.001), and FGF-2 negativity (p <.001). On multivariate analysis of OS, greater hemoglobin levels (RR, 4.62; p = .002) and FGF-2 expression (RR, 3.25; p = .002) maintained significance. Conclusions: Tumor cell expression of FGF-2 appeared to be an independent negative predictor

  19. Predictors of Poor Pregnancy Outcomes Among Antenatal Care Attendees in Primary Health Care Facilities in Cross River State, Nigeria: A Multilevel Model.

    PubMed

    Ameh, Soter; Adeleye, Omokhoa A; Kabiru, Caroline W; Agan, Thomas; Duke, Roseline; Mkpanam, Nkese; Nwoha, Doris

    2016-08-01

    Objectives Pregnancy carries a high risk for millions of women and varies by urban-rural location in Nigeria, a country with the second highest maternal deaths in the world. Addressing multilevel predictors of poor pregnancy outcomes among antenatal care (ANC) attendees in primary health care (PHC) facilities could reduce the high maternal mortality rate in Nigeria. This study utilised the "Risk Approach" strategy to (1) compare the risks of poor pregnancy outcomes among ANC attendees by urban-rural location; and (2) determine predictors of poor pregnancy outcomes among ANC attendees in urban-rural PHC facilities in Cross River State, Nigeria. Methods A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15-49 years recruited through multistage sampling. Data on risk factors of poor pregnancy outcomes were collected using interviewer-administered questionnaires and clinic records. Respondents were categorised into low, medium or high risk of poor pregnancy outcomes, based on their overall risk scores. Predictors of poor pregnancy outcomes were determined by multilevel ordinal logistic regression. Results A greater proportion of the women in the rural areas were below the middle socio-economic quintile (75 vs. 4 %, p < 0.001), had no education (12 vs. 2 %, p < 0.001), and were in the 15-24 age group (58 vs. 35 %, p < 0.001) whereas women in the urban areas were older than 35 years (10 vs. 5 %, p < 0.001). The women attending antenatal care in the urban PHC facilities had a low overall risk of poor pregnancy outcomes than those in the rural facilities (64 vs. 50 %, p = 0.034). Pregnant women in the urban areas had decreased odds of being at high risk of poor pregnancy outcomes versus the combined medium and low risks compared with those in the rural areas (OR 0.55, 95 % CI 0.09-0.65). Conclusions for Practice Pregnant women attending antenatal care in rural PHC facilities are more at risk of poor pregnancy outcomes than those

  20. Patient-reported outcomes 3 months after spine surgery: is it an accurate predictor of 12-month outcome in real-world registry platforms?

    PubMed

    Parker, Scott L; Asher, Anthony L; Godil, Saniya S; Devin, Clinton J; McGirt, Matthew J

    2015-12-01

    OBJECT The health care landscape is rapidly shifting to incentivize quality of care rather than quantity of care. Quality and outcomes registry platforms lie at the center of all emerging evidence-driven reform models and will be used to inform decision makers in health care delivery. Obtaining real-world registry outcomes data from patients 12 months after spine surgery remains a challenge. The authors set out to determine whether 3-month patient-reported outcomes accurately predict 12-month outcomes and, hence, whether 3-month measurement systems suffice to identify effective versus noneffective spine care. METHODS All patients undergoing lumbar spine surgery for degenerative disease at a single medical institution over a 2-year period were enrolled in a prospective longitudinal registry. Patient-reported outcome instruments (numeric rating scale [NRS], Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12], EQ-5D, and the Zung Self-Rating Depression Scale) were recorded prospectively at baseline and at 3 months and 12 months after surgery. Linear regression was performed to determine the independent association of 3- and 12-month outcome. Receiver operating characteristic (ROC) curve analysis was performed to determine whether improvement in general health state (EQ-5D) and disability (ODI) at 3 months accurately predicted improvement and achievement of minimum clinical important difference (MCID) at 12 months. RESULTS A total of 593 patients undergoing elective lumbar surgery were included in the study. There was a significant correlation between 3-month and 12-month EQ-5D (r = 0.71; p < 0.0001) and ODI (r = 0.70; p < 0.0001); however, the authors observed a sizable discrepancy in achievement of a clinically significant improvement (MCID) threshold at 3 versus 12 months on an individual patient level. For postoperative disability (ODI), 11.5% of patients who achieved an MCID threshold at 3 months dropped below this threshold at 12 months; 10

  1. Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease

    PubMed Central

    Yu, Xian-Peng; Wu, Chang-Yan; Ren, Xue-Jun; Yuan, Fei; Song, Xian-Tao; Luo, Ya-Wei; He, Ji-Qiang; Gao, Yue-Chun; Huang, Fang-Jiong; Gu, Cheng-Xiong; Sun, Li-Zhong; Lyu, Shu-Zheng; Chen, Fang

    2016-01-01

    Background: There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events. Methods: All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups. Results: Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3–8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group. Conclusions: During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF

  2. High-throughput RNAi screening of human kinases identifies predictors of clinical outcome in colorectal cancer patients treated with oxaliplatin

    PubMed Central

    Li, Ajian; Tang, Erjiang; Peng, Jian; Tang, Wenxian; Zhang, Yong; Lu, Liang; Xiao, Yihua; Wei, Qing; Yin, Lu; Li, Huaguang

    2015-01-01

    The purpose of this study is to identify protein kinase genes that modulate oxaliplatin cytotoxicity in vitro and evaluate the roles of these genes in predicting clinical outcomes in CRC patients receiving oxaliplatin-based adjuvant chemotherapy. A high-throughput RNAi screening targeting 626 human kinase genes was performed to identify kinase genes whose inhibition potentiates oxaliplatin sensitivity in CRC cells. The associations between copy numbers of the candidate genes and recurrence-free survival and overall survival were analyzed in 142 stage III CRC patients receiving first-line oxaliplatin-based adjuvant chemotherapy who were enrolled from two independent hospitals. HT-RNAi screening identified 40 kinase genes whose inhibition potentiated oxaliplatin cytotoxicity in DLD1 cells. The relative copy number (RCN) of MAP4K1 and CDKL4 were associated with increased risks of both recurrence and death. Moreover, significant genes-based risk score and the ratios of RCN of different genes can further categorize patients into subgroups with distinctly differing outcomes. The estimated AUC for the prediction models including clinical variables plus kinase biomarkers was 0.77 for the recurrence and 0.82 for the survival models. The copy numbers of MAP4K1 and CDKL4 can predict clinical outcomes in CRC patients treated with oxaliplatin-based chemotherapy. PMID:25904054

  3. Predictors of short-term outcomes related to central subfield foveal thickness after intravitreal bevacizumab for macular edema due to central retinal vein occlusion

    PubMed Central

    Wang, Mei-Zi; Feng, Kang; Lu, Yao; Qian, Fang; Lu, Xin-Rong; Zang, Si-Wen; Zhao, Lin

    2016-01-01

    AIM To investigate the predictive factors for short-term effects of intravitreal bevacizumab injections on central subfield foveal thickness (CSFT) in patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO). METHODS This was a retrospective study in 60 eyes treated with intravitreal bevacizumab injections for ME due to CRVO. Follow-up was three months. The Early Treatment Diabetic Retinopathy Study (ETDRS) score and CSFT measured by spectral-domain optical coherence tomography (SD-OCT) were used to observe the changes in best-corrected visual acuity (BCVA). Baseline BCVA, CSFT, age, CRVO duration and the presence of cystoid macular edema (CME) or subretinal fluid (SRF) were analyzed as potential predictive factors of the effects of intravitreal bevacizumab injections. RESULTS BCVA improved from 0.9 logMAR at baseline to 0.6 logMAR at 3mo, which was associated with a significant reduction in CSFT from 721 µm to 392 µm 3mo after injection. About 50% of CME cases and more than 90% of SRF cases responded to treatment with a complete resolution at 3mo. Age (P=0.036) and low baseline CSFT (P=0.037) were associated with a good 3-month prognosis. Patients >60 years old achieved better CME resolution (P=0.031) and lower CSFT at 3mo (305 µm vs 474 µm, P=0.003). CONCLUSION Intravitreal bevacizumab significantly improved visual acuity and CSFT in patients with CRVO after 3mo. Older age and lower baseline CSFT were good predictors of short-term CSFT outcomes. The retinal thickness response to bevacizumab might depend on the resolution of CME rather than SRF. PMID:26949616

  4. KRAS mutation is a weak, but valid predictor for poor prognosis and treatment outcomes in NSCLC: A meta-analysis of 41 studies

    PubMed Central

    Pan, Wei; Yang, Yan; Zhu, Hongcheng; Zhang, Youcheng; Zhou, Rongping; Sun, Xinchen

    2016-01-01

    Mutation of oncogene KRAS is common in non-small cell lung cancer (NSCLC), however, its clinical significance is still controversial. Independent studies evaluating its prognostic and predictive value usually drew inconsistent conclusions. Hence, We performed a meta-analysis with 41 relative publications, retrieved from multi-databases, to reconcile these controversial results and to give an overall impression of KRAS mutation in NSCLC. According to our findings, KRAS mutation was significantly associated with worse overall survival (OS) and disease-free survival (DFS) in early stage resected NSCLC (hazard ratio or HR=1.56 and 1.57, 95% CI 1.39-1.76 and 1.17-2.09 respectively), and with inferior outcomes of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) treatment and chemotherapy (relative risk or RR=0.21 and 0.66 for objective response rate or ORR, 95% CI 0.12-0.39 and 0.54-0.81 respectively; HR=1.46 and 1.30 for progression-free survival or PFS, 95%CI 1.23-1.74 and 1.14-1.50 respectively) in advanced NSCLC. When EGFR mutant patients were excluded, KRAS mutation was still significantly associated with worse OS and PFS of EGFR-TKIs (HR=1.40 and 1.35, 95 % CI 1.21-1.61 and 1.11-1.64). Although KRAS mutant patients presented worse DFS and PFS of chemotherapy (HR=1.33 and 1.11, 95% CI 0.97-1.84 and 0.95-1.30), and lower response rate to EGFR-TKIs or chemotherapy (RR=0.55 and 0.88, 95 % CI 0.27-1.11 and 0.76-1.02), statistical differences were not met. In conclusion, KRAS mutation is a weak, but valid predictor for poor prognosis and treatment outcomes in NSCLC. There's a need for developing target therapies for KRAS mutant lung cancer and other tumors. PMID:26840022

  5. Low T3 syndrome is a strong predictor of poor outcomes in patients with community-acquired pneumonia

    PubMed Central

    Liu, Jinliang; Wu, Xuejie; Lu, Fang; Zhao, Lifang; Shi, Lingxian; Xu, Feng

    2016-01-01

    Low T3 syndrome was previously reported to be linked to poor clinical outcomes in critically ill patients. The aim of this study was to evaluate the predictive power of low T3 syndrome for clinical outcomes in patients with community-acquired pneumonia (CAP). Data for 503 patients were analyzed retrospectively, and the primary end point was 30-day mortality. The intensive care unit (ICU) admission rate and 30-day mortality were 8.3% and 6.4% respectively. The prevalence of low T3 syndrome differed significantly between survivors and nonsurvivors (29.1% vs 71.9%, P < 0.001), and low T3 syndrome was associated with a remarkable increased risk of 30-day mortality and ICU admission in patients with severe CAP. Multivariate logistic regression analysis produced an odds ratio of 2.96 (95% CI 1.14–7.76, P = 0.025) for 30-day mortality in CAP patients with low T3 syndrome. Survival analysis revealed that the survival rate among CAP patients with low T3 syndrome was lower than that in the control group (P < 0.01). Adding low T3 syndrome to the PSI and CURB-65 significantly increased the areas under the ROC curves for predicting ICU admission and 30-day mortality. In conclusion, low T3 syndrome is an independent risk factor for 30-day mortality in CAP patients. PMID:26928863

  6. Prevalence and Predictors of Clinically Significant Depressive Symptoms Among Chinese and Malawian Children: A Cross-Cultural Comparative Cross-Sectional Study

    PubMed Central

    Zgambo, Maggie; Kalembo, Fatch Welcome; Wang, Honghong; He, Guoping; Chen, Sanmei

    2015-01-01

    Background: Multicultural comparative studies have recently increased scientific knowledge base regarding the mental health of diverse populations. This cross-cultural study was cross-sectionally designed to assess differences in the prevalence and predictors of clinically significant depressive symptoms between Chinese and Malawian children. Methods: A total of 478 children (237 Chinese and 241 Malawians) were randomly recruited in the study. The participants completed a Children Depression Inventory in the dimensions of Negative Mood, Interpersonal Problems, Ineffectiveness, Anhedonia, and Negative Self- Esteem. They further provided demographic and family structure information. Data were analyzed by Student’s t-test, Chi-square test, and logistic regression. Results: The prevalence of clinically significant depressive symptoms was 16% and 12.4% for Chinese and Malawian study participants, respectively. Multivariate logistic regression analysis showed that fighting among siblings (adjusted odds ratio [aOR] = 4.1, 95% CI, 3.5–5.9), fighting among children and parents (aOR = 7.7, 95% CI, 4.6–9.8) and living with father only (aOR = 4.1, 95% CI, 3.4–6.7) were significant predictors of clinically significant depressive symptoms among Chinese study participants. On the other hand, clinically significant depressive symptoms were predicted by employment status of a mom only among Malawian study participants (aOR = 3.0, 95% CI, 2.3–5.9). Conclusions: We conclude that diverse cultures affect children’s mental health differently and this cluster of children has a noticeable amount of depressive symptoms that in the least requires further diagnosis and preventive measures. PMID:25560344

  7. Postsecondary Outcomes for Students with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Farnham, Lindsey Beth

    2011-01-01

    A survey of 89 post secondary youth with intellectual impairments exiting a college based school-to-work program tracked school and post school experiences to identify significant correlates and predictors of post school outcomes. The three significant predictors were self-determination training, course taking patterns, and home care skills…

  8. Urinary Proteome and Systolic Blood Pressure as Predictors of 5-Year Cardiovascular and Cardiac Outcomes in a General Population.

    PubMed

    Zhang, Zhen-Yu; Thijs, Lutgarde; Petit, Thibault; Gu, Yu-Mei; Jacobs, Lotte; Yang, Wen-Yi; Liu, Yan-Ping; Koeck, Thomas; Zürbig, Petra; Jin, Yu; Verhamme, Peter; Voigt, Jens-Uwe; Kuznetsova, Tatiana; Mischak, Harald; Staessen, Jan A

    2015-07-01

    In a previous cross-sectional study, we identified a multidimensional urinary classifier (HF1), which was associated with left ventricular dysfunction. We investigated whether HF1 predicts cardiovascular end points over and beyond traditional risk factors. In 791 randomly recruited Flemish (mean age, 51.2 years; 50.6% women), we quantified HF1 by capillary electrophoresis coupled with mass spectrometry. In addition, we measured cardiovascular risk factors. HF1 averaged -0.97 U (range, -3.26 to 2.60). Over 6.1 years (median), 35 participants died and 63, 45, and 22 experienced fatal or nonfatal cardiovascular, cardiac, or coronary events, respectively. The incidence of fatal combined with nonfatal cardiovascular and cardiac end points, standardized for sex and age, increased across thirds of the HF1 distribution (P≤0.014), whereas trends for all-cause mortality and coronary events were nonsignificant (P≥0.10). The multivariable-adjusted hazard ratios (+1-SD) were 1.30 (95% confidence interval, 1.03-1.65; P=0.029) and 1.39 (1.06-1.84; P=0.018) for cardiovascular and cardiac events in relation to HF1. For systolic pressure, the corresponding estimates were 0.97 (0.74-1.28; P=0.85) and 0.93 (0.67-1.29; P=0.66), respectively. The HF1 upper thresholds optimized by maximizing Younden's index were -0.50 and -0.36 U for cardiovascular and cardiac end points, respectively. Prognostic accuracy significantly (P≤0.006) improved by adding HF1 to Cox models already including the other baseline predictors. Sensitivity analyses, from which we excluded 71 participants with previous cardiovascular disease, were confirmatory. In conclusion, over a 6-year period, the urinary proteome, but not systolic pressure, predicted cardiovascular and cardiac disease. PMID:26063667

  9. Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients With Healthcare-Associated Ventriculitis and Meningitis

    PubMed Central

    Srihawan, Chanunya; Castelblanco, Rodrigo Lopez; Salazar, Lucrecia; Wootton, Susan H.; Aguilera, Elizabeth; Ostrosky-Zeichner, Luis; Sandberg, David I.; Choi, HuiMahn A.; Lee, Kiwon; Kitigawa, Ryan; Tandon, Nitin; Hasbun, Rodrigo

    2016-01-01

    Background. Healthcare-associated meningitis or ventriculitis is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Methods. We performed a retrospective study of adults and children with the diagnosis of healthcare-associated meningitis or ventriculitis, as defined by the 2015 Centers of Disease Control and Prevention case definition, at 2 large tertiary care hospitals in Houston, Texas from July 2003 to November 2014. Patients were identified by infection control practitioners and by screening cerebrospinal fluid samples sent to the central laboratory. We collected data on demographics, clinical presentations, laboratory results, imaging studies, treatments, and outcomes. Results. A total of 215 patients were included (166 adults and 49 children). A positive cerebrospinal fluid culture was seen in 106 (49%) patients, with the majority of the etiologies being Staphylococcus and Gram-negative rods. An adverse clinical outcome was seen in 167 patients (77.7%) and was defined as death in 20 patients (9.3%), persistent vegetative state in 31 patients (14.4%), severe disability in 77 patients (35.8%), or moderate disability in 39 patients (18.1%). On logistic regression analysis, age >45 years (adjusted odds ratio [OR], 6.47; 95% confidence interval [CI], 2.31–18.11; P ≤ .001), abnormal neurological exam (adjusted OR, 3.04; 95% CI, 1.27–7.29; P = .013), and mechanical ventilation (adjusted OR, 5.34; 95% CI, 1.51–18.92; P = .01) were associated with an adverse outcome. Conclusions. Healthcare-associated meningitis or ventriculitis is associated with significant morbidity and mortality. PMID:27419154

  10. Adjuvant Embolization with N-butyl Cyanoacrylate in the Treatment of Cerebral Arteriovenous Malformations: Outcomes, Complications, and Predictors of Neurologic Deficits

    PubMed Central

    Starke, Robert M.; Komotar, Ricardo J.; Otten, Marc L.; Hahn, David K.; Fischer, Laura E.; Hwang, Brian Y.; Garrett, Matthew C.; Sciacca, Robert R.; Sisti, Michael B.; Solomon, Robert A.; Lavine, Sean D.; Connolly, E. Sander; Meyers, Philip M.

    2009-01-01

    Background and Purpose To assess the frequency, severity, and predictors of neurologic deficits following adjuvant embolization for cerebral arteriovenous malformations (AVMs). Methods From 1997-2006, 202 of 275 AVM patients received embolization prior to microsurgery (n=176) or radiosurgery (n=26). Patients were examined before and after endovascular embolization, and at clinical follow-up (mean 43.4±34.6 months). Outcome was classified according to the modified Rankin Scale (mRS). New neurological deficits after embolization were defined as minimal (no change in overall mRS), moderate (mRS≤2), or significant (mRS>2). Results 202 patients were treated in 377 embolization procedures. There were a total of 29 new clinical deficits after embolization (8% of procedures; 14% of patients), of which 19 were moderate or significant. Post-embolization deficits resolved in a significant number of patients over time (p<0.0001). Five patients suffered persistent neurological deficits due to embolization (1.3% of procedures; 2.5% of patients). In multivariate analysis, the following variables significantly predicted new neurological deficit following embolization: complex AVM with treatment plan specifying more than one embolization procedure (OR=2.7; 95% CI, 1.4-8.6), diameter <3cm (OR=3.2; 95%, CI 1.2-9.1), diameter >6cm (OR=6.2; 95% CI, 1.0-57.0), deep venous drainage (OR=2.7; 95% CI, 1.1-6.9) or eloquent location (OR=2.4; 95% CI, 1.0-5.7). These variables were weighted and used to compute an AVM Embolization Prognostic Risk Score for each patient. A score of 0 predicted no new deficits, a score of 1 predicted a new deficit rate of 6%, a score of 2 predicted a new deficit rate of 15%, a score of 3 predicted a new deficit rate of 21%, and a score of 4 predicted a new deficit rate of 50% (p<0.0001). Conclusions Small and large size, eloquent location, deep venous drainage, and complex vascular anatomy requiring multiple embolization procedures are risk factors for the

  11. Temporal profiles of blood pressure, circulating nitric oxide, and adrenomedullin as predictors of clinical outcome in acute ischemic stroke patients

    PubMed Central

    SERRANO-PONZ, MARTA; RODRIGO-GASQUÉ, CARMEN; SILES, EVA; MARTÍNEZ-LARA, ESTHER; OCHOA-CALLEJERO, LAURA; MARTÍNEZ, ALFREDO

    2016-01-01

    Stroke remains an important health and social challenge. The present study investigated whether blood pressure (BP) parameters and circulating levels of nitric oxide metabolites (NOx) and adrenomedullin (AM) may predict clinical outcomes of stroke. Patients (n=76) diagnosed with acute ischemic stroke were admitted to the stroke unit and clinical history data and monitored parameters were recorded. Blood plasma was collected at days 1, 2, and 7 to measure NOx and AM levels. Infarct volume, neurological severity [on the National Institutes of Health Stroke Scale (NIHSS)], and functional prognosis (on the Rankin scale) were measured as clinical outcomes. Patients with higher BP had more severe symptoms (NIHSS >3; P<0.01) and BP variability predicted neurological severity and growth of infarct volume. NOx values were significantly lower in stroke patients than in healthy controls (P<0.01). An increase in NOx levels from day 1 to day 2 was beneficial for the patients as measured by NIHSS at 7 days and 3 months, and by Rankin at 3 months [odds ratio (OR), 0.91] whereas a steep increase from day 2 to day 7 was detrimental and associated with an increase in infarct volume (OR, 35.3). AM levels were significantly higher in patients at day 1 and 2 than in healthy individuals (P<0.01) and these levels returned to normal at day 7. Patients with high AM levels at day 2 had significantly higher NIHSS scores measured at day 1 (P<0.05) and 7 (P<0.01). A receiving operating characteristic curve analysis identified that AM levels at day 2 of >522.13 pg/ml predicted increased neurological severity at day 7 (area under the curve=0.721). Multivariate logistic regression indicated that AM levels at day 2 predicted increased neurological severity at 7 days and at 3 months. BP parameters and changing levels for NOx and AM predicted long-term clinical outcomes as measured by infarct volume, neurological severity scale, and functional prognosis. PMID:27035412

  12. Temporal profiles of blood pressure, circulating nitric oxide, and adrenomedullin as predictors of clinical outcome in acute ischemic stroke patients.

    PubMed

    Serrano-Ponz, Marta; Rodrigo-Gasqué, Carmen; Siles, Eva; Martínez-Lara, Esther; Ochoa-Callejero, Laura; Martínez, Alfredo

    2016-05-01

    Stroke remains an important health and social challenge. The present study investigated whether blood pressure (BP) parameters and circulating levels of nitric oxide metabolites (NOx) and adrenomedullin (AM) may predict clinical outcomes of stroke. Patients (n=76) diagnosed with acute ischemic stroke were admitted to the stroke unit and clinical history data and monitored parameters were recorded. Blood plasma was collected at days 1, 2, and 7 to measure NOx and AM levels. Infarct volume, neurological severity [on the National Institutes of Health Stroke Scale (NIHSS)], and functional prognosis (on the Rankin scale) were measured as clinical outcomes. Patients with higher BP had more severe symptoms (NIHSS >3; P<0.01) and BP variability predicted neurological severity and growth of infarct volume. NOx values were significantly lower in stroke patients than in healthy controls (P<0.01). An increase in NOx levels from day 1 to day 2 was beneficial for the patients as measured by NIHSS at 7 days and 3 months, and by Rankin at 3 months [odds ratio (OR), 0.91] whereas a steep increase from day 2 to day 7 was detrimental and associated with an increase in infarct volume (OR, 35.3). AM levels were significantly higher in patients at day 1 and 2 than in healthy individuals (P<0.01) and these levels returned to normal at day 7. Patients with high AM levels at day 2 had significantly higher NIHSS scores measured at day 1 (P<0.05) and 7 (P<0.01). A receiving operating characteristic curve analysis identified that AM levels at day 2 of >522.13 pg/ml predicted increased neurological severity at day 7 (area under the curve=0.721). Multivariate logistic regression indicated that AM levels at day 2 predicted increased neurological severity at 7 days and at 3 months. BP parameters and changing levels for NOx and AM predicted long‑term clinical outcomes as measured by infarct volume, neurological severity scale, and functional prognosis. PMID:27035412

  13. Serum metabolomics identifies citrulline as a predictor of adverse outcomes in an equine model of gut-derived sepsis.

    PubMed

    Steelman, Samantha M; Johnson, Philip; Jackson, Amy; Schulze, James; Chowdhary, Bhanu P

    2014-05-15

    Acute laminitis is an inflammatory disease of the equine foot that often occurs secondarily to sepsis or systemic inflammation associated with gastrointestinal disease. It has been suggested that laminitis is similar to multiple organ dysfunction syndrome in humans, although in horses the weight-bearing laminar epithelium of the foot appears to be the tissue most sensitive to insult and the first "organ" to fail. Metabolomics performed on serum samples collected before (Con) and after (Lmn) experimental induction of gastrointestinal-associated sepsis in six horses detected 1,177 metabolites of both mammalian and bacterial origin in equine serum. Network and correlation analyses suggested a dysregulation of fatty acid metabolism in the Lmn group, as well as an accumulation of organic acids such as lactate. Furthermore, concentrations of the amino acid citrulline were decreased in Lmn samples from all study animals, suggesting that citrulline might be useful as a biomarker to identify critically ill animals that are at risk of developing laminitis. We therefore established normal ranges of plasma citrulline concentrations in a separate group of horses (n = 36) and tested the ability of citrulline to predict adverse outcomes (laminitis or death) in critically ill horses (n = 23). Plasma citrulline was significantly lower in critically ill horses that went on to experience adverse outcomes (n = 6). Further study is required to accurately determine a diagnostic cutoff, but the present data are suggestive of the predictive value of citrulline as a biomarker for laminar failure in equine sepsis. PMID:24619519

  14. The demographics of significant firearm injury in Canadian trauma centres and the associated predictors of inhospital mortality

    PubMed Central

    Finley, Christian J.; Hemenway, David; Clifton, Joanne; Brown, D. Ross; Simons, Richard K.; Hameed, S. Morad

    2008-01-01

    Objective Our primary objective was to evaluate demographic and causal factors of inhospital mortality for significant firearm-related injuries (i.e., those with an Injury Severity Score [ISS] > 12) in Canadian trauma centres. Methods We analyzed data submitted to the Canadian Institute for Health Information (CIHI) in the National Trauma Registry for all firearm-injured patients for fiscal years 1999–2003. Univariate and bivariate adjusting for ISS and multivariate logistic regression were performed. Results Men accounted for 94% of the 784 injured. In all patients, the percentages of self-inflicted, intentional, unintentional and unknown injuries were 27.8%, 60.3%, 6.1% and 5.7%, respectively. The inhospital fatality rate was 39.8%, with 83% of fatalities occurring on the first day. Two-thirds of patients were discharged home. Univariate and adjusted analysis found that ISS, first systolic blood pressure (BP), first systolic BP under 100, first Glasgow Coma Scale (GCS) score, age over 45 years, self-inflicted injury, intentional injury and injury at home significantly worsened the odds ratio of death in hospital and that police shooting was relatively beneficial. BP under 100, age over 45 years and a low GCS score had an adjusted odds ratio of death of 4.12, 1.99 and 0.64 per point increase, respectively. The multivariate model showed that ISS, BP under 100, first GCS score, sex and self-inflicted injury were significant in predicting inhospital death. Conclusion A predominance of young men are injured intentionally with handguns in Canada, whereas older patients suffer self-inflicted injuries with long guns. The significant number of firearm deaths, largely in the first day, highlights the importance of preventative strategies and the need for rapid transport of patients to trauma centres for urgent care. PMID:18682765

  15. Heart rate variables in the Vascular Quality Initiative are not reliable predictors of adverse cardiac outcomes or mortality after major elective vascular surgery

    PubMed Central

    Scali, Salvatore; Bertges, Daniel; Neal, Daniel; Patel, Virendra; Eldrup-Jorgensen, Jens; Cronenwett, Jack; Beck, Adam

    2015-01-01

    associations disappeared in controlling for beta-blocker status. For AFB and open AAA repair patients, there was no significant association between AHR and MACE or 30-day mortality, irrespective or cardiac risk or beta-blocker status. DHR and extremes of highest intraoperative HR (>90 or 100 beats/min) were analyzed among all three operations, and no consistent associations with MACE or 30-day mortality were detected. Conclusions The VQI AHR and highest intraoperative HR variables are highly confounded by patient presentation, operative variables, and beta-blocker therapy. The discordance between cardiac risk and HR as well as the lack of consistent correlation to outcome makes them unreliable predictors. The VQI has elected to discontinue collecting AHR and highest intraoperative HR data, given insufficient evidence to suggest their importance as an outcome measure. PMID:26067200

  16. Predictors of Teacher Intervention in Indirect Bullying at School and Outcome of a Professional Development Presentation for Teachers

    ERIC Educational Resources Information Center

    Dedousis-Wallace, Anna; Shute, Rosalyn; Varlow, Megan; Murrihy, Rachael; Kidman, Tony

    2014-01-01

    This study with 326 girls-school teachers developed and tested a model of predictors of the likelihood that teachers will intervene in indirect bullying, and evaluated a professional development presentation. Teachers responded to bullying vignettes before and after a presentation on indirect bullying (Experimentals) or adolescent mental health…

  17. Indirect Bullying: Predictors of Teacher Intervention, and Outcome of a Pilot Educational Presentation about Impact on Adolescent Mental Health

    ERIC Educational Resources Information Center

    Dedousis-Wallace, Anna; Shute, Rosalyn H.

    2009-01-01

    We examined teacher characteristics predicting likelihood of intervening in indirect bullying (N=55) and piloted a 45-minute educational presentation about its mental health impact. Teachers' global empathy and perceived seriousness of indirect bullying vignettes were predictors of their likelihood of intervening, but knowledge of mental health…

  18. Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi.

    PubMed

    Lee, Joo Yong; Kim, Jae Heon; Kang, Dong Hyuk; Chung, Doo Yong; Lee, Dae Hun; Do Jung, Hae; Kwon, Jong Kyou; Cho, Kang Su

    2016-01-01

    We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive database of 1,519 patients who underwent the first session of SWL for urinary stones between 2005 and 2013. Ultimately, 604 patients with radiopaque ureteral stones were eligible for this study. Stone related variables including stone size, mean stone density (MSD), skin-to-stone distance, and SHI were obtained on NCCT. Patients were classified into the low and high SHI groups using mean SHI and compared. One-session success rate in the high SHI group was better than in the low SHI group (74.3% vs. 63.9%, P = 0.008). Multivariate logistic regression analyses revealed that smaller stone size (OR 0.889, 95% CI: 0.841-0.937, P < 0.001), lower MSD (OR 0.995, 95% CI: 0.994-0.996, P < 0.001), and higher SHI (OR 1.011, 95% CI: 1.008-1.014, P < 0.001) were independent predictors of one-session success. The radiologic heterogeneity of urinary stones or SHI was an independent predictor for SWL success in patients with ureteral calculi and a useful clinical parameter for stone fragility. PMID:27035621

  19. Patients with polycythemia vera and essential thrombocythemia with prior malignancy do not have significantly worse outcome.

    PubMed

    Cherry, Mohamad; Cardenas-Turanzas, Marylou; Pham, Hannah; Kantarjian, Hagop; Cortes, Jorge; Pierce, Sherry; Zhou, Lingsha; Verstovsek, Srdan

    2013-11-01

    The clinical relevance of prior malignancy (PM) in patients with essential thrombocythemia (ET) and polycythemia vera (PV) is largely unknown. We retrospectively evaluated 437 patients (ET, n=263; PV, n=174) treated at MD Anderson between 1960 and 2010. Forty-four patients had PM (ET, 10%; PV, 11%), with median time to diagnosis of 66 months. PM was not associated with abnormal cytogenetics, JAK2-mutation frequency, blood-cell counts or progression to acute leukemia or myelofibrosis. In multivariate analysis, only older age and high LDH levels were associated with worse OS. In conclusion, PM does not predict worse outcomes for patients with ET and PV. PMID:23993426

  20. Regardless of central obesity, metabolic syndrome is a significant predictor of type 2 diabetes in Japanese Americans

    PubMed Central

    Sakashita, Yu; Nakanishi, Shuhei; Yoneda, Masayasu; Nakashima, Reiko; Yamane, Kiminori; Kohno, Nobuoki

    2015-01-01

    Aims/Introduction The impact of metabolic syndrome (MetS) on the development of type 2 diabetes has been reported in different ethnic populations. However, whether central obesity is an essential component as a diagnostic criterion for MetS remains a controversial topic. The aim of the present study was to investigate the association between MetS and the incidence of type 2 diabetes with or without central obesity in a Japanese American population. Materials and Methods We examined whether MetS predicts incident type 2 diabetes among 928 Japanese American participants who did not have diabetes enrolled in an ongoing medical survey between 1992 and 2007. MetS was defined on the basis of American Heart Association/National Heart, Lung, and Blood Institute criteria. The average follow-up period was approximately 6.8 years. Results During the follow-up period, 116 new cases of diabetes were diagnosed. Compared to the participants without MetS, the hazard ratio (HR) for incident type 2 diabetes was significantly higher in participants with MetS, after adjustment for sex, age and impaired glucose tolerance (HR 1.64, 95% CI 1.11–2.42). The risk of type 2 diabetes was found to be significantly higher in participants with MetS but without central obesity (HR 2.07, 95% CI 1.25–3.41), as well as in participants with MetS and with central obesity (HR 2.46, 95% CI 1.51–4.01) than in participants with neither MetS nor central obesity, after adjustment for sex, age and impaired glucose tolerance. Conclusions These results show that the presence of MetS, with or without central obesity, could independently predict the development of type 2 diabetes in Japanese Americans. PMID:26417409

  1. Calculating Clinically Significant Change: Applications of the Clinical Global Impressions (CGI) Scale to Evaluate Client Outcomes in Private Practice

    ERIC Educational Resources Information Center

    Kelly, Peter James

    2010-01-01

    The Clinical Global Impressions (CGI) scale is a therapist-rated measure of client outcome that has been widely used within the research literature. The current study aimed to develop reliable and clinically significant change indices for the CGI, and to demonstrate its application in private psychological practice. Following the guidelines…

  2. Predictors of Significant Worsening of Patient-Reported Fatigue over a One-Month Timeframe in Ambulatory Patients with Common Solid Tumors

    PubMed Central

    Fisch, Michael J.; Zhao, Fengmin; O'Mara, Ann M.; Wang, Xin Shelley; Cella, David; Cleeland, Charles S.

    2014-01-01

    Purpose Understanding the determinants of fatigue worsening may help distinguish between different fatigue phenotypes and inform clinical trial designs. Patients and Methods Patients with invasive cancer of the breast, prostate, colon/rectum, or lung were enrolled from multiple sites. At enrollment during an outpatient visit and 4–5 weeks later patients rated their symptoms on a 0–10 numerical rating scale. A 2-point change was considered clinically significant for fatigue change. Effects of demographic and clinical factors on patient-reported fatigue were examined using logistic regression models. Results 3123 patients were enrolled at baseline and 3032 were analyzable for fatigue change. At baseline, 23% had no fatigue, 35% mild, 25% moderate, and 17% severe. Key parameters in our model of fatigue worsening includes fatigue at baseline (OR 0.75), disease status (OR 1.99), performance status (OR 1.38), history of depression (OR 1.28), patient perception of bother due to comorbidity (OR 1.26) and treatment exposures including recent cancer treatment (OR 1.77), and use of corticosteroids (1.37). The impact of gender was examined only in colorectal and lung cancer patients, and it was a significant factor with men most likely to experience worsening of fatigue (OR=1.46). Conclusions Predictors of fatigue worsening include multiple factors that are difficult to modify: baseline fatigue level, gender, disease status, performance status, recent cancer treatment, bother due to comorbidity, and history of depression. Future fatigue prevention and treatment trial designs should account for key predictors of worsening fatigue. PMID:24151111

  3. Psychological factors predict adherence to methotrexate in rheumatoid arthritis; findings from a systematic review of rates, predictors and associations with patient-reported and clinical outcomes

    PubMed Central

    Bluett, James; Barton, Anne; Hyrich, Kimme L; Cordingley, Lis; Verstappen, Suzanne M M

    2016-01-01

    Treatment response to methotrexate (MTX) for rheumatoid arthritis (RA) is not universal and non-adherence may partially explain this. The aims of this systematic review were to: (1) summarise existing rates of adherence to MTX, (2) identify predictors of adherence to MTX, and (3) assess the association between non-adherence and patient outcomes. The authors conducted a systematic search of papers published from January 1980 to February 2015 in PubMed, PsycINFO, EMBASE and CINAHL databases. Studies were eligible for inclusion if: (1) MTX was used as monotherapy or in combination with other therapies, (2) MTX was used in an RA or inflammatory polyarthritis population, (3) adherence was defined and measured as the extent to which patients followed their MTX regimen during the period of prescription, and (4) it was an original piece of research. In total, 10 studies met the inclusion criteria and 8 were evaluated as high quality. Rates of adherence ranged from 59% to 107%, and exposed differences in definitions of adherence, study methodologies and sample heterogeneity. A number of potential predictors of MTX adherence were identified; the strongest being related to beliefs in the necessity and efficacy of MTX, absence of low mood, mild disease and MTX monotherapy. Furthermore, 3 studies tested the association of adherence with disease activity as an outcome measure; all 3 found non-adherence associated with poor treatment response. This systematic review shows the importance of adherence to MTX treatment and summarises the associated modifiable factors. PMID:26848403

  4. Optimal Skin-to-Stone Distance Is a Positive Predictor for Successful Outcomes in Upper Ureter Calculi following Extracorporeal Shock Wave Lithotripsy: A Bayesian Model Averaging Approach

    PubMed Central

    Cho, Kang Su; Jung, Hae Do; Ham, Won Sik; Chung, Doo Yong; Kang, Yong Jin; Jang, Won Sik; Kwon, Jong Kyou; Choi, Young Deuk; Lee, Joo Yong

    2015-01-01

    Objectives To investigate whether skin-to-stone distance (SSD), which remains controversial in patients with ureter stones, can be a predicting factor for one session success following extracorporeal shock wave lithotripsy (ESWL) in patients with upper ureter stones. Patients and Methods We retrospectively reviewed the medical records of 1,519 patients who underwent their first ESWL between January 2005 and December 2013. Among these patients, 492 had upper ureter stones that measured 4–20 mm and were eligible for our analyses. Maximal stone length, mean stone density (HU), and SSD were determined on pretreatment non-contrast computed tomography (NCCT). For subgroup analyses, patients were divided into four groups. Group 1 consisted of patients with SSD<25th percentile, group 2 consisted of patients with SSD in the 25th to 50th percentile, group 3 patients had SSD in the 50th to 75th percentile, and group 4 patients had SSD≥75th percentile. Results In analyses of group 2 patients versus others, there were no statistical differences in mean age, stone length and density. However, the one session success rate in group 2 was higher than other groups (77.9% vs. 67.0%; P = 0.032). The multivariate logistic regression model revealed that shorter stone length, lower stone density, and the group 2 SSD were positive predictors for successful outcomes in ESWL. Using the Bayesian model-averaging approach, longer stone length, lower stone density, and group 2 SSD can be also positive predictors for successful outcomes following ESWL. Conclusions Our data indicate that a group 2 SSD of approximately 10 cm is a positive predictor for success following ESWL. PMID:26659086

  5. Prenatal Diagnosis and Evaluation of Sonographic Predictors for Intervention and Adverse Outcome in Congenital Pulmonary Airway Malformation

    PubMed Central

    Hellmund, Astrid; Berg, Christoph; Geipel, Annegret; Bludau, Meike; Heydweiller, Andreas; Bachour, Haitham; Müller, Andreas; Müller, Annette; Gembruch, Ulrich

    2016-01-01

    Objective To describe antenatal findings and evaluate prenatal risk parameters for adverse outcome or need for intervention in fetuses with congenital pulmonary airway malformation (CPAM). Methods In our retrospective study all fetuses with a prenatal diagnosis of CPAM detected in our tertiary referral center between 2002 and 2013 were analyzed. Sonographic findings were noted and measurements of mass-to-thorax-ratio (MTR), congenital pulmonary airway malformation volume-ratio (CVR) and observed to expected lung-to head-ratio (o/e LHR) were conducted and correlated to fetal or neonatal morbidity and mortality and/or need for prenatal intervention. Results 67 fetuses with CPAM were included in the study. Hydropic fetuses were observed in 16.4% (11/67) of cases, prenatal intervention was undertaken in 9 cases; 7 pregnancies were terminated. The survival rate of non-hydropic fetuses with conservatively managed CPAM was 98.0% (50/51), the survival rate for hydropic fetuses with intention to treat was 42.9% (3/7). 10 (18.2%) children needed respiratory assistance. Fetuses with a CVR of <0.91 were significantly less likely to experience adverse outcome or need for prenatal intervention with sensitivity, specificity and positive/negative predictive value of 0.89, 0.71, 0.62 and 0.93, respectively. A MTR (mass-to-thorax-ratio) of < 0.51 had a positive predictive value of 0.54 and a negative predictive value of 0.96 of adverse events with a sensitivity of 0.95 and a specificity of 0.63. The negative predictive value for o/e LHR of 45% was 0.84 with sensitivity, specificity and positive predictive value of 0.73, 0.68 and 0.52, respectively. Conclusions The majority of cases with CPAM have a favorable outcome. MTR and CVR are able to identify fetuses at risk, the o/e LHR is less sensitive. PMID:26978067

  6. Blood mitochondrial enzymatic assay as a predictor of long-term outcome in severe traumatic brain injury.

    PubMed

    Sinha, Sumit; Raheja, Amol; Samson, Neha; Bhoi, Sanjeev; Selvi, Arul; Sharma, Pushpa; Sharma, Bhawani Shankar

    2016-08-01

    Recent studies have observed the central role of mitochondrial dysfunction in severe traumatic brain injury (sTBI). One hundred and seven sTBI patients (18-65years old, presenting within 8hours of injury) were randomised for a placebo controlled phase II trial of progesterone with or without hypothermia. We serially analysed blood mitochondrial enzymes (Complex I [C1], Complex IV [C4] and pyruvate dehydrogenase complex [PDH]) using a dipstick assay at admission and 7days later for 37 patients, irrespective of assigned group. Favorable Glasgow Outcome Scale (GOS) at 1year was associated with admission C1 levels above 0.19μg, admission C4 levels above 0.19μg and day 7 C1 levels above 0.17μg, all per 25μl of blood. Unfavorable GOS at 1year was associated with admission serum PDH levels above 0.23μg/25μl of blood. Survivors at 1year had significantly higher admission serum C1 levels above 0.19μg/25μl and day 7 C1 levels above 0.17μg/25μl. To our knowledge this is the first clinical trial associating blood mitochondrial enzymes with long-term outcome in sTBI. Serial monitoring and optimisation of blood C1, C4 and PDH levels could aid in prognostication and potentially guide in using mitochondrial targeted therapies. Blood mitochondrial enzymatic assay might suggest global reduction-oxidation status. PMID:27262871

  7. Are serum cytokines early predictors for the outcome of burn patients with inhalation injuries who do not survive?

    PubMed Central

    Gauglitz, Gerd G; Finnerty, Celeste C; Herndon, David N; Mlcak, Ronald P; Jeschke, Marc G

    2008-01-01

    Introduction Severely burned patients suffering from inhalation injury have a significantly increased risk for mortality compared with burned patients without inhalation injury. Severe burn is associated with a distinct serum cytokine profile and alterations in cytokines that contribute to morbidity and mortality. The aim of the present study was therefore to determine whether severely burned pediatric patients with concomitant inhalation injury who had a fatal outcome exhibited a different serum cytokine profile compared with burn patients with inhalation injury who survived. Early identification followed by appropriate management of these high-risk patients may lead to improved clinical outcome. Methods Thirteen severely burned children with inhalation injury who did not survive and 15 severely burned pediatric patients with inhalation injury who survived were enrolled in the study. Blood was collected within 24 hours of admission and 5 to 7 days later. Cytokine levels were profiled using multiplex antibody coated beads. Inhalation injury was diagnosed by bronchoscopy during the initial surgery. The number of days on the ventilator, peak inspiratory pressure rates, arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio and incidence of acute respiratory distress syndrome were recorded for those patients. Results Significantly altered levels of IL-4, IL-6, IL-7, IL-10, and IL-13 were detected within the first 7 days after admission in serum from burn pediatric patients with concomitant inhalation injury who did not survive when compared with similar patients who did (P < 0.05). Alterations in these cytokines were associated with increased incidence of acute respiratory distress syndrome, number of days under ventilation, increased peak inspiratory pressure, and lower PaO2/FiO2 ratio in this patient population. Multiple logistic regression analysis revealed that patients with increased IL-6 and IL-10 as well as decreased IL-7 serum levels had a

  8. The UKCAT-12 study: educational attainment, aptitude test performance, demographic and socio-economic contextual factors as predictors of first year outcome in a cross-sectional collaborative study of 12 UK medical schools

    PubMed Central

    2013-01-01

    Background Most UK medical schools use aptitude tests during student selection, but large-scale studies of predictive validity are rare. This study assesses the United Kingdom Clinical Aptitude Test (UKCAT), and its four sub-scales, along with measures of educational attainment, individual and contextual socio-economic background factors, as predictors of performance in the first year of medical school training. Methods A prospective study of 4,811 students in 12 UK medical schools taking the UKCAT from 2006 to 2008 as a part of the medical school application, for whom first year medical school examination results were available in 2008 to 2010. Results UKCAT scores and educational attainment measures (General Certificate of Education (GCE): A-levels, and so on; or Scottish Qualifications Authority (SQA): Scottish Highers, and so on) were significant predictors of outcome. UKCAT predicted outcome better in female students than male students, and better in mature than non-mature students. Incremental validity of UKCAT taking educational attainment into account was significant, but small. Medical school performance was also affected by sex (male students performing less well), ethnicity (non-White students performing less well), and a contextual measure of secondary schooling, students from secondary schools with greater average attainment at A-level (irrespective of public or private sector) performing less well. Multilevel modeling showed no differences between medical schools in predictive ability of the various measures. UKCAT sub-scales predicted similarly, except that Verbal Reasoning correlated positively with performance on Theory examinations, but negatively with Skills assessments. Conclusions This collaborative study in 12 medical schools shows the power of large-scale studies of medical education for answering previously unanswerable but important questions about medical student selection, education and training. UKCAT has predictive validity as a

  9. Psychiatric Outcome Over a Decade After Electrical Injury: Depression as a Predictor of Long-Term Adjustment.

    PubMed

    Hahn-Ketter, Amanda; Aase, Darrin M; Paxton, Jessica; Fink, Joseph W; Kelley, Kathleen M; Lee, Raphael C; Pliskin, Neil H

    2015-01-01

    Electrical injury (EI) produces a variety of physical, cognitive, and emotional consequences. Psychiatric and neurocognitive symptoms may complicate survivors' psychosocial adjustment and ability to return to work. However, due to a paucity of longitudinal research, the long-term course of EI remains poorly understood. The purpose of this study was to investigate psychiatric and functional status in EI patients over a decade after injury. Fourteen EI patients who originally underwent baseline neuropsychological evaluation participated in this long-term follow-up. Participants completed a telephone survey of functional status, neuropsychological symptom checklist, and the Psychosocial Adjustment to Illness Scale Self-Report. Participants were grouped according to baseline Beck Depression Inventory (BDI) scores. After an average of 12.36 years postinjury, participants with elevated baseline BDI scores experienced difficulty across multiple domains of psychosocial adjustment at follow-up. This group was also less likely to return to work and exhibited a significant increase in psychological distress. EI results in significant chronic psychiatric complaints for many survivors. In the current sample, psychiatric sequelae of EI continue to persist over a decade after injury. Moreover, elevated baseline BDI scores predicted worse outcomes for vocational and psychosocial adjustment. Findings underscore the impact of emotional symptoms on recovery and need for specialized psychiatric intervention immediately following injury. PMID:25377863

  10. Anion gap as a predictor of trauma outcomes in the older trauma population: correlations with injury severity and mortality.

    PubMed

    Leskovan, John J; Justiniano, Carla F; Bach, John A; Cook, Charles H; Lindsey, David E; Eiferman, Daniel S; Papadimos, Thomas J; Steinberg, Steven M; Bergese, Sergio D; Stawicki, Stanislaw P A; Evans, David C

    2013-11-01

    The relationship among traumatic injury, the associated metabolic/physiologic responses, and mortality is well established. Tissue hypoperfusion and metabolic derangement may not universally correlate with initial clinical presentation. We hypothesized that anion gap (AG) could be a useful gauge of trauma-related physiologic response and mortality in older patients with relatively lower injury acuity. We retrospectively analyzed data from 711 trauma patients older than 45 years. Parameters examined included demographics, injury characteristics, laboratories, morbidity, and mortality. Univariate and survival analyses were performed using PASW 18. A stepwise correlation exists between increasing Injury Severity Score and AG. Although AG less than 8 to 15 was not associated with a significant increase in mortality, greater mortality was seen for AG greater than 16 with further stepwise increases for AGs greater than 22. Anion gap correlated moderately with serum lactate and poorly with base excess. Increasing AG also correlated with morbidity and greater incidence of intensive care admissions. The presence of any complication increased from 28.6 per cent for patients with AG 12 or less to 45.5 per cent for patients with AG 22 or greater (P < 0.04). These findings support the contention that "low acuity" trauma patients with high AGs may not appear acutely ill but may harbor significant underlying metabolic and physiologic disturbances that could contribute to morbidity and mortality. Higher AG values (i.e., greater than 16) may be associated with worse clinical outcomes. PMID:24165258

  11. Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial

    PubMed Central

    Budohoski, Karol; Smith, Christopher; Hutchinson, Peter J.; Kirkpatrick, Peter J.

    2015-01-01

    BACKGROUND: There remains a proportion of patients with unfavorable outcomes after aneurysmal subarachnoid hemorrhage, of particular relevance in those who present with a good clinical grade. A forewarning of those at risk provides an opportunity towards more intensive monitoring, investigation, and prophylactic treatment prior to the clinical manifestation of advancing cerebral injury. OBJECTIVE: To assess whether biochemical markers sampled in the first days after the initial hemorrhage can predict poor outcome. METHODS: All patients recruited to the multicenter Simvastatin in Aneurysmal Hemorrhage Trial (STASH) were included. Baseline biochemical profiles were taken between time of ictus and day 4 post ictus. The t-test compared outcomes, and a backwards stepwise binary logistic regression was used to determine the factors providing independent prediction of an unfavorable outcome. RESULTS: Baseline biochemical data were obtained in approximately 91% of cases from 803 patients. On admission, 73% of patients were good grade (World Federation of Neurological Surgeons grades 1 or 2); however, 84% had a Fisher grade 3 or 4 on computed tomographic scan. For patients presenting with good grade on admission, higher levels of C-reactive protein, glucose, and white blood cells and lower levels of hematocrit, albumin, and hemoglobin were associated with poor outcome at discharge. C-reactive protein was found to be an independent predictor of outcome for patients presenting in good grade. CONCLUSION: Early recording of C-reactive protein may prove useful in detecting those good grade patients who are at greater risk of clinical deterioration and poor outcome. ABBREVIATIONS: ALP, alkaline phosphatase ALT, alanine aminotransferase CK, creatine kinase CRP, C-reactive protein EVD, external ventricular drainage ICH GCP, International Conference on Harmonisation guidelines for good clinical practice mRS, modified Rankin Scale SAH, subarachnoid hemorrhage STASH, Simvastatin in

  12. Biomarkers of treatment outcome in schizophrenia: Defining a benchmark for clinical significance.

    PubMed

    Levine, Stephen Z; Rabinowitz, Jonathan; Uher, Rudolf; Kapur, Shitij

    2015-10-01

    Emerging data from on imaging and genetic studies have generated interest in "clinically significant" biomarkers to predict response and prognosis. What constitutes "clinical significance" and how a biomarker would reach that threshold are unclear. To develop a benchmark we reviewed different approaches for defining "clinical significance" applied in schizophrenia research and identified that an improvement of 15 points on the PANSS Total is considered meaningful in clinical settings. Using this benchmark and we simulated thousands of schizophrenia trials, using characteristics derived from the NEWMEDS database with over 8000 patients with schizophrenia, to the kind of imaging, genetic, and other biomarkers that could attain clinical significance. We plotted the interaction between frequency-of-occurrence, the effect size of biomarkers and their relationship to the clinical significance threshold. Results show that categorical biomarkers are likely to attain clinical significance when they occur in 20-50% of the clinical population, and can predict at least a 8-10 point PANSS scale difference. Genetic markers are likely to have clinical significance when they occur in 20-50% of the population and can predict 7-9 points on the PANSS scale. A marker with a lower frequency or lesser effect size would find it hard to meet clinical significance thresholds for schizophrenia. The assumptions and limitations of this approach are discussed. Compared with standards in the rest of medicine, biomarkers that can attain this benchmark will be cost-effective and are likely to be adopted by clinical systems. PMID:26145487

  13. Predictor Variables in Computer Assisted Language Learning.

    ERIC Educational Resources Information Center

    Clark, Stephen K.

    1992-01-01

    Investigates several instruments measuring intelligence and prior conceptual knowledge/achievement to determine how well they predict outcomes in computer assisted language learning. Concludes that a non-verbal intelligence test was a significant predictor, but that prior conceptual knowledge of course content was low. Level of prior achievement…

  14. Evidence of clinically significant change: the therapeutic alliance and the possibilities of outcomes-informed care.

    PubMed

    Manning, Walter H

    2010-11-01

    This article addresses the issue of clinically significant (or meaningful) change resulting from treatment for stuttering. Research in both medical and behavioral fields indicates that clients often have their own unique perspective of meaningful clinical change and that this perspective is often different from that of the professional administering the treatment. Among the variables that the client brings to the treatment session are their progression through stages of therapeutic change and the ways in which they believe they are capable of coping with their problem. Research has shown that how an individual interprets the meaning his or her therapeutic experience is central to clinically significant change. Procedures for obtaining feedback from clients concerning clinically significant change and the quality of the therapeutic alliance are described. PMID:21080293

  15. Reduction of Subjective Distress in CBT for Childhood OCD: Nature of Change, Predictors, and Relation to Treatment Outcome

    PubMed Central

    Kircanski, Katharina; Wu, Monica; Piacentini, John

    2013-01-01

    Little research has investigated changes in subjective distress during cognitive-behavioral therapy (CBT) for anxiety disorders in youth. In the current study, 40 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age=11.9 years, 60% male, 80% Caucasian) and 36 parent informants completed separate weekly ratings of child distress for each OC symptom during a 12-session course of CBT. Between-session changes in distress were calculated at the start of, on average throughout, and at the end of treatment. On average throughout treatment, child- and parent-reported decreases in child distress were significant. Baseline OCD severity, functional impairment, and internalizing symptoms predicted degree of change in child distress. Additionally, greater decreases in child distress were predictive of more improved clinical outcomes. Findings advance our understanding of the strengths and limitations of this clinical tool. Future studies should examine youth distress change between and within CBT sessions across both subjective and psychophysiological levels of analysis. PMID:23774008

  16. Baseline depression severity as a predictor of single and combination antidepressant treatment outcome: results from the CO-MED trial.

    PubMed

    Friedman, Edward S; Davis, Lori L; Zisook, Sidney; Wisniewski, Stephen R; Trivedi, Madhukar H; Fava, Maurizio; Rush, A John

    2012-03-01

    The objective of this manuscript is to report associations between baseline depressive severity and (1) baseline sociodemographic and clinical characteristics, (2) treatment outcomes, and (3) differential outcomes for three treatment groups. Six hundred and sixty-five outpatients with nonpsychotic, major depressive disorder were prospectively randomized to treatment with either a selective serotonin reuptake inhibitor (SSRI) monotherapy (escitalopram plus placebo) or one of two antidepressant medication combinations (bupropion-sustained release plus escitalopram, or venlafaxine-extended release plus mirtazapine). For purposes of these analyses, participants were divided into four groups based on baseline severity by the 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR(16)) total score: mild (0-10) [N=81], moderate (11-15) [N=238], severe (16-20) [N=260] and very severe (21-27) [N=67]. Treatment outcomes at 12 and 28weeks were compared among the four severity groups. A history of childhood neglect and/or abuse was strongly associated with the severity of adult depression (1/2 of participants in the very severe group versus 1/5-1/4 of those in the mild group reported abuse and/or neglect). The degree of suicidality (e.g., 15/.4% of the very severe group ever attempted suicide versus none in the mild group), the number of suicide attempts (e.g., mean of .41±1.99 suicide attempts in the severe group versus 0.0±0.0 in the mild group) and severity of suicidality (e.g., 9.2% of participants in very severe group had a plan or made a gesture versus 5.6% in moderate group and none in the mild group) were increased in more severe groups. Participants with a greater baseline depressive severity reported significantly more psychiatric comorbidities (e.g. [at p<.05] increased rates of agoraphobia, bulimia, generalized anxiety, hypocondriasis, panic disorder, post-traumatic stress disorder, social phobia and somatoform disorder, with 23.9% of

  17. Betaine and Trimethylamine-N-Oxide as Predictors of Cardiovascular Outcomes Show Different Patterns in Diabetes Mellitus: An Observational Study

    PubMed Central

    Lever, Michael; George, Peter M.; Slow, Sandy; Bellamy, David; Young, Joanna M.; Ho, Markus; McEntyre, Christopher J.; Elmslie, Jane L.; Atkinson, Wendy; Molyneux, Sarah L.; Troughton, Richard W.; Frampton, Christopher M.; Richards, A. Mark; Chambers, Stephen T.

    2014-01-01

    Background Betaine is a major osmolyte, also important in methyl group metabolism. Concentrations of betaine, its metabolite dimethylglycine and analog trimethylamine-N-oxide (TMAO) in blood are cardiovascular risk markers. Diabetes disturbs betaine: does diabetes alter associations between betaine-related measures and cardiovascular risk? Methods Plasma samples were collected from 475 subjects four months after discharge following an acute coronary admission. Death (n = 81), secondary acute MI (n = 87), admission for heart failure (n = 85), unstable angina (n = 72) and all cardiovascular events (n = 283) were recorded (median follow-up: 1804 days). Results High and low metabolite concentrations were defined as top or bottom quintile of the total cohort. In subjects with diabetes (n = 79), high plasma betaine was associated with increased frequencies of events; significantly for heart failure, hazard ratio 3.1 (1.2–8.2) and all cardiovascular events, HR 2.8 (1.4–5.5). In subjects without diabetes (n = 396), low plasma betaine was associated with events; significantly for secondary myocardial infarction, HR 2.1 (1.2–3.6), unstable angina, HR 2.3 (1.3–4.0), and all cardiovascular events, HR 1.4 (1.0–1.9). In diabetes, high TMAO was a marker of all outcomes, HR 2.7 (1.1–7.1) for death, 4.0 (1.6–9.8) for myocardial infarction, 4.6 (2.0–10.7) for heart failure, 9.1 (2.8–29.7) for unstable angina and 2.0 (1.1–3.6) for all cardiovascular events. In subjects without diabetes TMAO was only significant for death, HR 2.7 (1.6–4.8) and heart failure, HR 1.9 (1.1–3.4). Adding the estimated glomerular filtration rate to Cox regression models tended to increase the apparent risks associated with low betaine. Conclusions Elevated plasma betaine concentration is a marker of cardiovascular risk in diabetes; conversely low plasma betaine concentrations indicate increased risk in the absence of diabetes. We speculate that the

  18. Significant Effect of Polymorphisms in CYP2D6 and ABCC2 on Clinical Outcomes of Adjuvant Tamoxifen Therapy for Breast Cancer Patients

    PubMed Central

    Kiyotani, Kazuma; Mushiroda, Taisei; Imamura, Chiyo K.; Hosono, Naoya; Tsunoda, Tatsuhiko; Kubo, Michiaki; Tanigawara, Yusuke; Flockhart, David A.; Desta, Zeruesenay; Skaar, Todd C.; Aki, Fuminori; Hirata, Koichi; Takatsuka, Yuichi; Okazaki, Minoru; Ohsumi, Shozo; Yamakawa, Takashi; Sasa, Mitsunori; Nakamura, Yusuke; Zembutsu, Hitoshi

    2010-01-01

    Purpose The clinical efficacy of tamoxifen is suspected to be influenced by the activity of drug-metabolizing enzymes and transporters involved in the formation, metabolism, and elimination of its active forms. We investigated relationships of polymorphisms in transporter genes and CYP2D6 to clinical outcome of patients receiving tamoxifen. Patients and Methods We studied 282 patients with hormone receptor–positive, invasive breast cancer receiving tamoxifen monotherapy, including 67 patients who have been previously reported. We investigated the effects of allelic variants of CYP2D6 and haplotype-tagging single nucleotide polymorphisms (tag-SNPs) of ABCB1, ABCC2, and ABCG2 on recurrence-free survival using the Kaplan-Meier method and Cox regression analysis. Plasma concentrations of tamoxifen metabolites were measured in 98 patients receiving tamoxifen 20 mg/d. Results CYP2D6 variants were significantly associated with shorter recurrence-free survival (P = .000036; hazard ratio [HR] = 9.52; 95% CI, 2.79 to 32.45 in patients with two variant alleles v patients without variant alleles). Among 51 tag-SNPs in transporter genes, a significant association was found at rs3740065 in ABCC2 (P = .00017; HR = 10.64; 95% CI, 1.44 to 78.88 in patients with AA v GG genotypes). The number of risk alleles of CYP2D6 and ABCC2 showed cumulative effects on recurrence-free survival (P = .000000055). Patients carrying four risk alleles had 45.25-fold higher risk compared with patients with ≤ one risk allele. CYP2D6 variants were associated with lower plasma levels of endoxifen and 4-hydroxytamoxifen (P = .0000043 and .00052), whereas no significant difference was found among ABCC2 genotype groups. Conclusion Our results suggest that polymorphisms in CYP2D6 and ABCC2 are important predictors for the prognosis of patients with breast cancer treated with tamoxifen. PMID:20124171

  19. Incidence, Predictors and Impact of Severe Periprocedural Bleeding According to VARC-2 Criteria on 1-Year Clinical Outcomes in Patients After Transcatheter Aortic Valve Implantation.

    PubMed

    Kochman, Janusz; Rymuza, Bartosz; Huczek, Zenon; Kołtowski, Łukasz; Ścisło, Piotr; Wilimski, Radosław; Ścibisz, Anna; Stanecka, Paulina; Filipiak, Krzysztof J; Opolski, Grzegorz

    2016-01-01

    There are differences in reporting bleeding complications after transcatheter aortic valve implantation (TAVI), which is a consequence of the lack of consensus for their definition. Furthermore, the amount of data on the impact of peri-procedural bleeding on the mid-term prognosis is still limited. The aim of this study was to investigate the incidence, predictors, and impact of life-threatening and major bleedings as defined by the Valve Academic Research Consortium 2 (VARC-2) in patients after TAVI over the mid-term prognosis.Consecutive patients who underwent TAVI from March 2010 to December 2013 were included. All data were classified according to the VARC-2 criteria. We assessed the incidence and the predictors of serious bleeding events (SBE), defined as life-threatening/disabling (LT/D) or major bleeding, and analyzed their impact on 30-day and 1-year clinical outcome.A total of 129 patients were included (79.1 ± 8.3 years; mean EuroSCORE = 17.8 ± 12.7). The SBE occurred in 25 patients (19.4%), of which 9 (7.0%) had LT/D and 16 (12.4%) had major bleeding. Trans-subclavian (TS) access (OR 4.38, 95% CI 2.13-14.29, P = 0.01) and diabetes (OR 2.93, 95% CI 1.08-7.93, P = 0.03) were identified as independent predictors of SBE. Patients with SBE had higher 30-day mortality (20.0% versus 4.0% P = 0.02) and 1-year mortality (40.0% versus 11.1%, P < 0.002). SBE independently predicted 1-year, all-cause mortality (HR 5.88, 95% CI 1.7319,94, P = 0.005).SBE are frequent after TAVI and are associated with decreased short and mid-term survival. Diabetes and TS access are independent risk factors for SBE. PMID:26673439

  20. Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi

    PubMed Central

    Lee, Joo Yong; Kim, Jae Heon; Kang, Dong Hyuk; Chung, Doo Yong; Lee, Dae Hun; Do Jung, Hae; Kwon, Jong Kyou; Cho, Kang Su

    2016-01-01

    We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive database of 1,519 patients who underwent the first session of SWL for urinary stones between 2005 and 2013. Ultimately, 604 patients with radiopaque ureteral stones were eligible for this study. Stone related variables including stone size, mean stone density (MSD), skin-to-stone distance, and SHI were obtained on NCCT. Patients were classified into the low and high SHI groups using mean SHI and compared. One-session success rate in the high SHI group was better than in the low SHI group (74.3% vs. 63.9%, P = 0.008). Multivariate logistic regression analyses revealed that smaller stone size (OR 0.889, 95% CI: 0.841–0.937, P < 0.001), lower MSD (OR 0.995, 95% CI: 0.994–0.996, P < 0.001), and higher SHI (OR 1.011, 95% CI: 1.008–1.014, P < 0.001) were independent predictors of one-session success. The radiologic heterogeneity of urinary stones or SHI was an independent predictor for SWL success in patients with ureteral calculi and a useful clinical parameter for stone fragility. PMID:27035621

  1. Randomized controlled trial of primary care physician motivational interviewing versus brief advice to engage adolescents with an Internet-based depression prevention intervention: 6-month outcomes and predictors of improvement.

    PubMed

    Hoek, Willemijn; Marko, Monika; Fogel, Joshua; Schuurmans, Josien; Gladstone, Tracy; Bradford, Nathan; Domanico, Rocco; Fagan, Blake; Bell, Carl; Reinecke, Mark A; Van Voorhees, Benjamin W

    2011-12-01

    We believe that primary care physicians could play a key role in engaging youth with a depression prevention intervention. We developed CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral and Interpersonal Training), which is an adolescent Internet-based behavior change model. We conducted a randomized comparison of two approaches in engaging adolescents with the Internet intervention: primary care physician (PCP) motivational interview + CATCH-IT Internet program (MI) vs PCP brief advice + CATCH-IT Internet program (BA). The participants (N = 84) were recruited by screening for risk of depression in 13 primary care practices. We compared depressive disorder outcomes between groups and within groups over 6 months and examined the potential predictors and moderators of outcomes across both study arms. Depressive symptom scores declined from baseline to 6 weeks with these statistically significant reductions sustained at the 6 months follow-up in both groups. No significant interactions with treatment condition were found. However, by 6 months, the MI group demonstrated significantly fewer depressive episodes and reported less hopelessness as compared with the BA group. Hierarchical linear modeling regressions showed higher ratings of ease of use of the Internet program predicting lower depressive symptom levels over 6 months. In conclusion, a primary care/Internet-based intervention model among adolescents demonstrated reductions in depressed mood over 6 months and may result in fewer depressive episodes. PMID:22061038

  2. Recurrence of hepatitis C virus genotype-4 infection following orthotopic liver transplantation: Natural history and predictors of outcome

    PubMed Central

    Mudawi, Hatim; Helmy, Ahmed; Kamel, Yasser; Al Saghier, Mohammed; Al Sofayan, Mohammed; Al Sebayel, Mohammed; Khalaf, Hatem; Al Bahili, Hamad; Al Shiek, Yasser; Alawi, Khalil; AlJedai, Ahmed; Mohamed, Hazem; Al Hamoudi, Waleed; Abdo, Ayman

    2009-01-01

    BACKGROUND AND OBJECTIVES: There are few reports on hepatitis C virus genotype 4 (HCV-4) recurrences after orthotopic liver transplantation (OLT). Therefore, we undertook a study to determine the epidemiological, clinical and virological characteristics of patients with biopsy-proven recurrent HCV infection and analyzed the factors that influence recurrent disease severity. We also compared disease recurrence and outcomes between HCV-4 and other genotypes. PATIENTS AND METHODS: All patients who underwent OLT (locally or abroad) for HCV related hepatic cirrhosis from 1991 to 2006 and had recurrent HCV infection were identified. Clinical, laboratory and pathological data before and after OLT were collected and analyzed. RESULTS: Of 116 patients who underwent OLT for hepatitis C, 46 (39.7%) patients satisfied the criteria of recurrent hepatitis C. Twenty-nine (63%) patients were infected with HCV genotype 4. Mean (SD) for age was 54.9 (10.9) years. Nineteen of the HCV genotype 4 patients (65.5%) were males, 21 (72.4%) received deceased donor grafts, and 7 (24.1%) developed ≥1 acute rejection episodes. Pathologically, 7 (24.1%) and 4 (13.8%) patients had inflammation grade 3-4 and fibrosis stage 3-4, respectively. Follow-up biopsy in 9 (31%) HCV genotype 4 patients showed stable, worse and improved fibrosis stage in 5, 2 and 2 patients, respectively. Of the 7 patients in the recurrent HCV group who died, 6 were infected with genotype 4 and 4 of them died of HCV-related disease. CONCLUSION: This analysis suggests that HCV recurrence following OLT in HCV-4 patients is not significantly different from its recurrence for other genotypes. PMID:19318754

  3. Psychosocial Predictors and Outcomes of Delayed Breast Reconstruction in Mastectomized Women in Mainland China: An Observational Study

    PubMed Central

    Wang, Tao; He, Jinguang; Qiao, Yufei; Wei, Jiao; Dong, Jiasheng

    2015-01-01

    Background The aim of the present study was to evaluate potential psychosocial factors that impact Chinese female breast cancer patients to select breast reconstruction (BR), and potential connection of psychosocial outcomes with their satisfaction with BR. Methods A total of 264 female breast cancer patients with mastectomy were recruited from 2012 to 2014. All patients were informed with BR options at their first visit. Personal and medical profiles were collected. Body image, self-esteem, depression and anxiety were assessed using validated scales. Patients who were selected to undergo BR after the first visit were followed up for six months. The same assessment was performed at 6 months post BR, and their satisfaction with BR was evaluated using the Alderman scale. Multivariate linear and logistic regressions were performed. Results Forty-seven percent of the patients (126/264) opted to undergo BR within six months after the initial visit. Multivariate logistic regression analysis revealed that self-esteem (P < 0.05), body image (P < 0.01), education level (P < 0.05), and their husband’s recommendation (P < 0.05) were highly related to the patients’ decision to undergo BR. In addition, multivariate linear regression analysis showed that patient satisfaction with BR was significantly associated with preoperative body image (P < 0.01), postoperative improvement in self-esteem (P < 0.01), improvement in body image (P < 0.01), reduction in depression (P < 0.05), pain (P < 0.05), and scarring (P < 0.01). Conclusions The psychosocial factors including self-esteem and body image are highly related to selecting the BR option and post-BR satisfaction in Chinese female breast cancer patients. PMID:26641252

  4. The significance of micro- and macrovascular biomarkers on cardiovascular outcome in chronic kidney disease: a prospective cohort study.

    PubMed

    Cseprekál, O; Egresits, J; Tabák, Á; Nemcsik, J; Járai, Z; Babos, L; Fodor, E; Farkas, K; Godina, G; Kárpáthi, K I; Kerkovits, L; Marton, A; Nemcsik-Bencze, Z; Németh, Z; Sallai, L; Kiss, I; Tislér, A

    2016-07-01

    Measures of small and large artery dysfunction have not been investigated in a single cohort for the prediction of cardiovascular (CV) events in patients with nondialysed (ND) chronic kidney disease (CKD). This prospective cohort study aimed to determine whether central pulse wave velocity (cPWV), central pulse pressure (CPP) or microvascular post-occlusive reactive hyperaemia area (PORHHA) independently predict CV events and mortality in CKD-ND. A total of 94 stage 1-5 CKD-ND (65.3±13.1 years; estimated glomerular filtration rate 35.3 (22.8-49.4) ml min(-1) per 1.73 m(2)) patients were followed-up for a median of 52 (36-65) months and had baseline cPWV and CPP measured by applanation tonometry and PORHHA by laser Doppler flowmetry. Multiple failure time Cox regression models were used to determine the predictive role of vascular parameters on CV mortality and events. Based on multiple linear regressions, baseline age, diabetes, CV disease, and systolic blood pressure (SBP) were independently related to cPWV (R(2)=0.3), SBP and PORHHA to CPP (R(2)=0.45), whereas CPP was the only parameter independently related to PORHHA (R(2)=0.16, all P<0.05). During follow-up, 41 CV events occurred (14 CV deaths). In univariate analyses, cPWV (1.07 (1.02-1.13) per m s(-1)), CPP (1.04 (1.01-1.07) per mm Hg) and lnPORHHA (0.70 (0.58-0.85) per ln(PU × s)) were all related to the outcome. Baseline diabetes (HR 3.07 (1.65-5.68)), lnFGF23 (fibroblast growth factor-23; 1.86 (1.13-3.06) per RU ml(-1)) and CPP (1.04 (1.01-1.07) per mm Hg) were independent predictors of CV events. The impaired pulsatile component of large arteries (CPP) independently of other vascular markers (cPWV, PORHHA) predicted CV outcomes in CKD-ND. CPP may integrate the information provided by cPWV and PORHHA. PMID:26424101

  5. Trajectories of Intrusive Parenting During Infancy and Toddlerhood as Predictors of Rural, Low-Income African American Boys’ School-Related Outcomes

    PubMed Central

    Clincy, Amanda R.; Mills-Koonce, W. Roger

    2015-01-01

    Stability and change in maternal intrusiveness during early childhood is rarely explored, particularly within African American families. The current study examined the prediction of maternal intrusiveness during the first 3 years of life among mothers of rural, low-income African American boys and its relation to school-related outcomes. Observations of mothers (N=230) interacting with children at 6, 24, and 36 months were coded and analyzed. Predictors of the trajectories and child outcomes were assessed using questionnaires and various tasks. On average, mothers of African American boys increased in intrusiveness across the first 3 years of life. Cumulative sociodemographic risk was associated with initial levels of intrusiveness, and child fearfulness and maternal negative regard predicted increases in intrusiveness overtime. After controlling for sociodemographic risk, child temperament, and parental negativity, increases in intrusiveness over the first 3 years of life were associated with lower levels of expressive communication, inhibitory control, and intellectual functioning but not with attention focusing. Comprehensive parenting intervention efforts aimed toward improving children’s outcomes must take into consideration the broader socioeconomic and affective context in which parenting behaviors occur, as well as stability and change in parenting over time. PMID:23889012

  6. Haunted by ghosts: prevalence, predictors and outcomes of spirit possession experiences among former child soldiers and war-affected civilians in Northern Uganda.

    PubMed

    Neuner, Frank; Pfeiffer, Anett; Schauer-Kaiser, Elisabeth; Odenwald, Michael; Elbert, Thomas; Ertl, Verena

    2012-08-01

    Phenomena of spirit possession have been documented in many cultures. Some authors have argued that spirit possession is a type of psychopathology, and should be included as a category in diagnostic manuals of mental disorders. However, there are hardly any quantitative studies that report the prevalence of spirit possession on a population level and that provide evidence for its validity as a psychopathological entity. In an epidemiological study that was carried out in 2007 and 2008 with N = 1113 youths and young adults aged between 12 and 25 years in war-affected regions of Northern Uganda we examined the prevalence, predictors and outcomes of cen, a local variant of spirit possession. Randomly selected participants were interviewed using a scale of cen, measures of psychopathology (PTSD and depression) as well as indicators of functional outcome on different levels, including suicide risk, daily activities, perceived discrimination, physical complaints and aggression. We found that cen was more common among former child soldiers then among subjects without a history of abduction. Cen was related to extreme levels of traumatic events and uniquely predicted functional outcome even when the effects of PTSD and depression were controlled for. Our findings show that a long-lasting war that is accompanied by the proliferation of spiritual and magical beliefs and propaganda can lead to high levels of harmful spirit possession. In addition, we provide evidence for the incremental validity of spirit possession as a trauma-related psychological disorder in this context. PMID:22580073

  7. Experimental induced avian E. coli salpingitis: Significant impact of strain and host factors on the clinical and pathological outcome.

    PubMed

    Olsen, Rikke Heidemann; Thøfner, Ida Cecilie Naundrup; Pors, Susanne Elisabeth; Pires Dos Santos, Teresa; Christensen, Jens Peter

    2016-05-30

    Several types of Escherichia coli have been associated with extra-intestinal infections in poultry, however, they may vary significantly in their virulence potential. The aim of the present study was to investigate the virulence of five strains of E. coli obtained from different disease manifestations or from the cloacae of a healthy chicken. The virulence potential of the strains were evaluated in an avian experimental model for ascending infections, and experiments were conducted in both layers and broiler breeders. The clinical outcome of infection was highly depending on the challenge strain, however, not significantly reflecting the origin of the strain. In general, broiler breeders had a more severe clinical outcomes of infection compared to layers, but major with-in group diversity was observed for all challenge strains of clinical origin. A single strain of ST95 (phylogroup B2) had a distinct ability to cause disease. Results of the study shows major differences in virulence of different strains of E. coli in ascending infections; however, there was no indication of tissue-specific adaptation, since strains obtained from lesions unrelated to the reproductive system were fully capable of causing experimental infection. In conclusion, the study provides evidence for the clinical outcome of infection with E. coli in poultry is largely influenced by the specific strain as well as individual host factors. PMID:27139030

  8. Greater Expectations: Using Hierarchical Linear Modeling to Examine Expectancy for Treatment Outcome as a Predictor of Treatment Response

    PubMed Central

    Price, Matthew; Anderson, Page; Henrich, Christopher C.; Rothbaum, Barbara Olasov

    2013-01-01

    A client’s expectation that therapy will be beneficial has long been considered an important factor contributing to therapeutic outcomes, but recent empirical work examining this hypothesis has primarily yielded null findings. The present study examined the contribution of expectancies for treatment outcome to actual treatment outcome from the start of therapy through 12-month follow-up in a clinical sample of individuals (n=72) treated for fear of flying with either in vivo exposure or virtual reality exposure therapy. Using a piecewise hierarchical linear model, outcome expectancy predicted treatment gains made during therapy but not during follow-up. Compared to lower levels, higher expectations for treatment outcome yielded stronger rates of symptom reduction from the beginning to the end of treatment on 2 standardized self-report questionnaires on fear of flying. The analytic approach of the current study is one potential reason that findings contrast with prior literature. The advantages of using hierarchical linear modeling to assess interindividual differences in longitudinal data are discussed. PMID:19027436

  9. Statistical Versus Clinical Significance for Infants with Brain Injury: Reanalysis of Outcome Data from a Randomized Controlled Study

    PubMed Central

    Badr, Lina Kurdahi

    2009-01-01

    By adopting more appropriate statistical methods to appraise data from a previously published randomized controlled trial (RCT), we evaluated the statistical and clinical significance of an intervention on the 18 month neurodevelopmental outcome of infants with suspected brain injury. The intervention group (n =32) received extensive, individualized cognitive/sensorimotor stimulation by public health nurses (PHNs) while the control group (n = 30) received standard follow-up care. At 18 months 43 infants remained in the study (22 = intervention, 21 = control). The results indicate that there was a significant statistical change within groups and a clinical significance whereby more infants in the intervention group improved in mental, motor and neurological functioning at 18 months compared to the control group. The benefits of looking at clinical significance from a meaningful aspect for practitioners are emphasized. PMID:19276403

  10. Patient Outcomes in Association With Significant Other Responses to Chronic Fatigue Syndrome: A Systematic Review of the Literature

    PubMed Central

    Band, Rebecca; Wearden, Alison; Barrowclough, Christine

    2015-01-01

    Social processes have been suggested as important in the maintenance of chronic fatigue syndrome (also known as myalgic encephalomyelitis; CFS/ME), but the specific role of close interpersonal relationships remains unclear. We reviewed 14 articles investigating significant other responses to close others with CFS/ME and the relationships between these responses and patient outcomes. Significant other beliefs attributing patient responsibility for the onset and ongoing symptoms of CFS/ME were associated with increased patient distress. Increased symptom severity, disability, and distress were also associated with both solicitous and negative significant other responses. Specific aspects of dyadic relationship quality, including high Expressed Emotion, were identified as important. We propose extending current theoretical models of CFS/ME to include two potential perpetuating interpersonal processes; the evidence reviewed suggests that the development of significant other–focused interventions may also be beneficial. PMID:26617440

  11. Socioeconomic Disparities in Ectopic Pregnancy: Predictors of Adverse Outcomes from Illinois Hospital-Based Care, 2000–2006

    PubMed Central

    Zhang, James X.; Lindau, Stacy Tessler

    2010-01-01

    This study aimed to identify the incidence of adverse outcomes from ectopic pregnancy hospital care in Illinois (2000–2006), and assess patient, neighborhood, hospital and time factors associated with these outcomes. Discharge data from Illinois hospitals were retrospectively analyzed and ectopic pregnancies were identified using DRG and ICD-9 diagnosis codes. The primary outcome was any complication identified by ICD-9 procedure codes. Secondary outcomes were length of stay and discharge status. Residential zip codes were linked to 2000 U.S. Census data to identify patients’ neighborhood demographics. Logistic regression was used to identify risk factors for adverse outcomes. Independent variables were insurance status, age, co-morbidities, neighborhood demographics, hospital type, hospital ectopic pregnancy service volume, and year of discharge. Of 13,007 ectopic pregnancy hospitalizations, 7.4% involved at least one complication identified by procedure codes. Hospitalizations covered by Medicare (for women with chronic disabilities) were more likely than those with other source or without insurance to result in surgical sterilization (OR 4.7, P = 0.012). Hospitalization longer than 2 days was more likely with Medicaid (OR 1.46, P<0.0005) or no insurance (OR 1.35, P<0.0005) versus other payers, and among church-operated versus secular hospitals (OR 1.21, P<0.0005). Compared to public hospitals, private hospitals had lower rates of complications (OR 0.39, P< 0.0005) and of hospitalization longer than 2 days (OR 0.57, P<0.0005). With time, hospitalizations became shorter (OR 0.53, P<0.0005) and complication rates higher (OR 1.33, P = 0.024). Ectopic pregnancy patients with Medicaid, Medicare or no insurance, and those admitted to public or religious hospitals, were more likely to experience adverse outcomes. PMID:20177756

  12. Socioeconomic disparities in ectopic pregnancy: predictors of adverse outcomes from Illinois hospital-based care, 2000-2006.

    PubMed

    Stulberg, Debra B; Zhang, James X; Lindau, Stacy Tessler

    2011-02-01

    This study aimed to identify the incidence of adverse outcomes from ectopic pregnancy hospital care in Illinois (2000-2006), and assess patient, neighborhood, hospital and time factors associated with these outcomes. Discharge data from Illinois hospitals were retrospectively analyzed and ectopic pregnancies were identified using DRG and ICD-9 diagnosis codes. The primary outcome was any complication identified by ICD-9 procedure codes. Secondary outcomes were length of stay and discharge status. Residential zip codes were linked to 2000 U.S. Census data to identify patients' neighborhood demographics. Logistic regression was used to identify risk factors for adverse outcomes. Independent variables were insurance status, age, co-morbidities, neighborhood demographics, hospital type, hospital ectopic pregnancy service volume, and year of discharge. Of 13,007 ectopic pregnancy hospitalizations, 7.4% involved at least one complication identified by procedure codes. Hospitalizations covered by Medicare (for women with chronic disabilities) were more likely than those with other source or without insurance to result in surgical sterilization (OR 4.7, P = 0.012). Hospitalization longer than 2 days was more likely with Medicaid (OR 1.46, P < 0.0005) or no insurance (OR 1.35, P < 0.0005) versus other payers, and among church-operated versus secular hospitals (OR 1.21, P < 0.0005). Compared to public hospitals, private hospitals had lower rates of complications (OR 0.39, P < 0.0005) and of hospitalization longer than 2 days (OR 0.57, P < 0.0005). With time, hospitalizations became shorter (OR 0.53, P < 0.0005) and complication rates higher (OR 1.33, P = 0.024). Ectopic pregnancy patients with Medicaid, Medicare or no insurance, and those admitted to public or religious hospitals, were more likely to experience adverse outcomes. PMID:20177756

  13. Predictors of Seizure Outcomes in Children with Tuberous Sclerosis Complex and Intractable Epilepsy Undergoing Resective Epilepsy Surgery: An Individual Participant Data Meta-Analysis

    PubMed Central

    Fallah, Aria; Guyatt, Gordon H.; Snead, O. Carter; Ebrahim, Shanil; Ibrahim, George M.; Mansouri, Alireza; Reddy, Deven; Walter, Stephen D.; Kulkarni, Abhaya V.; Bhandari, Mohit; Banfield, Laura; Bhatnagar, Neera; Liang, Shuli; Teutonico, Federica; Liao, Jianxiang; Rutka, James T.

    2013-01-01

    Objective To perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex undergoing resective epilepsy surgery. Data Sources Electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science), archives of major epilepsy and neurosurgery meetings, and bibliographies of relevant articles, with no language or date restrictions. Study Selection We included case-control or cohort studies of consecutive participants undergoing resective epilepsy surgery that reported seizure outcomes. We performed title and abstract and full text screening independently and in duplicate. We resolved disagreements through discussion. Data Extraction One author performed data extraction which was verified by a second author using predefined data fields including study quality assessment using a risk of bias instrument we developed. We recorded all preoperative factors that may plausibly predict seizure outcomes. Data Synthesis To identify predictors of a good seizure outcome (i.e. Engel Class I or II) we used logistic regression adjusting for length of follow-up for each preoperative variable. Results Of 9863 citations, 20 articles reporting on 181 participants were eligible. Good seizure outcomes were observed in 126 (69%) participants (Engel Class I: 102(56%); Engel class II: 24(13%)). In univariable analyses, absence of generalized seizure semiology (OR = 3.1, 95%CI = 1.2–8.2, p = 0.022), no or mild developmental delay (OR = 7.3, 95%CI = 2.1–24.7, p = 0.001), unifocal ictal scalp electroencephalographic (EEG) abnormality (OR = 3.2, 95%CI = 1.4–7.6, p = 0.008) and EEG/Magnetic resonance imaging concordance (OR = 4.9, 95%CI = 1.8–13.5, p = 0.002) were associated with a good postoperative seizure outcome. Conclusions Small retrospective cohort studies are inherently prone to bias, some of which are overcome

  14. Motivational and Skills, Social, and Self-Management Predictors of College Outcomes: Constructing the Student Readiness Inventory

    ERIC Educational Resources Information Center

    Le, Huy; Casillas, Alex; Robbins, Steven B.; Langley, Ronelle

    2005-01-01

    The authors used a rational-empirical approach to construct the Student Readiness Inventory, measuring psychosocial and academic-related skill factors found to predict two important college outcomes, academic performance and retention, in a recent meta-analysis. The initial item pool was administered to 5,970 first-year college students and high…

  15. Cognitive predictors and moderators of winter depression treatment outcomes in cognitive-behavioral therapy vs. light therapy.

    PubMed

    Sitnikov, Lilya; Rohan, Kelly J; Evans, Maggie; Mahon, Jennifer N; Nillni, Yael I

    2013-12-01

    There is no empirical basis for determining which seasonal affective disorder (SAD) patients are best suited for what type of treatment. Using data from a parent clinical trial comparing light therapy (LT), cognitive-behavioral therapy (CBT), and their combination (CBT + LT) for SAD, we constructed hierarchical linear regression models to explore baseline cognitive vulnerability constructs (i.e., dysfunctional attitudes, negative automatic thoughts, response styles) as prognostic and prescriptive factors of acute and next winter depression outcomes. Cognitive constructs did not predict or moderate acute treatment outcomes. Baseline dysfunctional attitudes and negative automatic thoughts were prescriptive of next winter treatment outcomes. Participants with higher baseline levels of dysfunctional attitudes and negative automatic thoughts had less severe depression the next winter if treated with CBT than if treated with LT. In addition, participants randomized to solo LT who scored at or above the sample mean on these cognitive measures at baseline had more severe depressive symptoms the next winter relative to those who scored below the mean. Baseline dysfunctional attitudes and negative automatic thoughts did not predict treatment outcomes in participants assigned to solo CBT or CBT + LT. Therefore, SAD patients with extremely rigid cognitions did not fare as well in the subsequent winter if treated initially with solo LT. Such patients may be better suited for initial treatment with CBT, which directly targets cognitive vulnerability processes. PMID:24211338

  16. Self-Handicapping and Defensive Pessimism: Exploring a Model of Predictors and Outcomes from a Self-Protection Perspective.

    ERIC Educational Resources Information Center

    Martin, Andrew J.; Marsh, Herbert W.; Debus, Raymond L.

    2001-01-01

    Examines self-handicapping and defensive pessimism, the factors that predict these strategies, and the associations between these strategies and a variety of academic outcomes. Findings reveal that task orientation negatively predicts both self-handicapping and defensive expectations and positively predicts reflectivity. Students high in…

  17. Predictors of Employment Outcomes for People with Visual Impairment in Taiwan: The Contribution of Disability Employment Services

    ERIC Educational Resources Information Center

    Jang, Yuh; Wang, Yun-Tung; Lin, Meng-Hsiu; Shih, Kevin J.

    2013-01-01

    Introduction: We investigated the employment status and identified factors that may affect the employment outcomes of people with visual impairments in Taiwan. Methods: A retrospective, ex post facto design study was conducted. The sample included 313 visually impaired clients who commenced and "closed" (completed) disability employment…

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  19. Familism as a Predictor of Parent-Adolescent Relationships and Developmental Outcomes for Adolescents in Armenian American Immigrant Families

    ERIC Educational Resources Information Center

    Ghazarian, Sharon R.; Supple, Andrew J.; Plunkett, Scott W.

    2008-01-01

    We investigated associations between familism, parent-adolescent relationships, and developmental outcomes for a sample of 97 Armenian adolescents in immigrant families. Our results suggested that adolescents emphasizing family needs over their own were more likely to report conformity to parents' wishes, respect for parental authority, and…

  20. Dysfunctional Attitudes Scale Perfectionism: A Predictor and Partial Mediator of Acute Treatment Outcome among Clinically Depressed Adolescents

    ERIC Educational Resources Information Center

    Jacobs, Rachel H.; Silva, Susan G.; Reinecke, Mark A.; Curry, John F.; Ginsburg, Golda S.; Kratochvil, Christopher J.; March, John S.

    2009-01-01

    The effect of perfectionism on acute treatment outcomes was explored in a randomized controlled trial of 439 clinically depressed adolescents (12-17 years of age) enrolled in the Treatment for Adolescents with Depression Study (TADS) who received cognitive behavior therapy (CBT), fluoxetine, a combination of CBT and FLX, or pill placebo. Measures…

  1. Long-Term Outcome in Cognitive-Behavioral Treatment of Panic Disorder: Clinical Predictors and Alternative Strategies for Assessment.

    ERIC Educational Resources Information Center

    Brown, Timothy A.; Barlow, David H.

    1995-01-01

    Examines long-term outcome of cognitive-behavioral treatment in 63 patients with panic disorder. Many patients (27%) sought further treatment for panic during follow-up because of less-than-adequate response to treatment; nevertheless, additional treatment did not result in further clinical improvement. Pretreatment severity of disorder and the…

  2. Preliminary Findings Supporting Insula Metabolic Activity as a Predictor of Outcome to Psychotherapy and Medication Treatments for Depression

    PubMed Central

    Dunlop, Boadie W.; Kelley, Mary E.; McGrath, Callie L.; Craighead, W. Edward; Mayberg, Helen S.

    2016-01-01

    A putative right anterior insula metabolism biomarker predictive of treatment outcomes was retrospectively applied to 30 depressed psychotherapy—or escitalopram-treated nonremitters who entered combination treatment. Patients whose added treatment matched the biomarker-indicated treatment remitted more often than biomarker-mismatched patients. PMID:26067435

  3. Juxtaposing Math Self-Efficacy and Self-Concept as Predictors of Long-Term Achievement Outcomes

    ERIC Educational Resources Information Center

    Parker, Philip David; Marsh, Herbert W.; Ciarrochi, Joseph; Marshall, Sarah; Abduljabbar, Adel Salah

    2014-01-01

    In this study, we tested the hypothesis that self-efficacy and self-concept reflect different underlying processes and both are critical to understanding long-term achievement outcomes. Although both types of self-belief are well established in educational psychology, research comparing and contrasting their relationship with achievement has been…

  4. Paced QRS duration and myocardial scar amount: predictors of long-term outcome of right ventricular apical pacing.

    PubMed

    Lee, Seung-Ah; Cha, Myung-Jin; Cho, Youngjin; Oh, Il-Young; Choi, Eue-Keun; Oh, Seil

    2016-07-01

    Long-term right ventricular apical pacing (RVAP) is reportedly associated with heart failure (HF) development. However, the predictors of pacing-induced HF (PHF) remained unclear. We retrospectively enrolled 234 patients without structural heart disease who underwent a permanent pacemaker implantation with RVAP between 1982 and 2004. RVAP-induced HF was defined as left ventricular ejection fraction decrease >5 % with HF symptom without other HF development etiology. The QRS duration of a paced beat (pQRSd) and myocardial scar score were analyzed from each patient's 12-lead ECG. During a mean 15.6 years (range 3.3-30.0 years), 48 patients (20.5 %) patients developed RVAP-induced HF. The PHF group patients had a longer pQRSd (192.4 ± 13.5 vs. 175.7 ± 14.7 ms in non-PHF patients, p < 0.001) and a higher myocardial scar score (5.2 ± 1.9 vs. 2.7 ± 1.9, respectively p < 0.001). In multivariate Cox regression analysis, old age at implantation [Hazard ratio (HR) 1.62, 95 % confidential interval (CI) 1.22-2.16, p = 0.001], a longer pQRSd (HR 1.54, 95 % CI 1.15-2.05, p = 0.003), a higher myocardial scar score (HR 1.23, 95 % CI 1.03-1.49, p = 0.037), and a higher percentage of ventricular pacing (HR 1.31, 95 % CI 1.01-1.49, p = 0.010) were independent predictors of PHF. Based on the results of the receiver-operating characteristic (ROC) curve, the pQRSd cutoff was 185 ms (AUC 0.79, sensitivity 66.7 %, specificity 76.3 %) and myocardial scar score cutoff value was 4 (AUC 0.81, sensitivity 81.3 %, specificity 66.1 %). The pQRSd was positively correlated with scar score (r = 0.70, p < 0.001). pQRSd ≥185 ms and/or myocardial scar score ≥4 might be independent long-term prognostic markers of PHF. PMID:26142378

  5. Nationwide inpatient prevalence, predictors and outcomes of Alzheimer’s Disease among older adults in the United States, 2002–2012

    PubMed Central

    Beydoun, May A.; Beydoun, Hind A.; Gamaldo, Alyssa A.; Rostant, Ola; Dore, Greg A.; Zonderman, Alan B.; Eid, Shaker M.

    2016-01-01

    In the inpatient setting, prevalence, predictors and outcomes (mortality risk (MR), length of stay (LOS) and total charges (TC)) of Alzheimer’s Disease (AD) are largely unknown. We used data on older adults (60y+) from the Nationwide Inpatient Sample (NIS) 2002–2012. AD prevalence was ~3.12% in 2012 (total weighted discharges with AD±standard error: 474,410±6,276). Co-morbidities prevailing more in AD inpatient admissions included depression (OR=1.67, 95%CI:1.63–1.71, p<0.001), fluid/electrolyte disorders (OR=1.25, 95%CI:1.22–1.27, p<0.001), weight loss (OR=1.26, 95%CI:1.22–1.30, p<0.001) and psychosis (OR=2.59, 95%CI:2.47–2.71, p<0.001), with mean total co-morbidities increasing over-time. AD was linked to higher MR, longer LOS but lower TC. TC rose in AD, while MR and LOS dropped markedly over-time. In AD, co-morbidities predicting simultaneously higher MR, TC and LOS (2012) included congestive heart failure, chronic pulmonary disease, coagulopathy, fluid/electrolyte disorders, metastatic cancer, paralysis, pulmonary circulatory disorders and weight loss. In sum, co-morbidities and TC increased over-time in AD, while MR and LOS dropped. Few co-morbidities predicted occurrence of AD or adverse outcomes in AD. PMID:26402000

  6. Mouse p53-Deficient Cancer Models as Platforms for Obtaining Genomic Predictors of Human Cancer Clinical Outcomes

    PubMed Central

    Dueñas, Marta; Santos, Mirentxu; Aranda, Juan F.; Bielza, Concha; Martínez-Cruz, Ana B.; Lorz, Corina; Taron, Miquel; Ciruelos, Eva M.; Rodríguez-Peralto, José L.; Martín, Miguel; Larrañaga, Pedro; Dahabreh, Jubrail; Stathopoulos, George P.; Rosell, Rafael; Paramio, Jesús M.; García-Escudero, Ramón

    2012-01-01

    Mutations in the TP53 gene are very common in human cancers, and are associated with poor clinical outcome. Transgenic mouse models lacking the Trp53 gene or that express mutant Trp53 transgenes produce tumours with malignant features in many organs. We previously showed the transcriptome of a p53-deficient mouse skin carcinoma model to be similar to those of human cancers with TP53 mutations and associated with poor clinical outcomes. This report shows that much of the 682-gene signature of this murine skin carcinoma transcriptome is also present in breast and lung cancer mouse models in which p53 is inhibited. Further, we report validated gene-expression-based tests for predicting the clinical outcome of human breast and lung adenocarcinoma. It was found that human patients with cancer could be stratified based on the similarity of their transcriptome with the mouse skin carcinoma 682-gene signature. The results also provide new targets for the treatment of p53-defective tumours. PMID:22880004

  7. Motivation to change and treatment attendance as predictors of alcohol-use outcomes among project-based Housing First residents.

    PubMed

    Collins, Susan E; Malone, Daniel K; Larimer, Mary E

    2012-08-01

    Collins et al. (2012) indicated that time spent in a project-based Housing First (HF) intervention was associated with improved two-year alcohol-use trajectories among chronically homeless individuals with alcohol problems. To explore potential correlates of these findings, we tested the relative prediction of alcohol-use outcomes by motivation to change (MTC) and substance abuse treatment attendance. Participants (N=95) were chronically homeless individuals with alcohol problems receiving a project-based HF intervention in the context of a larger nonrandomized controlled trial (Larimer et al., 2009). Participants were interviewed regularly over the two-year follow-up. Treatment attendance and MTC were measured using items from the Addiction Severity Index and the SOCRATES, respectively. Alcohol-use outcomes included alcohol quantity, problems and dependence. Generalized estimating equation modeling indicated that MTC variables and not treatment attendance consistently predicted alcohol-use outcomes over the two-year follow-up. Findings suggest that the importance of motivation to change may outweigh treatment attendance in supporting alcohol behavior change in this population. PMID:22513197

  8. Joint Modeling of Cross-Sectional Health Outcomes and Longitudinal Predictors via Mixtures of Means and Variances

    PubMed Central

    Jiang, Bei; Elliott, Michael R.; Sammel, Mary D.; Wang, Naisyin

    2015-01-01

    Summary Joint modeling methods have become popular tools to link important features extracted from longitudinal data to a primary event. While most modeling strategies have focused on the association between the longitudinal mean trajectories and risk of an event, we consider joint models that incorporate information from both long-term trends and short-term variability in a longitudinal submodel. We also consider both shared random effect and latent class approaches in the primary-outcome model to predict a binary outcome of interest. We develop simulation studies to compare and contrast these two modeling strategies; in particular, we study in detail the effects of the primary-outcome model misspecification. Among other findings, we note that when we analyze data from a shared random-effect using a latent class model while the information from the longitudinal data is weak, the latent class approach is more sensitive to such a model misspecification. Under this setting, the latent class model has a superior performance in within-sample prediction that cannot be duplicated when predicting new samples. This is a unique feature of the latent class approach that is new as far as we know to the existing literature. Finally, we use the proposed models to study how Follicle Stimulating Hormone (FSH) trajectories are related to the risk of developing severe hot flashes for participating women in the Penn Ovarian Aging Study. PMID:25652674

  9. Evidence for No Significant Impact of Müllerian Anomalies on Reproductive Outcomes of Twin Pregnancy in Korean Women.

    PubMed

    Shim, Sohyun; Hur, Yoon-Mi; Kim, Da Hee; Seong, Seok Ju; Kim, Mi-La; Shin, Joong Sik

    2016-04-01

    The present article aimed to evaluate the impact of congenital Müllerian anomalies (MA) on twin pregnancy after 24 gestational weeks in Korean women. All records of twin pregnancies in a large maternity hospital in Korea between January 2005 and July 2013 were analyzed. Patients with monochorionic monoamniotic (MCMA) twins, non-Korean patients, patients with twins delivered prior to 24 gestational weeks, and patients with miscarriage of one fetus or intrauterine fetal death (IUFD) before 24 gestational weeks were excluded from data analysis. In total, 1,422 women with twin pregnancy were eligible for data analysis, including 17 (1.2%) who had a known congenital MA (septate uterus, bicornuate uterus, arcuate uterus, and unicornuate uterus). Except for the mode of conception, baseline demographics were similar between women with MA and those without MA. No significant differences were found in pregnancy outcomes of gestational age at delivery (p = .86), birth weight of smaller and larger twins (p = .54 and p = .65), and number of twins with birth weight <5th percentile for gestational age (p = .43).The rates of obstetrical complications such as pre-eclampsia, gestational diabetes mellitus (GDM), placenta previa, cerclage, IUFD, and postpartum hemorrhage were not significantly different between the two groups either. We concluded that the presence of congenital MA may not increase obstetrical risks in outcomes of pregnancy of twins delivered after 24 gestational weeks. PMID:26880019

  10. Clinical significance of interleukin-1 genotype in smoking patients as a predictor of peri-implantitis: A case-control study

    PubMed Central

    García-Delaney, Cristina; Sánchez-Garcés, Maria-Ángeles; Sánchez-Torres, Alba; Gay-Escoda, Cosme

    2015-01-01

    Background Interleukin-1 (IL-1) is a proinflammatory cytokine that plays an important role in the pathogenesis of periodontitis, and so it might be useful to detect high-risk cases of peri-implantitis. It has been reported that IL-1 polymorphisms and smoking habit have a synergic effect, increasing the incidence of peri-implantitis. The aim of the present study was to evaluate the relationship between IL-1 gene polymorphisms and peri-implantitis in smoking patients. Material and Methods A case-control study was performed in 27 patients with peri-implantitis and 27 patients with healthy implants. All patients included were smokers. IL-1A-C889T, IL-1B+C3953T and IL-1RN+T2018C were identified by polymerase chain reaction (PCR) amplification in order to establish a relation between these variables and the presence of peri-implantitis. A bivariate analysis was performed and odds-ratio (OR) were calculated. Results The incidence of peri-implantitis was significantly higher in patients with previous history of periodontitis (p=0.024; OR=10.9). Both groups were similar regarding IL-1A-C889T, IL-1B+C3953T and IL-1RN+T2018C genotypes. No increased risk in heavy smokers with IL-1 polymorphism was found. Conclusions IL-1 genotypes do not seem to be good predictors of peri-implantitis in the great majority of smoking patients. Furthermore, no synergic effect was found between IL-1 genotypes and heavy smokers. Patients with a previous history of periodontitis were more prone to peri-implantitis. Key words:Peri-implantitis, interleukin-1 genotype positive, case-control study, smoking. PMID:26449434

  11. A Selective Account of Effective Paradigms and Significant Outcomes in the Discovery of Inspirational Marine Natural Products⊥†

    PubMed Central

    Sashidhara, Koneni V.; White, Kimberly N.; Crews, Phillip

    2009-01-01

    Marine natural products continue to be a source of significant molecular structures that serve as a stimulus to seed further significant research. This account reviews some of the major advances in the study of marine biomolecules made at UC Santa Cruz over more than three decades. The continuing challenge of discovery and characterization of what we term “inspirational molecular structures”, will be presented in a comprehensive fashion. Examples of privileged molecular structures and their impact on biomedicinal research will be an important theme. The three major groups of organisms explored include: seaweeds, sponges, and marine derived fungi, and the study of their active principles has greatly benefited from synergistic collaborations with both academic and biopharmaceutical groups. The concluding sections of this chronicle will touch on prospects for future outcomes involving new sources and strategies. PMID:19209899

  12. Exposure to Agent Orange is a significant predictor of prostate-specific antigen (PSA)-based recurrence and a rapid PSA doubling time after radical prostatectomy

    PubMed Central

    Shah, Sagar R.; Freedland, Stephen J.; Aronson, William J.; Kane, Christopher J.; Presti, Joseph C.; Amling, Christopher L.; Terris, Martha K.

    2011-01-01

    OBJECTIVE To investigate and report the clinicopathological characteristics and outcomes after radical prostatectomy (RP) in patients with prostate cancer and previous exposure to Agent Orange (AO), particularly in relationship to race. PATIENTS AND METHODS In 1495 veterans who had undergone RP the clinicopathological characteristics, biochemical progression rates, and prostate-specific antigen (PSA) doubling time (DT) after recurrence between AO-exposed and unexposed men were compared using logistic and linear regression and Cox proportional hazards analyses, and stratified by race. RESULTS The 206 (14%) men with AO exposure were more likely to be black (P = 0.001), younger (P < 0.001), treated more recently (P < 0.001), have a higher body mass index (P = 0.001), have clinical stage T1 disease (P < 0.001), and have lower preoperative PSA levels (P = 0.001). After adjusting for several clinical characteristics, AO exposure was not significantly related to adverse pathological features but was significantly associated with biochemical progression risk (relative risk 1.55, 95% confidence interval 1.15–2.09, P = 0.004) and shorter PSADT (P < 0.001) after recurrence (8.2 vs 18.6 months). When stratified by race, these associations were present and similar in both races, with no significant interaction between race and AO exposure for predicting biochemical recurrence or mean adjusted PSADT (P interaction >0.20). CONCLUSIONS Patients with AO exposure and treated with RP were more likely to be black, present with lower risk features, have an increased risk of biochemical progression, and shorter PSADT after recurrence. When stratified by race, the association between AO exposure and poor outcomes was present in both races. These findings suggest that among selected men who choose RP, AO exposure might be associated with more aggressive prostate cancer. PMID:19298411

  13. Predictors of clinical outcome in a national hospitalised cohort across both waves of the influenza A/H1N1 pandemic 2009–2010 in the UK

    PubMed Central

    Myles, Puja R; Semple, Malcolm G; Lim, Wei Shen; Openshaw, Peter J M; Gadd, Elaine M; Read, Robert C; Taylor, Bruce L; Brett, Stephen J; McMenamin, James; Enstone, Joanne E; Armstrong, Colin; Bannister, Barbara; Nicholson, Karl G

    2012-01-01

    Background Although generally mild, the 2009–2010 influenza A/H1N1 pandemic caused two major surges in hospital admissions in the UK. The characteristics of patients admitted during successive waves are described. Methods Data were systematically obtained on 1520 patients admitted to 75 UK hospitals between May 2009 and January 2010. Multivariable analyses identified factors predictive of severe outcome. Results Patients aged 5–54 years were over-represented compared with winter seasonal admissions for acute respiratory infection, as were non-white ethnic groups (first wave only). In the second wave patients were less likely to be school age than in the first wave, but their condition was more likely to be severe on presentation to hospital and they were more likely to have delayed admission. Overall, 45% had comorbid conditions, 16.5% required high dependency (level 2) or critical (level 3) care and 5.3% died. As in 1918–1919, the likelihood of severe outcome by age followed a W-shaped distribution. Pre-admission antiviral drug use decreased from 13.3% to 10% between the first and second waves (p=0.048), while antibiotic prescribing increased from 13.6% to 21.6% (p<0.001). Independent predictors of severe outcome were age 55–64 years, chronic lung disease (non-asthma, non-chronic obstructive pulmonary disease), neurological disease, recorded obesity, delayed admission (≥5 days after illness onset), pneumonia, C-reactive protein ≥100 mg/litre, and the need for supplemental oxygen or intravenous fluid replacement on admission. Conclusions There were demographic, ethnic and clinical differences between patients admitted with pandemic H1N1 infection and those hospitalised during seasonal influenza activity. Despite national policies favouring use of antiviral drugs, few patients received these before admission and many were given antibiotics. PMID:22407890

  14. Predictors of adolescent outcomes among 4-6-year-old children with attention-deficit/hyperactivity disorder.

    PubMed

    Lahey, Benjamin B; Lee, Steve S; Sibley, Margaret H; Applegate, Brooks; Molina, Brooke S G; Pelham, William E

    2016-02-01

    Children who met Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria for attention-deficit/hyperactivity disorder (ADHD) with functional impairment in at least one setting at 4-6 years of age were followed prospectively through age 18 years. On average, the 125 children (107 boys) with ADHD at baseline improved over time, but still continued to exhibit more symptoms, functional impairment, and risky behavior through adolescence than demographically matched healthy comparison children. These findings support the predictive validity of the diagnosis of ADHD at younger ages by demonstrating that the symptoms and impairment are enduring. Nonetheless, there were marked variations in developmental outcomes. Among children with ADHD, higher numbers of inattention and hyperactivity-impulsivity symptoms and higher number of concurrent symptoms (oppositional, conduct disorder, anxiety, and depression) measured at baseline each predicted higher future levels of the same dimension of symptoms. In addition, higher baseline levels of inattention, oppositional, conduct disorder, and anxiety symptoms predicted greater future functional impairment. Among children with ADHD, girls and children from families with lower family incomes had relatively poorer outcomes. Although outcomes varied along a continuum, approximately 10% of the children with ADHD at 4-6 years could be classified as functioning in the normative range on multiple measures during 15-18 years. Although this finding awaits replication, lower levels of hyperactivity-impulsivity symptoms at 4-6 years predicted more normative functioning during adolescence. These findings suggest that ADHD identified in early childhood predicts an increased likelihood of functional impairment through adolescence for most, but not all, children. (PsycINFO Database Record PMID:26854503

  15. Alcoholics Anonymous and Hazardously Drinking Women Returning to the Community After Incarceration: Predictors of Attendance and Outcome

    PubMed Central

    Schonbrun, Yael Chatav; Strong, David R.; Anderson, Bradley J.; Caviness, Celeste M.; Brown, Richard A.; Stein, Michael D.

    2016-01-01

    Background The number of females incarcerated within the United States has risen dramatically in recent decades and high rates of alcohol problems are evident among this population. Although little is known about the patterns of help utilization and efficacy for alcohol problems, preliminary evidence suggests that AA is a widely available resource for this population. Methods Data were collected as part of a study evaluating the effect of a brief intervention to reduce alcohol use among hazardously drinking (i.e., score of 8 or above on the Alcohol Use Disorders Identification Test or 4 or more drinks at a time on at least 3 days in prior 3 months) incarcerated women. The current study characterized demographic, clinical, and previous AA attendance variables associated with AA attendance in the 6-months following incarceration. Associations between frequency of AA attendance and drinking outcomes following incarceration were also evaluated. Results Among the 224 participants who provided data about AA attendance, 54% reported some AA attendance during the follow-up assessment period. AA attendance in the year prior to study entry (OR = 4.02; 95% CI: 3.32–4.71) and greater baseline consequences of alcohol use (OR = 2.09; 95% CI: 1.73–2.44) were associated with increased odds of higher frequency of AA attendance following incarceration. Weekly or greater AA attendance was associated with reductions in negative drinking consequences (B = −0.45; p < 0.01) and frequency of drinking days (B = −0.28; p < 0.01) following incarceration. Conclusions Findings from this study suggest that AA is frequently utilized by hazardously drinking women following incarceration. Alcohol outcomes may be enhanced by AA attendance at a weekly or greater frequency is associated with better alcohol outcomes relative to lower levels of AA attendance. Evaluation of clinical guidelines for prescribing AA attendance for incarcerated women remains a task for future research. PMID:21158877

  16. Gallium-67 imaging: A predictor of residual tumor viability and clinical outcome in patients with diffuse large-cell lymphoma

    SciTech Connect

    Kaplan, W.D.; Jochelson, M.S.; Herman, T.S.; Nadler, L.M.; Stomper, P.C.; Takvorian, T.; Andersen, J.W.; Canellos, G.P. )

    1990-12-01

    Durable complete remissions (CRs) can be achieved in patients with diffuse large-cell lymphoma (DLCL) with multidrug chemotherapy. The length of time to reach CR may be predictive of treatment outcome. However, defining CR by chest radiograph or computed tomography (CT) is often difficult since residual abnormalities do not always indicate residual disease. We have prospectively evaluated the ability of gallium-67 citrate (Ga-67) imaging to define residual disease and predict outcome in 37 consecutive patients with DLCL. Patients received 296 to 370 megabecquerels (MBq) Ga-67 and were imaged prior to, following cycles 4 to 6, and at completion of intensive chemotherapy. Ga-67 scan results were correlated with radiographic studies. Seventeen of 37 patients (46%) showed persistent, abnormal Ga-67 uptake halfway through chemotherapy. Of these, four were in CR, 11 were in partial remission (PR), and two showed no change in tumor size. At follow-up, 10 (59%) have died (three who were scored as CR and seven who were in PR halfway through therapy), two are alive with active tumor, one relapsed and survives following bone marrow transplant, and four (three in PR and one in CR at the therapeutic halfway point) are without disease at a median of 28 months from presentation. Of the 20 patients who were Ga-67-negative halfway through therapy, 11 were in CR and nine were in PR. Five of 20 patients (25%) have died. Three, in radiographic CR died at 11, 26, and 28 months, and two in radiographic PR died at 15 and 17 months. One patient is alive with active tumor, and 14 patients (70%) are alive without disease at a median of 34 months from presentation. Ga-67 imaging proved to be an excellent indicator of residual viable tumor; a positive scan halfway through therapy predicted for a poor outcome and may well justify a change in treatment.

  17. Comparing Experiential Acceptance and Cognitive Reappraisal of Psychotic Symptoms as Predictors of Functional Outcome among Individuals with Serious Mental Illness

    PubMed Central

    Vilardaga, Roger; Hayes, Steven C.; Atkins, David C.; Bresee, Christie; Kambiz, Alaei

    2013-01-01

    Background Two psychological regulation strategies to cope with psychotic symptoms proposed by the cognitive behavioral tradition were examined in this study: cognitive reappraisal and experiential acceptance. Although cognitive behavior therapy for psychosis has increasing empirical support, little is known about the role of these two strategies using methods of known ecological validity. Methods Intensive longitudinal data was gathered from 25 individuals diagnosed with a psychiatric disorder with psychotic features. During the course of six days we measured contextual factors, psychotic and stressful events, psychological regulation strategies and functional outcome. Results Positive psychotic symptoms and stressful events had negative associations with quality of life and affect, whereas experiential acceptance had positive associations with them. Cognitive reappraisal had inconsistent associations with quality of life and no association with affect. Social interactions and engagement in activities had a positive association with quality of life. Results were supported by additional and exploratory analyses. Conclusions Across measures of functional outcome, experiential acceptance appears to be an effective coping strategy for individuals facing psychotic and stressful experiences, whereas cognitive reappraisal does not. Results suggest the need to further investigate the role of these psychological regulation strategies using ecologically valid methods in order to inform treatment development efforts. PMID:23747581

  18. Frequency of Educational Computer Use as a Longitudinal Predictor of Educational Outcome in Young People with Specific Language Impairment

    PubMed Central

    Durkin, Kevin; Conti-Ramsden, Gina

    2012-01-01

    Computer use draws on linguistic abilities. Using this medium thus presents challenges for young people with Specific Language Impairment (SLI) and raises questions of whether computer-based tasks are appropriate for them. We consider theoretical arguments predicting impaired performance and negative outcomes relative to peers without SLI versus the possibility of positive gains. We examine the relationship between frequency of computer use (for leisure and educational purposes) and educational achievement; in particular examination performance at the end of compulsory education and level of educational progress two years later. Participants were 49 young people with SLI and 56 typically developing (TD) young people. At around age 17, the two groups did not differ in frequency of educational computer use or leisure computer use. There were no associations between computer use and educational outcomes in the TD group. In the SLI group, after PIQ was controlled for, educational computer use at around 17 years of age contributed substantially to the prediction of educational progress at 19 years. The findings suggest that educational uses of computers are conducive to educational progress in young people with SLI. PMID:23300610

  19. Personality Trait Level and Change as Predictors of Health Outcomes: Findings From a National Study of Americans (MIDUS)

    PubMed Central

    Pitzer, Lindsay; Armour, Cherie; Karlamangla, Arun; Ryff, Carol D.; Mroczek, Daniel K.

    2012-01-01

    Objectives. Personality traits predict numerous health outcomes, but previous studies have rarely used personality change to predict health. Methods. The current investigation utilized a large national sample of 3,990 participants from the Midlife in the U.S. study (MIDUS) to examine if both personality trait level and personality change longitudinally predict 3 different health outcomes (i.e., self-rated physical health, self-reported blood pressure, and number of days limited at work or home due to physical health reasons) over a 10-year span. Results. Each of the Big Five traits, except openness, predicted self-rated health. Change in agreeableness, conscientiousness, and extraversion also predicted self-rated health. Trait levels of conscientiousness and neuroticism level predicted self-reported blood pressure. All trait levels except agreeableness predicted number of work days limited. Only change in conscientiousness predicted the number of work days limited. Discussion. Findings demonstrate that a full understanding of the link between personality and health requires consideration of trait change as well as trait level. PMID:21765062

  20. Evaluation of the PaO2/FiO2 ratio after cardiac surgery as a predictor of outcome during hospital stay

    PubMed Central

    2014-01-01

    Background The arterial partial pressure of O2 and the fraction of inspired oxygen (PaO2/FiO2) ratio is widely used in ICUs as an indicator of oxygenation status. Although cardiac surgery and ICU scores can predict mortality, during the first hours after cardiac surgery few instruments are available to assess outcome. The aim of this study was to evaluate the usefulness of PaO2/FIO2 ratio to predict mortality in patients immediately after cardiac surgery. Methods We prospectively studied 2725 consecutive cardiac surgery patients between 2004 and 2009. PaO2/FiO2 ratio was measured on admission and at 3 h, 6 h, 12 h and 24 h after ICU admission, together with clinical data and outcomes. Results All PaO2/FIO2 ratio measurements differed between survivors and non-survivors (p < 0.001). The PaO2/FIO2 at 3 h after ICU admission was the best predictor of mortality based on area under the curve (p < 0.001) and the optimum threshold estimation gave an optimal cut-off of 222 (95% Confidence interval (CI): 202–242), yielding three groups of patients: Group 1, with PaO2/FIO2 > 242; Group 2, with PaO2/FIO2 from 202 to 242; and Group 3, with PaO2/FIO2 < 202. Group 3 showed higher in-ICU mortality and ICU length of stay and Groups 2 and 3 also showed higher respiratory complication rates. The presence of a PaO2/FIO2 ratio < 202 at 3 h after admission was shown to be a predictor of in-ICU mortality (OR:1.364; 95% CI:1.212-1.625, p < 0.001) and of worse long-term survival (88.8% vs. 95.8%; Log rank p = 0.002. Adjusted Hazard ratio: 1.48; 95% CI:1.293–1.786; p = 0.004). Conclusions A simple determination of PaO2/FIO2 at 3 h after ICU admission may be useful to identify patients at risk immediately after cardiac surgery. PMID:25928646

  1. Going Tobacco-Free: Predictors of Clinician Reactions and Outcomes of the NY State OASAS Tobacco-Free Regulation

    PubMed Central

    de Tormes Eby, Lillian Turner; George, Kerrin; Brown, B. Lindsay

    2012-01-01

    In an effort to reduce patient tobacco dependence and create healthier work environments, New York State (NYS) mandated 100% tobacco-free addiction treatment programs for state funded or certified facilities in 2008. We present the results of a longitudinal study examining how local implementation features shape clinician reactions to the regulation and influence post-regulation clinician behavior and strain. A cohort of 147 clinicians associated with 13 treatment organizations throughout NYS completed a survey prior to the passage of the regulation and again approximately 1 year post-regulation. Findings reveal that local implementation features of clinician participation in the planning for change, the provision of change-related information, and perceived organizational support predicted perceptions of change management fairness, which in turn predicted clinical practice behaviors to support smoking cessation, as well as psychological and behavioral strain. In contrast, self-efficacy for change was neither related to local implementation or clinician outcomes. Practical implications are discussed. PMID:22959978

  2. Childhood to Early-Midlife Systolic Blood Pressure Trajectories: Early-Life Predictors, Effect Modifiers, and Adult Cardiovascular Outcomes.

    PubMed

    Theodore, Reremoana F; Broadbent, Jonathan; Nagin, Daniel; Ambler, Antony; Hogan, Sean; Ramrakha, Sandhya; Cutfield, Wayne; Williams, Michael J A; Harrington,