Leadership = Communication? The Relations of Leaders' Communication Styles with Leadership Styles, Knowledge Sharing and Leadership Outcomes.

PubMed

de Vries, Reinout E; Bakker-Pieper, Angelique; Oostenveld, Wyneke

2010-09-01

PURPOSE: The purpose of this study was to investigate the relations between leaders' communication styles and charismatic leadership, human-oriented leadership (leader's consideration), task-oriented leadership (leader's initiating structure), and leadership outcomes. METHODOLOGY: A survey was conducted among 279 employees of a governmental organization. The following six main communication styles were operationalized: verbal aggressiveness, expressiveness, preciseness, assuredness, supportiveness, and argumentativeness. Regression analyses were employed to test three main hypotheses. FINDINGS: In line with expectations, the study showed that charismatic and human-oriented leadership are mainly communicative, while task-oriented leadership is significantly less communicative. The communication styles were strongly and differentially related to knowledge sharing behaviors, perceived leader performance, satisfaction with the leader, and subordinate's team commitment. Multiple regression analyses showed that the leadership styles mediated the relations between the communication styles and leadership outcomes. However, leader's preciseness explained variance in perceived leader performance and satisfaction with the leader above and beyond the leadership style variables. IMPLICATIONS: This study offers potentially invaluable input for leadership training programs by showing the importance of leader's supportiveness, assuredness, and preciseness when communicating with subordinates. ORIGINALITY/VALUE: Although one of the core elements of leadership is interpersonal communication, this study is one of the first to use a comprehensive communication styles instrument in the study of leadership.

The Interaction Effects of Program Training, Dosage, and Implementation Quality on Targeted Student Outcomes for The RULER Approach to Social and Emotional Learning

ERIC Educational Resources Information Center

Reyes, Maria Regina; Brackett, Marc A.; Rivers, Susan E.; Elbertson, Nicole A.; Salovey, Peter

2012-01-01

This study examined how training, dosage, and implementation quality of a social and emotional learning program, The RULER Approach, were related to students' social and emotional competencies. There were no main effects for any of the variables on student outcomes, but students had more positive outcomes when their teachers (a) attended more…

Determinants of Child Outcomes in a Cohort of Children in the Free Pre-School Year in Ireland, 2012/2013

ERIC Educational Resources Information Center

McKeown, Kieran; Haase, Trutz; Pratschke, Jonathan

2015-01-01

The study analyses determinants of child outcomes in a cohort of children who participated in the Free Pre-School Year. Child outcomes are measured through a before-and-after assessment of children using the Early Development Instrument. The sample comprises 448 children in 70 early years centres. There are three main findings. First, children…

Sex differences in left main coronary artery stenting: Different characteristics but similar outcomes for women compared with men.

PubMed

Shin, Eun-Seok; Lee, Cheol Whan; Ahn, Jung-Min; Lee, Pil Hyung; Chang, Mineok; Kim, Min-Ju; Yoon, Sung-Han; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Park, Seong-Wook; Park, Seung-Jung

2018-02-15

The clinical outcomes for women compared with men undergoing left main PCI were sparse. We compared the characteristics and long-term outcomes in women versus men after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main CAD. We identified 2328 patients (545 women; 1783 men) with unprotected left main CAD who received PCI with DES between January 2007 and December 2013 in the Interventional Cardiology Research In-cooperation Society-left MAIN revascularization (IRIS-MAIN) registry. The primary outcome was a composite of death from any cause, myocardial infarction, or stroke. The median follow-up time was 2.9years (interquartile range: 1.0-4.1years). Women were older, had a higher incidence of insulin-requiring diabetes mellitus and hypertension, and more commonly presented with acute coronary syndrome than men. Left main ostial lesion was more common in women, whereas left main bifurcation lesion with more extensive CAD was more common in men. The incidence of primary outcome was similar between the two groups (10.8% vs. 10.8%, respectively, log-rank p=0.587). The results were similar after adjustment for baseline variables and consistent across major subgroups. The need for target lesion revascularization was significantly higher in women than in men (8.8% vs. 5.7%, respectively, p<0.05) but the sex bias was not confirmed after adjusting for confounders. Women, as compared to men, had different clinical and lesion characteristics but similar long-term outcomes after PCI with DES for left main CAD. Copyright © 2017 Elsevier B.V. All rights reserved.

[Patient-reported and patient-weighted outcomes in ophthalmology].

PubMed

Scheibler, F; Finger, R P; Grosselfinger, R; Dintsios, C-M

2010-03-01

Considering patients' values and preferences in comparative effectiveness research (CER) is one of the main challenges in ophthalmology (value-based medicine). This article defines core terms in CER. The concept of patient-relevant (or patient-important) outcomes is distinguished from patient-reported outcomes (PRO) by means of examples in the field of ophthalmology. In order to be able to give a consistant recommendation if an intervention leads to conflicting results for different outcomes (trade-off), a ranking of outcomes will be necessary. Examples of studies in glaucoma patients are provided that demonstrate the possibilities of ranking of outcomes based on patient preferences.

Generalizability of EXCEL and NOBLE results to a large registry population with unprotected left main coronary artery disease.

PubMed

Lee, Pil Hyung; Kang, Se Hun; Han, Seungbong; Ahn, Jung-Min; Bae, Jae Seok; Lee, Cheol Hyun; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Lee, Cheol Whan; Park, Seong-Wook; Park, Duk-Woo; Park, Seung-Jung

2017-12-01

The aim of this study was to determine how trial-based findings of EXCEL and NOBLE might be interpreted and generalizable in 'real-world' settings with comparison of data from the large-scaled, all-comer Interventional Research Incorporation Society-Left MAIN Revascularization (IRIS-MAIN) registry. We compared baseline clinical and procedural characteristics and also determined how the relative treatment effect of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) was different in EXCEL and NOBLE, compared with those of the multicenter, IRIS-MAIN registry (n=2481). The primary outcome for between-study comparison was a composite of death, myocardial infarction (MI), or stroke. There were between-study differences in patient risk profiles (age, BMI, diabetes, and clinical presentation), lesion complexities, and procedural characteristics (stent type, the use of off-pump surgery, and radial artery); the proportion of diabetes and acute coronary syndrome was particularly lower in NOBLE than in other studies. Although there was interstudy heterogeneity for the protocol definition of MI, the risks for serious composite outcome of death, MI, or stroke were similar between PCI and CABG in EXCEL [hazard ratio (HR): 1.00; 95% confidence interval (CI): 0.79-1.26; P=0.98] and in the matched cohort of IRIS-MAIN (HR: 1.08; 95%CI: 0.85-1.38; P=0.53), whereas it was significantly higher after PCI than after CABG in NOBLE (HR: 1.47; 95%CI: 1.06-2.05; P=0.02), which was driven by more common MI and stroke after PCI. In the comparison of a large-sized, all-comer registry, the EXCEL trial might represent better generalizability with respect to baseline characteristics and observed clinical outcomes compared with the NOBLE trial.

Role of serum immunoglobulins for predicting sarcoidosis outcome: A cohort study.

PubMed

Belhomme, Nicolas; Jouneau, Stéphane; Bouzillé, Guillaume; Decaux, Olivier; Lederlin, Mathieu; Guillot, Stéphanie; Perlat, Antoinette; Jégo, Patrick

2018-01-01

Sarcoidosis is a systemic granulomatous disease which carries variable outcomes. Serum protein electrophoresis is an easily accessible and routinely performed examination at diagnosis, in order to search for hypergammaglobulinemia, which is frequently found, and to rule out other granulomatous diseases such as common variable immunodeficiency. We aimed to assess the impact of baseline immunoglobulin level on the outcome of sarcoidosis. We conducted a retrospective cohort-study, at Rennes University Hospital, in which all newly diagnosed patients for whom a serum protein electrophoresis had been performed at baseline were enrolled, from 2006 to 2014. The main outcome was the need for corticosteroid treatment within 2 years from diagnosis, the secondary outcome was the occurrence of relapse among treated patients. Eighty patients were included in the study, and 41.25% of them exhibited an elevated globulins rate. In univariate analysis, an elevated ACE level >70 U/l, Afro-Caribbean origin, and extra-pulmonary involvement, were associated with the need for corticosteroid treatment. In multivariate analysis, only ACE elevation (OR = 1.03, IC95% 1.01-1.05, p = 0.009) and extra-pulmonary involvement (OR = 5.8, IC95% 1.4-24, p = 0.015) were significant. Immunoglobulin level was not associated with the main outcome. Regarding the secondary outcome, none of the studied features were predictive of relapse among the 34 treated patients followed for two years. There was no relation between the immunoglobulin level at diagnosis and the evolution of sarcoidosis. An elevated ACE level and the presence of initial extra-pulmonary involvement were both associated with a more severe course of the disease necessitating a corticosteroid treatment.

Intensivist-reported Facilitators and Barriers to Discussing Post-Discharge Outcomes with Intensive Care Unit Surrogates. A Qualitative Study

PubMed Central

Davis, Wesley E.; Needham, Dale M.; White, Douglas B.; Eakin, Michelle N.

2016-01-01

Rationale: Intensive care unit (ICU) patients’ expected post-discharge outcomes are rarely discussed in family meetings despite this information being centrally important to patients and their families. Objectives: To characterize intensivist-identified barriers and facilitators to discussing post-discharge outcomes with surrogates of ICU patients. Methods: Qualitative study conducted via one-on-one, semistructured telephone interviews with 23 intensivists from 20 hospitals with accreditation council for graduate medical education–accredited critical care medicine programs in 16 states. A limited application of grounded theory methods was used to code transcribed interviews and identify themes and illustrative quotes. Measurements and Main Results: Intensivists reported tension between their professional responsibility to discuss likely functional outcomes versus uncertainty about their ability to predict those outcomes for an individual patient. They cited three main barriers as limiting their ability to conduct conversations about post-discharge outcomes with ICU surrogates: (1) incorrectly optimistic expectations for recovery among ICU surrogates, (2) having little or no contact with their patients after ICU discharge, and (3) minimal confidence applying existing outcomes research to individual patients. Despite these barriers, experience talking to ICU surrogates, seeing ICU survivors in the outpatient setting, and trusted research on functional outcomes were identified as important facilitators to discussing likely patient outcomes with surrogates. Intensivists generally welcomed questions from surrogates about post-discharge outcomes as opportunities to initiate conversations about prognosis and patient values. Conclusions: In this sample of intensivists from 20 academic hospitals, experience conducting conversations with surrogates and interactions with ICU survivors as outpatients were identified as facilitating discussion of expected post-discharge outcomes while optimistic surrogate expectations and prognostic uncertainty were barriers. There was tension between self-perceived ability to prognosticate and belief in a professional obligation to discuss patient outcomes. PMID:27294981

Risk Factors for Postoperative Respiratory Mortality and Morbidity in Patients Undergoing Coronary Artery Bypass Grafting

PubMed Central

Rajaei, Samira; Dabbagh, Ali

2012-01-01

ABSTRACT Nowadays, coronary artery bypass grafting (CABG) is considered to be one of the most common surgical procedures. This procedure has been the main topic in many clinical research studies, which have assessed the effect of the procedure on patients’ outcomes. Like other surgical procedures, this procedure is also accompanied by a number of unwanted complications, including those of the respiratory system. Since the respiratory system plays an integral role in defining the clinical outcome of patients, improvements in studies that can assess and predict clinical outcomes of the respiratory system, assume greater importance. There are a number of predictive models which can assess patients in the preoperative period and introduce a number of risk factors, which could be considered as prognostic factors for patients undergoing CABG. The respiratory system is among the clinical systems that are assessed in many prediction scoring systems. This review assesses the main studies which have evaluated the possible risk factors for postoperative respiratory mortality and morbidity, in patients undergoing CABG. PMID:24223339

Are we measuring what matters in health technology assessment of disease management? Systematic literature review.

PubMed

Steuten, Lotte; Vrijhoef, Bert; Severens, Hans; van Merode, Frits; Spreeuwenberg, Cor

2006-01-01

An overview was produced of indicators currently used to assess disease management programs and, based on these findings, provide a framework regarding sets of indicators that should be used when taking the aims and types of disease management programs into account. A systematic literature review was performed. Thirty-six studies met the inclusion criteria. It appeared that a link between aims of disease management and evaluated structure, process, as well as outcome indicators does not exist in a substantial part of published studies on disease management of diabetes and asthma/chronic obstructive pulmonary disease, especially when efficiency of care is concerned. Furthermore, structure indicators are largely missing from the evaluations, although these are of major importance for the interpretation of outcomes for purposes of decision-making. Efficiency of disease management is mainly evaluated by means of process indicators; the use of outcome indicators is less common. Within a framework, structure, process, and outcome indicators for effectiveness and efficiency are recommended for each type of disease management program. The link between aims of disease management and evaluated structure, process, and outcome indicators does not exist in a substantial part of published studies on disease management. The added value of this study mainly lies in the development of a framework to guide the choice of indicators for health technology assessment of disease management.

Evaluating the Effects of Basic Skills Mathematics Placement on Academic Outcomes of Community College Students

ERIC Educational Resources Information Center

Melguizo, Tatiana; Bo, Hans; Prather, George; Kim, Bo

2011-01-01

The main objective of the authors' proposed study is to evaluate the effectiveness of math placement policies for entering community college students on these students' academic success in math, and their transfer and graduation rates. The main research question that guides the proposed study is: What are the effects of various basic skills…

Funding source and primary outcome changes in clinical trials registered on ClinicalTrials.gov are associated with the reporting of a statistically significant primary outcome: a cross-sectional study.

PubMed

Ramagopalan, Sreeram V; Skingsley, Andrew P; Handunnetthi, Lahiru; Magnus, Daniel; Klingel, Michelle; Pakpoor, Julia; Goldacre, Ben

2015-01-01

We and others have shown a significant proportion of interventional trials registered on ClinicalTrials.gov have their primary outcomes altered after the listed study start and completion dates. The objectives of this study were to investigate whether changes made to primary outcomes are associated with the likelihood of reporting a statistically significant primary outcome on ClinicalTrials.gov. A cross-sectional analysis of all interventional clinical trials registered on ClinicalTrials.gov as of 20 November 2014 was performed. The main outcome was any change made to the initially listed primary outcome and the time of the change in relation to the trial start and end date. 13,238 completed interventional trials were registered with ClinicalTrials.gov that also had study results posted on the website. 2555 (19.3%) had one or more statistically significant primary outcomes. Statistical analysis showed that registration year, funding source and primary outcome change after trial completion were associated with reporting a statistically significant primary outcome .  Funding source and primary outcome change after trial completion are associated with a statistically significant primary outcome report on clinicaltrials.gov.

Traces of Teaching Methods in a Language Class and the Relationship between Teachers' Intended Learning Outcomes and Students' Uptake

ERIC Educational Resources Information Center

Mahmoudabadi, Zahra

2017-01-01

This study has two main objectives: first, to find traces of teaching methods in a language class and second, to study the relationship between intended learning outcomes and uptake, which is defined as what students claim to have learned. In order to identify the teaching method, after five sessions of observation, class activities and procedures…

Academic and Mental Health Outcomes of Youth Placed in Out-of-Home Care: The Role of School Stability and Engagement

ERIC Educational Resources Information Center

Leonard, Skyler S.; Gudiño, Omar G.

2016-01-01

Background: Youth placed in out-of-home care are at significant risk of low academic achievement and poor mental health. Few studies have considered the potential effects of school-related factors, such as school placement stability and school engagement, on youth outcomes. Objective: The current study examined the potential main effects of school…

The Effect of Reciprocal-Teaching Strategy on Learning Outcomes and Attitudes of Qassim-University Students in "Islamic Culture"

ERIC Educational Resources Information Center

Al-Harby, Jubeir Suleiman Samir

2016-01-01

The main intent of the current study was to investigate the effectiveness of the reciprocal-teaching strategy in learning outcomes and attitudes of Qassim-University students in Islamic culture. The study was conducted in Oqlat Al-Soqour Faculty of Sciences and Arts for paucity of research conducted in such a faculty, as well as for being the…

Leadership = Communication? The Relations of Leaders’ Communication Styles with Leadership Styles, Knowledge Sharing and Leadership Outcomes

PubMed Central

Bakker-Pieper, Angelique; Oostenveld, Wyneke

2009-01-01

Purpose The purpose of this study was to investigate the relations between leaders’ communication styles and charismatic leadership, human-oriented leadership (leader’s consideration), task-oriented leadership (leader’s initiating structure), and leadership outcomes. Methodology A survey was conducted among 279 employees of a governmental organization. The following six main communication styles were operationalized: verbal aggressiveness, expressiveness, preciseness, assuredness, supportiveness, and argumentativeness. Regression analyses were employed to test three main hypotheses. Findings In line with expectations, the study showed that charismatic and human-oriented leadership are mainly communicative, while task-oriented leadership is significantly less communicative. The communication styles were strongly and differentially related to knowledge sharing behaviors, perceived leader performance, satisfaction with the leader, and subordinate’s team commitment. Multiple regression analyses showed that the leadership styles mediated the relations between the communication styles and leadership outcomes. However, leader’s preciseness explained variance in perceived leader performance and satisfaction with the leader above and beyond the leadership style variables. Implications This study offers potentially invaluable input for leadership training programs by showing the importance of leader’s supportiveness, assuredness, and preciseness when communicating with subordinates. Originality/value Although one of the core elements of leadership is interpersonal communication, this study is one of the first to use a comprehensive communication styles instrument in the study of leadership. PMID:20700375

The Wider Benefits of Higher Education. Report.

ERIC Educational Resources Information Center

London Univ. (England). Inst. of Education.

This research used data from the British National Child Development Study to assess the effects of higher education on a number of noneconomic adult outcomes in the United Kingdom, with controls in place to take into account earlier family circumstances and earlier educational attainment. Outcomes were mainly assessed at age 33, and control…

Ramadan, Fasting and Educational Outcomes

ERIC Educational Resources Information Center

Oosterbeek, Hessel; van der Klaauw, Bas

2013-01-01

Using a difference-in-differences framework, we estimate the impact of Ramadan on educational outcomes of Muslim students living in a non-Muslim country. For identification we exploit that the number of Ramadan weeks during the course that we study, varies from year to year, ranging from zero to four. Our main finding is that Ramadan observance…

Differentiated Effects of Community Schooling on Cognitive and Social-Emotional Learning Outcomes

ERIC Educational Resources Information Center

Heers, Marieke; Ghysels, Joris; Groot, Wim; van den Brink, Henriëtte Maassen

2015-01-01

Community schools are becoming increasingly popular. They aim to enhance children's educational performance by offering extended educational and social services. As community schools mainly focus on disadvantaged children, this study evaluates the effects of community schooling on the educational outcomes of these pupils. We focus on care pupils…

[Six-months outcomes after admission in acute geriatric care unit secondary to a fall].

PubMed

Dickes-Sotty, Hélène; Chevalet, Pascal; Fix, Marie-Hélène; Riaudel, Typhaine; Serre-Sahel, Caroline; Ould-Aoudia, Vincent; Berrut, Gilles; De Decker, Laure

2012-12-01

Fall in elderly subject is a main event by its medical and social consequences, but few studies were dedicated to the prognosis from hospitalization in geriatric acute care unit. Describe the outcome of elderly subjects hospitalized after a fall in geriatric acute care unit. Longitudinal study of 6 months follow-up, 100 patients of 75 and more years old hospitalized after a fall in acute care geriatric unit. On a total of 128 patients hospitalized for fall, 100 agreed to participate in the study, 3 died during the hospitalization, so 97 subjects were able to be followed. During 6 months after the hospitalization, 14 patients died (14.9%), 51 (58%) have fallen again (58%) and 11 (22%) of them suffer from severe injuries. Thirty seven (39.7%) were rehospitalized and 10 of them related to fall. Among the patients coming from their home, 25 had been institutionalized. The main risk factor which have been identified to be associated with a new fall during the follow-up was a known dementia at the entry. The medical and social prognosis of an elderly subject hospitalized in an acute care unit is severe. The main comorbidity which influences the medical and social outcome is a known dementia, in addition to a history of previous fall.

Conceptual framework for outcomes research studies of hepatitis C: an analytical review

PubMed Central

Sbarigia, Urbano; Denee, Tom R; Turner, Norris G; Wan, George J; Morrison, Alan; Kaufman, Anna S; Rice, Gary; Dusheiko, Geoffrey M

2016-01-01

Hepatitis C virus infection is one of the main causes of chronic liver disease worldwide. Until recently, the standard antiviral regimen for hepatitis C was a combination of an interferon derivative and ribavirin, but a plethora of new antiviral drugs is becoming available. While these new drugs have shown great efficacy in clinical trials, observational studies are needed to determine their effectiveness in clinical practice. Previous observational studies have shown that multiple factors, besides the drug regimen, affect patient outcomes in clinical practice. Here, we provide an analytical review of published outcomes studies of the management of hepatitis C virus infection. A conceptual framework defines the relationships between four categories of variables: health care system structure, patient characteristics, process-of-care, and patient outcomes. This framework can provide a starting point for outcomes studies addressing the use and effectiveness of new antiviral drug treatments. PMID:27313473

Assessment of the Incorporation of Patient-Centric Outcomes in Studies of Minimally Invasive Glaucoma Surgical Devices

PubMed Central

Le, Jimmy T.; Viswanathan, Shilpa; Tarver, Michelle E.; Eydelman, Malvina; Li, Tianjing

2017-01-01

IMPORTANCE Minimally invasive glaucoma surgical (MIGS) devices are one option for lowering intraocular pressure in patients with glaucoma. OBJECTIVE To examine how often existing clinical studies of MIGS devices registered on ClinicalTrials.gov measure patient-centric outcomes that patients value directly. DESIGN, SETTING, AND PARTICIPANTS We searched ClinicalTrials.gov, a registry of publicly and privately supported clinical studies, on February 20, 2015, for records of MIGS device studies involving patients with glaucoma. Two investigators independently abstracted study design and outcome details from eligible records. We classified outcomes as patient-centric or not patient-centric using a prespecified definition. MAIN OUTCOMES AND MEASURES Proportion of patient-centric and nonpatient-centric outcomes registered on ClinicalTrials.gov. RESULTS We identified 51 eligible studies specifying 127 outcomes. Reduction in intraocular pressure was the most frequent outcome specified (78/127; 61%) and a primary outcome in 41 studies. Patient-centric outcomes—such as adverse events (n = 19; 15%), topical medication use (n = 16; 13%), visual acuity (n = 4; 3%), and health-related quality of life (n = 1; 1%)—were less frequently specified (n = 40; 32%) and a primary outcome in only 12 studies. CONCLUSION AND RELEVANCE Patient-centric outcomes that provide insight into the relative desirability and acceptability of the benefits and risks of MIGS devices are not well represented in current clinical studies. PMID:27389667

Studying Visual Displays: How to Instructionally Support Learning

ERIC Educational Resources Information Center

Renkl, Alexander; Scheiter, Katharina

2017-01-01

Visual displays are very frequently used in learning materials. Although visual displays have great potential to foster learning, they also pose substantial demands on learners so that the actual learning outcomes are often disappointing. In this article, we pursue three main goals. First, we identify the main difficulties that learners have when…

Goal-setting in diabetes self-management: A systematic review and meta-analysis examining content and effectiveness of goal-setting interventions.

PubMed

Fredrix, Milou; McSharry, Jenny; Flannery, Caragh; Dinneen, Sean; Byrne, Molly

2018-03-02

Goal-setting is recommended and widely used within diabetes self-management programmes. However, empirical evidence around its effectiveness lacks clarity. This review aims to evaluate the effectiveness of goal-setting interventions on diabetes outcomes and to determine which behaviour change techniques (BCTs) are frequently used within these interventions. A systematic search identified 14 studies, describing 12 interventions targeting diabetic-control which incorporated goal-setting as the main intervention strategy. Study characteristics, outcome measures and effect sizes of the included studies were extracted and checked by two authors. The BCT taxonomy v1 was used to identify intervention content. Meta-analyses were conducted to assess intervention effects on the primary outcome of average blood glucose levels (HbA1c) and on body-weight. Psycho-social and behavioural outcomes were summarised in narrative syntheses. Significant post-intervention improvements in HbA1C were found (-.22, 95% CI, -.40, -.04) across studies. No other main effects were identified. The BCT 'goal-setting (behaviour)' was most frequently implemented and was identified in 84% of the interventions. Goal-setting interventions appear to be associated with reduced HbA1C levels. However, the low numbers of studies identified and the risk biases across studies suggest more research is needed to further explore goal-setting BCTs in diabetes self-management.

Use of the Community College Goals Inventory in Assessing Institutional Success in Allocating Appropriate Priorities to Its Goals and to Estimate the Change of Priorities Needed to Achieve Its Intended Outcomes. AIR Forum 1980 Paper.

ERIC Educational Resources Information Center

Capoor, Madan

The use of the Community College Goals Inventory (CCGI) to assess priorities assigned to institutional goals and to estimate priority changes required to reach intended outcomes was studied. The CCGI consists of goal statements that mainly cover outcome and process goal areas. Respondents indicate their perceptions of how much importance is…

The Impact of College Quality on Early Labor Market Outcomes in China

ERIC Educational Resources Information Center

Yu, Li

2014-01-01

This study aims to explore the impact of college quality on early labor market outcomes in China, including the fresh college graduates' initial employment status and starting wages for students who graduated in 2011. The main data source is the College Student Labor Market (CSLM) survey conducted by Tsinghua University. Distinguished from…

Morningness-Eveningness and Educational Outcomes: The Lark Has an Advantage over the Owl at High School

ERIC Educational Resources Information Center

Preckel, Franzis; Lipnevich, Anastasiya A.; Boehme, Katharina; Brandner, Lena; Georgi, Karsten; Konen, Tanja; Mursin, Katharina; Roberts, Richard D.

2013-01-01

Background: Chronotype refers to individuals' preference for morning or evening activities. Its two dimensions (morningness and eveningness) are related to a number of academic outcomes. Aims: The main goal of the study was to investigate the incremental validity of chronotype as a predictor of academic achievement after controlling for a number…

A retrospective study of viral central nervous system infections: relationship amongst aetiology, clinical course and outcome.

PubMed

Calleri, Guido; Libanore, Valentina; Corcione, Silvia; De Rosa, Francesco G; Caramello, Pietro

2017-04-01

To describe the clinical pattern of viral central nervous system (CNS) infections and compare meningitis and encephalitis. This is a retrospective study reporting the clinical characteristics and outcome of 138 cases of viral meningitis and meningoencephalitis in a real life experience at a referral centre in Turin, Northern Italy. Enteroviruses were predominant in younger patients who were mainly presenting with signs of meningitis, had shorter hospital admission and absence of complications, whereas herpesviruses had more often signs of encephalitis, were more frequent in elderly patients, had longer hospital admission and frequent complications and sequelae. Two main clinical entities with different epidemiology, clinical aspects and prognosis may be identified within the group of viral CNS inefctions.

Interprofessional education for delirium care: a systematic review.

PubMed

Sockalingam, Sanjeev; Tan, Adrienne; Hawa, Raed; Pollex, Heather; Abbey, Susan; Hodges, Brian David

2014-07-01

Recent delirium prevention and treatment guidelines recommend the use of an interprofessional team trained and competent in delirium care. We conducted a systematic review to identify the evidence for the value of interprofessional delirium education programs on learning outcomes. We searched several databases and the grey literature. Studies describing an education intervention, involving two or more healthcare professions and reporting on at least one learning outcome as classified by Kirkpatrick's evaluation framework were included in this review. Ten out of 633 abstracts reviewed met the study inclusion criteria. Several studies reported on more than one learning outcome. Two studies focused on learner reactions to interprofessional delirium education; three studies focused on learning outcomes (e.g. delirium knowledge); six studies focused on learner behavior in practice; and six studies reported on learning results (e.g. patient outcomes), mainly changes in delirium rates post-intervention. Studies reporting changes in patient outcomes following the delirium education intervention used an interprofessional practice (IPP) intervention in combination with interprofessional education (IPE). Our review of the limited evidence suggests that IPE programs may influence team and patient outcomes in delirium care. More systematic studies of the effectiveness of interprofessional delirium education interventions are needed.

Theory-based self-management educational interventions on patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials.

PubMed

Zhao, Fang-Fang; Suhonen, Riitta; Koskinen, Sanna; Leino-Kilpi, Helena

2017-04-01

To synthesize the effects of theory-based self-management educational interventions on patients with type 2 diabetes (T2DM) in randomized controlled trials. Type 2 diabetes is a common chronic disease causing complications that put a heavy burden on society and reduce the quality of life of patients. Good self-management of diabetes can prevent complications and improve the quality of life of T2DM patients. Systematic review with meta-analysis of randomized controlled trials following Cochrane methods. A literature search was carried out in the MEDLINE, EMBASE, CINAHL, PSYCINFO, and Web of Science databases (1980-April 2015). The risk of bias of these eligible studies was assessed independently by two authors using the Cochrane Collaboration's tool. The Publication bias of the main outcomes was examined. Statistical heterogeneity and random-effects model were used for meta-analysis. Twenty studies with 5802 participants met the inclusion criteria. The interventions in the studies were based on one or more theories which mostly belong to mid-range theories. The pooled main outcomes by random-effects model showed significant improvements in HbA1c, self-efficacy, and diabetes knowledge, but not in BMI. As for quality of life, no conclusions can be drawn as the pooled outcome became the opposite with reduced heterogeneity after one study was excluded. No significant publication bias was found in the main outcomes. To get theory-based interventions to produce more effects, the role of patients should be more involved and stronger and the education team should be trained beyond the primary preparation for the self-management education program. © 2016 John Wiley & Sons Ltd.

Parental Book Reading and Social-Emotional Outcomes for Head Start Children in Foster Care.

PubMed

Lee, Kyunghee; Lee, Jung-Sook

2016-01-01

This study examines the associations between parental book reading and social-emotional outcomes for Head Start children in foster care. Despite no main Head Start impact on parental book reading, subgroup effects were found. Foster parents in Head Start provided more book reading for children with disabilities but less for children with low preacademic scores. Head Start enhanced social-emotional outcomes for children in foster care. The positive impacts of Head Start on children's social-emotional outcomes were greater when parents read books frequently. Head Start should include more foster families and provided parenting skills to enhance social-emotional outcomes for children in foster care.

[Pallidal and subthalamic stimulation in Parkinson's disease: lessons from the unsatisfactory results].

PubMed

2001-01-01

Deep brain stimulation is being widely used in advanced Parkinson's disease (PD). Outcome determinants are not known. Some relevant data about outcome may be obtained from the study of patients with unsatisfactory results. We have retrospectively analyzed the number and causes of unsatisfactory results (insufficient improvement 6 months after the intervention) in 211 patients. Forty patients (18.9%) experienced an unsatisfactory result. Inadequate clinical selection by advanced age, abnormal MRI and levodopa unresponsive symptoms was the main cause in 28 cases. In 11 patients a misplacement of the electrode was reported. In 2 cases no cause was identified. Thirty-four out of the 40 patients corresponded to the early experience of the teams involved in the study. We conclude that the main factors responsible for a negative outcome are related to the inadequate clinical selection of the patients and the incorrect placement of the electrode. The experience of the team may also be a key factor.

Influence of the National Trauma Data Bank on the study of trauma outcomes: is it time to set research best practices to further enhance its impact?

PubMed

Haider, Adil H; Saleem, Taimur; Leow, Jeffrey J; Villegas, Cassandra V; Kisat, Mehreen; Schneider, Eric B; Haut, Elliott R; Stevens, Kent A; Cornwell, Edward E; MacKenzie, Ellen J; Efron, David T

2012-05-01

Risk-adjusted analyses are critical in evaluating trauma outcomes. The National Trauma Data Bank (NTDB) is a statistically robust registry that allows such analyses; however, analytical techniques are not yet standardized. In this study, we examined peer-reviewed manuscripts published using NTDB data, with particular attention to characteristics strongly associated with trauma outcomes. Our objective was to determine if there are substantial variations in the methodology and quality of risk-adjusted analyses and therefore, whether development of best practices for risk-adjusted analyses is warranted. A database of all studies using NTDB data published through December 2010 was created by searching PubMed and Embase. Studies with multivariate risk-adjusted analyses were examined for their central question, main outcomes measures, analytical techniques, covariates in adjusted analyses, and handling of missing data. Of 286 NTDB publications, 122 performed a multivariable adjusted analysis. These studies focused on clinical outcomes (51 studies), public health policy or injury prevention (30), quality (16), disparities (15), trauma center designation (6), or scoring systems (4). Mortality was the main outcome in 98 of these studies. There were considerable differences in the covariates used for case adjustment. The 3 covariates most frequently controlled for were age (95%), Injury Severity Score (85%), and sex (78%). Up to 43% of studies did not control for the 5 basic covariates necessary to conduct a risk-adjusted analysis of trauma mortality. Less than 10% of studies used clustering to adjust for facility differences or imputation to handle missing data. There is significant variability in how risk-adjusted analyses using data from the NTDB are performed. Best practices are needed to further improve the quality of research from the NTDB. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Toward a Set of Measures of Student Learning Outcomes in Higher Education: Evidence from Brazil

ERIC Educational Resources Information Center

Melguizo, Tatiana; Wainer, Jacques

2016-01-01

The main objective of this study was to work toward the development of a number of measures of student learning outcomes (SLOs) in higher education. Specifically, we used data from "Exame Nacional de Desempenho dos Estudantes" (ENADE), a college-exit examination developed and used in Brazil. The fact that Brazil administered the ENADE to…

Education and Reproduction of Social Inequality: German Politics and Sociology of Education

ERIC Educational Resources Information Center

Sunker, Heinz

2004-01-01

This article deals with central issues in the field of sociology and politics of education after the publication of the outcomes of the Program for International Student Assessment (PISA) study for Germany. These outcomes serve to remind us of the old debate on politics of education in the 1960s. The main topic since then remains the reproduction…

Maternal nutrition and birth outcomes.

PubMed

Abu-Saad, Kathleen; Fraser, Drora

2010-01-01

In this review, the authors summarize current knowledge on maternal nutritional requirements during pregnancy, with a focus on the nutrients that have been most commonly investigated in association with birth outcomes. Data sourcing and extraction included searches of the primary resources establishing maternal nutrient requirements during pregnancy (e.g., Dietary Reference Intakes), and searches of Medline for "maternal nutrition"/[specific nutrient of interest] and "birth/pregnancy outcomes," focusing mainly on the less extensively reviewed evidence from observational studies of maternal dietary intake and birth outcomes. The authors used a conceptual framework which took both primary and secondary factors (e.g., baseline maternal nutritional status, socioeconomic status of the study populations, timing and methods of assessing maternal nutritional variables) into account when interpreting study findings. The authors conclude that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.

Slum upgrading strategies involving physical environment and infrastructure interventions and their effects on health and socio-economic outcomes.

PubMed

Turley, Ruth; Saith, Ruhi; Bhan, Nandita; Rehfuess, Eva; Carter, Ben

2013-01-31

Slums are densely populated, neglected parts of cities where housing and living conditions are exceptionally poor. In situ slum upgrading, at its basic level, involves improving the physical environment of the existing area, such as improving and installing basic infrastructure like water, sanitation, solid waste collection, electricity, storm water drainage, access roads and footpaths, and street lighting, as well as home improvements and securing land tenure. To explore the effects of slum upgrading strategies involving physical environment and infrastructure interventions on the health, quality of life and socio-economic wellbeing of urban slum dwellers in low and middle income countries (LMIC). Where reported, data were collected on the perspectives of slum dwellers regarding their needs, preferences for and satisfaction with interventions received. We searched for published and unpublished studies in 28 bibliographic databases including multidisciplinary (for example Scopus) and specialist databases covering health, social science, urban planning, environment and LMIC topics. Snowballing techniques included searching websites, journal handsearching, contacting authors and reference list checking. Searches were not restricted by language or publication date. We included studies examining the impact of slum upgrading strategies involving physical environment or infrastructure improvements (with or without additional co-interventions) on the health, quality of life and socio-economic wellbeing of LMIC urban slum dwellers. Randomised controlled trials (RCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) were eligible for the main analysis. Controlled studies with only post-intervention data (CPI) and uncontrolled before and after (UBA) studies were included in a separate narrative to examine consistency of results and to supplement evidence gaps in the main analysis. Two authors independently extracted data and assessed risk of bias for each study. Differences between the included study interventions and outcomes precluded meta-analysis so the results were presented in a narrative summary with illustrative harvest plots. The body of evidence for outcomes within the main analysis was assessed according to GRADE as very low, low, moderate or high quality. We identified 10,488 unique records, with 323 screened as full text. Five studies were included for the main analysis: one RCT with a low risk, two CBAs with a moderate risk and two CBAs with a high risk of bias. Three CBAs evaluated multicomponent slum upgrading strategies. Road paving only was evaluated in one RCT and water supply in one CBA. A total of 3453 households or observations were included within the four studies reporting sample sizes.Most health outcomes in the main studies related to communicable diseases, for which the body of evidence was judged to be low quality. One CBA with a moderate risk of bias found that diarrhoeal incidence was reduced in households which received water connections from a private water company (risk ratio (RR) 0.53; 95% confidence interval (CI) 0.27 to 1.04) and the severity of diarrhoeal episodes (RR 0.48; 95% CI 0.19 to 1.22). There was no effect for duration of diarrhoea. Road paving did not result in changes in parasitic infections or sickness in one RCT. After multicomponent slum upgrading, claims for a waterborne disease as opposed to a non-waterborne disease reduced (RR 0.64; 95% CI 0.27 to 0.98) in one CBA with a high risk of bias but there was no change in sanitation-related mortality in a CBA with a moderate risk of bias.The majority of socio-economic outcomes reported within the main studies related to financial poverty, for which the body of evidence was of very low quality. Results were mixed amongst the main studies; one RCT and two CBAs reported no effect on the income of slum dwellers following slum upgrading. One further CBA found significant reduction in monthly water expenditure (mean difference (MD) -17.11 pesos; 95% CI -32.6 to -1.62). One RCT also showed mixed results for employment variables, finding no effect on unemployment levels but increased weekly worked hours (MD 4.68; 95% CI -0.46 to 9.82) and lower risk of residents intending to migrate for work (RR 0.78; 95% CI 0.60 to 1.01).There was no evidence available to assess the impact of slum upgrading on non-communicable diseases or social capital. Maternal and perinatal conditions, infant mortality, nutritional deficiencies, injuries, self-reported quality of life, education and crime were evaluated in one study each.Nine supporting studies were included that measured varying outcomes (6794 households or observations within eight studies reporting sample sizes). One CPI evaluated cement flooring only while three UBAs and five CPIs evaluated multicomponent slum upgrading strategies. All studies but one had a high risk of bias.The studies reinforced main study findings for diarrhoea incidence and water-related expenditure. Findings for parasitic infections and financial poverty were inconsistent with the main studies. In addition, supporting studies reported a number of disparate outcomes that were not evaluated in the main studies.Five supporting studies included some limited information on slum dweller perspectives. They indicated the importance of appropriate siting of facilities, preference for private facilities, delivering synergistic interventions together, and ensuring that infrastructure was fit for purpose and systems were provided for cleaning, maintenance and repair. A high risk of bias within the included studies, heterogeneity and evidence gaps prevent firm conclusions on the effect of slum upgrading strategies on health and socio-economic wellbeing. The most common health and socio-economic outcomes reported were communicable diseases and indicators of financial poverty. There was a limited but consistent body of evidence to suggest that slum upgrading may reduce the incidence of diarrhoeal diseases and water-related expenditure. The information available on slum dwellers' perspectives provided some insight to barriers and facilitators for successful implementation and maintenance of interventions.The availability and use of reliable, comparable outcome measures to determine the effect of slum upgrading on health, quality of life and socio-economic wellbeing would make a useful contribution to new research in this important area. Given the complexity in delivering slum upgrading, evaluations should look to incorporate process and qualitative information alongside quantitative effectiveness data to determine which particular interventions work (or don't work) and for whom.

Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis.

PubMed

Steinsbekk, Aslak; Rygg, Lisbeth Ø; Lisulo, Monde; Rise, Marit B; Fretheim, Atle

2012-07-23

Diabetes self-management education (DSME) can be delivered in many forms. Group based DSME is widespread due to being a cheaper method and the added advantages of having patient meet and discuss with each other. assess effects of group-based DSME compared to routine treatment on clinical, lifestyle and psychosocial outcomes in type-2 diabetes patients. A systematic review with meta-analysis. Computerised bibliographic database were searched up to January 2008 for randomised controlled trials evaluating group-based DSME for adult type-2 diabetics versus routine treatment where the intervention had at least one session and =/>6 months follow-up. At least two reviewers independently extracted data and assessed study quality. In total 21 studies (26 publications, 2833 participants) were included. Of all the participants 4 out of 10 were male, baseline age was 60 years, BMI 31.6, HbA1c 8.23%, diabetes duration 8 years and 82% used medication. For the main clinical outcomes, HbA1c was significantly reduced at 6 months (0.44% points; P=0.0006, 13 studies, 1883 participants), 12 months (0.46% points; P=0.001, 11 studies, 1503 participants) and 2 years (0.87% points; P<0.00001, 3 studies, 397 participants) and fasting blood glucose levels were also significantly reduced at 12 months (1.26 mmol/l; P<0.00001, 5 studies, 690 participants) but not at 6 months. For the main lifestyle outcomes, diabetes knowledge was improved significantly at 6 months (SMD 0.83; P=0.00001, 6 studies, 768 participants), 12 months (SMD 0.85; P<0.00001, 5 studies, 955 participants) and 2 years (SMD 1.59; P=0.03, 2 studies, 355 participants) and self-management skills also improved significantly at 6 months (SMD 0.55; P=0.01, 4 studies, 534 participants). For the main psychosocial outcomes, there were significant improvement for empowerment/self-efficacy (SMD 0.28, P=0.01, 2 studies, 326 participants) after 6 months. For quality of life no conclusion could be drawn due to high heterogeneity. For the secondary outcomes there were significant improvements in patient satisfaction and body weight at 12 months for the intervention group. There were no differences between the groups in mortality rate, body mass index, blood pressure and lipid profile. Group-based DSME in people with type 2 diabetes results in improvements in clinical, lifestyle and psychosocial outcomes.

Unmet reproductive health needs among women in some West African countries: a systematic review of outcome measures and determinants.

PubMed

Ayanore, Martin Amogre; Pavlova, Milena; Groot, Wim

2016-01-16

Identifying relevant measures of women's reproductive health needs is critical to improve women's chances of service utilization. The study aims to systematically review and analyze the adequacy of outcome measures and determinants applied in previous studies for assessing women reproductive health needs across West Africa. Evidence on outcomes and determinants of unmet reproductive health needs among women of childbearing age in diverse multicultural, religious, and ethnic settings in West African countries was systematically reviewed. The review included recent English language publications (from January 2009 - March 2014). Clinical studies particularly on obstetric care services and reproductive services in relation to HIV/AIDS were excluded. We acknowledge the possibility to have excluded non-English publications and yet-to-be-published articles related to the study aim and objectives. Outcomes and determinants were assessed and defined at three main levels; contraceptive use, obstetric care, and antenatal care utilization. Results show increasing unmet need for women's reproductive health needs. Socio-cultural norms and practices resulting in discontinuation of service use, economic constraints, travel distance to access services and low education levels of women were found to be key predictors of service utilization for contraception, antenatal and obstetric care services. Outcome measures were mainly assessed based on service utilization, satisfaction, cost, and quality of services available as core measures across the three levels assessed in this review. Evidence from this review indicates that currently applied measures of women's reproductive health needs might be inadequate in attaining best maternal outcomes since they appear rather broad. More support and research for developing and advancing context-related measures may help to improve women's maternal health.

Outcome based education enacted: teachers' tensions in balancing between student learning and bureaucracy.

PubMed

Barman, Linda; Silén, Charlotte; Bolander Laksov, Klara

2014-12-01

This paper reports on how teachers within health sciences education translate outcome-based education (OBE) into practice when they design courses. The study is an empirical contribution to the debate about outcome- and competency-based approaches in health sciences education. A qualitative method was used to study how teachers from 14 different study programmes designed courses before and after OBE was implemented. Using an interpretative approach, analysis of documents and interviews was carried out. The findings show that teachers enacted OBE either to design for more competency-oriented teaching-learning, or to further detail knowledge and thus move towards reductionism. Teachers mainly understood the outcome-based framework as useful to support students' learning, although the demand for accountability created tension and became a bureaucratic hindrance to design for development of professional competence. The paper shows variations of how teachers enacted the same outcome-based framework for instructional design. These differences can add a richer understanding of how outcome- or competency-based approaches relate to teaching-learning at a course level.

Outcomes of critically ill intensive care unit patients treated with fosfomycin for infections due to pandrug-resistant and extensively drug-resistant carbapenemase-producing Gram-negative bacteria.

PubMed

Pontikis, Konstantinos; Karaiskos, Ilias; Bastani, Styliani; Dimopoulos, George; Kalogirou, Michalis; Katsiari, Maria; Oikonomou, Angelos; Poulakou, Garyphallia; Roilides, Emmanuel; Giamarellou, Helen

2014-01-01

Fosfomycin is active in vitro against extensively drug-resistant (XDR) and pandrug-resistant (PDR) Pseudomonas aeruginosa and Klebsiella pneumoniae carbapenemase-producing strains; however, the in vivo effectiveness against such pathogens is almost unknown. A multicentre, observational, prospective case-series study was performed in 11 ICUs. All consecutive fosfomycin-treated patients suffering from XDR or PDR fosfomycin-susceptible, microbiologically documented infections were recorded. Clinical and microbiological outcomes were assessed. A safety analysis was performed. In total, 68 patients received fosfomycin during the study period, 48 of whom were considered suitable for effectiveness analysis based on predefined criteria. Bacteraemia and ventilator-associated pneumonia were the main infections. Carbapenemase-producing K. pneumoniae and P. aeruginosa were isolated in 41 and 17 cases, respectively. All isolates exhibited an XDR or PDR profile, being fosfomycin-susceptible by definition. Fosfomycin was administered intravenously at a median dose of 24g/day for a median of 14 days, mainly in combination with colistin or tigecycline. Clinical outcome at Day 14 was successful in 54.2% of patients, whilst failure, indeterminate outcome and superinfection were documented in 33.3%, 6.3% and 6.3%, respectively. All-cause mortality at Day 28 was 37.5%. Bacterial eradication was observed in 56.3% of cases. Fosfomycin resistance developed in three cases. The main adverse event was reversible hypokalaemia. In conclusion, fosfomycin could have a place in the armamentarium against XDR and PDR Gram-negative infections in the critically ill. Resistance development during therapy, which has been a matter of concern in previous studies, did not occur frequently. The necessity of combination with other antibiotics requires further investigation. Copyright © 2013 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study.

PubMed

Zanette, Elvira; Parpinelli, Mary Angela; Surita, Fernanda Garanhani; Costa, Maria Laura; Haddad, Samira Maerrawi; Sousa, Maria Helena; E Silva, Joao Luiz Pinto; Souza, Joao Paulo; Cecatti, Jose Guilherme

2014-01-16

Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders. This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed. Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care. In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity.

Definition of Failed Induction of Labor and Its Predictive Factors: Two Unsolved Issues of an Everyday Clinical Situation.

PubMed

Baños, Núria; Migliorelli, Federico; Posadas, Eduardo; Ferreri, Janisse; Palacio, Montse

2015-01-01

The objectives of this review were to identify the predictive factors of induction of labor (IOL) failure or success as well as to highlight the current heterogeneity regarding the definition and diagnosis of failed IOL. Only studies in which the main or secondary outcome was failed IOL, defined as not entering the active phase of labor after 24 h of prostaglandin administration ± 12 h of oxytocin infusion, were included in the review. The data collected were: study design, definition of failed IOL, induction method, IOL indications, failed IOL rate, cesarean section because of failed IOL and predictors of failed IOL. The database search detected 507 publications. The main reason for exclusion was that the primary or secondary outcomes were not the predetermined definition of failed IOL (not achieving active phase of labor). Finally, 7 studies were eligible. The main predictive factors identified in the review were cervical status, evaluated by the Bishop score or cervical length. Failed IOL should be defined as the inability to achieve the active phase of labor, considering that the definition of IOL is to enter the active phase of labor. A universal definition of failed IOL is an essential requisite to analyze and obtain solid results and conclusions on this issue. An important finding of this review is that only 7 of all the studies reviewed assessed achieving the active phase of labor as a primary or secondary IOL outcome. Another conclusion is that cervical status remains the most important predictor of IOL outcome, although the value of the parameters explored up to now is limited. To find or develop predictive tools to identify those women exposed to IOL who may not reach the active phase of labor is crucial to minimize the risks and costs associated with IOL failure while opening a great opportunity for investigation. Therefore, other predictive tools should be studied in order to improve IOL outcome in terms of health and economic burden. © 2015 S. Karger AG, Basel.

Similarities amid the Difference: Caregiving Burden and Adaptation Outcomes in Dyads of Parents and Their Children with and without Cerebral Palsy

ERIC Educational Resources Information Center

Carona, C.; Crespo, C.; Canavarro, M. C.

2013-01-01

This study had two main objectives: first, to examine the direct and indirect effects, via social support, of caregiving burden on the adaptation outcomes of children/adolescents with cerebral palsy and their parents; and second, to assess the invariance of such models in clinical vs. healthy subsamples. Participants were 210 dyads of…

The impact of patients’ involvement in cooking on their mortality and morbidity: A 19-year follow-up of patients diagnosed with type 2 diabetes mellitus

PubMed Central

Siersma, Volkert; Køster-Rasmussen, Rasmus; Olivarius, Niels De Fine; Waldorff, Frans Boch

2015-01-01

Abstract Objective. This study explored the impact of involvement in cooking on long-term morbidity and mortality among patients newly diagnosed with type 2 diabetes mellitus (T2DM). Design and subjects. Data are from the population-based study Diabetes Care in General Practice. In baseline questionnaires, 1348 patients newly diagnosed with T2DM gave information on how frequently they consumed a warm main meal and how often they cooked it themselves. The selected patients were followed up for 19 years in the Danish National Patient Registry and the Danish Register of Causes of Death. Main outcome measures. This study analysed the association between involvement in cooking and each of seven pre-specified outcomes was analysed in Cox regression models with stepwise adjustment for possible confounders and mediators. Results. 92% of the patients with T2DM consumed a warm main meal = five times per week. Among these, women who cooked for themselves less than once a week had a higher risk of diabetes-related deaths (HR 1.86 [95% CI 1.03–3.35], p = 0.039) and stroke (HR 2.47 [95% CI 1.08–5.65], p = 0.033), after adjustment for confounders. For men, infrequent cooking was not related to increased risk for the outcomes investigated. Conclusions. In patients newly diagnosed with T2DM and with a regular intake of warm main meals, infrequent involvement in cooking was associated with an increased risk of diabetes-related death and stroke for women, but not for men. General practitioners should pay special attention to managing diabetes treatment in female patients newly diagnosed with T2DM who report infrequent involvement in cooking. PMID:25592166

Prognostic factors for non-success in patients with sciatica and disc herniation.

PubMed

Haugen, Anne Julsrud; Brox, Jens Ivar; Grøvle, Lars; Keller, Anne; Natvig, Bård; Soldal, Dag; Grotle, Margreth

2012-09-22

Few studies have investigated prognostic factors for patients with sciatica, especially for patients treated without surgery. The aim of this study was to identify factors associated with non-success after 1 and 2 years of follow-up and to test the prognostic value of surgical treatment for sciatica. The study was a prospective multicentre observational study including 466 patients with sciatica and lumbar disc herniation. Potential prognostic factors were sociodemographic characteristics, back pain history, kinesiophobia, emotional distress, pain, comorbidity and clinical examination findings. Study participation did not alter treatment considerations for the patients in the clinics. Patients reported on the questionnaires if surgery of the disc herniation had been performed. Uni- and multivariate logistic regression analyses were used to evaluate factors associated with non-success, defined as Maine-Seattle Back Questionnaire score of ≥5 (0-12) (primary outcome) and Sciatica Bothersomeness Index ≥7 (0-24) (secondary outcome). Rates of non-success were at 1 and 2 years 44% and 39% for the main outcome and 47% and 42% for the secondary outcome. Approximately 1/3 of the patients were treated surgically. For the main outcome variable, in the final multivariate model non-success at 1 year was significantly associated with being male (OR 1.70 [95% CI; 1.06 - 2.73]), smoker (2.06 [1.31 - 3.25]), more back pain (1.0 [1.01 - 1.02]), more comorbid subjective health complaints (1.09 [1.03 - 1.15]), reduced tendon reflex (1.62 [1.03 - 2.56]), and not treated surgically (2.97 [1.75 - 5.04]). Further, factors significantly associated with non-success at 2 years were duration of back problems >; 1 year (1.92 [1.11 - 3.32]), duration of sciatica >; 3 months (2.30 [1.40 - 3.80]), more comorbid subjective health complaints (1.10 [1.03 - 1.17]) and kinesiophobia (1.04 [1.00 - 1.08]). For the secondary outcome variable, in the final multivariate model, more comorbid subjective health complaints, more back pain, muscular weakness at clinical examination, and not treated surgically, were independent prognostic factors for non-success at both 1 and 2 years. The results indicate that the prognosis for sciatica referred to secondary care is not that good and only slightly better after surgery and that comorbidity should be assessed in patients with sciatica. This calls for a broader assessment of patients with sciatica than the traditional clinical assessment in which mainly the physical symptoms and signs are investigated.

The Effect of Blood Alcohol Level and Pre-Injury Chronic Alcohol Use on Outcome from Severe Traumatic Brain Injury in Hispanics, Anglo-Caucasians, and African Americans

PubMed Central

O’Dell, Keira M.; Hannay, H. Julia; Biney, Fedora O.; Robertson, Claudia S.; Tian, T. Siva

2012-01-01

Objective To examine a) ethnic differences in blood alcohol level (BAL) and pre-injury chronic alcohol use (PI-ETOH) within a severe closed head injury (CHI) sample, and b) the main and interaction effects of BAL, PI-ETOH, and ethnicity on functional outcome following severe CHI. Participants 434 Hispanic, Anglo-Caucasian, and African American individuals with severe CHI. Design Retrospective cohort study. Setting Consecutive admissions to a level one trauma center. Main measures BAL upon admission to the trauma center was collected for each patient. Additional information regarding PI-ETOH was collected in a subset of patients (N=116). Functional outcome was measured using the Disability Rating Scale (DRS) at 6 months post-injury. Results A one-way ANOVA revealed ethnic differences in mean BAL. Hierarchical multiple regression indicated that BAL did not predict DRS outcomes after controlling for pertinent covariates. An interaction effect between PI-ETOH and ethnicity was observed, such that presence of chronic alcohol use predicted worse functional outcome for Anglo-Caucasians and African Americans, but more favorable outcome for Hispanics. Conclusions Ethnic differences in BALs within our severe TBI sample mirrored ethnic drinking patterns observed in the general population, with Hispanics having the highest BALs. A paradoxical relationship between PI-ETOH and functional outcome was observed for Hispanics. PMID:22955101

Effect of Transcendental Meditation on Employee Stress, Depression, and Burnout: A Randomized Controlled Study

PubMed Central

Elder, Charles; Nidich, Sanford; Moriarty, Francis; Nidich, Randi

2014-01-01

Context: Workplace stress and burnout are pervasive problems, affecting employee performance and personal health. Objective: To evaluate the effects of the Transcendental Meditation program on psychological distress and burnout among staff at a residential therapeutic school for students with severe behavioral problems. Design: A total of 40 secondary schoolteachers and support staff at the Bennington School in Vermont, a therapeutic school for children with behavioral problems, were randomly assigned to either practice of the Transcendental Meditation program or a wait-list control group. The Transcendental Meditation course was provided by certified instructors. Main Outcome Measures: Outcome measures were assessed at baseline and at four months, and included perceived stress, depression, and burnout. A multivariate analysis of covariance was used to determine overall effects. Results: Analysis of the 4-month intervention data indicated a significant improvement in the main outcomes of the study resulting from practice of the Transcendental Meditation program compared with controls (Wilks Λ [3,28] = 0.695; p = 0.019). Results of univariate F tests indicated a significant reduction of all main outcome measures: perceived stress (F[1,32] = 13.42; p = < 0.001); depression (F[1,32] = 6.92; p = 0.013); and overall teacher burnout (F[1,32] = 6.18; p = 0.018). Effect sizes ranged from 0.40 to 0.94. Conclusions: The Transcendental Meditation program was effective in reducing psychological distress in teachers and support staff working in a therapeutic school for students with behavioral problems. These findings have important implications for employees’ job performance as well as their mental and physical health. PMID:24626068

Composite outcomes in randomized clinical trials: arguments for and against.

PubMed

Ross, Sue

2007-02-01

Composite outcomes that combine a number of individual outcomes (such as types of morbidity) are frequently used as primary outcomes in obstetrical trials. The main argument for their use is to ensure that trials can answer important clinical questions in a timely fashion, without needing huge sample sizes. Arguments against their use are that composite outcomes may be difficult to use and interpret, leading to errors in sample size estimation, possible contradictory trial results, and difficulty in interpreting findings. Such problems may reduce the credibility of the research, and may impact on the implementation of findings. Composite outcomes are an attractive solution to help to overcome the problem of limited available resources for clinical trials. However, future studies should carefully consider both the advantages and disadvantages before using composite outcomes. Rigorous development and reporting of composite outcomes is essential if the research is to be useful.

The Meaning of Disease and Spiritual Responses to Stressors in Adults With Acute Leukemia Undergoing Hematopoietic Stem Cell Transplantation.

PubMed

Farsi, Zahra

2015-12-01

Some studies have shown that patients with cancer may experience significant spiritual distress as well as spiritual growth, that there is a positive association between spirituality and coping, and that positive religious coping predicts enhanced health outcomes. This study was designed to help explain how the meaning of disease and spiritual responses to threatening stressors influence the final experiential outcomes of adults with leukemia undergoing hematopoietic stem cell transplantation in Iran. This grounded theory study conducted in-depth interviews between 2009 and 2011 on 10 adults in Iran with leukemia undergoing hematopoietic stem cell transplantation. Recorded audio interviews were transcribed verbatim in Persian and coded and analyzed using Corbin and Strauss (2008)'s approach. Main categories that emerged from data included "experiencing the meaning of cancer"; "changing perceptions of death, life and health"; and "moving toward perfection and sublimity." "Finding meaning" was the main concept that defined the final outcome of the experience of participants. Understanding the meaning to patients of disease and treatments may help healthcare providers better appreciate the patients' perspective and improve the physician-patient relationship. Nurses are well positioned to play a decisive role in helping patients cope effectively with their treatment process and in helping ensure positive outcomes for treatments through their helping patients find the unique meaning of their experience.

77 FR 28360 - Notice of Proposed Information Collection Requests; Office of Planning, Evaluation and Policy...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-14

... study has two main components: (1) A review of recent research on the identification of ELs with special... descriptive in nature. The study is not a program evaluation and does not purport to assess program outcomes...

INTEGRATING EPIDEMIOLOGY AND TOXICOLOGY IN NEUROTOXICITY RISK ASSESSMENT.

EPA Science Inventory

This manuscript provides an overview of the use of data from toxicology and epidemiology studies for neurotoxicity risk assessment. Parameters such as the use of subjects, study designs, exposures, and measured outcomes are compared and contrasted. The main concern for use of d...

Evaluation of a novel vital sign device to reduce maternal mortality and morbidity in low-resource settings: a mixed method feasibility study for the CRADLE-3 trial.

PubMed

Vousden, Nicola; Lawley, Elodie; Nathan, Hannah L; Seed, Paul T; Brown, Adrian; Muchengwa, Tafadzwa; Charantimath, Umesh; Bellad, Mrutyunjaya; Gidiri, Muchabayiwa Francis; Goudar, Shivaprasad; Chappell, Lucy C; Sandall, Jane; Shennan, Andrew H

2018-04-27

The CRADLE-3 trial is a stepped-wedge randomised controlled trial aiming to reduce maternal mortality and morbidity by implementing a novel vital sign device (CRADLE Vital Sign Alert) and training package into routine maternity care in 10 low-income sites. The MRC Guidance on complex interventions proposes that interventions and implementation strategies be shaped by early phase piloting and development work. We present the findings of a three-month mixed-methodology feasibility study for this trial, describe how this was informed by the MRC guidance and the study design was refined. The fidelity, dose, feasibility and acceptability of implementation and training materials were assessed in three representative non-trial sites (Zimbabwe, Ethiopia, India) using multiple-choice questionnaires, evaluation of clinical management (action log), healthcare provider (HCP) semi-structured interviews and focus groups 4-10 weeks after implementation. Simultaneously, the 10 sites included in the main trial (eight countries) collected primary outcome data to inform the power calculation and randomisation allocation and assess the feasibility of data collection. The package was implemented with high fidelity (85% of HCP trained, n = 204). The questionnaires indicated a good understanding of device use with 75% of participants scoring > 75% (n = 97; 90% of those distributed). Action logs were inconsistently completed but indicated that the majority of HCP responded appropriately to abnormal results. From 18 HCP interviews and two focus groups it was widely reported that the intervention improved capacity to make clinical decisions, escalate care and make appropriate referrals. Nine of the ten main trial sites achieved ethical approval for pilot data collection. Intensive care was an inconsistent marker of morbidity and stroke an infrequent outcome and therefore they were removed from the main trial composite outcome. Tools and methods of data collection were optimized and event rates used to inform randomisation. This feasibility study demonstrates that the components of the intervention were acceptable, methods of implementing were successful and the main trial design would be feasible. Qualitative work identified key moderators that informed the main trial process evaluation. Changes to the training package, implementation strategy, study design and processes were identified to refine the implementation in the main trial. ISRCTN41244132 ; Registered 24/11/2015.

A multilevel examination of affective job insecurity climate on safety outcomes.

PubMed

Jiang, Lixin; Probst, Tahira M

2016-07-01

Previous research has established a causal link between individual perceptions of job insecurity and safety outcomes. However, whether job insecurity climate is associated with safety outcomes has not been studied. The purpose of the current study was to explore the main and cross-level interaction effects of affective job insecurity climate on safety outcomes, including behavioral safety compliance, reporting attitudes, workplace injuries, experienced safety events, unreported safety events, and accident underreporting, beyond individual affective job insecurity. With 171 employees nested in 40 workgroups, multilevel analyses revealed that the negative impacts of individual affective job insecurity on safety outcomes are exacerbated when they occur in a climate of high affective job insecurity. These results are interpreted in light of safety management efforts and suggest that efforts to create a secure climate within one's workgroup may reap safety-related benefits. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Narrowing the Gap in Outcomes for Vulnerable Groups: Overview and Analysis of Available Datasets on Vulnerable Groups and the Five ECM Outcomes. Executive Summary

ERIC Educational Resources Information Center

Morris, Marian

2007-01-01

This summary presents the main findings from a data mapping and analysis study commissioned by the Local Government Association (LGA) from the National Foundation for Educational Research (NFER) as part of a two-year development and research programme, Narrowing the Gap. This programme seeks to make a significant difference in "narrowing the…

[The experimental study of guinea pig cytomegalovirus infection in the kidney of the pup of guinea pig].

PubMed

Wang, Xin-rong; Chen, Su-hua; Liu, Hai-zhi; Xiong, Jin-wen; Ling, Xia-zhen

2004-02-01

To study the relationship of guinea pig cytomegalovirus (GPCMV) infection with the outcome of pregnancy by the kidney of guinea pig (GP). Twenty first-trimester gestation GPs were randomly selected, intraperitoneally inoculated with GPCMV. Then female GPs and the pups were killed within 24 h after delivery. By in situ hybridization (ISH) with three phases GPCMV late-mRNA probes labeled by digoxin, the virus load and its distribution were screened inside the pup's kidney. Twenty GPs totally conceived 63 pups. Among them, 42 had normal outcome and lived longer than 24 h; 21 had abnormal outcome such as abortion, fetal death, et al. By in situ hybridization, the infection rate of normal pups was 7.1% (3/42) and the average optical density (A) was 0.105 +/- 0.052. The infection rate of abnormal pups was 28. 6% (6/21) and the A was 0.158 +/- 0.047. The difference of the A was significant (t = 2.57, P < 0.05). The positive signal of ISH was mainly distributed in the epithelium of renal tubule and collecting duct. It is concluded that the late-mRNA mainly expressed in the epithelium of renal tubule and collecting duct and the expression level was related with the abnormal pregnancy outcome.

Association between thymic function and allogeneic hematopoietic stem cell transplantation outcome: results of a pediatric study.

PubMed

Saglio, Francesco; Cena, Silvia; Berger, Massimo; Quarello, Paola; Boccasavia, Viola; Ferrando, Federica; Pittana, Laura; Bruno, Benedetto; Fagioli, Franca

2015-06-01

Robust T cell function recovery has been shown to be crucial in determining allogeneic hematopoietic stem cell transplantation (HSCT) outcome, and there is growing evidence that the thymus plays a central role in regulating this process. We performed a long-term analysis of the role of thymic activity recovery in a population of pediatric patients undergoing allogeneic HSCT by signal joint T cell receptor excision circle (sjTREC) quantification. In this study, characterized by a long-term follow-up (median, 72 months), we found patients with higher levels of sjTRECs before transplantation had a statistically significant reduced risk of death compared with patients with lower values (relative risk, .31; 95% confidence interval, .30 to .32; P = .02), showing this different outcome was mainly related to a reduction of relapse incidence (14% versus 43%, P = .02). Unlike previous reports, we observed no correlation between sjTREC levels and lymphocyte recovery. Moreover, we confirmed that only graft-versus-host disease influenced thymic activity after transplantation. In conclusion, our results suggest an association between pretransplantation thymic activity and the long-term outcome of pediatric patients undergoing HSCT, mainly through a reduction of relapse opportunities. Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

High construal level can help negotiators to reach integrative agreements: The role of information exchange and judgement accuracy.

PubMed

Wening, Stefanie; Keith, Nina; Abele, Andrea E

2016-06-01

In negotiations, a focus on interests (why negotiators want something) is key to integrative agreements. Yet, many negotiators spontaneously focus on positions (what they want), with suboptimal outcomes. Our research applies construal-level theory to negotiations and proposes that a high construal level instigates a focus on interests during negotiations which, in turn, positively affects outcomes. In particular, we tested the notion that the effect of construal level on outcomes was mediated by information exchange and judgement accuracy. Finally, we expected the mere mode of presentation of task material to affect construal levels and manipulated construal levels using concrete versus abstract negotiation tasks. In two experiments, participants negotiated in dyads in either a high- or low-construal-level condition. In Study 1, high-construal-level dyads outperformed dyads in the low-construal-level condition; this main effect was mediated by information exchange. Study 2 replicated both the main and mediation effects using judgement accuracy as mediator and additionally yielded a positive effect of a high construal level on a second, more complex negotiation task. These results not only provide empirical evidence for the theoretically proposed link between construal levels and negotiation outcomes but also shed light on the processes underlying this effect. © 2015 The British Psychological Society.

Scarf pin-related hijab syndrome: A new name for an unusual type of foreign body aspiration

PubMed Central

Kakamad, Fahmi H.; Bakir, Delan Ahmed

2017-01-01

Background Foreign body aspiration refers to the inhalation of an object into the respiratory system and is a serious and potentially fatal event. A distinct group of patients has recently been recognized among Muslim nations. These patients include women who wear headscarves and place the safety pin in their mouth prior to securing the veils, leading to accidental foreign body aspiration. The aim of this study was to analyze the main presentation, diagnosis, treatment, and outcome of patients with scarf pin aspiration. Methods This prospective study involved patients with a history of scarf pin aspiration admitted to a single center during an 18-month period. Their main presentation, diagnosis, treatment, and outcome were analyzed. Results In total, 27 patients were included. The needle was extracted by flexible bronchoscopy in 12 (44.4%) patients, rigid bronchoscopy in 13 (48.1%), and thoracotomy in 2 (74%). One patient died during rigid bronchoscopy. All remaining 26 patients were satisfied with the postsurgical outcome at a mean follow-up of 1 week. Conclusions Scarf pin aspiration differs from other types of foreign body aspiration considering the specific population affected, and its management algorithm may thus differ from that of other foreign bodies. The left main bronchus is the most common site of pin impaction. Rigid bronchoscopy is the most commonly performed procedure for successful retrieval. PMID:28627978

Scarf pin-related hijab syndrome: A new name for an unusual type of foreign body aspiration.

PubMed

Baram, Aram; Kakamad, Fahmi H; Bakir, Delan Ahmed

2017-12-01

Background Foreign body aspiration refers to the inhalation of an object into the respiratory system and is a serious and potentially fatal event. A distinct group of patients has recently been recognized among Muslim nations. These patients include women who wear headscarves and place the safety pin in their mouth prior to securing the veils, leading to accidental foreign body aspiration. The aim of this study was to analyze the main presentation, diagnosis, treatment, and outcome of patients with scarf pin aspiration. Methods This prospective study involved patients with a history of scarf pin aspiration admitted to a single center during an 18-month period. Their main presentation, diagnosis, treatment, and outcome were analyzed. Results In total, 27 patients were included. The needle was extracted by flexible bronchoscopy in 12 (44.4%) patients, rigid bronchoscopy in 13 (48.1%), and thoracotomy in 2 (74%). One patient died during rigid bronchoscopy. All remaining 26 patients were satisfied with the postsurgical outcome at a mean follow-up of 1 week. Conclusions Scarf pin aspiration differs from other types of foreign body aspiration considering the specific population affected, and its management algorithm may thus differ from that of other foreign bodies. The left main bronchus is the most common site of pin impaction. Rigid bronchoscopy is the most commonly performed procedure for successful retrieval.

Risk factors for unfavorable outcome of pulmonary tuberculosis in adults in Taipei, Taiwan.

PubMed

Yen, Yung-Feng; Yen, Muh-Yong; Shih, Hsiu-Chen; Deng, Chung-Yeh

2012-05-01

This study was undertaken to identify factors associated with unfavorable outcomes in patients with pulmonary tuberculosis (PTB) in Taipei, Taiwan in 2007-2008. Taiwanese adults with culture-positive PTB diagnosed in Taipei during the study period were included in this retrospective cohort study. Unfavorable outcomes were classified as treatment default, death, treatment failure, or transfer. Of 1616 eligible patients, 22.6% (365) had unfavorable outcomes, mainly death. After controlling for patient sociodemographic factors, clinical findings, and underlying disease, independent risk factors for unfavorable outcomes included advanced age, unemployment, end-stage renal disease requiring dialysis, malignancy, acid-fast bacilius smear-positivity, multidrug-resistant TB, and notification from ordinary ward or intensive care unit. In contrast, patients receiving directly observed treatment, and with a high school or higher education were significantly less likely to have unfavorable outcomes. This study advanced our understanding by revealing that a high school or higher education might lower the risk of an unfavorable outcome. Our results also confirmed the risk factors for unfavorable outcomes shown in previous research. Future TB control programmes in Taiwan should target particularly high-risk patients including those who had lower educational levels. Copyright © 2012 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Does Assessing Suicidality Frequently and Repeatedly Cause Harm? A Randomized Control Study

PubMed Central

Law, Mary Kate; Furr, R. Michael; Arnold, Elizabeth Mayfield; Mneimne, Malek; Jaquett, Caroline; Fleeson, William

2015-01-01

Assessing suicidality is common in mental health practice and is fundamental to suicide research. Although necessary, there is significant concern that such assessments have unintended harmful consequences. Using a longitudinal randomized control design, we evaluated whether repeated and frequent assessments of suicide-related thoughts and behaviors negatively affected individuals, including those at-risk for suicide-related outcomes. Adults (N = 282), including many diagnosed with Borderline Personality Disorder (BPD), were recruited through psychiatric outpatient clinics and from the community at large, and were randomly assigned to assessment groups. A Control Assessment group responded to questions regarding negative psychological experiences several times each day during a 2-week Main Observation phase. During the same observation period, an Intensive Suicide Assessment group responded to the same questions, along with questions regarding suicidal behavior and ideation. Negative psychological outcomes were measured during the Main Observation phase (for BPD symptoms unrelated to suicide and for BPD-relevant emotions) and/or at the end of each week during the Main Observation phase and monthly for 6 months thereafter (for all outcomes, including suicidal ideation and behavior). Results revealed little evidence that intensive suicide assessment triggered negative outcomes, including suicidal ideation or behavior, even among people with BPD. A handful of effects did reach or approach significance, though these were temporary and non-robust. However, given the seriousness of some outcomes, we recommend that researchers or clinicians who implement experience sampling methods including suicide-related items carefully consider the benefits of asking about suicide and to inform participants about possible risks. PMID:25894705

Does assessing suicidality frequently and repeatedly cause harm? A randomized control study.

PubMed

Law, Mary Kate; Furr, R Michael; Arnold, Elizabeth Mayfield; Mneimne, Malek; Jaquett, Caroline; Fleeson, William

2015-12-01

Assessing suicidality is common in mental health practice and is fundamental to suicide research. Although necessary, there is significant concern that such assessments have unintended harmful consequences. Using a longitudinal randomized control design, the authors evaluated whether repeated and frequent assessments of suicide-related thoughts and behaviors negatively affected individuals, including those at-risk for suicide-related outcomes. Adults (N = 282), including many diagnosed with borderline personality disorder (BPD), were recruited through psychiatric outpatient clinics and from the community at large, and were randomly assigned to assessment groups. A control assessment group responded to questions regarding negative psychological experiences several times each day during a 2-week main observation phase. During the same observation period, an intensive suicide assessment group responded to the same questions, along with questions regarding suicidal behavior and ideation. Negative psychological outcomes were measured during the main observation phase (for BPD symptoms unrelated to suicide and for BPD-relevant emotions) and/or at the end of each week during the main observation phase and monthly for 6 months thereafter (for all outcomes, including suicidal ideation and behavior). Results revealed little evidence that intensive suicide assessment triggered negative outcomes, including suicidal ideation or behavior, even among people with BPD. A handful of effects did reach or approach significance, though these were temporary and nonrobust. However, given the seriousness of some outcomes, the authors recommend that researchers or clinicians who implement experience sampling methods including suicide-related items carefully consider the benefits of asking about suicide and to inform participants about possible risks. (c) 2015 APA, all rights reserved).

Information Technology-Based Interventions to Improve Drug-Drug Interaction Outcomes: A Systematic Review on Features and Effects.

PubMed

Nabovati, Ehsan; Vakili-Arki, Hasan; Taherzadeh, Zhila; Saberi, Mohammad Reza; Medlock, Stephanie; Abu-Hanna, Ameen; Eslami, Saeid

2017-01-01

The purpose of this systematic review was to identify features and effects of information technology (IT)-based interventions on outcomes related to drug-drug interactions (DDI outcomes). A literature search was conducted in Medline, EMBASE, and the Cochrane Library for published English-language studies. Studies were included if a main outcome was related to DDIs, the intervention involved an IT-based system, and the study design was experimental or observational with controls. Study characteristics, including features and effects of IT-based interventions, were extracted. Nineteen studies comprising five randomized controlled trials (RCT), five non-randomized controlled trials (NRCT) and nine observational studies with controls (OWC) were included. Sixty-four percent of prescriber-directed interventions, and all non-prescriber interventions, were effective. Each of the following characteristics corresponded to groups of studies of which a majority were effective: automatic provision of recommendations within the providers' workflow, intervention at the time of decision-making, integration into other systems, and requiring the reason for not following the recommendations. Only two studies measured clinical outcomes: an RCT that showed no significant improvement and an OWC that showed improvement, but did not statistically assess the effect. Most studies that measured surrogate outcomes (e.g. potential DDIs) and other outcomes (e.g. adherence to alerts) showed improvements. IT-based interventions improve surrogate clinical outcomes and adherence to DDI alerts. However, there is lack of robust evidence about their effectiveness on clinical outcomes. It is recommended that researchers consider the identified features of effective interventions in the design of interventions and evaluate the effectiveness on DDI outcomes, particularly clinical outcomes.

Child maltreatment prevention: a systematic review of reviews.

PubMed

Mikton, Christopher; Butchart, Alexander

2009-05-01

To synthesize recent evidence from systematic and comprehensive reviews on the effectiveness of universal and selective child maltreatment prevention interventions, evaluate the methodological quality of the reviews and outcome evaluation studies they are based on, and map the geographical distribution of the evidence. A systematic review of reviews was conducted. The quality of the systematic reviews was evaluated with a tool for the assessment of multiple systematic reviews (AMSTAR), and the quality of the outcome evaluations was assessed using indicators of internal validity and of the construct validity of outcome measures. The review focused on seven main types of interventions: home visiting, parent education, child sex abuse prevention, abusive head trauma prevention, multi-component interventions, media-based interventions, and support and mutual aid groups. Four of the seven - home-visiting, parent education, abusive head trauma prevention and multi-component interventions - show promise in preventing actual child maltreatment. Three of them - home visiting, parent education and child sexual abuse prevention - appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on. An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low- and middle-income countries and make up only 0.6% of the total evidence base. Evidence for the effectiveness of four of the seven main types of interventions for preventing child maltreatment is promising, although it is weakened by methodological problems and paucity of outcome evaluations from low- and middle-income countries.

Treatment of alcohol use disorder and co-occurring PTSD.

PubMed

Taylor, Mandrill; Petrakis, Ismene; Ralevski, Elizabeth

2017-07-01

Alcohol use disorder (AUD) is a serious psychiatric disorder with medical, psychiatric, and social consequences. In individuals with comorbid post-traumatic stress disorder (PTSD), treatment outcomes are notably worse in comparison with treatment outcomes associated with either disorder occurring alone. There is a growing literature evaluating treatments, both pharmacotherapy and psychotherapy focused, in individuals with co-occurring AUD and PTSD. The main objective of this review was to evaluate pharmacotherapy and psychotherapy studies that were specifically designed to evaluate the treatment of individuals with comorbid AUD and PTSD. MEDLINE and PUBMED databases were searched with no specific time period. Studies focusing on SUD treatments were excluded. Because the number of random clinical trial (RCT) studies was small, all publications (including open label, single case, and secondary analyses) were included. Sixteen studies met criteria and were organized based on whether they evaluated the efficacy of pharmacotherapy, psychotherapy, or both. Pharmacological interventions with either AUD or PTSD agents were mainly effective in reducing drinking outcomes; only one study using sertraline found that the active study medication was superior to placebo in reducing PTSD symptoms. Psychotherapies were not superior to a comparative treatment in reducing drinking outcomes. Only 1 study showed reduction in PTSD symptoms in a small sample of completers. The single RCT that evaluated the efficacy of naltrexone in combination with psychotherapies (prolonged exposure or supportive counseling) found that naltrexone in combination with prolonged exposure was better for drinking outcomes at follow-up. Although these studies represent a good start in terms of research in treatment interventions of co-occurring AUD and PTSD, the studies are very limited, most lack adequate power, and the majority suffer from inadequate control groups. In particular, there is a strong need to develop and evaluate the combined medication and psychological-based treatment interventions for those with comorbid AUD and PTSD.

Global Risk Score and Clinical SYNTAX Score as Predictors of Clinical Outcomes of Patients Undergoing Unprotected Left Main Percutaneous Catheter Intervention

PubMed Central

Cuenza, Lucky; Collado, Marianne P.; Ho Khe Sui, James

2017-01-01

Background Risk stratification is an important component of left main percutaneous catheter intervention (PCI) which has emerged as a feasible alternative to cardiac surgery. We sought to compare the clinical SYNTAX score and the global risk score in predicting outcomes of patients undergoing unprotected left main PCI in our institution. Methods Clinical, angiographic and procedural characteristics of 92 patients who underwent unprotected left main PCI (mean age 62 ± 12.1 years) were analyzed. Patients were risk stratified into tertiles of high, intermediate and low risk using the global risk score (GRS) and the clinical SYNTAX score (CSS) and were prospectively followed up at 1 year for the occurrence of major adverse cardiovascular events (MACEs), defined as a composite of all cause mortality, cardiac mortality, non-fatal myocardial infarction, stroke, coronary artery bypass, and target vessel revascularization. Results There were 26 (28.2%) who experienced MACEs, of which 10 (10.8%) patients died. Multivariable hazards analysis showed that the GRS (hazard ratio (HR) = 5.5, P = 0.001) and CSS (HR = 4.3, P = 0.001) were both independent predictors of MACEs. Kaplan-Meier analysis showed higher incidence of MACEs with the intermediate and higher risk categories compared to those classified as low risk. Receiver-operator characteristic analysis showed that the GRS has better discriminatory ability than the CSS in the prediction of 1 year MACEs (0.891 vs. 0.743, P = 0.007). Conclusion The GRS and CSS are predictive of outcomes after left main PCI. The GRS appears to have superior predictive and prognostic utility compared to the CSS. This study emphasizes the importance of combining both anatomic and clinical variables for optimum prognostication and management decisions in left main PCI. PMID:29317974

Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis

PubMed Central

2012-01-01

Background Diabetes self-management education (DSME) can be delivered in many forms. Group based DSME is widespread due to being a cheaper method and the added advantages of having patient meet and discuss with each other. assess effects of group-based DSME compared to routine treatment on clinical, lifestyle and psychosocial outcomes in type-2 diabetes patients. Methods A systematic review with meta-analysis. Computerised bibliographic database were searched up to January 2008 for randomised controlled trials evaluating group-based DSME for adult type-2 diabetics versus routine treatment where the intervention had at least one session and =/>6 months follow-up. At least two reviewers independently extracted data and assessed study quality. Results In total 21 studies (26 publications, 2833 participants) were included. Of all the participants 4 out of 10 were male, baseline age was 60 years, BMI 31.6, HbA1c 8.23%, diabetes duration 8 years and 82% used medication. For the main clinical outcomes, HbA1c was significantly reduced at 6 months (0.44% points; P = 0.0006, 13 studies, 1883 participants), 12 months (0.46% points; P = 0.001, 11 studies, 1503 participants) and 2 years (0.87% points; P < 0.00001, 3 studies, 397 participants) and fasting blood glucose levels were also significantly reduced at 12 months (1.26 mmol/l; P < 0.00001, 5 studies, 690 participants) but not at 6 months. For the main lifestyle outcomes, diabetes knowledge was improved significantly at 6 months (SMD 0.83; P = 0.00001, 6 studies, 768 participants), 12 months (SMD 0.85; P < 0.00001, 5 studies, 955 participants) and 2 years (SMD 1.59; P = 0.03, 2 studies, 355 participants) and self-management skills also improved significantly at 6 months (SMD 0.55; P = 0.01, 4 studies, 534 participants). For the main psychosocial outcomes, there were significant improvement for empowerment/self-efficacy (SMD 0.28, P = 0.01, 2 studies, 326 participants) after 6 months. For quality of life no conclusion could be drawn due to high heterogeneity. For the secondary outcomes there were significant improvements in patient satisfaction and body weight at 12 months for the intervention group. There were no differences between the groups in mortality rate, body mass index, blood pressure and lipid profile. Conclusions Group-based DSME in people with type 2 diabetes results in improvements in clinical, lifestyle and psychosocial outcomes. PMID:22824531

The impact of Public Reporting on clinical outcomes: a systematic review and meta-analysis.

PubMed

Campanella, Paolo; Vukovic, Vladimir; Parente, Paolo; Sulejmani, Adela; Ricciardi, Walter; Specchia, Maria Lucia

2016-07-22

To assess both qualitatively and quantitatively the impact of Public Reporting (PR) on clinical outcomes, we carried out a systematic review of published studies on this topic. Pubmed, Web of Science and SCOPUS databases were searched to identify studies published from 1991 to 2014 that investigated the relationship between PR and clinical outcomes. Studies were considered eligible if they investigated the relationship between PR and clinical outcomes and comprehensively described the PR mechanism and the study design adopted. Among the clinical outcomes identified, meta-analysis was performed for overall mortality rate which quantitative data were exhaustively reported in a sufficient number of studies. Two reviewers conducted all data extraction independently and disagreements were resolved through discussion. The same reviewers evaluated also the quality of the studies using a GRADE approach. Twenty-seven studies were included. Mainly, the effect of PR on clinical outcomes was positive. Meta-analysis regarding overall mortality included, in a context of high heterogeneity, 10 studies with a total of 1,840,401 experimental events and 3,670,446 control events and resulted in a RR of 0.85 (95 % CI, 0.79-0.92). The introduction of PR programs at different levels of the healthcare sector is a challenging but rewarding public health strategy. Existing research covering different clinical outcomes supports the idea that PR could, in fact, stimulate providers to improve healthcare quality.

Dependability of results in conference abstracts of randomized controlled trials in ophthalmology and author financial conflicts of interest as a factor associated with full publication.

PubMed

Saldanha, Ian J; Scherer, Roberta W; Rodriguez-Barraquer, Isabel; Jampel, Henry D; Dickersin, Kay

2016-04-26

Discrepancies between information in conference abstracts and full publications describing the same randomized controlled trial have been reported. The association between author conflicts of interest and the publication of randomized controlled trials is unclear. The objective of this study was to use randomized controlled trials in ophthalmology to evaluate (1) the agreement in the reported main outcome results by comparing abstracts and corresponding publications and (2) the association between the author conflicts of interest and publication of the results presented in the abstracts. We considered abstracts describing results of randomized controlled trials presented at the 2001-2004 Association for Research in Vision and Ophthalmology conferences as eligible for our study. Through electronic searching and by emailing abstract authors, we identified the earliest publication (journal article) containing results of each abstract's main outcome through November 2013. We categorized the discordance between the main outcome results in the abstract and its paired publication as qualitative (a difference in the direction of the estimated effect) or as quantitative. We used the Association for Research in Vision and Ophthalmology categories for conflicts of interest: financial interest, employee of business with interest, consultant to business with interest, inventor/developer with patent, and receiving ≥ 1 gift from industry in the past year. We calculated the relative risks (RRs) of publication associated with the categories of conflicts of interest for abstracts with results that were statistically significant, not statistically significant, or not reported. We included 513 abstracts, 230 (44.8 %) of which reached publication. Among the 86 pairs with the same main outcome domain at the same time point, 47 pairs (54.7 %) had discordant results: qualitative discordance in 7 pairs and quantitative discordance in 40 pairs. Quantitative discordance was indicated as < 10, 10-20, > 20 %, and unclear in 14, 5, 14, and 7 pairs, respectively. First authors reporting of one or more conflicts of interest was associated with a greater likelihood of publication (RR = 1.31; 95 % CI = 1.04 to 1.64) and a shorter time-to-publication (log-rank p = 0.026). First author conflicts of interests that were associated with publication were financial support (RR = 1.50; 95 % CI = 1.19 to 1.90) and one or more gifts (RR = 1.42; 95 % CI = 1.05 to 1.92). The association between conflicts of interest and publication remained, irrespective of the statistical significance of the results. More than half the abstract/publication pairs exhibited some amount of discordance in the main outcome results, calling into question the dependability of conference abstracts. Regardless of the main outcome results, the conflicts of interests of the abstract's first author were associated with publication.

The effects of pharmacist interventions on adult outpatients with cancer: A systematic review.

PubMed

Colombo, L R P; Aguiar, P M; Lima, T M; Storpirtis, S

2017-08-01

Most antineoplastic drugs are highly toxic and have low therapeutic indexes, which can result in drug-related problems. In this context, pharmacist interventions may play an important role in the success of the treatment. The objective of this study was to examine the effects of pharmacist interventions on adult outpatients with cancer using antineoplastic drugs. A literature search was performed using PubMed, ISI Web of Science and LILACS databases from January 1990 to April 2016, using MeSH terms or text words related to pharmacist interventions, cancer and outpatient care. Studies published in English, Portuguese or Spanish on the effects of pharmacist interventions in outcome measures in adult outpatients with cancer were included. Two independent authors performed study selection and data extraction with a consensus process. The articles were analysed according to previously established criteria, such as country, study design, setting, population, type of cancer, description of the intervention and control groups, outcomes, main conclusions and study limitations. A total of 874 records were identified, of which 11 satisfied the inclusion criteria. The studies were conducted mainly in the United States and included patients aged >50 years. Most studies had a before-after design. Pharmacist interventions primarily included educating and counselling patients on the management of adverse events. Rates of nausea and vomiting control, medication adherence and patient satisfaction were the most common outcome measures; a significant benefit in these parameters as a result of pharmacist interventions was noted in most studies. The findings from this systematic review indicate that pharmacist interventions can improve outcome measures in outpatients with cancer. However, the collective quality of the studies was poor and gaps identified indicate that further research is needed to provide more robust results. © 2017 John Wiley & Sons Ltd.

Selective reporting bias of harm outcomes within studies: findings from a cohort of systematic reviews.

PubMed

Saini, Pooja; Loke, Yoon K; Gamble, Carrol; Altman, Douglas G; Williamson, Paula R; Kirkham, Jamie J

2014-11-21

To determine the extent and nature of selective non-reporting of harm outcomes in clinical studies that were eligible for inclusion in a cohort of systematic reviews. Cohort study of systematic reviews from two databases. Outcome reporting bias in trials for harm outcomes (ORBIT II) in systematic reviews from the Cochrane Library and a separate cohort of systematic reviews of adverse events. 92 systematic reviews of randomised controlled trials and non-randomised studies published in the Cochrane Library between issue 9, 2012 and issue 2, 2013 (Cochrane cohort) and 230 systematic reviews published between 1 January 2007 and 31 December 2011 in other publications, synthesising data on harm outcomes (adverse event cohort). A 13 point classification system for missing outcome data on harm was developed and applied to the studies. 86% (79/92) of reviews in the Cochrane cohort did not include full data from the main harm outcome of interest of each review for all of the eligible studies included within that review; 76% (173/230) for the adverse event cohort. Overall, the single primary harm outcome was inadequately reported in 76% (705/931) of the studies included in the 92 reviews from the Cochrane cohort and not reported in 47% (4159/8837) of the 230 reviews in the adverse event cohort. In a sample of primary studies not reporting on the single primary harm outcome in the review, scrutiny of the study publication revealed that outcome reporting bias was suspected in nearly two thirds (63%, 248/393). The number of reviews suspected of outcome reporting bias as a result of missing or partially reported harm related outcomes from at least one eligible study is high. The declaration of important harms and the quality of the reporting of harm outcomes must be improved in both primary studies and systematic reviews. © Saini et al 2014.

A randomized controlled trial of pre-conception treatment for periodontal disease to improve periodontal status during pregnancy and birth outcomes.

PubMed

Jiang, Hong; Xiong, Xu; Su, Yi; Zhang, Yiming; Wu, Hongqiao; Jiang, Zhijun; Qian, Xu

2013-12-09

Evidence has suggested that periodontal disease is associated with an increased risk of various adverse pregnancy and birth outcomes. However, several large clinical randomized controlled trials failed to demonstrate periodontal therapy during pregnancy reduced the incidence of adverse pregnancy and birth outcomes. It has been suggested that the pre-conception period may be an optimal period for periodontal disease treatment rather than during pregnancy. To date, no randomized controlled trial (RCT) has examined if treating periodontal disease before pregnancy reduces adverse birth outcomes. This study aims to examine if the pre-conception treatment of periodontal disease will lead to improved periodontal status during late pregnancy and subsequent birth outcomes. A sample of 470 (235 in each arm of the study) pre-conception women who plan to conceive within one year and with periodontal disease will be recruited for the study. All participants will be randomly allocated to the intervention or control group. The intervention group will receive free therapy including dental scaling and root planning (the standard therapy), supragingival prophylaxis, and oral hygiene education. The control group will only receive supragingival prophylaxis and oral hygiene education. Women will be followed throughout their pregnancy and then to childbirth. The main outcomes include periodontal disease status in late pregnancy and birth outcomes measured such as mean birth weight (grams), and mean gestational age (weeks). Periodontal disease will be diagnosed through a dental examination by measuring probing depth, clinical attachment loss and percentage of bleeding on probing (BOP) between gestational age of 32 and 36 weeks. Local and systemic inflammatory mediators are also included as main outcomes. This will be the first RCT to test whether treating periodontal disease among pre-conception women reduces periodontal disease during pregnancy and prevents adverse birth outcomes. If the effect of pre-pregnancy periodontal treatment is confirmed, this intervention could be recommended for application in low- or middle-income countries to improve both oral health and maternal and child health. This trial is registered with Chinese Clinical Trial Registry (ChiCTR): ChiCTR-TRC-12001913.

Prevalence of primary outcome changes in clinical trials registered on ClinicalTrials.gov: a cross-sectional study.

PubMed

Ramagopalan, Sreeram; Skingsley, Andrew P; Handunnetthi, Lahiru; Klingel, Michelle; Magnus, Daniel; Pakpoor, Julia; Goldacre, Ben

2014-01-01

An important principle in the good conduct of clinical trials is that a summary of the trial protocol, with a pre-defined primary outcome, should be freely available before the study commences. The clinical trials registry ClinicalTrials.gov provides one method of doing this, and once the trial is registered, any changes made to the primary outcome are documented. The objectives of this study were: to assess the proportion of registered trials on ClinicalTrials.gov that had the primary outcome changed; to assess when the primary outcome was changed in relation to the listed study start and end dates and to assess whether the primary outcome change had any relation to the study sponsor. A cross-sectional analysis of all interventional clinical trials registered on ClinicalTrials.gov as of 25 October 2012 was performed. The main outcome was any change made to the initially listed primary outcome and the time of the change in relation to the trial start and end date. Our analysis showed that 28229 of 89204 (31.7%) registered studies had their primary outcome changed.  Industry funding was associated with all primary outcome changes, odds ratio (OR)= 1.36, 95% confidence interval (CI)=1.31-1.41, p<0.001; with primary outcome changes after study start date OR=1.37, 95% CI=1.32-1.42, p<0.001; with primary outcome changes after primary completion date OR=1.84, 95% CI=1.75-1.94, p<0.001 and with primary outcome changes after study completion date OR=1.82, 95% CI=1.73-1.91, p<0.001.  Conclusions A significant proportion of interventional trials registered on ClinicalTrials.gov have their primary outcomes altered after the listed study start and completion dates. These changes are associated with funding source.

Does public reporting influence quality, patient and provider's perspective, market share and disparities? A review.

PubMed

Vukovic, Vladimir; Parente, Paolo; Campanella, Paolo; Sulejmani, Adela; Ricciardi, Walter; Specchia, Maria Lucia

2017-12-01

Public reporting (PR) of healthcare (HC) provider's quality was proposed as a public health instrument for providing transparency and accountability in HC. Our aim was to assess the impact of PR on five main domains: quality improvement; patient choice, service utilization and market share; provider's perspective; patient experience; and unintended consequences. PubMed, Scopus, ISI WOS, and EconLit databases were searched to identify studies investigating relationships between PR and five main domains, published up to April 1, 2016. Sixty-two papers published between 1988 and 2015 were included. Nineteen studies investigated quality improvement, 19 studies explored the unintended consequences of PR, 10 explored the effects on market share, 10 on patients' choice, 7 evaluated the provider's perspective, 4 economic outcome, 4 service utilization, 2 purchasers' use of PR and 2 studies explored patient experiences. The effect of PR was diverse throughout the studies-mostly positive on: patient experience (100%), quality improvement (63%), patient choice, service utilization and market share (46%); mixed on provider's perspective and economic outcome (27%) and mainly negative on unintended consequences (68%). Our research covering different outcomes and settings reported that PR is associated with changes in HC provider's behavior and can influence market share. Unintended consequences are a concern of PR and should be taken into account when allocating HC resources. The experiences collected in this paper could give a snapshot about the impact of PR on a HC user's perception of the providers' quality of care, helping them to make empowered choices. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Patients' knowledge about the outcomes of thyroid biopsy: a patient survey.

PubMed

Singh Ospina, Naykky; Castaneda-Guarderas, Ana; Ward, Russell; Brito, Juan P; Maraka, Spyridoula; Zeballos Palacios, Claudia; Yost, Kathleen J; Dean, Diana S; Montori, Victor M

2018-06-16

Fine-needle aspiration biopsy of the thyroid is an increasingly common outpatient procedure. Patients are counseled about the indications and risks of this procedure and informed consent is obtained. We aimed to assess the extent to which patients acquired necessary knowledge during this process. Survey study conducted in a thyroid nodule clinic at a referral center. Adult patients who had just undergone a thyroid biopsy were asked to complete a survey, including eight questions regarding the indications and potential outcomes of thyroid biopsy. The main outcome of the study was to assess the patients' knowledge based on the response to each individual survey question. Two-hundred and ninety-seven patients were eligible, of which 196 (66%) completed the survey: most were women (76%), had adequate reading health literacy (95%) and a mean age of 58 years. Although 86% of patients correctly identified evaluation for thyroid cancer as the main indication for their biopsy, 56% were not aware of the likelihood of this diagnosis. Almost all (>90%) of respondents knew that results could be benign or malignant; fewer were aware of non-diagnostic (71%) or indeterminate (68%) outcomes, or of the need for additional diagnostic testing after the biopsy (33%). After undergoing thyroid biopsy, a high proportion of well-educated patients remained unaware of their risk for thyroid cancer, potential outcomes, and downstream consequences of their biopsy. This quality gap raises the possibility that informed consent procedures that meet legal standards may leave patients undergoing thyroid biopsy paradoxically uninformed.

Outcomes of organ donation in brain-dead patient's families: Ethical perspective.

PubMed

Ahmadian, Shamsi; Rahimi, Abolfazl; Khaleghi, Ebrahim

2017-01-01

The families of brain-dead patients have a significant role in the process of decision making for organ donation. Organ donation is a traumatic experience. The ethical responsibility of healthcare systems respecting organ donation is far beyond the phase of decision making for donation. The principles of donation-related ethics require healthcare providers and organ procurement organizations to respect donor families and protect them against any probable harm. Given the difficult and traumatic nature of donation-related experience, understanding the outcomes of donation appears crucial. The aim of this study was to explore the outcomes of organ donation for the families of brain-dead patients. This was a qualitative descriptive study to which a purposeful sample of 19 donor family members were recruited. Data were collected through holding in-depth semi-structured interviews with the participants. Data analysis was performed by following the qualitative content analysis approach developed by Elo and Kyngäs. The main category of the data was "Decision to organ donation: a challenge from conflict to transcendence." This main category consisted of 10 subcategories and 3 general categories. The general categories were "challenging outcomes," "reassuring outcomes," and "transcending outcomes." Ethical considerations: The study was approved by the regional ethical review board. The ethical principles of informed consent, confidentiality, and non-identification were used. Donor families experience different challenges which range from conflict and doubtfulness to confidence, satisfaction, and transcendence. Healthcare providers and organ procurers should not discontinue care and support provision to donor families after obtaining their consent to donate because the post-decision phase is also associated with different complexities and difficulties with which donor families may not be able to cope effectively. In order to help donor families achieve positive outcomes from the tragedy of significant loss, healthcare professionals need to facilitate the process of achieving confidence and transcendence by them.

Analysis of and reflection on bachelor thesis in nursing students: A descriptive study in Spain.

PubMed

Roca, Judith; Gros, Silvia; Canet, Olga

2018-06-11

The bachelor thesis, a final year subject to obtain a nursing degree, presents an ideal opportunity for the development and assessment of professional competencies. Thus, it is necessary to specify that the structure of the bachelor thesis works as an element of review and reflection from both a pedagogical and professional perspective. To analyse the main elements of the bachelor thesis in the nursing degree 2015-16 in Spain. A transversal descriptive study was conducted using a quantitative documentary analysis via study guides or grade reports. The variables were the main academic elements of the bachelor thesis subject (credits, competencies, learning outcomes, contents, methodologies, training activities and assessment). A probabilistic sample of 66 institutions was studied using descriptive statistics with statistical measures of central tendency and measures of variability. The results showed a maximum range of 12 and a minimum of 6 European Credit Transfer and Accumulation System. The definition and number of competencies to be developed varied and the learning outcomes were formulated in only 40.9% of the guides consulted. The most widely used teaching methodologies and training activities were academic supervision (87.9%) and autonomous work (80.3%). Regarding types of work, basic investigation (34.8%), care plans (33.3%) and literature review (30,3%) ranked highest. No specific descriptors could be linked to the contents. Finally, two main assessment tools were found: process and product. The rubric is presented as a main element of the assessment. The bachelor thesis is conceived as autonomous, personal and original academic work. But no homogeneity was observed in the key development elements such as competencies, teaching strategies, or type of bachelor thesis. Therefore, the findings from the analysis and the bibliographic review are presented as recommendations as regards the outcome, structure and/or teaching elements linked to the bachelor thesis. Copyright © 2018 Elsevier Ltd. All rights reserved.

Investigations of Crashes Involving Pregnant Occupants

PubMed Central

Klinich, Kathleen DeSantis; Schneider, Lawrence W.; Moore, Jamie L.; Pearlman, Mark D.

2000-01-01

Case reports of 16 crashes involving pregnant occupants are presented that illustrate the main conclusions of a crash-investigation program that includes 42 crashes investigated to date. Some unusual cases that are exceptions to the overall trends are also described. The study indicates a strong association between adverse fetal outcome and both crash severity and maternal injury. Proper restraint use, with and without airbag deployment, generally leads to acceptable fetal outcomes in lower severity crashes, while it does not affect fetal outcome in high-severity crashes. Compared to properly restrained pregnant occupants, improperly restrained occupants have a higher risk of adverse fetal outcome in lower severity crashes, which comprise the majority of all motor-vehicle collisions. PMID:11558095

Impact of cooking and home food preparation interventions among adults: outcomes and implications for future programs.

PubMed

Reicks, Marla; Trofholz, Amanda C; Stang, Jamie S; Laska, Melissa N

2014-01-01

Cooking programs are growing in popularity; however, an extensive review has not examined their overall impact. Therefore, this study reviewed previous research on cooking/home food preparation interventions and diet and health-related outcomes among adults and identified implications for practice and research. Literature review and descriptive summative method. Dietary intake, knowledge/skills, cooking attitudes and self-efficacy/confidence, health outcomes. Articles evaluating the effectiveness of interventions that included cooking/home food preparation as the primary aim (January, 1980 through December, 2011) were identified via Ovid MEDLINE, Agricola, and Web of Science databases. Studies grouped according to design and outcomes were reviewed for validity using an established coding system. Results were summarized for several outcome categories. Of 28 studies identified, 12 included a control group with 6 as nonrandomized and 6 as randomized controlled trials. Evaluation was done postintervention for 5 studies, pre- and postintervention for 23, and beyond postintervention for 15. Qualitative and quantitative measures suggested a positive influence on main outcomes. However, nonrigorous study designs, varying study populations, and the use of nonvalidated assessment tools limited stronger conclusions. Well-designed studies are needed that rigorously evaluate long-term impact on cooking behavior, dietary intake, obesity and other health outcomes. Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

[Nursing students' satisfaction and perception of their first clinical placement: observational study].

PubMed

Comparcini, Dania; Simonetti, Valentina; Tomietto, Marco; Galli, Francesco; Fiorani, Catia; Di Labio, Luisa; Cicolini, Giancarlo

2014-01-01

Clinical learning environments are defined as an interactive network of forces within the clinical context that influence students' learning outcomes. Nursing students' satisfaction could be strictly related to their learning outcomes. Aim. To analyze the first year nursing students' clinical learning experience and to identify the main determinants of students' satisfaction. The observational study was carried out in five Italian nursing degree courses. 420 students filled out the validated Italian version of the "Clinical Learning Environment and Supervision plus Nurse Teacher (CLES+T) scale" after the conclusion of their first clinical placement. The mean values of the main sub-dimensions of CLES+T varied from 4.02 (pedagogical atmosphere) to 3.30 (supervisory relationship). Students were mainly satisfied with their clinical placement, however the findings showed statistical significantly differences among the five nursing courses. The main determinants of the overall students' satisfaction are the nurse manager's leadership style and the integration between theoretical knowledge and everyday practice of nursing through the relationship among students, clinical tutors and nurse teacher. Our results may contribute to better understand nursing students' perception of their first clinical placement. However, further research are needed to evaluate which organizational factors and clinical training models may enhance the clinical learning experience.

Maternal total caffeine intake, mainly from Japanese and Chinese tea, during pregnancy was associated with risk of preterm birth: the Osaka Maternal and Child Health Study.

PubMed

Okubo, Hitomi; Miyake, Yoshihiro; Tanaka, Keiko; Sasaki, Satoshi; Hirota, Yoshio

2015-04-01

The relation of maternal caffeine intake with birth outcomes is still inconclusive and has not been examined in Japan, where the sources of caffeine intake are different from those in Western countries. We hypothesized that maternal consumption of total caffeine and culture-specific major sources of caffeine would be associated with birth outcomes among Japanese pregnant. The study subjects were 858 Japanese women who delivered singleton infants. Maternal diet during pregnancy was assessed using a validated, self-administered diet history questionnaire. Birth outcomes considered were low birth weight (LBW; <2500 g), preterm birth (PTB; <37 weeks of gestation), and small for gestational age (SGA; <10th percentile). The main caffeine sources were Japanese and Chinese tea (73.5%), coffee (14.3%), black tea (6.6%), and soft drinks (3.5%). After controlling for confounders, maternal total caffeine intake during pregnancy was significantly associated with an increased risk of PTB (odds ratio per 100 mg/d caffeine increase, 1.28; 95% confidence interval, 1.03-1.58; P for trend = .03). However, no evident relationships were observed between total caffeine intake and risk of LBW or SGA. As for caffeine sources, higher Japanese and Chinese tea consumption was associated with an increased risk of PTB (odds ratio per 1 cup/d increase, 1.14; 95% confidence interval, 1.00-1.30; P for trend = .04), but not LBW or SGA. There were no associations between consumption of the other beverages examined and birth outcomes. In conclusion, this prospective birth cohort in Japan suggests that higher maternal total caffeine intake, mainly in the form of Japanese and Chinese tea, during pregnancy is associated with a greater risk of PTB. Copyright © 2015 Elsevier Inc. All rights reserved.

77 FR 32952 - Notice of Proposed Collection Requests; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-04

... has two main components: (1) A review of recent research on the identification of ELs with special... descriptive in nature. The study is not a program evaluation and does not purport to assess program outcomes...

Maine Technical College System Annual Report, 1996.

ERIC Educational Resources Information Center

Fitzsimmons, John

Focusing on the 1995-96 academic year, this report discusses programs and outcomes for the seven colleges in the Maine Technical College System (MTCS). Following a message from the System President, general outcomes for the MTCS are described. This section indicates that systemwide enrollment in fall 1995 was 4,475, representing a 24% increase…

Effect of progressive muscle relaxation versus intake of ginger powder on dysmenorrhoea amongst the nursing students in Pune.

PubMed

Halder, Annesa

2012-01-01

The present study was conducted to examine the comparative efficacy of progressive muscle relaxation and the oral intake of ginger on symptoms of dysmenorrhoea among nursing students of Pune, Maharashtra. The study students (n = 75) were divided into three groups, two experimental and one control Ginger powder 1 gm per dose was administered twice a day with warm water after meal to the second experimental group during the first three days of their menstruation. Main outcome measures were the severity of selected symptoms of dysmenorrhoea. The daily symptom calendar, a 5-point Likert Scale was used to assess the severity of selected symptoms of dysmenorrhoea. Main outcome measures were the severity of selected symptoms of dysmenorrhoea, which were analysed using MANOVA. It was concluded that in treating symptoms of dysmenorrhoea, ginger powder has efficacy superior to progressive muscle relaxation.

The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010.

PubMed

Baugh, Nancy; Harris, David E; Aboueissa, AbouEl-Makarim; Sarton, Cheryl; Lichter, Erika

2016-01-01

The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG) and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000-2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU), and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes.

Epidemiologic tools to study the influence of environmental factors on fecundity and pregnancy-related outcomes.

PubMed

Slama, Rémy; Ballester, Ferran; Casas, Maribel; Cordier, Sylvaine; Eggesbø, Merete; Iniguez, Carmen; Nieuwenhuijsen, Mark; Philippat, Claire; Rey, Sylvie; Vandentorren, Stéphanie; Vrijheid, Martine

2014-01-01

Adverse pregnancy outcomes entail a large health burden for the mother and offspring; a part of it might be avoided by better understanding the role of environmental factors in their etiology. Our aims were to review the assessment tools to characterize fecundity troubles and pregnancy-related outcomes in human populations and their sensitivity to environmental factors. For each outcome, we reviewed the possible study designs, main sources of bias, and their suggested cures. In terms of study design, for most pregnancy outcomes, cohorts with recruitment early during or even before pregnancy allow efficient characterization of pregnancy-related events, time-varying confounders, and in utero exposures that may impact birth outcomes and child health. Studies on congenital anomalies require specific designs, assessment of anomalies in medical pregnancy terminations, and, for congenital anomalies diagnosed postnatally, follow-up during several months after birth. Statistical analyses should take into account environmental exposures during the relevant time windows; survival models are an appropriate approach for fecundity, fetal loss, and gestational duration/preterm delivery. Analysis of gestational duration could distinguish pregnancies according to delivery induction (and possibly pregnancy-related conditions). In conclusion, careful design and analysis are required to better characterize environmental effects on human reproduction.

Influence of quality of care and individual patient characteristics on quality of life and return to work in survivors of the acute respiratory distress syndrome: protocol for a prospective, observational, multi-centre patient cohort study (DACAPO).

PubMed

Brandstetter, Susanne; Dodoo-Schittko, Frank; Blecha, Sebastian; Sebök, Philipp; Thomann-Hackner, Kathrin; Quintel, Michael; Weber-Carstens, Steffen; Bein, Thomas; Apfelbacher, Christian

2015-12-17

Health-related quality of life (HRQoL) and return to work are important outcomes in critical care medicine, reaching beyond mortality. Little is known on factors predictive of HRQoL and return to work in critical illness, including the acute respiratory distress syndrome (ARDS), and no evidence exists on the role of quality of care (QoC) for outcomes in survivors of ARDS. It is the aim of the DACAPO study ("Surviving ARDS: the influence of QoC and individual patient characteristics on quality of life") to investigate the role of QoC and individual patient characteristics on quality of life and return to work. A prospective, observational, multi-centre patient cohort study will be performed in Germany, using hospitals from the "ARDS Network Germany" as the main recruiting centres. It is envisaged to recruit 2400 patients into the DACAPO study and to analyse a study population of 1500 survivors. They will be followed up until 12 months after discharge from hospital. QoC will be assessed as process quality, structural quality and volume at the institutional level. The main outcomes (HRQoL and return to work) will be assessed by self-report questionnaires. Further data collection includes general medical and ARDS-related characteristics of patients as well as sociodemographic and psycho-social parameters. Multilevel hierarchical modelling will be performed to analyse the effects of QoC and individual patient characteristics on outcomes, taking the cluster structure of the data into account. By obtaining comprehensive data at patient and hospital level using a prospective multi-centre design, the DACAPO-study is the first study investigating the influence of QoC on individual outcomes of ARDS survivors.

Effects of Detailed Illustrations on Science Learning: An Eye-Tracking Study

ERIC Educational Resources Information Center

Lin, Yu Ying; Holmqvist, Kenneth; Miyoshi, Kiyofumi; Ashida, Hiroshi

2017-01-01

The eye-tracking method was used to assess the influence of detailed, colorful illustrations on reading behaviors and learning outcomes. Based on participants' subjective ratings in a pre-study, we selected eight one-page human anatomy lessons. In the main study, participants learned these eight human anatomy lessons; four were accompanied by…

Can aircraft noise less than or equal 115 to dBA adversely affect reproductive outcome in USAF women?

NASA Astrophysics Data System (ADS)

Brubaker, P. A.

1985-06-01

It has been suggested, mainly through animal studies, that exposure to high noise levels may be associated with lower birth weight, reduced gestational length and other adverse reproductive outcomes. Few studies have been done on humans to show this association. The Air Force employs pregnant women in areas where there is a high potential for exposure to high noise levels. This study proposes a method to determine if there is an association between high frequency noise levels or = 115 dBA and adverse reproductive outcomes through a review of records and self-administered questionnaires in a case-comparison design. Prevelance rates will be calculated and a multiple logistic regression analysis computed for the independent variables that can affect reproduction.

Severe traumatic brain injury management and clinical outcome using the Lund concept.

PubMed

Koskinen, L-O D; Olivecrona, M; Grände, P O

2014-12-26

This review covers the main principles of the Lund concept for treatment of severe traumatic brain injury. This is followed by a description of results of clinical studies in which this therapy or a modified version of the therapy has been used. Unlike other guidelines, which are based on meta-analytical approaches, important components of the Lund concept are based on physiological mechanisms for regulation of brain volume and brain perfusion and to reduce transcapillary plasma leakage and the need for plasma volume expanders. There have been nine non-randomized and two randomized outcome studies with the Lund concept or modified versions of the concept. The non-randomized studies indicated that the Lund concept is beneficial for outcome. The two randomized studies were small but showed better outcome in the groups of patients treated according to the modified principles of the Lund concept than in the groups given a more conventional treatment. Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.

A dose-ranging study evaluating once-daily oral administration of the factor Xa inhibitor rivaroxaban in the treatment of patients with acute symptomatic deep vein thrombosis: the Einstein-DVT Dose-Ranging Study.

PubMed

Buller, Harry R; Lensing, Anthonie W A; Prins, Martin H; Agnelli, Giancarlo; Cohen, Alexander; Gallus, Alexander S; Misselwitz, Frank; Raskob, Gary; Schellong, Sebastian; Segers, Annelise

2008-09-15

We performed a randomized dose-ranging study, double-blind for rivaroxaban doses and open-label for the comparator (low-molecular-weight heparin followed by vitamin K antagonists) to assess the optimal dose of rivaroxaban for the treatment of deep vein thrombosis. A total of 543 patients with acute deep-venous thrombosis received rivaroxaban 20, 30, or 40 mg once daily or comparator. Treatment lasted for 84 days. The primary efficacy outcome was the 3-month incidence of the composite of symptomatic venous thromboembolic complications and asymptomatic deterioration in thrombotic burden as assessed by comparison of ultrasound and perfusion lung scanning at day 84 with baseline. The main safety outcome was the composite of major bleeding and clinically relevant nonmajor bleeding. A total of 449 (83%) of the 543 patients could be included in the per-protocol population. The primary efficacy outcome occurred in 6.1%, 5.4%, and 6.6% of the rivaroxaban 20-, 30-, and 40-mg treatment groups, respectively, and in 9.9% of those receiving standard therapy. The main safety outcome occurred in 5.9%, 6.0%, and 2.2% of the rivaroxaban 20-, 30-, and 40-mg treatment groups, respectively, and in 8.8% of those receiving standard therapy. These results with simple fixed-dose oral regimens justify phase 3 evaluations (www.ClinicalTrials.gov no.NCT00395772).

Gender Moderates the Progression from Fearful Temperament to Social Withdrawal through Protective Parenting.

PubMed

Kiel, Elizabeth J; Premo, Julie E; Buss, Kristin A

2016-05-01

Child gender may exert its influence on development, not as a main effect, but as a moderator among predictors and outcomes. We examined this notion in relations among toddler fearful temperament, maternal protective parenting, maternal accuracy in predicting toddler distress to novelty, and child social withdrawal. In two multi-method, longitudinal studies of toddlers (24 months at Time 1; n s = 93 and 117, respectively) and their mothers, few main effect gender differences occurred. Moderation existed in both studies: only for highly accurate mothers of boys, fearful temperament related to protective parenting, which then predicted later social withdrawal. Thus, studying only main-effect gender differences may obscure important differences in how boys and girls develop from fearful temperament to later social withdrawal.

Assessing Learners' Perceived Readiness for Computer-Supported Collaborative Learning (CSCL): A Study on Initial Development and Validation

ERIC Educational Resources Information Center

Xiong, Yao; So, Hyo-Jeong; Toh, Yancy

2015-01-01

The main purpose of this study was to develop an instrument that assesses university students' perceived readiness for computer-supported collaborative learning (CSCL). Assessment in CSCL research had predominantly focused on measuring "after-collaboration" outcomes and "during-collaboration" behaviors while…

Human Rights Education in Social Studies in the Netherlands: A Case Study Textbook Analysis

ERIC Educational Resources Information Center

de Kort, Frauke

2017-01-01

Citizenship education is one of the main aims of the mandated subject of social studies in secondary schools in the Netherlands. Moreover, the learning outcomes of social studies refer to constitutional rights. Internationally, citizenship education and human rights education are considered to be mutually reinforcing. One may, thus, expect that…

Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group.

PubMed

Vergouwen, Mervyn D I; Vermeulen, Marinus; van Gijn, Jan; Rinkel, Gabriel J E; Wijdicks, Eelco F; Muizelaar, J Paul; Mendelow, A David; Juvela, Seppo; Yonas, Howard; Terbrugge, Karel G; Macdonald, R Loch; Diringer, Michael N; Broderick, Joseph P; Dreier, Jens P; Roos, Yvo B W E M

2010-10-01

In clinical trials and observational studies there is considerable inconsistency in the use of definitions to describe delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. A major cause for this inconsistency is the combining of radiographic evidence of vasospasm with clinical features of cerebral ischemia, although multiple factors may contribute to DCI. The second issue is the variability and overlap of terms used to describe each phenomenon. This makes comparisons among studies difficult. An international ad hoc panel of experts involved in subarachnoid hemorrhage research developed and proposed a definition of DCI to be used as an outcome measure in clinical trials and observational studies. We used a consensus-building approach. It is proposed that in observational studies and clinical trials aiming to investigate strategies to prevent DCI, the 2 main outcome measures should be: (1) cerebral infarction identified on CT or MRI or proven at autopsy, after exclusion of procedure-related infarctions; and (2) functional outcome. Secondary outcome measure should be clinical deterioration caused by DCI, after exclusion of other potential causes of clinical deterioration. Vasospasm on angiography or transcranial Doppler can also be used as an outcome measure to investigate proof of concept but should be interpreted in conjunction with DCI or functional outcome. The proposed measures reflect the most relevant morphological and clinical features of DCI without regard to pathogenesis to be used as an outcome measure in clinical trials and observational studies.

Causal illusions in children when the outcome is frequent

PubMed Central

2017-01-01

Causal illusions occur when people perceive a causal relation between two events that are actually unrelated. One factor that has been shown to promote these mistaken beliefs is the outcome probability. Thus, people tend to overestimate the strength of a causal relation when the potential consequence (i.e. the outcome) occurs with a high probability (outcome-density bias). Given that children and adults differ in several important features involved in causal judgment, including prior knowledge and basic cognitive skills, developmental studies can be considered an outstanding approach to detect and further explore the psychological processes and mechanisms underlying this bias. However, the outcome density bias has been mainly explored in adulthood, and no previous evidence for this bias has been reported in children. Thus, the purpose of this study was to extend outcome-density bias research to childhood. In two experiments, children between 6 and 8 years old were exposed to two similar setups, both showing a non-contingent relation between the potential cause and the outcome. These two scenarios differed only in the probability of the outcome, which could either be high or low. Children judged the relation between the two events to be stronger in the high probability of the outcome setting, revealing that, like adults, they develop causal illusions when the outcome is frequent. PMID:28898294

Maine Technical College System 1993/1994 Annual Report.

ERIC Educational Resources Information Center

Maine Technical Coll. System, Augusta.

Focusing on data from the 1993-94 academic year, this report discusses programs and outcomes for the seven colleges in the Maine Technical College System (MTCS). Following a message from the System President, general outcomes for the MTCS are described. This section indicates that systemwide enrollment in 1993-94 was 4,305, representing a 19%…

Child maltreatment prevention: a systematic review of reviews

PubMed Central

Butchart, Alexander

2009-01-01

Abstract Objective To synthesize recent evidence from systematic and comprehensive reviews on the effectiveness of universal and selective child maltreatment prevention interventions, evaluate the methodological quality of the reviews and outcome evaluation studies they are based on, and map the geographical distribution of the evidence. Methods A systematic review of reviews was conducted. The quality of the systematic reviews was evaluated with a tool for the assessment of multiple systematic reviews (AMSTAR), and the quality of the outcome evaluations was assessed using indicators of internal validity and of the construct validity of outcome measures. Findings The review focused on seven main types of interventions: home visiting, parent education, child sex abuse prevention, abusive head trauma prevention, multi-component interventions, media-based interventions, and support and mutual aid groups. Four of the seven – home-visiting, parent education, abusive head trauma prevention and multi-component interventions – show promise in preventing actual child maltreatment. Three of them – home visiting, parent education and child sexual abuse prevention – appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on. An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low- and middle-income countries and make up only 0.6% of the total evidence base. Conclusion Evidence for the effectiveness of four of the seven main types of interventions for preventing child maltreatment is promising, although it is weakened by methodological problems and paucity of outcome evaluations from low- and middle-income countries. PMID:19551253

Significance of off-pump coronary artery bypass grafting compared with percutaneous coronary intervention: a propensity score analysis.

PubMed

Marui, Akira; Kimura, Takeshi; Tanaka, Shiro; Furukawa, Yutaka; Kita, Toru; Sakata, Ryuzo

2012-01-01

Although there have been several studies that compared the efficacy of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), the impact of off-pump CABG (OPCAB) has not been well elucidated. The objective of the present study was to compare the outcomes after PCI, on-pump CABG (ONCAB), and OPCAB in patients with multivessel and/or left main disease. Among the 9877 patients undergoing first PCI using bare-metal stents or CABG who were enrolled in the CREDO-Kyoto Registry, 6327 patients with multivessel and/or left main disease were enrolled into the present study (67.9±9.8 years old). Among them, 3877 patients received PCI, 1388 ONCAB, and 1069 OPCAB. Median follow-up was 3.5 years. Comparing PCI with all CABG (ONCAB and OPCAB), propensity-score-adjusted all-cause mortality after PCI was higher than that CABG (hazard ratio (95% confidence interval): 1.37 (1.15-1.63), p<0.01). The incidence of stroke was lower after PCI than that after CABG (0.75 (0.59-0.96), p=0.02). CABG was associated with better survival outcomes than PCI in the elderly (interaction p=0.04). Comparing OPCAB with PCI or ONCAB, propensity-score-adjusted all-cause mortality after PCI was higher than that after OPCAB (1.50 (1.20-1.86), p<0.01). Adjusted mortality was similar between ONCAB and OPCAB (1.18 (0.93-1.51), p=0.33). The incidence of stroke after OPCAB was similar to that after PCI (0.98 (0.71-1.34), p>0.99), but incidence of stroke after ONCAB was higher than that after OPCAB (1.59 (1.16-2.18), p<0.01). In patients with multivessel and/or left main disease, CABG, particularly OPCAB, is associated with better survival outcomes than PCI using bare-metal stents. Survival outcomes are similar between ONCAB and OPCAB.

Drug utilization and medication costs at the end of life.

PubMed

Pont, Lisa; Jansen, Kristian; Schaufel, Margrete Aase; Haugen, Dagny Faksvåg; Ruths, Sabine

2016-01-01

In the end stages of life, drug treatment goals shift to symptom control and quality of life and as such changes in drug utilization are expected. The aim of this paper is to review the extent to which costs are considered in drug utilization research at the end of life, with a particular focus on the outcome measures being used. This systematic review identified seven studies across varied settings studies reporting both drug utilization and medication cost outcome measures. The main factors identified that impacted medication use and cost were the time period considered and the provision of specialist palliative care services. Combining drug utilization and medication cost outcomes is critical for the allocation of healthcare resources and the development of a sound health policy.

Epidemiology of end-stage renal disease in the countries of the Gulf Cooperation Council: a systematic review

PubMed Central

Hassanien, Amal A.; Al-Shaikh, Fahdah; Vamos, Eszter P.; Yadegarfar, Ghasem; Majeed, Azeem

2012-01-01

Objectives To describe the epidemiology of end stage renal disease (ESRD). Design Mixed-methods systematic review. Setting The countries of the Gulf Cooperation Council (GCC) which consist of Saudi Arabia, the United Arab Emirates, Kuwait, Qatar, Bahrain, and Oman. Participants Defined to have ESRD or patients on regular dialysis for a minimum dialysis period of at least three months. Since many outcomes were reviewed, studies that estimated the incidence and prevalence of ESRD as outcomes should not have defined the study population as ESRD population or patients on regular dialysis. Studies where the study population mainly comprised children or pregnant woman were excluded. Main outcome measures The trends of the incidence, prevalence, and mortality rate of ESRD; also, causes of mortality, primary causes and co-morbid conditions associated with ESRD. Results 44 studies included in this review show that the incidence of ESRD has increased while the prevalence and mortality rate of ESRD in the GCC has not been reported sufficiently. The leading primary causes of ESRD recorded in the countries of the GCC is diabetes with the most prevalent co-morbid conditions being Hypertension and Hepatitis C Virus infection; the most common cause of death was cardiovascular disease and sepsis. Conclusions This review highlights that the lack of national renal registries data is a critical issue in the countries of the GCC. The available data also do not provide an accurate and updated estimate for relevant outcomes. Additionally, considering the increasing burden of chronic kidney disease (CKD), these results stressed the needs and the importance of preventative strategies for leading causes of ESRD. Furthermore, more studies are needed to describe the epidemiology of ESRD and for assessing the overall quality of renal care. PMID:22768372

Factors predicting sensory and motor recovery after the repair of upper limb peripheral nerve injuries

PubMed Central

He, Bo; Zhu, Zhaowei; Zhu, Qingtang; Zhou, Xiang; Zheng, Canbin; Li, Pengliang; Zhu, Shuang; Liu, Xiaolin; Zhu, Jiakai

2014-01-01

OBJECTIVE: To investigate the factors associated with sensory and motor recovery after the repair of upper limb peripheral nerve injuries. DATA SOURCES: The online PubMed database was searched for English articles describing outcomes after the repair of median, ulnar, radial, and digital nerve injuries in humans with a publication date between 1 January 1990 and 16 February 2011. STUDY SELECTION: The following types of article were selected: (1) clinical trials describing the repair of median, ulnar, radial, and digital nerve injuries published in English; and (2) studies that reported sufficient patient information, including age, mechanism of injury, nerve injured, injury location, defect length, repair time, repair method, and repair materials. SPSS 13.0 software was used to perform univariate and multivariate logistic regression analyses and to investigate the patient and intervention factors associated with outcomes. MAIN OUTCOME MEASURES: Sensory function was assessed using the Mackinnon-Dellon scale and motor function was assessed using the manual muscle test. Satisfactory motor recovery was defined as grade M4 or M5, and satisfactory sensory recovery was defined as grade S3+ or S4. RESULTS: Seventy-one articles were included in this study. Univariate and multivariate logistic regression analyses showed that repair time, repair materials, and nerve injured were independent predictors of outcome after the repair of nerve injuries (P < 0.05), and that the nerve injured was the main factor affecting the rate of good to excellent recovery. CONCLUSION: Predictors of outcome after the repair of peripheral nerve injuries include age, gender, repair time, repair materials, nerve injured, defect length, and duration of follow-up. PMID:25206870

Clinical outcomes after estimated versus calculated activity of radioiodine for the treatment of hyperthyroidism: systematic review and meta-analysis.

PubMed

de Rooij, A; Vandenbroucke, J P; Smit, J W A; Stokkel, M P M; Dekkers, O M

2009-11-01

Despite the long experience with radioiodine for hyperthyroidism, controversy remains regarding the optimal method to determine the activity that is required to achieve long-term euthyroidism. To compare the effect of estimated versus calculated activity of radioiodine in hyperthyroidism. Design Systematic review and meta-analysis. We searched the databases Medline, EMBASE, Web of Science, and Cochrane Library for randomized and nonrandomized studies, comparing the effect of activity estimation methods with dosimetry for hyperthyroidism. The main outcome measure was the frequency of treatment success, defined as persistent euthyroidism after radioiodine treatment at the end of follow-up in the dose estimated and calculated dosimetry group. Furthermore, we assessed the cure rates of hyperthyroidism. Three randomized and five nonrandomized studies, comparing the effect of estimated versus calculated activity of radioiodine on clinical outcomes for the treatment of hyperthyroidism, were included. The weighted mean relative frequency of successful treatment outcome (euthyroidism) was 1.03 (95% confidence interval (CI) 0.91-1.16) for estimated versus calculated activity; the weighted mean relative frequency of cure of hyperthyroidism (eu- or hypothyroidism) was 1.03 (95% CI 0.96-1.10). Subgroup analysis showed a relative frequency of euthyroidism of 1.03 (95% CI 0.84-1.26) for Graves' disease and of 1.05 (95% CI 0.91-1.19) for toxic multinodular goiter. The two main methods used to determine the activity in the treatment of hyperthyroidism with radioiodine, estimated and calculated, resulted in an equally successful treatment outcome. However, the heterogeneity of the included studies is a strong limitation that prevents a definitive conclusion from this meta-analysis.

Network for Surveillance of Severe Maternal Morbidity: a powerful national collaboration generating data on maternal health outcomes and care.

PubMed

Cecatti, J G; Costa, M L; Haddad, S M; Parpinelli, M A; Souza, J P; Sousa, M H; Surita, F G; Pinto E Silva, J L; Pacagnella, R C; Passini, R

2016-05-01

To identify cases of severe maternal morbidity (SMM) during pregnancy and childbirth, their characteristics, and to test the feasibility of scaling up World Health Organization criteria for identifying women at risk of a worse outcome. Multicentre cross-sectional study. Twenty-seven referral maternity hospitals from all regions of Brazil. Cases of SMM identified among 82 388 delivering women over a 1-year period. Prospective surveillance using the World Health Organization's criteria for potentially life-threatening conditions (PLTC) and maternal near-miss (MNM) identified and assessed cases with severe morbidity or death. Indicators of maternal morbidity and mortality; sociodemographic, clinical and obstetric characteristics; gestational and perinatal outcomes; main causes of morbidity and delays in care. Among 9555 cases of SMM, there were 140 deaths and 770 cases of MNM. The main determining cause of maternal complication was hypertensive disease. Criteria for MNM conditions were more frequent as the severity of the outcome increased, all combined in over 75% of maternal deaths. This study identified around 9.5% of MNM or death among all cases developing any severe maternal complication. Multicentre studies on surveillance of SMM, with organised collaboration and adequate study protocols can be successfully implemented, even in low-income and middle-income settings, generating important information on maternal health and care to be used to implement appropriate health policies and interventions. Surveillance of severe maternal morbidity was proved to be possible in a hospital network in Brazil. © 2015 Royal College of Obstetricians and Gynaecologists.

ADA Title I allegations and the Mining, Quarrying, and Oil/Gas Extraction industry.

PubMed

Van Wieren, Todd A; Rhoades, Laura; McMahon, Brian T

2017-01-01

The majority of research about employment discrimination in the U.S. Mining, Quarrying, and Oil/Gas (MQOGE) industries has concentrated on gender and race, while little attention has focused on disability. To explore allegations of Americans with Disabilities Act (ADA) Title I discrimination made to the Equal Employment Opportunity Commission (EEOC) by individuals with disabilities against MQOGE employers. Key data available to this study included demographic characteristics of charging parties, size of employers, types of allegations, and case outcomes. Using descriptive analysis, allegation profiles were developed for MQOGE's three main sectors (i.e., Oil/Gas Extraction, Mining except Oil/Gas, and Support Activities). These three profiles where then comparatively analyzed. Lastly, regression analysis explored whether some of the available data could partially predict MQOGE case outcomes. The predominant characteristics of MQOGE allegations were found to be quite similar to the allegation profile of U.S. private-sector industry as a whole, and fairly representative of MQOGE's workforce demographics. Significant differences between MQOGE's three main sector profiles were noted on some important characteristics. Lastly, it was found that MQOGE case outcomes could be partially predicted via some of the available variables. The study's limitations were presented and recommendations were offered for further research.

Adverse outcome pathways: a concise introduction for toxicologists

PubMed Central

Vergauwen, Lucia; Hengstler, Jan G.; Angrish, Michelle; Whelan, Maurice

2018-01-01

Adverse outcome pathways are designed to provide a clear-cut mechanistic representation of critical toxicological effects that propagate over different layers of biological organization from the initial interaction of a chemical with a molecular target to an adverse outcome at the individual or population level. Adverse outcome pathways are currently gaining momentum, especially in view of their many potential applications as pragmatic tools in the fields of human toxicology, ecotoxicology and risk assessment. A number of guidance documents, issued by the Organization for Economic Cooperation and Development, as well as landmark papers, outlining best practices to develop, assess and use adverse outcome pathways, have been published in the last few years. The present paper provides a synopsis of the main principles related to the adverse outcome pathway framework for the toxicologist less familiar with this area, followed by two case studies relevant for human toxicology and ecotoxicology. PMID:28660287

Reported positive and negative outcomes associated with a self-practice/self-reflection cognitive-behavioural therapy exercise for CBT trainees.

PubMed

Spendelow, Jason S; Butler, Lisa J

2016-09-01

The aim of the current study was to identify outcomes of a self-practice/self-reflection (SP/SR) exercise for trainee clinical psychologists. Thirty-two trainees enrolled in their first year of a UK university doctoral clinical psychology training programme completed an online questionnaire following an eight-week exercise. Findings indicated an endorsement of many previously reported benefits of exercise participation, but also the identification of negative outcomes. Thematic analysis of qualitative data revealed that outcomes could be grouped into two main thematic domains (individual task outcomes and task organization issues) along with several subordinate themes. SP/SR is a useful tool in the development of trainee CBT therapist competences. There has been limited previous recognition of potential negative outcomes from this type of exercise. However, these can provide additional impetus for therapist skill development.

Economic Analysis of Centralized vs. Decentralized Electronic Data Capture in Multi-Center Clinical Studies

PubMed Central

Walden, Anita; Nahm, Meredith; Barnett, M. Edwina; Conde, Jose G.; Dent, Andrew; Fadiel, Ahmed; Perry, Theresa; Tolk, Chris; Tcheng, James E.; Eisenstein, Eric L.

2012-01-01

Background New data management models are emerging in multi-center clinical studies. We evaluated the incremental costs associated with decentralized vs. centralized models. Methods We developed clinical research network economic models to evaluate three data management models: centralized, decentralized with local software, and decentralized with shared database. Descriptive information from three clinical research studies served as inputs for these models. Main Outcome Measures The primary outcome was total data management costs. Secondary outcomes included: data management costs for sites, local data centers, and central coordinating centers. Results Both decentralized models were more costly than the centralized model for each clinical research study: the decentralized with local software model was the most expensive. Decreasing the number of local data centers and case book pages reduced cost differentials between models. Conclusion Decentralized vs. centralized data management in multi-center clinical research studies is associated with increases in data management costs. PMID:21335692

Male fetuses are associated with increased risk for cesarean delivery in Malaysian nulliparae.

PubMed

Viegas, Osborn A C; Lee, Pei Sue; Lim, Keng Joo; Ravichandran, Jeganathan

2008-01-01

The association between fetal sex and outcome of pregnancy and labor has been well documented in western populations. However, no studies in Malaysia or other developing countries have examined the effect of fetal sex on such outcomes.The main objective of this study was to determine the influence of fetal sex on the outcome of labor at term in a cohort of Malaysian nulliparae.A retrospective observational study was designed using data from 4644 Malaysian nulliparae who gave birth consecutively to singleton male babies at Hospital Sultanah Aminah, Johor Bahru, after normal full-term pregnancies.The results of this study indicate that mothers giving birth to male infants have a greater risk of requiring cesarean delivery because male babies are heavier and have statistically significantly greater head circumference (P < .001). These findings concur with those obtained in western populations and suggest that the differences in outcome observed are biological, not dictated by race, ethnicity, or environmental conditions. Such information could help in the antenatal assessment of Malaysian patients and stimulate more comprehensive studies of the mechanisms involved in this sex-based difference in outcomes. Reasons for such differences are proposed.

#13ReasonsWhy Health Professionals and Educators are Tweeting: A Systematic Analysis of Uses and Perceptions of Show Content and Learning Outcomes.

PubMed

Walker, Kimberly K; Burns, Kelli

2018-04-27

This study is a content analysis of health professionals' and educators' tweets about a popular Netflix show that depicts teen suicide: 13 Reasons Why. A content analysis of 740 tweets was conducted to determine the main themes associated with professionals' and educators' tweets about the show, as well as the valence of the tweets. Additionally, a thematic analysis of linked content in tweets (n = 178) was conducted to explore additional content shared about the show and modeling outcomes. Results indicated the largest percentage of tweets was related to social learning, particularly about outcomes that could occur from viewing the show. The valence of the tweets about outcomes was more positive than negative. However, linked materials commonly circulated in tweets signified greater concern with unintended learning outcomes. Some of the linked content included media guidelines for reporting on suicide with recommendations that entertainment producers follow the guidelines. This study emphasizes the importance of including social learning objectives in future typologies of Twitter uses and demonstrates the importance of examining linked content in Twitter studies.

Association between funding, risk of bias, and outcome of randomised controlled trials in oral and maxillofacial surgery.

PubMed

Oomens, M A E M; Lazzari, S; Heymans, M W; Forouzanfar, T

2016-01-01

The influence of funding on the main outcome of a random control trial (RCT) is important, as it could potentially lead to bias towards industry, and results that are too optimistic. We investigated the association between funding, the published outcome, and the risk of bias in trials in oral and maxillofacial surgery (OMFS) published from January 2000 to May 2013 listed in PubMed. The methods used were scored using the risk of bias items given in a Delphi List. Sources of funding were recorded and categorised five ways: not funded, funded by industry, not funded by industry, supported by industry, and source of funds not clear. A total of 390 RCT met the inclusion criteria, and there was a correlation between funding and favourable main outcomes, although this was not significant. There was no correlation between the risk of bias and favourable results of the main outcome of a trial, or between the risk of bias and the reported source of funding in post-hoc analysis. We were unable to show a significant correlation between funding and a higher likelihood of a favourable result for the primary outcome in RCT in OMFS. We also failed to show a significant correlation between the risk of bias of a trial and its main outcome. In contrast, the source of funding proved to affect the risk of bias of a trial significantly, although not in post-hoc analysis. Funded trials were better organised, and so had a lower risk of bias. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Corruption and population health outcomes: an analysis of data from 133 countries using structural equation modeling.

PubMed

Factor, Roni; Kang, Minah

2015-09-01

The current study aims to develop a theoretical framework for understanding the antecedents of corruption and the effects of corruption on various health indicators. Using structural equation models, we analyzed a multinational dataset of 133 countries that included three main groups of variables--antecedents of corruption, corruption measures, and health indicators. Controlling for various factors, our results suggest that corruption rises as GDP per capita falls and as the regime becomes more autocratic. Higher corruption is associated with lower levels of health expenditure as a percentage of GDP per capita, and with poorer health outcomes. Countries with higher GDP per capita and better education for women have better health outcomes regardless of health expenditures and regime type. Our results suggest that there is no direct relationship between health expenditures and health outcomes after controlling for the other factors in the model. Our study enhances our understanding of the conceptual and theoretical links between corruption and health outcomes in a population, including factors that may mediate how corruption can affect health outcomes.

Organisational stressors, coping, and outcomes in competitive sport.

PubMed

Arnold, Rachel; Fletcher, David; Daniels, Kevin

2017-04-01

Organisational stressors are associated with positive and negative outcomes in extant literature; however, little is known about which demands predict which outcomes. Extant theory and literature also suggests that coping style may influence an individual's resilience or vulnerability to stressors and, subsequently, their psychological responses and outcomes. The purpose of this study was, therefore, to examine the main effects of organisational stressors and coping styles on various outcomes (e.g., positive and negative affect, performance satisfaction). Sport performers (n = 414) completed measures of organisational stressors, coping styles, positive and negative affect, and performance satisfaction. Multiple regression analyses revealed positive relationships of both goals and development stressors (duration and intensity) and team and culture stressors (frequency and intensity) on negative affect. Furthermore, problem-focused coping was positively related to positive affect, and emotion-focused coping was positively related to negative affect. This study furthers theoretical knowledge regarding the associations that both organisational stressors (and their dimensions) and coping styles can have with various outcomes, and practical understanding regarding the optimal design of stress management interventions.

Water Awareness Scale for Pre-Service Science Teachers: Validity and Reliability Study

ERIC Educational Resources Information Center

Filik Iscen, Cansu

2015-01-01

The role of teachers in the formation of environmentally sensitive behaviors in students is quite high. Thus, the water awareness of teachers, who represent role models for students, is rather important. The main purpose of this study is to identify the reliability and validity study outcomes of the Water Awareness Scale, which was developed to…

Are Teachers Ready for CLIL? Evidence from a European Study

ERIC Educational Resources Information Center

Pérez Cañado, María Luisa

2016-01-01

This article presents the outcomes of a European study on the main training needs which pre- and in-service teachers, teacher trainers, and coordinators consider they have in order to adapt to a bilingual education model. The macro-study has designed, validated and administered four sets of questionnaires to 706 informants across the whole of…

Practice patterns when treating patients with low back pain: a survey of physical therapists.

PubMed

Davies, Claire; Nitz, Arthur J; Mattacola, Carl G; Kitzman, Patrick; Howell, Dana; Viele, Kert; Baxter, David; Brockopp, Dorothy

2014-08-01

Low back pain (LBP), is a common musculoskeletal problem, affecting 75-85% of adults in their lifetime. Direct costs of LBP in the USA were estimated over 85 billion dollars in 2005 resulting in a significant economic burden for the healthcare system. LBP classification systems and outcome measures are available to guide physical therapy assessments and intervention. However, little is known about which, if any, physical therapists use in clinical practice. The purpose of this study was to identify the use of and barriers to LBP classification systems and outcome measures among physical therapists in one state. A mixed methods study using a cross-sectional cohort design with descriptive qualitative methods was performed. A survey collected both quantitative and qualitative data relevant to classification systems and outcome measures used by physical therapists working with patients with LBP. Physical therapists responded using classification systems designed to direct treatment predominantly. The McKenzie method was the most frequent approach to classify LBP. Barriers to use of classification systems and outcome measures were lack of knowledge, too limiting and time. Classification systems are being used for decision-making in physical therapy practice for patients with LBP. Lack of knowledge and training seems to be the main barrier to the use of classification systems in practice. The Oswestry Disability Index and Numerical Pain Scale were the most commonly used outcome measures. The main barrier to their use was lack of time. Continuing education and reading the literature were identified as important tools to teach evidence-based practice to physical therapists in practice.

Digital Clinical Communication for Families and Caregivers of Children or Young People With Short- or Long-Term Conditions: Rapid Review

PubMed Central

Armoiry, Xavier; Sturt, Jackie; Phelps, Emma Elizabeth; Walker, Clare-Louise; Court, Rachel; Taggart, Frances; Sutcliffe, Paul; Atherton, Helen

2018-01-01

Background The communication relationship between parents of children or young people with health conditions and health professionals is an important part of treatment, but it is unclear how far the use of digital clinical communication tools may affect this relationship. Objective The objective of our study was to describe, assess the feasibility of, and explore the impact of digital clinical communication between families or caregivers and health professionals. Methods We searched the literature using 5 electronic databases. We considered all types of study design published in the English language from January 2009 to August 2015. The population of interest included families and caregivers of children and young people aged less than 26 years with any type of health condition. The intervention was any technology permitting 2-way communication. Results We included 31 articles. The main designs were randomized controlled trials (RCTs; n=10), cross-sectional studies (n=9), pre- and postintervention uncontrolled (pre/post) studies (n=7), and qualitative interview studies (n=2); 6 had mixed-methods designs. In the majority of cases, we considered the quality rating to be fair. Many different types of health condition were represented. A breadth of digital communication tools were included: videoconferencing or videoconsultation (n=14), and Web messaging or emails (n=12). Health care professionals were mainly therapists or cognitive behavioral therapists (n=10), physicians (n=8), and nurses (n=6). Studies were very heterogeneous in terms of outcomes. Interventions were mainly evaluated using satisfaction or acceptance, or outcomes relating to feasibility. Clinical outcomes were rarely used. The RCTs showed that digital clinical communication had no impact in comparison with standard care. Uncontrolled pre/post studies showed good rates of satisfaction or acceptance. Some economic studies suggested that digital clinical communication may save costs. Conclusions This rapid review showed an emerging body of literature on the use of digital clinical communication to improve families’ and caregivers’ involvement in the health management of children or young people. Further research with appropriate study designs and longer-term outcome measures should be encouraged. Trial Registration PROSPERO CRD42016035467; http://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD 42016 035467(Archived by WebCite at http://www.webcitation.org/6vpgZU1FU) PMID:29305339

The Association of Frailty With Outcomes and Resource Use After Emergency General Surgery: A Population-Based Cohort Study.

PubMed

McIsaac, Daniel I; Moloo, Husein; Bryson, Gregory L; van Walraven, Carl

2017-05-01

Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS. Our main exposure was preoperative frailty, as defined by the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. The Adjusted Clinical Groups frailty-defining diagnoses indicator is a binary variable that uses 12 clusters of frailty-defining diagnoses. Our main outcome measures were 1-year all-cause mortality (primary), intensive care unit admission, length of stay, institutional discharge, and costs of care (secondary). Of 77,184 patients, 19,779 (25.6%) were frail. Death within 1 year occurred in 6626 (33.5%) frail patients compared with 11,366 (19.8%) nonfrail patients. After adjustment for sociodemographic and surgical confounders, this resulted in a hazard ratio of 1.29 (95% confidence interval [CI] 1.25-1.33). The risk of death for frail patients varied significantly across the postoperative period and was particularly high immediately after surgery (hazard ratio on postoperative day 1 = 23.1, 95% CI 22.3-24.1). Frailty was adversely associated with all secondary outcomes, including a 5.82-fold increase in the adjusted odds of institutional discharge (95% CI 5.53-6.12). After EGS, frailty is associated with increased rates of mortality, institutional discharge, and resource use. Strategies that might improve perioperative outcomes in frail EGS patients need to be developed and tested.

A core outcome set for clinical trials in acute diarrhoea.

PubMed

Karas, Jacek; Ashkenazi, Shai; Guarino, Alfredo; Lo Vecchio, Andrea; Shamir, Raanan; Vandenplas, Yvan; Szajewska, Hania

2015-04-01

Core outcome sets are the baseline for what should be measured in clinical research and, thus, should serve as a guide for what should be collected and reported. The Consensus Group on Outcome Measures Made in Pediatric Enteral Nutrition Clinical Trials, established in 2012, agreed that consensus on a core set of outcomes with agreed-upon definitions that should be measured and reported in clinical trials was needed. To achieve this goal, six working groups (WGs) were setup, including WG on acute diarrhoea, whose main goal was to develop a core outcome set for trials in acute diarrhoea. The first step identified how published outcomes related to acute diarrhoea were reported. The second focused on the methodology for determining which outcomes to measure in clinical trials. The third employed a two-phase questionnaire study using the Delphi technique to define clinically important outcomes to clinicians and parents. For therapeutic studies, the five most important outcome measures were diarrhoea duration, degree of dehydration, need for hospitalisation (or duration of hospitalisation for inpatients), the proportion of patients recovered by 48 h and adverse effects. The prophylactic core outcome set included prevention of diarrhoea, prevention of dehydration, prevention of hospitalisation and adverse effects. The outcome sets for therapy and prevention can be recommended for use in future trials of patients with gastroenteritis. Their envisioned goal is to decrease study heterogeneity and to ease the comparability of studies. WG's next step is to determine how to measure the outcomes included in the core set. 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.

Monitoring and Stimulating Development of Integrated Professional Skills in University Study Programmes

ERIC Educational Resources Information Center

Wahlgren, Marie; Ahlberg, Anders

2013-01-01

In Swedish higher education, quality assurance mainly focuses on course module outcomes. With this in mind we developed a qualitative method to monitor and stimulate progression of learning in two modularized engineering study programmes. A set of core professional values and skills were triangulated through interviews with students, teachers,…

Six Thinking Hats and Social Workers' Innovative Competence: An Experimental Study

ERIC Educational Resources Information Center

Azeez, Razaq Olugbenga

2016-01-01

Employees, no doubt, are the main force in organizations, and their innovative behaviours are vital for outcome efficacy. Innovative organisations, therefore, need creative employees who generate new ideas for product or process of innovation. This study investigated the effect of six thinking hats creativity technique on innovative competence of…

Cryptococcemia. An analysis of 28 cases with emphasis on the clinical outcome and its etiologic agent.

PubMed

Pasqualotto, Alessandro Comarú; Bittencourt Severo, Cecília; de Mattos Oliveira, Flávio; Severo, Luiz Carlos

2004-09-01

Clinical protocols of 28 cases of cryptococcemia studied between April 1995 and November 2002 were reviewed. The varieties of Cryptococcus neorformans, the underlying disease, and the severity and outcome of the disease were emphasized. Most patients were immunossupressed (89.3% with AIDS) and Cryptococcus neoformans var. grubii was the main recovered variety (92.8%). Regardless of antifungal treatment, in-hospital mortality was 41% strongly associated with APACHE II score, >14 (p<0.01).

Relationship Between Implementation of Collaborative Strategic Reading and Student Outcomes for Adolescents With Disabilities.

PubMed

Boardman, Alison G; Buckley, Pamela; Vaughn, Sharon; Roberts, Gregory; Scornavacco, Karla; Klingner, Janette K

2016-11-01

This study examines the interaction between the fidelity of implementation of a set of research-based strategies-Collaborative Strategic Reading (CSR)-and outcomes for students with mild to moderate disabilities using data from two nonoverlapping studies in middle school language arts and reading classrooms (Study 1) and middle school social studies and science classrooms (Study 2). The authors use a definition of fidelity that includes both the amount of CSR instruction delivered by teachers and the quality of implementation. Although there were no main effects for quality or amount of CSR instruction, in both studies there was an interaction effect between quality of implementation and special education status. The study used a within-groups design and multilevel analyses, and the results demonstrate that higher quality CSR instruction was associated with higher reading outcomes for students with disabilities. This finding was consistent across Study 1 and Study 2. Implications for practice and future research are discussed. © Hammill Institute on Disabilities 2016.

Predictors for work participation in individuals with an Autism spectrum disorder: a systematic review.

PubMed

Holwerda, Anja; van der Klink, Jac J L; Groothoff, Johan W; Brouwer, Sandra

2012-09-01

Research shows that only about 25% of people with autism are employed. We conducted a systematic review on factors facilitating or hindering work participation of people with autism in longitudinal studies. An extensive search in biomedical and psychological databases yielded 204 articles and 18 satisfied all inclusion criteria. We assessed the methodological quality of included studies using an established criteria list. Seventeen factors were identified and categorized as disease-related factors, personal factors or external factors. Limited cognitive ability was the only significant predictor consistently found for work outcome. Functional independence and institutionalization were both reported by one study to be significantly related to work outcome. Inconsistent findings or non significant findings were reported for the other fourteen factors. These findings emphasize the need for more high quality cohort studies focussing on work participation as the main outcome among people with Autism.

Traumatic Brain Injury Practice-Based Evidence Study: Design and Patients, Centers, Treatments, and Outcomes

PubMed Central

Horn, Susan D.; Corrigan, John D.; Bogner, Jennifer; Hammond, Flora M.; Seel, Ronald T.; Smout, Randall J.; Barrett, Ryan S.; Dijkers, Marcel P.; Whiteneck, Gale G.

2015-01-01

Objective To describe study design, patients, centers, treatments, and outcomes of a traumatic brain injury (TBI) practice-based evidence (PBE) study and to evaluate the generalizability of the findings to the US TBI inpatient rehabilitation population. Design Prospective, longitudinal observational study Setting 10 inpatient rehabilitation centers (9 US, 1 Canada) Participants Patients (n=2130) enrolled between October 2008 and Sept 2011, and admitted for inpatient rehabilitation after an index TBI injury Interventions Not applicable Main Outcome Measures Return to acute care during rehabilitation, rehabilitation length of stay, Functional Independence Measure (FIM) at discharge, residence at discharge, and 9 months post-discharge rehospitalization, FIM, participation, and subjective wellbeing. Results Level of admission FIM Cognitive score was found to create relatively homogeneous subgroups for subsequent analysis of best treatment combinations. There were significant differences in patient and injury characteristics, treatments, rehabilitation course, and outcomes by admission FIM Cognitive subgroups. TBI-PBE study patients overall were similar to US national TBI inpatient rehabilitation populations. Conclusions This TBI-PBE study succeeded in capturing naturally occurring variation within patients and treatments, offering opportunities to study best treatments for specific patient deficits. Subsequent papers in this issue report differences between patients and treatments and associations with outcomes in greater detail. PMID:26212396

Epidemiologic Tools to Study the Influence of Environmental Factors on Fecundity and Pregnancy-related Outcomes

PubMed Central

Slama, Rémy; Ballester, Ferran; Casas, Maribel; Cordier, Sylvaine; Eggesbø, Merete; Iniguez, Carmen; Nieuwenhuijsen, Mark; Philippat, Claire; Rey, Sylvie; Vandentorren, Stéphanie; Vrijheid, Martine

2014-01-01

Adverse pregnancy outcomes entail a large health burden for the mother and offspring; a part of it might be avoided by better understanding the role of environmental factors in their etiology. Our aims were to review the assessment tools to characterize fecundity troubles and pregnancy-related outcomes in human populations and their sensitivity to environmental factors. For each outcome, we reviewed the possible study designs, main sources of bias, and their suggested cures. In terms of study design, for most pregnancy outcomes, cohorts with recruitment early during or even before pregnancy allow efficient characterization of pregnancy-related events, time-varying confounders, and in utero exposures that may impact birth outcomes and child health. Studies on congenital anomalies require specific designs, assessment of anomalies in medical pregnancy terminations, and, for congenital anomalies diagnosed postnatally, follow-up during several months after birth. Statistical analyses should take into account environmental exposures during the relevant time windows; survival models are an appropriate approach for fecundity, fetal loss, and gestational duration/preterm delivery. Analysis of gestational duration could distinguish pregnancies according to delivery induction (and possibly pregnancy-related conditions). In conclusion, careful design and analysis are required to better characterize environmental effects on human reproduction. PMID:24363355

The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency.

PubMed

Sim, Julius; Lewis, Martyn

2012-03-01

To investigate methods to determine the size of a pilot study to inform a power calculation for a randomized controlled trial (RCT) using an interval/ratio outcome measure. Calculations based on confidence intervals (CIs) for the sample standard deviation (SD). Based on CIs for the sample SD, methods are demonstrated whereby (1) the observed SD can be adjusted to secure the desired level of statistical power in the main study with a specified level of confidence; (2) the sample for the main study, if calculated using the observed SD, can be adjusted, again to obtain the desired level of statistical power in the main study; (3) the power of the main study can be calculated for the situation in which the SD in the pilot study proves to be an underestimate of the true SD; and (4) an "efficient" pilot size can be determined to minimize the combined size of the pilot and main RCT. Trialists should calculate the appropriate size of a pilot study, just as they should the size of the main RCT, taking into account the twin needs to demonstrate efficiency in terms of recruitment and to produce precise estimates of treatment effect. Copyright © 2012 Elsevier Inc. All rights reserved.

Basal progesterone level as the main determinant of progesterone elevation on the day of hCG triggering in controlled ovarian stimulation cycles.

PubMed

Papaleo, Enrico; Corti, Laura; Vanni, Valeria Stella; Pagliardini, Luca; Ottolina, Jessica; De Michele, Francesca; La Marca, Antonio; Viganò, Paola; Candiani, Massimo

2014-07-01

Modest increases of serum progesterone at human chorionic gonadotrophin (hCG) administration in controlled ovarian hyperstimulation (COH) cycles have been shown to have a negative impact on pregnancy outcomes. The aim of this study was to identify early predictors of progesterone elevation at hCG. Pregnancy outcome of 303 consecutive patients undergoing COH and fresh day-3 embryo transfer was analysed. Considering the non-linear relationship between progesterone at hCG triggering and pregnancy outcomes, partial area under the curve (pAUC) analysis was used to implement marker identification potential of receiver operating characteristic (ROC) curve analysis. Multivariate logistic analysis was then performed to identify predictors of progesterone rise. Pregnancy outcomes could be predicted by pAUC analysis (pAUC = 0.58, 95 % CI 0.51-0.66, p = 0.02) and a significant detrimental cut-off could be calculated (progesterone at hCG > 1.35 ng/ml). Total dose of rFSH administered, E2 level at hCG but mostly basal progesterone level (OR = 12.21, 95 % CI 1.82-81.70) were predictors of progesterone rise above the cut-off. Basal progesterone is shown to be the main prognostic factor for progesterone elevation. This observation should be taken into consideration in the clinical management of IVF/ICSI cycles to improve pregnancy outcomes.

The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010

PubMed Central

Sarton, Cheryl; Lichter, Erika

2016-01-01

The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG) and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000–2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU), and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes. PMID:27747104

The development of a Simplified, Effective, Labour Monitoring-to-Action (SELMA) tool for Better Outcomes in Labour Difficulty (BOLD): study protocol.

PubMed

Souza, João Paulo; Oladapo, Olufemi T; Bohren, Meghan A; Mugerwa, Kidza; Fawole, Bukola; Moscovici, Leonardo; Alves, Domingos; Perdona, Gleici; Oliveira-Ciabati, Livia; Vogel, Joshua P; Tunçalp, Özge; Zhang, Jim; Hofmeyr, Justus; Bahl, Rajiv; Gülmezoglu, A Metin

2015-05-26

The partograph is currently the main tool available to support decision-making of health professionals during labour. However, the rate of appropriate use of the partograph is disappointingly low. Apart from limitations that are associated with partograph use, evidence of positive impact on labour-related health outcomes is lacking. The main goal of this study is to develop a Simplified, Effective, Labour Monitoring-to-Action (SELMA) tool. The primary objectives are: to identify the essential elements of intrapartum monitoring that trigger the decision to use interventions aimed at preventing poor labour outcomes; to develop a simplified, monitoring-to-action algorithm for labour management; and to compare the diagnostic performance of SELMA and partograph algorithms as tools to identify women who are likely to develop poor labour-related outcomes. A prospective cohort study will be conducted in eight health facilities in Nigeria and Uganda (four facilities from each country). All women admitted for vaginal birth will comprise the study population (estimated sample size: 7,812 women). Data will be collected on maternal characteristics on admission, labour events and pregnancy outcomes by trained research assistants at the participating health facilities. Prediction models will be developed to identify women at risk of intrapartum-related perinatal death or morbidity (primary outcomes) throughout the course of labour. These predictions models will be used to assemble a decision-support tool that will be able to suggest the best course of action to avert adverse outcomes during the course of labour. To develop this set of prediction models, we will use up-to-date techniques of prognostic research, including identification of important predictors, assigning of relative weights to each predictor, estimation of the predictive performance of the model through calibration and discrimination, and determination of its potential for application using internal validation techniques. This research offers an opportunity to revisit the theoretical basis of the partograph. It is envisioned that the final product would help providers overcome the challenging tasks of promptly interpreting complex labour information and deriving appropriate clinical actions, and thus increase efficiency of the care process, enhance providers' competence and ultimately improve labour outcomes. Please see related articles ' http://dx.doi.org/10.1186/s12978-015-0027-6 ' and ' http://dx.doi.org/10.1186/s12978-015-0028-5 '.

Gender Moderates the Progression from Fearful Temperament to Social Withdrawal through Protective Parenting

PubMed Central

Kiel, Elizabeth J.; Premo, Julie E.; Buss, Kristin A.

2015-01-01

Child gender may exert its influence on development, not as a main effect, but as a moderator among predictors and outcomes. We examined this notion in relations among toddler fearful temperament, maternal protective parenting, maternal accuracy in predicting toddler distress to novelty, and child social withdrawal. In two multi-method, longitudinal studies of toddlers (24 months at Time 1; ns = 93 and 117, respectively) and their mothers, few main effect gender differences occurred. Moderation existed in both studies: only for highly accurate mothers of boys, fearful temperament related to protective parenting, which then predicted later social withdrawal. Thus, studying only main-effect gender differences may obscure important differences in how boys and girls develop from fearful temperament to later social withdrawal. PMID:27231411

Intimacy-Enhancing Psychological Intervention for Men Diagnosed with Prostate Cancer and Their Partners: A Pilot Study

PubMed Central

Manne, S. L.; Kissane, D. W.; Nelson, C. J.; Mulhall, J. P.; Winkel, G.; Zaider, T.

2011-01-01

Introduction Few couple-focused interventions have been developed to improve distress and relationship outcomes among men diagnosed with localized prostate cancer and their partners. Aims We examined the effects of a five session Intimacy-Enhancing Therapy (IET) versus Usual Care (UC) on the psychological and relationship functioning of men diagnosed with localized prostate cancer and their partners. Pre-intervention levels of psychological and relationship functioning were evaluated as moderators of intervention effects. Methods Seventy one survivors and their partners completed a baseline survey and were subsequently randomly assigned to receive five sessions of IET or Usual Care (no treatment). Eight weeks after the baseline assessment, a follow-up survey was administered to survivor and partner. Main outcome measures Distress, well-being, relationship satisfaction, relationship intimacy, and communication were investigated as the main outcomes.. Results IET effects were largely moderated by pre-intervention psychosocial and relationship factors. Those survivors who had higher levels of cancer concerns at pre-treatment had significantly reduced concerns following IET. Similar moderating effects for pre-intervention levels were reported for the effects of IET on self-disclosure, perceived partner disclosure, and perceived partner responsiveness. Among partners beginning the intervention with higher cancer-specific distress, lower marital satisfaction, lower intimacy, and poorer communication, IET improved these outcomes. Conclusions IET had a marginally significant main effect upon survivor well-being but was effective among couples with fewer personal and relationship resources. Subsequent research is needed to replicate these findings with a larger sample and a longer follow-up. PMID:21210958

Using Propensity Score Methods to Approximate Factorial Experimental Designs to Analyze the Relationship between Two Variables and an Outcome

ERIC Educational Resources Information Center

Dong, Nianbo

2015-01-01

Researchers have become increasingly interested in programs' main and interaction effects of two variables (A and B, e.g., two treatment variables or one treatment variable and one moderator) on outcomes. A challenge for estimating main and interaction effects is to eliminate selection bias across A-by-B groups. I introduce Rubin's causal model to…

HRM and its effect on employee, organizational and financial outcomes in health care organizations

PubMed Central

2014-01-01

Background One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. Methods This study uses a unique dataset, based on the ‘ActiZ Benchmark in Healthcare’, a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. Results It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the ‘black box’ between HRM and performance. Conclusion The results underscore the importance of HRM in the health care sector, especially for HR and organizational outcomes. Further analyses of HRM in the health care sector will prove to be a productive endeavor for both scholars and HR managers. PMID:24938460

HRM and its effect on employee, organizational and financial outcomes in health care organizations.

PubMed

Vermeeren, Brenda; Steijn, Bram; Tummers, Lars; Lankhaar, Marcel; Poerstamper, Robbert-Jan; van Beek, Sandra

2014-06-17

One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. This study uses a unique dataset, based on the 'ActiZ Benchmark in Healthcare', a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the 'black box' between HRM and performance. The results underscore the importance of HRM in the health care sector, especially for HR and organizational outcomes. Further analyses of HRM in the health care sector will prove to be a productive endeavor for both scholars and HR managers.

Quality of Care for Patients with Type 2 Diabetes Mellitus in the Netherlands and the United States: A Comparison of Two Quality Improvement Programs

PubMed Central

Valk, Gerlof D; Renders, Carry M; Kriegsman, Didi MW; Newton, Katherine M; Twisk, Jos WR; van Eijk, Jacques ThM; van der Wal, Gerrit; Wagner, Edward H

2004-01-01

Objective To assess differences in diabetes care and patient outcomes by comparing two multifaceted quality improvement programs in two different countries, and to increase knowledge of effective elements of such programs. Study Setting Primary care in the ExtraMural Clinic (EMC) of the Department of General Practice of the Vrije Universiteit in Amsterdam, the Netherlands, and the Group Health Cooperative (GHC), a group-model health maintenance organization (HMO) in western Washington State in the United States. Data were collected from 1992 to 1997. Study Design In this observational study two diabetes cohorts in which a quality improvement program was implemented were compared. Both programs included a medical record system, clinical practice guidelines, physician educational meetings, audit, and feedback. Only the Dutch program (EMC) included guidelines on the structure of diabetes care and a recall system. Only the GHC program included educational outreach visits, formation of multidisciplinary teams, and patient self-management support. Data Collection Included were 379 EMC patients, and 2,119 GHC patients with type 2 diabetes mellitus. Main process outcomes were: annual number of diabetes visits, and number of HbA1c and blood lipid measurements. Main patient outcomes were HbA1c and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices. Principal Findings In the EMC process outcomes and glycemic control improved more than at GHC, however, GHC had better baseline measures. There were no differences between programs on blood lipid control. During follow-up, intensification of pharmacotherapy was noted at both sites. Differences noted between programs were in line with differences in diabetes guidelines. Conclusions Following implementation of guidelines and organizational improvement efforts, change occurred primarily in the process outcomes, rather than in the patient outcomes. Although much effort was put into improving process and patient outcomes, both complex programs still showed only moderate effects. PMID:15230924

Effects of Patient Pre-Injury and Injury Characteristics on Acute Rehabilitation Outcomes for Traumatic Brain Injury

PubMed Central

Corrigan, John D.; Horn, Susan D.; Barrett, Ryan S.; Smout, Randall J.; Bogner, Jennifer; Hammond, Flora M.; Brandstater, Murray E.; Majercik, Sarah

2015-01-01

Objective To examine associations of patient and injury characteristics with outcomes at inpatient rehabilitation discharge and 9 months post-discharge for patients with traumatic brain injury (TBI) Design Prospective, longitudinal observational study Setting 10 inpatient rehabilitation centers (9 US, 1 Canada) Participants Consecutive patients (n=2130) enrolled between 2008 and 2011, admitted for inpatient rehabilitation after index TBI injury, and divided into 5 subgroups based on rehabilitation admission FIM Cognitive score Interventions Not applicable Main Outcome Measures Rehabilitation length of stay, discharge to home, and FIM at discharge and 9 months post-discharge. Results Severity indices increased explained variation in outcomes beyond that accounted for by patient characteristics. FIM Motor scores were generally the most predictable. Higher functioning subgroups had more predictable outcomes then subgroups with lower cognitive function at admission. Age at injury, time from injury to rehabilitation admission, and functional independence at rehabilitation admission were the most consistent predictors across all outcomes and subgroups. Conclusions Findings from previous studies of the relationships among patient and injury characteristics and rehabilitation outcomes were largely replicated. Discharge outcomes were most strongly associated with injury severity characteristics; while predictors of functional independence at 9 months post-discharge included both patient and injury characteristics. PMID:26212398

Unfavourable outcomes among patients with MDR-TB on the standard 24-month regimen in Maharashtra, India

PubMed Central

Shewade, H. D.; Nagaraja, S. B.; Nair, S. A.; Parmar, M.

2017-01-01

Setting: Patients with multidrug-resistant tuberculosis (MDR-TB) registered for treatment (2011–2012 cohort) using the standard 24-month regimen, under the Revised National TB Control Programme's programmatic management of drug-resistant TB (PMDT), Maharashtra, India. Objectives: To assess the treatment outcomes and the timing and risk factors for unfavourable treatment outcomes, with a focus on death and loss to follow-up (LTFU). Method: This was a retrospective cohort study involving a review of PMDT records. Treatment outcomes were reported on 31 December 2014. Results: Of 4024 patients, treatment success was recorded in 1168 (29%). Unfavourable outcomes occurred in 2242 (56%), of whom 857 (21%) died and 768 (19%) were lost to follow-up. Treatment outcomes were missing on record review for 375 (9%) patients, and 239 (6%) were still undergoing treatment. Half of LTFU occurred within 3 months, and more than four fifths of deaths occurred after 6 months of treatment. Human immunodeficiency virus infection, being underweight, age ⩾ 15 years, male sex and pulmonary TB were the main risk factors for death, LTFU or other unfavourable treatment outcomes. Conclusion: The study found poor treatment outcomes in patients with MDR-TB registered for treatment in Maharashtra, India. Interventions are required to address the high rates of LTFU and death. PMID:28695084

Outcome and prognostic factors of patients with right-sided infective endocarditis requiring intensive care unit admission.

PubMed

Georges, Hugues; Leroy, Olivier; Airapetian, Norair; Lamblin, Nicolas; Zogheib, Elie; Devos, Patrick; Preau, Sebastien

2018-02-21

Right-sided infective endocarditis (RSIE) is an uncommon diagnosis accounting for less than 10% of cases of infective endocarditis. Optimal management for severely ill patients with RSIE remains challenging because few studies reported on management and outcome. The goal of our study was to determine outcome and associated prognostic factors in a population of ICU patients with a diagnosis of definite, active and severe RSIE. We performed a retrospective study in 10 French ICUs between January 2002 and December 2012. Main outcome was mortality at 30 days after ICU admission. Significant variables associated with 30-days mortality in the bivariate analysis were included in a logistic regression analysis. A total of 37 patients were studied. Mean age was 47.9 ± 18.4 years. Mean SAPS II, SOFA score and Charlson comorbidity index were 32.4 ± 17.4, 6.3 ± 4.4 and 3.1 ± 3.4, respectively. Causative pathogens, identified in 34 patients, were mainly staphylococci (n = 29). The source of endocarditis was a catheter related infection in 10 patients, intravenous drug abuse in 8 patients, cutaneous in 7 patients, urinary tract related in one patient and has an unknown origin in 7 patients. Vegetation size was higher than 20 mm for 14 patients. Valve tricuspid regurgitation was classified as severe in 11 patients. All patients received initial appropriate antimicrobial therapy. Aminoglycosides were delivered in combination with β-lactam antibiotics or vancomycin in 22 patients. Surgical procedure was performed in 14 patients. Eight patients (21.6%) died within 30 days following ICU admission. One independent prognostic factor was identified: use of aminoglycosides was associated with improved outcome (OR = 0.1; 95%CI = 0.0017-0.650; p = 0.007). Mortality of patients with RSIE needing ICU admission is high. Aminoglycosides used in combination with β-lactam or vancomycin could reduce 30 days mortality.

[Pharmacotherapy in the treatment of borderline personality disorder].

PubMed

Alliani, Daniela; Tarantelli, Silvia

2009-01-01

The aim of this study is to bring together the previous studies on pharmacotherapy of borderline disorder from the oldest to the recent ones, mainly focusing on atypical antipsychotic, whose success has been underlined in recent medical literature with peculiar reference to olanzapine. Since the '80 the pharmacotherapy in borderline personality disorder has been playing an increasing role in the interest of scientific community and in the medical practice as indicated by APA guidelines (2000). Nowadays the pharmacological approach, supported by some experimental outcomes, follow a so called "dimensional" standard. The targets of this standard drug approach are specific psychopathological "dimensions" of the disorder and related neurotransmitters' changes in particular linked to serotoninergic and dopaminergic systems, both supported by experimental outcomes. The psychopathological dimensions to which pharmacological approach is more suitable are: impulsiveness and emotional dysregulation. During the last past years, effectiveness of atypical antipsychotic drugs became of major interest in medical treatment of borderline disorder, mainly related to their action toward the serotoninergic and dopaminergic systems.

Simultaneous bilateral cataract surgery: economic analysis; Helsinki Simultaneous Bilateral Cataract Surgery Study Report 2.

PubMed

Leivo, Tiina; Sarikkola, Anna-Ulrika; Uusitalo, Risto J; Hellstedt, Timo; Ess, Sirje-Linda; Kivelä, Tero

2011-06-01

To present an economic-analysis comparison of simultaneous and sequential bilateral cataract surgery. Helsinki University Eye Hospital, Helsinki, Finland. Economic analysis. Effects were estimated from data in a study in which patients were randomized to have bilateral cataract surgery on the same day (study group) or sequentially (control group). The main clinical outcomes were corrected distance visual acuity, refraction, complications, Visual Function Index-7 (VF-7) scores, and patient-rated satisfaction with vision. Health-care costs of surgeries and preoperative and postoperative visits were estimated, including the cost of staff, equipment, material, floor space, overhead, and complications. The data were obtained from staff measurements, questionnaires, internal hospital records, and accountancy. Non-health-care costs of travel, home care, and time were estimated based on questionnaires from a random subset of patients. The main economic outcome measures were cost per VF-7 score unit change and cost per patient in simultaneous versus sequential surgery. The study comprised 520 patients (241 patients included non-health-care and time cost analyses). Surgical outcomes and patient satisfaction were similar in both groups. Simultaneous cataract surgery saved 449 Euros (€) per patient in health-care costs and €739 when travel and paid home-care costs were included. The savings added up to €849 per patient when the cost of lost working time was included. Compared with sequential bilateral cataract surgery, simultaneous bilateral cataract surgery provided comparable clinical outcomes with substantial savings in health-care and non-health-care-related costs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

[Individual therapy goals: on outcome documentation of inpatient psychotherapy from the patient and therapist viewpoint].

PubMed

Heuft, G; Senf, W; Wagener, R; Pintelon, C; Lorenzen, J

1996-01-01

The results of a study evaluation in practicability of two newly developed documentation forms are presented. Examined are 82 inpatient treatment episodes in an already published clinical concept with different treatment settings. Parallel versions of the forms were completed by patients and therapists. The 'Erge-Doku-A-Form' allows for the naming of up to five therapy goals determined at the beginning of therapy and evaluated in relation to their achieved quality at the end of therapy. The 'Erge-Doku-B-Form' describes a variety of problem areas as well as questions related to medication and changes induced by therapy. Surprising there were a high number of 230 Individual Therapy Goals (ITG) by patients and 262 ITG by therapists which could be arranged into 89 content categories and 5 main categories. Outcome measurement shows different results. There was a significant relationship between the 'well-being', the impression of 'satisfying treatment' at the end of the inpatient period and 'success in the main ITG'. The documentation forms presented here allow an outcome-measurement depending on differential indications.

Homophobia and Communal Coping for HIV risk management among Gay Men in Relationships

PubMed Central

Stachowski, Courtney; Stephenson, Rob

2015-01-01

Men who have sex with men (MSM) remain disproportionately affected by the HIV epidemic in the US and estimates suggest that one to two-thirds of new infections occur among main partners. Previous research has focused on individual MSM and their risk for HIV, yet couples’ ability to manage risk has been largely understudied. In particular, the role that homophobia plays in shaping the ability of gay male couples to cope with HIV risk is currently under-studied. A sample of 447 gay/bisexual men with main partners was taken from a 2011 survey of gay and bisexual men in Atlanta. Linear regression models were fitted for three couples’ coping outcome scales (outcome efficacy, couple efficacy, communal coping) and included indicators of homophobia (internalized homophobia and homophobic discrimination). Findings indicate that reporting of increased levels of internalized homophobia were consistently associated with decreased outcome measures of couples’ coping ability regarding risk management. The results highlight the role that homophobia plays in gay male couples’ relationships and HIV risk, extending the existing literature in the field of same-sex relationships as influenced by homophobia. PMID:25614049

Acculturation level and caregiver outcomes from a randomized intervention trial to enhance caregivers' health: evidence from REACH II.

PubMed

Meyer, Oanh L; Liu, Xiaoyan Lucia; Tancredi, Daniel; Ramirez, A Susana; Schulz, Richard; Hinton, Ladson

2018-06-01

Latinos comprise a growing segment of the caregiver population and vary widely in acculturation, yet little is known regarding how acculturation might affect caregiver stress or intervention outcomes. This study examined the relationship between acculturation and burden, bother, and depression in Latino dementia caregivers at baseline and following an intervention. This was a secondary data analysis of 211 Latino caregivers of older adults with dementia from Resources for Enhancing Alzheimer's Caregiver Health (REACH) II, a multisite randomized trial of caregiver interventions. Baseline and follow-up data were used to run mixed-effects models examining the main and moderating effect of acculturation on caregiver stress. No significant main effect of acculturation was found for any of the outcome measures, controlling for demographic covariates. Acculturation moderated the effect of the intervention on caregiver burden: those who were more acculturated benefited more from the intervention. Differential acculturation for Latino caregivers was not directly associated with caregiver burden, bother, or depression, but was associated with reducing burden from the intervention. Future research should explore by what mechanism acculturation influences caregiver burden following an intervention.

Maternal characteristics and birth outcomes of pregnant women who had offspring with congenital ear abnormalities - a population-based case-control study.

PubMed

Paput, László; Bánhidy, Ferenc; Czeizel, Andrew E

2011-09-01

To describe the maternal characteristics and birth outcomes of newborn infants affected with isolated ear congenital abnormalities (IECA), mainly isolated anotia/microtia and unclassified multiple congenital abnormalities (CAs) including anotia/microtia (UMAM). Cases with IECA and UMAM were compared with their matched controls and all controls without any defect and malformed controls affected with other defects in the population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities. The mothers of 354 cases with IECA did not show significant difference in age, but their mean birth order was higher while their socio-economic status based on the maternal employment status was lower compared to the figures of their matched controls. There was a male excess among cases with microtia and mainly with UMAM. The evaluation of birth outcomes of newborns affected with IECA indicated intrauterine fetal growth retardation. Newborn infants with isolated microtia had intrauterine growth retardation and the association of this developmental defect localized for a small region of head with the general fetal development raises interesting theoretical question.

Prognostic factors for non-success in patients with sciatica and disc herniation

PubMed Central

2012-01-01

Background Few studies have investigated prognostic factors for patients with sciatica, especially for patients treated without surgery. The aim of this study was to identify factors associated with non-success after 1 and 2 years of follow-up and to test the prognostic value of surgical treatment for sciatica. Methods The study was a prospective multicentre observational study including 466 patients with sciatica and lumbar disc herniation. Potential prognostic factors were sociodemographic characteristics, back pain history, kinesiophobia, emotional distress, pain, comorbidity and clinical examination findings. Study participation did not alter treatment considerations for the patients in the clinics. Patients reported on the questionnaires if surgery of the disc herniation had been performed. Uni- and multivariate logistic regression analyses were used to evaluate factors associated with non-success, defined as Maine–Seattle Back Questionnaire score of ≥5 (0–12) (primary outcome) and Sciatica Bothersomeness Index ≥7 (0–24) (secondary outcome). Results Rates of non-success were at 1 and 2 years 44% and 39% for the main outcome and 47% and 42% for the secondary outcome. Approximately 1/3 of the patients were treated surgically. For the main outcome variable, in the final multivariate model non-success at 1 year was significantly associated with being male (OR 1.70 [95% CI; 1.06 − 2.73]), smoker (2.06 [1.31 − 3.25]), more back pain (1.0 [1.01 − 1.02]), more comorbid subjective health complaints (1.09 [1.03 − 1.15]), reduced tendon reflex (1.62 [1.03 − 2.56]), and not treated surgically (2.97 [1.75 − 5.04]). Further, factors significantly associated with non-success at 2 years were duration of back problems >; 1 year (1.92 [1.11 − 3.32]), duration of sciatica >; 3 months (2.30 [1.40 − 3.80]), more comorbid subjective health complaints (1.10 [1.03 − 1.17]) and kinesiophobia (1.04 [1.00 − 1.08]). For the secondary outcome variable, in the final multivariate model, more comorbid subjective health complaints, more back pain, muscular weakness at clinical examination, and not treated surgically, were independent prognostic factors for non-success at both 1 and 2 years. Conclusions The results indicate that the prognosis for sciatica referred to secondary care is not that good and only slightly better after surgery and that comorbidity should be assessed in patients with sciatica. This calls for a broader assessment of patients with sciatica than the traditional clinical assessment in which mainly the physical symptoms and signs are investigated. PMID:22999108

Organizational climate, services, and outcomes in child welfare systems.

PubMed

Glisson, Charles; Green, Philip

2011-08-01

This study examines the association of organizational climate, casework services, and youth outcomes in child welfare systems. Building on preliminary findings linking organizational climate to youth outcomes over a 3-year follow-up period, the current study extends the follow-up period to 7 years and tests main, moderating and mediating effects of organizational climate and casework services on outcomes. The study applies hierarchical linear models (HLMs) analyses to all 5 waves of the National Survey of Child and Adolescent Well-being (NSCAW) with a US nationwide sample of 1,678 maltreated youth aged 4-16 years and 1,696 caseworkers from 88 child welfare systems. Organizational climate is assessed on 2 dimensions, Engagement and Stress, with scales from the well established measure, Organizational Social Context (OSC); youth outcomes are measured as problems in psychosocial functioning with the Child Behavior Checklist (CBCL); and casework services are assessed with original scales developed for the study and completed by the maltreated youths' primary caregivers and caseworkers. Maltreated youth served by child welfare systems with more engaged organizational climates have significantly better outcomes. Moreover, the quantity and quality of casework services neither mediate nor interact with the effects of organizational climate on youth outcomes. Organizational climate is associated with youth outcomes in child welfare systems, but a better understanding is needed of the mechanisms that link organizational climate to outcomes. In addition, there is a need for evidence-based organizational interventions that can improve the organizational climates and effectiveness of child welfare systems. Copyright © 2011 Elsevier Ltd. All rights reserved.

Feasibility of a Humor Training to Promote Humor and Decrease Stress in a Subclinical Sample: A Single-Arm Pilot Study

PubMed Central

Tagalidou, Nektaria; Loderer, Viola; Distlberger, Eva; Laireiter, Anton-Rupert

2018-01-01

The present study investigates the feasibility of a humor training for a subclinical sample suffering from increased stress, depressiveness, or anxiety. Based on diagnostic interviews, 35 people were invited to participate in a 7-week humor training. Evaluation measures were filled in prior training, after training, and at a 1-month follow-up including humor related outcomes (coping humor and cheerfulness) and mental health-related outcomes (perceived stress, depressiveness, anxiety, and well-being). Outcomes were analyzed using repeated-measures ANOVAs. Within-group comparisons of intention-to-treat analysis showed main effects of time with large effect sizes on all outcomes. Post hoc tests showed medium to large effect sizes on all outcomes from pre to post and results remained stable until follow-up. Satisfaction with the training was high, attrition rate low (17.1%), and participants would highly recommend the training. Summarizing the results, the pilot study showed promising effects for people suffering from subclinical symptoms. All outcomes were positively influenced and showed stability over time. Humor trainings could be integrated more into mental health care as an innovative program to reduce stress whilst promoting also positive emotions. However, as this study was a single-arm pilot study, further research (including also randomized controlled trials) is still needed to evaluate the effects more profoundly. PMID:29740368

Potential Utility of the SYNTAX Score 2 in Patients Undergoing Left Main Angioplasty

PubMed Central

Madeira, Sérgio; Raposo, Luís; Brito, João; Rodrigues, Ricardo; Gonçalves, Pedro; Teles, Rui; Gabriel, Henrique; Machado, Francisco; Almeida, Manuel; Mendes, Miguel

2016-01-01

Background The revascularization strategy of the left main disease is determinant for clinical outcomes. Objective We sought to 1) validate and compare the performance of the SYNTAX Score 1 and 2 for predicting major cardiovascular events at 4 years in patients who underwent unprotected left main angioplasty and 2) evaluate the long-term outcome according to the SYNTAX score 2-recommended revascularization strategy. Methods We retrospectively studied 132 patients from a single-centre registry who underwent unprotected left main angioplasty between March 1999 and December 2010. Discrimination and calibration of both models were assessed by ROC curve analysis, calibration curves and the Hosmer-Lemeshow test. Results Total event rate was 26.5% at 4 years.The AUC for the SYNTAX Score 1 and SYNTAX Score 2 for percutaneous coronary intervention, was 0.61 (95% CI: 0.49-0.73) and 0.67 (95% CI: 0.57-0.78), respectively. Despite a good overall adjustment for both models, the SYNTAX Score 2 tended to underpredict risk. In the 47 patients (36%) who should have undergone surgery according to the SYNTAX Score 2, event rate was numerically higher (30% vs. 25%; p=0.54), and for those with a higher difference between the two SYNTAX Score 2 scores (Percutaneous coronary intervention vs. Coronary artery by-pass graft risk estimation greater than 5.7%), event rate was almost double (40% vs. 22%; p=0.2). Conclusion The SYNTAX Score 2 may allow a better and individualized risk stratification of patients who need revascularization of an unprotected left main coronary artery. Prospective studies are needed for further validation. PMID:27007223

Effects of vitamin D supplementation on markers for cardiovascular disease and type 2 diabetes: an individual participant data meta-analysis of randomized controlled trials.

PubMed

Swart, Karin Ma; Lips, Paul; Brouwer, Ingeborg A; Jorde, Rolf; Heymans, Martijn W; Grimnes, Guri; Grübler, Martin R; Gaksch, Martin; Tomaschitz, Andreas; Pilz, Stefan; Eiriksdottir, Gudny; Gudnason, Vilmundur; Wamberg, Louise; Rejnmark, Lars; Sempos, Christopher T; Durazo-Arvizu, Ramón A; Dowling, Kirsten G; Hull, George; Škrabáková, Zuzana; Kiely, Mairead; Cashman, Kevin D; van Schoor, Natasja M

2018-06-01

Evidence from randomized controlled trials (RCTs) for the causal role of vitamin D on noncommunicable disease outcomes is inconclusive. The aim of this study was to investigate whether there are beneficial or harmful effects of cholecalciferol (vitamin D3) supplementation according to subgroups of remeasured serum 25-hydroxyvitamin D [25(OH)D] on cardiovascular and glucometabolic surrogate markers with the use of individual participant data (IPD) meta-analysis of RCTs. Twelve RCTs (16 wk to 1 y of follow-up) were included. For standardization, 25(OH)D concentrations for all participants (n = 2994) at baseline and postintervention were re-measured in bio-banked serum samples with the use of a certified liquid chromatography-tandem mass spectrometry method traceable to a reference measurement procedure. IPD meta-analyses were performed according to subgroups of remeasured 25(OH)D. Main outcomes were blood pressure and glycated hemoglobin (HbA1c). Secondary outcomes were LDL, HDL, and total cholesterol and triglycerides; parathyroid hormone (PTH); fasting glucose, insulin, and C-peptide; and 2-h glucose. In secondary analyses, other potential effect modifiers were studied. Remeasurement of 25(OH)D resulted in a lower mean 25(OH)D concentration in 10 of 12 RCTs. Vitamin D supplementation had no effect on the main outcomes of blood pressure and HbA1c. Supplementation resulted in 10-20% lower PTH concentrations, irrespective of the 25(OH)D subgroups. The subgroup analyses according to achieved 25(OH)D concentrations showed a significant decrease in LDL-cholesterol concentrations after vitamin D supplementation in 25(OH)D subgroups with <75, <100, and <125 nmol of -0.10 mmol/L (95% CI: -0.20, -0.00 mmol/L), -0.10 mmol/L (95% CI: -0.18, -0.02 mmol/L), and -0.07 mmol/L (95% CI: -0.14, -0.00 mmol/L), respectively. Patient features that modified the treatment effect could not be identified. For the main outcomes of blood pressure and HbA1c, the data support no benefit for vitamin D supplementation. For the secondary outcomes, in addition to its effect on PTH, we observed indications for a beneficial effect of vitamin D supplementation only on LDL cholesterol, which warrants further investigation. This trial was registered at www.clinicaltrials.gov as NCT02551835.

A review on leadership of head nurses and patient safety and quality of care.

PubMed

Verschueren, Marc; Kips, Johan; Euwema, Martin

2013-01-01

The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care. We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit. We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level. This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.

Activity and participation, quality of life and user satisfaction outcomes of environmental control systems and smart home technology: a systematic review.

PubMed

Brandt, Ase; Samuelsson, Kersti; Töytäri, Outi; Salminen, Anna-Liisa

2011-01-01

To examine activity and participation, quality of life, and user satisfaction outcomes of environmental control systems (ECSs) and smart home technology (SHT) interventions for persons with impairments. A systematic review. Seventeen databases, three conference proceedings, and two journals were searched without language or study design restrictions covering the period January 1993 - June 2009. Reviewers selected studies, extracted data, and assessed the methodological quality independently. Of 1739 studies identified, five effect studies and six descriptive studies were included. One study was on SHT and the remainder on ECS; functionalities were overlapping. The studies varied in most aspects, and no synthesis could be drawn. However, ECS/SHT tended to increase study participants' independence, instrumental activities of daily living, socialising, and quality of life. Two studies showed high user satisfaction. The level of evidence was regarded as low, mainly due to small study sizes, lacking confounder control, and a majority of descriptive studies. Due to few and small studies and study diversity, it was not possible to determine whether ECS/SHT have positive outcomes for persons with impairment, even though the technologies seem to be promising. High quality outcomes studies such as randomised controlled trials, when feasible, and large longitudinal multi-centre studies are required.

Self-Reported versus Professionally Assessed Functional Limitations in Community-Dwelling Very Old Individuals

ERIC Educational Resources Information Center

Carlsson, Gunilla; Haak, Maria; Nygren, Carita; Iwarsson, Susanne

2012-01-01

The objective of this study was to examine the relationship between self-reported and professionally assessed functional limitations in community-dwelling very old individuals. In total, 306 single-living adults aged 81-90 years were included in this cross-sectional study. The main outcome measure was the presence and absence of self-reported and…

Teaching "Cross-Cultural Communication" through Content Based Instruction: Curriculum Design and Learning Outcome from EFL Learners' Perspectives

ERIC Educational Resources Information Center

Tseng, Chia-Ti Heather

2017-01-01

This study aims to investigate EFL learners' perspectives for the effectiveness of content-based instruction in a cross-cultural communication course. The main objectives of this study are three-folds: (1) to examine students' perspectives regarding the effectiveness of content learning; (2) to examine students' perspectives regarding the…

Characteristics and Differences of Lifelong Learning Policy Implementation for the Elderly in Thailand

ERIC Educational Resources Information Center

Dhirathiti, Nopraenue S.; Pichitpatja, Pojjana

2018-01-01

The study examined the process of policy implementation of lifelong learning for the elderly in Thailand, covering four main regions within the country. The study empirically compared inputs, processes, outputs, and outcomes of policy implementation in the north, south, northeast, and central regions of Thailand and captured the rigor of policy…

Burnout as a Mediator between Work-School Conflict and Work Outcomes

ERIC Educational Resources Information Center

Laughman, Courtney; Boyd, Elizabeth M.; Rusbasan, David

2016-01-01

Conflict occurring between the roles of work and family has been heavily researched. Recently, however, research has been branching out to study roles beyond work and family. For example, a few researchers have investigated conflict that occurs between the roles of work and school. However, these studies have focused mainly on school and personal…

Beyond Mother Education: Maternal Practices as Predictors of Early Literacy Development in Chilean Children from Low-SES Households

ERIC Educational Resources Information Center

Mendive, Susana; Lissi, María Rosa; Bakeman, Roger; Reyes, Adriana

2017-01-01

Research Findings: To extend findings that are mainly based on North American studies with English speakers, we studied 989 Chilean mothers from households of low socioeconomic status and their prekindergarten children, posing 2 questions: (a) Do mothers' self-reported practices about literacy development predict early literacy outcomes over and…

Approaches to Increase Arsenic Awareness in Bangladesh: An Evaluation of an Arsenic Education Program

ERIC Educational Resources Information Center

George, Christine Marie; Factor-Litvak, Pam; Khan, Khalid; Islam, Tariqul; Singha, Ashit; Moon-Howard, Joyce; van Geen, Alexander; Graziano, Joseph H.

2013-01-01

The objective of this study was to design and evaluate a household-level arsenic education and well water arsenic testing intervention to increase arsenic awareness in Bangladesh. The authors randomly selected 1,000 study respondents located in 20 villages in Singair, Bangladesh. The main outcome was the change in knowledge of arsenic from…

From Thinking to Practice: School Staff Views on Disability Inclusion in Turkey

ERIC Educational Resources Information Center

Sakiz, Halis; Woods, Charlotte

2014-01-01

This paper presents outcomes of a qualitative interview study conducted in four Turkish primary schools that had been identified by the Ministry of Education as engaging in the inclusion of disabled students. The main purpose of the study was to examine school staff views on inclusion in their schools. Data were collected through semi-structured…

Facilitating mental health help-seeking by young adults with a dedicated online program: a feasibility study of Link

PubMed Central

Kauer, Sylvia D; Buhagiar, Kerrie; Blake, Victoria; Cotton, Sue; Sanci, Lena

2017-01-01

Objective To explore the feasibility of a dedicated online youth mental health help-seeking intervention and to evaluate using a randomised controlled trial (RCT) study design in order to identify any modifications needed before commencement of the full-scale RCT. Design A pilot RCT with 1:1 randomisation to either the intervention or comparison arm. Setting An online study conducted Australia-wide. Participants 18–25 year olds living in Australia were recruited via social media. Intervention Link is a dedicated online mental health help-seeking navigation tool that matches user’s mental health issues, severity and service-type preferences (online, phone and face-to-face) with appropriate youth-friendly services. The comparison arm was usual help-seeking strategies with a link to Google.com. Main outcome measures The primary outcome was the number of acceptability and feasibility criteria successfully met. Intervention and study design acceptability and feasibility were assessed by nine criteria. Secondary outcomes, via online surveys (at baseline, 1 week and 1 month) measured service use, help-seeking intentions, psychological distress, barriers to help-seeking, attitudes towards mental health help-seeking, mental health literacy, satisfaction and trust. Results Fifty-one participants were randomised (intervention: n=24; comparison: n=27). Three out of four of the intervention and two out of five of the study design criteria were met. Unmet criteria could be addressed by modifications to the study design. Qualitative analysis demonstrated that Link was useful to participants and may have increased their positive experiences towards help-seeking. There were no observable differences between arms in any outcome measures and no harms were detected. Conclusion Generally, the Link intervention and study design were acceptable and feasible with modifications suggested for the four out of nine unmet criteria. The main trial will hence have shorter surveys and a simpler recruitment process, use positive affect as the primary outcome and will not link to Google.com for the comparison arm. Trial registration number Australian New Zealand Clinical Trials Registry, ACTRN12614000386639. PMID:28694345

Outcome regimes of binary raindrop collisions

NASA Astrophysics Data System (ADS)

Testik, Firat Y.

2009-11-01

This study delineates the physical conditions that are responsible for the occurrence of main outcome regimes (i.e., bounce, coalescence, and breakup) for binary drop collisions with a precipitation microphysics perspective. Physical considerations based on the collision kinetic energy and the surface energies of the colliding drops lead to the development of a theoretical regime diagram for the drop/raindrop collision outcomes in the We- p plane ( We — Weber number, p — raindrop diameter ratio). This theoretical regime diagram is supported by laboratory experimental observations of drop collisions using high-speed imaging. Results of this fundamental study bring in new insights into the quantitative understanding of drop dynamics, applications of which extend beyond precipitation microphysics. In particular, results of this drop collision study are expected to give impetus to the physics-based dynamic modeling of the drop size distributions that is essential for various typical modern engineering applications, including numerical modeling of evolution of raindrop size distribution in rain shaft.

A study of best practices in promoting sustainable urbanization in China.

PubMed

Tan, Yongtao; Xu, Hui; Jiao, Liudan; Ochoa, J Jorge; Shen, Liyin

2017-05-15

In the past twenty years, various sustainable urban development policies and methods had been implemented within China, such that sustainable urbanization is now more widely accepted. Some of these policies and methods have been found to be successful in improving the sustainability of cities in China. Those practices can be defined as the best practices of sustainable urbanization, which can provide useful references for future urban developments. However, few existing studies examine how to learn from these best practices. Combining the methods of content analysis and social network analysis, this paper conducts a comprehensive study on 150 best practices of sustainable urbanization in China. The methods and outcomes of the 150 best practices are identified. The research findings demonstrate the statistics of categories, methods and outcomes of the 150 best practices and the main adopted methods. The achieved outcomes in different regions of China are also presented. Copyright © 2017 Elsevier Ltd. All rights reserved.

Methodology Series Module 1: Cohort Studies

PubMed Central

Setia, Maninder Singh

2016-01-01

Cohort design is a type of nonexperimental or observational study design. In a cohort study, the participants do not have the outcome of interest to begin with. They are selected based on the exposure status of the individual. They are then followed over time to evaluate for the occurrence of the outcome of interest. Some examples of cohort studies are (1) Framingham Cohort study, (2) Swiss HIV Cohort study, and (3) The Danish Cohort study of psoriasis and depression. These studies may be prospective, retrospective, or a combination of both of these types. Since at the time of entry into the cohort study, the individuals do not have outcome, the temporality between exposure and outcome is well defined in a cohort design. If the exposure is rare, then a cohort design is an efficient method to study the relation between exposure and outcomes. A retrospective cohort study can be completed fast and is relatively inexpensive compared with a prospective cohort study. Follow-up of the study participants is very important in a cohort study, and losses are an important source of bias in these types of studies. These studies are used to estimate the cumulative incidence and incidence rate. One of the main strengths of a cohort study is the longitudinal nature of the data. Some of the variables in the data will be time-varying and some may be time independent. Thus, advanced modeling techniques (such as fixed and random effects models) are useful in analysis of these studies. PMID:26955090

Methodology Series Module 1: Cohort Studies.

PubMed

Setia, Maninder Singh

2016-01-01

Cohort design is a type of nonexperimental or observational study design. In a cohort study, the participants do not have the outcome of interest to begin with. They are selected based on the exposure status of the individual. They are then followed over time to evaluate for the occurrence of the outcome of interest. Some examples of cohort studies are (1) Framingham Cohort study, (2) Swiss HIV Cohort study, and (3) The Danish Cohort study of psoriasis and depression. These studies may be prospective, retrospective, or a combination of both of these types. Since at the time of entry into the cohort study, the individuals do not have outcome, the temporality between exposure and outcome is well defined in a cohort design. If the exposure is rare, then a cohort design is an efficient method to study the relation between exposure and outcomes. A retrospective cohort study can be completed fast and is relatively inexpensive compared with a prospective cohort study. Follow-up of the study participants is very important in a cohort study, and losses are an important source of bias in these types of studies. These studies are used to estimate the cumulative incidence and incidence rate. One of the main strengths of a cohort study is the longitudinal nature of the data. Some of the variables in the data will be time-varying and some may be time independent. Thus, advanced modeling techniques (such as fixed and random effects models) are useful in analysis of these studies.

Translation, adaptation and validation of the Coronary Revascularization Outcome Questionnaire into Greek.

PubMed

Takousi, Maria G; Schmeer, Stefanie; Manaras, Irene; Olympios, Christoforos D; Fakiolas, Constantine N; Makos, Georgios; Troop, Nick A

2016-04-01

Evaluating the impact of coronary revascularization on patients' health related quality of life with a patient-based and disease-specific tool is important for drawing conclusions about treatment and outcomes. This study reports on the translation, adaptation and psychometric evaluation of a Greek version of the Coronary Revascularization Outcome Questionnaire (CROQ-Gr). A total of 609 (81.7% male) patients who had undergone coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting) were recruited from four hospitals in Athens. After translating the CROQ into Greek, a preliminary qualitative study and a pilot quantitative study were conducted. A full psychometric evaluation was carried out on the main study's data. The psychometric evaluation demonstrated that the CROQ-Gr is acceptable to patients (high response rate, low missing data) and has a good level of reliability (internal consistency >0.70, test-retest reliability >0.90) and validity (both content and construct validity). The results of this study show the CROQ-Gr to be a psychometrically rigorous patient-based measure of outcomes of coronary revascularization. It would be appropriate for use in evaluative research as well as a routine clinical tool to aid cardiologists in monitoring the outcomes of care. © The European Society of Cardiology 2015.

Is β-blocker (atenolol) a preferred antihypertensive in acute intracerebral hemorrhage?

PubMed

Kalita, Jayantee; Misra, Usha Kant; Kumar, Bishwanath

2013-07-01

The mortality in intracerebral hemorrhage (ICH) is mainly due to raised intracranial pressure, and its complications mediated by sympathetic overactivity. There is paucity of studies evaluating the role of β-blockers in the outcome of ICH. This study reports the role of atenolol in reducing mortality, pneumonia, systemic inflammatory response syndrome (SIRS), and 3 months outcome in the patients with hypertensive ICH. 138 consecutive patients with hypertensive ICH were included and their stroke risk factors and clinical details were recorded. Consciousness was assessed by Glasgow Coma Scale and severity of stroke by Canadian Neurological Scale. Volume of hematoma was measures on CT scan and occurrence of SIRS and pneumonia were noted. 3 months outcome was categorized into good (Barthel index >12) and poor (BI < 12). The patients were categorized into those receiving atenolol and nonatenolol. The effects of atenolol on stroke outcome parameters were evaluated. Seventy-nine patients received atenolol and 59 did not and they mainly received amlodipine. There was no difference in the base line clinical characteristics between the two groups except smoking (P = 0.01) and baseline blood pressure (P = 0.007). Atenolol significantly reduced the mortality (11.4 vs 37.3 %, P < 0.0001), SIRS (16.4 vs 40.9 %, P = 0.007), and pneumonia (8.9 vs 30.5 %, P = 0.002) compared to those not receiving atenolol. At 3 months, patients with atenolol had insignificantly better outcome compared to nonatenolol group (49.1 vs 31.9 %, P = 0.11). Use of atenolol in hypertensive ICH results in reduction in mortality, SIRS, and pneumonia which may be due to its β-adrenergic blocking effect.

Free Radical Damage in Ischemia-Reperfusion Injury: An Obstacle in Acute Ischemic Stroke after Revascularization Therapy

PubMed Central

Jin, Hang; Sun, Xin; Huang, Shuo; Zhang, Fu-Liang; Guo, Zhen-Ni

2018-01-01

Acute ischemic stroke is a common cause of morbidity and mortality worldwide. Thrombolysis with recombinant tissue plasminogen activator and endovascular thrombectomy are the main revascularization therapies for acute ischemic stroke. However, ischemia-reperfusion injury after revascularization therapy can result in worsening outcomes. Among all possible pathological mechanisms of ischemia-reperfusion injury, free radical damage (mainly oxidative/nitrosative stress injury) has been found to play a key role in the process. Free radicals lead to protein dysfunction, DNA damage, and lipid peroxidation, resulting in cell death. Additionally, free radical damage has a strong connection with inducing hemorrhagic transformation and cerebral edema, which are the major complications of revascularization therapy, and mainly influencing neurological outcomes due to the disruption of the blood-brain barrier. In order to get a better clinical prognosis, more and more studies focus on the pharmaceutical and nonpharmaceutical neuroprotective therapies against free radical damage. This review discusses the pathological mechanisms of free radicals in ischemia-reperfusion injury and adjunctive neuroprotective therapies combined with revascularization therapy against free radical damage. PMID:29770166

Long-term outcomes and predictors of internet-delivered cognitive behavioral therapy for childhood anxiety disorders.

PubMed

Vigerland, Sarah; Serlachius, Eva; Thulin, Ulrika; Andersson, Gerhard; Larsson, Jan-Olov; Ljótsson, Brjánn

2017-03-01

This study investigated the long-term outcomes of internet-delivered cognitive behavior therapy (ICBT) for children with anxiety disorders, and potential pre-treatment predictors of treatment outcome. The sample included eighty-four children (8-12 years old) with anxiety disorders, from both a treatment group and a waitlist control (after participants had crossed over to treatment) of a previous randomized controlled study. Participants were assessed at post-treatment and three- and twelve-months after treatment using a semi-structured interview and parent ratings. Pre-treatment data were used to investigate predictors of treatment outcome at three-month follow-up. Intention-to-treat analysis showed that treatment gains were maintained at twelve-month follow-up, including clinician rated severity of the principal anxiety disorder, parent rated anxiety symptoms and global functioning, with mainly large effect sizes (Cohen's d = 0.63-2.35). Completer analyses showed that suspected autism spectrum disorder was associated with less change in symptom severity. No other pre-treatment measures significantly predicted treatment outcome. This study suggests that internet-delivered CBT can have long-term beneficial effects for children with anxiety disorders. Predictors of treatment outcome need to be evaluated further. Clinicaltrials.gov; NCT01533402. Copyright © 2016 Elsevier Ltd. All rights reserved.

One-year outcome after first-ever stroke according to stroke subtype, severity, risk factors and pre-stroke treatment. A population-based study from Tartu, Estonia.

PubMed

Vibo, R; Kõrv, J; Roose, M

2007-04-01

The aim of the current study was to evaluate the outcome at 1 year following a first-ever stroke based on a population-based registry from 2001 to 2003 in Tartu, Estonia. The outcome of first-ever stroke was assessed in 433 patients by stroke risk factors, demographic data and stroke severity at onset using the Barthel Index (BI) score and the modified Rankin Score (mRS) at seventh day, 6 months and 1 year. Female sex, older age, blood glucose value >10 mmol/l on admission and more severe stroke on admission were the best predictors of dependency 1 year following the first-ever stroke. At 1 year, the percentage of functionally dependent patients was 20% and the survival rate was 56%. The use of antihypertensive/antithrombotic medication prior to stroke did not significantly affect the outcome. The survival rate of stroke patients in Tartu is lower compared with other studied populations. The outcome of stroke was mainly determined by the initial severity of stroke and by elevated blood glucose value on admission. Patients with untreated hypertension had more severe stroke and trend for unfavourable outcome compared with those who were on treatment.

Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications

PubMed Central

Grille, Pedro; Tommasino, Nicolas

2015-01-01

Objective To analyze the clinical characteristics, complications and factors associated with the prognosis of severe traumatic brain injury among patients who undergo a decompressive craniectomy. Methods Retrospective study of patients seen in an intensive care unit with severe traumatic brain injury in whom a decompressive craniectomy was performed between the years 2003 and 2012. Patients were followed until their discharge from the intensive care unit. Their clinical-tomographic characteristics, complications, and factors associated with prognosis (univariate and multivariate analysis) were analyzed. Results A total of 64 patients were studied. Primary and lateral decompressive craniectomies were performed for the majority of patients. A high incidence of complications was found (78% neurological and 52% nonneurological). A total of 42 patients (66%) presented poor outcomes, and 22 (34%) had good neurological outcomes. Of the patients who survived, 61% had good neurological outcomes. In the univariate analysis, the factors significantly associated with poor neurological outcome were postdecompressive craniectomy intracranial hypertension, greater severity and worse neurological state at admission. In the multivariate analysis, only postcraniectomy intracranial hypertension was significantly associated with a poor outcome. Conclusion This study involved a very severe and difficult to manage group of patients with high morbimortality. Intracranial hypertension was a main factor of poor outcome in this population. PMID:26340150

Active versus passive humidification for self-ventilating tracheostomy and laryngectomy patients: a systematic review of the literature.

PubMed

Wong, C Y Y; Shakir, A A; Farboud, A; Whittet, H B

2016-12-01

To determine whether active or passive humidification methods are more effective in preventing pulmonary complications in self-ventilating neck breather patients. Systematic Review adhering to PRISMA guidance (checklist sourced from www.equator-network.org/). Review of current published relevant literature at a tertiary department of Otolaryngology and Head & Neck Surgery. We included all separate studies and comparison studies of active and passive humidification techniques in adult and paediatric neck breather patients. The primary outcome is the reduction in pulmonary complications. Secondary outcomes include patient compliance; carer and user satisfaction. Seven studies were included in this review: two RCTs (133 patients), one randomised controlled cross-over trial (29 patients), three randomised prospective studies (171 patients), and one retrospective study (73 patients). Only one study was conducted on paediatric neck breathers. The overall quality of the studies was low. Five studies were at a high risk of bias. Of the remaining two studies, one study had a low risk of bias and the other had an unclear risk. Despite limited subject evidence, results show that passive methods of humidification (mainly HME) is the preferred choice of humidification in the spontaneously breathing neck breather patients group mainly due to the reduction in pulmonary complaints, and better patient compliance. © 2015 John Wiley & Sons Ltd.

Variations in reporting of outcomes in randomized trials on diet and physical activity in pregnancy: A systematic review.

PubMed

Rogozińska, Ewelina; Marlin, Nadine; Yang, Fen; Dodd, Jodie M; Guelfi, Kym; Teede, Helena; Surita, Fernanda; Jensen, Dorte M; Geiker, Nina R W; Astrup, Arne; Yeo, SeonAe; Kinnunen, Tarja I; Stafne, Signe N; Cecatti, Jose G; Bogaerts, Annick; Hauner, Hans; Mol, Ben W; Scudeller, Tânia T; Vinter, Christina A; Renault, Kristina M; Devlieger, Roland; Thangaratinam, Shakila; Khan, Khalid S

2017-07-01

Trials on diet and physical activity in pregnancy report on various outcomes. We aimed to assess the variations in outcomes reported and their quality in trials on lifestyle interventions in pregnancy. We searched major databases without language restrictions for randomized controlled trials on diet and physical activity-based interventions in pregnancy up to March 2015. Two independent reviewers undertook study selection and data extraction. We estimated the percentage of papers reporting 'critically important' and 'important' outcomes. We defined the quality of reporting as a proportion using a six-item questionnaire. Regression analysis was used to identify factors affecting this quality. Sixty-six randomized controlled trials were published in 78 papers (66 main, 12 secondary). Gestational diabetes (57.6%, 38/66), preterm birth (48.5%, 32/66) and cesarian section (60.6%, 40/66), were the commonly reported 'critically important' outcomes. Gestational weight gain (84.5%, 56/66) and birth weight (87.9%, 58/66) were reported in most papers, although not considered critically important. The median quality of reporting was 0.60 (interquartile range 0.25, 0.83) for a maximum score of one. Study and journal characteristics did not affect quality. Many studies on lifestyle interventions in pregnancy do not report critically important outcomes, highlighting the need for core outcome set development. © 2017 Japan Society of Obstetrics and Gynecology.

Trust in management as a buffer of the relationships between overload and strain.

PubMed

Harvey, Steve; Kelloway, E Kevin; Duncan-Leiper, Leslie

2003-10-01

This study examined the role of trust in management as a moderating factor in work overload's impact on personal strain (i.e., burnout, psychological strain, and work's interference with family). Participants were 94 employees of an accounting firm responding to a survey. The results were supportive of all study propositions. Both work overload and trust in management had the expected negative and positive main effects on the outcomes variables, respectively. The impact of work overload on the outcome variables was moderated by employees' trust in management. The significance of these results and areas of future research are discussed. 2003 APA

Comparative effects of meditation and exercise on physical and psychosocial health outcomes: a review of randomized controlled trials.

PubMed

Edwards, Meghan K; Loprinzi, Paul D

2018-03-01

No review papers have examined studies that have directly compared non-active forms of meditation with exercise to evaluate effects on physical or psychosocial outcomes, which was the purpose of this paper. Studies were included if they had a randomized controlled trial (RCT) design, included a non-active form of meditation and exercise as intervention arms, and evaluated physical or psychosocial outcomes. The quality of included RCTs was rated using the Cochrane Collaboration's tool for assessing risk of bias in randomized trials. Five RCTs met the inclusion criteria. The total sample size across all studies was N = 325. Of the main outcomes assessed across the five studies, meditation was shown to be more effective than the exercise comparison arm when evaluating the psychosocial outcomes of anxiety, altruism, and life changes. Additionally, meditation was more effective at reducing chronic neck pain at rest and pain-related bothersomeness. Exercise, however, was more effective in improving physical health-related quality of life, HDL and LDL cholesterol, and fasting blood glucose levels. The interventions were found to be comparable when evaluating the outcomes of well-being, ethanol consumption, and perceived stress levels. Four of the evaluated studies were determined to have an overall 'unclear' risk of bias and one study was found to have a 'high' risk of bias. Exercise and non-active meditation may uniquely influence various health-related outcomes. A continued exploration of the effects of exercise and non-active meditation in controlled trials may yield a better understanding of their benefits.

Health benefits of aerobic training programs in adults aged 70 and over: a systematic review.

PubMed

Bouaziz, Walid; Vogel, Thomas; Schmitt, Elise; Kaltenbach, Georges; Geny, Bernard; Lang, Pierre Olivier

Aging is intrinsically associated with a progressive decline in muscle strength and mass, and aerobic capacity. This contributes to reduced mobility and impaired quality of life (QoL) among seniors. Regular physical activity, and more particularly aerobic training (AT), has demonstrated benefits on adults' health. The aim of this review was to assess the current level of evidence regarding the health benefits of AT in the population aged 70 years and over. A comprehensive, systematic database search for manuscripts was performed. Two reviewers independently assessed interventional studies for potential inclusion. Cardiovascular, metabolic, functional, cognitive, and QoL outcomes were targeted. Fifty-three studies were included totalling 2051 seniors aged 70 years and over. Studies selected were divided into 5 categories according to their main outcomes: cardiovascular function (34 studies), metabolic outcomes (26 studies), functional fitness (19 studies), cognitive functions (8 studies), and QoL (3 studies). With a good level of evidence but a wide heterogeneity between study designs, a significant and beneficial effect of AT was measured on the 5 outcomes. For QoL results showed a significant but slighter improvement. This systematic review highlights the benefits of AT on seniors' health outcome such as cardiovascular, functional, metabolic, cognitive, and QoL outcomes although the optimal program remains unclear. When more studies regarding this specific population are needed to determine the most favourable exercise program, clinicians should nevertheless encourage older adults over 70 to participate in AT programs to favour active and healthy ageing. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A dynamic quality assessment tool for laparoscopic hysterectomy to measure surgical outcomes.

PubMed

Driessen, Sara R C; Van Zwet, Erik W; Haazebroek, Pascal; Sandberg, Evelien M; Blikkendaal, Mathijs D; Twijnstra, Andries R H; Jansen, Frank Willem

2016-12-01

The current health care system has an urgent need for tools to measure quality. A wide range of quality indicators have been developed in an attempt to differentiate between high-quality and low-quality health care processes. However, one of the main issues of currently used indicators is the lack of case-mix correction and improvement possibilities. Case-mix is defined as specific (patient) characteristics that are known to potentially affect (surgical) outcome. If these characteristics are not taken into consideration, comparisons of outcome among health care providers may not be valid. The objective of the study was to develop and test a quality assessment tool for laparoscopic hysterectomy, which can serve as a new outcome quality indicator. This is a prospective, international, multicenter implementation study. A web-based application was developed with 3 main goals: (1) to measure the surgeon's performance using 3 primary outcomes (blood loss, operative time, and complications); (2) to provide immediate individual feedback using cumulative observed-minus-expected graphs; and (3) to detect consistently suboptimal performance after correcting for case-mix characteristics. All gynecologists who perform laparoscopic hysterectomies were requested to register their procedures in the application. A patient safety risk factor checklist was used by the surgeon for reflection. Thereafter a prospective implementation study was performed, and the application was tested using a survey that included the System Usability Scale. A total of 2066 laparoscopic hysterectomies were registered by 81 gynecologists. Mean operative time was 100 ± 39 minutes, blood loss 127 ± 163 mL, and the complication rate 6.1%. The overall survey response rate was 75%, and the mean System Usability Scale was 76.5 ± 13.6, which indicates that the application was good to excellent. The majority of surgeons reported that the application made them more aware of their performance, the outcomes, and patient safety, and they noted that the application provided motivation for improving future performance. We report the development and test of a real-time, dynamic, quality assessment tool for measuring individual surgical outcome for laparoscopic hysterectomy. Importantly, this tool provides opportunities for improving surgical performance. Our study provides a foundation for helping clinicians develop evidence-based quality indicators for other surgical procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Outcomes of mandated treatment for women with histories of abuse and co-occurring disorders.

PubMed

Clark, Colleen; Young, M Scott

2009-12-01

Although there is much momentum for behavioral health policies supporting mandated treatment, there is little evidence supporting its safety and effectiveness for individuals with complex issues. The authors used a national study of women with co-occurring psychiatric, substance use disorders and histories of trauma to compare mandated and voluntary treatment by examining psychiatric, substance use, and trauma-related outcomes following treatment. This quasi-experimental study included 2,726 women, with measures completed at baseline, 6-month, and 12-month follow-up. Two-way analyses of covariance examined the main and interactive effects of coercive status (mandated vs. voluntary) and condition (integrated treatment vs. services as usual) on psychiatric distress, trauma-related symptoms, and substance use outcomes. Women did better with integrated treatment and with mandated treatment regardless of treatment condition for psychiatric, trauma, and substance use outcomes at both follow-ups. Further research clarifying unintended side effects and change mechanisms of mandated treatment is needed to inform policy decisions.

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

PubMed Central

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

2009-01-01

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

Outcome of cataract surgery at one year in Kenya, the Philippines and Bangladesh.

PubMed

Lindfield, R; Kuper, H; Polack, S; Eusebio, C; Mathenge, W; Wadud, Z; Rashid, A M; Foster, A

2009-07-01

To assess the change in vision following cataract surgery in Kenya, Bangladesh and the Philippines and to identify causes and predictors of poor outcome. Cases were identified through surveys, outreach and clinics. They underwent preoperative visual acuity measurement and ophthalmic examination. Cases were re-examined 8-15 months after cataract surgery. Information on age, gender, poverty and literacy was collected at baseline. 452 eyes of 346 people underwent surgery. 124 (27%) eyes had an adverse outcome. In Kenya and the Philippines, the main cause of adverse outcome was refractive error (37% and 49% respectively of all adverse outcomes) then comorbid ocular disease (26% and 27%). In Bangladesh, this was comorbid disease (58%) then surgical complications (21%). There was no significant association between adverse outcome and gender, age, literacy, poverty or preoperative visual acuity. Adverse outcomes following cataract surgery were frequent in the three countries. Main causes were refractive error and preoperative comorbidities. Many patients are not attaining the outcomes available with modern surgery. Focus should be on correcting refractive error, through operative techniques or postoperative refraction, and on a system for assessing comorbidities and communicating risk to patients. These are only achievable with a commitment to ongoing surgical audit.

Decompressive Craniectomy for Traumatic Brain Injury: The Role of Cranioplasty and Hydrocephalus on Outcome.

PubMed

Nasi, Davide; Dobran, Mauro; Di Rienzo, Alessandro; di Somma, Lucia; Gladi, Maurizio; Moriconi, Elisa; Scerrati, Massimo; Iacoangeli, Maurizio

2018-05-14

After severe traumatic brain injury (sTBI) associated with uncontrollable high intracranial pressure (ICP), today the main challenge for neurosurgeons remains to identify who may obtain benefit from decompressive craniectomy (DC) and which factors after DC influence the prognosis of these patients. The aim of this paper was to identify the pre- and postoperative determinants of outcome after DC. This retrospective study included all patients undergoing DC for sTBI from 2003 to 2011. The 6-month outcome, assessed using the Glasgow Outcome Scale (GOS), was dichotomized into favorable (GOS scores 4 and 5) and unfavorable (GOS scores 1-3) outcome. Predictors of outcome were identified by uni- and multivariate analysis. There were 190 patients who underwent DC for sTBI in this study. Sixty patients (31.6%) died within 30 days after DC. Independent prognostic factors for survival after 30 days were Glasgow Coma Scale score at admission greater than 5 (P = 0.002) and bilateral pupil reactivity (P < 0.0001). Thirty days after DC, 67 patients (51.5%) out of 130 had unfavorable outcome (GOS scores 1-3) and 63 patients (49.5%) presented favorable outcome (GOS scores 4 and 5). The independent preoperative prognostic factors for poor outcome were age over 65 years (P < 0.0001) and bilateral absence of pupil reactivity (P = 0.0165). After DC, onset of postoperative hydrocephalus and delayed cranioplasty (3 months after DC) was associated with unfavorable outcome at multivariate analysis (P = 0.002 and P < 0.0001, respectively). In our study, the development of hydrocephalus after DC for sTBI and delayed cranial reconstruction were associated with unfavorable outcome. Copyright © 2018 Elsevier Inc. All rights reserved.

Technical Performance as a Predictor of Clinical Outcomes in Laparoscopic Gastric Cancer Surgery.

PubMed

Fecso, Andras B; Bhatti, Junaid A; Stotland, Peter K; Quereshy, Fayez A; Grantcharov, Teodor P

2018-03-23

The purpose of this study was to evaluate the relationship between technical performance and patient outcomes in laparoscopic gastric cancer surgery. Laparoscopic gastrectomy for cancer is an advanced procedure with high rate of postoperative morbidity and mortality. Many variables including patient, disease, and perioperative management factors have been shown to impact postoperative outcomes; however, the role of surgical performance is insufficiently investigated. A retrospective review was performed for all patients who had undergone laparoscopic gastrectomy for cancer at 3 teaching institutions between 2009 and 2015. Patients with available, unedited video-recording of their procedure were included in the study. Video files were rated for technical performance, using Objective Structured Assessments of Technical Skills (OSATS) and Generic Error Rating Tool instruments. The main outcome variable was major short-term complications. The effect of technical performance on patient outcomes was assessed using logistic regression analysis with backward selection strategy. Sixty-one patients with available video recordings were included in the study. The overall complication rate was 29.5%. The mean Charlson comorbidity index, type of procedure, and the global OSATS score were included in the final predictive model. Lower performance score (OSATS ≤29) remained an independent predictor for major short-term outcomes (odds ratio 6.49), while adjusting for comorbidities and type of procedure. Intraoperative technical performance predicts major short-term outcomes in laparoscopic gastrectomy for cancer. Ongoing assessment and enhancement of surgical skills using modern, evidence-based strategies might improve short-term patient outcomes. Future work should focus on developing and studying the effectiveness of such interventions in laparoscopic gastric cancer surgery.

To center or not to center? Investigating inertia with a multilevel autoregressive model.

PubMed

Hamaker, Ellen L; Grasman, Raoul P P P

2014-01-01

Whether level 1 predictors should be centered per cluster has received considerable attention in the multilevel literature. While most agree that there is no one preferred approach, it has also been argued that cluster mean centering is desirable when the within-cluster slope and the between-cluster slope are expected to deviate, and the main interest is in the within-cluster slope. However, we show in a series of simulations that if one has a multilevel autoregressive model in which the level 1 predictor is the lagged outcome variable (i.e., the outcome variable at the previous occasion), cluster mean centering will in general lead to a downward bias in the parameter estimate of the within-cluster slope (i.e., the autoregressive relationship). This is particularly relevant if the main question is whether there is on average an autoregressive effect. Nonetheless, we show that if the main interest is in estimating the effect of a level 2 predictor on the autoregressive parameter (i.e., a cross-level interaction), cluster mean centering should be preferred over other forms of centering. Hence, researchers should be clear on what is considered the main goal of their study, and base their choice of centering method on this when using a multilevel autoregressive model.

To center or not to center? Investigating inertia with a multilevel autoregressive model

PubMed Central

Hamaker, Ellen L.; Grasman, Raoul P. P. P.

2015-01-01

Whether level 1 predictors should be centered per cluster has received considerable attention in the multilevel literature. While most agree that there is no one preferred approach, it has also been argued that cluster mean centering is desirable when the within-cluster slope and the between-cluster slope are expected to deviate, and the main interest is in the within-cluster slope. However, we show in a series of simulations that if one has a multilevel autoregressive model in which the level 1 predictor is the lagged outcome variable (i.e., the outcome variable at the previous occasion), cluster mean centering will in general lead to a downward bias in the parameter estimate of the within-cluster slope (i.e., the autoregressive relationship). This is particularly relevant if the main question is whether there is on average an autoregressive effect. Nonetheless, we show that if the main interest is in estimating the effect of a level 2 predictor on the autoregressive parameter (i.e., a cross-level interaction), cluster mean centering should be preferred over other forms of centering. Hence, researchers should be clear on what is considered the main goal of their study, and base their choice of centering method on this when using a multilevel autoregressive model. PMID:25688215

Significance of off-pump coronary artery bypass grafting compared with percutaneous coronary intervention: a propensity score analysis

PubMed Central

Marui, Akira; Kimura, Takeshi; Tanaka, Shiro; Furukawa, Yutaka; Kita, Toru; Sakata, Ryuzo

2012-01-01

OBJECTIVE Although there have been several studies that compared the efficacy of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), the impact of off-pump CABG (OPCAB) has not been well elucidated. The objective of the present study was to compare the outcomes after PCI, on-pump CABG (ONCAB), and OPCAB in patients with multivessel and/or left main disease. METHODS Among the 9877 patients undergoing first PCI using bare-metal stents or CABG who were enrolled in the CREDO-Kyoto Registry, 6327 patients with multivessel and/or left main disease were enrolled into the present study (67.9 ± 9.8 years old). Among them, 3877 patients received PCI, 1388 ONCAB, and 1069 OPCAB. Median follow-up was 3.5 years. RESULTS Comparing PCI with all CABG (ONCAB and OPCAB), propensity-score-adjusted all-cause mortality after PCI was higher than that CABG (hazard ratio (95% confidence interval): 1.37 (1.15–1.63), p < 0.01). The incidence of stroke was lower after PCI than that after CABG (0.75 (0.59–0.96), p = 0.02). CABG was associated with better survival outcomes than PCI in the elderly (interaction p = 0.04). Comparing OPCAB with PCI or ONCAB, propensity-score-adjusted all-cause mortality after PCI was higher than that after OPCAB (1.50 (1.20–1.86), p < 0.01). Adjusted mortality was similar between ONCAB and OPCAB (1.18 (0.93–1.51), p = 0.33). The incidence of stroke after OPCAB was similar to that after PCI (0.98 (0.71–1.34), p > 0.99), but incidence of stroke after ONCAB was higher than that after OPCAB (1.59 (1.16–2.18), p < 0.01). CONCLUSIONS In patients with multivessel and/or left main disease, CABG, particularly OPCAB, is associated with better survival outcomes than PCI using bare-metal stents. Survival outcomes are similar between ONCAB and OPCAB. PMID:21676626

Interventions to improve cultural competency in healthcare: a systematic review of reviews

PubMed Central

2014-01-01

Background Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area. Methods A systematic review of review articles published between January 2000 and June 2012 was conducted. Electronic databases (including Medline, Cinahl and PsycINFO), reference lists of articles, and key websites were searched. Reviews of cultural competency in health settings only were included. Each review was critically appraised by two authors using a study appraisal tool and were given a quality assessment rating of weak, moderate or strong. Results Nineteen published reviews were identified. Reviews consisted of between 5 and 38 studies, included a variety of health care settings/contexts and a range of study types. There were three main categories of study outcomes: patient-related outcomes, provider-related outcomes, and health service access and utilization outcomes. The majority of reviews found moderate evidence of improvement in provider outcomes and health care access and utilization outcomes but weaker evidence for improvements in patient/client outcomes. Conclusion This review of reviews indicates that there is some evidence that interventions to improve cultural competency can improve patient/client health outcomes. However, a lack of methodological rigor is common amongst the studies included in reviews and many of the studies rely on self-report, which is subject to a range of biases, while objective evidence of intervention effectiveness was rare. Future research should measure both healthcare provider and patient/client health outcomes, consider organizational factors, and utilize more rigorous study designs. PMID:24589335

The Effectiveness and Cost-Effectiveness of a Rural Employer-Based Wellness Program

ERIC Educational Resources Information Center

Saleh, Shadi S.; Alameddine, Mohamad S.; Hill, Dan; Darney-Beuhler, Jessica; Morgan, Ann

2010-01-01

Context: The cost-effectiveness of employer-based wellness programs has been previously investigated with favorable financial and nonfinancial outcomes being detected. However, these investigations have mainly focused on large employers in urban settings. Very few studies examined wellness programs offered in rural settings. Purpose: This paper…

Social Cognitive Predictors of Pre-Service Teachers' Technology Integration Performance

ERIC Educational Resources Information Center

Perkmen, Serkan; Pamuk, Sonmez

2011-01-01

The main objective of the study was to examine interrelationships among social cognitive variables (self-efficacy, outcome expectations, and performance goals) and their role in predicting pre-service teachers' technology integration performance. Although researchers have examined the role of these variables in the teacher-education context, the…

Attitude Changes of Undergraduate University Students in General Education Courses

ERIC Educational Resources Information Center

Anderson, Mark W.; Teisl, Mario F.; Criner, George K.; Tisher, Sharon; Smith, Stewart; Hunter, Malcolm L.; Norton, Stephen A.; Jellison, Jody; Alyokhin, Andrei; Gallandt, Eric; Haggard, Sandra; Bicknell, Elizabeth

2007-01-01

Assessing learning outcomes in general education is increasingly important to accrediting bodies. A fertile area of assessment is measuring changes in student attitudes/values in response to general education. University of Maine faculty experimented with such an attitude assessment. In this study, the authors assessed changes in students'…

Instruction Design System of Allama Iqbal Open University: A Vehicle for Improvement or Mere a Salogon

ERIC Educational Resources Information Center

Ashfaq, Muhammad; Chaudry, Muhammad Ajmal; Iqbal, Muhammad Javed

2016-01-01

The main objective of this study was to ensure instructional quality, effectiveness, efficiency and enjoyment. Instructional design maximizes the value of the instructions for the learners. Instructional design include identifying instructional out-comes, developing instructional contents and established how instructional effectiveness will be…

Infusing Creativity into Eastern Classrooms: Evaluations from Student Perspectives

ERIC Educational Resources Information Center

Cheng, Vivian M. Y.

2011-01-01

Infusing creativity elements into regular classroom was an important movement in recent Asian educational reforms. A large-scale research study was conducted in Hong Kong to explore the possibilities, outcomes and difficulties of this kind of curriculum change from students' perspectives. Based mainly on Western creativity literature, this study…

Action Monitoring and Perfectionism in Anorexia Nervosa

ERIC Educational Resources Information Center

Pieters, Guido L. M.; de Bruijn, Ellen R. A.; Maas, Yvonne; Hulstijn, Wouter; Vandereycken, Walter; Peuskens, Joseph; Sabbe, Bernard G.

2007-01-01

To study action monitoring in anorexia nervosa, behavioral and EEG measures were obtained in underweight anorexia nervosa patients (n=17) and matched healthy controls (n=19) while performing a speeded choice-reaction task. Our main measures of interest were questionnaire outcomes, reaction times, error rates, and the error-related negativity ERP…

International Students' Proactive Behaviors in the United States: Effects of Information-Seeking Behaviors on School Life

ERIC Educational Resources Information Center

Cho, Jaehee; Lee, Seungjo

2016-01-01

Considering the continuous increase of international students, the main goal of this study was to examine how international students' proactive behaviors, particularly information seeking behaviors, would impact key emotional outcomes including communication satisfaction with instructors and school-life satisfaction. For this investigation, we…

Exploring the Use of Technology in Mentoring

ERIC Educational Resources Information Center

Wilcox, Denise

2017-01-01

Purpose: The purpose of this qualitative case study was to explore how using technology tools during mentoring impacts the desired outcomes, as defined by the mentor-mentee contract, of the mentoring relationships of technology workers at a private graduate university with the main campus in Southern California. Methodology: This was a single…

Prenatal and Postpartum Maternal Psychological Distress and Infant Development: A Systematic Review

ERIC Educational Resources Information Center

Kingston, Dawn; Tough, Suzanne; Whitfield, Heather

2012-01-01

Infant development plays a foundational role in optimal child development and health. Some studies have demonstrated an association between maternal psychological distress and infant outcomes, although the main emphasis has been on postpartum depression and infant-maternal attachment. Prevention and early intervention strategies would benefit from…

Objective Assessment of Vergence after Treatment of Concussion-Related CI: A Pilot Study

PubMed Central

Scheiman, Mitchell; Talasan, Henry; Mitchell, Gladys L; Alvarez, Tara L.

2016-01-01

Purpose To evaluate changes in objective measures of disparity vergence after office-based vision therapy (OBVT) for concussion-related convergence insufficiency (CI), and determine the feasibility of using this objective assessment as an outcome measure in a clinical trial. Methods This was a prospective, observational trial. All participants were treated with weekly OBVT with home reinforcement. Participants included two adolescents and three young adults with concussion-related, symptomatic CI. The primary outcome measure was average peak velocity for 4-degree symmetrical convergence steps. Other objective outcome measures of disparity vergence included time to peak velocity, latency, accuracy, settling time, and main sequence. We also evaluated saccadic eye movements using the same outcome measures. Changes in clinical measures (near point of convergence, positive fusional vergence at near, Convergence Insufficiency Symptom Survey (CISS) score) were evaluated. Results There were statistically significant and clinically meaningful changes in all clinical measures for convergence. Four of the five subjects met clinical success criteria. For the objective measures, we found a statistically significant increase in peak velocity, response accuracy to 4° symmetrical convergence and divergence step stimuli and the main sequence ratio for convergence step stimuli. Objective saccadic eye movements (5° and 10°) appeared normal pre-OBVT, and did not show any significant change after treatment. Conclusions This is the first report of the use of objective measures of disparity vergence as outcome measures for concussion-related convergence insufficiency. These measures provide additional information that is not accessible with clinical tests about underlying physiological mechanisms leading to changes in clinical findings and symptoms. The study results also demonstrate that patients with concussion can tolerate the visual demands (over 200 vergence and versional eye movements) during the 25-minute testing time and suggest that these measures could be used in a large-scale randomized clinical trial of concussion-related CI as outcome measures. PMID:27464574

Objective Assessment of Vergence after Treatment of Concussion-Related CI: A Pilot Study.

PubMed

Scheiman, Mitchell M; Talasan, Henry; Mitchell, G Lynn; Alvarez, Tara L

2017-01-01

To evaluate changes in objective measures of disparity vergence after office-based vision therapy (OBVT) for concussion-related convergence insufficiency (CI) and determine the feasibility of using this objective assessment as an outcome measure in a clinical trial. This was a prospective, observational trial. All participants were treated with weekly OBVT with home reinforcement. Participants included two adolescents and three young adults with concussion-related, symptomatic CI. The primary outcome measure was average peak velocity for 4° symmetrical convergence steps. Other objective outcome measures of disparity vergence included time to peak velocity, latency, accuracy, settling time, and main sequence. We also evaluated saccadic eye movements using the same outcome measures. Changes in clinical measures (near point of convergence, positive fusional vergence at near, Convergence Insufficiency Symptom Survey [CISS] score) were evaluated. There were statistically significant and clinically meaningful changes in all clinical measures for convergence. Four of the five subjects met clinical success criteria. For the objective measures, we found a statistically significant increase in peak velocity, response accuracy to 4° symmetrical convergence and divergence step stimuli, and the main sequence ratio for convergence step stimuli. Objective saccadic eye movements (5 and 10°) appeared normal pre-OBVT and did not show any significant change after treatment. This is the first report of the use of objective measures of disparity vergence as outcome measures for concussion-related convergence insufficiency. These measures provide additional information that is not accessible with clinical tests about underlying physiological mechanisms leading to changes in clinical findings and symptoms. The study results also demonstrate that patients with concussion can tolerate the visual demands (over 200 vergence and versional eye movements) during the 25-minute testing time and suggest that these measures could be used in a large-scale randomized clinical trial of concussion-related CI as outcome measures.

Sex-specific predictors of inpatient rehabilitation outcomes after traumatic brain injury

PubMed Central

Chan, Vincy; Mollayeva, Tatyana; Ottenbacher, Kenneth J.; Colantonio, Angela

2016-01-01

Objective To identify sex-specific predictors of inpatient rehabilitation outcomes among patients with a traumatic brain injury (TBI) from a population based perspective. Design Retrospective cohort study Setting Ontario, Canada Participants Patients in inpatient rehabilitation for a TBI within one year of acute care discharge between 2008/09 and 2011/12 (N=1,730, 70% male, 30% female). Interventions None Main Outcome Measures Inpatient rehabilitation length of stay, total Functional Independence Measure (FIM™) score, and motor and cognitive FIM™ ratings at discharge. Results Sex, as a covariate in multivariable linear regression models, was not a significant predictor of rehabilitation outcomes. While many of the predictors examined were similar across males and females, sex-specific multivariable models identified some predictors of rehabilitation outcome that are specific for males and females; mechanism of injury (p<.0001) was a significant predictor of functional outcome only among females while comorbidities (p<.0001) was a significant predictor for males only. Conclusions Predictors of outcomes after inpatient rehabilitation differed by sex, providing evidence for a sex-specific approach in planning and resource allocation for inpatient rehabilitation services for patients with TBI. PMID:26836952

Effect of a web-based audit and feedback intervention with outreach visits on the clinical performance of multidisciplinary teams: a cluster-randomized trial in cardiac rehabilitation.

PubMed

Gude, Wouter T; van Engen-Verheul, Mariëtte M; van der Veer, Sabine N; Kemps, Hareld M C; Jaspers, Monique W M; de Keizer, Nicolette F; Peek, Niels

2016-12-09

The objective of this study was to assess the effect of a web-based audit and feedback (A&F) intervention with outreach visits to support decision-making by multidisciplinary teams. We performed a multicentre cluster-randomized trial within the field of comprehensive cardiac rehabilitation (CR) in the Netherlands. Our participants were multidisciplinary teams in Dutch CR centres who were enrolled in the study between July 2012 and December 2013 and received the intervention for at least 1 year. The intervention included web-based A&F with feedback on clinical performance, facilities for goal setting and action planning, and educational outreach visits. Teams were randomized either to receive feedback that was limited to psychosocial rehabilitation (study group A) or to physical rehabilitation (study group B). The main outcome measure was the difference in performance between study groups in 11 care processes and six patient outcomes, measured at patient level. Secondary outcomes included effects on guideline concordance for the four main CR therapies. Data from 18 centres (14,847 patients) were analysed, of which 12 centres (9353 patients) were assigned to group A and six (5494 patients) to group B. During the intervention, a total of 233 quality improvement goals was identified by participating teams, of which 49 (21%) were achieved during the study period. Except for a modest improvement in data completeness (4.5% improvement per year; 95% CI 0.65 to 8.36), we found no effect of our intervention on any of our primary or secondary outcome measures. Within a multidisciplinary setting, our web-based A&F intervention engaged teams to define local performance improvement goals but failed to support them in actually completing the improvement actions that were needed to achieve those goals. Future research should focus on improving the actionability of feedback on clinical performance and on addressing the socio-technical perspective of the implementation process. NTR3251.

Cingulate Epilepsy

PubMed Central

Alkawadri, Rafeed; So, Norman K.; Van Ness, Paul C.; Alexopoulos, Andreas V.

2016-01-01

IMPORTANCE The literature on cingulate gyrus epilepsy in the magnetic resonance imaging era is limited to case reports and small case series. To our knowledge, this is the largest study of surgically confirmed epilepsy arising from the anterior or posterior cingulate region. OBJECTIVE To characterize the clinical and electrophysiological findings of epilepsies arising from the anterior and posterior cingulate gyrus. DESIGN, SETTING, AND PARTICIPANTS We studied consecutive cingulate gyrus epilepsy cases identified retrospectively from the Cleveland Clinic and University of Texas Southwestern Medical Center epilepsy databases from 1992 to 2009. Participants included 14 consecutive cases of cingulate gyrus epilepsies confirmed by restricted magnetic resonance image lesions and seizure freedom or marked improvement following lesionectomy. MAIN OUTCOMES AND MEASURES The main outcome measure was improvement in seizure frequency following surgery. The clinical, video electroencephalography, neuroimaging, pathology, and surgical outcome data were reviewed. RESULTS All 14 patients had cingulate epilepsy confirmed by restricted magnetic resonance image lesions and seizure freedom or marked improvement following lesionectomy. They were divided into 3 groups based on anatomical location of the lesion and corresponding seizure semiology. In the posterior cingulate group, all 4 patients had electroclinical findings suggestive of temporal origin of the epilepsy. The anterior cingulate cases were divided into a typical (Bancaud) group (6 cases with hypermotor seizures and infrequent generalization with the presence of fear, laughter, or severe interictal personality changes) and an atypical group (4 cases presenting with simple motor seizures and a tendency for more frequent generalization and less-favorable long-term surgical outcome). All atypical cases were associated with an underlying infiltrative astrocytoma. CONCLUSIONS AND RELEVANCE Posterior cingulate gyrus epilepsy may present with electroclinical findings that are suggestive of temporal lobe epilepsy and can be considered as another example of pseudotemporal epilepsies. The electroclinical presentation and surgical outcome of lesional anterior cingulate epilepsy is possibly influenced by the underlying pathology. This study highlights the difficulty in localizing seizures arising from the cingulate gyrus in the absence of a magnetic resonance image lesion. PMID:23753910

Addendum to "Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial".

PubMed

Prinz, Ronald J; Sanders, Matthew R; Shapiro, Cheri J; Whitaker, Daniel J; Lutzker, John R

2016-04-01

A previous article published several years ago (Prinz et al. Prevention Science, 10, 1-12, 2009) described the main results of a place-randomized-design study focused on the prevention of child-maltreatment-related outcomes at a population level through the implementation of a multilevel system of parenting and family support (the Triple P-Positive Parenting Program). The current report, prepared at the encouragement of the journal, provides additional details about procedures, measures, and design-related decisions, presents an additional analysis of the main outcome variables, and poses questions about the study and its implications. We also offer guidance about how the field can move forward to build on this line of research. From the outset, the three designated primary child maltreatment outcomes were county-wide rates for substantiated child maltreatment cases, out-of-home placements, and hospital-treated child maltreatment injuries, derived from independent data sources available through administrative archival records. Baseline equivalence between the two intervention conditions was reaffirmed. The additional analysis, which made use of a 5-year baseline (replacing a 1-year baseline) and ANCOVA, yielded large effect sizes for all three outcomes that converged with those from the original analyses. Overall, the study underscored the potential for community-wide parenting and family support to produce population-level preventive impact on child maltreatment. Issues addressed included (1) the need for replication of population-oriented maltreatment prevention strategies like the one tested in this randomized experiment, (2) the need to demonstrate that a parenting-based population approach to maltreatment prevention can also impact children's adjustment apart from child abuse, and (3) the role of implementation science for achieving greater population reach and maintenance over time.

The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain.

PubMed

Quon, Jeffrey A; Bishop, Paul B; Arthur, Brian

2015-06-01

The aim of this study was to determine if effectiveness differs between community-based doctors of chiropractic administering standardized evidence-based care that includes high-velocity low-amplitude spinal manipulative therapy (SMT) for acute low back pain (LBP). A secondary analysis of randomized controlled trial and observational pilot study data was performed with nonrandom allocation to 4 DCs. Patients included those with Quebec Task Force categories less than or equal to 2 and acute LBP of 2 to 4 weeks' duration. The intervention provided was clinical practice guidelines-based care including high-velocity low-amplitude SMT. Primary outcomes included changes from baseline in modified Roland Disability Questionnaire (RDQ) at 24 weeks. Comparisons of simple main effects at 24 weeks and of marginal main effects in repeated-measures analyses were performed. Between groups, adjusted point-specific differences in RDQ change were minimally clinically important but not statistically significant at 24 weeks (largest pairwise difference, -3.1; 95% confidence interval, -6.3 to 0.1; overall P = .10). However, in optimal analyses that considered the repeated nature of the measurements for each outcome, significant differences in marginal mean RDQ changes were found between groups (largest pairwise difference, -3.8; 95% confidence interval, -4.9 to 2.6; overall P = .03). Overall, DCs differed modestly in their effectiveness in improving LBP-specific disability. The point estimates mirrored typically reported effect sizes from recent systematic reviews of SMT; however, confidence limits did not exclude clinically negligible effects. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Experiences and Perceptions of Mentors in a Community Mentoring Program for At-Risk Students

ERIC Educational Resources Information Center

Allen, Belinda K.

2013-01-01

This phenomenological case study explored the perceptions and experiences of mentors who work for a community-based mentoring program that was created to provide at-risk minority students with male role models. Most studies from the past 20 years have assessed mainly the academic, social, and emotional outcomes of mentoring among at-risk minority…

Using Social Network Graphs as Visualization Tools to Influence Peer Selection Decision-Making Strategies to Access Information about Complex Socioscientific Issues

ERIC Educational Resources Information Center

Yoon, Susan A.

2011-01-01

This study extends previous research that explores how visualization affordances that computational tools provide and social network analyses that account for individual- and group-level dynamic processes can work in conjunction to improve learning outcomes. The study's main hypothesis is that when social network graphs are used in instruction,…

Commitment Profiles: The Configural Effect of the Forms and Foci of Commitment on Work Outcomes

ERIC Educational Resources Information Center

Tsoumbris, Petros; Xenikou, Athena

2010-01-01

This study is based upon the conceptual linking of the multidimensional and multi-focal nature of work-related commitment. The main aims of our study were to create, through K-means cluster analysis, commitment profiles based on the three components of organizational and occupational commitment, and to examine their joint effect on key work…

Turkish Preservice Primary School Teachers' Science Teaching Efficacy Beliefs and Attitudes toward Science: The Effect of a Primary Teacher Education Program

ERIC Educational Resources Information Center

Bayraktar, Sule

2011-01-01

The main purpose of this study was to investigate the effectiveness of a primary teacher education program in improving science teaching efficacy beliefs (personal science teaching efficacy beliefs and outcome expectancy beliefs) of preservice primary school teachers. The study also investigated whether the program has an effect on student…

Analysis of Covariance: Is It the Appropriate Model to Study Change?

ERIC Educational Resources Information Center

Marston, Paul T., Borich, Gary D.

The four main approaches to measuring treatment effects in schools; raw gain, residual gain, covariance, and true scores; were compared. A simulation study showed true score analysis produced a large number of Type-I errors. When corrected for this error, this method showed the least power of the four. This outcome was clearly the result of the…

Effects of an Automated Telephone Support System on Caregiver Burden and Anxiety: Findings from the REACH for TLC Intervention Study

ERIC Educational Resources Information Center

Mahoney, Diane Feeney; Tarlow, Barbara J.; Jones, Richard N.

2003-01-01

Purpose: We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response (IVR) intervention designed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer's disease (AD). Design and Methods: We conducted a randomized controlled study of 100 caregivers, 51 in the usual…

Digital Clinical Communication for Families and Caregivers of Children or Young People With Short- or Long-Term Conditions: Rapid Review.

PubMed

Armoiry, Xavier; Sturt, Jackie; Phelps, Emma Elizabeth; Walker, Clare-Louise; Court, Rachel; Taggart, Frances; Sutcliffe, Paul; Griffiths, Frances; Atherton, Helen

2018-01-05

The communication relationship between parents of children or young people with health conditions and health professionals is an important part of treatment, but it is unclear how far the use of digital clinical communication tools may affect this relationship. The objective of our study was to describe, assess the feasibility of, and explore the impact of digital clinical communication between families or caregivers and health professionals. We searched the literature using 5 electronic databases. We considered all types of study design published in the English language from January 2009 to August 2015. The population of interest included families and caregivers of children and young people aged less than 26 years with any type of health condition. The intervention was any technology permitting 2-way communication. We included 31 articles. The main designs were randomized controlled trials (RCTs; n=10), cross-sectional studies (n=9), pre- and postintervention uncontrolled (pre/post) studies (n=7), and qualitative interview studies (n=2); 6 had mixed-methods designs. In the majority of cases, we considered the quality rating to be fair. Many different types of health condition were represented. A breadth of digital communication tools were included: videoconferencing or videoconsultation (n=14), and Web messaging or emails (n=12). Health care professionals were mainly therapists or cognitive behavioral therapists (n=10), physicians (n=8), and nurses (n=6). Studies were very heterogeneous in terms of outcomes. Interventions were mainly evaluated using satisfaction or acceptance, or outcomes relating to feasibility. Clinical outcomes were rarely used. The RCTs showed that digital clinical communication had no impact in comparison with standard care. Uncontrolled pre/post studies showed good rates of satisfaction or acceptance. Some economic studies suggested that digital clinical communication may save costs. This rapid review showed an emerging body of literature on the use of digital clinical communication to improve families' and caregivers' involvement in the health management of children or young people. Further research with appropriate study designs and longer-term outcome measures should be encouraged. PROSPERO CRD42016035467; http://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD 42016 035467(Archived by WebCite at http://www.webcitation.org/6vpgZU1FU). ©Xavier Armoiry, Jackie Sturt, Emma Elizabeth Phelps, Clare-Louise Walker, Rachel Court, Frances Taggart, Paul Sutcliffe, Frances Griffiths, Helen Atherton. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.01.2018.

Prediction of Outcome after Moderate and Severe Traumatic Brain Injury: External Validation of the IMPACT and CRASH Prognostic Models

PubMed Central

Roozenbeek, Bob; Lingsma, Hester F.; Lecky, Fiona E.; Lu, Juan; Weir, James; Butcher, Isabella; McHugh, Gillian S.; Murray, Gordon D.; Perel, Pablo; Maas, Andrew I.R.; Steyerberg, Ewout W.

2012-01-01

Objective The International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models predict outcome after traumatic brain injury (TBI) but have not been compared in large datasets. The objective of this is study is to validate externally and compare the IMPACT and CRASH prognostic models for prediction of outcome after moderate or severe TBI. Design External validation study. Patients We considered 5 new datasets with a total of 9036 patients, comprising three randomized trials and two observational series, containing prospectively collected individual TBI patient data. Measurements Outcomes were mortality and unfavourable outcome, based on the Glasgow Outcome Score (GOS) at six months after injury. To assess performance, we studied the discrimination of the models (by AUCs), and calibration (by comparison of the mean observed to predicted outcomes and calibration slopes). Main Results The highest discrimination was found in the TARN trauma registry (AUCs between 0.83 and 0.87), and the lowest discrimination in the Pharmos trial (AUCs between 0.65 and 0.71). Although differences in predictor effects between development and validation populations were found (calibration slopes varying between 0.58 and 1.53), the differences in discrimination were largely explained by differences in case-mix in the validation studies. Calibration was good, the fraction of observed outcomes generally agreed well with the mean predicted outcome. No meaningful differences were noted in performance between the IMPACT and CRASH models. More complex models discriminated slightly better than simpler variants. Conclusions Since both the IMPACT and the CRASH prognostic models show good generalizability to more recent data, they are valid instruments to quantify prognosis in TBI. PMID:22511138

Therapist strategies early in therapy associated with good or poor outcomes among clients with low proactive agency.

PubMed

von der Lippe, Anna Louise; Oddli, Hanne Weie; Halvorsen, Margrethe Seeger

2017-09-10

Within a mixed methods program of research the present study aimed at expanding knowledge about interactions in the initial therapeutic collaboration by combining focus on client interpersonal style and therapist contribution. The study involves in-depth analyses of therapist-client interactions in the initial two sessions of good and poor outcome therapies. Based on interpersonal theory and previous research, the Inventory of Interpersonal Problems (IIP-64-C) was used to define poor outcome cases, that is, low proactive agency cases. To compare good and poor outcome cases matched on this interpersonal pattern, cases were drawn from two different samples; nine poor outcome cases from a large multi-site outpatient clinic study and nine good outcome cases from a process-outcome study of highly experienced therapists. Qualitative analysis of therapist behaviors resulted in 2 main categories, fostering client's proactive agentic involvement in change work and discouraging client's proactive agentic involvement in change work, 8 categories and 22 sub-categories. The findings revealed distinct and cohesive differences in therapist behaviors between the two outcome groups, and point to the particular therapist role of fostering client agency through engagement in a shared work on change when clients display strong unassertiveness and low readiness for change. Clinical or Methodological Significance Summary: The present analysis combines focus on client interpersonal style, therapist strategies/process and outcome. The categories generated from the present grounded theory analysis may serve as a foundation for identifying interactions that are associated with agentic involvement in future process research and practice, and hence we have formulated principles/strategies that were identified by the analysis.

Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques.

PubMed

Horbach, Sophie E R; Bouman, Mark-Bram; Smit, Jan Maerten; Özer, Müjde; Buncamper, Marlon E; Mullender, Margriet G

2015-06-01

Gender reassignment surgery is the keystone of the treatment of transgender patients. For male-to-female transgenders, this involves the creation of a neovagina. Many surgical methods for vaginoplasty have been opted. The penile skin inversion technique is the method of choice for most gender surgeons. However, the optimal surgical technique for vaginoplasty in transgender women has not yet been identified, as outcomes of the different techniques have never been compared. With this systematic review, we aim to give a detailed overview of the published outcomes of all currently available techniques for vaginoplasty in male-to-female transgenders. A PubMed and EMBASE search for relevant publications (1995-present), which provided data on the outcome of techniques for vaginoplasty in male-to-female transgender patients. Main outcome measures are complications, neovaginal depth and width, sexual function, patient satisfaction, and improvement in quality of life (QoL). Twenty-six studies satisfied the inclusion criteria. The majority of these studies were retrospective case series of low to intermediate quality. Outcome of the penile skin inversion technique was reported in 1,461 patients, bowel vaginoplasty in 102 patients. Neovaginal stenosis was the most frequent complication in both techniques. Sexual function and patient satisfaction were overall acceptable, but many different outcome measures were used. QoL was only reported in one study. Comparison between techniques was difficult due to the lack of standardization. The penile skin inversion technique is the most researched surgical procedure. Outcome of bowel vaginoplasty has been reported less frequently but does not seem to be inferior. The available literature is heterogeneous in patient groups, surgical procedure, outcome measurement tools, and follow-up. Standardized protocols and prospective study designs are mandatory for correct interpretation and comparability of data. © 2015 International Society for Sexual Medicine.

Effects of Admission and Treatment Strategies of DWI Courts on Offender Outcomes

PubMed Central

Sloan, Frank A.; Chepke, Lindsey M.; Davis, Dontrell V.; Acquah, Kofi; Zold-Kilbourne, Phyllis

2013-01-01

Purpose The purpose of this study is to classify DWI courts on the basis of the mix of difficult cases participating in the court (casemix severity) and the amount of involvement between the court and participant (service intensity). Using our classification typology, we assess how casemix severity and service intensity are associated with program outcomes. We expected that holding other factors constant, greater service intensity would improve program outcomes while a relatively severe casemix would result in worse program outcomes. Methods The study used data from 8 DWI courts, 7 from Michigan and 1 from North Carolina. Using a 2-way classification system based on court casemix severity and program intensity, we selected participants in 1 of the courts, and alternatively 2 courts as reference groups. Reference group courts had relatively severe casemixes and high service intensity. We used propensity score matching to match participants in the other courts to participants in the reference group court programs. Program outcome measures were the probabilities of participants’: failing to complete the court’s program; increasing educational attainment; participants improving employment from time of program enrollment; and re-arrest. Results For most outcomes, our main finding was that higher service intensity is associated with better outcomes for court participants, as anticipated, but a court’s casemix severity was unrelated to study outcomes. Conclusions Our results imply that devoting more resources to increasing duration of treatment is productive in terms of better outcomes, irrespective of the mix of participants in the court’s program PMID:23416679

Physiological ICSI (PICSI) vs. Conventional ICSI in Couples with Male Factor: A Systematic Review.

PubMed

Avalos-Durán, Georgina; Ángel, Ana María Emilia Cañedo-Del; Rivero-Murillo, Juana; Zambrano-Guerrero, Jaime Enoc; Carballo-Mondragón, Esperanza; Checa-Vizcaíno, Miguel Ángel

2018-04-19

To determine the efficacy of the physiological ICSI technique (PICSI) vs. conventional ICSI in the prognosis of couples, with respect to the following outcome measures: live births, clinical pregnancy, implantation, embryo quality, fertilization and miscarriage rates. A systematic review of the literature, extracting raw data and performing data analysis. Patient(s): Couples with the male factor, who were subjected to in-vitro fertilization. Main Outcome Measures: rates of live births, clinical pregnancy, implantation, embryo quality, fertilization and miscarriage. In the systematic search, we found 2,918 studies and an additional study from other sources; only two studies fulfilled the inclusion criteria for this systematic review. The rates of live births, clinical pregnancy, implantation, embryo quality, fertilization and miscarriage were similar for both groups. There is no statistically significant difference between PICSI vs. ICSI, for any of the outcomes analyzed in this study. Enough information is still not available to prove the efficacy of the PICSI technique over ICSI in couples with male factor.

Effective intervention strategies to improve health outcomes for cardiovascular disease patients with low health literacy skills: a systematic review.

PubMed

Lee, Tae Wha; Lee, Seon Heui; Kim, Hye Hyun; Kang, Soo Jin

2012-12-01

Systematic studies on the relationship between health literacy and health outcomes demonstrate that as health literacy declines, patients engage in fewer preventive health and self-care behaviors and have worse disease-related knowledge. The purpose of this study was to identify effective intervention strategies to improve health outcomes in patients with cardiovascular disease and low literacy skills. This study employs the following criteria recommended by Khan Kunz, Keijnen, and Antes (2003) for systematic review: framing question, identifying relevant literature, assessing quality of the literature, summarizing the evidence, and interpreting the finding. A total of 235 articles were reviewed by the research team, and 9 articles met inclusion criteria. Although nine studies were reviewed for their health outcomes, only six studies, which had a positive quality grade evaluation were used to recommend effective intervention strategies. Interventions were categorized into three groups: tailored counseling, self-monitoring, and periodic reminder. The main strategies used to improve health outcomes of low literacy patients included tailored counseling, improved provider-patient interactions, organizing information by patient preference, self-care algorithms, and self-directed learning. Specific strategies included written materials tailored to appropriate reading levels, materials using plain language, emphasizing key points with large font size, and using visual items such as icons or color codes. With evidence-driven strategies, health care professionals can use tailored interventions to provide better health education and counseling that meets patient needs and improves health outcomes. Copyright © 2012. Published by Elsevier B.V.

Does the patient‐held record improve continuity and related outcomes in cancer care: a systematic review

PubMed Central

Gysels, Marjolein; Richardson, Alison; Higginson, Irene J.

2006-01-01

Abstract Objectives  To assess the effectiveness of the patient‐held record (PHR) in cancer care. Background  Patients with cancer may receive care from different services resulting in gaps. A PHR could provide continuity and patient involvement in care. Search strategy  Relevant literature was identified through five electronic databases (Medline, Embase, Cinahl, CCTR and CDSR) and hand searches. Inclusion criteria  Patient‐held records in cancer care with the purpose of improving communication and information exchange between and within different levels of care and to promote continuity of care and patients’ involvement in their own care. Data extraction and synthesis  Data extraction recorded characteristics of intervention, type of study and factors that contributed to methodological quality of individual studies. Data were then contrasted by setting, objectives, population, study design, outcome measures and changes in outcome, including knowledge, satisfaction, anxiety and depression. Methodological quality of randomized control trials and non‐experimental studies were assessed with separate standard grading scales. Main results and conclusions  Seven randomized control trials and six non‐experimental studies were identified. Evaluations of the PHR have reached equivocal findings. Randomized trials found an absence of effect, non‐experimental evaluations shed light on the conditions for its successful use. Most patients welcomed introduction of a PHR. Main problems related to its suitability for different patient groups and the lack of agreement between patients and health professionals regarding its function. Further research is required to determine the conditions under which the PHR can realize its potential as a tool to promote continuity of care and patient participation. PMID:17324196

Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review.

PubMed

Söderström-Anttila, Viveca; Wennerholm, Ulla-Britt; Loft, Anne; Pinborg, Anja; Aittomäki, Kristiina; Romundstad, Liv Bente; Bergh, Christina

2016-01-01

Surrogacy is a highly debated method mainly used for treating women with infertility caused by uterine factors. This systematic review summarizes current levels of knowledge of the obstetric, medical and psychological outcomes for the surrogate mothers, the intended parents and children born as a result of surrogacy. PubMed, Cochrane and Embase databases up to February 2015 were searched. Cohort studies and case series were included. Original studies published in English and the Scandinavian languages were included. In case of double publications, the latest study was included. Abstracts only and case reports were excluded. Studies with a control group and case series (more than three cases) were included. Cohort studies, but not case series, were assessed for methodological quality, in terms of risk of bias. We examined a variety of main outcomes for the surrogate mothers, children and intended mothers, including obstetric outcome, relationship between surrogate mother and intended couple, surrogate's experiences after relinquishing the child, preterm birth, low birthweight, birth defects, perinatal mortality, child psychological development, parent-child relationship, and disclosure to the child. The search returned 1795 articles of which 55 met the inclusion criteria. The medical outcome for the children was satisfactory and comparable to previous results for children conceived after fresh IVF and oocyte donation. The rate of multiple pregnancies was 2.6-75.0%. Preterm birth rate in singletons varied between 0 and 11.5% and low birthweight occurred in between 0 and 11.1% of cases. At the age of 10 years there were no major psychological differences between children born after surrogacy and children born after other types of assisted reproductive technology (ART) or after natural conception. The obstetric outcomes for the surrogate mothers were mainly reported from case series. Hypertensive disorders in pregnancy were reported in between 3.2 and 10% of cases and placenta praevia/placental abruption in 4.9%. Cases with hysterectomies have also been reported. Most surrogate mothers scored within the normal range on personality tests. Most psychosocial variables were satisfactory, although difficulties related to handing over the child did occur. The psychological well-being of children whose mother had been a surrogate mother between 5 and 15 years earlier was found to be good. No major differences in psychological state were found between intended mothers, mothers who conceived after other types of ART and mothers whose pregnancies were the result of natural conception. Most studies reporting on surrogacy have serious methodological limitations. According to these studies, most surrogacy arrangements are successfully implemented and most surrogate mothers are well-motivated and have little difficulty separating from the children born as a result of the arrangement. The perinatal outcome of the children is comparable to standard IVF and oocyte donation and there is no evidence of harm to the children born as a result of surrogacy. However, these conclusions should be interpreted with caution. To date, there are no studies on children born after cross-border surrogacy or growing up with gay fathers. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Method for appraising model validity of randomised controlled trials of homeopathic treatment: multi-rater concordance study

PubMed Central

2012-01-01

Background A method for assessing the model validity of randomised controlled trials of homeopathy is needed. To date, only conventional standards for assessing intrinsic bias (internal validity) of trials have been invoked, with little recognition of the special characteristics of homeopathy. We aimed to identify relevant judgmental domains to use in assessing the model validity of homeopathic treatment (MVHT). We define MVHT as the extent to which a homeopathic intervention and the main measure of its outcome, as implemented in a randomised controlled trial (RCT), reflect 'state-of-the-art' homeopathic practice. Methods Using an iterative process, an international group of experts developed a set of six judgmental domains, with associated descriptive criteria. The domains address: (I) the rationale for the choice of the particular homeopathic intervention; (II) the homeopathic principles reflected in the intervention; (III) the extent of homeopathic practitioner input; (IV) the nature of the main outcome measure; (V) the capability of the main outcome measure to detect change; (VI) the length of follow-up to the endpoint of the study. Six papers reporting RCTs of homeopathy of varying design were randomly selected from the literature. A standard form was used to record each assessor's independent response per domain, using the optional verdicts 'Yes', 'Unclear', 'No'. Concordance among the eight verdicts per domain, across all six papers, was evaluated using the kappa (κ) statistic. Results The six judgmental domains enabled MVHT to be assessed with 'fair' to 'almost perfect' concordance in each case. For the six RCTs examined, the method allowed MVHT to be classified overall as 'acceptable' in three, 'unclear' in two, and 'inadequate' in one. Conclusion Future systematic reviews of RCTs in homeopathy should adopt the MVHT method as part of a complete appraisal of trial validity. PMID:22510227

Speech Therapy Telepractice for Vocal Cord Dysfunction (VCD): MaineCare (Medicaid) Cost Savings

PubMed Central

Towey, Michael P.

2012-01-01

This Brief Communication represents an analysis of the cost savings to MaineCare (also referred to as Medicaid) directly attributable to service provided via speech therapy telepractice. Seven female (primarily adolescent) MaineCare patients consecutively referred to Waldo County General Hospital (WCGH) with suspected diagnosis of Vocal Cord Dysfunction (VCD) were treated by speech therapy telepractice. Outcome data demonstrated a first month cost savings of $2376.72. The analysis additionally projected thousands of dollars of potential savings each month in reduced medical costs for this patient group as a result of successful treatment via speech therapy telepractice. The study suggests that without access to speech therapy telepractice for patients with VCD, the medical costs to MaineCare will be ongoing and significant. PMID:25945195

Unmatched U.S. Allopathic Seniors in the 2015 Main Residency Match: A Study of Applicant Behavior, Interview Selection, and Match Outcome.

PubMed

Liang, Mei; Curtin, Laurie S; Signer, Mona M; Savoia, Maria C

2017-07-01

The application and interview behaviors of unmatched U.S. allopathic medical school senior students (U.S. seniors) participating in the 2015 National Resident Matching Program (NRMP) Main Residency Match were studied in conjunction with their United States Medical Licensing Examination (USMLE) Step 1 scores and ranking preferences to understand their effects on Match outcome. USMLE Step 1 score and preferred specialty information were reviewed for U.S. seniors who responded to the 2015 NRMP Applicant Survey. Unmatched U.S. seniors were categorized as "strong," "solid," "marginal," or "weak" based on the perceived competitiveness of their Step 1 scores compared with U.S. seniors who matched in the same preferred specialty. The numbers of applications sent, interviews obtained, and programs ranked also were examined by Match outcome. Strong unmatched U.S. seniors submitted significantly more applications to achieve and attend approximately the same number of interviews as strong matched U.S. seniors. Strong unmatched seniors ranked fewer programs than their matched counterparts. As a group, unmatched U.S. seniors were less likely than their matched counterparts to rank a mix of competitive and less competitive programs and more likely to rank programs based on their perceived likelihood of matching. A small number of unmatched U.S. seniors would have matched if they had ranked programs that ranked them. U.S. seniors' Match outcomes may be affected by applicant characteristics that negatively influence their selection for interviews, and their difficulties may be exacerbated by disadvantageous ranking behaviors.

Young Adult Outcomes of Children Growing up with Chronic Illness: An analysis of the National Longitudinal Study of Adolescent Health

PubMed Central

Maslow, Gary R.; Haydon, Abigail; Ford, Carol Ann; Halpern, Carolyn Tucker

2012-01-01

Objective To examine young adult outcomes in a nationally representative US cohort of young adults who grew up with a chronic illness. Design Secondary analysis of nationally representative data from Wave III (2001) of the National Longitudinal Study of Adolescent Health. Setting United States Participants The analytic sample included 13,236 young adults 18–28 years old at Wave III. Main Exposure Self-report of a chronic physical illness (asthma, cancer, diabetes or epilepsy) in adolescence. Respondents with (1) asthma or (2) non-asthma chronic illness (cancer, diabetes, or epilepsy) were compared to subjects without these conditions. Main Outcome Measures Self-report of high school graduation, ever having a job, having a current job, living with parents, and ever receiving public assistance. Results Three percent of young adults had non-asthma chronic illness (cancer, diabetes, or epilepsy) and 16% had asthma. The majority of young adults with chronic illness graduated high school (81%) and were currently employed (60%). However, compared to healthy young adults, those with a non-asthma chronic illness were significantly less likely to graduate high school, ever have a job, or have a current job and were more likely to receive public assistance. When compared to young adults with asthma, young adults with non-asthma chronic illness again had significantly worse young adult outcomes on all measures. Conclusions Most young adults growing up with chronic illness graduate high school and are employed. However, these young adults are significantly less likely than their healthy peers to achieve these important educational and vocational milestones. PMID:21383274

Is Textbook Outcome a valuable composite measure for short-term outcomes of gastrointestinal treatments in the Netherlands using hospital information system data? A retrospective cohort study

PubMed Central

Salet, Nèwel; Bremmer, Rolf H; Verhagen, Marc A M T; Ekkelenkamp, Vivian E; Hansen, Bettina E; de Jonge, Pieter J F; de Man, Rob A

2018-01-01

Objective To develop a feasible model for monitoring short-term outcome of clinical care trajectories for hospitals in the Netherlands using data obtained from hospital information systems for identifying hospital variation. Study design Retrospective analysis of collected data from hospital information systems combined with clinical indicator definitions to define and compare short-term outcomes for three gastrointestinal pathways using the concept of Textbook Outcome. Setting 62 Dutch hospitals. Participants 45 848 unique gastrointestinal patients discharged in 2015. Main outcome measure A broad range of clinical outcomes including length of stay, reintervention, readmission and doctor–patient counselling. Results Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for gallstone disease (n=4369), colonoscopy for inflammatory bowel disease (IBD; n=19 330) and colonoscopy for colorectal cancer screening (n=22 149) were submitted to five suitable clinical indicators per treatment. The percentage of all patients who met all five criteria was 54%±9% (SD) for ERCP treatment. For IBD this was 47%±7% of the patients, and for colon cancer screening this number was 85%±14%. Conclusion This study shows that reusing data obtained from hospital information systems combined with clinical indicator definitions can be used to express short-term outcomes using the concept of Textbook Outcome without any excess registration. This information can provide meaningful insight into the clinical care trajectory on the level of individual patient care. Furthermore, this concept can be applied to many clinical trajectories within gastroenterology and beyond for monitoring and improving the clinical pathway and outcome for patients. PMID:29496668

Areas of disadvantage: a systematic review of effects of area-level socioeconomic status on substance use outcomes.

PubMed

Karriker-Jaffe, Katherine J

2011-01-01

This review examines whether area-level disadvantage is associated with increased substance use and whether study results are impacted by the size of the area examined, definition of socioeconomic status (SES), age or ethnicity of participants, outcome variables or analytic techniques. Five electronic databases and the reference sections of identified papers were searched to locate studies of the effects of area-level SES on substance use published through the end of 2007 in English-language, peer-reviewed journals or books. The 41 studies that met inclusion criteria included 238 effects, with a subsample of 34 studies (180 effects) used for the main analyses. Study findings were stratified by methodological characteristics and synthesised using generalised estimating equations to account for clustering of effects within studies. There was strong evidence that substance use outcomes cluster by geographic area, but there was limited and conflicting support for the hypothesis that area-level disadvantage is associated with increased substance use. Support for the disadvantage hypothesis appeared to vary by sample age and ethnicity, size of area examined, type of SES measure, specific outcome considered and analysis techniques. Future studies should use rigorous methods to yield more definitive conclusions about the effects of area-level SES on alcohol and drug outcomes, including composite measures of SES and both bivariate and multivariate analyses. Further research is needed to identify confounds of the relationship between area-level SES and substance use and to explain why the effects of area-level SES vary by outcome and residents' age. © 2010 Australasian Professional Society on Alcohol and other Drugs.

The effect of care pathways for hip fractures: a systematic review.

PubMed

Leigheb, Fabrizio; Vanhaecht, Kris; Sermeus, Walter; Lodewijckx, Cathy; Deneckere, Svin; Boonen, Steven; Boto, Paulo Alexandre Faria; Mendes, Rita Veloso; Panella, Massimiliano

2012-07-01

We performed a systematic review for primary studies on care pathways (CPs) for hip fracture (HF). The online databases MEDLINE-PubMed, Ovid-EMBASE, CINAHL-EBSCO host, and The Cochrane Library (Cochrane Central Register of Clinical Trials, Health Technology Assessment Database, NHS Economic Evaluation Database) were searched. Two researchers reviewed the literature independently. Primary studies that met predefined inclusion criteria were assessed for their methodological quality. A total of 15 publications were included: 15 primary studies corresponding with 12 main investigations. Primary studies were evaluated for clinical outcomes, process outcomes, and economic outcomes. The studies assessed a wide range of outcome measures. While a number of divergent clinical outcomes were reported, most studies showed positive results of process management and health-services utilization. In terms of mortality, the results provided evidence for a positive impact of CPs on in-hospital mortality. Most studies also showed a significantly reduced risk of complications, including medical complications, wound infections, and pressure sores. Moreover, time-span process measures showed that an improvement in the organization of care was achieved through the use of CPs. Conflicting results were observed with regard to functional recovery and mobility between patients treated with CPs compared to usual care. Although our review suggests that CPs can have positive effects in patients with HF, the available evidence is insufficient for formal recommendations. There is a need for more research on CPs with selected process and outcome indicators, for in-hospital and postdischarge management of HF, with an emphasis on well-designed randomized trials.

Nutritional Deficiency in Patients with Heart Failure.

PubMed

Sciatti, Edoardo; Lombardi, Carlo; Ravera, Alice; Vizzardi, Enrico; Bonadei, Ivano; Carubelli, Valentina; Gorga, Elio; Metra, Marco

2016-07-22

Heart failure (HF) is the main cause of mortality and morbidity in Western countries. Although evidence-based treatments have substantially improved outcomes, prognosis remains poor with high costs for health care systems. In patients with HF, poor dietary behaviors are associated with unsatisfactory quality of life and adverse outcome. The HF guidelines have not recommended a specific nutritional strategy. Despite the role of micronutrient deficiency, it has been extensively studied, and data about the efficacy of supplementation therapy in HF are not supported by large randomized trials and there is limited evidence regarding the outcomes. The aim of the present review is to analyze the state-of-the-art of nutritional deficiencies in HF, focusing on the physiological role and the prognostic impact of micronutrient supplementation.

Patient outcomes after critical illness: a systematic review of qualitative studies following hospital discharge.

PubMed

Hashem, Mohamed D; Nallagangula, Aparna; Nalamalapu, Swaroopa; Nunna, Krishidhar; Nausran, Utkarsh; Robinson, Karen A; Dinglas, Victor D; Needham, Dale M; Eakin, Michelle N

2016-10-26

There is growing interest in patient outcomes following critical illness, with an increasing number and different types of studies conducted, and a need for synthesis of existing findings to help inform the field. For this purpose we conducted a systematic review of qualitative studies evaluating patient outcomes after hospital discharge for survivors of critical illness. We searched the PubMed, EMBASE, CINAHL, PsycINFO, and CENTRAL databases from inception to June 2015. Studies were eligible for inclusion if the study population was >50 % adults discharged from the ICU, with qualitative evaluation of patient outcomes. Studies were excluded if they focused on specific ICU patient populations or specialty ICUs. Citations were screened in duplicate, and two reviewers extracted data sequentially for each eligible article. Themes related to patient outcome domains were coded and categorized based on the main domains of the Patient Reported Outcomes Measurement Information System (PROMIS) framework. A total of 2735 citations were screened, and 22 full-text articles were eligible, with year of publication ranging from 1995 to 2015. All of the qualitative themes were extracted from eligible studies and then categorized using PROMIS descriptors: satisfaction with life (16 studies), including positive outlook, acceptance, gratitude, independence, boredom, loneliness, and wishing they had not lived; mental health (15 articles), including symptoms of post-traumatic stress disorder, anxiety, depression, and irritability/anger; physical health (14 articles), including mobility, activities of daily living, fatigue, appetite, sensory changes, muscle weakness, and sleep disturbances; social health (seven articles), including changes in friends/family relationships; and ability to participate in social roles and activities (six articles), including hobbies and disability. ICU survivors may experience positive emotions and life satisfaction; however, a wide range of mental, physical, social, and functional sequelae occur after hospital discharge. These findings are important for understanding patient-centered outcomes in critical care and providing focus for future interventional studies aimed at improving outcomes of importance to ICU survivors.

Childhood Health Consequences of Maternal Obesity during Pregnancy: A Narrative Review.

PubMed

Gaillard, Romy; Santos, Susana; Duijts, Liesbeth; Felix, Janine F

2016-01-01

Obesity is a major public health problem among women of reproductive age. In a narrative review, we examined the influence of maternal obesity during pregnancy on fetal outcomes and childhood adiposity, cardio-metabolic, respiratory and cognitive-related health outcomes. We discuss results from recent studies, the causality and potential underlying mechanisms of observed associations and challenges for future epidemiological studies. Evidence from observational studies strongly suggests that maternal pre-pregnancy obesity and excessive gestational weight gain are associated with increased risks of fetal pregnancy complications and adverse childhood cardio-metabolic, respiratory and cognitive-related health outcomes. It remains unclear whether these associations are due to intrauterine mechanisms or explained by confounding family-based sociodemographic, lifestyle and genetic factors. The underlying mechanisms have mainly been assessed in animal studies and small human studies, and are yet to be further explored in large human studies. Key Message: Maternal obesity is an important modifiable factor during pregnancy that is associated with a variety of adverse offspring health outcomes. Further studies are needed to explore the causality and underlying mechanisms of the observed associations. Ultimately, preventive strategies focused on reducing maternal obesity and excessive weight gain during pregnancy may reduce common diseases in future generations. © 2016 S. Karger AG, Basel.

Core Outcome Domains for early phase clinical trials of sound-, psychology-, and pharmacology-based interventions to manage chronic subjective tinnitus in adults: the COMIT'ID study protocol for using a Delphi process and face-to-face meetings to establish consensus.

PubMed

Fackrell, Kathryn; Smith, Harriet; Colley, Veronica; Thacker, Brian; Horobin, Adele; Haider, Haúla F; Londero, Alain; Mazurek, Birgit; Hall, Deborah A

2017-08-23

The reporting of outcomes in clinical trials of subjective tinnitus indicates that many different tinnitus-related complaints are of interest to investigators, from perceptual attributes of the sound (e.g. loudness) to psychosocial impacts (e.g. quality of life). Even when considering one type of intervention strategy for subjective tinnitus, there is no agreement about what is critically important for deciding whether a treatment is effective. The main purpose of this observational study is, therefore to, develop Core Outcome Domain Sets for the three different intervention strategies (sound, psychological, and pharmacological) for adults with chronic subjective tinnitus that should be measured and reported in every clinical trial of these interventions. Secondary objectives are to identify the strengths and limitations of our study design for recruiting and reducing attrition of participants, and to explore uptake of the core outcomes. The 'Core Outcome Measures in Tinnitus: International Delphi' (COMIT'ID) study will use a mixed-methods approach that incorporates input from health care users at the pre-Delphi stage, a modified three-round Delphi survey and final consensus meetings (one for each intervention). The meetings will generate recommendations by stakeholder representatives on agreed Core Outcome Domain Sets specific to each intervention. A subsequent step will establish a common cross-cutting Core Outcome Domain Set by identifying the common outcome domains included in all three intervention-specific Core Outcome Domain Sets. To address the secondary objectives, we will gather feedback from participants about their experience of taking part in the Delphi process. We aspire to conduct an observational cohort study to evaluate uptake of the core outcomes in published studies at 7 years following Core Outcome Set publication. The COMIT'ID study aims to develop a Core Outcome Domain Set that is agreed as critically important for deciding whether a treatment for subjective tinnitus is effective. Such a recommendation would help to standardise future clinical trials worldwide and so we will determine if participation increases use of the Core Outcome Set in the long term. This project has been registered (November 2014) in the database of the Core Outcome Measures in Effectiveness Trials (COMET) initiative.

Individual- and organizational-level consequences of organizational citizenship behaviors: A meta-analysis.

PubMed

Podsakoff, Nathan P; Whiting, Steven W; Podsakoff, Philip M; Blume, Brian D

2009-01-01

Although one of the main reasons for the interest in organizational citizenship behaviors (OCBs) is the potential consequences of these behaviors, no study has been reported that summarizes the research regarding the relationships between OCBs and their outcomes. Therefore, the purpose of this study is to provide a meta-analytic examination of the relationships between OCBs and a variety of individual- and organizational-level outcomes. Results, based on 168 independent samples (N = 51,235 individuals), indicated that OCBs are related to a number of individual-level outcomes, including managerial ratings of employee performance, reward allocation decisions, and a variety of withdrawal-related criteria (e.g., employee turnover intentions, actual turnover, and absenteeism). In addition, OCBs were found to be related (k = 38; N = 3,611 units) to a number of organizational-level outcomes (e.g., productivity, efficiency, reduced costs, customer satisfaction, and unit-level turnover). Of interest, somewhat stronger relationships were observed between OCBs and unit-level performance measures in longitudinal studies than in cross-sectional studies, providing some evidence that OCBs are causally related to these criteria. The implications of these findings for both researchers and practitioners are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

How to select outcome measurement instruments for outcomes included in a "Core Outcome Set" - a practical guideline.

PubMed

Prinsen, Cecilia A C; Vohra, Sunita; Rose, Michael R; Boers, Maarten; Tugwell, Peter; Clarke, Mike; Williamson, Paula R; Terwee, Caroline B

2016-09-13

In cooperation with the Core Outcome Measures in Effectiveness Trials (COMET) initiative, the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative aimed to develop a guideline on how to select outcome measurement instruments for outcomes (i.e., constructs or domains) included in a "Core Outcome Set" (COS). A COS is an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease or trial population. Informed by a literature review to identify potentially relevant tasks on outcome measurement instrument selection, a Delphi study was performed among a panel of international experts, representing diverse stakeholders. In three consecutive rounds, panelists were asked to rate the importance of different tasks in the selection of outcome measurement instruments, to justify their choices, and to add other relevant tasks. Consensus was defined as being achieved when 70 % or more of the panelists agreed and when fewer than 15 % of the panelists disagreed. Of the 481 invited experts, 120 agreed to participate of whom 95 (79 %) completed the first Delphi questionnaire. We reached consensus on four main steps in the selection of outcome measurement instruments for COS: Step 1, conceptual considerations; Step 2, finding existing outcome measurement instruments, by means of a systematic review and/or a literature search; Step 3, quality assessment of outcome measurement instruments, by means of the evaluation of the measurement properties and feasibility aspects of outcome measurement instruments; and Step 4, generic recommendations on the selection of outcome measurement instruments for outcomes included in a COS (consensus ranged from 70 to 99 %). This study resulted in a consensus-based guideline on the methods for selecting outcome measurement instruments for outcomes included in a COS. This guideline can be used by COS developers in defining how to measure core outcomes.

A Participative Approach to Evaluation of Graduates' Professional Outcomes

ERIC Educational Resources Information Center

Clerici, Renata; Castiglioni, Maria; Grion, Valentina; Zago, Giuseppe; Da Re, Lorenza

2014-01-01

This work discusses the professional outcomes of University of Padova graduates in academic year 2007/08. Its aim was to carry out an overall assessment of higher education professional outcomes, involving all the main actors of the learning process, students, teachers and tutors, in a perspective of participatory evaluation, to improve teaching…

Intensity and breadth of participation in organized activities during the adolescent years: multiple associations with youth outcomes.

PubMed

Denault, Anne-Sophie; Poulin, François

2009-10-01

The goal of this study was to examine initial levels and rates of change in the intensity and breadth of participation in organized activities during the adolescent years, and how these participation practices were related to youth outcomes in later adolescence. The main objectives were (a) to examine growth curves of intensity and breadth of participation from Grades 7 through 11 and their interrelations, and (b) to test the associations between these dimensions of participation and academic orientation, risky behaviors, internalizing problems, and civic development in Grade 11. A homogenous sample of 299 youth (mean age = 13.37, SD = .41; 62% girls) were surveyed annually using questionnaires and phone interviews. The main results revealed that (a) even though both intensity and breadth of participation decreased over time, intensity of participation showed steeper declines by later grades, and (b) initial levels of participation were better predictors of later outcomes than rates of change over time. Regardless of the levels of change taking place over time, results revealed that youth with high initial levels of participation (both intensity and breadth) were more committed to school and developed more positive values towards society by Grade 11 than those who participated less. This might suggest that a high level of participation during early-to-mid-adolescence is particularly important when it comes to later outcomes.

Outcome of severe adult thrombotic microangiopathies in the intensive care unit.

PubMed

Pene, Frédéric; Vigneau, Cécile; Auburtin, Marc; Moreau, Delphine; Zahar, Jean-Ralph; Coste, Joël; Heshmati, Farhad; Mira, Jean-Paul

2005-01-01

Thrombotic microangiopathies, namely thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, are uncommon microvascular occlusive diseases. Despite the dramatic improvement in the outcome by exogenous plasma supply, either through plasma infusion or through plasma exchange, patients frequently require support in the intensive care unit. In the present study, we evaluated the outcome of a large cohort of patients with severe thrombotic microangiopathies. A retrospective multicenter study from January 1998 to June 2001. Fourteen French university hospital medical intensive care units. Sixty three adult patients with severe thrombotic microangiopathies. Of the 63 patients, 19 had a clinical presentation of thrombotic thrombocytopenic purpura, 18 had hemolytic uremic syndrome and 26 had combined neurologic and renal failures. Infections were the main etiology associated with thrombotic microangiopathies. The mortality rate was 35%. Of the survivors, all achieved complete remission. Whereas neurologic failure assessed through the Glasgow coma scale was an independent predictor of mortality [HR=0.845 (CI 95%: 0.759-0.940), P=0.002], renal impairment did not appear to be an adverse prognostic factor. The use of plasma exchange was independently associated with survival [HR=0.269 (CI 95%: 0.104-0.691), P=0.006]. Thrombotic microangiopathies with severe organ dysfunctions leading to hospitalization in the intensive care unit are associated with high mortality. Neurologic impairment appears to be the main adverse prognostic factor correlated to mortality, and the study confirms the importance of plasma exchange in the treatment of high-risk patients.

An orthogeriatric collaborative intervention program for fragility fractures: a retrospective cohort study.

PubMed

Leung, Andraay Hon-Chi; Lam, Tsz-Ping; Cheung, Wing-Hoi; Chan, Tan; Sze, Pan-Ching; Lau, Thomas; Leung, Kwok-Sui

2011-11-01

This retrospective cohort study aims to investigate the impact of regular pre- and postoperative geriatric input into the management of geriatric patients with hip fracture, with specific interests in morbidity and mortality. Patients with hip fracture (n = 548) older than 60 years were identified within a 2-year period. In the first year, the patients (n = 270) were managed mainly by orthopedics and this group constituted the control group. In the second year, this group of patients (orthogeriatric group, n = 278) had reviews by orthopedic surgeons and geriatricians (physicians specializing in medicine for the elderly), within 48 hours of admission and regularly thereafter. The main outcomes measured included demographics, length of hospital stay, postoperative complications, mortality, and functional outcomes. Data were collected from records of acute and rehabilitation admissions, and outpatient consultations. The admission to operation time for those in the orthogeriatric group was shorter by 17% (p = 0.02). The percentage of patients deceased at 12 months postoperative was 11.5% for the orthogeriatric group and 20.4% for the conventional group (p = 0.02). A higher percentage of patients in the orthogeriatric group remained independent for daily living activities (24.5%) when compared with the conventional group (23.7%; p = 0.02). In addition to existing evidence that postoperative orthogeriatric collaboration improves mortality and functional outcomes in older patients with hip fractures, this study suggests that allowing preoperative geriatric input in this model of care can produce even more superior results.

Pooled Patient-Level Meta-analysis of Children and Adults Completing a Computer-Based Anxiety Intervention Targeting Attentional Bias

PubMed Central

Price, Rebecca B.; Wallace, Meredith; Kuckertz, Jennie M.; Amir, Nader; Graur, Simona; Cummings, Logan; Popa, Paul; Carlbring, Per; Bar-Haim, Yair

2016-01-01

Computer-based approaches, such as Attention Bias Modification (ABM), could help improve access to care for anxiety. Study-level meta-analyses of ABM have produced conflicting findings and leave critical questions unresolved regarding ABM’s mechanisms of action and clinical potential. We pooled patient-level datasets from randomized controlled trials of children and adults with high-anxiety. Attentional bias (AB) towards threat, the target mechanism of ABM, was tested as an outcome and a mechanistic mediator and moderator of anxiety reduction. Diagnostic remission and Liebowitz Social Anxiety Scale (LSAS) were clinical outcomes available in enough studies to enable pooling. Per-patient data were obtained on at least one outcome from 13/16 eligible studies [86% of eligible participants; n=778]. Significant main effects of ABM on diagnostic remission (ABM—22.6%, control—10.8%; OR=2.57; p=.006) and AB (β*(95%CI)=−.63(−.83, −.42); p<.00005) were observed. There was no main effect of ABM on LSAS. However, moderator analyses suggested ABM was effective for patients who were younger (≤37y), trained in the lab, and/or assessed by clinicians. Under the same conditions where ABM was effective, mechanistic links between AB and anxiety reduction were supported. Under these specific circumstances, ABM reduces anxiety and acts through its target mechanism, supporting ABM’s theoretical basis while simultaneously suggesting clinical indications and refinements to improve its currently limited clinical potential. PMID:27693664

Trochleoplasty: Indications and Technique.

PubMed

Nolan, John E; Schottel, Patrick C; Endres, Nathan K

2018-05-09

Trochlear dysplasia is a well-described risk factor for patellar instability. Trochleoplasty has emerged as a procedure within the surgical armamentarium for patellar instability, yet its role is unclear. A variety of trochleoplasty procedures have emerged. The purpose of this review is to clarify indications for trochleoplasty, outline the technical steps involved in performing common trochleoplasties and report the published outcomes and potential complications of these procedures. Patellar instability with severe trochlear dysplasia is the main indication for trochleoplasty. Three types of trochleoplasty have emerged: (1) lateral facet elevation; (2) sulcus deepening; and (3) recession wedge. Deepening and recession wedge trochleoplasties are the most commonly performed. Trochleoplasty is a surgical option for addressing patellar instability in patients with severe trochlear dysplasia. Deepening and recession wedge trochleoplasties that address Dejour B and D dysplastic trochleas are the most studied, with both short- and midterm outcomes reported. Long-term outcomes are lacking and comparative studies are needed.

Child maltreatment and violent delinquency: disentangling main effects and subgroup effects.

PubMed

Mersky, Joshua P; Reynolds, Arthur J

2007-08-01

This study employs data from the Chicago Longitudinal Study (CLS) to investigate the relation between child maltreatment and the incidence and frequency of violent delinquency. The authors also examine if effects vary between physically abused and neglected children and if select indicators (sex, cumulative risk, public aid receipt) moderate the connections between maltreatment and violent outcomes. The CLS follows a cohort of 1,539 low-income, minority children who attended public kindergarten programs in 1985-1986. The primary sample includes 1,404 participants for whom maltreatment and delinquency status were verified. Maltreatment is significantly associated with all violent outcomes investigated. Effects are comparable for physically abused and neglected children. Results indicate that public assistance, particularly persistent receipt, moderates the association between maltreatment and multiple outcomes. Findings support the hypothesized connection between maltreatment and violent delinquency while highlighting certain subgroups that may be at elevated risk. Implications for research design and program development are discussed.

Intensive behavioral therapy for agoraphobia.

PubMed

Knuts, Inge J E; Esquivel, Gabriel; Overbeek, Thea; Schruers, Koen R J

2015-03-15

We investigated the efficacy of an intensive 1-week behavioral therapy program focusing on agoraphobia for panic disorder patients with agoraphobia (PDA). The study design was a case-control study. Main outcome measure was the agoraphobia score of the Fear Questionnaire (FQ-AGO). The outcomes on the FQ-AGO of a 1-week intensive therapy (96 patients) and a twice-weekly therapy (98 patients) were compared. Agoraphobia improved significantly in both groups, 1 week and 3 months after therapy. Effect size for changes in the 1-week intensive therapy on the FQ-AGO was 0.75. Limitations are use of antidepressants, no placebo group, and no long term follow-up. Behavioral therapy for agoraphobia can be shortened significantly if intensified without affecting therapy outcome, thus allowing patients a more rapid return to work and resumption of daily activities. Copyright © 2014 Elsevier B.V. All rights reserved.

Psychometric evaluation of commonly used game-specific skills tests in rugby: A systematic review

PubMed Central

Oorschot, Sander; Chiwaridzo, Matthew; CM Smits-Engelsman, Bouwien

2017-01-01

Objectives To (1) give an overview of commonly used game-specific skills tests in rugby and (2) evaluate available psychometric information of these tests. Methods The databases PubMed, MEDLINE CINAHL and Africa Wide information were systematically searched for articles published between January 1995 and March 2017. First, commonly used game-specific skills tests were identified. Second, the available psychometrics of these tests were evaluated and the methodological quality of the studies assessed using the Consensus-based Standards for the selection of health Measurement Instruments checklist. Studies included in the first step had to report detailed information on the construct and testing procedure of at least one game-specific skill, and studies included in the second step had additionally to report at least one psychometric property evaluating reliability, validity or responsiveness. Results 287 articles were identified in the first step, of which 30 articles met the inclusion criteria and 64 articles were identified in the second step of which 10 articles were included. Reactive agility, tackling and simulated rugby games were the most commonly used tests. All 10 studies reporting psychometrics reported reliability outcomes, revealing mainly strong evidence. However, all studies scored poor or fair on methodological quality. Four studies reported validity outcomes in which mainly moderate evidence was indicated, but all articles had fair methodological quality. Conclusion Game-specific skills tests indicated mainly high reliability and validity evidence, but the studies lacked methodological quality. Reactive agility seems to be a promising domain, but the specific tests need further development. Future high methodological quality studies are required in order to develop valid and reliable test batteries for rugby talent identification. Trial registration number PROSPERO CRD42015029747. PMID:29259812

The development and evaluation of content validity of the Zambia Spina Bifida Functional Measure: Preliminary studies

PubMed Central

Amosun, Seyi L.; Shilalukey-Ngoma, Mary P.; Kafaar, Zuhayr

2017-01-01

Background Very little is known on outcome measures for children with spina bifida (SB) in Zambia. If rehabilitation professionals managing children with SB in Zambia and other parts of sub-Saharan Africa are to instigate measuring outcomes routinely, a tool has to be made available. The main objective of this study was to develop an appropriate and culturally sensitive instrument for evaluating the impact of the interventions on children with SB in Zambia. Methods A mixed design method was used for the study. Domains were identified retrospectively and confirmation was done through a systematic review study. Items were generated through semi-structured interviews and focus group discussions. Qualitative data were downloaded, translated into English, transcribed verbatim and presented. These were then placed into categories of the main domains of care deductively through the process of manifest content analysis. Descriptive statistics, alpha coefficient and index of content validity were calculated using SPSS. Results Self-care, mobility and social function were identified as main domains, while participation and communication were sub-domains. A total of 100 statements were generated and 78 items were selected deductively. An alpha coefficient of 0.98 was computed and experts judged the items. Conclusions The new functional measure with an acceptable level of content validity titled Zambia Spina Bifida Functional Measure (ZSBFM) was developed. It was designed to evaluate effectiveness of interventions given to children with SB from the age of 6 months to 5 years. Psychometric properties of reliability and construct validity were tested and are reported in another study. PMID:28951850

Epidemiological and treatment profiles of spinal cord injury in southeast Nigeria.

PubMed

Nwankwo, O E; Uche, E O

2013-06-01

Retrospective study. To evaluate the epidemiology and treatment outcome of spinal cord injuries (SCIs) at three tertiary care centres within southeast Nigeria. Southeast Nigeria. Causes, seasonal variation, transportation to hospital, severity of injury, treatment and outcome of patients with SCIs treated by the authors at three study locations from September 2009 to August 2012 were studied. Eighty-five patients with SCI had been admitted during that period to the three hospitals and were qualified for the study. The age range was 2-75 years with a mean of 36.13 years. The 31-45 years age group is the most frequently affected. Altogether, 69 male and 16 female individuals were involved. Motor vehicle accident (MVA) (47, 55.3%) was the most frequent cause of injury. Falls from palm trees (3.5%) were markedly reduced from what they were inferred to be (40.2%) from a similar study in our area in 1988. Injury peaks were observed during major festivities. Only three patients (0.035%) were transported to care centres with an ambulance. Forty patients were classified as being affected by ASIA grade A injury, whereas 45 patients had various ASIA grades of incomplete injury. Sixty-eight patients were managed conservatively; 23 of them improved from their grades, 35 remained the same, 1 worsened, while 9 died. Of 17 patients treated operatively, 9 improved, 5 remained the same, 2 worsened and 1 died. Currently, SCIs reported in the three main hospitals located in southeast Nigeria are caused mainly by MVAs. SCI affects mainly male individuals and peak frequencies are observed during festivities.

Public availability of results of observational studies evaluating an intervention registered at ClinicalTrials.gov.

PubMed

Baudart, Marie; Ravaud, Philippe; Baron, Gabriel; Dechartres, Agnes; Haneef, Romana; Boutron, Isabelle

2016-01-28

Observational studies are essential for assessing safety. The aims of this study were to evaluate whether results of observational studies evaluating an intervention with safety outcome(s) registered at ClinicalTrials.gov were published and, if not, whether they were available through posting on ClinicalTrials.gov or the sponsor website. We identified a cohort of observational studies with safety outcome(s) registered on ClinicalTrials.gov after October 1, 2007, and completed between October 1, 2007, and December 31, 2011. We systematically searched PubMed for a publication, as well as ClinicalTrials.gov and the sponsor website for results. The main outcomes were the time to the first publication in journals and to the first public availability of the study results (i.e. published or posted on ClinicalTrials.gov or the sponsor website). For all studies with results publicly available, we evaluated the completeness of reporting (i.e. reported with the number of events per arm) of safety outcomes. We identified 489 studies; 334 (68%) were partially or completely funded by industry. Results for only 189 (39%, i.e. 65% of the total target number of participants) were published at least 30 months after the study completion. When searching other data sources, we obtained the results for 53% (n = 158; i.e. 93% of the total target number of participants) of unpublished studies; 31% (n = 94) were posted on ClinicalTrials.gov and 21% (n = 64) on the sponsor website. As compared with non-industry-funded studies, industry-funded study results were less likely to be published but not less likely to be publicly available. Of the 242 studies with a primary outcome recorded as a safety issue, all these outcomes were adequately reported in 86% (114/133) when available in a publication, 91% (62/68) when available on ClinicalTrials.gov, and 80% (33/41) when available on the sponsor website. Only 39% of observational studies evaluating an intervention with safety outcome(s) registered at ClinicalTrials.gov had their results published at least 30 months after study completion. The registration of these observational studies allowed searching other sources (results posted at ClinicalTrials.gov and sponsor website) and obtaining results for half of unpublished studies and 93% of the total target number of participants.

Clinical application of bone morphogenetic proteins for bone healing: a systematic review.

PubMed

Krishnakumar, Gopal Shankar; Roffi, Alice; Reale, Davide; Kon, Elizaveta; Filardo, Giuseppe

2017-06-01

This paper documents the existing evidence on bone morphogenetic proteins (BMPs) use for the treatment of bone fractures, non-union, and osteonecrosis, through a review of the clinical literature, underlying potential and limitations in terms of cost effectiveness and risk of complications. A systematic review was performed on the PubMed database using the following string: (bone morphogenetic proteins OR BMPs) and (bone repair OR bone regeneration) including papers from 2000 to 2016. The search focused on clinical trials dealing with BMPs application to favor bone regeneration in bone fractures, non-union, and osteonecrosis, in English language, with level of evidence I, II, III, and IV. Relevant data (type of study, number of patients, BMPs delivery material, dose, site, follow-up, outcome, and adverse events) were extracted and analyzed. Forty-four articles met the inclusion criteria: 10 randomized controlled trials (RCTs), 7 comparative studies, 18 case series, and 9 case reports. rhBMP-2 was documented mainly for the treatment of fractures, and rhBMP-7 mainly for non-unions and osteonecrosis. Mixed results were found among RCTs and comparative papers: 11 reported positive results for BMPs augmentation, 3 obtained no significant effects, and 2 showed negative results. The only study comparing the two BMPs showed a better outcome with rhBMP-2 for non-union treatment. Clinical evidence on BMPs use for the treatment of fractures, non-union, and osteonecrosis is still controversial, with the few available reports being mainly of low quality. While positive findings have been described in many studies, mixed results are still present in the literature in terms of efficacy and adverse events. The difficulties in drawing clear conclusions are also due to the studies heterogeneity, mainly in terms of different BMPs applied, with different concomitant treatments for each bone pathology. Therefore, further research with well-designed studies is needed in order to understand the real potential of this biological approach to favour bone healing.

Medical review practices for driver licensing volume 2: case studies of medical referrals and licensing outcomes in Maine, Ohio, Oregon, Texas, Washington, and Wisconsin.

DOT National Transportation Integrated Search

2017-03-01

This is the second of three reports examining driver medical review practices in the United States and how : they fulfill the basic functions of identifying, assessing, and rendering licensing decisions on medically at-risk : drivers. This volume pre...

Psychiatric Adjustment in the Year after Meningococcal Disease in Childhood

ERIC Educational Resources Information Center

Shears, Daniel; Nadel, Simon; Gledhill, Julia; Gordon, Fabiana; Garralda, M. Elena

2007-01-01

Objective: To assess psychiatric status after meningococcal disease. Method: Cohort study of 66 children (34 boys, 32 girls) ages 4 to 17 years admitted to pediatric hospitals with meningococcal disease. The main outcome measure was psychiatric disorder (1-year period and point prevalence on the Schedule for Affective Disorders and Schizophrenia…

Physical activity and resting pulse rate in older adults: findings from a randomized controlled trial

USDA-ARS?s Scientific Manuscript database

Background: Elevated resting pulse rate (RPR) is a well-recognized risk factor for adverse outcomes. Epidemiological evidence supports the beneficial effects of regular exercise for lowering RPR, but studies are mainly confined to persons younger than 65 years. We set out to evaluate the utility of ...

Exploring the Classroom Practice of Productive Pedagogies of the Malaysian Secondary School Geography Teacher

ERIC Educational Resources Information Center

Ahmad@Shaari, Mohammad Zohir; Jamil, Hazri; Razak, Nordin Abd

2012-01-01

The productive pedagogies as a framework to enhance teaching and learning outcomes were developed by Lingard et al. (2001) consisted of four main dimensions--intellectual quality, connectedness, supportive classroom environment, and working with and valuing differences. This study is to investigate the productive pedagogical practices among…

Analysing Language Education Policy for China's Minority Groups in Its Entirety

ERIC Educational Resources Information Center

Feng, Anwei; Sunuodula, Mamtimyn

2009-01-01

Two main bodies of literature are identifiable in minority education policy studies in China. Many adopt a descriptive approach to examining policy documents and general outcomes in their historical contexts while others focus on evaluating preferential policies made to address inequality issues in minority education. In most discussions,…

Changes in Weight and Health Behaviors from Freshman through Senior Year of College

ERIC Educational Resources Information Center

Racette, Susan B.; Deusinger, Susan S.; Strube, Michael J.; Highstein, Gabrielle R.; Deusinger, Robert H.

2008-01-01

Objective: To assess weight changes, exercise and diet behaviors among college students from the beginning of freshman year until the end of senior year. Design: Longitudinal observational study. Setting: Private university in St. Louis, Missouri. Participants: College students (138 females, 66 males). Main Outcome Measures: Weight and height were…

Speaking to Read: Meta-Analysis of Peer-Mediated Learning for English Language Learners

ERIC Educational Resources Information Center

Cole, Mikel W.

2014-01-01

This meta-analysis examines the effectiveness of a group of instructional approaches (i.e., cooperative, collaborative, and peer tutoring) at improving literacy outcomes for English language learners. Main effects analyses of a sample of 28 experimental and quasi-experimental studies reveal that peer-mediation is more effective for ELLs than…

The Sociology Research Experience Capstone Course at Three Institutions

ERIC Educational Resources Information Center

McKinney, Kathleen; Busher, Melissa

2011-01-01

This study describes the objectives, structures, and outcomes of a one-semester, required sociology research capstone course as taught at three institutions. Pre- and postquestionnaires from students, syllabi from instructors, and a random sample of final research papers were analyzed. Results indicate that the main foci of the course are to…

Parent-Reported Social Support for Child's Fruit and Vegetable Intake: Validity of Measures

ERIC Educational Resources Information Center

Dave, Jayna M.; Evans, Alexandra E.; Condrasky, Marge D.; Williams, Joel E.

2012-01-01

Objective: To develop and validate measures of parental social support to increase their child's fruit and vegetable (FV) consumption. Design: Cross-sectional study design. Setting: School and home. Participants: Two hundred three parents with at least 1 elementary school-aged child. Main Outcome Measure: Parents completed a questionnaire that…

Specific Learning Disabilities and the Concept of Psychological Subdeprivation: The Czechoslovak Experience.

ERIC Educational Resources Information Center

Matejcek, Zdenek; Dytrych, Zdenek

1993-01-01

The main outcomes of the Prague (Czechoslovakia) longitudinal studies following over 1,000 children for almost 30 years are summarized. The children were either born from unwanted pregnancies, with alcoholic fathers, born out-of-wedlock, or in divorced families. A theory of psychological subdeprivation is offered and applied to children with…

Time Trends in Bullying Behavior in Italy

ERIC Educational Resources Information Center

Vieno, Alessio; Lenzi, Michela; Gini, Gianluca; Pozzoli, Tiziana; Cavallo, Franco; Santinello, Massimo

2015-01-01

Background: Given the severity of outcomes associated with involvement in bullying and the resources spent in an effort to reduce its prevalence, it is important to investigate trends in the bullying's occurrence. The main aim of this study was to identify trends from 2002 to 2010 in prevalence of bullying and victimization among Italian…

Monitoring Educational Performance in the Caribbean. World Bank Working Paper.

ERIC Educational Resources Information Center

di Gropello, Emanuela

This study represents a first attempt at providing a comprehensive quantification of educational outcomes in the Caribbean region. Its main objectives are: (1) to define a set of operationally relevant education indicators; (2) to provide a database of comparable education indicators in Caribbean countries where data is available, namely Belize,…

Research Perspectives on Core French: A Literature Review

ERIC Educational Resources Information Center

Lapkin, Sharon; Mady, Callie; Arnott, Stephanie

2009-01-01

This article reviews the research literature on core French in three main areas: student diversity, delivery models for the core French program, and instructional approaches. These topics are put into context through a discussion of studies on community attitudes to French as a second language (FSL), dissatisfaction with core French outcomes and…

Understanding the Cycle: Childhood Maltreatment and Future Crime

ERIC Educational Resources Information Center

Currie, Janet; Tekin, Erdal

2012-01-01

Child maltreatment is a major social problem. This paper focuses on measuring the relationship between child maltreatment and crime using data from the National Longitudinal Study of Adolescent Health (Add Health). We focus on crime because it is one of the most costly potential outcomes of maltreatment. Our work addresses two main limitations of…

Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol

PubMed Central

Melloh, Markus; Röder, Christoph; Elfering, Achim; Theis, Jean-Claude; Müller, Urs; Staub, Lukas P; Aghayev, Emin; Zweig, Thomas; Barz, Thomas; Kohlmann, Thomas; Wieser, Simon; Jüni, Peter; Zwahlen, Marcel

2008-01-01

Background There is little evidence on differences across health care systems in choice and outcome of the treatment of chronic low back pain (CLBP) with spinal surgery and conservative treatment as the main options. At least six randomised controlled trials comparing these two options have been performed; they show conflicting results without clear-cut evidence for superior effectiveness of any of the evaluated interventions and could not address whether treatment effect varied across patient subgroups. Cost-utility analyses display inconsistent results when comparing surgical and conservative treatment of CLBP. Due to its higher feasibility, we chose to conduct a prospective observational cohort study. Methods This study aims to examine if 1. Differences across health care systems result in different treatment outcomes of surgical and conservative treatment of CLBP 2. Patient characteristics (work-related, psychological factors, etc.) and co-interventions (physiotherapy, cognitive behavioural therapy, return-to-work programs, etc.) modify the outcome of treatment for CLBP 3. Cost-utility in terms of quality-adjusted life years differs between surgical and conservative treatment of CLBP. This study will recruit 1000 patients from orthopaedic spine units, rehabilitation centres, and pain clinics in Switzerland and New Zealand. Effectiveness will be measured by the Oswestry Disability Index (ODI) at baseline and after six months. The change in ODI will be the primary endpoint of this study. Multiple linear regression models will be used, with the change in ODI from baseline to six months as the dependent variable and the type of health care system, type of treatment, patient characteristics, and co-interventions as independent variables. Interactions will be incorporated between type of treatment and different co-interventions and patient characteristics. Cost-utility will be measured with an index based on EQol-5D in combination with cost data. Conclusion This study will provide evidence if differences across health care systems in the outcome of treatment of CLBP exist. It will classify patients with CLBP into different clinical subgroups and help to identify specific target groups who might benefit from specific surgical or conservative interventions. Furthermore, cost-utility differences will be identified for different groups of patients with CLBP. Main results of this study should be replicated in future studies on CLBP. PMID:18534034

The Walking Interventions Through Texting (WalkIT) Trial: Rationale, Design, and Protocol for a Factorial Randomized Controlled Trial of Adaptive Interventions for Overweight and Obese, Inactive Adults.

PubMed

Hurley, Jane C; Hollingshead, Kevin E; Todd, Michael; Jarrett, Catherine L; Tucker, Wesley J; Angadi, Siddhartha S; Adams, Marc A

2015-09-11

Walking is a widely accepted and frequently targeted health promotion approach to increase physical activity (PA). Interventions to increase PA have produced only small improvements. Stronger and more potent behavioral intervention components are needed to increase time spent in PA, improve cardiometabolic risk markers, and optimize health. Our aim is to present the rationale and methods from the WalkIT Trial, a 4-month factorial randomized controlled trial (RCT) in inactive, overweight/obese adults. The main purpose of the study was to evaluate whether intensive adaptive components result in greater improvements to adults' PA compared to the static intervention components. Participants enrolled in a 2x2 factorial RCT and were assigned to one of four semi-automated, text message-based walking interventions. Experimental components included adaptive versus static steps/day goals, and immediate versus delayed reinforcement. Principles of percentile shaping and behavioral economics were used to operationalize experimental components. A Fitbit Zip measured the main outcome: participants' daily physical activity (steps and cadence) over the 4-month duration of the study. Secondary outcomes included self-reported PA, psychosocial outcomes, aerobic fitness, and cardiorespiratory risk factors assessed pre/post in a laboratory setting. Participants were recruited through email listservs and websites affiliated with the university campus, community businesses and local government, social groups, and social media advertising. This study has completed data collection as of December 2014, but data cleaning and preliminary analyses are still in progress. We expect to complete analysis of the main outcomes in late 2015 to early 2016. The Walking Interventions through Texting (WalkIT) Trial will further the understanding of theory-based intervention components to increase the PA of men and women who are healthy, insufficiently active and are overweight or obese. WalkIT is one of the first studies focusing on the individual components of combined goal setting and reward structures in a factorial design to increase walking. The trial is expected to produce results useful to future research interventions and perhaps industry initiatives, primarily focused on mHealth, goal setting, and those looking to promote behavior change through performance-based incentives. ClinicalTrials.gov NCT02053259; https://clinicaltrials.gov/ct2/show/NCT02053259 (Archived by WebCite at http://www.webcitation.org/6b65xLvmg).

Tobacco use in popular movies during the past decade

PubMed Central

Mekemson, C; Glik, D; Titus, K; Myerson, A; Shaivitz, A; Ang, A; Mitchell, S

2004-01-01

Objective: The top 50 commercially successful films released per year from 1991 to 2000 were content coded to assess trends in tobacco use over time and attributes of films predictive of higher smoking rates. Design: This observational study used media content analysis methods to generate data about tobacco use depictions in films studied (n = 497). Films are the basic unit of analysis. Once films were coded and preliminary analysis completed, outcome data were transformed to approximate multivariate normality before being analysed with general linear models and longitudinal mixed method regression methods. Main outcome measures: Tobacco use per minute of film was the main outcome measure used. Predictor variables include attributes of films and actors. Tobacco use was defined as any cigarette, cigar, and chewing tobacco use as well as the display of smoke and cigarette paraphernalia such as ashtrays, brand names, or logos within frames of films reviewed. Results: Smoking rates in the top films fluctuated yearly over the decade with an overall modest downward trend (p < 0.005), with the exception of R rated films where rates went up. Conclusions: The decrease in smoking rates found in films in the past decade is modest given extensive efforts to educate the entertainment industry on this issue over the past decade. Monitoring, education, advocacy, and policy change to bring tobacco depiction rates down further should continue. PMID:15564625

Ketogenic diet in pyruvate dehydrogenase complex deficiency: short- and long-term outcomes.

PubMed

Sofou, Kalliopi; Dahlin, Maria; Hallböök, Tove; Lindefeldt, Marie; Viggedal, Gerd; Darin, Niklas

2017-03-01

Our aime was to study the short- and long-term effects of ketogenic diet on the disease course and disease-related outcomes in patients with pyruvate dehydrogenase complex deficiency, the metabolic factors implicated in treatment outcomes, and potential safety and compliance issues. Pediatric patients diagnosed with pyruvate dehydrogenase complex deficiency in Sweden and treated with ketogenic diet were evaluated. Study assessments at specific time points included developmental and neurocognitive testing, patient log books, and investigator and parental questionnaires. A systematic literature review was also performed. Nineteen patients were assessed, the majority having prenatal disease onset. Patients were treated with ketogenic diet for a median of 2.9 years. All patients alive at the time of data registration at a median age of 6 years. The treatment had a positive effect mainly in the areas of epilepsy, ataxia, sleep disturbance, speech/language development, social functioning, and frequency of hospitalizations. It was also safe-except in one patient who discontinued because of acute pancreatitis. The median plasma concentration of ketone bodies (3-hydroxybutyric acid) was 3.3 mmol/l. Poor dietary compliance was associated with relapsing ataxia and stagnation of motor and neurocognitive development. Results of neurocognitive testing are reported for 12 of 19 patients. Ketogenic diet was an effective and safe treatment for the majority of patients. Treatment effect was mainly determined by disease phenotype and attainment and maintenance of ketosis.

A randomized trial of enema versus polyethylene glycol 3350 for fecal disimpaction in children presenting to an emergency department.

PubMed

Miller, Melissa K; Dowd, Mary Denise; Friesen, Craig A; Walsh-Kelly, Christine M

2012-02-01

This study aimed to compare efficacy of enema versus polyethylene glycol (PEG) 3350 for pediatric fecal impaction treatment. We conducted a prospective, randomized comparison of treatments of fecal impaction in children in a pediatric emergency department (ED). Treatment arms were a single milk and molasses enema in the ED or PEG 3350 for 3 days outpatient. Telephone follow-up was done on days 1, 3, and 5. The primary outcome was main symptom improvement. Additional outcomes were stool frequency, consistency, and ease of stool passage. Treatment failures (home enema, ED return, or hospital admission) were tracked. Seventy-nine subjects participated (39 PEG; 40 enema). At day 1, PEG subjects were less likely to have improved main symptom (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1-0.8) but no difference in other outcomes. Half (54%) in enema arm were reported as upset by ED therapy, whereas no children in PEG arm were upset (P < 0.05). At day 3, more patients in enema arm reported ideal stool consistency (74% vs 38%; P < 0.05). At day 5, no difference between groups was noted. Most treatment failures were in PEG arm (83%; P = 0.08). This pilot study suggests that disimpaction by enema may be superior to PEG for immediate relief of symptoms. Larger trials are needed to assess any advantage.

Plant-based ointments versus usual care in the management of chronic skin diseases: a comparative analysis on outcome and safety.

PubMed

Jong, Miek C; Ermuth, Ulrike; Augustin, Matthias

2013-10-01

To assess the outcome and safety of plant-based ointments versus usual care in the management of chronic skin diseases. Prospective mono-centric comparative analysis. Patients were recruited at an outpatient dermatology clinic and treated with plant-based ointments or care as usual. Main outcome criterion was the response rate, defined as the proportion of patients experiencing 'complete recovery' or 'major improvement' at 6, 12 and 24 months. Secondary outcome criteria were quality of life (SF-12 and EQ-5D), patient satisfaction and safety of treatment. A total of 112 patients with chronic skin diseases were evaluated of which 44 were treated with plant-based ointments (PO) and 68 received usual care (UC). The majority of patients suffered from psoriasis (PO: 50%; UC: 56%) or eczema (PO: 41%; UC: 32%) and were treated with homoeopathic topical ointments containing mahonia or cardiospermum or usual care creams containing calcipotriene and corticosteroids. The only significant difference in baseline status between the two groups was in disease severity score (PO: 1.8±0.7 versus UC: 2.4±0.8, p=0.0004). After two years, the main outcome of responders to treatment was 52.3% (95%-CI: 36.1-64.9) in the ointment and 41.2% (95%-CI: 20.4-42.2) in the UC group. Change in SF-12 (2 years compared to baseline), adjusted for baseline disease severity, was not significantly different between both groups; PO: 5.4 (95%-CI: 3.4-7.3) versus UC: 3.2 (95%-CI: 1.5-4.9). The adjusted EQ-5D was found to be significantly different between the two groups after two years, in favour of the ointment group; PO: 0.113 (95%-CI: 0.052-0.174) and UC: -0.008 (95%-CI: -0.055-0.038). Other secondary outcome parameters such as patient satisfaction and number of adverse drug reactions were comparable. The outcome of this study suggests at least therapeutic equivalence between plant-based ointments and usual care management of chronic skin diseases. As this non-randomised study was open to selection and other bias, further rigorous studies are needed to demonstrate the effectiveness of these topical products. Copyright © 2013 Elsevier Ltd. All rights reserved.

PROJECT TALENT, IDENTIFICATION, DEVELOPMENT, AND UTILIZATION OF HUMAN TALENTS--SELECTED PUPIL AND SCHOOL CHARACTERISTICS IN RELATION TO PERCENTAGE OF NEGROES IN SCHOOL ENROLLMENT. FINAL REPORT.

ERIC Educational Resources Information Center

BURKET, GEORGE R.; FLANAGAN, JOHN C.

CONSISTING MAINLY OF TABLES, THIS REPORT PRESENTS THE FINDINGS OF A STATISTICAL STUDY WHICH EXAMINED THE DIFFERENCES AND SIMILARITIES AMONG 733 PROJECT TALENT SENIOR HIGH SCHOOLS WITH VARYING PROPORTIONS OF NEGRO ENROLLMENT. THE FACTORS STUDIED IN THESE SCHOOLS WERE EDUCATIONAL OUTCOMES, SCHOOL PRACTICES, STUDENT BODY CHARACTERISTICS, AND SCHOOL…

In vitro fertilization outcomes in obese women under and above 35 years of age.

PubMed

Vural, F; Vural, B; Çakiroglu, Y

2016-01-01

To explore the impact of obesity on in vitro fertilization (IVF) outcomes and comparing the results with regards to age groups. This retrospective cohort recruited 780 women that underwent IVF. Women with polycystic ovarian syndrome (PCOS) were excluded from the study. Women under and above 35 years were categorized into three groups as normal weight, overweight, and obese. The main outcome measures were ovarian response, oocyte maturity, and clinical pregnancy rates. Despite oocyte count and fertilization rate that decreased in both younger and older obese women, this difference was not statistically significant. After age matched-normal weight controls, the clinical pregnancy rates were significantly decreased in older obese women. On the other hand, poor ovarian response observed significantly in young obese women without effect on pregnancy rates. These results suggested that obesity in young and old women has different outcomes and different steps of IVF process may be affected.

An application of the TROFLEI in secondary-school science classes in New Zealand

NASA Astrophysics Data System (ADS)

Bhan Koul, Rekha; Fisher, D. L.; Shaw, Toni

2011-07-01

Background and purpose: The present study reports on the findings of a study conducted in New Zealand using the actual and preferred forms of a classroom environment instrument, the Technology-Rich Outcomes-focussed Learning Environment Inventory (TROFLEI) and three affective outcome scales. Main aims of this study were to validate the instrument for use in New Zealand; to investigate differences between students' perceptions of (a) actual and preferred learning environments, (b) year levels and (c) gender; and to investigate associations between science classroom learning environment, attitude and self-efficacy. Sample TROFLEI was administered to 1027 high-school students from 30 classes. Design and method The 80-item TROFLEI assesses 10 classroom environment dimensions: student cohesiveness, teacher support, involvement, investigation, task orientation, cooperation, equity, differentiation, computer usage and young adult ethos. The three affective outcome scales used in the study are attitude to subject, attitude to computers and academic efficacy. Results The validity and reliability of the TROFLEI and three affective outcome scales for use in New Zealand were established. Differences in actual and preferred scores confirmed that students participating in the study sought better learning environments. Female students generally perceived their technology-related learning environment more positively. Year-13 students had consistently higher means for most (8 out of 13) of the learning environment dimensions. Statistically significant associations were found between the scales of TROLFLEI and three affective outcome scales. Conclusions The results of this study assist us in understanding the psychosocial learning environments in New Zealand in a technology-supported classroom and to determine its effectiveness in terms of selected learner outcomes.

The Trade-Off between Costs and Outcomes: The Case of Acute Myocardial Infarction

PubMed Central

Schreyögg, Jonas; Stargardt, Tom

2010-01-01

Objective To investigate and to quantify the relationship between hospital costs and health outcomes for patients with acute myocardial infarction (AMI) in Veterans Health Administration (VHA) hospitals using individual-level data for costs and outcomes. Data Sources VHA administrative files for the fiscal years 2000–2006. Study Design Costs were defined as costs incurred during the index hospitalization for treatment of AMI. Mortality and readmission, assessed 1 year after the index hospitalization, were used as measures of clinical outcome. We examined health outcomes as a function of costs and other patient-level and hospital-level characteristics using a two-stage Cox proportional hazard model that accounted for competing risks within a multilevel framework. To control for patient comorbidities, we compiled a comprehensive list of comorbidities that have been found in other studies to affect mortality and readmissions. Principal Findings We found that costs were negatively associated with mortality and readmissions. Every U.S.$100 less spent is associated with a 0.63 percent increase in the hazard of dying and a 1.24 percent increase in the hazard to be readmitted conditional on not dying. This main finding remained unchanged after a number of sensitivity checks. Conclusions Our results suggest that there is a trade-off between costs and outcomes. The negative association between costs and mortality suggests that outcomes should be monitored closely when introducing cost-containment programs. Additional studies are needed to examine the cost–outcome relationship for conditions other than AMI to see whether our results are consistent. PMID:20819109

The paradox of intragroup conflict: a meta-analysis.

PubMed

de Wit, Frank R C; Greer, Lindred L; Jehn, Karen A

2012-03-01

Since the meta-analysis by De Dreu and Weingart (2003b) on the effects of intragroup conflict on group outcomes, more than 80 new empirical studies of conflict have been conducted, often investigating more complex, moderated relationships between conflict and group outcomes, as well as new types of intragroup conflict, such as process conflict. To explore the trends in this new body of literature, we conducted a meta-analysis of 116 empirical studies of intragroup conflict (n = 8,880 groups) and its relationship with group outcomes. To address the heterogeneity across the studies included in the meta-analysis, we also investigated a number of moderating variables. Stable negative relationships were found between relationship and process conflict and group outcomes. In contrast to the results of De Dreu and Weingart, we did not find a strong and negative association between task conflict and group performance. Analyses of main effects as well as moderator analyses revealed a more complex picture. Task conflict and group performance were more positively related among studies where the association between task and relationship conflict was relatively weak, in studies conducted among top management teams rather than non-top management teams, and in studies where performance was measured in terms of financial performance or decision quality rather than overall performance.

Comparison of outcomes for African Americans, Hispanics, and Non-Hispanic Whites in the CATIE study.

PubMed

Arnold, Jodi Gonzalez; Miller, Alexander L; Cañive, José M; Rosenheck, Robert A; Swartz, Marvin S; Mintz, Jim

2013-06-01

Medication outcome literature in schizophrenia across racial-ethnic groups is sparse, with inconsistent findings. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study provided an opportunity for exploratory analyses of racial-ethnic outcomes. The study objective was to examine race-ethnicity outcomes for CATIE's main outcome (study discontinuation) and secondary outcomes. CATIE participants included whites (non-Hispanic) (N=722), African Americans (N=506), and Hispanics (N=170). Survival analyses and mixed-effects regression modeling were conducted, with adjustment for baseline sociodemographic differences and baseline scores of the secondary outcomes. Racial-ethnic groups had unique patterns of outcomes. Hispanics were much more likely to discontinue for lack of efficacy from perphenazine (64% versus 42% non-Hispanic whites and 24% African Americans) and ziprasidone (71% versus 40% non-Hispanic whites and 24% African Americans); Hispanics' quality of life also declined on these medications. Non-Hispanic whites were more likely to discontinue for lack of efficacy in general (averaging olanzapine, quetiapine, and risperidone discontinuation rates). African Americans were less likely to continue after the first phase (32% continuing versus 40% for non-Hispanic whites and 41% Hispanics). Discontinuations were driven by research burden, personal issues, and unspecified loss to follow-up. Non-Hispanic whites had higher depression scores during the follow-up period. African Americans had fewer side effects. CATIE results did not show disparities favoring non-Hispanic whites. CATIE may have provided state-of-the-art treatment and thus reduced disparate treatments observed in community clinics. African Americans discontinued even after consideration of socioeconomic differences. Why perphenazine and ziprasidone may be less effective with Hispanics should be explored.

Prevalence, recovery patterns and predictors of quality of life and costs after non-fatal injury: the Brabant Injury Outcome Surveillance (BIOS) study.

PubMed

de Jongh, M A C; Kruithof, N; Gosens, T; van de Ree, C L P; de Munter, L; Brouwers, L; Polinder, S; Lansink, K W W

2017-02-01

Trauma is a major public health problem worldwide that leads to high medical and societal costs. Overall, improved understanding of the full spectrum of the societal impact and burden of injury is needed. The main purpose of the Brabant Injury Outcome Surveillance (BIOS) study is to provide insight into prevalence, predictors and recovery patterns of short-term and long-term health-related quality of life (HRQoL) and costs after injury. This is a prospective, observational, follow-up cohort study in which HRQoL, psychological, social and functional outcome, and costs after trauma will be assessed during 24 months follow-up within injured patients admitted in 1 of 10 hospitals in the county Noord-Brabant, the Netherlands. Data will be collected by self-reported questionnaires at 1 week (including preinjury assessment), and 1, 3, 6, 12 and 24 months after injury. If patients are not capable of filling out the questionnaires, proxies will be asked to participate. Also, information about mechanism and severity of injury, comorbidity and indirect and direct costs will be collected. Mixed models will be used to examine the course of HRQoL, functional and psychological outcome, costs over time and between different groups, and to identify predictors for poor or good outcome. This study should make a substantial contribution to the international collaborative effort to assess the societal impact and burden of injuries more accurately. The BIOS results will also be used to develop an outcome prediction model for outcome evaluation including, besides the classic fatal, non-fatal outcome. NCT02508675. 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/.

Nursing Education Interventions for Managing Acute Pain in Hospital Settings: A Systematic Review of Clinical Outcomes and Teaching Methods.

PubMed

Drake, Gareth; de C Williams, Amanda C

2017-02-01

The objective of this review was to examine the effects of nursing education interventions on clinical outcomes for acute pain management in hospital settings, relating interventions to health care behavior change theory. Three databases were searched for nursing education interventions from 2002 to 2015 in acute hospital settings with clinical outcomes reported. Methodological quality was rated as strong, moderate, or weak using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies. The 12 eligible studies used varied didactic and interactive teaching methods. Several studies had weaknesses attributable to selection biases, uncontrolled confounders, and lack of blinding of outcome assessors. No studies made reference to behavior change theory in their design. Eight of the 12 studies investigated nursing documentation of pain assessment as the main outcome, with the majority reporting positive effects of education interventions on nursing pain assessment. Of the remaining studies, two reported mixed findings on patient self-report of pain scores as the key measure, one reported improvements in patient satisfaction with pain management after a nursing intervention, and one study found an increase in nurses' delivery of a relaxation treatment following an intervention. Improvements in design and evaluation of nursing education interventions are suggested, drawing on behavior change theory and emphasizing the relational, contextual, and emotionally demanding nature of nursing pain management in hospital settings. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Long-term outcome of pregnancy complicating with severe aplastic anemia under supportive care.

PubMed

Chen, Kuan-Ju; Chang, Yao-Lung; Chang, Horng; Su, Shen-Yuan; Peng, Hsiu-Huei; Chang, Shuenn-Dyh; Chao, An-Shine

2017-10-01

Pregnancy associated with aplastic anemia (AA) is a rare and heterogeneous disorder. We aimed to identify and evaluate the maternal and pregnant outcomes of pregnancy-associated severe AA treated with supportive care. A 25-year retrospective study was conducted at in a single center between 1990 and 2014 with pregnancy associated severe AA. In addition, relevant published cases of antenatally diagnosed pregnancy-associated severe AA after 1990 were identified by PubMed. The main goal was to determine the impact of various risk factors on maternal and fetal outcomes. 15 women with 18 pregnancies were enrolled. With addition of the published reports in literature, a total of 36 cases were included for reference review. Univariate analysis showed that low platelet counts (<2.0 × 10 9 /L), bone marrow hypocellularity (<25%), and late diagnosis during pregnancy were predictors of poor maternal outcomes (P < 0.05). The complication rate of pregnancy outcomes was 53.3%, including preterm delivery, small gestational age (SGA), preterm premature ruptured of membranes (PPROM) and preeclampsia. This study identified the risk factors of mortality and morbidity in pregnant women with severe AA, as well as the obstetrical complications associated with neonatal outcome. Copyright © 2017. Published by Elsevier B.V.

Health Outcomes of Sexual-Minority Youth in Canada: An Overview

PubMed Central

Blais, Martin; Bergeron, Félix-Antoine; Duford, Julie; Boislard, Marie-Aude; Hébert, Martine

2016-01-01

Objectives The objectives of this review are to (1) document health outcomes among sexual-minority youth (SMY) in Canada; and (2) identify sexual-minority-specific risk and protective factors Data Sources We conducted a review of Canadian data published after 2005 on the mental, physical and sexual health outcomes of SMY using relevant keywords. A total of 19 empirical studies and 2 research reports was included. Data Synthesis The study reviewed included 53 to 30 588 respondents (total = 81 567). SMY counted for 15.86% of the total sample. Overall, SMY in Canada show negative health outcomes in proportions varying from 7% to 69.4%, the most common issues being psychological distress and maladjustment. SMY are more likely than their heterosexual peers to report psychological distress/malfunctioning, suicidality, substance misuse, condomless intercourse, pregnancy involvement. Main SMY-specific risk factors were family rejection of one’s minority sexual orientation, homophobic bullying and victimization, and internalized homophobia. Among the few protective factors that were reported, school and family connectedness, school safety, parental support and sports involvement decreased the odds of negative health outcomes. Conclusions Canadian data show that SMY are more likely to experience negative health outcomes than their heterosexual peers. These results are consistent with data from around the world. Recommendations for research and intervention are discussed. PMID:28111592

Intensivist-reported Facilitators and Barriers to Discussing Post-Discharge Outcomes with Intensive Care Unit Surrogates. A Qualitative Study.

PubMed

Turnbull, Alison E; Davis, Wesley E; Needham, Dale M; White, Douglas B; Eakin, Michelle N

2016-09-01

Intensive care unit (ICU) patients' expected post-discharge outcomes are rarely discussed in family meetings despite this information being centrally important to patients and their families. To characterize intensivist-identified barriers and facilitators to discussing post-discharge outcomes with surrogates of ICU patients. Qualitative study conducted via one-on-one, semistructured telephone interviews with 23 intensivists from 20 hospitals with accreditation council for graduate medical education-accredited critical care medicine programs in 16 states. A limited application of grounded theory methods was used to code transcribed interviews and identify themes and illustrative quotes. Intensivists reported tension between their professional responsibility to discuss likely functional outcomes versus uncertainty about their ability to predict those outcomes for an individual patient. They cited three main barriers as limiting their ability to conduct conversations about post-discharge outcomes with ICU surrogates: (1) incorrectly optimistic expectations for recovery among ICU surrogates, (2) having little or no contact with their patients after ICU discharge, and (3) minimal confidence applying existing outcomes research to individual patients. Despite these barriers, experience talking to ICU surrogates, seeing ICU survivors in the outpatient setting, and trusted research on functional outcomes were identified as important facilitators to discussing likely patient outcomes with surrogates. Intensivists generally welcomed questions from surrogates about post-discharge outcomes as opportunities to initiate conversations about prognosis and patient values. In this sample of intensivists from 20 academic hospitals, experience conducting conversations with surrogates and interactions with ICU survivors as outpatients were identified as facilitating discussion of expected post-discharge outcomes while optimistic surrogate expectations and prognostic uncertainty were barriers. There was tension between self-perceived ability to prognosticate and belief in a professional obligation to discuss patient outcomes.

Efficacy of a family intervention program for prevention of hospitalization in patients with schizophrenia. A naturalistic multicenter controlled and randomized study in Spain.

PubMed

Mayoral, Fermín; Berrozpe, Adela; de la Higuera, Jesús; Martinez-Jambrina, Juan José; de Dios Luna, Juan; Torres-Gonzalez, Francisco

2015-01-01

According to most relevant guidelines, family psycho-educational interventions are considered to be one the most effective psychosocial treatments for people with schizophrenia. The main outcome measure in controlled and randomized studies has been prevention of relapses and admissions, and encouragement of compliance, although some questions remain about its applicability and results in clinical practice. The aim of study was to evaluate the efficacy and implementation of a single family psychoeducational intervention in 'real' conditions for people diagnosed with schizophrenia. A total of 88 families were randomized in two groups. The family intervention group received a 12 months psychoeducational treatment, and the other group followed normal standard treatment. Assessments were made at baseline, at 12 and at 18 months. The main outcome measure was hospitalization, and secondary outcome measures were clinical condition (BPRS-E) and social disability (DAS-II). A total of 71 patients finished the study (34 family intervention group and 37 control group). Patients who received family intervention reduced the risk of hospitalization by 40% (P = .4018; 95%CI: 0.1833-0.6204). Symptomatology improved significantly at 12 months (P = .4018; 95%CI: 0.1833-0.6204), but not at 18 months (P = .4018; 95%CI: 0.1833-0.6204). Social disability was significantly reduced in the family intervention group at 12 months and 18 months. Family psychoeducational intervention reduces hospitalization risk and improves clinical condition and social functioning of people with schizophrenia. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.

Review of drug treatment of oral submucous fibrosis.

PubMed

Chole, Revant H; Gondivkar, Shailesh M; Gadbail, Amol R; Balsaraf, Swati; Chaudhary, Sudesh; Dhore, Snehal V; Ghonmode, Sumeet; Balwani, Satish; Mankar, Mugdha; Tiwari, Manish; Parikh, Rima V

2012-05-01

This study undertook a review of the literature on drug treatment of oral submucous fibrosis. An electronic search was carried out for articles published between January 1960 to November 2011. Studies with high level of evidence were included. The levels of evidence of the articles were classified after the guidelines of the Oxford Centre for Evidence-Based Medicine. The main outcome measures used were improvement in oral ulceration, burning sensation, blanching and trismus. Only 13 publications showed a high level of evidence (3 randomized controlled trials and 10 clinical trials/controlled clinical trials), with a total of 1157 patients. Drugs like steroids, hyaluronidase, human placenta extracts, chymotrypsin and collagenase, pentoxifylline, nylidrin hydrochloride, iron and multivitamin supplements including lycopene, have been used. Only systemic agents were associated with few adverse effects like gastritis, gastric irritation and peripheral flushing with pentoxifylline, and flushingly warm skin with nylidrin hydrochloride; all other side-effects were mild and mainly local. Few studies with high levels of evidence were found. The drug treatment that is currently available for oral submucous fibrosis is clearly inadequate. There is a need for high-quality randomized controlled trials with carefully selected and standardized outcome measures. Copyright © 2011 Elsevier Ltd. All rights reserved.

Outcome of physiotherapy after surgery for cervical disc disease: a prospective randomised multi-centre trial

PubMed Central

2014-01-01

Background Many patients with cervical disc disease require leave from work, due to long-lasting, complex symptoms, including chronic pain and reduced levels of physical and psychological function. Surgery on a few segmental levels might be expected to resolve disc-specific pain and reduce neurological deficits, but not the non-specific neck pain and the frequent illness. No study has investigated whether post-surgery physiotherapy might improve the outcome of surgery. The main purpose of this study was to evaluate whether a well-structured rehabilitation programme might add benefit to the customary post-surgical treatment for cervical disc disease, with respect to function, disability, work capability, and cost effectiveness. Methods/Design This study was designed as a prospective, randomised, controlled, multi-centre study. An independent, blinded investigator will compare two alternatives of rehabilitation. We will include 200 patients of working age, with cervical disc disease confirmed by clinical findings and symptoms of cervical nerve root compression. After providing informed consent, study participants will be randomised to one of two alternative physiotherapy regimes; (A) customary treatment (information and advice on a specialist clinic); or (B) customary treatment plus active physiotherapy. Physiotherapy will follow a standardised, structured programme of neck-specific exercises combined with a behavioural approach. All patients will be evaluated both clinically and subjectively (with questionnaires) before surgery and at 6 weeks, 3 months, 6 months, 12 months, and 24 months after surgery. The main outcome variable will be neck-specific disability. Cost-effectiveness will also be calculated. Discussion We anticipate that the results of this study will provide evidence to support physiotherapeutic rehabilitation applied after surgery for cervical radiculopathy due to cervical disc disease. Trial registration ClinicalTrials.gov identifier: NCT01547611 PMID:24502414

Does Supportive Parenting Mitigate the Longitudinal Effects of Peer Victimization on Depressive Thoughts and Symptoms in Children?

PubMed Central

Bilsky, Sarah A.; Cole, David A.; Dukewich, Tammy L.; Martin, Nina C.; Sinclair, Keneisha R.; Tran, Cong V.; Roeder, Kathryn M.; Felton, Julia W.; Tilghman-Osborne, Carlos; Weitlauf, Amy S.; Maxwell, Melissa A.

2014-01-01

Cohen and Wills (Cohen, S., & Wills, T. A., 1985, Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357) described two broad models whereby social support could mitigate the deleterious effects of stress on health: a main effect model and stress-buffering model. A specific application of these models was tested in a three-wave, multimethod study of 1888 children to assess ways parental support (social support) mitigates the effects of peer victimization (stress) on children’s depressive symptoms and depression-related cognitions (health-related outcomes). Results revealed that (a) both supportive parenting and peer victimization had main effects on depressive symptoms and cognitions; (b) supportive parenting and peer victimization did not interact in the prediction of depressive thoughts and symptoms; (c) these results generalized across age and gender; and (d) increases in depressive symptoms were related to later reduction of supportive parenting and later increase in peer victimization. Although supportive parenting did not moderate the adverse outcomes associated with peer victimization, results show that its main effect can counterbalance or offset these effects to some degree. Implications for practice and future research are discussed. PMID:23713500

Does supportive parenting mitigate the longitudinal effects of peer victimization on depressive thoughts and symptoms in children?

PubMed

Bilsky, Sarah A; Cole, David A; Dukewich, Tammy L; Martin, Nina C; Sinclair, Keneisha R; Tran, Cong V; Roeder, Kathryn M; Felton, Julia W; Tilghman-Osborne, Carlos; Weitlauf, Amy S; Maxwell, Melissa A

2013-05-01

Cohen and Wills (Cohen, S., & Wills, T. A., 1985, Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310-357) described two broad models whereby social support could mitigate the deleterious effects of stress on health: a main effect model and stress-buffering model. A specific application of these models was tested in a three-wave, multimethod study of 1888 children to assess ways parental support (social support) mitigates the effects of peer victimization (stress) on children's depressive symptoms and depression-related cognitions (health-related outcomes). Results revealed that (a) both supportive parenting and peer victimization had main effects on depressive symptoms and cognitions; (b) supportive parenting and peer victimization did not interact in the prediction of depressive thoughts and symptoms; (c) these results generalized across age and gender; and (d) increases in depressive symptoms were related to later reduction of supportive parenting and later increase in peer victimization. Although supportive parenting did not moderate the adverse outcomes associated with peer victimization, results show that its main effect can counterbalance or offset these effects to some degree. Implications for practice and future research are discussed. © 2013 American Psychological Association

Reproductive outcome following abdominal myomectomy for a very large fibroid uterus.

PubMed

Pundir, J; Kopeika, J; Harris, L; Krishnan, N; Uwins, C; Siozos, A; Khalaf, Y; El-Toukhy, T

2015-01-01

The aim of this study was to assess the long-term reproductive outcome following abdominal myomectomy in women with very large fibroid uteri. It is a retrospective study of 90 subfertile women with the main outcome measure of live-birth rate following spontaneous and assisted conception. Mean age of the study population was 37 ± 5 years and mean uterine size was 21 ± 6 weeks. During follow-up (mean 50 ± 10 months), 28 (31%) pregnancies occurred; 18 spontaneous and 10 following IVF. The live-birth rate was 20% and the miscarriage rate was 32%. Multivariate analysis demonstrated that the chance of live birth was significantly reduced with increasing female age at the time of surgery (OR = 0.67, 95% CI 0.51-0.86, p = 0.002). The perioperative blood transfusion rate was 30% and the incidence of major complications was 6%. Fertility after abdominal myomectomy for very large fibroid uteri is possible, and its major determinant is female age at the time of surgery.

Use of digital media technology for primary prevention of STIs/HIV in youth.

PubMed

Chávez, Noé Rubén; Shearer, Lee S; Rosenthal, Susan L

2014-10-01

The relevant literature was reviewed to identify issues in research evaluating digital media technology (DMT) interventions for the primary prevention of STIs/HIV in adolescents and young adults. A literature search with relevant key terms was conducted in PubMed, for articles with studies that included: (a) participants between 11-29 years; (b) use of one or more of the following forms of DMT: interactive digital video or CD-ROM, computer, text messaging, or Internet; (c) evaluation of an STI/HIV primary prevention intervention; and (d) use of a cognitive, psychosocial, behavioral, or biological outcome. Twenty-nine studies were identified and included in the review. Based on the review of these studies, 7 main issues were discussed and recommendations for improving future research were offered. The 7 main issues were: (a) need for a balance between universal application and specific sub-group focus, (b) lack of a developmental framework, (c) challenge of applying DMT in resource limited contexts, (d) rapidly changing nature of DMT, (e) lack of biological outcomes, (f) lack of comparison/control groups to assess the impact of DMT, and (g) limited temporal follow-up. There is increasing literature evaluating the effectiveness of DMT for preventing STIs/HIV among adolescents and young adults. A careful consideration of 7 main issues identified in the literature can improve the design and evaluation of these interventions and enhance our understanding of their effectiveness. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Measuring outcomes in adult spinal deformity surgery: a systematic review to identify current strengths, weaknesses and gaps in patient-reported outcome measures.

PubMed

Faraj, Sayf S A; van Hooff, Miranda L; Holewijn, Roderick M; Polly, David W; Haanstra, Tsjitske M; de Kleuver, Marinus

2017-08-01

Adult spinal deformity (ASD) causes severe disability, reduces overall quality of life, and results in a substantial societal burden of disease. As healthcare is becoming more value based, and to facilitate global benchmarking, it is critical to identify and standardize patient-reported outcome measures (PROMs). This study aims to identify the current strengths, weaknesses, and gaps in PROMs used for ASD. Studies were included following a systematic search in multiple bibliographic databases between 2000 and 2015. PROMs were extracted and linked to the outcome domains of WHO's International Classification of Functioning and Health (ICF) framework. Subsequently, the clinimetric quality of identified PROMs was evaluated. The literature search identified 144 papers that met the inclusion criteria, and nine frequently used PROMs were identified. These covered 29 ICF outcome domains, which could be grouped into three of the four main ICF chapters: body function (n = 7), activity and participation (n = 19), environmental factors (n = 3), and body structure (n = 0). A low quantity (n = 3) of papers was identified that studied the clinimetric quality of PROMs. The Scoliosis Research Society (SRS)-22 has the highest level of clinimetric quality for ASD. Outcome domains related to mobility and pain were well represented. We identified a gap in current outcome measures regarding neurological and pulmonary function. In addition, no outcome domains were measured in the ICF chapter body structure. These results will serve as a foundation for the process of seeking international consensus on a standard set of outcome domains, accompanied PROMs and contributing factors to be used in future clinical trials and spine registries.

Early hyperreactive malarial splenomegaly and risk factors for evolution into the full-blown syndrome: a single-centre, retrospective, longitudinal study.

PubMed

Bisoffi, Zeno; Leoni, Stefania; Buonfrate, Dora; Lodesani, Claudia; Eseme, Franklin Esoka; Monteiro, Geraldo Badona; Marocco, Stefania; Guerriero, Massimo

2015-12-02

The hyperreactive malarial splenomegaly (HMS) represents a chronic, potentially fatal complication of malaria. Case definition includes: gross splenomegaly, high level of anti-malarial antibody and IgM, response to long-term anti-malarial prophylaxis. In this study, a large series of patients not fully meeting the case definition was tentatively classified as early hyperreactive malarial splenomegaly (e-HMS). The main research questions was: does "e-HMS" tend to evolve to the full-blown syndrome? And if so, what are the main factors influencing this evolution? Retrospective, longitudinal study. The patient database was searched to retrieve all potentially eligible patients. e-HMS was defined by splenomegaly of any size (with or without raised IgM), high anti-malarial antibody titre and exclusion of other causes of splenomegaly. The clinical outcome at following visits was analysed in relation to re-exposure to malaria, and to treatment (only part of the patients with e-HMS were treated with a single anti-malarial treatment and advised to follow an effective anti-malarial prophylaxis, if re-exposed). The association of the outcome with the main independent variables was first assessed with univariate analysis. A stepwise logistic regression model was then performed to study the association of the outcome with the main independent variables. One hundred and twenty-six subjects with e-HMS were retrieved. Eighty-one had at least one follow-up visit. Of 46 re-exposed to malaria for a variable period, 21 (46 %) had progressed, including 10/46 (22 %) evolving to full-blown HMS, while of 29 patients not re-exposed, 24 (93 %) had improved or cured and five (7 %) progressed (p < 0.001). At logistic regression re-exposure was confirmed as a major risk factor of progression (OR 9.458, CI 1.767-50.616) while treatment at initial visit was protective (OR 0.187, CI 0.054-0.650). e-HMS should be regarded as a clinical condition predisposing to HMS. Although the case definition may include false positives, e-HMS should be treated just as the full-blown syndrome. A single anti-malarial treatment is probably adequate, followed by effective prophylaxis for patients exposed again to malaria transmission.

Financial ties of principal investigators and randomized controlled trial outcomes: cross sectional study

PubMed Central

Ahn, Rosa; Woodbridge, Alexandra; Abraham, Ann; Saba, Susan; Korenstein, Deborah; Madden, Erin; Boscardin, W John

2017-01-01

Objective To examine the association between the presence of individual principal investigators’ financial ties to the manufacturer of the study drug and the trial’s outcomes after accounting for source of research funding. Design Cross sectional study of randomized controlled trials (RCTs). Setting Studies published in “core clinical” journals, as identified by Medline, between 1 January 2013 and 31 December 2013. Participants Random sample of RCTs focused on drug efficacy. Main outcome measure Association between financial ties of principal investigators and study outcome. Results A total of 190 papers describing 195 studies met inclusion criteria. Financial ties between principal investigators and the pharmaceutical industry were present in 132 (67.7%) studies. Of 397 principal investigators, 231 (58%) had financial ties and 166 (42%) did not. Of all principal investigators, 156 (39%) reported advisor/consultancy payments, 81 (20%) reported speakers’ fees, 81 (20%) reported unspecified financial ties, 52 (13%) reported honorariums, 52 (13%) reported employee relationships, 52 (13%) reported travel fees, 41 (10%) reported stock ownership, and 20 (5%) reported having a patent related to the study drug. The prevalence of financial ties of principal investigators was 76% (103/136) among positive studies and 49% (29/59) among negative studies. In unadjusted analyses, the presence of a financial tie was associated with a positive study outcome (odds ratio 3.23, 95% confidence interval 1.7 to 6.1). In the primary multivariate analysis, a financial tie was significantly associated with positive RCT outcome after adjustment for the study funding source (odds ratio 3.57 (1.7 to 7.7). The secondary analysis controlled for additional RCT characteristics such as study phase, sample size, country of first authors, specialty, trial registration, study design, type of analysis, comparator, and outcome measure. These characteristics did not appreciably affect the relation between financial ties and study outcomes (odds ratio 3.37, 1.4 to 7.9). Conclusions Financial ties of principal investigators were independently associated with positive clinical trial results. These findings may be suggestive of bias in the evidence base. PMID:28096109

Privileging Practice: Facing the Challenge of Integrated Working for Outcomes for Children

ERIC Educational Resources Information Center

Canavan, John; Coen, Liam; Dolan, Pat; Whyte, Liam

2009-01-01

Integrated working for outcomes is complex and challenging in theory and practice. Yet, outcomes and integrated working are central to the policy goals for children and families in Ireland. In this article, the authors present two main arguments: first, that reflective practice offers a useful general methodology for engaging with the theoretical…

Student Outcomes: Investigating Competency-Based Curriculum in Adult Basic Education. Research Report No. 5.

ERIC Educational Resources Information Center

Hazell, Pat

The outcomes attained by Australian adults enrolled in competency-based Certificate in Adult Foundation Education (CAFE) courses were examined. Special attention was paid to the outcomes achieved by students in the two lowest of the CAFE program's four levels. The main data sources were as follows: literature review; enrollment data from the…

Exploring assistive technology and post-school outcomes for students with severe disabilities.

PubMed

Bouck, Emily C; Flanagan, Sara M

2016-11-01

This study sought to understand the extent to which students with severe disabilities receive assistive technology in school and out-of-school, and the relationship between receipt of assistive technology in school and post-school outcomes for these students. This study was a secondary analysis of the National Longitudinal Transition Study-2 (NLTS2) from the USA. To analyze the data in this correlational study, researchers conducted frequency distributions, Chi Square Tests of Associations, significance tests and logistic regressions. The main results suggest (a) receipt of assistive technology in school varied greatly by disability identification; (b) receipt of assistive technology post-school also varied by disability identification, but receipt was generally lower; and (c) few statistically significant post-school outcome differences existed between students who received assistive technology and those who did not. An under-utilization of assistive technology exists in practice in the USA for students with severe disabilities. Implications for Rehabilitation An under-utilization of assistive technology for secondary students and adults with severe disabilities likely exists. A need exists for improved collaboration between professionals in rehabilitation and professionals in schools to ensure continuation of needed services or aids, such as assistive technology. Additional research is needed to better understand the adult life (or post-school) outcomes of individuals with severe disabilities, factors from PK-12 schooling or post-school services that positively and negative impact those outcomes.

Health outcomes of non-nutritive sweeteners: analysis of the research landscape.

PubMed

Lohner, Szimonetta; Toews, Ingrid; Meerpohl, Joerg J

2017-09-08

Food products containing non-nutritive sweeteners (NNSs) instead of sugar have become increasingly popular in the last decades. Their appeal is obviously related to their calorie-free sweet taste. However, with the dramatic increase in their consumption, it is reasonable and timely to evaluate their potential health benefits and, more importantly, potential adverse effects. The main aim of this scoping review was to map the evidence about health outcomes possibly associated with regular NNS consumption by examining the extent, range, and nature of research activity in this area. We systematically searched Ovid MEDLINE, EMBASE and the Cochrane CENTRAL databases for studies on NNSs (artificial sweeteners or natural, non-caloric sweeteners, either used individually or in combination) using text terms with appropriate truncation and relevant indexing terms. All human studies investigating any health outcomes of a NNS intervention or exposure were eligible for inclusion. No studies were excluded based on language, study design or methodological quality. Data for each health outcome were summarized in tabular form and were discussed narratively. Finally, we included 372 studies in our scoping review, comprising 15 systematic reviews, 155 randomized controlled trials (RCTs), 23 non-randomized controlled trials, 57 cohort studies, 52 case-control studies, 28 cross sectional studies and 42 case series/case reports. In healthy subjects, appetite and short term food intake, risk of cancer, risk of diabetes, risk of dental caries, weight gain and risk of obesity are the most investigated health outcomes. Overall there is no conclusive evidence for beneficial and harmful effects on those outcomes. Numerous health outcomes including headaches, depression, behavioral and cognitive effects, neurological effects, risk of preterm delivery, cardiovascular effects or risk of chronic kidney disease were investigated in fewer studies and further research is needed. In subjects with diabetes and hypertension, the evidence regarding health outcomes of NNS use is also inconsistent. This scoping review identifies the needs for future research to address the numerous evidence gaps related to health effects of NNSs use.It also specifies the research questions and areas where a systematic review with meta-analyses is required for the proper evaluation of health outcomes associated to regular NNSs consumption.

Mobile phones, radiofrequency fields, and health effects in children--epidemiological studies.

PubMed

Feychting, Maria

2011-12-01

In 2004, when WHO organized a workshop on children's sensitivity to electromagnetic fields, very few studies on radiofrequency fields were available. With the recent increase in mobile phone use among children and adolescents, WHO has identified studies on health effects in this age-group as a high priority research area. There are no empirical data supporting the notion that children and adolescents are more susceptible to RF exposure, but the number of studies is still relatively small. There are a few cross-sectional studies on well-being, cognitive effects and behavioral problems, and some cohort studies, mainly of maternal use of mobile phones during pregnancy. Cancer outcomes have been studied in relation to environmental RF exposure, e.g. from transmitters, and only one study on mobile phone use in children and adolescents and brain tumor risk has been published. Several methodological limitations need to be taken into consideration when interpreting the findings of the epidemiological studies. The cross-sectional design does not allow determination of the temporal sequence of exposure and outcome, and for several outcomes there is a large potential for reversed causality, i.e. that the outcome causes an increased RF exposure rather than the opposite. Biases such as recall errors in self-reported mobile phone use, lack of confounding control, e.g. of other aspects of mobile phone use than RF fields, trained behaviors, and pubertal development, makes causal interpretations impossible. Future studies need to include prospectively collected exposure information, incident outcomes, and proper confounding control. Monitoring of brain tumor incidence trends is strongly recommended. Copyright © 2011 Elsevier Ltd. All rights reserved.

Association Between Onset-to-Door Time and Clinical Outcomes After Ischemic Stroke.

PubMed

Matsuo, Ryu; Yamaguchi, Yuko; Matsushita, Tomonaga; Hata, Jun; Kiyuna, Fumi; Fukuda, Kenji; Wakisaka, Yoshinobu; Kuroda, Junya; Ago, Tetsuro; Kitazono, Takanari; Kamouchi, Masahiro

2017-11-01

The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke. This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9% men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T 0-1 , ≤1 hour; T 1-2 , >1 and ≤2 hours; T 2-3 , >2 and ≤3 hours; T 3-6 , >3 and ≤6 hours; T 6-12 , >6 and ≤12 hours; T 12-24 , >12 and ≤24 hours; and T 24- , >24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0-1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis. Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement ( T 0- 1 , 2.79 [2.28-3.42]; T 1-2 , 2.49 [2.02-3.07]; T 2-3 , 1.52 [1.21-1.92]; T 3-6 , 1.72 [1.44-2.05], with reference to T 24- ) and good functional outcome ( T 0-1 , 2.68 [2.05-3.49], T 1-2 2.10 [1.60-2.77], T 2-3 1.53 [1.15-2.03], T 3-6 1.31 [1.05-1.64], with reference to T 24- ), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival). Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after ischemic stroke, regardless of reperfusion treatment or stroke severity. © 2017 American Heart Association, Inc.

An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes

PubMed Central

2013-01-01

Background Studies have shown that communities have not always been able to implement evidence-based prevention programs with quality and achieve outcomes demonstrated by prevention science. Implementation support interventions are needed to bridge this gap between science and practice. The purpose of this article is to present two-year outcomes from an evaluation of the Assets Getting To Outcomes (AGTO) intervention in 12 Maine communities engaged in promoting Developmental Assets, a positive youth development approach to prevention. AGTO is an implementation support intervention that consists of: a manual of text and tools; face-to-face training, and onsite technical assistance, focused on activities shown to be associated with obtaining positive results across any prevention program. Methods This study uses a nested and cross-sectional, cluster randomized controlled design. Participants were coalition members and program staff from 12 communities in Maine. Each coalition nominated up to five prevention programs to participate. At random, six coalitions and their respective 30 programs received the two-year AGTO intervention and the other six maintained routine operations. The study assessed prevention practitioner capacity (efficacy and behaviors), practitioner exposure to and use of AGTO, practitioner perceptions of AGTO, and prevention program performance. Capacity of coalition members and performance of their programs were compared between the two groups across the baseline, one-, and two-year time points. Results We found no significant differences between AGTO and control group’s prevention capacity. However, within the AGTO group, significant differences were found between those with greater exposure to and use of AGTO. Programs that received the highest number of technical assistance hours showed the most program improvement. Conclusions This study is the first of its kind to show that use of an implementation support intervention-AGTO -yielded improvements in practitioner capacity and consequently in program performance on a large sample of practitioners and programs using a randomized controlled design. ClinicalTrials.gov identifier NCT00780338 PMID:23924279

Reliability of diagnosis and clinical efficacy of visceral osteopathy: a systematic review.

PubMed

Guillaud, Albin; Darbois, Nelly; Monvoisin, Richard; Pinsault, Nicolas

2018-02-17

In 2010, the World Health Organization published benchmarks for training in osteopathy in which osteopathic visceral techniques are included. The purpose of this study was to identify and critically appraise the scientific literature concerning the reliability of diagnosis and the clinical efficacy of techniques used in visceral osteopathy. Databases MEDLINE, OSTMED.DR, the Cochrane Library, Osteopathic Research Web, Google Scholar, Journal of American Osteopathic Association (JAOA) website, International Journal of Osteopathic Medicine (IJOM) website, and the catalog of Académie d'ostéopathie de France website were searched through December 2017. Only inter-rater reliability studies including at least two raters or the intra-rater reliability studies including at least two assessments by the same rater were included. For efficacy studies, only randomized-controlled-trials (RCT) or crossover studies on unhealthy subjects (any condition, duration and outcome) were included. Risk of bias was determined using a modified version of the quality appraisal tool for studies of diagnostic reliability (QAREL) in reliability studies. For the efficacy studies, the Cochrane risk of bias tool was used to assess their methodological design. Two authors performed data extraction and analysis. Eight reliability studies and six efficacy studies were included. The analysis of reliability studies shows that the diagnostic techniques used in visceral osteopathy are unreliable. Regarding efficacy studies, the least biased study shows no significant difference for the main outcome. The main risks of bias found in the included studies were due to the absence of blinding of the examiners, an unsuitable statistical method or an absence of primary study outcome. The results of the systematic review lead us to conclude that well-conducted and sound evidence on the reliability and the efficacy of techniques in visceral osteopathy is absent. The review is registered PROSPERO 12th of December 2016. Registration number is CRD4201605286 .

A systematic review of clinical supervision evaluation studies in nursing.

PubMed

Cutcliffe, John R; Sloan, Graham; Bashaw, Marie

2018-02-15

According to the international, extant literature published during the last 20 years or so, clinical supervision (CS) in nursing is now a reasonably common phenomenon. Nevertheless, what appears to be noticeably 'thin on the ground' in this body of literature are empirical evaluations of CS, especially those pertaining to client outcomes. Accordingly, the authors undertook a systematic review of empirical evaluations of CS in nursing to determine the state of the science. Adopting the approach documented by Stroup et al. (JAMA, 283, 2000, 2008), the authors searched for reports of evaluation studies of CS in nursing - published during the years 1995 to 2015. Keywords for the search were 'clinical supervision', 'evaluation', 'efficacy', 'nursing', and combinations of these keywords. Electronic databases used were CINAHL, MEDLINE, PsychLIT, and the British Nursing Index. The research evidence from twenty-eight (28) studies reviewed is presented, outlining the main findings with an overview of each study presented. The following broad themes were identified and are each discussed in the study: narrative/anecdotal accounts of positive outcomes for clinical supervision, narrative/anecdotal accounts of negative outcomes for clinical supervision, empirical positive outcomes reported by supervisee, and empirical findings showing no effect by supervisee. © 2018 Australian College of Mental Health Nurses Inc.

The effects of on-screen, point of care computer reminders on processes and outcomes of care

PubMed Central

Shojania, Kaveh G; Jennings, Alison; Mayhew, Alain; Ramsay, Craig R; Eccles, Martin P; Grimshaw, Jeremy

2014-01-01

Background The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering ‘computer reminders’. Objectives To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. Search methods We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. Selection criteria Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. Data collection and analysis Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. Main results Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). Authors’ conclusions Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis. PMID:19588323

Health economic studies: an introduction to cost-benefit, cost-effectiveness, and cost-utility analyses.

PubMed

Angevine, Peter D; Berven, Sigurd

2014-10-15

Narrative overview. To provide clinicians with a basic understanding of economic studies, including cost-benefit, cost-effectiveness, and cost-utility analyses. As decisions regarding public health policy, insurance reimbursement, and patient care incorporate factors other than traditional outcomes such as satisfaction or symptom resolution, health economic studies are increasingly prominent in the literature. This trend will likely continue, and it is therefore important for clinicians to have a fundamental understanding of the common types of economic studies and be able to read them critically. In this brief article, the basic concepts of economic studies and the differences between cost-benefit, cost-effectiveness, and cost-utility studies are discussed. An overview of the field of health economic analysis is presented. Cost-benefit, cost-effectiveness, and cost-utility studies all integrate cost and outcome data into a decision analysis model. These different types of studies are distinguished mainly by the way in which outcomes are valued. Obtaining accurate cost data is often difficult and can limit the generalizability of a study. With a basic understanding of health economic analysis, clinicians can be informed consumers of these important studies.

The effect of statins on renal outcomes in patients with diabetic kidney disease: A systematic review and meta-analysis.

PubMed

Qin, Xin; Dong, Hui; Fang, Ke; Lu, Fuer

2017-09-01

The effects of statins on renal outcomes in patients with diabetic kidney disease were conflicting. The aim of the study was to investigate whether statins treatment could affect renal outcomes (albuminuria or proteinuria, estimated glomerular filtration rate [eGFR]) for diabetic kidney disease patients. We searched the PubMed, OVID (including MEDLINE and EMBASE), Web of Science and the Cochrane Central Register of Controlled Trials. Randomized controlled trials evaluating the efficacy of statins in diabetic kidney disease patients were selected. The main outcomes were albuminuria (or proteinuria). Secondary outcomes were levels of eGFR. Two authors independently assessed study quality and extracted the information from enrolled trials. Eleven randomized controlled trials with a total number of 543 diabetic kidney disease participants were included in our study. The overall estimates showed that statins statistically reduced albuminuria (standardized mean differences -0.71, 95% CI -1.20 to -0.23, P = .004), though marked heterogeneity was found within studies. However, the analysis results indicated that statins could not reduce overt proteinuria (standardized mean differences -0.14, 95% CI -0.53 to 0.26, P = .49) or slow the rate of reduction in eGFR (standardized mean differences 0.06, 95% CI -0.14 to 0.26, P = .53). In general, our study demonstrated that statins might have beneficial effects on reducing albuminuria in diabetic kidney disease patients. However, there was no strong evidence that the same intervention had an effect on overt proteinuria or eGFR outcomes in these patients. Copyright © 2017 John Wiley & Sons, Ltd.

Quality of care for patients with type 2 diabetes mellitus in the Netherlands and the United States: a comparison of two quality improvement programs.

PubMed

Valk, Gerlof D; Renders, Carry M; Kriegsman, Didi M W; Newton, Katherine M; Twisk, Jos W R; van Eijk, Jacques Th M; van der Wal, Gerrit; Wagner, Edward H

2004-08-01

To assess differences in diabetes care and patient outcomes by comparing two multifaceted quality improvement programs in two different countries, and to increase knowledge of effective elements of such programs. Primary care in the ExtraMural Clinic (EMC) of the Department of General Practice of the Vrije Universiteit in Amsterdam, the Netherlands, and the Group Health Cooperative (GHC), a group-model health maintenance organization (HMO) in western Washington State in the United States. Data were collected from 1992 to 1997. In this observational study two diabetes cohorts in which a quality improvement program was implemented were compared. Both programs included a medical record system, clinical practice guidelines, physician educational meetings, audit, and feedback. Only the Dutch program (EMC) included guidelines on the structure of diabetes care and a recall system. Only the GHC program included educational outreach visits, formation of multidisciplinary teams, and patient self-management support. Included were 379 EMC patients, and 2,119 GHC patients with type 2 diabetes mellitus. Main process outcomes were: annual number of diabetes visits, and number of HbA1c and blood lipid measurements. Main patient outcomes were HbA1c and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices. In the EMC process outcomes and glycemic control improved more than at GHC, however, GHC had better baseline measures. There were no differences between programs on blood lipid control. During follow-up, intensification of pharmacotherapy was noted at both sites. Differences noted between programs were in line with differences in diabetes guidelines. Following implementation of guidelines and organizational improvement efforts, change occurred primarily in the process outcomes, rather than in the patient outcomes. Although much effort was put into improving process and patient outcomes, both complex programs still showed only moderate effects.

Rasch-family models are more valuable than score-based approaches for analysing longitudinal patient-reported outcomes with missing data.

PubMed

de Bock, Élodie; Hardouin, Jean-Benoit; Blanchin, Myriam; Le Neel, Tanguy; Kubis, Gildas; Bonnaud-Antignac, Angélique; Dantan, Étienne; Sébille, Véronique

2016-10-01

The objective was to compare classical test theory and Rasch-family models derived from item response theory for the analysis of longitudinal patient-reported outcomes data with possibly informative intermittent missing items. A simulation study was performed in order to assess and compare the performance of classical test theory and Rasch model in terms of bias, control of the type I error and power of the test of time effect. The type I error was controlled for classical test theory and Rasch model whether data were complete or some items were missing. Both methods were unbiased and displayed similar power with complete data. When items were missing, Rasch model remained unbiased and displayed higher power than classical test theory. Rasch model performed better than the classical test theory approach regarding the analysis of longitudinal patient-reported outcomes with possibly informative intermittent missing items mainly for power. This study highlights the interest of Rasch-based models in clinical research and epidemiology for the analysis of incomplete patient-reported outcomes data. © The Author(s) 2013.

Maternal thyroid function and the outcome of external cephalic version: a prospective cohort study

PubMed Central

2011-01-01

Background To investigate the relation between maternal thyroid function and the outcome of external cephalic version (ECV) in breech presentation. Methods Prospective cohort study in 141 women (≥ 35 weeks gestation) with a singleton fetus in breech. Blood samples for assessing thyroid function were taken prior to ECV. Main outcome measure was the relation between maternal thyroid function and ECV outcome indicated by post ECV ultrasound. Results ECV success rate was 77/141 (55%), 41/48 (85%) in multipara and 36/93 (39%) in primipara. Women with a failed ECV attempt had significantly higher TSH concentrations than women with a successful ECV (p < 0.001). Multiple logistic regression showed that TSH (OR: 0.52, 95% CI: 0.30-0.90), nulliparity (OR: 0.11, 95% CI: 0.03-0.36), frank breech (OR: 0.30, 95% CI: 0.10-0.93) and placenta anterior (OR: 0.31, 95% CI: 0.11-0.85) were independently related to ECV success. Conclusions Higher TSH levels increase the risk of ECV failure. Trial registration number ClinicalTrials.gov: NCT00516555 PMID:21269431

Outcome of Assisted Reproductive Technology (ART) and Subsequent Self-Reported Life Satisfaction

PubMed Central

Kuivasaari-Pirinen, Paula; Koivumaa-Honkanen, Heli; Hippeläinen, Maritta; Raatikainen, Kaisa; Heinonen, Seppo

2014-01-01

Objective To compare life satisfaction between women with successful or unsuccessful outcome after assisted reproductive treatment (ART) by taking into account the time since the last ART. Design Cohort study. Setting Tertiary hospital. Patients A total of 987 consecutive women who had undergone ART during 1996–2007 were invited and altogether 505 women participated in the study. Interventions A postal enquiry with a life satisfaction scale. Main Outcome Measure Self-reported life satisfaction in respect to the time since the last ART. Results In general, women who achieved a live birth after ART had a significantly higher life satisfaction than those who had unsuccessful ART, especially when compared in the first three years. The difference disappeared in the time period of 6–9 years after ART. The unsuccessfully treated women who had a child by some other means before or after the unsuccessful ART had comparable life satisfaction with successfully treated women even earlier. Conclusions Even if unsuccessful ART outcome is associated with subsequent lower level of life satisfaction, it does not seem to threaten the long-term wellbeing. PMID:25393846

A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis: a pilot trial.

PubMed

Schencking, Martin; Wilm, Stefan; Redaelli, Marcus

2013-01-01

An increasingly aging population implies an increasing prevalence of osteoarthritis (OA) of hip or knee. It has been ascertained that unspecific hydrotherapy of OA according to Sebastian Kneipp not only improves the range of mobility but also reduces pain significantly and increases the quality of life of the patients affected. The main aim of this pilot study was to determine the effects of hydrotherapy in comparison to conventional physiotherapy, and to analyze the feasibility of the study design under clinical circumstances. The study design is a prospective randomized controlled three-arm clinical pilot trial, carried out at a specialist clinic for integrative medicine. Thirty patients diagnosed with symptomatic OA of hip or knee and radiologic findings were randomly assigned to one of two intervention groups and a control group: hydrotherapy (group 1), physiotherapy (group 2), and both physiotherapy and hydrotherapy (group 3, control group) of the affected joint. pain intensity of the affected joint in the course of inpatient treatment; secondary outcome: health-related quality of life, joint-specific pain and mobility in the course of the study. Concerning the main outcome, intervention group 1 showed most beneficial effects in the course of inpatient treatment, followed by groups 3 and 2, and also the indirect flexion ability of hip or knee together with the general patient mobility through the "timed up and go" test were mainly improved within group 1 followed by groups 3 and 2. The results of this pilot study demonstrate beneficial effects of hydrotherapy. The study design is feasible. For statistically significant evidence and a robust conclusion of efficacy of Kneipp's hydrotherapy, a larger sample size is necessary. NCT 00950326.

Driving Errors in Parkinson’s Disease: Moving Closer to Predicting On-Road Outcomes

PubMed Central

Brumback, Babette; Monahan, Miriam; Malaty, Irene I.; Rodriguez, Ramon L.; Okun, Michael S.; McFarland, Nikolaus R.

2014-01-01

Age-related medical conditions such as Parkinson’s disease (PD) compromise driver fitness. Results from studies are unclear on the specific driving errors that underlie passing or failing an on-road assessment. In this study, we determined the between-group differences and quantified the on-road driving errors that predicted pass or fail on-road outcomes in 101 drivers with PD (mean age = 69.38 ± 7.43) and 138 healthy control (HC) drivers (mean age = 71.76 ± 5.08). Participants with PD had minor differences in demographics and driving habits and history but made more and different driving errors than HC participants. Drivers with PD failed the on-road test to a greater extent than HC drivers (41% vs. 9%), χ2(1) = 35.54, HC N = 138, PD N = 99, p < .001. The driving errors predicting on-road pass or fail outcomes (95% confidence interval, Nagelkerke R2 =.771) were made in visual scanning, signaling, vehicle positioning, speeding (mainly underspeeding, t(61) = 7.004, p < .001, and total errors. Although it is difficult to predict on-road outcomes, this study provides a foundation for doing so. PMID:24367958

Health and Occupational Outcomes Among Injured, Nonstandard Shift Workers.

PubMed

Wong, Imelda S; Smith, Peter M; Mustard, Cameron A; Gignac, Monique A M

2015-11-01

This study compares health and occupational outcomes following a work-related injury for nonstandard and day-shift workers. National Population Health Survey data were used to explore outcomes 2 years post-work injury. Retrospective-matched cohort analyses examined main effects and interactions of shift schedule and work injury with changes in health, shift schedule, and labor force status. Models were adjusted for respondent characteristics, baseline health status, and occupational strength requirements. Injured nonstandard shift workers reported lower health utility index scores, compared with uninjured and injured daytime workers and uninjured nonstandard-shift workers. No significant interactions between shift and injury were found with schedule change and leaving the labor force. Injured nonstandard-shift workers are as likely to remain employed as other groups, but may be vulnerable in terms of diminished health.

Surgical outcomes in patients with cutaneous malignant melanoma in Europe - a systematic literature review.

PubMed

Costa Svedman, F; Spanopoulos, D; Taylor, A; Amelio, J; Hansson, J

2017-04-01

There is limited comparative evidence of the outcomes of different types of surgical management in patients with malignant melanoma in Europe. To address that gap we conducted a systematic literature review to summarize studies reporting outcomes of surgical procedures in patients with malignant melanoma in Europe. Medline was searched for European studies published in English, between 2004 and 2014 reporting surgical outcomes in adults with cutaneous malignant melanoma. We identified 23 studies that evaluated 18 332 patients treated surgically between 1979 and 2009 from 11 European countries. Most of the studies (21/23) were observational; the two remaining studies were randomized controlled trials (RCTs). Studies compared the effect of a range of surgical interventions on a range of clinical outcomes, more commonly overall survival (OS) and disease-free survival (DFS)/recurrence-free survival (RFS). Wider excisions were not associated with improved survival in patients with melanoma thickness ≥2 mm in both studies (RCTs), however, recent results based on long-term follow-up data associate 3 cm excision margins (vs. 1 cm) with favourable survival outcomes. There was some evidence that complete lymph node dissection after positive sentinel lymph node offers survival benefits over therapeutic lymph node dissection. Sentinel lymph node biopsy was not shown to be associated with significant OS benefits, however, it was overly related with higher rates of DFS/RFS. This review highlights the difficulties of making comparisons between different types of surgical procedures for malignant melanoma. As surgery remains the main treatment, this is an important field, and further evidence, particularly from RCTs, is needed. © 2016 European Academy of Dermatology and Venereology.

Empirically Based Composite Fracture Prediction Model From the Global Longitudinal Study of Osteoporosis in Postmenopausal Women (GLOW)

PubMed Central

Compston, Juliet E.; Chapurlat, Roland D.; Pfeilschifter, Johannes; Cooper, Cyrus; Hosmer, David W.; Adachi, Jonathan D.; Anderson, Frederick A.; Díez-Pérez, Adolfo; Greenspan, Susan L.; Netelenbos, J. Coen; Nieves, Jeri W.; Rossini, Maurizio; Watts, Nelson B.; Hooven, Frederick H.; LaCroix, Andrea Z.; March, Lyn; Roux, Christian; Saag, Kenneth G.; Siris, Ethel S.; Silverman, Stuart; Gehlbach, Stephen H.

2014-01-01

Context: Several fracture prediction models that combine fractures at different sites into a composite outcome are in current use. However, to the extent individual fracture sites have differing risk factor profiles, model discrimination is impaired. Objective: The objective of the study was to improve model discrimination by developing a 5-year composite fracture prediction model for fracture sites that display similar risk profiles. Design: This was a prospective, observational cohort study. Setting: The study was conducted at primary care practices in 10 countries. Patients: Women aged 55 years or older participated in the study. Intervention: Self-administered questionnaires collected data on patient characteristics, fracture risk factors, and previous fractures. Main Outcome Measure: The main outcome is time to first clinical fracture of hip, pelvis, upper leg, clavicle, or spine, each of which exhibits a strong association with advanced age. Results: Of four composite fracture models considered, model discrimination (c index) is highest for an age-related fracture model (c index of 0.75, 47 066 women), and lowest for Fracture Risk Assessment Tool (FRAX) major fracture and a 10-site model (c indices of 0.67 and 0.65). The unadjusted increase in fracture risk for an additional 10 years of age ranges from 80% to 180% for the individual bones in the age-associated model. Five other fracture sites not considered for the age-associated model (upper arm/shoulder, rib, wrist, lower leg, and ankle) have age associations for an additional 10 years of age from a 10% decrease to a 60% increase. Conclusions: After examining results for 10 different bone fracture sites, advanced age appeared the single best possibility for uniting several different sites, resulting in an empirically based composite fracture risk model. PMID:24423345

Malaria infection, poor nutrition and indoor air pollution mediate socioeconomic differences in adverse pregnancy outcomes in Cape Coast, Ghana.

PubMed

Amegah, Adeladza K; Damptey, Obed K; Sarpong, Gideon A; Duah, Emmanuel; Vervoorn, David J; Jaakkola, Jouni J K

2013-01-01

The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES). Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES. A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire. In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440-145) reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355-87), low education (187 g; 95% CI: 355-20), studentship during pregnancy (291 g; 95% CI: 506-76) and low income (147 g; 95% CI: 277-17). In causal pathway analysis, malaria infection (6-20%), poor nutrition (2-51%) and indoor air pollution (10-62%) mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41-7.21) risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31-2.56) of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67-12.49) and 278% (RR: 3.78; 95% CI: 1.39-10.27) increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10-21%, 16-44% and 31-52% of the observed effects of socioeconomic disadvantage on LBW risk. We provide evidence of the effects of socioeconomic deprivation, substantially mediated by malaria infection, poor nutrition and indoor air pollution, on pregnancy outcomes in a developing country setting.

Development of a core outcome set for studies involving patients undergoing major lower limb amputation for peripheral arterial disease: study protocol for a systematic review and identification of a core outcome set using a Delphi survey.

PubMed

Ambler, Graeme K; Bosanquet, David C; Brookes-Howell, Lucy; Thomas-Jones, Emma; Waldron, Cherry-Ann; Edwards, Adrian G K; Twine, Christopher P

2017-12-28

The development of a standardised reporting set is important to ensure that research is directed towards the most important outcomes and that data is comparable. To ensure validity, the set must be agreed by a consensus of stakeholders including patients, healthcare professionals and lay representatives. There is currently no agreed core outcome set for patients undergoing major lower limb amputation for peripheral arterial disease (PAD) for either short- or medium-term research outcomes. By developing these sets we aim to rationalise future trial outcomes, facilitate meta-analysis and improve the quality and applicability of amputation research. We will undertake a comprehensive systematic review of studies of patients undergoing major lower limb amputation for PAD. Data regarding all primary and secondary outcomes reported in relevant studies will be extracted and summarised as outcome domains. We will then undertake focus groups with key stakeholders (patients, carers, health and social care workers) to collect qualitative data to identify the main short- and medium-term research outcomes for patients undergoing major lower limb amputation. Results of the systematic review and focus groups will be combined to create a comprehensive list of potential key outcomes. Stakeholders (patients, researchers and health and social care workers) will then be polled to determine which of the outcomes are considered to be important in a general context using a three-phase Delphi process. After preliminary analysis, results will be presented at a face-to-face meeting of key stakeholders for discussion and voting on the final set of core outcomes. This project is being run in parallel with a feasibility trial assessing perineural catheters in patients undergoing lower limb amputation (the PLACEMENT trial). Full ethical approval has been granted for the study (Wales REC 3 reference number 16/WA/0353). Core outcome sets will be developed for short- and medium-term outcomes of research involving patients undergoing major lower limb amputation for PAD. This will help with the design of future trials and facilitate meta-analyses of trial data. PROSPERO: CRD42017059329 . Registered on 30 March 2017. 975 . Registered on 5 April 2017.

Getting to Know a Place: Built Environment Walkability and Children's Spatial Representation of Their Home-School (h-s) Route.

PubMed

Moran, Mika R; Eizenberg, Efrat; Plaut, Pnina

2017-06-06

The literature on environmental walkability to date has mainly focused on walking and related health outcomes. While previous studies suggest associations between walking and spatial knowledge, the associations between environmental walkability and spatial knowledge is yet to be explored. The current study addresses this lacuna in research by exploring children's mental representations of their home-school (h-s) route, vis.

The treatment of perfectionism within the eating disorders: a pilot study.

PubMed

Goldstein, Mandy; Peters, Lorna; Thornton, Christopher E; Touyz, Stephen W

2014-05-01

The aim of this pilot study was to investigate the impact of the direct treatment of perfectionism on the outcome of perfectionism and eating disorder pathology. Sixty-one participants, attending day hospital treatment, participated in a randomised controlled study, in which treatment as usual (TAU) was compared with TAU combined with a clinician-lead cognitive behavioural treatment for perfectionism (TAU+P). Linear mixed model analysis revealed no significant interaction effects but significant main effects for time on variables measuring eating pathology and perfectionism. Outcomes supported the effectiveness of overall treatment but suggested that adding direct treatment of perfectionism did not enhance treatment. The results are discussed in relation to the existing literature on the treatment of perfectionism. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

Data article on the effect of work engagement strategies on faculty staff behavioural outcomes in private universities.

PubMed

Falola, Hezekiah Olubusayo; Olokundun, Maxwell Ayodele; Salau, Odunayo Paul; Oludayo, Olumuyiwa Akinrole; Ibidunni, Ayodotun Stephen

2018-06-01

The main objective of this study was to present a data article that investigate the effect of work engagement strategies on faculty behavioural outcomes. Few studies analyse how work engagement strategies could help in driving standard work behaviour particularly in higher institutions. In an attempt to bridge this gap, this study was carried out using descriptive research method and Structural Equation Model (AMOS 22) for the analysis of four hundred and forty one (441) valid questionnaire which were completed by the faculty members of the six selected private universities in Nigeria using stratified and simple random sampling techniques. Factor model which shows high-reliability and good fit was generated, while construct validity was provided through convergent and discriminant analyses.

The etiology and determinants of hospital closure.

PubMed

Longo, D R; Sohn, M W; Shortell, S M

1996-01-01

This article examines the etiology of hospital closure and the correlates of hospital closure and the extent of similarity in this organizational outcome between pre- and post-Prospective Payment System (PPS) implementation. It also replicates a study from an earlier time period. Findings support the study's main hypotheses: in more stringent and turbulent markets, institutional and strategic variables are more important determinants of hospital closure. Merger acquisitions are found to be similar to both system acquisitions and autonomous hospitals. Standard Metropolitan Statistical Area (SMSA) status and regulation show an effect on hospital closure and merger acquisition. While many similarities exist when compared to the replicated study and findings prior to PPS implementation, it appears that sufficient differences exist to support the hypothesis that the PPS has an impact upon hospital organizational outcome.

Brain lesions in septic shock: a magnetic resonance imaging study.

PubMed

Sharshar, Tarek; Carlier, Robert; Bernard, Francis; Guidoux, Céline; Brouland, Jean-Philippe; Nardi, Olivier; de la Grandmaison, Geoffroy Lorin; Aboab, Jérôme; Gray, Françoise; Menon, David; Annane, Djillali

2007-05-01

Understanding of sepsis-induced brain dysfunction remains poor, and relies mainly on data from animals or post-mortem studies in patients. The current study provided findings from magnetic resonance imaging of the brain in septic shock. Nine patients with septic shock and brain dysfunction [7 women, median age 63 years (interquartile range 61-79 years), SAPS II: 48 (44-56), SOFA: 8 (6-10)] underwent brain magnetic resonance imaging including gradient echo T1-weighted, fluid-attenuated inversion recovery (FLAIR), T2-weighted and diffusion isotropic images, and mapping of apparent diffusion coefficient. Brain imaging was normal in two patients, showed multiple ischaemic strokes in two patients, and in the remaining patients showed white matter lesions at the level of the centrum semiovale, predominating around Virchow-Robin spaces, ranging from small multiple areas to diffuse lesions, and characterised by hyperintensity on FLAIR images. The main lesions were also characterised by reduced signal on diffusion isotropic images and increased apparent diffusion coefficient. The lesions of the white matter worsened with increasing duration of shock and were correlated with Glasgow Outcome Score. This preliminary study showed that sepsis-induced brain lesions can be documented by magnetic resonance imaging. These lesions predominated in the white matter, suggesting increased blood-brain barrier permeability, and were associated with poor outcome.

Middle School Students' Science Self-Efficacy and Its Sources: Examination of Gender Difference

ERIC Educational Resources Information Center

Kiran, Dekant; Sungur, Semra

2012-01-01

The main purpose of the present study is to investigate middle school students' science self-efficacy as well as its sources and outcomes as a function of gender. Bandura's hypothesized sources of self-efficacy (i.e., mastery experience, vicarious experience, verbal persuasion, and emotional arousal) in addition to being inviting with self and…

Implementation of National Guidelines for Healthy School Meals: The Relationship between Process and Outcome

ERIC Educational Resources Information Center

Holthe, Asle; Larsen, Torill; Samdal, Oddrun

2011-01-01

The implementation of policy interventions at the school level is often considered an organizational change process. The main goal of the present study was to examine the degree of implementation of Norwegian national guidelines for healthy school meals and how organizational capacity at the school level contributed to the degree of…

Enhancing Social Competence for Disadvantaged Youth in Pre-Vocational Education: Model Development through Design-Based Research

ERIC Educational Resources Information Center

Kuhn, Ida Kristina

2017-01-01

This study investigates the enhancement of social competence for disadvantaged young people based on the example of the "Werkschule Bremen" educational course. Theoretical approaches to social competence as a learning outcome are mainly based on the model of social information processing, although the meaning of both practical and…

Dietary Behaviors and Portion Sizes of Black Women Who Enrolled in "SisterTalk" and Variation by Demographic Characteristics

ERIC Educational Resources Information Center

Gans, Kim M.; Risica, Patricia Markham; Kirtania, Usree; Jennings, Alishia; Strolla, Leslie O.; Steiner-Asiedu, Matilda; Hardy, Norma; Lasater, Thomas M.

2009-01-01

Objective: To describe the dietary behaviors of black women who enrolled in the SisterTalk weight control study. Design: Baseline data collected via telephone survey and in-person screening. Setting: Boston, Massachusetts and surrounding areas. Participants: 461 black women completed the baseline assessments. Main Outcome Measures: Measured height…

Extracurricular Activity and Parental Involvement Predict Positive Outcomes in Elementary School Children

ERIC Educational Resources Information Center

Lagace-Seguin, Daniel G.; Case, Emily

2010-01-01

The main goal of this study was to explore if parental involvement and extracurricular activity participation could predict well-being and academic competence in elementary school children. Seventy-two children (mean age = 10.9 years, SD = 0.85) and their parents participated. Results revealed that parental pressure and support, when paired with…

Diet Quality Is Low among Female Food Pantry Clients in Eastern Alabama

ERIC Educational Resources Information Center

Duffy, Patricia; Zizza, Claire; Jacoby, Jocelynn; Tayie, Francis A.

2009-01-01

Objective: Examine diet quality, food security, and obesity among female food pantry clients. Design: Cross-sectional study. Setting: A food pantry in Lee County, Alabama. Participants: Fifty-five female food pantry clients between 19 and 50 years of age. Main Outcome Measure(s): Diet quality using United States (US) Department of Agriculture…

The Importance of Course Design on Classroom Performance of Marketing Students

ERIC Educational Resources Information Center

Black, Gregory S.; Daughtrey, Clayton L.; Lewis, Jeffrey S.

2014-01-01

The main objective of this study was to investigate the impact of course design on marketing student outcomes by examining data gathered over several semesters from 563 undergraduate students enrolled in marketing classes at a major university. During this period of time, respondents were enrolled in one of four marketing courses, each of which…

Effects of Sibship Structure Revisited: Evidence from Intrafamily Resource Transfer in Taiwan

ERIC Educational Resources Information Center

Chu, C. Y. Cyrus; Xie, Yu; Yu, Ruoh-rong

2007-01-01

Numerous studies have consistently found negative effects of sibship size on educational outcomes. Three main explanations of these effects have been offered in the literature: (1) the dilution of family resources, (2) a changing intellectual environment in the family for each succeeding sibling, and (3) unobserved selectivity at the family level.…

School Policy on Teaching and School Learning Environment: Direct and Indirect Effects upon Student Outcome Measures

ERIC Educational Resources Information Center

Kyriakides, Leonidas; Creemers, Bert P. M.

2012-01-01

School policy on teaching and the school learning environment (SLE) are the main school factors of the dynamic model of educational effectiveness (Creemers & Kyriakides, 2008). A longitudinal study in which 50 primary schools, 108 classes, and 2369 students participated generated evidence supporting the validity of the dynamic model. This…

Connect for Health: Design of a Clinical-Community Childhood Obesity Intervention Testing Best Practices of Positive Outliers

PubMed Central

Taveras, Elsie M.; Marshall, Richard; Sharifi, Mona; Avalon, Earlene; Fiechtner, Lauren; Horan, Christine; Orav, John; Price, Sarah N.; Sequist, Thomas; Slater, Daniel

2016-01-01

Background The Connect for Health study is designed to assess whether a novel approach to care delivery that leverages clinical and community resources and addresses socio-contextual factors will improve body mass index (BMI) and family-centered, obesity-related outcomes of interest to parents and children. The intervention is informed by clinical, community, parent, and youth stakeholders and incorporates successful strategies and best practices learned from ‘positive outlier” families, i.e., those who have succeeded in changing their health behaviors and improve their BMI in the context of adverse built and social environments. Design Two-arm, randomized controlled trial with measures at baseline and 12 months after randomization. Participants 2-12 year old children with overweight or obesity (BMI≥ 85th percentile) and their parents/guardians recruited from 6 pediatric practices in eastern Massachusetts. Intervention Children randomized to the intervention arm receive a contextually-tailored intervention delivered by trained health coaches who use advanced geographic information system tools to characterize children's environments and neighborhood resources. Health coaches link families to community-level resources and use multiple support modalities including text messages and virtual visits to support families over a one-year intervention period. The control group receives enhanced pediatric care plus non-tailored health coaching. Main Outcome Measures Lower age-associated increase in BMI over a 1-year period. The main parent- and child-reported outcome is improved health-related quality of life. Conclusions The Connect for Health study seeks to support families in leveraging clinical and community resources to improve obesity-related outcomes that are most important to parents and children. PMID:26427562

Longitudinal associations between binge eating and overeating and adverse outcomes among adolescents and young adults: Does loss of control matter?

PubMed Central

Sonneville, Kendrin R.; Horton, Nicholas J.; Micali, Nadia; Crosby, Ross D.; Swanson, Sonja A.; Solmi, Francesca; Field, Alison E.

2013-01-01

Objective To investigate the association between overeating (without loss of control) and binge eating (overeating with loss of control) and adverse outcomes. Design Prospective cohort study. Setting Adolescents and young adults living throughout the United States. Participants 16,882 males and females participating in the Growing Up Today Study who were 9–15 years old at enrollment in 1996. Main Exposure Overeating and binge eating assessed via questionnaire every 12–24 months between 1996 and 2005. Main Outcome Measures Risk of becoming overweight or obese, starting to binge drinking frequently, starting to use marijuana, starting to use other drugs, and developing high levels of depressive symptoms. Generalized estimating equations were used to estimate associations. All models controlled for age and sex; additional covariates varied by outcome. Results Among this large cohort of adolescents and young adults, binge eating is more common among females than males. In fully-adjusted models, binge eating, but not overeating, was associated with incident overweight/obesity (OR=1.73, 95% CI=1.11, 2.69) and with the onset of high depressive symptoms (OR=2.19, 95% CI=1.40, 3.45). Neither overeating nor binge eating was associated with starting to binge drink frequently, while both overeating and binge eating predicted starting to use marijuana and other drugs. Conclusions Although any overeating, with or without loss of control, predicted the onset marijuana and other drug use, we found that binge eating is uniquely predictive of incident overweight/obesity and the onset of high depressive symptoms. These findings suggest that loss of control is an important indicator of severity of overeating episodes. PMID:23229786

Outcomes for primary kidney transplantation from donation after Citizens' death in China: a single center experience of 367 cases.

PubMed

Xue, Wujun; Tian, Puxun; Xiang, Heli; Ding, Xiaoming; Pan, Xiaoming; Yan, Hang; Hou, Jun; Feng, Xinshun; Liu, Linjuan; Ding, Chenguang; Tian, Xiaohui; Li, Yang; Zheng, Jin

2017-04-04

The cases of donation after brain death followed by circulatory death (DBCD) and donation after cardiac death (DCD) have been increased year by year in China. Further research is needed to understand in the outcomes and risk factors of delayed graft function (DGF) in order to minimize the risk of DGF and ameliorate its potential impact on long-term outcomes. This study was to explore the differences in outcomes between DBCD and DCD transplant and the main risk factors for DGF in DBCD. Retrospective analysis of the clinical data of 367donations after citizens' death kidney transplant procedures (donors and recipients) between July 2012 and August 2015 at our center. During the study period, the donation success rate was 25.3%. 164 cases of DBCD and 35 cases of DCD had been implemented and 367 kidneys were transplanted. The incidence of DGF in DBCD group were significantly lower than that of DCD group (12.0% vs. 27.0%, p = 0.002). The 1-year percent freedom from acute rejection (AR) was significantly higher in DBCD group compared with it of DCD group (94% vs. 82%, p = 0.036). Multivariate logistic regression analysis of the kidney transplants revealed that the high risk factors for DGF after renal transplantation in DBCD were history of hypertension (Odds Ratio [OR] = 5.88, 95% CI: 1.90 to 18.2, p = 0.002), low blood pressure (BP < 80 mmHg) (OR = 4.86, 95% CI: 1.58 to 14.9, p = 0.006) and serum creatinine of donor (OR = 1.09, 95% CI: 1.03 to 1.16, p = 0.003) before donation. The outcomes of DBCD could be better than DCD in DGF and AR. The main risk factors for DGF in DBCD kidney transplants are donors with a history of hypertension, low blood pressure, and serum creatinine of donor before donation.

Reasons and outcomes of admissions to the medical wards of jimma university specialized hospital, southwest ethiopia.

PubMed

Ali, Elias; Woldie, Mirkuzie

2010-07-01

Non-communicable diseases are the main reasons for admission to the medical wards in high-income countries. While in low and middle income countries communicable diseases are the main reasons for admission to the medical wards. However, in some low and middle income countries the reasons for admission are changing from communicable diseases to non-communicable diseases. But, data on reasons for admission to the medical wards of low income countries is scarce. Therefore, this study takes one year data from a low income country referral hospital aiming at describing the recent reasons and outcomes of medical admissions to see whether there is a change in reasons for admission and the outcome. A retrospective study examined patient case notes and ward registration books of medical admissions at Jimma University Specialized Hospital from January 1, 2008 to December 31, 2008. Socio-demographic variables, reasons and outcomes of admission were some of the variables recorded during the data collection. The International Statistical Classification of Disease was used for sorting and categorizing the diagnosis. The data was then analyzed using SPSS windows version 13.0. A total of 610 patient case notes were reviewed. The mean age of the patients was 36 years (SD ± 15.75). The highest number of admissions 218 (35.7%) was among the age groups 21 to 30 years. Communicable diseases; namely severe community acquired pneumonia 139(22.8%), all infectious and parasitic diseases category 100 (16.4%), and pyogenic as well as chronic meningitis 80(13.1%) were the most common reasons for admission. The death rate among patients admitted to the medical wards was 12.6%. Communicable diseases were still the common reasons for medical admissions at Jimma University Specialized Hospital. The outcome of medical admissions has not changed over sixteen years.

When Service-Learning Is Not a "Border-Crossing" Experience: Outcomes of a Graduate Spanish Online Course

ERIC Educational Resources Information Center

Carracelas-Juncal, Carmen

2013-01-01

Research on Spanish service-learning has focused mainly on the outcomes of service-learning for undergraduate students learning Spanish as a second language. This article examines the role of service-learning in a graduate online course for practicing Spanish teachers and the outcomes of the service-learning experience for three participants who…

Social Capital and Health: A Review of Prospective Multilevel Studies

PubMed Central

Murayama, Hiroshi; Fujiwara, Yoshinori; Kawachi, Ichiro

2012-01-01

Background This article presents an overview of the concept of social capital, reviews prospective multilevel analytic studies of the association between social capital and health, and discusses intervention strategies that enhance social capital. Methods We conducted a systematic search of published peer-reviewed literature on the PubMed database and categorized studies according to health outcome. Results We identified 13 articles that satisfied the inclusion criteria for the review. In general, both individual social capital and area/workplace social capital had positive effects on health outcomes, regardless of study design, setting, follow-up period, or type of health outcome. Prospective studies that used a multilevel approach were mainly conducted in Western countries. Although we identified some cross-sectional multilevel studies that were conducted in Asian countries, including Japan, no prospective studies have been conducted in Asia. Conclusions Prospective evidence from multilevel analytic studies of the effect of social capital on health is very limited at present. If epidemiologic findings on the association between social capital and health are to be put to practical use, we must gather additional evidence and explore the feasibility of interventions that build social capital as a means of promoting health. PMID:22447212

Social capital and health: a review of prospective multilevel studies.

PubMed

Murayama, Hiroshi; Fujiwara, Yoshinori; Kawachi, Ichiro

2012-01-01

This article presents an overview of the concept of social capital, reviews prospective multilevel analytic studies of the association between social capital and health, and discusses intervention strategies that enhance social capital. We conducted a systematic search of published peer-reviewed literature on the PubMed database and categorized studies according to health outcome. We identified 13 articles that satisfied the inclusion criteria for the review. In general, both individual social capital and area/workplace social capital had positive effects on health outcomes, regardless of study design, setting, follow-up period, or type of health outcome. Prospective studies that used a multilevel approach were mainly conducted in Western countries. Although we identified some cross-sectional multilevel studies that were conducted in Asian countries, including Japan, no prospective studies have been conducted in Asia. Prospective evidence from multilevel analytic studies of the effect of social capital on health is very limited at present. If epidemiologic findings on the association between social capital and health are to be put to practical use, we must gather additional evidence and explore the feasibility of interventions that build social capital as a means of promoting health.

Clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems: a systematic review and meta-analysis.

PubMed

Wright, Barry; Barry, Melissa; Hughes, Ellen; Trépel, Dominic; Ali, Shehzad; Allgar, Victoria; Cottrill, Lucy; Duffy, Steven; Fell, Jenny; Glanville, Julie; Glaser, Danya; Hackney, Lisa; Manea, Laura; McMillan, Dean; Palmer, Stephen; Prior, Vivien; Whitton, Clare; Perry, Amanda; Gilbody, Simon

2015-07-01

Services have variable practices for identifying and providing interventions for 'severe attachment problems' (disorganised attachment patterns and attachment disorders). Several government reports have highlighted the need for better parenting interventions in at-risk groups. This report was commissioned to evaluate the clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems (the main review). One supplementary review explored the evaluation of assessment tools and a second reviewed 10-year outcome data to better inform health economic aspects of the main review. A total of 29 electronic databases were searched with additional mechanisms for identifying a wide pool of references using the Cochrane methodology. Examples of databases searched include PsycINFO (1806 to January week 1, 2012), MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations (1946 to December week 4, 2011) and EMBASE (1974 to week 1, 2012). Searches were carried out between 6 and 12 January 2012. Papers identified were screened and data were extracted by two independent reviewers, with disagreements arbitrated by a third independent reviewer. Quality assessment tools were used, including quality assessment of diagnostic accuracy studies - version 2 and the Cochrane risk of bias tool. Meta-analysis of randomised controlled trials (RCTs) of parenting interventions was undertaken. A health economics analysis was conducted. The initial search returned 10,167 citations. This yielded 29 RCTs in the main review of parenting interventions to improve attachment patterns, and one involving children with reactive attachment disorder. A meta-analysis of eight studies seeking to improve outcome in at-risk populations showed statistically significant improvement in disorganised attachment. The interventions saw less disorganised attachment at outcome than the control (odds ratio 0.47, 95% confidence interval 0.34 to 0.65; p < 0.00001). Much of this focused around interventions improving maternal sensitivity, with or without video feedback. In our first supplementary review, 35 papers evaluated an attachment assessment tool demonstrating validity or psychometric data. Only five reported test-retest data. Twenty-six studies reported inter-rater reliability, with 24 reporting a level of 0.7 or above. Cronbach's alphas were reported in 12 studies for the comparative tests (11 with α > 0.7) and four studies for the reference tests (four with α > 0.7). Three carried out concurrent validity comparing the Strange Situation Procedure (SSP) with another assessment tool. These had good sensitivity but poor specificity. The Disturbances of Attachment Interview had good sensitivity and specificity with the research diagnostic criteria (RDC) for attachment disorders. In our supplementary review of 10-year outcomes in cohorts using a baseline reference standard, two studies were found with disorganised attachment at baseline, with one finding raised psychopathology in adolescence. Budget impact analysis of costs was estimated because a decision model could not be justifiably populated. This, alongside other findings, informed research priorities. There are relatively few UK-based clinical trials. A 10-year follow-up, while necessary for our health economists for long-term sequelae, yielded a limited number of papers. Maternal sensitivity interventions show good outcomes in at-risk populations, but require further research with complex children. The SSP and RDC for attachment disorders remain the reference standards for identification until more concurrent and predictive validity research is conducted. A birth cohort with sequential attachment measures and outcomes across different domains is recommended with further, methodologically sound randomised controlled intervention trials. The main area identified for future work was a need for good-quality RCTs in at-risk groups such as those entering foster care or adoption. This study is registered as PROSPERO CRD42011001395. The National Institute for Health Research Health Technology Assessment programme.

How to ask: older adults' preferred tools in health outcome prioritization.

PubMed

Case, Siobhan M; Fried, Terri R; O'Leary, John

2013-04-01

To assess older adults' attitudes toward eliciting health outcome priorities. This observational cohort study of 356 community-living adults age ≥65 included three tools: (1) Health Outcomes: ranking four outcomes (survival, function, freedom from pain, and freedom from other symptoms); (2) Now vs. Later: rating importance of current versus future quality of life; (3) Attitude Scale: agreement with statements about health outcomes and current versus future health. Whereas 41% preferred Health Outcomes, 40% preferred the Attitude Scale. Only 7-12% rated any tool as very hard or hard. In bivariate analysis, participants of non-white race and with lower education, health literacy, and functional status were significantly more likely to rate at least one of the tools as easy (p < .05). Across all tools, 17% of participants believed tools would change care. The main reason for thinking there would be no change was satisfaction with existing care (62%). There is variability in how older persons wish to be asked about health outcome priorities. Few find this task difficult, and difficulty was not greater among participants with lower health literacy, education, or health status. By offering different tools, healthcare providers can help patients clarify their health outcome priorities. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

How to ask: Older adults’ preferred tools in health outcome prioritization

PubMed Central

Case, Siobhan M.; Fried, Terri R.; O’Leary, John

2012-01-01

OBJECTIVE To assess older adults’ attitudes toward eliciting health outcome priorities. METHODS This observational cohort study of 356 community-living adults age ≥ 65 included three tools: 1) Health Outcomes: ranking four outcomes (survival, function, freedom from pain, and freedom from other symptoms); 2) Now vs. Later: rating importance of current versus future quality of life; 3) Attitude Scale: agreement with statements about health outcomes and current versus future health. RESULTS Whereas 41% preferred Health Outcomes, 40% preferred the Attitude Scale. Only 7–12% rated any tool as very hard or hard. In bivariate analysis, participants of non-white race and with lower education, health literacy, and functional status were significantly more likely to rate at least one of the tools as easy (p<0.05). Across all tools, 17% of participants believed tools would change care. The main reason for thinking there would be no change was satisfaction with existing care (62%). CONCLUSIONS There is variability in how older persons wish to be asked about health outcome priorities. Few find this task difficult, and difficulty was not greater among participants with lower health literacy, education, or health status. PRACTICE IMPLICATIONS By offering different tools, healthcare providers can help patients clarify their health outcome priorities. PMID:23218242

Prediction of antiepileptic drug treatment outcomes using machine learning

NASA Astrophysics Data System (ADS)

Colic, Sinisa; Wither, Robert G.; Lang, Min; Zhang, Liang; Eubanks, James H.; Bardakjian, Berj L.

2017-02-01

Objective. Antiepileptic drug (AED) treatments produce inconsistent outcomes, often necessitating patients to go through several drug trials until a successful treatment can be found. This study proposes the use of machine learning techniques to predict epilepsy treatment outcomes of commonly used AEDs. Approach. Machine learning algorithms were trained and evaluated using features obtained from intracranial electroencephalogram (iEEG) recordings of the epileptiform discharges observed in Mecp2-deficient mouse model of the Rett Syndrome. Previous work have linked the presence of cross-frequency coupling (I CFC) of the delta (2-5 Hz) rhythm with the fast ripple (400-600 Hz) rhythm in epileptiform discharges. Using the I CFC to label post-treatment outcomes we compared support vector machines (SVMs) and random forest (RF) machine learning classifiers for providing likelihood scores of successful treatment outcomes. Main results. (a) There was heterogeneity in AED treatment outcomes, (b) machine learning techniques could be used to rank the efficacy of AEDs by estimating likelihood scores for successful treatment outcome, (c) I CFC features yielded the most effective a priori identification of appropriate AED treatment, and (d) both classifiers performed comparably. Significance. Machine learning approaches yielded predictions of successful drug treatment outcomes which in turn could reduce the burdens of drug trials and lead to substantial improvements in patient quality of life.

Atrazine and Pregnancy Outcomes: A Systematic Review of Epidemiologic Evidence

PubMed Central

Goodman, Michael; Mandel, Jack S; DeSesso, John M; Scialli, Anthony R

2014-01-01

Atrazine (ATR) is a commonly used agricultural herbicide that has been the subject of epidemiologic studies assessing its relation to reproductive health problems. This review evaluates both the consistency and the quality of epidemiologic evidence testing the hypothesis that ATR exposure, at usually encountered levels, is a risk factor for birth defects, small for gestational age birth weight, prematurity, miscarriages, and problems of fetal growth and development. We followed the current methodological guidelines for systematic reviews by using two independent researchers to identify, retrieve, and evaluate the relevant epidemiologic literature on the relation of ATR to various adverse outcomes of birth and pregnancy. Each eligible paper was summarized with respect to its methods and results with particular attention to study design and exposure assessment, which have been cited as the main areas of weakness in ATR research. As a quantitative meta-analysis was not feasible, the study results were categorized qualitatively as positive, null, or mixed. The literature on ATR and pregnancy-related health outcomes is growing rapidly, but the quality of the data is poor with most papers using aggregate rather than individual-level information. Without good quality data, the results are difficult to assess; however, it is worth noting that none of the outcome categories demonstrated consistent positive associations across studies. Considering the poor quality of the data and the lack of robust findings across studies, conclusions about a causal link between ATR and adverse pregnancy outcomes are not warranted. PMID:24797711

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

PubMed Central

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

2016-01-01

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

Physical and functional outcomes following multidisciplinary residential rehabilitation for prearthritic hip pain among young active UK military personnel

PubMed Central

Coppack, Russell J; Bilzon, James L; Wills, Andrew K; McCurdie, Ian M; Partridge, Laura K; Nicol, Alastair M; Bennett, Alexander N

2016-01-01

Background There are no studies describing the clinical outcomes of a residential, multidisciplinary team (MDT) rehabilitation intervention for patients with prearthritic hip pain. The aim of this cohort study was to describe the functional and physical outcomes of multidisciplinary residential rehabilitation for UK military personnel with prearthritic hip pain. Methods Participants (N=40) with a mean age of 33 years referred to a specialist residential rehabilitation centre completed a comprehensive multidisciplinary residential intervention. The main outcome measures were mean pain, physical function (modified shuttle test (MST) and Y-balance test), hip range of motion (HROM) and a patient-reported outcome measure (The Copenhagen Hip and Groin Outcome Score, HAGOS). All scores for symptomatic hips were taken at baseline and post-treatment. Results There were improvements in the Y-balance test and HROM following rehabilitation. There were significant improvements in mean difference (T1-to-T2) for Y-balance scores (15.8 cm, 95% CI 10.7 to 20.9, p<0.001), HROM (6.5° increase in hip flexion, 95% CI 4.6 to 9.4, p<0.001) and hip internal rotation (4.6°, 95% CI 2.7 to 6.6, p<0.001). Scores for HAGOS, pain, MST and functional activity assessment showed no improvement. Conclusions Among UK military personnel with prearthritic hip pain, MDT residential rehabilitation resulted in improvements in a functional Y-balance test, hip flexion and internal rotation. The study suggests short-term benefits across some outcomes for the current UK military approach to MDT residential rehabilitation. PMID:27900174

Physical and functional outcomes following multidisciplinary residential rehabilitation for prearthritic hip pain among young active UK military personnel.

PubMed

Coppack, Russell J; Bilzon, James L; Wills, Andrew K; McCurdie, Ian M; Partridge, Laura K; Nicol, Alastair M; Bennett, Alexander N

2016-01-01

There are no studies describing the clinical outcomes of a residential, multidisciplinary team (MDT) rehabilitation intervention for patients with prearthritic hip pain. The aim of this cohort study was to describe the functional and physical outcomes of multidisciplinary residential rehabilitation for UK military personnel with prearthritic hip pain. Participants (N=40) with a mean age of 33 years referred to a specialist residential rehabilitation centre completed a comprehensive multidisciplinary residential intervention. The main outcome measures were mean pain, physical function (modified shuttle test (MST) and Y-balance test), hip range of motion (HROM) and a patient-reported outcome measure (The Copenhagen Hip and Groin Outcome Score, HAGOS). All scores for symptomatic hips were taken at baseline and post-treatment. There were improvements in the Y-balance test and HROM following rehabilitation. There were significant improvements in mean difference (T1-to-T2) for Y-balance scores (15.8 cm, 95% CI 10.7 to 20.9, p<0.001), HROM (6.5° increase in hip flexion, 95% CI 4.6 to 9.4, p<0.001) and hip internal rotation (4.6°, 95% CI 2.7 to 6.6, p<0.001). Scores for HAGOS, pain, MST and functional activity assessment showed no improvement. Among UK military personnel with prearthritic hip pain, MDT residential rehabilitation resulted in improvements in a functional Y-balance test, hip flexion and internal rotation. The study suggests short-term benefits across some outcomes for the current UK military approach to MDT residential rehabilitation.

Intrathecal application of the nimodipine slow-release microparticle system eg-1962 for prevention of delayed cerebral ischemia and improvement of outcome after aneurysmal subarachnoid hemorrhage.

PubMed

Etminan, Nima; Macdonald, R Loch; Davis, Cara; Burton, Kevin; Steiger, Hans-Jakob; Hänggi, Daniel

2015-01-01

The effective reduction of delayed cerebral ischemia (DCI), a main contributor for poor outcome following aneurysmal subarachnoid hemorrhage (SAH), remains challenging. Previous clinical trials on systemic pharmaceutical treatment of SAH mostly failed to improve outcome, probably because of insensitive pharmaceutical targets and outcome measures, small sample size, insufficient subarachnoid drug concentrations and also detrimental, systemic effects of the experimental treatment per se. Interestingly, in studies that are more recent, intrathecal administration of nicardipine pellets following surgical aneurysm repair was suggested to have a beneficial effect on DCI and neurological outcome. However, this positive effect remained restricted to patients who were treated surgically for a ruptured aneurysm. Because of the favorable results of the preclinical data on DCI and neurological outcome in the absence of neurotoxicity or systemic side effects, we are initiating clinical trials. The PROMISE (Prolonged Release nimOdipine MIcro particles after Subarachnoid hemorrhage) trial is designed as an unblinded, nonrandomized, single-center, single-dose, dose-escalation safety and tolerability phase 1 study in patients surgically treated for aSAH and will investigate the effect of intracisternal EG-1962 administration. The NEWTON (Nimodipine microparticles to Enhance recovery While reducing TOxicity after subarachNoid hemorrhage) trial is a phase 1/2a multicenter, controlled, randomized, open-label, dose-escalation, safety, tolerability, and pharmacokinetic study comparing EG-1962 and nimodipine in patients with aneurysmal SAH.

Hidden Treasures and Secret Pitfalls: Application of the Capability Approach to ParkinsonNet.

PubMed

Canoy, Marcel; Faber, Marjan J; Munneke, Marten; Oortwijn, Wija; Nijkrake, Maarten J; Bloem, Bastiaan R

2015-01-01

In the Netherlands, the largest health technology assessment (HTA) program funds mainly (cost-)effectiveness studies and implementation research. The cost-effectiveness studies are usually controlled clinical trials which simultaneously collect cost data. The success of a clinical trial typically depends on the effect size for the primary outcome, such as health gains or mortality rates. A drawback is that in case of a negative primary outcome, relevant other (and perhaps more implicit) benefits might be missed. Conversely, positive trials can contain adverse outcomes that may also remain hidden. The capability approach (developed by Nobel Prize winner and philosopher Sen) is an instrument that may reveal such "hidden treasures and secret pitfalls" that lie embedded within clinical trials, beyond the more traditional outcomes. Here, we exemplify the possible merits of the capability approach using a large clinical trial (funded by the HTA program in the Netherlands) that aimed to evaluate the ParkinsonNet concept, an innovative network approach for Parkinson patients. This trial showed no effects for the primary outcome, but the ParkinsonNet concept tested in this study was nevertheless met with great enthusiasm and was rapidly implemented throughout an entire country, and meanwhile also internationally. We applied the capability approach to the ParkinsonNet concept, and this analysis yielded additional benefits within several capability domains. These findings seems to substantiate the claim that richer policy debates may ensue by applying the capability approach to clinical trial data, in addition to traditional outcomes.

Efficacy of Naltrexone for the Treatment of Alcohol Dependence in Latino Populations.

PubMed

López, Cristina M; Barr, Simone C; Reid-Quiñones, Kathryn; de Arellano, Michael A

2017-05-01

Naltrexone has been identified as a promising psychopharmacological treatment for alcohol dependence. Previous studies have suggested that its efficacy may vary based on ethnic background. The current study examined the efficacy of naltrexone in the treatment of alcohol dependence in Latino adults, a previously unexplored population. This was a secondary analysis of the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study. The overall COMBINE sample consisted of 1,383 adult participants who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for alcohol dependence, including 155 Latinos, who are the focus of this report. Consistent with the main trial, primary drinking outcomes, including percentage of days abstinent (PDA) and time to first heavy drinking day (TTHD), were examined. In addition, we examined the effects of naltrexone on a clinically relevant secondary outcome measure, global clinical outcome of alcohol consumption and alcohol-related problems. As seen with the subsample of African Americans from the COMBINE Study, results of the present analysis indicated that there were no significant effects of naltrexone on PDA and TTHD despite these significant effects in the original study. However, contrary to findings in the African American subsample, for Latino participants naltrexone was a significant predictor of a good global clinical outcome (i.e., abstinence or moderate drinking without problems). Naltrexone was not significantly associated with improvements in the primary drinking outcomes of PDA or TTHD at the end of treatment or at follow-up. However, Latinos appeared to benefit from naltrexone as demonstrated by improved ratings of global clinical outcome. These results indicate mixed findings for the efficacy of naltrexone among Latinos in the COMBINE Study.

Outcomes for street children and youth under multidisciplinary care in a drop-in centre in Tegucigalpa, Honduras.

PubMed

Souza, Renato; Porten, Klaudia; Nicholas, Sarala; Grais, Rebecca

2011-11-01

There is little evidence to describe the feasibility and outcomes of services for the care of street children and youth in low-income countries. To describe the outcomes of a multidisciplinary case management approach delivered in a drop-in centre for street children and youth. A longitudinal study of street children and youth followed in an urban drop-in centre. Four hundred (400) street children and youth received a multidisciplinary case management therapeutic package based on the community reinforcement approach. The main outcomes were changes in psychological distress, substance abuse and social situation scores. The median follow-up time for the cohort was 18 months. There were reductions in the levels of psychological distress (p = 0.0001) and substance abuse (p ≤ 0.0001) in the cohort as well as an improvement in the social situation of street children and youth (p = 0.0001). There was a main effect of gender (p < 0.001) and a significant interaction of gender over time (p < 0.001) on improvements in levels of psychological distress. Survival analysis showed that the probability of remaining on substances at 12 months was 0.76 (95% CI: 0.69-0.81) and 0.51 (95% CI: 0.42-0.59) at 24 months. At 12 months, fewer female patients remained using substances compared to male (p < 0.01). To be most effective, programmes and strategies for children and youth in street situations in developing countries should target both their health and social needs.

Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.

PubMed

Cerqueira, Raphael O; Frey, Benicio N; Leclerc, Emilie; Brietzke, Elisa

2017-12-01

The objective of this study was to evaluate whether Vitex agnus castus is a safe and effective treatment for PMS and premenstrual dysphoric disorder (PMDD) and to discuss the implications of these findings for clinical practice. A systematic review of literature was conducted using PubMed and Scielo databases. The inclusion criteria were randomized controlled trials (RCT) using V. agnus castus in individuals with PMS or PMDD that compared this intervention with placebo or an active comparator and included a description of blinding and dropouts/withdrawals. The search was conducted by two independent investigators who reached consensus on the included trials. A total of eight RCTs were included in this study. Most studies focused on PMS, and the diagnostic criteria of PMS and PMDD changed over the years. Three different preparations of V. agnus castus (VAC) were tested, and there was significant variability in the measurement of treatment outcomes between the studies. Nevertheless, all eight studies were positive for VAC in the treatment of PMS or PMDD and VAC was overall well tolerated. Main limitations were differences in definition of diagnostic criteria, the instruments used as main outcome measures, and different preparations of VAC extracts limit the comparison of results between studies. In conclusion, the RCTs using VAC for treatment of PMS/PMDD suggested that the VAC extract is a safe and efficacious alternative to be considered for the treatment of PMS/PMDD symptoms.

The Behavior of Matter under Nonequilibrium Conditions: Fundamental Aspects and Applications: Progress Report for Period August 15, 1989 - April 14, 1990

DOE R&D Accomplishments Database

Prigogine, I.

1989-10-01

As in the previous period, our work has been concerned with the study of the properties of nonequilibrium systems and especially with the mechanism of self-organization. As is well-known, the study of self-organization began with the investigation of hydrodynamical or chemical instabilities studied from the point of view of macroscopic physics. The main outcome is that nonequilibrium generates spatial correlations of macroscopic physics. The main outcome is that nonequilibrium generated spatial correlations of macroscopic range whose characteristics length is an intrinsic property and whose amplitude is determined by nonequilibrium constraints. A survey of the macroscopic approach to nonequilibrium states is given in the paper. "Nonequilibrium States and Long Range Correlations in Chemical Dynamics", by G. Nicolis at al. However, over the last few years important progress has been made in the simulation of nonequilibrium situations using mainly molecular dynamics. It appears now that processes corresponding to self-organization as well as the appearance of long-range correlations can be obtained in this way starting from a program involving Newtonian dynamics (generally the laws of interaction correspond to hard spheres or hard disks). Examples of such types of studies leading to Benard instabilities, to chemical clocks, or to spatial structure formation are given in this report. As a result, we may now view self-organization as a direct expression of tan appropriate microscopic dynamics. This is the reason why we have devoted much work to the study of large Poincare systems (LPS) involving continuous sets of resonances. These systems have been shown to lead, according to the constraints, either to equilibrium situations or to nonequilibrium states involving long range correlations. We discuss LPS in the frame of classical mechanics.

Extended infusion versus intermittent infusion of imipenem in the treatment of ventilator-associated pneumonia.

PubMed

Ibrahim, Mohamed M; Tammam, Tarek Fouad; Ebaed, Mohy El Deen; Sarhan, Hatem A; Gad, Gamal F; Hussein, Amal K

2017-01-01

Mechanical ventilation support can be the main source of ventilator-associated pneumonia (VAP). VAP is a serious infection that may be associated with dangerous gram-negative bacteria mainly, and it leads to an increase in the mortality in the intensive care unit (ICU). Imipenem is one of the strongest antibiotics now available for treating VAP which is associated with gram-negative and gram-positive bacteria, and it belongs to beta-lactam antibiotic group (carbapenem). This study tried to investigate the efficacy of imipenem against VAP when it was infused within 180 min versus the efficacy when it was infused within 30-60 min. This study was conducted in main ICU in general hospital which consists of surgical and medical beds within 2 years. One hundred and eighty-seven patients were enrolled on it. This study is a retrospective cohort which was conducted within 2 years. The efficacy of imipenem which was administered by intermittent infusion (30-60 min) within first year was compared with the efficacy of imipenem which was administered by extended infusion (180 min) within second year in the field of VAP curing and cost reduction. All data were collected retrospectively from patient medical files and were statistically analyzed by SPSS version 20. The study was designed to measure clinical and cost reduction outcomes, mortality and hospital stay. The results indicated that there is a significant decrease in mortality, number of recurrent infection, and ICU stay length, and the number of mechanical ventilator days was associated with extended imipenem infusion during the second year of the study. The use of imipenem with extended infusion over 3 hours enhances its clinical outcomes in the treatment of VAP.

Long-term risk of mental health problems in women experiencing preterm birth: a longitudinal study of 29 mothers.

PubMed

Misund, Aud R; Nerdrum, Per; Bråten, Stein; Pripp, Are Hugo; Diseth, Trond H

2013-10-31

Several studies have reported significantly higher stress levels, both short and long terms, among mothers giving preterm birth compared with mothers giving birth at term. Stress, however, is a psychological phenomenon that may present as anxiety, depression and/or trauma reactions. In this study, the long-term mental health outcomes and the prevalence of anxiety, depression and trauma reactions in women experiencing preterm birth were explored. Interactional, main effect variables and predictors were identified. Twenty-nine mothers of 35 premature children born before the 33rd week of pregnancy were assessed within 2 weeks postpartum (T0), 2 weeks after hospitalization (T1), 6 months post-term (T2), and 18 months post-term (T3). The standardized psychometric methods Impact of Event Scale (IES), General Health Questionnaire (GHQ) and State Anxiety Inventory (STAI-X1) assessed the maternal mental health outcomes. The maternal mental health problems except state anxiety decreased from T0 to T1, but remained high and stable at T3. The prevalence of posttraumatic stress reactions (PTSR) and posttraumatic stress disorder (PTSD) at T0 and T3 was 52% and 23%, respectively. We identified the time period between T0 and T1 to have a significant main effect on mental health outcomes. The predictors of higher levels of mental health problems were preeclampsia, previous psychological treatment, age, trait anxiety and infant's postnatal intraventricular haemorrhage. Bleeding in pregnancy predicted lower levels of mental health problems. The prevalence of maternal mental health problems remained high, emphasizing the importance of effective interventions.

The relationship of undernutrition/psychosocial factors and developmental outcomes of children in extreme poverty in Ethiopia.

PubMed

Worku, Berhanu Nigussie; Abessa, Teklu Gemechu; Wondafrash, Mekitie; Vanvuchelen, Marleen; Bruckers, Liesbeth; Kolsteren, Patrick; Granitzer, Marita

2018-02-09

Extreme poverty is severe deprivation of basic needs and services. Children living in extreme poverty may lack adequate parental care and face increased developmental and health risks. However, there is a paucity of literature on the combined influences of undernutrition and psychosocial factors (such as limited play materials, playground, playtime, interactions of children with their peers and mother-child interaction) on children's developmental outcomes. The main objective of this study was, therefore, to ascertain the association of developmental outcomes and psychosocial factors after controlling nutritional indices. A community-based cross-sectional study design was used to compare the developmental outcomes of extremely poor children (N = 819: 420 girls and 399 boys) younger than 5 years versus age-matched reference children (N = 819: 414 girls and 405 boys) in South-West Ethiopia. Using Denver II-Jimma, development in personal-social, language, fine and gross motor skills were assessed, and social-emotional skills were evaluated using the Ages and Stages Questionnaires: Social-Emotional (ASQ: SE). Nutritional status was derived from the anthropometric method. Independent samples t-test was used to detect mean differences in developmental outcomes between extremely poor and reference children. Multiple linear regression analysis was employed to identify nutritional and psychosocial factors associated with the developmental scores of children in extreme poverty. Children in extreme poverty performed worse in all the developmental domains than the reference children. Among the 819 extremely poor children, 325 (39.7%) were stunted, 135 (16.5%) were underweight and 27 (3.3%) were wasted. The results also disclosed that stunting and underweightness were negatively associated with all the developmental skills. After taking into account the effects of stunting and being underweight on the developmental scores, it was observed that limited play activities, limited child-to-child interactions and mother-child relationships were negatively related mainly to gross motor and language performances of children in extreme poverty. Undernutrition and psychosocial factors were negatively related to the developmental outcomes, independently, of children living in extreme poverty. Intervention, for these children, should integrate home-based play-assisted developmental stimulation and nutritional rehabilitation.

Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial

PubMed Central

Killaspy, Helen; Barnes, Thomas R E; Barrett, Barbara; Byford, Sarah; Clayton, Katie; Dinsmore, John; Floyd, Siobhan; Hoadley, Angela; Johnson, Tony; Kalaitzaki, Eleftheria; King, Michael; Leurent, Baptiste; Maratos, Anna; O’Neill, Francis A; Osborn, David P; Patterson, Sue; Soteriou, Tony; Tyrer, Peter; Waller, Diane

2012-01-01

Objectives To evaluate the clinical effectiveness of group art therapy for people with schizophrenia and to test whether any benefits exceed those of an active control treatment. Design Three arm, rater blinded, pragmatic, randomised controlled trial. Setting Secondary care services across 15 sites in the United Kingdom. Participants 417 people aged 18 or over, who had a diagnosis of schizophrenia and provided written informed consent to take part in the study. Interventions Participants, stratified by site, were randomised to 12 months of weekly group art therapy plus standard care, 12 months of weekly activity groups plus standard care, or standard care alone. Art therapy and activity groups had up to eight members and lasted for 90 minutes. In art therapy, members were given access to a range of art materials and encouraged to use these to express themselves freely. Members of activity groups were offered various activities that did not involve use of art or craft materials and were encouraged to collectively select those they wanted to pursue. Main outcome measures The primary outcomes were global functioning, measured using the global assessment of functioning scale, and mental health symptoms, measured using the positive and negative syndrome scale, 24 months after randomisation. Main secondary outcomes were levels of group attendance, social functioning, and satisfaction with care at 12 and 24 months. Results 417 participants were assigned to either art therapy (n=140), activity groups (n=140), or standard care alone (n=137). Primary outcomes between the three study arms did not differ. The adjusted mean difference between art therapy and standard care at 24 months on the global assessment of functioning scale was −0.9 (95% confidence interval −3.8 to 2.1), and on the positive and negative syndrome scale was 0.7 (−3.1 to 4.6). Secondary outcomes did not differ between those referred to art therapy or those referred to standard care at 12 or 24 months. Conclusions Referring people with established schizophrenia to group art therapy as delivered in this trial did not improve global functioning, mental health, or other health related outcomes. Trial registration Current Controlled Trials ISRCTN46150447. PMID:22374932

Outcome related to impact on daily living: preliminary validation of the ORIDL instrument.

PubMed

Reilly, David; Mercer, Stewart W; Bikker, Annemieke P; Harrison, Tansy

2007-09-02

The challenge of finding practical, patient-rated outcome measures is a key issue in the evaluation of health care systems and interventions. The ORIDL (Outcome in Relation to Impact on Daily Living) instrument (formerly referred to as the Glasgow Homoeopathic Hospital Outcomes Scale or GHHOS) has been developed to measure patient's views of the outcome of their care by asking about change, and relating this to impact on daily life. The aim of the present paper is to describe the background and potential uses of the ORIDL, and to report on its preliminary validation in a series of three studies in secondary and primary care. In the first study, 105 patients attending the Glasgow Homoeopathic Hospital (GHH) were followed-up at 12 months and changes in health status were measured by the EuroQol (EQOL) and the ORIDL. In the second study, 187 new patients at the GHH were followed-up at 3, 12, and 33 months, using the ORIDL, the Short Form 12 (SF-12), and the Measure Yourself Medical Outcome Profile (MYMOP). In study three, 323 patients in primary care were followed for 1 month post-consultation using the ORIDL and MYMOP. In all 3 studies the Patient Enablement Instrument (PEI) was also used as an outcome measure. Study 1 showed substantial improvements in main complaint and well-being over 12 months using the ORIDL, with two-thirds of patients reporting improvements in daily living. These improvements were not significantly correlated with changes in serial measures of the EQOL between baseline and 12 months, but were correlated with the EQOL transitions measure. Study 2 showed step-wise improvements in ORIDL scores between 3 and 33 months, which were only weakly associated with similar changes in SF-12 scores. However, MYMOP change scores correlated well with ORIDL scores at all time points. Study 3 showed similar high correlations between ORIDL scores and MYMOP scores. In all 3 studies, ORIDL scores were also significantly correlated with PEI-outcome scores. There is significant agreement between patient outcomes assessed by the ORIDL and the EQOL transition scale, the MYMOP, and the PEI-outcome instrument, suggesting that the ORIDL may be a valid and sensitive tool for measuring change in relation to impact on life.

Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis

PubMed Central

Derricott, Hayley; Jones, Rebecca L.; Heazell, Alexander E. P.

2017-01-01

Background Advanced maternal age (AMA; ≥35 years) is an increasing trend and is reported to be associated with various pregnancy complications. Objective To determine the risk of stillbirth and other adverse pregnancy outcomes in women of AMA. Search strategy Embase, Medline (Ovid), Cochrane Database of Systematic Reviews, ClinicalTrials.gov, LILACS and conference proceedings were searched from ≥2000. Selection criteria Cohort and case-control studies reporting data on one or more co-primary outcomes (stillbirth or fetal growth restriction (FGR)) and/or secondary outcomes in mothers ≥35 years and <35 years. Data collection and analysis The effect of age on pregnancy outcome was investigated by random effects meta-analysis and meta-regression. Stillbirth rates were correlated to rates of maternal diabetes, obesity, hypertension and use of assisted reproductive therapies (ART). Main results Out of 1940 identified titles; 63 cohort studies and 12 case-control studies were included in the meta-analysis. AMA increased the risk of stillbirth (OR 1.75, 95%CI 1.62 to 1.89) with a population attributable risk of 4.7%. Similar trends were seen for risks of FGR, neonatal death, NICU unit admission restriction and GDM. The relationship between AMA and stillbirth was not related to maternal morbidity or ART. Conclusions Stillbirth risk increases with increasing maternal age. This is not wholly explained by maternal co-morbidities and use of ART. We propose that placental dysfunction may mediate adverse pregnancy outcome in AMA. Further prospective studies are needed to directly test this hypothesis. PMID:29040334

Systematic review of social media interventions for smoking cessation.

PubMed

Naslund, John A; Kim, Sunny Jung; Aschbrenner, Kelly A; McCulloch, Laura J; Brunette, Mary F; Dallery, Jesse; Bartels, Stephen J; Marsch, Lisa A

2017-10-01

Popular social media could extend the reach of smoking cessation efforts. In this systematic review, our objectives were: 1) to determine whether social media interventions for smoking cessation are feasible, acceptable, and potentially effective; 2) to identify approaches for recruiting subjects; and 3) to examine the specific intervention design components and strategies employed to promote user engagement and retention. We searched Scopus, Medline, EMBASE, Cochrane Central, PsychINFO, CINAHL, and Web of Science through July 2016 and reference lists of relevant articles. Included studies described social media interventions for smoking cessation and must have reported outcomes related to feasibility, acceptability, usability, or smoking-related outcomes. We identified 7 studies (all were published since 2014) that enrolled 9755 participants (median=136 [range 40 to 9042]). Studies mainly used Facebook (n=4) or Twitter (n=2), and emerged as feasible and acceptable. Five studies reported smoking-related outcomes such as greater abstinence, reduction in relapse, and an increase in quit attempts. Most studies (n=6) recruited participants using online or Facebook advertisements. Tailored content, targeted reminders, and moderated discussions were used to promote participant engagement. Three studies found that active participation through posting comments or liking content may be associated with improved outcomes. Retention ranged from 35% to 84% (median=70%) across the included studies. Our review highlights the feasibility, acceptability and preliminary effectiveness of social media interventions for smoking cessation. Future research should continue to explore approaches for promoting user engagement and retention, and whether sustained engagement translates to clinically meaningful smoking cessation outcomes. Copyright © 2017. Published by Elsevier Ltd.

More effective and less expensive: lessons from five studies examining community approaches to care.

PubMed

Browne, G; Roberts, J; Gafni, A; Weir, R; Watt, S; Byrne, C

1995-11-01

Does the nature of community health services used by chronically ill clients and their caregivers have an impact on utilization of services, expenditure and well-being outcomes? A series of five studies, (four historic cohort and one randomized trial) examined clients suffering from a variety of chronic conditions in a number of community settings in different regions of Southern Ontario. Study sample composition and size varied. Each study was designed to quantify the well-being outcomes, and expenditure associated with different community approaches is covered under a nation-wide system of health insurance plans. As a collective, these studies represent increasing methodological rigor. Multiple-perspective client well-being outcome measures were used. Caregiver burden was also analyzed. A common approach to quantification and evaluation of expenditure for service consumption was applied across all five studies. The nature of community health services (proactive versus reactive approaches to care) was found to have direct and measurable impact on total expenditure for health service utilization and client well-being outcomes. A recurring pattern of lower expenditure for community health service utilization and equal or better client outcomes was associated with well-integrated proactive services when compared with individual fragmented, reactive approaches to care. The main lesson emerging from examining the five studies on approaches to community care is that it is as, or more, effective and less expensive to offer complete proactive health care services to chronically ill people in the early stages of their illness than to provide services on demand in a piecemeal manner.

Involving Latina/o parents in patient-centered outcomes research: Contributions to research study design, implementation and outcomes.

PubMed

Pérez Jolles, Mónica; Martinez, Maria; Garcia, San Juanita; Stein, Gabriela L; Thomas, Kathleen C

2017-10-01

Comparative effectiveness research (CER) is supported by policymakers as a way to provide service providers and patients with evidence-based information to make better health-care decisions and ultimately improve services for patients. However, Latina/o patients are rarely involved as study advisors, and there is a lack of documentation on how their voices contribute to the research process when they are included as collaborators. The purpose of this article was to contribute to the literature by presenting concrete contributions of Latina/o parent involvement to study design, implementation and outcomes in the context of a CER study called Padres Efectivos (Parent Activation). Researchers facilitated a collaborative relationship with parents by establishing a mentor parent group. The contributions of parent involvement in the following stages of the research process are described: (i) proposal development, (ii) implementation of protocols, (iii) analysis plan and (iv) dissemination of results. Mentor parents' contributions helped tailor the content of the intervention to their needs during proposal, increased recruitment, validated the main outcome measure and added two important outcome measures, emphasized the importance of controlling for novice treatment status and developed innovative dissemination strategies. Mentor parents' guidance to the researchers has contributed to reaching recruitment goals, strengthened the study protocol, expanded findings, supported broad ownership of study implications and enriched the overall study data collection efforts. These findings can inform future research efforts seeking an active Latino parent collaboration and the timely incorporation of parent voices in each phase of the research process. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

REFOCUS Trial: protocol for a cluster randomised controlled trial of a pro-recovery intervention within community based mental health teams.

PubMed

Slade, Mike; Bird, Victoria; Le Boutillier, Clair; Williams, Julie; McCrone, Paul; Leamy, Mary

2011-11-23

There is a consensus about the importance of 'recovery' in mental health services, but the evidence base is limited. A two centre, cluster randomised controlled trial. Participants are community-based mental health teams, and service users aged 18-65 years with a primary clinical diagnosis of psychosis. In relation to the REFOCUS Manual researchintorecovery.com/refocus, which describes a 12-month, pro-recovery intervention based on the REFOCUS Model, the objectives are: (1) To establish the effectiveness of the intervention described in the REFOCUS Manual; (2) To validate the REFOCUS Model; (3) To establish and optimise trial parameters for the REFOCUS Manual; and (4) To understand the relationship between clinical outcomes and recovery outcomes. The hypothesis for the main study is that service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) compared to service users receiving care from control teams. The hypothesis for the secondary study is that black service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) and client satisfaction (as measured by the CSQ) compared to Black service users receiving care from control teams. The intervention comprises treatment as usual plus two components: recovery-promoting relationships and working practices. The control condition is treatment as usual. The primary outcme is the Process of Recovery Questionnaire (QPR). Secondary outcomes are satisfaction, Goal setting - Personal Primary Outcome, hope, well-being, empowerment, and quality of life. Primary outcomes for the secondary study will be QPR and satisfaction. Cost data will be estimated, and clinical outcomes will also be reported (symptomatology, need, social disability, functioning). 29 teams (15 intervention and 14 control) will be randomised. Within each team, 15 services users will be randomly chosen, giving a total sample of 435 service users (225 in intervention and 210 in control). Power for the main study: 336 service users will give power to detect a medium effect size of 0.4 (alpha 0.05, power = 0.8) on both QPR sub-scales. Power for the secondary study: 89 participants will give power to detect an effect size of 0.67 on both QPR sub-scales and on CSQ. A range of approaches are used to minimise bias, although service users and clinicians cannot be blinded. This cluster-RCT will evaluate a pro-recovery intervention in community mental health teams. ISRCTN: ISRCTN02507940.

REFOCUS Trial: protocol for a cluster randomised controlled trial of a pro-recovery intervention within community based mental health teams

PubMed Central

2011-01-01

Background There is a consensus about the importance of 'recovery' in mental health services, but the evidence base is limited. Methods/Design A two centre, cluster randomised controlled trial. Participants are community-based mental health teams, and service users aged 18-65 years with a primary clinical diagnosis of psychosis. In relation to the REFOCUS Manual researchintorecovery.com/refocus, which describes a 12-month, pro-recovery intervention based on the REFOCUS Model, the objectives are: (1) To establish the effectiveness of the intervention described in the REFOCUS Manual; (2) To validate the REFOCUS Model; (3) To establish and optimise trial parameters for the REFOCUS Manual; and (4) To understand the relationship between clinical outcomes and recovery outcomes. The hypothesis for the main study is that service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) compared to service users receiving care from control teams. The hypothesis for the secondary study is that black service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) and client satisfaction (as measured by the CSQ) compared to Black service users receiving care from control teams. The intervention comprises treatment as usual plus two components: recovery-promoting relationships and working practices. The control condition is treatment as usual. The primary outcme is the Process of Recovery Questionnaire (QPR). Secondary outcomes are satisfaction, Goal setting - Personal Primary Outcome, hope, well-being, empowerment, and quality of life. Primary outcomes for the secondary study will be QPR and satisfaction. Cost data will be estimated, and clinical outcomes will also be reported (symptomatology, need, social disability, functioning). 29 teams (15 intervention and 14 control) will be randomised. Within each team, 15 services users will be randomly chosen, giving a total sample of 435 service users (225 in intervention and 210 in control). Power for the main study: 336 service users will give power to detect a medium effect size of 0.4 (alpha 0.05, power = 0.8) on both QPR sub-scales. Power for the secondary study: 89 participants will give power to detect an effect size of 0.67 on both QPR sub-scales and on CSQ. A range of approaches are used to minimise bias, although service users and clinicians cannot be blinded. Discussion This cluster-RCT will evaluate a pro-recovery intervention in community mental health teams. Trial registration ISRCTN: ISRCTN02507940 PMID:22112008

Adolescent cannabis and tobacco use and educational outcomes at age 16: birth cohort study.

PubMed

Stiby, Alexander I; Hickman, Matthew; Munafò, Marcus R; Heron, Jon; Yip, Vikki L; Macleod, John

2015-04-01

To investigate the relationship between cannabis and tobacco use by age 15 and subsequent educational outcomes. Birth cohort study. England. The sample was drawn from the Avon Longitudinal Study of Parents and Children; a core sample of 1155 individuals had complete information on all the variables. The main exposures were cannabis and tobacco use at age 15 assessed in clinic by computer-assisted questionnaire and serum cotinine. The main outcomes were performance in standardized assessments at 16 [Key Stage 4, General Certificate of Secondary Education (GCSE)] in English and mathematics (mean scores), completion of five or more assessments at grade C level or higher and leaving school having achieved no qualifications. Analyses were sequentially adjusted for multiple covariates using a hierarchical approach. Covariates considered were: maternal substance use (ever tobacco or cannabis use, alcohol use above recommended limits); life course socio-economic position (family occupational class, maternal education, family income); child sex; month and year of birth; child educational attainment prior to age 11 (Key Stage 2); child substance use (tobacco, alcohol and cannabis) prior to age 15 and child conduct disorder. In fully adjusted models both cannabis and tobacco use at age 15 were associated with subsequent adverse educational outcomes. In general, the dose-response effect seen was consistent across all educational outcomes assessed. Weekly cannabis use was associated negatively with English GCSE results [grade point difference (GPD), -5.93, 95% confidence interval (CI) = -8.34, -3.53] and with mathematics GCSE results (GPD, -6.91, 95% CI = -9.92, -3.89). Daily tobacco smoking was associated negatively with English GCSE (GPD, -11.90, 95% CI = -13.47, -10.33) and with mathematics GCSE (GPD, -16.72, 95% CI = -18.57, -14.86). The greatest attenuation of these effects was seen on adjustment for other substance use and conduct disorder. Following adjustment, tobacco appeared to have a consistently stronger effect than cannabis. Both cannabis and tobacco use in adolescence are associated strongly with subsequent adverse educational outcomes. Given the non-specific patterns of association seen and the attenuation of estimates on adjustment, it is possible that these effects arise through non-causal mechanisms, although a causal explanation cannot be discounted. © 2015 Society for the Study of Addiction. © 2014 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review

PubMed Central

Damiani, Gianfranco; Salvatori, Eleonora; Silvestrini, Giulia; Ivanova, Ivana; Bojovic, Luka; Iodice, Lanfranco; Ricciardi, Walter

2015-01-01

Purpose Cardiovascular diseases are the leading cause of death and disability worldwide. Among these diseases, heart failure (HF) and acute myocardial infarction (AMI) are the most common causes of hospitalization. Therefore, readmission for HF and AMI is receiving increasing attention. Several socioeconomic factors could affect readmissions in this target group, and thus, a systematic review was conducted to identify the effect of socioeconomic factors on the risk for readmission in people aged 65 years and older with HF or AMI. Methods The search was carried out by querying an electronic database and hand searching. Studies with an association between the risk for readmission and at least one socioeconomic factor in patients aged 65 years or older who are affected by HF or AMI were included. A quality assessment was conducted independently by two reviewers. The agreement was quantified by Cohen’s Kappa statistic. The outcomes of studies were categorized in the short-term and the long-term, according to the follow-up period of readmission. A positive association was reported if an increase in the risk for readmission among disadvantaged patients was found. A cumulative effect of socioeconomic factors was computed by considering the association for each study and the number of available studies. Results A total of eleven articles were included in the review. They were mainly published in the United States. All the articles analyzed patients who were hospitalized for HF, and four of them also analyzed patients with AMI. Seven studies (63.6%) were found for the short-term outcome, and four studies (36.4%) were found for the long-term outcome. For the short-term outcome, race/ethnicity and marital status showed a positive cumulative effect on the risk for readmission. Regarding the educational level of a patient, no effect was found. Conclusion Among the socioeconomic factors, mainly race/ethnicity and marital status affect the risk for readmission in elderly people with HF or AMI. Multidisciplinary hospital-based quality initiatives, disease management, and care transition programs are a priority for health care systems to achieve better coordination. PMID:25653510

Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review.

PubMed

Damiani, Gianfranco; Salvatori, Eleonora; Silvestrini, Giulia; Ivanova, Ivana; Bojovic, Luka; Iodice, Lanfranco; Ricciardi, Walter

2015-01-01

Cardiovascular diseases are the leading cause of death and disability worldwide. Among these diseases, heart failure (HF) and acute myocardial infarction (AMI) are the most common causes of hospitalization. Therefore, readmission for HF and AMI is receiving increasing attention. Several socioeconomic factors could affect readmissions in this target group, and thus, a systematic review was conducted to identify the effect of socioeconomic factors on the risk for readmission in people aged 65 years and older with HF or AMI. The search was carried out by querying an electronic database and hand searching. Studies with an association between the risk for readmission and at least one socioeconomic factor in patients aged 65 years or older who are affected by HF or AMI were included. A quality assessment was conducted independently by two reviewers. The agreement was quantified by Cohen's Kappa statistic. The outcomes of studies were categorized in the short-term and the long-term, according to the follow-up period of readmission. A positive association was reported if an increase in the risk for readmission among disadvantaged patients was found. A cumulative effect of socioeconomic factors was computed by considering the association for each study and the number of available studies. A total of eleven articles were included in the review. They were mainly published in the United States. All the articles analyzed patients who were hospitalized for HF, and four of them also analyzed patients with AMI. Seven studies (63.6%) were found for the short-term outcome, and four studies (36.4%) were found for the long-term outcome. For the short-term outcome, race/ethnicity and marital status showed a positive cumulative effect on the risk for readmission. Regarding the educational level of a patient, no effect was found. Among the socioeconomic factors, mainly race/ethnicity and marital status affect the risk for readmission in elderly people with HF or AMI. Multidisciplinary hospital-based quality initiatives, disease management, and care transition programs are a priority for health care systems to achieve better coordination.

Patellofemoral Arthroplasty: Current Concepts and Review of the Literature

PubMed Central

Pisanu, Gabriele; Rosso, Federica; Bertolo, Corrado; Dettoni, Federico; Blonna, Davide; Bonasia, Davide Edoardo; Rossi, Roberto

2017-01-01

Patellofemoral osteoarthritis (PFOA) can be associated with anterior knee pain, stiffness, and functional impairment. Some authors report that PFOA affects approximately 9% of patients older than 40 years with a greater prevalence in females. Etiology of PFOA is multifactorial and is related to the presence of abnormal stresses at the PF joint due to knee- and patient-related factors. The need for a joint preserving treatment by isolated replacement of the injured compartment of the knee led to the development of PF arthroplasty (PFA). When a correct PF replacement is performed, PFA preserves physiologic tibiofemoral joint, thus allowing patients for a rapid recovery with a high satisfaction. The outcomes for PFA are quite variable with a trend toward good to excellent results, mainly owing to the improvement in surgical techniques, patient selection, and implant design. The development of the second generation of PFA improved the outcomes, which is attributed to the different trochlear designs. Recently, encouraging results have been provided by the association of PFA and unicompartmental knee arthroplasty (UKA). In many studies, the main cause of PFA failure is progression of tibiofemoral OA. The aim of this brief review of literature is to summarize the clinical features, indications and contraindications, surgical techniques, complications, and outcomes of PFA. PMID:29270562

Verbal memory functioning moderates psychotherapy treatment response for PTSD-Related nightmares.

PubMed

Scott, J Cobb; Harb, Gerlinde; Brownlow, Janeese A; Greene, Jennifer; Gur, Ruben C; Ross, Richard J

2017-04-01

Posttraumatic stress disorder (PTSD) is associated with cognitive deficits in attention, executive control, and memory, although few studies have investigated the relevance of cognitive difficulties for treatment outcomes. We examined whether cognitive functioning and history of traumatic brain injury (TBI) were associated with response to cognitive-behavioral therapy (CBT) for PTSD-related sleep problems. In a randomized controlled trial of Imagery Rehearsal (IR) added to components of CBT for Insomnia (IR + cCBT-I) compared to cCBT-I alone for PTSD-related recurrent nightmares, 94 U.S. veterans completed a battery of cognitive tests. TBI was assessed via structured clinical interview. Mixed-effects models examined main effects of cognitive functioning and interactions with time on primary sleep and nightmare outcomes. Significant verbal immediate memory by time interactions were found for nightmare distress, nightmare frequency, and sleep quality, even after controlling for overall cognitive performance and depression. TBI exhibited main effects on outcomes but no interactions with time. Findings indicated that individuals with lower verbal memory performance were less likely to respond to treatment across two sleep interventions. Veterans with TBI displayed greater symptoms but no altered trajectories of treatment response. Together with prior literature, findings suggest that verbal memory functioning may be important to consider in PTSD treatment implementation. Published by Elsevier Ltd.

Outcome of Doctors Attending the European Society for Paediatric Endocrinology Winter Schools 2008-2014.

PubMed

Donaldson, Malcolm D C

2017-01-01

Since 1995, the European Society for Paediatric Endocrinology (ESPE) has hosted Winter School (WS), a 5-day interactive meeting of 25 trainees and 7 teachers designed to cover all main endocrine topics. The aim of the present study was to determine subsequent outcome in ex-WS "students." A questionnaire was sent in August 2016 to all ESPE WS participants between 2008 and 2014. Information was requested on job/training status at WS attendance and in 2016, and subsequent involvement with ESPE. Of 174 participants (144 women, 30 men) including 5 attending two WS, 129 (74.5%) responded. At the time of WS/2016 survey 58/3 participants were junior trainees, 38/21 senior trainees, and 33/101 consultants. One hundred and seventeen (90.6%) responders were still involved with endocrinology, 107 (82%) rating WS as having a strong/very strong influence on their careers. Following WS, 80/174 (46%) participants had attended at least one ESPE main meeting, 28 (16%) had been awarded ESPE fellowships, and 34 (19%) had become ESPE members. The great majority of WS participants responding to the questionnaire are still involved with endocrinology and rated WS as influential. This favourable outcome supports the continuing funding of WS and similar educational programmes. © 2017 S. Karger AG, Basel.

Story Immersion in a Health Videogame for Childhood Obesity Prevention.

PubMed

Lu, Amy Shirong; Thompson, Debbe; Baranowski, Janice; Buday, Richard; Baranowski, Tom

2012-02-15

Stories can serve as powerful tools for health interventions. Story immersion refers to the experience of being absorbed in a story. This is among the first studies to analyze story immersion's role in health videogames among children by addressing two main questions: Will children be more immersed when the main characters are similar to them? Do increased levels of immersion relate to more positive health outcomes? Eighty-seven 10-12-year-old African-American, Caucasian, and Hispanic children from Houston, TX, played a health videogame, "Escape from Diab" (Archimage, Houston, TX), featuring a protagonist with both African-American and Hispanic phenotypic features. Children's demographic information, immersion, and health outcomes (i.e., preference, motivation, and self-efficacy) were recorded and then correlated and analyzed. African-American and Hispanic participants reported higher immersion scores than Caucasian participants ( P = 0.01). Story immersion correlated positively ( P values < 0.03) with an increase in Fruit and Vegetable Preference ( r = 0.27), Intrinsic Motivation for Water ( r = 0.29), Vegetable Self-Efficacy ( r = 0.24), and Physical Activity Self-Efficacy ( r = 0.32). Ethnic similarity between videogame characters and players enhanced immersion and several health outcomes. Effectively embedding characters with similar phenotypic features to the target population in interactive health videogame narratives may be important when motivating children to adopt obesity prevention behaviors.

Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review.

PubMed

Franceschi, Francesco; Franceschetti, Edoardo; Torre, Guglielmo; Papalia, Rocco; Samuelsson, Kristian; Karlsson, Jón; Denaro, Vincenzo

2016-04-01

Tibiotalocalcaneal arthrodesis is aimed to block the ankle joint motion in cases of severe osteoarthritis, avascular necrosis of the talus and/or failure of arthroplasty operations. This systematic review was carried out to evaluate the clinical outcome after tibiotalocalcaneal arthrodesis using intramedullary nail either open and arthroscopically assisted. Focus was on the success rate of the procedure in terms of union and complications and on the comparison between the techniques. The databases PubMed (Medline), EMBASE and Cochrane Library were searched in order to retrieve relevant studies. All therapeutic level 1-4 studies involving humans with intramedullary nail fixation technique were included. Only studies written in English, Italian, French, Spanish and German were included. Data related to the type of surgery, complications and clinical outcomes were extracted and analysed. A total of 83 studies were identified, of which 32 studies were eligible for inclusion; 31 case series and one randomized controlled trial. The main reported outcome score was the American Orthopaedic Foot and Ankle Society scale. Almost, all the included studies reported higher than 50% union rates and a significant improvement in terms of the clinical and mechanical ankle function after treatment. Results suggest that satisfactory outcomes can be achieved by tibiotalocalcaneal arthrodesis using intramedullary nailing. Low complication rates contribute to make this a safe procedure. No comparison can be done between arthroscopic and open technique, due to the lack of scientific works on the first one. IV.

Neurolinguistic programming: a systematic review of the effects on health outcomes.

PubMed

Sturt, Jackie; Ali, Saima; Robertson, Wendy; Metcalfe, David; Grove, Amy; Bourne, Claire; Bridle, Chris

2012-11-01

Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. To evaluate the effects of NLP on health-related outcomes. Systematic review of experimental studies. The following data sources were searched: MEDLINE, PsycINFO, ASSIA, AMED, CINAHL, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4-20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain. There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes.

Neurolinguistic programming: a systematic review of the effects on health outcomes

PubMed Central

Sturt, Jackie; Ali, Saima; Robertson, Wendy; Metcalfe, David; Grove, Amy; Bourne, Claire; Bridle, Chris

2012-01-01

Background Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. Aim To evaluate the effects of NLP on health-related outcomes. Design and setting Systematic review of experimental studies. Method The following data sources were searched: MEDLINE®, PsycINFO, ASSIA, AMED, CINAHL®, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. Results Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4–20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain. Conclusion There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes. PMID:23211179

Correlational analysis and predictive validity of psychological constructs related with pain in fibromyalgia

PubMed Central

2011-01-01

Background Fibromyalgia (FM) is a prevalent and disabling disorder characterized by a history of widespread pain for at least three months. Pain is considered a complex experience in which affective and cognitive aspects are crucial for prognosis. The aim of this study is to assess the importance of pain-related psychological constructs on function and pain in patients with FM. Methods Design Multicentric, naturalistic, one-year follow-up study. Setting and study sample. Patients will be recruited from primary care health centres in the region of Aragon, Spain. Patients considered for inclusion are those aged 18-65 years, able to understand Spanish, who fulfil criteria for primary FM according to the American College of Rheumatology, with no previous psychological treatment. Measurements The variables measured will be the following: main variables (pain assessed with a visual analogue scale and with sphygmomanometer and general function assessed with Fibromyalgia Impact Questionnaire, and), psychological constructs (pain catastrophizing, pain acceptance, mental defeat, psychological inflexibility, perceived injustice, mindfulness, and positive and negative affect), and secondary variables (sociodemographic variables, anxiety and depression assessed with Hospital Anxiety and Depression Scale, and psychiatric interview assessed with MINI). Assessments will be carried at baseline and at one-year follow-up. Main outcome Pain Visual Analogue Scale. Analysis The existence of differences in socio-demographic, main outcome and other variables regarding pain-related psychological constructs will be analysed using Chi Square test for qualitative variables, or Student t test or variance analysis, respectively, for variables fulfilling the normality hypothesis. To assess the predictive value of pain-related psychological construct on main outcome variables at one-year follow-up, use will be made of a logistic regression analysis adjusted for socio-demographic and clinical variables. A Spearman Rho non-parametric correlation matrix will be developed to determine possible overlapping between pain-related psychological constructs. Discussion In recent years, the relevance of cognitive and affective aspects for the treatment of chronic pain, not only in FM but also in other chronic pain diseases, has been widely acknowledged. However, the relative importance of these psychological constructs, the relationship and possible overlapping between them, or the exact meaning of them in pain are not enough known. PMID:21214948

Application of WHO recommendations in outcome assessment of clinical series published in hand surgery journals with five years interval.

PubMed

Alarab, H; Dubert, T

2015-02-01

Outcome measurement is becoming increasingly important in hand surgery. The International classification of functioning, disability and health (ICF), is a WHO multi-dimensional approach to health condition including three domains: body "functions and structures", activities and participation. The aim of this study was to measure how often these three ICF domains were included in outcome measurements of the clinical series published in the American, European and French hand surgery journals. Our study included clinical series published in 2007 and 2012 in the American Journal Of Hand Surgery, European Journal Of Hand Surgery and Chirurgie de la Main. Analysis of each of these publications was done in two steps. First, we checked the presence or absence of the three domains of ICF in outcome measurement without considering the way it was measured. Then, we reported the use of evaluation instruments and/or quantitative measurement for each domain. We included 54 series in 2007 and 119 in 2012. The number of series reporting on the three domains and using at least one quantitative measurement for each domain represents 6% of articles in 2007 and 10% in 2012. This study shows that the quality of outcome measurement has improved over these 5 years, but remains poor according to the ICF recommendation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Intermediate and Long-term Outcomes of Mitomycin C-enhanced Trabeculectomy as a First Glaucoma Procedure in Uveitic Glaucoma.

PubMed

Almobarak, Faisal A; Alharbi, Ali H; Morales, Jose; Aljadaan, Ibrahim

2017-05-01

To evaluate the intermediate and long-term outcomes of mitomycin C-enhanced trabeculectomy as a first glaucoma procedure in uveitic glaucoma. Retrospective cohort study included 70 eyes of 50 patients with uveitic glaucoma who underwent mitomycin C-enhanced trabeculectomy as a first glaucoma procedure at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 1996 and 2014. The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the presence of visually threatening complications, and the need for further surgeries to control the IOP. Surgical outcome of each eye was classified as an absolute success, qualified success, or failure, based on the main outcome measures. The mean follow-up period was 77.0 months (±40.9). The IOP and number of antiglaucoma medications decreased significantly from a mean of 39.5 mm Hg (±8.9) and 3.7 (±0.8) to 14.4 mm Hg (±6.9) and 1 (±1.3) at the last follow-up, respectively (P<0.001 for both). The cumulative probabilities of success were 60% and 35.7% at 36 and 60 months postoperatively, respectively. The most common complications were cataract development and progression (45.3%), hypotony (IOP ≤5 mm Hg) (30%) and IOP spike≥30 mm Hg (10%). Eighteen eyes (25.7%) needed a second procedure to control the IOP. Although mitomycin C-enhanced trabeculectomy offers reasonable intermediate and long-term IOP control and safety in uveitic glaucoma, a significant number of patients needed further procedures to control the pressure. Thus, continuous monitoring of the pressure and inflammation are crucial.

Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease.

PubMed

van Hagen, Iris M; Baart, Sara; Fong Soe Khioe, Rebekah; Sliwa-Hahnle, Karen; Taha, Nasser; Lelonek, Malgorzata; Tavazzi, Luigi; Maggioni, Aldo Pietro; Johnson, Mark R; Maniadakis, Nikolaos; Fordham, Richard; Hall, Roger; Roos-Hesselink, Jolien W

2018-05-01

Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease. The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country). A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate. While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Impact of study outcome on submission and acceptance metrics for peer reviewed medical journals: six year retrospective review of all completed GlaxoSmithKline human drug research studies.

PubMed

Evoniuk, Gary; Mansi, Bernadette; DeCastro, Barbara; Sykes, Jennie

2017-04-21

Objectives  To determine whether the outcome of drug studies influenced submission and/or acceptance rates for publication in peer reviewed medical journals. Design  A six year retrospective review of publication status by study outcome for all human drug research studies conducted by a single industry sponsor (GlaxoSmithKline) that completed from 1 January 2009 to 30 June 2014 and were therefore due for manuscript submission (per the sponsor's policy) to peer reviewed journals within 18 months of study completion-that is, 31 December 2015. In addition, manuscripts from studies completing after 30 June 2014 were included irrespective of outcome if they were submitted before 31 December 2015. Setting  Studies conducted by a single industry sponsor (GlaxoSmithKline) Studies reviewed  1064 human drug research studies. Main outcome measures  All studies were assigned a publication status at 26 February 2016 including (as applicable): study completion date, date of first primary manuscript submission, number of submissions, journal decision(s), and publication date. All studies were also classified with assessors blinded to publication status as "positive" (perceived favorable outcome for the drug under study), "negative" (perceived unfavorable outcome for the drug under study), mixed, or non-comparative based on the presence and outcome of the primary outcome measure(s) for each study. "Negative" studies included safety studies in which the primary outcome was achieved but was adverse for the drug under study. For the total cohort and each of the four study outcomes, measures included descriptive statistics for study phase, time from study completion to submission and publication, and number and outcome (accepted/rejected) of publication submissions. Results  Of the 1064 studies (phase I-IV, interventional and non-interventional) included, 321 had study outcomes classified as positive, 155 as negative, 52 as mixed, and 536 as non-comparative. At the time of publication cut-off date (26 February 2016), 904 (85%) studies had been submitted for publication as full manuscripts and 751 (71%) had been successfully published or accepted, with 100 (9%) still under journal review. An additional 77 (7%) studies were conference abstracts and were not included in submission or publication rates. Submission rates by study outcome were 79% for the 321 studies with positive outcomes, 92% for the 155 with negative outcomes, 94% for the 52 with mixed outcomes, and 85% for the 536 non-comparative studies; while rates of publication at the cut-off date were 66%, 77%, 77%, and 71%, respectively. Median time from study completion to submission was 537 days (interquartile range 396-638 days) and 823 days (650-1063 days) from completion to publication, with similar times observed across study outcomes. First time acceptance rates were 56% for studies with positive outcomes and 48% for studies with negative outcomes. Over 10% of studies across all categories required three or more submissions to achieve successful publication. At the time of analysis, 83 studies had not been submitted for publication, including 49 bioequivalence studies with positive outcomes and 33 non-comparative studies. Most studies (98%, 1041/1064) had results posted to one or more public registers, including all studies subject to FDAAA (Food and Drug Administration Amendments Act) requirements for posting to www.clinicaltrials.gov Conclusions  Over the period studied, there was no evidence of submission or publication bias: 92% of studies with negative outcomes were submitted for publication by the cut-off date versus 79% of those with positive outcomes. Publication rates were slightly higher for studies with a negative (that is, unfavorable) outcome compared with a positive outcome, despite a slightly lower rate of acceptance at first submission. Many studies required multiple submission attempts before they were accepted for publication. Analyses focusing solely on publication rates do not take into account unsuccessful efforts to publish. Sponsors and journal editors should share similar information to contribute to better understanding of issues and barriers to full transparency. 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.

Multiple thrombophilic single nucleotide polymorphisms lack a significant effect on outcomes in fresh IVF cycles: an analysis of 1717 patients.

PubMed

Patounakis, George; Bergh, Eric; Forman, Eric J; Tao, Xin; Lonczak, Agnieszka; Franasiak, Jason M; Treff, Nathan; Scott, Richard T

2016-01-01

The aim of the study is to determine if thrombophilic single nucleotide polymorphisms (SNPs) affect outcomes in fresh in vitro fertilization (IVF) cycles in a large general infertility population. A prospective cohort analysis was performed at a university-affiliated private IVF center of female patients undergoing fresh non-donor IVF cycles. The effect of the following thrombophilic SNPs on IVF outcomes were explored: factor V (Leiden and H1299R), prothrombin (G20210A), factor XIII (V34L), β-fibrinogen (-455G → A), plasminogen activator inhibitor-1 (4G/5G), human platelet antigen-1 (a/b9L33P), and methylenetetrahydrofolate reductase (C677T and A1298C). The main outcome measures included positive pregnancy test, clinical pregnancy, embryo implantation, live birth, and pregnancy loss. Patients (1717) were enrolled in the study, and a total of 4169 embryos were transferred. There were no statistically significant differences in positive pregnancy test, clinical pregnancy, embryo implantation, live birth, or pregnancy loss in the analysis of 1717 patients attempting their first cycle of IVF. Receiver operator characteristics and logistic regression analyses showed that outcomes cannot be predicted by the cumulative number of thrombophilic mutations present in the patient. Individual and cumulative thrombophilic SNPs do not affect IVF outcomes. Therefore, initial screening for these SNPs is not indicated.

Cataract: trends in surgical procedures and visual outcomes; a study in a tertiary care hospital.

PubMed

Naeem, Mohammad; Khan, Ayasha; Khan, Muhammad Zia-ul-Islam; Adil, Muhammad; Abbas, Syed Hussain; Khan, Muhammad Usman; Naz, Syeda Maria

2012-03-01

To determine the current procedures in practice and visual outcome following a cataract surgery. The study was conducted from January 7 to April 7, 2011 in the Eye Unit of the Lady Reading Hospital, Peshawar, involving 181 patients. Basic demographics of the patients as well as the type of cataract surgery were noted. Risk factors like diabetes mellitus and glaucoma were also noted for each patient. A pre-operative visual acuity was determined. The patient was examined after two months to determine the visual improvement. Out of 181 patients, 117 were males and 64 were females. Age ranged from 5 years to 83 years with a median age of 60. Most common procedure performed (60.2%) was extra capsular cataract extraction with posterior chamber intraocular lense (ECCE), followed by Phacoemulsification (24.3%). Visual outcome was good in 88.3%, borderline in 8.3% and poor in 3.3% patients. The main reasons for poor visual outcomes were diabetic retinopathy 42.8%, glaucoma-related vision loss 19.0%, history of trauma with retinal detachment 9.5%, and age-related macular degeneration 9.5%. Poor visual outcome was found in diabetic and Glaucoma patients. Surgical complications (3.8%) were rare. Overall a good visual outcome was noted in cataract surgery, which was similar to World Health Organisation guidelines. Extra capsular cataract extraction was the most common procedure followed by Phacoemulsification.

Achievement for All: improving psychosocial outcomes for students with special educational needs and disabilities.

PubMed

Humphrey, Neil; Lendrum, Ann; Barlow, Alexandra; Wigelsworth, Michael; Squires, Garry

2013-04-01

Students with special educational needs and disabilities (SEND) are at a greatly increased risk of experiencing poor psychosocial outcomes. Developing effective interventions that address the cause of these outcomes has therefore become a major policy priority in recent years. We report on a national evaluation of the Achievement for All (AfA) programme that was designed to improve outcomes for students with SEND through: (1) academic assessment, tracking and intervention, (2) structured conversations with parents, and (3) developing provision to improve wider outcomes (e.g. positive relationships). Using a quasi-experimental, pre-test-post-test control group design, we assessed the impact of AfA on teacher ratings of the behaviour problems, positive relationships and bullying of students with SEND over an 18-month period. Participants were 4758 students with SEND drawn from 323 schools across England. Our main impact analysis demonstrated that AfA had a significant impact on all three response variables when compared to usual practice. Hierarchical linear modelling of data from the intervention group highlighted a range of school-level contextual factors and implementation activities and student-level individual differences that moderated the impact of AfA on our study outcomes. The implications of our findings are discussed, and study strengths and limitations are noted. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Relationship between LAAM-methadone preference and treatment outcomes.

PubMed

White, Jason M; Danz, Cath; Kneebone, Joanne; La Vincente, Sophie F; Newcombe, David A L; Ali, Robert L

2002-05-01

Studies of relative LAAM-methadone preference have indicated that a significant proportion of patients prefer levo-alpha-acetylmethadol (LAAM). The present study was designed to determine whether this preference is associated with better treatment outcomes. Sixty-two stable methadone patients participated in a randomised crossover clinical trial. They received LAAM (alternate days) and methadone (daily) for 3 months each, followed by a further 6-month period during which they were free to choose between the drugs. LAAM maintenance was associated with a lower rate of heroin use than methadone maintenance based on analysis of morphine concentration in hair and equivalent health outcomes. The majority of subjects showed a preference for LAAM (n=27, 69.2%) rather than methadone (n=12, 30.8%). The main reasons given for the LAAM preference were that it produced less withdrawal (39.3%), fewer side effects (28.5%), less craving for heroin (17.9%), and entailed fewer pick-up days (14.3%). Those who chose LAAM had lower levels of heroin use during LAAM maintenance, significantly better outcomes on two sub-scales of the SF-36 (Vitality and Mental Health), and reported that they felt more normal and that they were 'held' better when on LAAM. For those who chose methadone, there were no differences in outcomes between the LAAM and methadone maintenance periods. Preference for LAAM is associated with treatment outcomes as good or better than those with methadone.

Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): A SEC/SECTCV Consensus Position Paper.

PubMed

López-Sendón, José; González-Juanatey, José Ramón; Pinto, Fausto; Cuenca Castillo, José; Badimón, Lina; Dalmau, Regina; González Torrecilla, Esteban; López-Mínguez, José Ramón; Maceira, Alicia M; Pascual-Figal, Domingo; Pomar Moya-Prats, José Luis; Sionis, Alessandro; Zamorano, José Luis

2015-11-01

Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Design and validation of instruments to measure knowledge.

PubMed

Elliott, T E; Regal, R R; Elliott, B A; Renier, C M

2001-01-01

Measuring health care providers' learning after they have participated in educational interventions that use experimental designs requires valid, reliable, and practical instruments. A literature review was conducted. In addition, experience gained from designing and validating instruments for measuring the effect of an educational intervention informed this process. The eight main steps for designing, validating, and testing the reliability of instruments for measuring learning outcomes are presented. The key considerations and rationale for this process are discussed. Methods for critiquing and adapting existent instruments and creating new ones are offered. This study may help other investigators in developing valid, reliable, and practical instruments for measuring the outcomes of educational activities.

Predictors of employment status of treated patients with DSM-III-R diagnosis. Can logistic regression model find a solution?

PubMed

Daradkeh, T K; Karim, L

1994-01-01

To investigate the predictors of employment status of patients with DSM-III-R diagnosis, 55 patients were selected by a simple random technique from the main psychiatric clinic in Al Ain, United Arab Emirates. Structured and formal assessments were carried out to extract the potential predictors of outcome of schizophrenia. Logistic regression model revealed that being married, absence of schizoid personality, free or with minimum symptoms of the illness, later age of onset, and higher educational attainment were the most significant predictors of employment outcome. The implications of the results of this study are discussed in the text.

Lorre cluster: an outcome of recent asteroid collision

NASA Astrophysics Data System (ADS)

Novakovic, B.; Dell'Oro, A.; Cellino, A.; Knezevic, Z.

2012-09-01

Here we show an example of a young asteroid cluster located in a dynamically stable region, which was produced by partial disruption of a primitive body about 30 km in size. According to our estimation it is only 1.9±0.3 Myr old, thus its post-impact evolution is very limited. The parent body had a large orbital inclination, and was subject to collisions with typical impact speeds higher by a factor of 2 than in the most common situations encountered in the main belt. For the first time we have at disposal the observable outcome of a very recent event to study high-speed collisions involving primitive asteroids.

Teachers as Secondary Players: Involvement in Field Trips to Natural Environments

NASA Astrophysics Data System (ADS)

Alon, Nirit Lavie; Tal, Tali

2017-08-01

This study focused on field trips to natural environments where the teacher plays a secondary role alongside a professional guide. We investigated teachers' and field trip guides' views of the teacher's role, the teacher's actual function on the field trip, and the relationship between them. We observed field trips, interviewed teachers and guides, and administered questionnaires. We found different levels of teacher involvement, ranging from mainly supervising and giving technical help, to high involvement especially in the cognitive domain and sometimes in the social domain. Analysis of students' self-reported outcomes showed that the more students believe their teachers are involved, the higher the self-reported learning outcomes.

Making sense of global warming: Norwegians appropriating knowledge of anthropogenic climate change.

PubMed

Ryghaug, Marianne; Sørensen, Knut Holtan; Naess, Robert

2011-11-01

This paper studies how people reason about and make sense of human-made global warming, based on ten focus group interviews with Norwegian citizens. It shows that the domestication of climate science knowledge was shaped through five sense-making devices: news media coverage of changes in nature, particularly the weather, the coverage of presumed experts' disagreement about global warming, critical attitudes towards media, observations of political inaction, and considerations with respect to everyday life. These sense-making devices allowed for ambiguous outcomes, and the paper argues four main outcomes with respect to the domestication processes: the acceptors, the tempered acceptors, the uncertain and the sceptics.

Rotational Spectroscopy of Reactive Species at the Center for Astrochemical Studies.

NASA Astrophysics Data System (ADS)

Lattanzi, Valerio; Spezzano, Silvia; Caselli, Paola

2017-06-01

The Center for Astrochemical Studies at the Max Planck Institute for Extraterrestrial Physics in Garching, is a recently established group which collects scientists with very diverse backgrounds. In the same group observers, theoreticians, chemists and molecular astrophysicists join their efforts with the ultimate goal of properly interpreting observations with the new generation telescopes and unveiling our astrochemical/physical heritage. Among these tasks, the gas-phase spectroscopic characterisation of molecular species of astrophysical relevance is one of the main goals of the laboratory sub-group. This talk will mainly focus on the first experiment built in our center, the CASAC (CAS Absorption Cell) spectrometer: this experiment has been optimised on the production and probe of small molecular ions and radicals. The main laboratory techniques along with the more prominent outcomes of recent studies will be presented. Finally, a brief update on the status of the other instruments available in our center will be given, including their planned upgrades.

Fat and neurosurgery: does obesity affect outcome after intracranial surgery?

PubMed

Schultheiss, Kim E; Jang, Yeon Gyoe; Yanowitch, Rachel N; Tolentino, Jocelyn; Curry, Daniel J; Lüders, Jürgen; Asgarzadie-Gadim, Farbod; Macdonald, R Loch

2009-02-01

Obesity has been linked to increased morbidity and mortality after some surgical procedures. The purpose of this study was to determine whether obesity affects outcome after general neurosurgery and subarachnoid hemorrhage (SAH). Three data sets were analyzed, including a retrospective review of 404 patients undergoing cranial and spinal neurosurgical procedures, a prospective collection of 100 patients with aneurysmal SAH, and data from 3567 patients with aneurysmal SAH who were entered into randomized clinical trials of tirilazad. For each data set, outcome was assessed by mortality, postoperative morbidity, and Glasgow Outcome Scale score. Prognostic factors, including body weight and body mass index, were tested for their effect on these outcomes using multivariable logistic regression. For patients undergoing general cranial and spinal neurosurgery, independent predictors of morbidity and mortality were age, American Society of Anesthesia class, disseminated malignancy, emergency surgery, and increased duration of surgery. For patients with SAH, score on the Glasgow Outcome Scale was associated with age and admission Glasgow Coma Scale score. In the tirilazad data set, multiple factors were associated with score on the Glasgow Outcome Scale, but, as with the other 2 data sets, body weight had no relationship to outcome. Obesity may have less effect on the outcome of patients with mainly cranial neurosurgical disease and aneurysmal SAH than it does on patients undergoing other types of surgery.

Heart-lung transplantation: pediatric indications and outcomes

PubMed Central

2014-01-01

As indications for heart-lung transplant (HLT) have changed to some degree in the past 30 years, this treatment is being used less frequently in children due to more advanced care of severe heart and lung disease. This is fortunate as the outcomes for HLT are poor compared to other solid organ transplants and this is mainly due to the poorer outcome of the lung graft. PMID:25132980

Children who screen positive for autism at 2.5 years and receive early intervention: a prospective naturalistic 2-year outcome study

PubMed Central

Spjut Jansson, Birgitta; Miniscalco, Carmela; Westerlund, Joakim; Kantzer, Anne-Katrin; Fernell, Elisabeth; Gillberg, Christopher

2016-01-01

Background Previous research has stressed the importance of early identification and intervention for children with autism spectrum disorders. Methods Children who had screened positive for autism at the age of 2.5 years in a general population screening and then received a diagnosis of autism spectrum disorder were enrolled in an intervention program provided by Swedish habilitation services. The following interventions were available: a comprehensive intervention based on Applied Behavior Analysis – Intensive Learning (IL) – in two settings, which included home- and preschool-based (IL Regular) and only home-based (IL Modified) and eclectic interventions. Results There was considerable variability in terms of outcome, but intervention group status was not associated with any of the chosen outcome variables. Conclusion The main finding was that the type of intervention was not critical for outcome of adaptive or global functioning. The variability in outcome demonstrates the need for continuous assessments and evaluation of the child’s function and behavior throughout the intervention period. PMID:27621636

Outcome prediction in home- and community-based brain injury rehabilitation using the Mayo-Portland Adaptability Inventory.

PubMed

Malec, James F; Parrot, Devan; Altman, Irwin M; Swick, Shannon

2015-01-01

The objective of the study was to develop statistical formulas to predict levels of community participation on discharge from post-hospital brain injury rehabilitation using retrospective data analysis. Data were collected from seven geographically distinct programmes in a home- and community-based brain injury rehabilitation provider network. Participants were 642 individuals with post-traumatic brain injury. Interventions consisted of home- and community-based brain injury rehabilitation. The main outcome measure was the Mayo-Portland Adaptability Inventory (MPAI-4) Participation Index. Linear discriminant models using admission MPAI-4 Participation Index score and log chronicity correctly predicted excellent (no to minimal participation limitations), very good (very mild participation limitations), good (mild participation limitations), and limited (significant participation limitations) outcome levels at discharge. Predicting broad outcome categories for post-hospital rehabilitation programmes based on admission assessment data appears feasible and valid. Equations to provide patients and families with probability statements on admission about expected levels of outcome are provided. It is unknown to what degree these prediction equations can be reliably applied and valid in other settings.

Implementation of a cardiac PET stress program: comparison of outcomes to the preceding SPECT era.

PubMed

Knight, Stacey; Min, David B; Le, Viet T; Meredith, Kent G; Dhar, Ritesh; Biswas, Santanu; Jensen, Kurt R; Mason, Steven M; Ethington, Jon-David; Lappe, Donald L; Muhlestein, Joseph B; Anderson, Jeffrey L; Knowlton, Kirk U

2018-05-03

Cardiac positron emission testing (PET) is more accurate than single photon emission computed tomography (SPECT) at identifying coronary artery disease (CAD); however, the 2 modalities have not been thoroughly compared in a real-world setting. We conducted a retrospective analysis of 60-day catheterization outcomes and 1-year major adverse cardiovascular events (MACE) after the transition from a SPECT- to a PET-based myocardial perfusion imaging (MPI) program. MPI patients at Intermountain Medical Center from January 2011-December 2012 (the SPECT era, n = 6,777) and January 2014-December 2015 (the PET era, n = 7,817) were studied. Outcomes studied were 60-day coronary angiography, high-grade obstructive CAD, left main/severe 3-vessel disease, revascularization, and 1-year MACE-revascularization (MACE-revasc; death, myocardial infarction [MI], or revascularization >60 days). Patients were 64 ± 13 years old; 54% were male and 90% were of European descent; and 57% represented a screening population (no prior MI, revascularization, or CAD). During the PET era, compared with the SPECT era, a higher percentage of patients underwent coronary angiography (13.2% vs. 9.7%, P < 0.0001), had high-grade obstructive CAD (10.5% vs. 6.9%, P < 0.0001), had left main or severe 3-vessel disease (3.0% vs. 2.3%, P = 0.012), and had coronary revascularization (56.7% vs. 47.1%, P = 0.0001). Similar catheterization outcomes were seen when restricted to the screening population. There was no difference in 1-year MACE-revasc (PET [5.8%] vs. SPECT [5.3%], P = 0.31). The PET-based MPI program resulted in improved identification of patients with high-grade obstructive CAD, as well as a larger percentage of revascularization, thus resulting in fewer patients undergoing coronary angiography without revascularization. This observational study was funded using internal departmental funds.

Treatment patterns and outcomes in the prophylaxis of chemotherapy-induced (febrile) neutropenia with biosimilar filgrastim (the MONITOR-GCSF study).

PubMed

Gascón, Pere; Aapro, Matti; Ludwig, Heinz; Bokemeyer, Carsten; Boccadoro, Mario; Turner, Matthew; Denhaerynck, Kris; MacDonald, Karen; Abraham, Ivo

2016-02-01

The purpose of this study is to examine the real-world treatment patterns and outcomes of chemotherapy-induced (febrile) neutropenia (chemotherapy-induced (CIN)/febrile neutropenia (FN)) prophylaxis with biosimilar filgrastim (Zarzio®). MONITOR-GCSF is an international (12 countries), multi-center (140), prospective (max. six cycles), observational, open-label, pharmaco-epidemiologic study of cancer patients (n = 1447) treated with myelosuppressive chemotherapy across a total of 6,213 cycles and receiving prophylaxis with Zarzio®. Data were analyzed using both the patient and cycle as unit of analysis. Most (72.3 %) received primary prophylaxis; dosed mainly (53.2 %) at 30 MIU but differentiated by weight, chemotoxicity, and tumor type; and mainly (53.2 %) initiated in the 24-72h post-chemotherapy window but differentiated by prophylaxis type, tumor type, and chemotoxicity and for modal/median duration of 5 days. Relative to European Organisation for Research and Treatment of Cancer (EORTC) guidelines, 56.6 % were correctly prophylacted, 17.4 % under-prophylacted, and 26.0 % over-prophylacted. The following incidence rates were recorded: CIN grade 4 13.2 % of patients and 3.9 % of cycles, FN 5.9 % of patients and 1.4 % of cycles, CIN/FN-related hospitalizations 6.1 % of patients and 1.5 % of cycles, CIN/FN-related chemotherapy disturbances 9.5 % of patients and 2.8 % of cycles, and composite outcomes index 22.3 % of patients and 6.7 % of cycles. Rates varied by type of prophylaxis and tumor, chemotoxicity, initiation day, and prophylaxis duration. There were 1834 musculoskeletal events with 24.7 % of patients reporting bone pain of any grade (mostly mild to moderate), and 148 adverse drug reactions, including 4 serious, were recorded in 76 patients. The clinical and safety outcomes are well within the range of historically reported data for originator filgrastim underscoring the clinical effectiveness and safety of biosimilar filgrastim in daily clinical practice.

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.

Psychological distress and in vitro fertilization outcome

PubMed Central

Pasch, Lauri A.; Gregorich, Steven E.; Katz, Patricia K.; Millstein, Susan G.; Nachtigall, Robert D.; Bleil, Maria E.; Adler, Nancy E.

2016-01-01

Objective To examine whether psychological distress predicts IVF treatment outcome as well as whether IVF treatment outcome predicts subsequent psychological distress. Design Prospective cohort study over an 18-month period. Setting Five community and academic fertility practices. Patients Two hundred and two women who initiated their first IVF cycle. Interventions Women completed interviews and questionnaires at baseline and at 4, 10, and 18 months follow-up. Main Outcome Measures IVF cycle outcome and psychological distress. Results Using a binary logistic model including covariates (woman’s age, ethnicity, income, education, parity, duration of infertility, and time interval), pre-treatment depression and anxiety were not significant predictors of the outcome of the first IVF cycle. Using linear regression models including covariates (woman’s age, income, education, parity, duration of infertility, assessment point, time since last treatment cycle, and pre-IVF depression or anxiety), experiencing failed IVF was associated with higher post-IVF depression and anxiety. Conclusions IVF failure predicts subsequent psychological distress, but pre-IVF psychological distress does not predict IVF failure. Instead of focusing efforts on psychological interventions specifically aimed at improving the chance of pregnancy, these findings suggest that attention be paid to helping patients prepare for and cope with treatment and treatment failure. PMID:22698636

Factors affecting the visual outcome in hyphema management in Guinness Eye Center Onitsha.

PubMed

Onyekwe, L O

2008-12-01

This study aims of determining the complications, outcome of hyphema treatment and recommend ways of enhancing good visual outcome. The records of all cases of hyphema seen from 1st January 2001 to 31st December 2005 were reviewed retrospectively. The variables analyzed were the biodata of all the patients, the agents causing hyphema, associated injuries and complications. Visual acuity at presentation, discharge and last visit was analyzed. Seventy four patients that had hyphema were reviewed. The male:female ratio was 3.5:1. Trauma was predominantly main cause of hyphema. The common agents of injury include whip (23.2%) and fist (18.8%). The common complications were secondary glaucoma (52.5%), corneal siderosis (30.0%) and rebleeding (10%). Visual outcome is related to time ofpresentation, complications and treatment. Significant improvement was achieved following treatment. Hyphema is a common complication of eye injuries. It is commonly associated with other eye injuries like vitreous haemorrhage and cataract. Common complications include secondary glaucoma, corneal siderosis and rebleeding. Visual outcome is dependent on time of presentation, severity and nature of complications. Visual outcome can be improved by early presentation and detection of complications and appropriate treatment.

Transition to work: Perspectives from the autism spectrum.

PubMed

Hedley, Darren; Cai, Ru; Uljarevic, Mirko; Wilmot, Mathilda; Spoor, Jennifer R; Richdale, Amanda; Dissanayake, Cheryl

2017-03-01

To improve employment outcomes for adults with autism spectrum disorder, it is necessary to identify factors associated with successful transition to work from the perspectives of the individual and from those who work with or support them. This study involved focus groups with adults with autism spectrum disorder ( n = 9) participating in a 3-year employment and training programme, as well as focus groups with family members ( n = 6), support staff ( n = 7) and co-workers ( n = 6). The aim was to gain better understanding of the experience of transition to work, barriers and also the factors that promote workplace success. Main themes included factors that facilitated success at work ( Enablers), barriers to success ( Challenges) and programme outcomes ( Outcomes). Organisation support, advice from co-workers, supportive leadership, allowance of environmental modifications and presence of a consultant were identified as enablers that most facilitated success at work. Challenges included task-related difficulties, individual factors, social difficulties and distractibility, not managing work-related stress, and being perceived to be too frank. Outcomes were rated as positive and encompassed work-related outcomes, as well as outcomes related to sense of purpose, achieving personal independence and improvements in social relationships, both with work colleagues and within families.

Computer-assisted cognitive remediation therapy: cognition, self-esteem and quality of life in schizophrenia.

PubMed

Garrido, Gemma; Barrios, Maite; Penadés, Rafael; Enríquez, Maria; Garolera, Maite; Aragay, Núria; Pajares, Marta; Vallès, Vicenç; Delgado, Luis; Alberni, Joan; Faixa, Carlota; Vendrell, Josep M

2013-11-01

Quality of life (QoL) is an important outcome in the treatment of schizophrenia. Cognitive deficits have an impact on functional outcomes. Cognitive remediation therapy is emerging as a psychological intervention that targets cognitive impairment, but the effect of computer-assisted cognitive remediation on neuropsychology and social functioning and wellbeing remains unclear. The aim of the current study is to investigate the neurocognitive outcomes of computer-assisted cognitive remediation (CACR) therapy in a sample of schizophrenia patients, and to measure the quality of life and self-esteem as secondary outcomes. Sixty-seven people with schizophrenia were randomly assigned to computer-assisted cognitive remediation or an active control condition. The main outcomes were neuropsychological measures and secondary outcomes (self-esteem and quality of life). Measurements were recorded at baseline and post-treatment. The CACR therapy group improved in speed of processing, working memory and reasoning and problem-solving cognitive domains. QoL and self-esteem measures also showed significant improvements over time in this group. Computer-assisted cognitive remediation therapy for people with schizophrenia achieved improvements in neuropsychological performance and in QoL and self-esteem measurements. © 2013 Elsevier B.V. All rights reserved.

Pregnancy outcome after induction of labor in women with previous cesarean section.

PubMed

Ashwal, Eran; Hiersch, Liran; Melamed, Nir; Ben-Zion, Maya; Brezovsky, Alex; Wiznitzer, Arnon; Yogev, Yariv

2015-03-01

As conflicting data exist concerning the safety of induction of labor (IoL) in women with previous single lower segment cesarean section (CS), we aimed to assess pregnancy outcome following IoL in such patient population. All singleton pregnancies with previous single CS which underwent IoL during 2008-2012 were included (study group). Their pregnancy outcome was compared to those pregnancies with previous single CS that admitted with spontaneous onset of labor (control group). Overall, 1898 pregnancies were eligible, of them, 259 underwent IoL, and 1639 were admitted with spontaneous onset of labor. Parity, gestational age at delivery and birthweight were similar. Women in the study group were more likely to undergo CS mainly due to labor dystocia (8.1 versus 3.7%, p < 0.01). The rate of CS due to non-reassuring fetal heart rate was similar. No difference was found in the rate of uterine rupture/dehiscence. Short-term neonatal outcome was similar between the groups. On multivariable logistic regression analysis, IoL was not independently associated with uterine rupture (OR 1.33, 95% C.I 0.46-3.84, p = 0.59). Our data suggest that IoL in women with one previous low segment CS neither increases the risk of uterine rupture nor adversely affects immediate neonatal outcome.

The effect of increasing the supply of skilled health providers on pregnancy and birth outcomes: evidence from the midwives service scheme in Nigeria.

PubMed

Okeke, Edward; Glick, Peter; Chari, Amalavoyal; Abubakar, Isa Sadeeq; Pitchforth, Emma; Exley, Josephine; Bashir, Usman; Gu, Kun; Onwujekwe, Obinna

2016-08-23

Limited availability of skilled health providers in developing countries is thought to be an important barrier to achieving maternal and child health-related MDG goals. Little is known, however, about the extent to which scaling-up supply of health providers will lead to improved pregnancy and birth outcomes. We study the effects of the Midwives Service Scheme (MSS), a public sector program in Nigeria that increased the supply of skilled midwives in rural communities on pregnancy and birth outcomes. We surveyed 7,104 women with a birth within the preceding five years across 12 states in Nigeria and compared changes in birth outcomes in MSS communities to changes in non-MSS communities over the same period. The main measured effect of the scheme was a 7.3-percentage point increase in antenatal care use in program clinics and a 5-percentage point increase in overall use of antenatal care, both within the first year of the program. We found no statistically significant effect of the scheme on skilled birth attendance or on maternal delivery complications. This study highlights the complexity of improving maternal and child health outcomes in developing countries, and shows that scaling up supply of midwives may not be sufficient on its own.

Bacterial meningitis in alcoholic patients: A population-based prospective study.

PubMed

van Veen, Kiril E B; Brouwer, Matthijs C; van der Ende, Arie; van de Beek, Diederik

2017-04-01

To study clinical features and outcome of community-acquired bacterial meningitis in alcoholic patients. Patients with a history of alcoholism were selected from our nationwide, prospective cohort on community-acquired bacterial meningitis performed from March 2006 to October 2014. Data on patient history, symptoms and signs on admission, treatment, and outcome were prospectively collected. Of 1359 included episodes, 88 episodes (6%) occurred in 88 alcoholic patients. Seizures as presenting symptom were present in 18% alcoholic patients, and 23% presented with co-existing pneumonia. Causative organisms were Streptococcus pneumoniae in 76%, Listeria monocytogenes in 8%, and Neisseria meningitidis in 6% of patients. A high rate of systemic complications occurred with respiratory failure in 40% and endocarditis in 9% of patients. Outcome was unfavorable in 58% of alcoholic patients, and 25% died. Alcoholism was associated with unfavorable outcome in a multivariate analysis (OR 1.96; 95% CI 1.12-3.46; P = 0.019), but not with death (OR 0.76; 95% CI 0.35-1.68; P = 0.762). Alcoholic bacterial meningitis patients often have an unfavorable outcome, which appears to result from a high rate of systemic complications, mainly respiratory failure. Seizures are common in alcoholic patients and warrant caution of development of an alcohol withdrawal syndrome. Copyright © 2017. Published by Elsevier Ltd.

Design and rationale for a randomised comparison of everolimus-eluting stents and coronary artery bypass graft surgery in selected patients with left main coronary artery disease: the EXCEL trial.

PubMed

Kappetein, Arie Pieter; Serruys, Patrick W; Sabik, Joseph F; Leon, Martin B; Taggart, David P; Morice, Marie-Claude; Gersh, Bernard J; Pocock, Stuart J; Cohen, David J; Wallentin, Lars; Ben-Yehuda, Ori; van Es, Gerrit-Anne; Simonton, Charles A; Stone, Gregg W

2016-09-18

Coronary artery bypass graft (CABG) surgery is the standard of care for revascularisation of patients with left main coronary artery disease (LMCAD). Recent studies have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may provide comparable outcomes in selected patients with LMCAD without extensive CAD. We therefore designed a trial to investigate whether PCI with XIENCE cobalt-chromium everolimus-eluting stents (CoCr-EES) would result in non-inferior or superior clinical outcomes to CABG in selected patients with LMCAD. The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial is a prospective, open-label, multicentre, international study of 1,900 randomised subjects. Patients with significant LMCAD with a SYNTAX score ≤32 and local Heart Team consensus that the subject is appropriate for revascularisation by both PCI and CABG are consented and randomised 1:1 to undergo PCI using CoCr-EES or CABG. All patients undergo follow-up for five years. The primary endpoint is the three-year composite rate of death, stroke or myocardial infarction, assessed at a median follow-up of at least three years (with at least two-year follow-up in all patients), powered for sequential non-inferiority and superiority testing. The EXCEL study will define the contemporary roles of CABG and PCI using XIENCE CoCr-EES in patients with LMCAD disease with low and intermediate SYNTAX scores.

The role of a behavioural medicine intervention in physiotherapy for the effects of rehabilitation outcomes in exercise-based cardiac rehabilitation (ECRA) - the study protocol of a randomised, controlled trial.

PubMed

Borg, Sabina; Öberg, Birgitta; Nilsson, Lennart; Söderlund, Anne; Bäck, Maria

2017-05-25

To help patients with coronary artery disease (CAD) benefit from the positive health effects attained by exercise-based cardiac rehabilitation (CR), adherence to these programmes according to international guidelines is important. Strategies to increase adherence to exercise-based CR are mainly an unexplored area. The objective of this study is to investigate the effects of a behavioural medicine intervention in physiotherapy, containing goal-setting, self-monitoring and feedback, with the aim of improving rehabilitation outcomes for exercise-based CR, compared with usual care. This is a randomised, controlled trial. A total of 160 patients with CAD will be included consecutively at the Coronary Care Unit at a university hospital in Sweden. Patients are randomised 1:1 using sealed envelopes to usual care or a behavioural medicine intervention in physiotherapy, in addition to usual care for 4 months. Outcome assessment at baseline, 4 and 12 months includes submaximal aerobic capacity (primary outcome), exercise adherence, muscle endurance, level of physical activity, biomarkers, anxiety and depression, health-related quality of life, patient enablement and self-efficacy (secondary outcomes). This is the first study to evaluate the role of an integrated behavioural medicine intervention in exercise-based CR in the effects of rehabilitation outcomes. The results of this study will provide valuable information about the effect of these interventions in exercise-based CR and it has the potential to inform and assist in further treatment in secondary prevention for patients with CAD. The study include all items from the World Health Organization Trial Registration Data Set. NCT02895451, 2016-08-16, retrospectively registered.

Outcome expectations and use of smokeless tobacco (snus): a cross-sectional study among young Norwegian snus users.

PubMed

Wiium, Nora; Aarø, Leif E

2011-02-01

In this study, measures of outcome expectancies related to use of snus (wet snuff) were used to predict reported frequency of snus use. Data stem from a nation-wide survey in Norway among 16- to 20-year-olds. Only users of snus were included in the statistical analyses (n = 589). The main outcome measure, frequency of snus use, was measured as a categorical variable - occasional, weekly and daily use. Four dimensions of outcome expectancies (mood regulation, smoking control, weight control and negative health outcomes) were measured and confirmed in a confirmatory factor analysis. Informants tended to believe that snus use is harmful to health, but still they supported the idea of snus as a way to control own cigarette smoking. In a SEM model, two of the four dimensions of outcome expectancies turned out to be particularly significant predictors of frequency of snus use - mood regulation and smoking control. No significant interactions with gender were found. Males scored higher than females on "mood regulation", and "smoking control", while females scored higher than males on "negative health outcomes". If more smokers were convinced that snus use is a less harmful alternative, more of them might start using snus, not only because there is some association between health outcome expectancies and snus use, but also because snus use by many is perceived as a remedy to stop smoking and as a way to gain some of the mood regulation benefits which are usually associated with smoking. © 2010 The Authors. Scandinavian Journal of Psychology © 2010 The Scandinavian Psychological Associations.

Rationale and Methodology of the SARAH Trial: Long-Term Cardiovascular Outcomes in Patients With Resistant Hypertension and Obstructive Sleep Apnea.

PubMed

Sapiña-Beltrán, Esther; Torres, Gerard; Martínez-Alonso, Montserrat; Sánchez-de-la-Torre, Manuel; Franch, Maria; Bravo, Carmen; Masa, Juan F; Felez, Miquel; Fortuna-Gutierrez, Ana Maria; Abad, Jorge; García-Río, Francisco; Drager, Luciano F; Lee Chi-Hang, Ronald; Martínez-García, Miguel Ángel; Barbé, Ferran; Dalmases, Mireia

2018-05-22

Patients with resistant hypertension (RH) have a high risk of developing cardiovascular events; therefore, new therapeutic approaches to better control blood pressure may be useful in improving cardiovascular outcomes. The prevalence of obstructive sleep apnea (OSA) is very high among patients with RH. Continuous positive airway pressure (CPAP) has been shown to be an effective treatment for reducing blood pressure in patients with RH. Nevertheless, the long-term effect of CPAP treatment on cardiovascular outcomes has not been explored. The main objective of the SARAH study is to assess the impact of OSA and its treatment on cardiovascular outcomes (morbidity and mortality) in patients with RH. This study is a multi-center, prospective, observational cohort study. A total of 1371 patients with RH will be enrolled in the study and followed once a year for five years. At inclusion, ambulatory blood pressure monitoring (ABPM) and a sleep study will be performed in all subjects. Socio-demographic, clinical and cardiovascular variables will be collected at baseline and follow-up. Subsequently, subjects with OSA will be managed according to local standard practice. Based on the OSA diagnosis and its treatment, three cohorts of subjects with RH will be defined: non-OSA, treated OSA and non-treated OSA. This study will contribute to elucidating the long-term impact of OSA treatments on blood pressure control and cardiovascular outcomes in patients with RH. These results will contribute to improve the cardiovascular prognosis of patients with RH. Copyright © 2018 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

Learning Nanotechnology with Texts and Comics: The Impacts on Students of Different Achievement Levels

ERIC Educational Resources Information Center

Lin, Shu-Fen; Lin, Huann-shyang

2016-01-01

Comics are popular with adolescents because of their features of humor, narrative, and visual imagery. The purposes of this study were to examine the learning outcomes and emotional perceptions of reading a science comic book and a science text booklet for students of different levels of achievement, and to explore the main factors of the two…

Examining Variation in the Impact of School-Wide Positive Behavioral Interventions and Supports: Findings from a Randomized Controlled Effectiveness Trial

ERIC Educational Resources Information Center

Bradshaw, Catherine P.; Waasdorp, Tracy E.; Leaf, Philip J.

2015-01-01

School-Wide Positive Behavioral Interventions and Supports (SWPBIS; Sugai & Horner, 2006) is currently implemented in over 20,000 schools across the country with the goal of preventing disruptive behavior problems and enhancing the school climate. While previous studies have indicated significant main effects of SWPBIS on student outcomes, the…

Curriculum Integration in the Senior Secondary School: A Case Study in A National Assessment Context

ERIC Educational Resources Information Center

McPhail, Graham

2018-01-01

This paper considers curriculum integration in the secondary school context and investigates the claims made that it can enhance learning outcomes for students. I argue that curriculum integration should be utilized not as a main means of curricular delivery but as a supplementary opportunity to put disciplinary knowledge to use in certain,…

Influence of Mother, Father, and Child Risk on Parenting and Children's Cognitive and Social Behaviors

ERIC Educational Resources Information Center

Cabrera, Natasha J.; Fagan, Jay; Wight, Vanessa; Schadler, Cornelia

2011-01-01

The association among mothers', fathers', and infants' risk and cognitive and social behaviors at 24 months was examined using structual equation modeling and data on 4,200 on toddlers and their parents from the Early Childhood Longitudinal Study, Birth Cohort. There were 3 main findings. First, for cognitive outcomes, maternal risk was directly…

Depression and Social Context: Primary Supporter Relationship Factors Associated with Depressive Symptoms among a Disadvantaged Population with HIV/AIDS

ERIC Educational Resources Information Center

Knowlton, Amy R.; Curry, Aaron; Hua, Wei; Wissow, Lawrence

2009-01-01

Social support is associated with better health outcomes among chronically ill individuals, yet support receipt can be stressful. The study examined supporter relationship factors, among n = 156 main-supporter-HIV+support-recipient dyads, associated with recipient's depression (CES-D greater than or equal to 16). Results indicated that support…

Stress, Social Support, and Outcomes in Two Probability Samples of Homeless Adults

ERIC Educational Resources Information Center

Toro, Paul A.; Tulloch, Elizabeth; Ouellette, Nicole

2008-01-01

This study investigated the main effects of social support measures and their stress-buffering effects in two samples of homeless adults (Ns =249 and 219) obtained in the same large county (surrounding Detroit) at different points in time over an 8-year period (1992-1994 and 2000-2002). The findings suggest that the construct of social support,…

Implementation and Outcomes of Online Self and Peer Assessment on Group Based Honours Research Projects

ERIC Educational Resources Information Center

Wu, Chengqing; Chanda, Emmanuel; Willison, John

2014-01-01

Honours research projects in the School of Civil, Environmental and Mining Engineering at the University of Adelaide are run with small groups of students working with an academic supervisor in a chosen area for one year. The research project is mainly self-directed study, which makes it very difficult to fairly assess the contribution of…

For the Love of Learning Science: Connecting Learning Orientation and Career Productivity in Physics and Chemistry

ERIC Educational Resources Information Center

Hazari, Zahra; Potvin, Geoff; Tai, Robert H.; Almarode, John

2010-01-01

An individual's motivational orientation serves as a drive to action and can influence their career success. This study examines how goal orientation toward the pursuit of a graduate degree in physics and chemistry influences later success outcomes of practicing physicists and chemists. Two main categories of goal orientation are examined in this…

Influence of Cultural Cognition, Social Aspect of Culture, and Personality on Trust

DTIC Science & Technology

2013-12-31

of individualists whereby their satisfaction towards business negotiation stems mainly from high economic gains or personal outcomes. Therefore, it...2007) conducted a study on attributions of trustworthiness to unfamiliar trustees among Japanese and Canadians undergraduate business students. No...High means score of analytic-holism scale signifies high level of holism. No statistically significant difference was found between Malays, Chinese

Field Trips to Natural Environments: How Outdoor Educators Use the Physical Environment

ERIC Educational Resources Information Center

Lavie Alon, Nirit; Tal, Tali

2017-01-01

The main assumption of this study is that the natural environment is an important part of learning in out-of-school settings. We therefore aimed at understanding how outdoor educators (OEs) refer to, and use, the natural environment while guiding field trips, and how their use of the natural environment affects student learning outcomes. Using a…

Pregnancy-associated-cancer in the French West Indies (Martinique): maternal and neonatal outcomes.

PubMed

Melan, Kathleen; Volumenie, Jean-Luc; Wan-Ajouhu, Gaël; Ulric-Gervaise, Stephen; Veronique-Baudin, Jacqueline; Joachim, Clarisse

2017-10-02

The management of pregnancy-associated-cancer (PAC) requires epidemiological evaluation of the pathways of care. The aim of this study was to describe maternal and neonatal outcomes of PAC in Martinique. A retrospective study was conducted using data from medical records and the Martinique Cancer Registry for all PAC diagnosed between 1st January 2000 and 31st December 2014. Eighteen women were diagnosed with PAC: 17 during pregnancy and one during the postpartum period. Mean age at diagnosis was 35.7 ± 5.4 years. PAC were mainly gynecological cancers (12/18); the other sites were: lymphoma, brain, liver, colon, skin and unknown primary site. In most cases, PAC was detected in symptomatic individuals (72.2%). Nine women had nodal involvement or initial metastasis at diagnosis. No chemotherapy was administered in cases of preservation of pregnancy. Seven fetal losses caused by abortion and miscarriage were recorded, and 11 women conducted viable pregnancies. The main neonatal pathology observed was prematurity (58.3%). Cancer management during pregnancy is a challenge for French West-Indies territories. A Caribbean Observatory of rare cancers could help to ensure a coordinated approach to support and monitoring for these patients.

Impacts of making sense of adversity on depression, posttraumatic stress disorder, and posttraumatic growth among a sample of mainly newly diagnosed HIV-positive Chinese young homosexual men: the mediating role of resilience.

PubMed

Yu, Nancy Xiaonan; Chen, Lihua; Ye, Zhi; Li, Xiaoming; Lin, Danhua

2017-01-01

The experience of HIV, as a life-transforming event, might produce both negative and positive outcomes. Guided by the stress appraisal model, the present study investigated the hypothesized pathways in predicting symptomatology and posttraumatic growth (PTG) in a sample of Chinese male patients with HIV (PHIV) who were mainly newly diagnosed, young, and homosexual. In this cross-sectional study, 141 Chinese male PHIV (87.2% of them were homosexual) completed measures of making negative/positive sense of adversity, resilience, depression, posttraumatic stress disorder (PTSD), and PTG. The path analysis results showed that making negative sense of adversity was associated with depression and PTSD, partially mediated by low levels of resilience, whereas making positive sense of adversity was associated with PTG, partially mediated by resilience. The results suggest that negative and positive outcomes of trauma are impacted by making negative and positive sense of adversity, respectively, via two separate pathways, both mediated by resilience. Our findings contribute to an understanding of the cognitive process of symptomatology and PTG in the HIV context. Theoretical considerations, clinical implications, and future directions are discussed.

The Moderating Role of Power Distance on the Relationship between Employee Participation and Outcome Variables.

PubMed

Rafiei, Sima; Pourreza, Abolghasem

2013-06-01

Many organisations have realised the importance of human resource for their competitive advantage. Empowering employees is therefore essential for organisational effectiveness. This study aimed to investigate the relationship between employee participation with outcome variables such as organisational commitment, job satisfaction, perception of justice in an organisation and readiness to accept job responsibilities. It further examined the impact of power distance on the relationship between participation and four outcome variables. This was a cross sectional study with a descriptive research design conducted among employees and managers of hospitals affiliated with Tehran University of Medical Sciences, Tehran, Iran. A questionnaire as a main procedure to gather data was developed, distributed and collected. Descriptive statistics, Pearson correlation coefficient and moderated multiple regression were used to analyse the study data. Findings of the study showed that the level of power distance perceived by employees had a significant relationship with employee participation, organisational commitment, job satisfaction, perception of justice and readiness to accept job responsibilities. There was also a significant relationship between employee participation and four outcome variables. The moderated multiple regression results supported the hypothesis that power distance had a significant effect on the relationship between employee participation and four outcome variables. Organisations in which employee empowerment is practiced through diverse means such as participating them in decision making related to their field of work, appear to have more committed and satisfied employees with positive perception toward justice in the organisational interactions and readiness to accept job responsibilities.

Has general practitioner computing made a difference to patient care? A systematic review of published reports.

PubMed Central

Sullivan, F.; Mitchell, E.

1995-01-01

OBJECTIVE--To review findings from studies of the influence of desktop computers on primary care consultations. DESIGN--Systematic review of world reports from 1984 to 1994. SETTING--The computerised catalogues of Medline, BIDS, and GPlit were searched, as well as conference proceedings, books, bibliographies, and references in books and journal articles. SUBJECTS--30 papers met the inclusion criteria and were included for detailed review. INTERVENTIONS--A validated scheme for assessing methodological adequacy was used to score each paper. MAIN OUTCOME MEASURES--Papers were rated on sample formation, baseline differences, unit of allocation, outcome measures, and follow up. Differences in outcomes were also recorded. RESULTS--Four of the six papers dealing with the consultation process showed that consultations took longer. Doctor initiated and "medical" content of consultations increased at the expense of a reduction in patient initiated and "social" content. Each of the 21 studies which looked at clinician performance showed an improvement when a computer was used (from 8% to 50%, with better results for single preventive measures). Only one of the three studies looking at patient outcomes showed an improvement (diastolic blood pressure control 5 mm Hg better after one year, with fewer doctor-patient consultations). CONCLUSIONS--Using a computer in the consultation may help improve clinician performance but may increase the length of the consultation. More studies are needed to assess the effects on patient outcomes of using a computer in consultations. PMID:7580494

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

PubMed

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

2016-01-01

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

eHealth for Patient Engagement: A Systematic Review.

PubMed

Barello, Serena; Triberti, Stefano; Graffigna, Guendalina; Libreri, Chiara; Serino, Silvia; Hibbard, Judith; Riva, Giuseppe

2015-01-01

eHealth interventions are recognized to have a tremendous potential to promote patient engagement. To date, the majority of studies examine the efficacy of eHealth in enhancing clinical outcomes without focusing on patient engagement in its specificity. This paper aimed at reviewing findings from the literature about the use of eHealth in engaging patients in their own care process. We undertook a comprehensive literature search within the peer-reviewed international literature. Eleven studies met the inclusion criteria. eHealth interventions reviewed were mainly devoted to foster only partial dimensions of patient engagement (i.e., alternatively cognitive, emotional or behavioral domains related to healthcare management), thus failing to consider the complexity of such an experience. This also led to a great heterogeneity of technologies, assessed variables and achieved outcomes. This systematic review underlines the need for a more holistic view of patient needs to actually engage them in eHealth interventions and obtaining positive outcomes. In this sense, patient engagement constitute a new frontiers for healthcare models where eHealth could maximize its potentialities.

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

PubMed Central

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

2016-01-01

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

Literature review on monitoring technologies and their outcomes in independently living elderly people.

PubMed

Peetoom, Kirsten K B; Lexis, Monique A S; Joore, Manuela; Dirksen, Carmen D; De Witte, Luc P

2015-07-01

To obtain insight into what kind of monitoring technologies exist to monitor activity in-home, what the characteristics and aims of applying these technologies are, what kind of research has been conducted on their effects and what kind of outcomes are reported. A systematic document search was conducted within the scientific databases Pubmed, Embase, Cochrane, PsycINFO and Cinahl, complemented by Google Scholar. Documents were included in this review if they reported on monitoring technologies that detect activities of daily living (ADL) or significant events, e.g. falls, of elderly people in-home, with the aim of prolonging independent living. Five main types of monitoring technologies were identified: PIR motion sensors, body-worn sensors, pressure sensors, video monitoring and sound recognition. In addition, multicomponent technologies and smart home technologies were identified. Research into the use of monitoring technologies is widespread, but in its infancy, consisting mainly of small-scale studies and including few longitudinal studies. Monitoring technology is a promising field, with applications to the long-term care of elderly persons. However, monitoring technologies have to be brought to the next level, with longitudinal studies that evaluate their (cost-) effectiveness to demonstrate the potential to prolong independent living of elderly persons. [Box: see text].

Thinking through postoperative cognitive dysfunction: How to bridge the gap between clinical and pre-clinical perspectives.

PubMed

Hovens, Iris B; Schoemaker, Regien G; van der Zee, Eddy A; Heineman, Erik; Izaks, Gerbrand J; van Leeuwen, Barbara L

2012-10-01

Following surgery, patients may experience cognitive decline, which can seriously reduce quality of life. This postoperative cognitive dysfunction (POCD) is mainly seen in the elderly and is thought to be mediated by surgery-induced inflammatory reactions. Clinical studies tend to define POCD as a persisting, generalised decline in cognition, without specifying which cognitive functions are impaired. Pre-clinical research mainly describes early hippocampal dysfunction as a consequence of surgery-induced neuroinflammation. These different approaches to study POCD impede translation between clinical and pre-clinical research outcomes and may hamper the development of appropriate interventions. This article analyses which cognitive domains deteriorate after surgery and which brain areas might be involved. The most important outcomes are: (1) POCD encompasses a wide range of cognitive impairments; (2) POCD affects larger areas of the brain; and (3) individual variation in the vulnerability of neuronal networks to neuroinflammatory mechanisms may determine if and how POCD manifests itself. We argue that, for pre-clinical and clinical research of POCD to advance, the effects of surgery on various cognitive functions and brain areas should be studied. Moreover, in addition to general characteristics, research should take inter-relationships between cognitive complaints and physical and mental characteristics into account. Copyright © 2012 Elsevier Inc. All rights reserved.

Global burden of mental disorders among children aged 5-14 years.

PubMed

Baranne, Marie Laure; Falissard, Bruno

2018-01-01

The global burden of disease (GBD) study provides information about fatal and non-fatal health outcomes around the world. The objective of this work is to describe the burden of mental disorders among children aged 5-14 years in each of the six regions of the World Health Organisation. Data come from the GBD 2015 study. Outcomes: disability-adjusted life-years (DALYs) are the main indicator of GBD studies and are built from years of life lost (YLLs) and years of life lived with disability (YLDs). Mental disorders are among the leading causes of YLDs and of DALYs in Europe and the Americas. Because of the importance of infectious diseases, mental disorders appear marginal in Africa for YLLs although they play an important role in YLDs there. Because the epidemiological transition that has taken place in Europe and the Americas (i.e., a switch from acute and infectious conditions to chronic and mental health issues) is likely to happen sooner or later across the entire planet, mental health problems in youth are likely to become one of the main public health challenges of the twenty-first century. These results should improve health care if policy-makers use them to develop health policies to meet the real needs of populations (especially children) today.

Postural control in chronic obstructive pulmonary disease: a systematic review.

PubMed

Porto, E F; Castro, A A M; Schmidt, V G S; Rabelo, H M; Kümpel, C; Nascimento, O A; Jardim, J R

2015-01-01

Patients with chronic obstructive pulmonary disease (COPD) fall frequently, although the risk of falls may seem less important than the respiratory consequences of the disease. Nevertheless, falls are associated to increased mortality, decreased independence and physical activity levels, and worsening of quality of life. The aims of this systematic review was to evaluate information in the literature with regard to whether impaired postural control is more prevalent in COPD patients than in healthy age-matched subjects, and to assess the main characteristics these patients present that contribute to impaired postural control. Five databases were searched with no dates or language limits. The MEDLINE, PubMed, EMBASE, Web of Science, and PEDro databases were searched using "balance", "postural control", and "COPD" as keywords. The search strategies were oriented and guided by a health science librarian and were performed on March 27, 2014. The studies included were those that evaluated postural control in COPD patients as their main outcome and scored more than five points on the PEDro scale. Studies supplied by the database search strategy were assessed independently by two blinded researchers. A total of 484 manuscripts were found using the "balance in COPD or postural control in COPD" keywords. Forty-three manuscripts appeared more than once, and 397 did not evaluate postural control in COPD patients as the primary outcome. Thus, only 14 studies had postural control as their primary outcome. Our study examiners found only seven studies that had a PEDro score higher than five points. The examiners' interrater agreement was 76.4%. Six of those studies were accomplished with a control group and one study used their patients as their own controls. The studies were published between 2004 and 2013. Patients with COPD present postural control impairment when compared with age-matched healthy controls. Associated factors contributing to impaired postural control were muscle weakness, physical inactivity, elderly age, need for supplemental oxygen, and limited mobility.

Methods, metrics and research gaps around minimum data sets for nursing practice and fundamental care: A scoping literature review.

PubMed

Muntlin Athlin, Åsa

2018-06-01

To examine and map research on minimum data sets linked to nursing practice and the fundamentals of care. Another aim was to identify gaps in the evidence to suggest future research questions to highlight the need for standardisation of terminology around nursing practice and fundamental care. Addressing fundamental care has been highlighted internationally as a response to missed nursing care. Systematic performance measurements are needed to capture nursing practice outcomes. Overview of the literature framed by the scoping study methodology. PubMed and CINAHL were searched using the following inclusion criteria: peer-reviewed empirical quantitative and qualitative studies related to minimum data sets and nursing practice published in English. No time restrictions were set. Exclusion criteria were as follows: no available full text, reviews and methodological and discursive studies. Data were categorised into one of the fundamentals of care elements. The review included 20 studies published in 1999-2016. Settings were mainly nursing homes or hospitals. Of 14 elements of the fundamentals of care, 11 were identified as measures in the included studies, but their frequency varied. The most commonly identified elements concerned safety, prevention and medication (n = 11), comfort (n = 6) and eating and drinking (n = 5). Studies have used minimum data sets and included variables linked to nursing practices and fundamentals of care. However, the relations of these variables to nursing practice were not always clearly described and the main purpose of the studies was seldom to measure the outcomes of nursing interventions. More robust studies focusing on nursing practice and patient outcomes are warranted. Using minimum data sets can highlight the nurses' work and what impact it has on direct patient care. Appropriate models, systems and standardised terminology are needed to facilitate the documentation of nursing activities. © 2017 John Wiley & Sons Ltd.

Caregiver Insightfulness and Young Children’s Violence Exposure: Testing a Relational Model of Risk and Resilience

PubMed Central

Gray, Sarah A. O.; Forbes, Danielle; Briggs-Gowan, Margaret; Carter, Alice S.

2016-01-01

This study employed a relational post-traumatic stress frame to explore the co-contribution of young children’s exposure to violence and caregiver insightfulness on child behavioral outcomes in a high-risk, non-referred sample of caregivers and preschoolers (n = 64; mean age 3.83 years, SD = .77). Caregiver insightfulness did not have a main effect on child outcomes but did moderate the relation between violence exposure and child behavior across all observed outcomes. Violence-exposed children with non-insightful caregivers demonstrated higher caregiver-rated internalizing and externalizing behaviors and observer-rated negative affect than all other groups. Among children not exposed to violence, insightfulness was not related to children’s behavior problems or negative affect, suggesting violence-specific processes. Though cross-sectional, results suggest that the effects of violence and caregiver insightfulness on child outcomes are contingent on one another and that caregiver insightfulness may play a protective role in contexts of violence. PMID:26503175

Mother-child conversations about safety: implications for socializing safety values in children.

PubMed

O'Neal, Elizabeth E; Plumert, Jodie M

2014-05-01

This study examined how mothers socialize their children about safety through conversations about potentially unsafe activities. Mothers and their 8- and 10-year-old children discussed and rated the safety of 12 photographs depicting another same-gender child engaged in potentially dangerous activities. Conversations usually unfolded with children giving the first rating or rationale, followed by additional discussion between the mother and child. Mothers and children relied on 2 main types of rationales to justify their ratings: potential outcomes of the activity and specific features of the situation (dangerous and nondangerous). Mothers (but not children) used dangerous feature rationales more often than dangerous outcome rationales. When disagreements arose, mothers typically guided children to adopt their own rating rather than the child's rating. Additionally, children who used more nondangerous feature and outcome rationales had experienced more injuries requiring medical attention. Mothers' focus on dangerous features appears to reflect their efforts to help children make causal connections between dangerous elements of the situation and adverse outcomes that might result.

Parents of children with eating disorders: developing theory-based health communication messages to promote caregiver well-being.

PubMed

Patel, Sheetal; Shafer, Autumn; Brown, Jane; Bulik, Cynthia; Zucker, Nancy

2014-01-01

Parents of children with eating disorders experience extreme emotional burden because of the intensity and duration of the recovery process. While parental involvement in a child's eating disorder treatment improves outcomes, parents often neglect their own well-being, which can impede their child's recovery. This study extends the research on caregivers and on health theory in practice by conducting formative research to develop a theory-based communication intervention encouraging parents to engage in adaptive coping and self-care behaviors. The Transactional Model of Stress and Coping and the Transtheoretical Model guided qualitative assessments of the determinants of parents' coping behaviors. Three focus groups with 19 parents of children with eating disorders and 19 semi-structured interviews with experts specializing in eating disorders were conducted. Findings indicate that parents and experts see parents' need for permission to take time for themselves as the main barrier to self-care. The main motivator for parents to engage in coping behaviors is awareness of a connection between self-care and their child's health outcomes. Participant evaluation of six potential messages for main themes and effectiveness revealed that theory-based elements, such as certain processes of change within the Transtheoretical Model, were important to changing health behavior.

How are we assessing near-peer teaching in undergraduate health professional education? A systematic review.

PubMed

Irvine, Susan; Williams, Brett; McKenna, Lisa

2017-03-01

Near Peer teaching (NPT) is reported as an effective pedagogical approach to student learning and performance. Studies in medicine, nursing and health sciences have relied mainly on self-reports to describe its benefits, focusing on psychomotor and cognitive aspects of learning. Despite increasing research reports on peer teaching internationally, little is known about the various domains of learning used in assessment of performance and objective learning outcomes of NPT. To determine the domains of learning and assessment outcomes used in NPT in undergraduate health professional education. Quantitative systematic review was conducted in accord with the PRISMA protocol and the Joanna Briggs Institute processes. A wide literature search was conducted for the period 1990-November 2015 of fourteen databases. Grey literature was undertaken from all key research articles. Studies meeting the inclusion criteria were eligible for consideration, including measured learning outcomes of near-peer teaching in undergraduate education in nursing, medicine and health sciences. Set limitations included publications after 1990 (2015 inclusive), English language and objective learning outcomes. A quality appraisal process involving two independent reviewers was used to analyse the data. Of 212 selected articles, 26 were included in the review. Terminology was confusing and found to be a barrier to the review process. Although some studies demonstrated effective learning outcomes resulting from near-peer teaching, others were inconclusive. Studies focused on cognitive and psychomotor abilities of learners with none assessing metacognition, affective behaviours or learning outcomes from quality of understanding. The studies reviewed focused on cognitive and psychomotor abilities of learners. Even though evidence clearly indicates that metacognition and affective behaviours have direct influence on learning and performance, indicating more research around this topic is warranted. Methodological quality of the studies and lack of theoretical frameworks underpinned by educational psychology may have contributed to inconsistencies in learning outcomes reported. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations

PubMed Central

Ketelaar, Nicole ABM; Faber, Marjan J; Flottorp, Signe; Rygh, Liv Helen; Deane, Katherine HO; Eccles, Martin P

2014-01-01

Background It is becoming increasingly common to release information about the performance of hospitals, health professionals or providers, and healthcare organisations into the public domain. However, we do not know how this information is used and to what extent such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers and purchasers, or to what extent the performance of professionals and providers can be affected. Objectives To determine the effectiveness of the public release of performance data in changing the behaviour of healthcare consumers, professionals and organisations. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE Ovid (from 1966), EMBASE Ovid (from 1979), CINAHL, PsycINFO Ovid (from 1806) and DARE up to 2011. Selection criteria We searched for randomised or quasi-randomised trials, interrupted time series and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or individuals. The papers had to report at least one main outcome related to selecting or changing care. Other outcome measures were awareness, attitude, views and knowledge of performance data and costs. Data collection and analysis Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers and healthcare purchasers), performance data, main outcomes (choice of healthcare provider and improvement by means of changes in care) and other outcomes (awareness, attitude, views, knowledge of performance data and costs). Main results We included four studies containing more than 35,000 consumers, and 1560 hospitals. Three studies were conducted in the USA and examined consumer behaviour after the public release of performance data. Two studies found no effect of Consumer Assessment of Healthcare Providers and Systems information on health plan choice in a Medicaid population. One interrupted time series study found a small positive effect of the publishing of data on patient volumes for coronary bypass surgery and low-complication outliers for lumbar discectomy, but these effects did not persist longer than two months after each public release. No effects on patient volumes for acute myocardial infarction were found. One cluster-randomised controlled trial, conducted in Canada, studied improvement changes in care after the public release of performance data for patients with acute myocardial infarction and congestive heart failure. No effects for the composite process-of-care indicators for either condition were found, but there were some improvements in the individual process-of-care indicators. There was an effect on the mortality rates for acute myocardial infarction. More quality improvement activities were initiated in response to the publicly-released report cards. No secondary outcomes were reported. Authors’ conclusions The small body of evidence available provides no consistent evidence that the public release of performance data changes consumer behaviour or improves care. Evidence that the public release of performance data may have an impact on the behaviour of healthcare professionals or organisations is lacking. PMID:22071813

Long-term effects of transference interpretation in dynamic psychotherapy of personality disorders.

PubMed

Høglend, P; Dahl, H-S; Hersoug, A G; Lorentzen, S; Perry, J C

2011-10-01

Only a few treatment studies of personality disorders (PD) patients are on longer-term psychotherapy, general outcome measures are used, and follow-up periods are usually short. More studies of long-term therapies, using outcome measures of core psychopathology, are needed. This study is a dismantling randomized controlled clinical trial, specifically designed to study long-term effects of transference interpretation. Forty-six patients with mainly cluster C personality disorders were randomly assigned to 1 year of dynamic psychotherapy with or without transference interpretations. The outcome measures were remission from PD, improvement in interpersonal functioning, and use of mental health resources in the 3-year period after treatment termination. After therapy with transference interpretation PD-patients improved significantly more in core psychopathology and interpersonal functioning, the drop-out rate was reduced to zero, and use of health services was reduced to 50%, compared to therapy without this ingredient. Three years after treatment termination, 73% no longer met diagnostic criteria for any PD in the transference group, compared to 44% in the comparison group. PD-patients with co-morbid disorders improved in both treatment arms in this study. However, transference interpretation improved outcome substantially more. Long-term psychotherapy that includes transference interpretation is an effective treatment for cluster C personality disorders and milder cluster B personality disorders. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Trends in preterm birth: singleton and multiple pregnancies in the Netherlands, 2000-2007.

PubMed

Schaaf, J M; Mol, B W J; Abu-Hanna, A; Ravelli, A C J

2011-09-01

Several studies have reported increasing trends in preterm birth in developed countries, mainly attributable to an increase in medically indicated preterm births. Our aim was to describe trends in preterm birth among singleton and multiple pregnancies in the Netherlands. Prospective cohort study. Nationwide study. We studied 1,451,246 pregnant women from 2000 to 2007. We assessed trends in preterm birth. We subdivided preterm birth into spontaneous preterm birth after premature prelabour rupture of membranes (pPROM), medically indicated preterm birth and spontaneous preterm birth without pPROM. We performed analyses separately for singletons and multiples. The primary outcome was preterm birth, defined as birth before 37 weeks of gestation, with very preterm birth (<32 weeks of gestation) being a secondary outcome. The risk of preterm birth was 7.7% and the risk of very preterm birth was 1.3%. In singleton pregnancies, the preterm birth risk decreased significantly from 6.4% to 6.0% (P < 0.0001), mainly as a result of the decrease in spontaneous preterm birth without pPROM (3.6-3.1%, P < 0.0001). In multiple pregnancies, the preterm birth risk increased significantly (47.3-47.7%, P = 0.047), mainly as a result of medically indicated preterm birth, which increased from 15.0% to 17.9% (P < 0.0001). In the Netherlands, the preterm birth risk in singleton pregnancies decreased significantly over the years. The trend of increasing preterm birth risk reported in other countries was only observed in (medically indicated) preterm birth in multiple pregnancies. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

The Walking Interventions Through Texting (WalkIT) Trial: Rationale, Design, and Protocol for a Factorial Randomized Controlled Trial of Adaptive Interventions for Overweight and Obese, Inactive Adults

PubMed Central

Hurley, Jane C; Hollingshead, Kevin E; Todd, Michael; Jarrett, Catherine L; Tucker, Wesley J; Angadi, Siddhartha S

2015-01-01

Background Walking is a widely accepted and frequently targeted health promotion approach to increase physical activity (PA). Interventions to increase PA have produced only small improvements. Stronger and more potent behavioral intervention components are needed to increase time spent in PA, improve cardiometabolic risk markers, and optimize health. Objective Our aim is to present the rationale and methods from the WalkIT Trial, a 4-month factorial randomized controlled trial (RCT) in inactive, overweight/obese adults. The main purpose of the study was to evaluate whether intensive adaptive components result in greater improvements to adults’ PA compared to the static intervention components. Methods Participants enrolled in a 2x2 factorial RCT and were assigned to one of four semi-automated, text message–based walking interventions. Experimental components included adaptive versus static steps/day goals, and immediate versus delayed reinforcement. Principles of percentile shaping and behavioral economics were used to operationalize experimental components. A Fitbit Zip measured the main outcome: participants’ daily physical activity (steps and cadence) over the 4-month duration of the study. Secondary outcomes included self-reported PA, psychosocial outcomes, aerobic fitness, and cardiorespiratory risk factors assessed pre/post in a laboratory setting. Participants were recruited through email listservs and websites affiliated with the university campus, community businesses and local government, social groups, and social media advertising. Results This study has completed data collection as of December 2014, but data cleaning and preliminary analyses are still in progress. We expect to complete analysis of the main outcomes in late 2015 to early 2016. Conclusions The Walking Interventions through Texting (WalkIT) Trial will further the understanding of theory-based intervention components to increase the PA of men and women who are healthy, insufficiently active and are overweight or obese. WalkIT is one of the first studies focusing on the individual components of combined goal setting and reward structures in a factorial design to increase walking. The trial is expected to produce results useful to future research interventions and perhaps industry initiatives, primarily focused on mHealth, goal setting, and those looking to promote behavior change through performance-based incentives. Trial Registration ClinicalTrials.gov NCT02053259; https://clinicaltrials.gov/ct2/show/NCT02053259 (Archived by WebCite at http://www.webcitation.org/6b65xLvmg). PMID:26362511

Predictors of poor treatment outcomes in multidrug-resistant tuberculosis patients: a retrospective cohort study.

PubMed

Javaid, A; Ullah, I; Masud, H; Basit, A; Ahmad, W; Butt, Z A; Qasim, M

2018-06-01

We aimed to determine the characteristics, treatment outcomes and risk factors for poor treatment outcomes among multidrug-resistant (MDR) tuberculosis (TB) patients in Khyber Pakhtunkhwa province, Pakistan. A retrospective cohort study including all patients with MDR-TB who sought care at the MDR-TB unit in Peshawar was conducted between January 2012 and April 2014. Patients were followed until an outcome of TB treatment was recorded as successful (cured or completed) or unsuccessful. Binary logistic regression was used to identify predictors of poor outcome, i.e. unsuccessful treatment outcomes. Overall, 535 patients were included. The proportion of female subjects was relatively higher (n = 300, 56.1%) than male subjects. The mean (standard deviation) age of patients was 30.37 (14.09) years. Of 535 patients for whom treatment outcomes were available, 402 (75.1%) were cured, 4 (0.7%) completed therapy, 34 (6.4%) had disease that failed to respond to therapy, 93 (17.4%) died and two (0.4%) defaulted; in total, 129 (24.1%) had an unsuccessful outcome. We found three significant predictors of unsuccessful treatment during multivariate logistic regression: being married (odds ratio (OR) = 2.17, 95% confidence interval (CI) 1.01, 4.66), resistance to second-line drugs (OR = 2.61, 95% CI 1.61, 4.21) and presence of extensively drug-resistant TB (OR = 7.82, 95% CI 2.90, 21.07). Approximately 75% of the treatment success rate set by the Global Plan to Stop TB was achieved. Resistance to second-line drugs and presence of extensively drug-resistant TB are the main risk factors for poor treatment outcomes. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Epidemiology of traumatic upper limb amputations.

PubMed

Pomares, G; Coudane, H; Dap, F; Dautel, G

2018-04-01

While published data on functional outcomes after upper limb amputations are plentiful, epidemiology data are relatively rare. This led us to performing an epidemiology study of traumatic upper limb amputations at our facility. This retrospective study spanned a 10-year period of cases seen at the SOS Main (Hand emergency center) of the Nancy University Hospital in France. Patients who suffered traumatic amputation of the upper limb were identified and divided into two groups: replantation and surgical amputation. All anatomical amputation levels were retained. Non-traumatic amputations were excluded. Epidemiology data (sex, age, dominant side, injured side) was collected along with the specific anatomical level of the injury, the injury mechanism and whether it was work-related. We also looked at the success rate of microsurgery and whether multi-finger amputations were partial or complete. In parallel, the annual incidence of amputations seen at the SOS Main over this period was calculated. Over the 10-year period, 1715 traumatic upper-limb amputations were identified, which was 3% of all cases seen at the SOS Main. Most of the cases involved middle-aged men. Revascularization was attempted in one-third of cases and microsurgery was successful in 70% of cases. The surgical amputation group consisted of 1132 patients with a mean age of 59 years, while the replantation group consisted of 583 patients with a mean age of 48 years. The primary mechanism of injury was a table saw. This injury, which must be addressed urgently, is not very common in everyday practice. This is contrary to lower limb amputations, which are more common and occur in the context of micro- and macroangiopathy in older patients. The success rate of microsurgery in this cohort must be placed in the context of age, amputation level and mechanism. The functional outcomes are not always as good as the vascular outcomes. This data is invaluable as it fills a gap in our knowledge about amputations. IV. Copyright © 2018. Published by Elsevier Masson SAS.

Prevalence, risk factors and outcome of childhood abuse reported by female university students in jeddah.

PubMed

Ibrahim, Nahla K; Jalali, Ekram A; Al-Ahmadi, Jawaher R; Al-Bar, Adnan A

2008-01-01

Child abuse constitutes all forms of physical and /or emotional ill treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power. The objective of the study was to determine the prevalence, types, main predictors and outcome of child abuse, retrospectively reported by female university students in Jeddah. A cross sectional study was conducted and the Standardized Arabic Version of Child Abuse Screening Tool for Young Adult (18-24 years old) was used. Ethical standards of confidentiality and freedom to participate were followed. Multistage stratified random sample was used with selection of 1,897 females. About two-thirds (68.3 %) of students reported exposure to some form of child abuse. Physical and emotional forms were recalled by 45.1 % & 50.6 % of students, respectively, while, 2.9 % reported exposure to forced contact sexual assault. Parents and siblings were the commonest perpetrators of both physical & emotional abuse, while other relatives and extra-familial persons were the main offenders of sexual violence. The predictors of exposure to three forms of abuse together were: existence of parent who hit the other (aOR= 2.54; 95 % CI: 1.88-3.42), non-university graduated mother (aOR =1.83; p

Treating Pain in Pregnancy with Acupuncture: Observational Study Results from a Free Clinic in New Zealand.

PubMed

Soliday, Elizabeth; Betts, Debra

2018-02-01

Clinic-based acupuncturists, midwives, and physiotherapists have reported using acupuncture to treat lumbopelvic pain in pregnancy, a common condition that may affect functioning and quality of life. To contribute to the emerging evidence on treatment outcomes, we collected patient-reported pain reduction data from women treated during pregnancy in a no-pay, hospital-based acupuncture service in New Zealand. Observational study of patient-reported symptom reduction.The main outcome measure was the MYMOP (Measure Your Medical Outcome Profile), a brief, validated self-report instrument. Open-ended questions on treatment experiences and adverse events were included. Of the 81 women on whom we had complete treatment data, the majority (N = 72, 89%) reported clinically meaningful symptom reduction. Patient-reported adverse events were infrequent and mild. Patient-reported and treatment-related lumbopelvic pain symptom reduction findings provide further evidence that acupuncture in pregnancy is safe and beneficial in a field setting. We discuss this study's unique contributions in providing guidance for clinicians who practice acupuncture in pregnancy, including midwives, physiotherapists, and physicians. Copyright © 2018. Published by Elsevier B.V.

Methods Used and Topics Addressed in Quantitative Health Research on Gay, Bisexual and Other Men Who Have Sex With Men: A Systematic Review of the Literature.

PubMed

Brennan, David J; Bauer, Greta R; Bradley, Kaitlin; Tran, Oth Vilaythong

2017-01-01

Research on sexual minority men (gay, bisexual, and other men who have sex with men) was examined with regard to the measures of sexual orientation used, the methods of research, and the main health outcomes under study. A systematic review of English-language quantitative studies was conducted focused on the health of sexual minority men published in 2010 (n = 250). The results provide a snapshot of the literature and revealed that research on sexual minority men overwhelmingly focused on HIV, STIs, and sexual health for which sexual orientation was most commonly defined behaviorally. For topics of mental health or body/fitness outcomes, sexual orientation was most commonly defined by identity. Most study samples were venue-based, and only 8.8% of published papers drew data from population-based samples. The findings suggest that there exists a need for research on sexual minority men's health beyond STIs and HIV that will examine mental and physical health outcomes beyond sexual risk, uses probability-based samples, and addresses intersectional concerns related to race/ethnicity and age.

[Wellness-activities to prevent metabolic syndrome among patients with schizophrenia].

PubMed

Brönner, Monika; Betz, Christine; Christ, Sarah; Froböse, Teresa; Pitschel-Walz, Gabi; Bäuml, Josef

2010-01-01

Weight gain and metabolic disturbances are growing side effects of a modern antipsychotic therapy. Different programs were developed to reduce them. This article gives an overview of existing and evaluated programs. A literature research was made through PubMed. Relevant reviews and intervention studies were identified. Studies with the main outcome variable of weight reductions are numerous, even randomised controlled trials. Short-term weight loss under antipsychotic treatment is possible, but there is still a lack of long-term studies. Life style interventions, which include e. g. physical exercise, are not that common. Also, interventions such as wellness-activities, which contribute by means of adequate motivation strategies to an enhancement of the general well-being, are still missing. Present results turned out to be positive. Further programs which exceed weight management are required. There is necessity for more studies with consistent outcome variables and methods, especially long-term programs. Georg Thieme Verlag KG Stuttgart, New York.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: institutional outcomes assessment and the role of the Laboratory of Physiology.

PubMed

Freitas, José Alberto de Souza; Trindade-Suedam, Ivy Kiemle; Garib, Daniela Gamba; Neves, Lucimara Teixeira das; Almeida, Ana Lúcia Pompéia Fraga de; Yaedú, Renato Yassukata Faria; Oliveira, Thaís Marchini; Soares, Simone; Lauris, Rita de Cássia Moura Carvalho; Yamashita, Renata Paciello; Trindade, Alceu Sergio; Trindade, Inge Elly Kiemle; Pinto, João Henrique Nogueira

2013-01-01

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.

Oropharyngeal dysphagia in myotonic dystrophy type 1: a systematic review.

PubMed

Pilz, Walmari; Baijens, Laura W J; Kremer, Bernd

2014-06-01

A systematic review was conducted to investigate the pathophysiology of and diagnostic procedures for oropharyngeal dysphagia in myotonic dystrophy (MD). The electronic databases Embase, PubMed, and The Cochrane Library were used. The search was limited to English, Dutch, French, German, Spanish, and Portuguese publications. Sixteen studies met the inclusion criteria. Two independent reviewers assessed the methodological quality of the included articles. Swallowing assessment tools, the corresponding protocols, the studies' outcome measurements, and main findings are summarized and presented. The body of literature on pathophysiology of swallowing in dysphagic patients with MD type 1 remains scant. The included studies are heterogeneous with respect to design and outcome measures and hence are not directly comparable. More importantly, most studies had methodological problems. These are discussed in detail and recommendations for further research on diagnostic examinations for swallowing disorders in patients with MD type 1 are provided.

Hospital-Based Comprehensive Care Programs for Children With Special Health Care Needs

PubMed Central

Cohen, Eyal; Jovcevska, Vesna; Kuo, Dennis Z.; Mahant, Sanjay

2014-01-01

Objective To examine the effectiveness of hospital-based comprehensive care programs in improving the quality of care for children with special health care needs. Data Sources A systematic review was conducted using Ovid MEDLINE, CINAHL, EMBASE, PsycINFO, Sociological Abstracts SocioFile, and Web of Science. Study Selection Evaluations of comprehensive care programs for categorical (those with single disease) and noncategorical groups of children with special health care needs were included. Selected articles were reviewed independently by 2 raters. Data Extraction Models of care focused on comprehensive care based at least partially in a hospital setting. The main outcome measures were the proportions of studies demonstrating improvement in the Institute of Medicine’s quality-of-care domains (effectiveness of care, efficiency of care, patient or family centeredness, patient safety, timeliness of care, and equity of care). Data Synthesis Thirty-three unique programs were included, 13 (39%) of which were randomized controlled trials. Improved outcomes most commonly reported were efficiency of care (64% [49 of 76 outcomes]), effectiveness of care (60% [57 of 95 outcomes]), and patient or family centeredness (53% [10 of 19 outcomes). Outcomes less commonly evaluated were patient safety (9% [3 of 33 programs]), timeliness of care (6% [2 of 33 programs]), and equity of care (0%). Randomized controlled trials occurred more frequently in studies evaluating categorical vs noncategorical disease populations (11 of 17 [65%] vs 2 of 16 [17%], P = .008). Conclusions Although positive, the evidence supporting comprehensive hospital-based programs for children with special health care needs is restricted primarily to nonexperimental studies of children with categorical diseases and is limited by inadequate outcome measures. Additional high-quality evidence with appropriate comparative groups and broad outcomes is necessary to justify continued development and growth of programs for broad groups of children with special health care needs. PMID:21646589

A Checklist-based Intervention to Improve Surgical Outcomes in Michigan: Evaluation of the Keystone Surgery Program

PubMed Central

Reames, Bradley N.; Krell, Robert W.; Campbell, Darrell A.; Dimick, Justin B.

2015-01-01

Importance Previous studies of checklist-based quality improvement interventions have reported mixed results. Objective To evaluate whether implementation of a checklist-based quality improvement intervention, Keystone Surgery, was associated with improved outcomes in patients undergoing general surgery in large statewide population. Design, Setting and Exposure Retrospective longitudinal study examining surgical outcomes in Michigan patients using Michigan Surgical Quality Collaborative clinical registry data from the years 2006–2010 (n=64,891 patients in 29 hospitals). Multivariable logistic regression and difference-in-differences analytic approaches were used to evaluate whether Keystone Surgery program implementation was associated with improved surgical outcomes following general surgery procedures, apart from existing temporal trends toward improved outcomes during the study period. Main Outcome Measures Risk-adjusted rates of superficial surgical site infection, wound complications, any complication, and 30-day mortality. Results Implementation of Keystone Surgery in participating centers (n=14 hospitals) was not associated with improvements in surgical outcomes during the study period. Adjusted rates of superficial surgical site infection (3.2 vs. 3.2%, p=0.91), wound complications (5.9 vs. 6.5%, p=0.30), any complication (12.4 vs. 13.2%, p=0.26), and 30-day mortality (2.1 vs. 1.9%, p=0.32) at participating hospitals were similar before and after implementation. Difference-in-differences analysis accounting for trends in non-participating centers (n=15 hospitals), and sensitivity analysis excluding patients receiving surgery in the first 6- or 12-months after program implementation yielded similar results. Conclusions and Relevance Implementation of a checklist-based quality improvement intervention did not impact rates of adverse surgical outcomes among patients undergoing general surgery in participating Michigan hospitals. Additional research is needed to understand why this program was not successful prior to further dissemination and implementation of this model to other populations. PMID:25588183

Improving health outcomes for young people with long term conditions: The role of digital communication in current and future patient-clinician communication for NHS providers of specialist clinical services for young people - LYNC study protocol.

PubMed

Griffiths, Frances E; Atherton, Helen; Barker, Jack R; Cave, Jonathan Ak; Dennick, Kathryn; Dowdall, Peter; Fraser, Joe; Huxley, Caroline; Kim, Sung-Wook; Madan, Jason J; Matharu, Harjit; Musumadi, Luhanga; Palmer, Tom M; Paul, Moli; Sankaranarayanan, Sailesh; Slowther, Anne-Marie; Sujan, Mark A; Sutcliffe, Paul A; Sturt, Jackie

2015-01-01

Young people living with long term conditions are vulnerable to health service disengagement. This endangers their long term health. Studies report requests for digital forms of communication - email, text, social media - with their health care team. Digital clinical communication is troublesome for the UK NHS. In this article we aim to present the research protocol for evaluating the impacts and outcomes of digital clinical communications for young people living with long term conditions and provide critical analysis of their use, monitoring and evaluation by NHS providers (LYNC study: Long term conditions, Young people, Networked Communications). The research involves: (a) patient and public involvement activities with 16-24 year olds with and without long term health conditions; (b) six literature reviews; (c) case studies - the main empirical part of the study - and (d) synthesis and a consensus meeting. Case studies use a mixed methods design. Interviews and non-participant observation of practitioners and patients communicating in up to 20 specialist clinical settings will be combined with data, aggregated at the case level (non-identifiable patient data) on a range of clinical outcomes meaningful within the case and across cases. We will describe the use of digital clinical communication from the perspective of patients, clinical staff, support staff and managers, interviewing up to 15 young people and 15 staff per case study. Outcome data includes emergency admissions, A&E attendance and DNA (did not attend) rates. Case studies will be analysed to understand impacts of digital clinical communication on patient health outcomes, health care costs and consumption, ethics and patient safety.

Perceived Neighborhood Violence, Parenting Styles, and Developmental Outcomes among Spanish Adolescents

ERIC Educational Resources Information Center

Gracia, Enrique; Fuentes, Maria C.; Garcia, Fernando; Lila, Marisol

2012-01-01

This article analyzed perceptions of neighborhood violence of Spanish adolescents (N = 1,015) from authoritative, authoritarian, indulgent, and neglectful families, and its association with three sets of developmental outcomes (psychological, behavioral, and academic). Tests of main and interactive effects were conducted to answer research…

The feasibility of a randomized controlled trial of esophagectomy for esophageal cancer - the ROMIO (Randomized Oesophagectomy: Minimally Invasive or Open) study: protocol for a randomized controlled trial

PubMed Central

2014-01-01

Background There is a need for evidence of the clinical effectiveness of minimally invasive surgery for the treatment of esophageal cancer, but randomized controlled trials in surgery are often difficult to conduct. The ROMIO (Randomized Open or Minimally Invasive Oesophagectomy) study will establish the feasibility of a main trial which will examine the clinical and cost-effectiveness of minimally invasive and open surgical procedures for the treatment of esophageal cancer. Methods/Design A pilot randomized controlled trial (RCT), in two centers (University Hospitals Bristol NHS Foundation Trust and Plymouth Hospitals NHS Trust) will examine numbers of incident and eligible patients who consent to participate in the ROMIO study. Interventions will include esophagectomy by: (1) open gastric mobilization and right thoracotomy, (2) laparoscopic gastric mobilization and right thoracotomy, and (3) totally minimally invasive surgery (in the Bristol center only). The primary outcomes of the feasibility study will be measures of recruitment, successful development of methods to monitor quality of surgery and fidelity to a surgical protocol, and development of a core outcome set to evaluate esophageal cancer surgery. The study will test patient-reported outcomes measures to assess recovery, methods to blind participants, assessments of surgical morbidity, and methods to capture cost and resource use. ROMIO will integrate methods to monitor and improve recruitment using audio recordings of consultations between recruiting surgeons, nurses, and patients to provide feedback for recruiting staff. Discussion The ROMIO study aims to establish efficient methods to undertake a main trial of minimally invasive surgery versus open surgery for esophageal cancer. Trial registration The pilot trial has Current Controlled Trials registration number ISRCTN59036820(25/02/2013) at http://www.controlled-trials.com; the ROMIO trial record at that site gives a link to the original version of the study protocol. PMID:24888266

A Core Outcome Set for the Benefits and Adverse Events of Bariatric and Metabolic Surgery: The BARIACT Project.

PubMed

Coulman, Karen D; Hopkins, James; Brookes, Sara T; Chalmers, Katy; Main, Barry; Owen-Smith, Amanda; Andrews, Robert C; Byrne, James; Donovan, Jenny L; Mazza, Graziella; Reeves, Barnaby C; Rogers, Chris A; Thompson, Janice L; Welbourn, Richard; Wordsworth, Sarah; Blazeby, Jane M

2016-11-01

Bariatric and metabolic surgery is used as a treatment for patients with severe and complex obesity. However, there is a need to improve outcome selection and reporting in bariatric surgery trials. A Core Outcome Set (COS), an agreed minimum set of outcomes reported in all studies of a specific condition, may achieve this. Here, we present the development of a COS for BARIAtric and metabolic surgery Clinical Trials-the BARIACT Study. Outcomes identified from systematic reviews and patient interviews informed a questionnaire survey. Patients and health professionals were surveyed three times and asked to rate the importance of each item on a 1-9 scale. Delphi methods provided anonymised feedback to participants. Items not meeting predefined criteria were discarded between rounds. Remaining items were discussed at consensus meetings, held separately with patients and professionals, where the COS was agreed. Data sources identified 2,990 outcomes, which were used to develop a 130-item questionnaire. Round 1 response rates were moderate but subsequently improved to above 75% for other rounds. After rounds 2 and 3, 81 and 14 items were discarded, respectively, leaving 35 items for discussion at consensus meetings. The final COS included nine items: "weight," "diabetes status," "cardiovascular risk," "overall quality of life (QOL)," "mortality," "technical complications of the specific operation," "any re-operation/re-intervention," "dysphagia/regurgitation," and "micronutrient status." The main limitation of this study was that it was based in the United Kingdom only. The COS is recommended to be used as a minimum in all trials of bariatric and metabolic surgery. Adoption of the COS will improve data synthesis and the value of research data. Future work will establish methods for the measurement of the outcomes in the COS.

Long-Chain Polyunsaturated Fatty Acids and Clinical Outcomes of Preterm Infants.

PubMed

Lapillonne, Alexandre; Moltu, Sissel J

2016-01-01

Long-chain polyunsaturated fatty acids (LCPUFAs) play specific roles during the perinatal period and are very important nutrients to consider. The possible effects of LCPUFAs, particularly docosahexaenoic acid (DHA), on various clinical outcomes of preterm infants are discussed in this paper. Since DHA accumulates in the central nervous system during development, a lot of attention has focused on the effects of DHA on neurodevelopment. Experimental studies as well as recent clinical trials show that providing larger amounts of DHA than currently and routinely provided is associated with better neurological outcomes at 18 months to 2 years. This early advantage, however, does not seem to translate into detectable change in visual and neurodevelopmental outcomes or behavior when assessed in childhood. There is growing evidence that, in addition to effects on development, omega-3 LCPUFAs may reduce the incidence or severity of neonatal morbidities by affecting different steps of the immune and anti-inflammatory response. Studies in preterm infants suggest that the omega-3 LCPUFAs may play a significant role by reducing the risk of bronchopulmonary dysplasia, necrotizing enterocolitis and possibly retinopathy of prematurity and sepsis. Overall, evidence is increasing to support the benefits of high-dose DHA for various health outcomes of preterm infants. These findings are of major clinical relevance mainly because infants born preterm are at particularly high risk for a nutritional deficit in omega-3 fatty acids, predisposing to adverse neonatal outcomes. Further studies are warranted to address these issues as well as to more precisely determine the LCPUFA requirement in order to favor the best possible outcomes of preterm infants. © 2016 S. Karger AG, Basel.

Long-term outcomes of patients receiving a massive transfusion after trauma.

PubMed

Mitra, Biswadev; Gabbe, Belinda J; Kaukonen, Kirsi-Maija; Olaussen, Alexander; Cooper, David J; Cameron, Peter A

2014-10-01

Resuscitation of patients presenting with hemorrhagic shock after major trauma has evolved to incorporate multiple strategies to maintain tissue perfusion and oxygenation while managing coagulation disorders. We aimed to study changes across time in long-term outcomes in patients with major trauma. A retrospective observational study in a single major trauma center in Australia was conducted. We included all patients with major trauma and massive blood transfusion within the first 24 h during a 6-year period (from 2006 to 2011). The main outcome measures were Glasgow Outcome Score-Extended (GOSE) and work capacity at 6 and 12 months. There were 5,915 patients with major trauma of which 365 (6.2%; 95% confidence interval [95% CI], 5.6 - 6.8) received a massive transfusion. The proportion of major trauma patients receiving a massive transfusion decreased across time from 8.2% to 4.4% (P < 0.01). There were statistically significant trends toward lower volumes of red blood cell transfusion and higher ratios of fresh-frozen plasma to red blood cells (P < 0.01). Among massively transfused patients, there was no significant change in measured outcomes during the study period, with a persistent 23% mortality in hospital, 52% unfavorable GOSE at 6 months, and 44% unfavorable GOSE at 12 months. Massive transfusion was independently associated with unfavorable outcomes at 6 months after injury (adjusted odds ratio, 1.56; 95% CI, 1.05 - 2.31) but not at 12 months (adjusted odds ratio, 0.85; 95% CI, 0.72 - 1.01). A significant reduction in massive transfusion rates was observed. Unfavorable long-term outcomes among patients receiving a massive transfusion after trauma were frequent with a substantial proportion of survivors experiencing poor functional status 1 year after injury.

Gender Differences in the Consequences of Divorce: A Study of Multiple Outcomes.

PubMed

Leopold, Thomas

2018-06-01

In this study, I examined gender differences in the consequences of divorce by tracing annual change in 20 outcome measures covering four domains: economic, housing and domestic, health and well-being, and social. I used data from the German Socio-Economic Panel Study (SOEP) and fixed-effects panel regression models on a sample of N = 18,030 individuals initially observed in a marital union, N = 1,220 of whom divorced across the observation period (1984-2015). Three main findings emerged from the analysis. First, men were more vulnerable to short-term consequences of divorce for subjective measures of well-being, but postdivorce adaptation alleviated gender differences in these outcomes. Second, a medium-term view on multiple outcomes showed more similarity than differences between women and men. The medium-term consequences of divorce were similar in terms of subjective economic well-being; mental health, physical health, and psychological well-being; residential moves, homeownership, and satisfaction with housework; and chances of repartnering, social integration with friends and relatives, and feelings of loneliness. Third, the key domain in which large and persistent gender differences emerged were women's disproportionate losses in household income and associated increases in their risk of poverty and single parenting. Taken together, these findings suggest that men's disproportionate strain of divorce is transient, whereas women's is chronic.

Evaluating Alcoholics Anonymous's effect on drinking in Project MATCH using cross-lagged regression panel analysis.

PubMed

Magura, Stephen; Cleland, Charles M; Tonigan, J Scott

2013-05-01

The objective of the study is to determine whether Alcoholics Anonymous (AA) participation leads to reduced drinking and problems related to drinking within Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), an existing national alcoholism treatment data set. The method used is structural equation modeling of panel data with cross-lagged partial regression coefficients. The main advantage of this technique for the analysis of AA outcomes is that potential reciprocal causation between AA participation and drinking behavior can be explicitly modeled through the specification of finite causal lags. For the outpatient subsample (n = 952), the results strongly support the hypothesis that AA attendance leads to increases in alcohol abstinence and reduces drinking/ problems, whereas a causal effect in the reverse direction is unsupported. For the aftercare subsample (n = 774), the results are not as clear but also suggest that AA attendance leads to better outcomes. Although randomized controlled trials are the surest means of establishing causal relations between interventions and outcomes, such trials are rare in AA research for practical reasons. The current study successfully exploited the multiple data waves in Project MATCH to examine evidence of causality between AA participation and drinking outcomes. The study obtained unique statistical results supporting the effectiveness of AA primarily in the context of primary outpatient treatment for alcoholism.

Adolescent cannabis and tobacco use and educational outcomes at age 16: birth cohort study

PubMed Central

Hickman, Matthew; Munafò, Marcus R.; Heron, Jon; Yip, Vikki L.; Macleod, John

2015-01-01

Abstract Aims To investigate the relationship between cannabis and tobacco use by age 15 and subsequent educational outcomes. Design Birth cohort study. Setting England. Participants The sample was drawn from the Avon Longitudinal Study of Parents and Children; a core sample of 1155 individuals had complete information on all the variables. Measurements The main exposures were cannabis and tobacco use at age 15 assessed in clinic by computer‐assisted questionnaire and serum cotinine. The main outcomes were performance in standardized assessments at 16 [Key Stage 4, General Certificate of Secondary Education (GCSE)] in English and mathematics (mean scores), completion of five or more assessments at grade C level or higher and leaving school having achieved no qualifications. Analyses were sequentially adjusted for multiple covariates using a hierarchical approach. Covariates considered were: maternal substance use (ever tobacco or cannabis use, alcohol use above recommended limits); life course socio‐economic position (family occupational class, maternal education, family income); child sex; month and year of birth; child educational attainment prior to age 11 (Key Stage 2); child substance use (tobacco, alcohol and cannabis) prior to age 15 and child conduct disorder. Findings In fully adjusted models both cannabis and tobacco use at age 15 were associated with subsequent adverse educational outcomes. In general, the dose–response effect seen was consistent across all educational outcomes assessed. Weekly cannabis use was associated negatively with English GCSE results [grade point difference (GPD), –5.93, 95% confidence interval (CI) = –8.34, –3.53] and with mathematics GCSE results (GPD, –6.91, 95% CI = –9.92, –3.89). Daily tobacco smoking was associated negatively with English GCSE (GPD, –11.90, 95% CI = –13.47, –10.33) and with mathematics GCSE (GPD, –16.72, 95% CI = –18.57, –14.86). The greatest attenuation of these effects was seen on adjustment for other substance use and conduct disorder. Following adjustment, tobacco appeared to have a consistently stronger effect than cannabis. Conclusions Both cannabis and tobacco use in adolescence are associated strongly with subsequent adverse educational outcomes. Given the non‐specific patterns of association seen and the attenuation of estimates on adjustment, it is possible that these effects arise through non‐causal mechanisms, although a causal explanation cannot be discounted. © 2015 Society for the Study of Addiction PMID:25488831

Preschool Center Quality and School Readiness: Quality Effects and Variation by Demographic and Child Characteristics

PubMed Central

Keys, Tran D.; Farkas, George; Burchinal, Margaret R.; Duncan, Greg J.; Vandell, Deborah L.; Li, Weilin; Ruzek, Erik A.; Howes, Carollee

2014-01-01

This article examines associations between observed quality in preschool center classrooms for approximately 6,250 three- to five-year-olds and their school readiness skills at kindergarten entry. Secondary analyses were conducted using data from four large-scale studies to estimate the effects of preschool center quality and interactions between quality and demographic characteristics and child entry skills and behaviors. Findings were summarized across studies using meta-analytic methods. Results indicate small, but statistically significant associations for preschool center quality main effects on language and mathematics outcomes with little evidence of moderation by demographic characteristics or child entry skills and behaviors. Preschool center quality was not reliably related to socioemotional outcomes. The authors discuss possible explanations for the small effect sizes and lack of differential effects. PMID:23331043

Surgical Satisfaction, Quality of Life, and Their Association After Gender-Affirming Surgery: A Follow-up Study.

PubMed

van de Grift, Tim C; Elaut, Els; Cerwenka, Susanne C; Cohen-Kettenis, Peggy T; Kreukels, Baudewijntje P C

2018-02-17

We assessed the outcomes of gender-affirming surgery (GAS, or sex-reassignment surgery) 4 to 6 years after first clinical contact, and the associations between postoperative (dis)satisfaction and quality of life (QoL). Our multicenter, cross-sectional follow-up study involved persons diagnosed with gender dysphoria (DSM-IV-TR) who applied for medical interventions from 2007 until 2009. Of 546 eligible persons, 201 (37%) responded, of whom 136 had undergone GAS (genital, chest, facial, vocal cord and/or thyroid cartilage surgery). Main outcome measures were procedure performed, self-reported complications, and satisfaction with surgical outcomes (standardized questionnaires), QoL (Satisfaction With Life Scale, Subjective Happiness Scale, Cantril Ladder), gender dysphoria (Utrecht Gender Dysphoria Scale), and psychological symptoms (Symptom Checklist-90). Postoperative satisfaction was 94% to 100%, depending on the type of surgery performed. Eight (6%) of the participants reported dissatisfaction and/or regret, which was associated with preoperative psychological symptoms or self-reported surgical complications (OR = 6.07). Satisfied respondents' QoL scores were similar to reference values; dissatisfied or regretful respondents' scores were lower. Therefore, dissatisfaction after GAS may be viewed as indicator of unfavorable psychological and QoL outcomes.

Toward a culture-by-context perspective on negotiation: negotiating teams in the United States and Taiwan.

PubMed

Gelfand, Michele J; Brett, Jeanne; Gunia, Brian C; Imai, Lynn; Huang, Tsai-Jung; Hsu, Bi-Fen

2013-05-01

Within the United States, teams outperform solos in negotiation (Thompson, Peterson, & Brodt, 1996). The current research examined whether this team advantage generalizes to negotiators from a collectivist culture (Taiwan). Because different cultures have different social norms, and because the team context may amplify the norms that are salient in a particular culture (Gelfand & Realo, 1999), we predicted that the effect of teams on negotiation would differ across cultures. Specifically, we predicted that since harmony norms predominate in collectivist cultures like Taiwan, the team context would amplify a concern with harmony, leading Taiwanese teams to negotiate especially suboptimal outcomes. In support, 2 studies showed that Taiwanese teams negotiated less-optimal outcomes than Taiwanese solos. We also used a moderated-mediation analysis to investigate the mechanism (Hayes, 2012), documenting that the interactive effect of culture and context on outcomes was mediated by harmony norms. By showing that the same situational conditions (team negotiations) can have divergent effects on negotiation outcomes across cultures, our results point toward a nuanced, sociocontextual view that moves beyond the culture-as-main-effect approach to studying culture and negotiations. PsycINFO Database Record (c) 2013 APA, all rights reserved.

The urban environment and sexual risk behavior among men who have sex with men.

PubMed

Frye, Victoria; Latka, Mary H; Koblin, Beryl; Halkitis, Perry N; Putnam, Sara; Galea, Sandro; Vlahov, David

2006-03-01

Increasingly, studies show that characteristics of the urban environment influence a wide variety of health behaviors and disease outcomes, yet few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). This focus is important as many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. As interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, consideration of broader environmental influences is needed. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM is underdeveloped. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions.

Health and social determinants and outcomes of home cooking: A systematic review of observational studies.

PubMed

Mills, Susanna; White, Martin; Brown, Heather; Wrieden, Wendy; Kwasnicka, Dominika; Halligan, Joel; Robalino, Shannon; Adams, Jean

2017-04-01

Many dietary interventions assume a positive influence of home cooking on diet, health and social outcomes, but evidence remains inconsistent. We aimed to systematically review health and social determinants and outcomes of home cooking. Given the absence of a widely accepted, established definition, we defined home cooking as the actions required for preparing hot or cold foods at home, including combining, mixing and often heating ingredients. Nineteen electronic databases were searched for relevant literature. Peer-reviewed studies in English were included if they focussed mainly on home cooking, and presented post 19 th century observational or qualitative data on participants from high/very high human development index countries. Interventional study designs, which have previously been reviewed, were excluded. Themes were summarised using narrative synthesis. From 13,341 unique records, 38 studies - primarily cross-sectional in design - met the inclusion criteria. A conceptual model was developed, mapping determinants of home cooking to layers of influence including non-modifiable, individual, community and cultural factors. Key determinants included female gender, greater time availability and employment, close personal relationships, and culture and ethnic background. Putative outcomes were mostly at an individual level and focused on potential dietary benefits. Findings show that determinants of home cooking are more complex than simply possessing cooking skills, and that potential positive associations between cooking, diet and health require further confirmation. Current evidence is limited by reliance on cross-sectional studies and authors' conceptualisation of determinants and outcomes. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Youth Physical Activity Resources Use and Activity Measured by Accelerometry

PubMed Central

Maslow, Andréa L.; Colabianchi, Natalie

2014-01-01

Objectives To examine whether utilization of physical activity resources (eg, parks) was associated with daily physical activity measured by accelerometry. Methods 111 adolescents completed a travel diary with concurrent accelerometry. The main exposure was self-reported utilization of a physical activity resource (none/1+ resources). The main outcomes were total minutes spent in daily 1) moderate-vigorous physical activity and 2) vigorous physical activity. Results Utilizing a physical activity resource was significantly associated with total minutes in moderate-vigorous physical activity. African-Americans and males had significantly greater moderate-vigorous physical activity. Conclusions Results from this study support the development and use of physical activity resources. PMID:21204684

Youth physical activity resource use and activity measured by accelerometry.

PubMed

Maslow, Andréa L; Colabianchi, Natalie

2011-01-01

To examine whether use of physical activity resources (eg, parks) was associated with daily physical activity measured by accelerometry. One hundred eleven adolescents completed a travel diary with concurrent accelerometry. The main exposure was self-reported use of a physical activity resource (none /1+ resources). The main outcomes were total minutes spent in daily (1) moderate-vigorous physical activity and (2) vigorous physical activity. Using a physical activity resource was significantly associated with total minutes in moderate-vigorous physical activity. African Americans and males had significantly greater moderate-vigorous physical activity. Results from this study support the development and use of physical activity resources.

Implicit cognitive processes in psychopathology: an introduction.

PubMed

Wiers, Reinout W; Teachman, Bethany A; De Houwer, Jan

2007-06-01

Implicit or automatic processes are important in understanding the etiology and maintenance of psychopathological problems. In order to study implicit processes in psychopathology, measures are needed that are valid and reliable when applied to clinical problems. One of the main topics in this special issue concerns the development and validation of new or modified implicit tests in different domains of psychopathology. The other main topic concerns the prediction of clinical outcomes and new ways to directly influence implicit processes in psychopathology. We summarize the contributions to this special issue and discuss how they further our knowledge of implicit processes in psychopathology and how to measure them.

Positive Attributes Buffer the Negative Associations Between Low Intelligence and High Psychopathology With Educational Outcomes.

PubMed

Hoffmann, Mauricio Scopel; Leibenluft, Ellen; Stringaris, Argyris; Laporte, Paola Paganella; Pan, Pedro Mario; Gadelha, Ary; Manfro, Gisele Gus; Miguel, Eurípedes Constantino; Rohde, Luis Augusto; Salum, Giovanni Abrahão

2016-01-01

This study examines the extent to which children's positive attributes are distinct from psychopathology. We also investigate whether positive attributes change or "buffer" the impact of low intelligence and high psychopathology on negative educational outcomes. In a community sample of 2,240 children (6-14 years of age), we investigated associations among positive attributes, psychopathology, intelligence, and negative educational outcomes. Negative educational outcomes were operationalized as learning problems and poor academic performance. We tested the discriminant validity of psychopathology versus positive attributes using confirmatory factor analysis (CFA) and propensity score matching analysis (PSM), and used generalized estimating equations (GEE) models to test main effects and interactions among predictors of educational outcomes. According to both CFA and PSM, positive attributes and psychiatric symptoms were distinct constructs. Positive attributes were associated with lower levels of negative educational outcomes, independent of intelligence and psychopathology. Positive attributes buffer the negative effects of lower intelligence on learning problems, and higher psychopathology on poor academic performance. Children's positive attributes are associated with lower levels of negative school outcomes. Positive attributes act both independently and by modifying the negative effects of low intelligence and high psychiatric symptoms on educational outcomes. Subsequent research should test interventions designed to foster the development of positive attributes in children at high risk for educational problems. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. All rights reserved.

Positive Attributes Buffer the Negative Associations Between Low Intelligence and High Psychopathology With Educational Outcomes

PubMed Central

Hoffmann, Mauricio Scopel; Leibenluft, Ellen; Stringaris, Argyris; Laporte, Paola Paganella; Pan, Pedro Mario; Gadelha, Ary; Manfro, Gisele Gus; Miguel, Eurípedes Constantino; Rohde, Luis Augusto; Salum, Giovanni Abrahão

2016-01-01

Objective This study examines the extent to which children’s positive attributes are distinct from psychopathology. We also investigate whether positive attributes change or “buffer” the impact of low intelligence and high psychopathology on negative educational outcomes. Method In a community sample of 2,240 children (6–14 years of age), we investigated associations among positive attributes, psychopathology, intelligence, and negative educational outcomes. Negative educational outcomes were operationalized as learning problems and poor academic performance. We tested the discriminant validity of psychopathology versus positive attributes using confirmatory factor analysis (CFA) and propensity score matching analysis (PSM), and used generalized estimating equations (GEE) models to test main effects and interactions among predictors of educational outcomes. Results According to both CFA and PSM, positive attributes and psychiatric symptoms were distinct constructs. Positive attributes were associated with lower levels of negative educational outcomes, independent of intelligence and psychopathology. Positive attributes buffer the negative effects of lower intelligence on learning problems, and higher psychopathology on poor academic performance. Conclusion Children’s positive attributes are associated with lower levels of negative school outcomes. Positive attributes act both independently and by modifying the negative effects of low intelligence and high psychiatric symptoms on educational outcomes. Subsequent research should test interventions designed to foster the development of positive attributes in children at high risk for educational problems. PMID:26703909

Small-for-gestational age and large-for-gestational age thresholds to predict infants at risk of adverse delivery and neonatal outcomes: are current charts adequate? An observational study from the Born in Bradford cohort

PubMed Central

Norris, T; Johnson, W; Farrar, D; Tuffnell, D; Wright, J; Cameron, N

2015-01-01

Objectives Construct an ethnic-specific chart and compare the prediction of adverse outcomes using this chart with the clinically recommended UK-WHO and customised birth weight charts using cut-offs for small-for-gestational age (SGA: birth weight <10th centile) and large-for-gestational age (LGA: birth weight >90th centile). Design Prospective cohort study. Setting Born in Bradford (BiB) study, UK. Participants 3980 White British and 4448 Pakistani infants with complete data for gestational age, birth weight, ethnicity, maternal height, weight and parity. Main outcome measures Prevalence of SGA and LGA, using the three charts and indicators of diagnostic utility (sensitivity, specificity and area under the receiver operating characteristic (AUROC)) of these chart-specific cut-offs to predict delivery and neonatal outcomes and a composite outcome. Results In White British and Pakistani infants, the prevalence of SGA and LGA differed depending on the chart used. Increased risk of SGA was observed when using the UK-WHO and customised charts as opposed to the ethnic-specific chart, while the opposite was apparent when classifying LGA infants. However, the predictive utility of all three charts to identify adverse clinical outcomes was poor, with only the prediction of shoulder dystocia achieving an AUROC>0.62 on all three charts. Conclusions Despite being recommended in national clinical guidelines, the UK-WHO and customised birth weight charts perform poorly at identifying infants at risk of adverse neonatal outcomes. Being small or large may increase the risk of an adverse outcome; however, size alone is not sensitive or specific enough with current detection to be useful. However, a significant amount of missing data for some of the outcomes may have limited the power needed to determine true associations. PMID:25783424

A quasi-experimental outcomes analysis of a psychoeducation intervention for pregnant women with abuse-related posttraumatic stress

PubMed Central

Rowe, Heather; Sperlich, Mickey; Seng, Julia S.

2015-01-01

Objective To test the effectiveness of a trauma-specific psycho-educational intervention for pregnant women with a history of childhood maltreatment on six intrapartum and postpartum psychological outcomes. Design Quasi-experimental study comparing women from a single-group pretest-posttest pilot intervention study with women matched from a prospective observational study. Setting Rural and university-based prenatal clinics. Participants Pregnant women entered the study by responding to an advertisement or by referral from a maternity care provider. Women could take part whether or not they met posttraumatic stress disorder diagnostic criteria. Outcomes data exist for 17 pilot intervention study participants and 43 matched observational study participants. Interventions Participants in the observational study received usual care. Participants in the pilot intervention study received usual care plus the intervention, a fully manualized self-study program supported by weekly phone tutoring sessions with a health professional. Main Outcome Measures The National Women’s Study PTSD Module; The Peritraumatic Dissociation Experience Questionnaire); The Perception of Care Questionnaire; The Postpartum Depression Screening Scale; The Postpartum Bonding Questionnaire; and a semantic differential appraisal of the labor experience. Results Participants in the intervention study had better scores on all measures. Differences in means between participants in the intervention study and participants in the observational study equated to medium effect sized for dissociation during labor, rating of labor experience, and perception of care in labor, and small effect sizes for postpartum PTSD symptoms, postpartum depression symptoms, and mother-infant bonding. Conclusion This trauma-specific intervention reaches and benefits pregnant women with a history of childhood maltreatment. PMID:24754455

A prospective study of short- and long-term cosmetic outcome after reduction mammaplasty from three different perspectives: the patient, a department surgeon, and an independent private practitioner in plastic surgery.

PubMed

Breiting, Line Bro; Henriksen, Trine Foged; Kalialis, Louise Vennegaard; Gramkow, Christina; Høyer, Anette Pernille

2012-08-01

Numerous studies have examined the outcome of reduction mammaplasty. This study evaluates the cosmetic outcome after reduction mammaplasty from the perspective of the patient, a ward surgeon, and a private practitioner in plastic surgery, and analyzes which factors influence it. The material stems from a Danish quality assurance program in the public health care system. Nonparametric statistics and logistic regression were used to compare cosmetic outcomes and possible confounding. Over 80 percent of the patients evaluated the short- and long-term cosmetic outcome as good or very good. The surgeons and especially the private practitioner were more critical. The evaluation of breast features also differs between patients and surgeons. The main issue for patients is symmetry. With time, patients and the private practitioner become more critical about the scars. Surgeons are most concerned about nipple bottoming out. Predictive factors for surgeons were the patient's age, body mass index, and postoperative complications. Evaluation by patients was, in addition to complications, influenced by the preoperative information given, confidence in the treatment, and the overall course on the ward. Patients evaluate cosmetic outcome significantly more favorably than surgeons and especially the private practitioner. They are also concerned about different breast features. Decreased nipple sensation does not influence the patient's evaluation. Evaluation by the surgeons depends on more objective measures than does evaluation by the patients. One must not underestimate the importance of factors such as preoperative information about the surgery and complications, together with proper and qualified care. Therapeutic, II.

24/7 Presence of Medical Staff in the Labor Ward; No Day-Night Differences in Perinatal and Maternal Outcomes.

PubMed

Tavares, Sara; Cavaco-Gomes, João; Moucho, Marina; Severo, Milton; Mateus, Mário; Ramalho, Carla; Visser, Gerard H A; Montenegro, Nuno

2017-05-01

Objective  The objective of this study was to assess possible day-night differences in perinatal and maternal labor outcomes in a hospital setting with no day-night differences in the presence of experienced medical staff. Design  This was a retrospective study conducted over 5 years between 2008 and 2012. Setting  This study was set at the obstetric delivery unit in a tertiary hospital. Population  A total of 9,143 singleton deliveries were assessed after 34 weeks of gestation and after exclusion of major congenital malformations, inductions of labor, and elective cesarean sections. Materials and Methods  Data were collected using the hospital electronic medical records. Time periods of 8 hours were defined (daytime between 8 am and 4 pm, evening time between 4 pm and 12 pm, and nighttime between 12 pm and 8 am). Differences between the three time periods were assessed using software R Core Team (2013). Main outcome measures were neonatal birth asphyxia, neonatal intensive care unit admission, and neonatal death. Results  There were no differences in perinatal and maternal outcomes in the course of the day, apart from a higher incidence of third- and fourth-degree tears during the evening. Neonatal outcome after obstetric emergencies (uterine rupture, partial placental abruption, and cord prolapse) also showed no day-night differences. Conclusion  Adverse nighttime-related outcomes may be avoided by the 24/7 presence of experienced medical staff. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hepatocellular carcinoma with main portal vein tumor thrombus: a comparative study comparing hepatectomy with or without neoadjuvant radiotherapy.

PubMed

Li, Nan; Feng, Shuang; Xue, Jie; Wei, Xu-Biao; Shi, Jie; Guo, Wei-Xing; Lau, Wan-Yee; Wu, Meng-Chao; Cheng, Shu-Qun; Meng, Yan

2016-06-01

Hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (mPVTT) has a poor prognosis even after surgical resection. Whether neoadjuvant radiotherapy improves surgical outcomes is currently unknown. The aim of this study was to compare the survival of patients with resectable HCC and mPVTT who underwent neoadjuvant therapy to those who underwent surgery alone. A non-randomized comparative study was performed. For patients in the neoadjuvant radiotherapy group, three-dimensional conformal radiotherapy was administrated with a daily fraction of 300 cGy in 6 consecutive days. Hepatectomy was carried out 4 weeks after completion of irradiation. 95 patients were enrolled into this study. In the neoadjuvant radiotherapy group (n = 45), 12 patients showed gross radiological reduction in extent of PVTT. In 6 patients, the extent of PVTT was reduced to be within the ipsilateral side of the portal vein. When compared with patients who underwent surgery alone (n = 50), neoadjuvant radiotherapy significantly decreased the rates of HCC recurrence and HCC-related death, with hazard ratios of 0.36 (95% CI, 0.19-0.70) and 0.32 (95% CI, 0.18-0.57), respectively. For patients with HCC with mPVTT, neoadjuvant radiotherapy before partial hepatectomy provided better postoperative survival outcomes than partial hepatectomy alone. Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Semen quality and alcohol intake: a systematic review and meta-analysis.

PubMed

Ricci, Elena; Al Beitawi, Suha; Cipriani, Sonia; Candiani, Massimo; Chiaffarino, Francesca; Viganò, Paola; Noli, Stefania; Parazzini, Fabio

2017-01-01

Alcohol consumption is widespread in the Western world. Some studies have suggested a negative association between alcohol intake and semen quality although others have not confirmed this. MEDLINE and Embase were searched using 'alcohol intake' OR 'alcohol consumption' OR 'alcohol drinking' OR 'lifestyle' combined with 'semen quality' OR 'sperm quality' OR 'sperm volume' OR 'sperm concentration' OR 'sperm motility' for full-length observational articles, published in English. Reference lists of retrieved articles were searched for other pertinent studies. Main outcome measures were sperm parameters, if provided as means (standard deviation or standard error) or as medians (interquartile range). Fifteen cross-sectional studies were included, with 16,395 men enrolled. Main results showed that alcohol intake has a detrimental effect on semen volume (pooled estimate for no/low alcohol consumption 0.25 ml, 95% CI, 0.07 to 0.42) and normal morphology (1.87%, 95% CI, 0.86 to 2.88%). The difference was more marked when comparing occasional versus daily consumers, rather than never versus occasional, suggesting a moderate consumption did not adversely affect semen parameters. Hence, studies evaluating the effect of changes on semen parameters on the reproductive outcomes are needed in advance of providing recommendations regarding alcohol intake other than the advice to avoid heavy alcohol drinking. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Short-term variations in bone remodeling markers of an oral contraception formulation containing 3 mg of drospirenone plus 30 microg of ethinyl estradiol: observational study in young postadolescent women.

PubMed

Paoletti, Anna Maria; Orrù, Marisa; Lello, Stefano; Floris, Stefano; Ranuzzi, Francesca; Etzi, Rossella; Zedda, Pierina; Guerriero, Stefano; Fratta, Stefania; Sorge, Roberto; Mallarini, Giorgio; Melis, Gian Benedetto

2004-10-01

The clinical study of treated subjects and nontreated controls was made in healthy eumenorrheic young postadolescent women volunteers in the Department of Obstetrics and Gynaecology at Cagliari University, to investigate whether an oral contraceptive (OC) containing drospirenone (3 mg) plus ethinyl estradiol (30 microg) (DRSP+EE) can affect bone metabolism. Control group (n = 26) and OC group (n = 28) women did not differ in age, body mass index, waist-to-hip ratio and main outcome measures [urinary levels of deoxypyridinoline and pyridinoline, serum levels of osteocalcin, bone specific alkaline phosphatase (bSAP), total testosterone (total-T), sex hormone-binding globulin (SHBG), progesterone and bone mineral density (BMD) at the heel]. The control group was studied at the luteal phase (LP) during both the first and the sixth menstrual cycle; the OC group was studied during the first cycle at the LP, and on days 16-18 of the sixth cycle of DRSP+EE treatment. At the sixth cycle, in the control group, the main outcome measures did not change compared to baseline. In the OC group, deoxypyridinoline, pyridinoline, osteocalcin, bSAP, total-T and progesterone levels were reduced, whereas SHBG levels were increased. The BMD was unchanged compared to baseline. The results suggest that 6-month DRSP+EE treatment decreases bone turnover. Copyright 2004 Elsevier Inc.

Impact of an electronic sepsis initiative on antibiotic use and health care facility-onset Clostridium difficile infection rates.

PubMed

Hiensch, Robert; Poeran, Jashvant; Saunders-Hao, Patricia; Adams, Victoria; Powell, Charles A; Glasser, Allison; Mazumdar, Madhu; Patel, Gopi

2017-10-01

Although integrated, electronic sepsis screening and treatment protocols are thought to improve patient outcomes, less is known about their unintended consequences. We aimed to determine if the introduction of a sepsis initiative coincided with increases in broad-spectrum antibiotic use and health care facility-onset (HCFO) Clostridium difficile infection (CDI) rates. We used interrupted time series data from a large, tertiary, urban academic medical center including all adult inpatients on 4 medicine wards (June 2011-July 2014). The main exposure was implementation of the sepsis screening program; the main outcomes were the use of broad-spectrum antibiotics (including 3 that were part of an order set designed for the sepsis initiative) and HCFO CDI rates. Segmented regression analyses compared outcomes in 3 time segments: before (11 months), during (14 months), and after (12 months) implementation of a sepsis initiative. Antibiotic use and HFCO CDI rates increased during the period of implementation and the period after implementation compared with baseline; these increases were highest in the period after implementation (level change, 50.4 days of therapy per 1,000 patient days for overall antibiotic use and 10.8 HCFO CDIs per 10,000 patient days; P < .05). Remarkably, the main drivers of overall antibiotic use were not those included in the sepsis order set. The implementation of an electronic sepsis screening and treatment protocol coincided with increased broad-spectrum antibiotic use and HCFO CDIs. Because these protocols are increasingly used, further study of their unintended consequences is warranted. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

A comparison of pregnancy outcomes in Ghanaian women with varying dietary diversity: a prospective cohort study protocol

PubMed Central

Saaka, Mahama; Siassi, Fereydoun; Qorbani, Mostafa; Yavari, Parvaneh; Danquah, Ina; Sotoudeh, Gity

2016-01-01

Introduction Poor dietary intake during pregnancy can have negative repercussions on the mother and fetus. This study therefore aims to explore the dietary diversity (DD) of pregnant women and its associations with pregnancy outcomes among women in Northern Ghana. The main outcome variables to be measured are gestational weight gain and birth weight. Methods and analysis A prospective cohort study design will be used and 600 pregnant women in their first trimester will be systematically recruited at health facilities and followed until delivery. In three follow-up visits after recruitment, information on sociodemographic and general characteristics, physical activity (International Physical Activity Questionnaire (IPAQ) short form, dietary intake (24-hour food recall), anthropometry and pregnancy outcomes will be collected. DD will be measured three times using the minimum DD-women (MDD-W) indicator and the mean of the three values overall will be used to determine low (<5 food groups) and high (≥5 food groups) DD. Data will be analysed using SPSS. Comparisons between groups (categorical data) will be made using the χ2 test for proportions, and t-tests and ANOVA will be performed on continuous variables. Regression analysis will be used to identify independent outcome predictors while controlling for possible confounding factors. The results may help to identify differences in DD between healthy and unhealthy pregnancy outcomes. Ethics and dissemination The study protocol has been approved by the ethics committee of Tehran University of Medical Sciences and the ethical review committee of the Tamale Teaching Hospital. Written informed consent will be obtained from all subjects. The results will be published in due course. PMID:27655259

Long-term outcomes of childhood cancer survivors in Sweden: a population-based study of education, employment, and income.

PubMed

Boman, Krister K; Lindblad, Frank; Hjern, Anders

2010-03-01

Studies of different national populations were indispensable for estimating the impact of illness-related disability on social outcomes in adult childhood cancer survivors. The effects of childhood cancer on educational attainment, employment, and income in adulthood in a Swedish setting were studied. The study population was a national cohort of 1.46 million Swedish residents, including 1716 survivors of childhood cancer diagnosed before their 16th birthday, followed up in 2002 in registries at >25 years of age. Main outcomes were educational attainment, employment, and net income. Markers of persistent disability were considered, and outcomes were analyzed with multivariate linear and logistic regression models adjusted for age, sex, and socioeconomic indicators of the childhood households. Non-central nervous system (CNS) cancer survivors had similar education, employment, and income as the general population in adjusted models, whereas survivors of CNS tumors more often had no more than basic (< or =9 years) education (relative risk [RR], 1.80 [95% confidence interval (95% CI), 1.45-2.23]), less often attained education beyond secondary school (RR, 0.69 [95% CI, 0.58-0.81]), and less often were employed (RR, 0.85 [95% CI, 0.77-0.94]). Predicted net income from work was lower in CNS tumor survivors (P <.001) than in the general population, even after the exclusion of individuals who received economic disability compensation. CNS tumor survivors had poorer social outcomes compared with the general population, whereas outcomes for survivors of other childhood cancers were similar to the general population. Established late effects highlighted the importance of improved, safer pediatric CNS tumor treatment protocols and surveillance that identified individual needs for preventive and remedial measures.

A Systematic Review and Meta-Analysis of a Measure of Staff/Child Interaction Quality (the Classroom Assessment Scoring System) in Early Childhood Education and Care Settings and Child Outcomes.

PubMed

Perlman, Michal; Falenchuk, Olesya; Fletcher, Brooke; McMullen, Evelyn; Beyene, Joseph; Shah, Prakesh S

2016-01-01

The quality of staff/child interactions as measured by the Classroom Assessment Scoring System (CLASS) in Early Childhood Education and Care (ECEC) programs is thought to be important for children's outcomes. The CLASS is made of three domains that assess Emotional Support, Classroom Organization and Instructional Support. It is a relatively new measure that is being used increasingly for research, quality monitoring/accountability and other applied purposes. Our objective was to evaluate the association between the CLASS and child outcomes. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were conducted up to July 3, 2015. Studies that measured association between the CLASS and child outcomes for preschool-aged children who attended ECEC programs were included after screening by two independent reviewers. Searches and data extraction were conducted by two independent reviewers. Thirty-five studies were systematically reviewed of which 19 provided data for meta-analyses. Most studies had moderate to high risk of bias. Of the 14 meta-analyses we conducted, associations between Classroom Organization and Pencil Tapping and between Instructional Support and SSRS Social Skills were significant with pooled correlations of .06 and .09 respectively. All associations were in the expected direction. In the systematic review, significant correlations were reported mainly from one large dataset. Substantial heterogeneity in use of the CLASS, its dimensions, child outcomes and statistical measures was identified. Greater consistency in study methodology is urgently needed. Given the multitude of factors that impact child development it is encouraging that our analyses revealed some, although small, associations between the CLASS and children's outcomes.

A Systematic Review and Meta-Analysis of a Measure of Staff/Child Interaction Quality (the Classroom Assessment Scoring System) in Early Childhood Education and Care Settings and Child Outcomes

PubMed Central

Perlman, Michal; Falenchuk, Olesya; Fletcher, Brooke; McMullen, Evelyn; Beyene, Joseph; Shah, Prakesh S.

2016-01-01

The quality of staff/child interactions as measured by the Classroom Assessment Scoring System (CLASS) in Early Childhood Education and Care (ECEC) programs is thought to be important for children’s outcomes. The CLASS is made of three domains that assess Emotional Support, Classroom Organization and Instructional Support. It is a relatively new measure that is being used increasingly for research, quality monitoring/accountability and other applied purposes. Our objective was to evaluate the association between the CLASS and child outcomes. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were conducted up to July 3, 2015. Studies that measured association between the CLASS and child outcomes for preschool-aged children who attended ECEC programs were included after screening by two independent reviewers. Searches and data extraction were conducted by two independent reviewers. Thirty-five studies were systematically reviewed of which 19 provided data for meta-analyses. Most studies had moderate to high risk of bias. Of the 14 meta-analyses we conducted, associations between Classroom Organization and Pencil Tapping and between Instructional Support and SSRS Social Skills were significant with pooled correlations of .06 and .09 respectively. All associations were in the expected direction. In the systematic review, significant correlations were reported mainly from one large dataset. Substantial heterogeneity in use of the CLASS, its dimensions, child outcomes and statistical measures was identified. Greater consistency in study methodology is urgently needed. Given the multitude of factors that impact child development it is encouraging that our analyses revealed some, although small, associations between the CLASS and children’s outcomes. PMID:28036333

Which is Superior, Doppler Velocimetry or Non-stress Test or Both in Predicting the Perinatal Outcome of High-Risk Pregnancies.

PubMed

Subramanian, Vijaya; Venkat, Janani; Dhanapal, Mohana

2016-10-01

To analyze which is superior, Doppler velocimetry or non-stress test or both by means of categorization into four groups and comparing the prediction of perinatal outcome in high-risk pregnancies like anemia, hypertensive disorders of pregnancies. This was a prospective study conducted at the Department of Obstetrics and Gynaecology, ISO KGH, Madras Medical College, Chennai, in the year 2014. Two hundred high-risk pregnancies like anemia, hypertensive disorders of pregnancy were included in the study. They were examined systematically, and Doppler velocimetry and non-stress test were done. The main vessels studied by Doppler were umbilical artery and middle cerebral artery, and the indices were calculated. The results of the non-stress test were interpreted as reactive and non-reactive. Based on the results of Doppler and non-stress test, the 200 cases were categorized into four groups and the results were analyzed. Among the 200 cases of high-risk pregnancies, those with a normal Doppler study and a reactive non-stress test had good perinatal outcome. When both were abnormal, there was a higher percentage of adverse outcome as compared to that of either Doppler alone being abnormal or non-stress test alone being non-reactive. It was also found that abnormal Doppler but with a reactive non-stress test had the advantage of prolonging the pregnancy and bringing a better outcome indicating that non-stress test is surely a good test of well-being. When Doppler was normal, but non-stress test was non-reactive, there was an increase in the rate of cesarean section. Each method of fetal surveillance reflects different aspect of maternal and fetal pathophysiology. Hence, combining these will help to bring out better perinatal outcome.

Influence of safety motivation and climate on safety behaviour and outcomes: evidence from the Saudi Arabian construction industry.

PubMed

Panuwatwanich, Kriengsak; Al-Haadir, Saeed; Stewart, Rodney A

2017-03-01

Over the last three decades, safety literature has focused on safety climate and its role in forecasting injuries and accidents. However, research findings regarding the relationships between safety climate and other key outcome constructs are somewhat inconsistent. Recent safety climate literature suggests that examining the role of safety motivation may help provide a better explanation of such relationships. The research presented in this article aimed to empirically analyse the relationships among safety motivation, safety climate, safety behaviour and safety outcomes within the context of the Saudi Arabian construction industry. A conceptual model was developed to examine the relationships among four main constructs: safety motivation, safety climate, safety behaviour and safety outcomes. Based on the survey data collected in Saudi Arabia from site engineers and project managers (n = 295), statistical analyses were carried out, including confirmatory and exploratory factor analysis, and structural equation modelling to assess the model and test the hypotheses. The main results indicated that safety motivation could positively influence safety behaviour through safety climate, which plays a mediating role for this mechanism. The results also confirmed that safety behaviour could predict safety outcomes within the context of the Saudi Arabian construction industry.

Ethnic Gaps in Educational Attainment and Labor-Market Outcomes: Evidence from France

ERIC Educational Resources Information Center

Langevin, Gabin; Masclet, David; Moizeau, Fabien; Peterle, Emmanuel

2017-01-01

We use data from the "Trajectoires et Origines" survey to analyze ethnic gaps in education and labor-market outcomes between second-generation immigrants and their French-native counterparts. Our three main findings underscore the importance of family background in explaining lifelong ethnic inequalities. First, second-generation…

Statistical analysis plan for the Laser-1st versus Drops-1st for Glaucoma and Ocular Hypertension Trial (LiGHT): a multi-centre randomised controlled trial.

PubMed

Vickerstaff, Victoria; Ambler, Gareth; Bunce, Catey; Xing, Wen; Gazzard, Gus

2015-11-11

The LiGHT trial (Laser-1st versus Drops-1st for Glaucoma and Ocular Hypertension Trial) is a multicentre randomised controlled trial of two treatment pathways for patients who are newly diagnosed with open-angle glaucoma (OAG) and ocular hypertension (OHT). The main hypothesis for the trial is that lowering intraocular pressure (IOP) with selective laser trabeculoplasty (SLT) as the primary treatment ('Laser-1st') leads to a better health-related quality of life than for those started on IOP-lowering drops as their primary treatment ('Medicine-1st') and that this is associated with reduced costs and improved tolerability of treatment. This paper describes the statistical analysis plan for the study. The LiGHT trial is an unmasked, multi-centre randomised controlled trial. A total of 718 patients (359 per arm) are being randomised to two groups: medicine-first or laser-first treatment. Outcomes are recorded at baseline and at 6-month intervals up to 36 months. The primary outcome measure is health-related quality of life (HRQL) at 36 months measured using the EQ-5D-5L. The main secondary outcome is the Glaucoma Utility Index. We plan to analyse the patient outcome data according to the group to which the patient was originally assigned. Methods of statistical analysis are described, including the handling of missing data, the covariates used in the adjusted analyses and the planned sensitivity analyses. The trial was registered with the ISRCTN register on 23/07/2012, number ISRCTN32038223 .

Normal stress-only myocardial single photon emission computed tomography predicts good outcome in patients with coronary artery stenoses between 40 and 70.

PubMed

Jiang, Zhixin; Liu, Yangqing; Xin, Chaofan; Zhou, Yanli; Wang, Cheng; Zhao, Zhongqiang; Li, Chunxiang; Li, Dianfu

2016-09-01

Normal stress myocardial single photon emission computed tomography (SPECT) usually indicates good physiologic function of all coronary lesions, and also indicates a good outcome. We hypothesize that it can still predict good outcome in patients with coronary stenoses between 40 and 70%. A group of patients who underwent stress myocardial SPECT after coronary angiography were consecutively recruited in our center. Patients were eligible if they had one or more coronary stenoses between 40 and 70%. Patients with coronary stenoses greater than 50% diameter of left main or greater than 70% diameter of nonleft main epicardial vessels, and left ventricular ejection fraction less than 50% were excluded. The outcome was defined as major adverse events, including cardiac death, nonfatal myocardial infarction, and revascularization. Patients' survival curves were constructed accorded to the method of Kaplan and Meier and compared using the log-rank test. A study cohort of 77 patients was enrolled. According to the summed stress score, 43 patients were assigned to the perfusion defect group and 34 patients were assigned to the perfusion normal group. The follow-up duration was 6.4±0.3 years. In the perfusion normal group, only one of 34 (2.9%) patients developed major adverse events. In the perfusion defect group, six of 43 (14%) developed major adverse events, P-value of 0.041. It is safe to defer a percutaneous coronary intervention in patients with coronary stenoses between 40 and 70% and normal stress myocardial SPECT.

Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature

PubMed Central

McLeod, Tamara C. Valovich; Lewis, Joy H.; Whelihan, Kate; Bacon, Cailee E. Welch

2017-01-01

Objective: To systematically review the literature regarding rest and return to activity after sport-related concussion. Data Sources: The search was conducted in the Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, Educational Resources Information Center, Ovid MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, physical and cognitive rest, and return to activity. Study Selection: Studies were included if they were published in English; were original research; and evaluated the use of, compliance with, or effectiveness of physical or cognitive rest or provided empirical evidence supporting the graded return-to-activity progression. Data Extraction: The study design, patient or participant sample, interventions used, outcome measures, main results, and conclusions were extracted, as appropriate, from each article. Data Synthesis: Articles were categorized into groups based on their ability to address one of the primary clinical questions of interest: use of rest, rest effectiveness, compliance with recommendations, or outcome after graded return-to-activity progression. A qualitative synthesis of the results was provided, along with summary tables. Conclusions: Our main findings suggest that rest is underused by health care providers, recommendations for rest are broad and not specific to individual patients, an initial period of moderate physical and cognitive rest (eg, limited physical activity and light mental activity) may improve outcomes during the acute postinjury phase, significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists, and additional research is needed to empirically evaluate the effectiveness of graded return-to-activity progressions. Furthermore, there is a significant need to translate knowledge of best practices in concussion management to primary care providers. PMID:28387547

A prospective trial of customized adherence enhancement plus long-acting injectable antipsychotic medication in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder

PubMed Central

Sajatovic, Martha; Levin, Jennifer; Ramirez, Luis F.; Hahn, David Y.; Tatsuoka, Curtis; Bialko, Christopher S.; Cassidy, Kristin A.; Fuentes-Casiano, Edna; Williams, Tiffany D.

2014-01-01

Background Treatment non-adherence in people with schizophrenia is associated with relapse and homelessness. Building upon the usefulness of long-acting medication, and our work in psychosocial interventions to enhance adherence, we conducted a prospective uncontrolled trial of customized adherence enhancement (CAE) plus long-acting injectable antipsychotic (LAI) using haloperidol decanoate in 30 homeless or recently homeless individuals with schizophrenia and schizoaffective disorder. Methods Participants received monthly CAE and LAI (CAE-L) for 6 months. Primary outcomes were adherence as measured by the Tablets Routine Questionnaire (TRQ) and housing status. Secondary outcomes included psychiatric symptoms, functioning, side effects, and hospitalizations. Results Mean age of participants was 41.8 years (SD 8.6), mainly minorities (90% African-American) and mainly single/never married (70%). Most (97%) had past or current substance abuse, and had been incarcerated (97%). Ten individuals (33%) terminated the study prematurely. CAE-L was associated with good adherence to LAI (76% at 6 months) and dramatic improvement in oral medication adherence, which changed from missing 46% of medication at study enrollment to missing only 10% at study end (p = 0.03). There were significant improvements in psychiatric symptoms (p<.001) and functioning (p<.001). Akathisia was a major side effect with LAI. Conclusion While interpretation of findings must be tempered by the methodological limitations, CAE-L appears to be associated with improved adherence, symptoms, and functioning in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. Additional research is needed on effective and practical approaches to improving health outcomes for homeless people with serious mental illness. PMID:24434094

Asfotase Alfa Treatment Improves Survival for Perinatal and Infantile Hypophosphatasia

PubMed Central

Rockman-Greenberg, Cheryl; Ozono, Keiichi; Riese, Richard; Moseley, Scott; Melian, Agustin; Thompson, David D.; Bishop, Nicholas; Hofmann, Christine

2016-01-01

Context: Hypophosphatasia (HPP) is an inborn error of metabolism that, in its most severe perinatal and infantile forms, results in 50–100% mortality, typically from respiratory complications. Objectives: Our objective was to better understand the effect of treatment with asfotase alfa, a first-in-class enzyme replacement therapy, on mortality in neonates and infants with severe HPP. Design/Setting: Data from patients with the perinatal and infantile forms of HPP in two ongoing, multicenter, multinational, open-label, phase 2 interventional studies of asfotase alfa treatment were compared with data from similar patients from a retrospective natural history study. Patients: Thirty-seven treated patients (median treatment duration, 2.7 years) and 48 historical controls of similar chronological age and HPP characteristics. Interventions: Treated patients received asfotase alfa as sc injections either 1 mg/kg six times per week or 2 mg/kg thrice weekly. Main Outcome Measures: Survival, skeletal health quantified radiographically on treatment, and ventilatory status were the main outcome measures for this study. Results: Asfotase alfa was associated with improved survival in treated patients vs historical controls: 95% vs 42% at age 1 year and 84% vs 27% at age 5 years, respectively (P < .0001, Kaplan-Meier log-rank test). Whereas 5% (1/20) of the historical controls who required ventilatory assistance survived, 76% (16/21) of the ventilated and treated patients survived, among whom 75% (12/16) were weaned from ventilatory support. This better respiratory outcome accompanied radiographic improvements in skeletal mineralization and health. Conclusions: Asfotase alfa mineralizes the HPP skeleton, including the ribs, and improves respiratory function and survival in life-threatening perinatal and infantile HPP. PMID:26529632

Sexual Outcomes and Satisfaction with Hysterectomy: Influence of Patient Education

PubMed Central

Bradford, Andrea; Meston, Cindy

2010-01-01

Introduction Many women experience improved sexual function after hysterectomy. However, a sizeable minority of women report worsened sexual function after the surgery, and concerns about the effect of surgery on sexual function are common among women planning to undergo hysterectomy. Aim The present study examined the role of education about the potential sexual consequences of hysterectomy in predicting self-reported outcomes and satisfaction with the procedure. Methods We conducted a cross-sectional survey of 204 women who had undergone simple hysterectomy in the preceding 3–12 months. Participants volunteered in response to a Web-based advertisement. Main Outcome Measures Participants indicated their current sexual function using the Female Sexual Function Index (FSFI), and reported positive and negative sexual outcomes experienced after hysterectomy using a checklist. Participants also completed questionnaire items regarding satisfaction with hysterectomy and education from their physicians about sexual risks and benefits prior to surgery. Results Current sexual function scores were related to self-reports of positive and negative sexual outcomes following hysterectomy and overall satisfaction with hysterectomy. Education from a physician about possible adverse sexual outcomes was largely unrelated to self-reports of having experienced those outcomes. However, education about possible negative sexual outcomes predicted overall satisfaction with hysterectomy when controlling for self-reports of positive and negative sexual outcomes. Conclusion Education about potential negative sexual outcomes after surgery may enhance satisfaction with hysterectomy, independent of whether negative sexual outcomes were experienced. Including a discussion of potential sexual changes after surgery may enhance the benefits of presurgical counseling prior to hysterectomy. PMID:17087803

Neurosurgeon academic impact is associated with clinical outcomes after clipping of ruptured intracranial aneurysms

PubMed Central

Ibrahim, George M.; Wang, Justin; Guha, Daipayan; Mamdani, Muhammad; Schweizer, Tom A.; Macdonald, R. Loch

2017-01-01

Background Surgeon-dependent factors such as experience and volume are associated with patient outcomes. However, it is unknown whether a surgeon’s research productivity could be related to outcomes. The main aim of this study is to investigate the association between the surgeon’s academic productivity and clinical outcomes following neurosurgical clipping of ruptured aneurysms. Methods We performed a post-hoc analysis of 3567 patients who underwent clipping of ruptured intracranial aneurysms in the randomized trials of tirilazad mesylate from 1990 to 1997. These trials included 162 centers and 156 surgeons from 21 countries. Primary and secondary outcomes were: Glasgow outcome scale score and mortality, respectively. Total publications, H-index, and graduate degrees were used as academic indicators for each surgeon. The association between outcomes and academic factors were assessed using a hierarchical logistic regression analysis, adjusting for patient covariates. Results Academic profiles were available for 147 surgeons, treating a total of 3307 patients. Most surgeons were from the USA (62, 42%), Canada (18, 12%), and Germany (15, 10%). On univariate analysis, the H-index correlated with better functional outcomes and lower mortality rates. In the multivariate model, patients under the care of surgeons with higher H-indices demonstrated improved neurological outcomes (p = 0.01) compared to surgeons with lower H-indices, without any significant difference in mortality. None of the other academic indicators were significantly associated with outcomes. Conclusion Although prognostication following surgery for ruptured intracranial aneurysms primarily depends on clinical and radiological factors, the academic impact of the operating neurosurgeon may explain some heterogeneity in surgical outcomes. PMID:28727832

Neurosurgeon academic impact is associated with clinical outcomes after clipping of ruptured intracranial aneurysms.

PubMed

Alotaibi, Naif M; Ibrahim, George M; Wang, Justin; Guha, Daipayan; Mamdani, Muhammad; Schweizer, Tom A; Macdonald, R Loch

2017-01-01

Surgeon-dependent factors such as experience and volume are associated with patient outcomes. However, it is unknown whether a surgeon's research productivity could be related to outcomes. The main aim of this study is to investigate the association between the surgeon's academic productivity and clinical outcomes following neurosurgical clipping of ruptured aneurysms. We performed a post-hoc analysis of 3567 patients who underwent clipping of ruptured intracranial aneurysms in the randomized trials of tirilazad mesylate from 1990 to 1997. These trials included 162 centers and 156 surgeons from 21 countries. Primary and secondary outcomes were: Glasgow outcome scale score and mortality, respectively. Total publications, H-index, and graduate degrees were used as academic indicators for each surgeon. The association between outcomes and academic factors were assessed using a hierarchical logistic regression analysis, adjusting for patient covariates. Academic profiles were available for 147 surgeons, treating a total of 3307 patients. Most surgeons were from the USA (62, 42%), Canada (18, 12%), and Germany (15, 10%). On univariate analysis, the H-index correlated with better functional outcomes and lower mortality rates. In the multivariate model, patients under the care of surgeons with higher H-indices demonstrated improved neurological outcomes (p = 0.01) compared to surgeons with lower H-indices, without any significant difference in mortality. None of the other academic indicators were significantly associated with outcomes. Although prognostication following surgery for ruptured intracranial aneurysms primarily depends on clinical and radiological factors, the academic impact of the operating neurosurgeon may explain some heterogeneity in surgical outcomes.

Perceptions of Males and Females' Use of Aggressive Affirming and Nonaffirming Messages in an Interpersonal Dispute: You've Come a Long Way Baby?

ERIC Educational Resources Information Center

Jordan-Jackson, Felecia F.; Lin, Yang; Rancer, Andrew S.; Infante, Dominic A.

2008-01-01

This study examines perceptions of argumentative and verbally aggressive conduct, and also five relationship-outcome factors contingent upon dyad sex and communicator style. Participants viewed one of four videos that manipulated the sex and the communicator style of a dyad in an interpersonal dispute. Significant main effects were observed for…