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PubMed1978

Incidence of circulatory arrest in patients with acute myocardial infarction in coronary unit. Mechanism of their genesis and factors conditioning successful resuscitation.

The incidence, circumstances, and mechanism of development of cardiac arrest in 786 patients with myocardial infarction treated at a coronary care unit within a five-year period were studied and clinical factors are analysed with respect to success of resuscitation. One or more episodes of cardiac arrest occurred in a total of 156 patients (19.8%). Of these, 25 (16.0%) were successfully resuscitated and 131 (84.0%) died. At the clinical ward where the patients had been transferred after the acute stage, cardiac arrest occurred in additional 22 patients, of whom two were successfully resuscitated. Thus, the total number of successfully resuscitated patients throughout the five-year period was twenty-seven. The results of resuscitation were poorer in elderly patients, in those with anterior infarction, and above all in patients with severe symptoms of mechanical heart failure. Anamnestic factors (chronic angina pectoris, previous myocardial infarction, hypertension, diabetes mellitus, ischaemic disease of the lower limbs) were not significantly associated with the results of resuscitation. Primary ventricular fibrillation was the principal mechanism of cardiac arrest in 24 of the 27 patients successfully resuscitated, and its total incidence in the investigated group was 3%. The prognosis of resuscitation in patients with primary ventricular fibrillation was very good, and in all of them the resuscitation was successful and permanent.

Adult↗

PubMed1995

Determinants of success with spot localization biopsy of the breast.

BACKGROUND: The accurate diagnosis of nonpalpable lesions of the breast by spot localization biopsy depends upon numerous variables. STUDY DESIGN: Multivariate analysis was used to identify variables influencing the success of spot localization biopsy of 757 lesions (27.3 percent of which were malignant) in 738 patients. RESULTS: Ninety percent of the lesions were removed with the first excision as documented by specimen radiography, but 2.3 percent (18 lesions) were not evident on specimen radiography with up to four excisional attempts. Eight (44 percent) of these 18 were in fact removed because they could not be seen on follow-up mammograms. Lesions with calcifications only were significantly more difficult to remove than were masses (87 compared with 96 percent, respectively, p < 0.001). The use of both hooked wire and methylene blue dye was significantly less successful than wire or dye alone (84 compared with 93 and 91 percent, respectively, p < 0.001). A second attempt was successful in 71 percent (52 lesions) of the remaining 75 percent lesions and additional attempts at excision were often associated with success. Success was highly variable among surgeons but could not be related to experience. CONCLUSIONS: Calcifications are more difficult to remove than masses, and combining hooked wire with dye does not improve the success rate. Additional excisional attempts are worthwhile if the lesion is not seen on the first radiograph of the specimen.

Adult↗

PubMed1995

Measuring the success of treatment in patient terms.

Measuring the success of major surgeries such as total hip and total knee replacement is important for both case selection and public policy. Patients, purchasers, and practitioners must choose among clinical scoring systems, health status measures, and patient satisfaction ratings to monitor performance and ensure appropriate use of costly procedures. The present study compares results from the Medical Outcomes Study Short Form 36 (SF-36) Health Status Survey and clinical scoring systems to direct patient ratings of success. Data come from a study of 128 total knee-replacement procedure and 211 total hip replacements. Analyses indicate that for both hip and knee patients, success is related closely to posttreatment physical function and bodily pain. Patient ratings of success also are related to the clinical scores used by physicians. Success is related less to change from pretreatment function for knee patients than for hip patients. Although patient ratings of success are generally consistent with other outcome measures, their relationship to patient expectations, satisfaction, and attributions need to be understood before they can become a useful tool for performance monitoring and case selection.

Activities of Daily Living↗

PubMed1994

Dimensions associated with successful implementation of a hospital based integrated order entry system.

Implementation of an integrated electronic medical record requires direct physician order entry. This application involves multi-level changes in the whole system of care, from physicians attitudes to interdepartmental relations. This study reports the results of the first round of a modified Delphi, where a diverse group of individuals were asked to identify the most important facilitating and impeding factors associated with implementation of an order entry application. From a Q-sort of their responses, we identified 20 systemic, behavioral, and attitudinal dimensions perceived to be causal factors in successful implementation. We also explored how these dimensions may influence success by comparing successful with unsuccessful hospitals in terms of the frequency with which these dimensions were differently mentioned by respondents. We found that although available functionality was the most commonly mentioned factor by all participants, hardware availability, physician involvement, administration support, and medical administration involvement were more often mentioned by successful hospitals than by less successful hospitals. These results suggest that these factors were not present in the less successful hospitals. We also found that the frequency of responses within each category varied depending on the institutional role of the individuals responding. Those involved in support tended to see organizational variables as more important than those in clinical positions, whereas clinicians viewed administrative support and involvement of the chief as more important. These findings support the notion that the changes involved in instituting a physician order entry system are system wide and involve individual as well as organizational factors.

Attitude of Health Personnel↗

PubMed1994

Markers of successful recruitment of students to family practice residency programs.

BACKGROUND AND OBJECTIVES: With limited numbers of medical students choosing a primary care specialty, family practice residency programs have had to complete to fill available residency positions. The purpose of this study was to determine the characteristics of the recruiting process used by US family practice residencies and to compare recruiting strategies used by successful and unsuccessful programs. METHODS: We surveyed program directors of all 361 nonmilitary, accredited, US family practice residency programs in existence for more than 2 years. The questionnaire elicited information on program descriptors, recruitment process, and fill rate in the National Resident Matching Program. RESULTS: Seventy-eight percent (282) of the program directors returned usable questionnaires. Success in filling available positions through the Match was significantly associated with high quality of current housestaff and faculty and current residents' positive feelings about the program (P < .01). Program directors perceived successful programs as having an outstanding reputation and being regarded positively by other departments within the institution (P < .01). Programs in the Pacific and Mountain regions of the United States are more successful in recruitment. Programs not filling available positions through the Match spent more effort in recruiting strategies such as mailing and marketing materials (P < .01). CONCLUSION: Having high-quality faculty, housestaff, and residents with good attitudes are markers of success in the Match. Less successful programs appear to try harder to attract residents.

Academic Medical Centers↗

PubMed1994

[Effects and side effects of the drug "Success"].

To raise the rate of success to 100% is certainly a goal worth striving for. However, the closer one approaches this ultimate success, the more one is confronted with unexpected difficulties, such as difficulties in recognizing and proving, extremely high success rates as well as ethical problems. Furthermore, in the range of a high success rate all attempts for further amelioration necessarily lead to deterioration of this success rate; this is illustrated by an example from ophthalmology. Actually, coping with success is a great challenge, and the teaching requires not only great skills but also a solid philosophical background. Teachers must meet high demands. This applies also to the general public and the authorities acting in its name who have to appoint gifted teachers and have to support their mission.

Clinical Competence↗

PubMed1995

Larval density and feeding success of Ixodes scapularis on two species of Peromyscus.

One potential mechanism for the regulation of tick populations is density-dependent feeding success on vertebrate hosts. In a series of laboratory experiments, we tested whether the density of larval Ixodes scapularis on the mice Peromyscus maniculatus and Peromyscus leucopus influenced tick feeding success. For both host species, the proportion of ticks feeding to repletion was constant (approximately 40-50%) over a range of infestation from 5 to 100 ticks per mouse. For P. leucopus, neither mass nor molting success of fed ticks was significantly related to tick density on the host. However, for P. maniculatus, we observed a statistically significant increase in molting success with increasing tick density on hosts, thus demonstrating facilitation rather than density-dependent regulation. Although results were not statistically significant, we observed a tendency for previously exposed P. leucopus to support lower tick feeding success than naive mice; however, even for previously exposed mice, tick feeding success was not density dependent. Our results do not support the notion that density-dependent feeding on hosts regulates density of I. scapularis populations at the numbers tested.

Animals↗

PubMedDate not supplied

[Successful aging: conceiving the aging process from a more positive perspective].

In 1987 John Rowe introduced the concept of Successful Aging. This is a new point of view, and its appearance has been followed by a growing amount of literature and research on the subject. The author reviews the concept of Successful Aging and some of the results of his experimental work. The growing numbers of people who age successfully leads us to reconsider some of the concepts that continue to prevail about aging. It seems that we can think of aging as something more than progressive and irreversible functional deterioration. Throughout the text the author insists on: the heterogeneity of the aging process and the possibility of a preventive approach to avoid the disabilities associated with the aging process. Our current knowledge on the subject faces the challenge of establishing specific preventive measures that would lead to successful aging. Some factors identified as positively associated with successful aging are: belonging to a high socio-economic level, relatively low body weight good pulmonary function, good cognitive status, lack of diabetes and high blood pressure and sustained physical and social activities. The study of the successful aging process will lead us to a better understanding of the aging process itself, and will result in the identification of behaviors that should be promoted to optimize this life period. Existing evidence of a significant remaining plasticity even in the very old opens interesting perspectives of eventual correction of erratic aging.

Aged↗

PubMedDate not supplied

Predictors and mediators of successful long-term withdrawal from antihypertensive medications. TONE Cooperative Research Group. Trial of Nonpharmacologic Interventions in the Elderly.

BACKGROUND: National guidelines recommend consideration of step down or withdrawal of medication in patients with well-controlled hypertension, but knowledge of factors that predict or mediate success in achieving this goal is limited. OBJECTIVE: To identify patient characteristics associated with success in controlling blood pressure (BP) after withdrawal of antihypertensive medication. DESIGN: The Trial of Nonpharmacologic Interventions in the Elderly tested whether lifestyle interventions designed to promote weight loss or a reduced intake of sodium, alone or in combination, provided satisfactory BP control among elderly patients (aged 60-80 years) with hypertension after withdrawal from antihypertensive drug therapy. Participants were observed for 15 to 36 months after attempted drug withdrawal. MAIN OUTCOME MEASURES: Trial end points were defined by (1) a sustained BP of 150/90 mm Hg or higher, (2) a clinical cardiovascular event, or (3) a decision by participants or their personal physicians to resume BP medication. RESULTS: Proportional hazards regression analyses indicated that the hazard (+/- SE) of experiencing an end point among persons assigned to active interventions was 75% +/- 9% (weight loss), 68% +/- 7% (sodium reduction), and 55% +/- 7% (combined weight loss/sodium reduction) that of the hazard for those assigned to usual care. Lower baseline systolic BP (P < .001), fewer years since diagnosis of hypertension (P < .001), fewer years of antihypertensive treatment (P < .001), and no history of cardiovascular disease (P = .01) were important predictors of maintaining successful nonpharmacological BP control throughout follow-up, based on logistic regression analysis. Age, ethnicity, baseline level of physical activity baseline weight, medication class, smoking status, and alcohol intake were not statistically significant predictors. During follow-up, the extent of weight loss (P = .001) and urinary sodium excretion (P = .04) were associated with a reduction in the risk of trial end points in a graded fashion. CONCLUSIONS: Withdrawal from antihypertensive medication is most likely to be successful in patients with well-controlled hypertension who have been recently (within 5 years) diagnosed or treated, and who adhere to life-style interventions involving weight loss and sodium reduction. More than 80% of these patients may have success in medication withdrawal for longer than 1 year.

Aged↗

PubMed2000

Predictors of virological success and ensuing failure in HIV-positive patients starting highly active antiretroviral therapy in Europe: results from the EuroSIDA study.

BACKGROUND: Predictors of virological response to highly active antiretroviral therapy (HAART) have never been systematically evaluated in a large continental multicenter cohort of unselected human immunodeficiency virus (HIV)-infected people. OBJECTIVE: To determine the factors related to achieving and maintaining undetectable plasma HIV-1 RNA levels among HIV-1-infected patients first starting protease inhibitor- or nonnucleoside retrotranscriptase inhibitor-containing HAART in Europe. DESIGN: Prospective multicenter cohort study. SETTING: Fifty-two clinical centers in 17 European countries included in the EuroSIDA Study Group, from August 1996 to April 1999. PATIENTS: A total of 1469 HIV-positive patients first starting HAART recruited from an unselected cohort of more than 7300 HIV-positive patients. MAIN OUTCOME MEASURE: Detection of factors related to virological success after first starting HAART (baseline) and ensuing failure by standard survival techniques, including Kaplan-Meier techniques and Cox proportional hazards models. All analyses were intention to treat. RESULTS: Most patients (80%) achieved plasma HIV-1 RNA levels of less than 500 copies/mL during follow-up (60.4% at 6 months from the onset of HAART). Patients with higher baseline HIV-1 RNA levels (relative hazard [RH], 0.76 per log higher; 95% confidence interval [CI], 0.69-0.84; P<.001) and those taking saquinavir mesylate hard gel as a single protease inhibitor (RH, 0.62; 95% CI, 0.47-0.82; P<.001) were less likely to reach undetectable HIV-1 RNA levels. Conversely, higher CD4+ lymphocyte counts (RH per 50% higher, 1.09; 95% CI, 1.02-1.16; P = .008) and the initiation of 3 or more new antiretroviral drugs (RH, 1.29; 95% CI, 1.03-1.61; P = .02) were independent predictors of higher success. Once success was achieved, HIV-1 RNA levels rebounded in more than one third of all patients during follow-up (24% at 6 months). Antiretroviral-naive patients (RH, 0.50; 95% CI, 0.29-0.87; P = .01), older patients (RH, 0.86 per year older; 95% CI, 0.75-0.99; P = .04), and those starting a protease inhibitor other than saquinavir hard gel (RH, 0.66; 95% CI, 0.44-0.98; P = .04) were at decreased hazard for virological failure. Higher baseline HIV-1 RNA level (RH, 1.18 per log higher; 95% CI, 0.99-1.40; P = .06) and a longer time to achieve virological success (RH per 12 months, 1.53; 95% CI, 0.99-2.38; P = .06) were marginally significant predictors of a decreased hazard of ensuing virological failure. CONCLUSIONS: HAART is associated with a favorable virological response if started when the baseline HIV-1 RNA level is low, if at least 2 new nucleoside retrotranscriptase inhibitors are added, and if standard doses of saquinavir hard gel capsule are avoided as a single protease inhibitor. Older patients are more likely to achieve virological success. Thereafter, the higher durability of virological response is predicted by an antiretroviral-naive status and by the use of specific regimens. Lower baseline HIV-1 RNA levels and rapid maximal viral suppression seem to be other important factors in the durability of virological response.

Anti-HIV Agents↗

PubMed2002

Success and predictability of provox prosthesis voice rehabilitation.

OBJECTIVES: To determine the success rate and relating clinical factors of voice prosthesis rehabilitation and to analyze the discrimination ability of the multidimensional Harrison-Robillard-Shultz Tracheoesophageal Puncture Rating Scale (HRS Rating Scale). DESIGN: Prospective clinical study. SETTING: University Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Inselspital, Bern, Switzerland. SUBJECTS AND METHODS: From 1992 through 1998, 87 patients with advanced squamous cell carcinoma of the larynx and/or hypopharynx underwent primary tracheoesophageal puncture after total laryngectomy. Clinician otolaryngologists and speech/language pathologists independently used the HRS Rating Scale for success assessment of voice prosthesis rehabilitation. RESULTS: Age, sex, tumor localization, tumor stage, and radiation therapy had no influence on the success of voice prosthesis rehabilitation. Overall, voice rehabilitation success rates between 40% and 62% were achieved. Speech/language pathologists and clinician otolaryngologists evaluated the same patient group without significant statistical differences. The HRS Rating Scale analysis showed an equal distribution of the subscale parameter care in functional and nonfunctional speakers and a strong correlation between the subscale parameters quality and use. CONCLUSIONS: Because of its safety and simplicity, tracheoesophageal puncture has become a state of the art method for voice rehabilitation after total laryngectomy. The short-term superiority of voice prosthesis in voice rehabilitation over esophageal speech rehabilitation must be seen in light of comparable long-term success rates of the 2 methods.

Adult↗

PubMed2005

Procedural success and complications following percutaneous coronary interventions among Asians and Pacific Islanders.

BACKGROUND: Although Asians and Pacific Islanders (PI) make up the fastest growing ethnic group in the United States, little is known about the clinical characteristics, procedural success, and procedure-related complications of those who undergo percutaneous coronary interventions (PCI). HYPOTHESIS: This study investigated PCI procedural success and procedural complications among PI and Asian patients in comparison with Caucasians. METHODS: We examined clinical characteristics, procedural success (post-PCI lesion < 50%) and procedure-related complications (hemorrhage, renal failure, myocardial infarction, stroke, bypass surgery, death) for all patients undergoing PCI at our hospital from January 1999 to June 2003. RESULTS: Overall, 2,598 PCIs were performed--1,058 (39%) in Caucasians, 1,163 (43%) in Asians, and 377 (14%) in PIs. The mean age of PIs (59 +/- 11 years) was significantly lower than that of Caucasians (65 +/- 12 years) and Asians (66 +/- 12 years). The mean body mass index (26 +/- 5) of Asians was significantly lower, while that of PIs (31 +/- 7) was significantly higher than that of Caucasians (28 +/- 6). More Asians (33.3%) and PIs (40.5%) had diabetes mellitus than did Caucasians (19.9%). More Asians (71.6%) and PIs (76.1%) had hypertension than did Caucasians (61.9%). Renal failure was more prevalent in Asians and PIs (6.0 and 7.4%, respectively) than in Caucasians (3.8%). Other than a higher prevalence of disease involving the left anterior descending vessel in Asians (56.4%) compared with Caucasians (50.4%), angiographic features across the three races were similar. There was no significant difference in procedural success (approximately 94%) or procedure-related complications among Caucasians (6.4%), Asians (7.1%), and PIs (4.3%). CONCLUSION: Although PIs and Asians have a substantially higher burden of comorbidities than Caucasians, race does not appear to influence PCI procedural success or procedure-related complications.

Aged↗

PubMed2007

Self-administered cognitive screening for a study of successful aging among community-dwelling seniors: a preliminary study.

BACKGROUND: Cognitive functioning is a central component of successful aging. Yet, there are few published instruments for brief and reliable self-administered cognitive assessment that could be used in large population-based studies of community-dwelling elderly people. OBJECTIVE: We examined the utility of a self-administered cognitive screening instrument in a group of community-dwelling older adults, and we evaluated correlations of the performance on this measure with demographic variables and specific indicators of self-rated successful aging. METHOD: We assessed 182 well-educated adults ages 58 to 99 with a modified version of a previously published cognitive screening instrument (Cognitive Assessment Screening Test--Revised; CAST-R), a measure of cognitive complaints (Cognitive Failures Questionnaire; CFQ), and a self-rating of successful aging. We used the SF-36 Physical and Mental Composite Scores as measures of physical and mental health-related functioning. RESULTS: As expected, most individuals performed well on the CAST-R; only 7% of participants fell below a previously established cut score for cognitive impairment. CAST-R scores were positively correlated with level of education, income, SF-36 Mental Composite Scores, and a self-rating of successful aging, and negatively correlated with chronological age. Scores on the CAST-R were not correlated with cognitive complaints (CFQ total score) or SF-36 Physical Composite Scores. CONCLUSIONS: A self-administered cognitive screening tool may be a useful, albeit limited, way of screening for cognitive disabilities among well-educated, community-dwelling older adults. Although preliminary, significant associations with several successful aging-related variables in expected directions represent the first step in establishing the validity of the CAST-R.

Activities of Daily Living↗

PubMed2001

Internal jugular vein versus external jugular vein anastamosis: implications for successful free tissue transfer.

BACKGROUND: Microvascular free flaps are becoming the reconstructive option of choice for many head and neck defects. Many previous studies have examined factors predicting free flap survival. No study has compared differences in free flap survival when anastomosed to the internal or external jugular systems. METHODS: Retrospective review of all free flaps performed at an academic medical center by a single head and neck microvascular surgeon during the period July 1995 to December 1999. Flaps were closely monitored postoperatively and taken back to the operating room urgently for arterial insufficiency or venous congestion. RESULTS: On hundred fifty-six free flaps were performed during this time period. Sixty-five free flaps were anastomosed to the external jugular (EJ) vein and 86 to the IJ system (62 to the proximal common facial vein, 17 end-side on the IJ, and 7 to other branches). Five had either two venous anastomoses or were anastomosed to other veins and were excluded from statistical analysis. Six (4%) vascular thromboses occurred; 5 were venous and 1 arterial. Success by group was 99% for IJ anastomosis (1 arterial thrombosis) and 92% for EJ anastomosis (5 venous thromboses, p =.03). Urgent anastomotic revision and reperfusion salvaged 5 of the 6 flaps (overall success 99%). CONCLUSIONS: Although the overall success rate (96% success with 99% success with salvage) is comparable to other large series, microvascular free flaps anastomosed to the external jugular vein failed at a significantly higher rate than those anastomosed to the IJ system. This suggests that the IJ system should be used as a recipient vessel when feasible.

Anastomosis, Surgical↗

PubMed2006

The wrecking effects of race and social class on self and success.

The literature on success neurosis has expanded in recent years to include a consideration of preoedipal as well as oedipal factors. Typically, success neurosis is considered to be a symptomatic result of complex intrapsychic phenomena, whether they be at the oedipal and/or preoedipal level. Having previously considered that success neurosis can also be determined by internalized representations of "real" factors, such as racism and poverty (Holmes, in press, b) the author here considers how these factors become primary intrapsychic building blocks of success neurosis through their negative impact on the components of success in the self and the ego.

Achievement↗

PubMedDate not supplied

Sample size and the probability of a successful trial.

This paper describes the distinction between the concept of statistical power and the probability of getting a successful trial. While one can choose a very high statistical power to detect a certain treatment effect, the high statistical power does not necessarily translate to a high success probability if the treatment effect to detect is based on the perceived ability of the drug candidate. The crucial factor hinges on our knowledge of the drug's ability to deliver the effect used to power the study. The paper discusses a framework to calculate the 'average success probability' and demonstrates how uncertainty about the treatment effect could affect the average success probability for a confirmatory trial. It complements an earlier work by O'Hagan et al. (Pharmaceutical Statistics 2005; 4:187-201) published in this journal. Computer codes to calculate the average success probability are included.

Algorithms↗

PubMed2005

Statistical modelling of the differences between successive R-R intervals.

Understanding the behaviour of R-R interval data and its successive differences is critical to the dynamics of cardiac control. Several time domain measures that quantify R-R interval variability have important clinical significance in terms of risk stratification and evaluating the effectiveness of treatment procedures. The present approach at examining the distributions of successive beat-to-beat differences of R-R interval data from different populations and under different conditions (baseline and reaction times) provides a valuable insight into their previously unexplored distributional properties. In particular, our analysis reveals that the successive differences have non-normal statistical distributions (a contradiction to the commonly used assumption of normality), and the absolute successive R-R interval differences approximately follows a Weibull distribution. As an illustration of the utility of this approach, we explore the statistical properties of the time domain measure: root mean square successive difference, study the association between the Weibull scale parameter estimate and respiratory sinus arrhythmia, and propose improvements in artifact detection algorithms.

Adult↗

PubMed2003

Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies.

OBJECTIVE: The use of methotrexate (MTX) for the treatment of tubal ectopic pregnancy (EP) has become common practice, although the factors associated with a favorable outcome are not totally clear. The aim of this study was to investigate the predictors of successful MTX treatment. METHODS: One hundred and thirty-seven women with unruptured tubal EP in whom the hematosalpinx could be directly visualized by pelvic ultrasound were studied. Women who met the inclusion criteria were treated with MTX either: 50 mg/m(2) intramuscularly (n = 70) or with 1 mg/kg injected directly into the hematosalpinx under sonographic guidance (n = 67). The associations between the outcome of the treatment and different factors studied (human chorionic gonadotropin (hCG) level, progesterone level, hematosalpinx diameter, hemoperitoneum volume and mode of MTX administration) were analyzed. RESULTS: The overall success rate, defined by a post-treatment normal hCG level (< 10 mIU/mL), was 79.6%. The initial hCG level and the route of administration of MTX appeared to be two independent factors that predicted success. Multivariate analysis demonstrated that the success rate was significantly better when MTX was administered locally: the odds ratio (OR) was 9.7 (95% CI, 3.1-30), and was significantly poorer when the hCG level was >/= 1000 mIU/mL (P < 0.002): the OR was 0.10 (95% CI, 0.07-0.49). CONCLUSION: Among selected women with tubal EPs, the route of administration of MTX and the initial level of serum hCG are the most important factors associated with the success of medical treatment.

Abortifacient Agents, Nonsteroidal↗