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At least 433 records · Page 24Linked to original sources

Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the prostate cancer outcomes study.

BACKGROUND: Men treated for clinically localized prostate cancer with either radical prostatectomy or external beam radiotherapy usually survive many years with the side effects of these treatments. We present treatment-specific quality-of-life outcomes for prostate cancer patients 5 years after initial diagnosis. METHODS: The cohort consisted of men aged 55-74 years who were newly diagnosed with clinically localized prostate cancer in 1994-1995 and were treated with radical prostatectomy (n = 901) or external beam radiotherapy (n = 286). We used clinical and quality-of-life data previously collected at the time of diagnosis (i.e., baseline) and at the 2-year follow-up and data newly collected at 5 years after diagnosis to compare urinary, bowel, and sexual function and to examine temporal changes in those functions. Odds ratios (ORs) and adjusted percentages were calculated by logistic regression. All statistical tests were two-sided. RESULTS: At 5 years after diagnosis, overall sexual function declined in both groups to approximately the same level. However, at 5 years after diagnosis, erectile dysfunction was more prevalent in the radical prostatectomy group than in the external beam radiotherapy group (79.3% versus 63.5%; OR = 2.5, 95% confidence interval [CI] = 1.6 to 3.8). Approximately 14%-16% of radical prostatectomy and 4% of external beam radiotherapy patients were incontinent at 5 years (OR = 4.4, 95% CI = 2.2 to 8.6). Bowel urgency and painful hemorrhoids were more common in the external beam radiotherapy group than in the radical prostatectomy group. All of these differences remained statistically significant after adjustment for confounders and for differences between treatment groups in some baseline characteristics. CONCLUSIONS: At 5 years after diagnosis, men treated with radical prostatectomy for localized prostate cancer continue to experience worse urinary incontinence than men treated with external beam radiotherapy. However, the two treatment groups were more similar to each other with respect to overall sexual function, mostly because of a continuing decline in erectile function among the external beam radiotherapy patients between years 2 and 5.

Aged↗

Effectiveness of palivizumab: evaluation of outcomes from the 1998 to 1999 respiratory syncytial virus season. The Palivizumab Outcomes Study Group.

BACKGROUND: Respiratory syncytial virus (RSV) remains a significant cause of morbidity, especially in premature infants and immunocompromised children, resulting in approximately 100 000 hospitalizations annually. A study was performed to evaluate the outcomes of those given palivizumab (Synagis; MedImmune, Inc., Gaithersburg, MD) during the 1998 to 1999 RSV season, its first season in general use. METHODS: A retrospective chart review of 1839 patients from 9 United States sites was conducted, representing all patients given palivizumab at each site. Those evaluated were to have a gestational age of < or =35 weeks, were to be <2 years old at their first injection and were to have received at least one dose of palivizumab (humanized monoclonal antibody against RSV) between September, 1998, and May, 1999. Gestational age, comorbidities, frequency of injections, hospitalizations and length of hospital stays were assessed. RESULTS: The antigen- or culture-positive RSV hospitalization rates for those given prophylaxis were 2.3% (42 of 1839) overall, 16/399 (4.0%) with chronic lung disease of infancy and 26 of 1227 (2.1%) born prematurely without chronic lung disease of infancy. Twenty-six patients had a gestational age of >35 weeks and were included in the analysis. CONCLUSIONS: Only 2.3% of children receiving palivizumab prophylaxis were hospitalized with RSV lower respiratory infection. This compares favorably with the rates observed in the pivotal trial (IMpact-RSV trial in 1996 to 1997), in which prophylaxis reduced hospitalization from 10.6% in the placebo group to 4.8% in those children receiving prophylaxis.

Antibodies, Monoclonal↗

Ambulatory blood pressure measurement as a predictor of outcome in an Irish population: methodology for ascertaining mortality outcome.

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) has proven to be a superior predictor of morbid events when compared to clinic or office blood pressure measurement (CBPM). The purpose of this study was to evaluate the predictive value of ABPM in a sample of 14 414 people referred for management of cardiovascular risk. METHODS: In this paper we describe the methodology required to examine mortality outcome in the absence of a national unique identifier. RESULTS: Using a computerized database of deaths we were able to establish that 1348 people had died by the end of the follow-up period (30 September 2002). Sixty-four percent of deaths were cardiovascular and in 207 subjects who had post-mortem examinations, 78% were cardiovascular. CONCLUSIONS: The accurate identification of the cause of death in a large population will allow comparison of the relative predictive power of APBM and CBPM in an Irish population.

Blood Pressure Monitoring, Ambulatory↗

Brain potentials associated with outcome expectation and outcome evaluation.

Feedback-related negativity is a negative deflection in brain potentials associated with feedback indicating monetary losses or response errors. Feedback-related negativity is studied primarily in paradigms in which participants experience negative outcomes that appear to be contingent upon their previous choices. This study investigated whether feedback-related negativity can be elicited by a randomly assigned cue indicating potential monetary loss. The expected loss or win can be materialized or averted depending on participants' performance in a subsequent game. Compared with the win cue, the loss cue elicited a weak but significant feedback-related negativity-like effect. It is suggested that the anterior cingulate cortex, which generates feedback-related negativity, may function as a pre-warning system that alerts the brain to get ready for future events.

Adult↗

Economic analysis of costs and consequences of the treatment of drug misuse: 2-year outcome data from the National Treatment Outcome Research Study (NTORS).

AIMS: Some economic costs and consequences of drug misuse and treatment were investigated among clients recruited to the National Treatment Outcome Research Study (NTORS). DESIGN: This was a longitudinal prospective cohort design comprising 549 clients recruited from 54 residential and community treatment programmes: data were collected from interviews conducted at treatment intake, at 1 year and at 2-year follow-ups. MEASUREMENTS: Treatment costs included index and other drug treatments. Costs were estimated for use of health and social care services, criminal activity and the use of criminal justice resources. Costs were based upon self-reported data collected by structured face-to-face interviews combined with unit cost estimates taken from a variety of sources. FINDINGS: Addiction treatment was costed at pound 2.9 million in the 2 years prior to index treatment, and a further pound 4.4 million in the subsequent 2 years. Economic benefits were largely accounted for by reduced crime and victim costs of crime. Crime costs fell by pound 16.1 million during the first year, and by pound 11.3 million during the second year. Health-care costs were relatively small but approximately doubled during the course of the study. The ratio of consequences to net treatment investment varied from 18 : 1 to 9.5 : 1, depending on assumptions. This is likely to be a conservative estimate of the benefit-cost ratio because many potential benefits were not estimated. CONCLUSIONS: The data showed clear economic benefits to treating drug misusers in England.

Adult↗

Outcomes of an ambulatory cardiac pacing program: indications, risks, benefits, and outcomes.

UNLABELLED: The purpose of this review was to evaluate the economical benefits and outcomes of an ambulatory pacing system implantation program that began in 1991 for new and replacement pacing system implantations. Patient access, incidence of complications, hospital bed day utilization, economic impact, safety, and practicality of the Ambulatory Pacing System Implantation Program was retrospectively reviewed from August 1991 to March 1994. The Ambulatory Pacing System Implantation Program includes pre-operative outpatient assessment in the pacemaker clinic, admission to the Day Medical Unit followed by same day pacing system implantation, discharge home after a short period of observation, and, in selected cases, cardiac monitoring, followed by pacemaker clinic visit 24-hours postimplantation. RESULTS: Two hundred four cardiac pacing systems, 154 new and 50 replacements (pulse generator/leads), were implanted under the guidelines of the Ambulatory Pacing System Implantation Program between August 1991 and March 1994. Eighty-seven percent of the patients were implanted with passive fixation leads, the remaining with active fixation leads; all but four of which were leads implanted in the atria. Preprocedure wait time was decreased from 16 to 2 days for elective pacing system implantation. The incidence of lead dislodgment in the first, second, and third year of the Ambulatory Pacing System Implantation Program was 20%, 12%, 5%, respectively; compared to 11% for a similar number of cases in previous years done as inpatients. The incidence of new infection was 2.4% compared to < 1% in previous years. Six of the 204 (2%) cases required admission overnight. A total savings of 1,456 bed days ($1,275,450.00; Canadian) has been realized for an equivalent number of cases when compared with previous years. The operational cost was reduced by $3,976.00 per case. CONCLUSION: It has been shown that the Ambulatory Pacing System Implantation Program has improved client access, and is a safe and economical approach to implantation of cardiac pacing systems.

Ambulatory Surgical Procedures↗

Measuring the outcome of contact tracing. 2. The responsibilities of the health worker and the outcome of contact investigations.

The previous paper (Satin and Mills, 1978) concerned information on patients who were interviewed by health workers in five selected clinics; information on the contacts named by these patients was similarly analysed. This paper describes and evaluates the activities of the health workers and the outcome of contact investigations. At all stages of the contact tracing process, differences were observed between men and women. It was found that more than half of the male contacts and half the female contacts were known to have been examined. Of those contacts examined, at least two-thirds of them attended the same clinic as the patient who had named them, and 85% of these contacts were found to have a treatable condition. It will be seen that the concept of success or effectiveness of contact tracing is complex in definition and measurement.

Allied Health Personnel↗

Can shared care deliver better outcomes for patients undergoing total hip replacement? A prospective assessment of patient outcomes and associated service use.

OBJECTIVES: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. DESIGN: Prospective, observational cohort study. SETTING: Two regions in The Netherlands where different organisational health care models have been implemented: a shared care setting (experimental group) and a care as usual setting (control group). PATIENTS: One hundred and fifteen patients undergoing total hip replacement: 56 in the experimental group and 59 in the control group. MAIN MEASURES: Functional health status according to the sickness impact profile, hip function, patient satisfaction and use of health care services. RESULTS: Two weeks before hip replacement both groups were comparable concerning patient characteristics, hip function and health status. The mean improvement of the total sickness impact profile score between two weeks before hip replacement and six months after was -1.92 in the shared care group, compared to -5.11 in care as usual group, a difference in favour of the control group (p=0.02). The mean length of hospital stay was comparable in both settings: 12.8 days in the shared care group and 13.2 days in the care as usual group. After hip replacement, compared to care as usual, patients in the shared care group received more homecare, with a higher frequency, and for a longer period of time. No differences in patient satisfaction between the two groups were found. CONCLUSIONS: Six months after hip replacement, the health status of patients in the care as usual group, using significantly less home care, was better than the status of patients in the shared care group. DISCUSSION: The utilisation of home care after hip replacement should be critically appraised in view of the need to stimulate patients' independence.

Journal Article↗

Adverse pregnancy outcome: sensitive periods, types of adverse outcomes, and relationships with critical exposure periods.

A wide variety of agents has been demonstrated to be capable of affecting the fetus in utero. Certain generalizations can be made concerning these teratogens. Two of the most important of these principles are the specificity of the agent and the time during gestation of the exposure. Although noticeable adverse effects are structural malformations, there are numerous functional malformations, such as lower intelligence and poor reproductive outcome, that may follow exposure to these agents. There is some evidence that future behavior may be affected by in utero teratogen exposure; however, this field has been infrequently investigated and no firm conclusions can be drawn.

Abnormalities, Drug-Induced↗

Outcome evaluation of gabapentin as add-on therapy for partial seizures. "NEON" Study Investigators Group. Neurontin Evaluation of Outcomes in Neurological Practice.

OBJECTIVE: The safety, tolerability, efficacy, and impact on quality of life of gabapentin (Neurontin) as adjunctive therapy to carbamazepine (CBZ) and/or phenytoin (PHT) was assessed in epileptic patients with partial seizures. METHODS: NEON (Neurontin Evaluation of Outcomes in Neurological Practice) was an open-label, prospective, multicentre study conducted in patients on a stable dose of CBZ and/or PHT and experiencing an average of up to 4 complex partial seizures with or without secondary generalization per month, with no seizure-free months. The treatment lasted 20 weeks. Gabapentin was started at 400 mg/day and was individually titrated to effective tolerable dose up to 2400 mg/day. Quality of life was evaluated using the QOLIE-10 questionnaire. RESULTS: A total of 141 patients were enrolled at 36 sites; 114 patients were evaluable for efficacy analyses. The mean maintenance dose of gabapentin was 1600 mg/day (range = 300-3200). A decrease of 50% or more in frequency of complex partial + secondary generalized seizures was observed in 81 (71%) patients (p = 0.0001). Fifty two (46%) patients were seizure-free during the last 8 weeks of treatment. A significant improvement (p < 0.05) was observed in 5 of the 10 questions of the QOLIE-10, as well as in the composite QOL score (p = 0.0002). The most frequent adverse events included somnolence (16%), dizziness (9%), and asthenia (6%). Twenty-five (18%) patients prematurely discontinued the study, 16 (11%) of them due to adverse events. CONCLUSIONS: This study indicates that treatment with gabapentin as adjunctive therapy to standard antiepileptic drugs in this group of patients not only provides significant improvement in seizure control, but also has a positive impact on quality of life. The clinical benefits in efficacy, safety and tolerability demonstrated at 20 weeks are sustained, and no tolerance develops with gabapentin in longer term use.

Acetates↗

Relationship between health services outcomes and social and economic outcomes in workplace injury and disease: data sources and methods.

BACKGROUND: Understanding the mediating role of health care in mitigating social, economic and occupational role disability is a complex task. METHODS: No single method of research will be successful in addressing all elements of this NORA research priority area. In this paper, we argue that research methods are needed which have the following components: (1) the detailed measurement of therapeutic intervention and the impacts of this intervention on clinical and functional health status using study designs which rule out competing explanations, (2) a longitudinal follow-up component which measures social, economic, and occupational role function following the conclusion of therapy, and (3) a commitment to execute studies across multiple settings to observe the variations in health care and in social and occupational role function that arise as a result of differences in labor market factors and employer and government policies. CONCLUSIONS: More comprehensive portraits of the longitudinal trajectory of individual workers, social, economic and occupational role function following an occupational injury or illness will have significance for a large number of policy sectors.

Accidents, Occupational↗

Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease: a science advisory from the American Heart Association Kidney And Cardiovascular Disease Council; the Councils on High Blood Pressure Research, Cardiovascular Disease in the Young, and Epidemiology and Prevention; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: developed in collaboration with the National Kidney Foundation.

Chronic kidney disease (CKD) occurs commonly in patients with cardiovascular disease. In addition, CKD is a risk factor for the development and progression of cardiovascular disease. In this advisory, we present recommendations for the detection of CKD in patients with cardiovascular disease. CKD can be reliably detected with the combined use of the Modification of Diet in Renal Disease equation to estimate glomerular filtration rate and a sensitive test to detect microalbuminuria. All patients with cardiovascular disease should be screened for evidence of kidney disease with these two determinations.

American Hospital Association↗