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Sample records for outcome score hoos

  1. Validation of the HOOS, JR: A Short-form Hip Replacement Survey.

    PubMed

    Lyman, Stephen; Lee, Yuo-Yu; Franklin, Patricia D; Li, Wenjun; Mayman, David J; Padgett, Douglas E

    2016-06-01

    Patient-reported outcome measures (PROMs) are increasingly in demand for outcomes evaluation by hospitals, administrators, and policymakers. However, assessing total hip arthroplasty (THA) through such instruments is challenging because most existing measures of hip health are lengthy and/or proprietary. The objective of this study was to derive a patient-relevant short-form survey based on the Hip disability and Osteoarthritis Outcome Score (HOOS), focusing specifically on outcomes after THA. We retrospectively evaluated patients with hip osteoarthritis who underwent primary unilateral THA and who had completed preoperative and 2-year postoperative PROMs using our hospital's hip replacement registry. The 2-year followup in this population was 81% (4308 of 5351 patients). Of these, 2371 completed every item on the HOOS before surgery and at 2 years, making them eligible for the formal item reduction analysis. Through semistructured interviews with 30 patients, we identified items in the HOOS deemed qualitatively most important to patients with hip osteoarthritis. The original HOOS has 40 items, the four quality-of-life items were excluded a priori, five were excluded for being redundant, and one was excluded based on patient-relevance surveys. The remaining 30 items were evaluated using Rasch modeling to yield a final six-item HOOS, Joint Replacement (HOOS, JR), representing a single construct of "hip health." We calculated HOOS, JR scores for the Hospital for Special Surgery (HSS) cohort and validated this new score for internal consistency, external validity (versus HOOS and WOMAC domains), responsiveness to THA, and floor and ceiling effects. Additional external validation was performed using calculated HOOS, JR scores in collaboration with the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) nationally representative joint replacement registry (n = 910). The resulting six-item PROM (HOOS, JR) retained items

  2. Legend of Wan Hoo

    NASA Technical Reports Server (NTRS)

    2004-01-01

    According to one ancient legend, a Chinese official named Wan Hoo attempted a flight to the moon using a large wicker chair to which were fastened 47 large rockets. Forty seven assistants, each armed with a torch, rushed forward to light the fuses. In a moment, there was a tremendous roar accompanied by billowing clouds of smoke. When the smoke cleared, the flying chair and Wan Hoo were gone.

  3. Legend of Wan Hoo

    NASA Technical Reports Server (NTRS)

    2004-01-01

    According to one ancient legend, a Chinese official named Wan Hoo attempted a flight to the moon using a large wicker chair to which were fastened 47 large rockets. Forty seven assistants, each armed with a torch, rushed forward to light the fuses. In a moment, there was a tremendous roar accompanied by billowing clouds of smoke. When the smoke cleared, the flying chair and Wan Hoo were gone.

  4. A genomic score prognostic of outcome in trauma patients.

    PubMed

    Warren, H Shaw; Elson, Constance M; Hayden, Douglas L; Schoenfeld, David A; Cobb, J Perren; Maier, Ronald V; Moldawer, Lyle L; Moore, Ernest E; Harbrecht, Brian G; Pelak, Kimberly; Cuschieri, Joseph; Herndon, David N; Jeschke, Marc G; Finnerty, Celeste C; Brownstein, Bernard H; Hennessy, Laura; Mason, Philip H; Tompkins, Ronald G

    2009-01-01

    Traumatic injuries frequently lead to infection, organ failure, and death. Health care providers rely on several injury scoring systems to quantify the extent of injury and to help predict clinical outcome. Physiological, anatomical, and clinical laboratory analytic scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE], Injury Severity Score [ISS]) are utilized, with limited success, to predict outcome following injury. The recent development of techniques for measuring the expression level of all of a person's genes simultaneously may make it possible to develop an injury scoring system based on the degree of gene activation. We hypothesized that a peripheral blood leukocyte gene expression score could predict outcome, including multiple organ failure, following severe blunt trauma. To test such a scoring system, we measured gene expression of peripheral blood leukocytes from patients within 12 h of traumatic injury. cRNA derived from whole blood leukocytes obtained within 12 h of injury provided gene expression data for the entire genome that were used to create a composite gene expression score for each patient. Total blood leukocytes were chosen because they are active during inflammation, which is reflective of poor outcome. The gene expression score combines the activation levels of all the genes into a single number which compares the patient's gene expression to the average gene expression in uninjured volunteers. Expression profiles from healthy volunteers were averaged to create a reference gene expression profile which was used to compute a difference from reference (DFR) score for each patient. This score described the overall genomic response of patients within the first 12 h following severe blunt trauma. Regression models were used to compare the association of the DFR, APACHE, and ISS scores with outcome. We hypothesized that patients with a total gene response more different from uninjured volunteers would tend to have poorer

  5. The Impact of Automated Essay Scoring on Writing Outcomes

    ERIC Educational Resources Information Center

    Shermis, Mark D.; Garvan, Cynthia Wilson; Diao, Yanbo

    2008-01-01

    This study was an expanded replication of an earlier endeavor (Shermis, Burstein, & Bliss, 2004) to document the writing outcomes associated with automated essay scoring. The focus of the current study was on determining whether exposure to multiple writing prompts facilitated writing production variables (Essay Score, Essay Length, and Number…

  6. Scoring Systems for Outcome Prediction of Patients with Perforation Peritonitis

    PubMed Central

    Litake, Manjusha Madhusudhan

    2016-01-01

    Introduction Peritonitis continues to be one of the major infectious problems confronting a surgeon. Mannheim Peritonitis Index (MPI), Physiological and Operative Severity Score for en Umeration of Mortality (POSSUM) and Morbidity and sepsis score of Stoner and Elebute have been devised for risk assessment and for prediction of postoperative outcome. Aim The aim of this study was to find the accuracy of these scores in predicting outcome in terms of mortality in patients undergoing exploratory laprotomy for perforation peritonitis. Materials and Methods The prospective study was carried out in 100 diagnosed cases of perforation at our centre in a single unit over a period of 21 months from December 2012 to August 2014. Study was conducted on all cases of peritonitis albeit primary, tertiary, iatrogenic and those with age less than 12 years were excluded from the study. All the relevant data were collected and three scores were computed from one set of data from the patient. The main outcome measure was survival of the patient. The Receiver Operator Characteristics (ROC) curves were obtained for the three scores. Area Under the Curves (AUC) was calculated. Sensitivity and specificity were calculated at a cut off point obtained from the ROC curves. Results POSSUM had an AUC of 0.99, sepsis score had an AUC of 0.98 and MPI had an AUC of 0.95. The cut off point score of 51 for POSSUM had an accuracy of 93.8 and positive predictive value of 70.5, the score of 29 for MPI had an accuracy of 82.8 and positive predictive value of 46 and the score of 22 for sepsis score had an accuracy of 95.9 and positive predictive value of 86.67. Conclusion POSSUM score was found to be superior in prediction of mortality as compared to sepsis score of Stoner and Elebute and MPI. POSSUM and MPI over predicted mortality in some cases. None of these scores are strictly preoperative. PMID:27134924

  7. Analyzing Gensini Score as a Semi-Continuous Outcome.

    PubMed

    Kashani, Homa; Zeraati, Hojjat; Mohammad, Kazem; Goodarzynejad, Hamidreza; Mahmoudi, Mahmood; Sadeghian, Saeed; Boroumand, Mohammadali

    2016-04-13

    Background: Investigators frequently encounter continuous outcomes with plenty of values clumped at zero called semi-continuous outcomes. The Gensini score, one of the most widely used scoring systems for expressing coronary angiographic results, is of this type. The aim of this study was to apply two statistical approaches based on the categorization and original scale of the Gensini score to simultaneously assess the association between covariates and the presence and severity of coronary artery disease (CAD). Methods: We considered the data on 1594 individuals admitted to Tehran Heart Center with CAD symptoms from July 2004 to February 2008. The participants' baseline demographic and clinical characteristics were collected, and their coronary angiographic results were expressed through the Gensini score. The generalized ordinal threshold and two-part models were applied for the statistical analyses. Results: Totally, 320 (20.1%) individuals had a Gensini score of zero. The results of neither the two-part model nor the generalized ordinal threshold model showed a significant association between Factor V Leiden and the occurrence of CAD. However, based on the two-part model, Factor V Leiden was associated with the severity of CAD, such that the Gensini score increased by moving from a wild genotype to a heterozygote (β = 0.44; 95% CI: 0.20-0.69 in logarithm scale) or a homozygote mutant (β = 0.70; 95% CI: 0.28- 1.12 in logarithm scale). The proportional odds assumption was not met in our data ([Formula: see text]= 54.26; p value < 0.001); however, a trend toward severe CAD was also observed at each category of the Gensini score using the generalized ordinal threshold model. Conclusion: We conclude that besides loss of information by sorting a semi-continuous outcome, violation from the proportional odds assumption complicates the final decision, especially for clinicians. Therefore, more straightforward models such as the two-part model should receive more

  8. Covariate Selection in Propensity Scores Using Outcome Proxies

    ERIC Educational Resources Information Center

    Kelcey, Ben

    2011-01-01

    This study examined the practical problem of covariate selection in propensity scores (PSs) given a predetermined set of covariates. Because the bias reduction capacity of a confounding covariate is proportional to the concurrent relationships it has with the outcome and treatment, particular focus is set on how we might approximate…

  9. Hydroperoxyl Radicals (HOO(.) ): Vitamin E Regeneration and H-Bond Effects on the Hydrogen Atom Transfer.

    PubMed

    Cedrowski, Jakub; Litwinienko, Grzegorz; Baschieri, Andrea; Amorati, Riccardo

    2016-11-07

    Hydroperoxyl (HOO(.) ) and alkylperoxyl (ROO(.) ) radicals show a different behavior in H-atom-transfer processes. Both radicals react with an analogue of α-tocopherol (TOH), but HOO(.) , unlike ROO(.) , is able to regenerate TOH by a fast H-atom transfer: TO(.) +HOO(.) →TOH+O2 . The kinetic solvent effect on the H-atom transfer from TOH to HOO(.) is much stronger than that observed for ROO(.) because noncovalent interactions with polar solvents (Solv⋅⋅⋅HOO(.) ) destabilize the transition state.

  10. High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes

    PubMed Central

    Custer, Aimee; Sufrinko, Alicia; Elbin, R. J.; Covassin, Tracey; Collins, Micky; Kontos, Anthony

    2016-01-01

    Context:  Some healthy athletes report high levels of baseline concussion symptoms, which may be attributable to several factors (eg, illness, personality, somaticizing). However, the role of baseline symptoms in outcomes after sport-related concussion (SRC) has not been empirically examined. Objective:  To determine if athletes with high symptom scores at baseline performed worse than athletes without baseline symptoms on neurocognitive testing after SRC. Design:  Cohort study. Setting:  High school and collegiate athletic programs. Patients or Other Participants:  A total of 670 high school and collegiate athletes participated in the study. Participants were divided into groups with either no baseline symptoms (Postconcussion Symptom Scale [PCSS] score = 0, n = 247) or a high level of baseline symptoms (PCSS score > 18 [top 10% of sample], n = 68). Main Outcome Measure(s):  Participants were evaluated at baseline and 2 to 7 days after SRC with the Immediate Post-concussion Assessment and Cognitive Test and PCSS. Outcome measures were Immediate Post-concussion Assessment and Cognitive Test composite scores (verbal memory, visual memory, visual motor processing speed, and reaction time) and total symptom score on the PCSS. The groups were compared using repeated-measures analyses of variance with Bonferroni correction to assess interactions between group and time for symptoms and neurocognitive impairment. Results:  The no-symptoms group represented 38% of the original sample, whereas the high-symptoms group represented 11% of the sample. The high-symptoms group experienced a larger decline from preinjury to postinjury than the no-symptoms group in verbal (P = .03) and visual memory (P = .05). However, total concussion-symptom scores increased from preinjury to postinjury for the no-symptoms group (P = .001) but remained stable for the high-symptoms group. Conclusions:>  Reported baseline symptoms may help identify athletes at risk for worse

  11. Rapid Acute Physiology Score versus Rapid Emergency Medicine Score in Trauma Outcome Prediction; a Comparative Study

    PubMed Central

    Nakhjavan-Shahraki, Babak; Baikpour, Masoud; Yousefifard, Mahmoud; Nikseresht, Zahra Sadat; Abiri, Samaneh; Mirzay Razaz, Jalaledin; Faridaalaee, Gholamreza; Pouraghae, Mahboob; Shirzadegan, Sahar; Hosseini, Mostafa

    2017-01-01

    Introduction: Rapid acute physiology score (RAPS) and rapid emergency medicine score (REMS) are two physiologic models for measuring injury severity in emergency settings. The present study was designed to compare the two models in outcome prediction of trauma patients presenting to emergency department (ED). Methods: In this prospective cross-sectional study, the two models of RAPS and REMS were compared regarding prediction of mortality and poor outcome (severe disability based on Glasgow outcome scale) of trauma patients presenting to the EDs of 5 educational hospitals in Iran (Tehran, Tabriz, Urmia, Jahrom and Ilam) from May to October 2016. The discriminatory power and calibration of the models were calculated and compared using STATA 11. Results: 2148 patients with the mean age of 39.50±17.27 years were studied (75.56% males). The area under the curve of REMS and RAPS in predicting in-hospital mortality were calculated to be 0.93 (95% CI: 0.92-0.95) and 0.899 (95% CI: 0.86-0.93), respectively (p=0.02). These measures were 0.92 (95% CI: 0.90-0.94) and 0.86 (95% CI: 0.83-0.90), respectively, regarding poor outcome (p=0.001). The optimum cut-off point in predicting outcome was found to be 3 for REMS model and 2 for RAPS model. The sensitivity and specificity of REMS and RAPS in the mentioned cut offs were 95.93 vs. 85.37 and 77.63 vs. 83.51, respectively, in predicting mortality. Calibration and overall performance of the two models were acceptable. Conclusion: The present study showed that adding age and level of arterial oxygen saturation to the variables included in RAPS model can increase its predictive value. Therefore, it seems that REMS could be used for predicting mortality and poor outcome of trauma patients in emergency settings. PMID:28286837

  12. Worthing Physiological Score vs Revised Trauma Score in Outcome Prediction of Trauma patients; a Comparative Study

    PubMed Central

    Nakhjavan-Shahraki, Babak; Yousefifard, Mahmoud; Hajighanbari, Mohammad Javad; Karimi, Parviz; Baikpour, Masoud; Mirzay Razaz, Jalaledin; Yaseri, Mehdi; Shahsavari, Kavous; Mahdizadeh, Fatemeh; Hosseini, Mostafa

    2017-01-01

    Introduction: Awareness about the outcome of trauma patients in the emergency department (ED) has become a topic of interest. Accordingly, the present study aimed to compare the rapid trauma score (RTS) and worthing physiological scoring system (WPSS) in predicting in-hospital mortality and poor outcome of trauma patients. Methods: In this comparative study trauma patients brought to five EDs in different cities of Iran during the year 2016 were included. After data collection, discriminatory power and calibration of the models were assessed and compared using STATA 11. Results: 2148 patients with the mean age of 39.50±17.27 years were included (75.56% males). The AUC of RTS and WPSS models for prediction of mortality were 0.86 (95% CI: 0.82-0.90) and 0.91 (95% CI: 0.87-0.94), respectively (p=0.006). RTS had a sensitivity of 71.54 (95% CI: 62.59-79.13) and a specificity of 97.38 (95% CI: 96.56-98.01) in prediction of mortality. These measures for the WPSS were 87.80 (95% CI: 80.38-92.78) and 83.45 (95% CI: 81.75-85.04), respectively. The AUC of RTS and WPSS in predicting poor outcome were 0.81 (95% CI: 0.77-0.85) and 0.89 (95% CI: 0.85-0.92), respectively (p<0.0001). Conclusion: The findings showed a higher prognostic value for the WPSS model in predicting mortality and severe disabilities in trauma patients compared to the RTS model. Both models had good overall performance in prediction of mortality and poor outcome. PMID:28286838

  13. Outcome prediction in gastroschisis - The gastroschisis prognostic score (GPS) revisited.

    PubMed

    Puligandla, Pramod S; Baird, Robert; Skarsgard, Eric D; Emil, Sherif; Laberge, Jean-Martin

    2017-05-01

    The GPS enables risk stratification for gastroschisis and helps discriminate low from high morbidity groups. The purpose of this study was to revalidate GPS's characterization of a high morbidity group and to quantify relationships between the GPS and outcomes. With REB approval, complete survivor data from a national gastroschisis registry was collected. GPS bowel injury scoring was revalidated excluding the initial inception/validation cohorts (>2011). Length of stay (LOS), 1st enteral feed days (dFPO), TPN days (dTPN), and aggregate complications (COMP) were compared between low and high morbidity risk groups. Mathematical relationships between outcomes and integer increases in GPS were explored using the entire cohort (2005-present). Median (range) LOS, dPO, and dTPN for the entire cohort (n=849) was 36 (26,62), 13 (9,18), and 27 (20,46) days, respectively. High-risk patients (GPS≥2; n=80) experienced significantly worse outcomes than low risk patients (n=263). Each integer increase in GPS was associated with increases in LOS and dTPN by 16.9 and 12.7days, respectively (p<0.01). COMP rate was also increased in the high-risk cohort (46.3% vs. 22.8%; p<0.01). The GPS effectively discriminates low from high morbidity risk groups. Within the high risk group, integer increases in GPS produce quantitatively differentiated outcomes which may guide initial counseling and resource allocation. IIb. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Favorable outcome in open globe injuries with low OTS score.

    PubMed

    Cillino, Giovanni; Ferraro, Lucia; Casuccio, Alessandra; Cillino Salvatore

    2014-09-01

    Open globe eye injuries can have profound social and economic consequences. Here, we describe two cases of war and outdoor activity open globe eye injury where, despite a low OTS score, current microsurgical technology allowed for a favorable outcome. A 33-year-old Libyan soldier had been treated for an open-globe grenade blast trauma to his left eye, which showed light perception and OTS score 2. He had undergone a lensectomy and PPV with silicone oil tamponade. Surgical treatment included scleral buckling, cornea trephination, temporary Eckardt keratoprosthesis, PPV revision, intraocular lens (IOL) implantation, and corneal grafting. Six months later, his VA was improved to 20/70. CASE REPORT 2: A 35-year-old man presented with a corneal laceration in his left eye from a meat skewer, with marked hypotony and LP. After primary corneal wound closure, B-scan ultrasonography revealed massive vitreous hemorrhage (OTS score 2). The patient underwent open cataract extraction with IOL implantation, 23 gauge PPV, laser photocoagulation of the retinochoroidal laceration, and a gas tamponade. After three weeks, the patient underwent a 2nd 23G PPV due to a fibrinous reaction. Six month later, the patients exhibited 20/25 VA. These cases confirm that even for patients with a low OTS and poor visual prognosis, an up-to-date surgery protocol may achieve visual results adequate for leading an autonomous daily life.

  15. Predicting outcomes in partial nephrectomy: is the renal score useful?

    PubMed Central

    Matos, André Costa; Dall´Oglio, Marcos F.; Colombo, José Roberto; Crippa, Alexandre; Juveniz, João A. Q.; Argolo, Felipe Coelho

    2017-01-01

    ABSTRACT Introduction and Objective The R.E.N.A.L. nephrometry system (RNS) has been validated in multiple open, laparoscopic and robotic partial nephrectomy series. The aim of this study was to test the accuracy of R.E.N.A.L. nephrometry system in predicting perioperative outcomes in surgical treatment of kidney tumors <7.0cm in a prospective model. Materials and Methods Seventy-one patients were selected and included in this prospective study. We evaluate the accuracy of RNS in predicting perioperative outcomes (WIT, OT, EBL, LOS, conversion, complications and surgical margins) in partial nephrectomy using ROC curves, univariate and multivariate analyses. R.E.N.A.L. was divided in 3 groups: low complexity (LC), medium complexity (MC) and high complexity (HC). Results No patients in LC group had WIT >20 min, versus 41.4% and 64.3% MC and HC groups respectively (p=0.03); AUC=0.643 (p=0.07). RNS was associated with convertion rate (LC:28.6% ; MC:47.6%; HC:77.3%, p=0.02). Patients with RNS <8 were most often subjected to partial nephrectomy (93% x 72%, p=0.03) and laparoscopic partial nephrectomy (56.8% x 28%, p=0.02), AUC=0.715 (p=0.002). The RNS was also associated with operative time. Patients with a score >8 had 6.06 times greater chance of having a surgery duration >180 min. (p=0.017), AUC=0.63 (p=0.059). R.E.N.A.L. score did not correlate with EBL, complications (Clavien >3), LOS or positive surgical margin. Conclusion R.E.N.A.L. score was a good method in predicting surgical access route and type of nephrectomy. Also was associated with OT and WIT, but with weak accuracy. Although, RNS was not associated with Clavien >3, EBL, LOS or positive surgical margin. PMID:28266814

  16. Predicting outcomes in partial nephrectomy: is the renal score useful?

    PubMed

    Matos, André Costa; Dall'Oglio, Marcos F; Colombo, José Roberto; Crippa, Alexandre; Juveniz, João A Q; Argolo, Felipe Coelho

    2017-01-01

    The R.E.N.A.L. nephrometry system (RNS) has been validated in multiple open, laparoscopic and robotic partial nephrectomy series. The aim of this study was to test the accuracy of R.E.N.A.L. nephrometry system in predicting perioperative outcomes in surgical treatment of kidney tumors <7.0cm in a prospective model. Seventy-one patients were selected and included in this prospective study. We evaluate the accuracy of RNS in predicting perioperative outcomes (WIT, OT, EBL, LOS, conversion, complications and surgical margins) in partial nephrectomy using ROC curves, univariate and multivariate analyses. R.E.N.A.L. was divided in 3 groups: low complexity (LC), medium complexity (MC) and high complexity (HC). No patients in LC group had WIT >20 min, versus 41.4% and 64.3% MC and HC groups respectively (p=0.03); AUC=0.643 (p=0.07). RNS was associated with convertion rate (LC:28.6% ; MC:47.6%; HC:77.3%, p=0.02). Patients with RNS <8 were most often subjected to partial nephrectomy (93% x 72%, p=0.03) and laparoscopic partial nephrectomy (56.8% x 28%, p=0.02), AUC=0.715 (p=0.002). The RNS was also associated with operative time. Patients with a score >8 had 6.06 times greater chance of having a surgery duration >180 min. (p=0.017), AUC=0.63 (p=0.059). R.E.N.A.L. score did not correlate with EBL, complications (Clavien >3), LOS or positive surgical margin. R.E.N.A.L. score was a good method in predicting surgical access route and type of nephrectomy. Also was associated with OT and WIT, but with weak accuracy. Although, RNS was not associated with Clavien >3, EBL, LOS or positive surgical margin. Copyright® by the International Brazilian Journal of Urology.

  17. Impact of Living With Scoliosis: A utility Outcome Score Assessment.

    PubMed

    Aldebeyan, Sultan; Sinno, Hani; Makhdom, Asim; Ouellet, Jean A; Saran, Neil

    2017-01-15

    Survey. The aim of this study was to objectify the burden of adolescent idiopathic scoliosis (AIS) to better advocate for scoliosis care in the future. AIS is a common spinal deformity that can affect individuals on many levels. Patients with big curves usually seek medical advice for surgical correction of their deformity. Participants completed an online questionnaire to help measure the health burden of AIS. Three utility outcome measures were then calculated. These included the visual analog scale, time trade off, and standard gamble. Student t test and linear regression were used for statistical analysis. One hundred and ten participants were included in the analysis. The mean visual analog scale, time trade off, and standard gamble scores for AIS were 0.77 ± 0.16, 0.90 ± 0.11, and 0.91 ± 0.13, respectively. Factors such as age, sex, income, and level of education were dependent predictors of utility scores for AIS. Our participants demonstrated a significant perceived burden of AIS. If faced with AIS, participants were willing to sacrifice 3.6 years of their lives and undergo a procedure with 9% mortality rate to gain perfect health. Such findings can guide future allocation of resources for better scoliosis care and management. 4.

  18. Scoring systems for the characterization of sepsis and associated outcomes

    PubMed Central

    McLymont, Natalie

    2016-01-01

    Sepsis is responsible for the utilisation of a significant proportion of healthcare resources and has high mortality rates. Early diagnosis and prompt interventions are associated with better outcomes but is impeded by a lack of diagnostic tools and the heterogeneous and enigmatic nature of sepsis. The recently updated definitions of sepsis have moved away from the centrality of inflammation and the systemic inflammatory response syndrome (SIRS) criteria which have been shown to be non-specific. Sepsis is now defined as a “life-threatening organ dysfunction caused by a dysregulated host response to infection”. The Quick (q) Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score is proposed as a surrogate for organ dysfunction and may act as a risk predictor for patients with known or suspected infection, as well as being a prompt for clinicians to consider the diagnosis of sepsis. Early warning scores (EWS) are track and trigger physiological monitoring systems that have become integrated within many healthcare systems for the detection of acutely deteriorating patients. The recent study by Churpek and colleagues sought to compare qSOFA to more established alerting criteria in a population of patients with presumed infection, and compared the ability to predict death or unplanned intensive care unit (ICU) admission. This perspective paper discusses recent advances in the diagnostic criteria for sepsis and how qSOFA may fit into the pre-existing models of acute care and sepsis quality improvement. PMID:28149888

  19. Scoring systems for the characterization of sepsis and associated outcomes.

    PubMed

    McLymont, Natalie; Glover, Guy W

    2016-12-01

    Sepsis is responsible for the utilisation of a significant proportion of healthcare resources and has high mortality rates. Early diagnosis and prompt interventions are associated with better outcomes but is impeded by a lack of diagnostic tools and the heterogeneous and enigmatic nature of sepsis. The recently updated definitions of sepsis have moved away from the centrality of inflammation and the systemic inflammatory response syndrome (SIRS) criteria which have been shown to be non-specific. Sepsis is now defined as a "life-threatening organ dysfunction caused by a dysregulated host response to infection". The Quick (q) Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score is proposed as a surrogate for organ dysfunction and may act as a risk predictor for patients with known or suspected infection, as well as being a prompt for clinicians to consider the diagnosis of sepsis. Early warning scores (EWS) are track and trigger physiological monitoring systems that have become integrated within many healthcare systems for the detection of acutely deteriorating patients. The recent study by Churpek and colleagues sought to compare qSOFA to more established alerting criteria in a population of patients with presumed infection, and compared the ability to predict death or unplanned intensive care unit (ICU) admission. This perspective paper discusses recent advances in the diagnostic criteria for sepsis and how qSOFA may fit into the pre-existing models of acute care and sepsis quality improvement.

  20. Bilateral Hallux Valgus: A Utility Outcome Score Assessment.

    PubMed

    Makhdom, Asim M; Sinno, Hani; Aldebeyan, Sultan; Cota, Adam; Hamdy, Reggie Charles; Alzahrani, Mohammad; Janelle, Chantal

    2016-01-01

    Hallux valgus is the most common forefoot problem in adults. Although it can cause considerable disability and affect the quality of life of those affected, many patients seek medical attention because of cosmetic concerns. Our aim was to objectively measure the perceived health burden of living with bilateral hallux valgus. Previously validated utility outcome measures, including the visual analog scale, time trade-off, and standard gamble tests, were used to quantify the health burden for single-eye blindness, double-eye blindness, and bilateral hallux valgus in 103 healthy subjects using an online survey. The Student t test and linear regression analysis were used for statistical analysis. The mean visual analog scale, time trade-off, and standard gamble scores for bilateral hallux valgus were 0.86 ± 1.6, 0.95 ± 0.5, and 0.95 ± 0.14, respectively. These were significantly greater than the utility scores for single-eye and double-eye blindness (p < .05). Age, gender, race, income, and education were not statistically significant independent predictors of the utility scores for hallux valgus. In conclusion, we have objectively demonstrated the effect of living with bilateral hallux valgus deformities. Our sample population reported being willing to undergo a procedure with a 5% mortality rate and sacrifice 1.8 years of life to attain perfect health and avoid the bilateral hallux valgus health state. Our findings will guide us in counseling our patients and understanding how they perceive their foot deformity. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. The Gait Deviation Index Is Associated with Hip Muscle Strength and Patient-Reported Outcome in Patients with Severe Hip Osteoarthritis—A Cross-Sectional Study

    PubMed Central

    Rosenlund, Signe; Holsgaard-Larsen, Anders; Overgaard, Søren; Jensen, Carsten

    2016-01-01

    Background The Gait Deviation Index summarizes overall gait ‘quality’, based on kinematic data from a 3-dimensional gait analysis. However, it is unknown which clinical outcomes may affect the Gait Deviation Index in patients with primary hip osteoarthritis. The aim of this study was to investigate associations between Gait Deviation Index as a measure of gait ‘quality’ and hip muscle strength and between Gait Deviation Index and patient-reported outcomes in patients with primary hip osteoarthritis. Method Forty-seven patients (34 males), aged 61.1 ± 6.7 years, with BMI 27.3 ± 3.4 (kg/m2) and with severe primary hip osteoarthritis underwent 3-dimensional gait analysis. Mean Gait Deviation Index, pain after walking and maximal isometric hip muscle strength (flexor, extensor, and abductor) were recorded. All patients completed the ‘Physical Function Short-form of the Hip disability and Osteoarthritis Outcome Score (HOOS-Physical Function) and the Hip disability and Osteoarthritis Outcome Score subscales for pain (HOOS-Pain) and quality-of-life (HOOS-QOL). Results Mean Gait Deviation Index was positively associated with hip abduction strength (p<0.01, r = 0.40), hip flexion strength (p = 0.01, r = 0.37), HOOS-Physical Function (p<0.01, r = 0.41) HOOS-QOL (p<0.01, r = 0.41), and negatively associated with HOOS-Pain after walking (p<0.01, r = -0.45). Adjusting the analysis for walking speed did not affect the association. Conclusion Patients with the strongest hip abductor and hip flexor muscles had the best gait ‘quality’. Furthermore, patients with higher physical function, quality of life scores and lower pain levels demonstrated better gait ‘quality’. These findings indicate that interventions aimed at improving hip muscle strength and pain management may to a moderate degree improve the overall gait ‘quality’ in patients with primary hip OA. PMID:27065007

  2. Diabetes and kidney cancer outcomes: a propensity score analysis.

    PubMed

    Nayan, Madhur; Finelli, Antonio; Jewett, Michael A S; Juurlink, David N; Austin, Peter C; Kulkarni, Girish S; Hamilton, Robert J

    2017-02-01

    There is conflicting evidence whether diabetes is associated with survival outcomes in patients undergoing a nephrectomy for renal cell carcinoma. We performed a retrospective review of 1034 patients undergoing nephrectomy for unilateral, M0, renal cell carcinoma between 2000 and 2016 at a tertiary academic center. Inverse probability of treatment weights were derived from a propensity score model based on various clinical, surgical, and pathological characteristics. We used Cox proportional hazard models to evaluate the association between diabetes and disease-free survival, cancer-specific survival, and overall survival in the sample weighted by the inverse probability of treatment weights. Furthermore, to evaluate whether severity of diabetes was associated with survival outcomes, we performed separate analyses where inverse probability of treatment weights were computed based on the probability of having diabetes that was controlled by medication. Of the 1034 patients, 180 (17 %) had diabetes. Of these, 139 (77 %) patients required medications for diabetes control while the remaining 41 (23 %) had diet controlled diabetes. Median follow-up was 50 months (IQR 17-86). Diabetes at the time of surgery was not significantly associated with disease-free survival (HR 1.11, 95 % CI 0.64 -1.91), cancer-specific survival (HR 0.96, 95 % CI 0.49-1.91), or overall survival (HR 1.28, 95 % CI 0.84-1.95). We found similar results when we compared diabetics controlled with medication vs. non-diabetics or diet controlled diabetics. In summary, we found no significant association between diabetes and survival outcomes in patients undergoing nephrectomy for M0 renal cell carcinoma. These results suggest that diabetics should be treated and followed in a similar manner to non-diabetics.

  3. How Criterion Scores Predict the Overall Impact Score and Funding Outcomes for National Institutes of Health Peer-Reviewed Applications.

    PubMed

    Eblen, Matthew K; Wagner, Robin M; RoyChowdhury, Deepshikha; Patel, Katherine C; Pearson, Katrina

    2016-01-01

    Understanding the factors associated with successful funding outcomes of research project grant (R01) applications is critical for the biomedical research community. R01 applications are evaluated through the National Institutes of Health (NIH) peer review system, where peer reviewers are asked to evaluate and assign scores to five research criteria when assessing an application's scientific and technical merit. This study examined the relationship of the five research criterion scores to the Overall Impact score and the likelihood of being funded for over 123,700 competing R01 applications for fiscal years 2010 through 2013. The relationships of other application and applicant characteristics, including demographics, to scoring and funding outcomes were studied as well. The analyses showed that the Approach and, to a lesser extent, the Significance criterion scores were the main predictors of an R01 application's Overall Impact score and its likelihood of being funded. Applicants might consider these findings when submitting future R01 applications to NIH.

  4. John Charnley Award: Preoperative Patient-reported Outcome Measures Predict Clinically Meaningful Improvement in Function After THA.

    PubMed

    Berliner, Jonathan L; Brodke, Dane J; Chan, Vanessa; SooHoo, Nelson F; Bozic, Kevin J

    2016-02-01

    Despite the overall effectiveness of total hip arthroplasty (THA), a subset of patients remain dissatisfied with their results because of persistent pain or functional limitations. It is therefore important to develop predictive tools capable of identifying patients at risk for poor outcomes before surgery. The purpose of this study was to use preoperative patient-reported outcome measure (PROM) scores to predict which patients undergoing THA are most likely to experience a clinically meaningful change in functional outcome 1 year after surgery. A retrospective cohort study design was used to evaluate preoperative and 1-year postoperative SF-12 version 2 (SF12v2) and Hip Disability and Osteoarthritis Outcome Score (HOOS) scores from 537 selected patients who underwent primary unilateral THA. Minimum clinically important differences (MCIDs) were calculated using a distribution-based method. A receiver operating characteristic analysis was used to calculate threshold values, defined as the levels at which substantial changes occurred, and their predictive ability. MCID values for HOOS and SF12v2 physical component summary (PCS) scores were calculated to be 9.1 and 4.6, respectively. We analyzed the effect of SF12v2 mental component summary (MCS) scores, which measure mental and emotional health, on SF12v2 PCS and HOOS threshold values. Threshold values for preoperative HOOS and PCS scores were a maximum of 51.0 (area under the curve [AUC], 0.74; p < 0.001) and 32.5 (AUC, 0.62; p < 0.001), respectively. As preoperative mental and emotional health improved, which was reflected by a higher MCS score, HOOS and PCS threshold values also increased. When preoperative mental and emotional health were taken into account, both HOOS and PCS threshold values' predictive ability improved (AUCs increased to 0.77 and 0.69, respectively). We identified PROM threshold values that predict clinically meaningful improvements in functional outcome after THA. Patients with a higher level

  5. The APPLE Score – A Novel Score for the Prediction of Rhythm Outcomes after Repeat Catheter Ablation of Atrial Fibrillation

    PubMed Central

    Kornej, Jelena; Hindricks, Gerhard; Arya, Arash; Sommer, Philipp; Husser, Daniela; Bollmann, Andreas

    2017-01-01

    Background Arrhythmia recurrences after catheter ablation occur in up to 50% within one year but their prediction remains challenging. Recently, we developed a novel score for the prediction of rhythm outcomes after single AF ablation demonstrating superiority to other scores. The current study was performed to 1) prove the predictive value of the APPLE score in patients undergoing repeat AF ablation and 2) compare it with the CHADS2 and CHA2DS2-VASc scores. Methods Rhythm outcome between 3–12 months after AF ablation were documented. The APPLE score (one point for Age >65 years, Persistent AF, imPaired eGFR (<60 ml/min/1.73m2), LA diameter ≥43 mm, EF <50%) was calculated in every patient before procedure. Results 379 consecutive patients from The Leipzig Heart Center AF Ablation Registry (60±10 years, 65% male, 70% paroxysmal AF) undergoing repeat AF catheter ablation were included. Arrhythmia recurrences were observed in 133 patients (35%). While the CHADS2 (AUC 0.577, p = 0.037) and CHA2DS2-VASc scores (AUC 0.590, p = 0.015) demonstrated low predictive value, the APPLE score showed better prediction of arrhythmia recurrences (AUC 0.617, p = 0.002) than other scores (both p<0.001). Compared to patients with an APPLE score of 0, the risk (OR) for arrhythmia recurrences was 2.9, 3.0 and 6.0 (all p<0.01) for APPLE scores 1, 2, or ≥3, respectively. Conclusions The novel APPLE score is superior to the CHADS2 and CHA2DS2-VASc scores for prediction of rhythm outcomes after repeat AF catheter ablation. It may be helpful to identify patients with low, intermediate or high risk for recurrences after repeat procedure. PMID:28085921

  6. Does the Aristotle Score predict outcome in congenital heart surgery?

    PubMed

    Kang, Nicholas; Tsang, Victor T; Elliott, Martin J; de Leval, Marc R; Cole, Timothy J

    2006-06-01

    The Aristotle Score has been proposed as a measure of 'complexity' in congenital heart surgery, and a tool for comparing performance amongst different centres. To date, however, it remains unvalidated. We examined whether the Basic Aristotle Score was a useful predictor of mortality following open-heart surgery, and compared it to the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system. We also examined the ability of the Aristotle Score to measure performance. The Basic Aristotle Score and RACHS-1 risk categories were assigned retrospectively to 1085 operations involving cardiopulmonary bypass in children less than 18 years of age. Multiple logistic regression analysis was used to determine the significance of the Aristotle Score and RACHS-1 category as independent predictors of in-hospital mortality. Operative performance was calculated using the Aristotle equation: performance = complexity x survival. Multiple logistic regression identified RACHS-1 category to be a powerful predictor of mortality (Wald 17.7, p < 0.0001), whereas Aristotle Score was only weakly associated with mortality (Wald 4.8, p = 0.03). Age at operation and bypass time were also highly significant predictors of postoperative death (Wald 13.7 and 33.8, respectively, p < 0.0001 for both). Operative performance was measured at 7.52 units. The Basic Aristotle Score was only weakly associated with postoperative mortality in this series. Operative performance appeared to be inflated by the fact that the overall complexity of cases was relatively high in this series. An alternative equation (performance = complexity/mortality) is proposed as a fairer and more logical method of risk-adjustment.

  7. Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score.

    PubMed

    Maeremans, Joren; Spratt, James C; Knaapen, Paul; Walsh, Simon; Agostoni, Pierfrancesco; Wilson, William; Avran, Alexandre; Faurie, Benjamin; Bressollette, Erwan; Kayaert, Peter; Bagnall, Alan J; Smith, Dave; McEntegart, Margaret B; Smith, William H T; Kelly, Paul; Irving, John; Smith, Elliot J; Strange, Julian W; Dens, Jo

    2017-05-04

    This study sought to create a contemporary scoring tool to predict technical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) from patients treated by hybrid operators with differing experience levels. Current scoring systems need regular updating to cope with the positive evolutions regarding materials, techniques, and outcomes, while at the same time being applicable for a broad range of operators. Clinical and angiographic characteristics from 880 CTO-PCIs included in the REgistry of CrossBoss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE) were analyzed by using a derivation and validation set (2:1 ratio). Variables significantly associated with technical failure in the multivariable analysis were incorporated in the score. Subsequently, the discriminatory capacity was assessed and the validation set was used to compare with the J-CTO score and PROGRESS scores. Technical success in the derivation and validation sets was 83% and 85%, respectively. Multivariate analysis identified six parameters associated with technical failure: blunt stump (beta coefficient (b) = 1.014); calcification (b = 0.908); tortuosity ≥45° (b = 0.964); lesion length 20 mm (b = 0.556); diseased distal landing zone (b = 0.794), and previous bypass graft on CTO vessel (b = 0.833). Score variables remained significant after bootstrapping. The RECHARGE score showed better discriminatory capacity in both sets (area-under-the-curve (AUC) = 0.783 and 0.711), compared to the J-CTO (AUC = 0.676) and PROGRESS (AUC = 0.608) scores. The RECHARGE score is a novel, easy-to-use tool for assessing the risk for technical failure in hybrid CTO-PCI and has the potential to perform well for a broad community of operators. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  8. How Criterion Scores Predict the Overall Impact Score and Funding Outcomes for National Institutes of Health Peer-Reviewed Applications

    PubMed Central

    Eblen, Matthew K.; Wagner, Robin M.; RoyChowdhury, Deepshikha; Patel, Katherine C.; Pearson, Katrina

    2016-01-01

    Understanding the factors associated with successful funding outcomes of research project grant (R01) applications is critical for the biomedical research community. R01 applications are evaluated through the National Institutes of Health (NIH) peer review system, where peer reviewers are asked to evaluate and assign scores to five research criteria when assessing an application’s scientific and technical merit. This study examined the relationship of the five research criterion scores to the Overall Impact score and the likelihood of being funded for over 123,700 competing R01 applications for fiscal years 2010 through 2013. The relationships of other application and applicant characteristics, including demographics, to scoring and funding outcomes were studied as well. The analyses showed that the Approach and, to a lesser extent, the Significance criterion scores were the main predictors of an R01 application’s Overall Impact score and its likelihood of being funded. Applicants might consider these findings when submitting future R01 applications to NIH. PMID:27249058

  9. Using IRT Trait Estimates versus Summated Scores in Predicting Outcomes

    ERIC Educational Resources Information Center

    Xu, Ting; Stone, Clement A.

    2012-01-01

    It has been argued that item response theory trait estimates should be used in analyses rather than number right (NR) or summated scale (SS) scores. Thissen and Orlando postulated that IRT scaling tends to produce trait estimates that are linearly related to the underlying trait being measured. Therefore, IRT trait estimates can be more useful…

  10. Outcome of intensive care unit patients using Pediatric Risk of Mortality (PRISM) score.

    PubMed

    Bellad, Roopa; Rao, Surendra; Patil, V D; Mahantshetti, N S

    2009-12-01

    We conducted this study to evaluate the outcome of 203 patients admitted to PICU, using PRISM score. Overall mortality was 16.7%. The mean PRISM score was 6.5+/-3.6 and 15.5+/-7 for survivors and non survivors, respectively (OR: 1.36; 95% CI=1.24 -1.5; P<0.001). PRISM score also correlated well with length of hospital stay and the number of organ failures (P<0.001). A cut off score of 15 was associated with 89.2% accuracy. PRISM score is highly sensitive in predicting the outcome of pediatric patients in an ICU setting.

  11. Context-specific close-range "hoo" calls in wild gibbons (Hylobates lar).

    PubMed

    Clarke, Esther; Reichard, Ulrich H; Zuberbühler, Klaus

    2015-04-08

    Close range calls are produced by many animals during intra-specific interactions, such as during home range defence, playing, begging for food, and directing others. In this study, we investigated the most common close range vocalisation of lar gibbons (Hylobates lar), the 'hoo' call. Gibbons and siamangs (family Hylobatidae) are known for their conspicuous and elaborate songs, while quieter, close range vocalisations have received almost no empirical attention, perhaps due to the difficult observation conditions in their natural forest habitats. We found that 'hoo' calls were emitted by both sexes in a variety of contexts, including feeding, separation from group members, encountering predators, interacting with neighbours, or as part of duet songs by the mated pair. Acoustic analyses revealed that 'hoo' calls varied in a number of spectral parameters as a function of the different contexts. Males' and females' 'hoo' calls showed similar variation in these context-specific parameter differences, although there were also consistent sex differences in frequency across contexts. Our study provides evidence that lar gibbons are able to generate significant, context-dependent acoustic variation within their main social call, which potentially allows recipients to make inferences about the external events experienced by the caller. Communicating about different events by producing subtle acoustic variation within some call types appears to be a general feature of primate communication, which can increase the expressive power of vocal signals within the constraints of limited vocal tract flexibility that is typical for all non-human primates. In this sense, this study is of direct relevance for the on-going debate about the nature and origins of vocally-based referential communication and the evolution of human speech.

  12. Antithrombotic drugs and non-variceal bleeding outcomes and risk scoring systems: comparison of Glasgow Blatchford, Rockall and Charlson scores.

    PubMed

    Taha, Ali S; McCloskey, Caroline; Craigen, Theresa; Angerson, Wilson J

    2016-10-01

    Antithrombotic drugs (ATDs) cause non-variceal upper gastrointestinal bleeding (NVUGIB). Risk scoring systems have not been validated in ATD users. We compared Blatchford, Rockall and Charlson scores in predicting outcomes of NVUGIB in ATD users and controls. A total of 2071 patients with NVUGIB were grouped into ATD users (n=851) and controls (n=1220) in a single-centre retrospective analysis. Outcomes included duration of hospital admission, the need for blood transfusion, rebleeding requiring surgery and 30-day mortality. Duration of admission correlated with all scores in controls, but correlations were significantly weaker in ATD users. Rank correlation coefficients in control versus ATD: 0.45 vs 0.20 for Blatchford; 0.48 vs 0.32 for Rockall and 0.42 vs 0.26 for Charlson (all p<0.001). The need for transfusion was best predicted by Blatchford (p<0.001 vs Rockall and Charlson in both ATD users and controls), but all scores performed less well in ATD users. Area under the receiver operation characteristic curve (AUC) in control versus ATD: 0.90 vs 0.85 for Blatchford; 0.77 vs 0.61 for Rockall and 0.69 vs 0.56 for Charlson (all p<0.005). In predicting surgery, Rockall performed best; while mortality was best predicted by Charlson with lower AUCs in ATD patients than controls (p<0.05). Stratification showed the scores' performance to be age-dependent. Blatchford score was the strongest predictor of transfusion, Rockall's had the strongest correlation with duration of admission and with rebleeding requiring surgery and Charlson was best in predicting 30-day mortality. Modifications of these systems should be explored to improve their efficiency in ATD users.

  13. An Empirical Investigation of Dispositional Antecedents and Performance-Related Outcomes of Credit Scores

    ERIC Educational Resources Information Center

    Bernerth, Jeremy B.; Taylor, Shannon G.; Walker, H. Jack; Whitman, Daniel S.

    2012-01-01

    Many organizations use credit scores as an employment screening tool, but little is known about the legitimacy of such practices. To address this important gap, the reported research conceptualized credit scores as a biographical measure of financial responsibility and investigated dispositional antecedents and performance-related outcomes. Using…

  14. An Empirical Investigation of Dispositional Antecedents and Performance-Related Outcomes of Credit Scores

    ERIC Educational Resources Information Center

    Bernerth, Jeremy B.; Taylor, Shannon G.; Walker, H. Jack; Whitman, Daniel S.

    2012-01-01

    Many organizations use credit scores as an employment screening tool, but little is known about the legitimacy of such practices. To address this important gap, the reported research conceptualized credit scores as a biographical measure of financial responsibility and investigated dispositional antecedents and performance-related outcomes. Using…

  15. Comparison of Three Risk Scores to Predict Outcomes of Severe Lower Gastrointestinal Bleeding

    PubMed Central

    Camus, Marine; Jensen, Dennis M.; Ohning, Gordon V.; Kovacs, Thomas O.; Jutabha, Rome; Ghassemi, Kevin A.; Machicado, Gustavo A.; Dulai, Gareth S.; Jensen, Mary Ellen; Gornbein, Jeffrey A.

    2014-01-01

    Background & aims Improved medical decisions by using a score at the initial patient triage level may lead to improvements in patient management, outcomes, and resource utilization. There is no validated score for management of lower gastrointestinal bleeding (LGIB) unlike for upper GIB. The aim of our study was to compare the accuracies of 3 different prognostic scores (CURE Hemostasis prognosis score, Charlston index and ASA score) for the prediction of 30 day rebleeding, surgery and death in severe LGIB. Methods Data on consecutive patients hospitalized with severe GI bleeding from January 2006 to October 2011 in our two-tertiary academic referral centers were prospectively collected. Sensitivities, specificities, accuracies and area under the receiver operating characteristic (AUROC) were computed for three scores for predictions of rebleeding, surgery and mortality at 30 days. Results 235 consecutive patients with LGIB were included between 2006 and 2011. 23% of patients rebled, 6% had surgery, and 7.7% of patients died. The accuracies of each score never reached 70% for predicting rebleeding or surgery in either. The ASA score had a highest accuracy for predicting mortality within 30 days (83.5%) whereas the CURE Hemostasis prognosis score and the Charlson index both had accuracies less than 75% for the prediction of death within 30 days. Conclusions ASA score could be useful to predict death within 30 days. However a new score is still warranted to predict all 30 days outcomes (rebleeding, surgery and death) in LGIB. PMID:25599218

  16. Waterlow score as a surrogate marker for predicting adverse outcome in acute pancreatitis

    PubMed Central

    Gillick, K; Elbeltagi, H; Bhattacharya, S

    2016-01-01

    Introduction Introduced originally to stratify risk for developing decubitus ulcers, the Waterlow scoring system is recorded routinely for surgical admissions. It is a composite score, reflecting patients’ general condition and co-morbidities. The aim of this study was to investigate whether the Waterlow score can be used as an independent surrogate marker to predict severity and adverse outcome in acute pancreatitis. Methods In this retrospective analysis, a consecutive cohort was studied of 250 patients presenting with acute pancreatitis, all of whom had their Waterlow score calculated on admission. Primary outcome measures were length of hospital stay and mortality. Secondary outcome measures included rate of intensive care unit (ICU) admission and development of complications such as peripancreatic free fluid, pancreatic necrosis and pseudocyst formation. Correlation of the Waterlow score with some known markers of disease severity and outcomes was also analysed. Results The Waterlow score correlated strongly with the most commonly used marker of disease severity, the Glasgow score (analysis of variance, p=0.0012). Inpatient mortality, rate of ICU admission and length of hospital stay increased with a higher Waterlow score (Mann–Whitney U test, p=0.0007, p=0.049 and p=0.0002 respectively). There was, however, no significant association between the Waterlow score and the incidence of three known complications of pancreatitis: presence of peripancreatic fluid, pancreatic pseudocyst formation and pancreatic necrosis. Receiver operating characteristic curve analysis demonstrated good predictive power of the Waterlow score for mortality (area under the curve [AUC]: 0.73), ICU admission (AUC: 0.65) and length of stay >7 days (AUC: 0.64). This is comparable with the predictive power of the Glasgow score and C-reactive protein. Conclusions The Waterlow score for patients admitted with acute pancreatitis could provide a useful tool in prospective assessment of

  17. An empirical investigation of dispositional antecedents and performance-related outcomes of credit scores.

    PubMed

    Bernerth, Jeremy B; Taylor, Shannon G; Walker, H Jack; Whitman, Daniel S

    2012-03-01

    Many organizations use credit scores as an employment screening tool, but little is known about the legitimacy of such practices. To address this important gap, the reported research conceptualized credit scores as a biographical measure of financial responsibility and investigated dispositional antecedents and performance-related outcomes. Using personality data collected from employees, objective credit scores obtained from the Fair Isaac Corporation, and performance data provided by supervisors, we found conscientiousness to be positively related and agreeableness to be negatively related to credit scores. Results also indicate significant relationships between credit scores and task performance and organizational citizenship behaviors. Credit scores did not, however, predict workplace deviance. Implications for organizations currently using or planning to use credit scores as part of the screening process are discussed.

  18. Analyzing Proportion Scores as Outcomes for Prevention Trials: a Statistical Primer.

    PubMed

    Chen, Kehui; Cheng, Yu; Berkout, Olga; Lindhiem, Oliver

    2016-03-10

    In prevention trials, outcomes of interest frequently include data that are best quantified as proportion scores. In some cases, however, proportion scores may violate the statistical assumptions underlying common analytic methods. In this paper, we provide guidelines for analyzing frequency and proportion data as primary outcomes. We describe standard methods including generalized linear regression models to compare mean proportion scores and examine tools for testing normality and other assumptions for each model. Recommendations are made for instances when the assumptions are not met, including transformations for proportion scores that are non-normal. We also discuss more sophisticated analytical tools to model change in proportion scores over time. The guidelines provide ready-to-use analytical strategies for frequency and proportion data that are commonly encountered in prevention science.

  19. Retrospective study of long-term outcome after brain arteriovenous malformation rupture: the RAP score.

    PubMed

    Shotar, Eimad; Debarre, Matthieu; Sourour, Nader-Antoine; Di Maria, Federico; Gabrieli, Joseph; Nouet, Aurélien; Chiras, Jacques; Degos, Vincent; Clarençon, Frédéric

    2017-01-20

    OBJECTIVE The authors aimed to design a score for stratifying patients with brain arteriovenous malformation (BAVM) rupture, based on the likelihood of a poor long-term neurological outcome. METHODS The records of consecutive patients with BAVM hemorrhagic events who had been admitted over a period of 11 years were retrospectively reviewed. Independent predictors of a poor long-term outcome (modified Rankin Scale score ≥ 3) beyond 1 year after admission were identified. A risk stratification scale was developed and compared with the intracranial hemorrhage (ICH) score to predict poor outcome and inpatient mortality. RESULTS One hundred thirty-five patients with 139 independent hemorrhagic events related to BAVM rupture were included in this analysis. Multivariate logistic regression followed by stepwise analysis showed that consciousness level according to the Glasgow Coma Scale (OR 6.5, 95% CI 3.1-13.7, p < 10(-3)), hematoma volume (OR 1.8, 95% CI 1.2-2.8, p = 0.005), and intraventricular hemorrhage (OR 7.5, 95% CI 2.66-21, p < 10(-3)) were independently associated with a poor outcome. A 12-point scale for ruptured BAVM prognostication was constructed combining these 3 factors. The score obtained using this new scale, the ruptured AVM prognostic (RAP) score, was a stronger predictor of a poor long-term outcome (area under the receiver operating characteristic curve [AUC] 0.87, 95% CI 0.8-0.92, p = 0.009) and inpatient mortality (AUC 0.91, 95% CI 0.85-0.95, p = 0.006) than the ICH score. For a RAP score ≥ 6, sensitivity and specificity for predicting poor outcome were 76.8% (95% CI 63.6-87) and 90.8% (95% CI 81.9-96.2), respectively. CONCLUSIONS The authors propose a new admission score, the RAP score, dedicated to stratifying the risk of poor long-term outcome after BAVM rupture. This easy-to-use scoring system may help to improve communication between health care providers and consistency in clinical research. Only external prospective cohorts and population

  20. Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study.

    PubMed

    Exarchopoulos, Themistocles; Charitidou, Efstratia; Dedeilias, Panagiotis; Charitos, Christos; Routsi, Christina

    2015-07-01

    Most scoring systems used to predict clinical outcome in critical care were not designed for application in cardiac surgery patients. To compare the predictive ability of the most widely used scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Sequential Organ Failure Assessment [SOFA]) and of 2 specialized systems (European System for Cardiac Operative Risk Evaluation [EuroSCORE] II and the cardiac surgery score [CASUS]) for clinical outcome in patients after cardiac surgery. Consecutive patients admitted to a cardiac surgical intensive care unit (CSICU) were prospectively studied. Data on the preoperative condition, intraoperative parameters, and postoperative course were collected. EuroSCORE II, CASUS, and scores from 3 general severity-scoring systems (APACHE II, SAPS II, and SOFA) were calculated on the first postoperative day. Clinical outcome was defined as 30-day mortality and in-hospital morbidity. A total of 150 patients were included. Thirty-day mortality was 6%. CASUS was superior in outcome prediction, both in relation to discrimination (area under curve, 0.89) and calibration (Brier score = 0.043, χ(2) = 2.2, P = .89), followed by EuroSCORE II for 30-day mortality (area under curve, 0.87) and SOFA for morbidity (Spearman ρ= 0.37 and 0.35 for the CSICU length of stay and duration of mechanical ventilation, respectively; Wilcoxon W = 367.5, P = .03 for probability of readmission to CSICU). CASUS can be recommended as the most reliable and beneficial option for benchmarking and risk stratification in cardiac surgery patients. ©2015 American Association of Critical-Care Nurses.

  1. SIRS score on admission and initial concentration of IL-6 as severe acute pancreatitis outcome predictors.

    PubMed

    Gregoric, Pavle; Pavle, Gregoric; Sijacki, Ana; Ana, Sijacki; Stankovic, Sanja; Sanja, Stankovic; Radenkovic, Dejan; Dejan, Radenkovic; Ivancevic, Nenad; Nenad, Ivancevic; Karamarkovic, Aleksandar; Aleksandar, Karamarkovic; Popovic, Nada; Nada, Popovic; Karadzic, Borivoje; Borivoje, Karadzic; Stijak, Lazar; Stefanovic, Branislav; Branislav, Stefanovic; Milosevic, Zoran; Zoran, Milosević; Bajec, Djordje; Djordje, Bajec

    2010-01-01

    Early recognition of severe form of acute pancreatitis is important because these patients need more agressive diagnostic and therapeutical approach an can develope systemic complications such as: sepsis, coagulopathy, Acute Lung Injury (ALI), Acute Respiratory Distress Syndrome (ARDS), Multiple Organ Dysfunction Syndrome (MODS), Multiple Organ Failure (MOF). To determine role of the combination of Systemic Inflammatory Response Syndrome (SIRS) score and serum Interleukin-6 (IL-6) level on admission as predictor of illness severity and outcome of Severe Acute Pancreatitis (SAP). We evaluated 234 patients with first onset of SAP appears in last twenty four hours. A total of 77 (33%) patients died. SIRS score and serum IL-6 concentration were measured in first hour after admission. In 105 patients with SIRS score 3 and higher, initial measured IL-6 levels were significantly higher than in the group of remaining 129 patients (72 +/- 67 pg/mL, vs 18 +/- 15 pg/mL). All nonsurvivals were in the first group, with SIRS score 3 and 4 and initial IL-6 concentration 113 +/- 27 pg/mL. The values of C-reactive Protein (CRP) measured after 48h, Acute Physiology and Chronic Health Evaluation (APACHE II) score on admission and Ranson score showed the similar correlation, but serum amylase level did not correlate significantly with Ranson score, IL-6 concentration and APACHE II score. The combination of SIRS score on admission and IL-6 serum concentration can be early, predictor of illness severity and outcome in SAP.

  2. Prognostication of long-term outcomes after subarachnoid hemorrhage: The FRESH score.

    PubMed

    Witsch, Jens; Frey, Hans-Peter; Patel, Sweta; Park, Soojin; Lahiri, Shouri; Schmidt, J Michael; Agarwal, Sachin; Falo, Maria Cristina; Velazquez, Angela; Jaja, Blessing; Macdonald, R Loch; Connolly, E Sander; Claassen, Jan

    2016-07-01

    To create a multidimensional tool to prognosticate long-term functional, cognitive, and quality of life outcomes after spontaneous subarachnoid hemorrhage (SAH) using data up to 48 hours after admission. Data were prospectively collected for 1,619 consecutive patients enrolled in the SAH outcome project July 1996 to March 2014. Linear models (LMs) were applied to identify factors associated with outcome in 1,526 patients with complete data. Twelve-month functional, cognitive, and quality of life outcomes were measured using the modified Rankin scale (mRS), Telephone Interview for Cognitive Status, and Sickness Impact Profile. Based on the LM residuals, we constructed the FRESH score (Functional Recovery Expected after Subarachnoid Hemorrhage). Score performance, discrimination, and internal validity were tested using the area under the receiver operating characteristic curve (AUC), Nagelkerke and Cox/Snell R(2) , and bootstrapping. For external validation, we used a control population of SAH patients from the CONSCIOUS-1 study (n = 413). The FRESH score was composed of Hunt & Hess and APACHE-II physiologic scores on admission, age, and aneurysmal rebleed within 48 hours. Separate scores to prognosticate 1-year cognition (FRESH-cog) and quality of life (FRESH-quol) were developed controlling for education and premorbid disability. Poor functional outcome (mRS = 4-6) for score levels 1 through 9 respectively was present in 3, 6, 12, 38, 61, 83, 92, 98, and 100% at 1-year follow-up. Performance of FRESH (AUC = 0.90), FRESH-cog (AUC = 0.80), and FRESH-quol (AUC = 0.78) was high. External validation of our cohort using mRS as endpoint showed satisfactory results (AUC = 0.77). To allow for convenient score calculation, we built a smartphone app available for free download. FRESH is the first clinical tool to prognosticate long-term outcome after spontaneous SAH in a multidimensional manner. Ann Neurol 2016;80:46-58. © 2016 American Neurological Association.

  3. TURN Score Predicts 90-day Outcome in Acute Ischemic Stroke Patients After IV Thrombolysis.

    PubMed

    Asuzu, David; Nyström, Karin; Schindler, Joseph; Wira, Charles; Greer, David; Halliday, Janet; Sheth, Kevin N

    2015-10-01

    We developed the TURN score for predicting symptomatic intracerebral hemorrhage (sICH) after IV thrombolysis. Our purpose was to evaluate its ability to predict 90-day outcome. We retrospectively analyzed data from 303 patients who received IV rt-PA during the NINDS rt-PA trial. Severe outcome was defined as 90-day modified Rankin scale (mRS) scores ≥5, 90-day Barthel index (BI) scores <60 and 90-day Glasgow Outcome Scale (GOS) scores >2. Excellent outcome was defined as 90-day mRS scores ≤1, 90-day BI scores ≥95 and 90-day GOS scores = 1. Agreement between TURN and 90-day outcome was assessed by univariate logistic regression reporting odds ratios (OR) and by areas under the receiver operating characteristic curves (AUROC). TURN was also compared with 6 other scores for predicting sICH or severe outcome. TURN predicted 90-day mRS ≥5 with OR 5.73, 95% confidence interval (3.60, 9.10), P < 0.001 and AUROC 0.83, 95% confidence interval (0.77, 0.89). TURN also predicted 90-day mRS ≤1 with OR 5.24, 95% confidence interval (3.43, 7.99), P < 0.001 and AUROC 0.80, 95% confidence interval (0.74, 0.85). TURN predicted 90-day mRS ≥5 with OR significantly higher than DRAGON (2.30, P = 0.01), ASTRAL (1.18, P < 0.001), HAT (2.89, P = 0.05) and SEDAN (2.16, P = 0.01), and with AUROC significantly higher than SPAN-100 (0.64, P < 0.001) and SEDAN (0.71, P = 0.01). Likewise, TURN predicted 90-day mRS ≤1 with OR significantly higher than Stroke-TPI (2.89, P = 0.05), DRAGON (2.29, P = 0.01), ASTRAL (1.15, P < 0.001), HAT (2.71, P = 0.04) and SEDAN (2.15, P = 0.01), and with AUROC significantly higher than SPAN-100 (0.58, P < 0.001) and SEDAN (0.70, P = 0.01). Similar results were obtained using 90-day BI and 90-day GOS scores. TURN predicted 90-day outcome with comparable or better accuracy compared to several existing clinical scores.

  4. Translation and cultural adaptation of the Hip Outcome Score to the Portuguese language☆☆☆

    PubMed Central

    de Oliveira, Liszt Palmeira; Moura Cardinot, Themis; Nunes Carreras Del Castillo, Letícia; Cavalheiro Queiroz, Marcelo; Cavalli Polesello, Giancarlo

    2014-01-01

    Objective to translate the Hip Outcome Score clinical evaluation questionnaire into Portuguese and culturally adapt it for Brazil. Methods the Hip Outcome Score questionnaire was translated into Portuguese following the methodology consisting of the steps of translation, back-translation, pretesting and final translation. Results the pretesting was applied to 30 patients with hip pain without arthrosis. In the domain relating to activities of daily living, there were no difficulties in comprehending the translated questionnaire. In presenting the final translation of the questionnaire, all the questions were understood by more than 85% of the individuals. Conclusion the Hip Outcome Score questionnaire was translated and adapted to the Portuguese language and can be used in clinical evaluation on the hip. Additional studies are underway with the objective of evaluating the reproducibility and validity of the Brazilian translation. PMID:26229816

  5. Psychometric Evaluation of the Lower Extremity Computerized Adaptive Test, the Modified Harris Hip Score, and the Hip Outcome Score

    PubMed Central

    Hung, Man; Hon, Shirley D.; Cheng, Christine; Franklin, Jeremy D.; Aoki, Stephen K.; Anderson, Mike B.; Kapron, Ashley L.; Peters, Christopher L.; Pelt, Christopher E.

    2014-01-01

    Background: The applicability and validity of many patient-reported outcome measures in the high-functioning population are not well understood. Purpose: To compare the psychometric properties of the modified Harris Hip Score (mHHS), the Hip Outcome Score activities of daily living subscale (HOS-ADL) and sports (HOS-sports), and the Lower Extremity Computerized Adaptive Test (LE CAT). The hypotheses was that all instruments would perform well but that the LE CAT would show superiority psychometrically because a combination of CAT and a large item bank allows for a high degree of measurement precision. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Data were collected from 472 advanced-age, active participants from the Huntsman World Senior Games in 2012. Validity evidences were examined through item fit, dimensionality, monotonicity, local independence, differential item functioning, person raw score to measure correlation, and instrument coverage (ie, ceiling and floor effects), and reliability evidences were examined through Cronbach alpha and person separation index. Results: All instruments demonstrated good item fit, unidimensionality, monotonicity, local independence, and person raw score to measure correlations. The HOS-ADL had high ceiling effects of 36.02%, and the mHHS had ceiling effects of 27.54%. The LE CAT had ceiling effects of 8.47%, and the HOS-sports had no ceiling effects. None of the instruments had any floor effects. The mHHS had a very low Cronbach alpha of 0.41 and an extremely low person separation index of 0.08. Reliabilities for the LE CAT were excellent and for the HOS-ADL and HOS-sports were good. Conclusion: The LE CAT showed better psychometric properties overall than the HOS-ADL, HOS-sports, and mHHS for the senior population. The mHHS demonstrated pronounced ceiling effects and poor reliabilities that should be of concern. The high ceiling effects for the HOS-ADL were also of concern. The LE CAT was superior

  6. Status epilepticus severity score (STESS): A useful tool to predict outcome of status epilepticus.

    PubMed

    Goyal, Manoj Kumar; Chakravarthi, Sudheer; Modi, Manish; Bhalla, Ashish; Lal, Vivek

    2015-12-01

    The treatment protocols for status epilepticus (SE) range from small doses of intravenous benzodiazepines to induction of coma. The pros and cons of more aggressive treatment regimen remain debatable. The importance of an index need not be overemphasized which can predict outcome of SE and guide the intensity of treatment. We tried to evaluate utility of one such index Status epilepticus severity score (STESS). 44 consecutive patients of SE were enrolled in the study. STESS results were compared with various outcome measures: (a) mortality, (b) final neurological outcome at discharge as defined by functional independence measure (FIM) (good outcome: FIM score 5-7; bad outcome: FIM score 1-4), (c) control of SE within 1h of start of treatment and (d) need for coma induction. A higher STESS score correlated significantly with poor neurological outcome at discharge (p=0.0001), need for coma induction (p=0.0001) and lack of response to treatment within 1h (p=0.001). A STESS of <3 was found to have a negative predictive value of 96.9% for mortality, 96.7% for poor neurological outcome at discharge and 96.7% for need of coma induction, while a STESS of <2 had negative predictive value of 100% for mortality, coma induction and poor neurological outcome at discharge. STESS can reliably predict the outcome of status epilepticus. Further studies on STESS based treatment approach may help in designing better therapeutic regimens for SE. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Comparison of Three Risk Scores to Predict Outcomes of Severe Lower Gastrointestinal Bleeding.

    PubMed

    Camus, Marine; Jensen, Dennis M; Ohning, Gordon V; Kovacs, Thomas O; Jutabha, Rome; Ghassemi, Kevin A; Machicado, Gustavo A; Dulai, Gareth S; Jensen, Mary E; Gornbein, Jeffrey A

    2016-01-01

    Improved medical decisions by using a score at the initial patient triage level may lead to improvements in patient management, outcomes, and resource utilization. There is no validated score for management of lower gastrointestinal bleeding (LGIB) unlike for upper gastrointestinal bleeding. The aim of our study was to compare the accuracies of 3 different prognostic scores [Center for Ulcer Research and Education Hemostasis prognosis score, Charlson index, and American Society of Anesthesiologists (ASA) score] for the prediction of 30-day rebleeding, surgery, and death in severe LGIB. Data on consecutive patients hospitalized with severe gastrointestinal bleeding from January 2006 to October 2011 in our 2 tertiary academic referral centers were prospectively collected. Sensitivities, specificities, accuracies, and area under the receiver operator characteristic curve were computed for 3 scores for predictions of rebleeding, surgery, and mortality at 30 days. Two hundred thirty-five consecutive patients with LGIB were included between 2006 and 2011. Twenty-three percent of patients rebled, 6% had surgery, and 7.7% of patients died. The accuracies of each score never reached 70% for predicting rebleeding or surgery in either. The ASA score had a highest accuracy for predicting mortality within 30 days (83.5%), whereas the Center for Ulcer Research and Education Hemostasis prognosis score and the Charlson index both had accuracies <75% for the prediction of death within 30 days. ASA score could be useful to predict death within 30 days. However, a new score is still warranted to predict all 30 days outcomes (rebleeding, surgery, and death) in LGIB.

  8. The iScore predicts poor functional outcomes early after hospitalization for an acute ischemic stroke.

    PubMed

    Saposnik, Gustavo; Raptis, Stavroula; Kapral, Moira K; Liu, Ying; Tu, Jack V; Mamdani, Muhammad; Austin, Peter C

    2011-12-01

    The iScore is a prediction tool originally developed to estimate the risk of death after hospitalization for an acute ischemic stroke. Our objective was to determine whether the iScore could also predict poor functional outcomes. We applied the iScore to patients presenting with an acute ischemic stroke at multiple hospitals in Ontario, Canada, between 2003 and 2008, who had been identified from the Registry of the Canadian Stroke Network regional stroke center database (n=3818) and from an external data set, the Registry of the Canadian Stroke Network Ontario Stroke Audit (n=4635). Patients were excluded if they were included in the sample used to develop and validate the initial iScore. Poor functional outcomes were defined as: (1) death at 30 days or disability at discharge, in which disability was defined as having a modified Rankin Scale 3 to 5; and (2) death at 30 days or institutionalization at discharge. The prevalence of poor functional outcomes in the Registry of the Canadian Stroke Network and the Ontario Stroke Audit, respectively, were 55.7% and 44.1% for death at 30 days or disability at discharge and 16.9% and 16.2%, respectively, for death at 30 days or institutionalization at discharge. The iScore stratified the risk of poor outcomes in low- and high-risk individuals. Observed versus predicted outcomes showed high correlations: 0.988 and 0.940 for mortality or disability and 0.985 and 0.993 for mortality or institutionalization in the Registry of the Canadian Stroke Network and Ontario Stroke Audit cohorts. The iScore can be used to estimate the risk of death or a poor functional outcome after an acute ischemic stroke.

  9. Does a patient's Mallampati score predict outcome after maxillomandibular advancement for obstructive sleep apnoea?

    PubMed

    Islam, Shofiq; Selbong, Uthaya; Taylor, Christopher J; Ormiston, Ian W

    2015-01-01

    The Mallampati airway classification has been used to estimate the success of uvulopalatopharyngoplasty in patients with obstructive sleep apnoea (OSA) but its predictive value in maxillomandibular advancement has not been proved. We aimed to explore the association between preoperative Mallampati scores and surgical outcome after bimaxillary advancement for OSA. We retrospectively analysed data on 50 patients who had maxillofacial operations for OSA at our hospital and stratified them into two groups based on Mallampati scores: high (class III/IV) and low (class I/II). We compared pre- and postoperative apnoea/hypopnoea indices (AHIs), Epworth sleepiness scores, and lowest recorded oxygen saturation in both groups. The postoperative values for all three outcome measures were not significantly different when patients were stratified according to the Mallampati classification (mean (SD) AHI was 41(19) before and 7 (6) after operation in the low group, and 42 (15) before and 9 (7) after in the high group). Success rates (AHI less than 15 postoperatively) were similar in both low and high score groups (p>0.05). Maxillomandibular advancement alleviates obstruction at multiple levels and our study has shown comparable surgical outcomes in both groups. The Mallampati score can be used to optimise patient selection for surgeons considering single-level procedures for OSA. Our study suggests that the Mallampati classification is less useful for the prediction of surgical outcome after maxillomandibular advancement surgery.

  10. Early warning score independently predicts adverse outcome and mortality in patients with acute pancreatitis.

    PubMed

    Jones, Michael J; Neal, Christopher P; Ngu, Wee Sing; Dennison, Ashley R; Garcea, Giuseppe

    2017-08-01

    The aim of this study was to compare the prognostic value of established scoring systems with early warning scores in a large cohort of patients with acute pancreatitis. In patients presenting with acute pancreatitis, age, sex, American Society of Anaesthesiologists (ASA) grade, Modified Glasgow Score, Ranson criteria, APACHE II scores and early warning score (EWS) were recorded for the first 72 h following admission. These variables were compared between survivors and non-survivors, between patients with mild/moderate and severe pancreatitis (based on the 2012 Atlanta Classification) and between patients with a favourable or adverse outcome. A total of 629 patients were identified. EWS was the best predictor of adverse outcome amongst all of the assessed variables (area under curve (AUC) values 0.81, 0.84 and 0.83 for days 1, 2 and 3, respectively) and was the most accurate predictor of mortality on both days 2 and 3 (AUC values of 0.88 and 0.89, respectively). Multivariable analysis revealed that an EWS ≥2 was independently associated with severity of pancreatitis, adverse outcome and mortality. This study confirms the usefulness of EWS in predicting the outcome of acute pancreatitis. It should become the mainstay of risk stratification in patients with acute pancreatitis.

  11. Ultrasonographic features and severity scoring of periventricular hemorrhagic infarction in relation to risk factors and outcome.

    PubMed

    Bassan, Haim; Benson, Carol B; Limperopoulos, Catherine; Feldman, Henry A; Ringer, Steven A; Veracruz, Elaine; Stewart, Jane E; Soul, Janet S; Disalvo, Donald N; Volpe, Joseph J; du Plessis, Adré J

    2006-06-01

    Early diagnosis of periventricular hemorrhagic infarction in premature infants is based on bedside neonatal cranial ultrasonography. Currently, evaluation of its morphology and evolution by cranial ultrasound relies largely on data predating major advances in perinatal care and lacks a consistent classification system for determining severity of injury. The objective of this study was to examine the ultrasonographic morphology and evolution of periventricular hemorrhagic infarction in the modern NICU and to determine the value of a cranial ultrasonography-based severity score for predicting outcome. We retrospectively evaluated all cranial ultrasounds and medical records of 58 premature infants with periventricular hemorrhagic infarction. We assigned each subject a severity score based on extent of echodensity, unilateral versus bilateral, and presence or absence of midline shift. A neurologic examination was performed after 12 months adjusted age. The parenchymal echodensity of periventricular hemorrhagic infarction most often involved parietal and frontal territories and evolved into single and/or multiple cysts. One quarter of cases were bilateral, and nearly 70% were extensive. Higher severity scores were significantly associated with pulmonary hemorrhage and low bicarbonate levels and with outcomes of fatality, early neonatal seizures, and motor disability. Despite advances in perinatal medicine, periventricular hemorrhagic infarction remains an important complication of prematurity. Periventricular hemorrhagic infarction can be graded using a scoring system based on sonographic characteristics. Higher severity scores predict worse outcome. Such severity scoring could improve the clinician's ability to counsel parents regarding management decisions and early intervention strategies.

  12. Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system.

    PubMed

    du Toit, Nagib; Mustak, Hamza; Cook, Colin

    2015-01-01

    To determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS. A prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome. There were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P<0.005). Reliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.

  13. Variable selection for propensity score models when estimating treatment effects on multiple outcomes: a simulation study.

    PubMed

    Wyss, Richard; Girman, Cynthia J; LoCasale, Robert J; Brookhart, Alan M; Stürmer, Til

    2013-01-01

    It is often preferable to simplify the estimation of treatment effects on multiple outcomes by using a single propensity score (PS) model. Variable selection in PS models impacts the efficiency and validity of treatment effects. However, the impact of different variable selection strategies on the estimated treatment effects in settings involving multiple outcomes is not well understood. The authors use simulations to evaluate the impact of different variable selection strategies on the bias and precision of effect estimates to provide insight into the performance of various PS models in settings with multiple outcomes. Simulated studies consisted of dichotomous treatment, two Poisson outcomes, and eight standard-normal covariates. Covariates were selected for the PS models based on their effects on treatment, a specific outcome, or both outcomes. The PSs were implemented using stratification, matching, and weighting (inverse probability treatment weighting). PS models including only covariates affecting a specific outcome (outcome-specific models) resulted in the most efficient effect estimates. The PS model that only included covariates affecting either outcome (generic-outcome model) performed best among the models that simultaneously controlled measured confounding for both outcomes. Similar patterns were observed over the range of parameter values assessed and all PS implementation methods. A single, generic-outcome model performed well compared with separate outcome-specific models in most scenarios considered. The results emphasize the benefit of using prior knowledge to identify covariates that affect the outcome when constructing PS models and support the potential to use a single, generic-outcome PS model when multiple outcomes are being examined. Copyright © 2012 John Wiley & Sons, Ltd.

  14. Comparison of contemporary risk scores for predicting outcomes after surgery for active infective endocarditis.

    PubMed

    Wang, Tom Kai Ming; Oh, Timothy; Voss, Jamie; Gamble, Greg; Kang, Nicholas; Pemberton, James

    2015-03-01

    Decision making regarding surgery for acute bacterial endocarditis is complex given its heterogeneity and often fatal course. Few studies have investigated the utility of operative risk scores in this setting. Endocarditis-specific scores have recently been developed. We assessed the prognostic utility of contemporary risk scores for mortality and morbidity after endocarditis surgery. Additive and logistic EuroSCORE I, EuroSCORE II, additive Society of Thoracic Surgeon's (STS) Endocarditis Score and additive De Feo-Cotrufo Score were retrospectively calculated for patients undergoing surgery for endocarditis during 2005-2011. Pre-specified primary outcomes were operative mortality, composite morbidity and mortality during follow-up. A total of 146 patients were included with an operative mortality of 6.8 % followed for 4.1 ± 2.4 years. Mean scores were additive EuroSCORE I: 8.0 ± 2.5, logistic EuroSCORE I: 13.2 ± 10.1 %, EuroSCORE II: 9.1 % ± 9.4 %, STS Score: 32.2 ± 13.5 and De Feo-Cotrufo Score: 14.6 ± 9.2. Corresponding areas under curve (AUC) for operative mortality 0.653, 0.645, 0.656, 0.699 and 0.744; for composite morbidity were 0.623, 0.625, 0.720, 0.714 and 0.774; and long-term mortality 0.588, 0.579, 0.686, 0.735 and 0.751. The best tool for post-operative stroke was EuroSCORE II: AUC 0.837; for ventilation >24 h and return to theatre the De Feo-Cotrufo Scores were: AUC 0.821 and 0.712. Pre-operative inotrope or intra-aortic balloon pump treatment, previous coronary bypass grafting and dialysis were independent predictors of operative and long-term mortality. In conclusion, risk models developed specifically from endocarditis surgeries and incorporating endocarditis variables have improved prognostic ability of outcomes, and can play an important role in the decision making towards surgery for endocarditis.

  15. Patient-Reported Outcome Measures-What Data Do We Really Need?

    PubMed

    Lyman, Stephen; Hidaka, Chisa

    2016-06-01

    The Center for Medicaid and Medicare Services has recently announced the inclusion of several patient-reported outcome measures (PROMs), including the abbreviated Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteoarthritis Outcome Score for joint replacement (HOOS, JR and KOOS, JR) for the purpose of quality assessment in total hip and total knee replacement (THR and TKR). Historically, Center for Medicaid and Medicare Services and other agencies have used measures of process (eg, % vaccinated) or adverse events (eg, infection rates, readmission rates) for quality assessment. However, the use of PROMs has become a priority based on stated goals by the National Quality Strategy and Institute of Medicine for a more patient-centered approach. Here, we review several general health and joint-specific PROMs, which have been extensively used in research to assess treatment efficacy and discuss their relevance to the new criteria for quality assessment, particularly for THR and TKR. Although we expect HOOS, JR and KOOS, JR to yield much useful information in the near term, these surveys are likely an interim solution. In the future, we anticipate that novel measurement platforms, such as wearable technologies or patient-specific surveys, may open new and exciting avenues of research to discover which types of data-perhaps not previously available-best represent patient quality of life and satisfaction after THR, TKR, or other orthopedic procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Ability of Lower-Extremity Injury Severity Scores to Predict Functional Outcome After Limb Salvage

    PubMed Central

    Ly, Thuan V.; Travison, Thomas G.; Castillo, Renan C.; Bosse, Michael J.; MacKenzie, Ellen J.

    2008-01-01

    Background: Lower-extremity injury severity scoring systems were developed to assist surgeons in decision-making regarding whether to amputate or perform limb salvage after high-energy trauma to the lower extremity. These scoring systems have been shown to not be good predictors of limb amputation or salvage. This study was performed to evaluate the clinical utility of the five commonly used lower-extremity injury severity scoring systems as predictors of final functional outcome. Methods: We analyzed data from a cohort of patients who participated in a multicenter prospective study of clinical and functional outcomes after high-energy lower-extremity trauma. Injury severity was assessed with use of the Mangled Extremity Severity Score; the Limb Salvage Index; the Predictive Salvage Index; the Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score; and the Hannover Fracture Scale-98. Functional outcomes were measured with use of the physical and psychosocial domains of the Sickness Impact Profile at both six months and two years following hospital discharge. Four hundred and seven subjects for whom the reconstruction regimen was considered successful at six months were included in the analysis. We used partial correlation statistics and multiple linear regression models to quantify the association between injury severity scores and Sickness Impact Profile outcomes with the subjects' ages held constant. Results: The mean age of the patients was thirty-six years (interquartile range, twenty-six to forty-four years); 75.2% were male and 24.8% were female. The median Sickness Impact Profile scores were 15.2 and 6.0 points at six and twenty-four months, respectively. The analysis showed that none of the scoring systems were predictive of the Sickness Impact Profile outcomes at six or twenty-four months to any reasonable degree. Likewise, none were predictive of patient recovery between six and twenty-four months postoperatively as

  17. The People Next Door: Getting along with the Neighbors in "Yoo-Hoo Mrs. Goldberg" and "District 9"

    ERIC Educational Resources Information Center

    Beck, Bernard

    2010-01-01

    Two different perspectives on the immigrant struggles are found in a documentary about the radio and television program "The Goldbergs" and a science fiction thriller about the treatment of an immigrant alien community. "Yoo-Hoo Mrs. Goldberg" is optimistic and celebrates the achievements of an established ethnic community in America and the woman…

  18. The People Next Door: Getting along with the Neighbors in "Yoo-Hoo Mrs. Goldberg" and "District 9"

    ERIC Educational Resources Information Center

    Beck, Bernard

    2010-01-01

    Two different perspectives on the immigrant struggles are found in a documentary about the radio and television program "The Goldbergs" and a science fiction thriller about the treatment of an immigrant alien community. "Yoo-Hoo Mrs. Goldberg" is optimistic and celebrates the achievements of an established ethnic community in America and the woman…

  19. PCL-retaining versus PCL-substituting TKR - Outcome assessment based on the "forgotten joint score".

    PubMed

    Thippanna, Rajshekar K; Mahesh, Pramod; Kumar, Malhar N

    2015-12-01

    Posterior cruciate ligament (PCL) retention or sacrifice figures prominently among the current controversies in total knee arthroplasty (TKA). Even though biomechanical advantages and disadvantages have been claimed for each type of TKA, clinical studies have not shown significant differences in the outcomes. In this retrospective study, the recently introduced "forgotten joint score" (FJS) was used to assess whether any differences exist between the two types of total knee replacement (TKR). FJ scores of 169 patients with PCL-retaining TKA and 178 patients with PCL sacrificing were obtained. The mean follow-up period was 3.5 years and the minimum follow-up period was 2.5 years. Both groups showed high FJ scores indicating that majority of the patients were oblivious to the presence of the artificial joint during daily activities. There was no statistically significant difference between the mean FJ scores of the two groups. Scores of subsets based on gender, age and unilateral and bilateral TKR also did not show significant differences. Since there are no clinically important differences between the two types of TKR, the choice of the TKA should be based on surgeon preferences and training and local conditions of the knee. Patient-reported outcomes appear to be similar regardless of the choice of TKA. Further prospective studies and validation of FJS outcomes with those of other questionnaires are essential to confirm the absence of differences between PCL retention and sacrifice.

  20. Secondary Evaluations of MTA 36-Month Outcomes: Propensity Score and Growth Mixture Model Analyses

    ERIC Educational Resources Information Center

    Swanson, James M.; Hinshaw, Stephen P.; Arnold, L. Eugene; Gibbons, Robert D.; Marcus, Sue; Hur, Kwan; Jensen, Peter S.; Vitiello, Benedetto; Abikoff, Howard B.: Greenhill, Laurence L.; Hechtman, Lily; Pelham, William E.; Wells, Karen C.; Conners, C. Keith; March, John S.; Elliott, Glen R.; Epstein, Jeffery N.; Hoagwood, Kimberly; Hoza, Betsy; Molina, Brooke S. G.; Newcorn, Jeffrey H.; Severe, Joanne B.; Wigal, Timothy

    2007-01-01

    Objective: To evaluate two hypotheses: that self-selection bias contributed to lack of medication advantage at the 36-month assessment of the Multimodal Treatment Study of Children With ADHD (MTA) and that overall improvement over time obscured treatment effects in subgroups with different outcome trajectories. Method: Propensity score analyses,…

  1. Does Year Round Schooling Affect the Outcome and Growth of California's API Scores?

    ERIC Educational Resources Information Center

    Wu, Amery D.; Stone, Jake E.

    2010-01-01

    This paper examined whether year round schooling (YRS) in California had an effect upon the outcome and growth of schools' Academic Performance Index (API) scores. While many previous studies had examined the connection between YRS and academic achievement, most had lacked the statistical rigour required to provide reliable interpretations. As a…

  2. Propensity Score Matching of Children in Kinship and Nonkinship Foster Care: Do Permanency Outcomes Still Differ?

    ERIC Educational Resources Information Center

    Koh, Eun; Testa, Mark F.

    2008-01-01

    This study compares the permanency outcomes of children in kinship foster care with a matched sample of children in nonkinship foster care in Illinois. It addresses the issue of selection bias by using propensity score matching (PSM) to balance mean differences in the characteristics of children in kinship and nonkinship foster homes. The data…

  3. Understanding Foster Youth Outcomes: Is Propensity Scoring Better than Traditional Methods?

    ERIC Educational Resources Information Center

    Berzin, Stephanie Cosner

    2010-01-01

    Objectives: This study seeks to examine the relationship between foster care and outcomes using multiple comparison methods to account for factors that put foster youth at risk independent of care. Methods: Using the National Longitudinal Survey of Youth 1997, matching, propensity scoring, and comparisons to the general population are used to…

  4. Secondary Evaluations of MTA 36-Month Outcomes: Propensity Score and Growth Mixture Model Analyses

    ERIC Educational Resources Information Center

    Swanson, James M.; Hinshaw, Stephen P.; Arnold, L. Eugene; Gibbons, Robert D.; Marcus, Sue; Hur, Kwan; Jensen, Peter S.; Vitiello, Benedetto; Abikoff, Howard B.: Greenhill, Laurence L.; Hechtman, Lily; Pelham, William E.; Wells, Karen C.; Conners, C. Keith; March, John S.; Elliott, Glen R.; Epstein, Jeffery N.; Hoagwood, Kimberly; Hoza, Betsy; Molina, Brooke S. G.; Newcorn, Jeffrey H.; Severe, Joanne B.; Wigal, Timothy

    2007-01-01

    Objective: To evaluate two hypotheses: that self-selection bias contributed to lack of medication advantage at the 36-month assessment of the Multimodal Treatment Study of Children With ADHD (MTA) and that overall improvement over time obscured treatment effects in subgroups with different outcome trajectories. Method: Propensity score analyses,…

  5. SYNTAX Score and Long-Term Outcomes: The BARI-2D Trial.

    PubMed

    Ikeno, Fumiaki; Brooks, Maria Mori; Nakagawa, Kaori; Kim, Min-Kyu; Kaneda, Hideaki; Mitsutake, Yoshiaki; Vlachos, Helen A; Schwartz, Leonard; Frye, Robert L; Kelsey, Sheryl F; Waseda, Katsuhisa; Hlatky, Mark A

    2017-01-31

    The extent of coronary disease affects clinical outcomes and may predict the effectiveness of coronary revascularization with either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score quantifies the extent of coronary disease. This study sought to determine whether SYNTAX scores predicted outcomes and the effectiveness of coronary revascularization compared with medical therapy in the BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial. Baseline SYNTAX scores were retrospectively calculated for BARI-2D patients without prior revascularization (N = 1,550) by angiographic laboratory investigators masked to patient characteristics and outcomes. The primary outcome was major cardiovascular events (a composite of death, myocardial infarction, and stroke) over 5 years. A mid/high SYNTAX score (≥23) was associated with a higher risk of major cardiovascular events (hazard ratio: 1.36, confidence interval: 1.07 to 1.75, p = 0.01). Patients in the CABG stratum had significantly higher SYNTAX scores: 36% had mid/high SYNTAX scores compared with 13% in the PCI stratum (p < 0.001). Among patients with low SYNTAX scores (≤22), major cardiovascular events did not differ significantly between revascularization and medical therapy, either in the CABG stratum (26.1% vs. 29.9%, p = 0.41) or in the PCI stratum (17.8% vs. 19.2%, p = 0.84). Among patients with mid/high SYNTAX scores, however, major cardiovascular events were lower after revascularization than with medical therapy in the CABG stratum (15.3% vs. 30.3%, p = 0.02), but not in the PCI stratum (35.6% vs. 26.5%, p = 0.12). Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical

  6. A clinical risk score of myocardial fibrosis predicts adverse outcomes in aortic stenosis

    PubMed Central

    Chin, Calvin W.L.; Messika-Zeitoun, David; Shah, Anoop S.V.; Lefevre, Guillaume; Bailleul, Sophie; Yeung, Emily N.W.; Koo, Maria; Mirsadraee, Saeed; Mathieu, Tiffany; Semple, Scott I.; Mills, Nicholas L.; Vahanian, Alec; Newby, David E.; Dweck, Marc R.

    2016-01-01

    Aims Midwall myocardial fibrosis on cardiovascular magnetic resonance (CMR) is a marker of early ventricular decompensation and adverse outcomes in aortic stenosis (AS). We aimed to develop and validate a novel clinical score using variables associated with midwall fibrosis. Methods and results One hundred forty-seven patients (peak aortic velocity (Vmax) 3.9 [3.2,4.4] m/s) underwent CMR to determine midwall fibrosis (CMR cohort). Routine clinical variables that demonstrated significant association with midwall fibrosis were included in a multivariate logistic score. We validated the prognostic value of the score in two separate outcome cohorts of asymptomatic patients (internal: n = 127, follow-up 10.3 [5.7,11.2] years; external: n = 289, follow-up 2.6 [1.6,4.5] years). Primary outcome was a composite of AS-related events (cardiovascular death, heart failure, and new angina, dyspnoea, or syncope). The final score consisted of age, sex, Vmax, high-sensitivity troponin I concentration, and electrocardiographic strain pattern [c-statistic 0.85 (95% confidence interval 0.78–0.91), P < 0.001; Hosmer–Lemeshow χ2 = 7.33, P = 0.50]. Patients in the outcome cohorts were classified according to the sensitivity and specificity of this score (both at 98%): low risk (probability score <7%), intermediate risk (7–57%), and high risk (>57%). In the internal outcome cohort, AS-related event rates were >10-fold higher in high-risk patients compared with those at low risk (23.9 vs. 2.1 events/100 patient-years, respectively; log rank P < 0.001). Similar findings were observed in the external outcome cohort (31.6 vs. 4.6 events/100 patient-years, respectively; log rank P < 0.001). Conclusion We propose a clinical score that predicts adverse outcomes in asymptomatic AS patients and potentially identifies high-risk patients who may benefit from early valve replacement. PMID:26491110

  7. Alberta Stroke Program Early CT Score Infarct Location Predicts Outcome Following M2 Occlusion.

    PubMed

    Khan, Muhib; Baird, Grayson L; Goddeau, Richard P; Silver, Brian; Henninger, Nils

    2017-01-01

    Although it is generally thought that patients with distal middle cerebral artery (M2) occlusion have a favorable outcome, it has previously been demonstrated that a substantial minority will have a poor outcome by 90 days. We sought to determine whether assessing the Alberta Stroke Program Early CT Score (ASPECTS) infarct location allows for identifying patients at risk for a poor 90-day outcome. We retrospectively analyzed patients with isolated acute M2 occlusion admitted to a single academic center between January 2010 and August 2012. Infarct regions were defined according to ASPECTS system on the initial head computed tomography. Discriminant function analysis was used to define specific ASPECTS regions that are predictive of the 90-day functional outcome as defined as a modified Rankin Scale score of 3-6. In addition, logistic regression was used to model the relationship between each individual ASPECT region with poor outcome; for evaluation and comparison, odds ratios, c-statistics, and Akaike information criterion values were estimated for each region. Ninety patients with isolated M2 were included in the final analysis. ASPECTS score ≤6 predicted poor outcome in this cohort (sensitivity = 0.591, specificity = 0.838, p < 0.001). Using multiple approaches, we found that infarction in ASPECTS regions M3 and M6 were strongly associated with poor functional status by 90 days. Infarction in ASPECTS regions M3 and M6 are key predictors of functional outcome following isolated distal M2 occlusion. These findings will be helpful in stratifying outcomes if validated in future studies.

  8. SF-36 summary and subscale scores are reliable outcomes of neuropsychiatric events in systemic lupus erythematosus

    PubMed Central

    Hanly, J. G.; Urowitz, M. B.; Jackson, D.; Bae, S.C.; Gordon, C.; Wallace, D.J.; Clarke, A.; Bernatsky, S.; Vasudevan, A.; Isenberg, D.; Rahman, A.; Sanchez-Guerrero, J.; Romero-Diaz, J.; Merrill, J. T.; Fortin, P.R.; Gladman, D.D.; Bruce, I. N.; Steinsson, K.; Khamashta, M.; Alarcón, G.S.; Fessler, B.; Petri, M.; Manzi, S.; Nived, O.; Sturfelt, G.; Ramsey-Goldman, R.; Dooley, M.A.; Aranow, C.; Van Vollenhoven, R.; Ramos-Casals, M.; Zoma, A.; Kalunian, K.; Farewell, V.

    2013-01-01

    Objective To examine change in health-related quality of life (HRQoL) in association with clinical outcomes of neuropsychiatric (NP) events in SLE. Methods An international study evaluated newly diagnosed SLE patients for NP events attributed to SLE and non-SLE causes. Outcome of events was determined by physician-completed 7-point scale and compared to patient-completed SF-36 questionnaires. Statistical analysis used linear mixed-effects regression models with patient specific random effects. Results 274 patients (92% female; 68% Caucasian), from a cohort of 1400, had ≥ 1 NP event where the interval between assessments was 12.3 ± 2 months. The overall difference in change between visits in mental component summary (MCS) scores of the SF-36 was significant (p<0.0001) following adjustments for gender, ethnicity, center and previous score. A consistent improvement in NP status (N=295) was associated with an increase in the mean(SD) adjusted MCS score of 3.66(0.89) in SF-36 scores. Between paired visits where NP status consistently deteriorated (N=30), the adjusted MCS score decreased by 4.00(1.96). For the physical component summary (PCS) scores the corresponding changes were +1.73(0.71) and −0.62(1.58) (p<0.05) respectively. Changes in SF-36 subscales were in the same direction (p<0.05; with the exception of role physical). Sensitivity analyses confirmed these findings. Adjustment for age, education, medications, SLE disease activity, organ damage, disease duration, attribution and characteristics of NP events did not substantially alter the results. Conclusion Changes in SF-36 summary and subscale scores, in particular those related to mental health, are strongly associated with the clinical outcome of NP events in SLE patients. PMID:21342917

  9. Five-minute Apgar score and educational outcomes: retrospective cohort study of 751,369 children.

    PubMed

    Tweed, Emily J; Mackay, Daniel F; Nelson, Scott M; Cooper, Sally-Ann; Pell, Jill P

    2016-03-01

    The Apgar score is used worldwide for assessing the clinical condition and short-term prognosis of newborn infants. Evidence for a relationship with long-term educational outcomes is conflicting. We investigated whether Apgar score at 5 min after birth was associated with additional support needs (ASN) and educational attainment. Data on pregnancy, delivery and later educational outcomes for children attending Scottish schools between 2006 and 2011 were collated by linking individual-level data from national educational and maternity databases. The relationship between Apgar score and overall ASN, type-specific ASN and educational attainment was assessed using binary, multinomial and generalised ordinal logistic regression models, respectively. Missing covariate data were imputed. Of the 751,369 children eligible, 9741 (1.3%) had a low or intermediate Apgar score and 49,962 (6.6%) had ASN. Low Apgar score was independently associated with overall ASN status (adjusted OR for Apgar ≤3, OR 1.52 95% CI 1.35 to 1.70), as well as ASN due to cognitive (OR 1.26, 95% CI 1.09 to 1.47), sensory (OR 2.49 95% CI 1.66 to 3.73) and motor (OR 3.57, 95% CI 2.86 to 4.47) impairments. There was a dose-response relationship between Apgar score and overall ASN status: of those scoring 0-3, 10.1% had ASN, compared with 9.1% of those scoring 4-7 and 6.6% of those scoring 7-10. A low Apgar score was associated with lower educational attainment, but this was not robust to adjustment for confounders. Apgar scores are associated with long-term as well as short-term prognoses, and with educational as well as clinical outcomes at the population level. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Disability after encephalitis: development and validation of a new outcome score

    PubMed Central

    Begum, Ashia; Ooi, Mong How; Faragher, Brian; Lai, Boon Foo; Sandaradura, Indunil; Mohan, Anand; Mandhan, Gaurav; Meharwade, Pratibha; Subhashini, S; Abhishek, Gulia; Begum, Asma; Penkulinti, Srihari; Shankar, M Veera; Ravikumar, R; Young, Carolyn; Cardosa, Mary Jane; Ravi, V; Wong, See Chang; Kneen, Rachel; Solomon, Tom

    2010-01-01

    Abstract Objective To develop a simple tool for assessing the severity of disability resulting from Japanese encephalitis and whether, as a result, a child is likely to be dependent. Methods A new outcome score based on a 15-item questionnaire was developed after a literature review, examination of current assessment tools, discussion with experts and a pilot study. The score was used to evaluate 100 children in Malaysia (56 Japanese encephalitis patients, 2 patients with encephalitis of unknown etiology and 42 controls) and 95 in India (36 Japanese encephalitis patients, 41 patients with encephalitis of unknown etiology and 18 controls). Inter- and intra-observer variability in the outcome score was determined and the score was compared with full clinical assessment. Findings There was good inter-observer agreement on using the new score to identify likely dependency (Κ = 0.942 for Malaysian children; Κ = 0.786 for Indian children) and good intra-observer agreement (Κ = 1.000 and 0.902, respectively). In addition, agreement between the new score and clinical assessment was also good (Κ = 0.906 and 0.762, respectively). The sensitivity and specificity of the new score for identifying children likely to be dependent were 100% and 98.4% in Malaysia and 100% and 93.8% in India. Positive and negative predictive values were 84.2% and 100% in Malaysia and 65.6% and 100% in India. Conclusion The new tool for assessing disability in children after Japanese encephalitis was simple to use and scores correlated well with clinical assessment. PMID:20680123

  11. Pneumococcal pneumonia - Are the new severity scores more accurate in predicting adverse outcomes?

    PubMed

    Ribeiro, C; Ladeira, I; Gaio, A R; Brito, M C

    2013-01-01

    The site-of-care decision is one of the most important factors in the management of patients with community-acquired pneumonia. The severity scores are validated prognostic tools for community-acquired pneumonia mortality and treatment site decision. The aim of this paper was to compare the discriminatory power of four scores - the classic PSI and CURB65 ant the most recent SCAP and SMART-COP - in predicting major adverse events: death, ICU admission, need for invasive mechanical ventilation or vasopressor support in patients admitted with pneumococcal pneumonia. A five year retrospective study of patients admitted for pneumococcal pneumonia. Patients were stratified based on admission data and assigned to low-, intermediate-, and high-risk classes for each score. Results were obtained comparing low versus non-low risk classes. We studied 142 episodes of hospitalization with 2 deaths and 10 patients needing mechanical ventilation and vasopressor support. The majority of patients were classified as low risk by all scores - we found high negative predictive values for all adverse events studied, the most negative value corresponding to the SCAP score. The more recent scores showed better accuracy for predicting ICU admission and need for ventilation or vasopressor support (mostly for the SCAP score with higher AUC values for all adverse events). The rate of all adverse outcomes increased directly with increasing risk class in all scores. The new gravity scores appear to have a higher discriminatory power in all adverse events in our study, particularly, the SCAP score. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  12. The CHA(2)DS(2)-VASc score reflects clinical outcomes in nonvalvular atrial fibrillation patients with an initial cardioembolic stroke.

    PubMed

    Deguchi, Ichiro; Hayashi, Takeshi; Ohe, Yasuko; Kato, Yuji; Nagoya, Harumitsu; Fukuoka, Takuya; Maruyama, Hajime; Horiuchi, Yohsuke; Tanahashi, Norio

    2013-11-01

    Whether the CHA(2)DS(2)-VASc score reflects severity or clinical outcomes in patients with an initial cardioembolic stroke associated with nonvalvular atrial fibrillation (NAVF) was investigated. This study included 327 patients hospitalized between April 2007 and March 2012 for an initial cardioembolic stroke associated with NVAF with no history of stroke. The National Institutes of Health Stroke Scale (NIHSS) score on admission and clinical outcome (modified Rankin Scale [mRS] score after 90 days) were retrospectively evaluated according to the CHA(2)DS(2)-VASc score. CHA(2)DS(2)-VASc scores were 0, 3.1%; 1, 9.1%; 2, 24.5%; 3, 26%; 4, 20.8%; 5, 14.4%; and 6, 2.1%. The median NIHSS scores for CHA(2)DS(2)-VASc scores of 0-6 were 4.5, 8, 8, 10, 11, 17, and 23, respectively. Severity differed according to the CHA(2)DS(2)-VASc score. The clinical outcomes according to the CHA(2)DS(2)-VASc scores were as follows: score 0, mRS scores of 0-2 (80%) and 3-6 (20%); score 1, mRS scores of 0-2 (80%) and 3-6 (20%); score 2, mRS scores of 0-2 (64%) and 3-6 (36%); score 3, mRS scores of 0-2 (48%) and 3-6 (52%); score 4, mRS scores of 0-2 (28%) and 3-6 (72%); score 5, mRS scores of 0-2 (26%) and 3-6 (74%); and score 6, mRS scores of 0-2 (29%) and 3-6 (71%). The clinical outcome worsened as the CHA(2)DS(2)-VASc score increased. On logistic regression analysis, age, NIHSS score on admission, and thrombolytic therapy were related to a clinical outcome. The severity of NVAF-induced initial cardioembolic stroke increased with higher CHA(2)DS(2)-VASc scores, and the outcomes were poor. The present study suggests that the CHA(2)DS(2)-VASc score may be useful not only for the evaluation of stroke risk but also for the prediction of clinical outcomes after stroke. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. FLiGS Score: A New Method of Outcome Assessment for Lip Carcinoma–Treated Patients

    PubMed Central

    Grassi, Rita; Toia, Francesca; Di Rosa, Luigi; Cordova, Adriana

    2015-01-01

    Background: Lip cancer and its treatment have considerable functional and cosmetic effects with resultant nutritional and physical detriments. As we continue to investigate new treatment regimens, we are simultaneously required to assess postoperative outcomes to design interventions that lessen the adverse impact of this disease process. We wish to introduce Functional Lip Glasgow Scale (FLiGS) score as a new method of outcome assessment to measure the effect of lip cancer and its treatment on patients’ daily functioning. Methods: Fifty patients affected by lip squamous cell carcinoma were recruited between 2009 and 2013. Patients were asked to fill the FLiGS questionnaire before surgery, 1 month, 6 months, and 1 year after surgery. The subscores were used to calculate a total FLiGS score of global oral disability. Statistical analysis was performed to test validity and reliability. Results: FLiGS scores improved significantly from preoperative to 12 months postoperative values (P = 0.000). Statistical evidence of validity was provided through rs (Spearman correlation coefficient) that resulted >0.30 for all surveys and for which P < 0.001. FLiGS score reliability was shown through examination of internal consistency and test-retest reliability. Conclusions: FLiGS score is a simple way of assessing functional impairment related to lip cancer before and after surgery; it is sensitive, valid, reliable, and clinically relevant: it provides useful information to orient the physician in the postoperative management and in the rehabilitation program. PMID:26034652

  14. Aristotle score predicts outcome in patients requiring extracorporeal circulatory support following repair of congenital heart disease.

    PubMed

    Derby, Christopher D; Kolcz, Jacek; Kerins, Paul J; Duncan, Daniel R; Quezada, Emilio; Pizarro, Christian

    2007-01-01

    Extracorporeal membrane oxygenation (ECMO) has become the standard technique of mechanical support for the failing circulation following repair of congenital heart lesions. The objective of this study was to identify predictors of survival in patients requiring postcardiotomy ECMO. The Aristotle score, a method developed to evaluate quality of care based on complexity, was investigated as a potential predictor of outcome. Between 2003 and 2005, 37 patients required ECMO following corrective surgery for congenital heart disease. Records were reviewed retrospectively with emphasis on factors affecting survival to discharge. The comprehensive Aristotle complexity score was calculated for each patient. Overall, 28 patients (76%) survived to decannulation and 17 patients (46%) survived to discharge. There were 24 (65%) neonates and 10 patients (27%) with single ventricle physiology, with a hospital survival of 42% (10 of 24) and 50% (5 of 10), respectively. Univariate factors associated with survival included Aristotle score, duration of support, reexploration, multiple organ failure, and number of complications. Age, weight, and single-ventricle physiology were not significant. In a logistic regression model, an Aristotle score < 14 was identified as a predictor of survival (OR 0.12, CI 0.02-0.87). The Aristotle score is predictive of outcome in patients requiring postcardiotomy ECMO and may serve as a uniform criterion when comparing and evaluating quality of care and performance in this complex patient population.

  15. Comparison of the Combined versus Conventional Apgar Scores in Predicting Adverse Neonatal Outcomes

    PubMed Central

    Dalili, Hosein; Sheikh, Mahdi; Hardani, Amir Kamal; Nili, Firouzeh; Shariat, Mamak; Nayeri, Fatemeh

    2016-01-01

    Objectives Assessing the value of the Combined-Apgar score in predicting neonatal mortality and morbidity compared to the Conventional-Apgar. Methods This prospective cohort study evaluated 942 neonates (166 very preterm, 233 near term, and 543 term) admitted to a tertiary referral hospital. At 1- and 5-minutes after delivery, the Conventional and Combined Apgar scores were recorded. The neonates were followed, and the following information was recorded: the occurrence of severe hyperbilirubinemia requiring medical intervention, the requirement for mechanical ventilation, the occurrence of intraventricular hemorrhage (IVH), and neonatal mortality. Results Before adjusting for the potential confounders, a low Conventional (<7) or Combined (<10) Apgar score at 5-minutes was associated with adverse neonatal outcomes. However, after adjustment for the gestational age, birth weight and the requirement for neonatal resuscitation in the delivery room, a depressed 5-minute Conventional-Apgar score lost its significant associations with all the measured adverse outcomes; after the adjustments, a low 5-minute Combined-Apgar score remained significantly associated with the requirement for mechanical ventilation (OR,18.61; 95%CI,6.75–51.29), IVH (OR,4.8; 95%CI,1.91–12.01), and neonatal mortality (OR,20.22; 95%CI,4.22–96.88). Additionally, using Receiver Operating Characteristics (ROC) curves, the area under the curve was higher for the Combined-Apgar than the Conventional-Apgar for the prediction of neonatal mortality and the measured morbidities among all the admitted neonates and their gestational age subgroups. Conclusions The newly proposed Combined-Apgar score can be a good predictor of neonatal mortality and morbidity in the admitted neonates, regardless of their gestational age and resuscitation status. It is also superior to the Conventional-Apgar in predicting adverse neonatal outcomes in very preterm, near term and term neonates. PMID:26871908

  16. A predictive scoring instrument for tuberculosis lost to follow-up outcome

    PubMed Central

    2012-01-01

    Background Adherence to tuberculosis (TB) treatment is troublesome, due to long therapy duration, quick therapeutic response which allows the patient to disregard about the rest of their treatment and the lack of motivation on behalf of the patient for improved. The objective of this study was to develop and validate a scoring system to predict the probability of lost to follow-up outcome in TB patients as a way to identify patients suitable for directly observed treatments (DOT) and other interventions to improve adherence. Methods Two prospective cohorts, were used to develop and validate a logistic regression model. A scoring system was constructed, based on the coefficients of factors associated with a lost to follow-up outcome. The probability of lost to follow-up outcome associated with each score was calculated. Predictions in both cohorts were tested using receiver operating characteristic curves (ROC). Results The best model to predict lost to follow-up outcome included the following characteristics: immigration (1 point value), living alone (1 point) or in an institution (2 points), previous anti-TB treatment (2 points), poor patient understanding (2 points), intravenous drugs use (IDU) (4 points) or unknown IDU status (1 point). Scores of 0, 1, 2, 3, 4 and 5 points were associated with a lost to follow-up probability of 2,2% 5,4% 9,9%, 16,4%, 15%, and 28%, respectively. The ROC curve for the validation group demonstrated a good fit (AUC: 0,67 [95% CI; 0,65-0,70]). Conclusion This model has a good capacity to predict a lost to follow-up outcome. Its use could help TB Programs to determine which patients are good candidates for DOT and other strategies to improve TB treatment adherence. PMID:22938040

  17. Effectiveness of Modified Early Warning Score in predicting outcomes in oncology patients.

    PubMed

    Cooksley, Tim; Kitlowski, Emma; Haji-Michael, Philip

    2012-11-01

    Patients at risk of rapid deterioration and critical illness often have preceding changes in physiological parameters. Track and trigger systems, such as the Modified Early Warning Score (MEWS) used in the UK, have been demonstrated to have some utility in identifying these patients particularly among general medical and surgical patients. Assess the effectiveness of MEWS and the proposed (NHS Early Warning Score) in oncology patients. Identify the key physiological parameters that predict outcome in this cohort. We performed a retrospective analysis at a specialist oncology hospital in the North West of England. The data for 840 patients reviewed by the Outreach Team between April 2009 and January 2011 was analysed. The effectiveness of the MEWS in predicting Critical Care admission and 30 day mortality was assessed. Statistical analysis to identify the key physiological parameters in predicting these two outcomes was also performed. The MEWS score was statistically significant in predicting both outcome measures (CCU admission P = 0.037 and 30 day mortality P = 0.004). Respiratory rate (P = 0.0003/P = 0.0001) and temperature (P = 0.033/P ≤ 0.0001) were the key physiological variables in predicting clinical deterioration. Blood pressure (P = 0.999/P = 0.619) and pulse rate (P = 0.446/P = 0.051) did not have statistical significance in predicting either outcome. However, analysis of receiver operator curves showed that MEWS had poor value in predicting both outcomes (0.55 and 0.6, respectively). The currently used track and trigger systems have poor discriminatory value in identifying Oncological patients at risk of deterioration. An adapted score more focused upon the key predictive physiological parameters in this population needs to be developed to produce a more effective tool.

  18. Predicting outcome after arteriovenous malformation-associated intracerebral hemorrhage with the original ICH score.

    PubMed

    Appelboom, Geoffrey; Hwang, Brian Y; Bruce, Samuel S; Piazza, Matthew A; Kellner, Christopher P; Meyers, Philip M; Connolly, E Sander

    2012-12-01

    To evaluate the predictive ability of the original ICH Score (oICH) in a large independent cohort of patients with arteriovenous malformation-associated intracerebral hemorrhage (AVM-ICH), an important cause of intracerebral hemorrhage (ICH) that is associated with significantly different epidemiology, clinical course, and outcome compared with primary ICH. During the period 1997-2009, 91 patients were admitted to Columbia Medical Center with acute AVM-ICH. Demographic and admission clinical and radiographic variables were obtained for 84 patients through retrospective chart review. Admission oICH and Spetzler-Martin grading scale (SMGS) were calculated. Outcome was assessed at 3 months using the modified Rankin Scale (mRS). Maximum Youden Indices were used to identify cutoffs for age and ICH volume that are associated with optimal predictive accuracy for an unfavorable outcome (mRS ≥ 3). Receiver operating characteristic (ROC) analysis was used to evaluate the predictive performance of oICH, and oICH with new age and ICH cutoff points (new AVM-ICH score based on original ICH Score [AVM-oICH]). The mean age was 35 years ± 14, and mean ICH volume was 22 mL ± 20. At 3-month follow-up, 3 (4%) patients were dead, and 15 (18%) had an unfavorable outcome. Two of the patients who died had oICH of 3, and one had oICH of 5. ICH volume of 37 mL and age of 41 years were identified as optimal cutoffs for predicting an unfavorable outcome. oICH and AVM-oICH showed good predictive accuracies with area under the curve of 0.914 and 0.891 (P = 0.422). AVM-oICH and oICH had similarly high sensitivities (0.889 and 0.944; P = 1.00), but the former had significantly greater specificity (0.879 vs. 0.682; P < 0.001). oICH is a valid clinical grading scale with high predictive accuracy for functional outcome after AVM-ICH. It is unclear whether the score is appropriate for risk stratification with regard to mortality because of the low risk of death associated with AVM-ICH. Simple

  19. Fuzzy logic-based prognostic score for outcome prediction in esophageal cancer.

    PubMed

    Wang, Chang-Yu; Lee, Tsair-Fwu; Fang, Chun-Hsiung; Chou, Jyh-Horng

    2012-11-01

    Given the poor prognosis of esophageal cancer and the invasiveness of combined modality treatment, improved prognostic scoring systems are needed. We developed a fuzzy logic-based system to improve the predictive performance of a risk score based on the serum concentrations of C-reactive protein (CRP) and albumin in a cohort of 271 patients with esophageal cancer before radiotherapy. Univariate and multivariate survival analyses were employed to validate the independent prognostic value of the fuzzy risk score. To further compare the predictive performance of the fuzzy risk score with other prognostic scoring systems, time-dependent receiver operating characteristic curve (ROC) analysis was used. Application of fuzzy logic to the serum values of CRP and albumin increased predictive performance for 1-year overall survival (AUC=0.773) compared with that of a single marker (AUC=0.743 and 0.700 for CRP and albumin, respectively), where the AUC denotes the area under curve. This fuzzy logic-based approach also performed consistently better than the Glasgow Prognostic Score (GPS) (AUC=0.745). Thus, application of fuzzy logic to the analysis of serum markers can more accurately predict the outcome for patients with esophageal cancer.

  20. THRIVE score predicts outcomes with a third-generation endovascular stroke treatment device in the TREVO-2 trial.

    PubMed

    Flint, Alexander C; Xiang, Bin; Gupta, Rishi; Nogueira, Raul G; Lutsep, Helmi L; Jovin, Tudor G; Albers, Gregory W; Liebeskind, David S; Sanossian, Nerses; Smith, Wade S

    2013-12-01

    Several outcome prediction scores have been tested in patients receiving acute stroke treatment with previous generations of endovascular stroke treatment devices. The TREVO-2 trial was a randomized controlled trial comparing a novel endovascular stroke treatment device (the Trevo device) to a previous-generation endovascular stroke treatment device (the Merci device). We used data from the TREVO-2 trial to validate the Totaled Health Risks in Vascular Events (THRIVE) score in patients receiving treatment with a third-generation endovascular stroke treatment device and to compare THRIVE to other predictive scores. We used logistic regression to model outcomes and compared score performance with receiver operating characteristic curve analysis. In the TREVO-2 trial, the THRIVE score strongly predicts clinical outcome and mortality. The relationship between THRIVE score and outcome is not influenced by either success of recanalization or the type of device used (Trevo versus Merci). The superiority of the Trevo device to the Merci device is evident particularly among patients with a low-to-moderate THRIVE score (0-5; 53.8% good outcome with Trevo versus 27.5% good outcome with Merci). In receiver operating characteristic curve analysis, the THRIVE score was comparable or superior to several other outcome prediction scores (HIAT, HIAT-2, SPAN-100, and iScore). The THRIVE score strongly predicts clinical outcome and mortality in the TREVO-2 trial. Taken together with THRIVE validation data from patients receiving intravenous tissue-type plasminogen activator or no acute treatment, the THRIVE score has broad predictive power in patients with acute ischemic stroke, which is likely because THRIVE reflects a set of strong nonmodifiable predictors of stroke outcome. A free Web calculator for the THRIVE score is available at http://www.thrivescore.org.

  1. Support Vector Hazards Machine: A Counting Process Framework for Learning Risk Scores for Censored Outcomes.

    PubMed

    Wang, Yuanjia; Chen, Tianle; Zeng, Donglin

    2016-01-01

    Learning risk scores to predict dichotomous or continuous outcomes using machine learning approaches has been studied extensively. However, how to learn risk scores for time-to-event outcomes subject to right censoring has received little attention until recently. Existing approaches rely on inverse probability weighting or rank-based regression, which may be inefficient. In this paper, we develop a new support vector hazards machine (SVHM) approach to predict censored outcomes. Our method is based on predicting the counting process associated with the time-to-event outcomes among subjects at risk via a series of support vector machines. Introducing counting processes to represent time-to-event data leads to a connection between support vector machines in supervised learning and hazards regression in standard survival analysis. To account for different at risk populations at observed event times, a time-varying offset is used in estimating risk scores. The resulting optimization is a convex quadratic programming problem that can easily incorporate non-linearity using kernel trick. We demonstrate an interesting link from the profiled empirical risk function of SVHM to the Cox partial likelihood. We then formally show that SVHM is optimal in discriminating covariate-specific hazard function from population average hazard function, and establish the consistency and learning rate of the predicted risk using the estimated risk scores. Simulation studies show improved prediction accuracy of the event times using SVHM compared to existing machine learning methods and standard conventional approaches. Finally, we analyze two real world biomedical study data where we use clinical markers and neuroimaging biomarkers to predict age-at-onset of a disease, and demonstrate superiority of SVHM in distinguishing high risk versus low risk subjects.

  2. Prediction of en-route complications during interfacility transport by outcome predictive scores in ED.

    PubMed

    Wong, Y K; Lui, C T; Li, K K; Wong, C Y; Lee, M M; Tong, W L; Ong, K L; Tang, S Y H

    2016-05-01

    The objective was to determine the accuracy of the outcome predictive scores (Modified Early Warning Score [MEWS]; Hypotension, Low Oxygen Saturation, Low Temperature, Abnormal ECG, Loss of Independence [HOTEL] score; and Simple Clinical Score [SCS]) in predicting en-route complications during interfacility transport (IFT) in emergency department. This was a retrospective cohort study. All IFT cases by ambulances with either nurse-led or physician-led escort, occurring between 1 January 2011 and 31 December 2012, were included. Obstetric and pediatric cases (age < 18 years) were excluded. The condition of patients was quantified by using the predictive scores (MEWS, HOTEL, and SCS) at triage station and on ambulance departure. The accuracy of predictive scores was compared by the receiver operating characteristic (ROC) curves. A total of 659 cases were included. Seventeen cases had en-route complications (2.6%). The complication rate in physician-escorted transport (2.2%) was similar to that in nurse-escorted transport (2.6%). None of the 57 intubated cases had en-route complications. The area under the ROC curve for MEWS was 0.662 (triage) and 0.479 (departure). The accuracy of MEWS at triage was better than that at departure (P = .049). The area under the ROC curve for HOTEL was 0.613 (triage) and 0.597 (departure), and that for SCS was 0.6 (triage) and 0.568 (departure). In general, the predictive scores at triage were better than those on departure. None of the scores had good accuracy in prediction of en-route complications during IFT. MEWS at triage was among the best one already but was not ideal. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Validation study of the Forgotten Joint Score-12 as a universal patient-reported outcome measure.

    PubMed

    Matsumoto, Mikio; Baba, Tomonori; Homma, Yasuhiro; Kobayashi, Hideo; Ochi, Hironori; Yuasa, Takahito; Behrend, Henrik; Kaneko, Kazuo

    2015-10-01

    The Forgotten Joint Score-12 (FJS-12) is for patients to forget their artificial joint and is reportedly a useful patient-reported outcome tool for artificial joints. The purpose of this study was to determine whether the FJS-12 is as useful as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) or the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) in Japan. All patients who visited our hospital's hip joint specialists following unilateral THA from August 2013 to July 2014 were evaluated. Medical staff members other than physicians administered three questionnaires. Items evaluated were (1) the reliability of the FJS-12 and (2) correlations between the FJS-12 and the total and subscale scores of the WOMAC or JHEQ. Of 130 patients, 22 were excluded. Cronbach's α coefficient was 0.97 for the FJS-12. The FJS-12 showed a significantly lower score than the WOMAC or JHEQ (p < 0.01). The FJS-12 was moderately correlated with the total WOMAC score (r = 0.522) and its subscale scores for "stiffness" (r = 0.401) and "function" (r = 0.539) and was weakly correlated with the score for "pain" (r = 0.289). The FJS-12 was favorably correlated with the total JHEQ score (r = 0.686) and its subscale scores (r = 0.530-0.643). The FJS-12 was correlated with and showed reliability similar to that of the JHEQ and WOMAC. The FJS-12, which is not affected by culture or lifestyle, may be useful in Japan.

  4. Impact of a high Edinburgh Postnatal Depression Scale score on obstetric and perinatal outcomes

    PubMed Central

    Navaratne, Pathmila; Foo, Xin Y; Kumar, Sailesh

    2016-01-01

    The aim of this retrospective study was to characterise intrapartum and neonatal outcomes in women with an antenatally recorded Edinburgh Postnatal Depression Score (EPDS) ≤ 9 compared with women with a score of ≥12 at a major Australian tertiary maternity hospital. Women with scores ≥12 are at particularly high risk of major depressive symptomatology. There were 20512 (78.6%) women with a score ≤ 9 and 2708 (10.4%) had a score ≥ 12. Category 1 caesarean sections where there was immediate threat to life (maternal or fetal) were more common in women with EPDS scores ≥12 (5.2% vs. 4.3%, OR 1.24 95% CI 1.03–1.49, p = 0.024). Pre-term birth (<37 weeks) was also more common (11.7% vs. 8.6%, OR 1.38 95% CI 1.21–1.57, p < 0.001). Women with high scores had higher rates of babies with birth weights <5th centile (6.2% vs. 4.4%, p < 0.001). Apgar score < 7 at 5 minutes were more frequent in the high EPDS group (3.1% vs. 2%, OR 1.52 95% CI 1.18–1.93, p < 0.001). Resuscitation at birth (34.4% vs. 30.6%, p < 0.001) and neonatal death (0.48% vs. 0.13%, OR 2.52 95% CI 1.2–5.0, p < 0.001) were higher in babies of these women. These results suggest poorer intrapartum and neonatal outcomes for women with high EPDS scores. PMID:27658526

  5. Predictors of Outcome in Patients Presenting with Acute Ischemic Stroke and Mild Stroke Scale Scores.

    PubMed

    Kenmuir, Cynthia L; Hammer, Maxim; Jovin, Tudor; Reddy, Vivek; Wechsler, Lawrence; Jadhav, Ashutosh

    2015-07-01

    Although National Institutes of Health Stroke Scale (NIHSS) is a known predictor of outcome in acute ischemic stroke, there are other factors like age, ambulatory status, and ability to swallow that may be predictors of outcome but are not assessed by the traditional NIHSS. The aim of this retrospective review was to identify predictors of outcome in mild ischemic stroke. Discharge outcomes from patients who presented to our large academic stroke center with acute ischemic stroke from 2005 to 2013 were retrospectively reviewed. Of 7189 patients reviewed, 2597 had initial NIHSS less than 5. Outcome measures were modified Rankin Scale (MRS) score 0-1 and discharge to home. In all, 65% of patients with NIHSS 0-4 were discharged directly home independent of treatment. Of those patients discharged to home, 74% were able to ambulate independently and 98% passed their dysphagia screen. Of patients not discharged directly home, 66% were unable to ambulate independently and 21% did not pass their dysphagia screen. Multivariate logistic regression analysis revealed a significant effect of dysphagia screen (P = .001), ability to ambulate independently (P = .002), age (P = .016), and NIHSS (P = .005) on discharge to home but not MRS of 0-1 (P = .564). In patients with mild stroke scale scores defined as NIHSS 0-4, several factors including age, NIHSS, ambulatory status, and ability to swallow may be independent predictors of functional outcome and discharge home. These data support the development of a modified grading system for assessing functional outcome in mild stroke that considers these factors. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  6. Screening Characteristics of TIMI Score in Predicting Acute Coronary Syndrome Outcome; a Diagnostic Accuracy Study

    PubMed Central

    Alavi-Moghaddam, Mostafa; Safari, Saeed; Alavi-Moghaddam, Hamideh

    2017-01-01

    Introduction: In cases with potential diagnosis of ischemic chest pain, screening high risk patients for adverse outcomes would be very helpful. The present study was designed aiming to determine the diagnostic accuracy of thrombolysis in myocardial infarction (TIMI) score in Patients with potential diagnosis of ischemic chest pain. Method: This diagnostic accuracy study was designed to evaluate the screening performance characteristics of TIMI score in predicting 30-day outcomes of mortality, myocardial infarction (MI), and need for revascularization in patients presenting to ED with complaint of typical chest pain and diagnosis of unstable angina or Non-ST elevation MI. Results: 901 patients with the mean age of 58.17 ± 15.00 years (19-90) were studied (52.9% male). Mean TIMI score of the studied patients was 0.97 ± 0.93 (0-5) and the highest frequency of the score belonged to 0 to 2 with 37.2%, 35.3%, and 21.4%, respectively. In total, 170 (18.8%) patients experienced the outcomes evaluated in this study. Total sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio of TIMI score were 20 (95% CI: 17 – 24), 99 (95% CI: 97 – 100), 98 (95% CI: 93 – 100), 42 (95% CI: 39 – 46), 58 (95% CI: 14 – 229), and 1.3 (95% CI: 1.2 – 1.4), respectively. Area under the ROC curve of this system for prediction of 30-day mortality, MI, and need for revascularization were 0.51 (95% CI: 0.47 – 0.55), 0.58 (95% CI: 0.54 – 0.62) and 0.56 (95% CI: 0.52 – 0.60), respectively. Conclusion: Based on the findings of the present study, it seems that TIMI score has a high specificity in predicting 30-day adverse outcomes of mortality, MI, and need for revascularization following acute coronary syndrome. However, since its sensitivity, negative predictive value, and negative likelihood ratio are low, it cannot be used as a proper screening tool for ruling out low risk patients in ED. PMID:28286825

  7. What factors predict improvements in outcomes scores and reoperations after the Bernese periacetabular osteotomy?

    PubMed

    Beaulé, Paul E; Dowding, Chris; Parker, Gillian; Ryu, Jae-Jin

    2015-02-01

    The Bernese periacetabular osteotomy (PAO) has entered its fourth decade and is frequently used for corrective osteotomy in patients with acetabular dysplasia. Although our capacity to preserve the joint after corrective osteotomy is excellent, gaining a better understanding on how well patients function after this surgery is important as well. (1) What changes in patient-reported outcomes scores occur in patients treated with PAO for hip dysplasia in the setting of a single-surgeon practice? (2) What are the predictors of clinical function and survivorship? All 67 patients presenting to a single surgeon's clinic with hip dysplasia treated with PAO between October 2005 and January 2013 were prospectively followed. Baseline demographic data as well as pre- and postoperative radiographic and functional measurements were obtained with a minimum of 1-year followup. Radiographic criteria included Tönnis grade, Tönnis angle, minimum joint space width, center-edge angle, presence of crossover sign, medial translation of the hip center, and alpha angle. We also used validated outcome measures including the WOMAC, the UCLA Activity Scale, and the SF-12. Multiple regression analysis was used to determine predictors of functional outcome scores. There were increases in WOMAC, UCLA, and SF-12 Physical scores. Higher preoperative alpha angle was associated with a lower postoperative WOMAC score (β=-0.47; 95% confidence interval [CI], -0.92 to -0.02; R2=0.08; p=0.04). The 5-year Kaplan-Meier survivorship was 94.1% (95% CI, 90.7-97.5) with reoperation (ie, hip arthroscopy and/or total hip arthroplasty) used as the endpoint for failure. With the limited numbers available, we could not identify any demographic or radiographic factors associated with reoperation. Overall survivorship for the PAO at our center at 5 years is comparable to other clinical series with overall functional scores improving. A greater alpha angle preoperatively was associated with poorer patient

  8. Effects of neuromuscular training (NEMEX-TJR) on patient-reported outcomes and physical function in severe primary hip or knee osteoarthritis: a controlled before-and-after study

    PubMed Central

    2013-01-01

    Background The benefits of exercise in mild and moderate knee or hip osteoarthritis (OA) are apparent, but the evidence in severe OA is less clear. We recently reported that neuromuscular training was well tolerated and feasible in patients with severe primary hip or knee OA. The aims of this controlled before-and-after study were to compare baseline status to an age-matched population-based reference group and to examine the effects of neuromuscular training on patient-reported outcomes and physical function in patients with severe primary OA of the hip or knee. Methods 87 patients (60–77 years) with severe primary OA of the hip (n = 38, 55% women) or knee (n = 49, 59% women) awaiting total joint replacement (TJR) had supervised, neuromuscular training (NEMEX-TJR) in groups with individualized level and progression of training. A reference group (n = 43, 53% women) was included for comparison with patients’ data. Assessments included self-reported outcomes (HOOS/KOOS) and measures of physical function (chair stands, number of knee bends/30 sec, knee extensor strength, 20-meter walk test) at baseline and at follow-up before TJR. Analysis of covariance (ANCOVA) was used for comparing patients and references and elucidating influence of demographic factors on change. The paired t-test was used for comparisons within groups. Results At baseline, patients reported worse scores than the references in all HOOS/KOOS subscales (hip 27–47%, knee 14–52%, of reference scores, respectively) and had functional limitations (hip 72–85%, knee 42–85%, of references scores, respectively). NEMEX-TJR (mean 12 weeks (SD 5.6) of training) improved self-reported outcomes (hip 9–29%, knee 7–20%) and physical function (hip 3–18%, knee 5–19%) (p < 0.005). Between 42% and 62% of hip OA patients, and 39% and 61% of knee OA patients, displayed a clinically meaningful improvement (≥15%) in HOOS/KOOS subscales by training. The improvement in HOOS

  9. A novel CT volume index score correlates with outcomes in polytrauma patients with pulmonary contusion.

    PubMed

    Strumwasser, Aaron; Chu, Eveline; Yeung, Louise; Miraflor, Emily; Sadjadi, Javid; Victorino, Gregory P

    2011-10-01

    Exact quantification of pulmonary contusion by computed tomography (CT) may help trauma surgeons identify high-risk populations. We hypothesized that the size of pulmonary contusions, measured accurately, will predict outcomes. Our specific aims were to (1) precisely quantify pulmonary contusion size using pixel analysis, (2) correlate contusion size with outcomes, and (3) determine the threshold contusion size portending complications. Thoracic CTs of 106 consecutive polytrauma patients with pulmonary contusion were evaluated at a university-based urban trauma center. A novel CT volume index (CTVI) score was calculated based on the ratio of affected lung to total lung [slices of lung on CT × affected pixel region/lung pixel region × 0.45 (left side) + slices of lung on CT × affected pixel region/lung pixel region × 0.55 (right side)]. Multivariate analysis correlated CTVI and patient predictors' impact on outcomes. Of 106 polytrauma patients (mean ISS = 28 ± 1.2, AIS chest = 3.5 ± 0.1), 39 developed complications (acute respiratory distress syndrome [ARDS], pneumonia, and/or death). Mean CTVI was significantly higher in the group with complications (0.28 ± 0.03 versus 17 ± 0.02, P = 0.01). By multivariate analysis, CTVI predicted longer ICU LOS (R(2) = 0.84, P < 0.01). A receiver operating curve (ROC) analysis identified a CTVI threshold score of 0.2 (AUC 0.67, P < 0.01) for developing pneumonia, ARDS or death. Patients with CTVI scores of 0.2 or more had longer hospitalization, longer ICU LOS, more ventilator days, and developed pneumonia (P < 0.01). Higher CTVI scores predicted prolonged ICU LOS across all sizes of pulmonary contusion. Pulmonary contusion volumes greater than 20% of total lung volume specifically identifies patients at risk for developing complications. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Model for end-stage liver disease score versus Maddrey discriminant function score in assessing short-term outcome in alcoholic hepatitis.

    PubMed

    Kadian, Monil; Kakkar, Rajesh; Dhar, Minakshi; Kaushik, Rajeev Mohan

    2014-03-01

    The Maddrey Discriminant Function (mDF) score and the Model for End-Stage Liver Disease (MELD) score are standard prognostic scores for predicting disease severity and mortality in alcoholic hepatitis (AH).This prospective study compared the MELD score and the mDF score as predictors of short-term outcome in AH. The admission MELD score and the mDF score were assessed in 47 patients with a diagnosis of AH in the Himalayan Institute Hospital, Dehradun, India and the concordance (C) statistics of the two scores for 28-day mortality were determined and compared. Both the MELD score and the mDF score on day 1 were significantly higher in non-survivors than in survivors (P = 0.0001 each). The C-statistic for 28-day mortality for the MELD score was 0.91 (P < 0.0001, 95% confidence interval [CI] 0.79-0.97) and for the mDF score 0.90 (P < 0.0001, 95% CI 0.78-0.97). There was no significant difference between the C-statistics of the two scores (P = 0.83, 95% CI -0.07 to 0.09). For predicting 28-day mortality, the optimal MELD score of > 19 (sensitivity 91.6% and specificity 85.7%) corresponded to the mDF score of > 52.8 (sensitivity 91.6% and specificity 82.8%). Both the MELD score and the mDF score at admission were strong and equally good predictors of 28-day mortality in patients with AH, but the optimal mDF score corresponding to optimal MELD score was higher than the conventional one. Thus, MELD score may be used as an alternative to mDF score for predicting short-term mortality in AH with an advantage. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  11. Stage IV Gastro-Entero-Pancreatic Neuroendocrine Neoplasms: A Risk Score to Predict Clinical Outcome.

    PubMed

    Panzuto, Francesco; Merola, Elettra; Pavel, Marianne Ellen; Rinke, Anja; Kump, Patrizia; Partelli, Stefano; Rinzivillo, Maria; Rodriguez-Laval, Victor; Pape, Ulrich Frank; Lipp, Rainer; Gress, Thomas; Wiedenmann, Bertram; Falconi, Massimo; Delle Fave, Gianfranco

    2017-04-01

    Several risk factors predict clinical outcome in gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs); however, the impact of their combination has not been investigated so far. A retrospective analysis of stage IV GEP-NENs was performed. Multivariate analysis for progression of disease (PD) was performed by Cox proportional hazards method to obtain a risk score. Area under the curve obtained by receiver operating characteristic analysis was used to assess the score performance. Progression-free survival analysis was performed by Kaplan-Meier method. Two hundred eighty-three stage IV GEP-NENs were evaluated, including 93 grade 1 neuroendocrine tumors (32.9%), 153 grade 2 neuroendocrine tumors (54%), and 37 grade 3 neuroendocrine carcinomas (13.1%). Independent risk factors for PD were Ki67, proportion of metastatic liver involvement, and presence of extra-abdominal metastases. The risk score was calculated as follows: (0.025 × Ki67) + [(0 if no liver metastases or liver involvement <25%) OR (0.405 if liver involvement 25%-50%) OR (0.462 if liver involvement >50%)] + [(0 if no extra-abdominal metastases) OR (0.528 if extra-abdominal metastases present)]. The risk score accuracy to predict PD was superior compared with the G grading system (area under the curve: 0.705 and 0.622, respectively). Three subgroups of patients with low, intermediate, and high risk of PD according to risk score were identified, median progression-free survival being 26 months, 19 months, and 12 months, respectively. In stage IV GEP-NENs, a risk score able to predict PD was obtained by combining Ki67, proportion of metastatic liver involvement, and presence of extra-abdominal metastases. The score may help to discriminate patients with different progression risk level to plan tailored therapeutic approaches and follow-up programs. The Oncologist 2017;22:409-415Implications for Practice: Clinical outcome of patients with advanced gastro-entero-pancreatic neuroendocrine

  12. Comparing the performance of propensity score methods in healthcare database studies with rare outcomes.

    PubMed

    Franklin, Jessica M; Eddings, Wesley; Austin, Peter C; Stuart, Elizabeth A; Schneeweiss, Sebastian

    2017-02-16

    Nonrandomized studies of treatments from electronic healthcare databases are critical for producing the evidence necessary to making informed treatment decisions, but often rely on comparing rates of events observed in a small number of patients. In addition, studies constructed from electronic healthcare databases, for example, administrative claims data, often adjust for many, possibly hundreds, of potential confounders. Despite the importance of maximizing efficiency when there are many confounders and few observed outcome events, there has been relatively little research on the relative performance of different propensity score methods in this context. In this paper, we compare a wide variety of propensity-based estimators of the marginal relative risk. In contrast to prior research that has focused on specific statistical methods in isolation of other analytic choices, we instead consider a method to be defined by the complete multistep process from propensity score modeling to final treatment effect estimation. Propensity score model estimation methods considered include ordinary logistic regression, Bayesian logistic regression, lasso, and boosted regression trees. Methods for utilizing the propensity score include pair matching, full matching, decile strata, fine strata, regression adjustment using one or two nonlinear splines, inverse propensity weighting, and matching weights. We evaluate methods via a 'plasmode' simulation study, which creates simulated datasets on the basis of a real cohort study of two treatments constructed from administrative claims data. Our results suggest that regression adjustment and matching weights, regardless of the propensity score model estimation method, provide lower bias and mean squared error in the context of rare binary outcomes. Copyright © 2017 John Wiley & Sons, Ltd.

  13. Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis.

    PubMed

    Ferro, José M; Bacelar-Nicolau, Helena; Rodrigues, Teresa; Bacelar-Nicolau, Leonor; Canhão, Patrícia; Crassard, Isabelle; Bousser, Marie-Germaine; Dutra, Aurélio Pimenta; Massaro, Ayrton; Mackowiack-Cordiolani, Marie-Anne; Leys, Didier; Fontes, João; Stam, Jan; Barinagarrementeria, Fernando

    2009-01-01

    Around 15% of patients die or become dependent after cerebral vein and dural sinus thrombosis (CVT). We used the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) sample (624 patients, with a median follow-up time of 478 days) to develop a Cox proportional hazards regression model to predict outcome, dichotomised by a modified Rankin Scale score >2. From the model hazard ratios, a risk score was derived and a cut-off point selected. The model and the score were tested in 2 validation samples: (1) the prospective Cerebral Venous Thrombosis Portuguese Collaborative Study Group (VENOPORT) sample with 91 patients; (2) a sample of 169 consecutive CVT patients admitted to 5 ISCVT centres after the end of the ISCVT recruitment period. Sensitivity, specificity, c statistics and overall efficiency to predict outcome at 6 months were calculated. The model (hazard ratios: malignancy 4.53; coma 4.19; thrombosis of the deep venous system 3.03; mental status disturbance 2.18; male gender 1.60; intracranial haemorrhage 1.42) had overall efficiencies of 85.1, 84.4 and 90.0%, in the derivation sample and validation samples 1 and 2, respectively. Using the risk score (range from 0 to 9) with a cut-off of >or=3 points, overall efficiency was 85.4, 84.4 and 90.1% in the derivation sample and validation samples 1 and 2, respectively. Sensitivity and specificity in the combined samples were 96.1 and 13.6%, respectively. The CVT risk score has a good estimated overall rate of correct classifications in both validation samples, but its specificity is low. It can be used to avoid unnecessary or dangerous interventions in low-risk patients, and may help to identify high-risk CVT patients. (c) 2009 S. Karger AG, Basel.

  14. Outcome After Radiosurgery for Brain Metastases in Patients With Low Karnofsky Performance Scale (KPS) Scores

    SciTech Connect

    Chernov, Mikhail F. |. E-mail: m_chernov@yahoo.com; Nakaya, Kotaro; Izawa, Masahiro; Usuba, Yuki; Kato, Koichi; Hori, Tomokatsu; Hayashi, Motohiro |; Muragaki, Yoshihiro |; Iseki, Hiroshi ||; Takakura, Kintomo ||

    2007-04-01

    Purpose: The objective of this retrospective study was evaluation of the outcome after stereotactic radiosurgery (SRS) in patients with intracranial metastases and poor performance status. Methods and Materials: Forty consecutive patients with metastatic brain tumors and Karnofsky performance scale (KPS) scores {<=}50 (mean, 43 {+-} 8; median, 40) treated with SRS were analyzed. Poor performance status was caused by presence of intracranial metastases in 28 cases (70%) and resulted from uncontrolled extracerebral disease in 12 (30%). Results: Survival after SRS varied from 3 days to 11.5 months (mean, 3.8 {+-} 2.9 months; median, 3.3 months). Survival probability constituted 0.50 {+-} 0.07 at 3 months and 0.20 {+-} 0.05 at 6 months posttreatment. Cause of low KPS score (p = 0.0173) and presence of distant metastases beside the brain (p = 0.0308) showed statistically significant associations with overall survival in multivariate Cox proportional hazards regression analysis. Median survival was 6.0 months if low KPS score was caused by cerebral disease and distant metastases in regions beyond the brain were absent, 3.3 months if low KPS score was caused by cerebral disease and distant metastases in regions beyond the brain were present, and 1.0 month if poor performance status resulted from extracerebral disease. Conclusions: Identification of the cause of low KPS score (cerebral vs. extracerebral) in patients with metastatic brain tumor(s) may be important for prediction of the outcome after radiosurgical treatment. If poor patient performance status without surgical indications is caused by intracranial tumor(s), SRS may be a reasonable treatment option.

  15. Predicting Long-Term Outcomes in Pleural Infections. RAPID Score for Risk Stratification.

    PubMed

    White, Heath D; Henry, Christopher; Stock, Eileen M; Arroliga, Alejandro C; Ghamande, Shekhar

    2015-09-01

    Pleural infections are associated with significant morbidity and mortality. The recently developed RAPID (renal, age, purulence, infection source, and dietary factors) score consists of five clinical factors that can identify patients at risk for increased mortality. The objective of this study was to further validate the RAPID score in a diverse cohort, identify factors associated with mortality, and provide long-term outcomes. We evaluated a single-center retrospective cohort of 187 patients with culture-positive pleural infections. Patients were classified by RAPID scores into low-risk (0-2), medium-risk (3-4), and high-risk (5-7) groups. The Social Security Death Index was used to determine date of death. All-cause mortality was assessed at 3 months, 1 year, 3 years, and 5 years. Clinical factors and comorbid conditions were evaluated for association. Three-month mortality for low-, medium-, and high-risk groups was 1.5, 17.8, and 47.8%, respectively. Increased odds were observed among medium-risk (odds ratio, 14.3; 95% confidence interval, 1.8-112.6; P = 0.01) and high-risk groups (odds ratio, 53.3; 95% confidence interval, 6.8-416.8; P < 0.01). This trend continued at 1, 3, and 5 years. Factors associated with high-risk scores include gram-negative rod infections, heart disease, diabetes, cancer, lung disease, and increased length of stay. When applied to a diverse patient cohort, the RAPID score predicts outcomes in patients up to 5 years and may aid in long-term risk stratification on presentation.

  16. [Hong Seok-hoo's translation of "New Edition of Physiology Textbook"(1906) and its meanings].

    PubMed

    Park, Jun-Hyoung; Park, Hyoung-Woo

    2012-12-01

    Hong Seok-hoo, who took charge of Jejungwon, was successful in translating Jiro Tsuboi's book titled "New Edition of Physiology Textbook (1897)" in Japanese and publishing it with a title of "New Edition of Physiology Textbook" in 1906. Jiro Tsuboi, the original author of that book, was a doctor having majored in Hygienics in Germany and was also known to have done pioneering work in Hygienics and Occupational and Environmental Medicine in Japan. At that time, he wrote that book for the purpose of teaching his students at Ordinary Middle School and Normal School. Therefore, it was not intended as a Physiology textbook for medical students, but an introductory book explaining Physiology with a wide range of subjects including hygienic matters in a broader sense. Hong Seok-hoo made an almost complete translation of the "New Edition of Physiology Textbook." While editing the book, however, he changed some of the most Japanese-style contents to meet the Korean conditions then, and made up for some insufficient contents with reference to the original author's other books. Although it was not included in an original version of that book, he also compiled a physiology dictionary in order to help Korean readers acquire medical terms in a more systematic way. Just like other textbooks of Jejungwon, the "New Edition of Physiology Textbook" was also put into Korean only. Hong Seok-hoo accepted Japanese-style medical terms, but also changed some of them or coined new words, considering the Korean circumstances then. He seemed to do so in an effort to introduce Western medicine in a more independent way while overcoming his limitations of translation. In particular, this book criticized that a long-term use of cosmetics might cause a serious lead poisoning from a Christian viewpoint, saying that a God-created human body should be kept intact as it is. In addition, in the course of reediting premodern books, the term "Lord" was changed into "God," which is considered a kind of

  17. Early warning score: An indicator of adverse outcomes in postoperative patients on a gynecologic oncology service.

    PubMed

    Smith, Haller J; Pasko, Daniel N; Haygood, Christen L Walters; Boone, Jonathan D; Harper, Lorie M; Straughn, J Michael

    2016-10-01

    In 2014, our hospital implemented an early warning score (EWS) to identify inpatients at risk for clinical deterioration. EWS≥8 is associated with ≥10% mortality in medical admissions. Since postoperative hemodynamic changes may alter EWS, we evaluated EWS in post-laparotomy patients. Gynecologic oncology patients admitted for laparotomy from 9/1/2014 to 7/31/2015 were categorized by highest EWS during admission: <5, 5-7, and ≥8. The primary outcome was a composite including death, ICU transfer, rapid response team activation, pulmonary embolus, sepsis, and reoperation. For patients with the composite, highest EWS prior to that outcome was evaluated. Secondary outcomes were length of stay (LOS), readmission, and transfusion. Groups were compared using chi-square test for trend, analysis of variance, and Kruskal-Wallis tests. A receiver operating characteristic (ROC) curve estimated the association between EWS and the composite outcome. 411 patients were included: 217 (52.8%) with EWS<5, 151 (36.7%) with EWS 5-7, and 43 (10.5%) with EWS≥8. The composite occurred in 32.6% of patients with EWS≥8, 7.3% with EWS 5-7, and 0% with EWS<5 (p<0.01). EWS≥8 was associated with longer LOS, higher readmission rate, and more transfusions. For the composite, the area under the ROC curve was 0.89 (95% CI 0.84-0.94). EWS≥5 had 100% sensitivity and 56.2% specificity for the primary outcome; EWS≥8 had 56.0% sensitivity and 92.5% specificity for the primary outcome. EWS≥5 after laparotomy is associated with adverse outcomes. Future studies should evaluate the ability of EWS to predict and prevent these outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. NIHSS-time score easily predicts outcomes in rt-PA patients: the SAMURAI rt-PA registry.

    PubMed

    Aoki, Junya; Kimura, Kazumi; Koga, Masatoshi; Kario, Kazuomi; Nakagawara, Jyoji; Furui, Eisuke; Shiokawa, Yoshiaki; Hasegawa, Yasuhiro; Okuda, Satoshi; Yamagami, Hiroshi; Okada, Yasushi; Shibazaki, Kensaku; Sakamoto, Yuki; Toyoda, Kazunori

    2013-04-15

    We aimed to devise a scale comprising a simple multiplication of initial National Institutes of Health Stroke Scale (NIHSS) score and onset-to-treatment time (OTT) as a scale for predicting outcomes after recombinant tissue plasminogen activator (rt-PA) therapy. Data from rt-PA patients in 10 stroke centers in Japan were investigated. NIHSS-time score was calculated as initial NIHSS score×OTT. Subjects comprised 526 patients. Median NIHSS score was 12 (7-18), and median OTT was 2.42 h (2.00-2.75 h). Median NIHSS-time score was 27.7 (16.9-41.7). Good (modified Rankin Scale [mRS] 0-1) and poor (mRS 4-6) outcome rates at 3months for patients with NIHSS-time scores ≤ 10 were 71.1% and 7.8%, compared to 54.7% and 16.5% for scores >10 and ≤ 20, 38.9% and 31.9% for scores >20 and ≤ 30, 25.0% and 44.6% for scores >30 and ≤ 40, and 17.4% and 61.8% for scores >40, respectively. Cut-off NIHSS-time scores to predict good and poor outcomes with 50% probability were defined as 20 and 40, respectively. Multivariate logistic regression analysis revealed NIHSS-time score as an independent predictor of good (odds ratio [OR], 0.587; 95% confidence interval [CI], 0.422-0.818, p=0.002) and poor (OR, 1.756; 95%CI, 1.227-2.514, p=0.002) outcomes after adjusting for age, sex, NIHSS score, OTT, Alberta Stroke Program Early CT Score, internal carotid artery occlusion, and glucose level. NIHSS-time score predicts clinical outcomes in rt-PA patients. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. The FAT Score, a Fibrosis Score of Adipose Tissue: Predicting Weight-Loss Outcome After Gastric Bypass.

    PubMed

    Bel Lassen, Pierre; Charlotte, Frederic; Liu, Yuejun; Bedossa, Pierre; Le Naour, Gilles; Tordjman, Joan; Poitou, Christine; Bouillot, Jean-Luc; Genser, Laurent; Zucker, Jean-Daniel; Sokolovska, Nataliya; Aron-Wisnewsky, Judith; Clément, Karine

    2017-07-01

    Bariatric surgery (BS) induces major and sustainable weight loss in many patients. Factors predicting poor weight-loss response (PR) need to be identified to improve patient care. Quantification of subcutaneous adipose tissue (scAT) fibrosis is negatively associated with post-BS weight loss, but whether it could constitute a predictor applicable in clinical routine remains to be demonstrated. To create a semiquantitative score evaluating scAT fibrosis and test its predictive value on weight-loss response after Roux-en-Y gastric bypass (RYGB). We created a fibrosis score of adipose tissue (FAT score) integrating perilobular and pericellular fibrosis. Using this score, we characterized 183 perioperative scAT biopsy specimens from severely obese patients who underwent RYGB (n = 85 from a training cohort; n = 98 from a confirmation cohort). PR to RYGB was defined as <28% of total weight loss at 1 year (lowest tertile). The link between FAT score and PR was tested in univariate and multivariate models. FAT score was directly associated with increasing scAT fibrosis measured by a standard quantification method (P for trend <0.001). FAT score interobserver agreement was good (κ = 0.76). FAT score ≥2 was significantly associated with PR. The association remained significant after adjustment for age, diabetes status, hypertension, percent fat mass, and interleukin-6 level (adjusted odds ratio, 3.6; 95% confidence interval, 1.8 to 7.2; P = 0.003). The FAT score is a new, simple, semiquantitative evaluation of human scAT fibrosis that may help identify patients with a potential limited weight-loss response to RYGB.

  20. Using acute kidney injury severity and scoring systems to predict outcome in patients with burn injury.

    PubMed

    Kuo, George; Yang, Shih-Yi; Chuang, Shiow-Shuh; Fan, Pei-Chun; Chang, Chih-Hsiang; Hsiao, Yen-Chang; Chen, Yung-Chang

    2016-12-01

    Acute kidney injury (AKI) is a frequent complication of severe burn injury and is associated with mortality. The definition of AKI was modified by the Kidney Disease Improving Global Outcomes Group in 2012. So far, no study has compared the outcome accuracy of the new AKI staging guidelines with that of the complex score system. Hence, we compared the accuracy of these approaches in predicting mortality. This was a post hoc analysis of prospectively collected data from an intensive care burn unit in a tertiary care university hospital. Patients admitted to this unit from July 2004 to December 2006 were enrolled. Demographic, clinical, and laboratory data and prognostic risk scores were used as predictors of mortality. A total of 145 adult patients with a mean age of 41.9 years were studied. Thirty-five patients (24.1%) died during the hospital course. Among the prognostic risk models, the Acute Physiology and Chronic Health Evaluation III system exhibited the strongest discriminative power and the AKI staging system also predicted mortality well (areas under the receiver operating characteristic curve: 0.889 vs. 0.835). Multivariate logistic regression analysis identified total burn surface area, ventilator use, AKI, and toxic epidermal necrolysis as independent risk factors for mortality. Our results revealed that AKI stage has considerable discriminative power for predicting mortality. Compared with other prognostic models, AKI stage is easier to use to assess outcome in patients with severe burn injury. Copyright © 2016. Published by Elsevier B.V.

  1. Oncologic outcomes between open and robotic-assisted radical cystectomy: a propensity score matched analysis.

    PubMed

    Ahdoot, Michael; Almario, Leanne; Araya, Hiwot; Busch, Jonas; Conti, Simon; Gonzalgo, Mark L

    2014-12-01

    To compare oncologic outcomes between open radical cystectomy (ORC) and robotic-assisted radical cystectomy (RARC) using propensity score (PS) matching of preoperative variables. A group of 51 consecutive patients who underwent RARC between 2009 and 2012 were matched by propensity scoring with an equal number of patients who underwent ORC. Patient demographics, clinical staging, pathologic staging, pathologic grading, histology, positive margin status, lymph node yield, duration of hospital stay, and overall survival were examined. PS-matched ORC and RARC cohorts demonstrated no significant differences with respect to preoperative variables, pathologic stage, grade, histology, metastasis at preoperative staging, and postoperative positive margin status. There were statistically significant differences in nodal status (66.7 % N0 for ORC vs. 80.4 % N0 for RARC, p = 0.039) and median lymph node yield (6 for ORC vs. 18 for RARC, p < 0.0001). No positive soft tissue margins were observed in the RARC group compared to 5.9 % in the ORC group (p = 0.332). There were no significant differences in mean duration of hospital stay or mean overall survival between ORC and RARC. ORC and RARC represent effective surgical approaches for the treatment of bladder cancer. Histopathologic outcomes for RARC compare favorably to ORC with respect to soft tissue margin rates and lymph node yield. These data suggest that RARC is an acceptable surgical approach for treatment of bladder cancer that can achieve outcomes that are equal or superior to those of ORC.

  2. Capillary Index Score and Correlation with Outcomes in Acute Ischemic Stroke: A Meta-analysis

    PubMed Central

    Jagani, Manoj; Brinjikji, Waleed; Murad, Mohammad H.; Rabinstein, Alejandro A.; Cloft, Harry J.; Kallmes, David F.

    2017-01-01

    Background and Purpose The capillary index score (CIS) has been recently introduced as a metric for rating the collateral circulation of ischemic stroke patients. Multiple studies in the last five years have evaluated the correlation of good CIS with clinical outcomes and suggested the use of CIS in selecting patients for endovascular treatment. We performed a meta-analysis of these studies comparing CIS with clinical outcomes. Methods We conducted a computerized search of three databases from January 2011 to November 2015 for studies related to CIS and outcomes. A CIS = 0 or 1 is considered poor (pCIS) and a CIS = 2 or 3 is considered favorable (fCIS). Using random-effect meta-analysis, we evaluated the relationship of CIS to neurological outcome (modified Rankin scale score ≤ 2), recanalization, and post-treatment hemorrhage. Meta-regression analysis of good neurological outcome was performed for adjusting baseline National Institutes of Health Stroke Scale (NIHSS) between groups. Results Six studies totaling 338 patients (212 with fCISs and 126 with pCISs) were included in the analysis. Patients with fCIS had higher likelihood of good neurological outcome [relative risk (RR) = 3.03; confidence interval (CI) = 95%, 2.05–4.47; p < 0.001] and lower risk of post-treatment hemorrhage (RR = 0.38; CI = 95%, 0.19–0.93; p = 0.04) as compared with patients in the pCIS group. When adjusting for baseline NIHSS, patients with fCIS had higher RR of good neurological outcome when compared with those with pCIS (RR = 2.94; CI = 95%, 1.23–7, p < 0.0001). Favorable CIS was not associated with higher rates of recanalization. Conclusions Observational evidence suggests that acute ischemic stroke patients with fCIS may have higher rates of good neurological outcomes compared with patients with pCIS, independent of baseline NIHSS. CIS may be used as another tool to select patients for endovascular treatment of acute ischemic stroke. PMID:28243344

  3. Validation of the LOD score compared with APACHE II score in prediction of the hospital outcome in critically ill patients.

    PubMed

    Khwannimit, Bodin

    2008-01-01

    The Logistic Organ Dysfunction score (LOD) is an organ dysfunction score that can predict hospital mortality. The aim of this study was to validate the performance of the LOD score compared with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in a mixed intensive care unit (ICU) at a tertiary referral university hospital in Thailand. The data were collected prospectively on consecutive ICU admissions over a 24 month period from July1, 2004 until June 30, 2006. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUROC). The calibration was assessed by the Hosmer-Lemeshow goodness-of-fit H statistic. The overall fit of the model was evaluated by the Brier's score. Overall, 1,429 patients were enrolled during the study period. The mortality in the ICU was 20.9% and in the hospital was 27.9%. The median ICU and hospital lengths of stay were 3 and 18 days, respectively, for all patients. Both models showed excellent discrimination. The AUROC for the LOD and APACHE II were 0.860 [95% confidence interval (CI) = 0.838-0.882] and 0.898 (95% Cl = 0.879-0.917), respectively. The LOD score had perfect calibration with the Hosmer-Lemeshow goodness-of-fit H chi-2 = 10 (p = 0.44). However, the APACHE II had poor calibration with the Hosmer-Lemeshow goodness-of-fit H chi-2 = 75.69 (p < 0.001). Brier's score showed the overall fit for both models were 0.123 (95%Cl = 0.107-0.141) and 0.114 (0.098-0.132) for the LOD and APACHE II, respectively. Thus, the LOD score was found to be accurate for predicting hospital mortality for general critically ill patients in Thailand.

  4. Patient reported outcomes in hip arthroplasty registries.

    PubMed

    Paulsen, Aksel

    2014-05-01

    PROs are used increasingly in orthopedics and in joint registries, but still many aspects of use in this area have not been examined in depth. To be able to introduce PROs in the DHR in a scientific fashion, my studies were warranted; the feasibility of four often used PROs (OHS, HOOS, EQ-5D and SF-12) was examined in a registry context. Having the PROs in the target language is an absolute necessity, so I translated, cross-culturally adapted and validated a Danish language version of an often used PRO (OHS), since this PRO had no properly developed Danish language version. To minimize data loss and to maximize the data quality I validated our data capture procedure, an up to date AFP system, by comparing scannable, paper-based PROs, with manual single-key- and double-key entered data. To help further registry-PRO studies, I calculated the number of patients needed to discriminate between subgroups of age, sex, diagnosis, and prosthesis type for each of four often used PROs (OHS, HOOS, EQ-5D and SF-12), and to simplify the clinical interpretation of PRO scores and PRO change scores in PRO studies, I estimated MCII and PASS for two often used PROs (EQ-5D and HOOS). The feasibility study included 5,747 THA patients registered in the DHR, and I found only minor differences between the disease-specific and the generic PROs regarding ceiling and floor effects as well as discarded items. The HOOS, the OHS, the SF-12, and the EQ-5D are all appropriate PROs for administration in a hip registry. I found that group sizes from 51 to 1,566 were needed for subgroup analysis, depending on descriptive factors and choice of PRO. The AFP study included 200 THA patients (398 PROs, 4,875 items and 21,887 data fields), and gave excellent results provided use of highly structured questionnaires. OMR performed equally as well as manual double-key entering, and better than single-key entering. The PRO translation and validation study included 2,278 patients (and 212 patients for the test

  5. Integrated risk scoring model for predicting dynamic hip screw treatment outcome of intertrochanteric fracture.

    PubMed

    Hsu, Cheng-En; Huang, Kui-Chou; Lin, Tzu-Chieh; Tong, Kwok-Man; Lee, Mei-Hsuan; Chiu, Yung-Cheng

    2016-11-01

    Dynamic hip screw (DHS) is a common device for treating intertrochanteric fracture (ITF). Various risk factors have been reported to be associated with the operative treatment outcome. However, an integrated risk scoring prediction model is lacking. In this study, we aimed to develop a prediction model for treatment outcome of intertrochanteric fracture. We analyzed 442 AO/OTA 31-A1 and A2 fractures which were treated with DHS during the period January 2000 to June 2014 in a level I trauma center. Risk factors including age, gender, injured side, lag screw position, AO/OTA classification, tip-apex distance, postoperative lateral wall fracture, reduction patterns were analyzed to determine their influence on treatment outcome. Integrated risk scores of significant predictors were used to construct a prediction model. AO/OTA 31-A2 classification, postoperative lateral wall fracture, posteriorly inserted lag screw and varus reduction pattern were significant risk predictors for DHS failure. The failure risk for low- and high-risk groups were significantly different (P<0.001) CONCLUSION: AO/OTA 31-A2 classification, postoperative lateral wall fracture, posteriorly inserted lag screw and varus reduction pattern were significant risk predictors for DHS failure. We developed a model that integrates these factors to predict the treatment outcome, which had excellent prediction accuracy and discriminatory ability. The models may provide useful information for orthopedic doctors to identify patients who need early intervention as well as ITF patients who require more frequent follow-up in the postoperative period. Copyright © 2016. Published by Elsevier Ltd.

  6. Age, PaO2/FIO2, and Plateau Pressure Score: A Proposal for a Simple Outcome Score in Patients With the Acute Respiratory Distress Syndrome.

    PubMed

    Villar, Jesús; Ambrós, Alfonso; Soler, Juan Alfonso; Martínez, Domingo; Ferrando, Carlos; Solano, Rosario; Mosteiro, Fernando; Blanco, Jesús; Martín-Rodríguez, Carmen; Fernández, María Del Mar; López, Julia; Díaz-Domínguez, Francisco J; Andaluz-Ojeda, David; Merayo, Eleuterio; Pérez-Méndez, Lina; Fernández, Rosa Lidia; Kacmarek, Robert M

    2016-07-01

    Although there is general agreement on the characteristic features of the acute respiratory distress syndrome, we lack a scoring system that predicts acute respiratory distress syndrome outcome with high probability. Our objective was to develop an outcome score that clinicians could easily calculate at the bedside to predict the risk of death of acute respiratory distress syndrome patients 24 hours after diagnosis. A prospective, multicenter, observational, descriptive, and validation study. A network of multidisciplinary ICUs. Six-hundred patients meeting Berlin criteria for moderate and severe acute respiratory distress syndrome enrolled in two independent cohorts treated with lung-protective ventilation. None. Using individual demographic, pulmonary, and systemic data at 24 hours after acute respiratory distress syndrome diagnosis, we derived our prediction score in 300 acute respiratory distress syndrome patients based on stratification of variable values into tertiles, and validated in an independent cohort of 300 acute respiratory distress syndrome patients. Primary outcome was in-hospital mortality. We found that a 9-point score based on patient's age, PaO2/FIO2 ratio, and plateau pressure at 24 hours after acute respiratory distress syndrome diagnosis was associated with death. Patients with a score greater than 7 had a mortality of 83.3% (relative risk, 5.7; 95% CI, 3.0-11.0), whereas patients with scores less than 5 had a mortality of 14.5% (p < 0.0000001). We confirmed the predictive validity of the score in a validation cohort. A simple 9-point score based on the values of age, PaO2/FIO2 ratio, and plateau pressure calculated at 24 hours on protective ventilation after acute respiratory distress syndrome diagnosis could be used in real time for rating prognosis of acute respiratory distress syndrome patients with high probability.

  7. The PER (Preoperative Esophagectomy Risk) Score: A Simple Risk Score to Predict Short-Term and Long-Term Outcome in Patients with Surgically Treated Esophageal Cancer

    PubMed Central

    Reeh, Matthias; Metze, Johannes; Uzunoglu, Faik G.; Nentwich, Michael; Ghadban, Tarik; Wellner, Ullrich; Bockhorn, Maximilian; Kluge, Stefan; Izbicki, Jakob R.; Vashist, Yogesh K.

    2016-01-01

    Abstract Esophageal resection in patients with esophageal cancer (EC) is still associated with high mortality and morbidity rates. We aimed to develop a simple preoperative risk score for the prediction of short-term and long-term outcomes for patients with EC treated by esophageal resection. In total, 498 patients suffering from esophageal carcinoma, who underwent esophageal resection, were included in this retrospective cohort study. Three preoperative esophagectomy risk (PER) groups were defined based on preoperative functional evaluation of different organ systems by validated tools (revised cardiac risk index, model for end-stage liver disease score, and pulmonary function test). Clinicopathological parameters, morbidity, and mortality as well as disease-free survival (DFS) and overall survival (OS) were correlated to the PER score. The PER score significantly predicted the short-term outcome of patients with EC who underwent esophageal resection. PER 2 and PER 3 patients had at least double the risk of morbidity and mortality compared to PER 1 patients. Furthermore, a higher PER score was associated with shorter DFS (P < 0.001) and OS (P < 0.001). The PER score was identified as an independent predictor of tumor recurrence (hazard ratio [HR] 2.1; P < 0.001) and OS (HR 2.2; P < 0.001). The PER score allows preoperative objective allocation of patients with EC into different risk categories for morbidity, mortality, and long-term outcomes. Thus, multicenter studies are needed for independent validation of the PER score. PMID:26886613

  8. Cardiovascular Outcomes in the Outpatient Kidney Transplant Clinic: The Framingham Risk Score Revisited

    PubMed Central

    Kiberd, Bryce; Panek, Romuald

    2008-01-01

    Background and objectives: Cardiovascular disease is an important cause of morbidity and death in kidney transplant recipients. This study examines the Framingham risk score's ability to predict cardiac and stroke events. Because cyclosporine and tacrolimus have different cardiovascular risk profiles, these agents were also examined. Design, setting, participants, & measurements: A prospective cohort evaluation of 540 patients were followed for a median of 4.7 yr in an outpatient kidney transplant clinic. Baseline Framingham risk scores were calculated and all cardiovascular outcomes were collected. Results: Rates per 100 patient-years were 1.79 for cardiac and 0.78 for stroke events. The ratio of observed-to-predicted cardiac events was 1.64-fold higher [95% confidence interval (CI) 1.19 to 2.94] for the cohort, 2.74-fold higher (95% CI 1.70 to 4.24) in patients age 45 to 60 with prior cardiac disease or diabetes mellitus, but not higher in other age subgroups. Stroke was not increased above predicted. Risk scores for cardiac (c = 0.65, P = 0.003) and stroke (c = 0.71, P = 0.004) events were modest predictors. 10-yr event scores for cardiac (9.3 versus 13.5%, P < 0.001) and stroke (7.1 versus 10.0%, P = 0.002) were lower for tacrolimus compared with cyclosporine-treated patients. However observed cardiac events were higher in tacrolimus recipients (2.50, 95% CI 1.09 to 5.90) in an adjusted Cox model. Conclusions: Although risk scores are only modest predictors, patients with the highest event rates are easily identified. Treating high-risk patients with cardioprotective medications should remain a priority. PMID:18322053

  9. A novel application of propensity score matching to estimate Alcoholics Anonymous’ effect on drinking outcomes

    PubMed Central

    Magura, Stephen; McKean, Joseph; Kosten, Scott; Tonigan, J. Scott

    2012-01-01

    Background Randomized controlled trials (RCTs) of mutual aid, including Alcoholics Anonymous (AA), are notoriously difficult to conduct and correlational studies are problematic to interpret due to potential confounds. Methods A secondary analysis was conducted of Project MATCH, a RCT of alcoholism treatments. Although MATCH did not randomly assign subjects to AA vs. no AA, the 12 Step Facilitation (TSF) condition did result in a higher proportion of subjects attending community AA meetings than in the other two treatment conditions. The key inference is that there exists a latent subgroup in MATCH who attended AA only because its constituents received TSF, not because of the “normal” factors leading to self-selection of AA. A novel application of propensity score matching (PSM) allowed four latent AA-related subgroups to be identified to estimate an unconfounded effect of AA on drinking outcomes. Results The study hypotheses were supported: subjects who consistently attended AA solely due to their exposure to TSF (the “Added AA” subgroup) had better drinking outcomes than equivalent subjects who did not consistently attend AA, but would have so attended, had they been exposed to TSF (the “Potential AA” subgroup); this indicates an AA effect on drinking. Conclusions The analysis presents evidence that consistent AA attendance improves drinking outcomes, independent of “normal” confounding factors that make correlations between AA attendance and outcomes difficult to interpret. PMID:23040721

  10. Modified periodontal risk assessment score: long-term predictive value of treatment outcomes. A retrospective study.

    PubMed

    Leininger, Matthieu; Tenenbaum, Henri; Davideau, Jean-Luc

    2010-05-01

    The aim of this study was to evaluate the long-term clinical predictive value of the periodontal risk assessment diagram surface (PRAS) score and the influence of patient compliance on the treatment outcomes. Thirty subjects suffering from periodontitis were re-examined 6-12 years after the initial diagnosis and periodontal treatments. The baseline PRAS score was calculated from the initial clinical and radiograph records. Patients were then classified into a low-to-moderate (0-20) or a high-risk group (>20). Patients who did not attend any supportive periodontal therapy were classified into a non-compliant group. PRAS and compliance were correlated to the mean tooth loss (TL)/year and the mean variation in the number of periodontal pockets with a probing depth (PPD) >4 mm. TL was 0.11 for the low-to-moderate-risk group and 0.26 for the high-risk group (p<0.05); PPD number reduction was 2.57 and 2.17, respectively, and bleeding on probing reduction was 6.7% and 23.3%, respectively. Comparing the compliance groups, the PPD number reduction was 3.39 in the compliant group and 1.40 in the non-compliant group (p<0.05). This study showed the reliability of PRAS in evaluating long-term TL and patient susceptibility to periodontal disease. Our data confirmed the positive influence of patient compliance on periodontal treatment outcomes.

  11. Aprotinin in primary cardiac surgery: operative outcome of propensity score-matched study.

    PubMed

    Ngaage, Dumbor L; Cale, Alexander R; Cowen, Michael E; Griffin, Steven; Guvendik, Levant

    2008-10-01

    Some recent multicenter series have questioned the safety of aprotinin in primary cardiac operations. We report a large, single-center experience with aprotinin therapy in primary cardiac operations and discuss the limitations and potential confounders of current treatment strategies. We compared myocardial infarction, neurologic events, renal insufficiency, and operative death after first-time coronary or valve procedures, or both, in 3334 patients treated with full-dose aprotinin with 3417 patients not treated with aprotinin who underwent operation between March 1998 and January 2007. Further analysis was performed for 341 propensity score-matched pairs. There were substantial differences between the groups. Aprotinin patients were higher risk on account of older age, unstable symptoms, poor ejection fraction, preoperative hemodynamic support, emergency/urgent operations, and combined coronary/valve operations. Postoperative bleeding and blood product transfusion were considerably reduced in aprotinin patients, as was median duration of mechanical ventilation. Aprotinin was neither a predictor of postoperative myocardial infarction, renal insufficiency, neurologic dysfunction, or operative death. Achieving parity between the groups by propensity score matching eliminated the elevated rates of postoperative renal insufficiency, neurologic dysfunction, and operative death observed in aprotinin patients in the unmatched comparison. These adverse outcomes were evenly distributed between matched groups. Conversely, blood transfusion had univariate associations with all adverse outcome measures. Full-dose aprotinin use was not associated with myocardial infarction, neurologic dysfunction, renal insufficiency, or death after coronary or valve operations. We observed less postoperative bleeding and blood product transfusion, and early extubation with the use of aprotinin.

  12. Vasoactive Inotropic Score (VIS) as Biomarker of Short-Term Outcomes in Adolescents after Cardiothoracic Surgery.

    PubMed

    Garcia, Richard U; Walters, Henry L; Delius, Ralph E; Aggarwal, Sanjeev

    2016-02-01

    Our aim was to evaluate the Vasoactive Inotropic Score (VIS) as a prognostic marker in adolescents following surgery for congenital heart disease. This single-center retrospective chart review included patients 10-18 years of age, who underwent cardiac surgery from 2009 to 2014. Hourly VIS was calculated for the initial 48 postoperative hours using standard formulae and incorporating doses of six pressors. The composite adverse outcome was defined as any one of death, resuscitation or mechanical support, arrhythmia, infection requiring antibacterial therapy, acute kidney injury or neurologic injury. Surgeries were risk-stratified by the type of surgical repair using the validated STAT score. Statistical analysis (SPSS 19.0) included Mann-Whitney U test, Chi-square test, ROC curves, and binary regression analysis. Our cohort (n = 149) had a mean (SD) age of 13.9 (2.4) years and included 97 (65.1 %) males. Maximal VIS at 24 and 48 h following surgery was significantly higher in subjects (n = 27) who suffered an adverse outcome. Subjects with adverse outcome had longer bypass and cross-clamp times, durations of stay in the hospital, and a higher rate of acute kidney injury, compared to those (n = 122) without postoperative adverse outcomes. The area under the ROC for maximum VIS at 24-48 h after surgery was 0.76, with sensitivity, specificity, and positive and negative predictive values with 95 % CI of 67 (48-82) %, 74 (70-77) %, and 36 (26-44) % and 91 (86-95) %, respectively, at a cutoff >4.75. On binary logistic regression, maximum VIS on second postoperative day remained significantly associated with adverse outcome (OR 1.35; 95 % CI> 1.12-1.64, p = 0.002). Maximal VIS at 24 and 48 h correlated significantly with length of stay and time to extubation. Maximal VIS on the second postoperative day predicts adverse outcome in adolescents following cardiac surgery. This simple yet robust prognostic indicator may aid in risk stratification and targeted interventions in

  13. Athlete Characteristics and Outcome Scores for Computerized Neuropsychological Assessment: A Preliminary Analysis

    PubMed Central

    Brown, Cathleen N; Guskiewicz, Kevin M; Bleiberg, Joseph

    2007-01-01

    Context: Computerized neuropsychological testing is used in athletics; however, normative data on an athletic population are lacking. Objective: To investigate factors, such as sex, SAT score, alertness, and sport, and their effects on baseline neuropsychological test scores. A secondary purpose was to begin establishing preliminary reference data for nonsymptomatic collegiate athletes. Design: Observational study. Setting: Research laboratory. Patients or Other Participants: The study population comprised 327 National Collegiate Athletic Association Division I athletes from 12 men's and women's sports. Main Outcome Measure(s): Athletes were baseline tested before their first competitive season. Athletes completed demographics forms and self-reported history of concussion (1 or no concussion and 2 or more concussions) and SAT scores (<1000, 1000 to 1200, and >1200). The 108 women had a mean age of 18.39 ± 0.09 years, height of 167.94 ± 0.86 cm, and mass of 62.36 ± 1.07 kg. The 219 men had a mean age of 18.49 ± 0.07 years, height of 183.24 ± 1.68 cm, and mass of 88.05 ± 1.82 kg. Sports participation included women's soccer, lacrosse, basketball, and field hockey; men's football, soccer, lacrosse, and wrestling; and women's and men's track and cheerleading. We used the Automated Neuropsychological Assessment Metrics (Army Medical Research and Materiel Command, Ft Detrick, MD) and measured throughput scores (the number of correct responses per minute) as the dependent variable for each subtest, with higher scores reflecting increased speed and accuracy of responses. Subsets included 2 simple reaction time (SRT) tests, math processing (MTH), Sternberg memory search (ST6), matching to sample pairs (MSP), procedural reaction time (PRO), code digit substitution (CDS), and the Stanford sleep scale Likert-type score. Results: Women scored better than men on the ST6 (P < .05), while men scored significantly better than women on the SRT and MSP tests. The highest-scoring

  14. Survival Outcomes Following Pediatric Liver Transplantation (Pedi-SOFT) Score: A Novel Predictive Index.

    PubMed

    Rana, A; Pallister, Z S; Guiteau, J J; Cotton, R T; Halazun, K; Nalty, C C; Khaderi, S A; O'Mahony, C A; Goss, J A

    2015-07-01

    A prognostic index to predict survival after liver transplantation could address several clinical needs. Here, we devised a scoring system that predicts recipient survival after pediatric liver transplantation. We used univariate and multivariate analysis on 4565 pediatric liver transplant recipients data and identified independent recipient and donor risk factors for posttransplant mortality at 3 months. Multiple imputation was used to account for missing variables. We identified five factors as significant predictors of recipient mortality after pediatric liver transplantation: two previous transplants (OR 5.88, CI 2.88-12.01), one previous transplant (OR 2.54, CI 1.75-3.68), life support (OR 3.68, CI 2.39-5.67), renal insufficiency (OR 2.66, CI 1.84-3.84), recipient weight under 6 kilograms (OR 1.67, CI 1.12-2.36) and cadaveric technical variant allograft (OR 1.38, CI 1.03-1.83). The Survival Outcomes Following Pediatric Liver Transplant score assigns weighted risk points to each of these factors in a scoring system to predict 3-month recipient survival after liver transplantation with a C-statistic of 0.74. Although quite accurate when compared with other posttransplant survival models, we would not advocate individual clinical application of the index. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  15. External validation of Resorlu-Unsal stone score as predictor of outcomes after retrograde intrarenal surgery.

    PubMed

    Sfoungaristos, Stavros; Gofrit, Ofer N; Mykoniatis, Ioannis; Landau, Ezekiel H; Katafigiotis, Ioannis; Pode, Dov; Constantinides, Constantinos A; Duvdevani, Mordechai

    2016-08-01

    To externally validate Resorlu-Unsal stone score (RUSS) and to evaluate its predictive accuracy. Data of patients who underwent retrograde intrarenal surgery (RIRS) between October 2013 and June 2015 were collected. RUSS was applied to all patients, and the nomogram was externally validated. Area under the curve (AUC) was used for clinical validity assessment. A total of 85 patients were included in the study. Mean patient age was 54.3 ± 16.5, and mean stone size was 12.0 ± 6.21 mm. After applying RUSS, 56.5, 28.2, 9.41, and 5.88 % had score 0, 1, 2, and 3, respectively. RUSS was significantly associated with stone location and size. Postoperative stone-free rate was 74.1 %. Postoperative outcomes were significantly associated with RUSS and stone size. RUSS was found to be the only significant independent predictor in multivariate analysis, while it provided high predictive accuracy with an estimated AUC of 0.707. RUSS is a simple scoring system that may predict postoperative stone-free rate after RIRS with great efficacy and accuracy.

  16. Scoring System Prognostic of Outcome in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome

    PubMed Central

    Ahn, Kwang Woo; Hu, Zhen-Huan; Nishihori, Taiga; Malone, Adriana K.; Valcárcel, David; Grunwald, Michael R.; Bacher, Ulrike; Hamilton, Betty; Kharfan-Dabaja, Mohamed A.; Saad, Ayman; Cutler, Corey; Warlick, Erica; Reshef, Ran; Wirk, Baldeep Mona; Sabloff, Mitchell; Fasan, Omotayo; Gerds, Aaron; Marks, David; Olsson, Richard; Wood, William Allen; Costa, Luciano J.; Miller, Alan M.; Cortes, Jorge; Daly, Andrew; Kindwall-Keller, Tamila L.; Kamble, Rammurti; Rizzieri, David A.; Cahn, Jean-Yves; Gale, Robert Peter; William, Basem; Litzow, Mark; Wiernik, Peter H.; Liesveld, Jane; Savani, Bipin N.; Vij, Ravi; Ustun, Celalettin; Copelan, Edward; Popat, Uday; Kalaycio, Matt; Maziarz, Richard; Alyea, Edwin; Sobecks, Ron; Pavletic, Steven; Tallman, Martin; Saber, Wael

    2016-01-01

    Purpose To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS). Patients and Methods We examined 2,133 patients with MDS undergoing HLA-matched (n = 1,728) or -mismatched (n = 405) allo HCT from 2000 to 2012. We used a Cox multivariable model to identify factors prognostic of mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using these factors was assigned to the remaining patients undergoing HLA-matched allo HCT (validation cohort; n = 577) as well as to patients undergoing HLA-mismatched allo HCT. Results Blood blasts greater than 3% (hazard ratio [HR], 1.41; 95% CI, 1.08 to 1.85), platelets 50 × 109/L or less at transplantation (HR, 1.37; 95% CI, 1.18 to 1.61), Karnofsky performance status less than 90% (HR, 1.25; 95% CI, 1.06 to 1.28), comprehensive cytogenetic risk score of poor or very poor (HR, 1.43; 95% CI, 1.14 to 1.80), and age 30 to 49 years (HR, 1.60; 95% CI, 1.09 to 2.35) were associated with increased hazard of death and assigned 1 point in the scoring system. Monosomal karyotype (HR, 2.01; 95% CI, 1.65 to 2.45) and age 50 years or older (HR, 1.93; 95% CI, 1.36 to 2.83) were assigned 2 points. The 3-year overall survival after transplantation in patients with low (0 to 1 points), intermediate (2 to 3), high (4 to 5) and very high (≥ 6) scores was 71% (95% CI, 58% to 85%), 49% (95% CI, 42% to 56%), 41% (95% CI, 31% to 51%), and 25% (95% CI, 4% to 46%), respectively (P < .001). Increasing score was predictive of increased relapse (P < .001) and treatment-related mortality (P < .001) in the HLA-matched set and relapse (P < .001) in the HLA-mismatched cohort. Conclusion The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched allo HCT for MDS. PMID:27044940

  17. Scoring System Prognostic of Outcome in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome.

    PubMed

    Shaffer, Brian C; Ahn, Kwang Woo; Hu, Zhen-Huan; Nishihori, Taiga; Malone, Adriana K; Valcárcel, David; Grunwald, Michael R; Bacher, Ulrike; Hamilton, Betty; Kharfan-Dabaja, Mohamed A; Saad, Ayman; Cutler, Corey; Warlick, Erica; Reshef, Ran; Wirk, Baldeep Mona; Sabloff, Mitchell; Fasan, Omotayo; Gerds, Aaron; Marks, David; Olsson, Richard; Wood, William Allen; Costa, Luciano J; Miller, Alan M; Cortes, Jorge; Daly, Andrew; Kindwall-Keller, Tamila L; Kamble, Rammurti; Rizzieri, David A; Cahn, Jean-Yves; Gale, Robert Peter; William, Basem; Litzow, Mark; Wiernik, Peter H; Liesveld, Jane; Savani, Bipin N; Vij, Ravi; Ustun, Celalettin; Copelan, Edward; Popat, Uday; Kalaycio, Matt; Maziarz, Richard; Alyea, Edwin; Sobecks, Ron; Pavletic, Steven; Tallman, Martin; Saber, Wael

    2016-06-01

    To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS). We examined 2,133 patients with MDS undergoing HLA-matched (n = 1,728) or -mismatched (n = 405) allo HCT from 2000 to 2012. We used a Cox multivariable model to identify factors prognostic of mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using these factors was assigned to the remaining patients undergoing HLA-matched allo HCT (validation cohort; n = 577) as well as to patients undergoing HLA-mismatched allo HCT. Blood blasts greater than 3% (hazard ratio [HR], 1.41; 95% CI, 1.08 to 1.85), platelets 50 × 10(9)/L or less at transplantation (HR, 1.37; 95% CI, 1.18 to 1.61), Karnofsky performance status less than 90% (HR, 1.25; 95% CI, 1.06 to 1.28), comprehensive cytogenetic risk score of poor or very poor (HR, 1.43; 95% CI, 1.14 to 1.80), and age 30 to 49 years (HR, 1.60; 95% CI, 1.09 to 2.35) were associated with increased hazard of death and assigned 1 point in the scoring system. Monosomal karyotype (HR, 2.01; 95% CI, 1.65 to 2.45) and age 50 years or older (HR, 1.93; 95% CI, 1.36 to 2.83) were assigned 2 points. The 3-year overall survival after transplantation in patients with low (0 to 1 points), intermediate (2 to 3), high (4 to 5) and very high (≥ 6) scores was 71% (95% CI, 58% to 85%), 49% (95% CI, 42% to 56%), 41% (95% CI, 31% to 51%), and 25% (95% CI, 4% to 46%), respectively (P < .001). Increasing score was predictive of increased relapse (P < .001) and treatment-related mortality (P < .001) in the HLA-matched set and relapse (P < .001) in the HLA-mismatched cohort. The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched allo HCT for MDS. © 2016 by American Society of Clinical Oncology.

  18. Outcome of revascularization in moyamoya disease: Evaluation of a new angiographic scoring system

    PubMed Central

    Sahoo, Siddhartha Shankar; Suri, Ashish; Bansal, Sumit; Devarajan, S. Leve Joseph; Sharma, Bhawani Shankar

    2015-01-01

    Background: Moyamoya disease (MMD) is a chronic progressive cerebrovascular occlusive disease affecting commonly the anterior circle of Willis. Matushima grade inadequately reflects the angiographic changes postrevascularization procedure. Aims: To analyze the clinical and angiographic outcome of revascularization procedures (direct [ST-middle cerebral artery (MCA) anastomosis] and indirect [encephalo-duro-arterio-myo-synangiosis (EDAMS)]) in MMD and validate a new angiographic scoring system. Materials and Methods: Retrospective study included symptomatic patients of MMD who underwent revascularization; both indirect and combined methods between January 2002 and April 2012. Follow-up angiography was done after at least 3 months. We devised a novel scoring system the “angiographic outcome score” (AOS) including reformation of distal MCA and anterior cerebral artery, regression of basal moyamoya vessels, leptomeningeal collaterals and overall perfusion. AOS was applied to the angiograms independently by a neuroradiologist and a neurosurgeon that were blinded toward its preoperative or postoperative status. Results: Totally 33 patients underwent 36 EDAMS and 4 combined procedures (EDAMS + ST-MCA bypass). The mean follow-up was 20 months. None had recurrent transient ischemic attack or fresh infarct. Postoperative AOS was significantly higher than preoperative AOS. The Spearman rho showed positive correlation between Matushima grade and postoperative AOS. Significant regression of basal moyamoya vessels and increase in number of loci of transdural collaterals was seen. Conclusions: EDAMS is a simple yet effective method of revascularization in both pediatric as well as adult age groups. AOS is a simple, precise and easily reproducible scoring system, which reflects the favorable angiographic changes after revascularization. PMID:26425151

  19. Neonatal status: an objective scoring method for identifying infants at risk for poor outcome.

    PubMed

    Salamy, A; Davis, S; Eldredge, L; Wakeley, A; Tooley, W H

    1988-01-01

    The likelihood of sustaining neurological, sensory or cognitive deficits is considerably greater for very low birthweight (VLBW) infants who require intensive care in early postnatal life than those without major neonatal illness. Identifying which, if any, medical events are responsible for an adverse outcome is most difficult in the face of multiple concurrent complications. In this research, a principal components analysis was performed in order to arrive at a set of orthogonal variables which succinctly described clinical involvement in the nursery. With this procedure, a single hypothetical factor depicting neonatal status (NS) was computed. Principal component scores were then generated for NS and assigned to 252 VLBW (less than 1500 g) infants. These subjects were followed prospectively from birth to 4 years of age. Standardized measures of neurological, sensory and intellectual function were regularly administered. Neonatal status was shown to be significantly correlated with the various test results and predictive of long-term development. When subjects were divided into quartiles with respect to NS, a specific subgroup was identified as "at high risk" for poor outcome. Those subjects falling into the lower quartile incurred more neurological abnormalities persisting beyond the first year. They also suffered a higher incidence of intracranial hemorrhage and sensori-neural hearing loss. In addition, the lower 25%, as a group, scored well below all others on traditional tests of mental ability. These differences were sustained throughout infancy and early childhood and could not be attributed to a number of demographic variables including sex, gestational age, birthweight, Apgar scores or parental educational level.

  20. Periarrest Modified Early Warning Score (MEWS) predicts the outcome of in-hospital cardiac arrest.

    PubMed

    Wang, An-Yi; Fang, Cheng-Chung; Chen, Shyr-Chyr; Tsai, Shin-Han; Kao, Wei-Fong

    2016-02-01

    The Modified Early Warning Score (MEWS) reflects the physiological changes of cardiac arrest and has been used in identifying patient deterioration. Physiological reserve capacity is an important outcome predictor, but is seldom reported due to recording limitations in cardiac arrest patients. The aim of the study was to evaluate whether periarrest MEWS could be a further prognostic factor in in-hospital cardiac arrest. This was a retrospective cohort study of nontrauma adult patients who had experienced in-hospital cardiac arrest during emergency department stays at an urban, 2600-bed tertiary medical center in Taiwan from February 2011 to July 2013. Data regarding patients' characteristics, Charlson Comorbidity Score, MEWS score before events, mode of arrest, and outcome details were extracted following the Utstein guidelines for uniform reporting of cardiac arrest. During the 30-month period, 234 patients suffered in-hospital cardiac arrest during emergency department stays, and 99 patients with periarrest MEWS were included in the final analysis. The MEWS at triage did not differ significantly between survival-to-discharge and mortality groups (3.42 ± 2.2 vs. 4.02 ± 2.65, p = 0.811). Periarrest MEWS was lower in the survival-to-discharge group (4.41 ± 2.28 vs. 5.82 ± 2.84, p = 0.053). In multivariate logistic regression analysis, periarrest MEWS was an independent predictors for survival to discharge. A rise in periarrest MEWS reduced the chance of survival to discharge by 0.77-fold (95% confidence interval: 0.60-0.97, p = 0.028). The simplest MEWS system not only can be used as a prevention measure, but the periarrest MEWS could also be considered as an independent predictor of mortality after in-hospital cardiac arrest. Copyright © 2015. Published by Elsevier B.V.

  1. Aggregate National Early Warning Score (NEWS) values are more important than high scores for a single vital signs parameter for discriminating the risk of adverse outcomes.

    PubMed

    Jarvis, Stuart; Kovacs, Caroline; Briggs, Jim; Meredith, Paul; Schmidt, Paul E; Featherstone, Peter I; Prytherch, David R; Smith, Gary B

    2015-02-01

    The Royal College of Physicians (RCPL) National Early Warning Score (NEWS) escalates care to a doctor at NEWS values of ≥5 and when the score for any single vital sign is 3. We calculated the 24-h risk of serious clinical outcomes for vital signs observation sets with NEWS values of 3, 4 and 5, separately determining risks when the score did/did not include a single score of 3. We compared workloads generated by the RCPL's escalation protocol and for aggregate NEWS value alone. Aggregate NEWS values of 3 or 4 (n=142,282) formed 15.1% of all vital signs sets measured; those containing a single vital sign scoring 3 (n=36,207) constituted 3.8% of all sets. Aggregate NEWS values of either 3 or 4 with a component score of 3 have significantly lower risks (OR: 0.26 and 0.53) than an aggregate value of 5 (OR: 1.0). Escalating care to a doctor when any single component of NEWS scores 3 compared to when aggregate NEWS values ≥5, would have increased doctors' workload by 40% with only a small increase in detected adverse outcomes from 2.99 to 3.08 per day (a 3% improvement in detection). The recommended NEWS escalation protocol produces additional work for the bedside nurse and responding doctor, disproportionate to a modest benefit in increased detection of adverse outcomes. It may have significant ramifications for efficient staff resource allocation, distort patient safety focus and risk alarm fatigue. Our findings suggest that the RCPL escalation guidance warrants review. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. The prognostic value of the wuerzburg bleb classification score for the outcome of trabeculectomy.

    PubMed

    Klink, Thomas; Kann, Gunda; Ellinger, Patrick; Klink, Janine; Grehn, Franz; Guthoff, Rainer

    2011-01-01

    the Wuerzburg bleb classification score (WBCS) aims at an objective and standardized assessment of the developing filtering bleb after trabeculectomy, in order to detect and treat bleb scarring at the earliest possible stage of development. The purpose of this retrospective study was to evaluate the prognostic value of the early postoperative WBCS for the long-term outcome of trabeculectomy. the WBCS is a grading system for clinical bleb morphology. It evaluates the following parameters: vascularization, corkscrew vessels, encapsulation and microcysts. The WBCS of 113 eyes of 113 consecutive patients after trabeculectomy was determined 1 day, 1 and 2 weeks, 3, 6 and 12 months after surgery. Complete success was defined as an intra-ocular pressure (IOP) <21 mm Hg and >20% pressure reduction without glaucoma medication after 1 year. a complete success rate of 73.9% and a qualified success rate of 82.4% were achieved 1 year after surgery. The average total bleb score during follow-up in the success group was always higher than in the failure group, but there was no statistically significant difference at any time. The bleb average score for eyes with an IOP of ≤ 12 mm Hg after 2 weeks was significantly higher (p = 0.005) than for eyes with an IOP ≥ 13 mm Hg at the end of follow-up. patients with a higher early WBCS postoperatively had a significantly lower IOP 1 year after surgery. However, the study could not reveal a certain prognostic value of the early total bleb score using the WBCS for the long-term complete success of trabeculectomy. 2010 S. Karger AG, Basel.

  3. Low 22-item sinonasal outcome test scores in chronic rhinosinusitis: Why do patients seek treatment?

    PubMed

    Levy, Joshua M; Mace, Jess C; Rudmik, Luke; Soler, Zachary M; Smith, Timothy L

    2017-01-01

    Patients with chronic rhinosinusitis (CRS) who experience minimal reductions in quality of life (QoL) may present for treatment despite QoL scores comparable to controls without CRS. This study seeks to identify cofactors influencing patients with CRS and low 22-item Sinonasal Outcome Test (SNOT-22) scores to seek care. Prospective, multicenter, observational cohort. Patients with CRS were enrolled between April 2011 and September 2015. Patients with sinonasal mucocele or unilateral sinus opacification were excluded. Control subjects without CRS were enrolled for comparison. Low-SNOT CRS was defined as a SNOT-22 score < 20. A total of 774 subjects (low-SNOT CRS, n = 38; high-SNOT CRS, SNOT-22 ≥ 20, n = 641; controls without CRS, n = 95) were enrolled. Low SNOT scores were identified in 6% of subjects with CRS. After adjustment, low-SNOT CRS and control groups without CRS reported similar baseline average SNOT-22 total scores (P = .879). Unexpectedly, compared to controls, low-SNOT CRS patients had significantly better average psychological (2.1 ± 2.3 vs. 5.8 ± 6.0; P = .030) and sleep dysfunction (2.7 ± 3.4 vs. 6.0 ± 5.2; P = .016) scores. Fourteen of 38 (37%) low-SNOT patients elected to undergo endoscopic sinus surgery (ESS), with a significantly lower likelihood of reporting a minimal clinically important difference (MCID) when compared to high-SNOT patients (43% vs. 82%; P < .001) after a mean follow-up of ∼15 months. Low-SNOT CRS patients represent an outlier population for which measures of QoL fail to identify factors influencing the decision to seek treatment. Low-SNOT CRS patients electing ESS have a decreased likelihood of reporting MCIDs following ESS. Further study is required to identify novel factors associated with treatment-seeking behavior in this population. 3B Laryngoscope, 127:22-28, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  4. Portsmouth physiological and operative severity score for the Enumeration of Mortality and morbidity scoring system in general surgical practice and identifying risk factors for poor outcome

    PubMed Central

    Tyagi, Ashish; Nagpal, Nitin; Sidhu, D. S.; Singh, Amandeep; Tyagi, Anjali

    2017-01-01

    Background: Estimation of the outcome is paramount in disease stratification and subsequent management in severely ill surgical patients. Risk scoring helps us quantify the prospects of adverse outcome in a patient. Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) the world over has proved itself as a worthy scoring system and the present study was done to evaluate the feasibility of P-POSSUM as a risk scoring system as a tool in efficacious prediction of mortality and morbidity in our demographic profile. Materials and Methods: Validity of P-POSSUM was assessed prospectively in fifty major general surgeries performed at our hospital from May 2011 to October 2012. Data were collected to obtain P-POSSUM score, and statistical analysis was performed. Results: Majority (72%) of patients was male and mean age was 40.24 ± 18.6 years. Seventy-eight percentage procedures were emergency laparotomies commonly performed for perforation peritonitis. Mean physiological score was 17.56 ± 7.6, and operative score was 17.76 ± 4.5 (total score = 35.3 ± 10.4). The ratio of observed to expected mortality rate was 0.86 and morbidity rate was 0.78. Discussion: P-POSSUM accurately predicted both mortality and morbidity in patients who underwent major surgical procedures in our setup. Thus, it helped us in identifying patients who required preferential attention and aggressive management. Widespread application of this tool can result in better distribution of care among high-risk surgical patients. PMID:28250670

  5. Validity of Outcome Prediction Scoring Systems in Korean Patients with Severe Adult Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation Therapy.

    PubMed

    Lee, Seunghyun; Yeo, Hye Ju; Yoon, Seong Hoon; Lee, Seung Eun; Cho, Woo Hyun; Jeon, Doo Soo; Kim, Yun Seong; Son, Bong Soo; Kim, Do Hyung

    2016-06-01

    Recently, several prognostic scoring systems for patients with severe acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) have been published. The aim of this study was to validate the established scoring systems for outcome prediction in Korean patients. We retrospectively reviewed the data of 50 patients on ECMO therapy in our center from 2012 to 2014. A calculation of outcome prediction scoring tools was performed and the comparison across various models was conducted. In our study, the overall hospital survival was 46% and successful weaning rate was 58%. The Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) score showed good discrimination of mortality prediction for patients on ECMO with AUC of 0.80 (95% CI 0.66-0.90). The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and simplified acute physiology score (SAPS) II score also showed fair prediction ability with AUC of 0.79 (95% CI 0.65-0.89) and AUC of 0.78 (95% CI 0.64-0.88), respectively. However, the ECMOnet score failed to predict mortality with AUC of 0.51 (95% CI 0.37-0.66). When evaluating the predictive accuracy according to optimal cut-off point of each scoring system, RESP score had a best specificity of 91.3% and 66.7% of sensitivity, respectively. This study supports the clinical usefulness of the prognostic scoring tools for severe ARDS with ECMO therapy when applying to the Korean patients receiving ECMO.

  6. Patient-reported outcome measures in arthroplasty registries.

    PubMed

    Rolfson, Ola; Eresian Chenok, Kate; Bohm, Eric; Lübbeke, Anne; Denissen, Geke; Dunn, Jennifer; Lyman, Stephen; Franklin, Patricia; Dunbar, Michael; Overgaard, Søren; Garellick, Göran; Dawson, Jill

    2016-07-01

    The International Society of Arthroplasty Registries (ISAR) Steering Committee established the Patient-Reported Outcome Measures (PROMs) Working Group to convene, evaluate, and advise on best practices in the selection, administration, and interpretation of PROMs and to support the adoption and use of PROMs for hip and knee arthroplasty in registries worldwide. The 2 main types of PROMs include generic (general health) PROMs, which provide a measure of general health for any health state, and specific PROMs, which focus on specific symptoms, diseases, organs, body regions, or body functions. The establishment of a PROM instrument requires the fulfillment of methodological standards and rigorous testing to ensure that it is valid, reliable, responsive, and acceptable to the intended population. A survey of the 41 ISAR member registries showed that 8 registries administered a PROMs program that covered all elective hip or knee arthroplasty patients and 6 registries collected PROMs for sample populations; 1 other registry had planned but had not started collection of PROMs. The most common generic instruments used were the EuroQol 5 dimension health outcome survey (EQ-5D) and the Short Form 12 health survey (SF-12) or the similar Veterans RAND 12-item health survey (VR-12). The most common specific PROMs were the Hip disability and Osteoarthritis Outcome Score (HOOS), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Oxford Hip Score (OHS), the Oxford Knee Score (OKS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the University of California at Los Angeles Activity Score (UCLA).

  7. Magnetic Resonance Imaging-DRAGON score: 3-month outcome prediction after intravenous thrombolysis for anterior circulation stroke.

    PubMed

    Turc, Guillaume; Apoil, Marion; Naggara, Olivier; Calvet, David; Lamy, Catherine; Tataru, Alina M; Méder, Jean-François; Mas, Jean-Louis; Baron, Jean-Claude; Oppenheim, Catherine; Touzé, Emmanuel

    2013-05-01

    The DRAGON score, which includes clinical and computed tomographic scan parameters, showed a high specificity to predict 3-month outcome in patients with acute ischemic stroke treated by intravenous tissue plasminogen activator. We adapted the score for patients undergoing MRI as the first-line diagnostic tool. We reviewed patients with consecutive anterior circulation ischemic stroke treated ≤ 4.5 hour by intravenous tissue plasminogen activator between 2003 and 2012 in our center, where MRI is systematically implemented as first-line diagnostic work-up. We derived the MRI-DRAGON score keeping all clinical parameters of computed tomography-DRAGON (age, initial National Institutes of Health Stroke Scale and glucose level, prestroke handicap, onset to treatment time), and considering the following radiological variables: proximal middle cerebral artery occlusion on MR angiography instead of hyperdense middle cerebral artery sign, and diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI ASPECTS) ≤ 5 instead of early infarct signs on computed tomography. Poor 3-month outcome was defined as modified Rankin scale >2. We calculated c-statistics as a measure of predictive ability and performed an internal cross-validation. Two hundred twenty-eight patients were included. Poor outcome was observed in 98 (43%) patients and was significantly associated with all parameters of the MRI-DRAGON score in multivariate analysis, except for onset to treatment time (nonsignificant trend). The c-statistic was 0.83 (95% confidence interval, 0.78-0.88) for poor outcome prediction. All patients with a MRI-DRAGON score ≤ 2 (n=22) had a good outcome, whereas all patients with a score ≥ 8 (n=11) had a poor outcome. The MRI-DRAGON score is a simple tool to predict 3-month outcome in acute stroke patients screened by MRI then treated by intravenous tissue plasminogen activator and may help for therapeutic decision.

  8. Correlation Between Changes in Visual Analog Scale and Patient-Reported Outcome Scores and Patient Satisfaction After Hip Arthroscopic Surgery.

    PubMed

    Chandrasekaran, Sivashankar; Gui, Chengcheng; Walsh, John P; Lodhia, Parth; Suarez-Ahedo, Carlos; Domb, Benjamin G

    2017-09-01

    Improvements in pain, function, and patient satisfaction are used to evaluate the outcomes of hip arthroscopic surgery. To identify correlations between the visual analog scale (VAS) score for pain and patient satisfaction with 4 commonly used patient-reported outcome (PRO) scores to determine to what extent changes in these 2 parameters are reflected in each of the PRO scores. Cohort study (diagnosis); Level of evidence, 3. Patients undergoing hip arthroscopic surgery between February 2008 and February 2013 were assessed prospectively before surgery, at 3 months, and annually thereafter with the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-sports-specific subscale (HOS-SSS), and Hip Outcome Score-activities of daily living (HOS-ADL). Patients were also assessed using a 10-point VAS for pain and queried for satisfaction at the same time points ("0" indicated no pain, and "10" indicated complete satisfaction with surgery). The VAS score and patient satisfaction were correlated with changes in the 4 PRO scores. During the study period, 1417 patients underwent hip arthroscopic surgery, of whom 1137 patients had 2-year postoperative PRO scores after primary surgery. There was a significant improvement in all PRO scores at 2-year follow-up. The mean improvements in mHHS, NAHS, HOS-ADL, and HOS-SSS scores were 16.7, 21.6, 19.7, and 22.7 points, respectively. The mean improvement in the VAS score was 2.9 points. Mean patient satisfaction at 2-year follow-up was 7.74 (of 10). There was a statistically significant correlation between the VAS and patient satisfaction scores and changes in each of the 4 PRO scores. The strength of the correlation was moderate. This study demonstrated a moderate correlation between the VAS and patient satisfaction outcomes and changes in 4 commonly used PRO scores in hip arthroscopic surgery (mHHS, HOS-ADL, HOS-SSS, and NAHS). In addition to several PRO instruments, a VAS for pain and patient satisfaction

  9. International prostate symptom score as a clinical outcome measure for Ethiopian patients with urethral stricture.

    PubMed

    Lemma, Be-ede; Taye, Mulat; Hawando, Tegene; Bakke, August

    2004-10-01

    Eighty-four urethral stricture patients and 73 controls were studied prospectively over a 6 months period in Tikur Anbessa Hospital from April to August 2000. The purpose of the study was to evaluate the use of International Prostate Symptom Score (IPSS) as an outcome measurement instrument for urethral stricture patients in Ethiopia. The Amharic translation of IPSS (IPSS Amh) was used in this study. Internal consistency was 0.91. Construct validity was 0.73. Test-retest reliability was 0.95. Sensitivity and specificity were 76% and 71% respectively. In conclusion the IPSS Amh was found to be valid for use in urethral stricture patients in Ethiopia. We recommend the wide use of this cheap and easily available clinical measurement instrument.

  10. Neurodevelopmental outcome in babies with a low Apgar score from Zimbabwe.

    PubMed

    Wolf, M J; Wolf, B; Bijleveld, C; Beunen, G; Casaer, P

    1997-12-01

    The early identification of neurological dysfunction in the neonatal period, the predictive value of single items of the neonatal neurological examination (NNE) adapted from Prechtl and the developmental outcome at 1 year of age in infants with a low Apgar score in Zimbabwe were studied. One hundred and sixty-five infants were examined with the NNE and 142 with the Bayley Scale of Infant Development (BSID) at 1 year of age. Twenty-three infants had cerebral palsy, ten had a motor delay or developmental delay, and four were mentally retarded. The NNE proved to be a sensitive instrument for detecting neurodevelopmental abnormality. Logistic regression analysis was used to investigate the relationship between the BSID and nine selected predictors from the NNE. This resulted in a correct classification of 94%. However, the number of false negatives was high. By using only the variability of movements and fixation as predictors the number of false negatives was reduced to one.

  11. Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis

    PubMed Central

    Tilbury, Claire; Holtslag, Maarten J; Tordoir, Rutger L; Leichtenberg, Claudia S; Verdegaal, Suzan H M; Kroon, Herman M; Fiocco, Marta; Nelissen, Rob G H H; Vliet Vlieland, Thea P M

    2016-01-01

    Background and purpose There is no consensus on the impact of radiographic severity of hip and knee osteoarthritis (OA) on the clinical outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed whether preoperative radiographic severity of OA is related to improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA. Patients and methods This prospective cohort study included 302 THA patients and 271 TKA patients with hip or knee OA. In the THA patients, preoperatively 26% had mild OA and 74% had severe OA; in the TKA patients, preoperatively 27% had mild OA and 73% had severe OA. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and patient-reported outcomes (PROMs): Oxford hip/knee score, hip/knee injury and osteoarthritis outcome score (HOOS/KOOS), SF36, and EQ5D. Change scores of PROMs were compared with mild OA (KL 0–2) and severe OA (KL 3–4) using a multivariate linear regression model. Results Adjusted for sex, age, preoperative scores, BMI, and Charnley score, radiographic severity of OA in THA was associated with improvement in HOOS “Activities of daily living”, “Pain”, and “Symptoms”, and SF36 physical component summary (“PCS”) scale. In TKA, we found no such associations. Interpretation The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA. PMID:26484651

  12. Surgical Comanagement by Hospitalists Improves Patient Outcomes: A Propensity Score Analysis.

    PubMed

    Rohatgi, Nidhi; Loftus, Pooja; Grujic, Olgica; Cullen, Mark; Hopkins, Joseph; Ahuja, Neera

    2016-08-01

    The aim of the study was to examine the impact of a surgical comanagement (SCM) hospitalist program on patient outcomes at an academic institution. Prior studies may have underestimated the impact of SCM due to methodological shortcomings. This is a retrospective study utilizing a propensity score-weighted intervention (n = 16,930) and control group (n = 3695). Patients were admitted between January 2009 to July 2012 (pre-SCM) and September 2012 to September 2013 (post-SCM) to Orthopedic or Neurosurgery at our institution. Using propensity score methods, linear regression, and a difference-in-difference approach, we estimated changes in outcomes between pre and post periods, while adjusting for confounding patient characteristics. The SCM intervention was associated with a significant differential decrease in the proportion of patients with at least 1 medical complication [odds ratio (OR) 0.86; 95% confidence interval (CI), 0.74-0.96; P = 0.008), the proportion of patients with length of stay at least 5 days (OR 0.75; 95% CI, 0.67-0.84; P < 0.001), 30-day readmission rate for medical cause (OR 0.67; 95% CI, 0.52-0.81; P < 0.001), and the proportion of patients with at least 2 medical consultants (OR 0.55; 95% CI, 0.49-0.63; P < 0.001). There was no significant change in patient satisfaction (OR 1.08; 95% CI, 0.87-1.33; P = 0.507). We estimated average savings of $2642 to $4303 per patient in the post-SCM group. The overall provider satisfaction with SCM was 88.3%. The SCM intervention reduces medical complications, length of stay, 30-day readmissions, number of consultants, and cost of care.

  13. Joint awareness after ACL reconstruction: patient-reported outcomes measured with the Forgotten Joint Score-12.

    PubMed

    Behrend, Henrik; Zdravkovic, Vilijam; Giesinger, Johannes M; Giesinger, Karlmeinrad

    2017-05-01

    To measure joint awareness in patients who have undergone anterior cruciate ligament (ACL) reconstruction and to investigate medium- and long-term results of the procedure. All patients who had undergone ACL reconstruction with the same arthroscopic surgical technique at our institution between 2011 and 2014 (medium-term follow-up group (Group I)) or between 2000 and 2005 (long-term follow-up group (Group II)) were considered for inclusion in the study. A group of healthy controls were recruited to obtain reference values for the FJS-12 (Forgotten Joint Score-12). Propensity score matching was applied to improve comparability of patients and healthy controls in terms of sex and age. Fifty-eight patients of the Group I (mean follow-up 31.5 (SD13.4) months, range 12-54), 57 patients of the Group II (mean follow-up 139 (SD15.2) months, range 120-179), and the healthy control samples (100 individuals) were analysed. Significantly lower FJS-12 was found in both groups (Group I: 71.6 and Group II: 70.1), compared to the two matched control groups (88.1 and 90.0). The concept of joint awareness was successfully applied to evaluate medium- and long-term results of ACL reconstruction. The clinical relevance of this study is that it extends the construct of joint awareness as a patient-reported outcome parameter to ACL reconstruction surgery. Level III.

  14. Differential Outcomes With Early and Late Repeat Transplantation in the Era of the Lung Allocation Score

    PubMed Central

    Osho, Asishana A.; Castleberry, Anthony W.; Snyder, Laurie D.; Palmer, Scott M.; Ganapathi, Asvin M.; Hirji, Sameer A.; Lin, Shu S.; Davis, R. Duane; Hartwig, Matthew G.

    2016-01-01

    Background Rates of repeat lung transplantation have increased since implementation of the lung allocation score (LAS). The purpose of this study is to compare survival between repeat (ReTx) and primary (LTx) lung transplant recipients in the LAS era. Methods We extracted data from 9,270 LTx and 456 ReTx recipients since LAS implementation, from the United Network for Organ Sharing registry. Propensity scoring was used to match ReTx and LTx recipients. Kaplan-Meier analysis compared survival between LTx and ReTx groups, with and without stratification based on time between first and second transplant. Multivariable Cox models estimated predictors of survival in lung recipients. Results Comparing all ReTx to LTx demonstrates a survival advantage for LTx that is diminished with propensity score matching (p = 0.174). Considering LTx against ReTx greater than 90 days after the initial procedure, there are similar survival results (p < 0.067). In contrast, ReTx within 90 days was associated with a survival disadvantage that persisted despite matching (p = 0.011). In ReTx populations, factors conferring worse outcomes include intensive care unit admission, unilateral transplantation, poor functional status, and primary graft dysfunction as the indication for retransplantation (p < 0.05). Conclusions Late lung retransplantation appears to be as beneficial as primary transplantation in propensity-matched patients. However, survival is severely diminished in those retransplanted less than 90 days after primary transplantation. The utility of early retransplantation needs to be carefully weighed in light of risks. PMID:25442999

  15. The bleeding score predicts clinical outcomes and replacement therapy in adults with von Willebrand disease.

    PubMed

    Federici, Augusto B; Bucciarelli, Paolo; Castaman, Giancarlo; Mazzucconi, Maria G; Morfini, Massimo; Rocino, Angiola; Schiavoni, Mario; Peyvandi, Flora; Rodeghiero, Francesco; Mannucci, Pier Mannuccio

    2014-06-26

    Analyses of the bleeding tendency by means of the bleeding score (BS) have been proposed until now to confirm diagnosis but not to predict clinical outcomes in patients with inherited von Willebrand disease (VWD). We prospectively followed up, for 1 year, 796 Italian patients with different types of VWD to determine whether the previous BS of European VWD1 is useful to predict the occurrence of spontaneous bleeds severe enough to require replacement therapy with desmopressin (DDAVP) and/or von Willebrand factor (VWF)/factor VIII concentrates. Among the 796 patients included, 75 (9.4%) needed treatment of 232 spontaneous bleeding events. BS >10 and VWF:ristocetin cofactor activity <10 U/dL were associated with the risk of bleeding, but only a BS >10 remained highly associated in a multivariable Cox proportional hazard model (adjusted hazard ratio: 7.27 [95% confidence interval, 3.83-13.83]). Although the bleeding event-free survival was different in VWD types, only a BS >10 could predict for each type which patient had bleeding events severe enough to require treatment with DDAVP and/or concentrates. Therefore, BS can be considered a simple predictor of clinical outcomes of VWD and may identify patients needing intensive therapeutic regimens.

  16. Outcomes of Influenza Infections in Hematopoietic Cell Transplant Recipients: Application of an Immunodeficiency Scoring Index.

    PubMed

    Kmeid, Joumana; Vanichanan, Jakapat; Shah, Dimpy P; El Chaer, Firas; Azzi, Jacques; Ariza-Heredia, Ella J; Hosing, Chitra; Mulanovich, Victor; Chemaly, Roy F

    2016-03-01

    Hematopoietic cell transplant (HCT) recipients have lower immune response to influenza vaccination and are susceptible to lower respiratory tract infection (LRI) and death. We determined clinical characteristics and outcomes of laboratory-confirmed influenza, including 2014/H3N2 infection, in 146 HCT recipients. An immunodeficiency scoring index (ISI) was applied to identify patients at high risk for LRI and death. Thirty-three patients (23%) developed LRI and 7 (5%) died within 30 days of diagnosis. Most patients received antiviral therapy (83%); however, only 18% received it within 48 hours of symptom onset. The incidence of LRI was significantly higher in the ISI high-risk group than it was in the low-risk group (P < .001). Receiving early antiviral therapy was associated with a substantial reduction in LRI for all ISI risk groups with the greatest risk reduction observed in the high-risk group. When compared with previous seasons, no significant differences in patient outcomes were observed during the 2014/H3N2 season; however, antiviral therapy was more promptly initiated in the latter season. The ISI that was originally developed for respiratory syncytial virus may help identify HCT recipients at risk for progression to LRI and mortality after influenza infection. These patients should be monitored more closely. Early initiation of antiviral therapy for influenza in HCT recipients, regardless of the ISI risk group, may improve morbidity as well as mortality.

  17. Outcomes of Influenza Infections in Hematopoietic Cell Transplant Recipients: Application of an Immunodeficiency Scoring Index

    PubMed Central

    Kmeid, Joumana; Vanichanan, Jakapat; Shah, Dimpy P.; El Chaer, Firas; Azzi, Jacques; Heredia, Ella Ariza; Hosing, Chitra; Mulanovich, Victor; Chemaly, Roy F.

    2015-01-01

    Hematopoietic cell transplant (HCT) recipients have lower immune response to influenza vaccination and are susceptible to lower respiratory tract infection (LRI) and death. We determined clinical characteristics and outcomes of laboratory-confirmed influenza, including 2014/H3N2 infection, in 146 HCT recipients. An immunodeficiency scoring index (ISI) was applied to identify patients at high risk for LRI and death. Thirty three patients developed LRI (23%), and 7 died within 30 days of diagnosis (5%). Most patients received antiviral therapy (83%); however, only 18% received it within 48 hours of symptom onset. The incidence of LRI was significantly higher in the ISI high-risk group than in the low-risk group (P < 0.001). Receiving early antiviral therapy was associated with a substantial reduction in LRI for all ISI risk groups with the greatest risk reduction observed in the high-risk group. When compared to previous seasons, no significant differences in patient outcomes were observed during the 2014/H3N2 season; however, antiviral therapy was more promptly initiated in the latter season. The ISI that was originally developed for respiratory syncytial virus may help identifying HCT recipients at risk for progression to LRI and mortality following influenza infection. These patients should be monitored more closely. Early initiation of antiviral therapy for influenza in HCT recipients, irrespective of the ISI risk group, may improve morbidity as well as mortality. PMID:26638804

  18. Cost-benefit comparison of the Oxford Knee score and the American Knee Society score in measuring outcome of total knee arthroplasty.

    PubMed

    Medalla, Greg Anthony; Moonot, Pradeep; Peel, Tamlyn; Kalairajah, Yegappan; Field, Richard E

    2009-06-01

    The American Knee Society score (AKSS) and the Oxford Knee score (OKS) are validated outcome measures for evaluation of total knee arthroplasties (TKAs). We investigated whether patient self-assessment using the OKS offers a viable alternative to clinical review using the AKSS. Preoperative, 2-year, 5-year, and 10-year postoperative OKS and AKSS were reviewed from TKA patients. The scores were analyzed using the Pearson correlation. There was good correlation of OKS and AKSS at 2 years. This implies that patient self-assessment is a viable screening tool to identify which patients require clinical review, at 2 years, after TKA. However, the moderate correlation at 5 and 10 years indicates that clinical evaluation remains necessary at these time points.

  19. Predictive values of D-dimer assay, GRACE scores and TIMI scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction

    PubMed Central

    Satilmisoglu, Muhammet Hulusi; Ozyilmaz, Sinem Ozbay; Gul, Mehmet; Ak Yildirim, Hayriye; Kayapinar, Osman; Gokturk, Kadir; Aksu, Huseyin; Erkanli, Korhan; Eksik, Abdurrahman

    2017-01-01

    Purpose To determine the predictive values of D-dimer assay, Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Patients and methods A total of 234 patients (mean age: 57.2±11.7 years, 75.2% were males) hospitalized with NSTEMI were included. Data on D-dimer assay, GRACE and TIMI risk scores were recorded. Logistic regression analysis was conducted to determine the risk factors predicting increased mortality. Results Median D-dimer levels were 349.5 (48.0–7,210.0) ng/mL, the average TIMI score was 3.2±1.2 and the GRACE score was 90.4±27.6 with high GRACE scores (>118) in 17.5% of patients. The GRACE score was correlated positively with both the D-dimer assay (r=0.215, P=0.01) and TIMI scores (r=0.504, P=0.000). Multivariate logistic regression analysis revealed that higher creatinine levels (odds ratio =18.465, 95% confidence interval: 1.059–322.084, P=0.046) constituted the only significant predictor of increased mortality risk with no predictive values for age, D-dimer assay, ejection fraction, glucose, hemoglobin A1c, sodium, albumin or total cholesterol levels for mortality. Conclusion Serum creatinine levels constituted the sole independent determinant of mortality risk, with no significant values for D-dimer assay, GRACE or TIMI scores for predicting the risk of mortality in NSTEMI patients. PMID:28408834

  20. A Genomic Instability Score in Discriminating Nonequivalent Outcomes of BRCA1/2 Mutations and in Predicting Outcomes of Ovarian Cancer Treated with Platinum-Based Chemotherapy

    PubMed Central

    Hao, Dapeng

    2014-01-01

    Detecting mutation in BRCA1/2 is a generally accepted strategy for screening ovarian cancers that have impaired homologous recombination (HR) ability and improved sensitivity to PARP inhibitor. However, a substantial subset of BRCA-mutant ovarian cancer patients shows less impaired or unimpaired HR ability, resulting in nonequivalent outcome after ovarian cancer development. We hypothesize that genomic instability provides a lifetime record of DNA repair deficiency and predicts ovarian cancer outcome. Based on the multi-dimensional TCGA ovarian cancer data, we developed a biological rationale-driven genomic instability score integrating somatic mutation and copy number change in a tumor genome. The score successfully divided BRCA-mutant ovarian tumors into cases of significantly improved outcome and cases of unimproved outcome. The score was also capable of discriminating HR-deficiency indicated by BRCA1 epigenetically silencing, EMSY amplification and homozygous deletion of core HR genes. We further found that the score was positively correlated with the complete response rate of chemotherapy and the rate of platinum-sensitivity, and predicted improved outcome of ovarian cancer, regardless of BRCA-mutation status. The score may have important value in outcome prediction and clinical trial design. PMID:25437005

  1. Outcome scores in spinal surgery quantified: excellent, good, fair and poor in terms of patient-completed tools.

    PubMed

    Tafazal, Suhayl I; Sell, Philip J

    2006-11-01

    Outcome scores are very useful tools in the field of spinal surgery as they allow us to assess a patient's progress and the effect of various treatments. The clinical importance of a score change is not so clear. Although previous studies have looked at the minimum clinically important score change, the degree of score change varies considerably. Our study is a prospective cohort study of 193 patients undergoing discectomy, decompression and fusion procedures with minimum 2-year follow-up. We have used three standard outcome measures in common usage, the oswestry disability index (ODI), the low back outcome score (LBOS) and the visual analogue score (VAS). We have defined each of these scores according to a global measure of outcome graded by the patient as excellent, good, fair or poor. We have also graded patient perception and classified excellent and good as success and fair and poor as failure. Our results suggest that a median 24-point change in the ODI equates with a good outcome or is the minimum change needed for success. We have also found that different surgical disorders have very different minimal clinically important differences as perceived by patient perception. We found that for a discectomy a minimum 27-point change in the ODI would be classed as a success, for a decompression the change in ODI needed to class it as a success would be 16 points, whereas for a fusion the change in the ODI would be only 13 points. We believe that patient-rated global measures of outcome are of value and we have quantified them in terms of the standard outcome measures used in spinal surgery.

  2. Technical Performance Score: Predictor of Outcomes in Complete Atrioventricular Septal Defect Repair.

    PubMed

    IJsselhof, Rinske; Gauvreau, Kim; Del Nido, Pedro; Nathan, Meena

    2017-10-01

    Technical performance score (TPS) has been associated with both early and late outcomes across a wide range of congenital cardiac procedures. We sought to validate TPS as predictor of outcomes for complete atrioventricular septal defect (CAVSD) repair. This was a single-center retrospective review of patients after balanced CAVSD repair between January 1, 2000, and March 1, 2016. We assigned TPS (class 1, no residua; class 2, minor residua; class 3, major residua or reintervention before discharge for residua) based on summation of subcomponent scores from discharge echocardiograms. Outcomes of interest were in-hospital complications, postoperative days on ventilator, and postdischarge reintervention. Among 350 patients, median age was 3.2 months (interquartile range [IQR], 2.4 to 4.2 months). Fifty-four patients (16%) had class 1 TPS, 218 (62%) class 2, 63 (18%) class 3, and 15 (4%) were unscorable. There were 36 complications (10%), and median postoperative days on ventilator were 2 (IQR, 1 to 3) days. There were 34 postdischarge reinterventions (10%). Median follow-up was 2.6 years (IQR, 0.09 to 7.9) years. On multivariable modeling, class 3 TPS was associated with complications (odds ratio 5.45, 95% confidence interval [CI]: 1.06 to 28.1, p = 0.04), prolonged postoperative ventilator days (hazard ratio [HR] 0.54, 95% CI: 0.37 to 0.80, p = 0.002), and postdischarge reintervention (HR 5.61, 95% CI: 1.28 to 24.5, p = 0.02) after adjusting for covariates such as age, weight, genetic abnormality, concomitant procedure, prematurity, and second bypass run. At our center, CAVSD repair was associated with low morbidity. TPS may identify patients with complications, prolonged days on ventilator, and who require postdischarge reinterventions; thus, it provides feedback on areas of improvement and allows identification of patients who warrant closer follow-up. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Technical performance score is associated with outcomes after the Norwood procedure.

    PubMed

    Nathan, Meena; Sleeper, Lynn A; Ohye, Richard G; Frommelt, Peter C; Caldarone, Christopher A; Tweddell, James S; Lu, Minmin; Pearson, Gail D; Gaynor, J William; Pizarro, Christian; Williams, Ismee A; Colan, Steven D; Dunbar-Masterson, Carolyn; Gruber, Peter J; Hill, Kevin; Hirsch-Romano, Jennifer; Jacobs, Jeffrey P; Kaltman, Jonathan R; Kumar, S Ram; Morales, David; Bradley, Scott M; Kanter, Kirk; Newburger, Jane W

    2014-11-01

    The technical performance score (TPS) has been reported in a single center study to predict the outcomes after congenital cardiac surgery. We sought to determine the association of the TPS with outcomes in patients undergoing the Norwood procedure in the Single Ventricle Reconstruction trial. We calculated the TPS (class 1, optimal; class 2, adequate; class 3, inadequate) according to the predischarge echocardiograms analyzed in a core laboratory and unplanned reinterventions that occurred before discharge from the Norwood hospitalization. Multivariable regression examined the association of the TPS with interval to first extubation, Norwood length of stay, death or transplantation, unplanned postdischarge reinterventions, and neurodevelopment at 14 months old. Of 549 patients undergoing a Norwood procedure, 356 (65%) had an echocardiogram adequate to assess atrial septal restriction or arch obstruction or an unplanned reintervention, enabling calculation of the TPS. On multivariable regression, adjusting for preoperative variables, a better TPS was an independent predictor of a shorter interval to first extubation (P=.019), better transplant-free survival before Norwood discharge (P<.001; odds ratio, 9.1 for inadequate vs optimal), shorter hospital length of stay (P<.001), fewer unplanned reinterventions between Norwood discharge and stage II (P=.004), and a higher Bayley II psychomotor development index at 14 months (P=.031). The TPS was not associated with transplant-free survival after Norwood discharge, unplanned reinterventions after stage II, or the Bayley II mental development index at 14 months. TPS is an independent predictor of important outcomes after Norwood and could serve as a tool for quality improvement. Copyright © 2014 The American Association for Thoracic Surgery. All rights reserved.

  4. Surgical Outcomes in Patients with High Spinal Instability Neoplasm Score Secondary to Spinal Giant Cell Tumors

    PubMed Central

    Elder, Benjamin D.; Sankey, Eric W.; Goodwin, C. Rory; Kosztowski, Thomas A.; Lo, Sheng-Fu L.; Bydon, Ali; Wolinsky, Jean-Paul; Gokaslan, Ziya L.; Witham, Timothy F.; Sciubba, Daniel M.

    2015-01-01

    Study Design Retrospective review. Objective To describe the surgical outcomes in patients with high preoperative Spinal Instability Neoplastic Score (SINS) secondary to spinal giant cell tumors (GCT) and evaluate the impact of en bloc versus intralesional resection and preoperative embolization on postoperative outcomes. Methods A retrospective analysis was performed on 14 patients with GCTs of the spine who underwent surgical treatment prior to the use of denosumab. A univariate analysis was performed comparing the patient demographics, perioperative characteristics, and surgical outcomes between patients who underwent en bloc marginal (n = 6) compared with those who had intralesional (n = 8) resection. Results Six patients underwent en bloc resections and eight underwent intralesional resection. Preoperative embolization was performed in eight patients. All patients were alive at last follow-up, with a mean follow-up length of 43 months. Patients who underwent en bloc resection had longer average operative times (p = 0.0251), higher rates of early (p = 0.0182) and late (p = 0.0389) complications, and a higher rate of surgical revision (p = 0.0120). There was a 25% (2/8 patients) local recurrence rate for intralesional resection and a 0% (0/6 patients) local recurrence rate for en bloc resection (p = 0.0929). Conclusions Surgical excision of spinal GCTs causing significant instability, assessed by SINS, is associated with high intraoperative blood loss despite embolization and independent of resection method. En bloc resection requires a longer operative duration and is associated with a higher risk of complications when compared with intralesional resection. However, the increased morbidity associated with en bloc resection may be justified as it may minimize the risk of local recurrence. PMID:26835198

  5. Biomarkers, lactate, and clinical scores as outcome predictors in systemic poisons exposures.

    PubMed

    Lionte, C; Sorodoc, V; Tuchilus, C; Cimpoiesu, D; Jaba, E

    2017-07-01

    Acute exposure to systemic poisons represents an important challenge in clinical toxicology. We aimed to analyze the potential role of cardiac biomarkers, routine laboratory tests, and clinical scores as morbidity and in-hospital mortality predictors in patients intoxicated with various systemic poisons. We conducted a prospective study on adults acutely exposed to systemic poisons. We determined the PSS, Glasgow Coma Scale (GCS), and we performed electrocardiogram, laboratory tests, lactate and cardiac biomarkers (which were reassessed 4 h, respectively 6 h later). Of 120 patients included, 45% developed complications, 19.2% had a poor outcome, and 5% died. Multivariate logistic regression sustained lactate (odds ratio (OR) 1.58; confidence interval (CI) 95%: 0.97-2.59; p 0.066), MB isoenzyme of creatine kinase (6h-CKMB; OR 1.08; CI 95%: 1.02-1.16; p 0.018) as predictors for a poor outcome. A GCS < 10 (OR 0.113; CI 95%: 0.019-0.658; p 0.015) and 4h-lactate (OR 4.87; CI 95%: 0.79-29.82; p 0.087) predicted mortality after systemic poisons exposure. Receiver operating characteristic analysis showed that brain natriuretic peptide (area under the curve (AUC), 0.96; CI 95%: 0.92-0.99; p < 0.001), lactate (AUC, 0.91; CI 95%: 0.85-0.97; p < 0.001), and 6h-CKMB have good discriminatory capacity for predicting a poor outcome. In conclusion, these biomarkers, lactate, and GCS can be used to predict morbidity and mortality after systemic poisons exposure.

  6. Apgar scores at 10 min and outcomes at 6-7 years following hypoxic-ischaemic encephalopathy.

    PubMed

    Natarajan, Girija; Shankaran, Seetha; Laptook, Abbot R; Pappas, Athina; Bann, Carla M; McDonald, Scott A; Das, Abhik; Higgins, Rosemary D; Hintz, Susan R; Vohr, Betty R

    2013-11-01

    To determine the association between 10 min Apgar scores and 6-7-year outcomes in children with perinatal hypoxic-ischaemic encephalopathy (HIE) enrolled in the National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) whole body cooling randomised controlled trial (RCT). Evaluations at 6-7 years included the Wechsler Preschool and Primary Scale of Intelligence III or Wechsler Intelligence Scale for Children IV and Gross Motor Functional Classification Scale. Primary outcome was death/moderate or severe disability. Logistic regression was used to examine the association between 10 min Apgar scores and outcomes after adjusting for birth weight, gestational age, gender, outborn status, hypothermia treatment and centre. In the study cohort (n=174), 64/85 (75%) of those with 10 min Apgar score of 0-3 had death/disability compared with 40/89 (45%) of those with scores >3. Each point increase in 10 min Apgar scores was associated with a significantly lower adjusted risk of death/disability, death, death/IQ <70, death/cerebral palsy (CP) and disability, IQ<70 and CP among survivors (all p<0.05). Among the 24 children with a 10 min Apgar score of 0, five (20.8%) survived without disability. The risk-adjusted probabilities of death/disability were significantly lower in cooled infants with Apgar scores of 0-3; there was no significant interaction between cooling and Apgar scores (p=0.26). Among children with perinatal HIE enrolled in the NICHD cooling RCT, 10 min Apgar scores were significantly associated with school-age outcomes. A fifth of infants with 10 min Apgar score of 0 survived without disability to school age, suggesting the need for caution in limiting resuscitation to a specified duration.

  7. Apgar scores at 10 min and outcomes at 6–7 years following hypoxic-ischaemic encephalopathy

    PubMed Central

    Natarajan, Girija; Shankaran, Seetha; Laptook, Abbot R; Pappas, Athina; Bann, Carla M; McDonald, Scott A; Das, Abhik; Higgins, Rosemary D; Hintz, Susan R; Vohr, Betty R

    2014-01-01

    Aim To determine the association between 10 min Apgar scores and 6–7-year outcomes in children with perinatal hypoxic-ischaemic encephalopathy (HIE) enrolled in the National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) whole body cooling randomised controlled trial (RCT). Methods Evaluations at 6–7 years included the Wechsler Preschool and Primary Scale of Intelligence III or Wechsler Intelligence Scale for Children IV and Gross Motor Functional Classification Scale. Primary outcome was death/moderate or severe disability. Logistic regression was used to examine the association between 10 min Apgar scores and outcomes after adjusting for birth weight, gestational age, gender, outborn status, hypothermia treatment and centre. Results In the study cohort (n=174), 64/85 (75%) of those with 10 min Apgar score of 0–3 had death/disability compared with 40/89 (45%) of those with scores >3. Each point increase in 10 min Apgar scores was associated with a significantly lower adjusted risk of death/disability, death, death/IQ <70, death/cerebral palsy (CP) and disability, IQ<70 and CP among survivors (all p<0.05). Among the 24 children with a 10 min Apgar score of 0, five (20.8%) survived without disability. The risk-adjusted probabilities of death/disability were significantly lower in cooled infants with Apgar scores of 0–3; there was no significant interaction between cooling and Apgar scores (p=0.26). Conclusions Among children with perinatal HIE enrolled in the NICHD cooling RCT, 10 min Apgar scores were significantly associated with school-age outcomes. A fifth of infants with 10 min Apgar score of 0 survived without disability to school age, suggesting the need for caution in limiting resuscitation to a specified duration. PMID:23896791

  8. The Role of the Model of End-Stage Liver Disease Score in Predicting Outcomes of Carotid Endarterectomy.

    PubMed

    Krafcik, Brianna M; Farber, Alik; Eslami, Mohammad H; Kalish, Jeffrey A; Rybin, Denis; Doros, Gheorghe; King, Elizabeth G; Siracuse, Jeffrey J

    2016-08-01

    The Model of End-Stage Liver Disease (MELD) score has been traditionally utilized to prioritize for liver transplantation; however, recent literature has shown its value in predicting surgical outcomes for patients with hepatic dysfunction. The benefit of carotid endarterectomy in asymptomatic patients is dependent on low perioperative morbidity. Our objective was to use MELD score to predict outcomes in asymptomatic patients undergoing carotid endarterectomy. Patients undergoing carotid endarterectomy were identified in the National Surgical Quality Improvement Program data sets from 2005 to 2012. The Model of End-Stage Liver Disease score was calculated using serum bilirubin, creatinine, and the international normalized ratio (INR). Patients were grouped into low (<9), moderate (9-14), and high (15+) MELD classifications. The effect of the MELD score on postoperative morbidity and mortality was assessed by multivariable logistic and gamma regressions and propensity matching. There were 7966 patients with asymptomatic carotid endarterectomy identified. The majority 5556 (70%) had a low MELD score, 1952 (25%) had a moderate MELD score, and 458 (5%) had a high MELD score. High MELD score was independently predictive of postoperative death, increased length of stay, need for transfusion, pulmonary complications, and a statistical trend toward increased cardiac arrest/myocardial infarction. The Model of End-Stage Liver Disease score did not affect postoperative stroke, wound complications, or operative time. High MELD score places asymptomatic patients undergoing carotid endarterectomy at a higher risk of adverse outcomes in the 30 days following surgery. This provides further empirical evidence for risk stratification when considering treatment for these patients. Outcomes of medical management or carotid stenting should be investigated in high-risk patients. © The Author(s) 2016.

  9. Prognostication and intensive care unit outcome: the evolving role of scoring systems.

    PubMed

    Herridge, Margaret S

    2003-12-01

    a much more complete understanding of the patient's entire ICU course as opposed to the initial 24-hour period. Daily scores also help to capture the intensity of resource use and may help us gain a better understanding of what is truly ICU-acquired organ dysfunction. These measures may also be used for research to better characterize the natural history and course of a certain disease group or population. Also, they may be used in innovative ways to predict ICU mortality and post-ICU long-term morbidity. These current and developing applications will help us to further understand the link between ICU severity of illness and long-term morbidity as we move beyond survival as the sole measure of ICU outcome.

  10. Relative Influence of Capillary Index Score, Revascularization and Time on Stroke Outcomes from the IMS III Trial

    PubMed Central

    Al-Ali, Firas; Elias, John J.; Tomsick, Thomas A.; Liebeskind, David S; Broderick, Joseph P.

    2015-01-01

    Background and Purpose Until recently, acute ischemic stroke (AIS) trials have failed to show a benefit of endovascular therapy (EVT) compared to standard therapy, leading some authors to recommend decreasing the time from ictus to revascularization (TIR) to improve outcomes. We hypothesize that improving patient selection using the capillary index score (CIS) may also be a useful strategy. Methods CIS was calculated, blinded to outcome, from pre-treatment diagnostic cerebral angiograms for 78 subjects in the Interventional Management of Stroke (IMS) III database with internal carotid artery (ICA) and middle cerebral artery trunk (M1) occlusion. The CIS was dichotomized into favorable (fCIS = 2 or 3) and poor (pCIS = 0 or 1). Outcomes were categorized based on the modified Rankin Scale (mRS) score at 90-days (0 to 2 considered a good outcome). Modified thrombolysis in cerebral infarction (mTICI) score 2b or 3 was considered good revascularization. Multivariable logistic regression was performed to relate CIS, TIR, mTICI score, and NIH Stroke Scale score to good outcomes. Results Only CIS and mTICI score were correlated with good outcomes (p < 0.01). Patients with fCIS and good revascularization achieved 71% mRS ≤ 2, compared to 13% for patients with pCIS and good revascularization. Conclusions In this subset of patients from the IMS III Trial, CIS and mTICI were strong predictors of outcome after endovascular reperfusion. Using the CIS to improve patient selection could be a powerful strategy to improve rate of good outcomes in EVT. A randomized trial is needed. Clinical Trial Registration: www.clinicaltrials.gov. Unique identifier: NCT00359424 PMID:25953374

  11. Application of the Sequential Organ Failure Assessment Score to predict outcome in critically ill dogs: preliminary results.

    PubMed

    Ripanti, D; Dino, G; Piovano, G; Farca, A

    2012-08-01

    In human medicine the Sequential Organ Failure Assessment (SOFA) score is one of the most commonly organ dysfunction scoring systems used to assess critically ill patients and to predict the outcome in Intensive Care Units (ICUs). It is composed of scores from six organ systems (respiratory, cardiovascular, hepatic, coagulation, renal, and neurological) graded according to the degree of the dysfunction. The aim of the current study was to describe the applicability of the SOFA score in assessing the outcome of critically ill dogs. A total of 45 dogs admitted to the ICU was enrolled. Among these, 40 dogs completed the study: 50 % survived and left the veterinary clinic. The SOFA score was computed for each dog every 24 hours for the first 3 days of ICU stay, starting on the day of admission. A statistically significant correlation between SOFA score and death or survival was found. Most of the dogs showing an increase of the SOFA score in the first 3 days of hospitalization died, whereas the dogs with a decrease of the score survived. These results suggest that the SOFA score system could be considered a useful indicator of prognosis in ICUs hospitalized dogs.

  12. Development of the Knee Injury and Osteoarthritis Outcome Score for Children (KOOS-Child)

    PubMed Central

    2012-01-01

    Background and purpose The Knee Injury and Osteoarthritis Outcome Score (KOOS) is distinguished from other knee-specific measures by the inclusion of separate scales for evaluation of activities of daily living, sports and recreation function, and knee-related quality of life, with presentation of separate subscale scores as a profile. However, its applicability in children has not been established. In this study, we examined how well the KOOS could be understood in a cohort of children with knee injury, with a view to preparing a pediatric version (KOOS-Child). Material and methods A trained researcher conducted cognitive interviews with 34 Swedish children who had symptomatic knee injuries (either primary or repeated). They were 10–16 years of age, and were selected to allow for equal group representation of age and sex. All the interviews were recorded. 4 researchers analyzed the data and modified the original KOOS questionnaire. Results Many children (n =14) had difficulty in tracking items based on the time frame and an equivalent number of children had trouble in understanding several terms. Mapping errors resulted from misinterpretation of items and from design issues related to the item such as double-barreled format. Most children understood how to use the 5-point Likert response scale. Many children found the instructions confusing from both a lexical and a formatting point of view. Overall, most children found that several items were irrelevant. Interpretation The original KOOS is not well understood by children. Modifications related to comprehension, mapping of responses, and jargon in the KOOS were made based on qualitative feedback from the children. PMID:23140110

  13. Does US Medical Licensing Examination Step l score really matter in surgical residency match outcomes (and should it)?

    PubMed

    Andriole, Dorothy A; Yan, Yan; Jeffe, Donna B

    2008-03-01

    The relationship between US Medical Licensing Examination Step 1 scores and core surgical-specialty match outcomes has not been well defined. With IRB approval, we measured associations between aggregate Step 1 scores and other specialty-specific, match-process variables for 3 surgical-specialty matches. Chi-square tests measured differences between proportions of US students and independent applicants (ie, all non-US allopathic student applicants) who matched. Independent samples t-tests compared differences in Step 1 scores between matched- and unmatched-applicant groups. Pearson correlations measured the magnitude and direction of associations between matched-applicants' Step 1 scores and other variables of interest and between Step 1 scores for all match participants and percentage of positions filled by US students (two-tailed p values). Step 1 scores were lower for unmatched- than matched-applicant groups for each specialty examined (each p < 0.0001). Matched-applicant groups' Step 1 scores positively correlated with each unmatched-applicant groups' Step 1 scores (r =.82, p < 0.0001), Step 1 gap between matched- and unmatched-applicant groups' scores (r = .40, p = 0.035), percentage of positions filled by US students (r = .62, p < 0.0001), and mean number of applications filed/applicant (r = .50, p < 0.0001). Step 1 scores for all match participants correlated with percentage of positions filled by US students (r = .61, p = 0.0006). Step 1 scores were closely related to match process outcomes and match participation itself, with increasing Step 1 scores among both matched- and unmatched-applicant groups as specialty selectivity increased.

  14. Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series.

    PubMed

    Hanna, Nawar; Sun, Maxine; Trinh, Quoc-Dien; Hansen, Jens; Bianchi, Marco; Montorsi, Francesco; Shariat, Shahrokh F; Graefen, Markus; Perrotte, Paul; Karakiewicz, Pierre I

    2012-04-01

    Nephroureterectomy (NU) represents the primary management for patients with nonmetastatic upper tract urothelial carcinoma (UTUC). Either an open NU (ONU) or a laparoscopic NU (LNU) may be considered. Despite the presence of several reports comparing perioperative and cancer-control outcomes between the two approaches, no reports relied on a population-based cohort. Examine intraoperative and postoperative morbidity of ONU and LNU in a population-based cohort. We relied on the US Nationwide Inpatient Sample (NIS) to identify patients with nonmetastatic UTUC treated with ONU or LNU between 1998 and 2009. Overall, 7401 (90.8%) and 754 (9.2%) patients underwent ONU and LNU, respectively. To adjust for potential baseline differences between the two groups, propensity-score-based matching was performed. This resulted in 3016 (80%) ONU patients matched to 754 (20%) LNU patients. All patients underwent NU. The rates of intra- and postoperative complications, blood transfusions, prolonged length of stay (pLOS), and in-hospital mortality were assessed for both procedures. Multivariable logistic regression analyses were performed within the cohort after propensity-score matching. For ONU versus LNU respectively, the following rates were recorded: blood transfusions, 15% versus 10% (p<0.001); intraoperative complications, 4.7% versus 2.1% (p=0.002); postoperative complications, 17% versus 15% (p=0.24); pLOS (≥5 d), 47% versus 28% (p<0.001); in-hospital mortality, 1.3% versus 0.7% (p=0.12). In multivariable logistic regression analyses, LNU patients were less likely to receive a blood transfusion (odds ratio [OR]: 0.6; p<0.001), to experience any intraoperative complications (OR: 0.4; p=0.002), and to have a pLOS (OR: 0.4; p<0.001). Overall, postoperative complications were equivalent. However, LNU patients had fewer respiratory complications (OR: 0.4; p=0.007). This study is limited by its retrospective nature. After adjustment for potential selection biases, LNU is

  15. In Search of a Gold Standard Scoring System for the Subjective Evaluation of Cosmetic Outcomes Following Breast-Conserving Therapy.

    PubMed

    Racz, Jennifer M; Hong, Nicole Look; Latosinsky, Steven

    2015-01-01

    The absence of a widely accepted method for aesthetic evaluation following breast-conserving surgery for breast cancer limits the ability to evaluate cosmetic outcomes. In this study, two different panel scoring approaches were compared in an attempt to identify a gold standard scoring system for subjectively assessing cosmetic outcomes following breast-conserving therapy. Standardized photographs of each participant were evaluated independently by twelve health care professionals involved in breast cancer diagnosis and treatment using the Danoff four-point scale. Individual Danoff scores were combined using two methods, a random sample "three-panel" score and an iterative "Delphi-panel" score, in order to create a final cosmetic score for each patient. Agreement between these two aggregative approaches was assessed with a weighted kappa (wk) statistic. Patient and professional recruitment occurred at two separate tertiary care multi-disciplinary breast health centers. Women with unilateral breast cancer who underwent breast-conserving therapy (segmental mastectomy or lumpectomy and radiotherapy) and were at least 2 years after radiotherapy were asked to participate. Ninety-seven women were evaluated. The Delphi approach required three rounds of evaluation to obtain greater than 50% agreement in all photographs. The wk statistic between scores generated from the "three-panel" and "Delphi-panel" approaches was 0.80 (95% CI: 0.71-0.89), thus demonstrating substantial agreement. Evaluation of cosmetic outcomes following breast-conserving therapy using a "three-panel" and "Delphi-panel" score provide similar results, confirming the reliability of either approach for subjective evaluation. Simplicity of use and interpretation favors the "three-panel" score. Future work should concentrate on the integration of the three-panel score with objective and patient-reported scales to generate a comprehensive cosmetic evaluation platform. © 2015 Wiley Periodicals, Inc.

  16. The Nottingham Expectation and Complication score following Surgery (NECS): an universal scale for surgical outcome audit and peer comparison.

    PubMed

    Ingale, Harshal; Muquit, Samiul; Al-Helli, Othman; White, Barrie; Basu, Surajit

    2017-04-01

    Consultant Outcomes Publication (COP) is an NHS England initiative for promoting improvements in quality of care. However, at present outcomes are commonly expressed as mortality rates which do not necessarily reflect the performance of surgeons. We developed the Nottingham Expectation and Complication score following Surgery (NECS) to determine the success of surgical treatment from both the clinical perspective and the practical expectations agreed between surgeons and patients during the consent process. This was a pilot study to trial the use of the NECS score. It is a simple expression of overall outcome comprising three clinical domains: S - surgical outcome, T - surgical/technical complications and M - medical complications recorded by the treating clinician, and practical outcome determined by a joint clinical/patient assessment. 107 elective neurosurgical patients were included in this prospective study. 95 completed questionnaires were included. 75% patients achieved the best possible treatment score (S3T3M4). Of the 25% of patients who did not achieve this ideal outcome, the most common cause was either medical deterioration 18%, or technical complications of surgery discussed during the consent process 17%, or both. Surgeons rated their outcomes as expectations exceeded in 2% of cases, met in 92%, partially met in 5% and failed in 1%. Patients rated their outcomes as expectations exceeded in 37%, met in 37%, partially met in 18%, and 5% reported that their expectations were not met or they were worse than before the operation. Bivariate correlation analysis (Pearson's r coefficient) between overall 'expectation score' of patients and surgeons showed moderate correlation with r = .25 (p = .014). NECS score can be used as an indicator to assess technical performance and patient satisfaction. It provides a more balanced quality indicator of the surgical service delivery than COP. It also offers additional advantages for auditing/planning improving

  17. CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: a retrospective chart review.

    PubMed

    Elijovich, Lucas; Goyal, Nitin; Mainali, Shraddha; Hoit, Dan; Arthur, Adam S; Whitehead, Matthew; Choudhri, Asim F

    2016-06-01

    Acute ischemic stroke (AIS) due to emergent large-vessel occlusion (ELVO) has a poor prognosis. To examine the hypothesis that a better collateral score on pretreatment CT angiography (CTA) would correlate with a smaller final infarct volume and a more favorable clinical outcome after endovascular therapy (EVT). A retrospective chart review of the University of Tennessee AIS database from February 2011 to February 2013 was conducted. All patients with CTA-proven LVO treated with EVT were included. Recanalization after EVT was defined by Thrombolysis in Cerebral Infarction (TICI) score ≥2. Favorable outcome was assessed as a modified Rankin Score ≤3. Fifty patients with ELVO were studied. The mean National Institutes of Health Stroke Scale score was 17 (2-27) and 38 of the patients (76%) received intravenous tissue plasminogen activator. The recanalization rate for EVT was 86.6%. Good clinical outcome was achieved in 32% of patients. Univariate predictors of good outcome included good collateral scores (CS) on presenting CTA (p=0.043) and successful recanalization (p=0.02). Multivariate analysis confirmed both good CS (p=0.024) and successful recanalization (p=0.009) as predictors of favorable outcome. Applying results of the multivariate analysis to our cohort we were able to determine the likelihood of good clinical outcome as well as predictors of smaller final infarct volume after successful recanalization. Good CS predict smaller infarct volumes and better clinical outcome in patients recanalized with EVT. These data support the use of this technique in selecting patients for EVT. Poor CS should be considered as an exclusion criterion for EVT as patients with poor CS have poor clinical outcomes despite recanalization. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Comparing different calcification scores to detect outcomes in chronic kidney disease patients with vascular calcification.

    PubMed

    NasrAllah, Mohamed M; Nassef, Amr; Elshaboni, Tarik H; Morise, Fadia; Osman, Noha A; Sharaf El Din, Usama A

    2016-10-01

    There is no consensus on the most appropriate technique to diagnose vascular calcification in chronic kidney disease. This is primarily because of the absence of direct comparisons of predictive values of the various calcification scores, especially outside the coronary vascular beds, to detect clinical outcomes. We included 93 haemodialysis patients and performed 6 vascular calcification scores: two scores utilised simple X-rays of abdominal aorta and peripheral vessels. CT scans of the thoracic, upper abdominal and lower abdominal aorta were performed to calculate the aortic calcification index and CT of the pelvis for calcification of iliac vessels. Patients were followed for 63months (mean 46.8months) for first major cardiovascular events and mortality. Nineteen cardiovascular events and 28 deaths occurred. Calcification was detected more sensitively in central and peripheral beds using CT scans compared to X-rays (p<0.001). CT scans detected calcification more frequently in distal than proximal vascular beds (p<0.001). Calcification of the pelvic vessels and lower abdominal aorta were most predictive of events including pre-existing cardiovascular disease O.R. 6.5 (95% C.I. 2-22; p=0.001) and O.R. 3 (95% C.I. 1.1-9; p=0.035); new major cardiovascular events H.R. 4.2 (95% C.I. 1.5-11; p=0.006) and H.R. 2 (95% C.I. 0.8-5.3; p=0.1) as well as mortality H.R. 2.8 (95% C.I. 1.3-6; p=0.01) and H.R. 2.2 (95% C.I. 1.04-5; p=0.04) respectively. CT based techniques are more sensitive than plain X-rays at detecting peripheral and aortic vascular calcifications. Distal CT scans of the aorta and pelvic vessels have the highest predictive value for cardiovascular events and mortality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. High GMS score hypospadias: Outcomes after one- and two-stage operations.

    PubMed

    Huang, Jonathan; Rayfield, Lael; Broecker, Bruce; Cerwinka, Wolfgang; Kirsch, Andrew; Scherz, Hal; Smith, Edwin; Elmore, James

    2017-06-01

    Established criteria to assist surgeons in deciding between a one- or two-stage operation for severe hypospadias are lacking. While anatomical features may preclude some surgical options, the decision to approach severe hypospadias in a one- or two-stage fashion is generally based on individual surgeon preference. This decision has been described as a dilemma as outcomes range widely and there is lack of evidence supporting the superiority of one approach over the other. The aim of this study is to determine whether the GMS hypospadias score may provide some guidance in choosing the surgical approach used for correction of severe hypospadias. GMS scores were preoperatively assigned to patients having primary surgery for hypospadias. Those patients having surgery for the most severe hypospadias were selected and formed the study cohort. The records of these patients were reviewed and pertinent data collected. Complications requiring further surgery were assessed and correlated with the GMS score and the surgical technique used for repair (one-stage vs. two-stage). Eighty-seven boys were identified with a GMS score (range 3-12) of 10 or higher. At a mean follow-up of 22 months the overall complication rate for the cohort after final planned surgery was 39%. For intended one-stage procedures (n = 48) an acceptable result was achieved with one surgery for 28 patients (58%), with two surgeries for 14 (29%), and with three to five surgeries for six (13%). For intended two-stage procedures (n = 39) an acceptable result was achieved with two surgeries for 26 patients (67%), three surgeries for eight (21%), and four surgeries for three (8%). Two other patients having two-stage surgery required seven surgeries to achieve an acceptable result. Complication rates are summarized in the Table. The complication rates for GMS 10 patients were similar (27% and 33%, p = 0.28) for one- and two-stage repairs, respectively. GMS 11 patients having a one-stage repair had a

  20. Validation of the Spanish version of the Hip Outcome Score: a multicenter study.

    PubMed

    Seijas, Roberto; Sallent, Andrea; Ruiz-Ibán, Miguel Angel; Ares, Oscar; Marín-Peña, Oliver; Cuéllar, Ricardo; Muriel, Alfonso

    2014-05-13

    The Hip Outcome Score (HOS) is a self-reported questionnaire evaluating the outcomes of treatment interventions for hip pathologies, divided in 19 items of activities of daily life (ADL) and 9 sports' items. The aim of the present study is to translate and validate HOS into Spanish. A prospective and multicenter study with 100 patients undergoing hip arthroscopy was performed between June 2012 and January 2013. Crosscultural adaptation was used to translate HOS into Spanish. Patients completed the questionnaire before and after surgery. Feasibility, reliability, internal consistency, construct validity (correlation with Western Ontario and McMaster Universities Osteoarthritis Index), ceiling and floor effects and sensitivity to change were assessed for the present study. Mean age was 45.05 years old. 36 women and 64 men were included. Feasibility: 13% had at least one missing item within the ADL subscale and 17% within the sport subscale. Reliability: the translated version of HOS was highly reproducible with intraclass correlation coefficient of 0.95 for ADL and 0.94 for the sports subscale. Internal consistency was confirmed with Cronbach's alpha >0.90 in both subscales. Construct validity showed statistically significant correlation with WOMAC. Ceiling effect was observed in 6% and 12% for ADL and sports subscale, respectively. Floor effect was found in 3% and 37% ADL and sports subscale, respectively. Large sensitivity to change was shown in both subscales. The translated version of HOS into Spanish has shown to be feasible, reliable and sensible to changes for patients undergoing hip arthroscopy. This validated translation of HOS allows for comparisons between studies involving either Spanish- or English-speaking patients. Prognostic study, Level I.

  1. Validation of the Spanish version of the hip outcome score: a multicenter study

    PubMed Central

    2014-01-01

    Background The Hip Outcome Score (HOS) is a self-reported questionnaire evaluating the outcomes of treatment interventions for hip pathologies, divided in 19 items of activities of daily life (ADL) and 9 sports’ items. The aim of the present study is to translate and validate HOS into Spanish. Methods A prospective and multicenter study with 100 patients undergoing hip arthroscopy was performed between June 2012 and January 2013. Crosscultural adaptation was used to translate HOS into Spanish. Patients completed the questionnaire before and after surgery. Feasibility, reliability, internal consistency, construct validity (correlation with Western Ontario and McMaster Universities Osteoarthritis Index), ceiling and floor effects and sensitivity to change were assessed for the present study. Results Mean age was 45.05 years old. 36 women and 64 men were included. Feasibility: 13% had at least one missing item within the ADL subscale and 17% within the sport subscale. Reliability: the translated version of HOS was highly reproducible with intraclass correlation coefficient of 0.95 for ADL and 0.94 for the sports subscale. Internal consistency was confirmed with Cronbach’s alpha >0.90 in both subscales. Construct validity showed statistically significant correlation with WOMAC. Ceiling effect was observed in 6% and 12% for ADL and sports subscale, respectively. Floor effect was found in 3% and 37% ADL and sports subscale, respectively. Large sensitivity to change was shown in both subscales. Conclusion The translated version of HOS into Spanish has shown to be feasible, reliable and sensible to changes for patients undergoing hip arthroscopy. This validated translation of HOS allows for comparisons between studies involving either Spanish- or English-speaking patients. Level of evidence Prognostic study, Level I PMID:24884511

  2. Interaction between the Kansas City Cardiomyopathy Questionnaire and the Pocock's clinical score in predicting heart failure outcomes.

    PubMed

    Sawadogo, Kiswendsida; Ambroise, Jérôme; Vercauteren, Steven; Castadot, Marc; Vanhalewyn, Michel; Col, Jacques; Robert, Annie

    2016-05-01

    Heart failure (HF) is a complex syndrome. Its appropriate management should combine several health measurements. We assessed the relationship between the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Pocock's clinical score. We conducted a prospective registry of HF outpatients. The main outcome was occurrence of death or hospitalization during a 6-month follow-up. A multivariate logistic regression was performed, including the KCCQ overall summary score, the Pocock's clinical score and their interaction in the model. From January 2008 to December 2010, 143 patients were involved. Mean age of patients was 68 years, and 74% were men. KCCQ's overall summary score and Pocock's clinical score were inversely correlated (r = -0.24, p = 0.026). A total of 61 (42.7%) events occurred. There was a high proportion of events (77.8%) in patients with a Pocock's clinical score > 50%, whatever the KCCQ score value. When the KCCQ score was ≤ 50 %, there was a low increase in risk as the Pocock's clinical score increased (OR 2.0 [0.6; 6.6]). However, when the KCCQ score was between 50 and 75 or ≥ 75 %, there was a high increase in risk as the Pocock's clinical score increased (OR 6.9 [1.2; 38.9] and OR 7.4 [0.8; 69.7], respectively). Patients with a high Pocock's clinical score are at a high risk of death or hospitalization. For patients with a low Pocock's clinical score, the KCCQ score can identify those at risk of these events.

  3. The Zhongshan score: a novel and simple anatomic classification system to predict perioperative outcomes of nephron-sparing surgery.

    PubMed

    Zhou, Lin; Guo, Jianming; Wang, Hang; Wang, Guomin

    2015-02-01

    In the zero ischemia era of nephron-sparing surgery (NSS), a new anatomic classification system (ACS) is needed to adjust to these new surgical techniques. We devised a novel and simple ACS, and compared it with the RENAL and PADUA scores to predict the risk of NSS outcomes. We retrospectively evaluated 789 patients who underwent NSS with available imaging between January 2007 and July 2014. Demographic and clinical data were assessed. The Zhongshan (ZS) score consisted of three parameters. RENAL, PADUA, and ZS scores are divided into three groups, that is, high, moderate, and low scores. For operative time (OT), significant differences were seen between any two groups of ZS score and PADUA score (all P < 0.05). For ZS score, patients with moderate and high scores had longer warm ischemia time (WIT) and greater increase in SCr compared with low score (all P < 0.05). What is more, the differences between moderate and high scores classified by ZS score were borderline but trending toward significance in WIT (P = 0.064) and increase in SCr (P = 0.052). Interestingly, RENAL showed no significant difference between moderate and high complexity in OT, WIT, estimated blood loss, and increase in SCr. Compared with patients with a low score of ZS, those with a high or moderate score had 8.1-fold or 3.3-fold higher risk of surgical complications, respectively (all P < 0.05). As for RENAL score, patients with a high or moderate score had 5.7-fold or 1.9-fold higher risk of surgical complications, respectively (all P < 0.05). Patients with a high or moderate score of PADUA had 2.3-fold or 2.8-fold higher risk of surgical complications, respectively (all P < 0.05). In the ROC curve analysis, ZS score had the greatest AUC for surgical complications (AUC = 0.632) and the conversion to radical nephrectomy (AUC = 0.845) (all P < 0.05). In conclusion, the ability of ZS score to predict the surgical complexity and surgical complications of NSS

  4. The Patient Acceptable Symptomatic State for the Modified Harris Hip Score and Hip Outcome Score Among Patients Undergoing Surgical Treatment for Femoroacetabular Impingement.

    PubMed

    Chahal, Jaskarndip; Van Thiel, Geoffrey S; Mather, Richard C; Lee, Simon; Song, Sang Hoon; Davis, Aileen M; Salata, Michael; Nho, Shane J

    2015-08-01

    There is minimal information available on the threshold at which patients consider themselves to be well for patient-reported outcome measures used in patients treated with hip arthroscopy for femoroacetabular impingement (FAI). To determine the patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) in patients with FAI treated with arthroscopic hip surgery. Cohort study (diagnosis); Level of evidence, 2. A consecutive series of patients at a single institution with FAI who were treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty were eligible. The mHHS (score range, 0-100) and the HOS (score range, 0-100) were administered at baseline and at 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: "Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?" There were 130 patients (mean ± SD age, 35.6 ± 11.7 years), and 42.3% were male. Based on a receiver operator curve analysis, the PASS values-at which patients considered their status to be satisfactory-at 1 year after surgery were 74 (mHHS), 87 (HOS-activities of daily living subscale), and 75 (HOS-sports subscale). The PASS threshold was not affected by baseline scores across different instruments. However, patients with higher baseline scores were more likely to achieve the PASS (odds ratios: 3.36 [mHHS], 3.83 [HOS-activities of daily living], 3.38 [HOS-sports]). Age and sex were not significantly related to the odds of achieving the PASS for the mHHS or the HOS. This is the first study to determine the PASS for 2 commonly used hip joint patient-reported outcome measures in patients undergoing surgery for FAI. The study findings can allow researchers to determine if interventions related to FAI are meaningful to

  5. Influence of wound scores and microbiology on the outcome of the diabetic foot syndrome.

    PubMed

    Bravo-Molina, Alejandra; Linares-Palomino, José Patricio; Lozano-Alonso, Silvia; Asensio-García, Ricardo; Ros-Díe, Eduardo; Hernández-Quero, José

    2016-03-01

    To establish if the microbiology and the TEXAS, PEDIS and Wagner wound classifications of the diabetic foot syndrome (DFS) predict amputation. Prospective cohort study of 250 patients with DFS from 2009 to 2013. Tissue samples for culture were obtained and wound classification scores were recorded at admission. Infection was monomicrobial in 131 patients (52%). Staphylococcus aureus was the most frequent pathogen (76 patients, 30%); being methicillin-resistant S. aureus in 26% (20/76) Escherichia coli and Enterobacter faecalis were 2nd and 3rd most frequent pathogens. Two hundred nine patients (85%) needed amputation being major in 25 patients (10%). The three wound scales associated minor amputation but did not predict this outcome. Predictors of minor amputation in the multivariate analysis were the presence of osteomyelitis, the location of the wound in the forefoot and of major amputation elevated C reactive proteine (CRP) levels. A low ankle-brachial index (ABI) predicted major amputation in the follow-up. Overall, 74% of gram-positives were sensitive to quinolones and 98% to vancomycin and 90% of gram-negatives to cefotaxime and 95% to carbapenems. The presence of osteomyelitis and the location of the wound in the forefoot predict minor amputation and elevated CRP levels predict major amputation. In the follow-up a low ABI predicts major amputation. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Knee injury and osteoarthritis outcome score of Korean national ice hockey players.

    PubMed

    Kim, Hyeyoung; Hwang, Sujin; Lee, Byoung-Hee

    2017-09-01

    [Purpose] To investigate sports injuries in Korean national ice hockey players by surveying parts, times, types, frequency, cure, and prevention types of sports injuries and provide basic data for injury prevention and performance improvement of ice hockey players. Another purpose of this study was to evaluate the incidence of ice hockey injuries according to age and the relationship between etiological factors and injuries in high school students. [Subjects and Methods] This was a cross-sectional study. Eighteen female ice hockey players in Korean elite athletes were recruited for this study. This study was conducted by a self-administered questionnaire survey using Knee Injury and Osteoarthritis Outcome Score (KOOS) of national ice hockey players. [Results] Participants were injured mainly during training. Injuries were caused by skate, puck-contact, and body check. Five subscales of KOOS were significantly correlated with each other except that the correlation between activities of daily living and quality of life was insignificant. [Conclusion] For injury prevention in national team ice hockey players, full gear is recommended. In addition, therapist in the field needs to conduct injury prevention through consistent observations and counseling in order to prevent injury and improve performance. Ice hockey players also need sufficient rest with systematic and scientific training for injury prevention and performance improvement.

  7. Impact of ureteric stent on outcome of extracorporeal shockwave lithotripsy: A propensity score analysis

    PubMed Central

    Gołąb, Adam; Słojewski, Marcin

    2016-01-01

    Introduction Extracorporeal shockwave lithotripsy (SWL) is one of the most frequently performed procedures in patients with urolithiasis. For ureter-localized stones, SWL is often preceded by a double J stent insertion. However, fear of serious complications, including sepsis associated with stents, is often expressed. The following study assessed the impact of stent insertions on the results of SWL in patients with ureteric stones. Material and methods The study group consisted of 411 ureteric stone patients who were treated with SWL from January 2010 to December 2014. In 60 cases, treatment was preceded by ureteric stent insertion. A propensity scoring system was used to pair non-stented patients with the stented group. Success rates were assessed and compared using the chi-squared test. Multivariate logistic regression analysis was used to evaluate the influence of particular variables on the stone-free rate. Results The overall success rate was 82.2%. After matching, the success rate of the stented group was not significantly different from the control group (85.0% vs. 83.3% respectively, p = 0.80). The mean number of sessions was higher in the stented group (1.88 per patient). Stones located in the lower part of the ureter have the greatest chance of being successfully treated. Conclusions The double J stent has no influence on the outcome of SWL treatment. In view of the greater likelihood of having additional sessions, this approach should be reserved for selected cases. PMID:27551556

  8. Predictive value of SYNTAX score II for clinical outcomes in octogenarian undergoing percutaneous coronary intervention

    PubMed Central

    Kurniawan, Evan; Ding, Feng-Hua; Zhang, Qi; Yang, Zhen-Kun; Hu, Jian; Shen, Wei-Feng; Zhang, Rui-Yan

    2016-01-01

    Objective To evaluate the predictive value of SYNTAX Score II (SS-II) for percutaneous coronary intervention (PCI) in octogenarian (≥ 80 years old) undergoing PCI. Methods & Results Data from three consecutive years of octogenarian undergoing PCI from Ruijin Hospital (Shanghai, China) was retrospectively collected (n = 308). Follow up clinical data at one year including all cause mortality, cardiac mortality and main adverse cardiovascular and cerebrovascular events (MACCE) were collected. Patients were stratified according to tertiles of SS-II for PCI: SS-II ≤ 26 (n = 104), SS-II: 27–31 (n = 102), SS-II > 31 (n = 102). After adjustment for confounding factors, SS-II for PCI was an independent risk factors for all cause mortality (odds ratio: 2.77, 95% CI: 1.13–8.06; P = 0.04). Kaplan-Meier curves showed higher event rates for all cause mortality and cardiac mortality in higher tertile of SS-II for PCI (Log-Rank test P = 0.002 and P = 0.001, respectively). SS-II for PCI predicted one year mortality in octogenarian population undergoing PCI. Conclusions In octogenarian, SS-II which incorporated clinical variables with angiographic anatomy variable was suitable in risk stratifying and predicting clinical outcomes at one year. PMID:27899937

  9. The Enhanced liver fibrosis score is associated with clinical outcomes and disease progression in patients with chronic liver disease.

    PubMed

    Irvine, Katharine M; Wockner, Leesa F; Shanker, Mihir; Fagan, Kevin J; Horsfall, Leigh U; Fletcher, Linda M; Ungerer, Jacobus P J; Pretorius, Carel J; Miller, Gregory C; Clouston, Andrew D; Lampe, Guy; Powell, Elizabeth E

    2016-03-01

    Current tools for risk stratification of chronic liver disease subjects are limited. We aimed to determine whether the serum-based ELF (Enhanced Liver Fibrosis) test predicted liver-related clinical outcomes, or progression to advanced liver disease, and to compare the performance of ELF to liver biopsy and non-invasive algorithms. Three hundred patients with ELF scores assayed at the time of liver biopsy were followed up (median 6.1 years) for liver-related clinical outcomes (n = 16) and clear evidence of progression to advanced fibrosis (n = 18), by review of medical records and clinical data. Fourteen of 73 (19.2%) patients with ELF score indicative of advanced fibrosis (≥9.8, the manufacturer's cut-off) had a liver-related clinical outcome, compared to only two of 227 (<1%) patients with ELF score <9.8. In contrast, the simple scores APRI and FIB-4 would only have predicted subsequent decompensation in six and four patients respectively. A unit increase in ELF score was associated with a 2.53-fold increased risk of a liver-related event (adjusted for age and stage of fibrosis). In patients without advanced fibrosis on biopsy at recruitment, 55% (10/18) with an ELF score ≥9.8 showed clear evidence of progression to advanced fibrosis (after an average 6 years), whereas only 3.5% of those with an ELF score <9.8 (8/207) progressed (average 14 years). In these subjects, a unit increase in ELF score was associated with a 4.34-fold increased risk of progression. The ELF score is a valuable tool for risk stratification of patients with chronic liver disease. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population.

    PubMed

    Bradley, Katharine A; Rubinsky, Anna D; Lapham, Gwen T; Berger, Douglas; Bryson, Christopher; Achtmeyer, Carol; Hawkins, Eric J; Chavez, Laura J; Williams, Emily C; Kivlahan, Daniel R

    2016-11-01

    To evaluate the association between Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) alcohol screening scores, collected as part of routine clinical care, and three outcomes in the following year (Aim 1), and the association between changes in AUDIT-C risk group at 1-year follow-up and the same outcomes in the subsequent year (Aim 2). Cohort study. Twenty-four US Veterans Affairs (VA) healthcare systems (2004-07), before systematic implementation of brief intervention. A total of 486 115 out-patients with AUDIT-Cs documented in their electronic health records (EHRs) on two occasions ≥ 12 months apart ('baseline' and 'follow-up'). Independent measures were baseline AUDIT-C scores and change in standard AUDIT-C risk groups (no use, low-risk use and mild, moderate, severe misuse) from baseline to follow-up. Outcome measures were (1) high-density lipoprotein cholesterol (HDL), (2) alcohol-related gastrointestinal hospitalizations ('GI hospitalizations') and (3) physical trauma, each in the years after baseline and follow-up. Baseline AUDIT-C scores had a positive association with outcomes in the following year. Across AUDIT-C scores 0-12, mean HDL ranged from 41.4 [95% confidence interval (CI) = 41.3-41.5] to 53.5 (95% CI = 51.4-55.6) mg/l, and probabilities of GI hospitalizations from 0.49% (95% CI = 0.48-0.51%) to 1.8% (95% CI = 1.3-2.3%) and trauma from 3.0% (95% CI = 2.95-3.06%) to 6.0% (95% CI = 5.2-6.8%). At follow-up, patients who increased to moderate or severe alcohol misuse had consistently higher mean HDL and probabilities of subsequent GI hospitalizations or trauma compared with those who did not (P-values all < 0.05). For example, among those with baseline low-risk use, in those with persistent low-risk use versus severe misuse at follow-up, the probabilities of subsequent trauma were 2.65% (95% CI = 2.54-2.75%) versus 5.15% (95% CI = 3.86-6.45%), respectively. However, for patients who decreased to lower AUDIT-C risk

  11. Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic Models

    PubMed Central

    Majdan, Marek; Brazinova, Alexandra; Rusnak, Martin; Leitgeb, Johannes

    2017-01-01

    Objectives: Prognosis of outcome after traumatic brain injury (TBI) is important in the assessment of quality of care and can help improve treatment and outcome. The aim of this study was to compare the prognostic value of relatively simple injury severity scores between each other and against a gold standard model – the IMPACT-extended (IMP-E) multivariable prognostic model. Materials and Methods: For this study, 866 patients with moderate/severe TBI from Austria were analyzed. The prognostic performances of the Glasgow coma scale (GCS), GCS motor (GCSM) score, abbreviated injury scale for the head region, Marshall computed tomographic (CT) classification, and Rotterdam CT score were compared side-by-side and against the IMP-E score. The area under the receiver operating characteristics curve (AUC) and Nagelkerke's R2 were used to assess the prognostic performance. Outcomes at the Intensive Care Unit, at hospital discharge, and at 6 months (mortality and unfavorable outcome) were used as end-points. Results: Comparing AUCs and R2s of the same model across four outcomes, only little variation was apparent. A similar pattern is observed when comparing the models between each other: Variation of AUCs <±0.09 and R2s by up to ±0.17 points suggest that all scores perform similarly in predicting outcomes at various points (AUCs: 0.65–0.77; R2s: 0.09–0.27). All scores performed significantly worse than the IMP-E model (with AUC > 0.83 and R2 > 0.42 for all outcomes): AUCs were worse by 0.10–0.22 (P < 0.05) and R2s were worse by 0.22–0.39 points. Conclusions: All tested simple scores can provide reasonably valid prognosis. However, it is confirmed that well-developed multivariable prognostic models outperform these scores significantly and should be used for prognosis in patients after TBI wherever possible. PMID:28149077

  12. The performance of different propensity score methods for estimating absolute effects of treatments on survival outcomes: A simulation study.

    PubMed

    Austin, Peter C; Schuster, Tibor

    2016-10-01

    Observational studies are increasingly being used to estimate the effect of treatments, interventions and exposures on outcomes that can occur over time. Historically, the hazard ratio, which is a relative measure of effect, has been reported. However, medical decision making is best informed when both relative and absolute measures of effect are reported. When outcomes are time-to-event in nature, the effect of treatment can also be quantified as the change in mean or median survival time due to treatment and the absolute reduction in the probability of the occurrence of an event within a specified duration of follow-up. We describe how three different propensity score methods, propensity score matching, stratification on the propensity score and inverse probability of treatment weighting using the propensity score, can be used to estimate absolute measures of treatment effect on survival outcomes. These methods are all based on estimating marginal survival functions under treatment and lack of treatment. We then conducted an extensive series of Monte Carlo simulations to compare the relative performance of these methods for estimating the absolute effects of treatment on survival outcomes. We found that stratification on the propensity score resulted in the greatest bias. Caliper matching on the propensity score and a method based on earlier work by Cole and Hernán tended to have the best performance for estimating absolute effects of treatment on survival outcomes. When the prevalence of treatment was less extreme, then inverse probability of treatment weighting-based methods tended to perform better than matching-based methods.

  13. The performance of different propensity score methods for estimating absolute effects of treatments on survival outcomes: A simulation study

    PubMed Central

    Schuster, Tibor

    2014-01-01

    Observational studies are increasingly being used to estimate the effect of treatments, interventions and exposures on outcomes that can occur over time. Historically, the hazard ratio, which is a relative measure of effect, has been reported. However, medical decision making is best informed when both relative and absolute measures of effect are reported. When outcomes are time-to-event in nature, the effect of treatment can also be quantified as the change in mean or median survival time due to treatment and the absolute reduction in the probability of the occurrence of an event within a specified duration of follow-up. We describe how three different propensity score methods, propensity score matching, stratification on the propensity score and inverse probability of treatment weighting using the propensity score, can be used to estimate absolute measures of treatment effect on survival outcomes. These methods are all based on estimating marginal survival functions under treatment and lack of treatment. We then conducted an extensive series of Monte Carlo simulations to compare the relative performance of these methods for estimating the absolute effects of treatment on survival outcomes. We found that stratification on the propensity score resulted in the greatest bias. Caliper matching on the propensity score and a method based on earlier work by Cole and Hernán tended to have the best performance for estimating absolute effects of treatment on survival outcomes. When the prevalence of treatment was less extreme, then inverse probability of treatment weighting-based methods tended to perform better than matching-based methods. PMID:24463885

  14. Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke.

    PubMed

    Sarraj, Amrou; Albright, Karen; Barreto, Andrew D; Boehme, Amelia K; Sitton, Clark W; Choi, Jeanie; Lutzker, Steven L; Sun, Chung-Huan J; Bibars, Wafi; Nguyen, Claude B; Mir, Osman; Vahidy, Farhaan; Wu, Tzu-Ching; Lopez, George A; Gonzales, Nicole R; Edgell, Randall; Martin-Schild, Sheryl; Hallevi, Hen; Chen, Peng Roc; Dannenbaum, Mark; Saver, Jeffrey L; Liebeskind, David S; Nogueira, Raul G; Gupta, Rishi; Grotta, James C; Savitz, Sean I

    2013-12-01

    Intra-arterial therapy (IAT) promotes recanalization of large artery occlusions in acute ischemic stroke. Despite high recanalization rates, poor clinical outcomes are common. We attempted to optimize a score that combines clinical and imaging variables to more accurately predict poor outcome after IAT in anterior circulation occlusions. Patients with acute ischemic stroke undergoing IAT at University of Texas (UT) Houston for large artery occlusions (middle cerebral artery or internal carotid artery) were reviewed. Independent predictors of poor outcome (modified Rankin Scale, 4-6) were studied. External validation was performed on IAT-treated patients at Emory University. A total of 163 patients were identified at UT Houston. Independent predictors of poor outcome (P≤0.2) were identified as score variables using sensitivity analysis and logistic regression. Houston Intra-Arterial Therapy 2 (HIAT2) score ranges 0 to 10: age (≤59=0, 60-79=2, ≥80 years=4), glucose (<150=0, ≥150=1), National Institute Health Stroke Scale (≤10=0, 11-20=1, ≥21=2), the Alberta Stroke Program Early CT Score (8-10=0, ≤7=3). Patients with HIAT2≥5 were more likely to have poor outcomes at discharge (odds ratio, 6.43; 95% confidence interval, 2.75-15.02; P<0.001). After adjusting for reperfusion (Thrombolysis in Cerebral Infarction score≥2b) and time from symptom onset to recanalization, HIAT2≥5 remained an independent predictor of poor outcome (odds ratio, 5.88; 95% confidence interval, 1.96-17.64; P=0.02). Results from the cohort of Emory (198 patients) were consistent; patients with HIAT2 score≥5 had 6× greater odds of poor outcome at discharge and at 90 days. HIAT2 outperformed other previously published predictive scores. The HIAT2 score, which combines clinical and imaging variables, performed better than all previous scores in predicting poor outcome after IAT for anterior circulation large artery occlusions.

  15. Impact of age-adjusted Charlson comorbidity score on outcomes for patients with early-stage endometrial cancer.

    PubMed

    Robbins, Jared R; Gayar, Omar H; Zaki, Mark; Mahan, Meredith; Buekers, Thomas; Elshaikh, Mohamed A

    2013-12-01

    To determine the impact of Age-Adjusted Charlson Comorbidity (AAC) index score on survival outcomes for patients with early stage endometrial cancer. After IRB-approval, AAC score at time of hysterectomy was retrospectively tabulated by physician chart review for 671 patients with 2009 FIGO stage I-II endometrioid adenocarcinoma. Patients were grouped based on their AAC scores as follows: 0-1 (n=204), 2-3 (n=293) and >3 (n=174). Kaplan-Meier and log-rank test methods and univariate and multivariate modeling with Cox regression analysis was used to determine significant predictors of each survival endpoint. After a median follow-up of 85 months, 225 deaths were recorded (34 from EC and 191 from other causes) with a 7-year Overall (OS) and Disease-specific survival (DSS) of 77.6% and 94.0%, respectively. Based on AAC grouping, the 7-year OS, DSS, and Recurrence-free survival (RFS) were: 92.9%, 96.8%, and 94.9% for AAC 0-1; 81.7%, 95.3%, and 89.8% for AAC 2-3: and 56%, 88.2%, and 84.9% for AAC>3 (p<0.0001, p=0.005 and p=0.013, respectively). On multivariate analyses, higher AAC score, tumor grade, lower uterine segment involvement, and lymphovascular space invasion were significantly independent predictors for shorter OS, while for DSS and RFS, higher tumor grade and lymphovascular space invasion were significant predictors of worse outcome, but higher AAC score was not. Comorbidity score is as important as pathological features for predicting overall survival outcomes in patients with early-stage endometrioid endometrial carcinoma. Higher AAC scores accurately predicted for worse OS. Comorbidity score should be considered in prospective clinical trials of endometrial carcinoma. © 2013.

  16. The Knee injury and Osteoarthritis Outcome Score reflects the severity of knee osteoarthritis better than the revised Knee Society Score in a general Japanese population.

    PubMed

    Oishi, Kazuki; Tsuda, Eiichi; Yamamoto, Yuji; Maeda, Shugo; Sasaki, Eiji; Chiba, Daisuke; Takahashi, Ippei; Nakaji, Shigeyuki; Ishibashi, Yasuyuki

    2016-01-01

    The purposes of this study were to examine population-based reference data for sex- and age-related differences between the 2011 revised Knee Society Score (KSS2011) and the Knee injury and Osteoarthritis Outcome Score (KOOS), to assess the correlation between those scores and radiographic knee osteoarthritis (OA), and to validate the use of the scores in a general Japanese population. This cross-sectional study included 963 volunteers (368 males, 595 females; mean age: 54.7years). Participants were classified into five subgroups by age: under 40, 40s, 50s, 60s, and over 70years old. The KSS2011 and KOOS were determined using self-administered questionnaires. Weight-bearing radiographs of the bilateral knee were taken and graded according to the Kellgren-Lawrence (KL) scale. The mean KSS2011 and KOOS were compared among age groups. Correlations between the severity of knee OA and each score were assessed using multiple regression analysis. The overall KSS2011 tended to gradually decrease with age. Most subscales of the KSS2011 did not show sex-related differences. Similarly, the overall KOOS and all its subscales steadily decreased by approximately 20 points per decade with age. Most subscales of the KOOS were significantly decreased in females over 50. The KL grade was significantly related to both the overall KOOS (β=-0.42, p<0.001) and KSS2011 (β=-0.13, p=0.001), though the correlation to the KOOS was stronger. The overall KSS2011 and KOOS appear to decrease with age. In this population, the KOOS reflects the severity of knee OA better than the KSS2011. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes.

    PubMed

    Dalili, Hosein; Nili, Firouzeh; Sheikh, Mahdi; Hardani, Amir Kamal; Shariat, Mamak; Nayeri, Fatemeh

    2015-01-01

    To compare the Conventional, Specified, Expanded and Combined Apgar scoring systems in predicting birth asphyxia and the adverse early neurologic outcomes. This prospective cohort study was conducted on 464 admitted neonates. In the delivery room, after delivery the umbilical cord was double clamped and a blood samples was obtained from the umbilical artery for blood gas analysis, meanwhile on the 1- , 5- and 10- minutes Conventional, Specified, Expanded, and Combined Apgar scores were recorded. Then the neonates were followed and intracranial ultrasound imaging was performed, and the following information were recorded: the occurrence of birth asphyxia, hypoxic Ischemic Encephalopathy (HIE), intraventricular hemorrhage (IVH), and neonatal seizure. The Combined-Apgar score had the highest sensitivity (97%) and specificity (99%) in predicting birth asphyxia, followed by the Specified-Apgar score that was also highly sensitive (95%) and specific (97%). The Expanded-Apgar score was highly specific (95%) but not sensitive (67%) and the Conventional-Apgar score had the lowest sensitivity (81%) and low specificity (81%) in predicting birth asphyxia. When adjusted for gestational age, only the low 5-minute Combined-Apgar score was independently associated with the occurrence of HIE (B = 1.61, P = 0.02) and IVH (B = 2.8, P = 0.01). The newly proposed Combined-Apgar score is highly sensitive and specific in predicting birth asphyxia and also is a good predictor of the occurrence of HIE and IVH in asphyxiated neonates.

  18. Application of a Novel CT-Based Iliac Artery Calcification Scoring System for Predicting Renal Transplant Outcomes.

    PubMed

    Davis, Bradley; Marin, Daniele; Hurwitz, Lynne M; Ronald, James; Ellis, Matthew J; Ravindra, Kadiyala V; Collins, Bradley H; Kim, Charles Y

    2016-02-01

    The objective of our study was to assess whether the degree and distribution of iliac artery calcifications as determined by a CT-based calcium scoring system correlates with outcomes after renal transplant. A retrospective review of renal transplant recipients who underwent CT of the pelvis within 2 years before surgery yielded 131 patients: 75 men and 56 women with a mean age of 52 years. Three radiologists assigned a separate semiquantitative score for calcification length, circumferential involvement, and morphology for the common iliac arteries and for the external iliac arteries. The operative and clinical notes were reviewed to determine which iliac arterial segment was used for anastomosis, the complexity of the operation, and whether delayed graft function (DGF) occurred. Renal allograft survival and patient survival were calculated using the Kaplan-Meier technique. Excellent interobserver agreement was noted for each calcification score category. The common iliac arteries showed significantly higher average calcification scores than the external iliac arteries for all categories. Advanced age and diabetes mellitus were independently predictive of higher scores in each category, whereas hypertension, cigarette smoking, hyperlipidemia, and sex were not. Based on multivariate analysis, only the calcification morphology score of the arterial segment used for anastomosis was independently predictive of a higher rate of surgical complexity and of DGF. None of the scores was predictive of graft or patient survival. However, patients with CT evidence of iliac arterial calcification had a lower 1-year survival after transplant than those who did not (92% vs 98%, respectively; p = 0.05). Only the calcification morphology score of the arterial segment used for anastomosis was significantly predictive of surgical complexity and of DGF. Routine pretransplant CT for calcification scoring in patients of advanced age or those with diabetes mellitus may enable selection

  19. The survival outcomes following liver transplantation (SOFT) score: validation with contemporaneous data and stratification of high-risk cohorts.

    PubMed

    Rana, Abbas; Jie, Tun; Porubsky, Marian; Habib, Shahid; Rilo, Horacio; Kaplan, Bruce; Gruessner, Angelika; Gruessner, Rainer

    2013-01-01

    Models to project survival after liver transplantation are important to optimize outcomes. We introduced the survival outcomes following liver transplantation (SOFT) score in 2008 (1) and designed to predict survival in liver recipients at three months post-transplant with a C statistic of 0.70. Our objective was to validate the SOFT score, with more contemporaneous data from the OPTN database. We also applied the SOFT score to cohorts of the sickest transplant candidates and the poorest-quality allografts. Analysis included 21 949 patients transplanted from August 1, 2006, to October 1, 2010. Kaplan-Meier survival functions were used for time-to-event analysis. Model discrimination was assessed using the area under the receiver operating characteristic (ROC) curve. We validated the SOFT score in this cohort of 21 949 liver recipients. The C statistic was 0.70 (CI 0.68-0.71), identical to the original analysis. When applied to cohorts of high-risk recipients and poor-quality donor allografts, the SOFT score projected survival with a C statistic between 0.65 and 0.74. In this study, a validated SOFT score was informative among cohorts of the sickest transplant candidates and the poorest-quality allografts. © 2013 John Wiley & Sons A/S.

  20. A Comparative Study of Glasgow Coma Scale and Full Outline of Unresponsiveness Scores for Predicting Long-Term Outcome After Brain Injury.

    PubMed

    McNett, Molly M; Amato, Shelly; Philippbar, Sue Ann

    2016-01-01

    The aim of this study was to compare predictive ability of hospital Glasgow Coma Scale (GCS) scores and scores obtained using a novel coma scoring tool (the Full Outline of Unresponsiveness [FOUR] scale) on long-term outcomes among patients with traumatic brain injury. Preliminary research of the FOUR scale suggests that it is comparable with GCS for predicting mortality and functional outcome at hospital discharge. No research has investigated relationships between coma scores and outcome 12 months postinjury. This is a prospective cohort study. Data were gathered on adult patients with traumatic brain injury admitted to urban level I trauma center. GCS and FOUR scores were assigned at 24 and 72 hours and at hospital discharge. Glasgow Outcome Scale scores were assigned at 6 and 12 months. The sample size was n = 107. Mean age was 53.5 (SD = ±21, range = 18-91) years. Spearman correlations were comparable and strongest among discharge GCS and FOUR scores and 12-month outcome (r = .73, p < .000; r = .72, p < .000). Multivariate regression models indicate that age and discharge GCS were the strongest predictors of outcome. Areas under the curve were similar for GCS and FOUR scores, with discharge scores occupying the largest areas. GCS and FOUR scores were comparable in bivariate associations with long-term outcome. Discharge coma scores performed best for both tools, with GCS discharge scores predictive in multivariate models.

  1. National Institutes of Health Stroke Scale-Time Score Predicts Outcome after Endovascular Therapy in Acute Ischemic Stroke: A Retrospective Single-Center Study.

    PubMed

    Todo, Kenichi; Sakai, Nobuyuki; Kono, Tomoyuki; Hoshi, Taku; Imamura, Hirotoshi; Adachi, Hidemitsu; Kohara, Nobuo

    2016-05-01

    Outcomes after successful endovascular therapy in acute ischemic stroke are associated with onset-to-reperfusion time (ORT) and the National Institutes of Health Stroke Scale (NIHSS) score. In intravenous recombinant tissue plasminogen activator therapy, the NIHSS-time score, calculated by multiplying onset-to-treatment time with the NIHSS score, has been shown to predict clinical outcomes. In this study, we assessed whether a similar combination of the ORT and the NIHSS score can be applied to predict the outcomes after endovascular therapy. We retrospectively reviewed the charts of 128 consecutive ischemic stroke patients with successful reperfusion after endovascular therapy. We analyzed the association of the ORT, the NIHSS score, and the NIHSS-time score with good outcome (modified Rankin Scale score ≤ 2 at 3 months). Good outcome rates for patients with NIHSS-time scores of 84.7 or lower, scores higher than 84.7 up to 127.5 or lower, and scores higher than 127.5 were 72.1%, 44.2%, and 14.3%, respectively (P < .01). Multivariate logistic regression analysis revealed that the NIHSS-time score was an independent predictor of good outcomes (odds ratio, .372; 95% confidence interval, .175-.789) after adjusting for age, sex, internal carotid artery occlusion, plasma glucose level, ORT, and NIHSS score. The NIHSS-time score can predict good clinical outcomes after endovascular treatment. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  2. The 5-minute Apgar score: survival and short-term outcomes in extremely low-birth-weight infants.

    PubMed

    Phalen, Ann Gibbons; Kirkby, Sharon; Dysart, Kevin

    2012-01-01

    The Apgar score is a standardized tool for evaluating newborns in the delivery room. Despite its long history and widespread use, debate remains over its reliability of predicting neonatal outcomes, especially in extremely low-birth-weight premature infants. The aim of the study was to examine the relationship between the 5-minute Apgar score of extremely low-birth-weight infants, as it relates to survival and morbidities associated with prematurity and length of hospital stay. A retrospective query of the Alere neonatal database from 2001 to 2011 examined all infants less than 32 weeks' gestation and less than 1000-g birth weight. The 5-minute Apgar score was divided into 2 groups, score of 4 or greater or less than 4. The study compared results of the 5-minute Apgar score and associated morbidities in surviving infants. Statistical analyses included chi-square, Fisher exact test, t test, and multivariate regression. The sample consisted of 3898 infants with an 86.4% (n = 3366) survival rate. Controlling for gestational age and birth weight, surviving infants with a 5-minute Apgar score of less than 4 were more likely to demonstrate nonintact survival. Infants with a low 5-minute Apgar score have greater risk for mortality and morbidities associated with prematurity.

  3. Postoperative outcome after oesophagectomy for cancer: Nutritional status is the missing ring in the current prognostic scores.

    PubMed

    Filip, B; Scarpa, M; Cavallin, F; Cagol, M; Alfieri, R; Saadeh, L; Ancona, E; Castoro, C

    2015-06-01

    Several prognostic scores were designed in order to estimate the risk of postoperative adverse events. None of them includes a component directly associated to the nutritional status. The aims of the study were the evaluation of performance of risk-adjusted models for early outcomes after oesophagectomy and to develop a score for severe complication prediction with special consideration regarding nutritional status. A comparison of POSSUM and Charlson score and their derivates, ASA, Lagarde score and nutritional index (PNI) was performed on 167 patients undergoing oesophagectomy for cancer. A logistic regression model was also estimated to obtain a new prognostic score for severe morbidity prediction. Overall morbidity was 35.3% (59 cases), severe complications (grade III-V of Clavien-Dindo classification) occurred in 20 cases. Discrimination was poor for all the scores. Multivariable analysis identified pulse, connective tissue disease, PNI and potassium as independent predictors of severe morbidity. This model showed good discrimination and calibration. Internal validation using standard bootstrapping techniques confirmed the good performance. Nutrition could be an independent risk factor for major complications and a nutritional status coefficient could be included in current prognostic scores to improve risk estimation of major postoperative complications after oesophagectomy for cancer. Copyright © 2015. Published by Elsevier Ltd.

  4. The Dutch version of the knee injury and osteoarthritis outcome score: A validation study

    PubMed Central

    de Groot, Ingrid B; Favejee, Marein M; Reijman, Max; Verhaar, Jan AN; Terwee, Caroline B

    2008-01-01

    Background The Knee Injury and Osteoarthritis Outcome Score (KOOS) was constructed in Sweden. This questionnaire has proved to be valid for several orthopedic interventions of the knee. It has been formally translated and validated in several languages, but not yet in Dutch. The purpose of the present study was to evaluate the clinimetric properties of the Dutch version of the KOOS questionnaire in knee patients with various stages of osteoarthritis (OA). Methods The Swedish version of the KOOS questionnaire was first translated into Dutch according to a standardized procedure and second tested for clinimetric quality. The study population consisted of patients with different stages of OA (mild, moderate and severe) and of patients after primary TKA, and after a revision of the TKA. All patients filled in the Dutch KOOS questionnaire, as well as the SF-36 and a Visual Analogue Scale for pain. The following analyses were performed to evaluate the clinimetric quality of the KOOS: Cronbach's alpha (internal consistency), principal component analyses (factor analysis), intraclass correlation coefficients (reliability), spearman's correlation coefficient (construct validity), and floor and ceiling effects. Results For all patients groups Cronbach's alpha was for all subscales above 0.70. The ICCs, assessed for the patient groups with mild and moderate OA and after revision of the TKA patients, were above 0.70 for all subscales. Of the predefined hypotheses 60% or more could be confirmed for the patients with mild and moderate OA and for the TKA patients. For the other patient groups less than 45% could be confirmed. Ceiling effects were present in the mild OA group for the subscales Pain, Symptoms and ADL and for the subscale Sport/Recreation in the severe OA group. Floor effects were found for the subscales Sport/Recreation and Qol in the severe OA and revision TKA groups. Conclusion Based on these different clinimetric properties within the present study we conclude

  5. Communicating patient-reported outcome scores using graphic formats: results from a mixed-methods evaluation.

    PubMed

    Brundage, Michael D; Smith, Katherine C; Little, Emily A; Bantug, Elissa T; Snyder, Claire F

    2015-10-01

    Patient-reported outcomes (PROs) promote patient-centered care by using PRO research results ("group-level data") to inform decision making and by monitoring individual patient's PROs ("individual-level data") to inform care. We investigated the interpretability of current PRO data presentation formats. This cross-sectional mixed-methods study randomized purposively sampled cancer patients and clinicians to evaluate six group-data or four individual-data formats. A self-directed exercise assessed participants' interpretation accuracy and ratings of ease-of-understanding and usefulness (0 = least to 10 = most) of each format. Semi-structured qualitative interviews explored helpful and confusing format attributes. We reached thematic saturation with 50 patients (44 % < college graduate) and 20 clinicians. For group-level data, patients rated simple line graphs highest for ease-of-understanding and usefulness (median 8.0; 33 % selected for easiest to understand/most useful) and clinicians rated simple line graphs highest for ease-of-understanding and usefulness (median 9.0, 8.5) but most often selected line graphs with confidence limits or norms (30 % for each format for easiest to understand/most useful). Qualitative results support that clinicians value confidence intervals, norms, and p values, but patients find them confusing. For individual-level data, both patients and clinicians rated line graphs highest for ease-of-understanding (median 8.0 patients, 8.5 clinicians) and usefulness (median 8.0, 9.0) and selected them as easiest to understand (50, 70 %) and most useful (62, 80 %). The qualitative interviews supported highlighting scores requiring clinical attention and providing reference values. This study has identified preferences and opportunities for improving on current formats for PRO presentation and will inform development of best practices for PRO presentation. Both patients and clinicians prefer line graphs across group-level data and individual

  6. The impact of living with a functional and aesthetic nasal deformity after primary rhinoplasty: a utility outcomes score assessment.

    PubMed

    Sinno, Hani; Izadpanah, Ali; Thibaudeau, Stephanie; Christodoulou, Georges; Tahiri, Youssef; Slavin, Sumner A; Lin, Samuel J

    2012-10-01

    Revision rhinoplasty for functional deformities can be both an aesthetic and reconstructive surgical challenge. We set out to quantify the health state utility assessment of living with the physical appearance of nasal asymmetry along with having nasal obstruction. The use of utility scores has helped to establish the health burden of living with various medical conditions. We sought to quantify living with a health state of nasal asymmetry with nasal obstruction after primary rhinoplasty using utility outcome scores. We used previously validated utility outcome measures to quantify the health burden of this clinical scenario in 128 prospective subjects. These subjects were from a sample of the population and medical students recruited to complete a survey to determine the utility outcome score of revision rhinoplasty using visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) tests to obtain utility scores for revision rhinoplasty. Linear regression and Student t test were used for statistical analysis. All measures (VAS, TTO, and SG) for functional nasal deformity (0.80±0.13, 0.90±0.12, and 0.91±0.13, respectively) of the 128 prospective subjects participating in this online study were significantly different (P<0.005) from the corresponding scores for monocular blindness (0.63±0.15, 0.85±0.16, and 0.85±0.19, respectively) and binocular blindness (0.38±0.18, 0.66±0.25, and 0.69±0.24, respectively). Being white was inversely related to the VAS utility scores for rhinoplasty (P<0.05). Additionally, female sex was positively correlated to the TTO score. Age, income, and education were not predictors of utility scores. In a sample of the population and medical students, VAS, TTO, and SG utility scores for revision rhinoplasty were determined and can be compared objectively with other health states and diseases with known utility scores. In a preoperative setting, women were objectively willing to potentially "trade" more years of life to

  7. Vitamin D status and 3-month Glasgow Outcome Scale scores in patients in neurocritical care: prospective analysis of 497 patients.

    PubMed

    Guan, Jian; Karsy, Michael; Brock, Andrea A; Eli, Ilyas M; Manton, Gabrielle M; Ledyard, Holly K; Hawryluk, Gregory W J; Park, Min S

    2017-08-11

    OBJECTIVE Vitamin D deficiency has been associated with a variety of negative outcomes in critically ill patients, but little focused study on the effects of hypovitaminosis D has been performed in the neurocritical care population. In this study, the authors examined the effect of vitamin D deficiency on 3-month outcomes after discharge from a neurocritical care unit (NCCU). METHODS The authors prospectively analyzed 25-hydroxy vitamin D levels in patients admitted to the NCCU of a quaternary care center over a 6-month period. Glasgow Outcome Scale (GOS) scores were used to evaluate their 3-month outcome, and univariate and multivariate logistic regression was used to evaluate the effects of vitamin D deficiency. RESULTS Four hundred ninety-seven patients met the inclusion criteria. In the binomial logistic regression model, patients without vitamin D deficiency (> 20 ng/dl) were significantly more likely to have a 3-month GOS score of 4 or 5 than those who were vitamin D deficient (OR 1.768 [95% CI 1.095-2.852]). Patients with a higher Simplified Acute Physiology Score (SAPS II) (OR 0.925 [95% CI 0.910-0.940]) and those admitted for stroke (OR 0.409 [95% CI 0.209-0.803]) or those with an "other" diagnosis (OR 0.409 [95% CI 0.217-0.772]) were significantly more likely to have a 3-month GOS score of 3 or less. CONCLUSIONS Vitamin D deficiency is associated with worse 3-month postdischarge GOS scores in patients admitted to an NCCU. Additional study is needed to determine the role of vitamin D supplementation in the NCCU population.

  8. 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.

  9. Applicability of different scoring systems in outcome prediction of patients with mixed drug poisoning-induced coma

    PubMed Central

    Eizadi Mood, Nastaran; Sabzghabaee, Ali Mohammad; Khalili-Dehkordi, Zahra

    2011-01-01

    Background: Mixed drugs poisoning (MDP) is common in the emergency departments. Because of the limited number of intensive care unit beds, recognition of risk factors to divide the patients into different survival groups is necessary. Poisoning due to ingestion of different medications may have additive or antagonistic effects on different parameters included in the scoring systems; therefore, the aim of the study was to compare applicability of the different scoring systems in outcomes prediction of patients admitted with MDP-induced coma. Methods: This prospective, observational study included 93 patients with MDP-induced coma. Clinical and laboratory data conforming to the Acute Physiology and Chronic Health Evaluation (APACHE II), Modified APACHE II Score (MAS), Mainz Emergency Evaluation Scores (MEES) and Glasgow Coma Scale (GCS) were recorded for all patients on admission (time0) and 24 h later (time24). The outcome was recorded in two categories: Survived with or without complication and non-survived. Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under the ROC curve (AUC). Results: The mortality rate was 9.7%. Mean of each scoring system was statistically significant between time0 and time24 in the survivors. However, it was not significant in non-survivors. Discrimination was excellent for GCS24 (0.90±0.05), APACHE II24 (0.89±0.01), MAS24 (0.86±0.10), and APACHE II0 (0.83±0.11) AUC. Conclusion: The GCS24, APACHE II24, MAS24, and APACHE II0 scoring systems seem to predict the outcome in comatose patients due to MDP more accurately. GCS and MAS may have superiority over the others in being easy to perform and not requiring laboratory data. PMID:22223905

  10. Comparison of four lung scoring systems for the assessment of the pathological outcomes derived from Actinobacillus pleuropneumoniae experimental infections

    PubMed Central

    2014-01-01

    Background In this study, four lung lesion scoring methods (Slaughterhouse Pleurisy Evaluation System [SPES], Consolidation Lung Lesion Score [LLS], Image analyses [IA] and Ratio of lung weight/body weight [LW/BW]) were compared for the assessment of the different pathological outcomes derived from an Actinobacillus pleuropneumoniae (App) experimental infection model. Moreover, pathological data was coupled with clinical (fever, inappetence and clinical score), production (average daily weigh gain [ADWG]) and diagnostic (PCR, ELISA and bacterial isolation) parameters within the four infection outcomes (peracute, acute, subclinically infected and non-infected). Results From the 61 inoculated animals, 9 were classified as peracute (presence of severe App-like clinical signs and lesions and sudden death or euthanasia shortly after inoculation), 31 as acutely affected (presence of App-like clinical signs and lesions and survival until the end of the experiment), 12 as subclinically infected (very mild or no clinical signs but App infection confirmed) and 9 as non-infected animals (lack of App-like clinical signs and lack of evidence of App infection). A significant correlation between all lung lesion scoring systems was found with the exception of SPES score versus LW/BW. SPES showed a statistically significant association with all clinical, production and diagnostic (with the exception of PCR detection of App in the tonsil) variables assessed. LLS and IA showed similar statistically significant associations as SPES, with the exception of seroconversion against App at necropsy. In contrast, LW/BW was statistically associated only with App isolation in lungs, presence of App-like lesions and ELISA OD values at necropsy. Conclusions In conclusion, SPES, LLS and IA are economic, fast and easy-to-perform lung scoring methods that, in combination with different clinical and diagnostic parameters, allow the characterization of different outcomes after App infection. PMID

  11. Treatment outcome of additional dextran to corticosteroid therapy on sudden deafness: propensity score-matched cohort analysis.

    PubMed

    Wang, Chi-Te; Chou, Hsu-Wen; Fang, Kai-Min; Lai, Mei-Shu; Cheng, Po-Wen

    2012-12-01

    This study aimed to investigate whether adding low-molecular-weight dextran to oral steroids in patients with idiopathic sudden sensorineural hearing loss resulted in better hearing outcomes than those in patients receiving oral corticosteroids alone. Historical cohort study. Tertiary teaching hospital. The authors reviewed the clinical records of 166 patients with idiopathic sudden sensorineural hearing loss. Therapeutic effectiveness was measured by the gain of pure-tone averages and 4 categories of hearing outcome (complete recovery, marked recovery, mild improvement, or no improvement). To manage potential confounding factors associated with treatment allocation, the authors matched the subjects from each group according to the propensity score (ie, the predicted probability that they would receive a specific treatment). The authors identified 50 pairs of propensity score-matched subjects (n = 100) without significant difference of all clinical factors (P > .05). Subsequent analyses demonstrated that the average hearing gain in subjects receiving additional dextran to oral steroid was 31.7 ± 21.5 dB, which did not differ from 33.0 ± 21.8 dB in subjects receiving steroids alone (P = .76). Difference of hearing outcomes between the 2 groups was also nonsignificant (P = .92). Matching propensity scores successfully balanced the heterogeneity between the dextran and steroid groups. Analytical results demonstrated that adding low-molecular-weight dextran to oral corticosteroids was not associated with greater hearing gain or better hearing outcome in idiopathic sudden sensorineural hearing loss.

  12. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group.

    PubMed

    Vasquez, Michael A; Rabe, Eberhard; McLafferty, Robert B; Shortell, Cynthia K; Marston, William A; Gillespie, David; Meissner, Mark H; Rutherford, Robert B

    2010-11-01

    In response to the need for a disease severity measurement, the American Venous Forum committee on outcomes assessment developed the Venous Severity Scoring system in 2000. There are three components of this scoring system, the Venous Disability Score, the Venous Segmental Disease Score, and the Venous Clinical Severity Score (VCSS). The VCSS was developed from elements of the CEAP classification (clinical grade, etiology, anatomy, pathophysiology), which is the worldwide standard for describing the clinical features of chronic venous disease. However, as a descriptive instrument, the CEAP classification responds poorly to change. The VCSS was subsequently developed as an evaluative instrument that would be responsive to changes in disease severity over time and in response to treatment. Based on initial experiences with the VCSS, an international ad hoc working group of the American Venous Forum was charged with updating the instrument. This revision of the VCSS is focused on clarifying ambiguities, updating terminology, and simplifying application. The specific language of proven quality-of-life instruments was used to better address the issues of patients at the lower end of the venous disease spectrum. Periodic review and revision are necessary for generating more universal applicability and for comparing treatment outcomes in a meaningful way.

  13. Propensity scores-potential outcomes framework to incorporate severity probabilities in the highway safety manual crash prediction algorithm.

    PubMed

    Sasidharan, Lekshmi; Donnell, Eric T

    2014-10-01

    Accurate estimation of the expected number of crashes at different severity levels for entities with and without countermeasures plays a vital role in selecting countermeasures in the framework of the safety management process. The current practice is to use the American Association of State Highway and Transportation Officials' Highway Safety Manual crash prediction algorithms, which combine safety performance functions and crash modification factors, to estimate the effects of safety countermeasures on different highway and street facility types. Many of these crash prediction algorithms are based solely on crash frequency, or assume that severity outcomes are unchanged when planning for, or implementing, safety countermeasures. Failing to account for the uncertainty associated with crash severity outcomes, and assuming crash severity distributions remain unchanged in safety performance evaluations, limits the utility of the Highway Safety Manual crash prediction algorithms in assessing the effect of safety countermeasures on crash severity. This study demonstrates the application of a propensity scores-potential outcomes framework to estimate the probability distribution for the occurrence of different crash severity levels by accounting for the uncertainties associated with them. The probability of fatal and severe injury crash occurrence at lighted and unlighted intersections is estimated in this paper using data from Minnesota. The results show that the expected probability of occurrence of fatal and severe injury crashes at a lighted intersection was 1 in 35 crashes and the estimated risk ratio indicates that the respective probabilities at an unlighted intersection was 1.14 times higher compared to lighted intersections. The results from the potential outcomes-propensity scores framework are compared to results obtained from traditional binary logit models, without application of propensity scores matching. Traditional binary logit analysis suggests that

  14. Risk Score Estimation: a new method to determine optimal timing of aneurysm clipping for improved management outcome.

    PubMed

    Duong, D H; Kolluri, V R; Spittaler, P J; Sengupta, R P

    1998-04-01

    The outcome of 703 patients who underwent surgery following aneurysmal subarachnoid hemorrhage were analyzed with regards to age, associated medical conditions, vasospasm and clinical status at the time of operation. Patients with Hunt and Hess grade I, II, and III had a 96%, 90% and 93% favorable (good and fair) outcome respectively. In contrast only 58% of patients with grade IV had the same result. The outcome was unfavorable in 13% of the patients who were older than 60 years of age and only in 9% of the patients between 30-59 years of age. All the patients younger than 30 years old had a good outcome. Associated medical condition increased the incidences of poor outcome (7% vs. 12%). Patients harboring vertebro basilar aneurysms had a poorer outcome, as opposed to those with aneurysms located in the anterior circulation (20% vs. 8%). The presence of angiographic vasospasm alone did not influence outcome. A proposed point value was given for each of the adverse factors and from this the optimal surgical time was determined for each individual patient. This concept of Risk Score Estimation approach may improve the management outcome of patients with ruptured intracranial aneurysms.

  15. Athlete characteristics and outcome scores for computerized neuropsychological assessment: a preliminary analysis.

    PubMed

    Brown, Cathleen N; Guskiewicz, Kevin M; Bleiberg, Joseph

    2007-01-01

    Computerized neuropsychological testing is used in athletics; however, normative data on an athletic population are lacking. To investigate factors, such as sex, SAT score, alertness, and sport, and their effects on baseline neuropsychological test scores. A secondary purpose was to begin establishing preliminary reference data for nonsymptomatic collegiate athletes. Observational study. Research laboratory. The study population comprised 327 National Collegiate Athletic Association Division I athletes from 12 men's and women's sports. Athletes were baseline tested before their first competitive season. Athletes completed demographics forms and self-reported history of concussion (1 or no concussion and 2 or more concussions) and SAT scores (<1000, 1000 to 1200, and >1200). The 108 women had a mean age of 18.39 +/- 0.09 years, height of 167.94 +/- 0.86 cm, and mass of 62.36 +/- 1.07 kg. The 219 men had a mean age of 18.49 +/- 0.07 years, height of 183.24 +/- 1.68 cm, and mass of 88.05 +/- 1.82 kg. Sports participation included women's soccer, lacrosse, basketball, and field hockey; men's football, soccer, lacrosse, and wrestling; and women's and men's track and cheerleading. We used the Automated Neuropsychological Assessment Metrics (Army Medical Research and Materiel Command, Ft Detrick, MD) and measured throughput scores (the number of correct responses per minute) as the dependent variable for each subtest, with higher scores reflecting increased speed and accuracy of responses. Subsets included 2 simple reaction time (SRT) tests, math processing (MTH), Sternberg memory search (ST6), matching to sample pairs (MSP), procedural reaction time (PRO), code digit substitution (CDS), and the Stanford sleep scale Likert-type score. Women scored better than men on the ST6 (P < .05), while men scored significantly better than women on the SRT and MSP tests. The highest-scoring SAT group performed better than other SAT groups on selected subtests (SRT, MTH, ST6, MSP, and

  16. Improving prediction of outcomes in African Americans with normal stress echocardiograms using a risk scoring system.

    PubMed

    Sutter, David A; Thomaides, Athanasios; Hornsby, Kyle; Mahenthiran, Jothiharan; Feigenbaum, Harvey; Sawada, Stephen G

    2013-06-01

    Cardiovascular mortality is high in African Americans, and those with normal results on stress echocardiography remain at increased risk. The aim of this study was to develop a risk scoring system to improve the prediction of cardiovascular events in African Americans with normal results on stress echocardiography. Clinical data and rest echocardiographic measurements were obtained in 548 consecutive African Americans with normal results on rest and stress echocardiography and ejection fractions ≥50%. Patients were followed for myocardial infarction and death for 3 years. Predictors of cardiovascular events were determined with Cox regression, and hazard ratios were used to determine the number of points in the risk score attributed to each independent predictor. During follow-up of 3 years, 47 patients (8.6%) had events. Five variables-age (≥45 years in men, ≥55 years in women), history of coronary disease, history of smoking, left ventricular hypertrophy, and exercise intolerance (<7 METs in men, <5 METs in women, or need for dobutamine stress)-were independent predictors of events. A risk score was derived for each patient (ranging from 0 to 8 risk points). The area under the curve for the risk score was 0.82 with the optimum cut-off risk score of 6. Among patients with risk scores ≥6, 30% had events, compared with 3% with risk score <6 (p <0.001). In conclusion, African Americans with normal results on stress echocardiography remain at significant risk for cardiovascular events. A risk score can be derived from clinical and echocardiographic variables, which can accurately distinguish high- and low-risk patients.

  17. Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage

    PubMed Central

    Sharma, Manik; John, Anil K; Al-Ejji, Khalid Mohsin; Wani, Hamidulla; Sultan, Khaleel; Al-Mohannadi, Muneera; Yakoob, Rafie; Derbala, Moutaz; Al-Dweik, Nazeeh; Butt, Muhammed Tariq; Al-Kaabi, Saad Rashid

    2015-01-01

    Background/Aims To evaluate the ability of the recently proposed albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 years (AIMS65) score to predict mortality in patients with acute upper gastrointestinal bleeding (UGIB). Methods AIMS65 scores were calculated in 251 consecutive patients presenting with acute UGIB by allotting 1 point each for albumin level <30 g/L, INR >1.5, alteration in mental status, systolic blood pressure ≤90 mm Hg, and age ≥65 years. Risk stratification was done during the initial 12 hours of hospital admission. Results Intensive care unit (ICU) admission, endoscopic therapy, or surgery were required in 51 patients (20.3%), 64 (25.5%), and 12 (4.8%), respectively. The predictive accuracy of AIMS65 scores ≥2 was high for blood transfusion (area under the receiver operator characteristic curve [AUROC], 0.59), ICU admission (AUROC, 0.61), and mortality (AUROC, 0.74). The overall mortality was 10.3% (n=26), and was 3%, 7.8%, 20%, 36%, and 40% for AIMS65 scores of 0, 1, 2, 3, and 4, respectively; these values were significantly higher in those with scores ≥2 (30.9%) than in those with scores <2 (4.5%, p<0.001). Conclusions AIMS65 is a simple, accurate, non-endoscopic risk score that can be applied early (within 12 hours of hospital admission) in patients with acute UGIB. AIMS65 scores ≥2 predict high in-hospital mortality. PMID:26473120

  18. Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system.

    PubMed

    Belmares, Jaime; Gerding, Dale N; Parada, Jorge P; Miskevics, Scott; Weaver, Frances; Johnson, Stuart

    2007-12-01

    To determine the response rate of Clostridium difficile disease (CDD) to treatment with metronidazole and assess a scoring system to predict response to treatment with metronidazole when applied at the time of CDD diagnosis. Retrospective review of patients with CDD who received primary treatment with metronidazole. We defined success as diarrhea resolution within 6 days of therapy. A CDD score was defined prospectively using variables suggested to correlate with disease severity. Among 102 evaluable patients, 72 had a successful response (70.6%). Twenty-one of the remaining 30 patients eventually responded to metronidazole, but required longer treatment, leaving 9 'true failures'. The mean CDD score was higher among true failures (2.89+/-1.4) than among all metronidazole responders (0.77+/-1.0) (p<.0001). The score was greater than 2 in 67% of true failures and 2 or less in 94% of metronidazole responders. Leukocytosis and abnormal CT scan findings were individual factors associated with a higher risk of metronidazole failure. Only 71% of CDD patients responded to metronidazole within 6 days, but the overall response rate was 91%. A CDD score greater than 2 was associated with metronidazole failure in 6 of 9 true failures. The CDD score will require prospective validation.

  19. Physiological-social scores in predicting outcomes of prehospital internal patients.

    PubMed

    Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

    2014-01-01

    The physiological-social modified early warning score system is a newly developed instrument for the identification of patients at risk. The aim of this study was to investigate the feasibility of using the physiological-social modified early warning score system for the identification of patients that needed prehospital emergency care. This prospective cohort study was conducted with 2157 patients. This instrument was used as a measure to detect critical illness in patients hospitalised in internal wards. Judgment by an emergency medicine specialist was used as a measure of standard. Data were analyzed by using receiver operating characteristics curves and the area under the curve with 95% confidence interval. The mean score of the physiological-social modified early warning score system was 2.71 ± 3.55. Moreover, 97.6% patients with the score ≥ 4 needed prehospital emergency services. The area under receiver operating characteristic curve was 0.738 (95% CI = 0.708-0.767). Emergency medical staffs can use PMEWS ≥ 4 to identify those patients hospitalised in the internal ward as at risk patients. The physiological-social modified early warning score system is suggested to be used for decision-making of emergency staff about internal patients' wards in EMS situations.

  20. Physiological-Social Scores in Predicting Outcomes of Prehospital Internal Patients

    PubMed Central

    Jamshidi-Orak, Roohangiz

    2014-01-01

    The physiological-social modified early warning score system is a newly developed instrument for the identification of patients at risk. The aim of this study was to investigate the feasibility of using the physiological-social modified early warning score system for the identification of patients that needed prehospital emergency care. This prospective cohort study was conducted with 2157 patients. This instrument was used as a measure to detect critical illness in patients hospitalised in internal wards. Judgment by an emergency medicine specialist was used as a measure of standard. Data were analyzed by using receiver operating characteristics curves and the area under the curve with 95% confidence interval. The mean score of the physiological-social modified early warning score system was 2.71 ± 3.55. Moreover, 97.6% patients with the score ≥ 4 needed prehospital emergency services. The area under receiver operating characteristic curve was 0.738 (95% CI = 0.708–0.767). Emergency medical staffs can use PMEWS ≥ 4 to identify those patients hospitalised in the internal ward as at risk patients. The physiological-social modified early warning score system is suggested to be used for decision-making of emergency staff about internal patients' wards in EMS situations. PMID:25298893

  1. Survival outcomes following liver transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation.

    PubMed

    Rana, A; Hardy, M A; Halazun, K J; Woodland, D C; Ratner, L E; Samstein, B; Guarrera, J V; Brown, R S; Emond, J C

    2008-12-01

    It is critical to balance waitlist mortality against posttransplant mortality. Our objective was to devise a scoring system that predicts recipient survival at 3 months following liver transplantation to complement MELD-predicted waitlist mortality. Univariate and multivariate analysis on 21,673 liver transplant recipients identified independent recipient and donor risk factors for posttransplant mortality. A retrospective analysis conducted on 30,321 waitlisted candidates reevaluated the predictive ability of the Model for End-Stage Liver Disease (MELD) score. We identified 13 recipient factors, 4 donor factors and 2 operative factors (warm and cold ischemia) as significant predictors of recipient mortality following liver transplantation at 3 months. The Survival Outcomes Following Liver Transplant (SOFT) Score utilized 18 risk factors (excluding warm ischemia) to successfully predict 3-month recipient survival following liver transplantation. This analysis represents a study of waitlisted candidates and transplant recipients of liver allografts after the MELD score was implemented. Unlike MELD, the SOFT score can accurately predict 3-month survival following liver transplantation. The most significant risk factors were previous transplantation and life support pretransplant. The SOFT score can help clinicians determine in real time which candidates should be transplanted with which allografts. Combined with MELD, SOFT can better quantify survival benefit for individual transplant procedures.

  2. Survival outcomes scores (SOFT, BAR, and Pedi-SOFT) are accurate in predicting post-liver transplant survival in adolescents.

    PubMed

    Conjeevaram Selvakumar, Praveen Kumar; Maksimak, Brian; Hanouneh, Ibrahim; Youssef, Dalia H; Lopez, Rocio; Alkhouri, Naim

    2016-09-01

    SOFT and BAR scores utilize recipient, donor, and graft factors to predict the 3-month survival after LT in adults (≥18 years). Recently, Pedi-SOFT score was developed to predict 3-month survival after LT in young children (≤12 years). These scoring systems have not been studied in adolescent patients (13-17 years). We evaluated the accuracy of these scoring systems in predicting the 3-month post-LT survival in adolescents through a retrospective analysis of data from UNOS of patients aged 13-17 years who received LT between 03/01/2002 and 12/31/2012. Recipients of combined organ transplants, donation after cardiac death, or living donor graft were excluded. A total of 711 adolescent LT recipients were included with a mean age of 15.2±1.4 years. A total of 100 patients died post-LT including 33 within 3 months. SOFT, BAR, and Pedi-SOFT scores were all found to be good predictors of 3-month post-transplant survival outcome with areas under the ROC curve of 0.81, 0.80, and 0.81, respectively. All three scores provided good accuracy for predicting 3-month survival post-LT in adolescents and may help clinical decision making to optimize survival rate and organ utilization. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Locally Advanced Rectal Cancer Patients Receiving Radio-Chemotherapy: A Novel Clinical-Pathologic Score Correlates With Global Outcome

    SciTech Connect

    Berardi, Rossana; Mantello, Giovanna; Scartozzi, Mario; Del Prete, Stefano; Luppi, Gabriele; Martinelli, Roberto; Fumagalli, Marco; Grillo-Ruggieri, Filippo; Bearzi, Italo; Mandolesi, Alessandra; Marmorale, Cristina; Cascinu, Stefano

    2009-12-01

    Purpose: To determine the importance of downstaging of locally advanced rectal cancer after neoadjuvant treatment. Methods and Materials: The study included all consecutive patients with locally advanced rectal cancer who underwent neoadjuvant treatment (chemotherapy and/or radiotherapy) in different Italian centers from June 1996 to December 2003. A novel score was used, calculated as the sum of numbers obtained by giving a negative or positive point, respectively, to each degree of increase or decrease in clinical to pathologic T and N status. Results: A total of 317 patients were eligible for analysis. Neoadjuvant treatments performed were as follows: radiotherapy alone in 75 of 317 patients (23.7%), radiotherapy plus chemotherapy in 242 of 317 patients (76.3%). Worse disease-free survival was observed in patients with a lower score (Score 1 = -3 to +3 vs. Score 2 = +4 to +7; p = 0.04). Conclusions: Our results suggest that a novel score, calculated from preoperative and pathologic tumor and lymph node status, could represent an important parameter to predict outcome in patients receiving neoadjuvant treatment for rectal cancer. The score could be useful to select patients for adjuvant chemotherapy after neoadjuvant treatment and surgery.

  4. A leukocyte score to improve clinical outcome predictions in bacteremic pneumococcal pneumonia in adults.

    PubMed

    Blot, Mathieu; Croisier, Delphine; Péchinot, André; Vagner, Ameline; Putot, Alain; Fillion, Aurélie; Baudouin, Nicolas; Quenot, Jean-Pierre; Charles, Pierre-Emmanuel; Bonniaud, Philippe; Chavanet, Pascal; Piroth, Lionel

    2014-09-01

    Bacteremic pneumococcal pneumonia (BPP) is associated with high and early mortality. A simple procedure to predict mortality is crucial. All adult patients with BPP admitted from 2005 through 2013 to the University Hospital of Dijon, France, were enrolled to study 30-day mortality and associated factors, particularly leukocyte counts. A simple leukocyte score was created by adding 1 point each for neutropenia (<1500 cells/mm(3)), lymphopenia (<400), and monocytopenia (<200). One hundred and ninety-two adult patients (mean age, 69 years; standard deviation [SD], 19 years) who had developed and were hospitalized for BPP (58% community-acquired) were included. The 30-day crude mortality rate was 21%. The mean Pneumonia Severity Index score was high at 127.3 (SD = 41.3). Among the 182 patients who had a white blood cell count, 34 (19%) had a high leukocyte score (≥2). Multivariate analysis revealed that mortality was significantly associated with a high leukocyte score (odds ratio, 6.28; 95% confidence interval, 2.35-16.78), a high respiratory rate, a low serum bicarbonate level, and an altered mental status (all P < .05). The leukocyte score was not significantly dependent on the previous state of immunosuppression, alcoholism, or viral coinfection, but it did correlate with an acute respiratory distress syndrome and a low serum bicarbonate level. This new leukocyte score, in combination with the well known predictive factors, seems of interest in predicting the risk of death in BPP. A high score correlated with organ dysfunction and probably reflects the level of immunoparalysis. Its predictive value has to be confirmed in other cohorts.

  5. Dynamic International Prognostic Scoring System scores, pre-transplant therapy and chronic graft-versus-host disease determine outcome after allogeneic hematopoietic stem cell transplantation for myelofibrosis

    PubMed Central

    Ditschkowski, Markus; Elmaagacli, Ahmet H.; Trenschel, Rudolf; Gromke, Tanja; Steckel, Nina K.; Koldehoff, Michael; Beelen, Dietrich W.

    2012-01-01

    Background Myelofibrosis is a myeloproliferative stem cell disorder curable exclusively by allogeneic hematopoietic stem cell transplantation and is associated with substantial mortality and morbidity. The aim of this study was to assess disease-specific and transplant-related risk factors that influence post-transplant outcome in patients with myelofibrosis. Design and Methods We retrospectively assessed 76 consecutive patients with primary (n=47) or secondary (n=29) myelofibrosis who underwent bone marrow (n=6) or peripheral blood stem cell (n=70) transplantation from sibling (n=30) or unrelated (n=46) donors between January 1994 and December 2010. The median follow-up of surviving patients was 55±7.5 months. Results Primary graft failure occurred in 5% and the non-relapse mortality rate at 1 year was 28%. The relapse-free survival rate was 50% with a relapse rate of 19% at 5 years. The use of pharmacological pre-treatment and the post-transplant occurrence of chronic graft-versus-host disease were significant independent unfavourable risk factors for post-transplant survival in multivariate analysis. Using the Dynamic International Prognostic Scoring System for risk stratification, low-risk patients had significantly better overall survival (P=0.014, hazard ratio 1.4) and relapse-free survival (P=0.02, hazard ratio 1.3) compared to the other risk groups of patients. The additional inclusion of thrombocytopenia, abnormal karyotype and transfusion need (Dynamic International Prognostic Scoring System Plus) resulted in a predicted 5-year overall survival of 100%, 51%, 54% and 30% for low, intermediate-1, intermediate-2 and high-risk groups, respectively. The relapse incidence was significantly higher in the absence of chronic graft-versus-host disease (P=0.006), and pharmacological pre-treatment (n=43) was associated with reduced relapse-free survival (P=0.001). Conclusions The data corroborate a strong correlation between alloreactivity and long-term post

  6. Estimating the effect of incident delirium on short-term outcomes in aged hip fracture patients through propensity score analysis.

    PubMed

    Radinovic, Kristina; Markovic-Denic, Ljiljana; Dubljanin-Raspopovic, Emilija; Marinkovic, Jelena; Milan, Zoka; Bumbasirevic, Vesna

    2015-07-01

    We aimed to evaluate the factors contributing to delirium after hip fracture and assess the effect of incident delirium on short-term clinical outcomes. A total of 270 non-delirious, consecutive hip fracture patients 60 years and older were included in a prospective cohort study. The patients were assessed with respect to physical status according to the American Society of Anesthesiologists classification, medical comorbidities with the Charlson Comorbidity Index, cognitive function with the Portable Mental Status Questionnaire and depression with the Geriatric Depressive Scale. Incident delirium was evaluated daily. Clinical outcomes and 1-month mortality were recorded. Incident delirium was present in 53.0% of patients. Patients with delirium were older (P = 0.046), had higher American Society of Anesthesiologists and Charlson Comorbidity Index scores (P < 0.001), lower Portable Mental Status Questionnaire scores and higher Geriatric Depressive Scale scores (P < 0.001, P = 0.003, respectively). After adjusting for age, multivariate regression analysis in the first model showed that patients with delirium were at higher risk of reintervention plus death (P < 0.05), complications P < 0.001), a higher severity complication score (P < 0.05) and longer length of hospital stay (P < 0.001). In the second model, after adjusting for propensity score, patients with delirium were at higher risk of reintervention plus death (P < 0.05) and longer length of hospital stay (P < 0.01). Patients who are older, with worse physical status, worse cognitive function and depression are more likely to develop delirium after hip fracture. Incident delirium has negative independent effects on short-term outcomes in elderly patients after hip fracture. © 2014 Japan Geriatrics Society.

  7. Child Feeding and Parenting Style Outcomes and Composite Score Measurement in the 'Feeding Healthy Food to Kids Randomised Controlled Trial'.

    PubMed

    Duncanson, Kerith; Burrows, Tracy L; Collins, Clare E

    2016-11-10

    Child feeding practices and parenting style each have an impact on child dietary intake, but it is unclear whether they influence each other or are amenable to change. The aims of this study were to measure child feeding and parenting styles in the Feeding Healthy Food to Kids (FHFK) Randomized Controlled Trial (RCT) and test a composite child feeding score and a composite parenting style score. Child feeding and parenting style data from 146 parent-child dyads (76 boys, aged 2.0-5.9 years) in the FHFK study were collected over a 12-month intervention. Parenting style was measured using parenting questions from the Longitudinal Study of Australian Children and the Child Feeding Questionnaire (CFQ) was used to measure child feeding practices. Data for both measures were collected at baseline, 3 and 12 months and then modelled to develop a composite child feeding score and a parenting score. Multivariate mixed effects linear regression was used to measure associations between variables over time. All child feeding domains from the CFQ were consistent between baseline and 12 months (p < 0.001), except for monitoring (0.12, p = 0.44). All parenting style domain scores were consistent over 12 months (p < 0.001), except for overprotection (0.22, p = 0.16). A significant correlation (r = 0.42, p < 0.0001) existed between child feeding score and parenting style score within the FHFK RCT. In conclusion, composite scores have potential applications in the analysis of relationships between child feeding and dietary or anthropometric data in intervention studies aimed at improving child feeding or parenting style. These applications have the potential to make a substantial contribution to the understanding of child feeding practices and parenting style, in relation to each other and to dietary intake and health outcomes amongst pre-school aged children.

  8. Comparison of point-of-care hemostatic assays, routine coagulation tests, and outcome scores in critically ill patients.

    PubMed

    Larsson, A; Tynngård, N; Kander, T; Bonnevier, J; Schött, U

    2015-10-01

    The purposes of the study are to compare point-of-care (POC) hemostatic devices in critically ill patients with routine laboratory tests and intensive care unit (ICU) outcome scoring assessments and to describe the time course of these variables in relation to mortality rate. Patients admitted to the ICU with a prognosis of more than 3 days of stay were included. The POC devices, Multiplate platelet aggregometry, rotational thromboelastometry, and ReoRox viscoelastic tests, were used. All variables were compared between survivors and nonsurvivors. Point-of-care results were compared to prothrombin time, activated partial thromboplastin time, platelet count, fibrinogen concentration, and Sequential Organ Failure Assessment score and Simplified Acute Physiology Score 3. Blood was sampled on days 0 to 1, 2 to 3, and 4 to 10 from 114 patients with mixed diagnoses during 237 sampling events. Nonsurvivors showed POC and laboratory signs of hypocoagulation and decreased fibrinolysis over time compared to survivors. ReoRox detected differences between survivors and nonsurvivors better than ROTEM and Multiplate. All POC and routine laboratory tests showed a hypocoagulative response in nonsurvivors compared to survivors. ReoRox was better than ROTEM and Multiplate at detecting differences between surviving and nonsurviving ICU patients. However, Simplified Acute Physiology Score 3 showed the best association to mortality outcome. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Modern perspectives of measurement validation emphasize justification of inferences based on patient-reported outcome scores: seventh paper in a series on patient reported outcomes.

    PubMed

    Sawatzky, Richard; Chan, Eric K H; Zumbo, Bruno D; Ahmed, Sara; Bartlett, Susan J; Bingham, Clifton O; Gardner, William; Jutai, Jeffrey; Kuspinar, Ayse; Sajobi, Tolulope; Lix, Lisa M

    2016-12-18

    Obtaining the patient's view about the outcome of care is an essential component of patient-centered care. Many patient-reported outcome (PRO) instruments for different purposes have been developed since the 1960s. Measurement validation is fundamental in the development, evaluation, and use of PRO instruments. This paper provides a review of modern perspectives of measurement validation in relation to the followings three questions as applied to PROs: (1) What evidence is needed to warrant comparisons between groups and individuals? (2) What evidence is needed to warrant comparisons over time? and (3) What are the value implications, including personal and societal consequences, of using PRO scores? Measurement validation is an ongoing process that involves the accumulation of evidence regarding the justification of inferences, actions, and decisions based on measurement scores. These include inferences pertaining to comparisons between groups and comparisons over time as well as consideration of value implications of using PRO scores. Personal and societal consequences must be examined as part of a comprehensive approach to measurement validation. The answers to these three questions are fundamental to the the validity of different types of inferences, actions, and decisions made on PRO scores in health research, health care administration, and clinical practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Validation of Patient-Reported Outcomes Measurement Information System Computerized Adaptive Tests Against the Foot and Ankle Outcome Score for 6 Common Foot and Ankle Pathologies.

    PubMed

    Koltsov, Jayme C B; Greenfield, Stephen T; Soukup, Dylan; Do, Huong T; Ellis, Scott J

    2017-08-01

    The field of foot and ankle surgery lacks a widely accepted gold-standard patient-reported outcome instrument. With the changing infrastructure of the medical profession, more efficient patient-reported outcome tools are needed to reduce respondent burden and increase participation while providing consistent and reliable measurement across multiple pathologies and disciplines. The primary purpose of the present study was to validate 3 Patient-Reported Outcomes Measurement Information System computer adaptive tests (CATs) most relevant to the foot and ankle discipline against the Foot and Ankle Outcome Score (FAOS) and the Short Form 12 general health status survey in patients with 6 common foot and ankle pathologies. Patients (n = 240) indicated for operative treatment for 1 of 6 common foot and ankle pathologies completed the CATs, FAOS, and Short Form 12 at their preoperative surgical visits, 1 week subsequently (before surgery), and at 6 months postoperatively. The psychometric properties of the instruments were assessed and compared. The Patient-Reported Outcomes Measurement Information System CATs each took less than 1 minute to complete, whereas the FAOS took 6.5 minutes, and the Short Form 12 took 3 minutes. CAT scores were more normally distributed and had fewer floor and ceiling effects than those on the FAOS, which reached as high as 24%. The CATs were more precise than the FAOS and had similar responsiveness and test-retest reliability. The physical function and mobility CATs correlated strongly with the activities subscale of the FAOS, and the pain interference CAT correlated strongly with the pain subscale of the FAOS. The CATs and FAOS were responsive to changes with operative treatment for 6 common foot and ankle pathologies. The CATs performed as well as or better than the FAOS in all aspects of psychometric validity. The Patient-Reported Outcomes Measurement Information System CATs show tremendous potential for improving the study of patient

  11. Special Education Outcomes and Young Australian School Students: A Propensity Score Analysis Replication

    ERIC Educational Resources Information Center

    Dempsey, Ian; Valentine, Megan

    2017-01-01

    Using a second cohort of Australian school students, this study repeated the propensity score analysis reported by Dempsey, Valentine, and Colyvas (2016) that found that 2 years after receiving special education support, a group of infant grade students performed significantly less well in academic and social skills in comparison to matched groups…

  12. The Disaggregation of Value-Added Test Scores to Assess Learning Outcomes in Economics Courses

    ERIC Educational Resources Information Center

    Walstad, William B.; Wagner, Jamie

    2016-01-01

    This study disaggregates posttest, pretest, and value-added or difference scores in economics into four types of economic learning: positive, retained, negative, and zero. The types are derived from patterns of student responses to individual items on a multiple-choice test. The micro and macro data from the "Test of Understanding in College…

  13. Impact of malnutrition on pediatric risk of mortality score and outcome in Pediatric Intensive Care Unit

    PubMed Central

    Nangalu, Romi; Pooni, Puneet Aulakh; Bhargav, Siddharth; Bains, Harmesh Singh

    2016-01-01

    Objectives: This study was done to determine the effect of malnutrition on mortality in Pediatric Intensive Care Unit (PICU) and on the pediatric risk of mortality (PRISM) scoring. Subjects and Methods: This was a prospective study done over 1 year. There were total 400 patients (1 month 14 years), who were divided into cases with weight for age <3rd centile and controls with ≥3rd centile of WHO charts. Cases were subdivided into mild/moderate (61–80% of expected weight for age) and severe malnutrition (<60%). Results: Out of total, 38.5% patients were underweight, and malnutrition was more in infancy, 61/104, i.e. 58.5% (P - 0.003). There was no significant difference in vitals at admission. Cases needed prolonged mechanical ventilation (P - 0.0063) and hospital stay (P - 0.0332) compared to controls. Mean and median PRISM scores were comparable in both the groups, but mortality was significantly higher in severely malnourished (P value 0.027). Conclusion: Severe malnutrition is independently associated with higher mortality even with similar PRISM score. There is need to give an additional score to children with weight for age <60% of expected. PMID:27555691

  14. The Disaggregation of Value-Added Test Scores to Assess Learning Outcomes in Economics Courses

    ERIC Educational Resources Information Center

    Walstad, William B.; Wagner, Jamie

    2016-01-01

    This study disaggregates posttest, pretest, and value-added or difference scores in economics into four types of economic learning: positive, retained, negative, and zero. The types are derived from patterns of student responses to individual items on a multiple-choice test. The micro and macro data from the "Test of Understanding in College…

  15. Pneumonia severity index class v patients with community-acquired pneumonia: characteristics, outcomes, and value of severity scores.

    PubMed

    Valencia, Mauricio; Badia, Joan R; Cavalcanti, Manuela; Ferrer, Miquel; Agustí, Carles; Angrill, Joaquin; García, Elisa; Mensa, Josep; Niederman, Michael S; Torres, Antoni

    2007-08-01

    Community-acquired pneumonia (CAP) with a pneumonia severity index (PSI) score in risk class V (PSI-V) is a potentially life-threatening condition, yet the majority of patients are not admitted to the ICU. The aim of this study was to characterize CAP patients in PSI-V to determine the risk factors for ICU admission and mortality, and to assess the performance of CAP severity scores in this population. Prospective observational study including hospitalized adults with CAP in PSI-V from 1996 to 2003. Clinical and laboratory data, microbiological findings, and outcomes were recorded. The PSI score; modified American Thoracic Society (ATS) score; the confusion, urea, respiratory rate, low BP (CURB) score, and CURB plus age of >/= 65 years score were calculated. A reduced score based on the acute illness variables contained in the PSI was also obtained. A total of 457 patients were included in the study (mean [+/- SD] age, 79 +/- 11 years), of whom 92 (20%) were admitted to the ICU. Patients in the ward were older (mean age, 82 +/- 10 vs 70 +/- 10 years, respectively) and had more comorbidities. ICU patients experienced significantly more acute organ failures. The mortality rate was higher in ICU patients, but also was high for non-ICU patients (37% vs 20%, respectively; p = 0,003). A low level of consciousness (odds ratio [OR], 3.95; 95% confidence interval [CI], 2 to 5) and shock (OR, 24.7; 95% CI, 14 to 44) were associated with a higher risk of death. The modified ATS severity rule had the best accuracy in predicting ICU admission and mortality. Most CAP patients PSI-V were treated on a hospital ward. Those admitted to the ICU were younger and had findings of more acute illness. The PSI performed well as a mortality prediction tool but was less appropriate for guiding site-of-care decisions.

  16. Biochemical markers and somatosensory evoked potentials in patients after cardiac arrest: the role of neurological outcome scores.

    PubMed

    Rana, Obaida R; Saygili, Erol; Schiefer, Johannes; Marx, Nikolaus; Schauerte, Patrick

    2011-06-15

    Biochemical markers, e.g. NSE or S100B, and somatosensory evoked potentials (SSEP) are considered promising candidates for neurological prognostic predictors in patients after cardiac arrest (CA). The Utstein Templates recommend the use of the Glasgow-Pittsburgh Cerebral Performance Categories (GP-CPC) to divide patients according to their neurological outcome. However, several studies investigating biochemical markers and SSEP are based on the Glasgow Outcome Score (GOS). We noticed that many studies failed to exclude patients who died without certified brain damage from patients classified as poor outcome, instead including all patients who died into this category. Therefore, we summarized the published NSE cut-off values and the derived sensitivity and specificity to predict poor outcome of those studies which only included patients with certified brain death in GOS-1 or GP-CPC-5 (group A) vs. those studies which did not differentiate between death from any cause or death due to primary brain damage (group B). On average, mean NSE cut-off values and sensitivity were higher (56 ± 35 ng/ml, 56 ± 18%) in group A than in group B (41 ± 17 ng/ml, 44 ± 25%), respectively. The specificity remained equally high in both groups. In analogy, the average sensitivity of SSEP to predict poor outcome was higher in group A (76 ± 11%) than in group B (50 ± 15%), while the specificity was similar in both groups. Conclusively, inclusion of deaths without certified brain damage after CA in neurological outcome studies will lead to underestimation of the prognostic power of biochemical or electrophysiological markers for brain damage. A modified GOS and GP-CPC score might help to avoid this bias.

  17. The totaled health risks in vascular events (THRIVE) score predicts ischemic stroke outcomes independent of thrombolytic therapy in the NINDS tPA trial.

    PubMed

    Kamel, Hooman; Patel, Nihar; Rao, Vivek A; Cullen, Sean P; Faigeles, Bonnie S; Smith, Wade S; Flint, Alexander C

    2013-10-01

    To date, no ischemic stroke outcome prediction scores have been validated for use in the setting of both endovascular and non-endovascular stroke treatments. The Totaled Health Risks in Vascular Events (THRIVE) score has been previously validated in patients undergoing endovascular stroke treatment, and we hypothesized that it would perform similarly well in patients receiving intravenous tissue plasminogen activator (tPA) or no acute therapy. We compared the performance of the THRIVE score between patients in the National Institutes of Neurological Disorders and Stroke (NINDS) tPA trial and patients in the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trials of endovascular stroke treatment. The predictive performance of the THRIVE score was compared using receiver operator characteristic (ROC) curve analysis. In the NINDS cohort, separate analyses were also performed for patients receiving tPA versus those receiving placebo. ROC curve analysis revealed a good prediction of outcomes across the range of THRIVE scores in both the NINDS and MERCI datasets. As we have previously found in the MERCI datasets, the THRIVE score, which encompasses the National Institutes of Health Stroke Scale (NIHSS) score, age, and chronic disease burden, was a better predictor of outcomes than NIHSS and age alone in the NINDS trial dataset. THRIVE score and tPA administration both strongly predicted outcome, but these effects were statistically independent. The THRIVE score provides accurate prediction of long-term neurologic outcomes in patients with acute ischemic stroke regardless of treatment modality. Both the THRIVE score and tPA administration predict outcome, but the THRIVE score does not influence the impact of tPA on outcome, and tPA administration does not influence the impact of THRIVE score on outcome. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Instrument for scoring clinical outcome of research for epidermolysis bullosa: a consensus-generated clinical research tool.

    PubMed

    Schwieger-Briel, Agnes; Chakkittakandiyil, Ajith; Lara-Corrales, Irene; Aujla, Nimrita; Lane, Alfred T; Lucky, Anne W; Bruckner, Anna L; Pope, Elena

    2015-01-01

    Epidermolysis bullosa (EB) is a genetic condition characterized by skin fragility and blistering. There is no instrument available for clinical outcome research measurements. Our aim was to develop a comprehensive instrument that is easy to use in the context of interventional studies. Item collection was accomplished using a two-step Delphi Internet survey process for practitioners and qualitative content analysis of patient and family interviews. Items were reduced based on frequency and importance using a 4-point Likert scale and were subject to consensus (>80% agreement) using the nominal group technique. Pilot data testing was performed in 21 consecutive patients attending an EB clinic. The final score, Instrument for Scoring Clinical Outcome of Research for Epidermolysis Bullosa (iscorEB), is a combined score that contains clinician items grouped in five domains (skin, mucosa, organ involvement, laboratory abnormalities, and complications and procedures; maximum score 114) and patient-derived items (pain, itch, functional limitations, sleep, mood, and effect on daily and leisurely activities; maximum score 120). Pilot testing revealed that combined (see below) and subscores were able to differentiate between EB subtypes and degrees of clinical severity (EB simplex 21.7 ± 16.5, junctional EB 28.0 ± 20.7, dystrophic EB 57.3 ± 24.6, p = 0.007; mild 17.3 ± 9.6, moderate 41.0 ± 19.4, and severe 64.5 ± 22.6, p < 0.001). There was high correlation between clinician and patient subscores (correlation coefficient = 0.79, p < 0.001). iscorEB seems to be a sensitive tool in differentiating between EB types and across the clinical spectrum of severity. Further validation studies are needed. © 2014 Wiley Periodicals, Inc.

  19. Impact of a standardized test package on exit examination scores and NCLEX-RN outcomes.

    PubMed

    Homard, Catherine M

    2013-03-01

    The purpose of this ex post facto correlational study was to compare exit examination scores and NCLEX-RN(®) pass rates of baccalaureate nursing students who differed in level of participation in a standardized test package. Three cohort groups emerged as a standardized test package was introduced: (a) students who did not participate in a standardized test package; (b) students with two semesters of a standardized test package; and (c) students with four semesters of a standardized test package. Benner's novice-to-expert theory framed the study in the belief that students best acquire knowledge and skills through practice and reflection. Students participating in four semesters of a standardized test package demonstrated higher exit examination scores and NCLEX-RN pass rates compared with students who did not participate in this package. This study's results could inform nurse educators about strategies to facilitate nursing student success on exit examinations and the NCLEX-RN. Copyright 2013, SLACK Incorporated.

  20. Development of a fetal risk assessment score for the prediction of neonatal outcome in the growth-restricted fetus.

    PubMed

    Ott, William J

    2012-10-01

    To develop and analyze a fetal risk assessment score (FRAS) that incorporates fetal arterial and venous blood flow studies (BFS), amniotic fluid volume, the non-stress test (NST) and an estimated fetal weight to improve the ability of antenatal testing to identify fetuses at risk for poor perinatal outcome and compare it to the Biophysical Profile (BPP). The Perinatal data base of the author's institution was searched for all patients with singleton gestation with the diagnosis of intrauterine growth restriction, and who had both a biophysical profile (BPP) and fetal BFS (umbilical and middle cerebral artery, ductus venosus) within 4 days of delivery. Fetuses with major congenital abnormalities, chromosomal anomalies, or who delivered less than 25 weeks gestation were excluded. A FRAS score was developed by assigning numerical points for increasing abnormal arterial and venous BFS, and one point each for a non-reactive NST, oligohydramnios or if the fetus was small for gestational age. Recommendations for delivery were based on the clinical situation and the results of the Biophysical Profile (BPP); the FRAS score was not available to the attending physician. The FRAS was then compared to the BPP for the prediction of poor neonatal outcome (significant neonatal complications or prolonged hospital stay) using receiver operating characteristic (ROC) curve analysis and χ(2) analysis. Two hundred twenty-nine patients were included in the study. The results of the ROC analysis showed that the designed FRAS (area: 0.802) was slightly better than the BPP (area: 0.659) at predicting poor perinatal outcome in a group of growth-restricted fetuses. The study gives support to the hypothesis that combining biophysical tests with BFS will improve the identification of potential high-risk patients at increased risk for poor neonatal outcome, but prospective, randomized studies are needed to confirm this hypothesis.

  1. Pediatric ECMO outcomes: comparison of centrifugal versus roller blood pumps using propensity score matching.

    PubMed

    Barrett, Cindy S; Jaggers, James J; Cook, E Francis; Graham, Dionne A; Yarlagadda, Vasmi V; Teele, Sarah A; Almond, Christopher S; Bratton, Susan L; Seeger, John D; Dalton, Heidi J; Rycus, Peter T; Laussen, Peter C; Thiagarajan, Ravi R

    2013-01-01

    Centrifugal blood pumps are being increasingly utilized in children supported with extracorporeal membrane oxygenation (ECMO). Our aim was to determine if survival and ECMO-related morbidities in children supported with venoarterial (VA) ECMO differed by blood pump type.Children aged less than 18 years who underwent VA ECMO support from 2007 to 2009 and reported to the Extracorporeal Life Support Organization registry were propensity score matched (Greedy 1:1 matching) using pre-ECMO characteristics.A total of 2,656 (centrifugal = 2,231, roller = 425) patients were identified and 548 patients (274 per pump type) were included in the propensity score-matched cohort. Children supported with centrifugal pumps had increased odds of hemolysis (odds ratio [OR], 4.03 95% confidence interval [CI], 2.37-6.87), hyperbilirubinemia (OR, 5.48; 95% CI, 2.62-11.49), need for inotropic support during ECMO (OR, 1.54; 95% CI, 1.09-2.17), metabolic alkalosis (blood pH > 7.6) during ECMO (OR, 3.13; 95% CI, 1.49-6.54), and acute renal failure (OR, 1.61; 95% CI, 1.10-2.39). Survival to hospital discharge did not differ by pump type.In a propensity score-matched cohort of pediatric ECMO patients, children supported with centrifugal pumps had increased odds of ECMO-related complications. There was no difference in survival between groups.

  2. Classification of individual well-being scores for the determination of adverse health and productivity outcomes in employee populations.

    PubMed

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

    2013-04-01

    Adverse health and productivity outcomes have imposed a considerable economic burden on employers. To facilitate optimal worksite intervention designs tailored to differing employee risk levels, the authors established cutoff points for an Individual Well-Being Score (IWBS) based on a global measure of well-being. Cross-sectional associations between IWBS and adverse health and productivity outcomes, including high health care cost, emergency room visits, short-term disability days, absenteeism, presenteeism, low job performance ratings, and low intentions to stay with the employer, were studied in a sample of 11,702 employees from a large employer. Receiver operating characteristics curves were evaluated to detect a single optimal cutoff value of IWBS for predicting 2 or more adverse outcomes. More granular segmentation was achieved by computing relative risks of each adverse outcome from logistic regressions accounting for sociodemographic characteristics. Results showed strong and significant nonlinear associations between IWBS and health and productivity outcomes. An IWBS of 75 was found to be the optimal single cutoff point to discriminate 2 or more adverse outcomes. Logistic regression models found abrupt reductions of relative risk also clustered at IWBS cutoffs of 53, 66, and 88, in addition to 75, which segmented employees into high, high-medium, medium, low-medium, and low risk groups. To determine validity and generalizability, cutoff values were applied in a smaller employee population (N=1853) and confirmed significant differences between risk groups across health and productivity outcomes. The reported segmentation of IWBS into discrete cohorts based on risk of adverse health and productivity outcomes should facilitate well-being comparisons and worksite interventions.

  3. Classification of Individual Well-Being Scores for the Determination of Adverse Health and Productivity Outcomes in Employee Populations

    PubMed Central

    Sears, Lindsay E.; Coberley, Carter R.; Pope, James E.

    2013-01-01

    Abstract Adverse health and productivity outcomes have imposed a considerable economic burden on employers. To facilitate optimal worksite intervention designs tailored to differing employee risk levels, the authors established cutoff points for an Individual Well-Being Score (IWBS) based on a global measure of well-being. Cross-sectional associations between IWBS and adverse health and productivity outcomes, including high health care cost, emergency room visits, short-term disability days, absenteeism, presenteeism, low job performance ratings, and low intentions to stay with the employer, were studied in a sample of 11,702 employees from a large employer. Receiver operating characteristics curves were evaluated to detect a single optimal cutoff value of IWBS for predicting 2 or more adverse outcomes. More granular segmentation was achieved by computing relative risks of each adverse outcome from logistic regressions accounting for sociodemographic characteristics. Results showed strong and significant nonlinear associations between IWBS and health and productivity outcomes. An IWBS of 75 was found to be the optimal single cutoff point to discriminate 2 or more adverse outcomes. Logistic regression models found abrupt reductions of relative risk also clustered at IWBS cutoffs of 53, 66, and 88, in addition to 75, which segmented employees into high, high-medium, medium, low-medium, and low risk groups. To determine validity and generalizability, cutoff values were applied in a smaller employee population (N=1853) and confirmed significant differences between risk groups across health and productivity outcomes. The reported segmentation of IWBS into discrete cohorts based on risk of adverse health and productivity outcomes should facilitate well-being comparisons and worksite interventions. (Population Health Management 2013;16:90–98) PMID:23013034

  4. Major Field Achievement Test in Business: Guidelines for Improved Outcome Scores--Part I

    ERIC Educational Resources Information Center

    McLaughlin, J. Patrick; White, Jason T.

    2007-01-01

    Outcomes measurements have always been an important part of proving to outside constituencies how you "measure up" to other schools with your business programs. A common nationally-normed exam that is used is the Major Field Achievement Test in Business from Educational Testing Services. Our paper discusses some guidelines that we are…

  5. Correlation of Social Science Students' Grade Outcome with Reading and Writing Scores.

    ERIC Educational Resources Information Center

    Parrott, Marietta

    A study was conducted at College of the Sequoias (COS) to examine the entry-level reading and writing skills of students and their grade outcomes in the social science courses for which they were enrolled. The study sought to identify any predictors of students' eventual success/non-success in class. The study focused on the placement test scores…

  6. External validation of the ability of the DRAGON score to predict outcome after thrombolysis treatment.

    PubMed

    Ovesen, C; Christensen, A; Nielsen, J K; Christensen, H

    2013-11-01

    Easy-to-perform and valid assessment scales for the effect of thrombolysis are essential in hyperacute stroke settings. Because of this we performed an external validation of the DRAGON scale proposed by Strbian et al. in a Danish cohort. All patients treated with intravenous recombinant plasminogen activator between 2009 and 2011 were included. Upon admission all patients underwent physical and neurological examination using the National Institutes of Health Stroke Scale along with non-contrast CT scans and CT angiography. Patients were followed up through the Outpatient Clinic and their modified Rankin Scale (mRS) was assessed after 3 months. Three hundred and three patients were included in the analysis. The DRAGON scale proved to have a good discriminative ability for predicting highly unfavourable outcome (mRS 5-6) (area under the curve-receiver operating characteristic [AUC-ROC]: 0.89; 95% confidence interval [CI] 0.81-0.96; p<0.001) and good outcome (mRS 0-2) (AUC-ROC: 0.79; 95% CI 0.73-0.85; p<0.001). When only patients with M1 occlusions were selected the DRAGON scale provided good discriminative capability (AUC-ROC: 0.89; 95% CI 0.78-1.0; p=0.003) for highly unfavourable outcome. We confirmed the validity of the DRAGON scale in predicting outcome after thrombolysis treatment.

  7. Accreditation Outcome Scores: Teacher Attitudes toward the Accreditation Process and Professional Development

    ERIC Educational Resources Information Center

    Ulmer, Phillip Gregory

    2015-01-01

    Accreditation is an essential component in the history of education in the United States and is a central catalyst for quality education, continuous improvement, and positive growth in student achievement. Although previous researchers identified teachers as an essential component in meeting accreditation outcomes, additional information was…

  8. 3-D volumetric computed tomographic scoring as an objective outcome measure for chronic rhinosinusitis: Clinical correlations and comparison to Lund-Mackay scoring

    PubMed Central

    Pallanch, John; Yu, Lifeng; Delone, David; Robb, Rich; Holmes, David R.; Camp, Jon; Edwards, Phil; McCollough, Cynthia H.; Ponikau, Jens; Dearking, Amy; Lane, John; Primak, Andrew; Shinkle, Aaron; Hagan, John; Frigas, Evangelo; Ocel, Joseph J.; Tombers, Nicole; Siwani, Rizwan; Orme, Nicholas; Reed, Kurtis; Jerath, Nivedita; Dhillon, Robinder; Kita, Hirohito

    2014-01-01

    Background We aimed to test the hypothesis that 3-D volume-based scoring of computed tomographic (CT) images of the paranasal sinuses was superior to Lund-Mackay CT scoring of disease severity in chronic rhinosinusitis (CRS). We determined correlation between changes in CT scores (using each scoring system) with changes in other measures of disease severity (symptoms, endoscopic scoring, and quality of life) in patients with CRS treated with triamcinolone. Methods The study group comprised 48 adult subjects with CRS. Baseline symptoms and quality of life were assessed. Endoscopy and CT scans were performed. Patients received a single systemic dose of intramuscular triamcinolone and were reevaluated 1 month later. Strengths of the correlations between changes in CT scores and changes in CRS signs and symptoms and quality of life were determined. Results We observed some variability in degree of improvement for the different symptom, endoscopic, and quality-of-life parameters after treatment. Improvement of parameters was significantly correlated with improvement in CT disease score using both CT scoring methods. However, volumetric CT scoring had greater correlation with these parameters than Lund-Mackay scoring. Conclusion Volumetric scoring exhibited higher degree of correlation than Lund-Mackay scoring when comparing improvement in CT score with improvement in score for symptoms, endoscopic exam, and quality of life in this group of patients who received beneficial medical treatment for CRS. PMID:24106202

  9. Multi-domain patient reported outcomes of irritable bowel syndrome: exploring person centered perspectives to better understand symptom severity scores

    PubMed Central

    Lackner, Jeffrey M.; Jaccard, James; Baum, Charles

    2012-01-01

    Objectives Patient reported outcomes (PRO) assessing multiple gastrointestinal symptoms are central to characterizing the therapeutic benefit of novel agents for irritable bowel syndrome (IBS). Common approaches that sum or average responses across different illness components must be unidimensional and have small unique variances to avoid aggregation bias and misinterpretation of clinical data. This study sought to evaluate the unidimensionality of the IBS Symptom Severity Scale (IBS-SSS) and to explore person centered cluster analytic methods for characterizing multivariate-based patient profiles. Methods Ninety-eight Rome-diagnosed IBS patients completed the IBS-SSS and a single, global item of symptom severity (UCLA Symptom Severity Scale) at pretreatment baseline of an NIH funded clinical trial. A k-means cluster analyses were performed on participants symptom severity scores. Results The IBS-SSS was not unidimensional. Exploratory cluster analyses revealed four common symptom profiles across five items of the IBS-SSS. One cluster of patients (25%) had elevated scores on pain frequency and bowel dissatisfaction, with less elevated but still high scores on life interference and low pain severity ratings. A second cluster (19%) was characterized by intermediate scores on both pain dimensions, but more elevated scores on bowel dissatisfaction. A third cluster (18%) was elevated across all IBS-SSS sub-components. The fourth and most common cluster (37%) had relatively low scores on all dimensions except bowel dissatisfaction and life interference due to IBS symptoms. Conclusions PRO endpoints and research on IBS more generally relying on multicomponent assessments of symptom severity should take into account the multidimensional structure of symptoms to avoid aggregation bias and to optimize the sensitivity of detecting treatment effects. PMID:23337220

  10. The Effect of Postoperative KT-1000 Arthrometer Score on Long-Term Outcome After Anterior Cruciate Ligament Reconstruction.

    PubMed

    Goodwillie, Andrew D; Shah, Sarav S; McHugh, Malachy P; Nicholas, Stephen J

    2017-06-01

    Many long-term studies have looked at outcomes after anterior cruciate ligament reconstruction (ACLR), but none have correlated long-term outcomes with postoperative laxity greater than 5 mm. It has been stated previously that more than 5 mm of postoperative graft laxity constituted a procedural failure. To directly compare tight grafts (<3 mm) and loose grafts (>5 mm) to determine the effect of graft laxity, as measured by KT-1000 arthrometer, after ACLR on long-term clinical outcomes. Cohort study; Level of evidence, 2. The study included 171 consecutive patients who had undergone transtibial bone-patellar tendon-bone ACLR between 1992 and 1998. At 6, 12, and 24 months postoperatively (the immediate postoperative period), patients were evaluated. Group A included patients with a maximal side-to-side (STS) difference in the immediate postoperative period of less than 3 mm (tight grafts), and group B included patients with a maximal STS difference of greater than 5 mm (loose grafts). Any patient with a history of ipsilateral or contralateral ACLR or ACL injury, meniscectomy, or cartilage restoration was excluded. Patients were prospectively followed to long-term follow-up, when a telephone interview was conducted regarding knee function and to document Lysholm, Tegner, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) subjective outcome scores. Eighty-seven patients met inclusion criteria: 66 tight grafts (group A) and 21 loose grafts (group B). The mean ± SD time to follow-up was 16.3 ± 1.5 years in group A (n = 46) and 16.8 ± 1.3 years in group B (n = 15). Tegner ( P = .77), Lysholm ( P = .85), KOOS ( P = .96), and IKDC ( P = .42) were found to have no statistically significant difference between groups at long-term follow-up. Both Tegner and Lysholm scores significantly improved in tight and loose grafts in the immediate postoperative period as well as at long-term follow-up compared with preoperatively

  11. Validation of Serial Alberta Stroke Program Early CT Score as an Outcome Predictor in Thrombolyzed Stroke Patients.

    PubMed

    Kong, Wan-Yee; Tan, Benjamin Y Q; Ngiam, Nicholas J H; Tan, Deborah Y C; Yuan, Christine H; Holmin, Staffan; Andersson, Tommy; Lundström, Erik; Teoh, Hock Luen; Chan, Bernard P L; Rathakrishnan, Rahul; Ting, Eric Y S; Sharma, Vijay K; Yeo, Leonard L L

    2017-10-01

    The Alberta Stroke Program Early CT Score (ASPECTS) on baseline imaging is an established predictor of functional outcome in anterior circulation acute ischemic stroke (AIS). We studied ASPECTS before intravenous thrombolysis (IVT) and at 24 hours to assess its prognostic value. Data for consecutive anterior circulation AIS patients treated with IVT from 2006 to 2013 were extracted from a prospectively managed registry at our tertiary center. Pre-thrombolysis and 24-hour ASPECTS were evaluated by 2 independent neuroradiologists. Outcome measures included symptomatic intracranial hemorrhage (SICH), modified Rankin Scale (mRS) at 90 days, and mortality. Unfavorable functional outcome was defined by mRS >1. Dramatic ASPECTS progression (DAP) was defined as deterioration in ASPECTS by 6 points or more. Of 554 AIS patients thrombolyzed during the study period, 400 suffered from anterior circulation infarction. The median age was 65 years (interquartile range (IQR): 59-70) and the median National Institutes of Health Stroke Scale score was 18 points (IQR: 12-22). Compared with the pre-IVT ASPECTS (area under the curve [AUC] = .64, 95% confidence interval [CI]: .54-.65, P = .001), ASPECTS on the 24-hour CT scan (AUC = .78, 95% CI: .73-.82, P < .001), and change in ASPECTS (AUC = .69, 95% CI: .64-.74, P < .001) were better predictors of unfavorable functional outcome at 3 months. DAP, noted in 34 (14.4%) patients with good baseline ASPECTS (8-10 points), was significantly associated with unfavorable functional outcome (odds ratio [OR]: 9.91, 95% CI: 3.37-29.19, P ≤ .001), mortality (OR: 21.99, 95% CI: 7.98-60.58, P < .001), and SICH (OR: 8.57, 95% CI: 2.87-25.59, P < .001). Compared with the pre-thrombolysis score, ASPECTS measured at 24 hours as well as serial change in ASPECTS is a better predictor of 3-month functional outcome. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. Re-evaluating the Relationship between Prenatal Employment and Birth Outcomes: A Policy-Relevant Application of Propensity Score Matching

    PubMed Central

    Kozhimannil, Katy Backes; Attanasio, Laura B.; McGovern, Patricia M.; Gjerdingen, Dwenda K.; Johnson, Pamela Jo

    2012-01-01

    BACKGROUND Prior research shows an association between prenatal employment characteristics and adverse birth outcomes but suffers methodological challenges in disentangling women’s employment choices from birth outcomes, and little U.S.-based prior research compares outcomes for employed women with those not employed. This study assessed the effect of prenatal employment status on birth outcomes. METHODS With data from the Listening to Mothers II survey, conducted among a nationally representative sample of women who delivered a singleton baby in a U.S. hospital in 2005 (N=1,573), we used propensity score matching to reduce potential selection bias. Primary outcomes were low birth weight (< 2,500 grams) and preterm birth (gestational age < 37 weeks). Exposure was prenatal employment status (full-time, part-time, not employed). We conducted separate outcomes analyses for each matched cohort using multivariable regression models. FINDINGS Comparing full-time employees with women who were not employed, full-time employment was not causally associated with preterm birth (adjusted odds ratio AOR = 1.37, p = 0.47) or low birth weight (AOR = 0.73, p = 0.41). Results were similar comparing full- and part-time workers. Consistent with prior research, black women, regardless of employment status, had increased odds of low birth weight compared with white women (AOR = 5.07, p =0.002). CONCLUSIONS Prenatal employment does not independently contribute to preterm births or low birth weight after accounting for characteristics of women with different employment statuses. Efforts to improve birth outcomes should focus on the characteristics of pregnant women (employed or not) that render them vulnerable. PMID:23266134

  13. The relationship between spinopelvic measurements and patient-reported outcome scores in patients with multiple myeloma of the spine.

    PubMed

    Yu, H M; Malhotra, K; Butler, J S; Patel, A; Sewell, M D; Li, Y Z; Molloy, S

    2016-09-01

    Patients with multiple myeloma (MM) develop deposits in the spine which may lead to vertebral compression fractures (VCFs). Our aim was to establish which spinopelvic parameters are associated with the greatest disability in patients with spinal myeloma and VCFs. We performed a retrospective cross-sectional review of 148 consecutive patients (87 male, 61 female) with spinal myeloma and analysed correlations between spinopelvic parameters and patient-reported outcome scores. The mean age of the patients was 65.5 years (37 to 91) and the mean number of vertebrae involved was 3.7 (1 to 15). The thoracolumbar region was most commonly affected (109 patients, 73.6%), and was the site of most posterior vertebral wall defects (47 patients, 31.8%). Poorer Oswestry Disability Index scores correlated with an increased sagittal vertical axis (p = 0.006), an increased number of VCFs (p = 0.035) and sternal involvement (p = 0.012). Poorer EuroQol visual analogue scale scores correlated with posterior vertebral wall defects in the thoracolumbar region (p = 0.012). The sagittal vertical axis increased with the number of fractures and kyphosis in the thoracolumbar (p = 0.009) and lumbar (p < 0.001) regions. In MM, patients with VCFs have poorer clinical scores at presentation in the presence of sagittal imbalance. Outcome is particularly affected by multiple fractures in the thoracolumbar and lumbar regions and by failure to prevent kyphosis. Patients with MM should be screened for spinal lesions early. Cite this article: Bone Joint J 2016;98-B:1234-9. ©2016 The British Editorial Society of Bone & Joint Surgery.

  14. Acute Kidney Injury Enhances Outcome Prediction Ability of Sequential Organ Failure Assessment Score in Critically Ill Patients

    PubMed Central

    Chang, Chih-Hsiang; Fan, Pei-Chun; Chang, Ming-Yang; Tian, Ya-Chung; Hung, Cheng-Chieh; Fang, Ji-Tseng; Yang, Chih-Wei; Chen, Yung-Chang

    2014-01-01

    Introduction Acute kidney injury (AKI) is a common and serious complication in intensive care unit (ICU) patients and also often part of a multiple organ failure syndrome. The sequential organ failure assessment (SOFA) score is an excellent tool for assessing the extent of organ dysfunction in critically ill patients. This study aimed to evaluate the outcome prediction ability of SOFA and Acute Physiology and Chronic Health Evaluation (APACHE) III score in ICU patients with AKI. Methods A total of 543 critically ill patients were admitted to the medical ICU of a tertiary-care hospital from July 2007 to June 2008. Demographic, clinical and laboratory variables were prospectively recorded for post hoc analysis as predictors of survival on the first day of ICU admission. Results One hundred and eighty-seven (34.4%) patients presented with AKI on the first day of ICU admission based on the risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function, and end-stage renal failure (RIFLE) classification. Major causes of the ICU admissions involved respiratory failure (58%). Overall in-ICU mortality was 37.9% and the hospital mortality was 44.7%. The predictive accuracy for ICU mortality of SOFA (areas under the receiver operating characteristic curves: 0.815±0.032) was as good as APACHE III in the AKI group. However, cumulative survival rates at 6-month follow-up following hospital discharge differed significantly (p<0.001) for SOFA score ≤10 vs. ≥11 in these ICU patients with AKI. Conclusions For patients coexisting with AKI admitted to ICU, this work recommends application of SOFA by physicians to assess ICU mortality because of its practicality and low cost. A SOFA score of ≥ “11” on ICU day 1 should be considered an indicator of negative short-term outcome. PMID:25279844

  15. Baseline MELD-XI score and outcome from veno-arterial extracorporeal membrane oxygenation support for acute decompensated heart failure.

    PubMed

    Sern Lim, Hoong

    2016-11-01

    Acute decompensated heart failure is the most common acute heart failure phenotype. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide bridging support for patients with acute decompensated heart failure to transplantation. We studied the association between baseline (<6 months), pre-ECMO (<24 h) parameters and outcome of VA-ECMO support in patients with severe acute decompensated heart failure. We included 26 consecutive patients with acute decompensated heart failure (acute myocarditis, myocardial infarction or post-cardiotomy shock were excluded) who were bridged with peripheral VA-ECMO to transplantation. Data within six months (baseline) and immediately pre-ECMO were collected. Model for end-stage liver disease (MELD) with sodium (MELD-Na) and without international normalized ratio (MELD-XI) scores were calculated. Outcome was defined as death at 30 days following VA-ECMO support. Thirteen of the 26 patients died within 30 days of VA-ECMO support. Univariate associations with 30-day mortality were baseline MELD-XI, baseline sodium, creatinine, bilirubin, pre-ECMO alanine aminotransferase and lactate. However, only baseline MELD-XI score (hazard ratio 2.678 (95% CI 1.085-6.607), p=0.033) was associated 30-day survival on logistic regression analysis. Survivors demonstrated greater reduction in inotropic and vasoactive drug support and improvement in alanine aminotransferase and lactate levels. Using a threshold based on the median MELD-XI of 14.1, 30-day survival in patients with a baseline MELD-XI ⩽ 14.1 was 69% compared with 31% in patients with baseline MELD-XI > 14.1 ( p=0.046). Baseline MELD-XI score, but not pre-ECMO parameters, is independently associated with outcomes from VA-ECMO support in patients with acute decompensated heart failure.

  16. Dynamic interaction between fetal adversity and a genetic score reflecting dopamine function on developmental outcomes at 36 months.

    PubMed

    Bischoff, Adrianne R; Pokhvisneva, Irina; Léger, Étienne; Gaudreau, Hélène; Steiner, Meir; Kennedy, James L; O'Donnell, Kieran J; Diorio, Josie; Meaney, Michael J; Silveira, Patrícia P

    2017-01-01

    Fetal adversity, evidenced by poor fetal growth for instance, is associated with increased risk for several diseases later in life. Classical cut-offs to characterize small (SGA) and large for gestational age (LGA) newborns are used to define long term vulnerability. We aimed at exploring the possible dynamism of different birth weight cut-offs in defining vulnerability in developmental outcomes (through the Bayley Scales of Infant and Toddler Development), using the example of a gene vs. fetal adversity interaction considering gene choices based on functional relevance to the studied outcome. 36-month-old children from an established prospective birth cohort (Maternal Adversity, Vulnerability, and Neurodevelopment) were classified according to birth weight ratio (BWR) (SGA ≤0.85, LGA >1.15, exploring a wide range of other cut-offs) and genotyped for polymorphisms associated with dopamine signaling (TaqIA-A1 allele, DRD2-141C Ins/Ins, DRD4 7-repeat, DAT1-10- repeat, Met/Met-COMT), composing a score based on the described function, in which hypofunctional variants received lower scores. There were 251 children (123 girls and 128 boys). Using the classic cut-offs (0.85 and 1.15), there were no statistically significant interactions between the neonatal groups and the dopamine genetic score. However, when changing the cut-offs, it is possible to see ranges of BWR that could be associated with vulnerability to poorer development according to the variation in the dopamine function. The classic birth weight cut-offs to define SGA and LGA newborns should be seen with caution, as depending on the outcome in question, the protocols for long-term follow up could be either too inclusive-therefore most costly, or unable to screen true vulnerabilities-and therefore ineffective to establish early interventions and primary prevention.

  17. To Study the Correlation of Thompson Scoring in Predicting Early Neonatal Outcome in Post Asphyxiated Term Neonates

    PubMed Central

    Sharma, Manisha; Dolker, Stanzin; Kothapalli, Sharada

    2016-01-01

    Introduction Throughout the world each year, an estimated 23% of the 4 million neonatal deaths and 8% of all deaths in <5 years of age are associated with signs of asphyxia at birth. Aim To study the role of cord arterial blood gas analysis at birth and serial Thompson score in predicting the early neonatal outcome in post asphyxiated term neonates. Materials and Methods The study was conducted in Department of Paediatrics, in Neonatal Intensive Care Unit (NICU), Hindu Rao Hospital, New Delhi from May 2014 to February. 2015. This study was a prospective cross-sectional study. During this period, a total of 145 post asphyxiated term neonates born in labour room/obstetric operation theatre were recruited. An informed consent was taken from all the parents. The protocol was approved by the institutional ethical committee. Inclusion criteria were full-term babies with low-Apgar score i.e., 1 min score of ≤ 7 National Neonatal Perinatal Database 2010 (NNPD 2010). Statistical Analysis SPSS 17.0 Software has been used for data analysis. The data were expressed in terms of Means, Standard Deviation and Proportion, followed by comparison between groups through chi-square test or Fisher’s-exact test. A p-value of less than 0.05 was considered as statistically significant. Results The present study was carried out on 145 post asphyxiated full-term babies with low-Apgar score i.e., 1min score of ≤7mild Thompson score on day I,2,3 were 96 (66.2%), 119 (82.06%), 125 (86.20%), moderate Thompson score on day 1,3, 7 were 13 (8.9%), 6 (4.13%), 2 (1.37%) and severe Thompson score on day 1, 3, 7 were 36 (24.8%), 13 (8.96%), 7 (4.82%) respectively. Total 11 patients died out of 145 post asphyxiated full-term babies within 7 days, among 11 patients, 7 died within 3 days. There was clinical improvement among HIE patients as indicated by serial Thompson score done on day 1, 3 and 7. Among 145 patients 62(42.8%) had seizure and 83(57.2%) did not have seizure. Most common type of

  18. To Study the Correlation of Thompson Scoring in Predicting Early Neonatal Outcome in Post Asphyxiated Term Neonates.

    PubMed

    Bhagwani, Dalip Kumar; Sharma, Manisha; Dolker, Stanzin; Kothapalli, Sharada

    2016-11-01

    Throughout the world each year, an estimated 23% of the 4 million neonatal deaths and 8% of all deaths in <5 years of age are associated with signs of asphyxia at birth. To study the role of cord arterial blood gas analysis at birth and serial Thompson score in predicting the early neonatal outcome in post asphyxiated term neonates. The study was conducted in Department of Paediatrics, in Neonatal Intensive Care Unit (NICU), Hindu Rao Hospital, New Delhi from May 2014 to February. 2015. This study was a prospective cross-sectional study. During this period, a total of 145 post asphyxiated term neonates born in labour room/obstetric operation theatre were recruited. An informed consent was taken from all the parents. The protocol was approved by the institutional ethical committee. Inclusion criteria were full-term babies with low-Apgar score i.e., 1 min score of ≤ 7 National Neonatal Perinatal Database 2010 (NNPD 2010). SPSS 17.0 Software has been used for data analysis. The data were expressed in terms of Means, Standard Deviation and Proportion, followed by comparison between groups through chi-square test or Fisher's-exact test. A p-value of less than 0.05 was considered as statistically significant. The present study was carried out on 145 post asphyxiated full-term babies with low-Apgar score i.e., 1min score of ≤7mild Thompson score on day I,2,3 were 96 (66.2%), 119 (82.06%), 125 (86.20%), moderate Thompson score on day 1,3, 7 were 13 (8.9%), 6 (4.13%), 2 (1.37%) and severe Thompson score on day 1, 3, 7 were 36 (24.8%), 13 (8.96%), 7 (4.82%) respectively. Total 11 patients died out of 145 post asphyxiated full-term babies within 7 days, among 11 patients, 7 died within 3 days. There was clinical improvement among HIE patients as indicated by serial Thompson score done on day 1, 3 and 7. Among 145 patients 62(42.8%) had seizure and 83(57.2%) did not have seizure. Most common type of seizure was subtle seizure in 25 (40.3%) followed by multifocal in 21 (33

  19. Survival outcomes of hepatocellular carcinoma resection with postoperative complications – a propensity-score-matched analysis

    PubMed Central

    Chok, Kenneth S.H.; Chan, Millies M.Y.; Dai, Wing Chiu; Chan, Albert C.Y.; Cheung, Tan To; Wong, Tiffany C.L.; She, Wong Hoi; Lo, Chung Mau

    2017-01-01

    Abstract Curative resection remains the only hope of cure for hepatocellular carcinoma (HCC), but postoperative complications can have a significant impact on long-term survival. However, only scarce data on such impact can be found in the literature. This retrospective study reviewed the prospectively collected data of patients who underwent primary liver resection for HCC at our hospital during the period from December 1989 to December 2014. Patients with and without postoperative complications were compared. A 1:1 propensity score matching was adopted by matching age, comorbidity, Model of End-stage Liver Disease score, tumor stage, and extent of resection. Totally 1710 patients were eligible for the study. Four hundred and sixty-one (27.0%) of them developed postoperative complications while 1249 (73.0%) did not. After propensity score matching, 922 patients were compared in a 1:1 ratio (461 with postoperative complications and 461 without). Patients who developed postoperative complications were demographically similar to patients who did not, but had more intraoperative blood loss and transfusion (both P < 0.001), longer hospital stay (17 vs 9 days; P < 0.001), worse hospital mortality (12.1% vs 0%; P < 0.001), and shorter overall survival (P < 0.001). On multivariate analysis, factors that might have affected overall survival were cancer stage (HR 1.22, P < 0.001), tumor size (HR 1.02, P = 0.005), tumor number (HR 1.08, P < 0.001), venous invasion (HR 1.38, P = 0.003), extent of resection (HR 1.19, P = 0.045), intraoperative blood loss (HR 1.11, P < 0.001), postoperative complication (HR 1.37, P < 0.001), and era effect (HR 1.27, P = 0.01). Patients should be monitored closely after HCC resection. Prompt treatment of postoperative complications may be salvational. PMID:28328851

  20. Online case studies: HESI Exit Exam scores and NCLEX-RN outcomes.

    PubMed

    Young, Anne; Rose, Gloria; Willson, Pamela

    2013-01-01

    Using data obtained for the 7th HESI Exit Exam (E(2)) validity study, the value of Elsevier's online case studies in assisting students to prepare for the E(2) and the National Council Licensure Examination for Registered Nurses (NCLEX-RN) was investigated. Of the 137 randomly selected schools of nursing, 72 (52.55%) participated in the study. The student sample consisted of 4,383 students from associate degree, baccalaureate, and diploma schools of nursing. Findings indicated that the mean E(2) score and the NCLEX-RN pass rate were significantly higher for students attending schools that used the case studies than they were for students attending schools that did not use the case studies. Descriptive data indicated that the case studies were most often used for remediation and examination preparation. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Impact of the clinical syntax score on 5-year clinical outcomes after sirolimus-eluting stents implantation.

    PubMed

    Hara, Hironori; Aoki, Jiro; Tanabe, Kengo; Nishi, Akihiro; Tanimoto, Shuzou; Nakajima, Yoshifumi; Yahagi, Kazuyuki; Nakashima, Makoto; Hashimoto, Takuya; Asami, Masahiko; Watanabe, Mika; Yoshida, Eri; Nakajima, Hiroyoshi; Hara, Kazuhiro

    2013-07-01

    The SYNTAX score stratifies risk among drug-eluting stent-treated patients and is based on lesion characteristics alone. The Clinical SYNTAX Score (CSS) combines the SYNTAX score with age, ejection fraction, and creatinine clearance. We assessed its ability to stratify long-term outcomes in sirolimus-eluting stents (SES)-treated patients. Between August 2004 and March 2005, 249 patients were treated with SES. Clinical follow-up was evaluated at more than 5 years. The CSS was available for 206 patients. More than 5-year clinical follow-up data (mean 2114 ± 107 days) and CSS (range 1-322, mean 35.3 ± 49.9, median 17.5) were available for 201 patients. We divided these scores into tertiles: CSS-LOW ≤ 9.5, 9.5 < CSS-MID ≤ 28, and CSS-HIGH > 28. CSS-HIGH was associated with a higher death rate (CSS-LOW 9.0 %, CSS-MID 11.9 %, CSS-HIGH 41.8 %; log-rank p < 0.001) and major adverse cardiovascular events (MACE) (CSS-LOW 29.8 %, CSS-MID 35.8 %, CSS-HIGH 61.2 %; log-rank p = 0.004). Independent predictors for death were hemodialysis [hazard ratio (HR) 3.82; p < 0.001], age (HR 1.67; p = 0.003), ejection fraction (HR 0.98, p = 0.012) and CSS (HR 1.73, p = 0.028), and those for MACE were hemodialysis (HR 2.53, p = 0.002) and CSS (HR 1.40, p = 0.028). Areas under the curve for the SYNTAX score and CSS for death were 0.60 and 0.78 (p < 0.001), whereas those for MACE were 0.58 and 0.68 (p < 0.001), respectively. The CSS predicts long-term outcomes among SES-treated patients better than the SYNTAX score.

  2. Preeclampsia in kidney transplanted women; Outcomes and a simple prognostic risk score system

    PubMed Central

    Reisæter, Anna Varberg; Zucknick, Manuela; Lorentzen, Bjørg; Vangen, Siri; Henriksen, Tore; Michelsen, Trond Melbye

    2017-01-01

    Women pregnant following kidney transplantation are at high risk of preeclampsia. Identifying the effects of preeclampsia on pregnancy outcome and allograft function in kidney transplanted women, and predicting which women will require more targeted follow-up and possible therapeutic intervention, could improve both maternal and neonatal outcome. In this retrospective cohort study of all pregnancies following kidney transplantation in Norway between 1969 and 2013, we used medical records to identify clinical characteristics predictive of preeclampsia. 175 pregnancies were included, in which preeclampsia was diagnosed in 65. Pregnancies with preeclampsia had significantly higher postpartum serum creatinine levels, higher risks of preterm delivery, caesarean delivery, and small for gestational age infants. In the final multivariate model chronic hypertension (aOR = 5.02 [95% CI, 2.47–10.18]), previous preeclampsia (aOR = 3.26 [95% CI, 1.43–7.43]), and elevated serum creatinine (≥125 μmol/L) at the start of pregnancy (aOR = 5.79 [95% CI, 1.91–17.59]) were prognostic factors for preeclampsia. Based on this model the risk was 19% when none of these factors were present, 45–59% risk when one was present, 80–87% risk when two were present, and 96% risk when all three were present. We suggest that the risk of preeclampsia in pregnancies in kidney transplanted women can be predicted with these variables, which are easily available at the start of pregnancy. PMID:28319175

  3. A Novel Prognostic Score, Based on Preoperative Nutritional Status, Predicts Outcomes of Patients after Curative Resection for Gastric Cancer

    PubMed Central

    Liu, Xuechao; Qiu, Haibo; Liu, Jianjun; Chen, Shangxiang; Xu, Dazhi; Li, Wei; Zhan, Youqing; Li, Yuanfang; Chen, Yingbo; Zhou, Zhiwei; Sun, Xiaowei

    2016-01-01

    PURPOSE: We aimed to determine whether preoperative nutritional status (PNS) was a valuable predictor of outcome in patients with gastric cancer (GC). METHODS: We retrospectively evaluated 1320 patients with GC undergoing curative resection. The PNS score was constructed based on four objective and easily measurable criteria: prognostic nutritional index (PNI) score 1, serum albumin <35 g/L, body mass index (BMI) <18.5 kg/m2, or preoperative weight loss ≥5% of body weight. The PNS score was 2 for patients who met three or four criteria, 1 for those who met one or two criteria, and 0 for those who didn't meet all of these criteria. RESULTS: The overall survival (OS) rates in patients with PNS scores 0, 1, and 2 were 59.1%, 42.4%, and 23.4%, respectively (P < 0.001). Multivariate analyses revealed the PNS was an independent predictor for OS (HR for PNS 1 and PNS 2: 1.497, 95 % CI: 1.230-1.820 and 2.434, 95 % CI: 1.773-3.340, respectively; p < 0.001). Furthermore, 5-year OS ranged from 92% (stage I) to 37% (stage III), while the combination of TNM and PNS stratified 5-year OS from 95% (TNM I, PNS 0) to 19% (TNM III, PNS 3). Of note, the prognostic significance of PNS was still maintained when stratified by TNM stage, age, sex, tumor size, anemia and adjuvant chemotherapy (All P < 0.05). CONCLUSIONS: The PNS, a novel nutritional-based prognostic score, is independently associated with OS in GC. Prospective studies are needed to validate its clinical utility. PMID:27877232

  4. A Novel Prognostic Score, Based on Preoperative Nutritional Status, Predicts Outcomes of Patients after Curative Resection for Gastric Cancer.

    PubMed

    Liu, Xuechao; Qiu, Haibo; Liu, Jianjun; Chen, Shangxiang; Xu, Dazhi; Li, Wei; Zhan, Youqing; Li, Yuanfang; Chen, Yingbo; Zhou, Zhiwei; Sun, Xiaowei

    2016-01-01

    PURPOSE: We aimed to determine whether preoperative nutritional status (PNS) was a valuable predictor of outcome in patients with gastric cancer (GC). METHODS: We retrospectively evaluated 1320 patients with GC undergoing curative resection. The PNS score was constructed based on four objective and easily measurable criteria: prognostic nutritional index (PNI) score 1, serum albumin <35 g/L, body mass index (BMI) <18.5 kg/m(2), or preoperative weight loss ≥5% of body weight. The PNS score was 2 for patients who met three or four criteria, 1 for those who met one or two criteria, and 0 for those who didn't meet all of these criteria. RESULTS: The overall survival (OS) rates in patients with PNS scores 0, 1, and 2 were 59.1%, 42.4%, and 23.4%, respectively (P < 0.001). Multivariate analyses revealed the PNS was an independent predictor for OS (HR for PNS 1 and PNS 2: 1.497, 95 % CI: 1.230-1.820 and 2.434, 95 % CI: 1.773-3.340, respectively; p < 0.001). Furthermore, 5-year OS ranged from 92% (stage I) to 37% (stage III), while the combination of TNM and PNS stratified 5-year OS from 95% (TNM I, PNS 0) to 19% (TNM III, PNS 3). Of note, the prognostic significance of PNS was still maintained when stratified by TNM stage, age, sex, tumor size, anemia and adjuvant chemotherapy (All P < 0.05). CONCLUSIONS: The PNS, a novel nutritional-based prognostic score, is independently associated with OS in GC. Prospective studies are needed to validate its clinical utility.

  5. Colon cancer with unresectable synchronous metastases: the AAAP scoring system for predicting the outcome after primary tumour resection.

    PubMed

    Li, Z M; Peng, Y F; Du, C Z; Gu, J

    2016-03-01

    The aim of this study was to develop a prognostic scoring system to predict the outcome of patients with unresectable metastatic colon cancer who received primary colon tumour resection. Patients with confirmed metastatic colon cancer treated at the Peking University Cancer Hospital between 2003 and 2012 were reviewed retrospectively. The correlation of clinicopathological factors with overall survival was analysed using the Kaplan-Meier method and the log-rank test. Independent prognostic factors were identified using a Cox proportional hazards regression model and were then combined to form a prognostic scoring system. A total of 110 eligible patients were included in the study. The median survival time was 10.4 months and the 2-year overall survival (OS) rate was 21.8%. Age over 70 years, an alkaline phosphatase (ALP) level over 160 IU/l, ascites, a platelet/lymphocyte ratio (PLR) above 162 and no postoperative therapy were independently associated with a shorter OS in multivariate analysis. Age, ALP, ascites and PLR were subsequently combined to form the so-called AAAP scoring system. Patients were classified into high, medium and low risk groups according to the score obtained. There were significant differences in OS between each group (P < 0.001). Age, ALP, ascites, PLR and postoperative therapy were independent prognostic factors for survival of patients with metastatic colonic cancer who underwent primary tumour resection. The AAAP scoring system may be a useful tool for surgical decision making. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  6. Good validity and reliability of the forgotten joint score in evaluating the outcome of total knee arthroplasty

    PubMed Central

    Thomsen, Morten G; Latifi, Roshan; Kallemose, Thomas; Barfod, Kristoffer W; Husted, Henrik; Troelsen, Anders

    2016-01-01

    Background and purpose When evaluating the outcome after total knee arthroplasty (TKA), increasing emphasis has been put on patient satisfaction and ability to perform activities of daily living. To address this, the forgotten joint score (FJS) for assessment of knee awareness has been developed. We investigated the validity and reliability of the FJS. Patients and methods A Danish version of the FJS questionnaire was created according to internationally accepted standards. 360 participants who underwent primary TKA were invited to participate in the study. Of these, 315 were included in a validity study and 150 in a reliability study. Correlation between the Oxford knee score (OKS) and the FJS was examined and test-retest evaluation was performed. A ceiling effect was defined as participants reaching a score within 15% of the maximum achievable score. Results The validity study revealed a strong correlation between the FJS and the OKS (intraclass correlation coefficient (ICC) = 0.81, 95% CI: 0.77–0.85; p < 0.001). The test-retest evaluation showed almost perfect reliability for the FJS total score (ICC = 0.91, 95% CI: 0.88–0.94) and substantial reliability or better for individual items of the FJS (ICC? 0.79). We found a high level of internal consistency (Cronbach’s? = 0.96). The ceiling effect for the FJS was 16%, as compared to 37% for the OKS. Interpretation The FJS showed good construct validity and test-retest reliability. It had a lower ceiling effect than the OKS. The FJS appears to be a promising tool for evaluation of small differences in knee performance in groups of patients with good clinical results after TKA. PMID:26937689

  7. Good validity and reliability of the forgotten joint score in evaluating the outcome of total knee arthroplasty.

    PubMed

    Thomsen, Morten G; Latifi, Roshan; Kallemose, Thomas; Barfod, Kristoffer W; Husted, Henrik; Troelsen, Anders

    2016-06-01

    Background and purpose - When evaluating the outcome after total knee arthroplasty (TKA), increasing emphasis has been put on patient satisfaction and ability to perform activities of daily living. To address this, the forgotten joint score (FJS) for assessment of knee awareness has been developed. We investigated the validity and reliability of the FJS. Patients and methods - A Danish version of the FJS questionnaire was created according to internationally accepted standards. 360 participants who underwent primary TKA were invited to participate in the study. Of these, 315 were included in a validity study and 150 in a reliability study. Correlation between the Oxford knee score (OKS) and the FJS was examined and test-retest evaluation was performed. A ceiling effect was defined as participants reaching a score within 15% of the maximum achievable score. Results - The validity study revealed a strong correlation between the FJS and the OKS (intraclass correlation coefficient (ICC) = 0.81, 95% CI: 0.77-0.85; p < 0.001). The test-retest evaluation showed almost perfect reliability for the FJS total score (ICC = 0.91, 95% CI: 0.88-0.94) and substantial reliability or better for individual items of the FJS (ICC? 0.79). We found a high level of internal consistency (Cronbach's? = 0.96). The ceiling effect for the FJS was 16%, as compared to 37% for the OKS. Interpretation - The FJS showed good construct validity and test-retest reliability. It had a lower ceiling effect than the OKS. The FJS appears to be a promising tool for evaluation of small differences in knee performance in groups of patients with good clinical results after TKA.

  8. Do we still need IQ-scores? Misleading interpretations of neurocognitive outcome in pediatric patients with medulloblastoma: a retrospective study.

    PubMed

    Wegenschimmel, Barbara; Leiss, Ulrike; Veigl, Michaela; Rosenmayr, Verena; Formann, Anton; Slavc, Irene; Pletschko, Thomas

    2017-08-04

    Over the past decades, many studies used global outcome measures like the IQ when reporting cognitive outcome of pediatric brain tumor patients, assuming that intelligence is a singular and homogeneous construct. In contrast, especially in clinical neuropsychology, the assessment and interpretation of distinct neurocognitive domains emerged as standard. By definition, the full scale IQ (FIQ) is a score attempting to measure intelligence. It is established by calculating the average performance of a number of subtests. Therefore, FIQ depends on the subtests that are used and the influence neurocognitive functions have on these performances. Consequently, the present study investigated the impact of neuropsychological domains on the singular "g-factor" concept and analysed the consequences for interpretation of clinical outcome. The sample consisted of 37 pediatric patients with medulloblastoma, assessed 0-3 years after diagnosis with the Wechsler Intelligence Scales. Information processing speed and visuomotor function were measured by the Trailmaking Test, Form A. Our findings indicate that FIQ was considerably impacted by processing speed and visuomotor coordination, which leaded to an underestimation of the general cognitive performance of many patients. One year after diagnosis, when patients showed the largest norm-deviation, this effect seemed to be at its peak. As already recommended in international guidelines, a comprehensive neuropsychological test battery is necessary to fully understand cognitive outcome. If IQ-tests are used, a detailed subtest analysis with respect to the impact of processing speed seems essential. Otherwise patients may be at risk for wrong decision making, especially in educational guidance.

  9. Five-Year Clinical Outcome of Endoscopic Versus Open Radial Artery Harvesting: A Propensity Score Analysis.

    PubMed

    Bisleri, Gianluigi; Giroletti, Laura; Hrapkowicz, Tomasz; Bertuletti, Martina; Zembala, Marian; Arieti, Mario; Muneretto, Claudio

    2016-10-01

    Despite the popularity of less invasive approaches for conduits procurement in coronary artery bypass graft surgery, concerns have been raised about the potential detrimental effects of the endoscopic technique when compared with the conventional "open" technique. Among 470 patients undergoing coronary surgery with the use of a radial artery conduit, a propensity score analysis was performed among those patients assigned either to an open technique (n = 82) or to an endoscopic approach (n = 82). Endoscopic harvesting was performed with a nonsealed system. The primary endpoint was cardiac-related mortality, and secondary endpoint was survival free from major cardiac and cerebrovascular adverse events. Moreover, hand and forearm sensory discomfort and forearm wound healing were also assessed. No conversion to the open technique occurred in patients undergoing endoscopic harvesting. No patients in either group showed hand ischemia; wound infection occurred only in the open group (open 7.3% versus endoscopic 0%, p = 0.007). Wound healing (Hollander scale) was considerably better in the endoscopic group (open 3.3, endoscopic 4.7; p < 0.001) as well as paresthesia at the latest follow-up (open 19.5% versus endoscopic 3.6%, p < 0.001). Pain (visual analog scale score) was significantly reduced with the endoscopic technique (open 3.2, endoscopic 1.2; p = 0.003). At 5 years of follow-up, freedom from cardiac-related mortality (open 96.3% ± 2.1% versus endoscopic 98.1% ± 1.8%; p = 0.448) as well as survival free from major cardiac and cerebrovascular adverse events (open 93.9% ± 2.6% versus endoscopic 93% ± 3.4%; p = 0.996) were similar among the groups. Endoscopic radial artery harvesting allows for incremental benefits in the short term in terms of improved cosmesis and reduced wound and neurologic complications, without yielding detrimental effects in terms of graft-related events at 5 years of follow-up. Copyright © 2016 The Society of Thoracic Surgeons

  10. A validation of the National Early Warning Score to predict outcome in patients with COPD exacerbation.

    PubMed

    Hodgson, Luke E; Dimitrov, Borislav D; Congleton, Jo; Venn, Richard; Forni, Lui G; Roderick, Paul J

    2017-01-01

    The National Early Warning Score (NEWS), proposed as a standardised track and trigger system, may perform less well in acute exacerbation of COPD (AECOPD). This study externally validated NEWS and modifications (Chronic Respiratory Early Warning Score (CREWS) and Salford-NEWS) in AECOPD. An observational cohort study (2012-2014, two UK acute medical units (AMUs)), compared AECOPD (2361 admissions, 942 individuals, International Statistical Classification of Diseases and Related Health Problems-10 J40-J44 codes) with AMU patients (37 109 admissions, 20 415 individuals). In-hospital mortality prediction was done by admission NEWS, CREWS and Salford-NEWS assessed by discrimination (area under receiver operating characteristic curves (AUROCs)) and calibration (plots and Hosmer-Lemeshow (H-L) goodness-of-fit). Median admission NEWS in AECOPD was 4 (IQR 2-6) versus 1 (0-3) in AMUs (p≤0.001), despite mortality of 4.5% in both. AECOPD AUROCs were NEWS 0.74 (95% CI 0.66 to 0.82), CREWS 0.72 (0.63 to 0.80) and Salford-NEWS 0.62 (0.53 to 0.70). AMU NEWS AUROC was 0.77 (0.75 to 0.78). At threshold NEWS=5 for AECOPD (44% of admissions), positive predictive value (PPV) of death was 8% (5 to 11) and negative predictive value (NPV) was 98% (97 to 99) versus AMU patients PPV of 17% (16 to 19) and NPV of 97% (97 to 97). For NEWS in AECOPD H-L p value=0.202. This first validation of the NEWS in AECOPD found modest discrimination to predict mortality. Lower specificity of NEWS in patients with AECOPD versus other AMU patients reflects acute and chronic respiratory physiological disturbance (including hypoxia), with resultant low PPV at NEWS=5. CREWS and Salford-NEWS, adjusting for chronic hypoxia, increased the specificity and PPV but there was no gain in discrimination. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. The Telemark Breast Score: a Valid Method for Evaluation of Outcome after Breast Surgery

    PubMed Central

    Stark, Birgit

    2017-01-01

    Background: “Telemark Breast Score” (TBS) has been developed at Telemark Hospital in Norway for evaluation of results after breast surgery based on standardized patients’ photographs taken as a part of daily routine. Its reliability has recently been tested and approved. The external validity of the TBS was assessed by matching its data against the internationally recognized Breast-Q (BQ) questionnaire as a further step to study the validity of this new tool. Methods: The ideal distribution of breast volume is 45% of the total volume above and 55% below the nipple, and a 40° slope line at the upper pole. TBS makes the evaluation of these parameters of breast aesthetics more explicit. The method has been tested on photographs from 31 patients operated on for breast cancer with the Deep Inferior Perforator Flap. The evaluation was done by an independent experienced plastic surgeon earlier participating in the test–retests. The external validity of TBS was investigated against domains 1 and 3 of the BQ reconstruction module. The concordance between ratings was analyzed. Results: Concordance between TBS items and BQ domain 1 items regarding patient satisfaction, and between TBS items and BQ domain 3 items regarding how the patient experienced the outcome of breast reconstruction was relatively high except for 6 comparisons where we could not statistically ensure that more pairs were concordant than discordant. A total of 178 comparisons appeared to be concordant. This means that for all other comparisons, there was a preponderance of pairs of concordant observations, which indicates that measurements from the 2 instruments follow each other. Conclusion: The present data indicate that the TBS can be recommended as a valid tool to professionals for assessment of the outcome after breast reconstruction. PMID:28280676

  12. Patient-reported outcome measures in arthroplasty registries

    PubMed Central

    Eresian Chenok, Kate; Bohm, Eric; Lübbeke, Anne; Denissen, Geke; Dunn, Jennifer; Lyman, Stephen; Franklin, Patricia; Dunbar, Michael; Overgaard, Søren; Garellick, Göran; Dawson, Jill

    2016-01-01

    The International Society of Arthroplasty Registries (ISAR) Steering Committee established the Patient-Reported Outcome Measures (PROMs) Working Group to convene, evaluate, and advise on best practices in the selection, administration, and interpretation of PROMs and to support the adoption and use of PROMs for hip and knee arthroplasty in registries worldwide. The 2 main types of PROMs include generic (general health) PROMs, which provide a measure of general health for any health state, and specific PROMs, which focus on specific symptoms, diseases, organs, body regions, or body functions. The establishment of a PROM instrument requires the fulfillment of methodological standards and rigorous testing to ensure that it is valid, reliable, responsive, and acceptable to the intended population. A survey of the 41 ISAR member registries showed that 8 registries administered a PROMs program that covered all elective hip or knee arthroplasty patients and 6 registries collected PROMs for sample populations; 1 other registry had planned but had not started collection of PROMs. The most common generic instruments used were the EuroQol 5 dimension health outcome survey (EQ-5D) and the Short Form 12 health survey (SF-12) or the similar Veterans RAND 12-item health survey (VR-12). The most common specific PROMs were the Hip disability and Osteoarthritis Outcome Score (HOOS), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Oxford Hip Score (OHS), the Oxford Knee Score (OKS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the University of California at Los Angeles Activity Score (UCLA). PMID:27168175

  13. Estimating cancer survival and clinical outcome based on genetic tumor progression scores.

    PubMed

    Rahnenführer, Jörg; Beerenwinkel, Niko; Schulz, Wolfgang A; Hartmann, Christian; von Deimling, Andreas; Wullich, Bernd; Lengauer, Thomas

    2005-05-15

    In cancer research, prediction of time to death or relapse is important for a meaningful tumor classification and selecting appropriate therapies. Survival prognosis is typically based on clinical and histological parameters. There is increasing interest in identifying genetic markers that better capture the status of a tumor in order to improve on existing predictions. The accumulation of genetic alterations during tumor progression can be used for the assessment of the genetic status of the tumor. For modeling dependences between the genetic events, evolutionary tree models have been applied. Mixture models of oncogenetic trees provide a probabilistic framework for the estimation of typical pathogenetic routes. From these models we derive a genetic progression score (GPS) that estimates the genetic status of a tumor. GPS is calculated for glioblastoma patients from loss of heterozygosity measurements and for prostate cancer patients from comparative genomic hybridization measurements. Cox proportional hazard models are then fitted to observed survival times of glioblastoma patients and to times until PSA relapse following radical prostatectomy of prostate cancer patients. It turns out that the genetically defined GPS is predictive even after adjustment for classical clinical markers and thus can be considered a medically relevant prognostic factor. Mtreemix, a software package for estimating tree mixture models, is freely available for non-commercial users at http://mtreemix.bioinf.mpi-sb.mpg.de. The raw cancer datasets and R code for the analysis with Cox models are available upon request from the corresponding author.

  14. Immunodeficiency scoring index to predict poor outcomes in hematopoietic cell transplant recipients with RSV infections.

    PubMed

    Shah, Dimpy P; Ghantoji, Shashank S; Ariza-Heredia, Ella J; Shah, Jharna N; El Taoum, Katia K; Shah, Pankil K; Nesher, Lior; Hosing, Chitra; Rondon, Gabriela; Champlin, Richard E; Chemaly, Roy F

    2014-05-22

    We developed an immunodeficiency scoring index for respiratory syncytial virus (ISI-RSV) infection, based on a cohort of 237 allogeneic hematopoietic cell transplant (allo-HCT) recipients, that can predict the risk of progression to lower respiratory tract infection (LRTI) and RSV-associated mortality. A weighted index was calculated using adjusted hazard ratios for immunodeficiency markers. Based on the ISI-RSV (range, 0-12), patients were stratified into low (0-2), moderate (3-6), and high (7-12) risk groups. A significant trend of increasing incidence of LRTI and RSV-associated mortality was observed as the risk increased from low to moderate to high (P < .001). Patients in the high-risk group had the greatest benefit of ribavirin-based therapy at the upper respiratory tract infection stage and the highest risk for progression to LRTI and death when antiviral therapy was not given (6.5 [95% confidence interval (CI), 1.8-23.6] and 8.1 [95% CI, 1.1-57.6], respectively). The ISI-RSV is designed to stratify allo-HCT recipients with RSV infection into groups according to their risk for progression to LRTI and RSV-associated mortality. Identification of high-risk groups using this index would distinguish patients who would benefit the most from antiviral therapy, mainly with aerosolized ribavirin. The ISI-RSV should be validated in a multi-institutional study.

  15. Incremental validity of the Psychopathy Checklist facet scores: predicting release outcome in six samples.

    PubMed

    Walters, Glenn D; Knight, Raymond A; Grann, Martin; Dahle, Klaus-Peter

    2008-05-01

    The incremental validity of the 4 facet scores (Interpersonal, Affective, Lifestyle, Antisocial) of the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991, 2003) and the Psychopathy Checklist: Screening Version (PCL:SV; S. D. Hart, D. N. Cox, & R. D. Hare, 1995) was evaluated in 6 forensic/correctional samples with average follow-ups ranging from 20 weeks to 10 years. Results indicated that whereas Facet 4 (Antisocial) achieved incremental validity relative to the first 3 facets (Interpersonal, Affective, and Lifestyle) in predicting recidivism in all 6 samples, a block of the first 3 facets achieved incremental validity relative to the 4th facet in only 1 sample. Thus, although there was consistent support for the incremental validity of Facet 4 above and beyond the first 3 facets, there was minimal support for the incremental validity of Facets 1, 2, and 3 above and beyond Facet 4. The implications of these findings for the psychopathy construct in general and the PCL-R/SV in particular are discussed.

  16. Comparison of the Long-Term Outcomes of Mechanical and Bioprosthetic Aortic Valves - A Propensity Score Analysis.

    PubMed

    Minakata, Kenji; Tanaka, Shiro; Tamura, Nobushige; Yanagi, Shigeki; Ohkawa, Yohei; Okonogi, Shuichi; Kaneko, Tatsuo; Usui, Akihiko; Abe, Tomonobu; Shimamoto, Mitsuomi; Takahara, Yoshiharu; Yamanaka, Kazuo; Yaku, Hitoshi; Sakata, Ryuzo

    2017-07-25

    The aim of this study was to assess the long-term outcomes of aortic valve replacement (AVR) with either mechanical or bioprosthetic valves according to age at operation.Methods and Results:A total of 1,002 patients (527 mechanical valves and 475 bioprosthetic valves) undergoing first-time AVR were categorized according to age at operation: group Y, age <60 years; group M, age 60-69 years; and group O, age ≥70 years). Outcomes were compared on propensity score analysis (adjusted for 28 variables). Hazard ratio (HR) was calculated using the Cox regression model with adjustment for propensity score with bioprosthetic valve as a reference (HR=1). There were no significant differences in overall mortality between mechanical and bioprosthetic valves for all age groups. Valve-related mortality was significantly higher for mechanical valves in group O (HR, 2.53; P=0.02). Reoperation rate was significantly lower for mechanical valves in group Y (HR, 0.16; P<0.01) and group M (no events for mechanical valves). Although the rate of thromboembolic events was higher in mechanical valves in group Y (no events for tissue valves) and group M (HR, 9.05; P=0.03), there were no significant differences in bleeding events between all age groups. The type of prosthetic valve used in AVR does not significantly influence overall mortality.

  17. Evaluation of the Dutch version of the Foot and Ankle Outcome Score (FAOS): Responsiveness and Minimally Important Change.

    PubMed

    Sierevelt, I N; van Eekeren, I C M; Haverkamp, D; Reilingh, M L; Terwee, C B; Kerkhoffs, G M M J

    2016-04-01

    The aim of this study was to evaluate the responsiveness of the Foot and Ankle Outcome Score (FAOS) and provide data on the Minimally Important Change (MIC) in patients 1 year after hindfoot and ankle surgery. Prospective pre-operative and 1 year post-operative FAOS scores were collected from 145 patients. A patient's global assessment and a longitudinal derived Function Change Score were used as external anchors. To assess responsiveness, effect sizes (ES) and Standardized Response Means (SRM) were calculated and hypotheses on their magnitudes were formulated. Additional ROC curve analysis was performed, and the Area Under the Curve (AUC) was calculated as a measure of responsiveness. MIC values were estimated using two different methods: (1) the mean change method and (2) the optimal cut-off point of the ROC curve. Responsiveness was supported by confirmation of 84% of the hypothesized ES and SRM and almost all AUCs exceeding 0.70. MIC values ranged from 7 (symptoms) to 38 (sport) points. They varied between calculation methods and were negatively associated with baseline values. A considerable amount of MIC values did not exceed the smallest detectable change limit, indicating that the FAOS is more suitable at group level than for longitudinally following individual patients. The FAOS demonstrated good responsiveness in patients 1 year after hindfoot and ankle surgery. Due to their wide variation, MIC estimates derived in this study should be interpreted with caution. However, these estimates can be of value to facilitate sample size calculation in future studies. Diagnostic study, Level I.

  18. Collagenase Clostridium Histolyticum versus Limited Fasciectomy for Dupuytren's Contracture: Outcomes from a Multicenter Propensity Score Matched Study.

    PubMed

    Zhou, Chao; Hovius, Steven E R; Slijper, Harm P; Feitz, Reinier; Van Nieuwenhoven, Christianne A; Pieters, Adriana J; Selles, Ruud W

    2015-07-01

    Controversy exists about the relative effectiveness of injectable collagenase (collagenase clostridium histolyticum) and limited fasciectomy in the treatment of Dupuytren's contracture. The authors compared the effectiveness of both techniques in actual clinical practice. This study evaluated all subjects treated with collagenase clostridium histolyticum or limited fasciectomy for metacarpophalangeal and/or proximal interphalangeal joint contractures between 2011 and 2014 at seven practice sites. The authors compared the degree of residual contracture (active extension deficit), Michigan Hand Outcomes Questionnaire scores, and adverse events at follow-up visits occurring between 6 and 12 weeks after surgery or the last injection with the use of propensity score matching. In 132 matched subjects who were treated with collagenase (n = 66) or fasciectomy (n = 66), the degree of residual contracture at follow-up for affected metacarpophalangeal joints was not significantly different (13 degrees versus 6 degrees; p = 0.095) and affected proximal interphalangeal joints had significantly worse residual contracture in the collagenase group compared with those in the fasciectomy group (25 degrees versus 15 degrees; p = 0.010). Collagenase subjects experienced fewer serious adverse events than did fasciectomy subjects and reported larger improvements in the Michigan Hand Outcomes Questionnaire subscores evaluating satisfaction with hand function, activities of daily living, and work performance. This propensity score-matched study showed that collagenase clostridium histolyticum was not significantly different from limited fasciectomy in reducing metacarpophalangeal joint contractures, whereas proximal interphalangeal joint contractures showed slightly better reduction following limited fasciectomy. Collagenase provided a more rapid recovery of hand function than did fasciectomy and was associated with fewer serious adverse events. Therapeutic, III.

  19. Effects of intraoperative colloid administration on outcome in a population-based general surgical cohort: a propensity score analysis.

    PubMed

    Canet, J; Sabaté, S; Mazo, V

    2013-08-01

    Many studies on colloids have recently been retracted, leaving us with uncertain evidence of their safety. We aimed to analyze whether intraoperative colloid administration is associated with postoperative complications. The prospectively compiled database of the ARISCAT study of a large, representative cohort of general surgical patients was reanalyzed to compare outcomes according to whether intraoperative colloids were administered or not; a propensity score was used to adjust for potential confounders. The primary outcomes were major postoperative complications. Secondary outcomes were postoperative hospital-free days within 90 days and mortality at 30 and 90 days. In a retrospective survey we asked each center's data collectors to estimate the proportions of the different colloids administered during the study period. Of 2462 patients analyzed, 556 (22.6%) received some type of colloid intraoperatively. The median (25th-75th percentile) of total fluids administered was significantly higher in patients receiving colloids (10.0 [6.9-14.1] mL·kg-1·h-1 vs. 8.8 [6.0-12.8] mL·kg-1·h-1 for patients not receiving colloids; P<0.01). The median volume of colloids administered was 7.5 (6.3-10.4) mL·kg-1. An estimated 75.7% of the patients received third-generation hydroxyethyl starches (130/0.4). Significantly associated complications, after propensity score adjustment, were atelectasis, respiratory infection, bronchospasm, arrhythmia, sepsis, paralytic ileum, and hyperglycemia. Patients receiving colloids had 1.9 fewer postoperative hospital-free days (P<0.006). There were no significant differences in 30- and 90-day mortality. Our study suggests an association of intraoperative colloid administration, mainly of 130/0.4 hydroxyethyl starches, with diverse major postoperative complications and longer hospital stay. Controlled studies are urgently needed to assess the safety profile of colloid use in surgical patients.

  20. A propensity-score matched comparison of perioperative and early renal functional outcomes of robotic versus open partial nephrectomy.

    PubMed

    Wu, Zhenjie; Li, Mingmin; Qu, Le; Ye, Huamao; Liu, Bing; Yang, Qing; Sheng, Jing; Xiao, Liang; Lv, Chen; Yang, Bo; Gao, Xu; Gao, Xiaofeng; Xu, Chuanliang; Hou, Jianguo; Sun, Yinghao; Wang, Linhui

    2014-01-01

    To compare the perioperative and early renal functional outcomes of RPN with OPN for kidney tumors. A total of 209 RPN or OPN patients with availability of preoperative cross-sectional imaging since 2009 at our center were included. To adjust for potential baseline confounders propensity-score matching was performed, which resulted in 94 OPNs matched to 51 RPNs. Perioperative and early renal functional outcomes were compared. In propensity-score matched analysis, RPN procedures were well tolerated and resulted in significant decreases in postoperative analgesic time (24 vs. 48 hr, p<0.001) and visual analog pain scale (3 vs. 4, p<0.001). Besides, the RPN patients had a significantly shorter LOS (9 vs. 11 days, p = 0.008) and less EBL (100 vs. 200 ml, p<0.001), but median operative time was significantly longer (229 vs. 182 min, p<0.001). Ischemia time, transfusion rates, complication rates, percentage eGFR decline and CKD upstaging were equivalent after RPN versus OPN. In multivariable logistic regression analysis, RPN patients were less likely to have a prolonged LOS (odds ratio [OR]: 0.409; p = 0.016), while more likely to experience a longer operative time (OR: 4.296; p = 0.001). However, the statistical significance for the protective effect of RPN versus OPN in EBL was not confirmed by examining the risk of EBL≥400 ml (OR: 0.488; p = 0.212). When adjusted for potential selection biases, RPN offers comparable perioperative and early renal functional outcomes to those of OPN, with the added advantage of improved postoperative pain control and a shorter LOS.

  1. Impact of pretreatment noncontrast CT Alberta Stroke Program Early CT Score on clinical outcome after intra-arterial stroke therapy.

    PubMed

    Yoo, Albert J; Zaidat, Osama O; Chaudhry, Zeshan A; Berkhemer, Olvert A; González, R Gilberto; Goyal, Mayank; Demchuk, Andrew M; Menon, Bijoy K; Mualem, Elan; Ueda, Dawn; Buell, Hope; Sit, Siu Po; Bose, Arani

    2014-03-01

    The efficacy of intra-arterial treatment remains uncertain. Because most centers performing IAT use noncontrast CT (NCCT) imaging, it is critical to understand the impact of NCCT findings on treatment outcomes. This study aimed to compare functional independence and safety among patients undergoing intra-arterial treatment stratified by the extent of ischemic change on pretreatment NCCT. The study cohort was derived from multicenter trials of the Penumbra System. Inclusion criteria were anterior circulation proximal occlusion, evaluable pretreatment NCCT, and known time to reperfusion. Ischemic change was quantified using the Alberta Stroke Program Early CT Score (ASPECTS) and stratified into 3 prespecified groups for comparison: 0 to 4 (most ischemic change) versus 5 to 7 versus 8 to 10 (least ischemic change). A total of 249 patients were analyzed: 40 with ASPECTS 0 to 4, 83 with ASPECTS 5 to 7, and 126 with ASPECTS 8 to 10. For ASPECTS 0 to 4, 5 to 7, and 8 to 10, respectively, good outcome (modified Rankin Scale score, 0-2) rates were 5%, 38.6%, and 46% (P<0.0001), and mortality rates were 55%, 28.9%, and 19% (P=0.0001). The only significant pairwise differences were between ASPECTS 0 to 4 and other groups. Symptomatic hemorrhage was more common with lower ASPECTS (P=0.02). Shorter time to reperfusion was significantly associated with better outcomes among patients with ASPECTS 8 to 10 (P=0.01). A similar relationship was seen for ASPECTS 5 to 7 but was not statistically significant. No such relationship was seen for ASPECTS 0 to 4. NCCT seems useful for excluding patients with the greatest burden of ischemic damage from futile intra-arterial treatment, which is unlikely to result in patient functional independence and increases the risk of hemorrhage.

  2. The Portuguese version of the Outcome Questionnaire (OQ-45): Normative data, reliability, and clinical significance cut-offs scores.

    PubMed

    Machado, Paulo P P; Fassnacht, Daniel B

    2015-12-01

    The Outcome Questionnaire (OQ-45) is one of the most extensively used standardized self-report instruments to monitor psychotherapy outcomes. The questionnaire is designed specifically for the assessment of change during psychotherapy treatments. Therefore, it is crucial to provide norms and clinical cut-off values for clinicians and researchers. The current study aims at providing study provides norms, reliability indices, and clinical cut-off values for the Portuguese version of the scale. Data from two large non-clinical samples (high school/university, N = 1,669; community, N = 879) and one clinical sample (n = 201) were used to investigate psychometric properties and derive normative data for all OQ-45 subscales and the total score. Significant and substantial differences were found for all subscales between the clinical and non-clinical sample. The Portuguese version also showed adequate reliabilities (internal consistency, test-retest), which were comparable to the original version. To assess individual clinical change, clinical cut-off values and reliable change indices were calculated allowing clinicians and researchers to monitor and evaluate clients' individual change. The Portuguese version of the OQ-45 is a reliable instrument with comparable Portuguese norms and cut-off scores to those from the original version. This allows clinicians and researchers to use this instrument for evaluating change and outcome in psychotherapy. This study provides norms for non-clinical and clinical Portuguese samples and investigates the reliability (internal consistency and test-retest) of the OQ-45. Cut-off values and reliable change index are provided allowing clinicians to evaluate clinical change and clients' response to treatment, monitoring the quality of mental health care services. These can be used, in routine clinical practice, as benchmarks for treatment progress and to empirically base clinical decisions such as continuation of treatment or considering

  3. Clinical Outcomes of SMART Versus Luminexx Nitinol Stent Implantation for Aortoiliac Artery Disease: A Propensity Score-Matched Multicenter Study.

    PubMed

    Shintani, Yoshiaki; Soga, Yoshimitsu; Takahara, Mitsuyoshi; Iida, Osamu; Kawasaki, Daizo; Yamauchi, Yasutaka; Suzuki, Kenji; Hirano, Keisuke; Kawasaki, Tomohiro

    2015-10-01

    Endovascular therapy for aortoiliac (AI) lesions using stents is widely accepted. However, the long-term outcome of 2 different types of nitinol stents for AI lesions is unknown. The aim of this study was to examine the long-term outcome of the SMART and Luminexx nitinol stents for the treatment of de novo AI lesions. This study was a multicenter retrospective analysis of a prospectively maintained database. The study enrolled consecutive patients undergoing primary stenting for de novo AI artery stenosis between January 2005 and December 2009. A total of 1503 lesions in 1229 patients treated with SMART or Luminexx primary stenting were enrolled. The primary end point was primary patency, secondary end points were the primary assisted patency, secondary patency, and major adverse limb events (MALEs), which included major amputation and major reintervention. To minimize the differences between the groups, a propensity score matching analysis was performed, and 284 lesions per group were analyzed to identify outcomes. After the propensity score matching analysis, the lesion length was 60 ± 37 and 57 ± 31 mm (P = .275), and the reference vessel diameter was 8.2 ± 1.5 and 8.3 ± 1.5 mm (P = .482) in the SMART and Luminexx groups, respectively. The primary patency at 3 years was not significantly different between the groups (83.5% vs 82.2%, P = .842, respectively). The assisted primary patency and secondary patency rates were also not significantly different (91.7% vs 93.2%, P = .340, 99.2% vs 98.8%, P = .922). In addition, the MALE rate was not significantly different between the groups (98.3% vs 97.3%, P = .821). The current data suggest that the use of nitinol stents for the AI artery provided good long-term patency and freedom from MALE for 3 years of follow-up, regardless of whether SMART or Luminexx stents were used. © The Author(s) 2014.

  4. Effects of Game Location, Quality of Opposition and Starting Quarter Score in the outcome of elite water polo quarters.

    PubMed

    Gómez, Miguel A; Delaserna, Ana; Lupo, Corrado; Sampaio, Jaime E

    2014-02-12

    The notational analysis is used to investigate teams' performance in water polo, especially focused on the determinants of success. Recently, a new topic has emerged "the situational variables", this term includes the game conditions that may influence the performance at a behavioural level. Then, the aim of this study was to identify the interactive effects of Starting Quarter Score (i.e., score difference at the beginning of each quarter and at the final score) and Game Location (i.e., home and away teams) in relation to Quality of Opposition (i.e., positions of difference between opposing teams at the end-of-season rankings) in elite men's water polo games. Data comprised 528 games (n = 2,112 quarters) from the first Spanish water polo division. A linear regression analysis was applied to show the impact of Starting Quarter Score and Game Location in relation to Quality of Opposition (unbalanced and balanced) for quarter (all quarters, and second, third, and forth quarter). Results showed that SQS has an important effect for all quarters (0.16), and for the second (0.14) and third (0.14) quarters in balanced games (while the fourth quarter has an unpredictable outcome), and for each quarter (all quarters: 0.33; second quarter: 0.55; third quarter: 0.44; fourth quarter: 0.26) in unbalanced games. In addition, GL effects emerged for balanced (0.31) and unbalanced (0.45) games for all quarters, and specifically for the second quarter of the unbalanced games. Therefore, this study showed the elite water polo game dynamics, indirectly providing a reference for coaches (i.e., effective tactical approach) and physical trainers (i.e., high performance intensities) plans to improve their players' performance.

  5. Development and Validation of a Protein-Based Risk Score for Cardiovascular Outcomes Among Patients With Stable Coronary Heart Disease.

    PubMed

    Ganz, Peter; Heidecker, Bettina; Hveem, Kristian; Jonasson, Christian; Kato, Shintaro; Segal, Mark R; Sterling, David G; Williams, Stephen A

    2016-06-21

    Precise stratification of cardiovascular risk in patients with coronary heart disease (CHD) is needed to inform treatment decisions. To derive and validate a score to predict risk of cardiovascular outcomes among patients with CHD, using large-scale analysis of circulating proteins. Prospective cohort study of participants with stable CHD. For the derivation cohort (Heart and Soul study), outpatients from San Francisco were enrolled from 2000 through 2002 and followed up through November 2011 (≤11.1 years). For the validation cohort (HUNT3, a Norwegian population-based study), participants were enrolled from 2006 through 2008 and followed up through April 2012 (5.6 years). Using modified aptamers, 1130 proteins were measured in plasma samples. A 9-protein risk score was derived and validated for 4-year probability of myocardial infarction, stroke, heart failure, and all-cause death. Tests, including the C statistic, were used to assess performance of the 9-protein risk score, which was compared with the Framingham secondary event model, refit to the cohorts in this study. Within-person change in the 9-protein risk score was evaluated in the Heart and Soul study from paired samples collected 4.8 years apart. From the derivation cohort, 938 samples were analyzed, participants' median age at enrollment was 67.0 years, and 82% were men. From the validation cohort, 971 samples were analyzed, participants' median age at enrollment was 70.2 years, and 72% were men. In the derivation cohort, C statistics were 0.66 for refit Framingham, 0.74 for 9-protein, and 0.75 for refit Framingham plus 9-protein models. In the validation cohort, C statistics were 0.64 for refit Framingham, 0.70 for 9-protein, and 0.71 for refit Framingham plus 9-protein models. Adding the 9-protein risk score to the refit Framingham model increased the C statistic by 0.09 (95% CI, 0.06-0.12) in the derivation cohort, and in the validation cohort, the C statistic was increased by 0.05 (95% CI, 0

  6. Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 Scores on Severity and Functional Outcome in Acute Ischemic Stroke with Atrial Fibrillation.

    PubMed

    Tanaka, Koji; Yamada, Takeshi; Torii, Takako; Furuta, Konosuke; Matsumoto, Shoji; Yoshimura, Takeo; Takase, Kei-ichiro; Wakata, Yoshifumi; Nakashima, Naoki; Kira, Jun-ichi; Murai, Hiroyuki

    2015-07-01

    We examined the association between pre-admission risk scores and severity on admission and functional outcome in acute ischemic stroke with atrial fibrillation (AF). Between September 2011 and April 2014, we retrospectively extracted consecutive ischemic stroke patients with AF whose pre-admission modified Rankin Scale (mRS) score was 2 or less from our prospective database. Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were calculated in each patient, and their association with the National Institutes of Health Stroke Scale (NIHSS) score on admission or unfavorable outcome (mRS ≥ 3 at 3 months from the onset) was assessed. A total of 344 patients (189 were men; age, 77.7 ± 10.0 years) were included in the analysis. The median pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were 2, 4, and 4, respectively. NIHSS score on admission was positively correlated with pre-admission CHADS2 (ρ = .116, P = .031), CHA2DS2-VASc (ρ = .166, P = .020), and R2CHADS2 scores (ρ = .106, P = .049). Receiver operating characteristic (ROC) curve analysis revealed that pre-admission CHADS2 score of 2 or more (sensitivity, 80%; specificity, 45%; area under the ROC curve [AUC], .654), CHA2DS2-VASc score of 3 or more (sensitivity, 86%; specificity, 44%; AUC, .683), and R2CHADS2 score of 4 or more (sensitivity, 61%; specificity, 62%; AUC, .657) were associated with unfavorable outcome. The pre-admission CHA2DS2-VASc score was better than the pre-admission CHADS2 score in estimating unfavorable outcome (P = .017). In multivariate analysis, cutoffs of these scores, female sex, higher NIHSS score, and internal carotid artery occlusion were associated with unfavorable outcome. Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were associated with onset severity and functional outcome in acute ischemic stroke with AF. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Assessing Field Triage Decisions and the International Classification Injury Severity Score (ICISS) at Predicting Outcomes of Trauma Patients.

    PubMed

    Allen, Casey J; Baldor, Daniel J; Schulman, Carl I; Pizano, Louis R; Livingstone, Alan S; Namias, Nicholas

    2017-06-01

    Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS <0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED). We assess outcomes of those with an ICISS <0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed. ICISS was calculated from the product of the survival risk ratios for a patient's three worst injuries. Outcomes were compared between patients with ICISS <0.85 either triaged to the ED or its separate, neighboring, free-standing TC at a large urban hospital. A total of 32,191 (83%) patients were triaged to the ED by EMS and 6,827 (17%) were triaged to the TC. Of these, 2544 had an ICISS <0.85, with 2145 (84%) being triaged to the TC and 399 (16%) to the ED. In these patients, those taken to the TC more often required admission, and those taken to the ED had better outcomes. When the confounders influencing triage to an ED or a TC are eliminated, those triaged by EMS to the ED rather than the TC had better overall outcomes. EMS providers better identified patients at risk for mortality than did the retrospective application of ICISS. ICISS <0.85 does not identify the absolute need for TC as EMS providers were able to appropriately triage a large portion of this population to the ED.

  8. Placement and Delinquency Outcomes Among System-Involved Youth Referred to Multisystemic Therapy: A Propensity Score Matching Analysis.

    PubMed

    Vidal, Sarah; Steeger, Christine M; Caron, Colleen; Lasher, Leanne; Connell, Christian M

    2017-03-17

    Multisystemic therapy (MST) was developed to help youth with serious social, emotional, and behavioral problems. Research on the efficacy and effectiveness of MST has shown positive outcomes in different domains of development and functioning among various populations of youth. Nonetheless, even with a large body of literature investigating the treatment effects of MST, few studies have focused on the effectiveness of MST through large-scale dissemination efforts. Utilizing a large sample of youth involved in a statewide dissemination of MST (n = 740; 43% females; 14% Black; 29% Hispanic; 49% White; Mage = 14.9 years), propensity score matching was employed to account for baseline differences between the treatment (n = 577) and comparison (n = 163) groups. Treatment effects were examined based on three outcomes: out-of-home placement, adjudication, and placement in a juvenile training school over a 6-year period. Significant group differences remained after adjusting for baseline differences, with youth who received MST experiencing better outcomes in offending rates than youth who did not have an opportunity to complete MST due to non-clinical or administrative reasons. Survival analyses revealed rates of all three outcomes were approximately 40% lower among the treatment group. Overall, this study adds to the body of literature supporting the long-term effectiveness of MST in reducing offending among high-risk youth. The findings underscore the potential benefits of taking evidence-based programs such as MST to scale to improve the well-being and functioning of high-risk youth. However, strategies to effectively deliver the program in mental health service settings, and to address the specific needs of high-risk youth are necessary.

  9. [Usefulness of the residual SYNTAX score to predict long term outcome in acute coronary syndrome patients underwent percutaneous coronary intervention].

    PubMed

    Song, Y; Xu, J J; Tang, X F; Ma, Y L; Yao, Y; He, C; Wang, H H; Liu, R; Xu, N; Jiang, P; Jiang, L; Zhao, X Y; Gao, Z; Gao, R L; Qiao, S B; Yang, Y J; Xu, B; Yuan, J Q

    2017-02-21

    Objective: To quantify the extent and complexity of residual coronary stenosis following PCI by the residual SYNTAX score, and to evaluate its impact on adverse ischemic outcomes in acute coronary syndrome(ACS) patients. Methods: From January 2013 to December 2013, a total of 1 414 consecutive moderate- and high-risk ACS patients who underwent any PCI with multi-vessel coronary artery disease were evaluated.Patients were stratified by rSS quartiles and their outcomes were compared. Results: The rSS was 4.8±6.7. 591 patients (41.8%) had rSS=0(CR), 233 patients (16.5%) had rSS>0 but ≤ 3, 296 patients (20.9%) had rSS>3 but ≤8 and 294 patients (20.8%) had rSS>8.Clinical risk factors were more frequent in patients with incomplete revascularization(IR) compared with complete revascularization(CR). The 2-year rates of all-caused death(1.2% vs 0.4%, 2.0%, 4.4%, P=0.003), cardiac death, revascularization and MACCE were significantly higher in high rSS group, compared to other groups.By multivariable analysis, rSS was a strong independent predictor of ischemic outcomes at 2-year, including all-cause mortality (HR=1.05, 95%CI 1.01-1.09, P=0.019), cardiac death, revascularization and MACCE. Conclusions: The rSS is a strong independent predictor of all-caused death, cardiac death, revascularization and MACCE and has moderated predictive ability for those ischemic outcomes.

  10. Comparison of ceiling effects between two patient-rating scores and a physician-rating score in the assessment of outcome after the surgical treatment of distal radial fractures.

    PubMed

    Kim, S-J; Lee, B-G; Lee, C-H; Choi, W-S; Kim, J-H; Lee, K-H

    2015-12-01

    We compared the ceiling effects of two patient-rating scores, the Disability of the Arm, Shoulder and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE), and a physician-rating score, the Modified Mayo Wrist Score (MMWS) in assessing the outcome of surgical treatment of an unstable distal radial fracture. A total of 77 women with a mean age of 64.2 years (50 to 88) who underwent fixation using a volar locking plate for an unstable distal radial fracture between 2011 and 2013 were enrolled in this study. All completed the DASH and PRWE questionnaires one year post-operatively and were assessed using the MMWS by the senior author. The ceiling effects in the outcome data assessed for each score were estimated. The data assessed with both patient-rating scores, the DASH and PRWE, showed substantial ceiling effects, whereas the data assessed with MMWS showed no ceiling effect. Researchers should be aware of a possible ceiling effect in the assessment of the outcome of the surgical treatment of distal radial fractures using patient-rating scores. It could also increase the likelihood of a type II error. ©2015 The British Editorial Society of Bone & Joint Surgery.

  11. Development of a composite outcome score for a complex intervention - measuring the impact of Community Health Workers.

    PubMed

    Watt, Hilary; Harris, Matthew; Noyes, Jane; Whitaker, Rhiannon; Hoare, Zoe; Edwards, Rhiannon Tudor; Haines, Andy

    2015-03-21

    In health services research, composite scores to measure changes in health-seeking behaviour and uptake of services do not exist. We describe the rationale and analytical considerations for a composite primary outcome for primary care research. We simulate its use in a large hypothetical population and use it to calculate sample sizes. We apply it within the context of a proposed cluster randomised controlled trial (RCT) of a Community Health Worker (CHW) intervention. We define the outcome as the proportion of the services (immunizations, screening tests, stop-smoking clinics) received by household members, of those that they were eligible to receive. First, we simulated a population household structure (by age and sex), based on household composition data from the 2011 England and Wales census. The ratio of eligible to received services was calculated for each simulated household based on published eligibility criteria and service uptake rates, and was used to calculate sample size scenarios for a cluster RCT of a CHW intervention. We assume varying intervention percentage effects and varying levels of clustering. Assuming no disease risk factor clustering at the household level, 11.7% of households in the hypothetical population of 20,000 households were eligible for no services, 26.4% for 1, 20.7% for 2, 15.3% for 3 and 25.8% for 4 or more. To demonstrate a small CHW intervention percentage effect (10% improvement in uptake of services out of those who would not otherwise have taken them up, and additionally assuming intra-class correlation of 0.01 between households served by different CHWs), around 4,000 households would be needed in each of the intervention and control arms. This equates to 40 CHWs (each servicing 100 households) needed in the intervention arm. If the CHWs were more effective (20%), then only 170 households would be needed in each of the intervention and control arms. This is a useful first step towards a process-centred composite score of

  12. Is pre-existing dementia an independent predictor of outcome after stroke? A propensity score-matched analysis.

    PubMed

    Saposnik, Gustavo; Kapral, Moira K; Cote, Robert; Rochon, Paula A; Wang, Julie; Raptis, Stavroula; Mamdani, Muhammad; Black, Sandra E

    2012-11-01

    With an aging population, patients are increasingly likely to present with stroke and pre-existing dementia, which may lead to greater death and disability. The aim of this work was to assess the risk of all-cause mortality and poor functional outcomes after ischemic stroke in patients with and without pre-existing dementia. We conducted a multicenter cohort study of all patients presenting to 12 tertiary care institutions participating in the Registry of the Canadian Stroke Network (RCSN) with a first ischemic stroke between 2003 and 2008. Individuals with pre-existing dementia were matched using propensity-score methods with patients without dementia during their index hospitalization based on the following characteristics: age (within 3 years), sex, stroke severity, stroke subtype (lacunar vs. non-lacunar), level of consciousness, vascular risk factors, dysphagia, glucose and creatinine on admission, Charlson index, residence prior to hospitalization (home vs. other), pre-admission dependency, hospital arrival via ambulance, admission to stroke unit, thrombolysis, and palliative care. A propensity score for all-cause mortality and clinical outcomes was developed. Registry of the Canadian Stroke Network (RCSN) and Registered Persons Database (RPDB). The primary outcome was all-cause mortality at 30 days. Secondary outcomes included mortality at discharge and at 1 year, disability at discharge (modified Rankin scale ≥ 3), medical complications (pneumonia), and discharge disposition. A subgroup analysis assessing the risk of intracerebral hemorrhage among those receiving thrombolysis was also conducted. We matched 877 patients with an acute ischemic stroke and pre-existing dementia to 877 stroke patients without dementia. Patients were well matched. The mean age was 82 years and 58 % were women. Mortality at discharge, 30 days, and 1 year after stroke was similar in patients with and without dementia [for mortality at discharge RR 0.88 [95 % confidence interval

  13. Predictors of active cancer thromboembolic outcomes. RIETE experience of the Khorana score in cancer-associated thrombosis.

    PubMed

    Tafur, Alfonso J; Caprini, Joseph A; Cote, Lauren; Trujillo-Santos, Javier; Del Toro, Jorge; Garcia-Bragado, Fernando; Tolosa, Carles; Barillari, Giovanni; Visona, Adriana; Monreal, Manuel

    2017-03-09

    Even though the Khorana risk score (KRS) has been validated to predict against the development of VTE among patients with cancer, it has a low positive predictive value. It is also unknown whether the score predicts outcomes in patients with cancer with established VTE. We selected a cohort of patients with active cancer from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to assess the prognostic value of the KRS at inception in predicting the likelihood of VTE recurrences, major bleeding and mortality during the course of anticoagulant therapy. We analysed 7948 consecutive patients with cancer-associated VTE. Of these, 2253 (28 %) scored 0 points, 4550 (57 %) 1-2 points and 1145 (14 %) scored ≥3 points. During the course of anticoagulation, amongst patient with low, moderate and high risk KRS, the rate of VTE recurrences was of 6.21 (95 %CI: 4.99-7.63), 11.2 (95 %CI: 9.91-12.7) and 19.4 (95 %CI: 15.4-24.1) events per 100 patient-years; the rate of major bleeding of 5.24 (95 %CI: 4.13-6.56), 10.3 (95 %CI: 9.02-11.7) and 19.4 (95 %CI: 15.4-24.1) bleeds per 100 patient-years and the mortality rate of 25.3 (95 %CI: 22.8-28.0), 58.5 (95 %CI: 55.5-61.7) and 120 (95 %CI: 110-131) deaths per 100 patient-years, respectively. The C-statistic was 0.53 (0.50-0.56) for recurrent VTE, 0.56 (95 %CI: 0.54-0.59) for major bleeding and 0.54 (95 %CI: 0.52-0.56) for death. In conclusion, most VTEs occur in patients with low or moderate risk scores. The KRS did not accurately predict VTE recurrence, major bleeding, or mortality among patients with cancer-associated thrombosis.

  14. The impact of the use of the Early Warning Score (EWS) on patient outcomes: a systematic review.

    PubMed

    Alam, N; Hobbelink, E L; van Tienhoven, A J; van de Ven, P M; Jansma, E P; Nanayakkara, P W B

    2014-05-01

    Acute deterioration in critical ill patients is often preceded by changes in physiological parameters, such as pulse, blood pressure, temperature and respiratory rate. If these changes in the patient's vital parameters are recognized early, excess mortality and serious adverse events (SAEs) such as cardiac arrest may be prevented. The Early Warning Score (EWS) is a scoring system which assists with the detection of physiological changes and may help identify patients at risk of further deterioration. The aim of this systematic review is to evaluate the impact of the use of the Early Warning Score (EWS) on particular patient outcomes, such as in-hospital mortality, patterns of intensive care unit admission and usage, length of hospital stay, cardiac arrests and other serious adverse events of adult patients on general wards and in medical admission units. Systematic review of studies identified from the bibliographic databases of PubMed, EMBASE.com and The Cochrane Library. All controlled studies which measured in-hospital mortality, ICU mortality, serious adverse events (SAEs), cardiopulmonary arrest, length of stay and documentation of physiological parameters which used a EWS on the ward or the emergency department to identify patients at risk were included in the review. Three reviewers (NA, AT and EH) independently screened all potentially relevant titles and abstracts for eligibility, by using a standardized data-worksheet. Meta-analysis was not possible due to heterogeneity. Seven studies met the inclusion criteria. The results of our included studies were mixed, with a positive trend towards better clinical outcomes following the introduction of the EWS chart, sometimes coupled with an outreach service. Six of the seven included studies used mortality as an endpoint: two of these studies reported no significant difference in in-hospital mortality rate; two found a significant reduction of in-hospital mortality; two other studies described a trend towards

  15. Effects of Game Location, Quality of Opposition, and Starting Quarter Score in the Outcome of Elite Water Polo Quarters.

    PubMed

    Ruano, Miguel Á; Serna, Ana D; Lupo, Corrado; Sampaio, Jaime E

    2016-04-01

    The notational analysis is used to investigate teams' performance in water polo, especially focused on the determinants of success. Recently, a new topic has emerged "the situational variables," which includes the game conditions that may influence the performance at a behavioral level. The aim of this study was to identify the interactive effects of starting quarter score (SQS) (i.e., score difference at the beginning of each quarter and at the final score) and game location (GL) (i.e., home and away teams) in relation to quality of opposition (i.e., positions of difference between opposing teams at the end-of-season rankings) in elite men's water polo games. Data comprised 528 games (n = 2,112 quarters) from the first Spanish water polo division. A linear regression analysis was applied to show the impact of SQS and GL in relation to quality of opposition (unbalanced and balanced) for quarter (all quarters, and second, third, and fourth quarters). Results showed that SQS has an important effect for all quarters (0.16) and for the second (0.14) and third (0.14) quarters in balanced games (whereas the fourth quarter has an unpredictable outcome), and for each quarter (all quarters: 0.33; second quarter: 0.55; third quarter: 0.44; fourth quarter: 0.26) in unbalanced games. In addition, GL effects emerged for balanced (0.31) and unbalanced (0.45) games for all quarters and specifically for the second quarter of the unbalanced games. Therefore, this study showed that the elite water polo game dynamics, indirectly providing a reference for coaches (i.e., effective tactical approach) and physical trainers (i.e., high performance intensities), plans to improve their players' performance.

  16. Predicting outcome in acute severe ulcerative colitis: comparison of the Travis and Ho scores using UK IBD audit data.

    PubMed

    Lynch, R W; Churchhouse, A M D; Protheroe, A; Arnott, I D R

    2016-06-01

    Acute severe ulcerative colitis is categorised using the Truelove & Witts criteria. The Travis and the Ho scores are calculated following 72 h of steroid treatment to identify patients at risk of failing steroid therapy who require colectomy or second-line medical therapy. To compare the Travis and the Ho scores in a large unselected cohort to determine which might be more clinically relevant. We analysed 3049 patients with ulcerative colitis from the 2010 round of the UK IBD audit of which 984 had acute severe ulcerative colitis. 420 patients had sufficient data for analysis. Patients were allocated into either a Travis high- or low-risk group and either a Ho high-, intermediate- or low-risk group. We assessed whether further medical or surgical intervention and outcomes varied between groups. High-risk patients in Travis and the Ho groups, when compared to lower risk groups, were more likely to fail steroid therapy: 64.5% (131/203) vs. 38.7% (84/217) (P < 0.0001) for Travis and 66.2% (96/145) vs. 46.7% (85/182) vs. 36.6% (34/93) (P < 0.0001) for Ho. They were also more likely to undergo surgery 34.0% (69/203) vs. 9.7% (21/217) for Travis and 33.1% (48/145) vs. 17.0% (31/182) vs. 11.8% (11/93) (P < 0.0001) for Ho. Travis high patients were more likely to be refractory to second-line medical therapy: 44.6% (37/83) vs. 20.0% (9/45) (P = 0.01). Patients identified as high risk using the Travis or the Ho scoring systems are more likely to be resistant to IV steroids and require surgery. Risk of surgery in both high-risk populations is lower than previously reported. © 2016 John Wiley & Sons Ltd.

  17. Differential outcomes with early and late repeat transplantation in the era of the lung allocation score.

    PubMed

    Osho, Asishana A; Castleberry, Anthony W; Snyder, Laurie D; Palmer, Scott M; Ganapathi, Asvin M; Hirji, Sameer A; Lin, Shu S; Davis, R Duane; Hartwig, Matthew G

    2014-12-01

    Rates of repeat lung transplantation have increased since implementation of the lung allocation score (LAS). The purpose of this study is to compare survival between repeat (ReTx) and primary (LTx) lung transplant recipients in the LAS era. We extracted data from 9,270 LTx and 456 ReTx recipients since LAS implementation, from the United Network for Organ Sharing registry. Propensity scoring was used to match ReTx and LTx recipients. Kaplan-Meier analysis compared survival between LTx and ReTx groups, with and without stratification based on time between first and second transplant. Multivariable Cox models estimated predictors of survival in lung recipients. Comparing all ReTx to LTx demonstrates a survival advantage for LTx that is diminished with propensity score matching (p = 0.174). Considering LTx against ReTx greater than 90 days after the initial procedure, there are similar survival results (p < 0.067). In contrast, ReTx within 90 days was associated with a survival disadvantage that persisted despite matching (p = 0.011). In ReTx populations, factors conferring worse outcomes include intensive care unit admission, unilateral transplantation, poor functional status, and primary graft dysfunction as the indication for retransplantation (p < 0.05). Late lung retransplantation appears to be as beneficial as primary transplantation in propensity-matched patients. However, survival is severely diminished in those retransplanted less than 90 days after primary transplantation. The utility of early retransplantation needs to be carefully weighed in light of risks. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  18. SARC‐F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes

    PubMed Central

    Miller, Douglas K.; Simonsick, Eleanor M.; Ferrucci, Luigi; Morley, John E.

    2015-01-01

    Background A brief, inexpensive screening test for sarcopenia would be helpful for clinicians and their patients. To screen for persons with sarcopenia, we developed a simple five‐item questionnaire (SARC‐F) based on cardinal features or consequences of sarcopenia. Methods We investigated the utility of SARC‐F in the African American Health (AAH) study, Baltimore Longitudinal Study of Aging (BLSA), and National Health and Nutrition Examination Survey (NHANES). Internal consistency reliability for SARC‐F was determined using Cronbach's alpha. We evaluated SARC‐F factorial validity using principal components analysis and criterion validity by examining its association with exam‐based indicators of sarcopenia. Construct validity was examined using cross‐sectional and longitudinal differences among those with high (≥4) vs. low (<4) SARC‐F scores for mortality and health outcomes. Results SARC‐F exhibited good internal consistency reliability and factorial, criterion, and construct validity. AAH participants with SARC‐F scores ≥ 4 had more Instrumental Activity of Daily Living (IADL) deficits, slower chair stand times, lower grip strength, lower short physical performance battery scores, and a higher likelihood of recent hospitalization and of having a gait speed of <0.8 m/s. SARC‐F scores ≥ 4 in AAH also were associated with 6 year IADL deficits, slower chair stand times, lower short physical performance battery scores, having a gait speed of <0.8 m/s, being hospitalized recently, and mortality. SARC‐F scores ≥ 4 in the BLSA cohort were associated with having more IADL deficits and lower grip strength (both hands) in cross‐sectional comparisons and with IADL deficits, lower grip strength (both hands), and mortality at follow‐up. NHANES participants with SARC‐F scores ≥ 4 had slower 20 ft walk times, had lower peak force knee extensor strength, and were more likely to have been hospitalized recently in

  19. Propensity Score Analysis of the Role of Initial Antifungal Therapy in the Outcome of Candida glabrata Bloodstream Infections

    PubMed Central

    Fernández-Ruiz, M.; Aguado, J. M.; Merino, P.; Lora-Pablos, D.; Martín-Dávila, P.; Cuenca-Estrella, M.

    2016-01-01

    Candida glabrata isolates have reduced in vitro susceptibility to azoles, which raises concerns about the clinical effectiveness of fluconazole for treating bloodstream infection (BSI) by this Candida species. We aimed to evaluate whether the choice of initial antifungal treatment (fluconazole versus echinocandins or liposomal amphotericin B [L-AmB]-based regimens) has an impact on the outcome of C. glabrata BSI. We analyzed data from a prospective, multicenter, population-based surveillance program on candidemia conducted in 5 metropolitan areas of Spain (May 2010 to April 2011). Adult patients with an episode of C. glabrata BSI were included. The main outcomes were 14-day mortality and treatment failure (14-day mortality and/or persistent C. glabrata BSI for ≥48 h despite antifungal initiation). The impact of using fluconazole as initial antifungal treatment on the patients' prognosis was assessed by logistic regression analysis with the addition of a propensity score approach. A total of 94 patients with C. glabrata BSI were identified. Of these, 34 had received fluconazole and 35 had received an echinocandin/L-AmB-based regimen. Patients in the echinocandin/L-AmB group had poorer baseline clinical status than did those in the fluconazole group. Patients in the fluconazole group were more frequently (55.9% versus 28.6%) and much earlier (median time, 3 versus 7 days) switched to another antifungal regimen. Overall, 14-day mortality was 13% (9/69) and treatment failure 34.8% (24/69), with no significant differences between the groups. On multivariate analysis, after adjusting for baseline characteristics by propensity score, fluconazole use was not associated with an unfavorable evolution (adjusted odds ratio [OR] for 14-day mortality, 1.16, with 95% confidence interval [CI] of 0.22 to 6.17; adjusted OR for treatment failure, 0.83, with 95% CI of 0.27 to 2.61). In conclusion, initial fluconazole treatment was not associated with a poorer outcome than that

  20. Does SYNTAX score predict in-hospital outcomes in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention?

    PubMed

    Ayça, Burak; Akın, Fatih; Celik, Omer; Cetin, Sükrü; Sahin, Irfan; Gülşen, Kamil; Kalyoncuoğlu, Muhsin; Katkat, Fahrettin; Okuyan, Ertuğrul; Dinçkal, Mustafa Hakan

    2014-01-01

    SYNTAX score (SxS) has been demonstrated to predict long-term outcomes in stable patients with coronary artery disease. But its prognostic value for patients with acute coronary syndrome remains unknown. To evaluate whether SxS could predict in-hospital outcomes for patients admitted with ST elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (pPCI). The study included 538 patients with STEMI who underwent pPCI between January 2010 and December 2012. The patients were divided into two groups: low SxS (< 22) and high SxS (> 22). The SxS of all patients was calculated from aninitial angiogram and TIMI flow grade of infarct related artery was calculated after pPCI. Left ventricular systolic functions of the patients were evaluated with an echocardiogram in the following week. The rates of reinfarction and mortality during hospitalisation were obtained from the medical records of our hospital. The high SxS group had more no-reflow (41% and 25.1%, p < 0.001, respectively), lower ejection fraction (38.2 ± 7.5% and 44.6 ± 8.8%, p < 0.001, respectively), and greater rates of re-infarction (9.5% and 7.3%, p = 0.037, respectively) and mortality (0.9% and 0.2%, p = 0.021, respectively) during hospitalisation compared to the low SxS group. On multivariate logistic regression analysis including clinical variables, SxS was an independent predictor of no-reflow (OR 1.081, 95% CI 1.032-1.133, p = 0.001). SxS is a useful tool that can predict in-hospital outcomes of patients with STEMI undergoing pPCI.

  1. A study of radiological scoring system evaluating extrapancreatic inflammation with conventional radiological and clinical scores in predicting outcomes in acute pancreatitis.

    PubMed

    Sharma, Vishal; Rana, Surinder S; Sharma, Ravi K; Kang, Mandeep; Gupta, Rajesh; Bhasin, Deepak K

    2015-01-01

    A number of scoring systems are available to predict prognosis in acute pancreatitis (AP). The aim of the study was to compare extra-pancreatic inflammation on computed tomography (CT) (EPIC score) and renal rim sign with clinical scores (BISAP, SIRS) and conventional CT severity index (CTSI) and modified CTSI (MCTSI) in predicting persistent organ failure (POF), intervention and mortality. The demographic, clinical and radiographic data from patients with AP were retrospectively evaluated. The scores were evaluated by calculating receiver operator characteristic (ROC) curves and area under the ROC (AUROC). Of the 105 patients (65 males; mean age 40.6±12.9 years) included, 8 died, 71 developed POF, and 16 needed intervention. The mean CTSI, MCTSI and EPIC scores were 5.8±3.0, 7.1±2.6 and 4.0±1.9 respectively. The AUROC for SIRS, BISAP, CTSI, MCTSI, Renal Rim Score and EPIC score in predicting POF were 0.65 (95%CI 0.53-0.78), 0.75 (95%CI 0.65-0.86), 0.66 (95%CI 0.54-0.78), 0.70 (95%CI 0.58-0.81), 0.64 (95%CI 0.52-0.76), 0.71 (95%CI 0.60-0.83), for radiological/endoscopic intervention were 0.50 (95%CI 0.35-0.65), 0.64 (95%CI 0.49-0.78), 0.51 (95%CI 0.36-0.66), 0.55 (95%CI 0.41-0.70), 0.51 (95%CI 0.36-0.67), 0.66 (95%CI 0.52-0.81), and for mortality 0.57 (95%CI 0.38-0.75), 0.90 (95%CI 0.83-0.97), 0.67 (95%CI 0.50-0.83), 0.68 (95%CI 0.51-0.85), 0.73 (95%CI 0.57-0.89) and 0.77 (95%CI 0.64-0.90) respectively. The prognostic performance of various clinical and radiological scoring systems in AP is comparable with BISAP having the highest accuracy for predicting POF and mortality.

  2. Survival outcomes in liver transplant recipients with Model for End-stage Liver Disease scores of 40 or higher: a decade-long experience

    PubMed Central

    Panchal, Hina J; Durinka, Joel B; Patterson, Jeromy; Karipineni, Farah; Ashburn, Sarah; Siskind, Eric; Ortiz, Jorge

    2015-01-01

    Background The Model for End-stage Liver Disease (MELD) has been used as a prognostic tool since 2002 to predict pre-transplant mortality. Increasing proportions of transplant candidates with higher MELD scores, combined with improvements in transplant outcomes, mandate the need to study surgical outcomes in patients with MELD scores of ≥40. Methods A retrospective longitudinal analysis of United Network for Organ Sharing (UNOS) data on all liver transplantations performed between February 2002 and June 2011 (n = 33 398) stratified by MELD score (<30, 30–39, ≥40) was conducted. The primary outcomes of interest were short- and longterm graft and patient survival. A Kaplan–Meier product limit method and Cox regression were used. A subanalysis using a futile population was performed to determine futility predictors. Results Of the 33 398 transplant recipients analysed, 74% scored <30, 18% scored 30–39, and 8% scored ≥40 at transplantation. Recipients with MELD scores of ≥40 were more likely to be younger (P < 0.001), non-White and to have shorter waitlist times (P < 0.001). Overall patient survival correlated inversely with increasing MELD score; this trend was consistent for both short-term (30 days and 90 days) and longterm (1, 3 and 5 years) graft and patient survival. In multivariate analysis, increasing age, African-American ethnicity, donor obesity and diabetes were negative predictors of survival. Futility predictors included patient age of >60 years, obesity, peri-transplantation intensive care unit hospitalization with ventilation, and multiple comorbidities. Conclusions Liver transplantation in recipients with MELD scores of ≥40 offers acceptable longterm survival outcomes. Futility predictors indicate the need for prospective follow-up studies to define the population to gain the highest benefit from this precious resource. PMID:26373873

  3. Estimating the safety effects of lane widths on urban streets in Nebraska using the propensity scores-potential outcomes framework.

    PubMed

    Wood, Jonathan S; Gooch, Jeffrey P; Donnell, Eric T

    2015-09-01

    A sufficient understanding of the safety impact of lane widths in urban areas is necessary to produce geometric designs that optimize safety performance for all users. The overarching trend found in the research literature is that as lane widths narrow, crash frequency increases. However, this trend is inconsistent and is the result of multiple cross-sectional studies that have issues related to lack of control for potential confounding variables, unobserved heterogeneity or omitted variable bias, or endogeneity among independent variables, among others. Using ten years of mid-block crash data on urban arterials and collectors from four cities in Nebraska, crash modification factors (CMFs) were estimated for various lane widths and crash types. These CMFs were developed using the propensity scores-potential outcomes methodology. This method reduces many of the issues associated with cross-sectional regression models when estimating the safety effects of infrastructure-related design features. Generalized boosting, a non-parametric modeling technique, was used to estimate the propensity scores. Matching was performed using both Nearest Neighbor and Mahalanobis matching techniques. CMF estimation was done using mixed-effects negative binomial or Poisson regression with the matched data. Lane widths included in the analysis included 9ft, 10ft, 11ft, and 12ft. Some of the estimated CMFs were point estimates while others were functions of traffic volume (i.e., the CMF changed depending on the traffic volume). Roadways with 10ft travel lanes were found to experience the highest crash frequency relative to other lane widths. Meanwhile, roads with 9ft travel lanes were found to experience the lowest relative crash frequency. While this may be due to increased driver caution when traveling on narrow lanes, it is possible that unobserved factors influenced this result. CMFs for target crash types (sideswipe same-direction and sideswipe opposite-direction) were consistent

  4. National perioperative outcomes of pulmonary lobectomy for cancer in the obese patient: a propensity score matched analysis.

    PubMed

    Launer, Hunter; Nguyen, Danh V; Cooke, David T

    2013-05-01

    Obesity in the United States is a growing epidemic that results in challenging patients with complicated comorbidities. We sought to compare hospital outcomes of obese patients with those of nonobese patients undergoing pulmonary lobectomy for cancer. We performed a retrospective cohort analysis of obese (body mass index ≥ 30 kg/m(2)) and nonobese (body mass index < 30 kg/m(2)) patients undergoing pulmonary lobectomy for lung cancer. By using the Nationwide Inpatient Sample database from 2002 to 2007, we determined independent risk factors for perioperative death, discharge to an institutional care facility, and prolonged hospital length of stay (>14 days). Cohorts were matched on the basis of propensity scores incorporating preoperative patient variables. We identified 1238 obese patients (3.7%) and 31,983 nonobese patients (96.3%) undergoing lobectomy for cancer. In regard to patient demographics, obese patients were younger (mean age, 64.8 vs 66.7, P < .001) and predominantly female (59.5% vs 50.0%, P < .001) compared with nonobese patients. After matching based on propensity scores, except for a greater incidence of pulmonary insufficiency (P = .03) and pneumonia (P = .01) in the obese group, there were no differences in postoperative complications. By controlling for patient demographics, obese patients had higher odds to be discharged to an institutional care facility (odds ratio, 1.21; P = .02) but not for prolonged hospital length of stay or perioperative death. Obese patients have an increased risk for postoperative pulmonary complications but not other morbidity, mortality, or prolonged hospital length of stay after lobectomy for cancer. Obesity should not be considered a surgical risk factor for pulmonary resection. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  5. Initial use of echinocandins does not negatively influence outcome in Candida parapsilosis bloodstream infection: a propensity score analysis.

    PubMed

    Fernández-Ruiz, Mario; Aguado, José María; Almirante, Benito; Lora-Pablos, David; Padilla, Belén; Puig-Asensio, Mireia; Montejo, Miguel; García-Rodríguez, Julio; Pemán, Javier; Ruiz Pérez de Pipaón, Maite; Cuenca-Estrella, Manuel

    2014-05-01

    Concerns have arisen regarding the optimal antifungal regimen for Candida parapsilosis bloodstream infection (BSI) in view of its reduced susceptibility to echinocandins. The Prospective Population Study on Candidemia in Spain (CANDIPOP) is a prospective multicenter, population-based surveillance program on Candida BSI conducted through a 12-month period in 29 Spanish hospitals. Clinical isolates were identified by DNA sequencing, and antifungal susceptibility testing was performed by the European Committee on Antimicrobial Susceptibility Testing methodology. Predictors for clinical failure (all-cause mortality between days 3 to 30, or persistent candidemia for ≥72 hours after initiation of therapy) in episodes of C. parapsilosis species complex BSI were assessed by logistic regression analysis. We further analyzed the impact of echinocandin-based regimen as the initial antifungal therapy (within the first 72 hours) by using a propensity score approach. Among 752 episodes of Candida BSI identified, 200 (26.6%) were due to C. parapsilosis species complex. We finally analyzed 194 episodes occurring in 190 patients. Clinical failure occurred in 58 of 177 (32.8%) of evaluable episodes. Orotracheal intubation (adjusted odds ratio [AOR], 2.81; P = .018) and septic shock (AOR, 2.91; P = .081) emerged as risk factors for clinical failure, whereas early central venous catheter removal was protective (AOR, 0.43; P = .040). Neither univariate nor multivariate analysis revealed that the initial use of an echinocandin-based regimen had any impact on the risk of clinical failure. Incorporation of the propensity score into the model did not change this finding. The initial use of an echinocandin-based regimen does not seem to negatively influence outcome in C. parapsilosis BSI.

  6. A multicenter study analyzing the relationship of a standardized radiographic scoring system of adolescent idiopathic scoliosis and the Scoliosis Research Society outcomes instrument.

    PubMed

    Wilson, Philip L; Newton, Peter O; Wenger, Dennis R; Haher, Thomas; Merola, Andrew; Lenke, Larry; Lowe, Thomas; Clements, David; Betz, Randy

    2002-09-15

    A multicenter study examining the association between radiographic and outcomes measures in adolescent idiopathic scoliosis. To evaluate the association between an objective radiographic scoring system and patient quality of life measures as determined by the Scoliosis Research Society outcomes instrument. Although surgical correction of scoliosis has been reported to be positively correlated with patient outcomes, studies to date have been unable to demonstrate an association between radiographic measures of deformity and outcomes measures in patients with adolescent idiopathic scoliosis. A standardized radiographic deformity scoring system and the Scoliosis Research Society outcome tool were used prospectively in seven scoliosis centers to collect data on patients with adolescent idiopathic scoliosis. A total of 354 data points for 265 patients consisting of those with nonoperative or preoperative curves >or=10 degrees, as well as those with surgically treated curves, were analyzed. Correlation analysis was performed to identify significant relationships between any of the radiographic measures, the Harms Study Group radiographic deformity scores (total, sagittal, coronal), and the seven Scoliosis Research Society outcome domains (Total Pain, General Self-Image, General Function, Activity, Postoperative Self-Image, Postoperative Function, and Satisfaction) as well as Scoliosis Research Society outcomes instrument total scores. Radiographic measures that were identified as significantly correlated with Scoliosis Research Society outcome scores were then entered into a stepwise regression analysis. The coronal measures of thoracic curve and lumbar curve magnitude were found to be significantly correlated with the Total Pain, General Self-Image, and total Scoliosis Research Society scores (P < 0.0001). The thoracic and upper thoracic curve magnitudes were also correlated with General Function (P < 0.002). The "coronal" subscore as well as the "total" score of the

  7. Combination of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Cardiac Surgery Score (CASUS) to Improve Outcome Prediction in Cardiac Surgery.

    PubMed

    Doerr, Fabian; Heldwein, Matthias B; Bayer, Ole; Sabashnikov, Anton; Weymann, Alexander; Dohmen, Pascal M; Wahlers, Thorsten; Hekmat, Khosro

    2015-08-17

    BACKGROUND We hypothesized that the combination of a preoperative and a postoperative scoring system would improve the accuracy of mortality prediction and therefore combined the preoperative 'additive EuroSCORE' (European system for cardiac operative risk evaluation) with the postoperative 'additive CASUS' (Cardiac Surgery Score) to form the 'modified CASUS'. MATERIAL AND METHODS We included all consecutive adult patients after cardiac surgery during January 2007 and December 2010 in our prospective study. Our single-centre study was conducted in a German general referral university hospital. The original additive and the 'modified CASUS' were tested using calibration and discrimination statistics. We compared the area under the curve (AUC) of the receiver characteristic curves (ROC) by DeLong's method and calculated overall correct classification (OCC) values. RESULTS The mean age among the total of 5207 patients was 67.2 ± 10.9 years. Whilst the ICU mortality was 5.9% we observed a mean length of ICU stay of 4.6 ± 7.0 days. Both models demonstrated excellent discriminatory power (mean AUC of 'modified CASUS': ≥ 0.929; 'additive CASUS': ≥ 0.920), with no significant differences according to DeLong. Neither model showed a significant p-value (<0.05) in calibration. We detected the best OCC during the 2nd day (modified: 96.5%; original: 96.6%). CONCLUSIONS Our 'additive' and 'modified' CASUS are reasonable overall predictors. We could not detect any improvement in the accuracy of mortality prediction in cardiac surgery by combining a preoperative and a postoperative scoring system. A separate calculation of the two individual elements is therefore recommended.

  8. Mixed-effects beta regression for modeling continuous bounded outcome scores using NONMEM when data are not on the boundaries.

    PubMed

    Xu, Xu Steven; Samtani, Mahesh N; Dunne, Adrian; Nandy, Partha; Vermeulen, An; De Ridder, Filip

    2013-08-01

    Beta regression models have been recommended for continuous bounded outcome scores that are often collected in clinical studies. Implementing beta regression in NONMEM presents difficulties since it does not provide gamma functions required by the beta distribution density function. The objective of the study was to implement mixed-effects beta regression models in NONMEM using Nemes' approximation to the gamma function and to evaluate the performance of the NONMEM implementation of mixed-effects beta regression in comparison to the commonly used SAS approach. Monte Carlo simulations were conducted to simulate continuous outcomes within an interval of (0, 70) based on a beta regression model in the context of Alzheimer's disease. Six samples per subject over a 3 years period were simulated at 0, 0.5, 1, 1.5, 2, and 3 years. One thousand trials were simulated and each trial had 250 subjects. The simulation-reestimation exercise indicated that the NONMEM implementation using Laplace and Nemes' approximations provided only slightly higher bias and relative RMSE (RRMSE) compared to the commonly used SAS approach with adaptive Gaussian quadrature and built-in gamma functions, i.e., the difference in bias and RRMSE for fixed-effect parameters, random effects on intercept, and the precision parameter were <1-3 %, while the difference in the random effects on the slope was <3-7 % under the studied simulation conditions. The mixed-effect beta regression model described the disease progression for the cognitive component of the Alzheimer's disease assessment scale from the Alzheimer's Disease Neuroimaging Initiative study. In conclusion, with Nemes' approximation of the gamma function, NONMEM provided comparable estimates to those from SAS for both fixed and random-effect parameters. In addition, the NONMEM run time for the mixed beta regression models appeared to be much shorter compared to SAS, i.e., 1-2 versus 20-40 s for the model and data used in the manuscript.

  9. Minimal Clinically Important Difference of Patient Reported Outcome Measures of Lower Extremity Injuries in Orthopedics

    PubMed Central

    Çelik, Derya; Çoban, Özge; Kılıçoğlu, Önder

    2017-01-01

    Purpose: MCID scores for outcome measures are frequently used evidence-based guides to gage meaningful changes. To conduct a systematic review of the quality and content of the the minimal clinically important difference (MCID) relating to 16 patient-rated outcome measures (PROM) used in lower extremity. Methods: We conducted a systematic literature review on articles reporting MCID in lower extremity outcome measures and orthopedics from January 1, 1980, to May 10, 2016. We evaluated MCID of the 16 patient reported outcome measures (PROM) which were Harris Hip Score (HHS), Oxford Hip Score (OHS), Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score (HOOS), The International Knee Documentation Committee Subjective Knee Form (IKDC), The Lysholm Scale, The Western Ontario Meniscal Evaluation Tool (WOMET), The Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QOL), The Lower Extremity Functional Scale (LEFS), The Western Ontario and Mcmaster Universities Index (WOMAC), Knee İnjury And Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Kujala Anterior Knee Pain Scale, The Victorian Institute of Sports Assessment Patellar Tendinosis (Jumper’s Knee) (VİSA-P), Tegner Activity Rating Scale, Marx Activity Rating Scale, Foot And Ankle Outcome Score (FAOS), The Foot Function Index (FFI), Foot And Ankle Ability Measure (FAAM), The Foot And Ankle Disability Index Score and Sports Module, Achill Tendon Total Rupture Score(ATRS), The Victorian İnstitute Of Sports Assesment Achilles Questionnaire(VİSA-A), American Orthopaedic Foot and Ankle Society (AOFAS). A search of the PubMed/MEDLINE, PEDro and Cochrane Cen¬tral Register of Controlled Trials and Web of Science databases from the date of inception to May 1, 2016 was conducted. The terms “minimal clinically important difference,” “minimal clinically important change”, “minimal clinically important improvement” “were combined with one of the PROM as mentioned above

  10. Combining acute diffusion-weighted imaging and mean transmit time lesion volumes with National Institutes of Health Stroke Scale Score improves the prediction of acute stroke outcome.

    PubMed

    Yoo, Albert J; Barak, Elizabeth R; Copen, William A; Kamalian, Shahmir; Gharai, Leila Rezai; Pervez, Muhammad A; Schwamm, Lee H; González, R Gilberto; Schaefer, Pamela W

    2010-08-01

    The purpose of this study was to determine whether acute diffusion-weighted imaging (DWI) and mean transit time (MTT) lesion volumes and presenting National Institutes of Health Stroke Scale (NIHSS) can identify patients with acute ischemic stroke who will have a high probability of good and poor outcomes. Fifty-four patients with acute ischemic stroke who had MRI within 9 hours of symptom onset and 3-month follow-up with modified Rankin scale were evaluated. Acute DWI and MTT lesion volumes and baseline NIHSS scores were calculated. Clinical outcomes were considered good if the modified Rankin Scale was 0 to 2. The 33 of 54 (61%) patients with good outcomes had significantly smaller DWI lesion volumes (P=0.0001), smaller MTT lesion volumes (P<0.0001), and lower NIHSS scores (P<0.0001) compared with those with poor outcomes. Receiver operating characteristic curves for DWI, MTT, and NIHSS relative to poor outcome had areas under the curve of 0.889, 0.854, and 0.930, respectively, which were not significantly different. DWI and MTT lesion volumes predicted outcome better than mismatch volume or percentage mismatch. All patients with a DWI volume >72 mL (13 of 54) and an NIHSS score >20 (6 of 54) had poor outcomes. All patients with an MTT volume of <47 mL (16 of 54) and an NIHSS score <8 (17 of 54) had good outcomes. Combining clinical and imaging thresholds improved prognostic yield (70%) over clinical (43%) or imaging (54%) thresholds alone (P=0.01). Combining quantitative DWI and MTT with NIHSS predicts good and poor outcomes with high probability and is superior to NIHSS alone.

  11. Application of propensity scores and potential outcomes to estimate effectiveness of traffic safety countermeasures: Exploratory analysis using intersection lighting data.

    PubMed

    Sasidharan, Lekshmi; Donnell, Eric T

    2013-01-01

    More than 5.5 million police-reported traffic crashes occurred in the United States in 2009, resulting in 33,808 fatalities and more than 2.2 million injuries. Significant funds are expended annually by federal, state, and local transportation agencies in an effort to reduce traffic crashes. Effective safety management involves selecting highway and street locations with potential for safety improvements; correctly diagnosing safety problems; identifying appropriate countermeasures; prioritizing countermeasure implementation at selected sites; and, evaluating the effectiveness of implemented countermeasures. Accurate estimation of countermeasure effectiveness is a critical component of the safety management process. In this study, a statistical modeling framework, based on propensity scores and potential outcomes, is described to estimate countermeasure effectiveness from non-randomized observational data. Average treatment effects are estimated using semi-parametric estimation methods. To demonstrate the framework, the average treatment effect of fixed roadway lighting at intersections in Minnesota is estimated. The results indicate that fixed roadway lighting reduces expected nighttime crashes by approximately 6%, which compares favorably to other, recent lighting-safety research findings.

  12. Combination of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Cardiac Surgery Score (CASUS) to Improve Outcome Prediction in Cardiac Surgery

    PubMed Central

    Doerr, Fabian; Heldwein, Matthias B.; Bayer, Ole; Sabashnikov, Anton; Weymann, Alexander; Dohmen, Pascal M.; Wahlers, Thorsten; Hekmat, Khosro

    2015-01-01

    Background We hypothesized that the combination of a preoperative and a postoperative scoring system would improve the accuracy of mortality prediction and therefore combined the preoperative ‘additive EuroSCORE‘ (European system for cardiac operative risk evaluation) with the postoperative ‘additive CASUS’ (Cardiac Surgery Score) to form the ‘modified CASUS’. Material/Methods We included all consecutive adult patients after cardiac surgery during January 2007 and December 2010 in our prospective study. Our single-centre study was conducted in a German general referral university hospital. The original additive and the ‘modified CASUS’ were tested using calibration and discrimination statistics. We compared the area under the curve (AUC) of the receiver characteristic curves (ROC) by DeLong’s method and calculated overall correct classification (OCC) values. Results The mean age among the total of 5207 patients was 67.2±10.9 years. Whilst the ICU mortality was 5.9% we observed a mean length of ICU stay of 4.6±7.0 days. Both models demonstrated excellent discriminatory power (mean AUC of ‘modified CASUS’: ≥0.929; ‘additive CASUS’: ≥0.920), with no significant differences according to DeLong. Neither model showed a significant p-value (<0.05) in calibration. We detected the best OCC during the 2nd day (modified: 96.5%; original: 96.6%). Conclusions Our ‘additive’ and ‘modified’ CASUS are reasonable overall predictors. We could not detect any improvement in the accuracy of mortality prediction in cardiac surgery by combining a preoperative and a postoperative scoring system. A separate calculation of the two individual elements is therefore recommended. PMID:26279053

  13. Influence of the echocardiographic score and not of the previous surgical mitral commissurotomy on the outcome of percutaneous mitral balloon valvuloplasty.

    PubMed

    Peixoto, E C; Peixoto, R T; Borges, I P; Oliveira, P S; Labrunie, M; Salles Netto, M; Villela, R A; Labrunie, P; Brito, G A; Peixoto, R T

    2001-06-01

    To evaluate prior mitral surgical commissurotomy and echocardiographic score influence on the outcomes and complications of percutaneous mitral balloon valvuloplasty. We performed 459 complete mitral valvuloplasty procedures. Four hundred thirteen were primary valvuloplasty and 46 were in patients who had undergone prior surgical commissurotomy. The prior commissurotomy group was older, had higher echo scores, and a tendency toward a higher percentage of atrial fibrillation. When the groups were compared with each other, no differences were found in pre- and postprocedure mean pulmonary artery pressure, mean mitral gradient, mitral valve area, and mitral regurgitation. Because we found no significant differences, we subdivided the entire group based on echo scores, those with echo scores < or =8 and those with echo scores >8 the mitral valve area being higher in the < or =8 echo score group 2.06+/-0.42 versus 1.90+/-0.40 cm2 (p=0.0090) in the >8 echo score group. Dividing the groups based on echo score revealed that the higher echo score group had smaller mitral valve areas postvalvuloplasty.

  14. Association between the SVS/AAVS anatomical severity grading score and operative outcomes in fenestrated endovascular repair of juxtarenal aortic aneurysm.

    PubMed

    Kristmundsson, Thorarinn; Sonesson, Björn; Dias, Nuno; Malina, Martin; Resch, Timothy

    2013-06-01

    To evaluate the association between the Society for Vascular Surgery/American Association for Vascular Surgery (SVS/AAVS) anatomical severity grading (ASG) score and operative outcomes in fenestrated endovascular repair (f-EVAR) for juxtarenal aortic aneurysm. A review was conducted of all patients treated at our clinic with commercially available, custom-made f-EVAR devices between June 2007 and December 2011. Preoperative computed tomography (CT) scans were analyzed in a dedicated vascular 3-dimensional workstation for calculation of the ASG score. Of the 100 patients treated with f-EVAR during the study period, 88 (69 men; mean age 70 years, range 50-82) had high quality CT scans available for generating semiautomatic centerline-of-flow reconstructions needed to calculate the ASG score. The mean score was used to divide the patients into high and low score groups for comparison of operative outcomes. A total ASG score ≥24 was associated with longer procedure time (357±121 vs. 298±131 minutes, p=0.03) and more frequent intraoperative adjunctive maneuvers (48% vs. 29% of patients, p=0.05). An ASG neck score ≥7 was associated with longer procedure time (365±126 vs. 288±119 minutes, p<0.01), more operative adverse events (31% vs. 14% of patients, p=0.05), higher radiation exposure (53828±37341 vs. 38788±25846 μGym(2), p=0.04), and more frequent postoperative complications (46% vs. 18% of patients, p<0.01). An ASG aneurysm score ≥5 was associated with operative adverse events (44% vs. 19% of patients, p=0.04). No relationship was found between the ASG score and blood loss, contrast volume, fluoroscopy time, or hospital stays. The ASG score is associated with operative adverse events, intraoperative adjunctive maneuvers, radiation exposure, and postoperative complications in patients treated with f-EVAR for juxtarenal aortic aneurysm.

  15. Performance of EQ-5D, howRu and Oxford hip & knee scores in assessing the outcome of hip and knee replacements.

    PubMed

    Benson, Tim; Williams, Dan H; Potts, Henry W W

    2016-09-22

    We aimed to compare the performance of EQ-5D-3 L and howRu, which are short generic patient-reported outcome measures (PROMs), in assessing the outcome of hip and knee replacements, using the Oxford Hip Score (OHS) and the Oxford Knee Scores (OKS) for comparison. Outcome was assessed as the difference between pre-surgery and 6-month post-surgery scores. We used a large sample from the NHS PROMs database, which used EQ-5D-3 L, and a small cohort of patients having the same operations collected by MyClinicalOutcomes (MCO), which used howRu. Both cohorts completed the OHS (hips) or the OKS (knees). The change (outcome) between pre-op and post-op scores as measured by howRu was greater than that measured by EQ-5D, relative to that measured by OHS or OKS. For hip replacements, the correlation for change measured by howRu and OHS was r = 0.77 (0.66-0.85). The corresponding correlation for change measured by EQ-5D Index and OHS was r = 0.64 (0.63-0.64). For knee replacements the correlation between change in howRu and OKS was r = 0.86 (0.75-0.92); between EQ-5D Index and OKS r = 0.59 (0.58-0.60). For hip and knee replacement, the outcome measured by howRu was more highly correlated with that measured by the condition-specific Oxford Hip and Knee Scores than were EQ-5D Index or EQ-VAS. The magnitude of change before and after surgery was also greater.

  16. CHA2 DS2 -VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm.

    PubMed

    Ye, Siqin; Qian, Min; Zhao, Bo; Buchsbaum, Richard; Sacco, Ralph L; Levin, Bruce; Di Tullio, Marco R; Mann, Douglas L; Pullicino, Patrick M; Freudenberger, Ronald S; Teerlink, John R; Mohr, J P; Graham, Susan; Labovitz, Arthur J; Estol, Conrado J; Lok, Dirk J; Ponikowski, Piotr; Anker, Stefan D; Lip, Gregory Y H; Thompson, John L P; Homma, Shunichi

    2016-10-01

    The aim of this study was to determine whether the CHA2 DS2 -VASc score can predict adverse outcomes such as death, ischaemic stroke, and major haemorrhage, in patients with systolic heart failure in sinus rhythm. CHA2 DS2 -VASc scores were calculated for 1101 patients randomized to warfarin and 1123 patients randomized to aspirin. Adverse outcomes were defined as death or ischaemic stroke, death alone, ischaemic stroke alone, and major haemorrhage. Using proportional hazards models, we found that each 1-point increase in the CHA2 DS2 -VASc score was associated with increased hazard of death or ischaemic stroke events [hazard ratio (HR) for the warfarin arm = 1.21, 95% confidence interval (CI) 1.13-1.30, P < 0.001; for aspirin, HR = 1.20, 95% CI 1.11-1.29, P < 0.001]. Similar increased hazards for higher CHA2 DS2 -VASc scores were observed for death alone, ischaemic stroke alone, and major haemorrhage. Overall performance of the CHA2 DS2 -VASc score was assessed using c-statistics for full models containing the risk score, treatment assignment, and score-treatment interaction, with the c-statistics for the full models ranging from 0.57 for death to 0.68 for major haemorrhage. The CHA2 DS2 -VASc score predicted adverse outcomes in patients with systolic heart failure in sinus rhythm, with modest prediction accuracy. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

  17. Do physiological scoring and a novel point of care metabolic screen predict 48-h outcome in admissions from the emergency department resuscitation area?

    PubMed

    Jafar, Anisa J N; Junghans, Cornelia; Kwok, Chun Shing; Hymers, Chrissie; Monk, Kerri J; Gold, Ed; Harris, Tim R

    2016-04-01

    We aimed to compare the performance of a widely used physiological score [Modified Early Warning Score (MEWS)] and a novel metabolic score (derived from a blood gas) in predicting outcome in emergency department patients. We carried out a prospective observational study using a convenience sample of 200 patients presenting to the resuscitation area of an inner-city teaching hospital over 4 months. We looked primarily at whether either score predicted new organ failure at 48 h. Our secondary outcome measures were escalation of care and mortality at 48 h. In univariate analysis, MEWS and the metabolic score predicted 48-h organ failure [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.04-1.35, P=0.009, and OR 1.34, 95% CI 1.015-1.56, P<0.001, respectively]. Both MEWS and the metabolic score predicted 48-h death (OR 1.32, 95% CI 1.02-1.71, P=0.03, and OR 1.56, 95% CI 1.18-2.06, P=0.002, respectively) in univariate analysis. Neither predicted 48-h escalation of care. The metabolic score remained statistically significant at predicting organ failure or death after controlling for MEWS parameters (OR 1.35, 95% CI 1.13-1.62, P=0.001, and OR 1.74, 95% CI 1.13-2.69, P=0.01, respectively). In contrast, MEWS was no longer associated with these outcomes; however, our study has small participant numbers. This pilot data suggest that a blood gas-derived metabolic score on emergency department arrival may be superior to MEWS at predicting organ failure and death at 48 h.

  18. The effects of blastocyst morphological score and blastocoele re-expansion speed after warming on pregnancy outcomes

    PubMed Central

    Yin, Huiqun; He, Ruibing; Wang, Cunli; Zhu, Jie; Li, Yang

    2016-01-01

    Objective The aim of this study was to investigate associations between the morphology score of blastocysts and blastocoele re-expansion speed after warming with clinical outcomes, which could assist in making correct and cost-effective decisions regarding the appropriate time to vitrify blastocysts and to transfer vitrified-warmed blastocysts. Methods A total of 327 vitrified-warmed two-blastocyst transfer cycles in women 38 years old and younger were included in this retrospective study. Results The clinical pregnancy rate (CPR) and implantation rate (IR) of transfers of two good-morphology grade 4 blastocysts vitrified on day 5 (64.1% and 46.8%, respectively) were significantly higher than the CPR and IR associated with the transfers of two good-morphology grade 3 blastocysts vitrified on day 5 (46.7% and 32.2%, respectively). No significant differences were found in the CPR and IR among the transfers of two good-morphology grade 4 blastocysts regardless of the day of cryopreservation. Logistic regression analysis showed that blastocoele re-expansion speed after warming was associated with the CPR. Conclusion The selection of a good-morphology grade 4 blastocyst to be vitrified could be superior to the choice of a grade 3 blastocyst. Extending the culture of grade 3 blastocysts and freezing grade 4 or higher blastocysts on day 6 could lead to a greater likelihood of pregnancy. Since re-expansion was shown to be a morphological marker of superior blastocyst viability, blastocysts that quickly re-expand after warming should be prioritized for transfer. PMID:27104155

  19. The effects of blastocyst morphological score and blastocoele re-expansion speed after warming on pregnancy outcomes.

    PubMed

    Yin, Huiqun; Jiang, Hong; He, Ruibing; Wang, Cunli; Zhu, Jie; Li, Yang

    2016-03-01

    The aim of this study was to investigate associations between the morphology score of blastocysts and blastocoele re-expansion speed after warming with clinical outcomes, which could assist in making correct and cost-effective decisions regarding the appropriate time to vitrify blastocysts and to transfer vitrified-warmed blastocysts. A total of 327 vitrified-warmed two-blastocyst transfer cycles in women 38 years old and younger were included in this retrospective study. The clinical pregnancy rate (CPR) and implantation rate (IR) of transfers of two good-morphology grade 4 blastocysts vitrified on day 5 (64.1% and 46.8%, respectively) were significantly higher than the CPR and IR associated with the transfers of two good-morphology grade 3 blastocysts vitrified on day 5 (46.7% and 32.2%, respectively). No significant differences were found in the CPR and IR among the transfers of two good-morphology grade 4 blastocysts regardless of the day of cryopreservation. Logistic regression analysis showed that blastocoele re-expansion speed after warming was associated with the CPR. The selection of a good-morphology grade 4 blastocyst to be vitrified could be superior to the choice of a grade 3 blastocyst. Extending the culture of grade 3 blastocysts and freezing grade 4 or higher blastocysts on day 6 could lead to a greater likelihood of pregnancy. Since re-expansion was shown to be a morphological marker of superior blastocyst viability, blastocysts that quickly re-expand after warming should be prioritized for transfer.

  20. Safety evaluation of continuous green T intersections: A propensity scores-genetic matching-potential outcomes approach.

    PubMed

    Wood, Jonathan; Donnell, Eric T

    2016-08-01

    The continuous green T intersection is characterized by a channelized left-turn movement from the minor street approach onto the major street, along with a continuous through movement on the major street. The continuous flow through movement is not controlled by the three-phase traffic signal that is used to separate all other movements at the intersection. Rather, the continuous through movement typically has a green through arrow indicator to inform drivers that they do not have to stop. Past research has consistently shown that there are operational and environmental benefits to implementing this intersection form at three-leg locations, when compared to a conventional signalized intersection. These benefits include reduced delay, fuel consumption, and emissions. The safety effects of the conventional green T intersection are less clear. Past research has been limited to small sample sizes, or utilized only statistical comparisons reported crashes to evaluate the safety performance relative to similar intersection types. The present study overcomes past safety research evaluations by using a propensity scores-potential outcomes framework, with genetic matching, to compare the safety performance of the continuous green T to conventional signalized intersections, using treatment and comparison site data from Florida and South Carolina. The results show that the expected total, fatal and injury, and target crash (rear-end, angle, and sideswipe) frequencies are lower at the continuous green T intersection relative to the conventional signalized intersection (CMFs of 0.958 [95% CI=0.772-1.189], 0.846 [95% CI=0.651-1.099], and 0.920 [95% CI=0.714-1.185], respectively).

  1. Propensity Score Analysis Comparing Clinical Outcomes of Drug-Eluting vs Bare Nitinol Stents in Femoropopliteal Lesions.

    PubMed

    Soga, Yoshimitsu; Takahara, Mitsuyoshi; Iida, Osamu; Nakano, Masatsugu; Yamauchi, Yasutaka; Zen, Kan; Kawasaki, Daizo; Ando, Kenji

    2016-02-01

    To present a propensity score matching analysis comparing the 1-year outcomes of de novo femoropopliteal lesions treated with drug-eluting stents (DES) or bare nitinol stents (BNS). A retrospective review was conducted of 452 limbs in 389 patients (mean age 74±8 years; 284 men) treated with DES implantation and 1808 limbs in 1441 patients (mean age 72±9 years; 1023 men) implanted with BNS for de novo femoropopliteal lesions. One-year follow-up data were available on all patients. The primary endpoint was 12-month restenosis assessed by duplex ultrasonography or follow-up angiography within ±2 months. Secondary endpoint was major adverse limb events (MALE) including major amputation, any reintervention, and restenosis. The BNS group was more likely to have current smoking, chronic total occlusion, and poor below-the-knee runoff. The stratification analysis demonstrated that diabetes mellitus (DM) and reference vessel diameter (RVD) had a significant interaction on the association of DES vs BNS implantation with restenosis (interaction p<0.05). Thus, the population was stratified into 4 subgroups (1: -DM, RVD ≥5 mm, 2: +DM, RVD ≥5 mm, 3: -DM, RVD <5 mm, and 4: +DM, RVD <5 mm); the RVD threshold was empirically determined. There were no significant intergroup differences in baseline variables after matching. There was no significant difference in restenosis risk between DES and BNS in the RVD ≥5 mm subgroup regardless of the presence of DM. The DES group had a significantly higher restenosis risk in the RVD <5 mm subgroup regardless of the presence of DM. No significant difference was observed in the risk of major amputation, reintervention, or MALE in any subgroup. These results suggest that a first-generation DES was not superior to a conventional BNS for femoropopliteal lesions. © The Author(s) 2015.

  2. Sensitivity to Change of a Computer Adaptive Testing Instrument for Outcome Measurement After Hip and Knee Arthroplasty and Periacetabular Osteotomy.

    PubMed

    McDonough, Christine M; Stoiber, Eva; Tomek, Ivan M; Ni, Pengsheng; Kim, Young-Jo; Tian, Feng; Jette, Alan M

    Study Design Clinical measurement study. Background Computer adaptive testing (CAT) methods may allow detection of change across the continuum of osteoarthritis (OA) care. Objective To evaluate the sensitivity to change of a self-report OA CAT instrument (OA-CAT) following surgery. Methods Core measures consisted of the 5-item OA-CAT function, pain, and disability scales; the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); the University of California at Los Angeles activity rating scale; and the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12), which were administered in 3 samples. Fifty-three patients with hip dysplasia completed the core measures, the Hip disability and Osteoarthritis Outcome Score physical function short form (HOOS-PS), and the Modified Harris Hip Score (MHHS) before periacetabular osteotomy, and at 6 months, 1 year, and 2 years after periacetabular osteotomy. The hip (n = 62) and knee (n = 66) arthroplasty samples completed core measures and the MHHS or the Knee Society's Knee Scoring System at baseline and at 3-month follow-up. Mean change, floor and ceiling effects (percent), and effect size were calculated. Results For osteotomy, the 6-month physical function effect sizes for the OA-CAT, WOMAC, HOOS-PS, MHHS, and SF-12 physical component summary scores were 0.66 (95% confidence interval [CI]: 0.08, 1.61), 0.78 (95% CI: 0.56, 1.10), 0.91 (95% CI: 0.70, 1.21), 0.64 (95% CI: 0.22, 1.07), and 0.87 (95% CI: 0.53, 1.38), respectively. Effect-size trends were all increased at 1 year, and most were level at 2 years. For hip arthroplasty, the OA-CAT, WOMAC, MHHS, and SF-12 effect sizes were 1.27 (95% CI: 0.88, 1.84), 1.50 (95% CI: 1.20, 1.80), 0.68 (95% CI: 0.35, 1.04), and 0.56 (95% CI: 0.29, 0.88), respectively. For knee arthroplasty, the OA-CAT, WOMAC, Knee Society Knee Scoring System, and SF-12 effect sizes were 0.81 (95% CI: 0.56, 1.14), 0.85 (95% CI: 0.61, 1.10), 0.09 (95% CI: -0.22, 0.40), and -0.01 (95

  3. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

    PubMed Central

    Rix, Thomas E; Bates, Tom

    2007-01-01

    Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential. PMID:17550623

  4. The Impact of Previous Schooling Experiences on a Quaker High School's Graduating Students' College Entrance Exam Scores, Parents' Expectations, and College Acceptance Outcomes

    ERIC Educational Resources Information Center

    Galusha, Debbie K.

    2010-01-01

    The purpose of the study is to determine the impact of previous private, public, home, or international schooling experiences on a Quaker high school's graduating students' college entrance composite exam scores, parents' expectations, and college attendance outcomes. The study's results suggest that regardless of previous private, public, home,…

  5. Development and Validation of the Delinquency Reduction Outcome Profile (DROP) in a Sample of Incarcerated Juveniles: A Multiconstruct/Multisituational Scoring Approach

    ERIC Educational Resources Information Center

    Barbot, Baptiste; Haeffel, Gerald J.; Macomber, Donna; Hart, Lesley; Chapman, John; Grigorenko, Elena L.

    2012-01-01

    The "Delinquency Reduction Outcome Profile" ("DROP") is a novel situational-judgment test (SJT) designed to measure social decision making in delinquent youth. The DROP includes both a typical SJT scoring method, which captures the deviation of an individual response from an "ideal" expert-based response pattern, as well as a novel…

  6. The Impact of Previous Schooling Experiences on a Quaker High School's Graduating Students' College Entrance Exam Scores, Parents' Expectations, and College Acceptance Outcomes

    ERIC Educational Resources Information Center

    Galusha, Debbie K.

    2010-01-01

    The purpose of the study is to determine the impact of previous private, public, home, or international schooling experiences on a Quaker high school's graduating students' college entrance composite exam scores, parents' expectations, and college attendance outcomes. The study's results suggest that regardless of previous private, public, home,…

  7. How Close Is Close Enough? Testing Nonexperimental Estimates of Impact against Experimental Estimates of Impact with Education Test Scores as Outcomes. Discussion Paper No. 1242-02

    ERIC Educational Resources Information Center

    Wilde, Elizabeth Ty; Hollister, Robinson

    2002-01-01

    In this study we test the performance of some nonexperimental estimators of impacts applied to an educational intervention--reduction in class size--where achievement test scores were the outcome. We compare the nonexperimental estimates of the impacts to "true impact" estimates provided by a random-assignment design used to assess the…

  8. How Close Is Close Enough? Testing Nonexperimental Estimates of Impact against Experimental Estimates of Impact with Education Test Scores as Outcomes. Discussion Paper.

    ERIC Educational Resources Information Center

    Wilde, Elizabeth Ty; Hollister, Robinson

    This study tested the performance of nonexperimental estimators of impacts applied to a class size reduction intervention with achievement test scores as the outcome. Nonexperimental estimates of impacts were compared to "true impact" estimates provided by a random-assignment design that assessed intervention effects. Data came from…

  9. Consistency Test between Scoring Systems for Predicting Outcomes of Chronic Myeloid Leukemia in a Saudi Population Treated with Imatinib

    PubMed Central

    2017-01-01

    Inconsistency in prognostic scores occurs where two different risk categories are applied to the same chronic myeloid leukemia (CML) patient. This study evaluated common scoring systems for identifying risk groups based on patients' molecular responses to select the best prognostic score when conflict prognoses are obtained from patient profiles. We analyzed 104 patients diagnosed with CML and treated at King Abdulaziz Medical City, Saudi Arabia, who were monitored for major molecular response (achieving a BCR-ABL1 transcript level equal to or less than 0.1%) by Real-Time Quantitative Polymerase Chain Reaction (RQ-PCR), and their risk profiles were identified using Sokal, Hasford, EUTOS, and ELTS scores based on the patients' clinical and hematological parameters at diagnosis. Our results found that the Hasford score outperformed other scores in identifying risk categories for conflict groups, with an accuracy of 63%. PMID:28286862

  10. Is there an ideal outcome scoring system for facial reanimation surgery? A review of current methods and suggestions for future publications.

    PubMed

    Niziol, Rafal; Henry, Francis P; Leckenby, Jonathan I; Grobbelaar, Adriaan O

    2015-04-01

    Facial reanimation is the surgical process of attempting to restore dynamic, spontaneous symmetry to the paralysed face. We undertook to review the most frequently used scoring systems and discuss a universal set of assessments which every facial palsy surgeon can use to standardize the outcome of surgical intervention and allow a comparison to be drawn when comparing different operative techniques. A literature review was performed using PubMed and Cochrane databases to identify scoring systems for facial palsy, facial nerve regeneration and facial reanimation. The scoring systems were broken down into the following broad categories: observational, mathematical and computer-graphical measurements. More than 20 scoring systems were identified and included in the study. The scoring systems were analysed and assessed for reproducibility and inter-observer reliability. The current trend in the literature is to use the House-Brackmann Score due to its historical longevity, brevity and ease of understanding. However, this was never designed to assess outcomes of facial reanimation and there are clear limitations. Other more appropriate methods such as 3-D facial analysis are prohibitively expensive to widely implement. The quest continues to develop an ideal system. From this review it is clear that a quick, simple to use system should be used which incorporates the patient's own views. Therefore a combination of pre- and post-operative photographs of the patient should be assessed by an independent panel as well as the patient. We propose a universal set of photographs that can be used to standardize the outcome of surgical intervention when publishing results in the literature. This will allow a comparison to be drawn when comparing different operative techniques and help surgeons work collectively towards the same goal while improving patient outcomes.

  11. The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments

    PubMed Central

    Austin, Peter C

    2014-01-01

    Propensity score methods are increasingly being used to estimate causal treatment effects in observational studies. In medical and epidemiological studies, outcomes are frequently time-to-event in nature. Propensity-score methods are often applied incorrectly when estimating the effect of treatment on time-to-event outcomes. This article describes how two different propensity score methods (matching and inverse probability of treatment weighting) can be used to estimate the measures of effect that are frequently reported in randomized controlled trials: (i) marginal survival curves, which describe survival in the population if all subjects were treated or if all subjects were untreated; and (ii) marginal hazard ratios. The use of these propensity score methods allows one to replicate the measures of effect that are commonly reported in randomized controlled trials with time-to-event outcomes: both absolute and relative reductions in the probability of an event occurring can be determined. We also provide guidance on variable selection for the propensity score model, highlight methods for assessing the balance of baseline covariates between treated and untreated subjects, and describe the implementation of a sensitivity analysis to assess the effect of unmeasured confounding variables on the estimated treatment effect when outcomes are time-to-event in nature. The methods in the paper are illustrated by estimating the effect of discharge statin prescribing on the risk of death in a sample of patients hospitalized with acute myocardial infarction. In this tutorial article, we describe and illustrate all the steps necessary to conduct a comprehensive analysis of the effect of treatment on time-to-event outcomes. © 2013 The authors. Statistics in Medicine published by John Wiley & Sons, Ltd. PMID:24122911

  12. The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments.

    PubMed

    Austin, Peter C

    2014-03-30

    Propensity score methods are increasingly being used to estimate causal treatment effects in observational studies. In medical and epidemiological studies, outcomes are frequently time-to-event in nature. Propensity-score methods are often applied incorrectly when estimating the effect of treatment on time-to-event outcomes. This article describes how two different propensity score methods (matching and inverse probability of treatment weighting) can be used to estimate the measures of effect that are frequently reported in randomized controlled trials: (i) marginal survival curves, which describe survival in the population if all subjects were treated or if all subjects were untreated; and (ii) marginal hazard ratios. The use of these propensity score methods allows one to replicate the measures of effect that are commonly reported in randomized controlled trials with time-to-event outcomes: both absolute and relative reductions in the probability of an event occurring can be determined. We also provide guidance on variable selection for the propensity score model, highlight methods for assessing the balance of baseline covariates between treated and untreated subjects, and describe the implementation of a sensitivity analysis to assess the effect of unmeasured confounding variables on the estimated treatment effect when outcomes are time-to-event in nature. The methods in the paper are illustrated by estimating the effect of discharge statin prescribing on the risk of death in a sample of patients hospitalized with acute myocardial infarction. In this tutorial article, we describe and illustrate all the steps necessary to conduct a comprehensive analysis of the effect of treatment on time-to-event outcomes.

  13. Malnutrition in Geriatric Rehabilitation: Prevalence, Patient Outcomes, and Criterion Validity of the Scored Patient-Generated Subjective Global Assessment and the Mini Nutritional Assessment.

    PubMed

    Marshall, Skye; Young, Adrienne; Bauer, Judith; Isenring, Elizabeth

    2016-05-01

    Accurate identification and management of malnutrition is essential so that patient outcomes can be improved and resources used efficaciously. In malnourished older adults admitted to rehabilitation: 1) report the prevalence, health and aged care use, and mortality of malnourished older adults; 2) determine and compare the criterion (concurrent and predictive) validity of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment (MNA) in diagnosing malnutrition; and 3) identify the Scored PG-SGA score cut-off value associated with malnutrition. Observational, prospective cohort. Participants were 57 older adults (65 years and older; mean±standard deviation age=79.1±7.3 years) from two rural rehabilitation units in New South Wales, Australia. Scored PG-SGA; MNA; and the International Statistical Classification of Diseases and Health Related Problems, 10th revision, Australian Modification (ICD-10-AM) classification of malnutrition were compared to establish concurrent validity and report malnutrition prevalence. Length of stay, discharge location, rehospitalization, admission to a residential aged care facility, and mortality were measured to report health-related outcomes and to establish predictive validity. Malnutrition prevalence varied according to assessment tool (ICD-10-AM: 46%; Scored PG-SGA: 53%; MNA: 28%). Using the ICD-10-AM as the reference standard, the Scored PG-SGA ratings (sensitivity 100%, specificity 87%) and score (sensitivity 92%, specificity 84%, ROC AUC [receiver operating characteristics area under the curve]=0.910±0.038) showed strong concurrent validity, and the MNA had moderate concurrent validity (sensitivity 58%, specificity 97%, receiver operating characteristics area under the curve=0.854±0.052). The Scored PG-SGA rating, Scored PG-SGA score, and MNA showed good predictive validity. Malnutrition can increase the risk of longer rehospitalization length of stay, admission to a residential

  14. Science Teacher Efficacy and Outcome Expectancy as Predictors of Students' End-of-Instruction (EOI) Biology I Test Scores

    ERIC Educational Resources Information Center

    Angle, Julie; Moseley, Christine

    2009-01-01

    The purpose of this study was to compare teacher efficacy beliefs of secondary Biology I teachers whose students' mean scores on the statewide End-of-Instruction (EOI) Biology I test met or exceeded the state academic proficiency level (Proficient Group) to teacher efficacy beliefs of secondary Biology I teachers whose students' mean scores on the…

  15. Epileptic Seizures in Patients Following Surgical Treatment of Acute Subdural Hematoma-Incidence, Risk Factors, Patient Outcome, and Development of New Scoring System for Prophylactic Antiepileptic Treatment (GATE-24 score).

    PubMed

    Won, Sae-Yeon; Dubinski, Daniel; Herrmann, Eva; Cuca, Colleen; Strzelczyk, Adam; Seifert, Volker; Konczalla, Juergen; Freiman, Thomas M

    2017-05-01

    Clinically evident or subclinical seizures are common manifestations in acute subdural hematoma (aSDH); however, there is a paucity of research investigating the relationship between seizures and aSDH. The purpose of this study is 2-fold: determine incidence and predictors of seizures and then establish a guideline in patients with aSDH to standardize the decision for prophylactic antiepileptic treatment. The author analyzed 139 patients with aSDH treated from 2007 until 2015. Baseline characteristics and clinical findings including Glasgow Coma Scale (GCS) at admission, 24 hours after operation, timing of operation, anticoagulation, and Glasgow Outcome Scale at hospital discharge and after 3 months were analyzed. Multivariate logistic regression analysis was performed to detect independent predictors of seizures, and a scoring system was developed. Of 139 patients, overall incidence of seizures was 38%, preoperatively 16% and postoperatively 24%. Ninety percent of patients with preoperative seizures were seizure free after operation for 3 months. Independent predictors of seizures were GCS <9 (odds ratio [OR] 3.3), operation after 24 hours (OR 2.0), and anticoagulation (OR 2.2). Patients with seizures had a significantly higher rate of unfavorable outcome at hospital discharge (P = 0.001) and in 3-month follow-up (P = 0.002). Furthermore, a score system (GATE-24) was developed. In patients with GCS <14, anticoagulation, or surgical treatment 24 hours after onset, a prophylactic antiepileptic treatment is recommended. Occurrence of seizures affected severity and outcomes after surgical treatment of aSDH. Therefore seizure prophylaxis should be considered in high-risk patients on the basis of the GATE-24 score to promote better clinical outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Psychometric properties of the Knee injury and Osteoarthritis Outcome Score for Children (KOOS-Child) in children with knee disorders.

    PubMed

    Ortqvist, Maria; Iversen, Maura D; Janarv, Per-Mats; Broström, Eva W; Roos, Ewa M

    2014-10-01

    The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered valid and reliable questionnaire for adults with joint injury or degenerative disease. Recent data indicate a lack of comprehensibility when this is used with children. Thus, a preliminary KOOS-Child was developed. This study aims to evaluate psychometric properties of the final KOOS-Child when used in children with knee disorders. 115 children (boys/girls 51/64, 7-16 years) with knee disorders were recruited. All children (n=115) completed the KOOS-Child, the Child-Health Assessment Questionnaire (CHAQ) and the EQ-5D-Youth version (EQ-5D-Y) at baseline to evaluate construct validity. Two additional administrations (1-3 weeks and 3 months) were performed for analyses of reliability (internal consistency and test-retest; n=72) and responsiveness (n=91). An anchor-based approach was used to evaluate responsiveness and interpretability. After item reduction, the final KOOS-Child consists of 39 items divided into five subscales. No floor or ceiling effects (≤15%) were found. An exploratory factor analysis on subscale level demonstrated that items in all subscales except for Symptoms loaded on one factor (Eigenvalues 3.1-5.5, Symptom: 2 factors, Eigenvalue >1). Sufficient homogeneity was found for all subscales (Cronbach's α = 0.80-0.90) except for the Symptoms subscale (α = 0.59). Test-retest reliability was substantial to excellent for all subscales (Intraclass Correlation Coefficient 0.78-0.91, Smallest Detectable Change (SDC)ind 14.6-22.6, SDCgroup 1.7-2.7). Construct validity was confirmed, and greater effect sizes were seen in those reporting improved clinical status. Minimal important changes greater than the SDCs were found for patients reporting to be better and much better. The final KOOS-Child demonstrates good psychometric properties and supports the use of the KOOS-Child when evaluating children with knee disorders. Published by the BMJ Publishing Group Limited

  17. Long-Term Clinical Outcomes according to Initial Management and Thrombolysis In Myocardial Infarction Risk Score in Patients with Acute Non-ST-Segment Elevation Myocardial Infarction

    PubMed Central

    Jeong, Hae Chang; Jeong, Myung Ho; Chae, Shung Chull; Hur, Seung Ho; Hong, Taek Jong; Kim, Young Jo; Seong, In Whan; Chae, Jei Keon; Rhew, Jay Young; Chae, In Ho; Cho, Myeong Chan; Bae, Jang Ho; Rha, Seung Woon; Kim, Chong Jin; Choi, Donghoon; Jang, Yang Soo; Yoon, Junghan; Chung, Wook Sung; Cho, Jeong Gwan; Seung, Ki Bae; Park, Seung Jung

    2010-01-01

    Purpose There is still debate about the timing of revascularization in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). We analyzed the long-term clinical outcomes of the timing of revascularization in patients with acute NSTEMI obtained from the Korea Acute Myocardial Infarction Registry (KAMIR). Materials and Methods 2,845 patients with acute NSTEMI (65.6 ± 12.5 years, 1,836 males) who were enrolled in KAMIR were included in the present study. The therapeutic strategy of NSTEMI was categorized into early invasive (within 48 hours, 65.8 ± 12.6 years, 856 males) and late invasive treatment (65.3 ± 12.1 years, 979 males). The initial- and long-term clinical outcomes were compared between two groups according to the level of Thrombolysis In Myocardial Infarction (TIMI) risk score. Results There were significant differences in-hospital mortality and the incidence of major adverse cardiac events during one-year clinical follow-up between two groups (2.1% vs. 4.8%, p < 0.001, 10.0% vs. 13.5%, p = 0.004, respectively). According to the TIMI risk score, there was no significant difference of long-term clinical outcomes in patients with low to moderate TIMI risk score, but significant difference in patients with high TIMI risk score (≥ 5 points). Conclusions The old age, high Killip class, low ejection fraction, high TIMI risk score, and late invasive treatment strategy are the independent predictors for the long-term clinical outcomes in patients with NSTEMI. PMID:20046515

  18. Alberta stroke program early computed tomographic scoring performance in a series of patients undergoing computed tomography and MRI: reader agreement, modality agreement, and outcome prediction.

    PubMed

    McTaggart, Ryan A; Jovin, Tudor G; Lansberg, Maarten G; Mlynash, Michael; Jayaraman, Mahesh V; Choudhri, Omar A; Inoue, Manabu; Marks, Michael P; Albers, Gregory W

    2015-02-01

    In this study, we compare the performance of pretreatment Alberta Stroke Program Early Computed Tomographic scoring (ASPECTS) using noncontrast CT (NCCT) and MRI in a large endovascular therapy cohort. Prospectively enrolled patients underwent baseline NCCT and MRI and started endovascular therapy within 12 hours of stroke onset. Inclusion criteria for this analysis were evaluable pretreatment NCCT, diffusion-weighted MRI (DWI), and 90-day modified Rankin Scale scores. Two expert readers graded ischemic change on NCCT and DWI using the ASPECTS. ASPECTS scores were analyzed with the full scale or were trichotomized (0-4 versus 5-7 versus 8-10) or dichotomized (0-7 versus 8-10). Good functional outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. Seventy-four patients fulfilled our study criteria. The full-scale inter-rater agreement for CT-ASPECTS and DWI-ASPECTS was 0.579 and 0.867, respectively. DWI-ASPECTS correlated with functional outcome (P=0.004), whereas CT-ASPECTS did not (P=0.534). Both DWI-ASPECTS and CT-ASPECTS correlated with DWI volume. The receiver operating characteristic analysis revealed that DWI-ASPECTS outperformed both CT-ASPECTS and the time interval between symptom onset and start of the procedure for predicting good functional outcome (modified Rankin Scale score, ≤2) and DWI volume ≥70 mL. Inter-rater agreement for DWI-ASPECTS was superior to that for CT-ASPECTS. DWI-ASPECTS outperformed NCCT ASPECTS for predicting functional outcome at 90 days. © 2014 American Heart Association, Inc.

  19. Two-year clinical outcomes of Absorb bioresorbable vascular scaffold implantation in complex coronary artery disease patients stratified by SYNTAX score and ABSORB II study enrolment criteria.

    PubMed

    Kraak, Robin P; Grundeken, Maik J; Hassell, Mariëlla E; Elias, Joëlle; Koch, Karel T; Henriques, José P; Piek, Jan J; Baan, Jan; Vis, Marije M; Tijssen, Jan G P; de Winter, Robbert J; Wykrzykowska, Joanna J

    2016-08-05

    This study presents the two-year clinical outcomes of the Amsterdam ABSORB registry stratified by lesion and patient characteristics complexity (SYNTAX score and ABSORB II study enrolment criteria). Patients treated with BVS were included in this prospective registry and stratified according to the ABSORB II trial inclusion and exclusion criteria and the SYNTAX score. The registry comprises 135 patients (59±11 years, 73% male, 18% diabetic) with 159 lesions. Median follow-up duration was 774 days (742-829). Median SYNTAX score was 11.5 (Q1-Q3: 6-17.5). Two-year event rates were cardiac death 0.7%, MI 5.3%, TVR 13.6%, TLR 11.4%, definite ST 3.0% and TVF 14.4%, respectively. Stratified analyses showed a significantly higher revascularisation rate in patients not meeting ABSORB II criteria (TVR: 2.3% vs. 19.2%, p=0.010, and TLR: 2.3% vs. 15.8%, p=0.025) and patients with SYNTAX score ≥11.5 (TVR: 4.8% vs. 21.8%, p=0.006, and TLR: 3.2% vs. 17.4%, p=0.007). The use of Absorb BVS in patients meeting the ABSORB II trial inclusion criteria or those with low SYNTAX scores is associated with acceptable clinical outcomes at two-year follow-up. Patients with more complex characteristics have significantly higher revascularisation rates.

  20. Aortic arch calcification on chest X-ray combined with coronary calcium score show additional benefit for diagnosis and outcome in patients with angina

    PubMed Central

    Woo, Jong Shin; Kim, Weon; Kwon, Se Hwan; Youn, Hyo Chul; Kim, Hyun Soo; Kim, Jin Bae; Kim, Soo Joong; Kim, Woo-Shik; Kim, Kwon Sam

    2016-01-01

    Background The coronary artery calcium (CAC) and aortic arch calcification (AoAC) are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina. Methods A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3. Results During the four years of follow-up, 620 patients were treated by coronary stenting and 153 (7%) adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score < 400, AoAC showed an additive predictive value in detecting significant coronary artery disease (CAD). A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score. Conclusions As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays. PMID:27103916

  1. The Japanese Histologic Classification and T-score in the Oxford Classification system could predict renal outcome in Japanese IgA nephropathy patients.

    PubMed

    Kaihan, Ahmad Baseer; Yasuda, Yoshinari; Katsuno, Takayuki; Kato, Sawako; Imaizumi, Takahiro; Ozeki, Takaya; Hishida, Manabu; Nagata, Takanobu; Ando, Masahiko; Tsuboi, Naotake; Maruyama, Shoichi

    2017-03-27

    The Oxford Classification is utilized globally, but has not been fully validated. In this study, we conducted a comparative analysis between the Oxford Classification and Japanese Histologic Classification (JHC) to predict renal outcome in Japanese patients with IgA nephropathy (IgAN). A retrospective cohort study including 86 adult IgAN patients was conducted. The Oxford Classification and the JHC were evaluated by 7 independent specialists. The JHC, MEST score in the Oxford Classification, and crescents were analyzed in association with renal outcome, defined as a 50% increase in serum creatinine. In multivariate analysis without the JHC, only the T score was significantly associated with renal outcome. While, a significant association was revealed only in the JHC on multivariate analysis with JHC. The JHC and T score in the Oxford Classification were associated with renal outcome among Japanese patients with IgAN. Superiority of the JHC as a predictive index should be validated with larger study population and cohort studies in different ethnicities.

  2. A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression.

    PubMed

    Lei, Mingxing; Liu, Yaosheng; Yan, Liang; Tang, Chuanghao; Yang, Shaoxing; Liu, Shubin

    2016-12-01

    This study aims to create and validate a score for survival and functional outcome of lung cancer patients with metastatic spinal cord compression (MSCC) after posterior decompressive surgery. The entire cohort of 73 consecutive patients was randomly assigned to a test group (N = 37) and a validation group (N = 36). In the test group, we retrospectively analyzed 10 preoperative characteristics. Characteristics significantly associated with survival on multivariate analysis were included in the score. Patients in the validation group were used to confirm whether the score was reproducible. Postoperative functional outcome was analyzed both in the test and validation groups. On multivariate analysis, preoperative ambulatory status (P = 0.0017), visceral metastases (P = 0.0002), and time developing motor deficits (P = 0.0004) had significant impact on survival and were included in the scoring system. According to the prognostic scores, which ranged from 0 to 6 points, two risk groups were designed: 0-2 and 3-6 points and the median survival was 2.6 months (95 % CI, 1.0-3.8 months) and 10.7 months (95 % CI, 7.1-13.7 months), respectively (P < 0.0001). In the validation group, the corresponding median survival was 2.7 months (95 % CI, 1.6-5.5 months) and 10.8 months (5.8-13.6 months), respectively (P < 0.0001). In addition, the functional outcome was worse in patients with 0-2 points than in patients with 3-6 points both in the test (P = 0.0023) and validation groups (P = 0.0298). Patients with scores of 0-2 points, who have short survival time (life expectancy less than 3 months) and poor functional outcome, appear best treated with radiotherapy or best supportive care alone. Surgery may be no longer in consideration in most of the patients in this group. Patients with score of 3-6 points should be surgical candidates, because survival prognosis (life expectancy more than 10 months) and functional outcome are favorable after surgery.

  3. Interpreting score differences in the SF-36 Vitality scale: using clinical conditions and functional outcomes to define the minimally important difference.

    PubMed

    Bjorner, Jakob B; Wallenstein, Gene V; Martin, Marie C; Lin, Peggy; Blaisdell-Gross, Bonnie; Tak Piech, Catherine; Mody, Samir H

    2007-04-01

    To propose the minimally important difference (MID) for the SF-36 Vitality (VT) scale by evaluating the association of score differences with clinical conditions and functional outcomes. Analyses were performed on data from the Medical Outcomes Study (n = 3445). The first analyses regressed VT scores (0-100 scale) on chronic conditions that cause fatigue in order to determine the impact of each condition on VT. The second set of analyses examined the relationship between baseline VT scores and other outcomes at baseline, 1-year, and 7-year follow-up. VT scores were significantly reduced in patients with anemia [5 points (95% CI 2-9 points)], CHF [6 (3-9) points], and COPD [6 (3-9) points]. Decreases in VT score were significantly associated with increased odds of negative outcomes, including inability to work due to health at baseline [OR (5 points) = 1.27 (95% CI 1.24-1.31), OR (10 points) = 1.62 (1.54-1.71)], job loss at 1 year [OR (5) = 1.13 (1.08-1.19), OR (10) = 1.28 (1.17-1.41)], hospitalization at 1 year [OR (5) = 1.08 (1.05-1.11), OR (10) = 1.17 (1.10-1.23)], short-term mortality [0-18 months-Hazard Ratio (HR) (5) = 1.10-1.71, HR (10) = 1.21-2.39, depending on VT level] and long-term mortality [19+ months-HR (5) = 1.05-1.31, HR (10) = 1.10-1.54]. The mortality risk increase was largest at low VT levels. VT decrements of 5-10 points were seen for diseases known to cause fatigue. Further, differences of 5-10 points in the VT score were associated with significant increased risk of negative outcomes. We recommend an MID of 5 points for analyses of groups with VT scores below average. For follow-up of individual patients, we recommend a 10-point difference as important.

  4. Scarring of Soft Tissues Following Apical Surgery: Visual Assessment of Outcomes One Year After Intervention Using the Bern and Manchester Scores.

    PubMed

    von Arx, Thomas; Janner, Simone Fm; Hänni, Stefan; Bornstein, Michael M

    The successful outcome of apical surgery is usually defined by absence of clinical signs and symptoms and resolution of previous periapical radiolucencies. However, little attention is given to soft tissue scarring. The present study evaluated the severity of gingival and mucosal scarring 1 year following apical surgery of 52 teeth. Clinical pictures taken at the 1-year examination were rated by three observers using specific scarring scores. The overall repeatability of the two scores was high (85.3%), whereas the overall reproducibility was relatively low (44.2%). None of the tested variables proved significant for influencing scar severity.

  5. Evaluation of the outcome of patients admitted to the pediatric intensive care unit in Alexandria using the pediatric risk of mortality (PRISM) score.

    PubMed

    El-Nawawy, Ahmed

    2003-04-01

    The aim of this prospective study was to evaluate the use of pediatric risk of mortality (PRISM) score to predict the patient outcome in Alexandria Pediatric Intensive Care Unit (PICU). The study included all admissions to a tertiary care teaching hospital for 13 months. All patients were subjected to thorough history taking and clinical examination. The PRISM score was obtained within 8 h from admission (including 14 parameters with 34 variables). The primary affected system, referral site, number of organ failure on admission, length of hospital stay (LOS) and outcome of patients were recorded. The bed occupancy rate, turnover rate, average LOS, total and adjusted death rates were also recorded. Results showed that the total and adjusted mortality rates were 50 and 38 per cent respectively (n = 205/406 and 125/326, respectively). The mean PRISM score on admission was 26. Non-survivors showed a significantly higher mean score compared with survivors (36 vs. 17). Non-survivors compared with survivors, were significantly younger (12 vs. 23 months), had shorter LOS (3.8 vs. 5.3 days), three or four organ system failure on admission (77 vs. 25 per cent, and 9 vs. 0 per cent of patients) and had significantly higher percentage of sepsis syndrome and neurological diseases, as the primary affected system (20 vs. 10 per cent and 26 vs. 16 per cent). The PRISM score showed a significant positive correlation only with the number of organ failure on admission (r = 0.8104; p < 0.001). The cut-off point of survival was a PRISM score 26 with expected/observed ratio of 1.05 for non-survivors with 91.6 per cent accuracy. Multiple logistic regression analysis revealed that PRISM score, LOS, and the primary affected system were relevant predictors of patient outcome in PICU. In conclusion, the PRISM score is proved to be a good predictor of outcome for children admitted to a PICU with a cut-off point of 26. The mortality in the PICU is affected by LOS, primary system affected, and

  6. Predictive Value of Combining the Ankle-Brachial Index and SYNTAX Score for the Prediction of Outcome After Percutaneous Coronary Intervention (from the SHINANO Registry).

    PubMed

    Ueki, Yasushi; Miura, Takashi; Miyashita, Yusuke; Motoki, Hirohiko; Shimada, Kentaro; Kobayashi, Masanori; Nakajima, Hiroyuki; Kimura, Hikaru; Akanuma, Hiroshi; Mawatari, Eiichiro; Sato, Toshio; Hotta, Shoji; Kamiyoshi, Yuichi; Maruyama, Takuya; Watanabe, Noboru; Eisawa, Takayuki; Aso, Shinichi; Uchikawa, Shinichiro; Hashizume, Naoto; Sekimura, Noriyuki; Morita, Takehiro; Ebisawa, Soichiro; Izawa, Atsushi; Koyama, Jun; Ikeda, Uichi

    2016-01-15

    The Synergy Between PCI With TAXUS and Cardiac Surgery (SYNTAX) score is effective in predicting clinical outcome after percutaneous coronary intervention (PCI). However, its prediction ability is low because it reflects only the coronary characterization. We assessed the predictive value of combining the ankle-brachial index (ABI) and SYNTAX score to predict clinical outcomes after PCI. The ABI-SYNTAX score was calculated for 1,197 patients recruited from the Shinshu Prospective Multi-center Analysis for Elderly Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention (SHINANO) registry, a prospective, observational, multicenter cohort study in Japan. The primary end points were major adverse cardiovascular and cerebrovascular events (MACE; all-cause death, myocardial infarction, and stroke) in the first year after PCI. The ABI-SYNTAX score was calculated by categorizing and summing up the ABI and SYNTAX scores. ABI ≤ 0.49 was defined as 4, 0.5 to 0.69 as 3, 0.7 to 0.89 as 2, 0.9 to 1.09 as 1, and 1.1 to 1.5 as 0; an SYNTAX score ≤ 22 was defined as 0, 23 to 32 as 1, and ≥ 33 as 2. Patients were divided into low (0), moderate (1 to 2), and high (3 to 6) groups. The MACE rate was significantly higher in the high ABI-SYNTAX score group than in the lower 2 groups (low: 4.6% vs moderate: 7.0% vs high: 13.9%, p = 0.002). Multivariate regression analysis found that ABI-SYNTAX score independently predicted MACE (hazards ratio 1.25, 95% confidence interval 1.02 to 1.52, p = 0.029). The respective C-statistic for the ABI-SYNTAX and SYNTAX score for 1-year MACE was 0.60 and 0.55, respectively. In conclusion, combining the ABI and SYNTAX scores improved the prediction of 1-year adverse ischemic events compared with the SYNTAX score alone.

  7. Comparisons of the Outcome Prediction Performance of Injury Severity Scoring Tools Using the Abbreviated Injury Scale 90 Update 98 (AIS 98) and 2005 Update 2008 (AIS 2008).

    PubMed

    Tohira, Hideo; Jacobs, Ian; Mountain, David; Gibson, Nick; Yeo, Allen

    2011-01-01

    The Abbreviated Injury Scale (AIS) was revised in 2005 and updated in 2008 (AIS 2008). We aimed to compare the outcome prediction performance of AIS-based injury severity scoring tools by using AIS 2008 and AIS 98. We used all major trauma patients hospitalized to the Royal Perth Hospital between 1994 and 2008. We selected five AIS-based injury severity scoring tools, including Injury Severity Score (ISS), New Injury Severity Score (NISS), modified Anatomic Profile (mAP), Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). We selected survival after injury as a target outcome. We used the area under the Receiver Operating Characteristic curve (AUROC) as a performance measure. First, we compared the five tools using all cases whose records included all variables for the TRISS (complete dataset) using a 10-fold cross-validation. Second, we compared the ISS and NISS for AIS 98 and AIS 2008 using all subjects (whole dataset). We identified 1,269 and 4,174 cases for a complete dataset and a whole dataset, respectively. With the 10-fold cross-validation, there were no clear differences in the AUROCs between the AIS 98- and AIS 2008-based scores. With the second comparison, the AIS 98-based ISS performed significantly worse than the AIS 2008-based ISS (p<0.0001), while there was no significant difference between the AIS 98- and AIS 2008-based NISSs. Researchers should be aware of these findings when they select an injury severity scoring tool for their studies.

  8. Relationship between pre-embryo pronuclear morphology (zygote score) and standard day 2 or 3 embryo morphology with regard to assisted reproductive technique outcomes.

    PubMed

    Payne, John F; Raburn, Douglas J; Couchman, Grace M; Price, Thomas M; Jamison, Margaret G; Walmer, David K

    2005-10-01

    To test the hypothesis that pregnancy rates are low if grade Z1 pre-embryos are not available for transfer and to determine if pronuclear morphology is a better predictor of pregnancy than traditional embryo morphology. Prospective clinical study. Academic human reproduction laboratory. One hundred couples undergoing IVF with conventional insemination or ICSI. Embryo quality was assessed using both pre-embryo pronuclear morphology (zygote scoring or Z-scoring) at the time of fertilization evaluation and standard day 2 and day 3 embryo morphology (number of blastomeres and grading based on degree of fragmentation and blastomere size). We tested two decision models, one based on Z-scores and another on morphology, to determine which grading system better predicted pregnancy outcomes in assisted reproductive technique. Zygote score and embryo morphology were measured for all embryos and the transferred embryo pool. Implantation and pregnancy rates resulting from the embryo transfers of all cycles were calculated. The Z-score distribution of 552 embryos was 27% Z1, 8% Z2, 50% Z3, and 15% Z4. Z1 and Z3 embryos had significantly (P approximately .03) higher quality over Z2 and Z4 embryos. Using the Z-score decision model with Z1 embryos having highest priority for transfer, pregnancy rates were similar between Z1 and Z3 embryos. Using embryo morphology as a decision model, pregnancy rates were highest in transfers containing one or two "best"-quality embryos. Z1 and Z3 embryos had similar morphology and pregnancy rates. The decision model based on the Z-score model was not better than standard embryo morphology in predicting pregnancy outcome.

  9. Lack of functional information explains the poor performance of 'clot load scores' at predicting outcome in acute pulmonary embolism.

    PubMed

    Clark, A R; Milne, D; Wilsher, M; Burrowes, K S; Bajaj, M; Tawhai, M H

    2014-01-01

    Clot load scores have previously been developed with the goal of improving prognosis in acute pulmonary embolism (PE). These scores provide a simple estimate of pulmonary vascular bed obstruction, however they have not been adopted clinically as they have poor correlation with mortality and right ventricular (RV) dysfunction. This study performed a quantitative analysis of blood flow and gas exchange in 12 patient-specific models of PE, to understand the limitations of current clot load scores and how their prognostic value could be improved. Prediction of hypoxemia in the models when using estimated baseline (non-occluded) minute ventilation and cardiac output correlated closely with clinical metrics for RV dysfunction, whereas the clot load score had only a weak correlation. The model predicts that large central clots have a greater impact on function than smaller distributed clots with the same total clot load, and that the partial occlusion of a vessel only has a significant impact on pulmonary function when the vessel is close to completely occluded. The effect of clot distribution on the redistribution of blood from its normal pattern - and hence the magnitude of the potential effect on gas exchange - is represented in the model but is not included in current clot load scores. Improved scoring systems need to account for the expected normal distribution of blood in the lung, and the impact of clot on redistributing the blood flow.

  10. Development and validation of a patient-reported outcome measure in vitiligo: The Self Assessment Vitiligo Extent Score (SA-VES).

    PubMed

    van Geel, Nanja; Lommerts, Janny E; Bekkenk, Marcel W; Prinsen, Cecilia A C; Eleftheriadou, Viktoria; Taieb, Alain; Picardo, Mauro; Ezzedine, Khaled; Wolkerstorfer, Albert; Speeckaert, Reinhart

    2017-03-01

    The Vitiligo Extent Score (VES) has recently been introduced as a physicians' score for the clinical assessment of the extent of vitiligo, but a good patient self-assessment score is lacking. The objective is to develop and validate a simplified version of the VES as a patient-reported outcome measure (PROM). After extensive pilot testing, patients were asked to score their vitiligo extent twice with an interval of 2 weeks using the Self Assessment Vitiligo Extent Score (SA-VES). The scores were compared with the physicians' evaluation (VES). The SA-VES demonstrated very good test-retest reliability (intraclass correlation = 0.948, 95% confidence interval [CI]: 0.911-0.970) that was not affected by age, skin type, or vitiligo distribution pattern. According to patients, this evaluation method was easy to use (22% very easy; 49% easy; 29% normal) and required <5 minutes in the majority of patients (73%, <5 minutes; 24%, 5-10 minutes; 2%, 10-15 minutes). Comparison of the SA-VES and the VES demonstrated excellent correlation (r = 0.986, P <.001). Few patients had a dark skin type. The results demonstrate excellent reliability of the SA-VES and excellent correlation with its investigator-reported counterpart (VES). This patient-oriented evaluation method provides a useful tool for the assessment of vitiligo extent. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  11. [Usefulness of scoring risk for adverse outcomes in older patients with the Identification of Seniors at Risk scale and the Triage Risk Screening Tool: a meta-analysis].

    PubMed

    Rivero-Santana, Amado; Del Pino-Sedeño, Tasmania; Ramallo-Fariña, Yolanda; Vergara, Itziar; Serrano-Aguilar, Pedro

    2017-02-01

    A considerable proportion of the geriatric population experiences unfavorable outcomes of hospital emergency department care. An assessment of risk for adverse outcomes would facilitate making changes in clinical management by adjusting available resources to needs according to an individual patient's risk. Risk assessment tools are available, but their prognostic precision varies. This systematic review sought to quantify the prognostic precision of 2 geriatric screening and risk assessment tools commonly used in emergency settings for patients at high risk of adverse outcomes (revisits, functional deterioration, readmissions, or death): the Identification of Seniors at Risk (ISAR) scale and the Triage Risk Screening Tool (TRST). We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and SCOPUS, with no date limits, to find relevant studies. Quality was assessed with the QUADAS-2 checklist (for quality assessment of diagnostic accuracy studies). We pooled data for prognostic yield reported for the ISAR and TRST scores for each short- and medium-term outcome using bivariate random-effects modeling. The sensitivity of the ISAR scoring system as a whole ranged between 67% and 99%; specificity fell between 21% and 41%. TRST sensitivity ranged between 52% and 75% and specificity between 39% and 51%.We conclude that the tools currently used to assess risk of adverse outcomes in patients of advanced age attended in hospital emergency departments do not have adequate prognostic precision to be clinically useful.

  12. A comparison of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Trauma-Injury Severity Score (TRISS) for outcome assessment in intensive care unit trauma patients.

    PubMed

    Wong, D T; Barrow, P M; Gomez, M; McGuire, G P

    1996-10-01

    To assess the ability of the Acute Physiology and Chronic Health Evaluation (APACHE II) system and Trauma-Injury Severity Scoring (TRISS) system in predicting group mortality in intensive care unit (ICU) trauma patients. Prospective study. A Canadian adult trauma tertiary referral hospital. Consecutive trauma patients admitted to the medical-surgical ICU or the neurosurgical ICU. None. For each patient, demographic data, mechanism of injury, and surgical status were collected. Revised Trauma Scores and Injury Severity Scores were calculated from emergency room and operative data. The APACHE II score was calculated based on the data from the first 24 hrs of ICU admission. The probability of death was calculated for each patient based on the APACHE II and TRISS equations. The ability to predict group mortality for APACHE II and TRISS was assessed by receiver operating characteristic curve analysis, two by two decision matrices, and calibration curve analysis. Four hundred seventy trauma patients were admitted to the ICU. Sixty-three (13%) patients died and 407 (87%) survived. There were significant differences between survivors and nonsurvivors in age, Glasgow Coma Scale, Revised Trauma Score, Injury Severity Score, and APACHE II score. By receiver operating characteristic curve analysis, the areas under the curves (+/- SEM) of APACHE II and TRISS were 0.92 +/- 0.02 and 0.89 +/- 0.02, respectively. Using two by two decision matrices with a decision criterion of 0.5, the sensitivities, specificities, and percentages correctly classified were 50.8%, 97.3%, and 91.1%, respectively, for APACHE II, and 50.8%, 97.1%, and 90.9%, respectively, for TRISS. From the calibration curves, the r2 value was .93 (p = .0001) for APACHE II and .67 (p = .004) for TRISS. Both APACHE II and TRISS scores were shown to accurately predict group mortality in ICU trauma patients. APACHE II and TRISS may be utilized for quality assurance in ICU trauma patients. However, neither APACHE II nor

  13. Image analysis of immunohistochemistry is superior to visual scoring as shown for patient outcome of esophageal adenocarcinoma.

    PubMed

    Feuchtinger, Annette; Stiehler, Tabitha; Jütting, Uta; Marjanovic, Goran; Luber, Birgit; Langer, Rupert; Walch, Axel

    2015-01-01

    Quantification of protein expression based on immunohistochemistry (IHC) is an important step in clinical diagnoses and translational tissue-based research. Manual scoring systems are used in order to evaluate protein expression based on staining intensities and distribution patterns. However, visual scoring remains an inherently subjective approach. The aim of our study was to explore whether digital image analysis proves to be an alternative or even superior tool to quantify expression of membrane-bound proteins. We analyzed five membrane-binding biomarkers (HER2, EGFR, pEGFR, β-catenin, and E-cadherin) and performed IHC on tumor tissue microarrays from 153 esophageal adenocarcinomas patients from a single center study. The tissue cores were scored visually applying an established routine scoring system as well as by using digital image analysis obtaining a continuous spectrum of average staining intensity. Subsequently, we compared both assessments by survival analysis as an end point. There were no significant correlations with patient survival using visual scoring of β-catenin, E-cadherin, pEGFR, or HER2. In contrast, the results for digital image analysis approach indicated that there were significant associations with disease-free survival for β-catenin, E-cadherin, pEGFR, and HER2 (P = 0.0125, P = 0.0014, P = 0.0299, and P = 0.0096, respectively). For EGFR, there was a greater association with patient survival when digital image analysis was used compared to when visual scoring was (visual: P = 0.0045, image analysis: P < 0.0001). The results of this study indicated that digital image analysis was superior to visual scoring. Digital image analysis is more sensitive and, therefore, better able to detect biological differences within the tissues with greater accuracy. This increased sensitivity improves the quality of quantification.

  14. Impact of clinical risk scores and BRAF V600E mutation status on outcome in papillary thyroid cancer.

    PubMed

    Niederer-Wüst, Séverine M; Jochum, Wolfram; Förbs, Diana; Brändle, Michael; Bilz, Stefan; Clerici, Thomas; Oettli, René; Müller, Joachim; Haile, Sarah R; Ess, Silvia; Stoeckli, Sandro J; Broglie, Martina A

    2015-01-01

    To evaluate the relationship between the BRAF V600E mutation and clinicopathologic parameters and to assess the impact of the BRAF V600E mutation and established risk scores on survival in patients with papillary thyroid carcinoma (PTC). Retrospective analysis of a consecutive, single-institutional cohort of patients with PTC larger than 1 cm. Clinical risk scores according to the Metastases, Age, Completeness of Resection, Invasion, Size (MACIS), European Organisation for Research and Treatment of Cancer (EORTC), and tumor, node, metastases (TNM) scoring systems were determined. BRAF exon 15 mutation analysis was performed by polymerase chain reaction and Sanger sequencing. BRAF V600E mutations were found in 75/116 (65%) PTC. The rates for 5- and 10-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were 92% and 87%, 98% and 96%, and 96% and 94%, respectively. Low MACIS scores were associated with longer OS (10 y 95% vs 75%, P = .008), DSS (10 y 100% vs 89%, P = .02) and RFS (100% vs 85%, P = .006). Comparable survival advantages were observed for patients with early EORTC scores and low TNM stage. BRAF V600E mutation status was not associated with clinicopathologic characteristics of aggressive behavior such as extrathyroidal extension, lymph node metastases, higher T-categories, male sex, and greater age. Furthermore, BRAF V600E mutation status was not correlated with clinical risk scores and decreased survival. In concordance with other studies, we did not find a negative prognostic impact of a positive BRAF V600E mutation status on survival. In contrast, the risk algorithms MACIS, EORTC score, and TNM stage were associated with impaired prognosis. Therefore, clinical staging systems represent better tools for risk stratification than BRAF V600E mutation status. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Need for Two-Year Patient-Reported Outcomes Score for Lumbar Spine Surgery Is Procedure-Specific: Analysis From a Prospective Longitudinal Spine Registry.

    PubMed

    Kim, Elliott J; Chotai, Silky; Archer, Kristin R; Bydon, Mohamad; Asher, Anthony L; Devin, Clinton J

    2017-09-01

    Retrospective analysis of prospectively collected data. The aim of this study was to determine whether 1-year patient-reported outcomes (PROs) can accurately assess effective care for patients undergoing surgery for degenerative lumbar spine disease. Prospective longitudinal PROs registries provide a means to accurately assess outcomes and determine the relative effectiveness of various spine treatments. Obtaining long-term PROs can be costly and challenging. Patients enrolled into a prospective registry who underwent lumbar spine surgery for degenerative disease were included. Baseline, 1-year, and 2-year Oswestry Disability Index (ODI) scores were captured. Previously published minimum clinically important difference (MCID) for ODI (14.9) was used. Multivariable linear regression model was created to derive model-estimated 2-year ODI scores. Absolute differences between 1-year and 2-year ODI were compared to absolute differences between 2-year and model-estimated 2-year ODI. Concordance rates in achieving MCID at 1-year and 2-year and predictive values were calculated. A total of 868 patients were analyzed. One-year ODI scores differed from 2-year scores by an absolute difference of 9.7 ± 8.9 points and predictive model-estimated 2-year scores differed from actual 2-year scores by 8.8 ± 7.3 points. The model-estimated 2-year ODI was significantly different than actual 1-year ODI in assessing actual 2-year ODI for all procedures (P = 0.001) except for primary (P = 0.932) and revision microdiscectomy (P = 0.978) and primary laminectomy (P = 0.267). The discordance rates of achieving or not achieving MCID for ODI ranged from 8% to 27%. Concordance rate was about 90% for primary and revision microdiscectomy. The positive and negative predictive value of 1-year ODI to predict 2-year ODI was 83% and 67% for all procedures and 92% and 67% for primary and 100% and 86% for revision microdiscectomy respectively. One-year disability outcomes can

  16. A Protocol for the Hamilton Rating Scale for Depression: Item Scoring Rules, Rater Training, and Outcome Accuracy with Data on its Application in a Clinical Trial

    PubMed Central

    Rohan, Kelly J.; Rough, Jennifer N.; Evans, Maggie; Ho, Sheau-Yan; Meyerhoff, Jonah; Roberts, Lorinda M.; Vacek, Pamela M.

    2016-01-01

    Background We present a fully articulated protocol for the Hamilton Rating Scale for Depression (HAM-D), including item scoring rules, rater training procedures, and a data management algorithm to increase accuracy of scores prior to outcome analyses. The latter involves identifying potentially inaccurate scores as interviews with discrepancies between two independent raters on the basis of either scores (≥ 5-point difference) or meeting threshold for depression recurrence status, a long-term treatment outcome with public health significance. Discrepancies are resolved by assigning two new raters, identifying items with disagreement per an algorithm, and reaching consensus on the most accurate scores for those items. Methods These methods were applied in a clinical trial where the primary outcome was the Structured Interview Guide for the Hamilton Rating Scale for Depression—Seasonal Affective Disorder version (SIGH-SAD), which includes the 21-item HAM-D and 8 items assessing atypical symptoms. 177 seasonally depressed adult patients were enrolled and interviewed at 10 time points across treatment and the 2-year followup interval for a total of 1,589 completed interviews with 1,535 (96.6%) archived. Results Inter-rater reliability ranged from ICCs of .923 to .967. Only 86 (5.6%) interviews met criteria for a between-rater discrepancy. HAM-D items “Depressed Mood,” “Work and Activities,” “Middle Insomnia,” and “Hypochondriasis” and Atypical items “Fatigability” and “Hypersomnia” contributed most to discrepancies. Limitations Generalizability beyond well-trained, experienced raters in a clinical trial is unknown. Conclusions Researchers might want to consider adopting this protocol in part or full. Clinicians might want to tailor it to their needs. PMID:27130960

  17. The National Early Warning Score (NEWS) for outcome prediction in emergency department patients with community-acquired pneumonia: results from a 6-year prospective cohort study

    PubMed Central

    Sbiti-Rohr, Diana; Kutz, Alexander; Christ-Crain, Mirjam; Thomann, Robert; Zimmerli, Werner; Hoess, Claus; Henzen, Christoph; Mueller, Beat; Schuetz, Philipp

    2016-01-01

    Objective To investigate the accuracy of the National Early Warning Score (NEWS) to predict mortality and adverse clinical outcomes for patients with community-acquired pneumonia (CAP) compared to standard risk scores such as the pneumonia severity index (PSI) and CURB-65. Design Secondary analysis of patients included in a previous randomised-controlled trial with a median follow-up of 6.1 years. Settings Patients with CAP included on admission to the emergency departments (ED) of 6 tertiary care hospitals in Switzerland. Participants A total of 925 patients with confirmed CAP were included. NEWS, PSI and CURB-65 scores were calculated on admission to the ED based on admission data. Main outcome measure Our primary outcome was all-cause mortality within 6 years of follow-up. Secondary outcomes were adverse clinical outcome defined as intensive care unit (ICU) admission, empyema and unplanned hospital readmission all occurring within 30 days after admission. We used regression models to study associations of baseline risk scores and outcomes with the area under the receiver operating curve (AUC) as a measure of discrimination. Results 6-year overall mortality was 45.1% (n=417) with a stepwise increase with higher NEWS categories. For 30 day and 6-year mortality prediction, NEWS showed only low discrimination (AUC 0.65 and 0.60) inferior compared to PSI and CURB-65. For prediction of ICU admission, NEWS showed moderate discrimination (AUC 0.73) and improved the prognostic accuracy of a regression model, including PSI (AUC from 0.66 to 0.74, p=0.001) and CURB-65 (AUC from 0.64 to 0.73, p=0.015). NEWS was also superior to PSI and CURB-65 for prediction of empyema, but did not well predict rehospitalisation. Conclusions NEWS provides additional prognostic information with regard to risk of ICU admission and complications and thereby improves traditional clinical-risk scores in the management of patients with CAP in the ED setting. Trial registration number

  18. The Patient- And Nutrition-Derived Outcome Risk Assessment Score (PANDORA): Development of a Simple Predictive Risk Score for 30-Day In-Hospital Mortality Based on Demographics, Clinical Observation, and Nutrition.

    PubMed

    Hiesmayr, Michael; Frantal, Sophie; Schindler, Karin; Themessl-Huber, Michael; Mouhieddine, Mohamed; Schuh, Christian; Pernicka, Elisabeth; Schneider, Stéphane; Singer, Pierre; Ljunqvist, Olle; Pichard, Claude; Laviano, Alessandro; Kosak, Sigrid; Bauer, Peter

    2015-01-01

    To develop a simple scoring system to predict 30 day in-hospital mortality of in-patients excluding those from intensive care units based on easily obtainable demographic, disease and nutrition related patient data. Score development with general estimation equation methodology and model selection by P-value thresholding based on a cross-sectional sample of 52 risk indicators with 123 item classes collected with questionnaires and stored in an multilingual online database. Worldwide prospective cross-sectional cohort with 30 day in-hospital mortality from the nutritionDay 2006-2009 and an external validation sample from 2012. We included 43894 patients from 2480 units in 32 countries. 1631(3.72%) patients died within 30 days in hospital. The Patient- And Nutrition-Derived Outcome Risk Assessment (PANDORA) score predicts 30-day hospital mortality based on 7 indicators with 31 item classes on a scale from 0 to 75 points. The indicators are age (0 to 17 points), nutrient intake on nutritionDay (0 to 12 points), mobility (0 to 11 points), fluid status (0 to 10 points), BMI (0 to 9 points), cancer (9 points) and main patient group (0 to 7 points). An appropriate model fit has been achieved. The area under the receiver operating characteristic curve for mortality prediction was 0.82 in the development sample and 0.79 in the external validation sample. The PANDORA score is a simple, robust scoring system for a general population of hospitalised patients to be used for risk stratification and benchmarking.

  19. Development and validation of the Delinquency Reduction Outcome Profile (DROP) in a sample of incarcerated juveniles: a multiconstruct/multisituational scoring approach.

    PubMed

    Barbot, Baptiste; Haeffel, Gerald J; Macomber, Donna; Hart, Lesley; Chapman, John; Grigorenko, Elena L

    2012-12-01

    The Delinquency Reduction Outcome Profile (DROP) is a novel situational-judgment test (SJT) designed to measure social decision making in delinquent youth. The DROP includes both a typical SJT scoring method, which captures the deviation of an individual response from an "ideal" expert-based response pattern, as well as a novel "Multiconstruct-Multisituational" (MCMS) factor-scoring method, enabling the assessment "in context" of latent dimensions reflecting stable decision-making tendencies. The authors present the development and validation of the DROP across 2 studies establishing its reliability and internal and concurrent validity using a sample of 1,922 young detainees and a sample of juveniles from the community. The authors also discuss the potential usefulness of the DROP as a prognostic tool to predict recidivism for delinquent youth and to monitor changes in intervention programs designed to improve social decision-making skills. Benefits of the MCMS scoring approach for SJT literature and psychological measurement are also discussed.

  20. Child Feeding and Parenting Style Outcomes and Composite Score Measurement in the ‘Feeding Healthy Food to Kids Randomised Controlled Trial’

    PubMed Central

    Duncanson, Kerith; Burrows, Tracy L.; Collins, Clare E.

    2016-01-01

    Child feeding practices and parenting style each have an impact on child dietary intake, but it is unclear whether they influence each other or are amenable to change. The aims of this study were to measure child feeding and parenting styles in the Feeding Healthy Food to Kids (FHFK) Randomized Controlled Trial (RCT) and test a composite child feeding score and a composite parenting style score. Child feeding and parenting style data from 146 parent-child dyads (76 boys, aged 2.0–5.9 years) in the FHFK study were collected over a 12-month intervention. Parenting style was measured using parenting questions from the Longitudinal Study of Australian Children and the Child Feeding Questionnaire (CFQ) was used to measure child feeding practices. Data for both measures were collected at baseline, 3 and 12 months and then modelled to develop a composite child feeding score and a parenting score. Multivariate mixed effects linear regression was used to measure associations between variables over time. All child feeding domains from the CFQ were consistent between baseline and 12 months (p < 0.001), except for monitoring (0.12, p = 0.44). All parenting style domain scores were consistent over 12 months (p < 0.001), except for overprotection (0.22, p = 0.16). A significant correlation (r = 0.42, p < 0.0001) existed between child feeding score and parenting style score within the FHFK RCT. In conclusion, composite scores have potential applications in the analysis of relationships between child feeding and dietary or anthropometric data in intervention studies aimed at improving child feeding or parenting style. These applications have the potential to make a substantial contribution to the understanding of child feeding practices and parenting style, in relation to each other and to dietary intake and health outcomes amongst pre-school aged children. PMID:27834906

  1. Novel scoring system as a useful model to predict the outcome of patients with acute liver failure: Application to indication criteria for liver transplantation.

    PubMed

    Naiki, Takafumi; Nakayama, Nobuaki; Mochida, Satoshi; Oketani, Makoto; Takikawa, Yasuhiro; Suzuki, Kazuyuki; Tada, Shin-Ichiro; Ichida, Takafumi; Moriwaki, Hisataka; Tsubouchi, Hirohito

    2012-01-01

      In Japan, the indication for liver transplantation in patients with acute liver failure (ALF) is currently determined according to the guideline published in 1996. However, its predictive accuracy has fallen in recent patients. Thus, we attempted to establish a new guideline.   The subjects were 1096 ALF patients enrolled in a nationwide survey. All patients showed a prothrombin time <40% of the standardized value and grade II or more severe hepatic encephalopathy. A multiple logistic regression analysis and receiver operating characteristic analysis were performed in 698 patients seen between 1998 and 2003 to identify significant parameters determining the outcome of patients. The extracted parameters were graded as numerical scores. An established scoring system was validated in patients seen between 2004 and 2008.   Six parameters were identified and graded as 0, 1 and/or 2; the interval between disease onset and development of hepatic encephalopathy, prothrombin time, serum total bilirubin concentration, the ratio of direct to total bilirubin concentration, peripheral platelet count and the presence of liver atrophy. When the prognosis of the patients with total score of 5 or more was judged as "death", the predictive accuracy was 0.80 with sensitivity, specificity, positive predictive value and negative predictive value greater than 0.70. The values were similarly high in patients for validation.   Novel scoring system for predicting the outcome of ALF patients may be useful to determine the indication of liver transplantation, since the system showed high predictive accuracy even after validation. © 2011 The Japan Society of Hepatology.

  2. Pulmonary symptoms measured by the national institutes of health lung score predict overall survival, nonrelapse mortality, and patient-reported outcomes in chronic graft-versus-host disease.

    PubMed

    Palmer, Jeanne; Williams, Kirsten; Inamoto, Yoshihiro; Chai, Xiaoyu; Martin, Paul J; Tomas, Linus Santo; Cutler, Corey; Weisdorf, Daniel; Kurland, Brenda F; Carpenter, Paul A; Pidala, Joseph; Pavletic, Steven Z; Wood, William; Jacobsohn, David; Arai, Sally; Arora, Mukta; Jagasia, Madan; Vogelsang, Georgia B; Lee, Stephanie J

    2014-03-01

    The 2005 National Institutes of Health (NIH) Consensus Conference recommended assessment of lung function in patients with chronic graft-versus-host disease (GVHD) by both pulmonary function tests (PFTs) and assessment of pulmonary symptoms. We tested whether pulmonary measures were associated with nonrelapse mortality (NRM), overall survival (OS), and patient-reported outcomes (PRO). Clinician and patient-reported data were collected serially in a prospective, multicenter, observational study. Available PFT data were abstracted. Cox regression models were fit for outcomes using a time-varying covariate model for lung function measures and adjusting for patient and transplantation characteristics and nonlung chronic GVHD severity. A total of 1591 visits (496 patients) were used in this analysis. The NIH symptom-based lung score was associated with NRM (P = .02), OS (P = .02), patient-reported symptoms (P < .001) and functional status (P < .001). Worsening of NIH symptom-based lung score over time was associated with higher NRM and lower survival. All other measures were not associated with OS or NRM; although, some were associated with patient-reported lung symptoms. In conclusion, the NIH symptom-based lung symptom score of 0 to 3 is associated with NRM, OS, and PRO measures in patients with chronic GVHD. Worsening of the NIH symptom-based lung score was associated with increased mortality.

  3. Microwave ablation of malignant renal tumours: intermediate-term results and usefulness of RENAL and mRENAL scores for predicting outcomes and complications.

    PubMed

    Ierardi, Anna Maria; Puliti, Alessio; Angileri, Salvatore Alessio; Petrillo, Mario; Duka, Ejona; Floridi, Chiara; Lecchi, Michela; Carrafiello, Gianpaolo

    2017-05-01

    The aim of this study was to evaluate intermediate-term results after microwave ablation (MWA) of renal tumours and determine the association of RENAL and modified RENAL (mRENAL) scores with oncological outcomes and complications. In May 2008-September 2014, 58 patients affected by early-stage RCC (renal cell carcinoma; T1a or T1b) were judged unsuitable for surgery and treated with percutaneous MWA. Follow-up was performed with contrast-enhanced computed tomography at 1, 3, 6, 12 and 24 months after the procedure. Technical success (TS), primary technical effectiveness (PTE), secondary technical effectiveness (STE), the local tumour progression rate (LTPR), the cancer-specific survival rate (CSSR), disease-free survival (DFS), overall survival (OS) and safety were recorded. All lesions were evaluated using RENAL and mRENAL scores, and complications were assessed with RENAL scores. The TS rate was 100%, PTE was 93%, STE was 100%, LTPR was 15.7% at 1 year, CSSR was 96.5%, DFS was 87.9% at 5 years, and OS was 80.6%. Mean follow-up was 25.7 months (range 3-72). The mean ± standard deviation (SD) RENAL and mRENAL scores of all treated tumours were 6.7 ± 2.05 (range 4-11) and 7 ± 2.3 (range 4-12), respectively. Major complications occurred in two (2/58) and minor complications in three patients (3/58). Overall complications correlated significantly with RENAL scores; in particular, E and L represent negative predictors for safety and effectiveness. MWA is a valuable alternative for treating RCCs. The correlation with outcomes and complications of RENAL and mRENAL scores could help to customise MWA indications in RCC patients.

  4. Impact of Glasgow Coma Scale score and pupil parameters on mortality rate and outcome in pediatric and adult severe traumatic brain injury: a retrospective, multicenter cohort study.

    PubMed

    Emami, Pedram; Czorlich, Patrick; Fritzsche, Friederike S; Westphal, Manfred; Rueger, Johannes M; Lefering, Rolf; Hoffmann, Michael

    2017-03-01

    OBJECTIVE Prediction of death and functional outcome is essential for determining treatment strategies and allocation of resources for patients with severe traumatic brain injury (TBI). The aim of this study was to evaluate, by using pupillary status and Glasgow Coma Scale (GCS) score, if patients with severe TBI who are ≤ 15 years old have a lower mortality rate and better outcome than adults with severe TBI. METHODS A retrospective cohort analysis of patients suffering from severe TBI registered in the Trauma Registry of the German Society for Trauma Surgery between 2002 and 2013 was undertaken. Severe TBI was defined as an Abbreviated Injury Scale of the head (AIShead) score of ≥ 3 and an AIS score for any other part of the body that does not exceed the AIShead score. Only patients with complete data (GCS score, age, and pupil parameters) were included. To assess the impact of GCS score and pupil parameters, the authors also used the recently introduced Eppendorf-Cologne Scale and divided the study population into 2 groups: children (0-15 years old) and adults (16-55 years old). Each patient's outcome was measured at discharge from the trauma center by using the Glasgow Outcome Scale. RESULTS A total of 9959 patients fulfilled the study inclusion criteria; 888 (8.9%) patients were ≤ 15 years old (median 10 years). The overall mortality rate and the mortality rate for patients with a GCS of 3 and bilaterally fixed and dilated pupils (19.9% and 16.3%, respectively) were higher for the adults than for the pediatric patients (85% vs 80.9%, respectively), although cardiopulmonary resuscitation rates were significantly higher in the pediatric patients (5.6% vs 8.8%, respectively). In the multivariate logistic regression analysis, no motor response (OR 3.490, 95% CI 2.240-5.435) and fixed pupils (OR 4.197, 95% CI 3.271-5.386) and bilateral dilated pupils (OR 2.848, 95% CI 2.282-3.556) were associated with a higher mortality rate. Patients ≤ 15 years old had a

  5. Use of the AngioSculpt scoring balloon for infrapopliteal lesions in patients with critical limb ischemia: 1-year outcome.

    PubMed

    Bosiers, Marc; Deloose, Koen; Cagiannos, Catherine; Verbist, Jürgen; Peeters, Patrick

    2009-01-01

    The AngioSculpt Scoring Balloon Catheter (AngioScore, Inc., Fremont, CA) is composed of a semicompliant balloon encircled by three nitinol spiral struts providing targeted lesion scoring on balloon inflation. Between April 2005 and April 2006, procedural and follow-up data on 31 patients (mean age 76 years; 54.8% males) endovascularly treated for severe infrapopliteal disease were collected. The AngioSculpt catheter was used to treat 36 complex, tibioperoneal, atherosclerotic lesions. All patients had symptomatic critical limb ischemia (Rutherford 4-5) and single-vessel runoff to the ankle. Complication-free survival at 1 month was the safety end point, whereas primary patency and limb salvage were the efficacy end points evaluated at 1 year. The AngioSculpt balloon was successfully inflated in all 36 target lesions. Eleven patients (35.5%) required additional stenting for minor dissections or suboptimal stenosis reduction. The 1-month complication-free survival was 96.8%. One-year survival, primary patency, and limb salvage rates were 83.9 +/- 6.6%, 61.0 +/- 9.3%, and 86.3 +/- 6.4%, respectively. The 1-year data show the AngioSculpt Scoring Balloon Catheter to be an effective and safe treatment for infrapopliteal, atherosclerotic lesions in patients with critical limb ischemia. However, more patients, a longer follow-up, and randomized studies comparing it with conventional balloon angioplasty and stenting in the infrapopliteal region are required.

  6. The National Early Warning Score (NEWS) for outcome prediction in emergency department patients with community-acquired pneumonia: results from a 6-year prospective cohort study.

    PubMed

    Sbiti-Rohr, Diana; Kutz, Alexander; Christ-Crain, Mirjam; Thomann, Robert; Zimmerli, Werner; Hoess, Claus; Henzen, Christoph; Mueller, Beat; Schuetz, Philipp

    2016-09-28

    To investigate the accuracy of the National Early Warning Score (NEWS) to predict mortality and adverse clinical outcomes for patients with community-acquired pneumonia (CAP) compared to standard risk scores such as the pneumonia severity index (PSI) and CURB-65. Secondary analysis of patients included in a previous randomised-controlled trial with a median follow-up of 6.1 years. Patients with CAP included on admission to the emergency departments (ED) of 6 tertiary care hospitals in Switzerland. A total of 925 patients with confirmed CAP were included. NEWS, PSI and CURB-65 scores were calculated on admission to the ED based on admission data. Our primary outcome was all-cause mortality within 6 years of follow-up. Secondary outcomes were adverse clinical outcome defined as intensive care unit (ICU) admission, empyema and unplanned hospital readmission all occurring within 30 days after admission. We used regression models to study associations of baseline risk scores and outcomes with the area under the receiver operating curve (AUC) as a measure of discrimination. 6-year overall mortality was 45.1% (n=417) with a stepwise increase with higher NEWS categories. For 30 day and 6-year mortality prediction, NEWS showed only low discrimination (AUC 0.65 and 0.60) inferior compared to PSI and CURB-65. For prediction of ICU admission, NEWS showed moderate discrimination (AUC 0.73) and improved the prognostic accuracy of a regression model, including PSI (AUC from 0.66 to 0.74, p=0.001) and CURB-65 (AUC from 0.64 to 0.73, p=0.015). NEWS was also superior to PSI and CURB-65 for prediction of empyema, but did not well predict rehospitalisation. NEWS provides additional prognostic information with regard to risk of ICU admission and complications and thereby improves traditional clinical-risk scores in the management of patients with CAP in the ED setting. ISRCTN95122877; Post-results. Published by the BMJ Publishing Group Limited. For permission to use (where not

  7. Association between cytokine response, the LRINEC score and outcome in patients with necrotising soft tissue infection: a multicentre, prospective study

    PubMed Central

    Hansen, Marco Bo; Rasmussen, Lars Simon; Svensson, Mattias; Chakrakodi, Bhavya; Bruun, Trond; Madsen, Martin Bruun; Perner, Anders; Garred, Peter; Hyldegaard, Ole; Norrby-Teglund, Anna; Nekludov, Michael; Arnell, Per; Rosén, Anders; Oscarsson, Nicklas; Karlsson, Ylva; Oppegaard, Oddvar; Skrede, Steinar; Itzek, Andreas; Wahl, Anna Mygind; Hedetoft, Morten; Bærnthsen, Nina Falcon; Müller, Rasmus; Nedrebø, Torbjørn

    2017-01-01

    Early assessment of necrotising soft tissue infection (NSTI) is challenging. Analysis of inflammatory markers could provide important information about disease severity and guide decision making. For this purpose, we investigated the association between cytokine levels and the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC)-score, disease severity and mortality in NSTI patients. In 159 patients, plasma was analysed for IL-1β, IL-6, IL-10 and TNF-α upon admission. The severity of NSTI was assessed by SAPS, SOFA score, septic shock, microbial aetiology, renal replacement therapy and amputation. We found no significant difference in cytokine levels according to a LRINEC- score above or below 6 (IL-1β: 3.0 vs. 1.3; IL-6: 607 vs. 289; IL-10: 38.4 vs. 38.8; TNF-α: 15.1 vs. 7.8 pg/mL, P > 0.05). Patients with β-haemolytic streptococcal infection had higher level of particularly IL-6. There was no difference in mortality between patients with a LRINEC-score above or below 6. In the adjusted analysis assessing 30-day mortality, the association was strongest for IL-1β (OR 3.86 [95% CI, 1.43-10.40], P = 0.008) and IL-10 (4.80 [1.67-13.78], P = 0.004). In conclusion, we found no significant association between the LRINEC-score and cytokine levels on admission. IL-6 was consistently associated with disease severity, whereas IL-1β had the strongest association with 30-day mortality. PMID:28176831

  8. Effects of cognitive behavioral therapy in patients with depressive disorder and comorbid insomnia: A propensity score-matched outcome study.

    PubMed

    Hsu, Hui-Min; Chou, Kuei-Ru; Lin, Kuan-Chia; Chen, Kuan-Yu; Su, Shu-Fang; Chung, Min-Huey

    2015-10-01

    We evaluated the effects of cognitive behavioral therapy for insomnia (CBT-I) in inpatients with a diagnosis of depression and comorbid insomnia. This study used a prospective, parallel-group design. The experimental group received CBT-I for no more than 90 min once weekly for 6 weeks and the control group only have health education manuals for insomnia. The following questionnaires were administered at baseline: the Hamilton Rating Scale for Depression (HAM-D), Dysfunctional Beliefs and Attitudes about Sleep (DBAS), Presleep Arousal Scale (PSAS), Sleep Hygiene Practice (SHP), and Pittsburgh Sleep Quality Index. The questionnaires were readministered after the completion of the 6-wk CBT-I intervention and 1 month following the completion of CBT-I, to determine the effects of the CBT-I intervention over time. The analysis of Generalized Estimation Equations was identified the difference between the experimental group and the control group by controlling for the variables in BZD dose and propensity score of gender, age, and the scores for the DBAS-16, PSAS, SHPS, and HAM-D. Consequently, the significant difference in the PSQI scores was observed at the 1-month follow-up assessment however, no significant intergroup difference in the PSQI scores was found at the completion of the CBT-I intervention between two groups. As a conclusion, we found that overall sleep quality significantly improved in patients who received CBT-I after we controlled for the BZD dose and propensity score, which suggests that CBT-I may represent a useful clinical strategy for improving sleep quality in patients with depression and comorbid insomnia. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. A magnetic resonance imaging-based prognostic scoring system to predict outcome in transplant-eligible patients with multiple myeloma.

    PubMed

    Mai, Elias K; Hielscher, Thomas; Kloth, Jost K; Merz, Maximilian; Shah, Sofia; Raab, Marc S; Hillengass, Michaela; Wagner, Barbara; Jauch, Anna; Hose, Dirk; Weber, Marc-André; Delorme, Stefan; Goldschmidt, Hartmut; Hillengass, Jens

    2015-06-01

    Diffuse and focal bone marrow infiltration patterns detected by magnetic resonance imaging have been shown to be of prognostic significance in all stages of monoclonal plasma cell disorders and have, therefore, been incorporated into the definition of the disease. The aim of this retrospective analysis was to develop a rapidly evaluable prognostic scoring system, incorporating the most significant information acquired from magnetic resonance imaging. Therefore, the impact of bone marrow infiltration patterns on progression-free and overall survival in 161 transplant-eligible myeloma patients was evaluated. Compared to salt and pepper/minimal diffuse infiltration, moderate/severe diffuse infiltration had a negative prognostic impact on both progression-free survival (P<0.001) and overall survival (P=0.003). More than 25 focal lesions on whole-body magnetic resonance imaging or more than seven on axial magnetic resonance imaging were associated with an adverse prognosis (progression-free survival: P=0.001/0.003 and overall survival: P=0.04/0.02). A magnetic resonance imaging-based prognostic scoring system, combining grouped diffuse and focal infiltration patterns, was formulated and is applicable to whole-body as well as axial magnetic resonance imaging. The score identified high-risk patients with median progression-free and overall survival of 23.4 and 55.9 months, respectively (whole-body-based). Multivariate analyses demonstrated that the magnetic resonance imaging-based prognostic score stage III (high-risk) and adverse cytogenetics are independent prognostic factors for both progression-free and overall survival (whole-body-based, progression-free survival: hazard ratio=3.65, P<0.001; overall survival: hazard ratio=5.19, P=0.005). In conclusion, we suggest a magnetic resonance imaging-based prognostic scoring system which is a robust, easy to assess and interpret parameter summarizing significant magnetic resonance imaging findings in transplant

  10. CHADS2 score is associated with 3-month clinical outcomes after intravenous rt-PA therapy in stroke patients with atrial fibrillation: SAMURAI rt-PA Registry.

    PubMed

    Koga, Masatoshi; Kimura, Kazumi; Shibazaki, Kensaku; Shiokawa, Yoshiaki; Nakagawara, Jyoji; Furui, Eisuke; Yamagami, Hiroshi; Okada, Yasushi; Hasegawa, Yasuhiro; Kario, Kazuomi; Okuda, Satoshi; Naganuma, Masaki; Nezu, Tomohisa; Maeda, Koichiro; Minematsu, Kazuo; Toyoda, Kazunori

    2011-07-15

    The aim of this study was to examine whether CHADS(2) score is associated with clinical outcomes following recombinant tissue type plasminogen activator (rt-PA) therapy in stroke patients with atrial fibrillation (AF). We studied 218 consecutive stroke patients with AF [126 men, mean age 74.2 (SD 9.6) years] who received intravenous rt-PA therapy. CHADS(2) score was calculated as follows: 2 points for prior ischemic stroke and 1 point for each of the following: age≥75 years, hypertension, diabetes, and congestive heart failure. Congestive heart failure was documented in 23 patients, hypertension in 138, age≥75 years in 116, diabetes in 35, and prior stroke in 35. The distribution of each CHADS(2) score was: score of 0, 16.1% of patients; 1, 30.3%; 2, 29.4%; and 3 to 5, 24.3%. The median initial NIHSS score for each CHADS(2) category was 12 (IQR 8-17), 16 (10-20), 14.5 (10-20.75), and 16 (11-21), respectively (p=0.168). Symptomatic ICH within the initial 36 h was found in 2.9%, 4.6%, 6.3%, and 0% of patients with each CHADS(2) category, respectively. Cardiovascular events within 3 months occurred in 0%, 0%, 7.8% and 5.7%, respectively. Percentage of patients with chronic independence at 3 months corresponding to modified Rankin Scale≤2 was 57.1%, 45.5%, 31.3%, and 28.3%, respectively. Adjusted CHADS(2) score was inversely associated with chronic independence (OR 0.72, 95% CI 0.55-0.93). Lower CHADS(2) score was associated with chronic independence at 3 months after intravenous rt-PA therapy in stroke patients with AF. Copyright © 2011 Elsevier B.V. All rights reserved.

  11. Impact of different scoring algorithms applied to multiple-mark survey items on outcome assessment: an in-field study on health-related knowledge.

    PubMed

    Domnich, A; Panatto, D; Arata, L; Bevilacqua, I; Apprato, L; Gasparini, R; Amicizia, D

    2015-01-01

    Health-related knowledge is often assessed through multiple-choice tests. Among the different types of formats, researchers may opt to use multiple-mark items, i.e. with more than one correct answer. Although multiple-mark items have long been used in the academic setting - sometimes with scant or inconclusive results - little is known about the implementation of this format in research on in-field health education and promotion. A study population of secondary school students completed a survey on nutrition-related knowledge, followed by a single- lecture intervention. Answers were scored by means of eight different scoring algorithms and analyzed from the perspective of classical test theory. The same survey was re-administered to a sample of the students in order to evaluate the short-term change in their knowledge. In all, 286 questionnaires were analyzed. Partial scoring algorithms displayed better psychometric characteristics than the dichotomous rule. In particular, the algorithm proposed by Ripkey and the balanced rule showed greater internal consistency and relative efficiency in scoring multiple-mark items. A penalizing algorithm in which the proportion of marked distracters was subtracted from that of marked correct answers was the only one that highlighted a significant difference in performance between natives and immigrants, probably owing to its slightly better discriminatory ability. This algorithm was also associated with the largest effect size in the pre-/post-intervention score change. The choice of an appropriate rule for scoring multiple- mark items in research on health education and promotion should consider not only the psychometric properties of single algorithms but also the study aims and outcomes, since scoring rules differ in terms of biasness, reliability, difficulty, sensitivity to guessing and discrimination.

  12. The combination of indocyanine green clearance test and model for end-stage liver disease score predicts early graft outcome after liver transplantation.

    PubMed

    Yunhua, Tang; Weiqiang, Ju; Maogen, Chen; Sai, Yang; Zhiheng, Zhang; Dongping, Wang; Zhiyong, Guo; Xiaoshun, He

    2017-08-22

    Early allograft dysfunction (EAD) and early postoperative complications are two important clinical endpoints when evaluating clinical outcomes of liver transplantation (LT). We developed and validated two ICGR15-MELD models in 87 liver transplant recipients for predicting EAD and early postoperative complications after LT by incorporating the quantitative liver function tests (ICGR15) into the MELD score. Eighty seven consecutive patients who underwent LT were collected and divided into a training cohort (n = 61) and an internal validation cohort (n = 26). For predicting EAD after LT, the area under curve (AUC) for ICGR15-MELD score was 0.876, with a sensitivity of 92.0% and a specificity of 75.0%, which is better than MELD score or ICGR15 alone. The recipients with a ICGR15-MELD score ≥0.243 have a higher incidence of EAD than those with a ICGR15-MELD score <0.243 (P <0.001). For predicting early postoperative complications, the AUC of ICGR15-MELD score was 0.832, with a sensitivity of 90.9% and a specificity of 71.0%. Those recipients with an ICGR15-MELD score ≥0.098 have a higher incidence of early postoperative complications than those with an ICGR15-MELD score <0.098 (P < 0.001). Finally, application of the two ICGR15-MELD models in the validation cohort still gave good accuracy (AUC, 0.835 and 0.826, respectively) in predicting EAD and early postoperative complications after LT. The combination of quantitative liver function tests (ICGR15) and the preoperative MELD score is a reliable and effective predictor of EAD and early postoperative complications after LT, which is better than MELD score or ICGR15 alone.

  13. Validation of a questionnaire assessing patient's aesthetic and functional outcome after nasal reconstruction: the patient NAFEQ-score.

    PubMed

    Moolenburgh, S E; Mureau, M A M; Duivenvoorden, H J; Hofer, S O P

    2009-05-01

    In determining patient satisfaction with functional and aesthetic outcome after reconstructive surgery, including nasal reconstruction, standardised assessment instruments are very important. These standardised tools are needed to adequately evaluate and compare outcome results. Since no such instrument existed for nasal reconstruction, a standardised evaluation questionnaire was developed to assess aesthetic and functional outcome after nasal reconstruction. Items of the Nasal Appearance and Function Evaluation Questionnaire (NAFEQ) were derived from both the literature and experiences with patients. The NAFEQ was validated on 30 nasal reconstruction patients and a reference group of 175 people. A factor analysis confirmed the arrangement of the questionnaire in two subscales: functional and aesthetic outcome. High Cronbach's alpha values (>0.70) for both subscales showed that the NAFEQ was an internally consistent instrument. This study demonstrated that the NAFEQ can be used as a standardised questionnaire for detailed evaluation of aesthetic and functional outcome after nasal reconstruction. Its widespread use would enable comparison of results achieved by different techniques, surgeons and centres in a standardised fashion.

  14. Formation of translational risk score based on correlation coefficients as an alternative to Cox regression models for predicting outcome in patients with NSCLC.

    PubMed

    Kössler, Wolfgang; Fiebeler, Anette; Willms, Arnulf; ElAidi, Tina; Klosterhalfen, Bernd; Klinge, Uwe

    2011-07-27

    Personalised cancer therapy, such as that used for bronchial carcinoma (BC), requires treatment to be adjusted to the patient's status. Individual risk for progression is estimated from clinical and molecular-biological data using translational score systems. Additional molecular information can improve outcome prediction depending on the marker used and the applied algorithm. Two models, one based on regressions and the other on correlations, were used to investigate the effect of combining various items of prognostic information to produce a comprehensive score. This was carried out using correlation coefficients, with options concerning a more plausible selection of variables for modelling, and this is considered better than classical regression analysis. Clinical data concerning 63 BC patients were used to investigate the expression pattern of five tumour-associated proteins. Significant impact on survival was determined using log-rank tests. Significant variables were integrated into a Cox regression model and a new variable called integrative score of individual risk (ISIR), based on Spearman's correlations, was obtained. High tumour stage (TNM) was predictive for poor survival, while CD68 and Gas6 protein expression correlated with a favourable outcome. Cox regression model analysis predicted outcome more accurately than using each variable in isolation, and correctly classified 84% of patients as having a clear risk status. Calculation of the integrated score for an individual risk (ISIR), considering tumour size (T), lymph node status (N), metastasis (M), Gas6 and CD68 identified 82% of patients as having a clear risk status. Combining protein expression analysis of CD68 and GAS6 with T, N and M, using Cox regression or ISIR, improves prediction. Considering the increasing number of molecular markers, subsequent studies will be required to validate translational algorithms for the prognostic potential to select variables with a high prognostic power; the

  15. Validation of the English language Forgotten Joint Score-12 as an outcome measure for total hip and knee arthroplasty in a British population.

    PubMed

    Hamilton, D F; Loth, F L; Giesinger, J M; Giesinger, K; MacDonald, D J; Patton, J T; Simpson, A H R W; Howie, C R

    2017-02-01

    To validate the English language Forgotten Joint Score-12 (FJS-12) as a tool to evaluate the outcome of hip and knee arthroplasty in a United Kingdom population. All patients undergoing surgery between January and August 2014 were eligible for inclusion. Prospective data were collected from 205 patients undergoing total hip arthroplasty (THA) and 231 patients undergoing total knee arthroplasty (TKA). Outcomes were assessed with the FJS-12 and the Oxford Hip and Knee Scores (OHS, OKS) pre-operatively, then at six and 12 months post-operatively. Internal consistency, convergent validity, effect size, relative validity and ceiling effects were determined. Data for the TKA and THA patients showed high internal consistency for the FJS-12 (Cronbach α = 0.97 in TKAs, 0.98 in THAs). Convergent validity with the Oxford Scores was high (r = 0.85 in TKAs, r = 0.79 for THAs). From six to 12 months, the change was higher for the FJS-12 than for the OHS in THA patients (effect size d = 0.21 versus -0.03). Ceiling effects at one-year follow-up were low for the FJS-12 with just 3.9% (TKA) and 8.8% (THA) of patients achieving the best possible score. The FJS-12 has strong measurement properties in terms of validity, internal consistency and sensitivity to change in TKA and THA patients. Low ceiling effects and good relative validity allow the monitoring of longer term outcomes, particularly in well-performing groups after total joint arthroplasty. Cite this article: Bone Joint J 2017;99-B:218-24. ©2017 Hamilton et al.

  16. CHADS2 and CHA2DS2-VASc Scores Predict the Risk of Ischemic Stroke Outcome in Patients with Interatrial Block without Atrial Fibrillation

    PubMed Central

    Wu, Jin-Tao; Chu, Ying-Jie; Long, De-Yong; Dong, Jian-Zeng; Fan, Xian-Wei; Yang, Hai-Tao; Duan, Hong-Yan; Yan, Li-Jie; Qian, Peng

    2017-01-01

    Aim: To evaluate the role of CHADS2 and CHA2DS2-VASc scores in predicting the risk of ischemic stroke or transient ischemic attack (TIA) outcomes in patients with interatrial block (IAB) without a history of atrial fibrillation (AF). Methods: A retrospective study was conducted, including 1,046 non-anticoagulated inpatients (612 males, 434 females; mean age: 63 ± 10 years) with IAB and without AF. IAB was defined as P-wave duration > 120 ms using a 12-lead electrocardiogram. CHADS2 and CHA2DS2-VASc scores were retrospectively calculated. The primary outcomes evaluated were ischemic stroke or TIA. Results: During the mean follow-up period of 4.9 ± 0.7 years, 55 (5.3%) patients had an ischemic stroke or TIA. Receiver operating characteristic (ROC) curve analysis showed that the CHADS2 score [area under the curve (AUC), 0.638; 95% confidence interval (CI), 0.562–0.715; P = 0.001] and the CHA2DS2-VASc score (AUC, 0.671; 95% CI, 0.599–0.744; P <0.001) were predictive of ischemic strokes or TIA. Cut-off point analysis showed that a CHADS2 score ≥ 3 (sensitivity = 0.455 and specificity = 0.747) and a CHA2DS2-VASc score ≥ 4 (sensitivity = 0.564 and specificity = 0.700) provided the highest predictive value for ischemic stroke or TIA. The multivariate Cox regression analysis showed that CHADS2 [hazard ratio (HR), 1.442; 95% CI, 1.171–1.774; P = 0.001] and CHA2DS2-VASc (HR, 1.420; 95% CI, 1.203–1.677; P <0.001) scores were independently associated with ischemic stroke or TIA following adjustment for smoking, left atrial diameter, antiplatelet agents, angiotensin inhibitors, and statins. Conclusions: CHADS2 and CHA2DS2-VASc scores may be predictors of risk of ischemic stroke or TIA in patients with IAB without AF. PMID:27301462

  17. Association of serum interleukin-6, interleukin-8, and Acute Physiology and Chronic Health Evaluation II score with clinical outcome in patients with acute respiratory distress syndrome

    PubMed Central

    Swaroopa, Deme; Bhaskar, Kakarla; Mahathi, T.; Katkam, Shivakrishna; Raju, Y. Satyanarayana; Chandra, Naval; Kutala, Vijay Kumar

    2016-01-01

    Background and Aim: Studies on potential biomarkers in experimental models of acute lung injury (ALI) and clinical samples from patients with ALI have provided evidence to the pathophysiology of the mechanisms of lung injury and predictor of clinical outcome. Because of the high mortality and substantial variability in outcomes in patients with acute respiratory distress syndrome (ARDS), identification of biomarkers such as cytokines is important to determine prognosis and guide clinical decision-making. Materials and Methods: In this study, we have included thirty patients admitted to Intensive Care Unit diagnosed with ARDS, and serum samples were collected on day 1 and 7 and were analyzed for serum interleukin-6 (IL-6) and IL-8 by ELISA method, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring was done on day 1. Results: The mortality in the patients observed with ARDS was 34%. APACHE II score was significantly higher in nonsurvivors as compared to survivors. There were no significant differences in gender and biochemical and hematological parameters among the survivors and nonsurvivors. Serum IL-6 and IL-8 levels on day 1 were significantly higher in all the ARDS patients as compared to healthy controls and these levels were returned to near-normal basal levels on day 7. The serum IL-6 and IL-8 levels measured on day 7 were of survivors. As compared to survivors, the IL-6 and IL-8 levels were significantly higher in nonsurvivors measured on day 1. Spearman's rank correlation analysis indicated a significant positive correlation of APACHE II with IL-8. By using APACHE II score, IL-6, and IL-8, the receiver operating characteristic curve was plotted and the provided predictable accuracy of mortality (outcome) was 94%. Conclusion: The present study highlighted the importance of measuring the cytokines such as IL-6 and IL-8 in patients with ARDS in predicting the clinical outcome. PMID:27688627

  18. Do all men with pathological Gleason score 8-10 prostate cancer have poor outcomes? Results from the SEARCH database.

    PubMed

    Fischer, Sean; Lin, Daniel; Simon, Ross M; Howard, Lauren E; Aronson, William J; Terris, Martha K; Kane, Christopher J; Amling, Christopher L; Cooperberg, Matt R; Freedland, Stephen J; Vidal, Adriana C

    2016-08-01

    To determine whether there are subsets of men with pathological high grade prostate cancer (Gleason score 8-10) with particularly high or low 2-year biochemical recurrence (BCR) risk after radical prostatectomy (RP) when stratified into groups based on combinations of pathological features, such as surgical margin status, extracapsular extension (ECE) and seminal vesicle invasion (SVI). We identified 459 men treated with RP with pathological Gleason score 8-10 prostate cancer in the SEARCH database. The men were stratified into five groups based on pathological characteristics: group 1, men with negative surgical margins (NSMs) and no ECE; group 2, men with positive surgical margin (PSMs) and no ECE; group 3, men with NSMs and ECE; group 4, men with PSMs and ECE; and group 5, men with SVI. Cox proportional hazards models and the log-rank test were used to compare BCR among the groups. At 2 years after RP, pathological group was significantly correlated with BCR (log-rank, P < 0.001) with patients in group 5 (+SVI) having the highest BCR risk (66%) and those in group 1 (NSMs and no ECE) having the lowest risk (14%). When we compared groups 2, 3, and 4, with each other, there was no significant difference in BCR among the groups (~50% 2-year BCR risk; log-rank P = 0.28). Results were similar when adjusting for prostate-specific antigen, age, pathological Gleason sum and clinical stage, or after excluding men who received adjuvant therapy. In patients with high grade (Gleason score 8-10) prostate cancer after RP, the presence of either PSMs, ECE or SVI was associated with an increased risk of early BCR, with a 2-year BCR risk of ≥50%. Conversely, men with organ-confined margin-negative disease had a very low risk of early BCR despite Gleason score 8-10 disease. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  19. Outcome of inappropriate empirical antibiotic therapy in patients with Staphylococcus aureus bacteraemia: analytical strategy using propensity scores.

    PubMed

    Kim, S-H; Park, W-B; Lee, C-S; Kang, C-I; Bang, J-W; Kim, H-B; Kim, N-J; Kim, E-C; Oh, M D; Choe, K-W

    2006-01-01

    Patients with Staphylococcus aureus bacteraemia (SAB) who received either inappropriate or appropriate empirical therapy were compared by using two risk stratification models: (1) a cohort study using a propensity score to adjust for confounding by empirical treatment assignment; and (2) a propensity-matched case-control study. Inappropriate empirical therapy was modelled on the basis of patient characteristics, and included in the multivariate model to adjust for confounding. For case-matching analysis, patients with inappropriate empirical therapy (cases) were matched to those with appropriate empirical therapy (controls) on the basis of the propensity score (within 0.03 on a scale of 0-1). In total, 238 patients with SAB were enrolled in the cohort study. Characteristics associated with inappropriate empirical therapy were methicillin resistance, underlying haematological malignancy, no history of colonisation with methicillin-resistant S. aureus, and a long hospital stay before SAB. These variables were included in the propensity score, which had an area under the receiver operating characteristics curve of 85%. In the cohort study, SAB-related mortality was 39% (45/117) for inappropriate empirical therapy vs. 28% (34/121) for appropriate empirical therapy (odds ratio (OR) 1.60; 95% CI 0.93-2.76). After adjustment for independent predictors for mortality and the propensity score, inappropriate empirical therapy was not associated with mortality (adjusted OR 1.39; 95% CI 0.62-3.15). In the matched case-control study (50 pairs), SAB-related mortality was 32% (16/50) for inappropriate empirical therapy and 28% (14/50) for appropriate empirical therapy (McNemar's test; p 0.85; OR 1.15; 95% CI 0.51-2.64). In conclusion, inappropriate empirical therapy resulted in only a slight tendency towards increased mortality in patients with SAB.

  20. Outcomes of Critical Limb Ischemia in an Urban, Safety Net Hospital Population with High WIfI Amputation Scores

    PubMed Central

    Ward, Robert; Dunn, Joie; Clavijo, Leonardo; Shavelle, David; Rowe, Vincent; Woo, Karen

    2017-01-01

    Background Patients presenting to a public hospital with critical limb ischemia (CLI) typically have advanced disease with significant comorbidities. The purpose of this study was to assess the influence of revascularization on 1-year amputation rate of CLI patients presenting to Los Angeles County USC Medical Center, classified according to the Society for Vascular Surgery Wound, Ischemia and foot Infection (WIfI). Methods A retrospective review of patients who presented to a public hospital with CLI from February 2010 to July 2014 was performed. Patients were classified according to the WIfI system. Only patients with complete data who survived at least 12 months after presentation were included. Results Ninety-three patients with 98 affected limbs were included. The mean age was 62.8 years. Eighty-two patients (84%) had hypertension and 71 (72%) had diabetes. Fifty (57.5%) limbs had Trans-Atlantic Inter-Society Consensus (TASC) C or D femoral–popliteal lesions and 82 (98%) had significant infrapopliteal disease. The majority had moderate or high WIfI amputation and revascularization scores. Eighty-four (86%) limbs underwent open, endovascular, or hybrid revascularization. Overall, one year major amputation (OYMA) rate was 26.5%. In limbs with high WIfI amputation score, the OYMA was 34.5%: 21.4% in those who were revascularized and 57% in those who were not. On univariable analysis, factors associated with increased risk of OYMA were nonrevascularization (P = 0.005), hyperlipidemia (P = 0.06), hemodialysis (P = 0.005), gangrene (P = 0.02), ulcer classification (P = 0.05), WIfI amputation score (P = 0.026), and WIfI wound grade (P = 0.04). On multivariable analysis, increasing WIfI amputation score (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.0–3.39) was associated with increased risk of OYMA while revascularization (OR 0.24, 95% CI 0.07–0.80) was associated with decreased risk of OYMA. Conclusions The OYMA rates in this population were consistent

  1. Outcomes of Critical Limb Ischemia in an Urban, Safety Net Hospital Population with High WIfI Amputation Scores.

    PubMed

    Ward, Robert; Dunn, Joie; Clavijo, Leonardo; Shavelle, David; Rowe, Vincent; Woo, Karen

    2017-01-01

    Patients presenting to a public hospital with critical limb ischemia (CLI) typically have advanced disease with significant comorbidities. The purpose of this study was to assess the influence of revascularization on 1-year amputation rate of CLI patients presenting to Los Angeles County USC Medical Center, classified according to the Society for Vascular Surgery Wound, Ischemia and foot Infection (WIfI). A retrospective review of patients who presented to a public hospital with CLI from February 2010 to July 2014 was performed. Patients were classified according to the WIfI system. Only patients with complete data who survived at least 12 months after presentation were included. Ninety-three patients with 98 affected limbs were included. The mean age was 62.8 years. Eighty-two patients (84%) had hypertension and 71 (72%) had diabetes. Fifty (57.5%) limbs had Trans-Atlantic Inter-Society Consensus (TASC) C or D femoral-popliteal lesions and 82 (98%) had significant infrapopliteal disease. The majority had moderate or high WIfI amputation and revascularization scores. Eighty-four (86%) limbs underwent open, endovascular, or hybrid revascularization. Overall, one year major amputation (OYMA) rate was 26.5%. In limbs with high WIfI amputation score, the OYMA was 34.5%: 21.4% in those who were revascularized and 57% in those who were not. On univariable analysis, factors associated with increased risk of OYMA were nonrevascularization (P = 0.005), hyperlipidemia (P = 0.06), hemodialysis (P = 0.005), gangrene (P = 0.02), ulcer classification (P = 0.05), WIfI amputation score (P = 0.026), and WIfI wound grade (P = 0.04). On multivariable analysis, increasing WIfI amputation score (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.0-3.39) was associated with increased risk of OYMA while revascularization (OR 0.24, 95% CI 0.07-0.80) was associated with decreased risk of OYMA. The OYMA rates in this population were consistent with those predicted by the

  2. Using Propensity Score Methods to Approximate Factorial Experimental Designs to Analyze the Relationship between Two Variables and an Outcome

    ERIC Educational Resources Information Center

    Dong, Nianbo

    2015-01-01

    Researchers have become increasingly interested in programs' main and interaction effects of two variables (A and B, e.g., two treatment variables or one treatment variable and one moderator) on outcomes. A challenge for estimating main and interaction effects is to eliminate selection bias across A-by-B groups. I introduce Rubin's causal model to…

  3. Altering School Progression through Delayed Entry or Kindergarten Retention: Propensity Score Analysis of Long-Term Outcomes

    ERIC Educational Resources Information Center

    Raffaele Mendez, Linda M.; Kim, Eun Sook; Ferron, John; Woods, Bonnie

    2015-01-01

    The authors examined long-term outcomes for children who experienced delayed entry to kindergarten or kindergarten retention. They used a cohort of 6,841 students to compare these groups to each other and typically progressing peers. First, the authors compared the groups on demographic and early childhood variables. For the long-term school-based…

  4. Altering School Progression through Delayed Entry or Kindergarten Retention: Propensity Score Analysis of Long-Term Outcomes

    ERIC Educational Resources Information Center

    Raffaele Mendez, Linda M.; Kim, Eun Sook; Ferron, John; Woods, Bonnie

    2015-01-01

    The authors examined long-term outcomes for children who experienced delayed entry to kindergarten or kindergarten retention. They used a cohort of 6,841 students to compare these groups to each other and typically progressing peers. First, the authors compared the groups on demographic and early childhood variables. For the long-term school-based…

  5. Using Propensity Score Methods to Approximate Factorial Experimental Designs to Analyze the Relationship between Two Variables and an Outcome

    ERIC Educational Resources Information Center

    Dong, Nianbo

    2015-01-01

    Researchers have become increasingly interested in programs' main and interaction effects of two variables (A and B, e.g., two treatment variables or one treatment variable and one moderator) on outcomes. A challenge for estimating main and interaction effects is to eliminate selection bias across A-by-B groups. I introduce Rubin's causal model to…

  6. Multipoint incremental motor unit number estimation versus amyotrophic lateral sclerosis functional rating scale and the medical research council sum score as an outcome measure in amyotrophic lateral sclerosis.

    PubMed

    Jagtap, Sujit Abajirao; Kuruvilla, Abraham; Govind, Preetha; Nair, Muralidharan D; Sarada, C; Varma, Ravi Prasad

    2014-07-01

    Monitoring the disease progression in amyotrophic lateral sclerosis (ALS) is a challenge due to different rates of progression between patients. Besides clinical methods to monitor disease progression, such as the ALS functional rating scale (ALSFRS) and the medical research council (MRC) sum score, quantitative methods like motor unit number estimation (MUNE) are of interest. The objective of the present study is to evaluate the rate of progression in ALS using multipoint incremental MUNE and to compare MUNE, ALSFRS and MRC sum score at baseline and at 6 months for progression of the disease. Multipoint incremental MUNE using median nerve, ALS-FRS and MRC sum score was carried out in 29 ALS patients at baseline and then at 6 months. Of the 29 ALS patients studied, the mean MUNE at baseline was 21.80 (standard deviation [SD]: 19.46, range 4-73), 15.9 in the spinal onset group (SD: 14.60) and 30.16 (SD: 22.89) in the bulbar onset group. Spinal onset patients had 74.02% of baseline MUNE value while bulbar onset patients had only 24.74% baseline value MUNE at 6 months follow-up (Unpaired t-test, P = 0.001). ALSFRS and MRC sum score showed statistically significant decline (P < 0.001) at 6 months follow-up. MUNE had the highest sensitivity for progression of the disease when compared to the ALS FRS and MRC sum score. Multipoint incremental MUNE is a valuable tool for outcome measure in ALS and other diseases characterized by motor unit loss. The rate of decline of multipoint incremental MUNE is more sensitive than that of MRC sum score and ALSFRS-R, when expressed as the percentage change from baseline.

  7. Characteristics and Behavioral Outcomes for Youth in Group Care and Family-Based Care: A Propensity Score Matching Approach Using National Data

    PubMed Central

    James, Sigrid; Roesch, Scott; Zhang, Jin Jin

    2013-01-01

    This study aimed to answer two questions: (a) Given expected differences in children who are placed in group care compared to those in family-based settings, is it possible to match children on baseline characteristics? (b) Are there differences in behavioral outcomes for youth with episodes in group care versus those in family-based care? Using data from the National Survey of Child and Adolescent Well-Being, the study sample included 1,191 children with episodes in out-of-home care (n = 254 youth with group care episodes; n = 937 youth with episodes in family-based care and no group care). Conditioning variables were identified, which distinguished between the two groups of youth. Using propensity score matching, all youth placed into group care were matched on the propensity score with family-based care youth. Behavioral outcomes at 36 months, as measured by the Child Behavior Checklist, were compared for the matched sample. Of the total 254 youth with group care episodes, 157 could be matched to youth with episodes in family-based care. No significant differences remained between the two groups in the matched sample, and findings revealed no significant differences in longitudinal behavioral outcomes. PMID:24273403

  8. Association of High Sensitive CRP Level and COPD Assessment Test Scores with Clinically Important Predictive Outcomes in Stable COPD Patients

    PubMed Central

    Ghobadi, Hassan; Beukaghazadeh, Katrin; Ansarin, Khalil

    2015-01-01

    Background: High sensitive CRP (hs-CRP) is used as a marker of systemic inflammation in chronic obstructive pulmonary disease (COPD). However, we hypothesize that the raised hs-CRP is not closely related to the multiple consequences of COPD. This study was undertaken to investigate the association of COPD assessment test (CAT) score with SpO2, FEV1, body mass index (BMI), obstruction, dyspnea and exercise capacity (BODE) index and COPD exacerbation rate and compare it with the association to serum hs-CRP level. Materials and Methods: Sixty patients with stable COPD referred to the pulmonology clinic of Ardabil Imam Khomeini Hospital were included in this study. SpO2, 6-minute walk distance (6MWD), body mass index, BODE index, and pulmonary function test as well as exacerbation rate were determined in COPD patients. Then, the CAT questionnaire was completed by patients. Serum level of hs-CRP was measured in all patients and 15 controls. We statistically compared the relationships and correlations among the variables. Results: Hs-CRP level was significantly raised in patients (P=0.005). In these patients, the correlation of hs-CRP level with BODE index was significant (P=0.008). However, the correlation of hs-CRP with SpO2 and FEV1 was not significant (P=0.47 and P=0.17, respectively). Also, the correlation of CAT score with SpO2, FEV1, BODE index, and exacerbation rate in the previous year was significant (P<0.001, P<0.001, P<0.001 and P=0.017, respectively). Conclusion: SpO2, FEV1, BODE index and exacerbation rate are more correlated with CAT scores than with the serum level of hs-CRP in stable COPD patients. The findings of this study should be considered in management of stable COPD patients. PMID:26221150

  9. Out-of-hospital births, U.S., 1978: birth weight and Apgar scores as measures of outcome.

    PubMed Central

    Declercq, E R

    1984-01-01

    An examination of 1978 natality data for the United States disclosed that low birth weight was less common among 30,819 infants born out of hospital than among 3,294,101 infants born in hospital in that year. When controls were applied for birth attendant, infants' race, and mothers' education, age, nativity, and parity, the data revealed that white, well-educated women between 25 and 39 years of age, who were having their second babies and were attended by midwives out of hospital, were at least risk of bearing low birth weight infants. The incidence rate of low birth weight babies was lower for midwife-attended births in every category examined. For college-educated white women, for example, the incidence rate was 2.0 percent among those attended by midwives, 4.6 percent among those giving birth in hospital, and 3.6 percent among those whose out-of-hospital deliveries were attended by physicians. Apgar scores for babies born both in and out of hospital were also studied but, because of inconsistent reporting, were given less attention. Excellent (9-10) Apgar scores were more common among babies born out of hospital than among those born in hospital (63 percent compared with 49 percent), particularly for out-of-hospital births attended by physicians. At least with respect to birth weight and Apgar scores, the claim that out-of-hospital births are inherently more dangerous than hospital births receives no support from these data. The findings also suggest the need for further refinement of vital statistics categories to permit the analysis of distinctions between births attended by certified nurse-midwives and those attended by lay midwives, as well as differences between births at home and those in alternative birth centers. PMID:6422497

  10. Organ dysfunction as estimated by the sequential organ failure assessment score is related to outcome in critically ill burn patients.

    PubMed

    Lorente, José A; Vallejo, Alfonso; Galeiras, Rita; Tómicic, Vinko; Zamora, Javier; Cerdá, Enrique; de la Cal, Miguel A; Esteban, Andrés

    2009-02-01

    The objectives of the study were to assess organ dysfunction in burn patients by using the Sequential Organ Failure Assessment (SOFA) score, to determine the relationship between early (day 1) and late (day 4) organ dysfunction, as well as the change in organ dysfunction from admission to day 4, and mortality. The design was a prospective observational cohort study. Patients were admitted to our intensive care burn unit with severe thermal burns (> or =20% total body surface area [BSA] burned) or inhalation injury with a delay from injury to admission less than 12 h and a length of stay less than 3 days (n = 439; age, 46.0 +/- 20.3 yrs; total BSA burned, 31.6% +/- 20.2% [mean +/- SD]; inhalation injury, 44.4%; crude mortality, 18.5%). Sequential Organ Failure Assessment scores were measured on admission (SOFA 0) and on subsequent days (SOFA 1, SOFA 2, SOFA 3, and SOFA 4). The difference between SOFA 0 and SOFA 4 (DeltaSOFA 0-4) was calculated. Multivariate logistic regression analyses, including other variables associated with mortality in the models, were performed to calculate adjusted odds ratios (ORs) of organ dysfunction measurements for mortality. After adjusting for age, BSA burned, diagnosis of inhalation injury, and sex, SOFA 1 (OR, 1.89; 95% confidence interval [CI], 1.55-2.32), SOFA 4 (OR, 1.33; 95% CI, 1.19-1.47), and DeltaSOFA 0-4 (OR, 1.40; 95% CI, 1.28-1.55) were independently associated with mortality. The SOFA score is useful to assess organ dysfunction in burn patients. Burn-induced organ dysfunction (early and late), as well as the change in organ dysfunction, is independently associated with mortality.

  11. External validation of the APPS, a new and simple outcome prediction score in patients with the acute respiratory distress syndrome.

    PubMed

    Bos, Lieuwe D; Schouten, Laura R; Cremer, Olaf L; Ong, David S Y; Schultz, Marcus J

    2016-12-01

    A recently developed prediction score based on age, arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2) and plateau pressure (abbreviated as 'APPS') was shown to accurately predict mortality in patients diagnosed with the acute respiratory distress syndrome (ARDS). After thorough temporal external validation of the APPS, we tested the spatial external validity in a cohort of ARDS patients recruited during 3 years in two hospitals in the Netherlands. Consecutive patients with moderate or severe ARDS according to the Berlin definition were included in this observational multicenter cohort study from the mixed medical-surgical ICUs of two university hospitals. The APPS was calculated per patient with the maximal airway pressure instead of the plateau pressure as all patients were ventilated in pressure-controlled mode. The predictive accuracy for hospital mortality was evaluated by calculating the area under the receiver operating characteristics curve (AUC-ROC). Additionally, the score was recalibrated and reassessed. In total, 439 patients with moderate or severe ARDS were analyzed. All-cause hospital mortality was 43 %. The APPS predicted all-cause hospital mortality with moderate accuracy, with an AUC-ROC of 0.62 [95 % confidence interval (CI) 0.56-0.67]. Calibration was moderate using the original cutoff values (Hosmer-Lemeshow goodness of fit P < 0.001), and recalibration was performed for the cutoff value for age and plateau pressure. This resulted in good calibration (P = 1.0), but predictive accuracy did not improve (AUC-ROC 0.63, 95 % CI 0.58-0.68). The predictive accuracy for all-cause hospital mortality of the APPS was moderate, also after recalibration of the score, and thus the APPS does not seem to be fitted for that purpose. The APPS might serve as simple tool for stratification of mortality in patients with moderate or severe ARDS. Without recalibrations, the performance of the APPS was moderate and we should

  12. Comparison of surgical outcome and the systemic inflammatory response syndrome score between retroperitoneoscopic hand-assisted nephroureterectomy and open nephroureterectomy.

    PubMed

    Sato, Yoshikazu; Nanbu, Akihito; Tanda, Hitoshi; Kato, Shuji; Onishi, Shigeki; Nakajima, Hisao; Nitta, Toshikazu; Koroku, Mikio; Akagashi, Keigo; Hanzawa, Tatsuo

    2006-12-01

    The goal of this study is to compare surgical and oncological outcomes of laparoscopic nephroureterectomy and the open surgery using the concept of systemic inflammatory response syndrome (SIRS) in addition to common variables. Thirty-six and 23 patients having upper urinary tract urothelial cancer who were operated on with retroperitoneoscopic hand-assisted nephroureterectomy (RHANU) or standard open nephroureterectomy (ONU) retrospectively, were analyzed. Median operation time was 140 (range 70-200) and 60 (range 45-85) minutes, respectively in the RHANU group and the ONU group. The median days to ambulation and hospital stay of the RHANU group were significantly shorter than those of the ONU group. There was no significant difference in the incidence of SIRS and other surgical results between the two groups. In oncological outcome, no significant difference was found in the bladder recurrence rate (RHANU vs. ONU; 52% vs. 45%), local recurrence (0% vs. 0%), distant metastasis (11% vs. 13%) or survival rate (94% vs. 91%) between the RHANU group and the ONU group at 2-year follow-up. There was no port site recurrence in the RHANU group. Although the RHANU may have an advantage in terms of earlier recovery, there were no significant differences in the incidence of SIRS and oncological outcomes between the RHANU group and the ONU group.

  13. Guy's Stone Score (GSS) Based on Intravenous Pyelogram (IVP) Findings Predicting Upper Pole Access Percutaneous Nephrolithotomy (PCNL) Outcomes

    PubMed Central

    Rod-Ong, Pattara; Kitirattrakarn, Pruit; Chongruksut, Wilaiwan

    2016-01-01

    Objective. To predict the success rate and complications following percutaneous nephrolithotomy via the upper pole using the Guy's Stone Score (GSS) based on the findings of a preoperative intravenous pyelogram (IVP). Patients and Methods. Two hundred and twenty-seven renal operations, which were carried out using PCNL via the upper pole, were classified according to the GSS assigned. Any complications were classified according to the Clavien classification. The success rates and incidence of any complications were compared between each GSS. Results. The immediate success rates were 87.50% of GSS1, 71.43% of GSS2, 53.62% of GSS3, and 38.46% of GSS4, P < 0.01. There were statistically significant differences between the groups in stone size, overall immediate success rate, operative time, number of access tracts, and frequency of tubeless PCNL. Major complications (a Clavien score of 3–5) were significantly higher in the cases with a higher GSS. Conclusion. A GSS based on an IVP is a simple and reliable tool in predicting the success rate and possible complications following upper pole access PCNL. PMID:28003822

  14. The relationship of newborn adiposity to fetal growth outcome based on birth weight or the modified neonatal growth assessment score

    PubMed Central

    Lee, W; Riggs, T; Koo, W; Deter, RL; Yeo, L; Romero, R

    2013-01-01

    Objectives (1) Develop reference ranges of neonatal adiposity using air displacement plethysmography. (2) Use new reference ranges for neonatal adiposity to compare two different methods of evaluating neonatal nutritional status. Methods Three hundred and twenty-four normal neonates (35–41 weeks post-menstrual age) had body fat (%BF) and total fat mass (FM, g) measured using air displacement plethysmography shortly after delivery. Results were stratified for 92 of these neonates with corresponding fetal biometry using two methods for classifying nutritional status: (1) population-based weight percentiles; and (2) a modified neonatal growth assessment score (m3NGAS51). Results At the 50th percentile, &BF varied from 7.7% (35 weeks) to 11.8% (41 weeks), while the corresponding 50th percentiles for total FM were 186–436g. Among the subset of 92 neonates, no significant differences in adiposity were found between small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA) groups using population-based weight standards. Classification of the same neonates using m3NGAS51 showed significant differences in mean %BF between corresponding groups. Conclusions Population-based weight criteria for neonatal nutritional status can lead to misclassification on the basis of adiposity. A neonatal growth assessment score, that considers the growth potential of several anatomic parameters, appears to more effectively classify under-and over-nourished newborns. PMID:22494346

  15. The Correlation of Serum Metal Ions with Functional Outcome Scores at Three-to-Six Years following Large Head Metal-on-Metal Hip Arthroplasty

    PubMed Central

    Patange Subbarao, Sheethal Prasad; Malek, Ibrahim A.; Mohanty, Khitish; Thomas, Phillip; John, Alun

    2013-01-01

    Based on success of hip resurfacing, large head Metal on Metal (MoM) hip arthroplasty has gained significant popularity in recent years. There are growing concerns about metal ions related soft tissue abnormalities. The aim of this study was to define a correlation of metal ions with various functional outcome scores following large head MoM hip arthroplasty. Consecutive cohort of 70 patients (76 hips) with large head MoM hip arthroplasty using SL-Plus femoral stem and Cormet acetabular component were prospectively followed up. An independent observer assessed the patients which included serology for metal ion levels and collection of Oxford Hip, Harris hip, WOMAC, SF-36 & modified UCLA scores. Median serum cobalt and chromium levels were 3.10 μg/L (0.35–62.92) and 4.21 μg/L (0.73–69.27) with total of median 7.30 μg/L (2.38–132.19). The median Oxford, Harris, WOMAC, SF-36 and modified UCLA scores were 36 (6–48), 87 (21–100), 36 (24–110), 104 (10–125), and 3 (1–9), respectively. Seventeen patients had elevated serum cobalt and chromium levels ≥7 μg/L. There was no significant correlation between serum metal ion levels with any of these outcome scores. We recommend extreme caution during follow up of these patients with large head MoM arthroplasty. PMID:24959353

  16. Prognostic Value of the Clinical SYNTAX Score on 2-Year Outcomes in Patients With Acute Coronary Syndrome Who Underwent Percutaneous Coronary Intervention.

    PubMed

    He, Chen; Song, Ying; Wang, Chuang-Shi; Yao, Yi; Tang, Xiao-Fang; Zhao, Xue-Yan; Gao, Run-Lin; Yang, Yue-Jin; Xu, Bo; Yuan, Jin-Qing

    2017-03-01

    This prospective, single-center, observational study evaluated prognostic value of clinical SYNTAX score (CSS) on 2-year outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). The SYNTAX score (SS) is a scoring system based on the complexity and severity of coronary lesions and is thought to be a prognostic tool to predict long-term outcomes. However, SS was a sole angiographic grading tool only with no consideration for clinical factors. There are few studies investigating the prognostic value of CSS in patients with ACS who underwent PCI. From January 2013 to December 2013, 6,099 consecutive patients with ACS admitted to FuWai hospital and underwent PCI were enrolled in this study. Based on CSS, patients were divided into low CSS group (CSS ≤ 6.5; 2,012 patients), mid-CSS group (6.5 < CSS < 13.8; 2,056 patients), and high CSS group (CSS ≥ 13.8; 2,031 patients). At 2-year follow-up, rates of cardiac death and major adverse cardiac events (MACE) were significantly higher in the high CSS group. Compared with baseline SS, CSS demonstrated significantly improved performance for 2-year cardiac death (receiver-operating characteristic curve C-statistic: 0.74 vs 0.62, p <0.001) but not for MACE (receiver-operating characteristic curve C-statistic: 0.60 vs 0.59, p = 0.29). By multivariable analysis, the CSS combined with PCI history and hypertension were strong predictors for cardiac death and CSS, intra-aortic balloon pump support, diabetes, and successful PCI were independent predictors for MACE. In conclusion, compared with the anatomic SS, CSS was suitable in risk stratifying and predicting 2-year clinical outcome among ACS population.

  17. Combination of liver biopsy with MELD-XI scores for post-transplant outcome prediction in patients with advanced heart failure and suspected liver dysfunction.

    PubMed

    Farr, Maryjane; Mitchell, James; Lippel, Matthew; Kato, Tomoko S; Jin, Zhezhen; Ippolito, Paul; Dove, Lorna; Jorde, Ulrich P; Takayama, Hiroo; Emond, Jean; Naka, Yoshifumi; Mancini, Donna; Lefkowitch, Jay H; Schulze, P Christian

    2015-07-01

    Functional and structural liver abnormalities may be found in patients with advanced heart failure (HF). The Model of End-Stage Liver Disease Excluding INR (MELD-XI) score allows functional risk stratification of HF patients on and off anti-coagulation awaiting heart transplantation (HTx), but these scores may improve or worsen depending on bridging therapies and during time on the waiting list. Liver biopsy is sometimes performed to assess for severity of fibrosis. Uncertainty remains whether biopsy in addition to MELD-XI improves prediction of adverse outcomes in patients evaluated for HTx. Sixty-eight patients suspected of advanced liver disease underwent liver biopsy as part of their HTx evaluation. A liver risk score (fibrosis-on-biopsy + 1) × MELD-XI was generated for each patient. Fifty-two patients were listed, of whom 14 had mechanical circulatory support (MCS). Thirty-six patients underwent transplantation and 27 patients survived ≥1 year post-HTx (74%, as compared with 88% average 1-year survival in HTx patients without suspected liver disease; p < 0.01). Survivors had a lower liver risk score at evaluation for HTx (31.0 ± 20.4 vs 65.2 ± 28.6, p < 0.01). A cut-point of 45 for liver risk score was identified by receiver-operating-characteristic (ROC) analysis. In the analysis using Cox proportional hazards models, a liver risk score ≥45 at evaluation for HTx was associated with greater risk of death at 1 year post-HTx compared with a score of <45 in both univariable (HR 3.94, 95% CI 1.77-8.79, p < 0.001) and multivariable (HR 4.35, 95% CI 1.77-8.79, p < 0.001) analyses. Patients who died <1 year post-HTx had an increased frequency of acute graft dysfunction (44.4% vs 3.7%, p = 0.009), longer ventilation times (55.6% vs 11.1%, p = 0.013) and severe bleeding events (44.4% vs 11.1%, p = 0.049). The liver risk score at evaluation for HTx also predicted 1-year mortality after HTx listing (p < 0.001). Patients with HF and advanced liver dysfunction are

  18. Influence of Cobb Angle and ISIS2 Surface Topography Volumetric Asymmetry on Scoliosis Research Society-22 Outcome Scores in Scoliosis.

    PubMed

    Brewer, Paul; Berryman, Fiona; Baker, De; Pynsent, Paul; Gardner, Adrian

    2013-11-01

    Retrospective sequential patient series. To establish the relationship between the magnitude of the deformity in scoliosis and patients' perception of their condition, as measured with Scoliosis Research Society-22 scores. A total of 93 untreated patients with adolescent idiopathic scoliosis were included retrospectively. The Cobb angle was measured from a plain radiograph, and volumetric asymmetry was measured by ISIS2 surface topography. The association between Scoliosis Research Society scores for function, pain, self-image, and mental health against Cobb angle and volumetric asymmetry was investigated using the Pearson correlation coefficient. Correlation of both Cobb angle and volumetric asymmetry with function and pain was weak (all < .23); these correlation values were not statistically significant. Correlation of Cobb angle and volumetric asymmetry with self-image, was higher, although still moderate (-.37 for Cobb angle and -.44 for volumetric asymmetry). Both were statistically significant (Cobb angle, p = .0002; volumetric asymmetry; p = .00001). Cobb angle contributed 13.8% to the linear relationship with self-image, whereas volumetric asymmetry contributed 19.3%. For mental health, correlation was statistically significant with Cobb angle (p = .011) and volumetric asymmetry (p = .0005), but the correlation was low to moderate (-.26 and -.35, respectively). Cobb angle contributed 6.9% to the linear relationship with mental health, whereas volumetric asymmetry contributed 12.4%. Volumetric asymmetry correlates better with both mental health and self-image compared with Cobb angle, but the correlation was only moderate. This study suggests that a patient's own perception of self-image and mental health is multifactorial and not completely explained through present objective measurements of the size of the deformity. This helps to explain the difficulties in any objective analysis of a problem with multifactorial perception issues. Further study is

  19. Care Needs and Clinical Outcomes of Older People with Dementia: A Population-Based Propensity Score-Matched Cohort Study

    PubMed Central

    Hsiao, Fei-Yuan; Peng, Li-Ning; Wen, Yu-Wen; Liang, Chih-Kuang; Wang, Pei-Ning; Chen, Liang-Kung

    2015-01-01

    Objective To explore the healthcare resource utilization, psychotropic drug use and mortality of older people with dementia. Design A nationwide propensity score-matched cohort study. Setting National Health Insurance Research database. Participants A total of 32,649 elderly people with dementia and their propensity-score matched controls (n=32,649). Measurements Outpatient visits, inpatient care, psychotropic drug use, in-hospital mortality and all-cause mortality at 90 and 365 days. Results Compared to the non-dementia group, a higher proportion of patients with dementia used inpatient services (1 year after index date: 20.91% vs. 9.55%), and the dementia group had more outpatient visits (median [standard deviation]: 7.00 [8.87] vs. 3.00 [8.30]). Furthermore, dementia cases with acute admission had the highest psychotropic drug utilization both at baseline and at the post-index dates (difference-in-differences: all <0.001). Dementia was associated with an increased risk of all-cause mortality (90 days, Odds ratio (OR)=1.85 [95%CI 1.67-2.05], p<0.001; 365 days, OR=1.59 [1.50-1.69], p<0.001) and in-hospital mortality (90 days, OR=1.97 [1.71-2.27], p<0.001; 365 days, OR=1.82 [1.61-2.05], p<0.001) compared to matched controls. Conclusions When older people with dementia are admitted for acute illnesses, they may increase their use of psychotropic agents and their risk of death, particularly in-hospital mortality. PMID:25955163

  20. A laboratory score at presentation to rule-out serious cardiac outcomes or death in patients presenting with symptoms suggestive of acute coronary syndrome.

    PubMed

    Kavsak, Peter A; Shortt, Colleen; Ma, Jinhui; Clayton, Natasha; Sherbino, Jonathan; Hill, Stephen A; McQueen, Matthew; Mehta, Shamir R; Devereaux, P J; Worster, Andrew

    2017-06-01

    We evaluated whether a low high-sensitivity cardiac troponin (hs-cTn) cutoff combined with glucose, red cell distribution width (RDW), and the estimated glomerular filtration rate (eGFR) can be used to rule-out a serious cardiac outcome or death in patients presenting with symptoms suggestive of acute coronary syndrome (ACS). This was a prospective observational emergency department (ED) study enrolling consecutive patients presenting with symptoms suggestive of ACS (ClinicalTrials.gov: NCT01994577). The primary outcome was a 7-day composite of myocardial infarction, unstable angina, decompensated congestive heart failure, serious ventricular cardiac arrhythmia, or death. A laboratory score combining glucose, RDW, eGFR with hs-cTnT (Roche) or hs-cTnI (Abbott) was compared to hs-cTn alone using the limit of detection (LoD; hs-cTnT<5ng/l/hs-cTnI<2ng/l) as the cutoff. A benchmark of >99% sensitivity was used to assess the laboratory panel with hs-cTn versus the LoD alone to identify low-risk patients suitable for discharge. A total of 1095 patients (n=267 composite-outcomes) had measurements of glucose, RDW, eGFR, hs-cTnT, and hs-cTnI at presentation. Applying the hs-cTn LoD alone as the cutoff missed 5 composite-outcomes (sensitivity=98.1%), however the addition of the laboratory panel to the hs-cTn LoD increased the sensitivity to >99% with approximately 10% of the population identified as low-risk. The percentage of low-risk patients was increased to 15% (1 composite-outcome missed) when employing a low measurable hs-cTnI cutoff with the laboratory panel (laboratory score<2 points). A laboratory score with hs-cTn may identify low-risk patients suitable for ED discharge at presentation. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Outcomes After Cryoablation Versus Partial Nephrectomy for Sporadic Renal Tumors in a Solitary Kidney: A Propensity Score Analysis.

    PubMed

    Bhindi, Bimal; Mason, Ross J; Haddad, Mustafa M; Boorjian, Stephen A; Leibovich, Bradley C; Atwell, Thomas D; Weisbrod, Adam J; Schmit, Grant D; Thompson, R Houston

    2017-09-26

    While partial nephrectomy (PN) is considered the standard approach for a tumor in a solitary kidney, percutaneous cryoablation (PCA) is emerging as an alternative nephron-sparing option. To compare outcomes between PCA and PN for tumors in a solitary kidney. Patients who underwent PCA or PN between 2005 and 2015 for a single primary renal tumor in a solitary kidney were identified using Mayo Clinic Registries. Exclusion criteria were inherited tumor syndromes and salvage procedures. PCA and PN. To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. The risk of having a post-treatment complication and percent drop in estimated glomerular filtration rate (eGFR), as well as the risks of local/ipsilateral recurrence, distant metastasis, and cancer-specific mortality, were compared between groups using logistic, linear, and Fine-and-Gray competing risk regression models. The cohort included 118 patients (PCA: 54; PN: 64) with a median follow-up of 47 mo (interquartile range 18, 74). In unadjusted analyses, PCA was associated with a lower risk of complications (15% vs 31%; odds ratio [OR]=0.38; 95% confidence interval [CI] 0.15, 0.96; p=0.04). However, upon accounting for baseline differences with IPTW adjustment, there was no longer a significant difference in the risk of complications (28% vs 29%; OR=0.95; 95% CI 0.53, 1.69; p=0.9). There were no significant differences between PCA and PN in percentage drop in eGFR at discharge (mean: 11% vs 16%; β=-5%; 95% CI -13, 3; p=0.2) or at 3 mo (12% vs 9%; β=3%; 95% CI -3, 10; p=0.3). Likewise, no significant differences were noted in local recurrence (HR=0.87; 95% CI 0.38, 1.98; p=0.7), distant metastases (HR=0.60; 95% CI 0.30, 1.20; p=0.2), or cancer-specific mortality (HR=1.13; 95% CI 0.32, 3.98; p=0.8). Limitations include the sample size, given the relative rarity of renal masses in solitary kidneys. Our study found no

  2. The sphericity deviation score: a quantitative radiologic outcome measure of Legg-Calvé Perthes disease applicable at the stage of healing and at skeletal maturity.

    PubMed

    Siddesh, Nandi D; Shah, Hitesh; Tercier, Stéphane; Pai, Harish; Nair, Sreekumaran; Joseph, Benjamin

    2014-01-01

    This study aimed to determine if a new measure of sphericity of the femoral head, the Sphericity Deviation Score (SDS), could be estimated reliably at the stage of healing of Legg-Calvé-Perthes disease (LCPD) and to determine if the SDS at the healing stage reflects the outcome at skeletal maturity. The SDS was measured with image analysis software on radiographs of 120 children with unilateral LCPD at healing of the disease and at skeletal maturity. The reproducibility of measurement was assessed. SDS values for hips in different Stulberg classes were calculated. On the basis of SDS values at healing of 82 children, a logistic regression model was developed to determine the probability of a good outcome at skeletal maturity. The validity of the model was tested on another 38 children. The SDS values at the stage of healing and at skeletal maturity were comparable. The SDS values were lowest for Stulberg Class I hips and highest for Class IV and V hips. The validated regression model showed a very high probability of a good outcome (Stulberg Class I or II) at skeletal maturity if the SDS at the stage of healing was below 10. A reliable estimate of the outcome of LCPD at skeletal maturity can be made by computing the SDS as soon as the disease heals.

  3. The 'Lumbar Fusion Outcome Score' (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain.

    PubMed

    Mattei, Tobias A; Rehman, Azeem A; Teles, Alisson R; Aldag, Jean C; Dinh, Dzung H; McCall, Todd D

    2017-01-01

    In order to evaluate the predictive effect of non-invasive preoperative imaging methods on surgical outcomes of lumbar fusion for patients with degenerative disc disease (DDD) and refractory chronic axial low back pain (LBP), the authors conducted a retrospective review of 45 patients with DDD and refractory LBP submitted to anterior lumbar interbody fusion (ALIF) at a single center from 2007 to 2010. Surgical outcomes - as measured by Visual Analog Scale (VAS/back pain) and Oswestry Disability Index (ODI) - were evaluated pre-operatively and at 6 weeks, 3 months, 6 months, and 1 year post-operatively. Linear mixed-effects models were generated in order to identify possible preoperative imaging characteristics (including bone scan/99mTc scintigraphy increased endplate uptake, Modic endplate changes, and disc degeneration graded according to Pfirrmann classification) which may be predictive of long-term surgical outcomes . After controlling for confounders, a combined score, the Lumbar Fusion Outcome Score (LUFOS), was developed. The LUFOS grading system was able to stratify patients in two general groups (Non-surgical: LUFOS 0 and 1; Surgical: LUFOS 2 and 3) that presented significantly different surgical outcomes in terms of estimated marginal means of VAS/back pain (p = 0.001) and ODI (p = 0.006) beginning at 3 months and continuing up to 1 year of follow-up. In conclusion,  LUFOS has been devised as a new practical and surgically oriented grading system based on simple key parameters from non-invasive preoperative imaging exams (magnetic resonance imaging/MRI and bone scan/99mTc scintigraphy) which has been shown to be highly predictive of surgical outcomes of patients undergoing lumbar fusion for treatment for refractory chronic axial LBP.

  4. Unexplained Pain Post Total Knee Arthroplasty With an Oxford Knee Score ≥20 at 6 Months Predicts Good 2-Year Outcome.

    PubMed

    Seah, Renyi Benjamin; Lim, Winston Shang Rong; Lo, Ngai Nung; Yew, Andy Khye Soo; Chong, Hwei Chi; Yeo, Seng Jin

    2017-03-01

    Total knee arthroplasty (TKA) is an effective procedure for end-stage osteoarthritis of the knee. Some patients experience persistent unexplained pain post-TKA despite normal investigations. The purpose of this study is to identify which of these patients are likely to improve without any surgical intervention. We hypothesize that patients with unexplained persistent pain and a poor 6-month Oxford knee score (OKS) post-TKA can improve at 2 years. Prospectively collected data for all primary unilateral TKA performed from June 2004 to January 2012 were analyzed to identify which patients with unexplained pain at 6 months will improve at 2 years. Patients were included if they had persistent pain and an OKS <27 at 6 months; normal radiological and clinical investigations; no infection identified; surgery performed for primary osteoarthritis. Two hundred sixty patients with OKS <27 at 6 months were analyzed. These patients were subdivided into 2 groups (group 1: 6-month OKS 20-26, group 2: 6-month OKS less than 20). One hundred ninety-one out of 208 (92%) patients in group 1 experienced improvement in pain and outcome at 2 years. Most of the group 1 patients attained a minimal clinically important difference in OKS of at least 5 (P < .001) at 2 years. Group 1 patients also reported better Knee Society Functional Score and Short Form Survey 36 mean scores at 2 years. In patients with unexplained pain, an OKS of at least 20 at 6 months predicts good functional outcome at 2 years. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Distal third humeri fractures treated using the Synthes™ 3.5-mm extra-articular distal humeral locking compression plate: clinical, radiographic and patient outcome scores.

    PubMed

    Fawi, Hassan; Lewis, James; Rao, Prasad; Parfitt, Dan; Mohanty, Khitish; Ghandour, Adel

    2015-04-01

    Conventional management protocols for distal humeral extra-articular fractures (e.g. conservative, double columnar plating) are often associated with complications. We aimed to describe our experience of using the Synthes™ 3.5-mm extra-articular distal humeral locking compression plate for treatment of extra-articular distal humeral fractures. We prospectively studied 23 consecutive patients who underwent fixation, in a tertiary trauma centre, over 2 years. Data, including patient demographics, duration of follow-up, patient satisfaction, visual analogue score (VAS), Oxford Elbow Score, and final outcome on discharge, were collected and analyzed. Of the 23 patients (12 males, 11 females; mean age 47.5 years; range 18 years to 89 years), all fractures united radiologically and clinically after the index procedure, with a mean time to fracture union of 15.7 weeks (range 9 weeks to 34 weeks) and a mean time to discharge of 17.8 weeks (range 13 weeks to 34 weeks). Oxford Elbow Score was 36.5 (range 11 to 48) at 4.6 months postoperatively; at 20 months follow-up, it was 40 (range 14 to 48) and the VAS was 8.5 (range 5 to 10). One patient had radial nerve neuropraxia pre-operatively, and one postoperatively, and both recovered uneventfully 3 months postoperatively. Neither superficial, nor deep infections were observed in this cohort. The present study reports satisfactory outcome with the usage of the Synthes plate for extra-articular fracture management. It has become the technique of choice in our centre because it provides excellent results.

  6. Long-term prediction of functional outcome after stroke using the Alberta Stroke Program Early Computed Tomography Score in the subacute stage.

    PubMed

    Alexander, Lisa D; Pettersen, Jacqueline A; Hopyan, Julia J; Sahlas, Demetrios J; Black, Sandra E

    2012-11-01

    Stroke patients who arrive at hospital more than 24 hours after symptom onset could benefit from a simple means of assessing long-term prognosis in this subacute stage. We evaluated whether clinical factors along with ischemic injury assessed subacutely using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) had predictive value for functional independence after stroke. Computed tomography (CT) scans obtained ≥ 2 days after first-ever ischemic stroke were scored independently and retrospectively by 3 stroke neurologists using the ASPECTS. Functional outcome was measured using the Functional Independence Measure, which assesses the amount of caregiver assistance required by patients during daily activities. Multiple linear regression was used to develop a predictive model for functional prognosis at 1 month, 3 months, and 1 year poststroke. For our 55 patients, CT scanning was done on average 4 days poststroke. The interrater agreement for subacute ASPECTS was excellent, with a κ-weighted value of 0.90. Lesions involving the frontal and superior parietal ASPECTS regions were significant predictors of lower Functional Independence Measure scores at all 3 time points studied. In combination with such factors as age, marital status, and the severity of initial neurologic deficit, a subacute ASPECTS score >5 had significant predictive value for greater functional independence at 3 months (R(2) = 0.701; P < .001) and 1 year (R(2) = 0.528; P < .001) poststroke. Our data indicate that in the subacute stage, ASPECTS is reliable and can help predict which patients may be likely to regain functional independence up to 1 year after sustaining ischemic stroke. Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Is chronic kidney disease an adverse factor in lung cancer clinical outcome? A propensity score matching study

    PubMed Central

    Lu, Ming‐Shian; Chen, Miao‐Fen; Lin, Chien‐Chao; Tseng, Yuan‐Hsi; Huang, Yao‐Kuang; Liu, Hui‐Ping

    2017-01-01

    Background Comorbidity has a great impact on lung cancer survival. Renal function status may affect treatment decisions and drug toxicity. The survival outcome in lung cancer patients with coexisting chronic kidney disease (CKD) has not been fully evaluated. We hypothesized that CKD is an independent risk factor for mortality in patients with lung cancer. Methods A retrospective, propensity‐matched study of 434 patients diagnosed between June 2004 and May 2012 was conducted. CKD was defined as estimated glomerular filtration rate <60 mL/minute. Lung cancer and coexisting CKD patients were matched 1:1 to patients with lung cancer without CKD. Results Age, gender, smoking status, histology, and lung cancer stage were not statistically significantly different between the CKD and non‐CKD groups. Kaplan–Meier survival analysis demonstrated a median survival of 7.26 months (95% confidence interval [CI] 6.06–8.46) in the CKD group compared with 7.82 months (95% CI 6.33–9.30) in the non‐CKD group (P = 0.41). Lung cancer stage‐specific survival is not affected by CKD. Although lung cancer patients with CKD presented with an increased risk of death of 6%, this result was not statistically significant (hazard ratio 1.06, 95% CI 0.93–1.22; P = 0.41). Conclusion According to our limited experience, CKD is not an independent risk factor for survival in lung cancer patients. Clinicians should not be discouraged to treat lung cancer patients with CKD. PMID:28207203

  8. Is chronic kidney disease an adverse factor in lung cancer clinical outcome? A propensity score matching study.

    PubMed

    Lu, Ming-Shian; Chen, Miao-Fen; Lin, Chien-Chao; Tseng, Yuan-Hsi; Huang, Yao-Kuang; Liu, Hui-Ping; Tsai, Ying-Huang

    2017-03-01

    Comorbidity has a great impact on lung cancer survival. Renal function status may affect treatment decisions and drug toxicity. The survival outcome in lung cancer patients with coexisting chronic kidney disease (CKD) has not been fully evaluated. We hypothesized that CKD is an independent risk factor for mortality in patients with lung cancer. A retrospective, propensity-matched study of 434 patients diagnosed between June 2004 and May 2012 was conducted. CKD was defined as estimated glomerular filtration rate <60 mL/minute. Lung cancer and coexisting CKD patients were matched 1:1 to patients with lung cancer without CKD. Age, gender, smoking status, histology, and lung cancer stage were not statistically significantly different between the CKD and non-CKD groups. Kaplan-Meier survival analysis demonstrated a median survival of 7.26 months (95% confidence interval [CI] 6.06-8.46) in the CKD group compared with 7.82 months (95% CI 6.33-9.30) in the non-CKD group (P = 0.41). Lung cancer stage-specific survival is not affected by CKD. Although lung cancer patients with CKD presented with an increased risk of death of 6%, this result was not statistically significant (hazard ratio 1.06, 95% CI 0.93-1.22; P = 0.41). According to our limited experience, CKD is not an independent risk factor for survival in lung cancer patients. Clinicians should not be discouraged to treat lung cancer patients with CKD. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

  9. Review of gunshot injuries in cats and dogs and utility of a triage scoring system to predict short-term outcome: 37 cases (2003-2008).

    PubMed

    Olsen, Lisa E; Streeter, Elizabeth M; DeCook, Rhonda R

    2014-10-15

    To describe the signalment, wound characteristics, and treatment of gunshot injuries in cats and dogs in urban and rural environments, and to evaluate the utility of the animal trauma triage (ATT) score as an early predictor of survival to discharge from the hospital. Retrospective case series. 29 dogs and 8 cats. Medical records of cats and dogs evaluated for gunshot wounds from 2003 and 2008 at a private urban referral practice in Cedar Rapids, Iowa, and an urban veterinary teaching hospital in Ames, Iowa, were reviewed. Information collected included signalment, chief reason for evaluation, circumstance of the injury, general physical examination findings, wound characteristics, treatments provided, cost of care, survival to discharge from the hospital (yes vs no), and duration of hospital stay. For each animal, ATT scores were calculated and evaluated as a prognostic tool. 37 animals met study inclusion criteria. Animals with higher ATT scores had a greater likelihood of poor outcome following gunshot injury. Animals with higher ATT scores, classified as low (< 4.5) or high (> 4.5), were found to have a longer duration of stay, classified as zero (0 days), short (1 to 3 days), or long (> 3 days). Young male dogs generally considered working breeds were overrepresented (29/37 [78.4%]). A preference for low-velocity, low-kinetic-energy firearms was identified (19/37 [52%]). The most numerous wounds were those inflicted to the limbs (12/37 [32.4%]), during low-visibility hours or hunting excursions. Calculated ATT scores on admission were higher in animals requiring blood products or surgical procedures and in nonsurvivors. Results of the present study suggested that regional preferences in breed ownership and firearm choice are responsible for variation in gunshot injury characteristics and management in animals sustaining injuries in rural and urban settings in Iowa. In cats and dogs, calculation of an ATT score may provide a useful predictor of the need for

  10. Testing for Plausibly Causal Links Between Parental Bereavement and Child Socio-Emotional and Academic Outcomes: A Propensity-Score Matching Model.

    PubMed

    Williams, Leslie D; Aber, J Lawrence

    2016-05-01

    The extant literature on parentally bereaved children has focused almost exclusively on the presence of negative mental health and socio-emotional outcomes among these children. However, findings from this literature have been equivocal. While some authors have found support for the presence of higher levels of internalizing and externalizing problems or mental health problems among this population, others have not found such a relationship. Additionally, study designs in this body of literature have limited both the internal and external validity of the research on parentally bereaved children. The present study seeks to address these issues of internal and external validity by utilizing propensity-score matching analyses to make plausibly causal inferences about the relationship between bereavement and internalizing and externalizing problems among children from a nearly nationally representative sample. This study also extends examination of the influence of parental bereavement to other domains of child development: namely, to academic outcomes. Findings suggest a lack of support for causal relationships between parental bereavement and either socio-emotional or academic outcomes among U.S. children. The plausibility of assumptions necessary to draw causal inferences is discussed.

  11. Identification, Geochemical Characterisation and Significance of Bitumen among the Grave Goods of the 7th Century Mound 1 Ship-Burial at Sutton Hoo (Suffolk, UK)

    PubMed Central

    Bowden, Stephen A.; Hacke, Marei; Parnell, John

    2016-01-01

    The 7th century ship-burial at Sutton Hoo is famous for the spectacular treasure discovered when it was first excavated in 1939. The finds include gold and garnet jewellery, silverware, coins and ceremonial armour of broad geographical provenance which make a vital contribution to understanding the political landscape of early medieval Northern Europe. Fragments of black organic material found scattered within the burial were originally identified as ‘Stockholm Tar’ and linked to waterproofing and maintenance of the ship. Here we present new scientific analyses undertaken to re-evaluate the nature and origin of these materials, leading to the identification of a previously unrecognised prestige material among the treasure: bitumen from the Middle East. Whether the bitumen was gifted as diplomatic gesture or acquired through trading links, its presence in the burial attests to the far-reaching network within which the elite of the region operated at this time. If the bitumen was worked into objects, either alone or in composite with other materials, then their significance within the burial would certainly have been strongly linked to their form or purpose. But the novelty of the material itself may have added to the exotic appeal. Archaeological finds of bitumen from this and earlier periods in Britain are extremely rare, despite the abundance of natural sources of bitumen within Great Britain. This find provides the first material evidence indicating that the extensively exploited Middle Eastern bitumen sources were traded northward beyond the Mediterranean to reach northern Europe and the British Isles. PMID:27906999

  12. Statins improve outcome in isolated heart valve operations: a propensity score analysis of 3,217 patients.

    PubMed

    Angeloni, Emiliano; Melina, Giovanni; Benedetto, Umberto; Refice, Simone; Bianchi, Paolo; Quarto, Cesare; Sinatra, Riccardo; Pepper, John R

    2011-07-01

    Whether statins can improve postoperative outcome in patients without coronary artery disease undergoing heart valve operations was assessed. Data for 3,217 patients undergoing isolated valve procedures at 2 institutions between May 2003 and May 2009 were reviewed. Clinical follow-up was completed. Two propensity-matched cohorts of 1,104 patients each were identified. Multivariable regression and Kaplan-Meyer survival analysis were performed to investigate risk factors correlated with death, stroke, myocardial infarction, and cardiac arrhythmias. The overall 30-day mortality rate was 2.7%, and 2,096 of 2,149 hospital survivors were alive at a median follow-up of 27 months. Preoperative statin treatment was independently associated with a significant reduction in the risk of hospital death (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.32 to 0.89; p=0.001), postoperative cardiac arrhythmias (OR, 0.76; 95% CI, 0.62 to 0.93; p<0.006), and stroke (OR, 0.54; 95% CI, 0.32 to 0.92; p=0.02) but was not independently associated with a reduced risk of postoperative myocardial infarction. At follow-up, Kaplan-Meyer survival analysis showed statistically significant lower rates of mortality (χ2, 4.41; hazard ratio [HR], 1.59; 95% CI, 1.13 to 2.27; p=0.03), stroke (χ2, 11.42; HR, 2.15; 95% CI, 1.37 to 3.27; p=0.0007), cardiac arrhythmias (χ2, 19.9; HR, 2.13; 95% CI, 1.81 to 2.72; p<0.0001), and major adverse cardiac and cerebrovascular events (χ2, 3.74; HR, 1.37; 95% CI, 0.99 to 1.74; p=0.05) in patients receiving statin treatment. No statistically significant difference was found between groups in myocardial infarction incidence at follow-up. Statin therapy is associated with a lower rate of adverse cardiovascular events after isolated heart valve operations. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Acidemia in neonates with a 5-minute Apgar score of 7 or greater - What are the outcomes?

    PubMed

    Sabol, Bethany A; Caughey, Aaron B

    2016-10-01

    The Apgar score is universally used for fetal assessment at the time of birth, whereas, the collection of fetal cord blood gases is performed commonly in high-risk situations or in the setting of Apgar scores of <7, which is a less standardized approach. It has been well-established that neonatal acidemia at the time of delivery can result in significant neonatal morbidity and death. Because of this association, knowledge of the fetal acid-base status and detection of acidemia at the time of delivery can serve as a sensitive and useful component in the assessment of a neonate's risk. Umbilical cord blood gas analysis is an accurate and validated tool for the assessment of neonatal acidemia at the time of delivery. Because the collection of fetal cord blood gases is not a standardized practice, it is possible that, with such a varied approach, some cases of neonatal acidemia are not detected, particularly in the setting of reassuring Apgar scores. In a setting of universally obtained cord blood gases, we sought to identify the rates of acidemia and associated factors in neonates with 5-minute Apgar scores of ≥7. This retrospective cohort study identified all term, singleton, nonanomolous neonates with 5-minute Apgar scores of ≥7. The incidence of umbilical artery pH ≤7.0 or ≤7.1 and base excess ≤-12 mmol/L or ≤-10 mmol/L were examined overall and in association with obstetric complications and adverse neonatal outcomes. Chi-squared tests were used to compare proportions, and multivariable logistic regression was used to control for potential confounders. In this cohort, the incidence of an umbilical artery pH of ≤7.0 was 0.5%, of a pH ≤7.1 was 3.4%, of a base excess ≤-12 mmol/L was 1.4%, and of ≤-10 mmol/L was 4.0%. Rates of neonatal acidemia were greater in the setting of meconium (4.3% vs 3.2%; P<.001), placental abruption (13.2% vs 3.4%; P<.001), and cesarean deliveries (5.8% vs 2.8%; P<.001), despite normal 5-minute Apgar scores. Additionally

  14. Patient-reported outcomes in Asia: evaluation of the properties of the Rheumatoid Arthritis Impact of Disease (RAID) score in multiethnic Asian patients with rheumatoid arthritis.

    PubMed

    Cheung, Peter P; Lahiri, Manjari; March, Lyn; Gossec, Laure

    2017-05-01

    Patient-reported outcomes (PROs) such as the Europe-developed Rheumatoid Arthritis Impact of Disease (RAID) are important to assess patients' quality of life. Their interpretation may be culture-dependent. To evaluate the potential utility of RAID in multiethnic Asian rheumatoid arthritis (RA) patients. Cross-sectional study of English-speaking RA patients in a Singapore tertiary center. Validity of RAID (scored between 0 and 10 with higher score indicating worse status) was assessed by Spearman's correlation with patient global assessment (PGA), DAS28 and short form 12 (SF-12). Consistency was assessed by Cronbach's alpha and test-retest reliability by intra-class correlation coefficient (ICC) 7 days after (n = 20). Feasibility was assessed by % of missing data. Eighty-two patients were analyzed: median age 53 years (Q1:Q3 44.7; 60.7), disease duration 4.2 years (1.4; 8.8), 66 (81%) women and 54 (66%) Chinese. Although RA was moderately active (median DAS28, 3.2 (2.5; 4.3)), RAID score was very low (median, 1.9 (0.6; 3.7)) with 44 (53.7%) patients having RAID score between 0 and 2. RAID was strongly correlated with PGA (r = 0.75), and moderately with other outcomes (DAS28 r = 0.46, SF12 physical r = -0.45 and SF12 mental r = -0.52, p < 0.0001 for all). Consistency was high (Cronbach's alpha = 0.91). Test-retest reliability was excellent; ICC = 0.84 (95% confidence interval 0.74-0.90). Feasibility was good with only 2 patients with missing data. Despite considerable floor effects, the RAID appeared to be a valid and practical PRO to assess the impact of RA in Asia. Multiethnic Asian patients may underestimate the impact of their disease compared to European patients.

  15. Patient outcomes after laminotomy, hemilaminectomy, laminectomy and laminectomy with instrumented fusion for spinal canal stenosis: a propensity score-based study from the Spine Tango registry.

    PubMed

    Munting, Everard; Röder, Christoph; Sobottke, Rolf; Dietrich, Daniel; Aghayev, Emin

    2015-02-01

    To compare patient outcomes and complication rates after different decompression techniques or instrumented fusion (IF) in lumbar spinal stenosis (LSS). The multicentre study was based on Spine Tango data. Inclusion criteria were LSS with a posterior decompression and pre- and postoperative COMI assessment between 3 and 24 months. 1,176 cases were assigned to four groups: (1) laminotomy (n = 642), (2) hemilaminectomy (n = 196), (3) laminectomy (n = 230) and (4) laminectomy combined with an IF (n = 108). Clinical outcomes were achievement of minimum relevant change in COMI back and leg pain and COMI score (2.2 points), surgical and general complications, measures taken due to complications, and reintervention on the index level based on patient information. The inverse propensity score weighting method was used for adjustment. Laminotomy, hemilaminectomy and laminectomy were significantly less beneficial than laminectomy in combination with IF regarding leg pain (ORs with 95% CI 0.52, 0.34-0.81; 0.25, 0.15-0.41; 0.44, 0.27-0.72, respectively) and COMI score improvement (ORs with 95% CI 0.51, 0.33-0.81; 0.30, 0.18-0.51; 0.48, 0.29-0.79, respectively). However, the sole decompressions caused significantly fewer surgical (ORs with 95% CI 0.42, 0.26-0.69; 0.33, 0.17-0.63; 0.39, 0.21-0.71, respectively) and general complications (ORs with 95% CI 0.11, 0.04-0.29; 0.03, 0.003-0.41; 0.25, 0.09-0.71, respectively) than laminectomy in combination with IF. Accordingly, the likelihood of required measures was also significantly lower after laminotomy (OR 0.28, 95% CI 0.17-0.46), hemilaminectomy (OR 0.28, 95% CI 0.15-0.53) and after laminectomy (OR 0.39,