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PubMed1998

Prediction of successful induction of labor: comparison of transvaginal ultrasonography and the Bishop score.

OBJECTIVE: To determine whether transvaginal ultrasonography of the cervix before induction of labor is a better predictor of successful induction than the Bishop score. STUDY DESIGN: Eighty-six consecutive patients scheduled for induction of labor underwent digital cervical examination followed by transvaginal ultrasonography to measure cervical length and to determine the presence of wedging. Patients were induced with either oxytocin or intracervical prostaglandin E2 gel followed by oxytocin when required. The agent for induction was selected on the basis of the digital examination. The primary outcome criteria were successful induction and the duration of labor. RESULTS: Successful induction and the duration of labor were significantly associated with the Bishop score and cervical length. Cervical wedging was associated only with successful induction. However, in a logistic regression model that included these parameters as independent variables, only the Bishop score and parity were significantly correlated with successful induction and the duration of labor. CONCLUSIONS: Transvaginal ultrasonographic evaluation of the cervix before induction of labor does not improve the prediction of cervical inducibility obtained by the Bishop score.

Adult↗

PubMed1998

Preoperative predictors of recurrent atrial fibrillation late after successful mitral valve reconstruction.

OBJECTIVE: Late outcome after mitral valve repair was examined to define preoperative predictors of recurrent atrial fibrillation late after successful mitral valve reconstruction. METHODS: One hundred and eighty-nine patients, 112 with preoperative sinus rhythm and 72 with preoperative chronic or intermittent atrial fibrillation, were followed for 12.2 +/- 10 years after valve repair. Clinic, hemodynamic end echocardiographic data were entered into Cox-regression and Kaplan-Meyer analysis to assess predictors for recurrent atrial fibrillation late after successful mitral valve repair. RESULTS: Univariate and multivariate predictors for recurrent atrial fibrillation late after successful mitral valve reconstruction were preoperative atrial fibrillation (P = 0.0001), preoperative antiarrhythmic drug treatment (P = 0.005), heart rate (P = 0.01), left ventricular ejection fraction (P = 0.01) and increased left ventricular posterior wall thickness (P = 0.05). Patients > 57.5 years with a mean pulmonary artery pressure > or =23 mm Hg and a history of preoperative antiarrhythmic drug treatment had an odds ratio of 53.33 (95% confidence limits 6.12-464.54) for atrial fibrillation late after successful mitral valve repair. CONCLUSION: Older patients with a history of atrial fibrillation, antiarrhythmic treatment or an elevated pulmonary artery pressure may present atrial fibrillation late after successful mitral valve repair. They could be considered for combined mitral valve reconstruction and surgery for atrial fibrillation even though sinus rhythm is present preoperatively.

Adult↗

PubMedDate not supplied

Emergency percutaneous nephrostomy: technical success based on level of operator experience.

PURPOSE: The outcomes of emergency percutaneous nephrostomy procedures performed by operators with different levels of experience were analyzed. PATIENTS AND METHODS: A prospective study of 160 patients undergoing 169 emergency percutaneous nephrostomies was conducted. Three categories of operator experience were compared based on the number of percutaneous nephrostomies performed each year (level 1 = more than 20, level 2 = 10-20, or level 3 = less than 10). RESULTS: The level 1 operators (mean fluoroscopy time, 2 minutes; mean procedure time, 25 minutes) achieved success in 141 of 142 cases (99%) and failed in one case (1%), which was repeated successfully the next day. The level 2 operators (mean fluoroscopy time, 6 minutes; mean procedure time, 35 minutes) achieved initial success in all of 15 cases (100%), but three cases (20%) were repeated the next day because of catheter migration or malposition. Level 3 operators (mean fluoroscopy time, 10 minutes; mean procedure time, 42 minutes) were successful in 10 of 12 cases (83%), but in four cases (33%) the procedure had to be repeated. CONCLUSION: The experience of the operators played little role in the initial success rate of the procedure after they had performed 10 or more per year. However, the level of experience did influence the number of procedures that needed to be repeated, the prevalence of minor complications, and the mean fluoroscopy and procedure time.

Clinical Competence↗

PubMed1993

Fear of success in anorexic young women.

Eating Disorders Inventories (EDI) and Thematic Apperception Tests (TATs) scored for fear of success were compared for 26 normal females enrolled at Harvard University and 45 eating-disordered females (27 bulimic and 18 anorexic) at Massachusetts General Hospital. The relationship between eating disorders and fear of success (FOS) was examined. Analyses revealed statistically significant differences in fear of success among the three groups. The anorexic group scored higher in FOS than both the bulimic group and the control group. The bulimic group did not differ significantly from the control group. These findings may have important clinical implications because fear of success may be evident in young women for whom anorexia nervosa is still in a prodromal phase. Thus, fear of success may be a marker of risk of anorexia nervosa.

Achievement↗

PubMed1998

Prediction of endometrial ablation success by preoperative findings.

Objective: To determine the influence of preoperative findings on the outcome of hysteroscopic endometrial ablation.Design: We performed a retrospective chart review of 80 women between the ages of 25 and 50 years who underwent an endometrial ablation for menorrhagia or menometrorrhagia from 1992 to 1996, through a university reproductive endocrinology clinic.Materials and Methods: All eligible patients had a detailed subjective history obtained for duration of dysmenorrhea (Dys) and menorrhagia or menometrorrhagia (Men). Each had a preoperative transvaginal pelvic ultrasound with documentation of the uterine cavity contour and if an intramural myoma was present. A gynecological examination was ascertained from the patients clinical record with regard to uterine size. A benign Papanicolaou smear within 1 year of surgery and a normal endometrial biopsy was required for inclusion. Those with evidence of carcinoma or menopausal symptoms were excluded. Each patient had endometrial preparation with either danazol, GnRHa, or progestin. All ablations were performed by the same surgeon with "rollerball" electrocautery. Those patients who required medical management or additional surgery to control their vaginal bleeding during follow-up were designated as ablation failures. The use of stepwise logistic regression with ablation outcome as the dependent measure was used along with univariate analyses via chi(2) and t test to compare successes and failures on specific characteristics.Results: The sample was divided into two groups, success (group 1) or failure (group 2), and were matched for gravity, parity, and uterine size. Between the two groups there were no significant differences in the duration of menorrhagia/menometrorrhagia or dysmenorrhea. Additional therapy was required in 41% of the study group, designated as failures. The length of follow-up was 36 months for group 1 and 27.7 months for group 2. The results are summarized in the table below.The difference in age between the two groups strongly suggests a tendency toward failure with increasing age (P =.06). The diagnosis of a normal uterine cavity preoperatively shows a trend for a successful outcome (P =.07) when compared with the presence of an intracavity lesion, fibroid, or polyp. Those patients with an intramural fibroid had a tendency toward a higher failure rate (P =.10). Comparing the medications used to prepare the endometrium, patients treated with danazol had a trend toward a higher success rate (P =.09) than GnRHa or progestins.Conclusion: Preoperative findings can provide additional information with regard to endometrial ablation success. It appears that the trend toward failure is increased in patients with increased age, the diagnosis of an abnormal uterine cavity by ultrasound, and the presence of an intramural fibroid. Danazol administration, to prepare the endometrium, appears to offer a lower failure rate compared to GnRH agonists or progestins. Patients at greater risk of endometrial ablation failure based on age >/=41 years, abnormal intrauterine cavity, or the presence of intramural fibroids should be counseled about the higher failure rate and consider an alternative procedure such as hysterectomy.

Journal Article↗

PubMed2003

Factors predicting successful needle-localized breast biopsy.

RATIONALE AND OBJECTIVES: The purpose of this study was to identify factors that predict successful removal of nonpalpable breast lesions with mammography-guided needle-localized breast biopsy. MATERIALS AND METHODS: Of the 455 consecutive patients referred for needle-localized breast biopsy of one or more nonpalpable breast lesions between January 1990 and December 1994, 272 (59.8%) had sufficiently complete data to be included in this study. Medical charts, pathology laboratory reports, wire-placement mammograms, and radiographs of specimens from each patient were retrospectively reviewed to evaluate the effect of the following factors on the success of the procedure: distance from the lesion to the localizing wire, breast density, breast size, specimen volume, and lesion volume. All radiographs were independently evaluated by two radiologists who are experts in breast imaging. RESULTS: Needle-localized breast biopsy was successful in 254 (93.3%) of 272 lesions. Placement of the localization wire within 5 mm of the breast lesion was a significant predictor of successful lesion removal (P = .007). Results from logistic regression analysis showed that needle-localized breast biopsy failure was associated with increased wire distance (P = .0006), decreased breast size (P = .02), and decreased specimen volume (P = .03). CONCLUSION: Needle localization wires should be placed within 5 mm of mammographically visible lesions to increase the probability of successful lesion excision.

Adult↗

PubMedDate not supplied

1,001 subclavian perivascular brachial plexus blocks: success with a nerve stimulator.

BACKGROUND AND OBJECTIVES: Among the supraclavicular approaches to the brachial plexus, the subclavian perivascular technique is a well-established method of anesthesia of the upper extremity. Ever since Kulenkampf described his technique, eliciting a paresthesia has been almost mandatory ("no paresthesia, no anesthesia"). Lately, nerve stimulators have become more popular. However, up to the present time, clinical studies involving the nerve stimulator have failed to show success rates comparable to paresthesia techniques. METHODS: Data from 1,001 consecutive, subclavian perivascular blocks were prospectively gathered over 2.5 years. All blocks were performed according to Winnie's technique, but using a nerve stimulator instead of a paresthesia. When an adequate response was obtained, 35 to 40 mL of local anesthetic solution was injected. RESULTS: Nine hundred seventy-three blocks (97.2%) were completely successful; 16 blocks (1.6%) were incomplete and needed supplementation; and 12 blocks (1.2%) failed and required general anesthesia, giving a success rate for regional anesthesia of 98.8%. CONCLUSIONS: The subclavian perivascular block consistently provides an effective block for surgery on the upper extremity. At the site of injection with this technique, the plexus is reduced to its smallest components and the sheath is reduced to its smallest volume, which explains in great part the success obtained with this block. We believe that we have demonstrated a nerve stimulator technique that is both highly successful and safe; no clinical pneumothorax was found nor did any other major complications develop.

Adolescent↗

PubMed1998

Optimizing energy potentials for success in protein tertiary structure prediction.

BACKGROUND: Success in solving the protein structure prediction problem relies on the choice of an accurate potential energy function. for a single protein sequence, it has been shown that the potential energy function can be optimized for predictive success by maximizing the energy gap between the correct structure and the ensemble of random structures relative to the distribution of the energies of these random structures (the Z-score). Different methods have been described for implementing this procedure for an ensemble of database proteins. Here, we demonstrate a new approach. RESULTS: For a single protein sequence, the probability of success (i.e the probability that the folded state is the lowest energy state) is derived. We then maximize the average probability of success for a set of proteins to obtain the optimal potential energy function. This results in maximum attention being focused on the proteins whose structures are difficult but not impossible to predict. CONCLUSIONS: Using a lattice model of proteins, we show that the optimal interaction potentials obtained by our method are both more accurate and more likely to produce successful predictions than those obtained by other averaging procedures.

Computer Simulation↗

PubMed1999

Poisson distribution of male mating success in laboratory populations of Drosophila melanogaster.

Variation among males and females in reproductive success is a major determinant of effective population size. Most studies of male mating success in Drosophila, however, have been done under conditions very different from those in typical cultures. We determined the distribution of male mating success in five laboratory populations of D. melanogaster maintained on a 14 d, discrete generation cycle fairly representative of standard Drosophila cultures. Mating success was measured as the number of matings a male could achieve under conditions closely approximating a regular culture vial of these populations. Preliminary studies determined that most mating in these populations occurred within 14 h of the flies attaining sexual maturity. Consequently, individual virgin males were marked with white paint on their thorax, put into vials with varying numbers of unmarked virgin flies of both sexes, and monitored continuously for matings over a period of up to 14 h. At various times during the assay, virgin males and females were added to these vials in proportions simulating the pattern of eclosion in culture vials. The observed variation in the number of matings per male in the five populations was, by and large, consistent with a Poisson distribution, suggesting that male mating success in short-generation-time, discrete-generation laboratory cultures of D. melanogaster may fulfil a fundamental assumption of the Wright-Fisher model of genetic drift in finite populations.

Animals↗

PubMed2003

An experimental study of the reproductive success of Echinostoma friedi (Trematoda : Echinostomatidae) in the golden hamster.

Viable eggs produced weekly per infective stage was used as a measure of the reproductive success of Echinostoma friedi during the first 12 weeks of infection in hamsters. The weekly reproductive success was not constant during the experiment in relation to the egg output and the proportion of viable eggs produced. The egg release started during week 2 post-inoculation, attaining a maximum during week 3. A decline in egg output was observed from week 9. Viable eggs were only produced from week 3 post-inoculation and a maximum was attained at week 4 of the experiment. A decline in egg viability was observed from week 9. Considering together the egg output and the egg viability, the maximum weekly reproductive success was obtained during week 4 post-inoculation. The changes in the weekly reproductive success were not reflected in variations in worm numbers and body sizes during the course of the infection. The humoral immune response of golden hamsters during the infection with E. friedi was determined. Increases of IgG levels against somatic and excretory/secretory products of E. friedi were detected coinciding with the reduction in the reproductive success.

Animals↗

PubMed2003

Smoking and polymorphisms of fucosyltransferase gene Le affect success of H. pylori eradication with lansoprazole, amoxicillin, and clarithromycin.

Identification of factors influencing success of Helicobacter pylori (HP) eradication is important for clinical practice. We have prospectively conducted an HP eradication study in the Aichi Cancer Center with a total of 142 patients available for analysis. The overall success rate was 61.3% (95% confidence interval 52.7-69.3%). Smoking during the medication for eradication significantly decreased the success rate (42.9%), whereas smoking cessation during the treatment was associated with a similar rate as for non-smokers (66.7%). We also examined links between an eradication outcome and polymorphisms of Le, Se, IL1A, IL1B, IL1RN and MPO genes, but with one exception none showed any association. The non-functional le allele of Le polymorphisms, leading to decreased expression of Le(b) antigen to which HP attaches with adhesin, showed a beneficial effect for success. Although further clarification is necessary, our study indicated that smoking cessation and Le gene polymorphisms may affect the success rate of HP eradication.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2001

"If you got everything, it's good enough": perspectives on successful aging in a Canadian Inuit community.

Structured interviews with 38 Inuit in the community of Holman were conducted to examine Inuit definitions of successful and unsuccessful aging. Qualitative analysis of the interview data suggests that (1) contrary to much of the literature about culture change in the Canadian North, there appear to be no perceivable differences in the ways Inuit of different age cohorts view aging and elderhood; (2) a successful old age is not one necessarily characterized by individual good health, but rather by the ability of the individual to successfully manage declining health; and (3) for Inuit, the most important determinants of a successful elderhood are not material but ideological. That is, an individual's attitudes in late life, and in particular their willingness to transmit their accumulated wisdom and knowledge to their juniors, are the critical determinants of whether an elder is viewed as having a successful old age.

Journal Article↗

PubMed2002

Factors associated with success of the extreme drug resistance assay in primary breast cancer specimens.

The extreme drug resistance (EDR) assay has not been widely studied in the setting of non-metastatic breast cancer. We evaluated the feasibility of performing the assay in 144 primary breast tumor specimens from two institutions by determining the rate of successful tumor culture for assays, number of drugs evaluated per assay, and time from tumor biopsy to receipt of results. We also sought to determine factors that are associated with assay success. An exploratory analysis was performed to detect possible associations between estrogen receptor (ER), progesterone receptor (PR) and HER2/NEU over-expression and extreme drug resistance demonstrated by the assay for specific chemotherapeutic agents. Of 144 tumor specimens submitted, tumor was successfully cultured for assay in 101(70%) of cases. A median of five drugs was evaluated per assay (range 2-9). Results were obtained in a median of 8 days (range 2-29). Young age, high tumor grade, PR negativity, and higher tumor submission weight were predictive for a successful assay. EDR was observed in 7-15% of tumors to doxorubicin, cyclophosphamide, 5-fluorouracil (5FU) and mitoxantrone, but EDR to paclitaxel was observed in 35%. Extreme drug resistance to 5-FU was associated with negative ER and PR status. There was a trend toward association between EDR to paclitaxel and HER2/NEU over-expression. The EDR assay may be successfully performed in the majority of tumors, and assay results are available in a timely fashion such that adjuvant treatment drug selection could be guided by results. These results may be helpful for designing possible future trials that evaluate the assay's role in adjuvant chemotherapy selection.

Age Factors↗

PubMed2002

Epididymal distension as a predictor of the success of PESA procedures.

PURPOSE: To evaluate the value of epididymal distension in predicting the success of percutaneous epididymal sperm aspiration (PESA) procedure. METHODS: Physical examination of epididymis to detect epididymal distension and PESA were performed in 49 obstructive azoospermic patients divided into two groups according to its causes (Group I: previous vasectomy, n = 27 and Group II: other causes, n = 22). RESULTS: Epididymal distension was found in 42 cases (85.7%). PESA was successful in 42 out of the 49 patients, giving a sperm retrieval rate of 85.7%. The success rate of PESA in Groups I and II is 92.6 and 77.3%, respectively. The accuracy, sensitivity, specificity, and positive and negative predictive value of epididymal distension for the overall patients were 86.7, 90.5, 64.2, 93.8, and 52.9%, respectively. The success rate of PESA procedure in patients with epididymal distension was significantly higher than in patients without epididymal distension (p < 0.05). CONCLUSIONS: The presence of epididymal distension in obstructive azoospermic men was predictive of PESA success.

Adult↗

PubMed1999

Prognostic factors for successful surgical outcome with preoperative prism adaptation test in patients with superior oblique palsy.

PURPOSE: This study evaluated the surgical outcome of patients managed with preoperative prism adaptation test (PAT) and investigated prognostic factors for successful motor alignment in adult patients with superior oblique palsy. METHODS: Prospective study of preoperative PAT was performed. Fifty-seven patients with superior oblique palsy, aged 16 to 81 years, participated in this study. Patients were assigned to surgery with the target angle based on either the original angle or the prism compensated angle. When the amount of neutralizing prism exceeded 4delta or more compared to the original angle of deviation, the patient was defined as having prism compensation, and the target angle for surgery was based on the amount of neutralizing prism. The motor success rate was compared between the 2 groups at the 3-month postoperative follow-up. RESULTS: The prism responders group showed a superior outcome compared to that of the prism non-responders group (77% successful outcome compared with 46%, p = 0.0397). The presence of prism compensation and the amount of vertical deviation were significant prognostic factors for successful motor alignment. CONCLUSION: Preoperative PAT is a useful prognostic indicator of successful surgical outcome in patients with superior oblique palsy.

Adaptation, Ocular↗

PubMed2001

Success rates in periodontal treatment as related to choice of evaluation criteria. Presentation of an evaluation criteria staircase for cost-benefit use.

BACKGROUND, AIMS: The aim of the present investigation was to determine the success rates of treatment of 36 patients with moderate to advanced periodontal disease as related to different clinical and radiographic criteria. METHOD: The treatment comprised oral hygiene education, subgingival scaling and root planing, and when judged indicated, periodontal surgery. An "evaluation criteria staircase" comprising 5 levels was introduced to be utilized for evaluation of the treatment results in 4 proximal sites (1 in each quadrant) which were followed for 3 years. The highest level of the staircase (level 1) is the most challenging and comprises the traditonal criteria for "perfect" periodontal health, while the lower levels are gradually less demanding. RESULTS: At the follow-up examination 3 years after active treatment, 52.1% of the experimental sites fulfilled the criteria for successful treatment according to level 1. On the lowest level (level 5) which only required no further loss of alveolar bone for treatment to be considered "successful", the number of such treated sites reached 95.1%. The present data showed that even if level 5 was accepted as the evaluation criterion for "success", resulting in very few failed sites (4.9%), these sites may demand considerable extra clinical time and costs for retreatment because of their distribution among many individuals (13.2%). This clinical time increases substantially if higher levels of success are desired. From a cost-benefit point of view, it is therefore of utmost importance that not only patient compliance but also disease resistance and the value of the affected tooth for the dentition are taken into consideration when the indications for retreatment are weighed. This is especially important since many sites were found to be non-progressive for a long time, even though they did not exhibit perfect periodontal health. CONCLUSIONS: It is suggested that the "evaluation criteria staircase" presented in this paper might be a helpful clinical instrument for decision-making in individually designed and site-related retreatments of patients with periodontal disease.

Adult↗

PubMed1986

Persistent high self-focus after failure and low self-focus after success: the depressive self-focusing style.

Two studies were conducted to assess the spontaneous self-focusing tendencies of depressed and nondepressed individuals after success and failure. Based on a self-regulatory perseveration theory of depression, it was expected that depressed individuals would be especially high in self-focus after failure and low in self-focus after success. The results of Experiment 1 suggested that immediately after an outcome, both depressed and nondepressed individuals are more self-focused after failure than after success. This finding led us to hypothesize that differences between depressed and nondepressed individuals in self-focus following success and failure emerge over time. Specifically, immediately following an outcome, both types of individuals self-focus more after failure because of self-regulatory concerns. However, over time, depressed individuals persist in higher levels of self-focus after failure than after success, whereas nondepressed individuals shift to the opposite, more hedonically beneficial pattern. The results of Experiment 2 provided clear support for these hypotheses. Theoretical implications of these results were discussed.

Adolescent↗

PubMed1987

Predicting successful completion of an aftercare program following treatment for alcoholism: the role of dispositional optimism.

In this study we investigated several variables as potential predictors of success in completing a transition program after treatment for alcoholism. Subjects were 54 men who had completed a 30-day treatment program and who were subsequently admitted to a 90-day inpatient aftercare program. The outcome measure was successful completion of this latter program. Predictor variables were dispositional optimism, hassles, uplifts, and several demographic variables. Optimism was positively associated with successful outcome. The simple association between uplifts and outcome also approached significance, but in the opposite to expected direction. Discriminant analyses used both of these variables, as well as age and education level, as predictors of successful outcome. There was no evidence of a role for hassles. Discussion centers on the importance of dispositional optimism as a predictor of successful adaptation in a variety of behavioral domains.

Adaptation, Psychological↗