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At least 217 records · Page 12Linked to original sources
PubMed1997

Patient dropout in an assisted reproductive technology program: implications for pregnancy rates.

OBJECTIVE: To study patient dropout and its impact on crude and cumulative pregnancy rates (PRs) after assisted reproductive technology (ART). DESIGN: Retrospective cohort study. SETTING: University hospital-based tertiary care fertility clinic. PATIENT(S): Two hundred two couples applying for their first ART treatment cycle. MAIN OUTCOME MEASURE(S): Drop-out rate and PR per cycle, cumulative drop-out rate and cumulative PR. RESULT(S): After three treatment cycles, the cumulative drop-out rate was 126 of 202 (62.4%); 13.9% (n = 28) was due to active censoring. Active censoring was shown to flatter cumulative PRs by life-table analysis. CONCLUSION: Dropout from ART is high, even when ART costs are covered by health cost insurance. Life-table analysis overestimates cumulative PRs in ART.

Cohort Studies↗
PubMed2001

Estimation and comparison of rates of change in repeated-measures studies with planned dropout.

Many repeated-measures studies are designed to compare rates of change over time in responses among treatment groups. In such studies, some responses are often censored because some individuals drop out before completing the study. The Vitamin D(3) Trial was a repeated-measures, randomized clinical trial for secondary hyperparathyroidism in hemodialysis patients in which the efficacy of vitamin D(3) infusions for suppressing the secretion of parathyroid hormone (PTH) was compared among four dose groups during dialysis over 12 weeks. In this trial some patients dropped out because the protocol stated that any individual should have been off protocol if his or her serum calcium (Ca) level exceeded 11.5 mg/dL. While the dropout mechanism for the Ca level (secondary response) corresponded to the missing at random (MAR) assumption (because whether patients dropped out or not depended only on their previously recorded Ca level), the MAR assumption for the PTH level (primary response) was not justifiable without taking into account the effect of the Ca level. We consider estimation and comparison of several estimators of mean rate of change in the presence of dropout due to the selection process inherent in a study design like the Vitamin D(3) Trial. Simulation experiments are used to compare the bias and efficiency of several estimators of mean rate of change. The estimators based on a bivariate mixed-effects model outperform all other estimators in the primary response as well as in the secondary response. These estimators are applied to the Vitamin D(3) Trial data.

Cholecalciferol↗
PubMed2003

Estimating the distribution of nonterminal event time in the presence of mortality or informative dropout.

We consider estimating the distribution of nonterminal event time that may be censored by a terminal event but not vice versa. This problem may arise in two scenarios: (1) clinical trials involving both terminal and nonterminal events, or (2) when the primary outcome of the trial is nonterminal but there exists informative dropout. Inference is complicated by the dependent censoring from mortality or informative dropout. In this paper, we show that the joint distribution of the events can be formulated such that only the association is parameterized, with the marginal distributions unspecified. A closed form estimator for the association parameter is obtained from a novel adaptation of Oakes' concordance estimating equation. Tests for independence and goodness-of-fit of the model are also developed. A computationally simple, consistent and asymptotically normal estimator for the marginal distribution of the nonterminal event is given. Simulations demonstrate that the methods work well with practical sample sizes. The proposals are illustrated with data from an AIDS clinical trial.

Anti-HIV Agents↗
PubMedDate not supplied

Association of school dropout with recent and past injecting drug use among African American adults.

We hypothesized that, among African American adults, starting and maintaining injecting drug use (IDU) would be associated with dropping out of high school, and that starting and stopping IDU would be associated with earning the general equivalency diploma (GED) after school dropout. Drawn from the 1991-1993 National Household Surveys on Drug Abuse (NHSDA), the nationally representative sample of African Americans consisted of 117 recent and 109 past IDUs. Conditional multiple logistic regression was used to estimate the hypothesized associations. African American high school dropouts and GED holders were 2-3 times more likely to have started and maintained IDU, as compared to high school graduates. Earning the GED was associated with starting and then stopping IDU. These findings merit further investigation because they might have significant public health implications for the prevention of IDU among African Americans.

Adolescent↗
PubMed2002

Correlates of dropout, efficacy, and adverse events in treatment with acetylcholinesterase inhibitors in Korean patients with Alzheimer's disease.

The correlates of dropout, efficacy, and adverse events in the treatment of Alzheimer's disease (AD) with acetylcholinesterase inhibitors (ChEI) are unclear. To investigate these issues, a 26-week prospective, randomized, open-labeled trial with donepezil or rivastigmine was undertaken. Sixty-four Korean patients with AD were recruited, and data on sociodemographic and clinical characteristics and several assessment scales were collected. Characteristics of available caregivers were also gathered. Information on adverse events and dropout was recorded. Thirty-five (55%) patients dropped out during treatment with ChEI, for reasons mainly related to financial burden of caregivers. Of the 29 patients who completed the 26-week trial, 16 (55%) were responsive to ChEI. Lower scores on the Clinical Dementia Rating and Blessed Dementia Scale at baseline were associated with the efficacy of ChEI. Of the total participants, 26 (41%) experienced adverse events, although these seemed to be mild and appeared to be associated with the psychological state of patients or coadministration of psychotropic drugs. In conclusion, ChEI seemed to be effective and well tolerated in the treatment of Korean patients with AD, but the use of this drug was limited mainly by the financial burden of caregivers.

Aged↗
PubMed1997

Self-determination and persistence in a real-life setting: toward a motivational model of high school dropout.

The purpose of this study was to propose and test a motivational model of high school dropout. The model posits that teachers, parents, and the school administration's behaviors towards students influence students' perceptions of competence and autonomy. The less autonomy supportive the social agents' behaviors are, the less positive the students' perceptions of competence and autonomy. In turn, the less positive students' perceptions are, the lower their level of self-determined school motivation are. Finally, low levels of self-determined motivation lead students to develop intentions to drop out of high school, which are later implemented, leading to actual dropout behavior. This model was tested with high school students (N = 4,537) by means of a prospective design. Results from analyses of variance and a structural equation modeling analysis (with LISREL) were found to support the model for all participants and for each gender separately.

Adolescent↗
PubMed2003

Alliance and dropout in family therapy for adolescents with behavior problems: individual and systemic effects.

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent and adolescent) and family levels (within-family differences). Participants were 34 families who received functional family therapy for the treatment of adolescent (aged 12-18 years) behavior problems. Families were classified as treatment dropouts (n=14) or completers (n=20). Videotapes of the first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that individual parent and adolescent alliances did not predict retention. However, as hypothesized, dropout cases had significantly higher unbalanced alliances (parent minus adolescent) than did completer cases. These findings highlight the importance of alliances in functional family therapy and suggest that how the alliance operates in conjoint family therapy may be a function of systemic rather than of individual processes.

Adolescent↗
PubMedDate not supplied

Engaging substance abusers after centralized assessment: predictors of treatment entry and dropout.

High attrition continues to be an important issue for substance abuse treatment providers. This study examined factors contributing to treatment entry and dropout after referral from centralized assessment. Univariate analysis showed that individuals with a shorter wait after assessment were more likely to attend an initial treatment appointment, while those who reported a history of physical or sexual abuse or were on probation were significantly more likely to drop out of treatment early. Multivariate analysis revealed, first, that persons with a comorbid psychiatric diagnosis and those referred to outpatient rather than residential care were less likely to enter treatment; and, second, that persons on probation and with a history of physical or sexual abuse were more likely to be early treatment dropouts. Findings suggest that decisions to seek help and to accept help are distinct, and that program factors play a substantial role in treatment engagement and retention.

Adult↗
PubMed1980

Dropouts and broken appointments. A literature review and agenda for future research.

Patient dropouts create inefficiencies for medical providers, threaten the validity of clinical research and may themselves suffer unnecessary morbidity. A review of literature concerning patient dropouts and broken appointments was undertaken in an effort to identify correlates of the behavior, assess proposed interventions and identify issues for the content and methodology of future research. While the bulk of existing reports deal with psychiatric and pediatric populations, studies of general adult clinics report missed appointments rates of 15 to 33 per cent and often emphasize demographic features of the patient. Other factors, such as patient beliefs, sociobehavioral characteristics, aspects of the disease and its therapy, patient-provider interactions and organizational features of the providing facility are less well studied, but probably more important. Organizational features exert a strong influence and are particularly amenable to modification. Patient surveys suggest that forgetting and administrative oversights are common problems, and the success of mailed appointment reminders supports this notion. Such surveys have often suggested successful intervention strategies. Future investigations should emphasize more consistent methodology, improved analysis techniques, identification of better predictors and development of a conceptual model for this patient behavior. These efforts may suggest new intervention methods, which should be evaluated for cost effectiveness and the feasibility of individualized application.

Appointments and Schedules↗
PubMed2004

Non-resective ablation therapy for hepatocellular carcinoma: effectiveness measured by intention-to-treat and dropout from liver transplant waiting list.

BACKGROUND: Orthotopic liver transplantation (OLT) for patients with small hepatocellular carcinoma (HCC) is widely accepted, and the usefulness of local ablation techniques as a bridge for liver transplantation is still under investigation. METHODS: From December 1997 to February 2003, patients with cirrhosis and T0-T1-T2-T3 stage HCC received multi-modality ablative therapy (MMT) for the treatment of their HCC and were evaluated for OLT; listed, and transplanted when an allograft became available. MMT included radiofrequency ablation (RFA), and/or Trans-Arterial Chemo-Embolization (TACE), and alcohol (EtOH) ablation, followed by Trans-Arterial Chemo-Infusion (TACI), with repeated treatments based on follow up hepatic magnetic resonance imaging (MRI) during the waiting period for OLT. RESULTS: A total of 135 HCC patients were seen at our center within this time frame. The intention-to-treat group included 33 (24.4%) patients with T0, T1, T2, T3 HCC and cirrhosis. There were 31 men and two women. The mean age was 53.6 +/- 7.2 yr. All patients received MMT with a mean of 2.90 +/- 1.5 procedures per patient. Tumor-node-metastasis (TNM) stages at time of listing were: T0 in one patient, T1 in nine patients, T2 in 17 patients, and T3 in six patients. Twenty-eight (85%) patients have received OLT. Five (12.19%) patients were listed and removed (dropout) from the transplant waiting list after waiting 5, 5, 5, 8, and 14 months respectively. The waiting time of the HCC listed group was 9.1 +/- 14.8 months with a mean follow up of 32 months. OLT patient survival and cancer-free survival are 92.9% and 95.24%, respectively; the overall survival of intention-to-treat group was 79% at 32 months follow up. Predictors of dropout included an alpha-fetoprotein (AFP, >400 ng/mL) and T3 HCC stage. CONCLUSION: Aggressive ablation therapy with a short transplant waiting time optimizes the use of OLT for curative intent in selective cirrhotic HCC patients.

Antineoplastic Agents↗
PubMed2006

A hybrid model for nonignorable dropout in longitudinal binary responses.

This article presents a likelihood-based method for handling nonignorable dropout in longitudinal studies with binary responses. The methodology developed is appropriate when the target of inference is the marginal distribution of the response at each occasion and its dependence on covariates. A "hybrid" model is formulated, which is designed to retain advantageous features of the selection and pattern-mixture model approaches. This formulation accommodates a variety of assumed forms of nonignorable dropout, while maintaining transparency of the constraints required for identifying the overall model. Once appropriate identifying constraints have been imposed, likelihood-based estimation is conducted via the EM algorithm. The article concludes by applying the approach to data from a randomized clinical trial comparing two doses of a contraceptive.

Algorithms↗
PubMed1999

Reasons of dropout from short- and long-term self-injection therapy for impotence.

OBJECTIVE: To define the satisfaction rate and the dropout causes of intracavernous self-injection therapy in impotent patients. METHODS: A total of 250 impotent patients treated with intracavernous injection of drugs from 1991 to 1997 were mailed a questionnaire about their experience with this method. If the patient discontinued therapy, eight possible explanations for discontinuation were tested to identify reasons for terminating therapy (multiple choices were allowed). The causes of impotence were correlated with the rates of patients continuing or discontinuing therapy. RESULTS: 144 of 250 patients (57.6%) returned the questionnaire. Of the 106 non-responding patients, 50% could not be reached due to relocation. The patients were divided into three groups according to the duration of injection use. In group I, 35 of 144 patients (24%) did not continue therapy at home because either they felt it was unnatural (20%), they were dissatisfied (20%), or they experienced improvement of spontaneous erections (15%). In group II, 57 of 144 patients (40%) continued therapy at home and dropped out after a mean duration of 6.9 (range 0.5-48) months due to dissatisfaction (22%), cost reasons (20%), or insufficient erection for penetration (19.4%). In group III, 52 of 144 patients (36%) were continuing therapy with a mean follow-up period of 19.8 (range 2-72) months. The mean ages were not statistically different in the three groups. Also the aetiologies of impotence were similar: 35% psychogenic, 25% organic, and 40% mixed psychogenic/organic. Patients with psychogenic aetiology seem to continue therapy more frequently than others. CONCLUSIONS: The long-term follow-up revealed a high attrition rate of intracavernous self-injection therapy. Patient dissatisfaction, cost, and insufficient erection for penetration were the major causes of dropout.

Adult↗
PubMed1978

The group psychotherapy dropout phenomenon revisited.

In this two-year study, patients referred for group therapy were extensively screened and carefully prepared for the therapy. In spite of this effort there was a 29% dorpout rate after group therapy began. All of the therapists reported that they disliked the patients who dropped out, and many of these patients were seen as hostile toward the therapists. The author suggests that for many groups the dropout phenomenom may be basic to the establishment of group cohesiveness and that instead of trying to prevent or reduce the dropout phenomenon, efforts should be directed toward reconceptualizing the more positive aspects of it.

Adult↗
PubMed1996

Eliminating (almost) treatment dropout of substance abusing or dependent delinquents through home-based multisystemic therapy.

OBJECTIVE: This study examined the effects of an innovative treatment model that was designed to reduce treatment dropout among substance abusing or dependent juvenile offenders. METHOD: One hundred eighteen delinquents who met diagnostic criteria for substance abuse or dependence were randomly assigned to receive either home-based multisystemic therapy (N=58) or treatment that was provided by the usual community services (N=60). RESULTS: In the multisystemic therapy condition, 98% (N=57) of the families completed a full course of treatment, which lasted an average of 130 days. In contrast, 78% (N=47) of the families assigned to treatment through the usual community services received no mental health or substance abuse treatment in the 5 months after referral. CONCLUSIONS: The serious and long-standing problem of high dropout rates in the substance abuse field can be greatly attenuated by services that increase accessibility and place greater responsibility for engagement on service providers.

Adolescent↗
PubMed1980

A correlation between dropout status and improvement in a psychiatric clinic.

Sixty psychiatric outpatients were independently evaluated before treatment in a mental health center and again after they had either completed five treatment visits or dropped out. Dropouts were older, more likely to be female, more severely ill, and more likely to expect medications. They improved less on scales of drug use, denial of illness, and grandiosity. Dropouts who did improve were more likely to have situational reactions. Better-educated patients had better outcomes. Patients who were satisfied with the treatment they received were the most likely to have improved.

Adult↗
PubMed1994

Sociodemographic characteristics of dropouts from a child guidance clinic.

OBJECTIVE: This study examined the characteristics of families who dropped out and families who maintained contact with a children's psychiatric outpatient clinic through various phases of intake and treatment. METHODS: One year after intake, the authors examined the status of all patients (N = 555) who had sought treatment at an urban, university-affiliated children's psychiatric outpatient clinic over a two-year period and had completed the intake process. Factors associated with dropout were identified at four points in the clinic process: during intake, during evaluation, at completion of evaluation, and during treatment. RESULTS: Urban residence, minority status, single-parent status, and Medicaid status were related to dropout at intake and during evaluation but not at subsequent clinic phases. Nonminority, two-parent, suburban families of higher socioeconomic status were more likely to drop out at the completion of the evaluation. CONCLUSIONS: These results indicate that factors associated with attrition vary with the clinic phase. Further investigations of the clinical course of minority children and families involved with children's mental health services are necessary to understand the needs of this population and to design interventions such as increasing minority staff and providing training in multi-cultural competence.

Adolescent↗
PubMed1995

Identifying early dropouts from a rehabilitation program for psychiatric outpatients.

The attendance of 112 patients referred to an outpatient psychiatric rehabilitation program was retrospectively examined, and characteristics of dropouts were compared with those of patients who remained in treatment during the first eight weeks. Discriminant function analysis revealed that a combination of three variables correctly predicted 81 percent of the dropout group. The variables were a hostile, labile, or bizarre affect; a diagnosis of personality disorder; and impaired orientation. Patients with these characteristics require a thorough assessment of specific needs and deficits and ongoing evaluation of treatment approaches such as adaptations of psychosocial rehabilitation, dialectical behavior therapy, and assertive case management.

Adult↗
PubMedDate not supplied

A follow-along study of postsecondary outcomes for graduates and dropouts with mild disabilities in a rural setting.

Eighty-six students with mild disabilities living in a rural area who had graduated (n = 52) or dropped out of (n = 34) high school were interviewed at two points in time (7 months apart) about their employment, residential status, and participation in postsecondary education and training programs. Information was also collected on students' high school experiences (educational, vocational, and work) and the reasons they dropped out of school. Of the students who had graduated (Caucasian = 26, black = 25, and other = 1), 31 were male and 21 were female. Of the students who had dropped out (Caucasian = 18, black = 15, and other = 1), 22 were male and 12 female. It was found that the majority of graduates and dropouts were employed full-time at both interviews, and held jobs that paid above minimum wage and provided employee benefits, as well. Nevertheless, by the time of the terminal interview, graduates had worked proportionally more time since high school than dropouts and had been employed in their current job more than twice as long. Neither group of former special education students was particularly active in pursuing postsecondary education or training programs. Finally, these former students had participated in a limited range of educational and vocational experiences during high school, both in terms of diploma tracks and vocational education programs. The implications of the findings for long-term employment and community adjustment are discussed.

Adolescent↗