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Results for “Prognostic model”

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PubMed2004

[Intra-arterial docetaxel chemotherapy with high-dose calcitriol in relapsing metastatic prostate cancer].

Ten patients with hormone relapsing metastatic prostate cancer who had been previously treated with extensive radiotherapy for metastasis and chemotherapy including docetaxel and platinum compounds were evaluated to determine the safety and efficacy of docetaxel with high-dose calcitriol and platinum compound combination intra-arterial chemotherapy. Nine patients with ECOG performance status 3 or greater, and 9 with 12-month survival probability less than 0.5 in the CALGB prognostic model, including 3 aged over 80, were assessable for therapeutic results, adverse events and clinical benefit response. Improvement of QOL and relief of the bone pain were seen immediately after the intra-arterial chemotherapy treatment. Considering that high-dose calcitriol and platinum compound combination intra-arterial chemotherapy is easily administered without major toxic events even to outpatients, it will be a treatment option for the clinical benefit of relapsing prostate cancer patients with poor prognoses.

Aged↗

PubMedDate not supplied

Breath tests with stable isotopes: have they a role in liver transplantation?

Evaluation of liver function is crucial in the overall management of patients with liver disease. In particular, patients with end-stage liver disease need accurate prognostic indicators to plan liver transplantation, and in this case, to manage their presence in the waiting list. Availability of predictors of clinical outcome is further essential after liver transplant, mainly to correctly diagnose and adequately treat complications, such as acute rejection, drug toxicity, liver dysfunction. Breath tests using labelled substrates selectively metabolized within the liver may represent an accurate diagnostic and prognostic tool in these clinical conditions, possibly with an adjuntive role to the most commonly used prognostic models (Child-Pugh and MELD scores). Promising results have been in fact recently obtained by the use of different substrates (aminopyrine, methacetin, erythromycin, methionine) which explore different metabolic function of the hepatocyte. The usefulness of breath tests has been documented in liver disease patients both before and after liver transplantation, in the early as well as in the late phase.

Breath Tests↗

PubMed2002

Applying temporal abstraction and case-based reasoning to predict approaching influenza waves.

The goal of the TeCoMed project is to send early warnings against forthcoming waves or even epidemics of infectious diseases, especially of influenza, to interested practitioners, pharmacists etc. in the German federal state Mecklenburg-Western Pomerania. The forecast of these waves is based on written confirmations of unfitness for work of the main German health insurance company. Since influenza waves are difficult to predict because of their cyclic but not regular behaviour, statistical methods based on the computation of mean values are not helpful. Instead, we have developed a prognostic model that makes use of similar former courses. Our method combines Case-based Reasoning with Temporal Abstraction to decide whether early warning is appropriate.

Germany↗

PubMed1992

[Will medical research face a recruitment problem?].

Prognoses show that Norwegian medical research will experience a recruitment crisis at the end of this century and approaching the year 2010. Two different prognostic models have been used to estimate the demand for recruitment. The first is based on no growth in the number of research personnel, while the second is based upon a 2% annual growth in personnel. This latter alternative shows that there may be a great demand for research trainee positions within the medical sciences in the higher education sector, especially from the mid 1990s. Today (1991) we have around 550 research trainees. By the year 2000 there will be an additional demand for 100 recruitment positions, and a further 300 positions by the year 2010. In the no growth alternative, the future demand will be lower than the 1991 level for the period 1992 to 2010. For various reasons it will be difficult to fill the demand for research personnel. First, it is necessary to consider the public education policy: From 1981 until today the number of students studying medicine and dentistry has declined. This means that a larger proportion of students must be recruited to research if today's level of medical research education is to be maintained or increased. Second, which disciplines should do medical research? Today many research trainees in medicine are not doctors, and will not be able to fill future research positions at clinics. These are some of the results of a recent study on recruitment to Norwegian medical research, carried out by the Institute for Studies in Research and Higher Education.

Education, Dental, Continuing↗

PubMed2005

Prediction of mortality in acute renal failure in the tropics.

Despite significant improvements in medical care, acute renal failure (ARF) remains a high risk for mortality. It is important to be able to predict the outcome in these patients in view of the emotional and ethical needs of the patients and to address questions of efficiency and quality of care. We analyzed the risk factors predicting mortality prospectively in a group of 265 patients using univariate and multiple logistic regression analysis. A prognostic model was evolved that included 10 variables. The model showed good discrimination [(receiver operating characteristic (ROC) area=0.91) and correctly classified 88.30% of patients. The variables significantly associated with mortality were coma odds ratio (OR)=9.8], oliguria (OR=4.9), jaundice (OR=3.7), hypotension (OR=3.1), assisted ventilation (OR=2.3), hospital acquired ARF (OR=2.3), sepsis (OR=2.2), and hypoalbuminemia (OR=1.7). Age and male gender were included in the model as they are clinically important. The score was validated in the same sample by boot strapping. It was also validated in a prospective sample of 194 patients. The model was calibrated by the Hosmer-Lemeshow goodness-of-fit test. It was compared with two generic illness scores and one specific ARF score and was found to be superior to them. The model was verified in different subgroups of ARF like hospital acquired, community acquired, intensive care settings, nonintensive care settings, due to sepsis, due to nonsepsis etiologies, and showed good predictability and discrimination.

Acute Kidney Injury↗

PubMed2005

[Prognosis of the severity of acute pancreatitis by the neural network method].

For prognozing the character of the development of acute pancreatitis a neural network of the direct spread of the signal was developed with 15 inlets, 5 neurons of the latent layer and two outlets. The network was trained with the help of an algorithm of an inverse spread of the error. The sensitivity of the produced prognostic model was 100%, specificity at admission--70%, on the first day--80%, on the second and third day--90%. Before the moment of hospitalization 57 patients were observed during 72 hours. The diagnosis was confirmed in all cases by the methods of computed tomography with contrast amplification.

APACHE↗

PubMed2005

[Admission of elderly patients to intensive care].

Elderly patients have an increased probability of dying after treatment in an intensive care unit (ICU), compared with younger patients. The risk of dying is largely determined by the admission type (patients with planned admissions have a better prognosis than those with unplanned admissions), severity of illness and functional status prior to admission. Elderly patients surviving ICU often experience a decline in functional status. No data are available on the factors that predict functional outcome. Elderly patients do not necessarily prefer life-sustaining treatment to palliative care. The willingness to undergo ICU treatment depends on the likelihood of survival and beneficial functional outcome. New prognostic models should be developed specifically to predict both survival and functional outcome in individual elderly patients after admission to ICU.

Age Factors↗

PubMed2002

Primary sclerosing cholangitis.

Primary sclerosing cholangitis (PSC) is a chronic cholestatic syndrome of unknown etiology frequently associated with inflammatory bowel disease and characterized by diffuse inflammation and fibrosis of the intra and/or extrahepatic bile ducts. Recent studies seem to favor autoimmunity in the context of a genetic predisposition as the most likely underlying mechanism for the development of the disease, however our knowledge on the pathogenesis of PSC is still incomplete and further work is needed. The most common manifestations are fatigue, pruritus, jaundice and abdominal pain; however, the increasing use of invasive cholangiography has led to diagnosing this condition in a high proportion of asymptomatic patients. PSC usually follows a progressive course leading to biliary cirrhosis with complications of portal hypertension and hepatic failure. Patients with PSC also may develop a number of other complications, including bacterial cholangitis, dominant biliary strictures, conditions of chronic cholestasis, colorectal cancer and cholangiocarcinoma. Currently, no medical therapy aimed at disrupting disease progression is available, although high-dose ursodeoxycholic acid and other medicines are being evaluated in clinical trials. A better understanding of the pathogenesis of the disease will serve as a guide for evaluating new medical approaches. Liver transplantation is the only therapeutic alternative that improves survival in patients with end-stage PSC. Prognostic models are useful in determining the timing of liver transplantation.

Journal Article↗

PubMed2005

Formative evaluation of a prototype system for automated analysis of mass spectrometry data.

Mass Spectrometry (MS) is emerging as a breakthrough mass-throughput technology capable of producing powerful clinical diagnostic and prognostic models and of identifying important disease biomarkers. Few individuals possess the necessary skills to carry out MS analyses competently, and access to such individuals is limited in most settings, hindering progress in this field. We seek to ease this burden by creating a fully automated system (FAST-AIMS) capable of analyzing mass spectra to produce high-quality diagnostic and outcome prediction models and identify related biomarkers. In the present report we introduce the system and conduct a formative evaluation in which 6 users apply it to a challenging dataset. FAST-AIMS' performance is compared to that of an expert statistician as well as to a previously published analysis by an independent group. In our experiments FAST-AIMS when used by both MS-sophisticated users (n=4) and naïve users (n=2) achieves performance (a) comparable to our human expert, and (b) superior to the previously published manual analysis; in addition (c) the system's estimates future performance accurately, thus avoiding overfitting.

Algorithms↗

PubMed2006

Prognostic utility of carotid ultrasound and cardiac SPECT imaging in coronary artery bypass patients.

BACKGROUND: The aim of our study was to evaluate the role of myocardial perfusion imaging (MPI) and common carotid artery intima-media thickness (CCA IMT) in the prognosis of patients with coronary artery disease referred for coronary artery bypass surgery (CABG) in a newly made prognostic model. MATERIAL AND METHODS: 63 patients (age 60.36 +/- 8.28 years) with angiographically established coronary artery disease referred for CABG were evaluated for: age, smoking, family disposition, dyslipidaemia, arterial hypertension, obesity, diabetes mellitus, previous myocardial infarction and revascularization. Patients underwent nitrate enhanced Gated SPECT myocardial perfusion imaging, with 17-segment analysis for calculation of perfusion scores and viability index. Common carotid artery IMT was measured by B-mode ultrasound. Patients were followed for cardiovascular events 12 months after CABG. RESULTS: The obtained data reported mean values of left ventricular ejection fraction (LVEF) 46.2 +/- 14.4%, viability index 0.76 +/- 0.55, SRS 17.76 +/- 13.81 and summed nitrate score 12.89 +/- 10.36. Ultrasound detected CCA IMT 0.90 +/- 0.24 mm, with increased value in 67.2% and presence of carotid plaques in 27.1% of pts. We registered 14 events and 8.8% mortality rate. Multiple regression modelling showed bilateral carotid plaque presence as a predictor of total events. Viability index and CCA IMT have been found as independent death predictors. CONCLUSIONS: Myocardial perfusion viability index and CCA IMT are predictors, independently associated with prognosis of patients referred for CABG.

Aged↗

PubMed1991

Prognostic significance of calcitonin immunoreactivity, amyloid staining, and flow cytometric DNA measurements in medullary thyroid carcinoma.

The proven power of DNA ploidy to predict mortality risk in medullary thyroid carcinoma (MTC) may be weakened when analyzed in conjunction with calcitonin immunoreactivity (CI) and amyloid staining (AS) of tumors. In this study 12 prognostic variables, including DNA ploidy, CI, and AS, were studied in 65 patients with MTC (57 sporadic; mean age 51 years) treated during 1946 through 1970. Cause-specific mortality rates at 10 and 15 years were 15% and 26%, respectively. By univariate analysis, TNM stages III or IV (p less than 0.0001), tumor unresectability (p less than 0.0001), male sex (p = 0.019), negative AS (p = 0.032), and low CI (p = 0.033) were significant predictors of increased mortality rates. DNA ploidy (p = 0.058) and inheritance pattern (p = 0.25) were nonsignificant. By multivariate analysis, only TNM stage, tumor resectability, and AS were independently significant (p less than 0.005). A prognostic model was created, based on presence or absence of these independent risk factors, and four risk groups were defined, capable of predictably defining mortality rates in MTC (p less than 0.0001). The model requires validation in larger series and independent verification by others. However, we believe that a risk-group scheme for MTC based on AS, disease stage, and completeness of tumor resection may have wide applicability and prove relevant to clinicians treating this disease.

Adolescent↗

PubMed1991

[Risk factors and survival prognosis in lymphogranulomatosis: a statistical analysis].

To examine risk factors and to design prognostic models for the total, relapse-free and after-relapse survival, use was made of the Cox model for unifactorial and multidimensional analysis based on the retrospective estimation of the results of the treatment of 235 patients with lymphogranulomatosis, stages II-III. Radiotherapy according to the radical program was carried out in conjunction with polychemotherapy according to the COPP scheme. The number of areas of damage, massiveness of injury to the mediastinum, involvement of the spleen into the process appeared the most informative risk factors for predicting both total and relapse-free survival. The prediction of the after-relapse survival was considerably influenced by the age combined with carrying out of not less than 3 cycles of polychemotherapy given to the patients during initial treatment or with the presence of intoxication symptoms and increased ESR. The tables of the survival probability were calculated.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

[The prognostic factors and evolution of the quality of life in primary biliary cirrhosis].

The prognostic factors and the evolution of the quality of life were evaluated in 38 patients with primary biliary cirrhosis (94.7% females, mean age 52.6 +/- 2.0 years) followed up for more than 36 months (mean 65.3 +/- 3.7 months). Karnofsky's index significantly declined during follow up (p less than 0.05) in a parallel fashion to modified Child's hepatic functional class (p less than 0.05) and to the days of hospital readmission (p less than 0.05). Eleven patients (28.9%) died, and the median survival was 88.7 months. The comparison of the actuarial curves showed the following to be significant poor prognostic factors at the time of diagnosis: a) clinical: more than one associated autoimmune disease, weight loss of more than 10% of the ideal weight, jaundice, upper gastrointestinal hemorrhage associated with portal hypertension, portal-systemic encephalopathy and a modified Child's hepatic functional class of 9 or more; b) biochemical: serum albumin lower than 3.5 g/dl and bilirubin higher than 2 mg/dl; c) histological: Total histological activity index of 10 or more and erosive necrosis index of 2 or more (Knodell et al.), lobular granulomas, and stage IV (Ludwig et al). A significant correlation was found (p less than 0.001) between the R index of the Mayo Clinic and the mean survival time of our patients. As a temporary policy, we indicate hepatic transplant when R is 9.2 or higher (life expectancy lower than 24 months), awaiting our own probabilistic prognostic model with the inclusion of quality of life criteria.

Adult↗

PubMed1990

[Prognostic factors in the acute stage of myocardial infarction: analysis of 893 cases].

The prognostic factors in the acute stage of 893 myocardial infarction patients, admitted during a period from 1970 to 1986, were analysed. The overall mortality was 15.6%, including 14.4% cardiac death and 1.1% non-cardiac death. Single factor analysis indicated that age, sex, occupation, history of hypertension, chest pain during the episode, systolic blood pressure, heart rate and site of infarction at the time of admission, presence of complications such as cardiogenic shock, arrhythmias, stroke and monitoring in CCU or not were related to the overall mortality and cardiac death. Multiple factor logistic regression analysis indicated that for the overall mortality, the independent prognostic factors included presence of cardiogenic shock, heart rate and chest pain at the time of admission; for the cardiac death, the independent factors included age, occupation, history of hypertension, heart rate and chest pain at the time of admission, involvement of anterior wall and presence of cardiogenic shock and arrhythmias. Basing on the above findings we establish a risk factors predicting prognostic model of acute myocardial infarction in its acute stage.

Adult↗

PubMed1989

[The importance of detecting prepathologic states in preventing chronic nonspecific lung diseases].

A study is presented of 863 patients with chronic unspecific pulmonary diseases (CUPD) and 2785 healthy persons and a method was worked out of detection of predisease states in which stages may be singled out; initial health state with risk factors--threatening period--premorbid state--prenosological condition. From the viewpoint of these factors a prognostic model of CUPD in healthy persons is designed.

Chronic Disease↗

PubMed1989

Prognosis in equine colic patients using multivariable analysis.

Multiple logistic regression was used to investigate prognosis in 308 horses referred to the University of Minnesota veterinary teaching hospital with colic. Bivariate results identified the following significant individual parameters: absent or hypomotile abdominal sounds, medical or surgical classification, peritoneal fluid total protein, anion gap, serum glucose, capillary refill time, blood pH, heart rate, packed cell volume, base excess, serum chloride, plasma bicarbonate, serum urinary nitrogen and age. Two multivariable prognostic models were developed using logistic regression. Model I (based on 257 cases with a mortality rate of 39%) included age, sex, medical or surgical classification, capillary refill time, packed cell volume and heart rate. Model II (based on 138 cases with a mortality rate of 48%) included age, sex, medical or surgical classification, capillary refill time, serum bicarbonate, serum chloride and respiratory rate. Predictive performance of the models was evaluated by treating the calculated probability of death for each horse as a continuous test result. The influence of varying the probability cutoff point for death on test characteristics (sensitivity, specificity and positive and negative predictive values) was determined. These models have not been validated and thus their performance in a different population is uncertain.

Animals↗

PubMedDate not supplied

Patient characteristics and pre-operative therapeutic modalities.

The International Cooperative Study on the Timing of Aneurysm Surgery included 68 participating centers from 16 different countries. Eight Italian neurosurgical units participated in the Study: Bellaria Hospital, Bologna; Neurological Institute of Milan, Milan; University Hospital, Brescia; University of Milan, Milan; University of Padova, Padova; University of Rome, Rome; Civil Hospital, Verona; and Civil Hospital, Vicenza. The overall case contribution from the Italian centers was 485 cases, 14.1% of the total study population. As compared to the other centers included in the Study, the Italian centers exhibited a higher percentage of patients with impaired consciousness; a later interval of planned surgery from SAH; frequent use of preoperative lumbar drainage, as well as antihypertensives, anticonvulsants, antifibrinolytics, steroids, diuretics and LMW dextran; and less frequent use of sedatives and narcotics. The individual Italian centers differed significantly in regard to patient characteristics and preoperative therapeutic modalities. There was a relatively high number of stuporous or comatose patients admitted to Centers 1, 7 and 8, very few admitted to Centers 5 and 6, and none admitted to Center 2. The different distribution of key prognostic factors prevents a direct comparison of the overall management results of the centers. A stratification of the patients according to a risk scale and/or a prognostic model is required for comparison of the management results.

Female↗

PubMed1987

Clinical investigation of human alpha interferon in chronic myelogenous leukemia.

Fifty-one patients with previously untreated or minimally treated chronic myelogenous leukemia in chronic phase received human alpha interferon 3 to 9 X 10(6) units intramuscularly (IM) daily until complete hematologic remission, then at doses ranging from 3 X 10(6) units every other day to 9 X 10(6) units daily. Forty-one (80%) patients achieved a hematologic response, 36 (71%) of them attaining a complete hematologic remission with normal peripheral WBC and differential counts. Responding patients showed continuous but slow normalization of several other blood and marrow parameters including platelet counts, serum lactic dehydrogenase and B12 levels, and marrow cellularity and maturation index. Suppression of the Philadelphia chromosome on serial cytogenetic studies of marrow metaphases was documented in 20 of the 36 patients who achieved complete hematologic remission (56%; 39% of total group), eight of whom (22%) had a decrease of the Philadelphia chromosome-positive metaphases to less than 35%. These changes were persistent for 6 months or longer in 18 patients, seven of whom had continuous suppression of the Philadelphia chromosome to less than 90% for a median of 30+ months (range 21+ to 39+ months). After a median follow-up period of 37 months, 25 patients remain in continued disease control with interferon therapy. The projected 3-year survival rate is 76%, with a yearly death rate of 6%, 9%, and 9% in the first 3 years. Response, Philadelphia chromosome suppression, and survival were significantly better among patients in the low-risk category compared to intermediate- and high-risk categories, as defined by a multivariate analysis-derived prognostic model. The projected 3-year survival rate was 94% for patients who achieved a complete hematologic remission on interferon therapy and 45% for those who did not. Thirteen patients have developed blastic crisis, six with lymphoid and three with undifferentiated morphology. We conclude that human leukocyte alpha interferon effectively controls chronic myeloid leukemia and allows reappearance of diploid hemopoietic cells in some patients.

Aged↗