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PubMed1990

Outcome at discharge for patients in an ongoing follow-up study of hospital treatment.

Methodological and practical difficulties have limited the growth of knowledge about outcome of psychiatric hospital treatment. The authors report on outcome at hospital discharge for 103 long-term and 93 short-term patients treated at the C. F. Menninger Memorial Hospital, part of an ongoing follow-up study of hospital treatment. Discharge outcome is based mainly on ratings of symptoms, global functioning, and therapeutic alliance as well as on patients' reports of satisfaction. At discharge both long- and short-term patients were found to have low levels of symptoms (based on the Brief Psychiatric Rating Scale) and a relatively adequate level of functioning (in the 51-to-60 range on the Global Assessment Scale) and to have been highly satisfied with treatment.

Adult↗

PubMed1999

BMIPP imaging to improve the value of sestamibi scintigraphy for predicting functional outcome in severe chronic ischemic left ventricular dysfunction.

UNLABELLED: Mismatching between beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) and perfusion accurately predicts functional outcome after acute myocardial infarction. The current investigation was aimed at evaluating the value of this method to predict the evolution of global function according to the applied treatment in patients with chronic ischemic heart disease. METHODS: Twenty patients with infarction and chronic left ventricular dysfunction were studied (median infarction age 12 wk, range 2 wk-15 y). Radionuclide angiography, two-dimensional echocardiography and BMIPP and gated sestamibi scintigraphy were performed with the patient at rest before and >6 mo after treatment (revascularization in 13 patients and conservative therapy in 7 patients). In 7 patients, radionuclide angiography was repeated after 1 y. RESULTS: On a patient basis, mismatching with BMIPP less than sestamibi was noted in 15 patients at baseline. Of these 15 patients, 11 had significant functional improvement at follow-up versus only 1 of the 5 patients with a matched decreased uptake. Hence, the combined sestamibi/BMIPP was 73% positive and 80% negative in predicting functional outcome, with a global accuracy of 75%. On a segmental basis, using an optimal threshold of uptake defined by receiver operating characteristic curve analysis, sestamibi was only 63% accurate in predicting regional outcome. Adding BMIPP improved the accuracy to 80% (P = 0.001). At follow-up, significant mismatching was still noted in 7 patients in the revascularized group and 1 in the medically treated group. The mismatch was associated with a further increase in ejection fraction at 1-y follow-up in only the revascularized group. CONCLUSION: In patients with chronic left ventricular dysfunction after infarction, a mismatching with BMIPP less than sestamibi reliably identifies jeopardized but viable myocardium and predicts functional recovery with an accuracy similar to that reported in the acute and subacute phases of the infarction.

Aged↗

PubMed1999

Assessment of regional and global left ventricular function by reinjection T1-201 and rest Tc-99m sestamibi ECG-gated SPECT: comparison with three-dimensional magnetic resonance imaging.

OBJECTIVES: The purpose of this study was to test the ability of reinjection thallium-201 and rest technetium-99m sestamibi ECG (electrocardiographic)-gated SPECT (i.e., reinjection-g-SPECT [single-photon emission computed tomography] and MIBI-g-SPECT) to determine regional and global functional parameters. BACKGROUND: The ECG-gated perfusion SPECT was reported to provide accurate left ventricular ejection fraction (LVEF) using an automated algorithm. We hypothesized that other various functional data may be obtained using reinjection-g-SPECT and MIBI-g-SPECT. METHODS: Reinjection-g-SPECT, MIBI-g-SPECT, and three-dimensional magnetic resonance imaging (3DMRI) were conducted in 20 patients with coronary artery disease. Regional wall motion (RWM) and wall thickening (RWT) were analyzed using semiquantitative visual scoring by each g-SPECT and 3DMRI. The left ventricular end-systolic and end-diastolic volumes (EDV, ESV) and LVEF estimated by reinjection- and MIBI-g-SPECT were compared with the results of 3DMRI. RESULTS: A high degree of agreement in RWM and RWT assessment was observed between each g-SPECT and 3DMRI (kappa >.70, p < .001). The LVEF values by reinjection- and MIBI-g-SPECT correlated and agreed well with those by 3DMRI (reinjection: r = .92, SEE = 5.9%, SD of differences = 5.7%; sestamibi: r = .94, SEE = 4.4%, SD of differences = 5.1%). The same also pertained to EDV (reinjection: r = .85, SEE = 18.7 ml, SD of differences = 18.4 ml; sestamibi: r = .92, SEE = 13.1 ml, SD of differences = 13.0 ml) and ESV (reinjection: r = .94, SEE = 10.3 ml, SD of differences = 10.3 ml; sestamibi: r = .97, SEE = 6.7 ml [p < .05 vs. reinjection by F test], SD of differences = 6.6 ml [p < .05 vs. reinjection by F test]). CONCLUSIONS: Reinjection- and MIBI-g-SPECT provide clinically satisfactory various functional data. These functional data in combination with the perfusion information will improve diagnostic and prognostic accuracy without an increase in cost or the radiation dose to the patients.

Adult↗

PubMed2002

Evaluation of inotropic changes in ventricular function by NOGA mapping: comparison with echocardiography.

Assessment of left ventricular (LV) function in the catheterization laboratory is important to optimize treatment decisions and guide catheter-based local therapies. NOGA electromechanical mapping was developed to assess LV contraction during catheterization; however, quantitative analysis of its "local shortening" (LS) algorithm and direct comparison with conventional methods are lacking. We evaluated the accuracy of NOGA-based regional and global function by examining its ability to detect pharmacologically induced changes in contractility compared with echocardiography. Ten anesthetized pigs were paced to ensure a constant heart rate throughout the experiment. Electromechanical maps of the LV and short-axis echocardiograms were obtained 1) at baseline, 2) during intravenous dobutamine, and 3) after intravenous propranolol. NOGA LS and ejection fraction (EF) consistently increased under dobutamine and decreased after propranolol. NOGA LS and NOGA and echocardiography circumferential shortening correlated highly with one another (r > 0.80), as did NOGA EF with echocardiography EF (r = 0.92), although absolute values differed somewhat. Thus NOGA-based global and regional function correlates closely with echocardiography and is sensitive to changes in contractility, but, at the upper end of the scale, LV function is underestimated.

Animals↗

PubMed1984

Computer recognition of radiopaque myocardial markers.

Radiopaque markers implanted in the heart have been used both clinically and experimentally to examine cardiac function. From the position of the markers, both regional and global function can be determined. A major problem with using radiopaque markers is the excessive time required for data analysis. Each marker in every cine frame must be identified and digitized by the investigator. To circumvent this problem, a computer system was developed to automatically identify the markers. The cine film is projected onto a TV camera from which the video signal is digitized and transferred into a computer. The investigator identifies the markers in the first cine frame and thereafter the computer advances the film and locates the markers. The markers are recognized based on positional information from the previous cine frame and on a video density profile. This system greatly reduced the investigators' time required for data analysis.

Animals↗

PubMed2005

Cognitive deficits predict low treatment retention in cocaine dependent patients.

Previously, we found that impaired cognition predicted treatment dropout from cognitive behavioral therapy (CBT) in a small sample of cocaine dependent patients. To further address the role of impaired cognition in retention and treatment outcome of cocaine-dependent patients in CBT, we expanded a previous investigation to a larger sample, added depressed cocaine patients, and added an additional cognitive assessment. Fifty-six cocaine dependent patients receiving CBT in outpatient clinical trials were assessed for cognitive performance at treatment entry with the computerized MicroCog (MC) and the Wisconsin Card Sort Test (WCST). Treatment completion was defined as 12 or more weeks. Treatment dropouts had significantly lower MC scores (poorer cognitive functioning) than completers on attention, memory, spatial ability, speed, accuracy, global functioning, and cognitive proficiency, with effect sizes in the moderate to large range. These findings were not affected by depression, demographics (age, gender, race, sex, marital status) or drug use (years of cocaine use or average weekly cocaine expenditure in the prior 30 days). In contrast, patients' performance on the WCST was in the average or near-average range, and WCST scores did not differentiate between completers and dropouts. Consistent with previous research, results suggest that mild cognitive impairments (< or =1 S.D. below the mean) negatively affect retention in outpatient CBT treatment for cocaine dependence. Future studies should examine whether there are specific effects of different executive functioning abilities on treatment outcome. Modified behavioral and pharmacologic interventions should be considered to target mild cognitive impairments to improve substance treatment outcome.

Adult↗

PubMed1989

Community adjustment of chronic schizophrenic patients in urban and rural settings.

The influence of environmental conditions on the community adjustment of chronic schizophrenic patients who live in boarding homes and other residential facilities was studied using data from medical records and interviews with patients. Seventy-eight patients living in an urban area and 46 patients living in a rural area were included in the study. Compared with rural patients, urban patients were more likely to live in substandard dwellings, to receive less practical support from the home operator, and to report more incongruence with household members and aversive neighborhood conditions. Urban patients showed significantly more psychopathology, functioned more poorly in relationships with others, and had poorer global functioning than rural patients. Except for the physical condition of patients' dwellings, all the environmental conditions measured in the study were significantly associated with some measures of community adjustment regardless of geographic setting.

Adult↗

PubMed1980

[Physiological-pathophysiological evaluation of possibilities and limits of unilateral renal function tests].

1. Issuing from the clinical method of proceeding in side-separated diagnosis of the renal function under theoretical aspect a survey orientation for the renal global function is tried. 2. The method orientation is done according to semiquantitative and quantitative valuation. The isotope and contrast remedy urography, the functional tests after Howard, Rapoport and Stamey, the conventional side-separated estimation of the clearance, the isotope sequence scintigraphy as well as the diagnostics of the renal and intrarenal haemodynamics (renin determination, measuring of the renal plasma flow by means of PAH and other indicators [133-xenon-wash-our-technique]). 3. Finally a valuation of the method concerning the side-separated diagnostics of the renal elimination function as well as of the stenosis of the renal arteries is done taking into consideration the performability of the investigation methods in the clinic.

Acid-Base Equilibrium↗

PubMed1991

Dose-related effects of isoflurane associated with low plasma concentrations of verapamil on global and regional function in normal and compromised canine myocardium.

Global and regional myocardial functions were studied in seven open-chest dogs with constant low plasma concentrations of verapamil as increasing concentrations of isoflurane (0.75, 1, 1.5 MAC) were administered in the presence of normal myocardial perfusion and after application of critical constriction of the left anterior descending coronary artery. In the presence of verapamil, increases in isoflurane concentrations caused dose-dependent myocardial depression both before and after critical coronary constriction. The systemic and coronary vasodilatation associated with high concentrations of isoflurane did not occur in the presence of verapamil. The association of verapamil with isoflurane caused regional myocardial dysfunction that worsened at high isoflurane concentrations. This regional dysfunction could not be antagonized in two dogs. The effects of isoflurane on regional function were not modified by application of a critical coronary constriction.

Animals↗

PubMed1999

Cine MR imaging after myocardial infarction--assessment and follow-up of regional and global left ventricular function.

Myocardial infarction often leads to regional wall motion defects and in case of large defects to remodeling of the left ventricle. With this study, changes in regional and global myocardial function of 12 patients 3 weeks after myocardial infarction and after revascularization therapy were determined using MRI. Cine MRI was performed at study entry at rest and during low-dose dobutamine stimulation. All patients were re-examined at rest 3 and 6 months after the revascularization, including analysis of wall thickening and of left ventricular end-diastolic volume index (LVEDVI), end-systolic volume index (LVESVI), ejection fraction (LVEF), and mass index. After revascularization. 6 patients with stress-induced improvement of regional wall thickening recovered, 4 patients without improvement did not, but 2 patients without stress-induced improvement of wall thickening also recovered. Concerning global cardiac function, patients with mainly improved regional wall motion also showed a lower LVESVI and a higher LVEF than patients without improvement of regional contractility 6 months after revascularization in comparison to study entry. In conclusion, improvement of global myocardial function after revascularization is higher in patients with improved contractility in the infarcted region. The extent of the response of regions with wall motion defects to dobutamine stress correlates with the actual improvement after revascularization, and, therefore, dobutamine stress MRI may be helpful in selecting patients that will have a higher benefit from a revascularization therapy.

Adult↗

PubMed2005

Mechanism of sudden cardiac death in pigs with viable chronically dysfunctional myocardium and ischemic cardiomyopathy.

Pigs with viable chronically dysfunctional myocardium and ischemic cardiomyopathy are at high risk of sudden cardiac death (SCD). We sought to identify the arrhythmic mechanism of SCD, the relation to changes in left ventricular (LV) function, and inducibility of malignant arrhythmias before SCD. Juvenile pigs (n = 72) were instrumented with chronic stenoses on proximal left anterior descending and circumflex arteries. Survival was only 29% 3 mo after instrumentation, and all deaths were sudden and without prodromal symptoms of heart failure. Triphenyltetrazolium chloride staining demonstrated necrosis in only nine animals averaging 2.3 +/- 0.9% of the LV, with no difference between SCD animals and survivors. Implantable loop recorders (n = 13) documented both ventricular fibrillation (n = 6) and bradyasystole (n = 2) as the arrhythmic mechanism of death. Although regional and global function were depressed [anteroseptal wall thickening 1.8 +/- 0.2 vs. 4.2 +/- 0.2 mm in Sham animals (P < 0.001); fractional shortening 21 +/- 2 vs. 31 +/- 1% in Sham animals (P < 0.01)], there were no differences between SCD animals and survivors. LV mass increased in animals with ischemic cardiomyopathy and was greater in animals with SCD (4.0 +/- 0.2 vs. 3.1 +/- 0.1 g/kg in survivors; P < 0.001). Serial programmed ventricular stimulation failed to induce any sustained arrhythmias. We conclude that pigs with viable dysfunctional myocardium and globally reduced LV function have a high rate of SCD with a spectrum of arrhythmias similar to patients with ischemic cardiomyopathy. The risk is independent of necrosis but appears to increase with LV hypertrophy. Like patients with ischemic cardiomyopathy, programmed stimulation is insensitive to predict SCD when viable dysfunctional myocardium is the pathological substrate.

Animals↗

PubMed2006

Metabolic and hemodynamic features of elderly patients undergoing beating heart coronary artery bypass graft surgery.

AIM: Coronary artery bypass graft (CABG) surgery, nowadays, is increasingly performed in patients who are older and have more comorbidities than subjects operated on a decade ago. In this study, we investigated metabolic and hemodynamic features of elderly patients with single vessel coronary artery disease (CAD), undergoing beating heart coronary artery bypass graft (BHCABG) surgery. METHODS: Twenty-five elderly patients, ages 73-78 years, with isolated left anterior descending artery (LAD) disease, were enrolled and compared to a younger similar group of 25 patients, mean age 48+/-1.2 years. A single vessel left internal mammary artery (LIMA) to LAD BHCABG was performed in all patients. Duration of temporary LAD occlusion was 9.8+/-0.5 min in the elderly group, and 10+/-0.4 min in the younger group. Myocardial arterial-venous differences in glucose, lactate, and creatine phosphokinase (CPK) were performed at different time points: preoperatively in the operating room (T0); at the end of the grafting procedure (T1); and before closing the chest (T2). Left ventricular stroke work index (LVSWI), as an indicator of global function of left ventricle, were recorded at T0, T1, T2, 6 (T3) and 48 (T4) hours postoperatively. RESULTS: Preoperative glucose extraction, observed in both groups, did not augment during and after surgery. In addition, neither lactate nor CPK were released in the coronary sinus during temporary LAD occlusion and following reperfusion in either group. Similarly, no significant changes in LVSWI were observed intra- and perioperatively between the two groups. CONCLUSIONS: Cardiac metabolism, hemodynamic parameters and global left ventricular function were not affected in either group by brief LAD occlusion during BHCABG, suggesting that BHCABG is a well-tolerated surgical approach, which can be safely attempted in patients of any age.

Age Factors↗

PubMed2004

Multimethod Validity Assessment of the SWAP-200 Dysphoric Q-Factor.

The aim of this study was to investigate the convergent validity of the Shedler-Westen Assessment Procedure Q-Sort Dysphoric Q-Factor with scales from the therapist, the patient, and independent observers. Therapists used the Shedler-Westen Assessment Procedure Q-Sort to describe their patients after the therapeutic assessment and the first two therapy sessions (when available). Independent observers completed a number of symptom distress, global functioning, and Axis II psychopathology measures after watching videotapes of the therapeutic assessment. They also completed a measure of social cognition and object relations after watching videotape of the therapeutic assessment and the first two therapy sessions (when available). Patients completed measures of symptomatology and personality assessment. Results indicated several significant correlations between the Dysphoric Q-Factor and a number of the clinician ratings of depressive symptomatology. In addition, three clinician ratings (Personality Disorder Index, Global Assessment of Functioning scale, and the experience and management of aggressive impulses variable of the Social Cognition and Object Relations Scale) demonstrated unique and nonredundant predictive ability in accounting for the variance of the Dysphoric Q-Factor. The patient self-report measures, however, did not correlate significantly with the Dysphoric Q-Factor, although several correlations demonstrated trends toward statistical significance.

Adult↗

PubMed2002

[Psychic impairment in psychosomatic and psychiatric quality assessment: global assessment of functioning scale (GAF) vs. impairment score (IS)].

OBJECTIVES: The Global Assessment of Functioning Scale (GAF) and the Impairment-Score (IS) are important instruments for Quality Assessment. There are only few studies examining the quality of statistical power of the GAF-Scale indicating problems in construct validity and no larger studies for the IS. METHODS: For a sample of 263 patients the Psy-BaDo and an OPD-Rating were completed. RESULTS: Though the distribution of both scales show large range, the proportion of explained variance is 58 %. This proportion can be increased to 68 % for the IS by including the OPD-Ratings. The GAF-Scale in contrast is not associated with the OPD-Ratings. CONCLUSIONS: The results indicate, that the combination of both scales is necessary to represent the whole variance of psychic impairment (ICD-10 Chapter F & Z). In addition the valid rating of both scales is very difficult for patients with somatic disorders and somato-psychic problems.

Activities of Daily Living↗

PubMed2003

Construct validity of the Global Assessment of Functioning Scale for clients with anxiety disorder.

The Global Assessment of Functioning Scale is a widely used although poorly researched measurement of overall mental health or illness. This study investigated construct validity for clients with anxiety disorder. Analysis suggests that current suicidality was the most significant predictor of ratings. Current homicidality, work/school problems, and inability to care for oneself were not significantly correlated with scale ratings.

Adult↗

PubMed1984

Improvement in regional and global left ventricular function after intracoronary thrombolysis: assessment with two-dimensional echocardiography.

After acute myocardial infarction, 23 patients undergoing intracoronary thrombolysis and 10 patients receiving conventional medical treatment were studied by 2-dimensional echocardiography to determine changes in regional and global left ventricular (LV) performance. Both quantitative and qualitative analysis of echocardiographic studies showed improvement in regional and global LV function in 18 patients with successful reperfusion immediately after thrombolysis to 10 days later (p less than 0.0005). Eleven patients who were studied before thrombolysis demonstrated no change in regional or global LV function immediately after thrombolysis. LV function did not improve in the conventionally treated group. These data indicate that in patients with acute coronary artery occlusion successfully reperfused by intracoronary thrombolysis, regional and global LV function improved by day 10 but not immediately after reperfusion.

Adult↗

PubMed2002

Effects of brief training on application of the Global Assessment of Functioning Scale.

31 staff members within one VA medical center were briefly trained in using the Global Assessment of Functioning scale. At both pre- and posttraining participants provided Global Assessment of Functioning scores and identified their GAF-derivation strategies for two vignettes describing hypothetical patients. Analysis showed that initially there was inter- and intrarater inconsistency in strategy for deriving scores and that training increased consistency. Participants persisted in giving ratings that exceeded the criterion score. However, training significantly reduced Global Assessment of Functioning scores for one vignette, bringing scores closer to the criterion, and a significant number of people gave lower ratings after training. The study highlights common errors and points to the need for formal training in use of the scale.

Adult↗

PubMed2000

Prediction of improvement in global left ventricular function in patients with chronic coronary artery disease and impaired left ventricular function: rest thallium-201 SPET versus low-dose dobutamine echocardiography.

Accurate assessment of myocardial viability permits selection of patients who would benefit from myocardial revascularization. Currently, rest-redistribution thallium-201 scintigraphy and low-dose dobutamine echocardiography are among the most used techniques for the identification of viable myocardium. Thirty-one consecutive patients (all men, mean age 60 +/- 8 years) with chronic coronary artery disease and reduced left ventricular ejection fraction (31% +/- 7%) were studied. Rest 201Tl single-photon emission tomography (SPET), low-dose dobutamine echocardiography and radionuclide angiography were performed before revascularization. Radionuclide angiography and echocardiography were repeated after revascularization. An a/dyskinetic segment was considered viable on 201Tl SPET when tracer uptake was >65%, while improvement on low-dose dobutamine echocardiography was considered a marker of viability. Increase in global ejection fraction was considered significant at > or = 5%. In identifying viable segments, rest 201Tl SPET showed higher sensitivity than low-dose dobutamine echocardiography (72% vs 53%, P<0.05), while specificity was not significantly different (86% vs 88%). In 17 patients, global ejection fraction increased > or = 5% (group 1) while in 14 it did not (group 2). A higher number of a/dyskinetic segments were viable on 201Tl SPET in group 1 than in group 2 (2.6 +/- 1.9 vs 0.6 +/- 1.2, P < 0.005), while no significant differences were observed on low-dose dobutamine echocardiography (1.7 +/- 1.6 vs 1.1 +/- 1.6). A significant correlation was found between the number of a/dyskinetic segments viable on 201Tl SPET and post-revascularization changes in ejection fraction (r = 0.52, P < 0.05), but such a correlation was not observed for low-dose dobutamine echocardiography. Using as the cut-off the presence of at least one viable a/dyskinetic segment, rest 201Tl SPET had a higher sensitivity (82% vs 53%, P = 0.07) and showed a trend towards higher accuracy and specificity (77% vs 58%, and 71% vs 64%, respectively) as compared with low-dose dobutamine echocardiography. In conclusion, these findings suggest that when severely reduced global function is present, rest 201Tl SPET evaluation of viability is more accurate than low-dose dobutamine echocardiography for the identification of patients who will benefit most from revascularization.

Adrenergic beta-Agonists↗