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At least 397 records · Page 22Linked to original sources
PubMed2004

Kidney Disease Outcomes Quality Initiative (K/DOQI) and the Dialysis Outcomes and Practice Patterns Study (DOPPS): nutrition guidelines, indicators, and practices.

BACKGROUND: Nutritional markers are important predictors of morbidity and mortality in dialysis patients. The Clinical Practice Guidelines for Nutrition in Chronic Renal Failure provides guidelines for assessing nutritional status that were evaluated using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS). METHODS: The level of various nutritional markers (serum albumin, modified subjective global assessment, serum creatinine, normalized protein catabolic rate [nPCR], and body mass index) were described for representative samples of patients and facilities from 7 countries (France, Germany, Italy, Spain, Japan, United Kingdom, and United States) participating in the DOPPS. RESULTS: A strong inverse association was observed between mortality and serum albumin, with a mortality risk 1.38 times higher for patients with serum albumin concentration less than 3.5 g/dL (35 g/L). There were significant differences by country in the proportion of moderately and severely malnourished patients as determined by the modified subjective global assessment score. In the US sample, severely and moderately malnourished patients had a higher mortality risk compared with those not malnourished, 33% and 5% higher, respectively. An inverse relationship exists between serum creatinine concentration and mortality, with a mortality risk 60% to 70% higher in the lowest quartile group compared with the highest quartile group in Europe and the United States. Levels of nPCR varied significantly between European countries, and there was no association between mortality and nPCR in US data. After adjustment for demographic and comorbidity factors, the mortality risk decreased as body mass index increased in both US and European samples. CONCLUSION: DOPPS data highlight the importance of routine assessment of nutritional status, using multiple parameters, in clinical practice to improve patient care.

Body Mass Index↗
PubMedDate not supplied

[Outcome assessment in total knee arthroplasty: is the clinical measurement of range of motion a reliable measurable outcome variable?].

AIM: The aim of this clinical study was to investigate the reliability of the clinical assessment (visual and goniometric) of the range of motion of the knee joint. METHOD: 30 patients were assessed concerning the range of motion of their knee joints by visual and goniometric measurements. Assessment was performed by three investigators. The obtained data were used to analyse the intra- and interobserver reliability. Statistical analysis was performed using the Spearman coefficient of correlation [r (s)]. RESULTS: Intraobserver agreement was consistent across observers regarding the visual and goniometric assessment of flexion (r (s) > 0.6), whereas reliability was uniformly low for both measurements regarding the assessment of extension (r (s) < 0.6). Interobserver agreement was consistent across all three goniometric and two out of three visual assessments regarding the measurement of flexion (r (s) > 0.6); the interobserver reproducibility of extension, however, was uniformly low both for the visual and goniometric measurements (r (s) < 0.6). CONCLUSION: Reliability of clinical assessment of range of motion should be taken critically into consideration whilst performing classical function-related scoring systems when measuring outcome after total joint arthroplasty, since these scoring systems are strongly based on a valid and reliable assessment of range of motion.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

Outcomes for substance user treatment in women: results from the Baltimore Drug and Alcohol Treatment Outcomes Study.

The Baltimore Drug and Alcohol Treatment Outcomes Study is a large study focusing on a single city. Over 1000 adult male and female substance users entering treatment in 16 publicly funded substance use treatment programs in the City of Baltimore between 1998 and 1999 were evaluated at four time periods (intake, 30 days after treatment, 6 month, and 12 month follow-ups). A comprehensive psychological battery was administered at each assessment interval. In this article, we report on the seven domains (alcohol, drug, medical, legal, employment, family, and psychological) of the addiction severity index (ASI) with the 459 women who participated in the study. Overall, statistically significant differences across time showed improvement as a result of substance user treatment were found in six of the seven ASI domains; no statistically significant effects for time were found for the medical composite scores. Drug and alcohol use among the participants was significantly reduced as early as 30 days after treatment. We discuss these findings in relation to the specific treatment needs of women who are addicted.

Adult↗
PubMed2004

CD4+ T-cell recovery and clinical outcome in HIV-1-infected patients exposed to multiple antiretroviral regimens: partial control of viremia is associated with favorable outcome.

The goal of antiretroviral therapy is clinical benefit through the suppression of viral replication and the immunologic reconstitution of HIV-1-infected patients. In spite of the availability of different highly active antiretroviral therapy only some patients sustain undetectable plasma viremia. We performed an observational study from October 1987 to February 2001 on immunologic and clinical outcome of 148 HIV-1-infected patients from an open clinical cohort at São Paulo University, Brazil. The median T CD4+ at starting first monitored regimen was 227 cells per microliter, with 65% of patients previously exposed to antiretroviral regimens, mostly dual therapy. Virologic response to antiretroviral therapy, after a median period of 179 weeks of monitored treatment, allowed classifying patients as aviremic (RNA plasma viremia below 500 copies per milliliter); viremic (current viral load at historic levels), and viremic-attenuated groups (detectable viremia, but > 1 log viral suppression). HIV RNA viral load, T CD4+ cells count, HIV-1 pol sequencing, inflammatory parameters, and clinical events were documented during a median follow-up of 251 weeks. This study observed better clinical and immunologic responses in the aviremic group, but the viremic-attenuated group showed a significant gain in CD4+ cells (p < 0.013) and a decreased number of cases progressing to an AIDS-defining clinical condition (p < 0.001) compared to the viremic group.

Adult↗
PubMed2002

Patient outcomes beyond hospitalization: carotid endarterectomy surgical patient outcomes after a rapid recovery program.

Improved surgical techniques for carotid endarterectomy (CEA) surgical patients have resulted in improved postoperative hemodynamic stability of patients and reduced lengths of hospitalization. The purpose of this pilot project was to determine CEA patient outcomes after a rapid recovery hospitalization program. Thirty-nine patients were enrolled in the study and contacted at 1 month after CEA surgery to examine carotid occlusive disease clinical symptoms, functional status, atherosclerotic disease risk-factor reduction, and patient satisfaction. Findings of the pilot study demonstrated that CEA surgical patients were able to resume physical and psychosocial functioning by 1 month after surgery at levels comparable to preoperative functioning. Subjects reported relief of carotid artery occlusive disease symptoms and reported high levels of independent functioning and satisfaction with CEA surgery. Men in the study had significantly higher levels of reported independence in functioning compared with the women, using a "0" to "10" scale to rate level of functioning independence. Findings from the pilot study will be used to develop an early recovery and atherosclerotic disease risk-factor modification program for CEA surgical patients.

Activities of Daily Living↗
PubMed2001

Using case mix and adverse event outcome reports for outcome-based quality monitoring.

The OBQM process is similar to many of the QI/PI processes that agencies have used in the past. The Adverse Event Outcome and Cse Mix Reports, based on OASIS data, provide agencies with clinical out come data that can be used to improve quality of care. The reposts are a first step in the effort to bring the home care industry to a new era of using patient-centered data as the basis for improving services.

Diagnosis-Related Groups↗
PubMed2001

Trauma outcome analysis of a Jakarta University Hospital using the TRISS method: validation and limitation in comparison with the major trauma outcome study. Trauma and Injury Severity Score.

BACKGROUND: In this prospective study, the TRISS methodology is used to compare trauma care at a University Hospital in Jakarta, Indonesia, with the standards reported in the Major Trauma Outcome Study (MTOS). METHODS: Between February 24, 1999, and July 1, 1999, all consecutive patients with multiple and severe trauma were included in the study (n = 105). Survival analysis was completed for 97 (92%) patients. RESULTS: The majority of patients were men (81%), and the average age was 28 years. Ninety-five patients (98%) sustained blunt trauma, with motor vehicle crashes being the most common (68%). The predicted mortality was 14% and the observed mortality was 29%. The Z and M statistics were 7.87 and 0.843, respectively. CONCLUSION: We conclude that in developing countries both institution-bound factors and specific limitations in the TRISS methodology are responsible for the difference between predicted and observed mortality, indicating the need for a regional database.

Adolescent↗
PubMed2005

Analysis of outcome following allogeneic haemopoietic stem cell transplantation for myeloma using myeloablative conditioning--evidence for a superior outcome using melphalan combined with total body irradiation.

We have undertaken a retrospective multicentre analysis of 139 patients (median age 44.4 years) undergoing allogeneic haematopoietic stem cell transplantation (HSCT) for multiple myeloma using myeloablative conditioning. The majority of patients received total body irradiation (TBI) combined with either melphalan (56.9%) or cyclophosphamide (28.5%). Overall, transplant-related mortality (TRM) was 37.9% at 1 year and was not significantly different for patients receiving melphalan/TBI compared with cyclophosphamide/TBI. The overall complete remission (CR) rate, including patients in CR at the time of transplant, was greater for patients receiving melphalan/TBI (64.7%) compared with cyclophosphamide/TBI (47.2%)(P = 0.085). A significantly higher proportion of patients with continuing disease at the time of transplant achieved CR post-transplant following melphalan/TBI conditioning compared with cyclophosphamide/TBI (52.9% and 33.4% respectively, P = 0.009). Relapse/progression rates at 5 years were significantly lower for melphalan/TBI (36.7%) compared with cyclophosphamide/TBI (80.8%, P < 0.0001) and remained significant in multivariate analysis. This resulted in an overall survival at 5 years of 44.1% and 28.1% for melphalan/TBI and cyclophosphamide/TBI, respectively (P = 0.059). These results demonstrate that the type of conditioning for sibling allogeneic HSCT for myeloma has a major effect on transplant outcome.

Adult↗
PubMedDate not supplied

Discrepancies between patient-reported outcomes and clinician-reported outcomes in chronic venous disease, irritable bowel syndrome, and peripheral arterial occlusive disease.

OBJECTIVE: To explore the degree of agreement between patient- and clinician-reported outcomes (PROs and CROs, respectively) in three chronic diseases. METHODS: Respectively, 120, 131, and 61 French general practitioners (GPs) included 291, 307, and 90 patients with chronic venous disease (CVD), irritable bowel syndrome (IBS), and peripheral arterial occlusive disease (PAOD), in a cross-sectional survey. Patients completed a specific Health-Related Quality of Life (QoL) questionnaire (Chronic Venous Insufficiency Questionnaire [CIVIQ], Functional Digestive Disorders Quality of Life [FDDQL], and Claudication Scale [CLAU-S], respectively) and scored their pain (visual analog scale, pain-free walking distance). GPs were concomitantly asked to estimate patients' pain and QoL. RESULTS: Although correlated (CVD and IBS: Kw = 0.27 and Kw = 0.31, respectively; PAOD: r = 0.64, P < 0.01), pain intensity estimated by GPs was lower than as estimated by patients with CVD and IBS (e.g., 39.0 +/- 24.9 vs. 30.4 +/- 21.0 for IBS), and pain-free walking distance was greater as estimated by GPs than by patients with PAOD. Pain estimated by patients only partially reflected their QoL (r between 0.30 and 0.78; P between 0.02 and <0.01). Global QoL scores estimated by patients and GPs were moderately correlated (Kw between 0.17 and 0.28). GPs underestimated QoL impairment in CVD (global score: 72 +/- 19 vs. 61 +/- 20) and in most dimensions of the IBS questionnaire (in six of eight dimensions), and overestimated QoL impairment in PAOD (54 +/- 21 vs. 66 +/- 23). CONCLUSIONS: Although correlated, PROs and CROs differed. In addition, their relationship was not consistent across diseases. PROs are therefore essential to take account of all the aspects of diseases.

Aged↗
PubMed2006

Medication decisions and clinical outcomes in the Canadian National Outcomes Measurement Study in Schizophrenia.

OBJECTIVE: To evaluate over a 2-year period, patients from academic/non-academic centres, from each region of Canada, to determine whether location or other variables such as medication type, gender or income was associated with outcome as defined by non-hospitalization and persistence on original treatment. METHOD: A total of 448 patients were recruited from academic and non-academic centres across all provinces of Canada and followed up for 2 years. RESULTS: Patients from British Columbia had significantly lower rates of hospitalization than patients from other provinces. Male patients showed greater symptomatic improvement at 2 years from initial assessment compared to females. Patients on clozapine, risperidone and olanzapine were least likely to be hospitalized. CONCLUSION: There were some regional differences noted in both utilization of types of antipsychotic medications and hospitalization rates. In this sample of stable out-patients over 70% who started on monotherapy with clozapine, risperidone, olanzapine and quetiapine remained on the same medication over the 2-year study period.

Academic Medical Centers↗
PubMed1988

Factors affecting the outcome of maternity care. II. Neonatal outcomes and resources beyond the hospital of birth.

Analysis of data about perinatal mortality and indicators of resources at maternity hospitals in the West Midlands region between 1977 and 1983 showed that paediatric staff ratios were inversely related to in-house mortality rates. In this paper, the outcomes for and resources used by transferred babies are added to those of the hospital of birth for three of the study years--1978, 1980, and 1982. Patterns of transfer differ between units and over time in the region, and a regional neonatal intensive care policy was introduced in 1980. Analysis of the new variables showed that in 1978 paediatric staffing was significantly inversely related to neonatal mortality. In later years, neonatal mortality of births at maternity units is explained entirely by the proportion of low or very low weight births.

England↗
PubMed2003

Clinico-biologic features and treatment outcome of adult pro-B-ALL patients enrolled in the GIMEMA 0496 study: absence of the ALL1/AF4 and of the BCR/ABL fusion genes correlates with a significantly better clinical outcome.

To elucidate the biologic and clinical heterogeneity of adult pro-B acute lymphoblastic leukemia (ALL) (ie, terminal deoxynucletidyl-transferase-positive[TdT+], CD19+, CD10-, surface immunoglobulin-negative [SIg-]), we evaluated 66 patients enrolled in the Italian multicentric Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA) 0496 study between October 1996 and December 1999. The ALL1/AF4 fusion transcript, originating from the t(4;11) translocation, was detected in 24 patients (36.4%), and the BCR/ABL chimeric product was found in 6 patients (9%), while the remaining 36 cases (54.6%) were ALL1/AF4-BCR/ABL-negative. A white blood cell (WBC) count higher than 50 x 109/L was found in 13 of 24, 2 of 6, and 6 of 36 of the ALL1/AF4-positive, BCR/ABL-positive, and ALL1/AF4-BCR/AB-negative patients, respectively (P =.007). None of the 24 ALL1/AF4-positive patients coexpressed the CD13 and/or CD33 myeloid antigens. By contrast, CD13 and CD33 molecules were detected, respectively, in 3 of 6 and in 14 of 33 cases of the BCR/ABL-positive patient group, and in 2 of 6 and 9 of 35 cases of the ALL1/AF4-BCR/ABL-negative patient group. These differences still remained statistically significant even if the BCR/ABL-positive patients were excluded from the analysis. A complete remission (CR) was achieved in 52 (83.4%) of the 62 patients with ALL evaluable for response to treatment. CR rates were similar in the 3 genotypic groups. By contrast, comparing patients with or without the ALL1/AF4 gene the probability of remaining in continuous complete remission (CCR) at 3.5 years was 16% and 49.8%, respectively (P =.005). Our data demonstrate that in adult pro-B-ALL a distinction should be made between pro-B-ALL cases with and without the ALL1/AF4 or the BCR/ABL chimeric genes, since the absence of both of these fusion genes correlates with a significantly better clinical outcome after intensive polychemotherapy treatment without hematopoietic stem cell transplantation.

Adolescent↗
PubMed1999

Outcome of admission to a medium secure psychiatric unit. I. Short- and long-term outcome.

BACKGROUND: This is the first long-term follow-up of patients discharged from a medium secure unit. AIMS: To describe the short- and long-term outcomes of admission for all patients discharged during a 14-year period. METHOD: A longitudinal cohort study of all 234 patients discharged from the Denis Hill Unit, Bethlem Royal Hospital, between 1980 and 1994, followed for an average 6.6 years. RESULTS: Although 48% of admissions were from prison, only 8% returned there, with most being transferred to another psychiatric bed. One-fifth of patients spent none of the follow-up time in the community; 75% of patients had at least one readmission; only 24% were convicted of further offences. CONCLUSIONS: Re-offending rates are comparable with those for patients discharged from high-security hospitals, and much lower than those for released prisoners. The high readmission rates indicate the need for a range of services to maintain former patients in the community.

Adolescent↗
PubMed2006

Midterm outcomes from the TALON Registry: treating peripherals with SilverHawk: outcomes collection.

PURPOSE: To determine midterm clinical outcomes among patients with lower extremity peripheral arterial disease who underwent revascularization with catheter-based plaque excision (PE). METHODS: Between August 2003 and February 2005, 19 institutions participating in the observational, nonrandomized, multicenter TALON registry enrolled 601 consecutive patients (353 men; mean age 70+/-11, range 36-98) with 1258 symptomatic lower extremity atherosclerotic lesions (748 limbs) treated by plaque excision with the SilverHawk catheter. Approximately 50% of the patients had diabetes, and nearly one third of the procedures were indicated for Rutherford ischemia category > or =4. Mean lesion lengths above and below the knee, respectively, were 62.5+/-68.5 mm (interquartile range [IQR], 20.0-80.0) and 33.4+/-42.7 mm (IQR 15.0-37.5). The primary endpoints of the study were target lesion revascularization (TLR) at 6 and 12 months. RESULTS: The device achieved < or =50% residual diameter stenosis in 94.7% of lesions; procedural success was 97.6%. Nearly half (41.9%) of the procedures involved PE of > or =2 lesions. Nearly three quarters (73.3%) of the lesions did not require adjunctive therapy, and stent placement following PE occurred in only 6.3% of lesions. The 6- and 12-month rates of survival free of TLR were 90% and 80%, respectively. Rates of TLR were similar among patients with diabetes (11%) and without diabetes (9%). In the multivariate analysis, significant predictors of TLR at 6 months were a history of MI or coronary revascularization (HR 5.49, 95% CI 1.87 to 16.10, p=0.0008), multiple (> or =2) lesions (HR 1.37, 95% CI 1.11 to 1.70, p=0.0019), and increasing Rutherford category (HR 1.84, 95% CI 1.28 to 2.65, p=0.0003). Lesion length >50 mm was associated with a 2.9-fold increased risk for TLR (HR 2.88, 95% CI 1.18 to 7.01, p=0.012); lesion length >100 mm was associated with a 3.3-fold increase in TLR (HR 3.32, 95% CI 1.15 to 9.56, p=0.016). CONCLUSION: In patients undergoing revascularization for lower extremity atherosclerotic disease, catheter-based PE achieves favorable procedural success and avoids the need for repeat revascularization at midterm follow-up. These findings support PE as a primary endovascular therapy for patients undergoing lower extremity arterial revascularization.

Adult↗
PubMed1999

Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy.

BACKGROUND: The purposes of this study were to document the natural history of brachial plexus birth palsy, in relation to the recovery of biceps function, in the first six months of life; to assess the outcome after microsurgical repair of the brachial plexus in patients who had no recovery of biceps function at six months; and to compare the results of transfer of the latissimus dorsi and teres major tendons with the results of derotation osteotomy of the humerus and to compare the results of the tendon transfers and the osteotomy with the natural history of the disorder. METHODS: Sixty-six patients (sixty-seven lesions) who had brachial plexus birth palsy were seen for an initial evaluation when they were less than three months old. The time of recovery of biceps function was recorded for each month of life for six months from the date of birth. The patients were divided into groups according to the month of life during which recovery of biceps strength was noted. A physical examination and an assessment with use of the functional criteria of Mallet were performed each month. Microsurgical repair of the brachial plexus was performed in six infants who had no evidence of biceps function within the first six months of life. Another group of twenty-seven patients were referred for evaluation of chronic neuropathy after they were six months old. A transfer of the latissimus dorsi and teres major tendons to the rotator cuff was performed in nine of these patients and a derotation osteotomy of the humerus was performed in seven because of an internal rotation contracture or functional weakness of the external rotators of the shoulder. RESULTS: Twenty-two infants had recovery of biceps function within the first three months of life and had normal function at the time of the latest evaluation. Infants who had recovery of biceps function during the fourth, fifth, or sixth month of life later had significantly worse function, according to the criteria described by Mallet, than those who had had recovery in the first three months (p<0.005). The clinical results for the six patients who had had microsurgical repair six months after birth were significantly better (p<0.04) than those for the fifteen patients who had had recovery of biceps function in the fifth month of life. However, the results for the patients who had had repair of the brachial plexus were not found to be better than those for the eleven patients who had had recovery of biceps function in the fourth month of life. The improvement in function, as assessed with use of the Mallet criteria, after tendon transfer (p<0.001) and humeral osteotomy (p<0.0001) was significant. CONCLUSIONS: The present study confirms the observation of Gilbert and Tassin that it is rare for infants who have recovery of biceps function after the age of three months to have complete neurological recovery. Microsurgical repair was effective in improving function in the small subgroup of patients who had no evidence of recovery of biceps function within the first six months of life.

Arm↗
PubMed1998

The Health of the Nation Outcome Scales in psychiatric hospitalisation: a multicentre study examining outcome and prediction of length of stay.

OBJECTIVE: The Health of the Nation Outcome Scales (HoNOS) is a reliable instrument, useful in detecting change in symptoms and functioning during psychiatric hospitalisation. The present study examines its utility in predicting length of stay of patients in six private psychiatric hospitals in four Australian States. METHOD: The HoNOS was administered on admission and discharge in six private psychiatric hospitals in Australia. RESULTS: There were significant differences in total score and in all sub-scales between admission and discharge. There were no significant associations between total HoNOS scores and length of stay, either for individual hospitals or for specific diagnosis-related groups. There were only very weak associations, of doubtful practical clinical significance, between length of stay of all patients and individual HoNOS sub-scales. CONCLUSION: While the HoNOS is of some value in providing a readily administered and understood measure for clinicians, on the basis of these findings it is unlikely to be of utility in predicting length of stay or in offering a 'gate-keeping' service in decision-making in regard to the allocation of resources for individual patients.

Adult↗
PubMed1998

Outcomes of noncardiac surgical procedures in children and adults with congenital heart disease. Mayo Perioperative Outcomes Group.

OBJECTIVE: To assess the outcomes and risk factors for morbidity associated with anesthesia and noncardiac surgical procedures in children and adults with congenital heart disease. DESIGN: We conducted a retrospective cohort study of the 6-year period from January 1987 through November 1992 at one of the Mayo-affiliated hospitals in Rochester, Minnesota. MATERIAL AND METHODS: In all children and adults 50 years of age or younger with congenital heart disease who underwent one or more noncardiac surgical or diagnostic procedures and anesthesia, we analyzed the risk factors for 30-day perioperative morbidity and mortality. RESULTS: The overall frequency of complications among the 276 patients who underwent 480 noncardiac surgical procedures and anesthesia was 5.8% (28 of 480), and only 1 patient died intraoperatively. Major risk factors univariately associated with complications for the first procedures (15 of 276 patients or 5.4%) included the presence of cyanosis (P = 0.002), current treatment for congestive heart failure (P<0.001), poor general health (P<0.001), and younger age at the time of the procedure (P = 0.027). Procedures performed on the respiratory and nervous systems also were associated with high frequencies of complications. Complications in patients undergoing ambulatory surgical procedures were infrequent (1.7%). CONCLUSION: The frequency of perioperative complications in children and adults who have congenital heart disease and undergo noncardiac surgical procedures and anesthesia is low. Patients who have pulmonary hypertension, congestive heart failure, or cyanosis and children with congenital heart disease who are younger than 2 years of age have an increased frequency of perioperative morbidity.

Adolescent↗