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PubMed2002

Use of a routine, self-report outcome measure (HoNOSCA-SR) in two adolescent mental health services. Health of the Nation Outcome Scale for Children and Adolescents.

BACKGROUND: The Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) is an established outcome measure for child and adolescent mental health. Little is known of adolescent views on outcome. AIMS: To develop and test the properties of an adolescent, self-rated version of the scale (HoNOSCA-SR) against the established clinician-rated version. METHOD: A comparison was made of 6-weekly clinician-rated and self-rated assessments of adolescents attending two services, using HoNOSCA and other mental health measures. RESULTS: Adolescents found HoNOSCA-SR acceptable and easy to rate. They rated fewer difficulties than the clinicians and these difficulties were felt to improve less during treatment, although this varied with diagnosis and length of treatment. Although HoNOSCA-SR showed satisfactory reliability and validity, agreement between clinicians and users in individual cases was poor. CONCLUSIONS: Routine outcome measurement can include adolescent self-rating with modest additional resources. The discrepancy between staff and adolescent views requires further evaluation.

Adolescent↗

PubMed2006

Student and community outcomes in service-learning: part 2--community outcomes.

This article is the second of a two-part series reporting outcomes from a service-learning program implemented in a bachelor of science in nursing program. Part 1 (on pages 512-515) described students' perceptions of outcomes realized from the program, and Part 2 describes the community outcomes. The purposes of the program were to provide students with history-taking, blood pressure, and heart rate assessment skills, and beginning counseling skills, as well as to provide the university community with blood pressure screening and counseling in a convenient and accessible location. Data on community outcomes were collected on a continual basis during the hypertension screening and counseling program implementation. Clients were anonymously surveyed on health behavior actions taken after their screening and on the screening process. More than 700 client screenings were performed over 2 years, with positive health behavior changes being reported by clients.

Clinical Clerkship↗

PubMed2002

[Outcomes count: the importance of measuring the outcomes of hospital care].

A century ago the Boston surgeon Earnest A. Codman described in detail the requirements for monitoring quality of care and emphasized the importance of outcomes in evaluating care. At the time the medical societies were disconcerted by his ideas, which were perceived as revolutionary. After several decade of focusing on the structures and processes of care we are now witnessing a renaissance of measuring outcomes. This paper emphasizes the need for outcomes measurement monitor quality of care. The introduction of diagnosis-related groups in Germany is the most recent development that underlines the importance of outcomes measurement and benchmarking.

Germany↗

PubMed2006

Variations across field settings in the use of the indicators for nursing outcomes classification outcomes.

The Nursing Outcomes Classification (NOC) includes with each outcome a set of indicators to provide concrete referents for measurement of the outcome. Not all indicators are relevant for all instances of the rating of an outcome. The choice of indicators to use varies by clinical setting. Patterns of variation in use of indicators have implications for both nurse clinicians in understanding their practice and nurse informaticists in developing nursing information systems.

Adolescent↗

PubMed1994

Outcomes analysis in spinal research. How clinical research differs from outcomes analysis.

This article discusses the outcomes research movement and makes a distinction between clinical research that includes measures of function and quality of life as variables, and outcomes measurement for operational purposes such as quality assurance and reporting to insurers and regulatory agencies. Suggestions are made about how to begin outcomes data collection in an orthopedic clinic setting and how to select which patient outcomes may be most relevant to the assessment of treatment for spinal deformities.

Humans↗

PubMed1993

Outcome of rationing access to open-heart surgery: effect of the wait for elective surgery on patient outcome.

OBJECTIVE: To assess the effect of the waiting period before elective open-heart surgery on patient outcomes. DESIGN: Retrospective analysis. SETTING: The Montreal Heart Institute, a referral centre in cardiology and cardiac surgery. PATIENTS: All 568 patients who underwent open-heart surgery on an elective basis or following urgent admission or interhospital transfer between October 1991 and February 1992. MAIN OUTCOME MEASURES: In-hospital death rate, incidence of postoperative complications, length of stay in the intensive care unit (ICU) and total length of hospital stay. RESULTS: A total of 206 patients (151 men and 55 women with an average age of 59.0 [standard error of the mean (SEM) 1] years) underwent elective surgery, and 362 patients (264 men and 98 women with an average age of 62.0 [SEM 1] years) underwent urgent surgery. The mean wait for elective surgery was 2.8 (SEM 0.2) months. There was no significant difference between the two groups in the in-hospital death rate (4% v. 4%), the average length of stay in the ICU (4.4 [SEM 0.2] days v. 5.8 [SEM 1] days) or the average total length of hospital stay (9.0 [SEM 0.4] days v. 9.1 [SEM 1] days). As would be expected, postoperative complications developed in significantly more patients in the urgent group (27%) than the elective group (18%) (p = 0.02). Eight patients were admitted on an urgent basis for surgery owing to worsening symptoms or acute myocardial infarction after a mean wait of 4.6 months. One patient died suddenly at home 1 month after medical investigation while awaiting repeat coronary artery bypass grafting. Among the 206 patients who underwent elective surgery there was no relation between waiting time and adverse clinical outcomes after surgery. CONCLUSIONS: The results suggest that the wait before elective open-heart surgery had no effect on patient outcome after surgery in our institution. A policy of a short waiting period before elective open-heart surgery for patients whose condition is stable is safe and acceptable only if rapid access to medical and surgical treatment is available should it become necessary.

Analysis of Variance↗

PubMedDate not supplied

Predicting outcome of schizophrenia: significance of symptom profiles and outcome dimensions.

To clarify the antecedents of poor long-term outcome in schizophrenia, 58 DSM-III diagnosed schizophrenic inpatients, mostly chronic, were prospectively assessed on psychiatric symptoms and background variables. The 46 patients (79.3%) who could be relocated after 1 to 4 years (mean, 2.7 years) were evaluated on a multidimensional outcome scale and days of subsequent hospitalization. We found, contrary to prevailing belief, that a baseline positive, not negative, syndrome predicted poor outcome. Thought disturbance portended the worst prognosis and depressive syndrome the best. Multiple regression analysis showed (a) reliable prediction for 9 of 10 outcome measures (r values from .49 to .61); (b) separate contributions by clinical, genealogical, and historical predictors; and (c) different sets of variables that predicted social v occupational adjustment. The results have implications for prognosis, rehabilitation planning, and understanding of the obstacles to successful transition to community living.

Affective Symptoms↗

PubMed2005

Influence of clinical outcome and outcome period definitions on estimates of absolute clinical and economic benefits of influenza vaccination in community dwelling elderly persons.

Studies assessing the clinical and economic benefits of vaccination in the elderly have used different clinical outcomes (e.g. hospitalizations for pneumonia or influenza versus hospitalizations for respiratory and cardiovascular causes) and different outcome periods (e.g. peak versus total influenza season) on which to base estimates of clinical effectiveness and cost effectiveness. We explored the implications of these varying approaches by comparing two health economic analysis models of influenza vaccination of community-dwelling elderly persons. We developed computerized models using clinical data from 3 large US HMOs for the 1998-1999 and 1999-2000 influenza seasons. The primary health economic model used a broad definition of clinical events and outcome period and included hospitalizations for all respiratory and cardiovascular events that occurred during the entire influenza season. The alternative model used more restrictive definitions and included pneumonia or influenza hospitalizations occurring during the peak influenza season. The results of Monte Carlo simulation showed that, with the more inclusive primary model, influenza vaccination resulted in net medical care cost savings due to fewer respiratory or cardiovascular hospitalizations of Dollars 71/person vaccinated (5th-95th percentile Dollars 32-118) and net savings of Dollars 809/year of life saved (5th-95th percentile Dollars 331-1450). In contrast, the alternate model found costs of Dollars 3.50/person vaccinated (5th-95th percentile Dollars -11 to 5) and net costs of Dollars 91/year of life saved (5th-95th percentile Dollars -309 to 126). Our findings confirm that influenza vaccination of the elderly is most likely cost saving and supports policies and programs that advocate routine immunization of all persons 65 and older. They also highlight how different outcome definitions can influence the results of health economic analyses.

Aged↗

PubMed2006

Long-term survival from gynecologic cancer: psychosocial outcomes, supportive care needs and positive outcomes.

OBJECTIVES: To assess the long-term psychosocial outcomes and supportive care needs of gynecologic cancer survivors. METHODS: Women who had received care in a tertiary-based gynecologic cancer center 1-8 years earlier and who were disease-free were invited to complete a mailed self-report questionnaire to assess psychosocial outcomes and supportive care needs. RESULTS: In total, 199 survivors participated in the study. Survivors reported normal quality of life and relationship adjustment although functioning was at the lower end of the range; over two-thirds (68%) reported positive outcomes. However, nearly one-third (29%) reported clinical levels of anxiety and the most frequently endorsed need concerned fear of disease recurrence (24%). About one-fifth (19%) reported symptoms that indicated posttraumatic stress disorder (PTSD) and this rose to close to one-third (29%) for survivors of advanced stage disease. Nearly 90% of survivors reported supportive care needs and the diagnosis of anxiety or PTSD resulted in a four-fold increase in unmet needs. Needs most frequently concerned "existential survivorship" (e.g., spiritual beliefs, decision making, the meaning of life) and "comprehensive cancer care" (e.g., team care, communication, local health care services). Years since diagnosis was not related to distress or need levels. CONCLUSIONS: All members of the care team need to be aware that significant psychosocial morbidity may occur many years after the successful treatment of a gynecologic malignancy and may be associated with elevated supportive care needs. Comprehensive and extended supportive care services are required to address anxiety and trauma responses and investigate strategies to meet ongoing needs in order to improve long-term psychosocial outcomes.

Adult↗

PubMed2003

The long term outcome of feminizing genital surgery for congenital adrenal hyperplasia: anatomical, functional and cosmetic outcomes, psychosexual development, and satisfaction in adult female patients.

BACKGROUND: There are only a few reports analyzing the long term outcome of feminizing surgery in females with congenital adrenal hyperplasia (CAH). Such analysis is crucial to evaluate the treatment and to make necessary adjustments. STUDY OBJECTIVES: To evaluate the adult outcome after feminizing surgery in adult females with salt wasting CAH. DESIGN: Retrospective observational followup investigation. SETTING: Outpatient clinic of a University Medical Center, in 2002. PARTICIPANTS: Eight patients (born 1973-1983) who underwent feminizing surgery in infancy by the same procedure and the same pediatric surgeon in our center, and 19 healthy female controls (for visual analog scales). METHODS: (a) Study of patients' records (n=8); (b) Systematic evaluation of the current situation (n=6): uroflowmetry, a written questionnaire to screen for psychopathology (Youth Adult Self Report, YASR), structured gynecologic examination and a structured psychosexual interview, including scoring on visual analog scales. RESULTS: (a) The first surgery (age 0.1-3.7 yr) consisted of clitoris reduction and vaginoplasty (single-stage) in 7 patients and clitoris reduction only in one patient. The latter patient had vaginoplasty in puberty. In puberty, 6 of the 7 patients with an initial single-stage procedure required re-vaginoplasty. All 6 patients who participated in this systematic evaluation had undergone (re-) vaginoplasty in puberty; (b) 2 of the 6 patients experienced some urinary incontinence, and in one of them, the uroflowmetry result was abnormal. The YASR showed no psychopathology, except for 1 patient with a slightly elevated externalizing score. Gynecologic examination (n=5) revealed vaginal strictures in 3 patients (1 severe, 2 mild). The 2 patients without vaginal strictures had coitus regularly. In the interview, 2 patients called themselves bisexual, the other 4 heterosexual. None of the patients had homosexual contacts. Sexual developmental milestones (romantic interest, falling in love, kissing and petting, coitus) had been reached by all, except for 1 patient who did not have coitus yet. In the patient group, satisfaction with height, body hair, and external genitalia and sexual fantasies and interest, measured with visual analog scales, was not different compared to the control group, except for satisfaction with total body appearance, which was significantly lower in the patients. CONCLUSION: Despite the poor outcome of the initial single-stage surgery in infancy and the inevitable re-operation in puberty, the adult outcome in our study population seems more positive than the findings in the few previous reports, especially with respect to sexual development and activity.

Adrenal Hyperplasia, Congenital↗

PubMed2005

Control of matching by differential outcome expectancies in the absence of differential sample-outcome associations: a serial compound view.

In this study, pigeons learned 2 separate one-to-many conditional discriminations in which they matched form samples to line and hue comparisons. Correct choices within each comparison dimension yielded differential (food vs. no-food) outcomes that were not predictable from the samples alone. At asymptote, latency to make a correct choice was shorter when food was the contingent outcome than when no food was the outcome. More important, when the samples from each task were subsequently exchanged, comparison choice varied systematically as a function of the sample and the set of new comparison alternatives that followed them. Together, these results indicate that choices were cued by differential outcome expectancies arising from serial compounds consisting of each sample and the dimensional characteristics of the comparisons.

Analysis of Variance↗

PubMed2002

Correlates of coronary blood flow before and after percutaneous coronary intervention and their relationship to angiographic and clinical outcomes in the RESTORE trial. Randomized Efficacy Study of Tirofiban for Outcomes and REstenosis.

BACKGROUND AND OBJECTIVES: Slower blood flow in the setting of acute myocardial infarction (MI) has been related to adverse outcomes, but the relationship of coronary blood flow after percutaneous transluminal coronary angioplasty (PTCA) in the setting of acute coronary syndromes to adverse outcomes and restenosis has not been well described. We sought to evaluate the correlates of pre- and post-PTCA coronary blood flow to shed light on potential modifiable determinants. METHODS: The RESTORE trial (Randomized Efficacy Study of Tirofiban for Outcomes and REstenosis) was a randomized, double-blind, placebo-controlled trial of tirofiban in patients undergoing balloon angioplasty or directional atherectomy within 72 hours of occurrence of either unstable angina pectoris or acute MI. Coronary blood flow was assessed with the corrected TIMI frame count (CTFC), and clinical outcomes were assessed at 30 days. RESULTS: In addition to tighter and longer minimum lumen diameters (MLDs), the multivariate correlates of slower flow before PTCA also included the presence of thrombus, collaterals, left coronary artery lesion location, acute MI, and >8F catheter size. As well as the above variables, type C and D dissection grades were related to slower post-PTCA CTFC. Death, or the composite of death/MI/coronary artery bypass graft at 30 days, was more frequent among patients with slower post-PTCA CTFCs and those with post-PTCA thrombus. In a multivariate model correcting for reference segment diameter and MLD, the post-PTCA CTFC was an independent predictor of late lumen loss and the follow-up MLD at 6 months. As a single index that integrates functional and anatomical aspects of the post-PTCA results, the ratio of CTFC/MLD was associated with death/MI by 30 days. CONCLUSIONS: In addition to MLD, variables such as the presence of thrombus, left coronary artery lesion location, and dissection grade also are associated with slower coronary blood flow after PTCA. In turn, post-PTCA CTFCs were an independent predictor of late lumen loss and follow-up MLDs. Furthermore, patients who die or who sustain other adverse cardiac events have slower coronary blood flow and greater thrombus burden after PTCA.

Angina, Unstable↗

PubMed2005

Contiguity and the outcome density bias in action-outcome contingency judgements.

In cause-outcome contingency judgement tasks, judgements often reflect the actual contingency but are also influenced by the overall probability of the outcome, P(O). Action-outcome instrumental learning tasks can foster a pattern in which judgements of positive contingencies become less positive as P(O) increases. Variable contiguity between the action and the outcome may produce this bias. Experiment 1 recorded judgements of positive contingencies that were largely uninfluenced by P(O) using an immediate contiguity procedure. Experiment 2 directly compared variable versus constant contiguity. The predicted interaction between contiguity and P(O) was observed for positive contingencies. These results stress the sensitivity of the causal learning mechanism to temporal contiguity.

Association Learning↗

PubMed2006

Correlates and outcomes of dementia among dialysis patients: the Dialysis Outcomes and Practice Patterns Study.

BACKGROUND: Recent studies suggest a high prevalence of cognitive impairment and dementia in persons with end-stage renal disease (ESRD), yet risk factors for dementia and its prognostic significance in persons with ESRD remain unclear. The goals of this study were to determine the prevalence, correlates and dialysis-related outcomes of dementia in an international sample of haemodialysis patients. METHODS: We analysed data collected from a cohort of 16 694 patients in the Dialysis Outcomes and Practice Patterns Study. Dementia was defined as a diagnosis of dementia documented in the medical record. We used logistic regression to determine the baseline correlates of dementia and Cox proportional hazards models to determine the relative risk (RR) of death and dialysis withdrawal for patients with dementia, while adjusting for a number of confounding factors. RESULTS: Overall, 4% of the cohort had a recorded diagnosis of dementia. In the cross-sectional analyses, risk factors for dementia in the general population including age, black race, low educational attainment, cerebrovascular disease and diabetes, as well as modifiable uraemia-related factors, including markers of malnutrition and anaemia, were independently associated with dementia. After adjustment for a number of confounding factors, dementia was associated with an increased risk of death [RR 1.48, 95% confidence interval (CI) 1.32-1.66] and dialysis withdrawal (RR 2.01, 95% CI 1.57-2.57). CONCLUSIONS: Dementia is associated with adverse outcomes among ESRD patients. Dialysis providers should consider instituting routine screening for cognitive impairment among elderly patients in order to identify those at risk for associated adverse outcomes.

Adolescent↗

PubMed2003

The worst injury predicts mortality outcome the best: rethinking the role of multiple injuries in trauma outcome scoring.

BACKGROUND: The prediction of outcome after injury must incorporate measures of injury severity, but there is no consensus on how many injuries should be used in calculating these measures. Initially, the single worst injury was used to predict outcome, but the introduction of the Injury Severity Score allowed up to three injuries to contribute to outcome prediction. Subsequently, other outcome prediction approaches used many (New Injury Severity Score [NISS]) or all (ICISS and Trauma Registry Abbreviated Injury Scale Score [TRAIS], which use International Classification of Diseases, Ninth Revision [ICD-9] and Abbreviated Injury Scale [AIS] survival risk ratios [SRRs], respectively) of a patient's injuries. The ability of only the most severe injury in predicting mortality has never been studied. Our objective was to determine the ability of a patient's worst injury to predict mortality. METHODS: A 10-fold cross-validation design was used to compute six scores for each of 160,208 patients from a large trauma database (the National Trauma Data Bank [NTDB]). The scores were ICISS, TRAIS, ICISS1 (only a patient's worst ICD-9 SRR), TRAIS1 (only a patient's worst AIS SRR), NISS (sum of squares of worst three AIS severity measures), and MAXAIS (worst AIS severity measure). Discrimination was assessed using the area under the receiver operating characteristic curve. Logistic regression R2 gauged the proportion of variance each score explained. The Akaike information criterion, a deviance statistic (lower is better), assessed model fit. RESULTS: The receiver operating characteristic curve, R2, and Akaike information criterion statistics (NC_ICISS and NC_ICDSRR1 represents scores derived from the original North Carolina Hospital Discharge Database SRRs) are summarized in tabular form in the Results section. CONCLUSION: Regardless of scoring type (ICD/AIS SRRs or AIS severity), a patient's worst injury discriminates survival better, fits better, and explains more variance than currently used multiple injury scores.

Abbreviated Injury Scale↗

PubMed1979

Long-term outcome in children with temporal lobe seizures. I: Social outcome and childhood factors.

One-hundred children, diagnosed as having temporal lobe epilepsy and reported on in 1966, have been followed into adult life. In this 1977 survey they have been coded into four social outcome categories, A, B, C and D. A: 33 per cent are found to be seizure-free and independent; B: 21 per cent are socially and economically independent but are receiving anticonvulsant treatment and are not necessarily seizure-free; C: O9 per cent are dependent either on their parents or in institutions; D: 5 per cent died under the age of 15. Biological factors ascertained and coded in childhood are related to adult outcome. Eight adverse factors emerged: an IQ below 90, onset of seizures before 2 years 4 months, five or more grand mal attacks, temporal lobe seizure frequency of one per day or more, a left-sided focus, the hyperkinetic syndrome, catastrophic rage and special schooling. The presence of first-degree relatives with seizure disorders was a good prognostic sign. Disorderly homes in childhood did not significantly affect adult outcome. All but one of those achieving Group A status had received normal schooling. In general, the prognosis for children with limbic seizures is clear before the end of adolescence. A simple count of the number of childhood adverse factors predicts adult outcome at a high level of significance.

Adolescent↗

PubMed1999

Outcome of cataract surgery considering the preoperative situation: a study of possible predictors of the functional outcome.

AIM: To analyse possible predictors of the self assessed functional outcome of a cataract extraction. METHODS: The patients' self assessed visual function was studied by use of a questionnaire, the "Catquest", before and 6 months after surgery. All patients (n=1933, mean age 75.5 years, 66.8% women) who were undergoing cataract surgery in March 1995, in 35 different departments of ophthalmology participating in the National Swedish Cataract Register, were included in the study. A routine ophthalmic examination was performed before and after surgery. The following preoperative variables were studied with regard to a possible relation to the outcome: age, sex, ocular comorbidity, best corrected preoperative vision (better eye), first or second eye surgery, other diseases with a need for long term medication, need for home help, need for subsidised travel by taxi. RESULTS: Ocular comorbidity was strongly related to a "no benefit" outcome after surgery (p= 0.005). Second eye surgery and young age was related to a "very good benefit" outcome after surgery (p=0.0001 and p<0.0001 respectively). CONCLUSIONS: Patients with an ocular comorbidity in the eye undergoing a cataract extraction were characterised by a significantly higher frequency of deteriorated self assessed visual function after surgery than patients with no ocular comorbidity. The highest degree of improvement was most frequently found in younger patients undergoing second eye surgery.

Adult↗

PubMed2003

Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS).

BACKGROUND: Severe acute respiratory syndrome (SARS) was diagnosed in Hong Kong in over 1700 patients between March and early June 2003. METHODS: 115 patients diagnosed with SARS were admitted to Queen Elizabeth Hospital, a large regional hospital in Hong Kong, from March 2003, of whom 100 were either discharged or were dead at 31 May. The patients were prospectively studied after admission to assess their short term outcomes and the risk factors associated with adverse outcomes, defined as death or the need for mechanical ventilation RESULTS: At the time of writing 18 patients had died, with a crude mortality rate of 15.7% and a 21 day mortality of 10% (standard error 3%). Thirty nine patients (34%) were admitted to the intensive care unit, 30 of whom (26%) required mechanical ventilation. Multivariate analysis showed that age above 60 (hazards ratio (HR) 3.5, 95% CI 1.2 to 10.2; p=0.02), presence of diabetes mellitus or heart disease (HR 9.1, 95% CI 2.8 to 29.1; p<0.001), and the presence of other comorbid conditions (HR 5.2, 95% CI 1.4 to 19.7; p=0.01) were independently associated with mortality. However, only the presence of diabetes mellitus and/or cardiac disease (HR 7.3, 95% CI 3.1 to 17.4; p<0.001) was associated with adverse outcomes as a whole. CONCLUSION: SARS is a new disease entity that carries significant morbidity and mortality. Specific clinical and laboratory parameters predicting unfavourable outcomes have been identified.

Adult↗