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Sample records for significant outcome predictor

  1. Choosing Outcomes of Significance.

    ERIC Educational Resources Information Center

    Spady, William G.

    1994-01-01

    Outcomes are high-quality, culminating demonstrations of significant learning in context. The High Success Network uses the "Demonstration Mountain" to differentiate among three major "learning zones" and six different forms of learning demonstrations that increase in complexity, generalizability, and significance, along with…

  2. From Screening to Early Identification and Intervention: Discovering Predictors to Successful Outcomes for Children with Significant Hearing Loss.

    ERIC Educational Resources Information Center

    Yoshinaga-Itano, Christine

    2003-01-01

    Research findings from a series of longitudinal studies of the language, speech, and social-emotional development of children with hearing impairments and hearing parents found language development is positively and significantly affected by the age of identification of the hearing loss and age of initiation into Colorado early intervention…

  3. Predictors of outcome in fungal keratitis

    PubMed Central

    Venkatesh Prajna, N; Krishnan, T; Mascarenhas, J; Srinivasan, M; Oldenburg, C E; Toutain-Kidd, C M; Sy, A; McLeod, S D; Zegans, M E; Acharya, N R; Lietman, T M; Porco, T C

    2012-01-01

    Purpose To analyse predictors of clinical outcome in fungal keratitis. Methods Data was collected during a prospective, randomized, controlled, double-masked clinical trial of treatment for fungal keratitis. Clinical features at presentation and demographics were collected at the enrolment visit for all patients. Pre-specified clinical outcomes included 3-month visual acuity and infiltrate/scar size, time to re-epithelialization, and corneal perforation. A separate multivariable model with each outcome as the dependent variable included all predictor variables. Results Predictors for worse 3-month visual acuity include older age (P=0.024), worse presentation visual acuity (P<0.001), larger infiltrate size at presentation (P<0.001), and pigmented ulcer (P=0.030). Larger infiltrate size at presentation was a significant predictor of worse 3-month infiltrate/scar size (P<0.001). Larger epithelial defect size was a significant predictor of perforation (P=0.0013). Predictors of longer time to re-epithelialization include infiltrate size at presentation (P<0.001) and older age (P=0.025). Conclusion Ulcer severity at presentation is highly predictive of worse outcomes. Presentation of clinical characteristics such as baseline acuity and infiltrate scar can provide important information to clinicians about prognosis, and may help guide management and treatment decisions. Prevention of corneal ulcer remains important, as it is difficult to change the course of the ulcer once it has begun. PMID:22744392

  4. Relapse of childhood acute lymphoblastic leukemia and outcomes at a reference center in Latin America: organomegaly at diagnosis is a significant clinical predictor.

    PubMed

    Jaime-Pérez, José Carlos; Pinzón-Uresti, Mónica Andrea; Jiménez-Castillo, Raúl Alberto; Colunga-Pedraza, Julia Esther; González-Llano, Óscar; Gómez-Almaguer, David

    2017-06-03

    Relapse is the major cause of treatment failure in acute lymphoblastic leukemia (ALL) of childhood; it is more frequent among high-risk patients from low-middle income than from high-income countries. The frequency, sites and outcome of relapsed ALL in children of northeast Mexico over a decade was documented. A retrospective analysis of 246 children belonging to a low-income group <16 years with de novo ALL during 2004-2015 was performed. Five-year overall survival (OS) and event-free survival was estimated by Kaplan-Meier analysis. Data on time, site, response to therapy and final outcome of relapse were analyzed. Hazard ratios (HRs) of relapse and death were estimated by the Cox regression model. Very early relapse was defined as that occurring in <18 months, early relapse between 18 and 36 months, and late relapse >36 months from diagnosis, respectively. Eighty-seven (35.4%) children relapsed. Five-year OS was 82.6% in children without relapse vs. 42% for relapsed patients. Bone marrow (BM) was the most frequent site of relapse (51.72%). Isolated central nervous system (CNS) relapses occurred in 29.9%. Five-year OS was 11.2% for BM and 15.5% for early relapse. HR of relapse for organomegaly was 3.683, 2.247 for an initial white blood cell count >50 000 × 10(9)/l and 1.169 for positive minimal residual disease status. A high rate of very early, CNS, and BM relapse with a considerably low 5-year OS requiring reassessment of therapy was documented. Organomegaly at diagnosis was a highly significant clinical predictor for relapse.

  5. Posterior quadrant epilepsy surgery: predictors of outcome.

    PubMed

    Davis, Kristin L; Murro, Anthony M; Park, Yong D; Lee, Gregory P; Cohen, Morris J; Smith, Joseph R

    2012-11-01

    To identify predictors of seizure recurrence following posterior quadrant epilepsy surgery. Between 1983 and 2008, 43 medically refractory epilepsy patients underwent posterior quadrant epilepsy surgery. Epilepsy surgery involved the occipital lobe in all cases; some cases also included resection of the adjacent parietal or temporal cortex. Using a logistic regression model, we evaluated the relationship between outcome (Engel class I-IV) and 5 outcome predictors: absence of a visual aura, a temporal lobe type aura, versive head movement unaccompanied by a visual aura, non-focal interictal scalp EEG, and surgical pathology other than low grade tumor or cortical dysplasia. We also determined the relative risk for significant post-operative cognitive decline of Wechsler intelligence test score among those receiving complete lobectomies compared to those receiving partial lobectomies. Overall, outcome was favorable at 1 year following surgery: 22 (51.2%) patients Engel class I, 10 (24%) patients Engel class II, 5 (12%) patients Engel class III, and 6 (14%) patients Engel class IV. The 3 best univariate predictors of seizure recurrence were versive head movement unaccompanied by visual aura, non-focal interictal scalp EEG, and pathology other than low grade tumor or cortical dysplasia. A multivariate predictor combining temporal lobe type aura, versive head movement unaccompanied by visual aura, non-focal interictal scalp EEG, and pathology other than low grade tumor or cortical dysplasia was optimum. Complete lobectomy significantly increased the risk of post-operative decline of Wechsler intelligence score. These findings indicate that posterior quadrant epilepsy surgery may provide sustained seizure control. A multivariate model combining temporal lobe type aura, versive head movement unaccompanied by a visual aura, non-focal interictal scalp EEG, and pathology other than low grade tumor or cortical dysplasia may contribute to predicting seizure recurrence following

  6. PREDICTORS FOR POST- STROKE DELIRIUM OUTCOME

    PubMed Central

    Dostovic, Zikrija; Dostovic, Ernestina; Smajlovic, Dzevdet; Ibrahimagic, Omer C.; Avdic, Leila; Becirovic, Elvir

    2016-01-01

    Background: There have been only a small number of studies that have evaluated the outcome of post-stroke delirium. Objectives: To evaluate the effects of gender, age, stroke localization, delirium severity, previous illnesses, associated medical complications on delirium outcome as well as, to determine effects of delirium on cognitive functioning one year after stroke. Patients and Methods: Comprehensive neuropsychological assessments were performed within the first week of stroke onset, at hospital discharge, and followed-up for 3, 6 and 12 months after stroke. We used diagnostic tools such as Glazgow Coma Scale, Delirium Rating Scale, National Institutes of Health Stroke Scale and Mini-Mental State. Results: Patients who developed post-stroke delirium had significantly more complications (p = 0.0005). Direct logistic regression was performed to assess the impact of several factors on the likelihood that patients will die. The strongest predictor of outcome was age, mean age ≥ 65 years with a odds ratio (OR) 4.9. Cox’s regression survival was conducted to assess the impact of multiple factors on survival. The accompanying medical complications were the strongest predictor of respondents poore outcome with Hazard-risk 3.3. Cognitive assessments including Mini Mental State score have showen that post-stroke delirium patients had significant cognitive impairment, three (p = 0.0005), six months (p = 0.0005) and one year (p = 0.0005) after stroke, compared to patients without delirium. Conclusion: Patient gender, age, localization of stroke, severity of delirium, chronic diseases and emerging complications significantly affect the outcome of post- stroke delirium. Delirium significantly reduced cognitive functioning of after stroke patients. PMID:27999490

  7. Developmental Trajectories of Clinically Significant ADHD Symptoms from Grade 3 through 12 in a High-Risk Sample: Predictors and Outcomes

    PubMed Central

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

    2015-01-01

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

  8. Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU®)

    PubMed Central

    2014-01-01

    Background Blunt thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially. Hence, the aim of this study was to identify the influence of critical structural damages on mortality. Methods All patients in the database of the TraumaRegister DGU® (TR-DGU) from 2002–2011 with AIS Chest ≥ 2, blunt trauma, age of 16 or older and an ISS ≥ 16 were analyzed. Outcome parameters were in-hospital mortality as well as ventilation time in patients surviving the initial 14 days after trauma. Results 22613 Patients were included (mean ISS 30.5 ± 12.6; 74.7% male; Mean Age 46.1 ± 197 years; mortality 17.5%; mean duration of ventilation 7.3 ± 11.5; mean ICU stay 11.7 ± 14.1 days). Only a limited number of specific injuries had a significant impact on survival. Major thoracic vessel injuries (AIS ≥5), bilateral lung contusion, bilateral flail chest, structural heart injury (AIS ≥3) significantly influence mortality in study patients. Several extrathoracic factors (age, blood transfusion, systolic blood pressure and extrathoracic severe injuries) were also predictive of increased mortality. Most injuries of the thoracic wall had no or only a moderate effect on the duration of ventilation. Injuries to the lung (laceration, contusion or pneumothoraces) had a moderate prolonging effect. Cardiac injuries and severe injuries to the thoracic vessels induced a substantially prolonged ventilation interval. Conclusions We demonstrate quantitatively the influence of specific structural damages of the chest on critical outcome parameters. While most injuries of the chest wall have no or only limited impact in the study collective, injuries to the lung overall show adverse outcome. Injuries to the heart or thoracic vessels have a

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

    PubMed Central

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

    2016-01-01

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

  10. Sports concussion: management and predictors of outcome.

    PubMed

    Reddy, Cara Camiolo; Collins, Michael W

    2009-01-01

    Interest in sports concussion has grown widely in the last two decades among laypersons and medical professionals. Significant contributions of evidence-based research have led to a better understanding of this multifaceted, but still often elusive, injury. This information has transformed all aspects of concussion management, from on-field evaluation through return-to-play guidelines. The aim of this article is to highlight important research regarding predictors of outcome and treatment protocols. This research has been the basis of the paradigm shift from traditional concussion grading scales to individualized care. Today, concussion management requires a patient-centered approach with individualized assessment, including risk factor analysis, neurocognitive testing, and a thorough symptom evaluation.

  11. Predictors of Driving Outcomes in Advancing Age

    PubMed Central

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

    2012-01-01

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

  12. Predictors of Functional Outcome Following Stroke.

    PubMed

    Harvey, Richard L

    2015-11-01

    Predicting functional outcome in stroke is challenging to most clinicians, partly because of the complexity of the condition and also because of the lack of validated prognostic models. The strongest predictors of functional outcome are age and motor function at stroke onset. There is a growing literature on predicting recovery of upper limb after stroke; however, literature on prediction of language recovery remains sparse. This review covers the current status of predicting functional outcome after stroke focusing on recovery of activities of daily living, ambulation, upper limb use, and aphasia. Use of clinical factors, imaging, and neurophysiological measures are discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Pretreatment predictors of outcome in anorexia nervosa.

    PubMed

    Halmi, K A; Goldberg, S C; Casper, R C; Eckert, E D; Davis, J M

    1979-01-01

    The relationship of selected pretreatment characteristics to weight gain during treatment was examined in 81 anorexia nervosa patients. Good prognostic indicators correlating positively with weight gain were: no previous hospitalizations for anorexia nervosa, a great amount of overactivity before treatment, less denial of illness, less psychosexual immaturity and the admission to feeling hunger. A perinatal history of delivery complications was associated with the poor outcome predictor of prior hospitalizations.

  14. Predictors of outcome in acute encephalitis

    PubMed Central

    Thakur, Kiran T.; Motta, Melissa; Asemota, Anthony O.; Kirsch, Hannah L.; Benavides, David R.; Schneider, Eric B.; McArthur, Justin C.; Geocadin, Romergryko G.

    2013-01-01

    Objective: To investigate predictors of outcome in patients with all-cause encephalitis receiving care in the intensive care unit. Methods: A retrospective analysis of encephalitis cases at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center was performed. Using multivariate logistic regression analysis, we examined mortality and predictors of good outcome (defined as modified Rankin Scale scores of 1–3) and poor outcome (scores 4 and 5) in those surviving to hospital discharge. Results: In our cohort of 103 patients, the median age was 52 years (interquartile range 26), 52 patients (50.49%) were male, 28 patients (27.18%) had viral encephalitis, 19 (18.45%) developed status epilepticus (SE), 15 (14.56%) had cerebral edema, and 19 (18.45%) died. In our multivariate logistic regression analysis, death was associated with cerebral edema (odds ratio [OR] 18.06, 95% confidence interval [CI] 3.14–103.92), SE (OR 8.16, 95% CI 1.55–43.10), and thrombocytopenia (OR 6.28, 95% CI 1.41–28.03). Endotracheal intubation requirement with ventilator support was highly correlated with death (95%). In addition, in those patients who survived, viral, nonviral, and unknown causes of encephalitis were less likely to have a poor outcome at hospital discharge compared with an autoimmune etiology (viral encephalitis: OR 0.09, 95% CI 0.01–0.57; nonviral encephalitis: OR 0.02, 95% CI 0.01–0.31; unknown etiology: OR 0.18, 95% CI 0.04–0.91). Conclusions: Our study suggests that predictors of death in patients with encephalitis comprise potentially reversible conditions including cerebral edema, SE, and thrombocytopenia. Further prospective studies are needed to determine whether aggressive management of these complications in patients with encephalitis improves outcome. PMID:23892708

  15. Predictors of outcome in acute encephalitis.

    PubMed

    Thakur, Kiran T; Motta, Melissa; Asemota, Anthony O; Kirsch, Hannah L; Benavides, David R; Schneider, Eric B; McArthur, Justin C; Geocadin, Romergryko G; Venkatesan, Arun

    2013-08-27

    To investigate predictors of outcome in patients with all-cause encephalitis receiving care in the intensive care unit. A retrospective analysis of encephalitis cases at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center was performed. Using multivariate logistic regression analysis, we examined mortality and predictors of good outcome (defined as modified Rankin Scale scores of 1-3) and poor outcome (scores 4 and 5) in those surviving to hospital discharge. In our cohort of 103 patients, the median age was 52 years (interquartile range 26), 52 patients (50.49%) were male, 28 patients (27.18%) had viral encephalitis, 19 (18.45%) developed status epilepticus (SE), 15 (14.56%) had cerebral edema, and 19 (18.45%) died. In our multivariate logistic regression analysis, death was associated with cerebral edema (odds ratio [OR] 18.06, 95% confidence interval [CI] 3.14-103.92), SE (OR 8.16, 95% CI 1.55-43.10), and thrombocytopenia (OR 6.28, 95% CI 1.41-28.03). Endotracheal intubation requirement with ventilator support was highly correlated with death (95%). In addition, in those patients who survived, viral, nonviral, and unknown causes of encephalitis were less likely to have a poor outcome at hospital discharge compared with an autoimmune etiology (viral encephalitis: OR 0.09, 95% CI 0.01-0.57; nonviral encephalitis: OR 0.02, 95% CI 0.01-0.31; unknown etiology: OR 0.18, 95% CI 0.04-0.91). Our study suggests that predictors of death in patients with encephalitis comprise potentially reversible conditions including cerebral edema, SE, and thrombocytopenia. Further prospective studies are needed to determine whether aggressive management of these complications in patients with encephalitis improves outcome.

  16. Sacrifice as a predictor of marital outcomes.

    PubMed

    Stanley, Scott M; Whitton, Sarah W; Sadberry, Sabina Low; Clements, Mari L; Markman, Howard J

    2006-09-01

    We investigated the prospective associations between attitudes about sacrifice and marital outcomes in 38 married couples. Specifically, a measure of satisfaction with sacrifice was proposed to be a potent longitudinal predictor of marital adjustment and distress based on existing cross-sectional studies and also to mediate the association between commitment and marital adjustment. Results demonstrated that attitudes about sacrifice discriminated between couples who would become distressed versus nondistressed over time. Sacrifice attitudes also predicted the maintenance of relationship adjustment over time even better than earlier relationship adjustment. Finally, sacrifice attitudes mediated the link between commitment and relationship adjustment for husbands, but not wives. Implications for intervention are discussed.

  17. Predictors of unfavorable thermal outcome during newborn emergency retrievals.

    PubMed

    Skiöld, Beatrice; Stewart, Michael; Theda, Christiane

    2015-01-01

    Maintenance of normal body temperature is a challenge during transports. We aimed to identify predisposing factors for unfavorable thermal outcome during emergency retrievals of neonates. Demographic data and clinical variables for transports performed over a 2-year period were extracted from the Newborn Emergency Transport Service (Victoria, Australia) database. Arrival temperatures outside normothermia (36.5°-37.5°C) were defined as an unfavorable outcome. Normothermia on arrival at the receiving hospital was achieved in 78% of 1,261 transports. The strongest predictor of unfavorable thermal outcome was an abnormal temperature at the start of the retrieval (odds ratio [OR] = 8.04; 95% confidence interval [CI], 5.91-10.95; P < .001) followed by very low weight on transport (< 1,500 g; OR = 2.49; 95% CI, 1.63-3.80; P < .001) and respiratory support (OR = 1.81; 95% CI, 1.29-2.54; P = .001). Medications (eg, inotropes and sedation/muscle relaxation) or central/peripheral venous/arterial lines were not significant predictors of outcome when temperature at retrieval start, weight at transport, and respiratory support were adjusted as cofactors. Mode of transport (road, fixed wing, or rotary wing aircraft) and outside temperature were not associated with thermal outcome. Abnormal temperature at the start of the retrieval, very low transport weight, and respiratory support were strong predictors of unfavorable thermal outcome during neonatal emergency transports. Copyright © 2015 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  18. C3 Glomerulopathy: Clinicopathologic Features and Predictors of Outcome

    PubMed Central

    Medjeral-Thomas, Nicholas R.; O’Shaughnessy, Michelle M.; O’Regan, John A.; Traynor, Carol; Flanagan, Michael; Wong, Limy; Teoh, Chia Wei; Awan, Atif; Waldron, Mary; Cairns, Tom; O’Kelly, Patrick; Dorman, Anthony M.; Pickering, Matthew C.; Conlon, Peter J.

    2014-01-01

    Summary Background and objectives The term C3 glomerulopathy describes renal disorders characterized by the presence of glomerular deposits composed of C3 in the absence of significant amounts of Ig. On the basis of electron microscopy appearance, subsets of C3 glomerulopathy include dense deposit disease (DDD) and C3 glomerulonephritis (C3GN). The full spectrum of histologic change observed in C3 glomerulopathy has yet to be defined and pathologic predictors of renal outcome within this patient population remain largely unknown. This study thus characterized a large C3 glomerulopathy cohort and identified clinicopathologic predictors of renal outcome. Design, setting, participants, & measurements All patients with kidney biopsies fulfilling criteria for C3 glomerulopathy from two quaternary renal centers within the United Kingdom and Ireland between 1992 and 2012 were retrospectively reviewed. We recorded histologic, demographic, and clinical data and determined predictors of ESRD using the Cox proportional hazards model. Results Eighty patients with C3 glomerulopathy were identified: 21 with DDD and 59 with C3GN. Patients with DDD were younger, more likely to have low serum C3 levels, and more likely to have crescentic GN than patients with C3GN. Patients with C3GN were older and had more severe arteriolar sclerosis, glomerular sclerosis, and interstitial scarring than patients with DDD. Of 70 patients with available follow-up data, 20 (29%) progressed to ESRD after a median of 28 months. Age >16 years, DDD subtype, and crescentic GN were independent predictors of ESRD within the entire cohort. Renal impairment at presentation predicted ESRD only among patients with DDD. Conclusions Although detailed serologic and genetic data are lacking, this study nevertheless identifies important clinicopathologic distinctions between patients with DDD and C3GN. These include independent predictors of renal outcome. If replicated in other cohorts, these predictors could be

  19. Gastroschisis: Antenatal Sonographic Predictors of Adverse Neonatal Outcome

    PubMed Central

    Ferraro, Zachary Michael; Moretti, Felipe; Fung Kee Fung, Karen

    2014-01-01

    Objectives. The aim of this review was to identify clinically significant ultrasound predictors of adverse neonatal outcome in fetal gastroschisis. Methods. A quasi-systematic review was conducted in PubMed and Ovid using the key terms “gastroschisis,” “predictors,” “outcome,” and “ultrasound.” Results. A total of 18 papers were included. The most common sonographic predictors were intra-abdominal bowel dilatation (IABD), intrauterine growth restriction (IUGR), and bowel dilatation not otherwise specified (NOS). Three ultrasound markers were consistently found to be statistically insignificant with respect to predicting adverse outcome including abdominal circumference, stomach herniation and dilatation, and extra-abdominal bowel dilatation (EABD). Conclusions. Gastroschisis is associated with several comorbidities, yet there is much discrepancy in the literature regarding which specific ultrasound markers best predict adverse neonatal outcomes. Future research should include prospective trials with larger sample sizes and use well-defined and consistent definitions of the adverse outcomes investigated with consideration given to IABD. PMID:25587450

  20. Predictors of Clinical Outcome After Acute Achilles Tendon Ruptures.

    PubMed

    Olsson, Nicklas; Petzold, Max; Brorsson, Annelie; Karlsson, Jón; Eriksson, Bengt I; Silbernagel, Karin Grävare

    2014-06-01

    In patients with an acute Achilles tendon rupture, it has not been possible to determine the superiority of a single specific treatment modality over other treatments with respect to symptoms and function. When several pertinent treatment protocols are available for an injury, it is of interest to understand how other variables, such as age, sex, or physical activity level, affect outcome to better individualize the treatment. To investigate predictors of both symptomatic and functional outcomes after an acute Achilles tendon rupture. Cohort study (Prognosis); Level of evidence, 2. Ninety-three patients (79 men and 14 women; mean age, 40 years) were evaluated prospectively at 3, 6, and 12 months. The main outcome measures in this study were the Achilles tendon Total Rupture Score (ATRS) for symptoms and maximum heel-rise height for function. The independent variables evaluated as possible predictors of outcome included treatment, sex, age, body mass index (BMI), physical activity level, symptoms, and quality of life. Treatment, age, BMI, physical activity level, heel-rise height at 6 months, and the ATRS at 3 months were eligible for further analysis. Only male sex was included for the prediction models. The 4 different multiple linear regression models (predicting the ATRS at 6 and 12 months and heel-rise height at 6 and 12 months) were significant (P < .001-.002), and the R (2) values for the models were 0.222 to 0.409. Surgical or nonsurgical treatment is a moderate predictor of symptoms and a weak predictor of heel-rise height after an acute Achilles tendon rupture. At the 6-month follow-up, surgical treatment was associated with a larger heel-rise height, but the opposite was seen at 12 months. Surgical treatment resulted in a lower degree of symptoms. Increasing age was a strong predictor of reduced heel-rise height, and an increase in age of 10 years reduced the expected heel-rise height by approximately 8%. A higher BMI was also a strong predictor of a

  1. Therapeutic hypothermia after cardiac arrest: outcome predictors

    PubMed Central

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

    2015-01-01

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

  2. Predictors of Hearing-Aid Outcomes.

    PubMed

    Lopez-Poveda, Enrique A; Johannesen, Peter T; Pérez-González, Patricia; Blanco, José L; Kalluri, Sridhar; Edwards, Brent

    2017-01-01

    Over 360 million people worldwide suffer from disabling hearing loss. Most of them can be treated with hearing aids. Unfortunately, performance with hearing aids and the benefit obtained from using them vary widely across users. Here, we investigate the reasons for such variability. Sixty-eight hearing-aid users or candidates were fitted bilaterally with nonlinear hearing aids using standard procedures. Treatment outcome was assessed by measuring aided speech intelligibility in a time-reversed two-talker background and self-reported improvement in hearing ability. Statistical predictive models of these outcomes were obtained using linear combinations of 19 predictors, including demographic and audiological data, indicators of cochlear mechanical dysfunction and auditory temporal processing skills, hearing-aid settings, working memory capacity, and pretreatment self-perceived hearing ability. Aided intelligibility tended to be better for younger hearing-aid users with good unaided intelligibility in quiet and with good temporal processing abilities. Intelligibility tended to improve by increasing amplification for low-intensity sounds and by using more linear amplification for high-intensity sounds. Self-reported improvement in hearing ability was hard to predict but tended to be smaller for users with better working memory capacity. Indicators of cochlear mechanical dysfunction, alone or in combination with hearing settings, did not affect outcome predictions. The results may be useful for improving hearing aids and setting patients' expectations.

  3. Predictors of Hearing-Aid Outcomes

    PubMed Central

    Johannesen, Peter T.; Pérez-González, Patricia; Blanco, José L.; Kalluri, Sridhar; Edwards, Brent

    2017-01-01

    Over 360 million people worldwide suffer from disabling hearing loss. Most of them can be treated with hearing aids. Unfortunately, performance with hearing aids and the benefit obtained from using them vary widely across users. Here, we investigate the reasons for such variability. Sixty-eight hearing-aid users or candidates were fitted bilaterally with nonlinear hearing aids using standard procedures. Treatment outcome was assessed by measuring aided speech intelligibility in a time-reversed two-talker background and self-reported improvement in hearing ability. Statistical predictive models of these outcomes were obtained using linear combinations of 19 predictors, including demographic and audiological data, indicators of cochlear mechanical dysfunction and auditory temporal processing skills, hearing-aid settings, working memory capacity, and pretreatment self-perceived hearing ability. Aided intelligibility tended to be better for younger hearing-aid users with good unaided intelligibility in quiet and with good temporal processing abilities. Intelligibility tended to improve by increasing amplification for low-intensity sounds and by using more linear amplification for high-intensity sounds. Self-reported improvement in hearing ability was hard to predict but tended to be smaller for users with better working memory capacity. Indicators of cochlear mechanical dysfunction, alone or in combination with hearing settings, did not affect outcome predictions. The results may be useful for improving hearing aids and setting patients’ expectations. PMID:28929903

  4. Stroke Location Is an Independent Predictor of Cognitive Outcome.

    PubMed

    Munsch, Fanny; Sagnier, Sharmila; Asselineau, Julien; Bigourdan, Antoine; Guttmann, Charles R; Debruxelles, Sabrina; Poli, Mathilde; Renou, Pauline; Perez, Paul; Dousset, Vincent; Sibon, Igor; Tourdias, Thomas

    2016-01-01

    On top of functional outcome, accurate prediction of cognitive outcome for stroke patients is an unmet need with major implications for clinical management. We investigated whether stroke location may contribute independent prognostic value to multifactorial predictive models of functional and cognitive outcomes. Four hundred twenty-eight consecutive patients with ischemic stroke were prospectively assessed with magnetic resonance imaging at 24 to 72 hours and at 3 months for functional outcome using the modified Rankin Scale and cognitive outcome using the Montreal Cognitive Assessment (MoCA). Statistical maps of functional and cognitive eloquent regions were derived from the first 215 patients (development sample) using voxel-based lesion-symptom mapping. We used multivariate logistic regression models to study the influence of stroke location (number of eloquent voxels from voxel-based lesion-symptom mapping maps), age, initial National Institutes of Health Stroke Scale and stroke volume on modified Rankin Scale and MoCA. The second part of our cohort was used as an independent replication sample. In univariate analyses, stroke location, age, initial National Institutes of Health Stroke Scale, and stroke volume were all predictive of poor modified Rankin Scale and MoCA. In multivariable analyses, stroke location remained the strongest independent predictor of MoCA and significantly improved the prediction compared with using only age, initial National Institutes of Health Stroke Scale, and stroke volume (area under the curve increased from 0.697-0.771; difference=0.073; 95% confidence interval, 0.008-0.155). In contrast, stroke location did not persist as independent predictor of modified Rankin Scale that was mainly driven by initial National Institutes of Health Stroke Scale (area under the curve going from 0.840 to 0.835). Similar results were obtained in the replication sample. Stroke location is an independent predictor of cognitive outcome (MoCA) at 3

  5. Treatment outcome and its predictors among Asian problem drinkers.

    PubMed

    Manning, Victoria; Gomez, Brenda; Koh, Puay Kee; Ng, Andrew; Guo, Song; Kandasami, Gomathinayagam; Wong, Kim Eng

    2013-03-01

    Evidence of treatment effectiveness for alcohol use disorders (AUD) have emerged predominantly from Western studies, using highly controlled trials that may not reflect real-world settings. This paper examines treatment outcome and its predictors among Asian problem drinkers participating in a treatment outcome monitoring program at an addiction treatment centre in Singapore. Data were collected at intake and 3, 6 and 12 months, although the focus of this paper is on reliable change at 3 months among the 70% who were followed up. Five hundred and forty-one AUD-diagnosed outpatients presenting for treatment, over a 2-year period, were assessed on drinking behaviours and administered the Addiction Severity Index-Lite, Personal Wellbeing Index (PWI) and Treatment Perceptions Questionnaire. At 3 months, drinking days, alcohol units and alcohol use severity had more than halved and 69% were either abstinent or had reliably reduced their drinking days. Baseline drinking days and treatment satisfaction predicted 3-month drinking frequency but not severity. Positive alcohol outcomes observed at 3 months were sustained among those followed up until 12 months. Mean PWI score improved significantly and fell within the 'normal' range. Treatment satisfaction also emerged as the only significant predictor of reliable positive change in both drinking days and PWI score. Significant reductions in drinking frequency and severity are possible for Asian problem drinkers after 12 weeks of outpatient treatment. The identified predictors suggest that more frequent drinkers and patients with past/current psychiatric comorbidities may require a more intensive treatment approach to optimise treatment outcomes. © 2012 Australasian Professional Society on Alcohol and other Drugs.

  6. Predictors of Trachomatous Trichiasis Surgery Outcome.

    PubMed

    Habtamu, Esmael; Wondie, Tariku; Aweke, Sintayehu; Tadesse, Zerihun; Zerihun, Mulat; Gashaw, Bizuayehu; Wondimagegn, Guadie S; Mengistie, Hiwot D; Rajak, Saul N; Callahan, Kelly; Weiss, Helen A; Burton, Matthew J

    2017-08-01

    Unfavorable outcomes after trachomatous trichiasis (TT) surgery are undermining the global trachoma elimination effort. This analysis investigates predictors of postoperative TT (PTT), eyelid contour abnormalities (ECAs), and granuloma in the 2 most common TT surgery procedures: posterior lamellar tarsal rotation (PLTR) and bilamellar tarsal rotation (BLTR). Secondary data analysis from a randomized, controlled, single-masked clinical trial. A total of 1000 patients with TT, with lashes touching the eye or evidence of epilation, in association with tarsal conjunctival scarring. Participants were randomly allocated and received BLTR (n = 501) or PLTR (n = 499) surgery. Disease severity at baseline, surgical incisions, sutures, and corrections were graded during and immediately after surgery. Participants were examined at 6 and 12 months by assessors masked to allocation. Predictors of PTT, ECA, and granuloma. Data were available for 992 (99.2%) trial participants (496 in each arm). There was strong evidence that performing more peripheral dissection with scissors in PLTR (odd ratio [OR], 0.70; 95% confidence interval [CI], 0.54-0.91; P = 0.008) and BLTR (OR, 0.83; 95% CI, 0.72-0.96; P = 0.01) independently protected against PTT. Baseline major trichiasis and mixed location lashes and immediate postoperative central undercorrection independently predicted PTT in both surgical procedures. Peripheral lashes in PLTR (OR, 5.91; 95% CI, 1.48-23.5; P = 0.01) and external central incision height ≥4 mm in BLTR (OR, 2.89; 95% CI, 1.55-5.41; P = 0.001) were independently associated with PTT. Suture interval asymmetry of >2 mm (OR, 3.18; 95% CI, 1.31-7.70; P = 0.01) in PLTR and baseline conjunctival scarring in BLTR (OR, 1.72; 95% CI, 1.06-2.81; P = 0.03) were independently associated with ECA. Older age was independently associated with ECA in both PLTR (P value for trend < 0.0001) and BLTR (P value for trend = 0.03). There was substantial intersurgeon variability

  7. Identifying predictors of treatment outcome in a drug court program.

    PubMed

    Roll, John M; Prendergast, Michael; Richardson, Kimberly; Burdon, William; Ramirez, Anthony

    2005-01-01

    Drug courts are popular for dealing with drug-abusing offenders. However, relatively little is known about participant characteristics that reliably predict either success or failure in these treatment settings. In this article, we report on 99 individuals who were enrolled in a drug court program (approximately one-half of whom successfully completed the program). Using, logistic regression techniques we identified 2 significant predictors of outcome. First, individuals who were employed at the time of their enrollment into the drug court program were more likely to successfully complete the treatment program. Second, individuals with a history of illicit intravenous drug use were less likely to complete the program.

  8. Predictors of outcomes of total knee replacement surgery.

    PubMed

    Judge, Andy; Arden, Nigel K; Cooper, Cyrus; Kassim Javaid, M; Carr, Andrew J; Field, Richard E; Dieppe, Paul A

    2012-10-01

    To identify pre-operative predictors of patient-reported outcomes of primary total knee replacement (TKR) surgery. The Elective Orthopaedic Centre database is a large prospective cohort of 1991 patients receiving primary TKR in south-west London from 2005 to 2008. The primary outcome is the 6-month post-operative Oxford Knee Score (OKS). To classify whether patients had a clinically important outcome, we calculated a patient acceptable symptom state (PASS) for the 6-month OKS related to satisfaction with surgery. Potential predictor variables were pre-operative OKS, age, sex, BMI, deprivation, surgical side, diagnosis, operation type, American Society of Anesthesiologists grade and EQ5D anxiety/depression. Regression modelling was used to identify predictors of outcome. The strongest determinants of outcome include pre-operative pain/function-those with less severe pre-operative disease obtain the best outcomes; diagnosis in relation to pain outcome-patients with RA did better than those with OA; deprivation-those living in poorer areas had worse outcomes; and anxiety/depression-worse pre-operative anxiety/depression led to worse pain. Differences were observed between predictors of pain and functional outcomes. Diagnosis of RA and anxiety/depression were associated with pain, whereas age and gender were specifically associated with function. BMI was not a clinically important predictor of outcome. This study identified clinically important predictors of attained pain/function post-TKR. Predictors of pain were not necessarily the same as functional outcomes, which may be important in the context of a patient's expectations of surgery. Other predictive factors need to be identified to improve our ability to recognize patients at risk of poor TKR outcomes.

  9. Predictors and outcomes of transfers from peritoneal dialysis to hemodialysis.

    PubMed

    Lan, Patrick G; Clayton, Philip A; Saunders, John; Polkinghorne, Kevan R; Snelling, Paul L

    2015-01-01

    Peritoneal dialysis (PD) patients are commonly required to transfer to hemodialysis (HD), however the literature describing the outcomes of such transfers is limited. The aim of our study was to describe the predictors of these transfers and their outcomes according to vascular access at the time of transfer. A retrospective cohort study using registry data of all adult patients commencing PD as their initial renal replacement therapy in Australia or New Zealand between 2004 - 2010 was performed. Follow-up was until 31 December 2010. Logistic regression models were constructed to determine possible predictors of transfer within both 6 and 12 months of PD commencement. Cox analysis and competing risks regression were used to determine the predictors of survival and transplantation post-transfer. The analysis included 4,781 incident PD patients, of whom 1,699 transferred to HD during the study period. Logistic models did not identify any clinically useful predictors of transfer within 6 or 12 months (c-statistics 0.54 and 0.55 respectively). 67% of patients commenced HD with a central venous catheter (CVC). CVC use at transfer was associated with increased mortality (hazard ratio 1.37, 95% confidence interval (CI) 1.11 - 1.68, p = 0.003) and a borderline significant reduction in the incidence of transplantation (subhazard ratio 0.76, 95% CI 0.58 - 1.00, p = 0.05). It is difficult to predict the transfer to HD for incident PD patients. PD patients who commence HD with a CVC have a higher risk of mortality and a lower likelihood of undergoing renal transplantation. Copyright © 2015 International Society for Peritoneal Dialysis.

  10. Predictors and Outcomes of Transfers from Peritoneal Dialysis to Hemodialysis

    PubMed Central

    Lan, Patrick G.; Clayton, Philip A.; Saunders, John; Polkinghorne, Kevan R.; Snelling, Paul L.

    2015-01-01

    ♦ Introduction: Peritoneal dialysis (PD) patients are commonly required to transfer to hemodialysis (HD), however the literature describing the outcomes of such transfers is limited. The aim of our study was to describe the predictors of these transfers and their outcomes according to vascular access at the time of transfer. ♦ Methods: A retrospective cohort study using registry data of all adult patients commencing PD as their initial renal replacement therapy in Australia or New Zealand between 2004 – 2010 was performed. Follow-up was until 31 December 2010. Logistic regression models were constructed to determine possible predictors of transfer within both 6 and 12 months of PD commencement. Cox analysis and competing risks regression were used to determine the predictors of survival and transplantation post-transfer. ♦ Results: The analysis included 4,781 incident PD patients, of whom 1,699 transferred to HD during the study period. Logistic models did not identify any clinically useful predictors of transfer within 6 or 12 months (c-statistics 0.54 and 0.55 respectively). 67% of patients commenced HD with a central venous catheter (CVC). CVC use at transfer was associated with increased mortality (hazard ratio 1.37, 95% confidence interval (CI) 1.11 – 1.68, p = 0.003) and a borderline significant reduction in the incidence of transplantation (subhazard ratio 0.76, 95% CI 0.58 – 1.00, p = 0.05). ♦ Conclusions: It is difficult to predict the transfer to HD for incident PD patients. PD patients who commence HD with a CVC have a higher risk of mortality and a lower likelihood of undergoing renal transplantation. PMID:24497591

  11. First trimester predictors of adverse pregnancy outcomes.

    PubMed

    Brameld, Kate J; Dickinson, Jan E; O'Leary, Peter; Bower, Carol; Goldblatt, Jack; Hewitt, Beverley; Murch, Ashleigh; Stock, Rosanne

    2008-12-01

    To identify first trimester indicators of adverse pregnancy outcomes. Data were obtained from the statewide evaluation of first trimester screening for Down syndrome in Western Australia which included 22,695 pregnancies screened between August 2001 and October 2003. Screening data were linked with pregnancy outcome information from the Hospital Morbidity Database and the Birth Defects Registry. The odds ratios (OR) of adverse outcomes were analysed for combined risk incorporating maternal age, nuchal translucency (NT) and biochemical parameters and then separately for each parameter (pregnancy-associated plasma protein-A (PAPP-A), free beta human chorionic gonadotropin (beta-hCG) and NT). Risk assessments for first trimester combined screening are derived from maternal age, ultrasound measurement of fetal NT, maternal serum free beta-hCG and PAPP-A. Increased combined risk for Down syndrome was significantly (P < 0.01) associated with spontaneous loss at or before 24 weeks gestation (OR 13.51), birth defects (OR 6.58) and preterm birth at or before 32 weeks gestation (OR 3.2). Maternal serum PAPP-A below the 5th centile was associated with Down syndrome (OR 8.43), spontaneous loss before 24 weeks (OR 5.04) and later than 24 weeks (OR 4.50), preterm delivery before 32 weeks (OR 3.11) and before 37 weeks (OR 2.24). NT above the 95th centile was associated with Down syndrome (OR 43.91), birth defects (OR 4.02) and spontaneous loss before 24 weeks (OR 6.24). Low levels of free beta-hCG and increased NT were less consistently associated with adverse outcomes and high levels of free beta-hCG showed limited use as an indicator. The detection rates for all outcomes other than Down syndrome were less than 40%. Biochemical indicators and NT that are measured during first trimester screening for Down syndrome show a number of associations with adverse outcomes, but do not show appropriate performance characteristics for screening tests. These data are consistent with the

  12. Computerized EEG: predictor of outcome in schizophrenia.

    PubMed

    Itil, T M; Marasa, J; Saletu, B; Davis, S; Mucciardi, A N

    1975-03-01

    Based on a double blind cross-over study, it was determined that schizophrenic patient who have more high frequency fast activity and a lesser degree of alpha and slow waves in computerized EEG before the treatment have a better therapeutic outcome to the major tranquilizer (neuroleptic) treatment. The correlation between pretreatment high frequency computer EEG measurements and better therapeutic outcome reached the level of statistical significance. "Therapy resistant" schizophrenic patients were characterized by a lesser degree of very fast beta activity, more alpha waves and slow waves, higher amplitudes in computer EEG, and a lesser degree of acute (florid) psychotic symptomatology but more "negative" symptoms such as motor retardation and blunted affect. One of the most striking results of the study is the finding that schizophrenic patients with certain psychopathological profiles also have similar computer EEG profiles.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-12-01

    Gyrification brain abnormalities are considered a marker of early deviations from normal developmental trajectories and a putative predictor of poor outcome in psychiatric disorders. The aim of this study was to explore cortical folding morphology in patients with anorexia nervosa (AN). A MRI brain study was conducted on 38 patients with AN, 20 fully recovered patients, and 38 healthy women. Local gyrification was measured with procedures implemented in FreeSurfer. Vertex-wise comparisons were carried out to compare: (1) AN patients and healthy women; (2) patients with a full remission at a 3-year longitudinal follow-up assessment and patients who did not recover. AN patients exhibited significantly lower gyrification when compared with healthy controls. Patients with a poor 3-year outcome had significantly lower baseline gyrification when compared to both healthy women and patients with full recovery at follow-up, even after controlling for the effects of duration of illness and gray matter volume. No significant correlation has been found between gyrification, body mass index, amount of weight loss, onset age, and duration of illness. Brain gyrification significantly predicted outcome at follow-up even after controlling for the effects of duration of illness and other clinical prognostic factors. Although the role of starvation in determining our findings cannot be excluded, our study showed that brain gyrification might be a predictor of outcome in AN. Further studies are needed to understand if brain gyrification abnormalities are indices of early neurodevelopmental alterations, the consequence of starvation, or the interaction between both factors. © 2015 Wiley Periodicals, Inc.

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

    PubMed

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

    1990-05-01

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

  16. Predictors of psychological outcome in patients with eating disorders: A routine outcome monitoring study.

    PubMed

    Dingemans, Alexandra E; van Son, Gabriëlle E; Aardoom, Jiska J; Bruidegom, Kiki; Slof-Op 't Landt, Margarita C T; van Furth, Eric F

    2016-09-01

    Identifying predictors of psychological outcome for patients with eating disorders may improve the effectiveness of treatment. Patients with different pre-treatment characteristics and symptoms may benefit from different therapies. This study aimed to identify potential predictors of treatment outcome in a large naturalistic cohort of patients with an eating disorder. The study sample included patients (N = 1153) with all types of eating disorders who were receiving residential, day, or outpatient treatment. Remission was defined by means of four different indicators based on the Eating Disorder Examination-Questionnaire global score: 1. achieving reliable change; 2. showing a 50% reduction in baseline symptom severity; 3. reaching the clinical significance cut-off point; and 4. a combination of indicators 2 and 3. Potential predictor variables were investigated in univariate and multivariate Cox regression models. Different predictors were found for the four outcome criteria. Patients with high levels of interpersonal distrust at baseline were less likely to have achieved reliable change in eating disorder psychopathology. Higher self-esteem and less body dissatisfaction at baseline was independently associated with a symptom reduction of more than 50% and/or reaching the clinical significance cut-off point. Contrary to our expectations, no differences in outcome were found between the eating disorder subtypes. Clinically, it is important to reduce the risk of poor outcome and to achieve a rapid response in treatment using an intervention designed for this purpose, such as shared decision making or an intervention directed at self-esteem or body image, which may act as a catalyst for change. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:863-873). © 2016 Wiley Periodicals, Inc.

  17. Predictors of Poor Outcome in ANCA-Associated Vasculitis (AAV).

    PubMed

    Vega, Luis E; Espinoza, Luis R

    2016-12-01

    It is important to recognize factors that might predict poor outcome and prognosis in patients with AAV. The predictors reported in the literature encompass genetic, histopathological, and clinical ones. Genetic studies (genetic predictors) have found genes that are associated with prediction of poor response to treatment, deterioration of renal function, and risk of mortality. Histopathological studies (histopathological predictors) have shown that sclerotic renal lesions are associated with increased risk of progression to end-stage renal disease and death. Lastly, scores (clinical predictors) obtained with tool as FFS, Maldini risk score, VDI, and emerging new biomarkers could potentially be helpful in assessment of prognosis in the future.

  18. Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke.

    PubMed

    Joundi, Raed A; Martino, Rosemary; Saposnik, Gustavo; Giannakeas, Vasily; Fang, Jiming; Kapral, Moira K

    2017-04-01

    Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many and which patients are screened and how failing a swallowing screen affects patient outcomes. We sought to evaluate predictors of receiving dysphagia screening after acute ischemic stroke and outcomes after failing a screening test. We used the Ontario Stroke Registry from April 1, 2010, to March 31, 2013, to identify patients hospitalized with acute ischemic stroke and determine predictors of documented dysphagia screening and outcomes after failing the screening test, including pneumonia, disability, and death. Among 7171 patients, 6677 patients were eligible to receive dysphagia screening within 72 hours, yet 1280 (19.2%) patients did not undergo documented screening. Patients with mild strokes were significantly less likely than those with more severe strokes to have documented screening (adjusted odds ratio, 0.51; 95% confidence interval [CI], 0.41-0.64). Failing dysphagia screening was associated with poor outcomes, including pneumonia (adjusted odds ratio, 4.71; 95% CI, 3.43-6.47), severe disability (adjusted odds ratio, 5.19; 95% CI, 4.48-6.02), discharge to long-term care (adjusted odds ratio, 2.79; 95% CI, 2.11-3.79), and 1-year mortality (adjusted hazard ratio, 2.42; 95% CI, 2.09-2.80). Associations were maintained in patients with mild strokes. One in 5 patients with acute ischemic stroke did not have documented dysphagia screening, and patients with mild strokes were substantially less likely to have documented screening. Failing dysphagia screening was associated with poor outcomes, including in patients with mild strokes, highlighting the importance of dysphagia screening for all patients with acute ischemic stroke. © 2017 American Heart Association, Inc.

  19. Predictors of stereoacuity outcome in visually mature subjects with exotropia

    PubMed Central

    Koç, F; Sefi-Yurdakul, N

    2016-01-01

    The purpose of this study was to determine the predictors of stereoacuity outcome in visually mature subjects with exotropia following surgical correction. Visually mature subjects who were surgically aligned and had been tested for stereoacuity in the postoperative period were studied retrospectively. Subjects were grouped with respect to their responses to Titmus or TNO stereotests. Characteristics such as amblyopia, anisometropia, and characteristics of the exodeviation such as time of onset, duration, intermittency, presence of an A or V pattern, distance-near disparity, coexisting vertical deviation, and inferior oblique overaction, were compared between the groups. One hundred and four visually mature subjects with exotropia met the inclusion criteria. Stereoacuity was achieved in 77% of the study group and only 9% of these could achieve fine stereoacuity. Negative stereoacuity was more frequently associated with larger deviation angles, higher anisometropia, inferior oblique overaction, pattern strabismus, coexisting vertical strabismus, and distance-near disparity, but not at a statistically significant level. The optimal cutoff for strabismus duration was 20 years for a positive stereoacuity outcome. Any-level visual acuity difference was found to decrease the chance for positive stereoacuity significantly. The odds ratios for the stereoacuity positivity were 4.05 for strabismus duration <20 years, 7.9 for strabismus onset >1 year of age, 3.79 for weaker eye visual acuity >20/25 and 9.85 for intermittency of strabismus. Intermittence of exotropia was the strongest predictor for positive stereoacuity. Exotropia onset after 1 year of age, absence of any-level visual acuity difference, and strabismus duration <20 years were the other predictors with decreasing power. PMID:26584792

  20. Predictors of substance abuse treatment outcomes in Tennessee.

    PubMed

    Kedia, Satish; Williams, Charles

    2003-01-01

    In planning and implementing programs to treat substance abuse, it is important to understand which factors influence post-treatment abstinence. This article identifies and analyzes several variables important in predicting the likelihood of abstinence among substance abuse clients. The data used in this study was collected from 1,350 clients treated for alcohol or drug abuse in residential, halfway house, or outpatient facilities in Tennessee. We analyzed 22 variables as possible treatment outcome predictors by using two statistical procedures: stepwise logistic regression analysis and Quick, Unbiased, Efficient, Statistical Tree (QUEST) analysis, a tree-structured classification algorithm analysis. We found one pretreatment, five in-treatment, and three post-treatment variables to be significant predictors of treatment outcome: previous treatment history, perceived helpfulness of the treatment, simultaneous treatment for mental health, number of days in treatment,completion of treatment, special skills training during treatment, obtaining healthcare services for major physical health problem after treatment, living with someone using alcohol or drugs post treatment, and arrest record since treatment.

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

    PubMed

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

    2015-05-01

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

  2. Outcome predictors in cardiopulmonary resuscitation facilitated by extracorporeal membrane oxygenation.

    PubMed

    Jung, Christian; Janssen, Kyra; Kaluza, Mirko; Fuernau, Georg; Poerner, Tudor Constantin; Fritzenwanger, Michael; Pfeifer, Ruediger; Thiele, Holger; Figulla, Hans Reiner

    2016-03-01

    Cardiac arrest is the major cause of sudden death in developed countries. Extracorporeal cardiopulmonary resuscitation (ECPR) employs extracorporeal membrane oxygenation (ECMO) in patients without return of spontaneous circulation (ROSC) by conventional cardiopulmonary resuscitation (CPR). Aim of the current study was to assess short- and long-term outcome in patients treated with ECPR in our tertiary center and to identify predictors of outcome. We retrospectively collected data of all patients treated with ECPR at our institution from 2002 to 2013. Outcome was assessed according to patient records; good neurological outcome was defined as cerebral performance category 1 or 2. Quality of life data was collected using EQ-5 questionnaire. Uni- and multivariate analysis was applied to identify predictors of outcome. One-hundred and seventeen patients were included into the study. Weaning from ECMO was successful in 61 (52 %) patients. Thirty-day survival endpoint was achieved by 27 (23 %) patients. Good neurological outcome was present in 17 (15 %) patients. Multivariate analysis revealed baseline serum lactate as the strongest predictor of outcome, whereas age and out-of-hospital CPR did not predict outcome. The optimal lactate cut-off to discriminate outcome was determined at 4.6 mmol/l [HR 3.55 (2.29-5.49), p < 0.001, log-rank test]. ECPR represents a treatment option in patients without ROSC after conventional CPR rescuing 15 % of patients with good neurological outcome. Serum lactate may play a crucial role in patient selection for ECPR.

  3. Separable Attentional Predictors of Language Outcome

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  4. Separable Attentional Predictors of Language Outcome

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  5. Long-term outcomes and predictors in pediatric liver retransplantation.

    PubMed

    Dreyzin, Alexandra; Lunz, John; Venkat, Veena; Martin, Lillian; Bond, Geoffrey J; Soltys, Kyle A; Sindhi, Rakesh; Mazariegos, George V

    2015-12-01

    Historically, 9-29% of pediatric liver transplant recipients have required retransplantation. Although outcomes have improved over the last decade, currently published patient and graft survival remain lower after retransplant than after primary transplant. Data from liver retransplantation recipients at our institution between 1991 and 2013 were retrospectively reviewed. Kaplan-Meier estimates were used to depict patient and graft survival. Predictors of survival were analyzed using a series of Cox proportional hazards models. Predictors were analyzed separately for patients who had "early" (≤ 30 days after primary transplant) and "late" retransplants. Eighty-four patients underwent retransplant at a median time of 241 days. Sixty percent had late retransplants. At one, five, and 10 yr, actuarial patient and graft survival were 73%/71%, 66%/63%, and 58%/53%, respectively. Since 2002, patient and graft survival improved to 86%/86% at one yr and 93%/87% at five yr. While operative complications were a common cause of death after earlier retransplants, since 2002, infection has been the only cause of death. Significant morbidities at five-yr follow-up include renal dysfunction (15%), diabetes (13%), hypertension (26%), chronic rejection (7%), and PTLD (2%). Current survival after pediatric liver retransplantation has improved significantly, but long-term immunosuppressant morbidity remains an opportunity for improvement. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Preschool Predictors of Kindergarten Language Outcomes

    ERIC Educational Resources Information Center

    Walk, Anne; Matsuo, Hisako; Giovanoni, Alex

    2015-01-01

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

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

    PubMed

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

    2016-08-01

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

  8. Significance testing for correlated binary outcome data.

    PubMed

    Rosner, B; Milton, R C

    1988-06-01

    Multiple logistic regression is a commonly used multivariate technique for analyzing data with a binary outcome. One assumption needed for this method of analysis is the independence of outcome for all sample points in a data set. In ophthalmologic data and other types of correlated binary data, this assumption is often grossly violated and the validity of the technique becomes an issue. A technique has been developed (Rosner, 1984) that utilizes a polychotomous logistic regression model to allow one to look at multiple exposure variables in the context of a correlated binary data structure. This model is an extension of the beta-binomial model, which has been widely used to model correlated binary data when no covariates are present. In this paper, a relationship is developed between the two techniques, whereby it is shown that use of ordinary logistic regression in the presence of correlated binary data can result in true significance levels that are considerably larger than nominal levels in frequently encountered situations. This relationship is explored in detail in the case of a single dichotomous exposure variable. In this case, the appropriate test statistic can be expressed as an adjusted chi-square statistic based on the 2 X 2 contingency table relating exposure to outcome. The test statistic is easily computed as a function of the ordinary chi-square statistic and the correlation between eyes (or more generally between cluster members) for outcome and exposure, respectively. This generalizes some previous results obtained by Koval and Donner (1987, in Festschrift for V. M. Joshi, I. B. MacNeill (ed.), Vol. V, 199-224.(ABSTRACT TRUNCATED AT 250 WORDS)

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

    ERIC Educational Resources Information Center

    Ben Itzchak, Esther; Zachor, Ditza A.

    2009-01-01

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

  10. Predictors of Developmental Outcomes for Infants Who Are Medically Fragile.

    ERIC Educational Resources Information Center

    Smith, Timothy B.; Boyce, Glenna C.

    This paper presents results of a preliminary study which evaluated medical birth data as potential predictors of developmental outcome, and developed and tested an instrument designed for this purpose. Forty low birthweight children, all of whom had experienced neonatal intraventricular hemorrhage, were evaluated at school age (66 months) on the…

  11. Evaluating Predictors of Outcome for Children in Psychotherapy.

    ERIC Educational Resources Information Center

    Bush, Rita Masden; And Others

    Most research in psychotherapy has focused on adult clients, while child psychotherapy has been comparatively neglected. To identify predictors of outcome in psychotherapy for children, the relationship between several client, therapist, and economic variables was examined. Subjects were 268 children and their families who had completed treatment…

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

    ERIC Educational Resources Information Center

    Ben Itzchak, Esther; Zachor, Ditza A.

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Nethercut, Gail; Adler, Nancy

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  16. Predictors of Infective Outcomes Following Hip Fracture

    PubMed Central

    Hotchen, Andrew J.; Vonberg, Frederick W.; Ironside, Emily C.; Ross-Thriepland, Stephen; Avery, Naomi; Pearce, Oliver J. N.

    2016-01-01

    Objectives: This study sought to assess the value of differing pre-operative measures in prediction of post-operative non-surgical site infection (NSSI) and length of hospital stay following hip fracture surgery. Methods: All patients admitted during a one year period with a hip fracture to our department were included in the study (n=207). Primary outcome measures were ten independent risk factors correlated to the development of non-surgical site infection following surgery for hip fracture. Secondary outcome measures were duration of hospital stay and inpatient mortality. Results: The patients who had severe cognitive impairment had a 71.0% risk of developing non-surgical site infection. Patients who had multiple medical co-morbidities also had increased risk of developing non-surgical site infection at 59.1%. Patients who developed NSSI on average stayed in hospital 13.1 days longer than patients who did not (31.6 vs. 18.5, p < .001). Conclusions: This study demonstrates the importance of reducing post-operative infection in hip fracture patients in view of reducing morbidity, mortality and cost. These patients can be stratified by risk factors and interventions can be employed in view of reducing inpatient post-operative infection rates in this cohort. PMID:28138499

  17. Predictors of outcomes in outpatients with anorexia nervosa - Results from the ANTOP study.

    PubMed

    Wild, Beate; Friederich, Hans-Christoph; Zipfel, Stephan; Resmark, Gaby; Giel, Katrin; Teufel, Martin; Schellberg, Dieter; Löwe, Bernd; de Zwaan, Martina; Zeeck, Almut; Herpertz, Stephan; Burgmer, Markus; von Wietersheim, Jörn; Tagay, Sefik; Dinkel, Andreas; Herzog, Wolfgang

    2016-10-30

    This study aimed to determine predictors of BMI and recovery for outpatients with anorexia nervosa (AN). Patients were participants of the ANTOP (Anorexia Nervosa Treatment of Out-Patients) trial and randomized to focal psychodynamic therapy (FPT), enhanced cognitive behavior therapy (CBT-E), or optimized treatment as usual (TAU-O). N=169 patients participated in the one-year follow-up (T4). Outcomes were the BMI and global outcome (recovery/partial syndrome/full syndrome) at T4. We examined the following baseline variables as possible predictors: age, BMI, duration of illness, subtype of AN, various axis I diagnoses, quality of life, self-esteem, and psychological characteristics relevant to AN. Linear and logistic regression analyses were conducted to identify the predictors of the BMI and global outcome. The strongest positive predictor for BMI and recovery at T4 was a higher baseline BMI of the patients. Negative predictors for BMI and recovery were a duration of illness >6 years and a lifetime depression diagnosis at baseline. Additionally, higher bodily pain was significantly associated with a lower BMI and self-esteem was a positive predictor for recovery at T4. A higher baseline BMI and shorter illness duration led to a better outcome. Further research is necessary to investigate whether or not AN patients with lifetime depression, higher bodily pain, and lower self-esteem may benefit from specific treatment approaches. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Neonatal Seizures: A Review of Outcomes and Outcome Predictors.

    PubMed

    Pisani, Francesco; Spagnoli, Carlotta

    2016-01-01

    The majority of neonatal seizures are of acute symptomatic origin, and their occurrence is associated with higher mortality and morbidity compared with the general population, even if there is conflicting evidence of a detrimental effect per se. Etiology is considered the main determinant of outcome, but other factors, including gestational age, brain damage severity, neonatal neurological examination, and electroencephalographically (EEG) interictal and ictal characteristics are also related to neurodevelopmental outcome or death. Therefore, accuracy in early prognostication since the neonatal period can be improved by conveniently integrating different clinical and instrumental findings.The aim of this review is first to review the outcome of newborns with seizures (mortality, epilepsy, cerebral palsy, and intellectual disability), second to review the risk factors for adverse outcome after seizures in the newborn period, considering clinical, EEG/amplitude-integrated EEG, and neuroimaging findings associated with adverse outcome and lack of response to treatment, and finally to review published scoring systems for predicting neurologic outcome after neonatal seizures. Georg Thieme Verlag KG Stuttgart · New York.

  19. Employment specialist competencies as predictors of employment outcomes.

    PubMed

    Taylor, Amanda C; Bond, Gary R

    2014-01-01

    Employment specialist competencies were examined as predictors of employment outcomes for consumers with serious mental illness participating in supported employment. Self-report and supervisor-rated performance measures from 57 employment specialists were correlated with three consumer employment outcomes (i.e., competitive employment rate, 90-day employment rate, and dropout rate). Employment specialists varied from 0 to 80 % in the competitive employment rates for their caseloads. Supervisor ratings of job performance and employment specialist efficacy, percentage of time in the community, and frequency of contacts with consumers were associated with employment outcomes. Employment specialist self-report measures were unrelated to employment outcomes. Surprisingly, employment specialists with larger caseload sizes had higher employment rates. Employment specialists vary widely in their effectiveness. Behavioral measures and supervisory ratings of employment specialists were most predictive of employment outcomes. Direct observation of employment specialist job performance appears to be the most promising method for identifying competencies predictive of employment outcome.

  20. Predictors of outcome following endoscopic thoracic sympathectomy.

    PubMed

    Bell, David; Jedynak, Justin; Bell, Roger

    2014-01-01

    Endoscopic thoracic sympathectomy (ETS) provides definitive management for primary focal hyperhidrosis and facial blushing. These conditions are debilitating and not uncommon, but many clinicians avoid ETS due to the risk of complications, particularly compensatory sweating (CS). This retrospective cohort study aimed to evaluate the degree of symptom resolution, patient satisfaction and adverse reactions after ETS and to identify subgroups of patients more likely to achieve a satisfactory outcome. From 2004 to 2010, 210 patients underwent ETS performed by a single surgeon. These patients responded to a questionnaire regarding levels of satisfaction, symptom resolution and complications encountered, particularly CS. Palmar hyperhidrosis (97%) and scalp/facial hyperhidrosis (93%) demonstrated greater degrees of symptom resolution than axillary hyperhidrosis (71%) and facial blushing (71%) (P < 0.001). Rates of severe CS were lowest in patients with palmar hyperhidrosis (8%) and highest in patients with axillary (26%) and scalp/facial (44.5%) hyperhidrosis (P = 0.0003). The probability of experiencing no CS was highest at young ages and decreased with age (P = 0.0006). Satisfaction rates also fell as age increased (P = 0.004). Satisfaction rates were highest in patients with palmar (90%) and lowest in patients with scalp/facial (52%) hyperhidrosis (P < 0.02). Patient satisfaction following ETS is highest among younger patients and those undergoing the procedure for palmar hyperhidrosis. Dissatisfaction arises from failure to achieve the desired aim as well as the development of severe CS, which is more common in older patients and those undergoing ETS for axillary and scalp/facial hyperhidrosis. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

  1. Predictors of outcome for cognitive behaviour therapy in binge eating disorder.

    PubMed

    Lammers, Mirjam W; Vroling, Maartje S; Ouwens, Machteld A; Engels, Rutger C M E; van Strien, Tatjana

    2015-05-01

    The aim of this naturalistic study was to identify pretreatment predictors of response to cognitive behaviour therapy in treatment-seeking patients with binge eating disorder (BED; N = 304). Furthermore, we examined end-of-treatment factors that predict treatment outcome 6 months later (N = 190). We assessed eating disorder psychopathology, general psychopathology, personality characteristics and demographic variables using self-report questionnaires. Treatment outcome was measured using the bulimia subscale of the Eating Disorder Inventory 1. Predictors were determined using hierarchical linear regression analyses. Several variables significantly predicted outcome, four of which were found to be both baseline predictors of treatment outcome and end-of-treatment predictors of follow-up: Higher levels of drive for thinness, higher levels of interoceptive awareness, lower levels of binge eating pathology and, in women, lower levels of body dissatisfaction predicted better outcome in the short and longer term. Based on these results, several suggestions are made to improve treatment outcome for BED patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

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

    PubMed

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

    2012-05-01

    This study examined gender differences in the level and developmental course of relational aggression in middle childhood, as well as early predictors and outcomes of relational aggression, after controlling for concurrent physical aggression. Relational (RAgg) and Physical aggression (PAgg) scores for 558 boys and 545 girls at ages 8-11 in the NICHD Study of Early Child Care and Youth Development (SECCYD) were created by combining the highest rating for each item across mother and teacher reports. Longitudinal analyses were conducted using Latent Curve Models of RAgg with PAgg as a time-varying covariate, with all parameters allowed to vary by gender. Boys and girls had different growth parameters of RAgg. Girls' RAgg intercept was higher and the slope was not different from zero; boys' RAgg intercept was lower and the slope declined. Mother-child conflict in early childhood predicted RAgg intercept for both boys and girls, but maternal harsh control and sensitivity were also uniquely predictive for girls, whereas center care was uniquely predictive for boys. RAgg intercept predicted adolescent self-reports of depression for girls and delinquency and risk-taking for both boys and girls; the magnitude of the association with risk-taking was significantly greater for boys.

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

    PubMed Central

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

    2012-01-01

    This study examined gender differences in the level and developmental course of relational aggression in middle childhood, as well as early predictors and outcomes of relational aggression, after controlling for concurrent physical aggression. Relational (RAgg) and Physical aggression (PAgg) scores for 558 boys and 545 girls at ages 8–11 in the NICHD Study of Early Child Care and Youth Development (SECCYD) were created by combining the highest rating for each item across mother and teacher reports. Longitudinal analyses were conducted using Latent Curve Models of RAgg with PAgg as a time-varying covariate, with all parameters allowed to vary by gender. Boys and girls had different growth parameters of RAgg. Girls’ RAgg intercept was higher and the slope was not different from zero; boys’ RAgg intercept was lower and the slope declined. Mother-child conflict in early childhood predicted RAgg intercept for both boys and girls, but maternal harsh control and sensitivity were also uniquely predictive for girls, whereas center care was uniquely predictive for boys. RAgg intercept predicted adolescent self-reports of depression for girls and delinquency and risk-taking for both boys and girls; the magnitude of the association with risk-taking was significantly greater for boys. PMID:22665946

  4. Predictors associated with improved cognitive-behavioral therapy outcome in pediatric obsessive-compulsive disorder.

    PubMed

    Torp, Nor Christian; Dahl, Kitty; Skarphedinsson, Gudmundur; Compton, Scott; Thomsen, Per Hove; Weidle, Bernhard; Hybel, Katja; Valderhaug, Robert; Melin, Karin; Nissen, Judit Becker; Ivarsson, Tord

    2015-03-01

    To identify predictors of treatment response in a large sample of pediatric participants with obsessive-compulsive disorder (OCD). The Nordic Long-term Obsessive compulsive disorder (OCD) Treatment Study (NordLOTS) included 269 children and adolescents, 7 to 17 years of age, with a DSM-IV diagnosis of OCD. Outcomes were evaluated after 14 weekly sessions of exposure-based cognitive-behavioral therapy (CBT). The association of 20 potential predictors, identified by literature review, along with their outcomes, was evaluated using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) posttreatment. A CY-BOCS total score of ≤15 was the primary outcome measure. The univariate analyses showed that children and adolescents who were older had more severe OCD, greater functional impairment, higher rates of internalizing and externalizing symptoms, and higher levels of anxiety and depression symptoms before treatment had significantly poorer outcomes after 14 weeks of treatment. However, only age was a significant predictor in the multivariate model. In the multivariate analysis, only age predicted better treatment outcome. Using univariate analysis, a variety of predictors of poorer treatment outcome after CBT was identified. The high impact of comorbid symptoms on outcome in pediatric OCD suggests that treatment should address comorbidity issues. The lack of a family predictor may be related to high family involvement in this study. Future research strategies should focus on optimizing intervention in the presence of these characteristics to achieve greater benefits for patients with OCD. Clinical trial registration information-Nordic Long-term Obsessive compulsive disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119. Copyright © 2015 American Academy of Child & Adolescent Psychaitry. Published by Elsevier Inc. All rights reserved.

  5. Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital.

    PubMed

    Halawa, Eman F; Draz, Iman; Ahmed, Dalia; Shaheen, Hala A

    2015-11-01

    Convulsive status epilepticus is a common neurologic emergency in pediatrics. We aimed to study the etiology, clinical features, and prognostic factors among pediatric patients with convulsive status epilepticus. Seventy patients were included in this cohort study from pediatric emergency department of the specialized Children Hospital of Cairo University. The outcome was evaluated using the Glasgow Outcome Score. Acute symptomatic etiology was the most common cause of convulsive status epilepticus. Refractory convulsive status epilepticus was observed more significantly in cases caused by acute symptomatic etiologies. The outcome was mortality in 26 (37.1%) patients, severe disability in 15 (21.4%), moderate disability in 17 (24.3%), and good recovery in 12 (17.1%) patients. The significant predictor of mortality was lower modified Glasgow Coma Scale score on admission, whereas lower modified Glasgow Coma Scale score on admission and refractory convulsive status epilepticus were the significant predictors for disability and mortality. © The Author(s) 2015.

  6. Changes in self-efficacy and outcome-expectancy as predictors of anxiety outcomes from the CALM study

    PubMed Central

    Brown, Lily A.; Wiley, Joshua F.; Wolitzky-Taylor, Kate; Roy-Byrne, Peter; Sherbourne, Cathy; Stein, Murray B.; Sullivan, Greer; Rose, Raphael D.; Bystritsky, Alexander; Craske, Michelle G.

    2014-01-01

    Objective While self-efficacy (SE) and outcome-expectancy (OE) have been well researched as predictors of outcome, few studies have investigated changes in these variables across treatments. We evaluated changes in OE and SE throughout treatment as predictors of outcomes in a large sample with panic disorder, generalized anxiety disorder, social anxiety disorder, or post-traumatic stress disorder. We hypothesized that increases in SE and OE would predict reductions in anxiety and depression as well as improvement in functioning. Method Participants (mean age = 43.3, SD=13.2, 71.1% female, 55.5% white) were recruited from primary care centers throughout the US and were randomized to receive either Coordinated Anxiety Learning and Management (CALM) treatment, comprised of cognitive-behavioral therapy, psychotropic medication, or both, or to usual care. SE and OE ratings were collected at each session for participants in the CALM treatment (n=482) and were entered into a structural equation model as predictors of changes in Brief Symptom Inventory, Anxiety Sensitivity Index, Patient Health Questionnaire, and Sheehan Disability Scale outcomes at 6, 12, and 18 months after baseline. Results The best fitting models predict symptom levels from OE and SE and not vice versa. The slopes and intercept of OE significantly predicted change in each outcome variable except PHQ-8. The slope and intercept of SE significantly predicted change in each outcome variable. Conclusion Over and above absolute level, increases in SE and OE were significant predictors of decreases in symptoms and increases in functioning. Implications for treatment are discussed, as well as future directions of research. PMID:24619599

  7. Traumatized refugees: morbidity, treatment and predictors of outcome.

    PubMed

    Buhmann, Caecilie Böck

    2014-08-01

    Despite large numbers of traumatized refugees, little is known about effective treatment of war trauma in refugees and immigrants. Few studies evaluating treatment have been published and most studies are follow-up studies with methodological limitations and little comparability across studies. The purpose of the PhD is to characterize transcultural trauma patients in Denmark needing psychiatric treatment with regards to psychopathology and predictors of mental health and to evaluate the effects of the treatment. Two studies reported in 4 papers form the basis of the thesis. FORLOB (Paper 1-3) was a follow-up study that included all patients receiving treatment at the Competence Center for Transcultural Psychiatry in Copenhagen from April 2008 to February 2010. Patients completed self-ratings of symptoms of PTSD, depression and anxiety as well as level of functioning and quality of life (HTQ, HSCL-25, SDS & WHO-5) before treatment and after treatment. Associations of co-morbid diagnoses and predictors of the patients' health condition were examined with linear and logistic regression and Pearson's correlation coefficients. Treatment in FORLOB consisted of a combination of Sertraline, Mianserin, psycho-education and Trauma-Focused Cognitive Behavioral Therapy (TFCBT). The treatment administered to each patient was monitored in detail and changes in outcome and predictors of change were analyzed. PTF1 (Paper 4) was a randomized controlled clinical trial with 2x2 factorial design (antidepressants, TFCBT, antidepressants & TFCBT, waiting list). Potential participants were screened amongst adult patients referred to the Competence Center for Transcultural Psychiatry in the period June 2009-2011. Patients with PTSD, war trauma and without a psychotic disorder were included. The manualized treatment consisted of weekly sessions with a physician and/or psychologist over a period of 6 months. The treatment effect was evaluated with a combination of self-ratings and blinded

  8. Predictors of pediatric cochlear implantation outcomes in South Africa.

    PubMed

    le Roux, Talita; Vinck, Bart; Butler, Iain; Cass, Nicolize; Louw, Liebie; Nauta, Leone; Schlesinger, Dani; Soer, Maggi; Tshifularo, Mashudu; Swanepoel, De Wet

    2016-05-01

    To identify and describe predictors of pediatric cochlear implantation outcomes in a South African population. A retrospective study of 301 pediatric cochlear implant (CI) recipients from five CI programs was conducted and cross-sectional outcome data were added at the time of data collection. Twenty potential prognostic factors were identified from the retrospective dataset, including demographical, CI, risk and family factors. Multiple regression analyses were performed to identify predictor variables that influence outcomes in terms of auditory performance (CAP scores), speech production (SIR scores), communication mode and educational placement. Although implanted children within this sample did not have equal opportunity to access a second implant, bilateral implantation was strongly predictive of better auditory performance and speech production scores, an oral mode of communication and mainstream education. NICU admittance/prematurity were associated with poorer auditory performance and speech production scores, together with a higher probability for non-oral communication and non-mainstream education. The presence of one or more additional developmental condition was predictive of poorer outcomes in terms of speech production and educational placement, while a delay between diagnosis and implantation of more than one year was also related to non-mainstream education. Ethnicities other than Caucasian were predictive of poorer auditory performance scores and a lower probability for mainstream education. An extensive range of prognostic indicators were identified for pediatric CI outcomes in South Africa. These predictive factors of better and poorer outcomes should guide pediatric CI services to promote optimal outcomes and assist professionals in providing evidence-based informational counseling. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Predictors and Outcomes of Adolescent Bariatric Support Group Attendance

    PubMed Central

    Sawhney, Payal; Modi, Avani; Jenkins, Todd M.; Zeller, Margaret; Kollar, Linda M.; Inge, Thomas H.; Xanthakos, Stavra A.

    2013-01-01

    Background Attending support groups connects adults undergoing bariatric surgery to peers and may improve weight loss efficacy. Predictors and outcomes of support group attendance of adolescents undergoing bariatric surgery are unknown. Objective The objective of this cohort study was to determine the rate, predictors, and outcomes of support group attendance in a free-standing adolescent bariatric program. Setting Academic children’s hospital in the U.S. Methods Charts of 68 consecutive adolescents who underwent laparoscopic Roux-en-y gastric bypass or vertical sleeve gastrectomy were retrospectively reviewed, recording demographic and anthropometric variables, support group, and clinic visit attendance. Prospectively collected vitamin adherence data were also analyzed. Univariate analyses evaluated characteristics and multivariate analyses evaluated predictors of support group attendance, clinic visit, and vitamin adherence. Results Of the 68 subjects, one third attended 1–3 support sessions, one third attended ≥4, and one third were non-attenders. Greater distance from clinical center (p=0.01) and caregiver bariatric history (p=0.05) were associated with decreased attendance. Only high pre-operative body mass index (BMI) (p < 0.01) and caregiver bariatric history (p < 0.01) were independently associated with decreased attendance. Increased attendance was associated with higher 6 (p=0.03) and 12 month (p<0.01) clinic visit attendance but not with multi-vitamin adherence (p=0.33). Conclusions Caregiver bariatric history and higher pre-operative BMI were associated with decreasing attendance at an adolescent bariatric support group program. This highlights a need to encourage attendance in these patients since adolescent attendance at support group sessions was positively associated with greater adherence to scheduled clinic visits post-operatively which may positively influence long-term outcomes. PMID:23810608

  10. Pediatric epilepsy surgery: could age be a predictor of outcomes?

    PubMed

    Jenny, Benoit; Smoll, Nicolas; El Hassani, Yassine; Momjian, Shahan; Pollo, Claudio; Korff, Christian M; Seeck, Margitta; Schaller, Karl

    2016-08-01

    OBJECTIVE Like adults, many children suffering from intractable seizures benefit from surgical therapy. Although various reports indicate that early intervention may avoid severe developmental consequences often associated with intractable epilepsy, surgery is still considered a last option for many children. In this retrospective study, the authors aimed to determine whether pediatric epilepsy surgery, in particular during the first years of life, relates to measurable benefits. METHODS Data from 78 patients (age range 5 months to 17 years) who underwent epilepsy surgery at the Geneva and Lausanne University Hospitals between 1997 and 2012 were reviewed retrospectively. Patients were dichotomized into 2 groups: infants (≤ 3 years of age, n = 19), and children/adolescents (4-17 years of age, n = 59). Compared with children/adolescents, infants more often had a diagnosis of dysplasia (37% vs 10%, respectively; p < 0.05, chi-square test). RESULTS The overall seizure-free rate was 76.9%, with 89.5% in infants and 72.9% in the children/adolescents group. Infants were 2.76 times as likely to achieve seizure-free status as children/adolescents. Postoperative antiepileptic medication was reduced in 67.9% of patients. Only 11.4% of the patients were taking more than 2 antiepileptic drugs after surgery, compared with 43% before surgery (p < 0.0001). The overall complication rate was 15.1% (6.4% transient hemiparesis), and no major complications or deaths occurred. CONCLUSIONS The data show a high seizure-free rate in children ≤ 3 years of age, despite a higher occurrence of dysplastic, potentially ill-defined lesions. Pediatric patients undergoing epilepsy surgery can expect a significant reduction in their need for medication. Given the excellent results in the infant group, prospective studies are warranted to determine whether age ≤ 3 years is a predictor for excellent surgical outcome.

  11. Chloride alterations in hospitalized patients: Prevalence and outcome significance

    PubMed Central

    Thongprayoon, Charat; Cheungpasitporn, Wisit; Cheng, Zhen

    2017-01-01

    Serum Cl (sCl) alterations in hospitalized patients have not been comprehensively studied in recent years. The aim of this study is to investigate the prevalence and outcome significance of (1) sCl alterations on hospital admission, and (2) sCl evolution within the first 48 hr of hospital admission. We conducted a retrospective study of all hospital admissions in the years 2011–2013 at Mayo Clinic Rochester, a 2000-bed tertiary medical center. Outcome measures included hospital mortality, length of hospital stay and discharge disposition. 76,719 unique admissions (≥18 years old) were studied. Based on hospital mortality, sCl in the range of 105–108 mmol/L was found to be optimal. sCl <100 (n = 13,611) and >108 (n = 11,395) mmol/L independently predicted a higher risk of hospital mortality, longer hospital stay and being discharged to a care facility. 13,089 patients (17.1%) had serum anion gap >12 mmol/L; their hospital mortality, when compared to 63,630 patients (82.9%) with anion gap ≤12 mmol/L, was worse. Notably, patients with elevated anion gap displayed a progressively worsening mortality with rising sCl. sCl elevation within 48 hr of admission was associated with a higher proportion of 0.9% saline administration and was an independent predictor for hospital mortality. Moreover, the magnitude of sCl rise was inversely correlated to the days of patient survival. In conclusion, serum Cl alterations on admission predict poor clinical outcomes. Post-admission sCl increase, due to Cl-rich fluid infusion, independently predicts hospital mortality. These results raise a critical question of whether iatrogenic cause of hyperchloremia should be avoided, a question to be addressed by future prospective studies. PMID:28328963

  12. Objective predictors of outcome in forensic mental health services-a systematic review.

    PubMed

    Sedgwick, Ottilie; Young, Susan; Das, Mrigendra; Kumari, Veena

    2016-12-01

    This systematic review aimed to examine whether neurobiological methods, or other methods independent of clinical judgment, have been investigated to assist decision making in forensic mental health services and, if so, whether this may be a useful strategy for predicting outcomes. OVID-Medline, Embase, and PsychInfo (inception-January 2015) were searched, limiting to English and human studies, using terms relating to "predict," "outcome," "psychiatry," and "forensic" to identify primary research articles reporting on predictors of outcome in forensic mental health services not reliant on clinical judgment/self-report. Fifty studies investigating demographic, neuropsychological/neurophysiological, and biological predictors were identified, reporting on 3 broad outcomes: (i) inpatient violence, (ii) length of stay, (iii) reoffending. Factors associated positively, negatively, and showing no relationship with each outcome were extracted and compiled across studies. Of various demographic predictors examined, the most consistent associations were between previous psychiatric admissions and inpatient violence; a more "severe" offense and a longer length of stay; and young age and reoffending. Poor performance on tests of cognitive control and social cognition predicted inpatient violence while a neurophysiological measure of impulsivity showed utility predicting reoffending. Serum cholesterol and creatine kinase emerged as biological factors with potential to predict future inpatient violence. Research in this field is in its infancy, but investigations conducted to date indicate that using objective markers is a promising strategy to predict clinically significant outcomes.

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

    PubMed Central

    Voineskos, Sophocles H.; Frank, Simon G.

    2015-01-01

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

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

    PubMed

    Wanberg, C R; Kammeyer-Mueller, J D

    2000-06-01

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

  15. Educational outcomes in extremely preterm children: neuropsychological correlates and predictors of attainment.

    PubMed

    Johnson, Samantha; Wolke, Dieter; Hennessy, Enid; Marlow, Neil

    2011-01-01

    This study assessed the impact of extremely preterm birth on academic attainment at 11 years of age, investigated neuropsychological antecedents of attainment in reading and mathematics, and examined early predictors of educational outcomes. Children born extremely preterm had significantly poorer academic attainment and a higher prevalence of learning difficulties than their term peers. General cognitive ability and specific deficits in visuospatial skills or phoneme deletion at 6 years were predictive of mathematics and reading attainment at 11 years in both extremely preterm and term children. Phonological processing, attention, and executive functions at 6 years were also associated with academic attainment in children born extremely preterm. Furthermore, social factors, neonatal factors (necrotizing enterocolitis, breech delivery, abnormal cerebral ultrasound, early breast milk provision), and developmental factors at 30 months (head circumference, cognitive development), were independent predictors of educational outcomes at 11 years. Neonatal complications combined with assessments of early cognitive function provide moderate prediction for educational outcomes in children born extremely preterm.

  16. Predictors of 6-month and 3-year outcomes after psychological intervention for psychogenic non epileptic seizures.

    PubMed

    Duncan, Roderick; Anderson, James; Cullen, Breda; Meldrum, Steven

    2016-03-01

    To determine outcome and its predictors following psychological intervention in people with Psychogenic Non-Epileptic Seizures (PNES) METHODS: Prospective audit of 89 consecutive patients. PNES were recorded at baseline (initial psychology appointment), at 6 months and 3 years post the initial appointment. Six-month data was obtained by face-to-face interview, while 3-year data was obtained by contacting general practitioners and by postal survey. Eight patients had stopped having PNES at the first appointment and were discharged. At 6-month follow up 43/81 patients (53.1%) were free of seizures. Predictors of cessation of seizures were: patient employed (OR 4.48, p=0.004), short waiting time for intervention (OR 0.94, p=0.018), the patient feeling they had some control over the seizures (OR 3.30, p=0.021), and an internal locus of control ((OR 7.46, p=0.001). Outcomes at 3 years based on patient report were available in 32/81 patients (36%). 11/32 patients reported being free of seizures. 50/65 patients were not accessing any healthcare for seizures. There were no significant predictors of either outcome among the variables collected. Just over half of our patients reported being free of seizures following intervention. Being employed predicted good outcome, but the best predictor of being seizure free at 6 months was having an internal locus of control. This may be useful practically and requires further study. No good predictors of long-term outcome were found, possibly because of loss to follow up. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  17. Predictors of positive esophagogastroduodenoscopy outcomes in children and adolescents: a single center experience.

    PubMed

    Lyons, Hernando; Zhang, Ying; Szpunar, Susan; Dharmaraj, Rajmohan

    2017-07-28

    Esophagogastroduodenoscopy (EGD) has become a key element in the diagnosis and therapy of many gastrointestinal diseases affecting children. The aim of this study was to evaluate predictors of positive outcomes in children undergoing their first diagnostic EGD with biopsies at a single center. This retrospective study was based on findings from existing EGD and histopathological reports. All procedures were performed between July 2006 and July 2013. Details of each patient's clinical presentation and EGD were abstracted from medical records to determine the predictors of positive EGD outcomes. A total of 1133 records of patients between the ages of 0 and 18 years old were evaluated. Of these patients, 51.5% (n = 573) were female and 24.5% (n = 278) were younger than 4 years old. The mean age at the time of EGD was 9.6 ± 5.7 years (mean ± standard deviation). The most common indications for the procedure were abdominal pain (54.9%) and emesis (31.9%). The overall prevalence of any endoscopic abnormality was 54.5% and the overall prevalence of any histological abnormality was 59.1%. A multivariate logistic regression found that patients 12 years or older (odds ratio, OR = 1.46; 95% confidence interval, CI 1.31-1.63), African-American race (OR = 2.20; 95% CI 1.45-3.34), dysphagia (OR = 1.96; 95% CI 1.28-3.00) and positive celiac antibodies (OR = 2.25; 95% CI 1.52-3.34) were all significant independent predictors of a positive EGD outcome. Several clinical variables were found to be independent predictors of positive EGD outcomes in children and adolescents. Prospective studies using standardized definitions of clinical variables and endoscopy outcomes are needed to further understand predictors of positive EGDs.

  18. Interprofessional teamwork skills as predictors of clinical outcomes in a simulated healthcare setting.

    PubMed

    Shrader, Sarah; Kern, Donna; Zoller, James; Blue, Amy

    2013-01-01

    Teaching interprofessional (IP) teamwork skills is a goal of interprofessional education. The purpose of this study was to examine the relationship between IP teamwork skills, attitudes and clinical outcomes in a simulated clinical setting. One hundred-twenty health professions students (medicine, pharmacy, physician assistant) worked in interprofessional teams to manage a "patient" in a health care simulation setting. Students completed the Interdisciplinary Education Perception Scale (IEPS) attitudinal survey instrument. Students' responses were averaged by team to create an IEPS attitudes score. Teamwork skills for each team were rated by trained observers using a checklist to calculate a teamwork score (TWS). Clinical outcome scores (COS) were determined by summation of completed clinical tasks performed by the team based on an expert developed checklist. Regression analyses were conducted to determine the relationship of IEPS and TWS with COS. IEPS score was not a significant predictor of COS (p=0.054), but TWS was a significant predictor (p<0.001) of COS. Results suggest that in a simulated clinical setting, students' interprofessional teamwork skills are significant predictors of positive clinical outcomes. Interprofessional curricular models that produce effective teamwork skills can improve student performance in clinical environments and likely improve teamwork practice to positively affect patient care outcomes.

  19. 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.

  20. Social cognitive predictors of treatment outcome in cannabis dependence.

    PubMed

    Gullo, Matthew J; Matveeva, Marya; Feeney, Gerald F X; Young, Ross McD; Connor, Jason P

    2017-01-01

    Drug-related outcomes expectancies and refusal self-efficacy are core components of Social Cognitive Theory. Both predict treatment outcome in alcohol use disorders. Few studies have reported expectancies and refusal self-efficacy in cannabis dependence. None have examined both, although both constructs are key targets in Cognitive-Behavioural Therapy (CBT). This study tests the predictive role of expectancies and refusal self-efficacy in treatment outcome for cannabis dependence. Outpatients completed a comprehensive assessment when commencing cannabis treatment and predictors of treatment outcome were tested. A university hospital alcohol and drug outpatient clinic. 221 cannabis-dependent patients participated in a 6-week CBT program where the goal was abstinence. Cannabis Expectancy Questionnaire and Cannabis Refusal Self-Efficacy Questionnaire, cannabis dependence severity [Severity of Dependence Scale], psychological distress [General Health Questionnaire] at baseline; the timeline follow-back procedure at baseline and each session. Patients reporting lower confidence in their ability to resist cannabis during high negative affect (emotional relief refusal self-efficacy) had a lower likelihood of abstinence (p=0.004), more days of use (p<0.001), and larger amount used (p<0.001). Negative cannabis expectancies predicted greater likelihood of abstinence (p=0.024). Higher positive expectancies were associated with lower emotional relief self-efficacy, mediating its association with outcome (p<0.001). Emotional relief refusal self-efficacy and negative expectancies are predictive of better treatment outcomes for cannabis dependence. Positive expectancies may indirectly predict poorer outcome because of a negative association with self-efficacy, but this conclusion remains tentative as directionality could not be established. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Stuttering severity, psychosocial impact and lexical diversity as predictors of outcome for treatment of stuttering.

    PubMed

    Cook, Susanne; Donlan, Chris; Howell, Peter

    2013-06-01

    This study assessed factors that predicted therapy outcome for children and adolescents who stuttered after attendance at an intensive therapy course. The factors examined were stuttering severity, lexical diversity measured by Type Token Ratio, and psychosocial impact of stuttering on the child's life. Fifty-four children who stuttered (CWS) participated in the study. The hypotheses were: (1) CWS with high initial stuttering severity would be more likely to persist than those with low initial severity; (2) lexical diversity before treatment should be related to therapy outcome; (3) psychosocial factors would affect therapy outcome. The predictions were assessed by linear and logistic regression analyses. Initial stuttering severity was the only significant predictor for stuttering severity after therapy. However, psychosocial impact correlated with improvement in fluency, and lexical diversity correlated with therapy outcome. Only initial stuttering severity was a significant predictor of therapy outcome after an intensive therapy intervention. This is in agreement with the study of Howell and Davis (2011). Readers will get an overview of the literature on risk factors that are considered to predict therapy outcomes for CWS. They will be able to (a) identify what variable represent potential risk factors, (b) describe the psychosocial impact of stuttering, (c) explain how lexical diversity is measured, and (d) describe different assessment instruments used to decide on the outcome of therapy. Copyright © 2012 Elsevier Inc. All rights reserved.

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

    PubMed Central

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

    2012-01-01

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

  3. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy

    PubMed Central

    Kawakita, Tetsuya; Parikh, Laura I.; Ramsey, Patrick S.; Huang, Chun-Chih; Zeymo, Alexander; Fernandez, Miguel; Smith, Samuel; Iqbal, Sara N.

    2016-01-01

    Objective We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). Study Design This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth). Predictors including TBA level, hepatic transaminase level, gestational age at diagnosis, underlying liver disease, and use of ursodeoxycholic acid were evaluated. Results Of 233 women with ICP, 152 women had TBA levels 10-39.9 μmol/L, 55 had TBA 40-99.9 μmol/L, and 26 had TBA ≥100 μmol/L. There was no difference in maternal age, ethnicity, or prepregnancy body mass index according to TBA level. Increasing TBA level was associated with higher hepatic transaminase and total bilirubin level (P < .05). TBA levels ≥100 μmol/L were associated with increased risk of stillbirth (P< .01). Increasing TBA level was also associated with earlier gestational age at diagnosis (P< .01) and ursodeoxycholic acid use (P = .02). After adjusting for confounders, no predictors were associated with composite neonatal morbidity. TBA 40-99.9 μmol/L and TBA ≥100 μmol/L were associated with increased risk of meconium-stained amniotic fluid (adjusted odds ratio, 3.55; 95% confidence interval, 1.45–8.68 and adjusted odds ratio, 4.55; 95% confidence interval, 1.47–14.08, respectively). Conclusion In women with ICP, TBA level ≥100 μmol/L was associated with increased risk of stillbirth. TBA ≥40 μmol/L was associated with increased risk of meconium

  4. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy.

    PubMed

    Kawakita, Tetsuya; Parikh, Laura I; Ramsey, Patrick S; Huang, Chun-Chih; Zeymo, Alexander; Fernandez, Miguel; Smith, Samuel; Iqbal, Sara N

    2015-10-01

    We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth). Predictors including TBA level, hepatic transaminase level, gestational age at diagnosis, underlying liver disease, and use of ursodeoxycholic acid were evaluated. Of 233 women with ICP, 152 women had TBA levels 10-39.9 μmol/L, 55 had TBA 40-99.9 μmol/L, and 26 had TBA ≥100 μmol/L. There was no difference in maternal age, ethnicity, or prepregnancy body mass index according to TBA level. Increasing TBA level was associated with higher hepatic transaminase and total bilirubin level (P < .05). TBA levels ≥100 μmol/L were associated with increased risk of stillbirth (P < .01). Increasing TBA level was also associated with earlier gestational age at diagnosis (P < .01) and ursodeoxycholic acid use (P = .02). After adjusting for confounders, no predictors were associated with composite neonatal morbidity. TBA 40-99.9 μmol/L and TBA ≥100 μmol/L were associated with increased risk of meconium-stained amniotic fluid (adjusted odds ratio, 3.55; 95% confidence interval, 1.45-8.68 and adjusted odds ratio, 4.55; 95% confidence interval, 1.47-14.08, respectively). In women with ICP, TBA level ≥100 μmol/L was associated with increased risk of stillbirth. TBA ≥40 μmol/L was associated with increased risk of meconium-stained amniotic fluid. Copyright © 2015 Elsevier Inc

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

    PubMed Central

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

    2016-01-01

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

  6. Predicting clinically significant changes in motor and functional outcomes after robot-assisted stroke rehabilitation.

    PubMed

    Hsieh, Yu-wei; Lin, Keh-chung; Wu, Ching-yi; Lien, Hen-yu; Chen, Jean-lon; Chen, Chih-chi; Chang, Wei-han

    2014-02-01

    To investigate the predictors of minimal clinically important changes on outcome measures after robot-assisted therapy (RT). Observational cohort study. Outpatient rehabilitation clinics. A cohort of outpatients with stroke (N=55). Patients with stroke received RT for 90 to 105min/d, 5d/wk, for 4 weeks. Outcome measures, including the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL), were measured before and after the intervention. Potential predictors include age, sex, side of lesion, time since stroke onset, finger extension, Box and Block Test (BBT) score, and FMA distal score. Statistical analysis showed that the BBT score (odds ratio[OR]=1.06; P=.04) was a significant predictor of clinically important changes in the FMA. Being a woman (OR=3.9; P=.05) and BBT score (OR=1.07; P=.02) were the 2 significant predictors of clinically significant changes in the MAL amount of use subscale. The BBT score was the significant predictor of an increased probability of achieving clinically important changes in the MAL quality of movement subscale (OR=1.07; P=.02). The R(2) values for the 3 logistic regression models were low (.114-.272). The results revealed that patients with stroke who had greater manual dexterity measured by the BBT appear to have a higher probability of achieving clinically significant motor and functional outcomes after RT. Further studies are needed to evaluate other potential predictors to improve the models and validate the findings. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  7. Functional capacity as a significant independent predictor of postoperative mortality for octogenarian ASA-III patients.

    PubMed

    Visnjevac, Ognjen; Lee, Jun; Pourafkari, Leili; Dosluoglu, Hasan H; Nader, Nader D

    2014-10-01

    The American Society of Anesthesiology's (ASA) 6-point physical status classification remains one of the most significant predictors of perioperative morbidity and mortality and is the most widely used risk stratification tool worldwide. Its utility is significantly limited for octogenarians, however, as the majority of these patients are classified as ASA-III. Thus, for patients aged 80 or older, we hypothesized that incorporating patients' functional status, defined by the ability to perform activities of daily living independently, would improve perioperative risk stratification. All data were extracted from the Veterans Affairs Surgical Quality Improvement Program, a perioperative prospectively maintained computerized database. ASA-III patients were reclassified into subgroups IIIA or IIIB, with IIIA representing functionally independent patients and IIIB representing partially or fully dependent patients. Functional status was self-reported during preoperative assessments. In this database, mortality data (primary outcome) was reliably available for all patients for the duration of the 96-month follow-up period, as were other perioperative patient data. Seven hundred and fifty-nine (72.4%) patients were classified as ASA-IIIA, and 290 (27.6%) patients were ASA-IIIB. Thirty-day and long-term survival was significantly better in the ASA-IIIA group, irrespective of type of surgery (hazard ratio 1.87, confidence interval 1.55-2.25, p < .001). ASA-IIIB hazard ratios for mortality were greatest for orthopedic and vascular surgery patients, but a significant divergence in survival between ASA-IIIA and IIIB patients was observed in all surgical specialties. As evidenced by Kaplan-Meier and multivariate analyses, functional capacity was a significant independent predictor of mortality for ASA-III patients older than 80 years of age. Published by Oxford University Press on behalf of the Gerontological Society of America 2014.

  8. Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety.

    PubMed

    Hedman, Erik; Lindefors, Nils; Andersson, Gerhard; Andersson, Erik; Lekander, Mats; Rück, Christian; Ljótsson, Brjánn

    2013-10-01

    Internet-based cognitive behavior therapy (CBT) for severe health anxiety can be effective, but not all patients achieve full remission. Under these circumstances, knowledge about predictors is essential for the clinician in order to make reliable treatment recommendations. The primary aim of this study was to investigate clinical, demographic, and therapy process-related predictors of Internet-based CBT for severe health anxiety. We performed three types of analyses on data from a sample comprising participants (N = 81) who had received Internet-based CBT in a randomized controlled trial. Outcomes were a) end state health anxiety, b) improvement in health anxiety (continuous change scores), and c) clinically significant improvement. Outcomes were assessed at six-month follow-up. The results showed that the most stable predictors of both end state health anxiety and improvement were baseline health anxiety and depressive symptoms. Treatment adherence, i.e. the number of completed treatment modules, also significantly predicted outcome. Notably, health anxiety at baseline was positively associated with symptom improvement while depressive symptoms was negatively related to improvement. Demographic factors were largely without significant impact on end state symptoms or improvement. We conclude that baseline symptom burden and adherence to treatment have strong predictive effects in Internet-based CBT for severe health anxiety.

  9. Predictors of outcome following traumatic brain injury in young children.

    PubMed

    Prasad, Mary R; Ewing-Cobbs, Linda; Swank, Paul R; Kramer, Larry

    2002-02-01

    The relationship between clinical and neuroimaging variables and multiple outcome measures was examined in a longitudinal, prospective study of 60 children less than 6 years of age who sustained either inflicted or noninflicted traumatic brain injury. Hierarchical multiple regression indicated that the modified Glasgow Coma Scale score, the duration of impaired consciousness and the number of intracranial lesions visualized on CT/MRI accounted for a significant amount of the variance in the Glasgow Outcome Scale (GOS), cognitive and motor scores at baseline, 3- and 12-month evaluations. Inflicted brain injury adversely affected both GOS and cognitive outcomes. Pupillary abnormalities were associated with poorer motor outcome. Neither age at injury nor the Injury Severity Score accounted for significant variability in outcomes. Copyright 2002 S. Karger AG, Basel

  10. Evaluation of predictors of adverse outcome in febrile neutropenic episodes in pediatric oncology patients.

    PubMed

    Bothra, Meenakshi; Seth, Rachna; Kapil, Arti; Dwivedi, S N; Bhatnagar, Shinjini; Xess, Immaculata

    2013-04-01

    To identify predictors associated with adverse outcome in febrile neutropenic episodes among pediatric oncology patients between 1 and 18 y age, to ascertain the prevalence of invasive bacterial or fungal infection/mortality, to determine the common organisms causing invasive bacterial infection in children with febrile neutropenia and to evaluate their current antimicrobial sensitivity pattern. It was an observational descriptive study conducted between February 2009 through July 2010. Febrile neutropenic episodes satisfying the inclusion criteria were enrolled. Relevant history was taken followed by a detailed clinical examination and laboratory examination. Logistic Regression analysis was used to identify significant predictors of adverse outcome in febrile neutropenic episodes. Out of the 155 febrile neutropenic episodes studied, adverse outcome occurred in 53(34 %) of the episodes. History of three or more previous episodes of febrile neutropenia, child being already on oral antibiotics and Chest Radiograph abnormality at presentation were found to be significantly associated with adverse outcome on multivariate logistic regression analysis. Documented invasive bacterial and fungal infection was seen in 27.8 % and 14.2 % episodes. Mortality occurred in 8 (5 %) of episodes. Gram negative bacterial infections were more common. Most common bacteria isolated was Escherichia coli and the commonest gram positive organism isolated was Staphylococcus aureus (MSSA). On multivariate analysis, the variables found to be significantly associated with adverse outcome in febrile neutropenic episodes were three or more previous episodes of febrile neutropenia, child being already on oral antibiotics and Chest Radioraph abnormality at presentation.

  11. Predictors of outcomes following reablement in community-dwelling older adults.

    PubMed

    Tuntland, Hanne; Kjeken, Ingvild; Langeland, Eva; Folkestad, Bjarte; Espehaug, Birgitte; Førland, Oddvar; Aaslund, Mona Kristin

    2017-01-01

    Reablement is a rehabilitation intervention for community-dwelling older adults, which has recently been implemented in several countries. Its purpose is to improve functional ability in daily occupations (everyday activities) perceived as important by the older person. Performance and satisfaction with performance in everyday life are the major outcomes of reablement. However, the evidence base concerning which factors predict better outcomes and who receives the greatest benefit in reablement is lacking. The objective of this study was to determine the potential factors that predict occupational performance and satisfaction with that performance at 10 weeks follow-up. The sample in this study was derived from a nationwide clinical controlled trial evaluating the effects of reablement in Norway and consisted of 712 participants living in 34 municipalities. Multiple linear regression was used to investigate possible predictors of occupational performance (COPM-P) and satisfaction with that performance (COPM-S) at 10 weeks follow-up based on the Canadian Occupational Performance Measure (COPM). The results indicate that the factors that significantly predicted better COPM-P and COPM-S outcomes at 10 weeks follow-up were higher baseline scores of COPM-P and COPM-S respectively, female sex, having a fracture as the major health condition and high motivation for rehabilitation. Conversely, the factors that significantly predicted poorer COPM-P and COPM-S outcomes were having a neurological disease other than stroke, having dizziness/balance problems as the major health condition and having pain/discomfort. In addition, having anxiety/depression was a predictor of poorer COPM-P outcomes. The two regression models explained 38.3% and 38.8% of the total variance of the dependent variables of occupational performance and satisfaction with that performance, respectively. The results indicate that diagnosis, functional level, sex and motivation are significant predictors of

  12. Predictors of outcomes following reablement in community-dwelling older adults

    PubMed Central

    Tuntland, Hanne; Kjeken, Ingvild; Langeland, Eva; Folkestad, Bjarte; Espehaug, Birgitte; Førland, Oddvar; Aaslund, Mona Kristin

    2017-01-01

    Background Reablement is a rehabilitation intervention for community-dwelling older adults, which has recently been implemented in several countries. Its purpose is to improve functional ability in daily occupations (everyday activities) perceived as important by the older person. Performance and satisfaction with performance in everyday life are the major outcomes of reablement. However, the evidence base concerning which factors predict better outcomes and who receives the greatest benefit in reablement is lacking. Objective The objective of this study was to determine the potential factors that predict occupational performance and satisfaction with that performance at 10 weeks follow-up. Methods The sample in this study was derived from a nationwide clinical controlled trial evaluating the effects of reablement in Norway and consisted of 712 participants living in 34 municipalities. Multiple linear regression was used to investigate possible predictors of occupational performance (COPM-P) and satisfaction with that performance (COPM-S) at 10 weeks follow-up based on the Canadian Occupational Performance Measure (COPM). Results The results indicate that the factors that significantly predicted better COPM-P and COPM-S outcomes at 10 weeks follow-up were higher baseline scores of COPM-P and COPM-S respectively, female sex, having a fracture as the major health condition and high motivation for rehabilitation. Conversely, the factors that significantly predicted poorer COPM-P and COPM-S outcomes were having a neurological disease other than stroke, having dizziness/balance problems as the major health condition and having pain/discomfort. In addition, having anxiety/depression was a predictor of poorer COPM-P outcomes. The two regression models explained 38.3% and 38.8% of the total variance of the dependent variables of occupational performance and satisfaction with that performance, respectively. Conclusion The results indicate that diagnosis, functional level

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

    PubMed

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

    2010-11-01

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

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

    PubMed Central

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

    2010-01-01

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

  15. Changing trends and predictors of outcome in patients with acute poisoning admitted to the intensive care.

    PubMed

    Jayashree, M; Singhi, S

    2011-10-01

    Acute poisoning in children is a medical emergency and preventable cause of morbidity and mortality. Knowledge about the nature, magnitude, outcome and predictors of outcome is necessary for management and allocation of scant resources. This is a retrospective study conducted in the Pediatric Intensive Care Unit (PICU) of an urban multi speciality teaching and referral hospital in North India from January 1993 to June 2008 to determine the epidemiology, clinical profile, outcome and predictors of outcome in children with acute poisoning. Data of 225 children with acute poisoning was retrieved from case records with respect to demographic profile, time to presentation, PRISM score, clinical features, investigations, therapeutic measures, complications and outcome in terms of survival or death. Survivors and non-survivors were compared to determine the predictors of mortality. Acute poisoning constituted 3.9% of total PICU admissions; almost all (96.9%) were accidental. The mean age of study patient's was 3.3 ± 3.1 (range 0.10-12) years with majority (61.3%) being toddlers (1-3 years). In the overall cohort, kerosene (27.1%) and prescription drugs (26.7%) were the most common causative agents followed by organophosphates (16.0%), corrosives (7.6%), carbamates (4.9%) and aluminum phosphide (4.9%). However the trends of the three 5-year interval (1993 till the end of 1997, 1998 till the end of 2002 and 2003 till the end of June 2008) revealed a significant decrease in kerosene, aluminum phosphide and iron with increase in organophosphate compound poisoning. Ninety nine (44%) patients required supplemental oxygen, of which nearly half (n = 42; 42.4%) needed mechanical ventilation. Twenty (8.9%) died; cause of death being iron poisoning in five; aluminum phosphide in four; organophosphates in three and one each because of kerosene, diesel, carbamate, corrosive, sewing machine lubricant, isoniazid, salicylate and maduramycin poisoning. There has been a significant

  16. Pharmacogenomic Predictors of Citalopram Treatment Outcome in Major Depressive Disorder

    PubMed Central

    Mamdani, Firoza; Berlim, Marcelo; Beaulieu, Marie-Martine; Turecki, Gustavo

    2017-01-01

    Objectives A significant proportion of patients with major depressive disorder (MDD)do not improve following treatment with first-line antidepressants, and currently, there are no objective indicators of predictors of antidepressant response. The aim of this study was to investigate pre-treatment peripheral gene expression differences between future remitters and non -responders to citalopram treatment and identify potential pharmacogenomic predictors of response. Methods We conducted a gene expression study using Affymetrix HG -U133 Plus2 microarrays in peripheral blood samples from untreated individuals with MDD (N = 77), ascertained at a community outpatient clinic, prior to an 8 -week treatment with citalopram. Gene expression differences were assessed between remitters and non -responders to treatment. Technical validation of significant probesets was carried out by qRT-PCR. Results A total of 434 probesets displayed significant correlation to change in score and 33 probesests were differentially expressed between eventual remitters and non-responders. Probesets for SMAD 7 (SMA-and MAD -related protein 7) and SIGLECP3 (sialic acid-binding immunoglobulin-like lectin, pseudogene 3) were the most significant differentially expressed genes following FDR correction, and both were down -regulated in individuals who responded to treatment. Conclusions These findings point to SMAD7 and SIGLECP3 as candidate predictive biomarkers of antidepressant response. PMID:23530732

  17. Life Span Studies of ADHD-Conceptual Challenges and Predictors of Persistence and Outcome.

    PubMed

    Caye, Arthur; Swanson, James; Thapar, Anita; Sibley, Margaret; Arseneault, Louise; Hechtman, Lily; Arnold, L Eugene; Niclasen, Janni; Moffitt, Terrie; Rohde, Luis Augusto

    2016-12-01

    There is a renewed interest in better conceptualizing trajectories of attention-deficit/hyperactivity disorder (ADHD) from childhood to adulthood, driven by an increased recognition of long-term impairment and potential persistence beyond childhood and adolescence. This review addresses the following major issues relevant to the course of ADHD in light of current evidence from longitudinal studies: (1) conceptual and methodological issues related to measurement of persistence of ADHD, (2) estimates of persistence rate from childhood to adulthood and its predictors, (3) long-term negative outcomes of childhood ADHD and their early predictors, and (4) the recently proposed new adult-onset ADHD. Estimates of persistence vary widely in the literature, and diagnostic criteria, sample characteristics, and information source are the most important factors explaining variability among studies. Evidence indicates that ADHD severity, comorbid conduct disorder and major depressive disorder, and treatment for ADHD are the main predictors of ADHD persistence from childhood to adulthood. Comorbid conduct disorder and ADHD severity in childhood are the most important predictors of adverse outcomes in adulthood among children with ADHD. Three recent population studies suggested the existence of a significant proportion of individuals who report onset of ADHD symptoms and impairments after childhood. Finally, we highlight areas for improvement to increase our understanding of ADHD across the life span.

  18. Temperament and impulsivity predictors of smoking cessation outcomes.

    PubMed

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

    2014-01-01

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

  19. Predictors of good outcome in medium to large spontaneous supratentorial intracerebral haemorrhages

    PubMed Central

    Castellanos, M; Leira, R; Tejada, J; Gil-Peralta, A; Davalos, A; Castillo, J; t for

    2005-01-01

    Objective: To determine potential predictors of good outcome in primary medium to large intracerebral haemorrhages (ICH) which could be useful for selecting patients for surgical procedures. Methods: Subjects were 138 patients with spontaneous hemispheric ICH >20 ml. They were non-surgically treated and were admitted consecutively to 15 hospitals within the first 12 hours of symptom onset (mean (SD), 5.8 (3.1) hours). Haematoma volume was measured on computed tomography (CT) at admission. Stroke severity was assessed by the Canadian stroke scale (CSS). Good outcome was defined as modified Rankin score ⩽2 at three months. Results: At the end of the follow up period, 45 patients (32.6%) had good outcome. Baseline stroke severity, systolic and diastolic blood pressure, body temperature, and acute phase reaction biochemical markers (ESR, C-reactive protein, fibrinogen, neutrophil count) were significantly associated with good outcome in bivariate analyses. Of the initial CT scan variables, intraventricular contamination, deep location, mass effect, and greater ICH volume were related to poor outcome. On multiple logistic regression analysis, cortical location of bleeding (odds ratio 3.79 (95% confidence interval 1.2 to 12.01); p = 0.023), high CSS score (OR 2.3 (1.6 to 3.1); p<0.0001), and low fibrinogen concentrations (OR 0.92 (0.87 to 0.97); p = 0.001) were independent predictors of good outcome. These three factors correctly classified 85% of patients. Conclusions: Good outcome in medium to large ICH can be predicted on admission by three readily assessable factors (CSS score, ICH location, and fibrinogen levels). These predictors may be helpful in selecting patients for surgical treatment. PMID:15834028

  20. Early outcome and predictors of early outcome in patients treated surgically for central cord syndrome.

    PubMed

    Kepler, Christopher K; Kong, Christopher; Schroeder, Gregory D; Hjelm, Nikolaus; Sayadipour, Amir; Vaccaro, Alexander R; Anderson, D Greg

    2015-10-01

    The purpose of this study was to characterize changes in American Spinal Injury Association motor score (AMS) in the 1st week after traumatic central cord syndrome (CCS) to identify predictors of improved early outcome in patients treated with early versus delayed surgical intervention. All patients presenting to a regional spinal cord injury center between January 2004 and June 2009 were queried for those with a diagnosis of CCS. Patients treated conservatively were excluded. A prospectively maintained spinal cord injury database was used to track AMS throughout each patient's hospitalization. Hospital records provided information regarding demographics, presenting neurological examination, imaging findings, comorbidities, timing and nature of surgical procedures, and length of stay (LOS) in the hospital and intensive care unit (ICU). Patients were separated into those who underwent early surgery, within 1 day of presentation (early group), and those who underwent surgery on a delayed basis (delayed group). Differences between groups were analyzed using the Student t-test and chi-square test. Predictors of outcome were identified using correlation analysis and multiple linear regression. Of 426 patients in the database, 80 (18.8%) were diagnosed as having CCS, and 68 of them ultimately underwent surgical decompression. Nineteen (28%) of 68 patients underwent surgery within 1 day of presentation (early group) while the remaining 49 patients (72%) underwent surgery on a delayed basis (delayed group). The mean age in the early group was significantly younger than that of the delayed group (52 vs 59 years, p = 0.049). Other characteristics were similar between groups including sex, proportion of patients with cord edema on MRI (44% early vs 55% delayed, p = 0.47), and proportion of patients with cervical fracture (26% early vs 28% delayed, p = 0.98). Patients in the early group presented with an AMS of 62.5 versus 70.0 for the delayed group (p = 0.36). No difference

  1. Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review.

    PubMed

    Driessen, Sara R C; Sandberg, Evelien M; la Chapelle, Claire F; Twijnstra, Andries R H; Rhemrev, Johann P T; Jansen, Frank Willem

    2016-01-01

    The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case

  2. Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers.

    PubMed

    Ozdemir, Ozcan; Giray, Semih; Arlier, Zulfikar; Baş, Demet Funda; Inanc, Yusuf; Colak, Ertugrul

    2015-01-01

    Successful recanalization after endovascular stroke therapy (EVT) did not translate into a good clinical outcome in randomized trials. The goal of the study was to identify the predictors of a good outcome after mechanical thrombectomy with stent retrievers. A retrospective analysis of a prospectively collected database included consecutive patients treated with stent retrievers. We evaluated the influence of risk factors for stroke, baseline NIHSS score, Alberta Stroke Program Early CT (ASPECT) score, recanalization rate, onset-to-recanalization and onset-to-groin puncture time, and glucose levels at admission on good outcomes. The number of stent passes during procedure and symptomatic hemorrhage rate were also recorded. A modified Rankin Scale (mRS) score of 0-2 at 90 days was considered as a good outcome. From January 2011 to 2014, 70 consecutive patients with an acute ischemic stroke underwent EVT with stent retrievers. The absence of a medical history of diabetes was associated with good outcomes. Apart from diabetes, the baseline demographic and clinical characteristics of patients were similar between subjects with poor outcome versus those with good outcomes. Median time from onset to recanalization was significantly shorter in patients with good outcomes 245 (IQR: 216-313 min) compared with poor outcome patients (315 (IQR: 240-360 min); P = 0.023). Symptomatic intracranial hemorrhage was observed in eight (21.6%) of 37 patients with poor outcomes and no symptomatic hemorrhage was seen in patients with good outcomes (P = 0.006). In multivariate stepwise logistic regression analysis, a favorable ASPECT score (ASPECT > 7) and successful recanalization after EVT were predictors of good outcomes. Every 10-year increase was associated with a 3.60-fold decrease in the probability of a good outcome at 3 months. The probability of a good outcome decreases by 1.43-fold for each 20 mg/dL increase in the blood glucose at admission. To achieve a good outcome after EVT

  3. [Predictors of outcome of a smoking cessation treatment by gender].

    PubMed

    Marqueta, Adriana; Nerín, Isabel; Jiménez-Muro, Adriana; Gargallo, Pilar; Beamonte, Asunción

    2013-01-01

    To identify factors predictive of the outcome of a smoking cessation program by gender. A cross-sectional study of smokers starting treatment in a smoking cessation clinic from 2002 to 2007 was conducted. The variables consisted of data on sociodemographic factors, smoking habits, the social context of smoking and psychiatric comorbidity prior to or during the smoking cessation process. All patients received multicomponent treatment consisting of psychological and pharmacological interventions. Success was defined as self-reported continuous abstinence confirmed by cooximetry (CO ≤10 ppm). Logistic regression was used to analyze the factors predictive of success. A total of 1302 persons (52.1% men and 47.9% women), with a mean age of 43.4 (10.2) years, were included. The mean number of cigarettes smoked per day was 25.3 (10.4) and the mean Fagerström test score was 6.2 (2.2) points. The success rate was 41.3% (538) with no differences by gender. Positive predictors were lower nicotine dependence and having a non-smoking partner in men and older age, smoking fewer cigarettes per day, having fewer smoking friends and not experiencing depression or anxiety during the treatment in women. Men and women have similar tobacco abstinence outcomes although gender factors play a role in determining abstinence. The gender perspective should be incorporated in smoking prevention and cessation programs. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

  4. ENDOCRINE TUMOURS: Genetic predictors of thyroid cancer outcome.

    PubMed

    Tavares, Catarina; Melo, Miguel; Cameselle-Teijeiro, José Manuel; Soares, Paula; Sobrinho-Simões, Manuel

    2016-04-01

    Genetic predictors of outcome are reviewed in the context of a disease--cancer--that can be (too) simplistically described as a 'successful, invasive clone of our own tissues'. Context has many faces that determine a thyroid cancer patient's outcome beyond the influence of genetic markers. There is also plenty of evidence on the prognostic meaning of the interplay between genetics and context/microenvironment factors (encapsulation, degree of invasion, staging, etc.). This review addresses only genetic alterations detected by molecular methods in surgically resected specimens, thus ruling out immunohistochemistry and (F)ISH, despite their crucial relevance as topographically oriented methods. For the sake of the discussion, well-differentiated carcinomas were divided into two main morphologic types: papillary carcinoma (classic and most variants) displaying BRAFV600E mutations and RET/papillary thyroid carcinoma rearrangements and the group of follicular patterned carcinomas that encompasses follicular carcinoma and the encapsulated form of follicular variant of papillary carcinoma, displaying RAS mutations and PAX8/PPARγ rearrangement. TERT promoter mutations have been recently described (and associated with distant metastases and reduced survival) in papillary and follicular carcinomas, as well as in poorly differentiated and undifferentiated carcinoma. TP53 mutations, previously thought to be restricted to less differentiated carcinomas, were also detected in papillary and follicular carcinoma and found to carry a guarded prognosis. Besides their putative importance for targeted therapies, the prognostic meaning of such mutations is discussed per se and in the setting of concurrent BRAF mutation. © 2016 European Society of Endocrinology.

  5. Predictors of outcome in idiopathic rapidly progressive glomerulonephritis (IRPGN)

    PubMed Central

    Alexopoulos, Efstathios; Gionanlis, Lazaros; Papayianni, Ekaterini; Kokolina, Elizabeth; Leontsini, Maria; Memmos, Dimitrios

    2006-01-01

    Background Small vessel vasculitides are known to follow a devastating course towards end-stage renal disease, unless treated with immunosuppressive regiments. We investigated the value of clinical, histological and immunohistochemical parameters as predictors of outcome at diagnosis in patients with pauci immune necrotizing glomerulonephritis. Methods In 34 patients the percentage and evolution stage of crescents, the presence of glomerular necrosis, the degree or severity of arteriosclerosis, as well as the extent of tubulointerstitial infiltration, interstial fibrosis and tubular atrophy were assessed. Monoclonal antibodies were used to identify infiltrating macrophages, α-SMA(+) and PCNA(+) cells, the expression of integrins α3β1 and LFA-1β, the adhesion molecule ICAM-1, the growth factor TGF-β1 and the terminal complement component C5b-9. Results 24 pts (70.6%) showed a complete or partial response to the treatment. The follow-up period was 20 ± 22 months. At multivariate analysis, serum CRP (p = 0.024), the intensity of tubular expression of C5b-9 (p < 0.0001) as well as the extent of glomerular and tubular expression of α3β1 integrin (p = 0.001 and 0.008 respectively) independently predicted the response to treatment. The response rate was better in ANCA(+) pts (p = 0.008). The extent of interstitial infiltrate (p < 0.0001), the severity of tubulointerstitial fibrosis (p < 0.0001) and the severity of tubular TGF-β1 expression (p < 0.0001) were independent predictors of long term outcome of renal function. Conclusion Patients with ANCA-associated renal vasculitis seem to respond better to the treatment. Acute phase reactants, such as CRP, implying a more intense parenchymal inflammatory reaction, as well as the intensity of the de novo expression of C5b-9 and the glomerular and tubular expression of α3β1 integrin predict the response to therapy. The severity of TIN lesions and of the tubulo-interstitial TGF-β1 and C5b-9 expression predict an

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  8. Predictors of clinical outcome following lumbar disc surgery: the value of historical, physical examination, and muscle function variables.

    PubMed

    Hebert, Jeffrey J; Fritz, Julie M; Koppenhaver, Shane L; Thackeray, Anne; Kjaer, Per

    2016-01-01

    Explore the relationships between preoperative findings and clinical outcome following lumbar disc surgery, and investigate the prognostic value of physical examination findings after accounting for information acquired from the clinical history. We recruited 55 adult patients scheduled for first time, single-level lumbar discectomy. Participants underwent a standardized preoperative evaluation including real-time ultrasound imaging assessment of lumbar multifidus function, and an 8-week postoperative rehabilitation programme. Clinical outcome was defined by change in disability, and leg and low back pain (LBP) intensity at 10 weeks. Linear regression models were used to identify univariate and multivariate predictors of outcome. Univariate predictors of better outcome varied depending on the outcome measure. Clinical history predictors included a greater proportion of leg pain to LBP, pain medication use, greater time to surgery, and no history of previous physical or injection therapy. Physical examination predictors were a positive straight or cross straight leg raise test, diminished lower extremity strength, sensation or reflexes, and the presence of postural abnormality or pain peripheralization. Preoperative pain peripheralization remained a significant predictor of improved disability (p = 0.04) and LBP (p = 0.02) after accounting for information from the clinical history. Preoperative lumbar multifidus function was not associated with clinical outcome. Information gleaned from the clinical history and physical examination helps to identify patients more likely to succeed with lumbar disc surgery. While this study helps to inform clinical practice, additional research confirming these results is required prior to confident clinical implementation.

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

    PubMed

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

    2016-03-01

    Pulmonary hypertension (PH) is associated with poor outcomes in the dialysis and general populations, but its effect in CKD is unclear. We evaluated the prevalence and predictors of PH measures and their associations with long-term clinical outcomes in patients with nondialysis-dependent CKD. Chronic Renal Insufficiency Cohort (CRIC) Study participants who had Doppler echocardiography performed were considered for inclusion. PH was defined as the presence of estimated pulmonary artery systolic pressure (PASP) >35 mmHg and/or tricuspid regurgitant velocity (TRV) >2.5 m/s. Associations between PH, PASP, and TRV and cardiovascular events, renal events, and all-cause mortality were examined using Cox proportional hazards models. Of 2959 eligible participants, 21% (n=625) had PH, with higher rates among those with lower levels of kidney function. In the multivariate model, older age, anemia, lower left ventricular ejection fraction, and presence of left ventricular hypertrophy were associated with greater odds of having PH. After adjusting for relevant confounding variables, PH was independently associated with higher risk for death (hazard ratio, 1.38; 95% confidence interval, 1.10 to 1.72) and cardiovascular events (hazard ratio, 1.23; 95% confidence interval, 1.00 to 1.52) but not renal events. Similarly, TRV and PASP were associated with death and cardiovascular events but not renal events. In this study of patients with CKD and preserved left ventricular systolic function, we report a high prevalence of PH. PH and higher TRV and PASP (echocardiographic measures of PH) are associated with adverse outcomes in CKD. Future studies may explain the mechanisms that underlie these findings. Copyright © 2016 by the American Society of Nephrology.

  10. Prognostic indices with brief and standard CBT for panic disorder: I. Predictors of outcome.

    PubMed

    Dow, Michael G T; Kenardy, Justin A; Johnston, Derek W; Newman, Michelle G; Taylor, C Barr; Thomson, Aileen

    2007-10-01

    Although the effectiveness of cognitive behavioural therapy (CBT) in the management of panic disorder (PD) is now well established, there have been few studies of predictors of outcome with this patient group using clinical effectiveness trial data, a hypothesis-testing model, and a dependent measure of clinically significant change. The data for this study came from a randomized controlled trial of three forms of CBT delivery for PD with and without agoraphobia (two 6-week CBT programmes, one of which was computer assisted, and one therapist-directed 12-week CBT programme), comprising a total of 186 patients across two sites. Based on previous related research, five hypothesized predictors of post-treatment and follow-up outcome were identified and examined, using a series of bivariate and multivariate analyses. The results in general supported the hypotheses. Strength of blood/injury fears, age of initial onset of panic symptoms, co-morbid social anxieties and degree of agoraphobic avoidance were predictive of both measures of post-treatment outcome. Degree of residual social difficulties and the continued use of anxiolytics at post-treatment were also shown to predict poor outcome at the 6-month follow-up. However, strength of continuing dysfunctional agoraphobic cognitions by the end of active treatment did not predict outcome at follow-up for the sample as a whole. The identification of consistent predictors of outcome with CBT has many clinical and research benefits. As CBT, however, is being delivered increasingly in a variety of brief formats, further research is required to identify moderators of response to these 'non-standard' treatment formats.

  11. Prognosis of juvenile myoclonic epilepsy 45 years after onset: seizure outcome and predictors.

    PubMed

    Senf, Philine; Schmitz, Bettina; Holtkamp, Martin; Janz, Dieter

    2013-12-10

    Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized epilepsy subsyndrome, contributing to approximately 3% to 11% of adolescent and adult cases of epilepsy. However, little is known about the long-term medical evolution of this clinical entity. The aim of this study was to analyze long-term outcome in a clinically well-defined series of patients with JME for seizure evolution and predictors of seizure outcome. In this retrospective cohort study, we analyzed seizure outcome in 66 patients who had JME, were treated at the Department of Neurology, Charité-Universitätsmedizin Berlin, and were initially diagnosed by a single senior epileptologist. After a mean follow-up time of 44.6 years (20-69 years), 59.1% of patients remained free of seizures for at least 5 years before the last contact. Among the seizure-free patients, 28 (71.8%) were still taking antiepileptic drugs and 11 (28.2%) were off medication for at least the last 5 years. We identified manifestation of additional absence seizures at onset of JME as an independent predictor of an unfavorable outcome regarding seizure freedom. A significant proportion of patients with JME were seizure-free and off antiepileptic drug therapy in the later course of their disorder. Patients with JME and additional absence seizures might represent a different JME subtype with a worse outcome.

  12. Predictors of favourable outcome in non-variceal upper gastrointestinal bleeding: implications for early discharge?

    PubMed

    Rotondano, Gianluca; Cipolletta, Livio; Koch, Maurizio; Bianco, Maria Antonia; Grossi, Enzo; Marmo, Riccardo

    2014-03-01

    There is a lack of validated predictors on which to decide the timing of discharge in patients already hospitalized for upper nonvariceal bleeding. Identify factors that appear to protect nonvariceal bleeders from the development of negative outcome (rebleeding, surgery, death). Secondary analysis of two prospective multicenter studies. Multivariate analyses for each investigated outcome were performed; a single model was developed including all factors that were statistically significant in each sub-model. A final score was developed to predict favourable outcomes. Prognostic accuracy was tested with ROC curve analysis. Out of 2398 patients, 211 (8.8%) developed one or more adverse outcomes: 87 (3.63%) had rebleeding, 46 (1.92%) needed surgery and 107 (4.46%) died. Predictors of favourable prognosis were: ASA score 1 or 2, absence of neoplasia, outpatient bleeding, use of low-dose aspirin, no need for transfusions, clean-based ulcer, age <70 years, no haemodynamic instability successful endoscopic diagnosis/therapy, no Dieulafoy's lesion at endoscopy, no hematemesis on presentation and no need for endoscopic treatment. Overall prognostic accuracy of the model was 83%. The final score accurately identified 20-30% of patients that eventually do not develop any negative outcome. The "good luck score" may be a useful tool in deciding when to discharge a patient already hospitalized for acute non-variceal bleeding. Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  13. Outcome Expectation Ratings as Predictors of Success in Weight Reduction.

    ERIC Educational Resources Information Center

    And Others; Bradley, Ian

    1980-01-01

    Obese persons about to enter a group program intended to produce "conditioned satiety" were asked to estimate their weight loss. Their outcome expectation correlated significantly with weight loss recorded seven weeks later. However, the magnitude of expected weight loss exceeded the actual amount of weight lost. (Author)

  14. Predictors of short-term outcome to exercise and manual therapy for people with hip osteoarthritis.

    PubMed

    French, Helen P; Galvin, Rose; Cusack, Tara; McCarthy, Geraldine M

    2014-01-01

    Physical therapy for hip osteoarthritis (OA) has shown short-term effects but limited long-term benefit. There has been limited research, with inconsistent results, in identifying prognostic factors associated with a positive response to physical therapy. The purpose of this study was to identify potential predictors of response to physical therapy (exercise therapy [ET] with or without adjunctive manual therapy [MT]) for hip OA based on baseline patient-specific and clinical characteristics. A prognostic study was conducted. Secondary analysis of data from a multicenter randomized controlled trial (RCT) (N=131) that evaluated the effectiveness of ET and ET+MT for hip OA was undertaken. Treatment response was defined using OMERACT/OARSI responder criteria. Ten baseline measures were used as predictor variables. Regression analyses were undertaken to identify predictors of outcome. Discriminative ability (sensitivity, specificity, and likelihood ratios) of significant variables was calculated. The RCT results showed no significant difference in most outcomes between ET and ET+MT at 9 and 18 weeks posttreatment. Forty-six patients were classified as responders at 9 weeks, and 36 patients were classified as responders at 18 weeks. Four baseline variables were predictive of a positive outcome at 9 weeks: male sex, pain with activity (<6/10), Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale score (<34/68), and psychological health (Hospital Anxiety and Depression Scale score <9/42). No predictor variables were identified at the 18-week follow-up. Prognostic accuracy was fair for all 4 variables (sensitivity=0.5-0.58, specificity=0.57-0.72, likelihood ratios=1.25-1.77), indicating fair discriminative ability at predicting treatment response. The short-term follow-up limits the interpretation of results, and the low number of identified responders may have resulted in possible overfitting of the predictor model. The authors were

  15. FGF-23 as a Predictor of Renal Outcome in Diabetic Nephropathy

    PubMed Central

    Zatz, Roberto; Graciolli, Fabiana G.; dos Reis, Luciene M.; Barros, Rui T.; Jorgetti, Vanda; Moysés, Rosa M.A.

    2011-01-01

    Summary Background and objectives Fibroblast growth factor 23 (FGF-23) has emerged as a new factor in mineral metabolism in chronic kidney disease (CKD). An important regulator of phosphorus homeostasis, FGF-23 has been shown to independently predict CKD progression in nondiabetic renal disease. We analyzed the relation between FGF-23 and renal outcome in diabetic nephropathy (DN). Design, setting, participants, & measurements DN patients participating in a clinical trial (enalapril+placebo versus enalapril+losartan) had baseline data collected and were followed until June 2009 or until the primary outcome was reached. Four patients were lost to follow-up. The composite primary outcome was defined as death, doubling of serum creatinine, and/or dialysis need. Results At baseline, serum FGF-23 showed a significant association with serum creatinine, intact parathyroid hormone, proteinuria, urinary fractional excretion of phosphate, male sex, and race. Interestingly, FGF-23 was not related to calcium, phosphorus, 25OH-vitamin D, or 24-hour urinary phosphorus. Mean follow-up time was 30.7 ± 10 months. Cox regression showed that FGF-23 was an independent predictor of the primary outcome, even after adjustment for creatinine clearance and intact parathyroid hormone (10 pg/ml FGF-23 increase = hazard ratio, 1.09; 95% CI, 1.01 to 1.16, P = 0.02). Finally, Kaplan-Meier analysis showed a significantly higher risk of the primary outcome in patients with FGF-23 values of >70 pg/ml. Conclusions FGF-23 is a significant independent predictor of renal outcome in patients with macroalbuminuric DN. Further studies should clarify whether this relation is causal and whether FGF-23 should be a new therapeutic target for CKD prevention. PMID:20966122

  16. Methamphetamine use is an independent predictor of poor outcome after aneurysmal subarachnoid hemorrhage.

    PubMed

    Moon, Karam; Albuquerque, Felipe C; Mitkov, Mario; Ducruet, Andrew F; Wilson, David A; Crowley, R Webster; Nakaji, Peter; McDougall, Cameron G

    2015-05-01

    Clinical outcomes of methamphetamine users with aneurysmal subarachnoid hemorrhage (aSAH) are unknown. To analyze differences in presentation, in-hospital morbidity, and outcomes between methamphetamine users and non-users. All 472 patients included in the Barrow Ruptured Aneurysm Trial from 2003 to 2007 were reviewed. Patients with 1- and 3-year follow-up were included in this analysis (n=398). Methamphetamine users were identified as patients who provided a history of methamphetamine use on admission or tested positive on urine toxicology testing. Methamphetamine users were compared with non-users using univariate analysis. Outcomes were then analyzed using multivariate logistic regression models for demographic characteristics, medical comorbidities, radiographic and clinical presentation, and vasospasm. Thirty-one patients (7.8%) were identified as methamphetamine users in this cohort. Methamphetamine users were younger than non-users (mean age 42.8 vs 55 years, p<0.001). In multivariate logistic regression models, methamphetamine use was an independent predictor of poor Glasgow Outcome Scale score at both 1 year (OR=5.02; 95% CI 1.03 to 24.48; p<0.05) and 3 years (OR=7.18; 95% CI 1.73 to 29.87; p=0.007). Other independent predictors in this model included older age, clinical vasospasm, diabetes, and aneurysm size. Cocaine and tobacco use were not significantly associated with poor outcome in our cohort. Methamphetamine use was not significantly associated with vasospasm, higher Fisher or Hunt and Hess grade, or intraparenchymal hemorrhage/intraventricular hemorrhage. Methamphetamine users have significantly worse outcomes at 1 and 3 years following aSAH. Further analysis is necessary to understand the pathological response associated with methamphetamine use in this setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Predictors of pregnancy outcome for infertile couples attending IVF and ICSI programmes.

    PubMed

    Zhang, Z; Zhu, L-L; Jiang, H-S; Chen, H; Chen, Y; Dai, Y-T

    2016-11-01

    The purpose of this study was to evaluate the predictors of pregnancy outcome for infertile couples attending in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) programmes. Infertile couples attending IVF or ICSI procedures were included in this study. Related data including semen parameters and male and female age and body mass index were collected and analysed. The main outcome was clinical pregnancy, defined as an ultrasound detection of foetal heartbeat 6 weeks after embryo transfer. A total of 1316 couples who underwent IVF and 266 who underwent ICSI were recruited for this study. A multivariate logistic regression with likelihood ratio test revealed the following predictors of pregnancy outcome: female age and sperm DNA fragmentation index (DFI) and acrosomal activity in IVF procedures (chi-square of likelihood ratio = 26.42, d.f. = 3, P < 0.005) and female age and DFI in ICSI procedures (chi-square of likelihood ratio = 18.88, d.f. = 2, P < 0.005). In conclusion, our study indicated that sperm DFI, female age and acrosomal levels have a significant effect on ART pregnancy outcome.

  18. Outcomes and predictors of localized or locally-advanced prostate cancer treated by radiotherapy in Indonesia

    PubMed Central

    Supit, Wempy; Mochtar, Chaidir Arif; Santoso, Rachmat Budi; Umbas, Rainy

    2013-01-01

    Purpose: Presently there is no published data on the outcomes of localized or locally-advanced prostate cancer (PCa) treated by external-beam radiotherapy (RT) in Indonesia. Methods: This study retrospectively analyzed 96 patients with localized or locally-advanced PCa treated by RT from year 1995 to 2009, at the national referral hospital and the national cancer hospital of Indonesia. Cumulative prostate and pelvic radiation dose/type was <70 Gy conventional RT in 84.4% patients, and ≥70 Gy Three dimensional-conformal or intensity modulated RT in 15.6% patients. Overall survival (OS) and biochemical progression-free survival (BFS) were estimated by Kaplan-Meier. Predictors of OS and biochemical recurrence were analyzed by multivariate Cox regressions. Results: The median follow-up was 61 months (range, 24 to 169 months). There were 3.1% low-risk, 26% intermediate-risk, and 70.8% high-risk cases. More than half of the patients (52.1%) had pretreatment prostate-specific antigen (PSA) >20 ng/mL. The 5-year survival outcome of low-risk, intermediate-risk, and high-risk patients were: OS, 100%, 94.7%, and 67.9% (P=0.297); and BFS, 100%, 94.1%, and 57.1% (P=0.016), respectively. In the high-risk group, the 5-year OS was 88.3% in patients who received adjuvant hormonal androgen deprivation therapy (HT), compared to 53% in RT only, P=0.08. Significant predictors of OS include high-risk group (hazard Ratio [HR], 9.35; 95% confidence interval [CI], 1.52 to 57.6; P=0.016), adjuvant therapy (HR, 0.175; 95% CI, 0.05 to 0.58; P=0.005), detection by transurethral resection of the prostate (TUR-P) (HR, 6.81; 95% CI, 2.28 to 20.33; P=0.001), and pretreatment PSA (HR, 1.003; 95% CI, 1.00 to 1.005; P=0.039). The sole predictor of biochemical failure was pretreatment PSA (P=0.04), with odds ratio of 4.52 (95% CI, 1.61 to 12.65) for PSA >20 ng/mL. Conclusions: RT is an effective treatment modality for localized or locally-advanced PCa in Indonesian patients, with outcomes and

  19. Satellite Sign: A Poor Outcome Predictor in Intracerebral Hemorrhage.

    PubMed

    Shimoda, Yoshiteru; Ohtomo, Satoru; Arai, Hiroaki; Okada, Ken; Tominaga, Teiji

    2017-06-13

    The presence of high-density starry dots around the intracerebral hemorrhage (ICH), which we termed as a satellite sign, is occasionally observed in CT. The relationship between ICH with a satellite sign and its functional outcome has not been identified. This study aimed to determine whether the presence of a satellite sign could be an independent prognostic factor for patients with ICH. Patients with acute spontaneous ICH were retrospectively identified and their initial CT scans were reviewed. A satellite sign was defined as scattered high-density lesions completely separate from the main hemorrhage in at least the single axial slice. Functional outcome was evaluated using the modified Rankin Scale (mRS) at discharge. Poor functional outcome was defined as mRS scores of 3-6. Univariate and multivariate logistic regression analyses were applied to assess the presence of a satellite sign and its association with poor functional outcome. A total of 241 patients with ICH were enrolled in the study. Of these, 98 (40.7%) had a satellite sign. Patients with a satellite sign had a significantly higher rate of poor functional outcome (95.9%) than those without a satellite sign (55.9%, p < 0.0001). Multivariate logistic regression analysis revealed that higher age (OR 1.06; 95% CI 1.03-1.10; p = 0.00016), large hemorrhage size (OR 1.06; 95% CI 1.03-1.11; p = 0.00015), and ICH with a satellite sign (OR 13.5; 95% CI 4.42-53.4; p < 0.0001) were significantly related to poor outcome. A satellite sign was significantly related with higher systolic blood pressure (p = 0.0014), higher diastolic blood pressure (p = 0.0117), shorter activated partial thromboplastin time (p = 0.0427), higher rate of intraventricular bleeding (p < 0.0001), and larger main hemorrhage (p < 0.0001). The presence of a satellite sign in the initial CT scan is associated with a significantly worse functional outcome in ICH patients. © 2017 S. Karger AG, Basel.

  20. Psychological mindedness as a predictor of psychotherapy outcome: a preliminary report.

    PubMed

    Conte, H R; Plutchik, R; Jung, B B; Picard, S; Karasu, T B; Lotterman, A

    1990-01-01

    This study investigated the properties of a new measure of psychological mindness (PM). A 45-item self-report questionnaire was administered to consecutive admissions to a large outpatient clinic that provides primarily psychodynamically oriented individual psychotherapy. The PM scores of a sample of 44 of these patients who attended a median of 15 sessions were correlated with several outcome measures obtained from retrospective chart reviews. These measures consisted of the number of sessions attended, discharge ratings, and change scores on a Global Assessment Scale (GAS) and on a symptom checklist. Coefficient alpha for the Psychological Mindedness (PM) Scale indicated high reliability. Total PM score correlated significantly with three of the outcome measures. Twenty of the 45-items were good predictors of one or more outcome measures.

  1. MRI and EEG as long-term seizure outcome predictors in familial mesial temporal lobe epilepsy.

    PubMed

    Morita, Marcia E; Yasuda, Clarissa Lin; Betting, Luiz E; Pacagnella, Denise; Conz, Livia; Barbosa, Patricia Horn; Maurer-Morelli, Claudia Vianna; Costa, Andre Luiz F; Kobayashi, Eliane; Lopes-Cendes, Iscia; Cendes, Fernando

    2012-12-11

    To evaluate the natural history and outcome predictors in familial mesial temporal lobe epilepsy (FMTLE). We conducted a longitudinal study of 103 individuals from 17 FMTLE families (mean follow-up: 7.6 years). We divided subjects into 3 groups: FMTLE (n = 53), unclassified seizure (n = 18), and asymptomatics (n = 32). We divided FMTLE patients into 3 subgroups: seizure-free (n = 19), infrequent (n = 17) seizures, and frequent (n = 17) seizures and further reclassified them into favorable and poor outcome. We defined hippocampal atrophy (HA) by visual MRI analysis and performed volumetry in those who had 2 MRIs. FMTLE patients with infrequent seizures evolved to either frequent seizures (17.6%) or seizure freedom (23.5%). In the seizure-free group, most remained seizure-free and 21% developed infrequent seizures. All patients with frequent seizures remained in the same status or underwent surgery. Twelve percent of the asymptomatics and 22% of the unclassified-seizure group evolved to FMTLE with infrequent seizures. Predictive factors of poor outcome were presence of HA (p = 0.0192) and interictal epileptiform discharges (p = 0.0174). The relationship between initial precipitating incidents and clinical outcome was not significant although a tendency was observed (p = 0.055). Use of antiepileptic drugs and secondary generalized seizures during the patient's lifetime did not predict poor outcome. We observed progression of HA only in the group with frequent seizures. Most patients with FMTLE continued in the same clinical status. However, patients with frequent seizures had progression of HA and none improved except those who underwent surgery. Interictal epileptiform discharges and HA predicted poorer outcome in FMTLE, and there was a tendency in favor of initial precipitating incidents as outcome predictors.

  2. Predictors of Outcomes in a Performance Ladder Program.

    ERIC Educational Resources Information Center

    Dicks, Robert H.; McHenry, James D.

    1985-01-01

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

  3. Outcome predictors in African-American deceased-donor renal allograft recipients.

    PubMed

    Brown, Kristian L; El-Amm, Jose M; Doshi, Mona D; Singh, Atul; Cincotta, Elizabeth; Morawski, Katherina; Losanoff, Julian E; West, Miguel S; Gruber, Scott A

    2009-01-01

    The relative importance of donor and recipient risk factors in predicting outcomes in African-American (AA) renal allograft recipients receiving contemporary immunosuppression, including early steroid withdrawal, has not been previously examined. We assessed the impact of 21 risk factors on five primary outcomes in 132 deceased-donor AA renal allograft recipients transplanted from July 2001 to August 2006 with follow-up 6-67 (mean 35 +/- 17) months by univariate and multivariate analysis. Thymoglobulin or basiliximab was given for induction, and mycophenolate mofetil with either tacrolimus or sirolimus (SRL) +/- prednisone for maintenance. Non-compliance accounted for 26% of graft loss (GL) and 19% of acute rejection (AR) episodes, and was more prevalent in patients who were HCV+ and those on prednisone. Delayed graft function remained a significant predictor of GL, but not via increased AR, and donor ethnicity emerged as an important predictor of patient death. De novo use of SRL resulted in increased AR, and only increased recipient age significantly predicted new-onset diabetes mellitus. Our preliminary results suggest the need for improvements in patient education, pre-transplant psychosocial assessment, and late post-transplant psychosocial support and can be utilized to help guide donor/recipient selection and tailor immunosuppressive management to optimize outcomes in this challenging group of patients.

  4. Predictors of outcome for telephone and face-to-face administered cognitive behavioral therapy for depression

    PubMed Central

    Stiles-Shields, C.; Corden, M. E.; Kwasny, M. J.; Schueller, S. M.; Mohr, D. C.

    2015-01-01

    Background Cognitive behavioral therapy (CBT) can be delivered efficaciously through various modalities, including telephone (T-CBT) and face-to-face (FtF-CBT). The purpose of this study was to explore predictors of outcome in T-CBT and FtF-CBT for depression. Method A total of 325 depressed participants were randomized to receive eighteen 45-min sessions of T-CBT or FtF-CBT. Depression severity was measured using the Hamilton Depression Rating Scale (HAMD) and the Patient Health Questionnaire-9 (PHQ-9). Classification and regression tree (CART) analyses were conducted with baseline participant demographics and psychological characteristics predicting depression outcomes, HAMD and PHQ-9, at end of treatment (week 18). Results The demographic and psychological characteristics accurately identified 85.3% and 85.0% of treatment responders and 85.7% and 85.0% of treatment non-responders on the HAMD and PHQ-9, respectively. The Coping self-efficacy (CSE) scale predicted outcome on both the HAMD and PHQ-9; those with moderate to high CSE were likely to respond with no other variable influencing that prediction. Among those with low CSE, depression severity influenced response. Social support, physical functioning, and employment emerged as predictors only for the HAMD, and sex predicted response on the PHQ-9. Treatment delivery method (i.e. telephone or face-to-face) did not impact the prediction of outcome. Conclusions Findings suggest that the predictors of improved depression are similar across treatment modalities. Most importantly, a moderate to high level of CSE significantly increases the chance of responding in both T-CBT and FtF-CBT. Among patients with low CSE, those with lower depressive symptom severity are more likely to do well in treatment. PMID:26077620

  5. Patient motivation as a predictor of process and outcome in psychotherapy.

    PubMed

    Keithly, L J; Samples, S J; Strupp, H H

    1980-01-01

    This study examined the effect of the patient's level of motivation upon process and outcome in short-term psychotherapy. 18 shy, anxious, and depressed male college students received up to 25 sessions of therapy with experienced professional therapists. Analyses of audiotaped samples from four therapy sessions indicated that motivation was a good predictor of a patient's behavior in therapy. These analyses also suggested that the patient's level of motivation may influence the therapist's behavior during treatment. Lastly, ratings of motivation significantly predicted both the therapist's and the clinician's ratings of overall improvement, but not the patient's rating of overall improvement or the residual maladjustment scores derived from the MMPI.

  6. Significant adverse events and outcomes after medical abortion.

    PubMed

    Cleland, Kelly; Creinin, Mitchell D; Nucatola, Deborah; Nshom, Montsine; Trussell, James

    2013-01-01

    To analyze rates of significant adverse events and outcomes in women having a medical abortion at Planned Parenthood health centers in 2009 and 2010 and to identify changes in the rates of adverse events and outcomes between the 2 years. In this database review we analyzed data from Planned Parenthood affiliates that provided medical abortion in 2009 and 2010 almost exclusively using an evidence-based buccal misoprostol regimen. We evaluated the incidence of six clinically significant adverse events (hospital admission, blood transfusion, emergency department treatment, intravenous antibiotics administration, infection, and death) and two significant outcomes (ongoing pregnancy and ectopic pregnancy diagnosed after medical abortion treatment was initiated). We calculated an overall rate as well as rates for each event and identified changes between the 2 years. Among 233,805 medical abortions provided in 2009 and 2010, significant adverse events or outcomes were reported in 1,530 cases (0.65%). There was no statistically significant difference in overall rates between years. The most common significant outcome was ongoing intrauterine pregnancy (0.50%); significant adverse events occurred in 0.16% of cases. One patient death occurred as a result of an undiagnosed ectopic pregnancy. Only rates for emergency department treatment and blood transfusion differed by year and were slightly higher in 2010. Review of this large data set reinforces the safety of the evidence-based medical abortion regimen. III.

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-12-01

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

  9. Predictors of quality of life outcomes after revision total hip replacement.

    PubMed

    Biring, G S; Masri, B A; Greidanus, N V; Duncan, C P; Garbuz, D S

    2007-11-01

    A prospective cohort of 222 patients who underwent revision hip replacement between April 2001 and March 2004 was evaluated to determine predictors of function, pain and activity level between one and two years post-operatively, and to define quality of life outcomes using validated patient reported outcome tools. Predictive models were developed and proportional odds regression analyses were performed to identify factors that predict quality of life outcomes at one and two years post-operatively. The dependent outcome variables were the Western Ontario and McMaster Osteoarthritis Index (WOMAC) function and pain scores, and University of California Los Angeles activity scores. The independent variables included patient demographics, operative factors, and objective quality of life parameters, including pre-operative WOMAC, and the Short Form-12 mental component score. There was a significant improvement (t-test, p < 0.001) in all patient quality of life scores. In the predictive model, factors predictive of improved function (original regression analyses, p < 0.05) included a higher pre-operative WOMAC function score (p < 0.001), age between 60 and 70 years (p < 0.037), male gender (p = 0.017), lower Charnley class (p < 0.001) and aseptic loosening being the indication for revision (p < 0.003). Using the WOMAC pain score as an outcome variable, factors predictive of improvement included the pre-operative WOMAC function score (p = 0.001), age between 60 and 70 years (p = 0.004), male gender (p = 0.005), lower Charnley class (p = 0.001) and no previous revision procedure (p = 0.023). The pre-operative WOMAC function score (p = 0.001), the indication for the operation (p = 0.007), and the operating surgeon (p = 0.008) were significant predictors of the activity assessment at follow-up. Predictors of quality of life outcomes after revision hip replacement were established. Although some patient-specific and surgery-specific variables were important, age, gender

  10. Predictors and outcomes of nurse leader job stress experienced by AWHONN members.

    PubMed

    Kath, Lisa M; Stichler, Jaynelle F; Ehrhart, Mark G; Schultze, Tressa A

    2013-01-01

    To measure the relationships among stressors (personal factors, job/role factors, hospital factors), job stress, and outcomes experienced by nurse leaders and examine moderation of autonomy and leadership style on outcomes of job stress. A cross-sectional, quantitative design. Acute and nonacute care settings throughout North America. A nonprobability convenience sample of 392 was drawn from a population of nurse leaders across the United States and Canada who were members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). A mailing list was obtained from AWHONN, and a total of 3,986 recruitment and follow-up postcards were sent to nurse leaders. Participants were asked to complete the survey online or request a hard copy to return by mail. Study variables were measured using previously published scales with demonstrated psychometric properties. Nurse leaders reported stress averages above the midpoint of the scales. Personal factors did not significantly predict stress, but role overload, organizational constraints, and role ambiguity were found to be the best predictors of stress. Job satisfaction, intent to quit, and mental health symptoms were the most significant outcomes of stress. Autonomy moderated relationships between perceptions of stress and outcomes with low autonomy showing greater negative outcomes when levels of stress are higher. Nurse leaders experience significant job stress that may suggest a need to design and implement evidence-based interventions to reduce stress among this group. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  11. Work characteristics as predictors of correctional supervisors’ health outcomes

    PubMed Central

    Buden, Jennifer C.; Dugan, Alicia G.; Namazi, Sara; Huedo-Medina, Tania B.; Cherniack, Martin G.; Faghri, Pouran D.

    2016-01-01

    Objective This study examined associations among health behaviors, psychosocial work factors, and health status. Methods Correctional supervisors (n=157) completed a survey that assessed interpersonal and organizational views on health. Chi-square and logistic regressions were used to examine relationships among variables. Results Respondents had a higher prevalence of obesity and comorbidities compared to the general U.S. adult population. Burnout was significantly associated with nutrition, physical activity, sleep duration, sleep quality, diabetes, and anxiety/depression. Job meaning, job satisfaction and workplace social support may predict health behaviors and outcomes. Conclusions Correctional supervisors are understudied and have poor overall health status. Improving health behaviors of middle-management employees may have a beneficial effect on the health of the entire workforce. This paper demonstrates the importance of psychosocial work factors that may contribute to health behaviors and outcomes. PMID:27483335

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  15. Tension-time index as a predictor of extubation outcome in ventilated children.

    PubMed

    Harikumar, Gopinathannair; Egberongbe, Yaya; Nadel, Simon; Wheatley, Elizabeth; Moxham, John; Greenough, Anne; Rafferty, Gerrard F

    2009-11-15

    Indices that assess the load on the respiratory muscles, such as the tension-time index (TTI), may predict extubation outcome. To evaluate the performance of a noninvasive assessment of TTI, the respiratory muscle tension time index (TTmus), by comparison to that of the diaphragm tension time index (TTdi) and other predictors of extubation outcome in ventilated children. Eighty children (median [range] age 2.1 yr [0.15-16]) admitted to pediatric intensive care units at King's College and St Mary's Hospitals who required mechanical ventilation for more than 24 hours were studied. TTmus, maximal inspiratory pressure, respiratory drive, respiratory system mechanics, and functional residual capacity using a helium dilution technique, the rapid shallow breathing and CROP indices (compliance, rate, oxygenation, and pressure) indexed for body weight were measured and standard clinical data recorded in all patients. TTdi was measured in 28 of the 80 children using balloon catheters. Eight children (three in the TTdi group) failed extubation. TTmus (0.199 vs. 0.09) and TTdi (0.157 vs. 0.07) were significantly higher in children who failed extubation. TTmus greater than 0.18 (n = 80) and TTdi greater than 0.15 (n = 28) had sensitivities and specificities of 100% in predicting extubation failure. The other predictors performed less well. Invasive and noninvasive measurements of TTI may provide accurate prediction of extubation outcome in mechanically ventilated children.

  16. Variation Coefficient of Stone Density: A Novel Predictor of the Outcome of Extracorporeal Shockwave Lithotripsy.

    PubMed

    Yamashita, Shimpei; Kohjimoto, Yasuo; Iguchi, Takashi; Nishizawa, Satoshi; Iba, Akinori; Kikkawa, Kazuro; Hara, Isao

    2017-04-01

    Although previous studies have indicated that stone heterogeneity can affect extracorporeal shockwave lithotripsy (SWL) outcomes, there is no established measurement of stone heterogeneity on CT imagery. We investigated whether variation coefficient of stone density (VCSD) can predict shockwave success. We conducted a retrospective review of 245 patients with urinary calculi who had undergone SWL. We compared the predictive powers of treatment success between VCSD and other parameters associated with CT attenuation. In addition, we performed logistic regression analysis to identify the factors contributing to treatment success. Treatment success was determined within 3 months after first treatment using noncontrast CT. The treatment success rate was 47.8% (117/245 cases). From receiver operating characteristic curves for treatment success, area under curve of VCSD (0.7181) was larger than that of mean stone density (MSD) (0.6384, p = 0.09) and standard deviation of stone density (0.5412, p < 0.01). Multivariate analysis revealed that MSD (p = 0.028) and VCSD (p < 0.001) independently predicted the outcome. Categorized by stone location, VCSD was the independent significant predictor for SWL outcomes in both kidney (p = 0.047) and ureteral calculi (p < 0.001). We found that VCSD can be a novel predictor of SWL success. The development of nomograms or scoring systems, including VCSD, can assist in the decision process for patients and minimize unnecessary delay in treatment of urolithiasis.

  17. Clinical predictors of genetic testing outcomes in hypertrophic cardiomyopathy.

    PubMed

    Ingles, Jodie; Sarina, Tanya; Yeates, Laura; Hunt, Lauren; Macciocca, Ivan; McCormack, Louise; Winship, Ingrid; McGaughran, Julie; Atherton, John; Semsarian, Christopher

    2013-12-01

    Genetic testing for hypertrophic cardiomyopathy has been commercially available for almost a decade; however, low mutation detection rate and cost have hindered uptake. This study sought to identify clinical variables that can predict probands with hypertrophic cardiomyopathy in whom a pathogenic mutation will be identified. Probands attending specialized cardiac genetic clinics across Australia over a 10-year period (2002-2011), who met clinical diagnostic criteria for hypertrophic cardiomyopathy and who underwent genetic testing for hypertrophic cardiomyopathy were included. Clinical, family history, and genotype information were collected. A total of 265 unrelated individuals with hypertrophic cardiomyopathy were included, with 138 (52%) having at least one mutation identified. The mutation detection rate was significantly higher in the probands with hypertrophic cardiomyopathy with an established family history of disease (72 vs. 29%, P < 0.0001), and a positive family history of sudden cardiac death further increased the detection rate (89 vs. 59%, P < 0.0001). Multivariate analysis identified female gender, increased left-ventricular wall thickness, family history of hypertrophic cardiomyopathy, and family history of sudden cardiac death as being associated with greatest chance of identifying a gene mutation. Multiple mutation carriers (n = 16, 6%) were more likely to have suffered an out-of-hospital cardiac arrest or sudden cardiac death (31 vs. 7%, P = 0.012). Family history is a key clinical predictor of a positive genetic diagnosis and has direct clinical relevance, particularly in the pretest genetic counseling setting.

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

    PubMed

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

    2011-09-01

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

  19. Predictors of professional placement outcome: cultural background, English speaking and international student status.

    PubMed

    Attrill, Stacie; McAllister, Sue; Lincoln, Michelle

    2016-08-01

    Placements provide opportunities for students to develop practice skills in professional settings. Learning in placements may be challenging for culturally and linguistically diverse (CALD) students, international students, or those without sufficient English proficiency for professional practice. This study investigated whether these factors, which are hypothesized to influence acculturation, predict poor placement outcome. Placement outcome data were collected for 854 students who completed 2747 placements. Placement outcome was categorized into 'Pass' or 'At risk' categories. Multilevel binomial regression analysis was used to determine whether being CALD, an international student, speaking 'English as an additional language', or a 'Language other than English at home' predicted placement outcome. In multiple multilevel analysis speaking English as an additional language and being an international student were significant predictors of 'at risk' placements, but other variables tested were not. Effect sizes were small indicating untested factors also influenced placement outcome. These results suggest that students' English as an additional language or international student status influences success in placements. The extent of acculturation may explain the differences in placement outcome for the groups tested. This suggests that learning needs for placement may differ for students undertaking more acculturative adjustments. Further research is needed to understand this and to identify placement support strategies.

  20. Change in asthma control over time: predictors and outcomes.

    PubMed

    Schatz, Michael; Zeiger, Robert S; Yang, Su-Jau; Chen, Wansu; Crawford, William; Sajjan, Shiva; Allen-Ramey, Felicia

    2014-01-01

    Maintenance of asthma control over time is a clear goal of national asthma guidelines, but few studies have addressed the natural history of asthma control over time. To assess the impairment domain of asthma control over time in patients with persistent asthma and to determine predictors and consequences of controlled and uncontrolled asthma over time. Patients 18-56 years old with persistent asthma who completed baseline (November 2007) and follow-up asthma surveys (April, July, October 2008) were included in the study. The survey included the Asthma Control Test as well as questions regarding other patient and asthma characteristics. Health care utilization (pharmacy and exacerbations) for 2008 was obtained from administrative data. The baseline and first follow-up surveys were completed by 1267 patients, and all 4 surveys were completed by 782 patients. Patients with well-controlled asthma at baseline were significantly more likely (P < .0001) to have well-controlled asthma over the following year (76.2%-80.4%) than patients with uncontrolled asthma at baseline (33.5%-36.9%). Patients whose asthma control improved over the first several months of follow-up experienced significantly (P < .05) fewer exacerbations over the subsequent year than patients with initially uncontrolled asthma who did not improve. Degree of asthma control at one point in time is strongly related to the achievement or maintenance of control and to asthma exacerbations over time. Patients with uncontrolled asthma, especially very poorly controlled asthma, should receive intensive management and follow-up in an attempt to achieve well-controlled asthma over time. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  1. Predictors of Visual Outcome Following Surgical Resection of Medial Sphenoid Wing Meningiomas

    PubMed Central

    Chaichana, Kaisorn L.; Jackson, Christopher; Patel, Amar; Miller, Neil R.; Subramanian, Prem; Lim, Michael; Gallia, Gary; Olivi, Alessandro; Weingart, Jon; Brem, Henry; Quiñones-Hinojosa, Alfredo

    2012-01-01

    Objective Medial sphenoid wing meningiomas (SWMs) are relatively common tumors that are associated with significant morbidity and mortality, primarily from their anatomic proximity to many critical neurological and vascular structures. A major complication is visual deterioration. This study aimed to identify predictors of visual outcome following medial SWM resection. Design Retrospective, stepwise multivariate proportional hazards regression analysis. Setting Johns Hopkins Hospital. Participants All patients who underwent medial SWM resection from 1998 to 2009. Main Outcome Measures Visual function. Results Sixty-five medial SWM resections were performed. After multivariate proportional hazards regression analysis, preoperative visual decline (relative risk [RR] 95% confidence interval [CI]; 13.431 [2.601 to 46.077], p = 0.006), subtotal resection (RR [95% CI]; 3.717 [1.204 to 13.889], p = 0.02), and repeat surgery (RR [95% CI]; 5.681 [1.278 to 19.802], p = 0.03) were found to be independent predictors of visual decline at last follow-up. Tumor recurrence and postoperative radiation therapy trended toward, but did not reach statistical significance. Conclusion These findings advocate for early and aggressive surgical intervention for patients with medial SWMs to maximize the likelihood of subsequent visual preservation. This may provide patients and physicians with prognostic information that may guide medical and surgical therapy for patients with medial SWMs. PMID:24083123

  2. 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.

  3. Predictors of neurodevelopmental outcome for preterm infants with brain injury: MRI, medical and environmental factors

    PubMed Central

    Badr, Lina Kurdahi; Bookheimer, Susan; Purdy, Isabell; Deeb, Mary

    2009-01-01

    This multi-center correlational prospective study examined early neonatal predictors of neurodevelopment in 59 premature infants (mean birth weight=1713.8±1242.5 g; mean gestational age=31.2±3.6 weeks) suspected to have sustained brain injury at birth. The mental and motor development of the infants selected from five university-affiliated hospitals was assessed at baseline (59 infants), 12 (55 infants), and 18 months (46 infants) using Bayley II scales. Factors correlating with Bayley II scores at 12 and 18 months included head circumference, results of neurological and magnetic resonance imaging (MRI) examination at baseline, environmental factors such as mother–infant interactions and levels of parental stress, and infant medical factors such as Apgar scores at 5 min and length of hospital stay. Multiple regression analyses distinguished the most significant predictors of mental and motor development. The best predictors of mental and motor development at 18 months were head circumference, neurological examinations, and MRI results. These findings suggest that in infants suspected of brain injury at birth, neurological assessments and head circumference measurements are just as predictive of developmental outcome at 18 months as MRI, and this is especially relevant in developing countries or other locations where MRI is not possible. The presence of this information may offer the potential of early tailored interventions to improve the mental and motor development of children in developing countries or other facilities where MRI is unavailable. PMID:19141366

  4. Demographical and clinicopathological characteristics in heart failure and outcome predictors: a prospective, observational study

    PubMed Central

    Sajeev, Chakanalil Govindan; George, Biju; Rajesh, Gopalan Nair; Krishnan, Mangalath Narayanan

    2016-01-01

    Abstract Aims The aims of the study were to study the demographical and clinicopathological characteristics of patients presenting with heart failure and evaluate the 1 year outcomes and to identify risk predictors if any. Methods and results A prospective observational study was conducted in consecutive patients of systolic heart failure. The study was divided into two parts—an initial 6 month enrolment phase followed up for 1 year for major adverse cardiovascular events. All patients were treated according to the Institutional Heart Failure Protocol. Demographical and clinicopathophysiological characteristics were studied, and results were analysed. A total of 143 patients were enrolled. The mean age of subjects was 56.4 years with male subjects constituting almost two‐thirds of the study population. The commonest aetiology of heart failure was ischemic with valvular heart disease being the commonest cause of non‐ischemic heart failure. Bendopnea, a recently described symptom of heart failure, was found in a significant number of subjects. By univariate analysis, male sex (P = 0.042) and cardiomegaly (P = 0.035) were predictors of rehospitalization, whereas the univariate predictors of mortality were ischemic aetiology (P = 0.000), age > 50 years (P = 0.007), hypertension (P = 0.012), worsening NYHA class (P = 0.003), diabetes mellitus (P = 0.009), and hypokalaemia (P = 0.006). Multivariate analysis performed showed age > 50 years [P = 0.007; OR (CI) = 13.547 (2.034–90.238)], NYHA class [P = 0.002; OR (CI) = 32.300 (3.733–276.532)], and hypokalaemia [P = 0.031; OR (CI) = 7.524 (1.208–46.862)] as significant predictors of mortality during long‐term follow‐up. Conclusions The study will definitely help us to throw more light in identifying risk predictors of heart failure and help in improving clinical outcomes. PMID:28217308

  5. Predictors of 1-year outcomes in the Taiwan Acute Coronary Syndrome Full Spectrum Registry.

    PubMed

    Chiang, Fu-Tien; Shyu, Kou-Gi; Wu, Chiung-Jen; Mar, Guang-Yuan; Hou, Charles Jia-Yin; Li, Ai-Hsien; Wen, Ming-Shien; Lai, Wen-Ter; Lin, Shing-Jong; Kuo, Chi-Tai; Kuo, Chieh; Li, Yi-Heng; Hwang, Juey-Jen

    2014-11-01

    Evidence-based guidelines have been formulated for optimal management of acute coronary syndrome (ACS). The Taiwan ACS Full Spectrum Registry aimed to evaluate the ACS management and identify the predictors of clinical outcomes of death/myocardial infarction/stroke 1 year post hospital discharge. Three thousand and eighty confirmed ACS patients enrolled in this registry were followed up for 1 year at 3-month intervals. Patient data on medical interventions as well as clinical events were recorded and analyzed by descriptive statistics. One-year mortality among patients with ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina was 6.1%, 10.1%, and 6.2%, respectively. Use of secondary preventive therapies was suboptimal throughout the follow-up phase, especially dual antiplatelet therapy, which fell from 74.8% patients at discharge to 24.9% patients at 1-year follow-up. The odds of an adverse incidence of death/myocardial infarction/stroke 1 year after discharge was significantly reduced in patients receiving aspirin and clopidogrel for ≥9 months and was consequently higher in patients in whom dual antiplatelet therapy was discontinued or prescribed for <9 months. Chronic renal failure, in-hospital bleeding, a diagnosis of NSTEMI, and antiplatelet therapy discontinuation had a negative association with 1-year outcomes, whereas the use of drug-eluting stents and antiplatelet agents, clopidogrel and aspirin, were predictors of positive outcomes. There is a significant deviation from evidence-based guidelines in ACS management in Taiwan as reported in other countries. Policy adherence, especially with regard to dual antiplatelet therapy may hold the key to long-term favorable outcomes and improved survival rates in ACS patients in Taiwan. Copyright © 2013. Published by Elsevier B.V.

  6. Exploring predictors of treatment outcome in cognitive behavior therapy for sleep disturbance following acquired brain injury.

    PubMed

    Nguyen, Sylvia; McKenzie, Dean; McKay, Adam; Wong, Dana; Rajaratnam, Shantha M W; Spitz, Gershon; Williams, Gavin; Mansfield, Darren; Ponsford, Jennie

    2017-04-19

    To identify predictors of treatment response to cognitive behavior therapy (CBT) for sleep disturbance following acquired brain injury (ABI). Classification and regression tree (CART) analysis was conducted on individual patient data from two pilot randomized controlled trials (RCTs): one in traumatic brain injury (TBI), the other in stroke. The combined sample comprised 32 participants; 15 receiving CBT and 17 allocated to treatment as usual (TAU). The outcome was reliable improvement on the Pittsburgh Sleep Quality Index (PSQI). Study group was a statistically significant predictor of outcome, with CBT participants more likely to achieve reliable improvements than TAU (OR = 4.88, p = 0.042). Study group (CBT vs. TAU) exhibited an area under the ROC curve (AUROC) of 69%. In separate CART analyzes, verbal memory (CVLT-II >45.5), age (<47.5) and baseline depression (HADS-D > 6) predicted positive outcomes in CBT recipients. Each of these variables added a small (∼5%) but not statistically significant amount to AUROC over study group. In this ABI sample, better memory, younger age, and higher baseline depression were associated with positive treatment response to CBT although individually these variables were not better than group alone in predicting outcomes. The present findings generate hypotheses for further investigation in future studies. Implications for rehabilitation Cognitive behavior therapy improves sleep quality over treatment as usual in persons with acquired brain injury. Individuals who are younger in age with better memory and co-morbid symptoms of depression are more likely to respond to the treatment. These findings are based on a small sample and can be considered hypothesis generating for future clinical studies.

  7. Persistent nasal methicillin-resistant staphylococcus aureus carriage in hemodialysis outpatients: a predictor of worse outcome

    PubMed Central

    2013-01-01

    Background Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a well defined risk factor for subsequent bacteremia and death in various groups of patients, but its impact on outcome in patients receiving long-term hemodialysis (HD) is under debate. Methods This prospective interventional cohort study (performed 2004 to 2010) enrolled 289 HD outpatients of an urban dialysis-unit. Nasal swab cultures for MRSA were performed in all patients upon first admission, at transfer from another dialysis facility or readmission after hospitalisation. Nasal MRSA carriers were treated in a separate ward and received mupirocin nasal ointment. Concomitant extra-nasal MRSA colonization was treated with 0.2% chlorhexidine mouth rinse (throat) or octenidine dihydrochloride containing antiseptic soaps and 2% chlorhexidine body washes (skin). Clinical data and outcome of carriers and noncarriers were systematically analyzed. Results The screening approach identified 34 nasal MRSA carriers (11.7%). Extra-nasal MRSA colonization was observed in 11/34 (32%) nasal MRSA carriers. History of malignancy and an increased Charlson Comorbidity Index were significant predictors for nasal MRSA carriers, whereas traditional risk factors for MRSA colonization or markers of inflammation or malnutrition were not able to discriminate. Kaplan-Meier analysis demonstrated significant survival differences between MRSA carriers and noncarriers. Mupirocin ointment persistently eliminated nasal MRSA colonization in 26/34 (73.5%) patients. Persistent nasal MRSA carriers with failure of this eradication approach had an extremely poor prognosis with an all-cause mortality rate >85%. Conclusions Nasal MRSA carriage with failure of mupirocin decolonization was associated with increased mortality despite a lack of overt clinical signs of infection. Further studies are needed to demonstrate whether nasal MRSA colonization represents a novel predictor of worse outcome or just another

  8. Upper aerodigestive tract sequelae in severe enterovirus 71 infection: predictors and outcome.

    PubMed

    Tsou, Yung-An; Cheng, Yuan-Kai; Chung, Hsiung-Kwan; Yeh, Yi-Chun; Lin, Chia-Der; Tsai, Ming-Hsui; Chang, Jeng-Sheng

    2008-01-01

    Enterovirus 71 (EV71) infection sequelae can be severe and life-threatening, and long-term follow-up outcomes remain unknown. Therefore, we conducted a retrospective follow-up study to review airway and neurological sequelae development in patients with severe EV71 infection. We also studied the incidence and risk factors for tracheotomy and gastrostomy requirement. We investigated 202 EV71-infected children according to their disease stage. Seventy-two of them were diagnosed to have EV71 encephalitis, which was characterized by myoclonus, ataxia, nystagmus, oculomotor palsy and bulbar palsy or combinations of these conditions. All the 72 patients required endotracheal intubation due to respiratory failure or ventilator dependence; among these, 14 underwent tracheostomy and 10 underwent gastrostomy. All patients were followed-up for at least 3 years after discharge. Predictors of tracheostomy and gastrostomy requirement were age <2 years, body weight <10th percentile, pulmonary hemorrhage or edema, meningeal symptoms and magnetic resonance imaging (MRI) findings of upper spinal cord and brainstem. We determined outcome based on persistent tracheostomy or gastrostomy requirement and whether patients developed positive neurological sequelae. Significant tracheostomy and gastrostomy predictors were age <2 years, pulmonary edema or hemorrhage, hypotension, hemiparesis and positive MRI findings. Statistical analysis revealed pulmonary edema and hypotension as index predictors of tracheostomy requirement and pulmonary edema as the significant risk factor for gastrostomy. Long-term neuropsychological impact was observed on children who present the signs of the pulmonary edema or hypotension in the early onset of the EV71 infection. EV71-infected patients who develop neurological pulmonary edema or hypotension should be hemodynamically stabilized and undergo early tracheostomy to prevent further complications. This may improve the decannulation success rate after the

  9. Significant Learning Outcomes: NMC Ends Report, September 1995.

    ERIC Educational Resources Information Center

    Berman, Jack; And Others

    In an effort to determine success in fostering student development as well-rounded human beings, Northwestern Michigan College (NMC) undertook a study of student achievement related to significant learning outcomes established by the college. The study focused on four measures of achievement: results from a spring 1995 administration of the…

  10. Predictors of Developmental Outcome in Very Low Birth Weight Infants.

    ERIC Educational Resources Information Center

    Macias, Michelle M.; Saylor, Conway F.; Younginer, Erik; Katikaneni, Lakshmi D.

    2000-01-01

    Examined predictors of development in very low birth weight infants from diverse backgrounds. Found that low income and greater frequency of medical problems predicted developmental risk on the Bayley Scales. In two-parent households, paternal education predicted developmental scores. Several individual biomedical factors predicted…

  11. Seizure Outcomes and Predictors of Recurrent Post-Stroke Seizure: A Retrospective Observational Cohort Study

    PubMed Central

    Motoyama, Rie; Fukuma, Kazuki; Miyagi, Tetsuya; Nishimura, Kazutaka; Toyoda, Kazunori; Nagatsuka, Kazuyuki

    2015-01-01

    Background Seizure is a common complication after stroke (termed “post-stroke seizure,” PSS). Although many studies have assessed outcomes and risk factors of PSS, no reliable predictors are currently available to determine PSS recurrence. We compared baseline clinical characteristics and post-stroke treatment regimens between recurrent and non-recurrent PSS patients to identify factors predictive of recurrence. Methods Consecutive PSS patients admitted to our stroke center between January 2011 and July 2013 were monitored until February 2014 (median 357 days; IQR, 160–552) and retrospectively evaluated for baseline clinical characteristics and PSS recurrence. Cumulative recurrence rates at 90, 180, and 360 days post-stroke were estimated by Kaplan—Meier analysis. Independent predictors of recurrent PSS were identified by Cox proportional-hazards analysis. Results A total of 104 patients (71 men; mean age, 72.1 ± 11.2 years) were analyzed. PSS recurred in 31 patients (30%) during the follow-up. Factors significantly associated with PSS recurrence by log-rank analysis included previous PSS, valproic acid (VPA) monotherapy, polytherapy with antiepileptic drugs (AEDs), frontal cortical lesion, and higher modified Rankin Scale score at discharge (all p < 0.05). Independent predictors of recurrent PSS were age <74 years (HR 2.38, 95% CI 1.02–5.90), VPA monotherapy (HR 3.86, 95% CI 1.30–12.62), and convulsions on admission (HR 3.87, 95% CI 1.35–12.76). Conclusions Approximately one-third of PSS patients experienced seizure recurrence within one year. The predictors of recurrent PSS were younger age, presence of convulsions and VPA monotherapy. Our findings should be interpreted cautiously in countries where monotherapy with second-generation AEDs has been approved because this study was conducted while second-generation AEDs had not been officially approved for monotherapy in Japan. PMID:26309124

  12. Clinical and kidney morphologic predictors of outcome for renal artery stenting: data to inform patient selection.

    PubMed

    Modrall, J Gregory; Rosero, Eric B; Leonard, David; Timaran, Carlos H; Anthony, Thomas; Arko, Frank A; Valentine, R James; Clagett, G Patrick; Trimmer, Clayton

    2011-05-01

    The purpose of the current study was to identify clinical and kidney morphologic features that predict a favorable blood pressure (BP) response to renal artery stenting (RAS). The study cohort consisted of 149 patients who underwent primary RAS over 9 years. Patients were categorized as "responders" based on modified American Heart Association guidelines: BP <160/90 mm Hg on fewer antihypertensive medications or diastolic BP <90 mm Hg on the same medications. All other patients were deemed "nonresponders." Renal volume was estimated as kidney length × width × depth/2 based on preoperative computed tomography or magnetic resonance scans. Median follow-up was 19 months (interquartile range [IQR] 10.0-29.5 months). The median age of the cohort was 68 years (IQR, 60-74 years). A favorable BP response was observed in 50 of 149 patients (34%). Multivariate analysis identified three independent predictors of a positive BP response: (1) requirement for four or more medications (odds ratio, 29.9; P = .0001), (2) preoperative diastolic BP >90 mm Hg (OR, 31.4; P = .0011), and (3) preoperative clonidine use (OR, 7.3; P = .029). The BP response rate varied significantly based on the number of predictors present per patient (P < .0001). Among patients with three-drug hypertension, a larger ipsilateral kidney (volume ≥150 cm(3)) increased the BP response rate more than threefold compared with patients with smaller kidneys (63% vs 18% BP response rate; P = .018). The current study demonstrated that three clinical predictors (≥4 antihypertensive medications, diastolic BP ≥90 mm Hg, and clonidine use) are preoperative predictors of BP response to RAS. Kidney volume may help in discriminating responders from nonresponders among those patients with three-drug hypertension. These parameters may assist clinicians in patient selection and provide more concrete data with which to counsel patients on the likely outcomes for RAS. Published by Mosby, Inc.

  13. Therapeutic Alliance With Depressed Adolescents: Predictor or Outcome? Disentangling Temporal Confounds to Understand Early Improvement.

    PubMed

    Labouliere, Christa D; Reyes, J P; Shirk, Stephen; Karver, Marc

    2015-06-04

    Psychotherapy research reveals consistent associations between therapeutic alliance and treatment outcomes in the youth literature; however, past research frequently suffered measurement issues that obscured temporal relationships between alliance and symptomatology by measuring variables later in therapy, thereby precluding examination of important early changes. The current study aimed to explore the directions of effect between alliance and outcome early in therapy with adolescents by examining associations between first- and fourth-session therapeutic alliance and symptomatology. Thirty-four adolescents (∼63% female, 38% ethnic/racial minority) participated in a school-based cognitive-behavioral therapy for adolescents with depression. Participants completed the Beck Depression Inventory at baseline and Session 4, and therapeutic alliance was coded from audiotapes of Sessions 1 and 4 by objective coders using the Alliance Observation Coding System. Autoregressive path analyses determined that first-session therapeutic alliance was a strong significant predictor of Session 4 depression symptoms, but pretreatment depression scores were not significantly predictive of subsequent therapeutic alliance. Adding reciprocal effects between alliance and depression scores did not adversely affect model fit, suggesting that reciprocal effects may exist. Early therapeutic alliance with adolescents is critical to fostering early gains in depressive symptomatology. Knowing alliance's subsequent effect on youth outcomes, clinicians should increase effort to foster a strong relationship in early sessions and additional research should be conducted on the reciprocal effects of therapeutic alliance and treatment outcome in adolescence.

  14. Predictors of outcomes and refractoriness in status epilepticus: A prospective study.

    PubMed

    Atmaca, Murat Mert; Bebek, Nerses; Baykan, Betül; Gökyiğit, Ayşen; Gürses, Candan

    2017-10-01

    The objective of this study was to determine the predictors of outcomes and refractoriness in status epilepticus (SE). This is a prospective study of 59 adult patients with SE who were admitted to the Emergency Department between February 2012 and December 2013. The effects of clinical, demographic, and electrophysiologic features of patients with SE were evaluated. To evaluate outcome in SE, STESS, mSTESS, and EMSE scales were used. Logistic regression analysis showed that being aged ≥65years (p=0.02, OR: 17.68, 95% CI: [1.6-198.4]) for the short term and having potentially fatal etiology (p=0.027, OR: 11.7, 95% CI: [1.3-103]) for the long term were the only independent predictors of poor outcomes; whereas, the presence of periodic epileptiform discharges (PEDs) in EEG was the only independent predictor of refractoriness (p=0.032, OR: 13.7, 95% CI: [1.3-148.5]). The patients with ≥3 Status Epilepticus Severity Score (STESS) did not have poorer outcomes in the short- (p=0.157) and long term (p=0.065). There was no difference between patients with 0-2, 3-4, and ≥4 mSTESS in the short- and long term in terms of outcome (p=0.28 and 0.063, respectively). Also, there was no difference between subgroups (convulsive SE [CSE], nonconvulsive SE [NCSE], and epilepsia partialis continua [EPC]) in terms of STESS and mSTESS. When patients with EPC were excluded, both STESS and mSTESS scores of the patients correlated with poorer long-term outcomes (p=0.025 and 0.017, respectively). The patients with ≥64 points in the Epidemiology-based Mortality in SE-Etiology, age, comorbidity, EEG (EMSE-EACE) score and those with ≥27 points in EMSE-Etiology, age, comorbidity (EMSE-EAC) score did not have poorer outcomes in the short term (p=0.06 and 0.274, respectively) while they had significantly poorer outcome in the long term (p<0.001 and 0.002, respectively). In subgroup analysis, patients with CSE with ≥64 points in EMSE-EACE had significantly poorer outcome in the both

  15. Neurocognitive Predictors of ADHD Outcome: a 6-Year Follow-up Study.

    PubMed

    van Lieshout, Marloes; Luman, Marjolein; Twisk, Jos W R; Faraone, Stephen V; Heslenfeld, Dirk J; Hartman, Catharina A; Hoekstra, Pieter J; Franke, Barbara; Buitelaar, Jan K; Rommelse, Nanda N J; Oosterlaan, Jaap

    2017-02-01

    Although a broad array of neurocognitive dysfunctions are associated with ADHD, it is unknown whether these dysfunctions play a role in the course of ADHD symptoms. The present longitudinal study investigated whether neurocognitive functions assessed at study-entry (mean age = 11.5 years, SD = 2.7) predicted ADHD symptom severity and overall functioning 6 years later (mean age = 17.4 years, 82.6 % = male) in a carefully phenotyped large sample of 226 Caucasian participants from 182 families diagnosed with ADHD-combined type. Outcome measures were dimensional measures of ADHD symptom severity and the Kiddie-Global Assessment Scale (K-GAS) for overall functioning. Predictors were derived from component scores for 8 domains of neurocognitive functioning: working memory, motor inhibition, cognitive inhibition, reaction time variability, timing, information processing speed, motor control, intelligence. Effects of age, gender, and pharmacological treatment were considered. Results showed that better working memory predicted lower ADHD symptom severity (R (2)  = 3.0 %), and less reaction time variability predicted better overall functioning (higher K-GAS-score, R (2)  = 5.6 %). Predictors were still significant with baseline behavior included in the models. The role of neurocognitive functioning in the long term outcome of ADHD behavior is discussed.

  16. Predictors of vocational outcomes using individual placement and support for people with mental illness.

    PubMed

    Nygren, Ulla; Markström, Urban; Bernspång, Birgitta; Svensson, Bengt; Hansson, Lars; Sandlund, Mikael

    2013-01-01

    People with disabilities find it harder to enter the labour market than people without disabilities and those with a mental illness are, in relation to people with other disabilities, employed at an essentially lower extent. Many are effectively helped by the vocational rehabilitation model Individual Placement and Support (IPS), but there are still many individuals left in undesired unemployment. This study investigates potential predictors of the vocational outcomes of a one-year follow up of IPS in the north of Sweden. The participants were 65 men and women, mostly younger than 30 years of age diagnosed with a mental illness (predominantly with a diagnosis of anxiety and/or depression). Baseline data related to sociodemographic and clinical characteristics of the client, the client's own perceptions of every day living and participation, self-esteem and quality of life, as well as the quantity of employment support, were investigated using analyses of logistic regression. Of three identified potential predictors, only psychiatric symptoms remained significant in the multivariate logistic regression analyses. A lower level of symptoms increased the odds with 5.5 for gaining employment during one year. Careful investigation of how psychiatric symptoms influence clients' occupational performance is of importance. By understanding essential aspects of the relationships between the clients' individual characteristics, the rehabilitation context and the vocational outcomes, more appropriate and effective interventions may be offered to the individual client.

  17. Predictors of quality of life outcomes in chronic rhinosinusitis after sinus surgery.

    PubMed

    Katotomichelakis, Michael; Simopoulos, Efthimios; Tripsianis, Gregory; Balatsouras, Dimitrios; Danielides, Gerasimos; Kourousis, Christos; Livaditis, Miltos; Danielides, Vassilios

    2014-04-01

    The predictive value of olfaction for quality of life (QoL) recovery after endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) is still underestimated. The aim of this study was to explore the proportion of patients suffering from CRS who experience clinically significant QoL improvement after ESS and identify pre-operative clinical phenotypes that best predict surgical outcomes for QoL, focusing mainly on the role of patients' olfaction. One hundred eleven patients following ESS for CRS and 48 healthy subjects were studied. Olfactory function was expressed by the combined "Threshold Discrimination Identification" score using "Sniffin' sticks" test pre-treatment and 12 months after treatment. All subjects completed validated, widely used QoL questionnaires, specific for olfaction (Questionnaire of Olfactory Deficits: QOD), for assessing psychology (Beck Depression Inventory: BDI) and for general health (Short Form-36: SF-36). Statistically significant improvement of olfactory function by 41.8% and of all QoL questionnaires scores (all p < 0.001) was observed on the 12-month follow-up examination. Clinically significant improvement for QoL was measured in a proportion of 56.8% of patients on QOD, 64.9% on SF-36 and 49.5% on BDI scales results. Although olfactory dysfunction, nasal polyps, female gender, high socio-economic status and non-smoking habits were significantly associated with better QoL results, multivariate logistic regression analysis revealed that only olfactory dysfunction and nasal polyps were independent predictors significantly associated with higher likelihood of clinically significant improvement in all QoL questionnaire results. Olfactory dysfunction and nasal polyps were independent pre-operative predictors for surgical outcomes with regard to QoL results.

  18. Breast Cancer Incidence and Predictors of Surgical Outcome: a Nationwide Longitudinal Study in Taiwan.

    PubMed

    Chang, Hong-Tai; Shi, Hon-Yi; Wang, Being-Whey; Yeh, Shu-Chuan Jennifer

    2017-06-01

    Despite the huge and growing global burden of patients who require breast cancer surgery, high-quality population-based studies of breast cancer trends and outcomes are scarce. The purpose of this study was to explore the incidence of breast cancer and predictors of hospital resource utilisation, mortality and recurrence in a nationwide population of patients who have received surgery. This retrospective study analysed trends and outcomes in a Taiwan population of 77 971 patients after breast cancer surgery during 1996-2010. The Cox proportional hazards model was used for multivariate assessment of both mortality and recurrence predictors. The data analysis indicated that, during this period, the estimated mean hospital treatment cost and mean length of stay increased by 16.3% and 53.4%, respectively. The estimated mean overall survival time was 138.9 months (standard deviation 0.3 months) and the overall 1, 3, 5 and 10 year survival rates were 97.3, 89.2, 82.2 and 70.1%, respectively. The estimated mean overall recurrence time was 10.8 months (standard deviation 0.2 months) and the overall 1, 3, 5 and 10 year recurrence rates were 0.1, 18.8, 26.6 and 36.0%, respectively. Outcomes were significantly associated with age, Deyo-Charlson comorbidity index score, surgeon seniority, hospital volume, surgeon volume, surgery type, hospital level and baseline comorbidities (P<0.001). Analyses of these population-based data revealed simultaneous increases in the standard incidence of breast cancer surgery and its associated medical resource utilisation. Notably, healthcare providers and patients should recognise that both patient attributes and hospital attributes may affect breast cancer surgery outcomes. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  19. Parent Training: Goals, Models and Predictors. Symposium--Parent Training: Models and Predictors of Outcome.

    ERIC Educational Resources Information Center

    Baker, Bruce L.

    Parent training goals, models, and predictors of effectiveness are examined with examples from three parent training models: (1) a combination of group sessions and intensive in-home consultation visits to prepare families receiving their child home again after residential treatment; (2) intensive in-home training intended to prevent residential…

  20. Mentor and Protege Predictors and Outcomes of Mentoring in a Formal Mentoring Program

    ERIC Educational Resources Information Center

    Wanberg, Connie R.; Kammeyer-Mueller, John; Marchese, Marc

    2006-01-01

    This study examines the predictors and outcomes of mentoring received by participants of a 12-month formal mentoring program. Based on relationship theory, we examined how the personality of the individuals in the mentoring dyad, their perceived similarity, and mentor perceived support for mentoring contributed to relationship outcomes. The study…

  1. Anthropometric predictors of low birth weight outcome in teenage pregnancy.

    PubMed

    Maso, M J; Gong, E J; Jacobson, M S; Bross, D S; Heald, F P

    1988-05-01

    The highest relative risks of low birth weight are found among births to teenage mothers. An analysis of anthropometrics (weight, mid-arm circumference, and triceps skinfold) among black teenagers attending an adolescent prenatal program was studied. The sample consisted of 100 girls under 17 years. Data were collected from 19 to 35 weeks gestation. Adolescent mothers who delivered low birth weight (LBW) infants demonstrated different patterns of anthropometric changes than teen mothers who delivered normal birth weight (NBW) infants. Mean mid-arm circumference increases in the LBW group (0.05 mm/wk) were significantly less than mean increases in the NBW group (0.80 mm/wk) (p less than 0.05). Arm fat area estimates of the LBW mothers demonstrated weekly depletion (-24.9 mm2/wk), which was significantly less than those of the NBW group, who accumulated fat (+15.3 mm2/wk) (p less than .05). Changes in maternal nutritional status may in part mediate the birthweight outcome in adolescent pregnancy. Anthropometrics may be useful in predicting those teens at highest risk of bearing LBW infants.

  2. Dementia as a predictor of adverse outcomes following stroke: an evaluation of diagnostic methods.

    PubMed

    Desmond, D W; Moroney, J T; Bagiella, E; Sano, M; Stern, Y

    1998-01-01

    Although it is understood that dementia is a risk factor for adverse outcomes, little is known about the predictive validity of the numerous methods that have been proposed for its diagnosis. Thus, we performed the present study to assess the utility of a variety of diagnostic methods in the prediction of adverse outcomes following stroke. We administered neuropsychological, neurological, and functional examinations to 244 patients (age, 71.7+/-8.5 years) 3 months after ischemic stroke. We diagnosed dementia using each of the following methods: (1) neuropsychological testing, requiring deficits in increasing numbers of cognitive domains, both with and without memory impairment, as well as functional impairment; (2) Mini-Mental State Examination (MMSE) score of <24; and (3) neurologists' clinical judgment. We then used survival analyses to investigate the ability of diagnoses based on those methods to predict death and recurrent stroke during long-term follow-up. Log-rank tests and Cox proportional hazards analyses, with recurrent stroke entered as a time dependent covariate, determined that all of the paradigms were significant predictors of mortality, but the performance of paradigms based on neuropsychological testing was superior to the use of the MMSE and clinical judgment, particularly when memory impairment was required. Log-rank tests determined that paradigms based on neuropsychological testing were the only significant predictors of recurrent stroke and performed best when memory impairment was required. Our results suggest that dementia diagnosis based on neuropsychological assessment and an operationalized paradigm requiring deficits in memory and other cognitive domains is superior to other conventional methods in its ability to identify patients at elevated risk of adverse outcomes following stroke.

  3. The Antidepressant Treatment Response Index as a Predictor of Reboxetine Treatment Outcome in Major Depressive Disorder.

    PubMed

    Caudill, Marissa M; Hunter, Aimee M; Cook, Ian A; Leuchter, Andrew F

    2015-10-01

    Biomarkers to predict clinical outcomes early during the treatment of major depressive disorder (MDD) could reduce suffering and improve outcomes. A quantitative electroencephalogram (qEEG) biomarker, the Antidepressant Treatment Response (ATR) index, has been associated with outcomes of treatment with selective serotonin reuptake inhibitor antidepressants in patients with MDD. Here, we report the results of a post hoc analysis initiated to evaluate whether the ATR index may also be associated with reboxetine treatment outcome, given that its putative mechanism of action is via norepinephrine reuptake inhibition (NRI). Twenty-five adults with MDD underwent qEEG studies during open-label treatment with reboxetine at doses of 8 to 10 mg daily for 8 weeks. The ATR index calculated after 1 week of reboxetine treatment was significantly associated with overall Hamilton Depression Rating Scale (HAM-D) improvement at week 8 (r=0.605, P=.001), even after controlling for baseline depression severity (P=.002). The ATR index predicted response (≥50% reduction in HAM-D) with 70.6% sensitivity and 87.5% specificity, and remission (final HAM-D≤7) with 87.5% sensitivity and 64.7% specificity. These results suggest that the ATR index may be a useful biomarker of clinical response during NRI treatment of adults with MDD. Future studies are warranted to investigate further the potential utility of the ATR index as a predictor of noradrenergic antidepressant treatment response.

  4. Predictors of outcome in patients with tuberculous meningitis.

    PubMed

    Hosoglu, S; Geyik, M F; Balik, I; Aygen, B; Erol, S; Aygencel, T G; Mert, A; Saltoglu, N; Dokmetas, I; Felek, S; Sunbul, M; Irmak, H; Aydin, K; Kokoglu, O F; Ucmak, H; Altindis, M; Loeb, M

    2002-01-01

    To assess predictors of mortality and neurological sequelae in patients with tuberculous meningitis (TBM). Patients with TBM treated at 12 university hospitals in Turkey between 1985 and 1997 were evaluated using a standardised protocol applied retrospectively. Variables associated with hospital mortality as well as with the presence of neurological sequelae at 6 months were determined using logistic regression models. Four hundred and thirty-four patients between the ages of 13 and 83 years (mean 33 years) were evaluated. Sixty-eight per cent of these patients presented with Medical Research Council Stage II or III. One hundred and one patients (23.3%) died and 67 (27%) of evaluable survivors had neurological sequelae. In multi-variable analysis, convulsion (OR 3.3, 95%CI 1.2-9.0, P = 0.02), comatose mental status (OR 6.0, 95%CI 3.6-10.2, P = 0.01), and delayed or interrupted treatment (OR 5.1, 95%CI 2.4-11.2, P = 0.01) were shown to be predictors for mortality. The presence of extra-meningeal tuberculosis (OR 2.1, 95%CI 1.1-4.2, P = 0.035), cranial nerve palsy (OR 2.6, 95%CI 1.4-4.2, P = 0.01), hemiparesia/focal weakness (OR 9.3, 95%CI 3.8-22.6, P = 0.01), hemiplegia/multiple neurological deficit (OR 7.1, 95%CI 2.14-23.38, P = 0.01) and drowsiness (OR 4.2, 95%CI 2.04-8.82, P = 0.01) were independent predictors of neurological sequelae at 6 months following hospital discharge. The results of this study emphasise the importance of prompt and uninterrupted anti-tuberculosis therapy for tuberculous meningitis. The presence of seizures or coma on admission to hospital are important predictors for mortality, while the presence of focal neurological signs is a predictor for persistent neurological sequelae in survivors.

  5. Process Predictors of the Outcome of Group Drug Counseling

    PubMed Central

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

    2012-01-01

    Objective This study examined the relation of process variables to the outcome of group drug counseling, a commonly used community treatment, for cocaine dependence. Method Videotaped group drug counseling sessions from 440 adult patients (23% female, 41% minority) were rated for member alliance, group cohesion, participation, self-disclosure, positive and non-positive feedback and advice, during the 6-month treatment of cocaine dependence. Average, session-level, and slopes of process scores were evaluated. Primary outcomes were monthly cocaine use (days using out of 30), next session cocaine use, and duration of sustained abstinence from cocaine. Secondary outcomes were endorsement of 12-step philosophy and beliefs about substance abuse. Results More positive alliances (with counselor) were associated with reductions in days using cocaine per month and next-session cocaine use, and increases in endorsement of 12-step philosophy. Patient self-disclosure about the past and degree of participation in the group were generally not predictive of group drug counseling outcomes. More advice from counselor and other group members were consistently associated with poorer outcomes in all categories. Individual differences in changes in process variables over time (linear slopes) were generally not predictive of treatment outcomes. Conclusions Some group behaviors widely believed to be associated with outcome, such as self-disclosure and participation, were not generally predictive of outcomes of group drug counseling, but alliance with the group counselor was positively associated, and advice giving negatively associated, with the outcome of treatments for cocaine dependence. PMID:23106760

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

    PubMed Central

    McKeague, Ian W.; Qian, Min

    2015-01-01

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

  7. Baseline predictors of treatment outcome in Internet-based alcohol interventions: a recursive partitioning analysis alongside a randomized trial

    PubMed Central

    2013-01-01

    Background Internet-based interventions are seen as attractive for harmful users of alcohol and lead to desirable clinical outcomes. Some participants will however not achieve the desired results. In this study, harmful users of alcohol have been partitioned in subgroups with low, intermediate or high probability of positive treatment outcome, using recursive partitioning classification tree analysis. Methods Data were obtained from a randomized controlled trial assessing the effectiveness of two Internet-based alcohol interventions. The main outcome variable was treatment response, a dichotomous outcome measure for treatment success. Candidate predictors for the classification analysis were first selected using univariate regression. Next, a tree decision model to classify participants in categories with a low, medium and high probability of treatment response was constructed using recursive partitioning software. Results Based on literature review, 46 potentially relevant baseline predictors were identified. Five variables were selected using univariate regression as candidate predictors for the classification analysis. Two variables were found most relevant for classification and selected for the decision tree model: ‘living alone’, and ‘interpersonal sensitivity’. Using sensitivity analysis, the robustness of the decision tree model was supported. Conclusions Harmful alcohol users in a shared living situation, with high interpersonal sensitivity, have a significantly higher probability of positive treatment outcome. The resulting decision tree model may be used as part of a decision support system but is on its own insufficient as a screening algorithm with satisfactory clinical utility. Trial registration Netherlands Trial Register (Cochrane Collaboration): NTR-TC1155. PMID:23651767

  8. Tuberculosis in Malaysia: predictors of treatment outcomes in a national registry.

    PubMed

    Liew, S M; Khoo, E M; Ho, B K; Lee, Y K; Mimi, O; Fazlina, M Y; Asmah, R; Lee, W K; Harmy, M Y; Chinna, K; Jiloris, F D

    2015-07-01

    To determine treatment outcomes and associated predictors of all patients registered in 2012 with the Malaysian National Tuberculosis (TB) Surveillance Registry. Sociodemographic and clinical data were analysed. Unfavourable outcomes included treatment failure, transferred out and lost to follow-up, treatment defaulters, those not evaluated and all-cause mortality. In total, 21 582 patients were registered. The mean age was 42.36 ± 17.77 years, and 14.2% were non-Malaysians. The majority were new cases (93.6%). One fifth (21.5%) had unfavourable outcomes; of these, 46% died, 49% transferred out or defaulted and 1% failed treatment. Predictors of unfavourable outcomes were older age, male sex, foreign citizenship, lower education, no bacille Calmette-Guérin (BCG) vaccination scar, treatment in tertiary settings, smoking, previous anti-tuberculosis treatment, human immunodeficiency virus infection, not receiving directly observed treatment, advanced chest radiography findings, multidrug-resistant TB (MDR-TB) and extra-pulmonary TB. For all-cause mortality, predictors were similar except for rural dwelling and nationality (higher mortality among locals). Absence of BCG scar, previous treatment for TB and MDR-TB were not found to be predictors of all-cause mortality. Indigenous populations in East Malaysia had lower rates of unfavourable treatment outcomes. One fifth of TB patients had unfavourable outcomes. Intervention strategies should target those at increased risk of unfavourable outcomes and all-cause mortality.

  9. Client Predictors of Short-term Psychotherapy Outcomes among Asian and White American Outpatients

    PubMed Central

    Kim, Jin E.; Zane, Nolan W.; Blozis, Shelley A.

    2015-01-01

    Purpose To examine predictors of psychotherapy outcomes, focusing on client characteristics that are especially salient for culturally diverse clients. Method Sixty clients (31 women; 27 White Americans, 33 Asian Americans) participated in this treatment study. Client characteristics were measured at pre-treatment, and outcomes were measured post-fourth session via therapist ratings of functioning and symptomatology. Regression analyses were utilized to test for predictors of outcomes, and bootstrap analyses were utilized to test for mediators. Results Higher levels of somatic symptoms predicted lower psychosocial functioning at post-treatment. Avoidant coping style predicted more negative symptoms and more psychological discomfort. Non-English language preference predicted worse outcomes; this effect was mediated by an avoidant coping style. Conclusions Language preference, avoidant coping style, and somatic symptoms predicted treatment outcome in a culturally diverse sample. Findings suggest that race/ethnicity-related variables may function through mediating proximal variables to affect outcomes. PMID:22836681

  10. Clinical significance and predictors of treatment response to cognitive-behavior therapy for insomnia secondary to chronic pain.

    PubMed

    Currie, Shawn R; Wilson, Keith G; Curran, Dorothyann

    2002-04-01

    We examined individual responses to cognitive-behavior therapy for insomnia in 51 persons with chronic pain to determine the rate of clinically significant change and to identify predictors of successful treatment response. Outcome measures consisted of the Pittsburgh Sleep Quality Index (PSQI) and diary measures of sleep latency and sleep continuity. Using reliable change indices, 57% of participants were statistically improved on the PSQI after 7 weeks of treatment, but only 18% were considered fully recovered from their sleep problems. No demographic variables predicted treatment response but persons who reliably improved on the PSQI had a lower sleep self-efficacy at baseline. Improvers showed a significant increase in sleep self-efficacy ratings and a decrease in self-reported levels of distress and pain-related disability. These results suggest that patients with insomnia secondary to chronic medical conditions can be helped with cognitive-behavior therapy, although most individuals continue to have mild or subthreshold sleep problems at posttreatment.

  11. Causes and outcomes of new onset status epilepticus and predictors of refractoriness to therapy.

    PubMed

    Jayalakshmi, Sita; Vooturi, Sudhindra; Sahu, Sambit; Yada, Praveen Kumar; Mohandas, Surath

    2016-04-01

    We aimed to evaluate the determinants of outcome in new onset refractory status epilepticus (SE). A retrospective analysis of patients with new onset SE admitted between May 2005 and October 2013 was performed. Regression analysis was used to determine factors that affect progression of new onset SE to refractory status epilepticus (RSE) and mortality. Among 114 patients with new onset SE, 52 patients progressed to RSE. Sixty seven (58.7%) were men. New onset RSE patients were younger than new onset SE patients (mean 35.9 ± standard deviation18.2 versus 28.7 ± 20.2 years; p=0.050). Cryptogenic aetiology was the most significant determinant of progression of new onset SE to RSE (Exp [β]=5.68; p=0.001). The overall mortality in the entire group was 23.7%, significantly higher in new onset RSE group (40.4% versus 9.7%; p<0.0001). New onset RSE patients with symptomatic and cryptogenic etiology did not differ for clinical characteristics and outcome. Acidosis was the strongest predictor of mortality in the entire cohort (Exp [β]=8.72; p=0.005). Nearly half of the patients with new onset SE progressed to RSE. While cryptogenic aetiology determined progression of new onset SE to RSE, acidosis was associated with mortality. The outcome was similar between symptomatic and cryptogenic new onset RSE. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Spinal fusion in patients with congenital heart disease. Predictors of outcome.

    PubMed

    Coran, D L; Rodgers, W B; Keane, J F; Hall, J E; Emans, J B

    1999-07-01

    The strong association between congenital heart disease and spinal deformity is well established, but data on the risks and outcome of spinal fusion surgery in patients with congenital heart disease are scarce. The purpose of this study was to identify predictors of perioperative risk and outcome in a large series of children and adolescents with congenital heart disease who underwent spinal fusion for scoliosis or kyphosis. In the authors' retrospective analysis of 74 consecutive patients with congenital heart disease undergoing spinal fusion, there were two deaths (2.7%) and 18 significant complications (24.3%) in the perioperative period. Preoperative cyanosis (arterial oxygen saturation < 90% at rest) with uncorrected or incompletely corrected congenital heart disease was associated with both deaths. Complications occurred in nine of 18 (50%) patients with cyanosis and in 11 of 56 (20%) patients without cyanosis. As judged by multivariate analysis the best predictors of perioperative outcome were the overall physical status of the patient as represented by the American Society of Anesthesiologists' preoperative score and a higher rate of intraoperative blood loss. Seventeen of 43 patients (40%) with an American Society of Anesthesiologists score of 3 or higher experienced complications including two perioperative deaths. Successful spinal fusion and correction were achieved in 97% of patients. Children and adolescents with congenital heart disease can undergo elective spinal fusion with risks that relate to overall cardiac status. Careful assessment of preoperative status by pediatric cardiologists and cardiac anesthesiologists familiar with surgical treatment of patients with congenital heart disease will assist the orthopaedic surgeon in providing the most realistic estimate of risk.

  13. Predictors of short and long term outcome in patellofemoral pain syndrome: a prospective longitudinal study

    PubMed Central

    2010-01-01

    Background Patellofemoral pain syndrome (PFP) is a common musculoskeletal condition that has a tendency to become chronic and problematic in a proportion of affected individuals. The objective of this study was to identify prognostic factors that may have clinical utility in predicting poor outcome on measures of pain and function in individuals with PFP. Methods A prospective follow-up study was conducted of 179 participants in a randomised clinical trial. Nine baseline factors (age, gender, body mass index, arch height, duration of knee pain, worst pain visual analogue scale, Kujala Patellofemoral Score (KPS), functional index questionnaire (FIQ), step down repetitions) were investigated for their prognostic ability on outcome assessed at six, 12 and 52 weeks (worst pain, KPS and FIQ). Factors with significant univariate associations were entered into multivariate linear regression models to identify a group of factors independently associated with poor outcome. Results Long symptom duration was the most consistent predictor of poor outcome over 52 weeks rated on the KPS and the FIQ (β-0.07, 95% confidence interval -0.1 to -0.03, p < 0.000; and -0.02, -0.03 to -0.01, p < 0.000, respectively). Worse KPS at baseline was predictive of outcome at six, 12 and 52 weeks. Gender, body mass index and arch height were generally not associated with outcome (univariate analysis), while age, worst pain, FIQ and step downs were excluded during multivariate analyses. Conclusions Patients presenting with PFP of long duration who score worse on the KPS have a poorer prognosis, irrespective of age, gender and morphometry. These results suggest that strategies aimed at preventing chronicity of more severe PFP may optimise prognosis. PMID:20082723

  14. Effectiveness and outcome predictors of long-term lithium prophylaxis in unipolar major depressive disorder

    PubMed Central

    Baethge, Christopher; Gruschka, Philipp; Smolka, Michael N.; Berghöfer, Anne; Bschor, Tom; Müller-Oerlinghausen, Bruno; Bauer, Michael

    2003-01-01

    Objective To determine the effectiveness of lithium prophylaxis in unipolar major depressive disorder (MDD) and to identify predictors of outcome including comedication. Methods In this long-term naturalistic study, clinical data from 55 patients with MDD (DSM-III-R) were collected prospectively in an outpatient clinic specializing in the treatment of affective disorders. Outcome measures Change in hospital admission rate (number and duration) during prophylaxis compared with the period before prophylaxis, Morbidity-Index during prophylaxis and time to first recurrence after initiation of lithium treatment. Results During an average follow-up period of 6.7 years, a significant decline in the number of days spent in hospital (p < 0.001; 52 d/yr less; 95; CI 31–73 d) and a low Morbidity-Index (mean 0.07) was observed. Only in 6 patients did medication have to be changed because of side-effects (n = 4) or a lack of efficacy (n = 2). None of the independent variables we analyzed proved to be important in predicting the outcome of lithium prophylaxis. Comedication was necessary in 21 patients. The overall outcome of their prophylactic treatment, however, did not differ from the group that did not receive comedication in the symptom-free intervals. Conclusions The results of this study, with its long observation period and the inclusion of comedication as a confounding variable, indicate that lithium is a potent prophylactic agent for unipolar MDD in a naturalistic setting. In contrast to the findings of others, age was not associated with the outcome of prophylaxis, and latency did not predict outcome. Contrary to doubts that have been raised in recent years with regard to the effectiveness of lithium in everyday clinical practice, lithium appears to be a safe and potent alternative to antidepressants. PMID:14517579

  15. Pre-treatment haemoglobin and peripheral blood lymphocyte count as independent predictors of outcome in carcinoma of cervix.

    PubMed

    Hoskin, P J; Rojas, A M; Peiris, S N; Mullassery, V; Chong, I Y

    2014-04-01

    To evaluate pre-treatment haemoglobin and peripheral blood lymphocyte (PBL) counts as predictors of treatment outcome in cervix carcinoma treated with radical chemoradiation. Pre-treatment PBL counts and haemoglobin concentrations were retrieved from full blood count examinations from 111 patients who received concurrent chemoradiotherapy. Overall survival and relapse-free survival were obtained using the Kaplan-Meier method by ranking the data by median haemoglobin and PBL, singly and then in association. Their independence and significance as predictors of outcome were analysed using the Cox proportional hazard model. Survival rates were significantly higher in patients whose haemoglobin level or PBL counts were at or above the corresponding median value. At 5 years, rates of overall survival were 77% versus 41% (P = 0.0003) and 75% versus 42% (P = 0.002), when dichotomised around median haemoglobin and PBL, respectively. In multivariate and univariate analyses, both PBL and haemoglobin were independent and significant predictors for risk of death and relapse. Their predictive power was dramatically enhanced when the data were stratified into four groups by associating patients with haemoglobin ≥ median or < median with those whose PBL was ≥ or < median. Baseline PBL and haemoglobin seem to be strong, independent predictors of treatment outcome in carcinoma of the cervix, particularly if patient response is ranked using the predictors simultaneously. The hypothesis needs to be tested and, if confirmed, the markers should be used in combination to identify those at greater risk of failure who may benefit from additional therapy, with further validation in prospective trials offering treatment modification. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  16. Predictors and long-term health outcomes of eating disorders

    PubMed Central

    Whelan, Denis R.; Sandler, Dale P.; Hall, Janet E.; Weinberg, Clarice R.

    2017-01-01

    Anorexia and bulimia nervosa may have long-term effects on overall and reproductive health. We studied predictors of self-reported eating disorders and associations with later health events. We estimated odds ratios (ORs) for these associations in 47,759 participants from the Sister Study. Two percent (n = 967) of participants reported a history of an eating disorder. Risk factors included being non-Hispanic white, having well-educated parents, recent birth cohort (OR = 2.16, 95% confidence interval [CI]: 2.01–2.32 per decade), and having a sister with an eating disorder (OR = 3.68, CI: 1.92–7.02). As adults, women who had experienced eating disorders were more likely to smoke, to be underweight, to have had depression, to have had a later first birth, to have experienced bleeding or nausea during pregnancy, or to have had a miscarriage or induced abortion. In this descriptive analysis, we identified predictors of and possible long-term health consequences of eating disorders. Eating disorders may have become more common over time. Interventions should focus on prevention and mitigation of long-term adverse health effects. PMID:28700663

  17. Identification of and At-Risk Interventions for Pre-Deployment Psychophysiologic Predictors of Post-Deployment Mental Health Outcomes

    DTIC Science & Technology

    2013-10-01

    Interventions for Pre-Deployment Psychophysiologic Predictors of Post-Deployment Mental Health Outcomes PRINCIPAL INVESTIGATOR: Jeffrey M. Pyne, M.D...Interventions for Pre-Deployment Psychophysiologic Predictors of Post-Deployment Mental Health Outcomes 5b. GRANT NUMBER W81XWH-08-2-0031 5c...Identification of and At-Risk Interventions for Pre-deployment Psychophysiologic Predictors of Post-deployment Mental Health Outcomes – Progress

  18. Connecting stuttering management and measurement: IV. Predictors of outcome for a behavioural treatment for stuttering.

    PubMed

    Block, Susan; Onslow, Mark; Packman, Ann; Dacakis, Georgia

    2006-01-01

    Clinical trials have shown that behavioural treatments based on variants of prolonged-speech (PS) are best practice for reducing the stuttering rate in adults. However, while stuttering is significantly reduced or eliminated for most adults in the short-term with such treatment, relapse in the longer-term is common. Consequently, there has been interest in attempting to establish variables that predict responsiveness to PS-based treatments. Identifying such variables would enable risk prediction and also contribute to the tailoring of treatments to suit individuals who are less likely to benefit in the long-term from the conventional PS-based treatments. Variables that have been investigated to date are the stuttering severity, the attitude to communication and the locus of control. The present study revisited this issue with methodological improvements. Prospective, continuous measures of outcome several years after treatment, and well-powered, least-squares multivariate regression, with backwards elimination, were used to determine the best model to predict short- and long-term outcomes of a PS-based treatment. Other predictor variables were also included. The stuttering rates of 78 participants were measured immediately after the intensive stage of treatment, and during a surprise telephone call 3.5-5 years after treatment. Attitude to communication and locus of control were separate constructs to stuttering rate. While the stuttering rate predicted outcome, neither of the two non-behavioural variables predicted outcome in either the short- or the long-term. The most significant finding is that the non-behavioural variables of attitude to communication and locus of control did not predict treatment outcomes. This is contrary to the findings of most previous studies.

  19. Serum YKL-40 as predictor of outcome in hypersensitivity pneumonitis.

    PubMed

    Long, Xiaoping; He, Xuan; Ohshimo, Shinichiro; Griese, Matthias; Sarria, Rafael; Guzman, Josune; Costabel, Ulrich; Bonella, Francesco

    2017-02-01

    YKL-40, a chitinase-like protein mainly secreted by macrophages, neutrophils and epithelial cells, is increased in patients with idiopathic interstitial pneumonia and sarcoidosis. We aimed to investigate the role of YKL-40 as a biomarker in hypersensitivity pneumonitis (HP).72 HP patients, 100 interstitial lung disease (ILD) controls and 60 healthy controls were studied. YKL-40 was measured by ELISA in serum and bronchoalveolar lavage fluid (BALF) at baseline and follow-up. The relationship between YKL-40 levels, clinical variables and disease outcome was evaluated.Baseline serum YKL-40 levels were significantly higher in HP patients than in healthy controls (p<0.001), but lower than in patients with other ILDs. Baseline BALF YKL-40 levels in HP patients were the highest among ILD patients. In HP patients, serum YKL-40 correlated with the diffusing capacity of the lung for carbon monoxide at baseline (p<0.01) and over time (p<0.001). HP patients whose disease progressed or who died had higher baseline YKL-40 levels than those who remained stable and survived (p<0.001). At a cut-off of 119 ng·mL(-1), the baseline serum YKL-40 level predicted disease progression (hazard ratio 6.567; p<0.001), and at a cut-off of 150 ng·mL(-1) was associated with mortality (hazard ratio 9.989; p<0.001).Serum YKL-40 may be a useful prognostic biomarker in HP patients.

  20. The adolescent outcome of hyperactive children: predictors of psychiatric, academic, social, and emotional adjustment.

    PubMed

    Fischer, M; Barkley, R A; Fletcher, K E; Smallish, L

    1993-03-01

    To investigate predictors of adolescent outcome in a large sample of hyperactive children. 123 hyperactive children were followed prospectively over an 8-year period. Multiple linear and logistical regression equations were used to relate childhood predictor variables to adolescent academic, psychiatric, social, and emotional adjustment. Adolescent academic skills were related to childhood cognitive and academic competence while school conduct was predicted by other variables including early family stress. Duration of mental health treatment received often was negatively related to outcome, apparently serving as a marker variable for severity of disturbance in the child. Childhood impulsivity-hyperactivity and paternal antisocial acts were associated with later oppositional-defiant behaviors. Only child defiance and not hyperactivity predicted later arrests, however. Emotional problems in adolescence were predicted by more special education enrollment. Adolescent social competence was associated with parental personal competence, whereas maternal mental health status at outcome was related to variables unassociated with child adjustment. Various outcome domains had different sets of predictors; no single predictor cut across all domains. Although a limited amount of variance in outcome was explained, findings suggest that promoting family and parental competence as well as assessing and treating defiance and aggression very early may improve outcome.

  1. Outcomes of Acute Chest Syndrome in Adult Patients with Sickle Cell Disease: Predictors of Mortality

    PubMed Central

    Allareddy, Veerajalandhar; Roy, Aparna; Lee, Min Kyeong; Nalliah, Romesh P.; Rampa, Sankeerth; Allareddy, Veerasathpurush; Rotta, Alexandre T.

    2014-01-01

    Adults with sickle cell disease(SCD) are a growing population. Recent national estimates of outcomes in acute chest syndrome(ACS) among adults with SCD are lacking. We describe the incidence, outcomes and predictors of mortality in ACS in adults. We hypothesize that any need for mechanical ventilation is an independent predictor of mortality. Methods We performed a retrospective analysis of the Nationwide Inpatient Sample(2004–2010),the largest all payer inpatient database in United States, to estimate the incidence and outcomes of ACS needing mechanical ventilation(MV) and exchange transfusion(ET) in patients >21 years. The effects of MV and ET on outcomes including length of stay(LOS) and in-hospital mortality(IHM) were examined using multivariable linear and logistic regression models respectively. The effects of age, sex, race, type of sickle cell crisis, race, co-morbid burden, insurance status, type of admission, and hospital characteristics were adjusted in the regression models. Results Of the 24,699 hospitalizations, 4.6% needed MV(2.7% for <96 hours, 1.9% for ≥96 hours), 6% had ET, with a mean length of stay(LOS) of 7.8 days and an in-hospital mortality rate(IHM) of 1.6%. There was a gradual yearly increase in ACS hospitalizations that needed MV(2.6% in 2004 to 5.8% in 2010). Hb-SS disease was the phenotype in 84.3% of all hospitalizations. After adjusting for a multitude of patient and hospital related factors, patients who had MV for <96 hours(OR = 67.53,p<0.01) or those who had MV for ≥96 hours(OR = 8.73,p<0.01) were associated with a significantly higher odds for IHM when compared to their counterparts. Patients who had MV for ≥96 hours and those who had ET had a significantly longer LOS in-hospitals(p<0.001). Conclusion In this large cohort of hospitalized adults with SCD patients with ACS, the need for mechanical ventilation predicted higher mortality rates and increased hospital resource utilization. Identification of risk factors

  2. Predictors and outcome of obstetric admissions to intensive care unit: A comparative study.

    PubMed

    Jain, Shruti; Guleria, Kiran; Vaid, Neelam B; Suneja, Amita; Ahuja, Sharmila

    2016-01-01

    This descriptive observational study was carried out in Guru Teg Bahadur Hospital to identify predictors and outcome of obstetric admission to Intensive Care Unit (ICU). Ninety consecutive pregnant patients or those up to 42 days of termination of pregnancy admitted to ICU from October 2010 to December 2011 were enrolled as study subjects with selection of a suitable comparison group. Qualitative statistics of both groups were compared using Pearson's Chi-square test and Fisher's exact test. Odds ratio was calculated for significant factors. Low socioeconomic status, duration of complaints more than 12 h, delay at intermediary facility, and peripartum hysterectomy increased probability of admission to ICU. High incidence of obstetric admissions to ICU as compared to other countries stresses on need for separate obstetric ICU. Availability of high dependency unit can decrease preload to ICU by 5%. Patients with hemorrhagic disorders and those undergoing peripartum hysterectomy need more intensive care.

  3. Analysis of clinical parameters and cardiac magnetic resonance imaging as predictors of outcome in pediatric myocarditis.

    PubMed

    Sachdeva, Shagun; Song, Xiaoyan; Dham, Niti; Heath, Deneen M; DeBiasi, Roberta L

    2015-02-15

    Myocarditis causes significant morbidity and mortality in pediatric patients, with potential adverse outcomes including heart failure, transplantation requirement, and/or death. The objective of this study was to determine predictors of early and late poor outcomes, defined as requirement for extracorporeal membrane oxygenation, ventricular assist device, transplantation, or death in pediatric myocarditis patients. A retrospective cohort study was conducted to evaluate pediatric myocarditis presenting over a 5-year period at a pediatric institution. Patients were identified using an institutional heart failure database and International Classification of Diseases, Ninth Revision, discharge diagnosis codes for myocarditis and confirmed by review of medical records. Data extraction included epidemiologic factors, the presenting ejection fraction (EF), initial and peak troponin levels, brain natriuretic peptide (BNP) level, pathogen identification, cardiac magnetic resonance imaging (MRI), and outcomes. Univariate and multivariate regression was performed to identify variables predictive of outcomes. Because published pediatric cardiac MRI data are sparse, whether late enhancement was associated with specific clinical variables or predictive of outcomes was also evaluated. Fifty-eight patients were identified. The mean age was 10.5 years, 64% were male, 62% were Caucasian, 15% were African-American, and 23% were Hispanic or Asian. Eighty-one percent presented at the institution <1 week after symptom onset. Presenting EFs were normal (>50%) or mildly decreased (40% to 50%) in 48%, moderately decreased (30% to 40%) in 9%, and severely decreased (<30%) in 42%. Thirty patients (52%) underwent viral studies; 17 of these (56%) had acute viral origins of myocarditis identified, including 8 with parvovirus (2 with influenza coinfection), 7 with enterovirus, 1 with Epstein-Barr virus, and 1 with cytomegalovirus. Twenty-eight percent had poor outcomes. Univariate analysis

  4. Predictors of functional outcome among stroke patients in Lima, Peru.

    PubMed

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

    2013-10-01

    Because of the aging population in low- and middle-income countries, cerebrovascular disease is expected to remain a leading cause of death. Little has been published about stroke in Peru. We conducted a retrospective cohort study of hospitalized stroke patients at a referral center hospital in Lima, Peru to explore factors associated with functional outcome among stroke patients. We identified 579 patients hospitalized for ischemic stroke or intracerebral hemorrhage stroke at the National Institute of Neurologic Sciences in Lima, Peru in 2008 and 2009. A favorable outcome was defined as a modified Rankin scale score of ≤ 2 at discharge. The mean age was 63.3 years; 75.6% had ischemic stroke; the average duration of stay was 17.3 days. At hospital discharge, 231 (39.9%) had a favorable outcome. The overall mortality rate was 5.2%. In multivariate models, the likelihood of having a favorable outcome decreased linearly with increasing age (P = .02) and increasing National Institutes of Health Stroke Scale (NIHSS) score (P = .02). Favorable outcome was also associated with male gender (relative risk [RR] 1.2; 95% confidence interval [CI] 1.0-1.5) and divorced status (RR 1.3; 95% CI 1.1-1.7). Patients on Salud Integral de Salud (SIS; public assistance-type insurance; RR 0.7; 95% CI 0.5-1.0) were also less likely to have a favorable outcome. Favorable outcome after stroke was independently associated with younger age, a lower NIHSS score, male gender, being divorced, and not being on SIS insurance. These findings suggest that additional study of worse functional outcomes in patients with SIS insurance be conducted and confirm the importance of risk adjustment for age, stroke severity (according to the NIHSS scale), and other socioeconomic factors in outcomes studies. Future studies should preferentially assess outcome at 30 days and 6 months to provide more reliable comparisons and allow additional study of Peruvian end-of-life decision-making and care. Copyright

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

    PubMed Central

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

    2013-01-01

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

  6. Usefulness of total lymphocyte count as predictor of outcome in patients with chronic heart failure.

    PubMed

    Charach, Gideon; Grosskopf, Itamar; Roth, Arie; Afek, Arnon; Wexler, Dov; Sheps, David; Weintraub, Moshe; Rabinovich, Alexander; Keren, Gad; George, Jacob

    2011-05-01

    Low lymphocyte count has been considered a predictive marker of unfavorable outcomes for patients with heart failure (HF). Baseline blood samples for complete blood counts, differential counts, renal function tests. and lipid profile were prospectively obtained to assess the association between lymphocyte count and clinical outcomes in 305 patients with HF (average New York Heart Association [NYHA] class 2.8). The mean follow-up duration was 4.7 years (range 8 months to 8.4 years), and 111 patients (36%) died during the follow-up period. The mean lymphocyte count for the group was 1,803.64 ± 740.3, and the mean left ventricular ejection fraction (LVEF) was 37%. Patients with low lymphocyte counts (<1,600 median count) after 8 years had significantly lower survival rates than those with lymphocyte counts ≥1,600 (58% vs 72%, p=0.012). The prediction of poorest survival was for patients in NYHA class III or IV and with lymphocyte counts <1,600. Regression analysis showed that lymphocyte level, the LVEF, and NYHA class were predictors of mortality. Of these, NYHA class was the most prominent predictor, followed by lymphocyte count, which was even more significant than the LVEF (hazard ratio 0.76, p=0.037). In conclusion, the findings of this study demonstrate that total lymphocyte count is an important prognostic factor, inversely associated with predicted mortality. Although the total low lymphocyte count was correlated with a lower NYHA class and a lower LVEF, it emerged as an independent death risk factor in patients with chronic HF.

  7. Clinical Predictors of Neurological Outcome within 72 h after Traumatic Cervical Spinal Cord Injury.

    PubMed

    Qiu, Zhi; Wang, Fangyong; Hong, Yi; Zhang, Junwei; Tang, Hehu; Li, Xiang; Jiang, Shudong; Lv, Zhen; Liu, Shujia; Chen, Shizheng; Liu, Jiesheng

    2016-12-12

    To investigate the prognostic values of clinical factors 72 h within traumatic cervical spinal cord injury (TCSCI). Data were extracted from the medical materials of 57 TCSCI cases. AIS was used as the outcome measure and divided into dichotomous variables by two methods, i.e. "complete(AIS = A)/incomplete(AIS ≠ A) SCI" and "motor complete(AIS = A or B)/incomplete(AIS ≠ A and B) SCI". Relationships between evaluated factors and outcomes were investigated by univariate and multivariate methods. MRI Cord transection (MCT) cases, most significantly related to complete SCIs by univariate analysis (P = 0.006), all showed complete SCIs when discharged, which makes it unsuitable for logistic regression. With MCT cases removed, univariate analysis was conducted again, then logistic regression. At last, only C5 spine injury (P = 0.024, OR = 0.241) was related to complete SCI. Cases with compression flexion injury mechanism (CFIM), most significantly related to motor complete SCIs by univariate analysis (P = 0.001), was also unsuitable for logistic regression for the same reason. At last, C3 spine injury (P = 0.033, OR = 0.068) and high energy injury (P = 0.033, OR = 14.763) were related to motor complete SCIs with CFIM cases removed. The results show that MCT and C5 spine injury are good predictors for complete/incomplete SCIs. CFIM, C3 spine injury and high energy injury are good predictors for motor complete/incomplete SCIs.

  8. Clinical predictors and outcome implications of early readmission in lung transplant recipients.

    PubMed

    Osho, Asishana A; Castleberry, Anthony W; Yerokun, Babatunde A; Mulvihill, Michael S; Rucker, Justin; Snyder, Laurie D; Davis, Robert D; Hartwig, Matthew G

    2017-05-01

    The purpose of this study was to identify risk factors and outcome implications for 30-day hospital readmission in lung transplant recipients. We conducted a retrospective cohort study of lung transplant cases from a single, high-volume lung transplant program between January 2000 and March 2012. Demographic and health data were reviewed for all patients. Risk factors for 30-day readmission (defined as readmission within 30 days of discharge from index lung transplant hospitalization) were modeled using logistic regression, with selection of parameters by backward elimination. The sample comprised 795 patients after excluding scheduled readmissions and in-hospital deaths. Overall 30-day readmission rate was 45.4% (n = 361). Readmission rates were similar across different diagnosis categories and procedure types. By univariate analysis, post-operative complications that predisposed to 30-day readmission included pneumonia, any infection, and atrial fibrillation (all p < 0.05). In the final multivariate model, occurrence of any post-transplant complication was the most significant risk factor for 30-day readmission (odds ratio = 1.764; 95% confidence interval, 1.259-2.470). Even for patients with no documented perioperative complication, readmission rates were still >35%. Kaplan-Meier analysis and multi-variate regression modeling to assess readmission as a predictor of long-term outcomes showed that 30-day readmission was not a significant predictor of worse survival in lung recipients. Occurrence of at least 1 post-transplant complication increases risk for 30-day readmission in lung transplant recipients. In this patient population, 30-day readmission does not predispose to adverse long-term survival. Quality indicators other than 30-day readmission may be needed to assess hospitals that perform lung transplantation. Copyright © 2017 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  9. Clinical predictors and outcome implications of early readmission in lung transplant recipients

    PubMed Central

    Osho, Asishana A.; Castleberry, Anthony W.; Yerokun, Babatunde A.; Mulvihill, Michael S.; Rucker, Justin; Snyder, Laurie D.; Davis, Robert D.; Hartwig, Matthew G.

    2017-01-01

    BACKGROUND The purpose of this study was to identify risk factors and outcome implications for 30-day hospital readmission in lung transplant recipients. METHODS We conducted a retrospective cohort study of lung transplant cases from a single, high-volume lung transplant program between January 2000 and March 2012. Demographic and health data were reviewed for all patients. Risk factors for 30-day readmission (defined as readmission within 30 days of discharge from index lung transplant hospitalization) were modeled using logistic regression, with selection of parameters by backward elimination. RESULTS The sample comprised 795 patients after excluding scheduled readmissions and in-hospital deaths. Overall 30-day readmission rate was 45.4% (n = 361). Readmission rates were similar across different diagnosis categories and procedure types. By univariate analysis, post-operative complications that predisposed to 30-day readmission included pneumonia, any infection, and atrial fibrillation (all p < 0.05). In the final multivariate model, occurrence of any post-transplant complication was the most significant risk factor for 30-day readmission (odds ratio = 1.764; 95% confidence interval, 1.259–2.470). Even for patients with no documented perioperative complication, readmission rates were still > 35%. Kaplan-Meier analysis and multi-variate regression modeling to assess readmission as a predictor of long-term outcomes showed that 30-day readmission was not a significant predictor of worse survival in lung recipients. CONCLUSIONS Occurrence of at least 1 post-transplant complication increases risk for 30-day readmission in lung transplant recipients. In this patient population, 30-day readmission does not predispose to adverse long-term survival. Quality indicators other than 30-day readmission may be needed to assess hospitals that perform lung transplantation. PMID:27932071

  10. Clinical Predictors of Neurological Outcome within 72 h after Traumatic Cervical Spinal Cord Injury

    PubMed Central

    Qiu, Zhi; Wang, Fangyong; Hong, Yi; Zhang, Junwei; Tang, Hehu; Li, Xiang; Jiang, Shudong; Lv, Zhen; Liu, Shujia; Chen, Shizheng; Liu, Jiesheng

    2016-01-01

    To investigate the prognostic values of clinical factors 72 h within traumatic cervical spinal cord injury (TCSCI). Data were extracted from the medical materials of 57 TCSCI cases. AIS was used as the outcome measure and divided into dichotomous variables by two methods, i.e. “complete(AIS = A)/incomplete(AIS ≠ A) SCI” and “motor complete(AIS = A or B)/incomplete(AIS ≠ A and B) SCI”. Relationships between evaluated factors and outcomes were investigated by univariate and multivariate methods. MRI Cord transection (MCT) cases, most significantly related to complete SCIs by univariate analysis (P = 0.006), all showed complete SCIs when discharged, which makes it unsuitable for logistic regression. With MCT cases removed, univariate analysis was conducted again, then logistic regression. At last, only C5 spine injury (P = 0.024, OR = 0.241) was related to complete SCI. Cases with compression flexion injury mechanism (CFIM), most significantly related to motor complete SCIs by univariate analysis (P = 0.001), was also unsuitable for logistic regression for the same reason. At last, C3 spine injury (P = 0.033, OR = 0.068) and high energy injury (P = 0.033, OR = 14.763) were related to motor complete SCIs with CFIM cases removed. The results show that MCT and C5 spine injury are good predictors for complete/incomplete SCIs. CFIM, C3 spine injury and high energy injury are good predictors for motor complete/incomplete SCIs. PMID:27941855

  11. Healthcare-associated and nosocomial bacterial infections in cirrhosis: predictors and impact on outcome.

    PubMed

    Sargenti, Konstantina; Prytz, Hanne; Strand, Anna; Nilsson, Emma; Kalaitzakis, Evangelos

    2015-02-01

    Population-based data on the occurrence of healthcare-associated (HCA) and hospital-acquired (HA) bacterial infections in cirrhosis, their predictors, and their impact on outcome are limited. All patients with incident cirrhosis in 2001-2010 residing in an area of 600,000 inhabitants were retrospectively identified. All serious bacterial infections (resulting in or occurring during an inpatient hospital episode) during this period were registered. Acquisition type, site of infection, occurrence of infection-related acute-on-chronic liver failure (ACLF), acute kidney injury (AKI) and bacterial resistance were analysed. Patients were followed longitudinally until death, transplant or end of 2011. A total of 398 serious infections occurred in 241/633 (38%) patients. Forty-seven per cent were HCA and 21% HA. Proton pump inhibitor (PPI) use was more common in HA (80%) vs. HCA (64%) vs. community-acquired (44%) infections (P < 0.001). In regression analysis, decompensated status, use of antibiotics and PPIs at infection diagnosis were independent predictors of HCA/HA infections (P < 0.05). After adjustment for confounders, HCA/HA infections were significantly related to infection-related ACLF (P < 0.05), but not severe sepsis, AKI or infection-related mortality (P > 0.05). Antibiotic-resistant infections were more frequent among HA (17%) than HCA (6%) or community-acquired (8%) infections (P < 0.05). Antibiotic-resistant HCA/HA infections were independently related to severe sepsis (P < 0.05). In a population-based cirrhotic cohort, two-thirds of serious bacterial infections were HCA or HA. Decompensated liver disease, antibiotics and PPIs were predictors of serious HCA/HA infections, which were associated with the development of ACLF. Antibiotic resistance was frequent, especially in HA infections, and contributed to risk of severe sepsis. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Cognitive behavioral therapy for compulsive buying behavior: Predictors of treatment outcome.

    PubMed

    Granero, R; Fernández-Aranda, F; Mestre-Bach, G; Steward, T; Baño, M; Agüera, Z; Mallorquí-Bagué, N; Aymamí, N; Gómez-Peña, M; Sancho, M; Sánchez, I; Menchón, J M; Martín-Romera, V; Jiménez-Murcia, S

    2017-01-01

    Compulsive buying behavior (CBB) is receiving increasing consideration in both consumer and psychiatric-epidemiological research, yet empirical evidence on treatment interventions is scarce and mostly from small homogeneous clinical samples. To estimate the short-term effectiveness of a standardized, individual cognitive behavioral therapy intervention (CBT) in a sample of n=97 treatment-seeking patients diagnosed with CBB, and to identify the most relevant predictors of therapy outcome. The intervention consisted of 12 individual CBT weekly sessions, lasting approximately 45minutes each. Data on patients' personality traits, psychopathology, sociodemographic factors, and compulsive buying behavior were used in our analysis. The risk (cumulative incidence) of poor adherence to the CBT program was 27.8%. The presence of relapses during the CBT program was 47.4% and the dropout rate was 46.4%. Significant predictors of poor therapy adherence were being male, high levels of depression and obsessive-compulsive symptoms, low anxiety levels, high persistence, high harm avoidance and low self-transcendence. Cognitive behavioral models show promise in treating CBB, however future interventions for CBB should be designed via a multidimensional approach in which patients' sex, comorbid symptom levels and the personality-trait profiles play a central role. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. Physiological and computed tomographic predictors of outcome from lung volume reduction surgery.

    PubMed

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

    2010-03-01

    Previous investigations have identified several potential predictors of outcomes from lung volume reduction surgery (LVRS). A concern regarding these studies has been their small sample size, which may limit generalizability. We therefore sought to examine radiographic and physiologic predictors of surgical outcomes in a large, multicenter clinical investigation, the National Emphysema Treatment Trial. To identify objective radiographic and physiological indices of lung disease that have prognostic value in subjects with chronic obstructive pulmonary disease being evaluated for LVRS. A subset of the subjects undergoing LVRS in the National Emphysema Treatment Trial underwent preoperative high-resolution computed tomographic (CT) scanning of the chest and measures of static lung recoil at total lung capacity (SRtlc) and inspiratory resistance (Ri). The relationship between CT measures of emphysema, the ratio of upper to lower zone emphysema, CT measures of airway disease, SRtlc, Ri, the ratio of residual volume to total lung capacity (RV/TLC), and both 6-month postoperative changes in FEV(1) and maximal exercise capacity were assessed. Physiological measures of lung elastic recoil and inspiratory resistance were not correlated with improvement in either the FEV(1) (R = -0.03, P = 0.78 and R = -0.17, P = 0.16, respectively) or maximal exercise capacity (R = -0.02, P = 0.83 and R = 0.08, P = 0.53, respectively). The RV/TLC ratio and CT measures of emphysema and its upper to lower zone ratio were only weakly predictive of postoperative changes in both the FEV(1) (R = 0.11, P = 0.01; R = 0.2, P < 0.0001; and R = 0.23, P < 0.0001, respectively) and maximal exercise capacity (R = 0.17, P = 0.0001; R = 0.15, P = 0.002; and R = 0.15, P = 0.002, respectively). CT assessments of airway disease were not predictive of change in FEV(1) or exercise capacity in this cohort. The RV/TLC ratio and CT measures of emphysema and its distribution are weak but statistically significant

  14. Novel Predictors of Peritonitis-Related Outcomes in the BRAZPD Cohort

    PubMed Central

    de Moraes, Thyago Proença; Olandoski, Marcia; Caramori, Jaqueline C.T.; Martin, Luis C.; Fernandes, Natália; Divino-Filho, José Carolino; Pecoits-Filho, Roberto; Barretti, Pasqual

    2014-01-01

    ♦ Introduction: Peritonitis remains the main cause of peritoneal dialysis (PD) technique failure worldwide, despite significant reductions in infection rates observed over the past decades. Several studies have described risk factors for peritonitis, technique failure and mortality. However, there are scarce data regarding predictors of complications during and after a peritonitis episode. The aim of our study was to analyze predictors of peritonitis-related outcome in the Brazilian Peritoneal Dialysis study (BRAZPD) cohort. ♦ Methods: All adult incident patients recruited in the BRAZPD Study between December 2004 and October 2007, who remained at least 90 days on PD and presented their first peritonitis episode (n = 474 patients) were included in the study. The endpoints analyzed were non-resolution, death due to a peritonitis episode and long-term technique survival after a peritonitis episode. ♦ Results: In the multivariable regression, non-resolution was independently associated with older age (odds ratio (OR) 1.02; p < 0.01), collagenosis as the primary renal disease (OR 4.6; p < 0.05) and Pseudomonas spp as etiological agent (OR 2.9; p < 0.05). Patients who were transferred from APD to CAPD during peritonitis therapy presented a higher risk of non-response (OR 2.5; p < 0.05). The only factor associated with death during a peritonitis episode was older age (OR 1.04; p < 0.05). Exposure to vancomycin and male gender were the independent predictors of long-term technique failure (OR 2.2; p < 0.01). ♦ Conclusion: Apart from confirming previous observations of the negative impact of older age and Pseudomonas spp peritonitis on outcomes, we observed that collagenosis may negatively impact response to treatment and exposure to vancomycin may possibly reduce long-term technique survival. It is important to emphasize that the association of vancomycin with technique failure does not prove causality. These findings shed light on new factors predicting outcome

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

    PubMed Central

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

    2010-01-01

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

  16. Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma.

    PubMed

    Greene, Wendy R; Oyetunji, Tolulope A; Bowers, Umar; Haider, Adil H; Mellman, Thomas A; Cornwell, Edward E; Siram, Suryanarayana M; Chang, David C

    2010-04-01

    Patients with penetrating injuries are known to have worse outcomes than those with blunt trauma. We hypothesize that within each injury mechanism there should be no outcome difference between insured and uninsured patients. The National Trauma Data Bank version 7 was analyzed. Patients aged 65 years and older and burn patients were excluded. The insurance status was categorized as insured (private, government/military, or Medicaid) and uninsured. Multivariate analysis adjusted for insurance status, mechanism of injury, age, race, sex, injury severity score, shock, head injury, extremity injury, teaching hospital status, and year. A total of 1,203,243 patients were analyzed, with a mortality rate of 3.7%. The death rate was significantly higher in penetrating trauma patients versus blunt trauma patients (7.9% vs 3.0%; P < .001), and higher in the uninsured (5.3% vs 3.2%; P < .001). On multivariate analysis, uninsured patients had an increased odds of death than insured patients, in both penetrating and blunt trauma patients. Penetrating trauma patients with insurance still had a greater risk of death than blunt trauma patients without insurance. Insurance status is a potent predictor of outcome in both penetrating and blunt trauma. Copyright 2010 Elsevier Inc. All rights reserved.

  17. Predictors of severe outcomes in patients with Clostridium difficile infection from a Hispanic population.

    PubMed

    Paláu-Dávila, Laura; Garza-González, Elvira; Gutiérrez-Delgado, Eva María; Camacho-Ortiz, Adrián

    2017-01-01

    Factors associated with complicated Clostridium difficile infection (CDI) may vary among populations, and predictors of severe outcomes in CDI have not been studied in Hispanic patients. The aim of this study was to identify factors associated with a higher risk of colectomy, all-cause mortality, and CDI-associated mortality in a Hispanic population. We performed a retrospective study of all hospitalized patients with a diagnosis of CDI between January 1, 2011 and September 30, 2015 in a 450-bed teaching hospital in Monterrey, northeast Mexico. Three main outcomes were defined: fulminant colitis with subsequent colectomy, all-cause mortality within 30 days of diagnosis, and CDI-attributable mortality. Of 261 patients with diarrhea, 176 were diagnosed with CDI. For colectomy, Charlson comorbidity index, ICU stay and mechanical ventilation prior to CDI diagnosis, days with diarrhea prior to treatment, total days of hospital stay and days after CDI diagnosis, elevated ATLAS score, days of diarrhea post CDI treatment, and treatment failure significantly predicted the necessity of surgical treatment with colectomy. Treatment failure, persistent diarrhea, and a high ATLAS score were identified as risk factors for severe outcomes of CDI. A low albumin concentration and high creatinine were associated with higher overall mortality.

  18. Height gain during early childhood is an important predictor of schooling and mathematics ability outcomes.

    PubMed

    Gandhi, Mihir; Ashorn, Per; Maleta, Kenneth; Teivaanmäki, Tiina; Duan, Xiaolian; Cheung, Yin Bun

    2011-08-01

    To examine the association between height gain at different stages of early childhood and schooling and cognitive outcomes in 12-year-old Malawian children. A prospective cohort study looking at the growth and development of 325 rural Malawian children. Main outcome measures were highest school grade completed, number of times repeating grades and percentage of correctly answered mathematical questions at 12 years of age. Height-for-age at 1 month and conditional height gain for 6, 18 and 60 months were used as predictors. Ordinal logistic and linear regression analyses were used to estimate the association and adjust for confounder. The conditional height gain during 18-60 months was positively associated with mathematics test results (p=0.003) and negatively associated with number of times repeating grades (p=0.011). It was not significantly associated with highest grade completed (p=0.194) if those who never attended school were included as having completed zero grade, but was positively (p=0.049) associated with this outcome among those who ever attended school. Height gain during the 18-60 months period of age was related to schooling and mathematics ability at age 12 years. The importance of promoting catch-up growth after the period when stunting is common should receive attention. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

  19. Predictors of Fetal and Maternal Outcome in the Crucible of Hepatic Dysfunction During Pregnancy

    PubMed Central

    Suresh, Indrajit; TR, Vijaykumar; HP, Nandeesh

    2017-01-01

    Background Hepatic dysfunction during pregnancy places both the mother and the fetus at risk. Investigations which are efficient, cost effective and easily available for prognostication are required to tackle this global problem. We studied the etiologies and evaluated investigations for predictive efficiency. Methods One hundred ninety-seven pregnant women with hepatic dysfunction during pregnancy were identified. All patients were followed up till 8 weeks after termination of pregnancy or death. Clinico-demographic, biochemical and hematological data were collected and analyzed. Results One hundred ninety-seven of 6,122 females had abnormal liver function tests. Pre-eclampsia (57%), eclampsia (19%), HELLP syndrome (8%), viral infection (6%), hyperemesis gravidarum (5%), intrahepatic cholestasis of pregnancy (4%), chronic liver disease (1%) and sepsis were encountered. There were 41 fetal deaths, 42% preterm deliveries, and NICU admission rate was 27%. Five maternal deaths occurred. Maternal anemia, thrombocytopenia, hyperbilirubinemia and coagulopathy were statistically significant in adverse fetal outcomes. Serum bilirubin performed better than INR as a predictor of both maternal and fetal outcomes. Conclusions Hepatic dysfunction during pregnancy is associated with adverse events for both the mother and the fetus and hypertensive disorders remain the major cause. Maternal bilirubin levels and INR have a role in predicting adverse feto-maternal outcome. PMID:28270873

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

    PubMed

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

    2016-01-01

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

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

    PubMed

    Wadsworth, Barbara; Felton, Fiona; Linus, Rita

    2016-01-01

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

  2. Persistent hypoalbuminemia is a predictor of outcome in cervical spinal cord injury.

    PubMed

    Jin, Guo-Xin; Li, Lei; Cui, Shao-Qian; Duan, Jing-Zhu; Wang, Huan

    2014-09-01

    , ASIA A, and C4 and above neurologic injury were significantly associated with death. Similar to the ASIA scale and neurologic level, persistent hypoalbuminemia seems to be an independent predictor of outcome in patients with CSCI. Thus, a randomized trial assessing albumin in the treatment of cervical spinal cord injury is warranted. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Craniofacial morphologic predictors of oral appliance outcomes in patients with obstructive sleep apnea.

    PubMed

    Shen, Hsin-Lan; Wen, Yu-Wen; Chen, Ning-Hung; Liao, Yu-Fang

    2012-11-01

    Oral appliances (OAs) that advance the mandible can improve the intake of oxygen and reduce the number of apneic episodes in patients who have obstructive sleep apnea. Although OAs are not as effective as continuous positive airway pressure therapy, they are an important therapeutic consideration for patients with obstructive sleep apnea. However, the ability to predict efficacy of OAs is limited. The authors conducted a study to assess the value of relevant clinical and cephalometric variables that can help predict the outcome of OA use in an Asian population. Fifty-two Taiwanese patients consecutively treated with OAs were included in the study. Relevant clinical and cephalometric variables were determined at baseline. Treatment success was defined as a reduction of more than 50 percent in the apnea-hypopnea index and the residual apnea-hypopnea index less than 10 per hour with OAs. The predictive value of variables for treatment outcome was evaluated by means of univariate and multivariate analyses. A receiver operating characteristic curve for the multivariate logistic regression model was constructed. A good outcome was found in 29 participants (56 percent). Minimal retroglossal airway, mandibular position and anterior face height were significant predictors of OA treatment success. The area under the receiver operating characteristic curve was 0.862, reflecting good model discrimination. Some cephalometric variables had a predictive value for the outcome of OA use. OA treatment outcome was favorable in patients with certain craniofacial structures such as narrow minimal retroglossal airway, mandibular retrusion and short anterior face height. Practitioners should consider OAs for treatment of patients with obstructive sleep apnea who have narrow minimal retroglossal airways, mandibular retrusion and short anterior face heights.

  4. Eye Color as a Predictor of Outcomes in Behavior Therapy.

    ERIC Educational Resources Information Center

    Markle, Allan; And Others

    1984-01-01

    Examined the relationship between outcomes of behaviorally oriented treatment for children (N=366) and eye color. Findings were consistent with theoretical expectations: Dark-eyed children and teenagers responded better to reactive treatment programs than their light-eyed counterparts, while the reverse was true for self-paced treatment programs.…

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  6. Positive Outcomes from Poor Starts: Predictors of Dropping Back In

    ERIC Educational Resources Information Center

    Hill, Lauren E.; Jepsen, Christopher

    2007-01-01

    A vast body of research finds an association between missteps taken during the teen years (such as motherhood or dropping out of high school) and poor economic and educational outcomes. However, youth who take major missteps as teens often have subsequent success in school or the labor market. This paper attempts to draw lessons from youth who…

  7. Eye Color as a Predictor of Outcomes in Behavior Therapy.

    ERIC Educational Resources Information Center

    Markle, Allan; And Others

    1984-01-01

    Examined the relationship between outcomes of behaviorally oriented treatment for children (N=366) and eye color. Findings were consistent with theoretical expectations: Dark-eyed children and teenagers responded better to reactive treatment programs than their light-eyed counterparts, while the reverse was true for self-paced treatment programs.…

  8. Predictors of Outcome following Acquired Brain Injury in Children

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  9. Marital Status as a Predictor of Perinatal Outcome in Finland.

    ERIC Educational Resources Information Center

    Manderbacka, Kristiina; And Others

    1992-01-01

    Examined association between mother's marital status and perinatal outcome among single births in Finland in 1987 (n=56,595 infants). Found that perinatal deaths, low birthweight, and preterm infants were more common among single mothers than among married mothers. Results for cohabiting mothers were more similar to those of married than to those…

  10. Students with Intellectual Disabilities: Predictors of Transition Outcomes

    ERIC Educational Resources Information Center

    Baer, Robert M.; Daviso, Alfred W., III; Flexer, Robert W.; Queen, Rachel McMahan; Meindl, Richard S.

    2011-01-01

    This study examined the outcomes of 409 students with mental retardation or multiple disabilities from 177 school districts in a Great Lakes state. These students with intellectual disabilities were interviewed at exit and 1 year following graduation. The authors developed and tested three regression models--two to predict full-time employment and…

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

    ERIC Educational Resources Information Center

    Luo, Jiali; Jamieson-Drake, David

    2015-01-01

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

  12. Predictors of Outcome following Acquired Brain Injury in Children

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Luo, Jiali; Jamieson-Drake, David

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  15. Process Predictors of the Outcome of Group Drug Counseling

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  17. Process Predictors of the Outcome of Group Drug Counseling

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  19. Students with Intellectual Disabilities: Predictors of Transition Outcomes

    ERIC Educational Resources Information Center

    Baer, Robert M.; Daviso, Alfred W., III; Flexer, Robert W.; Queen, Rachel McMahan; Meindl, Richard S.

    2011-01-01

    This study examined the outcomes of 409 students with mental retardation or multiple disabilities from 177 school districts in a Great Lakes state. These students with intellectual disabilities were interviewed at exit and 1 year following graduation. The authors developed and tested three regression models--two to predict full-time employment and…

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

    PubMed Central

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

    2016-01-01

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

  1. Pre-treatment child and family characteristics as predictors of outcome in cognitive behavioural therapy for youth anxiety disorders.

    PubMed

    Lundkvist-Houndoumadi, Irene; Hougaard, Esben; Thastum, Mikael

    2014-11-01

    Cognitive behavioural therapy (CBT) has been found to be effective for children and adolescents (6-18 years) with anxiety disorders, but the non-response rate is high-a fact that may argue for the importance of studies on pre-treatment characteristics of children and their families that predict treatment outcome. To provide a systematic review of clinical and demographic pre-treatment child and family predictors of treatment outcome in CBT for anxiety disorders in youth. A systematic literature search was conducted based on electronic databases (PsycINFO, Embase and PubMed), and retrieved studies were analysed according to the box-score method of counting significant findings. 24 studies with a sample size ≥ 60 were located. Most studies dealt with the following predictors: child age, gender, comorbidity, symptom severity and parental psychopathology. There was some evidence that a higher degree of pre-treatment symptomatic severity and non-anxiety comorbidity predicted higher end-state severity, but not a lesser degree of improvement. There was some but inconsistent support for a negative influence of parental psychopathology. Studies on pre-treatment child and family predictors of outcome in CBT for youth anxiety disorders have until now resulted in few findings of clinical or theoretical significance.

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

    PubMed Central

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

    2015-01-01

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

  3. Preschool children's response to behavioural parent training and parental predictors of outcome in routine clinical care.

    PubMed

    van der Veen-Mulders, Lianne; Hoekstra, Pieter J; Nauta, Maaike H; van den Hoofdakker, Barbara J

    2017-08-30

    To investigate the effectiveness of behavioral parent training (BPT) for preschool children with disruptive behaviours and to explore parental predictors of response. Parents of 68 preschool children, aged between 2.7 and 5.9 years, participated in BPT. We evaluated the changes in children's behaviour after BPT with a one group pretest-posttest design, using a waiting period for a double pretest. Outcome was based on parents' reports of the intensity and number of behaviour problems on the Eyberg Child Behavior Inventory. Predictor variables included parents' attention-deficit/hyperactivity disorder symptoms, antisocial behaviours, and alcohol use, and maternal parenting self-efficacy and disciplining. Mother-reported child behaviour problems did not change in the waiting period but improved significantly after BPT (d = 0.63). High levels of alcohol use by fathers and low levels of maternal ineffective disciplining were each associated with somewhat worse outcome. BPT under routine care conditions clearly improves disruptive behaviours in preschool children. Mothers who consider themselves as inadequate in disciplining and mothers whose partners do not consume high levels of alcohol report the largest improvements. Key practitioner Disruptive behaviours in referred preschool children improve when parents follow behavioural parent training under routine care conditions. Behavioural parent training is useful to help parents experience fewer behaviours as troublesome. About one third of the parents for whom behavioural parent training was indicated never started the treatment. Clinicians are recommended to put additional effort in motivating and facilitating parents to actually participate in behavioural parent training. It may be useful to assess and treat problematic alcohol use in fathers before behavioural parent training. Behavioural parent training may be particularly effective when mothers perceive themselves as inadequate in disciplining. Copyright © 2017

  4. Latent class profiles of depressive symptoms from early to middle childhood: predictors, outcomes, and gender effects

    PubMed Central

    Whalen, Diana J.; Luby, Joan L.; Tilman, Rebecca; Mike, Anissa; Barch, Deanna; Belden, Andy C.

    2015-01-01

    Background There has been little available data to inform the predictors and outcomes of latent class trajectories of depressive symptoms beginning during preschool and continuing throughout school age. Further, the extant literature in this domain has been limited by the use of parent report checklists of non-specific ‘internalizing’ psychopathology rather than diagnostic interviews for depression. Methods To address these gaps in the literature, the current study applied growth mixture modeling to depressive symptom severity endorsed by children and/or their caregivers (N = 348) during a structured clinical interview, in a ten-year longitudinal dataset spanning from preschool into late school age. Results Three distinct trajectories of depressive symptom severity were found in boys and girls. For boys, but not girls, the high depression severity latent class increased in depressive symptoms from preschool through school age, followed by a decline in depressive symptom severity during later school age. For girls, the high depression severity latent class remained stable across time. Early childhood social adversity, familial history of affective disorder, preschool-onset ODD/CD, and school age functional impairment differentiated high-risk trajectory classes among both boys and girls. Conclusions Extending the literature on trajectories of depressive symptoms to the preschool period, these findings incorporate structured clinical interviews of depressive symptom severity and indicate gender differences as well as psychosocial predictors and functional outcomes among children in high severity latent classes. The findings from this study suggest that increased attention to screening for depressive symptoms in early childhood is of significant public health importance. PMID:26748606

  5. Latent class profiles of depressive symptoms from early to middle childhood: predictors, outcomes, and gender effects.

    PubMed

    Whalen, Diana J; Luby, Joan L; Tilman, Rebecca; Mike, Anissa; Barch, Deanna; Belden, Andy C

    2016-07-01

    There has been little available data to inform the predictors and outcomes of latent class trajectories of depressive symptoms beginning during preschool and continuing throughout school age. Further, the extant literature in this domain has been limited by the use of parent report checklists of nonspecific 'internalizing' psychopathology rather than diagnostic interviews for depression. To address these gaps in the literature, this study applied growth mixture modeling to depressive symptom severity endorsed by children and/or their caregivers (N = 348) during a structured clinical interview in a 10-year longitudinal dataset spanning from preschool into late school age. Three distinct trajectories of depressive symptom severity were found in boys and girls. For boys, but not girls, the high depression severity latent class increased in depressive symptoms from preschool through school age, followed by a decline in depressive symptom severity during later school age. For girls, the high depression severity latent class remained stable across time. Early childhood social adversity, familial history of affective disorder, preschool-onset ODD/CD, and school age functional impairment differentiated high-risk trajectory classes among both boys and girls. Extending the literature on trajectories of depressive symptoms to the preschool period, these findings incorporate structured clinical interviews of depressive symptom severity and indicate gender differences as well as psychosocial predictors and functional outcomes among children in high severity latent classes. The findings from this study suggest that increased attention to screening for depressive symptoms in early childhood is of significant public health importance. © 2016 Association for Child and Adolescent Mental Health.

  6. Seroma in ventral incisional herniorrhaphy: incidence, predictors and outcome.

    PubMed

    Kaafarani, Haytham M A; Hur, Kwan; Hirter, Angie; Kim, Lawrence T; Thomas, Anthony; Berger, David H; Reda, Domenic; Itani, Kamal M F

    2009-11-01

    Factors leading to seroma following ventral incisional herniorrhaphy (VIH) are poorly understood. Between 2004 and 2006, patients were prospectively randomized at 4 Veterans Affairs hospitals to undergo laparoscopic or open VIH. Patients who developed seromas within 8 weeks postoperatively were compared with those who did not. Multivariate analyses were performed to identify predictors of seroma. Of 145 patients who underwent VIH, 24 (16.6%) developed seromas. Patients who underwent open VIH had more seromas than those who underwent laparoscopic VIH (23.3% vs 6.8%, P = .011). Seroma patients had hernias that were never spontaneously reducible (0% vs 21%, P = .015), had more abdominal incisions preoperatively (mean, 2.4 vs 1.8; P = .037), and were less likely to have drain catheters placed than those without seromas (30.0% vs 63.1%, P = .011). In multivariate analyses, open VIH predicted seroma (odds ratio, 5.5; 95% confidence interval, 1.6-18.8), as well as the specific hospital at which the procedure was performed. Spontaneous resolution occurred in 71% of seromas; 29% required aspiration. Procedural characteristics and hernia characteristics rather than patient comorbidities predicted seroma in VIH.

  7. Factors related to drug approvals: predictors of outcome?

    PubMed

    Liberti, Lawrence; Breckenridge, Alasdair; Hoekman, Jarno; McAuslane, Neil; Stolk, Pieter; Leufkens, Hubert

    2017-03-10

    There is growing interest in characterising factors associated with positive regulatory outcomes for drug marketing authorisations. We assessed empirical studies published over the past 15 years seeking to identify predictive factors. Factors were classified to one of four 'factor clusters': evidentiary support; product or indication characteristics; company experience or strategy; social and regulatory factors. We observed a heterogeneous mix of technical factors (e.g., study designs, clinical evidence of efficacy) and less studied social factors (e.g., company-regulator interactions). We confirmed factors known to be of relevance to drug approval decisions (imperative) and a cohort of less understood (compensatory) social factors. Having robust supportive clinical evidence, addressing rare or serious illness, following scientific advice and prior company experience were associated with positive outcomes, which illustrated the multifactorial nature of regulatory decision making and factors need to be considered holistically while having varying, context-dependent importance.

  8. Predictors of Clinical Outcomes in Sexually Abused Adolescents.

    PubMed

    Tocker, Lotem; Ben-Amitay, Galit; Horesh-Reinman, Netta; Lask, Michal; Toren, Paz

    2017-01-01

    This cross-sectional, case control study examines the association between child sexual abuse and interpersonal and intrapersonal outcomes among 54 adolescents, examining specific clinical measures (depression, anxiety, dissociation, and posttraumatic stress disorder, attachment patterns, self-esteem, self-disclosure, and family environment characteristics). The research results point to a correlation between sexual abuse and higher levels of the clinical measures. In addition, a correlation was found between sexual abuse and level of avoidant attachment, self-esteem, and family environment characteristics. Stepwise hierarchical regressions were conducted to examine how adolescent attributes predicted depression, anxiety, and dissociation beyond the prediction based on sexual abuse. A combination of self-esteem, anxiety attachment, and family cohesiveness made sexual abuse insignificant when predicting levels of depression, anxiety, and dissociation. This study contributes to characterizing the emotional, personal, and family attributes of adolescents who experienced sexual abuse. It also raises questions about the clinical outcomes usually associated with sexual abuse.

  9. Willingness for treatment as a predictor of retention and outcomes.

    PubMed

    Erickson, J R; Stevens, S; McKnight, P; Figueredo, A J

    1995-01-01

    Retention in drug treatment is important to successful outcomes. The purpose of this study was to test assumptions made in the development and implementation of the ASSET project. The three assumptions were that living conditions of the homeless adult drug user influence willingness for treatment; willingness relates to treatment tenure; and, conditions, willingness and time in treatment influence treatment outcomes. Data on alcohol use, drug use, employment and housing as well as motivation, readiness and suitability of treatment were collected from 494 homeless adults at baseline and at follow-up. Data were subjected to multivariate causal analysis using factor analytic structural equations modeling. Practical fit indices were acceptable. The measurement model confirmed a higher order construct labelled willingness encompassing motivation, readiness and suitability. The structural model demonstrated that willingness positively related to treatment tenure; willingness positively influenced change in drug use and housing; and, tenure related positively to change in housing.

  10. Hypercholesterolaemia in pregnancy as a predictor of adverse pregnancy outcome.

    PubMed

    Maymunah, Adegbesan-Omilabu; Kehinde, Okunade; Abidoye, Gbadegesin; Oluwatosin, Akinsola

    2014-12-01

    Prevention of viable spontaneous preterm birth and low birth weight through screening is one of the key aims of antenatal care as these have implications for the child, mother and society. If women can be identified to be at high risk of these adverse birth outcomes in early pregnancy, they can be targeted for more intensive antenatal surveillance and prophylactic interventions. This study is therefore aimed to determine the association between elevated maternal serum cholesterol level in pregnancy and adverse pregnancy outcome. It was a prospective observational cohort study in which eligible participants were enrolled at gestational age of 14 to 20 weeks. Blood samples were obtained to measure total serum cholesterol concentrations and the sera were then analyzed enzymatically by the cholesterol oxidase: p-aminophenazone (CHOD PAP) method. Pregnancy outcomes were obtained by extraction from medical records and the labour ward register. The incidences of the two adverse pregnancy outcomes examined in the study (preterm births and low birth weight (LBW) in term neonates) were 8.0% and 14.4% respectively. Preterm birth was 6.89-times more common in mothers with high cholesterol than in control mothers with normal total cholesterol level (38.5% versus 5.4%, P=0.029) while LBW was 7.99-times more common in mothers with high total maternal cholesterol than in mothers with normal cholesterol (87.5% versus 10.5%, P=0.019). We can infer that the high maternal serum cholesterol (hypercholesterolaemia) is associated with preterm delivery/ low birth weight (LBW) in term infants. However, further validation of these findings with more robust prospective and longitudinal characterization of maternal serum cholesterol profiles is required in subsequent investigations.

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

    PubMed Central

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

    2016-01-01

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

  12. Neural predictors of 12-month weight loss outcomes following bariatric surgery.

    PubMed

    Holsen, L M; Davidson, P; Cerit, H; Hye, T; Moondra, P; Haimovici, F; Sogg, S; Shikora, S; Goldstein, J M; Evins, A E; Stoeckel, L E

    2017-08-14

    Despite the effectiveness of bariatric surgery, there is still substantial variability in long-term weight outcomes and few factors with predictive power to explain this variability. Neuroimaging may provide a novel biomarker with utility beyond other commonly used variables in bariatric surgery trials to improve prediction of long-term weight-loss outcomes. The purpose of this study was to evaluate the effects of sleeve gastrectomy (SG) on reward and cognitive control circuitry postsurgery and determine the extent to which baseline brain activity predicts weight loss at 12-month postsurgery. Using a longitudinal design, behavioral, hormone and neuroimaging data (during a desire for palatable food regulation paradigm) were collected from 18 patients undergoing SG at baseline (<1 month prior) and 12-month post-SG. SG patients lost an average of 29.0% of their weight (percentage of total weight loss (%TWL)) at 12-month post-SG, with significant variability (range: 16.0-43.5%). Maladaptive eating behaviors (uncontrolled, emotional and externally cued eating) improved (P<0.01), in parallel with reductions in fasting hormones (acyl ghrelin, leptin, glucose, insulin; P<0.05). Brain activity in the nucleus accumbens (NAcc), caudate, pallidum and amygdala during desire for palatable food enhancement vs regulation decreased from baseline to 12 months (P (family-wise error (FWE))<0.05). Dorsolateral and dorsomedial prefrontal cortex activity during desire for palatable food regulation (vs enhancement) increased from baseline to 12 months (P(FWE)<0.05). Baseline activity in the NAcc and hypothalamus during desire for palatable food enhancement was significantly predictive of %TWL at 12 months (P (FWE)<0.05), superior to behavioral and hormone predictors, which did not significantly predict %TWL (P>0.10). Using stepwise linear regression, left NAcc activity accounted for 54% of the explained variance in %TWL at 12 months. Consistent with previous obesity studies, reward

  13. Enlarging vertebrobasilar nonsaccular intracranial aneurysms: frequency, predictors, and clinical outcome of growth.

    PubMed

    Mangrum, Wells I; Huston, John; Link, Michael J; Wiebers, David O; McClelland, Robyn L; Christianson, Teresa J H; Flemming, Kelly D

    2005-01-01

    Vertebrobasilar nonsaccular intracranial aneurysms (NIAs) are characterized by elongation, dilation, and tortuosity of the vertebrobasilar arteries. The goal of this study was to define the frequency, predictors, and clinical outcome of the enlargement of vertebrobasilar NIAs. Patients with vertebrobasilar fusiform or dolichoectatic aneurysms demonstrated on imaging studies between 1989 and 2001 were identified. In particular, patients who had undergone serial imaging were included in this study and their medical records were retrospectively reviewed. Prospective information was collected from medical records or death certificates when available. Both initial and serial imaging studies were reviewed. The authors defined NIA enlargement as a change in lesion diameter greater than 2 mm or noted on the neuroradiologist's report. A Cox proportional hazards regression was used to model time from diagnosis of the vertebrobasilar NIA to the first documented enlargement as a function of various predictors. The Kaplan-Meier method was used to study patient death as a function of aneurysm growth. Of the 159 patients with a diagnosis of vertebrobasilar NIA, 52 had undergone serial imaging studies including 25 patients with aneurysm enlargement. Lesion growth significantly correlated with symptomatic compression at the initial diagnosis (p = 0.0028), lesion type (p < 0.001), and the initial maximal lesion diameter (median 15 mm in patients whose aneurysm enlarged compared with median 8 mm in patients whose aneurysm did not enlarge; p < 0.001). The mortality rate was 5.7 times higher in patients with aneurysm growth than in those with no enlargement after adjustment for patient age (p = 0.002). Forty-eight percent of vertebrobasilar NIAs demonstrated on serial imaging enlarged, and this growth was associated with significant morbidity and death. Significant risk factors for aneurysm enlargement included symptomatic compression at the initial diagnosis, transitional or fusiform

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

    ERIC Educational Resources Information Center

    Andrew, Rachel; Tiggemann, Marika; Clark, Levina

    2016-01-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

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

    ERIC Educational Resources Information Center

    Andrew, Rachel; Tiggemann, Marika; Clark, Levina

    2016-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

  1. Predictors of outcome in residential cognitive and interpersonal treatment for social phobia: do cognitive and social dysfunction moderate treatment outcome?

    PubMed

    Borge, Finn-Magnus; Hoffart, Asle; Sexton, Harold

    2010-09-01

    The predictors of residential cognitive (RCT) and residential interpersonal Treatment (RIPT) for social phobia were explored. (1) Sotsky et al. (1991) found differential effects of CT and IPT for depression, suggesting that the level of cognitive or social dysfunction predicted differential outcome. We examined whether an analogous effect could be demonstrated in 10 weeks of residential treatment of 80 social phobia subjects. (2) We also included expectations, age of onset, severity of illness, concurrent anxiety, mood, avoidant personality disorder, and body dysmorphic disorder as predictors in this exploratory study. Main outcome was the social phobia subscale of Social Phobia and Anxiety Inventory (SPAI SP). DSM-IV axis I and II interviews were completed. (1) Sotsky et al. (1991) findings were not reproduced. However, RIPT subjects with poor general functioning were less improved following treatment. Subjects with concurrent agoraphobia responded better with RCT than subjects without agoraphobia. (2) Age of onset and expectations were the most powerful predictors of post treatment outcome. Some patient characteristics appear to impact outcome with RIPT and RCT differentially. The findings are discussed. (c) 2010 Elsevier Ltd. All rights reserved.

  2. Outcomes and Satisfaction with Endoscopic Carpal Tunnel Releases and the Predictors - A Retrospective Cohort Study

    PubMed Central

    Chen, Alvin Chao-Yu; Wu, Meng-Huang; Cheng, Chun-Ying; Chan, Yi-Sheng

    2016-01-01

    Background: Patient’s final satisfaction with endoscopic carpal tunnel release (ECTR) is still unpredictable. The study aims to find the predictive factors for satisfaction in patients with carpal tunnel syndrome (CTS) treated by ECTR using the Boston CTS questionnaire. Methods: We conducted a retrospective chart review of 37 patients (55 hands) who received ECTR and completed Boston carpal tunnel questionnaire at preoperative visit, 1 month and 6 months after operation while a telephone interview was conducted at 2 years after operation. Independent risk variables, including mean symptom severity scale, functional status scale, each item in questionnaire at all the time points, ASA physical status scale, age, gender, dominant site lesion, bilateral lesions, duration of symptoms and anesthesia method were recorded. Final outcome was determined by the patient’s satisfaction at the interval of 2 years. Predictors to outcome were analyzed by stepwise multiple regression analysis and tested with Pearson correlation test. A p value of less than 0.05 was considered significant. Results: The severity of hand or wrist numbness during the daytime (Q6, explained 6.5% variances), the severity of numbness or tingling at night (Q9, explained 16.2% variances), the functional status of writing (q1, explained 13.9% variances), carrying grocery bags (q7, explained 13.6% variances) had significant predictive value (p<0.001). Other factors were not significant in the analysis including ASA, gender, age, dominant site lesion, bilateral lesions, anesthesia method and duration of symptoms. Conclusions: Boston questionnaire is a simple and reliable tool with high predictive values to evaluate patient’s outcome and satisfaction in ECTR. PMID:28217200

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

    PubMed Central

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

    2014-01-01

    Adolescent mothers and their children are at risk for a myriad of negative outcomes. This study examined risk and protective factors and their impact on a sample (N=172) of impoverished adolescent mothers. Multiple regression analyses revealed that depressed adolescent mothers report higher levels of parenting stress, and that their children are more at risk for maltreatment and are developmentally behind other babies. In addition, adolescent mothers with restricted social support have babies who are at higher risk for maltreatment. Finally, mothers who were older during pregnancy were more likely to stay in school. Implications for program development are discussed. PMID:25378892

  4. Predictors of neurocognitive outcomes on antiretroviral therapy after cryptococcal meningitis: a prospective cohort study.

    PubMed

    Carlson, Renee Donahue; Rolfes, Melissa A; Birkenkamp, Kate E; Nakasujja, Noeline; Rajasingham, Radha; Meya, David B; Boulware, David R

    2014-06-01

    Cryptococcal meningitis is the most common cause of adult meningitis in Africa, yet neurocognitive outcomes are unknown. We investigated the incidence and predictors of neurologic impairment among cryptococcal survivors. HIV-infected, antiretroviral-naive Ugandans with cryptococcal meningitis underwent standardized neuropsychological testing at 1, 3, 6, and 12 months. A quantitative neurocognitive performance z-score (QNPZ) was calculated based on population z-scores from HIV-negative Ugandans (n = 100). Comparison was made with an HIV-infected, non-meningitis cohort (n = 110). Among 78 cryptococcal meningitis survivors with median CD4 count of 13 cells/μL (interquartile range: 6-44), decreased global cognitive function occurred through 12 months compared with the HIV-infected, non-cryptococcosis cohort (QNPZ-6 at 12 months, P = 0.036). Tests of performance in eight cognitive domains was impaired 1 month after cryptococcal diagnosis; however, cryptococcal meningitis survivors improved their global neurocognitive function over 12 months with residual impairment (mean z-scores < -1), only in domains of motor speed, gross motor and executive function at 12 months. There was no evidence that neurocognitive outcome was associated with initial demographics, HIV parameters, or meningitis severity. Paradoxically, persons with sterile CSF cultures after 14 days of induction amphotericin therapy had worse neurocognitive outcomes than those still culture-positive at 14 days (P = 0.002). Cryptococcal meningitis survivors have significant short-term neurocognitive impairment with marked improvement over the first 12 months. Few characteristics related to severity of cryptococcosis, including Cryptococcus burden, were associated with neurocognitive outcome.

  5. ["Who profits?" - patient characteristics as outcome predictors in psychosomatic rehabilitation].

    PubMed

    Oster, J; Müller, G; Wietersheim, J von

    2009-04-01

    The study was to examine how far treatment success in psychosomatic rehabilitation can be predicted from patients' characteristics. The aim of this study included the development of outcome criteria, the analysis of bivariate correlations, as well as development and examination of multivariate models. The motivation for dealing with job-related problems was evaluated separately. Data were available from admission, discharge and three-months follow-up. The data of 463 patients were included. Generated were success criteria concerning sociomedical development, health as well as the ability to work. All success criteria were dichotomized. In the criteria defined, successful outcomes were found in 40 to 60% of the patients. In the bivariate analyses, it was shown that many sick days before rehabilitation, applications for pension, severe disability, high impairment, and suggestion for rehabilitation by the insurance agency, have basically negative effects on success. Correlations with the variables concerning motivation for dealing with job-related problems were rather weak. In multivariate model development, models of different quality were found. For prediction of working ability at discharge, there was an explained variance of nearly 60%. In the other success criteria as well, explained variance amounted to over 20%. The models consist of different constellations of variables, the number of sick days before rehabilitation, variables of application for pension and severity of the impairment frequently included. In case of a current sick leave, rehabilitation should be started early, sociomedical problems have to be dealt with explicitly, and rehabilitation should be accompanied by preparatory and aftercare measures.

  6. Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes

    PubMed Central

    Schmidt, C. Max; Choi, Jennifer; Powell, Emilie S.; Yiannoutsos, Constantin T.; Zyromski, Nicholas J.; Nakeeb, Attila; Pitt, Henry A.; Wiebke, Eric A.; Madura, James A.; Lillemoe, Keith D.

    2009-01-01

    Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF) and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD). We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9%). Perioperative mortality of patients with PF was 0%. Forty-five of 46 PF (98%) closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality. PMID:19461951

  7. [Predictors of nosocomial infection in acute stroke. Relation with morbimortality and outcome].

    PubMed

    Ros, Lourdes; García, Miguel; Prat, Josep; González, Carmen; Gimeno, Concepción; Albert, Amparo; Pascual, José María

    2007-03-31

    Stroke is a very important cause of mortality and disability. This study has the objective of identifying predictor factors and the clinical consequences of nosocomial infection in acute stroke. We prospectively identified a consecutive cohort of patients who were admitted after an acute stroke. We used predefined diagnostic criteria by the World Health Organization and Sociedad Española de Neurología for stroke, and by Centers for Disease Control and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica for infection. 258 patients with acute stroke were included. 102 (39.5%) had at least one nosocomial infection -45.5% women; age (standard deviation) 78.2 (9.7) years-. The mean hospital stay was 14.9 days (8.4) in infection patients and 8.4 days (5.6) in no infection patients (p < 0.001). 31 patients died and 22 (71%) had at least one cause of infection. Using logistic regression analysis, the dysphagia (odds ratio [OR] = 12.7; 95% confidence interval [CI], 5.3-30.1; p < 0.001) is the strongest and independent predictor of nosocomial infection. Others factors are crural motor affectation (OR = 4.5; 95% CI, 1.7-12.3; p = 0.003), urinary incontinence (OR = 2.9; 95% CI, 1.3-6.4; p = 0.009) and diabetes mellitus (OR = 2.3; 95% CI, 1.1-4.7; p = 0.03). Baseline imbalance National Institutes of Health Stroke Scale (NIHSS) > 20 during the admission (OR = 17.3; 95% CI, 5.1-59.5; p < 0.001), mass effect diagnosticated on computerized axial tomography (OR = 4.4; 95% CI, 1.4-14; p = 0.012), poor neurological outcome during the first day (OR = 11.6; 95% CI, 3.6-37.2; p < 0.001), chest infection (OR = 5.7; 95% CI, 1.8-18.3; p = 0.003) and the hyperglucemia in admission (OR = 6; 95% CI, 1.5-25.6; p = 0.015) are the independient predictor factors that increased the likelihood for mortality in acute stroke. Baseline imbalance NIHSS > 20 (OR = 8.9; 95% CI, 2.7-29; p < 0.001), poor outcome neurological during the first day (OR = 8.1; 95% CI, 2.2-29.6%; p = 0

  8. Stroke prevention care delivery: predictors of risk factor management outcomes.

    PubMed

    Ireland, Sandra E; Arthur, Heather M; Gunn, Elizabeth A; Oczkowski, Wieslaw

    2011-02-01

    Internationally, the development and implementation of stroke care guidelines have resulted in the evolution of stroke prevention outpatient clinics designed to accelerate patient access to treatment and behavioral risk reduction following transient ischemic attack or stroke. To examine the extent to which selected demographic, social-psychological, physiological, and adherence characteristics predicted achievement of blood pressure and glucose targets in a group of patients referred to a Canadian stroke prevention clinic with confirmed transient ischemic attack (TIA) or stroke and hypertension and/or diabetes. A total of 313, English speaking, adult patients who were referred from family or emergency department physicians to a stroke prevention clinic provided demographic data and received social-psychological screening testing at intake. Of these, 93 participants who met criteria of confirmed TIA or stroke plus hypertension and/or diabetes were identified as the study group. Seventy-seven of study group participants completed a 6-month follow-up. Admission screening tests included the Modified and Mini-Mental State Examinations, Trail Making Test, Clock Drawing Test, a medication self-efficacy scale, the Lubben Social Network Scale and the Geriatric Depression Scale. Family physician follow-up was ascertained 4-8 weeks after intake. At approximately 6 months after the initial screening measures, 77 study group participants completed additional measures of adherence, blood pressure and/or glycated hemoglobin. Transient ischemic attack was confirmed in 58% and stroke in 42% of the study group. Mean age was 69 years (SD=11); 53% were male; 97% had hypertension; and 25% were diabetic; some had both. Twenty-three percent were not followed-up by family practitioners. At 6-month follow-up, 97% reported ≥80% adherence to medication; only 57% met treatment targets. A logistic regression analysis identified three independent predictors of achieving blood pressure and

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

    PubMed Central

    2013-01-01

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

  10. Retention Loss of Resin Based Fissure Sealants - a Valid Predictor for Clinical Outcome?

    PubMed Central

    Mickenautsch, Steffen; Yengopal, Veerasamy

    2013-01-01

    Purpose: The null-hypothesis that retention loss of resin fissure sealants predicts caries manifestation no more accurately than random values was tested. Methods: Systematic reviews were checked and electronic databases searched for clinical trials. Trials reporting on the retention of resin sealants and caries occurrence in permanent molar teeth, with minimum 24-month follow-up period, were included. Extracted data: number of sealed teeth, number of teeth without completely retained sealants, number of sealed teeth with caries. The number of teeth with complete sealant retention and absence of carious lesions/cavities was calculated; the predictive outcomes: true/false positive; false/true negative were established. Random values were generated as control-data. Diagnostic Odds ratios (DOR) were computed and tested for statistical difference. Summary Receiver Operating Characteristic curves were plotted. Results: 95 trials were found. Median DOR values were 1.21 and 0.28 for test- and control data, respectively. Wilcoxon test (z = 0.56; p = 0.58) and Sign test (z = 1.38; p = 0.17) results were statistically non-significant. The null-hypothesis was not rejected. Conclusions: Predictions based on the retention loss of resin sealants, regarding caries manifestation, was no more accurate than random guesses. Sealant retention loss appears not to be a valid predictor for clinical outcome. PMID:24078856

  11. Clinical predictors and outcomes of consistent bronchodilator response in the childhood asthma management program.

    PubMed

    Sharma, Sunita; Litonjua, Augusto A; Tantisira, Kelan G; Fuhlbrigge, Anne L; Szefler, Stanley J; Strunk, Robert C; Zeiger, Robert S; Murphy, Amy J; Weiss, Scott T

    2008-11-01

    Among asthmatic subjects, bronchodilator response (BDR) to inhaled beta(2)-adrenergic agonists is variable, and the significance of a consistent response over time is unknown. We assessed baseline clinical variables and determined the clinical outcomes associated with a consistently positive BDR over 4 years in children with mild-to-moderate persistent asthma. In the 1041 participants in the Childhood Asthma Management Program, subjects with a change in FEV(1) of 12% or greater (and 200 mL) after inhaled beta(2)-agonist administration at each of their yearly follow-up visits (consistent BDR) were compared with those who did not have a consistent BDR. We identified 52 children with consistent BDRs over the 4-year trial. Multivariable logistic regression modeling demonstrated that lower baseline prebronchodilator FEV(1) values (odds ratio, 0.71; P < .0001), higher log10 IgE levels (odds ratio, 1.97; P = .002), and lack of treatment with inhaled corticosteroids (odds ratio, 0.31; P = .009) were associated with a consistent BDR. Individuals who had a consistent BDR had more hospital visits (P = .007), required more prednisone bursts (P = .0007), had increased nocturnal awakenings caused by asthma (P < .0001), and missed more days of school (P = .03) than nonresponders during the 4-year follow-up. We have identified predictors of consistent BDR and determined that this phenotype is associated with poor clinical outcomes.

  12. Clinical Predictors and Outcomes of Consistent Bronchodilator Response in the Childhood Asthma Management Program

    PubMed Central

    Sharma, Sunita; Litonjua, Augusto A.; Tantisira, Kelan G.; Fuhlbrigge, Anne L.; Szefler, Stanley J.; Strunk, Robert C.; Zeiger, Robert S.; Murphy, Amy J.; Weiss, Scott T.

    2010-01-01

    Background Among asthmatics, bronchodilator response (BDR) to inhaled ß2- adrenergic agonists is variable, and the significance of a consistent response over time is unknown. Objective We assessed baseline clinical variables and determined the clinical outcomes associated with a consistently positive BDR over 4 years in children with mild-moderate persistent asthma. Methods In the 1,041 participants in the Childhood Asthma Management Program (CAMP), subjects with a change in FEV1 of 12% or greater (and 200mLs) after inhaled ß2 agonist at each of their yearly follow-up visits (consistent BDR) were compared with those who did not have a consistent BDR. Results We identified 52 children with consistent BDR over the 4-year trial. Multivariable logistic regression modeling demonstrated that baseline pre-bronchodilator FEV1 (OR=0.71, p<0.0001), log 10 IgE level (OR=1.97, p=0.002), and lack of treatment with inhaled corticosteroids (OR=0.31, p=0.009) were associated with a consistent BDR. Individuals who had a consistent BDR had more hospital visits (p=0.007), required more prednisone bursts (p=0.0007), had increased nocturnal awakenings due to asthma (p<0.0001), and missed more days of school (p=0.03) than non-responders during the 4-year follow-up. Conclusions We have identified predictors of consistent BDR and determined that this phenotype is associated with poor clinical outcomes. PMID:18848350

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

    PubMed

    Tavernier, Royette; Willoughby, Teena

    2014-08-01

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

  14. The vortex--an early predictor of cardiovascular outcome?

    PubMed

    Pedrizzetti, Gianni; La Canna, Giovanni; Alfieri, Ottavio; Tonti, Giovanni

    2014-09-01

    Blood motion in the heart features vortices that accompany the redirection of jet flows towards the outlet tracks. Vortices have a crucial role in fluid dynamics. The stability of cardiac vorticity is vital to the dynamic balance between rotating blood and myocardial tissue and to the development of cardiac dysfunction. Moreover, vortex dynamics immediately reflect physiological changes to the surrounding system, and can provide early indications of long-term outcome. However, the pathophysiological relevance of cardiac fluid dynamics is still unknown. We postulate that maladaptive intracardiac vortex dynamics might modulate the progressive remodelling of the left ventricle towards heart failure. The evaluation of blood flow presents a new paradigm in cardiac function analysis, with the potential for sensitive risk identification of cardiac abnormalities. Description of cardiac flow patterns after surgery or device therapy provides an intrinsic qualitative evaluation of therapeutic procedures, and could enable early risk stratification of patients vulnerable to adverse cardiac remodelling.

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

    PubMed

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

    2016-03-10

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2007-01-01

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

  18. The use of the impingement test as a predictor of outcome following subacromial decompression for rotator cuff tendinosis.

    PubMed

    Kirkley, Alexandra; Litchfield, Robert B; Jackowski, Dianne M; Lo, Ian K

    2002-01-01

    To evaluate the use of the impingement test as a predictor of outcome following subacromial decompression for patients with rotator cuff tendinosis. Observational study. An impingement test was administered to each patient immediately before surgery. Patients underwent a subacromial decompression and were assessed postoperatively at 3 and 6 months. The primary outcome measure was the Western Ontario Rotator Cuff Index (WORC). Thirty patients (mean age, 47.0 years; range, 29.4 to 71.2 years) took part in this study. There was no significant correlation between the classic impingement test (Neer's impingement sign before and after subacromial injection of local anesthetic) and the change in WORC score (r = -.174, P =.358). Similar results were obtained for the aggregate impingement test (pain at rest plus Neer's impingement sign plus Hawkins sign plus resisted abduction) before and after subacromial injection of local anesthetic (r = -.208, P =.270). When divided into categories of improvement following the classic impingement test (worse 0%-25%, 26%-50%, 51%-75%, 76%-100% better), there was no significant difference between groups for outcome as indicated by WORC score (P =.203). Results were similar for the aggregate impingement test (P =.271). The impingement test is a poor tool for predicting the success of subacromial decompression. There are 6 assumptions discussed that must hold true in order for the impingement test to be a useful predictor of outcome following subacromial decompression. If one or more of these assumptions are not met, or are only partially met, the impingement test would be rendered invalid as a predictor of outcome, as this study suggests.

  19. A systematic review of studies identifying predictors of poor return to work outcomes following workplace injury.

    PubMed

    Street, Tamara D; Lacey, Sarah J

    2015-06-05

    Injuries occurring in the workplace can have serious implications for the health of the individual, the productivity of the employer and the overall economic community. The objective of this paper is to increase the current state of understanding of individual demographic and psychosocial characteristics associated with extended absenteeism from the workforce due to a workplace injury. Studies included in this systematic literature review tracked participants' return to work status over a minimum of three months, identified either demographic, psychosocial or general injury predictors of poor return to work outcomes and included a heterogeneous sample of workplace injuries. Identified predictors of poor return to work outcomes included older age, female gender, divorced marital status, two or more dependent family members, lower education levels, employment variables associated with reduced labour market desirability, severity or sensitive injury locations, negative attitudes and outcome perceptions of the participant. There is a need for clear and consistent definition and measurement of return to work outcomes and a holistic theoretical model integrating injury, psychosocial and demographic predictors of return to work. Through greater understanding of the nature of factors affecting return to work, improved outcomes could be achieved.

  20. Predictors of Outcomes in Autism Early Intervention: Why Don’t We Know More?

    PubMed Central

    Vivanti, Giacomo; Prior, Margot; Williams, Katrina; Dissanayake, Cheryl

    2014-01-01

    Response to early intervention programs in autism is variable. However, the factors associated with positive versus poor treatment outcomes remain unknown. Hence the issue of which intervention/s should be chosen for an individual child remains a common dilemma. We argue that lack of knowledge on “what works for whom and why” in autism reflects a number of issues in current approaches to outcomes research, and we provide recommendations to address these limitations. These include: a theory-driven selection of putative predictors; the inclusion of proximal measures that are directly relevant to the learning mechanisms demanded by the specific educational strategies; the consideration of family characteristics. Moreover, all data on associations between predictor and outcome variables should be reported in treatment studies. PMID:24999470

  1. Tumor budding is an independent predictor of outcome in AJCC/UICC stage II colorectal cancer.

    PubMed

    Betge, Johannes; Kornprat, Peter; Pollheimer, Marion J; Lindtner, Richard A; Schlemmer, Andrea; Rehak, Peter; Vieth, Michael; Langner, Cord

    2012-11-01

    In colorectal cancer, the morphology of the invasive tumor margin may reflect aggressiveness of tumor growth, thus providing important prognostic information. The tumor growth pattern according to Jass and the extent of tumor budding were analyzed in patients with American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) stage II disease. Tumors of 120 randomly selected patients with AJCC/UICC stage II disease were retrospectively reviewed for tumor growth pattern (expanding vs. infiltrating) and the extent of tumor budding, with high-grade budding reflecting presence of 10 or more budding foci scattered at the invasive tumor margin. Progression-free and cancer-specific survivals were determined by the Kaplan-Meier method. For multivariable analysis, Cox's proportional hazards regression models were performed. The infiltrating growth pattern was significantly associated with histological subtype and lymphovascular invasion, while high-grade budding was significantly associated with tumor grade and lymphovascular invasion. High-grade budding, but not the infiltrating growth pattern, was significantly associated with outcome in univariable analysis. Cox's proportional hazards regression models proved tumor budding to be an independent predictor of disease progression (hazard ratio 3.91, 95 % confidence interval 1.3-11.77; P = 0.02) and cancer-related death (hazard ratio 5.90, 95 % confidence interval 1.62-21.51; P = 0.007). The combination of infiltrating growth pattern and high-grade budding did not have a stronger prognostic significance than tumor budding alone. Tumor budding independently predicted patient outcome in patients with AJCC/UICC stage II colorectal cancer and may therefore be used for accurate prognostication, patient counseling, and design of clinical trials by using integrated multimodal therapy.

  2. Brain Metastasis from Colorectal Cancer: Predictors and Treatment Outcomes.

    PubMed

    Nozawa, Hiroaki; Ishihara, Soichiro; Kawai, Kazushige; Sasaki, Kazuhito; Murono, Koji; Otani, Kensuke; Nishikawa, Takeshi; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Hata, Keisuke; Watanabe, Toshiaki

    2017-07-13

    Difficulties are associated with the management of brain metastasis (BM), which portends a poor prognosis in the treatment of colorectal cancer (CRC). The aim of the present study was to identify risk factors for BM in CRC and evaluate the outcomes of various treatment modalities. We retrospectively reviewed data on a total of 2,238 patients with primary CRC who underwent surgical resection at our hospital between 1999 and 2014. Predictive factors for BM and prognostic factors after the diagnosis of BM were examined by univariate and multivariate analyses using Cox proportional hazards models. Three patients (0.1%) had BM at the initial diagnosis, and 23 patients (1.2%) developed metachronous BM during the median follow-up period of 44.6 months. Lung and bone metastases were identified as independent predictive factors for BM. Median survival after the diagnosis of BM was 7.4 months. Stereotactic radiosurgery, administered to 41% of the patients with BM, was associated with a better postdiagnostic survival. CRC patients with metastasis to the lung or bone were at a higher risk of BM. Because the survival is still limited, it is crucial to determine the treatment strategy in consideration of the characteristics of each therapy and quality of life in CRC patients with BM. © 2017 S. Karger AG, Basel.

  3. Body composition changes in pregnancy: measurement, predictors and outcomes

    PubMed Central

    Widen, EM; Gallagher, D

    2014-01-01

    Prevalence of overweight and obesity has risen in the United States over the past few decades. Concurrent with this rise in obesity has been an increase in pregravid body mass index and gestational weight gain affecting maternal body composition changes in pregnancy. During pregnancy, many of the assumptions inherent in body composition estimation are violated, particularly the hydration of fat-free mass, and available methods are unable to disentangle maternal composition from fetus and supporting tissues; therefore, estimates of maternal body composition during pregnancy are prone to error. Here we review commonly used and available methods for assessing body composition changes in pregnancy, including: (1) anthropometry, (2) total body water, (3) densitometry, (4) imaging, (5) dual-energy X-ray absorptiometry, (6) bioelectrical impedance and (7) ultrasound. Several of these methods can measure regional changes in adipose tissue; however, most of these methods provide only whole-body estimates of fat and fat-free mass. Consideration is given to factors that may influence changes in maternal body composition, as well as long-term maternal and offspring outcomes. Finally, we provide recommendations for future research in this area. PMID:24667754

  4. Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients.

    PubMed

    Iseki, Kunitoshi; Yamazato, Masanobu; Tozawa, Masahiko; Takishita, Shuichi

    2002-05-01

    Although hypocholesterolemia is common in chronic hemodialysis patients, its effect on survival has not been studied in a large patients population. A cohort of chronic hemodialysis patients (N = 1167) was prospectively followed from January 1991 to January 2001. The survival impact of this cohort, who were divided according to different baseline levels of serum cholesterol, were calculated with the multivariate Cox proportional hazard analysis after adjusting for baseline clinical and laboratory variables. During the study period, 567 (48.6%) patients died. The mean (SD) baseline level of serum cholesterol was 171.0 (40.8) mg/dL and ranged from 76 to 378 mg/dL. The five-year survival rate was highest (0.812) in the subgroup that had a serum cholesterol range of 200 to 219 mg/dL and was lowest (0.608) in the subgroup with serum cholesterol values of <140 mg/dL. The five-year survival rate was 0.735 in the subgroup with serum cholesterol of > or =220 mg/dL. Serum cholesterol was a significant predictor of death with an adjusted hazards ratio (95% confidence interval) was 0.939 (0.891 to 0.989). In a subgroup of patients with serum albumin values > or =4.5 g/dL (N = 128), the adjusted hazards ratio was even greater at 1.370 (1.105 to 1.692). Other than sex, body mass index and serum albumin were significant determinants of baseline levels of serum cholesterol. Hypocholesterolemia was an independent predictor of death in patients on chronic hemodialysis. This impact of hypercholesterolemia on survival was only evident in a subgroup of patients whose serum albumin was more than 4.5 g/dL.

  5. Outcome of patients with ectopia cordis and significant intracardiac defects.

    PubMed

    Hornberger, L K; Colan, S D; Lock, J E; Wessel, D L; Mayer, J E

    1996-11-01

    Previous reports suggest a poor prognosis for patients with ectopia cordis and significant congenital heart disease. To determine the outcome of affected patients in a recent medical and surgical era, we reviewed the clinical course, echocardiograms, catheterization data, and operative reports of all patients with ectopia cordis and significant heart disease encountered at Children's Hospital from 1982 to the present. We identified 13 patients with conotruncal defects and either thoracic (TEC, n = 4) or thoracoabdominal (TAEC, n = 9) ectopia cordis. Diagnosis was established in utero in 6, with termination of pregnancy in 2 and death before transfer to Children's Hospital in 1. Of 10 patients postnatally managed at Children's Hospital, 4 of 8 with TAEC and 1 of 2 with TEC survived beyond infancy, with an age at most recent follow-up of 3.5 to 9.8 years. All 5 survivors had procedures as neonates to provide skin coverage over the midline defect and heart, with concomitant repair of a small omphalocele in 4. Three underwent successful surgical repair of the cardiac defect, including ventricular septal defect closure for double-outlet right ventricle (9 months), repair of tetralogy of Fallot with pulmonary atresia (2.6 years), and repair of double-outlet right ventricle, pulmonary stenosis, and total anomalous pulmonary venous connection to the coronary sinus (3.3 years). Two other patients with TAEC, conoventricular defects, and hypoplastic left ventricle underwent single-ventricle palliation. One patient, at 4 years of age underwent a right cavopulmonary anastomosis and intra-atrial coronary sinus-to-right superior vena cava baffle. The second patient had a modified Fontan procedure. None of the 5 survivors had significant extrathoracic defects, whereas all 3 who died by 3 weeks of age had both a large omphalocele and pulmonary hypoplasia. Two infants with pentalogy of Cantrell, 1 with a large omphalocele, died of fungal sepsis by 5 weeks of age, and 1 other died

  6. Predictors of prison-based treatment outcomes: a comparison of men and women participants.

    PubMed

    Messina, Nena; Burdon, William; Hagopian, Garo; Prendergast, Michael

    2006-01-01

    The purpose of this study was to examine differences between men and women entering prison-based therapeutic community (TC) treatment and to explore the relationship of those differences to posttreatment outcomes (i.e., aftercare participation and reincarceration rates). Extensive treatment-intake interview data for 4,386 women and 4,164 men from 16 prison-based TCs in California were compared using chi-square analyses and t-tests. Logistic regression analyses were then conducted separately for men and women to identify gender-specific factors associated with post-treatment outcomes. Prison intake data and treatment participation data come from a 5-year process and outcome evaluation of the California Department of Corrections' (CDC) Prison Treatment Expansion Initiative. The return-to-custody data came from the CDC's Offender Based Information System. Bivariate results showed that women were at a substantial disadvantage compared with their male counterparts with regard to histories of employment, substance abuse, psychological functioning, and sexual and physical abuse prior to incarceration. In contrast, men had more serious criminal justice involvement than women prior to incarceration. After controlling for these and other factors related to outcomes, regression findings showed that there were both similarities and differences with regard to gender-specific predictors of posttreatment outcomes. Time in treatment and motivation for treatment were similar predictors of aftercare participation for men and women. Psychological impairment was the strongest predictor of recidivism for both men and women. Substantial differences in background characteristics and the limited number of predictors related to posttreatment outcomes for women suggests the plausibility of gender-specific paths in the recovery process.

  7. Neurogenic pulmonary edema in patients with nontraumatic intracerebral hemorrhage: predictors and association with outcome.

    PubMed

    Junttila, Eija; Ala-Kokko, Tero; Ohtonen, Pasi; Vaarala, Anne; Karttunen, Ari; Vuolteenaho, Olli; Salo, Tuula; Sutinen, Meeri; Karhu, Toni; Herzig, Karl-Heinz; Koskenkari, Juha

    2013-04-01

    Neurogenic pulmonary edema (NPE) is a well-recognized phenomenon after intracranial insult. In this study, we evaluated the predictors for NPE and its association with outcome in patients with intensive care unit-treated nontraumatic intracranial hemorrhage. This was a prospective, observational clinical study in a university-level intensive care unit. Clinical characteristics, level of consciousness, and Acute Physiology and Chronic Health Evaluation (APACHE) II score were recorded on admission and the findings of primary head computed tomography were reviewed. A chest radiograph and arterial blood gas analysis were taken serially and NPE was determined as acute bilateral infiltrates in chest radiograph and hypoxemia. Echocardiography and cardiac and inflammatory markers were recorded. The 1-year outcome was assessed using the Glasgow Outcome Scale. NPE developed in 38 (35%) of the 108 patients included. Predictors for NPE were higher APACHE II score (≥20, odds ratio 6.17, P = 0.003) and higher interleukin-6 plasma concentration (>40 pg/mL, odds ratio 5.62, P = 0.003). Of patients with 0, 1, or 2 predictors mentioned above, 4%, 37%, and 65% had NPE, respectively. NPE was associated with a higher 1-year mortality (37% vs 14%, P = 0.007, respectively), but with an unchanged functional outcome after 1 year (Glasgow Outcome Scale score 1-3, 53% vs 51%, P > 0.9). Predictors for NPE are the severity of disease defined by APACHE II scores and higher levels of systemic inflammatory mediators. NPE is associated with a higher 1-year mortality, but not with a poorer 1-year functional outcome.

  8. 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.

  9. Right heart failure and "failure to thrive" after left ventricular assist device: clinical predictors and outcomes.

    PubMed

    Baumwol, Jay; Macdonald, Peter S; Keogh, Anne M; Kotlyar, Eugene; Spratt, Phillip; Jansz, Paul; Hayward, Christopher S

    2011-08-01

    This study determined predictors of early post-operative right heart failure (RHF) and its consequences, as well as predictors of those who clinically thrive longer term after insertion of a continuous-flow left ventricular assist device (LVAD). Pre-operative and latest follow-up data were analyzed for 40 consecutive patients who received third-generation centrifugal-flow LVADs. RHF was defined using previously described criteria, including post-operative inotropes, pulmonary vasodilator use, or right-sided mechanical support. Patients were also categorized according to clinical outcomes after LVAD insertion. LVADs were implanted as a bridge to transplantation (BTT) in 33 patients and as destination therapy in 7. Before LVAD implant, 22 patients were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 1, and 17 were at level 2. Temporary mechanical assistance was present in 50% of the cohort at LVAD implantation. The 6-month survival/progression to transplant was 92.5%. Average LVAD support time was 385 days (range, 21-1,011 days). RHF developed postoperatively in 13 of 40 patients (32.5%). RHF patients had more severe pre-operative tricuspid incompetence than non-RHF patients. The BTT patients with evidence of RHF had poorer survival to transplant (6 of 11 [54.5%]) than those without RHF (20 of 22 [90.9%]), p = 0.027). There were no other hemodynamic or echocardiographic predictors of short-term RHF. After LVAD, 22 of the 40 patients (55%) thrived clinically. For BTT patients, 20 of 21 (95%) of those who thrived progressed to transplant or were alive at latest follow-up vs 6 of 12 (50%) of those who failed to thrive (FTT; p < 0.005). The thrivers had lower New York Heart Association class (1.5 vs 2.9, p < 0.001), spent less time in the hospital, and had less ventricular tachycardia than the FTT patients. However, no differences were noted in pre-operative INTERMACS level, echocardiographic, hemodynamic, and biochemical indices, or

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

    ERIC Educational Resources Information Center

    Hewege, Chandana Rathnasiri; Perera, Liyanage Chamila Roshani

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Hewege, Chandana Rathnasiri; Perera, Liyanage Chamila Roshani

    2013-01-01

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

  12. Clinico-electrophysiological profile and predictors of functional outcome in Guillain-Barre syndrome (GBS).

    PubMed

    Verma, Rajesh; Chaudhari, Tejendra Sukdeo; Raut, Tushar Premraj; Garg, Ravindra Kumar

    2013-12-15

    Guillain-Barre syndrome (GBS) is an acute polyradiculoneuropathy with varied severity of presentation. To study the clinical and electrophysiological profile of patients with GBS and to determine the factors associated with poor functional outcome and need for mechanical ventilation. It was a hospital-based prospective observational study. 90 patients with GBS diagnosed as per Asbury and Cornblath criteria were enrolled and followed up for 6 months. Various epidemiological, clinical and electrophysiological parameters were evaluated. Hughes motor scale was used to measure functional outcome. Factors associated with poor functional outcome and need for mechanical ventilation were determined. 90 patients (56 males; 34 females; mean age of 29.3±15.2 years) were enrolled in this study. Amongst these 6 (6.7%) patients died during in-hospital stay. Antecedent infection was present in 29 (32.2%), autonomic dysfunction in 31 (34.4%), bulbar palsy in 21 (23.3%), neck flexor weakness in 52 (57.8%). 60 cases (66.7%) were of axonal variety and 30 (33.3%) of demyelinating variety. On univariate analysis, predictors associated with poor functional outcome at 6 months were autonomic dysfunction (p=0.013), neck flexor weakness (p=0.009), requirement of ventilatory assistance (p=<0.001), MRC sum score<30 on admission (p=<0.001) and axonal pattern on electrophysiological assessment (p=<0.001). On multivariate analysis, MRC sum score<30 on admission (p=0.007) and axonal pattern on electrophysiological assessment (p=<0.001) were independently associated with poor functional outcome at 6 months. Factors associated with need for mechanical ventilation were presence of autonomic dysfunction (p=<0.001), cranial nerve palsy including facial palsy (p=<0.001) and bulbar palsy (p=0.002), neck flexor weakness (p=<0.001), low MRC sum score (<30) (p=0.001), and low proximal CPN CMAP amplitude to distal CPN CMAP amplitude ratio (p=0.042); none of them being significant on multivariate analysis

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

    PubMed Central

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

    2016-01-01

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

  14. Vagus nerve stimulation: outcome and predictors of seizure freedom in long-term follow-up.

    PubMed

    Ghaemi, Kazem; Elsharkawy, Alaa Eldin; Schulz, Reinhard; Hoppe, Matthias; Polster, Tilman; Pannek, Heinz; Ebner, Alois

    2010-06-01

    To present long-term outcome and to identify predictors of seizure freedom after vagus nerve stimulation (VNS). All patients who had undergone VNS implantation in the Epilepsy Centre Bethel were retrospectively reviewed. There were 144 patients who had undergone complete presurgical evaluation, including detailed clinical history, magnetic resonance imaging, and long-term video-EEG with ictal and interictal recordings. After implantation, all patients were examined at regular intervals of 4 weeks for 6-9 months. During this period the antiepileptic medication remained constant. All patients included in this study were followed up for a minimum of 2 years. Ten patients remained seizure-free for more than 1 year after VNS implantation (6.9%). Seizures improved in 89 patients (61.8%) but no changes were observed in 45 patients (31.3%). The following factors were significant in the univariate analysis: age at implantation, multifocal interictal epileptiform discharges, unilateral interictal epileptiform discharge, cortical dysgenesis, and psychomotor seizure. Stepwise multivariate analysis showed that unilateral interictal epileptiform discharges (IEDs), P=0.014, HR=0.112 (95% CIs, 0.019-0.642), cortical dysgenesis P=0.007, HR=0.065 (95% CIs, 0.009-0.481) and younger age at implantation P=0.026, HR=7.533 (95% CIs 1.28-44.50) were independent predictors of seizure freedom in the long-term follow-up. VNS implantation may render patients with some forms of cortical dysgenesis (parietooccipital polymicrogyria, macrogyria) seizure-free. Patients with unilateral IEDs and earlier implantation achieved the most benefit from VNS. Copyright 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  15. Predictors of renal and patient outcomes in atheroembolic renal disease: a prospective study.

    PubMed

    Scolari, Francesco; Ravani, Pietro; Pola, Alessandra; Guerini, Simona; Zubani, Roberto; Movilli, Ezio; Savoldi, Silvana; Malberti, Fabio; Maiorca, Rosario

    2003-06-01

    Atheroembolic renal disease (AERD) is part of a multisystemic disease accompanied by high cardiovascular comorbidity and mortality. Interrelationships between traditional risk factors for atherosclerosis, vascular comorbidities, precipitating factors, and markers of clinical severity of the disease in determining outcome remain poorly understood. Patients with AERD presenting to a single center between 1996 and 2002 were followed-up with prospective collection of clinical and biochemical data. The major outcomes included end-stage renal disease (ESRD) and death. Ninety-five patients were identified (81 male). AERD was iatrogenic in 87%. Mean age was 71.4 yr. Twenty-three patients (24%) developed ESRD; 36 patients (37.9%) died. Cox regression analysis showed that significant independent predictors of ESRD were long-standing hypertension (hazard ratio [HR] = 1.1; P < 0.001) and preexisting chronic renal impairment (HR = 2.12; P = 0.02); use of statins was independently associated with decreased risk of ESRD (HR = 0.02; P = 0.003). Age (HR = 1.09; P = 0.009), diabetes (HR = 2.55; P = 0.034), and ESRD (HR = 2.21; P = 0.029) were independent risk factors for patient mortality; male gender was independently associated with decreased risk of death (HR = 0.27; P = 0.007). Cardiovascular comorbidities, precipitating factors, and clinical severity of AERD had no prognostic impact on renal and patient survival. It is concluded that AERD has a strong clinical impact on patient and renal survival. The study clearly shows the importance of preexisting chronic renal impairment in determining both renal and patient outcome, this latter being mediated by the development of ESRD. The protective effect of statins on the development of ESRD should be evaluated in a prospective study.

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

    PubMed Central

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

    2014-01-01

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

  17. Distance to thrombus in acute middle cerebral artery occlusion: a predictor of outcome after intravenous thrombolysis for acute ischemic stroke.

    PubMed

    Friedrich, Benjamin; Gawlitza, Matthias; Schob, Stefan; Hobohm, Carsten; Raviolo, Mariana; Hoffmann, Karl-Titus; Lobsien, Donald

    2015-03-01

    In patients with acute middle cerebral artery (MCA) stroke, therapeutic decisions are influenced by the location of the occlusion. This study aimed to analyze clinical outcomes in patients with acute ischemic MCA stroke treated with systemic intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator, according to the location of the occlusion. Of 621 patients screened, 136 with acute stroke and MCA occlusion confirmed by CT angiography were retrospectively included in this study. The distance from the carotid T to the thrombus (DT) on coronal maximum intensity projection images and the thrombus length were measured. The correlation between DT and the modified Rankin Scale score at 90 days was analyzed. DT was an independent predictor of clinical outcome in stroke patients treated with IVT. A long DT was significantly correlated with a good clinical outcome (modified Rankin Scale score at 90 days ≤2). A poor clinical outcome was exponentially more likely than a good outcome when the DT was <16 mm (P<0.001). The thrombus length was not correlated with the modified Rankin Scale score at 90 days. A long thrombus (>8 mm) occurred significantly more often in the proximal MCA than the distal MCA (P<0.001). DT is an independent predictor of clinical outcome in patients with acute MCA occlusion treated with IVT. In acute stroke with MCA occlusion confirmed by CT angiography and DT <16 mm, the likelihood of a good clinical outcome after treatment with IVT was exponentially <50%. This might warrant the evaluation of other therapy forms than IVT in patients with proximal MCA occlusion. © 2015 American Heart Association, Inc.

  18. Religiosity as a Predictor of Adolescents' Substance Use Disorder Treatment Outcomes

    PubMed Central

    Yeterian, Julie D.; Bursik, Krisanne; Kelly, John F.

    2014-01-01

    Background A growing body of research on adults with substance use disorders (SUD) suggests that higher levels of religiosity and/or spirituality are associated with better treatment outcomes. However, investigation into the role of religiosity and spirituality in adolescent SUD treatment response remains scarce. The present study examines religiosity as a predictor of treatment outcomes in an adolescent sample, with alcohol/other drug problem recognition as a hypothesized moderator of this relationship. Problem recognition was selected as a moderator in an attempt to identify a subset of adolescents who would be more likely to use religious resources when attempting to change their substance use. Methods 127 outpatient adolescents age 14 to 19 (M age = 16.7, SD = 1.2, 24% female) were followed for 1 year after treatment intake. Growth curve analyses were used to assess the impact of baseline religiosity and problem recognition on subsequent abstinence rates, drug-related consequences, and psychological distress. Results On average, abstinence did not change significantly during the follow-up period, whereas drug-related consequences and psychological distress decreased significantly. Religiosity did not predict changes in abstinence or psychological distress over time. Religiosity did predict reductions in drug-related consequences over time (b = -0.20, t = -2.18, p = .03). However, when problem recognition was added to the model, the impact of religiosity on consequences became non-significant and there was no interaction between religiosity and problem recognition on consequences. Conclusions The main hypothesis was largely unsupported. Possible explanations include that the sample was low in religiosity and few participants were actively seeking sobriety at treatment intake. Findings suggest adolescent outpatients with SUD may differ from their adult counterparts in the role that religiosity plays in recovery. PMID:25222569

  19. Depression as a predictor of worse quality of life outcomes following nonoperative treatment for lumbar stenosis.

    PubMed

    Lubelski, Daniel; Thompson, Nicolas R; Bansal, Sachin; Mroz, Thomas E; Mazanec, Daniel J; Benzel, Edward C; Khalaf, Tagreed

    2015-03-01

    The goal of this study was to determine whether pretreatment depression is predictive of quality of life (QOL) improvement for patients with lumbar spinal stenosis (LSS) who are treated conservatively. This retrospective cohort study included patients with LSS and concordant neurogenic claudication who were treated nonoperatively at a single institution between September 2010 and March 2013. Patient QOL measures were recorded pretreatment and then 4 months after treatment. Pretreatment depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Successful outcome was defined as posttreatment improvement in EuroQol-5D (EQ-5D) index or in Pain and Disability Questionnaire (PDQ) scores. Regression analysis was performed to identify independent predictors of outcome while controlling for confounding variables. A total of 502 patients were included in the study. The average age for these patients was 66.1 years, with 51% female and 90.6% white. After adjusting for baseline demographic and clinical variables, there was a statistically significant association between baseline PHQ-9 score and posttreatment change in EQ-5D index (β = -0.007, p = 0.0002). All other things being equal, a patient with a baseline PHQ-9 score of 0 (no depression) would be expected to improve in the EQ-5D index by 0.14 points (greater than the minimum clinically important difference) more than would a patient with a baseline PHQ-9 score of 20 (major depression). There was no significant association between baseline PHQ-9 score and change in Pain and Disability Questionnaire scores. When controlling for other baseline characteristics, severely depressed patients with LSS who are treated nonoperatively have significantly less improvement in their QOL compared with those with little or no depression. These data are similar to the negative predictive effects of depression on posttreatment QOL following lumbar fusion surgery.

  20. Cardiopulmonary exercise testing variables as predictors of long-term outcome in thoracic sarcoidosis

    PubMed Central

    Lopes, A.J.; Menezes, S.L.S.; Dias, C.M.; Oliveira, J.F.; Mainenti, M.R.M.; Guimarães, F.S.

    2012-01-01

    Cardiopulmonary exercise testing (CPET) plays an important role in the assessment of functional capacity in patients with interstitial lung disease. The aim of this study was to identify CPET measures that might be helpful in predicting the vital capacity and diffusion capacity outcomes of patients with thoracic sarcoidosis. A longitudinal study was conducted on 42 nonsmoking patients with thoracic sarcoidosis (median age = 46.5 years, 22 females). At the first evaluation, spirometry, the measurement of single-breath carbon monoxide diffusing capacity (DLCOsb) and CPET were performed. Five years later, the patients underwent a second evaluation consisting of spirometry and DLCOsb measurement. After 5 years, forced vital capacity (FVC)% and DLCOsb% had decreased significantly [95.5 (82-105) vs 87.5 (58-103) and 93.5 (79-103) vs 84.5 (44-102), respectively; P < 0.0001 for both]. In CPET, the peak oxygen uptake, maximum respiratory rate, breathing reserve, alveolar-arterial oxygen pressure gradient at peak exercise (P(A-a)O2), and Δ SpO2 values showed a strong correlation with the relative differences for FVC% and DLCOsb% (P < 0.0001 for all). P(A-a)O2 ≥22 mmHg and breathing reserve ≤40% were identified as significant independent variables for the decline in pulmonary function. Patients with thoracic sarcoidosis showed a significant reduction in FVC% and DLCOsb% after 5 years of follow-up. These data show that the outcome measures of CPET are predictors of the decline of pulmonary function. PMID:22331135

  1. Prevalence, predictors and clinical significance of Blastocystis sp. in Sebha, Libya

    PubMed Central

    2013-01-01

    Background Blastocystis sp. has a worldwide distribution and is often the most common human intestinal protozoan reported in children and adults in developing countries. The clinical relevance of Blastocystis sp. remains controversial. This study was undertaken to determine the prevalence of Blastocystis infection and its association with gastrointestinal symptoms among outpatients in Sebha city, Libya. Methods A total of 380 stool samples were collected from outpatients attending the Central Laboratory in Sebha, Libya for routine stool examination. The presence of Blastocystis sp. was screened comparing light microscopy of direct smears against in vitro cultivation. Demographic and socioeconomic information were collected with a standardized questionnaire. Results The overall prevalence of Blastocystis infection was 22.1%. The prevalence was significantly higher among patients aged ≥18 years compared to those aged < 18 years (29.4% vs 9.9%; x2 = 19.746; P < 0.001), and in males compared to females (26.4% vs 17.5%; x2 = 4.374; P = 0.036). Univariate analysis showed significant associations between Blastocystis infection and the occupational status (P = 0.017), family size (P = 0.023) and educational level (P = 0.042) of the participants. Multiple logistic regression analysis confirmed that the age of ≥ 18 years (OR = 5.7; 95% CI = 2.21; 9.86) and occupational status (OR = 2.2; 95% CI = 1.02, 4.70) as significant predictors of Blastocystis infection among this population. In those who had only Blastocystis infection but no other gastrointestinal parasitic infections, the prevalence of gastrointestinal symptoms was higher compared to those without Blastocystis infection (35.3% vs 13.2%; x2 = 25.8; P < 0.001). The most common symptoms among these patients were abdominal pain (76.4%), flatulence (41.1%) and diarrhoea (21.5%). Conclusions Blastocystis sp. is prevalent and associated with

  2. Prevalence, predictors and clinical significance of Blastocystis sp. in Sebha, Libya.

    PubMed

    Abdulsalam, Awatif M; Ithoi, Init; Al-Mekhlafi, Hesham M; Khan, Abdul Hafeez; Ahmed, Abdulhamid; Surin, Johari; Mak, Joon Wah

    2013-04-08

    Blastocystis sp. has a worldwide distribution and is often the most common human intestinal protozoan reported in children and adults in developing countries. The clinical relevance of Blastocystis sp. remains controversial. This study was undertaken to determine the prevalence of Blastocystis infection and its association with gastrointestinal symptoms among outpatients in Sebha city, Libya. A total of 380 stool samples were collected from outpatients attending the Central Laboratory in Sebha, Libya for routine stool examination. The presence of Blastocystis sp. was screened comparing light microscopy of direct smears against in vitro cultivation. Demographic and socioeconomic information were collected with a standardized questionnaire. The overall prevalence of Blastocystis infection was 22.1%. The prevalence was significantly higher among patients aged ≥18 years compared to those aged < 18 years (29.4% vs 9.9%; x² = 19.746; P < 0.001), and in males compared to females (26.4% vs 17.5%; x² = 4.374; P = 0.036). Univariate analysis showed significant associations between Blastocystis infection and the occupational status (P = 0.017), family size (P = 0.023) and educational level (P = 0.042) of the participants. Multiple logistic regression analysis confirmed that the age of ≥ 18 years (OR = 5.7; 95% CI = 2.21; 9.86) and occupational status (OR = 2.2; 95% CI = 1.02, 4.70) as significant predictors of Blastocystis infection among this population. In those who had only Blastocystis infection but no other gastrointestinal parasitic infections, the prevalence of gastrointestinal symptoms was higher compared to those without Blastocystis infection (35.3% vs 13.2%; x² = 25.8; P < 0.001). The most common symptoms among these patients were abdominal pain (76.4%), flatulence (41.1%) and diarrhoea (21.5%). Blastocystis sp. is prevalent and associated with gastrointestinal symptoms among communities in Sebha city, Libya. Age and occupational status were the significant

  3. Predictors of Long-Term Outcome of Thoracic Sympathectomy in Patients with Complex Regional Pain Syndrome Type 2.

    PubMed

    Alkosha, Hazem M; Elkiran, Yasser M

    2016-08-01

    Long-term results of sympathectomy in patients with complex regional pain syndrome (CRPS) type 2 varies widely among studies due to nonspecific or vague criteria of diagnosis and absence of outcome predictors that help good patient selection. The objective was to determine the predictors of long-term outcome of sympathectomy in patients with upper limb CRPS type 2. A retrospective cohort, in which those who underwent thoracic sympathectomy for upper limb CRPS type 2 from 2007 to 2014, were included. Demographic and clinical data of patients, in addition to stellate ganglion block (SGB) details and percent of pain relief at the end of follow-up, were collected and used for statistical analysis. Our study included 53 patients, with a mean age of 47 ± 7 years, and 60% females. Using bivariate correlations; age, sex, nerve injured, type of injury, and occupation were not significantly correlated to outcome. Multiple linear regression analysis of correlated variables revealed that duration of pain relief after SGB and degree of sympathetic overactivity were positive predictors (β = 0.286, P = 0.027, and β = 0.257, P = 0.003, respectively), whereas presence of allodynia was a negative predictor (β = -0.280, P = 0.041) of the final pain relief. Final pain relief was better in those patients who experienced extended relief of their pain >2 days after SGB (P = 0.001, Kruskal Wallis test). Thoracic sympathectomy may prove more effective than reported in carefully selected CRPS patients with prominent sympathetic overactivity, no or early allodynia, and pain relief >2 days after SGB. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Behavioral Economic Predictors of Brief Alcohol Intervention Outcomes

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Yeom, Yei-Jin

    2013-12-01

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

  6. Trunk performance after stroke: an eye catching predictor of functional outcome.

    PubMed

    Verheyden, Geert; Nieuwboer, Alice; De Wit, Liesbet; Feys, Hilde; Schuback, Birgit; Baert, Ilse; Jenni, Walter; Schupp, Wilfried; Thijs, Vincent; De Weerdt, Willy

    2007-07-01

    Trunk performance is an important predictor of functional outcome after stroke. However, the percentage of explained variance varies considerably between studies. This may be explained by the stroke population examined, the different scales used to assess trunk performance and the time points used to measure outcome. The aim of this multicentre study was to examine the predictive validity of the Trunk Impairment Scale (TIS) and its subscales when predicting the Barthel Index score at 6 months after stroke. A total of 102 subjects were recruited in three European rehabilitation centres. Participants were assessed on admission (median time since stroke onset 20 days) and 6 months after stroke. Correlation analysis and forward stepwise multiple regression analysis were used to model outcome. The best predictors of the Barthel Index scores at 6 months after stroke were total TIS score (partial R2 = 0.52, p<.0001) and static sitting balance subscale score (partial R2 = 0.50, p<.0001) on admission. The TIS score on admission and its static sitting balance subscale were stronger predictors of the Barthel Index score at 6 months than the Barthel Index score itself on admission. This study emphasises the importance of trunk performance, especially static sitting balance, when predicting functional outcome after stroke. The TIS is recommended as a prediction instrument in the rehabilitation setting when considering the prognosis of stroke patients. Future studies should address the evolution of trunk performance over time and the evaluation of treatment interventions to improve trunk performance.

  7. Predictors for long-term seizure outcome in juvenile myoclonic epilepsy: 25-63 years of follow-up.

    PubMed

    Geithner, Julia; Schneider, Felix; Wang, Zhong; Berneiser, Julia; Herzer, Rosemarie; Kessler, Christof; Runge, Uwe

    2012-08-01

    The long-term seizure outcome of juvenile myoclonic epilepsy (JME) is still controversial; the value of factors that are potentially predictive for seizure outcome remains unclear. The aim of this study was both to investigate the long-term seizure outcome in patients with JME after a follow-up of at least 25 years and to identify factors that are predictive for the seizure outcome. Data from 31 patients (19 women) with JME were studied. All of them had a follow-up of at least 25 years (mean 39.1 years) and were reevaluated with a review of their medical records and direct telephone or face-to-face interview. Of 31 patients 21 (67.7%) became seizure-free; in six of them (28.6%) antiepileptic drug (AED) treatment was discontinued due to seizure freedom. The occurrence of generalized tonic-clonic seizures (GTCS) preceded by bilateral myoclonic seizures (BMS) (p = 0.03), a long duration of epilepsy with unsuccessful treatment (p = 0.022), and AED polytherapy (p = 0.023) were identified as significant predictors for a poor long-term seizure outcome, whereas complete remission of GTCS under AED significantly increased the chance for complete seizure freedom (p = 0.012). The occurrence of photoparoxysmal responses significantly increases the risk of seizure recurrence after AED discontinuation (p = 0.05). This study shows conclusively that JME is a heterogeneous epilepsy syndrome. Life-long AED treatment is not necessarily required to maintain seizure freedom. Several long-term outcome predictors that can potentially increase the ability of clinicians and their confidence to recommend different treatment options to patients with JME were identified. Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.

  8. Clinical and paraclinical profile, and predictors of outcome in 90 cases of scrub typhus, Meghalaya, India.

    PubMed

    Sivarajan, Sunuraj; Shivalli, Siddharudha; Bhuyan, Debomallya; Mawlong, Michael; Barman, Rittwick

    2016-10-05

    India is an integral component of "tsutsugamushi triangle" which depicts a part of the globe endemic to scrub typhus. Owing to frequent outbreaks witnessed in different parts of the country in the recent past, scrub typhus is described as a re-emerging infectious disease in India. The present study aimed to study the clinical and paraclinical profile, complications and predictors of outcome among 90 cases of scrub typhus diagnosed in a hospital of north-eastern India from Sept 2011 to Aug 2012. A longitudinal study was conducted in a hospital of Meghalaya, India between Sept 2011 and Aug 2012. Diagnosis of scrub typhus was arrived by SD BIOLINE tsutsugamushi (solid phase immunochromatographic assay) rapid diagnostic test for antibodies (IgM, IgG or IgA). Descriptive analyses of age, gender, geographic area, symptoms and signs, treatment, laboratory findings, complications, and outcome were conducted. Relative risk (RR) with 95 % confidence interval (CI) was computed for Multiple Organ Dysfunction Syndrome (MODS) and mortality. Binary logistic regression was applied to the significant correlates (P < 0.05) on univariate analysis to identify the predictors of MODS and mortality in scrub typhus. As many as 662 clinically suspected scrub typhus patients were tested and 90 (13.6 %) were diagnosed to have scrub typhus. Out of 90 patients, 52.2 % (n = 47) were males and their mean (SD) age was 36.29 (13.38) years. Fever of <7 days (n = 75, 83.3 %), myalgia (n = 56, 62.2 %), pain abdomen (n = 24, 26.7 %), headache (n = 24, 26.7 %), nausea/vomiting (n = 21, 23.3 %), dry cough (n = 21, 23.3 %), hepatomegaly (n = 24, 26.7 %), splenomegaly (n = 22, 24.4 %), and lymphadenopathy (n = 20, 22.2 %) were the predominant clinical features. Eschar was seen in 10 patients (11.1 %). One third (n = 30) of the patients developed at least one systemic complication. Acute hepatitis (n = 15, 16.7 %), pneumonitis (n = 14

  9. Outcome after burns: an observational study on burn scar maturation and predictors for severe scarring.

    PubMed

    van der Wal, Martijn B A; Vloemans, Jos F P M; Tuinebreijer, Wim E; van de Ven, Peter; van Unen, Ella; van Zuijlen, Paul P M; Middelkoop, Esther

    2012-01-01

    Long-term outcome of burn scars as well as the relation with clinically relevant parameters has not been studied quantitatively. Therefore, we conducted a detailed analysis on the clinical changes of burn scars in a longitudinal setup. In addition, we focused on the differences in scar quality in relation to the depth, etiology of the burn wound and age of the patient. Burn scars of 474 patients were subjected to a scar assessment protocol 3, 6, and 12 months postburn. Three different age groups were defined (≤5, 5-18, and ≥18 years). The observer part of the patient and observer scar assessment scale revealed a significant (p < 0.001) improvement in scar quality at 12 months compared with the 3- and 6-month data. Predictors for severe scarring are depth of the wound (p < 0.001) and total body surface area burned (p < 0.001). Etiology (p = 0.753) and age (p > 0.230) have no significant influence on scar quality when corrected for sex, total body surface area burned, time, and age or etiology, respectively.

  10. Anti-Müllerian hormone as a predictor of IVF outcome.

    PubMed

    Lekamge, Dharmawijaya N; Barry, Michael; Kolo, Michele; Lane, Michelle; Gilchrist, Robert B; Tremellen, Kelton P

    2007-05-01

    Serum anti-Müllerian hormone (AMH) concentration and antral follicle count (AFC) are two increasingly popular static measures used to predict ovarian reserve prior to IVF treatment. While they have been shown to be good predictors of oocyte yield during ovarian stimulation, their status as indicators of oocyte quality and pregnancy rates is currently uncertain. The present study measured baseline concentrations of serum AMH and FSH, and AFC from 126 women undergoing IVF treatment. These data were then related to IVF outcomes. As expected, patients with lower serum AMH and AFC produced a significantly (P < 0.001) lower number of oocytes compared with patients with higher serum AMH/AFC. Fertilization rates in patients with lower serum AMH were significantly inferior compared with patients with higher serum AMH, irrespective of whether IVF (P = 0.043) or intracytoplasmic sperm injection (P = 0.006) was used to achieve fertilization. These low AMH patients yielded fewer oocytes, had lower fertilization rates, generated fewer embryos, and had a higher incidence of miscarriage during fresh transfers, ultimately culminating in a halving of the pregnancy rate per IVF cycle compared with the high AMH group.

  11. Incidence, Predictors and Outcomes of Major Bleeding in Patients Following Percutaneous Coronary Interventions in Australia.

    PubMed

    Wlodarczyk, John; Ajani, Andrew E; Kemp, Dante; Andrianopoulos, Nick; Brennan, Angela L; Duffy, Stephen J; Clark, David J; Reid, Christopher M

    2016-02-01

    Major bleeding is a serious complication of percutaneous coronary intervention (PCI). We set out to investigate the incidence of major bleeding and its impact on hospitalisation and long-term mortality. We examined seven years of registry data encompassing 16,860 PCI procedures. Between 2005 and 2011 major bleeding increased from 1.3% to 3.4%. In patients with ST elevated myocardial infarction (STEMI), the rate increased from 2.3% to 6.4%. The increase remained significant after adjusting for patient and procedural characteristics (OR=1.09/year, p=0.001). Bleeding risk was highest in patients presenting with out-of-hospital cardiac arrest and cardiogenic shock (CS). Women, STEMI patients, those aged over 70yrs or weighing <60kg were at higher risk. Glycoprotein IIb/IIIa-inhibitor use more than doubled the risk of bleeding (OR=2.28, p=<0.001). Mortality rates at one year were 4.18% overall and 7.9% in STEMI. Bleeding was a strong predictor of mortality after adjusting for potential confounders (HR=2.92, 95% CI: 2.08, 4.09). Bleeding significantly increased length of stay (med four days vs seven days) and rehospitalisation at 12 months (OR=1.36, 95% CI: 1.08, 1.70). Major bleeding rates post-PCI appear to be increasing in Australia. Bleeding increases hospitalisation and is associated with poor clinical outcomes. Copyright © 2015. Published by Elsevier B.V.

  12. Predictors of depression outcomes among abstinent methamphetamine-dependent individuals exposed to an exercise intervention.

    PubMed

    Haglund, Margaret; Ang, Alfonso; Mooney, Larissa; Gonzales, Rachel; Chudzynski, Joy; Cooper, Christopher B; Dolezal, Brett A; Gitlin, Michael; Rawson, Richard A

    2015-04-01

    This paper expands on a study investigating depression outcomes in response to an 8-week exercise intervention among methamphetamine (MA) dependent individuals in early recovery. A total of 135 MA-dependent individuals enrolled in residential treatment were randomly assigned to either a structured exercise intervention or a structured health education control group. Both groups were similar in format: 60-minute sessions, offered three times a week over an 8-week study period. Results showed that at the 8-week trial endpoint, participants randomized to the exercise intervention showed significantly greater reduction in depression symptom scores than participants randomized to the health education group, and that participants who attended the greatest number of exercise sessions derived the greatest benefit. This paper further analyzes study data to uncover individual predictors of depression response to exercise and finds that among participants randomized to exercise treatment, individuals with the most severe medical, psychiatric, and addiction disease burden at baseline showed the most significant improvement in depressive symptoms by study endpoint. Our findings suggest that exercise in moderate dose is effective at treating depressive symptoms in individuals in early recovery from addiction, and furthermore, that treatment with exercise appears to be particularly beneficial to individuals who suffer from severe medical, psychiatric, and addictive disorders. © American Academy of Addiction Psychiatry.

  13. Predictors of lifestyle intervention outcome and dropout: the SLIM study.

    PubMed

    Roumen, C; Feskens, E J M; Corpeleijn, E; Mensink, M; Saris, W H M; Blaak, E E

    2011-10-01

    To evaluate the effect of a 4.1-year (range 3-6 years) lifestyle intervention according to general public health recommendations on glucose tolerance and dropout in a Dutch population with impaired glucose tolerance (IGT). In the Study on Lifestyle intervention and Impaired glucose tolerance Maastricht, 147 Caucasian IGT subjects were randomized to an intervention group (INT: n=74; 38 male, 36 female) and control group (CON: n=73; 37 male, 36 female). Annually, subjects underwent measurements of body weight, anthropometry, glucose tolerance (oral glucose tolerance test), insulin resistance (homeostasis model assessment-insulin resistance), maximal aerobic capacity (VO(2) max), blood lipids and blood pressure. INT received individual advice regarding a healthy diet and physical activity. INT decreased their saturated fat intake, increased their carbohydrate intake (P<0.05) and VO(2) max (P=0.04) compared with CON. Body weight did not change significantly (P=0.20) between the groups. After an initial decrease, 2-h glucose levels overall increased in INT (+0.11 mmol/l), but significantly less than CON (+1.18 mmol/l; P=0.04). Diabetes incidence was lower in INT versus CON (30 versus 56%, P=0.04). Change in body weight was associated with change in 2-h glucose levels (β=0.399 mmol/l per kg, P=0.02). Dropouts had a lower aerobic fitness and socioeconomic status, and a higher body mass index (BMI) and 2-h glucose compared with non-dropouts. Prolonged feasible changes in diet and physical activity prevent deterioration of glucose tolerance and reduce diabetes risk. Low socioeconomic status, low aerobic fitness and high BMI and 2-h glucose are indicative of dropout to the program.

  14. Dimensional measures of personality as a predictor of outcome at 5-year follow-up in women with bulimia nervosa.

    PubMed

    Rowe, Sarah; Jordan, Jennifer; McIntosh, Virginia; Carter, Frances; Frampton, Chris; Bulik, Cynthia; Joyce, Peter

    2011-02-28

    Dimensional models are commonly used as a supplement to the categorical model within the field of personality disorders. The purpose of this study was to examine personality dimensions as predictors of 5-year outcomes among women with bulimia nervosa. One hundred and thirty-four women with bulimia nervosa participated in a randomised psychotherapy treatment trial. Data was available for 109 out of the 134 participants at follow-up. Outcomes were the presence of any eating disorder (past year), the presence of a mood disorder episode (past year), and the global assessment of functioning at 5-year follow-up. Self-directedness was the only predictor of any eating disorder diagnosis (past year) at 5-year follow-up. Asceticism significantly predicted the presence of a mood disorder episode (past year) at 5 years. Borderline personality disorder symptoms predicted global functioning at 5 years. These results suggest that high self-directedness at pre-treatment may offer potential prognostic information regarding eating disorder status 5 years post-treatment. Furthermore, no single measure predicted outcome for all variables (any eating disorder diagnosis, a mood disorder episode (past year), or global functioning) at 5-year follow-up. This suggests that a comprehensive personality assessment using multiple measures is desirable for predicting outcomes.

  15. Social-cognitive predictors of vocational outcomes in transition youth with epilepsy: Application of social cognitive career theory.

    PubMed

    Sung, Connie; Connor, Annemarie

    2017-08-01

    This study examined the utility of social-cognitive career theory (SCCT; Lent, Brown, & Hackett, 1994) as a framework to investigate career self-efficacy, outcome expectations, goals, and contextual supports and barriers as predictors of choice actions among transition-age individuals with epilepsy. Moreover, these SCCT constructs are offered as an operational definition of work participation in this population. Using a quantitative descriptive research design and hierarchical regression analysis (HRA), 90 transition-age individuals with epilepsy, age 18-25, were recruited from affiliates of the Epilepsy Foundation and invited to complete an online survey comprised of a series of self-report social-cognitive measures. The HRA findings indicated that self-efficacy, outcome expectations, and environmental supports were significant predictors of work participation in youth and young adults with epilepsy. The final model accounted for 58% of the variance in work participation, which is considered a large effect size. The research findings provide support for the use of the SCCT framework to identify predictors of work participation and to provide guidance for designing customized vocational rehabilitation services and career development interventions for individuals with epilepsy in the transition from adolescence to adulthood. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  16. Donor Predictors of Allograft Utilization and Recipient Outcomes after Heart Transplantation

    PubMed Central

    Khush, Kiran K.; Menza, Rebecca; Nguyen, John; Zaroff, Jonathan G.; Goldstein, Benjamin A.

    2013-01-01

    Background Despite a national organ donor shortage and a growing population of patients with end-stage heart disease, the acceptance rate of donor hearts for transplantation is low. We sought to identify donor predictors of allograft non-utilization, and to determine whether these predictors are in fact associated with adverse recipient post-transplant outcomes. Methods and Results We studied a cohort of 1,872 potential organ donors managed by the California Transplant Donor Network from 2001–2008. Forty five percent of available allografts were accepted for heart transplantation. Donor predictors of allograft non-utilization included age>50 years, female sex, death due to cerebrovascular accident, hypertension, diabetes, a positive troponin assay, left ventricular dysfunction and regional wall motion abnormalities, and left ventricular hypertrophy. For hearts that were transplanted, only donor cause of death was associated with prolonged recipient hospitalization post-transplant, and only donor diabetes was predictive of increased recipient mortality. Conclusions While there are many donor predictors of allograft discard in the current era, these characteristics appear to have little effect on recipient outcomes when the hearts are transplanted. Our results suggest that more liberal use of cardiac allografts with relative contraindications may be warranted. PMID:23392789

  17. Religiosity as a Predictor of Adolescents' Substance Use Disorder Treatment Outcomes.

    PubMed

    Yeterian, Julie D; Bursik, Krisanne; Kelly, John F

    2015-01-01

    A growing body of research on adults with substance use disorders (SUDs) suggests that higher levels of religiosity and/or spirituality are associated with better treatment outcomes. However, investigation into the role of religiosity and spirituality in adolescent SUD treatment response remains scarce. The present study examines religiosity as a predictor of treatment outcomes in an adolescent sample, with alcohol/other drug problem recognition as a hypothesized moderator of this relationship. Problem recognition was selected as a moderator in an attempt to identify a subset of adolescents who would be more likely to use religious resources when attempting to change their substance use. One hundred twenty-seven outpatient adolescents aged 14 to 19 (Mage=16.7, SD=1.2, 24% female) were followed for 1 year after treatment intake. Growth curve analyses were used to assess the impact of baseline religiosity and problem recognition on subsequent abstinence rates, drug-related consequences, and psychological distress. On average, abstinence did not change significantly during the follow-up period, whereas drug-related consequences and psychological distress decreased significantly. Religiosity did not predict changes in abstinence or psychological distress over time. Religiosity did predict reductions in drug-related consequences over time (b=-0.20, t=-2.18, P=.03). However, when problem recognition was added to the model, the impact of religiosity on consequences became nonsignificant, and there was no interaction between religiosity and problem recognition on consequences. The main hypothesis was largely unsupported. Possible explanations include that the sample was low in religiosity and few participants were actively seeking sobriety at treatment intake. Findings suggest adolescent outpatients with SUD may differ from their adult counterparts in the role that religiosity plays in recovery.

  18. Predictors of outcome after alcohol septal ablation therapy in patients with hypertrophic obstructive cardiomyopathy.

    PubMed

    Chang, Su Min; Lakkis, Nasser M; Franklin, Jennifer; Spencer, William H; Nagueh, Sherif F

    2004-02-24

    Alcohol septal ablation (ASA) therapy results in clinical and hemodynamic improvement in patients with hypertrophic obstructive cardiomyopathy. However, a subset remains symptomatic afterward, requiring additional procedures. We sought to examine the determinants of an unsatisfactory outcome, defined as unchanged symptoms with <50% reduction of baseline left ventricular outflow tract (LVOT) gradient. Of 173 consecutive hypertrophic obstructive cardiomyopathy patients who underwent ASA, 39 had an unsatisfactory outcome after the first procedure. Patients with an unsatisfactory outcome had a higher baseline LVOT gradient, fewer septal arteries injected with ethanol, lower peak creatine kinase (CK), smaller septal area opacified by contrast echocardiography, and higher residual gradient in the catheterization laboratory after ASA (all P<0.05). Symptoms, septal thickness, mitral regurgitation severity, and ventricular function were not determinants of outcome. On multiple logistic regression, LVOT gradient reduction after ASA in the catheterization laboratory to > or =25 mm Hg (OR, 5.5; P=0.01) and peak CK <1300 U/L (OR, 2.5; P=0.04) were the independent predictors of an unsatisfactory outcome. The residual LVOT gradient in the catheterization laboratory and peak CK leak after ASA are the independent predictors of ASA outcome.

  19. Predictors of early school age outcomes in very low birth weight children.

    PubMed

    Taylor, H G; Klein, N; Schatschneider, C; Hack, M

    1998-08-01

    The purpose of this study was to examine predictors of outcome in very low birth weight (< 1500 g) children. The very low birth weight sample consisted of 68 children weighing less than 750 g at birth and 65 children weighing 750 to 1499 g at birth who had been matched to the less than 750 g birth weight children in terms of hospital of birth, age, sex, and race. Mean ages for these two groups were 6.7 and 6.9 years, respectively. Outcomes were measured in terms of tests of cognitive function, neuropsychological abilities, and academic achievement and parent and teacher ratings of child behavior and school performance. A weighted sum of the number of major neonatal medical complications (Neonatal Risk Index) provided a composite measure of biological risk. Social risks were also assessed. Results indicated that the Neonatal Risk Index was the most consistent predictor of outcomes. Even after taking social risks into account, neonatal risk predicted overall cognitive ability and other achievement, neuropsychological, and behavior outcomes. Individual neonatal complications that predicted outcomes included severe cerebral ultrasonographic abnormality, chronic lung disease, necrotizing enterocolitis, and apnea of prematurity. Research and therapy to prevent or reduce neonatal complications and amelioration of social risks are of critical importance in improving outcomes of very low birth weight.

  20. Psoas Muscle Area as a Predictor of Outcomes in Transcatheter Aortic Valve Implantation.

    PubMed

    Garg, Lohit; Agrawal, Sahil; Pew, Timothy; Hanzel, George S; Abbas, Amr E; Gallagher, Michael J; Shannon, Francis L; Hanson, Ivan D

    2017-02-01

    Frailty is a powerful predictor of outcomes after transcatheter aortic valve implantation (TAVI). Sarcopenia as assessed by psoas muscle area (PMA) is a validated tool to assess frailty before surgical procedures. We evaluated PMA as a predictor of outcomes after TAVI in 152 consecutive patients who underwent this procedure at our institution from 2011 to 2014. Preoperative computed tomography scans were used to measure PMA, which then was indexed to body surface area. Outcomes evaluated included (1) early poor outcome (30 days mortality, stroke, dialysis, and prolonged ventilation), (2) 1-year mortality, and (3) high-resource utilization (length of stay >7 days, discharge to rehabilitation, or readmission within 30 days). Indexed PMA (odds ratio [OR] 3.19, confidence interval [CI] 1.30 to 7.83; p = 0.012) and age (OR 1.92, CI 1.87 to 1.98; p = 0.012) predicted early poor outcome. Society of Thoracic Surgeons score predicted 1-year mortality (hazard ratio 3.07, CI 1.93 to 6.23; p = 0.011). High-resource utilization was observed more frequently in patients with PMA less than the median (73% vs 51%, OR 2.65, CI 1.32 to 5.36; p = 0.006). In conclusion, indexed PMA predicts early poor outcome and high-resource utilization after TAVI. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. The baseline serum value of α-amylase is a significant predictor of distance running performance.

    PubMed

    Lippi, Giuseppe; Salvagno, Gian Luca; Danese, Elisa; Tarperi, Cantor; La Torre, Antonio; Guidi, Gian Cesare; Schena, Federico

    2015-02-01

    This study was planned to investigate whether serum α-amylase concentration may be associated with running performance, physiological characteristics and other clinical chemistry analytes in a large sample of recreational athletes undergoing distance running. Forty-three amateur runners successfully concluded a 21.1 km half-marathon at 75%-85% of their maximal oxygen uptake (VO2max). Blood was drawn during warm up and 15 min after conclusion of the run. After correction for body weight change, significant post-run increases were observed for serum values of alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, bilirubin, creatine kinase (CK), iron, lactate dehydrogenase (LDH), triglycerides, urea and uric acid, whereas the values of body weight, glomerular filtration rate, total and low density lipoprotein-cholesterol were significantly decreased. The concentration of serum α-amylase was unchanged. In univariate analysis, significant associations with running performance were found for gender, VO2max, training regimen and pre-run serum values of α-amylase, CK, glucose, high density lipoprotein-cholesterol, LDH, urea and uric acid. In multivariate analysis, only VO2max (p=0.042) and baseline α-amylase (p=0.021) remained significant predictors of running performance. The combination of these two variables predicted 71% of variance in running performance. The baseline concentration of serum α-amylase was positively correlated with variation of serum glucose during the trial (r=0.345; p=0.025) and negatively with capillary blood lactate at the end of the run (r=-0.352; p=0.021). We showed that the baseline serum α-amylase concentration significantly and independently predicts distance running performance in recreational runners.

  2. Drinking water is a significant predictor of Blastocystis infection among rural Malaysian primary schoolchildren.

    PubMed

    Abdulsalam, Awatif M; Ithoi, Init; Al-Mekhlafi, Hesham M; Ahmed, Abdulhamid; Surin, Johari; Mak, Joon-Wah

    2012-07-01

    Blastocystis infection has a worldwide distribution especially among the disadvantaged population and immunocompromised subjects. This study was carried out to determine the prevalence and the association of Blastocystis infection with the socio-economic characteristics among 300 primary schoolchildren, living in rural communities in Lipis and Raub districts of Pahang state, Malaysia. Stool samples were collected and examined for the presence of Blastocystis using direct smear microscopy after in vitro cultivation in Jones' medium. The overall prevalence of Blastocystis infection was found to be as high as 25.7%. The prevalence was significantly higher among children with gastrointestinal symptoms as compared to asymptomatic children (x2 =4.246; P=0.039). Univariate and multivariate analyses showed that absence of a piped water supply (OR=3.13; 95% CI=1.78, 5.46; P<0.001) and low levels of mothers' education (OR=3.41; 95% CI=1.62, 7.18; P<0.01) were the significant predictors of Blastocystis infection. In conclusion, Blastocystis is prevalent among rural children and the important factors that determine the infection were the sources of drinking water and mothers' educational level. Interventions with provision of clean water supply and health education especially to mothers are required.

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

    PubMed

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

    2016-06-01

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

  4. Concurrent Treatment for Posttraumatic Stress Disorder and Alcohol Dependence: Predictors and Moderators of Outcome

    PubMed Central

    Zandberg, Laurie J.; Rosenfield, David; McLean, Carmen P.; Powers, Mark B.; Asnaani, Anu; Foa, Edna B.

    2015-01-01

    Objective The present study examined predictors and moderators of treatment response among 165 adults meeting DSM-IV criteria for comorbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD) who were randomized to 24 weeks of naltrexone (NAL), NAL and prolonged exposure (PE), pill placebo, or pill placebo and PE. All participants received supportive counseling for alcohol use. Method Six domains of predictors/moderators (23 variables) were evaluated using measures of PTSD (Posttraumatic Stress Symptom Scale Interview; PSS-I) and AD (percent days drinking from the Timeline Follow-Back Interview) collected every four weeks throughout treatment. Multi-level modeling using the Fournier approach was employed to evaluate predictors and moderators of rates of symptom improvement and post-treatment outcomes. Results Combat trauma, sexual assault trauma, and higher baseline anxiety sensitivity predicted slower improvement and poorer PTSD outcome. Combat trauma, white race, and higher baseline drinking severity predicted poorer drinking outcome. PTSD severity moderated the efficacy of PE on PTSD outcomes, such that the benefit of PE over no-PE was greater for participants with higher baseline PTSD severity. Baseline depressive severity moderated the efficacy of PE on drinking outcomes, whereby the benefit of PE over no-PE was greater for participants with higher depressive symptoms. NAL effects were most beneficial for those with the longest duration of alcohol dependence. Conclusions These results suggest that concurrent, trauma-focused treatment should be recommended for PTSD-AD patients who present with moderate or severe baseline PTSD and depressive symptoms. Future research should examine the mechanisms underlying poorer outcome among identified sub-groups of PTSD-AD patients. PMID:26460570

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

    PubMed Central

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

    2014-01-01

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

  6. Predictors of Outcome among Pathological Gamblers Receiving Cognitive Behavioral Group Therapy.

    PubMed

    Jiménez-Murcia, Susana; Granero, Roser; Fernández-Aranda, Fernando; Arcelus, Jon; Aymamí, M Neus; Gómez-Peña, Monica; Tárrega, Salome; Moragas, Laura; Del Pino-Gutiérrez, Amparo; Sauchelli, Sarah; Fagundo, Ana B; Brewin, Nicola; Menchón, Jose M

    2015-01-01

    The aim of this study was to evaluate posttreatment changes of individuals with a diagnosis of gambling disorder (GD) treated with group cognitive behavioral therapy (CBT), to assess the potential moderator effect of sex on CBT outcome, and to explore the best predictors of posttreatment changes, relapse, and dropout rates. A cohort design was applied with a prospective follow-up. The sample comprised 440 patients and the CBT intervention consisted of 16 weekly outpatient group sessions and a 3-month follow-up period. Patients showed significant improvements in both the level of psychopathology and the severity of the gambling behavior. High self-transcendence and the involvement of the spouse or partner in the therapy predicted a higher risk of relapse. Younger age and low education predicted a higher risk of dropout. Many patients with GD can be treated with strategies to improve self-control and emotional regulation, but other techniques should be incorporated to address the individual characteristics of each patient. This is particularly important in group therapy, in which the same treatment is applied to several patients simultaneously. The involvement of a family member needs to be carefully considered since it may have a negative effect on the response to treatment if not adequately managed.

  7. Hypochloraemia as a predictor of developing hyponatraemia and poor outcome in acute heart failure patients.

    PubMed

    Radulović, Bojana; Potočnjak, Ines; Dokoza Terešak, Sanda; Trbušić, Matias; Vrkić, Nada; Malogorski, Davorin; Starčević, Neven; Milošević, Milan; Frank, Saša; Degoricija, Vesna

    2016-06-01

    Heart failure (HF) is a major public health issue currently affecting more than 23 million patients worldwide. Hyponatraemia has been shown to be a predictor of poor outcome in patients with acute and chronic HF. Therefore, we aimed at finding a marker for early detection of patients at risk for developing hyponatraemia. To this end, the present study investigated the relationship between initial serum chloride and follow-up sodium levels in acute heart failure (AHF) patients. The present study was performed as a prospective, single-centre, observational research with a total of 152 hospitalised AHF patients. Compared to patients with initial normochloraemia, patients with initial hypochloraemia had a statistically significantly higher incidence of hyponatraemia after a 3-month follow-up [P<0.001; odds ratio (OR)=27.08, CI: 4.3-170.7]. A similar finding was obtained upon exclusion of patients with initial hyponatraemia with Fishers test [P=0.034; odds ratio (OR)=15.5, CI:1.7-140.6]. Binary logistic regression revealed a significantly increased in-hospital mortality in the hypochloraemic/normonatriaemic (OR=4.08, CI 1.08-15.43, P=0.039), but not in the hypochloraemic/hyponatraemic, normochloraemic/hyponatraemic or normonatriaemic/normochloraemic patients. Ejection fraction (EF) at admission was significantly higher in hypochloraemic/normonatriaemic, compared to normonatriaemic/normochloraemic patients, but similar to EF in both hypochloraemic/hyponatraemic and normochloraemic/hyponatraemic patients. The N-terminal precursor Brain Natriuretic Peptide (Nt-proBNP) levels at admission were significantly lower in hypochloraemic/normonatriaemic compared to hypochloraemic/hyponatraemic and normonatriaemic/normochloraemic patients, respectively. The data show that initial low serum chloride concentration is predictive of developing hyponatraemia and associated with increased in-hospital mortality in AHF patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

    PubMed

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

    2014-01-01

    Providing anesthesia for gastrointestinal (GI) endoscopy procedures in morbidly obese patients is a challenge for a variety of reasons. The negative impact of obesity on the respiratory system combined with a need to share the upper airway and necessity to preserve the spontaneous ventilation, together add to difficulties. This retrospective cohort study included patients with a body mass index (BMI) >40 kg/m(2) that underwent out-patient GI endoscopy between September 2010 and February 2011. Patient data was analyzed for procedure, airway management technique as well as hypoxemic and cardiovascular events. A total of 119 patients met the inclusion criteria. Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available. Frequency of desaturation episodes showed statistically significant relation to previous history of obstructive sleep apnea (OSA). These desaturation episodes were found to be statistically independent of increasing BMI of patients. Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation. With suitable modification of anesthesia technique, it is possible to reduce the incidence of adverse respiratory events in morbidly obese patients undergoing GI endoscopy procedures, thereby avoiding the need for endotracheal intubation.

  9. C-reactive Protein as a Predictor of Adverse outcome in Patients with Acute Coronary Syndrome

    PubMed Central

    Sheikh, A. S.; Yahya, S.; Sheikh, N. S.; Sheikh, A. A

    2012-01-01

    Background and Objectives: The acute-phase reactant C-reactive protein (CRP) has been shown to reflect systemic and vascular inflammation and to predict future cardiovascular events. The objective of this study was to evaluate the prognostic value of CRP in predicting cardiovascular outcome in patients presenting with acute coronary syndromes. Patients and Methods: This prospective, single-centered study was carried out by the Department of Pathology in collaboration with the Department of Cardiology, Bolan Medical College Complex Quetta, Balochistan, Pakistan from January 2009 to December 2009. We studied 963 consecutive patients presenting with chest pain to Accident and Emergency Department. Patients were divided into four groups. Group-1 comprised patients with unstable angina; group-2 included patients with acute ST elevation myocardial infarction (STEMI); group-3 comprised patients with Non-ST elevation myocardial infarction (Non-STEMI) and group-4 was the control group. All four groups were followed-up for 90 days for occurrence of cardiovascular events. Results: The CRP was elevated (>3 mg/L) among 27.6% patients in Group-1; 70.9% in group- 2; 77.9% in group-3 and 5.3% in the control group. Among cases with elevated CRP, 92.1% had a cardiac event compared to 34.3% among patients with CRP £3 mg/L (P < 0.0001). The mortality was significantly higher (P < 0.0001) in group-2 (8.9%) and group-3 (11.9%) as compared to group-1 (2.1%). There was no cardiac event or mortality in Group-4. Conclusions: Elevated CRP is a predictor of adverse outcome in patients with acute coronary syndromes and helps in identifying patients who may be at risk of cardiovascular complications. PMID:22754634

  10. C-reactive Protein as a Predictor of Adverse outcome in Patients with Acute Coronary Syndrome.

    PubMed

    Sheikh, A S; Yahya, S; Sheikh, N S; Sheikh, A A

    2012-01-01

    The acute-phase reactant C-reactive protein (CRP) has been shown to reflect systemic and vascular inflammation and to predict future cardiovascular events. The objective of this study was to evaluate the prognostic value of CRP in predicting cardiovascular outcome in patients presenting with acute coronary syndromes. This prospective, single-centered study was carried out by the Department of Pathology in collaboration with the Department of Cardiology, Bolan Medical College Complex Quetta, Balochistan, Pakistan from January 2009 to December 2009. We studied 963 consecutive patients presenting with chest pain to Accident and Emergency Department. Patients were divided into four groups. Group-1 comprised patients with unstable angina; group-2 included patients with acute ST elevation myocardial infarction (STEMI); group-3 comprised patients with Non-ST elevation myocardial infarction (Non-STEMI) and group-4 was the control group. All four groups were followed-up for 90 days for occurrence of cardiovascular events. The CRP was elevated (>3 mg/L) among 27.6% patients in Group-1; 70.9% in group- 2; 77.9% in group-3 and 5.3% in the control group. Among cases with elevated CRP, 92.1% had a cardiac event compared to 34.3% among patients with CRP £3 mg/L (P < 0.0001). The mortality was significantly higher (P < 0.0001) in group-2 (8.9%) and group-3 (11.9%) as compared to group-1 (2.1%). There was no cardiac event or mortality in Group-4. Elevated CRP is a predictor of adverse outcome in patients with acute coronary syndromes and helps in identifying patients who may be at risk of cardiovascular complications.

  11. Predictors and outcomes of ocular hypertension after open-globe injury.

    PubMed

    Turalba, Angela V; Shah, Ankoor S; Andreoli, Michael T; Andreoli, Christopher M; Rhee, Douglas J

    2014-01-01

    Evaluate predictors and outcomes of ocular hypertension after open-globe injury. This is a retrospective, case-control study reviewing records of consecutive patients with open-globe injuries treated at Massachusetts Eye and Ear Infirmary between February 1999 and January 2007. Of 658 patients treated, 382 had at least 2 months of follow-up and sufficient data to be included. Main outcome measures are visual acuity, intraocular pressure (IOP), and type of glaucoma intervention employed. Sixty-five (17%) patients developed ocular hypertension defined as IOP≥22 mm Hg at >1 visit or requiring treatment. Increased age (P<0.001), hyphema (0.025), lens injury (P<0.0001), and zone II injury (P=0.0254) are risk factors for developing ocular hypertension after open-globe injury. Forty-eight (74%) patients with ocular hypertension were treated medically, 8 (12%) underwent filtering or glaucoma drainage device surgery, 5 (8%) had IOP normalization with observation, while 4 (6%) required anterior chamber washout with no other glaucoma surgery. Patients with ocular hypertension had an average maximum IOP=33.4 mm Hg at a median follow-up of 21 days, with most patients maintaining normal IOP at all follow-up time points. Visual acuity improved over time with median acuity of hand motions preoperatively, and 20/60 at 12 and 36 months. Ocular hypertension is a significant complication after open-globe injury that sometimes requires surgical intervention. Predictive factors can alert physicians to monitor for elevated IOP in the first month after trauma. Most patients with traumatic ocular hypertension had improved visual acuity and IOP normalization over time.

  12. Psychological Versus Generic Critical Thinking as Predictors and Outcome Measures in a Large Undergraduate Human Development Course

    ERIC Educational Resources Information Center

    Williams, Robert L.; Oliver, Renee; Stockdale, Susan

    2004-01-01

    This study examines the differential status of psychological critical thinking and generic critical thinking as predictors of test performance and as outcome measures in a large human development course. Psychological critical thinking proved to be the better predictor of test performance and more responsive to instructional procedures in the…

  13. Aneurysm rebleeding after poor-grade aneurysmal subarachnoid hemorrhage: Predictors and impact on clinical outcomes.

    PubMed

    Zhao, Bing; Fan, Yilin; Xiong, Ye; Yin, Rong; Zheng, Kuang; Li, Zequn; Tan, Xianxi; Yang, Hua; Zhong, Ming

    2016-12-15

    Aneurysm rebleeding is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH) and more often occurs in patients with poor-grade aSAH. Limited data on predictors of rebleeding in these patients are available. To investigate predictors of aneurysm rebleeding after poor-grade aSAH and the association of rebleeding with clinical outcomes. A multicenter poor-grade aneurysm study was a prospective and observational registry of consecutive patients who presented with poor-grade aSAH defined as a World Federation of Neurosurgical Societies (WFNS) grade of IV or V. Rebleeding was defined as a new hemorrhage on computed tomography scan. Clinical outcomes were assessed with modified Rankin score. Multivariate logistic regression analyses were used to determine independent predictors of rebleeding and association between the rebleeding and clinical outcomes at 12months. Of the 297 patients included in this study, 30 (10.1%) patients experienced rebleeding. Most rebleeding occurred within 24h after ictus. 22 (73.3%) patients died at discharge. Aneurysm rebleeding was independently associated with poor outcome (odds ratio [OR] 36.37, p<0.001) and associated with mortality (OR 25.03, p<0.001) at 12months. The multivariate analysis showed that a lower Fisher grade (OR 0.49, 95% CI 0.31-0.77; p=0.002), ruptured anterior cerebral artery aneurysms (OR 4.26, 95% CI 1.07-16.90; p=0.039), external ventricular drainage (OR 4.62, 95% CI 1.46-14.59; p=0.009) were independently associated with aneurysm rebleeding. The outcome of aneurysm rebleeding remains very poor. A lower Fisher grade, ruptured anterior cerebral artery aneurysms, external ventricular drainage were associated with increased risk of rebleeding. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Predictors of favourable outcome in young people with a first episode psychosis without antipsychotic medication.

    PubMed

    Conus, Philippe; Cotton, Sue M; Francey, Shona M; O'Donoghue, Brian; Schimmelmann, Benno G; McGorry, Patrick D; Lambert, Martin

    2017-07-01

    Data from the literature suggests that some first episode psychosis (FEP) patients may recover without antipsychotic medication. There is however no reliable way to identify them. In a previous paper we found, in a cohort of 584 FEP patients, that those consistently refusing medication had poorer pre-morbid functioning, less insight, higher rate of substance use and poorer outcome. However, some medication refusers, had a favourable outcome. The study aim was to identify predictors of good short term outcome despite non-exposure to medication. The Early Psychosis Prevention and Intervention Centre (EPPIC) admitted 786 FEP patients between 1998 and 2000. Data were collected from patients' files using a standardized questionnaire. Data on medication adherence was available in 584 patients. Among the 17.9% of patients who consistently refused medication over the entire treatment phase we compared patients who had a favourable symptomatic and functional outcome with those who did not. Among patients who consistently refused medication, 41% achieved symptomatic remission and 33% reached functional recovery. Predictors of symptomatic remission were a better premorbid functioning level, higher education and employment status at baseline. Predictors of functional recovery were a shorter duration of the prodrome phase, less severe psychopathology at baseline and lower cannabis use. Despite limitations mainly linked to the fact that non-exposure to antipsychotic medication was based on patient's treatment refusal, this study identified some characteristics which may contribute to the identification of a sub-group of FEP patients who may have good short term outcome without antipsychotic treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Predictors and outcomes of mycobacteremia among HIV-infected smear- negative presumptive tuberculosis patients in Uganda.

    PubMed

    Nakiyingi, Lydia; Ssengooba, Willy; Nakanjako, Damalie; Armstrong, Derek; Holshouser, Molly; Kirenga, Bruce J; Shah, Maunank; Mayanja-Kizza, Harriet; Joloba, Moses L; Ellner, Jerrold J; Dorman, Susan E; Manabe, Yukari C

    2015-02-15

    Sputum smear microscopy for tuberculosis (TB) diagnosis lacks sensitivity in HIV-infected symptomatic patients and increases the likelihood that mycobacterial infections particularly disseminated TB will be missed; delays in diagnosis can be fatal. Given the duration for MTB growth in blood culture, clinical predictors of MTB bacteremia may improve early diagnosis of mycobacteremia. We describe the predictors and mortality outcome of mycobacteremia among HIV-infected sputum smear-negative presumptive TB patients in a high prevalence HIV/TB setting. Between January and November 2011, all consenting HIV-infected adults suspected to have TB (presumptive TB) were consecutively enrolled. Diagnostic assessment included sputum smear microscopy, urine Determine TB lipoarabinomannan (LAM) antigen test, mycobacterial sputum and blood cultures, chest X-ray, and CD4 cell counts in addition to clinical and socio-demographic data. Patients were followed for 12 months post-enrolment. Of 394 sputum smear-negative participants [female, 63.7%; median age (IQR) 32 (28-39) years], 41/394 (10.4%) had positive mycobacterial blood cultures (mycobacteremia); all isolates were M. tuberculosis (MTB). The median CD4 cell count was significantly lower among patients with mycobacteremia when compared with those without (CD4 31 versus 122 cells/μL, p < 0.001). In a multivariate analysis, male gender [OR 3.4, 95%CI (1.4-7.6), p = 0.005], CD4 count <100 cells/μL [OR 3.1, 95% CI (1.1-8.6), p = 0.030] and a positive lateral flow urine TB LAM antigen test [OR 15.3, 95%CI (5.7-41.1), p < 0.001] were significantly associated with mycobacteremia. At 12 months of follow-up, a trend towards increased mortality was observed in patients that were MTB blood culture positive (35.3%) compared with those that were MTB blood culture negative (23.3%) (p = 0.065). Mycobacteremia occurred in 10% of smear-negative patients and was associated with higher mortality compared with smear

  16. Lactate clearance as the predictor of outcome in pediatric septic shock

    PubMed Central

    Choudhary, Richa; Sitaraman, Sadasivan; Choudhary, Anita

    2017-01-01

    Context: Septic shock can rapidly evolve into multiple system organ failure and death. In the recent years, hyperlactatemia has been found to be a risk factor for mortality in critically ill adults. Aims: To evaluate the predictive value of lactate clearance and to determine the optimal cut-off value for predicting outcome in children with septic shock. Settings and Design: A prospective observational study was performed on children with septic shock admitted to pediatric Intensive Care Unit (PICU). Subjects and Methods: Serial lactate levels were measured at PICU admission, 24 and 48 h later. Lactate clearance, percent decrease in lactate level in 24 h, was calculated. The primary outcome measure was survival or nonsurvival at the end of hospital stay. We performed receiver operating characteristic analyses to calculate optimal cut-off values. Results: The mean lactate levels at admission were significantly higher in the nonsurvivors than survivors, 5.12 ± 3.51 versus 3.13 ± 1.71 mmol/L (P = 0.0001). The cut-off for lactate level at admission for the best prediction of mortality was determined as ≥4 mmol/L (odds ratio 5.4; 95% confidence interval [CI] =2.45–12.09). Mean lactate clearance was significantly higher in survivors than nonsurvivors (17.9 ± 39.9 vs. −23.2 ± 62.7; P < 0.0001). A lactate clearance rate of <10% at 24 h had a sensitivity and specificity of 78.7% and 72.2%, respectively and a positive predictive value of 83.1% for death. Failure to achieve a lactate clearance of more than 10% was associated with greater risk of mortality (likelihood ratio + 2.83; 95% CI = 1.82–4.41). Conclusions: Serial lactate levels can be used to predict outcome in pediatric septic shock. A 24 h lactate clearance cut-off of <10% is a predictor of in-hospital mortality in such patients. PMID:28367008

  17. Predictors of smoking reduction outcomes in a sample of 287 patients with schizophrenia spectrum disorders.

    PubMed

    Wu, Bo-Jian; Lan, Tsuo-Hung

    2017-02-01

    Many studies have investigated whether a type of antipsychotics or type of adjuvant is associated with smoking reduction in patients with schizophrenia. However, there has been no study exploring a comprehensive range of factors related to smoking reduction in schizophrenia patients. We analyzed a dataset of 287 smoking patients with schizophrenia who participated in an 8-week open-label study with high- (n = 90) or low-dose nicotine dermal patches (n = 132) or bupropion (n = 65). A logistic regression model and a linear mixed model were used to explore factors associated with the outcomes of smoking cessation and reduction, i.e., the number of cigarettes smoked and the level of nicotine dependence. The total cessation rate was 6.3 % (18/287). There were no significant predictors of cessation. The time effect of reduction was significant during the program (p = 0.001). Type of antipsychotics (p = 0.018), readiness to quit (p = 0.014), baseline number of cigarettes smoked per day (p = 0.001), and nicotine dependence level (p = 0.001) were significantly associated with smoking reduction. Patients on first-generation antipsychotics (n = 129) or clozapine (n = 70) reduced their smoking more than those on non-clozapine second-generation antipsychotics (n = 74). Patients in the preparation stage (n = 97) or in the contemplation (n = 70) reduced their smoking more than those in the precontemplation stage (n = 120). The mechanisms of tobacco addiction need to be better understood for further development of effective cessation programs in patients with schizophrenia.

  18. Endotoxin Exposure: Predictors and Prevalence of Associated Asthma Outcomes in the United States

    PubMed Central

    Mendy, Angelico; Metwali, Nervana; Salo, Päivi; Co, Caroll; Jaramillo, Renee; Rose, Kathryn M.; Zeldin, Darryl C.

    2015-01-01

    Rationale: Inhaled endotoxin induces airway inflammation and is an established risk factor for asthma. The 2005–2006 National Health and Nutrition Examination Survey included measures of endotoxin and allergens in homes as well as specific IgE to inhalant allergens. Objectives: To understand the relationships between endotoxin exposure, asthma outcomes, and sensitization status for 15 aeroallergens in a nationally representative sample. Methods: Participants were administered questionnaires in their homes. Reservoir dust was vacuum sampled to generate composite bedding and bedroom floor samples. We analyzed 7,450 National Health and Nutrition Examination Survey dust and quality assurance samples for their endotoxin content using extreme quality assurance measures. Data for 6,963 subjects were available, making this the largest study of endotoxin exposure to date. Log-transformed endotoxin concentrations were analyzed using logistic models and forward stepwise linear regression. Analyses were weighted to provide national prevalence estimates and unbiased variances. Measurements and Main Results: Endotoxin exposure was significantly associated with wheeze in the past 12 months, wheeze during exercise, doctor and/or emergency room visits for wheeze, and use of prescription medications for wheeze. Models adjusted for age, sex, race and/or ethnicity, and poverty-to-income ratio and stratified by allergy status showed that these relationships were not dependent upon sensitization status but were worsened among those living in poverty. Significant predictors of higher endotoxin exposures were lower family income; Hispanic ethnicity; participant age; dog(s), cat(s), cockroaches, and/or smoker(s) in the home; and carpeted floors. Conclusions: In this U.S. nationwide representative sample, higher endotoxin exposure was significantly associated with measures of wheeze, with no observed protective effect regardless of sensitization status. PMID:26258643

  19. Endotoxin Exposure: Predictors and Prevalence of Associated Asthma Outcomes in the United States.

    PubMed

    Thorne, Peter S; Mendy, Angelico; Metwali, Nervana; Salo, Päivi; Co, Caroll; Jaramillo, Renee; Rose, Kathryn M; Zeldin, Darryl C

    2015-12-01

    Inhaled endotoxin induces airway inflammation and is an established risk factor for asthma. The 2005-2006 National Health and Nutrition Examination Survey included measures of endotoxin and allergens in homes as well as specific IgE to inhalant allergens. To understand the relationships between endotoxin exposure, asthma outcomes, and sensitization status for 15 aeroallergens in a nationally representative sample. Participants were administered questionnaires in their homes. Reservoir dust was vacuum sampled to generate composite bedding and bedroom floor samples. We analyzed 7,450 National Health and Nutrition Examination Survey dust and quality assurance samples for their endotoxin content using extreme quality assurance measures. Data for 6,963 subjects were available, making this the largest study of endotoxin exposure to date. Log-transformed endotoxin concentrations were analyzed using logistic models and forward stepwise linear regression. Analyses were weighted to provide national prevalence estimates and unbiased variances. Endotoxin exposure was significantly associated with wheeze in the past 12 months, wheeze during exercise, doctor and/or emergency room visits for wheeze, and use of prescription medications for wheeze. Models adjusted for age, sex, race and/or ethnicity, and poverty-to-income ratio and stratified by allergy status showed that these relationships were not dependent upon sensitization status but were worsened among those living in poverty. Significant predictors of higher endotoxin exposures were lower family income; Hispanic ethnicity; participant age; dog(s), cat(s), cockroaches, and/or smoker(s) in the home; and carpeted floors. In this U.S. nationwide representative sample, higher endotoxin exposure was significantly associated with measures of wheeze, with no observed protective effect regardless of sensitization status.

  20. Predictor Variables Associated With Positive Fast Track Outcomes at the End of Third Grade

    PubMed Central

    2009-01-01

    Progress has been made in understanding the outcome effects of preventive interventions and treatments designed to reduce children's conduct problems. However, limited research has explored the factors that may affect the degree to which an intervention is likely to benefit particular individuals. This study examines selected child, family, and community baseline characteristics that may predict proximal outcomes from the Fast Track intervention. The primary goal of this study was to examine predictors of outcomes after 3 years of intervention participation, at the end of 3rd grade. Three types of proximal outcomes were examined: parent-rated aggression, teacher-rated oppositional-aggressive behavior, and special education involvement. The relation between 11 risk factors and these 3 outcomes was examined, with separate regression analyses for the intervention and control groups. Moderate evidence of prediction of outcome effects was found, although none of the baseline variables were found to predict all 3 outcomes, and different patterns of prediction emerged for home versus school outcomes. PMID:11930970

  1. Smoldering (asymptomatic) multiple myeloma: current diagnostic criteria, new predictors of outcome, and follow-up recommendations.

    PubMed

    Bladé, Joan; Dimopoulos, Meletios; Rosiñol, Laura; Rajkumar, S Vincent; Kyle, Robert A

    2010-02-01

    To provide an overview on smoldering (asymptomatic) multiple myeloma (SMM) including current diagnostic criteria, predictors of progression, pattern of progression, and outcome. A comprehensive review of the literature on risk factors for progression, treatment attempts to delay progression and outcome in patients with SMM. The risk factors for progression of SMM include: plasma cell mass including M-protein size and percentage of bone marrow clonal plasma cells (BMPC), abnormal free light chain ratio, proportion of phenotypically abnormal BMPC, immunoparesis, evolution pattern (evolving v nonevolving), and pattern of magnetic resonance imaging abnormalities. Most patients with SMM progress with anemia and/or skeletal involvement. Immediate therapy with cytotoxic agents, such as melphalan/prednisone has not resulted in improved outcome. Patients should not be treated until progressive disease with end-organ damage occurs. Increasing anemia is the most reliable indicator of progression. These recently recognized predictors of outcome may be helpful for better disease monitoring and for investigation of new treatment approaches. Thus, recommendations for follow-up every to 3 to 6 months depending on the risk of progression are suggested, and clinical trials with new noncytotoxic biologically derived agents to delay progression, particularly in high-risk patients, are ongoing.

  2. Surgical treatment of inflammatory abdominal aortic aneurysms: Outcome and predictors analysis

    PubMed Central

    Nuellari, Edmond; Esposito, Giampiero; Kuci, Saimir; Kapedani, Edmond

    2014-01-01

    Objectives The aim of this study is to report our experience on the postoperative outcome of surgical treatment of inflammatory abdominal aortic aneurysm (IAAA). Materials and Methods Between 1997–2014, 35 patients with IAAA underwent surgery. The mean age was 63 ± 18 years. Chronic renal failure was identified in 11 (31.4%) patients and confirmed ischemic heart disease in 15 (43%) patients. The mean aortic aneurysm diameter was 68 ± 25 mm. The abdominal aorta was clamped above the renal arteries in 6 (17%) patients. Results The hospital mortality was 5.7% (2 patients). Three patients developed an aortic pseudoaneurysm and underwent a redo operation. Another patient developed a femoral anastomotic pseudoaneurysm 7 years after operation and he was treated surgically. The actuarial free-reoperation actuarial survival at 1, 5 and 7 years was 94%, 62% and 50%, respectively. The Cox model revealed the delta erythrocyte sedimentation rate (p = 0.002), ischemic heart disease (p = 0.006) and renal failure (p = 0.036) as strong predictors for poor overall outcome. Conclusion Early postoperative outcome in terms of mortality and morbidity seems acceptable, however, patients with IAAA have an increased risk for reoperation due to pseudonaneurysm formation. Strong predictors for poor overall outcome seem to be the elevated erythrocyte sedimentation rate, ischemic heart disease and chronic renal failure. PMID:25243075

  3. Surgical Treatment of Inflammatory Abdominal Aortic Aneurysms: Outcome and Predictors Analysis

    PubMed Central

    Nuellari, Edmond; Prifti, Edvin; Esposito, Giampiero; Kapedani, Edmond

    2014-01-01

    Objectives: The aim of this study is to report our experience on the postoperative outcome of surgical treatment of inflammatory abdominal aortic aneurysm (IAAA). Materials and Methods: Between 1997-2014, 35 patients with IAAA underwent surgery. The mean age was 63+/-18years. Chronic renal failure was identified in 11(31.4%)patients and confirmed ischemic heart disease in 15(43%)patients. The mean aortic aneurysm diameter was 68+/-25mm. The abdominal aorta was clamped above the renal arteries in 6 (17%) patients. Results: The hospital mortality was 5.7% (2 patients). Three patients developed an aortic pseudoaneurysm and underwent a redo operation. Another patient developed a femoral anastomotic pseudoaneurysm 7 years after operation and he was treated surgically. The actuarial free-reoperation actuarial survival at 1, 5 and 7 years was 94%, 62% and 50% respectively. The Cox model revealed the delta ESR (p=0.002), ischemic heart disease (p=0.006) and renal failure (p=0.036) as strong predictors for poor overall outcome. Conclusion: Early postoperative outcome in terms of mortality and morbidity seems acceptable, however patients with IAAA have an increased risk for reoperation due to pseudonaneurysm formation. Strong predictors for poor overall outcome seems to be the elevated erythrocyte sedimentation rate, ischemic heart disease and chronic renal failure. PMID:25568545

  4. Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis.

    PubMed

    Heinzow, Hauke S; Lenz, Philipp; Köhler, Michael; Reinecke, Frank; Ullerich, Hansjörg; Domschke, Wolfram; Domagk, Dirk; Meister, Tobias

    2012-10-07

    To determine the clinical outcome and predictors of survival after transjugular intrahepatic portosystemic stent shunt (TIPS) implantation in cirrhotic patients. Eighty-one patients with liver cirrhosis and consequential portal hypertension had TIPS implantation (bare metal) for either refractory ascites (RA) (n = 27) or variceal bleeding (VB) (n = 54). Endpoints for the study were: technical success, stent occlusion and stent stenosis, rebleeding, RA and mortality. Clinical records of patients were collected and analysed. Baseline characteristics [e.g., age, sex, CHILD score and the model for end-stage liver disease score (MELD score), underlying disease] were retrieved. The Kaplan-Meier method was employed to calculate survival from the time of TIPS implantation and comparisons were made by log rank test. A multivariate analysis of factors influencing survival was carried out using the Cox proportional hazards regression model. Results were expressed as medians and ranges. Comparisons between groups were performed by using the Mann-Whitney U-test and the χ2 test as appropriate. No difference could be seen in terms of age, sex, underlying disease or degree of portal pressure gradient (PPG) reduction between the ascites and the bleeding group. The PPG significantly decreased from 23.4 ± 5.3 mmHg (VB) vs. 22.1 ± 5.5 mmHg (RA) before TIPS to 11.8 ± 4.0 vs. 11.7 ± 4.2 after TIPS implantation (P = 0.001 within each group). There was a tendency towards more patients with stage CHILD A in the bleeding group compared to the ascites group (24 vs 6, P = 0.052). The median survival for the ascites group was 29 mo compared to > 60 mo for the bleeding group (P = 0.009). The number of radiological controls for stent patency was 6.3 for bleeders and 3.8 for ascites patients (P = 0.029). Kaplan-Meier calculation indicated that stent occlusion at first control (P = 0.027), ascites prior to TIPS implantation (P = 0.009), CHILD stage (P = 0.013), MELD score (P = 0.001) and

  5. Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis

    PubMed Central

    Heinzow, Hauke S; Lenz, Philipp; Köhler, Michael; Reinecke, Frank; Ullerich, Hansjörg; Domschke, Wolfram; Domagk, Dirk; Meister, Tobias

    2012-01-01

    AIM: To determine the clinical outcome and predictors of survival after transjugular intrahepatic portosystemic stent shunt (TIPS) implantation in cirrhotic patients. METHODS: Eighty-one patients with liver cirrhosis and consequential portal hypertension had TIPS implantation (bare metal) for either refractory ascites (RA) (n = 27) or variceal bleeding (VB) (n = 54). Endpoints for the study were: technical success, stent occlusion and stent stenosis, rebleeding, RA and mortality. Clinical records of patients were collected and analysed. Baseline characteristics [e.g., age, sex, CHILD score and the model for end-stage liver disease score (MELD score), underlying disease] were retrieved. The Kaplan-Meier method was employed to calculate survival from the time of TIPS implantation and comparisons were made by log rank test. A multivariate analysis of factors influencing survival was carried out using the Cox proportional hazards regression model. Results were expressed as medians and ranges. Comparisons between groups were performed by using the Mann-Whitney U-test and the χ2 test as appropriate. RESULTS: No difference could be seen in terms of age, sex, underlying disease or degree of portal pressure gradient (PPG) reduction between the ascites and the bleeding group. The PPG significantly decreased from 23.4 ± 5.3 mmHg (VB) vs 22.1 ± 5.5 mmHg (RA) before TIPS to 11.8 ± 4.0 vs 11.7 ± 4.2 after TIPS implantation (P = 0.001 within each group). There was a tendency towards more patients with stage CHILD A in the bleeding group compared to the ascites group (24 vs 6, P = 0.052). The median survival for the ascites group was 29 mo compared to > 60 mo for the bleeding group (P = 0.009). The number of radiological controls for stent patency was 6.3 for bleeders and 3.8 for ascites patients (P = 0.029). Kaplan-Meier calculation indicated that stent occlusion at first control (P = 0.027), ascites prior to TIPS implantation (P = 0.009), CHILD stage (P = 0.013), MELD score

  6. Risk predictors for adverse outcome in pediatric febrile neutropenia: Single center experience from a low and middle-income country.

    PubMed

    Prasad, M; Chinnaswamy, G; Arora, B; Vora, T; Hawaldar, R; Banavali, S

    2014-01-01

    Risk stratification of patients with febrile neutropenia (FN) into those at "High Risk" and "Low Risk" of developing complications helps in making decisions regarding optimal treatment, such as whether to treat with oral or intravenous antibiotics, whether to treat as inpatient or outpatient and how long to treat. Risk predictors obtained from Western studies on pediatric FN are unlikely to be relevant to low middle-income country (LMICs). Our study aimed to identify clinical and laboratory parameters predictive of poor outcomes in children with chemotherapy-induced FN in a LMIC. Two hundred and fifty consecutive episodes of chemotherapy-induced FN in pediatric (<15 years) patients were analyzed prospectively. Adverse outcomes were defined as per SPOG 2003 FN study as serious medical complications (SMC) due to infection, microbiologically defined infection, and radiologically defined pneumonia (RDP). Variables found to be significant for adverse outcome (P < 0.05) on univariate analysis were selected for multivariate analysis. Five factors that were found to independently predict adverse outcome were (a) previously documented infection in the past 6 months, (b) presence of significant focus of infection, (c) absolute phagocyte count <100/mm3, (d) peak temperature more than 39°C in this episode of FN, and (e) fever lasting more than 5 days during this episode of FN. Identifying the risk factors for adverse outcome in pediatric FN, which are objective and applicable across LMICs would contribute in developing guidelines for the management of FN in a resource-limited setting.

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

    PubMed Central

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

    2009-01-01

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

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

    PubMed Central

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

    2010-01-01

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

  9. Low-frequency Subthalamic Stimulation in Parkinson's Disease: Long-term Outcome and Predictors.

    PubMed

    Zibetti, Maurizio; Moro, Elena; Krishna, Vibhor; Sammartino, Francesco; Picillo, Marina; Munhoz, Renato P; Lozano, Andres M; Fasano, Alfonso

    2016-01-01

    Parkinson's disease patients undergoing subthalamic nucleus deep brain stimulation (STN DBS) at standard frequency (>100 Hz) often develop gait impairment, postural instability and speech difficulties. Low frequency stimulation (<100 Hz, LFS) can improve such axial symptoms, but there are concerns that improvement may be transient. To identify long-term outcome and predictors of low-frequency subthalamic stimulation in Parkinson's disease. Through a chart review we identified 85 out of 324 STN DBS patients who received a trial of LFS and describe their characteristics and outcome predictors. Patients were switched to LFS (<100 Hz) 3.8 ± 3.3 years after surgery. Most patients (64%) attained a subjective improvement of gait, speech or balance for 2.0 ± 1.9 years. Motor scores improved within the first year after the stimulation change and showed a slower progression over time when compared to patients switched back to high frequency stimulation. UPDRS III axial score on medication before surgery and the y-axis coordinate of the active contact were independent predictors of LFS retention. This report provides evidence that the use of LFS yields an enduring benefit in a considerable percentage of patients who develop axial motor symptoms during conventional stimulation. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    PubMed

    Andrew, Rachel; Tiggemann, Marika; Clark, Levina

    2016-03-01

    This study aimed to investigate prospective predictors and health-related outcomes of positive body image in adolescent girls. In so doing, the modified acceptance model of intuitive eating was also examined longitudinally. A sample of 298 girls aged 12 to 16 years completed a questionnaire containing measures of body appreciation, potential predictors, and a range of health outcomes, at 2 time points separated by 1 year. Longitudinal change regression models showed that perceived body acceptance by others (positively), self-objectification and social comparison (negatively), and body appreciation (positively) prospectively predicted intuitive eating 1 year later, consistent with the acceptance model of intuitive eating. Perceived body acceptance by others was the only proposed predictor to prospectively predict an increase in body appreciation over time. Time 1 body appreciation prospectively predicted a decrease in dieting, alcohol, and cigarette use, and an increase in physical activity 1 year later. In particular, girls with low body appreciation were more likely than girls with high body appreciation to take up alcohol and cigarette use between time points. The results highlight body appreciation as an important target for interventions designed to prevent or delay the uptake of alcohol and cigarette consumption among girls. More broadly, they suggest that a positive body image can confer considerable benefit for adolescent girls. (c) 2016 APA, all rights reserved).

  11. Significant Independent Predictors of Vitamin D Deficiency in Inpatients and Outpatients of a Nephrology Unit

    PubMed Central

    Bentli, Recep; Taskapan, Hulya; Toktaş, Halil; Ulutas, Ozkan; Ozkahraman, Adnan; Comert, Melda

    2013-01-01

    Aims. Kidney disease was found to be a major risk factor for vitamin D deficiency in a population study of patients hospitalized. The aims of the study were to describe the prevalence of vitamin D deficiency inpatients and outpatients in a nephrology department during fall and to evaluate effect of assessing serum 25-hydroxyvitamin D (25(OH)D) levels and previous supplementation of cholecalciferol on vitamin D status. Methods. We studied 280 subjects in total, between October and January. The subjects were recruited from the following two groups: (a) inpatients and (b) outpatients in nephrology unit. We examined previous documentary evidence of vitamin D supplementation of the patients. Results. The prevalence of vitamin D deficiency among these 280 patients was 62,1% (174 patients). Fifty-three patients (18.9%) had severe vitamin D deficiency, 121 patients (43.2%) moderate vitamin D deficiency, and 66 patients (23.6%) vitamin D insufficiency. In logistic regression analysis female gender, not having vitamin D supplementation history, low serum albumin, and low blood urea nitrogen levels were significant independent predictors of vitamin D deficiency while no association of vitamin D deficiency with diabetes mellitus, serum creatinine, eGFR, and being hospitalized was found. Conclusion. Vitamin D deficiency, seems to be an important problem in both inpatients and outpatients of nephrology. Monitoring serum 25(OH)D concentrations regularly and replacement of vitamin D are important. Women in Turkey are at more risk of deficiency and may therefore need to consume higher doses of vitamin D. PMID:23737771

  12. Evaluation of malnutrition as a predictor of adverse outcomes in febrile neutropenia associated with paediatric haematological malignancies.

    PubMed

    Chaudhuri, Jasodhara; Biswas, Tamoghna; Datta, Jyotishka; Sabui, Tapas Kumar; Chatterjee, Sukanta; Ray, Somosri; Raychaudhuri, Dibyendu; Mandal, Kalyanbrata; Chatterjee, Kaushani; Chakraborty, Swapna

    2016-07-01

    Malnutrition has been reported in the literature to be adversely associated with outcomes in paediatric malignancies. Our objective in this paper was to evaluate malnutrition as a potential predictor for adverse outcomes in febrile neutropenia associated with haematological malignancies. A prospective observational study was performed in a tertiary care teaching hospital of Kolkata, India. Forty-eight participants, suffering from haematological malignancy, were included. Participants were included if they experienced at least one episode of febrile neutropenia. For children aged <5 years, weight for height, height for age and weight for age were used as criteria for defining malnutrition, while body mass index for age was used in children ≥5 years. A total of 162 episodes of febrile neutropenia were studied. Thirty patients (30/48, 62.5%) included in the study had malnutrition. In bivariate analyses at patient level, there is a strong association between malnutrition and death (odds ratio (OR) 7.286, 95% confidence interval (CI) 0.838-63.345, one-tailed P = 0.044), and life-threatening complications show a moderate trend towards significance (OR 3.333, 95% CI 0.791-14.052, one-tailed P = 0.084). Survival functions were significantly different between malnourished and non-malnourished children (log rank test χ(2)  = 4.609, degree of freedom = 1, P = 0.032). Wasting was associated with life-threatening complications in children aged <5 years (OR 14, 95% CI 1.135-172.642, one-tailed P = 0.036). Logistic regression analyses at episode level revealed that phase of treatment and respiratory system involvement were significant predictors of death, while malnutrition was not. Malnutrition may be a potential predictor of mortality in febrile neutropenia. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  13. Removable plate treatment of anterior forced crossbite: Effectiveness, efficiency, and potential outcome predictors.

    PubMed

    Bock, Niko C; Klewitz, Heidi; Hudel, Helge; Ruf, Sabine

    2015-07-01

    In addition to studying the effectiveness and efficiency of removable acrylic plates in correcting anterior forced crossbite, the influence of outcome predictors were evaluated. In all, 65 patients met the inclusion criteria of anterior forced crossbite, mixed dentition, removable plate treatment, and complete case documentation. Effectiveness was assessed based on pre- and posttreatment study casts (which were analyzed for successful treatment outcomes defined as ≥ 1 mm of overjet and overbite) and efficiency was assessed based on treatment duration and number of appointments. Potential outcome predictors were also evaluated, including age, gender, dental maturity, Angle Class, number of teeth in crossbite, severity of crossbite, overbite, ANB angle, Wits appraisal, mandibular plane angle, and patient compliance. Successful crossbite correction was achieved in 48 of the 65 patients (74%) within a median of 2.8 months and 2.0 appointments. Plate treatment was discontinued following another median of 11.6 months and 6.5 appointments. Promising outcome predictors are the number of teeth in crossbite (1-2 versus 3-4 teeth = success in 81 versus 42% of cases), dental maturity (early versus late mixed dentition = success in 84 versus 52% of cases), and Angle Class (I versus III = success in 83 versus 61% of cases). Removable acrylic plates were found to be moderately effective and efficient in correcting anterior forced crossbite. Children presenting with Angle Class I and crossbites involving not more than two teeth when treatment is started during the period of early mixed dentition had the best prognosis for treatment success.

  14. Predictors and clinical outcomes of persistent methicillin-resistant Staphylococcus aureus bacteremia: a prospective observational study.

    PubMed

    Ok, Hea Sung; Lee, Hyoun Soo; Park, Man Je; Kim, Ki Hoon; Kim, Byeong Ki; Wi, Yu Mi; Kim, June Myung

    2013-11-01

    The high mortality attributable to persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in spite of glycopeptide treatment has heightened the need for early detection and intervention with alternative agents. The purpose of this study was to determine the clinical characteristics of and risk factors for persistent MRSA bacteremia. All first episodes of significant MRSA bacteremia at a 710-bed academic medical center from November 2009 through August 2010 were recorded. Blood cultures were conducted at 3 days and every 2 to 3 days thereafter until clearance. Clinical characteristics and outcomes were compared between persistent MRSA bacteremia (≥ 7 days) and nonpersistent MRSA bacteremia (≤ 3 days). Of 79 patients with MRSA bacteremia during the study period, 31 (39.2%) had persistent MRSA bacteremia. The persistent MRSA bacteremia group had significantly higher 30-day mortality than the nonpersistent MRSA bacteremia group (58.1% vs. 16.7%, p < 0.001). Multivariate analysis indicated that metastatic infection at presentation (odds ratio [OR], 14.57; 95% confidence interval [CI], 3.52 to 60.34; p < 0.001) and delayed catheter removal in catheter-related infection (OR, 3.80; 95% CI, 1.04 to 13.88; p = 0.004) were independent predictors of persistent MRSA bacteremia. Patients with a time to blood culture positivity (TTP) of < 11.8 hours were at increased risk of persistent MRSA bacteremia (29.0% vs. 8.3%, p = 0.029). High mortality in patients with persistent MRSA bacteremia was noted. Early detection of metastatic infection and early removal of infected intravascular catheters should be considered to reduce the risk of persistent MRSA bacteremia. Further studies are needed to evaluate the role of TTP for predicting persistent MRSA bacteremia.

  15. Non-mass breast lesions on ultrasound: final outcomes and predictors of malignancy.

    PubMed

    Park, Jong Won; Ko, Kyung Hee; Kim, Eun-Kyung; Kuzmiak, Cherie M; Jung, Hae Kyoung

    2017-09-01

    Background Breast cancer can present as non-mass lesions (NMLs) on ultrasound. However, knowledge of and understanding about NMLs are scarce. Purpose To retrospectively investigate the final outcomes of sonographic breast NMLs and determine the clinical and radiologic variables associated with malignancy Material and Methods In our radiologic database of breast ultrasound examinations between 2011 and 2014, we found 119 women with 121 NMLs with available histopathologic or sonographic follow-up (over 2 years) data. We collected the clinical variables (patient's age, symptoms, and mammographic density) and histopathologic data as well as radiologic variables (mammographic and ultrasound findings) after retrospective review by two radiologists, the authors of the current paper, in consensus. We classified the ultrasound findings according to distribution (focal, linear or segmental, and regional) and associated features (calcification, architectural distortion, and ductal changes) and analyzed the associations between variables and malignancy using the t test and χ(2) test. Results Of the 121 NMLs, 88 (72.7%) were benign and 33 (27.3%) were malignant. Ductal carcinoma in situ (DCIS) (17/33, 51.5%) and invasive ductal cancer with or without DCIS (13/33, 39.4%) comprised the main malignancies, and malignancy was significantly associated with palpability ( P = 0.000). Mammographic findings and sonographic distribution and associated features were significantly different between benign and malignant lesions ( P = 0.000, P = 0.004, and P = 0.001, respectively). Malignant lesions showed more frequent calcifications combined with asymmetry ( P = 0.000) on mammography and linear-segmental distributions ( P = 0.001) and associated calcifications ( P = 0.019) or architectural distortions ( P = 0.015) on ultrasound. Conclusion Breast NMLs on ultrasound showed high risk of malignancy. Symptoms and mammographic and ultrasound findings can be

  16. Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs.

    PubMed

    Damle, Rachelle N; Cherng, Nicole B; Flahive, Julie M; Davids, Jennifer S; Maykel, Justin A; Sturrock, Paul R; Sweeney, W Brian; Alavi, Karim

    2014-12-01

    After passage of the Affordable Care Act, 30 -day hospital readmissions have come under greater scrutiny. Excess readmissions for certain medical conditions and procedures now result in penalizations on all Medicare reimbursements. The purpose of this work was to define the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery. Adults undergoing colorectal surgery were studied using data from the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify patient-related risk factors for, and 30-day outcomes of, readmission after colorectal surgery. This study was conducted at an academic hospital and its affiliates. Adults ≥18 years of age who underwent colorectal surgery for cancer, diverticular disease, IBD, or benign tumors between 2008 and 2011 were included in this study. Readmission within 30 days of index discharge was the main outcome measured. A total of 70,484 patients survived the index hospitalization after colorectal surgery; 9632 (13.7%) were readmitted within 30 days of discharge. The strongest independent predictors of readmission were length of stay ≥4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.54; 95% CI 1.46-1.51), and discharge to skilled nursing (OR 1.62; 95% CI 1.49-1.76) or rehabilitation facility (OR 2.93; 95% CI 2.53-3.40). Of those readmitted, half of the readmissions occurred within 7 days, 13% required the intensive care unit, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was more than 2 times higher ($26,917 vs $13,817; p < 0.001) for readmitted than for nonreadmitted patients. Follow-up was limited to 30 days after initial discharge. Readmissions after colorectal resection occur frequently and incur a significant financial burden on the health-care system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating health-care costs.

  17. Mean platelet volume in acute phase of ischemic stroke, as predictor of mortality and functional outcome after 1 year.

    PubMed

    Arévalo-Lorido, José Carlos; Carretero-Gómez, Juana; Álvarez-Oliva, Alejandra; Gutiérrez-Montaño, Concepción; Fernández-Recio, José María; Najarro-Díez, Francisco

    2013-05-01

    Mean platelet volume (MPV) could be a predictor of prognosis after ischemic stroke. Our aim is to investigate the association of MPV with a greater mortality and morbidity (defined as readmissions) after 1 year of follow-up in patients with acute stroke, and with a poor functional outcome in these patients. Patients with ischemic stroke (N = 379) were recruited and assessed for an average of 46.27 weeks. MPV was measured at admission. The sample was divided in thirds according with the tertiles of distribution of MPV. Univariate and multivariate analysis were performed. The median (interquartile range) of MPV by third was 10 (0.7), 11(0.4), and 12 (0.8) fentoliters. Patients within highest third had a significant higher risk of either death or readmission (odds ratio 1.3; 95% confidence interval 1.00-1.7; P < .048) compared with patients within the lowest third. Functional outcome, defined as a modified Rankin Scale score of 3 to 6, was significantly higher (P < .0004) by greater third of MPV. MPV may be an easily available predictor for the prognosis in patients with acute ischemic stroke. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Therapeutic alliance and cohesion variables as predictors of outcome in short-term group psychotherapy.

    PubMed

    Joyce, Anthony S; Piper, William E; Ogrodniczuk, John S

    2007-07-01

    The current study explored the relative ability of aggregate therapeutic alliance and cohesion variables to predict short-term group therapy outcome. Data were collected from a comparative trial of two forms of time-limited group psychotherapy for complicated grief (Piper, McCallum, Joyce, Rosie, & Ogrodniczuk, 2001). The therapeutic alliance and elements of the cohesion construct were measured from the perspectives of each patient and the group therapist at intervals during the groups; scores were aggregated across assessments. Hierarchical multiple regression analyses, adjusting for the effects of treatment approach (interpretive vs. supportive) and specific group membership, demonstrated that the patient-rated alliance was a consistent predictor of outcome. Two cohesion measures, reflecting other participants' (therapist, other members) views of the patient's "fit" with the group, also accounted for variation in outcome. Implications of the findings for research and clinical practice, and the limitations of the measurement approach taken in this study, are considered.

  19. Predictors of favourable outcome in inflammatory Crohn's disease. A retrospective observational study.

    PubMed

    Zabana, Yamile; Garcia-Planella, Esther; van Domselaar, Manuel; Mañosa, Míriam; Gordillo, Jordi; López-Sanromán, Antonio; Cabré, Eduard; Domènech, Eugeni

    2013-12-01

    No studies have specifically searched for predictors of a favourable outcome that would allow a conservative therapeutic approach in adult Crohn's disease (CD). To identify predictors of a favourable disease course over time at CD diagnosis. We identified and included all patients diagnosed with CD between January 1994 and December 2003, who had CD with an inflammatory pattern and no perianal disease at diagnosis, and who were followed up for at least 5 years. Clinical and therapeutic features until December 2008 and losses to follow-up were identified. We defined a favourable outcome as the absence of stricturing and penetrating complications of the disease (including perianal disease), together with the absence of need for anti-TNF therapy or resectional surgery during follow up. One hundred and forty-five patients were included and followed up for a median of 96 months (IQR, 79-140). At diagnosis, location was ileal in 39%, colonic in 28%, and ileocolonic in 32%; 50% of the patients were active smokers, and 41% used immunomodulators. Eighty-two patients (57%) met the criteria for a favourable outcome at the end of follow-up. The only factor associated with a favourable outcome was isolated colonic involvement (P=0.022), with 73% of these patients meeting the criteria for a favourable outcome. A favourable outcome of initially uncomplicated CD is not easily predicted at disease diagnosis by means of clinical or epidemiologic factors. Nevertheless, patients with isolated colonic disease are less likely to have an aggressive course. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

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

    PubMed

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

    2013-12-01

    Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change. (c) 2013 APA, all rights reserved.

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

    ERIC Educational Resources Information Center

    Safian-Rush, Donna

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

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

    ERIC Educational Resources Information Center

    Safian-Rush, Donna

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

  3. 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.

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

    PubMed

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

    2016-04-01

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

  5. Laparoscopic Heller myotomy plus Dor fundoplication in 137 achalasic patients: results on symptoms relief and successful outcome predictors.

    PubMed

    Parise, Paolo; Santi, Stefano; Solito, Biagio; Pallabazzer, Giovanni; Rossi, Mauro

    2011-03-01

    Aim of this study was to review our experience with laparoscopic Heller-Dor (LHD) intervention and identify possible success predictors. LHD is an effective and safe treatment for achalasia. However, open debates are still held on which antireflux procedure should be added and on how long the myotomy on to the stomach should be. A lot of successful outcome predictors have been investigated with sometimes conflicting results. 137 achalasic patients underwent LHD at our institution. Pre-operatively all underwent a complete morphologic and functional work-up. Follow-up visits were scheduled at 1, 3, 6 months and then every year. Median follow-up was 65 months. Pre-operatively dysphagia was present in 100% cases, regurgitation in 84.6% and mean lower esophageal sphincter (LES) resting pressure was 29.1 mmHg. We observed 3 mucosal perforations. Mortality was null. The median of oral food intake resumption was second post-operative day and mean post-operative hospital stay was 3.4 days. Dysphagia was treated with success in 94.78% cases and regurgitation in 82.84%. Post-operative mean LES resting pressure was 13.64 mmHg. New-onset heartburn was observed in 10.9% of patients. 9.7% of cases required pneumatic dilations and 1.5% a laparoscopic re-do myotomy. An high pre-operative dysphagia score resulted to be the only statistically significant prognostic factor. Sex, age, dysphagia duration and LES resting pressure did not reach statistical significance. LHD is a safe procedure with good results in about 90% of patients even at a long-term follow-up. Predictors of successful outcome are still poorly plain and sometimes conflicting in literature.

  6. Predictors of functional outcome following intracapsular hip fracture in elderly women. A one-year prospective cohort study.

    PubMed

    Haentjens, P; Autier, Ph; Barette, M; Boonen, S

    2005-07-01

    To explore potential predictors of functional outcome one year after the injury in elderly women who sustained a displaced intracapsular hip fracture and who were treated with internal fixation, hemiarthroplasty, or total hip arthroplasty. Eighty-four women aged > or =50 years were enrolled on a consecutive basis in this one-year prospective cohort study reflecting standard day-to-day clinical practice. The main outcome measure was the rapid disability rating scale version-2 (RDRS-2) applied at hospital discharge and one year later. At hospital discharge, the total hip arthroplasty group was younger and had a better functional status than the internal fixation or hemiarthroplasty groups. One year later, the best function was still observed in the total arthroplasty group, but the differences were small and failed to achieve the level of statistical significance. During that one-year period, walking ability or mobility did not change significantly after total hip arthroplasty, but a significant proportion of the women developed cognitive impairment, including mental confusion, uncooperativeness, and depression. Overall, the most significant predictors of poor functional status one year after fracture were increasing age, living in an institution at time of injury, and poor functional status at discharge. In elderly women with a displaced intracapsular hip fracture, total hip arthroplasty is associated with a functional benefit within the first months after surgery. However, the extent to which this functional benefit is maintained over time, is less clear. These results support the need for randomised studies to quantify the extent to which, in elderly women, the early functional benefit of total hip arthroplasty is maintained in the long run or compromised by progressive cognitive impairment and other negative determinants of functional outcome.

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

    PubMed

    Price, Matthew; Anderson, Page L

    2012-06-01

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

  8. Outcome Expectancy as a Predictor of Treatment Response in Cognitive Behavioral Therapy for Public Speaking Fears Within Social Anxiety Disorder

    PubMed Central

    Price, Matthew; Anderson, Page L.

    2012-01-01

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

  9. DCYTB is a predictor of outcome in breast cancer that functions via iron-independent mechanisms.

    PubMed

    Lemler, David J; Lynch, Miranda L; Tesfay, Lia; Deng, Zhiyong; Paul, Bibbin T; Wang, Xiaohong; Hegde, Poornima; Manz, David H; Torti, Suzy V; Torti, Frank M

    2017-03-07

    Duodenal cytochrome b (DCYTB) is a ferrireductase that functions together with divalent metal transporter 1 (DMT1) to mediate dietary iron reduction and uptake in the duodenum. DCYTB is also a member of a 16-gene iron regulatory gene signature (IRGS) that predicts metastasis-free survival in breast cancer patients. To better understand the relationship between DCYTB and breast cancer, we explored in detail the prognostic significance and molecular function of DCYTB in breast cancer. The prognostic significance of DCYTB expression was evaluated using publicly available microarray data. Signaling Pathway Impact Analysis (SPIA) of microarray data was used to identify potential novel functions of DCYTB. The role of DCYTB was assessed using immunohistochemistry and measurements of iron uptake, iron metabolism, and FAK signaling. High DCYTB expression was associated with prolonged survival in two large independent cohorts, together totaling 1610 patients (cohort #1, p = 1.6e-11, n = 741; cohort #2, p = 1.2e-05, n = 869; log-rank test) as well as in the Gene expression-based Outcome for Breast cancer Online (GOBO) cohort (p < 1.0e-05, n = 1379). High DCYTB expression was also associated with increased survival in homogeneously treated groups of patients who received either tamoxifen or chemotherapy. Immunohistochemistry revealed that DCYTB is localized on the plasma membrane of breast epithelial cells, and that expression is dramatically reduced in high-grade tumors. Surprisingly, neither overexpression nor knockdown of DCYTB affected levels of ferritin H, transferrin receptor, labile iron or total cellular iron in breast cancer cells. Because SPIA pathway analysis of patient microarray data revealed an association between DCYTB and the focal adhesion pathway, we examined the influence of DCYTB on FAK activation in breast cancer cells. These experiments reveal that DCYTB reduces adhesion and activation of focal adhesion kinase (FAK) and its adapter

  10. The Prehospital Sepsis Project: out-of-hospital physiologic predictors of sepsis outcomes.

    PubMed

    Baez, Amado Alejandro; Hanudel, Priscilla; Wilcox, Susan Renee

    2013-12-01

    Severe sepsis and septic shock are common, expensive and often fatal medical problems. The care of the critically sick and injured often begins in the prehospital setting; there is limited data available related to predictors and interventions specific to sepsis in the prehospital arena. The objective of this study was to assess the predictive effect of physiologic elements commonly reported in the out-of-hospital setting in the outcomes of patients transported with sepsis. This was a cross-sectional descriptive study. Data from the years 2004-2006 were collected. Adult cases (≥18 years of age) transported by Emergency Medical Services to a major academic center with the diagnosis of sepsis as defined by ICD-9-CM diagnostic codes were included. Descriptive statistics and standard deviations were used to present group characteristics. Chi-square was used for statistical significance and odds ratio (OR) to assess strength of association. Statistical significance was set at the .05 level. Physiologic variables studied included mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and shock index (SI). Sixty-three (63) patients were included. Outcome variables included a mean hospital length of stay (HLOS) of 13.75 days (SD = 9.97), mean ventilator days of 4.93 (SD = 7.87), in-hospital mortality of 22 out of 63 (34.9%), and mean intensive care unit length-of-stay (ICU-LOS) of 7.02 days (SD = 7.98). Although SI and RR were found to predict intensive care unit (ICU) admissions, [OR 5.96 (CI, 1.49-25.78; P = .003) and OR 4.81 (CI, 1.16-21.01; P = .0116), respectively] none of the studied variables were found to predict mortality (MAP <65 mmHg: P = .39; HR >90: P = .60; RR >20 P = .11; SI >0.7 P = .35). This study demonstrated that the out-of-hospital shock index and respiratory rate have high predictability for ICU admission. Further studies should include the development of an out-of-hospital sepsis score.

  11. Predictors of Stimulant Abuse Treatment Outcomes in Severely Mentally Ill Outpatients

    PubMed Central

    Angelo, Frank N.; McDonell, Michael G.; Lewin, Michael R.; Srebnik, Debra; Lowe, Jessica; Roll, John; Ries, Richard

    2012-01-01

    Background Severe mental illness is often exclusionary criteria for studies examining factors that influence addiction treatment outcome. Therefore, little is known about predictors of treatment response of individuals receiving psychosocial treatments for addictions who suffer from co-occurring severe mental illness. Methods The impact of demographic, substance abuse severity, psychiatric severity, and service utilization variables on in-treatment performance (i.e., longest duration of abstinence) in a 12-week contingency management (CM) intervention for stimulant abuse in 96 severely mentally ill adults was investigated. A 4-step linear regression was used to identify independent predictors of in-treatment abstinence. Results This model accounted for 37.4% of variance in the longest duration of abstinence outcome. Lower levels of stimulant use (i.e., stimulant-negative urine test) and psychiatric severity (i.e., lower levels of psychiatric distress), as well as higher rates of outpatient treatment utilization at study entry were independently associated with longer duration of drug abstinence. Conclusion These data suggest that individuals with low levels of stimulant use and psychiatric severity, as well as those actively engaged in services are most likely to succeed in a typical CM intervention. For others, modifications to CM interventions, such as increasing the value of reinforcement or adding CM to evidence based psychiatric interventions may improve treatment outcomes. PMID:23273776

  12. Predictors of mortality and poor functional outcome in severe spontaneous intracerebral hemorrhage: a prospective observational study.

    PubMed

    Ferrete-Araujo, A M; Egea-Guerrero, J J; Vilches-Arenas, Á; Godoy, D A; Murillo-Cabezas, F

    2015-10-01

    To analyze mortality and functional outcome in patients with severe spontaneous intracerebral hemorrhage (ICH), and identify the clinical characteristics, radiological findings and therapeutic procedures predictive of mortality in the Intensive Care Unit (ICU) and during hospitalization, as well as of poor functional results at 6 months. A prospective, observational study was carried out. Neurocritical Care Unit of a university hospital. Patients diagnosed with ICH were included over a period of 23 months. Demographic characteristics, cardiovascular risk factors, regular medication, laboratory test parameters, cranial CT findings, therapeutic procedures and outcome data. None. A total of 186 patients with ICH met the inclusion criteria. Surgery to evacuate ICH was performed in 25.8% of the patients. The mortality rate was 46.7%. The modified Rankin score at 6 months was 5 (RI: 4.6). Multivariate Cox regression analysis showed the presence of diabetes, prior anticoagulation, as well as APACHE II severity and the type of bleeding on the cranial CT scan to be predictors of mortality and poor functional outcomes. On the other hand, neurosurgical procedures and intracranial pressure (ICP) monitoring were associated with better outcomes. The presence of comorbidities such as diabetes, or previous anticoagulation, as well as the CT findings were associated to poorer outcomes. In contrast, ICP monitoring and early neurosurgery were predictive of longer survival and better functional outcomes. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  13. Automated computer-based CT stratification as a predictor of outcome in hypersensitivity pneumonitis.

    PubMed

    Jacob, Joseph; Bartholmai, B J; Rajagopalan, S; Karwoski, R; Mak, S M; Mok, W; Della Casa, G; Sugino, K; Walsh, S L F; Wells, A U; Hansell, D M

    2017-09-01

    Hypersensitivity pneumonitis (HP) has a variable clinical course. Modelling of quantitative CALIPER-derived CT data can identify distinct disease phenotypes. Mortality prediction using CALIPER analysis was compared to the interstitial lung disease gender, age, physiology (ILD-GAP) outcome model. CALIPER CT analysis of parenchymal patterns in 98 consecutive HP patients was compared to visual CT scoring by two radiologists. Functional indices including forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLco) in univariate and multivariate Cox mortality models. Automated stratification of CALIPER scores was evaluated against outcome models. Univariate predictors of mortality included visual and CALIPER CT fibrotic patterns, and all functional indices. Multivariate analyses identified only two independent predictors of mortality: CALIPER reticular pattern (p = 0.001) and DLco (p < 0.0001). Automated stratification distinguished three distinct HP groups (log-rank test p < 0.0001). Substitution of automated stratified groups for FVC and DLco in the ILD-GAP model demonstrated no loss of model strength (C-Index = 0.73 for both models). Model strength improved when automated stratified groups were combined with the ILD-GAP model (C-Index = 0.77). CALIPER-derived variables are the strongest CT predictors of mortality in HP. Automated CT stratification is equivalent to functional indices in the ILD-GAP model for predicting outcome in HP. • Computer CT analysis better predicts mortality than visual CT analysis in HP. • Quantitative CT analysis is equivalent to functional indices for prognostication in HP. • Prognostication using the ILD-GAP model improves when combined with quantitative CT analysis.

  14. Immune thrombocytopenia in adults: a prospective cohort study of clinical features and predictors of outcome

    PubMed Central

    Grimaldi-Bensouda, Lamiae; Nordon, Clémentine; Michel, Marc; Viallard, Jean-François; Adoue, Daniel; Magy-Bertrand, Nadine; Durand, Jean-Marc; Quittet, Philippe; Fain, Olivier; Bonnotte, Bernard; Morin, Anne-Sophie; Morel, Nathalie; Costedoat-Chalumeau, Nathalie; Pan-Petesch, Brigitte; Khellaf, Mehdi; Perlat, Antoinette; Sacre, Karim; Lefrere, François; Abenhaim, Lucien; Godeau, Bertrand

    2016-01-01

    This prospective observational cohort study aimed to explore the clinical features of incident immune thrombocytopenia in adults and predictors of outcome, while determining if a family history of autoimmune disorder is a risk factor for immune thrombocytopenia. All adults, 18 years of age or older, recently diagnosed with immune thrombocytopenia were consecutively recruited across 21 hospital centers in France. Data were collected at diagnosis and after 12 months. Predictors of chronicity at 12 months were explored using logistic regression models. The association between family history of autoimmune disorder and the risk of developing immune thrombocytopenia was explored using a conditional logistic regression model after matching each case to 10 controls. One hundred and forty-three patients were included: 63% female, mean age 48 years old (Standard Deviation=19), and 84% presented with bleeding symptoms. Median platelet count was 10×109/L. Initial treatment was required in 82% of patients. After 12 months, only 37% of patients not subject to disease-modifying interventions achieved cure. The sole possible predictor of chronicity at 12 months was a higher platelet count at baseline [Odds Ratio 1.03; 95%CI: 1.00, 1.06]. No association was found between outcome and any of the following features: age, sex, presence of either bleeding symptoms or antinuclear antibodies at diagnosis. Likewise, family history of autoimmune disorder was not associated with incident immune thrombocytopenia. Immune thrombocytopenia in adults has been shown to progress to a chronic form in the majority of patients. A lower platelet count could be indicative of a more favorable outcome. PMID:27229715

  15. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery.

    PubMed

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13-30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9-43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.

  16. Serum lactate levels as the predictor of outcome in pediatric septic shock

    PubMed Central

    Jat, Kana Ram; Jhamb, Urmila; Gupta, Vinod K.

    2011-01-01

    Background and Aims: An association of high lactate levels with mortality has been found in adult patients with septic shock. However, there is controversial literature regarding the same in children. The aim of this study was to find the correlation of serum lactate levels in pediatric septic shock with survival. Settings and Design: This was a prospective observational study at PICU of a tertiary care center of North India. Materials and Methods: A total of 30 children admitted to PICU with diagnosis of septic shock were included in the study. PRISM III score and demographic characteristics of all children were recorded. Serum lactate levels were measured in arterial blood at 0-3, 12, and 24 h of PICU admission. The outcome (survival or death) was correlated with serum lactate levels. Results: Septic shock was the most common (79.3%) type of shock and had 50% mortality. Initial as well as subsequent lactate levels were significantly higher in nonsurvivors. A lactate value of more than 45 mg/dl (5 mmol/l) at 0–3, 12, and 24 h of PICU admission had an odds ratio for death of 6.7, 12.5, and 8.6 (95% CI: 1.044–42.431, 1.850–84.442, 1.241–61.683) with a positive predictive value (PPV) of 38%, 71%, 64% and a negative predictive value (NPV) of 80%, 83%, and 83%, respectively. Conclusions: Nonsurvivors had higher blood lactate levels at admission as well as at 12 and 24 h. A lactate value of more than 45 mg/dl (5 mmol/l) was a good predictor of death. PMID:21814374

  17. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery

    PubMed Central

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13–30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9–43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention. PMID:27855225

  18. Preconception Predictors of Birth Outcomes: Prospective Findings from the Central Pennsylvania Women's Health Study

    PubMed Central

    Misra, Dawn P.; Hillemeier, Marianne M.; Downs, Danielle Symons; Chuang, Cynthia H.; Camacho, Fabian T.; Dyer, Anne-Marie

    2009-01-01

    Objective To examine maternal pre-pregnancy (preconception) predictors of birthweight and fetal growth for singleton live births occurring over a 2-year period in a prospective study. Methods Data are from a population-based cohort study of 1,420 women who were interviewed at baseline and 2-years later; self-report data and birth records were obtained for incident live births during the followup period. The analytic sample includes 116 singleton births. Baseline preconception maternal health status and health-related behaviors were examined as predictors of birthweight and fetal growth, controlling for prenatal and sociodemographic variables, using multiple regression analysis. Results Preconception BMI (overweight or obese) and vegetable consumption (at least one serving per day) had statistically significant independent and positive effects on birthweight and fetal growth. Maternal weight gain during pregnancy, a prenatal variable, was an additional independent predictor of birthweight and fetal growth. Sociodemographic variables were not significant predictors after controlling for preconception and prenatal maternal characteristics. Conclusions Findings confirm that preconception maternal health status and health-related behaviors can affect birthweight and fetal growth independent of prenatal and socioeconomic variables. Implications for preconception care are discussed. PMID:19472041

  19. Are albumin and total lymphocyte count significant and reliable predictors of mortality in fractured neck of femur patients?

    PubMed

    Kumar, Vishwajeet; Alva, Avinash; Akkena, Sudheer; Jones, Morgan; Murphy, Philip N; Clough, Tim

    2014-10-01

    Hip fractures are a significant cause of mortality and morbidity in the elderly. It is important to identify factors that predict an increased mortality following hip fracture. The aim of this study was to identify significant predictors of mortality at 6 and 12 months following hip fractures. Three hundred patients above the age of 65 were identified who were admitted in to the hospital with fracture neck of femur. Two hundred and seventy-four patients were operated and were included into the study. Variables collected were age, gender, significant comorbidities, admission albumin level and admission total lymphocyte count (TLC). Admission time and subsequent time to surgery were also analysed. Our study showed that albumin and TLC were found to be the only clearly significant mortality predictors at 12 months and a delay of up to 4 days to surgery does not significantly increase the mortality at 12 months.

  20. Early outcomes and predictors in 260 patients with psychogenic nonepileptic attacks.

    PubMed

    McKenzie, P; Oto, M; Russell, A; Pelosi, A; Duncan, R

    2010-01-05

    To determine short-term outcome and its predictors in patients with psychogenic nonepileptic attacks (PNEA). Retrospective cohort study of outcomes relating to attendance at follow-up, spells, use of emergency services, employment, and social security payments recorded at 6 and 12 months post diagnosis in 260 consecutive patients. A total of 187 patients (71.9%) attended at least 1 follow-up visit, and 105 patients (40.4%) attended 2. A total of 71/187 patients (38.0%) were spell-free at last follow-up. In contrast, 35/187 patients (18.7%) had marked increase in spell frequency postdiagnosis. Delay to diagnosis had no relationship to outcome. Patients with anxiety or depression were 2.32 times less likely to become spell-free (p = 0.012), and patients drawing social security payments at baseline were 2.34 times less likely to become spell-free (p = 0.014), than patients without those factors. Men were 2.46 times more likely to become spell-free than women (p = 0.016). While 93/187 patients (49.7%) were using emergency medical services at baseline, only 29/187 (15.5%) were using them at follow-up (p < 0.001). This was independent of whether or not the patient became spell-free. A substantial minority of our patients became spell-free with communication of the diagnosis the only intervention. Previous psychiatric diagnoses, social security payments, and gender were important predictors of outcome. Most patients stopped using emergency services, irrespective of whether or not spells continued. Outcomes other than spell frequency may be important in patients with psychogenic nonepileptic attacks.

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

    PubMed Central

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

    2011-01-01

    Objective Given the fundamental role of thought disorder in schizophrenia, subtle communication disturbance may be a valuable predictor of subsequent development of psychosis. Here we examined the contribution of thought and communication disturbance to the prediction of outcome in adolescents identified as putatively prodromal for psychosis. Method Transcribed speech samples were elicited from 105 adolescents (54 identified as being at clinical high risk for a first episode of psychosis (CHR) and 51 demographically comparable comparison subjects) and coded for formal thought disorder (FTD) and linguistic cohesion. We then examined the association of baseline FTD/cohesion with conversion to psychosis and social and role outcome at follow-up, approximately one year later. Results At baseline, CHR patients who subsequently converted to psychosis (CHR+) showed an elevated rate of illogical thinking and poverty of content (POC) in their speech, relative to both typically developing controls and non-converters (CHR−). CHR+ youth also used significantly less referential cohesion at baseline, indicating that they provide fewer references to people, objects, or events mentioned in preceding utterances. Multiple regression models indicated that, among measures of FTD/cohesion, illogical thinking was uniquely predictive of subsequent conversion to psychosis, whereas POC and referential cohesion were significant predictors of social and role functioning, respectively. Conclusions Despite the absence of fully psychotic symptoms, putatively prodromal individuals evidence signs of communication disturbance that are qualitatively similar to those seen in schizophrenia, and are predictive of both conversion to psychosis and psychosocial outcome. These findings suggest that FTD measures have prognostic significance for at-risk youth. PMID:21703494

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

    PubMed

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

    2016-01-01

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

  3. Red cell distribution width as a novel predictor for clinical outcomes in patients with paroxysmal atrial fibrillation.

    PubMed

    Lee, Ki Hong; Park, Hyung Wook; Cho, Jeong Gwan; Yoon, Nam Sik; Kim, Sung Soo; Kim, Mi Ran; Kim, Min Chul; Cho, Kyung Hoon; Kim, Hyun Kuk; Kim, Cheol Hwan; Kim, Kyung Hwan; Jun, Seung Jin; Kim, Woo Jin; Lee, Kyoung Jin; Jeong, Hae Chang; Cho, Jae Yeong; Park, Keun-Ho; Sim, Doo sun; Yoon, Hyun Ju; Kim, Kye Hun; Hong, Young Joon; Kim, Ju Han; Ahn, Youngkeun; Jeong, Myung Ho; Park, Jong Chun

    2015-10-01

    Elevated red cell distribution width (RDW) has been known to be associated with adverse long-term outcomes in patients with cardiovascular diseases. We aimed to evaluate relationship between RDW values and clinical outcomes in patients with paroxysmal atrial fibrillation (AF). We analysed 567 patients who were newly diagnosed as paroxysmal AF. Clinical outcomes were analysed after median 4.8 (3.4-6.9) years follow-up. The composite clinical outcomes were defined as the composite of death, hospitalization due to heart failure, and new-onset stroke. Bleeding events were composed of major and minor bleeding. The relationship of RDW with clinical outcomes was assessed using continuous or categorical variables as quartiles: <12.8, 12.8-13.2, 13.3-13.8, and ≥13.9%. Patients with the highest RDW quartile were the oldest and had more frequent history of heart failure. CHA2DS2-VASc score was increased along with increasing RDW quartiles (1.75 ± 1.48 vs. 1.77 ± 1.63 vs. 1.87 ± 1.61 vs. 2.33 ± 1.65, P = 0.008). Incidence of new-onset stroke (log-rank P = 0.032), the composite clinical outcomes (log-rank P = 0.014), and bleeding events (log-rank P = 0.001) were increased as increasing RDW quartiles. Multivariate analysis identified that RDW was a significant predictor for new-onset stroke [adjusted hazard ratio (HR) 1.32, 95% confidence interval (CI) 1.06-1.65, P = 0.015], the composite clinical outcomes (adjusted HR 1.21, 95% CI 1.03-1.41, P = 0.017), and bleeding events (adjusted HR 1.36, 95% CI 1.13-1.64, P = 0.001). RDW can be a new, useful, novel predictor of clinical and safety outcomes in patients with paroxysmal AF. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  4. Predictors of outcome in paediatric IgA nephropathy with regard to clinical and histopathological variables (Oxford classification).

    PubMed

    Edström Halling, Stella; Söderberg, Magnus P; Berg, Ulla B

    2012-02-01

    There has been a lack of international consensus on the classification and the predictive value of the histopathology findings in IgA nephropathy (IgAN). Recently, the International IgA Nephropathy Network has developed the Oxford classification in which four histological variables with the most prognostic importance are identified (MEST score). Our objective was to validate these findings and to assess their predictive power in our cohort and to compare them to identified clinical predictors. Ninety-nine children with a follow-up time >5 years were included and investigated with clearances of inulin or iohexol for glomerular filtration rate (GFR), proteinuria and blood pressure at biopsy and during follow-up. Biopsies (90/99) were re-evaluated and scored according to the Oxford classification. Eighteen patients progressed to a poor outcome [end-stage renal disease (ESRD) or GFR reduction >50%]. In the univariate analysis, we found that mesangial hypercellullarity score >0.5, presence of endocapillary hypercellularity or tubular atrophy/interstitial fibrosis of >25% were each associated with a poor outcome, and also presence of cellular or fibrocellular crescents and of global glomerulosclerosis, but segmental glomerulosclerosis did not reach statistical significance. The clinical predictors of a poor outcome were a low GFR, a high mean arterial blood pressure and a high amount of albuminuria (log Ualb/c) at time of biopsy and low GFR and a high log Ualb/c during follow-up. We found that three of the four histology lesions identified in the Oxford classification, as well as presence of crescents, were valid in predicting a poor outcome in our cohort of patients.

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

    SciTech Connect

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

    2015-08-01

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

  6. Predictors of functional outcome vary by the hemisphere of involvement in major ischemic stroke treated with intra-arterial therapy: a retrospective cohort study

    PubMed Central

    2010-01-01

    Background Conflicting data exists regarding the effect of hemispheric lateralization on acute ischemic stroke outcome. Some of this variability may be related to heterogeneous study populations, particularly with respect to the level of arterial occlusion. Furthermore, little is known about the relationship between stroke lateralization and predictors of outcome. The purpose of this study was to characterize the impact of stroke lateralization on both functional outcome and its predictors in a well-defined population of anterior circulation proximal artery occlusions treated with IAT. Methods Thirty-five consecutive left- and 35 consecutive right-sided stroke patients with intracranial ICA and/or MCA occlusions who underwent IAT were retrospectively analyzed. Ischemic change on pre-treatment imaging was quantified. Reperfusion success was graded using the Mori scale. Good outcome at three months was defined as an mRS ≤ 2. Left- and right-sided strokes were compared for outcome and its predictors. Result Of 70 patients with median NIHSS score of 18 (IQR, 14-21), 19 (27.1%) had a good outcome. There were 21 terminal ICA and 49 MCA occlusions. There was no difference in the rate of good outcomes between left- (n = 9) and right-sided (n = 10) strokes (p = 0.99). There were no significant differences in occlusion level, age, ischemic change on initial imaging and degree of reperfusion between left- and right-sided strokes. Left-sided strokes had higher baseline NIHSS scores (p = 0.02) and lower admission SBP (p = 0.009). Independent predictors of outcome for left-sided strokes were NIHSS (p = 0.0002) and reperfusion (p = 0.006), and for right-sided strokes were age (p = 0.002) and reperfusion (p = 0.003). In univariate analysis, pre-treatment ischemic change on NCCT was associated with outcome only for left-sided strokes (p = 0.05). Conclusions In anterior circulation proximal artery occlusions treated with IAT, hemispheric lateralization influences the clinical and

  7. Significance of intrarenal concentrations of gentamicin for the outcome of experimental pyelonephritis in rats.

    PubMed

    Bergeron, M G; Bastille, A; Lessard, C; Gagnon, P M

    1982-07-01

    The significance of continuous intrarenal levels of gentamicin in the treatment of acute pyelonephritis due to Echerichia coli was investigated in rats. Treatment was started 24 hr after E. coli was injected into the left kidney. A single dose or three successive doses (10 mg/kg of body weight) of gentamicin administered ip every 8 hr could not sterilize the kidneys. Injections of gentamicin (10 mg/kg) every 12 hr for seven or 14 days resulted in continuous levels of the drug in the medulla that persisted above the minimal inhibitory concentration for E. coli (1.6 microgram/ml) for six months or more. Whereas greater than or equal to 73% of the right kidneys or urine specimens were found to be sterile up to six months following a week of therapy, only 23% of the left kidneys were sterile. Two weeks of treatment sterilized greater than or equal to 86% of the left kidneys, right kidneys, and urine specimens. Concentrations of drug in serum and urine were poor predictors of both the intrarenal distribution of drug and the outcome of pyelonephritis.

  8. Relating quality of life to outcomes and predictors in adult cochlear implant users: Are we measuring the right things?

    PubMed

    Moberly, Aaron C; Harris, Michael S; Boyce, Lauren; Vasil, Kara; Wucinich, Taylor; Pisoni, David B; Baxter, Jodi; Ray, Christin; Shafiro, Valeriy

    2017-08-04

    Current clinical outcome measures for adults receiving cochlear implants (CIs) consist of word and sentence recognition, primarily under quiet conditions. However, these measures may not adequately reflect patients' CI-specific quality of life (QOL). This study first examined traditional auditory-only speech recognition measures and other potentially relevant auditory measures as correlates of QOL in CI users. Second, scores on nonauditory tasks of language and cognition were examined as potential predictors of QOL. Twenty-five postlingually deafened adults with CIs were assessed. Participants completed a validated CI-specific QOL measure (the Nijmegen Cochlear Implant Questionnaire) and were tested for word and sentence recognition in quiet, as well as sentence recognition in speech-shaped noise. Participants also completed assessments of audiovisual speech recognition, environmental sound identification, and a task of complex auditory verbal processing. Several nonauditory language and cognitive tasks were examined as potential predictors of QOL. Quality-of-life scores significantly correlated with scores for audiovisual speech recognition and recognition of complex sentences in quiet but not sentences in noise or isolated words. No significant correlations were obtained between QOL and environmental sound identification or complex auditory verbal processing. Quality-of-life subdomain scores were predicted by several nonauditory language and cognitive tasks as well as some patient characteristics. Postoperative measures of recognition of sentences in quiet and audiovisual sentence recognition correlate with CI-related QOL. Findings suggest that sentence recognition tasks are QOL-relevant outcomes but only explain a small fraction of the variability in QOL outcomes for this patient population. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  9. Clinical and Imaging Predictors of Surgical Outcome in Multilevel Cervical Ossification of Posterior Longitudinal Ligament: An Analysis of 184 Patients

    PubMed Central

    Cao, Peng; Yuan, Wen; Wu, Huiqiao; Yang, Lili; Tian, Ye; Liang, Lei

    2015-01-01

    Objective To investigate the clinical and imaging predictors of surgical outcomes in patients with ossification of the posterior longitudinal ligament (OPLL). Materials and Methods From May 2010 to April 2012, a total of 200 consecutive patients with cervical OPLL were recruited for this study. Of them, 184 patients (130 men and 54 women) who could be tracked for more than 24 months after surgery were finally included for analysis. Their demographic, clinical and radiological data were collected preoperatively. The recovery ratio in terms of JOA score was used to assess the outcome of the patients preoperatively and at 2 years postoperatively. A JOA recovery rate less than 50% was considered a poor outcome. Results Compared with good outcome group, an older mean age at operation, a longer mean duration of symptoms, a lower mean pre-operativer JOA score, and a higher proportion of diabetics were observed in poor outcome group. Patients in poor outcome group were more likely to present kyphotic cervical alignment, smaller mean transverse area of the spinal cord, and intramedullary signal abnormalities. The result of multivariate stepwise logistic regression showed that a longer duration of symptoms and the presence of T1 hypo-intensity intramedullary changes on MRI were significant risk factors of lower JOA recovery ratios. Conclusion A longer duration of symptom, T1 hypointensity on MRI and a history of minor trauma were highly predictive of a poor outcome for patients undergoing surgical treatment of OPLL. Age at operation, the history of diabetes, the preoperative JOA score, the transverse area of the spinal cord and T2 hyper-intensity on MRI were also associated with the prognosis of OPLL. PMID:26327216

  10. Reasoning and Rehabilitation cognitive skills programme for mentally disordered offenders: Predictors of outcome

    PubMed Central

    Young, Susan; Das, Mrigendra; Gudjonsson, Gisli H

    2016-01-01

    AIM To investigate factors predicting treatment completion and treatment outcome of the Reasoning and Rehabilitation Mental Health Programme (R&R2MHP) cognitive skills programme for mentally disordered offenders. METHODS Secondary analysis of data previously obtained from 97 male patients who were sectioned and detained under the United Kingdom Mental Health Act in low, medium and high security hospitals and who had completed R&R2MHP. Predictors of treatment completion included background variables and five outcome measures: Four self-reported measures of violent attitudes, social problem-solving skills, reactive anger and locus of control and an objective measure of behaviour on the ward that was completed by staff. Completion of the 16 session programme, which was delivered on a weekly basis, was classified as ≥ 12 sessions. RESULTS It was found that the R&R2MHP is appropriate for delivery to participants of different ages, ethnic background, and at different levels of security without the completion rate or treatment effectiveness being compromised. Participants taking oral typical psychotropic medication were over seven times more likely to complete the programme than other participants. Behavioural disturbance on the ward prior to commencing the programme predicted non-completion (medium effect size). As far as treatment completion was concerned, none of the background factors predicted treatment effectiveness (age, ethnic background, level of security, number of previous convictions and number of previous hospital admissions). The best predictor of treatment effectiveness was attitude towards violence suggesting that this should be the primary outcome measure in future research evaluating outcomes of the R&R2MHP cognitive skills program. CONCLUSION The findings suggest that a stable mental state is a key factor that predicts treatment completion. PMID:28078205

  11. Reasoning and Rehabilitation cognitive skills programme for mentally disordered offenders: Predictors of outcome.

    PubMed

    Young, Susan; Das, Mrigendra; Gudjonsson, Gisli H

    2016-12-22

    To investigate factors predicting treatment completion and treatment outcome of the Reasoning and Rehabilitation Mental Health Programme (R&R2MHP) cognitive skills programme for mentally disordered offenders. Secondary analysis of data previously obtained from 97 male patients who were sectioned and detained under the United Kingdom Mental Health Act in low, medium and high security hospitals and who had completed R&R2MHP. Predictors of treatment completion included background variables and five outcome measures: Four self-reported measures of violent attitudes, social problem-solving skills, reactive anger and locus of control and an objective measure of behaviour on the ward that was completed by staff. Completion of the 16 session programme, which was delivered on a weekly basis, was classified as ≥ 12 sessions. It was found that the R&R2MHP is appropriate for delivery to participants of different ages, ethnic background, and at different levels of security without the completion rate or treatment effectiveness being compromised. Participants taking oral typical psychotropic medication were over seven times more likely to complete the programme than other participants. Behavioural disturbance on the ward prior to commencing the programme predicted non-completion (medium effect size). As far as treatment completion was concerned, none of the background factors predicted treatment effectiveness (age, ethnic background, level of security, number of previous convictions and number of previous hospital admissions). The best predictor of treatment effectiveness was attitude towards violence suggesting that this should be the primary outcome measure in future research evaluating outcomes of the R&R2MHP cognitive skills program. The findings suggest that a stable mental state is a key factor that predicts treatment completion.

  12. Predictors and outcomes for caregivers of people with mild cognitive impairment: a systematic literature review.

    PubMed

    Seeher, Katrin; Low, Lee-Fay; Reppermund, Simone; Brodaty, Henry

    2013-05-01

    Dementia caregiving is strongly linked to depression, anxiety, and burden in caregivers. Little is known about whether the same holds for people supporting an older person with mild cognitive impairment (MCI). We aim to systematically review the current evidence for negative caregiver outcomes in MCI using Pearlin and colleagues' stress process model as a theoretical framework. Widely used scientific literature databases were searched using MCI- and caregiver-related terms with "AND" relations. Results were limited to quantitative English language articles published in peer-reviewed journals between 1980 and November 2010. Of the 266 identified articles, six reported relevant depression data on 988 MCI caregivers (73% spouses). The pooled Center for Epidemiologic Studies Depression scale (CES-D) mean score was 12.95 (standard deviation = 6.16). The pooled depression prevalence (i.e., CES-D score ≥ 16 or equivalent) was 23%. Two studies compared depression in MCI and dementia caregivers, indicating higher levels in dementia caregivers. Other outcomes, such as burden, stress, or anxiety, were only investigated by individual studies precluding pooling of data. Similarly, pooling of the data on the predictors of caregiver outcomes was impossible because of data heterogeneity. However, descriptive analysis of predictors revealed that Pearlin and colleagues' caregiver stress process model at least partially applies to the MCI context. The studies reviewed were all cross sectional in design, involving clinical samples, thus limiting generalizability. Depression and psychological comorbidity, although not as pronounced as in dementia caregivers, are common complications in MCI caregivers. The long-term course of outcomes in MCI caregivers requires further investigation. Copyright © 2013 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

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

    PubMed Central

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

    2015-01-01

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

  14. Mild preoperative renal dysfunction as a predictor of long-term clinical outcome after coronary bypass surgery.

    PubMed

    van de Wal, Ruud M A; van Brussel, Ben L; Voors, Adriaan A; Smilde, Tom D J; Kelder, Johannes C; van Swieten, Henry A; van Gilst, Wiek H; van Veldhuisen, Dirk Jan; Plokker, H W Thijs

    2005-02-01

    Renal dysfunction is a prognostic marker in patients with cardiovascular disease. However, no long-term follow-up studies on the influence of mild renal dysfunction on mortality in patients undergoing coronary bypass grafting have been reported. Therefore, we aimed to identify the significance of preoperative (mild) renal dysfunction as a long-term predictor of clinical outcome after coronary bypass surgery. In 358 patients who underwent isolated saphenous vein aorta-coronary artery bypass grafting, estimated glomerular filtration rates were calculated with the Cockroft-Gault equation (GFRc). Patients were categorized into 2 groups (group 1, GFRc >71.1 mL x min (-1) x 1.73 m (-2) ; group 2, GFRc <71.1 mL x min (-1) x 1.73 m (-2) ). Multivariate Cox proportional hazard analyses were performed to determine the independent prognostic value of GFRc. During a median follow-up of 18.2 years, 233 patients (65.1%) died. Patients who died had lower GFRc and were older. Multivariate analysis demonstrated that total mortality in patients with lower GFRc was significantly increased (lower GFRc group vs normal GFRc group: hazard ratio, 1.44; P = .019). Lower GFRc was also an independent predictor of cardiac mortality (hazard ratio, 1.51; P = .032). No significant differences were observed between groups in the occurrence of myocardial infarction and the need for reintervention. Our study demonstrates that after long-term follow-up, preoperative mild renal dysfunction is an independent predictor of long-term (cardiac) mortality in patients who undergo coronary artery bypass grafting.

  15. Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC—UK gynaecological oncology surgical outcomes and complications)

    PubMed Central

    Iyer, R; Gentry-Maharaj, A; Nordin, A; Burnell, M; Liston, R; Manchanda, R; Das, N; Desai, R; Gornall, R; Beardmore-Gray, A; Nevin, J; Hillaby, K; Leeson, S; Linder, A; Lopes, A; Meechan, D; Mould, T; Varkey, S; Olaitan, A; Rufford, B; Ryan, A; Shanbhag, S; Thackeray, A; Wood, N; Reynolds, K; Menon, U

    2015-01-01

    Background: There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study. Methods: Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I–V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications. Results: Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II–V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05). Conclusions: This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk. PMID:25535730

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

    PubMed

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

    2013-05-01

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

  17. Subcapsular hematoma in blunt splenic injury: A significant predictor of failure of nonoperative management.

    PubMed

    Lopez, Joseph Martin; McGonagill, Patrick W; Gross, Jessica Lynn; Hoth, J Jason; Chang, Michael C; Parker, Karen; Requarth, Jay A; Miller, Preston Roy

    2015-12-01

    In patients with blunt splenic injury (BSI), patient selection, angiography, and embolization have contributed to low nonoperative management (NOM) failure rates. Despite these advances, some patients will fail NOM. We noted that a significant proportion of NOM failures had subcapsular hematomas (SCHs) identified on imaging. We sought to determine if there is a correlation between SCH and higher risk of NOM failure after BSI. Our institutional trauma registry was queried for all patients with BSI during a 2-year period. Charts were reviewed to determine grade, presence of SCH, and outcome of NOM. Under current institutional protocol, all stable patients with BSI Grades III to V and those with contrast blush on computed tomography are referred for angiography and embolization. Failure of NOM was declared if splenectomy was required for bleeding after an initial plan of nonoperation. From May 2012 to May 2014, 312 patients with BSI were identified. A total of 253 patients (81%) underwent NOM. Overall, 15 (5.9%) failed NOM. Of those undergoing NOM, 34 had SCH and 12 failed (35.3% vs. 1.5% without SCH, p = 0.0001). Failure rates in Grades 1 to 4 were 2.3%, 3.8%, 8.8%, and 19.2%, respectively. NOM failure rates in the subset with SCH for Grades I to IV were 20%, 25%, 30.8%, and 80%, respectively. These are significantly higher than patients without SCH in Grades II to IV (0%, p = 0.003; 2.3%, p = 0.008; and 4.8%, p = 0.016) and approach significance in Grade I (1.2%, p = 0.11). There were no SCHs and no failures of NOM in Grade V injuries. The NOM failure rate of BSI patients with SCH is significantly higher than those without SCH. Patients with BSI Grades I to III slated for NOM must be observed as the failure rate approaches 30%. Splenectomy should be considered in patients with Grade IV BSI with SCH, as NOM failure rate is 80%. Therapeutic study, level IV.

  18. Youth psychotherapy outcomes in usual care and predictors of outcome group membership.

    PubMed

    Smith, Ashley M; Jensen-Doss, Amanda

    2017-02-01

    Improving mental health services for youth in usual care (UC) is one of the most critical issues in mental health services research. Identification of change groups in UC (e.g., recovery, improvement, no response, deterioration) can help researchers gain a richer understanding of UC and facilitate efforts to tailor UC to individuals who may not be responding well to treatment. This study used the reliable change index (RCI; Jacobson & Truax, 1991) to examine change groups within youth UC on two parent report outcome measures-symptom severity and functioning-using a large, naturalistic sample of youth (N = 672) treated in UC served at four clinics operating under a large county-wide public mental health authority. Results indicated that the majority of youth exhibited no reliable change. Furthermore, findings revealed low concordance between how youth were classified on both outcome measures. Multinomial logistic regression was used to predict group membership from an expanded set of youth demographic and clinical variables. Findings indicated that baseline problem severity and lower baseline functioning generally predicted higher likelihood of being classified into a more positive change group. Older age predicted increased likelihood of being in a more positive change group, while diagnosis of an internalizing disorder or serious mental illness (SMI) both predicted greater likelihood of falling into a more negative change group. Overall, these results suggest the importance of a more nuanced understanding of change in UC, as well as work aimed at identifying targets for improvement for youth who are not responding well. (PsycINFO Database Record

  19. Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer.

    PubMed

    Kanda, Mitsuro; Mizuno, Akira; Tanaka, Chie; Kobayashi, Daisuke; Fujiwara, Michitaka; Iwata, Naoki; Hayashi, Masamichi; Yamada, Suguru; Nakayama, Goro; Fujii, Tsutomu; Sugimoto, Hiroyuki; Koike, Masahiko; Takami, Hideki; Niwa, Yukiko; Murotani, Kenta; Kodera, Yasuhiro

    2016-06-01

    Evidence indicates that impaired immunocompetence and nutritional status adversely affect short-term and long-term outcomes of patients with cancer. We aimed to evaluate the clinical significance of preoperative immunocompetence and nutritional status according to Onodera's prognostic nutrition index (PNI) among patients who underwent curative gastrectomy for gastric cancer (GC).This study included 260 patients with stage II/III GC who underwent R0 resection. The predictive values of preoperative nutritional status for postoperative outcome (morbidity and prognosis) were evaluated. Onodera's PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (per mm).The mean preoperative PNI was 47.8. The area under the curve for predicting complications was greater for PNI compared with the serum albumin concentration or lymphocyte count. Multivariate analysis identified preoperative PNI < 47 as an independent predictor of postoperative morbidity. Moreover, patients in the PNI < 47 group experienced significantly shorter overall and disease-free survival compared with those in the PNI ≥ 47 group, notably because of a higher prevalence of hematogenous metastasis as the initial recurrence. Subgroup analysis according to disease stage and postoperative adjuvant treatment revealed that the prognostic significance of PNI was more apparent in patients with stage II GC and in those who received adjuvant chemotherapy.Preoperative PNI is easy and inexpensive to determine, and our findings indicate that PNI served as a significant predictor of postoperative morbidity, prognosis, and recurrence patterns of patients with stage II/III GC.

  20. Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer

    PubMed Central

    Kanda, Mitsuro; Mizuno, Akira; Tanaka, Chie; Kobayashi, Daisuke; Fujiwara, Michitaka; Iwata, Naoki; Hayashi, Masamichi; Yamada, Suguru; Nakayama, Goro; Fujii, Tsutomu; Sugimoto, Hiroyuki; Koike, Masahiko; Takami, Hideki; Niwa, Yukiko; Murotani, Kenta; Kodera, Yasuhiro

    2016-01-01

    Abstract Evidence indicates that impaired immunocompetence and nutritional status adversely affect short-term and long-term outcomes of patients with cancer. We aimed to evaluate the clinical significance of preoperative immunocompetence and nutritional status according to Onodera's prognostic nutrition index (PNI) among patients who underwent curative gastrectomy for gastric cancer (GC). This study included 260 patients with stage II/III GC who underwent R0 resection. The predictive values of preoperative nutritional status for postoperative outcome (morbidity and prognosis) were evaluated. Onodera's PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (per mm3). The mean preoperative PNI was 47.8. The area under the curve for predicting complications was greater for PNI compared with the serum albumin concentration or lymphocyte count. Multivariate analysis identified preoperative PNI < 47 as an independent predictor of postoperative morbidity. Moreover, patients in the PNI < 47 group experienced significantly shorter overall and disease-free survival compared with those in the PNI ≥ 47 group, notably because of a higher prevalence of hematogenous metastasis as the initial recurrence. Subgroup analysis according to disease stage and postoperative adjuvant treatment revealed that the prognostic significance of PNI was more apparent in patients with stage II GC and in those who received adjuvant chemotherapy. Preoperative PNI is easy and inexpensive to determine, and our findings indicate that PNI served as a significant predictor of postoperative morbidity, prognosis, and recurrence patterns of patients with stage II/III GC. PMID:27310954

  1. The spectrum of acute encephalitis: causes, management, and predictors of outcome.

    PubMed

    Singh, Tarun D; Fugate, Jennifer E; Rabinstein, Alejandro A

    2015-01-27

    To describe and analyze etiologies, clinical presentations, therapeutic management, and outcomes of patients with acute encephalitis and identify outcome predictors. We conducted a retrospective review of patients diagnosed with acute encephalitis at Mayo Clinic Rochester between January 2000 and December 2012. On the basis of the final diagnosis, the patients were categorized into 3 groups: viral encephalitis, autoimmune encephalitis, and encephalitis of unknown/other etiology. Multivariate logistic regression analysis was used to analyze factors associated with good (modified Rankin Scale scores of 0-2) or poor (scores of 3-6) outcome at hospital discharge. We identified 198 patients (100 [50.5%] men and 98 [49.5%] women) with a median age of 58 years (range 41.8-69). Etiologies included viral infection (n = 95, 48%), autoimmune (n = 44, 22%), and unknown/others (n = 59, 30%). Good outcome at discharge was achieved by 48 patients (50.5%) with viral encephalitis, 17 (40.5%) with autoimmune encephalitis, and 32 (54.2%) with unknown/other etiologies. Mortality rates were 8%, 12%, and 5% in each of the 3 categories, respectively. On multivariate regression analysis, the factors that were associated with poor outcome were age 65 years or older (p = 0.0307), immunocompromised state (p = 0.0153), coma (p = 0.0062), mechanical ventilation (p = 0.0124), and acute thrombocytopenia (p = 0.0329). CSF polymorphonuclear cell count was also strongly associated with poor outcome in viral encephalitis (p = 0.0027). Advanced age, immunocompromised state, coma, mechanical ventilation, and acute thrombocytopenia portend a worse prognosis in acute encephalitis. In contrast, the etiology of encephalitis, development of seizures or focal neurologic deficit, and MRI findings were not associated with clinical outcomes. © 2014 American Academy of Neurology.

  2. Abnormal liver function tests as predictors of adverse maternal outcomes in women with preeclampsia.

    PubMed

    Kozic, Jennifer R; Benton, Samantha J; Hutcheon, Jennifer A; Payne, Beth A; Magee, Laura A; von Dadelszen, Peter

    2011-10-01

    To evaluate whether (1) the absolute magnitude of liver function test values, (2) the percentage change in liver function test values over time, or (3) the rate of change in liver function test values over time predicts adverse maternal outcomes in women with preeclampsia. We used data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study, a prospective multicentre cohort study assessing predictors of adverse maternal outcomes in women with preeclampsia. Women with at least one liver function test performed at the time of hospital admission were included. Liver functions were tested by serum concentrations of aspartate amino transferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH), albumin, total bilirubin, and the international normalized prothrombin time ratio. Parameters investigated were absolute levels, change within 48 hours of hospital admission, change from admission to delivery or outcome, and rate of change from admission to delivery or outcome of each liver function test. The ability of these parameters to predict adverse outcomes was assessed using logistic regression analyses and by calculating the receiver operating characteristic (ROC) area under the curve (AUC). Of the 2008 women, 1056 (53%) had at least one abnormal liver function test result. The odds of having an adverse maternal outcome were higher in women with any abnormal liver function test than in women with normal results. When test results were stratified into quartiles, women with results in the highest quartile (lowest quartile for albumin) were at higher risk of adverse outcomes than women in the lowest quartile for all parameters (highest for albumin). The absolute magnitude of AST, ALT, and LDH predicted adverse maternal outcomes (AST: ROC AUC 0.73 [95% CI 0.67 to 0.97]; ALT: ROC AUC 0.73 [95% CI 0.67 to 0.79]; LDH: ROC AUC 0.74 [95% CI 0.68 to 0.81]). Neither change of liver function test results, within 48 hours of admission or from admission to

  3. Biological age is better than chronological as predictor of 3-month outcome in ischemic stroke.

    PubMed

    Soriano-Tárraga, Carolina; Mola-Caminal, Marina; Giralt-Steinhauer, Eva; Ois, Angel; Rodríguez-Campello, Ana; Cuadrado-Godia, Elisa; Gómez-González, Alejandra; Vivanco-Hidalgo, Rosa M; Fernández-Cadenas, Israel; Cullell, Natalia; Roquer, Jaume; Jiménez-Conde, Jordi

    2017-08-22

    To analyze the effect of age-related DNA methylation changes in multiple cytosine-phosphate-guanine (CpG) sites (biological age [b-age]) on patient outcomes at 3 months after an ischemic stroke. We included 511 patients with first-ever acute ischemic stroke assessed at Hospital del Mar (Barcelona, Spain) as the discovery cohort. Demographic and clinical data, including chronological age (c-age), vascular risk factors, initial stroke severity, recanalization treatment, and previous and 3-month modified Rankin Scale (p-mRS and 3-mRS, respectively) were registered. B-age was estimated with an algorithm, based on DNA methylation in 71 CpGs. Bivariate analysis determined variables associated with 3-mRS for inclusion in ordinal multivariate analysis. After ordinal regressions for 3-month ischemic stroke outcome (3-mRS), b-age was associated with outcome (odds ratio 1.04 [95% confidence interval 1.01-1.07]), nullifying c-age. Stepwise regression kept b-age, basal NIH Stroke Scale, sex, p-mRS, and recanalization treatment as better explanatory variables, instead of c-age. These results were successfully replicated in an independent cohort. B-age, estimated by DNA methylation, is an independent predictor of ischemic stroke outcome regardless of chronological years. © 2017 American Academy of Neurology.

  4. Incidence, predictors and outcomes of acute-on-chronic liver failure in outpatients with cirrhosis.

    PubMed

    Piano, Salvatore; Tonon, Marta; Vettore, Elia; Stanco, Marialuisa; Pilutti, Chiara; Romano, Antonietta; Mareso, Sara; Gambino, Carmine; Brocca, Alessandra; Sticca, Antonietta; Fasolato, Silvano; Angeli, Paolo

    2017-07-19

    Acute-on-chronic liver failure (ACLF) is the most life-threatening complication of cirrhosis. Prevalence and outcomes of ACLF have recently been described in hospitalized patients with cirrhosis. However, no data is currently available on the prevalence and the risk factors of ACLF in outpatients with cirrhosis. The aim of this study was to evaluate incidence, predictors and outcomes of ACLF in a large cohort of outpatients with cirrhosis. A total of 466 patients with cirrhosis consecutively evaluated in the outpatient clinic of a tertiary hospital were included and followed up until death and/or liver transplantation for a mean of 45±44months. Data on development of hepatic and extrahepatic organ failures were collected during this period. ACLF was defined and graded according to the EASL-CLIF Consortium definition. During the follow-up, 118 patients (25%) developed ACLF: 57 grade-1, 33 grade-2 and 28 grade-3. The probability of developing ACLF was 14%, 29%, and 41% at 1year, 5years, and 10years, respectively. In the multivariate analysis, baseline mean arterial pressure (hazard ratio [HR] 0.96; p=0.012), ascites (HR 2.53; p=0.019), model of end-stage liver disease score (HR 1.26; p<0.001) and baseline hemoglobin (HR 0.07; p=0.012) were found to be independent predictors of the development of ACLF at one year. As expected, ACLF was associated with a poor prognosis, with a 3-month probability of transplant-free survival of 56%. Outpatients with cirrhosis have a high risk of developing ACLF. The degree of liver failure and circulatory dysfunction are associated with the development of ACLF, as well as low values of hemoglobin. These simple variables may help to identify patients at a high risk of developing ACLF and to plan a program of close surveillance and prevention in these patients. There is a need to identify predictors of acute-on-chronic liver failure (ACLF) in patients with cirrhosis in order to identify patients at high risk of developing ACLF and to

  5. Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes: Insights From the PREVENT IV Trial

    PubMed Central

    Harskamp, Ralf E.; Alexander, John H.; Ferguson, T. Bruce; Hager, Rebecca; Mack, Michael J.; Englum, Brian; Wojdyla, Daniel; Schulte, Phillip J.; Kouchoukos, Nicholas T.; de Winter, Robbert J.; Gibson, C. Michael; Peterson, Eric D.; Harrington, Robert A.; Smith, Peter K.; Lopes, Renato D.

    2015-01-01

    Background The internal mammary artery (IMA) is the preferred conduit for bypassing the left anterior descending (LAD) artery in patients undergoing coronary artery bypass grafting (CABG). Systematic evaluation of the frequency and predictors of IMA failure and long-term outcomes is lacking. Methods and Results PREVENT IV trial participants who underwent IMA-LAD revascularization and had 12–18-month angiographic follow-up (n=1539) were included. Logistic regression with fast false selection rate methods was used to identify characteristics associated with IMA failure (≥75% stenosis). The relationship between IMA failure and long-term outcomes including death, myocardial infarction, and repeat revascularization was assessed using Cox regression. IMA failure occurred in 132 participants (8.6%). Predictors of IMA graft failure were LAD stenosis <75% (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.19–2.59), additional bypass graft to diagonal branch (OR, 1.92; 95% CI, 1.33–2.76), and not having diabetes (OR, 1.82; 95% CI, 1.20–2.78). LAD stenosis and additional diagonal graft remained predictive of IMA failure in an alternative model that included angiographic failure or death before angiography as the outcome. IMA failure was associated with a significantly higher incidence of subsequent acute (<14 days of angiography) clinical events, mostly due to a higher rate of repeat revascularization. Conclusions IMA failure was common and associated with higher rates of repeat revascularization, and patients with intermediate LAD stenosis or with an additional bypass graft to the diagonal branch had increased risk for IMA failure. These findings raise concerns regarding competitive flow and the benefit of CABG in intermediate LAD stenosis without functional evidence of ischemia. Clinical Trial Registration Information ClinicalTrials.gov. Identifier: NCT00042081. PMID:26647082

  6. Cardiovascular predictors of long-term outcomes after non-traumatic subarachnoid hemorrhage.

    PubMed

    Zaroff, Jonathan G; Leong, Jonathan; Kim, Helen; Young, William L; Cullen, Sean P; Rao, Vivek A; Sorel, Michael; Quesenberry, Charles P; Sidney, Steve

    2012-12-01

    Cardiac injury is common after subarachnoid hemorrhage (SAH) and is associated with adverse early outcomes, but long-term effects are unknown. The first aim of this study was to compare the long-term rates of death, stroke, and cardiac events in SAH survivors versus a matched population without SAH. The second aim was to quantify the effects of cardiac injury on the outcome rates. This was a retrospective cohort study of patients with and without non-traumatic SAH. For aim #1, the predictor variable was SAH and the outcome variables were all-cause and cerebrovascular mortality, stroke, cardiac mortality, acute coronary syndrome (ACS), and heart failure (HF) admission. A multivariable Cox proportional hazards analysis was performed. For aim #2, the predictor variables were cardiac injury (elevated serum cardiac enzymes or a diagnosis code for ACS) and dysfunction (pulmonary edema on X-Ray or a diagnosis code for HF). Compared with 4,695 members without SAH, the 910 SAH patients had higher rates of all-cause mortality (hazard ratio [HR 2.6], 95% confidence intervals [CI] 2.0-3.4), cerebrovascular mortality (HR 30.6, CI 13.5-69.4), and stroke (HR 10.2, CI 7.5-13.8). Compared with the non-SAH group, the SAH patients with cardiac injury had increased rates of all-cause mortality (HR 5.3, CI 3.0-9.3), cardiac mortality (HR 7.3, CI 1.7-31.6), and heart failure (HR 4.3, CI 1.53-11.88). SAH survivors have increased long-term mortality and stroke rates compared with a matched non-SAH population. SAH-induced cardiac injury is associated with an increased risk of death and heart failure hospitalization.

  7. Treatment Moderators and Predictors of Outcome in the Treatment of Early Age Mania (TEAM) Study

    PubMed Central

    Vitiello, Benedetto; Riddle, Mark A.; Yenokyan, Gayane; Axelson, David A.; Wagner, Karen D.; Joshi, Paramjit; Walkup, John T.; Luby, Joan; Birmaher, Boris; Ryan, Neal D.; Emslie, Graham; Robb, Adelaide; Tillman, Rebecca

    2012-01-01

    Objective Both the diagnosis and treatment of bipolar disorder in youth remain the subject of debate. In the Treatment of Early Age Mania (TEAM) study, risperidone was more effective than lithium or divalproex in children diagnosed with bipolar mania and highly comorbid with attention deficit/hyperactivity disorder (ADHD). We searched for treatment moderators and predictors of outcome. Method TEAM was a multi-site, 8-week, randomized clinical trial of risperidone, lithium, or divalproex in 279 medication-naïve patients, age 6–15 years, with a DSM-IV diagnosis of bipolar disorder currently in manic or mixed phase. Outcome measures included binary end-of-treatment responder status and change in the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (KMRS). Baseline demographics and clinical characteristics were tested as modifiers of treatment effect and as overall predictors of outcome. Results Moderator effects were detected for site, ADHD, and obesity. Across sites, the response ratio (RR) for risperidone vs. lithium ranged from 1.2 (95% CI 0.8, 1.7) to 8.3 (1.1, 60.8), and for risperidone vs. divalproex from 1.3 (0.8, 2.2) to 10.5 (1.4, 77.7). The RR for risperidone vs. lithium was 2.1 for patients with ADHD, but 1.0 for those without ADHD, and 2.3 (1.6, 3.3) for non-obese patients, but 1.1 (0.6, 2.0) for obese ones. Older age and less severe ADHD symptoms were associated with greater improvement on the KMRS. Conclusions Risperidone was more effective than lithium or divalproex across the demographics and clinical characteristics of the sample, but the magnitude of its effect was influenced by site-related characteristics and presence of ADHD. PMID:22917200

  8. Predictors of Self-Reported Psychosocial Outcomes in Individuals With Dementia

    PubMed Central

    Judge, Katherine S.

    2013-01-01

    Purpose: Little is known about the illness experience from the perspective of individuals with dementia (IWDs), as most quantitative research has focused on IWDs’ psychosocial issues from proxy reports. The primary aim of this study was to better understand the impact of the illness experience on well-being from the perspective of the IWD through the framework of the Stress Process Model for Individuals with Dementia (SPM for IWDs). Design and Methods: Guided by the SPM for IWDs, self-report data were collected from IWDs (N = 131) about their illness experience, including primary objective and subjective stressors, secondary role and intrapsychic strains, and well-being outcomes. Using multiple linear regression, primary stressors, secondary strains, and background and context characteristics were entered into 3 prediction models for each outcome: anxiety, depression, and quality of life (QoL).Results: Three distinct prediction patterns emerged for each of the outcome measures. Embarrassment about memory loss was the unique predictor of anxiety, whereas physical health strain and role captivity uniquely predicted depression. Unique predictors for QoL included lower perceived instrumental activities of daily living (IADL) difficulty and higher self-efficacy. Implications: This study provided valuable insight into the illness experience from the perspective of the IWD and identified key areas amenable to interventions, such as managing embarrassment about memory problems as well as improving self-efficacy and inner strength. Moreover, this study provided additional support for the inclusion of IWDs in the research process and highlighted the need for further research regarding clinical application of findings, testing of hypotheses, and analyzing efficacy of interventions. PMID:23107792

  9. 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.

  10. Homework "Dose," Type, and Helpfulness as Predictors of Clinical Outcomes in Prolonged Exposure for PTSD.

    PubMed

    Cooper, Andrew A; Kline, Alexander C; Graham, Belinda; Bedard-Gilligan, Michele; Mello, Patricia G; Feeny, Norah C; Zoellner, Lori A

    2017-03-01

    Homework is often viewed as central to prolonged exposure (PE) for posttraumatic stress disorder (PTSD), but its relationship with treatment outcome is not well understood. We evaluated homework type, dose, and patients' perceptions of helpfulness as predictors of symptom change and posttreatment outcomes in PE. Patients with chronic PTSD received PE in a randomized clinical trial. Independent evaluators assessed PTSD severity at pre- and posttreatment. Patients reported homework adherence and perceived helpfulness at the beginning of each session, separately for in vivo and imaginal exposure assignments. These variables were examined as predictors of change in PTSD symptoms, PTSD remission, and good end-state functioning (GESF; low PTSD, depression, and anxiety) at posttreatment. Higher imaginal homework adherence predicted greater symptom improvement between sessions and across treatment, as well as twice the odds of achieving remission and GESF. Patients who were at least moderately adherent to imaginal homework assignments (two or more times a week) reported more symptom gains than those who were least adherent but did not differ from those who were most adherent. In vivo adherence was not consistently associated with better outcome, perhaps due to heterogeneity in form and function of weekly assignments. Higher ratings of helpfulness of both types of homework predicted greater symptom improvement from pre- to posttreatment and between sessions. Overall, imaginal exposure homework may complement in-session exposures by enhancing key change processes, though perfect adherence is not necessary. Patients' perceptions of helpfulness may reflect buy-in or perceived match between homework completion and functional impairment. Clinically, in addition to targeting adherence to homework assignments, querying about perceived helpfulness and adjusting assignments appropriately may help augment clinical gains. Copyright © 2016. Published by Elsevier Ltd.

  11. Extracorporeal Membrane Oxygenation for Adult Community-Acquired Pneumonia: Outcomes and Predictors of Mortality.

    PubMed

    Ramanathan, Kollengode; Tan, Chuen Seng; Rycus, Peter; MacLaren, Graeme

    2017-05-01

    Extracorporeal membrane oxygenation is a rescue therapy used to support severe cardiorespiratory failure. Data on outcomes from severe community-acquired pneumonia in adults receiving rescue extracorporeal membrane oxygenation are mainly confined to single-center experiences or specific pathogens. We examined data from the Extracorporeal Life Support Organisation registry to identify risk factors for poor outcomes in adult patients with community-acquired pneumonia. Retrospective data analysis. Extracorporeal Life Support Organization Registry database. We collected deidentified data on adult patients (> 18 yr) receiving extracorporeal membrane oxygenation for community-acquired pneumonia between 2002 and 2012. Patients with incomplete data or brain death were excluded. The primary outcome measure was in-hospital mortality. Other measurements included demographic information, pre-extracorporeal membrane oxygenation mechanical ventilation and biochemical variables, inotrope requirements, extracorporeal membrane oxygenation mode, duration, and complications. Initial univariate analysis assessed potential associations between survival and various pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation factors. Variables with p values of less than 0.1 were considered for logistic regression analysis to identify predictors of mortality. None. One thousand fifty-five patients, who satisfied inclusion criteria, were included in the final analysis. There was an increase in the number of patients cannulated per annum over the 10-year period studied. Univariate analysis identified pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation variables associated with high mortality. Further multiple regression analysis identified certain pre-extracorporeal membrane oxygenation factors as predictors of mortality, including duration of mechanical ventilation prior to extracorporeal membrane oxygenation, lower arterial pressure, fungal

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

    PubMed

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

    2015-08-01

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

  13. Outcome Predictors in Nonoperative Management of Newly Diagnosed Subacromial Impingement Syndrome: A Longitudinal Study

    PubMed Central

    TaheriAzam, Afshin; Sadatsafavi, Mohsen; Moayyeri, Alireza

    2005-01-01

    Abstract and Introduction Abstract Objective This prospective investigation is designed to determine the prognostic factors associated with the response to conservative therapy of subacromial impingement syndrome. Materials and Methods We treated 102 patients with subacromial impingement syndrome, diagnosed by physical examination and a subacromial lidocaine injection test, with a standardized conservative protocol. We followed the patients for a period of 12 months. Outcome was evaluated with Constant score and effects of 8 variables: Age, sex, pretreatment symptom duration, dominant shoulder, initial Constant score, active range of motion, acromion morphology, and acromial spur on patient outcomes were evaluated with univariate and multivariate analyses. Results Among 89 patients (44 men; mean age, 56.4 years) who finished the study, the mean difference between initial and final scores was 15.9 (95% confidence interval [CI]: 13.9–17.8). Three variables, the initial Constant score (b = .52, 95% CI: .28–.76), the duration of disease before treatment (b = −4.4, 95% CI: from −7.2 to −1.6), and acromial morphology (b = −5.3, 95% CI: from −9.8 to −.8) were found to be independent predictors of outcome (model R2 = .68). Conclusion Patients with more severe disease, a long duration of symptoms, and type II or III acromion may require more invasive therapeutic options as the first intervention. Introduction Subacromial impingement and rotator cuff tears are common causes of shoulder disability. For the first time, Neer[1] popularized the concept of this syndrome, and described it as impingement of the rotator cuff tendon below the anteroinferior part of the acromion. This impingement caused tendonitis and eventual tendon tear. He described a clinical sign in which pain was aggravated when the affected shoulder was placed in forward-flexed and internally rotated position. He also introduced an impingement test that evaluated pain relief in response to

  14. Prognosis and predictors of outcome of refractory generalized convulsive status epilepticus in adults treated in neurointensive care unit.

    PubMed

    Vooturi, Sudhindra; Jayalakshmi, Sita; Sahu, Sambit; Mohandas, Surath

    2014-11-01

    To evaluate the etiological profile, clinical characteristics and outcome of patients with refractory generalized convulsive status epilepticus treated in Neurological Intensive Care Unit (NICU). In this open cohort study, data of 126 patients, aged 18 years and above, with convulsive status epilepticus (SE) admitted in NICU was collected. Status epilepticus was defined as seizures lasting for more than five minutes without regaining consciousness. Refractory SE (RSE) was defined as SE refractory to 2 antiepileptic drugs and requiring anesthetic agents for seizure control. Survival and regression analysis were done to analyze the outcome and factors predicting outcome respectively in the study population. Out of 126 patients, 81 patients had non -refractory status epilepticus (NRSE); 45 (35.7%) had RSE. Acute symptomatic etiology was noted in 58.6% of entire cohort. Significantly higher percentage of patients with RSE had an etiology of CNS infections than NRSE group (44.4% vs. 23.5%; P=0.0171). Amongst the CNS infections, viral encephalitis was significantly higher in RSE than NRSE patients (31% vs. 6.2%; P=0.0004). All the patients with RSE required mechanical ventilation. Overall mortality was 19%. The mortality in RSE was 42% (19 out of 45), significantly higher when compared to NRSE where only 6% (5 out of 81) died. On logistic regression, the only predictor of death was fever with an odds ratio of 8.55 (P=0.024). CNS infections, especially viral encephalitis and complications of mechanical ventilation were significantly higher in adult RSE patients. Although mortality is higher in adult patients with RSE, etiology does not contribute to mortality; however fever predicts mortality in these patients. Aggressive management of underlying etiology and prevention of systemic complications may improve outcome in adult RSE patients. Copyright © 2014 Elsevier B.V. All rights reserved.

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

    PubMed

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

    2011-05-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1998-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1998-01-01

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

  18. Moderators, mediators and nonspecific predictors of outcome after cognitive rehabilitation of executive functions in a randomised controlled trial.

    PubMed

    Tornås, Sveinung; Stubberud, Jan; Solbakk, Anne-Kristin; Evans, Jonathan; Schanke, Anne-Kristine; Løvstad, Marianne

    2017-06-27

    Moderators, mediators and nonspecific predictors of treatment after cognitive rehabilitation of executive functions in a randomised controlled trial Objective: To explore moderators, mediators and nonspecific predictors of executive functioning after cognitive rehabilitation in a randomised controlled trial, comparing Goal Management Training (GMT) with an active psycho-educative control-intervention, in patients with chronic acquired brain injury. Seventy patients with executive dysfunction were randomly allocated to GMT (n = 33) or control (n = 37). Outcome measures were established by factor-analysis and included cognitive executive complaints, emotional dysregulation and psychological distress. Higher age and IQ emerged as nonspecific predictors. Verbal memory and planning ability at baseline moderated cognitive executive complaints, while planning ability at six-month follow-up mediated all three outcome measures. Inhibitory cognitive control emerged as a unique GMT specific mediator. A general pattern regardless of intervention was identified; higher levels of self-reported cognitive-and executive-symptoms of emotional dysregulation and psychological distress at six-month follow-up mediated less improvement across outcome factors. The majority of treatment effects were nonspecific to intervention, probably underscoring the variables' general contribution to outcome of cognitive rehabilitation interventions. Interventions targeting specific cognitive domains, such as attention or working memory, need to take into account the patients' overall cognitive and emotional self-perceived functioning. Future studies should investigate the identified predictors further, and also consider other predictor candidates.

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

    PubMed

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

    2015-09-01

    Although randomized studies have shown optimal medical therapy (OMT) to be as efficacious as revascularization in stable coronary heart disease (CHD), the application of OMT in routine practice is suboptimal. We sought to understand the predictors of receiving OMT in stable CHD and its impact on clinical outcomes. All patients with stable CHD based on coronary angiography from October 2008 to September 2011 were identified in Ontario, Canada. OMT was defined as concurrent use of β blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and statin. Aspirin use was not part of the OMT definition because of database limitations. Multivariable hierarchical logistic models identified predictors of OMT in the 12 months after angiography. Cox proportional hazard models with time-varying covariates for OMT and revascularization status examined differences in death and nonfatal myocardial infarction (MI). In these models, patients transitioned among 4 mutually exclusive treatment groups: no OMT and no revascularization, no OMT and revascularization, OMT and no revascularization, OMT and revascularization. Our cohort had 20,663 patients. Over a mean period of 2.5 years, 8.7% had died. Only 61% received OMT within 12 months. The strongest predictor of receiving OMT at 12 months was OMT before the angiogram (odds ratio 14.40, 95% confidence interval [CI] 13.17 to 15.75, p <0.001). Relative to no OMT and nonrevascularized patients, patients on OMT and revascularized had the greatest reduction in mortality (hazard ratio 0.52, 95% CI 0.45 to 0.60, p <0.001) and nonfatal MI (hazard ratio 0.74, 95% CI 0.64 to 0.84, p <0.001). In conclusion, our study highlights the low rate of OMT in stable CHD. Patients who received both OMT and revascularization achieved the greatest reduction in mortality and nonfatal MI. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    PubMed

    Jakubovski, Ewgeni; Bloch, Michael H

    2016-09-01

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

  1. Trajectories of loneliness during childhood and adolescence: predictors and health outcomes.

    PubMed

    Qualter, P; Brown, S L; Rotenberg, K J; Vanhalst, J; Harris, R A; Goossens, L; Bangee, M; Munn, P

    2013-12-01

    The present study employed latent growth mixture modeling to discern distinct trajectories of loneliness using data collected at 2-year intervals from age 7-17 years (N = 586) and examine whether measures taken at age 5 years were good predictors of group membership. Four loneliness trajectory classes were identified: (1) low stable (37% of the sample), (2) moderate decliners (23%), (3) moderate increasers (18%), and (4) relatively high stable (22%). Predictors at age 5 years for the high stable trajectory were low trust beliefs, low trusting, low peer acceptance, parent reported negative reactivity, an internalizing attribution style, low self-worth, and passivity during observed play. The model also included outcome variables. We found that both the high stable and moderate increasing trajectories were associated with depressive symptoms, a higher frequency of visits to the doctor, and lower perceived general health at age 17. We discuss implications of findings for future empirical work. Copyright © 2013 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  2. Predictors of nonresponse in a questionnaire-based outcome study of vocational rehabilitation patients.

    PubMed

    Burrus, Cyrille; Ballabeni, Pierluigi; Deriaz, Olivier; Gobelet, Charles; Luthi, François

    2009-09-01

    To identify predictors of nonresponse to a self-report study of patients with orthopedic trauma hospitalized for vocational rehabilitation between November 15, 2003, and December 31, 2005. The role of biopsychosocial complexity, assessed using the INTERMED, was of particular interest. Cohort study. Questionnaires with quality of life, sociodemographic, and job-related questions were given to patients at hospitalization and 1 year after discharge. Sociodemographic data, biopsychosocial complexity, and presence of comorbidity were available at hospitalization (baseline) for all eligible patients. Logistic regression models were used to test a number of baseline variables as potential predictors of nonresponse to the questionnaires at each of the 2 time points. Rehabilitation clinic. Patients (N=990) hospitalized for vocational rehabilitation over a period of 2 years. Not applicable. Nonresponse to the questionnaires was the binary dependent variable. Patients with high biopsychosocial complexity, foreign native language, or low educational level were less likely to respond at both time points. Younger patients were less likely to respond at 1 year. Those living in a stable partnership were less likely than singles to respond at hospitalization. Sex, psychiatric, and somatic comorbidity and alcoholism were never associated with nonresponse. We stress the importance of assessing biopsychosocial complexity to predict nonresponse. Furthermore, the factors we found to be predictive of nonresponse are also known to influence treatment outcome and vocational rehabilitation. Therefore, it is important to increase the response rate of the groups of concern in order to reduce selection bias in epidemiologic investigations.

  3. Predictors of cessation treatment outcome and treatment moderators among smoking parents receiving quitline counselling or self-help material.

    PubMed

    Schuck, Kathrin; Otten, Roy; Kleinjan, Marloes; Bricker, Jonathan B; Engels, Rutger C M E

    2014-12-01

    Several cessation treatments effectively enhance cessation, but it is not always clear which treatment may be most suitable for a particular client. We examined predictors of treatment outcome and treatment moderators among smoking parents in the Netherlands. We conducted secondary analyses of a randomized controlled trial in which smoking parents received either quitline counselling (n=256) or a self-help brochure (n=256). Data collection was completed in October 2012. Endpoints were 7-day point prevalence abstinence and 6-month prolonged abstinence at 12-month follow-up. Potential predictors and moderators included socio-demographic characteristics, smoking-related variables, and child-related variables. Male gender, higher employment status, lower daily cigarette consumption, higher levels of confidence in quitting, presence of a child with a chronic respiratory illness, and wanting to quit for the health of one's child predicted abstinence at 12months. Significant treatment moderators were intention to quit and educational level. Quitline counselling was effective regardless of intention to quit and educational level, but self-help material was less effective among less motivated and lower educated parents. Certain subgroups of smokers, such as parents who are concerned about the health of their child, are particularly receptive to cessation support. Individual characteristics should be considered in treatment selections. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. 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.

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

    PubMed

    Shneyderman, Yuliya; Schwartz, Seth J

    2013-08-01

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

  6. Health behavior theories as predictors of hearing-aid uptake and outcomes.

    PubMed

    Saunders, Gabrielle H; Frederick, Melissa T; Silverman, ShienPei C; Nielsen, Claus; Laplante-Lévesque, Ariane

    2016-07-01

    To understand hearing behaviors of adults seeking help for the first time through the application of two models of health behavior change: the transtheoretical model and the health belief model. The relationships between attitudes and beliefs were examined relative to hearing-aid uptake and outcomes six months later. One hundred and sixty adults completed the University of Rhode Island change assessment (targeting the transtheoretical model), and the hearing beliefs questionnaire (targeting the health belief model), as well as the hearing handicap inventory and the psychosocial impact of hearing loss scale, within two months of an initial hearing assessment. Six months later, participants completed these same questionnaires, while those who had taken up hearing aids also completed hearing-aid outcome questionnaires. (1) Attitudes and beliefs were associated with future hearing-aid uptake, and were effective at modeling this behavior; (2) attitudes and beliefs changed following behavior change, and (3) attitudes and beliefs following behavior change were better predictors of hearing-aid outcomes than pre-behavior change attitudes and beliefs. A counseling-based intervention targeting the attitudes and beliefs assessed by the transtheoretical model and the health belief model has the potential to increase uptake of hearing health care.

  7. Reading Fluency As a Predictor of School Outcomes across Grades 4–9

    PubMed Central

    Bigozzi, Lucia; Tarchi, Christian; Vagnoli, Linda; Valente, Elena; Pinto, Giuliana

    2017-01-01

    This study analyzed the predictive relationship between reading fluency and school outcomes across school levels (primary, secondary, and high school), after controlling on the effect of reading comprehension. The sample included 489 children attending Italian primary (grades 4 and 5), secondary (grades 6 and 8), and high schools (grade 9). Students' reading fluency and comprehension were examined with a standardized reading achievement test. At the end of the school year, we requested the school reports of each participant. According to our data, reading fluency predicted all school marks in all literacy-based subjects, with reading rapidity being the most important predictor. School level did not moderate the relationship between reading fluency and school outcomes, confirming the importance of effortless and automatized reading even in higher school levels. Overall this study emphasizes the importance of identifying evidence-based tasks that can be administered in a short time and to many different individuals, which are easy to create, and are linked to school outcomes. PMID:28261134

  8. Reading Fluency As a Predictor of School Outcomes across Grades 4-9.

    PubMed

    Bigozzi, Lucia; Tarchi, Christian; Vagnoli, Linda; Valente, Elena; Pinto, Giuliana

    2017-01-01

    This study analyzed the predictive relationship between reading fluency and school outcomes across school levels (primary, secondary, and high school), after controlling on the effect of reading comprehension. The sample included 489 children attending Italian primary (grades 4 and 5), secondary (grades 6 and 8), and high schools (grade 9). Students' reading fluency and comprehension were examined with a standardized reading achievement test. At the end of the school year, we requested the school reports of each participant. According to our data, reading fluency predicted all school marks in all literacy-based subjects, with reading rapidity being the most important predictor. School level did not moderate the relationship between reading fluency and school outcomes, confirming the importance of effortless and automatized reading even in higher school levels. Overall this study emphasizes the importance of identifying evidence-based tasks that can be administered in a short time and to many different individuals, which are easy to create, and are linked to school outcomes.

  9. Etiological associations and outcome predictors of acute electroencephalography in childhood encephalitis.

    PubMed

    Mohammad, Shekeeb S; Soe, Samantha M; Pillai, Sekhar C; Nosadini, Margherita; Barnes, Elizabeth H; Gill, Deepak; Dale, Russell C

    2016-10-01

    To examine EEG features in a retrospective 13-year cohort of children with encephalitis. 354 EEGs from 119 patients during their admission were rated blind using a proforma with demonstrated inter-rater reliability (mean k=0.78). Patients belonged to 12 etiological groups that could be grouped into infectious and infection-associated (n=47), immune-mediated (n=36) and unknown (n=33). EEG features were analyzed between groups and for risk of abnormal Liverpool Outcome Score and drug resistant epilepsy (DRE) at last follow up. 86% children had an abnormal first EEG and 89% had at least one abnormal EEG. 55% had an abnormal outcome, and 13% had DRE after median follow-up of 7.3years (2.0-15.8years). Reactive background on first EEGs (9/11, p=0.04) and extreme spindles (4/11, p<0.001) distinguished patients with anti-N-Methyl-d-Aspartate Receptor encephalitis. Non-reactive EEG background (48% first EEGs) predicted abnormal outcome (OR 3.8, p<0.001). A shifting focal seizure pattern, seen in FIRES (4/5), anti-voltage gated potassium channel (2/3), Mycoplasma (1/10), other viral (1/10) and other unknown (1/28) encephalitis, was most predictive of DRE after multivariable analysis (OR 11.9, p<0.001). Non-reactive EEG background and the presence of shifting focal seizures resembling migrating partial seizures of infancy are predictors of abnormal outcome and DRE respectively in childhood encephalitis. EEG is a sensitive but non-discriminatory marker of childhood encephalitis. We highlight the EEG features that predict abnormal outcome and DRE. Copyright © 2016 International Federation of Clinical Neurophysiology. All rights reserved.

  10. Circulating angiogenic factors and urinary prolactin as predictors of adverse outcomes in women with preeclampsia.

    PubMed

    Leaños-Miranda, Alfredo; Campos-Galicia, Inova; Ramírez-Valenzuela, Karla Leticia; Chinolla-Arellano, Zarela Lizbeth; Isordia-Salas, Irma

    2013-05-01

    Preeclampsia is characterized by an imbalance in angiogenic factors. Urinary prolactin (PRL) levels and its antiangiogenic PRL fragments have been associated with disease severity. In this study, we assessed whether these biomarkers are associated with an increased risk of adverse maternal and perinatal outcomes in preeclamptic women. We studied 501 women with preeclampsia attended at a tertiary care hospital. Serum concentrations of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng), as well as urinary PRL levels, were measured by enzymed-linked immunosorbent assay. Antiangiogenic PRL fragments were determined by immunoblotting. The risk for any adverse maternal outcome and for having a small-for-gestational-age infant was higher among women with sFlt-1/PlGF ratios, sEng, and urinary PRL level values in the highest quartile (odds ratios ≥ 2.7), compared with the lowest quartile. Both urinary PRL levels and the presence of antiangiogenic PRL fragments were more closely associated with the risk of specific adverse maternal outcomes (placental abruption, hepatic hematoma or rupture, acute renal failure, pulmonary edema, maternal death, and need for endotracheal intubation, positive inotropic drug support, and hemodialysis; odds ratios ≥ 5.7 and ≥ 4.7, respectively) than either sFlt-1/PlGF ratio or sEng alone. We concluded that in preeclamptic women at the time of initial evaluation, sFlt-1/PlGF ratio and sEng are associated with increased risk of combined adverse maternal outcomes. However, urinary PRL concentrations and its antiangiogenic fragments appear to be better predictors of an adverse maternal outcome and may be useful for risk stratification in preeclampsia.

  11. Predictors and clinical significance of progression or regression of asymptomatic carotid stenosis.

    PubMed

    Kakkos, Stavros K; Nicolaides, Andrew N; Charalambous, Ioanna; Thomas, Dafydd; Giannopoulos, Argyrios; Naylor, A Ross; Geroulakos, George; Abbott, Anne L

    2014-04-01

    To determine baseline clinical and ultrasonographic plaque factors predictive of progression or regression of asymptomatic carotid stenosis and the predictive value of changes in stenosis severity on risk of first ipsilateral cerebral or retinal ischemic events (including stroke). A total of 1121 patients with asymptomatic carotid stenosis of 50% to 99% in relation to the bulb diameter (European Carotid Surgery Trial [ECST] method) underwent six monthly clinical assessments and carotid duplexes for up to 8 years (mean follow-up, 4 years). Progression or regression was considered present if there was a change of at least one grade higher or lower, respectively, persisting for at least two consecutive examinations. Regression occurred in 43 (3.8%), no change in 856 (76.4%), and progression in 222 (19.8%) patients. Younger age, high grades of stenosis, absence of discrete white areas in the plaque, and taking lipid lowering therapy were independent baseline predictors of increased incidence of regression. High serum creatinine, male gender, not taking lipid lowering therapy, low grades of stenosis, and increased plaque area were independent baseline predictors of progression. One hundred and thirty first ipsilateral cerebral or retinal ischemic events, including 59 strokes, occurred. Forty (67.8%) of the strokes occurred in patients whose stenosis was unchanged, 19 (32.2%) in those with progression, and zero in those with regression. For the entire cohort, the 8-year cumulative ipsilateral cerebral ischemic stroke rate was zero in patients with regression, 9% if the stenosis was unchanged, and 16% if there was progression (average annual stroke rates of 0%, 1.1%, and 2.0%, respectively; log-rank, P = .05; relative risk in patients with progression, 1.92; 95% confidence interval, 1.14-3.25). For patients with baseline stenosis 70% to 99% in relation to the distal internal carotid (North American Symptomatic Carotid Endarterectomy Trial [NASCET] method), in the absence

  12. PREDICTORS OF SUBSTANCE USE AND FAMILY THERAPY OUTCOME AMONG PHYSICALLY AND SEXUALLY ABUSED RUNAWAY ADOLESCENTS

    PubMed Central

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

    2008-01-01

    There is a dearth of research that examines the impact of family systems therapy on problems among sexually and/or physically abused youth. Given this void, differential outcome and predictors of substance use change were evaluated for abused, as, compared with nonabused, runaway adolescents who were randomly assigned to family therapy or treatment as usual Abused adolescents reported lower family cohesion at baseline, although both abused and nonabused adolescents showed similar substance use reductions. Utilizing hierarchical linear modeling, we found that substance use changed with change in cohesion over time. These findings link change in family functioning to change in adolescent substance use, supporting family systems theory. Findings suggest that a potent target of intervention involves focus on increasing positive communication interactions. PMID:16933433

  13. Attachment as a predictor of therapeutic outcome: a case study of a young patient with psychosis.

    PubMed

    Mihoci, Janja; Pesek, Marjeta Blinc

    2010-11-01

    Therapeutic alliance is one of the predictors of a successful therapy. In the current case study of the 26 year old male student diagnosed with paranoid schizophrenia we discuss the possible consequences of a short break in the therapeutic process on the treatment outcome. The client was appointed to an assistant psychologist for study support sessions and to work on his social skills and anxieties. The therapy continued regularly for a month and a half with some visible results in motivation, engagement and mood. After a break in the sessions due to the psychologist's absence, the client did not attend the sessions regularly. He became more withdrawn, his compliance with medical treatment was diminished and he did not meet his study goals.

  14. Self-engagement as a predictor of performance and emotional reactions to performance outcomes.

    PubMed

    Britt, Thomas W; McKibben, Eric S; Greene-Shortridge, Tiffany M; Beeco, Adam; Bodine, Ashley; Calcaterra, Jennifer; Evers, Terri; McNab, Jessica; West, Amanda

    2010-06-01

    Three studies examined the relationship between engagement in different types of tasks, performance on those tasks, and reactions to performance outcomes. The three studies included voting in the 2004 presidential election, test performance in an undergraduate course, and completion of personal projects during the course of the semester. Engagement in voting predicted voting in the presidential election and magnified positive feelings of voting for the winning candidate. Test engagement predicted performance on the test, and magnified positive feelings of not showing a discrepancy between expected and actual test performance. Engagement in personal projects interacted with task complexity to predict project completion, with engagement being related to goal completion for tasks high in complexity. Project engagement also magnified the positive effects of a high probability of completing the project. The results provide support for task engagement as a predictor of performance and as a facilitator of positive feelings following success.

  15. Burnout and Engagement: Relative Importance of Predictors and Outcomes in Two Health Care Worker Samples.

    PubMed

    Fragoso, Zachary L; Holcombe, Kyla J; McCluney, Courtney L; Fisher, Gwenith G; McGonagle, Alyssa K; Friebe, Susan J

    2016-06-09

    This study's purpose was twofold: first, to examine the relative importance of job demands and resources as predictors of burnout and engagement, and second, the relative importance of engagement and burnout related to health, depressive symptoms, work ability, organizational commitment, and turnover intentions in two samples of health care workers. Nurse leaders (n = 162) and licensed emergency medical technicians (EMTs; n = 102) completed surveys. In both samples, job demands predicted burnout more strongly than job resources, and job resources predicted engagement more strongly than job demands. Engagement held more weight than burnout for predicting commitment, and burnout held more weight for predicting health outcomes, depressive symptoms, and work ability. Results have implications for the design, evaluation, and effectiveness of workplace interventions to reduce burnout and improve engagement among health care workers. Actionable recommendations for increasing engagement and decreasing burnout in health care organizations are provided.

  16. Predictors of 6-month health utility outcomes in survivors of acute respiratory distress syndrome.

    PubMed

    Brown, Samuel M; Wilson, Emily; Presson, Angela P; Zhang, Chong; Dinglas, Victor D; Greene, Tom; Hopkins, Ramona O; Needham, Dale M

    2017-04-01

    With improving short-term mortality in acute respiratory distress syndrome (ARDS), understanding and improving quality of life (QOL) outcomes in ARDS survivors is a clinical and research priority. We sought to identify variables associated with QOL, as measured by the EQ-5D health utility score, after ARDS using contemporary data science methods. Analysis of prospectively acquired baseline variables and 6-month EQ-5D health utility scores for adults with ARDS enrolled in the ARDS Network Long-Term Outcomes Study (ALTOS). Penalised regression identified predictors of health utility, with results validated using 10-fold cross-validation. Among 616 ARDS survivors, several predictors were associated with 6-month EQ-5D utility scores, including two lifestyle factors. Specifically, older age, female sex, Hispanic/Latino ethnicity, current smoking and higher body mass index were associated with lower EQ-5D utilities, while living at home without assistance at baseline and AIDS were associated with higher EQ-5D utilities in ARDS survivors. No acute illness variables were associated with EQ-5D utility. Acute illness variables do not appear to be associated with postdischarge QOL among ARDS survivors. Functional independence and lifestyle factors, such as obesity and tobacco smoking, were associated with worse QOL. Future analyses of postdischarge health utility among ARDS survivors should incorporate measures of demographics and functional independence at baseline. NCT00719446 (ALTOS), NCT00434993 (ALTA), NCT00609180 (EDEN/OMEGA), and NCT00883948 (EDEN); Post-results. 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/.

  17. Clinical Spectrum, Therapeutic Outcomes, and Prognostic Predictors in Sjogren's Syndrome-associated Neuropathy.

    PubMed

    Sivadasan, Ajith; Muthusamy, Karthik; Patel, Bimal; Benjamin, Rohit Ninan; Prabhakar, A T; Mathew, Vivek; Aaron, Sanjith; Alexander, Mathew

    2017-01-01

    There are limited data regarding long-term follow-up and therapeutic outcomes in Sjogren's syndrome (SS)-associated peripheral neuropathy. In this study, we aim to study the clinical, electrophysiological spectrum and therapeutic responses among the different subtypes of SS-associated neuropathy. The predictors of suboptimal treatment response will be identified. The study included a retrospective cohort of patients with SS-associated neuropathy between January 2012 and November 2015. Baseline clinical, laboratory, electrophysiological data and details of treatment were noted. Therapeutic outcomes were assessed at follow-up and compared among the different subtypes. Prognostic predictors were determined using logistic regression analysis. Fifty-four patients were included in the study. Sensory ataxic neuropathy (17, including 9 with sensory ganglionopathy) and radiculoneuropathy (11) were the main subtypes. Notable atypical presentations included acute neuropathies, pure motor neuropathies, and hypertrophic neuropathy. Concomitant autoimmune disorders were present in 24 (44.4%) patients. Most presentations were subacute-chronic (51, 94.4%). Minor salivary gland biopsy had a higher yield compared to serological markers (81.5 vs. 44.4%). Sensory ataxic neuropathy was associated with greater severity and autonomic dysfunction. Improvement was noted in 33 (61%) patients. Cranial neuropathy and radiculoneuropathy subtypes were associated with the best treatment responses. Chronicity, orthostatic hypotension, baseline severity, and marked axonopathy (nerve biopsy) were predictive of a suboptimal therapeutic response. The study highlights the heterogeneous spectrum, atypical presentations, and differential therapeutic responses. SS-associated neuropathy remains underdiagnosed. Early diagnosis and prompt initiation of immunotherapy before worsening axonal degeneration is paramount. SS-associated neuropathy need not necessarily be associated with a poor prognosis.

  18. Heterogeneity in long-term trajectories of depressive symptoms: Patterns, predictors and outcomes

    PubMed Central

    Musliner, Katherine L.; Munk-Olsen, Trine; Eaton, William W.; Zandi, Peter P.

    2016-01-01

    Background Evidence suggests that long-term trajectories of depressive symptoms vary greatly throughout the population, with some individuals experiencing few or no symptoms, some experiencing transient symptoms and others experiencing chronic depression. The goal of this paper was to review studies that examined heterogeneity in long-term trajectories of depressive symptoms and summarize the current knowledge regarding a) the number and patterns of trajectories and b) antecedents and outcomes associated with different trajectory patterns. Methods We conducted a systematic review of literature in the Medline and PsychINFO databases. Articles were included if they a) modeled trajectories of depressive symptoms, b) used a group-based trajectory modeling approach, c) followed participants for 5+ years and d) had a sample size of at least 200. Results We identified 25 studies from 24 separate cohorts. Most of the studies identified either 3 or 4 distinct trajectory classes. Trajectories varied in terms of severity (low, medium, high) and stability (stable, increasing, decreasing). In most studies, the majority of participants had consistently few or no depressive symptoms, but a notable minority (usually < 10%) reported persistent symptoms. Predictors of trajectories with greater symptom burden included female gender, lower income/education and non-white race. Other predictors were specific to different populations (i.e. mothers, older adults). High symptom burden trajectories were associated with poor psychiatric and psychosocial outcomes. Limitations Comparisons between studies were qualitative. Conclusions Trajectories of depression symptoms in the general population are heterogeneous, with most individuals showing minimal symptoms but a notable minority experiencing chronic high symptom burden. PMID:26745437

  19. Radiofrequency ablation of atrial tachyarrhythmias in adults with tetralogy of Fallot - predictors of success and outcome.

    PubMed

    Ezzat, Vivienne A; Ryan, Matthew J; O'Leary, Justin; Ariti, Cono; Deanfield, John; Pandya, Bejal; Cullen, Shay; Walker, Fiona; Khan, Fakhar; Abrams, Dominic J; Lambiase, Pier D; Lowe, Martin D

    2017-03-01

    Adults with tetralogy of Fallot experience atrial tachyarrhythmias; however, there are a few data on the outcomes of radiofrequency ablation. We examined the characteristics, outcome, and predictors of recurrence of atrial tachyarrhythmias after radiofrequency ablation in tetralogy of Fallot patients. Methods/results Retrospective data were collected from 2004 to 2013. In total, 56 ablations were performed on 37 patients. We identified two matched controls per case: patients with tetralogy of Fallot but no radiofrequency ablation and not known to have atrial tachyarrhythmias. Acute success was 98%. Left atrial arrhythmias increased in frequency over time. The mean follow-up was 41 months; 78% were arrhythmia-free. Number of cardiac surgeries, age, and presence of atrial fibrillation were predictors of recurrence. Lone cavo-tricuspid isthmus-dependent flutter reduced the likelihood of atrial fibrillation. Right and left atria in patients with tetralogy of Fallot were larger in ablated cases than controls. NYHA class was worse in cases and improved after ablation; baseline status predicted death. Of matched non-ablated controls, a number of them had atrial fibrillation. These patients were excluded from the case-control study but analysed separately. Most of them had died during follow-up, whereas of the matched ablated cases all were alive and the majority in sinus rhythm. Patients with tetralogy of Fallot and atrial tachyarrhythmias have more dilated atria than those without atrial tachyarrhythmias. Radiofrequency ablation improves functional status. Left atrial ablation is more commonly required with repeat procedures. There is a high prevalence of atrial tachyarrhythmias, particularly atrial fibrillation, in patients with tetralogy of Fallot; early radiofrequency ablation may have a protective effect against this.

  20. Atazanavir concentration in hair is the strongest predictor of outcomes on antiretroviral therapy.

    PubMed

    Gandhi, Monica; Ameli, Niloufar; Bacchetti, Peter; Anastos, Kathryn; Gange, Stephen J; Minkoff, Howard; Young, Mary; Milam, Joel; Cohen, Mardge H; Sharp, Gerald B; Huang, Yong; Greenblatt, Ruth M

    2011-05-01

    Adequate exposure to antiretrovirals is important to maintain durable responses, but methods to assess exposure (eg, querying adherence and single plasma drug level measurements) are limited. Hair concentrations of antiretrovirals can integrate adherence and pharmacokinetics into a single assay. Small hair samples were collected from participants in the Women's Interagency HIV Study (WIHS), a large cohort of human immunodeficiency virus (HIV)-infected (and at-risk noninfected) women. From 2003 through 2008, we analyzed atazanavir hair concentrations longitudinally for women reporting receipt of atazanavir-based therapy. Multivariate random effects logistic regression models for repeated measures were used to estimate the association of hair drug levels with the primary outcome of virologic suppression (HIV RNA level, <80 copies/mL). 424 WIHS participants (51% African-American, 31% Hispanic) contributed 1443 person-visits to the analysis. After adjusting for age, race, treatment experience, pretreatment viral load, CD4 count and AIDS status, and self-reported adherence, hair levels were the strongest predictor of suppression. Categorized hair antiretroviral levels revealed a monotonic relationship to suppression; women with atazanavir levels in the highest quintile had odds ratios (ORs) of 59.8 (95% confidence ratio, 29.0-123.2) for virologic suppression. Hair atazanavir concentrations were even more strongly associated with resuppression of viral loads in subgroups in which there had been previous lapses in adherence (OR, 210.2 [95% CI, 46.0-961.1]), low hair levels (OR, 132.8 [95% CI, 26.5-666.0]), or detectable viremia (OR, 400.7 [95% CI, 52.3-3069.7]). Antiretroviral hair levels surpassed any other predictor of virologic outcomes to HIV treatment in a large cohort. Low antiretroviral exposure in hair may trigger interventions prior to failure or herald virologic failure in settings where measurement of viral loads is unavailable. Monitoring hair antiretroviral

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

    PubMed Central

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

    2016-01-01

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

  2. Metrics of salbutamol use as predictors of future adverse outcomes in asthma.

    PubMed

    Patel, M; Pilcher, J; Reddel, H K; Pritchard, A; Corin, A; Helm, C; Tofield, C; Shaw, D; Black, P; Weatherall, M; Beasley, R

    2013-10-01

    Beta-agonist overuse is associated with adverse outcomes in asthma, however, the relationships between different metrics of salbutamol use and future risk are uncertain. To investigate the relationship between metrics of salbutamol use and adverse outcome. In a 24-week randomized controlled trial of 303 asthma patients at risk of severe exacerbations which compared the efficacy and safety of combination budesonide/formoter